Long-term outcome of medically treated epilepsy.

Science.gov (United States)

Sillanpää, M; Schmidt, D

2017-01-01

To review the long-term outcome of epilepsy in population-based studies. Analysis of population-based studies. About two of three patients with new-onset epilepsy will, in the long run, enter five-year terminal remission. Chances for remission are best for those with idiopathic or cryptogenic epilepsy. It is unclear whether the seizure outcome has improved over the last several decades. Social outcome, however, may have become better because of the improved level of knowledge on and public attitudes toward people with epilepsy, and possibly fewer prejudices at home, daycare, school, military and labor market. While we still do not have a cure for epilepsy for all patients, relief of the medical and social consequences is available for many and hope is on the horizon for people with epilepsy. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

An antenatal prediction model for adverse birth outcomes in an urban population: The contribution of medical and non-medical risks.

Science.gov (United States)

Posthumus, A G; Birnie, E; van Veen, M J; Steegers, E A P; Bonsel, G J

2016-07-01

in the Netherlands the perinatal mortality rate is high compared to other European countries. Around eighty percent of perinatal mortality cases is preceded by being small for gestational age (SGA), preterm birth and/or having a low Apgar-score at 5 minutes after birth. Current risk detection in pregnancy focusses primarily on medical risks. However, non-medical risk factors may be relevant too. Both non-medical and medical risk factors are incorporated in the Rotterdam Reproductive Risk Reduction (R4U) scorecard. We investigated the associations between R4U risk factors and preterm birth, SGA and a low Apgar score. a prospective cohort study under routine practice conditions. six midwifery practices and two hospitals in Rotterdam, the Netherlands. 836 pregnant women. the R4U scorecard was filled out at the booking visit. after birth, the follow-up data on pregnancy outcomes were collected. Multivariate logistic regression was used to fit models for the prediction of any adverse outcome (preterm birth, SGA and/or a low Apgar score), stratified for ethnicity and socio-economic status (SES). factors predicting any adverse outcome for Western women were smoking during the first trimester and over-the-counter medication. For non-Western women risk factors were teenage pregnancy, advanced maternal age and an obstetric history of SGA. Risk factors for high SES women were low family income, no daily intake of vegetables and a history of preterm birth. For low SES women risk factors appeared to be low family income, non-Western ethnicity, smoking during the first trimester and a history of SGA. the presence of both medical and non-medical risk factors early in pregnancy predict the occurrence of adverse outcomes at birth. Furthermore the risk profiles for adverse outcomes differed according to SES and ethnicity. to optimise effective risk selection, both medical and non-medical risk factors should be taken into account in midwifery and obstetric care at the booking visit

Medical review licensing outcomes in drivers with visual field loss in Victoria, Australia

Science.gov (United States)

Muir, Carlyn; Charlton, Judith L; Odell, Morris; Keeffe, Jill; Wood, Joanne; Bohensky, Megan; Fildes, Brian; Oxley, Jennifer; Bentley, Sharon; Rizzo, Matthew

2017-01-01

Background Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. Methods A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field-related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. Results Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n=194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self-referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority’s Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. Conclusion The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be

Toward Diversity-Responsive Medical Education: Taking an Intersectionality-Based Approach to a Curriculum Evaluation

Science.gov (United States)

Muntinga, M. E.; Krajenbrink, V. Q.; Peerdeman, S. M.; Croiset, G.; Verdonk, P.

2016-01-01

Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a "narrow" or a "broad" definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at…

Medical complications and outcomes at an onsite rehabilitation unit for older people.

LENUS (Irish Health Repository)

Mulroy, M

2013-09-01

The rehabilitation of older patients in Ireland after an acute medical event occurs at dedicated onsite hospital units or at offsite centres. Information on medical complications and outcomes is inadequate.

Hindsight bias and outcome bias in the social construction of medical negligence: a review.

Science.gov (United States)

Hugh, Thomas B; Dekker, Sidney W A

2009-05-01

Medical negligence has been the subject of much public debate in recent decades. Although the steep increase in the frequency and size of claims against doctors at the end of the last century appears to have plateaued, in Australia at least, medical indemnity costs and consequences are still a matter of concern for doctors, medical defence organisations and governments in most developed countries. Imprecision in the legal definition of negligence opens the possibility that judgments of this issue at several levels may be subject to hindsight and outcome bias. Hindsight bias relates to the probability of an adverse event perceived by a retrospective observer ("I would have known it was going to happen"), while outcome bias is a largely subconscious cognitive distortion produced by the observer's knowledge of the adverse outcome. This review examines the relevant legal, medical, psychological and sociological literature on the operation of these pervasive and universal biases in the retrospective evaluation of adverse events. A finding of medical negligence is essentially an after-the-event social construction and is invariably affected by hindsight bias and knowledge of the adverse outcome. Such biases obviously pose a threat to the fairness of judgments. A number of debiasing strategies have been suggested but are relatively ineffective because of the universality and strength of these biases and the inherent difficulty of concealing from expert witnesses knowledge of the outcome. Education about the effect of the biases is therefore important for lawyers, medical expert witnesses and the judiciary.

Outcomes of medical emergencies on commercial airline flights.

Science.gov (United States)

Peterson, Drew C; Martin-Gill, Christian; Guyette, Francis X; Tobias, Adam Z; McCarthy, Catherine E; Harrington, Scott T; Delbridge, Theodore R; Yealy, Donald M

2013-05-30

Worldwide, 2.75 billion passengers fly on commercial airlines annually. When in-flight medical emergencies occur, access to care is limited. We describe in-flight medical emergencies and the outcomes of these events. We reviewed records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communications center from January 1, 2008, through October 31, 2010. We characterized the most common medical problems and the type of on-board assistance rendered. We determined the incidence of and factors associated with unscheduled aircraft diversion, transport to a hospital, and hospital admission, and we determined the incidence of death. There were 11,920 in-flight medical emergencies resulting in calls to the center (1 medical emergency per 604 flights). The most common problems were syncope or presyncope (37.4% of cases), respiratory symptoms (12.1%), and nausea or vomiting (9.5%). Physician passengers provided medical assistance in 48.1% of in-flight medical emergencies, and aircraft diversion occurred in 7.3%. Of 10,914 patients for whom postflight follow-up data were available, 25.8% were transported to a hospital by emergency-medical-service personnel, 8.6% were admitted, and 0.3% died. The most common triggers for admission were possible stroke (odds ratio, 3.36; 95% confidence interval [CI], 1.88 to 6.03), respiratory symptoms (odds ratio, 2.13; 95% CI, 1.48 to 3.06), and cardiac symptoms (odds ratio, 1.95; 95% CI, 1.37 to 2.77). Most in-flight medical emergencies were related to syncope, respiratory symptoms, or gastrointestinal symptoms, and a physician was frequently the responding medical volunteer. Few in-flight medical emergencies resulted in diversion of aircraft or death; one fourth of passengers who had an in-flight medical emergency underwent additional evaluation in a hospital. (Funded by the National Institutes of Health.).

Relationship between Medication Use and Cardiovascular Disease Health Outcomes in the Jackson Heart Study

Directory of Open Access Journals (Sweden)

Monique S. White

2011-06-01

Full Text Available Even though some medications have the potential to slow the progress of atherosclerosis and development of CVD, there are many at-risk individuals who continue to resist the benefits that are available by not following the advice of medical professionals. Non-adherence to prescribed drug regimens is a pervasive medical problem that negatively affects treatment outcomes. Information from standardized interviews of 5301 African Americans participating in the Jackson Heart Study was examined to determine the association between demographic parameters, behavior including adherence to prescribed medical regimens, and health outcomes. Data were also collected at Annual Follow-Up and Surveillance visits. During the two weeks prior to the examination visit, almost 52% of the participants reported taking blood pressure medication, 14% took cholesterol medication, 16% took medication for diabetes, and 19% took blood thinning medication. Of those who did not take the prescribed medications, the reasons given were the following: 47% were in a hurry, too busy, or forgot to take medications; 23% were trying to do without medications; 18% had no money to purchase medications; 19% indicated that the medications made them feel bad; 17% felt that they could not carry out daily functions when taking medications. The African American population can benefit from heightened awareness of the risk factors that are associated with CVD and the benefits of following a prescribed treatment regimen. Unacceptable secondary effects of prescribed medication comprised an important cause of non-compliance. Encouragement of this population to communicate with their healthcare providers to ensure that medication regimens are better tolerated could increase compliance and improve health outcomes.

Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review

OpenAIRE

Kruse, Clemens Scott; Beane, Amanda

2018-01-01

Background Health information technology (HIT) has been introduced into the health care industry since the 1960s when mainframes assisted with financial transactions, but questions remained about HIT’s contribution to medical outcomes. Several systematic reviews since the 1990s have focused on this relationship. This review updates the literature. Objective The purpose of this review was to analyze the current literature for the impact of HIT on medical outcomes. We hypothesized that there is...

Associations of pass-fail outcomes with psychological health of first-year medical students in a malaysian medical school.

Science.gov (United States)

Yusoff, Muhamad S B

2013-02-01

The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level. These consequences can include poor academic performance and impaired cognitive ability. This study was designed to explore associations between pass-fail outcome and psychological health parameters (i.e. stress, anxiety, and depression symptoms). A cross-sectional study was conducted on a cohort of first-year medical students in a Malaysian medical school. The depression anxiety stress scale 21-item assessment (DASS-21) was administered to them right after the final paper of the first-year final examination. Their final examination outcomes (i.e. pass or fail) were traced by using their student identity code (ID) through the Universiti Sains Malaysia academic office. A total of 194 (98.0%) of medical students responded to the DASS-21. An independent t-test showed that students who passed had significantly lower stress, anxiety, and depression symptoms than those who failed the first-year final examination (P passed the examination. Those who experienced high stress levels were more likely to fail than those who did not. Reducing the psychological distress of medical students prior to examination may help them to perform better in the examination.

Efficacy of a Device to Narrow the Coronary Sinus in Refractory Angina

NARCIS (Netherlands)

Verheye, Stefan; Jolicoeur, E. Marc; Behan, Miles W.; Pettersson, Thomas; Sainsbury, Paul; Hill, Jonathan; Vrolix, Mathias; Agostoni, Pierfrancesco; Engstrom, Thomas; Labinaz, Marino; de Silva, Ranil; Schwartz, Marc; Meyten, Nathalie; Uren, Neal G.; Doucet, Serge; Tanguay, Jean-Francois; Lindsay, Steven; Henry, Timothy D.; White, Christopher J.; Edelman, Elazer R.; Banai, Shmuel

2015-01-01

BACKGROUND Many patients with coronary artery disease who are not candidates for revascularization have refractory angina despite standard medical therapy. The balloon-expandable, stainless steel, hourglass-shaped, coronary-sinus reducing device creates a focal narrowing and increases pressure in

Achieving the Desired Transformation: Thoughts on Next Steps for Outcomes-Based Medical Education.

Science.gov (United States)

Holmboe, Eric S; Batalden, Paul

2015-09-01

Since the introduction of the outcomes-based medical education (OBME) movement, progress toward implementation has been active but challenging. Much of the angst and criticism has been directed at the approaches to assessment that are associated with outcomes-based or competency frameworks, particularly defining the outcomes. In addition, these changes to graduate medical education (GME) are concomitant with major change in health care systems--specifically, changes to increase quality and safety while reducing cost. Every sector, from medical education to health care delivery and financing, is in the midst of substantial change and disruption.The recent release of the Institute of Medicine's report on the financing and governance of GME highlights the urgent need to accelerate the transformation of medical education. One source of continued tension within the medical education community arises from the assumption that the much-needed increases in value and improvement in health care can be achieved by holding the current educational structures and architecture of learning in place while concomitantly withdrawing resources. The authors of this Perspective seek to reframe the important and necessary debate surrounding the current challenges to implementing OBME. Building on recent change and service theories (e.g., Theory U and coproduction), they propose several areas of redirection, including reexamination of curricular models and greater involvement of learners, teachers, and regulators in cocreating new training models, to help facilitate the desired transformation in medical education.

The effect of regular medication on the outcome of paracetamol poisoning

DEFF Research Database (Denmark)

Schmidt, L E; Dalhoff, K

2002-01-01

BACKGROUND: Patients admitted with paracetamol overdose frequently receive one or more types of regular medication that may affect the outcome of the paracetamol intoxication. AIM: To describe the use of regular medication in patients with paracetamol poisoning and to evaluate its effects...... on morbidity and mortality. METHODS: Seven hundred and thirty-seven consecutive patients admitted with paracetamol poisoning were studied and the use of regular medication was recorded. The relative risk of hepatic encephalopathy, death or liver transplantation, severe hepatic dysfunction and severe...... hepatocellular injury was evaluated by multivariate analysis. RESULTS: Regular medication was received by 332 patients (45%). Medication with benzodiazepines (105 cases), antidepressants (100 cases), neuroleptics (75 cases), paracetamol (58 cases), oral contraceptives (51 cases), beta-agonists (40 cases), opioid...

Medication supply, healthcare outcomes and healthcare expenses: longitudinal analyses of patients with type 2 diabetes and hypertension.

Science.gov (United States)

Chen, Chi-Chen; Blank, Robert H; Cheng, Shou-Hsia

2014-09-01

Patients with chronic conditions largely depend on proper medications to maintain health. This study aims to examine, for patients with diabetes and hypertension, whether the appropriateness of the quantity of drug obtained is associated with favorable healthcare outcomes and lower expenses. This study utilized a longitudinal design with a seven-year follow-up period from 2002 to 2009 under a universal health insurance program in Taiwan. The patients under study were those aged 18 years or older and newly diagnosed with type 2 diabetes or hypertension in 2002. Generalized estimating equations were performed to examine the relationship between medication supply and health outcomes as well as expenses. The results indicate that while compared with patients with an appropriate medication supply, patients with either an undersupply or an oversupply of medications tended to have poorer healthcare outcomes. The study also found that an excess supply of medications for patients with diabetes or hypertension resulted in higher total healthcare expenses. Either an undersupply or an oversupply of medication was associated with unfavorable healthcare outcomes, and that medication oversupply was associated with the increased consumption of health resources. Our findings suggest that improving appropriate medication supply is beneficial for the healthcare system. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Muhamad S. B. Yusoff

2013-02-01

Full Text Available Objectives: The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level. These consequences can include poor academic performance and impaired cognitive ability. This study was designed to explore associations between pass-fail outcome and psychological health parameters (i.e. stress, anxiety, and depression symptoms. Methods: A cross-sectional study was conducted on a cohort of first-year medical students in a Malaysian medical school. The depression anxiety stress scale 21-item assessment (DASS-21 was administered to them right after the final paper of the first-year final examination. Their final examination outcomes (i.e. pass or fail were traced by using their student identity code (ID through the Universiti Sains Malaysia academic office. Results: A total of 194 (98.0% of medical students responded to the DASS-21. An independent t-test showed that students who passed had significantly lower stress, anxiety, and depression symptoms than those who failed the first-year final examination (P <0.05. Those who experienced moderate to high stress were at 2.43 times higher risk for failing the examination than those who experienced normal to mild stress. Conclusion: Medical students whofailed in the final examination had higher psychological distress than those who passed the examination. Those who experienced high stress levels were more likely to fail than those who did not. Reducing the psychological distress of medical students prior to examination may help them to perform better in the examination.

Accreditation of Medical Education Programs: Moving From Student Outcomes to Continuous Quality Improvement Measures.

Science.gov (United States)

Blouin, Danielle; Tekian, Ara

2018-03-01

Accreditation of undergraduate medical education programs aims to ensure the quality of medical education and promote quality improvement, with the ultimate goal of providing optimal patient care. Direct linkages between accreditation and education quality are, however, difficult to establish. The literature examining the impact of accreditation predominantly focuses on student outcomes, such as performances on national examinations. However, student outcomes present challenges with regard to data availability, comparability, and contamination.The true impact of accreditation may well rest in its ability to promote continuous quality improvement (CQI) within medical education programs. The conceptual model grounding this paper suggests accreditation leads medical schools to commit resources to and engage in self-assessment activities that represent best practices of CQI, leading to the development within schools of a culture of CQI. In line with this model, measures of the impact of accreditation on medical schools need to include CQI-related markers. The CQI orientation of organizations can be measured using validated instruments from the business and management fields. Repeated determinations of medical schools' CQI orientation at various points throughout their accreditation cycles could provide additional evidence of the impact of accreditation on medical education. Strong CQI orientation should lead to high-quality medical education and would serve as a proxy marker for the quality of graduates and possibly for the quality of care they provide.It is time to move away from a focus on student outcomes as measures of the impact of accreditation and embrace additional markers, such as indicators of organizational CQI orientation.

[Reliability and validity of assessment of educational outcomes obtained by students of Medical Rescue at Medical University of Warsaw].

Science.gov (United States)

Panczyk, Mariusz; Stachacz, Grzegorz; Gałązkowski, Robert; Gotlib, Joanna

2016-01-01

In the interest of preservation of high degree of objectivity of information about students' educational outcomes, a system of assessment needs to meet criteria of appropriate reliability and validity. Analysis of reliability and validity of the system of assessment of students' educational outcomes for courses followed by an examination and covered by a curriculum in Medical Rescue at Medical University of Warsaw (MU W). A retrospective study enrolling a group of 421 students of eight subsequent full education cycles. Detailed data concerning grades for fourteen courses followed by an examination in the entire course of studies were collected. Reliability (Cronbach's alpha coefficient) and criteria validity (Spearman's rank correlation) were assessed. Internal consistency was estimated using a multiple regression model. The levels of assessment reliability for the general university, pre-clinical, and clinical scopes amounted to alpha: 0.42, 0.53, and 0.70, respectively. The strongest positive correlations between the results of pre-clinical and clinical trainings were found for the Anatomy course (r ≈ 0.30). Only in the case of the Pharmacology course it was found that students' achievements in this field were significantly correlated with all other courses of clinical training. The influence of educational outcomes in particular areas of clinical training on the final grade for the entire course of studies was diverse (β regression between 0.04 and 0.11). While the Pharmacology course had the strongest impact on final results, the Surgery course had the least influence on students' final grades (β = 0.04). 1. Sufficient reliability of the system of assessment of educational outcomes in Medical Rescue showed good precision and repeatability of assessment. 2. A low level of validity was caused by a failure to keep the appropriateness of the assessment of educational outcomes in several clinical courses. 3. Prognostic and diagnostic validity of methods used for

A Review of Outcome of Postgraduate Medical Training in Zambia ...

African Journals Online (AJOL)

A Review of Outcome of Postgraduate Medical Training in Zambia. K Bowa, F Goma, JINM Yikona, YF Mulla, SS Banda. Abstract. The University of Zambia School of Medicine was opened in 1966. Since inception, over 1200 undergraduate students have graduated with Bachelor of Medicine and Bachelor of Surgery.

Skills Decay in Military Medical Training: A Meta-synthesis of Research Outcomes.

Science.gov (United States)

Linde, Amber S; Caridha, Jona; Kunkler, Kevin J

2018-01-01

In fiscal year 2012, the Medical Simulation and Information Sciences Research Program released two Skills Decay (SD) research program announcements (PAs) under the Medical Readiness Initiative entitled "Medical Practice Initiative Breadth of Medical Practice & Disease Frequency Exposure (MPI-BMP)" and the "Medical Practice Initiative Procedural Skill Decay and Maintenance (MPI-PSD)." The Office of Naval Research also released a PA entitled "Medical Modeling and Simulation (MM&S) for Military Training and Education." A total investment of $12 M was made. This article provides a meta-synthesis of the Skills Decay research conducted under these efforts. The MSIRRP Medical Simulation Portfolio collected, reviewed, and analyzed the final reports of the Skills Decay research efforts from the three PAs. This paper provides a meta-synthesis of the outcomes of those studies. Focus of this study was to determine if the anticipated goals of the Skills Decay PAs were met as well as to provide a summary of lessons learned to the research community. Fourteen research questions posed by the PAs were structured into four main goals: (1) Skills Decay identification, (2) creation/validity of Skills Decay tools and feasibility and viability of data extraction project, (3) refreshment training to prevent or alleviate Skills Decay project, and (4) Skills Decay education content. Using a combination of training styles, choosing variables known to have Skills Decay predication value, and developing better ways of mining available data that can, in turn, provide feedback to training needs, it is possible for accurate Skills Decay models to be developed. These technologies have the ability not only capture the learner's reaction during the simulation, but to capture the simulation outcomes to predict a medical professional's level of experience and background. Lessons learned from the investments made by the government are extremely important in order to ensure that the outcomes of the

Using the MDRD value as an outcome predictor in emergency medical admissions.

LENUS (Irish Health Repository)

Chin, Jun Liong

2011-10-01

Both physiological- and laboratory-derived variables, alone or in combination, have been used to predict mortality among acute medical admissions. Using the Modification of Diet in Renal Disease (MDRD) not as an estimate of glomerular filtration rate but as an outcome predictor for hospital mortality, we examined the relationship between the MDRD value and in-hospital death during an emergency medical admission.

Predictors of Developmental Outcomes for Infants Who Are Medically Fragile.

Science.gov (United States)

Smith, Timothy B.; Boyce, Glenna C.

This paper presents results of a preliminary study which evaluated medical birth data as potential predictors of developmental outcome, and developed and tested an instrument designed for this purpose. Forty low birthweight children, all of whom had experienced neonatal intraventricular hemorrhage, were evaluated at school age (66 months) on the…

The effect of electronic medical record adoption on outcomes in US hospitals

Directory of Open Access Journals (Sweden)

Lee Jinhyung

2013-02-01

Full Text Available Abstract Background The electronic medical record (EMR is one of the most promising components of health information technology. However, the overall impact of EMR adoption on outcomes at US hospitals remains unknown. This study examined the relationship between basic EMR adoption and 30-day rehospitalization, 30-day mortality, inpatient mortality and length of stay. Methods Our overall approach was to compare outcomes for the two years before and two years after the year of EMR adoption, at 708 acute-care hospitals in the US from 2000 to 2007. We looked at the effect of EMR on outcomes using two methods. First, we compared the outcomes by quarter for the period before and after EMR adoption among hospitals that adopted EMR. Second, we compared hospitals that adopted EMR to those that did not, before and after EMR adoption, using a generalized linear model. Results Hospitals adopting EMR experienced 0.11 (95% CI: -0.218 to −0.002 days’ shorter length of stay and 0.182 percent lower 30-day mortality, but a 0.19 (95% CI: 0.0006 to 0.0033 percent increase in 30-day rehospitalization in the two years after EMR adoption. The association of EMR adoption with outcomes also varied by type of admission (medical vs. surgical. Conclusions Previous studies using observational data from large samples of hospitals have produced conflicting results. However, using different methods, we found a small but statistically significant association of EMR adoption with outcomes of hospitalization.

Adherence to medical treatment in relation to pregnancy, birth outcome & breastfeeding behavior among women with Crohn's disease.

Science.gov (United States)

Julsgaard, Mette

2016-07-01

Crohn's disease (CD) is common among women of fertile age, and it often requires maintenance medical treatment. Adherence to medical treatment among women with CD prior to, during, and after pregnancy has, however, never been examined. Although CD women have increased risk of adverse pregnancy outcomes, little is known about predictors for these outcomes in women with CD. In addition, the impact of breastfeeding on disease activity remains controversial. The aims of this PhD thesis were to determine adherence to treatment and to investigate predictors for and prevalence rates of non-adherence to maintenance medical treatment among women with CD prior to, during, and after pregnancy; to assess pregnancy outcomes among women with CD, taking medical treatment, smoking status, and disease activity into account; to assess breastfeeding rates and the impact of breastfeeding on the risk of relapse. We conducted a population-based prevalence study including 154 women with CD who had given birth within a six-year period. We combined questionnaire data, data from medical records, and medical register data. Among 105 (80%) respondents, more than half reported taking medication with an overall high adherence rate of 69.8%. Counselling, previous pregnancy, and planned pregnancy seemed to decrease the likelihood of non-adherence, whereas smoking seemed to predict non-adherence prior to pregnancy, although our sample size prevented any firm conclusions. During pregnancy, the vast majority (95%) of CD women were in remission. The children's birth weight did not differ in relation to maternal medical treatment, but mean birth weight in children of smokers in medical treatment was 274 g lower than that of children of non-smokers in medical treatment. In our relatively small study CD women in medical treatment were not at increased risk of adverse pregnancy outcomes compared with untreated women with CD. In total, 87.6% of CD women were breastfeeding, and rates did not vary by

[Outcome Quality in Medical Rehabilitation: Relationship Between "Patient-Reported Outcomes" (PROs) and Social Security Contributions].

Science.gov (United States)

Nübling, R; Kaluscha, R; Krischak, G; Kriz, D; Martin, H; Müller, G; Renzland, J; Reuss-Borst, M; Schmidt, J; Kaiser, U; Toepler, E

2017-02-01

Aim of the Study The outcome quality of medical rehabilitation is evaluated often by "Patient Reported Outcomes" (PROs). It is examined to what extent these PROs are corresponding with "hard" or "objective" outcomes such as payments of contributions to social insurance. Methods The "rehabilitation QM outcome study" includes self-reports of patients as well as data from the Rehabilitation Statistics Database (RSD) of the German pension insurance Baden-Wurttemberg. The sample for the question posed includes N=2 947 insured who were treated in 2011 in 21 clinics of the "health quality network" and who were either employed or unemployed at the time of the rehabilitation application (e. g. the workforce or labour force group, response rate: 55%). The sample turned out widely representative for the population of the insured persons. Results PROs and payment of contributions to pension insurance clearly correspond. In the year after the rehabilitation improved vs. not improved rehabilitees differed clearly with regard to their payments of contributions. Conclusions The results support the validity of PROs. For a comprehensive depiction of the outcome quality of rehabilitation PROs and payments of contributions should be considered supplementary. © Georg Thieme Verlag KG Stuttgart · New York.

Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections.

Science.gov (United States)

Gerber, Jeffrey S; Ross, Rachael K; Bryan, Matthew; Localio, A Russell; Szymczak, Julia E; Wasserman, Richard; Barkman, Darlene; Odeniyi, Folasade; Conaboy, Kathryn; Bell, Louis; Zaoutis, Theoklis E; Fiks, Alexander G

2017-12-19

Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment. To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children. A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score-matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts. Broad-spectrum antibiotics vs narrow-spectrum antibiotics. In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events. Of 30 159 children in the retrospective cohort (19 179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3% [95% CI, -0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868

An e-learning course in medical immunology: does it improve learning outcome?

Science.gov (United States)

Boye, Sondre; Moen, Torolf; Vik, Torstein

2012-01-01

E-learning is used by most medical students almost daily and several studies have shown e-learning to improve learning outcome in small-scale interventions. However, few studies have explored the effects of e-learning in immunology. To study the effect of an e-learning package in immunology on learning outcomes in a written integrated examination and to examine student satisfaction with the e-learning package. All second-year students at a Norwegian medical school were offered an animated e-learning package in basic immunology as a supplement to the regular teaching. Each student's log-on-time was recorded and linked with the student's score on multiple choice questions included in an integrated end-of-the-year written examination. Student satisfaction was assessed through a questionnaire. The intermediate-range students (interquartile range) on average scored 3.6% better on the immunology part of the examination per hour they had used the e-learning package (p = 0.0046) and log-on-time explained 17% of the variance in immunology score. The best and the less skilled students' examination outcomes were not affected by the e-learning. The e-learning was well appreciated among the students. Use of an e-learning package in immunology in addition to regular teaching improved learning outcomes for intermediate-range students.

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

Science.gov (United States)

Gerber, Jonathan P; Landau, Louis I

2010-01-01

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

Improvement of medical content in the curriculum of biomedical engineering based on assessment of students outcomes.

Science.gov (United States)

Abdulhay, Enas; Khnouf, Ruba; Haddad, Shireen; Al-Bashir, Areen

2017-08-04

Improvement of medical content in Biomedical Engineering curricula based on a qualitative assessment process or on a comparison with another high-standard program has been approached by a number of studies. However, the quantitative assessment tools have not been emphasized. The quantitative assessment tools can be more accurate and robust in cases of challenging multidisciplinary fields like that of Biomedical Engineering which includes biomedicine elements mixed with technology aspects. The major limitations of the previous research are the high dependence on surveys or pure qualitative approaches as well as the absence of strong focus on medical outcomes without implicit confusion with the technical ones. The proposed work presents the development and evaluation of an accurate/robust quantitative approach to the improvement of the medical content in the challenging multidisciplinary BME curriculum. The work presents quantitative assessment tools and subsequent improvement of curriculum medical content applied, as example for explanation, to the ABET (Accreditation Board for Engineering and Technology, USA) accredited biomedical engineering BME department at Jordan University of Science and Technology. The quantitative results of assessment of curriculum/course, capstone, exit exam, course assessment by student (CAS) as well as of surveys filled by alumni, seniors, employers and training supervisors were, first, mapped to the expected students' outcomes related to the medical field (SOsM). The collected data were then analyzed and discussed to find curriculum weakness points by tracking shortcomings in every outcome degree of achievement. Finally, actions were taken to fill in the gaps of the curriculum. Actions were also mapped to the students' medical outcomes (SOsM). Weighted averages of obtained quantitative values, mapped to SOsM, indicated accurately the achievement levels of all outcomes as well as the necessary improvements to be performed in curriculum

Integrated health outcomes research strategies in drug or medical device development, pre- and postmarketing: time for change.

Science.gov (United States)

Badía, Xavier; Guyver, Alice; Magaz, Sol; Bigorra, Juan

2002-06-01

The implementation of health outcomes research as a healthcare decision-making tool has expanded rapidly in the last decade. Drugs and medical devices are increasingly being required to demonstrate not only their efficacy and safety characteristics, but also their performance in at least three core dimensions of health outcomes research: clinical effectiveness, patient-reported outcomes and economic outcomes. However, the current integration of health outcomes research lacks coordination and communication and as a result, money and time is being spent on the generation of health outcomes research data which can be both insufficient and fail to satisfy the information demands of all the relevant stakeholders. In response to this, a new paradigm is evolving which involves the implementation of health outcomes research strategies that encompass the development, pre- and postmarketing stages of a drug or medical device.

Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis

Directory of Open Access Journals (Sweden)

Srinivas Samavedi

2014-01-01

Full Text Available Vesico-urethral anastomosis (VUA is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve.

Academic season does not influence cardiac surgical outcomes at US Academic Medical Centers.

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Lapar, Damien J; Bhamidipati, Castigliano M; Mery, Carlos M; Stukenborg, George J; Lau, Christine L; Kron, Irving L; Ailawadi, Gorav

2011-06-01

Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals and non-cardiothoracic teaching hospitals nationwide. From 2003 to 2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample database. Patients undergoing cardiac operations at cardiothoracic teaching and non-cardiothoracic teaching hospitals were identified using the Association of American Medical College's Graduate Medical Education Tracking System. Hierarchic multivariable logistic regression analyses were used to estimate the effect of academic quarter on risk-adjusted outcomes. Mean patient age was 65.9 ± 10.9 years. Women accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%), followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate were 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p = 0.12) or morbidity (p = 0.24) at academic medical centers. Risk-adjusted mortality and morbidity for cardiac operations were not associated with time of year in the US at teaching and nonteaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Narrow, duplicated internal auditory canal

Energy Technology Data Exchange (ETDEWEB)

Ferreira, T. [Servico de Neurorradiologia, Hospital Garcia de Orta, Avenida Torrado da Silva, 2801-951, Almada (Portugal); Shayestehfar, B. [Department of Radiology, UCLA Oliveview School of Medicine, Los Angeles, California (United States); Lufkin, R. [Department of Radiology, UCLA School of Medicine, Los Angeles, California (United States)

2003-05-01

A narrow internal auditory canal (IAC) constitutes a relative contraindication to cochlear implantation because it is associated with aplasia or hypoplasia of the vestibulocochlear nerve or its cochlear branch. We report an unusual case of a narrow, duplicated IAC, divided by a bony septum into a superior relatively large portion and an inferior stenotic portion, in which we could identify only the facial nerve. This case adds support to the association between a narrow IAC and aplasia or hypoplasia of the vestibulocochlear nerve. The normal facial nerve argues against the hypothesis that the narrow IAC is the result of a primary bony defect which inhibits the growth of the vestibulocochlear nerve. (orig.)

Flooding correlations in narrow channel

International Nuclear Information System (INIS)

Kim, S. H.; Baek, W. P.; Chang, S. H.

1999-01-01

Heat transfer in narrow gap is considered as important phenomena in severe accidents in nuclear power plants. Also in heat removal of electric chip. Critical heat flux(CHF) in narrow gap limits the maximum heat transfer rate in narrow channel. In case of closed bottom channel, flooding limited CHF occurrence is observed. Flooding correlations will be helpful to predict the CHF in closed bottom channel. In present study, flooding data for narrow channel geometry were collected and the work to recognize the effect of the span, w and gap size, s were performed. And new flooding correlations were suggested for high-aspect-ratio geometry. Also, flooding correlation was applied to flooding limited CHF data

Improving outcomes for patients with medication-resistant anxiety: effects of collaborative care with cognitive behavioral therapy.

Science.gov (United States)

Campbell-Sills, Laura; Roy-Byrne, Peter P; Craske, Michelle G; Bystritsky, Alexander; Sullivan, Greer; Stein, Murray B

2016-12-01

Many patients with anxiety disorders remain symptomatic after receiving evidence-based treatment, yet research on treatment-resistant anxiety is limited. We evaluated effects of cognitive behavioral therapy (CBT) on outcomes of patients with medication-resistant anxiety disorders using data from the Coordinated Anxiety Learning and Management (CALM) trial. Primary care patients who met study entry criteria (including DSM-IV diagnosis of generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or social anxiety disorder) despite ongoing pharmacotherapy of appropriate type, dose, and duration were classified as medication resistant (n = 227). Logistic regression was used to estimate effects of CALM's CBT program (CALM-CBT; chosen by 104 of 117 medication-resistant patients randomized to CALM) versus usual care (UC; n = 110) on response [≥ 50% reduction of 12-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptom score] and remission (BSI-12 < 6) at 6, 12, and 18 months. Within-group analyses examined outcomes by treatment choice (CBT vs. CBT plus medication management) and CBT dose. Approximately 58% of medication-resistant CALM-CBT patients responded and 46% remitted during the study. Relative to UC, CALM-CBT was associated with greater response at 6 months (AOR = 3.78, 95% CI 2.02-7.07) and 12 months (AOR = 2.49, 95% CI 1.36-4.58) and remission at 6, 12, and 18 months (AORs = 2.44 to 3.18). Patients in CBT plus medication management fared no better than those in CBT only. Some evidence suggested higher CBT dose produced better outcomes. CBT can improve outcomes for patients whose anxiety symptoms are resistant to standard pharmacotherapy. © 2016 Wiley Periodicals, Inc.

Formal public health education and career outcomes of medical school graduates.

Directory of Open Access Journals (Sweden)

Marie Krousel-Wood

Full Text Available BACKGROUND: Few data are available evaluating the associations of formal public health education with long-term career choice and professional outcomes among medical school graduates. The objective of this study was to determine if formal public health education via completion of a masters of public health (MPH degree among US medical school graduates was associated with early and long-term career choice, professional satisfaction, or research productivity. METHODS: We conducted a retrospective cohort study in 1108 physicians (17.1% completed a MPH degree who had 10-20 years of follow-up post medical school graduation. Multivariable logistic regression analyses were conducted. RESULTS: Compared to their counterparts with no MPH, medical school graduates with a MPH were more likely to have completed a generalist primary care residency only [relative risk (RR 1.79, 95% confidence interval (CI 1.35-2.29], obtain employment in an academic institution (RR 1.81; 95% CI 1.33-2.37 or government agency (RR 3.26; 95% CI 1.89-5.38, and practice public health (RR 39.84; 95% CI 12.13-107.38 or primary care (RR 1.59; 95% CI 1.18-2.05. Furthermore, medical school graduates with a MPH were more likely to conduct public health research (RR 8.79; 95% CI: 5.20-13.82, receive NIH or other federal funding (RR 3.11, 95% CI 1.74-5.33, have four or more peer-reviewed publications (RR 2.07; 95% CI 1.56-2.60, and have five or more scientific presentations (RR 2.31, 95% CI 1.70-2.98. CONCLUSION: Formal public health education via a MPH was associated with career choice and professional outcomes among physicians.

Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes

DEFF Research Database (Denmark)

Hansen, Trine Graabæk; Kjeldsen, Lene Juel

2013-01-01

Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality...... and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE......, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100...

The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review.

Science.gov (United States)

van Heuckelum, Milou; van den Ende, Cornelia H M; Houterman, Anne E J; Heemskerk, Charlotte P M; van Dulmen, Sandra; van den Bemt, Bart J F

2017-01-01

This study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients. A systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence. Of 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive. Considering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.

Training-related harassment and drinking outcomes in medical residents versus graduate students.

Science.gov (United States)

Shinsako, S A; Richman, J A; Rospenda, K M

2001-12-01

This study examined the prevalence of sexual harassment and generalized workplace abuse, and their differential effects on drinking behaviors in medical residents and graduate students at an urban American university. While medical residents had greater odds of experiencing harassment and abuse in their training programs, it was found that in most cases their deleterious drinking behaviors decreased, whereas graduate student drinking behaviors increased as a consequence of these experiences. The drinking outcomes of men were more affected by harassment and abuse than those of women.

Medical students' attitudes toward gay men.

Science.gov (United States)

Matharu, Kabir; Kravitz, Richard L; McMahon, Graham T; Wilson, Machelle D; Fitzgerald, Faith T

2012-08-08

Healthcare providers' attitudes toward sexual minorities influence patient comfort and outcomes. This study characterized medical student attitudes toward gay men, focusing on behavior, personhood, gay civil rights, and male toughness. A cross-sectional web-based anonymous survey was sent to medical students enrolled at the University of California, Davis (N = 371) with a response rate of 68%. Few respondents expressed negative attitudes toward gay men or would deny them civil rights. More negative responses were seen with respect to aspects of intimate behavior and homosexuality as a natural form of sexual expression. Men and students younger than 25 years old were more likely to endorse negative attitudes toward behavior as well as more traditional views on male toughness. We show that an important minority of students express discomfort with the behavior of gay men and hold to a narrow construction of male identity. These findings suggest that competency training must move beyond conceptual discussions and address attitudes toward behaviors through new pedagogical approaches.

Monitoring risk-adjusted medical outcomes allowing for changes over time.

Science.gov (United States)

Steiner, Stefan H; Mackay, R Jock

2014-10-01

We consider the problem of monitoring and comparing medical outcomes, such as surgical performance, over time. Performance is subject to change due to a variety of reasons including patient heterogeneity, learning, deteriorating skills due to aging, etc. For instance, we expect inexperienced surgeons to improve their skills with practice. We propose a graphical method to monitor surgical performance that incorporates risk adjustment to account for patient heterogeneity. The procedure gives more weight to recent outcomes and down-weights the influence of outcomes further in the past. The chart is clinically interpretable as it plots an estimate of the failure rate for a "standard" patient. The chart also includes a measure of uncertainty in this estimate. We can implement the method using historical data or start from scratch. As the monitoring proceeds, we can base the estimated failure rate on a known risk model or use the observed outcomes to update the risk model as time passes. We illustrate the proposed method with an example from cardiac surgery. © The Author 2013. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Clinical signs and outcome of dogs treated medically for degenerative lumbosacral stenosis: 98 cases (2004-2012).

Science.gov (United States)

De Decker, Steven; Wawrzenski, Lauren A; Volk, Holger A

2014-08-15

To compare clinical signs of dogs treated medically or surgically for degenerative lumbosacral stenosis (DLSS) and assess outcome after medical treatment. Retrospective case series. Client-owned dogs treated medically (n = 49) or surgically (49) for DLSS. Medical records from 2004 to 2012 were reviewed. Dogs were included if they had clinical signs, clinical examination findings, and MRI abnormalities consistent with DLSS. Several variables were compared between surgically and medically treated dogs: age, sex, duration of clinical signs, presence or absence of neurologic deficits, urinary and fecal incontinence, concurrent medical conditions, and medical treatment before referral. Medical treatment after obtaining a final diagnosis of DLSS consisted of restricted exercise in combination with anti-inflammatory and analgesic drugs. Surgical treatment consisted of dorsal lumbosacral laminectomy. Outcome for medically treated dogs was obtained via a standardized questionnaire. Neurologic deficits were observed significantly more often in surgically treated dogs. Surgically treated dogs had unsuccessful medical treatment before referral significantly more often than did medically treated dogs. Thirty-one of 49 (63.3%) medically treated dogs were available for follow-up evaluation. Of these 31 dogs, 17 (55%) were managed successfully, 10 (32.3%) were managed unsuccessfully and underwent surgical treatment, 3 (9.7%) were euthanized because of progression of clinical signs, and 1 (3.2%) was alive but had an increase in severity of clinical signs after medical management. Clinical signs differed in dogs treated medically or surgically for DLSS. Medical treatment for dogs with DLSS was associated with a fair prognosis.

The impact of a person-centred community pharmacy mental health medication support service on consumer outcomes.

Science.gov (United States)

McMillan, Sara S; Kelly, Fiona; Hattingh, H Laetitia; Fowler, Jane L; Mihala, Gabor; Wheeler, Amanda J

2018-04-01

Mental illness is a worldwide health priority. As medication is commonly used to treat mental illness, community pharmacy staff is well placed to assist consumers. To evaluate the effectiveness of a multifaceted, community pharmacy medication support service for mental health consumers. Pharmacists and pharmacy support staff in three Australian states were trained to deliver a flexible, goal-oriented medication support service for adults with mental illness over 3-6 months. Consumer-related outcome measures included perceptions of illness and health-related quality of life, medication beliefs, treatment satisfaction and medication adherence. Fifty-five of 100 trained pharmacies completed the intervention with 295 of the 418 recruited consumers (70.6% completion rate); 51.2% of consumers received two or more follow-ups. Significant improvements were reported by consumers for overall perceptions of illness (p Consumers also reported an increase in medication adherence (p = 0.005). A community pharmacy mental health medication support service that is goal-oriented, flexible and individualised, improved consumer outcomes across various measures. While further research into the cost-effectiveness and sustainability of such a service is warranted, this intervention could easily be adapted to other contexts.

Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy

Directory of Open Access Journals (Sweden)

Steinhausen S

2014-09-01

Full Text Available Simone Steinhausen,1 Oliver Ommen,2 Sunya-Lee Antoine,1 Thorsten Koehler,3 Holger Pfaff,4 Edmund Neugebauer11Institute for Research in Operative Medicine (IFOM, Witten/Herdecke University, Campus Cologne-Merheim, Germany; 2Federal Centre for Health Education (BZgA, Cologne, Germany; 3Institute for Applied Social Sciences (infas, Bonn, Germany; 4Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR, Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany Purpose: To investigate accident casualties’ long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon’s empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes.Patients and methods: Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward. The subjective evaluation of medical treatment outcome was measured 6 weeks and 12 months after discharge with the respective scale from the Cologne Patient Questionnaire. Physician Empathy was assessed with the Consultation and Relational Empathy Measure. The correlation between physician empathy and control variables with the subjective evaluation of medical treatment outcome 12 months after discharge was identified by means of logistic regression analysis under control of sociodemographic and injury-related factors.Results: One hundred and thirty-six patients were included within the logistic regression analysis at the 12-month follow-up. Compared to the 6-week follow-up, the level of subjective evaluation of medical treatment outcome was slightly lower and the association with physician empathy was weaker. Compared to patients who rated the empathy of their surgeon lower than 31 points, patients

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

Science.gov (United States)

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (pstudy is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Encounters between medical specialists and patients with medically unexplained physical symptoms; influences of communication on patient outcomes and use of health care: a literature overview.

NARCIS (Netherlands)

Weiland, A.; Kraats, R.E. van de; Blankenstein, A.H.; Saase, J.L.C.M. van; Molen, H.T. van der; Bramer, W.M.; Dulmen, A.M. van; Arends, L.R.

2012-01-01

Medically unexplained physical symptoms (MUPS) burden patients and health services due to large quantities of consultations and medical interventions. The aim of this study is to determine which elements of communication in non-psychiatric specialist MUPS care influence health outcomes. Systematic

Study to Measure the impact of Pharmacists and Pharmacy Services (STOMPP on Medication Non-Adherence: Medication Adherence and Clinical Outcomes

Directory of Open Access Journals (Sweden)

Sharrel Pinto, BS Pharm, DMM, MS, PhD

2018-02-01

Full Text Available Objective: To compare the impact of various pharmacy-based services on medication adherence and clinical outcomes. Design: Prospective, randomized control trial Setting: A local endocrinology group (clinic setting and community pharmacies belonging to a regional integrated delivery network (IDN in Toledo, OH Population: Subjects included within this study had type 2 diabetes, were prescribed a minimum of five medications, at least 18 years of age, having the ability to self-administer medications as prescribed, and be able to speak and understand English. Subjects were required to have Paramount health insurance, must be willing and able to provide informed consent, actively participate in the assigned MTM sessions, and have adequate transportation to attend the sessions at a participating pharmacy.  Methods: Patients were recruited through flyers at practice sites, referrals from physicians and pharmacists, and direct mailers. Members of the research team would screen patients to assess their eligibility to participate in the study. Patients who fit the inclusion criteria were randomized into one of the following four different groups: Pill Bottle (PB, Blister Pack (BP, Pill Bottle + Medication Therapy Management (PB+MTM, and Adherence Pharmacy (BP+MTM. Patients enrolled in the BP groups had their medications synchronized. Patients in the AP group were given the option to have their medications delivered, if needed. Practice innovation: We partnered with a regional integrated delivery network (IDN with multiple community pharmacy practice sites and a practice group of endocrinologists. A new practice model called Adherence Pharmacy was conceptualized and implemented within the community setting and was accessible to patients. Main Outcomes Measures: Medication adherence, measured using proportions of days covered (PDC and pill count scores at baseline, 3 months, 6 months, 9 months, and 12 months; Hemoglobin A1c (HbA1c, body mass index (BMI

Narrowing the Gap Between the Rhetoric and the Reality of Medical Ethics.

Science.gov (United States)

Silverman, David R.

1996-01-01

This paper argues that in the debate over medical ethics and its role in medical education, the divergence of law and reality reflects the law's flawed medical model, which poorly matches the dynamic of the physician-patient relationship and attempts ineffectually to reshape it, and also medicine's autonomous professional culture, which…

Flow of pedestrians through narrow doors with different competitiveness

International Nuclear Information System (INIS)

Garcimartín, A; Pastor, J M; Zuriguel, I; Parisi, D R; Martín-Gómez, C

2016-01-01

We report a thorough analysis of the intermittent flow of pedestrians through a narrow door. The observations include five different sets of evacuation drills with which we have investigated the effect of door size and competitiveness on the flow dynamics. Although the outcomes are in general compatible with the existence of the faster-is-slower effect, the temporal evolution of the instantaneous flow rate provides evidence of new features. These stress the crucial role of the number of people performing the tests, which has an influence on the obtained results. Once the transients at the beginning and end of the evacuation are removed, we have found that the time lapses between the passage of two consecutive pedestrians display heavy-tailed distributions in all the scenarios studied. Meanwhile, the distribution of burst sizes decays exponentially; this can be linked to a constant probability of finding a long-lasting clog during the evacuation process. Based on these results, a discussion is presented on the caution that should be exercised when measuring or describing the intermittent flow of pedestrians through narrow doors. (paper: interdisciplinary statistical mechanics)

A review of characteristics and outcomes of Australia's undergraduate medical education rural immersion programs.

Science.gov (United States)

O'Sullivan, Belinda G; McGrail, Matthew R; Russell, Deborah; Chambers, Helen; Major, Laura

2018-01-31

A key strategy for increasing the supply of rural doctors is rurally located medical education. In 2000, Australia introduced a national policy to increase rural immersion for undergraduate medical students. This study aims to describe the characteristics and outcomes of the rural immersion programs that were implemented in Australian medical schools. Information about 19 immersion programs was sourced in 2016 via the grey and published literature. A scoping review of the published peer-reviewed studies via Ovid MEDLINE and Informit (2000-2016) and direct journal searching included studies that focused on outcomes of undergraduate rural immersion in Australian medical schools from 2000 to 2016. Programs varied widely by selection criteria and program design, offering between 1- and 6-year immersion. Based on 26 studies from 10 medical schools, rural immersion was positively associated with rural practice in the first postgraduate year (internship) and early career (first 10 years post-qualifying). Having a rural background increased the effects of rural immersion. Evidence suggested that longer duration of immersion also increases the uptake of rural work, including by metropolitan-background students, though overall there was limited evidence about the influence of different program designs. Most evidence was based on relatively weak, predominantly cross-sectional research designs and single-institution studies. Many had flaws including small sample sizes, studying internship outcomes only, inadequately controlling for confounding variables, not using metropolitan-trained controls and providing limited justification as to the postgraduate stage at which rural practice outcomes were measured. Australia's immersion programs are moderately associated with an increased rural supply of early career doctors although metropolitan-trained students contribute equal numbers to overall rural workforce capacity. More research is needed about the influence of student interest

Medical humanities’ challenge to medicine

Science.gov (United States)

Macnaughton, Jane

2015-01-01

Medicine is predicated on a view of human nature that is highly positivist and atomistic. This is apparent in the way in which its students are taught, clinical consultations are structured and medical evidence is generated. The field of medical humanities originally emerged as a challenge to this overly narrow view, but it has rarely progressed beyond tinkering around the edges of medical education. This is partly because its practitioners have largely been working from within a pervasive medical culture from which it is difficult to break free, and partly because the field has been insufficiently armed with scholarly thinking from the humanities. This is beginning to change and there is a sign that research in medical humanities has the potential to mount a persuasive challenge to medicine’s ways of teaching, working and finding out. This article problematizes medicine’s narrow viewpoint, grounding its critique in philosophical ideas from phenomenology and pragmatism. I will reflect upon the historical context within which medical humanities has emerged and briefly examine specific examples of how its interdisciplinary approach, involving humanities scholars with clinicians and medical scientists, may develop new research directions in medicine. PMID:21851510

Medical humanities' challenge to medicine.

Science.gov (United States)

Macnaughton, Jane

2011-10-01

Medicine is predicated on a view of human nature that is highly positivist and atomistic. This is apparent in the way in which its students are taught, clinical consultations are structured and medical evidence is generated. The field of medical humanities originally emerged as a challenge to this overly narrow view, but it has rarely progressed beyond tinkering around the edges of medical education. This is partly because its practitioners have largely been working from within a pervasive medical culture from which it is difficult to break free, and partly because the field has been insufficiently armed with scholarly thinking from the humanities. This is beginning to change and there is a sign that research in medical humanities has the potential to mount a persuasive challenge to medicine's ways of teaching, working and finding out. This article problematizes medicine's narrow viewpoint, grounding its critique in philosophical ideas from phenomenology and pragmatism. I will reflect upon the historical context within which medical humanities has emerged and briefly examine specific examples of how its interdisciplinary approach, involving humanities scholars with clinicians and medical scientists, may develop new research directions in medicine. © 2011 Blackwell Publishing Ltd.

Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients.

Science.gov (United States)

Patzer, Rachel E; Serper, Marina; Reese, Peter P; Przytula, Kamila; Koval, Rachel; Ladner, Daniela P; Levitsky, Josh M; Abecassis, Michael M; Wolf, Michael S

2016-10-01

We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month. On average, patients knew what 91% of their medications were for (self-report) and demonstrated proper dosing (via observed demonstration) for 83% of medications. Overall, 35% were non-adherent based on either self-report or tacrolimus level. In multivariable analyses, fewer months since transplant and limited literacy were associated with non-adherence (all Padherence, and hospitalization could help target appropriate self-care interventions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Narrowing the Gap in Outcomes: Further Overview of Data and Evidence on the ECM Outcomes for Vulnerable Groups. Progress Report and Update

Science.gov (United States)

Morris, Marian; Easton, Claire

2008-01-01

Narrowing the Gap (NtG) is a two-year development and research programme, funded by the Department for Children, Schools and Families (DCSF) and the Local Government Association (LGA), working in partnership with other agencies, including local authorities. It seeks to make a significant difference, on a national scale, to the performance of…

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

Directory of Open Access Journals (Sweden)

Derek Bell

Full Text Available Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR, including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent for a minimum of 4 hours per day (65% of study group had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03 and had a lower 7 day re-admission rate (p<0.02. This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

DEFF Research Database (Denmark)

Clemmensen, Peter; Roe, Matthew T.; Hochman, Judith S.

2015-01-01

BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long......-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n....... There were no sex-specific, treatment-related differences in 30-day platelet reactivity. CONCLUSIONS: Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after...

Surgical Outcomes of Ahmed or Baerveldt Tube Shunt Implantation for medically Uncontrolled Traumatic Glaucoma.

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Yadgarov, Arkadiy; Liu, Dan; Crane, Elliot S; Khouri, Albert S

2017-01-01

To describe postoperative surgical success of either Ahmed or Baerveldt tube shunt implantation for eyes with medically uncontrolled traumatic glaucoma. A review was carried out to identify patients with traumatic glaucoma that required tube shunt implantation between 2009 and 2015 at Rutgers University in Newark, New Jersey, USA. Seventeen eyes from 17 patients met inclusion criteria, including at least 3-month postoperative follow-up. The main outcome measure was surgical success at 1-year follow-up after tube implantation. Mean preoperative intraocular pressure (IOP) was 34.1 ± 8.2 mm Hg on 3.1 ± 1.6 ocular hypotensive medications. Nine eyes (53%) sustained closed globe injury. Ten eyes (59%) received an Ahmed valve shunt and seven eyes (41%) received a Baerveldt tube shunt. Surgical success rate at 1 year postoperatively was 83%. Compared to preoperative, the mean postoperative IOP was significantly lower (16.1 ± 3.5 mm Hg, p Ahmed or Baerveldt tube shunt provided successful control of IOP in patients with medically uncontrollable traumatic glaucoma. Yadgarov A, Liu D, Crane ES, Khouri AS. Surgical Outcomes of Ahmed or Baerveldt Tube Shunt Implantation for medically Uncontrolled Traumatic Glaucoma. J Curr Glaucoma Pract 2017;11(1):16-21.

What European gynaecologists need to master: Consensus on medical expertise outcomes of pan-European postgraduate training in obstetrics & gynaecology.

