WorldWideScience

Sample records for inappropriate material offensive

  1. Offensive

    African Journals Online (AJOL)

    R.B. Ruthven

    The Dilemma of Treating 'Offensive' Terms in Duramazwi Guru reChiShona. 255 ... exercise to increase the sum of human knowledge but practical work to put together a .... written materials focusing on a wide range of aspects of Shona life.

  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...

  5. Environmental offenses in 1999. An evaluation of statistics

    International Nuclear Information System (INIS)

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

    2000-01-01

    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 [de

  6. Quantifying risk for decentralized offensive cyber operations

    OpenAIRE

    Klipstein, Michael S.

    2017-01-01

    Approved for public release; distribution is unlimited Includes supplementary material. Reissued 7 Sep 2017 with corrections to committee titles. Computer networks and the amount of information stored within government computer networks have become ubiquitous. With the possible decentralization of authorities to conduct offensive cyber operations, leaders and their respective staffs of organizations below the national level cannot adequately assess risks and consequences of these ope...

  7. 32 CFR 635.19 - Offense codes.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Offense codes. 635.19 Section 635.19 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS LAW ENFORCEMENT REPORTING Offense Reporting § 635.19 Offense codes. (a) The offense code describes, as nearly as possible, the...

  8. 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.

  9. Inappropriate Antidiuretic Hormone Secretion

    African Journals Online (AJOL)

    1974-06-08

    Jun 8, 1974 ... with Addison's disease, diarrhoea or salt-losing nephritis. (asymptomatic hyponatraemia).~ Schwartz et al.3 stud;ed two patients with anaplastic bronchus carcinoma and hyponatraemia in 1957, and they suggested that there was an inappropriate secretion of antidiuretic hormone (ADH). It is now well ...

  10. The New Option Offense for Winning Basketball.

    Science.gov (United States)

    Walker, A. L.; Donohue, Jack

    This reference book for basketball coaches provides a total program of both offensive and defensive strategies and tactics. The emphasis is upon an innovative offensive system with an accompanying defensive plan. The initial chapters deal with the installation of the three series of the New Option Offensive: "Red,""White," and "Blue." A drills…

  11. Development of offensive individual game skills and offensive game combinations in ice hockey

    OpenAIRE

    Janek, Michael

    2015-01-01

    Title: Development of offensive individual game skills and offensive game combinations in ice hockey Goals: The main aim of this thesis is to gather theoretical information about development and improvement of offensive individual game skills and offensive game combinations in ice hockey and suggest essential and key exercises of this issue. Methods: The thesis was primarily written with the use of searching method based on information from available expert literature, electronic sources and ...

  12. 28 CFR 20.32 - Includable offenses.

    Science.gov (United States)

    2010-07-01

    ... Exchange of Criminal History Record Information § 20.32 Includable offenses. (a) Criminal history record... vehicular manslaughter, driving under the influence of drugs or liquor, and hit and run), when unaccompanied by a § 20.32(a) offense. These exclusions may not be applicable to criminal history records...

  13. 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

  14. 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...

  15. German Submarine Offensives and South African Countermeasures

    African Journals Online (AJOL)

    Evert

    World War, with a number of opportunistic attacks also made by submarines travelling to the Far ..... This time round, however, the strategic importance of the Indian Ocean ... offensive operations in the Indian Ocean between the Gulf of Aden and the ... American seaboards, which ensured that an attack around the coast off ...

  16. 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...

  17. 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.)

  18. Automating cyber offensive operations for cyber challenges

    CSIR Research Space (South Africa)

    Burke, I

    2016-03-01

    Full Text Available with regards to attack automation. 2. Background on cyber games CTF exercises are offensive and defensive cyber training exercises whereby teams compete against one another to obtain flags or tokens hidden on various servers. In some cases these flags... are located on an opponent’s servers, which results in teams being required to attack adversary servers while maintaining defences on their own services (The National Cyber League 2013). These challenges are often time based and victors are determined based...

  19. 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.

  20. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

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

    2007-01-01

    to the patients. Topical, dermatological medications and medications not used regularly were excluded. RESULTS: 212 patients were prescribed 1621 medications by their GPs at baseline. In all, 640 (39.5%) of the medications had one or more inappropriate ratings in the 10 criteria making up the MAI. The main part...... is good. However, the majority of patients used one or more medications with inappropriate ratings. The inappropriate prescribing relates to specific therapeutic groups and criteria, which should be targeted in future interventions....

  1. 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...... xyphoid to V6) reduced the risk. Reprogramming or optimization of SVT treatment after the first clinical event of inappropriate shock was successful in preventing further inappropriate shocks for cardiac oversensing and SVT events. CONCLUSIONS: Inappropriate shocks, mainly due to cardiac oversensing...

  2. [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.

  3. 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.

  4. Development and Validation of the Basketball Offensive Game Performance Instrument

    Science.gov (United States)

    Chen, Weiyun; Hendricks, Kristin; Zhu, Weimo

    2013-01-01

    The purpose of this study was to design and validate the Basketball Offensive Game Performance Instrument (BOGPI) that assesses an individual player's offensive game performance competency in basketball. Twelve physical education teacher education (PETE) students playing two 10-minute, 3 vs. 3 basketball games were videotaped at end of a…

  5. Are Explicit Apologies Proportional to the Offenses They Address?

    Science.gov (United States)

    Heritage, John; Raymond, Chase Wesley

    2016-01-01

    We consider here Goffman's proposal of proportionality between virtual offenses and remedial actions, based on the examination of 102 cases of explicit apologies. To this end, we offer a typology of the primary apology formats within the dataset, together with a broad categorization of the types of virtual offenses to which these apologies are…

  6. Offense History and the Effectiveness of Juvenile Diversion Programs.

    Science.gov (United States)

    Osgood, D. Wayne; And Others

    Some evaluations have concluded that diversion programs for juvenile offenders (programs intended as community-based alternatives to formal justice dispositions) reduce recidivism only among youths with the least serious offense histories. To investigate the relationship of offense history to program effectiveness, three diversion programs were…

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Inherently Offensive: Airpower and the Dialectic with Defense

    Science.gov (United States)

    2017-06-01

    detailed definition up front. Ted Hopf, writing in The American Political Science Review, argues, “the offense-defense balance consists of three elements...technology contributed to air power’s ability to maintain overwhelming offensive 12 Hopf, Ted . "Polarity...fighters and surface-to-air missile systems. John Patterson explains why this is true, “most fighter aircraft operate in the X - and Ku-bands because

  12. 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.

  13. 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, ...

  14. Children's Context Inappropriate Anger and Salivary Cortisol

    Science.gov (United States)

    Locke, Robin L.; Davidson, Richard J.; Kalin, Ned H.; Goldsmith, H. Hill

    2009-01-01

    Some children show emotion that is not consistent with normative appraisal of the context and can therefore be defined as context inappropriate (CI). The authors used individual growth curve modeling and hierarchical multiple regression analyses to examine whether CI anger predicts differences in hypothalamic-pituitary-adrenal axis activity, as…

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

    African Journals Online (AJOL)

    Objectives: To quantify missed opportunities for immunisation, document reasons for their occurrence and evaluate the extent of inappropriately given vaccine doses. Design: A cross sectional study of children under two years of age attending health facilities. Setting: Six health facilities predominantly serving the slums of ...

  16. Functional Analysis and Reduction of Inappropriate Spitting

    Science.gov (United States)

    Carter, Stacy L.; Wheeler, John J.

    2007-01-01

    Functional analysis was used to determine the possible function of inappropriate spitting behavior of an adult woman who had been diagnosed with profound mental retardation. Results of an initial descriptive assessment indicated a possible attention function and led to an attention-based intervention, which was deemed ineffective at reducing the…

  17. Prediction of recidivism in exhibitionists: psychological, phallometric, and offense factors.

    Science.gov (United States)

    Greenberg, Sharon R Rabinowitz; Firestone, Philip; Bradford, John M; Greenberg, David M

    2002-10-01

    Exhibitionists have traditionally been regarded as nuisance offenders. However, empirical studies show that some offenders can be highly recidivistic and can escalate to incidents of Hands-on sexual assault. The objective of this study was to investigate predictors of recidivism in exhibitionists and clarify the differences between Hands-on and Hands-off sexual recidivists. The hundred and twenty-one exhibitionists were assessed at a university teaching hospital between 1983 and 1996. Archival data came from medical files and police files. The Psychopathy Checklist-Revised (PCL-R) was assessed retrospectively. Results indicated that over a mean follow-up period of 6.84 years, 11.7, 16.8, and 32.7% of exhibitionists were charged with or convicted of sexual, violent, or criminal offenses, respectively. Sexual reoffending recidivists were less educated, and had more prior sexual and criminal offenses. Violent, recidivists were also less educated, had lower Derogatis Sexual Functioning Inventory (DSFI) scores, higher PCL-R Totals, and more prior sexual, violent, and criminal offenses. Criminal recidivists were younger, less educated, had lower DSFI scores, higher PCL-R scores, higher Pedophile Indices, and more prior sexual, violent, and criminal offenses. Hands-on sexual recidivists demonstrated higher PCL-R ratings, higher Pedophile and Rape indices, and more prior sexual, violent, and criminal offenses than did Hands-off counterparts.

  18. 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.

  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. Offense-Defense Theory Analysis of Russian Cyber Capability

    Science.gov (United States)

    2015-03-01

    Internet and communications technologies IR international relations ISP Internet service provider RBN Russian Business Network Roskomnadzor Federal...Service for Supervision of Communications , Information Technology and Mass Media SCO Shanghai Cooperation Organization SORM System for Operative...complexity of contributing factors, it may be more meaningful to calculate dyadic , rather than systemic offense-defense balance, and it is valuable to

  2. 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.

  3. 49 CFR 1572.103 - Disqualifying criminal offenses.

    Science.gov (United States)

    2010-10-01

    ... disqualifying offense if convicted, or found not guilty by reason of insanity, in a civilian or military... security incident resulting in a significant loss of life, environmental damage, transportation system... disruption” does not include a work stoppage or other employee-related action not related to terrorism and...

  4. Potentially inappropriate prescribing in older patients admitted to psychiatric hospital

    NARCIS (Netherlands)

    Rongen, S.; Kramers, C.; O'Mahony, D.; Feuth, T.; Olde Rikkert, M.G.M.; Ahmed, A.I.A.

    2016-01-01

    OBJECTIVES: The objectives of this study are to determine the prevalence of potentially inappropriate prescribing including potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) and to assess related risk factors in older people with major psychiatric illness.

  5. 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.

  6. Evaluation method of offensive odor. Shuki no hyoka hoho

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, Y [The Tokyo Metropolitan Research Institute for Environmental Protection, Tokyo (Japan)

    1991-06-01

    As the evaluation method of offensive odor, two kinds of methods were outlined, a concentration measurement method for compounds emitting offensive odors and a sensory method by human olfactory organ. On the former, the method for measuring separately odors of twelve compounds controlled by the regulation act such as ammonia and hydrogen sulfide was outlined as well as the method for measuring odors of compound groups such as total reduced sulfur and total hydrocarbon. On the later, the evaluation scale of essential properties of odor such as quality, intensity, acceptability and pervasiveness was discussed. As typical sensory techniques, a scentometer, syringe method, odorless chamber method and olfactometer were outlined, and a triangle odor bag method widely used for the evaluation at present was described in detail which was developed to reduce demerits of a syringe method such as adsorption of odorants on a syringe surface. 24 refs., 6 figs., 3 tabs.

  7. 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.

  8. 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.

  9. Lvov and Sandomir Offensive Operation: the Look 70 Years

    Directory of Open Access Journals (Sweden)

    Valery Borisovich Makovskiy

    2015-01-01

    Full Text Available Successful advances of Soviet troops in Belarus created in the middle of July 1944 favorable conditions for large-scale operations on the southern flank of the Soviet-German front to complete the liberation of Ukraine and Moldova, driving Romania, Hungary, Bulgaria out of war, and driving the enemy from Czechoslovakia. During the Soviet offensive in Belorussia 1st Ukrainian Front began operation in the Lvov direction. The operation, which was later called the Lvov-Sandomierz, turned into a major offensive of more than 400 km and lasted from July 13 to August 29, 1944. The Soviet Supreme Command was seeking to crush Army Group "Northern Ukraine", liberate Western Ukraine and take the war to the south east Poland. Operations were carried out by 1st Ukrainian Front in close cooperation with the Soviet troops operating in the Belarusian direction. It was closely linked to the southern wing of the Soviet-German front, a series of successive and simultaneous front offensive operations, including operations by groups of fronts, united by a common concept and plan, such as Lvov-Sandomierz, Iasi-Kishenёvskaya, East Carpathian.

  10. 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.

  11. 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

  12. 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.

  13. 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.

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

    OpenAIRE

    Naid Kadušić; Alem Kukić; Zrna Agačević

    2010-01-01

    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 ga...

  15. Administrative Offenses in the Field of Traffic and Responsibility for Them

    Directory of Open Access Journals (Sweden)

    Svetlana V. Polyakova

    2017-12-01

    Full Text Available The Author analyzes the signs of an administrative offense in the field of traffic, considers its composition, paying special attention to the public danger as an obligatory general sign of such offenses. Offers a definition of the public danger of an administrative offense. Also in the article the problems based on high latency of administrative offenses in the field of traffic are considered. The Author reveals the connection between frequent changes to regulatory legal acts and the low efficiency of jurisdictional bodies in the prevention of violations of the Rules of Road Traffic.

  16. Setting Limits: The Child Who Uses Inappropriate Language

    Science.gov (United States)

    Greenberg, Polly

    2004-01-01

    This article discusses how to work with a child who uses inappropriate language. The words inappropriately used by young children are grouped into five categories: (1) names of body parts considered as private, and their nicknames; (2) bathroom words and body products; (3) religion-related words; (4) sexually charged words overheard when adults…

  17. 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 symptoms than group offenders (F = 5.127, p symptoms are higher in juvenile suspects of 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.

  18. 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.

  19. I'm Sorry "About That": Apologies, Indexicals, and (Unnamed) Offenses

    Science.gov (United States)

    Margutti, Piera; Traverso, Véronique; Pugliese, Rosa

    2016-01-01

    We investigate an apology format, "I'm sorry about it/that," where indexical terms (pronouns) refer to the offense rather than naming it. We identified two subsets in our collection of indexical apologies. In one, indexicals are subsequent either to the offense formulation or to an apology-relevant event; in the second, indexicals are…

  20. 25 CFR 11.907 - Transfer to Court of Indian Offenses.

    Science.gov (United States)

    2010-04-01

    ....907 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Children's Court § 11.907 Transfer to Court of Indian Offenses. (a) The presenting officer or the minor may file a petition requesting the children's court to transfer the minor to...

  1. Elements of anti-Islam populism : Critiquing Geert Wilders' politics of offense with Marcuse and Adorno

    NARCIS (Netherlands)

    Bot, Michiel

    2017-01-01

    The political performances of Dutch anti-Islam populist Geert Wilders revolve around a combination of giving and taking offense. In this article, I develop a critique of Wilders’ politics of offense by revisiting two classic texts of Frankfurt School critical theory that combine social theory with

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

    National Research Council Canada - National Science Library

    Turner, Charles

    2003-01-01

    ...: North Vietnamese and Viet Cong deceptive actions, American inability to analyze those actions, measures the United States had in place to detect and to counter North Vietnamese preparations for the offensive, and the incomplete organization of the American intelligence organization in theater. The Tet Offensive serves as a cautionary parable for modem-day and future military leadership.

  3. 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…

  4. Inappropriate use of payment weights to risk adjust readmission rates.

    Science.gov (United States)

    Fuller, Richard L; Goldfield, Norbert I; Averill, Richard F; Hughes, John S

    2012-01-01

    In this article, the authors demonstrate that the use of relative weights, as incorporated within the National Quality Forum-endorsed PacifiCare readmission measure, is inappropriate for risk adjusting rates of hospital readmission.

  5. [The forensic medical aspects of the inappropriate medical care in the modern-day Ukraine].

    Science.gov (United States)

    Franchuk, V V

    2018-01-01

    Despite the fact that the ever growing relevance of the problem of the inappropriate medical care was long ago brought to the worldwide attention, it has not been practically addressed in the Ukraine since the country gained independence in 1991. The objective of the present study was to consider the specific features of expert examination of the cases of inappropriate medical care as exemplified by the materials of the legal actions and lawsuits instituted against healthcare specialists violating their occupational duties. The results of forensic medical examination by the local Bureaux of forensic medical expertise concerning the 350 so-called malpractice suits instituted in the Ternopol, Zhitomir, and Chernovtsy regions during the period from 207 to 2016 were available for the analysis. The facts of inadequate and inappropriate medical care were documented in 245 (72.0%) cases. The frequency of diagnostic and therapeutic errors amounted to 29.7% and 26.9% respectively while the improper formulation of the medical documentation was recorded in 21.3% of the cases. The cases of poor organization of the diagnostic and treatment process accounted for 14.6% of the total whereas the improper behaviour of the medical personnel was reported in 7.5% of all the known cases of provision of the healthcare services. It is concluded that in the majority of the cases, the citizens of the modern-day Ukraine receive the inappropriate (insufficient and untimely) medical care. Over 80% of the cases of the inappropriate medical care currently provided in the country can be accounted for by the objective reasons, with each fifths case being due to the violation of professional responsibilities by the healthcare providers.

  6. 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

  7. 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

  8. 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)

  9. 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)

  10. 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)

  11. Alcohol-related predictors of adolescent driving: gender differences in crashes and offenses.

    Science.gov (United States)

    Shope, J T; Waller, P F; Lang, S W

    1996-11-01

    Demographic and alcohol-related data collected from eight-grade students (age 13 years) were used in logistic regression to predict subsequent first-year driving crashes and offenses (age 17 years). For young men's crashes and offenses, good-fitting models used living situation (both parents or not), parents' attitude about teen drinking (negative or neutral), and the interaction term. Young men who lived with both parents and reported negative parental attitudes regarding teen drinking were less likely to have crashes and offenses. For young women's crashes, a good-fitting model included friends' involvement with alcohol. Young women who reported that their friends were not involved with alcohol were least likely to have crashes. No model predicting young women's offenses emerged.

  12. 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.

  13. Offense-defense aspects of nanotechnologies: a forecast of potential military applications.

    Science.gov (United States)

    Shipbaugh, Calvin

    2006-01-01

    Potential military applications of nanotechnology will evolve in the next few decades. The implications for both defense and offense should be carefully assessed. Nanotechnology can push major changes in stability, and shape the consequences of future conflict.

  14. 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).

  15. Why women apologize more than men: gender differences in thresholds for perceiving offensive behavior.

    Science.gov (United States)

    Schumann, Karina; Ross, Michael

    2010-11-01

    Despite wide acceptance of the stereotype that women apologize more readily than men, there is little systematic evidence to support this stereotype or its supposed bases (e.g., men's fragile egos). We designed two studies to examine whether gender differences in apology behavior exist and, if so, why. In Study 1, participants reported in daily diaries all offenses they committed or experienced and whether an apology had been offered. Women reported offering more apologies than men, but they also reported committing more offenses. There was no gender difference in the proportion of offenses that prompted apologies. This finding suggests that men apologize less frequently than women because they have a higher threshold for what constitutes offensive behavior. In Study 2, we tested this threshold hypothesis by asking participants to evaluate both imaginary and recalled offenses. As predicted, men rated the offenses as less severe than women did. These different ratings of severity predicted both judgments of whether an apology was deserved and actual apology behavior.

  16. Inappropriate shocks in the subcutaneous ICD: Incidence, predictors and management

    NARCIS (Netherlands)

    Olde Nordkamp, Louise R. A.; Brouwer, Tom F.; Barr, Craig; Theuns, Dominic A. M. J.; Boersma, Lucas V. A.; Johansen, Jens B.; Neuzil, Petr; Wilde, Arthur A. M.; Carter, Nathan; Husby, Michael; Lambiase, Pier D.; Knops, Reinoud E.

    2015-01-01

    The entirely subcutaneous implantable cardioverter-defibrillator (S-ICD) eliminates the need for transvenous leads, and therefore has the potential to improve lead-longevity and reduce lead-related complications. The S-ICD has a morphology-based sensing algorithm of which inappropriate shocks have

  17. Polypharmacy and Potentially Inappropriate Medication in People with Dementia

    DEFF Research Database (Denmark)

    Kristensen, Rachel Underlien; Nørgaard, Ane; Jensen-Dahm, Christina

    2018-01-01

    BACKGROUND: Polypharmacy (use of ≥5 different medications) and potentially inappropriate medication (PIM) are well-known risk factors for numerous negative health outcomes. However, the use of polypharmacy and PIM in people with dementia is not well-described. OBJECTIVE: To examine the prevalence...

  18. [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.

  19. 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…

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

    African Journals Online (AJOL)

    By comparing the patients according to their site of care, 52.4 % (43/82) of ICU patients compared to 87.4 % (97/111) of medically hospitalized patient (non-ICU) were inappropriately receiving PPIs (p = 0.000). Conclusion: Adherence to the current practice guidelines for safe prescription of PPIs is poor. Thus, updating ...

  1. Assessing the feasibility and fidelity of an intervention for women with violent offenses.

    Science.gov (United States)

    Kubiak, Sheryl Pimlott; Fedock, Gina; Tillander, Elizabeth; Kim, Woo Jong; Bybee, Deborah

    2014-02-01

    Women convicted of assaultive or violent offenses represent a small but important subpopulation of adults involved in the criminal justice system. The limited treatment and rehabilitation programs that are available for these women are usually developed for male offenders and do not consider factors that are especially relevant to women, such as higher rates of mental health and substance use disorders as well as their likely histories of interpersonal violence. Moreover, women's trajectories into violent behavior - as well as their trajectories out - may differ from their male counterparts. Due to the absence of programs available for this unique population, a new gender-specific and trauma informed intervention, Beyond Violence, was developed. This paper describes a pilot study with a mixed-methods approach that assesses the feasibility and fidelity of the intervention within a state prison for women. Overall, various components of feasibility (i.e. engaging the target population, gaining institutional support, and finding skilled treatment staff), were realized, as were fidelity elements such as adherence to the intervention material, and high attendance and satisfaction by participants. The positive results of this pilot study increase the likelihood of dissemination of the intervention and a randomized control trial is currently underway. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Risk factors for inappropriate blood requisition among hospitals in Tanzania.

    Science.gov (United States)

    Mauka, Wilhellmuss I; Mtuy, Tara B; Mahande, Michael J; Msuya, Sia E; Mboya, Innocent B; Juma, Abdul; Philemon, Rune N

    2018-01-01

    Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply.

  3. Analisis Teori Offense-Defense Pada Reformasi Kebijakan Pertahanan Jepang Dalam Dinamika Keamanan Di Asia Timur

    Directory of Open Access Journals (Sweden)

    Fadhil Alghifari

    2016-05-01

    Full Text Available This paper will seek to demonstrate how the use of Offense-Defense Theory can best explain the Japan’s new defense reform legislation that enables the country to play a more comprehensive global security role commensurate with its capabilities, resources, national interests, and international responsibilities. Through this offense-defense lens, it will be argued that Japan’s new defense reform legislation is a response to the growing dominance of ‘offensive’ behaviour by the neighbouring countries in East Asia. This paper will then elaborate more about the elements that are used in the offense-defense theory to analyze the ‘offense’ dominance that prompts East Asian states behave aggressively and defensively including Japan. Furthermore, this paper will explain why Japan is currently playing the ‘defensive’ role to counter the growing dominance of ‘offense’ in East Asia through the four variables of offense-defense balance; military doctrine and technology, geographical considerations, social and political order, and diplomatic arrangements. Thus, we will see that Japan holds the key to the offense-defense and security balance in the increasingly hostile environment in East Asia.

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

    Science.gov (United States)

    Marmarinos, Christos; Kostopoulos, Nikolaos; Apostolidis, Alexandros

    2016-01-01

    Abstract 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. PMID:28149375

  5. 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.

  6. DIFFERENCES OF THE ROLE AMBIGUITY IN OFFENSE RESPONSIBILITIES OF TEAM SPORTS

    Directory of Open Access Journals (Sweden)

    Karamousalidis, G.

    2009-10-01

    Full Text Available The purpose of this research was to investigate the differences of the role ambiguity in offense responsibilitiesfor athletes of team sports. As sample were used 421 athletes of basketball (n=125, handball (n=106, volleyball(n=78 and soccer (n=112. We used the role ambiguity questionnaire (Role Ambiguity Scale, Beauchamp et al.,2002 and referred to the athletes’ responsibilities in offense.The correlations of items were high and ranged from .57 to .75, p <.01 whereas from the one way analysis (oneway, Anova appeared some statistically serious differences in one factor of role ambiguity (ambiguity inrelation to the scope of responsibilities in offense, F (3,415 = 4,416, p <.005. The volleyball and the handballathletes had more well defined roles regardless the scope of their responsibilities in offense, in relation to thoseof soccer. On the whole we come to the conclusion that among team sports there are not any differences in roleambiguity in offense responsibilities, except in one factor. More researches are necessary in connection to othervariables.

  7. 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.

  8. Inappropriate secretion of antidiuretic hormone treated with frusemide.

    Science.gov (United States)

    Decaux, G; Waterlot, Y; Genette, F; Hallemans, R; Demanet, J C

    1982-07-10

    Seven out of nine patients with chronic inappropriate secretion of antidiuretic hormone were successfully treated with 40 mg frusemide daily. One patient needed 80 mg, and the remaining patient achieved only a small increase in diuresis after 40 mg frusemide; this was probably related to his low creatinine clearance. In order to maintain a salt intake high enough to compensate for the loss of urine electrolytes 3 to 6 g sodium chloride was added as tablets to the sodium-free diet in six patients. Hypokalaemia occurred in five patients but was easily corrected with either supplements of potassium chloride or a potassium-sparing diuretic. These findings add further weight to evidence that Frusemide is a good alternative for the treatment of patients with inappropriate secretion of antidiuretic hormone who cannot tolerate water restriction.

  9. 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.

  10. 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.

  11. Clinical hyperthyroidism due to non-neoplastic inappropriate thyrotrophin secretion.

    OpenAIRE

    Chan, A. W.; MacFarlane, I. A.; van Heyningen, C.; Foy, P. M.

    1990-01-01

    We report a case of hyperthyroidism due to inappropriate thyrotrophin (TSH) secretion in a patient with selective pituitary resistance to thyroid hormone action. Symptoms of hyperthyroidism in patients with this disorder are usually mild, implying some peripheral tissue resistance to the metabolic effects of thyroid hormone. Our patient had unusually severe symptoms, including marked weight loss and cardiac arrythmias which required carbimazole and beta-blocker therapy for control. Somatostat...

  12. Detecting Inappropriate Access to Electronic Health Records Using Collaborative Filtering.

    Science.gov (United States)

    Menon, Aditya Krishna; Jiang, Xiaoqian; Kim, Jihoon; Vaidya, Jaideep; Ohno-Machado, Lucila

    2014-04-01

    Many healthcare facilities enforce security on their electronic health records (EHRs) through a corrective mechanism: some staff nominally have almost unrestricted access to the records, but there is a strict ex post facto audit process for inappropriate accesses, i.e., accesses that violate the facility's security and privacy policies. This process is inefficient, as each suspicious access has to be reviewed by a security expert, and is purely retrospective, as it occurs after damage may have been incurred. This motivates automated approaches based on machine learning using historical data. Previous attempts at such a system have successfully applied supervised learning models to this end, such as SVMs and logistic regression. While providing benefits over manual auditing, these approaches ignore the identity of the users and patients involved in a record access. Therefore, they cannot exploit the fact that a patient whose record was previously involved in a violation has an increased risk of being involved in a future violation. Motivated by this, in this paper, we propose a collaborative filtering inspired approach to predicting inappropriate accesses. Our solution integrates both explicit and latent features for staff and patients, the latter acting as a personalized "finger-print" based on historical access patterns. The proposed method, when applied to real EHR access data from two tertiary hospitals and a file-access dataset from Amazon, shows not only significantly improved performance compared to existing methods, but also provides insights as to what indicates an inappropriate access.

  13. 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.

  14. Modeling the Offensive-Defensive Interaction and Resulting Outcomes in Basketball.

    Directory of Open Access Journals (Sweden)

    Leonardo Lamas

    Full Text Available We analyzed the interaction between offensive (i.e. space creation dynamics--SCDs and defensive (i.e. space protection dynamics--SPDs actions in six play outcomes (free shot, contested shot, new SCD, reset, foul, and turnover in Spanish professional basketball games.Data consisted of 1548 SCD-SPD-outcome triples obtained from six play-off games. We used Bayesian methods to compute marginal probabilities of six outcomes following five different SCDs. We also computed probabilities of the six outcomes following the 16 most frequent SCD-SPD combinations.The pick action (e.g. pick and roll, pop and pop was the most prevalent SCD (33%. However, this SCD did not produce the highest probability of a free shot (0.235. The highest probability of a free shot followed the SCD without ball (0.409. The pick was performed not only to attempt scoring but also to initiate offenses, as it produced the highest probability leading to a new SCD (0.403. Additionally, the SPD performed influenced the outcome of the SCD. This reinforces the notion that the opposition (offensive-defensive interaction should be considered. To the best of our knowledge, in team sports, this is the first study to successfully model the tactical features involved in offense-defense interactions. Our analyses revealed that the high frequency of occurrence of some SCDs may be justified not only by an associated high probability of free shots but also by the possibility of progressively create more space in the defense (i.e. a new SCD as outcome. In the second case, it evidences offensive strategic features of progressive disruption of the defensive system through the concatenation of subsequent offensive actions.

  15. Modeling the Offensive-Defensive Interaction and Resulting Outcomes in Basketball.

    Science.gov (United States)

    Lamas, Leonardo; Santana, Felipe; Heiner, Matthew; Ugrinowitsch, Carlos; Fellingham, Gilbert

    2015-01-01

    We analyzed the interaction between offensive (i.e. space creation dynamics--SCDs) and defensive (i.e. space protection dynamics--SPDs) actions in six play outcomes (free shot, contested shot, new SCD, reset, foul, and turnover) in Spanish professional basketball games. Data consisted of 1548 SCD-SPD-outcome triples obtained from six play-off games. We used Bayesian methods to compute marginal probabilities of six outcomes following five different SCDs. We also computed probabilities of the six outcomes following the 16 most frequent SCD-SPD combinations. The pick action (e.g. pick and roll, pop and pop) was the most prevalent SCD (33%). However, this SCD did not produce the highest probability of a free shot (0.235). The highest probability of a free shot followed the SCD without ball (0.409). The pick was performed not only to attempt scoring but also to initiate offenses, as it produced the highest probability leading to a new SCD (0.403). Additionally, the SPD performed influenced the outcome of the SCD. This reinforces the notion that the opposition (offensive-defensive interaction) should be considered. To the best of our knowledge, in team sports, this is the first study to successfully model the tactical features involved in offense-defense interactions. Our analyses revealed that the high frequency of occurrence of some SCDs may be justified not only by an associated high probability of free shots but also by the possibility of progressively create more space in the defense (i.e. a new SCD as outcome). In the second case, it evidences offensive strategic features of progressive disruption of the defensive system through the concatenation of subsequent offensive actions.