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van der Aa, Jessica E; Tancredi, Annalisa; Goverde, Angelique J; Velebil, Petr; Feyereisl, Jaroslav; Benedetto, Chiara; Teunissen, Pim W; Scheele, Fedde

2017-09-01

European harmonisation of training standards in postgraduate medical education in Obstetrics and Gynaecology is needed because of the increasing mobility of medical specialists. Harmonisation of training will provide quality assurance of training and promote high quality care throughout Europe. Pan-European training standards should describe medical expertise outcomes that are required from the European gynaecologist. This paper reports on consensus development on the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. A Delphi procedure was performed amongst European gynaecologists and trainees in Obstetrics & Gynaecology, to develop consensus on outcomes of training. The consensus procedure consisted of two questionnaire rounds, followed by a consensus meeting. To ensure reasonability and feasibility for implementation of the training standards in Europe, implications of the outcomes were considered in a working group thereafter. We invited 142 gynaecologists and trainees in Obstetrics & Gynaecology for participation representing a wide range of European countries. They were selected through the European Board & College of Obstetrics and Gynaecology and the European Network of Trainees in Obstetrics & Gynaecology. Sixty people participated in round 1 and 2 of the consensus procedure, 38 (63.3%) of whom were gynaecologists and 22 (36.7%) were trainees in Obstetrics & Gynaecology. Twenty-eight European countries were represented in this response. Round 3 of the consensus procedure was performed in a consensus meeting with six experts. Implications of the training outcomes were discussed in a working group meeting, to ensure reasonability and feasibility of the material for implementation in Europe. The entire consensus procedure resulted in a core content of training standards of 188 outcomes, categorised in ten topics. European consensus was developed regarding the medical expertise outcomes of pan-European training in Obstetrics and

A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction.

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Leibowitz, Ruth; Day, Susan; Dunt, David

2003-06-01

The organization of after-hours primary medical care services is changing in many countries. Increasing demand, economic considerations and changes in doctors' attitudes are fueling these changes. Information for policy makers in this field is needed. However, a comprehensive review of the international literature that compares the effects of one model of after-hours care with another is lacking. The aim of this study was to carry out a systematic review of the international literature to determine what evidence exists about the effect of different models of out-of-hours primary medical care service on outcome. Original studies and systematic reviews written since 1976 on the subject of 'after-hours primary medical care services' were identified. Databases searched were Medline/Premedline, CINAHL, HealthSTAR, Current Contents, Cochrane Reviews, DARE, EBM Reviews and EconLit. For each paper where the optimal design would have been an interventional study, the 'level' of evidence was assessed as described in the National Health and Medical Research Council Handbook. 'Comparative' studies (levels I, II, III and IV pre-/post-test studies) were included in this review. Six main models of after-hours primary care services (not mutually exclusive) were identified: practice-based services, deputizing services, emergency departments, co-operatives, primary care centres, and telephone triage and advice services. Outcomes were divided into the following categories: clinical outcomes, medical workload, and patient and GP satisfaction. The results indicate that the introduction of a telephone triage and advice service for after-hours primary medical care may reduce the immediate medical workload. Deputizing services increase immediate medical workload because of the low use of telephone advice and the high home visiting rate. Co-operatives, which use telephone triage and primary care centres and have a low home visiting rate, reduce immediate medical workload. There is little

Treatment outcome of alcohol use disorder outpatients with or without medically assisted detoxification

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Merkx, Maarten J. M.; Schippers, Gerard M.; Koeter, Maarten W. J.; de Wildt, Wencke A. J. M.; Vedel, Ellen; Goudriaan, Anna E.; van den Brink, Wim

2014-01-01

Little is known about the incremental effects of medically assisted detoxification on outpatient treatment for alcohol use disorders. The objective of this study was to compare drinking outcomes in a psychosocial treatment program between two groups of heavy drinking patients who had an alcohol use

Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets.

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Tsai, Jack; Middleton, Margaret; Villegas, Jennifer; Johnson, Cindy; Retkin, Randye; Seidman, Alison; Sherman, Scott; Rosenheck, Robert A

2017-12-01

Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5.4 hours' worth of legal services to resolve. The most common problems were related to VA benefits, housing, family issues, and consumer issues. Among a subsample of 148 veterans who were followed for one year, we observed significant improvements in housing, income, and mental health. Veterans who received more partnership services showed greater improvements in housing and mental health than those who received fewer services, and those who achieved their predefined legal goals showed greater improvements in housing status and community integration than those who did not. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health.

Low-dose narrow-band UVB phototherapy combined with topical therapy is effective in psoriasis and does not inhibit systemic T-cell activation

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de Rie, M. A.; Out, T. A.; Bos, J. D.

1998-01-01

Psoriasis is a chronic T-cell-mediated inflammatory skin disease which can be treated with topical medication, phototherapy or systemic medication. A subgroup of psoriatic patients does not respond to monotherapy and needs combination therapy. We used low-dose narrow-band UVB phototherapy, combined

Dysmenorrhea among female medical students in King Abdulaziz University: Prevalence, Predictors and outcome

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Ibrahim, Nahla Khamis; AlGhamdi, Manar Saleh; Al-Shaibani, Alanoud Nawaf; AlAmri, Fatima Ali; Alharbi, Huda Abdulrahman; Al-Jadani, Arwa Kheder; Alfaidi, Raghad Ahmed

2015-01-01

Objective: To determine the prevalence, predictors and outcome of dysmenorrhea among female medical students in King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Methods: A cross-sectional study was conducted among 435 medical students at KAU, Jeddah selected through stratified random sample method. A pre-constructed, validated, self-administered questionnaire was used to collect personal and socio-demographic information. Data about menstrual history, stress, smoking were also collected. The severity of dysmenorrhea was scored by the “Visual Analogue Scale (VAS)”. Descriptive and analytical statistics were conducted. Results: The prevalence of dysmenorrhea was 60.9%. Logistic regression showed that heavy period was the first predictor of dysmenorrhea (aOR=1.94; 95% CI: 1.29- 2.91), followed by stress (aOR=1.90; 95% C.I.: 1.19-3.07). The prevalence of severe dysmenorrhea among the sufferers was 38.6%. Depressed mood was the commonest (80.8%) symptom accompanying dysmenorrhea. Regarding the outcome of dysmenorrhea, 67.5% of the sufferes reported emotional instability, while 28.3% reported absenteeism from the university. Conclusions: A high prevalence of dysmenorrhea was prevalent among medical students in King Abdulaziz University (KAU), Health promotion, screening programs, and stress management courses are recommended. PMID:26870088

IMPACT OF MEDICAL AND SOCIAL FACTORS ON SURGICAL OUTCOMES OF PULMONARY TUBERCULOSIS IN HIV POSITIVE PATIENTS

Directory of Open Access Journals (Sweden)

D. V. Аlkаz

2018-01-01

Full Text Available The article presents the study of the impact of social and medical factors and bad habits on the outcomes of planned surgery in 95 patients with concurrent respiratory tuberculosis and HIV infection The correlation analysis was performed which discovered the factors providing a positive impact on treatment outcomes The following factors have the strongest association with treatment outcome: patient's regular job, family, no alcohol or nicotine addiction, a form of tuberculosis, and administration of antiretroviral therapy It was noted that surgery outcome could be predicted and potential complications prevented 

The interactive effects of social support and physical functioning on HIV medical outcomes among African Americans whom inject drugs.

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Maragh-Bass, Allysha C; Denison, Julie A; Thorpe, Roland J; Knowlton, Amy R

2017-02-15

Research suggests a syndemic of substance use, mental illness, and familial conflict is associated with poor HIV medical outcomes among African American persons living with HIV (PLHIV). Social support may facilitate positive health outcomes. This study explores psychosocial correlates of HIV medical outcomes, defined as undetectable viral load (UVL) and acute care minimization. Data were from baseline of the BEACON study (N = 351). UVL was ≤40 copies/mL. Acute care minimization was defined as no ER visits and/or hospitalizations in 6 months. Descriptive statistics and Poisson regression were implemented (N = 351). Moderate syndemic burden was associated with viral suppression. Individuals with main partner caregivers had 35% higher likelihood of viral suppression than individuals whose main supporters were neither kin nor main partners (adjusted point-prevalence rate ratio [APR] = 1.35; 95% CI [1.05, 1.74]). Surprisingly, individuals with more health-related support were more likely to use acute care than individuals with less health-related support (pInteraction analyses showed that physical function modified the relationship between main supporter type and acute care minimization. Results suggest that social support receipt was not consistently associated with HIV medical outcomes. Conversely, higher syndemic burden may have facilitated positive outcomes through necessitating increased rates of health care engagement. Health care professionals should elicit discussion of social support to strengthen PLHIVs' and their supporters' relationships to improve their health. Results highlight the need for culturally tailored interventions to improve HIV medical outcomes among African American PLHIV substance users.

Jihadism, Narrow and Wide

DEFF Research Database (Denmark)

Sedgwick, Mark

2015-01-01

The term “jihadism” is popular, but difficult. It has narrow senses, which are generally valuable, and wide senses, which may be misleading. This article looks at the derivation and use of “jihadism” and of related terms, at definitions provided by a number of leading scholars, and at media usage....... It distinguishes two main groups of scholarly definitions, some careful and narrow, and some appearing to match loose media usage. However, it shows that even these scholarly definitions actually make important distinctions between jihadism and associated political and theological ideology. The article closes...

The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

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Abdallat, W [King Hussein Medical Centre, Amman (Jordan). Dept. of Ophthalmology

2011-07-01

The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

International Nuclear Information System (INIS)

Abdallat, W

2011-01-01

The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

Medical students’ attitudes toward gay men

Science.gov (United States)

2012-01-01

Background Healthcare providers’ attitudes toward sexual minorities influence patient comfort and outcomes. This study characterized medical student attitudes toward gay men, focusing on behavior, personhood, gay civil rights, and male toughness. Methods A cross-sectional web-based anonymous survey was sent to medical students enrolled at the University of California, Davis (N = 371) with a response rate of 68%. Results Few respondents expressed negative attitudes toward gay men or would deny them civil rights. More negative responses were seen with respect to aspects of intimate behavior and homosexuality as a natural form of sexual expression. Men and students younger than 25 years old were more likely to endorse negative attitudes toward behavior as well as more traditional views on male toughness. Conclusions We show that an important minority of students express discomfort with the behavior of gay men and hold to a narrow construction of male identity. These findings suggest that competency training must move beyond conceptual discussions and address attitudes toward behaviors through new pedagogical approaches. PMID:22873668

Medical students’ attitudes toward gay men

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Matharu Kabir

2012-08-01

Full Text Available Abstract Background Healthcare providers’ attitudes toward sexual minorities influence patient comfort and outcomes. This study characterized medical student attitudes toward gay men, focusing on behavior, personhood, gay civil rights, and male toughness. Methods A cross-sectional web-based anonymous survey was sent to medical students enrolled at the University of California, Davis (N = 371 with a response rate of 68%. Results Few respondents expressed negative attitudes toward gay men or would deny them civil rights. More negative responses were seen with respect to aspects of intimate behavior and homosexuality as a natural form of sexual expression. Men and students younger than 25 years old were more likely to endorse negative attitudes toward behavior as well as more traditional views on male toughness. Conclusions We show that an important minority of students express discomfort with the behavior of gay men and hold to a narrow construction of male identity. These findings suggest that competency training must move beyond conceptual discussions and address attitudes toward behaviors through new pedagogical approaches.

Learning curves and long-term outcome of simulation-based thoracentesis training for medical students

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2011-01-01

Background Simulation-based medical education has been widely used in medical skills training; however, the effectiveness and long-term outcome of simulation-based training in thoracentesis requires further investigation. The purpose of this study was to assess the learning curve of simulation-based thoracentesis training, study skills retention and transfer of knowledge to a clinical setting following simulation-based education intervention in thoracentesis procedures. Methods Fifty-two medical students were enrolled in this study. Each participant performed five supervised trials on the simulator. Participant's performance was assessed by performance score (PS), procedure time (PT), and participant's confidence (PC). Learning curves for each variable were generated. Long-term outcome of the training was measured by the retesting and clinical performance evaluation 6 months and 1 year, respectively, after initial training on the simulator. Results Significant improvements in PS, PT, and PC were noted among the first 3 to 4 test trials (p 0.05). Clinical competency in thoracentesis was improved in participants who received simulation training relative to that of first year medical residents without such experience (p simulation-based thoracentesis training can significantly improve an individual's performance. The saturation of learning from the simulator can be achieved after four practice sessions. Simulation-based training can assist in long-term retention of skills and can be partially transferred to clinical practice. PMID:21696584

Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake.

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Li, Yongqiang; Reinhardt, Jan D; Gosney, James E; Zhang, Xia; Hu, Xiaorong; Chen, Sijing; Ding, Mingpu; Li, Jianan

2012-06-01

To characterize a spinal cord injury (SCI) population from the 2008 Sichuan earthquake in China; to evaluate functional outcomes of physical rehabilitation interventions; to assess potential determinants of rehabilitation effectiveness; and to assess medical complications and management outcomes. A total of 51 earthquake victims with SCI were enrolled and underwent rehabilitation programming. Functional rehabilitation outcomes included ambulation ability, wheelchair mobility and activities of daily living (ADL) assessed with the Modified Barthel Index at the beginning and end of rehabilitation. Effectiveness of rehabilitation and the effect of other predictors were evaluated by mixed effects regression. Outcomes of medical complication management were determined by comparison of the incidence of respective complications at the beginning and end of rehabilitation. Ambulation, wheelchair mobility and ADL were significantly improved with rehabilitation programming. Both earlier rescue and earlier onset of rehabilitation were significant positive predictors of rehabilitation effectiveness, whereas delayed onset of rehabilitation combined with prolonged time to rescue resulted in a lesser positive effect. Medical complications were managed effectively in 63% (pressure ulcers) to 85% (deep vein thrombosis) of patients during rehabilitation. Earthquake victims with SCI may achieve significantly improved functional rehabilitation functional outcomes on a formal, institutional-based physical rehabilitation programme.

Device Physics of Narrow Gap Semiconductors

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Chu, Junhao

2010-01-01

Narrow gap semiconductors obey the general rules of semiconductor science, but often exhibit extreme features of these rules because of the same properties that produce their narrow gaps. Consequently these materials provide sensitive tests of theory, and the opportunity for the design of innovative devices. Narrow gap semiconductors are the most important materials for the preparation of advanced modern infrared systems. Device Physics of Narrow Gap Semiconductors offers descriptions of the materials science and device physics of these unique materials. Topics covered include impurities and defects, recombination mechanisms, surface and interface properties, and the properties of low dimensional systems for infrared applications. This book will help readers to understand not only the semiconductor physics and materials science, but also how they relate to advanced opto-electronic devices. The last chapter applies the understanding of device physics to photoconductive detectors, photovoltaic infrared detector...

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

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Loetz, Francisca

2010-01-01

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

The medicalization of love and narrow and broad conceptions of human well-being

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Nyholm, S.R.

2015-01-01

Would a "medicalization" of love be a "good" or "bad" form of medicalization? In discussing this question, Earp, Sandberg, and Savulescu primarily focus on the potential positive and negative consequences of turning love into a medical issue. But it can also be asked whether there is something

24/7 Presence of Medical Staff in the Labor Ward; No Day-Night Differences in Perinatal and Maternal Outcomes.

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Tavares, Sara; Cavaco-Gomes, João; Moucho, Marina; Severo, Milton; Mateus, Mário; Ramalho, Carla; Visser, Gerard H A; Montenegro, Nuno

2017-05-01

Objective  The objective of this study was to assess possible day-night differences in perinatal and maternal labor outcomes in a hospital setting with no day-night differences in the presence of experienced medical staff. Design  This was a retrospective study conducted over 5 years between 2008 and 2012. Setting  This study was set at the obstetric delivery unit in a tertiary hospital. Population  A total of 9,143 singleton deliveries were assessed after 34 weeks of gestation and after exclusion of major congenital malformations, inductions of labor, and elective cesarean sections. Materials and Methods  Data were collected using the hospital electronic medical records. Time periods of 8 hours were defined (daytime between 8 am and 4 pm, evening time between 4 pm and 12 pm, and nighttime between 12 pm and 8 am). Differences between the three time periods were assessed using software R Core Team (2013). Main outcome measures were neonatal birth asphyxia, neonatal intensive care unit admission, and neonatal death. Results  There were no differences in perinatal and maternal outcomes in the course of the day, apart from a higher incidence of third- and fourth-degree tears during the evening. Neonatal outcome after obstetric emergencies (uterine rupture, partial placental abruption, and cord prolapse) also showed no day-night differences. Conclusion  Adverse nighttime-related outcomes may be avoided by the 24/7 presence of experienced medical staff. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Same admissions tools, different outcomes: a critical perspective on predictive validity in three undergraduate medical schools.

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Edwards, Daniel; Friedman, Tim; Pearce, Jacob

2013-12-27

Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions. This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude test score based on UMAT, school result and interview score) were correlated with GPA over four years of study. Standard regression of each of the three admissions variables on GPA, for each institution at each year level was also conducted. Overall, the data found positive correlations between performance in medical school, school achievement and UMAT, but not interview. However, there were substantial differences between schools, across year levels, and within sections of UMAT exposed. Despite this, each admission variable was shown to add towards explaining course performance, net of other variables. The findings suggest the strength of multiple admissions tools in predicting outcomes of medical students. However, they also highlight the large differences in outcomes achieved by different schools, thus emphasising the pitfalls of generalising results from predictive validity studies without recognising the diverse ways in which they are designed and the variation in the institutional contexts in which they are administered. The assumption that high-positive correlations are desirable (or even expected) in these studies is also problematised.

Self-Reported Adverse Drug Reactions, Medication Adherence, and Clinical Outcomes among Major Depressive Disorder Patients in Ethiopia: A Prospective Hospital Based Study

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Tadesse Melaku Abegaz

2017-01-01

Full Text Available Background. There is paucity of data on prevalence of Adverse Drug Reactions (ADRs and adherence and clinical outcomes of antidepressants. The present study determined the magnitude of ADRs of antidepressants and their impact on the level of adherence and clinical outcome. Methods. A prospective cross-sectional study was conducted among depression patients from September 2016 to January 2017 at Gondar University Hospital psychiatry clinic. The Naranjo ADR probability scale was employed to assess the ADRs. The rate of medication adherence was determined using Morisky Medication Adherence Measurement Scale-Eight. Results. Two hundred seventeen patients participated in the study, more than half of them being males (122; 56.2%. More than one-half of the subjects had low adherence to their medications (124; 57.1% and about 186 (85.7% of the patients encountered ADR. The most common ADR was weight gain (29; 13.2%. More than one-half (125; 57.6% of the respondents showed improved clinical outcome. Optimal level of medication adherence decreased the likelihood of poor clinical outcome by 56.8%. Conclusion. ADRs were more prevalent. However, adherence to medications was very poor in the setup. Long duration of depression negatively affects the rate of adherence. In addition, adherence was found to influence the clinical outcome of depression patients.

Narrow dibaryon resonances

International Nuclear Information System (INIS)

Kajdalov, A.B.

1986-01-01

Experimental data on np interactions indicating to existence of narrow resonances in pp-system are discussed. Possible theoretical interpretations of these resonances are given. Experimental characteristics of the dibaryon resonances with isospin I=2 are considered

Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review.

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Aidala, Angela A; Wilson, Michael G; Shubert, Virginia; Gogolishvili, David; Globerman, Jason; Rueda, Sergio; Bozack, Anne K; Caban, Maria; Rourke, Sean B

2016-01-01

Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking "upstream" economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual's control that affect housing and residential environments and the health resources or risk exposures such contexts provide. We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include

Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review

Science.gov (United States)

Wilson, Michael G.; Shubert, Virginia; Gogolishvili, David; Globerman, Jason; Rueda, Sergio; Bozack, Anne K.; Caban, Maria; Rourke, Sean B.

2016-01-01

Background. Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking “upstream” economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual’s control that affect housing and residential environments and the health resources or risk exposures such contexts provide. Objectives. We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. Search methods. We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. Selection criteria. We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in

Association between patient unconscious or not alert conditions and cardiac arrest or high-acuity outcomes within the Medical Priority Dispatch System "Falls" protocol.

Science.gov (United States)

Clawson, Jeff; Olola, Christopher; Scott, Greg; Schultz, Bryon; Pertgen, Richard; Robinson, Don; Bagwell, Barry; Patterson, Brett

2010-01-01

Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though "not alert" falls patients with severe outcomes mostly are "hot" transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing. The objective of this study was to characterize the risk of cardiac arrest and "hot-transport" outcomes in patients with "not alert" condition, within the Medical Priority Dispatch System (MPDS®) Falls protocol descriptors. This retrospective study used 129 months of de-identified, aggregate, dispatch datasets from three US emergency communication centers. The communication centers used the Medical Priority Dispatch System version 11.3-OMEGA type (released in 2006) to interrogate Emergency Medical System callers, select dispatch codes assigned to various response configurations, and provide pre-arrival instructions. The distribution of cases and percentages of cardiac arrest and hot-transport outcomes, categorized by MPDS® code, was profiled. Assessment of the association between MPDS® Delta-level 3 (D-3) "not alert" condition and cardiac arrest and hot-transport outcomes then followed. Overall, patients within the D-3 and D-2 "long fall" conditions had the highest proportions (compared to the other determinants in the "falls" protocol) of cardiac arrest and hot-transport outcomes, respectively. "Not alert" condition was associated significantly with cardiac arrest and hot-transport outcomes (pdeterminant within the MPDS® "fall" protocol was associated significantly with severe outcomes for short falls (falls. As reported to 9-1-1, the complaint of a "fall" may include the presence of underlying conditions that go beyond the obvious traumatic injuries caused by the fall itself.

Graves' disease in children: long-term outcomes of medical therapy.

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Rabon, Shona; Burton, Amy M; White, Perrin C

2016-10-01

Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild. © 2016 John Wiley & Sons Ltd.

Left mainstem bronchial narrowing: a vascular compression syndrome? Evaluation by magnetic resonance imaging

International Nuclear Information System (INIS)

Hungate, R.G.; Newman, B.; Meza, M.P.

1998-01-01

Background and objective. Vascular compression of the left mainstem bronchus (LMSB) between the descending aorta (DA) and pulmonary artery (PA) has been suggested as a cause for LMSB narrowing in children. These anatomic relationships have not been compared with those in children with a normal LMSB. Materials and methods. We undertook a retrospective review of the medical and radiologic records of 10 symptomatic young children (1-19 months, 5 boys, 5 girls) with MR demonstration of LMSB narrowing and compared them to 40 young children without great vessel or bronchial abnormality on MR (1 week-19 months, 28 boys, 12 girls). Chest MR evaluation included assessment of airway and great vessel anatomy with specific attention to the course of the LMSB and its relationship to the adjacent DA and PA. The position of the DA in relation to the spine was carefully evaluated. Results. Five children had focal and five had diffuse LMSB narrowing. DA position at the level of the crossing LMSB: in 40 % of symptomatic children the DA was located in front of the adjacent vertebral body; in 40 %, 1 / 2 - 3 / 4 and in 20 % 1 / 4 - 1 / 2 of the circumference of the DA was located anterior to the spine. In the control group, the DA was prespinal in 10 %, with a trend toward a more paraspinal location of the DA. The trend toward a difference in position of the DA between symptomatic and control patients was statistically significant (P < 0.05). DA position was not related to age (up to 19 months). At the level where the LMSB crossed the DA, a segment of the PA was located anterior to the LMSB, more often the right PA (RPA) or pulmonary bifurcation in symptomatic children and the left PA (LPA) in controls. No correlation was apparent between length of LMSB narrowing and DA or PA position. Chest radiographic abnormalities, when present, were subtle. Excellent MR/bronchoscopic correlation of LMSB narrowing was found in nine of the ten symptomatic children. One child underwent posterior

Self-declared stock ownership and association with positive trial outcome in randomized controlled trials with binary outcomes published in general medical journals: a cross-sectional study.

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Falk Delgado, Alberto; Falk Delgado, Anna

2017-07-26

Describe the prevalence and types of conflicts of interest (COI) in published randomized controlled trials (RCTs) in general medical journals with a binary primary outcome and assess the association between conflicts of interest and favorable outcome. Parallel-group RCTs with a binary primary outcome published in three general medical journals during 2013-2015 were identified. COI type, funding source, and outcome were extracted. Binomial logistic regression model was performed to assess association between COI and funding source with outcome. A total of 509 consecutive parallel-group RCTs were included in the study. COI was reported in 74% in mixed funded RCTs and in 99% in for-profit funded RCTs. Stock ownership was reported in none of the non-profit RCTs, in 7% of mixed funded RCTs, and in 50% of for-profit funded RCTs. Mixed-funded RCTs had employees from the funding company in 11% and for-profit RCTs in 76%. Multivariable logistic regression revealed that stock ownership in the funding company among any of the authors was associated with a favorable outcome (odds ratio = 3.53; 95% confidence interval = 1.59-7.86; p < 0.01). COI in for-profit funded RCTs is extensive, because the factors related to COI are not fully independent, a multivariable analysis should be cautiously interpreted. However, after multivariable adjustment only stock ownership from the funding company among authors is associated with a favorable outcome.

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review.

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Moonesinghe, S R; Lowery, J; Shahi, N; Millen, A; Beard, J D

2011-03-22

To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Systematic review. Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes.

Large-amplitude and narrow-band vibration phenomenon of a foursquare fix-supported flexible plate in a rigid narrow channel

Energy Technology Data Exchange (ETDEWEB)

Liu Lifang, E-mail: liu_lifang1106@yahoo.cn [School of Nuclear Science and Engineering, North China Electric Power University, Zhuxinzhuang, Dewai, Beijing 102206 (China); Lu Daogang, E-mail: ludaogang@ncepu.edu.cn [School of Nuclear Science and Engineering, North China Electric Power University, Zhuxinzhuang, Dewai, Beijing 102206 (China); Li Yang, E-mail: qinxiuyi@sina.com [School of Nuclear Science and Engineering, North China Electric Power University, Zhuxinzhuang, Dewai, Beijing 102206 (China); Zhang Pan, E-mail: zhangpan@ncepu.edu.cn [School of Nuclear Science and Engineering, North China Electric Power University, Zhuxinzhuang, Dewai, Beijing 102206 (China); Niu Fenglei, E-mail: niufenglei@ncepu.edu.cn [School of Nuclear Science and Engineering, North China Electric Power University, Zhuxinzhuang, Dewai, Beijing 102206 (China)

2011-08-15

Highlights: > FIV of a foursquare fix-supported flexible plate exposed to axial flow was studied. > Special designed test section and advanced measuring equipments were adopted. > The narrow-band vibration phenomenon with large amplitude was observed. > Line of plate's vibration amplitude and flow rate was investigated. > The phenomenon and the measurement error were analyzed. - Abstract: An experiment was performed to analyze the flow-induced vibration behavior of a foursquare fix-supported flexible plate exposed to the axial flow within a rigid narrow channel. The large-amplitude and narrow-band vibration phenomenon was observed in the experiment when the flow velocity varied with the range of 0-5 m/s. The occurring condition and some characteristics of the large-amplitude and narrow-band vibrations were investigated.

The relevance and role of homestays in medical education: a scoping study.

Science.gov (United States)

Hughes, Bonnie Olivia; Moshabela, Mosa; Owen, Jenni; Gaede, Bernhard

2017-01-01

The community-based medical education curriculum is growing in popularity as a strategy to bring universal health coverage to underserved communities by providing medical students with hands-on training in primary health care. Accommodation and immersion of medical students within the community will become increasingly important to the success of community-based curricula. In the context of tourism, homestays, where local families host guests, have shown to provide an immersive accommodation experience. By exploring homestays in the educational context, this scoping study investigates their role in providing an immersive pedagogical experience for medical students. A scoping review was performed using the online databases ScienceDirect and the Duke University Library Database, which searches Academic Search Complete, JSTOR, LexisNexis Academic, Web of Science, Proquest, PubMed and WorldCat. Using the inclusion term 'homestays' and excluding the term 'tourism', 181 results were returned. AClose assessment using inclusion criteria narrowed this to 14 relevant articles. There is very little published research specific to the experience of medical students in community homestays, indicating a gap in the literature. However, the existing educational outcomes suggest homestays may have the potential to serve a significant role in medical education, especially as a component of decentralised or community-based programmes. The literature reveals that educational homestays influence language learning, cultural immersion, and the development of professional skills for health science careers. These outcomes relate to the level of engagement between students and hosts, including the catalytic role of community liaisons. Homestays offer a unique depth of experience that has the potential to enrich the education of participating students, and require further research, particularly in the context of distributed and decentralised training platforms for medical and health sciences

Comparison of Transplant Waitlist Outcomes for Pediatric Candidates Supported by Ventricular Assist Devices Versus Medical Therapy.

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Law, Sabrina P; Oron, Assaf P; Kemna, Mariska S; Albers, Erin L; McMullan, D Michael; Chen, Jonathan M; Law, Yuk M

2018-05-01

Ventricular assist devices have gained popularity in the management of refractory heart failure in children listed for heart transplantation. Our primary aim was to compare the composite endpoint of all-cause pretransplant mortality and loss of transplant eligibility in children who were treated with a ventricular assist device versus a medically managed cohort. This was a retrospective cohort analysis. Data were obtained from the Scientific Registry of Transplant Recipients. The at-risk population (n = 1,380) was less than 18 years old, either on a ventricular assist device (605 cases) or an equivalent-severity, intensively medically treated group (referred to as MED, 775 cases). None. The impact of ventricular assist devices was estimated via Cox proportional hazards regression (hazard ratio), dichotomizing 1-year outcomes to "poor" (22%: 193 deaths, 114 too sick) versus all others (940 successful transplants, 41 too healthy, 90 censored), while adjusting for conventional risk factors. Among children 0-12 months old, ventricular assist device was associated with a higher risk of poor outcomes (hazard ratio, 2.1; 95% CI, 1.5-3.0; p comparative study of ventricular assist devices versus medical therapy in children. Age is a significant modulator of waitlist outcomes for children with end-stage heart failure supported by ventricular assist device, with the impact of ventricular assist devices being more beneficial in adolescents.

Predictors of discontinuation of antipsychotic medication and subsequent outcomes in the European First Episode Schizophrenia Trial (EUFEST).

Science.gov (United States)

Landolt, Karin; Rössler, Wulf; Ajdacic-Gross, Vladeta; Derks, Eske M; Libiger, Jan; Kahn, René S; Fleischhacker, W Wolfgang

2016-04-01

This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation. We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%). Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries. Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation. Copyright © 2016 Elsevier B.V. All rights reserved.

Time-in-a-bottle (TIAB): a longitudinal, correlational study of patterns, potential predictors, and outcomes of immunosuppressive medication adherence in adult kidney transplant recipients.

Science.gov (United States)

Russell, Cynthia L; Ashbaugh, Catherine; Peace, Leanne; Cetingok, Muammer; Hamburger, Karen Q; Owens, Sarah; Coffey, Deanna; Webb, Andrew W; Hathaway, Donna; Winsett, Rebecca P; Madsen, Richard; Wakefield, Mark R

2013-01-01

This study examined patterns, potential predictors, and outcomes of immunosuppressive medication adherence in a convenience sample of 121 kidney transplant recipients aged 21 yr or older from three kidney transplant centers using a theory-based, descriptive, correlational, longitudinal design. Electronic monitoring was conducted for 12 months using electronic monitoring. Participants were persistent in taking their immunosuppressive medications, but execution, which includes both taking and timing, was poor. Older age was the only demographic variable associated with medication adherence (r = 0.25; p = 0.005). Of the potential predictors examined, only medication self-efficacy was associated with medication non-adherence, explaining about 9% of the variance (r = 0.31, p = 0.0006). The few poor outcomes that occurred were not significantly associated with medication non-adherence, although the small number of poor outcomes may have limited our ability to detect a link. Future research should test fully powered, theory-based, experimental interventions that include a medication self-efficacy component. © 2013 John Wiley & Sons A/S.

Evolution of deformation velocity in narrowing for Zircaloy 2

Energy Technology Data Exchange (ETDEWEB)

Cetlin, P R [Minas Gerais Univ., Belo Horizonte (Brazil). Dept. de Engenharia Metalurgica; Okuda, M Y [Goias Univ., Goiania (Brazil). Inst. de Matematica e Fisica

1980-09-01

Some studies on the deformation instability in strain shows that the differences in this instability may lead to localized narrowing or elongated narrowing, for Zircaloy-2. The variation of velocity deformation with the narrowing evolution is expected to be different for these two cases. The mentioned variation is discussed, a great difference in behavior having been observed for the case of localized narrowing.

Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis.

Science.gov (United States)

Raymond Guilbault, Ryan William; Vinson, Joseph Alexander

2017-01-01

Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.

Towards effective outcomes in teaching, learning and assessment of law in medical education.

Science.gov (United States)

Preston-Shoot, Michael; McKimm, Judy

2011-04-01

Law is slowly emerging as a core subject area in medical education, alongside content on the ethical responsibilities of doctors to protect and promote patient health and well-being. Curriculum statements have begun to advise on core content and methods for organising teaching and assessment. However, no comprehensive overview of approaches to the delivery of this law curriculum has been undertaken. This paper reports an assessment of the nature and strength of the published evidence base for the teaching, learning and assessment of law in medical education. It also provides a thematic content overview from the best available literature on the teaching of law to medical students and on the assessment of their legal knowledge and skills. A systematic review of the evidence base was completed. Detailed scrutiny resulted in the inclusion of 31 empirical sources and 11 conceptual papers. The quality of the included material was assessed. Significant gaps exist in the evidence base. Empirical studies of the teaching of law are characterised by insufficient sample sizes and a focus on individual study programmes. They rely on measures of student satisfaction and on evaluating short-term outcomes rather than assessing whether knowledge is retained and whether learning impacts on patient outcomes. Studies reveal a lack of coordination between pre- or non-clinical and clinical medico-legal education. Although evidence on the development of students' knowledge is available, much learning is distant from the practice in which its application would be tested. Law learning in clinical placements appears to be opportunistic rather than structured. The place of law in the curriculum remains uncertain and should be more clearly identified. A more robust knowledge base is needed to realise the aspirations behind curriculum statements on law and to enable medical students to develop sufficient legal literacy to manage challenging practice encounters. Further research is needed into

Decisions by Finnish Medical Research Ethics Committees: A Nationwide Study of Process and Outcomes.

Science.gov (United States)

Hemminki, Elina; Virtanen, Jorma I; Regushevskaya, Elena

2015-10-01

Review by research ethics committees (RECs) is the key in medical research regulation. Data from meeting notes and project summaries were abstracted from all projects submitted in 2002 (n = 1,004) and 2007 (n = 1,045) to the official medical RECs in Finland. Data from consecutive submissions were combined per project. When comparing RECs, logistic regression was used to adjust for application characteristics. The number of projects handled varied notably by REC. In the first handling, 85% of applications in 2002 and 77% in 2007 were approved, while 13% and 20% were tabled. For 61% of the projects, the review time was 89 days, and 6% had 6 months or longer. The variation by REC in approval rates, number of handlings, or long review times was not explained by project characteristics. In the last handling, 94% of the projects in both years were approved or concluded not to need a statement from that REC. The most common reason for tabling or not approving an application was patient autonomy, usually centered on the patient leaflet. The next most common reasons were requests for further information and dissatisfaction with the scientific aspects of the project. The reasons classified as "ethics" in the narrow sense were rare. The REC focus was to assure that researchers follow the various rules on medical research and to improve the quality of research and project documents. REC considerations could be divided into decisions based on ethics and recommendations covering other aspects. © The Author(s) 2015.

The Research on Medical Education Outcomes (ROMEO) Registry: Addressing Ethical and Practical Challenges of Using "Bigger," Longitudinal Educational Data.

Science.gov (United States)

Gillespie, Colleen; Zabar, Sondra; Altshuler, Lisa; Fox, Jaclyn; Pusic, Martin; Xu, Junchuan; Kalet, Adina

2016-05-01

Efforts to evaluate and optimize the effectiveness of medical education have been limited by the difficulty of designing medical education research. Longitudinal, epidemiological views of educational outcomes can help overcome limitations, but these approaches require "bigger data"-more learners, sources, and time points. The rich data institutions collect on students and residents can be mined, however, ethical and practical barriers to using these data must first be overcome. In 2008, the authors established the Research on Medical Education Outcomes (ROMEO) Registry, an educational data registry modeled after patient registries. New York University School of Medicine students, residents, and fellows provide consent for routinely collected educational, performance, quality improvement, and clinical practice data to be compiled into a deidentified, longitudinal database. As of January 2015, this registry included 1,225 residents and fellows across 12 programs (71% consent rate) and 841 medical students (86% consent rate). Procedures ensuring voluntary informed consent are essential to ethical enrollment and data use. Substantial resources are required to provide access to and manage the data. The registry supports educational scholarship. Seventy-two studies using registry data have been presented or published. These focus on evaluating the curriculum, quality of care, and measurement quality and on assessing needs, competencies, skills development, transfer of skills to practice, remediation patterns, and links between education and patient outcomes. The authors are working to integrate assessment of relevant outcomes into the curriculum, maximize both the quantity and quality of the data, and expand the registry across institutions.

Narrow Networks on the Individual Marketplace in 2017.

Science.gov (United States)

Polski, Daniel; Weiner, Janet; Zhang, Yuehan

2017-09-01

This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at 27% and 30%. We also find large differences in narrow networks by state and by plan type.

The medicalization of love and narrow and broad conceptions of human well-being.

Science.gov (United States)

Nyholm, Sven

2015-07-01

Would a "medicalization" of love be a "good" or "bad" form of medicalization? In discussing this question, Earp, Sandberg, and Savulescu primarily focus on the potential positive and negative consequences of turning love into a medical issue. But it can also be asked whether there is something intrinsically regrettable about medicalizing love. It is argued here that the medicalization of love can be seen as an "evaluative category mistake": it treats a core human value (love) as if it were mainly a means to other ends (viz. physical health and hedonic well-being). It is also argued that Earp et al's closing argument (that a scientific perspective on love actually adds more value to love) can be seen as involving another evaluative category mistake: it treats an object of desire and practical interest (namely, love) as if it mainly were an object of scientific contemplation and theoretical interest. It is concluded that, to relate love to health and well-being in a more satisfying way, we should construe the latter two in broader ways, whereby love is itself a component or element of human flourishing.

Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States.

Science.gov (United States)

Minami, Christina A; Sheils, Catherine R; Pavey, Emily; Chung, Jeanette W; Stulberg, Jonah J; Odell, David D; Yang, Anthony D; Bentrem, David J; Bilimoria, Karl Y

2017-03-01

The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates. This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts. Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95% CI 1.07 to 1.39), MI (OR 1.14; 95% CI 1.06 to 1.23), pneumonia (OR 1.09; 95% CI 1.03 to 1.16), acute renal failure (OR 1.15; 95% CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95% CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95% CI 1.08 to 1.30). Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to

Retrospective cohort clinical investigation of a dental implant with a narrow diameter and short length for the partial rehabilitation of extremely atrophic jaws.

Science.gov (United States)

Maló, Paulo S; de Araújo Nobre, Miguel A; Lopes, Armando V; Ferro, Ana S

2017-01-01

We investigated the short-term clinical outcomes of narrow-diameter short-length implants for the fixed-prosthetic partial rehabilitation of extremely resorbed jaws. Twenty-three patients requiring partial rehabilitations with narrow-platform short-length implants in any jaw were included in this study. In total, 30 implants 3.3 mm in diameter and 7 (n = 15 implants) or 8.5 (n = 15 implants) mm in length were inserted. The primary outcome measure was implant cumulative survival rate (CSR); the secondary outcome measures were marginal bone resorption at 1 and 3 years and the incidence of biologic and mechanical complications. Five patients (21.7%) with six implants (20%) were lost to follow-up. Two implants failed in two patients, yielding a CSR at 3 years of follow-up of 93.4%. The average (standard deviation) marginal bone resorption was 1.34 mm (0.95 mm) after the first year and 1.38 mm (0.78 mm) after the third year. Biologic complications occurred in three patients; mechanical complications occurred in three patients. Despite the limitations of the study, our findings show that the use of new narrow-diameter short-length implants for the rehabilitation of extremely atrophic regions is viable in the short-term, and can be considered a treatment alternative in extremely resorbed jaws.

Application of active learning modalities to achieve medical genetics competencies and their learning outcome assessments

Directory of Open Access Journals (Sweden)

Hagiwara N

2017-12-01

Full Text Available Nobuko Hagiwara Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, CA, USA Abstract: The steadily falling costs of genome sequencing, coupled with the growing number of genetic tests with proven clinical validity, have made the use of genetic testing more common in clinical practice. This development has necessitated nongeneticist physicians, especially primary care physicians, to become more responsible for assessing genetic risks for their patients. Providing undergraduate medical students a solid foundation in genomic medicine, therefore, has become all the more important to ensure the readiness of future physicians in applying genomic medicine to their patient care. In order to further enhance the effectiveness of instructing practical skills in medical genetics, the emphasis of active learning modules in genetics curriculum at medical schools has increased in recent years. This is because of the general acceptance of a better efficacy of active learner-centered pedagogy over passive lecturer-centered pedagogy. However, an objective standard to evaluate students’ skill levels in genomic medicine achieved by active learning is currently missing. Recently, entrustable professional activities (EPAs in genomic medicine have been proposed as a framework for developing physician competencies in genomic medicine. EPAs in genomic medicine provide a convenient guideline for not only developing genomic medicine curriculum but also assessing students’ competency levels in practicing genomic medicine. In this review, the efficacy of different types of active learning modules reported for medical genetics curricula is discussed using EPAs in genomic medicine as a common evaluation standard for modules’ learning outcomes. The utility of the EPAs in genomic medicine for designing active learning modules in undergraduate medical genetics curricula is also discussed. Keywords

Tablet splitting of narrow therapeutic index drugs: a nationwide survey in Taiwan.

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Chou, Chia-Lin; Hsu, Chia-Chen; Chou, Chia-Yu; Chen, Tzeng-Ji; Chou, Li-Fang; Chou, Yueh-Ching

2015-12-01

Tablet splitting or pill splitting frequently occurs in daily medical practice. For drugs with special pharmacokinetic characters, such as drugs with narrow therapeutic index (NTI), unequal split tablets might lead to erroneous dose titration and it even cause toxicity. The aim of this study was to investigate the frequency of prescribing split NTI drugs at ambulatory setting in Taiwan. A population-based retrospective study was conducted using the National Health Insurance Research Database in Taiwan. All ambulatory visits were analyzed from the longitudinal cohort datasets of the National Health Insurance Research Database. The details of ambulatory prescriptions containing NTI drugs were extracted by using the claims datasets of one million beneficiaries from National Healthcare Insurance Research Database in 2010 in Taiwan. The analyses were stratified by dosage form, patient age and the number of prescribed tablets in a single dose for each NTI drugs. Main outcome measures Number and distinct dosage forms of available NTI drug items in Taiwan, number of prescriptions involved split NTI drugs, and number of patients received split NTI drugs. A total of 148,548 patients had received 512,398 prescriptions of NTI drugs and 41.8 % (n = 62,121) of patients had received 36.3 % (n = 185,936) of NTI drug prescriptions in form of split tablets. The percentage of splitting was highest in digoxin prescriptions (81.0 %), followed by warfarin (72.0 %). In the elderly patients, split tablets were very prevalent with digoxin (82.4 %) and warfarin (84.5 %). NTI drugs were frequently prescribed to be taken in split forms in Taiwan. Interventions may be needed to provide effective and convenient NTI drug use. Further studies are needed to evaluate the clinical outcome of inappropriate split NTI drugs.

A systematic review of the literature describing the outcomes of near-peer mentoring programs for first year medical students.

Science.gov (United States)

Akinla, Olawunmi; Hagan, Pamela; Atiomo, William

2018-05-08

Transition into higher education has been identified as one of the most stressful periods for learners. Interventions targeting the transition phase such as near- peer mentoring might help address some of these challenges. We were however unable to identify a published systematic review of the literature describing outcomes of near-peer mentoring of medical students during the transition phase into medical school. The aim of this paper is to review the literature and describe the outcomes of near-peer mentoring schemes for first-year medical students in the transition phase. A search of different electronic databases was carried out, using the search terms peer, buddy, mentor*, counsel*, advise*, tutor*, student, medical, school. 1861 articles were identified, however only 5 studies met the inclusion criteria- primary mentees should be first-years, and mentors must be inclusive of second-years but not limited to them. In reporting this paper, the PRISMA guidelines were followed. Published material on near-peer mentoring for medical students is scarce. Three outcomes for peer mentoring were identified- professional and personal development, stress reduction, and ease of transitioning. Incidentally, peer-mentoring was also found to have facilitated the development of personal and professional attitudes in the mentors. The quality of the evaluation methods in the studies was however low to moderate. Near-peer-mentoring is a way of promoting professional and personal development. It is also promising to aid transition and maintain well-being of first-year medical students. However, larger, better quality longitudinal studies, are needed to ascertain its true value for these students.

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

Science.gov (United States)

Sillanpaa, Matti; Schmidt, Dieter

2009-01-01

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

Educational outcomes of a medical physicist program over the past 10 years in Japan

International Nuclear Information System (INIS)

Kadoya, Noriyuki; Karasawa, Kumiko; Sumida, Iori; Arimura, Hidetaka; Kakinohana, Yasumasa; Kabuki, Shigeto; Monzen, Hajime; Nishio, Teiji; Shirato, Hiroki; Yamada, Syogo

2017-01-01

The promotion plan for the Platform of Human Resource Development for Cancer (Ganpro) was initiated by the Ministry of Education, Culture, Sports, Science and Technology of Japan in 2007, establishing a curriculum for medical physicists. In this study, we surveyed the educational outcomes of the medical physicist program over the past 10 years since the initiation of Ganpro. The Japan Society of Medical Physics mailing list was used to announce this survey. The questionnaire was created by members of the Japanese Board for Medical Physicist Qualification, and was intended for the collection of information regarding the characteristics and career paths of medical physics students. Students who participated in the medical physics program from 2007 to 2016 were enrolled. Thirty-one universities (17 accredited and 14 non-accredited) were represented in the survey. In total, 491, 105 and 6 students were enrolled in the Master's, Doctorate and Residency programs, respectively. Most students held a Bachelor's degree in radiological technology (Master's program, 87%; Doctorate program, 72%). A large number of students with a Master's degree worked as radiological technologists (67%), whereas only 9% (n = 32) worked as medical physicists. In contrast, 53% (n = 28) of the students with a Doctorate degree worked as medical physicists. In total, 602 students (from 31 universities) completed the survey. Overall, although the number of the graduates who worked as medical physicists was small, this number increased annually. It thus seems that medical institutions in Japan are recognizing the necessity of licensed medical physicists in the radiotherapy community.

The prevalence, risk factors, and outcomes of medication trade-offs in kidney and liver transplant recipients: a pilot study.

Science.gov (United States)

Serper, Marina; Reese, Peter P; Patzer, Rachel R; Levitsky, Josh; Wolf, Michael S

2017-11-25

High out-of-pocket medication costs negatively impact adherence in transplantation. We evaluated the association of "medication trade-offs"-defined as choosing to spend money on other expenses over medications-with medication nonadherence and transplant outcomes. From 2011 to 2012, we performed a prospective study of 201 transplanted recipients (n = 103 liver, n = 98 kidney and) at two large US transplant centers. Structured interviews assessed socio-demographics, medication adherence, and medication trade-offs. Multivariable models assessing risk factors for medications trade-offs and the association between medications trade-offs and post-transplant hospital admissions were performed. A total of 17% of patients reported medication trade-offs; the most common trade-offs were inability to afford a prescription in the past 12 months and making choices between prescriptions and food. In multivariable analysis, insurance type (RR: 2.97, 95% CI: 1.19-7.40), limited health literacy (RR: 2.64, 95% CI: 1.23-5.64), and ≥3 comorbid conditions (RR: 2.48, 95% CI: 1.09-5.62; all P trade-offs. Patients with trade-offs were more likely to report nonadherence to medications (mean adherence: 77 ± 23% with trade-offs vs. 89 ± 19% without trade-offs, P trade-offs was associated with post-transplant hospital admissions (RR 1.64, 95% CI 1.14-2.35, P < 0.01). Assessments of financial barriers are warranted in clinical practice to identify nonadherence and improve post-transplant outcomes. © 2017 Steunstichting ESOT.

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

Science.gov (United States)

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

2015-01-01

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

QSOs with narrow emission lines

International Nuclear Information System (INIS)

Baldwin, J.A.; Mcmahon, R.; Hazard, C.; Williams, R.E.

1988-01-01

Observations of two new high-redshift, narrow-lined QSOs (NLQSOs) are presented and discussed together with observations of similar objects reported in the literature. Gravitational lensing is ruled out as a possible means of amplifying the luminosity for one of these objects. It is found that the NLQSOs have broad bases on their emission lines as well as the prominent narrow cores which define this class. Thus, these are not pole-on QSOs. The FWHM of the emission lines fits onto the smoothly falling tail of the lower end of the line-width distribution for complete QSO samples. The equivalent widths of the combined broad and narrow components of the lines are normal for QSOs of the luminosity range under study. However, the NLQSOs do show ionization differences from broader-lined QSOs; most significant, the semiforbidden C III/C IV intensity ratio is unusually low. The N/C abundance ratio in these objects is found to be normal; the Al/C abundance ratio may be quite high. 38 references

Optimal medical outcomes with limited liability: risk management principles for medical practices at the intersection of medicine, law, and business.

Science.gov (United States)

Paterick, Timothy J; Paterick, Timothy E; Waterhouse, Blake E

2007-01-01

Physicians practice at the intersection of medicine, law, and business. Each discipline creates its own challenges for the practicing physician: to practice efficient, effective medicine; to limit potential liability; and to create a positive financial outcome. Those challenges increase with escalating costs and reduced reimbursements. In this paper, the common clinical presentation of chest pain has been used to create a paradigm to educate physicians to understand efficient and effective approaches to diagnosis and treatment, and how effective communication with patients and meticulous documentation of all medical encounters can limit the potential for liability. Ultimately, given today's reimbursement formulas, physicians must also understand the cost of testing, in relation to its benefits, in an attempt to yield a positive financial outcome.

Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care

DEFF Research Database (Denmark)

Hedegaard, Ulla; Hallas, Jesper; Ravn-Nielsen, Lene Vestergaard

2016-01-01

BACKGROUND: Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify...... potential adherence problems. OBJECTIVES: To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics......-39% reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non...

Assessment of COPD-related outcomes via a national electronic medical record database.

Science.gov (United States)

Asche, Carl; Said, Quayyim; Joish, Vijay; Hall, Charles Oaxaca; Brixner, Diana

2008-01-01

The technology and sophistication of healthcare utilization databases have expanded over the last decade to include results of lab tests, vital signs, and other clinical information. This review provides an assessment of the methodological and analytical challenges of conducting chronic obstructive pulmonary disease (COPD) outcomes research in a national electronic medical records (EMR) dataset and its potential application towards the assessment of national health policy issues, as well as a description of the challenges or limitations. An EMR database and its application to measuring outcomes for COPD are described. The ability to measure adherence to the COPD evidence-based practice guidelines, generated by the NIH and HEDIS quality indicators, in this database was examined. Case studies, before and after their publication, were used to assess the adherence to guidelines and gauge the conformity to quality indicators. EMR was the only source of information for pulmonary function tests, but low frequency in ordering by primary care was an issue. The EMR data can be used to explore impact of variation in healthcare provision on clinical outcomes. The EMR database permits access to specific lab data and biometric information. The richness and depth of information on "real world" use of health services for large population-based analytical studies at relatively low cost render such databases an attractive resource for outcomes research. Various sources of information exist to perform outcomes research. It is important to understand the desired endpoints of such research and choose the appropriate database source.

Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial.

Science.gov (United States)

Lhommée, Eugénie; Wojtecki, Lars; Czernecki, Virginie; Witt, Karsten; Maier, Franziska; Tonder, Lisa; Timmermann, Lars; Hälbig, Thomas D; Pineau, Fanny; Durif, Franck; Witjas, Tatiana; Pinsker, Marcus; Mehdorn, Maximilian; Sixel-Döring, Friederike; Kupsch, Andreas; Krüger, Rejko; Elben, Saskia; Chabardès, Stephan; Thobois, Stéphane; Brefel-Courbon, Christine; Ory-Magne, Fabienne; Regis, Jean-Marie; Maltête, David; Sauvaget, Anne; Rau, Jörn; Schnitzler, Alfons; Schüpbach, Michael; Schade-Brittinger, Carmen; Deuschl, Gunther; Houeto, Jean-Luc; Krack, Paul

2018-03-01

Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only. Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral

Choice of outcomes and measurement instruments in randomised trials on eLearning in medical education: a systematic mapping review protocol.

Science.gov (United States)

Law, Gloria C; Apfelbacher, Christian; Posadzki, Pawel P; Kemp, Sandra; Tudor Car, Lorainne

2018-05-17

There will be a lack of 18 million healthcare workers by 2030. Multiplying the number of well-trained healthcare workers through innovative ways such as eLearning is highly recommended in solving this shortage. However, high heterogeneity of learning outcomes in eLearning systematic reviews reveals a lack of consistency and agreement on core learning outcomes in eLearning for medical education. In addition, there seems to be a lack of validity evidence for measurement instruments used in these trials. This undermines the credibility of these outcome measures and affects the ability to draw accurate and meaningful conclusions. The aim of this research is to address this issue by determining the choice of outcomes, measurement instruments and the prevalence of measurement instruments with validity evidence in randomised trials on eLearning for pre-registration medical education. We will conduct a systematic mapping and review to identify the types of outcomes, the kinds of measurement instruments and the prevalence of validity evidence among measurement instruments in eLearning randomised controlled trials (RCTs) in pre-registration medical education. The search period will be from January 1990 until August 2017. We will consider studies on eLearning for health professionals' education. Two reviewers will extract and manage data independently from the included studies. Data will be analysed and synthesised according to the aim of the review. Appropriate choice of outcomes and measurement tools is essential for ensuring high-quality research in the field of eLearning and eHealth. The results of this study could have positive implications for other eHealth interventions, including (1) improving quality and credibility of eLearning research, (2) enhancing the quality of digital medical education and (3) informing researchers, academics and curriculum developers about the types of outcomes and validity evidence for measurement instruments used in eLearning studies. The

Teaching recovery to medical students.