  16. Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study

    NARCIS (Netherlands)

    Bruin-Huisman, Linette; Abu-Hanna, Ameen; van Weert, Henk C. P. M.; Beers, Erna

    2017-01-01

    potentially inappropriate prescribing (PIP) is associated with adverse health effects in older patients. PIP comprises prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). to estimate the prevalence of PIMs and PPOs among older patients in primary

  17. 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...... natriuretic peptides, renin, and aldosterone were measured in the supine and upright positions of patients and compared with nine healthy age-matched control patients. RESULTS: The patients had low plasma osmolality (median 266 mOsm/kg) and measurable levels of arginine vasopressin (median 1.8 pg/mL). Values...

  18. Tariffs, Quotas, and the Corrupt Purchasing of Inappropriate Technology

    OpenAIRE

    Neil Campbell

    2005-01-01

    This paper develops a simple model where a manager of a firm in a Less-Developed Country (LDC) has the choice of whether or not to purchase an inappropriate technology in return for a bribe (kick-back) from the supplier of the technology. Provided that the manager achieves some minimum level of profit, the manager has a positive probability of not getting caught taking the bribe. The actual size of the bribe is determined by Nash axiomatic bargaining between the manager and the supplier. An i...

  19. 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

  20. Inappropriate mode switching clarified by using a chest radiograph

    Directory of Open Access Journals (Sweden)

    Brian Marino, DO

    2015-08-01

    Full Text Available An 80-year-old woman with a history of paroxysmal atrial fibrillation and atrioventricular node disease status post-dual chamber pacemaker placement was noted to have abnormal pacing episodes during a percutaneous coronary intervention. Pacemaker interrogation revealed a high number of short duration mode switching episodes. Representative electrograms demonstrated high frequency nonphysiologic recordings predominantly in the atrial lead. Intrinsic pacemaker malfunction was excluded. A chest radiograph showed excess atrial and ventricular lead slack in the right ventricular inflow. It was suspected that lead–lead interaction resulted in artifacts and oversensing, causing frequent short episodes of inappropriate mode switching.

  1. 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

  2. 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

  3. "I'm Sorry + Naming the Offense": A Format for Apologizing

    Science.gov (United States)

    Cirillo, Letizia; Colón de Carvajal, Isabel; Ticca, Anna Claudia

    2016-01-01

    The present article focuses on "I'm sorry + naming the offense"-formatted apologies occurring in phone calls in English. Apologies of this kind "emerge" and are oriented to as relevant actions when addressing an apologizable that is not the main business in ongoing talk. The sequential analysis of apologies and responses to…

  4. 44 CFR 17.635 - Reporting of and employee sanctions for convictions of criminal drug offenses.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reporting of and employee sanctions for convictions of criminal drug offenses. 17.635 Section 17.635 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL GOVERNMENTWIDE...

  5. 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

  6. The condition of counteraction to administrative corruption offenses in state authorities and local government

    Directory of Open Access Journals (Sweden)

    О. В. Клок

    2014-12-01

    Full Text Available Article discusses questions dedicated to the analysis of the condition of counteraction to administrative corruption offenses in Ukraine. The statistical information on the dynamics, structure, specific gravity, cost and latency of the administrative corruption is researched. The most effective measures against corrupt practices at the state and municipal service are drawn.

  7. 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.

  8. sanative measures against offensive odour that affect indigenous

    African Journals Online (AJOL)

    User

    ing of leather in a soapy water made with perfume toilet-soap after which drying is done under room temperature. .... are substances such as OdorXit, Baking soda, and Vinegar. Despite ... scented used for washing oneself. MATERIALS AND ...

  9. 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

  10. [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.

  11. 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 ...

  12. 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

  13. Differences among incarcerated women with assaultive offenses: isolated versus patterned use of violence.

    Science.gov (United States)

    Kubiak, Sheryl Pimlott; Kim, Woo Jong; Fedock, Gina; Bybee, Deborah

    2013-08-01

    A majority of the existing research on women's use of violence focuses on intimate partner violence, often excluding other types of violence for which women may be incarcerated. The current study expands this area of research by assessing between and within-group differences among a randomly selected group of incarcerated women (n = 543). Comparisons between violent and nonviolent offense types among women found few differences, but significant differences among women with an assaultive offense, based on the presence or absence of a self-reported uncaught violence, were found. Differences in women with isolated (i.e., single incident of violence perpetration through a review of formal and self-report data) and patterned uses of violence were present in relation to issues of mental health, substance abuse, criminogenic risk, and expressions of anger and personality factors. These findings have important implications for intervention as well as future research.

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. 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

    : English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-December 2016) covering community and nursing home residents aged ≥60years admitted to hospital. OUTCOMES: measurements of inappropriateness. A 17-item quality score was estimated...... estimation of clinical inappropriateness. CONCLUSIONS: Clinical inappropriateness and system factors that preclude alternative community care must be measured separately. They are two very different justifications for hospital admissions, requiring different solutions. Society has a duty to ensure...

  19. 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.

  20. The Prevalence of Inappropriate Image Duplication in Biomedical Research Publications

    Science.gov (United States)

    Casadevall, Arturo; Fang, Ferric C.

    2016-01-01

    ABSTRACT Inaccurate data in scientific papers can result from honest error or intentional falsification. This study attempted to determine the percentage of published papers that contain inappropriate image duplication, a specific type of inaccurate data. The images from a total of 20,621 papers published in 40 scientific journals from 1995 to 2014 were visually screened. Overall, 3.8% of published papers contained problematic figures, with at least half exhibiting features suggestive of deliberate manipulation. The prevalence of papers with problematic images has risen markedly during the past decade. Additional papers written by authors of papers with problematic images had an increased likelihood of containing problematic images as well. As this analysis focused only on one type of data, it is likely that the actual prevalence of inaccurate data in the published literature is higher. The marked variation in the frequency of problematic images among journals suggests that journal practices, such as prepublication image screening, influence the quality of the scientific literature. PMID:27273827

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar.

    Science.gov (United States)

    Alhmoud, Eman; Khalifa, Sabah; Bahi, Asma Abdulaziz

    2015-10-01

    Older patients receiving home health care are particularly at risk of receiving potentially inappropriate medications compared to community-dwelling population. Data on appropriateness of prescribing in these patients is limited. To investigate the prevalence, patterns and determinants of potentially inappropriate medications among elderly patients receiving Home Health Care Services in Qatar. Home Health Care Services department in Hamad Medical Corporation-Qatar. A cross-sectional study, conducted over a 3 months period. Patients 65 years and older, taking at least one medication and receiving home care services were included. Potentially inappropriate medications were identified and classified in accordance with the American Geriatrics Society 2012 Beers Criteria. Prevalence of potentially inappropriate medications using updated Beers criteria. A total of 191 patients (38.2%) had at least one potentially inappropriate medication. As per Beers criteria, 35% of medications were classified as medications to be avoided in older adults regardless of conditions and 9% as potentially inappropriate medications when used with certain diseases or syndromes. The majority of potentially inappropriate medications (56%) were classified as medications to be used with caution. The two leading classes of potentially inappropriate medications were antipsychotics (27.4%) and selective serotonin reuptake inhibitors (16%). Significant predictors of inappropriate prescribing were hypertension [adjusted OR 1.7; 95% CI (1.0, 2.8)], dementia [adjusted OR 2.0; 95% CI (1.2, 3.1)], depression [adjusted OR 21.6; 95% CI (2.8, 168.4)], and taking more than ten prescribed medications [adjusted OR 1.9; 95% CI (1.3, 2.8)]. Prescribing potentially inappropriate medications is common among older adults receiving home health care services in Qatar, a finding that warrants further attention. Polypharmacy, hypertension, depression and dementia were significantly associated with potentially

  6. 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.

  7. 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.

  8. 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

  9. 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…

  10. 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.

  11. The Legal Definition of Dangerous Driving in the Context of the Legislation on Administrative Offenses

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    Vladimir I. Maiorov

    2018-01-01

    Full Text Available This article analyzes the introduction of the concept of «dangerous driving» in the Russian legislation. The definitions of dangerous driving enshrined in the laws of foreign countries as well as a mechanism of calling to account for this offense are considered. The Author notes that there are a number of institutional and legal issues which may arise in the implementation of this new regulation. The ways of how to address the mentioned problems and further perspectives of complementing and improving the dangerous driving rules are determined. Finally, the relevance of innovation was concluded despite its mixed assessment in the society.

  12. TET Offensive II Field Force Vietnam After Action Report 31 January - 18 February 1968

    Science.gov (United States)

    1968-03-01

    and the 5th VC Division. V During this same period of time there were no majur shifts in ARVN forces . However III Corps shifted three...8217-".•: ’ ’SSIFJED U.S. ARMY. VIETNAM. II FIELD FORCE . TET OFFENSIVE II FIELD FORCE VIETNAM AFTER ACTION REPORT, 31 JANUARY-18 FEB- RUARY 1968...H FIELD FORCE VIETNAM AFTER ACTION REPORT 31 January-18 February 1968 RECORD K0- ! FlSjl fi-.-A-,>-•: it tT*\\ : *si h s» -wP Mr-, £< St

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. Offender and offense characteristics of a nonrandom sample of mass murderers.

    Science.gov (United States)

    Hempel, A G; Meloy, J R; Richards, T C

    1999-01-01

    A nonrandom sample (N = 30) of mass murderers in the United States and Canada during the past 50 years was studied. Data suggest that such individuals are single or divorced males in their fourth decade of life with various Axis I paranoid and/or depressive conditions and Axis II personality traits and disorders, usually Clusters A and B. The mass murder is precipitated by a major loss related to employment or relationship. A warrior mentality suffuses the planning and attack behavior of the subject, and greater deaths and higher casualty rates are significantly more likely if the perpetrator is psychotic at the time of the offense. Alcohol plays a very minor role. A large proportion of subjects will convey their central motivation in a psychological abstract, a phrase or sentence yelled with great emotion at the beginning of the mass murder; but in our study sample, only 20 percent directly threatened their victims before the offense. Death by suicide or at the hands of others is the usual outcome for the mass murderer.

  19. 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%.

  20. 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

  1. 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

  2. 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.

  3. 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

  4. Knowledge Translation Strategy to Reduce the Use of Potentially Inappropriate Medications in Hospitalized Elderly Adults.

    Science.gov (United States)

    Cossette, Benoit; Bergeron, Josée; Ricard, Geneviève; Éthier, Jean-François; Joly-Mischlich, Thomas; Levine, Mitchell; Sene, Modou; Mallet, Louise; Lanthier, Luc; Payette, Hélène; Rodrigue, Marie-Claude; Brazeau, Serge

    2016-12-01

    To evaluate the effect of a knowledge translation (KT) strategy to reduce potentially inappropriate medication (PIM) use in hospitalized elderly adults. Segmented regression analysis of an interrupted time series. Teaching hospital. Individuals aged 75 and older discharged from the hospital in 2013/14 (mean age 83.3, 54.5% female). The KT strategy comprises the distribution of educational materials, presentations by geriatricians, pharmacist-physician interventions based on alerts from a computerized alert system, and comprehensive geriatric assessments. Rate of PIM use (number of patient-days with use of at least one PIM/number of patient-days of hospitalization for individuals aged ≥75). For 8,622 patients with 14,071 admissions, a total of 145,061 patient-days were analyzed. One or more PIMs were prescribed on 28,776 (19.8%) patient-days; a higher rate was found for individuals aged 75 to 84 (24.0%) than for those aged 85 and older (14.4%) (P patient-days with at least one PIM was observed immediately after the intervention. A KT strategy resulted in decreased use of PIM in elderly adults in the hospital. Additional interventions will be implemented to maintain or further reduce PIM use. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  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. 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....

  7. Inappropriate prescribing and prescribing omissions among drug-related problems using STOPP-START criteria

    NARCIS (Netherlands)

    Verdoorn, M.A.; Kwint, H.-F.; Faber, A.; L. Bouvy, M.

    2013-01-01

    Background and objectives: Medication review has been suggested as a way to prevent drug related problems (DRPs). Screening tools have been formulated to identify potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) respectively called Screening Tool of Older

  8. 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.

  9. "Oh" + Apology + Solution: A Practice for Managing the Concomitant Presence of a Possible Offense and a Problem-to-Be-Solved

    Science.gov (United States)

    Pino, Marco; Pozzuoli, Loredana; Riccioni, Ilaria; Castellarin, Valentine

    2016-01-01

    In this article we examine a turn construction ("oh"+apology+solution) that speakers use to deal with the concomitant presence of a possible offense and a problem-to-be-solved in the immediately preceding interactional environment. We show that speakers collaborate in differentiating the offense aspect and the problem aspect of an…

  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. Inappropriateness of cardiovascular radiological imaging testing; a tertiary care referral center study.

    Directory of Open Access Journals (Sweden)

    Clara Carpeggiani

    Full Text Available AIMS: Radiological inappropriateness in medical imaging leads to loss of resources and accumulation of avoidable population cancer risk. Aim of the study was to audit the appropriateness rate of different cardiac radiological examinations. METHODS AND PRINCIPAL FINDINGS: With a retrospective, observational study we reviewed clinical records of 818 consecutive patients (67 ± 12 years, 75% males admitted from January 1-May 31, 2010 to the National Research Council - Tuscany Region Gabriele Monasterio Foundation cardiology division. A total of 940 procedures were audited: 250 chest x-rays (CXR; 240 coronary computed tomographies (CCT; 250 coronary angiographies (CA; 200 percutaneous coronary interventions (PCI. For each test, indications were rated on the basis of guidelines class of recommendation and level of evidence: definitely appropriate (A, including class I, appropriate, and class IIa, probably appropriate, uncertain (U, class IIb, probably inappropriate, or inappropriate (I, class III, definitely inappropriate. Appropriateness was suboptimal for all tests: CXR (A = 48%, U = 10%, I = 42%; CCT (A = 58%, U = 24%, I = 18%; CA (A = 45%, U = 25%, I = 30%; PCI (A = 63%, U = 15%, I = 22%. Top reasons for inappropriateness were: routine on hospital admission (70% of inappropriate CXR; first line application in asymptomatic low-risk patients (42% of CCT or in patients with unchanged clinical status post-revascularization (20% of CA; PCI in patients either asymptomatic or with miscellaneous symptoms and without inducible ischemia on non-invasive testing (36% of inappropriate PCI. CONCLUSION AND SIGNIFICANCE: Public healthcare system--with universal access paid for with public money--is haemorrhaging significant resources and accumulating avoidable long-term cancer risk with inappropriate cardiovascular imaging prevention.

  13. Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.

    Science.gov (United States)

    Peeraully, R; Henderson, K; Davies, B

    2016-04-01

    Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level.

  14. 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.

  15. Predictors of Inappropriate Use of Diagnostic Tests and Management of Bronchiolitis

    Science.gov (United States)

    Sarmiento, Lorena; Rojas-Soto, Gladys E.

    2017-01-01

    Background The aim of the present study was to determine predictors of inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. Methods In an analytical cross-sectional study, we determined independent predictors of the inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. We defined a composite outcome score as the main outcome variable. Results Of the 303 included patients, 216 (71.3%) experienced an inappropriate use of diagnostic tests and treatment of bronchiolitis. After controlling for potential confounders, it was found that atopic dermatitis (OR 5.30; CI 95% 1.14–24.79; p = 0.034), length of hospital stay (OR 1.48; CI 95% 1.08–2.03; p = 0.015), and the number of siblings (OR 1.92; CI 95% 1.13–3.26; p = 0.015) were independent predictors of an inappropriate use of diagnostic tests and treatment of the disease. Conclusions Inappropriate use of diagnostic tests and treatment of bronchiolitis was a highly prevalent outcome in our population of study. Participants with atopic dermatitis, a longer hospital stay, and a greater number of siblings were at increased risk for inappropriate use of diagnostic tests and management of the disease. PMID:28758127

  16. Emotion Knowledge and Attentional Differences in Preschoolers Showing Context-Inappropriate Anger.

    Science.gov (United States)

    Locke, Robin L; Lang, Nichole J

    2016-08-01

    Some children show anger inappropriate for the situation based on the predominant incentives, which is called context-inappropriate anger. Children need to attend to and interpret situational incentives for appropriate emotional responses. We examined associations of context-inappropriate anger with emotion recognition and attention problems in 43 preschoolers (42% male; M age = 55.1 months, SD = 4.1). Parents rated context-inappropriate anger across situations. Teachers rated attention problems using the Child Behavior Checklist-Teacher Report Form. Emotion recognition was ability to recognize emotional faces using the Emotion Matching Test. Anger perception bias was indicated by anger to non-anger situations using an adapted Affect Knowledge Test. 28% of children showed context-inappropriate anger, which correlated with lower emotion recognition (β = -.28) and higher attention problems (β = .36). Higher attention problems correlated with more anger perception bias (β = .32). This cross-sectional, correlational study provides preliminary findings that children with context-inappropriate anger showed more attention problems, which suggests that both "problems" tend to covary and associate with deficits or biases in emotion knowledge. © The Author(s) 2016.

  17. 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.

  18. 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.

  19. 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.

  20. 77 FR 51698 - Authorization To Seize Property Involved in Drug Offenses for Administrative Forfeiture (2012R-9P)

    Science.gov (United States)

    2012-08-27

    ... obtained. In recognition of the link between drug trafficking and many criminal organizations, the Attorney... to combat firearm-related violent crime. The nexus between drug trafficking and firearm violence is... Involved in Drug Offenses for Administrative Forfeiture (2012R-9P) AGENCY: Department of Justice. ACTION...

  1. 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…

  2. 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).

  3. Long-term follow-up of exhibitionists: psychological, phallometric, and offense characteristics.

    Science.gov (United States)

    Firestone, Philip; Kingston, Drew A; Wexler, Audrey; Bradford, John M

    2006-01-01

    Exhibitionism has historically been viewed as more of a nuisance than a serious criminal justice matter. Research has demonstrated that the number of exhibitionists who are detected re-offending is a significant under-representation of the number who actually re-offend. The objective of this study was to extend a previous study conducted on exhibitionists, while attempting to solve the limitations described in that study. Two hundred eight exhibitionists were assessed at a university teaching hospital between 1983 and 1996. Archival data were derived from police and medical files. Results indicated that, over a mean follow-up period of 13.24 years, 23.6, 31.3, and 38.9 percent of exhibitionists were charged with or convicted of sexual, violent, or criminal offenses, respectively. Undoubtedly, this is an under-representation of the true rate, as we have no way of knowing how many exhibitionists re-offended and did not get caught. Nevertheless, in the present investigation, sexual recidivists compared with non-recidivists were less educated, scored higher on the Michigan Alcohol Screening Test (MAST), the Psychopathy Checklist, Revised (PCL-R), and the Pedophile Index. Violent recidivists were also less educated and scored higher on the MAST, PCL-R, and the Pedophile Index, and had accumulated a greater number of prior violent or criminal charges and/or convictions. Criminal recidivists were less educated; scored higher on the MAST, Buss-Durkee Hostility Inventory (BDHI), PCL-R, and Pedophile Index; and had accumulated a greater number of prior sexual, violent, and criminal offenses. Finally, the hands-on sexual recidivists accumulated a greater number of prior violent and criminal charges and or convictions than did the hands-off sexual recidivists.

  4. 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

  5. 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.

  6. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol

    Directory of Open Access Journals (Sweden)

    Amélie Perrin

    2017-09-01

    Full Text Available Background: Each year, around one out of two nursing home (NH residents are hospitalized in France, and about half to the emergency department (ED. These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents is determined by a multidisciplinary team of experts. Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization. Keywords: Inappropriate transfer, Nursing home resident, Emergency department transfer, Potentially avoidable transfer, Appropriateness of transfer, Inappropriate hospitalization

  7. 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.

  8. Materials

    CSIR Research Space (South Africa)

    Van Wyk, Llewellyn V

    2009-02-01

    Full Text Available . It is generally included as part of a structurally insulated panel (SIP) where the foam is sandwiched between external skins of steel, wood or cement. Cement composites Cement bonded composites are an important class of building materials. These products... for their stone buildings, including the Egyptians, Aztecs and Inca’s. As stone is a very dense material it requires intensive heating to become warm. Rocks were generally stacked dry but mud, and later cement, can be used as a mortar to hold the rocks...

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

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    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.

  10. Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta

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    West LM

    2012-12-01

    Full Text Available Appropriate prescribing remains an important priority in all medical areas of practice. Objective: The objective of this study was to apply a Medication Appropriateness Index (MAI to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED.Method: This study was carried out at Malta’s general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medication treatment for inappropriateness was assessed by using the MAI. Under-prescribing was also screened for. Results: Treatment charts of 125 patients, including 697 medications, were assessed using a MAI. Overall, 115 (92% patients had one or more medications with one or more MAI criteria rated as inappropriate, giving a total of 384 (55.1% medications prescribed inappropriately. The mean SD MAI score per drug was 1.78 (SD=2.19. The most common medication classes with appropriateness problems were supplements (20.1%, antibiotics (20.0% and steroids (19.8%. The most common problems involved incorrect directions (26% and incorrect dosages (18.5%. There were 36 omitted medications with untreated indications. Conclusion: There is considerable inappropriate prescribing which could have significant negative effects regarding patient care.

  11. 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.

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

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    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

  13. 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.

  14. 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.

  15. [Impact of potentially inappropriate drug usage on health insurance business results].

    Science.gov (United States)

    Kirschke, Malin; Böhme, Jacqueline

    2014-09-01

    In Germany a list was drawn up that included 83 potentially inappropriate drugs. The PRISCUS list published in 2010 was intended to highlight certain problems in the pharmakotherapy of elderly patients and serve as a support for improved medicine safety. Almost a third of the insurance portfolio of the HALLESCHE Krankenversicherung aged over 75 years takes drugs that are on the PRISCUS list. Benzodiazepine and Z-drugs are taken most frequently. The costs per insurant with potentially inappropriate medication are on average higher than for policyholders who do not take drugs on the PRISCUS list. The costs per insurant are rising, with an increase in the number of PRISCUS agents being taken as well. However, there is still no scientific proof that potentially inappropriate drugs lead to adverse drug events.

  16. Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States.

    Science.gov (United States)

    Durkin, Michael J; Feng, Qianxi; Warren, Kyle; Lockhart, Peter B; Thornhill, Martin H; Munshi, Kiraat D; Henderson, Rochelle R; Hsueh, Kevin; Fraser, Victoria J

    2018-05-01

    The purpose of this study was to assess dental antibiotic prescribing trends over time, to quantify the number and types of antibiotics dentists prescribe inappropriately, and to estimate the excess health care costs of inappropriate antibiotic prescribing with the use of a large cohort of general dentists in the United States. We used a quasi-Poisson regression model to analyze antibiotic prescriptions trends by general dentists between January 1, 2013, and December 31, 2015, with the use of data from Express Scripts Holding Company, a large pharmacy benefits manager. We evaluated antibiotic duration and appropriateness for general dentists. Appropriateness was evaluated by reviewing the antibiotic prescribed and the duration of the prescription. Overall, the number and rate of antibiotic prescriptions prescribed by general dentists remained stable in our cohort. During the 3-year study period, approximately 14% of antibiotic prescriptions were deemed inappropriate, based on the antibiotic prescribed, antibiotic treatment duration, or both indicators. The quasi-Poisson regression model, which adjusted for number of beneficiaries covered, revealed a small but statistically significant decrease in the monthly rate of inappropriate antibiotic prescriptions by 0.32% (95% confidence interval, 0.14% to 0.50%; P = .001). Overall antibiotic prescribing practices among general dentists in this cohort remained stable over time. The rate of inappropriate antibiotic prescriptions by general dentists decreased slightly over time. From these authors' definition of appropriate antibiotic prescription choice and duration, inappropriate antibiotic prescriptions are common (14% of all antibiotic prescriptions) among general dentists. Further analyses with the use of chart review, administrative data sets, or other approaches are needed to better evaluate antibiotic prescribing practices among dentists. Copyright © 2018 American Dental Association. Published by Elsevier Inc. All

  17. 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

  18. On Indemnity for Non-Pecuniary Damage for Administrative Offenses Committed in Ukraine

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    Oleksii Ostapenko

    2018-06-01

    Full Text Available The article considers the issues of moral responsibility of a person guilty of committing an administrative offense in Ukraine. It offers argumentative author’s vision of the possibility and need to consolidate a number of administrative-legal norms with the aim of legal regulation of moral responsibility, both property and non-property. It analyzes the historical aspect of compensation for non-pecuniary damage, as well as defines the conventions of the International Labor Organization, which provide for compensation for damage suffered by the victim. Attention is drawn to the fact that the current administrative law does not provide for the issue of indemnity for non-pecuniary damage for administrative offenses committed. It is noted about the relationship of morality and law and the moral responsibility is separated from the legal one. The concepts of “harm”, “social danger” are disclosed. Moral and non-personal liability are distinguished. The content of moral damage, fixed in the legislation of foreign countries is analyzed. On the basis of the current administrative legislation of Ukraine, circumstances have been clarified that exclude administrative liability, indicating no liability, including for moral damage. The norms of the criminal-procedural legislation of Ukraine, which provide for indemnity (compensation for damage to the victim at any stage of criminal proceedings are analyzed. Judicial practice is used in this regard. The provisions on conciliation of the parties, on the basis of which the victim has the opportunity to make a decision to refuse to indemnify non-pecuniary damage both before the beginning of the jurisdictional proceedings and during its execution at one or another procedural stage, are considered. The grounds for liability for the moral damage, fixed in the Civil Code of Ukraine are determined. Conclusions are made on the compensation of the moral damage to the victim of property and non-property content

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

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    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

  20. Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

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    Christine Grützmann Faustino

    2011-03-01

    Full Text Available Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80. The Beers criteria (2003 version were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6% with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%. The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0 and number of medications prescribed (p<0.001 were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7. The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001; this result was not age-dependent (p=0.285. Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a

  1. Understanding inappropriate hospital admissions of patients presenting to the Emergency Department.

    Directory of Open Access Journals (Sweden)

    Roberta Siliquini

    2005-06-01

    Full Text Available

    Objectives. To identify 1 the characteristics of patients receiving non acute (inappropriate care and 2 the variables associated to inappropriate hospital use, in order to 3 estimate the relevance of the problem and to 4 focus future concurrent reviews and efforts to allocate patients to alternative health care settings.

    Design. A prospective review of a random sample of adult patients who presented to the Emergency Department of the Molinette Hospital. Patients were assessed at admission and on day 3, 5and 8 using the Appropriateness Evaluation Protocol (Italian validated version. Patients: 490 overall; 312 (64 % medical and 178 (36 % surgical.

    Outcome measures. Acute (appropriate and non acute (inappropriate admissions, Major Disease Category, costs, mean weights of Diagnosis Related Groups, and length of stay (days.

    Results. The proportion of patients requiring acute care declined rapidly from presentation (84.5% to the fifth day of admission (60.9%. Patients admitted during weekends showed a higher rate of inappropriate stay on day 5 (P=0.04. The proportion of inappropriate admissions was higher for medical rather than surgical patients (P=0.07 at presentation and at day 5 (P < 0.01. Traditional social-demographic variables were not significant risk indicators for inappropriate admissions. The likelihood ratio for inappropriate admission at presentation was significantly higher for minor illnesses and disturbances (P=0.03.

    Inappropriate stay on day 5 was significantly associated with lower cost (P < 0.01, lower mean DRG weight (P < 0.01 and shorter length of stay (P=0.05 for medical but not for surgical admissions.

    Conclusions. Traditional epidemiological indicators are inadequate to target prospective concurrent reviews. Qualitative studies focusing on patient physician dialogue in different situations and contexts could

  2. Demographic and Motivation Differences Among Online Sex Offenders by Type of Offense: An Exploration of Routine Activities Theories.

    Science.gov (United States)

    Navarro, Jordana N; Jasinski, Jana L

    2015-01-01

    This article presents an analysis of the relationship between online sexual offenders' demographic background and characteristics indicative of motivation and offense type. Specifically, we investigate whether these characteristics can distinguish different online sexual offender groups from one another as well as inform routine activity theorists on what potentially motivates perpetrators. Using multinomial logistic regression, this study found that online sexual offenders' demographic backgrounds and characteristics indicative of motivation do vary by offense types. Two important implications of this study are that the term "online sexual offender" encompasses different types of offenders, including some who do not align with mainstream media's characterization of "predators," and that the potential offender within routine activity theory can be the focus of empirical investigation rather than taken as a given in research.

  3. The relationship of dangerous driving with traffic offenses: A study on an adapted measure of dangerous driving.

    Science.gov (United States)

    Iliescu, Dragoş; Sârbescu, Paul

    2013-03-01

    Using data from three different samples and more than 1000 participants, the current study examines differences in dangerous driving in terms of age, gender, professional driving, as well as the relationship of dangerous driving with behavioral indicators (mileage) and criteria (traffic offenses). The study uses an adapted (Romanian) version of the Dula Dangerous Driving Index (DDDI, Dula and Ballard, 2003) and also reports data on the psychometric characteristics of this measure. Findings suggest that the Romanian version of the DDDI has sound psychometric properties. Dangerous driving is higher in males and occasional drivers, is not correlated with mileage and is significantly related with speeding as a traffic offense, both self-reported and objectively measured. The utility of predictive models including dangerous driving is not very large: logistic regression models have a significant fit to the data, but their misclassification rate (especially in terms of sensitivity) is unacceptable high. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. '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

  5. 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.

  6. Identifying and analyzing the construction and effectiveness of offensive plays in basketball by using systematic observation.