LENUS (Irish Health Repository)

Feeney, Larkin

2013-03-01

Community mental health services are evolving toward more holistic, patient-centered, recovery-based practices. This change necessitates an attitudinal shift from mental health workers, and training in recovery principles is helpful in achieving this change. Medical students often have narrow, doctor-centered concepts of mental health care. Traditional clinical placements in psychiatry do little to address this. We evaluated a recovery-focused teaching program for medical students in psychiatry.

Ocular Biometrics of Myopic Eyes With Narrow Angles.

Science.gov (United States)

Chong, Gabriel T; Wen, Joanne C; Su, Daniel Hsien-Wen; Stinnett, Sandra; Asrani, Sanjay

2016-02-01

The purpose of this study was to compare the ocular biometrics between myopic patients with and without narrow angles. Patients with a stable myopic refraction (myopia worse than -1.00 D spherical equivalent) were prospectively recruited. Angle status was assessed using gonioscopy and biometric measurements were performed using an anterior segment optical coherence tomography and an IOLMaster. A total of 29 patients (58 eyes) were enrolled with 13 patients (26 eyes) classified as having narrow angles and 16 patients (32 eyes) classified as having open angles. Baseline demographics of age, sex, and ethnicity did not differ significantly between the 2 groups. The patients with narrow angles were on average older than those with open angles but the difference did not reach statistical significance (P=0.12). The central anterior chamber depth was significantly less in the eyes with narrow angles (P=0.05). However, the average lens thickness, although greater in the eyes with narrow angles, did not reach statistical significance (P=0.10). Refractive error, axial lengths, and iris thicknesses did not differ significantly between the 2 groups (P=0.32, 0.47, 0.15). Narrow angles can occur in myopic eyes. Routine gonioscopy is therefore recommended for all patients regardless of refractive error.

Intramyocardial arterial narrowing in dogs with subaortic stenosis.

Science.gov (United States)

Falk, T; Jönsson, L; Pedersen, H D

2004-09-01

Earlier studies have described intramyocardial arterial narrowing based on hyperplasia and hypertrophy of the vessel wall in dogs with subaortic stenosis (SAS). In theory, such changes might increase the risk of sudden death, as they seem to do in heart disease in other species. This retrospective pathological study describes and quantifies intramyocardial arterial narrowing in 44 dogs with naturally occurring SAS and in eight control dogs. The majority of the dogs with SAS died suddenly (n=27); nine had died or been euthanased with signs of heart failure and eight were euthanased without clinical signs. Dogs with SAS had significantly narrower intramyocardial arteries (Pdogs. Male dogs and those with more severe hypertrophy had more vessel narrowing (P=0.02 and P=0.02, respectively), whereas dogs with dilated hearts had slightly less pronounced arterial thickening (P=0.01). Arterial narrowing was not related to age, but fibrosis increased with age (P=0.047). Dogs that died suddenly did not have a greater number of arterial changes than other dogs with SAS. This study suggests that most dogs with SAS have intramyocardial arterial narrowing and that the risk of dying suddenly is not significantly related to the overall degree of vessel obliteration.

Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management.

Science.gov (United States)

Coburn, Brian W; Bendlin, Kayli A; Sayles, Harlan; Meza, Jane; Russell, Cynthia L; Mikuls, Ted R

2017-09-01

Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes. The aim of this study was to examine associations of patient and provider factors with optimal gout management. Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement. A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20-2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50-3.68) and dose escalation (OR, 2.48; 95% CI, 2.48-4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02-1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12-0.37). Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.

Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives.

Science.gov (United States)

Engels, Melanie J; Chaffee, Bruce W; Clark, John S

2015-12-01

An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was "improved measurement and reporting of the impact of PPMI programs on patient outcomes." A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Highly Tunable Narrow Bandpass MEMS Filter

KAUST Repository

Hafiz, Md Abdullah Al

2017-07-07

We demonstrate a proof-of-concept highly tunable narrow bandpass filter based on electrothermally and electrostatically actuated microelectromechanical-system (MEMS) resonators. The device consists of two mechanically uncoupled clamped-clamped arch resonators, designed such that their resonance frequencies are independently tuned to obtain the desired narrow passband. Through the electrothermal and electrostatic actuation, the stiffness of the structures is highly tunable. We experimentally demonstrate significant percentage tuning (~125%) of the filter center frequency by varying the applied electrothermal voltages to the resonating structures, while maintaining a narrow passband of 550 ± 50 Hz, a stopband rejection of >17 dB, and a passband ripple ≤ 2.5 dB. An analytical model based on the Euler-Bernoulli beam theory is used to confirm the behavior of the filter, and the origin of the high tunability using electrothermal actuation is discussed.

Oriental Medical Treatment of Lumbar Spinal Stenosis

Directory of Open Access Journals (Sweden)

Hae-Yeon Lee

2003-12-01

Full Text Available Lumbar spinal stenosis results from the progressive combined narrowing of the central spinal canal, the neurorecesses, and the neuroforaminal canals. In the absence of prior surgery, tumor, or infection, the spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposis posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral disc margins, or a combination of two or more of the above factors. Patients with spinal stenosis become symptomatic when pain, motor weakness, paresthesia, or other neurologic compromise causes distress. In one case, we administrated oriental medical treatment with acupuncture treatment and herb-medicine. Oriental medical treatment showed desirable effect on lumbar spinal stenosis.

History and Outcomes of 50 Years of Physician-Scientist Training in Medical Scientist Training Programs.

Science.gov (United States)

Harding, Clifford V; Akabas, Myles H; Andersen, Olaf S

2017-10-01

Physician-scientists are needed to continue the great pace of recent biomedical research and translate scientific findings to clinical applications. MD-PhD programs represent one approach to train physician-scientists. MD-PhD training started in the 1950s and expanded greatly with the Medical Scientist Training Program (MSTP), launched in 1964 by the National Institute of General Medical Sciences (NIGMS) at the National Institutes of Health. MD-PhD training has been influenced by substantial changes in medical education, science, and clinical fields since its inception. In 2014, NIGMS held a 50th Anniversary MSTP Symposium highlighting the program and assessing its outcomes. In 2016, there were over 90 active MD-PhD programs in the United States, of which 45 were MSTP supported, with a total of 988 trainee slots. Over 10,000 students have received MSTP support since 1964. The authors present data for the demographic characteristics and outcomes for 9,683 MSTP trainees from 1975-2014. The integration of MD and PhD training has allowed trainees to develop a rigorous foundation in research in concert with clinical training. MSTP graduates have had relative success in obtaining research grants and have become prominent leaders in many biomedical research fields. Many challenges remain, however, including the need to maintain rigorous scientific components in evolving medical curricula, to enhance research-oriented residency and fellowship opportunities in a widening scope of fields targeted by MSTP graduates, to achieve greater racial diversity and gender balance in the physician-scientist workforce, and to sustain subsequent research activities of physician-scientists.

The effect of a clinical medical librarian on in-patient care outcomes.

Science.gov (United States)

Esparza, Julia M; Shi, Runhua; McLarty, Jerry; Comegys, Marianne; Banks, Daniel E

2013-07-01

The research sought to determine the effect of a clinical medical librarian (CML) on outcomes of in-patients on the internal medicine service. A prospective study was performed with two internal medicine in-patient teams. Team 1 included a CML who accompanied the team on daily rounds. The CML answered questions posed at the point of care immediately or in emails post-rounds. Patients on Team 2, which did not include a CML, as well as patients who did not require consultation by the CML on Team 1, served as the control population. Numerous clinical and library metrics were gathered on each question. Patients on Team 1 who required an answer to a clinical question were more ill and had a longer length of stay, higher costs, and higher readmission rates compared to those in the control group. Using a matched pair analysis, we showed no difference in clinical outcomes between the intervention group and the control group. This study is the largest attempt to prospectively measure changes in patient outcomes when physicians were accompanied by a CML on rounds. This approach may serve as a model for further studies to define when and how CMLs are most effective.

Dose evaluation of narrow-beam

International Nuclear Information System (INIS)

Goto, Shinichi

1999-01-01

Reliability of the dose from the narrow photon beam becomes more important since the single high-dose rate radiosurgery becoming popular. The dose evaluation for the optimal dose is difficult due to absence of lateral electronic equilibrium. Data necessary for treatment regimen are TMR (tissue maximum ratio), OCR (off center ratio) and S c,p (total scatter factor). The narrow-beam was 10 MV X-ray from Varian Clinac 2100C equipped with cylindrical Fischer collimator CBI system. Detection was performed by Kodak XV-2 film, a PTW natural diamond detector M60003, Scanditronics silicon detector EDD-5 or Fujitec micro-chamber FDC-9.4C. Phantoms were the water equivalent one (PTW, RW3), water one (PTW, MP3 system) and Wellhofer WP600 system. Factors above were actually measured to reveal that in the dose evaluation of narrow photon beam, TMR should be measured by micro-chamber, OCR, by film, and S c,p , by the two. The use of diamond detector was recommended for more precise measurement and evaluation of the dose. The importance of water phantom in the radiosurgery system was also shown. (K.H.)

Workplace-based assessment for vocational registration of international medical graduates.

Science.gov (United States)

Lillis, Steven; Van Dyk, Valencia

2014-01-01

Medical regulatory authorities need efficient and effective methods of ensuring the competence of immigrating international medical graduates (IMGs). Not all IMGs who apply for specialist vocational registration will have directly comparable qualifications to those usually accepted. As general licensure examinations are inappropriate for these doctors, workplace-based assessment (WBA) techniques would appear to provide a solution. However, there is little published data on such outcomes. All cases of WBA (n = 81) used for vocational registration of IMGs in New Zealand between 2008 and 2013 were collated and analyzed. The successful completion rate of IMGs through the pathway was 87%. The majority (64%) undertook the year of supervised practice and the final assessment in a provincial center. For those unsuccessful in the pathway, inadequate clinical knowledge was the most common deficit found, followed by poor clinical reasoning. A WBA approach for assessing readiness of IMGs for vocational registration is feasible. The constructivist theoretical perspective of WBA has particular advantages in assessing the standard of practice for experienced practitioners working in narrow scopes than traditional methods of assessment. The majority of IMGs undertook both the clinical year and the assessment in provincial hospitals, thus providing a workforce for underserved areas. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study

NARCIS (Netherlands)

Ensing, Sabine; Abu-Hanna, Ameen; Roseboom, Tessa J.; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J.; Ravelli, Anita C. J.

2015-01-01

To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Population cohort study. Not applicable. A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. None. Primary outcome Apgar score

Elder abuse and its medical outcomes in older Chinese people with cognitive and physical impairments.

Science.gov (United States)

Fang, Boye; Yan, Elsie; Chan, Ko Ling; Ip, Partick

2018-05-04

Elder abuse poses a major public health threat considering the ongoing rapid aging of the global population. This study investigates the association between elder abuse by family caregivers and medical outcomes among older Chinese patients with cognitive and physical impairments in the People's Republic of China. Using cross-sectional design, 1002 older patients (aged 55 y and older) and their family caregivers were recruited from 3 grade A hospitals in Guangdong Province. The major independent variable is caregiver-reported elder abuse, while outcome variables include cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, peptic ulcer, digestive disorder, chronic hepatic disease, chronic renal disease, metabolic disease, acute inflammation, joint disease, tumor, and general injury. The prevalence of these medical conditions among patients who were abused and those who were not were compared using descriptive analyses and chi-square tests, and logistic regression was used to establish the relevant independent associations. A total of 429 (42.8%) older persons have experienced physical or psychological abuse over the past 12 months. After adjusting for potential confounders, abused older persons were more susceptible to cardiovascular disease, chronic obstructive pulmonary disease, peptic ulcer, digestive disorder, metabolic disease, acute inflammation, tumor, and injuries. Elder abuse is associated with various major medical morbidities. Interdisciplinary cooperation is necessary to identify and reduce the adverse physiological consequences in victims. Copyright © 2018 John Wiley & Sons, Ltd.

Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease

DEFF Research Database (Denmark)

Schoos, Mikkel Malby; Sejersten, Maria Sejersten; Baber, Usman

2015-01-01

Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials......, this study emphasizes the need for an efficient prehospital phase with focus on CV disease and proper triage of patients suitable for invasive evaluation if the outcomes of acute heart disease are to be improved further in the current international context of hospitals merging into highly specialized...

A quasi-experimental design based on regional variations: discussion of a method for evaluating outcomes of medical practice

DEFF Research Database (Denmark)

Loft, A; Andersen, T F; Madsen, Mette

1989-01-01

A large proportion of common medical practices are subject to substantial regional variation resulting in numerous natural experiments. Opportunities are thereby provided for outcome evaluation through quasi-experimental design. If patients treated in different regions were comparable a natural...... experiment involving alternative treatments could be regarded as 'pseudo randomised', but empirical investigations are needed to verify this prerequisite. This paper discusses the role of quasi-experimental designs in assessment of medical care with evaluation of outcomes after hysterectomy in Denmark...... groups are elicited from administrative data. We conclude that it is possible to establish a quasi-experimental design based on regional variations and that the comparability of the groups included may be assessed through registry data. The importance of technology diffusion for the prospects...

The effect of narrow provider networks on health care use.

Science.gov (United States)

Atwood, Alicia; Lo Sasso, Anthony T

2016-12-01

Network design is an often overlooked aspect of health insurance contracts. Recent policy factors have resulted in narrower provider networks. We provide plausibly causal evidence on the effect of narrow network plans offered by a large national health insurance carrier in a major metropolitan market. Our econometric design exploits the fact that some firms offer a narrow network plan to their employees and some do not. Our results show that narrow network health plans lead to reductions in health care utilization and spending. We find evidence that narrow networks save money by selecting lower cost providers into the network. Copyright © 2016 Elsevier B.V. All rights reserved.

Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

Directory of Open Access Journals (Sweden)

Negewo NA

2017-10-01

Full Text Available Netsanet A Negewo,1,2 Peter G Gibson,1–3 Peter AB Wark,1–3 Jodie L Simpson,1,2 Vanessa M McDonald1–4 1Priority Research Centre for Healthy Lungs, 2Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, 3Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, 4School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Background: COPD patients are often prescribed multiple medications for their respiratory disease and comorbidities. This can lead to complex medication regimens resulting in poor adherence, medication errors, and drug–drug interactions. The relationship between clinical outcomes and medication burden beyond medication count in COPD is largely unknown.Objectives: The aim of this study was to explore the relationships of medication burden in COPD with clinical outcomes, comorbidities, and multidimensional indices.Methods: In a cross-sectional study, COPD patients (n=222 were assessed for demographic information, comorbidities, medication use, and clinical outcomes. Complexity of medication regimens was quantified using the validated medication regimen complexity index (MRCI.Results: Participants (58.6% males had a mean (SD age of 69.1 (8.3 years with a postbronchodilator forced expiratory volume in 1 second % predicted of 56.5 (20.4 and a median of five comorbidities. The median (q1, q3 total MRCI score was 24 (18.5, 31. COPD-specific medication regimens were more complex than those of non-COPD medications (median MRCI: 14.5 versus 9, respectively; P<0.0001. Complex dosage formulations contributed the most to higher MRCI scores of COPD-specific medications while dosing frequency primarily drove the complexity associated with non-COPD medications. Participants in Global Initiative for Chronic Obstructive Lung Disease quadrant D had the highest median MRCI score for COPD medications (15

Two Versus Three Narrow-Diameter Implants with Locator Attachments Supporting Mandibular Overdentures: A Two-Year Prospective Study

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Ali M. El-Sheikh

2012-01-01

Full Text Available Purpose. To compare treatment outcome (survival rate, condition of hard and soft peri-implant tissues and prosthodontic maintenance requirements of two versus three narrow-diameter bone level implants with Locator attachments supporting mandibular overdentures. Materials and Methods. Twenty completely edentulous patients with atrophic mandibles were treated. Ten patients (Group A were treated with overdentures supported by two narrow (3.3-mm diameter implants (Straumann AG, Basel, Switzerland and ten patients (Group B were treated with overdentures supported by three narrow implants. Locator (Zest Anchors, USA attachments were used for prosthetic anchorage. Standardized clinical and radiographic parameters (survival rate, plaque index, calculus index, gingival index, bleeding index, probing depth and marginal bone loss were evaluated at the time of the completion of the prosthetic treatment (baseline and after 6, 12 and 24 months of functional loading. Prosthodontic maintenance requirements were also scored. Results. Only one implant was lost (Group B during the healing period. There were no significant differences with regards to any of the studied clinical and radiographic parameters between the two groups (>0.05. Few prosthetic complications were recorded. Conclusions. No need to insert more than two narrow-diameter bone level implants with Locator attachments in cases of atrophic mandible to support an overdenture, however, long-term prospective studies are required to support this notion.

Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial.

Directory of Open Access Journals (Sweden)

Mandira Paul

Full Text Available Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education.To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India.Secondary outcome of a randomised, controlled, non-inferiority trial.Outpatient primary health care clinics in rural and urban Rajasthan, India.Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85 mg/l and were below 18 years.Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1 in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol, using opaque sealed envelopes. Blinding during outcome assessment was not possible.Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups.731 women were randomized to the clinic follow-up group (n = 353 or home-assessment group (n = 378. 623 (85% women were successfully followed up, of those 597 (96% were satisfied and 592 (95% found the abortion better or as expected, with no difference between study groups. The majority, 355 (57% women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%, in the home-assessment group preferred

Undergraduate Medical Education Research in Malaysia: Time for a Change

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

2015-01-01

Objective: Special Study Module (SSM) is a mandatory research module implemented in Universiti Kebangsaan Malaysia (UKM). The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication. Methods: It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1st seven weeks of year-5. In year-4, students are assigned to a faculty-supervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed. Results: Total 257 projects were completed and presented in annual scientific meetings from which 57 (22.2%) articles were published in peer reviewed journals. Conclusion: Mandatory undergraduate student research project brings an opportunity to develop students’ capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education. PMID:26150832

Team functioning as a predictor of patient outcomes in early medical home implementation.

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Wu, Frances M; Rubenstein, Lisa V; Yoon, Jean

2018-03-12

New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p team functioning within PCMH models for achieving improved patient outcomes. A focus on team functioning is important especially in the early implementation of team-based primary care models.

Correlates of Narrow Bracketing

DEFF Research Database (Denmark)

Koch, Alexander; Nafziger, Julia

We examine whether different phenomena of narrow bracketing can be traced back to some common characteristic and whether and how different phenomena are related. We find that making dominated lottery choices or ignoring the endowment when making risky choices are related phenomena and are both as...

The effect of a clinical medical librarian on in-patient care outcomes*

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Esparza, Julia M.; Shi, Runhua; McLarty, Jerry; Comegys, Marianne; Banks, Daniel E.

2013-01-01

Objective: The research sought to determine the effect of a clinical medical librarian (CML) on outcomes of in-patients on the internal medicine service. Methods: A prospective study was performed with two internal medicine in-patient teams. Team 1 included a CML who accompanied the team on daily rounds. The CML answered questions posed at the point of care immediately or in emails post-rounds. Patients on Team 2, which did not include a CML, as well as patients who did not require consultation by the CML on Team 1, served as the control population. Numerous clinical and library metrics were gathered on each question. Results: Patients on Team 1 who required an answer to a clinical question were more ill and had a longer length of stay, higher costs, and higher readmission rates compared to those in the control group. Using a matched pair analysis, we showed no difference in clinical outcomes between the intervention group and the control group. Conclusions: This study is the largest attempt to prospectively measure changes in patient outcomes when physicians were accompanied by a CML on rounds. This approach may serve as a model for further studies to define when and how CMLs are most effective. PMID:23930088

Acquisition and visualization techniques for narrow spectral color imaging.

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Neumann, László; García, Rafael; Basa, János; Hegedüs, Ramón

2013-06-01

This paper introduces a new approach in narrow-band imaging (NBI). Existing NBI techniques generate images by selecting discrete bands over the full visible spectrum or an even wider spectral range. In contrast, here we perform the sampling with filters covering a tight spectral window. This image acquisition method, named narrow spectral imaging, can be particularly useful when optical information is only available within a narrow spectral window, such as in the case of deep-water transmittance, which constitutes the principal motivation of this work. In this study we demonstrate the potential of the proposed photographic technique on nonunderwater scenes recorded under controlled conditions. To this end three multilayer narrow bandpass filters were employed, which transmit at 440, 456, and 470 nm bluish wavelengths, respectively. Since the differences among the images captured in such a narrow spectral window can be extremely small, both image acquisition and visualization require a novel approach. First, high-bit-depth images were acquired with multilayer narrow-band filters either placed in front of the illumination or mounted on the camera lens. Second, a color-mapping method is proposed, using which the input data can be transformed onto the entire display color gamut with a continuous and perceptually nearly uniform mapping, while ensuring optimally high information content for human perception.

Can outcome-based continuing medical education improve performance of immigrant physicians?

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Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

2011-01-01

Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Reporting bias inflates the reputation of medical treatments: A comparison of outcomes in clinical trials and online product reviews.

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de Barra, Mícheál

2017-03-01

People often hold unduly positive expectations about the outcomes of medicines and other healthcare products. Here the following explanation is tested: people who have a positive outcome tend to tell more people about their disease/treatment than people with poor or average outcomes. Akin to the file drawer problem in science, this systematically and positively distorts the information available to others. If people with good treatment outcomes are more inclined to tell others, then they should also be more inclined to write online medical product reviews. Therefore, average treatment outcomes in these reviews should be more positive than those found in randomised controlled trials (RCTs). Data on duration of treatment and outcome (i.e., weight/cholesterol change) were extracted from user-generated health product reviews on Amazon.com and compared to RCT data for the same treatments using ANOVA. The sample included 1675 reviews of cholesterol reduction (Benecol, CholestOff) and weight loss (Orlistat) treatments and the primary outcome was cholesterol change (Bencol and CholestOff) or weight change (Orlistat). In three independent tests, average outcomes reported in the reviews were substantially more positive than the outcomes reported in the medical literature (η 2  = 0.01 to 0.06; p = 0.04 to 0.001). For example, average cholesterol change following use of Benecol is -14 mg/dl in RCTs and -45 mg/dl in online reviews. People with good treatment outcomes are more inclined to share information about their treatment, which distorts the information available to others. People who rely on word of mouth reputation, electronic or real life, are likely to develop unduly positive expectations. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel.

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Shmueli, Liora; Davidovitch, Nadav; Pliskin, Joseph S; Balicer, Ran D; Hekselman, Igal; Greenfield, Geva

2017-12-08

Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one. Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%). Clinical uncertainty or dissatisfaction with patient-physician communication

A CHF Model in Narrow Gaps under Saturated Boiling

International Nuclear Information System (INIS)

Park, Suki; Kim, Hyeonil; Park, Cheol

2014-01-01

Many researchers have paid a great attention to the CHF in narrow gaps due to enormous industrial applications. Especially, a great number of researches on the CHF have been carried out in relation to nuclear safety issues such as in-vessel retention for nuclear power plants during a severe accident. Analytical studies to predict the CHF in narrow gaps have been also reported. Yu et al. (2012) developed an analytical model to predict the CHF on downward facing and inclined heaters based on the model of Kandlikar et al. (2001) for an upward facing heater. A new theoretical model is developed to predict the CHF in narrow gaps under saturated pool boiling. This model is applicable when one side of coolant channels or both sides are heated including the effects of heater orientation. The present model is compared with the experimental CHF data obtained in narrow gaps. A new analytical CHF model is proposed to predict CHF for narrow gaps under saturated pool boiling. This model can be applied to one-side or two-sides heating surface and also consider the effects of heater orientation on CHF. The present model is compared with the experimental data obtained in narrow gaps with one heater. The comparisons indicate that the present model shows a good agreement with the experimental CHF data in the horizontal annular tubes. However, it generally under-predicts the experimental data in the narrow rectangular gaps except the data obtained in the gap thickness of 10 mm and the horizontal downward facing heater

Cognitive behavioral treatment outcomes in adolescent ADHD.

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Antshel, Kevin M; Faraone, Stephen V; Gordon, Michael

2014-08-01

To assess the efficacy of cognitive behavioral therapy (CBT) for managing adolescent ADHD. A total of 68 adolescents with ADHD and associated psychiatric comorbidities completed a manualized CBT treatment protocol. The intervention used in the study was a downward extension of the Safren et al. program for adults with ADHD who have symptoms unresolved by medication. Outcome variables consisted of narrow band (ADHD) and broadband (e.g., mood, anxiety, conduct) symptom measures (Behavior Assessment System for Children-2nd edition and ADHD-Rating Scales) as well as functioning measures (parent/teacher ratings and several ecologically real-world measures). Treatment effects emerged on the medication dosage, parent rating of pharmacotherapy adherence, adolescent self-report of personal adjustment (e.g., self-esteem), parent and teacher ratings of inattentive symptoms, school attendance, school tardiness, parent report of peer, family and academic functioning and teacher report of adolescent relationship with teacher, academic progress, and adolescent self-esteem. Adolescents with ADHD with oppositional defiant disorder were rated by parents and teachers as benefiting less from the CBT intervention. Adolescents with ADHD and comorbid anxiety/depression were rated by parents and teachers as benefiting more from the CBT intervention. A downward extension of an empirically validated adult ADHD CBT protocol can benefit some adolescents with ADHD. © 2012 SAGE Publications.

Electron correlations in narrow band systems

International Nuclear Information System (INIS)

Kishore, R.

1983-01-01

The effect of the electron correlations in narrow bands, such as d(f) bands in the transition (rare earth) metals and their compounds and the impurity bands in doped semiconductors is studied. The narrow band systems is described, by the Hubbard Hamiltonian. By proposing a local self-energy for the interacting electron, it is found that the results are exact in both atomic and band limits and reduce to the Hartree Fock results for U/Δ → 0, where U is the intra-atomic Coulomb interaction and Δ is the bandwidth of the noninteracting electrons. For the Lorentzian form of the density of states of the noninteracting electrons, this approximation turns out to be equivalent to the third Hubbard approximation. A simple argument, based on the mean free path obtained from the imaginary part of the self energy, shows how the electron correlations can give rise to a discontinous metal-nonmetal transition as proposed by Mott. The band narrowing and the existence of the satellite below the Fermi energy in Ni, found in photoemission experiments, can also be understood. (Author) [pt

Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

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Hagemann, Vera; Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen

2017-03-29

The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (ptechnical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.

Fracture strength and probability of survival of narrow and extra-narrow dental implants after fatigue testing: In vitro and in silico analysis.

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Bordin, Dimorvan; Bergamo, Edmara T P; Fardin, Vinicius P; Coelho, Paulo G; Bonfante, Estevam A

2017-07-01

To assess the probability of survival (reliability) and failure modes of narrow implants with different diameters. For fatigue testing, 42 implants with the same macrogeometry and internal conical connection were divided, according to diameter, as follows: narrow (Ø3.3×10mm) and extra-narrow (Ø2.9×10mm) (21 per group). Identical abutments were torqued to the implants and standardized maxillary incisor crowns were cemented and subjected to step-stress accelerated life testing (SSALT) in water. The use-level probability Weibull curves, and reliability for a mission of 50,000 and 100,000 cycles at 50N, 100, 150 and 180N were calculated. For the finite element analysis (FEA), two virtual models, simulating the samples tested in fatigue, were constructed. Loading at 50N and 100N were applied 30° off-axis at the crown. The von-Mises stress was calculated for implant and abutment. The beta (β) values were: 0.67 for narrow and 1.32 for extra-narrow implants, indicating that failure rates did not increase with fatigue in the former, but more likely were associated with damage accumulation and wear-out failures in the latter. Both groups showed high reliability (up to 97.5%) at 50 and 100N. A decreased reliability was observed for both groups at 150 and 180N (ranging from 0 to 82.3%), but no significant difference was observed between groups. Failure predominantly involved abutment fracture for both groups. FEA at 50N-load, Ø3.3mm showed higher von-Mises stress for abutment (7.75%) and implant (2%) when compared to the Ø2.9mm. There was no significant difference between narrow and extra-narrow implants regarding probability of survival. The failure mode was similar for both groups, restricted to abutment fracture. Copyright © 2017 Elsevier Ltd. All rights reserved.

Associations between Narrow Angle and Adult Anthropometry: The Liwan Eye Study

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Jiang, Yuzhen; He, Mingguang; Friedman, David S.; Khawaja, Anthony P.; Lee, Pak Sang; Nolan, Winifred P.; Yin, Qiuxia; Foster, Paul J.

2015-01-01

Purpose To assess the associations between narrow angle and adult anthropometry. Methods Chinese adults aged 50 years and older were recruited from a population-based survey in the Liwan District of Guangzhou, China. Narrow angle was defined as the posterior trabecular meshwork not visible under static gonioscopy in at least three quadrants (i.e. a circumference of at least 270°). Logistic regression models were used to examine the associations between narrow angle and anthropomorphic measures (height, weight and body mass index, BMI). Results Among the 912 participants, lower weight, shorter height, and lower BMI were significantly associated with narrower angle width (tests for trend: mean angle width in degrees vs weight p<0.001; vs height p<0.001; vs BMI p = 0.012). In univariate analyses, shorter height, lower weight and lower BMI were all significantly associated with greater odds of narrow angle. The crude association between height and narrow angle was largely attributable to a stronger association with age and sex. Lower BMI and weight remained significantly associated with narrow angle after adjustment for height, age, sex, axial ocular biometric measures and education. In analyses stratified by sex, the association between BMI and narrow angle was only observed in women. Conclusion Lower BMI and weight were associated with significantly greater odds of narrow angle after adjusting for age, education, axial ocular biometric measures and height. The odds of narrow angle increased 7% per 1 unit decrease in BMI. This association was most evident in women. PMID:24707840

A naturally narrow positive-parity Θ+

International Nuclear Information System (INIS)

Carlson, Carl E.; Carone, Christopher D.; Kwee, Herry J.; Nazaryan, Vahagn

2004-01-01

We present a consistent color-flavor-spin-orbital wave function for a positive-parity Θ + that naturally explains the observed narrowness of the state. The wave function is totally symmetric in its flavor-spin part and totally antisymmetric in its color-orbital part. If flavor-spin interactions dominate, this wave function renders the positive-parity Θ + lighter than its negative-parity counterpart. We consider decays of the Θ + and compute the overlap of this state with the kinematically allowed final states. Our results are numerically small. We note that dynamical correlations between quarks are not necessary to obtain narrow pentaquark widths

Do stressful life events predict medical treatment outcome in first episode of depression?

DEFF Research Database (Denmark)

Bock, Camilla; Bukh, Jens Drachmann; Vinberg, Maj

2009-01-01

BACKGROUND: It is unclear whether medical treatment outcome in first episode depression differ for patients with and without stressful life events prior to onset of depression. METHODS: Patients discharged with a diagnosis of a single depressive episode from a psychiatric in- or outpatient hospital......-II) and the interview of recent life events (IRLE). Medical treatment history was assessed in detail using standardised procedures (TRAQ). Remission was defined as a score or= 4 on TRAQ following (1) first trial of antidepressant treatment (2) two adequate trials of antidepressant treatment. RESULTS: A total of 399...... patients participated in the interview and among these 301 patients obtained a SCAN diagnosis of a single depressive episode. A total of 62.8% of the 301 patients experienced at least one moderate to severe stressful life event in a 6 months period prior to symptom onset. The presence of a stressful life...

Craniofacial Surgery and Adverse Outcomes: An Inquiry Into Medical Negligence.

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Svider, Peter F; Eloy, Jean Anderson; Folbe, Adam J; Carron, Michael A; Zuliani, Giancarlo F; Shkoukani, Mahdi A

2015-07-01

This study aimed to evaluate factors contributing to medical negligence relevant to craniofacial surgery. Retrospective analysis of verdict and settlement reports on the Westlaw legal database for outcome, awards, physician defendants, and other specific factors raised in malpractice litigation. Of 42 verdicts and settlement reports included, 52.4% were resolved with either an out-of-court settlement or plaintiff verdict, with aggregate payments totaling $50.1M (in 2013 dollars). Median settlements and jury-awarded damages were $988,000 and $555,000, respectively. Payments in pediatric cases ($1.2M) were significantly higher. Plastic surgeons, oral surgeons, and otolaryngologists were the most commonly named defendants. The most common alleged factors included intraoperative negligence (69.0%), permanent deficits (54.8%), requiring additional surgery (52.4%), missed/delayed diagnosis of a complication (42.9%), disfigurement/scarring (28.6%), postoperative negligence (28.6%), and inadequate informed consent (20.6% of surgical cases). Failure to diagnose a fracture (19.0%) and cleft-reparative procedures (14.3%) were the most frequently litigated entities. Medical negligence related to craniofacial surgery involves plaintiffs in a wide age range as well as physician defendants in numerous specialties, and proceedings resolved with settlement and plaintiff verdict involve substantial payments. Cases with death, allegedly permanent injuries, and pediatric plaintiffs had significantly higher payments. © The Author(s) 2015.

Subglottic cysts and asymmetrical subglottic narrowing on neck radiograph

International Nuclear Information System (INIS)

Holinger, L.D.; Torium, D.M.; Anandappa, E.C.

1988-01-01

The congenital subglottic hemangioma typically appears as an asymmetric subglottic narrowing or mass on frontal neck radiograph. Therefore, soft tissue neck radiography has been advocated as a definitive non-operative approach for diagnosing these lesions. However, we have noted similar asymmetric subglottic narrowing in patients with acquired subglottic cysts. These retention cysts occur following long-term intubation in the neonate. The mechanism probably involves subglottic fibrosis which obstructs glands with subsequent cyst formation. Acquired subglottic cysts typically appear as an asymmetric narrowing on frontal or lateral soft tissue neck radiographs. These lesions may produce airway compromise but are effectively treated by forceps or laser removal. Acquired subglottic cysts must be included in the differential diagnosis of asymmetric subglottic narrowing. The definitive diagnosis is made by direct laryngoscopy, not soft tissue neck radiograph. (orig.)

The relationship between learning preferences (styles and approaches) and learning outcomes among pre-clinical undergraduate medical students.

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Liew, Siaw-Cheok; Sidhu, Jagmohni; Barua, Ankur

2015-03-11

Learning styles and approaches of individual undergraduate medical students vary considerably and as a consequence, their learning needs also differ from one student to another. This study was conducted to identify different learning styles and approaches of pre-clinical, undergraduate medical students and also to determine the relationships of learning preferences with performances in the summative examinations. A cross-sectional study was conducted among randomly selected 419 pre-clinical, undergraduate medical students of the International Medical University (IMU) in Kuala Lumpur. The number of students from Year 2 was 217 while that from Year 3 was 202. The Visual, Auditory, Read/Write, Kinesthetic (VARK) and the Approaches and Study Skills Inventory for Students (ASSIST) questionnaires were used for data collection. This study revealed that 343 students (81.9%) had unimodal learning style, while the remaining 76 (18.1%) used a multimodal learning style. Among the unimodal learners, a majority (30.1%) were of Kinesthetic (K) type. Among the middle and high achievers in summative examinations, a majority had unimodal (Kinaesthetic) learning style (30.5%) and were also strategic/deep learners (79.4%). However, the learning styles and approaches did not contribute significantly towards the learning outcomes in summative examinations. A majority of the students in this study had Unimodal (Kinesthetic) learning style. The learning preferences (styles and approaches) did not contribute significantly to the learning outcomes. Future work to re-assess the viability of these learning preferences (styles and approaches) after the incorporation of teaching-learning instructions tailored specifically to the students will be beneficial to help medical teachers in facilitating students to become more capable learners.

Medication Desensitization: Characterization of Outcomes and Risk Factors for Reactions.

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Murray, Taryn S; Rice, Todd W; Wheeler, Arthur P; Phillips, Elizabeth J; Dworski, Ryszard T; Stollings, Joanna L

2016-03-01

Although its mechanisms are poorly understood, desensitization has been used to induce a temporary state of immune unresponsiveness in patients who have IgE-, non-IgE-, or pharmacologically mediated reactions when a drug has no alternatives. The purpose of this study was to characterize the outcomes and identify risk factors for reactions during drug desensitization. A retrospective review of electronic medical records of adult patients undergoing drug desensitization from January 1, 2011, to December 31, 2013, was conducted in 2 intensive care units at a tertiary medical center. We used multivariate analysis to determine if specified risk factors were associated with reacting during the desensitization. Reactions were classified according to the pretest probability prior to desensitization, and then, reactions during desensitization were classified based on the occurrence of cutaneous reactions as follows: successful with no reaction, mild reaction, moderate reaction, or failed. Failure could result from any systemic allergic or cutaneous reaction resulting in procedure termination. The desensitizations were also assessed to determine if the patient required de-escalation secondary to a reaction. A total of 88 desensitizations were performed in 69 patients. Desensitization was completed with no cutaneous reaction in 85% of patients. No baseline characteristic, medication class (P = 0.46), or indication for desensitization (P = 0.59) was associated with having a reaction. Reported histories of urticaria (P desensitization. However, neither history of urticaria nor labored breathing was independently associated with having a reaction in multivariate analysis (OR = 0.979, 95% CI = 0.325-2.952, P = 0.970, and OR = 1.626, 95% CI = 0.536-4.931, P = 0.739, respectively). Drug desensitization is safe for patients who have no alternative for therapy. Reported allergy histories of urticaria and labored breathing are both associated with having a reaction during the

Long-term outcomes of patent foramen ovale closure or medical therapy after cryptogenic stroke: A meta-analysis of randomized trials.

Science.gov (United States)

Abdelaziz, Hesham K; Saad, Marwan; Abuomara, Hossamaldin Z; Nairooz, Ramez; Pothineni, Naga Venkata K; Madmani, Mohamed E; Roberts, David H; Mahmud, Ehtisham

2018-05-04

To examine long-term clinical outcomes with transcatheter patent foramen ovale (PFO) closure versus medical therapy alone in patients with cryptogenic stroke. A long-standing debate regarding the optimal approach for the management of patients with PFO after a cryptogenic stroke exists. An electronic search was performed for randomized clinical trials (RCTs) reporting clinical outcomes with PFO closure vs. medical therapy alone after stroke. Random effects DerSimonian-Laird risk ratios (RR) were calculated. The main outcome was recurrence of stroke. Other outcomes included transient ischemic attack (TIA), new-onset atrial fibrillation/flutter (AF/AFL), major bleeding, serious adverse events, and device-related complications. All-cause mortality was also examined. Five RCTs with a total of 3,440 patients were included. At a mean follow-up of 4.02 ± 1.57 years, PFO closure was associated with less recurrence of stroke (RR = 0.43; 95% CI 0.19-0.91; P = .027) compared with medical therapy alone. No difference was observed between both strategies for TIA (P = .21), major bleeding (P = .69), serious adverse events (P = .35), and all-cause death (P = .48). However, PFO closure, was associated with increased new-onset AF/AFL (P < .001), risk of pulmonary embolism (P = .04), and device-related complications (P < .001). On a subgroup analysis, stroke recurrence rate remained lower in PFO closure arm regardless of the type of closure device used (P interaction  = .50), or the presence of substantial shunt in the majority of study population (P interaction  = .13). Transcatheter PFO closure reduces the recurrence of stroke compared with medical therapy alone, with no significant safety concerns. Close follow-up of patients after PFO closure is recommended to detect new-onset atrial arrhythmias. © 2018 Wiley Periodicals, Inc.

Motion tracking in narrow spaces: a structured light approach

DEFF Research Database (Denmark)

Olesen, Oline Vinter; Paulsen, Rasmus; Højgaard, Liselotte

2010-01-01

We present a novel tracking system for patient head motion inside 3D medical scanners. Currently, the system is targeted at the Siemens High Resolution Research Tomograph (HRRT) PET scanner. Partial face surfaces are reconstructed using a miniaturized structured light system. The reconstructed 3D...... the system to a standard optical motion tracker based on a rigid tracking tool. Our system achieves an angular RMSE of 0.11 degrees demonstrating its relevance for motion compensated 3D scan image reconstructions as well as its competitiveness against the standard optical system with an RMSE of 0.08 degrees...... point clouds are matched to a reference surface using a robust iterative closest point algorithm. A main challenge is the narrow geometry requiring a compact structured light system and an oblique angle of observation. The system is validated using a mannequin head mounted on a rotary stage. We compare...

Main features of narrow sociological theories explaining mental disorders

Directory of Open Access Journals (Sweden)

Opalić Petar

2006-01-01

Full Text Available In the introduction, the author states that sociological theories explaining mental disorders in the narrow sense have originated as an opposition to medical, i.e. biological model of interpreting mental disorders. With regard to this, the following sociological theories explaining mental disorders are presented in more detail: theory of anomie by Durkheim and Merton (with Merton’s typology of deviant behavior, social roles theory by Parsons, labeling theory by Scheff and other authors, theoretical career model of the mentally ill, the concept of psychic disorder of etnomethodology and finally, the anti-psychiatric interpretation of mental disorders. It is concluded that, although historically older, sociological theories of the onset of mental disorders are filling the epistemological void that occurred in understanding the role of society on the whole and a series of social factors particularly on the different aspects of understanding mental disorders.

Medical image transmission via communication satellite: evaluation of ultrasonographic images.

Science.gov (United States)

Suzuki, H; Horikoshi, H; Shiba, H; Shimamoto, S

1996-01-01

As compared with terrestrial circuits, communication satellites possess superior characteristics such as wide area coverage, broadcasting functions, high capacity, and resistance to disasters. Utilizing the narrow band channel (64 kbps) of the stationary communication satellite JCSAT1 located at an altitude of 36,000 km above the equator, we investigated satelliterelayed dynamic medical images transmitted by video signals, using hepatic ultrasonography as a model. We conclude that the "variable playing speed transmission scheme" proposed by us is effective for the transmission of dynamic images in the narrow band channel. This promises to permit diverse utilization and applications for purposes such as the transmission of other types of ultrasonic images as well as remotely directed medical diagnosis and treatment.

Design, Construction, Demonstration and Delivery of an Automated Narrow Gap Welding System.

Science.gov (United States)

1982-06-29

DESIGN, CONSTRUCTION, DEMONSTRATION AND DELIVERY OF WE DA4I &NARROW GAP CONTRACT NO. NOOGOO-81-C-E923 TO DAVID TAYLOR NAVAL RESEARCH AND DEVELOPMENT...the automated * Narrow Gap welding process, is the narrow (3/8 - inch), square-butt joint *design. This narrow joint greatly reduces the volume of weld...AD-i45 495 DESIGN CONSTRUCTION DEMONSTRATION AiND DELIVERY OF RN 1/j AUrOMATED NARROW GAP WELDING SYSTEMI() CRC AUTOMATIC WELDING CO HOUSTON TX 29

The transition from medical student to doctor: perceptions of final year students and preregistration house officers related to expected learning outcomes.

Science.gov (United States)

Lempp, H; Seabrook, M; Cochrane, M; Rees, J

2005-03-01

In this prospective qualitative study over 12 months, we evaluated the educational and clinical effectiveness of a new final year undergraduate programme in a London medical school (Guy's, King's and St Thomas'). A stratified sample of 17/360 final year students were interviewed four times, and the content was assessed against 32 amalgamated learning outcomes identified in 1997 in The New Doctor. At the beginning of the preregistration year, eight of the learning outcomes were already met, 10 partly, eight remained to be attained and for six, insufficient evidence existed. Preregistration house officers who have been through the final year student house officer programme expressed competence in many of the outcomes of the General Medical Council's New Doctor. The study identified areas such as prescribing where further developments are needed and will help in planning the new foundation programme.

Does an outcome-based approach to continuing medical education improve physicians' competences in rational prescribing?

Science.gov (United States)

Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Dastgiri, Saeed; Hult, Hakan; Dahlgren, Lars Owe; Wahlstrom, Rolf

2009-11-01

Continuing medical education (CME) is compulsory in Iran, and traditionally it is lecture-based, which is mostly not successful. Outcome-based education has been proposed for CME programs. To evaluate the effectiveness of an outcome-based educational intervention with a new approach based on outcomes and aligned teaching methods, on knowledge and skills of general physicians (GPs) working in primary care compared with a concurrent CME program in the field of "Rational prescribing". The method used was cluster randomized controlled design. All GPs working in six cities in one province in Iran were invited to participate. The cities were matched and randomly divided into an intervention arm for education on rational prescribing with an outcome-based approach, and a control arm for a traditional program on the same topic. Knowledge and skills were assessed using a pre- and post-test, including case scenarios. In total, 112 GPs participated. There were significant improvements in knowledge and prescribing skills after the training in the intervention arm as well as in comparison with the changes in the control arm. The overall intervention effect was 26 percentage units. The introduction of an outcome-based approach in CME appears to be effective when creating programs to improve GPs' knowledge and skills.

Narrow Escape of Interacting Diffusing Particles

Science.gov (United States)

Agranov, Tal; Meerson, Baruch

2018-03-01

The narrow escape problem deals with the calculation of the mean escape time (MET) of a Brownian particle from a bounded domain through a small hole on the domain's boundary. Here we develop a formalism which allows us to evaluate the nonescape probability of a gas of diffusing particles that may interact with each other. In some cases the nonescape probability allows us to evaluate the MET of the first particle. The formalism is based on the fluctuating hydrodynamics and the recently developed macroscopic fluctuation theory. We also uncover an unexpected connection between the narrow escape of interacting particles and thermal runaway in chemical reactors.

The outcomes and acceptability of near-peer teaching among medical students in clinical skills.

Science.gov (United States)

Khaw, Carole; Raw, Lynne

2016-06-12

To determine the outcomes and acceptability of final-year students tutoring in Clinical Skills to Years 1-2 students in a 4-week Medical Education elective. A paper-based survey with 14 questions requiring responses on a Likert-like scale and 2 questions with free-text responses was used to investigate Year 6 student-tutor (n=45) and Years 1-2 tutee (n=348) perceptions of near-peer teaching in Clinical Skills. The independent t-test compared mean responses from student-tutors and tutees, and thematic analysis of free-text responses was conducted. Tutee perceptions were significantly higher than student-tutor self-perceptions in small-group teaching and facilitation skills (p=0.000), teaching history-taking skills (p=0.046) and teaching physical examination skills (p=0.000). Perceptions in aspects of 'Confidence in tutoring' were not significantly different for student-tutors and tutees, with both having lowest perceptions for identifying and providing remediation for underperforming tutees. Student-tutors rated all areas of personal and professional development highly. Main themes emerging from analysis of student comments were the benefits to student-tutors, benefits to tutees and areas needing improvement, with outcomes of this near-peer teaching relating well to cognitive and social theories in the literature. Both student tutors and their tutees perceived near-peer teaching in Clinical Skills to be acceptable and beneficial with particular implications for Medical Education.

Narrow Framing and Long-Term Care Insurance

OpenAIRE

Daniel Gottlieb; Olivia S. Mitchell

2015-01-01

We propose a model of narrow framing in insurance and test it using data from a new module we designed and fielded in the Health and Retirement Study. We show that respondents subject to narrow framing are substantially less likely to buy long-term care insurance than average. This effect is distinct from, and much larger than, the effects of risk aversion or adverse selection, and it offers a new explanation for why people underinsure their later-life care needs.

Dosimetry of narrow band UVB treatments

International Nuclear Information System (INIS)

Goode, D.H.; Mannering, D.M.

1996-01-01

Full text: For many years psoriasis has been treated with broad band UVB lamps. These lamps have a bell shaped spectrum which peaks at 305 nm and extends from 280 nm to 350 nm. However research with monochromatic UV radiation has shown that wavelengths between 300 nm and 320 nm are the most efficacious for clearing psoriasis while wavelengths below 305 nm are most effective for producing the undesirable side effect of erythema (sunburn). In response to these findings Philips developed a narrow band UVB tube in which a large fraction of the output was confined to a narrow peak (bandwidth 2.5 nm) situated at 311 nm. Christchurch Hospital replaced broad band UVB with narrow band treatments in August 1995 and as this required UV exposures to be substantially increased new protocols had to be developed. Three aspects needed to be addressed. These were translating the dose from broad band to narrow band for current patients, determining the initial dose for new patients and developing a formula for increasing subsequent exposures to both types of patient. To translate doses the spectral irradiance (μW/cm 2 /nm) that would fall on the patient was measured in both the old broad band and the new narrow band treatment units and from this UV doses were calculated. All doses were expressed in mJ/cm 2 of unweighted UV over the range 250 nm to 400 nm. The erythemal effectiveness of the two units were compared by using the CIE 1987 curve to express doses in terms of the equivalent exposure of monochromatic 297 nm radiation. It was found that an exposure of 3.96 mJ/cm 2 from the broad band FS40 tubes and 12.79 mJ/cm 2 from the narrow band TL/01 tubes were both equivalent to 1.00 mJ/cm 2 of monochromatic 297 nm radiation so when transferring patients all broad band doses needed to be increased by a factor of 3.2. Before transferring any patients this factor was confirmed by conducting two minimal erythema dose (MED) tests on a normal subject, one in each unit. For new patients a

Attitudes Toward Medications and the Relationship to Outcomes in Patients with Schizophrenia.

Science.gov (United States)

Campbell, Angela H; Scalo, Julieta F; Crismon, M Lynn; Barner, Jamie C; Argo, Tami R; Lawson, Kenneth A; Miller, Alexander

The determinants of attitudes toward medication (ATM) are not well elucidated. In particular, literature remains equivocal regarding the influence of cognition, adverse events, and psychiatric symptomatology. This study evaluated relationships between those outcomes in schizophrenia and ATM. This is a retrospective analysis of data collected during the Texas Medication Algorithm Project (TMAP, n=307 with schizophrenia-related diagnoses), in outpatient clinics at baseline and every 3 months for ≥1 year (for cognition: 3rd and 9th month only). The Drug Attitude Inventory (DAI-30) measured ATM, and independent variables were: cognition (Trail Making Test [TMT], Verbal Fluency Test, Hopkins Verbal Learning Test), adverse events (Systematic Assessment for Treatment-Emergent Adverse Events, Barnes Akathisia Rating Scale), psychiatric symptomatology (Brief Psychiatric Rating Scale, Scale for Assessment of Negative Symptoms [SANS]), and medication adherence (Medication Compliance Scale). Analyses included binary logistic regression (cognition, psychiatric symptoms) and chi-square (adverse events, adherence) for baseline comparisons, and linear regression (cognition) or ANOVA (adverse events, adherence) for changes over time. Mean DAI-30 scores did not change over 12 months. Odds of positive ATM increased with higher TMT Part B scores (p=0.03) and lower SANS scores (p=0.02). Worsening of general psychopathology (p<0.001), positive symptoms (p<0.001), and negative symptoms (p=0.007) correlated with negative changes in DAI-30 scores. Relationships between cognition, negative symptoms, and ATM warrant further investigation. Studies evaluating therapies for cognitive deficits and negative symptoms should consider including ATM measures as endpoints. Patterns and inconsistencies in findings across studies raise questions about whether some factors thought to influence ATM have nonlinear relationships.

Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.

Science.gov (United States)

Saver, Jeffrey L; Carroll, John D; Thaler, David E; Smalling, Richard W; MacDonald, Lee A; Marks, David S; Tirschwell, David L

2017-09-14

Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomization. The results of the analysis of the primary outcome from the original trial period have been reported previously; the current analysis of data from the extended follow-up period was considered to be exploratory. We enrolled 980 patients (mean age, 45.9 years) at 69 sites. Patients were followed for a median of 5.9 years. Treatment exposure in the two groups was unequal (3141 patient-years in the PFO closure group vs. 2669 patient-years in the medical-therapy group), owing to a higher dropout rate in the medical-therapy group. In the intention-to-treat population, recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient-years, respectively (hazard ratio with PFO closure vs. medical therapy, 0.55; 95% confidence interval [CI], 0.31 to 0.999; P=0.046 by the log-rank test). Recurrent ischemic stroke of undetermined cause occurred in 10 patients in the PFO closure group and in 23 patients in the medical-therapy group (hazard ratio, 0.38; 95% CI, 0.18 to 0.79; P=0.007). Venous thromboembolism (which comprised events of pulmonary embolism and deep-vein thrombosis) was more common in the PFO closure group

Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

LENUS (Irish Health Repository)

Pope, George

2012-01-31

OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.

Narrow n anti n resonances

International Nuclear Information System (INIS)

Bogdanova, L.N.; Dalkarov, O.D.; Kerbikov, B.O.; Shapiro, I.S.

1975-01-01

The present status of the problem of quasinuclear states in systems of nucleons and antinucleons is reviewed. The theoretical predictions are compared with experimental data on narrow meson resonances near N anti N threshold which appeared in 1971-74

Narrowing of the Coronary Sinus: A Device-Based Therapy for Persistent Angina Pectoris.

Science.gov (United States)

Konigstein, Maayan; Verheye, Stefan; Jolicœur, E Marc; Banai, Shmuel

2016-01-01

Alongside the remarkable advances in medical and invasive therapies for the treatment of ischemic heart disease, an increasing number of patients with advanced coronary artery disease unsuitable for revascularization continue to suffer from angina pectoris despite optimal medical therapy. Patients with chronic angina have poor quality of life and increased levels of anxiety and depression. A considerable number of innovative therapeutic modalities for the treatment of chronic angina have been investigated over the years; however, none of these therapeutic options has become a standard of care, and none are widely utilized. Current treatment options for refractory angina focus on medical therapy and secondary risk factor modification. Interventions to create increased pressure in the coronary sinus may alleviate myocardial ischemia by forcing redistribution of coronary blood flow from the less ischemic subepicardium to the more ischemic subendocardium, thus relieving symptoms of ischemia. Percutaneous, transvenous implantation of a balloon expandable, hourglass-shaped, stainless steel mesh in the coronary sinus to create a fixed focal narrowing and to increase backwards pressure, may serve as a new device-based therapy destined for the treatment of refractory angina pectoris.

A risk-adjusted O-E CUSUM with monitoring bands for monitoring medical outcomes.

Science.gov (United States)

Sun, Rena Jie; Kalbfleisch, John D

2013-03-01

In order to monitor a medical center's survival outcomes using simple plots, we introduce a risk-adjusted Observed-Expected (O-E) Cumulative SUM (CUSUM) along with monitoring bands as decision criterion.The proposed monitoring bands can be used in place of a more traditional but complicated V-shaped mask or the simultaneous use of two one-sided CUSUMs. The resulting plot is designed to simultaneously monitor for failure time outcomes that are "worse than expected" or "better than expected." The slopes of the O-E CUSUM provide direct estimates of the relative risk (as compared to a standard or expected failure rate) for the data being monitored. Appropriate rejection regions are obtained by controlling the false alarm rate (type I error) over a period of given length. Simulation studies are conducted to illustrate the performance of the proposed method. A case study is carried out for 58 liver transplant centers. The use of CUSUM methods for quality improvement is stressed. Copyright © 2013, The International Biometric Society.

Problem-based learning in pre-clinical medical education: 22 years of outcome research.

Science.gov (United States)

Hartling, Lisa; Spooner, Carol; Tjosvold, Lisa; Oswald, Anna

2010-01-01

To conduct a systematic review of problem-based learning (PBL) in undergraduate, pre-clinical medical education. A research librarian developed comprehensive search strategies for MEDLINE, PSYCINFO, and ERIC (1985-2007). Two reviewers independently screened search results and applied inclusion criteria. Studies were included if they had a comparison group and reported primary data for evaluative outcomes. One reviewer extracted data and a second reviewer checked data for accuracy. Two reviewers independently assessed methodological quality. Quantitative synthesis was not performed due to heterogeneity. A qualitative review with detailed evidence tables is provided. Thirty unique studies were included. Knowledge acquisition measured by exam scores was the most frequent outcome reported; 12 of 15 studies found no significant differences. Individual studies demonstrated either improved clerkship (N = 3) or residency (N = 1) performance, or benefits on some clinical competencies during internships for PBL (N = 1). Three of four studies found some benefits for PBL when evaluating diagnostic accuracy. Three studies found few differences of clinical (or practical) importance on the impact of PBL on practicing physicians. Twenty-two years of research shows that PBL does not impact knowledge acquisition; evidence for other outcomes does not provide unequivocal support for enhanced learning. Work is needed to determine the most appropriate outcome measures to capture and quantify the effects of PBL. General conclusions are limited by methodological weaknesses and heterogeneity across studies. The critical appraisal of previous studies, conducted as part of this review, provides direction for future research in this area.

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies.

Science.gov (United States)

Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M

2015-11-03

Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in advanced life support (ALS). Evidence supporting the superiority of ALS over basic life support (BLS) is limited, but some studies suggest ALS may harm patients. To compare outcomes after ALS and BLS in out-of-hospital medical emergencies. Observational study with adjustment for propensity score weights and instrumental variable analyses based on county-level variations in ALS use. Traditional Medicare. 20% random sample of Medicare beneficiaries from nonrural counties between 2006 and 2011 with major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. Neurologic functioning and survival to 30 days, 90 days, 1 year, and 2 years. Except in cases of AMI, patients showed superior unadjusted outcomes with BLS despite being older and having more comorbidities. In propensity score analyses, survival to 90 days among patients with trauma, stroke, and respiratory failure was higher with BLS than ALS (6.1 percentage points [95% CI, 5.4 to 6.8 percentage points] for trauma; 7.0 percentage points [CI, 6.2 to 7.7 percentage points] for stroke; and 3.7 percentage points [CI, 2.5 to 4.8 percentage points] for respiratory failure). Patients with AMI did not exhibit differences in survival at 30 days but had better survival at 90 days with ALS (1.0 percentage point [CI, 0.1 to 1.9 percentage points]). Neurologic functioning favored BLS for all diagnoses. Results from instrumental variable analyses were broadly consistent with propensity score analyses for trauma and stroke, showed no survival differences between BLS and ALS for respiratory failure, and showed better survival at all time points with BLS than ALS for patients with AMI. Only Medicare beneficiaries from nonrural counties were studied. Advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS. National Science Foundation, Agency for

Pool Boiling CHF in Inclined Narrow Annuli

International Nuclear Information System (INIS)

Kang, Myeong Gie

2010-01-01

Pool boiling heat transfer has been studied extensively since it is frequently encountered in various heat transfer equipment. Recently, it has been widely investigated in nuclear power plants for application to the advanced light water reactors designs. Through the review on the published results it can be concluded that knowledge on the combined effects of the surface orientation and a confined space on pool boiling heat transfer is of great practical importance and also of great academic interest. Fujita et al. investigated pool boiling heat transfer, from boiling inception to the critical heat flux (CHF, q' CHF ), in a confined narrow space between heated and unheated parallel rectangular plates. They identified that both the confined space and the surface orientation changed heat transfer much. Kim and Suh changed the surface orientation angles of a downward heating rectangular channel having a narrow gap from the downward-facing position (180 .deg.) to the vertical position (90 .deg.). They observed that the CHF generally decreased as the inclination angle (θ ) increased. Yao and Chang studied pool boiling heat transfer in a confined heat transfer for vertical narrow annuli with closed bottoms. They observed that when the gap size ( s ) of the annulus was decreased the effect of space confinement to boiling heat transfer increased. The CHF was occurred at much lower value for the confined space comparing to the unconfined pool boiling. Pool boiling heat transfer in narrow horizontal annular crevices was studied by Hung and Yao. They concluded that the CHF decreased with decreasing gap size of the annuli and described the importance of the thin film evaporation to explain the lower CHF of narrow crevices. The effect of the inclination angle on the CHF on countercurrent boiling in an inclined uniformly heated tube with closed bottoms was also studied by Liu et al. They concluded that the CHF reduced with the inclination angle decrease. A study was carried out

Rethinking research in the medical humanities: a scoping review and narrative synthesis of quantitative outcome studies.

Science.gov (United States)

Dennhardt, Silke; Apramian, Tavis; Lingard, Lorelei; Torabi, Nazi; Arntfield, Shannon

2016-03-01

The rise of medical humanities teaching in medical education has introduced pressure to prove efficacy and utility. Review articles on the available evidence have been criticised for poor methodology and unwarranted conclusions. To support a more nuanced discussion of how the medical humanities work, we conducted a scoping review of quantitative studies of medical humanities teaching. Using a search strategy involving MEDLINE, EMBASE and ERIC, and hand searching, our scoping review located 11 045 articles that referred to the use of medical humanities teaching in medical education. Of these, 62 studies using quantitative evaluation methods were selected for review. Three iterations of analysis were performed: descriptive, conceptual, and discursive. Descriptive analysis revealed that the medical humanities as a whole cannot be easily systematised based on simple descriptive categories. Conceptual analysis supported the development of a conceptual framework in which the foci of the arts and humanities in medical education can be mapped alongside their related epistemic functions for teaching and learning. Within the framework, art functioned as expertise, as dialogue or as a means of expression and transformation. In the discursive analysis, we found three main ways in which the relationship between the arts and humanities and medicine was constructed as, respectively, intrinsic, additive and curative. This review offers a nuanced framework of how different types of medical humanities work. The epistemological assumptions and discursive positioning of medical humanities teaching frame the forms of outcomes research that are considered relevant to curriculum decision making, and shed light on why dominant review methodologies make some functions of medical humanities teaching visible and render others invisible. We recommend the use of this framework to improve the rigor and relevance of future explorations of the efficacy and utility of medical humanities teaching

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

Directory of Open Access Journals (Sweden)

Sandra Barbeiro

2018-03-01

Full Text Available Narrow-band imaging is an advanced imaging system that applies optic digital methods to enhance endoscopic images and improves visualization of the mucosal surface architecture and microvascular pattern. Narrow-band imaging use has been suggested to be an important adjunctive tool to white-light endoscopy to improve the detection of lesions in the digestive tract. Importantly, it also allows the distinction between benign and malignant lesions, targeting biopsies, prediction of the risk of invasive cancer, delimitation of resection margins, and identification of residual neoplasia in a scar. Thus, in expert hands it is a useful tool that enables the physician to decide on the best treatment (endoscopic or surgical and management. Current evidence suggests that it should be used routinely for patients at increased risk for digestive neoplastic lesions and could become the standard of care in the near future, at least in referral centers. However, adequate training programs to promote the implementation of narrow-band imaging in daily clinical practice are needed. In this review, we summarize the current scientific evidence on the clinical usefulness of narrow-band imaging in the diagnosis and characterization of digestive tract lesions/cancers and describe the available classification systems.

Assessing learning outcomes and cost effectiveness of an online sleep curriculum for medical students.

Science.gov (United States)

Bandla, Hari; Franco, Rose A; Simpson, Deborah; Brennan, Kimberly; McKanry, Jennifer; Bragg, Dawn

2012-08-15

Sleep disorders are highly prevalent across all age groups but often remain undiagnosed and untreated, resulting in significant health consequences. To overcome an inadequacy of available curricula and learner and instructor time constraints, this study sought to determine if an online sleep medicine curriculum would achieve equivalent learner outcomes when compared with traditional, classroom-based, face-to-face instruction at equivalent costs. Medical students rotating on a required clinical clerkship received instruction in 4 core clinical sleep-medicine competency domains in 1 of 2 delivery formats: a single 2.5-hour face-to-face workshop or 4 asynchronous e-learning modules. Immediate learning outcomes were assessed in a subsequent clerkship using a multiple-choice examination and standardized patient station, with long-term outcomes assessed through analysis of students' patient write-ups for inclusion of sleep complaints and diagnoses before and after the intervention. Instructional costs by delivery format were tracked. Descriptive and inferential statistical analyses compared learning outcomes and costs by instructional delivery method (face-to-face versus e-learning). Face-to-face learners, compared with online learners, were more satisfied with instruction. Learning outcomes (i.e., multiple-choice examination, standardized patient encounter, patient write-up), as measured by short-term and long-term assessments, were roughly equivalent. Design, delivery, and learner-assessment costs by format were equivalent at the end of 1 year, due to higher ongoing teaching costs associated with face-to-face learning offsetting online development and delivery costs. Because short-term and long-term learner performance outcomes were roughly equivalent, based on delivery method, the cost effectiveness of online learning is an economically and educationally viable instruction platform for clinical clerkships.

RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

Science.gov (United States)

Zapatero-Gaviria, Antonio; Javier Elola-Somoza, Francisco; Casariego-Vales, Emilio; Fernandez-Perez, Cristina; Gomez-Huelgas, Ricardo; Bernal, José Luis; Barba-Martín, Raquel

2017-08-01

To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. Spanish National Health Service. One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. Greater hospital complexity was associated with longer average length of stays (r: 0.42; P International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Interventions for enhancing medication compliance/adherence with benefits in treatment outcomes

Directory of Open Access Journals (Sweden)

Hagen, Anja

2007-01-01

Full Text Available Scientific background: Poor compliance or adherence in drug therapy can cause increased morbidity, mortality and enormous costs in the healthcare system (in Germany annually approximately 10 billion euros. Different methods are used for enhancing the compliance or adherence. Research questions: The evaluation addresses the questions about existence, efficacy, cost-benefit relation as well as ethical-social and juridical implications of strategies for enhancing compliance or adherence in drug therapy with concomitant improvements in treatment outcomes. Methods: A systematic literature search was conducted in the medical, also health economic relevant, literature databases in January 2007, beginning from 2002. Systematic reviews on the basis of (randomised controlled trials (RCT concerning interventions to enhance compliance or adherence with regard to treatment outcomes as well as systematic reviews of health economic analyses were included in the evaluation. Additionally, it was also searched for publications which primarily considered ethical-social and juridical aspects of these interventions for the German context. Results: One systematic review with data for 57 RCT was included in the medical evaluation and one systematic review with data for six studies into the health economic evaluation. No publication primary concerning ethical-social or juridical implications could be identified. A significant positive effect on the treatment outcome was reported for 22 evaluated interventions. For many interventions the results can be classified as reliable: counseling with providing an information leaflet and compliance diary chart followed by phone consultation for helicobacter pylori positive patients, repeated counseling for patients with acute asthma symptoms, telephone calls to establish the level of compliance and to make recommendations based on that for the therapy of cardiovascular diseases, calls of an automated telephone system with phone

Redefining "Medical Care."

Science.gov (United States)

Roth, Lauren R

President Donald J. Trump has said he will repeal the Affordable Care Act (ACA) and replace it with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of "medical care" that can be reimbursed through an HSA are listed in section 213(d) of the Internal Revenue Code (Code) and include expenses "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. It does not include the many social factors that determine health outcomes. Though the United States spends over seventeen percent of gross domestic product (GDP) on "healthcare", the country's focus on the traditional medicalized model of health results in overall population health that is far beneath the results of other countries that spend significantly less. Precision medicine is one exceptional way in which American healthcare has focused more on individuals instead of providing broad, one-size-fits-all medical care. The precision medicine movement calls for using the genetic code of individuals to both predict future illness and to target treatments for current illnesses. Yet the definition of "medical care" under the Code remains the same for all. My proposal for precision healthcare accounts involves two steps-- the first of which requires permitting physicians to write prescriptions for a broader range of goods and services. The social determinants of health are as important to health outcomes as are surgical procedures and drugs--or perhaps more so according to many population health studies. The second step requires agencies and courts to interpret what constitutes "medical care" under the Code differently depending on the taxpayer's income level. Childhood sports programs and payments

Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study.

Science.gov (United States)

Ensing, Sabine; Abu-Hanna, Ameen; Roseboom, Tessa J; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J; Ravelli, Anita C J

2015-08-01

To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Population cohort study. Not applicable. A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. None. Primary outcome Apgar score score score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score score matching, the risk of an Apgar score Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Early outcome of noma surgery

NARCIS (Netherlands)

Bouman, M A; Marck, K W; Griep, J E M; Marck, R E; Huijing, M A; Werker, P M N

2010-01-01

INTRODUCTION: Reconstructive noma surgery is performed on many short-term medical missions. The treatment outcome, however, has rarely been studied. MATERIALS AND METHODS: We studied complications and clinical outcome of reconstructive noma surgery performed during four short-term medical missions.

The Effect of Divided Attention on Emotion-Induced Memory Narrowing

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Steinmetz, Katherine R. Mickley; Waring, Jill D.; Kensinger, Elizabeth A.

2014-01-01

Individuals are more likely to remember emotional than neutral information, but this benefit does not always extend to the surrounding background information. This memory narrowing is theorized to be linked to the availability of attentional resources at encoding. In contrast to the predictions of this theoretical account, altering participants’ attentional resources at encoding, by dividing attention, did not affect the emotion-induced memory narrowing. Attention was divided using three separate manipulations: a digit ordering task (Experiment 1), an arithmetic task (Experiment 2), and an auditory discrimination task (Experiment 3). Across all three experiments, divided attention decreased memory across-the-board but did not affect the degree of memory narrowing. These findings suggest that theories to explain memory narrowing must be expanded to include other potential mechanisms beyond limitations of attentional resources. PMID:24295041

The effect of divided attention on emotion-induced memory narrowing.

Science.gov (United States)

Mickley Steinmetz, Katherine R; Waring, Jill D; Kensinger, Elizabeth A

2014-01-01

Individuals are more likely to remember emotional than neutral information, but this benefit does not always extend to the surrounding background information. This memory narrowing is theorised to be linked to the availability of attentional resources at encoding. In contrast to the predictions of this theoretical account, altering participants' attentional resources at encoding by dividing attention did not affect emotion-induced memory narrowing. Attention was divided using three separate manipulations: a digit ordering task (Experiment 1), an arithmetic task (Experiment 2) and an auditory discrimination task (Experiment 3). Across all three experiments, divided attention decreased memory across the board but did not affect the degree of memory narrowing. These findings suggest that theories to explain memory narrowing must be expanded to include other potential mechanisms beyond the limitations of attentional resources.

Standardized assessment of psychosocial factors and their influence on medically confirmed health outcomes in workers: a systematic review.

Science.gov (United States)

Rosário, Susel; Fonseca, João A; Nienhaus, Albert; da Costa, José Torres

2016-01-01

Previous studies of psychosocial work factors have indicated their importance for workers' health. However, to what extent health problems can be attributed to the nature of the work environment or other psychosocial factors is not clear. No previous systematic review has used inclusion criteria based on specific medical evaluation of work-related health outcomes and the use of validated instruments for the assessment of the psychosocial (work) environment. The aim of this systematic review is to summarize the evidence assessing the relationship between the psychosocial work environment and workers' health based on studies that used standardized and validated instruments to assess the psychosocial work environment and that focused on medically confirmed health outcomes. A systematic review of the literature was carried out by searching the databases PubMed, B-ON, Science Direct, Psycarticles, Psychology and Behavioral Sciences Collection and the search engine (Google Scholar) using appropriate words for studies published from 2004 to 2014. This review follows the recommendations of the Statement for Reporting Systematic Reviews (PRISMA). Studies were included in the review if data on psychosocial validated assessment method(s) for the study population and specific medical evaluation of health-related work outcome(s) were presented. In total, the search strategy yielded 10,623 references, of which 10 studies (seven prospective cohort and three cross-sectional) met the inclusion criteria. Most studies (7/10) observed an adverse effect of poor psychosocial work factors on workers' health: 3 on sickness absence, 4 on cardiovascular diseases. The other 3 studies reported detrimental effects on sleep and on disease-associated biomarkers. A more consistent effect was observed in studies of higher methodological quality that used a prospective design jointly with the use of validated instruments for the assessment of the psychosocial (work) environment and clinical

Bayesian Face Recognition and Perceptual Narrowing in Face-Space

Science.gov (United States)

Balas, Benjamin

2012-01-01

During the first year of life, infants' face recognition abilities are subject to "perceptual narrowing", the end result of which is that observers lose the ability to distinguish previously discriminable faces (e.g. other-race faces) from one another. Perceptual narrowing has been reported for faces of different species and different races, in…

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland.

Science.gov (United States)

Aiken, Abigail R A; Digol, Irena; Trussell, James; Gomperts, Rebecca

2017-05-16

Objectives  To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine. Design  Population based study. Setting  Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances. Population  1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012. Main outcome measures  Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised. Results  In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek

Birth centre confinement at the Queen Victoria Medical Centre. I. Obstetric and neonatal outcome.

Science.gov (United States)

Campbell, J; Hudson, H; Lumley, J; Morris, N; Rao, J; Spensley, J

1981-10-03

A review of hte first 175 confinements at the Queen Victoria Medical Centre Birth Centre is presented. The design, structure and function of hte Birth Centre is described and the safety of the programme demonstrated. Seventy-four pregnancies (42%) accepted for Birth Centre confinement required transfer because of antepartum or intrapartum complications. There were satisfactory obstetric and neonatal outcomes in all pregnancies. The first year's experience has allowed a reassessment of the risk factors, which will permit greater use of the Birth Centre without any increases risk to mothers or babies.

Natural Convective Heat Transfer from Narrow Plates

CERN Document Server

Oosthuizen, Patrick H

2013-01-01

Natural Convective Heat Transfer from Narrow Plates deals with a heat transfer situation that is of significant practical importance but which is not adequately dealt with in any existing textbooks or in any widely available review papers. The aim of the book is to introduce the reader to recent studies of natural convection from narrow plates including the effects of plate edge conditions, plate inclination, thermal conditions at the plate surface and interaction of the flows over adjacent plates. Both numerical and experimental studies are discussed and correlation equations based on the results of these studies are reviewed.

The association between residents' work-rounds styles and the process and outcome of medical care.

Science.gov (United States)

Ashton, C M; Wray, N P; Friedland, J A; Zollo, A J; Scheurich, J W

1994-04-01

To determine whether the manner in which residents conduct work rounds is associated with the adequacy of their care processes and the outcomes of their patients. Two types of data were collected: time and motion data for residents (n = 12) during work rounds, and clinical and outcome data for the patients they cared for during the observation period (n = 211). Five residents were classified as data gatherers because they spent twice as much time gathering clinical data about their patients as they spent engaging in other activities. Three physicians blinded to the resident's identity rated the quality of the care process and assessed the frequency of undesirable events occurring during the stay and after discharge. A data-gathering style was associated with higher quality of care as judged by both process and outcomes. The data gatherers were more likely to comply with the "stability of medications before discharge" criterion (86% of the data gatherers' cases vs 73% of others', p = 0.07), and their patients were less likely to have unanticipated problems, in that fewer required calls from nurses (20% vs 37%, p work-rounds style is associated with better process and outcome. Residency programs should provide formal instruction to trainees in the conduct of work rounds.

Race and Medication Adherence Moderate Cessation Outcomes in Criminal Justice Smokers.

Science.gov (United States)

Cropsey, Karen L; Clark, C Brendan; Zhang, Xiao; Hendricks, Peter S; Jardin, Bianca F; Lahti, Adrienne C

2015-09-01

Smokers in the criminal justice system represent some of the most disadvantaged smokers in the U.S., as they have high rates of smoking (70%-80%) and are primarily uninsured, with low access to medical interventions. Few studies have examined smoking-cessation interventions in racially diverse smokers, and none have examined these characteristics among individuals supervised in the community. The purpose of this study is to determine if four sessions of standard behavioral counseling for smoking cessation would differentially aid smoking cessation for African American versus non-Hispanic white smokers under community corrections supervision. An RCT. Five hundred smokers under community corrections supervision were recruited between 2009 and 2013 via flyers posted at the community corrections offices. All participants received 12 weeks of bupropion plus brief physician advice to quit smoking. Half of the participants received four sessions of 20-30 minutes of smoking-cessation counseling following tobacco treatment guidelines, whereas half received no additional counseling. Generalized estimating equations were used to determine factors associated with smoking abstinence across time. Analyses were conducted in 2014. The end-of-treatment abstinence rate across groups was 9.4%, with no significant main effects indicating group differences. However, behavioral counseling had a differential effect on cessation: whites who received counseling had higher quit rates than whites who did not receive counseling. Conversely, African Americans who did not receive counseling had higher average cessation rates than African Americans who received counseling. Overall, medication-adherent African American smokers had higher abstinence rates relative to other smokers. Racial disparities in smoking cessation are not evident among those who are adherent to medication. More research is needed to better understand the differential effect that behavioral counseling might have on treatment

Preliminary Design of a Synchronized Narrow Bandwidth FEL for Taiwan Light Source

CERN Document Server

Keung Lau Wai; Ching Fan, Tai; Zone Hsiao Feng; Tung Hsu Kuo; Hwang, Ching Shiang; Cheng Kuo Chin; Huei Luo Guo; Jen Wang Duan; Ping Wang Jau; Huey Wang Min

2004-01-01

Design study of a narrow line-width, high power IR-FEL facility has been carried out at NSRRC. This machine is designed to synchronize with the U9 undulator radiation of Taiwan Light Source and therefore provide new opportunity for chemical dynamics and condensed matter research. It has been proposed to use a super-conducting linac to provide a 60 MeV high quality electron beam to drive a 2.5-10 microns FEL oscillator with U5 undulator. Operating this linac in energy recovery mode will also be considered as an option to improve overall system effeciency and reduce heat loss and radiation dosage at the beam dump. Performance requirements and outcomes from this preliminary design study will be reported.

The Patient-Centered Medical Home (PCMH) Framing Typology for Understanding the Structure, Function, and Outcomes of PCMHs.

Science.gov (United States)

Kieber-Emmons, Autumn M; Miller, William L

2017-01-01

Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcomes by each type. Using the Patient-Centered Primary Care Collaborative 2012 to 2013 Annual Review, this secondary analysis of the published PCMH literature extracted data from publications of 59 PCMHs. Each of the 59 sites was categorized as 1 of 4 PCMH types: add-on, renovated, hybrid, or integrated. Six outcome measures (cost reductions, decreased emergency department/hospital utilization, improved quality, improved access, increased preventive services, and improved patient satisfaction) were independently coded for each site. Practices were combined based on type, and mean outcomes scores for each measure were displayed on radar graphs for comparison. While each type showed a characteristic pattern of success, only the integrated type improved in all 6 outcomes. No type achieved high success in all measures. There seem to be 4 types of PCMH, each of which shows a distinctive outcomes profile. Within the PCMH framing typology, direction is emerging for how best to transform primary care to achieve the greatest success. © Copyright 2017 by the American Board of Family Medicine.

Are narrow mesons, baryons and dibaryons evidence for multiquark states?

International Nuclear Information System (INIS)

Tatischeff, B.; Yonnet, J.

2000-01-01

Several narrow structures have been progressively observed since the last fifteen years, in di-baryonic invariant mass spectra or in missing mass spectra. More recently, narrow structures were observed in baryonic and now in mesonic mass spectra. Since these small peaks appear at fixed masses, independently of the experiment, they are associated with real states. There is no room to explain these states within classical nuclear physics taking into account baryonic and mesonic degrees of freedom. An interpretation is proposed, which associate these narrow structures with two coloured quark clusters. (authors)

Contemporary Management of Struvite Stones Using Combined Endourologic and Medical Treatment: Predictors of Unfavorable Clinical Outcome.

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Iqbal, Muhammad Waqas; Youssef, Ramy F; Neisius, Andreas; Kuntz, Nicholas; Hanna, Jonathan; Ferrandino, Michael N; Preminger, Glenn M; Lipkin, Michael E

2016-07-01

Struvite stones have been associated with significant morbidity and mortality, yet there has not been a report on the medical management of struvite stones in almost 20 years. We report on the contemporary outcomes of the surgical and medical management of struvite stones in a contemporary series. A retrospective review of patients who were treated with percutaneous nephrolithotomy (PCNL) for struvite stones at Duke University Medical Center between January 2005 and September 2012 identified a total of 75 patients. Of these, 43 patients had adequate follow-up and were included in this analysis. Stone activity, defined as either stone recurrence or stone-related events, and predictors of activity were evaluated after combined surgical and medical treatment. The study included 43 patients with either pure (35%) or mixed (65%) struvite stones with a median age of 55±15 years (range 21-89 years). The stone-free rate after PCNL was 42%. Stone recurrence occurred in 23% of patients. Postoperatively, 30% of patients had a stone-related event, while 60% of residual stones remained stable with no growth after a median follow-up of 22 months (range 6-67 mos). Kidney function remained stable during follow-up. Independent predictors of stone activity included the presence of residual stones >0.4 cm(2), preoperative large stone burden (>10 cm(2)), and the presence of medical comorbidities (P<0.05). Struvite stones can be managed safely with PCNL followed by medical therapy. The majority of patients with residual fragments demonstrated no evidence of stone growth on medical therapy. With careful follow-up and medical management, kidney function can be maintained and stone morbidity can be minimized. Initial large stone burden, residual stones after surgery, and associated medical comorbidities may have deleterious effect on stone recurrence or residual stone-related events.

Using data to improve medical practice by measuring processes and outcomes of care.

Science.gov (United States)

Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

2000-12-01

The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not

Use of the measure your medical outcome profile (MYMOP2 and W-BQ12 (Well-Being outcomes measures to evaluate chiropractic treatment: an observational study

Directory of Open Access Journals (Sweden)

Polus Barbara I

2011-03-01

Full Text Available Abstract Background The objective was to assess the use of the Measure Yourself Medical Outcome Profile (MYMOP2 and W-BQ12 well-being questionnaire for measuring clinical change associated with a course of chiropractic treatment. Methods Chiropractic care of the patients involved spinal manipulative therapy (SMT, mechanically assisted techniques, soft tissue therapy, and physiological therapeutic devices. Outcome measures used were MYMOP2 and the Well-Being Questionnaire 12 (W-BQ12. Results Statistical and clinical significant changes were demonstrated with W-BQ12 and MYMOP2. Conclusions The study demonstrated that MYMOP2 was responsive to change and may be a useful instrument for assessing clinical changes among chiropractic patients who present with a variety of symptoms and clinical conditions.

Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service.

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Lord, Kito; Parwani, Vivek; Ulrich, Andrew; Finn, Emily B; Rothenberg, Craig; Emerson, Beth; Rosenberg, Alana; Venkatesh, Arjun K

2018-03-20

Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality. A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p=0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p=0.003). Within the first 24h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding. Copyright © 2018 Elsevier Inc. All rights

Effect of Emergency Medical Services Use on Hospital Outcomes of Acute Hemorrhagic Stroke.

Science.gov (United States)

Kim, Sola; Shin, Sang Do; Ro, Young Sun; Song, Kyoung Jun; Lee, Yu Jin; Lee, Eui Jung; Ahn, Ki Ok; Kim, Taeyun; Hong, Ki Jeong; Kim, Yu Jin

2016-01-01

It is unclear whether the use of emergency medical services (EMS) is associated with enhanced survival and decreased disability after hemorrhagic stroke and whether the effect size of EMS use differs according to the length of stay (LOS) in emergency department (ED). Adult patients (19 years and older) with acute hemorrhagic stroke who survived to admission at 29 hospitals between 2008 and 2011 were analyzed, excluding those who had symptom-to-ED arrival time of 3 h or greater, received thrombolysis or craniotomy before inter-hospital transfer, or had experienced cardiac arrest, had unknown information about ambulance use and outcomes. Exposure variable was EMS use. Endpoints were survival at discharge and worsened modified Rankin Scale (W-MRS) defined as 3 or greater points difference between pre- and post-event MRS. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) for the outcomes were calculated, including potential confounders (demographic, socioeconomic status, clinical parameter, comorbidity, behavior, and time of event) in the final model and stratifying patients by inter-hospital transfer and by time interval from symptom to ED arrival (S2D). ED LOS, classified into short (hemorrhagic strokes were analyzed in which 75.6% were transported by EMS. For outcome measures, 17.4% and 41.4% were dead and had worsened MRS, respectively. AORs (95% CIs) of EMS were 0.67 (0.51-0.89) for death and 0.74 (0.59-0.92) for W-MRS in all patients. The effect size of EMS, however, was different according to LOS in ED. AORs (95% CIs) for death were 0.74 (0.54-1.01) in short LOS and 0.60 (0.44-0.83) in long LOS group. AORs (95% CIs) for W-MRS were 0.76 (0.60-0.97) in short LOS and 0.68 (0.52-0.88) in long LOS group. EMS transport was associated with lower hospital mortality and disability after acute hemorrhagic stroke. Effect size of EMS use for mortality was significant in patients with long ED LOS. Key  words: emergency medical service; hemorrhagic

Comparison of Outcomes before and after Ohio's Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study.

Directory of Open Access Journals (Sweden)

Ushma D Upadhyay

2016-08-01

Full Text Available In February 2011, an Ohio law took effect mandating use of the United States Food and Drug Administration (FDA-approved protocol for mifepristone, which is used with misoprostol for medication abortion. Other state legislatures have passed or enacted similar laws requiring use of the FDA-approved protocol for medication abortion. The objective of this study is to examine the association of this legal change with medication abortion outcomes and utilization.We used a retrospective cohort design, comparing outcomes of medication abortion patients in the prelaw period to those in the postlaw period. Sociodemographic and clinical chart data were abstracted from all medication abortion patients from 1 y prior to the law's implementation (January 2010-January 2011 to 3 y post implementation (February 2011-October 2014 at four abortion-providing health care facilities in Ohio. Outcome data were analyzed for all women undergoing abortion at ≤49 d gestation during the study period. The main outcomes were as follows: need for additional intervention following medication abortion (such as aspiration, repeat misoprostol, and blood transfusion, frequency of continuing pregnancy, reports of side effects, and the proportion of abortions that were medication abortions (versus other abortion procedures. Among the 2,783 medication abortions ≤49 d gestation, 4.9% (95% CI: 3.7%-6.2% in the prelaw and 14.3% (95% CI: 12.6%-16.0% in the postlaw period required one or more additional interventions. Women obtaining a medication abortion in the postlaw period had three times the odds of requiring an additional intervention as women in the prelaw period (adjusted odds ratio [AOR] = 3.11, 95% CI: 2.27-4.27. In a mixed effects multivariable model that uses facility-months as the unit of analysis to account for lack of independence by site, we found that the law change was associated with a 9.4% (95% CI: 4.0%-18.4% absolute increase in the rate of requiring an additional

Medical Education in Japan and Introduction of Medical Education at Tokyo Women’s Medical University

Institute of Scientific and Technical Information of China (English)

Yumiko Okubo

2014-01-01

Medical education in Japan changed rapidly in the last decade of the 20th century with the introduction of new education methods and implementation of the core curriculum and common achievement testing such as CBT and OSCE.Recently, there have been other movements in medical education in Japan that have introduced 'outcome(competency) based education(OBE)' and created a system for accreditation of medical education programs. This report provides an overview of current medical education in Japan. Moreover, it introduces medical education at Tokyo Women’s Medical University.

What's in a name? Expiratory tracheal narrowing in adults explained

International Nuclear Information System (INIS)

Leong, P.; Bardin, P.G.; Lau, K.K.

2013-01-01

Tracheomalacia, tracheobronchomalacia, and excessive dynamic airway collapse are all terms used to describe tracheal narrowing in expiration. The first two describe luminal reduction from cartilage softening and the latter refers to luminal reduction from exaggerated posterior membrane movement. Expiratory tracheal narrowing is a frequent occurrence that can cause symptoms of airway obstruction, such as dyspnoea, wheeze, and exercise intolerance. The accurate diagnosis and quantification of expiratory tracheal narrowing has important aetiological, therapeutic, and prognostic implications. The reference standard for diagnosis has traditionally been bronchoscopy; however, this method has significant limitations. Expiratory tracheal disorders are readily detected by four-dimensional dynamic volume multidetector computed tomography (4D-CT), an emerging, non-invasive method that will potentially enable detection and quantification of these conditions. This review discusses the morphological forms of expiratory tracheal narrowing and demonstrates the utility of 4D-CT in the diagnosis, quantification, and treatment of these important conditions

Multilayer Photonic Crystal for Spectral Narrowing of Emission

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Zhanfang LIU

2017-08-01

Full Text Available Multilayer colloidal crystal has been prepared by the layer-by-layer deposition of silica microspheres on a glass slide. Each layer is a slab consisting of a fcc close-packed colloidal arrays. By properly choosing the sizes of spheres, the whole spectral feature of multilayer colloidal crystal can be tuned. Here, we engineered a multilayer superlattice structure with an effective passband between two stop bands. This gives a strong narrowing effect on emission spectrum. With the stop bands at the shortwave and longwave edges of emission spectrum, the passband in the central wavelength region can be regarded as a strong decrease of suppression effect and enhancement of a narrow wavelength region of emission. The spectral narrowing modification effect of suitably engineered colloidal crystals shows up their importance in potential application as optical filters and lasing devices.DOI: http://dx.doi.org/10.5755/j01.ms.23.3.16320

Clinical profile and outcome of acute encephalitis syndrome (AES patients treated in College of Medical Sciences-Teaching Hospital

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Lekhjung J Thapa

2014-01-01

Full Text Available Objective: Acute encephalitis syndrome is a cause of significant morbidity and mortality in Nepal. Although Japanese encephalitis virus (JEV was thought to be a major cause for acute encephalitis syndrome, more non-Japanese encephalitis virus cases are reported. The outcome of patients with acute encephalitis syndrome is variable. Our study was designed to study the clinical profile and outcome of patients with acute encephalitis syndrome managed in tertiary care center in central Nepal. Methods: The record of patients admitted with diagnosis of acute encephalitis syndrome,from January 2010 to December 2010 in College of Medical Sciences-Teaching Hospital (CMS-TH was reviewed. They were classified clinically as meningitis, encephalitis and meningoencephalitis. The clinical details and reports of the patients were recorded and analyzed. Results: Total of 85 cases of meningitis and encephalitis were identified. Mean age was 19.18 years. Fifty-six (65.9% patients were males and 29 (34.1% were females. Sixty (70.58% patients had meningitis, 8 (9.41% had encephalitis, and 17 (20.0% had meningoencephalitis. JE serology was positive in 4 patients (4.7%. Seventy-two (84.7% patients made full recovery and were discharged from hospital. Thirteen (15.3% patients left against medical advice (LAMA. Conclusion: Acute encephalitis syndrome is still a major public health problem in Nepal. Few of these patients have Japanese Encephalitis. There is a trend towards improved outcome because of availability of improved health services. However, financial constraint remains a challenge in management of acute encephalitis syndrome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 31-37 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9685

Bandwidth-narrowed Bragg gratings inscribed in double-cladding fiber by femtosecond laser.

Science.gov (United States)

Shi, Jiawei; Li, Yuhua; Liu, Shuhui; Wang, Haiyan; Liu, Ningliang; Lu, Peixiang

2011-01-31

Bragg gratings with the bandwidth(FWHM) narrowed up to 79 pm were inscribed in double-cladding fiber with femtosecond radiation and a phase mask followed by an annealing treatment. With the annealing temperature below a critical value, the bandwidth of Bragg gratings induced by Type I-IR and Type II-IR index change was narrowed without the reduction of reflectivity. The bandwidth narrowing is due to the profile transformation of the refractive index modulation caused by the annealing treatment. This mechanism was verified by comparing bandwidth narrowing processes of FBGs written with different power densities.

THORACOLUMBAR BURST FRACTURE: STRUCTURAL CHANGES AND CLINICAL OUTCOME OF TREATMENT

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Rodrigo Arnold Tisot

2016-03-01

Full Text Available ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05 between initial collapse and SF-36 domains in both groups (operated and non-operated. Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

Physician empathy: Definition, outcome-relevance and its measurement in patient care and medical education [Ärztliche Empathie: Definition, Outcome-Relevanz und Messung in der Patientenversorgung und medizinischen Ausbildung

Directory of Open Access Journals (Sweden)

Neumann, Melanie

2012-02-01

Full Text Available [english] Objective: The present study gives a brief introduction into FurthermoreThe latter topic will be explored in detail as we conducted a pilot study on the German versions of two self-assessment instruments of empathy, which are mostly used in medical education research, namely the “Jefferson Scale of Physician Empathy, Student Version” (JSPE-S and the “Interpersonal Reactivity Index” (IRI.Methods: We first present an overview of the current empirical and theoretical literature on the definition and outcome-relevance of PE. Additionally, we conducted basic psychometric analyses of the German versions of the JSPE-S and the IRI. Data for this analyses is based on a cross-sectional pilot-survey in N=44 medical students and N=63 students of other disciplines from the University of Cologne. Results: PE includes the of the patient as well as verbal and non-verbal , which should result in a helpful therapeutic action of the physician. Patients’ health outcomes in different healthcare settings can be improved considerably from a high quality empathic encounter with their clinician. Basic psychometric results of the German JSPE-S and IRI measures show first promising results.Conclusion: PE as an essential and outcome-relevant element in the patient-physician relationship requires more consideration in the education of medical students and, thus, in medical education research. The German versions of the JSPE-S and IRI measures seem to be promising means to evaluate these education aims and to conduct medical education research on empathy.[german] Ziel: Die vorliegende Studie gibt einen kurzen Überblick Des Weiteren werden Letzteres Thema wird ausführlich behandelt, da eine Pilotstudie zur Testung zwei deutscher Versionen von Selbsteinschätzungsinstrumenten durchgeführt wurde, die derzeit am häufigsten in der internationalen Medizinischen Ausbildungsforschung genutzt werden. Dazu gehören die “Jefferson Scale of Physician Empathy

Neuropsychology Outcomes Following Trephine Epilepsy Surgery: The Inferior Temporal Gyrus Approach for Amygdalohippocampectomy in Medically Refractory Mesial Temporal Lobe Epilepsy.

Science.gov (United States)

Schoenberg, Mike R; Clifton, William E; Sever, Ryan W; Vale, Fernando L

2017-06-08

Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE) that are refractory to medical management. The inferior temporal gyrus (ITG) approach provides access to the mesial temporal lobe (MTL) structures with minimal tissue disruption. Reported neuropsychology outcomes following this approach are limited. To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospective design. Fifty-four participants had Engel class I/II outcome following resection of MTL using the ITG approach. All participants had localization-related epilepsy confirmed by long-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, and neuropsychology assessment. Clinical semiology/video-electroencephalography indicated that of the 54 patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) had pathology-confirmed mesial temporal sclerosis (MTS). Group level analyses found declines in verbal memory for patients with language-dominant resections ( P .05). Neuropsychology outcomes of an ITG approach for selective mesial temporal resection are comparable to other selective AH techniques showing minimal adverse cognitive effects. These data lend support to the ITG approach for selective AH as an option for MTLE. © Congress of Neurological Surgeons 2017.

Narrow plasmon resonances enabled by quasi-freestanding bilayer epitaxial graphene

Science.gov (United States)

Daniels, Kevin M.; Jadidi, M. Mehdi; Sushkov, Andrei B.; Nath, Anindya; Boyd, Anthony K.; Sridhara, Karthik; Drew, H. Dennis; Murphy, Thomas E.; Myers-Ward, Rachael L.; Gaskill, D. Kurt

2017-06-01

Exploiting the underdeveloped terahertz range (~1012-1013 Hz) of the electromagnetic spectrum could advance many scientific fields (e.g. medical imaging for the identification of tumors and other biological tissues, non-destructive evaluation of hidden objects or ultra-broadband communication). Despite the benefits of operating in this regime, generation, detection and manipulation have proven difficult, as few materials have functional interactions with THz radiation. In contrast, graphene supports resonances in the THz regime through structural confinement of surface plasmons, which can lead to enhanced absorption. In prior work, the achievable plasmon resonances in such structures have been limited by multiple electron scattering mechanisms (i.e. large carrier scattering rates) which greatly broaden the resonance (>100 cm-1 3 THz). We report the narrowest room temperature Drude response to-date, 30 cm-1 (0.87 THz), obtained using quasi-free standing bilayer epitaxial graphene (QFS BLG) synthesized on (0 0 0 1)6H-SiC. This narrow response is due to a 4-fold increase in carrier mobility and improved thickness and electronic uniformity of QFS BLG. Moreover, QFS BLG samples patterned into microribbons targeting 1.8-5.7 THz plasmon resonances also exhibit low scattering rates (37-53 cm-1). Due to the improved THz properties of QFS BLG, the effects of e-beam processing on carrier scattering rates was determined and we found that fabrication conditions can be tuned to minimize the impact on optoelectronic properties. In addition, electrostatic gating of patterned QFS BLG shows narrow band THz amplitude modulation. Taken together, these properties of QFS BLG should facilitate future development of THz optoelectronic devices for monochromatic applications.

Assessing correlations between geological hazards and health outcomes: Addressing complexity in medical geology.

Science.gov (United States)

Wardrop, Nicola Ann; Le Blond, Jennifer Susan

2015-11-01

The field of medical geology addresses the relationships between exposure to specific geological characteristics and the development of a range of health problems: for example, long-term exposure to arsenic in drinking water can result in the development of skin conditions and cancers. While these relationships are well characterised for some examples, in others there is a lack of understanding of the specific geological component(s) triggering disease onset, necessitating further research. This paper aims to highlight several important complexities in geological exposures and the development of related diseases that can create difficulties in the linkage of exposure and health outcome data. Several suggested approaches to deal with these complexities are also suggested. Long-term exposure and lengthy latent periods are common characteristics of many diseases related to geological hazards. In combination with long- or short-distance migrations over an individual's life, daily or weekly movement patterns and small-scale spatial heterogeneity in geological characteristics, it becomes problematic to appropriately assign exposure measurements to individuals. The inclusion of supplementary methods, such as questionnaires, movement diaries or Global Positioning System (GPS) trackers can support medical geology studies by providing evidence for the most appropriate exposure measurement locations. The complex and lengthy exposure-response pathways involved, small-distance spatial heterogeneity in environmental components and a range of other issues mean that interdisciplinary approaches to medical geology studies are necessary to provide robust evidence. Copyright © 2015. Published by Elsevier Ltd.

Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a Medical Center.

Science.gov (United States)

Burke, Michael V; Ebbert, Jon O; Schroeder, Darrell R; McFadden, David D; Hays, J Taylor

2015-11-01

Cigarette smoking causes premature mortality and multiple morbidity; stop smoking improves health. Higher rates of smoking cessation can be achieved through more intensive treatment, consisting of medication and extended counseling of patients, but there are challenges to integrating these interventions into healthcare delivery systems. A care model using a master-level counselor trained as a tobacco treatment specialist (TTS) to deliver behavioral intervention, teamed with a supervising physician/prescriber, affords an opportunity to integrate more intensive tobacco dependence treatment into hospitals, clinics, and other medical systems. This article analyzes treatment outcomes and predictors of abstinence for cigarette smokers being treated using the TTS-physician team in a large outpatient clinic over a 7-year period.This is an observational study of a large cohort of cigarette smokers treated for tobacco dependence at a medical center. Patients referred by the primary healthcare team for a TTS consult received a standard assessment and personalized treatment planning guided by a workbook. Medication and behavioral plans were developed collaboratively with each patient. Six months after the initial assessment, a telephone call was made to ascertain a 7-day period of self-reported abstinence. The univariate association of each baseline patient characteristic with self-reported tobacco abstinence at 6 months was evaluated using the chi-squared test. In addition, a multiple logistic regression analysis was performed with self-reported tobacco abstinence as the dependent variable and all baseline characteristics included as explanatory variables.Over a period of 7 years (2005-2011), 6824 cigarette smokers who provided general research authorization were seen for treatment. The 6-month self-reported abstinence rate was 28.1% (95% confidence interval: 27.7-30.1). The patients most likely to report abstinence were less dependent, more motivated to quit, and did not

Development and Validation of the "iCAN!"--A Self-Administered Questionnaire Measuring Outcomes/Competences and Professionalism of Medical Graduates

Science.gov (United States)

Dimoliatis, Ioannis D. K.; Lyrakos, Georgios N.; Tseretopoulou, Xanthippi; Tzamalis, Theodoros; Bazoukis, George; Benos, Alexis; Gogos, Charalambos; Malizos, Konstantinos; Pneumatikos, Ioannis; Thermos, Kyriaki; Kaldoudi, Eleni; Tzaphlidou, Margaret; Papadopoulos, Iordanis N.; Jelastopulu, Eleni

2014-01-01

The Tuning-Medicine Project produced a set of "level one" and "level two" learning outcomes/competences to be met by European medical graduates. In the learner-centered era self-assessment becomes more and more important. Our aim was to develop a self-completion questionnaire ("iCAN!") evaluating graduates' learning…

Application of active learning modalities to achieve medical genetics competencies and their learning outcome assessments.

Science.gov (United States)

Hagiwara, Nobuko

2017-01-01

The steadily falling costs of genome sequencing, coupled with the growing number of genetic tests with proven clinical validity, have made the use of genetic testing more common in clinical practice. This development has necessitated nongeneticist physicians, especially primary care physicians, to become more responsible for assessing genetic risks for their patients. Providing undergraduate medical students a solid foundation in genomic medicine, therefore, has become all the more important to ensure the readiness of future physicians in applying genomic medicine to their patient care. In order to further enhance the effectiveness of instructing practical skills in medical genetics, the emphasis of active learning modules in genetics curriculum at medical schools has increased in recent years. This is because of the general acceptance of a better efficacy of active learner-centered pedagogy over passive lecturer-centered pedagogy. However, an objective standard to evaluate students' skill levels in genomic medicine achieved by active learning is currently missing. Recently, entrustable professional activities (EPAs) in genomic medicine have been proposed as a framework for developing physician competencies in genomic medicine. EPAs in genomic medicine provide a convenient guideline for not only developing genomic medicine curriculum but also assessing students' competency levels in practicing genomic medicine. In this review, the efficacy of different types of active learning modules reported for medical genetics curricula is discussed using EPAs in genomic medicine as a common evaluation standard for modules' learning outcomes. The utility of the EPAs in genomic medicine for designing active learning modules in undergraduate medical genetics curricula is also discussed.

Providing physicians with feedback on medication adherence for people with chronic diseases taking long-term medication.

Science.gov (United States)

Zaugg, Vincent; Korb-Savoldelli, Virginie; Durieux, Pierre; Sabatier, Brigitte

2018-01-10

Poor medication adherence decreases treatment efficacy and worsens clinical outcomes, but average rates of adherence to long-term pharmacological treatments for chronic illnesses are only about 50%. Interventions for improving medication adherence largely focus on patients rather than on physicians; however, the strategies shown to be effective are complex and difficult to implement in clinical practice. There is a need for new care models addressing the problem of medication adherence, integrating this problem into the patient care process. Physicians tend to overestimate how well patients take their medication as prescribed. This can lead to missed opportunities to change medications, solve adverse effects, or propose the use of reminders in order to improve patients' adherence. Thus, providing physicians with feedback on medication adherence has the potential to prompt changes that improve their patients' adherence to prescribed medications. To assess the effects of providing physicians with feedback about their patients' medication adherence for improving adherence. We also assessed the effects of the intervention on patient outcomes, health resource use, and processes of care. We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase, all from database inception to December 2016 and without any language restriction. We also searched ISI Web of Science, two trials registers, and grey literature. We included randomised trials, controlled before-after studies, and interrupted time series studies that compared the effects of providing feedback to physicians about their patients' adherence to prescribed long-term medications for chronic diseases versus usual care. We included published or unpublished studies in any language. Participants included any physician and any patient prescribed with long-term medication for chronic disease. We included interventions providing the prescribing physician with

Educational attainment and health outcomes: Data from the Medical Expenditures Panel Survey.

Science.gov (United States)

Kaplan, Robert M; Fang, Zhengyi; Kirby, James

2017-06-01

Using data from the nationally representative Medical Expenditures Panel Survey (MEPS), we explored the extent to which health care utilization and health risk-taking, together with previously examined mediators, can explain the education-health gradient above and beyond what can be explained by previously examined mediators such as age, race, and poverty status. Health was measured using the Physical Component Score (PCS) from the Medical Outcomes Study 12-Item Short Form (SF-12). Educational attainment was self-reported and categorized as 1 (less than high school), 2 (high school graduate or GED), 3 (some college), 4 (bachelor's degree), and 5 (graduate degree). In bivariate analysis, we found systematic graded relationships between educational attainment and health including, SF-12 PCS scores, self-rated health, and activity limitations. In addition, education was associated with having more office visits and outpatient visits and less risk tolerance. Those with less education were also more likely to be uninsured throughout the year. Multivariate regression analysis suggested that adjustment for age, race, poverty status and marital status explained part, but not nearly all, of the relationship between education and health. Adding a variety of variables on health care and attitudes to the models provided no additional explanatory power. This pattern of results persisted even after stratifying on the number of self-reported chronic conditions. Our findings provide no evidence that access to and use of health care explains the education-health gradient. However, more research is necessary to conclusively rule out medical care as a mediator between education and health. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Creating a Common Data Model for Comparative Effectiveness with the Observational Medical Outcomes Partnership.

Science.gov (United States)

FitzHenry, F; Resnic, F S; Robbins, S L; Denton, J; Nookala, L; Meeker, D; Ohno-Machado, L; Matheny, M E

2015-01-01

Adoption of a common data model across health systems is a key infrastructure requirement to allow large scale distributed comparative effectiveness analyses. There are a growing number of common data models (CDM), such as Mini-Sentinel, and the Observational Medical Outcomes Partnership (OMOP) CDMs. In this case study, we describe the challenges and opportunities of a study specific use of the OMOP CDM by two health systems and describe three comparative effectiveness use cases developed from the CDM. The project transformed two health system databases (using crosswalks provided) into the OMOP CDM. Cohorts were developed from the transformed CDMs for three comparative effectiveness use case examples. Administrative/billing, demographic, order history, medication, and laboratory were included in the CDM transformation and cohort development rules. Record counts per person month are presented for the eligible cohorts, highlighting differences between the civilian and federal datasets, e.g. the federal data set had more outpatient visits per person month (6.44 vs. 2.05 per person month). The count of medications per person month reflected the fact that one system's medications were extracted from orders while the other system had pharmacy fills and medication administration records. The federal system also had a higher prevalence of the conditions in all three use cases. Both systems required manual coding of some types of data to convert to the CDM. The data transformation to the CDM was time consuming and resources required were substantial, beyond requirements for collecting native source data. The need to manually code subsets of data limited the conversion. However, once the native data was converted to the CDM, both systems were then able to use the same queries to identify cohorts. Thus, the CDM minimized the effort to develop cohorts and analyze the results across the sites.

40 years of military medical education: an overview of the Long-Term Career Outcome Study (LTCOS).

Science.gov (United States)

Durning, Steven J; Artino, Anthony R; Dong, Ting; Cruess, David F; Gilliland, William R; DeZee, Kent J; Saguil, Aaron; Waechter, Donna M; McManigle, John E

2012-09-01

In 2005, the Long-Term Career Outcome Study (LTCOS) was established by the Dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU). The original charge to the LTCOS team was to establish an electronic database of current and past students at USU. Since its inception, however, the LTCOS team has broadened its mission and started collecting and analyzing data on a continuous basis for the purposes of program evaluation and, in some cases, research. The purpose of this commentary is to review the history of the LTCOS, including details about USU, a brief review of prior LTCOS work, and progress made since our last essay on LTCOS efforts. This commentary also provides an introduction to the special issue, which is arranged as a series of articles that span the medical education continuum (i.e., before, during, and after medical school). The relative balance of articles in each phase of training represents the LTCOS team's efforts to address the entire continuum of medical education.

The ripples of adolescent motherhood: social, educational, and medical outcomes for children of teen and prior teen mothers.

Science.gov (United States)

Jutte, Douglas P; Roos, Noralou P; Brownell, Marni D; Briggs, Gemma; MacWilliam, Leonard; Roos, Leslie L

2010-01-01

We examined medical, educational and social risks to children of teen mothers and children of nonadolescent mothers with a history of teen birth (prior teen mothers) and considered these risks at both the individual and societal level. A population-based, retrospective cohort study tracked outcomes through young adulthood for children born in Manitoba, Canada (n = 32 179). chi(2) and logistic regression analyses examined risk of childhood death or hospitalization, failure to graduate high school, intervention by child protective services, becoming a teen mother, and welfare receipt as a young adult. For children of both teen and prior teen mothers, adjusted likelihoods of death during infancy, school-aged years, and adolescence were more than 2-fold higher than for other children. Risks for hospitalization, high hospital use, academic failure, and poor social outcomes were also substantially higher. At a societal level, only 16.5% of cohort children were born to teen and prior teen mothers. However, these children accounted for 27% of first-year hospitalizations, 34% of deaths (birth to 17 years), 30% of failures to graduate high school, 51% in foster care, 44% on welfare as young adults, and 56% of next-generation young teen mothers. Children of prior teen mothers had increased risks for poor health and for educational and social outcomes nearly equal to those seen in children of teen mothers. Combined, these relatively few children experienced a large share of the negative outcomes occurring among young people. Our results suggest the need to expand the definition of risk associated with adolescent motherhood and target their children for enhanced medical and social services. Copyright 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Learning outcomes and tutoring in problem based-learning: how do undergraduate medical students perceive them?