    Science.gov (United States)

    Fernandez, Jordi; Camerino, Oleguer; Anguera, M Teresa; Jonsson, Gudberg K

    2009-08-01

    In the field of sports research, there is a growing need for the rigorous collection of data that provide empirical evidence about the complex reality they refer to. Although sports psychology research has advanced considerably in recent years, in both extent and quality, one area of research that remains relatively unexplored is the dynamics of the sports group and the influence of the group on its members (George & Feltz, 1995; Widmeyer, Brawley, & Carron, 1992). Key aspects in this regard include the presence of regularities that are not detectable through visual inference or traditional methods of data analysis, the lack of standard observation instruments, and, assuming priority, the need to develop powerful, computerized coding systems, all of which must form part of an approach that is suitable for natural and habitual contexts. The present study is part of a broader research project concerning ACB teams (first Spanish basketball division) and considers the interaction context before teams try to score (where this is understood as how teams create scoring opportunities) as the core aspect that links team play. This investigation proposes a new model of analysis for studying the effectiveness and construction of offensive basketball plays in order to identify their outcomes, thus providing coaches with an important device for improving or consolidating them.

  7. 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.

  8. Development and validation of a notational system to study the offensive process in football.

    Science.gov (United States)

    Sarmento, Hugo; Anguera, Teresa; Campaniço, Jorge; Leitão, José

    2010-01-01

    The most striking change within football development is the application of science to its problems and in particular the use of increasingly sophisticated technology that, supported by scientific data, allows us to establish a "code of reading" the reality of the game. Therefore, this study describes the process of the development and validation of an ad hoc system of categorization, which allows the different methods of offensive game in football and the interaction to be analyzed. Therefore, through an exploratory phase of the study, we identified 10 vertebrate criteria and the respective behaviors observed for each of these criteria. We heard a panel of five experts with the purpose of a content validation. The resulting instrument is characterized by a combination of field formats and systems of categories. The reliability of the instrument was calculated by the intraobserver agreement, and values above 0.95 for all criteria were achieved. Two FC Barcelona games were coded and analyzed, which allowed the detection of various T-patterns. The results show that the instrument serves the purpose for which it was developed and can provide important information for the understanding of game interaction in football.

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

    Science.gov (United States)

    2016-06-14

    in theory . Offensive cyberspace operations have the potential to provide these types of power- projecting effects in the battlespace, but how can...approach to allow for the maturation of command relationships, authorities, and buildup of operational capacity. In the direct support model...send cyber- space liaisons to the air component to integrate joint cyberspace operations. A major step in the center’s maturation process is

  10. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ar Ryum; Lee, Seung Woo; Jang, In Seok; Kang, Hyun Gook; Seong, Poong Hyun [Dept. of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of); Park, Jin Kyun [Integrated Safety Assessment Division, Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2012-12-15

    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.

  12. 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.

  13. 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…

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

    Science.gov (United States)

    Vaz Patto, Maria Carlota; Rubiales, Diego

    2014-01-01

    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 (NHR) 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 NHR 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 NHR mechanisms to breed for broad-spectrum resistance to rust in legume species. PMID:25426128

  15. Teaching Women with Intellectual Disabilities to Identify and Report Inappropriate Staff-to-Resident Interactions

    Science.gov (United States)

    Bollman, Jessica R.; Davis, Paula K.

    2009-01-01

    This study examined the effectiveness of behavioral skills training in teaching 2 adult women with mild intellectual disabilities to report inappropriate staff-to-resident interactions. The reporting skill included making a self-advocacy response, walking away, and reporting the interaction. Participants' performance was measured during baseline,…

  16. 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.

  17. Inappropriate complementary feeding practice increases risk of stunting in children aged 12-24 months

    Directory of Open Access Journals (Sweden)

    Hijra Hijra

    2016-12-01

    Inappropriate complementary feeding practice increased the risk of stunting in 12-24 months old children by 8.26. This study confirms the need to scale up interventions during the first 2 years of life, including appropriate infant feeding practices.

  18. 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

  19. 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…

  20. An Action Research Study of Intellectual Disabilities, Inappropriate Behaviors and Learned Helplessness

    Science.gov (United States)

    Luper, Elizabeth P. S.; Lockley, Jeannie

    2008-01-01

    This study focused on a population of 36 female patients, aged 25 to 65, who were diagnosed with intellectual disabilities, all of whom had long-standing patterns of inappropriate behaviors. In an attempt to increase more appropriate behaviors in these patients, a set of standardized contingency rules were established. These rules were implemented…

  1. 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.…

  2. 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.

  3. 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

    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...

  4. 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

    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...

  5. 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.

  6. 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.

  7. Inappropriate shock delivery by implantable cardioverter defibrillator due to electrical interference with washing machine.

    Science.gov (United States)

    Chongtham, Dhanaraj Singh; Bahl, Ajay; Kumar, Rohit Manoj; Talwar, K K

    2007-05-31

    We report a patient with hypertrophic cardiomyopathy who received an inappropriate implantable cardioverter defibrillator shock due to electrical interference from a washing machine. This electrical interference was detected as an episode of ventricular fibrillation with delivery of shock without warning symptoms.

  8. 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.”

  9. 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

  10. Inappropriate and Excessive Guilt: Instrument Validation and Developmental Differences in Relation to Depression

    Science.gov (United States)

    Tilghman-Osborne, Carlos; Cole, David A.; Felton, Julia W.

    2012-01-01

    Inappropriate or excessive guilt is listed as a symptom of depression by the American Psychiatric Association ("1994"). Although many measures of guilt have been developed, definitional and operational problems exist, especially in the application of such measures in childhood and adolescence. To address these problems, the current study…

  11. [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.

  12. 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.

  13. 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.

  14. Multimodal neuroimaging measures and intelligence influence pedophile child sexual offense behavior.

    Science.gov (United States)

    Lett, Tristram A; Mohnke, Sebastian; Amelung, Till; Brandl, Eva J; Schiltz, Kolja; Pohl, Alexander; Gerwinn, Hannah; Kärgel, Christian; Massau, Claudia; Tenbergen, Gilian; Wittfoth, Matthias; Kneer, Jonas; Beier, Klaus M; Walter, Martin; Ponseti, Jorge; Krüger, Tillmann H C; Schiffer, Boris; Walter, Henrik

    2018-06-04

    Pedophilia is a heterogeneous disorder for which the neurobiological correlates are not well established. In particular, there are no biological markers identifying individuals with high risk to commit child sexual offense (CSO). Pedophiles with CSO (P+CSO; N = 73), pedophiles without CSO (P-CSO; N = 77), and non-pedophilic controls (NPC; N = 133) were assessed using multimodal structural neuroimaging measures including: cortical thickness (CT), surface area (SA), and white matter fractional anisotropy (FA), as well as full scale IQ (FSIQ) performance. Cortex-wise mediation analyses were used to assess the relationships among brain structure, FSIQ and CSO behavior. Lower FSIQ performance was strongly predict with P+CSO (Wald Chi 2 = 13.0, p = 3.1 × 10 -5 ). P+CSO had lower CT in the right motor cortex and pronounced reductions in SA spanning the bilateral frontal, temporal, cingulate, and insular regions (P FWE-corrected < 0.05). P+CSO also had lower FA particularly in the corpus callosum (P FWE-corrected < 0.05). The relationship between SA and P+CSO was significantly mediated by FSIQ, particularly in the prefrontal and anterior insular cortices (P FWE-corrected < 0.05). Within P+CSO, left prefrontal and right anterior cingulate SA negatively correlated with number of CSOs (P FWE-corrected < 0.05). This study demonstrates converging neurobiological findings in which P+CSO had lower FSIQ performance, reduced CT, reduced SA, and reduced FA, compared to P-CSO as well as NPC. Further, FSIQ potentially mediates abuse by pedophiles via aberrant SA, whereas the CT and FA associations were independent of FSIQ differences. These findings suggest aberrant neuroanatomy and lower intelligence as a potential core feature underlying child sexual abuse behavior by pedophiles. Copyright © 2018. Published by Elsevier B.V.

  15. 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)

  16. 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.

  17. 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)

  18. 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)

  19. Explicit versus implicit evaluation to detect inappropriate medication use in geriatric outpatients.

    Science.gov (United States)

    Bahat, Gulistan; Ilhan, Birkan; Bay, Ilker; Kilic, Cihan; Kucukdagli, Pinar; Oren, Meryem Merve; Karan, Mehmet Akif

    2018-04-19

    The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard. Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted. About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician's application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician's implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription. Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient-family preferences. There may be as much as STOPP

  20. 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.

  1. Brief Report: Reduction of Inappropriate Vocalizations for a Child with Autism Using a Self-Management Treatment Program.

    Science.gov (United States)

    Mancina, Catherine; Tankersley, Melody; Kamps, Debra; Kravits, Tammy; Parrett, Jean

    2000-01-01

    A study examined the effects of a self-management program used to reduce high rates of inappropriate vocalizations (e.g., humming, tongue clucking, perseveration, and echolalic words/phases) in a 12-year-old girl with autism. When self-management was applied to inappropriate vocalizations during leisure, prevocational, and reading tasks, the…

  2. Urea for long-term treatment of syndrome of inappropriate secretion of antidiuretic hormone.

    Science.gov (United States)

    Decaux, G; Genette, F

    1981-10-24

    The efficacy of oral urea in producing a sufficiently high osmotic diuresis was tested in seven patients with the syndrome of inappropriate secretion of antidiuretic hormone. In all patients urea corrected the hyponatraemia despite a normal fluid intake. Five patients were controlled (serum sodium concentration greater than 128 mmol(mEq)/1) with a dose of 30 g urea daily, and two with 60 g daily. The patients who needed 30 g drank 1-2 1 of fluid daily, while those who needed 60 g drank up to 3.1 per day. No major side effects were noted, even after treatment periods of up to 270 days. These findings suggest that urea is a safe and efficacious treatment of the syndrome of inappropriate secretion of antidiuretic hormone.

  3. 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.

  4. Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

    Directory of Open Access Journals (Sweden)

    Yoon Hi Cho

    2009-01-01

    Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

  5. Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

    Directory of Open Access Journals (Sweden)

    Rosenthal Stephen

    2009-12-01

    Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

  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. 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 ...

  8. 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...

  9. Morvan syndrome: a rare cause of syndrome of inappropriate antidiuretic hormone secretion

    OpenAIRE

    DEMIRBAS, SEREF; AYKAN, MUSA BARIS; ZENGIN, HAYDAR; MAZMAN, SEMIR; SAGLAM, KENAN

    2017-01-01

    The syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for an important part of hyponatremia cases. The causes of SIADH can be detected almost always. As a rare disorder, Morvan Syndrome can be defined by the sum of peripheral nerve hyperexcitability, autonomic instability and neuropsychiatric features. Antibodies to voltage-gated potassium channels (Anti ? VGKC-Ab) including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated ...

  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. 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.

  12. 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.

  13. 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.

  14. 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.

  15. Inappropriate drug donations: what has happened since the 1999 WHO guidelines?

    Science.gov (United States)

    van Dijk, D P; Dinant, G; Jacobs, J A

    2011-08-01

    Drug donations to developing countries may be part of medical relief operations in acute emergencies, development aid in non-emergency situations, or a corporate donations programme. After a number of documented inappropriate drug donations, the World Health Organization developed the 'Guidelines for Drug Donations', with the second and final version published in 1999. We reviewed the medical literature on drug donations since the Guidelines publication in 1999. Literature was retrieved from PubMed and other on-line databases as well as from relevant websites providing medical literature for use in developing countries. We considered the following donations to be inappropriate: (i) essential drugs in excessive quantities; (ii) mixed unused drugs (unsorted medicines and free samples); and (iii) drug dumping (large quantities of useless medicines). We retrieved 25 publications dated after 1999, including 20 and 5 from the scientific literature and 'grey' literature (technical reports, working papers), respectively. New information concerned emergencies in East Timor, Mozambique, El Salvador, Gujarat State (India), Aceh (Indonesia) and Sri Lanka. Except for East Timor and Gujarat, inappropriate donations still occurred, accounting for 85%, 37%, 70% and 80% of donations in Mozambique, El Salvador, Aceh and Sri Lanka, respectively. Very little information was found on drug donations in non-emergency situations. There are few recent reports on the compliance of drug donations with the World Health Organization guidelines. For emergency situations, there is still room for improvement. Drug donations in non-emergency situations need to be evaluated. A reform of drug donations policy is needed.

  16. The syndrome of inappropriate antidiuretic hormone secretion after giant leaf frog (Phyllomedusa bicolor) venom exposure.

    Science.gov (United States)

    Leban, Vid; Kozelj, Gordana; Brvar, Miran

    2016-09-15

    In Europe body purification and natural balance restoring rituals are becoming increasingly popular, but an introduction of Amazonian shamanic rituals in urban Europe can result in unexpected adverse events. A 44-year-old woman attended a Kambô or Sapo ritual in Slovenia where dried skin secretion from a giant leaf frog (Phyllomedusa bicolor) was applied to five freshly burned wounds at her shoulder. Afterwards, she drank 6 litres of water and gradually developed nausea and vomiting, confusion, lethargy, muscle weakness, spasms and cramps, seizure, decreased consciousness level and short-term memory loss. The initial laboratory tests showed profound plasma hypoosmolality (251 mOsm/kg) proportional to hyponatremia (116 mmol/L) combined with inappropriately elevated urine osmolality (523 mOsm/kg) and high urine sodium concentration (87 mmol/L) indicating a syndrome of inappropriate antidiuretic hormone secretion. The patient was treated with 0.9% sodium chloride and a restriction of water intake. Plasma osmolality and hyponatremia improved one day after venom exposure, but the symptoms disappeared as late as the third day. In patients presenting with neurological symptoms and a line of small body burns Phyllomedusa bicolor venom exposure should be suspected. Acute symptomatic hyponatremia after Phyllomedusa bicolor venom exposure is the result of inappropriate antidiuretic hormone secretion that can be exacerbated by excessive water intake. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. 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.

  18. Characteristics of the overflow pollution of storm drains with inappropriate sewage entry.

    Science.gov (United States)

    Yin, Hailong; Lu, Yi; Xu, Zuxin; Li, Huaizheng; Schwegler, Benedict R

    2017-02-01

    To probe the overflow pollution of separate storm drains with inappropriate sewage entries, in terms of the relationship between sewage entries and the corresponding dry-weather and wet-weather overflow, the monitoring activities were conducted in a storm drainage system in the Shanghai downtown area (374 ha). In this study site, samples from inappropriately entered dry-weather sewage and the overflow due to storm pumps operation on dry-weather and wet-weather days were collected and then monitored for six water quality constituents. It was found that overflow concentrations of dry-weather period could be higher than those of wet-weather period; under wet-weather period, the overflow concentrations of storm drains were close to or even higher than that of combined sewers. Relatively strong first flush mostly occurred under heavy rain that satisfied critical rainfall amount, maximum rainfall intensity, and maximum pumping discharge, while almost no first flush effect or only weak first flush effect was found for the other rainfall events. Such phenomenon was attributed to lower in-line pipe storage as compared to that of the combined sewers, and serious sediment accumulation within the storm pipes due to sewage entry. For this kind of system, treating a continuous overflow rate is a better strategy than treating the maximum amount of early part of the overflow. Correcting the key inappropriate sewage entries into storm drains should also be focused.

  19. 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.

  20. 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).

  1. 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.

  2. 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.

  3. Exploring sexuality profiles of adolescents who have engaged in sexual abuse and their link to delinquency and offense characteristics.

    Science.gov (United States)

    Spearson Goulet, Jo-Annie; Tardif, Monique

    2018-06-05

    Very few studies have taken a specific interest in the various sexual dimensions, beyond delinquent sexual behavior, of adolescents who have engaged in sexual abuse (AESA). Those that went beyond delinquent sexual behavior have report mixed results, suggesting they are a heterogeneous group. The current study used cluster analysis to examine the sexuality profiles of AESA, which included information on several sexual dimensions (atypical and normative fantasies and experiences, drive, body image, pornography, first masturbation, onset of sexual interest and first exposure to sex). Participants (N = 136) are adolescents who have engaged in sexual abuse involving physical contact, for which at least one parent also participated in the study. They were recruited from six specialized treatment centers and three youth centers in Quebec (Canada). Cluster analyses were performed to identify specific sexual profiles. Results suggest three clusters of AESA: 1- Discordant sexuality pertaining to adolescents who show mostly normative sexual interests, 2- Constrictive sexuality, characterizing adolescents who seem to be less invested/interested in their sexuality and 3- Overinvested sexuality for adolescents showing an exacerbated sexuality, including atypical sexual interest. Additional analyses (ANOVAs and Chi-square tests) reveal that five delinquency and offense characteristics were significantly more likely to be present in the Overinvested than the Constrictive cluster: non-sexual offenses, three or more victims, peer victims and alcohol and drug consumption. Advancing our knowledge on this topic can provide relevant data for clinicians to better target interventions. Copyright © 2018. Published by Elsevier Ltd.

  4. Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2.

    Science.gov (United States)

    Kimura, T; Ogura, F; Yamamoto, K; Uda, A; Nishioka, T; Kume, M; Makimoto, H; Yano, I; Hirai, M

    2017-04-01

    The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (stopp) criteria were updated in 2014 (stopp criteria ver.2), but few studies have evaluated the usefulness of stopp criteria in elderly patients. This prospective observational study evaluated the prevalence of potentially inappropriate medications (PIMs), and the efficacy of hospital pharmacists' assessment and intervention based on stopp criteria ver.2. The study was conducted at three medical units of Kobe University Hospital between April 2015 and March 2016. Pharmacists assessed and detected PIMs based on stopp criteria ver.2 and considered the patient's intention to change the prescription at the time of admission of each patient. If the pharmacists judged that benefits outweighed risks of prescription change and the patients consented to change the medications, they recommended the doctor to change the prescription. If there was a risk of exacerbation of disease by the change of medications and the pharmacists judged it to be difficult to adjust medications during hospitalization or the patients did not consent to change the medications, they did not recommend to change it. The pharmacists and the doctors discussed and finally decided whether to change the PIMs or not. The number of patients prescribed PIMs, the number and contents of PIMs, and the number of medications changed after pharmacists' intervention were calculated. Totally, 822 new inpatients aged ≥65 years prescribed ≥1 daily medicine were included. Their median (interquartile range) age was 75·0 (71·0-80·0) years, and 54·9% were male. According to the criteria, 346 patients (42·1%) were prescribed ≥1 PIMs. Patients prescribed PIMs took significantly more medications than others: 10·0 (7·0-13·0) vs. 6·0 (4·0-9·0), P older people (benzodiazepines) (30/67) and (iii) drugs that predictably increase the risk of falls in older people (hypnotic Z-drugs) (15/31). Over 40% elderly patients were prescribed PIMs

  5. 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

  6. 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.

  7. 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

  8. Proximal femoral osteosarcoma: Diagnostic challenges translate into delayed and inappropriate management.

    Science.gov (United States)

    Dahan, M; Anract, P; Babinet, A; Larousserie, F; Biau, D

    2017-11-01

    The proximal femuris is an uncommon site of osteosarcoma. The unusual manifestations at this site may lead to diagnostic and therapeutic mistakes. We therefore performed a retrospective study to estimate the proportions of patients with imaging study findings and/or clinical manifestations typical for osteosarcoma and/or inappropriate treatment decisions. Proximal femoral osteosarcoma often produces atypical clinical and radiological presentations. Consecutive patients who underwent surgery at our center to treat proximal femoral osteosarcoma were included. For each patient, we collected the epidemiological characteristics, clinical symptoms, imaging study findings, treatment, and tumor outcome. Proportions were computed with their confidence intervals. Twelve patients had surgery for proximal femoral osteosarcoma between 1986 and 2015. Imaging findings were typical in 1 (8%) patient; they consisted of ill-defined osteolysis in 11/12 (92%) patients, a periosteal reaction in 1/12 (8%) patient, soft tissue involvement in 7/12 (58%) patients, and immature osteoid matrix in 11/12 (92%) patients. No patient had the typical combination of pain with a soft tissue swelling. Management was inappropriate in 2/12 (17%) patients, who did not undergo all the recommended imaging studies before surgery and were treated in another center before the correct diagnosis was established. At last follow-up, 4 patients had died (after a mean of 7 years) and 8 were alive (after a mean of 4 years). Proximal femoral osteosarcoma is uncommon and rarely produces the typical clinical and imaging study findings. The atypical presentation often results in diagnostic errors and inappropriate treatments. Ill-defined osteolysis on standard radiographs should prompt computed tomography or magnetic resonance imaging of the proximal femur. Treatment in a specialized center is imperative. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. 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.

  10. Hypertrophic Pachymeningitis and the Syndrome of Inappropriate Antidiuretic Hormone Secretion: Coincidence or Cause?

    Science.gov (United States)

    Harsch, Igor Alexander; Schiffer, Anne; Konturek, Peter C

    2017-01-01

    To investigate a potential cause of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). A 70-year-old female patient had nausea and collapsed. Although euvolemic, pathological laboratory findings showed hyponatremia and hypoosmolality, and cerebral magnetic resonance imaging showed hypertrophic pachymeningitis. Secondary hypertrophic pachymeningitis was excluded. Other nonneurological reasons for SIADH were also excluded. Moderate fluid restriction restored an almost normal serum osmolality and sodium. This case of SIADH was conservatively treated with moderate fluid restriction that almost restored normal serum osmolality and sodium levels. © 2017 S. Karger AG, Basel.

  11. Morvan syndrome: a rare cause of syndrome of inappropriate antidiuretic hormone secretion.

    Science.gov (United States)

    Demirbas, Seref; Aykan, Musa Baris; Zengin, Haydar; Mazman, Semir; Saglam, Kenan

    2017-01-01

    The syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for an important part of hyponatremia cases. The causes of SIADH can be detected almost always. As a rare disorder, Morvan Syndrome can be defined by the sum of peripheral nerve hyperexcitability, autonomic instability and neuropsychiatric features. Antibodies to voltage-gated potassium channels (Anti - VGKC-Ab) including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated protein 1 antibodies (LGI1-Ab) were previously known for the potential association with this condition. We present a Morvan Syndrome in a patient who presented with various neuropsychiatric symptoms and SIADH.

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

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    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

  13. The Blunt Tool: Inappropriateness of the Concept of Transition for the Analyses of Democratic Consolidation

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    Dražen Lalić

    2010-01-01

    Full Text Available The article is analyzing the inappropriateness of the “classical” theories of transition for the analyses of democratic consolidation in the contemporary post-communist societies, including the Croatian one. The authors are claiming that the aforementioned theories are insufficient for a subtle explanation of the recent ongoing major political and social changes in the post-communist societies. The article is stressing the most characteristic examples of the “bluntness”, i.e. of the inappropriateness of the transition theory basic concepts for the analyses of democratic consolidation, as well as of the socio-cultural and socio-structural assumptions and other important concepts related to the post-communist transition phenomenon. Furthermore, the article is exposing the problems connected with various interpretations of the phases of the transition period in relation to the cleavage between the institutional constitution of the democratic system and the democratic deficit characteristic of the post-communist states. Finally, the article is bolding the necessity of re-conceptualization of the basic concepts of the theory of transition; however, not towards the construction of a new theory, but rather towards the adaptation of the existing theory to the recent social and political processes in the contemporaneous post-communist societies.

  14. 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.

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

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    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.

  16. 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

  17. Performance costs when emotion tunes inappropriate cognitive abilities: implications for mental resources and behavior.

    Science.gov (United States)

    Storbeck, Justin

    2012-08-01

    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. In 2 experiments, either an approach-motivated positive state or a withdrawal-motivated negative state was induced, and then participants completed a verbal or a spatial working memory task creating conditions of emotion-cognition alignment (e.g., approach/verbal) or misalignment (e.g., approach/spatial). A control condition was also included. To examine behavioral costs due to depleted self-control resources, participants completed either a Stroop task (Stroop, 1935; Experiment 1) or a Black/White implicit association test (IAT; Greenwald, McGhee, & Schwartz, 1998; Experiment 2). Participants in the misalignment conditions performed worse on the Stroop task, and they were worse at controlling their implicit attitude biases on the IAT. Thus, when emotion tunes inappropriate cognitive tendencies for one's current environment, self-control resources become depleted, impairing behavioral control. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

  18. 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.

  19. [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.

  20. Problems of applying legal liability for offenses in the sphere of long-term temporary usage of forests in Ukraine

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    Д. М. Мікулин

    2015-11-01

    Full Text Available Problem setting. Today the institute of legal responsibility functionates inefficiently, which can be explained by a weak theoretical development problems of this institution in particular legal sciences (including the environmental law; legislative gaps; low level of skills of the executive officers in the field of environmental protection, rational use, restoration and protection of natural resources. These provisions completely relate as well to the problems of applying legal responsibility for violations in the field of long-term temporary use of forests. Recent research and publications analysis. Issues of legal responsibility for offenses in the sphere of forest usage were considered in the scientific works of B. Boreiko, S. Kravchenko, O. Shumilo, O. Storchous etc. Anyhow, the legal precedents in the scope of offenses in the sphere of long-term temporary usage of forests in Ukraine remains not studied. Paper objective is the analysis of the most typical recent legal cases in the scope of long-term temporary usage of forests that demonstrate the roots for conflicts between the forest users, local public authorities and the public. Paper main body. Based the an analysis of cited precedents, it can be unequivocally concluded that the forest legislation doesn’t regulate efficiently the liability for violations in the field of long-term temporary usage of forests in Ukraine. Forest users often fail to comply with the contract terms of using forests in the part of veto on business activity, as well as constructing fences, that impedes the access of local residents to natural resources. The procedure for receiving forest lands in temporary usage is extremely corrupt, and citizens have to go to court to bring regional administrations to administrative responsibility for unjustified refusal to provide forest lands in the long-term temporary usage. Conclusions of the research. Author believes that the effective solution of modern problems is not

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

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    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

  2. 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.

  3. Inappropriate medication use and risk of falls – A prospective study in a large community-dwelling elderly cohort

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    Fourrier Annie

    2009-07-01

    Full Text Available Abstract Background Explicit criteria for determining potentially inappropriate medication consumption in elderly were elaborated by Beers et al. These lists have been used worldwide to evaluate medical prescriptions but there is little epidemiologic evidence demonstrating negative consequences of inappropriate medication use. It has been reported that some drugs could increase the risk of falls, which are a frequent and serious problem in elderly population. We aimed to evaluate the association between the use of potentially inappropriate medications and the risk of falls. Methods The 3C Study is a multicentre prospective cohort study conducted in France with 4 years of follow-up. Non-institutionalized men and women aged 65 years or over (N = 6343 were randomly selected from electoral rolls. Data on socio-demographic, medical characteristics and medication use (based on self-reports and data from the national healthcare insurance were collected. Use of inappropriate medication for elderly was defined from established criteria. Data about falls were collected at the two follow-up examinations (2 years and 4 years after baseline. The association between the exposure to inappropriate medications and the risk of falls was evaluated using multivariate models (Cox model and logistic regression. Results 32% of subjects reported inappropriate medication use at baseline and 29% at least two of the three examinations; 22% had fallen 2 times or more during follow-up. Overall, inappropriate medication users had an increased risk of falling. This increase was mainly due to the use of long-acting benzodiazepines (adjusted odds ratio (OR = 1.4, 95% confidence interval: [1.1–1.8], in both occasional and regular users, other inappropriate psychotropics (adjusted OR = 1.7 [1.7–2.7] in regular users, or medication with anticholinergic properties (adjusted OR = 1.6 [1.2–2.1] in regular users. Neither occasional, nor regular use of short- or intermediate

  4. 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.

  5. Standardized programming to reduce the burden of inappropriate therapies in implantable cardioverter defibrillators - Single centre follow up results

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    U. Boles

    2018-03-01

    Full Text Available Background: Current algorithms and device morphology templates have been proposed in current Implantable Cardioverter-Defibrillators (ICDs to minimize inappropriate therapies (ITS, but this has not been completely successful. Aim: Assess the impact of a deliberate strategy of using an atrial lead implant with standardized parameters; based on all current ICD discriminators and technologies, on the burden of ITS. Method: A retrospective single-centre analysis of 250 patients with either dual chamber (DR ICDs or biventricular ICDs (CRTDs over a (41.9 ± 27.3 month period was performed. The incidence of ITS on all ICD and CRTD patients was chronicled after the implementation of standardized programming. Results: 39 events of anti-tachycardial pacing (ATP and/or shocks were identified in 20 patients (8% incidence rate among patients. The total number of individual therapies was 120, of which 34% were inappropriate ATP, and 36% were inappropriate shocks. 11 patients of the 250 patients received ITS (4.4%. Of the 20 patients, four had ICDs for primary prevention and 16 for a secondary prevention. All the episodes in the primary indication group were inappropriate, while seven patients (43% of the secondary indication group experienced inappropriate therapies. Conclusions: The burden of ITS in the population of patients receiving ICDs was 4.4% in the presence of atrial leads. The proposed rationalized programming criteria seems an effective strategy to minimize the burden of inappropriate therapies and will require further validation. Keywords: Implantable cardioverter-defibrillator (ICDs, Inappropriate therapies, Standardized programming

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

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    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.

  7. 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)

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

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    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.

  9. 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

  10. Low disease prevalence and inappropriate implantable cardioverter defibrillator shock rate in Brugada syndrome

    DEFF Research Database (Denmark)

    Holst, Anders Gaarsdal; Jensen, Henrik Kjærulf; Eschen, Ole

    2012-01-01

    AimsBrugada syndrome (BrS) is an inherited channelopathy that predisposes to malignant ventricular arrhythmias and thereby syncope and sudden cardiac death. Prior studies characterizing BrS patients have used highly selected referral populations from tertiary centres and prevalence estimates have...... been carried out using electrocardiogram (ECG) surveys only. We aimed to identify and characterize all diagnosed BrS patients in Denmark (population 5.4 million).Methods and resultsBrugada syndrome patients were identified using several modalities including identification in all Danish tertiary......%) experienced inappropriate shocks during a median follow-up of 47 months. No patient died or experienced aborted sudden cardiac death during follow-up.ConclusionsWe report the first nationwide study of BrS patients. We found a low incidence of diagnosed definite BrS compared with estimates from ECG surveys...

  11. 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.

  12. Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory.

    Science.gov (United States)

    Kiechle, Frederick L; Arcenas, Rodney C; Rogers, Linda C

    2014-01-01

    Benchmarks and metrics related to laboratory test utilization are based on evidence-based medical literature that may suffer from a positive publication bias. Guidelines are only as good as the data reviewed to create them. Disruptive technologies require time for appropriate use to be established before utilization review will be meaningful. Metrics include monitoring the use of obsolete tests and the inappropriate use of lab tests. Test utilization by clients in a hospital outreach program can be used to monitor the impact of new clients on lab workload. A multi-disciplinary laboratory utilization committee is the most effective tool for modifying bad habits, and reviewing and approving new tests for the lab formulary or by sending them out to a reference lab. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. 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.

  14. 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

  15. Identifying and acting on potentially inappropriate care? Inadequacy of current hospital coding for this task.

    Science.gov (United States)

    Cooper, P David; Smart, David R

    2017-06-01

    Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel. Assessment of accuracy of official hospital coding data for hyperbaric services in a tertiary referral hospital. All official hyperbaric-relevant coding data submitted to the relevant Australian Government agencies by the Royal Hobart Hospital, Tasmania, Australia for financial year 2010-2011 were reviewed and compared against actual hyperbaric unit activity as determined by reference to original source documents. Hospital coding data contained one or more errors in diagnoses and/or procedures in 70% of patients treated with hyperbaric oxygen that year. Multiple discrete error types were identified, including (but not limited to): missing patients; missing treatments; 'additional' treatments; 'additional' patients; incorrect procedure codes and incorrect diagnostic codes. Incidental observations of errors in surgical, anaesthetic and intensive care coding within this cohort suggest that the problems are not restricted to the specialty of hyperbaric medicine alone. Publications from other centres indicate that these problems are not unique to this institution or State. Current Government datasets are irretrievably compromised and not fit for purpose. Attempting to inform the healthcare policy debate by reference to these datasets is inappropriate. Urgent clinical engagement with hospital coding departments is warranted.

  16. 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.

  17. Effect of rational and irrational statements on intensity and 'inappropriateness' of emotional distress and irrational beliefs in psychotherapy patients.

    Science.gov (United States)

    Cramer, D; Kupshik, G

    1993-09-01

    Ellis's rational-emotive theory postulates that since irrational statements augment emotional distress, replacing irrational with rational statements should lessen distress. This hypothesis was tested in the initial stages of psychotherapy by having 13 and 14 clinical out-patients respectively repeat for one minute either rational or irrational statements about their major presenting psychological problem. The distinction by Ellis & Harper (1975) that 'inappropriate' emotions differ qualitatively from 'appropriate' emotions was also examined. Although the experimental intervention had no effect on a post-test measure of irrational beliefs, patients repeating rational statements had significantly lower appropriate and inappropriate negative emotions at post-test, suggesting that inappropriate emotions do not differ qualitatively from appropriate emotions and that making rational statements may lower emotional distress in patients. Patients reiterating irrational statements showed no change in emotions, implying that these kinds of irrational cognitions may have already been present.

  18. Substantial reduction of inappropriate tablet splitting with computerised decision support: a prospective intervention study assessing potential benefit and harm

    Directory of Open Access Journals (Sweden)

    Quinzler Renate

    2009-06-01

    Full Text Available Abstract Background Currently ambulatory patients break one in four tablets before ingestion. Roughly 10% of them are not suitable for splitting because they lack score lines or because enteric or modified release coating is destroyed impairing safety and effectiveness of the medication. We assessed impact and safety of computerised decision support on the inappropriate prescription of split tablets. Methods We performed a prospective intervention study in a 1680-bed university hospital. Over a 15-week period we evaluated all electronically composed medication regimens and determined the fraction of tablets and capsules that demanded inappropriate splitting. In a subsequent intervention phase of 15 weeks duration for 10553 oral drugs divisibility characteristics were indicated in the system. In addition, an alert was generated and displayed during the prescription process whenever the entered dosage regimen demanded inappropriate splitting (splitting of capsules, unscored tablets, or scored tablets unsuitable for the intended fragmentation. Results During the baseline period 12.5% of all drugs required splitting and 2.7% of all drugs (257/9545 required inappropriate splitting. During the intervention period the frequency of inappropriate splitting was significantly reduced (1.4% of all drugs (146/10486; p = 0.0008. In response to half of the alerts (69/136 physicians adjusted the medication regimen. In the other half (67/136 no corrections were made although a switch to more suitable drugs (scored tablets, tablets with lower strength, liquid formulation was possible in 82% (55/67. Conclusion This study revealed that computerised decision support can immediately reduce the frequency of inappropriate splitting without introducing new safety hazards.

  19. 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.

  20. Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs.

    Science.gov (United States)

    Barnett, Mitchell J; Perry, Paul J; Langstaff, Jodi D; Kaboli, Peter J

    2006-06-01

    Inappropriate prescribing in the elderly is common, but rates across different health care systems and the impact of formulary restrictions are not well described. To determine if rates of inappropriate medication use in the elderly differ between the Veterans Affairs (VA) health care system and the private sector Medicare health maintenance organization (HMO) patients. A cross-sectional study design compared administrative pharmacy claims from 10 distinct geographic regions in the United States in the VA health care system and 10 analogous regions for patients enrolled in Medicare HMOs. The cohorts included 123,633 VA and 157,517 Medicare HMO patients aged 65 years and older. Inappropriate medication use was identified using the Zhan modification of the Beers criteria, which categorizes 33 potentially inappropriate drugs into 3 major classifications: "always avoid," "rarely appropriate," and "some indications." Comparisons between the VA health care system and the private sector Medicare HMO were performed for overall differences and stratified by gender and age. The drug formulary status of the Zhan-criteria drugs was known for the VA health system but not for the Medicare HMO patients. Compared with private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%, P private sector for males (21% vs. 24%, P private sector Medicare HMOs, elderly VA patients were less likely to receive medications defined by the Zhan criteria as potentially inappropriate. A restrictive formulary that excludes 12 of the 33 Zhan criteria drugs may be a factor in the reduction of undesired prescribing patterns in elderly populations.

  1. 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

  2. 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

    2011-01-01

    Purpose The aim of this study was to investigat the offensive efficiency of the professional handball players forming the front and rear lines. Methods Our investigation was carried out on four matches (final, semi-finals and classifying match) at the 19th 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. Results 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. Conclusion The present results demonstrate that finalist teams were found to be clearly characterized by L2 and A3 players taller and

  3. 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.

  4. Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status.

    Science.gov (United States)

    Dallazen, Camila; Silva, Sara Araújo da; Gonçalves, Vivian Siqueira Santos; Nilson, Eduardo Augusto Fernandes; Crispim, Sandra Patricia; Lang, Regina Maria Ferreira; Moreira, Júlia Dubois; Tietzmann, Daniela Cardoso; Vítolo, Márcia Regina

    2018-02-19

    The study aimed to identify factors associated with the introduction of inappropriate complementary feeding in the first year of life in children living in municipalities (counties) with low socioeconomic statusl. This was a cross-sectional multicenter study in 1,567 children 12 to 59 months of age in 48 municipalities participating in the Brazil Without Poverty plan in the South of Brazil. A structured questionnaire was applied to the children's parents to obtain socio-demographic information and the age at which inappropriate complementary foods were introduced for the first time in complementary feeding. Prevalence of introduction of sugar before four months of age was 35.5% (n = 497; 95%CI: 33.1-38.0). The prevalence rates for the introduction of cookies/crackers, creamy yogurt, and jelly before six months of age were 20.4% (n = 287; 95%CI: 18.3-22.3), 24.8% (n = 349; 95%CI: 22.4-27.1), and 13.8% (n = 192; 95%CI: 12.0-15.7), respectively. Associations were identified between low maternal schooling (PR = 1.25; 95%CI: 1.03-1.51) and low monthly family income (PR = 1.22; CI95%: 1.01-1.48) and the introduction of inappropriate complementary feeding. The study identified the introduction of inappropriate complementary feeding in the first year of life among children in municipalities with high socioeconomic vulnerability in the South of Brazil, associated with low maternal schooling and low monthly family income.

  5. 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

    2012-01-01

    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. PMID:22922913

  6. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients : A Nested Case Control Study

    NARCIS (Netherlands)

    van der Stelt, C. A K; Vermeulen Windsant-van den Tweel, A. M A; Egberts, A. C G; van den Bemt, P. M L A; Leendertse, A. J.; Hermens, W. A J J; van Marum, R. J.; Derijks, H. J.

    2016-01-01

    Introduction: Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will

  7. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study

    NARCIS (Netherlands)

    van der Stelt, C.A.K.; Vermeulen Windsant-van den Tweel, A.M.A.; Egberts, A.C.G.|info:eu-repo/dai/nl/162850050; van den Bemt, P.M.L.A.|info:eu-repo/dai/nl/151330689; Leendertse, A.J.; Hermens, W.A.J.J.; van Marum, R.J.; Derijks, Jeroen|info:eu-repo/dai/nl/304840505

    2016-01-01

    Introduction: Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will

  8. 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.

  9. [Discontinuation of potentially inappropriate medications at the end of life: perspectives from patients, their relatives, and physicians

    NARCIS (Netherlands)

    Geijteman, E.C.; Tempelman, M.M.; Dees, M.K.; Huisman, B.A.H.; Perez, R.S.; Zuylen, L. van; Heide, A. van der

    2017-01-01

    OBJECTIVE: To obtain insight into the perspectives of patients, relatives and physicians towards potentially inappropriate medications (PIMs) at the end of life. DESIGN: Qualitative interview study. METHOD: An analysis of in-depth interviews with 17 patients who were diagnosed as having a life

  10. 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.

  11. 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.

  12. Making the Tg-Confinement Effect Disappear in Thin Polystyrene Films: Good Physics vs. Inappropriate Analysis

    Science.gov (United States)

    Torkelson, John; Chen, Lawrence

    2013-03-01

    The Tg-confinement effect in polymers was first characterized in supported polystyrene (PS) films by Keddie et al. in 1994. Since then, many researchers have shown that (pseudo-)thermodynamic Tg measurements of supported PS films taken on cooling consistently yield the same qualitative results, with a decrease from bulk Tg beginning at 40-60 nm thickness and becoming very strong below 20 nm thickness. Some quantitative differences have been noted between studies, which may be ascribed to measurement method or the analysis employed. In 2004, we showed that the Tg-confinement effect in PS may be suppressed by adding several wt% of small-molecule diluents such as dioctyl phthalate. Recently, Kremer and co-workers (Macromolecules 2010, 43, 9937) reported that there was no Tg-confinement in supported PS films based on an analysis of the second derivative of ellipsometry data and use of a ninth order polynomial fit. Here, we demonstrate a new method for suppressing the Tg-confinement effect. In particular, PS made by emulsion polymerization yields no Tg-confinement effect as measured by ellipsometry or fluorescence, while PS made by anionic or conventional free radical polymerization yield strong Tg-confinement effects. The difference is hypothesized to result from surfactant in the emulsion polymerized PS. We also show that the absence of the Tg-confinement effect reported by Kremer is due to inappropriate analysis of ellipsometry data and that correct analysis yields Tg-confinement effects.

  13. An observation on inappropriate probiotic subgroup classifications in the meta-analysis by Lau and Chamberlain

    Directory of Open Access Journals (Sweden)

    McFarl

    2016-09-01

    Full Text Available Lynne V McFarland Department of Medicinal Chemistry, University of Washington, Seattle, WA, USA I read with great interest the systematic review of meta-analysis assessing probiotics for the prevention of Clostridium difficile-associated diarrhea (CDAD published in the International Journal of General Medicine. These authors pooled 26 randomized controlled trials (RCTs and concluded that Lactobacilli, mixtures, and Saccharomyces probiotics were effective in preventing CDAD. However, the meta-analysis by Lau and Chamberlain is flawed due to improper classification by the types of probiotics. It is important to recognize that the efficacy of probiotics for various diseases has been shown to be strain specific for each probiotic product, and thus the data should only be pooled for probiotics that are of the identical type. In their analysis of probiotic subgroups by various species, the authors have inappropriately merged different types of Lactobacilli into one subgroup “Lactobacilli” and different types of mixtures into one group classified as “Mix”.View the original paper by Lau and Chamberlain. 

  14. Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study.

    Science.gov (United States)

    Harun, N A; Finlay, A Y; Salek, M S; Piguet, V

    2015-09-01

    Outpatient discharge decision making in dermatology is poorly understood. To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics. Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed. The mean age of the clinicians was 48.8 years (range 33.0-67.0), 17 (43%) were men and 19 (48%) had > 20 years of clinical experience. One hundred and forty-eight influences were reported, with five main themes: (i) disease-based influences included type of diagnosis (100% of clinicians), guidelines (100%) and treatment needed (100%); (ii) clinician-based influences included the clinician's level of experience (100%), seniority (37%), emotional attitude (95%), 'gut feeling' (25%), personal attitude towards discharge (45%) and level of perception (100%); (iii) patient-based influences included patients' ability to cope with their disease (100%), wishes (70%), quality of life (32%), command of English (40%) and cultural background (25%); (iv) practice-based influences included good primary care (100%), secondary support structure (100%) and clinic capacity pressure (67%); (v) policy-based influences included pressure from hospital managers (57%) and an active discharge policy (7%). Fourteen (9%) influences were potentially inappropriate. This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence-based training to improve discharge decision appropriateness. © 2015 British Association of Dermatologists.

  15. 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.

  16. Acute motor and sensory axonal neuropathy-associated syndrome of inappropriate antidiuretic hormone secretion

    Directory of Open Access Journals (Sweden)

    Weeraporn Srisung

    2015-10-01

    Full Text Available A 36-year-old man presented with a six week history of progressive ascending weakness. Physical examination showed generalized motor weakness, more severe in the lower extremities (LE, muscle wasting, absent LE reflexes, dysesthesia, and no cranial nerve involvement. Neurologic workup was consistent with acute motor and sensory axonal neuropathy (AMSAN, a variant of Guillain-Barre syndrome. Concomitantly on admission, serum chemistry panel showed a sodium (Na 115 mmol/L with normal kidney function. Urine showed Na <20 mmol/L, and specific gravity 1.045. Urine osmolality was not available initially. He received IV fluid for volume expansion. The Na did not significantly improve after he became euvolemic. Fluid restriction was then tried with mild improvement. Endocrine work-up ruled out hypothyroidism and adrenal insufficiency. Repeat labs showed serum Na 124 mmol/L, urine Na 191 mmol/L and urine Osm 531 mOsm, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH was diagnosed. Our case report suggests that SIADH should be high on the differential diagnosis for hyponatremia in patients with AMSAN, especially in the setting of euvolemia.

  17. Reduction in inappropriate prevention of urinary tract infections in long-term care facilities.

    Science.gov (United States)

    Rummukainen, Maija-Liisa; Jakobsson, Aino; Matsinen, Maire; Järvenpää, Salme; Nissinen, Antti; Karppi, Pertti; Lyytikäinen, Outi

    2012-10-01

    Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs. A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire. The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings. The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  18. 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.

  19. Inappropriate sexual behaviours of patients towards practising physiotherapists: a study using qualitative methods.

    Science.gov (United States)

    O'Sullivan, V; Weerakoon, P

    1999-01-01

    Recent research recognizes the occurrence of inappropriate sexual behaviour (ISB) by patients towards health professionals. The objective of this study was to explore in-depth the clinical context and effect of incidents of ISB towards practising physiotherapists. In-depth interviews were conducted with a sub-sample of nine physiotherapists who were part of a larger survey on ISB. Quantitative analyses of the survey responses are reported elsewhere. Interview participants were asked to describe an incident of ISB by a patient that was either perceived to be the worst or was the most recent. They were asked questions on a variety of themes, such as their relationship with the patient prior to incident, the effects of the incident, the strategies used to deal with the incident, and changes in practice as a result of the incident. All interview participants reported encountering some level of ISB from patients. Although the overall frequency of these behaviours was relatively low, the range of behaviours was diverse. Regardless of the perceived severity of the incident, only four participants labelled their experience as 'sexual harassment'. Many reported negative effects on work performance. Participants mainly used physical measures to prevent further incidents, rather than confronting the perpetrator or reporting the incident. The findings are discussed in the context of theory pertaining to boundaries and issues of transference and counter-transference. This emphasized the need for effective communication skills training of both undergraduate and graduate physiotherapists in the prevention and management of ISB from patients.

  20. Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin.

    Science.gov (United States)

    Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B

    2012-06-01

    Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

  1. 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.

  2. 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.

  3. 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.

  4. Attributes and circumstances that induce inappropriate health services demand: a study of the health sector in Brazil.

    Science.gov (United States)

    Guimarães, Djalma S; Soares, Eduardo J O; Júnior, Gileno Ferraz; Medeiros, Denise D

    2015-02-18

    The current economic and social context has required health systems to provide top quality services and to be efficient in controlling costs. An obstacle to achieve these goals is the inappropriate health services demand. This study aims to present these inappropriate health service demand determinants from data on telephone calls made to a medical advice call centre. This study used a Brazilian medical advice call centre data sample in the period of November and December 2012 (n = 19690), which supplied data on the user's initial request, the physician's recommendation, information on the patient and circumstances (the day and time of the day of the telephone call). The convergence between user intent and medical recommendation consists in adequate demand; otherwise the divergence consists in an inadequate one. In this way, using a logistic regression model, the critical factors that determine inappropriate health services request could be estimated. In general, the user's initial intent is the most critical for the inappropriate health system demand occurrence: the greater the complexity of the patient's initial intent, the greater the chance the intent is wrong: (OR: 1.160; 95% CI: 1.113-1.210). With regard to the social characteristics, men are more likely to make inappropriate requests (OR: 1.102; 95% CI: 1038-1169); as well as youngsters are more likely to use the system incorrectly (OR = .993; 95% CI: .992 - .994). Regarding the circumstances (day and time of the call), requests in the final hours of the day and on days close to the weekend are more likely to be the inappropriate ones (OR: 1.082 for each six hour increase; 95% CI: 1.049-1.116) and weekday (OR: 1.017 for each day increase; 95% CI: 1.002-1.032). The critical profile for the inappropriate use occurrence consists of males and youngsters, who use the health service in the final hours of the day and at weekends, and mainly want to use more complex services. A practical implication of this

  5. Unpacking Cultural Variations in Social Anxiety and the Offensive-Type of Taijin Kyofusho Through the Indirect Effects of Intolerance of Uncertainty and Self-Construals

    OpenAIRE

    Zhou, Biru; Lacroix, Franca; Sasaki, Jun; Peng, Yunshi; Wang, Xia; Ryder, Andrew,

    2014-01-01

    International audience; This paper presents two studies that aim to unpack cultural variations in general social anxiety and the offensive-type of \\emph{Taijin Kyofusho} (OTKS) -- a type of social anxiety characterized by the extreme fear of offending others. Cultural variations in the expression and manifestation of social anxiety are well established; however, the mechanisms underpinning this relation are unclear. The present studies use the Parallel Multiple Mediation Model to study how so...

  6. 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...

  7. HiRITER - An evaluation tool to reduce the adverse effect of inappropriate human actions in nuclear power plants

    International Nuclear Information System (INIS)

    Park, J.; Jung, W.; Kim, J.; Kim, S.; Heo, G.

    2012-01-01

    From end-users to regulatory bodies, it is widely recognized that human-induced events including inappropriate human actions are one of the most crucial sources degrading the overall safety of nuclear power plants (NPPs). This means that a systematic framework through which inappropriate human actions can be effectively identified is necessary to enhance the safety of NPPs. For this reason, HiRITER (High Risk Inducible Task Evaluator) has been developed, which is able to evaluate the effect of inappropriate human actions on risk as well as performance. To this end, HiRITER integrates three modules that have distinctive roles: human error prediction module that is able to determine the types of failure modes resulting from inappropriate human actions with the associated daily task, performance evaluation module that computes the loss of electric power due to the change of component configurations caused by human error and risk evaluation module that clarifies whether or not the propagation of human error can trigger an unexpected shutdown of NPPs. In addition, a couple of real events that had occurred in domestic NPPs are simulated in order to validate the feasibility of HiRITER. As a result, it is observed that the results of HiRITER are largely congruent with those of real events. Therefore, although a huge amount of additional effort is indispensable to enhance the overall accuracy of estimated results, it is expected that HiRITER could be a good starting point to reduce the adverse effect of inappropriate human actions in NPPs

  8. 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.

  9. Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh

    Directory of Open Access Journals (Sweden)

    Rasu RS

    2014-12-01

    Full Text Available Rafia S Rasu,1 Mohammad Iqbal,2 SMA Hanifi,2 Ariful Moula2 Shahidul Hoque,2 Sabrina Rasheed,2 Abbas Bhuiya2 1School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA; 2Centre for Equity and Health System, International Centre for Diarrhoeal Disease Research (ICDDR,B, Dhaka, Bangladesh Objective: Village doctors, informal health care providers practicing modern medicine, are dominant health care providers in rural Bangladesh. Given their role, it is important to examine their prescription pattern and inappropriate use of medication. Methods: These cross-sectional study data were collected through surveys of patients seen by village doctors during 2008 and 2010 at Chakaria, a typical rural area of Bangladesh. Categorization of appropriate, inappropriate, and harmful prescriptions by disease conditions was based on guidelines defined by the World Health Organization (WHO, the United Nations Children’s Fund (UNICEF, and the Government of Bangladesh. Analytical categorization of polypharmacy was defined when five or more medications were prescribed for a patient at a single visit. Findings: A total of 2,587 prescriptions were written by village doctors during the survey periods. Among the prescriptions were appropriate (10%, inappropriate (8%, combination of appropriate and inappropriate (63%, and harmful medications (19%. Village doctors with more than high school education were 53% less likely (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.26–0.86 to give polypharmacy prescriptions than those with less than high school education. While exploring determinants of prescribing inappropriate and harmful medications, this study found that polypharmacy prescriptions were six times more likely [OR: 6.00, 95% CI: 3.88–9.29] to have harmful medications than prescriptions with <5 medications. Conclusion: Village doctors’ training and supervision may improve the quality of services and establish accountability for the

  10. 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 value value value value value 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

  11. Police-registered offenses and psychiatric disorders among young males : the Finnish "From a boy to a man" birth cohort study.

    Science.gov (United States)

    Elonheimo, Henrik; Niemelä, Solja; Parkkola, Kai; Multimäki, Petteri; Helenius, Hans; Nuutila, Ari-Matti; Sourander, Andre

    2007-06-01

    To study associations between crime and psychiatric disorders among adolescent males in a representative population-based cohort study. The sample includes 2,712 Finnish boys born in 1981. Information on criminality consists of offenses registered in the Finnish National Police Register 1998-2001. Crime was classified according to frequency and type (drug, violent, property, traffic, and drunk driving offenses). Information on psychiatric diagnoses between 1999 and 2004 was collected from the Finnish National Military Register. Of the 2,712 boys, 22% had a crime registration during the 4-year period, and 10% had at least one psychiatric disorder according to the Military Register. Those with psychiatric disorders accounted for 49% of all crimes. Of those with more than five crimes (n = 98), 59% had psychiatric diagnoses. After adjusting for other crime types and childhood socio-economic status, property crime was independently associated with several diagnoses: antisocial personality (APD), substance use (SUD), psychotic, anxiety, and adjustment disorders. Drug offending was independently associated with APD, SUD, and psychotic disorder, and traffic offenses with APD. Youth crime is predominantly associated with antisocial personality and substance use disorders. Crime prevention efforts should focus on boys showing a risk for antisocial and substance use problems. In particular, property, drug, and repeat offenders need mental health and substance use assessment. There is a need to develop integrated mental health and substance use treatment services for young offenders within or alongside the criminal justice system.

  12. 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.

  13. 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

  14. Treatment of the syndrome of inappropriate secretion of antidiuretic hormone by urea.

    Science.gov (United States)

    Decaux, G; Brimioulle, S; Genette, F; Mockel, J

    1980-07-01

    Recent data have shown the role of urea in the urinary concentrating mechanism. We studied the effects of exogenous urea administration in hyponatremia associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In 20 patients with SIADH, we observed a positive correlation between serum sodium and blood urea levels (r = 0.65; p less than 0.01). In one patient with an oat cell carcinoma and SIADH-induced hyponatremia, we observed the same positive correlation (r = 0.80; p less than 0.01) but also a negative one between the excreted fraction of filtered sodium and urinary urea (r = -0.67; p less than 0.001). The short-term administration of low doses of urea (4 to 10 g) resulted in correcting the "salt-losing" tendency of this patient. Longer term administration of high doses of urea (30 g/day) was attempted with the same patient as well as with a healthy volunteer subject with Pitressin-induced SIADH. in both patients, urea treatment lowered urinary sodium excretion as long as hyponatremia was significant (less than 130 meq/liter). Urea treatment also induced a persistent osmotic diuresis, allowing a normal daily intake of water despite SIADH. This was clearly shown during the long-term treatment of a third patient with SIADH who was taking 30 g urea/day during 11 weeks. It is concluded that urea is a good alternative in the treatment of patients with SIADH who presented with persistent hyponatremia despite the restriction of water intake.

  15. 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.

  16. Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults

    Directory of Open Access Journals (Sweden)

    Galli TB

    2016-12-01

    Full Text Available Background: Potentially inappropriate medication (PIM use in the elderly is associated with increased risk of adverse drug reactions (ADRs, but there is limited information regarding PIM use in the intensive care unit (ICU setting. Objective: The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly. Methods: This study enrolled all critically ill older adults (60 years or more admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records. Results: According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599, of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association. Conclusions: There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.

  17. 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.

  18. Ibuprofen Can Induce Syndrome of Inappropriate Diuresis in Healthy Young Patients

    Directory of Open Access Journals (Sweden)

    Céline Roche

    2013-01-01

    Full Text Available A 30-year-old caucasian woman, without past medical history or known drug use, was admitted to the emergency department for persistent fever and arthralgias. The laboratory analysis showed moderate hypoosmolar hyponatremia (Na: 132 mmol/L, osmolality: 239 mOsm/L, normal sodium excretion (<20 mmol/L, and a high urinary osmolality (415 mOsm/L. Later, she deteriorated with seizures and deeper hyponatremia (Na: 113 mmol/L and so was moved to the critical care unit. At first, no obvious aetiology was found, the patient was euvolemic, as she was well hydrated and lacked concerning findings of heart failure, renal disease, or liver cirrhosis. A syndrome of inappropriate diuresis (SIAD was proposed, and corrective measures were started immediately to reduce her hyponatremia, including restriction of fluid intake. The administration of intravenous hypertonic saline solution permitted normal neurological status to be restored and corrected the sodium concentration but induced reversible acute renal failure. Further investigation revealed that the patient had ingested 8 g ibuprofen two days before admission. After other aetiologies were ruled out, drug-induced SIAD due to ibuprofen was the most likely diagnosis for this patient. SIAD-associated hyponatremia and acute renal failure are rare side effects of nonsteroidal anti-inflammatory drugs, particularly in young people. Therefore, this case may represent a unique case of NSAID-induced SIAD and highlight the need to obtain thorough medication histories and exclude all other potential causes in hyponatremic patients.

  19. 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.

  20. 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

  1. A copeptin-based classification of the osmoregulatory defects in the syndrome of inappropriate antidiuresis.

    Science.gov (United States)

    Fenske, Wiebke Kristin; Christ-Crain, Mirjam; Hörning, Anna; Simet, Jessica; Szinnai, Gabor; Fassnacht, Martin; Rutishauser, Jonas; Bichet, Daniel G; Störk, Stefan; Allolio, Bruno

    2014-10-01

    Hyponatremia, the most frequent electrolyte disorder, is caused predominantly by the syndrome of inappropriate antidiuresis (SIAD). A comprehensive characterization of SIAD subtypes, defined by type of osmotic dysregulation, is lacking, but may aid in predicting therapeutic success. Here, we analyzed serial measurements of serum osmolality and serum sodium, plasma arginine vasopressin (AVP), and plasma copeptin concentrations from 50 patients with hyponatremia who underwent hypertonic saline infusion. A close correlation between copeptin concentrations and serum osmolality existed in 68 healthy controls, with a mean osmotic threshold±SD of 282±4 mOsM/kg H2O. Furthermore, saline-induced changes in copeptin concentrations correlated with changes in AVP concentrations in controls and patients. With use of copeptin concentration as a surrogate measure of AVP concentration, patients with SIAD could be grouped according to osmoregulatory defect: Ten percent of patients had grossly elevated copeptin concentrations independent of serum osmolality (type A); 14% had copeptin concentrations that increased linearly with rising serum osmolality but had abnormally low osmotic thresholds (type B); 44% had normal copeptin concentrations independent of osmolality (type C), and 12% had suppressed copeptin concentrations independent of osmolality (type D). A novel SIAD subtype discovered in 20% of patients was characterized by a linear decrease in copeptin concentrations with increasing serum osmolality (type E or "barostat reset"). In conclusion, a partial or complete loss of AVP osmoregulation occurs in patients with SIAD. Although the mechanisms underlying osmoregulatory defects in individual patients are presumably diverse, we hypothesize that treatment responses and patient outcomes will vary according to SIAD subtype. Copyright © 2014 by the American Society of Nephrology.

  2. Potentially inappropriate medication: Association between the use of antidepressant drugs and the subsequent risk for dementia.

    Science.gov (United States)

    Heser, Kathrin; Luck, Tobias; Röhr, Susanne; Wiese, Birgitt; Kaduszkiewicz, Hanna; Oey, Anke; Bickel, Horst; Mösch, Edelgard; Weyerer, Siegfried; Werle, Jochen; Brettschneider, Christian; König, Hans-Helmut; Fuchs, Angela; Pentzek, Michael; van den Bussche, Hendrik; Scherer, Martin; Maier, Wolfgang; Riedel-Heller, Steffi G; Wagner, Michael

    2018-01-15

    Potentially inappropriate medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia. We used data of a prospective cohort study of non-demented primary care patients (n = 3239, mean age = 79.62) to compute Cox proportional hazards models. The risk for subsequent dementia was estimated over eight follow-ups up to 12 years depending on antidepressant intake and covariates. The intake of antidepressants was associated with an increased risk for subsequent dementia (HR = 1.53, 95% CI: 1.16-2.02, p = .003; age-, sex-, education-adjusted). PIM antidepressants (HR = 1.49, 95% CI: 1.06-2.10, p = .021), but not other antidepressants (HR = 1.04, 95% CI: 0.66-1.66, p = .863), were associated with an increased risk for subsequent dementia (in age-, sex-, education-, and depressive symptoms adjusted models). Significant associations disappeared after global cognition at baseline was controlled for. Methodological limitations such as selection biases and self-reported drug assessments might have influenced the results. Only antidepressants considered as PIM were associated with an increased subsequent dementia risk. Anticholinergic effects might explain this relationship. The association disappeared after the statistical control for global cognition at baseline. Nonetheless, physicians should avoid the prescription of PIM antidepressants in elderly patients whenever possible. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. 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.

  4. 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.