Science.gov (United States)

AlHaqwi, Ali I

2014-04-01

To explore opinions of undergraduate medical students regarding learning outcomes of the instructional strategy of Problem Based Learning (PBL). In addition their views were sought about the role of tutors and qualities of effective tutors. This was a cross-sectional, questionnaire based study which was conducted in two colleges of Medicine, Central region, Saudi Arabia during the period of 1st of April to 30(th) June 2012. One hundred seventy four undergraduate medical students participated in this study. Seventy percent of participants have indicated that PBL strategy contributed to the development of their knowledge, presentation skills, team work abilities, and accepting criticism from other colleagues. Regarding the tutors' role in PBL tutorials, majority of the participants (75%) indicated that this role is essential, nevertheless, only 58% of students indicated that this role is clear and well identified. Sixty three percent of participants preferred a member role in the PBL tutorials and 80 percent of participants preferred both content and process expert tutors in the PBL tutorials. Significant statistical difference was noted between the views of students and their schools, gender, and study phase. Majority of the participants believed that PBL had a positive impact on the development of their cognitive, personal and teamwork skills. The view of the students in this study and the available evidence suggest that tutor should have both qualities; content and process expertise, in order to have the best outcomes from the PBL tutorials.

Narrow linewidth pulsed optical parametric oscillator

Indian Academy of Sciences (India)

Tunable narrow linewidth radiation by optical parametric oscillation has many applications, particularly in spectroscopic investigation. In this paper, different techniques such as injection seeding, use of spectral selecting element like grating, grating and etalon in combination, grazing angle of incidence, entangled cavity ...

Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome.

Science.gov (United States)

Van der Linden, Lorenz; Decoutere, Liesbeth; Walgraeve, Karolien; Milisen, Koen; Flamaing, Johan; Spriet, Isabel; Tournoy, Jos

2017-02-01

Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions. Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients. A monocentric, prospective controlled trial was undertaken at the geriatric wards of a large university hospital. Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review, upon which recommendations were provided to the treating physicians. The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission. Secondary outcomes included RASP-identified potentially inappropriate medications (PIMs), the number of Emergency Department (ED) visits and quality of life (QOL) registered up to 3 months after discharge. On average, patients (n = 172) took 10 drugs on admission and were 84.5 years (standard deviation 4.8) of age. More drugs were discontinued or reduced in dose in the intervention group {control vs.intervention:median (interquartile range [IQR]) 3 (2-5) vs. 5 (3-7); p < 0.001}. More PIMs were discontinued in the intervention group, leading to less PIM at discharge [control vs.intervention:median (IQR) 2 (1-3) vs. 0.5 (0-1); p < 0.001]. No signal of harm was seen, and a significant improvement of QOL and less ED visits without hospitalization were observed. The combined intervention safely reduced drug use in very old inpatients and outperformed usual geriatric care. An increased QOL was seen, as well as a trend towards less ED visits. ClinicalTrials.gov Identifier: NCT01513265.

Clinical Outcome Metrics for Optimization of Robust Training

Science.gov (United States)

Ebert, D.; Byrne, V. E.; McGuire, K. M.; Hurst, V. W., IV; Kerstman, E. L.; Cole, R. W.; Sargsyan, A. E.; Garcia, K. M.; Reyes, D.; Young, M.

2016-01-01

Introduction: The emphasis of this research is on the Human Research Program (HRP) Exploration Medical Capability's (ExMC) "Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-Flight Medical Capabilities." Specifically, this project aims to contribute to the closure of gap ExMC 2.02: We do not know how the inclusion of a physician crew medical officer quantitatively impacts clinical outcomes during exploration missions. The experiments are specifically designed to address clinical outcome differences between physician and non-physician cohorts in both near-term and longer-term (mission impacting) outcomes. Methods: Medical simulations will systematically compare success of individual diagnostic and therapeutic procedure simulations performed by physician and non-physician crew medical officer (CMO) analogs using clearly defined short-term (individual procedure) outcome metrics. In the subsequent step of the project, the procedure simulation outcomes will be used as input to a modified version of the NASA Integrated Medical Model (IMM) to analyze the effect of the outcome (degree of success) of individual procedures (including successful, imperfectly performed, and failed procedures) on overall long-term clinical outcomes and the consequent mission impacts. The procedures to be simulated are endotracheal intubation, fundoscopic examination, kidney/urinary ultrasound, ultrasound-guided intravenous catheter insertion, and a differential diagnosis exercise. Multiple assessment techniques will be used, centered on medical procedure simulation studies occurring at 3, 6, and 12 months after initial training (as depicted in the following flow diagram of the experiment design). Discussion: Analysis of procedure outcomes in the physician and non-physician groups and their subsets (tested at different elapsed times post training) will allow the team to 1) define differences between physician and non-physician CMOs in terms of both procedure performance

Q2 anti Q2 states with relatively narrow widths

International Nuclear Information System (INIS)

Ono, Seiji.

1978-09-01

Using the mass formulas which correctly predict the mass of mesons and baryons the mass of diquark states is computed. From this mass spectrum the existance of the observed narrow baryonia and wide baryonia can be naturally understood. Other relatively narrow Q 2 anti Q 2 states are predicted to exist. (orig.) [de

Influence of the narrow {111} planes on axial and planar ion channeling.

Science.gov (United States)

Motapothula, M; Dang, Z Y; Venkatesan, T; Breese, M B H; Rana, M A; Osman, A

2012-05-11

We report channeling patterns where clearly resolved effects of the narrow {111} planes are observed in axial and planar alignments for 2 MeV protons passing through a 55 nm [001] silicon membrane. At certain axes, such as and , the offset in atomic rows forming the narrow {111} planes results in shielding from the large potential at the wide {111} planes, producing a region of shallow, asymmetric potential from which axial channeling patterns have no plane of symmetry. At small tilts from such axes, different behavior is observed from the wide and narrow {111} planes. At planar alignment, distinctive channeling effects due to the narrow planes are observed. As a consequence of the shallow potential well at the narrow planes, incident protons suffer dechanneled trajectories which are excluded from channeling within the wide planes, resulting in an anomalously large scattered beam at {111} alignment.

[Nursing care management in dermatological patient on phototherapy narrow band UVB].

Science.gov (United States)

de Argila Fernández-Durán, Nuria; Blasco Maldonado, Celeste; Martín Gómez, Mónica

2013-01-01

Phototherapy with narrow band ultraviolet B is a treatment used in some dermatology units, and is the first choice in some dermatological diseases due to being comfortable and cheap. The aim of this paper is to describe the management and nursing care by grouping more specific diagnoses, following NANDA-NIC/NOC taxonomy, such as the methodology from application, technique, material, and personnel to space-related aspects, with the aim of avoiding the clinical variability and the possible associated risks for the patients, and for the nurses who administer the treatment. The continuity of the same nurse in the follow-up sessions stimulates the relationship between medical personnel and patients, key points for loyalty and therapeutic adherence. This paper examines a consensus procedure with the Dermatology Unit Team and accredited by the Hospital Quality Unit. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Experimental Study on Critical Power in a Hemispherical Narrow Gap

International Nuclear Information System (INIS)

Park, Rae-Joon; Ha, Kwang-Soon; Kim, Sang-Baik; Kim, Hee-Dong; Jeong, Ji-Hwan

2002-01-01

An experimental study of critical heat flux in gap (CHFG) has been performed to investigate the inherent cooling mechanism in a hemispherical narrow gap. The objectives of the CHFG test are to measure critical power from a critical heat removal rate through the hemispherical narrow gap using distilled water with experimental parameters of system pressure and gap width. The CHFG test results have shown that a countercurrent flow limitation (CCFL) brings about local dryout at the small edge region of the upper part and finally global dryout in a hemispherical narrow gap. Increases in the gap width and pressure lead to an increase in critical power. The measured values of critical power are lower than the predictions made by other empirical CHF correlations applicable to flat plate, annuli, and small spherical gaps. The measured data on critical power in the hemispherical narrow gaps have been correlated using nondimensional parameters with a range of approximately ±20%. The developed correlation has been expanded to apply the spherical geometry using the Siemens/KWU correlation

Medication Review and Patient Outcomes in an Orthopedic Department

DEFF Research Database (Denmark)

Lisby, Marianne; Bonnerup, Dorthe Krogsgaard; Brock, Birgitte

2015-01-01

OBJECTIVE: We investigated the health-related effect of systematic medication review performed by a clinical pharmacist and a clinical pharmacologist on nonelective elderly orthopedic patients. METHODS: This is a nonblinded randomized controlled study of 108 patients 65 years or older treated...... with at least 4 drugs. For the intervention, the clinical pharmacist reviewed the participants' medication after completion of the usual medication routine. Information was collected from medical charts, interviews with participants, and database registrations of drug purchase. Results were conferred...

Narrow-width mechanism of a=5 Ξ-state

International Nuclear Information System (INIS)

Kumagai-Fuse, I.; Akaishi, Y.

1995-04-01

Narrow-width mechanism of ≡ 5 H is discussed by calculating conversion widths to all its possible decay channels. Since the conversion processes have small reaction Q values, the three- and four- body decays are strongly suppressed owing to small phase volumes available. Decay widths to the two-body channels are significantly reduced by the distortion of emitted-particle waves. This mechanism brings about a narrow width of ≡ 5 H. The total width is estimated to be 0.87 MeV, in which the largest contribution comes from the decay into the Λ 4 H * +Λ channel. (author)

Narrow resonances and short-range interactions

International Nuclear Information System (INIS)

Gelman, Boris A.

2009-01-01

Narrow resonances in systems with short-range interactions are discussed in an effective field theory (EFT) framework. An effective Lagrangian is formulated in the form of a combined expansion in powers of a momentum Q 0 | 0 --a resonance peak energy. At leading order in the combined expansion, a two-body scattering amplitude is the sum of a smooth background term of order Q 0 and a Breit-Wigner term of order Q 2 (δε) -1 which becomes dominant for δε 3 . Such an EFT is applicable to systems in which short-distance dynamics generates a low-lying quasistationary state. The EFT is generalized to describe a narrow low-lying resonance in a system of charged particles. It is shown that in the case of Coulomb repulsion, a two-body scattering amplitude at leading order in a combined expansion is the sum of a Coulomb-modified background term and a Breit-Wigner amplitude with parameters renormalized by Coulomb interactions.

Efficacy of a device to narrow the coronary sinus in refractory angina

DEFF Research Database (Denmark)

Verheye, Stefan; Jolicœur, E Marc; Behan, Miles W

2015-01-01

BACKGROUND: Many patients with coronary artery disease who are not candidates for revascularization have refractory angina despite standard medical therapy. The balloon-expandable, stainless steel, hourglass-shaped, coronary-sinus reducing device creates a focal narrowing and increases pressure...... in the coronary sinus, thus redistributing blood into ischemic myocardium. METHODS: We randomly assigned 104 patients with Canadian Cardiovascular Society (CCS) class III or IV angina (on a scale from I to IV, with higher classes indicating greater limitations on physical activity owing to angina) and myocardial.......6 points; P=0.03). There were no significant between-group differences in improvement in exercise time or in the mean change in the wall-motion index as assessed by means of dobutamine echocardiography. At 6 months, 1 patient in the treatment group had had a myocardial infarction; in the control group, 1...

Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness.

Science.gov (United States)

de la Garza, Santiago; Phuoc, Vania; Throneberry, Steven; Blumenthal-Barby, Jennifer; McCullough, Laurence; Coverdale, John

2017-08-01

One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.

Do Municipal Mergers Improve Fiscal Outcomes?

DEFF Research Database (Denmark)

Hansen, Sune Welling; Houlberg, Kurt; Holm Pedersen, Lene

2014-01-01

Improved fiscal management is a frequent justification for promoting boundary consolidations. However, whether or not this is actually the case is rarely placed under rigorous empirical scrutiny. Hence, this article investigates if fiscal outcomes are improved when municipalities are merged....... The basic argument is that the conceptualisation of fiscal management in political science is often too narrow as it focuses on the budget and pays hardly any attention to balances in the final accounts and debts – elements of management which are central to policy making. On this background, the causal...... relationship between municipal mergers and fiscal outcomes is analysed. Measured on the balance between revenues and expenses, liquid assets and debts, municipal mergers improve the fiscal outcomes of the municipalities in a five-year perspective, although the pre-reform effects tend to be negative...

The effects of training mental health practitioners in medication management to address nonadherence: a systematic review of clinician-related outcomes

Directory of Open Access Journals (Sweden)

Bressington D

2013-05-01

Full Text Available Daniel Bressington,1 Esther Coren,1 Douglas MacInnes21Department of Health, Well-Being and Family, 2Centre for Health and Social Care Research, Canterbury Christ Church University, Canterbury, UKBackground: Nonadherence with medicine prescribed for mental health is a common problem that results in poor clinical outcomes for service users. Studies that provide medication management-related training for the mental health workforce have demonstrated that improvements in the knowledge, attitudes, and skills of staff can help to address nonadherence. This systematic review aims to establish the effectiveness of these training interventions in terms of clinician-related outcomes.Methods: Five electronic databases were systematically searched: PubMed, CINAHL, Medline, PsycInfo, and Google Scholar. Studies were included if they were qualitative or quantitative in nature and were primarily designed to provide mental health clinicians with knowledge and interventions in order to improve service users' experiences of taking psychotropic medications, and therefore potentially address nonadherence issues.Results: A total of five quantitative studies were included in the review. All studies reported improvements in clinicians' knowledge, attitudes, and skills immediately following training. The largest effect sizes related to improvements in clinicians' knowledge and attitudes towards nonadherence. Training interventions of longer duration resulted in the greatest knowledge- and skills-related effect sizes.Conclusion: The findings of this review indicate that training interventions are likely to improve clinician-related outcomes; however, due to the methodological limitations of the current evidence base, future research in this area should aim to conduct robust randomized controlled trials with follow-up and consider collecting qualitative data to explore clinicians' experiences of using the approaches in clinical practice.Keywords: staff training

Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

DEFF Research Database (Denmark)

Melloni, Chiara; Cornel, Jan H; Hafley, Gail

2016-01-01

AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS...... AND RESULTS: We estimated creatinine clearance for 8953 medically managed acute coronary syndrome patients enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial. Patients were classified by chronic kidney disease stage: normal renal...... function/mild (creatinine clearance >60 mL/min); moderate (creatinine clearance 30-60 mL/min); severe (creatinine clearance event rates through 30 months were evaluated for ischemic (cardiovascular death, myocardial infarction or stroke; primary end point) and bleeding (Global Use...

The Future of Medical Dosimetry

Energy Technology Data Exchange (ETDEWEB)

Adams, Robert D., E-mail: robert_adams@med.unc.edu

2015-07-01

The world of health care delivery is becoming increasingly complex. The purpose of this manuscript is to analyze current metrics and analytically predict future practices and principles of medical dosimetry. The results indicate five potential areas precipitating change factors: a) evolutionary and revolutionary thinking processes, b) social factors, c) economic factors, d) political factors, and e) technological factors. Outcomes indicate that significant changes will occur in the job structure and content of being a practicing medical dosimetrist. Discussion indicates potential variables that can occur within each process and change factor and how the predicted outcomes can deviate from normative values. Finally, based on predicted outcomes, future opportunities for medical dosimetrists are given.

Analytical approximations for wide and narrow resonances

International Nuclear Information System (INIS)

Suster, Luis Carlos; Martinez, Aquilino Senra; Silva, Fernando Carvalho da

2005-01-01

This paper aims at developing analytical expressions for the adjoint neutron spectrum in the resonance energy region, taking into account both narrow and wide resonance approximations, in order to reduce the numerical computations involved. These analytical expressions, besides reducing computing time, are very simple from a mathematical point of view. The results obtained with this analytical formulation were compared to a reference solution obtained with a numerical method previously developed to solve the neutron balance adjoint equations. Narrow and wide resonances of U 238 were treated and the analytical procedure gave satisfactory results as compared with the reference solution, for the resonance energy range. The adjoint neutron spectrum is useful to determine the neutron resonance absorption, so that multigroup adjoint cross sections used by the adjoint diffusion equation can be obtained. (author)

Analytical approximations for wide and narrow resonances

Energy Technology Data Exchange (ETDEWEB)

Suster, Luis Carlos; Martinez, Aquilino Senra; Silva, Fernando Carvalho da [Universidade Federal, Rio de Janeiro, RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia. Programa de Engenharia Nuclear]. E-mail: aquilino@lmp.ufrj.br

2005-07-01

This paper aims at developing analytical expressions for the adjoint neutron spectrum in the resonance energy region, taking into account both narrow and wide resonance approximations, in order to reduce the numerical computations involved. These analytical expressions, besides reducing computing time, are very simple from a mathematical point of view. The results obtained with this analytical formulation were compared to a reference solution obtained with a numerical method previously developed to solve the neutron balance adjoint equations. Narrow and wide resonances of U{sup 238} were treated and the analytical procedure gave satisfactory results as compared with the reference solution, for the resonance energy range. The adjoint neutron spectrum is useful to determine the neutron resonance absorption, so that multigroup adjoint cross sections used by the adjoint diffusion equation can be obtained. (author)

Narrow duplicated internal auditory canal: radiological findings and review of the literature

International Nuclear Information System (INIS)

Demir, Oezguen Ilhan; Cakmakci, Handan; Men, Sueleyman; Erdag, Taner Kemal

2005-01-01

Narrow duplicated internal auditory canal (IAC) is a rare malformation of the temporal bone that is associated with ipsilateral congenital sensorineural hearing loss. This may be an isolated finding or a part of a syndrome. Radiological examination should demonstrate aplasia or hypoplasia of the neural components of the narrow IAC, to guide the surgical approach. We report a 7-year-old boy with Klippel-Feil syndrome with a narrow double IAC with no sensorineural hearing loss but with conductive hearing loss. In this patient, the IAC consisted of two separate narrow bony canals clearly seen on 3D temporal bone CT and one nerve that was delineated on MRI. The contralateral external auditory canal was stenotic and the ossicles were dysplastic. (orig.)

Neuropathic Pain Medication Use Does Not Alter Outcomes of Spinal Cord Stimulation for Lower Extremity Pain.

Science.gov (United States)

Maher, Dermot P; Martins, Yuri Chaves; Doshi, Tina; Bicket, Mark; Zhang, Kui; Hanna, George; Ahmed, Shihab

2018-01-01

Spinal cord stimulation (SCS) for the treatment of lower extremity pain is believed to the result of increased activity in the descending inhibitory and decreased activity in the ascending excitatory tracts. Evidence suggests that the analgesia afforded by SCS may be altered using certain neuropathic pain medications that also modulate neurotransmitters in these sensory tracts. We hypothesize that neuropathic pain medications may alter the response to SCS therapy. One hundred and fifteen subjects undergoing SCS therapy for lower extremity pain were retrospectively examined. The pharmacologic profile, including stable use of neuropathic and opioid medications, were recorded. Three separate logistic regression models examined the odds ratio of primary outcomes; a successful SCS trial, a 50% decrease in pain or a 50% reduction in opioid use one year after implant. Neither the use of opioids or neuropathic pain medications were associated with changes in the odds of a successful SCS trial or a 50% pain reduction. A higher dose of chronic opioids use prior to a trial was associated with greater odds of having a 50% reduction in opioid use following implant. OR 1.02, 95% CI 1.01-1.02, p-value neuropathic pain medications did not change the odds of either a successful SCS trial, or of experiencing a 50% reduction in pain at one year. The association between higher opioid doses and greater odds of a 50% reduction in opioid use may be the reflective of SCS's ability to reduce opioid reliance in chronic pain patients. © 2017 International Neuromodulation Society.

76 FR 60733 - Drawbridge Operation Regulations; Narrow Bay, Smith Point, NY

Science.gov (United States)

2011-09-30

... Operation Regulations; Narrow Bay, Smith Point, NY AGENCY: Coast Guard, DHS. ACTION: Notice of temporary... deviation from the regulation governing the operation of the Smith Point Bridge, 6.1, across Narrow Bay, between Smith Point and Fire Island, New York. The deviation is necessary to facilitate bridge...

Spark PRM: Using RRTs within PRMs to efficiently explore narrow passages

KAUST Repository

Shi, Kensen; Denny, Jory; Amato, Nancy M.

2014-01-01

© 2014 IEEE. Probabilistic RoadMaps (PRMs) have been successful for many high-dimensional motion planning problems. However, they encounter difficulties when mapping narrow passages. While many PRM sampling methods have been proposed to increase the proportion of samples within narrow passages, such difficult planning areas still pose many challenges. We introduce a novel algorithm, Spark PRM, that sparks the growth of Rapidly-expanding Random Trees (RRTs) from narrow passage samples generated by a PRM. The RRT rapidly generates further narrow passage samples, ideally until the passage is fully mapped. After reaching a terminating condition, the tree stops growing and is added to the roadmap. Spark PRM is a general method that can be applied to all PRM variants. We study the benefits of Spark PRM with a variety of sampling strategies in a wide array of environments. We show significant speedups in computation time over RRT, Sampling-based Roadmap of Trees (SRT), and various PRM variants.

Spark PRM: Using RRTs within PRMs to efficiently explore narrow passages

KAUST Repository

Shi, Kensen

2014-05-01

© 2014 IEEE. Probabilistic RoadMaps (PRMs) have been successful for many high-dimensional motion planning problems. However, they encounter difficulties when mapping narrow passages. While many PRM sampling methods have been proposed to increase the proportion of samples within narrow passages, such difficult planning areas still pose many challenges. We introduce a novel algorithm, Spark PRM, that sparks the growth of Rapidly-expanding Random Trees (RRTs) from narrow passage samples generated by a PRM. The RRT rapidly generates further narrow passage samples, ideally until the passage is fully mapped. After reaching a terminating condition, the tree stops growing and is added to the roadmap. Spark PRM is a general method that can be applied to all PRM variants. We study the benefits of Spark PRM with a variety of sampling strategies in a wide array of environments. We show significant speedups in computation time over RRT, Sampling-based Roadmap of Trees (SRT), and various PRM variants.

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.

Science.gov (United States)

Issenberg, S Barry; McGaghie, William C; Petrusa, Emil R; Lee Gordon, David; Scalese, Ross J

2005-01-01

simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. While research in this field needs improvement in terms of rigor and quality, high

A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes.

Science.gov (United States)

Malec, J F; Buffington, A L; Moessner, A M; Degiorgio, L

2000-08-01

To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. Five levels of Vocational Independence Scale (VIS). Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employment; 10% in sheltered work; and 10% not placed. At 1-year follow-up (n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at 1-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement.

Retrospective analysis of first-line treatment for follicular lymphoma based on outcomes and medical economics.

Science.gov (United States)

Muneishi, Manaka; Nakamura, Ayaka; Tachibana, Katsumi; Suemitsu, Junko; Hasebe, Shinji; Takeuchi, Kazuto; Yakushijin, Yoshihiro

2018-04-01

Follicular lymphoma (FL) is the most common type of non-Hodgkin lymphoma (NHL), with indolent progression. Several treatment options are selected, based not only on disease status, quality of life (QOL), and age of patient, but also on recent increasing medical costs. We retrospectively analysed the first-line treatment of FL with regard to treatment outcomes and medical economics, and discuss the appropriate strategies for FL. Data on a total of 69 newly-diagnosed patients with FL was retrospectively collected from 2001 to 2015. The median age of the patients was 60 years and the median follow-up was 58 months. A total of 25 cases with FL were treated with R monotherapy, and 28 cases were treated with R-CHOP as first-line treatment. The factors affecting the decision of physicians to use R or R-CHOP treatment were serum level of lactate dehydrogenase (LDH) and disease stage. The first-line treatment-associated survival did not show any statistical differences between R and R-CHOP. The average hospitalization and average of all medical costs during the first-line treatment were 4.1 days (R) versus 55.7 days (R-CHOP), and JPY 1,707,693 (USD 15,324) (R) versus JPY 2,136,117 (USD 19,170) (R-CHOP), respectively. R monotherapy for patients whose diseases show low tumor burden and who are not candidates for local treatment has benefits as a first-line treatment compared to R-CHOP, based on the patients' QOL and medical economics.

Spatio-Temporal Encoding in Medical Ultrasound Imaging

DEFF Research Database (Denmark)

Gran, Fredrik

2005-01-01

In this dissertation two methods for spatio-temporal encoding in medical ultrasound imaging are investigated. The first technique is based on a frequency division approach. Here, the available spectrum of the transducer is divided into a set of narrow bands. A waveform is designed for each band...... the signal to noise ratio and simultaneously the penetration depth so that the medical doctor can image deeper lying structures. The method is tested both experimentally and in simulation and has also evaluated for the purpose of blood flow estimation. The work presented is based on four papers which...

Risk of Adverse Health Outcomes and Decrements in Performance Due to In-flight Medical Conditions

Science.gov (United States)

Antonsen,Erik

2017-01-01

The drive to undertake long-duration space exploration missions at greater distances from Earth gives rise to many challenges concerning human performance under extreme conditions. At NASA, the Human Research Program (HRP) has been established to investigate the specific risks to astronaut health and performance presented by space exploration, in addition to developing necessary countermeasures and technology to reduce risk and facilitate safer, more productive missions in space (NASA Human Research Program 2009). The HRP is divided into five subsections, covering behavioral health, space radiation, habitability, and other areas of interest. Within this structure is the ExMC Element, whose research contributes to the overall development of new technologies to overcome the challenges of expanding human exploration and habitation of space. The risk statement provided by the HRP to the ExMC Element states: "Given that medical conditions/events will occur during human spaceflight missions, there is a possibility of adverse health outcomes and decrements in performance in mission and for long term health" (NASA Human Research Program 2016). Within this risk context, the Exploration Medical Capabilities (ExMC) Element is specifically concerned with establishing evidenced-based methods of monitoring and maintaining astronaut health. Essential to completing this task is the advancement in techniques that identify, prevent, and treat any health threats that may occur during space missions. The ultimate goal of the ExMC Element is to develop and demonstrate a pathway for medical system integration into vehicle and mission design to mitigate the risk of medical issues. Integral to this effort is inclusion of an evidence-based medical and data handling system appropriate for long-duration, exploration-class missions. This requires a clear Concept of Operations, quantitative risk metrics or other tools to address changing risk throughout a mission, and system scoping and system

Cervical spine degenerative changes (narrowed intervertebral disc spaces and osteophytes) in coal miners

International Nuclear Information System (INIS)

Zejda, J. E.; Stasiow, B.

2003-01-01

A series of 685 x-rays films of the cervical spine obtained in coal miners was analyzed to explore the occurrence of narrowed disc spaces and osteophytes in this occupational group, and to examine the association of x-rays changes with age, duration of employment, and duration of occupational exposure to hand-arm vibration. All data were extracted from individual medical files of coal miners examined for suspected hand-arm vibration-related disorders in 1989-1999 at the Occupational Medicine Center in Katowice. The narrowed intervertebral disc spaces were found in 188 coal miners (26.9%) and osteophytes in 332 coal miners (47.5%). The occurrence of degenerative changes in coal miners was similar to that observed in a small group of 68 blue-collar workers (no exposure to hand-arm vibration) employed in the coal industry. Univariate comparisons showed that intervertebral disc spaces and osteophytes were more frequent among older subjects and among subjects with longer duration of employment. The results of logistic regression analysis confirmed statistically significant effect of age, but not of other factors included in the model. When both x-ray changes were grouped together (a combined dependent variable) age remained the only statistically significant explanatory variable. The findings do not support the view that the examined degenerative changes in cervical spine are more prevalent in coal miners and depend on duration of physical work or local exposure to hand-arm vibration in this occupational group. (author)

Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.

Science.gov (United States)

Grilo, Carlos M; White, Marney A; Masheb, Robin M; Gueorguieva, Ralitza

2015-04-01

We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings. One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes. Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss. Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED. clinicaltrials.gov: NCT00537810 (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Interface band gap narrowing behind open circuit voltage losses in Cu2ZnSnS4 solar cells

DEFF Research Database (Denmark)

Crovetto, Andrea; Palsgaard, Mattias Lau Nøhr; Gunst, Tue

2017-01-01

We present evidence that bandgap narrowing at the heterointerface may be a major cause of the large open circuit voltage deficit of Cu2ZnSnS4/CdS solar cells. Bandgap narrowing is caused by surface states that extend the Cu2ZnSnS4valence band into the forbidden gap. Those surface states...... are consistently found in Cu2ZnSnS4, but not in Cu2ZnSnSe4, by first-principles calculations. They do not simply arise from defects at surfaces but are an intrinsic feature of Cu2ZnSnS4 surfaces. By including those states in a device model, the outcome of previously published temperature-dependent open circuit...... voltage measurements on Cu2ZnSnS4 solar cells can be reproduced quantitatively without necessarily assuming a cliff-like conduction band offset with the CdS buffer layer. Our first-principles calculations indicate that Zn-based alternative buffer layers are advantageous due to the ability of...

78 FR 23845 - Drawbridge Operation Regulations; Narrow Bay, Smith Point, NY

Science.gov (United States)

2013-04-23

... Operation Regulations; Narrow Bay, Smith Point, NY AGENCY: Coast Guard, DHS. ACTION: Notice of temporary... deviation from the regulation governing the operation of the Smith Point Bridge, mile 6.1, across Narrow Bay, between Smith Point and Fire Island, New York. The deviation is necessary to facilitate the Smith Point...

Fundamental resource dis/advantages, youth health and adult educational outcomes.

Science.gov (United States)

Elman, Cheryl; Wray, Linda A; Xi, Juan

2014-01-01

Recent studies find lasting effects of poor youth health on educational attainment but use young samples and narrow life course windows of observation to explore outcomes. We apply a life course framework to three sets of Health and Retirement Study birth cohorts to examine early health status effects on education and skills attainment measured late in life. The older cohorts that we study were the earliest recipients of U.S. policies promoting continuing education through the GI Bill, community college expansions and new credentials such as the GED. We examine a wide range of outcomes but focus on GEDs, postsecondary school entry and adult human capital as job-related training. We find that older U.S. cohorts had considerable exposure to these forms of attainment and that the effects of youth health on them vary by outcome: health selection and ascription group effects are weak or fade, respectively, in outcomes associated with delayed or adult attainment. However, poorer health and social disadvantage in youth and barriers associated with ascription carry forward to limit attainment of key credentials such as diplomas and college degrees. We find that the human capital - health gradient is dynamic and that narrow windows of observation in existing studies miss much of it. National context also matters for studying health-education linkages over the life course. Copyright © 2013 Elsevier Inc. All rights reserved.

Clinical Profile and Outcome of Asphyxiated Newborn in a Medical College Teaching Hospital

Directory of Open Access Journals (Sweden)

Kiran Panthee

2016-06-01

Full Text Available Introduction: Perinatal asphyxia, a major topic in neonatology, is a severe condition which has a high impact on neonatal mortality and morbidity and neurological and intellectual development of the infant. It is defined by WHO as "failure to initiate and sustain breathing at birth". It is estimated that around four million babies are born asphyxiated and among those one million die and an equal number of babies develop serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. This study was done to identify the occurrence, clinical profile and, immediate outcome of perinatal asphyxia in Lumbini Medical College Teaching Hospital. Methods: It was a retrospective study where 82 cases who fulfilled the inclusion criteria were included between December 2014 to November 2015. Inclusion criteria included newborns with: a Apgar score equal to or less than six at five minutes, b requirement of  more than one minute of positive pressure ventilation, c signs of fetal distress (heart rate of less than 100 beats per minute, late decelerations. Results: Out of total 425 neonatal intensive care unit (NICU admissions, 82 (19.3% cases were of asphyxia among which 56 were inborn and 26 were referred from outside. Of those 82 cases, 47 (57.3% cases developed hypoxic ischemic encephalopathy (HIE; HIE stage I had good outcome with survival rate of 95% and HIE stage III had poor outcome with survival rate of only 25%. Conclusion: Despite advances in management of neonates, perinatal asphyxia is still the leading cause of neonatal intensive care unit admission and mortality and morbidity in neonates.

Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school

Science.gov (United States)

Yu, Tzu-Chieh; Wilson, Nichola C; Singh, Primal P; Lemanu, Daniel P; Hawken, Susan J; Hill, Andrew G

2011-01-01

Introduction International interest in peer-teaching and peer-assisted learning (PAL) during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice. Objective To summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students. Method A literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of “Kirkpatrick’s Levels of Learning” were used to grade the impact size of study outcomes. Results From 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective contexts, achieves short-term learner outcomes that are comparable with those produced by faculty-based teaching. Furthermore, peer-teaching has beneficial effects on student-teacher learning outcomes. Conclusions Peer-teaching in undergraduate medical programs is comparable to conventional teaching when utilized in selected contexts. There is evidence to suggest

The Effect of Divided Attention on Emotion-Induced Memory Narrowing

OpenAIRE

Steinmetz, Katherine R. Mickley; Waring, Jill D.; Kensinger, Elizabeth A.

2013-01-01

Individuals are more likely to remember emotional than neutral information, but this benefit does not always extend to the surrounding background information. This memory narrowing is theorized to be linked to the availability of attentional resources at encoding. In contrast to the predictions of this theoretical account, altering participants’ attentional resources at encoding, by dividing attention, did not affect the emotion-induced memory narrowing. Attention was divided using three sepa...

Predicting Inpatient Detoxification Outcome of Alcohol and Drug Dependent Patients: The Influence of Sociodemographic Environment, Motivation, Impulsivity, and Medical Comorbidities

Directory of Open Access Journals (Sweden)

Yvonne Sofin

2017-01-01

Full Text Available Aims. This prospective study aims to identify patient characteristics as predictors for treatment outcome during inpatient detoxification treatment for drug and alcohol dependent patients. Methods. A mixed gender sample of 832 consecutively admitted drug and alcohol dependent patients were interviewed by an experienced physician. The impact of a variety of factors concerning social environment, therapy motivation, impulsivity related variables, medical history, and addiction severity on treatment outcome was examined. Results. 525 (63.1% of the patients completed detoxification treatment whereas 307 (36.9% dropped out prematurely. Being female, living in a partnership, having children, being employed, and having good education were predictive for a positive outcome. Family, health, the fear of losing the job, prosecution, and emergency admission were significant motivational predictors for treatment outcome. Being younger, history of imprisonment, and the number of previous drop-outs were predictive for a negative outcome. Conclusions. Variables concerning social environment and the number of previous drop-outs have been identified as best predictors for treatment outcome. Socially stable patients benefit from the current treatment setting and treatment shall be adapted for patients with negative predictors. Treatment may consequently be tailored with respect to intervention type, duration, and intensity to improve the outcome for those patients that fulfil criteria with negative impact on treatment retention.

DEFINING THE RELEVANT OUTCOME MEASURES IN MEDICAL DEVICE ASSESSMENTS: AN ANALYSIS OF THE DEFINITION PROCESS IN HEALTH TECHNOLOGY ASSESSMENT.

Science.gov (United States)

Jacobs, Esther; Antoine, Sunya-Lee; Prediger, Barbara; Neugebauer, Edmund; Eikermann, Michaela

2017-01-01

Defining relevant outcome measures for clinical trials on medical devices (MD) is complex, as there is a large variety of potentially relevant outcomes. The chosen outcomes vary widely across clinical trials making the assessment in evidence syntheses very challenging. The objective is to provide an overview on the current common procedures of health technology assessment (HTA) institutions in defining outcome measures in MD trials. In 2012-14, the Web pages of 126 institutions involved in HTA were searched for methodological manuals written in English or German that describe methods for the predefinition process of outcome measures. Additionally, the institutions were contacted by email. Relevant information was extracted. All process steps were performed independently by two reviewers. Twenty-four manuals and ten responses from the email request were included in the analysis. Overall, 88.5 percent of the institutions describe the type of outcomes that should be considered in detail and 84.6 percent agree that the main focus should be on patient relevant outcomes. Specifically related to MD, information could be obtained in 26 percent of the included manuals and email responses. Eleven percent of the institutions report a particular consideration of MD related outcomes. This detailed analysis on common procedures of HTA institutions in the context of defining relevant outcome measures for the assessment of MD shows that standardized procedures for MD from the perspective of HTA institutions are not widespread. This leads to the question if a homogenous approach should be implemented in the field of HTA on MD.

Fabrication of continuous electrospun filaments with potential for use as medical fibres.

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Mouthuy, Pierre-Alexis; Zargar, Nasim; Hakimi, Osnat; Lostis, Emilie; Carr, Andrew

2015-05-19

Soft tissue injuries represent a substantial and growing social and economic burden. Medical fibres are commonly used to repair these injuries during surgery. Patient's outcomes are, however, not promising with around 40% of surgical repairs failing within the first few months after surgery due to poor tissue regeneration. The application of nanofibrous filaments and yarns as medical fibres and scaffolds has been suggested to improve soft tissue regeneration and enhance the quality of the repair. However, due to a lack of robustness and reliability of the current fabrication methods, continuous nanofibrous filaments cannot be manufactured and scaled up in industrial settings and are not currently available for clinical use. We have developed a robust and automated method that enables the manufacture of continuous electrospun filaments and which has the potential to be integrated into existing textile production lines. The technology uses a wire guide to form submicrofibres in a dense, narrow mesh which can be detached as a long and continuous thread. The thread can then be stretched and used to create multifilament yarns which can imitate the hierarchical architecture of tissues such as tendons and ligaments. Electrospun polydioxanone yarns produced by this method showed improved cellular proliferation and adhesion when compared to medical monofilament fibres in current clinical use. In vivo, the electrospun yarns showed a good safety profile with mild foreign body reaction and complete degradation within 5 months after implantation. These results suggest that this filament collection method has the potential to become a useful platform for the fabrication of future medical textiles.

Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school

Directory of Open Access Journals (Sweden)

Yu TC

2011-06-01

Full Text Available Tzu-Chieh Yu¹, Nichola C Wilson², Primal P Singh¹, Daniel P Lemanu¹, Susan J Hawken³, Andrew G Hill¹¹South Auckland Clinical School, University of Auckland, Auckland, New Zealand; ²Department of Surgery, University of Auckland, Auckland, New Zealand; ³Department of Psychological Medicine, University of Auckland, Auckland, New ZealandIntroduction: International interest in peer-teaching and peer-assisted learning (PAL during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice.Objective: To summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students.Method: A literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of “Kirkpatrick’s Levels of Learning” were used to grade the impact size of study outcomes.Results: From 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective

MRI of surgically created pulmonary artery narrowing in the dog

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Hernandez, R.J.; Rocchini, A.P.; Bove, E.L.; Chenevert, T.L.; Gubin, B. (Michigan Univ., Ann Arbor (USA). Dept. of Radiology)

1989-11-01

Narrowing of the pulmonary arteries was created surgically in twelve dogs. In six of the dogs the narrowing was central (main pulmonary artery), and in the remaining six the narrowing was located peripherally at the hilar level of the right pulmonary artery beyond the pericardial reflection. MRI and angiography were performed in all dogs. MRI clearly delineated the site of the pulmonary band and the caliber of the pulmonary artery at the site of the band in all dogs (N=6). MRI was not able to visualize any of the stenosis of the right pulmonary arteries at the hila, beyond the pericardial reflection. In addition, optimal imaging planes to depict each segment of the central pulmonary arteries were determined. The capability to image in oblique planes is essential in evaluating the morphology of the central pulmonary arteries. (orig.).

MRI of surgically created pulmonary artery narrowing in the dog

International Nuclear Information System (INIS)

Hernandez, R.J.; Rocchini, A.P.; Bove, E.L.; Chenevert, T.L.; Gubin, B.

1989-01-01

Narrowing of the pulmonary arteries was created surgically in twelve dogs. In six of the dogs the narrowing was central (main pulmonary artery), and in the remaining six the narrowing was located peripherally at the hilar level of the right pulmonary artery beyond the pericardial reflection. MRI and angiography were performed in all dogs. MRI clearly delineated the site of the pulmonary band and the caliber of the pulmonary artery at the site of the band in all dogs (N=6). MRI was not able to visualize any of the stenosis of the right pulmonary arteries at the hila, beyond the pericardial reflection. In addition, optimal imaging planes to depict each segment of the central pulmonary arteries were determined. The capability to image in oblique planes is essential in evaluating the morphology of the central pulmonary arteries. (orig.)

Long-term medical outcomes in survivors of extra-ocular retinoblastoma: the Memorial Sloan-Kettering Cancer Center (MSKCC) experience.

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Friedman, Danielle Novetsky; Sklar, Charles A; Oeffinger, Kevin C; Kernan, Nancy A; Khakoo, Yasmin; Marr, Brian P; Wolden, Suzanne L; Abramson, David H; Dunkel, Ira J

2013-04-01

Data on long-term outcomes of survivors of extra-ocular retinoblastoma are lacking. The authors sought to provide the first report characterizing long-term outcomes among survivors of extra-ocular retinoblastoma. Retrospective analysis of long-term medical outcomes in 19 survivors of extra-ocular retinoblastoma treated between 1992 and 2009. Severity of outcomes was graded using Common Terminology Criteria for Adverse Events. All patients received intensive multimodality therapy for their extra-ocular disease after management of their primary intra-ocular disease, including conventional chemotherapy (n = 19, 100%), radiotherapy (n = 15, 69%), and/or high-dose chemotherapy with autologous stem cell transplant (n = 17, 89%). The median follow-up was 7.8 years from diagnosis of extra-ocular retinoblastoma (range 2-17.8 years). The most common long-term non-visual outcomes were hearing loss (n = 15, 79%), short stature (n = 7, 37%), and secondary malignancies [SMN] (n = 6, 31%). Sixty-eight percent of survivors exhibited ≥2 non-visual long-term outcomes of any grade. Except short stature, which was not graded for severity, Grade 3-4 outcomes were limited to: ototoxicity (n = 8; n = 4 require hearing aids), SMNs (n = 6), and unequal limb length (n = 1). Five patients who developed SMNs carried a known RB1 mutation. SMNs developed at a median of 11.1 years after initial diagnosis; two patients died of their SMN. Long-term cardiac, pulmonary, hepatobiliary, or renal conditions were not identified in any survivors. Long-term outcomes are commonly seen in extra-ocular retinoblastoma survivors but the majority are mild-moderate in their severity. Longer comprehensive follow-up is needed to fully assess treatment-related outcomes but the information collected to date may affect management decisions for children with extra-ocular disease. Copyright © 2012 Wiley Periodicals, Inc.

Assessing the Utility of Compound Trait Estimates of Narrow Personality Traits.

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Credé, Marcus; Harms, Peter D; Blacksmith, Nikki; Wood, Dustin

2016-01-01

It has been argued that approximations of narrow traits can be made through linear combinations of broad traits such as the Big Five personality traits. Indeed, Hough and Ones ( 2001 ) used a qualitative analysis of scale content to arrive at a taxonomy of how Big Five traits might be combined to approximate various narrow traits. However, the utility of such compound trait approximations has yet to be established beyond specific cases such as integrity and customer service orientation. Using data from the Eugene-Springfield Community Sample (Goldberg, 2008 ), we explore the ability of linear composites of scores on Big Five traits to approximate scores on 127 narrow trait measures from 5 well-known non-Big-Five omnibus measures of personality. Our findings indicate that individuals' standing on more than 30 narrow traits can be well estimated from 3 different types of linear composites of scores on Big Five traits without a substantial sacrifice in criterion validity. We discuss theoretical accounts for why such relationships exist as well as the theoretical and practical implications of these findings for researchers and practitioners.

Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years.

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Tyrer, Peter; Salkovskis, Paul; Tyrer, Helen; Wang, Duolao; Crawford, Michael J; Dupont, Simon; Cooper, Sylvia; Green, John; Murphy, David; Smith, Georgina; Bhogal, Sharandeep; Nourmand, Shaeda; Lazarevic, Valentina; Loebenberg, Gemma; Evered, Rachel; Kings, Stephanie; McNulty, Antoinette; Lisseman-Stones, Yvonne; McAllister, Sharon; Kramo, Kofi; Nagar, Jessica; Reid, Steven; Sanatinia, Rahil; Whittamore, Katherine; Walker, Gemma; Philip, Aaron; Warwick, Hilary; Byford, Sarah; Barrett, Barbara

2017-09-01

Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care. To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients. Randomised controlled trial. Five general hospitals in London, Middlesex and Nottinghamshire. A total of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not. Cognitive-behaviour therapy for health anxiety - between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. Primary - researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes - costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years. Of the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overall p  < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety ( p

Einstein-Podolsky-Rosen Entanglement of Narrow-Band Photons from Cold Atoms

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Lee, Jong-Chan; Park, Kwang-Kyoon; Zhao, Tian-Ming; Kim, Yoon-Ho

2016-12-01

Einstein-Podolsky-Rosen (EPR) entanglement introduced in 1935 deals with two particles that are entangled in their positions and momenta. Here we report the first experimental demonstration of EPR position-momentum entanglement of narrow-band photon pairs generated from cold atoms. By using two-photon quantum ghost imaging and ghost interference, we demonstrate explicitly that the narrow-band photon pairs violate the separability criterion, confirming EPR entanglement. We further demonstrate continuous variable EPR steering for positions and momenta of the two photons. Our new source of EPR-entangled narrow-band photons is expected to play an essential role in spatially multiplexed quantum information processing, such as, storage of quantum correlated images, quantum interface involving hyperentangled photons, etc.

Einstein-Podolsky-Rosen Entanglement of Narrow-Band Photons from Cold Atoms.

Science.gov (United States)

Lee, Jong-Chan; Park, Kwang-Kyoon; Zhao, Tian-Ming; Kim, Yoon-Ho

2016-12-16

Einstein-Podolsky-Rosen (EPR) entanglement introduced in 1935 deals with two particles that are entangled in their positions and momenta. Here we report the first experimental demonstration of EPR position-momentum entanglement of narrow-band photon pairs generated from cold atoms. By using two-photon quantum ghost imaging and ghost interference, we demonstrate explicitly that the narrow-band photon pairs violate the separability criterion, confirming EPR entanglement. We further demonstrate continuous variable EPR steering for positions and momenta of the two photons. Our new source of EPR-entangled narrow-band photons is expected to play an essential role in spatially multiplexed quantum information processing, such as, storage of quantum correlated images, quantum interface involving hyperentangled photons, etc.

Experimental study on occupant evacuation in narrow seat aisle

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Huang, Shenshi; Lu, Shouxiang; Lo, Siuming; Li, Changhai; Guo, Yafei

2018-07-01

Narrow seat aisle is an important area in the train car interior due to the large passenger population, however evacuation therein has not gained enough concerns. In this experimental study, the occupant evacuation of the narrow seat aisle area is investigated, with the aisle width of 0.4-0.6 m and the evacuation direction of forward and backward. The evacuation behaviors are analyzed based on the video record, and the discussion is carried out in the aspect of evacuation time, crowdedness, evacuation order, and aisle conflicts. The result shows that with the increasing aisle width, total evacuation time and the average specific evacuation rate decrease. The aisle is crowded for some time, with a large linear occupant densities. The evacuation order of each occupant is mainly related to the seat position. Moreover, it is found that the aisle conflicts can be well described by Burstedde's model. This study gives a useful benchmark for evacuation simulation of narrow seat aisle, and provides reference to safety design of seat area in train cars.

CYP2D6 phenotypes are associated with adverse outcomes related to opioid medications

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St Sauver JL

2017-07-01

Full Text Available Jennifer L St Sauver,1,2 Janet E Olson,1,3 Veronique L Roger,1,2,4 Wayne T Nicholson,5 John L Black III,3,6 Paul Y Takahashi,7 Pedro J Caraballo,7 Elizabeth J Bell,2 Debra J Jacobson,1,2 Nicholas B Larson,1 Suzette J Bielinski,1,3 1Department of Health Sciences Research, 2Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, 3Center for Individualized Medicine, 4Department of Cardiovascular Diseases, 5Department of Anesthesiology and Perioperative Medicine, 6Department of Laboratory Medicine and Pathology, 7Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA Background: Variation in the CYP2D6 gene may affect response to opioids in both poor and ultrarapid metabolizers, but data demonstrating such associations have been mixed, and the impact of variants on toxicity-related symptoms (e.g., nausea is unclear. Therefore, we examined the association between CYP2D6 phenotype and poor pain control or other adverse symptoms related to the use of opioids in a sample of primary care patients.Materials and methods: We identified all patients in the Mayo Clinic RIGHT Protocol who were prescribed an opioid medication between July 01, 2013 and June 30, 2015, and categorized patients into three phenotypes: poor, intermediate to extensive, or ultrarapid CYP2D6 metabolizers. We reviewed the electronic health record of these patients for indications of poor pain control or adverse symptoms related to medication use. Associations between phenotype and outcomes were assessed using Chi-square tests and logistic regression.Results: Overall, 257 (25% of RIGHT Protocol participants patients received at least one opioid prescription; of these, 40 (15% were poor metabolizers, 146 (57% were intermediate to extensive metabolizers, and 71 (28% were ultrarapid metabolizers. We removed patients that were prescribed a CYP2D6 inhibitor medication (n=38. After adjusting for age and sex, patients with a poor or ultrarapid

The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

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Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G., Jr.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

The narrow-gap TIG welding concerns the electric power plants manufacturers

International Nuclear Information System (INIS)

Anon.

2009-01-01

Polysoude, France, played host to an expert forum on narrow gap welding from 5-7 November 2008. The successful event welcomed around one hundred experts.The power plant construction sector is currently booming worldwide. For plant construction this means using more pressure-resistant, thick-walled pipes made from high temperature steels. The key quality features of this new steel grade are the values for high creep rupture strength that also apply without restriction as the benchmark for every weld seam on these pipes. In particular, the forum on narrow gap welding addressed this area of automated welding technology. During the forum, Mr Hans-Peter Mariner (Polysoude's CEO), has offered an in-depth insight into the latest developments in narrow gap welding. This presentation highlighted that with wall thicknesses of over 60 mm, welding time is shortened by a factor of five to ten in comparison to conventional TIG processes with a traditional V seam. The welding characteristics of the parent material are the decisive factor in the application of the narrow gap process. Technical advances in equipment technology such as automatic centring, HF-free ignition, seam preparation and optimised gas protection further increase the application limits. The geometry and gap width of the weld groove are based on the mechanical properties of the materials being joined, with the shrinkage characteristics of the seam being particularly important. Another key part of the programme was a presentation on the three different narrow gap-welding techniques. The first involves a single pass weld per layer and torch or work-piece revolution. The second is dual pass welding next to one another, when the seam preparation or positioning exceed the required narrow tolerances of a few tenths of a millimetre for one stringer bead per layer. TIG narrow gap welding with a shuttle-motion electrode is ideal with very large wall thicknesses of 150-200 mm. This is particularly the case if the

Unsuccessful outcomes after posterior urethroplasty: definition, diagnosis, and treatment.

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Koraitim, Mamdouh M

2012-05-01

To establish some guidelines for the definition, diagnosis, and treatment of failed posterior urethroplasty. We identified 20 successive patients who required a secondary endoscopic or surgical procedure after anastomotic repair of a postpelvic fracture urethral injury from 1979 to 2010. Of the 20 patients, 18 had undergone perineal repair and 2 a perineo-abdominal procedure. Their medical records were reviewed with a focus on 6 postoperative items: symptoms, onset of unsuccessful result, urethral calibration, urethrocystography, urethroscopy, and treatment. Follow-up ranged from 1 to 25 years (mean 14). Of the 20 patients, 11 (55%) presented shortly after removal of the urethral stent with failure to void (n = 9) or incontinence (n = 2), and 9 (45%) presented 1 month to 12 years after surgery with a weak stream. Early failures resulted from obstruction at the site of repair in 5 patients, retraction of the bulbar urethra in 3, wrong anastomosis to a false tract in 1, and an open bladder neck in 2. Correction was accomplished by salvage urethroplasty in 8 patients and bladder neck repair in 2. Late failures resulted from narrowing of the anastomosis and were corrected by direct visual internal urethrotomy in 7 patients and surgery in 2. Unsuccessful outcomes can be encountered shortly after removal of the urethral stent or delayed for several months or years after surgery. Early cases present by an inability to void or incontinence and usually require salvage urethroplasty or bladder neck repair. Late cases present by a weak urinary stream, are due to narrowing of the anastomosis, and are usually corrected by direct visual internal urethrotomy. Copyright © 2012 Elsevier Inc. All rights reserved.

Outcome discrepancies and selective reporting: impacting the leading journals?

Science.gov (United States)

Fleming, Padhraig S; Koletsi, Despina; Dwan, Kerry; Pandis, Nikolaos

2015-01-01

Selective outcome reporting of either interesting or positive research findings is problematic, running the risk of poorly-informed treatment decisions. We aimed to assess the extent of outcome and other discrepancies and possible selective reporting between registry entries and published reports among leading medical journals. Randomized controlled trials published over a 6-month period from July to December 31st, 2013, were identified in five high impact medical journals: The Lancet, British Medical Journal, New England Journal of Medicine, Annals of Internal Medicine and Journal of American Medical Association were obtained. Discrepancies between published studies and registry entries were identified and related to factors including registration timing, source of funding and presence of statistically significant results. Over the 6-month period, 137 RCTs were found. Of these, 18% (n = 25) had discrepancies related to primary outcomes with the primary outcome changed in 15% (n = 20). Moreover, differences relating to non-primary outcomes were found in 64% (n = 87) with both omission of pre-specified non-primary outcomes (39%) and introduction of new non-primary outcomes (44%) common. No relationship between primary or non-primary outcome change and registration timing (prospective or retrospective; P = 0.11), source of funding (P = 0.92) and presence of statistically significant results (P = 0.92) was found. Discrepancies between registry entries and published articles for primary and non-primary outcomes were common among trials published in leading medical journals. Novel approaches are required to address this problem.

Cervical spinal canal narrowing and cervical neurologi-cal injuries

Directory of Open Access Journals (Sweden)

ZHANG Ling

2012-04-01

Full Text Available 【Abstract】Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms in-cluding neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C 1 to C 7 ranges from 15.33 mm to 20.46 mm, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C 4 for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (≤14 mm in Whites, ≤ 12 mm in Japanese, ≤13.7 mm in Chinese. Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflam-matory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this re-view will be helpful in diagnosing spinal cord and neuro-logical injuries with the geometric parameters of cervical spine in the future. Key words: Spinal cord injuries; Spinal stenosis; Trauma, nervous system

Availability of Care Concordant With Patient-centered Medical Home Principles Among Those With Chronic Conditions: Measuring Care Outcomes.

Science.gov (United States)

Pourat, Nadereh; Charles, Shana A; Snyder, Sophie

2016-03-01

Care delivery redesign in the form of patient-centered medical home (PCMH) is considered as a potential solution to improve patient outcomes and reduce costs, particularly for patients with chronic conditions. But studies of prevalence or impact at the population level are rare. We aimed to assess whether desired outcomes indicating better care delivery and patient-centeredness were associated with receipt of care according to 3 important PCMH principles. We analyzed data from a representative population survey in California in 2009, focusing on a population with chronic condition who had a usual source of care. We used bivariate, logistic, and negative-binomial regressions. The indicators of PCMH concordant care included continuity of care (personal doctor), care coordination, and care management (individual treatment plan). Outcomes included flu shots, count of outpatient visits, any emergency department visit, timely provider communication, and confidence in self-care. We found that patients whose care was concordant with all 3 PCMH principles were more likely to receive flu shots, more outpatient care, and timely response from providers. Concordance with 2 principles led to some desired outcomes. Concordance with only 1 principle was not associated with desired outcomes. Patients who received care that met 3 key aspects of PCMH: coordination, continuity, and management, had better quality of care and more efficient use of the health care system.

Role of Leadership in Narrowing the Gap between Science and Practice: Improving Treatment Outcomes at the Systems Level.

Science.gov (United States)

Saeed, Sy Atezaz; Bloch, Richard M; Silver, Stuart

2015-09-01

It's been well documented that health care does not reliably transfer what we know from science into clinical practice. As a result, Americans do not always receive the care suggested by the scientific evidence. Despite the best intentions of a dedicated and skilled healthcare workforce, this can often lead to poor clinical outcomes. As research and technology rapidly advance, this gap between science and practice appears to be widening. There is an increasing public concern about a lack of access to appropriate treatment, pervasiveness of unsafe practices, and wasteful uses of precious health care resources leading to suboptimum treatment outcomes. Leadership has a critical role in creating and sustaining the environment that supports health services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Leadership has some responsibility to improve outcomes by insuring effective use of evidence-based treatment guidelines; measurement-based care; knowledge and skills management; care coordination; and information technologies. This paper addresses leadership issues in these components of a system's ability to improve treatment outcomes.

Immediate Outcome of Hypoxic Ischaemic Encephalopathy in Hypoxiate Newborns in Nepal Medical College.

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Shrestha, S; Shrestha, G S; Sharma, A

2016-05-01

Birth asphyxia is the fifth major cause of under-five child deaths after pneumonia, diarrhoea, neonatal infections and complications of preterm birth. It is one of the important causes of neonatal mortality and morbidity accounting up to 30% of neonatal death in Nepal. It is also an important cause of long-term neurological disability and impairment. The mortality rate due to birth asphyxia is considered a good guide to the quality of perinatal care. This study was conducted to assess the rate of birth asphyxia, risk factors and outcome of the babies who were asphyxiated at birth. A prospective study was conducted during the period of one year from April 2013 to March 2014 in Nepal Medical College. All the term babies born during the period with APGAR score at 5 minutes of newborn babies were assessed for clinical features of hypoxic ischemic encephalopathy (HIE) and its immediate outcome. Out of 2226 live births, 47 (15.9%) newborns had birth asphyxia with the rate of 21.1/1000 live births. The mortality rate due to birth asphyxia was 4.25%. Meconium stained liquor was present in 31(65.96%) cases during delivery and prolonged rupture of membrane in 7(14.89%). Early identification and close monitoring of high-risk mothers with maintaining partograph during labor help to reduce birth asphyxia.

Body temperature change and outcomes in patients undergoing long-distance air medical transport.

Science.gov (United States)

Nakajima, Mikio; Aso, Shotaro; Yasunaga, Hideo; Shirokawa, Masamitsu; Nakano, Tomotsugu; Miyakuni, Yasuhiko; Goto, Hideaki; Yamaguchi, Yoshihiro

2018-04-30

Short-distance air medical transport for adult emergency patients does not significantly affect patients' body temperature and outcomes. This study aimed to examine the influence of long-distance air medical transport on patients' body temperatures and the relationship between body temperature change and mortality. We retrospectively enrolled consecutive patients transferred via helicopter or plane from isolated islands to an emergency medical center in Tokyo, Japan between April 2010 and December 2016. Patients' average body temperature was compared before and after air transport using a paired t-test, and corrections between body temperature change and flight duration were calculated using Pearson's correlation coefficient. Multivariable logistic regression models were then used to examine the association between body temperature change and in-hospital mortality. Of 1253 patients, the median age was 72 years (interquartile range, 60-82 years) and median flight duration was 71 min (interquartile range, 54-93 min). In-hospital mortality was 8.5%, and average body temperature was significantly different before and after air transport (36.7 °C versus 36.3 °C; difference: -0.36 °C; 95% confidence interval, -0.30 to -0.42; p 38.0 °C) or normothermia (36.0-37.9 °C) before air transport and hypothermia after air transport (odds ratio, 2.08; 95% confidence interval, 1.20-3.63; p = 0.009), and (ii) winter season (odds ratio, 2.15; 95% confidence interval, 1.08-4.27; p = 0.030). Physicians should consider body temperature change during long-distance air transport in patients with not only hypothermia but also normothermia or hyperthermia before air transport, especially in winter. Copyright © 2018 Elsevier Inc. All rights reserved.

Pressure Fluctuation Characteristics of Narrow Gauge Train Running Through Tunnel

Science.gov (United States)

Suzuki, Masahiro; Sakuma, Yutaka

Pressure fluctuations on the sides of narrow (1067 mm) gauge trains running in tunnels are measured for the first time to investigate the aerodynamic force acting on the trains. The present measurements are compared with earlier measurements obtained with the Shinkansen trains. The results are as follows: (1) The aerodynamic force, which stems from pressure fluctuations on the sides of cars, puts the energy into the vibration of the car body running through a tunnel. (2) While the pressure fluctuations appear only on one of the two sides of the trains running in double-track tunnels, the fluctuations in opposite phase on both sides in single-track tunnels. (3) The on-track test data of the narrow gauge trains show the same tendency as those of the Shinkansen trains, although it is suggested that the pressure fluctuations develop faster along the narrow gauge trains than the Shinkansen trains.

CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea

International Nuclear Information System (INIS)

Bohlman, M.E.; Haponik, E.F.; Smith, P.L.; Allen, R.P.; Bleecker, E.R.; Goldman, S.M.

1983-01-01

Sleep apnea is a major cause of daytime hypersomnolence. Among the proposed etiologies, focal obstruction of the airways at the level of the pharynx has been suggested but not proven. Using computed tomography, the cross-sectional area of the airway can be readily assessed. Thirty-three adults with clinically proven sleep apnea and 12 normal adults underwent systematic computed tomography of the neck. Significant airway narrowing was demonstrated in all the patients with obstructive sleep apnea, whereas no such narrowing was seen in the controls. In 11, the narrowing was at a single level, whereas in 22 patients two or more levels were affected. This study has shown that a structurally abnormal airway may serve as an anatomic substrate for the development of sleep apnea. On the basis of this evidence, uvulopalatopharyngoplasty has been performed in two patients with relief of symptoms in one

Beyond "medical tourism": Canadian companies marketing medical travel.

Science.gov (United States)

Turner, Leigh

2012-06-15

-border health services available in the United States and intranational travel to clinics in Canada. In contrast to medical tourism companies, they do not market holiday tours in addition to medical care. Two companies occupy a narrow market niche and promote testing for CCSVI and "Liberation therapy" for multiple sclerosis. Three additional companies offer bariatric surgery and cosmetic surgery at facilities in Mexico. Four businesses offer health insurance products intended to cover the cost of obtaining privately financed health care in the U.S. These businesses also help their clients arrange treatment beyond Canada's borders. Finally, one medical travel company based in Canada markets health services primarily to U.S. citizens. This article uses content analysis of websites of Canadian companies marketing medical travel to provide insight into Canada's medical travel industry. The article reveals a complex marketplace with different types of companies taking distinct approaches to marketing medical travel.

Sensor based on Fano resonances of plane metamaterial with narrow slits

Energy Technology Data Exchange (ETDEWEB)

Huang, Wan-Xia, E-mail: kate@mail.ahnu.edu.cn [State Key Laboratory of Surface Physics, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education) and Physics Department, Fudan University, Shanghai 200433 (China); The College of Physics and Electronic Information, Anhui Normal University, Wuhu, Anhui 241000 (China); Guo, Juan-Juan; Wang, Mao-Sheng; Zhao, Guo-Ren [The College of Physics and Electronic Information, Anhui Normal University, Wuhu, Anhui 241000 (China)

2017-03-11

The optical properties of a composite metamaterial composed of narrow slits and nano hole pairs have been investigated experimentally and numerically. The strength of the transmission peak originating from the interference between the coupled surface plasmon polaritons (SPP) of the narrow slit and the SPP modes of the hole array is modulated by the degree of symmetry breaking. Some SPP modes can be inhibited by controlling the spacer layer thickness. Our metamaterial has potential applications in sensing and weak signal detection. - Highlights: • The plasmonic nanostructure composed of narrow slits and nano hole pairs were designed. • The optical properties were investigated experimentally and numerically. • The Fano resonances were found on the compound nanostructure. • The results have potential applications in sensing and weak signal detection.

Extrinsic stretching narrowing and anterior indentation of the rectosigmoid junction

International Nuclear Information System (INIS)

Schulman, A.; Fataar, S.

1979-01-01

Thirty-five cases of extrinsic narrowing or anterior indentation of the rectosigmoid junction (RSJ) have been studied. The RSJ lies directly behind the pouch of Douglas which is a favoured site for peritoneal metastasis, abscess and endometriosis. Any space-occupying lesion of sufficient size at this site will indent the anterior aspects of the RSJ. Causes include distension or tumour of the ileum or sigmoid colon, gross ascites (when the patient is erect), and tumours below the pelvic peritonium, such as gynaecological neoplasm and internal iliac artery aneurysm. When a desmoplastic metastasis in the pouch of Douglas infiltrates the outer layers of the RSJ, the fibrosis produces an eccentric shortening on its anterior aspect, which in turn causes a pleating of the mucosa with the folds radiating towards the shortened area. This is also seen with primary pelvic carcinomas directly adherent to the rectum, endometriosis with repeated bleeding and increasing eccentric, submucosal fibrosis, and chronic abscess in the pouch of Douglas. Not all extrinsic narrowing of the RSJ are pathological. One case of anterior indentation followed operation for rectal prolapse. Ten additional cases showed narrowing due to a technical artefact air-distended colon rising into the upper abdomen to cause stretching at the RSJ. As with ascites, this narrowing due to 'high-rise sigmoid' disappeared when the patients became recumbent and the colonic air redistributed. (author)

Predictors of Intraocular Pressure After Phacoemulsification in Primary Open-Angle Glaucoma Eyes with Wide Versus Narrower Angles (An American Ophthalmological Society Thesis).

Science.gov (United States)

Lin, Shan C; Masis, Marisse; Porco, Travis C; Pasquale, Louis R

2017-08-01

To assess if narrower-angle status and anterior segment optical coherence tomography (AS-OCT) parameters can predict intraocular pressure (IOP) drop in primary open-angle glaucoma (POAG) patients after cataract surgery. This was a prospective case series of consecutive cataract surgery patients with POAG and no peripheral anterior synechiae (PAS) using a standardized postoperative management protocol. Preoperatively, patients underwent gonioscopy and AS-OCT. The same glaucoma medication regimen was resumed by 1 month. Potential predictors of IOP reduction included narrower-angle status by gonioscopy and angle-opening distance (AOD500) as well as other AS-OCT parameters. Mixed-effects regression adjusted for use of both eyes and other potential confounders. We enrolled 66 eyes of 40 glaucoma patients. The IOP reduction at 1 year was 4.2±3 mm Hg (26%, P gonioscopy. By AOD500 classification, the narrower-angle group had 3.4±3 mm Hg (21%, P <.001) reduction vs 2.5±3 mm Hg (16%, P <.001) in the wide-angle group ( P =.031 for difference). When the entire cohort was assessed, iris thickness, iris area, and lens vault were correlated with increasing IOP reduction at 1 year ( P <.05 for all). In POAG eyes, cataract surgery lowered IOP to a greater degree in the narrower-angle group than in the wide-angle group, and parameters relating to iris thickness and area, as well as lens vault, were correlated with IOP reduction. These findings can guide ophthalmologists in their selection of cataract surgery as a potential management option.

Novel structural flexibility identification in narrow frequency bands

International Nuclear Information System (INIS)

Zhang, J; Moon, F L

2012-01-01

A ‘Sub-PolyMAX’ method is proposed in this paper not only for estimating modal parameters, but also for identifying structural flexibility by processing the impact test data in narrow frequency bands. The traditional PolyMAX method obtains denominator polynomial coefficients by minimizing the least square (LS) errors of frequency response function (FRF) estimates over the whole frequency range, but FRF peaks in different structural modes may have different levels of magnitude, which leads to the modal parameters identified for the modes with small FRF peaks being inaccurate. In contrast, the proposed Sub-PolyMAX method implements the LS solver in each subspace of the whole frequency range separately; thus the results identified from a narrow frequency band are not affected by FRF data in other frequency bands. In performing structural identification in narrow frequency bands, not in the whole frequency space, the proposed method has the following merits: (1) it produces accurate modal parameters, even for the modes with very small FRF peaks; (2) it significantly reduces computation cost by reducing the number of frequency lines and the model order in each LS implementation; (3) it accurately identifies structural flexibility from impact test data, from which structural deflection under any static load can be predicted. Numerical and laboratory examples are investigated to verify the effectiveness of the proposed method. (paper)

Joint Space Narrowing in Patients With Pisotriquetral Osteoarthritis.

Science.gov (United States)

Ten Berg, Paul W L; Heeg, Erik; Strackee, Simon D; Streekstra, Geert J

2017-09-01

Patients with suspected pisotriquetral osteoarthritis may show joint space narrowing. However, the extent of joint space narrowing and its deviation from the joint space width (JSW) in normal anatomy is unknown. In this pathoanatomic study, we therefore compared the JSW in the pisotriquetral joint between osteoarthritic patient wrists and healthy wrists. We reviewed preoperative computed tomography (CT) scans of 8 wrists of patients with ulnar-sided wrist pain who underwent a pisiformectomy with confirmed pisotriquetral osteoarthritis at surgery. We also reviewed CT scans of 20 normal wrists from healthy volunteers serving as control group. Three-dimensional CT models of the pisiform and triquetrum were obtained from both affected and normal wrists, after which the minimum JSW was calculated in an automated fashion. In the patient group, the median (interquartile range) of the minimum JSW was 0.1 mm (0.0-0.2), and in the control group, 0.8 mm (0.3-0.9) ( P = .007). We showed that the pisotriquetral joint space in osteoarthritic patient wrists was significantly narrowed compared with healthy wrists. These results suggest that JSW evaluation has a potential diagnostic value in the work-up of patients with suspected pisotriquetral osteoarthritis. This is an interesting area for future clinical research, especially because no gold standard for diagnosing pisotriquetral osteoarthritis has been established yet.

OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records.

Science.gov (United States)

Chen, Jonathan H; Podchiyska, Tanya; Altman, Russ B

2016-03-01

To answer a "grand challenge" in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com's product recommender. EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender's ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10(-10)) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10(-16)). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from "correct" ones. Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. "interesting" suggestions). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government

The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

Science.gov (United States)

Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

Optimizing medication safety in the home.

Science.gov (United States)

LeBlanc, Raeanne Genevieve; Choi, Jeungok

2015-06-01

Medication safety among community-dwelling older adults in the United States is an ongoing health issue impacting health outcomes, chronic disease management, and aging in place at home. This article describes a medication safety improvement project that aimed to: (1) Increase the ability of participants to manage medications, (2) Identify and make necessary medication changes, (3) Create an accurate up-to-date medication list to be available in the home, and (4) Provide communication between the primary care provider, participant, and case manager. An in-home medication assessment was completed for 25 participants using an evidence-based medication management software system. This process was used to review medications; identify medication-related problems; create a shared medication list; and convey this information to the primary care provider, case manager, and client while addressing needed medication changes. Educational interventions on management and understanding of medications were provided to participants to emphasize the correct use of medications and use of a personal medication record. Outcome improvements included provision of an accurate medication list, early identification of medication-related problems, identification of drug duplication, and identification of medication self-management challenges that can be useful for optimizing medication safety-related home healthcare and inform future interventions.

The effect of physician staffing model on patient outcomes in a medical progressive care unit.

Science.gov (United States)

Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S

2016-04-01

Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

Artificial neural network applied to ONB in vertical narrow annulus experiment

International Nuclear Information System (INIS)

Yun Guo; Guanghui Su; Dounan Jia; Jiaqiang Wang

2005-01-01

Full text of publication follows: It is very important to study the onset of nucleate boiling (ONB) in narrow channel. Engineering applications of the narrow channel are used more and more widely. The narrow channel is used in microelectronics. Narrow annular channel is also adopted to design the new type of heat exchanger. The ONB is usually regarded as the point of demarcation between the single-phase flow and two phase flow. So it is significant to study the onset of nucleate boiling in the judgment of the flow pattern and engineering design. Although the researches showed that the ONB in narrow space channel were different from that in common pipe, most of them did not study the bilateral heated effect on the ONB. The ONB was investigated for water flowing in the annular channel which gap is 1.2 mm at the pressure range from 0.10 to 5.0 MPa. The effect of some parameters on the ONB, such as the mass flux, pressure, inlet subcooled temperature, bilateral heating was analyzed. But the experiment has not been carried in great wide range of the pressure and flow flux. So the artificial neural networks were used to predict the ONB at wide range parameter. Recently artificial neural networks (ANNs) have been used widely in the field of reactor thermal-hydraulics because they can solve very complex multivariable and high non-linearity problems. The researchers can pay attention to the output results and be unaware of the inside characters of the networks. Most of them are used to predict the critical heat flux and some other accident problems. In fact some small-scale artificial neural networks can be used in thermal-hydraulic experiments easily. Based on the ONB experimental data, an artificial neural network (BP) is built to specify the ONB. According to a lot of experiments data another middle scale ANN is built to predict the ONB of narrow gap annular channels. The results are compared with other correlations. It was concluded that the power density of ONB in the

Midterm Results of Uterine Artery Embolization Using Narrow-Size Calibrated Embozene Microspheres

International Nuclear Information System (INIS)

Stampfl, Ulrike; Radeleff, Boris; Sommer, Christof; Stampfl, Sibylle; Dahlke, Angelika; Bellemann, Nadine; Kauczor, Hans-Ulrich; Richter, Goetz M.

2011-01-01

Purpose: To evaluate safety and efficacy of uterine artery embolization using narrow-size-range polyphosphazene-coated hydrogel microspheres (Embozene, CeloNova Biosciences, Newnan, GA). Methods: Between May 2006 and September 2008, a total of 121 consecutive patients (mean ± SD age 42.1 ± 5.4 years, range 30.5–51.5 years) were enrolled onto this single-center study. The primary study endpoint was safety as assessed by the society of interventional radiology (SIR) classification. The secondary endpoint was efficacy, which was based on a 1-year magnetic resonance imaging study and relief of symptoms documented by the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire over a 2-year interval. Results: The mean ± SD diameter of the dominant fibroid was 6.4 ± 2.6 (range, 2.9–13.9) cm and the mean volume 137.2 ± 245.1 (range, 5.3–1184) ml. Most patients had multiple fibroids with 11% more than 10. A total of 240 of 242 interventions were completed as planned, a technical success rate of 99.2%. According to the SIR classification, one type A, eight type C, and one type D complication occurred. Total devascularization was noted in 96% (116 of 121) of dominant fibroids. Volume decrease was 4% at 2 weeks, 52% (P < 0.001) at 3 months, 78% (P < 0.001) at 6 months, and 91% at 12 months (P < 0.001). The latter difference was statistically significant (P = 0.007). A total of 92% had improved hypermenorrhea at 1 year and 94% at 2 years. Dysmenorrhea was improved in 96% at 1 year and in 95% at 2 years. The overall health status score was 60.4 ± 26.2 points at baseline and 96.9 ± 3.8 after 1 year (P = 0.0019).ConclusionUterine artery embolization with Embozene microspheres is a safe procedure. Its efficacy is demonstrated by high fibroid devascularization and volume reduction rates and significant improvements of clinical symptoms and quality-of-life scores during follow-up.

Cervical spinal canal narrowing in idiopathic syringomyelia

International Nuclear Information System (INIS)

Struck, Aaron F.; Carr, Carrie M.; Shah, Vinil; Hesselink, John R.; Haughton, Victor M.

2016-01-01

The cervical spine in Chiari I patient with syringomyelia has significantly different anteroposterior diameters than it does in Chiari I patients without syringomyelia. We tested the hypothesis that patients with idiopathic syringomyelia (IS) also have abnormal cervical spinal canal diameters. The finding in both groups may relate to the pathogenesis of syringomyelia. Local institutional review boards approved this retrospective study. Patients with IS were compared to age-matched controls with normal sagittal spine MR. All subjects had T1-weighted spin-echo (500/20) and T2-weighted fast spin-echo (2000/90) sagittal cervical spine images at 1.5 T. Readers blinded to demographic data and study hypothesis measured anteroposterior diameters at each cervical level. The spinal canal diameters were compared with a Mann-Whitney U test. The overall difference was assessed with a Friedman test. Seventeen subjects were read by two reviewers to assess inter-rater reliability. Fifty IS patients with 50 age-matched controls were studied. IS subjects had one or more syrinxes varying from 1 to 19 spinal segments. Spinal canal diameters narrowed from C1 to C3 and then enlarged from C5 to C7 in both groups. Diameters from C2 to C4 were narrower in the IS group (p < 0.005) than in controls. The ratio of the C3 to the C7 diameters was also smaller (p = 0.004) in IS than controls. Collectively, the spinal canal diameters in the IS were significantly different from controls (Friedman test p < 0.0001). Patients with IS have abnormally narrow upper and mid cervical spinal canal diameters and greater positive tapering between C3 and C7. (orig.)

Cervical spinal canal narrowing in idiopathic syringomyelia

Energy Technology Data Exchange (ETDEWEB)

Struck, Aaron F. [Massachusetts General Hospital, Department of Neurology, Boston, MA (United States); Carr, Carrie M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shah, Vinil [University of California San Francisco, Department of Radiology, San Francisco, CA (United States); Hesselink, John R. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Haughton, Victor M. [University of Wisconsin, Department of Radiology, Madison, WI (United States)

2016-08-15

The cervical spine in Chiari I patient with syringomyelia has significantly different anteroposterior diameters than it does in Chiari I patients without syringomyelia. We tested the hypothesis that patients with idiopathic syringomyelia (IS) also have abnormal cervical spinal canal diameters. The finding in both groups may relate to the pathogenesis of syringomyelia. Local institutional review boards approved this retrospective study. Patients with IS were compared to age-matched controls with normal sagittal spine MR. All subjects had T1-weighted spin-echo (500/20) and T2-weighted fast spin-echo (2000/90) sagittal cervical spine images at 1.5 T. Readers blinded to demographic data and study hypothesis measured anteroposterior diameters at each cervical level. The spinal canal diameters were compared with a Mann-Whitney U test. The overall difference was assessed with a Friedman test. Seventeen subjects were read by two reviewers to assess inter-rater reliability. Fifty IS patients with 50 age-matched controls were studied. IS subjects had one or more syrinxes varying from 1 to 19 spinal segments. Spinal canal diameters narrowed from C1 to C3 and then enlarged from C5 to C7 in both groups. Diameters from C2 to C4 were narrower in the IS group (p < 0.005) than in controls. The ratio of the C3 to the C7 diameters was also smaller (p = 0.004) in IS than controls. Collectively, the spinal canal diameters in the IS were significantly different from controls (Friedman test p < 0.0001). Patients with IS have abnormally narrow upper and mid cervical spinal canal diameters and greater positive tapering between C3 and C7. (orig.)

Application of narrow-band television to industrial and commercial communications

Science.gov (United States)

Embrey, B. C., Jr.; Southworth, G. R.

1974-01-01

The development of narrow-band systems for use in space systems is presented. Applications of the technology to future spacecraft requirements are discussed along with narrow-band television's influence in stimulating development within the industry. The transferral of the technology into industrial and commercial communications is described. Major areas included are: (1) medicine; (2) education; (3) remote sensing for traffic control; and (5) weather observation. Applications in data processing, image enhancement, and information retrieval are provided by the combination of the TV camera and the computer.

The normal vulva in medical textbooks.

Science.gov (United States)

Andrikopoulou, M; Michala, L; Creighton, S M; Liao, L-M

2013-10-01

When a healthy woman expresses concerns about her vulva, the doctor's response should be informed by clinical knowledge. For many doctors, accumulation of such knowledge would have begun with undergraduate teaching and medical textbooks. The aim of this study is to examine the information on female genital morphology in medical textbooks. A total of 59 gynaecology and anatomy textbooks were searched for information on the dimensions of vulval constitutent parts. No textbook gave measurements for all vulval structures. Vaginal length was reported in 21/59 textbooks, clitoral size in 15/59 and labia minora in 1/59. Where measurements appear, they suggest narrower ranges than recent reports. Information of vulval morphology is scanty and inaccurate in medical textbooks. The general lack of professional resources means that doctors may consciously or non-consciously rely upon personal experiences and popular culture to form their opinions, as do their patients.

Narrowing sex differences in life expectancy: regional variations, 1971-1991

Directory of Open Access Journals (Sweden)

Frank Trovato

2001-12-01

Full Text Available A number of industrialized nations have recently experienced some degrees of constriction in their long-standing sex differentials in life expectancy at birth. In this study we examine this phenomenon in the context of Canada’s regions between 1971 and 1991: Atlantic (Newfoundland, Nova Scotia, New Brunswick, Prince Edward Island; Quebec, Ontario, and the West (Manitoba, Saskatchewan, Alberta, British Columbia, Yukon and Northwest Territories. Decomposition analysis based on multiple decrement life tables is applied to address three questions: (1 Are there regional differentials in the degree of narrowing in the sex gap in life expectancy? (2 What is the relative contribution of major causes of death to observed sex differences in average length of life within and across regions? (3 How do the contributions of cause-of-death components vary across regions to either widen or narrow the sex gap in survival? It is shown that the magnitude of the sex gap is not uniform across the regions, though the differences are not large. The most important contributors to a narrowing of the sex gap in life expectancy are heart disease and external types of mortality (i.e., accidents, violence, and suicide, followed by lung cancer and other types of chronic conditions. In substantive terms these results indicate that over time men have been making sufficient gains in these causes of death as to narrow some of the gender gap in overall survival. Regions show similarity in these effects.

High Prevalence of Narrow Angles among Chinese-American Glaucoma and Glaucoma Suspect Patients

Science.gov (United States)

Seider, Michael I; Pekmezci, Melike; Han, Ying; Sandhu, Simi; Kwok, Shiu Y; Lee, Roland Y; Lin, Shan C

2009-01-01

Purpose To evaluate the prevalence of gonioscopically narrow angles in a Chinese-American population with glaucoma or glaucoma suspicion. Patients and Methods Charts from all Chinese-American patients seen in a comprehensive ophthalmology clinic in the Chinatown district of San Francisco in 2002 were reviewed. One eye from each patient with glaucoma or glaucoma suspicion that met inclusion criteria was included (n=108). Data was collected for gender, age, race (self-declared), refraction (spherical equivalent), intraocular pressure (IOP), gonioscopy and vertical cup-to-disk ratio (CDR). Results Sixty percent (n=65) of Chinese-American eyes with glaucoma or glaucoma suspicion had gonioscopically narrow angles (Shaffer grade ≤2 in three or more quadrants). Those with narrow angles were significantly older (P=0.004) than their open angle counterparts, but the two groups did not differ in terms of gender, refraction, IOP or CDR (all, P≥0.071). In a multivariate model including age, gender and refraction as predictors of angle grade (open or narrow), only age was a significant predictor of angle grade (P=0.004). Conclusions A large proportion of Chinese-Americans in our study population with glaucoma or glaucoma suspicion had gonioscopically narrow angles. In multivariate analysis, patients with narrow angles were older than those with open angles but did not differ from them in terms of gender or refraction. Continued evaluation of angle closure glaucoma risk among Chinese-Americans is needed. PMID:19826385

High prevalence of narrow angles among Chinese-American glaucoma and glaucoma suspect patients.

Science.gov (United States)

Seider, Michael I; Pekmezci, Melike; Han, Ying; Sandhu, Simi; Kwok, Shiu Y; Lee, Roland Y; Lin, Shan C

2009-01-01

To evaluate the prevalence of gonioscopically narrow angles in a Chinese-American population with glaucoma or glaucoma suspicion. Charts from all Chinese-American patients seen in a comprehensive ophthalmology clinic in the Chinatown district of San Francisco in 2002 were reviewed. One eye from each patient with glaucoma or glaucoma suspicion that met inclusion criteria was included (n=108). Data were collected for sex, age, race (self-declared), refraction (spherical equivalent), intraocular pressure, gonioscopy, and vertical cup-to-disk ratio. Sixty percent (n=65) of Chinese-American eyes with glaucoma or glaucoma suspicion had gonioscopically narrow angles (Shaffer grade or = 0.071). In a multivariate model including age, sex, and refraction as predictors of angle grade (open or narrow), only age was a significant predictor of angle grade (P=0.004). A large proportion of Chinese-Americans in our study population with glaucoma or glaucoma suspicion had gonioscopically narrow angles. In multivariate analysis, patients with narrow angles were older than those with open angles but did not differ from them in terms of sex or refraction. Continued evaluation of angle closure glaucoma risk among Chinese-Americans is needed.

The adverse influence of spina bifida occulta on the medical treatment outcome of primary monosymptomatic nocturnal enuresis

Directory of Open Access Journals (Sweden)

Basri Cakiroglu

2014-12-01

Full Text Available Objective: Previous reports have suggested that the incidence of spina bifida occulta (SBO in patients with primary monosymptomatic nocturnal enuresis (PMNE is higher than the general population. The purpose of this study was to investigate the effect of spina bifida occulta on the medical treatment outcome of PMNE. Material and Methods: Between January 2008 and December 2011, a total of 223 children (151 boys and 72 girls, aged 6-16 years; mean age: 10.1 ± 3.04 years with PMNE were reviewed retrospectively. All of the children underwent physical examination, urine analysis, urinary tract ultrasonography and kidney ureter bladder (KUB scout film. All patients were initially treated with a timed voiding program and were given desmopressin acetate when necessary. Results: Spina bifida occulta was detected in 75 children (33.6%. Spina bifida occulta affected L4 in 2 children, L5 in 6 children, L4-L5 in 3 children, S1 in 52 children, S2 in 7 children and S1-S2 in 2 children. Treatment was successful in 79% of the children without SBO, and in only 48% of the children with SBO. Medical treatment success rates differed significantly between the study groups. Conclusion: The presence of spina bifida occulta significantly affects the response to medical treatment in patients with PMNE. Thus, verifying spina bifida occulta status in PMNE can facilitate prognostic predictions about the response to medical treatment.

The effect of regular medication on the outcome of paracetamol poisoning

DEFF Research Database (Denmark)

Schmidt, L E; Dalhoff, K

2002-01-01

hepatocellular injury was evaluated by multivariate analysis. RESULTS: Regular medication was received by 332 patients (45%). Medication with benzodiazepines (105 cases), antidepressants (100 cases), neuroleptics (75 cases), paracetamol (58 cases), oral contraceptives (51 cases), beta-agonists (40 cases), opioid......, neuroleptics, paracetamol, oral contraceptives, beta-agonists or anticonvulsants in the multivariate analysis. CONCLUSIONS: Regular medication with psychotropic medication, analgesics, oral contraceptives, beta-agonists or anticonvulsants was frequent in patients admitted with paracetamol poisoning. Medication...

THE TREATMENT OF OPEN- AND NARROW-ANGLE GLAUCOMA

African Journals Online (AJOL)

1971-04-10

Apr 10, 1971 ... glaucoma will be considered: narrow-angle glaucoma. (acute glaucoma) and ... emotional or a physical crisis. The pain is in the distribu- .... ness, not increased pressure, haunts people suffering from glaucoma'.' The saga of ...

The Effect of Plan Type and Comprehensive Medication Reviews on High-Risk Medication Use.

Science.gov (United States)

Almodovar, Armando Silva; Axon, David Rhys; Coleman, Ashley M; Warholak, Terri; Nahata, Milap C

2018-05-01

In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers. To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use. This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years. Performance data were downloaded per Medicare contract from the CMS. We matched Medicare insurance provider performance data with the enrollment data of each contract. Mann Whitney U and Spearman rho tests and a hierarchical linear regression model assessed the relationship between provider characteristics, high-risk medication use, and CMR completion rate outcome measures. In 2014, an inverse correlation between CMR completion rate and high-risk medication use was identified among MAPD plan providers. This relationship was further strengthened in 2015. No correlation was detected between the CMR completion rate and high-risk medication use among PDP plan providers in either year. A multivariate regression found an inverse association with high-risk medication use among MAPD plan providers in comparison with PDP plan providers in 2014 (beta = -0.358, P plan providers and higher CMR completion rates were associated with lower use of high-risk medications among beneficiaries. No outside funding supported this study. Silva Almodovar reports a fellowship funded by SinfoniaRx, Tucson, Arizona, during the time of this study. The other authors have nothing to disclose.

Association between medication adherence and clinical outcomes in patients with chronic kidney disease: a prospective cohort study.

Science.gov (United States)

Tangkiatkumjai, Mayuree; Walker, Dawn-Marie; Praditpornsilpa, Kearkiat; Boardman, Helen

2017-06-01

There is limited evidence of medication adherence related to progression of chronic kidney disease (CKD) worldwide. The aim of this study was to determine associations between medication adherence and the progression of CKD in outpatients with CKD. This cohort study recruited 339 Thai patients with stages 3-5 CKD. Patients with a glomerular disease or receiving renal replacement therapy before recruitment were excluded. 295 were followed up regarding their serum creatinine, blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol over 12 months. Medication adherence was measured at baseline using the Thai version of the 8-Item Morisky Medication Adherence Scale ® . The primary outcome was the progression of CKD. The progression of CKD was defined as either a decline in estimated glomerular filtration rate of at least 3 ml/min/1.73 m 2 /year or initiation of renal replacement therapy. Univariate and multivariate analyses were performed using Chi-squared tests and multiple logistic regressions. Twenty-one percent had poor adherence. Younger patients were more likely to have poor adherence (adjusted OR 2.81, 95 % CI 1.45-5.43). Anti-hypertensive agents were the most frequently reported as not being taken (52 %). Patients with poor adherence were associated with the progression of CKD (adjusted OR 1.96, 95 % CI 1.02-3.76). Those with poor adherence were less likely to control their blood pressure, than moderate-to-high adherence group (p < 0.01). The findings suggest that CKD patients with poor medication adherence are more likely to have progression of CKD. Health care providers should acknowledge these findings and provide effective strategies to deal with this issue.

[Health claims for medical foods].

Science.gov (United States)

Katan, Martijn B

2013-01-01

Souvenaid (Nutricia, Zoetermeer, the Netherlands) is a medical food for the dietary management of early Alzheimer's disease. The mix of nutrients in this drink is suggested to have a beneficial effect on cognitive function; such implicit health claims for medical foods are not checked by government agencies. Souvenaid has been investigated in three clinical trials. The first trial showed that Souvenaid produced a significant improvement in delayed verbal recall, but not in other psychological tests. The second and largest trial showed no effect on any outcome. The third trial showed no significant effect at 12 or 24 weeks, but a significant difference in the 24-week time course of the composite memory score. None of these outcomes was clearly specified as a primary outcome at trial registration. In conclusion, there is no convincing proof that Souvenaid benefits cognitive function. Better scrutiny of the efficacy of medical foods is warranted.

Laser linewidth narrowing using transient spectral hole burning

Energy Technology Data Exchange (ETDEWEB)

Thiel, Charles W.; Cone, Rufus L. [Department of Physics, Montana State University, Bozeman, MT 59715 (United States); Böttger, Thomas, E-mail: tbottger@usfca.edu [Department of Physics and Astronomy, 2130 Fulton Street, University of San Francisco, San Francisco, CA 94117 (United States)

2014-08-01

We demonstrate significant narrowing of laser linewidths by high optical density materials with inhomogeneously broadened absorption. As a laser propagates through the material, the nonlinear spectral hole burning process causes a progressive self-filtering of the laser spectrum, potentially reaching values less than the homogeneous linewidth. The transient spectral hole dynamically adjusts itself to the instantaneous frequency of the laser, passively suppressing laser phase noise and side modes over the entire material absorption bandwidth without the need for electronic or optical feedback to the laser. Wide bandwidth laser phase noise suppression was demonstrated using Er{sup 3+} doped Y{sub 2}SiO{sub 5} and LiNbO{sub 3} at 1.5 μm by employing time-delayed self-heterodyne detection of an external cavity diode laser to study the spectral narrowing effect. Our method is not restricted to any particular wavelength or laser system and is attractive for a range of applications where ultra-low phase noise sources are required. - Highlights: • We demonstrate significant laser linewidths narrowing by high optical density materials. • Nonlinear spectral hole burning causes progressive self-filtering of laser spectrum. • Filter dynamically adjusts itself to the instantaneous frequency of the laser. • Demonstrated at 1.5 μm in Er{sup 3+} doped Y{sub 2}SiO{sub 5} and LiNbO{sub 3}. • Linewidth filtering is not restricted to any particular wavelength or laser system.

Three-Body Recombination near a Narrow Feshbach Resonance in Li 6

Science.gov (United States)

Li, Jiaming; Liu, Ji; Luo, Le; Gao, Bo

2018-05-01

We experimentally measure and theoretically analyze the three-atom recombination rate, L3, around a narrow s -wave magnetic Feshbach resonance of Li 6 - Li 6 at 543.3 G. By examining both the magnetic field dependence and, especially, the temperature dependence of L3 over a wide range of temperatures from a few μ K to above 200 μ K , we show that three-atom recombination through a narrow resonance follows a universal behavior determined by the long-range van der Waals potential and can be described by a set of rate equations in which three-body recombination proceeds via successive pairwise interactions. We expect the underlying physical picture to be applicable not only to narrow s wave resonances, but also to resonances in nonzero partial waves, and not only at ultracold temperatures, but also at much higher temperatures.

Validation of the OMERACT Magnetic Resonance Imaging Joint Space Narrowing Score for the Wrist in a Multireader Longitudinal Trial

DEFF Research Database (Denmark)

Glinatsi, Daniel; Lillegraven, Siri; Haavardsholm, Espen A

2015-01-01

OBJECTIVE: To assess the intrareader and interreader agreement and sensitivity to change of the Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Joint Space Narrowing (RAMRIS-JSN) score in the rheumatoid arthritis (RA) wrist in a longitudinal multireader...... exercise. METHODS: Coronal T1-weighted MR image sets of 1 wrist from 20 patients with early RA were assessed twice for JSN at 17 sites at baseline and after 36 or 60 months by 4 readers blinded to patient data but not time order. The joints were scored 0-4 according to the OMERACT RAMRIS-JSN score...

Enhanced Light Narrow Transmission through Cascaded Metallic Structure with Periodic Aperture Arrays

International Nuclear Information System (INIS)

Yang Hong-Yan; Zhong Yan-Ru; Xiao Gong-Li; Zhang Zhen-Rong

2012-01-01

We present experimental and numerical studies on the enhanced light narrow transmission through cascaded Au/SiO x N y /Au aperture arrays by varying the refractive index and thickness of SiO x N y . It is found that the enhancement as well as narrowing of the optical transmission originates from the coupling role of surface plasmon polaritons. The results indicate that the transmission enhancement is highly dependent on the refractive index and thickness of SiO x N y . A higher transmission efficiency and narrower peak are obtained in Au/SiO 2.1 N 0.3 /Au structure with a small refractive index (1.6) and thin thickness (0.2 μm)

Looking through an adolescent literacy lens at the narrow view of reading.

Science.gov (United States)

Ehren, Barbara J

2009-04-01

This commentary is a personal reaction to A. G. Kamhi's (2007) article on the "narrow view" of reading and his suggestion that this view be adopted as a way to address the reading problems of children and adolescents. In this article, I consider the narrow view of reading from an adolescent literacy perspective and discuss the practical implications of adopting this view in the schools. Discussion revolves around the complexities of reading comprehension, comprehension as a teachable set of complex processes, and the speech-language pathologist's role in reading comprehension. Although I acknowledge that the narrow view of reading may have merit, I opine that it may create more problems than it solves.

Beyond "medical tourism": Canadian companies marketing medical travel

Science.gov (United States)

2012-01-01

businesses market regional, cross-border health services available in the United States and intranational travel to clinics in Canada. In contrast to medical tourism companies, they do not market holiday tours in addition to medical care. Two companies occupy a narrow market niche and promote testing for CCSVI and “Liberation therapy” for multiple sclerosis. Three additional companies offer bariatric surgery and cosmetic surgery at facilities in Mexico. Four businesses offer health insurance products intended to cover the cost of obtaining privately financed health care in the U.S. These businesses also help their clients arrange treatment beyond Canada’s borders. Finally, one medical travel company based in Canada markets health services primarily to U.S. citizens. Conclusions This article uses content analysis of websites of Canadian companies marketing medical travel to provide insight into Canada’s medical travel industry. The article reveals a complex marketplace with different types of companies taking distinct approaches to marketing medical travel. PMID:22703873

Photonic bandgap narrowing in conical hollow core Bragg fibers

Energy Technology Data Exchange (ETDEWEB)

Ozturk, Fahri Emre; Yildirim, Adem; Kanik, Mehmet [UNAM-National Nanotechnology Research Center, Bilkent University, 06800 Ankara (Turkey); Institute of Materials Science and Nanotechnology, Bilkent University, 06800 Ankara (Turkey); Bayindir, Mehmet, E-mail: bayindir@nano.org.tr [UNAM-National Nanotechnology Research Center, Bilkent University, 06800 Ankara (Turkey); Institute of Materials Science and Nanotechnology, Bilkent University, 06800 Ankara (Turkey); Department of Physics, Bilkent University, 06800 Ankara (Turkey)

2014-08-18

We report the photonic bandgap engineering of Bragg fibers by controlling the thickness profile of the fiber during the thermal drawing. Conical hollow core Bragg fibers were produced by thermal drawing under a rapidly alternating load, which was applied by introducing steep changes to the fiber drawing speed. In conventional cylindrical Bragg fibers, light is guided by omnidirectional reflections from interior dielectric mirrors with a single quarter wave stack period. In conical fibers, the diameter reduction introduced a gradient of the quarter wave stack period along the length of the fiber. Therefore, the light guided within the fiber encountered slightly smaller dielectric layer thicknesses at each reflection, resulting in a progressive blueshift of the reflectance spectrum. As the reflectance spectrum shifts, longer wavelengths of the initial bandgap cease to be omnidirectionally reflected and exit through the cladding, which narrows the photonic bandgap. A narrow transmission bandwidth is particularly desirable in hollow waveguide mid-infrared sensing schemes, where broadband light is coupled to the fiber and the analyte vapor is introduced into the hollow core to measure infrared absorption. We carried out sensing simulations using the absorption spectrum of isopropyl alcohol vapor to demonstrate the importance of narrow bandgap fibers in chemical sensing applications.

High prevalence of narrow angles among Filipino-American patients.

Science.gov (United States)

Seider, Michael I; Sáles, Christopher S; Lee, Roland Y; Agadzi, Anthony K; Porco, Travis C; Weinreb, Robert N; Lin, Shan C

2011-03-01

To determine the prevalence of gonioscopically narrow anterior chamber angles in a Filipino-American clinic population. The records of 122 consecutive, new, self-declared Filipino-American patients examined in a comprehensive ophthalmology clinic in Vallejo, California were reviewed retrospectively. After exclusion, 222 eyes from 112 patients remained for analysis. Data were collected for anterior chamber angle grade as determined by gonioscopy (Shaffer system), age, sex, manifest refraction (spherical equivalent), intraocular pressure, and cup-to-disk ratio. Data from both eyes of patients were included and modeled using standard linear mixed-effects regression. As a comparison, data were also collected from a group of 30 consecutive White patients from the same clinic. After exclusion, 50 eyes from 25 White patients remained for comparison. At least 1 eye of 24% of Filipino-American patients had a narrow anterior chamber angle (Shaffer grade ≤ 2). Filipino-American angle grade significantly decreased with increasingly hyperopic refraction (P=0.007) and larger cup-to-disk ratio (P=0.038). Filipino-American women had significantly decreased angle grades compared with men (P=0.028), but angle grade did not vary by intraocular pressure or age (all, P≥ 0.059). Narrow anterior chamber angles are highly prevalent in Filipino-American patients in our clinic population.

Electron correlations in narrow energy bands: modified polar model approach

Directory of Open Access Journals (Sweden)

L. Didukh

2008-09-01

Full Text Available The electron correlations in narrow energy bands are examined within the framework of the modified form of polar model. This model permits to analyze the effect of strong Coulomb correlation, inter-atomic exchange and correlated hopping of electrons and explain some peculiarities of the properties of narrow-band materials, namely the metal-insulator transition with an increase of temperature, nonlinear concentration dependence of Curie temperature and peculiarities of transport properties of electronic subsystem. Using a variant of generalized Hartree-Fock approximation, the single-electron Green's function and quasi-particle energy spectrum of the model are calculated. Metal-insulator transition with the change of temperature is investigated in a system with correlated hopping. Processes of ferromagnetic ordering stabilization in the system with various forms of electronic DOS are studied. The static conductivity and effective spin-dependent masses of current carriers are calculated as a function of electron concentration at various DOS forms. The correlated hopping is shown to cause the electron-hole asymmetry of transport and ferromagnetic properties of narrow band materials.

Clinical and radiographic evaluation of early loaded narrow-diameter implants

DEFF Research Database (Denmark)

Maiorana, Carlo; King, Paul; Quaas, Sebastian

2015-01-01

OBJECTIVE: To evaluate the clinical reliability of narrow implants placed in a one-stage procedure and early loaded in the upper and lower incisor region. MATERIAL AND METHODS: This is a prospective, single-arm, multicenter study in which patients with missing natural dentition in upper lateral a...... be considered as a valid solution in the treatment of the localized narrow bony defects in the anterior area with reduced spaces between the natural teeth....... healing period. Clinical and radiographic checks were performed at implant placement, loading, and at the 6, 12, 24, and 36 months follow-up visits. RESULTS: A total of 69 subjects with 97 implants have been included in this study. From surgery to 36 months follow-up, 5.6% of the implants showed bone loss...... loss between loading and the 1-year follow-up visit (Galindo-Moreno et al. 2012). This finding, associated with a stable probing pocket depth and a stable crown-gingiva distance, using a one-stage surgical procedure helps to maintain the integrity of the peri-implant soft tissues. Narrow implants can...

Nonlinear narrow Doppler-free resonances for optical transitions and annihilation radiation of a positronium atom

International Nuclear Information System (INIS)

Letokhov, V.S.; Minogin, V.G.

1976-01-01

The possibilities of obtaining narrow resonances without the Doppler broadening for transition between the fine structure levels of the ground and first excited states of a positronium atom are considered. An analysis is carried out of the conditions required for observation of the narrow resonances of saturation of single quantum absorption in the 1S-2P transitions and observation of narrow two-photon absorption resonances in the 1S-2S transitions. It is shown that narrow 2γ annihilation radiation lines of a positronium atom may be obtained with a width much smaller than the Doppler one

A Comparison of Midwife-Led and Medical-Led Models of Care and Their Relationship to Adverse Fetal and Neonatal Outcomes: A Retrospective Cohort Study in New Zealand.

Directory of Open Access Journals (Sweden)

Ellie Wernham

2016-09-01

Full Text Available Internationally, a typical model of maternity care is a medically led system with varying levels of midwifery input. New Zealand has a midwife-led model of care, and there are movements in other countries to adopt such a system. There is a paucity of systemic evaluation that formally investigates safety-related outcomes in relationship to midwife-led care within an entire maternity service. The main objective of this study was to compare major adverse perinatal outcomes between midwife-led and medical-led maternity care in New Zealand.This was a population-based retrospective cohort study. Participants were mother/baby pairs for all 244,047 singleton, term deliveries occurring between 1 January 2008 and 31 December 2012 in New Zealand in which no major fetal, neonatal, chromosomal or metabolic abnormality was identified and the mother was first registered with a midwife, obstetrician, or general practitioner as lead maternity carer. Main outcome measures were low Apgar score at five min, intrauterine hypoxia, birth-related asphyxia, neonatal encephalopathy, small for gestational age (as a negative control, and mortality outcomes (perinatal related mortality, stillbirth, and neonatal mortality. Logistic regression models were fitted, with crude and adjusted odds ratios (ORs generated for each outcome for midwife-led versus medical-led care (based on lead maternity carer at first registration with 95% confidence intervals. Fully adjusted models included age, ethnicity, deprivation, trimester of registration, parity, smoking, body mass index (BMI, and pre-existing diabetes and/or hypertension in the model. Of the 244,047 pregnancies included in the study, 223,385 (91.5% were first registered with a midwife lead maternity carer, and 20,662 (8.5% with a medical lead maternity carer. Adjusted ORs showed that medical-led births were associated with lower odds of an Apgar score of less than seven at 5 min (OR 0.52; 95% confidence interval 0

Outcomes management of mechanically ventilated patients: utilizing informatics technology.

Science.gov (United States)

Smith, K R

1998-11-01

This article examines an informatics system developed for outcomes management of the mechanically ventilated adult population, focusing on weaning the patient from mechanical ventilation. The link between medical informatics and outcomes management is discussed, along with the development of methods, tools, and data sets for outcomes management of the mechanically ventilated adult population at an acute care academic institution. Pros and cons of this system are identified, and specific areas for improvement of future health care outcomes medical informatics systems are discussed.

Early-life medical care and human capital accumulation

DEFF Research Database (Denmark)

Daysal, N. Meltem

2015-01-01

that both types of interventions may benefit not only child health but also long-term educational outcomes. In addition, early-life medical interventions may improve the educational outcomes of siblings. These findings can be used to design policies that improve long-term outcomes and reduce economic......Ample empirical evidence links adverse conditions during early childhood (the period from conception to age five) to worse health outcomes and lower academic achievement in adulthood. Can early-life medical care and public health interventions ameliorate these effects? Recent research suggests...

Narrow beam neutron dosimetry.

Science.gov (United States)

Ferenci, M Sutton

2004-01-01

Organ and effective doses have been estimated for male and female anthropomorphic mathematical models exposed to monoenergetic narrow beams of neutrons with energies from 10(-11) to 1000 MeV. Calculations were performed for anterior-posterior, posterior-anterior, left-lateral and right-lateral irradiation geometries. The beam diameter used in the calculations was 7.62 cm and the phantoms were irradiated at a height of 1 m above the ground. This geometry was chosen to simulate an accidental scenario (a worker walking through the beam) at Flight Path 30 Left (FP30L) of the Weapons Neutron Research (WNR) Facility at Los Alamos National Laboratory. The calculations were carried out using the Monte Carlo transport code MCNPX 2.5c.

Association of lens vault with narrow angles among different ethnic groups.

Science.gov (United States)

Lee, Roland Y; Huang, Guofu; Cui, Qi N; He, Mingguang; Porco, Travis C; Lin, Shan C

2012-06-01

To compare lens vault between open-angle and narrow-angle eyes in African-, Caucasian-, Hispanic-, Chinese- and Filipino-Americans. In this prospective study, 436 patients with open angle and narrow angle based on the Shaffer gonioscopic grading classification underwent anterior-segment optical coherence tomography. The Zhongshan Angle Assessment Program was used to calculate lens vault. The narrow-angle group included 32 Chinese-Americans, 22 Filipino-Americans, 26 African-Americans, 24 Hispanic-Americans and 73 Caucasian-Americans. The open-angle group included 56 Chinese-Americans, 29 Filipino-Americans, 45 African-Americans, 27 Hispanic-Americans and 102 Caucasian-Americans. Linear mixed effect regression models, accounting for the use of both eyes and adjusting for age, sex, pupil diameter and spherical equivalent, were used to test for the ethnicity and angle coefficients. Tukey's multiple comparison test was used for pairwise comparisons among the open-angle racial groups. Significant difference in lens vault was found among the open-angle racial groups (P = 0.022). For the open-angle patients, mean values for the lens vault measurements were 265 ± 288 µm for Chinese-Americans, 431 ± 248 µm for Caucasian-Americans, 302 ± 213 µm for Filipino-Americans, 304 ± 263 µm for Hispanic-Americans and 200 ± 237 µm for African-Americans. Using Tukey's multiple comparison for pairwise comparisons among the open-angle racial groups, a significant difference was found between African-American and Caucasian-Americans groups (P values for the rest of the pairwise comparisons were not statistically significant. No significant difference was found among the narrow-angle racial groups (P = 0.14). Comparison between the open angle and narrow angle within each racial group revealed significant difference for all racial groups (P < 0.05). Among all the ethnicities included in this study, narrow-angle eyes have greater lens vault compared to open

Definition of Quality Criteria of the Technological Process of Narrow Web UV-Printing

Directory of Open Access Journals (Sweden)

Volodymyr Shybanov

2013-11-01

Full Text Available The application of Narrow Web UV-flexographic printing has several advantages compared with offset printing. In particular, they are the lack of the operation of water-ink balance setting in the technological process, the ability to print on a wide range of materials and so on. Though the imprint quality is clearly based on standards in offset printing, there are no clearly indicated requirements for Narrow Web UV flexographic printing. The absence of such requirements on quality parameters of the technological process of Narrow Web UV-Printing predetermined conducting its analysis with the help of expert surveys.

Narrow coherent effects in πNN-dynamics

International Nuclear Information System (INIS)

Kudryavtsev, A.E.; Obrant, G.Z.