  5. SPECIFIC ASPECTS OF THE OFFENSE OF LEAVING THE PLACE OF THE ACCIDENT

    Directory of Open Access Journals (Sweden)

    Alin-Sorin NICOLESCU

    2018-05-01

    Full Text Available The legislator has adopted the respective texts of law to the new social realities once with the repeal of the criminal segment of GEO no. 195/2002 relating to the circulation on public roads, republished and the introduction of this one in the content of the New Criminal Code. The offence of leaving the place of the accident, actually found in the content of the provisions of art. 338 of Criminal Code is one of the eight offences against the safety on public roads. Knowing important modifications, the legal text may appear relatively ambiguous if we refer to the old indictment, meaning that certain factual situations remained outside the criminal law. We will analyse in this regard the obligations that arise to the driver in case of a traffic accident, bringing into question even the decriminalization of the prohibition of the consumption of alcohol after the road event. Furthermore, we will treat even aspects related to the causes of special no imputation that, on a closer analysis, can create problems of interpretation. Through the phrase “it does not constitute the offence of leaving the place of the accident when only material damages occurred after the accident”, the legislator has chosen to indict this offence even if the victim has evaluable lesions within 1-2 days of medical care, on condition that for the same fact, in the old regulation, 10 days were required or it was an oversight of the legislator that it is to be resolved at some point?

  6. 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....

  7. The Voroshilov Lectures. Materials from the Soviet General Staff Academy. Volume 1. Issues of Soviet Military Strategy,

    Science.gov (United States)

    1989-06-01

    army defensive operation, this was the companion course to the material presented in the third semester on front offensive operations. In addition, a...center and supporting elements. Glossary 359 KOSMICHESKAIA SISTEMA Space system: A grouping of space and ground-based forces and means assigned to

  8. 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.

  9. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

    OpenAIRE

    Pauline Siew Mei Lai; Yin Yen Wong; Yong Chia Low; Hui Ling Lau; Kin-Fah Chin; Sanjiv Mahadeva

    2014-01-01

    Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hosp...

  10. Les perceptions de justice et de discrimination des candidats face à des questions inappropriées au recrutement

    OpenAIRE

    Ocana , Tania

    2017-01-01

    Applicants’ reaction research has mostly focused on fairness perceptions, but several researchers encourage the study of perceived job discrimination during the selection process, as well as specific consequences of that discrimination. In order to create a situation in which discrimination was possible, we studied the effects of inappropriate job interview questions related to a stigma on fairness and discrimination perceptions as well their impact on the recruiters’ and the organization’s i...

  11. Response to hypothetical social scenarios in individuals with traumatic brain injury who present inappropriate social behavior: a preliminary report.

    Science.gov (United States)

    Gagnon, Jean; Henry, Anne; Decoste, François-Pierre; Ouellette, Michel; McDuff, Pierre; Daelman, Sacha

    2013-03-01

    Very little research thus far has examined the decision making that underlies inappropriate social behavior (ISB) post-TBI (traumatic brain injury). To verify the usefulness of a new instrument, the Social Responding Task, for investigating whether, in social decision making, individuals with TBI, who present inappropriate social behavior (ISB), have difficulty anticipating their own feelings of embarrassment and others' angry reactions following an ISB. Seven subjects with TBI presenting with inappropriate social behavior (TBI-ISB), 10 presenting with appropriate social behavior (TBI-ASB), and 15 healthy controls were given 12 hypothetical scenarios three times, each time ending with a different behavioral response. Subjects were asked to gauge the likelihood of their displaying the behavior in that situation (part A) and of it being followed by an angry reaction from the other or by feelings of embarrassment in themselves (part B). TBI-ISB subjects scored higher than TBI-ASB and healthy controls on a scale of likelihood of displaying an ISB. RESULTS regarding expectations of angry reactions from others and feelings of embarrassment after an ISB were similar among groups. Negative correlations between endorsement of an inappropriate behavior and anticipation of negative emotional consequences were significant for both TBI-ASB and control subjects, but not for TBI-ISB subjects. RESULTS suggest that the TBI-ISB participants were likely to endorse an ISB despite being able to anticipate a negative emotional response in themselves or others, suggesting that there were other explanations for their poor behavior. A self-reported likely response to hypothetical social scenarios can be a useful approach for studying the neurocognitive processes behind the poor choices of individuals with TBI-ISB, but the task needs further validation studies. A comprehensive discussion follows on the underlying mechanisms affecting social behaviors after a TBI.

  12. Response to Hypothetical Social Scenarios in Individuals with Traumatic Brain Injury Who Present Inappropriate Social Behavior: A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Michel Ouellette

    2013-01-01

    Full Text Available Background: Very little research thus far has examined the decision making that underlies inappropriate social behavior (ISB post-TBI (traumatic brain injury. Objectives: To verify the usefulness of a new instrument, the Social Responding Task, for investigating whether, in social decision making, individuals with TBI, who present inappropriate social behavior (ISB, have difficulty anticipating their own feelings of embarrassment and others’ angry reactions following an ISB. Methods: Seven subjects with TBI presenting with inappropriate social behavior (TBI-ISB, 10 presenting with appropriate social behavior (TBI-ASB, and 15 healthy controls were given 12 hypothetical scenarios three times, each time ending with a different behavioral response. Subjects were asked to gauge the likelihood of their displaying the behavior in that situation (part A and of it being followed by an angry reaction from the other or by feelings of embarrassment in themselves (part B. Results: TBI-ISB subjects scored higher than TBI-ASB and healthy controls on a scale of likelihood of displaying an ISB. Results regarding expectations of angry reactions from others and feelings of embarrassment after an ISB were similar among groups. Negative correlations between endorsement of an inappropriate behavior and anticipation of negative emotional consequences were significant for both TBI-ASB and control subjects, but not for TBI-ISB subjects. Conclusions: Results suggest that the TBI-ISB participants were likely to endorse an ISB despite being able to anticipate a negative emotional response in themselves or others, suggesting that there were other explanations for their poor behavior. A self-reported likely response to hypothetical social scenarios can be a useful approach for studying the neurocognitive processes behind the poor choices of individuals with TBI-ISB, but the task needs further validation studies. A comprehensive discussion follows on the underlying

  13. Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

    Science.gov (United States)

    Lohman, Matthew C; Cotton, Brandi P; Zagaria, Alexandra B; Bao, Yuhua; Greenberg, Rebecca L; Fortuna, Karen L; Bruce, Martha L

    2017-12-01

    Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. Cross-sectional analysis using data from 132 home health agencies in the US. Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes

  14. A comparison of two tools to screen potentially inappropriate medication in internal medicine patients.

    Science.gov (United States)

    Blanc, A-L; Spasojevic, S; Leszek, A; Théodoloz, M; Bonnabry, P; Fumeaux, T; Schaad, N

    2018-04-01

    Potentially inappropriate medication (PIM) is an important issue for inpatient management; it has been associated with safety problems, such as increases in adverse drugs events, and with longer hospital stays and higher healthcare costs. To compare two PIM-screening tools-STOPP/START and PIM-Check-applied to internal medicine patients. A second objective was to compare the use of PIMs in readmitted and non-readmitted patients. A retrospective observational study, in the general internal medicine ward of a Swiss non-university hospital. We analysed a random sample of 50 patients, hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and compared them to a sample of 50 sex- and age-matched patients who were not readmitted. PIMs were screened using the STOPP/START tool, developed for geriatric patients, and the PIM-Check tool, developed for internal medicine patients. The time needed to perform each patient's analysis was measured. A clinical pharmacist counted and evaluated each PIM detected, based on its clinical relevance to the individual patient's case. The rates of screened and validated PIMs involving readmitted and non-readmitted patients were compared. Across the whole population, PIM-Check and STOPP/START detected 1348 and 537 PIMs, respectively, representing 13.5 and 5.4 PIMs/patient. Screening time was substantially shorter with PIM-Check than with STOPP/START (4 vs 10 minutes, respectively). The clinical pharmacist judged that 45% and 42% of the PIMs detected using PIM-Check and STOPP/START, respectively, were clinically relevant to individual patients' cases. No significant differences in the rates of detected and clinically relevant PIM were found between readmitted and non-readmitted patients. Internal medicine patients are frequently prescribed PIMs. PIM-Check's PIM detection rate was three times higher than STOPP/START's, and its screening time was shorter thanks to its electronic interface. Nearly

  15. Indicators of inappropriate tumour marker use through the mining of electronic health records.

    Science.gov (United States)

    Gion, Massimo; Cardinali, Giulia; Trevisiol, Chiara; Zappa, Marco; Rainato, Giulia; Fabricio, Aline S C

    2017-08-01

    Although the issue of monitoring appropriateness of tumour markers (TMs) request in outpatients remains crucial, proper indicators are still demanding. The present study developed and explored indicators of inappropriate TM ordering in outpatients through the data mining of electronic health records (EHRs). Carcinoembryonic antigen (CEA), alfa-fetoprotein (AFP), carbohydrate antigen (CA)125, CA15.3, CA19.9, and prostate-specific antigen (PSA) ordered in outpatients during a year were examined by mining EHRs of a Local Health Authority in Italy. Evidence-based criteria were used to develop performance indicators. Demographic and clinical information associated with TM orders were examined. A total of 80 813 TMs were ordered in 52 536 outpatients (1.54 markers/patient). Indicators related to disease codes, gender, age, and TM repetitions were developed, and their application showed that (1) CA15.3 and CEA are prevalently requested in patients with cancer (79.2% and 65.6%) whereas the other TMs are largely requested also in patients without cancer; (2) requests of PSA in women and of CA125 or CA15.3 in men are negligible; (3) although requests in people older than 80 years are relevant (16.4% of total), the highest rate of request of all markers occurs in patients aged 40 to 79 years; (4) CA15.3 and CEA are mainly requested in cancer cases between 50 and 79 years and AFP, CA19.9, and CA125 in those between 60 and 69 years; (5) associated with cancer code for all age intervals; and (6) multiple repetitions of AFP, CA125, CA15.3, CA19.9, and CEA are prevalent in cancer patients or benign diseases to which TMs are appropriate, whereas PSA repetitions occur mainly in patients without cancer. The developed indicators resulted suitable to monitor TM overordering in outpatients through the mining of EHRs. The present study is a first approach towards the use of big-data mining for TM appropriateness evaluation purposes. © 2017 John Wiley & Sons, Ltd.

  16. 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

  17. Child Labor: Global Offensive.

    Science.gov (United States)

    Sutcliffe, Peter; And Others

    1993-01-01

    Includes "An Evil Unbearable to the Human Heart" (Sutcliffe); "Fighting Indifference and Inaction" (Fromont); "Concerted International Action for Children"; "New Shelter for Street Kids of Ankara" (Fromont); "IPEC's International Program for Elimination of Child Labor Challenge to Brazilian…

  18. 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.

  19. Associations of repeated high alcohol use with unsafe driving behaviors, traffic offenses, and traffic crashes among young drivers: Findings from the New Zealand Drivers Study.

    Science.gov (United States)

    Begg, Dorothy; Brookland, Rebecca; Connor, Jennie

    2017-02-17

    The objective of this study was to describe self-reported high alcohol use at each of the 3 licensing stages of graduated driver licensing and its relationship to drink-driving behaviors, intentional risky driving, aggressive driving, alcohol traffic offenses, non-alcohol traffic offenses, and traffic crashes. The New Zealand Drivers Study (NZDS) is a multistage, prospective cohort study of newly licensed drivers interviewed at all 3 stages of the graduated driver licensing system: learner (baseline), restricted (intermediate), and full license. At each stage, alcohol use was self-reported using the Alcohol Use Disorders Identification Test (AUDIT-C), with high alcohol use defined as a score of ≥4 for males and ≥3 for females. Sociodemographic and personality data were obtained at the baseline interview. Alcohol-related, intentional risky, and aggressive driving behaviors were self-reported following each license stage. Traffic crashes and offenses were identified from police records. Crashes were also self-reported. Twenty-six percent (n = 397) reported no high alcohol use, 22% at one license stage, 30% at 2 stages, and 22% at 3 stages. Poisson regression results (unadjusted and adjusted) showed that the number of stages where high alcohol use was reported was significantly associated with each of the outcomes. For most outcomes, and especially the alcohol-involved outcomes, the relative risk increased with the number of stages of high alcohol use. We found that high alcohol use was common among young newly licensed drivers and those who repeatedly reported high alcohol use were at a significantly higher risk of unsafe driving behaviors. Recently introduced zero blood alcohol concentration (BAC) should help to address this problem, but other strategies are required to target persistent offenders.

  20. [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

  1. 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

  2. 2012 American Geriatrics Society Beers criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the Screening Tool of Older Person's Potentially Inappropriate Prescriptions.

    Science.gov (United States)

    Blanco-Reina, Encarnación; Ariza-Zafra, Gabriel; Ocaña-Riola, Ricardo; León-Ortiz, Matilde

    2014-07-01

    To determine the prevalence of potentially inappropriate medications (PIMs) and related factors through a comparative analysis of the Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP), the 2003 Beers criteria, and the 2012 AGS update of the Beers criteria. Cross-sectional. Primary care. Community-dwelling persons aged 65 and older who live on the island of Lanzarote, Spain (N = 407). Sociodemographic characteristics; independence in activities of daily living; cognitive function; Geriatric Depression Scale; clinical diagnoses; and complete data on indication, dosage, and length of drug treatments. One thousand eight hundred seventh-two prescriptions were examined, and the rate of PIMs was assessed with the three criteria. The primary endpoint was the percentage of participants receiving at least one PIM. Multivariate logistic regression was used to examine the factors related to PIMs. Potentially inappropriate medications were present in 24.3%, 35.4%, and 44% of participants, according to the 2003 Beers criteria, STOPP, and 2012 Beers criteria, respectively. The profile of PIMs was also different (the most frequent being benzodiazepines in both Beers criteria lists and aspirin in the STOPP). The number of drugs was associated with risk of prescribing PIMs in all three models, as was the presence of a psychological disorder in the 2003 Beers criteria (odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.26-3.40) and the 2012 Beers criteria (OR = 2.91, 95% CI = 1.83-4.66). The kappa for degree of agreement between STOPP and the 2012 Beers criteria was 0.35 (95% CI = 0.25-0.44). The 2012 Beers criteria detected the highest number of PIMs, and given the scant overlapping with the STOPP criteria, the use of both tools may be seen as complementary. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  3. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors.

    Science.gov (United States)

    Lai, Pauline Siew Mei; Wong, Yin Yen; Low, Yong Chia; Lau, Hui Ling; Chin, Kin-Fah; Mahadeva, Sanjiv

    2014-01-01

    Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25-75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients' demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing

  4. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

    Directory of Open Access Journals (Sweden)

    Pauline Siew Mei Lai

    2014-06-01

    Full Text Available Background. Proton pump inhibitors (PPIs are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing.Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution.Setting. Prospective audit in a tertiary hospital in Malaysia.Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients’ demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI.Main Outcome Measure. Proportion of appropriate IV PPI prescriptions.Results. Data for 106 patients were collected. Most patients were male [65(61.3%], Chinese [50(47.2%], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%] and medical [42(39.6%] departments. Only 50/106(47.2% patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9% were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8% patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%, followed by clinical pharmacists (50%, and inpatient pharmacists (37.5%, p = 0.027.Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence

  5. 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

  6. 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.

  7. 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

  8. 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 Thornvig; Tfelt-Hansen, Jacob; Jacobsen, Peter K

    2017-01-01

    Inappropriate implantable cardioverter-defibrillator (ICD) shock therapy is painful, stressful, and typically occurs unexpected in conscious patients and may be related to a less favourable prognosis. In our institution, we have observed four cases of multiple inappropriate ICD shocks during reset...... a ventricular fibrillation (VF) zone starting at 146 b.p.m., with shock therapy only and changes in sensitivity settings making the ICD more sensitive. In all cases, the reason for the multiple inappropriate shocks was that the VF zone was reached due to exercise-induced sinus tachycardia or due to oversensing...... 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...

  9. Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy.

    Science.gov (United States)

    Manckoundia, Patrick; Menu, Didier; Turcu, Alin; Honnart, Didier; Rossignol, Sylvie; Alixant, Jean-Christophe; Sylvestre, Franck-Henry; Bailly, Vanessa; Dion, Michèle; Putot, Alain

    2016-07-01

    To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions. Prospective multicenter study. Burgundy (France), EDs and medical nursing homes (MNHs). 1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013. For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), and diagnosis made in the ED. The French version of the Appropriateness Evaluation Protocol grid was applied to each admission to the ED, and in some situations, the expert committee ruled on the appropriateness of the admission to the ED. MNH characteristics were also recorded. Two groups were constituted according to the appropriateness or not of admission to the ED. Mean age of the 1000 residents was 87. There were 706 women. Two-thirds were referred to the EDs by a physician, mainly a general practitioner. In 91.7%, the transfer to the ED was organized by a medical dispatcher, and 8.8% were transported by medicalized transport. More than 95% had a GIRS ≤4. Among the admissions to EDs, 18.1% were inappropriate. Female gender (P = .017), nonmedicalized transport (P = .002), public MNH (P = .044), and nonaccess to a geriatric opinion in an emergency (P = .043) were determinants of inappropriate admission to EDs. In this first study on admissions to EDs of MNH residents using French data, we found a lower rate of admissions to the ED than that reported in the literature. Female gender, nonmedicalized transport, public MNH, and nonaccess to a geriatric opinion in an emergency were associated with inappropriate admission to EDs. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier

  10. 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.

  11. Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards.

    Science.gov (United States)

    Goulding, Lucy; Adamson, Joy; Watt, Ian; Wright, John

    2015-10-01

    Prior research suggests that the placement of patients on clinically inappropriate hospital wards may increase the risk of experiencing patient safety issues. To explore patients' perspectives of the quality and safety of the care received during their inpatient stay on a clinically inappropriate hospital ward. Qualitative study using semi-structured interviews. Nineteen patients who had spent time on at least one clinically inappropriate ward during their hospital stay at a large NHS teaching hospital in England. Patients would prefer to be treated on the correct specialty ward, but it is generally accepted that this may not be possible. When patients are placed on inappropriate wards, they may lack a sense of belonging. Participants commented on potential failings in communication, medical staff availability, nurses' knowledge and the resources available, each of which may contribute to unsafe care. Patients generally acknowledge the need for placement on inappropriate wards due to demand for inpatient beds, but may report dissatisfaction in terms of preference and belonging. Importantly, patients recount issues resulting from this placement that may compromise their safety. Hospital managers should be encouraged to appreciate this insight and potential threat to safe practice and where possible avoid inappropriate ward transfers and admissions. Where such admissions are unavoidable, staff should take action to address the gaps in safety of care that have been identified. © 2013 John Wiley & Sons Ltd.

  12. Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression.

    Science.gov (United States)

    Guligowska, Agnieszka; Pigłowska, Małgorzata; Fife, Elizaveta; Kostka, Joanna; Sołtysik, Bartłomiej K; Kroc, Łukasz; Kostka, Tomasz

    2016-01-01

    The study is a case-control analysis of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a relationship between nutrient deficiencies and these adverse changes. A total of 130 older subjects participated in the study: 65 with diagnosed depression (16 men and 49 women) and 65 age- and sex-matched controls without depression. All patients underwent comprehensive geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment, cognitive performance was evaluated by the Mini-Mental State Examination and physical functioning by the Timed "Up & Go" test and handgrip strength. The pattern of consumption of various nutrients was analyzed in detail. The differences in cognitive functioning observed between the groups were related to specific nutrient intake, as was handgrip strength to some extent. The differences in nutritional status, several functional tests and muscle strength were related to both the presence of depression and inappropriate consumption of certain nutrients. The incidence of falls and poor quality of life may be partially associated with the presence of depression. The inappropriate intake of selected nutrients may impair the functioning and quality of life of older adults with depression, such as the excess consumption of sucrose and insufficient consumption of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients should be translated into dietary patterns which allow the individual patient to address these nutrient deficiencies.

  13. 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.

  14. 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.

  15. Inappropriately low aldosterone concentrations in adults with AIDS-related diarrhoea in Zambia: a study of response to fluid challenge

    Directory of Open Access Journals (Sweden)

    Lumayi Ruth

    2008-04-01

    Full Text Available Abstract Background Chronic diarrhoea is one of the most debilitating consequences of HIV infection in sub-Saharan Africa and it carries a high mortality rate. We report unexpectedly low concentrations of circulating aldosterone in 12 patients (6 men, 6 women in the University Teaching Hospital, Lusaka, who all had diarrhoea for over one month. Changes in serum electrolytes, blood pressure, Karnofsky score and serum aldosterone concentration were being monitored during a short study of responses to saline infusion (3 litres/24 h over 72 hours. Findings At baseline, 9/12 (75% of the patients were hyponatraemic, 10/11 (91% were hypokalaemic, and 6/12 (50% had undetectable aldosterone concentrations. Blood pressure and Karnofsky score rose and creatinine concentration fell in response to the infusion. Conclusion Circulating aldosterone concentrations were inappropriately low and complicate the profound electrolyte deficiencies resulting from chronic diarrhoea. Management of these deficiencies needs to be more aggressive than is currently practised and consideration should be given to a formal clinical trial of mineralocorticoid replacement in these severely ill patients. If the inappropriately low aldosterone reflects a general adrenal failure, it may explain a considerable proportion of the high mortality seen both before and after initiation of anti-retroviral therapy.

  16. 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

  17. 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

  18. Prohibition of Turning to a Worse Scenario in Judicial Activity: on the Example of Consideration of the Cases on Administrative Offenses

    Directory of Open Access Journals (Sweden)

    Evgenii V. Taribo

    2017-12-01

    Full Text Available The article explores the prohibition of turning to a worse: how it is enshrined in the legislation on administrative violations, and how it manifests its effect in judicial practice. As analysis of legislation and judicial practice shows, courts of general jurisdiction and arbitration courts differently understand and apply this prohibition. This is due to the different legislative and organizational bases on which the process of bringing to administrative responsibility is based, in which courts of general and arbitration jurisdictions are involved. The article notes that the provisions of the draft of the new Code on Administrative Offenses, developed by the State Duma of the 6th convocation, point to a possible reduction of the scope of this ban. In this regard, the author comes to the conclusion that the legislator and the courts are to decide on a conceptually unified approach to the problem of the prohibition of turning to the worst in the field of administrative responsibility

  19. 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'.

  20. A patient who sufferred pulmonary tuberculosis with syndrome of inappropriate secretion of antidiuretic hormone, after radiotherapy for pulmonary adenocarcinoma

    International Nuclear Information System (INIS)

    Kobayashi, Kashin; Horiguchi, Takahiko; Hata, Hideharu; Sasaki, Yasushi; Hirose, Masahiro; Shiga, Mamoru; Kondo, Rieko; Tachikawa, Souichi

    2007-01-01

    A 62-year-old man presented in June 2006 with right thoracic pain, cough, and weight loss, which had persisted for 3 months. Chest X-ray showed a mass-like shadow in the right pulmonary apex, suggesting a stage IIIb adenocarcinoma which was confirmed by biopsy. We gave a total radiation dose of 60 Gy, after this which general malaise and weakness were noted. The results of endocrinological examinations suggested syndrome of inappropriate antidiuretic hormone secretion (SIADH). Thoracic CT showed ground-glass opacity (GGO) in both lungs, and we could not rule out pulmonary tuberculosis. A sputum was positive for acid-fast stain and polymerase polymerase chain reaction-Tuberculosa (PCR-Tb), suggesting that SIADH was associated with pulmonary tuberculosis. Water restriction, i.v. physiological saline, and anti-tuberculosis therapy relieved hyponatremia and the symptoms. (author)

  1. Can Physicians Identify Inappropriate Nuclear Stress Tests? An Examination of Inter-rater Reliability for the 2009 Appropriate Use Criteria for Radionuclide Imaging

    Science.gov (United States)

    Ye, Siqin; Rabbani, LeRoy E.; Kelly, Christopher R.; Kelly, Maureen R.; Lewis, Matthew; Paz, Yehuda; Peck, Clara L.; Rao, Shaline; Bokhari, Sabahat; Weiner, Shepard D.; Einstein, Andrew J.

    2014-01-01

    Background We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria (AUC) for radionuclide imaging (RNI) and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Methods and Results Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 AUC. Consensus classification by two cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests was calculated. Inter-rater reliability of the AUC was assessed using Cohen’s kappa statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 NSTs as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for non-cardiologist raters was modest (unweighted Cohen’s kappa, 0.51, 95% confidence interval, 0.45 to 0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%. Conclusions Inter-rater reliability for the 2009 AUC for RNI is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. PMID:25563660

  2. 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.

  3. Interaction between shock coils increased the incidence of inappropriate therapies and lead failure in implantable cardioverter defibrillator.

    Science.gov (United States)

    El Garhy, Mohammad; Ohlow, Marc-Alexander; Lauer, Bernward

    Shock coil interaction in patients with multiple implantable cardioverter defibrillator (ICD) leads is occasionally observed. We aimed to evaluate the incidence of shock coil interaction and its clinical relevance. All ICD patients (646 patients) who came to follow up control in our ICD ambulance between January 1, 2011, and December 31, 2011 in the department of cardiology in Bad Berka hospital were retrospectively evaluated in this study. All baseline demographic, clinical, and procedural characteristics and postoperative chest x ray in postero-anterior and lateral view as well as clinical and ICD follow up data were evaluated. Among 646 patients 42 had multiple ICD leads (6.5%) of whom 36 patients (5.5% of total cohort patients and 85.7% of patients with multiple ICD leads) had shock coil interaction and presented the study group (Group I). The control group (Group II) consisted of 610 patients without coil-coil interaction including patients with single shock lead (604 patients) or patients with multiple leads but without interaction between shock coils (6 patients). Inappropriate anti-tachycardia therapies and RV lead revisions were more frequent in patients with interaction between shock coils (Group I vs Group II: 27.7% and 5.7%; p = 0.049 and 30.6% vs 6.4; p = 0.0001, respectively). Interaction between shock coils may be one of possible causes of lead failure and resulted in inappropriate therapies and subsequent lead revision. Copyright © 2018 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

  4. Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression

    Directory of Open Access Journals (Sweden)

    Guligowska A

    2016-10-01

    Full Text Available Agnieszka Guligowska,1 Małgorzata Pigłowska,1 Elizaveta Fife,1 Joanna Kostka,2 Bartłomiej K Sołtysik,1 Łukasz Kroc,1 Tomasz Kostka1 1Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Lodz, Poland; 2Department of Physical Medicine, Medical University of Lodz, Lodz, Poland Objectives: The study is a case-control analysis of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a relationship between nutrient deficiencies and these adverse changes.Patients and methods: A total of 130 older subjects participated in the study: 65 with diagnosed depression (16 men and 49 women and 65 age- and sex-matched controls without depression. All patients underwent comprehensive geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment, cognitive performance was evaluated by the Mini-Mental State Examination and physical functioning by the Timed “Up & Go” test and handgrip strength. The pattern of consumption of various nutrients was analyzed in detail.Results: The differences in cognitive functioning observed between the groups were related to specific nutrient intake, as was handgrip strength to some extent. The differences in nutritional status, several functional tests and muscle strength were related to both the presence of depression and inappropriate consumption of certain nutrients.Conclusion: The incidence of falls and poor quality of life may be partially associated with the presence of depression. The inappropriate intake of selected nutrients may impair the functioning and quality of life of older adults with depression, such as the excess consumption of sucrose and insufficient consumption of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients should be translated into dietary patterns which allow the individual patient to address these nutrient deficiencies. Keywords: aging, cognitive

  5. 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

    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.

  6. 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.

  7. 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.

  8. 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

  9. Incorporating Local Culture in English Teaching Material for Undergraduate Students

    Directory of Open Access Journals (Sweden)

    Wijaya Mahardika I Gusti Ngurah Agung

    2018-01-01

    Full Text Available This paper discusses the incorporation of local cultural material in a teaching material developed for the students of the Hinduism Education Department of IHDN Denpasar. Teaching material plays an important part in teaching learning process, yet inappropriate teaching materials may become more harmful than useful. The unique nature of the HED students warranted the need for a tailor-made teaching material. The study found that the use of culturally familiar materials is beneficial for the students learning process. The result of the study also highlighted students’ needs and prior knowledge as the main factors to be considered when developing teaching material.

  10. 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

  11. 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

  12. 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

  13. 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

  14. Radiation sterilization of plastic packing materials and aseptic packaging

    International Nuclear Information System (INIS)

    Tokuoka, Keiko

    1986-01-01

    In the present day of 'satiation', quality, not quantity, is emphasized for foods, the consumers being oriented toward raw and healthy foodstuff. Aseptic Packaging is excellent means of conservation. While conventionally chemicals have been used for sterilization of packing materials for aseptic packaging, the sterilization by radiation is used in part recently. The following are described : history of aseptic packaging and its features, sterilization by radiation, γ-ray sterilization of large-sized containers, the development of an aseptic packaging system using electron rays, the occurrence of offensive odors from packing materials (comparison of odors from various materials, volatile substances occurring in irradiated polyethylene, influence of film grade upon the formation of carboxylic acid, influence of the irradiation conditions upon the occurrences of volatile substances, volatile substances occurring in the irradiation of bag-in-box packing materials), changes in properties of the packing materials. (Mori, K.)

  15. 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.

  16. Variety Is Not the Spice of Life for People with Autism Spectrum Disorders: Frequency Ratings of Central, Variable and Inappropriate Aspects of Common Real-Life Events

    Science.gov (United States)

    Loth, Eva; Happe, Francesca; Gomez, Juan Carlos

    2010-01-01

    This study used a novel rating task to investigate whether high-functioning individuals with autism spectrum disorder (ASD) have difficulties distinguishing essential from variable aspects of familiar events. Participants read stories about everyday events and judged how often central, variable, and inappropriate event-components normally occur in…

  17. Risk of iatrogenic human immunodeficiency virus infection through transfusion of blood tested by inappropriately stored or expired rapid antibody assays in a Zambian hospital

    NARCIS (Netherlands)

    Consten, E. C.; van der Meer, J. T.; de Wolf, F.; Heij, H. A.; Henny, P. C.; van Lanschot, J. J.

    1997-01-01

    BACKGROUND: The purpose of this study was to estimate the risk of human immunodeficiency virus (HIV) infection via the transfusion of blood tested by inappropriately stored or expired rapid antibody assays in Zambia. STUDY DESIGN AND METHODS: Surgical patients (n = 370) were tested with antibody

  18. 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.

  19. 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…

  20. Foodborne Infectious Diseases Mediated by Inappropriate Infection Control in Food Service Businesses and Relevant Countermeasures in Korea.

    Science.gov (United States)

    Park, Jong Myong; You, Young-Hyun; Cho, Hyun-Min; Hong, Ji Won; Ghim, Sa-Youl

    2017-06-01

    The objective of this review is to propose an appropriate course of action for improving the guidelines followed by food handlers for control of infection. For this purpose, previous epidemiological reports related to acute gastroenteritis in food service businesses mediated by food handlers were intensively analyzed. Relevant studies were identified in international databases. We selected eligible papers reporting foodborne infectious disease outbreaks. Among primary literature collection, the abstract of each article was investigated to find cases that absolutely identified a causative factor to be food handlers' inappropriate infection control and the taxon of causative microbial agents by epidemiological methodologies. Information about the sites (type of food business) where the outbreaks occurred was investigated. A wide variety of causative microbial agents has been investigated, using several epidemiological methods. These agents have shown diverse propagation pathways based on their own molecular pathogenesis, physiology, taxonomy, and etiology. Depending on etiology, transmission, propagation, and microbiological traits, we can predict the transmission characteristics of pathogens in food preparation areas. The infected food workers have a somewhat different ecological place in infection epidemiology as compared to the general population. However, the current Korean Food Safety Act cannot propose detailed guidelines. Therefore, different methodologies have to be made available to prevent further infections.

  1. [Individualized restorative designs and clinical evaluation for dental implants in the anterior esthetic zone with inappropriate conditions].

    Science.gov (United States)

    Dai, Wen-yong; Zhou, Guo-xing; Zhang, Xiao-zhen; Zhao, Yi; Wang, Jie; Yang, Yi; Zhu, Zhi-jun; Tang, Chun-bo

    2014-08-01

    To offer individualized restorative strategies for patients receiving dental implants in the anterior esthetic zone but with inappropriate available conditions and evaluate the clinical outcomes. Forty-six patients with 58 implants were recruited for the study in accordance with the criteria and received individualized implant prostheses in the anterior esthetic zone. The patients were followed up for 3-24 months, and the clinical outcomes were evaluated by pink and white esthetic scores (PES/WES). The patients were from 18 to 69 years old, and followed up for 12.6 months in average. According to the third month follow-up esthetic scores, for PES, 1.72% of the patients got low scores, 44.83% got medium scores and 53.45% got high scores; For WES, 0% got low scores, 20.69% got medium scores and 79.31% got high scores. No implant failure or peri-implantitis occurred. Individualized restorative designs for implants in the esthetic zone can effectively improve the appearance of the prostheses which originally have no appropriate available space. Close follow-up and monitoring of the peri-implant soft tissue and proper oral hygiene instructions are important to ensure the conditions of the prostheses.

  2. 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.

  3. 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.

  4. What happens if we compare chopsticks with forks? The impact of making inappropriate comparisons in cross-cultural research.

    Science.gov (United States)

    Chen, Fang Fang

    2008-11-01

    It is a common practice to export instruments developed in one culture to another. Little is known about the consequences of making inappropriate comparisons in cross-cultural research. Several studies were conducted to fill in this gap. Study 1 examined the impact of lacking factor loading invariance on regression slope comparisons. When factor loadings of a predictor are higher in the reference group (e.g., United States), for which the scale was developed, than in the focal group (e.g., China), into which the scale was imported, the predictive relationship (e.g., self-esteem predicting life satisfaction) is artificially stronger in the reference group but weaker in the focal group, creating a bogus interaction effect of predictor by group (e.g., self-esteem by culture); the opposite pattern is found when the reference group has higher loadings in an outcome variable. Studies 2 and 3 examined the impact of lacking loading and intercept (i.e., point of origin) invariance on factor means, respectively. When the reference group has higher loadings or intercepts, the mean is overestimated in that group but underestimated in the focal group, resulting in a pseudo group difference. (c) 2008 APA, all rights reserved.

  5. 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.

  6. Inappropriate requests from patients

    African Journals Online (AJOL)

    doctors continue to provide these patients with life-sustaining .... mentally different judgments about the best interests of ... ed suicide is legal. While it is clear ... Epidemiological studies have mainly been used to assess the risk of lung cancer in ...

  7. 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

  8. Using the Violence Risk Scale-Sexual Offense version in sexual violence risk assessments: Updated risk categories and recidivism estimates from a multisite sample of treated sexual offenders.

    Science.gov (United States)

    Olver, Mark E; Mundt, James C; Thornton, David; Beggs Christofferson, Sarah M; Kingston, Drew A; Sowden, Justina N; Nicholaichuk, Terry P; Gordon, Audrey; Wong, Stephen C P

    2018-04-30

    The present study sought to develop updated risk categories and recidivism estimates for the Violence Risk Scale-Sexual Offense version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003-2017), a sexual offender risk assessment and treatment planning tool. The overarching purpose was to increase the clarity and accuracy of communicating risk assessment information that includes a systematic incorporation of new information (i.e., change) to modify risk estimates. Four treated samples of sexual offenders with VRS-SO pretreatment, posttreatment, and Static-99R ratings were combined with a minimum follow-up period of 10-years postrelease (N = 913). Logistic regression was used to model 5- and 10-year sexual and violent (including sexual) recidivism estimates across 6 different regression models employing specific risk and change score information from the VRS-SO and/or Static-99R. A rationale is presented for clinical applications of select models and the necessity of controlling for baseline risk when utilizing change information across repeated assessments. Information concerning relative risk (percentiles) and absolute risk (recidivism estimates) is integrated with common risk assessment language guidelines to generate new risk categories for the VRS-SO. Guidelines for model selection and forensic clinical application of the risk estimates are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  9. 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

  10. 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

  11. 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.

  12. Usage of Video Analysis of Traffic Conflicts for the Evaluation of Inappropriately Designed Building Elements on Intersections

    Science.gov (United States)

    Krivda, Vladislav; Petru, Jan

    2018-04-01

    Human society is constantly evolving in all areas. The transport is no exception – especially development of road transport is considerable and visible on all levels. However, it is necessary to look for tools that can harmonize economic and social progress with the full preservation of the environment for future generations. The so-called sustainable development of road transport is also closely related to the issue of creating safe transport infrastructure. For example, roads must be in compliance with technical rules on one hand and on the other one they have to be clearly understandable for all road participants (drivers, pedestrians, etc.). Unfortunately, even if the designer of transport construction meets the technical requirements, the result is a dangerous place where very frequently the accidents or traffic conflicts take place. There exist statistics of accidents, but on the contrary, there are not any statistics of traffic conflicts. And simply monitoring the traffic conflicts can lead to early detection of problematic places in road infrastructure and thus increasing the safety in the road traffic. There are many methods used for monitoring traffic conflicts. The method used in the Czech Republic is described in the submitted paper. The original method, which monitored mainly and only the behaviour of drivers and their mistakes, was innovated, so that it could be used also for evaluation of inappropriately designed building elements of road constructions. Therefore, the paper deals with the description of so-called Innovated Video Analysis of Traffic Conflicts (IVATC) and with the usage of this method for one particular example of intersection, where larger vehicles (buses, trucks, etc.) had problems with passing through it. It points out to the fact that even a relatively small change can lead to the increase of the road safety.

  13. 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.

  14. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis.

    Science.gov (United States)

    Anderson, Kristen; Stowasser, Danielle; Freeman, Christopher; Scott, Ian

    2014-12-08

    To synthesise qualitative studies that explore prescribers' perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. All healthcare settings. Medical and non-medical prescribers of medicines to adults. Prescribers' perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. 21 studies were included; most explored primary care physicians' perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. A multitude of highly interdependent factors shape prescribers' behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the

  15. Predictors of initiation and persistence of recurrent binge eating and inappropriate weight compensatory behaviors in college men.

    Science.gov (United States)

    Dakanalis, Antonios; Clerici, Massimo; Caslini, Manuela; Gaudio, Santino; Serino, Silvia; Riva, Giuseppe; Carrà, Giuseppe

    2016-06-01

    The transition to college is considered as a risk period for the development of behavioral symptoms of eating disorders (BSEDs) and some evidence suggests that, amongst men, these symptoms occurring on a regular basis remain relatively stable over the college period. Nevertheless, little is known about factors associated with persistent engagement in and initiation of recurrent (or regular) binge eating and inappropriate weight compensatory behaviors in this population. The objective of this report was to address these research gaps. Data were examined from 2,555 male first-year college students who completed an assessment of potential vulnerability factors and BSEDs at the beginning of the autumn semester (baseline) and nine months later (end of the spring semester; follow-up). Elevated negative affectivity, body dissatisfaction, self-objectification, and lower self-esteem at baseline were predictive of persistent engagement in regular binge eating and four compensatory behaviors (self-induced vomiting, laxative/diuretic abuse, fasting, exercise) at follow-up, as well as initiation of all these behaviors occurring regularly (i.e., at least weekly for 3 months). Self-objectification (thinking and monitoring the body's outward appearance from a third-person perspective) emerged as the largest contributor of both the initiation and persistence of all behavioral symptoms. Data emphasize that the same psychological factors underlie initiation and persistence of recurrent BSEDs and should shape the focus of future interventions for college men. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:581-590). © 2016 Wiley Periodicals, Inc.

  16. 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.

  17. Use of posttreatment imaging and biomarkers in survivors of early-stage breast cancer: Inappropriate surveillance or necessary care?

    Science.gov (United States)

    Hahn, Erin E; Tang, Tania; Lee, Janet S; Munoz-Plaza, Corrine E; Shen, Ernest; Rowley, Braden; Maeda, Jared L; Mosen, David M; Ruckdeschel, John C; Gould, Michael K

    2016-03-15

    Advanced imaging and serum biomarkers are commonly used for surveillance in patients with early-stage breast cancer, despite recommendations against this practice. Incentives to perform such low-value testing may be less prominent in integrated health care delivery systems. The purpose of the current study was to evaluate and compare the use of these services within 2 integrated systems: Kaiser Permanente (KP) and Intermountain Healthcare (IH). The authors also sought to distinguish the indication for testing: diagnostic purposes or routine surveillance. Patients with American Joint Committee on Cancer stage 0 to II breast cancer diagnosed between 2009 and 2010 were identified and the use of imaging and biomarker tests over an 18-month period were quantified, starting at 1 year after diagnosis. Chart abstraction was performed on a random sample of patients who received testing to identify the indication for testing. Multivariate regression was used to explore associations with the use of nonrecommended care. A total of 6585 patients were identified; 22% had stage 0 disease, 44% had stage I disease, and 34% had stage II disease. Overall, 24% of patients received at least 1 imaging test (25% at KP vs 22% at IH; P = .009) and 28% of patients received at least 1 biomarker (36% at KP vs 13% at IH; Ptests were performed to evaluate symptoms or signs. Virtually all biomarkers were ordered for routine surveillance. Stage of disease, medical center that provided the services, and provider experience were found to be significantly associated with the use of biomarkers. Advanced imaging was most often performed for appropriate indications, but biomarkers were used for nonrecommended surveillance. Distinguishing between inappropriate use for surveillance and appropriate diagnostic testing is essential when evaluating adherence to recommendations. © 2015 American Cancer Society.

  18. 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.

  19. Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

    Science.gov (United States)

    Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

    2018-03-01

    Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. The U.S. Air Force Academy Lacked Effective Controls Over Heritage Assets and Guest House Inventories, and Inappropriately Solicited and Accepted Monetary Gifts

    Science.gov (United States)

    2013-09-23

    Inventories, and Inappropriately Solicited and Accepted Monetary Gifts Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden...Accepted Monetary Gifts 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK...Monetary Gifts Objective We determined whether the U.S. Air Force Academy (USAFA), its nonappropriated fund instrumentalities (NAFIs), and its supporting

  7. 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.

  8. The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

    Science.gov (United States)

    Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

    2014-10-01

    Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS

  9. Reducing inappropriate non-steroidal anti-inflammatory prescription in primary care patients with chronic kidney disease.

    Science.gov (United States)

    Keohane, David M; Dennehy, Thomas; Keohane, Kenneth P; Shanahan, Eamonn

    2017-08-14

    Purpose The purpose of this paper is to reduce inappropriate non-steroidal anti-inflammatory prescribing in primary care patients with chronic kidney disease (CKD). Once diagnosed, CKD management involves delaying progression to end stage renal failure and preventing complications. It is well established that non-steroidal anti-inflammatories have a negative effect on kidney function and consequently, all nephrology consensus groups suggest avoiding this drug class in CKD. Design/methodology/approach The sampling criteria included all practice patients with a known CKD risk factor. This group was refined to include those with an estimated glomerular filtration rate (eGFR)<60 ml/min per 1.73m2 (stage 3 CKD or greater). Phase one analysed how many prescriptions had occurred in this group over the preceding three months. The intervention involved creating an automated alert on at risk patient records if non-steroidal anti-inflammatories were prescribed and discussing the rationale with practice staff. The re-audit phase occurred three months' post intervention. Findings The study revealed 728/7,500 (9.7 per cent) patients at risk from CKD and 158 (2.1 per cent) who were subsequently found to have an eGFR<60 ml/min, indicating=stage 3 CKD. In phase one, 10.2 per cent of at risk patients had received a non-steroidal anti-inflammatory prescription in the preceding three months. Additionally, 6.2 per cent had received non-steroidal anti-inflammatories on repeat prescription. Phase two post intervention revealed a significant 75 per cent reduction in the total non-steroidal anti-inflammatories prescribed and a 90 per cent reduction in repeat non-steroidal anti-inflammatory prescriptions in those with CKD. Originality/value The study significantly reduced non-steroidal anti-inflammatory prescription in those with CKD in primary care settings. It also created a CKD register within the practice and an enduring medication alert system for individuals that risk nephrotoxic

  10. Implementation of a Computerized Order Entry Tool to Reduce the Inappropriate and Unnecessary Use of Cardiac Stress Tests With Imaging in Hospitalized Patients.

    Science.gov (United States)

    Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Balderston, Jessica R; Litwack, Andrew J; Goldberg, Lee R

    2016-10-15

    The rising use of imaging cardiac stress tests has led to potentially unnecessary testing. Interventions designed to reduce inappropriate stress testing have focused on the ambulatory setting. We developed a computerized order entry tool intended to reduce the use of imaging cardiac stress tests and improve appropriate use in hospitalized patients. The tool was evaluated using preimplementation and postimplementation cohorts at a single urban academic teaching hospital. All hospitalized patients referred for testing were included. The co-primary outcomes were the use of imaging stress tests as a percentage of all stress tests and the percentage of inappropriate tests, compared between the 2 cohorts. There were 478 patients in the precohort and 463 in the postcohort. The indication was chest pain in 66% and preoperative in 18% and was not significantly different between groups. The use of nonimaging stress tests increased from 4% in the pregroup to 15% in the postgroup (p nonimaging stress tests increased from 7% to 25% (p nonimaging cardiac stress tests and reduced the use of imaging tests yet was not able to reduce inappropriate use. Our study highlights the differences in cardiac stress testing between hospitalized and ambulatory patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study.

    Science.gov (United States)

    O Riordan, David; Aubert, Carole Elodie; Walsh, Kieran A; Van Dorland, Anette; Rodondi, Nicolas; Du Puy, Robert S; Poortvliet, Rosalinde K E; Gussekloo, Jacobijn; Sinnott, Carol; Byrne, Stephen; Galvin, Rose; Jukema, J Wouter; Mooijaart, Simon P; Baumgartner, Christine; McCarthy, Vera; Walsh, Elaine K; Collet, Tinh-Hai; Dekkers, Olaf M; Blum, Manuel R; Kearney, Patricia M

    2018-03-22

    To estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries. A secondary analysis of the Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial dataset. A subset of 48/80 PIP and 22/34 PPOs indicators from the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria were applied to prescribed medication data for 532/737 trial participants in Ireland, Switzerland and the Netherlands. The overall prevalence of PIP was lower in the Irish participants (8.7%) compared with the Swiss (16.7%) and Dutch (12.5%) participants (P=0.15) and was not statistically significant. The overall prevalence of PPOs was approximately one-quarter in the Swiss (25.3%) and Dutch (24%) participants and lower in the Irish (14%) participants (P=0.04) and the difference was statistically significant. The hypnotic Z-drugs were the most frequent PIP in Irish participants, (3.5%, n=4), while it was non-steroidal anti-inflammatory drug and oral anticoagulant combination, sulfonylureas with a long duration of action, and benzodiazepines (all 4.3%, n=7) in Swiss, and benzodiazepines (7.1%, n=18) in Dutch participants. The most frequent PPOs in Irish participants were vitamin D and calcium in osteoporosis (3.5%, n=4). In the Swiss and Dutch participants, they were bone antiresorptive/anabolic therapy in osteoporosis (9.9%, n=16, 8.6%, n=22) respectively. The odds of any PIP after adjusting for age, sex, multimorbidity and polypharmacy were (adjusted OR (aOR)) 3.04 (95% CI 1.33 to 6.95, P<0.01) for Swiss participants and aOR 1.74 (95% CI 0.79 to 3.85, P=0.17) for Dutch participants compared with Irish participants. The odds of any PPOs were aOR 2.48 (95% CI 1.27 to 4.85, P<0.01) for Swiss participants and aOR 2.10 (95% CI 1.11 to 3.96, P=0

  12. De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study.

    Science.gov (United States)

    Laan, Bart J; Spijkerman, Ingrid J B; Godfried, Mieke H; Pasmooij, Berend C; Maaskant, Jolanda M; Borgert, Marjon J; Opmeer, Brent C; Vos, Margreet C; Geerlings, Suzanne E

    2017-01-10

    Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy. In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated. This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications. Dutch trial registry: NTR6015 . Registered 9 August 2016.

  13. 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.

  14. Morvan's syndrome with anti contactin associated protein like 2 – voltage gated potassium channel antibody presenting with syndrome of inappropriate antidiuretic hormone secretion

    Directory of Open Access Journals (Sweden)

    Anjani Kumar Sharma

    2016-01-01

    Full Text Available Morvan's syndrome is a rare autoimmune disorder characterized by triad of peripheral nerve hyperexcitability, autonomic dysfunction, and central nervous system symptoms. Antibodies against contactin-associated protein-like 2 (CASPR2, a subtype of voltage-gated potassium channel (VGKC complex, are found in a significant proportion of patients with Morvan's syndrome and are thought to play a key role in peripheral as well as central clinical manifestations. We report a patient of Morvan's syndrome with positive CASPR2–anti-VGKC antibody having syndrome of inappropriate antidiuretic hormone as a cause of persistent hyponatremia.

  15. 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

  16. Material Science

    Energy Technology Data Exchange (ETDEWEB)

    Won, Dong Yeon; Kim, Heung

    1987-08-15

    This book introduces material science, which includes key of a high-tech industry, new materials of dream like new metal material and semiconductor, classification of materials, microstructure of materials and characteristic. It mentions magic new materials such as shape memory alloy, fine ceramics, engineering fine ceramics, electronic ceramics, engineering plastic, glass, silicone conductor, optical fiber mixed materials and integrated circuit, challenge for new material and development of new materials.

  17. Material Science

    International Nuclear Information System (INIS)

    Won, Dong Yeon; Kim, Heung

    1987-08-01

    This book introduces material science, which includes key of a high-tech industry, new materials of dream like new metal material and semiconductor, classification of materials, microstructure of materials and characteristic. It mentions magic new materials such as shape memory alloy, fine ceramics, engineering fine ceramics, electronic ceramics, engineering plastic, glass, silicone conductor, optical fiber mixed materials and integrated circuit, challenge for new material and development of new materials.

  18. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries.

    Science.gov (United States)

    Renom-Guiteras, Anna; Meyer, Gabriele; Thürmann, Petra A

    2015-07-01

    The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people, which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice. A preliminary PIM list was developed, based on the German PRISCUS list of potentially inappropriate medications and other PIM lists from the USA, Canada and France. Thirty experts on geriatric prescribing from Estonia, Finland, France, the Netherlands, Spain and Sweden participated; eight experts performed a structured expansion of the list, suggesting further medications; twenty-seven experts participated in a two-round Delphi survey assessing the appropriateness of drugs and suggesting dose adjustments and therapeutic alternatives. Finally, twelve experts completed a brief final survey to decide upon issues requiring further consensus. Experts reached a consensus that 282 chemical substances or drug classes from 34 therapeutic groups are PIM for older people; some PIM are restricted to a certain dose or duration of use. The PIM list contains suggestions for dose adjustments and therapeutic alternatives. The European Union (EU)(7)-PIM list is a screening tool, developed with participation of experts from seven European countries, that allows identification and comparison of PIM prescribing patterns for older people across European countries. It can also be used as a guide in clinical practice, although it does not substitute the decision-making process of individualised prescribing for older people. Further research is needed to investigate the feasibility and applicability and, finally, the clinical benefits of the newly developed list.

  19. Inactivation of the infralimbic prefrontal cortex in rats reduces the influence of inappropriate habitual responding in a response-conflict task.

    Science.gov (United States)

    Haddon, J E; Killcross, S

    2011-12-29

    Previous research suggests the infralimbic cortex is important in situations when there is competition between goal-directed and habitual responding. Here we used a response conflict procedure to further explore the involvement of the infralimbic cortex in this relationship. Rats received training on two instrumental biconditional discriminations, one auditory and one visual, in two distinct contexts. One discrimination was "over-trained" relative to the other, "under-trained," discrimination in the ratio 3:1. At test, animals were presented with incongruent audiovisual stimulus compounds of the training stimuli in the under-trained context. The stimulus elements of these test compounds have previously dictated different lever press responses during training. Rats receiving control infusions into the infralimbic cortex showed a significant interference effect, producing more responses to the over-trained (habitual), but context-inappropriate, stimulus element of the incongruent compound. This interference effect was abolished by inactivation of the infralimbic cortex; animals showed a reduced tendency to produce the habitual but inappropriate response compared with animals receiving control infusions. This finding provides evidence that the infralimbic cortex is involved in attenuating the influence of goal-directed behavior, for example context-appropriate responding. Copyright © 2011 IBRO. Published by Elsevier Ltd. All rights reserved.

  20. Coach Expectations About Off-Field Conduct and Bystander Intervention by U.S. College Football Players to Prevent Inappropriate Sexual Behavior.

    Science.gov (United States)

    Kroshus, Emily; Paskus, Tom; Bell, Lydia

    2015-09-21

    The objective of the present study was to assess whether there is a positive association between expectations about off-field conduct set by the team coach and the likelihood that college football players intend to engage as prosocial bystanders in the prevention of what they consider to be inappropriate sexual behavior. In a sample of U.S. collegiate football players (N = 3,281), a path analysis model tested the association between coach expectations, perceived likelihood of discipline for off-field transgressions, and likelihood of intending to intervene to prevent inappropriate sexual behavior. Mediation of these relationships by the athlete's sense of exploitative entitlement and their attitudes about intervening were also assessed. Findings supported the hypothesized relationships, with expectations and discipline associated with bystander intentions both directly and indirectly through the mediating pathways of entitlement and attitudes about intervening. These findings provide evidence about the important role that sports team coaches can play in encouraging bystander intervention by clarifying expectations and consequences for conduct off the field of play. Athletic departments can provide a framework within which coaches are informed about the importance of setting and enforcing standards for off-field behavior, and are appropriately incentivized to do so. © The Author(s) 2015.

  1. A case of syndrome involving the inappropriate secretion of antidiuretic hormone developed during radiation therapy in a patient with invasive thymoma complicated with myasthenia gravis

    International Nuclear Information System (INIS)

    Chikuie, Naoki; Ishida, Simon; Sato, Tomohiko; Furutama, Daisuke; Sugino, Shyouichi; Kimura, Humihiro; Hanafusa, Toshiaki

    2007-01-01

    We present the case of a 56-year-old male with a syndrome involving the inappropriate secretion of antidiuretic hormone (SIADH), which developed during radiation therapy for invasive thymoma, complicated with myasthenia gravis (MG). Chest computed tomography revealed a huge mediastinal mass lesion spreading to the pulmonary artery, vena cava and pericardium. He was diagnosed with invasive thymoma, based on the pathological findings of a mediastinal tumor biopsy under computed tomography guidance. He received outpatient radiotherapy for the invasive thymoma, and two weeks after the initiation of radiation at a dose of 22 Gy, was admitted to our hospital because of hypercapnea due to weakness of the diaphragm and disturbance of consciousness. Laboratory examinations of the patient showed hyponatremia, plasma hypoosmolarity in the presence of concentrated urine and inappropriately increased concentration of the plasma antidiuretic hormone. He was also diagnosed as having myasthenia gravis, based on the existence of an anti-acetylcholine receptor antibody. The SIADH was treated by fluid restriction and sodium chloride, and MG was treated with plasma exchange and prednisolone. He recovered from respiratory failure, and his hyponatremia was improved. To our knowledge, this is a rare description of an invasive thymoma associated with SIADH. (author)

  2. Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol.

    Science.gov (United States)

    Mucalo, Iva; Hadžiabdić, Maja Ortner; Brajković, Andrea; Lukić, Sonja; Marić, Patricia; Marinović, Ivana; Bačić-Vrca, Vesna

    2017-08-01

    The aim of this study was to measure the prevalence of potentially inappropriate medications (PIMs) by using the EU(7)-PIM list, STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) version 2 criteria and the new comprehensive protocol. This prospective study involved a sample of 276 consecutive elderly patients discharged from the university teaching hospital. Age, gender, diagnoses, medication history and medicines at discharge were recorded. The main outcome measure was the prevalence of PIMs according to each set of criteria: EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. The median patient age (range) was 74 (65-92) years. The median number of prescribed medications was 7 (1-17). STOPP identified 393 PIMs affecting 190 patients (69%), EU(7)-PIM list identified 330 PIMs in 184 patients (66.7%) whilst the comprehensive protocol identified 134 PIMs in 102 patients (37%). STOPP version 2 criteria identified significantly more PIMs per patient than the other two protocols (p comprehensive protocol and was found as a more sensitive tool for PIM detection.

  3. Materials and material testing

    International Nuclear Information System (INIS)

    Joergens, H.

    1978-01-01

    A review based on 105 literature quotations is given on the latest state of development in the steel sector and in the field of non-ferrous metals and plastics. The works quoted also include, preparation, working, welding including simulation methods, improvement of weldability, material mechanics (explanation of defects mechanisms by means of fracture mechanics), defect causes (corrosion, erosion, hydrogen influence), mechanical-technological and non-destructive material testing. Examples from the field of reactor building are also given within there topics. (IHOE) [de

  4. Selection of IFE target materials from a safety and environmental perspective

    Energy Technology Data Exchange (ETDEWEB)

    Latkowski, J.F. E-mail: latkowski1@llnl.gov; Sanz, J.; Reyes, S.; Gomez del Rio, J

    2001-05-21

    Target materials for inertial fusion energy (IFE) power plant designs might be selected for a wide variety of reasons including wall absorption of driver energy, material opacity, cost and ease of fabrication. While each of these issues are of great importance, target materials should also be selected based upon their safety and environmental (S and E) characteristics. The present work focuses on the recycling, waste management and accident dose characteristics of potential target materials. If target materials are recycled so that the quantity is small, isotopic separation may be economically viable. Therefore, calculations have been completed for all stable isotopes for all elements from lithium to polonium. The results of these calculations are used to identify specific isotopes and elements that are most likely to be offensive as well as those most likely to be acceptable in terms of their S and E characteristics.

  5. Selection of IFE target materials from a safety and environmental perspective

    Science.gov (United States)

    Latkowski, J. F.; Sanz, J.; Reyes, S.; Gomez del Rio, J.

    2001-05-01

    Target materials for inertial fusion energy (IFE) power plant designs might be selected for a wide variety of reasons including wall absorption of driver energy, material opacity, cost and ease of fabrication. While each of these issues are of great importance, target materials should also be selected based upon their safety and environmental (S&E) characteristics. The present work focuses on the recycling, waste management and accident dose characteristics of potential target materials. If target materials are recycled so that the quantity is small, isotopic separation may be economically viable. Therefore, calculations have been completed for all stable isotopes for all elements from lithium to polonium. The results of these calculations are used to identify specific isotopes and elements that are most likely to be offensive as well as those most likely to be acceptable in terms of their S&E characteristics.

  6. 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.

  7. Visualization and Analysis-Oriented Reconstruction of Material Interfaces

    Energy Technology Data Exchange (ETDEWEB)

    Childs, Henry R.

    2010-03-05

    Reconstructing boundaries along material interfaces from volume fractions is a difficult problem, especially because the under-resolved nature of the input data allows for many correct interpretations. Worse, algorithms widely accepted as appropriate for simulation are inappropriate for visualization. In this paper, we describe a new algorithm that is specifically intended for reconstructing material interfaces for visualization and analysis requirements. The algorithm performs well with respect to memory footprint and execution time, has desirable properties in various accuracy metrics, and also produces smooth surfaces with few artifacts, even when faced with more than two materials per cell.

  8. 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.

  9. Variety is not the spice of life for people with autism spectrum disorders: frequency ratings of central, variable and inappropriate aspects of common real-life events.

    Science.gov (United States)

    Loth, Eva; Happé, Francesca; Gómez, Juan Carlos

    2010-06-01

    This study used a novel rating task to investigate whether high-functioning individuals with autism spectrum disorder (ASD) have difficulties distinguishing essential from variable aspects of familiar events. Participants read stories about everyday events and judged how often central, variable, and inappropriate event-components normally occur in this type of situation. The ASD boys made significantly more errors than the typically developing boys in rating the occurrences of variable aspects. In both groups, ratings of variable aspects were age-related, but in the ASD boys, they were also related to theory of mind and weak coherence test scores, and to severity of autistic symptoms. Implications for the understanding of some repetitive behaviours, such as the tendency to adhere to inflexible routines, are discussed.

  10. Sudden Onset of Life-Threatening Methaemoglobinaemia After Intake of Inappropriately Stored Vegetable (Collard Greens Meal in a 2.5-Year-Old Child

    Directory of Open Access Journals (Sweden)

    Ozlem Cakmak Yilmaz

    2015-06-01

    Full Text Available Acquired methaemoglobinaemia most commonly occurs due to intake of or contact to certain drugs, such as local anesthetics. However, intake of certain vegetables which are essential for a healthy diet may also cause methaemoglobinaemia due to their high nitrate or nitrite content, and prolonged and inappropriate storage after preparation of vegetable meals increases the risk. We present a 2.5-year-old girl with Down's syndrome who presented with central cyanosis due to severe methaemoglobinemiae with a methaemoglobin level of 62% after intake of collard greens (Brassica oleracea var. acephala soup. Although development of methaemoglobinaemia after food intake has been reported rarely before, recognition of this potentially life-threatening condition early in its course may be life-saving. [Cukurova Med J 2015; 40(2.000: 353-357

  11. 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.

  12. 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.

  13. Optical materials

    International Nuclear Information System (INIS)

    Poker, D.B.; Ortiz, C.

    1989-01-01

    This book reports on: Diamond films, Synthesis of optical materials, Structure related optical properties, Radiation effects in optical materials, Characterization of optical materials, Deposition of optical thin films, and Optical fibers and waveguides

  14. 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...

  15. Organización didáctica del proceso de enseñanza - aprendizaje para la construcción del juego ofensivo en balonmano [Teaching- learning's process to build offensive game's strategies in handball. A didactic organization

    Directory of Open Access Journals (Sweden)

    Sebastián Feu Molina

    2009-12-01

    Full Text Available Resumen Frecuentemente, los entrenadores demandan de sus jugadores una respuesta motriz ofensiva eficaz, no programada,  en función de los acontecimientos que observan en el juego y en coordinación con el juego colectivo con sus compañeros. Para lograr respuestas de este tipo, es necesario orientar el proceso de enseñanza aprendizaje hacia un modelo constructivista que favorezca la asimilación de la utilidad táctica de los contenidos, la autonomía y creatividad del jugador. Este trabajo presenta una estructuración de los contenidos ofensivos del balonmano en torno a un hilo conductor para su aprendizaje, los principios del juego, y una organización de los métodos y recursos que permitan que el jugador al finalizar su etapa de formación pueda  tomar de decisiones eficaces en función de los condicionantes del juego. Palabras clave: balonmano, juego libre, constructivismo, espacio, normas.   Abstract requently, coaches demand of their players an effective motor offensive answer, not scheduled, according to the events they observe in the game and in coordination with the collective game with their partners. In order to achieve answers of this type, it’s necessary to aim the learning teaching process toward a constructive model which permits to assimilate easier the tactical utility of the contents, the autonomy and the player's creativity. This document presents a framework of the offensive contents of the handball for its learning, the principles of the game, and an organization of the methods and resources which permit the player can make effective decisions according to the game conditions when he had finished the training phase. Key words: handball, free game, constructivist, space, norms.

  16. On the Materials Science of Nature's Arms Race.

    Science.gov (United States)

    Liu, Zengqian; Zhang, Zhefeng; Ritchie, Robert O

    2018-06-05

    Biological material systems have evolved unique combinations of mechanical properties to fulfill their specific function through a series of ingenious designs. Seeking lessons from Nature by replicating the underlying principles of such biological materials offers new promise for creating unique combinations of properties in man-made systems. One case in point is Nature's means of attack and defense. During the long-term evolutionary "arms race," naturally evolved weapons have achieved exceptional mechanical efficiency with a synergy of effective offense and persistence-two characteristics that often tend to be mutually exclusive in many synthetic systems-which may present a notable source of new materials science knowledge and inspiration. This review categorizes Nature's weapons into ten distinct groups, and discusses the unique structural and mechanical designs of each group by taking representative systems as examples. The approach described is to extract the common principles underlying such designs that could be translated into man-made materials. Further, recent advances in replicating the design principles of natural weapons at differing lengthscales in artificial materials, devices and tools to tackle practical problems are revisited, and the challenges associated with biological and bioinspired materials research in terms of both processing and properties are discussed. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  17. Sensitive and specific markers for insulin resistance, hyperandrogenemia, and inappropriate gonadotrophin secretion in women with polycystic ovary syndrome: a case-control study from Bahrain

    Directory of Open Access Journals (Sweden)

    Al-Ayadhi MA

    2012-05-01

    Full Text Available Jamal Golbahar,1,2,* Maha Al-Ayadhi,2,* Negalla Mohan Das,2 Khalid Gumaa,2 1Department of Molecular Medicine, Al-Jawhara Centre for Genetic Diagnosis and Research, 2Department of Medical Biochemistry, College of Medicine and Medical Sciences, AGU, Manama, Bahrain *These authors contributed equally to this articleBackground: In women with polycystic ovary syndrome (PCOS, despite a high prevalence of insulin resistance, hyperandrogenemia, and disturbances in the secretion of gonadotrophin, the principal causes of biochemical abnormalities and the best endocrine markers for PCOS have not been fully identified.Subjects and methods: Serum levels of insulin, glucose, follicle-stimulating hormone (FSH, luteinizing hormone (LH, total testosterone, estrogen, sex hormone-binding capacity (SHBG, and other related indices such as homeostasis model assessment, insulin glucose ratios, LH/FSH ratios, and the free androgen index (FAI were determined and compared in women with PCOS (n = 50 and women without PCOS (n = 50.Results: In multivariate logistic regression analyses, among all insulin resistance indices, only hyperinsulinemia (odds ratio [OR] = 2.6; confidence interval [CI]: 1.3–5.2; P = 0.008 was significantly and independently associated with PCOS when adjusted for body mass index (BMI, hyperandrogenemia, and LH/FSH ratios. The LH/FSH ratio (OR = 5.4; CI: 1.2–23.0, P = 0.03 was the only marker among those indices for inappropriate gonadotrophin secretion that significantly and independently associated with PCOS when adjusted for BMI and hyperinsulinemia. Among those indices for hyperandrogenemia, FAI (OR = 1.1; CI: 1.0–2.7; P = 0.02 and SHBG (OR = 1.2; CI: 1.2–3.4; P = 0.03 were significantly and independently associated with PCOS when adjusted for BMI and hyperinsulinemia. In addition, receiver operating characteristic analysis showed that the best predictive markers for PCOS were insulin (area under the curve [AUC] = 0.944; CI: 0.887–0

  18. Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria.

    Science.gov (United States)

    Trautner, Barbara W; Prasad, Pooja; Grigoryan, Larissa; Hysong, Sylvia J; Kramer, Jennifer R; Rajan, Suja; Petersen, Nancy J; Rosen, Tracey; Drekonja, Dimitri M; Graber, Christopher; Patel, Payal; Lichtenberger, Paola; Gauthier, Timothy P; Wiseman, Steve; Jones, Makoto; Sales, Anne; Krein, Sarah; Naik, Aanand Dinkar

    2018-01-19

    Antimicrobial stewardship to combat the spread of antibiotic-resistant bacteria has become a national priority. This project focuses on reducing inappropriate use of antimicrobials for asymptomatic bacteriuria (ASB), a very common condition that leads to antimicrobial overuse in acute and long-term care. We previously conducted a successful intervention, entitled "Kicking Catheter Associated Urinary Tract Infection (CAUTI): the No Knee-Jerk Antibiotics Campaign," to decrease guideline-discordant ordering of urine cultures and antibiotics for ASB. The current objective is to facilitate implementation of a scalable version of the Kicking CAUTI campaign across four geographically diverse Veterans Health Administration facilities while assessing what aspects of an antimicrobial stewardship intervention are essential to success and sustainability. This project uses an interrupted time series design with four control sites. The two main intervention tools are (1) an evidence-based algorithm that distills the guidelines into a streamlined clinical pathway and (2) case-based audit and feedback to train clinicians to use the algorithm. Our conceptual framework for the development and implementation of this intervention draws on May's General Theory of Implementation. The intervention is directed at providers in acute and long-term care, and the goal is to reduce inappropriate screening for and treatment of ASB in all patients and residents, not just those with urinary catheters. The start-up for each facility consists of centrally-led phone calls with local site champions and baseline surveys. Case-based audit and feedback will begin at a given site after the start-up period and continue for 12 months, followed by a sustainability assessment. In addition to the clinical outcomes, we will explore the relationship between the dose of the intervention and clinical outcomes. This project moves from a proof-of-concept effectiveness study to implementation involving

  19. 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...

  20. Number of medications and adverse drug events by unintentional poisoning among older adults in consideration of inappropriate drug use : A Swedish population-based matched case-control study

    NARCIS (Netherlands)

    Rausch, Christian; Laflamme, L.; Bultmann, U.; Moller, J.

    Purpose This national, population-based study aims to determine the association between the number of prescribed medications and adverse drug events (ADE) by unintentional poisoning and examine this risk when known indicators of inappropriate drug use (IDU) are accounted for. Methods We employed a

  1. Modified Reporting of Positive Urine Cultures to Reduce Inappropriate Treatment of Asymptomatic Bacteriuria Among Nonpregnant, Noncatheterized Inpatients: A Randomized Controlled Trial.

    Science.gov (United States)

    Daley, Peter; Garcia, David; Inayatullah, Raheel; Penney, Carla; Boyd, Sarah

    2018-05-28

    DESIGNWe conducted a randomized, parallel, unblinded, superiority trial of a laboratory reporting intervention designed to reduce antibiotic treatment of asymptomatic bacteriuria (ASB).METHODSResults of positive urine cultures from 110 consecutive inpatients at 2 urban acute-care hospitals were randomized to standard report (control) or modified report (intervention). The standard report included bacterial count, bacterial identification, and antibiotic susceptibility information including drug dosage and cost. The modified report stated: "This POSITIVE urine culture may represent asymptomatic bacteriuria or urinary tract infection. If urinary tract infection is suspected clinically, please call the microbiology laboratory … for identification and susceptibility results." We used the following exclusion criteria: age pregnancy, presence of an indwelling urinary catheter, samples from patients already on antibiotics, neutropenia, or admission to an intensive care unit. The primary efficacy outcome was the proportion of appropriate antibiotic therapy prescribed.RESULTSAccording to our intention-to-treat (ITT) analysis, the proportion of appropriate treatment (urinary tract infection treated plus ASB not treated) was higher in the modified arm than in the standard arm: 44 of 55 (80.0%) versus 29 of 55 (52.7%), respectively (absolute difference, -27.3%; RR, 0.42; P = .002; number needed to report for benefit, 3.7).CONCLUSIONSModified reporting resulted in a significant reduction in inappropriate antibiotic treatment without an increase in adverse events. Safety should be further assessed in a large effectiveness trial before implementationTRIAL REGISTRATION. clinicaltrials.gov#NCT02797613Infect Control Hosp Epidemiol 2018;1-6.

  2. Anti-Aquaporin-4 Antibody-Positive Neuromyelitis Optica Presenting with Syndrome of Inappropriate Antidiuretic Hormone Secretion as an Initial Manifestation

    Directory of Open Access Journals (Sweden)

    H. Nakajima

    2011-10-01

    Full Text Available The distribution of neuromyelitis optica (NMO-characteristic brain lesions corresponds to sites of high aquaporin-4 (AQP4 expression, and the brainstem and hypothalamus lesions that express high levels of AQP4 protein are relatively characteristic of NMO. The syndrome of inappropriate antidiuretic hormone secretion (SIADH is one of the important causes of hyponatremia and results from an abnormal production or sustained secretion of antidiuretic hormone (ADH. SIADH has been associated with many clinical states or syndromes, and the hypothalamic-neurohypophyseal system regulates the feedback control system for ADH secretion. We report the case of a 63-year-old man with NMO, whose initial manifestation was hyponatremia caused by SIADH. Retrospective analysis revealed that the serum anti-AQP4 antibody was positive, and an MRI scan showed a unilateral lesion in the hypothalamus. SIADH recovered completely with regression of the hypothalamic lesion. As such, NMO should even be considered in patients who develop SIADH and have no optic nerve or spinal cord lesions but have MRI-documented hypothalamic lesions.

  3. Hyperthyroidism due to thyroid-stimulating hormone secretion after surgery for Cushing's syndrome: a novel cause of the syndrome of inappropriate secretion of thyroid-stimulating hormone.

    Science.gov (United States)

    Tamada, Daisuke; Onodera, Toshiharu; Kitamura, Tetsuhiro; Yamamoto, Yuichi; Hayashi, Yoshitaka; Murata, Yoshiharu; Otsuki, Michio; Shimomura, Iichiro

    2013-07-01

    Hyperthyroidism with the syndrome of inappropriate secretion of TSH (SITSH) occurred by a decrease in hydrocortisone dose after surgery for Cushing's syndrome. This is a novel cause of SITSH. The aim of this study was to describe and discuss 2 cases of SITSH patients that were found after surgery for Cushing's syndrome. We also checked whether SITSH occurred in 7 consecutive patients with Cushing's syndrome after surgery. A 45-year-old Japanese woman with ACTH-independent Cushing's syndrome and a 37-year-old Japanese man with ACTH-dependent Cushing's syndrome presented SITSH caused by insufficient replacement of hydrocortisone for postoperative adrenal insufficiency. When the dose of hydrocortisone was reduced to less than 20 mg/d within 18 days after surgery, SITSH occurred in both cases. We examined whether the change of the hydrocortisone dose induced the secretion of TSH. Free T₃ and TSH were normalized by the hydrocortisone dose increase of 30 mg/d, and these were elevated by the dose decrease of 10 mg/d. We also checked TSH and thyroid hormone levels of the 7 consecutive patients with Cushing's syndrome after surgery. Six (66.6 %) of 9 patients showed SITSH. This is the first report that insufficient replacement of hydrocortisone after surgery for Cushing's syndrome caused SITSH. Hyperthyroidism by SITSH as well as adrenal insufficiency can contribute to withdrawal symptoms of hydrocortisone replacement. We need to consider the possibility of SITSH for the pathological evaluation of withdrawal syndrome of hydrocortisone replacement.

  4. Dual paraneoplastic syndromes: small cell lung carcinoma-related oncogenic osteomalacia, and syndrome of inappropriate antidiuretic hormone secretion: report of a case and review of the literature.

    Science.gov (United States)

    Tantisattamo, Ekamol; Ng, Roland C K

    2011-07-01

    Acquired isolated renal phosphate wasting associated with a tumor, known as oncogenic osteomalacia or tumor-induced osteomalacia, is a rare paraneoplastic syndrome caused by overproduction of fibroblast growth factor 23. Oncogenic osteomalacia is usually associated with benign mesenchymal tumors. Syndrome of inappropriate antidiuretic hormone secretion (SIADH), on the other hand, is a common paraneoplastic syndrome caused by small cell carcinoma (SCC). Concomitant oncogenic osteomalacia and SIADH associated with SCC is very rare with only 4 other cases reported in the literature. The authors report a case of small cell lung cancer (SCLC)-related renal wasting hypophosphatemia and concurrent SIADH, and review the literature reporting 9 other cases of SCC associated with oncogenic osteomalacia. Almost half of reported cases of renal phosphate wasting associated with SCC concomitantly presented with SIADH. These cases had initial serum phosphorus level lower and survival periods shorter than those without SIADH. This rare combination of a dual paraneoplastic syndrome and low serum phosphorus may be a poor prognostic sign. In addition, both renal phosphate wasting and SIADH usually occur in a short period of time before identification of SCC. Therefore, renal wasting hypophosphatemia with concomitant SIADH/hyponatremia should prompt a search for SCC rather than a benign mesenchymal tumor.

  5. Use of offensive coefficient to analyse sport performance in indoor soccer UTILIZACIÓN DE COEFICIENTES OFENSIVOS PARA EL ANÁLISIS DEL RENDIMIENTO DEPORTIVO EN EL FÚTBOL SALA

    Directory of Open Access Journals (Sweden)

    R. De Bortoli

    2010-09-01

    Full Text Available The objective was the study of the game action of indoor soccer teams through the analysis of offensive coefficients, verifying its relationship with field performance estimated by the final result of games. Competitions by the Federación Gaúcha de Fútbol Sala (Brasil were followed for 9 years. Shots were divided into three different categories: 1 LAN: shots+finish line shots+goals; 2 MET: finish line shots+goals; and 3 GOL: goals. From those data the following indexes were obtained: 1 Offensive Outpout: (PO: ratio LAN of team 'A'/LAN of antagonist {PO = (LAN 'A'*100 / (LAN 'A'+LAN 'B'}; 2 Objectivity Index (IO: percentage of shots that reached the finish line {IO=(MET*100/LAN}; 3 Proficiency Index (IA: percentage of shots transformed into goals {IA=(GOL*100/LAN}; 4 Proficiency/Objectivity Rate (TA/O: percentage of shots reaching the finish line (MET transformed into goals {TA/O=(GOL*100/MET}; and 5 Game Volume (VJ: TA/O+PO+IO. Results obtained show that PO, IA and VJ were higher in winner than in loser teams. Ratio of PO corresponding to winners and losers was higher than those for IA or VJ. This study confirms the validity of the evaluation of performance through shot characterization and allows to conclude that IA is a better predictor of performance than PO; that is, the quality of shots is more important than its quantity.

     

    RESUMEN

    Nuestro objetivo fue el estudio de las acciones de juego de los equipos de fútbol sala a través de la obtención de una serie de coeficientes ofensivos, verificando se existe alguna relación entre éstos y el rendimiento en el campo estimado en función del resultado final de los partidos. Durante un período de nueve años se ha realizado un seguimiento de los lanzamientos en partidos oficiales disputados por equipos de la Federación Gaúcha de Fútbol Sala (Brasil. Los

  6. Contrast Materials

    Science.gov (United States)

    ... is mixed with water before administration liquid paste tablet When iodine-based and barium-sulfate contrast materials ... for patients with kidney failure or allergies to MRI and/or computed tomography (CT) contrast material. Microbubble ...

  7. Dirac materials

    OpenAIRE

    Wehling, T. O.; Black-Schaffer, A. M.; Balatsky, A. V.

    2014-01-01

    A wide range of materials, like d-wave superconductors, graphene, and topological insulators, share a fundamental similarity: their low-energy fermionic excitations behave as massless Dirac particles rather than fermions obeying the usual Schrodinger Hamiltonian. This emergent behavior of Dirac fermions in condensed matter systems defines the unifying framework for a class of materials we call "Dirac materials''. In order to establish this class of materials, we illustrate how Dirac fermions ...

  8. 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.

  9. Uruguay's ambitious energy goals: Focus on biomass; Uruguayische Energie-Offensive. Ambitionierte Ziele sollen vor allem mit Biomasse erreicht werden

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, Dierk

    2012-07-01

    Pasture farming has a long-standing tradition in Uruguay, but it is threatened now as soy, rice, citrus fruit, sugar cane and especially forest wood are getting sought after as animal feed and power generation materials. While forests are growing, the country's energy policy is aiming at a 50 percent share of renewable energy sources in primary energy supply. This makes Uruguay a leading country in Latin America. (orig.)

  10. Composite materials

    International Nuclear Information System (INIS)

    Sambrook, D.J.

    1976-01-01

    A superconductor composite is described comprising at least one longitudinally extending superconductor filament or bundle of sub-filaments, each filament or bundle of sub-filaments being surrounded by and in good electrical contact with a matrix material, the matrix material comprising a plurality of longitudinally extending cells of a metal of high electrical conductivity surrounded by a material of lower electrical conductivity. The high electrical conductivity material surrounding the superconducting filament or bundle of sub-filaments is interrupted by a radially extending wall of the material of the lower electrical conductivity, the arrangement being such that at least two superconductor filaments or sub-filaments are circumferentially circumscribed by a single annulus of the material of high electrical conductivity. The annulus is electrically interrupted by a radially extending wall of the material of low electrical conductivity

  11. Aerospace materials and material technologies

    CERN Document Server

    Wanhill, R

    2017-01-01

    This book is a comprehensive compilation of chapters on materials (both established and evolving) and material technologies that are important for aerospace systems. It considers aerospace materials in three Parts. Part I covers Metallic Materials (Mg, Al, Al-Li, Ti, aero steels, Ni, intermetallics, bronzes and Nb alloys); Part II deals with Composites (GLARE, PMCs, CMCs and Carbon based CMCs); and Part III considers Special Materials. This compilation has ensured that no important aerospace material system is ignored. Emphasis is laid in each chapter on the underlying scientific principles as well as basic and fundamental mechanisms leading to processing, characterization, property evaluation and applications. A considerable amount of materials data is compiled and presented in appendices at the end of the book. This book will be useful to students, researchers and professionals working in the domain of aerospace materials.

  12. Materials Discovery | Materials Science | NREL

    Science.gov (United States)

    Discovery Materials Discovery Images of red and yellow particles NREL's research in materials characterization of sample by incoming beam and measuring outgoing particles, with data being stored and analyzed Staff Scientist Dr. Zakutayev specializes in design of novel semiconductor materials for energy

  13. Inappropriate Use of the Quasi-Reversible Electrode Kinetic Model in Simulation-Experiment Comparisons of Voltammetric Processes That Approach the Reversible Limit

    KAUST Repository

    Simonov, Alexandr N.; Morris, Graham P.; Mashkina, Elena A.; Bethwaite, Blair; Gillow, Kathryn; Baker, Ruth E.; Gavaghan, David J.; Bond, Alan M.

    2014-01-01

    Many electrode processes that approach the "reversible" (infinitely fast) limit under voltammetric conditions have been inappropriately analyzed by comparison of experimental data and theory derived from the "quasi-reversible" model. Simulations based on "reversible" and "quasi-reversible" models have been fitted to an extensive series of a.c. voltammetric experiments undertaken at macrodisk glassy carbon (GC) electrodes for oxidation of ferrocene (Fc0/+) in CH3CN (0.10 M (n-Bu)4NPF6) and reduction of [Ru(NH 3)6]3+ and [Fe(CN)6]3- in 1 M KCl aqueous electrolyte. The confidence with which parameters such as standard formal potential (E0), heterogeneous electron transfer rate constant at E0 (k0), charge transfer coefficient (α), uncompensated resistance (Ru), and double layer capacitance (CDL) can be reported using the "quasi- reversible" model has been assessed using bootstrapping and parameter sweep (contour plot) techniques. Underparameterization, such as that which occurs when modeling CDL with a potential independent value, results in a less than optimal level of experiment-theory agreement. Overparameterization may improve the agreement but easily results in generation of physically meaningful but incorrect values of the recovered parameters, as is the case with the very fast Fc0/+ and [Ru(NH3)6]3+/2+ processes. In summary, for fast electrode kinetics approaching the "reversible" limit, it is recommended that the "reversible" model be used for theory-experiment comparisons with only E0, R u, and CDL being quantified and a lower limit of k 0 being reported; e.g., k0 ≥ 9 cm s-1 for the Fc0/+ process. © 2014 American Chemical Society.

  14. Inappropriate Use of the Quasi-Reversible Electrode Kinetic Model in Simulation-Experiment Comparisons of Voltammetric Processes That Approach the Reversible Limit

    KAUST Repository

    Simonov, Alexandr N.

    2014-08-19

    Many electrode processes that approach the "reversible" (infinitely fast) limit under voltammetric conditions have been inappropriately analyzed by comparison of experimental data and theory derived from the "quasi-reversible" model. Simulations based on "reversible" and "quasi-reversible" models have been fitted to an extensive series of a.c. voltammetric experiments undertaken at macrodisk glassy carbon (GC) electrodes for oxidation of ferrocene (Fc0/+) in CH3CN (0.10 M (n-Bu)4NPF6) and reduction of [Ru(NH 3)6]3+ and [Fe(CN)6]3- in 1 M KCl aqueous electrolyte. The confidence with which parameters such as standard formal potential (E0), heterogeneous electron transfer rate constant at E0 (k0), charge transfer coefficient (α), uncompensated resistance (Ru), and double layer capacitance (CDL) can be reported using the "quasi- reversible" model has been assessed using bootstrapping and parameter sweep (contour plot) techniques. Underparameterization, such as that which occurs when modeling CDL with a potential independent value, results in a less than optimal level of experiment-theory agreement. Overparameterization may improve the agreement but easily results in generation of physically meaningful but incorrect values of the recovered parameters, as is the case with the very fast Fc0/+ and [Ru(NH3)6]3+/2+ processes. In summary, for fast electrode kinetics approaching the "reversible" limit, it is recommended that the "reversible" model be used for theory-experiment comparisons with only E0, R u, and CDL being quantified and a lower limit of k 0 being reported; e.g., k0 ≥ 9 cm s-1 for the Fc0/+ process. © 2014 American Chemical Society.

  15. Inappropriate use of the quasi-reversible electrode kinetic model in simulation-experiment comparisons of voltammetric processes that approach the reversible limit.

    Science.gov (United States)

    Simonov, Alexandr N; Morris, Graham P; Mashkina, Elena A; Bethwaite, Blair; Gillow, Kathryn; Baker, Ruth E; Gavaghan, David J; Bond, Alan M

    2014-08-19

    Many electrode processes that approach the "reversible" (infinitely fast) limit under voltammetric conditions have been inappropriately analyzed by comparison of experimental data and theory derived from the "quasi-reversible" model. Simulations based on "reversible" and "quasi-reversible" models have been fitted to an extensive series of a.c. voltammetric experiments undertaken at macrodisk glassy carbon (GC) electrodes for oxidation of ferrocene (Fc(0/+)) in CH3CN (0.10 M (n-Bu)4NPF6) and reduction of [Ru(NH3)6](3+) and [Fe(CN)6](3-) in 1 M KCl aqueous electrolyte. The confidence with which parameters such as standard formal potential (E(0)), heterogeneous electron transfer rate constant at E(0) (k(0)), charge transfer coefficient (α), uncompensated resistance (Ru), and double layer capacitance (CDL) can be reported using the "quasi-reversible" model has been assessed using bootstrapping and parameter sweep (contour plot) techniques. Underparameterization, such as that which occurs when modeling CDL with a potential independent value, results in a less than optimal level of experiment-theory agreement. Overparameterization may improve the agreement but easily results in generation of physically meaningful but incorrect values of the recovered parameters, as is the case with the very fast Fc(0/+) and [Ru(NH3)6](3+/2+) processes. In summary, for fast electrode kinetics approaching the "reversible" limit, it is recommended that the "reversible" model be used for theory-experiment comparisons with only E(0), Ru, and CDL being quantified and a lower limit of k(0) being reported; e.g., k(0) ≥ 9 cm s(-1) for the Fc(0/+) process.

  16. Nano Materials

    International Nuclear Information System (INIS)

    Jin, In Ju; Lee, Ik Mo; Kwon, Yeung Gu

    2006-02-01

    This book introduces background of nano science such as summary, plenty room at the bottom, access way to nano technique, nanoparticles using bottom-up method which are a marvel of nature, and modern alchemy : chemical synthesis of artificial nano structure, understanding of quantum mechanics, STM/AFM, nano metal powder, ceramic nanoparticles, nano structure film, manufacture of nanoparticles using reverse micelle method, carbon nano tube, sol-gel material, nano energy material, nano catalyst nano bio material technology and spintronics.

  17. Material Systems

    DEFF Research Database (Denmark)

    Jensen, Mads Brath; Mortensen, Henrik Rubæk; Mullins, Michael

    2009-01-01

    This paper describes and reflects upon the results of an investigative project which explores the setting up of a material system - a parametric and generative assembly consisting of and taking into consideration material properties, manufacturing constraints and geometric behavior. The project...... approaches the subject through the construction of a logic-driven system aiming to explore the possibilities of a material system that fulfills spatial, structural and performative requirements concurrently and how these are negotiated in situations where they might be conflicting....

  18. Material focus

    DEFF Research Database (Denmark)

    Sokoler, Tomas; Vallgårda, Anna K. A.

    2009-01-01

    In this paper we build on the notion of computational composites, which hold a material perspective on computational technology. We argue that a focus on the material aspects of the technology could be a fruitful approach to achieve new expressions and to gain a new view on the technology's role...... in design. We study two of the computer's material properties: computed causality and connectability and through developing two computational composites that utilize these properties we begin to explore their potential expressions....

  19. Materializing Ethnography

    OpenAIRE

    Geismar, H.; Horst, H. A.

    2004-01-01

    The articles in this volume were originally presented in a panel entitled ‘Material Methodologies’ at the American Anthropological Association meeting in New Orleans (November 2002). The panel was devised to tie together theoretical advances in the study of the material with the creative possibilities of fieldwork practices. Through detailed ethnographic discussion, we highlighted the ways in which a focus on a specifically material world enabled us to discover new perspecti...

  20. Materials characterisation

    International Nuclear Information System (INIS)

    Azali Muhammad

    2005-01-01

    Various nuclear techniques have been developed and employed by technologies and scientists worldwide to physically and chemically characterise the material particularly those that have applications in industry. These include small angle neutron scattering (SANS), x-ray diffraction (XRD), scanning electron microscope (SEM) and transmission electron microscope (TEM) for the internal structural study of material, whereas, the x-ray fluorescence (XRF) for the chemical analysis, while the Moessbauer spectroscopy for the study on the magnetic properties and structural identity of material. Basic principle and instrumentations of the techniques are discussed in this chapter. Example of their applications in various disciplines particularly in characterisation of industrial materials also described

  1. New materials

    International Nuclear Information System (INIS)

    Joshi, S.K.; Rao, C.N.R.; Tsuruta, T.

    1992-01-01

    The book contains the state-of-the art lectures delivered at the discussion meeting on new materials, a field in which rapid advances are taking place. The main objective of the meeting was to bring active scientists in this area from Japan and India together. The topics covered diverse aspects of modern materials including high temperature superconducting compounds. (M.G.B.)

  2. Materials science

    International Nuclear Information System (INIS)

    2002-01-01

    the document is a collection of papers on different aspects of materials science. It discusses many items such as semiconductors, surface properties and interfaces, construction and civil engineering, metallic materials, polymers and composites, biology and biomaterials, metallurgy etc.. - 1 - Document1 Document1

  3. Biomimetic materials for controlling bone cell responses.

    Science.gov (United States)

    Drevelle, Olivier; Faucheux, Nathalie

    2013-01-01

    Bone defects that cannot "heal spontaneously during life" will become an ever greater health problem as populations age. Harvesting autografts has several drawbacks, such as pain and morbidity at both donor and acceptor sites, the limited quantity of material available, and frequently its inappropriate shape. Researchers have therefore developed alternative strategies that involve biomaterials to fill bone defects. These biomaterials must be biocompatible and interact with the surrounding bone tissue to allow their colonization by bone cells and blood vessels. The latest generation biomaterials are not inert; they control cell responses like adhesion, proliferation and differentiation. These biomaterials are called biomimetic materials. This review focuses on the development of third generation materials. We first briefly describe the bone tissue with its cells and matrix, and then how bone cells interact with the extracellular matrix. The next section covers the materials currently used to repair bone defects. Finally, we describe the strategies employed to modify the surface of materials, such as coating with hydroxyapatite and grafting biomolecules.

  4. Material Programming

    DEFF Research Database (Denmark)

    Vallgårda, Anna; Boer, Laurens; Tsaknaki, Vasiliki

    2017-01-01

    . Consequently we ask what the practice of programming and giving form to such materials would be like? How would we be able to familiarize ourselves with the dynamics of these materials and their different combinations of cause and effect? Which tools would we need and what would they look like? Will we program......, and color, but additionally being capable of sensing, actuating, and computing. Indeed, computers will not be things in and by themselves, but embedded into the materials that make up our surroundings. This also means that the way we interact with computers and the way we program them, will change...... these computational composites through external computers and then transfer the code them, or will the programming happen closer to the materials? In this feature we outline a new research program that floats between imagined futures and the development of a material programming practice....

  5. Composite material

    Science.gov (United States)

    Hutchens, Stacy A [Knoxville, TN; Woodward, Jonathan [Solihull, GB; Evans, Barbara R [Oak Ridge, TN; O'Neill, Hugh M [Knoxville, TN

    2012-02-07

    A composite biocompatible hydrogel material includes a porous polymer matrix, the polymer matrix including a plurality of pores and providing a Young's modulus of at least 10 GPa. A calcium comprising salt is disposed in at least some of the pores. The porous polymer matrix can comprise cellulose, including bacterial cellulose. The composite can be used as a bone graft material. A method of tissue repair within the body of animals includes the steps of providing a composite biocompatible hydrogel material including a porous polymer matrix, the polymer matrix including a plurality of pores and providing a Young's modulus of at least 10 GPa, and inserting the hydrogel material into cartilage or bone tissue of an animal, wherein the hydrogel material supports cell colonization in vitro for autologous cell seeding.

  6. Materials science

    International Nuclear Information System (INIS)

    Anon.

    1977-01-01

    The Materials Science Division is engaged in research on physical properties of materials and the effects of radiation upon them. This involves solid state materials undergoing phase transitions, energy storing materials, and biomaterials. The Division also offers research facilities for M.S. and Ph.D. thesis work in the fields of physics, chemistry, materials, and radiation sciences in cooperation with the various colleges and departments of the UPR Mayaguez Campus. It is anticipated that it will serve as a catalyst in starting energy-related research programs in cooperation with UPR faculty, especially programs involving solar energy. To encourage and promote cooperative efforts, contact is maintained with former graduate students and with visiting scientists from Latin American research institutions

  7. Touching Materiality

    DEFF Research Database (Denmark)

    Rasmussen, Lisa Rosén

    2012-01-01

    Dripping ink pens, colourful paint on skin, vegetables pots on a school roof. In interviews with three generations of former school pupils, memories of material objects bore a relation to everyday school life in the past. Interwoven, these objects entered the memorising processes, taking...... the interviewer and interviewee beyond an exclusively linguistic understanding of memory. This article analyses how the shifting objects of materiality in personal and generational school memories connects to material as well as sensuous experiences of everyday school life and its complex processes of learning....... Drawing on anthropological writings, the article argues that the objects of materiality are part of important but non-verbalised memories of schooling. The Dutch philosopher Eelco Runia’s notions of presence and metonymy are incorporated as tools for approaching objects of materiality in memory studies....

  8. Inappropriate Dietary and Occupational Patterns: Major Risk Factors Associated With Brucellosis in the Area Covered by Karaj Health Center No. 2

    Directory of Open Access Journals (Sweden)

    Yosef Khani

    2015-11-01

    Full Text Available Background: Brucellosis is one of the most common diseases among humans and livestock. Using contaminated and unpasteurized dairy products, having contact with infected livestock and, in general, inappropriate dietary patterns, as well as lack of hygiene, can be noted as the most common modes of transmission for such a disease. Objectives: Since the establishment of Alborz province in Iran and, accordingly, Alborz university of medical sciences, Karaj, Iran, there has been no study on the epidemiological situation of the disease. Therefore, the present study examines the epidemiology of Brucellosis at Karaj Health center No. 2, Karaj, Iran, during 2011 - 2012. Patients and Methods: This research was a cross-sectional descriptive study, on patients with Brucellosis, during 2011 - 2012, in the area covered by Karaj health center No. 2, Karaj, Iran. The data about all suspected cases, collected from polyclinic, laboratories and health centers, and confirmed by Wright, combs Wright and 2ME tests were reviewed. After recording the demographic data and laboratory results, they were entered into STATA 11 software and analyzed. Results: The number of patients reported in this study was 67. The incidence of the disease during 2011 - 2012 was, respectively, 3.75 and 4.6 per hundred thousand and the average incidence of the disease was 4.2 per hundred thousand. The highest rate of infection, in terms of occupation, was found among ranchers (40.29%. In 100% of the cases, there was a history of consumption of cottage cheese, fresh cow milk or other unpasteurized dairy products. Considering the incidence season, most cases of the disease (38.80% had occurred in the spring. In terms of gender, 56.71% were male and 43.28% of patients were female. As well, in terms of age, more 50% of the patients were in the age groups of 31 - 40 and 41 - 50 years old. Conclusions: Given the occurrence of more cases of the disease among individuals with risk factors, such as

  9. Community pharmacists' evaluation of potentially inappropriate prescribing in older community-dwelling patients with polypharmacy: observational research based on the GheOP³S tool.

    Science.gov (United States)

    Tommelein, Eline; Mehuys, Els; Van Tongelen, Inge; Petrovic, Mirko; Somers, Annemie; Colin, Pieter; Demarche, Sophie; Van Hees, Thierry; Christiaens, Thierry; Boussery, Koen

    2017-09-01

    In this study, we aimed to (i) determine the prevalence of potentially inappropriate prescribing (PIP) in community-dwelling older polypharmacy patients using the Ghent Older People's Prescriptions community-Pharmacy Screening (GheOP³S) tool, (ii) identify the items that account for the highest proportion of PIP and (iii) identify the patient variables that may influence the occurrence of PIP. Additionally, pharmacist-physician contacts emerging from PIP screening with the GheOP³S tool and feasibility of the GheOP³S tool in daily practice were evaluated. A prospective observational study was carried out between December 2013 and July 2014 in 204 community pharmacies in Belgium. Patients were eligible if they were (i) ≥70 years, (ii) community-dwelling, (iii) using ≥5 chronic drugs, (iv) a regular visitor of the pharmacy and (v) understanding Dutch or French. Community pharmacists used a structured interview to obtain demographic data and medication use and subsequently screened for PIP using the GheOP³S tool. A Poisson regression was used to investigate the association between different covariates and the number of PIP. In 987 (97%) of 1016 included patients, 3721 PIP items were detected (median of 3 per patient; inter quartile range: 2-5). Most frequently involved with PIP are drugs for the central nervous system such as hypnosedatives, antipsychotics and antidepressants. Risk factors for a higher PIP prevalence appeared to be a higher number of drugs (30% extra PIPs per 5 extra drugs), female gender (20% extra PIPs), higher body mass index (BMI, 20% extra PIPs per 10-unit increase in BMI) and poorer functional status (30% extra PIPs with 6-point increase). The feasibility of the GheOP³S tool was acceptable although digitalization of the tool would improve implementation. Despite detecting at least one PIP in 987 patients, only 39 physicians were contacted by the community pharmacists to discuss the items. A high prevalence of PIP in community

  10. Nuclear materials

    International Nuclear Information System (INIS)

    1996-01-01

    In 1998, Nuclear Regulatory Authority of the Slovak Republic (NRA SR) performed 38 inspections, 25 of them were performed in co-operation with IAEA inspectors. There is no fresh nuclear fuel at Bohunice A-1 NPP at present. Fresh fuel of Bohunice V-1 and V-2 NPPs is inspected in the fresh fuel storage.There are 327 fresh fuel assemblies in Mochovce NPP fresh fuel storage. In addition to that, are also 71 small users of nuclear materials in Slovakia. In most cases they use: covers made of depleted uranium for non-destructive works, detection of level in production plants, covers for therapeutical sources at medical facilities. In. 1995, NRA SR issued 4 new licences for nuclear material withdrawal. In the next part manipulation with nuclear materials, spent fuel stores and illegal trafficking in nuclear materials are reported

  11. Composite Materials

    DEFF Research Database (Denmark)

    Nielsen, Lauge Fuglsang

    This book deals with the mechanical and physical behavior of composites as influenced by composite geometry. "Composite Materials" provides a comprehensive introduction for researchers and students to modern composite materials research with a special emphasis on the significance of phase geometry......, viscoelastic behavior, and internal stress states. Other physical properties considered are thermal and electrical conductivities, diffusion coefficients, dielectric constants and magnetic permeability. Special attention is given to the effect of pore shape on the mechanical and physical behavior of porous....... The book enables the reader to a better understanding of the behavior of natural composites, improvement of such materials, and design of new materials with prescribed properties. A number of examples are presented: Special composite properties considered are stiffness, shrinkage, hygro-thermal behavior...

  12. Hazardous materials

    Science.gov (United States)

    ... substances that could harm human health or the environment. Hazardous means dangerous, so these materials must be ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  13. Utopian Materialities

    DEFF Research Database (Denmark)

    Elgaard-Jensen, Torben

    2004-01-01

    In various ways, this paper makes the counter-intuitive claim that the utopian and the material are thoroughlyinterdependent, rather than worlds apart. First, through a reading of Thomas More's Utopia, it is argued thatUtopia is the product of particular kinds of relations, rather than merely...... a detachment from the known world.Second, the utopianism of a new economy firm is examined. It is argued that the physical set-up of the firm -in particular the distribution of tables and chairs - evoke a number of alternatives to ordinary work practice.In this way the materialities of the firm are crucial...... to its persuasive image of being the office of the future.The notion that utopia is achieved through material arrangements is finally related to the analysis of facts andfictions in ANT. It is argued, that even though Utopias are neither fact nor fiction, they are both material andeffective...

  14. Propulsion materials

    Energy Technology Data Exchange (ETDEWEB)

    Wall, Edward J. [U.S. Dept. of Energy, Washington, D.C. (United States); Sullivan, Rogelio A. [U.S. Dept. of Energy, Washington, D.C. (United States); Gibbs, Jerry L. [U.S. Dept. of Energy, Washington, D.C. (United States)

    2008-01-01

    The Department of Energy’s (DOE’s) Office of Vehicle Technologies (OVT) is pleased to introduce the FY 2007 Annual Progress Report for the Propulsion Materials Research and Development Program. Together with DOE national laboratories and in partnership with private industry and universities across the United States, the program continues to engage in research and development (R&D) that provides enabling materials technology for fuel-efficient and environmentally friendly commercial and passenger vehicles.

  15. Encountering Materiality

    DEFF Research Database (Denmark)

    Svabo, Connie

    2016-01-01

    DHT researcher Connie Svabo and artist Charlotte Grum did a joint performance presentation titled Becoming Sheep, Becoming Animal at the international conference Encountering Materiality – Transdisciplinary Conversations, held in Geneve, Schwitzerland, June 23-25 2016.......DHT researcher Connie Svabo and artist Charlotte Grum did a joint performance presentation titled Becoming Sheep, Becoming Animal at the international conference Encountering Materiality – Transdisciplinary Conversations, held in Geneve, Schwitzerland, June 23-25 2016....

  16. Background Material

    DEFF Research Database (Denmark)

    Zandersen, Marianne; Hyytiäinen, Kari; Saraiva, Sofia

    This document serves as a background material to the BONUS Pilot Scenario Workshop, which aims to develop harmonised regional storylines of socio-ecological futures in the Baltic Sea region in a collaborative effort together with other BONUS projects and stakeholders.......This document serves as a background material to the BONUS Pilot Scenario Workshop, which aims to develop harmonised regional storylines of socio-ecological futures in the Baltic Sea region in a collaborative effort together with other BONUS projects and stakeholders....

  17. Management of functional Sprint Fidelis leads at cardiac resynchronization therapy-defibrillator generator replacement: a novel option for preventing inappropriate shocks from lead failure in fragile patients with high risk of sudden death.

    Science.gov (United States)

    Zhu, Dennis W X; Chu, Matthew M; House, Chad M

    2017-12-01

    In patients with a functional Sprint Fidelis lead at generator replacement, the manufacturer recommended to either continue to use the existing lead or replace it with a new lead. For those patients who continue to use a functional Fidelis lead, the risk of inappropriate shocks remains present if the lead fails in the future. We evaluated the feasibility of an alternative approach at the time of cardiac resynchronization therapy-defibrillator (CRT-D) generator replacement in patients with a functional bipolar left ventricular (LV) lead for prevention of inappropriate shocks from future Fidelis lead failure. During the procedure, the pace/sense IS-1 connection pin of the functional Fidelis lead was intentionally inserted into the LV port of the new CRT-D generator, while the existing bipolar LV lead IS-1 connection pin was inserted into the right ventricular (RV) pace/sense port. After such switching, the existing bipolar LV lead was used for functional LV pacing/sensing, while the Fidelis lead was used for functional RV pacing and high voltage shock only and could no longer be used for the purpose of sensing and detecting. This approach precluded oversensing and inappropriate shocks should the functional Fidelis lead fail in the future. Six fragile patients, who were not considered suitable candidates for lead replacement, underwent the alternative approach. During a follow-up of 35 ± 23 months, the CRT-D system functioned normally in five patients. The Fidelis lead fractured in one patient 7 months after generator replacement. The malfunction was detected promptly and the defected lead was replaced. No inappropriate detections or shock was triggered. In CRT-D patients with a functional Fidelis lead and a bipolar LV lead, switching of the Fidelis lead pace/sense IS-1 pin with the bipolar LV lead IS-1 pin at generator replacement did not affect normal system function. This novel approach may be valuable in fragile patients with high risk of sudden death for

  18. Organización didáctica del proceso de enseñanza - aprendizaje para la construcción del juego ofensivo en balonmano [Teaching- learning's process to build offensive game's strategies in handball. A didactic organization

    Directory of Open Access Journals (Sweden)

    Sebastián Feu Molina

    2009-12-01

    Full Text Available Normal 0 21 false false false ES X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} Resumen Frecuentemente, los entrenadores demandan de sus jugadores una respuesta motriz ofensiva eficaz, no programada,  en función de los acontecimientos que observan en el juego y en coordinación con el juego colectivo con sus compañeros. Para lograr respuestas de este tipo, es necesario orientar el proceso de enseñanza aprendizaje hacia un modelo constructivista que favorezca la asimilación de la utilidad táctica de los contenidos, la autonomía y creatividad del jugador. Este trabajo presenta una estructuración de los contenidos ofensivos del balonmano en torno a un hilo conductor para su aprendizaje, los principios del juego, y una organización de los métodos y recursos que permitan que el jugador al finalizar su etapa de formación pueda  tomar de decisiones eficaces en función de los condicionantes del juego. Palabras clave: balonmano, juego libre, constructivismo, espacio, normas.   Abstract requently, coaches demand of their players an effective motor offensive answer, not scheduled, according to the events they observe in the game and in coordination with the collective game with their partners. In order to achieve answers of this type, it’s necessary to aim the learning teaching process toward a constructive

  19. Layered materials

    Science.gov (United States)

    Johnson, David; Clarke, Simon; Wiley, John; Koumoto, Kunihito

    2014-06-01

    Layered compounds, materials with a large anisotropy to their bonding, electrical and/or magnetic properties, have been important in the development of solid state chemistry, physics and engineering applications. Layered materials were the initial test bed where chemists developed intercalation chemistry that evolved into the field of topochemical reactions where researchers are able to perform sequential steps to arrive at kinetically stable products that cannot be directly prepared by other approaches. Physicists have used layered compounds to discover and understand novel phenomena made more apparent through reduced dimensionality. The discovery of charge and spin density waves and more recently the remarkable discovery in condensed matter physics of the two-dimensional topological insulating state were discovered in two-dimensional materials. The understanding developed in two-dimensional materials enabled subsequent extension of these and other phenomena into three-dimensional materials. Layered compounds have also been used in many technologies as engineers and scientists used their unique properties to solve challenging technical problems (low temperature ion conduction for batteries, easy shear planes for lubrication in vacuum, edge decorated catalyst sites for catalytic removal of sulfur from oil, etc). The articles that are published in this issue provide an excellent overview of the spectrum of activities that are being pursued, as well as an introduction to some of the most established achievements in the field. Clusters of papers discussing thermoelectric properties, electronic structure and transport properties, growth of single two-dimensional layers, intercalation and more extensive topochemical reactions and the interleaving of two structures to form new materials highlight the breadth of current research in this area. These papers will hopefully serve as a useful guideline for the interested reader to different important aspects in this field and

  20. Electronic materials

    CERN Document Server

    Kwok, H L

    2010-01-01

    The electronic properties of solids have become of increasing importance in the age of information technology. The study of solids and materials, while having originated from the disciplines of physics and chemistry, has evolved independently over the past few decades. The classical treatment of solid-state physics, which emphasized classifications, theories and fundamental physical principles, is no longer able to bridge the gap between materials advances and applications. In particular, the more recent developments in device physics and technology have not necessarily been driven by new conc

  1. Safety issues of tooth whitening using peroxide-based materials.

    Science.gov (United States)

    Li, Y; Greenwall, L

    2013-07-01

    In-office tooth whitening using hydrogen peroxide (H₂O₂) has been practised in dentistry without significant safety concerns for more than a century. While few disputes exist regarding the efficacy of peroxide-based at-home whitening since its first introduction in 1989, its safety has been the cause of controversy and concern. This article reviews and discusses safety issues of tooth whitening using peroxide-based materials, including biological properties and toxicology of H₂O₂, use of chlorine dioxide, safety studies on tooth whitening, and clinical considerations of its use. Data accumulated during the last two decades demonstrate that, when used properly, peroxide-based tooth whitening is safe and effective. The most commonly seen side effects are tooth sensitivity and gingival irritation, which are usually mild to moderate and transient. So far there is no evidence of significant health risks associated with tooth whitening; however, potential adverse effects can occur with inappropriate application, abuse, or the use of inappropriate whitening products. With the knowledge on peroxide-based whitening materials and the recognition of potential adverse effects associated with the procedure, dental professionals are able to formulate an effective and safe tooth whitening regimen for individual patients to achieve maximal benefits while minimising potential risks.

  2. Supplementary Material

    Indian Academy of Sciences (India)

    mraga

    1. Supplementary Material. A soluble-lead Redox Flow Battery with corrugated graphite sheet and reticulated vitreous carbon as positive and negative current collectors by A Banerjee et al (pp 163-. 170). Figure S1. SEM images for bare substrates: (a) graphite sheet, (b) 20 ppi RVC, (c) 30 ppi. RVC and (d) 45 ppi RVC.

  3. Emerging Materiality

    DEFF Research Database (Denmark)

    Bertelsen, Olav Wedege; Breinbjerg, Morten; Pold, Søren

    2009-01-01

    The authors examine how materiality emerges from complex chains of mediation in creative software use. The primarily theoretical argument is inspired and illustrated by interviews with two composers of electronic music. The authors argue that computer mediated activity should not primarily be und...

  4. Atmospheric materiality

    DEFF Research Database (Denmark)

    Wieczorek, Izabela

    2016-01-01

    experience and, consequently, to the conceptual and methodological shifts in the production of space, and hence in the way we think about materiality. In this context, architectural space is understood as a contingent construction – a space of engagement that appears to us as a result of continuous...

  5. Absorbant materials

    International Nuclear Information System (INIS)

    Quetier, Monique.

    1978-11-01

    Absorbants play a very important part in the nuclear industry. They serve for the control, shut-down and neutron shielding of reactors and increase the capacity of spent fuel storage pools and of special transport containers. This paper surveys the usual absorbant materials, means of obtainment, their essential characteristics relating to their use and their behaviour under neutron irradiation [fr

  6. Friction Material Composites Materials Perspective

    CERN Document Server

    Sundarkrishnaa, K L

    2012-01-01

    Friction Material Composites is the first of the five volumes which strongly educates and updates engineers and other professionals in braking industries, research and test labs. It explains besides the formulation of design processes and its complete manufacturing input. This book gives an idea of mechanisms of friction and how to control them by designing .The book is  useful for designers  of automotive, rail and aero industries for designing the brake systems effectively with the integration of friction material composite design which is critical. It clearly  emphasizes the driving  safety and how serious designers should  select the design input. The significance of friction material component like brake pad or a liner as an integral part of the brake system of vehicles is explained. AFM pictures at nanolevel illustrate broadly the explanations given.

  7. Materials Science

    Science.gov (United States)

    2003-01-01

    The Materials Science Program is structured so that NASA s headquarters is responsible for the program content and selection, through the Enterprise Scientist, and MSFC provides for implementation of ground and flight programs with a Discipline Scientist and Discipline Manager. The Discipline Working Group of eminent scientists from outside of NASA acts in an advisory capacity and writes the Discipline Document from which the NRA content is derived. The program is reviewed approximately every three years by groups such as the Committee on Microgravity Research, the National Materials Advisory Board, and the OBPR Maximization and Prioritization (ReMaP) Task Force. The flight program has had as many as twenty-six principal investigators (PIs) in flight or flight definition stage, with the numbers of PIs in the future dependent on the results of the ReMaP Task Force and internal reviews. Each project has a NASA-appointed Project Scientist, considered a half-time job, who assists the PI in understanding and preparing for internal reviews such as the Science Concept Review and Requirements Definition Review. The Project Scientist also insures that the PI gets the maximum science support from MSFC, represents the PI to the MSFC community, and collaborates with the Project Manager to insure the project is well-supported and remains vital. Currently available flight equipment includes the Materials Science Research Rack (MSRR-1) and Microgravity Science Glovebox. Ground based projects fall into one or more of several categories. Intellectual Underpinning of Flight Program projects include theoretical studies backed by modeling and computer simulations; bring to maturity new research, often by young researchers, and may include preliminary short duration low gravity experiments in the KC-135 aircraft or drop tube; enable characterization of data sets from previous flights; and provide thermophysical property determinations to aid PIs. Radiation Shielding and preliminary In

  8. Magnetocaloric materials

    Energy Technology Data Exchange (ETDEWEB)

    Jeppesen, Stinus

    2008-10-15

    New and improved magnetocaloric materials are one of the cornerstones in the development of room temperature magnetic refrigeration. Magnetic refrigeration has been used since the 1930ies in cryogenic applications, but has since the discovery of room temperature refrigerants received enormous attention. This Ph.D. work has been mainly concerned with developing a new technique to characterize the magnetocaloric effect (MCE) and using this technique in the investigations on new and improved magnetocaloric materials. For this purpose a novel differential scanning calorimeter (DSC) with applied magnetic fields was developed for measuring heat capacity as function of magnetic field. Measurements using the developed DSC demonstrate a very high sensitivity, fast measurements and good agreement with results obtained by other techniques. Furthermore, two material systems have been described in this work. Both systems take basis in the mixed-valence manganite system La{sub 1-x}Ca{sub x}MnO{sub 3} well known from research on colossal magnetoresistance (CMR). The mixed-valence manganite crystallizes in the perovskite structure of general formula ABO{sub 3}. The first material system is designed to investigate the influence of low level Cu doping on the B-site. Six different samples were prepared with over-stoichiometric compositions La{sub 0.67}Ca{sub 0.33}Mn{sub 1.05}Cu{sub x}O{sub 3}, x=0, 1, 2, 3, 4 and 5%. All compositions crystallized well in the same perovskite structure, but the morphology of the samples changed drastically with doping. Investigation on the magnetocaloric properties revealed that small levels of Cu up to around 3% could improve the magnetocaloric performance of the materials. Furthermore, Cu could be used to tune the temperature interval without deteriorating the MCE, which is a much desired characteristic for potential use in magnetic refrigerators. A less comprehensive part of the work has been concerned with the investigation of doping on the A

  9. Materializing Superghosts

    OpenAIRE

    Alexandrov, Victor; Krotov, Dmitry; Losev, Andrei; Lysov, Vyacheslav

    2007-01-01

    We construct the off-shell BV realization of N=1, d=10 SYM with 7 auxillary fields. This becomes possible due to materialized ghost phenomenon. Namely, supersymmetry ghosts are coordinates on a manifold B of 10-dimensional spinors with pure spinors cut out. Auxillary fields are sections of a bundle over B, and supersymmetry transformations are nonlinear in ghosts. By integrating out axillary fields we obtain on-shell supersymmetric BV action with terms quadratic in antifields. Exactly this on...

  10. Material monitoring

    International Nuclear Information System (INIS)

    Kotter, W.; Zirker, L.; Hancock, J.A.

    1995-01-01

    Waste Reduction Operations Complex (WROC) facilities are located at the Idaho National Engineering Laboratory (INEL). The overall goal for the Pollution Prevention/Waste Minimization Unit is to identify and establish the correct amount of waste generated so that it can be reduced. Quarterly, the INEL Pollution Prevention (P2) Unit compares the projected amount of waste generated per process with the actual amount generated. Examples of waste streams that would be addresses for our facility would include be are not limited to: Maintenance, Upgrades, Office and Scrap Metal. There are three potential sources of this variance: inaccurate identification of those who generate the waste; inaccurate identification of the process that generates the waste; and inaccurate measurement of the actual amount generated. The Materials Monitoring Program was proposed to identify the sources of variance and reduce the variance to an acceptable level. Prior to the implementation of the Material Monitoring Program, all information that was gathered and recorded was done so through an informal estimation of waste generated by various personnel concerned with each processes. Due to the inaccuracy of the prior information gathering system, the Material Monitoring Program was established. The heart of this program consists of two main parts. In the first part potential waste generators provide information on projected waste generation process. In the second part, Maintenance, Office, Scrap Metal and Facility Upgrade wastes from given processes is disposed within the appropriate bin dedicated to that process. The Material Monitoring Program allows for the more accurate gathering of information on the various waste types that are being generated quarterly

  11. Thermoelectric Materials

    Science.gov (United States)

    Gao, Peng; Berkun, Isil; Schmidt, Robert D.; Luzenski, Matthew F.; Lu, Xu; Bordon Sarac, Patricia; Case, Eldon D.; Hogan, Timothy P.

    2014-06-01

    Mg2(Si,Sn) compounds are promising candidate low-cost, lightweight, nontoxic thermoelectric materials made from abundant elements and are suited for power generation applications in the intermediate temperature range of 600 K to 800 K. Knowledge on the transport and mechanical properties of Mg2(Si,Sn) compounds is essential to the design of Mg2(Si,Sn)-based thermoelectric devices. In this work, such materials were synthesized using the molten-salt sealing method and were powder processed, followed by pulsed electric sintering densification. A set of Mg2.08Si0.4- x Sn0.6Sb x (0 ≤ x ≤ 0.072) compounds were investigated, and a peak ZT of 1.50 was obtained at 716 K in Mg2.08Si0.364Sn0.6Sb0.036. The high ZT is attributed to a high electrical conductivity in these samples, possibly caused by a magnesium deficiency in the final product. The mechanical response of the material to stresses is a function of the elastic moduli. The temperature-dependent Young's modulus, shear modulus, bulk modulus, Poisson's ratio, acoustic wave speeds, and acoustic Debye temperature of the undoped Mg2(Si,Sn) compounds were measured using resonant ultrasound spectroscopy from 295 K to 603 K. In addition, the hardness and fracture toughness were measured at room temperature.

  12. FOREWORD: Materials metrology Materials metrology

    Science.gov (United States)

    Bennett, Seton; Valdés, Joaquin

    2010-04-01

    It seems that so much of modern life is defined by the materials we use. From aircraft to architecture, from cars to communications, from microelectronics to medicine, the development of new materials and the innovative application of existing ones have underpinned the technological advances that have transformed the way we live, work and play. Recognizing the need for a sound technical basis for drafting codes of practice and specifications for advanced materials, the governments of countries of the Economic Summit (G7) and the European Commission signed a Memorandum of Understanding in 1982 to establish the Versailles Project on Advanced Materials and Standards (VAMAS). This project supports international trade by enabling scientific collaboration as a precursor to the drafting of standards. The VAMAS participants recognized the importance of agreeing a reliable, universally accepted basis for the traceability of the measurements on which standards depend for their preparation and implementation. Seeing the need to involve the wider metrology community, VAMAS approached the Comité International des Poids et Mesures (CIPM). Following discussions with NMI Directors and a workshop at the BIPM in February 2005, the CIPM decided to establish an ad hoc Working Group on the metrology applicable to the measurement of material properties. The Working Group presented its conclusions to the CIPM in October 2007 and published its final report in 2008, leading to the signature of a Memorandum of Understanding between VAMAS and the BIPM. This MoU recognizes the work that is already going on in VAMAS as well as in the Consultative Committees of the CIPM and establishes a framework for an ongoing dialogue on issues of materials metrology. The question of what is meant by traceability in the metrology of the properties of materials is particularly vexed when the measurement results depend on a specified procedure. In these cases, confidence in results requires not only traceable

  13. Waste water compliance: staying on the offense

    Science.gov (United States)

    Cattlemen and regulators are interested in safe and effective environmental stewardship of beef production. Recent interest has focused on better management of runoff storage. Typically, storage ponds hold feedlot surface runoff until it can be applied to crops. While stored, the nutrient laden w...

  14. 32 CFR 935.40 - Criminal offenses.

    Science.gov (United States)

    2010-07-01

    ... prostitution; (c) Use any building, structure, vehicle, or public lands for the purpose of lewdness, assignation, or prostitution; (d) Possess or display (publicly or privately) any pornographic literature, film...

  15. German Submarine Offensives and South African Countermeasures

    African Journals Online (AJOL)

    Evert

    Scientia Militaria vol 44, no 1, 2016, pp 168-189. doi: 10.5787/44-1-1166 ..... report the presence of a body of German submarines moving south towards Cape Town. Despite ...... London: Arms and Armour Press, 1989, 100–101; Keegan op.

  16. Offensive Cyber Capability: Can it Reduce Cyberterrorism

    Science.gov (United States)

    2010-12-02

    conceivably happen? Or: ‘What would happen if. . . ?’”86 84 Peter Checkland and John...Understanding, Preventing, and Surviving Terrorism. New York: McGraw-Hill, 2005. Checkland , Peter and John Poulter. Learning for Action: A Short Definitive

  17. Electoral Offenses in The Common Law System

    OpenAIRE

    Vladimir Mulaj

    2013-01-01

    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 di...

  18. 78 FR 14017 - Courts of Indian Offenses

    Science.gov (United States)

    2013-03-04

    ... process of establishing, tribal courts; and are therefore no longer in need of an extra-tribal judicial... Health Hospital, and the Albuquerque Indian School Property (land held in trust for the 19 Pueblos of New... have courts to administer justice on land under their jurisdiction. Prior notice and comment are...

  19. Airpower and the 1972 Easter Offensive

    Science.gov (United States)

    2006-06-16

    so intimately familiar with the topic. Colonel David “ El Cid” Neuenswander, a combat veteran fighter pilot, was a former commander of the United...were the O-2 and the OV-10 Bronco . VNAF FACs were still using the older 0-1s. The fixed-wing gunship pilots also became FAC-A qualified. US Deploys

  20. The offense of capital market manipulation

    Directory of Open Access Journals (Sweden)

    Laura MANEA

    2012-01-01

    Full Text Available The novelty and use of current technology in stock exchange trading operations are just a few reasons for which the capital market domain is a controversial one, and the number of crimes already committed in the financial market raises the issue of securing the supply-demand relationship of capital and capital investment protection. If in the Community law there is no incrimination of market abuse, Romanian legislature sanctioned the capital market manipulation as criminal acts committed intentionally in order to discourage such practices and also to increase the confidence of investors in the financial market