1990-01-01

Coherent effect production is considered in πNN-dynamics with resonant pion-nucleon interaction via Brueckner theory and Faddev equations. It is shown that the narrow energy and final momentum dependence can arise in the inelastic S-wave πd-scattering. The energy dependence peculiarities can have a width an order magnitude less than πN-resonance one

Dynamic film thickness between bubbles and wall in a narrow channel

Science.gov (United States)

Ito, Daisuke; Damsohn, Manuel; Prasser, Horst-Michael; Aritomi, Masanori

2011-09-01

The present paper describes a novel technique to characterize the behavior of the liquid film between gas bubbles and the wall in a narrow channel. The method is based on the electrical conductance. Two liquid film sensors are installed on both opposite walls in a narrow rectangular channel. The liquid film thickness underneath the gas bubbles is recorded by the first sensor, while the void fraction information is obtained by measuring the conductance between the pair of opposite sensors. Both measurements are taken on a large two-dimensional domain and with a high speed. This makes it possible to obtain the two-dimensional distribution of the dynamic liquid film between the bubbles and the wall. In this study, this method was applied to an air-water flow ranging from bubbly to churn regimes in the narrow channel with a gap width of 1.5 mm.

Shared medical appointments: improving access, outcomes, and satisfaction for patients with chronic cardiac diseases.

Science.gov (United States)

Bartley, Kelly Bauer; Haney, Rebecca

2010-01-01

Improving access to care, health outcomes, and patient satisfaction are primary objectives for healthcare practices. This article outlines benefits, concerns, and possible challenges of shared medical appointments (SMAs) for patients and providers. The SMA model was designed to support providers' demanding schedules by allowing patients with the same chronic condition to be seen in a group setting. By concentrating on patient education and disease management, interactive meetings provide an opportunity for patients to share both successes and struggles with others experiencing similar challenges. Studies demonstrated that SMAs improved patient access, enhanced outcomes, and promoted patient satisfaction. This article describes the potential benefits of SMAs for patients with chronic heart disease, which consumes a large number of healthcare dollars related to hospital admissions, acute exacerbations, and symptom management. Education for self-management of chronic disease can become repetitive and time consuming. The SMA model introduces a fresh and unique style of healthcare visits, allowing providers to devote more time and attention to patients and improve productivity. The SMA model provides an outstanding method for nurse practitioners to demonstrate their role as a primary care provider, by leading patients in group discussions and evaluating their current health status. Patient selection, preparation, and facilitation of an SMA are discussed to demonstrate the complementary nature of an SMA approach in a healthcare practice.

DNB Mechanistic model assessment based on experimental data in narrow rectangular channel

International Nuclear Information System (INIS)

Zhou Lei; Yan Xiao; Huang Yanping; Xiao Zejun; Huang Shanfang

2011-01-01

The departure from nuclear boiling (DNB) is important concerning about the safety of a PWR. Lacking assessment by experimental data points, it's doubtful whether the existing models can be used in narrow rectangular channels or not. Based on experimental data points in narrow rectangular channels, two kinds of classical DNB models, which include liquid sublayer dryout model (LSDM) and bubble crowding model (BCM), were assessed. The results show that the BCM has much wider application range than the LSDM. Several thermal parameters show systematical influences on the calculated results by the models. The performances of all the models deteriorate as the void fraction increases. The reason may be attributed to the geometrical differences between a circular tube and narrow rectangular channel. (authors)

Coded excitation and sub-band processing for blood velocity estmation in medical ultrasound

DEFF Research Database (Denmark)

Gran, Fredrik; Udesen, Jesper; Jensen, Jørgen Arendt

2007-01-01

This paper investigates the use of broadband coded excitation and subband processing for blood velocity estimation in medical ultrasound. In conventional blood velocity estimation a long (narrow-band) pulse is emitted and the blood velocity is estimated using an auto-correlation based approach....... However, the axial resolution of the narrow-band pulse is too poor for brightness-mode (B-mode) imaging. Therefore, a separate transmission sequence is used for updating the B-mode image, which lowers the overall frame-rate of the system. By using broad-band excitation signals, the backscattered received...... signal can be divided into a number of narrow frequency bands. The blood velocity can be estimated in each of the bands and the velocity estimates can be averaged to form an improved estimate. Furthermore, since the excitation signal is broadband, no secondary B-mode sequence is required, and the frame...

Transparency or spectral narrowing for two-mode squeezing and entanglement

International Nuclear Information System (INIS)

Hu Xiangming; Oh, C. H.

2011-01-01

We analyze the nonadiabatic effects on the propagation of a two-mode squeezed field inside a medium of three-level Λ atoms that display the dark resonance. We identify the different effects for the two-mode quantum properties: (i) unconditional transparency for the sum squeezing and (ii) induced transparency or spectral narrowing for the difference squeezing depending on the relative widths of the initial correlation spectrum to the transparency window. These effects combine to induce transparency or spectrum narrowing for the bipartite entanglement. The potential applications range from quantum information to laser spectroscopy and frequency standards.

Production of highly polarized 3He using spectrally narrowed diode laser array bars

International Nuclear Information System (INIS)

Chann, B.; Babcock, E.; Anderson, L.W.; Walker, T.G.; Chen, W.C.; Smith, T.B.; Thompson, A.K.; Gentile, T.R.

2003-01-01

We have produced 70%-75% 3 He polarization by spin-exchange optical pumping in cells ≅100 cm 3 in volume. The polarization achieved is consistent with known spin-exchange and spin-relaxation rates, but only when the recently discovered temperature dependence of 3 He relaxation is included. Absolute 3 He polarization measurements were performed using two different methods in two different laboratories. The results were obtained with either a spectrally narrowed laser or one type of broadband laser. Based on tests of several larger cells at pressures near 1 bar, we find that the power required to reach the same polarization is typically three times lower for the spectrally narrowed laser. This last result indicates that spectrally narrowed lasers will be important for obtaining the highest polarization in large volume neutron spin filters. Polarization in excess of 55% as obtained in cells up to 640 cm 3 in volume and 70% polarization is anticipated with available increases in spectrally narrowed laser power

Medical decision making and medical education: challenges and opportunities.

Science.gov (United States)

Schwartz, Alan

2011-01-01

The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include the physician's own decision skills, the ability to guide patients in shared decisions, and knowledge of health policy decisions at the societal level. Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.

Free-Molecular Gas Flow in Narrow (Nanoscale) Channel

Czech Academy of Sciences Publication Activity Database

Levdansky, V.V.; Roldugin, V.I.; Žďanov, V.M.; Ždímal, Vladimír

2014-01-01

Roč. 87, č. 4 (2014), s. 802-814 ISSN 1062-0125 Grant - others:BRFFI(BY) T12P-018; RFBR(RU) 12-08-90009 Institutional support: RVO:67985858 Keywords : narrow channels * free-molecular gas flow * surface diffusion Subject RIV: CF - Physical ; Theoretical Chemistry

Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders.

Science.gov (United States)

Peebles, Rebecka; Lesser, Andrew; Park, Courtney Cheek; Heckert, Kerri; Timko, C Alix; Lantzouni, Eleni; Liebman, Ronald; Weaver, Laurel

2017-01-01

Medical stabilization through inpatient nutritional rehabilitation is often necessary for patients with eating disorders (EDs) but includes the inherent risk of refeeding syndrome. Here we describe our experience of implementing and sustaining an inpatient nutritional rehabilitation protocol designed to strategically prepare patients with EDs and their families for discharge to a home setting in an efficient and effective manner from a general adolescent medicine unit. We report outcomes at admission, discharge, and 4-weeks follow-up. Protocol development, implementation, and unique features of the protocol, are described. Data were collected retrospectively as part of a continuous quality improvement (QI) initiative. Safety outcomes were the clinical need for phosphorus, potassium, and magnesium supplementation, other evidence of refeeding syndrome, and unexpected readmissions within one month of discharge. The value outcome was length of stay (LOS). Treatment outcomes were the percentage median BMI (MBMI) change from admission to discharge, and from discharge to 4-weeks follow-up visit. A total of 215 patients (88% F, 12% M) were included. Patients averaged 15.3 years old (5.8-23.2y); 64% had AN, 18% had atypical anorexia (AtAN), 6% bulimia nervosa (BN), 5% purging disorder (PD), 4% avoidant-restrictive food intake disorder (ARFID), and 3% had an unspecified food and eating disorder (UFED). Average LOS was 11 days. Initial mean calorie level for patients at admission was 1466 and at discharge 3800 kcals/day. Phosphorus supplementation for refeeding hypophosphatemia (RH) was needed in 14% of inpatients; full-threshold refeeding syndrome did not occur. Only 3.8% were rehospitalized in the thirty days after discharge. Patients averaged 86.1% of a median MBMI for age and gender, 91.4% MBMI at discharge, and 100.9% MBMI at 4-weeks follow-up. Mean percentage MBMI differences between time points were significantly different (admission-discharge: 5.3%, p  <0

International and Interdisciplinary Identification of Health Care Transition Outcomes.

Science.gov (United States)

Fair, Cynthia; Cuttance, Jessica; Sharma, Niraj; Maslow, Gary; Wiener, Lori; Betz, Cecily; Porter, Jerlym; McLaughlin, Suzanne; Gilleland-Marchak, Jordan; Renwick, Amy; Naranjo, Diana; Jan, Sophia; Javalkar, Karina; Ferris, Maria

2016-03-01

There is a lack of agreement on what constitutes successful outcomes for the process of health care transition (HCT) among adolescent and young adults with special health care needs. To present HCT outcomes identified by a Delphi process with an interdisciplinary group of participants. A Delphi method involving 3 stages was deployed to refine a list of HCT outcomes. This 18-month study (from January 5, 2013, of stage 1 to July 3, 2014, of stage 3) included an initial literature search, expert interviews, and then 2 waves of a web-based survey. On this survey, 93 participants from outpatient, community-based, and primary care clinics rated the importance of the top HCT outcomes identified by the Delphi process. Analyses were performed from July 5, 2014, to December 5, 2014. Health care transition outcomes of adolescents and young adults with special health care needs. Importance ratings of identified HCT outcomes rated on a Likert scale from 1 (not important) to 9 (very important). The 2 waves of surveys included 117 and 93 participants as the list of outcomes was refined. Transition outcomes were refined by the 3 waves of the Delphi process, with quality of life being the highest-rated outcome with broad agreement. The 10 final outcomes identified included individual outcomes (quality of life, understanding the characteristics of conditions and complications, knowledge of medication, self-management, adherence to medication, and understanding health insurance), health services outcomes (attending medical appointments, having a medical home, and avoidance of unnecessary hospitalization), and a social outcome (having a social network). Participants indicated that different outcomes were likely needed for individuals with cognitive disabilities. Quality of life is an important construct relevant to HCT. Future research should identify valid measures associated with each outcome and further explore the role that quality of life plays in the HCT process. Achieving

Controllable ultra-narrow fluorescence and six-wave mixing under double electromagnetically induced transparency

International Nuclear Information System (INIS)

Wang, Z G; Zhang, Z Y; Che, J L; Zhang, Y Z; Li, C B; Zheng, H B; Zhang, Y P

2013-01-01

We report the first observation of six-wave mixing (SWM) and fluorescence signals in an electromagnetically induced transparency (EIT) window. Several remarkable advantages are described. First, multiple bright and dark states are simultaneously observed due to enhancement or suppression of the SWM signal. Second, ultra-narrow fluorescence, much narrower than the EIT window, is experimentally obtained. Third, the ultra-narrow fluorescence can also generate Autler–Townes splitting on scanning the coupling beam. Fourth, a double-peak EIT window is obtained using the nest-dressing scheme. Such studies concerning SWM and fluorescence have applications in optical switching, multi-channel communication and narrowband and long-range quantum communication. (letter)

Medications and impaired driving.

Science.gov (United States)

Hetland, Amanda; Carr, David B

2014-04-01

To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on classes of medications associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Only English-language articles that contained findings from observational or interventional designs with ≥ 10 participants were included in this review. Cross-sectional studies, case series, and case reports were excluded. Driving is an important task and activity for the majority of adults. Some commonly prescribed medications have been associated with driving impairment measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, hypnotics, antidepressants, opioid and nonsteroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies of medication impact on sedation, sleep latency, and psychomotor function, as well as the role of alcohol, are also discussed. Psychotropic agents and those with central nervous system side effects were associated with measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific classes of medications, educate their patients, and/or consider safer alternatives.

Heavy drinking, impulsivity and attentional narrowing following alcohol cue exposure.

Science.gov (United States)

Hicks, Joshua A; Fields, Sherecce; Davis, William E; Gable, Philip A

2015-08-01

Research shows that alcohol-related stimuli have the propensity to capture attention among individuals motivated to consume alcohol. Research has further demonstrated that impulsive individuals are especially prone to this type of attentional bias. Recently, it is suggested that alcohol cue exposure can also produce a general narrowing of attention consistent with the activation of approach motivational states. Based on previous models of addiction and recent research on the activation of approach motivational states, we predicted that impulsive individuals would demonstrate a constriction of attentional focus in response to alcohol cue exposure. Participants (n = 392) completed a task assessing attentional breadth in response to alcohol and non-alcohol cues, followed by measures of alcohol use and impulsivity. The findings revealed that impulsivity scores predicted narrowing of attentional scope following the presentation of alcohol cues for heavier drinkers but not for light drinkers. These results suggest that impulsive individuals who drink more heavily demonstrate a narrowing of attention in the presence of alcohol-related incentive cues. Implications for how these findings might account for the link between impulsivity and alcohol use and misuse are discussed.

Present status of heat transfer in narrow gap rectangular channel

International Nuclear Information System (INIS)

Sudo, Yukio; Kaminaga, Masanori

1990-01-01

In the safety evaluation for research nuclear reactors, at the time of abnormal transient change and accidents, after the tripping of a primary coolant pump, such event that the flow direction of coolant in a core reverses from steady downward flow to rising flow is supposed. In this case, the coexisting convection field, in which free convection and forced convection coexist, arises in place of forced convection, and especially in the research reactors using plate type fuel like JRR-3, it is important to grasp the heat transfer characteristics in the coexisting convection field in a narrow channel. Jackson et al. proposed the heat transfer correlation equation which can be applied to wide conditions including the coexisting convection zone, but its applicability to a narrow channel has not been confirmed. Based on the experimental results, in this study, the effect that the decrease of gap exerts to the convection heat transfer characteristics reported so far was investigated. The experiment and the results are reported. In this experiment on the coexisting convection zone in a narrow gap, the effect of main flow acceleration arose sufficiently large as compared with the effect of buoyancy, and heat transfer was promoted. (K.I.)

Nonstationary Narrow-Band Response and First-Passage Probability

DEFF Research Database (Denmark)

Krenk, Steen

1979-01-01

The notion of a nonstationary narrow-band stochastic process is introduced without reference to a frequency spectrum, and the joint distribution function of two consecutive maxima is approximated by use of an envelope. Based on these definitions the first passage problem is treated as a Markov po...

Narrow-band radio flares from red dwarf stars

Science.gov (United States)

White, Stephen M.; Kundu, Mukul R.; Jackson, Peter D.

1986-01-01

VLA observations of narrow-band behavior in 20 cm flares from two red dwarf stars, L726 - 8A and AD Leo, are reported. The flare on L726 - 8A was observed at 1415 and 1515 MHz; the flux and the evolution differed significantly at the two frequencies. The flare on AD Leo lasted for 2 hr at 1415 MHz but did not appear at 1515 MHz. The AD Leo flare appears to rule out a source drifting through the stellar corona and is unlikely to be due to plasma emission. In the cyclotron maser model the narrow-band behavior reflects the range of magnetic fields present within the source. The apparent constancy of this field for 2 hr is difficult to understand if magnetic reconnection is the source of energy for the flare. The consistent polarization exhibited by red dwarf flares at 20 cm may be related to stellar activity cycles, and changes in this polarization will permit measuring the length of these cycles.

Omnidirectional narrow optical filters for circularly polarized light in a nanocomposite structurally chiral medium.

Science.gov (United States)

Avendaño, Carlos G; Palomares, Laura O

2018-04-20

We consider the propagation of electromagnetic waves throughout a nanocomposite structurally chiral medium consisting of metallic nanoballs randomly dispersed in a structurally chiral material whose dielectric properties can be represented by a resonant effective uniaxial tensor. It is found that an omnidirectional narrow pass band and two omnidirectional narrow band gaps are created in the blue optical spectrum for right and left circularly polarized light, as well as narrow reflection bands for right circularly polarized light that can be controlled by varying the light incidence angle and the filling fraction of metallic inclusions.

Narrow Networks On The Health Insurance Marketplaces: Prevalence, Pricing, And The Cost Of Network Breadth.

Science.gov (United States)

Dafny, Leemore S; Hendel, Igal; Marone, Victoria; Ody, Christopher

2017-09-01

Anecdotal reports and systematic research highlight the prevalence of narrow-network plans on the Affordable Care Act's health insurance Marketplaces. At the same time, Marketplace premiums in the period 2014-16 were much lower than projected by the Congressional Budget Office in 2009. Using detailed data on the breadth of both hospital and physician networks, we studied the prevalence of narrow networks and quantified the association between network breadth and premiums. Controlling for many potentially confounding factors, we found that a plan with narrow physician and hospital networks was 16 percent cheaper than a plan with broad networks for both, and that narrowing the breadth of just one type of network was associated with a 6-9 percent decrease in premiums. Narrow-network plans also have a sizable impact on federal outlays, as they depress the premium of the second-lowest-price silver plan, to which subsidy amounts are linked. Holding all else constant, we estimate that federal subsidies would have been 10.8 percent higher in 2014 had Marketplaces required all plans to offer broad provider networks. Narrow networks are a promising source of potential savings for other segments of the commercial insurance market. Project HOPE—The People-to-People Health Foundation, Inc.

Single frequency narrow linewidth 2 micron laser, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — NASA needs narrow linewidth lasers in the 1.5 or 2 micron wavelength regime for coherent Lidar applications. The laser should be tunable by several nm and frequency...

Medication-related risk factors associated with health-related quality of life among community-dwelling elderly in China.

Science.gov (United States)

Zhang, Sha; Meng, Long; Qiu, Feng; Yang, Jia-Dan; Sun, Shusen

2018-01-01

Previous studies have demonstrated that medication adherence has an impact on health-related quality of life (HRQoL). However, other medication-related factors that may influence HRQoL have not been extensively studied, especially factors based on the Medication-Risk Questionnaire (MRQ), and such studies are mostly done in Western countries. Our objective was to explore risk factors associated with HRQoL among community-dwelling elderly with chronic diseases in mainland China, especially the medication-related risk factors regarding MRQ. The study was conducted in a community health service center through surveys to eligible patients. The main outcomes of HRQoL were assessed by the EuroQol-5D (EQ-5D) scale and EQ-visual analog scale (EQ-VAS). Medication-related risk factors according to MRQ associated with HRQoL were identified using a multiple linear regression. A total of 311 patients were analyzed, averaging 71.19±5.33 years, and 68.8% were female. The mean EQ-5D index was 0.72±0.09, and the mean EQ-VAS score was 71.37±11.97. The most prevalent problem was pain/discomfort, and 90.0% believed that they could take care of themselves without any problems. Sex, age, educational level, frailty, function status, and certain medication-related factors regarding MRQ were found to be significant factors impacting the HRQoL. A multivariate analysis showed that MRQ factors of polypharmacy, multimorbidity, feeling difficultly with taking medicines as prescribed, and taking medicines with narrow therapeutic index had negative impacts on the quality of life. Patient's internal characteristics and medication-related risk factors according to MRQ were associated with quality of life. The results of the MRQ is an indicator of quality of life that can identify patients who need interventions.

Depressive symptoms, HIV medication adherence, and HIV clinical outcomes in Tanzania: a prospective, observational study.

Directory of Open Access Journals (Sweden)

Nadya M Belenky

Full Text Available Depressive symptoms have been shown to independently affect both antiretroviral therapy (ART adherence and HIV clinical outcomes in high-income countries. We examined the prospective relationship between depressive symptoms and adherence, virologic failure, and suppressed immune function in people living with HIV/AIDS in Tanzania. Data from 403 study participants who were on stable ART and engaged in HIV clinical care were analyzed. We assessed crude and adjusted associations of depressive symptoms and ART adherence, both at baseline and at 12 months, using logistic regression. We used logistic generalized estimating equations to assess the association and 95% confidence intervals (CI between depressive symptoms and both virologic failure and suppressed immune function. Ten percent of participants reported moderate or severe depressive symptoms at baseline and 31% of participants experienced virologic failure (>150 copies/ml over two years. Depressive symptoms were associated with greater odds of reported medication nonadherence at both baseline (Odds Ratio [OR] per 1-unit increase = 1.18, 95% CI [1.12, 1.24] and 12 months (OR = 1.08, 95% CI [1.03, 1.14]. By contrast, increases in depressive symptom score were inversely related to both virologic failure (OR = 0.93, 95% CI [0.87, 1.00] and immune system suppression (OR = 0.88, 95% CI [0.79, 0.99], though the association between depressive symptoms and clinical outcomes was less precise than for the association with nonadherence. Findings indicate a positive association between depressive symptoms and nonadherence, and also an inverse relationship between depressive symptoms and clinical outcomes, possibly due to informative loss to follow-up.

Evaluating Depression Care Management in a Community Setting: Main Outcomes for a Medicaid HMO Population with Multiple Medical and Psychiatric Comorbidities

Directory of Open Access Journals (Sweden)

Jeanette A. Waxmonsky

2012-01-01

Full Text Available The authors describe the implementation of a depression care management (DCM program at Colorado Access, a public sector health plan, and describe the program’s clinical and system outcomes for members with chronic medical conditions. High medical risk, high cost Medicaid health plan members were identified and systematically screened for depression. A total of 370 members enrolled in the DCM program. Longitudinal analyses revealed significantly reduced depression severity scores at 3, 6, and 12 months after intervention as compared to baseline depression scores. At 12 months, 56% of enrollees in the DCM program had either a 50% reduction in PHQ-9 scores or a PHQ-9 score < 10. Longitudinal economic analyses comparing 12 months before and after intervention revealed a significant but modest increase in ER visits, outpatient office visits, and overall medical and pharmacy costs when adjusted for months enrolled in DCM. Limitations and recommendations for the integrated depression care management are discussed.

Accreditation of undergraduate and graduate medical education

DEFF Research Database (Denmark)

Davis, Deborah J; Ringsted, Charlotte

2006-01-01

Accreditation organizations such as the Liaison Committee for Medical Education (LCME), the Royal College of Physicians and Surgeons of Canada (RCPSC), and the Accreditation Council for Graduate Medical Education (ACGME) are charged with the difficult task of evaluating the educational quality...... of medical education programs in North America. Traditionally accreditation includes a more quantitative rather than qualitative judgment of the educational facilities, resources and teaching provided by the programs. The focus is on the educational process but the contributions of these to the outcomes...... are not at all clear. As medical education moves toward outcome-based education related to a broad and context-based concept of competence, the accreditation paradigm should change accordingly. Udgivelsesdato: 2006-Aug...

A critical review of simulation-based mastery learning with translational outcomes.

Science.gov (United States)

McGaghie, William C; Issenberg, Saul B; Barsuk, Jeffrey H; Wayne, Diane B

2014-04-01

This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care. This is a qualitative synthesis of SBML with translational (T) science research reports spanning a period of 7 years (2006-2013). We use the 'critical review' approach proposed by Norman and Eva to synthesise findings from 23 medical education studies that employ the mastery learning model and measure downstream translational outcomes. Research in SBML in medical education has addressed a range of interpersonal and technical skills. Measured outcomes have been achieved in educational laboratories (T1), and as improved patient care practices (T2), patient outcomes (T3) and collateral effects (T4). Simulation-based mastery learning in medical education can produce downstream results. Such results derive from integrated education and health services research programmes that are thematic, sustained and cumulative. The new discipline of implementation science holds promise to explain why medical education innovations are adopted slowly and how to accelerate innovation dissemination. © 2014 John Wiley & Sons Ltd.

Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

Science.gov (United States)

Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P

2014-01-01

The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

Volume dips; spot price ranges narrow

International Nuclear Information System (INIS)

Anon.

1994-01-01

This article is the September 1994 uranium market summary. Volume in the spot concentrates market fell below 1 million lbs U3O8. In total, twelve deals took place compared to 28 deals in August. Of the twelve deals, three took place in the spot concentrates market, two took place in the medium and long-term market, three in the conversion market, and four in the enrichment market. Restricted prices weakened, but unrestricted prices firmed slightly. The enrichment price range narrowed a bit

Medical cannabis use among patients with chronic pain in an interdisciplinary pain rehabilitation program: Characterization and treatment outcomes.

Science.gov (United States)

Shah, Arya; Craner, Julia; Cunningham, Julie L

2017-06-01

Cannabis is increasingly being used in the treatment of chronic pain. However, there is a lack of available research in the population of patients with chronic pain who are using cannabis. The current study examines clinical and treatment characteristics for patients who are admitted to a 3-week outpatient interdisciplinary chronic pain rehabilitation program. Participants (N=48) included patients with a positive urine drug screen for 9-carboxy-tetrahydrocannabinol (THC(+); n=24) and a matched comparison sample of patients with a negative screen (THC(-); n=24). Participants were matched for age, gender, race, education, and current prescription opioid use. Measures of pain, functioning, and quality of life were completed at admission and discharge. Medical chart review was conducted to assess medication and substance use history. Participants with a positive screen for THC were more likely to report a past history of illicit substance use, alcohol abuse, and current tobacco use. Cannabis use was not associated with a significantly lower morphine equivalence level for participants using prescription opioids (n=14). Both groups of participants reported significant improvement in pain severity, pain interference, depressive symptoms, and pain catastrophizing. There were no group- or treatment-related differences in these outcome variables. Results provide preliminary evidence that patients with chronic pain using cannabis may benefit from an interdisciplinary chronic pain program. Patients with chronic pain using cannabis may be at higher risk for substance-related negative outcomes, although more research is needed to understand this relationship. Copyright © 2017 Elsevier Inc. All rights reserved.

The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a cross-sectional collaborative study of 12 UK medical schools.

Science.gov (United States)

McManus, I C; Dewberry, Chris; Nicholson, Sandra; Dowell, Jonathan S

2013-11-14

Most UK medical schools use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the United Kingdom Clinical Aptitude Test (UKCAT), and its four sub-scales, along with measures of educational attainment, individual and contextual socio-economic background factors, as predictors of performance in the first year of medical school training. A prospective study of 4,811 students in 12 UK medical schools taking the UKCAT from 2006 to 2008 as a part of the medical school application, for whom first year medical school examination results were available in 2008 to 2010. UKCAT scores and educational attainment measures (General Certificate of Education (GCE): A-levels, and so on; or Scottish Qualifications Authority (SQA): Scottish Highers, and so on) were significant predictors of outcome. UKCAT predicted outcome better in female students than male students, and better in mature than non-mature students. Incremental validity of UKCAT taking educational attainment into account was significant, but small. Medical school performance was also affected by sex (male students performing less well), ethnicity (non-White students performing less well), and a contextual measure of secondary schooling, students from secondary schools with greater average attainment at A-level (irrespective of public or private sector) performing less well. Multilevel modeling showed no differences between medical schools in predictive ability of the various measures. UKCAT sub-scales predicted similarly, except that Verbal Reasoning correlated positively with performance on Theory examinations, but negatively with Skills assessments. This collaborative study in 12 medical schools shows the power of large-scale studies of medical education for answering previously unanswerable but important questions about medical student selection, education and training. UKCAT has predictive validity as a predictor of medical school outcome

Long-term functional outcome of pediatric stroke survivors.

Science.gov (United States)

Hurvitz, Edward; Warschausky, Seth; Berg, Michelle; Tsai, Shane

2004-01-01

To examine the long-term functional, psychosocial, and medical outcome of pediatric stroke survivors. This was a descriptive survey performed on patients with childhood stroke who participated in an earlier study. Measures included the Vineland Adaptive Behavior Scales (VABS) and the Diener Satisfaction with Life Scale. Current information on living situation, school placement, employment, and medical outcome were obtained. Twenty-nine (58%) patients participated. The mean age was 19.3 years (SD = 6.6), mean age of onset of stroke was 7.0 years (SD = 5.4), and mean follow-up time was 11.9 years (SD = 3.9). Diagnoses included hemorrhagic (31%) and ischemic (69%) stroke. All but one adult had finished high school, and the majority of participants had gone to college. 60% of patients over age 16 were employed. The average VABS levels for communication, daily living skills, socialization, and adaptive behavior fell into the moderately low range. Use of seizure medications and ADL dependence were the predictors for lower VABS levels (p life satisfaction. Patients who scored below adequate on VABS tended toward lower life satisfaction. Pediatric stroke survivors had good educational and mobility outcomes, but communication, ADL, and socialization fell into the low-moderate range. The different predictors of functional and subjective quality of life outcomes suggest that functional outcomes may mediate the relations between medical factors and satisfaction with life.

Assessment of atherosclerotic luminal narrowing of coronary arteries based on morphometrically generated visual guides.

Science.gov (United States)

Barth, Rolf F; Kellough, David A; Allenby, Patricia; Blower, Luke E; Hammond, Scott H; Allenby, Greg M; Buja, L Maximilian

Determination of the degree of stenosis of atherosclerotic coronary arteries is an important part of postmortem examination of the heart, but, unfortunately, estimation of the degree of luminal narrowing can be imprecise and tends to be approximations. Visual guides can be useful to assess this, but earlier attempts to develop such guides did not employ digital technology. Using this approach, we have developed two computer-generated morphometric guides to estimate the degree of luminal narrowing of atherosclerotic coronary arteries. The first is based on symmetric or eccentric circular or crescentic narrowing of the vessel lumen and the second on either slit-like or irregularly shaped narrowing of the vessel lumens. Using the Aperio ScanScope XT at a magnification of 20× we created digital whole-slide images of 20 representative microscopic cross sections of the left anterior descending (LAD) coronary artery, stained with either hematoxylin and eosin (H&E) or Movat's pentachrome stain. These cross sections illustrated a variety of luminal profiles and degrees of stenosis. Three representative types of images were selected and a visual guide was constructed with Adobe Photoshop CS5. Using the "Scale" and "Measurement" tools, we created a series of representations of stenosis with luminal cross sections depicting 20%, 40%, 60%, 70%, 80%, and 90% occlusion of the LAD branch. Four pathologists independently reviewed and scored the degree of atherosclerotic luminal narrowing based on our visual guides. In addition, digital technology was employed to determine the degree of narrowing by measuring the cross-sectional area of the 20 microscopic sections of the vessels, first assuming no narrowing and then comparing this to the percent of narrowing determined by precise measurement. Two of the observers were very experienced general autopsy pathologists, one was a first-year pathology resident on his first rotation on the autopsy service, and the fourth observer was a

Assessment of narrow angles by gonioscopy, Van Herick method and anterior segment optical coherence tomography.

Science.gov (United States)

Park, Seong Bae; Sung, Kyung Rim; Kang, Sung Yung; Jo, Jung Woo; Lee, Kyoung Sub; Kook, Michael S

2011-07-01

To evaluate anterior chamber (AC) angles using gonioscopy, Van Herick technique and anterior segment optical coherence tomography (AS-OCT). One hundred forty-eight consecutive subjects were enrolled. The agreement between any two of three diagnostic methods, gonioscopy, AS-OCT and Van Herick, was calculated in narrow-angle patients. The area under receiver-operating characteristic curves (AUC) for discriminating between narrow and open angles determined by gonioscopy was calculated in all participants for AS-OCT parameter angle opening distance (AOD), angle recess area, trabecular iris surface area and anterior chamber depth (ACD). As a subgroup analysis, capability of AS-OCT parameters for detecting angle closure defined by AS-OCT was assessed in narrow-angle patients. The agreement between the Van Herick method and gonioscopy in detecting angle closure was excellent in narrow angles (κ = 0.80, temporal; κ = 0.82, nasal). However, agreement between gonioscopy and AS-OCT and between the Van Herick method and AS-OCT was poor (κ = 0.11-0.16). Discrimination capability of AS-OCT parameters between open and narrow angles determined by gonioscopy was excellent for all AS-OCT parameters (AUC, temporal: AOD500 = 0.96, nasal: AOD500 = 0.99). The AUCs for detecting angle closure defined by AS-OCT image in narrow angle subjects was good for all AS-OCT parameters (AUC, 0.80-0.94) except for ACD (temporal: ACD = 0.70, nasal: ACD = 0.63). Assessment of narrow angles by gonioscopy and the Van Herick technique showed good agreement, but both measurements revealed poor agreement with AS-OCT. The angle closure detection capability of AS-OCT parameters was excellent; however, it was slightly lower in ACD.

PERSPECTIVES OF UKRAINIAN RAILWAY TOURISM DEVELOPMENT ON NARROW-GAUGE LINES OF ZAKARPATTIA

Directory of Open Access Journals (Sweden)

V. G. Kuznetsov

2015-07-01

Full Text Available Purpose.The purpose of the paper is: (1 the definition of perspectives development of Ukrainian railway tourism on the narrow gauge lines of Zakarpattia; 2 technical condition analysis of Borzhava narrow gauge railway for the project to restore the effective functioning of mountain railways track, width 750 mm in the Carpathian region, with the possibility of their accession to the distributed travel network; 3 the study of the modern state and tendencies of development of tourist industry of Ukraine and the passenger economy of national railways; 4 clarification of the role and place of the railway tourism in the transportation system. Methodology. The expert group has carried out field inspections and field investigations of facilities track facilities and passenger infrastructure, rolling stock and ancillary industries involved in the functioning narrow-gauge railway. It was estimated the overall technical condition of the railway track and engineering structures section of narrow-gauge Railways in the Carpathian region. Findings. In the framework of on-site examinations of the expert group found that the objects of tracks, passenger and freight infrastructure, rolling stock and ancillary industries involved in the operation of narrow-gauge Railways are in poor condition and require significant updates and major repairs. But the routes of passenger trains remain fit for participation in the project of development of railway tourism of Ukraine Originality. For the first time the state of the narrow-gauge railway for further implementation of the project on the development of rail tourism in Ukraine was realized. The analysis of foreign experience of organization of railway tourism has been carried out. The modern state and tendencies of development of tourist industry of Ukraine was studied, the factors of competitiveness of rail transport for providing tourist transport in Ukraine were identified and systematized.Practical value. The recovery

Experimental research on flow instability in vertical narrow annuli

Institute of Scientific and Technical Information of China (English)

WU Geping; QIU Suizheng; SU Guanghui; JIA Dounan

2007-01-01

A narrow annular test section of 1.5mm gap and 1800mm length was designed and manufactured, with good tightness and insulation. Experiments were carried out to investigate characteristics of flow instability of forced-convection in vertical narrow annuli. Using distilled water as work fluid, the experiments were conducted at pressures of 1.0～3.0 MPa, mass flow rates of 3.0～25 kg/h, heating power of 3.0～ 6.5kW and inlet fluid temperature of 20 ℃, 40 ℃ or 60℃. It was found that flow instability occured with fixed inlet condition and heating power when mass flow rate was below a special value. Effects of inlet subcooling, system pressure and mass flow rate on the system behavior were studied and the instability region was given.

Evaluation of Patient and Family Engagement Strategies to Improve Medication Safety.

Science.gov (United States)

Kim, Julia M; Suarez-Cuervo, Catalina; Berger, Zackary; Lee, Joy; Gayleard, Jessica; Rosenberg, Carol; Nagy, Natalia; Weeks, Kristina; Dy, Sydney

2018-04-01

Patient and family engagement (PFE) is critical for patient safety. We systematically reviewed types of PFE strategies implemented and their impact on medication safety. We searched MEDLINE, EMBASE, reference lists and websites to August 2016. Two investigators independently reviewed all abstracts and articles, and articles were additionally reviewed by two senior investigators for selection. One investigator abstracted data and two investigators reviewed the data for accuracy. Study quality was determined by consensus. Investigators developed a framework for defining the level of patient engagement: informing patients about medications (Level 1), informing about engagement with health care providers (Level 2), empowering patients with communication tools and skills (Level 3), partnering with patients in their care (Level 4), and integrating patients as full care team members (Level 5). We included 19 studies that mostly targeted older adults taking multiple medications. The median level of engagement was 2, ranging from 2-4. We identified no level 5 studies. Key themes for patient engagement strategies impacting medication safety were patient education and medication reconciliation, with a subtheme of patient portals. Most studies (84%) reported implementation outcomes. The most commonly reported medication safety outcomes were medication errors, including near misses and discrepancies (47%), and medication safety knowledge (37%). Most studies (63%) were of medium to low quality, and risk of bias was generally moderate. Among the 11 studies with control groups, 55% (n = 6) reported statistically significant improvement on at least one medication safety outcome. Further synthesis of medication safety measures was limited due to intervention and outcome heterogeneity. Key strategies for engaging patients in medication safety are education and medication reconciliation. Patient engagement levels were generally low, as defined by a novel framework for determining

Improvement of debate competence: an outcome of an introductory course for medical humanities

Directory of Open Access Journals (Sweden)

Kyung Hee Chun

2016-03-01

Full Text Available Purpose: Academic debate is an effective method to enhance the competences of critical thinking, problem solving, communication skills and cooperation skills. The present study examined the improvement of debate competence which is an outcome of debate-based flipped learning. Methods: A questionnaire was administrated to second-year premedical school students at Yeungnam University. In total 45 students participated in the survey. The survey questionnaire was composed of 60 items of eight subfactors on debate competence. To investigate the homogeneous of low and high achievement groups, 18 items on empathy and 75 items on critical thinking scales were used. To compare the pretest with posttest scores, data was analyzed using paired sample t-test. Results: There were no significant differences between low and high achievement groups by average grade at the beginning of the semester. There was a significant improvement in high achievers on the logical argumentation (p<0.001, proficiency in inquiry (p<0.01, active participation (p<0.001, ability to investigate and analyze (p<0.001, observance of debate rules (p<0.05, and acceptability (p<0.05. Even in low achievers, active participation (p<0.05 and ability to investigate and analyze (p<0.01 were significantly improved. Conclusion: Results showed that students could improve their debate competence by the debate-based flipped learning. A prospective and comparative study on the communication and teamwork competences needs to be conducted in the future. It is suggested that in-depth discussion for the curriculum design and teaching will be needed in terms of the effectiveness and the outcomes of the medical humanities.

A quantum criticality perspective on the charging of narrow quantum-dot levels

OpenAIRE

Kashcheyevs, V.; Karrasch, C.; Hecht, T.; Weichselbaum, A.; Meden, V.; Schiller, A.

2008-01-01

Understanding the charging of exceptionally narrow levels in quantum dots in the presence of interactions remains a challenge within mesoscopic physics. We address this fundamental question in the generic model of a narrow level capacitively coupled to a broad one. Using bosonization we show that for arbitrary capacitive coupling charging can be described by an analogy to the magnetization in the anisotropic Kondo model, featuring a low-energy crossover scale that depends in a power-law fashi...

Modeling on bubbly to churn flow pattern transition in narrow rectangular channel

International Nuclear Information System (INIS)

Wang Yanlin; Chen Bingde; Huang Yanping; Wang Junfeng

2012-01-01

A theoretical model based on some reasonable concepts was developed to predict the bubbly flow to churn flow pattern transition in vertical narrow rectangular channel under flow boiling condition. The maximum size of ideal bubble in narrow rectangular channel was calculated based on previous literature. The thermal hydraulics boundary condition of bubbly to churn flow pattern transition was exported from Helmholtz and maximum size of ideal bubble. The theoretical model was validated by existent experimental data. (authors)

Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project

Directory of Open Access Journals (Sweden)

Thomas Susie

2008-12-01

Full Text Available Abstract Background The aim of this project was primarily to assess the feasibility of individual exercise programs for older hospitalised patients at risk of functional decline, and secondarily to evaluate impact on discharge outcomes. Methods Design: Cohort service improvement project Setting: 500 bed acute metropolitan hospital Subjects: Patients aged 70 and older admitted to Flinders Medical Centre under the general medical, aged care and respiratory units from June to November 2006, at intermediate or high risk of functional decline, and able to commence exercise within 48 hours of admission Intervention: Functional Maintenance Program (FMP; an individually tailored exercise program to maintain functional mobility, prescribed and progressed by a physiotherapist, and supervised by an Allied Health Assistant (AHA, provided in addition to usual physiotherapy care Outcome measures: Feasibility (number of admissions suitable, commencing and complying with FMP. Impact (length of hospital stay (LOS, Aged Care Assessment Team (ACAT referrals and approvals, hospital readmissions within 28 days, and functional mobility (Elderly Mobility Scale Data Analysis: Descriptive and logistic regression analysis Results Of 1021 admissions of patients aged 70 or older to general medical, aged care and respiratory units, 22% (n = 220 were identified within 48 hours as suitable for FMP: 196 (89% commenced FMP within 48 hours of admission (FMP patients; 24 (11% received usual physiotherapy (usual care patients. Feasibility of individually tailored exercise programs for older medical patients was supported by high uptake (89%, low withdrawal (17% shown by those who commenced FMP, and good compliance with exercise sessions (70%. Logistic regression analysis showed a statistically significant decreased likelihood of referral for nursing home admission (OR = 0.228, 95% CI 0.088–0.587 and decreased likelihood of approval for admission to residential care (OR = 0

Medical abortion and the risk of subsequent adverse pregnancy outcomes

DEFF Research Database (Denmark)

Virk, Jasveer; Zhang, Jun; Olsen, Jørn

2007-01-01

BACKGROUND: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies. METHODS: We...... identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at ... weight (abortion were compared with risks in women who had had a first-trimester surgical abortion. RESULTS: Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women...

Volume and outcome of organ transplantation

NARCIS (Netherlands)

Banta, H.D.; Engel, G.L.; Schersten, T.

1992-01-01

In general, technically demanding medical procedures are associated with better outcomes when they are carried out in institutions and by physicians with higher volumes of practice. This paper examines the evidence for a volume-outcome relationship in the case of organ transplantation. Although few

Droplet squeezing through a narrow constriction: Minimum impulse and critical velocity

Science.gov (United States)

Zhang, Zhifeng; Drapaca, Corina; Chen, Xiaolin; Xu, Jie

2017-07-01

Models of a droplet passing through narrow constrictions have wide applications in science and engineering. In this paper, we report our findings on the minimum impulse (momentum change) of pushing a droplet through a narrow circular constriction. The existence of this minimum impulse is mathematically derived and numerically verified. The minimum impulse happens at a critical velocity when the time-averaged Young-Laplace pressure balances the total minor pressure loss in the constriction. Finally, numerical simulations are conducted to verify these concepts. These results could be relevant to problems of energy optimization and studies of chemical and biomedical systems.

The mean-size dependence of the exchange narrowing in molecular J-aggregates

International Nuclear Information System (INIS)

Chen Yulu; Zhao Jijun

2011-01-01

The effect of segment-size fluctuations on exchange narrowing in a molecular J-aggregate of site-energy disordered distributions is studied using a one-dimensional Frenkel-exciton model. It is found that the segment-size disorder leads to the width of the absorption spectra deviating from the scaling law, σ 4/3 of the site-energy disordered standard deviation σ, being suitable for the system only with the site-energy disorder. In larger σ, the segment-size disorder has little influence on the linear absorption spectra. With increasing segment mean-length, the absorption line width monotonically increases, and then approaches a saturated value. By comparing a system of larger mean-length segment with a smaller one, both with the same segment-size disorder, it is found that the absorption line width of the former is broadened, and the exchange narrowing effect is reduced. The present result shows that the correlation effect can be partially maintained for the system with larger mean-length segment. -- Research Highlights: → Segment fluctuations affect the exchange narrowing of molecular J-aggregates. → The width of the absorption spectra is found to deviate from the scaling law. → Increase in segment size causes increase in the width and then saturates. → Exchange narrowing is reduced for larger mean-size segment. → Correlation can be kept partly in the larger size segment.

Narrow-band radio flares from red dwarf stars

Energy Technology Data Exchange (ETDEWEB)

White, S.M.; Kundu, M.R.; Jackson, P.D.

1986-12-01

VLA observations of narrow-band behavior in 20 cm flares from two red dwarf stars, L726 - 8A and AD Leo, are reported. The flare on L726 - 8A was observed at 1415 and 1515 MHz; the flux and the evolution differed significantly at the two frequencies. The flare on AD Leo lasted for 2 hr at 1415 MHz but did not appear at 1515 MHz. The AD Leo flare appears to rule out a source drifting through the stellar corona and is unlikely to be due to plasma emission. In the cyclotron maser model the narrow-band behavior reflects the range of magnetic fields present within the source. The apparent constancy of this field for 2 hr is difficult to understand if magnetic reconnection is the source of energy for the flare. The consistent polarization exhibited by red dwarf flares at 20 cm may be related to stellar activity cycles, and changes in this polarization will permit measuring the length of these cycles. 22 references.

Maryland's Helicopter Emergency Medical Services Experience From 2001 to 2011: System Improvements and Patients' Outcomes.

Science.gov (United States)

Hirshon, Jon Mark; Galvagno, Samuel M; Comer, Angela; Millin, Michael G; Floccare, Douglas J; Alcorta, Richard L; Lawner, Benjamin J; Margolis, Asa M; Nable, Jose V; Bass, Robert R

2016-03-01

Helicopter emergency medical services (EMS) has become a well-established component of modern trauma systems. It is an expensive, limited resource with potential safety concerns. Helicopter EMS activation criteria intended to increase efficiency and reduce inappropriate use remain elusive and difficult to measure. This study evaluates the effect of statewide field trauma triage changes on helicopter EMS use and patient outcomes. Data were extracted from the helicopter EMS computer-aided dispatch database for in-state scene flights and from the state Trauma Registry for all trauma patients directly admitted from the scene or transferred to trauma centers from July 1, 2000, to June 30, 2011. Computer-aided dispatch flights were analyzed for periods corresponding to field triage protocol modifications intended to improve system efficiency. Outcomes were separately analyzed for trauma registry patients by mode of transport. The helicopter EMS computer-aided dispatch data set included 44,073 transports. There was a statewide decrease in helicopter EMS usage for trauma patients of 55.9%, differentially affecting counties closer to trauma centers. The Trauma Registry data set included 182,809 patients (37,407 helicopter transports, 128,129 ambulance transports, and 17,273 transfers). There was an increase of 21% in overall annual EMS scene trauma patients transported; ground transports increased by 33%, whereas helicopter EMS transports decreased by 49%. Helicopter EMS patient acuity increased, with an attendant increase in patient mortality. However, when standardized with W statistics, both helicopter EMS- and ground-transported trauma patients showed sustained improvement in mortality. Modifications to state protocols were associated with decreased helicopter EMS use and overall improved trauma patient outcomes. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Microsputterer with integrated ion-drag focusing for additive manufacturing of thin, narrow conductive lines

Science.gov (United States)

Kornbluth, Y. S.; Mathews, R. H.; Parameswaran, L.; Racz, L. M.; Velásquez-García, L. F.

2018-04-01

We report the design, modelling, and proof-of-concept demonstration of a continuously fed, atmospheric-pressure microplasma metal sputterer that is capable of printing conductive lines narrower than the width of the target without the need for post-processing or lithographic patterning. Ion drag-induced focusing is harnessed to print narrow lines; the focusing mechanism is modelled via COMSOL Multiphysics simulations and validated with experiments. A microplasma sputter head with gold target is constructed and used to deposit imprints with minimum feature sizes as narrow as 9 µm, roughness as small as 55 nm, and electrical resistivity as low as 1.1 µΩ · m.

Optically trapped atomic resonant devices for narrow linewidth spectral imaging

Science.gov (United States)

Qian, Lipeng

This thesis focuses on the development of atomic resonant devices for spectroscopic applications. The primary emphasis is on the imaging properties of optically thick atomic resonant fluorescent filters and their applications. In addition, this thesis presents a new concept for producing very narrow linewidth light as from an atomic vapor lamp pumped by a nanosecond pulse system. This research was motivated by application for missile warning system, and presents an innovative approach to a wide angle, ultra narrow linewidth imaging filter using a potassium vapor cell. The approach is to image onto and collect the fluorescent photons emitted from the surface of an optically thick potassium vapor cell, generating a 2 GHz pass-band imaging filter. This linewidth is narrow enough to fall within a Fraunhefer dark zone in the solar spectrum, thus make the detection solar blind. Experiments are conducted to measure the absorption line shape of the potassium resonant filter, the quantum efficiency of the fluorescent behavior, and the resolution of the fluorescent image. Fluorescent images with different spatial frequency components are analyzed by using a discrete Fourier transform, and the imaging capability of the fluorescent filter is described by its Modulation Transfer Function. For the detection of radiation that is spectrally broader than the linewidth of the potassium imaging filter, the fluorescent image is seen to be blurred by diffuse fluorescence from the slightly off resonant photons. To correct this, an ultra-thin potassium imaging filter is developed and characterized. The imaging property of the ultra-thin potassium imaging cell is tested with a potassium seeded flame, yielding a resolution image of ˜ 20 lines per mm. The physics behind the atomic resonant fluorescent filter is radiation trapping. The diffusion process of the resonant photons trapped in the atomic vapor is theoretically described in this thesis. A Monte Carlo method is used to simulate the

Effects of maternal psychotropic drug dosage on birth outcomes

Directory of Open Access Journals (Sweden)

Michielsen LA

2013-12-01

Full Text Available Laura A Michielsen,1 Frank MMA van der Heijden,1 Paddy KC Janssen,2 Harold JH Kuijpers11Vincent van Gogh Institute for Psychiatry, Venlo, the Netherlands; 2Department of Pharmacy, VieCuri Medical Centre, Venlo, the NetherlandsBackground: The aim of this retrospective study was to explore the relationship between psychotropic medication dosage and birth outcomes.Methods: A total of 136 women were enrolled, who had an active mental disorder, were taking medication to prevent a relapse, or had a history of postpartum depression or psychosis. Medication use was evaluated for the three trimesters and during labor. Based on the defined daily dose, medication use was classified into three groups. Primary outcome variables included the infant gestational age at birth, birth weight, and Apgar scores at one and 5 minutes.Results: Our study showed a significantly higher incidence of Apgar score ≤7 at 5 minutes in women taking psychotropic drugs as compared with the group taking no medication, respectively (16.3% versus 0.0%, P=0.01. There was no significant difference between the two groups in Apgar score at one minute or in gestational age and birth weight. The results showed no significant differences in gestational age, birth weight, or Apgar scores for a low–intermediate or high dose of a selective serotonin reuptake inhibitor and for a low or intermediate dose of an antipsychotic.Conclusion: This study does not indicate a relationship between doses of selective serotonin reuptake inhibitors and antipsychotics and adverse neonatal outcomes.Keywords: pregnancy, psychotropic medication, dosage, birth outcomes

Association of Academic Performance with Outcome Expectations and Its Domains in Nursing and Midwifery Students at Kermanshah University of Medical Sciences

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Sepideh Bakhtiari

2014-09-01

Full Text Available Introduction: Outcome expectation is considered as a basic and significant variable in education. It is a cognitive-motivational component that takes the individual into account as an active and sensible decision-maker. The present study was conducted to investigate the correlation of outcome expectations with academic performance of students of nursing and midwifery in Kermanshah University of Medical Sciences. Methods: In this descriptive cross-sectional study, the sample size included 218 nursing and midwifery students selected through convenient random sampling method. The instrument for data collection was the questionnaire of “outcome expectations of career decision-making and discovery targets”, which comprised of 13 questions in three domains of future orientation, job satisfaction and personal expectations. The questionnaires were coded after being completed and the obtained data were fed into SPSS-16 software and analyzed by descriptive statistics, t-test, Kolmogrov-Smirnov, ANOVA and Mann-Whitney tests. Results: The findings indicated no statistically significant difference between place of living (dormitory or home and outcome expectations along with its domains (39.4% and 60-6%. However, a significant correlation was reported between discipline, gender, admittance year and academic performance of the students (p0.05. Conclusion: The findings of this study indicated a positively positive significant relationship between students’ academic performance and outcome expectations along with its domains.

Period Effects, Cohort Effects, and the Narrowing Gender Wage Gap

Science.gov (United States)

Campbell, Colin; Pearlman, Jessica

2015-01-01

Despite the abundance of sociological research on the gender wage gap, questions remain. In particular, the role of cohorts is under investigated. Using data from the Current Population Survey, we use Age-Period-Cohort analysis to uniquely estimate age, period, and cohort effects on the gender wage gap. The narrowing of the gender wage gap that occurred between 1975 and 2009 is largely due to cohort effects. Since the mid-1990s, the gender wage gap has continued to close absent of period effects. While gains in female wages contributed to declines in the gender wage gap for cohorts born before 1950, for later cohorts the narrowing of the gender wage gap is primarily a result of declines in male wages. PMID:24090861

Vibration-tolerant narrow-linewidth semiconductor disk laser using novel frequency-stabilisation schemes

Science.gov (United States)

Hunter, Craig R.; Jones, Brynmor E.; Schlosser, Peter; Sørensen, Simon Toft; Strain, Michael J.; McKnight, Loyd J.

2018-02-01

This paper will present developments in narrow-linewidth semiconductor-disk-laser systems using novel frequencystabilisation schemes for reduced sensitivity to mechanical vibrations, a critical requirement for mobile applications. Narrow-linewidth single-frequency lasers are required for a range of applications including metrology and highresolution spectroscopy. Stabilisation of the laser was achieved using a monolithic fibre-optic ring resonator with free spectral range of 181 MHz and finesse of 52 to act as passive reference cavity for the laser. Such a cavity can operate over a broad wavelength range and is immune to a wide band of vibrational frequency noise due to its monolithic implementation. The frequency noise of the locked system has been measured and compared to typical Fabry-Perotlocked lasers using vibration equipment to simulate harsh environments, and analysed here. Locked linewidths of portable, narrow-linewidth laser system for harsh environments that can be flexibly designed for a range of applications.

Study on calculation model of onset of nucleate boiling in narrow channels

International Nuclear Information System (INIS)

Zhang Ming; Zhou Tao; Sheng Cheng; Fu Tao; Xiao Zejun

2011-01-01

In the reactor engineering, narrow channels was used widely for its high power density, exceptional heat transfer and actual engineering requirements. The point of Onset of Nucleate Boiling (ONB) is the key point of boiling heat transfer in narrow channels. The point of ONB can directly influence the following flow and heat transfer characteristics in the reactor. Due to the special structure and complexity flow, the point of ONB in narrow channels are effected by many factors, which characteristics are not understood completely yet. Using B and R model, Su Shun-yu model, Pan Liang-ming model and Yang Rui-chang model, the heat flux of onset of nucleate boiling is compared and analyzed by taking water as the medium . And then the relationships of the heat flux with pressure, mass flow and wall temperature are obtained. Based on the differences of each model, the mechanisms for the main influence factors are suggested. (authors)

Medical Student–Reported Outcomes of a Radiation Oncologist–Led Preclinical Course in Oncology: A Five-Year Analysis

Energy Technology Data Exchange (ETDEWEB)

Agarwal, Ankit; Koottappillil, Brian; Shah, Bhartesh; Ahuja, Divya; Hirsch, Ariel E., E-mail: Ariel.hirsch@bmc.org

2015-07-15

Purpose: There is a recognized need for more robust training in oncology for medical students. At our institution, we have offered a core dedicated oncology block, led by a radiation oncologist course director, during the second year of the medical school curriculum since the 2008-2009 academic year. Herein, we report the outcomes of the oncology block over the past 5 years through an analysis of student perceptions of the course, both immediately after completion of the block and in the third year. Methods and Materials: We analyzed 2 separate surveys. The first assessed student impressions of how well the course met each of the course's learning objectives through a survey that was administered to students immediately after the oncology block in 2012. The second was administered after students completed the oncology block during the required radiology clerkship in the third year. All questions used a 5-level Likert scale and were analyzed by use of a Wilcoxon signed-rank test. Results: Of the 169 students who took the oncology course in 2012, 127 (75.1%) completed the course feedback survey. Over 73% of students agreed or strongly agreed that the course met its 3 learning objectives. Of the 699 medical students who took the required radiology clerkship between 2010 and 2013, 538 participated in the second survey, for a total response rate of 77%. Of these students, 368 (68.4%) agreed or strongly agreed that the course was effective in contributing to their overall medical education. Conclusion: Student perceptions of the oncology block are favorable and have improved across multiple categories since the inception of the course. Students self-reported that a dedicated preclinical oncology block was effective in helping identify the basics of cancer therapy and laying the foundation for clinical electives in oncology, including radiation oncology.

Medical Student–Reported Outcomes of a Radiation Oncologist–Led Preclinical Course in Oncology: A Five-Year Analysis

International Nuclear Information System (INIS)

Agarwal, Ankit; Koottappillil, Brian; Shah, Bhartesh; Ahuja, Divya; Hirsch, Ariel E.

2015-01-01

Purpose: There is a recognized need for more robust training in oncology for medical students. At our institution, we have offered a core dedicated oncology block, led by a radiation oncologist course director, during the second year of the medical school curriculum since the 2008-2009 academic year. Herein, we report the outcomes of the oncology block over the past 5 years through an analysis of student perceptions of the course, both immediately after completion of the block and in the third year. Methods and Materials: We analyzed 2 separate surveys. The first assessed student impressions of how well the course met each of the course's learning objectives through a survey that was administered to students immediately after the oncology block in 2012. The second was administered after students completed the oncology block during the required radiology clerkship in the third year. All questions used a 5-level Likert scale and were analyzed by use of a Wilcoxon signed-rank test. Results: Of the 169 students who took the oncology course in 2012, 127 (75.1%) completed the course feedback survey. Over 73% of students agreed or strongly agreed that the course met its 3 learning objectives. Of the 699 medical students who took the required radiology clerkship between 2010 and 2013, 538 participated in the second survey, for a total response rate of 77%. Of these students, 368 (68.4%) agreed or strongly agreed that the course was effective in contributing to their overall medical education. Conclusion: Student perceptions of the oncology block are favorable and have improved across multiple categories since the inception of the course. Students self-reported that a dedicated preclinical oncology block was effective in helping identify the basics of cancer therapy and laying the foundation for clinical electives in oncology, including radiation oncology

Conversion of National Health Insurance Service-National Sample Cohort (NHIS-NSC) Database into Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM).

Science.gov (United States)

You, Seng Chan; Lee, Seongwon; Cho, Soo-Yeon; Park, Hojun; Jung, Sungjae; Cho, Jaehyeong; Yoon, Dukyong; Park, Rae Woong

2017-01-01

It is increasingly necessary to generate medical evidence applicable to Asian people compared to those in Western countries. Observational Health Data Sciences a Informatics (OHDSI) is an international collaborative which aims to facilitate generating high-quality evidence via creating and applying open-source data analytic solutions to a large network of health databases across countries. We aimed to incorporate Korean nationwide cohort data into the OHDSI network by converting the national sample cohort into Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM). The data of 1.13 million subjects was converted to OMOP-CDM, resulting in average 99.1% conversion rate. The ACHILLES, open-source OMOP-CDM-based data profiling tool, was conducted on the converted database to visualize data-driven characterization and access the quality of data. The OMOP-CDM version of National Health Insurance Service-National Sample Cohort (NHIS-NSC) can be a valuable tool for multiple aspects of medical research by incorporation into the OHDSI research network.

Forensic Medicine in South Africa: Associations between Medical Practice and Legal Case Progression and Outcomes in Female Murders

Science.gov (United States)

Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J.; Mathews, Shanaaz

2011-01-01

Background Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. Methods We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. Findings In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16–2.20), weapon recovered 1.36 (95% CI:0.58–2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14–3.00). None of the forensic medical activities increased the likelihood of a conviction. Conclusion The findings raise important questions about the role of forensic medicine in these cases. PMID:22194868

Forensic medicine in South Africa: associations between medical practice and legal case progression and outcomes in female murders.

Directory of Open Access Journals (Sweden)

Naeemah Abrahams

Full Text Available BACKGROUND: Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners; and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. METHODS: We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. FINDINGS: In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16-2.20, weapon recovered 1.36 (95% CI:0.58-2.15 and a detective visiting the crime scene 1.57 (95% CI:0.14-3.00. None of the forensic medical activities increased the likelihood of a conviction. CONCLUSION: The findings raise important questions about the role of forensic medicine in these cases.

RCT to evaluate the influence of adjuvant medical treatment of peritoneal endometriosis on the outcome of IVF.

Science.gov (United States)

Decleer, W; Osmanagaoglu, K; Verschueren, K; Comhaire, F; Devroey, P

2016-09-01

Does a 3-month adjuvant hormonal treatment of mild peritoneal endometriosis after laparoscopic surgery influence the outcome of IVF stimulation in terms of number of mature oocytes obtained per cycle? Complementary medical treatment of mild peritoneal endometriosis does not influence the number of oocytes per treatment cycle. Endometriosis is a disease known to be related to infertility. However, the influence of superficial endometriosis-and its treatment-is still a matter of debate. A prospective controlled, randomized, open label trial was performed between February 2012 and March 2014 and embryological and clinical outcomes were measured. Patients with laparoscopically diagnosed peritoneal endometriosis (n= 120) were treated by laser surgery after which they were sequentially randomized by computer-generated allocation to one of the two groups. The primary outcome of the trial was the number of Metaphase II (MII) oocytes. Sample size was chosen to detect a difference of two MII oocytes with a power of 80%. The control group (Group B) received the classical long protocol IVF stimulation, whereas the research group (Group A) had an additional pituitary suppression, of 3 months using a long-acting GnRH agonist, prior to IVF. A total of 120 patients were included in the study, 61 of them in the study group and 59 patients in the control group. One patient of the control group was lost to follow up leading to 58 evaluable patients. There was no difference in terms of the number of MII oocytes obtained per cycle: 8.2 in both groups (difference in MII between A and B: 0.07 [-1.89; 2.04] 95% confidence interval (CI)). Pregnancy rate did not differ, being 39.3% for Group A (24 out of 61 patients) versus 39.7% for Group B (23 out of 58 patients) (95% CI around difference in pregnancy rate between A and B: -0.31% [-17.96%; 17.86%]). However, a significantly (P = 0.025) lower dose of FSH (2561 IU for Group A and 2303 IU for Group B, 95% CI around difference in FSH between

Nasal base narrowing: the combined alar base excision technique.

Science.gov (United States)

Foda, Hossam M T

2007-01-01

To evaluate the role of the combined alar base excision technique in narrowing the nasal base and correcting excessive alar flare. The study included 60 cases presenting with a wide nasal base and excessive alar flaring. The surgical procedure combined an external alar wedge resection with an internal vestibular floor excision. All cases were followed up for a mean of 32 (range, 12-144) months. Nasal tip modification and correction of any preexisting caudal septal deformities were always completed before the nasal base narrowing. The mean width of the external alar wedge excised was 7.2 (range, 4-11) mm, whereas the mean width of the sill excision was 3.1 (range, 2-7) mm. Completing the internal excision first resulted in a more conservative external resection, thus avoiding any blunting of the alar-facial crease. No cases of postoperative bleeding, infection, or keloid formation were encountered, and the external alar wedge excision healed with an inconspicuous scar that was well hidden in the depth of the alar-facial crease. Finally, the risk of notching of the alar rim, which can occur at the junction of the external and internal excisions, was significantly reduced by adopting a 2-layered closure of the vestibular floor (P = .01). The combined alar base excision resulted in effective narrowing of the nasal base with elimination of excessive alar flare. Commonly feared complications, such as blunting of the alar-facial crease or notching of the alar rim, were avoided by using simple modifications in the technique of excision and closure.

Medical marijuana users in substance abuse treatment

Directory of Open Access Journals (Sweden)

Swartz Ronald

2010-03-01

Full Text Available Abstract Background The rise of authorized marijuana use in the U.S. means that many individuals are using cannabis as they concurrently engage in other forms of treatment, such as substance abuse counseling and psychotherapy. Clinical and legal decisions may be influenced by findings that suggest marijuana use during treatment serves as an obstacle to treatment success, compromises treatment integrity, or increases the prevalence or severity of relapse. In this paper, the author reviews the relationship between authorized marijuana use and substance abuse treatment utilizing data from a preliminary pilot study that, for the first time, uses a systematic methodology to collect data examining possible effects on treatment. Methods Data from the California Outcomes Measurement System (CalOMS were compared for medical (authorized marijuana users and non-marijuana users who were admitted to a public substance abuse treatment program in California. Behavioral and social treatment outcomes recorded by clinical staff at discharge and reported to the California Department of Alcohol and Drug Programs were assessed for both groups, which included a sample of 18 reported medical marijuana users. Results While the findings described here are preliminary and very limited due to the small sample size, the study demonstrates that questions about the relationship between medical marijuana use and involvement in drug treatment can be systematically evaluated. In this small sample, cannabis use did not seem to compromise substance abuse treatment amongst the medical marijuana using group, who (based on these preliminary data fared equal to or better than non-medical marijuana users in several important outcome categories (e.g., treatment completion, criminal justice involvement, medical concerns. Conclusions This exploratory study suggests that medical marijuana is consistent with participation in other forms of drug treatment and may not adversely affect

Medicalization of global health 3: the medicalization of the non-communicable diseases agenda

Directory of Open Access Journals (Sweden)

Jocalyn Clark

2014-05-01

Full Text Available There is growing recognition of the massive global burden of non-communicable diseases (NCDs due to their prevalence, projected social and economic costs, and traditional neglect compared to infectious disease. The 2011 UN Summit, WHO 25×25 targets, and support of major medical and advocacy organisations have propelled prominence of NCDs on the global health agenda. NCDs are by definition ‘diseases’ so already medicalized. But their social drivers and impacts are acknowledged, which demand a broad, whole-of-society approach. However, while both individual- and population-level targets are identified in the current NCD action plans, most recommended strategies tend towards the individualistic approach and do not address root causes of the NCD problem. These so-called population strategies risk being reduced to expectations of individual and behavioural change, which may have limited success and impact and deflect attention away from government policies or regulation of industry. Industry involvement in NCD agenda-setting props up a medicalized approach to NCDs: food and drink companies favour focus on individual choice and responsibility, and pharmaceutical and device companies favour calls for expanded access to medicines and treatment coverage. Current NCD framing creates expanded roles for physicians, healthcare workers, medicines and medical monitoring. The professional rather than the patient view dominates the NCD agenda and there is a lack of a broad, engaged, and independent NGO community. The challenge and opportunity lie in defining priorities and developing strategies that go beyond a narrow medicalized framing of the NCD problem and its solutions.

Medicalization of global health 3: the medicalization of the non-communicable diseases agenda.

Science.gov (United States)

Clark, Jocalyn

2014-01-01

There is growing recognition of the massive global burden of non-communicable diseases (NCDs) due to their prevalence, projected social and economic costs, and traditional neglect compared to infectious disease. The 2011 UN Summit, WHO 25×25 targets, and support of major medical and advocacy organisations have propelled prominence of NCDs on the global health agenda. NCDs are by definition 'diseases' so already medicalized. But their social drivers and impacts are acknowledged, which demand a broad, whole-of-society approach. However, while both individual- and population-level targets are identified in the current NCD action plans, most recommended strategies tend towards the individualistic approach and do not address root causes of the NCD problem. These so-called population strategies risk being reduced to expectations of individual and behavioural change, which may have limited success and impact and deflect attention away from government policies or regulation of industry. Industry involvement in NCD agenda-setting props up a medicalized approach to NCDs: food and drink companies favour focus on individual choice and responsibility, and pharmaceutical and device companies favour calls for expanded access to medicines and treatment coverage. Current NCD framing creates expanded roles for physicians, healthcare workers, medicines and medical monitoring. The professional rather than the patient view dominates the NCD agenda and there is a lack of a broad, engaged, and independent NGO community. The challenge and opportunity lie in defining priorities and developing strategies that go beyond a narrow medicalized framing of the NCD problem and its solutions.

A review of teaching skills development programmes for medical students.

Science.gov (United States)

Marton, Gregory E; McCullough, Brendan; Ramnanan, Christopher J

2015-02-01

The CanMEDS role of Scholar requires that medical trainees develop their skills as medical educators. The development of teaching skills in undergraduate medical students is therefore desirable, especially in view of the teaching obligations in residency programmes. The goal of this review was to identify the characteristics and outcomes of programmes designed to develop the teaching skills of undergraduate medical students. The authors searched medical literature databases using combinations of the search terms 'medical student', 'teacher', 'teaching skills', 'peer teaching', 'near-peer teaching' and 'student as teacher'. Twenty papers fit the predetermined search criteria, which included original characterisations of specific programmes involving undergraduate medical students. Three types of initiative were identified in the reviewed articles: peer teaching programmes; teaching workshops, and community outreach programmes. The majority of study participants were students in Years 3 and 4. Subjective self-evaluation by participants using Likert scale-based surveys was by far the most commonly used method of measuring project outcomes. Objective, quantitative teaching-related outcomes were rarely noted in the reports reviewed. Self-perceived improvements in teaching skills were noted by participants in most of the reports. Other perceived benefits included increases in organisational skills, knowledge and confidence in giving feedback. Although several types of programmes have been shown to subjectively improve the teaching skills of undergraduate medical students, characterisation of the objective outcomes of these initiatives is lacking and requires further study. © 2015 John Wiley & Sons Ltd.

Electrocardiogram artifact caused by rigors mimicking narrow complex tachycardia: a case report.

Science.gov (United States)

Matthias, Anne Thushara; Indrakumar, Jegarajah

2014-02-04

The electrocardiogram (ECG) is useful in the diagnosis of cardiac and non-cardiac conditions. Rigors due to shivering can cause electrocardiogram artifacts mimicking various cardiac rhythm abnormalities. We describe an 80-year-old Sri Lankan man with an abnormal electrocardiogram mimicking narrow complex tachycardia during the immediate post-operative period. Electrocardiogram changes caused by muscle tremor during rigors could mimic a narrow complex tachycardia. Identification of muscle tremor as a cause of electrocardiogram artifact can avoid unnecessary pharmacological and non-pharmacological intervention to prevent arrhythmias.

Medical tourism services available to residents of the United States.

Science.gov (United States)

Alleman, Brandon W; Luger, Tana; Reisinger, Heather Schacht; Martin, Rene; Horowitz, Michael D; Cram, Peter

2011-05-01

There are growing reports of United States (US) residents traveling overseas for medical care, but empirical data about medical tourism are limited. To characterize the businesses and business practices of entities promoting medical tourism and the types and costs of procedures being offered. DESIGN, PARTICIPANTS, AND OUTCOMES: Between June and August 2008, we conducted a telephone survey of all businesses engaged in facilitating overseas medical travel for US residents. We collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. We identified 63 medical tourism companies and 45 completed our survey (71%). Companies had a mean of 9.8 employees and had referred an average of 285 patients overseas (a total of approximately 13,500 patients). 35 (79%) companies reported requiring accreditation of foreign providers, 22 (50%) collected patient outcome data, but only 17 (39%) described formal medical records security policies. The most common destinations were India (23 companies, 55%), Costa Rica (14, 33%), and Thailand (12, 29%). The most common types of care included orthopedics (32 companies, 73%), cardiac care (23, 52%), and cosmetic surgery (29, 66%). 20 companies (44%) offered treatments not approved for use in the US--most commonly stem cell therapy. Average costs for common procedures, CABG ($18,600) and knee arthroplasty ($10,800), were similar to previous reports. The number of Americans traveling overseas for medical care with assistance from medical tourism companies is relatively small. Attention to medical records security and patient outcomes is variable and cost-savings are dependent on US prices. That said, overseas medical care can be a reasonable alternative for price sensitive patients in need of relatively common, elective medical

The Long-Term Career Outcome Study (LTCOS): what have we learned from 40 years of military medical education and where should we go?

Science.gov (United States)

Durning, Steven J; Artino, Anthony R; Dong, Ting; Cruess, David F; Gilliland, William R; DeZee, Kent J; Saguil, Aaron; Waechter, Donna M; McManigle, John E

2012-09-01

The work of the Long-Term Career Outcome Study (LTCOS), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU) has been a multidisciplinary effort spanning more than 5 years. Borrowing from the established program evaluation and quality assurance literature, the LTCOS team has organized its evaluation and research efforts into three phases: before medical school, during medical school, and after medical school. The purpose of this commentary is to summarize the research articles presented in this special issue and to answer two fundamental questions: (1) what has been learned from LTCOS research conducted to date, and (2) where should the LTCOS team take its evaluation and research efforts in the future? Answers to these questions are relevant to USU, and they also can inform other medical education institutions and policy makers. What is more, answers to these questions will help to ensure USU meets its societal obligation to provide the highest quality health care to military members, their families, and society at large.

Medical Students’ and Interns’ Attitudes toward Medical Ethics Education in a Thai Medical School

Directory of Open Access Journals (Sweden)

Sakda Sathirareuangchai

2016-03-01

Full Text Available Background: Medical ethics has been accepted as part of every accredited medical curriculum for the past 40 years. Medical students’ attitudes have an important role for development and improvement of the curriculum. Faculty of Medicine Siriraj Hospital is the oldest and largest medical school in Thailand, and has been teaching medical ethics since 1907. Objective: To determine attitudes among medical students and interns toward medical ethics education and understand the factors influencing their attitudes. Methods: Mixed quantitative and qualitative research was conducted with early 6th year medical students and interns. A questionnaire was adapted from previous studies and included some original items. Results: Of the 550 questionnaires distributed, 386 were returned (70.2% response rate. Males (n=180 made up 46.63 % of the sample. Interns (n=219, 56.74 % tended to have more positive attitudes toward ethics learning than did medical students (n = 167, 43.26 %. Male participants tended to agree more with negative statements about ethics learning than did females. There was no statistically significant effect of hometown (Bangkok versus elsewhere or grade point average on attitudes. The main problem cited with medical ethics education was lack of engaging methods. Conclusion: Because clinical experience has an effect on learners’ attitudes towards ethics education, medical ethics should be taught at the appropriate time and with proper techniques, such as drawing explicit ties between ethical principles and real-life situations. Attention to the more detailed aspects of these data should also facilitate improvements to curriculum content, thereby ensuring better educational outcomes.

The association of depression and anxiety with medical symptom burden in patients with chronic medical illness.

Science.gov (United States)

Katon, Wayne; Lin, Elizabeth H B; Kroenke, Kurt

2007-01-01

Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses. MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes. Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures. Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.

Outcomes after medical and surgical interventions in horses with temporohyoid osteoarthropathy.

Science.gov (United States)

Espinosa, P; Nieto, J E; Estell, K E; Kass, P H; Aleman, M

2017-11-01

Temporohyoid osteoarthropathy (THO) is a cause of neurological disease in horses that is characterised by facial and vestibulocochlear nerve deficits. Studies reporting and comparing survival following medical or surgical treatment of THO are lacking. To compare survival and prognosis in horses with THO treated medically or surgically, and to report surgical complications. Retrospective study. The medical records of horses diagnosed with THO were retrieved, and data on signalment, clinical signs and duration, corneal ulceration and bilateral occurrence were recorded. Neurological severity was graded according to clinical signs. Preoperative radiographic and endoscopic images were graded according to the severity of changes. Factors potentially affecting survival and treatment were compared using Cox proportional hazards regression. A total of 77 horses were identified as having THO during the period 1990-2014. Of these, 25 horses underwent ceratohyoid ostectomy (CHO) and eight underwent partial stylohyoid ostectomy (PSHO). Thirteen of 20, one of 25 and one of eight horses treated by medical therapy, CHO and PSHO, respectively, died or were subjected to euthanasia as a consequence of THO. Compared with CHO, medical therapy was significantly associated with nonsurvival, but there were no significant differences in survival between horses undergoing PSHO and medical therapy. The duration of clinical signs, and neurological, radiographic and endoscopic grades were not associated with survival of THO. However, the age of the horse was significantly associated with poorer survival. Survival time was significantly shorter in the medical therapy group compared with the two surgical groups combined, but did not differ significantly between the two surgical groups. No significant difference between groups was seen in the incidence of surgical complications (33.3% in the PSHO and 22.2% in the CHO group). This was a nonrandomised study of treatment effects on survival and

Narrow line width operation of a 980 nm gain guided tapered diode laser bar

DEFF Research Database (Denmark)

Vijayakumar, Deepak; Jensen, Ole Bjarlin; Barrientos-Barria, Jessica

2011-01-01

We demonstrate two different schemes for the spectral narrowing of a 12 emitter 980 nm gain guided tapered diode laser bar. In the first scheme, a reflective grating has been used in a Littman Metcalf configuration and the wavelength of the laser emission could be narrowed down from more than 5.......5 nm in the free running mode to 0.04 nm (FWHM) at an operating current of 30 A with an output power of 8 W. The spectrum was found to be tunable within a range of 16 nm. In the second scheme, a volume Bragg grating has been used to narrow the wavelength of the laser bar from over 5 nm to less than 0.......2 nm with an output of 5 W at 20 A. To our knowledge, this is the first time spectral narrowing has been performed on a gain guided tapered diode laser bar. In the Littman Metcalf configuration, the spectral brightness has been increased by 86 times and in the volume Bragg grating cavity the spectral...

The characteristic investigation on narrow-gap TIG weld joint of heavy wall austenitic stainless steel pipe

International Nuclear Information System (INIS)

Shim, Deog Nam; Jung, In Cheol

2003-01-01

Although Gas Tungsten Arc Welding (GTAW or TIG welding) is considered as high quality and precision welding process, it also has demerit of low melting rate. Narrow-gap TIG welding which has narrow joint width reduces the groove volume remarkably, so it could be shorten the welding time and decrease the overall shrinkage in heavy wall pipe welding. Generally narrow-gap TIG welding is used as orbital welding process, it is important to select the optimum conditions for the automatic control welding. This paper looks at the application and metallurgical properties on narrow-gap TIG welding joint of heavy wall large austenitic stainless steel pipe to determine the deposition efficiency, the resultant shrinkage and fracture toughness. The fracture toughness depends slightly on the welding heat input

Clinical long-term outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in infants.

Science.gov (United States)

Schleihauf, Julia; Cleuziou, Julie; Pabst von Ohain, Jelena; Meierhofer, Christian; Stern, Heiko; Shehu, Nerejda; Mkrtchyan, Naira; Kaltenecker, Emanuel; Kühn, Andreas; Nagdyman, Nicole; Hager, Alfred; Seidel, Heide; Lange, Rüdiger; Ewert, Peter; Wolf, Cordula M

2018-03-01

Surgical septal myectomy is performed to relieve left ventricular outflow tract narrowing in severe drug-refractory obstructive hypertrophic cardiomyopathy. The objective of this study was to assess the perioperative and long-term clinical outcome of this procedure performed during infancy. Clinical, transthoracic echocardiographic, electrocardiographic, 24-h Holter, cardiopulmonary exercise test and genetic data were extracted by medical record review. A subset of patients underwent additional prospective detailed clinical evaluation including cardiac magnetic resonance imaging with contrast. Surgery was performed in 23 paediatric patients between 1978 and 2015 at the German Heart Centre Munich. Twelve patients had undergone surgery during infancy (≤ 1 year) (Group A), 11 between 1 and 18 years of age (Group B). The underlying genetic diagnosis was Noonan syndrome spectrum and non-syndromic hypertrophic cardiomyopathy. As compared to Group B, patients in Group A showed more concomitant cardiac procedures and received more homologous transfusions. One perioperative death occurred in Group A, and none in Group B. Two patients in Group A but no patient in Group B required redo septal myectomy. The long-term clinical outcome was similar between the 2 groups. One patient in Group B required cardioverter-defibrillator/pacemaker implantation for higher degree atrioventricular block and none in Group A. There was no evidence of differences in myocardial fibrosis between groups on long-term follow-up magnetic resonance imaging. Surgical septal myectomy can be performed safely during infancy with favourable perioperative and long-term clinical outcome but with a trend towards a higher reoperation rate later in life. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Sub-arc narrow gap welding of Atucha 2 RPV closure head

International Nuclear Information System (INIS)

Hantsch, H.; Million, K.; Zimmermann, H.

1982-01-01

Narrow gap technology was used for reasons of design and fabrication when welding the closure-head dome to its flange. Preliminary tests had yielded the necessary improvements of the well-proven sub-arc practice. New facilities had to be developed for welding proper and for the accompanying machining work (finishing in the narrow gap). Special measures were adopted for monitoring the welding process and for recording the welding parameters. The new method was tried out on several large test coupons before welding of the final product was started. No difficulties were encountered during the welding job. Fabrication of the closure head is shown in a short film sequence. (orig.)

Onset of a nucleate boiling and incipient point of net vapor generation in narrow channel

International Nuclear Information System (INIS)

Hong, G.

2014-01-01

An experimental study on onset of nucleate boiling (ONB) and incipient point of net vapor generation (IPNVG) in narrow rectangular channel was presented. Flow direction in the channel was vertical upward. The experimental results indicate that the classical correlations of ONB for conventional channels were not suitable for the present narrow rectangular channel. The wall superheat needed to initiate boiling is found to be higher for the same given values of heat and mass flux. The experimental results of IPNVG indicate that the heat flux, triggering net vapor generation in narrow rectangular channel, is litter lower than that calculated by correlations for conventional channels. The relative prediction error of qIPNVG by Griffith model, Saha model and Sun model ranges from -17.9% to +9.6%. A new correlation was developed to predict the ONB in narrow rectangular channel. The proposed correlation predictions agreed well with the experimental data. (author)

f-band narrowing in uranium intermetallics

International Nuclear Information System (INIS)

Dunlap, B.D.; Litterst, F.J.; Malik, S.K.; Kierstead, H.A.; Crabtree, G.W.; Kwok, W.; Lam, D.J.; Mitchell, A.W.

1987-01-01

Although the discovery of heavy fermion behavior in uranium compounds has attracted a great deal of attention, relatively little work has been done which is sufficiently systematic to allow an assessment of the relationship of such behavior to more common phenomena, such as mixed valence, narrow-band effects, etc. In this paper we report bulk property measurements for a number of alloys which form a part of such a systematic study. The approach has been to take relatively simple and well-understood materials and alter their behavior by alloying to produce heavy fermion or Kondo behavior in a controlled way

Narrow-Bicliques: Cryptanalysis of Full IDEA

DEFF Research Database (Denmark)

Khovratovich, D.; Leurent, G.; Rechberger, C.

2012-01-01

We apply and extend the recently introduced biclique framework to IDEA and for the first time describe an approach to noticeably speed-up key-recovery for the full 8.5 round IDEA.We also show that the biclique approach to block cipher cryptanalysis not only obtains results on more rounds, but also...... extended with ways to allow for a significantly reduced data complexity with everything else being equal. For this we use available degrees of freedom as known from hash cryptanalysis to narrow the relevant differential trails. Our cryptanalysis is of high computational complexity, and does not threaten...

Analysis of welding distortion due to narrow-gap welding of upper port plug

International Nuclear Information System (INIS)

Biswas, Pankaj; Mandal, N.R.; Vasu, Parameswaran; Padasalag, Shrishail B.

2010-01-01

Narrow-gap welding is a low distortion welding process. This process allows very thick plates to be joined using fewer weld passes as compared to conventional V-groove or double V-groove welding. In case of narrow-gap arc welding as the heat input and weld volume is low, it reduces thermal stress leading to reduction of both residual stress and distortion. In this present study the effect of narrow-gap welding was studied on fabrication of a scaled down port plug in the form of a trapezoidal box made of 10 mm thick mild steel (MS) plates using gas tungsten arc welding (GTAW). Inherent strain method was used for numerical prediction of resulting distortions. The numerical results compared well with that of the experimentally measured distortion. The validated numerical scheme was used for prediction of weld induced distortion due to narrow-gap welding of full scale upper port plug made of 60 mm thick SS316LN material as is proposed for use in ITER project. It was observed that it is feasible to fabricate the said port plug keeping the distortions minimum within about 7 mm using GTAW for root pass welding followed by SMAW for filler runs.

Resistant Hypertension after Hypertensive Intracerebral Hemorrhage Is Associated with More Medical Interventions and Longer Hospital Stays without Affecting Outcome

Directory of Open Access Journals (Sweden)

Daojun Hong

2017-05-01

Full Text Available BackgroundHypertension (HTN is the most common cause of spontaneous intracerebral hemorrhage (ICH. The aim of this study is to investigate the role of resistant HTN in patients with ICH.Methods and resultsWe conducted a retrospective study of all consecutive ICH admissions at our medical center from November 2013 to October 2015. The clinical features of patients with resistant HTN (requiring four or more antihypertensive agents to keep systolic blood pressure <140 mm Hg were compared with those with responsive HTN (requiring three or fewer agents. Of the 152 patients with hypertensive ICH, 48 (31.6% had resistant HTN. Resistant HTN was independently associated with higher body mass index and proteinuria. Compared to the responsive group, patients with resistant HTN had higher initial blood pressures and greater requirement for ventilator support, hematoma evacuation, hypertonic saline therapy, and nicardipine infusion. Resistant HTN increases length of stay (LOS in the intensive care unit (ICU (4.2 vs 2.1 days; p = 0.007 and in the hospital (11.5 vs 7.0 days; p = 0.003. Multivariate regression analysis showed that the rate of systolic blood pressure >140 mm Hg and duration of nicardipine infusion were independently associated with LOS in the ICU. There was no significant difference in hematoma expansion and functional outcome at hospital discharge between the two groups.ConclusionResistant HTN in patients with ICH is associated with more medical interventions and longer LOS without effecting outcome at hospital discharge.

Intersession reliability of self-selected and narrow stance balance testing in older adults.

Science.gov (United States)

Riemann, Bryan L; Piersol, Kelsey

2017-10-01

Despite the common practice of using force platforms to assess balance of older adults, few investigations have examined the reliability of postural screening tests in this population. We sought to determine the test-retest reliability of self-selected and narrow stance balance testing with eyes open and eyes closed in healthy older adults. Thirty older adults (>65 years) completed 45 s trials of eyes open and eyes closed stability tests using self-selected and narrow stances on two separate days (1.9 ± .7 days). Average medial-lateral center of pressure velocity was computed. The ICC results ranged from .74 to .86, and no significant systematic changes (P eyes open and closed balance testing using self-selected and narrow stances in older adults was established which should provide a foundation for the development of fall risk screening tests.

Modeling of air flow through a narrow crack

International Nuclear Information System (INIS)

Trojek, T.; Cechak, T.; Moucka, L.; Fronka, A.

2004-01-01

Radon transport in dwellings is governed to a significant extent by pressure differences and properties of transport pathways. A model of air flow through narrow cracks was created in order to facilitate prediction of air velocity and air flow. Theoretical calculations, based on numerical solution of a system of differential equations, were compared with measurements carried out on a window crack. (P.A.)

An Item Bank for Abuse of Prescription Pain Medication from the Patient-Reported Outcomes Measurement Information System (PROMIS®).

Science.gov (United States)

Pilkonis, Paul A; Yu, Lan; Dodds, Nathan E; Johnston, Kelly L; Lawrence, Suzanne M; Hilton, Thomas F; Daley, Dennis C; Patkar, Ashwin A; McCarty, Dennis

2017-08-01

There is a need to monitor patients receiving prescription opioids to detect possible signs of abuse. To address this need, we developed and calibrated an item bank for severity of abuse of prescription pain medication as part of the Patient-Reported Outcomes Measurement Information System (PROMIS ® ). Comprehensive literature searches yielded an initial bank of 5,310 items relevant to substance use and abuse, including abuse of prescription pain medication, from over 80 unique instruments. After qualitative item analysis (i.e., focus groups, cognitive interviewing, expert review, and item revision), 25 items for abuse of prescribed pain medication were included in field testing. Items were written in a first-person, past-tense format, with a three-month time frame and five response options reflecting frequency or severity. The calibration sample included 448 respondents, 367 from the general population (ascertained through an internet panel) and 81 from community treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network. A final bank of 22 items was calibrated using the two-parameter graded response model from item response theory. A seven-item static short form was also developed. The test information curve showed that the PROMIS ® item bank for abuse of prescription pain medication provided substantial information in a broad range of severity. The initial psychometric characteristics of the item bank support its use as a computerized adaptive test or short form, with either version providing a brief, precise, and efficient measure relevant to both clinical and community samples. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Predicting soil nitrogen content using narrow-band indices from ...

African Journals Online (AJOL)

Optimal fertiliser applications for sustainable forest stand productivity management, whilst protecting the environment, is vital. This study estimated soil nitrogen content using leaf-level narrow-band vegetation indices derived from a hand-held 350–2 500 nm spectroradiometer. Leaf-level spectral data were collected and ...

Medication Safety Systems and the Important Role of Pharmacists.

Science.gov (United States)

Mansur, Jeannell M

2016-03-01

Preventable medication-related adverse events continue to occur in the healthcare setting. While the Institute of Medicine's To Err is Human, published in 2000, highlighted the prevalence of medical and medication-related errors in patient morbidity and mortality, there has not been significant documented progress in addressing system contributors to medication errors. The lack of progress may be related to the myriad of pharmaceutical options now available and the nuances of optimizing drug therapy to achieve desired outcomes and prevent undesirable outcomes. However, on a broader scale, there may be opportunities to focus on the design and performance of the many processes that are part of the medication system. Errors may occur in the storage, prescribing, transcription, preparation and dispensing, or administration and monitoring of medications. Each of these nodes of the medication system, with its many components, is prone to failure, resulting in harm to patients. The pharmacist is uniquely trained to be able to impact medication safety at the individual patient level through medication management skills that are part of the clinical pharmacist's role, but also to analyze the performance of medication processes and to lead redesign efforts to mitigate drug-related outcomes that may cause harm. One population that can benefit from a focus on medication safety through clinical pharmacy services and medication safety programs is the elderly, who are at risk for adverse drug events due to their many co-morbidities and the number of medications often used. This article describes the medication safety systems and provides a blueprint for creating a foundation for medication safety programs within healthcare organizations. The specific role of pharmacists and clinical pharmacy services in medication safety is also discussed here and in other articles in this Theme Issue.

76 FR 12969 - Campaign To Improve Poor Medication Adherence (U18)

Science.gov (United States)

2011-03-09

... the root causes for inadequate medication adherence, and effecting changes in knowledge and behaviors... adherence, a vital first step toward improved adherence behavior and better public health outcomes. DATES... adherence behavior and better health outcomes. Relevance Inadequate medication adherence is a $290 billion...

Narrow power deposition profiles on the JET divertor target

International Nuclear Information System (INIS)

Lingertat, J.; Laux, M.; Monk, R.

2001-01-01

One of the key unresolved issues in the design of a future fusion reactor is the power handling capability of the divertor target plates. Earlier we reported on the existence of narrow power deposition profiles in JET, obtained mainly from Langmuir probe measurements. We repeated these measurements in the MkI, MkII and MkIIGB divertor configurations with an upgraded probe system, which allowed us to study the profile shape in more detail. The main results of this study are: In NB heated discharges the electron temperature and power flux at the outer target show a distinct peak of ∼5 mm half-width near the separatrix strike point. The corresponding profiles on the inner target do not show a similar feature. The height of the narrow peak increases with NB heating power and decreases with deuterium and impurity gas puffing. Ion orbit losses are suggested as a possible explanation of the observed profile shape

Experimental Study on CHF in a Hemispherical Narrow Gap

International Nuclear Information System (INIS)

Jeong, J.H.; Park, R.J.; Kang, K.H.; Kim, S.B.; Kim, H.D.

1999-01-01

As a part of the SONATA-IV program, KAERI is conducting an experimental investigation of critical heat flux(CHF) in hemispherical narrow gaps. A visualization experiment, VISU-II, was done as the first step to get a visual observation of the flow behaviour inside a hemispherical gap and to understand the CHF-triggering mechanism. It was observed that the counter-current flow limitation (CCFL) phenomenon prevented water from wetting the heater surface and induced CHF. The CHFG (Critical Heat Flux in Gap) test is now being performed to measure the CHF and to investigate the inherent cooling mechanism in hemispherical narrow gaps. Temperature measurements over the heater surface show that the two-phase flow behaviour inside the gaps could be quite different from the other usual CHF experiments. The measured CHF points are lower than the predictions by existing empirical correlations based on the data measured with small-scale horizontal plates and vertical annulus. (authors)

Integral-Value Models for Outcomes over Continuous Time

DEFF Research Database (Denmark)

Harvey, Charles M.; Østerdal, Lars Peter

Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions on prefere...... on preferences between real- or vector-valued outcomes over continuous time are satisfied if and only if the preferences are represented by a value function having an integral form......Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions...

Period effects, cohort effects, and the narrowing gender wage gap.

Science.gov (United States)

Campbell, Colin; Pearlman, Jessica

2013-11-01

Despite the abundance of sociological research on the gender wage gap, questions remain. In particular, the role of cohorts is under investigated. Using data from the Current Population Survey, we use age-period-cohort analysis to uniquely estimate age, period, and cohort effects on the gender wage gap. The narrowing of the gender wage gap that occurred between 1975 and 2009 is largely due to cohort effects. Since the mid-1990s, the gender wage gap has continued to close absent of period effects. While gains in female wages contributed to declines in the gender wage gap for cohorts born before 1950, for later cohorts the narrowing of the gender wage gap is primarily a result of declines in male wages. Copyright © 2013 Elsevier Inc. All rights reserved.

Disease Patterns and Outcome for Medical Neurological Patients ...

African Journals Online (AJOL)

Aim: To review the disease pattern and outcome for neurological patients admitted to the intensive care unit (ICU) of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria was undertaken. Patients and Methods: The hospital records (case notes ICU records) were reviewed retrospectively for five years and the ...

Extended Narrow-Line Region in Seyfert Galaxies

Energy Technology Data Exchange (ETDEWEB)

Congiu, Enrico [Dipartimento di Fisica e Astronomia “G. Galilei”, Università di Padova, Padova (Italy); Astronomical Observatory of Brera, National Institute for Astrophysics, Milan (Italy); Contini, Marcella [School of Physics and Astronomy, Tel Aviv University, Tel Aviv (Israel); Ciroi, Stefano; Cracco, Valentina [Dipartimento di Fisica e Astronomia “G. Galilei”, Università di Padova, Padova (Italy); Di Mille, Francesco [Las Campanas Observatory, La Serena (Chile); Berton, Marco [Dipartimento di Fisica e Astronomia “G. Galilei”, Università di Padova, Padova (Italy); Astronomical Observatory of Brera, National Institute for Astrophysics, Milan (Italy); Frezzato, Michele; La Mura, Giovanni; Rafanelli, Piero, E-mail: enrico.congiu@phd.unipd.it [Dipartimento di Fisica e Astronomia “G. Galilei”, Università di Padova, Padova (Italy)

2017-10-24

We present our recent results about the extended narrow-line region (ENLR) of two nearby Seyfert 2 galaxies (IC 5063 and NGC 7212) obtained by modeling the observed line profiles and spectra with composite models (photoionization+shocks) in the different regions surrounding the AGN. Then, we compare the Seyfert 2 ENLRs with the very extended one recently discovered in the narrow-line Seyfert 1 (NLS1) galaxy Mrk 783. We have found several evidences of interaction between the ISM of the galaxies and their radio jets, such as (a) the contribution of shocks in ionizing the high velocity gas, (b) the complex kinematics showed by the profile of the emission lines, (c) the high fragmentation of matter, etc. The results suggest that the ENLR of IC 5063 have a hollow bi-conical shape, with one edge aligned to the galaxy disk, which may cause some kind of dependence on velocity of the ionization parameter. Regarding the Mrk 783 properties, it is found that the extension of the optical emission is almost twice the size of the radio one and it seems due to the AGN activity, although there is contamination by star formation around 12 arcsec from the nucleus. Diagnostic diagrams excluded the contribution of star formation in IC 5063 and NGC 7212, while the shock contribution was used to explain the spectra emitted by their high velocity gas.

A methodology to enlarge narrow stability windows

Energy Technology Data Exchange (ETDEWEB)

Araujo, Ewerton M.P.; Pastor, Jorge A.S.C.; Fontoura, Sergio A.B. [Pontificia Univ. Catolica do Rio de Janeiro (PUC-Rio), RJ (Brazil). Dept. de Engenharia Civil. Grupo de Tecnologia e Engenharia de Petroleo

2004-07-01

The stability window in a wellbore design is defined by the difference between fracture pressure and collapse pressure. Deep water environments typically present narrow stability windows, because rocks have low strength due to under-compaction process. Often also, horizontal wells are drilled to obtain a better development of reservoirs placed in thin layers of sandstone. In this scenario, several challenges are faced when drilling in deep water. The traditional approach for predicting instabilities is to determine collapses and fractures at borehole wall. However, the initiation of rupture does not indicate that the borehole fails to perform its function as a wellbore. Thus, a methodology in which the stability window may be enlarged is desirable. This paper presents one practical analytical methodology that consists in allowing wellbore pressures smaller than the conventional collapse pressure, i.e., based upon failure on the borehole wall. This means that a collapse region (shear failure) will be developed around the borehole wall. This collapse region is pre-defined and to estimate its size is used a failure criterion. The aforementioned methodology is implemented in a user-friendly software, which can perform analyses of stress, pore pressure, formation failure, mud weight and mud salinity design for drilling in shale formations. Simulations of a wellbore drilling in a narrow stability window environment are performed to demonstrate the improvements of using the methodology. (author)

Extended Narrow-Line Region in Seyfert Galaxies

International Nuclear Information System (INIS)

Congiu, Enrico; Contini, Marcella; Ciroi, Stefano; Cracco, Valentina; Di Mille, Francesco; Berton, Marco; Frezzato, Michele; La Mura, Giovanni; Rafanelli, Piero

2017-01-01

We present our recent results about the extended narrow-line region (ENLR) of two nearby Seyfert 2 galaxies (IC 5063 and NGC 7212) obtained by modeling the observed line profiles and spectra with composite models (photoionization+shocks) in the different regions surrounding the AGN. Then, we compare the Seyfert 2 ENLRs with the very extended one recently discovered in the narrow-line Seyfert 1 (NLS1) galaxy Mrk 783. We have found several evidences of interaction between the ISM of the galaxies and their radio jets, such as (a) the contribution of shocks in ionizing the high velocity gas, (b) the complex kinematics showed by the profile of the emission lines, (c) the high fragmentation of matter, etc. The results suggest that the ENLR of IC 5063 have a hollow bi-conical shape, with one edge aligned to the galaxy disk, which may cause some kind of dependence on velocity of the ionization parameter. Regarding the Mrk 783 properties, it is found that the extension of the optical emission is almost twice the size of the radio one and it seems due to the AGN activity, although there is contamination by star formation around 12 arcsec from the nucleus. Diagnostic diagrams excluded the contribution of star formation in IC 5063 and NGC 7212, while the shock contribution was used to explain the spectra emitted by their high velocity gas.

Developments in Veterinary Medical Education : Intentions, perceptions, learning processes and outcomes

NARCIS (Netherlands)

Jaarsma, A.D.C.

2008-01-01

The past decennia, veterinary medical education worldwide has gone through some rapid and major developments. Motivation for these developments were, among others, the explosion of (bio) medical knowledge, the related problem of curriculum overload and the mismatch between university and the

Subjective and Objective Evaluation of PBL Outcomes in Preclinical ...

African Journals Online (AJOL)

Subjective and Objective Evaluation of PBL Outcomes in Preclinical Medical Students. ... ABSTRACT: Problem based learning curriculum is widely recognized as a progressive, learner-centered, active learning approach and is currently used in the entire medical curriculum in over 10% of medical schools worldwide.

Narrowing of the middle cerebral artery: artificial intelligence methods and comparison of transcranial color coded duplex sonography with conventional TCD.

Science.gov (United States)

Swiercz, Miroslaw; Swiat, Maciej; Pawlak, Mikolaj; Weigele, John; Tarasewicz, Roman; Sobolewski, Andrzej; Hurst, Robert W; Mariak, Zenon D; Melhem, Elias R; Krejza, Jaroslaw

2010-01-01

The goal of the study was to compare performances of transcranial color-coded duplex sonography (TCCS) and transcranial Doppler sonography (TCD) in the diagnosis of the middle cerebral artery (MCA) narrowing in the same population of patients using statistical and nonstatistical intelligent models for data analysis. We prospectively collected data from 179 consecutive routine digital subtraction angiography (DSA) procedures performed in 111 patients (mean age 54.17+/-14.4 years; 59 women, 52 men) who underwent TCD and TCCS examinations simultaneously. Each patient was examined independently using both ultrasound techniques, 267 M1 segments of MCA were assessed and narrowings were classified as 50% lumen reduction. Diagnostic performance was estimated by two statistical and two artificial neural networks (ANN) classification methods. Separate models were constructed for the TCD and TCCS sonographic data, as well as for detection of "any narrowing" and "severe narrowing" of the MCA. Input for each classifier consisted of the peak-systolic, mean and end-diastolic velocities measured with each sonographic method; the output was MCA narrowing. Arterial narrowings less or equal 50% of lumen reduction were found in 55 and >50% narrowings in 26 out of 267 arteries, as indicated by DSA. In the category of "any narrowing" the rate of correct assignment by all models was 82% to 83% for TCCS and 79% to 81% for TCD. In the diagnosis of >50% narrowing the overall classification accuracy remained in the range of 89% to 90% for TCCS data and 90% to 91% for TCD data. For the diagnosis of any narrowing, the sensitivity of the TCCS was significantly higher than that of the TCD, while for diagnosis of >50% MCA narrowing, sensitivity of the TCCS was similar to sensitivity of the TCD. Our study showed that TCCS outperforms conventional TCD in detection of diagnosis of >50% MCA narrowing. (E-mail: jaroslaw.krejza@uphs.upenn.edu).

Effect of bubble interface parameters on predicted of bubble departure diameter in a narrow channel

International Nuclear Information System (INIS)

Xu Jianjun; Xie Tianzhou; Zhou Wenbin; Chen Bingde; Huang Yanping

2014-01-01

The predicted model on the bubble departure diameter in a narrow channel is built by analysis of forces acting on the bubble, and effects of bubble interface parameters such as the bubble inclination angle, upstream contact angle, downstream contact angle and bubble contact diameter on predicted bubble departure diameters in a narrow channel are analysed by comparing with the visual experimental data. Based on the above results, the bubble interface parameters as the input parameters used to obtain the bubble departure diameter in a narrow channel are assured, and the bubble departure diameters in a narrow channel are predicted by solving the force equation. The predicted bubble departure diameters are verified by the 58 bubble departure diameters obtained from the vertical and inclined visual experiment, and the predicted results agree with the experimental results. The different forces acting on the bubble are obtained and the effect of thermal parameters in this experiment on bubble departure diameters is analysed. (authors)

The Argument for a Narrow Conception of 'Religious Autonomy'

DEFF Research Database (Denmark)

Christoffersen, Lisbet

2015-01-01

This article argues for a both horizontal and vertical narrow concept of collective freedom of Religion. The most recent ECtHR judgments as well as the US Supreme Court Hosanna-Tabor case leads theory to establish religious autonomy based on parallel legal roders. Nordic theory has been based...

Hydrographic surveys of four narrows within the Namakan reservoir system, Voyageurs National Park, Minnesota, 2011

Science.gov (United States)

Densmore, Brenda K.; Strauch, Kellan R.; Ziegeweid, Jeffrey R.

2013-01-01

The U.S. Geological Survey performed multibeam echosounder hydrographic surveys of four narrows in the Namakan reservoir system in August 2011, in cooperation with the International Joint Commission and Environment Canada. The data-collection effort was completed to provide updated and detailed hydrographic data to Environment Canada for inclusion in a Hydrologic Engineering Centers River Analysis System hydraulic model. The Namakan reservoir system is composed of Namakan, Kabetogama, Sand Point, Crane, and Little Vermilion Lakes. Water elevations in the Namakan reservoir system are regulated according to rule curves, or guidelines for water-level management based on the time of year, established by the International Joint Commission. Water levels are monitored by established gages on Crane Lake and the outlet of Namakan Lake at Kettle Falls, but water elevations throughout the system may deviate from these measured values by as much as 0.3 meters, according to lake managers and residents. Deviations from expected water elevations may be caused by between-lake constrictions (narrows). According to the 2000 Rule Curve Assessment Workgroup, hydrologic models of the reservoir system are needed to better understand the system and to evaluate the recent changes made to rule curves in 2000. Hydrographic surveys were performed using a RESON SeaBat™7125 multibeam echosounder system. Surveys were completed at Namakan Narrows, Harrison Narrows, King Williams Narrows, and Little Vermilion Narrows. Hydrographic survey data were processed using Caris HIPSTM and SIPSTM software that interpolated a combined uncertainty and bathymetric estimator (CUBE) surface. Quality of the survey results was evaluated in relation to standards set by the International Hydrographic Organization (IHO) for describing the uncertainty of hydrographic surveys. More than 90 percent of the surveyed areas at the four narrows have resulting bed elevations that meet the IHO “Special Order” quality

Narrow electron injector for ballistic electron spectroscopy

International Nuclear Information System (INIS)

Kast, M.; Pacher, C.; Strasser, G.; Gornik, E.

2001-01-01

A three-terminal hot electron transistor is used to measure the normal energy distribution of ballistic electrons generated by an electron injector utilizing an improved injector design. A triple barrier resonant tunneling diode with a rectangular transmission function acts as a narrow (1 meV) energy filter. An asymmetric energy distribution with its maximum on the high-energy side with a full width at half maximum of ΔE inj =10 meV is derived. [copyright] 2001 American Institute of Physics

Analysis of ultra-narrow ferromagnetic domain walls

Energy Technology Data Exchange (ETDEWEB)

Jenkins, Catherine; Paul, David

2012-01-10

New materials with high magnetic anisotropy will have domains separated by ultra-narrow ferromagnetic walls with widths on the order of a few unit cells, approaching the limit where the elastic continuum approximation often used in micromagnetic simulations is accurate. The limits of this approximation are explored, and the static and dynamic interactions with intrinsic crystalline defects and external driving elds are modeled. The results developed here will be important when considering the stability of ultra-high-density storage media.

Nonadherence to psoriasis medication as an outcome of limited coping resources and conflicting goals: findings from a qualitative interview study with people with psoriasis.

Science.gov (United States)

Thorneloe, R J; Bundy, C; Griffiths, C E M; Ashcroft, D M; Cordingley, L

2017-03-01

Medication nonadherence is known to limit the effectiveness of available therapies; however, little is known specifically about medication adherence in people with psoriasis. Medicines self-management can feel onerous to those with dermatological conditions due to the nature of therapies prescribed and many individuals with psoriasis experience additional challenges such as physical and psychological comorbidities that place significant additional demands on individuals and may undermine adherence. Viewing nonadherence to medication as an outcome of limited personal coping resources and conflicting goals may help to explain medication nonadherence. To explore individuals' perspectives of their psoriasis, medication and its management. Twenty people with psoriasis were recruited from community samples in England and interviewed in-depth about their perceptions of their psoriasis, medication, and adherence to medication and self-management advice. Data were analysed using Framework Analysis. Participants reported that adhering to recommended treatment regimens conflicted with the management of the physical and psychological demands of living with psoriasis. Medication usage was viewed as a source of unresolved emotional distress and, for some, resulted in poor self-reported adherence, which included medication overuse, underuse and rejection of prescribed therapies. Perceived lack of engagement by clinicians with participants' self-management difficulties was viewed as an additional source of stress and distress. Adhering to medication in psoriasis can be an additional source of considerable emotional distress. We interpreted some episodes of nonadherence to psoriasis medication as rational attempts by individuals to minimize distress and to gain control over their life. © 2016 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

MAG narrow gap welding - an economic way to minimize welding expenses

International Nuclear Information System (INIS)

Kast, W.; Scholz, E.; Weyland, F.

1982-01-01

The thicker structural components are, the more important it is to take measures to reduce the volume of the weld. The welding process requiring the smallest possible weld section is the so-called narrow gap process. In submerged arc narrow gap welding as well as in MAG narrow gap welding different variants are imaginable, some of them already in practical use. With regard to efficiency and weld quality an optimum variant of the MAG narrow gap welding process is described. It constitutes a two wire system in which two wire electrodes of 1.2 mm diameter are arranged one behind the other. In order to avoid lack of fusion, the wire guides are slightly pointed towards each groove face. Thus, by inclining the two arcs burning one behind the other in the direction of weld progress, it is achieved that two separately solidifying weld pools and two beads per layer are simultaneously formed. Welding parameters are selected in such a way that a heat input of 16-20 kJ/cm and a deposition rate of 11-16 kgs/h are obtained. In spite of this comparatively high deposition rate, good impact values are found both in the weld and HAZ (largely reduced coarse-grain zone) which is due to an optimum weld build-up. With the available welding equipment the process can be applied to structural members having a thickness of 40-400 mm. The width of gap is 13 mm (root section) with a bevel angle of 1 0 . As filler metal, basic flux-cored wires are used which, depending on the base metal to be welded and the required tensile properties, can be of the Mn-, MnMo-, MnCrMo-, MnNi-, or MnNiMo-alloyed types. (orig.)

Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder.