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Sample records for nonmarital childbearing escalated

  1. Recent Trends and Variations in Nonmarital Childbearing.

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    Ventura, Stephanie

    1997-01-01

    Describes the increase in nonmarital childbearing in the United States in the past 50 years. Considers age differences in nonmarital childbearing and the disproportionate numbers of poorly educated unmarried mothers. Maintains that changes in sexual behavior of unmarried people and declines in marriages of unmarried pregnant women contributed to…

  2. Has Adolescent Childbearing Been Eclipsed by Nonmarital Childbearing?

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    Anne Martin

    2015-10-01

    Full Text Available Adolescent childbearing has received decreasing attention from academics and policymakers in recent years, which may in part reflect the decline in its incidence. Another reason may be its uncoupling from nonmarital childbearing. Adolescent childbearing became problematized only when it began occurring predominantly outside marriage. In recent decades, there have been historic rises in the rate of nonmarital childbearing, and importantly, the rise has been steeper among older mothers than among adolescent mothers. Today, two out of five births are to unmarried women, and the majority of these are to adults, not adolescents. Nonmarital childbearing is in and of itself associated with lower income and poorer maternal and child outcomes. However, unmarried adolescent mothers might face more difficulties than unmarried adult mothers due to their developmental status, education, living arrangements, and long-term prospects for work. If this is true, then the focus on adolescent mothers ought to continue. We suggest several facets of adolescent motherhood deserving of further study, and recommend that future research use unmarried mothers in their early 20s as a realistic comparison group.

  3. Nonmarital Childbearing, Union History, and Women's Health at Midlife.

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    Williams, Kristi; Sassler, Sharon; Frech, Adrianne; Addo, Fenaba; Cooksey, Elizabeth

    2011-06-01

    Despite high rates of nonmarital childbearing in the U.S., little is known about the health of women who have nonmarital births. We use data from the NLSY79 to examine differences in age 40 self-assessed health between women who had a premarital birth and those whose first birth occurred within marriage. We then differentiate women with a premarital first birth according to their subsequent union histories and estimate the effect of marrying or cohabiting versus remaining never-married on midlife self-assessed health, paying particular attention to the paternity status of the mother's partner and the stability of marital unions. To partially address selection bias, we employ multivariate propensity score techniques. Results suggest that premarital childbearing is negatively associated with midlife health for white and black (but not Hispanic) women. We find no evidence that these negative health consequences of nonmarital childbearing are mitigated by either marriage or cohabitation for black women. For other women, only enduring marriage to the biological father is associated with better health than remaining unpartnered.

  4. Marital Quality and Divorce Decisions: How Do Premarital Cohabitation and Nonmarital Childbearing Matter?

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    Tach, Laura M.; Halpern-Meekin, Sarah

    2012-01-01

    This study used the 1979 cohort of the National Longitudinal Survey of Youth (N = 3,481) to test whether the association between marital quality and divorce is moderated by premarital cohabitation or nonmarital childbearing status. Prior research identified lower marital quality as a key explanation for why couples who cohabit or have children…

  5. The relationship between academic achievement and nonmarital teenage childbearing: evidence from the panel study of income dynamics.

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    Lou, Cary; Thomas, Adam

    2015-06-01

    Females who do well in school are less likely than those who do poorly to experience a nonmarital teenage birth. However, little is known about which dimensions of academic achievement are the most strongly related to teenage childbearing, or about whether the relationship between achievement and childbearing varies according to the presence of other behavioral problems. Individual-level and family-level data from the Panel Study of Income Dynamics, combined with information on contextual state-level economic and policy measures, were used to study nonmarital childbearing between the ages of 16 and 19 among 701 females who turned 16 between 2000 and 2007. Multivariate logistic regression analyses examined the relationship between the probability of nonmarital teenage childbearing and age-standardized scores on academic assessments of letter-word identification, passage comprehension and applied problem-solving ability. Scores on the passage comprehension and applied problem-solving subtests were strongly associated with the probability of experiencing a nonmarital teenage birth among respondents who had relatively few behavioral problems. For this group, an increase of one standard deviation in the score on either assessment was associated with a reduction of about 50% in the risk of experiencing a nonmarital teenage birth. However, no evidence was found of an equivalent relationship among respondents with more pronounced behavioral problems or for the letter-word identification assessment. Future research should continue to explore the possibility that improvements in academic achievement may help to reduce the rate of nonmarital teenage childbearing. Copyright © 2015 by the Guttmacher Institute.

  6. Non-marital pregnancy and the second demographic transition in Australia in historical perspective

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    Gordon Carmichael

    2014-03-01

    Full Text Available Background: Australia has remarkably detailed data on non-marital pregnancy dating from 1908. They both offer insight into long-term trends in childbearing resulting from non-marital sexual activity and reveal in historical context key features of the second demographic transition and its genesis. Objective: Trends are traced in rates of non-marital conception of children ultimately born both outside and within marriage. A range of related indices is also presented in examining how demographic behaviour surrounding non-marital pregnancy (i helped generate the second demographic transition and (ii unfolded as a component of it. Methods: Core indices are rates of non-marital conception partitioned into additive components associated with marital and non-marital confinement. Data on non-marital and early marital births (at marriage durations 0-7 months are lagged back 38 weeks to a date of and age at conception basis to facilitate a common, unmarried, population at risk. Results: Post-war weakening of parental oversight of courtship was a fundamental trigger to the broader rejection of normative and institutional values that underpinned the second demographic transition. In tandem with denying the unmarried access to oral contraception it generated rampant youthful non-marital pregnancy, which undermined Judeo-Christian values, especially once abortion law reform occurred. Conclusions: Childbearing following non-marital conception transitioned rapidly after the 1960s from primarily the unintended product of youthful intercourse in non-coresidential relationships to mainly intended behaviour at normative reproductive ages in consensual unions. Family formation increasingly mixed non-marital births and premaritally and/or maritally conceived marital births.

  7. Three Decades of Nonmarital First Births among Fathers Aged 15-44 in the United States. NCHS Data Brief. Number 204

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    Martinez, Gladys M.

    2015-01-01

    Nonmarital childbearing in the United States increased from the 1940s to the 1990s, peaked in 2007-2008, and declined in 2013 (1-3). In 2013, the nonmarital birth rate was 44.8 births per 1,000 unmarried women aged 15-44. Using data from the National Survey of Family Growth (NSFG), this study examines nonmarital first births reported by fathers…

  8. Religiosity and the Transition to Nonmarital Parity

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    Smith, Scott James

    2014-01-01

    Nonmarital parity is associated with several negative outcomes, including health problems, educational problems, and poverty. Understanding the risk and protective factors associated with nonmarital parenthood can inform policy and interventions, reducing both the incidences and associated consequences. The current study focuses on how intrinsic and extrinsic religiosity (the degree to which individuals or groups employ religious ideology in forming values and making decisions) are related to the timing of nonmarital parity using discrete time hazard modeling of a nationally representative sample of adolescent females (N=7,367) from the National Longitudinal Study of Adolescent Health. The majority of the sample (86 %) claimed a religious affiliation and almost a third (32 %) had a nonmarital birth during the study. Even though the majority of the sample is White (67 %), Black and Hispanic females were more likely to experience a nonmarital birth. Results indicate that intrinsic and extrinsic religiosity and religious affiliation assert protective effects for some populations while religious affiliation increases risk in the full model. Recommendations for policy, intervention, and future research are offered. PMID:25298755

  9. Mothers' Repartnering after a Nonmarital Birth

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    Bzostek, Sharon H.; McLanahan, Sara S.; Carlson, Marcia J.

    2012-01-01

    This article examines the prevalence, predictors and outcomes of unmarried mothers' repartnering patterns following a nonmarital birth. Results indicate that, within five years after a birth, approximately two-thirds of unmarried mothers end their relationship with the focal child's biological father, and more than half of these mothers enter new…

  10. Nonmarital Fertility, Union History, and Women's Wealth.

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    Painter, Matthew; Frech, Adrianne; Williams, Kristi

    2015-02-01

    We use more than 20 years of data from the National Longitudinal Survey of Youth 1979 to examine wealth trajectories among mothers following a nonmarital first birth. We compare wealth according to union type and union stability, and we distinguish partners by biological parentage of the firstborn child. Net of controls for education, race/ethnicity, and family background, single mothers who enter into stable marriages with either a biological father or stepfather experience significant wealth advantages over time (more than $2,500 per year) relative to those who marry and divorce, cohabit, or remain unpartnered. Sensitivity analyses adjusting for unequal selection into marriage support these findings and demonstrate that race (but not ethnicity) and age at first birth structure mothers' access to later marriage. We conclude that not all single mothers have equal access to marriage; however, marriage, union stability, and paternity have distinct roles for wealth accumulation following a nonmarital birth.

  11. Adolescent childbearing.

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    Vernon, M

    1991-05-01

    The concern for the consequences of adolescent pregnancy are discussed. Childbirth among unmarried teenagers results in a higher incidence of low birth weight babies, a higher infant mortality and morbidity rate, a higher percentage of childbirth complications, a decreased likelihood of completing school, a higher risk of unemployment and welfare dependency, limited vocational opportunities, larger families, and vulnerability to psychological problems and distress. In 1988, 66% of all births to teens occurred outside of marriage. Out of wedlock live births to teens 14 years rose from 80.8% in 1970 to 92.5% in 1986, and for teens 15-19 years, 29.5% to 60.8%. 70% have a repeat pregnancy within the 1st year following their 1st childbirth. 50% have a 2nd child within 3 years. Most 2nd pregnancies occur in teenagers who are not using effective contractive methods, and the pregnancy is frequently unplanned and unwanted. The factors affecting the rate of 2nd pregnancy are age, race, marital status, education, and economic status. Teenage mothers tend to come from disadvantaged backgrounds, and childbearing compounds the poverty. Aid to families with dependent children 50% of payments were to teen mothers for the birth of their 1st child. Teen fathers are usually low income providers. The public costs are high. Some teen fathers abandon their children after birth, but many are interested in supporting their child. Specific programs to help prepare fathers are needed. Teenage mothers are stressed by child care arrangements, living arrangements, employment, school, relationships with peers, relationships with parents, housework and errands, health, finances, job counseling, community services, and child care information. Parents play an important role in guiding sexual involvement and early childbearing, and need to understand why teens get pregnant and to keep channels of communication open. Teens are influenced by media, peer pressure, lack of self-esteem, unhappiness

  12. Delayed childbearing.

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    Francis, H H

    1985-06-01

    In many Western nations, including England and Wales, Sweden, and the US, there is a current trend towards delayed childbearing because of women's pursuit of a career, later marriage, a longer interval between marriage and the 1st birth, and the increasing number of divorcees having children in a 2nd marriage. Wives of men in social classes I and II in England and Wales are, on average, having their 1st child at 27.9 years, 1.6 years later than in 1973, and in social classes IV and V, 1.0 years later than in 1973, at a mean age of 23.7 years. Consequently, the total period fertility rate for British women aged 30-34 years, 35-39 years, and 40 and over increased by 4%, 2%, and 4%, respectively, between 1982-83, in contrast to reductions of 2% and 3%, respectively, in the 15-19 year and 20-24 year age groups, with the 25-29-year-olds remaining static. The average maternal mortality for all parties in England and Wales during 1976-78 was 106/million for adolescents, 70.4/million for 20-24 year-olds, and 1162/million for those aged 40 years and older. The specific obstetric and allied conditions which increase with age are the hypertensive diseases of pregnancy, hemorrhage, pulmonary embolism, abortion, cardiac disease, caesarean section, ruptured uterus, and amniotic fluid embolism. The Swedish Medical Birth Registry of all live births and perinatal deaths since 1973 has shown that the risk of late fetal death is significantly greater in women aged 30-39 years than in those of the same parity and gravidity aged 20-24 years. The risk of giving birth to low birth weight babies preterm and at term and of premature labor are similarly increased. The early neonatal death rate also was increased for primigravidas and nulliparas in the 30-39 year age group but not in parous women. This is, in part, due to the rise in incidence of fetal abnormalities with advancing maternal age because of chromosomal and nonchromosomal anomalies. These also appear to be the cause of the

  13. University Students' Experiences of Nonmarital Breakups: A Grounded Theory

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    Hebert, Sarah; Popadiuk, Natalee

    2008-01-01

    Prior nonmarital breakup research has been focused on negative outcomes, rarely examining the personal growth aspects of this experience. In this study, we used a qualitative grounded theory methodology to explore the changes that university students reported experiencing as a result of a heterosexual nonmarital breakup and how those changes…

  14. Declining health disadvantage of non-marital children: Explanation of the trend in the Czech Republic 1990-2010

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    Martina Stipkova

    2013-10-01

    Full Text Available Background: There has been a rapid spread of non-marital childbearing in the Czech Republic during the last two decades. At the same time, the low birth weight rates of children born to married and unmarried mothers have converged. Objective: The goal is to explain the diminishing gap in low birth weight. Two explanations are assessed: the changing selection of unmarried mothers from disadvantaged socio-demographic groups, and increasing social support for unmarried mothers. Methods: Data from birth register are analysed. Marital status (married vs. unmarried disparities in low birth weight are modelled using logistic regression. Further analyses are then performed with a detailed measurement of partnership status. This detailed variable is partially missing and is thus supplemented with multiple imputation. Results: The main explanation for the narrowing gap between the outcomes of children born to married and unmarried mothers is the increasing social support for unmarried mothers. Unmarried motherhood has become less detrimental to a child's birth weight net of maternal demographic characteristics. The decline in selection from disadvantaged socio-demographic groups has also contributed to the convergence. However, the convergence of birth weight trends towards marital children seems to refer mostly to children of partnered mothers, with children of single mothers lagging behind. Conclusions: The positive trends in the health of non-marital children are interpreted as being the result of the increasing institutionalisation of parenthood in non-marital unions. However, this does not apply to unpartnered motherhood, which continues to represent a health disadvantage.

  15. Romania: Childbearing metamorphosis within a changing context

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    Christin Schröder

    2008-07-01

    Full Text Available In 1989, the socialist regime in Romania collapsed and the state's coercive pro-natalist policy ended. Since then, fertility has gone through major changes, namely, a massive reduction in fertility and important structural changes: birth postponement, an end to universal childbearing, and the emergence of non-marital births. Family formation has been postponed, but a pattern of early marriage still persists compared to other European countries. Although unmarried cohabitation is rising, it is rarely seen as an alternative to marriage. Modern contraceptive methods are being used increasingly, but traditional contraceptive methods continue to be widespread. Abortion, which was re-legalized in 1989 and made available after two decades of prohibition, has been practiced extensively ever since, especially after first birth. Romanians in 2004 continue to have a universal preference for parenting. However, the preference for the two-child family has declined and the desire for a larger family has become the exception. The transformation of the socialist regime into a democratic society with a market economy generated a socio-economic crisis, and the majority of social benefits have therefore been oriented towards alleviating poverty. Other social policies, including those affecting the family, were redefined. However, fewer funds were made available than for those geared to promote economic development or reduce poverty and, as a consequence, their impact on childbearing has been small.

  16. Lone mothers and their network support: Sociodemographic research of nonmarital parenthood in Serbia

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    Stanković Biljana

    2014-01-01

    Full Text Available The aim of this paper is to identify and describe the difficulties faced by families with nonmarital children (especially single-parent, available help and support, participation of the father in raising a child, and expected institutional help. That represents a first step toward better understanding of these families. The paper presents part of the results of research carried out in Belgrade with the aim of insight into the phenomenon of nonmarital childbearing at the individual level. It was conducted on a sample of 100 respondents, mothers of nonmarital children, who attend preschool. The survey was anonymous, carried out by the interview method. For this purpose a questionnaire with more than 50 questions was made, standardized to a great extent. In this paper, the focus is on the hardships and needs of the group of lone mothers. Though some issues take into account the answers of all respondents (21 cohabited mothers and 79 lone mothers, the analysis is largely related to the experiences and reflections of lone mothers. The 2011 Census data on prevalence of consensual unions and characteristics of persons living in them, as well as earlier data on the acknowledgment of paternity, do not indicate that nonmarital childbearing in Serbia takes place primarily in stable unions. It is realistic to assume that a large percentage of mothers with nonmarital children are lone mothers. The research results are generally consistent with the findings of relevant studies from our and foreign countries. As the largest difficulties, lone mothers emphasize financial problems, unemployment, housing difficulties, and child care, as well as a pronounced feeling of loneliness. Most of them in solving problems and rising children rely on their parents and siblings, with whom they often live in the same household. Every fifth lone mother when faced with a major problem, and every ninth in everyday raising a child can count on the father of the child. About a

  17. Spirituality in Childbearing Women

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    Callister, Lynn Clark; Khalaf, Inaam

    2010-01-01

    Childbearing is the ideal context within which to enrich spirituality. The purpose of this study was to generate themes regarding spirituality and religiosity among culturally diverse childbearing women. A secondary analysis was performed, using existing narrative data from cross-cultural studies of childbearing women. The following themes emerged from the data: childbirth as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, childbirth as a time to make religiosity more meaningful, the significance of a Higher Power in influencing birth outcomes, and childbirth as a spiritually transforming experience. In clinical settings, understanding the spiritual dimensions of childbirth is essential. Assessments of childbearing women may include the question, “Do you have any spiritual beliefs that will help us better care for you?” PMID:20498751

  18. Maybe I Do: Interpersonal Commitment and Premarital or Nonmarital Cohabitation

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    Stanley, Scott M.; Whitton, Sarah W.; Markman, Howard J.

    2004-01-01

    Explanations for the risks associated with premarital and nonmarital cohabitation (e.g., higher rates of breakup and divorce, lower relationship satisfaction, and greater risk for violent interaction) have focused on levels of conventionality, including attitudes about commitment to the institution of marriage. However, relatively little attention…

  19. Diffusion of childbearing within cohabitation.

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    Vitali, Agnese; Aassve, Arnstein; Lappegård, Trude

    2015-04-01

    The article analyzes the diffusion of childbearing within cohabitation in Norway, using municipality data over a 24-year period (1988-2011). Research has found substantial spatial heterogeneity in this phenomenon but also substantial spatial correlation, and the prevalence of childbearing within cohabitation has increased significantly over time. We consider several theoretical perspectives and implement a spatial panel model that allows accounting for autocorrelation not only on the dependent variable but also on key explanatory variables, and hence identifies the key determinants of diffusion of childbearing within cohabitation across space and over time. We find only partial support for the second demographic transition as a theory able to explain the diffusion of childbearing within cohabitation. Our results show that at least in the first phase of the diffusion (1988-1997), economic difficulties as measured by increased unemployment among men contributed to the diffusion of childbearing within cohabitation. However, the most important driver for childbearing within cohabitation is expansion in education for women.

  20. Single Mothers, Single Fathers: Gender Differences in Fertility after a Nonmarital Birth

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    Guzzo, Karen Benjamin; Hayford, Sarah R.

    2010-01-01

    Research on nonmarital fertility has focused almost exclusively on unmarried mothers, due in part to a lack of fertility information for men. Cycle 6 of the National Survey of Family Growth allows exploration of nonmarital fertility for both genders.The authors compare the characteristics of unmarried first-time mothers (n = 2,455) and fathers (n…

  1. Single Mothers, Single Fathers: Gender Differences in Fertility after a Nonmarital Birth

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    Guzzo, Karen Benjamin; Hayford, Sarah R.

    2010-01-01

    Research on nonmarital fertility has focused almost exclusively on unmarried mothers, due in part to a lack of fertility information for men. Cycle 6 of the National Survey of Family Growth allows exploration of nonmarital fertility for both genders.The authors compare the characteristics of unmarried first-time mothers (n = 2,455) and fathers (n…

  2. Nonmarital Fertility and the Effects of Divorce Rates on Youth Suicide Rates

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    Messner, Steven F.; Bjarnason, Thoroddur; Raffalovich, Lawrence E.; Robinson, Bryan K.

    2006-01-01

    Using pooled, time-series data for a sample of 15 developed nations, we assess the effect of divorce rates on gender-specific suicide rates for youths aged 15-19 with models of relative cohort size, lagged nonmarital fertility, and an interaction term for divorce rates and nonmarital fertility. The results reveal that, for young men, relative…

  3. Before escalation: behavioral and affective forecasting in escalation of commitment.

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    Ku, Gillian

    2008-11-01

    This research examines preinvestment forecasting processes in escalation of commitment, considering two questions: whether individuals are able to accurately predict their behavior and affect in escalation situations and how forecasting processes may be linked to actual escalation. Three experiments demonstrated that individuals underpredicted their escalation and overpredicted their postescalation regret. Two of the experiments also indicated that the less individuals predicted being entrapped, the more they escalated. Counter to expectations, anticipated regret did not predict escalation. The discussion focuses on the theoretical and practical importance of forecasting on escalation and on the importance of understanding both behavioral and affective forecasting effects simultaneously.

  4. Neighborhood Poverty and Nonmarital Fertility: Spatial and Temporal Dimensions

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    South, Scott J.; Crowder, Kyle

    2010-01-01

    Data from 4,855 respondents to the Panel Study of Income Dynamics were used to examine spatial and temporal dimensions of the effect of neighborhood poverty on teenage premarital childbearing. Although high poverty in the immediate neighborhood increased the risk of becoming an unmarried parent, high poverty in surrounding neighborhoods reduced…

  5. NEIGHBORHOOD POVERTY AND NONMARITAL FERTILITY: SPATIAL AND TEMPORAL DIMENSIONS

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    South, Scott J.; Crowder, Kyle

    2010-01-01

    Data from 4,855 respondents to the Panel Study of Income Dynamics were used to examine spatial and temporal dimensions of the effect of neighborhood poverty on teenage premarital childbearing. Although high poverty in the immediate neighborhood increased the risk of becoming an unmarried parent, high poverty in surrounding neighborhoods reduced this risk. The effect of local neighborhood poverty was especially pronounced when surrounding neighborhoods were economically advantaged. Measuring e...

  6. Happiness and Childbearing across Europe

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    Aassve, Arnstein; Goisis, Alice; Sironi, Maria

    2012-01-01

    Using happiness as a well-being measure and comparative data from the European social survey we focus in this paper on the link between happiness and childbearing across European countries. The analysis motivates from the recent lows in fertility in many European countries and that economic wellbeing measures are problematic when considering…

  7. Happiness and Childbearing across Europe

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    Aassve, Arnstein; Goisis, Alice; Sironi, Maria

    2012-01-01

    Using happiness as a well-being measure and comparative data from the European social survey we focus in this paper on the link between happiness and childbearing across European countries. The analysis motivates from the recent lows in fertility in many European countries and that economic wellbeing measures are problematic when considering…

  8. Single Mothers, Single Fathers: Gender Differences in Fertility after a Nonmarital Birth

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    Guzzo, Karen Benjamin; Hayford, Sarah R.

    2010-01-01

    Research on nonmarital fertility has focused almost exclusively on unmarried mothers, due in part to a lack of fertility information for men. Cycle 6 of the National Survey of Family Growth allows exploration of nonmarital fertility for both genders. We compare the characteristics of unmarried first-time mothers (n = 2,455) and fathers (n = 797), use event history techniques to model second birth hazards, and examine the distribution of men’s and women’s second births across types of relation...

  9. Decreasing nonmarital births and strengthening marriage to reduce poverty.

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    Amato, Paul R; Maynard, Rebecca A

    2007-01-01

    Since the 1970s, the share of U.S. children growing up in single-parent families has doubled, a trend that has disproportionately affected disadvantaged families. Paul Amato and Rebecca Maynard argue that reversing that trend would reduce poverty in the short-term and, perhaps more important, improve children's growth and development over the long term, thus reducing the likelihood that they would be poor when they grew up. The authors propose school and community programs to help prevent nonmarital births. They also propose to lower divorce rates by offering more educational programs to couples before and during marriage. Amato and Maynard recommend that all school systems offer health and sex education whose primary message is that parenthood is highly problematic for unmarried youth. They also recommend educating young people about methods to prevent unintended pregnancies. Ideally, the federal government would provide tested curriculum models that emphasize both abstinence and use of contraception. All youth should understand that unintended pregnancies are preventable and have enormous costs for the mother, the father, the child, and society. Strengthening marriage, argue the authors, is also potentially an effective strategy for fighting poverty. Researchers consistently find that premarital education improves marital quality and lowers the risk of divorce. About 40 percent of couples about to marry now participate in premarital education. Amato and Maynard recommend doubling that figure to 80 percent and making similar programs available for married couples. Increasing the number of couples receiving services could mean roughly 72,000 fewer divorces each year, or around 65,000 fewer children entering a single-parent family every year because of marital dissolution. After seven or eight years, half a million fewer children would have entered single-parent families through divorce. Efforts to decrease the share of children in single-parent households, say the

  10. Teenage Cohabitation, Marriage, and Childbearing

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    Manning, Wendy D.; Cohen, Jessica A.

    2014-01-01

    Cohabitation is an integral part of family research; however, little work examines cohabitation among teenagers or links between cohabitation and teenage childbearing. Drawing on the National Survey of Family Growth (2006–10), we examine family formation activities (i.e., cohabitation, marriage, and childbearing) of 3,945 15–19 year old women from the mid 1990s through 2010. One-third (34%) of teenagers cohabit, marry, or have a child. Teenage cohabitation and marriage are both positively associated with higher odds of having a child. The vast majority of single pregnant teenagers do not form a union before the birth of their child; only 22% cohabit and 5% marry. Yet most single pregnant teenagers eventually cohabit, 59% did so by the child’s third birthday and about 9% marry. Cohabitation is an important part of the landscape of the adolescent years, and many teenage mothers described as “single mothers” are actually in cohabiting relationships. PMID:25972620

  11. Cohabitation, post-conception unions, and the rise in nonmarital fertility.

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    Lichter, Daniel T; Sassler, Sharon; Turner, Richard N

    2014-09-01

    The majority of U.S. nonmarital births today are to cohabiting couples. This study focuses on transitions to cohabitation or marriage among pregnant unmarried women during the period between conception and birth. Results using the newly-released 2006-2010 National Survey of Family Growth show that nonmarital pregnancy is a significant precursor to cohabitation before childbirth (18%), exceeding transitions to marriage (5%) by factor of over three. For pregnant women, the boundaries between singlehood, cohabitation, and marriage are highly fluid. The results also reveal substantial variation in post-conception cohabiting and marital unions; e.g., disproportionately low percentages of black single and cohabiting women transitioned into marriage, even when conventional social and economic risk factors are controlled. The multivariate analyses also point to persistent class differences in patterns of family formation, including patterns of cohabitation and marriage following conception. Poorly educated women, in particular, are much more likely to become pregnant as singles living alone or as partners in cohabiting unions. But compared with college-educated women, pregnancies are less likely to lead to either cohabitation or marriage. This paper highlights the conceptual and technical challenges involved in making unambiguous interpretations of nonmarital fertility during a period of rising nonmarital cohabitation.

  12. Relationship-Specific Investments, Family Chaos, and Cohabitation Dissolution Following a Nonmarital Birth

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    Kamp Dush, Claire M.

    2011-01-01

    Predictors of two types of cohabitation dissolution, dissolution with a continued romantic relationship and without (i.e., breakup), were examined using data from mothers cohabiting at the time of a nonmarital birth in the Fragile Families and Child Wellbeing Study (N = 1,624). Life tables indicated 64% of unions dissolved within 5 years; of…

  13. Proposed amendments to the legal proposition on establishment of non-marital paternity from 1855

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    Kulauzov Maša M.

    2015-01-01

    Full Text Available Proposed amendments to the article 130 of Serbian Civil Code (henceforth: SCC of 1844 regarding establishment of non-marital paternity were scrutinized in this paper. Originally, establishment of non-marital paternity was granted, but with significant restriction that presumed parent could have been declared the father of an illegitimate child only if he had recognized paternity. That is the reason why in 1855 the Supreme Court suggested amendment to the provision concerning determination of paternity. According to proposed modification, evidence that presumed father was on intimate terms with child's mother in the time of conception should have been sufficient for establishment of paternity. As non-marital relationships were condemned in patriarchal Serbian 19th century society, illegitimate children were considered a product of sin and family disgrace. Hence, the Ministry of Justice, the State Council and Prince Aleksandar Karađorđević were not interested in bettering their position by widening possibilities of determination of fatherhood. Subsequently, in 1868 the amendment was passed by which non-marital paternity could not have been established by a court order, subject to certain exceptions (if one raped or abducted a woman, and the time of conception coincided with the time of abduction or rape. Since 1868 paternity could have been determined solely subject to the consent, i.e. recognition of the illegitimate father.

  14. Relationship-Specific Investments, Family Chaos, and Cohabitation Dissolution Following a Nonmarital Birth

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    Kamp Dush, Claire M.

    2011-01-01

    Predictors of two types of cohabitation dissolution, dissolution with a continued romantic relationship and without (i.e., breakup), were examined using data from mothers cohabiting at the time of a nonmarital birth in the Fragile Families and Child Wellbeing Study (N = 1,624). Life tables indicated 64% of unions dissolved within 5 years; of…

  15. Expo 86: An Escalation Prototype.

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    Ross, Jerry; Staw, Barry M.

    1986-01-01

    British Columbia remained committed to its decision to host a world's fair (Expo 86) despite rapidly increasing deficit projections. Expo is examined as a prototypical example of the escalation of commitment. Theory is proposed that integrates determinants of escalation from several levels of analysis over time. (CJH)

  16. Escalation Practices in Automotive Development

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    Tomaž Jurejevčič

    2016-12-01

    Full Text Available Research Question (RQ: In automotive business many risk-involved situations occur and when detected, an escalation process takes place. Although defined and controlled by process guidelines and being supported by experts, escalation brings increased emotional pressure and stress for parties involved. Do escalation processes in automotive industry maintain all implied challenges? Purpose: The purpose of the article is to present current status of escalation processes and gaps between theory and practice cases. Results of the analysis are recommendations of good engineering practice derived also from actual experiences and learned lessons. Method: The method involves analysis of practical cases from automotive development process, lessons learned, anonymous survey of automotive engineers and classification of experiences. Results: Results of the survey have shown that the controlled escalation process for know-how related escalations is needed in order to establish the environment where the team is able to provide new, sometimes unconventional ideas for the problem to be solved. Organization: Presented recommendations and measures enable organization and managers to put the expertise and experiences of employees into action for problem solving during escalation. Originality: In this article some practices are presented that, although simple and some yet seen, with proper adjustment stemming from real life processes give a fruitful settlement of escalations in automotive development business.

  17. Adolescent sexual behavior and childbearing.

    Science.gov (United States)

    Zabin, L S

    1994-01-01

    Low self esteem does not explain problems of adolescence, particularly unwanted pregnancy and early childbearing. This intimates that their root causes are personal rather than structural and socioeconomic, thereby allowing us to blame the victim. Contrary to popular opinion, few teens (10%) want to conceive and most teens want something other than pregnancy, indicating a need for effective intervention. Teens who were ambivalent about childbearing 2 years earlier are just as likely to have given birth as those who wanted to conceive. Teens self-concept is based on the reality of their environment, which, for most teens who have given birth, involves chronic unemployment, a culture of single parenthood in which men play no supportive role in the home, and the knowledge that teens who choose to continue to attend school despite having given birth fare the same as those who drop out of school. Structural changes (jobs and career goals), long term intervention, and continuous social support are needed to improve a teen's capacity to make choices, especially those concerning contraception. In other words, motivation must be so strong that conceptions are avoided. No family wants to go on welfare and no woman wants to have a baby while a teenager, but when teens become pregnant, they tend not to choose abortion. If welfare reform creates true opportunity for jobs, it will create the motivation to avoid pregnancy but not reduce the childbearing rate among teens that conceive. Very early maturation is correlated with very early onset of sexual activity. The very best sex education and services are unlikely to be offered at a young enough age in schools. US society is obsessed with and unwilling to talk about sex. The notion of choice is not part of poor America. Interactive interventions providing continuing support are needed to make a difference in adolescent pregnancy.

  18. Adolescent Pregnancy and Childbearing: Findings from Research.

    Science.gov (United States)

    Chilman, Catherine S.; And Others

    Issues and trends related to adolescent pregnancy and childbearing in the United States are discussed in the 12 papers collected in this publication. Chapters I and II delineate trends in teenage childbearing and explore aspects of psychosocial development and social problems associated with teenage illegitimacy. Chapters III and IV describe…

  19. Escalation of the Space Domain

    Science.gov (United States)

    2015-04-01

    spacepower – what is meant by spacepower and how might its elements be made available for escalation. Chapter 2 Escalation 101 “We sleep safely...its instruments of national power to change the forthcoming behavior of an adversary.21 There are two distinct types of coercion: punishment and...are similar in nature and application to those seen in science fiction moves or on television (i.e., Star Trek) that can provide direct kinetic

  20. Understanding behavior in escalation situations.

    Science.gov (United States)

    Staw, B M; Ross, J

    1989-10-13

    Everyday observation reveals that both individuals and organizations often become overly committed to losing courses of action; in a sense, throwing good money after bad. More than 10 years of research on this escalation problem shows that persistence is associated with at least four major clases of determinants: project, psychological, social, and organizational variables. The influence of these four sets of variables evolves over time, forming a dynamic model of behavior in escalation situations.

  1. Pornography consumption and non-marital sexual behaviour in a sample of young Indonesian university students

    DEFF Research Database (Denmark)

    Hald, Gert Martin; Mulya, Teguh Wijaya

    2013-01-01

    Using a sample of Indonesian university students and a cross sectional design, this study investigated prevalence rates and patterns of pornography consumption in Indonesia, a religious, sexually conservative, Muslim-majority nation with strict anti-pornography laws. Further, the association...... between pornography consumption and common non-marital sexual behaviours was explored. The study found that in this sample, pornography is as widely and readily consumed as in comparable international studies predominantly utilising Western background samples from more sexually liberal and less religious...... countries with very few laws on pornography. Gender differences in patterns of pornography consumption were pronounced and comparable with findings in international counterpart studies. For men only, pornography consumption was found to significantly predict common sexual behaviours in non-marital relations...

  2. Pornography consumption and non-marital sexual behaviour in a sample of young Indonesian university students.

    Science.gov (United States)

    Hald, Gert Martin; Mulya, Teguh Wijaya

    2013-01-01

    Using a sample of Indonesian university students and a cross sectional design, this study investigated prevalence rates and patterns of pornography consumption in Indonesia, a religious, sexually conservative, Muslim-majority nation with strict anti-pornography laws. Further, the association between pornography consumption and common non-marital sexual behaviours was explored. The study found that in this sample, pornography is as widely and readily consumed as in comparable international studies predominantly utilising Western background samples from more sexually liberal and less religious countries with very few laws on pornography. Gender differences in patterns of pornography consumption were pronounced and comparable with findings in international counterpart studies. For men only, pornography consumption was found to significantly predict common sexual behaviours in non-marital relations. The study is the first to provide insights into prevalence rates and patterns of pornography consumption and its association with common non-marital sexual behaviours in a sexually conservative, Muslim-majority nation with strict anti-pornography laws.

  3. Understanding Behavior in Escalation Situations.

    Science.gov (United States)

    Staw, Barry M.; Ross, Jerry

    1989-01-01

    The escalation of commitment has been variously labeled the psychology of entrapment, the sunk cost effect, and the too-much-invested-to-quit syndrome. This article reviews the state of research and describes four major determinants: project; psychological; social; and organizational variables. A model is provided. (YP)

  4. Crisis and Escalation in Cyberspace

    Science.gov (United States)

    2012-01-01

    which both sides cannot bear escalation without matching it. Inci- dentally , no state should count on being able to argue that some effect was an...note. Economic theory says that the greater the price of something, the less people will want it: If potato prices rises, people will eat pasta . If

  5. Coparenting experiences in African American families: an examination of single mothers and their nonmarital coparents.

    Science.gov (United States)

    Gonzalez, Michelle; Jones, Deborah; Parent, Justin

    2014-03-01

    African American youth from single-mother homes continue to be overrepresented in statistics on risk behavior and delinquency, a trend that many be attributed to father-absence, socioeconomic disadvantage, and compromises in parenting more typical of single than two-parent families. Yet, this risk-focused perspective ignores a long-standing strength of the African American community, the involvement and potential protective impact of extended family members in childrearing. This study describes the experiences of 95 African American single mothers and their nonmarital coparents who participated in a study of African American single-mother families with an 11-16-year-old child. Specifically, the study examines: (a) the extent to which nonmarital coparents are involved in childrearing; (b) the relative levels of risk (i.e., depression, mother-coparent conflict) and protective (i.e., parenting) associated with maternal and coparent involvement; and (c) how similarly and/or differently coparent and mother variables operate with regard to youth externalizing problems. Findings reveal that a range of family members and other adults actively participate in childrearing in African American single-mother families, coparents do not differ from mothers on certain study variables (i.e., depression and mother-coparent conflict) but do for others (parenting), and coparent involvement is associated with youth adjustment in ways that are similar to our more established understanding of maternal involvement. The potential clinical implications of the findings are discussed and future research directions are highlighted.

  6. East Asian childbearing patterns and policy developments.

    Science.gov (United States)

    Frejka, Tomas; Jones, Gavin W; Sardon, Jean-Paul

    2010-01-01

    Childbearing behavior in East Asian countries has changed rapidly during the past half century from an average of five to seven children per family, to replacement-level fertility, and subsequently to unprecedentedly low levels, the lowest in the world. This article analyzes fertility trends in Hong Kong, Japan, singapore, south Korea, and Taiwan using cohort fertility data and methods, then examines social and economic causes of the childbearing trends, and surveys policies pursued to reverse the fertility trends. Postponement of childbearing started in the 1970s with continuously fewer delayed births being "recuperated," which resulted in ultra-low fertility. A rapid expansion of education and employment among women in a patriarchal environment has generated a stark dilemma for women who would like to combine childbearing with a career. Policy responses have been slow, with a more serious attempt to address issues in recent years. Thus far public and private institutions are not devoting sufficient attention to generating broad social change supportive of parenting.

  7. Moving Walkways, Escalators, and Elevators

    CERN Document Server

    Cardinal, J; Hurtado, F; Langerman, S; Palop, B

    2007-01-01

    We study a simple geometric model of transportation facility that consists of two points between which the travel speed is high. This elementary definition can model shuttle services, tunnels, bridges, teleportation devices, escalators or moving walkways. The travel time between a pair of points is defined as a time distance, in such a way that a customer uses the transportation facility only if it is helpful. We give algorithms for finding the optimal location of such a transportation facility, where optimality is defined with respect to the maximum travel time between two points in a given set.

  8. Trends in Attitudes About Marriage, Childbearing, and Sexual Behavior: United States, 2002, 2006-2010, and 2011-2013.

    Science.gov (United States)

    Daugherty, Jill; Copen, Casey

    2016-03-17

    This report describes attitudes about marriage, childbearing, and sexual behavior among men and women aged 15-44 in the United States based on the 2002, 2006-2010, and 2011-2013 National Survey of Family Growth (NSFG). Data for all three survey periods were collected through in-person interviews with nationally representative, independent samples of men and women in the household population of the United States. The overall response rate for NSFG was 79% in 2002, 77% in 2006-2010, and 73% in 2011-2013. Attitudinal items examined in this report include those related to marriage, divorce, cohabitation, parenthood, and sexual behavior. Where data from all three survey periods were available, differences were tested using trend analysis. Data from the 2002 survey were not available for some attitude items, and in these cases, comparisons were made only between the 2006-2010 and 2011-2013 surveys. Attitudinal differences by age group were analyzed using 2011-2013 data. All results are shown separately for women and men. From 2002 to 2011-2013, there was an increase in the percentages of men and women who agreed with premarital cohabitation, nonmarital childbearing, the right for gay and lesbian adults to adopt children, same-sex sexual relations, and premarital sex for those aged 18. There was a decrease in the percentages of men and women who agreed with divorce. There was no change in the percentages of men and women who agreed with premarital sex for those aged 16. There was no change from 2006-2010 to 2011-2013 in attitudes regarding marriage, cohabitation and the risk of divorce, the necessity of having children for one's happiness, and raising children in a cohabiting union. Several of the attitudinal items varied significantly by age group for both men and women. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

  9. Escalation of commitment with transparent future outcomes.

    Science.gov (United States)

    Karlsson, Niklas; Gärling, Tommy; Bonini, Nicolao

    2005-01-01

    A frequent case of irrational decision making is the tendency to escalate commitment to a chosen course of action after unsuccessful prior investments of money, effort, or time (sunk costs). In previous research it is argued that escalation does not occur when future outcomes and alternative investments are transparent. Inconsistent with this argument, in an experiment in which undergraduates were presented fictitious investment problems with sunk costs, escalation was demonstrated when full information was given about investment alternatives and estimates of future returns. Thus, it is indicated that people may escalate despite knowing that it will not make them economically better off. A more comprehensive understanding of escalation requires disentangling people's noneconomic reasons for escalation.

  10. Nonmarital romantic relationship commitment and leave behavior: the mediating role of dissolution consideration.

    Science.gov (United States)

    Vanderdrift, Laura E; Agnew, Christopher R; Wilson, Juan E

    2009-09-01

    Two studies investigated the process by which individuals in nonmarital romantic relationships characterized by low commitment move toward enacting leave behaviors. Predictions based on the behavioral, goal, and implementation intention literatures were tested using a measure of dissolution consideration developed for this research. Dissolution consideration assesses how salient relationship termination is for an individual while one's relationship is intact. Study 1 developed and validated a measure of dissolution consideration and Study 2 was a longitudinal test of the utility of dissolution consideration in predicting the enactment of leave behaviors. Results indicated that dissolution consideration mediates the association between commitment and enacting leave behaviors, is associated with taking more immediate action, and provides unique explanatory power in leave behavior beyond the effect of commitment alone. Collectively, the findings suggest that dissolution consideration is an intermediate step between commitment and stay/leave behavior in close relationships.

  11. Discovering Self: Childbearing Adolescents' Maternal Identity.

    Science.gov (United States)

    Macintosh, Janelle; Callister, Lynn Clark

    2015-01-01

    Adolescent pregnancy and motherhood have long been a topic of interest for many healthcare professionals. However, there are limited data on how childbearing adolescents incorporate motherhood identity into their sense of self. The purpose of this study was to explore how childbearing adolescents perceive motherhood as becoming part of their personal identity. This qualitative study using ethnographic data collection involved 7 months of observation, interaction, and interviews. Data were collected from nine expectant adolescents during in-depth interviews. All participants were patients at a teen mother and child clinic staffed by certified nurse midwives and a pediatrician. Narrative content analysis revealed the overall theme of discovering self, with three major themes: confirming the pregnancy, the loss of my body, and imagining my child in my arms. Adolescent mothers may need assistance to construct their maternal identity in order to strengthen self-perceptions and improve maternal/child outcomes.

  12. Escalate shamefully, de-escalate angrily or gratefully: the influence of discrete emotions on escalation of commitment.

    Science.gov (United States)

    Dang, Junhua; Xiao, Shanshan; Liljedahl, Sophie

    2014-08-01

    Decision makers often tend to escalate their commitment when faced with a dilemma of whether to continue a losing course of action. Researchers recently began to investigate the influence of discrete emotions on this decision tendency. However, this work has mainly focused on negative emotions and rarely considered positive emotions, to say nothing of comparing the effects of both of them simultaneously. The current study addresses this need by presenting the results of three experiments that examined the effects of four emotions of both positive and negative valences in escalation situations. Experiment 1 investigated the relationships of three trait emotions (hope, shame, and anger) and escalation of commitment. Experiments 2 and 3 examined the effects of three induced emotions (anger, shame, and gratitude) on escalation of commitment in a student sample and an employee sample, respectively. The results revealed that the effects of discrete emotions in escalation situations are mainly due to their associated differences on the appraisal dimension of responsibility that is related to escalation situations rather than their valence. The theoretical and practical implications are discussed.

  13. Abortion Legalization and Childbearing in Mexico.

    Science.gov (United States)

    Gutiérrez Vázquez, Edith Y; Parrado, Emilio A

    2016-06-01

    In 2007 abortion was legalized in the Federal District of Mexico, making it the largest jurisdiction in Latin America, outside of Cuba, to allow women to have abortions on request during the first trimester of pregnancy. While the implications of the law for women's health and maternal mortality have been investigated, its potential association with fertility behavior has yet to be assessed. We examine metropolitan-area differences in overall and parity-specific childbearing, as well as the age pattern of childbearing between 2000 and 2010 to identify the contribution of abortion legalization to fertility in Mexico. Our statistical specification applies difference-in-difference regression methods that control for concomitant changes in other socioeconomic predictors of fertility to assess the differential influence of the law across age groups. In addition, we account for prior fertility levels and change to better separate the effect of the law from preceding trends. Overall, the evidence suggests a systematic association between abortion legalization and fertility. The law appears to have contributed to lower fertility in Mexico City compared to other metropolitan areas and prior trends. The influence is mostly visible among women aged 20-34 in connection with the transition to first and second child, with limited impact on teenage fertility. There is some evidence that its effect might be diffusing to the Greater Mexico City Metropolitan area.

  14. Assessment of non-marital sexual behaviours of men in Bangladesh: a methodological experiment using a modified confidential ballot-box method.

    Science.gov (United States)

    Chowdhury, M E; Alam, N; Anwar, I; Ahmed, A; Saidel, T; Mallick, P S; Kelly, R; Streatfield, P K

    2012-03-01

    This study assessed the effectiveness of a modified ballot-box method (MBBM) in eliciting non-marital sexual behaviours compared with face-to-face interview (FTFI). A cross-sectional survey collected data from men aged 18-49 years in Bangladesh using a multistage cluster sampling method. In total, 3499 and 3623 respondents were interviewed by MBBM and FTFI, respectively. In the MBBM, pre-recorded questions were administered using a portable audio-cassette player with two pairs of headphones used concurrently by the respondent and the interviewer. Overall, 18% of the respondents had non-marital sexual exposure in the past year. The MBBM elicited higher responses of non-marital sex (adjusted odds ratio (aOR) 1.3, 95% confidence interval [CI]: 1.1, 1.5) compared with FTFI. The interview methods did not, however, revealed significant differences in response to condom-use rates and the number of non-marital sexual partners. The MBBM is more effective than the FTFI method in eliciting higher responses rates of non-marital sexual contacts and may be recommended for reliable estimates of sexual behaviours.

  15. Age-varying associations between nonmarital sexual behavior and depressive symptoms across adolescence and young adulthood.

    Science.gov (United States)

    Vasilenko, Sara A

    2017-02-01

    Research has demonstrated associations between adolescent sexual behavior and depressive symptoms, but no single study has examined individuals at different ages throughout adolescence and young adulthood in order to determine at what ages sexual behavior may be associated with higher or lower levels of depressive symptoms. Using nationally representative longitudinal data and an innovative method, the time-varying effect model (TVEM), which examines how the strength of an association changes over time, this study examines how nonmarital sexual intercourse is associated with depressive symptoms at different ages, which behaviors and contexts may contribute to these associations, and whether associations differ for male and female participants. Findings indicate that sexual behavior in adolescence is associated with a higher level of depressive symptoms, particularly for female adolescents, and this association is relatively consistent across different partner types and adolescent contexts. Associations between sexual behavior and depressive symptoms in young adulthood are more dependent on partner factors and adolescent contexts; sexual behavior in young adulthood is associated with fewer depressive symptoms for women who have sex with a single partner and for men whose parents did not strongly disapprove of adolescent sexual behavior. Findings suggest that delaying sexual behavior into young adulthood may have some benefits for mental health, although contextual and relationship factors also play a role. (PsycINFO Database Record

  16. Relationship-Specific Investments, Family Chaos, and Cohabitation Dissolution Following a Non-marital Birth.

    Science.gov (United States)

    Kamp Dush, Claire M

    2011-12-01

    Predictors of two types of cohabitation dissolution, dissolution with a continued romantic relationship and without (i.e. breakup), were examined using data from mothers cohabiting at the time of a non-marital birth in the Fragile Families and Child Wellbeing Study (n = 1624). Life tables indicated 64% of unions dissolved within 5 years; of these, 76% broke-up. Black mothers had the highest rates of dissolution. Maximum likelihood discrete-time event history results revealed that younger mothers were more likely to experience cohabitation dissolution into a breakup. Fewer relationship-specific investments and more family chaos were also associated with greater risk of cohabitation dissolution into a breakup. Mothers' multipartnered fertility and fewer relationship-specific investments were associated with greater risk of cohabitation dissolution with a continued romantic relationship. Post-dissolution, mothers who maintained a romantic relationship were more likely to reenter a union with their former partner while mothers whose union broke-up most often remained so.

  17. Relationship-Specific Investments, Family Chaos, and Cohabitation Dissolution Following a Non-marital Birth

    Science.gov (United States)

    Kamp Dush, Claire M.

    2011-01-01

    Predictors of two types of cohabitation dissolution, dissolution with a continued romantic relationship and without (i.e. breakup), were examined using data from mothers cohabiting at the time of a non-marital birth in the Fragile Families and Child Wellbeing Study (n = 1624). Life tables indicated 64% of unions dissolved within 5 years; of these, 76% broke-up. Black mothers had the highest rates of dissolution. Maximum likelihood discrete-time event history results revealed that younger mothers were more likely to experience cohabitation dissolution into a breakup. Fewer relationship-specific investments and more family chaos were also associated with greater risk of cohabitation dissolution into a breakup. Mothers’ multipartnered fertility and fewer relationship-specific investments were associated with greater risk of cohabitation dissolution with a continued romantic relationship. Post-dissolution, mothers who maintained a romantic relationship were more likely to reenter a union with their former partner while mothers whose union broke-up most often remained so. PMID:22081737

  18. Commitment escalation to a failing family business

    OpenAIRE

    Chirico, Francesco; Salvato, Carlo; Byrne, Barbara; Akhter, Naveed; Arriaga Múzquiz, Juan

    2017-01-01

    The overarching intent of this manuscript is to heighten awareness to the concept of commitment escalation as it bears on a failing family business. Specifically, drawing on the concept of emotional ownership, together with self-justification arguments, we a) identify factors considered to be most forceful in contributing to the presence of commitment escalation and thus, resistance to change in a failing family business (i.e., emotional ownership, feeling of responsibility, investment of cap...

  19. Adolescent childbearing in sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    2003-02-01

    Full Text Available This article examines whether increased years of schooling exercised a consistent impact on delayed childbearing in sub-Saharan Africa. Data were drawn from Demographic and Health Surveys conducted in eight countries over the period 1987-1999. Multiple logistic regressions were used to assess trends and determinants in the probability of first birth during adolescence. Girls' education from about the secondary level onwards was found to be the only consistently significant covariate. No effect of community aggregate education was discernible, after controlling for urbanity and other individual-level variables. The results reinforce previous findings that improving girls' education is a key instrument for raising ages at first birth, but suggest that increases in schooling at lower levels alone bear only somewhat on the prospects for fertility decline among adolescents.

  20. Micro and macro factors affecting childbearing aspirations.

    Science.gov (United States)

    He, Y

    1992-01-01

    The conclusion of the discussion of factors affecting childbearing aspirations is that both a micro and a macro perspective must be included in an empirical analysis which would be useful for policy decisions. Micro factors tend to the economic function of the family, the economic value of children, cost of labor training, women's occupation, social security, household consumption, and education level. Attention to micro factors is important in the link between individual interests and state family planning (FP) policy. Macro factors tend to be ignored, but also impact on childbearing decisions. Macro factors are economic conditions, social and political factors, culture, and environmental factors such as ecology, natural resources, employment, economic development, and education. Macro factors affect the population as a whole and indirectly impact on individuals and the family. China's achievements in FP policy have been identified as a reduction of 200 million people, a shift in the population reproduction cycle downwards, increased standard of living, reduction in the burden of working people, and stabilization of macro factors. Successful policy should not rely on forced implementation. The past and present policies were successful not because of forced implementation, but because of awareness of macro and micro factors and voluntary use of FP. The voluntary nature of acceptance of FP suggests support for the FP policies. The current focus is on rural areas, and farmers in particular who are only aware of their needs and may feel state policy may interfere with their own interests. Implementation of FP among the rural population would be enhanced with an emphasis on their concerns such as social security in old age, the practical issues of having only daughters, and educational status. Educational campaigns promoting awareness of population pressure are needed and will benefit all the people. Social democratic doctrines can be introduced only from the outside

  1. Optimism as modifier of escalation of commitment.

    Science.gov (United States)

    Juliusson, Asgeir

    2006-10-01

    To study whether optimism-pessimism modifies escalation of commitment, 52 undergraduates were told that they had made an unsuccessful investment, then they chose to continue or discontinue this investment. Optimism about future returns was induced in one group by varying the probability of a successful outcome from an initial low to medium, pessimism was induced in another group by varying this probability from an initial high to medium. Supporting the assumption of the manipulation, the results showed that optimistic participants preferred to continue investments whereas pessimistic participants preferred not to. As predicted, when the sunk cost increased, optimism led to escalation of commitment, whereas pessimism led to de-escalation of commitment. These effects were strengthened when probability of a successful outcome was ambiguous.

  2. Sweeping Changes in Marriage, Cohabitation, and Childbearing in Central and Eastern Europe: New Insights from the Developmental Idealism Framework.

    Science.gov (United States)

    Thornton, Arland; Philipov, Dimiter

    2009-01-01

    In Central and Eastern Europe following the political transformations of the late 1980s and early 1990s there were dramatic declines in marriage and childbearing, significant increases in nonmarital cohabitation and childbearing, and a movement from reliance on abortion to a reliance on contraception for fertility limitation. Although many explanations have been offered for these trends, we offer new explanations based on ideational influences and the intersection of these ideational influences with structural factors. We focus on the political, economic, social, and cultural histories of the region, with particular emphasis on how countries in the region have interacted with and been influenced by Western European and North American countries. Our explanations emphasize the role of developmental models in guiding change in the region, suggesting that developmental idealism influenced family and demographic changes following the political transformations. Developmental idealism provides beliefs that modern family systems help to produce modern political and economic accomplishments and helps to establish the importance of freedom and equality as human rights in both the public and private spheres. The disintegration of the governments and the fall of the iron curtain in the late 1980s and early 1990s brought new understanding about social, economic, and family circumstances in the West, increasing consumption aspirations and expectations which clashed with both old economic realities and the dramatic declines in economic circumstances. In addition, the dissolution of the former governments removed or weakened systems supporting the bearing and rearing of children, and, the legitimacy of the former governments and their programs was largely destroyed, removing government support for old norms and patterns of behavior. In addition, the attacks of previous decades on the religious institutions in the region had in many places left these institutions weak. During this

  3. Type A behavior pattern and escalating commitment.

    Science.gov (United States)

    Schaubroeck, J; Williams, S

    1993-10-01

    Subjects (N = 98) were randomly assigned to high- and low-responsibility conditions in a commitment-escalation experiment. Global Type A behavior pattern and the underlying dimension of achievement strivings were positively related to the desire to continue the same course of action in the high prior-responsibility condition but not in the low prior-responsibility condition. These findings are discussed in terms of future research into the judgment processes of people with Type A personality and the possible role of escalating commitment in disorders experienced by people with Type A personality.

  4. Teenage Childbearing and its Health Consequences on the Mother ...

    African Journals Online (AJOL)

    greater risks for delivery complications, low-birth weight infants and ... and when there is no time involved, like mortality during the neonatal ... of early childbearing. Logistic and Cox hazard models are employed to examine the health impact of.

  5. How does childbearing affect fertility motivations and desires?

    Science.gov (United States)

    Miller, W B; Pasta, D J

    1995-01-01

    In this study we assume that fertility decisions are made one birth at a time and use longitudinal data collected from 401 married couples over a two-year period to explore how having a child affects two types of fertility motivation and three types of fertility desires. Using a series of five constrained multiple regression analyses, we tested the effects of two childbearing variables on these five types of motivation and desires in the context of a large set of control variables also hypothesized to affect fertility motivation and desires. The results demonstrate that the childbearing variables have a substantial effect in all five regression models. Specific findings indicate that childbearing stimulates greater positive motivation for childbearing and an increase in the number of children desired. Although this situation would appear to create a positive feedback loop in which each child born further increases the motivation and desire for children, the findings also suggest three different mechanisms whereby childbearing causes a counterbalancing regulation of that loop. These mechanisms include a negative motivation mechanism, a satiation mechanism, and a delay mechanism. The effect of these mechanisms on the termination of childbearing is considered in conjunction with a fourth mechanism, the achievement of desired family size.

  6. Neurobiology of escalated aggression and violence

    NARCIS (Netherlands)

    Miczek, Klaus A.; de Almeida, Rosa M. M.; Kravitz, Edward A.; Rissman, Emilie F.; de Boer, Sietse F.; Raine, Adrian

    2007-01-01

    Psychopathological violence in criminals and intense aggression in fruit flies and rodents are studied with novel behavioral, neurobiological, and genetic approaches that characterize the escalation from adaptive aggression to violence. One goal is to delineate the type of aggressive behavior and it

  7. Factors influencing first childbearing timing decisions among men: Path analysis

    Science.gov (United States)

    Kariman, Nourossadat; Amerian, Maliheh; Jannati, Padideh; Salmani, Fatemeh

    2016-01-01

    Background: Factors that influence men’s childbearing intentions have been relatively unexplored in the literature. Objective: This study aimed to determine the influencing factors about the first childbearing timing decisions of men. Materials and Methods: In this cross-sectional study, 300 men who were referred to private and governmental healthcare centers in Shahrood, Iran were randomly recruited from April to September 2014. Data were collected using a demographic questionnaire, the Quality of Life Questionnaire; ENRICH Marital Satisfaction Questionnaire, Synder’s Hope Scale, and the Multidimensional Scale of Perceived Social Support. Results: After removing the statistically insignificant paths, men’s age at marriage had the highest direct effect (β=0.86) on their first childbearing decision. Marital satisfaction (β=-0.09), social support (β=0.06), economic status (β=0.06), and quality of life (β=-0.08) were other effective factors on men’s first childbearing decisions. Moreover, marital satisfaction and social support had significant indirect effects on men’s childbearing decisions (β=-0.04 and -0.01, respectively). Conclusion: Many factors, including personal factors (age at marriage and quality of life), family factors (marital satisfaction), and social factors (social support), can affect men’s decision to have a child. Policymakers are hence required to develop strategies to promote the socioeconomic and family conditions of the couples and to encourage them to have as many children as they desire at an appropriate time. PMID:27738661

  8. Nuclear Escalation Ladders in South Asia

    Science.gov (United States)

    2011-04-01

    Ibid., pp. 211-212. 23 Fig. 3. Indian Escalation Ladder - Facing China in the Himalayas Response or Initiative Rung Order Thresholds and Rungs Peace...potential land-warfare ladders in the Himalayas . A. Territorial Boundaries India and Pakistan face each other across a common international... Himalayas from Ladakh in Kashmir south and east for 2,100 miles, interrupted by Nepal and Bhutan, which have their own northern borders with China of 768 and

  9. Exploratory Study of Childbearing Experiences of Women With Asperger Syndrome.

    Science.gov (United States)

    Gardner, Marcia; Suplee, Patricia D; Bloch, Joan; Lecks, Karen

    2016-01-01

    Increasing numbers of girls have been diagnosed with Asperger syndrome and other autism spectrum disorders (ASDs) over the past two decades; therefore, more women with ASDs are entering the childbearing phase of their lives. Little is known about the childbearing experiences of women with ASDs. This qualitative study describes the childbearing experiences of eight women with Asperger syndrome. Four major themes emerged: Processing Sensations, Needing to Have Control, Walking in the Dark, and Motherhood on My Own Terms. Clinicians can provide sensitive, individualized care by asking women with Asperger syndrome about their specific sensory experiences, counseling them about coping strategies for sensory intrusions, providing targeted support, and modifying the clinical environment to decrease distressing stimuli. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  10. De-escalating and escalating systemic therapy in triple negative breast cancer.

    Science.gov (United States)

    Carey, Lisa A

    2017-08-01

    Triple negative breast cancer has the highest relapse risk of all the clinical subsets, although the escalation of chemotherapy has benefited this subset substantially over recent years. Systemic options are limited to chemotherapy, which makes meaningful de-escalation or escalation of therapy more challenging but possible. Observational cohorts suggest a less than 10% risk of relapse and minimal if any benefit of chemotherapy in very small (<1 cm), node-negative triple negative disease. In higher risk, particularly node-positive disease, anthracycline/taxane-based regimens remain standard. Neoadjuvant chemotherapy clearly de-escalates surgery, although there are insufficient data to give less than standard chemotherapy on the basis of response to neoadjuvant therapy. Efforts to meaningfully escalate therapy in high-risk disease have included incorporating platinums into Neoadjuvant therapy, with clear benefit in pCR but uncertain impact on relapse and survival at this time. Residual disease after neoadjuvant chemotherapy carries a particularly poor prognosis; a recent randomized trial of 6 months' capecitabine in this setting suggested a survival advantage to this approach in higher risk residual disease. While not validated at this time, future directions are likely to include biologic prognostication with tumor and immune variables, as well as targeted non-cytotoxic approaches leveraging the molecular heterogeneity of triple negative disease. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Unwanted childbearing and household food insecurity in the United States.

    Science.gov (United States)

    Patel, Shivani A; Surkan, Pamela J

    2016-04-01

    Household food insecurity is a population health concern disproportionately affecting families with children in the United States. Unwanted childbearing may place unanticipated strain on families to meet basic needs, heightening the risk for household food insecurity. We investigated the association between mother's and father's report of unwanted childbearing and exposure to household food insecurity among children residing in two-parent households in the United States. Data from the Early Childhood Longitudinal Study - Birth Cohort, a nationally representative cohort of US children (n ∼ 6150), were used to estimate the odds of household food insecurity when children were aged 9 months and 2 years, separately, based on parental report of unwanted childbearing. The majority of children were reported as wanted by both parents (74.4%). Of the sample, report of unwanted childbearing by father-only was 20.0%, mother-only was 3.4% and joint mother and father was 2.2%. Household food insecurity was higher when children were 9 months compared with 2 years. In adjusted models accounting for confounders, children born to mothers and fathers who jointly reported unwanted childbearing were at higher odds of exposure to household food insecurity at 9 months [adjusted odds ratio (AOR) = 3.31; 95% confidence interval (CI): 1.97, 5.57] and 2 years (AOR = 2.52; 95% CI: 1.12, 5.68). In two-parent households, we found that children raised by parents reporting unwanted childbearing were more likely to be exposed to food insecurity and potentially related stressors. Further studies that prospectively measure wantedness before the child's birth will aid in confirming the direction of this association.

  12. De-Escalating the IT-Projects

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2007-12-01

    Full Text Available Escalation stickins with an ailing project beyond rational justifications. This happens because in the face of negative feedback, decision makers are strangled between whether to stick with or quit the dying project. Environmental uncertainty has been identified as the root cause of the escalatory behavior. This uncertainty emanates from several sources relating to individual, group, organization and broader environmental factors. This paper argues the premise that effective communication can help create an environment whereby workforce can develop an organized action thereby distributing the responsibility across the whole workforce and not the individuals – leading to the possible reduction of escalatory behavior in IT projects.

  13. Childhood Developmental Risk for Teen Childbearing in Britain.

    Science.gov (United States)

    Russell, Stephen T.

    2002-01-01

    Used prospective life history data from the National Child Development Study of Great Britain to examine family life risk factors and how their effects on teen childbearing risk varied, depending on the childhood age at which they were experienced. Demonstrated that socioeconomic status, family stress, and parental involvement in education during…

  14. The Netherlands: Childbearing within the context of a "Poldermodel" society

    NARCIS (Netherlands)

    Fokkema, T.; de Valk, H.; de Beer, J.; van Duin, C.

    2008-01-01

    The Netherlands has seen a considerable decline of the period total fertility rate and delayed childbearing, just like all other European countries. The drop in fertility, however, has not been as sharp as in many other regions of Europe. The period total fertility rate in the Netherlands has stabil

  15. The Consequences of Unintended Childbearing: A White Paper

    Science.gov (United States)

    Logan, Cassandra; Holcombe, Emily; Manlove, Jennifer; Ryan, Suzanne

    2007-01-01

    This report provides a critical review of the current research literature on the consequences of unintended childbearing for families and children. The review addresses the following potential consequences: prenatal and perinatal risks (e.g., inadequate or delayed initiation of prenatal care, smoking/drinking/substance use during pregnancy,…

  16. A feminist analysis of women's depression during the childbearing year.

    Science.gov (United States)

    DeJoseph, J F

    1997-01-01

    This article proposes a set of questions about difference, location, power, and representation that nurses can use to critique qualitative and quantitative studies for the utility of their findings in specific practice settings. It then uses these questions to conduct a feminist postmodern critique of a brief report of a longitudinal study about women's depression patterns throughout the childbearing year.

  17. Out-of-Wedlock Childbearing, Marital Prospects and Mate Selection

    Science.gov (United States)

    Qian, Zhenchao; Lichter, Daniel T.; Mellott, Leanna M.

    2005-01-01

    We apply marital search theory to examine whether out-of-wedlock childbearing affects mate selection patterns among American women. Using 1980-1995 CPS data, we apply probit models with selection to account for potential selection bias due to differences in "marriageability" between women in and not in unions. Compared to those without unmarried…

  18. Teenage Childbearing, Marital Status, and Depressive Symptoms in Later Life.

    Science.gov (United States)

    Kalil, Ariel; Kunz, James

    2002-01-01

    This longitudinal study tested the contribution of age and marital status at first birth to depressive symptomatology in early adulthood. Findings indicated that unmarried teenage childbearers displayed higher levels of depressive symptoms than women who first gave birth as married adults. The psychological health of married teenage mothers in…

  19. The Consequences of Unintended Childbearing: A White Paper

    Science.gov (United States)

    Logan, Cassandra; Holcombe, Emily; Manlove, Jennifer; Ryan, Suzanne

    2007-01-01

    This report provides a critical review of the current research literature on the consequences of unintended childbearing for families and children. The review addresses the following potential consequences: prenatal and perinatal risks (e.g., inadequate or delayed initiation of prenatal care, smoking/drinking/substance use during pregnancy,…

  20. Delayed childbearing in the U.S.: facts and fictions.

    Science.gov (United States)

    Baldwin, W H; Nord, C W

    1984-11-01

    Between 1970-82, the proportion of 1st births in the US to women 25 and older rose from 19-36% and the proportion of women still childless at ages 25-34 increased by 56% at about the same time. Although a sharp contrast with the baby boom era of the 1950s and 1960s, todays's epidemic of delayed childbearing is similar to patterns earlier in the 20th century. As then, much is due to delayed age at marriage, but baby boomers now in the their late 20s and early 30s are also delaying childbirth after marriage. The trend stems in part from their economic difficulties as they compete in a tight job market caused both by their large numbers and a turbulent economy. But it is also related to women's increasing education and, in turn, increasing opportunities in and commitment to the labor force, which can be expected to encourage a delayed childbearing even after prospects brighten for young people. Although a diverse group, most of today's delayed childbearers are white, highly educated, 2-career couples. Adequate daytime care for preschool children is a prime concern. Although more employers now offer childcare assistance and flexible work schedules to working parents, the juggle between jobs and childraising can be a strain. On the plus side are delayed childbearers' greater maturity and generally higher incomes, which can ease potential problems created by parent-child age differences as their children grow up. Businesses have been quick to respond to the new market of older, affluent, 1st-time mothers. New methods of treating of circumventing infertility and prenatal detection of chromosomal birth defects can now help overcome potential biological problems that may concern women who choose to delay childbearing past age 30.

  1. Dose escalation of a curcuminoid formulation

    Directory of Open Access Journals (Sweden)

    Crowell James

    2006-03-01

    Full Text Available Abstract Background Curcumin is the major yellow pigment extracted from turmeric, a commonly-used spice in India and Southeast Asia that has broad anticarcinogenic and cancer chemopreventive potential. However, few systematic studies of curcumin's pharmacology and toxicology in humans have been performed. Methods A dose escalation study was conducted to determine the maximum tolerated dose and safety of a single dose of standardized powder extract, uniformly milled curcumin (C3 Complex™, Sabinsa Corporation. Healthy volunteers were administered escalating doses from 500 to 12,000 mg. Results Seven of twenty-four subjects (30% experienced only minimal toxicity that did not appear to be dose-related. No curcumin was detected in the serum of subjects administered 500, 1,000, 2,000, 4,000, 6,000 or 8,000 mg. Low levels of curcumin were detected in two subjects administered 10,000 or 12,000 mg. Conclusion The tolerance of curcumin in high single oral doses appears to be excellent. Given that achieving systemic bioavailability of curcumin or its metabolites may not be essential for colorectal cancer chemoprevention, these findings warrant further investigation for its utility as a long-term chemopreventive agent.

  2. Tobacco and the Escalating Global Cancer Burden

    Directory of Open Access Journals (Sweden)

    Richard F. Oppeltz

    2011-01-01

    Full Text Available The global burden of cancer is escalating as a result of dramatic increases in the use of tobacco in the developing world. The use of tobacco is linked to the development of a broad variety of cancers, mainly lung cancer, the single most common cancer in the world. Tobacco smoking-attributable deaths extends beyond cancer and include stroke, heart attack and COPD. Widening disparities in cancer-related mortality have shifted towards a more dramatic burden in the developing world. Appropriate interventions must be implemented to reduce tobacco use and prevent global mortality that has escalated to epidemic levels. Tobacco control policies, including public health advertisement campaigns, warning labels, adoption of smoke-free laws, comprehensive bans and tax policies are highly effective measures to control tobacco use. Clinicians and academic institutions have to be actively committed to support tobacco control initiatives. The reduction in cancer related morbidity and mortality should be viewed as a global crisis and definitive results will depend on a multilevel effort to effectively reduce the burden of cancer, particularly in underprivileged regions of the world.

  3. Early Childbearing among Mexican-American Young Women: Place Matters

    OpenAIRE

    Richardson, Dawn Michele

    2010-01-01

    Compared to all other racial and ethnic groups in the United States, Mexican-American adolescents have by far the highest rates of early childbearing. Within the public health literature, these disproportionately high rates have generally been explored as a function of acculturation, which is described as a process involving the cultural, social, and psychological changes that take place post-migration. In order to elucidate acculturation's effect, specifically on the reproductive health and ...

  4. The role of anticipated regret in escalation of commitment.

    Science.gov (United States)

    Wong, Kin Fai Ellick; Kwong, Jessica Y Y

    2007-03-01

    This research tests the general proposition that people are motivated to reduce future regret under escalation situations. This is supported by the findings that (a) escalation of commitment is stronger when the possibility of future regret about withdrawal is high than when this possibility is low (Studies 1a and 1b) and (b) escalation of commitment increases as the net anticipated regret about withdrawal increases (Studies 2a and 2b). Furthermore, the regret effects in the 4 studies were above and beyond the personal responsibility effects on escalation. This research indicates that people in escalation situations are simultaneously influenced by the emotions they expect to experience in the future (e.g., anticipated regret) and by events that have happened in the past (e.g., responsibility for the initiating previous decision).

  5. Seroepidemiology of toxoplasmosis in childbearing women of Northwest Iran.

    Science.gov (United States)

    Rajaii, Mehrangiz; Pourhassan, Aboulfazl; Asle-Rahnamaie-Akbari, Najibeh; Aghebati, Leili; Xie, Juliana Ling; Goldust, Mohammad; Naghavi-Behzad, Mohammad

    2013-09-01

    Toxoplasma gondii causes the most common parasitic infection in the world. Congenital transmission, prenatal mortality and abortion are major problems of T. gondii. Prevalence of toxoplasmosis is high in Iran, especially in Azerbaijan. The current literature reviewed in this paper reveal results pertaining to various regions of Iran. The present cross-sectional e-study was designed to evaluate the seroprevalence of toxoplasmosis in childbearing women in Northwest Iran. We evaluated 1659 women in childbearing age from several cities in Northwestern Iran (Tabriz, Maragheh, Ahar, Marand, Sarab, Miane) from July 2009 to August 2010. Women aged between 20 and 40 years and seeking prenatal care were enrolled in the study. The subjects' sera were probed with indirect fluorescent antibody (IFA). A total of 1659 subjects were examined. Titres ranged from 1:100 to 1:800. In all, 899 subjects (54.13%) were seropositive. The highest frequency of seropositivity was shown in 1:200 dilution (36.08%) and in subjects from Maragheh (84% of 211 subjects). There was a direct linear relationship between seropositivity and age (p 0.001). Also, seroprevalence of toxoplasmosis was higher in subjects with primary school/lower educational level (p 0.001) and subjects living in rural regions (p 0.001). Overall, more than 50% of women in childbearing age were seropositive for toxoplasmosis in northwestern Iran. Increasing seroprevalence of toxoplasmosis with age was a predictable result due to longer exposure to the parasite. The relationship between increasing seroprevalence and lower educational level as well as living in rural areas is in line with the latest epidemiological findings, which also show such relationships due to lower socioeconomic status.

  6. Marriage formation as a process intermediary between migration and childbearing

    Directory of Open Access Journals (Sweden)

    Lesia Nedoluzhko

    2008-06-01

    Full Text Available In studies of differences in fertility between migrants and non-migrants, marriage interferes because migration can be motivated by an impending marriage or can entail entry into a marriage market with new opportunities. One would therefore expect elevated fertility after migration, although a competing theory states that on the contrary fertility ought to be reduced in the time around the move because migration temporarily disturbs the life of the migrant. In any case marriage appears as a process that is intermediary between migration and childbearing. To handle such issues it pays to have a technique that allows the analyst to separate any disruptive effects of migration from any boosting effects of marriage in studies of childbearing. The purposes of the present paper are (i to remind us that such a technique is available, in fact is straightforward, and (ii to apply the technique to further analyze a set of data on migration and first-time parenthood in Kyrgyzstan recently used by the second author and Gunnar Andersson. The technique has the neat feature that it allows us to operate with several "clocks" at the same time. In the analysis of first births we keep track of time since migration (for migrants and time since marriage formation (for the married beside the respondent's age (for women at childbearing ages; in other connections there may be more clocks. For such analyses we make use of a flexible graphical housekeeping device that allows the analyst to keep track of a feature like whether migration occurs before or after marriage, or at the same time. This is a half-century-old flow chart of statuses and transitions and is not much more complex than the famous Lexis diagram, which originated with Gustav Zeuner, as we now know. These reflexions were first presented at a symposium dedicated to Professor Zeuner.

  7. Valproic Acid in Women and Girls of Childbearing Age.

    Science.gov (United States)

    Gotlib, Dorothy; Ramaswamy, Rachel; Kurlander, Jacob E; DeRiggi, Alana; Riba, Michelle

    2017-09-01

    The aim of this paper is to evaluate recent literature on valproic acid (VPA) in women and girls of childbearing age and to emphasize new findings. Recent research confirms VPAs teratogenicity and risk of hormone disruption. VPA exposure in utero increases the risk for a variety of major congenital malformations (MCMs), reduced IQ and behavioral problems. In girls and women, VPA increases the risk of hormone abnormalities, obesity, and polycystic ovarian syndrome (PCOS). Despite guidelines recommending caution, VPA use continues to be prescribed to reproductive-aged women and girls. Despite significant and well-documented risk, adherence to guidelines in VPA use in reproductive-aged girls and women remains low.

  8. A New SDH-Based ATM Network Survivability Escalation Mechanism

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    This paper investigates survivability escalation strategies in multi-layers transport networks such as ATM/SDH/WDM networks, and presents oriented-failures and oriented-traffic escalation mechanisms. Furthermore, We present a new survivability Escalation strategy for SDH-Based ATM transport networks, which addresses difficult problem for resources sharing pool(RSP) among different layers restoration mechanisms. In this paper, we also present integer programming (IP) model for the resources sharing pool (RSP) design problem and the node simulation model for escalation Node. The simulation results show that the proposed ESP is very efficient. The proposed model can be easily extended for other types of multi-layer networks, such as WDM-based ATM networks or WDM-based SDH networks.

  9. Soviet declaratory policy regarding the controllability of escalation

    Energy Technology Data Exchange (ETDEWEB)

    Prewitt, J.L.

    1991-01-01

    Three variables were examined for their affect on Soviet views regarding the controllability of escalation. The first was bureaucratic affiliation. It was hypothesized that individuals affiliated with groups which directly controlled weapons would be more likely to support the controllability of escalation than those who were members of groups which did not control weapons. This hypothesis could not be rejected. The second variable was a commentator's rank. It was hypothesized that rank would act in two ways: (1) ideas regarding controlled escalation would appear at lower ranks first; and (2) unique views would be produced by specialized ranks within groups. The rank hypothesis could not be rejected. Certain escalation themes appeared to be presented first by military and civilian writers before being presented by the political leadership. The third variable, image of the West, did not appear to function as theorized. It was hypothesized that hard images of the West would be associated with the rejection of controlled escalation, whereas soft images would be associated with positions suggesting that escalation was controlled through joint US-Soviet cooperation.

  10. Socioeconomic Variation in the Effect of Economic Conditions on Marriage and Nonmarital Fertility in the United States: Evidence From the Great Recession.

    Science.gov (United States)

    Schneider, Daniel; Hastings, Orestes P

    2015-12-01

    The United States has become increasingly characterized by stark class divides in family structure. Poor women are less likely to marry than their more affluent counterparts but are far more likely to have a birth outside of marriage. Recent theoretical and qualitative work at the intersection of demography and cultural sociology suggests that these patterns are generated because poor women have high, nearly unattainable, economic standards for marriage but make a much weaker connection between economic standing and fertility decisions. We use the events of the Great Recession, leveraging variation in the severity of the crisis between years and across states, to examine how exposure to worse state-level economic conditions is related to poor women's likelihood of marriage and of having a nonmarital birth between 2008 and 2012. In accord with theory, we find that women of low socioeconomic status (SES) exposed to worse economic conditions are indeed somewhat less likely to marry. However, we also find that unmarried low-SES women exposed to worse economic conditions significantly reduce their fertility; economic standing is not disconnected from nonmarital fertility. Our results suggest that economic concerns were connected to fertility decisions for low-SES unmarried women during the Great Recession.

  11. The Netherlands: Childbearing within the context of a "Poldermodel" society

    Directory of Open Access Journals (Sweden)

    Coen Van Duin

    2008-07-01

    Full Text Available The Netherlands has seen a considerable decline of the period total fertility rate and delayed childbearing, just like all other European countries. The drop in fertility, however, has not been as sharp as in many other regions of Europe. The period total fertility rate in the Netherlands has stabilized since the late 1970s at around 1.6 children per woman, and it has even risen slightly since 1995. In addition, although the Netherlands has one of the oldest first-time mothers, completed fertility is still rather high compared to other European countries, suggesting a strong "catching up" of births by women in their thirties. This chapter provides a comprehensive overview of the main driving forces behind specific fertility trends in the Netherlands. Among other factors, it focuses on changing patterns of home leaving and union formation, declining partnership stability, and the growing acceptability and use of contraception. The chapter also looks at prolonged education, rising labor-force participation of women, economic uncertainties, the growing migrant population, and family policies. Data allowing, and to the extent possible, we examine the effects of these factors on decision-making about parenthood and the timing of childbearing.

  12. Teenage Childbearing and Educational Attainment in South Africa.

    Science.gov (United States)

    Timaeus, Ian M; Moultrie, Tom A

    2015-06-01

    The relationship between teenage childbearing and school attainment is investigated using nationally representative longitudinal data drawn from South Africa's National Income Dynamics Study. The analysis focuses on the outcomes by 2010 of a panel of 673 young women who were aged 15-18 and childless in 2008. Controlling for other factors, girls who went on to give birth had twice the odds of dropping out of school by 2010 and nearly five times the odds of failing to matriculate. Few girls from households in the highest-income quintile gave birth. Girls who attended schools in higher-income areas and were behind at school were much more likely to give birth than those who were in the appropriate grade for their age or were in no-fee schools. New mothers were much more likely to have re-enrolled in school by 2010 if they were rural residents, they belonged to relatively well-off households, or their own mother had attended secondary school. These findings suggest that, in South Africa, interventions that address poor school attainment would also reduce teenage childbearing. © 2015 The Population Council, Inc.

  13. Trends in Adolescent Childbearing in Kentucky: 1970-1977. Kentucky Women: Challenges and Prospects.

    Science.gov (United States)

    Keith, Verna; Garkovich, Lorraine

    This report analyzes trends in childbearing among Kentucky's adolescents from 1970 through 1977 and reviews childbearing patterns in Kentucky and in the United States for adolescents aged 10-14 and 15-19 to identify several factors associated with adolescent pregnancy. The fact that adolescent women are reaching biological maturity at an earlier…

  14. Attitudes toward fertility and childbearing scale: an assessment of a new instrument for women who are not yet mothers in Sweden

    National Research Council Canada - National Science Library

    Söderberg, Malin; Lundgren, Ingela; Christensson, Kyllike; Hildingsson, Ingegerd

    2013-01-01

    .... Attitudes among men and women about fertility and childbearing have been studied in different phases of fertile life, but instruments that assess attitudes toward fertility and childbearing among...

  15. Escalation and De-escalation of Therapy in COPD: Myths, Realities and Perspectives.

    Science.gov (United States)

    Cazzola, Mario; Rogliani, Paola; Matera, Maria Gabriella

    2015-09-01

    Chronic obstructive pulmonary disease (COPD) guidelines and strategies suggest escalating treatment, mainly depending on the severity of airflow obstruction. However, some de-escalation of therapy in COPD would be appropriate, although we still do not know when we should switch, step-up or step-down treatments in our patients. Unfortunately, trials comparing different strategies of step-up and step-down treatment (e.g. treatment initiation with one single agent and then further step-up if symptoms are not controlled versus initial use of double or triple therapy, possibly with lower doses of the individual components, or the role of N-acetylcysteine in combination therapy for a step-down approach) are still lacking. In general, there is a large and often inappropriate use of the inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination. However, the withdrawal of the ICS in COPD patients at low risk of exacerbation can be safe, provided that patients are under regular treatment with long-acting bronchodilators. Maximising the treatment in patients with a degree of clinical instability by including an ICS in the therapeutic regimen is useful to control the disease, but may not be needed during periods of clinical stability. In patients with severe but stable COPD, the withdrawal of the ICS from triple therapy [LABA + long-acting muscarinic antagonist (LAMA) + ICS] is possible, but not when the patient has been hospitalised for an acute exacerbation of COPD. We must still establish how long we should wait before withdrawing the ICS. It is still unclear whether the same is true when only the LABA or the LAMA is withdrawn while continuing treatment with the other bronchodilator and the ICS. In any case, we strongly believe that it is always better to avoid a therapeutic step-up progression when it is not needed rather than being forced subsequently into a step-down approach in which the outcome is always unpredictable.

  16. Conflict escalation in paediatric services: findings from a qualitative study.

    Science.gov (United States)

    Forbat, Liz; Teuten, Bea; Barclay, Sarah

    2015-08-01

    To explore clinician and family experiences of conflict in paediatric services, in order to map the trajectory of conflict escalation. Qualitative interview study, employing extreme-case sampling. Interviews were analysed using an iterative thematic approach to identify common themes regarding the experience and escalation of conflict. Thirty-eight health professionals and eight parents. All participants had direct experience of conflict, including physical assault and court proceedings, at the interface of acute and palliative care. Two teaching hospitals, one district general hospital and two paediatric hospices in England, in 2011. Conflicts escalate in a predictable manner. Clearly identifiable behaviours by both clinicians and parents are defined as mild, moderate and severe. Mild describes features like the insensitive use of language and a history of unresolved conflict. Moderate involves a deterioration of trust, and a breakdown of communication and relationships. Severe marks disintegration of working relationships, characterised by behavioural changes including aggression, and a shift in focus from the child's best interests to the conflict itself. Though conflicts may remain at one level, those which escalated tended to move sequentially from one level to the next. Understanding how conflicts escalate provides clinicians with a practical, evidence-based framework to identify the warning signs of conflict in paediatrics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Women's Labor Force Attachment and Childbearing in Finland

    Directory of Open Access Journals (Sweden)

    2004-04-01

    Full Text Available This paper analyzes the impact of women's economic activity, earnings and take-up of child home care allowance on childbearing, using a ten percent sample from a longitudinal register data set that covers the entire female population of reproductive age in Finland in 1988-2000. Results show that a woman's economic activity and income were positively correlated with entry into motherhood and to a lesser extent with having a second child. This supports the notion of a common pattern of this relationship in the Nordic countries. In the light of Finland's rollercoaster economic development in the 1990s, the effects of a change in female population composition by economic characteristics on the fertility trend were small.

  18. Abuse experiences, perceptions, and associated decisions during the childbearing cycle.

    Science.gov (United States)

    Lutz, Kristin F

    2005-11-01

    The study purpose was to generate a theoretical understanding of women's experiences and perceptions of intimate partner abuse during the childbearing cycle. Dimensional analysis, a grounded theory method, was used. Twenty-one interviews were conducted with 12 women who were (a) currently in an abusive relationship with an intimate male partner and pregnant or postpartum (n = 5) or who had (b) experienced abuse by an intimate male partner during a past pregnancy or postpartum (n = 7). Disparities between the two concurrent phenomena of abuse and pregnancy led women to feel as though they were living two separate lives. Pregnancy provided the impetus for reinvesting in the partnered relationship and constructing a family. Leaving an abusive relationship was not considered unless the partner ended the relationship first or the woman perceived an increased risk of danger. Postpartum up to 2 years after birth was a critical transitional time for women.

  19. Reducing and exaggerating escalation of commitment by option partitioning.

    Science.gov (United States)

    Kwong, Jessica Y Y; Wong, Kin Fai Ellick

    2014-07-01

    Options under escalation situations can be presented as a general class (e.g., investing in electronic products) or be partitioned into disjunctive suboptions within that class (e.g., investing in MP3 players, portable TV game consoles, and other electronic products). Drawing from the theoretical bases of partition priming and mental accounting, this research found support from 4 experiments that (a) a decision maker's commitment to a failing course of action is exaggerated when the escalation options are partitioned into multiple suboptions, whereas such commitment is reduced when the alternative options are portioned into suboptions, and (b) these partitioning effects are mediated by the subjective utility, including subjective values and probability, of the escalation option.

  20. Planning ahead: Improving escalation plans before the weekend.

    Science.gov (United States)

    Zarkali, Angeliki; Black, Duncan; Smee, Elizabeth; Deshraj, Anshul; Smallwood, Nicholas

    2014-01-01

    Handover is the system by which responsibility for patient care is transferred between healthcare professionals. A significant aspect of handover is the existence of an escalation plan for each patient in case of deterioration over the weekend. According to the Royal College of Physicians, all patients should have a clear escalation plan documented in the notes before a weekend, since parent medical teams (Consultant team in charge of care) are best placed to make these decisions. If left to on-call teams, at a time of deterioration over a weekend, they might not have all available information, the patient might be unable to be involved in the decisions, and the family might not be consulted. With this is mind, we decided to analyse the existing handover process in a medium sized district general hospital, with the aim of improving the process and the documentation of escalation plans. The results from our retrospective analysis of the system in place revealed a significant lack of documentation of escalation plans in the medical notes. Three sample wards were selected to analyse the current handover system and test proposed measures before hospital-wide implementation. After trialling of a physical handover meeting in addition to the existing intranet system and a proforma for the Friday ward round, the documentation of escalation plans in the patients' notes improved from 9.1% to 41.1%. Based on these results, as well as formal feedback from junior doctors and informal feedback from other staff, the physical handover meeting and Friday ward round proforma will be implemented throughout the Trust. Our interventions led to an improvement in the documentation of escalation plans in our hospital, thus saving precious time in the event of a patient's deterioration. This also ensures that families and patients are involved in the decision making process and kept informed, and reduces the burden for the weekend on-call teams.

  1. Elevator and Escalator Safety Education for Older Adults.

    Science.gov (United States)

    Hanks, Roma Stovall

    1996-01-01

    In eight focus groups in five cities, older adults identified their concerns about safety on elevators and escalators, often related to misunderstanding of the equipment. Their preferences for delivery of safety information included video/television, pamphlets, discussions, and posters. Educational interventions and modifications for disabilities…

  2. Les escales de Likert poden augmentar en sensibilitat?

    Directory of Open Access Journals (Sweden)

    Rafel Bisquerra Alzina

    2015-07-01

    Full Text Available En les investigacions que utilitzen escales tipus Likert s’apliquen principalment escales de 5 punts, sense una fonamentació metodològica que ho justifiqui. La revisió de 3 conegudes revistes permet arribar a aquesta conclusió. Sembla que es fa així per tradició i perquè és difícil posar nom a més de cinc opcions de resposta. En aquest article es posa en qüestió aquesta tradició i s’aporten arguments per proposar altres alternatives. S’analitza la importància de millorar la sensibilitat de les escales augmentant les opcions de resposta; es recomana evitar l’ús de denominacions categòriques, que strictu sensu impedeix el seu ús com a escala d’interval ja que la converteix en nominal (categòrica; s’analitza el rebuig a valors extrems, etc. Com a conseqüència, es recomana la proposta en favor d’escales d’onze punts (de 0 a 10.

  3. Childbearing Decision Making: A Qualitative Study of Women Living with HIV/AIDS in Southwest Nigeria

    Directory of Open Access Journals (Sweden)

    Y. A. Sofolahan

    2012-01-01

    Full Text Available Using the PEN-3 model, the purpose of this qualitative study was to understand the factors responsible for the childbearing decisions of women living with HIV/AIDS (WLHA in Lagos, Nigeria. Sixty WLHA who sought care at a teaching hospital in Lagos were recruited to participate in in-depth interviews. The average age of the participants was 30 years, and 48 participants were receiving antiretroviral therapy. Healthcare and spiritual practices, healthcare provider-patient communication about childbearing, and husband/partner support emerged as factors that contribute to the childbearing decisions of WLHA. The findings reveal the importance of discussing sexual reproductive health and childbearing issues with WLHA in the healthcare context prior to pregnancy.

  4. Embodied meanings of early childbearing among American Indian women: a turning point.

    Science.gov (United States)

    Palacios, Janelle; Chesla, Catherine; Kennedy, Holly; Strickland, June

    2012-01-01

    American Indian women often have poor perinatal outcomes and are at risk for early childbearing. The purpose of this qualitative study was to understand the experience and meaning of early childbearing among American Indian women. Employing interpretive phenomenology and a semistructured interview guide, we interviewed 30 adult American Indian women residing in a northwestern American Indian reservation about their experiences and meaning of early childbearing. Three overarching themes were tied to their eventual positive evaluation of the experience: 1) mourning a lost childhood, 2) seeking fulfillment, and 3) embodying responsibility. Women indicated that despite their tumultuous childhoods, early childbearing presented an opportunity to effect positive change in their lives. Women's health care providers are positioned to help women change their lives, thereby, improving health outcomes. © 2012 by the American College of Nurse-Midwives.

  5. The prevalence of obesity among female teachers of child-bearing ...

    African Journals Online (AJOL)

    The prevalence of obesity among female teachers of child-bearing age in Ghana. ... African Journal of Food, Agriculture, Nutrition and Development ... In Ghana, the prevalence of obesity has been found to be high particularly among women.

  6. Periodontal status and associated risk factors among childbearing age women in Cixi City of China*

    OpenAIRE

    Wu, Yan-Min; Liu, Jia; Sun, Wei-lian; Chen, Li-li; Chai, Li-guo; Xiao, Xiang; Cao, Zheng

    2013-01-01

    Objective: To investigate the periodontal status and associated risk factors among women of childbearing age to increase the awareness of oral health. Methods: The study was conducted on childbearing age women in Cixi, a city in Zhejiang Province in the southeast of China. A total of 754 women participated in periodontal examination while receiving prenatal care. Data of the women were collected from the Cixi Family Planning Commission and during an interview. Clinical periodontal indices, su...

  7. Social justice as a wider lens of support for childbearing women.

    Science.gov (United States)

    Logsdon, M Cynthia; Davis, Deborah Winders

    2010-01-01

    The ecological model is used as a framework for applying social justice concepts to the care of childbearing women and families. In this model, the environment of childbearing women has 3 distinct levels: macrosystem, mesosystem, and microsystem. Two scenarios are described and examples of nursing actions to promote social justice at each level are provided. This article demonstrates how maternal/infant nursing practice can be expanded to promote health equities, social justice, and support.

  8. Sociodemographic and dietary profile of 4,471 childbearing-age women planning a pregnancy

    OpenAIRE

    Marta Cuervo; Leticia Goni; Susana Santiago; Itziar Zazpe; Aquilino García; J. Alfredo Martínez

    2014-01-01

    Background: The maintenance of healthy lifestyles is of great importance to prevent pregnancy-related diseases at early stages. For this reason, the knowledge of the overall wellbeing of women at childbearing-age is necessary to provide appropriate advice to maintain or improve the nutritional status. The aim of this research was to assess the lifestyles of childbearing-age women planning a pregnancy and to examine the difference between primiparae and multiparae women on these lifestyles. Me...

  9. Biased information processing in the escalation paradigm: information search and information evaluation as potential mediators of escalating commitment.

    Science.gov (United States)

    Schultze, Thomas; Pfeiffer, Felix; Schulz-Hardt, Stefan

    2012-01-01

    Escalation of commitment denotes decision makers' increased reinvestment of resources in a losing course of action. Despite the relevance of this topic, little is known about how information is processed in escalation situations, that is, whether decision makers who receive negative outcome feedback on their initial decision search for and/or process information biasedly and whether these biases contribute to escalating commitment. Contrary to a widely cited study by E. J. Conlon and J. M. Parks (1987), in 3 experiments, the authors found that biases do not occur on the level of information search. Neither in a direct replication and extension of the original study with largely increased test power (Experiment 1) nor under methodologically improved conditions (Experiments 2 and 3) did decision makers responsible for failure differ from nonresponsible decision makers with regards to information search, and no selective search for information supporting the initial decision or voting for further reinvestment was observed. However, Experiments 3 and 4 show that the evaluation of the previously sought information is biased among participants who were responsible for initiating the course of action. Mediation analyses show that this evaluation bias in favor of reinvestment partially mediated the responsibility effect on escalation of commitment.

  10. E4 - Energy efficient elevators and escalators. Barriers to and strategies for promoting energy-efficient lift and escalator technologies

    Energy Technology Data Exchange (ETDEWEB)

    Duetschke, Elisabeth; Hirzel, Simon

    2010-02-25

    According to prior findings of the E4 project, considerable savings potential exists both for lifts and escalators that could be realized if appropriate technology is implemented. However, energy-efficient technology is slowly diffusing the market - a phenomenon that could be explained by barriers present in the market. A barrier is defined as a mechanism that inhibits a decision or behavior that appears to be both energy-efficient and economically efficient and thereby prevents investment in energy-efficient technologies. This document has two aims. First, it will identify influential barriers in the European lift and escalator market. This analysis is based on the literature as well as a study including interviews as well as group discussions with relevant stakeholders. Second, strategies and measures to overcome the barriers identified in the first step are outlined. Major barriers to the penetration of energy-efficient technologies identified in this paper include a lack of monitoring energy consumption of installations and a lack of awareness of as well as knowledge about energy-efficient technology. Thus, installations and components are usually chosen without a (comprehensive) assessment of their energy consumption and without considering life-cycle approaches. On top of this, split incentives are a regularly occurring barrier. Various stakeholders are influential in the decisionmaking process about an installation or its components. However, those who will later pay for the energy consumption often are not involved in this process. Moreover, it is important to keep in mind that the number of new lifts and escalators installed each year is relatively low compared to the existing stock. Thus, it is very important to discuss enhancement of energy efficiency also for the existing stock. Based on our analyses, several recommendations are developed in this paper that could contribute to a market transformation in the lift and escalator market. First of all, a

  11. STUDY OF PRIVILEGE ESCALATION ATTACK ON ANDROID AND ITS COUNTERMEASURES

    Directory of Open Access Journals (Sweden)

    REJO MATHEW

    2012-09-01

    Full Text Available Android is most commonly used platform for smartphones today which boasts of an advanced security model having MAC and sandboxing. These features allow developers and users to restrict the execution of anapplication to the privileges assigned. The exploitation of vulnerabilities of the program is confined within the privilege boundaries of an applications sandbox. Privilege escalation attacks have grown manifold as the use of android systems have increased. Different kinds of mechanisms have provided some sort of respite to the developers but the security feature handling by the developers has not helped much. In this paper we discuss the basics of the privilege escalation attack and the various techniques used to counter and prevent this problem.

  12. Childbearing in adolescence: intergenerational dejà-vu? Evidence from a Brazilian birth cohort.

    Science.gov (United States)

    Ferraro, Alexandre Archanjo; Cardoso, Viviane Cunha; Barbosa, Aline Pires; Da Silva, Antônio Augusto Moura; Faria, Carlos Augusto; De Ribeiro, Valdinar Souza; Bettiol, Heloisa; Barbieri, Marco Antonio

    2013-07-15

    Pregnancy in adolescence tends to repeat over generations. This event has been little studied in middle and low-income societies undergoing a rapid epidemiological transition. To assess this association it is important to adjust for socioeconomic conditions at different points in lifetime. Therefore, the aim of this study is to analyze the independent effect of adolescent childbearing in a generation on its recurrence in the subsequent generation, after adjusting for socioeconomic status at different points in life. The study was conducted on a prospective cohort of singleton liveborn females from the city of Ribeirão Preto, Brazil, evaluated in 1978/79, and their daughters assessed in 2002/04. A total of 1059 mother-daughter pairs were evaluated. The women who had their first childbirth before 20 years of age were considered to be adolescent mothers. The risk of childbearing in adolescence for the daughter was modeled as a function of the occurrence of teenage childbearing in her mother, after adjustment for socio-demographic variables in a Poisson regression model. The rate of childbearing during adolescence was 31.4% in 1978/79 and 17.1% in 2002/04. Among the daughters of the 1st generation adolescent mothers, this rate was 26.7%, as opposed to 12.7% among the daughters of non adolescent mothers. After adjustments the risk of adolescent childbearing for the 2nd generation was 35% higher for women whose mothers had been pregnant during adolescence - RR = 1.35 (95% CI 1.04-1.74). Adolescent childbearing in the 1st generation was a predictor of adolescent childbearing in the 2nd, regardless of socioeconomic factors determined at different points in lifetime.

  13. STUDY OF PRIVILEGE ESCALATION ATTACK ON ANDROID AND ITS COUNTERMEASURES

    OpenAIRE

    REJO MATHEW

    2012-01-01

    Android is most commonly used platform for smartphones today which boasts of an advanced security model having MAC and sandboxing. These features allow developers and users to restrict the execution of anapplication to the privileges assigned. The exploitation of vulnerabilities of the program is confined within the privilege boundaries of an applications sandbox. Privilege escalation attacks have grown manifold as the use of android systems have increased. Different kinds of mechanisms have ...

  14. State policy and teen childbearing: a review of research studies.

    Science.gov (United States)

    Beltz, Martha A; Sacks, Vanessa H; Moore, Kristin A; Terzian, Mary

    2015-02-01

    Teen childbearing is affected by many individual, family, and community factors; however, another potential influence is state policy. Rigorous studies of the relationship between state policy and teen birth rates are few in number but represent a body of knowledge that can inform policy and practice. This article reviews research assessing associations between state-level policies and teen birth rates, focusing on five policy areas: access to family planning, education, sex education, public assistance, and access to abortion services. Overall, several studies have found that measures related to access to and use of family planning services and contraceptives are related to lower state-level teen birth rates. These include adolescent enrollment in clinics, minors' access to contraception, conscience laws, family planning expenditures, and Medicaid waivers. Other studies, although largely cross-sectional analyses, have concluded that policies and practices to expand or improve public education are also associated with lower teen birth rates. These include expenditures on education, teacher-to-student ratios, and graduation requirements. However, the evidence regarding the role of public assistance, abortion access, and sex education policies in reducing teen birth rates is mixed and inconclusive. These conclusions must be viewed as tentative because of the limited number of rigorous studies that examine the relationship between state policy and teen birth rates over time. Many specific policies have only been analyzed by a single study, and few findings are based on recent data. As such, more research is needed to strengthen our understanding of the role of state policies in teen birth rates.

  15. Reproductive factors related to childbearing and mammographic breast density.

    Science.gov (United States)

    Yaghjyan, Lusine; Colditz, Graham A; Rosner, Bernard; Bertrand, Kimberly A; Tamimi, Rulla M

    2016-07-01

    We investigated the associations of reproductive factors related to childbearing with percent breast density, absolute dense and nondense areas, by menopausal status. This study included 4110 cancer-free women within the Nurses' Health Study and Nurses' Health Study II cohorts. Percent breast density, absolute dense and nondense areas were measured from digitized mammography film images with computerized techniques. All density measures were square root-transformed in all the analyses to improve normality. The data on reproductive variables and other breast cancer risk factors were obtained from biennial questionnaires, at the time of the mammogram date. As compared to nulliparous women, parous postmenopausal women had lower percent density (β = -0.60, 95 % CI -0.84; -0.37), smaller absolute dense area (β = -0.66, 95 % CI -1.03; -0.29), and greater nondense area (β = 0.72, 95 % CI 0.27; 1.16). Among parous women, number of children was inversely associated with percent density in pre- (β per one child = -0.12, 95 % CI -0.20; -0.05) and postmenopausal women (β per one child = -0.07, 95 % CI -0.12; -0.02). The positive associations of breastfeeding with absolute dense and nondense areas were limited to premenopausal women, while the positive association of the age at first child's birth with percent density and the inverse association with nondense area were limited to postmenopausal women. Women with greater number of children and younger age at first child's birth have more favorable breast density patterns that could explain subsequent breast cancer risk reduction.

  16. Another baby? Father involvement and childbearing in fragile families.

    Science.gov (United States)

    Kotila, Letitia E; Kamp Dush, Claire M

    2012-12-01

    An historic number of women in the United States have children outside of marriage, and with more than one father, yet little research has examined the association between family process and women's childbearing decisions. Using a subsample of unmarried women from the Fragile Families and Child Wellbeing Study (n = 2028), a study of primarily low-income unmarried parents, we conducted discrete-time survival analysis models to predict whether women had another child with the focal child's father (same-father birth) or with a new father (new-father birth). Father involvement was measured by engagement, indirect care, accessibility, and financial support. Overall, mothers who reported greater engagement and indirect care from the focal child's father were more likely to have a same-father birth even when he was not living in her home, and were also less likely to have a new-father birth. Further, mothers who reported greater accessibility and stable financial support from the focal child's nonresident father were also less likely to have a new-father birth. One pathway through which this may have occurred was that single mothers who perceived less indirect care and accessibility from the focal child's nonresident father were more likely to begin new romantic relationships. Indeed, whether or not the mother had a new romantic partner partially mediated the association between indirect care and a same-father birth and fully mediated the association between accessibility and a new-father birth, suggesting that one pathway linking father involvement to a new-father birth was through maternal repartnering. Clinical and policy implications are discussed.

  17. Flu, risks, and videotape: escalating fear and avoidance.

    Science.gov (United States)

    Rosoff, Heather; John, Richard S; Prager, Fynnwin

    2012-04-01

    While extensive risk perception research has focused on emotions, cognitions, and behavior at static points in time, less attention has been paid to how these variables might change over time. This study assesses how negative affect, threat beliefs, perceived risk, and intended avoidance behavior change over the course of an escalating biological disaster. A scenario simulation methodology was used that presents respondents with a video simulation of a 15-day series of local news reports to immerse respondents in the developing details of the disaster. Systemic manipulation of the virus's causal origin (terrorist attack, medical lab accident, unknown) and the respondent's proximity to the virus (local vs. opposite coast) allowed us to investigate the dynamics of public response. The unfolding scenario was presented in discrete episodes, allowing responses to be tracked over the episodes. The sample includes 600 respondents equally split by sex and by location, with half in the Washington, DC area, and half in the Los Angeles area. The results showed respondents' reactions to the flu epidemic increased as the disaster escalated. More importantly, there was considerable consistency across respondents' emotional, cognitive, and behavioral responses to the epidemic over the episodes. In addition, the reactions of respondents proximally closer to the epidemic increased more rapidly and with greater intensity than their distant counterparts. Finally, as the flu epidemic escalated, both terrorist and accidental flu releases were perceived as being less risky and were less likely to lead to avoidance behavior compared to the unknown flu release.

  18. Phylogenetic escalation and decline of plant defense strategies.

    Science.gov (United States)

    Agrawal, Anurag A; Fishbein, Mark

    2008-07-22

    As the basal resource in most food webs, plants have evolved myriad strategies to battle consumption by herbivores. Over the past 50 years, plant defense theories have been formulated to explain the remarkable variation in abundance, distribution, and diversity of secondary chemistry and other defensive traits. For example, classic theories of enemy-driven evolutionary dynamics have hypothesized that defensive traits escalate through the diversification process. Despite the fact that macroevolutionary patterns are an explicit part of defense theories, phylogenetic analyses have not been previously attempted to disentangle specific predictions concerning (i) investment in resistance traits, (ii) recovery after damage, and (iii) plant growth rate. We constructed a molecular phylogeny of 38 species of milkweed and tested four major predictions of defense theory using maximum-likelihood methods. We did not find support for the growth-rate hypothesis. Our key finding was a pattern of phyletic decline in the three most potent resistance traits (cardenolides, latex, and trichomes) and an escalation of regrowth ability. Our neontological approach complements more common paleontological approaches to discover directional trends in the evolution of life and points to the importance of natural enemies in the macroevolution of species. The finding of macroevolutionary escalating regowth ability and declining resistance provides a window into the ongoing coevolutionary dynamics between plants and herbivores and suggests a revision of classic plant defense theory. Where plants are primarily consumed by specialist herbivores, regrowth (or tolerance) may be favored over resistance traits during the diversification process.

  19. The effects of mortality salience on escalation of commitment.

    Science.gov (United States)

    Yen, Chih-Long; Lin, Chun-Yu

    2012-01-01

    Based on propositions derived from terror management theory (TMT), the current study proposes that people who are reminded of their mortality exhibit a higher degree of self-justification behavior to maintain their self-esteem. For this reason, they could be expected to stick with their previous decisions and invest an increasing amount of resources in those decisions, despite the fact that negative feedback has clearly indicated that they might be on a course toward failure (i.e., "escalation of commitment"). Our experiment showed that people who were reminded of their mortality were more likely to escalate their level of commitment by maintaining their current course of action. Two imaginary scenarios were tested. One of the scenarios involved deciding whether to send additional troops into the battlefield when previous attempts had failed; the other involved deciding whether to continue developing an anti-radar fighter plane when the enemy had already developed a device to detect it. The results supported our hypothesis that mortality salience increases the tendency to escalate one's level of commitment.

  20. Migration, Occupational Mobility, and Regional Escalators in Scotland

    Directory of Open Access Journals (Sweden)

    Maarten van Ham

    2012-01-01

    Full Text Available This paper seeks to unpick the complex relationship between an individual’s migration behaviour, their place of residence, and their occupational performance in the Scottish labour market between 1991 and 2001. We investigate whether Edinburgh has emerged as an occupational escalator region and whether individuals moving there experience more rapid upward occupational mobility than those living and moving elsewhere. Using country of birth, we also control for an individual’s propensity to make long distance moves during earlier periods of their life course. Using data from the Scottish Longitudinal Study, linking 1991 and 2001 individual census records, and logistic regressions, we show that those who migrate over long distances within or to Scotland are most likely to achieve upward occupational mobility. We also found that Edinburgh is by far the most important regional escalator in Scotland; those moving to Edinburgh are the most likely to experience upward occupational mobility from low to high occupational status jobs. This is an important finding as most of the literature on escalator regions focuses on international mega cities.

  1. Nicaraguan migration and the prevalence of adolescent childbearing in Costa Rica.

    Science.gov (United States)

    Sintonen, Heidi; Bonilla-Carrión, Roger Enrique; Ashorn, Per

    2013-02-01

    This study describes the dynamics of adolescent childbearing of Nicaraguan-born and Costa Rican-born adolescents in Costa Rica and examines the association between socio-demographic factors and adolescent childbearing in the country. We studied Nicaraguan-born and Costa Rican adolescents using the data of the 2000 Census. Multivariate logistic regression was used to analyze the association between country of origin and adolescent childbearing, while controlling for socio-demographic factors (age, education, union, urbanization and poverty). 26% of Nicaraguan-born migrants and 9.5% of Costa Ricans had given birth during adolescence. The migrants' increased odds of pregnancy decreased from 3.34 (CI 3.21, 3.48) to 1.88 (CI 1.79, 1.97) when controlling for socio-demographic factors. Age, low educational attainment, urban residence, poverty and union were all significant predictors of adolescent pregnancy. Nicaraguan-born status is associated with adolescent childbearing in Costa Rica. Further research is needed to understand what factors, other than socio-demographic indicators, contribute to the differing prevalence of adolescent childbearing in Costa Rica.

  2. Investigating the relationship between teenage childbearing and psychological distress using longitudinal evidence.

    Science.gov (United States)

    Mollborn, Stefanie; Morningstar, Elizabeth

    2009-09-01

    The high levels of depression among teenage mothers have received considerable research attention in smaller targeted samples, but a large-scale examination of the complex relationship between adolescent childbearing and psychological distress that explores bidirectional causality is needed. Using the National Longitudinal Study of Adolescent Health (Add Health) and the Early Childhood Longitudinal Study--Birth Cohort, we found that teenage mothers had higher levels of distress than their childless adolescent peers and adult mothers, but the experience of teenage childbearing did not appear to be the cause. Rather teenage mothers' distress levels were already higher than their peers before they became pregnant, and they remained higher after childbearing and into early and middle adulthood. We also found that distress did not increase the likelihood of adolescent childbearing except among poor teenagers. In this group, experiencing high levels of distress markedly increased the probability of becoming a teenage mother Among nonpoor teenage girls, the relationship between distress and subsequent teenage childbearing was spurious.

  3. Investigating the Relationship between Teenage Childbearing and Psychological Distress Using Longitudinal Evidence*

    Science.gov (United States)

    MOLLBORN, STEFANIE; MORNINGSTAR, ELIZABETH

    2011-01-01

    The high levels of depression among teenage mothers have received considerable research attention in smaller targeted samples, but a large-scale examination of the complex relationship between adolescent childbearing and psychological distress that explores bidirectional causality is needed. Using the National Longitudinal Study of Adolescent Health (Add Health) and the Early Childhood Longitudinal Study—Birth Cohort, we found that teenage mothers had higher levels of distress than their childless adolescent peers and adult mothers, but the experience of teenage childbearing did not appear to be the cause. Rather, teenage mothers’ distress levels were already higher than their peers before they became pregnant, and they remained higher after childbearing and into early and middle adulthood. We also found that distress did not increase the likelihood of adolescent childbearing except among poor teenagers. In this group, experiencing high levels of distress markedly increased the probability of becoming a teenage mother. Among nonpoor teenage girls, the relationship between distress and subsequent teenage childbearing was spurious. PMID:19711808

  4. Marriage Patterns and Childbearing: Results From a Quantitative Study in North of Iran.

    Science.gov (United States)

    Taghizadeh, Ziba; Behmanesh, Fereshteh; Ebadi, Abbas

    2015-09-22

    Social changes have rapidly removed arranged marriages and it seems the change in marriage pattern has played a role in childbearing. On the other hand, there is a great reduction in population in many countries which requires a comprehensive policy to manage the considerable drop in population. To achieve this goal, initially, the factors affecting fertility must be precisely identified. This study aims to examine the role of marriage patterns in childbearing. In this cross-sectional quantitative study, 880 married women 15-49 years old, living in the north of Iran were studied using a cluster sampling strategy. The results showed that there are no significant differences in reproductive behaviors of three patterns of marriage in Bobol city of Iran. It seems there is a convergence in childbearing due to the different patterns of marriage and Policymakers should pay attention to other determinants of reproductive behaviors in demographic planning.

  5. Social Stigma and Childbearing for Women Living With HIV/AIDS.

    Science.gov (United States)

    Cuca, Yvette P; Rose, Carol Dawson

    2016-09-01

    As more women become infected with HIV, the issue of childbearing becomes increasingly salient. A more nuanced understanding of women's situations is needed to provide high-quality and relevant services and support. We examined reproductive decision making among 20 women living with HIV through in-depth interviews. These women made decisions within situations of chaos, instability, and trauma, which often limited their ability to make truly informed choices about their lives and childbearing. Despite their HIV, many of the women wanted children, but experienced stigmatization related both to their HIV and to their decisions to have children. This stigmatization came from multiple sources, including health care providers, some of whom encouraged their patients to abort pregnancies because of their HIV. Participants, however, demonstrated resistance to stigmatization, through building supportive communities and developing trusting relationships with HIV providers. These results support the need for specialized HIV care for women of childbearing age.

  6. CONTROL SYSTEM FOR ESCALATOR = SISTEMA DE CONTROLE PARA ESCADA ROLANTE

    Directory of Open Access Journals (Sweden)

    Mauricio Ginez Romero

    2010-01-01

    Full Text Available Many business stablisment utilize escalator that performs it’s function in a regular way of work. There is a big waste of eletric power, as in a good part of it there isn’t a transportation of user. The search for new sources shouldnt’t is the only worry in the context of energetic resource, but also the development of new technologies aimed an optimal use of this recourse. In the conjuncture, this project aims to establish a escalators’ control system, to optimize their use and reduce energy consumption of equipment. The system’s operation is based on the principle that, after a time ta,, a free flow of user, which this time is previously define by a statistician study the escalator reduce its speed, if it has passed a time tb, being tb>ta, the escalator is stopped. If we have the presence of the user, the escalator presents low acceleration, establishing the regular way of work without risks of utilization. The energetic economy happens when the escalator is stopped, or working with reduced speed. The project consists in replace the eletric command of the reversor and with the direct start, by a system’s control proposed. The reduction of the energy comsumption was valued by a statistician study, so trough it we can increase the use of the system and stipulate of the economy zone for the escalators with high and low user’s flow. This system is ecologically correct and contribute for the consumption optimized of electric power. = Muitos estabelecimentos comerciais utilizam escadas rolantes que desempenham sua função em regime normal de funcionamento. Existe um grande desperdício de energia elétrica, já que em boa parte não há transporte de usuário. A busca por novas fontes não deve ser a única preocupação no contexto dos recursos energéticos, mas também o desenvolvimento de novas tecnologias que visam o uso otimizado destes recursos. Nesta conjuntura, este projeto visa implantar um sistema de controle para escadas

  7. Adolescent marriage and childbearing: the long-term economic outcome, Canada in the 1980s.

    Science.gov (United States)

    Grindstaff, C F

    1988-01-01

    The purpose of this paper is to examine the long-term economic outcomes (education, labor force participation, occupation, and income) associated with female adolescent marriage and childbearing. The 1981 Canadian census is the data source for all women in Canada at age 30, controlling for age at marriage and at first birth. The data suggest that women at age 30 in Canada are in the best economic circumstances when they remain single or when they marry at age 20 or older and either remain childless or begin their childbearing at age 25 or older. The implications of these findings are discussed.

  8. Limited socioeconomic opportunities and Latina teen childbearing: a qualitative study of family and structural factors affecting future expectations.

    Science.gov (United States)

    Minnis, Alexandra M; Marchi, Kristen; Ralph, Lauren; Biggs, M Antonia; Combellick, Sarah; Arons, Abigail; Brindis, Claire D; Braveman, Paula

    2013-04-01

    The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents. We conducted in-depth interviews with 65 pregnant foreign- and US-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing. Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in US-born adolescents' childbearing. Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents.

  9. Multilevel determinants of teenage childbearing in sub-Saharan Africa in the context of HIV/AIDS.

    Science.gov (United States)

    Magadi, Monica A

    2017-07-01

    This paper examined national variations and multilevel determinants of teenage childbearing in sub-Saharan Africa (SSA) in the context of HIV/AIDS using data from recent Demographic and Health Surveys conducted in 29 countries of SSA. Results showed significant community and national variations in teenage childbearing, partly explained by socio-economic and HIV/AIDS context. At community level, lower HIV/AIDS stigma, higher wealth and female education were associated with lower teenage childbearing. However, national socio-economic status had an intricate relationship with teenage childbearing. Higher national GDP per-capita was generally associated with higher teenage childbearing, and this relationship was stronger in lower HIV prevalence countries. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Dose escalation studies with caspofungin against Candida glabrata.

    Science.gov (United States)

    Domán, Marianna; Kovács, Renátó; Perlin, David S; Kardos, Gábor; Gesztelyi, Rudolf; Juhász, Béla; Bozó, Aliz; Majoros, László

    2015-09-01

    Echinocandins are recommended as first-line agents against invasive fungal infections caused by Candida glabrata, which still carry a high mortality rate. Dose escalation of echinocandins has been suggested to improve the clinical outcome against C. glabrata. To address this possibility, we performed in vitro and in vivo experiments with caspofungin against four WT C. glabrata clinical isolates, a drug-susceptible ATCC 90030 reference strain and two echinocandin-resistant strains with known FKS mutations. MIC values for the clinical isolates in RPMI 1640 were ≤ 0.03 mg l(-1 ) but increased to 0.125-0.25 mg l(-1 )in RPMI 1640+50% serum. In RPMI 1640+50% serum, the replication of C. glabrata was weaker than in RPMI 1640.Caspofungin in RPMI 1640 at 1 and 4 mg l(-1) showed a fungicidal effect within 7 h against three of the four clinical isolates but was only fungistatic at 16 and 32 mg l(-1) (paradoxically decreased killing activity). In RPMI 1640+50% serum, caspofungin at ≥ 1 mg l(-1) was rapidly fungicidal (within 3.31 h) against three of the four isolates. In a profoundly neutropenic murine model, all caspofungin doses (1, 2, 3, 5 and 20 mg kg(-1) daily) decreased the fungal tissue burdens significantly (P caspofungin dose escalation does not improve efficacy.

  11. IS Project Management and Risk Escalation: Towards A Dynamic Model

    Directory of Open Access Journals (Sweden)

    Angela Y Lin

    2015-03-01

    Full Text Available While the number of substantive investments in IS projects continues to grow, the number of failing projects also continues to increase at an alarming rate. Both the academic and industry literature suggests that inadequate attention to risk and its management continues to be a key factor in project failure. The typical approach taken is to identify and map potential risks, to act as a planning and diagnostic tool, and to prepare a contingency plan has been a factor-based approach. While it remains a valuable tool for mapping anticipated risks the factor-based approach is less effective when viewing project risks as emergent phenomena that un-fold during the course of the project, and require ongoing attention and risk management. In-formed by a case study of a failing university IS development project, this paper focuses on the phenomenon of risk escalation. The case findings suggest that rather than being defined ahead of the project, some project risks may emerge during the project as a consequence of escalation factors that were both antecedent to and a consequence of actual risk management decisions. The article concludes with suggestions as to how project managers can better man-age the emergent rather than static nature of risk phenomena.

  12. Racial and Ethnic Differences in the Role of Cohabitation in Premarital Childbearing.

    Science.gov (United States)

    Manning, Wendy D.; Landale, Nancy S.

    1996-01-01

    Examines cohabitation in premarital childbearing among U.S. women. Utilized data from the National Survey of Families and Households and the New York Fertility, Employment, and Migration Survey. Marked racial and ethnic differences in the role of the cohabiting union in family building were evident. Interprets findings in terms of long-standing…

  13. Why Wait? The Effect of Marriage and Childbearing on the Wages of Men and Women

    Science.gov (United States)

    Loughran, David S.; Zissimopoulos, Julie M.

    2009-01-01

    We use data from the earlier and later cohorts of the NLSY to estimate the effect of marriage and childbearing on wages. Our estimates imply that marriage lowers female wages 2-4 percent in the year of marriage. Marriage also lowers the wage growth of men and women by about two and four percentage points, respectively. A first birth lowers female…

  14. Love, marriage, then the baby carriage? Marriage timing and childbearing in Sweden

    NARCIS (Netherlands)

    Holland, J.A.

    2013-01-01

    Background: Some scholars claim that marriage is an outmoded institution, decoupled from the childbearing process in Sweden. However, it is likely that the presence of children is still linked to marriage, since most children born to cohabiting couples experience the marriage of their parents. The t

  15. Anatomical characterisation of the cricothyroid membrane in females of childbearing age using computed tomography.

    LENUS (Irish Health Repository)

    Long, N

    2014-02-01

    In the event of failure to secure the airway by conventional means, it may be necessary to perform invasive airway access via the cricothyroid membrane. No studies have addressed anatomy of this structure in the obstetric population. We aimed to review the anatomical variation of this structure in a population of childbearing age.

  16. Seroepidemiology of Toxoplasma gondii infection in women from the North of Portugal in their childbearing years

    Science.gov (United States)

    Seroprevalence of Toxoplasma gondii infection and associated risk factors were investigated in 401 women of childbearing age from the North of Portugal. Among the 98 (24.4%) seropositive women, 92 (93.9%) were detected as positive only for imunoglobulin (Ig) G, two women (2.0%) were positive only fo...

  17. Exposure to international migration and its effect on childbearing in Turkey.

    Science.gov (United States)

    White, Kari; Buckley, Cynthia J

    2011-01-01

    International migration alters social norms, family structures, and population development in sending regions. Each of these factors affects fertility, making the impact of international migration on childbearing an increasingly important area of study. In many sending regions, the Demographic and Health Surveys (DHS) provide a promising, but underutilized, source of data for understanding the relationship between international migration and childbearing. Using the household and individual questionnaires in the 2003 Turkish DHS, we develop a multi-layered approach for measuring international migration. We then use these measures to examine differences in childbearing among women in migrant and non-migrant households, assessing the effects of migrant selection and migration-related roles and attitudes on the number of children born. After adjusting for selection characteristics, we find return female migrants and migrant wives are not significantly different from women in non-migrant households; role and attitude differences have only modest impacts on the association between women’s exposure to migration and childbearing.

  18. Prevalence of Chlamydia trachomatis among Childbearing Age Women in India: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Kalpana Betha

    2016-01-01

    Full Text Available Background. Infection with Chlamydia trachomatis (CT can lead to reproductive sequelae. Information on the general population of childbearing age women in India is sparse. We reviewed the literature on CT prevalence within the general population of reproductive aged women in order to improve the efforts of public health screening programs and interventions. Objective. To conduct a literature review to determine the prevalence of Chlamydia trachomatis among childbearing age women in India. Search Strategy. Ovid Medline and PubMed databases were searched for articles from January 1, 2003, through December 31, 2014. Search terms included “Chlamydia trachomatis”, “CT”, “prevalence”, “India”, and “sexually transmitted infections”. Selection Criteria. Studies on prevalence data for CT among women of childbearing age (15–45 living in India were included. Data Collection and Analysis. Articles that met the inclusion criteria were extracted by two readers and discrepancies solved through discussion. Results. Reported prevalence of active CT infection among lower risk groups ranged from 0.1% to 1.1% and in higher risk group from 2.7% to 28.5%. Conclusion. CT prevalence among women in India is comparable to other countries. Screening programs to prevent adverse outcomes among Indian women of childbearing age and their offspring are warranted.

  19. Three Cases of Adolescent Childbearing Decision-Making: The Importance of Ambivalence

    Science.gov (United States)

    Bender, Soley S.

    2008-01-01

    Limited information is available about the childbearing decision-making experience by the pregnant adolescent. The purpose of this case study was to explore this experience with three pregnant teenagers. The study is based on nine qualitative interviews. Within-case descriptions applying the theoretical model of decision-making regarding unwanted…

  20. Three Cases of Adolescent Childbearing Decision-Making: The Importance of Ambivalence

    Science.gov (United States)

    Bender, Soley S.

    2008-01-01

    Limited information is available about the childbearing decision-making experience by the pregnant adolescent. The purpose of this case study was to explore this experience with three pregnant teenagers. The study is based on nine qualitative interviews. Within-case descriptions applying the theoretical model of decision-making regarding unwanted…

  1. Latina daughters' childbearing attitudes: the role of maternal expectations and education communication.

    Science.gov (United States)

    Mireles-Rios, Rebeca; Romo, Laura F

    2014-05-01

    Adolescent girls' and their mothers' expectations for their daughters' college attainment, mother-daughter communication about education, and daughters' early childbearing attitudes were examined in 146 U.S.-raised Latina girls (mean age = 14.4 years) and their mostly immigrant mothers. Through structural equation modeling, we tested in the present study a 3-path mediating model to identify mechanisms underlying the association between maternal expectations and daughters' childbearing attitudes. There was evidence to suggest that self-reported mother-daughter communication about education and the daughters' achievement orientation, as measured by their expectations to attend college and self-reported grades, were 2 mediating factors by which maternal college expectations for daughters were linked to their childbearing attitudes. Specifically, higher maternal expectations were associated with increased reported education communication, which in turn was associated with higher achievement orientation. In turn, higher achievement orientation was associated with the girls' desire to have a first child at older ages and more rejecting attitudes toward the prospect of an adolescent pregnancy. The findings underscore the crucial role that Latina mothers can play in both supporting their daughters' goals to pursue higher education and motivating daughters to avoid early childbearing. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  2. Happy families, high fertility? Childbearing choices in the context of family and partner relationships

    NARCIS (Netherlands)

    Rijken, A.J.

    2009-01-01

    Having a child is one of the most influential events people experience over their life course. Nowadays this event tends to be a matter of choice. This dissertation provides new insights into the childbearing choices and behaviour of Dutch couples by applying a ‘linked lives’ perspective and combini

  3. Happy families, high fertility?: childbearing choices in the context of family and partner relationships

    NARCIS (Netherlands)

    Rijken, A.J.

    2009-01-01

    Having a child is one of the most influential events people experience over their life course. Nowadays this event tends to be a matter of choice. This dissertation provides new insights into the childbearing choices and behaviour of Dutch couples by applying a ‘linked lives’ perspective and combini

  4. Factors Associated with Delayed Childbearing: From the Voices of Expectant Latina Adults and Teens in California

    Science.gov (United States)

    Biggs, M. Antonia; Ralph, Lauren; Minnis, Alexandra M.; Arons, Abigail; Marchi, Kristen S.; Lehrer, Jocelyn A.; Braveman, Paula A.; Brindis, Claire D.

    2010-01-01

    There has been limited research on the protective factors that help Latinas delay childbearing until adulthood. In-depth interviews were conducted with 65 pregnant Latina teenage and adult women in California who were about to have their first child. Lack of or inconsistent birth control use as teens was attributed to wanting or ambivalence toward…

  5. Childbearing traditions of Indian women at home and abroad: An integrative literature review.

    Science.gov (United States)

    Wells, Young-Oak; Dietsch, Elaine

    2014-12-01

    The percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia. To explore childbearing practices in India and Indian women's experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia. An integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian women's childbearing traditions. Five themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs. Indian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  6. The Impact of Legalized Abortion on Adolescent Childbearing in New York City.

    Science.gov (United States)

    Joyce, Theodore J.; Mocan, Naci H.

    1990-01-01

    Estimates impact of liberalization of New York State abortion law in 1970 on adolescent childbearing in New York City. Analyzes monthly data on number of births to White and Black adolescents from 1963-87. Findings indicate that level of births to Black adolescents fell 18.7 percent and births to White adolescents fell 14.1 percent after the law…

  7. Gender Equality and Outsourcing of Domestic Work, Childbearing, and Relationship Stability among British Couples

    Science.gov (United States)

    Schober, Pia S.

    2013-01-01

    This study investigates whether gender inequality in the division of housework and child care may be an obstacle to childbearing and relationship stability among different groups of British couples. Furthermore, it explores whether outsourcing of domestic labor ameliorates any negative effects of domestic work inequality. The empirical…

  8. Periodontal status and associated risk factors among childbearing age women in Cixi City of China

    Institute of Scientific and Technical Information of China (English)

    Yan-min WU; Jia LIU; Wei-lian SUN; Li-li CHEN; Li-guo CHAI; Xiang XIAO; Zheng CAO

    2013-01-01

    Objective:To investigate the periodontal status and associated risk factors among women of childbearing age to increase the awareness of oral health.Methods:The study was conducted on childbearing age women in Cixi,a city in Zhejiang Province in the southeast of China.A total of 754 women participated in periodontal examination while receiving prenatal care.Data of the women were collected from the Cixi Family Planning Commission and during an interview.Clinical periodontal indices,such as bleeding on probing (BOP),probing depth (PD),and clinical attachment level (CAL) were measured during the examination.Statistical analysis on subject-based data was performed.Results:The prevalence of periodontal disease among childbearing age women in Cixi was high (84.7%).A significant association was found between the disease and educational level,pregnancy,taking oral contraceptives,stress,alcohol consumption,overweight,dental visit,and teeth brushing (P<0.05).Women who suffered periodontal disease showed deep PD,obvious BOP,and clinical attachment loss.Among this population,pregnancy was closely associated with higher BOP percentage; teeth brushing no more than once per day or brushing for less than 1 min (P<0.001) after adjusting for age and stress.Conclusions:The periodontal status of childbearing age women in Cixi needs to be improved urgently.Attention towards the periodontal health should be warranted,especially for those in special statuses and with poor awareness.

  9. Gender Equality and Outsourcing of Domestic Work, Childbearing, and Relationship Stability among British Couples

    Science.gov (United States)

    Schober, Pia S.

    2013-01-01

    This study investigates whether gender inequality in the division of housework and child care may be an obstacle to childbearing and relationship stability among different groups of British couples. Furthermore, it explores whether outsourcing of domestic labor ameliorates any negative effects of domestic work inequality. The empirical…

  10. The Role of Contemporary Childbearing Postponement and Recuperation in Shaping Period Fertility Trends

    Directory of Open Access Journals (Sweden)

    Tomas Frejka

    2012-09-01

    3. These TPFR increases were predominantly the consequence of changes in cohort childbearing age patterns, i.e. changes in the timing of fertility. They were not generated by fertility quantum increases. During this period in almost all the low-fertility countries TPFRs were rising while corresponding total cohort fertility rates were declining.

  11. Metabolic syndrome in women of childbearing age and pregnancy: recognition and management of dyslipidemia.

    Science.gov (United States)

    Paramsothy, Pathmaja; Knopp, Robert H

    2005-01-01

    The obesity pandemic engenders the global threat of metabolic syndrome and its related disorders, including diabetes and coronary artery disease (CAD). The purpose of this review is to discuss the deleterious effects of metabolic syndrome on women of childbearing age, including pregnancy, with a discussion of lipid management. Treatment options will also be presented.

  12. Impact of Childbearing Decisions on Family Size of Korean Women with Systemic Lupus Erythematosus.

    Science.gov (United States)

    Kim, In Je; Kim, Hyoun-Ah; Suh, Chang-Hee; Park, Yong-Wook; Lee, Hye-Soon; Bang, So-Young; Bae, Sang-Cheol; Kang, Young Mo; Lee, Won Kyung; Park, Hyesook; Lee, Jisoo

    2016-05-01

    Systemic lupus erythematosus (SLE) predominantly affects women in their reproductive years and has a significant impact on childbearing. We investigated the influence of personal decision on family size among Korean women with SLE and factors that affect the decisions. A case-control study comparing childbearing history and decisions of 112 SLE patients and 135 controls was performed. Women with SLE participating in the Network for Lupus Clinical Research in South Korea and matching controls between ages of 18-45, who are/were married or living with a partner were included. Data regarding socio-demographics, reproductive history, and childbearing decisions were collected through a survey using a standardized questionnaire and medical record review. More women with SLE reported at least one pregnancy (85.7% vs. 71.9%, P = 0.009) or at least one live birth (85.7% vs. 71.9%, P = 0.003) compared with controls. Mean number of pregnancies was significantly higher (2.4 ± 1.6 vs. 1.4 ± 1.3, P < 0.001), and mean number of live births was significantly lower in women with SLE (1.2 ± 0.8 vs. 1.6 ± 0.8, P < 0.001). Significantly more women with SLE made the decision not to have children compared with controls (54.5% vs. 40.7%, P = 0.031), and health-related concerns were the major cause of the decision. Other socio-demographic factors did not influence the decision to limit childbearing in SLE women. The disease-related concerns had significant impact on family size and childbearing decisions among Korean women with SLE.

  13. Sociodemographic and dietary profile of 4,471 childbearing-age women planning a pregnancy

    Directory of Open Access Journals (Sweden)

    Marta Cuervo

    2014-02-01

    Full Text Available Background: The maintenance of healthy lifestyles is of great importance to prevent pregnancy-related diseases at early stages. For this reason, the knowledge of the overall wellbeing of women at childbearing-age is necessary to provide appropriate advice to maintain or improve the nutritional status. The aim of this research was to assess the lifestyles of childbearing-age women planning a pregnancy and to examine the difference between primiparae and multiparae women on these lifestyles. Methods: This cross-sectional survey involved 4,471 Spanish women at childbearing-age that were planning a pregnancy. Information was collected through a questionnaire by community health professionals. Results: The profile of childbearing-age recruited women planning a pregnancy were in her early thirties (31.4 ± 4.8 years and 72.5% were seeking for her first baby. They had a good self-perception of their nutritional and health status and followed a balanced diet. Interestingly, primiparae women had lower risk of health complications but they were greater consumers of tobacco and alcohol (p < 0.001, and consumed less fortified milk, iodine and iron supplements than multiparae women. Additionally, the examined population showed a more sedentary pattern in primiparae women as compared to the remaining group concerning hours/day lying, sitting and standing. Conclusion: Differences between both preconceptional conditions (primiparae and multiparae women bring a great opportunity to promote healthy habits among childbearing-aged women, according to the personal profile, in order to prevent burdens in future pregnancies underlying modifiable or preventable factors.

  14. Riding the Escalator: How Dangerous is it Really?

    Directory of Open Access Journals (Sweden)

    Louisa H. Schminke

    2013-03-01

    Full Text Available Introduction: About 10,000 escalator-related injuries per year result in emergency departmenttreatment in the United States. Since the 1990s, a steady increase has been reported, but fewstatistics on escalator-related injuries have been published worldwide. We have therefore analyzedescalator accident statistics in admissions to our hospital in Switzerland since 2000.Methods: Using retrospective electronic patient chart analysis, we included in our study patients>16 years treated over an 11-year period. We categorized patients in terms of gender, age andassociated risk factors, and classified accidents according to day, time, location and cause. Resultingtrauma was categorized according to type and location. We divided post-admission treatment intosurgical and conservative, and into treatment as an outpatient, in a short-stay unit, or as a hospitaladmission. Women and men were compared using Fisher’s exact test.Results: We identified 173 patients with 285 discrete injuries. Of these, 87 patients (50% werewomen. Fifty-three (61% of the women and 38 (44% of the men were >60 years old (P = 0.033.Fifty percent of the men (43/86of the men, but only 7% (6/87 of the women showed signs of alcoholintoxication (P < 0.0001. Accidents in women occurred predominantly on Tuesdays (19/87; 22%between 12PM and 6PM (35/87; 40%, and in men on Saturdays (16/86; 19% between 6PM and12AM (29/86; 34%; P = 0.0097. Sixty-two percent (44/71 of the accidents were in public transportfacilities and 30% (21/71 in shopping centers. The majority of injuries in women were to the lowerextremities (49/87; 56%, while most accidents in men were to the head and neck (51/86; 59%; P =0.0052. About half (90; 52% of the patients were treated conservatively. Almost half of all patients(76, 44% required hospital admission. Of those, 45% left the hospital within 24 hours of admission(short stay unit and 55% stayed longer than 24 hours.Conclusion: Escalator accidents can result in severe

  15. The Integrated Web Portal for Escalation with Overdose Control (EWOC).

    Science.gov (United States)

    Wang, Haibin; Tighiouart, Mourad; Huang, Shao-Chi; Berel, Dror; Cook-Wiens, Galen; Bresee, Catherine; Li, Quanlin; Rogatko, André

    2013-01-01

    In this paper, we present the design and implementation of a novel web portal for the cancer phase I clinical trial design method Escalation with Overdose Control (EWOC). The web portal has two major components: a web-based dose finding calculator; and a standalone and downloadable dose finding software which can be installed on Windows operating systems. The web-based dose finding calculator uses industry standards and is a database-driven and distributed computing platform for designing and conducting dose finding in cancer phase I clinical trials utilizing EWOC methodology. The web portal is developed using open source software: PHP, JQuery, R and OpenBUGS. It supports any standard browsers with internet connection. The web portal can be accessed at: http://biostatistics.csmc.edu.

  16. Factors associated with escalation and problematic approaches toward public figures.

    Science.gov (United States)

    Meloy, J Reid; James, David V; Mullen, Paul E; Pathé, Michele T; Farnham, Frank R; Preston, Lulu F; Darnley, Brian J

    2011-01-01

    Detailed comparison of factors associated with abnormal approach to the prominent and with escalation from communication to approach has not hitherto been undertaken. This partially reflects the failure of individual studies to adopt compatible terminologies. This study involves a careful dissection of six public figure studies, three involving U.S. politicians, two Hollywood celebrities, and one the British Royal Family. Common findings were unearthed across six headings. Approachers were significantly more likely to exhibit serious mental illness, engage in multiple means of communication, involve multiple contacts/targets, and to incorporate into their communication requests for help. They were significantly less likely to use threatening or antagonistic language in their communications, except in those cases involving security breaches. These results emphasize the importance of integrating mental health findings and preventive measures into risk management. Approach should not be regarded as a single behavioral category and has multiple motivations. Future studies should adopt standard terminology, preferably taken from the general stalking research.

  17. Do Sell-Side Stock Analysts Exhibit Escalation of Commitment?

    Science.gov (United States)

    Beshears, John; Milkman, Katherine L

    2011-03-01

    This paper presents evidence that when an analyst makes an out-of-consensus forecast of a company's quarterly earnings that turns out to be incorrect, she escalates her commitment to maintaining an out-of-consensus view on the company. Relative to an analyst who was close to the consensus, the out-of-consensus analyst adjusts her forecasts for the current fiscal year's earnings less in the direction of the quarterly earnings surprise. On average, this type of updating behavior reduces forecasting accuracy, so it does not seem to reflect superior private information. Further empirical results suggest that analysts do not have financial incentives to stand by extreme stock calls in the face of contradictory evidence. Managerial and financial market implications are discussed.

  18. Training Tolerance to Delay Using the Escalating Interest Task.

    Science.gov (United States)

    Rung, Jillian M; Young, Michael E

    2014-09-01

    The present study examined the lasting effects of exposure to reinforcement that increased in magnitude as a function of time between responses in a first-person shooter video game preparation of the escalating interest task. When reinforcement density increased as a function of time, it encouraged participants to wait longer between responses (shots of a weapon). Participants exposed to such contingencies waited significantly longer to fire their weapons than participants who were exposed to linear growth, where long inter-response times were not differentially reinforced. Those with experience in conditions where reinforcement density increased as a function of time showed persistently longer wait times when the contingencies changed in the latter portion of the game where the disincentive to fire quickly was removed. The potential utility of such contingencies for training tolerance to delay of reinforcement and the broader implications of training self-control are discussed.

  19. Misonidazole with dexamethasone rescue: an escalating dose toxicity study

    Energy Technology Data Exchange (ETDEWEB)

    Tanasichuk, H.; Urtasun, R.C.; Fulton, D.S.; Raleigh, J.

    1984-09-01

    Neurotoxicity induced by misonidazole (MISO) and desmethylmisonidazole (DMM) has become the dose limiting factor in clinical work. In 1981, the authors reported a preliminary study suggestive that Dexamethasone (DEXA) does have a protective effect against peripheral neuropathies (PN) resulting from toxicity of misonidazole. The authors are presently investigating the use of DEXA, with escalating doses of MISO in an attempt to modify its neurotoxicity. To date, 16 patients have been registered to receive total doses of MISO given in 9 equally divided doses over 3 weeks. DEXA is given 3 days prior to the first dose and continues for the duration of therapy. All patients receive palliative radiation. No toxicity was seen at the total dose of 13.5 gm/M/sub 2/. One grade I PN occurred in the first four patients receiving 15.5 gm/M/sub 2/. Six additional patients were entered at this dose level and no further incidence of PN was observed.

  20. Understanding the Emotional Aspects of Escalation of Commitment: The Role of Negative Affect

    Science.gov (United States)

    Wong, Kin Fai Ellick; Yik, Michelle; Kwong, Jessica Y. Y.

    2006-01-01

    Despite the importance of understanding the emotional aspects of organizational decision making, prior research has paid scant attention to the role of emotion in escalation of commitment. This article attempts to fill this gap by examining the relationship between negative affect and escalation of commitment. Results showed that regardless of…

  1. Attribution Bias and Overconfidence in Escalation of Commitment: The Role of Desire to Rectify Past Outcomes

    Science.gov (United States)

    Tine, Delilah Castillo

    2013-01-01

    Escalation of commitment is the voluntary continuation of investing resources into what appears to be a failing course of action whose outcome is uncertain. Investigation into the escalation of commitment phenomenon is important to organizations because such behavior could result in grave economic loss. This research investigates two cognitive…

  2. 42 CFR 405.1108 - MAC actions when request for review or escalation is filed.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false MAC actions when request for review or escalation...) Medicare Appeals Council Review § 405.1108 MAC actions when request for review or escalation is filed. (a) Except as specified in paragraphs (c) and (d) of this section, when a party requests that the MAC review...

  3. Inherently irrational? A computational model of escalation of commitment as Bayesian Updating.

    Science.gov (United States)

    Gilroy, Shawn P; Hantula, Donald A

    2016-06-01

    Monte Carlo simulations were performed to analyze the degree to which two-, three- and four-step learning histories of losses and gains correlated with escalation and persistence in extended extinction (continuous loss) conditions. Simulated learning histories were randomly generated at varying lengths and compositions and warranted probabilities were determined using Bayesian Updating methods. Bayesian Updating predicted instances where particular learning sequences were more likely to engender escalation and persistence under extinction conditions. All simulations revealed greater rates of escalation and persistence in the presence of heterogeneous (e.g., both Wins and Losses) lag sequences, with substantially increased rates of escalation when lags comprised predominantly of losses were followed by wins. These methods were then applied to human investment choices in earlier experiments. The Bayesian Updating models corresponded with data obtained from these experiments. These findings suggest that Bayesian Updating can be utilized as a model for understanding how and when individual commitment may escalate and persist despite continued failures.

  4. Escalation research: providing new frontiers for applying behavior analysis to organizational behavior.

    Science.gov (United States)

    Goltz, S M

    2000-01-01

    Decision fiascoes such as escalation of commitment, the tendency of decision makers to "throw good money after bad," can have serious consequences for organizations and are therefore of great interest in applied research. This paper discusses the use of behavior analysis in organizational behavior research on escalation. Among the most significant aspects of behavior-analytic research on escalation is that it has indicated that both the patterns of outcomes that decision makers have experienced for past decisions and the patterns of responses that they make are critical for understanding escalation. This research has also stimulated the refinement of methods by researchers to better assess decision making and the role reinforcement plays in it. Finally, behavior-analytic escalation research has not only indicated the utility of reinforcement principles for predicting more complex human behavior but has also suggested some additional areas for future exploration of decision making using behavior analysis.

  5. Early adolescent childbearing in low- and middle-income countries: associations with income inequity, human development and gender equality.

    Science.gov (United States)

    Decker, Michele R; Kalamar, Amanda; Tunçalp, Özge; Hindin, Michelle J

    2017-03-01

    Reducing unwanted adolescent childbearing is a global priority. Little is known about how national-level economic and human development indicators relate to early adolescent childbearing. This ecological study evaluates associations of Gross Domestic Product (GDP), GINI index, Human Development Index (HDI) and Gender-related Development Index (GDI; i.e. the HDI adjusted for gender disparities) with early adolescent childbearing in 27 low- and middle-income countries (LMICs) across three time periods. Among women ages 18–24, prevalence estimates for early birth (human development adjusted for gender disparities in educational and economic prospects, was more consistently related to early adolescent childbearing than the absolute development prospects as given by the HDI. While creating gender equality is an important goal in and of itself, the findings emphasize the potential for improved national-level gender equitable development as a means to improve adolescents’ sexual and reproductive health.

  6. A project for future life—Swedish women's thoughts on childbearing lacking experience of giving birth and parenthood

    Directory of Open Access Journals (Sweden)

    Kyllike Christensson

    2012-05-01

    Full Text Available A lifeworld hermeneutic approach was used in order to understand Swedish women's thoughts on childbearing. Nine women were interviewed, and they ranged in age from 22 to 28 years and represented diverse socioeconomic, educational, sexual, and fertility backgrounds. All women were similar in that they lacked experience of giving birth and parenthood. The analysis showed that childbearing includes dimensions of both immanence and transcendence. Immanence, as childbearing is seen as stagnant to women's freedom in present life. Transcendence, as childbearing is thought of as a project for future life, a part of female identity, and a conscious standpoint for which the woman wants to be prepared and for which she wants to create the best conditions.

  7. Intimate partner violence among women of childbearing age in a primary health care centre in Nigeria.

    Science.gov (United States)

    Ilika, Amobi L; Okonkwo, Prosper I; Adogu, Prosper

    2002-12-01

    This study assessed the prevalence and characteristics of intimate partner violence among women of childbearing age in a primary health centre. With interviewer-administered questionnaire, information on partner violence was elicited from three hundred women of childbearing age selected by systematic sampling in a primary health care (PHC) centre. Over 40% had experienced violence within the last 12 months. Type of marriage and partner's education had effect on violence. Perceived reasons for violence were economic demand (56.1%), reproductive issues (42.5%), alcohol and drugs (61.2%). Forty eight per cent reported to family members. Only 1% reported to the Police. Intimate partner violence is a prevalent public health problem in eastern Nigeria. Health workers and social organisations should recognise the problem and offer necessary support, and women should be empowered to navigate through the problem.

  8. Social outcomes of early childbearing: important considerations for the provision of clinical care.

    Science.gov (United States)

    Fessler, Kathryn Bondy

    2003-01-01

    Traditional understanding of adolescent childbearing includes a belief that the social and economic consequences for both mother and child are almost universally negative. Recent research, however, reveals that the outcomes resulting from the birth of children to young mothers are diverse and complex. Social circumstances contributing to adolescent pregnancy and parenting, such as poverty, poor educational opportunity, and violence, are also causes of less than optimal outcomes for young mothers and their children; thus, attributions of cause and effect are difficult to make. By reviewing outcomes research that approaches this question in a number of more creative ways, clinicians can gain a more complete understanding of this phenomenon. It is hoped that health care providers with access to new evidence about the social consequences of adolescent childbearing will have improved success and satisfaction in providing competent, compassionate care to pregnant and parenting adolescents.

  9. Understanding the Social Meaning of Infertility and Childbearing: A Qualitative Study of the Perception of Childbearing and Childlessness in Northern Ghana

    Science.gov (United States)

    Tabong, Philip Teg-Nefaah; Adongo, Philip Baba

    2013-01-01

    Background Infertility is a major medical condition that affects many married couples in sub-Saharan African and as such associated with several social meanings. This study therefore explored community's perception of childbearing and childlessness in Northern Ghana using the Upper West Region as a case study. Methods The study was exploratory and qualitative using in-depth and key informant interviews and focus group discussions. Fifteen marriage unions with infertility (childless), forty-five couples with children, and eight key informants were purposively sampled and interviewed using a semi-structured interview guides. Three focus group discussions were also carried out, one for childless women, one for women with children and one with men with children. The data collected were transcribed, coded, arranged, and analyzed for categories and themes and finally triangulated. Results The study revealed that infertility was caused by both social and biological factors. Socially couples could become infertile through supernatural causes such as bewitchment, and disobediences of social norms. Abortion, masturbation and use of contraceptives were also identified as causes of infertility. Most childless couples seek treatment from spiritualist, traditional healers and hospital. These sources of treatment are used simultaneously. Conclusion Childbearing is highly valued in the community and Childlessness is highly engendered, and stigmatised in this community with manifold social consequences. In such a community therefore, the concept of reproductive choice must encompass policies that make it possible for couples to aspire to have the number of children they wish. PMID:23342158

  10. Understanding the social meaning of infertility and childbearing: a qualitative study of the perception of childbearing and childlessness in Northern Ghana.

    Directory of Open Access Journals (Sweden)

    Philip Teg-Nefaah Tabong

    Full Text Available BACKGROUND: Infertility is a major medical condition that affects many married couples in sub-Saharan African and as such associated with several social meanings. This study therefore explored community's perception of childbearing and childlessness in Northern Ghana using the Upper West Region as a case study. METHODS: The study was exploratory and qualitative using in-depth and key informant interviews and focus group discussions. Fifteen marriage unions with infertility (childless, forty-five couples with children, and eight key informants were purposively sampled and interviewed using a semi-structured interview guides. Three focus group discussions were also carried out, one for childless women, one for women with children and one with men with children. The data collected were transcribed, coded, arranged, and analyzed for categories and themes and finally triangulated. RESULTS: The study revealed that infertility was caused by both social and biological factors. Socially couples could become infertile through supernatural causes such as bewitchment, and disobediences of social norms. Abortion, masturbation and use of contraceptives were also identified as causes of infertility. Most childless couples seek treatment from spiritualist, traditional healers and hospital. These sources of treatment are used simultaneously. CONCLUSION: Childbearing is highly valued in the community and Childlessness is highly engendered, and stigmatised in this community with manifold social consequences. In such a community therefore, the concept of reproductive choice must encompass policies that make it possible for couples to aspire to have the number of children they wish.

  11. Pharmacokinetics of Escalating Doses of Oral Psilocybin in Healthy Adults.

    Science.gov (United States)

    Brown, Randall T; Nicholas, Christopher R; Cozzi, Nicholas V; Gassman, Michele C; Cooper, Karen M; Muller, Daniel; Thomas, Chantelle D; Hetzel, Scott J; Henriquez, Kelsey M; Ribaudo, Alexandra S; Hutson, Paul R

    2017-03-28

    Psilocybin is a psychedelic tryptamine that has shown promise in recent clinical trials for the treatment of depression and substance use disorders. This open-label study of the pharmacokinetics of psilocybin was performed to describe the pharmacokinetics and safety profile of psilocybin in sequential, escalating oral doses of 0.3, 0.45, and 0.6 mg/kg in 12 healthy adults. Eligible healthy adults received 6-8 h of preparatory counseling in anticipation of the first dose of psilocybin. The escalating oral psilocybin doses were administered at approximately monthly intervals in a controlled setting and subjects were monitored for 24 h. Blood and urine samples were collected over 24 h and assayed by a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for psilocybin and psilocin, the active metabolite. The pharmacokinetics of psilocin were determined using both compartmental (NONMEM) and noncompartmental (WinNonlin) methods. No psilocybin was found in plasma or urine, and renal clearance of intact psilocin accounted for less than 2% of the total clearance. The pharmacokinetics of psilocin were linear within the twofold range of doses, and the elimination half-life of psilocin was 3 h (standard deviation 1.1). An extended elimination phase in some subjects suggests hydrolysis of the psilocin glucuronide metabolite. Variation in psilocin clearance was not predicted by body weight, and no serious adverse events occurred in the subjects studied. The small amount of psilocin renally excreted suggests that no dose reduction is needed for subjects with mild-moderate renal impairment. Simulation of fixed doses using the pharmacokinetic parameters suggest that an oral dose of 25 mg should approximate the drug exposure of a 0.3 mg/kg oral dose of psilocybin. Although doses of 0.6 mg/kg are in excess of likely therapeutic doses, no serious physical or psychological events occurred during or within 30 days of any dose. NCT02163707.

  12. Stress in Latino families following an adolescent's childbearing: effects on family relationships and siblings.

    Science.gov (United States)

    East, Patricia L; Chien, Nina C

    2013-04-01

    This study examined how increased stress in Latino families following an adolescent's childbearing impacts family relationships and the adolescent's siblings. Participants were 243 Mexican American youth (mean age: 13.7 years; 62% girls), or 121 youth who had a pregnant adolescent sister and 122 youth who had an adolescent sister who had never been pregnant. Youth and their mothers were studied at 4 time points across 15 months: The families of pregnant adolescents were studied when the adolescent sister was in her third trimester of pregnancy, and at 2 months, 6 months, and 12 months postpartum; the families of never-pregnant adolescents were studied at like intervals. Individual fixed-effects structural equation models were computed, which control for earlier measures of study constructs and thereby reduce omitted variable bias from preexisting family group differences. Results showed that an adolescent's childbearing was related to increases in family stress, which were related to increases in mothers' harsh parenting and mother-sibling conflict, which, in turn, were related to subsequent increases in siblings' problem behavior. Multiple group analyses revealed that the pathways through which a teenager's childbearing influences siblings operate similarly for girls and boys. Tests of an alternate ordering of model variables indicated a poor fit with the data. Findings provide evidence that the accumulation of stressful family changes following an adolescent's childbearing can negatively impact siblings. Findings also elucidate how family-level stress and disruption experienced across a family transition trickle down to affect family relationships and, in turn, child family members. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  13. The meaning of marriage vis-a-vis childbearing in Europe and the United States

    OpenAIRE

    Holland, Jennifer

    2015-01-01

    This paper extends Holland’s (2013) marriage typology, linking the timing of marriage, childbearing, and cohabitation, and apply it to the Harmonized Histories covering a range of European countries and the United States. The meaning of marriage is organized around six ideal types: Direct Family Forming, Post-Cohabitation Family Forming, Conception-Related Legitimizing, Birth-Related Legitimizing, Reinforcing and Capstone marriage. Although smaller shares of women entered marriage at each age...

  14. Teenage Childbearing and Its Life Cycle Consequences: Exploiting a Natural Experiment

    OpenAIRE

    V. Joseph Hotz; Sanders, Seth G.; Susan Williams McElroy

    1999-01-01

    In this paper, we exploit a 'natural experiment' associated with human reproduction to identify the effect of teen childbearing on subsequent educational attainment, family structure, labor market outcomes and financial self-sufficiency. In particular, we exploit the fact that a substantial fraction of women who become pregnant experience a miscarriage (spontaneous abortion) and thus do not have a birth. If miscarriages were purely random and if miscarriages were the only way, other than by l...

  15. Happy families, high fertility? Childbearing choices in the context of family and partner relationships

    OpenAIRE

    Rijken, A.J.

    2009-01-01

    Having a child is one of the most influential events people experience over their life course. Nowadays this event tends to be a matter of choice. This dissertation provides new insights into the childbearing choices and behaviour of Dutch couples by applying a ‘linked lives’ perspective and combining different data sources and methods. Whereas previous fertility research is largely limited to the effects of individual characteristics, usually women's, this study examines the ways in which ch...

  16. Media Influences on Social Outcomes: The Impact of MTV's 16 and Pregnant on Teen Childbearing

    OpenAIRE

    Melissa S. Kearney; Phillip B. Levine

    2014-01-01

    This paper explores how specific media images affect adolescent attitudes and outcomes. The specific context examined is the widely viewed MTV franchise, 16 and Pregnant, a series of reality TV shows including the Teen Mom sequels, which follow the lives of pregnant teenagers during the end of their pregnancy and early days of motherhood. We investigate whether the show influenced teens' interest in contraceptive use or abortion, and whether it ultimately altered teen childbearing outcomes. W...

  17. Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing in the U.S.

    Science.gov (United States)

    Penman-Aguilar, Ana; Carter, Marion; Snead, M. Christine; Kourtis, Athena P.

    2013-01-01

    Objectives We reviewed the literature focused on socioeconomic influences on teen childbearing and suggested directions for future research and practice related to this important indicator of teen sexual health. Methods We conducted an electronic search of Medline, ERIC, PsychLit, and Sociological Abstracts databases for articles published from January 1995 to November 2011. Selected articles from peer-reviewed journals included original quantitative analyses addressing socioeconomic influences on first birth among teen women in the U.S. Articles were abstracted for key information, ranked for quality according to the U.S. Preventive Services Task Force guidelines, assessed for bias, and synthesized. Results We selected articles with a range of observational study designs. Risk for bias varied across studies. All 12 studies that considered socioeconomic factors as influences on teen childbearing (vs. moderators or mediators of other effects) reported at least one statistically significant association relating low socioeconomic status, underemployment, low income, low education levels, neighborhood disadvantage, neighborhood physical disorder, or neighborhood-level income inequality to teen birth. Few reports included any associations contradicting this pattern. Conclusions This review suggests that unfavorable socioeconomic conditions experienced at the community and family levels contribute to the high teen birth rate in the U.S. Future research into social determinants of sexual health should include multiple levels of measurement whenever possible. Root causes of teen childbearing should be evaluated in various populations and contexts. Interventions that address socioeconomic influences at multiple levels could positively affect large numbers of teens and help eliminate disparities in teen childbearing. PMID:23450881

  18. Love, marriage, then the baby carriage? Marriage timing and childbearing in Sweden

    Directory of Open Access Journals (Sweden)

    Jennifer Holland

    2013-08-01

    Full Text Available BACKGROUND Some scholars claim that marriage is an outmoded institution, decoupled from the childbearing process in Sweden. However, it is likely that the presence of children is still linked to marriage, since most children born to cohabiting couples experience the marriage of their parents. The temporal ordering of childbearing and marriage may be informative as to the meaning of marriage. OBJECTIVE I develop a typology of marriage, structured around four possible meanings of marriage as a Family Forming, Legitimizing, Reinforcing and Capstone institution. METHODS I analyze administrative register data covering all Swedish women born between 1950 and 1977, who have lived continuously in Sweden and were never married and childless at age 18 (N = 1,396,305. I tabulate the incidence and type of all first marriages by age and educational attainment. RESULTS Family Forming marriage (prior to a first conception is the dominate first marriage type across all cohorts. The share of Legitimizing marriages (post-conception or within 12 months of a first birth has declined across cohorts. There is an emerging trend toward Capstone marriage (after the birth of two or more children. There is an educational gradient in the experience and type of first marriage. Tertiary-educated women more frequently marry prior to a first birth (Family Forming or Legitimizing marriage. While fewer less-educated women marry, there is greater diversity in the timing of their marriages relative to childbearing. CONCLUSIONS Results demonstrate a continued link between childbearing and marriage, although the ordering of these events may be changing for some subpopulations.

  19. Investigating the Relationship between Teenage Childbearing and Psychological Distress Using Longitudinal Evidence*

    OpenAIRE

    Mollborn, Stefanie; MORNINGSTAR, ELIZABETH

    2009-01-01

    The high levels of depression among teenage mothers have received considerable research attention in smaller targeted samples, but a large-scale examination of the complex relationship between adolescent childbearing and psychological distress that explores bidirectional causality is needed. Using the National Longitudinal Study of Adolescent Health (Add Health) and the Early Childhood Longitudinal Study—Birth Cohort, we found that teenage mothers had higher levels of distress than their chil...

  20. A systematic review of the nutritional status of women of a childbearing age with severe mental illness.

    Science.gov (United States)

    McColl, Helen; Dhillon, Manpreet; Howard, Louise M

    2013-02-01

    Little is known about the nutritional status of pregnant women with severe mental illness. We therefore carried out a systematic review to investigate whether pregnant women and childbearing aged women with severe mental illness have significantly greater nutritional deficiencies compared with pregnant women and childbearing aged women with no mental illness. We carried out a search using MEDLINE, EMBASE and PsycINFO from January 1980 to January 2011 for studies on nutritional status of childbearing aged women with psychotic disorders. Identification of papers and quality rating of papers (using a modified version of the Newcastle-Ottawa scale) was carried out by two reviewers independently. We identified and screened 4,130 potentially relevant studies from the electronic databases. Fifteen studies met the inclusion criteria (n = 587 women). There were no studies of pregnant women. There was some evidence of low serum folate and vitamin B(12) levels and elevated homocysteine levels in childbearing aged women with psychotic disorders. Further research into the nutritional status of childbearing aged women with severe mental illness is needed. Maternal nutrition has a profound impact on foetal outcome, is a modifiable risk factor and therefore needs prioritising in the care of all childbearing aged women with severe mental illness.

  1. Fertility and the fast-track: Continued childbearing among professionals in Sweden, 1991-2009

    Directory of Open Access Journals (Sweden)

    Maria Stanfors

    2014-08-01

    Full Text Available Background: During recent decades women have made considerable advances in education and the labor market, even in fast-track professions such as law, medicine, and academia. While women have entered high-status professions, the career paths of some jobs have changed little and are still inflexible, which implies that professional gains may be offset by familial losses. Objective: We investigate continued childbearing, focusing on the relationship between occupation and second and third births, among highly educated men and women in three high-status professions. Methods: We analyze the determinants of having a second or a third birth using longitudinal data from population registers in Sweden, 1991-2009. We use descriptive statistics and logistic models. Results: Net of demographic and socioeconomic controls, medical doctors are more likely to continue childbearing than lawyers and academics, irrespective of parity and gender. The patterns that emerge are independent of income. Public sector work is conducive to continued childbearing, especially for women. Conclusions: Although there are more opportunities to combine career and family in Sweden than in many other countries, this does not hold equally for all. The results indicate that working conditions and career structures contribute to making it easier for some groups than others to combine a professional career and children. Patterns that emerge reflect that women and men are not equally sensitive to career structures that imply a tradeoff between career and children at an early stage of the career. This puts policies promoting work and family for all into perspective.

  2. Moving policies upstream to mitigate the social determinants of early childbearing.

    Science.gov (United States)

    SmithBattle, Lee

    2012-01-01

    The teen birth rate in the United States is one of the highest in the post-industrialized world. International comparisons suggest that U.S. rates reflect high levels of social disadvantage and misguided policies that frame teen parenting as costly for mothers, children, and taxpayers. Studies that control for background factors that predispose teens to become parents highlight the social inequities that contribute to early childbearing and unfavorable maternal-child outcomes, regardless of maternal age. After reviewing these studies, federal policies that target and scrutinize teenage and single mothers are described and critiqued for the ways they disregard the social determinants of early childbearing and further the marginalization and social exclusion of low-income families. This review calls for public health nurses to challenge the ideological assumptions driving downstream policies and to advocate for comprehensive reforms that reduce the wide and growing inequities in education, income, and health among U.S. citizens. Building the public support and political will to move upstream will remain daunting in light of the pervasive stereotypes of teen parents and the ideological assumptions that early childbearing and poor maternal-child outcomes stem more from individual choices and lifestyles than from social inequities.

  3. Disability is not asexuality: the childbearing experiences and aspirations of women with disability in Zimbabwe.

    Science.gov (United States)

    Peta, Christine

    2017-05-01

    The aim of this article is to elucidate the childbearing experiences and aspirations of women with disability in Zimbabwe. The paper draws from a qualitative narrative study conducted by researchers at the University of Cape Town, South Africa, which explored the experiences of sexuality of disabled women in Zimbabwe and which used the Biographic Narrative Interpretive Method to generate data. In part, the study revealed that disabled women often encounter a diverse range of challenges that are associated with disability and which hinder them from realising their full sexual and reproductive health and rights. Some participants recounted that they are happy with the fact that they have their own biological children, albeit registering frustration with the fact that they are in most cases discriminated against both within and outside of reproductive healthcare centres. Participants who had not had any childbearing experiences by the time of the study reported that they aspired to have their own biological children. Whichever way, the women's narratives are challenging the myth that women with disability do not require space in the childbearing arena because they are disabled.

  4. Use of supplements containing folic acid among women of childbearing age--United States, 2007.

    Science.gov (United States)

    2008-01-11

    Neural tube defects (NTDs) are serious birth defects of the brain (anencephaly) and spine (spina bifida) that affect approximately 3,000 pregnancies each year in the United States. In 1992, the U.S. Public Health Service recommended that all women of childbearing age in the United States capable of becoming pregnant consume 400 microg of folic acid daily to reduce their risk for having a pregnancy affected by NTDs. To assess awareness, knowledge, and behavior related to folic acid among women of childbearing age (aged 18-45 years), CDC analyzed the results of a national survey conducted annually by the Gallup Organization during the period 2003-2007. This report summarizes the results of that analysis, which indicated that, among all women of childbearing age, those aged 18-24 years had the least awareness regarding folic acid consumption (61%), the least knowledge regarding when folic acid should be taken (6%), and the lowest reported daily use of supplements containing folic acid (30%). Because women in this age group account for nearly one third of all births in the United States, promotion of folic acid consumption should be targeted to this population.

  5. 77 FR 42353 - Escalate Capital Partners SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

    Science.gov (United States)

    2012-07-18

    ... ADMINISTRATION Escalate Capital Partners SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small Business Investment Act, Conflicts of Interest Notice is hereby given that Escalate Capital Partners SBIC I...). Escalate Capital Partners SBIC I, L.P. proposes to make a debt investment in Mavenir Systems, Inc.,...

  6. De-escalation, adequacy of antibiotic therapy and culture positivity in septic patients: an observational study

    Science.gov (United States)

    Moraes, Rafael Barberena; Guillén, Julián Alberto Viteri; Zabaleta, William Javier Castillo; Borges, Flavia Kessler

    2016-01-01

    Objective To evaluate the prevalence of antibiotic de-escalation in patients diagnosed with severe sepsis or septic shock at a public academic tertiary hospital and to evaluate antibiotic adequacy and culture positivity. Methods The prevalence of antibiotic de-escalation, the adequacy of antibiotic treatment and the rates of culture positivity were analyzed in patients with severe sepsis and septic shock between April and December 2013 at an intensive care unit in a tertiary university hospital. Results Among the 224 patients included in the study, de-escalation was appropriate in 66 patients (29.4%) but was implemented in 44 patients (19.6%). Among the patients who underwent de-escalation, half experienced narrowing of the antimicrobial spectrum. The mortality rate was 56.3%, with no differences between the patients with or without de-escalation (56.8% versus 56.1%; p = 0.999) nor in the length of hospital stay. Empirical antibiotic therapy was appropriate in 89% of cases. Microorganisms were isolated from total cultures in 30% of cases and from blood cultures in 26.3% of cases. Conclusion The adequacy rate of empirical antibiotic therapy was high, reflecting an active institutional policy of monitoring epidemiological profiles and institutional protocols on antimicrobial use. However, antibiotic de-escalation could have been implemented in a greater number of patients. De-escalation did not affect mortality rates. PMID:27626951

  7. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup.

    Science.gov (United States)

    Richmond, Janet S; Berlin, Jon S; Fishkind, Avrim B; Holloman, Garland H; Zeller, Scott L; Wilson, Michael P; Rifai, Muhamad Aly; Ng, Anthony T

    2012-02-01

    Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the "10 domains of de-escalation."

  8. Destined to die but not to wage war: how existential threat can contribute to escalation or de-escalation of violent intergroup conflict.

    Science.gov (United States)

    Jonas, Eva; Fritsche, Immo

    2013-10-01

    War means threat to people's lives. Research derived from terror management theory (TMT) illustrates that the awareness of death leads people to defend cultural ingroups and their worldviews to attain a sense of symbolic immortality and thereby buffer existential anxiety. This can result in hostile effects of mortality salience (MS), such as derogation of outgroup members, prejudice, stereotyping, aggression, and racism, which, in turn, can lead to the escalation of violent intergroup conflict and, thus, the escalation of war. Yet, escalation of destructive conflict following MS is not automatic. Instead, research on TMT suggests that MS does not necessarily result in conflict and intolerance but can also foster positive tendencies, such as intergroup fairness or approval of pacifism, depending on how existential threat is perceived, whether the need for symbolic self-transcendence is satisfied, which social norms are salient, and how social situations are interpreted. In the present article, we review current TMT research with the aim of reconciling the seemingly contradictory findings of hostile and peaceful reactions to reminders of death. We present a terror management model of escalation and de-escalation of violent intergroup conflicts, which takes into account the interaction between threat salience and features of the social situation. We also discuss possible intervention strategies to override detrimental consequences of existential threat and argue that war is not the inevitable consequence of threat. PsycINFO Database Record (c) 2013 APA, all rights reserved

  9. Effects of voluntary dose escalation in a placebo-controlled, flexible-dose trial of fesoterodine in subjects with overactive bladder.

    Science.gov (United States)

    Staskin, David; Khullar, Vik; Michel, Martin C; Morrow, Jon D; Sun, Franklin; Guan, Zhonghong; Dmochowski, Roger

    2011-11-01

    To characterize the response to fesoterodine treatment for overactive bladder (OAB) in subjects who did or did not choose to dose escalate in a flexible-dose study. Subjects were randomized to fesoterodine 4  mg or placebo. At week 2, subjects could remain on 4  mg (non-escalators) or choose to increase to 8  mg (escalators) for the remaining 10 weeks (sham escalation for placebo). Subjects completed 3-day bladder diaries at baseline, week 2 and week 12 noting micturitions, urgency episodes, and urgency urinary incontinence (UUI) episodes. Sixty-three per cent of 438 subjects randomized to fesoterodine and 73% of 445 randomized to placebo dose escalated. At baseline, fesoterodine escalators had significantly more micturitions and urgency episodes than fesoterodine non-escalators (P fesoterodine non-escalators versus escalators (P fesoterodine non-escalators and escalators (P > 0.05). The placebo escalator group did not demonstrate a similar response over placebo non-escalators following the dose escalation decision point. A rapid and robust response to fesoterodine 4  mg was demonstrated in non-escalators. Subjects who chose to dose escalate to fesoterodine 8  mg at week 2 showed significant improvement by week 12 versus baseline and week 2 (prior to escalation), as well as versus placebo. Dose escalation to 8  mg fesoterodine provided subjects with efficacy and tolerability similar to those who were satisfied with the 4-mg dose. Copyright © 2011 Wiley Periodicals, Inc.

  10. PET-guided dose escalation tomotherapy in malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Fodor, Andrei; Dell' Oca, Italo; Pasetti, Marcella; Di Muzio, Nadia Gisella [San Raffaele Scientific Institute, Milan (Italy). Dept. of Radiotherapy; Fiorino, Claudio; Broggi, Sara; Cattaneo, Giovanni Mauro; Calandrino, Riccardo [San Raffaele Scientific Institute, Milan (Italy). Medical Physics; Gianolli, Luigi [San Raffaele Scientific Institute, Milan (Italy). Dept. of Nuclear Medicine

    2011-11-15

    To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM). A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV). Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2-10 weeks. Median overall survival was 8 months (1.2-50.5 months) and 20 months (4.3-33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003). The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection. (orig.)

  11. Dengue: an escalating public health problem in Latin America.

    Science.gov (United States)

    Tapia-Conyer, Roberto; Betancourt-Cravioto, Miguel; Méndez-Galván, Jorge

    2012-05-01

    Dengue infection is a significant and escalating public health problem in Latin America. Its re-emergence and subsequent rise in the region over the past 50 years has largely been caused by a combination of a lack of political will, the radical growth of urban populations, migration flow and insufficient financial resources. Its increased incidence has been compounded by climate change, poor sanitation and extreme poverty, which lead to more breeding sites of the mosquito vector Aedes aegypti. In order to control dengue effectively, an integrated approach incorporating vector management and environmental and social solutions is required. To achieve success, these programmes require commitment and responses at both national and community level. The development of a vaccine is a vital tool in the fight against dengue. For successful introduction, those implementing vaccination need to be educated on the value of such a strategy. Effective political leadership, innovative financial mechanisms and co-operation across all disciplines, sectors and national borders are essential to eradication of the disease.

  12. Error Cost Escalation Through the Project Life Cycle

    Science.gov (United States)

    Stecklein, Jonette M.; Dabney, Jim; Dick, Brandon; Haskins, Bill; Lovell, Randy; Moroney, Gregory

    2004-01-01

    It is well known that the costs to fix errors increase as the project matures, but how fast do those costs build? A study was performed to determine the relative cost of fixing errors discovered during various phases of a project life cycle. This study used three approaches to determine the relative costs: the bottom-up cost method, the total cost breakdown method, and the top-down hypothetical project method. The approaches and results described in this paper presume development of a hardware/software system having project characteristics similar to those used in the development of a large, complex spacecraft, a military aircraft, or a small communications satellite. The results show the degree to which costs escalate, as errors are discovered and fixed at later and later phases in the project life cycle. If the cost of fixing a requirements error discovered during the requirements phase is defined to be 1 unit, the cost to fix that error if found during the design phase increases to 3 - 8 units; at the manufacturing/build phase, the cost to fix the error is 7 - 16 units; at the integration and test phase, the cost to fix the error becomes 21 - 78 units; and at the operations phase, the cost to fix the requirements error ranged from 29 units to more than 1500 units

  13. Escalation scenarios initiated by gas explosions on offshore installations. Probabilistic cause and consequence modelling

    Energy Technology Data Exchange (ETDEWEB)

    Eknes, Monika Loeland

    1996-12-31

    This Dr. ing. thesis deals with escalation scenarios initiated by gas explosions on offshore installations. Gas explosions is one of the major hazards to such installations. The objectives were to estimate the probability of ignition and frequency of gas explosions for gas leaks on top sides of offshore installations, and to estimate the response and resistance of components that could result in escalation if they failed. Main fields considered cover risk analysis methodology, gas explosions, simplified escalation models, evaluation of structural consequences, case studies, and guidelines. 107 refs., 33 figs., 33 tabs.

  14. PtmxGuard: An Improved Method for Android Kernel to Prevent Privilege Escalation Attack

    Directory of Open Access Journals (Sweden)

    Kong Bin

    2017-01-01

    Full Text Available Vulnerabilities in Android kernel give opportunity for attacker to damage the system. Privilege escalation is one of the most dangerous attacks, as it helps attacker to gain root privilege by exploiting kernel vulnerabilities. Mitigation technologies, static detection methods and dynamic defense methods have been suggested to prevent privilege escalation attack, but they still have some disadvantages. In this paper, we propose an improved method named PtmxGuard to enhance Android kernel and defeat privilege escalation attack. We focus on a typical attack pattern that attacker hijacks the control flow of Android kernel to modify process credentials by corrupting critical global function pointers. PtmxGuard enforces Code Pointer Integrity to Android kernel, checks the accuracy and reliability of those pointers when they’re triggered by related system calls, and intercepts the system calls when attack activities are detected. Experiment result demonstrates that PtmxGuard can defense privilege escalation attack effectively.

  15. Efficacy of imatinib dose escalation in Chinese gastrointestinal stromal tumor patients

    Institute of Scientific and Technical Information of China (English)

    Jian Li; Ji-Fang Gong; Jie Li; Jing Gao; Nai-Ping Sun; Lin Shen

    2012-01-01

    AIM:To investigate the efficacy and safety of imatinib dose escalation in Chinese patients with advanced gastrointestinal stromal tumor (GIST).METHODS:Advanced GIST patients previously failing 400 mg imatinib treatment were enrolled in this study.Patients received imatinib with dose escalation to 600mg/d,and further dose escalation to 800 mg/d if imatinib 600 mg/d failed.Progression-free survival,overall survival,clinical efficacy,c-kit/PDGFRA genotype and safety were evaluated.RESULTS:52 patients were enrolled in this study.For the 47 evaluable patients receiving imatinib (600 mg/d),the disease control rate was 40.4%,and the median progression-free survival for all patients was 17 wk (95% CI:3.9-30.1).The median overall survival after dose escalation was 81 wk (95% CI:36.2-125.8).Adverse events,mainly edema,fatigue,granulocytopenia and skin rash were tolerable.However,further dose escalation (800 mg/d) in 14 cases was ineffective,with disease progression and severe adverse events.Among 30 cases examined for gene mutations,patients with exon 9 mutations experienced a better progression-free survival of 47 wk.CONCLUSION:Imatinib dose escalation to 600 mg/d is more appropriate for Chinese patients and may achieve further survival benefit.

  16. Valproate in the treatment of epilepsy in girls and women of childbearing potential.

    Science.gov (United States)

    Tomson, Torbjörn; Marson, Anthony; Boon, Paul; Canevini, Maria Paola; Covanis, Athanasios; Gaily, Eija; Kälviäinen, Reetta; Trinka, Eugen

    2015-07-01

    This document provides guidance on the use of valproate in girls and women of childbearing age from a joint Task Force of the Commission on European Affairs of the International League Against Epilepsy (CEA-ILAE) and the European Academy of Neurology (EAN), following strengthened warnings from the Coordination Group for Mutual Recognition and Decentralised Procedures-Human (CMDh) of the European Medicines Agency (EMA), which highlight the risk of malformations and developmental problems in infants who are exposed to valproate in the womb. To produce these recommendations, the Task Force has considered teratogenic risks associated with use of valproate and treatment alternatives, the importance of seizure control and of patient and fetal risks with seizures, and the effectiveness of valproate and treatment alternatives in the treatment of different epilepsies. The Task Force's recommendations include the following: (1) Where possible, valproate should be avoided in women of childbearing potential. (2) The choice of treatment for girls and women of childbearing potential should be based on a shared decision between clinician and patient, and where appropriate, the patient's representatives. Discussions should include a careful risk-benefit assessment of reasonable treatment options for the patient's seizure or epilepsy type. (3) For seizure (or epilepsy) types where valproate is the most effective treatment, the risks and benefits of valproate and other treatment alternatives should be discussed. (4) Valproate should not be prescribed as a first-line treatment for focal epilepsy. (5) Valproate may be offered as a first-line treatment for epilepsy syndromes where it is the most effective treatment, including idiopathic (genetic) generalized syndromes associated with tonic-clonic seizures. (6) Valproate may be offered as a first-line treatment in situations where pregnancy is highly unlikely (e.g., significant intellectual or physical disability). (7) Women and girls

  17. Complementary and alternative medicine use among women during pregnancy and childbearing years

    Science.gov (United States)

    Holden, Selma C.; Gardiner, Paula; Birdee, Gurjeet; Davis, Roger B.; Yeh, Gloria Y.

    2015-01-01

    Objectives Little is known regarding complementary and alternative medicine (CAM) use during pregnancy and the preconception period. Since half of all U.S. pregnancies are unintended, understanding the patterns of CAM use among women of childbearing age has implications for fetal and maternal health. Methods Descriptive statistics were generated from the 2012 National Health Interview Survey (NHIS) to estimate weighted prevalence and patterns of CAM use by women of childbearing age. Comparisons were made between pregnant and non-pregnant respondents. Results In this sample of 10,002 women, 7% (n=727) were recently pregnant. Over one third of all the women used CAM during the previous year (34%/38%, pregnant/non-pregnant, respectively) and only half disclosed CAM use to conventional providers (50%/49%). In the adjusted model, taking multivitamins (OR=2.52 [2.22–2.86]) and moderate to heavy alcohol use (1.92 [1.53–2.41] were more likely associated with CAM use. The two most commonly used modalities were herbs (14%/17%) and yoga (13%/16%). The top reasons for CAM use were to improve general wellness or to prevent disease (33%/35%) and to treat back pain (16%/18%). When examining all pregnancy-related symptoms treated with CAM, no difference was found in the rates of CAM use between pregnant and non-pregnant users. Conclusions CAM use by women of childbearing age in the U.S is common, with over a third of the population using one or more therapies. However, only half disclosed their use to conventional providers despite limited evidence on safety and effectiveness. This study highlights the important need for further research in this area. PMID:26111221

  18. Cross-National Patterns of Intergenerational Continuities in Childbearing in Developed Countries

    Science.gov (United States)

    Murphy, Michael

    2013-01-01

    Earlier work has shown that the association between the fertility of parents and the fertility of children has become stronger over time in some societies. This article updates and broadens the geographic coverage to assess the magnitude of intergenerational continuities in childbearing in developed and middle-income societies using data for 46 populations from 28 developed countries drawn from a number of recent large-scale survey programs. Robust positive intergenerational fertility correlations are found across these countries into the most recent period, and although there is no indication that the strength of the relationship is declining, the increasing trend does not appear to be continuing. PMID:24215254

  19. Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

    Science.gov (United States)

    Back, Jonathan; Ross, Alastair J; Duncan, Myanna D; Jaye, Peter; Henderson, Katherine; Anderson, Janet E

    2017-06-26

    Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice. This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined"). Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  20. The Social Environment and Childbearing Expectations: Implications for Strength-Based Sexual Health Interventions for Latino Youth.

    Science.gov (United States)

    vanDommelen-Gonzalez, Evan; Deardorff, Julianna; Herd, Denise; Minnis, Alexandra M

    2016-06-01

    In the United States, adolescent childbearing is disproportionately higher among Latino youth, a growing population facing substantial social exclusion. Exploring the relationship between the social environment and sexual health outcomes among Latino youth may offer insights into the development of novel interventions. In this study, Latino youth in partnerships were recruited from neighborhood venues in San Francisco and completed in-depth interviews. Youth reported a desire to complete higher education goals prior to starting a family to improve future opportunities and further personal development. Youth stated that social network members, family and partners, were supportive of their individual childbearing expectations. Social environment barriers tied to poverty, immigration status, and gang violence hindered educational attainment. Some differences were noted by gender and immigrant generation. Building on protective social ties and creating avenues in poor, urban neighborhoods for Latino youth to fully access educational opportunities may counter early childbearing and improve sexual health.

  1. Translation and validation of a Chinese version of the Self-Control Schedule in Chinese childbearing women.

    Science.gov (United States)

    Ngai, Fei-Wan; Chan, Sally Wai-Chi; Holroyd, Eleanor

    2008-02-01

    The aims of this study were to translate and evaluate the psychometric properties of the Chinese version of the Self-Control Schedule (C-SCS) in Chinese childbearing women. The SCS was developed to measure learned resourcefulness, which facilitates people's coping under adversity. Promoting learned resourcefulness in childbearing women facilitates positive adaptation to motherhood, which is essential to both maternal and child health. Thus, a reliable and valid C-SCS is crucial for the development of interventions to promote learned resourcefulness in Chinese childbearing women. In phase one, the SCS was translated into Chinese using the technique of translation and back-translation and was reviewed by an expert panel for cultural equivalence. In phase two, psychometric testing of the C-SCS was conducted by using a convenience sample of 360 childbearing women recruited from an antenatal clinic of a regional hospital. Four instruments including the C-SCS, General Self-Efficacy Scale (GSE), Rosenberg's Self-Esteem Scale (RSES) and Edinburgh's Postnatal Depression Scale (EPDS) were administered to the participants. Ninety-two women participated in the four-week retest. The C-SCS demonstrated good internal consistency (Cronbach's alpha = 0.83) and test-retest reliability (ICC = 0.91). Factor analysis revealed the presence of three factors supporting the conceptual dimension of the original instrument. Significant correlations with GSE (r = 0.48, p < 0.01), RSES (r = 0.41, p < 0.01) and EPDS (r = -0.46, p < 0.01) demonstrated good construct validity. The findings suggest that the C-SCS is a reliable and valid instrument for measuring learned resourcefulness in Chinese childbearing women. The C-SCS provides midwives with a useful tool in the evaluation of interventions designed to strengthen Chinese women's learned resourcefulness and promote maternal well-being during childbearing.

  2. Tetanus, diphtheria, and acellular pertussis vaccination among women of childbearing age-United States, 2013.

    Science.gov (United States)

    O'Halloran, Alissa C; Lu, Peng-Jun; Williams, Walter W; Ding, Helen; Meyer, Sarah A

    2016-07-01

    The incidence of pertussis in the United States has increased since the 1990s. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination of pregnant women provides passive protection to infants. Tdap vaccination is currently recommended for pregnant women during each pregnancy, but coverage among pregnant women and women of childbearing age has been suboptimal. Data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) and 2013 National Health Interview Survey (NHIS) were used to determine national and state-specific Tdap vaccination coverage among women of childbearing age by self-reported pregnancy status at the time of the survey. Although this study could not assess coverage of Tdap vaccination received during pregnancy because questions on whether Tdap vaccination was received during pregnancy were not asked in BRFSS and NHIS, demographic and access-to-care factors associated with Tdap vaccination coverage in this population were assessed. Tdap vaccination coverage among all women 18-44 years old was 38.4% based on the BRFSS and 23.3% based on the NHIS. Overall, coverage did not differ by pregnancy status at the time of the survey. Coverage among all women 18-44 years old varied widely by state. Age, race and ethnicity, education, number of children in the household, and access-to-care characteristics were independently associated with Tdap vaccination in both surveys. We identified associations of demographic and access-to-care characteristics with Tdap vaccination that can guide strategies to improve vaccination rates in women during pregnancy.

  3. Dental services utilization by women of childbearing age by socioeconomic status.

    Science.gov (United States)

    Kaylor, Mary B; Polivka, Barbara J; Chaudry, Rosemary; Salsberry, Pamela; Wee, Alvin G

    2010-04-01

    For women of childbearing age, oral health not only affects their physical and psychological well-being but also that of their children. This study used the 2003-2004 Ohio Family Health Survey (N = 9,819) to examine dental need and utilization by women in Ohio. Predisposing, enabling, and need variables were examined as they effect dental health service utilization by women of childbearing age at different socioeconomic status (SES) levels. The proportion of women in the low SES group self reporting a dental need (18%) was 3 times that of the proportion of women in the higher SES group with a self reported need (6%). Results of bivariate analysis showed that having a dental visit in the past year varied significantly by SES, race, insurance status, provider density, and need. A racial disparity in dental service utilization was noted in the bivariate analysis of the middle SES group. While dental need and type of dental coverage varied by SES, both were significantly associated with utilization of dental services within all 3 SES categories in the logistic regressions. These results suggest that measures need to be implemented to meet the goal of increasing access and utilization of dental health services by low-income populations.

  4. The Effect of Early Marriages and Early Childbearing on Women's Nutritional Status in India.

    Science.gov (United States)

    Goli, Srinivas; Rammohan, Anu; Singh, Deepti

    2015-08-01

    The consequences of early childbearing on the growth and nutritional status of women in India has not been quantified in previous studies. Our study aimed to fill this gap by analysing the association between early marriage and early childbearing on nutritional status of Indian women, with a focus on Bihar and Andhra Pradesh, the two states accounting for the highest proportion of women marrying and giving first birth before 18 years of age. Our findings revealed that a substantial number of women were married before 18 years and thereby exposed to early pregnancy. Furthermore, a significantly higher proportion of women in the 'thin' category were married before 18 years, both in the Indian sample (33 %, p women married at higher ages. Similarly, across all our samples women whose first birth was before age 18 years also had a significantly higher probability of being in the 'thin' category across all our samples. This pattern was also observed for associations between early childbirth and anemia levels. We conclude that the net effect of the early age at marriage and age at first birth on nutritional status is significant. Our results underline the need for preventing early marriages and the consequent high adolescent pregnancies in India, particularly in high prevalence states. This will help to improve nutritional status and health care utilisation among women, thereby, prevent maternal and child mortality and thus, achieve the MDGs 4-5.

  5. Determinants of vitamin D status in fair-skinned women of childbearing age at northern latitudes.

    Directory of Open Access Journals (Sweden)

    Linnea Hedlund

    Full Text Available BACKGROUND AND OBJECTIVE: Poor vitamin D status during pregnancy has been associated with unfavorable outcomes for mother and child. Thus, adequate vitamin D status in women of childbearing age may be important. The aim of this study is to investigate the determinants of 25-hydroxyvitamin D (25(OHD serum concentrations in women of childbearing age living in Sweden, at latitude 57-58° north. METHOD: Eighty four non-pregnant, non-lactating, healthy, fair-skinned women aged between 25-40 years were included. All subjects provided blood samples, four day food records and answered questionnaires about sun exposure and lifestyle. Total serum 25(OHD was analyzed using Roche Cobas® electrochemoluminiescent immunoassay. RESULTS: Mean 25(OHD was 65.8±19.9 nmol/l and 23% of the subjects had concentrations <50 nmol/l. Only 1% had concentrations <25 nmol/l. Determinants of 25(OHD concentrations were recent sunbed use, recent travel to southern latitude, season, estrogen contraceptive use and use of supplementary vitamin D (R(2 = 0.27. CONCLUSION: Every fifth woman had 25(OHD concentrations <50 nmol/l. About 30% of the variation in vitamin D status was explained by sun exposure, use of vitamin D supplements and use of estrogen contraceptives. Cutaneous vitamin D synthesis seems to be a major contributor to vitamin D status, even at northern latitudes. Thus, recommendations on safe UV-B exposure could be beneficial for vitamin D status.

  6. Interest in a Twitter-delivered weight loss program among women of childbearing age.

    Science.gov (United States)

    Waring, Molly E; Schneider, Kristin L; Appelhans, Bradley M; Simas, Tiffany A Moore; Xiao, Rui S; Whited, Matthew C; Busch, Andrew M; Evans, Martinus M; Pagoto, Sherry L

    2016-06-01

    Weight management through the childbearing years is important, yet few women have access to efficacious weight loss programs. Online social network-delivered programs may increase reach and thus impact. The aim of this study was to gauge interest in a Twitter-based weight loss intervention among women of childbearing age and the feasibility of recruitment via Twitter. We recruited English-speaking women aged 18-45 years (N = 63) from Twitter to complete an anonymous online survey including open-ended questions about program advantages and concerns. Forty percent of participants were obese and 83 % were trying to lose weight. Eighty-one percent were interested in a Twitter-delivered weight loss program. Interest was high in all subgroups (62-100 %). Participants (59 %) cited program advantages, including convenience, support/accountability, and privacy. Concerns (59 %) included questions about privacy, support/accountability, engagement, efficacy, and technology barriers. Research is needed to develop and evaluate social media-delivered interventions, and to develop methods for recruiting participants directly from Twitter.

  7. Use of valproates in women of childbearing age and pregnant women with epilepsy

    Directory of Open Access Journals (Sweden)

    P. N. Vlasov

    2015-01-01

    Full Text Available The paper considers the specificity of using valproic acid (VA preparations in young childbearing-aged women with epilepsy and discusses the clinical situations of practical application of valproates during pregnancy in view of the baseline efficiency of therapy, the type of epileptic seizures, and the form of epilepsy. It provides a few scenarios of the course of pregnancy and possible treatment policy. Owing to its multiple mechanism of action, VA has been effectively used to treat idiopathic (generalized/focal cryptogenic and symptomatic focal epilepsies in patients of different age groups, including in childbearing-aged women. It is also effectively used to treat manias in the pattern of bipolar disorders and to prevent migraine. The range of action (the efficiency against different types of seizures and forms of epilepsy, good tolerance, a minimal aggravation risk, high continuous therapy rates, various drug dosage forms, including long-acting or intravenous formulatons, and favorable pharmacokinetic and pharmacodynamics profiles make VA indispensable at the present developmental stage of epileptology. However, VA has definite limitations: the drug is contra-indicated in some forms of mitochondrial encephalopathies; its prescription to young women requires comprehensive assessment of possible therapy consequences, especially in pregnancy planning, the drug should be used with extreme caution in the first trimester of pregnancy. The ideal variant of VA prescription in young women of fertile age is monotherapy, by using its minimal effective daily dose and sustained-release formulations. 

  8. The significance of social context: the case of adolescent childbearing in the African American community.

    Science.gov (United States)

    Henly, J R

    1993-11-01

    The persistence of racial differences in US adolescent pregnancy and contraceptive use rates even after traditional indicators of social class (e.g., parental education, income, or occupation) are controlled suggests a need to focus on broader social contextual issues. Important dimensions of the social context neglected in traditional approaches to socioeconomic status include the level of racial discrimination in the community, the percentage of same-race high status workers, the differential incentives of Blacks and Whites to avoid adolescent childbearing, the quality of schools attended, and the ability of families to provide child supervision. In addition, studies comparing the long-term effects of adolescent childbearing have found less severe costs for Blacks than Whites. This finding suggests the salience of psychosocial factors such as individual resiliency and survival. Although amelioration of poverty must be a major emphasis of social policy aimed at preventing adolescent pregnancy, employment programs that prepare teens for low-paying or nonexistent jobs and other interventions that fail to address the broader social context of discrimination are insufficient.

  9. Promoting de-escalation of commitment: a regulatory-focus perspective on sunk costs.

    Science.gov (United States)

    Molden, Daniel C; Hui, Chin Ming

    2011-01-01

    People frequently escalate their commitment to failing endeavors. Explanations for such behavior typically involve loss aversion, failure to recognize other alternatives, and concerns with justifying prior actions; all of these factors produce recommitment to previous decisions with the goal of erasing losses and vindicating these decisions. Solutions to escalation of commitment have therefore focused on external oversight and divided responsibility during decision making to attenuate loss aversion, blindness to alternatives, and justification biases. However, these solutions require substantial resources and have additional adverse effects. The present studies tested an alternative method for de-escalating commitment: activating broad motivations for growth and advancement (promotion). This approach should reduce concerns with loss and increase perceptions of alternatives, thereby attenuating justification motives. In two studies featuring hypothetical financial decisions, activating promotion motivations reduced recommitment to poorly performing investments as compared with both not activating any additional motivations and activating motivations for safety and security (prevention).

  10. Terrorist attacks escalate in frequency and fatalities preceding highly lethal attacks.

    Science.gov (United States)

    Martens, Andy; Sainudiin, Raazesh; Sibley, Chris G; Schimel, Jeff; Webber, David

    2014-01-01

    Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates--both in the number of people killed per attack and in the frequency of attacks--leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database) showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack.

  11. Audience reactions to peace journalism: How supporters and critics of the Israeli policy process escalation and de-escalation oriented media frames

    Directory of Open Access Journals (Sweden)

    Stephanie Thiel

    2014-04-01

    Full Text Available This paper reports on an experiment that uses the Israeli-Palestinian conflict as a natural laboratory for studying how recipients make sense of escalation vs. de-escalation oriented news articles. The results of the study indicate that media frames and individual frames have both a direct effect and complex interaction effects on participants’ text understanding. Particularly the effect of media war frames diminishes if they are incongruent with participants’ individual frames, and the propaganda function of reports about violence and human casualties can be neutralized if framed according to a peace frame. If participants had a priori positioned themselves in favor of the perpetrator, they may produce reactance, however.

  12. Choosing between stairs and escalators in China: The impact of location, height and pedestrian volume

    Science.gov (United States)

    Zacharias, John; Tang, Boshen

    2015-01-01

    Objective This research examines whether Beijing residents are more or less likely than Montréal residents to avoid stair climbing, by replicating a study in Montréal, Canada that measured the impacts of distance between stairs and escalator, height between floors and pedestrian volume on stair climbing rate. Method 15 stairways, 14 up-escalators and 13 down-escalators were selected in 13 publicly accessible settings in Beijing. Distance between the bottom or top of nearest stair and escalator combinations varied from 2.1 m to 114.1 m with height between floors varying from 3.3 m to 21.7 m. Simultaneous counts were conducted on stair and escalator pairs, for a total of 37,081 counted individuals. Results In the ascent model, pedestrian volume accounted for 16.3% of variance in stair climbing, 16.4% when height was added and 45.1% when distance was added. In the descent model, 40.9% of variance was explained by pedestrian volume, 41.5% when height was added and 45.5% when distance was added. Conclusion Separating stairs and escalator is effective in increasing stair climbing in Beijing, accounting for 29% of the variance in stair climbing, compared with 43% in Montreal. As in the Montreal case, distance has less effect on stair use rate when descending. Overall, 25.4% of Beijingers opted for stairs when ascending compared with 20.3% of Montrealers, and for descending 32.8% and 31.1% respectively. PMID:26844113

  13. Dose escalation for unresectable locally advanced non-small cell lung cancer: end of the line?

    Science.gov (United States)

    Hong, Julian C; Salama, Joseph K

    2016-02-01

    Radiation Therapy Oncology Group (RTOG) 0617 was a randomized trial that investigated both the impact of radiation dose-escalation and the addition of cetuximab on the treatment of non-small cell lung cancer (NSCLC). The results of RTOG 0617 were surprising, with the dose escalation randomization being closed prematurely due to futility stopping rules, and cetuximab ultimately showing no overall survival benefit. Locally advanced unresectable NSCLC has conventionally been treated with concurrent chemoradiation. Though advances in treatment technology have improved the ability to deliver adequate treatment dose, the foundation for radiotherapy (RT) has remained the same since the 1980s. Since then, progressive studies have sought to establish the safety and efficacy of escalating radiation dose to loco-regional disease. Though RTOG 0617 did not produce the anticipated result, much interest remains in dose escalation and establishing an explanation for the findings of this study. Cetuximab was also not found to provide a survival benefit when applied to an unselected population. However, planned retrospective analysis suggests that those patients with high epidermal growth factor receptor (EGFR) expression may benefit, suggesting that cetuximab should be applied in a targeted fashion. We discuss the results of RTOG 0617 and additional findings from post-hoc analysis that suggest that dose escalation may be limited by normal tissue toxicity. We also present ongoing studies that aim to address potential causes for mortality in the dose escalation arm through adaptive or proton therapy, and are also leveraging additional concurrent systemic agents such as tyrosine kinase inhibitors (TKIs) for EGFR-activating mutations or EML4-ALK rearrangements, and poly (ADP-ribose) polymerase (PARP) inhibitors.

  14. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup

    Directory of Open Access Journals (Sweden)

    Janet S. Richmond

    2012-04-01

    Full Text Available Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally deescalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1 ensure the safety of the patient, staff, and others in the area; (2 help the patient manage his emotions and distress and maintain or regain control of his behavior; (3 avoid the use of restraint when at all possible; and (4 avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the ‘‘10 domains of deescalation.’’ [West J Emerg Med. 2012;13(1:17–25.

  15. Evaluation of ovary dose for woman of childbearing age woman with breast cancer in tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soo Hyeong; Park, Soo Yeon; Choi, Ji Min; Park, Ju Young; Kim, Jong Suk [Dept. of Radiation Oncology, Samsung Medical Center, Seoul (Korea, Republic of)

    2014-12-15

    The aim of this study is to evaluate unwanted scattered dose to ovary by scattering and leakage generated from treatment fields of Tomotherapy for childbearing woman with breast cancer. The radiation treatments plans for left breast cancer were established using Tomotherapy planning system (Tomotherapy, Inc, USA). They were generated by using helical and direct Tomotherapy methods for comparison. The CT images for the planning were scanned with 2.5 mm slice thickness using anthropomorphic phantom (Alderson-Rando phantom, The Phantom Laboratory, USA). The measurement points for the ovary dose were determined at the points laterally 30 cm apart from mid-point of treatment field of the pelvis. The measurements were repeated five times and averaged using glass dosimeters (1.5 mm diameter and 12 mm of length) equipped with low-energy correction filter. The measures dose values were also converted to Organ Equivalent Dose (OED) by the linear exponential dose-response model. Scattered doses of ovary which were measured based on two methods of Tomo helical and Tomo direct showed average of 64.94±0.84 mGy and 37.64±1.20 mGy in left ovary part and average of 64.38±1.85 mGy and 32.96±1.11 mGy in right ovary part. This showed when executing Tomotherapy, measured scattered dose of Tomo Helical method which has relatively greater monitor units (MUs) and longer irradiation time are approximately 1.8 times higher than Tomo direct method. Scattered dose of left and right ovary of childbearing women is lower than ICRP recommended does which is not seriously worried level against the infertility and secondary cancer occurrence. However, as breast cancer occurrence ages become younger in the future and radiation therapy using high-precision image guidance equipment like Tomotherapy is developed, clinical follow-up studies about the ovary dose of childbearing women patients would be more required.

  16. Trends in adolescent unions and childbearing in four Central American countries

    Directory of Open Access Journals (Sweden)

    Remez, Lisa

    2009-07-01

    Full Text Available Context: Four low-income Central American nations—El Salvador, Guatemala, Honduras and Nicaragua—have the highest rates of adolescent fertility in Latin America. More information on time trends in adolescent marital and reproductive behaviors is needed to assess the need for improved information and services to delay marriage and childbearing. Methodology: Data from these countries’ recent Demographic and Health Surveys and Reproductive Health Surveys are used to examine trends in adolescent unions and childbearing by comparing two cohorts roughly a generation apart, 40–44-year-olds and 20–24-year-olds. We tested for significant differences over time, both for women overall and within subgroups, using Pearson Χ2 statistics that take the stratified, cluster sample design into account. Findings: As of 2001–2005/6, adolescent unions, which are far more likely to be consensual than legal, were still widespread in the subregion, as 45–60% of 20–24-year-old women in these four countries had entered into a union before their 20th birthday. Nonetheless, such early unions have fallen significantly over time in all four countries, declining by relatively less in Honduras (by six percentage points than in the other three countries (by 10–15 percentage points. In contrast, no comparable uniform trend emerged in the timing of first births: The proportions giving birth before age 20 fell significantly only in Nicaragua (by eight points; declines were smaller and nonsignificant in the other three countries (2–5 points. At the subgroup level, just one change was significant within area of residence—the 12-point decline in the proportion with any adolescent birth in urban areas in Nicaragua. Although the change was not significant at the population level, adolescent births increased significantly among less-educated women and the poorest women in El Salvador and Honduras, as traditional behaviors likely became more concentrated in those

  17. Omega-3 Fatty Acid Intake of Pregnant Women and Women of Childbearing Age in the United States: Potential for Deficiency?

    Science.gov (United States)

    Nordgren, Tara M; Lyden, Elizabeth; Anderson-Berry, Ann; Hanson, Corrine

    2017-02-26

    Omega-3 fatty acids play critical roles during fetal growth and development with increased intakes associated with improved maternal-fetal outcomes. Omega-3 fatty acid intake in Western diets is low, and the impact of socioeconomic factors on omega-3 fatty acid intake in pregnant women and women of childbearing age has not been reported. We used the National Health and Nutrition Examination Survey (NHANES) cycles 2003-2012 to assess the relationship between omega-3 fatty acid intake and socioeconomic factors in women of childbearing age. Out of 7266 eligible participants, 6478 were women of childbearing age, while 788 were identified as pregnant at the time of the survey. Mean EPA+DHA intake of the population was 89.0 mg with no significant difference between pregnant and non-pregnant women. By univariate and multivariate analyses adjusting for confounders, omega-3 fatty acid intake was significantly associated with poverty-to-income ratio, race, and educational attainment. Our results demonstrate that omega-3 fatty acid intake is a concern in pregnant women and women of childbearing age in the United States, and that socioeconomically disadvantaged populations are more susceptible to potential deficiencies. Strategies to increase omega-3 fatty acid intake in these populations could have the potential to improve maternal and infant health outcomes.

  18. Role of healthcare in childbearing decision-making of WLHA in Nigeria: Application of PEN-3 cultural model.

    Science.gov (United States)

    Sofolahan-Oladeinde, Y A; Iwelunmor, J I; Conserve, D F; Gbadegesin, A; Airhihenbuwa, C O

    2016-08-31

    Healthcare experiences among women living with HIV/AIDS (WLHA), determine their utilisation of sexual and reproductive health services, which ultimately influences their decisions on childbearing. This study aimed to understand the importance of healthcare support in the childbearing decision-making processes of WLHA, and its impact on eliminating new paediatric HIV infections. We conducted in-depth interviews between July and August 2012 with 15 WLHA receiving clinical HIV care at a teaching hospital in Lagos. Using PEN-3 cultural model, as a guide we explored perceptions of healthcare support pre- and post-partum. Findings indicate that faith in God for the delivery of a healthy child is significant during the pre-partum period, while the advice of healthcare workers concerning childbearing and access to available healthcare services carry more weight post-partum. Our findings have important implications for HIV treatment and care programmes geared towards WLHA considering childbearing, and ultimately the UN Global plan to eliminate mother-to-child transmission of HIV, as we move towards the 2030 agenda for sustainable development.

  19. A tale of two sisters : Investigating the socio-economic outcomes of teen childbearing in South Africa

    NARCIS (Netherlands)

    T. Kakal (Tasneem Aliasgar)

    2015-01-01

    textabstractThis mixed methods study attempts to understand the effect of teenage childbearing in determining future socio-economic consequences for teenage mothers. This is accomplished by assessing the effect of a teen birth on outcomes such as educational attainment, employment, welfare and

  20. Peer and Individual Risk Factors in Adolescence Explaining the Relationship Between Girls' Pubertal Timing and Teenage Childbearing.

    Science.gov (United States)

    Hendrick, C Emily; Cance, Jessica Duncan; Maslowsky, Julie

    2016-05-01

    Girls with early pubertal timing are at elevated risk for teenage childbearing; however, the modifiable mechanisms driving this relationship are not well understood. The objective of the current study was to determine whether substance use, perceived peer substance use, and older first sexual partners mediate the relationships among girls' pubertal timing, sexual debut, and teenage childbearing. Data are from Waves 1-15 of the female cohort of the National Longitudinal Surveys of Youth 1997 (NLSY97), a nationwide, ongoing cohort study of U.S. men and women born between 1980 and 1984. The analytic sample (n = 2066) was 12-14 years old in 1997 and ethnically diverse (51 % white, 27 % black, 22 % Latina). Using structural equation modeling, we found substance use in early adolescence and perceived peer substance use each partially mediated the relationships among girls' pubertal timing, sexual debut, and teenage childbearing. Our findings suggest early substance use behavior as one modifiable mechanism to be targeted by interventions aimed at preventing teenage childbearing among early developing girls.

  1. De-escalation empirical antibiotic therapy improved survival for patients with severe aplastic anemia treated with antithymocyte globulin.

    Science.gov (United States)

    Fu, Rong; Chen, Tong; Song, Jia; Wang, Guojin; Li, Lijuan; Ruan, Erbao; Liu, Hui; Wang, Yihao; Wang, Huaquan; Xing, Limin; Wu, Yuhong; Liu, Hong; Qu, Wen; Shao, Zonghong

    2017-02-01

    We aimed to investigate the efficacy and safety of de-escalation empirical therapy for controlling infection in patients with severe aplastic anaemia (SAA) treated with antithymocyte globulin (ATG). Eighty-seven ATG-treated SAA patients who had microbiological culture-confirmed infections from 2006 to 2015 in our center were retrospectively analyzed. The efficacy of de-escalation and non-de-escalation therapy was compared. Among all 87 patients, 63 patients were treated with de-escalation therapy and 24 patients with non-de-escalation therapy. More patients showed response to anti-infection treatment in de-escalation group than in non-de-escalation group both on day 7 (60.32% vs. 25.00%, P = 0.003) and on day 30 (79.37% vs. 58.33%, P = 0.047) since the initial antimicrobial therapy. On day 30, more patients had increased absolute neutrophil count in de-escalation group compared with non-de-escalation group (76.19% vs. 45.83%, P = 0.007), and de-escalation group had lower morality rate (17.46% vs. 37.50%, P = 0.047) and better survival outcome (P = 0.023) on day 90. Twenty-three patients in de-escalation group and 5 patients in non-escalation group received granulocyte transfusions. Granulocyte transfusions helped to control infections in both de-escalation group (P = 0.027) and non-de-escalation group (P = 0.042) on day 7, but did not improve survival on day 90. We concluded that de-escalation antibiotics improved survival in SAA patients after ATG treatment. Early administration of broad-spectrum antibiotics pending microbiological cultures combined with a commitment to change to narrow-spectrum antibiotics should be recommended for controlling infections in SAA patients treated with ATG. Granulocyte transfusions might be an adjunctive therapy in controlling infections.

  2. Trends in Childbearing, Marriage and Divorce in Sweden: An Update with Data up to 2012

    Directory of Open Access Journals (Sweden)

    Andersson, Gunnar

    2015-12-01

    Full Text Available We present an update of the main and parity-specific trends in vital family-demographic behavior in Sweden presented in Finnish Yearbook of Population Research 2011. Based on Swedish register data, previous time series of relative risks of childbearing, marriage, and divorce by calendar year are updated with another five years of observation. We demonstrate that more than a decade of increasing fertility levels turned into moderate fertility declines in 2011. This trend reversal pertains to all main birth orders. Marriage propensities continued to increase for mothers but stagnated for the childless. Since the turn of the century, trends in divorce risks seem to have leveled off, altogether reflecting a more prevalent role of marriage in recent Swedish family dynamics.

  3. Emergence of group B Streptococcus serotype IV in women of child-bearing age in Ireland.

    LENUS (Irish Health Repository)

    Kiely, R A

    2011-02-01

    This study determined the carriage rate and serotype distribution of group B Streptococcus (GBS) in women of child-bearing age in the southern region of Ireland. A total of 2000 vaginal swabs collected in two periods in 2004 and 2006 were examined and revealed a GBS carriage rate of 16·1%. Serotyping of isolates showed that serotypes Ia, II, III, IV, and V were the most prevalent. A high prevalence of serotype IV was found, increasing from 7·6% to 15·2% between 2004 and 2006. Random amplified polymorphic DNA analysis demonstrated considerable genetic heterogeneity in the serotype IV isolates. This serotype should be considered for inclusion in potential vaccines for use in Ireland.

  4. Environmental, Behavioral, and Cultural Factors That Influence Healthy Eating in Rural Women of Childbearing Age

    Directory of Open Access Journals (Sweden)

    Julia Mabry

    2016-01-01

    Full Text Available Despite increasing recognition of the role nutrition plays in the health of current and future generations, many women struggle to eat healthy. We used the PhotoVoice method to engage 10 rural women in identifying perceived barriers and facilitators to healthy eating in their homes and community. They took 354 photographs, selected and wrote captions for 62 images, and explored influential factors through group conversation. Using field notes and participant-generated captions, the research team categorized images into factors at the individual, relational, community/organizational, and societal levels of a socioecological model. Barriers included limited time, exposure to marketing, and the high cost of food. Facilitators included preparing food in advance and support from non-partners; opportunities to hunt, forage, and garden were also facilitators, which may be amplified in this rural environment. Nutritional interventions for rural women of childbearing age should be multi-component and focus on removing barriers at multiple socioecological levels.

  5. Assessment and Care of Childbearing Women With Severe and Persistent Mental Illness.

    Science.gov (United States)

    McKeever, Amy; Alderman, SueEllen; Luff, Stephanie; DeJesus, Brian

    Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  6. Parents' experience of unintended childbearing: A qualitative study of factors that mitigate or exacerbate effects.

    Science.gov (United States)

    Kavanaugh, Megan L; Kost, Kathryn; Frohwirth, Lori; Maddow-Zimet, Isaac; Gor, Vivian

    2017-02-01

    Births resulting from an unintended pregnancy affect individuals differentially, and some may experience more negative consequences than others. In this study, we sought to describe the mechanisms through which the severity of effects may be mitigated or exacerbated. We conducted in-depth interviews with 35 women and 30 men, all with a youngest child born resulting from an unintended pregnancy, in two urban sites in the United States. Respondents described both negative and positive effects of the child's birth in the areas of school; work and finances; partner relationships; personal health and outlook on life trajectories. Mechanisms through which unintended pregnancies mitigated or exacerbated certain effects fell at the individual (e.g. lifestyle modification), interpersonal (e.g. partner support) and structural (e.g. workplace flexibility) levels. These qualitative findings deepen understanding of the impact of unintended childbearing on the lives of women, men and families.

  7. A narrative literature review of the therapeutic effects of music upon childbearing women and neonates.

    Science.gov (United States)

    Hollins Martin, Caroline J

    2014-11-01

    Therapeutic effects of music are well recognised within the literature, with benefits for a variety of health problems documented. This narrative review summarises benefits in terms of reducing stress, anxiety, labour pain and depression in childbearing women. For neonates, music has been shown to reduce number of days to discharge, reduce pain response behaviours, increase weight gain, improve Brazelton scores, improve parent/infant intimacy, improve oxygen saturation, increase formula intake, stabilize vital signs and increase parental reports of calmed infants. The main criticism of the studies reviewed is lack of categorisation of the particulars of the variables within the music that directly influenced outcome variables. A recommendation is made that a music package be developed and relationships with variables rigorously evaluated. The validated product may then be made available for use. Since evidence supports advantages from listening to music, it is suggested that maternity professionals use it in more creative ways.

  8. Environmental, Behavioral, and Cultural Factors That Influence Healthy Eating in Rural Women of Childbearing Age

    Directory of Open Access Journals (Sweden)

    Julia Mabry

    2016-01-01

    Full Text Available Despite increasing recognition of the role nutrition plays in the health of current and future generations, many women struggle to eat healthy. We used the PhotoVoice method to engage 10 rural women in identifying perceived barriers and facilitators to healthy eating in their homes and community. They took 354 photographs, selected and wrote captions for 62 images, and explored influential factors through group conversation. Using field notes and participant-generated captions, the research team categorized images into factors at the individual, relational, community/organizational, and societal levels of a socioecological model. Barriers included limited time, exposure to marketing, and the high cost of food. Facilitators included preparing food in advance and support from non-partners; opportunities to hunt, forage, and garden were also facilitators, which may be amplified in this rural environment. Nutritional interventions for rural women of childbearing age should be multi-component and focus on removing barriers at multiple socioecological levels.

  9. [The vitamin D nutritional status in Chinese urban women of child-bearing age from 2010 to 2012].

    Science.gov (United States)

    Lu, J X; Liu, X B; Chen, J; Hu, Y C; Yun, C F; Li, W D; Wang, R; Yang, Y H; Mao, D Q; Piao, J H; Yang, X G; Yang, L C

    2017-02-06

    Objective: To evaluate the vitamin D nutritional status in Chinese women of child-bearing age by analyzing serum 25-hydroxyvitamin D level in 2010-2012. Methods: Data were obtained from the China Nutrition and Health Survey in 2010-2012. Using cluster sampling and proportional stratified random sampling, 1 514 women of child-bearing age (18-44 years old) from 34 metropolis and 41 small and medium-sized cities were included in this study. Demographic information was collected by questionnaire and serum 25-hydroxyvitamin D concentration was determined by radioimmunoassay, in accordance with the 2010 Institute of Medicine of the National Academies standards. We compared differences in vitamin D levels, specifically serious deficiency, lack of deficiency, insufficiency, and excess. Results: The overall serum 25-hydroxyvitamin D level of Chinese urban women of child-bearing age (P(50) (P(25)-P(75))) was 20.1 (15.1-26.3) ng/ml; minorities had a significantly higher serum 25-hydroxyvitamin D level of 22.0 (15.9-27.5) ng/ml compared with women of Han nationality (19.8 (14.9-26.2) ng/ml) (χ(2)=7.02, P=0.008). The proportions of women with serious deficiency, lack of deficiency, insufficiency, and excess vitamin D were 11.6% (n=175), 37.9% (n=574), 35.1% (n=531), and 0.3% (n=5), respectively. Only 15.1% (n=229) of women of child-bearing age had normal vitamin D nutritional status. No significant differences in vitamin D nutritional status were observed according to age, body mass index, city, nationality, educational level, marital status, or household income per capita (P>0.05). Conclusion: Most Chinese urban women of child-bearing age have poor vitamin D levels and require vitamin D supplementation.

  10. Iodine nutrition and thyroid function assessment in childbearing age women from Queretaro, Mexico

    Directory of Open Access Journals (Sweden)

    Lorena Méndez-Villa

    2014-01-01

    Full Text Available Objective: To assess iodine nutrition and thyroid function in Mexican childbearing age women. Methods: 101 childbearing age women (21.7 ± 3.5 years randomly selected from the university student population participated in this cross-sectional study. TSH, thyroid hormones, anti-thyroid antibodies, thyroid volume, iodine intake, and urinary iodine concentration (UIC were assessed. The knowledge about the importance of iodine in nutrition was also evaluated by using questionnaires. Results: TSH median (interquartile range value was 1.9 (1.4-2.5 mlU/L, while FT4 median value was 9.0 (8.39.6 μμg/dL. The median FT3 and total rT3 values were 3.3 pg/mL and 40.1 μg/dL, respectively. The prevalence of subclinical hypothyroidism (serum TSH >4.5 mlU/L and of positive anti-thyroid antibodies were 2.9% and <5.9%, respectively. Median thyroid volume was 5.6 mL and none of the subjects were diagnosed with goiter. Median urinary iodine concentration was 146 (104-180 μg/L. As for the knowledge of iodine nutrition, only 37.6% considered that a pregnant woman needs more dietary iodine than a non pregnant woman, while 43.6% recognized that the lack of iodine can cause mental retardation in children. Conclusions: Prevalence of thyroid test function abnormalities was low in this population and the median UIC indicates adequate iodine intake. We also found a poor knowledge about the importance iodine nutrition in the studied population.

  11. The cultural beliefs of Jordanian women during childbearing: implications for nursing care.

    Science.gov (United States)

    Bawadi, H A; Al-Hamdan, Z

    2017-06-01

    To determine the cultural and religious beliefs and practices about childbirth among Jordanian women and to indicate how these beliefs and practices can be integrated into the maternity care of Muslim women in general, especially those immigrating to Western countries. The physiology of childbirth is similar for all women worldwide, but the surroundings in which it takes place makes it a unique experience for each woman. Every society has cultural practices and beliefs related to childbirth, and what is considered to be a vital practice in one culture may be seen as insignificant in another. A qualitative research design with an interpretative phenomenological approach was used to conduct semi-structured, audiotaped interviews with nine Jordanian mothers. Five main themes identified: childbearing is a blessing of Allah, a time for special maternal care, a time for maternal self-renewal, a time for maternal spiritual purification and a time to prepare for the sacrifices of motherhood. The findings reflected the sensitivity of the grace of God in all the interviews, illustrating the permeating influence of religious beliefs on traditional Jordanian childbirth practices. In planning policies, health services globally should acknowledge the diverse need of migrant women during childbirth, in order to gain women's trust in maternity services. To offer sensitive care, nurses need to address mothers' cultural and spiritual needs and meet these needs respectfully. To improve the childbearing experience, maternity staff should consider these themes to help build trust with mothers based on an appreciation of their spiritual and cultural beliefs. © 2016 International Council of Nurses.

  12. Prevention of neural tube defects by folic acid - awareness among women of childbearing age in Slovakia.

    Science.gov (United States)

    Horn, F; Sabova, L; Pinterova, E; Hornova, J; Trnka, J

    2014-01-01

    Folic acid deficiency plays a central role in the aetiology of many congenital anomalies including neural tube defects. Protective effect of folic acid on embryo may be acquired only if taken periconceptionally. The aim of the study was to investigate the awareness about folic acid among women of childbearing age in Bratislava, Slovakia. There were 130 respondents involved in the research (106 pregnant women, 24 female students of medical faculty). Using questionnaire we acquired following data: pregnancy details, interest in diet before and during pregnancy, recommendations regarding nutrition and supplementation pre- and post-conception, knowledge about folic and other acid in 2004 and 2009. More than half of the respondents knew the sources of folic acid. The interest in the nutrition facts of the food dropped from 91 % to 58.5 %. The number of pregnant women advised about correct nutrition and folic acid supplementation before and during pregnancy increased from 16 % to 37 %. Planning the next gravidity with folic acid supplementation became greater than 21 % (38 % in 2009). Nevertheless, only 46 % of these women believed that proper food content with folic acid may prevent congenital anomalies. In a group of students planning to take folic acid periconceptionally the number raised up to 62.5 %. The results revealed low knowledge about the effect of folic acid on developing embryo among women of childbearing age. Effective intervention programs are needed with the aim to improve periconceptional intake of folic acid in 2004 and 2009. The results in both periods show low knowledge about this essential vitamin (Tab. 1, Fig. 8, Ref. 31).

  13. The surgical residency baby boom: changing patterns of childbearing during residency over a 30-year span.

    Science.gov (United States)

    Smith, Caitlin; Galante, Joseph M; Pierce, Jonathan L; Scherer, Lynette A

    2013-12-01

    Birthrates during surgical residency appear to be rising. One assumption is that this is due to changes in the structure of surgical residencies. The purpose of our study was to explore whether an increase in birthrates has occurred and the reasons for this. We conducted an anonymous survey of current residents and alumni from 1976 to 2009 at a single university-based surgery training program. Alumni (46 of 116) and current residents (38 of 51) were surveyed, and our response rate was approximately 50% (84 of 167). Respondents were grouped into cohorts based on their residency start year. The early cohort consisted of residents starting residency between 1976 and 1999, and the late cohort consisted of residents starting residency between 2000 and 2009. The percentage of male residents with children during residency training was similar for the early and late cohorts (34% [10 of 29] versus 41% [9 of 22]). For female residents, there was a substantial increase in childbearing for the late cohort (7% [1 of 15] versus 35% [6 of 18]). Fifty-two percent (44 of 84) of the respondents who had children during residency reported that work hours and schedule had a negative effect on their decision to have children. Most respondents reported that availability or cost of child care, impact on residency, support from the program, increased length of training, or availability of family leave did not factor as concerns. Childbearing during residency has increased in female residents in our study. Surgical residency programs may need to accommodate this change if they want to continue to recruit and retain talented residents.

  14. Unwarranted Variation in Utilization of Cesarean Birth Among Low-Risk Childbearing Women.

    Science.gov (United States)

    Jolles, Diana R

    2017-01-01

    Unwarranted variations in care are defined as differences in utilization of health care resources that cannot be explained by patient risk factors, standards of evidence-based medicine, or patient preferences. Also known as nonmedical determinants of variation, differences in health care utilization across the United States have been well documented in the literature during the past 40 years. The purpose of the literature review is to summarize the state of the science related to the nonmedical determinants of variation in cesarean birth among low-risk childbearing women, defined within national quality standards as nulliparous women with term, singleton pregnancies in the vertex presentation. A literature search was performed using the electronic databases PubMed, CINAHL, Ovid MEDLINE, Google Scholar, Cochrane Database of Systematic Reviews, and ProQuest Dissertation Database. Articles published in English, with full text available, including birth in the United States after 1995, are included in the analysis. Nine studies met criteria for inclusion. Forty-four states are represented within the data, with Arizona, California, Massachusetts, New Jersey, and New York being the subject of more than one of the publications analyzed. This literature review includes more than one million births, in at least 44 states between 1996 through 2009, revealing significant unwarranted variation in cesarean birth. Nonmedical determinants of variation, such as access to resources, hospital characteristics, payer source, and provider practice styles, are identified as independent predictors of increased cesarean utilization in more than half of the studies reviewed. In all studies reviewed, women of low medical risk demonstrate susceptibility to unwarranted variation in the use of cesarean birth. Continued emphasis on the specific needs of low-risk childbearing women is necessary to decrease unwarranted variation in the use of cesarean birth in the United States. Specific

  15. Model-based projections of Zika virus infections in childbearing women in the Americas.

    Science.gov (United States)

    Alex Perkins, T; Siraj, Amir S; Ruktanonchai, Corrine W; Kraemer, Moritz U G; Tatem, Andrew J

    2016-07-25

    Zika virus is a mosquito-borne pathogen that is rapidly spreading across the Americas. Due to associations between Zika virus infection and a range of fetal maladies(1,2), the epidemic trajectory of this viral infection poses a significant concern for the nearly 15 million children born in the Americas each year. Ascertaining the portion of this population that is truly at risk is an important priority. One recent estimate(3) suggested that 5.42 million childbearing women live in areas of the Americas that are suitable for Zika occurrence. To improve on that estimate, which did not take into account the protective effects of herd immunity, we developed a new approach that combines classic results from epidemiological theory with seroprevalence data and highly spatially resolved data about drivers of transmission to make location-specific projections of epidemic attack rates. Our results suggest that 1.65 (1.45-2.06) million childbearing women and 93.4 (81.6-117.1) million people in total could become infected before the first wave of the epidemic concludes. Based on current estimates of rates of adverse fetal outcomes among infected women(2,4,5), these results suggest that tens of thousands of pregnancies could be negatively impacted by the first wave of the epidemic. These projections constitute a revised upper limit of populations at risk in the current Zika epidemic, and our approach offers a new way to make rapid assessments of the threat posed by emerging infectious diseases more generally.

  16. Iodine nutrition and thyroid function assessment in childbearing age women from Queretaro, Mexico.

    Science.gov (United States)

    Méndez-Villa, Lorena; Elton-Puente, Juana Elizabeth; Solís-S, Juan Carlos; Sampson-Zaldívar, Eduardo; García-G, Carlota; Villalobos, Patricia; Colarossi, Ana; García, Olga Patricia; Robles-Osorio, Ludivina; García-Solís, Pablo

    2014-01-01

    To assess iodine nutrition and thyroid function in Mexican childbearing age women. 101 childbearing age women (21.7 ± 3.5 years) randomly selected from the university student population participated in this cross-sectional study. TSH, thyroid hormones, anti-thyroid antibodies, thyroid volume, iodine intake, and urinary iodine concentration (UIC) were assessed. The knowledge about the importance of iodine in nutrition was also evaluated by using questionnaires. TSH median (interquartile range) value was 1.9 (1.4-2.5) mIU/L, while FT4 median value was 9.0 (8.3- 9.6) μg/dL. The median FT3 and total rT3 values were 3.3 pg/mL and 40.1 ng/dL, respectively. The prevalence of subclinical hypothyroidism (serum TSH >4.5 mIU/L) and of positive anti-thyroid antibodies were 2.9% and <5.9%, respectively. Median thyroid volume was 5.6 mL and none of the subjects were diagnosed with goiter. Median urinary iodine concentration was 146 (104-180) μg/L. As for the knowledge of iodine nutrition, only 37.6% considered that a pregnant woman needs more dietary iodine than a non pregnant woman, while 43.6% recognized that the lack of iodine can cause mental retardation in children. Prevalence of thyroid test function abnormalities was low in this population and the median UIC indicates adequate iodine intake. We also found a poor knowledge about the importance iodine nutrition in the studied population.

  17. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm.

    Science.gov (United States)

    Karlsdottir, Sigfridur Inga; Halldorsdottir, Sigridur; Lundgren, Ingela

    2014-06-01

    Women's experiences regarding labour pain preparation and management have been largely neglected. Explore women's experiences regarding labour pain preparation and management in normal childbirth. The Vancouver School of doing phenomenology was the methodological approach of the study since it provides inside information about the lived experience. Data were collected through in-depth interviews with 14 participants; seven primiparous and seven multiparous women. The women described a challenging journey of no return through labour pain, with different landmarks on the journey. They described how they prepared for the pain; the context of the pain experience; how they experienced and managed the pain with different strategies and how they saw the pain at the journey's end. The quality of the midwife's presence and professionalism was of great importance to them. The 'good midwives' they described created a special atmosphere which was warm and secure and was conducive to their managing the pain. The women also described how important it was for them to have a supportive partner, with whom they had a mutual understanding, in order to manage the pain. In this paper, we are presenting a study within the third paradigm in labour pain preparation and management: the childbearing woman's paradigm - the first and second being the midwifery and the medical paradigm, respectively. Midwives can play a major role in working with women in their preparation and management of labour pain. In the future, more research has to be done to illuminate this essential part of the childbearing woman's paradigm. © 2013 Nordic College of Caring Science.

  18. Inhomogeneous dose escalation increases expected local control for NSCLC patients with lymph node involvement without increased mean lung dose

    DEFF Research Database (Denmark)

    Nielsen, Tine B; Hansen, Olfred; Schytte, Tine;

    2014-01-01

    in mediastinum, and the thorax wall. The dose was escalated using a TCP model implemented into the planning system. The difference in TCP values between the homogeneous and inhomogeneous plans were evaluated using two different TCP models. RESULTS: Dose escalation was possible for all patients. TCP values based...

  19. A Co-operative Inquiry Into Generating, Describing, and Transforming Knowledge About De-escalation Practices in Mental Health Settings

    DEFF Research Database (Denmark)

    Berring, Lene Lauge; Hummelvoll, Jan Kåre; Pedersen, Liselotte

    2016-01-01

    De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff...

  20. Effects of Adolescent Childbearing on Maternal Depression and Problem Behaviors: A Prospective, Population-Based Study Using Risk-Set Propensity Scores.

    Directory of Open Access Journals (Sweden)

    Alison E Hipwell

    Full Text Available Adolescent mothers are reportedly at risk for depression and problem behaviors in the postpartum period, but studies have rarely considered developmental context and have yet to disentangle the effects of childbearing on adolescent functioning from selection effects that are associated with early pregnancy. The current study examined changes in adolescent depression, conduct problems and substance use (alcohol, tobacco and marijuana across the peripartum period using risk-set propensity scores derived from a population-based, prospective study that began in childhood (the Pittsburgh Girls Study, PGS. Each of 147 childbearing adolescents (ages 12-19 was matched with two same-age, non-childbearing adolescents (n = 294 on pregnancy propensity using 15 time-varying risk variables derived from sociodemographic, psychopathology, substance use, family, peer and neighborhood domains assessed in the PGS wave prior to each pregnancy (T1. Postpartum depression and problem behaviors were assessed within the first 6 months following delivery (T2; data gathered from the non-childbearing adolescent controls spanned the same interval. Within the childbearing group, conduct problems and marijuana use reduced from T1 to T2, but depression severity and frequency of alcohol or tobacco use showed no change. When change was compared across the matched groups, conduct problems showed a greater reduction among childbearing adolescents. Relative to non-childbearing adolescents who reported more frequent substance use with time, childbearing adolescents reported no change in alcohol use and less frequent use of marijuana across the peripartum period. There were no group differences in patterns of change for depression severity and tobacco use. The results do not support the notion that adolescent childbearing represents a period of heightened risk for depression or problem behaviors.

  1. Some Take the Glass Escalator, Some Hit the Glass Ceiling? Career Consequences of Occupational Sex Segregation.

    Science.gov (United States)

    Hultin, Mia

    2003-01-01

    Analysis of Swedish longitudinal data (1,535 men, 1,584 women) showed that men in female-dominated occupations have substantially better internal promotion opportunities than equally qualified women. In male-dominated occupations, men and women have equal internal promotion chances. Results suggest a "glass escalator" advantage for men…

  2. Deterrence Without Escalation:A Case for the Arctic in 2040

    Science.gov (United States)

    2015-04-08

    and dangerous weather conditions, which make traditional power projection methods less effective. Furthermore, the distances in the Arctic are vast...AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY Deterrence Without Escalation: A Case for the Arctic in 2040 by Erik Carlson, Maj...1 2. The Arctic in 2040

  3. Temporal Aspects of Moral Disengagement in School Bullying: Crystallization or Escalation?

    Science.gov (United States)

    Obermann, Marie-Louise

    2013-01-01

    This study investigated the stability and change in bullying behavior and their relation to increases and decreases in moral disengagement, specifically exploring whether crystallization and escalation of disengagement occur. Within a 1-year span, two sets of data were collected. A total of 567 sixth to eighth graders participated in both data…

  4. The Effect of Image Compatibility and Escalation of Commitment on Decision Performance

    Directory of Open Access Journals (Sweden)

    Harris K. Turino

    2012-04-01

    Full Text Available This study aims at empirically examining the extent to which Image Theory, initially developed as a theoretical basis for selecting a strategy or a decision, can be a theoretical basis for predicting a decision performance in two opposite frames: positive and negative. Image compatibility are employed to operationalize such a theory and the decision under study is progress decision represented by escalation of commitment. Thus, this study also empirically examines the connection between image compatibility and escalation of commitment as well as escalation of commitment as a mediator of the relationship between image compatibility and decision performance. The research context is Indonesia Stock Exchange (IDX that suffered from crisis in the past year (negative frame yet has been recovered recently (positive frame. The respondents are 229 individual investors in IDX. They are involved in day-to-day decision making (progress decision making with regard to their investment portofolio. The results of this study show that high image compatibility tends to lead to better decision performance in both frames. However, image compatibility may only positively affect the escalation of commitment in positive frame

  5. Response Acquisition and Fixed-Ratio Escalation Based on Interresponse Times in Rats

    Science.gov (United States)

    Taylor, Tracy G.; Galuska, Chad M.; Banna, Kelly; Yahyavi-Firouz-Abadi, Noushin; See, Ronald E.

    2010-01-01

    The effectiveness of a fixed-ratio (FR) escalation procedure, developed by Pinkston and Branch (2004) and based on interresponse times (IRTs), was assessed during lever-press acquisition. Forty-nine experimentally naive adult male Long Evans rats were deprived of food for 24 hr prior to an extended acquisition session. Before the start of the…

  6. Army Support of Military Cyberspace Operations: Joint Contexts and Global Escalation Implications

    Science.gov (United States)

    2015-01-01

    updated deterrence strategy incorporating ACD and cyber offence . Richard Kugler posits that U.S. nuclear deterrence worked because it was credible...cyberspace force roles in escalation and deterrence requires a holistic consideration of environmental influences. As Ronald Deibert notes, “Securing

  7. Some Take the Glass Escalator, Some Hit the Glass Ceiling? Career Consequences of Occupational Sex Segregation.

    Science.gov (United States)

    Hultin, Mia

    2003-01-01

    Analysis of Swedish longitudinal data (1,535 men, 1,584 women) showed that men in female-dominated occupations have substantially better internal promotion opportunities than equally qualified women. In male-dominated occupations, men and women have equal internal promotion chances. Results suggest a "glass escalator" advantage for men…

  8. North Korea’s Provocation and Escalation Calculus: Dealing with the Kim Jong-un Regime

    Science.gov (United States)

    2015-08-01

    level” provocations while minimizing risks of potential rapid conflict escalation remains a central dilemma as was demonstrated in the reaction to North...Korean summit because of Seoul’s attempts to “depolitize” the event by keeping it purely at “the artistic, athletic, and cultural ” level. This was

  9. Brain Inflammation in an Infant With Hemimegalencephaly, Escalating Seizures, and Epileptic Encephalopathy

    OpenAIRE

    Kim, Se Hee; Millichap, John J.; Koh, Sookyong

    2016-01-01

    Hemimegalencephaly, a congenital brain malformation typically characterized by enlargement of one hemisphere, is frequently associated with intractable epilepsy. The authors report a case of a 12-month-old girl with hemimegalencephaly who underwent semiurgent hemispherectomy because of rapidly escalating seizures, arrested development, and associated encephalopathy. The brain tissue was examined and evaluated for neuroinflammation. Immunohistochemical analysis of the brain tissue revealed the...

  10. A Dynamical Tool to Study the Cultural Context of Conflict Escalation

    Science.gov (United States)

    2009-07-13

    advancing here is aimedt,. at identifying naturally occurrin se uences in escala . n d ’. . ,., time controlling for cultural conditions which couJd...escalation of provocation by a colleague at work, & om a relatively mild disagreement ("Your colleague criticizes your work") to open confrontation and

  11. Siding and other reactions to a conflict: A theory of escalation toward outsiders

    NARCIS (Netherlands)

    Van de Vliert, E

    1981-01-01

    Siding in a dyadic conflict is important because it precipitates escalation. Nevertheless, little is known about how and why a nonprofessional outsider (P) reacts when a conflict party puts him under pressure to take sides. Coalition and role conflict theories suggest four behavior alternatives (tak

  12. 18 CFR Table 1 to Part 301 - Functionalization and Escalation Codes

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Functionalization and Escalation Codes 1 Table 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM...

  13. The social process of escalation: a promising focus for crisis management research.

    Science.gov (United States)

    Bergström, Johan; Dekker, Sidney; Nyce, James M; Amer-Wåhlin, Isis

    2012-06-15

    This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.

  14. Impact of antibiotic de-escalation on clinical outcomes in community-acquired pneumococcal pneumonia.

    Science.gov (United States)

    Viasus, Diego; Simonetti, Antonella F; Garcia-Vidal, Carolina; Niubó, Jordi; Dorca, Jordi; Carratalà, Jordi

    2017-02-01

    Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) is lacking. We carried out a retrospective analysis of prospectively collected data of a cohort of hospitalized adults with CAPP. Pneumococcal aetiology was established in patients with one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids or sputum, and/or a positive urinary antigen test. De-escalation therapy was considered when the initial antibiotic therapy was narrowed to penicillin, amoxicillin or amoxicillin/clavulanate within the first 72 h after admission. The primary outcomes were 30 day mortality and length of hospital stay (LOS). Adjustment for confounders was performed with multivariate and propensity score analyses. Of 1410 episodes of CAPP, antibiotic de-escalation within the first 72 h after admission was performed in 166 cases. After adjustment, antibiotic de-escalation was not associated with a higher risk of mortality (OR = 0.83, 95% CI = 0.24-2.81), but it was found to be a protective factor for prolonged LOS (above the median) (OR = 0.46, 95% CI = 0.30-0.70). Similar results were found in patients classified into high-risk pneumonia severity index classes (IV-V), those with clinical instability and those with bacteraemia. No significant differences were documented in adverse drug reactions or readmission (Antibiotic de-escalation seems to be safe and effective in reducing the duration of LOS, and did not adversely affect outcomes of patients with CAPP, even those with bacteraemia and severe disease, and those who were clinically unstable. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Two experiments focusing on de-escalation oriented coverage of post-war conflicts

    Directory of Open Access Journals (Sweden)

    Wilhelm Kempf

    2005-10-01

    Full Text Available War coverage has a strong bias towards the promotion of conflict escalation and - though less pronounced - this bias often survives in post-war coverage as well. Even after the end of war, only a minority of journalists frame conflict in a firmly de-escalation oriented way. Do they have a chance to reach the public? Will their reports be respected by the audience as more balanced and unbiased? Will they have an impact on the audience's mental models of the conflict? Or will the audience continue to cling to its prejudices and reject news articles which do not affirm the enemy images that emerged during wartime? The present paper investigates these questions by means of two experimental studies. In the first experiment, news articles on three events in former Yugoslavia after the fall of Milosevic were presented to a total of n = 128 subjects, representative of the readership of the German quality press: (1 violent conflicts in Southern Serbia (December 2000, (2 the extradition of Milosevic to The Hague (June, 2001 and (3 the treaty between Serbia and Montenegro (March 2003. For each of the events, four different types of articles were used: moderately escalation oriented articles from prestigious German newspapers (Die Welt, Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung and three variants of these articles, (a with increased escalation-oriented framing, (b with moderate de-escalation oriented framing and (c with more strongly de-escalation oriented framing of the events. Each subject was asked to read one article on each of the three events in chronological order and after each article (a to narrate the reported events in their own words and (b to fill out a questionnaire designed to measure the acceptance of the articles as unbiased, well-balanced, interesting, etc. The subjects' mental models of the reported events were inferred from their narratives by means of quantitative content analysis. The second experiment measured the

  16. Taboos of childbearing and child-rearing in Bendel state of Nigeria.

    Science.gov (United States)

    Iweze, F A

    1983-01-01

    Certain marriage, childbearing, and child rearing practices within the Bendel State of Nigeria are outlined. In the rural communities early marriage is encouraged in order to ensure partners for eligible bachelors and "maidens of good repute." Childbearing and child rearing is incorporated within the framework of the extended family system, including monogamous and polygamous forms of marriages. Most marriages take place for the major purpose of childbearing. In Bendel State 2 types of birth attendants are prevalent. The traditional birth attendant (TBA) who does not have formal schooling and who acquires her skill and knowledge from either a relation or friend by means of an informal apprenticeship. In contrast the midwife has a formal--basic and professional--education and can only practice independently after passing the prescribed national examination and being registerd by the Nigerian Nursing and Midwifery Council. The midwife is responsible for the care of the woman during the antepartum, intrapartum, and postpartum period. She is also responsible for the care of the baby during the same period and up to the age of 28 days. From the 3rd month of pregnancy onward, the midwife will carry out regular abdominal massage and palpation. This technique is used to loosen the nerves and relax the muscles, facilitating an easy pregnancy and delivery as well as correcting malpresentations. The mother to be will also make a paste with kola nuts and rub the paste on her abdomen every day to prevent thrush and other skin infections in the newborn baby. In the northern parts of the state, the young primigravida is sent to her parents for circumcision. This practice is dying out as the young mothers to be become more knowledgeable about the risk of infection and other problems. During pregnancy the husband tries to support all his wife's needs. The mother to be is encouraged to avoid places where people fight and quarrel so that the baby is peace loving when born. After

  17. Dose escalation in permanent brachytherapy for prostate cancer: dosimetric and biological considerations

    Energy Technology Data Exchange (ETDEWEB)

    Li, X Allen [Department of Radiation Oncology, University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201-1595 (United States); Wang, Jian Z [Department of Radiation Oncology, University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201-1595 (United States); Stewart, Robert D [School of Health Sciences, Purdue University, West Lafayette, IN 47907-1338 (United States); Di Biase, Steven J [Department of Radiation Oncology, University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201-1595 (United States)

    2003-09-07

    No prospective dose escalation study for prostate brachytherapy (PB) with permanent implants has been reported. In this work, we have performed a dosimetric and biological analysis to explore the implications of dose escalation in PB using {sup 125}I and {sup 103}Pd implants. The concept of equivalent uniform dose (EUD), proposed originally for external-beam radiotherapy (EBRT), is applied to low dose rate brachytherapy. For a given {sup 125}I or {sup 103}Pd PB, the EUD for tumour that corresponds to a dose distribution delivered by EBRT is calculated based on the linear quadratic model. The EUD calculation is based on the dose volume histogram (DVH) obtained retrospectively from representative actual patient data. Tumour control probabilities (TCPs) are also determined in order to compare the relative effectiveness of different dose levels. The EUD for normal tissue is computed using the Lyman model. A commercial inverse treatment planning algorithm is used to investigate the feasibility of escalating the dose to prostate with acceptable dose increases in the rectum and urethra. The dosimetric calculation is performed for five representative patients with different prostate sizes. A series of PB dose levels are considered for each patient using {sup 125}I and {sup 103}Pd seeds. It is found that the PB prescribed doses (minimum peripheral dose) that give an equivalent EBRT dose of 64.8, 70.2, 75.6 and 81 Gy with a fraction size of 1.8 Gy are 129, 139, 150 and 161 Gy for {sup 125}I and 103, 112, 122 and 132 Gy for {sup 103}Pd implants, respectively. Estimates of the EUD and TCP for a series of possible prescribed dose levels (e.g., 145, 160, 170 and 180 Gy for {sup 125}I and 125, 135, 145 and 155 for {sup 103}Pd implants) are tabulated. The EUD calculation was found to depend strongly on DVHs and radiobiological parameters. The dosimetric calculations suggest that the dose to prostate can be escalated without a substantial increase in both rectal and urethral dose

  18. The childbearing health and related service needs of newcomers (CHARSNN study protocol

    Directory of Open Access Journals (Sweden)

    Saucier Jean-François

    2006-12-01

    Full Text Available Abstract Background Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories, are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery. Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canadian-born women. Our research questions are: (1 Do refugee or asylum-seeking women and their infants, experience a greater number or a different distribution of harmful health events during pregnancy, at birth, and during the postpartum period than non-refugee immigrant or Canadian-born women? (2 Are the harmful health events experienced postpartum by asylum-seeking women and their infants, addressed less often (compared to refugees, non-refugee immigrants, and Canadian-born women by the Canadian health care system as delivered in each of the three major receiving cities for newcomers? Methods/design This is a four-year multi-site prospective cohort study (pregnancy to 4 months postpartum. We will seek to recruit 2400 women [200 in each of 4 groups (refugees, asylum-seekers, non-refugee immigrants, and Canadian-born from 1 of 12 postpartum hospital units across the 3 largest receiving cities for newcomers to Canada – Montreal, Toronto, and Vancouver

  19. Survey on AIDS related knowledge and attitude among married people of childbearing age in China

    Institute of Scientific and Technical Information of China (English)

    Li Ying; Cheng Yi-min; Huang Na; Guo Xin; Wu Jun-qing; Ru Xiao-mei

    2005-01-01

    Objective: To learn about the current circumstances surrounding AIDS related knowledge, attitudes and relevant influential factors, and to provide recommendations for HIV/AIDS prevention and control.Methods: A cross sectional study was designed by the cluster sampling method, and a self-administered, closed, and anonymous questionnaire was administered. There were a total of 4,800 married people of childbearing age, from six counties, during the period November through December, 2003.Results: There were 4,693 valid questionnaires and the validity rate was 97.78%. The general correct rate of AIDS knowledge of the respondents was 63.60%. Factors such as sex, age, place of registered permanent residence and different areas had influence on the level of AIDS knowledge. Respondents knew more about AIDS transmission related knowledge than non-transmission related knowledge. Only 30.6% of respondents had heard about volunteer counseling and testing(VCT)of AIDS, and just 8.5% of them thought that they had the possibility of being infected with HIV/AIDS, 64.5% of participants were afraid of AIDS, 66.5% of them thought that HIV positive people should be quarantined, 74.1% of them held that HIV positive people should be forbidden to go to public places, and they would not like to have dinner (68.8%), shake hands (67.8%), or work (63.4%)with HIV positive people. Respondents of different sex, registered permanent residence, education and living places had different attitudes towards HIV/AIDS.Conclusion: The AIDS knowledge level of respondents is below the goal of 75% up to 2005 brought forward by National AIDS Office of China. It is very important to strengthen the Information, Education, Communication (IEC) on AIDS non-transmission related knowledge among married people of childbearing age, especially those who are younger, lower educated and female. Furthermore, the knowledge about VCT should be publicized. More than half of the respondents have negative attitudes towards

  20. Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS: literature review and case series report

    Directory of Open Access Journals (Sweden)

    Langan Julie

    2012-11-01

    Full Text Available Abstract Background “Neuroleptic malignant syndrome” (NMS is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined. Description We aimed to identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7 mg/day during days 1–15 to 346.9 mg/day during days 16–30 and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators. Conclusions Rapid dose escalation occurred in less than half of this case series (n = 5, 38.5%, although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS.

  1. "I definitely want grandbabies": Caregivers of adolescents with perinatally-acquired HIV reflect on dating and childbearing.

    Science.gov (United States)

    Fair, Cynthia D; Albright, Jamie N; Clark, Devon M; Houpt, Bethany

    2016-12-01

    Parents and caregivers of typically developing teens are often a source of information about sexual health and relationships. However, little is known about the information offered to adolescents with perinatally acquired HIV (APHIV) by caregivers who may provide support and guidance to their teen as they explore sexuality and childbearing. This qualitative exploratory study involved the in-depth interviews of 18 caregivers (17 females), including biological mothers (9), relatives (5), and adoptive/foster mothers (4), who care for APHIV. Interviews explored views regarding their adolescent's engagement in romantic relationships, sexual behaviors, and childbearing. The guardian's knowledge of mother-to-child-transmission (MTCT) was also assessed for accuracy. Transcribed interviews were coded for emergent themes. Analyses indicated that the majority of caregivers discussed sexual health and dating with their adolescent. However, guidance regarding disclosure to partners of the adolescent's HIV status varied. Some biological mothers and all relatives cautioned against disclosure, contrary to foster/adoptive mothers. Most caregivers wanted their adolescent to experience parenthood. Reasons affirming childbearing included the belief their child would be a good parent and wanted to experience parenthood, childbearing as a normative experience, and decreased HIV-related stigma. Biological mothers and most relatives did not know the risk of MTCT, as opposed to all foster/adoptive mothers who accurately stated the risk was 1% to 2%. The type of guardian influenced the nature of shared information related to disclosure and risk of MTCT. Sexual and reproductive health education should be provided to caregivers because they could be an important source of information for APHIV. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  2. Seafood consumption among pregnant and non-pregnant women of childbearing age in the United States, NHANES 1999-2006

    OpenAIRE

    2014-01-01

    Objectives: Long-chain polyunsaturated fatty acids found in seafood are essential for optimal neurodevelopment of the fetus. However, concerns about mercury contamination of seafood and its potential harm to the developing fetus have created uncertainty about seafood consumption for pregnant women. We compared fish and shellfish consumption patterns, as well as their predictors, among pregnant and non-pregnant women of childbearing age in the US.Methods: Data from 1,260 pregnant and 5,848 non...

  3. Teenage pregnancy: the impact of maternal adolescent childbearing and older sister’s teenage pregnancy on a younger sister

    OpenAIRE

    Wall-Wieler, Elizabeth; Roos, Leslie L.; Nickel, Nathan C.

    2016-01-01

    Background Risk factors for teenage pregnancy are linked to many factors, including a family history of teenage pregnancy. This research examines whether a mother’s teenage childbearing or an older sister’s teenage pregnancy more strongly predicts teenage pregnancy. Methods This study used linkable administrative databases housed at the Manitoba Centre for Health Policy (MCHP). The original cohort consisted of 17,115 women born in Manitoba between April 1, 1979 and March 31, 1994, who stayed ...

  4. Coping with Violence in Mental Health Care Settings: Patient and Staff Member Perspectives on De-escalation Practices.

    Science.gov (United States)

    Berring, Lene Lauge; Pedersen, Liselotte; Buus, Niels

    2016-10-01

    This multiple case study explored de-escalation processes in threatening and violent situations based on patients and staff members perspectives. Our post hoc analysis indicated that de-escalation included responsive interactions influenced by the perspectives of both patients and staff members. We assembled their perspectives in a mental model consisting of three interdependent stages: (1) memories and hope, (2) safety and creativity and (3) reflective moments. The data indicated that both patients and staff strived for peaceful solutions and that a dynamic and sociological understanding of de-escalation can foster shared problem solving in violent and threatening situations.

  5. Physical child abuse potential in adolescent girls: associations with psychopathology, maltreatment, and attitudes toward child-bearing.

    Science.gov (United States)

    Pajer, Kathleen A; Gardner, William; Lourie, Andrea; Chang, Chien-Ni; Wang, Wei; Currie, Lisa

    2014-02-01

    Adolescent mothers are at increased risk of mistreating their children. Intervening before they become pregnant would be an ideal primary prevention strategy. Our goal was to determine whether psychopathology, exposure to maltreatment, preparedness for child-bearing, substance use disorders (SUDs), IQ, race, and socioeconomic status were associated with the potential for child abuse in nonpregnant adolescent girls. The Child Abuse Potential Inventory (CAPI) was administered to 195 nonpregnant girls (aged 15 to 16 years; 54% African American) recruited from the community. Psychiatric diagnoses from a structured interview were used to form 4 groups: conduct disorder (CD), internalizing disorders (INTs; that is, depressive disorder, anxiety disorder, or both), CD + INTs, or no disorder. Exposure to maltreatment was assessed with the Childhood Trauma Questionnaire, and the Childbearing Attitudes Questionnaire measured maternal readiness. CAPI scores were positively correlated with all types of psychopathology, previous exposure to maltreatment, and negative attitudes toward child-bearing. IQ, SUDs, and demographic factors were not associated. Factors associated with child abuse potential interacted in complex ways, but the abuse potential of CD girls was high, regardless of other potentially protective factors. Our study demonstrates that adolescent girls who have CD or INT are at higher risk of perpetrating physical child abuse when they have children. However, the core features of CD may put this group at a particularly high risk, even in the context of possible protective factors. Treatment providers should consider pre-pregnant counselling about healthy mothering behaviours to girls with CD.

  6. Antiretroviral Therapy Helps HIV-Positive Women Navigate Social Expectations for and Clinical Recommendations against Childbearing in Uganda

    Directory of Open Access Journals (Sweden)

    Jasmine Kastner

    2014-01-01

    Full Text Available Understanding factors that influence pregnancy decision-making and experiences among HIV-positive women is important for developing integrated reproductive health and HIV services. Few studies have examined HIV-positive women’s navigation through the social and clinical factors that shape experiences of pregnancy in the context of access to antiretroviral therapy (ART. We conducted 25 semistructured interviews with HIV-positive, pregnant women receiving ART in Mbarara, Uganda in 2011 to explore how access to ART shapes pregnancy experiences. Main themes included: (1 clinical counselling about pregnancy is often dissuasive but focuses on the importance of ART adherence once pregnant; (2 accordingly, women demonstrate knowledge about the role of ART adherence in maintaining maternal health and reducing risks of perinatal HIV transmission; (3 this knowledge contributes to personal optimism about pregnancy and childbearing in the context of HIV; and (4 knowledge about and adherence to ART creates opportunities for HIV-positive women to manage normative community and social expectations of childbearing. Access to ART and knowledge of the accompanying lowered risks of mortality, morbidity, and HIV transmission improved experiences of pregnancy and empowered HIV-positive women to discretely manage conflicting social expectations and clinical recommendations regarding childbearing.

  7. Socio-cultural Context of Adolescents’ Motivation for Marriage and Childbearing in North-Western Nigeria: A Qualitative Approach

    Directory of Open Access Journals (Sweden)

    Godswill James

    2010-09-01

    Full Text Available Nigeria has experienced high fertility levels over the last three decades, despite the implementation of the National Policy on Population in 1988 which stipulated four children per woman, and eighteen years as the minimum age at marriage. The proportional contribution of adolescents’ fertility (among women age 15-19 to the overall fertility rate among women age 15-49 has been increasing over time. A comprehensive understanding of adolescents’ fertility behavior requires exploring the motivations and desires of both males and females as they influence male-female relationships and how the related behavioral outcomes are modified by contexts in which they occur. Hence, this research article investigated the contexts of adolescent motivations for marriage and childbearing in North-Western Nigeria. Primary data were obtained using qualitative methods. Thirty-six focus group discussions (FGDs were conducted among adolescents aged 15-19 years, stratified by sex, marital status, fertility status and residence; and 48 in-depth interviews (IDIs with community-resident adolescents who have ever married or/and have begun childbearing. Results show that adolescents’ attitudes are largely pronatalist. Motivations for teenage marriage and childbearing reflect various levels of influence, such as parental pressure and social norms. Individual needs and desires also feature prominently, including economic survival, connection with wealthy and powerful individuals, domestic help and guaranteed support, as well as high reproductive risks. There is need for an external catalyst to raise awareness and to address the reproductive behavior or norms in North-Western Nigeria.

  8. Safety and efficacy of flexible-dose fesoterodine in British subjects with overactive bladder: insights into factors associated with dose escalation.

    Science.gov (United States)

    Cardozo, Linda; Hall, Timothy; Ryan, John; Ebel Bitoun, Caty; Kausar, Imran; Darekar, Amanda; Wagg, Adrian

    2012-11-01

    This study evaluated the efficacy and safety of flexible-dose fesoterodine and factors associated with dose escalation in subjects with overactive bladder (OAB). In this 12-week, open-label study, 331 adults with OAB symptoms for ≥3 months, ≥8 micturitions and ≥3 urgency episodes per 24 h and who reported at least "some moderate" bladder-related problems were treated with fesoterodine 4 mg once daily for 4 weeks, with the option to escalate to 8 mg for the remaining 8 weeks based on discussion of efficacy and tolerability with the investigator. Factors influencing dose escalation were identified using stepwise logistic regression. Efficacy was assessed via 3-day bladder diaries and patient-reported outcomes. Of the subjects, 59 % dose escalated at week 4; 93 % of escalators cited insufficient clinical response. The decision to escalate was most often made by the subject (alone or with the investigator). Improvements from baseline were observed in diary and patient-reported outcomes at weeks 4 and 12. Smaller improvements in micturition frequency and worse bladder-related problems at week 4 were significantly associated with increased likelihood of dose escalation; baseline micturition frequency, age, sex, body mass index, antimuscarinic-associated adverse events and OAB symptom duration were not. Non-escalators had greater improvement from baseline to week 4 than escalators; by week 12, improvement was similar among escalators and non-escalators. Fesoterodine was well tolerated. Treatment with flexible-dose fesoterodine improved bladder diary and patient-reported outcomes. Lower clinical response was related to dose escalation; after escalation, response in escalators approached that of non-escalators.

  9. Preventing and De-Escalating Ethical Conflict: A Communication-Training Mediation Model.

    Science.gov (United States)

    Levin, Tomer T; Parker, Patricia A

    2015-01-01

    While ethical conflicts in the provision of healthcare are common, the current third-party mediator model is limited by a lack of expert ethical mediators, who are often not on site when conflict escalates. In order to improve clinical outcomes in situations such as conflicts at the end of life, we suggest that clinicians-physicians, nurses and social workers-be trained to prevent and de-escalate emerging conflicts. This can be achieved using a mediation model framed by a communication-training approach. A case example is presented and the model is discussed. The implication of this preventative/early intervention model for improving clinical outcomes, in particular end-of life conflict, is considered.

  10. The two faces of conscientiousness: duty and achievement striving in escalation of commitment dilemmas.

    Science.gov (United States)

    Moon, H

    2001-06-01

    The author proposes that 2 facets of conscientiousness, duty and achievement striving, affect decision makers in escalation of commitment dilemmas in opposing ways, thus masking the predictive ability of a broad measure of conscientiousness. It is proposed that duty is associated with an other-centered orientation and that achievement striving is associated with a self-centered orientation. Analyses of decisions from 360 respondents showed that duty was associated with a deescalation of commitment, achievement striving was associated with an escalation of commitment, and the broad measure of conscientiousness was unassociated with commitment. The author advocates the utility of understanding potential self-centered versus other-centered aspects of the criterion of interest when conducting personality-based research.

  11. [Prevalence of deficiency and dietary intake of iron, zinc and copper in Chilean childbearing age women].

    Science.gov (United States)

    Mujica-Coopman, María F; Borja, Angélica; Pizarro, Fernando; Olivares, Manuel

    2014-03-01

    The aim of the present study was to evaluate anemia, the biochemical status and dietary adequacy of iron (Fe), zinc (Zn) and copper (Cu), in Chilean childbearing age women. We studied a convenience sample of 86 women aged 18 to 48 years from Santiago, Chile. We determined anemia and the micronutrient status through hemoglobin (Hb) mean corpuscular volume, transferrin saturation, zinc protoporphyrin, serum ferritin (SF), serum Zn and Cu. Dietary adequacy was estimated using a food frequency questionnaire. Of all women, 4.7% had Fe deficiency (ID) anemia, 21 % ID without anemia, 26 % depleted Fe stores and 48.3% normal Fe status. Obese women had higher SF (p<0.01) compared with those classified as having normal BMI. Also, showed higher Hb (p<0.05) concentrations compared with overweight and normal weight women. Partidipants showed 3.5 % and 2.3 % of Zn and Cu deficiency, respectively. Also, 95 %, 94 % and 99 % had adequate intake of Fe, Zn and Cu respectively, according to EAR cut points. There were no significant differences in micronutrients intake across different nutritional status. There was a low prevalence of anemia, Fe, Zn and Cu deficiency. A high percentage of women reached micronutrient adequacy. However, 47% of women had ID without anemia and Fe depleted stores.

  12. Dietary diversification for prevention of anaemia among women of childbearing age from rural India.

    Science.gov (United States)

    Rao, Shobha; Joshi, Smita; Bhide, Pradnya; Puranik, Bhairavi; Asawari, Kanade

    2014-04-01

    To assess the impact of an intervention modifying dietary habits for the prevention of anaemia in rural India. Intervention study with data on anthropometric (weight, height) measurements, Hb and diet pattern. As per the cut-off for Hb in the government programme, women with Hb 11 g/dl formed the non-supplemented group. Settings Three villages near Pune city, Maharashtra, India. Rural non-pregnant women (n 317) of childbearing age (15-35 years). After 1 year of intervention, mean Hb increased (from 10.94 (sd 1.22) g/dl to 11.59 (sd 1.11) g/dl) significantly (P 50% of the meetings or repeating >50% of the recipes at home (0.45 g/dl) in the non-supplemented group and was smaller than that observed in the supplemented group. Consumption of green leafy vegetables more than twice weekly increased substantially from 44.7% to 60.6%, as did consumption of seasonal fruits. Logistic regression showed that women with lower participation in the intervention had three times higher risk (OR = 3.08; 95% CI 1.04, 9.13; P = 0.04) for no gain in Hb compared with those having high participation. Developing action programmes for improving nutritional awareness to enhance the consumption of Fe-rich foods has great potential for preventing anaemia in rural India.

  13. Fish consumption among women anglers of childbearing age in the Great Lakes region.

    Science.gov (United States)

    Connelly, Nancy A; Bruce Lauber, T; Niederdeppe, Jeff; Knuth, Barbara A

    2016-10-01

    Fish consumption advisories are issued by the federal government for women of childbearing age (WCBA). These advisories make recommendations about the amount and types of fish that should be consumed to provide the greatest health benefits to women and their children while avoiding risks from chemical contaminants. We used diary methods to study fish consumption patterns of 1395 WCBA in the Great Lakes coastal region who purchased fishing licenses, a group which has significant opportunity to eat larger quantities of fish. Very few members of this group reported exceeding the federal recommendations for total fish consumption (between 3% and 5% depending on assumptions about portion sizes), consumption of canned "white" tuna (0%), or consumption of "do not eat" species (4%). They did report eating more fish on average than recent national study estimates, but they did not report consuming as much fish as is recommended to obtain the greatest health benefits of fish consumption. Only 10-12% of study participants reported eating within the recommended range of 8-12oz. of fish per week, with 84-87% eating less than the recommended amount. Additional efforts are likely needed to encourage WCBA to eat more low-risk fish, even among this group of higher-than-average fish consumers.

  14. Dental insurance and dental service use by U.S. women of childbearing age.

    Science.gov (United States)

    Kaylor, Mary Beth; Polivka, Barbara J; Chaudry, Rosemary; Salsberry, Pamela; Wee, Alvin G

    2011-01-01

    Oral health has a significant effect on health, and for women, poor oral health can lead to poor birth outcomes and can affect their child's health. Nursing interventions to improve the oral health of at-risk women have the potential to increase maternal and child systemic and oral health. The identification of women at a high risk for poor oral health is a necessary to develop and evaluate these interventions. This study examined the factors related to dental insurance and dental service use for women of childbearing age in the United States. A secondary analysis of the 2003-2004 National Health and Nutrition Examination Survey was completed to examine the predisposing, enabling, and need variables associated with dental insurance status and dental service use in a representative random sample of 1,071 women. The results showed that over 40% of women had no dental insurance. Women with less education, lower income, and dental need were significantly less likely to have dental insurance. Dental utilization by the uninsured was low and a racial/ethnic disparity was noted. A lack of dental insurance and dental service utilization is a significant concern. Nurses working with low-income women should educate the population about oral health and advocate for policies to increase dental insurance coverage. © 2011 Wiley Periodicals, Inc.

  15. Does early childbearing and a sterilization-focused family planning programme in India fuel population growth?

    Directory of Open Access Journals (Sweden)

    Zoë Matthews

    2009-06-01

    Full Text Available Recent stagnation in the reduction of infant mortality in India can arguably be attributed to early child bearing practices and the lack of progress in lengthening birth intervals. Meanwhile, family planning efforts have been particularly successful in the southern states such as Andhra Pradesh, although family limitation is almost exclusively by means of sterilisation at increasingly younger ages. This paper examines the population impact of the unprecedented convergence of early childbearing trajectories in India and quantifies the potential implications stemming from the neglect of strategies that encourage delaying and spacing of births. The effects of adopting a 'later, longer and fewer' family planning strategy are compared with the continuation of fertility concentrated in the younger age groups. Results from the cohort component population projections suggest that a policy encouraging later marriage and birth spacing would achieve a future total population which is about 52 million less in 2050 than if the current early fertility trajectory is continued.

  16. Risk factors for Toxoplasma gondii infection in women of childbearing age

    Directory of Open Access Journals (Sweden)

    Mariza Martins Avelino

    2004-04-01

    Full Text Available OBJECTIVES: Determine the risk factors involved in toxoplasmosis transmission and determine whether pregnancy is a risk factor for toxoplasmosis infection. STUDY DESIGN: Cross-sectional study carried out on 2,242 women at childbearing age. An indirect immunofluorescence reaction was used to identify immunity to Toxoplasma gondii. Previous gestations were also analyzed as a possible risk factor. The results were analyzed by chi2 and OR tests, and by variance analysis. The sample was statistically balanced according to social-economic risk factors. RESULTS: Previously pregnant women were 1.74 times more frequently infected with toxoplasmosis, regardless of environmental conditions. Pregnant women living under unfavorable environmental conditions had an approximately two times increased risk of being infected for each risk factor (contact with host animals, presence of vehicles of oocyst transmission. Previous pregnancy was the risk factor that had the strongest influence on acquiring toxoplasmosis (variance analysis and statistical balancing. DISCUSSION: The prevalence of this zoonosis is high in Goiânia-GO, Brazil (65.8%. Inadequate environmental sanitation was not significantly correlated with toxoplasmosis infection, except when associated with previous pregnancy, showing that the fundamental cause for infection is not environmental. CONCLUSION: The finding that pregnancy makes women more vulnerable to this protozoan, makes it important to implement prophylactic control of at-risk pregnant women.

  17. Influence of depressive mood on quality of life ratings of women with epilepsy of childbearing age.

    Science.gov (United States)

    Todorova, Koraliya S; Kaprelyan, Ara G

    2013-01-01

    Depressive disorders are the most frequent psychiatric comorbidity in epilepsy. Depressive mood affects negatively quality of life (QOL) ratings, sometimes having greater impact than seizure-related variables. Women with epilepsy are a specific subgroup at risk of comorbid depression in consequence of certain biopsychosocial demands. The AIM of this study was to assess the relative contribution of mood, seizure-related and demographic variables on QOL scores in women with epilepsy of childbearing age. A psychiatric assessment was carried out of 65 women with epilepsy (aged 18-55, mean 37.23 +/- 11.83 yrs). Comorbid depressive disorder was diagnosed according to ICD-10 criteria. Its severity was evaluated on the Hamilton Depression Rating Scale (HAMD-17). A questionnaire for demographic and seizure-related variables was completed. Two self-assessment questionnaires were administered: the Seizure Severity Questionnaire (SSQ) and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). The data were analysed using SPSS for Windows (version 17.0). Univariate correlation and multiple stepwise regression analyses were performed to explore the association between possible prognostic variables (independent variables) and QOLIE-31 overall and subscale scores (dependent variables). Analysis showed that demographic factors: employment and education; seizure-related factors: seizure severity, seizure frequency, antiepileptic drug therapy and comorbid depressive disorder were the variables significantly associated with QOLIE-31 overall score (p Paying attention to the psychological needs of women with epilepsy will have a positive effect on their QOL.

  18. 'My beloved chloroform'. Attitudes to childbearing in colonial Queensland: a case study.

    Science.gov (United States)

    Woolcock, H R; Thearle, M J; Saunders, K

    1997-12-01

    In 1847 the anaesthetic and analgesic properties of chloroform were discovered. This technology generated a new era for midwifery: mothers could be relieved of pain in childbirth. The introduction of chloroform for childbirth saw increasing medical dominance in obstetrics, traditionally in the hands of the midwife. At the same time the use of chloroform sparked a medical and moral controversy which lasted for several decades. On the one hand women were destined by the 'curse of Eve' to experience pain during childbirth; on the other, medical humanitarians and practitioners believed that there were technical and moral reasons for alleviating pain in childbirth. In concentrating on the debate historians have largely ignored the reactions of mothers to the introduction of the technology. This paper explores changing attitudes to childbearing within the context of colonial Queensland society, 1860-90, by examining the correspondence of an upper-class mother. Her education and liberal outlook, and a certain ambivalence towards motherhood, all influenced her attitude to the use of chloroform and the process of childbirth.

  19. Trends in sexual experience, contraceptive use, and teenage childbearing: 1992-2002.

    Science.gov (United States)

    Manlove, Jennifer; Ikramullah, Erum; Mincieli, Lisa; Holcombe, Emily; Danish, Sana

    2009-05-01

    To examine how cohort trends in family, individual, and relationship characteristics are linked to trends in adolescent reproductive health outcomes to provide a better understanding of factors behind recent declines in teenage birth rates. We examine a sample of three cohorts of females and males aged 15-19 in 1992, 1997, and 2002, based on retrospective information from the 2002 National Survey of Family Growth. We identify how family, individual, and relationship characteristics are associated with the transition to sexual intercourse, contraceptive use at first sex, and the transition to a teen birth. Cohort trends and multivariate analyses indicate changes in family and relationship characteristics among American teens have been associated with positive trends in reproductive health since the early 1990s. Factors associated with improvement in adolescent reproductive health include positive changes in family environments (including increases in parental education and a reduced likelihood of being born to a teen mother) and positive trends in sexual relationships (including an increasing age at first sex and reductions in older partners). These positive trends may be offset, in part, by negative changes in family environments (including an increased likelihood of being born to unmarried parents) and the changing racial/ethnic composition of the teen population. Recent increases in the U.S. teen birth rate highlight the continued importance of improving reproductive health outcomes. Our research suggests that it is important for programs to take into consideration how family, individual, and relationship environments influence decision-making about sex, contraception, and childbearing.

  20. Use of pagers with an alarm escalation system to reduce cardiac monitor alarm signals.

    Science.gov (United States)

    Cvach, Maria M; Frank, Robert J; Doyle, Pete; Stevens, Zeina Khouri

    2014-01-01

    Alarm fatigue desensitizes nurses to alarm signals and presents potential for patient harm. This project describes an innovative method of communicating cardiac monitor alarms to pagers using an alarm escalation algorithm. This innovation was tested on 2 surgical progressive care units over a 6-month period. There was a significant decrease in mean frequency and duration of high-priority monitor alarms and improvement in nurses' perception of alarm response time, using this method of alarm communication.

  1. The social process of escalation: a promising focus for crisis management research

    Directory of Open Access Journals (Sweden)

    Bergström Johan

    2012-06-01

    Full Text Available Abstract Background This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Discussion Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved. However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.

  2. Choosing between stairs and escalators in China: The impact of location, height and pedestrian volume

    Directory of Open Access Journals (Sweden)

    John Zacharias

    2015-01-01

    Conclusion: Separating stairs and escalator is effective in increasing stair climbing in Beijing, accounting for 29% of the variance in stair climbing, compared with 43% in Montreal. As in the Montreal case, distance has less effect on stair use rate when descending. Overall, 25.4% of Beijingers opted for stairs when ascending compared with 20.3% of Montrealers, and for descending 32.8% and 31.1% respectively.

  3. Cognitive Targeting: A Coercive Air Power Theory for Conventional Escalation Control Against Nuclear Armed Adversaries

    Science.gov (United States)

    2016-06-01

    COGNITIVE TARGETING: A COERCIVE AIR POWER THEORY FOR CONVENTIONAL ESCALATION CONTROL AGAINST NUCLEAR- ARMED ADVERSARIES BY PAUL A. GOOSSEN, MAJ...process with both critical analysis and with encouragement. Most importantly, I want to express my most sincere appreciation to my family. Their love...regional powers such as North Korea, the post-Cold War geo-political environment characterized by U.S. hegemony is fading away. In the emerging

  4. Dose-Escalated Robotic SBRT for Stage I–II Prostate Cancer

    OpenAIRE

    Meier, Robert

    2015-01-01

    Stereotactic body radiotherapy (SBRT) is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I) dose-escalation should yield improved rates of cancer control; (II) the unique radiobiology of prostate cancer favors hypofractionation; and (III) the conformal nature of SBRT minimizes high-dose radiation delivery to immediately adjacent o...

  5. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer

    OpenAIRE

    Robert eMeier

    2015-01-01

    Abstract: Stereotactic body radiotherapy (SBRT) is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I) dose escalation should yield improved rates of cancer control; (II) the unique radiobiology of prostate cancer favors hypofractionation and (III) the conformal nature of SBRT minimizes high-dose radiation delivery to immediately a...

  6. Strategy Escalation: An emerging paradigm for safe clinical development of T cell gene therapies

    Directory of Open Access Journals (Sweden)

    Junghans Richard

    2010-06-01

    Full Text Available Abstract Gene therapy techniques are being applied to modify T cells with chimeric antigen receptors (CARs for therapeutic ends. The versatility of this platform has spawned multiple options for their application with new permutations in strategies continually being invented, a testimony to the creative energies of many investigators. The field is rapidly expanding with immense potential for impact against diverse cancers. But this rapid expansion, like the Big Bang, comes with a somewhat chaotic evolution of its therapeutic universe that can also be dangerous, as seen by recently publicized deaths. Time-honored methods for new drug testing embodied in Dose Escalation that were suitable for traditional inert agents are now inadequate for these novel "living drugs". In the following, I propose an approach to escalating risk for patient exposures with these new immuno-gene therapy agents, termed Strategy Escalation, that accounts for the molecular and biological features of the modified cells and the methods of their administration. This proposal is offered not as a prescriptive but as a discussion framework that investigators may wish to consider in configuring their intended clinical applications.

  7. Escalating doses of donor lymphocytes for incipient graft rejection following SCT for thalassemia.

    Science.gov (United States)

    Frugnoli, I; Cappelli, B; Chiesa, R; Biral, E; Noè, A; Evangelio, C; Fossati, M; Napolitano, S; Ciceri, F; Roncarolo, M G; Marktel, S

    2010-06-01

    Mixed chimerism (MC) and secondary graft failure are frequent events following SCT for thalassemia. There is limited information regarding the outcome of donor lymphocyte infusion (DLI) to prevent rejection, mainly from case reports describing only successful cases. We describe a series of seven children affected by beta-thalassemia treated with escalating doses of DLI for level 2-3 MC (donor<90%) following myeloablative SCT from a matched family donor. The infusions were safe and no acute or chronic GVHD were documented; five patients experienced neutropenia and thrombocytopenia resolving spontaneously. DLI was successful in converting to full donor chimerism two patients stratified in the low-risk class (Pesaro class II). Conversely, for five high-risk patients, DLI was not effective in preventing secondary graft failure. This limited series suggests that escalating doses of DLI are safe in thalassemia patients post myeloablative therapy but efficacy may be jeopardized by rapidly growing anti-donor alloimmunity in high-risk patients. We suggest giving escalating doses of donor T cells to attempt a graft-versus-thalassemia as soon as level 2-3 MC is detected.

  8. Mucosal healing in inflammatory bowel disease: Maintain orde-escalate therapy

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    In the past decade, thanks to the introduction of biologictherapies, a new therapeutic goal, mucosal healing(MH), has been introduced. MH is the expression of anarrest of disease progression, resulting in minor hospitalizations,surgeries, and prolonged clinical remission.MH may be achieved with several therapeutic strategiesreaching success rates up to 80% for both, ulcerativecolitis (UC) and Crohn's disease (CD). Various scoringsystems for UC and for the transmural CD, have beenproposed to standardize the definition of MH. Severalattempts have been undertaken to de-escalate therapyonce MH is achieved, thus, reducing the risk of adverseevents. In this review, we analysed the available studiesregarding the achievement of MH and the subsequenttreatment de-escalation according to disease typeand administered therapy, together with non-invasivemarkers proposed as predictors for relapse. The availabledata are not encouraging since de-escalation after theachievement of MH is followed by a high number ofclinical relapses reaching up to 50% within one year.Unclear is also another question, in case of combinationtherapies, which drug is more appropriate to stop, inorder to guarantee a durable remission. Predictorsof unfavourable outcome such as disease extension,perianal disease, or early onset disease appear to beinadequate to foresee behaviour of disease. Furtherstudies are warranted to investigate the role of histologichealing for the further course of disease.

  9. Ion Elevators and Escalators in Multilevel Structures for Lossless Ion Manipulations.

    Science.gov (United States)

    Ibrahim, Yehia M; Hamid, Ahmed M; Cox, Jonathan T; Garimella, Sandilya V B; Smith, Richard D

    2017-02-07

    We describe two approaches based upon ion "elevator" and "escalator" components that allow moving ions to different levels in structures for lossless ion manipulations (SLIM). Guided by ion motion simulations, we designed elevator and escalator components based upon ion current measurements providing essentially lossless transmission in multilevel designs. The ion elevator design allowed ions to efficiently bridge a 4 mm gap between levels. The component was integrated in a SLIM and coupled to a QTOF mass spectrometer using an ion funnel interface to evaluate the m/z range transmitted as compared to transmission within a level (e.g., in a linear section). The analysis of singly charged ions of m/z 600-2700 produced similar mass spectra for both elevator and straight (linear motion) components. In the ion escalator design, traveling waves (TW) were utilized to transport ions efficiently between two SLIM levels. Ion current measurements and ion mobility (IM) spectrometry analysis illustrated that ions can be transported between TW-SLIM levels with no significant loss of either ions or IM resolution. These developments provide a path for the development of multilevel designs providing, e.g., much longer IM path lengths, more compact designs, and the implementation of much more complex SLIM devices in which, e.g., different levels may operate at different temperatures or with different gases.

  10. Macroevolutionary patterns of glucosinolate defense and tests of defense-escalation and resource availability hypotheses.

    Science.gov (United States)

    Cacho, N Ivalú; Kliebenstein, Daniel J; Strauss, Sharon Y

    2015-11-01

    We explored macroevolutionary patterns of plant chemical defense in Streptanthus (Brassicaceae), tested for evolutionary escalation of defense, as predicted by Ehrlich and Raven's plant-herbivore coevolutionary arms-race hypothesis, and tested whether species inhabiting low-resource or harsh environments invest more in defense, as predicted by the resource availability hypothesis (RAH). We conducted phylogenetically explicit analyses using glucosinolate profiles, soil nutrient analyses, and microhabitat bareness estimates across 30 species of Streptanthus inhabiting varied environments and soils. We found weak to moderate phylogenetic signal in glucosinolate classes and no signal in total glucosinolate production; a trend toward evolutionary de-escalation in the numbers and diversity of glucosinolates, accompanied by an evolutionary increase in the proportion of aliphatic glucosinolates; some support for the RAH relative to soil macronutrients, but not relative to serpentine soil use; and that the number of glucosinolates increases with microhabitat bareness, which is associated with increased herbivory and drought. Weak phylogenetic signal in chemical defense has been observed in other plant systems. A more holistic approach incorporating other forms of defense might be necessary to confidently reject escalation of defense. That defense increases with microhabitat bareness supports the hypothesis that habitat bareness is an underappreciated selective force on plants in harsh environments.

  11. Terrorist attacks escalate in frequency and fatalities preceding highly lethal attacks.

    Directory of Open Access Journals (Sweden)

    Andy Martens

    Full Text Available Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates--both in the number of people killed per attack and in the frequency of attacks--leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack.

  12. Fragile Families and the Reproduction of Poverty

    OpenAIRE

    McLanahan, Sara

    2009-01-01

    In 1965, Daniel Patrick Moynihan warned that non-marital childbearing and marital dissolution were undermining the progress of African Americans. I argue that what Moynihan identified as a race-specific problem in the 1960s has now become a class-based phenomena as well. Using data from a new birth cohort study, I show that unmarried parents come from much more disadvantaged populations than married parents. I further argue that non-marital childbearing reproduces class and racial disparities...

  13. Impact of de-escalation of beta-lactam antibiotics on the emergence of antibiotic resistance in ICU patients: a retrospective observational study.

    Science.gov (United States)

    De Bus, Liesbet; Denys, Wouter; Catteeuw, Julie; Gadeyne, Bram; Vermeulen, Karel; Boelens, Jerina; Claeys, Geert; De Waele, Jan J; Decruyenaere, Johan; Depuydt, Pieter O

    2016-06-01

    Antibiotic de-escalation is promoted to limit prolonged exposure to broad-spectrum antibiotics, but proof that it prevents the emergence of resistance is lacking. We evaluated determinants of antibiotic de-escalation in an attempt to assess whether the latter is associated with a lower emergence of antimicrobial resistance. Antibiotic treatments, starting with empirical beta-lactam prescriptions, were prospectively documented during 2013 and 2014 in a tertiary intensive care unit (ICU) and categorized as continuation, de-escalation or escalation of the empirical antimicrobial treatment. Determinants of the de-escalation or escalation treatments were identified by multivariate logistic regression; the continuation category was used as the reference group. Using systematically collected diagnostic and surveillance cultures, we estimated the cumulative incidence of antimicrobial resistance following de-escalation or continuation of therapy, with adjustment for ICU discharge and death as competing risks. Of 478 anti-pseudomonal antibiotic prescriptions, 42 (9 %) were classified as escalation of the antimicrobial treatment and 121 (25 %) were classified as de-escalation, mainly through replacement of the originally prescribed antibiotics with those having a narrower spectrum. In multivariate analysis, de-escalation was associated with the identification of etiologic pathogens (p antibiotic course in the ICU in de-escalated versus continued prescriptions was 8 (range 6-10) versus 5 (range 4-7) days, respectively (p resistance to the initial beta-lactam antibiotic on day 14 were 30.6 and 23.5 % for de-escalation and continuation, respectively (p = 0.22). For the selection of multi-drug resistant pathogens, these values were 23.5 (de-escalation) and 18.6 % (continuation) respectively (p = 0.35). The emergence of antibiotic-resistant bacteria after exposure to anti-pseudomonal beta-lactam antibiotics was not lower following de-escalation.

  14. Escalating polypharmacy.

    Science.gov (United States)

    Gorard, D A

    2006-11-01

    New drug treatments, new indications for older drug treatments, lower thresholds for treating risk factors in preventative medicine, and an ageing population acquiring multiple pathologies all contribute to the development of polypharmacy. Longitudinal studies document the rise in prescribed medications, particularly in the elderly. The potential dangers of adverse drug reactions and interactions, poor adherence and confusion associated with ever-increasing polypharmacy are likely to worsen. Strategies to reduce prescribing will obviously decrease the dangers of polypharmacy. These include more considered prescribing when contemplating additions to patients' already lengthy prescription lists, and external reviews of medicine lists by a doctor or pharmacist. Despite such strategies, polypharmacy seems inevitable and considerations must be given to simplifying patients' multiple drug administrations using single-daily-dose regimens, fixed-dose combination pills, calendar-blister packaging and pill organizers.

  15. Childbearing during adolescence and offspring mortality: findings from three population-based cohorts in southern Brazil

    Directory of Open Access Journals (Sweden)

    Barros Fernando C

    2011-10-01

    Full Text Available Abstract Background The role of young maternal age as a determinant of adverse child health outcomes is controversial, with existing studies providing conflicting results. This work assessed the association between adolescent childbearing and early offspring mortality in three birth cohort studies from the city of Pelotas in Southern Brazil. Methods All hospital births from 1982 (6,011, 1993 (5,304, and 2004 (4,287 were identified and these infants were followed up. Deaths were monitored through vital registration, visits to hospitals and cemeteries. The analyses were restricted to women younger than 30 years who delivered singletons (72%, 70% and 67% of the original cohorts, respectively. Maternal age was categorized into three groups ( Results There were no interactions between maternal age and cohort year. After adjustment for confounding, pooled ORs for mothers aged 12-19 years were 0.6 (95% CI = 0.4; 1.0 for fetal death, 0.9 (0.6; 1.3 for perinatal death, 1.0 (0.7; 1.6 for early neonatal death, 1.6 (0.7; 3.4 for late neonatal death, 1.8 (1.1; 2.9 for postneonatal death, and 1.6 (1.2; 2.1 for infant death, when compared to mothers aged 20-29 years. Further adjustment for mediating variables led to the disappearance of the excess of postneonatal mortality. The number of mothers younger than 16 years was not sufficient for most analyses. Conclusion The slightly increased odds of postneonatal mortality among children of adolescent mothers suggest that social and environmental factors may be more important than maternal biologic immaturity.

  16. Effect of daily supplementation with iron and zinc on iron status of childbearing age women.

    Science.gov (United States)

    Mujica-Coopman, María F; Borja, Angélica; Pizarro, Fernando; Olivares, Manuel

    2015-05-01

    The objective was to determine the effect of daily supplementation with 30 mg of iron (Fe) plus 30 mg of zinc (Zn) for 3 months on Fe status of women of childbearing age. This was a randomized double-blind, placebo-controlled trial. Eighty-one women (18-45 years) were randomly assigned to receive either a daily single dose of 30 mg of Fe (group 1; n = 28) and 30 mg of Fe plus 30 mg of Zn (group 2; n = 26) or placebo (n = 27) for 3 months. Hemoglobin (Hb), mean corpuscular volume, serum Fe, total iron-binding capacity, transferrin saturation, erythrocyte Zn protoporphyrin, serum ferritin (SF), serum transferrin receptor (TfR), total body Fe, serum Zn, and high-sensitivity C-reactive protein were measured at baseline and at the end of the study. At baseline, 3.7, 28.4, and 3.7 % of women had iron-deficiency anemia (IDA), Fe deficiency without anemia, and depleted Fe stores, respectively. No significant differences on Fe status were found between groups before supplementation. After supplementation, group 2 showed a significant increase of Hb and total body Fe and a significant decrease of TfR compared with placebo (p < 0.05). Moreover, serum Zn increased significantly in group 2 compared with group 1 (p < 0.01) and placebo (p < 0.01). In conclusion, daily supplementation with 30 mg of Fe plus 30 mg of Zn for 3 months improved significantly the Fe and Zn status of women, compared with those who received placebo. The positive effect of Fe supplementation on Fe status is enhanced by combined Zn supplementation.

  17. Promoting family planning use after childbirth and desire to limit childbearing in Ethiopia.

    Science.gov (United States)

    Sathiya Susuman, A; Bado, Aristide; Lailulo, Yishak Abraham

    2014-07-16

    In Ethiopia the average fertility rate in rural areas is about 6 children per woman, while it is 2.4 children per woman in urban areas. It is with this concept in mind that the investigators of this study wanted to correlate the promotion of after-child-birth-use of family planning and desire to limit childbearing in Ethiopia. Postpartum amenorrhea signifies the interval between childbirth and the return of menstruation. The specific objective is to examine the desire to limit family size, along with cases of sterilized, fecund, postpartum amenorrhoea, declared in-fecund and menopausal women within the study area. The study is based on the analysis of secondary data obtained from the 2011 Ethiopian Demographic and Health Survey (EDHS). This study is concentrated on couples because we need to know more about married people's desire to limit their family size. The bivariate, ANOVA, and multivariate analyses were used to analyse the association. The total number of respondents was 6,745 (78.3% rural and 21.7% urban), with 93.6% of them being currently married and 6.4% of them living with a partner. The mean duration of amenorrhea among women who gave birth in the five years preceding the survey is 16 months. Women with equal numbers of sons and daughters were found to be 75.4% (OR=0.25) less likely to desire more children, compared to women with more sons than daughters. Achievable resolutions include increasing females' ages at marriage, avoiding unwanted teenage pregnancies, completely eradicating home delivery, and inspiring young people to use modern methods of family planning to achieve Millennium Development Goals 4 & 5.

  18. Childbearing and Economic Work: The Health Balance of Women in Accra, Ghana.

    Science.gov (United States)

    Waterhouse, Philippa; Hill, Allan G; Hinde, Andrew

    2016-02-01

    This study aims to investigate (1) whether the health of working women with young children differs from that of working women without young children, and (2) which social factors mediate the relationship between economic and maternal role performance and health among mothers with young children. The analyses uses panel data from 697 women present in both waves of the Women's Health Study for Accra (WHSA-I and WHSA-II); a community based study of women aged 18 years and older in the Accra Metropolitan Area of Ghana conducted in 2003 and 2008-2009. Change in physical and mental health between the survey waves is compared between women with a biological child alive at WHSA-II and born since WHSA-I and women without a living biological child at WHSA-II born in the interval. To account for attrition between the two survey waves selection models were used with unconditional change score models being used as the outcome model. We found in our sample of working women that those who had a child born between WHSA-I and WHSA-II who was still alive at WHSA-II did not experience a change in mental or physical health different from other women. Among working women with young children, educational status, relationship to the household head and household demography were associated with change in mental health at the 5 % level, whilst migration status and household demography was associated with change in physical health scores. The results suggest there are no health penalties of combining work and childbearing among women with young children in Accra, Ghana.

  19. Dose Escalation and Healthcare Resource Use among Ulcerative Colitis Patients Treated with Adalimumab in English Hospitals: An Analysis of Real-World Data.

    Directory of Open Access Journals (Sweden)

    Christopher M Black

    Full Text Available To describe the real-world use of adalimumab for maintenance treatment of ulcerative colitis (UC and associated healthcare costs in English hospitals.Retrospective cohort study.Analysis of NHS Hospital Episode Statistics linked with pharmacy dispensing data in English hospitals.Adult UC patients receiving ≥240mg during adalimumab treatment induction, subsequently maintained on adalimumab.Frequency and pattern of adalimumab use and dose escalation during maintenance treatment and associated healthcare costs (prescriptions and hospital visits.191 UC patients completed adalimumab treatment induction. 83 (43.46% dose escalated during maintenance treatment by ≥100% (equivalent to weekly dosing (median time to dose escalation: 139 days. 56 patients (67.47% subsequently de-escalated by ≥50% (median time to dose de-escalation: 21 days. Mean all-cause healthcare costs for all patients ≤12 months of index were £13,892. Dose escalators incurred greater mean healthcare costs than non-escalators ≤12 months of index (£14,596 vs. £13,351. Prescriptions accounted for 96.49% of UC-related healthcare costs (£11,090 of £11,494 in all patients.Within the cohort, 43.46% of UC patients escalated their adalimumab dose by ≥100% and incurred greater costs than non-escalators. The apparent underestimation of adalimumab dose escalation in previous studies may have resulted in underestimated costs in healthcare systems.

  20. [Study on the relationship between frequencies of prenatal care and neonatal low birth weight in women of childbearing age from rural areas of Shaanxi province].

    Science.gov (United States)

    Li, J M; Liu, D M; Zhang, X F; Qu, P F; Yan, H

    2017-04-10

    Objective: To investigate the relationship between frequencies of prenatal care and neonatal low birth weight (LBW) among women of childbearing age from the rural areas of Shaanxi province. Methods: A questionnaire survey was conducted among the childbearing-aged women from the rural areas. Samples were selected through multi stage stratified random sampling method. The childbearing aged women were in pregnancy or having had definite outcomes of pregnancy. Measurement of data was described by median±standard deviation, and chi square test was used to compare the rates. Neonatal low birth weight and frequencies of prenatal care were dependent variables and independent variables grouped into the generalized Poisson regression model. Confounding factors were under control. Results: The overall incidence rate of LBW was 3.75% among 18 911 rural women of childbearing age during 2010-2013. Frequencies on pregnancy care were up to 15 times (0.70%), with a minimum of 0 (0.70%), an average of 5.65±2.74 times (including ≥10 times accounted for 12.37%; ≥7 times accounted for 28.52%; ≥5 times accounted for 62.80% and controlling confounding factors, results from the generalized Poisson regression analysis revealed that the difference was statistically significant when compared to the reference group. The incidence of neonatal LBW in the 7 group (OR=1.61, 95%CI:1.31-2.00) while in the prenatal care, among women of childbearing age.

  1. How organizational escalation prevention potential affects success of implementation of innovations: electronic medical records in hospitals.

    Science.gov (United States)

    Lambooij, Mattijs S; Koster, Ferry

    2016-05-20

    Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation processes that do not meet their expectations, may prevent an organization of losing time and money on unsuccessful projects. EPP consists of a set of checks and balances incorporated in managerial practices that safeguard management against irrational (but very human) decisions and may limit the escalation of implementation projects. We study whether successful implementation of electronic medical records (EMRs) relates to EPP and investigate the organizational factors accounting for this relationship. Structural equation modelling (SEM), using questionnaire data of 427 doctors and 631 nurses who had experience with implementation and use of EMRs in hospitals, was applied to study whether formal governance and organizational culture mediate the relationship between EPP and the perceived added value of EMRs. Doctors and nurses in hospitals with more EPP report more successful implementation of EMR (in terms of perceived added value of the EMR). Formal governance mediates the relation between EPP and implementation success. We found no evidence that open or innovative culture explains the relationship between EPP and implementation success. There is a positive relationship between the level of EPP and perceived added value of EMRs. This relationship is explained by formal governance mechanisms of organizations. This means that management has a set of tangible tools to positively affect the success of innovation processes. However, it also means that management needs to be able to critically reflect on its (previous) actions and decisions and is willing to change plans if elements of EPP signal that the implementation process is hampered.

  2. Validation of treatment escalation as a definition of atopic eczema flares.

    Directory of Open Access Journals (Sweden)

    Kim S Thomas

    Full Text Available Atopic eczema (AE is a chronic disease with flares and remissions. Long-term control of AE flares has been identified as a core outcome domain for AE trials. However, it is unclear how flares should be defined and measured.To validate two concepts of AE flares based on daily reports of topical medication use: (i escalation of treatment and (ii days of topical anti-inflammatory medication use (topical corticosteroids and/or calcineurin inhibitors.Data from two published AE studies (studies A (n=336 and B (n=60 were analysed separately. Validity and feasibility of flare definitions were assessed using daily global bother (scale 0 to 10 as the reference standard. Intra-class correlations were reported for continuous variables, and odds ratios and area under the receiver operator characteristic (ROC curve for binary outcome measures.Good agreement was found between both AE flare definitions and change in global bother: area under the ROC curve for treatment escalation of 0.70 and 0.73 in studies A and B respectively, and area under the ROC curve of 0.69 for topical anti-inflammatory medication use (Study A only. Significant positive relationships were found between validated severity scales (POEM, SASSAD, TIS and the duration of AE flares occurring in the previous week - POEM and SASSAD rose by half a point for each unit increase in number of days in flare. Smaller increases were observed on the TIS scale. Completeness of daily diaries was 95% for Study A and 60% for Study B over 16 weeks.Both definitions were good proxy indicators of AE flares. We found no evidence that 'escalation of treatment' was a better measure of AE flares than 'use of topical anti-inflammatory medications'. Capturing disease flares in AE trials through daily recording of medication use is feasible and appears to be a good indicator of long-term control.Current Controlled Trials ISRCTN71423189 (Study A.

  3. Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Samantha, E-mail: Samantha.warren@oncology.ox.ac.uk [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Partridge, Mike [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Carrington, Rhys [Velindre Cancer Centre, Velindre Hospital, Cardiff (United Kingdom); Hurt, Chris [Wales Cancer Trials Unit, School of Medicine, Heath Park, Cardiff (United Kingdom); Crosby, Thomas [Velindre Cancer Centre, Velindre Hospital, Cardiff (United Kingdom); Hawkins, Maria A. [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom)

    2014-10-01

    Purpose: This study investigated the trade-off in tumor coverage and organ-at-risk sparing when applying dose escalation for concurrent chemoradiation therapy (CRT) of mid-esophageal cancer, using radiobiological modeling to estimate local control and normal tissue toxicity. Methods and Materials: Twenty-one patients with mid-esophageal cancer were selected from the SCOPE1 database (International Standard Randomised Controlled Trials number 47718479), with a mean planning target volume (PTV) of 327 cm{sup 3}. A boost volume, PTV2 (GTV + 0.5 cm margin), was created. Radiobiological modeling of tumor control probability (TCP) estimated the dose required for a clinically significant (+20%) increase in local control as 62.5 Gy/25 fractions. A RapidArc (RA) plan with a simultaneously integrated boost (SIB) to PTV2 (RA{sub 62.5}) was compared to a standard dose plan of 50 Gy/25 fractions (RA{sub 50}). Dose-volume metrics and estimates of normal tissue complication probability (NTCP) for heart and lungs were compared. Results: Clinically acceptable dose escalation was feasible for 16 of 21 patients, with significant gains (>18%) in tumor control from 38.2% (RA{sub 50}) to 56.3% (RA{sub 62.5}), and only a small increase in predicted toxicity: median heart NTCP 4.4% (RA{sub 50}) versus 5.6% (RA{sub 62.5}) P<.001 and median lung NTCP 6.5% (RA{sub 50}) versus 7.5% (RA{sub 62.5}) P<.001. Conclusions: Dose escalation to the GTV to improve local control is possible when overlap between PTV and organ-at-risk (<8% heart volume and <2.5% lung volume overlap for this study) generates only negligible increase in lung or heart toxicity. These predictions from radiobiological modeling should be tested in future clinical trials.

  4. Serum Retinol Concentrations, Race, and Socioeconomic Status in of Women of Childbearing Age in the United States

    Science.gov (United States)

    Hanson, Corrine; Lyden, Elizabeth; Abresch, Chad; Anderson-Berry, Ann

    2016-01-01

    Background: Vitamin A is an essential nutrient during pregnancy and throughout the lifecycle due to its role in the development of critical organ systems. Because maternal tissue is progressively depleted of vitamin A to supply fetal demands, women who become pregnant while possessing marginal vitamin A reserves are at increased risk of vitamin A inadequacy as pregnancy progresses. Few studies have assessed the relationship between socioeconomic factors and retinol status in women of childbearing age. Methods: We used the National Health and Nutrition Examination Survey (NHANES) to assess the relationship between serum retinol concentrations and socioeconomic factors in women of childbearing age. Women 14–45 years of age (n = 3170) from NHANES cycles 2003–2004 and 2005–2006 were included. Serum retinol concentrations were divided into categories according to World Health Organization criteria. All statistical procedures accounted for the weighted data and complex design of the NHANES sample. A p-value of < 0.05 was considered statistically significant. Results: The poverty score and race were significantly associated with vitamin A status after adjustment for confounders. Odds of retinol concentrations of <1.05 µmol/L were 1.85 times higher for those of lower socioeconomic status when compared to those of higher status (95% CI: 1.12–3.03, p = 0.02), and 3.1 times higher for non-Hispanic blacks when compared to non-Hispanic whites (95% CI: 1.50–6.41, p = 0.002). Dietary intakes of retinol activity equivalents were significantly lower in groups with higher poverty scores (p = 0.004). Conclusion There appear to be disparities in serum vitamin A levels in women of childbearing age related to income and race in the United States. PMID:27548213

  5. Impact of dose escalation and adaptive radiotherapy for cervical cancers on tumour shrinkage—a modelling study

    Science.gov (United States)

    Røthe Arnesen, Marius; Paulsen Hellebust, Taran; Malinen, Eirik

    2017-03-01

    Tumour shrinkage occurs during fractionated radiotherapy and is regulated by radiation induced cellular damage, repopulation of viable cells and clearance of dead cells. In some cases additional tumour shrinkage during external beam therapy may be beneficial, particularly for locally advanced cervical cancer where a small tumour volume may simplify and improve brachytherapy. In the current work, a mathematical tumour model is utilized to investigate how local dose escalation affects tumour shrinkage, focusing on implications for brachytherapy. The iterative two-compartment model is based upon linear-quadratic radiation response, a doubling time for viable cells and a half-time for clearance of dead cells. The model was individually fitted to clinical tumour volume data from fractionated radiotherapy of 25 cervical cancer patients. Three different fractionation patterns for dose escalation, all with an additional dose of 12.2 Gy, were simulated and compared to standard fractionation in terms of tumour shrinkage. An adaptive strategy where dose escalation was initiated after one week of treatment was also considered. For 22 out of 25 patients, a good model fit was achieved to the observed tumour shrinkage. A large degree of inter-patient variation was seen in predicted volume reduction following dose escalation. For the 10 best responding patients, a mean tumour volume reduction of 34  ±  3% (relative to standard treatment) was estimated at the time of brachytherapy. Timing of initiating dose escalation had a larger impact than the number of fractions applied. In conclusion, the model was found useful in evaluating the impact from dose escalation on tumour shrinkage. The results indicate that dose escalation could be conducted from the start of external beam radiotherapy in order to obtain additional tumour shrinkage before brachytherapy.

  6. Successful pregnancy outcome in paroxysmal nocturnal hemoglobinuria (PNH following escalated eculizumab dosing to control breakthrough hemolysis

    Directory of Open Access Journals (Sweden)

    Ruby Sharma

    2015-01-01

    Full Text Available Pregnancy in women with paroxysmal nocturnal hemoglobinuria (PNH is associated with increased maternal and fetal morbidity and mortality. There is limited published experience regarding therapy of PNH during pregnancy. We describe a case of a 30 year old female with hypoplastic myelodysplastic syndrome and PNH. After two years of treatment with eculizumab, she became pregnant. She developed breakthrough hemolysis at 20 weeks gestation. Pharmacokinetic and pharmacodynamic studies demonstrated a subtherapeutic eculizumab level with absence of complement blockade. Escalation of her eculizumab dose successfully controlled hemolysis and restored therapeutic eculizumab level and activity. She delivered a healthy baby at 36 weeks.

  7. Stop the escalators: using the built environment to increase usual daily activity

    OpenAIRE

    Westfall, Jack

    2010-01-01

    John M Westfall, Doug H FernaldDepartment of Family Medicine, University of Colorado Denver, Aurora, CO, USABackground: Obesity is an epidemic in the United States. Two-thirds of the population is overweight and does not get enough exercise. Eastern cities are full of escalators that transport obese Americans to and from the subway. Walking stairs is a moderate activity requiring 3–6 metabolic equivalent tasks (METS) and burning 3.5–7 kcal/min. We determined the caloric ex...

  8. Brain Inflammation in an Infant With Hemimegalencephaly, Escalating Seizures, and Epileptic Encephalopathy.

    Science.gov (United States)

    Kim, Se Hee; Millichap, John J; Koh, Sookyong

    2016-01-01

    Hemimegalencephaly, a congenital brain malformation typically characterized by enlargement of one hemisphere, is frequently associated with intractable epilepsy. The authors report a case of a 12-month-old girl with hemimegalencephaly who underwent semiurgent hemispherectomy because of rapidly escalating seizures, arrested development, and associated encephalopathy. The brain tissue was examined and evaluated for neuroinflammation. Immunohistochemical analysis of the brain tissue revealed the presence of abundant activated CD68-positive microglia and reactive astrogliosis. Detection of active inflammatory changes in the brain of a patient with hemimegalencephaly complicated by intractable epilepsy suggests a potential role of ongoing brain inflammation in seizure exacerbation and epileptic encephalopathy.

  9. Are women and men well informed about fertility? Childbearing intentions, fertility knowledge and information-gathering sources in Portugal.

    Science.gov (United States)

    Almeida-Santos, Teresa; Melo, Cláudia; Macedo, Ana; Moura-Ramos, Mariana

    2017-08-04

    The postponement of parenthood may increase the number of couples experiencing infertility and prolonged time to pregnancy. Previous research has revealed that childless people are not well informed regarding fertility, which may threat their childbearing intentions. This study aimed to examine fertility knowledge and childbearing intentions held by Portuguese people and their use and perceived usefulness of information sources on fertility. Participants were recruited using a random-route domiciliary approach. A total of 2404 individuals aged 18-45 were asked to complete a structured questionnaire evaluating socio-demographic characteristics, childbearing intentions, fertility knowledge and information-gathering sources regarding fertility. In total, 95.5% of the participants indicated the desire to have children in the future, and 61.7% reported that having children would contribute to life satisfaction. Most of the participants expressed the desire to have two children in the future. The discrepancy between the numbers of planned and desired children was higher in men, in participants with lower education levels, in professionally active participants and in the unemployed participants. Relationship stability seemed to be more important in influencing childbearing decisions than financial stability or family support. Participants' knowledge regarding fertility was poor. Women, the participants who were older than 25, the participants with longer education and the participants with higher income exhibited the greatest levels of knowledge of fertility, although this knowledge was only slightly enhanced in these subgroups. Also, the participants overestimated both the chances of spontaneous pregnancy and the success rates of assisted reproduction techniques. Finally, the results revealed that websites were the main information sources used by the participants and only 18.0% of the participants had previously discussed fertility issues with their doctors. Although

  10. [Evaluation of toxoplasmosis seroprevalence among 2416 women of childbearing age followed at the Pasteur Institute of New Caledonia].

    Science.gov (United States)

    Breurec, S; Berlioz-Arthaud, A; Baumann, E; Miègeville, M; Billaud, E

    2004-11-01

    Evaluation of Toxoplasmosis seroprevalence was conducted in 2416 women of childbearing age by Pasteur Institute of New-Caledonia. The estimated seroprevalence was 56.7%, significantly higher in the North-East part of the territory (79.1%), area characterized by strong precipitations, and in the Melanesian ethnic group (62.1%). The habits of this population could enhance contamination by ingestion of oocysts during childhood or adolescence, particularly in the North-East territory. Melanesian women living in the North-East and being not immunized against toxoplasmosis represent the population with the highest risk for Toxoplasma gondii infection.

  11. A Room to Grow: The Residential Density-Dependence of Childbearing in Europe and the United States

    Directory of Open Access Journals (Sweden)

    Nathanael Lauster

    2010-12-01

    produce new density-dependent fertility dynamics. In particular, childbearing becomes dependent upon residential roominess. This relationship is culturally specific, and that the cultural nature of this relationship means that professional and managerial classes are likely to be particularly influenced by residential roominess, while immigrants are less likely to be influenced. Hypotheses are tested linking residential roominess to the presence of an “own infant” in the household using census data from the Austria, Greece, Portugal, Spain, and the United States. Roominess predicts fertility in all countries, but to differing degrees.

  12. A Room to Grow: The Residential Density-dependence of Childbearing in Europe and the United States

    Directory of Open Access Journals (Sweden)

    Nathanael Lauster

    2010-01-01

    Full Text Available I argue that cultural processes linked to the demographic transition produce new density-dependent fertility dynamics. In particular, childbearing becomes dependent upon residential roominess. This relationship is culturally specific, and I argue that the cultural nature of this relationship means that professional and managerial classes are likely to be particularly influenced by residential roominess, while immigrants are less likely to be influenced. I test hypotheses linking residential roominess to the presence of an “own infant” in the household using census data from the Austria, Greece, Portugal, Spain, and the United States. Roominess predicts fertility in all countries, but to differing degrees.

  13. The changes in female physical and childbearing characteristics in china and potential association with risk of breast cancer

    Directory of Open Access Journals (Sweden)

    Zhang Qiang

    2012-05-01

    Full Text Available Abstract Background There has been a sharp increase in the incidence of breast cancer in China in recent years. A number of female physical characteristics, such as age at menarche, menopause, first birth and the duration of breastfeeding, have been linked to breast cancer, yet data on these factors in Chinese women is largely missing both for aggregate and age-specific data. Thus, the objective of this study was to explore changes in female menstrual and childbearing characteristics as a possible explanation for increasing rates of breast cancer in this country. Method From July to September 2008, a population based cross-sectional breast cancer survey covering 124,758 females from 4 provinces or cities in Eastern China was carried out, using multi-stage and cluster methods. In-person interviews based on a self-designed structured questionnaire were performed, in which female physiological and reproductive factors, such as age at menarche and menopause, menstrual cycle history, childbearing history, breastfeeding methods, abortions or miscarriage, were included. For every 10-year age category, the subjects were divided, and across those age groups, all the above factors were compared respectively and changes in physical and childbearing characteristics were evaluated. ANOVA was used to compare the differences across the groups. Results A total of 122058 subjects were included in the final analysis. The mean age at menarche was 15.39 years, the mean number of full-term pregnancies was 1.58, the mean duration of breastfeeding was 22.68 months, the mean age at first birth was 23.75 years, the mean frequency of miscarriage was 0.36, and the mean age at menopause was 48.63 years. Significant differences across the several age groups were noted for the age at menarche, number of full-term pregnancies, accumulated duration of breastfeeding, age at first birth, number of miscarriages, and age at menopause. These data clearly showed a gradual

  14. SU-E-T-622: Identification and Improvement of Patients Eligible for Dose Escalation with Matched Plans

    Energy Technology Data Exchange (ETDEWEB)

    Bush, K; Holcombe, C; Kapp, D; Buyyounouski, M; Hancock, S; Xing, L; Atwood, T; King, M [Department of Radiation Oncology, Stanford School of Medicine, Stanford, CA (United States)

    2014-06-15

    Purpose: Radiation-therapy dose-escalation beyond 80Gy may improve tumor control rates for patients with localized prostate cancer. Since toxicity remains a concern, treatment planners must achieve dose-escalation while still adhering to dose-constraints for surrounding structures. Patientmatching is a machine-learning technique that identifies prior patients that dosimetrically match DVH parameters of target volumes and critical structures prior to actual treatment planning. We evaluated the feasibility of patient-matching in (1)identifying candidates for safe dose-escalation; and (2)improving DVH parameters for critical structures in actual dose-escalated plans. Methods: We analyzed DVH parameters from 319 historical treatment plans to determine which plans could achieve dose-escalation (8640cGy) without exceeding Zelefsky dose-constraints (rectal and bladder V47Gy<53%, and V75.6Gy<30%, max-point dose to rectum of 8550cGy, max dose to PTV< 9504cGy). We then estimated the percentage of cases that could achieve safe dose-escalation using software that enables patient matching (QuickMatch, Siris Medical, Mountain View, CA). We then replanned a case that had violated DVH constraints with DVH parameters from patient matching, in order to determine whether this previously unacceptable plan could be made eligible with this automated technique. Results: Patient-matching improved the percentage of patients eligible for dose-escalation from 40% to 63% (p=4.7e-4, t-test). Using a commercial optimizer augmented with patient-matching, we demonstrated a case where patient-matching improved the toxicity-profile such that dose-escalation would have been possible; this plan was rapidly achieved using patientmatching software. In this patient, all lower-dose constraints were met with both the denovo and patient-matching plan. In the patient-matching plan, maximum dose to the rectum was 8385cGy, while the denovo plan failed to meet the maximum rectal constraint at 8571c

  15. Toxicity-dependent feasibility bounds for the escalation with overdose control approach in phase I cancer trials.

    Science.gov (United States)

    Wheeler, Graham M; Sweeting, Michael J; Mander, Adrian P

    2017-03-15

    Phase I trials of anti-cancer therapies aim to identify a maximum tolerated dose (MTD), defined as the dose that causes unacceptable toxicity in a target proportion of patients. Both rule-based and model-based methods have been proposed for MTD recommendation. The escalation with overdose control (EWOC) approach is a model-based design where the dose assigned to the next patient is one that, given all available data, has a posterior probability of exceeding the MTD equal to a pre-specified value known as the feasibility bound. The aim is to conservatively dose-escalate and approach the MTD, avoiding severe overdosing early on in a trial. The EWOC approach has been applied in practice with the feasibility bound either fixed or varying throughout a trial, yet some of the methods may recommend incoherent dose-escalation, that is, an increase in dose after observing severe toxicity at the current dose. We present examples where varying feasibility bounds have been used in practice, and propose a toxicity-dependent feasibility bound approach that guarantees coherent dose-escalation and incorporates the desirable features of other EWOC approaches. We show via detailed simulation studies that the toxicity-dependent feasibility bound approach provides improved MTD recommendation properties to the original EWOC approach for both discrete and continuous doses across most dose-toxicity scenarios, with comparable performance to other approaches without recommending incoherent dose escalation. © 2017 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  16. Daily-diary Evaluated Side Effects of Dose-escalation Radiotherapy of Prostate Cancer Using the Stereotactic Beamcath Technique

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, Per; Bergstroem, Per; Loefroth, Per-Olov; Franzen, Lars; Henriksson, Roger; Widmark, Anders [Umeaa Univ. (Sweden). Dept. of Radiation Sciences

    2003-06-01

    The aim of this study was to evaluate self-assessed late side effects in patients with prostate cancer treated with frameless stereotactic dose-escalation radiotherapy using BeamCath, a new technique that has been developed for accurate positioning of the prostate at treatment set-up, and in which a specially designed urethral catheter containing high-density fiducial markers is used. The method was tested in the first 104 patients in a Scandinavian dose-escalation study with doses up to 76 Gy. Side effects were reported in a daily diary and evaluated at the start of treatment (baseline) and at 1-year follow-up. The patients were compared with those treated with conventional (n=53) and conformal techniques (n=175). Dose-escalation radiotherapy (76 Gy) decreased urinary frequency, urgency and starting problems at 1-year in comparison with baseline. The dose-escalation therapy did not induce any increase in gastrointestinal side effects in comparison with the effect of conformal therapy h70 Gy at the 1-year follow-up, apart from a slight increase in rectal mucus in the 76 Gy group. All groups, except patients receiving the 74 Gy with smaller fields, reported a slight increase in gastrointestinal toxicity at 1-year compared with baseline. Dose-escalation radiotherapy of prostate cancer using the BeamCath technique did not induce any significant increase in late side effects in comparison with conformal technique.

  17. Investor’s Commitment Bias and Escalation of Firm’s Investment Decision

    Directory of Open Access Journals (Sweden)

    Anis JARBOUI

    2012-12-01

    Full Text Available This study examines the reasons of perseverance in firm’s investment decision. It shows the possible influence of three closely related features which are: firm’s financial indicators, investor’s risk profile, and investor’s commitment bias, on a firm’s investment decisions escalation. This study aims to provide evidence as to whether investor considers the financial and risk’s perception features (financial strength and risk profile to persevere his initial investment decision while he notes a high level of commitment bias. The proposed model of this paper uses GLM univariate data analyses to examine this relationship. Investor’s risk profile and his commitment bias have been measured by means of a questionnaire comprising several items. As for the selected sample, it has been composed of some 360 Tunisian individual investors. Our results have revealed that investors pay more attention to keep their psychology comfort than their financial comfort. It exposed the importance of the investor’s commitment bias and its risk perception in explaining investment decision escalation. Moreover results shows that there is strong and significant empirical relationship linking the escalatory behavior in investment decision and the interaction effects between the three independent variables. This means that, in practice, investors consider the three factors simultaneously.

  18. Chronic CRF1 receptor blockade reduces heroin intake escalation and dependence-induced hyperalgesia.

    Science.gov (United States)

    Park, Paula E; Schlosburg, Joel E; Vendruscolo, Leandro F; Schulteis, Gery; Edwards, Scott; Koob, George F

    2015-03-01

    Opioids represent effective drugs for the relief of pain, yet chronic opioid use often leads to a state of increased sensitivity to pain that is exacerbated during withdrawal. A sensitization of pain-related negative affect has been hypothesized to closely interact with addiction mechanisms. Neuro-adaptive changes occur as a consequence of excessive opioid exposure, including a recruitment of corticotropin-releasing factor (CRF) and norepinephrine (NE) brain stress systems. To better understand the mechanisms underlying the transition to dependence, we determined the effects of functional antagonism within these two systems on hyperalgesia-like behavior during heroin withdrawal utilizing models of both acute and chronic dependence. We found that passive or self-administered heroin produced a significant mechanical hypersensitivity. During acute opioid dependence, systemic administration of the CRF1 receptor antagonist MPZP (20 mg/kg) alleviated withdrawal-induced mechanical hypersensitivity. In contrast, several functional adrenergic system antagonists (clonidine, prazosin, propranolol) failed to alter mechanical hypersensitivity in this state. We then determined the effects of chronic MPZP or clonidine treatment on extended access heroin self-administration and found that MPZP, but not clonidine, attenuated escalation of heroin intake, whereas both drugs alleviated chronic dependence-associated hyperalgesia. These findings suggest that an early potentiation of CRF signaling occurs following opioid exposure that begins to drive both opioid-induced hyperalgesia and eventually intake escalation.

  19. EFFECT OF TARIFF ESCALATION ON GHANAIAN COCOA EXPORTS: AN EMPIRICAL PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Ahmed Abdul Aziz

    2017-01-01

    Full Text Available This study analyses the effects of tariff escalation on Ghanaian cocoa exports in four importing markets: USA, EU, Japan and Malaysia. The study estimates nominal and effective protection coefficients in these markets based on ad-valorem equivalent of applied and bound specific tariffs. Results revealed that, effective protection exists in the Japanese and Malaysian cocoa industries at different stages of processing on both bound and applied tariffs. In contrast, the USA and the EU do not effectively protect their cocoa industries, thus, no tariff escalation on applied tariffs against cocoa imports from Ghana. This study concludes that from a static effect, higher tariffs do have a negative consequence on Ghanaian cocoa exports in these importing countries. From a dynamic perspective however, the relationship between tariff structures in these importing countries and Ghanaian cocoa exports is somewhat ambiguous and each situation has to be viewed on their own merit. A complete elimination of tariffs as a form of trade barrier on Ghanaian cocoa exports does not necessarily imply that Ghana could easily increase its exports of value added cocoa.

  20. Stairs or escalator? Using theories of persuasion and motivation to facilitate healthy decision making.

    Science.gov (United States)

    Suri, Gaurav; Sheppes, Gal; Leslie, Sara; Gross, James J

    2014-12-01

    To encourage an increase in daily activity, researchers have tried a variety of health-related communications, but with mixed results. In the present research-using the stair escalator choice context-we examined predictions derived from the Heuristic Systematic Model (HSM), Self Determination Theory (SDT), and related theories. Specifically, we tested whether (as predicted by HSM) signs that encourage heuristic processing ("Take the Stairs") would have greatest impact when placed at the stair/escalator point of choice (when processing time is limited), whereas signs that encourage systematic processing ("Will You Take the Stairs?") would have greatest impact when placed at some distance from the point of choice (when processing time is less limited). We also tested whether (as predicted by SDT) messages promoting autonomy would be more likely to result in sustained motivated behavior (i.e., stair taking at subsequent uncued choice points) than messages that use commands. A series of studies involving more than 9,000 pedestrians provided support for these predictions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  1. Ion Elevators and Escalators in Multilevel Structures for Lossless Ion Manipulations

    Energy Technology Data Exchange (ETDEWEB)

    Ibrahim, Yehia M.; Hamid, Ahmed M.; Cox, Jonathan T.; Garimella, Sandilya V. B.; Smith, Richard D.

    2017-01-19

    We describe two approaches based upon ion ‘elevator’ and ‘escalator’ components that allow moving ions to different levels in structures for lossless ion manipulations (SLIM). Guided by ion motion simulations we designed elevator and escalator components providing essentially lossless transmission in multi-level designs based upon ion current measurements. The ion elevator design allowed ions to efficiently bridge a 4 mm gap between levels. The component was integrated in a SLIM and coupled to a QTOF mass spectrometer using an ion funnel interface to evaluate the m/z range transmitted as compared to transmission within a level (e.g. in a linear section). Mass spectra for singly-charged ions of m/z 600-2700 produced similar mass spectra for both elevator and straight (linear motion) components. In the ion escalator design, traveling waves (TW) were utilized to transport ions efficiently between two SLIM levels. Ion current measurements and ion mobility (IM) spectrometry analysis illustrated that ions can be transported between TW-SLIM levels with no significant loss of either ions or IM resolution. These developments provide a path for the development of multilevel designs providing e.g. much longer IM path lengths, more compact designs, and the implementation of much more complex SLIM devices in which e.g. different levels may operate at different temperatures or with different gases.

  2. Escalation with Overdose Control is More Efficient and Safer than Accelerated Titration for Dose Finding

    Directory of Open Access Journals (Sweden)

    André Rogatko

    2015-07-01

    Full Text Available The standard 3 + 3 or “modified Fibonacci” up-and-down (MF-UD method of dose escalation is by far the most used design in dose-finding cancer trials. However, MF-UD has always shown inferior performance when compared with its competitors regarding number of patients treated at optimal doses. A consequence of using less effective designs is that more patients are treated with doses outside the therapeutic window. In June 2012, the U S Food and Drug Administration (FDA rejected the proposal to use Escalation with Overdose Control (EWOC, an established dose-finding method which has been extensively used in FDA-approved first in human trials and imposed a variation of the MF-UD, known as accelerated titration (AT design. This event motivated us to perform an extensive simulation study comparing the operating characteristics of AT and EWOC. We show that the AT design has poor operating characteristics relative to three versions of EWOC under several practical scenarios. From the clinical investigator’s perspective, lower bias and mean square error make EWOC designs preferable than AT designs without compromising safety. From a patient’s perspective, uniformly higher proportion of patients receiving doses within an optimal range of the true MTD makes EWOC designs preferable than AT designs.

  3. An Hourly Dose-Escalation Desensitization Protocol for Aspirin-Exacerbated Respiratory Disease.

    Science.gov (United States)

    Chen, Justin R; Buchmiller, Brett L; Khan, David A

    2015-01-01

    Aspirin desensitization followed by maintenance therapy effectively improves symptom control in patients with aspirin exacerbated respiratory disease (AERD). The majority of current desensitization protocols use 3-hour dosing intervals and often require 2 to 3 days to complete. We evaluated hourly dose escalations in a subset of patients with chronic rhinosinusitis, nasal polyps, and asthma who historically reacted to aspirin within 1 hour or were avoiding aspirin with the goal of developing a safe and efficient desensitization protocol. Fifty-seven aspirin desensitizations were performed under the hourly protocol. All patients had refractory nasal polyposis as an indication for aspirin desensitization. The clinical characteristics of each subject were analyzed in relation to aspects of his or her reactions during the procedure. Ninety-eight percent of study patients were successfully treated under the hourly protocol, including those with a history of severe reactions and intubation. None required further medication than is available in an outpatient allergy clinic. A total of 96% of reactors recorded a bronchial or naso-ocular reaction within 1 hour of the preceding dose. Of the total patients on this protocol, 40% were able to complete the procedure in a single day, and 60% within 2 days. Patients with AERD who have a history of symptoms less than 1 hour after aspirin exposure can be safely desensitized with a 1-hour dose-escalation protocol that can often be completed in a single day. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  4. Terrorist Attacks Escalate in Frequency and Fatalities Preceding Highly Lethal Attacks

    Science.gov (United States)

    Martens, Andy; Sainudiin, Raazesh; Sibley, Chris G.; Schimel, Jeff; Webber, David

    2014-01-01

    Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates–both in the number of people killed per attack and in the frequency of attacks–leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database) showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack. PMID:24755753

  5. Dose escalation study of rhenium-186 hydroxyethylidene diphosphonate in patients with metastatic prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Klerk, J.M.H. de (Dept. of Nuclear Medicine, Univ. Hospital, Utrecht (Netherlands)); Zonnenberg, B.A. (Oncology Section, Dept. of Internal Medicine, Univ. Hospital, Utrecht (Netherlands)); Schip, A.D. van het (Dept. of Nuclear Medicine, Univ. Hospital, Utrecht (Netherlands)); Dijk, A. van (Center for Hospital Pharmacy, Univ. Hospital, Utrecht (Netherlands)); Han, S.H. (Dept. of Nuclear Medicine, Univ. Hospital, Utrecht (Netherlands)); Quirijnen, J.M.S.P. (Dept. of Nuclear Medicine, Univ. Hospital, Utrecht (Netherlands)); Blijham, G.H. (Oncology Section, Dept. of Internal Medicine, Univ. Hospital, Utrecht (Netherlands)); Rijk, P.P. van (Dept. of Nuclear Medicine, Univ. Hospital, Utrecht (Netherlands))

    1994-10-01

    Rhenium-186 hydroxyethylidene diphosphonate ([sup 186]Re-HEDP) has been used for the palliative treatment of metastatic bone pain. A phase 1 dose escalation study was performed using [sup 186]Re-HEDP. Twenty-four patients with hormone-resistant prostate cancer entered the study. Each patient had at least four bone metastases and adequate haematological function. Groups of at least three consecutive patients were treated with doses starting at 1295 MBq and increasing to 3515 MBq (escalated in increments of 555 MBq). Thrombocytopenia proved to be the dose-limiting toxicity, while leucopenia played a minor role. Early death occurred in one patient (10 days after administration) without clear relationship to the [sup 186]Re-HEDP therapy. Transient neurological dysfunction was seen in two cases. Two patients who received 3515 MBq [sup 186]Re-HEDP showed grade 3 toxicity (thrombocytes 25-50 x 10[sup 9]/l), defined as unacceptable toxicity. After treatment alkaline phosphatase levels showed a transient decrease in all patients (mean: 26% [+-] 10% IU/l; range: 11%-44%). Prostate-specific antigen values showed a decline in eight patients, preceded by a temporary increase in three patients. From this study we conclude that the maximally tolerated dose of [sup 186]Re-HEDP is 2960 MBq. A placebo-controlled comparative study on the efficacy of [sup 186]Re-HEDP has been initiated. (orig.)

  6. [Changes in the cytokine network through escalating SIRS after heart surgery].

    Science.gov (United States)

    Sablotzki, A; Mann, V; Simm, A; Czeslick, E

    2001-09-01

    Changes in the Cytokine Network Through Escalating SIRS After Heart Surgery. Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). There is a lot of information about the immunologic alterations in patients undergoing cardiopulmonary bypass, but only little is known about the expression of cytokines in patients with severe SIRS or MODS following cardiovascular surgery. In the present study, we investigated the inflammatory response of patients with an escalating SIRS following open heart surgery. Plasma levels of cytokines (IL-1beta, IL-6, IL-8, IL-10, IL-12, IL-18, GM-CSF and TGF-beta) were measured at the first four postoperative days in 12 adult male patients with severe SIRS (SIRS-group), and 15 patients with uncomplicated course (control-group) following myocardial revascularization. All cytokines (except IL-1beta) were significantly elevated in SIRS-patients, the analysis of differences between the survivors and non-survivors within the SIRS-group showed dramatically elevated levels of IL-8 and IL-18 in non-survivors. From the results of our investigation we can conclude that monitoring of immunologic parameters, e.g. IL-8 and/or IL-18 may be helpful for the early detection and prognosis of high-risk patients with severe SIRS and MODS following cardiac surgery.

  7. Iron deficiency, an independent risk factor for isolated hypothyroxinemia in pregnant and nonpregnant women of childbearing age in China.

    Science.gov (United States)

    Yu, Xiaohui; Shan, Zhongyan; Li, Chenyan; Mao, Jinyuan; Wang, Weiwei; Xie, Xiaochen; Liu, Aihua; Teng, Xiaochun; Zhou, Weiwei; Li, Chenyang; Xu, Bin; Bi, Lihua; Meng, Tao; Du, Jianling; Zhang, Shaowei; Gao, Zhengnan; Zhang, Xiaomei; Yang, Liu; Fan, Chenling; Teng, Weiping

    2015-04-01

    Isolated hypothyroxinemia during early pregnancy may irreversibly damage the neurodevelopment of offspring. However, the causes are not well clarified. To explore the association of iron deficiency (ID) with hypothyroid function of women in early pregnancy and nonpregnant women. A total of 7953 pregnant women of ≤ 12 weeks gestation and 2000 childbearing-aged women were recruited. A subpopulation including 3340 pregnant women and 1052 nonpregnant women with sufficient iodine intake and negative thyroid peroxidase antibody were studied. Mild and severe cases of hypothyroxinemia were defined as free T4 levels below the 10th percentile and the 5th percentile, respectively, with normal TSH. Total body iron, serum ferritin, and serum transferrin receptor were used as indicators for iron nutrition. Serum free T4 levels were significantly lower in both pregnant and nonpregnant women with ID compared with the corresponding groups without ID (both P women with ID than those without, in both pregnant and nonpregnant women (all P pregnant and nonpregnant childbearing-aged women, independent of the effects of iodine and thyroid autoimmunity. We speculate that ID may be a pathogenic factor for hypothyroxinemia, even in pregnant women during the first trimester.

  8. Behavioral health screening and intervention for women in Argentina: a preliminary model for the childbearing years

    Directory of Open Access Journals (Sweden)

    Suarez Ordoñez RM

    2015-06-01

    Full Text Available Rocio M Suarez Ordoñez,1 Jorgelina Cesolari,2 Casas Ofelia,2 Ivonne Villavicencio,1 Hendrée E Jones31Research Department, Institute of Cognitive Neuroscience INECO Oroño, 2Neonatology Department, Martin Maternity, Rosario, Santa Fe, Argentina; 3UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAAbstract: Untreated behavioral disorders in pregnant women and in women of childbearing age pose physical and psychological safety concerns and are barriers to the well-being of both mother and neonate. The present paper underlines the importance of screening in Argentina for behavioral problems in women of childbearing age, particularly pregnant women and their newborns. Emphasized is the need to formalize this comprehensive screening in a protocol that includes domains of mental disorders, behavioral disorders, education, social environment, employment, desire for maternity, substance use including non-prescription use of prescription medications, eating disorders, suicide risk, interpersonal violence, stress, and trauma. Implementation of such a model would require agreement and cooperation between the public and private health sectors as well as in the development of research for validation of the various screening and interventions tools that would be adopted for general use. Keywords: pregnancy, substance use, assessment, measures

  9. Quantitative risk-benefit analysis of fish consumption for women of child-bearing age in Hong Kong.

    Science.gov (United States)

    Chen, M Y Y; Wong, W W K; Chung, S W C; Tran, C H; Chan, B T P; Ho, Y Y; Xiao, Y

    2014-01-01

    Maternal fish consumption is associated with both risks from methylmercury (MeHg) and beneficial effects from omega-3 fatty acids to the developing foetal brain. This paper assessed the dietary exposure to MeHg of women of child-bearing age (20-49 years) in Hong Kong, and conducted risk-benefit analysis in terms of the effects in children's intelligent quotient (IQ) based on local data and the quantitative method derived by the expert consultation of FAO/WHO. Results showed that average and high consumers consume 450 and 1500 g of fish (including seafood) per week, respectively. About 11% of women of child-bearing age had a dietary exposure to MeHg exceeding the PTWI of 1.6 µg kg(-1) bw. In pregnant women MeHg intake may pose health risks to the developing foetuses. For average consumers, eating any of the 19 types of the most commonly consumed fish and seafood during pregnancy would result in 0.79-5.7 IQ points gain by their children. For high consumers, if they only ate tuna during pregnancy, it would cause 2.3 IQ points reduction in their children. The results indicated that for pregnant women the benefit outweighed the risk associated with eating fish if they consume different varieties of fish in moderation.

  10. Treatment of Infected Women of Childbearing Age Prevents Congenital Trypanosoma cruzi Infection by Eliminating the Parasitemia Detected by PCR.

    Science.gov (United States)

    Murcia, Laura; Simón, Marina; Carrilero, Bartolomé; Roig, Mercedes; Segovia, Manuel

    2017-05-01

    We evaluated the effectiveness of treating women of childbearing age with benznidazole to prevent congenital Chagas disease (CCD), as well as the usefulness of polymerase chain reaction (PCR) as a tool to predict the risk of transmission. Prospective study involving 144 T. cruzi seropositive pregnant women. The parasitological status was studied by PCR in 159 pregnancies, 38 of which involved a cohort of previously treated mothers. One hundred sixty children were examined by PCR and serologically studied at 0-6, 9 and 12 months and annually after treatment. PCR was seen to be useful for predicting the risk of congenital transmission: 18.8% of mothers with a positive PCR result transmitted the infection (16 infected children out of 85 pregnancies). No infected infants were detected among 74 pregnancies when PCR was negative. Of the treated mothers, 92.1% had negative PCR results, compared with 32.2% of untreated mothers. No infected infants were detected from previously treated mothers, compared with 13.2% among untreated mothers (P = .019; χ2). All infants treated before the first year of life were cured. Treating infected women of childbearing age prevents congenital Chagas disease. Polymerase chain reaction screening of T. cruzi-infected pregnant women is a useful tool for predicting the risk of congenital transmission.

  11. The Effect of Urinary Incontinence on Quality of Life of Women at Childbearing Age in Jeddah, Saudi Arabia.

    Science.gov (United States)

    Bakarman, Marwan A; Al-Ghamdi, Sadiah Saeed

    2015-07-19

    To estimate the prevalence of urinary incontinence among women of childbearing age at Maternity and Children's Hospital (MCH), Jeddah, 2012, and to assess its impact on the quality of their life. A cross-sectional analytic approach was carried out among women of childbearing age seen at MCH, Jeddah. Systematic random sampling technique was followed. Each woman fulfilling the inclusion criteria was invited to enroled in the study, the inclusion criteria were women aged 15-50 years, agreed to participate in the study, the exclusion criteria were pregnant women and patients who are seriously ill. Self-administered questionnaire using the King's Health Questionnaire was utilized to measure Health Related Quality of Life (HRQOL) of patients with UI. Out of 1200 patients attending the gynecology clinic in the MCH, 412 (34.3%) were diagnosed as having UI. Their age ranged between 15 and 50 years with a mean of 34.3 ± 7.2 years. Almost 50% indicated that UI affected them badly as wife, mother, their emotions, and their physical and social activities. The most commonly occurring problems were frequent micturition (88.3%), nocturnal enuresis (87.9%). The least occurring, were kidney problems (38.6%) and dripping during sexual activities (40.8%). Increasing age and higher parity were significantly associated with limitations in different life domains. Urinary incontinence is common and often disturbing for Saudi women. It adversely impaired their quality of life.

  12. Biological dose escalation and hypofractionation: what is there to be gained and how will it best be done?

    Science.gov (United States)

    Tree, A C; Alexander, E J; Van As, N J; Dearnaley, D P; Khoo, V

    2013-08-01

    The evidence supporting dose escalation for localised prostate cancer is widely accepted, but in tandem with improvements in biochemical control, dose escalation increases side-effects. In a scenario where most patients achieve control of their cancer, quality of life concerns predominate. Here we examine the biological ways in which an effective dose can be escalated without an unacceptable increase in toxicity. Possible avenues include exploiting the unusual radiobiology of prostate cancer by hypofractionation, the use of image guidance, adaptive planning and prostate motion management. We await with anticipation the results of large randomised trials of hypofractionation, moderate and profound, to establish whether we can further improve the balance between cure and quality of life.

  13. 自动扶梯金属结构测试探讨%Discussion on Escalator Metal Structural Test

    Institute of Scientific and Technical Information of China (English)

    陈卫红

    2011-01-01

    结合自动扶梯金属结构的挠度测试标准,通过一个测试实例探讨了自动扶梯金属结构的测试过程;利用桁架有限元模型对自动扶梯结构变形量较大的点进行局部挠度计算,计算结果证明符合客户合同的要求。%Combined with the deflection test standard of escalator metal structure, the escalator metal structural test process is discussed through a test case. The local deflection for the larger points of deformation of the escalator structure is calculated by use of the finite element model of truss, The results meet customer contract requirements.

  14. Escalation to Major Depressive Disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk.

    Science.gov (United States)

    Hill, Ryan M; Pettit, Jeremy W; Lewinsohn, Peter M; Seeley, John R; Klein, Daniel N

    2014-04-01

    The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD. Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD. Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation. Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD. Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Validation of Treatment Escalation as a Definition of Atopic Eczema Flares

    Science.gov (United States)

    Thomas, Kim S.; Stuart, Beth; O’Leary, Caroline J.; Schmitt, Jochen; Paul, Carle; Williams, Hywel C.; Langan, Sinead

    2015-01-01

    Background Atopic eczema (AE) is a chronic disease with flares and remissions. Long-term control of AE flares has been identified as a core outcome domain for AE trials. However, it is unclear how flares should be defined and measured. Objective To validate two concepts of AE flares based on daily reports of topical medication use: (i) escalation of treatment and (ii) days of topical anti-inflammatory medication use (topical corticosteroids and/or calcineurin inhibitors). Methods Data from two published AE studies (studies A (n=336) and B (n=60)) were analysed separately. Validity and feasibility of flare definitions were assessed using daily global bother (scale 0 to 10) as the reference standard. Intra-class correlations were reported for continuous variables, and odds ratios and area under the receiver operator characteristic (ROC) curve for binary outcome measures. Results Good agreement was found between both AE flare definitions and change in global bother: area under the ROC curve for treatment escalation of 0.70 and 0.73 in studies A and B respectively, and area under the ROC curve of 0.69 for topical anti-inflammatory medication use (Study A only). Significant positive relationships were found between validated severity scales (POEM, SASSAD, TIS) and the duration of AE flares occurring in the previous week – POEM and SASSAD rose by half a point for each unit increase in number of days in flare. Smaller increases were observed on the TIS scale. Completeness of daily diaries was 95% for Study A and 60% for Study B over 16 weeks). Conclusion Both definitions were good proxy indicators of AE flares. We found no evidence that ‘escalation of treatment’ was a better measure of AE flares than ‘use of topical anti-inflammatory medications’. Capturing disease flares in AE trials through daily recording of medication use is feasible and appears to be a good indicator of long-term control. Trial registration Current Controlled Trials ISRCTN71423189 (Study A

  16. Several dominants risk factors related to obesity in urban childbearing age women in Indonesia

    Directory of Open Access Journals (Sweden)

    Kencana Sari

    2016-01-01

    analyze several dominant riskfactors related to obesity in childbearing age women living in urban areas in Indonesia.Methods: This analysis used a part of Basic Health Research (Riskesdas 2007 data. The samples werederived from 258366 households. Riskesdas data on socio-demographic and other factors was collectedby questionnaire. Nutritional status was measured using body mass index (BMI. Cox regression withconstant time analysis was used for the analysis.Results: This analysis noted that there are 14357 (18.8% of women were obese and 62052 (81.2%normal. Compared with the respective reference groups, women aged 25-49 had a 3.5-fold greater riskof becoming obese [adjusted relative risk (RRa = 3.49; P = 0.000, and divorced or married had 2.5-foldhigher risk to be obese (RRa = 2.58; P= 0.000 and RRa = 2.62; P = 0.000, respectively. Furthermore,unemployed women had higher risk to be obese (RRa = 1.06; P = 0.000, and consuming excess proteinas well as often consume fatty foods made women had a higher risk of obesity (RRa = 1.09; P = 0.000 andRRa = 1.17; P = 0.000, respectively.Conclusion: Women aged 25-49, divorced or married, unemployed, consumed excess protein, and often consumefatty foods have a higher risk for becoming obese. (Health Science Journal of Indonesia 2015;6:63-8Key words: obesity, urban, women

  17. Factors associated with dose escalation of fesoterodine for treatment of overactive bladder in people >65 years of age: A post hoc analysis of data from the SOFIA study.

    Science.gov (United States)

    Wagg, Adrian; Darekar, Amanda; Arumi, Daniel; Khullar, Vik; Oelke, Matthias

    2015-06-01

    To investigate factors which may influence dose escalation of antimuscarinics for overactive bladder (OAB) in older patients and how dose escalation affects treatment efficacy. A post hoc analysis of data from the 12-week randomized, placebo controlled phase of the SOFIA study investigating treatment with fesoterodine in older people with OAB. Predictors and outcomes in patients aged ≥65 years with OAB who did or did not choose to escalate from fesoterodine 4 to 8 mg before the first dose-escalation choice point (week 4) and at the end of the study (week 12) were assessed. Variables which significantly increased likelihood of dose escalation were, at baseline, body mass index (OR: 1.06, 95% CI 1.01, 1.12; P = 0.0222), and male gender (OR: 2.06, 95% CI 1.28, 3.32; P = 0.0028) and at week 4, change from baseline in urgency episodes (OR: 1.12, 95% CI 1.05, 1.20; P = 0.0008), patient perception of bladder control (PPBC) (OR: 1.44, 95% CI 1.12, 1.84; P = 0.004). At week 12, dose escalation was associated with slightly reduced treatment outcomes compared to week 4 non-escalators. No baseline disease related factor associated with dose escalation was identified. Magnitude of change in urgency episodes and reduction in PPBC at 4 weeks were associated with dose escalation. These data may be of use to healthcare providers as they allow judgement to be made in individual patients, allowing treatment decisions to be made. At end of treatment, improvements in efficacy and quality of life were achieved in both escalators and non-escalators. © 2014 Wiley Periodicals, Inc.

  18. Can naturopathy provide answers to the escalating health care costs in India?

    Science.gov (United States)

    Tripathy, Jaya Prasad

    2015-01-01

    There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system. PMID:26151012

  19. Can naturopathy provide answers to the escalating health care costs in India?

    Directory of Open Access Journals (Sweden)

    Jaya Prasad Tripathy

    2015-04-01

    Full Text Available There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system.

  20. Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation. A planning study

    Energy Technology Data Exchange (ETDEWEB)

    Botticella, A.; Defraene, G. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Nackaerts, K. [KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Leuven (Belgium); Deroose, C. [KU Leuven - University of Leuven, University Hospitals Leuven, Nuclear Medicine, Leuven (Belgium); Coolen, J. [KU Leuven - University of Leuven, University Hospitals Leuven, Radiology Department, Leuven (Belgium); Nafteux, P. [University Hospitals Leuven, Department of Thoracic Surgery, Leuven (Belgium); Vanstraelen, B. [University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Joosten, S.; Michiels, L.A.W. [Fontys University of Applied Science, Institute Paramedical Studies, Medical Imaging and Radiotherapeutic Techniques, Eindhoven (Netherlands); Peeters, S. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Ruysscher, D. de [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht (Netherlands)

    2017-04-15

    After lung-sparing radiotherapy for malignant pleural mesothelioma (MPM), local failure at sites of previous gross disease represents the dominant form of failure. Our aim is to investigate if selective irradiation of the gross pleural disease only can allow dose escalation. In all, 12 consecutive stage I-IV MPM patients (6 left-sided and 6 right-sided) were retrospectively identified and included. A magnetic resonance imaging-based pleural gross tumor volume (GTV) was contoured. Two sets of planning target volumes (PTV) were generated for each patient: (1) a ''selective'' PTV (S-PTV), originating from a 5-mm isotropic expansion from the GTV and (2) an ''elective'' PTV (E-PTV), originating from a 5-mm isotropic expansion from the whole ipsilateral pleural space. Two sets of volumetric modulated arc therapy (VMAT) treatment plans were generated: a ''selective'' pleural irradiation plan (SPI plan) and an ''elective'' pleural irradiation plan (EPI plan, planned with a simultaneous integrated boost technique [SIB]). In the SPI plans, the average median dose to the S-PTV was 53.6 Gy (range 41-63.6 Gy). In 4 of 12 patients, it was possible to escalate the dose to the S-PTV to >58 Gy. In the EPI plans, the average median doses to the E-PTV and to the S-PTV were 48.6 Gy (range 38.5-58.7) and 49 Gy (range 38.6-59.5 Gy), respectively. No significant dose escalation was achievable. The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM. (orig.) [German] Beim malignen Pleuramesotheliom (MPM) ist nach lungenschonender Radiotherapie das lokale Scheitern an Stellen eines frueheren, sichtbaren Tumors die dominierende Form des Scheiterns. Unser Ziel ist es, zu untersuchen, ob die selektive

  1. The snowball effect: friendship moderates escalations in depressed affect among avoidant and excluded children.

    Science.gov (United States)

    Bukowski, William M; Laursen, Brett; Hoza, Betsy

    2010-11-01

    A three-wave longitudinal study conducted with preadolescent boys and girls (N = 231 at Time 1 [T1]) was used to assess the hypotheses that aspects of social withdrawal would be predictors of a "snowball" cascade of depressed affect, and that friendship experiences would moderate these effects. Consistent with these hypotheses, multilevel modeling showed that measures of avoidance and exclusion at T1 were associated with concurrent levels of depressed affect and were antecedent to escalating trajectories of depressed affect over time. These accelerating growth curves fit a snowball cascade model. The analyses also showed the protective effects of friendship. Specifically, the snowball effect was limited to avoidant and excluded children who were friendless. Depressed affect did not increase among avoidant and excluded children who were friended.

  2. The butterfly plant arms-race escalated by gene and genome duplications.

    Science.gov (United States)

    Edger, Patrick P; Heidel-Fischer, Hanna M; Bekaert, Michaël; Rota, Jadranka; Glöckner, Gernot; Platts, Adrian E; Heckel, David G; Der, Joshua P; Wafula, Eric K; Tang, Michelle; Hofberger, Johannes A; Smithson, Ann; Hall, Jocelyn C; Blanchette, Matthieu; Bureau, Thomas E; Wright, Stephen I; dePamphilis, Claude W; Eric Schranz, M; Barker, Michael S; Conant, Gavin C; Wahlberg, Niklas; Vogel, Heiko; Pires, J Chris; Wheat, Christopher W

    2015-07-07

    Coevolutionary interactions are thought to have spurred the evolution of key innovations and driven the diversification of much of life on Earth. However, the genetic and evolutionary basis of the innovations that facilitate such interactions remains poorly understood. We examined the coevolutionary interactions between plants (Brassicales) and butterflies (Pieridae), and uncovered evidence for an escalating evolutionary arms-race. Although gradual changes in trait complexity appear to have been facilitated by allelic turnover, key innovations are associated with gene and genome duplications. Furthermore, we show that the origins of both chemical defenses and of molecular counter adaptations were associated with shifts in diversification rates during the arms-race. These findings provide an important connection between the origins of biodiversity, coevolution, and the role of gene and genome duplications as a substrate for novel traits.

  3. Escalation, timing and severity of insurgent and terrorist events: Toward a unified theory of future threats

    CERN Document Server

    Johnson, Neil F

    2011-01-01

    I present a unified discussion of several recently published results concerning the escalation, timing and severity of violent events in human conflicts and global terrorism, and set them in the wider context of real-world and cyber-based collective violence and illicit activity. I point out how the borders distinguishing between such activities are becoming increasingly blurred in practice -- from insurgency, terrorism, criminal gangs and cyberwars, through to the 2011 Arab Spring uprisings and London riots. I review the robust empirical patterns that have been found, and summarize a minimal mechanistic model which can explain these patterns. I also explain why this mechanistic approach, which is inspired by non-equilibrium statistical physics, fits naturally within the framework of recent ideas within the social science literature concerning analytical sociology. In passing, I flag the fundamental flaws in each of the recent critiques which have surfaced concerning the robustness of these results and the re...

  4. Vaginal dose de-escalation in image guided adaptive brachytherapy for locally advanced cervical cancer.

    Science.gov (United States)

    Mohamed, Sandy; Lindegaard, Jacob Christian; de Leeuw, Astrid A C; Jürgenliemk-Schulz, Ina; Kirchheiner, Kathrin; Kirisits, Christian; Pötter, Richard; Tanderup, Kari

    2016-09-01

    Vaginal stenosis is a major problem following radiotherapy in cervical cancer. We investigated a new dose planning strategy for vaginal dose de-escalation (VDD). Fifty consecutive locally advanced cervical cancer patients without lower or middle vaginal involvement at diagnosis from 3 institutions were analysed. External beam radiotherapy was combined with MRI-guided brachytherapy. VDD was obtained by decreasing dwell times in ovoid/ring and increasing dwell times in tandem/needles. The aim was to maintain the target dose (D90 of HR-CTV⩾85Gy EQD2) while reducing the dose to the surface of the vagina to vaginal loading (ovoid/ring) was reduced from 51% to 33% of the total loading with VDD, which significantly reduced the dose to the vaginal dose points (pvaginal point was reduced by a mean of 4±4Gy EQD2 (pvaginal stenosis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Standardization of lyophilization medium for Streptococcus thermophilus subjected to viability escalation on freeze drying

    Directory of Open Access Journals (Sweden)

    Rohit Sharma

    2014-09-01

    Full Text Available The objective of the present study is to develop a lyophilization medium for Streptococcus thermophilus (NCIM 2904 as the industrial exploitation of this bacterium totally depends upon preservation and lyophilization protocols. Protective effect of 18 compounds were observed individually and in combinations with different sugars, sugar alcohols, polymers, protein concentrates and buffers. Among all the protectants tested, ammonium citrate (1% w/w, K2HPO4 (1% w/w and KH2PO4 (1% w/w provided lowest protection to these bacterial cells while 10% (w/w sodium caseinate, whey protein concentrate, sweet whey powder, and skim milk showed significant results in viability escalation. Survival in carbon sources like lactose, sucrose and maltodextrine was also favored maximally. Combination of sodium caseinate 10%, skim milk 5%, sucrose 5%, lactose 5% and mono sodium glutamate 1% in distilled water in ratio of 1:5 with S. thermophilus showed survival percentage of 96%.

  6. Escalation with Overdose Control Using Ordinal Toxicity Grades for Cancer Phase I Clinical Trials

    Directory of Open Access Journals (Sweden)

    Mourad Tighiouart

    2012-01-01

    Full Text Available We extend a Bayesian adaptive phase I clinical trial design known as escalation with overdose control (EWOC by introducing an intermediate grade 2 toxicity when assessing dose-limiting toxicity (DLT. Under the proportional odds model assumption of dose-toxicity relationship, we prove that in the absence of DLT, the dose allocated to the next patient given that the previously treated patient had a maximum of grade 2 toxicity is lower than the dose given to the next patient had the previously treated patient exhibited a grade 0 or 1 toxicity at the most. Further, we prove that the coherence properties of EWOC are preserved. Simulation results show that the safety of the trial is not compromised and the efficiency of the estimate of the maximum tolerated dose (MTD is maintained relative to EWOC treating DLT as a binary outcome and that fewer patients are overdosed using this design when the true MTD is close to the minimum dose.

  7. Teenage pregnancy: the impact of maternal adolescent childbearing and older sister's teenage pregnancy on a younger sister.

    Science.gov (United States)

    Wall-Wieler, Elizabeth; Roos, Leslie L; Nickel, Nathan C

    2016-05-25

    Risk factors for teenage pregnancy are linked to many factors, including a family history of teenage pregnancy. This research examines whether a mother's teenage childbearing or an older sister's teenage pregnancy more strongly predicts teenage pregnancy. This study used linkable administrative databases housed at the Manitoba Centre for Health Policy (MCHP). The original cohort consisted of 17,115 women born in Manitoba between April 1, 1979 and March 31, 1994, who stayed in the province until at least their 20(th) birthday, had at least one older sister, and had no missing values on key variables. Propensity score matching (1:2) was used to create balanced cohorts for two conditional logistic regression models; one examining the impact of an older sister's teenage pregnancy and the other analyzing the effect of the mother's teenage childbearing. The adjusted odds of becoming pregnant between ages 14 and 19 for teens with at least one older sister having a teenage pregnancy were 3.38 (99 % CI 2.77-4.13) times higher than for women whose older sister(s) did not have a teenage pregnancy. Teenage daughters of mothers who had their first child before age 20 had 1.57 (99 % CI 1.30-1.89) times higher odds of pregnancy than those whose mothers had their first child after age 19. Educational achievement was adjusted for in a sub-population examining the odds of pregnancy between ages 16 and 19. After this adjustment, the odds of teenage pregnancy for teens with at least one older sister who had a teenage pregnancy were reduced to 2.48 (99 % CI 2.01-3.06) and the odds of pregnancy for teen daughters of teenage mothers were reduced to 1.39 (99 % CI 1.15-1.68). Although both were significant, the relationship between an older sister's teenage pregnancy and a younger sister's teenage pregnancy is much stronger than that between a mother's teenage childbearing and a younger daughter's teenage pregnancy. This study contributes to understanding of the broader topic "who is

  8. A comparison of folate status in women of child-bearing age in Korea and in the United States

    Directory of Open Access Journals (Sweden)

    Hyun T

    2012-07-01

    Full Text Available Taisun Hyun,1 Suguna Badiga,2 Han Byul Jang,1 Young-Hee Han,1 Chandrika J Piyathilake21Department of Food and Nutrition, Chungbuk National University, Cheongju, Korea; 2Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USABackground: Even though several studies have demonstrated that periconceptional supplementation with folic acid (FA reduces the occurrence of neural tube defects, FA fortification has been a topic of intense debate due to the possible adverse effects of higher folate status on several health conditions. Several countries, including Korea, have been indecisive as to whether fortification is warranted or not. It is therefore helpful for these countries to compare folate concentrations in their populations with populations exposed to mandatory FA fortification.Purpose: To evaluate the differences in the distribution of circulating concentrations of folate in Korea and the United States (US at different time points.Methods: The Korean study populations consisted of women of child-bearing age recruited in 1999 and in 2009. The US study populations consisted of women of child-bearing age recruited in the post FA fortification era (2005 and 2009. Plasma and red blood cell (RBC folate concentrations were measured using the Lactobacillus casei microbiological assay.Results: The percentage of US women with neural tube defect-protective levels of RBC folate was significantly higher compared to Korean women in 1999 and 2009. However, in 2009, when FA supplements became readily available for Koreans, 50% of Korean women in the study achieved the neural tube defect-protective level of RBC folate; 11% of them demonstrating supraphysiologic concentrations of plasma folate. Even though FA fortification in the US resulted in more than 80of women achieving >400 ng/mL of RBC folate by 2009, nearly 50% also demonstrated having supraphysiologic concentrations of plasma folate, which prompted some researchers to

  9. Radiation Therapy Dose Escalation for Glioblastoma Multiforme in the Era of Temozolomide

    Energy Technology Data Exchange (ETDEWEB)

    Badiyan, Shahed N.; Markovina, Stephanie; Simpson, Joseph R.; Robinson, Clifford G.; DeWees, Todd [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Tran, David D.; Linette, Gerry [Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri (United States); Jalalizadeh, Rohan [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Dacey, Ralph; Rich, Keith M.; Chicoine, Michael R.; Dowling, Joshua L.; Leuthardt, Eric C.; Zipfel, Gregory J.; Kim, Albert H. [Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri (United States); Huang, Jiayi, E-mail: jhuang@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2014-11-15

    Purpose: To review clinical outcomes of moderate dose escalation using high-dose radiation therapy (HDRT) in the setting of concurrent temozolomide (TMZ) in patients with newly diagnosed glioblastoma multiforme (GBM), compared with standard-dose radiation therapy (SDRT). Methods and Materials: Adult patients aged <70 years with biopsy-proven GBM were treated with SDRT (60 Gy at 2 Gy per fraction) or with HDRT (>60 Gy) and TMZ from 2000 to 2012. Biological equivalent dose at 2-Gy fractions was calculated for the HDRT assuming an α/β ratio of 5.6 for GBM. Results: Eighty-one patients received SDRT, and 128 patients received HDRT with a median (range) biological equivalent dose at 2-Gy fractions of 64 Gy (61-76 Gy). Overall median follow-up time was 1.10 years, and for living patients it was 2.97 years. Actuarial 5-year overall survival (OS) and progression-free survival (PFS) rates for patients that received HDRT versus SDRT were 12.4% versus 13.2% (P=.71), and 5.6% versus 4.1% (P=.54), respectively. Age (P=.001) and gross total/near-total resection (GTR/NTR) (P=.001) were significantly associated with PFS on multivariate analysis. Younger age (P<.0001), GTR/NTR (P<.0001), and Karnofsky performance status ≥80 (P=.001) were associated with improved OS. On subset analyses, HDRT failed to improve PFS or OS for those aged <50 years or those who had GTR/NTR. Conclusion: Moderate radiation therapy dose escalation above 60 Gy with concurrent TMZ does not seem to improve clinical outcomes for patients with GBM.

  10. Capecitabine based postoperative accelerated chemoradiation of pancreatic carcinoma. A dose-escalation study

    Energy Technology Data Exchange (ETDEWEB)

    Morganti, Alessio G.; Picardi, Vincenzo; Ippolito, Edy; Massaccesi, Mariangela; Macchia, Gabriella; Deodato, Francesco (Radiotherapy Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy)), E-mail: gmacchia@rm.unicatt.it; Caravatta, Luciana; Tambaro, Rosa; Mignogna, Samantha (Palliative Therapies Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy)); Cellini, Numa; Valentini, Vincenzo; Mattiucci, Gian Carlo (Dept. of Radiotherapy, Policlinico Universitario ' A. Gemelli' , Catholic Univ., Rome (Italy)); Di Lullo, Liberato (Dept. of Oncology, ' F. Veneziale' General Hospital, Isernia (Italy)); Giglio, Gianfranco (Dept. of Oncology, ' A. Cardarelli' General Hospital Campobasso (Italy)); Caprino, Paola; Sofo, Luigi (Surgery Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy)); Ingrosso, Marcello (Endoscopy Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy))

    2010-05-15

    The objective of this study was to evaluate the safety of escalating up to 55 Gy within five weeks, the dose of external beam radiotherapy to the previous tumor site concurrently with a fixed daily dose of capecitabine, in patients with resected pancreatic cancer. Material and methods. Patients with resected pancreatic carcinoma were eligible for this study. Capecitabine was administered at a daily dose of 1600 mg/m2. Regional lymph nodes received a total radiation dose of 45 Gy with 1.8 Gy per fractions. The starting radiation dose to the tumor bed was 50.0 Gy (2.0 Gy/fraction, 25 fractions). Escalation was achieved up to a total dose of 55.0 Gy by increasing the fraction size by 0.2 Gy (2.2 Gy/fraction), while keeping the duration of radiotherapy to five weeks (25 fractions). A concomitant boost technique was used. Dose limiting toxicity (DLT) was defined as any grade>3 hematologic toxicity, grade>2 liver, renal, neurologic, gastrointestinal, or skin toxicity, by RTOG criteria, or any toxicity producing prolonged (> 10 days) radiotherapy interruption. Results and discussion. Twelve patients entered the study (median age: 64 years). In the first cohort (six patients), no patient experienced DLT. Similarly in the second cohort, no DLT occurred. All 12 patients completed the planned regimen of therapy. Nine patients experienced grade 1-2 nausea and/or vomiting. Grade 2 hematological toxicity occurred in four patients. The results of our study indicate that a total radiation dose up to 55.0 Gy/5 weeks can be safely administered to the tumor bed, concurrently with capecitabine (1600 mg/m2) in patients with resected pancreatic carcinoma.

  11. Caspofungin dose escalation for invasive candidiasis due to resistant Candida albicans.

    Science.gov (United States)

    Wiederhold, Nathan P; Najvar, Laura K; Bocanegra, Rosie A; Kirkpatrick, William R; Patterson, Thomas F

    2011-07-01

    Previous in vivo studies have reported caspofungin dose escalation to be effective against Candida glabrata with reduced susceptibility. We hypothesized that higher doses of caspofungin would be effective against invasive candidiasis caused by the more virulent species Candida albicans, including isolates resistant to this echinocandin. Immunocompetent mice were inoculated with one of three C. albicans isolates, including one susceptible and two resistant isolates with different FKS1 hot spot 1 point mutations. Mice received daily caspofungin treatment for 7 days and were then followed off therapy for 2 weeks to assess survival. Kidney tissue and blood were collected, and fungal burden and serum (1 → 3)-β-D-glucan were measured. Significant differences in virulence were observed among the three C. albicans isolates, which translated into differences in responses to caspofungin. The most virulent of the resistant isolates studied (isolate 43001; Fks1p F641S) did not respond to caspofungin doses of up to 10 mg/kg of body weight, as there were no differences in survival (survival range, 0 to 12% with treatment), tissue burden, or (1 → 3)-β-D-glucan concentration compared to those for untreated controls. Higher doses of caspofungin did improve survival against the second resistant isolate (53264; Fks1p S645P) that demonstrated reduced virulence (5 and 10 mg/kg; 80% survival). In contrast, caspofungin doses as low as 1 mg/kg improved survival (85 to 95%) and reduced tissue burden and (1 → 3)-β-D-glucan concentration against the susceptible isolate (ATCC 90028). These data suggest that caspofungin dose escalation for invasive candidiasis may not be consistently effective against resistant C. albicans isolates, and this may be associated with the virulence of the strain.

  12. Strategy for stochastic dose-rate induced enhanced elimination of malignant tumour without dose escalation.

    Science.gov (United States)

    Paul, Subhadip; Roy, Prasun Kumar

    2016-09-01

    The efficacy of radiation therapy, a primary modality of cancer treatment, depends in general upon the total radiation dose administered to the tumour during the course of therapy. Nevertheless, the delivered radiation also irradiates normal tissues and dose escalation procedure often increases the elimination of normal tissue as well. In this article, we have developed theoretical frameworks under the premise of linear-quadratic-linear (LQL) model using stochastic differential equation and Jensen's inequality for exploring the possibility of attending to the two therapeutic performance objectives in contraposition-increasing the elimination of prostate tumour cells and enhancing the relative sparing of normal tissue in fractionated radiation therapy, within a prescribed limit of total radiation dose. Our study predicts that stochastic temporal modulation in radiation dose-rate appreciably enhances prostate tumour cell elimination, without needing dose escalation in radiation therapy. However, constant higher dose-rate can also enhance the elimination of tumour cells. In this context, we have shown that the sparing of normal tissue with stochastic dose-rate is considerably more than the sparing of normal tissue with the equivalent constant higher dose-rate. Further, by contrasting the stochastic dose-rate effects under LQL and linear-quadratic (LQ) models, we have also shown that the LQ model over-estimates stochastic dose-rate effect in tumour and under-estimates the stochastic dose-rate effect in normal tissue. Our study indicates the possibility of utilizing stochastic modulation of radiation dose-rate for designing enhanced radiation therapy protocol for cancer.

  13. Methylphenidate as a reinforcer for rats: contingent delivery and intake escalation.

    Science.gov (United States)

    Marusich, Julie A; Beckmann, Joshua S; Gipson, Cassandra D; Bardo, Michael T

    2010-06-01

    Methylphenidate (MPH) is one of the most widely prescribed drugs for treating attention-deficit hyperactivity disorder. Previous research suggested that MPH is a reinforcer for rats, but not all of the manipulations to show that lever pressing is controlled by the contingency to obtain MPH have been examined. In Experiment 1, responding for MPH on a progressive ratio (PR) schedule was assessed. Rats self-administered varying doses of MPH (0.056-1.0 mg/kg/infusion) on a PR schedule of reinforcement, and self-administered more MPH than saline, with maximal responding occurring at a unit dose of 0.56 mg/kg/infusion. Experiment 2 examined if there were differences in responding between contingent and noncontingent MPH (0.56 mg/kg/infusion) on a fixed ratio schedule of reinforcement. Results showed that rats responded for contingent MPH, and that responding was not maintained when MPH was delivered noncontingently. Experiment 3 examined self-administration of MPH (0.1 or 0.3 mg/kg/infusion) during long access (6 hr) compared to short access sessions (1 hr). Results showed that rats given long access to MPH showed an escalation of intake across sessions, with this escalation being more pronounced at the lower unit dose (0.1 mg/kg/infusion); in contrast, rats given short access to MPH did not show an increase in MPH self-administration across sessions at either MPH dose tested. Taken together, these results indicate that MPH is an effective intravenous reinforcer for rats and that, similar to other stimulants such as cocaine, amphetamine and methamphetamine, MPH is subject to abuse as reflected by dysregulated intake across repeated long access sessions.

  14. Dose escalation in patients receiving whole-brain radiotherapy for brain metastases from colorectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Heisterkamp, Christine; Rades, Dirk [Dept. of Radiation Oncology, Univ. Hospital Schleswig-Holstein, Luebeck (Germany); Haatanen, Tiina [Dept. of Radiation Oncology, Univ. Hospital Hamburg-Eppendorf, Hamburg (Germany); Schild, Steven E. [Dept. of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States)

    2010-02-15

    Background and Purpose: Whole-brain radiotherapy (WBRT) alone is the most common treatment for brain metastases from colorectal cancer, as most patients are not candidates for more aggressive therapies such as resection or radiosurgery. The standard WBRT regimen, 30 Gy in ten fractions (10 x 3 Gy), has generally resulted in poor outcomes. This study investigated whether an escalation of the WBRT dose improves these results. Patients and Methods: Data from 53 patients receiving WBRT alone for brain metastases from colorectal cancer were retrospectively analyzed. 10 x 3 Gy (n = 35) was compared to higher doses (40 Gy/20 fractions or 45 Gy/15 fractions; n = 18) for overall survival (OS) and local control (LC). Additional factors evaluated for prognostic importance included age, gender, performance status, number of metastases, and extracerebral metastases. Results: The OS rates at 6 months were 17% after 10 x 3 Gy and 50% after 20 x 2 Gy/15 x 3 Gy (p = 0.014). On multivariate analysis, improved OS was significantly associated with higher WBRT dose (p = 0.047), Karnofsky Performance Score (KPS) {>=} 70 (p = 0.034), less than four brain metastases (p = 0.036), and lack of extracerebral metastases (p = 0.010). The LC rates at 6 months were 17% after 10 x 3 Gy and 50% after higher doses (p = 0.018). On multivariate analysis of LC, higher WBRT dose was significant (p = 0.028). A trend was observed for KPS {>=} 70 (p = 0.08) and less than four brain metastases (p = 0.06). Conclusion: These data suggest that patients with brain metastases from colorectal cancer treated with WBRT alone appeared to benefit from escalation of the radiation dose beyond 10 x 3 Gy in terms of improved OS and LC. (orig.)

  15. The Role of Age on Dose Limiting Toxicities (DLTs) in Phase I Dose-escalation Trials

    Science.gov (United States)

    Schwandt, A; Harris, P. J.; Hunsberger, S.; Deleporte, A.; Smith, G. L.; Vulih, D.; Anderson, B. D.; Ivy, S. P.

    2016-01-01

    Purpose Elderly oncology patients are not enrolled in early phase trials in proportion to the numbers of geriatric patients with cancer. There may be concern that elderly patients will not tolerate investigational agents as well as younger patients resulting in a disproportionate number of dose-limiting toxicities (DLTs). Recent single-institution studies provide conflicting data on the relationship between age and DLT. Experimental Design We retrospectively reviewed data about patients treated on single-agent, dose-escalation, phase I clinical trials sponsored by the Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute. Patients’ dose levels were described as percentage of maximum tolerated dose (%MTD), the highest dose level at which <33% of patients had a DLT, or recommended phase II dose (RP2D). Mixed-effect logistic regression models were used to analyze relationships between the probability of a DLT and age and other explanatory variables. Results Increasing dose, increasing age, and worsening performance status (PS) were significantly related to an increased probability of a DLT in this model (p<0.05). There was no association between dose level administered and age (p=0.57). Conclusions This analysis of phase I dose-escalation trials involving over 500 patients older than 70 years of age, is the largest reported. As age and dose level increased and PS worsened, the probability of a DLT increased. While increasing age was associated with occurrence of DLT, this risk remained within accepted thresholds of risk for phase I trials. There was no evidence of age bias on enrollment of patients on low or high dose levels. PMID:25028396

  16. [The course of recurrent urinary tract infections in non-pregnant women of childbearing age, the consequences for daily life and the ideas of the patients

    NARCIS (Netherlands)

    Groen, S.; Lagro-Janssen, A.L.M.

    2005-01-01

    OBJECTIVE: To investigate the natural history of recurrent urinary tract infections in women of childbearing age and to gain insight into their consequences and the ideas of the patients. DESIGN: Historical cohort-study and interviews with patients. METHOD: All non-pregnant women in the age-range 15

  17. [The course of recurrent urinary tract infections in non-pregnant women of childbearing age, the consequences for daily life and the ideas of the patients

    NARCIS (Netherlands)

    Groen, S.; Lagro-Janssen, A.L.M.

    2005-01-01

    OBJECTIVE: To investigate the natural history of recurrent urinary tract infections in women of childbearing age and to gain insight into their consequences and the ideas of the patients. DESIGN: Historical cohort-study and interviews with patients. METHOD: All non-pregnant women in the age-range

  18. Words of Violence: “Fear Speech,” or How Violent Conflict Escalation Relates to the Freedom of Expression

    NARCIS (Netherlands)

    Buyse, Antoine

    2014-01-01

    The limits of the freedom of expression are a perennial discussion in human rights discourse. This article focuses on identifying yardsticks to establish the boundaries of freedom of expression in cases where violence is a risk. It does so by using insights from the social sciences on the escalation

  19. A Phase I Dose-Escalation Study of Antibody BI-505 in Relapsed/Refractory Multiple Myeloma

    DEFF Research Database (Denmark)

    Hansson, Markus; Gimsing, Peter; Badros, Ashraf;

    2015-01-01

    , at escalating doses from 0.0004 to 20 mg/kg, with extension of therapy until disease progression for responding or stable patients receiving 0.09 mg/kg or higher doses. RESULTS: A total of 35 patients were enrolled. The most common adverse events were fatigue, pyrexia, headache, and nausea. Adverse events were...

  20. Escalation of Commitment to an Ineffective Course of Action: The Effect of Feedback Having Negative Implications for Self-Identity.

    Science.gov (United States)

    Brockner, Joel; And Others

    1986-01-01

    Examines entrapment, the process by which organizational decision makers escalate commitment to an ineffective course of action to justify allocation of previous resources. Two laboratory experiments exploring individuals' perceptions of entrapment and its effect on their self identity are described. Also discusses practical theoretical…

  1. An Investigation of the Relationships between Goals and Software Project Escalation: Insights from Goal Setting and Goal Orientation Theories

    Science.gov (United States)

    Lee, Jong Seok

    2013-01-01

    Escalation of commitment is manifested as a behavior in which an individual resists withdrawing from a failing course of action despite negative feedback, and it is an enduring problem that occurs in a variety of situations, including R&D investment decisions and software project overruns. To date, a variety of theoretical explanations have…

  2. An Investigation of the Relationships between Goals and Software Project Escalation: Insights from Goal Setting and Goal Orientation Theories

    Science.gov (United States)

    Lee, Jong Seok

    2013-01-01

    Escalation of commitment is manifested as a behavior in which an individual resists withdrawing from a failing course of action despite negative feedback, and it is an enduring problem that occurs in a variety of situations, including R&D investment decisions and software project overruns. To date, a variety of theoretical explanations have…

  3. Words of Violence: “Fear Speech,” or How Violent Conflict Escalation Relates to the Freedom of Expression

    NARCIS (Netherlands)

    Buyse, Antoine

    2014-01-01

    The limits of the freedom of expression are a perennial discussion in human rights discourse. This article focuses on identifying yardsticks to establish the boundaries of freedom of expression in cases where violence is a risk. It does so by using insights from the social sciences on the escalation

  4. How premarital children and childbearing in current marriage influence divorce of Swedish women in their first marriages

    Directory of Open Access Journals (Sweden)

    2002-08-01

    Full Text Available By using a Swedish register data set and applying hazard models with unobserved heterogeneity, this study demonstrates that the partners' childbearing history plays an important role in predicting the divorce risks of families with various combination of premarital children. Families with premarital children definitely have a higher risk of divorce than do those without premarital children. Producing a common child reduces the divorce risk, but as the youngest common child gets older, his or her role in maintaining family bond weakens. Families which the wife has premarital children by another man decidedly have a higher risk of divorce than do families with other combinations of premarital children. Other findings deviate from what has been reported in the literature.

  5. Socioeconomic, cultural and demographic determinants of childbearing desires among married women attending health centers in Hamedan (2012

    Directory of Open Access Journals (Sweden)

    Hatam Hosseini

    2014-04-01

    Full Text Available Background: Changes in values and attitudes of the Iranian society during the past few decades have greatly influenced the reproductive decisions and actions of individuals and families, especially women. The aim of this study was to analyze the determinants of childbearing desires of married women attending Health Centers in Hamedan. Methods: Data were collected through a survey which was conducted during November and December, 2012. This cross-sectional study was conducted on a sample of 273 eligible women who were selected randomly. A structured questionnaire was used for data collection. Results: Results showed that 70.7 percent of women did not want to have another child in addition to the children they had at the time of survey. Among these women, 55 percent and 84.3 percent had one and two children, respectively. Further, 78.4 percent of respondents stated that two children were the ideal number of children for the households. The most important reasons for the two-children pattern were economic problems and families’ problems in rearing and training the children, respectively. Results of multivariate analysis showed that the likelihood of stopping childbearing was higher among working women,women with more children, women at the end of reproduction age, women evaluating children’s benefits lower than their expenditures, and women with little tendency to prefer sons to daughters. Conclusion: Population policies to prevent further decline in fertility should be focused on employment, family, and quality of life, especially among women without children, women with one child and newly married couples.

  6. Intimate relationships and childbearing after adolescent depression: a population-based 15 year follow-up study.

    Science.gov (United States)

    Jonsson, U; Bohman, H; Hjern, A; von Knorring, L; Paaren, A; Olsson, G; von Knorring, A-L

    2011-08-01

    Adolescent depression is associated with a range of interpersonal adversities. We hypothesized that depressed adolescents are at subsequent increased risk of problems related to intimate relationships and childbearing in adulthood, and used longitudinal data to examine this. A population-based investigation of depression in 16 to 17 year olds was followed up after 15 years, at around the age of 30 years. Comparisons were made between adolescents with depression (n = 361, 78% females) and non-depressed peers (n = 248, 77% females). Data from both national registers and personal interviews were used. At follow-up, the former depressed and non-depressed adolescents had become parents to a similar extent. The former depressed females were more likely than the non-depressed females to report abortion, miscarriage, intimate partner violence and sexually transmitted disease. They also reported a higher number of intimate relationships and were more likely to have divorced and to be registered as single mothers. Depressed females with a comorbid disruptive disorder had a particularly poor outcome. In the depressed females without a disruptive disorder, only those who subsequently had recurrent depressions in adulthood were at increased risk of poor outcome. There was no indication that the formerly depressed males were at increased risk of subsequent problems related to intimate relationships. Females with adolescent depression subsequently have problems related to intimate relationships and childbearing. Disruptive disorders and recurrence of depression appear to be instrumental in this association. Attention should be given to intimate relationship problems and sexual and reproductive health issues in young women with depression.

  7. Effect of Two Different Multimicronutrient Supplements on Vitamin D Status in Women of Childbearing Age: A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Stefan Pilz

    2017-01-01

    Full Text Available The German Nutrition Society raised in 2012 the recommended daily vitamin D intake from 200 to 800 international units (IU to achieve 25-hydroxyvitamin D (25(OHD levels of at least 50 nmol/L, even when endogenous vitamin D synthesis is minimal such as in winter. We aimed to evaluate this recommendation in women of childbearing age. This is a single-center, randomized, open trial conducted from 8 January to 9 May 2016 in Esslingen, Germany. We randomized 201 apparently healthy women to receive for 8 weeks a daily multimicronutrient supplement containing either 200 IU (n = 100 or 800 IU vitamin D3 (n = 101. Primary outcome measure was serum 25(OHD. 196 participants completed the trial. Increases in 25(OHD (median with interquartile range from baseline to study end were 13.2 (5.9 to 20.7 nmol/L in the 200 IU group, and 35.8 (18.2 to 52.8 nmol/L in the 800 IU group (p < 0.001 for the between group difference. At study end, levels of ≥50 nmol/L were present in 70.4% of the 200 IU group and in 99% of the 800 IU group. Participants on hormonal contraceptives had higher baseline levels and a stronger increase in 25(OHD. In conclusion, daily supplementation of 800 IU vitamin D3 during wintertime in Germany is sufficient to achieve a 25(OHD level of at least 50 nmol/L in almost all women of childbearing age, whereas 200 IU are insufficient.

  8. Potential host-related risk factors for recurrent urinary tract infection in Saudi women of childbearing age.

    Science.gov (United States)

    Ahmed, Abul-Fotouh Abdel-Maguid; Solyman, Awatif Abdel-Karim; Kamal, Sanaa Moharram

    2016-08-01

    Risk factors for recurrent urinary tract infection (rUTI) in women may differ between individuals, age, and the community. This study aimed to evaluate host related risk factors for rUTI in sexually active Saudi women during the childbearing period. A case-control study was conducted in five healthcare centers and included married, nonpregnant women aged 18-40 years. A total of 217 women had rUTI (cases) and 252 did not (controls). A validated questionnaire, with a face-to-face interview, was applied to assess various demographic, behavioral, medical, and sexual data. Additionally, a thorough physical examination, saliva and blood analyses, uroflowmetry, and genitourinary ultrasonography were performed. Multivariate logistic regression analysis was used to identify the significant host related risk factors associated with rUTI. In multivariate analysis, attributable risks for rUTI were a history of childhood UTI [odds ratio (OR) = 6.8)] back-to-front douching/wiping after bowel movement (OR = 2.6), younger age at first intercourse (OR = 6.3), increased frequency of sexual intercourse (OR = 4.8), obstructed urinary flow (OR = 1.9), and genital prolapse (OR = 3.4). A total of 9.68 % of cases and none of the controls had high postvoid residual urine (positive predictive value for rUTI = 100 %). This is the first reported study to evaluate host related risk factors for rUTI in childbearing-age women in Saudi Arabia. Study findings indicate the association between rUTI and various factors that have been already established, with addition of improper rectal hygiene as a potential risk for recurrence.

  9. Effect of Two Different Multimicronutrient Supplements on Vitamin D Status in Women of Childbearing Age: A Randomized Trial

    Science.gov (United States)

    Pilz, Stefan; Hahn, Andreas; Schön, Christiane; Wilhelm, Manfred; Obeid, Rima

    2017-01-01

    The German Nutrition Society raised in 2012 the recommended daily vitamin D intake from 200 to 800 international units (IU) to achieve 25-hydroxyvitamin D (25(OH)D) levels of at least 50 nmol/L, even when endogenous vitamin D synthesis is minimal such as in winter. We aimed to evaluate this recommendation in women of childbearing age. This is a single-center, randomized, open trial conducted from 8 January to 9 May 2016 in Esslingen, Germany. We randomized 201 apparently healthy women to receive for 8 weeks a daily multimicronutrient supplement containing either 200 IU (n = 100) or 800 IU vitamin D3 (n = 101). Primary outcome measure was serum 25(OH)D. 196 participants completed the trial. Increases in 25(OH)D (median with interquartile range) from baseline to study end were 13.2 (5.9 to 20.7) nmol/L in the 200 IU group, and 35.8 (18.2 to 52.8) nmol/L in the 800 IU group (p < 0.001 for the between group difference). At study end, levels of ≥50 nmol/L were present in 70.4% of the 200 IU group and in 99% of the 800 IU group. Participants on hormonal contraceptives had higher baseline levels and a stronger increase in 25(OH)D. In conclusion, daily supplementation of 800 IU vitamin D3 during wintertime in Germany is sufficient to achieve a 25(OH)D level of at least 50 nmol/L in almost all women of childbearing age, whereas 200 IU are insufficient. PMID:28054964

  10. Socio-demographic and lifestyle factors associated with folate status among non-supplement-consuming Canadian women of childbearing age.

    Science.gov (United States)

    Shi, Yipu; De Groh, Margaret; MacFarlane, Amanda J

    2014-05-09

    Mandatory folic acid fortification was implemented in Canada in 1998 to reduce the risk of neural tube defects (NTD). Our objective was to assess the relationship between socio-demographic factors and folate status in non-supplement-consuming Canadian women of childbearing age. Data on demographic factors, lifestyle factors, physical measures and red blood cell (RBC) folate concentration were collected from 1,008 non-supplement-consuming women aged 15-49 years in the Canadian Health Measures Survey (2007-2009). RBC folate ³906 nmol/L was used as a cut-off for optimal folate status for protection from NTD. Approximately 75% of non-supplement consuming women had an RBC folate concentration ³906 nmol/L. Young age (15-19 years), White ethnicity, less than secondary education, lowest income adequacy, smoking and high body mass index were associated with a higher prevalence of lower folate status. After adjustment, only young age (adjusted odds ratio [OR] 1.99-95% confidence interval [CI]: 1.25-3.18) was associated with lower folate status. Less than secondary education (adjusted OR 5.66, 95% CI: 1.10-29.04) and lowest income adequacy (adjusted OR 4.77, 95% CI: 1.06-21.49) were associated with lower folate status in women aged 15-24 and 25-49 years, respectively. Many risk factors for lower folate status identified before food fortification was implemented were not associated with folate status in our representative sample of non-supplement-consuming Canadian women. However, younger women, women aged 15-24 with less than secondary education and women aged 25-49 with low income adequacy remain at risk of lower folate status, supporting the continued promotion of folic acid supplement use to women of childbearing age.

  11. Host-parasite arms race in mutation modifications: indefinite escalation despite a heavy load?

    Science.gov (United States)

    Haraguchi, Y; Sasaki, A

    1996-11-21

    If constantly changing genotypes are favorable in host and parasite coevolution, an indefinite escalation of mutation rates would result despite heavy mutational loads. We theoretically study this possibility by examining the mutation modifier dynamics of host and parasite that engage in genotype-specific epidemiological interaction. In the first model, we study the evolutionarily stable (ESS) mutation rate or switching rate if two alleles in a single locus are subjected to frequency-dependent selection favoring the rarer of the two. Mutation modifier locus is either tightly linked or unlinked to the selected locus. Sufficiently strong frequency-dependent selection may cause cycles in allele frequencies and a modifier with higher mutation rate enjoys the long-term advantage by randomizing the genotype of their offspring. Through the repeated events of invasion and replacement of mutation modifiers, the mutation rate continues to increase until the allele frequencies are stabilized. If some fraction of mutations are deleterious, there is no longer a pure ESS mutation rate: the evolutionarily stable population then consists of multiple strains concerning mutation modifier, typically one with a very high mutation rate and the other with a very low rate, stably coexisting and fighting off invasion by any other modifiers. These results are almost independent of the linkage between the selected and the modifier loci. In the second model, we consider the joint evolution of host and parasite mutation modifiers, assuming that a specific pair of host and parasite genotype densities change following the Nicholson-Bailey type model. If there is no cost of deleterious mutations, mutation rates of both species are escalated indefinitely by modifier evolution until they completely suppress the fluctuation of genotype densities. However, a small cost of deleterious mutation is enough to collapse this coevolutionary equilibrium of inflated mutations. Typical coevolutionary outcome

  12. Avoidance orientation and the escalation of negative communication in intimate relationships.

    Science.gov (United States)

    Kuster, Monika; Bernecker, Katharina; Backes, Sabine; Brandstätter, Veronika; Nussbeck, Fridtjof W; Bradbury, Thomas N; Martin, Mike; Sutter-Stickel, Dorothee; Bodenmann, Guy

    2015-08-01

    Avoidance goals heighten the salience of negative social experiences, and in intimate relationships such an orientation may contribute to communication difficulties and the perpetuation of avoidance. We therefore hypothesized that individuals with stronger avoidance goals would be particularly prone to engage in escalating levels of negative communication with their intimate partner, and we tested this prediction by conducting sequential analyses on videotaped observational data (28,470 observations) collected from 365 heterosexual couples engaging in a relationship-related conflict. While less avoidance-oriented spouses showed a decline in their likelihood of negative communication over the course of the 8-min conflict discussion, the likelihood that more avoidance-oriented spouses would display negative communication behaviors remained at a high level. The likelihood of negative communication even increased when avoidance-oriented spouses were confronted with negative communication behavior of their partners. The effects of avoidance orientation were independent of relationship satisfaction and neuroticism. These findings demonstrate that avoidance goals underlie individuals' heightened reactivity to the partner's negative behavior, while also clarifying 1 possible reason why some individuals engage in communication behaviors that may prove maladaptive to their relationship. (c) 2015 APA, all rights reserved.

  13. Real Option Method and Escalation of Commitment in the Evaluation of Investment Projects

    Directory of Open Access Journals (Sweden)

    Mehrdad Karami

    2011-01-01

    Full Text Available Problem statement: This study applies an experimental method to find out whether using the real option method along with the discounted cash flow techniques can reduce the decision-makers’ Escalation of Commitment (EC hereafter or their desire to keep up their commitment to a failed project. Approach: The real option method used for the evaluation of long-term projects also measures the flexibility value which may be produced during the implementation of the project. Results: The results indicate that those who use the real option method show lower EC to a failed project than those who merely use the net present value method. Conclusion/Recommendations: The major conclusion might be that using the real option method in capital budgeting can affect the users’ behavior and decisions and lead to better decision-making in the long-term projects. In view of the fact that longterm investment projects are costly and time-consuming, a greater need is felt for better methods of evaluating such projects and, in consequence, researchers should also consider the other affective aspects of using real method options on the users' behavior and decisions.

  14. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Robert eMeier

    2015-04-01

    Full Text Available Abstract: Stereotactic body radiotherapy (SBRT is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I dose escalation should yield improved rates of cancer control; (II the unique radiobiology of prostate cancer favors hypofractionation and (III the conformal nature of SBRT minimizes high-dose radiation delivery to immediately adjacent organs, potentially reducing complications. This approach is also more convenient for patients, and is cheaper than intensity modulated radiotherapy (IMRT. Several external beam platforms are capable of delivering SBRT for early-stage prostate cancer, although most of the mature reported series have employed a robotic non-coplanar platform (i.e., CyberKnife. Several large studies report 5-year biochemical relapse rates which compare favorably to IMRT. Rates of late GU toxicity are similar to those seen with IMRT, and rates of late rectal toxicity may be less than with IMRT and low dose rate (LDR brachytherapy. Patient-reported quality of life (QOL outcomes appear similar to IMRT in the urinary domain. Bowel QOL may be less adversely affected by SBRT than with other radiation modalities. After five years of follow-up, SBRT delivered on a robotic platform is yielding outcomes at least as favorable as IMRT, and may be considered appropriate therapy for stage I-II prostate cancer.

  15. 自动扶梯的历史%The History of the Escalator

    Institute of Scientific and Technical Information of China (English)

    David A.Cooper; 马英俊

    2000-01-01

    1859年,纳森·艾母兹发明了自动扶梯的第1个专利.这在当时是很超前的,因为第1台电动机是在19世纪70的年终逐出来的.在之后的80年代,西伯格、列诺、哈利、惠勒、道奇发展了自动扶梯这一事业.西伯格将elevatus(上升)和scale(梯级)合二为一创造出来自动扶梯(escalator)这一名词.那时,Otis公司是自司生产经营有冲突且是唯一有资格使用大写E开头拼写Escalator的公司.1911年,伦敦地铁安装了其第1台自动扶梯.自动扶梯迷人的历史从1859年发明以来延续至今.

  16. Biological equivalent dose studies for dose escalation in the stereotactic synchrotron radiation therapy clinical trials

    Energy Technology Data Exchange (ETDEWEB)

    Prezado, Y.; Fois, G.; Edouard, M.; Nemoz, C.; Renier, M.; Requardt, H.; Esteve, F.; Adam, JF.; Elleaume, H.; Bravin, A., E-mail: prezado@esrf.fr [ID17 Biomedical Beamline, European Synchrotron Radiation Facility (ESRF), 6 rue Jules Horowitz, BP 220, 38043 Grenoble Cedex (France)

    2009-03-15

    Synchrotron radiation is an innovative tool for the treatment of brain tumors. In the stereotactic synchrotron radiation therapy (SSRT) technique a radiation dose enhancement specific to the tumor is obtained. The tumor is loaded with a high atomic number (Z) element and it is irradiated in stereotactic conditions from several entrance angles. The aim of this work was to assess dosimetric properties of the SSRT for preparing clinical trials at the European Synchrotron Radiation Facility (ESRF). To estimate the possible risks, the doses received by the tumor and healthy tissues in the future clinical conditions have been calculated by using Monte Carlo simulations (PENELOPE code). The dose enhancement factors have been determined for different iodine concentrations in the tumor, several tumor positions, tumor sizes, and different beam sizes. A scheme for the dose escalation in the various phases of the clinical trials has been proposed. The biological equivalent doses and the normalized total doses received by the skull have been calculated in order to assure that the tolerance values are not reached.

  17. Incorporating a Patient Dichotomous Characteristic in Cancer Phase I Clinical Trials Using Escalation with Overdose Control

    Directory of Open Access Journals (Sweden)

    Mourad Tighiouart

    2012-01-01

    Full Text Available We describe a design for cancer phase I clinical trials that takes into account patients heterogeneity thought to be related to treatment susceptibility. The goal is to estimate the maximum tolerated dose (MTD given patient’s specific dichotomous covariate value. The design is Bayesian adaptive and is an extension of escalation with overdose control (EWOC. We will assess the performance of this method by comparing the following designs via extensive simulations: (1 design using a covariate; patients are accrued to the trial sequentially and the dose given to a patient depends on his/her baseline covariate value, (2 design ignoring the covariate; patients are accrued to the trial sequentially and the dose given to a patient does not depend on his/her baseline covariate value, and (3 design using separate trials; in each group, patients are accrued to the trial sequentially and EWOC is implemented in each group. These designs are compared with respect to safety of the trial and efficiency of the estimates of the MTDs via extensive simulations. We found that ignoring a significant baseline binary covariate in the model results in a substantial number of patients being overdosed. On the other hand, accounting for a nonsignificant covariate in the model has practically no effect on the safety of the trial and efficiency of the estimates of the MTDs.

  18. Importance of appropriate initial antibiotic therapy and de-escalation in the treatment of nosocomial pneumonia

    Directory of Open Access Journals (Sweden)

    J. Rello

    2007-08-01

    Full Text Available Inappropriate initial antibiotic therapy in nosocomial pneumonia is associated with higher mortality, longer hospital stays and increased healthcare costs. The key pathogens associated with these adverse outcomes include Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii. Due to the increasing rates of resistance, a new paradigm is needed for treating nosocomial infections in the intensive care unit (ICU. Optimal initial therapy consists of a broad-spectrum antibiotic started in a timely manner and administered at the correct dose and via the correct route. Because pathogen aetiology and resistance patterns vary from one ICU to another, recommendations for initial therapy should be tailored to each institution. Selection of the broad-spectrum antibiotic should be based on the patient's risk factors (including comorbidities, duration of ventilation and recent antibiotic exposure, suspected pathogen and up-to-date local resistance patterns. After 48–72 h, the patient should be reassessed and antibiotic therapy de-escalated based on the microbiological results and the clinical response.

  19. The influence of toxicity constraints in models of chemotherapeutic protocol escalation

    KAUST Repository

    Boston, E. A. J.

    2011-04-06

    The prospect of exploiting mathematical and computational models to gain insight into the influence of scheduling on cancer chemotherapeutic effectiveness is increasingly being considered. However, the question of whether such models are robust to the inclusion of additional tumour biology is relatively unexplored. In this paper, we consider a common strategy for improving protocol scheduling that has foundations in mathematical modelling, namely the concept of dose densification, whereby rest phases between drug administrations are reduced. To maintain a manageable scope in our studies, we focus on a single cell cycle phase-specific agent with uncomplicated pharmacokinetics, as motivated by 5-Fluorouracil-based adjuvant treatments of liver micrometastases. In particular, we explore predictions of the effectiveness of dose densification and other escalations of the protocol scheduling when the influence of toxicity constraints, cell cycle phase specificity and the evolution of drug resistance are all represented within the modelling. For our specific focus, we observe that the cell cycle and toxicity should not simply be neglected in modelling studies. Our explorations also reveal the prediction that dose densification is often, but not universally, effective. Furthermore, adjustments in the duration of drug administrations are predicted to be important, especially when dose densification in isolation does not yield improvements in protocol outcomes. © The author 2011. Published by Oxford University Press on behalf of the Institute of Mathematics and its Applications. All rights reserved.

  20. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer.

    Science.gov (United States)

    Meier, Robert

    2015-01-01

    Stereotactic body radiotherapy (SBRT) is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I) dose-escalation should yield improved rates of cancer control; (II) the unique radiobiology of prostate cancer favors hypofractionation; and (III) the conformal nature of SBRT minimizes high-dose radiation delivery to immediately adjacent organs, potentially reducing complications. This approach is also more convenient for patients, and is cheaper than intensity-modulated radiotherapy (IMRT). Several external beam platforms are capable of delivering SBRT for early-stage prostate cancer, although most of the mature reported series have employed a robotic non-coplanar platform (i.e., CyberKnife). Several large studies report 5-year biochemical relapse rates which compare favorably to IMRT. Rates of late GU toxicity are similar to those seen with IMRT, and rates of late rectal toxicity may be less than with IMRT and low-dose rate brachytherapy. Patient-reported quality of life (QOL) outcomes appear similar to IMRT in the urinary domain. Bowel QOL may be less adversely affected by SBRT than with other radiation modalities. After 5 years of follow-up, SBRT delivered on a robotic platform is yielding outcomes at least as favorable as IMRT, and may be considered appropriate therapy for stage I-II prostate cancer.

  1. Active measures for reducing the global climatic impacts of escalating CO 2 concentrations

    Science.gov (United States)

    Penner, S. S.; Schneider, A. M.; Kennedy, E. M.

    The buildup of CO 2 by fossil-fuel burning and associated climatic changes have become the subject of intensive investigations. Although the time scale on which significant climatic changes (e.g. mean temperature changes of several degrees, appreciable changes in global and regional rainfalls and winds, etc.) are expected to occur is long, it has been noted that the magnitude of the energy system is so vast that modifications in the primary resource mix should preferably be initiated within a decade or sooner. The notion that the most economical energy source will be replaced globally in response to longterm climate model predictions is probably false. Before policy matters of this type can be discussed reasonably, careful assessments must be made of alternative global measures that do not require curtailments of fossil-fuel applications. This study on active measures for reducing climate changes caused by escalating CO 2 concentrations deals with potentially important areas of research. We find: (a) reductions in the solar input to the Earth by reflecting sunlight directly are prohibitively costly; (b) desired changes in Earth albedo through judicious introduction of small particles can probably be accomplished at acceptable cost through the use of modified combustors on high-flying aircraft.

  2. Anticipatory 50 kHz ultrasonic vocalizations are associated with escalated alcohol intake in dependent rats.

    Science.gov (United States)

    Buck, Cara L; Malavar, Jordan C; George, Olivier; Koob, George F; Vendruscolo, Leandro F

    2014-09-01

    Rats emit 50kHz ultrasonic vocalizations (USVs) in situations of increased motivation, such as during the anticipation of palatable food or drugs of abuse. Whether the same holds true for the anticipation of alcohol intake remains unknown. Alcohol drinking in a nondependent state is thought to be mediated by its rewarding effects (positive reinforcement), whereas drinking in the dependent state is motivated by alcohol's stress-relieving effects (negative reinforcement). Here, we measured context-elicited 50kHz USVs in alcohol-dependent (alcohol vapor-exposed) and nondependent rats immediately before operant alcohol self-administration sessions. Dependent rats showed escalated levels of alcohol intake compared with nondependent rats. Overall, dependent and nondependent rats showed similar levels of anticipatory 50kHz USVs. However, the number of anticipatory USVs was positively correlated with alcohol intake in dependent rats but not nondependent rats. Additionally, dependent rats with higher alcohol intake displayed increased anticipatory 50kHz USVs compared with rats that had lower alcohol intake, whereas no difference was observed between rats with high and low alcohol intake in the nondependent group. Increased 50kHz USVs were specific for the anticipation of alcohol self-administration and did not generalize to a novel environment. These findings suggest that anticipatory 50kHz USVs may be an indicator of context-elicited negative reinforcement learning.

  3. Hydrogeologic assessment of escalating groundwater exploitation in the Indus Basin, Pakistan

    Science.gov (United States)

    Khan, S.; Rana, T.; Gabriel, H. F.; Ullah, Muhammad K.

    2008-12-01

    Groundwater development has contributed significantly to food security and reduction in poverty in Pakistan. Due to rapid population growth there has been a dramatic increase in the intensity of groundwater exploitation leading to declining water tables and deteriorating groundwater quality. In such prevailing conditions, the hydrogeological appraisal of escalating groundwater exploitation has become of paramount importance. Keeping this in view, a surface water-groundwater quantity and quality model was developed to assess future groundwater trends in the Rechna Doab (RD), a sub-catchment of the Indus River Basin. Scenario analysis shows that if dry conditions persist, there will be an overall decline in groundwater levels of around 10 m for the whole of RD during the next 25 years. The lower parts of RD with limited surface water supplies will undergo the highest decline in groundwater levels (10 to 20 m), which will make groundwater pumping very expensive for farmers. There is a high risk of groundwater salinization due to vertical upconing and lateral movement of highly saline groundwater into the fresh shallow aquifers in the upper parts of RD. If groundwater pumping is allowed to increase at the current rate, there will be an overall decline in groundwater salinity for the lower and middle parts of RD because of enhanced river leakage.

  4. Tomotherapy PET-guided dose escalation. A dosimetric feasibility study for patients with malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Maggio, Angelo; Cutaia, Claudia; Di Dia, Amalia; Bresciani, Sara; Miranti, Anna; Poli, Matteo; Stasi, Michele [Candiolo Cancer Institute - FPO, IRCCS, Medical Physics, Turin (Italy); Del Mastro, Elena; Garibaldi, Elisabetta; Gabriele, Pietro [Candiolo Cancer Institute - FPO, IRCCS, Radiotherapy Department, Turin (Italy)

    2016-02-15

    The aim of this study was to investigate whether a safe escalation of the dose to the pleural cavity and PET/CT-positive areas in patients with unresectable malignant pleural mesothelioma (MPM) is possible using helical tomotherapy (HT). We selected 12 patients with MPM. Three planning strategies were investigated. In the first strategy (standard treatment), treated comprised a prescribed median dose to the planning target volume (PTV) boost (PTV{sub 1}) of 64.5 Gy (range: 56 Gy/28 fractions to 66 Gy/30 fractions) and 51 Gy (range: 50.4 Gy/28 fractions to 54 Gy/30 fractions) to the pleura PTV (PTV{sub 2}). Thereafter, for each patient, two dose escalation plans were generated prescribing 62.5 and 70 Gy (2.5 and 2.8 Gy/fraction, respectively) to the PTV{sub 1} and 56 Gy (2.24 Gy/fraction) to the PTV{sub 2}, in 25 fractions. Dose-volume histogram (DVH) constraints and normal tissue complication probability (NTCP) calculations were used to evaluate the differences between the plans. For all plans, the 95 % PTVs received at least 95 % of the prescribed dose. For all patients, it was possible to perform the dose escalation in accordance with the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) constraints for organs at risk (OARs). The average contralateral lung dose was < 8 Gy. NTCP values for OARs did not increase significantly compared with the standard treatment (p > 0.05), except for the ipsilateral lung. For all plans, the lung volume ratio was strongly correlated with the V{sub 20}, V{sub 30}, and V{sub 40} DVHs of the lung (p < 0.0003) and with the lung mean dose (p < 0.0001). The results of this study suggest that by using HT it is possible to safely escalate the dose delivery to at least 62.5 Gy in PET-positive areas while treating the pleural cavity to 56 Gy in 25 fractions without significantly increasing the dose to the surrounding normal organs. (orig.) [German] Ziel war es, zu untersuchen, ob mit der helikalen Tomotherapie (HT) eine

  5. Reward devaluation and heroin escalation is associated with differential expression of CRF signaling genes.

    Science.gov (United States)

    McFalls, Ashley J; Imperio, Caesar G; Bixler, Georgina; Freeman, Willard M; Grigson, Patricia Sue; Vrana, Kent E

    2016-05-01

    One of the most damaging aspects of drug addiction is the degree to which natural rewards (family, friends, employment) are devalued in favor of seeking, obtaining and taking drugs. We have utilized an animal model of reward devaluation and heroin self-administration to explore the role of the coricotropin releasing factor (CRF) pathway. Given access to a saccharin cue followed by the opportunity to self-administer heroin, animals will parse into distinct phenotypes that suppress their saccharin intake (in favor of escalating heroin self-administration) or vice versa. We find that large saccharin suppressors (large heroin takers) demonstrate increased mRNA expression for elements of the CRF signaling pathway (CRF, CRF receptors and CRF binding protein) within the hippocampus, medial prefrontal cortex and the ventral tegmental area. Moreover, there were no gene expression changes of these components in the nucleus accumbens. Use of bisulfite conversion sequencing suggests that changes in CRF binding protein and CRF receptor gene expression may be mediated by differential promoter methylation.

  6. Beyond the mucus escalator: Complex ciliary hydrodynamics in disease and function

    Science.gov (United States)

    Nawroth, Janna; Guo, Hanliang; John, Dabiri; Kanso, Eva; McFall-Ngai, Margaret

    2015-11-01

    Cilia are microscopic, hair-like structures lining external and internal body surfaces where they interact with fluids. The main function of motile cilia is often described as that of a ``mucus escalator'', i.e., a homogeneous ciliary carpet moving along layer of mucus along the surface to transport food, germ cells, debris, or pathogens. Accordingly, the performance of ciliary systems is usually measured in terms of a single metric, transport velocity, or its presumed proxy, ciliary beat frequency. We challenge this simple view through the observation that both healthy and diseased biological systems exhibit a variety of cilia morphologies, beat patterns, and arrangements, resulting in complex flow patterns and transport phenomena that cannot be reduced to a single parameter. Here we present two case studies. In one system, the ciliated surface creates two distinct flow regimes for first trapping and then sheltering potential symbiont bacteria for further biochemical screening. In the other system, chronic disease induces a misalignment of ciliary beat, leading to a pathological transition from uniform mucus transport to a pattern of stagnation and circulation. These studies suggest that (a), we need to develop a wider range of metrics for describing ciliary transport in biological and clinical contexts, and (b), engineered ciliated systems exploiting a variety of design parameters could provide novel ways of manipulating fluids at the microscale.

  7. Looking forward and looking back: integrating completion and sunk-cost effects within an escalation-of-commitment progress decision.

    Science.gov (United States)

    Moon, H

    2001-02-01

    Currently, there are 2 conflicting frameworks with which to understand why decision makers might escalate their commitment to a previously chosen course of action: sunk costs and project completion. The author proposes that sunk costs and need to complete exert simultaneous pressures, both independent and interactive, on a decision maker's level of commitment. The responses of 340 participants were analyzed and supported a complementary relationship between the 2 predictors. In addition, sunk costs demonstrated a curvilinear influence on commitment and an interaction with level of completion that supported a Level of Completion x Sunk Cost moderation model. (A marginal utility model was not supported.) Results are discussed in terms of their relevance toward offering a complementary view of 2 potential antecedents to a decision maker's propensity to escalate his or her commitment to a previously chosen course of action.

  8. Enrollment, Childbearing Motivations, and Intentions of Couples in the Creighton Model Effectiveness, Intentions, and Behaviors Assessment (CEIBA Study

    Directory of Open Access Journals (Sweden)

    Joseph B. Stanford

    2017-09-01

    Full Text Available ContextThe Creighton Model FertilityCareTM System (CrM is a standardized approach for educating women about the biomarkers of their fertility. Couples can use this information for timing intercourse during “fertile” or “infertile” days in order to try to conceive or to avoid pregnancy.ObjectivesThe study of Creighton Model Effectiveness, Intentions, and Behaviors Assessment (CEIBA was conducted to assess fertility motivations, intentions, fertility-related sexual behaviors, and their impact on effectiveness to avoid and to conceive among new users of the CrM. This paper reports enrollment baseline characteristics.Settings and designWe conducted this prospective cohort study at 17 CrM FertilityCareTM Centers; 16 in the USA and one in Toronto, Canada.Materials and methodsCouples who were new or returning users of the CrM were eligible. Couples who were initially trying to conceive or had a history of subfertility were excluded. Couples were enrolled and followed prospectively by their CrM instructors and also by CEIBA study staff. They completed baseline questionnaires.Results1,132 new couples were assessed; 1,090 (96% couples were screened; 429 (39% couples were eligible; 305 women (71% and 290 (95% male partners were enrolled. The majority of women was engaged (39% or married (51%, college graduates (77%, Caucasian non-Hispanic (80%, and Roman Catholic (80%. The most common reasons for learning CrM (women were to use a natural method for family planning (91%, for moral/ethical/religious reasons (70%, the lack of side effects (71%, or insight into the menstrual cycle and fertility (62%. Women and men intended to have a mean of three and two additional children, respectively. Of women, 21% intended to have a child within a year and 60% between 1 and 3 years. The mean positive childbearing motivation score was 3.3 for both women and men (range 1–4, with 4 being most positive.ConclusionCouples beginning use of the CrM to avoid pregnancy

  9. Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making: a qualitative study from rural Vietnam.

    Science.gov (United States)

    Klingberg-Allvin, Marie; Berggren, Vanja; Binh, Nguyen Thanh; Bijay, Bharati; Johansson, Annika

    2012-01-01

    Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.

  10. Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas. Results of a prospective phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Piroth, M.D.; Pinkawa, M.; Holy, R. [RWTH Aachen University Hospital (Germany). Dept. of Radiation Oncology; Forschungszentrum Juelich GmbH (DE). Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain] (and others)

    2012-04-15

    Dose escalations above 60 Gy based on MRI have not led to prognostic benefits in glioblastoma patients yet. With positron emission tomography (PET) using [{sup 18}F]fluorethyl-L-tyrosine (FET), tumor coverage can be optimized with the option of regional dose escalation in the area of viable tumor tissue. In a prospective phase II study (January 2008 to December 2009), 22 patients (median age 55 years) received radiochemotherapy after surgery. The radiotherapy was performed as an MRI and FET-PET-based integrated-boost intensity-modulated radiotherapy (IMRT). The prescribed dose was 72 and 60 Gy (single dose 2.4 and 2.0 Gy, respectively) for the FET-PET- and MR-based PTV-FET{sub (72 Gy)} and PTV-MR{sub (60 Gy)}. FET-PET and MRI were performed routinely for follow-up. Quality of life and cognitive aspects were recorded by the EORTC-QLQ-C30/QLQ Brain20 and Mini-Mental Status Examination (MMSE), while the therapy-related toxicity was recorded using the CTC3.0 and RTOG scores. Median overall survival (OS) and disease-free survival (DFS) were 14.8 and 7.8 months, respectively. All local relapses were detected at least partly within the 95% dose volume of PTV-MR{sub (60 Gy)}. No relevant radiotherapy-related side effects were observed (excepted alopecia). In 2 patients, a pseudoprogression was observed in the MRI. Tumor progression could be excluded by FET-PET and was confirmed in further MRI and FET-PET imaging. No significant changes were observed in MMSE scores and in the EORTC QLQ-C30/QLQ-Brain20 questionnaires. Our dose escalation concept with a total dose of 72 Gy, based on FET-PET, did not lead to a survival benefit. Acute and late toxicity were not increased, compared with historical controls and published dose-escalation studies. (orig.)

  11. Words of Violence: “Fear Speech,” or How Violent Conflict Escalation Relates to the Freedom of Expression

    OpenAIRE

    Buyse, Antoine

    2014-01-01

    The limits of the freedom of expression are a perennial discussion in human rights discourse. This article focuses on identifying yardsticks to establish the boundaries of freedom of expression in cases where violence is a risk. It does so by using insights from the social sciences on the escalation of violent conflict. By emphasizing the interaction between violence and discourse, and its effect on antagonisms between groups, it offers an interdisciplinary perspective on an ongoing legal deb...

  12. Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

    Science.gov (United States)

    Johnston, Maximilian J; King, Dominic; Arora, Sonal; Cooper, Kerri; Panda, Neha Aparajita; Gosling, Rebecca; Singh, Kaushiki; Sanders, Bradley; Cox, Benita; Darzi, Ara

    2014-08-01

    In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety. © 2014 John Wiley & Sons, Ltd.

  13. Early Childbearing, Human Capital Attainment, and Mortality Risk: Evidence from a Longitudinal Demographic Surveillance Area in Rural KwaZulu-Natal, South Africa

    OpenAIRE

    Cally Ardington; Alicia Menendez; Tinofa Mutevedzi

    2015-01-01

    Using a rich longitudinal data set, we examine the relationship between teen fertility and both subsequent educational outcomes and HIV-related mortality risk in rural South Africa. Human capital deficits among teen mothers are large and significant, with earlier births associated with greater deficits. In contrast to many other studies from developed countries, we find no clear evidence of selectivity into teen childbearing in either schooling trajectories or prefertility household character...

  14. Evaluating the micronutrient status of women of child-bearing age living in the rural disaster areas one year after Wenchuan Earthquake.

    Science.gov (United States)

    Dong, Caixia; Ge, Pengfei; Ren, Xiaolan; Zhao, Xianfeng; Fan, Haoqiang; Yin, Shi-An; Weiderpass, Elisabete

    2014-01-01

    Populations with special physiological state, such as pregnant, nursing and women of child-bearing age, have been identified as nutritionally vulnerable during natural disaster. The objective of this survey was to evaluate the prevalence of anaemia and micronutrient status of women of reproductive age in April 2009 one year after the Wenchuan Earthquake. The survey recruited 58 pregnant, 66 lactating and 242 women of child-bearing age from 19 to 45 years. The concentrations of haemoglobin in whole blood and ferritin and micronutrients in serum were assayed. Among the three groups (pregnant, nursing and child-bearing women), respectively, the prevalence of anaemia was 29.1%, 25.5% and 28.8%; that of iron deficiency was 45.4%, 49.0% and 52.9%; and that of zinc deficiency was 45.4%, 23.0% and 33.5%. The sum of vitamin D deficiency and insufficiency was more than 90% in each group, and the total vitamin B12 deficiency and marginal deficiency prevalence percentages were 47.3%, 17.7% and 35.7%, respectively. The prevalence of vitamin A deficiency and marginal deficiency was 1.8% and 9.1% in pregnant women, 6.1% and 15.2% in nursing women and 8.6% and 21.3% in women of child-bearing age, respectively. Our findings indicated that the micronutrient status of women of reproductive age was poor in the disaster areas. Therefore, improving the micronutrient status of these women should be an urgent priority in these areas.

  15. What Influences Adolescent Girls' Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh.

    Directory of Open Access Journals (Sweden)

    A S M Shahabuddin

    Full Text Available Bangladesh has the highest rate of adolescent pregnancy in South Asia. Child marriage is one of the leading causes of pregnancies among adolescent girls. Although the country's contraceptive prevalence rate is quite satisfactory, only 52% of married adolescent girls use contraceptive methods. This qualitative study is aimed at exploring the factors that influence adolescent girls' decision-making process in relation to contraceptive methods use and childbearing.We collected qualitative data from study participants living in Rangpur district, Bangladesh. We conducted 35 in-depth interviews with married adolescent girls, 4 key informant interviews, and one focus group discussion with community health workers. Adolescent girls showed very low decision-making autonomy towards contraceptive methods use and childbearing. Decisions were mainly made by either their husbands or mothers-in-law. When husbands were unemployed and financially dependent on their parents, then the mothers-in-law played most important role for contraceptive use and childbearing decisions. Lack of reproductive health knowledge, lack of negotiation and communication ability with husbands and family members, and mistrust towards contraceptive methods also appeared as influential factors against using contraception resulting in early childbearing among married adolescent girls.Husbands and mothers-in-law of newly married adolescent girls need to be actively involved in health interventions so that they make more informed decisions regarding contraceptive use to delay pregnancies until 20 years of age. Misunderstanding and distrust regarding contraceptives can be diminished by engaging the wider societal actors in health intervention including neighbours, and other family members.

  16. Rituximab and escalated chemotherapy in elderly patients with aggressive diffuse large-cell lymphoma: a controlled clinical trial.

    Science.gov (United States)

    Avilés, Agustin; Nambo, María Jesus; Castañeda, Claudia; Cleto, Sergio; Neri, Natividad; Murillo, Edgar; Huerta-Guzmán, Judith; Contreras, Margarita

    2007-04-01

    The treatment of elderly patients with aggressive malignant lymphoma has not been defined. The addition of rituximab to conventional chemotherapy has been reported to improve the outcome, but most patients have good prognostic factors (performance status < 2, no severe associated diseases, low or low-intermediate clinical risk). Thus, we developed a combined regimen, including escalated doses of anthracycline and rituximab. The endpoint was to improve event-free survival (EFS) and overall survival. Two hundred and four (204) patients were randomly assigned to receive an escalated chemotherapy regimen (CEOP) with escalated dose of epirubicin, compared to the same regimen and addition of rituximab. All patients had poor prognostic factors: high- or high-intermediate clinical risk, poor performance status, bulky disease, and more than 2 with extranodal involvement. In an intent-to-treat analysis, all patients were evaluable for efficacy and toxicity. The complete response rates were similar in both arms: 74% in chemotherapy and 78% in the rituximab + chemotherapy program. EFS and overall survival were similar: 77% and 84%, respectively, in combined chemotherapy and 75% and 81% in the rituximab-chemotherapy regimen. Toxicity was mild and well tolerated. In elderly patients with diffuse large-cell lymphoma and poor prognostic factors, rituximab did not improve their outcome.

  17. Anuvasan Basti in escalating dose is an alternative for Snehapana before Vamana and Virechana: Trends from a pilot study

    Directory of Open Access Journals (Sweden)

    Priyadarshani Arvind Kadus

    2014-01-01

    Full Text Available Oral administration of medicated fats (oil or ghee is termed as Snehapana. It is an essential step before Vamana (therapeutic emesis and Virechana (therapeutic purgation. Ayurveda physicians often experience a poor compliance in 10-15% patients for oral administration of medicated fats especially in escalating doses. Incomplete Snehapana sometimes creates a problem for a physician to prepare the patient for these processes. These inconveniences made us think about effective alternatives to counter drawbacks and improve acceptance of Snehapana. The present study was planned to assess the efficacy of Anuvasana Basti (oil enema in escalating doses as an alternative for Snehapana. Anuvasana Basti of medicated sesame oil with rock salt was administered in 10 patients for three to seven days till they showed signs and symptoms of complete Snehana. The symptoms of Snehana like semisolid or loose stools, feeling exhausted without much exertion, lightness of body and oiliness of skin were observed. Though the Snehana symptoms varied in intensity, they were similar as they are produced after oral administration of fats. This trend suggests Anuvasana Basti in escalating dose is an alternative for Snehapana before administration of Shodhana therapy like Vamana or Virechana.

  18. Strategies of dose escalation in the treatment of locally advanced non-small cell lung cancer: image guidance and beyond

    Directory of Open Access Journals (Sweden)

    Alexander eChi

    2014-06-01

    Full Text Available Radiation dose in the setting of chemo-radiation for locally advanced non-small cell lung cancer (NSCLC has been historically limited by the risk of normal tissue toxicity and this has been hypothesized to correlate with the poor results in regard to local tumor recurrences. Dose escalation, as a means to improve local control, with concurrent chemotherapy has been shown to be feasible with three-dimensional conformal radiotherapy in early phase studies with good clinical outcome. However, the potential superiority of moderate dose escalation to 74 Gy has not been shown in phase III randomized studies. In this review, the limitations in target volume definition in previous studies; and the factors that may be critical to safe dose escalation in the treatment of locally advanced NSCLC, such as respiratory motion management, image guidance, intensity modulation, FDG-PET incorporation in the treatment planning process, and adaptive radiotherapy, are discussed. These factors, along with novel treatment approaches that have emerged in recent years, are proposed to warrant further investigation in future trials in a more comprehensive and integrated fashion.

  19. Childbearing dynamics of couples in a universalistic welfare state: The role of labor-market status, country of origin, and gender

    Directory of Open Access Journals (Sweden)

    Kirk Scott

    2007-12-01

    Full Text Available This article studies childbearing dynamics by labor-market status of co-residing parents in Sweden. We apply event-history techniques to longitudinal register data on the life histories of foreign-born mothers from ten different countries and the partners to these women, as well as to a sample of Swedish-born mothers and their partners. The context is a universalistic welfare state geared towards gender and social equality where formal social rights are largely independent of a person's civil status, citizenship, and country of origin. We investigate the extent to which the associations of parents' labor-market status with childbearing in Sweden differ between women and men and by country of origin. We find that the patterns of association are fairly similar on both of these individual dimensions. As measured by the way the labor-market activity of parents is related to their subsequent childbearing, we find evidence of equality by gender and at least some evidence of integration of immigrants into the dynamics of Swedish society.

  20. Strategic Stability Reconsidered: Prospects for Escalation and Nuclear War in the Middle East

    Energy Technology Data Exchange (ETDEWEB)

    Russell, J.A.

    2009-07-01

    for survival'. The paper first draws upon Thomas Schelling's ideas to assess the regional strategic framework, and finds systemic uncertainties which suggest that escalation by various parties - state and non-state actors - is a possible outcome. Both near-term and long-term scenarios are considered. The near-term nuclear use scenarios are all predicated on the assumption that nuclear use will occur within the context of escalation to or within war. As dangerous as these circumstances are, longer-term scenarios for nuclear use will also be proposed, which, like the alarming near-term scenarios, flow from the same unstable regional dynamics. The Middle East's unstable dynamics occur within a global environment characterized by a general sense of insecurity about various nuclear issues. Reflecting this situation, the Bulletin of Atomic Scientists recently moved its 'Doomsday Clock' from seven- to five minutes to midnight - the most advanced setting since 1981. Citing Iran's nuclear ambitions, North Korea's test of a nuclear weapon, the failure to secure nuclear materials, a controversial U.S. nuclear doctrine that some argue suggests an expanded role for nuclear weapons, and the continued presence of 26,000 nuclear weapons in the United States and Russia, the Bulletin expressed new concerns about global strategic stability. These developments occurred against a backdrop of the collapse of the 2005 Nonproliferation Treaty Review conference due, among other things, to disinterest in the global community in supporting the spread of nonproliferation norms. (author)

  1. Overview Chapter 5: Determinants of family formation and childbearing during the societal transition in Central and Eastern Europe

    Directory of Open Access Journals (Sweden)

    Tomas Frejka

    2008-07-01

    Full Text Available Societal conditions for early and high rates of childbearing were replaced by conditions generating late and low levels of fertility common in Western countries. Central among factors shaping the latter behaviour (job insecurity, unstable partnership relationships, expensive housing, and profound changes in norms, values and attitudes were the following: increasing proportions of young people were acquiring advanced education, a majority of women were gainfully employed, yet women were performing most household maintenance and childrearing duties. Two theories prevailed to explain what caused changes in family formation and fertility trends. One argues that the economic and social crises were the principal causes. The other considered the diffusion of western norms, values and attitudes as the prime factors of change. Neither reveals the root cause: the replacement of state socialist regimes with economic and political institutions of contemporary capitalism. The extraordinarily low period TFRs around 2000 were the result of low fertility of older women born around 1960 overlapping with low fertility of young women born during the 1970s.

  2. [Abnormal eating behaviours are not associated with micronutrient deficiencies among women of childbearing age from Mexico City].

    Science.gov (United States)

    Bojórquez-Chapela, Ietza; Mendoza-Flores, María Eugenia; Tolentino, Maricruz; Morales, Rosa Maria; De-Regil, Luz María

    2010-03-01

    The aim of this study was to evaluate the association between the risk of abnormal eating behaviors (AEB) and vitamin and mineral deficiencies among women. Women of childbearing age (n = 282) were systematically sampled with a random start (21.9% adolescents) in 6 suburbs in the west side of Mexico City, they were non pregnant or breastfeeding. Vitamin A, C, E, B12, folic acid, hemoglobin, ferritin, cupper, iron and zinc concentrations were measured. A questionnaire validated in the Mexican population was used for screening AEB. Data were analyzed by descriptive statistics and by using Fisher's test. Approximately 68% of the sample belonged to a mid-low or lower socioeconomic status. 14% had risk of AEB, without statistical differences between adults and teenagers. 10% used diuretics or laxatives to reduce weight within the trimester preceding the survey. Vitamin E, zinc and iron were the most widespread deficiencies affecting 47%, 44% and 27% of the population, respectively. There was no association between the AEB and micronutrient deficiencies neither when AEB were analyzed globally nor individually. Considering these results and the high prevalence of the AEB and overweight in this population, it is important to promote the adoption or healthy behaviors to achieve an adequate weight.

  3. Projected impact of the trend toward delayed childbearing on breast cancer incidence in the Saarland/FRG.

    Science.gov (United States)

    Brenner, H; Stegmaier, C

    1990-01-01

    The potential impact of the trend toward delayed childbearing or nulliparity on future breast cancer incidence is quantitatively assessed for the Saarland/FRG. Distribution of age at first birth is estimated from vital statistics for seven five-year birth cohorts from 1936-40 to 1966-70. Estimates of the relative risks associated with age at first birth or nulliparity are based on median results of 23 controlled epidemiologic studies conducted in Europe and North America. Compared to the birth cohorts around 1940, a steady increase in incidence up to about +15% is projected for the younger cohorts indicating a substantial public health impact. Using data of the population based cancer registry of the Saarland, the cumulative incidence of breast cancer up to age 50 is calculated as 1.52% for the 1936-40 birth cohort and is projected to rise to 1.75% in the 1966-70 cohort. Similar changes in fertility patterns have been observed in other parts of the FRG. Given the continuing rise in mortality from breast cancer in the FRG this stresses the need for more effective screening procedures.

  4. Exposure to solar ultraviolet radiation is associated with a decreased folate status in women of childbearing age.

    Science.gov (United States)

    Borradale, D; Isenring, E; Hacker, E; Kimlin, M G

    2014-02-05

    In vitro studies indicate that folate in collected human blood is vulnerable to degradation after exposure to ultraviolet (UV) radiation. This has raised concerns about folate depletion in individuals with high sun exposure. Here, we investigate the association between personal solar UV radiation exposure and serum folate concentration, using a three-week prospective study that was undertaken in females aged 18-47years in Brisbane, Australia (153 E, 27 S). Following two weeks of supplementation with 500μg of folic acid daily, the change in serum folate status was assessed over a 7-day period of measured personal sun exposure. Compared to participants with personal UV exposures of 600 Joules per day had significantly higher depletion of serum folate (p=0.015). Multivariable analysis revealed personal UV exposure as the strongest predictor accounting for 20% of the overall change in serum folate (Standardised B=-0.49; t=-3.75; p=solar UV radiation exposures reduces the effectiveness of folic acid supplementation. The consequences of this association may be most pronounced for vulnerable individuals, such as women who are pregnant or of childbearing age with high sun exposures.

  5. A randomised controlled trial of the efficacy and safety of allopurinol dose escalation to achieve target serum urate in people with gout.

    Science.gov (United States)

    Stamp, Lisa K; Chapman, Peter T; Barclay, Murray L; Horne, Anne; Frampton, Christopher; Tan, Paul; Drake, Jill; Dalbeth, Nicola

    2017-09-01

    To determine the efficacy and safety of allopurinol dose escalation using a treat-to-target serum urate (SU) approach. A randomised, controlled, parallel-group, comparative clinical trial was undertaken. People with gout receiving at least creatinine clearance (CrCL)-based allopurinol dose for ≥1 month and SU ≥6 mg/dL were recruited. Participants were randomised to continue current dose (control) or allopurinol dose escalation for 12 months. In the dose escalation group, allopurinol was increased monthly until SU was treatment target in most people with gout. Allopurinol dose escalation is well tolerated. ANZCTR12611000845932; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Dose-Escalation Study for Cardiac Radiosurgery in a Porcine Model

    Energy Technology Data Exchange (ETDEWEB)

    Blanck, Oliver, E-mail: oliver.blanck@uksh.de [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); CyberKnife Center Northern Germany, Guestrow (Germany); Bode, Frank [Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Gebhard, Maximilian [Institute of Pathology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Hunold, Peter [Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Brandt, Sebastian [Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Bruder, Ralf [Institute for Robotics and Cognitive Systems, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Grossherr, Martin [Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Vonthein, Reinhard [Institute of Medical Biometry and Statistics, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Rades, Dirk [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Dunst, Juergen [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); University Copenhagen (Denmark)

    2014-07-01

    Purpose: To perform a proof-of-principle dose-escalation study to radiosurgically induce scarring in cardiac muscle tissue to block veno-atrial electrical connections at the pulmonary vein antrum, similar to catheter ablation. Methods and Materials: Nine mini-pigs underwent pretreatment magnetic resonance imaging (MRI) evaluation of heart function and electrophysiology assessment by catheter measurements in the right superior pulmonary vein (RSPV). Immediately after examination, radiosurgery with randomized single-fraction doses of 0 and 17.5-35 Gy in 2.5-Gy steps were delivered to the RSPV antrum (target volume 5-8 cm{sup 3}). MRI and electrophysiology were repeated 6 months after therapy, followed by histopathologic examination. Results: Transmural scarring of cardiac muscle tissue was noted with doses ≥32.5 Gy. However, complete circumferential scarring of the RSPV was not achieved. Logistic regressions showed that extent and intensity of fibrosis significantly increased with dose. The 50% effective dose for intense fibrosis was 31.3 Gy (odds ratio 2.47/Gy, P<.01). Heart function was not affected, as verified by MRI and electrocardiogram evaluation. Adjacent critical structures were not damaged, as verified by pathology, demonstrating the short-term safety of small-volume cardiac radiosurgery with doses up to 35 Gy. Conclusions: Radiosurgery with doses >32.5 Gy in the healthy pig heart can induce circumscribed scars at the RSPV antrum noninvasively, mimicking the effect of catheter ablation. In our study we established a significant dose-response relationship for cardiac radiosurgery. The long-term effects and toxicity of such high radiation doses need further investigation in the pursuit of cardiac radiosurgery for noninvasive treatment of atrial fibrillation.

  7. Short-term Disulfiram to Reverse Latent HIV Infection: A Phase 2 Dose Escalation Study

    Science.gov (United States)

    Elliott, Julian H.; McMahon, James H.; Chang, Christina C.; Lee, Sulggi A.; Hartogensis, Wendy; Bumpus, Namandje; Savic, Rada; Roney, Janine; Hoh, Rebecca; Solomon, Ajantha; Piatak, Michael; Gorelick, Robert J.; Lifson, Jeff; Bacchetti, Peter; Deeks, Steven G.; Lewin, Sharon R.

    2016-01-01

    Background Disulfiram activates HIV transcription in a primary T-cell model of HIV latency and in a pilot clinical study increased plasma HIV RNA in individuals with adequate diulfiram exposure. Methods We conducted a prospective dose escalation study in order to optimise disulfiram exposure. Thirty people with HIV on suppressive antiretroviral therapy (ART) were enrolled, allocated sequentially to one of three dosing cohorts and received disulfiram daily for three days at a dose of 500mg, 1000mg or 2000mg. The primary endpoint was cell-associated unspliced (CA-US) HIV RNA in CD4+ T-cells. The study is registered with ClinicalTrials.gov, number NCT01944371. Findings The estimated fold increases in CA-US HIV RNA during and post-disulfiram for each cohort were: 500mg: 1·7 (95% confidence interval 1·3 – 2·2) and 2·1 (1·5 – 2·9); 1000mg: 1·9 (1·6 – 2·4) and 2·5 (1·9 – 3·3); and 2000mg: 1·6 (1·2 – 2·1) and 2·1 (1·5 – 3·1) respectively (p<0·003 for all). Disulfiram was well tolerated at all doses. Interpretation Short-term administration of disulfiram resulted in increases in CA-US HIV RNA at all doses, consistent with activating HIV latency. Disulfiram may be suited for future studies of combination and prolonged therapy to activate latent HIV. PMID:26614966

  8. Correcting the Science Record: Direct Stratospheric Injection vs. Asian Monsoon and the Solar Escalator

    Science.gov (United States)

    Fromm, M. D.; Nedoluha, G. E.; Kablick, G. P.

    2012-12-01

    Two entries in the literature in 2012 make provocative but unsupportable claims regarding pollutant pathways from the Earth to the stratosphere. One claims the 13 June 2011 Nabro volcano (Eritrea) emitted gases and particles into the troposphere, and these constituents reached the stratosphere in great abundance via the Asian Monsoon circulation [Bourassa et al., 2012]. The other claims that smoke from the Black Saturday fire storms (Australia) was emitted into the troposphere, and was lofted ~15 km into the stratosphere by solar-induced diabatic heating [de Laat et al., 2012]. In both cases the stratospheric plumes attributed to these events spread around the globe and lasted for months. We will show that in both cases the postulated pathways are incorrect; the correct pathway is a direct convective injection by volcanic eruption and pyrocumulonimbus (pyroCb), respectively. We will present satellite data that will unambiguously reveal multiple, distinct stratospheric volcano-convection columns from Nabro connected to height-resolved volcanic SO2 and sulfate particles. In the case of Black Saturday we will characterize the pyroCb columns with ground-based radar and satellite imagery. The young pyroCb plume in the stratosphere will be characterized with a synergistic analysis of several NASA A-Train passive and active remote sensors. We will discuss the implications of our findings with respect to how satellite-based data are best used for tracking and characterizing point source injection plumes in the stratosphere. Bourassa et al. (2012), Large Volcanic Aerosol Load in the Stratosphere Linked to Asian Monsoon Transport, Science, 337, 78, DOI: 10:1126/Science.1219371 de Laat, et al. (2012), A solar escalator: Observational evidence of the self-lifting of smoke and aerosols by absorption of solar radiation in the February 2009 Australian Black Saturday plume, J. Geophys. Res., 117, D04204, doi:10.1029/2011JD017016.

  9. Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Geier, M.; Astner, S.T.; Duma, M.N.; Putzhammer, J.; Winkler, C.; Molls, M.; Geinitz, H. [Technische Univ. Muenchen (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Jacob, V. [Universitaetsklinikum Freiburg (Germany). Klinik fuer Strahlenheilkunde; Nieder, C. [Nordland Hospital, Bodoe (Norway). Dept. of Oncology and Palliative Care; Tromsoe Univ. (Norway). Inst. of Clinical Medicine

    2012-05-15

    The goal of this work was to assess the feasibility of moderately hypofractionated simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) with helical tomotherapy in patients with localized prostate cancer regarding acute side effects and dose-volume histogram data (DVH data). Acute side effects and DVH data were evaluated of the first 40 intermediate risk prostate cancer patients treated with a definitive daily image-guided SIB-IMRT protocol via helical tomotherapy in our department. The planning target volume including the prostate and the base of the seminal vesicles with safety margins was treated with 70 Gy in 35 fractions. The boost volume containing the prostate and 3 mm safety margins (5 mm craniocaudal) was treated as SIB to a total dose of 76 Gy (2.17 Gy per fraction). Planning constraints for the anterior rectal wall were set in order not to exceed the dose of 76 Gy prescribed to the boost volume. Acute toxicity was evaluated prospectively using a modified CTCAE (Common Terminology Criteria for Adverse Events) score. SIB-IMRT allowed good rectal sparing, although the full boost dose was permitted to the anterior rectal wall. Median rectum dose was 38 Gy in all patients and the median volumes receiving at least 65 Gy (V65), 70 Gy (V70), and 75 Gy (V75) were 13.5%, 9%, and 3%, respectively. No grade 4 toxicity was observed. Acute grade 3 toxicity was observed in 20% of patients involving nocturia only. Grade 2 acute intestinal and urological side effects occurred in 25% and 57.5%, respectively. No correlation was found between acute toxicity and the DVH data. This institutional SIB-IMRT protocol using daily image guidance as a precondition for smaller safety margins allows dose escalation to the prostate without increasing acute toxicity. (orig.)

  10. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects

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    Gupta Shaon

    2009-07-01

    Full Text Available Abstract Background Cardiovascular risk factors start early, track through the young age and manifest in middle age in most societies. We conducted epidemiological studies to determine prevalence and age-specific trends in cardiovascular risk factors among adolescent and young urban Asian Indians. Methods Population based epidemiological studies to identify cardiovascular risk factors were performed in North India in 1999–2002. We evaluated major risk factors-smoking or tobacco use, obesity, truncal obesity, hypertension, dysglycemia and dyslipidemia using pre-specified definitions in 2051 subjects (male 1009, female 1042 aged 15–39 years of age. Age-stratified analyses were performed and significance of trends determined using regression analyses for numerical variables and Χ2 test for trend for categorical variables. Logistic regression was used to identify univariate and multivariate odds ratios (OR for correlation of age and risk factors. Results In males and females respectively, smoking or tobacco use was observed in 200 (11.8% and 18 (1.4%, overweight or obesity (body mass index, BMI ≥ 25 kg/m2 in 12.4% and 14.3%, high waist-hip ratio, WHR (males > 0.9, females > 0.8 in 15% and 32.3%, hypertension in 5.6% and 3.1%, high LDL cholesterol (≥ 130 mg/dl in 9.4% and 8.9%, low HDL cholesterol ( Conclusion Low prevalence of multiple cardiovascular risk factors (smoking, hypertension, dyslipidemias, diabetes and metabolic syndrome in adolescents and rapid escalation of these risk factors by age of 30–39 years is noted in urban Asian Indians. Interventions should focus on these individuals.

  11. Escalation, retreat, and female indifference as alternative outcomes of sexually antagonistic coevolution.

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    Rowe, Locke; Cameron, Erin; Day, Troy

    2005-05-01

    Verbal and quantitative genetic models of sexually antagonistic coevolution suggest that coevolutionary arms races should be common. Sexual selection favors exaggeration of male persistence traits that are costly to females, and females, in turn, are selected to resist these traits. The heightened resistance by females is thought to then favor further exaggeration in the male trait, leading to an escalating coevolutionary arms race between persistence and resistance traits. Much of this theory, however, is based on an (implicit) assumption that there are tight constraints on how female resistance can evolve. We develop a theory that identifies and relaxes these constraints, allowing female resistance to evolve in a fashion that better reflects known empirical patterns in the evolution of female preference functions (the resistance trait). Our results suggest that evolutionary arms races that lead to the exaggeration of persistence and resistance will be much less common than formerly predicted. Females sometimes evolve indifference to male traits rather than resistance and can even evolve to discriminate against these traits. These alternative outcomes depend on the existence of genetic variance in the components of the female sensory system underlying female resistance and on the strength of natural selection acting on these components. Female indifference tends to evolve when natural selection on the sensory system is weak, and under these conditions, sexually antagonistic coevolution tends not to reduce female fitness significantly at equilibrium. When natural selection on the female sensory system is strong, however, then arms races are more likely, and female fitness is then sometimes significantly depressed at equilibrium. Sexually antagonistic coevolution is thus likely to have strong deleterious effects on population fitness only when female sensory traits are under strong natural selection to perform functions in addition to those involved with mating

  12. Controlling cost escalation of healthcare: making universal health coverage sustainable in China.

    Science.gov (United States)

    Tang, Shenglan; Tao, Jingjing; Bekedam, Henk

    2012-01-01

    An increasingly number of low- and middle-income countries have developed and implemented a national policy towards universal coverage of healthcare for their citizens over the past decade. Among them is China which has expanded its population coverage by health insurance from around 29.7% in 2003 to over 90% at the end of 2010. While both central and local governments in China have significantly increased financial inputs into the two newly established health insurance schemes: new cooperative medical scheme (NCMS) for the rural population, and urban resident basic health insurance (URBMI), the cost of healthcare in China has also been rising rapidly at the annual rate of 17.0%% over the period of the past two decades years. The total health expenditure increased from 74.7 billion Chinese yuan in 1990 to 1998 billion Chinese yuan in 2010, while average health expenditure per capital reached the level of 1490.1 Chinese yuan per person in 2010, rising from 65.4 Chinese yuan per person in 1990. The repaid increased population coverage by government supported health insurance schemes has stimulated a rising use of healthcare, and thus given rise to more pressure on cost control in China.There are many effective measures of supply-side and demand-side cost control in healthcare available. Over the past three decades China had introduced many measures to control demand for health care, via a series of co-payment mechanisms. The paper introduces and discusses new initiatives and measures employed to control cost escalation of healthcare in China, including alternative provider payment methods, reforming drug procurement systems, and strengthening the application of standard clinical paths in treating patients at hospitals, and analyses the impacts of these initiatives and measures. The paper finally proposes ways forward to make universal health coverage in China more sustainable.

  13. Releasing stimuli and aggression in crickets: octopamine promotes escalation and maintenance but not initiation

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    Jan eRillich

    2015-04-01

    Full Text Available Biogenic amines have widespread effects on numerous behaviors, but their natural functions are often unclear. We investigated the role of octopamine (OA, the invertebrate analogue of noradrenaline, on initiation and maintenance of aggression in male crickets of different social status. The key-releasing stimulus for aggression is antennal fencing between males, a behavior occurring naturally on initial contact. We show that mechanical antennal stimulation (AS alone is sufficient to initiate an aggressive response (mandible threat display. The efficacy of AS was augmented in winners of a previous fight, but unaffected in losers. The efficacy of AS was not, however, influenced by OA receptor (OAR agonists or antagonists, regardless of social status. Additional experiments indicate that the efficacy of AS is also not influenced by dopamine (DA or serotonin (5HT. In addition to initiating an aggressive response, prior AS enhanced aggression exhibited in subsequent fights, whereby AS with a male antenna was now necessary, indicating a role for male contact pheromones. This priming effect of male-AS on subsequent aggression was dependent on OA since it was blocked by OAR-antagonists, and enhanced by OAR-agonists. Together our data reveal that neither OA, DA nor 5HT are required for initiating aggression in crickets, nor do these amines influence the efficacy of the natural releasing stimulus to initiate aggression. OA’s natural function is restricted to promoting escalation and maintenance of aggression once initiated, and this can be invoked by numerous experiences, including prior contact with a male antenna as shown here.

  14. Decision Regret in Men Undergoing Dose-Escalated Radiation Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Steer, Anna N. [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Aherne, Noel J., E-mail: noel.aherne@ncahs.health.nsw.gov.au [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Rural Clinical School Faculty of Medicine, University of New South Wales, Coffs Harbour (Australia); Gorzynska, Karen; Hoffman, Matthew; Last, Andrew; Hill, Jacques [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Shakespeare, Thomas P. [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Rural Clinical School Faculty of Medicine, University of New South Wales, Coffs Harbour (Australia)

    2013-07-15

    Purpose: Decision regret (DR) is a negative emotion associated with medical treatment decisions, and it is an important patient-centered outcome after therapy for localized prostate cancer. DR has been found to occur in up to 53% of patients treated for localized prostate cancer, and it may vary depending on treatment modality. DR after modern dose-escalated radiation therapy (DE-RT) has not been investigated previously, to our knowledge. Our primary aim was to evaluate DR in a cohort of patients treated with DE-RT. Methods and Materials: We surveyed 257 consecutive patients with localized prostate cancer who had previously received DE-RT, by means of a validated questionnaire. Results: There were 220 responses (85.6% response rate). Image-guided intensity modulated radiation therapy was given in 85.0% of patients and 3-dimensional conformal radiation therapy in 15.0%. Doses received included 73.8 Gy (34.5% patients), 74 Gy (53.6%), and 76 Gy (10.9%). Neoadjuvant androgen deprivation (AD) was given in 51.8% of patients and both neoadjuvant and adjuvant AD in 34.5%. The median follow-up time was 23 months (range, 12-67 months). In all, 3.8% of patients expressed DR for their choice of treatment. When asked whether they would choose DE-RT or AD again, only 0.5% probably or definitely would not choose DE-RT again, compared with 8.4% for AD (P<.01). Conclusion: Few patients treated with modern DE-RT express DR, with regret appearing to be lower than in previously published reports of patients treated with radical prostatectomy or older radiation therapy techniques. Patients experienced more regret with the AD component of treatment than with the radiation therapy component, with implications for informed consent. Further research should investigate regret associated with individual components of modern therapy, including AD, radiation therapy and surgery.

  15. Restriction of Convertible Bonds on Commitment Escalation%可转换债券对恶性增资的制约作用

    Institute of Scientific and Technical Information of China (English)

    唐洋; 胡张丽

    2012-01-01

    总结了已有的关于恶性增资形成机理及控制机制的研究成果,并且分析了股权融资及债券融资对恶性增资的治理作用。本文认为股权融资及债权融资都难以有效地控制恶性增资,而可转债作为一种特殊的融资方式,其特有的双重属性能够有效地制约恶性增资行为。具体来说,特别向下修正条款不仅不能制约恶性增资,反而会刺激恶性增资;回售条款能够在一定程度上制约恶性增资;赎回条款对恶性增资毫无治理作用。%The paper summarizes the findings about formation mechanism and control mechanism of commitment escalation,and analyzes the governance effect of equity financing and debt financing on commitment escalation.It thinks that equity financing and debt financing are difficult to control commitment escalation.However,dual properties of convertible bonds can help to restrict commitment escalation.Concretely speaking,the Downward Modification Provision can't restrict commitment escalation;on the contrary,it will stimulate commitment escalation.The Put Provision can restrict commitment escalation to some extent.The Call Provision has no governance effect on commitment escalation.

  16. Food fortification knowledge in women of child-bearing age at Nkowankowa township in Mopani District, Limpopo Province, South Africa.

    Science.gov (United States)

    Motadi, Selekane A; Mbhatsani, Vanessa; Shilote, Kulani O

    2016-07-29

    Globally, there is evidence that three micronutrients deficiencies are of public health concern among children. They are vitamin A, iodine and iron deficiencies. Communities particularly affected are those in situations where poverty, unemployment, civil unrest, war and exploitation remain endemic. Malnutrition is an impediment to productivity, economic growth and poverty eradication. It is estimated that 32% of the global burden would be removed by eliminating malnutrition, including micronutrients deficiencies. The study was carried out in NkowaNkowa township of Mopani District, Limpopo Province, South Africa. The main objective was to determine the women's knowledge on food fortification. The study design was descriptive. The snowballing method was used to identify women of child-bearing age. Data were collected from 120 participants using a questionnaire. The questionnaire consisted of socio-demographic, general questions on women's knowledge on food fortification. The questionnaire was administered by the researcher using the local language Xitsonga. The findings of the study revealed that a majority of 204 (57.0%) of the participants were able to define food fortification correctly while 257 (72.0%) of the participants knew which foods are fortified as well as the benefits of a food fortification programme. The majority (252 [70.0%]) of the participants knew that maize meal is one of the food vehicle used for fortification in South Africa. Most of the questions were answered correctly by more than 50.0% of the participants. The researcher deduced that the study participants are knowledgeable about food fortification based on the response given in relation to the programme.

  17. Screening of Toxoplasma gondii infection among childbearing age females and assessment of nurses' role in prevention and control of toxoplasmosis.

    Science.gov (United States)

    Saleh, Ahmed Megahed Ahmed; Ali, Hisham abd El-Raouf; Ahmed, Salwa Abdalla Mohamed; Hosny, Samah Mostafa; Morsy, Tosson A

    2014-08-01

    Toxoplasmosis, caused by Toxoplasma gondii is an obligate intracellular zoonotic protozoan parasite, with a worldwide distribution particularly in Arab countries including Egypt. The study evaluated toxoplasmosis infection among childbearing age Egyptian females and assessed the military nursing staff knowledge, attitude and compliance to toxoplasmosis prevention and control measures. The study was conductedin a general military hospital. CROSS-section descriptive research design was used to conduct this study. The subjects consisted of 14 young females (11 were in-patients undergoing gynecological treatment in a military hospital and 3 were staff nurses. On the other hand, 44 staff nurses were available for assessment who met the inclusion criteria. 4 tools were used for data collection: first consisted of self-administered questionnaires to assess nurses' socio-demographic data and knowledge, second rating scale to assess nurses' attitude towards toxoplasmosis infection and its prevention, third performance check list to measure nurses' compliance to infection control measures, and fourth measured the anti-Toxoplasma antibodies by commercial indirect hemagglutination test (IHAT). The results showed that almost half of the nurses had satisfactory levels of knowledge, attitude, and compliance to toxoplasmosis infection control measures. 22.2% of the pregnant women and 20% of non-pregnant ones showed antibodies against T. gondii. Thus health education about toxoplasmosis should be tailored to women whether married or single to help in avoiding the risk of infection. Frequent periodic IHAT should be done for people who continuously contact with cats. Adherence to strict infection prevention measures is a must to eliminate exposure to toxoplasmosis infection. Training intervention should be implemented to achieve successful improvement in knowledge, attitude, and compliance of toxoplasmosis control measures.

  18. The relation of the dynamics of anthropometric data in obese women of childbearing age with treatment type

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    S.I. Ismailov

    2017-05-01

    Full Text Available Background. The aim was to study efficiency of pathogenetic therapy and dynamics of anthropometric indexes in obese women of childbearing age having different endocrine patho­logy before and 6 months later after treatment. Materials and methods. Under an etiologic factor the obese patients were divided into three groups: with polycystic syndrome of ovaries (PCOS (n = 30, hypothalamic obesity (n = 21 and with obesity and primary hypothyroidism (n = 20. All patients were examined using biochemical, hormonal methods of research, magnetic resonance tomography of pituitary. Results. The patients of the first and second groups had significant decrease of body mass index (BMI after 6 months of treatment, while patients of the third group did not attain significant decrease of BMI over 6 months of treatment. In addition, 10 patients of the first group became pregnant (19.5 %. The patients of the first and second groups had significant improvement of indexes as compared to average data of waist circumference and waist — hip ratio against the treatment, while the patients of the third group did not find significant changes of those indexes over 6 months of treatment. Conclusions. The treatment with metformine in obese patients significantly improves clinical indices and declines BMI. Optimization of treatment of obesity in women of reproductive age is based on the individual programs, the choice of which is determined by the values of anthropometric indices, hormonal and metabolic status, features of food behavior and personality-emotional sphere, menstrual and reproductive functioning. Realization of curative measures complex considering the worked out algorithm of individual selection of obesity therapy allows reduce effectively and retain the attained body weight, improves somatic and reproductive health for the women of reproductive age.

  19. Impact of parental ages and other characteristics at childbearing on congenital anomalies: Results for the Czech Republic, 2000-2007

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    Jitka Rychtarikova

    2013-01-01

    Full Text Available BACKGROUND If the impact of maternal age at childbearing on congenital anomalies is well-known for the occurrence of Down syndrome, less is known concerning its effects on other major anomalies. Information is even scarcer for the possible effects of other maternal characteristics and of age of the father. OBJECTIVE We present new results on the associations between parental ages and other maternal characteristics, on the one hand, and congenital anomalies, on the other hand, using data linkage between three Czech registries on mother, newborn, and malformations, for the period 2000-2007. METHODS As the variables are in categorical format, binary logistic regression is used in order to investigate the relationship between presence/absence of a congenital anomaly, for each of the eleven types of anomalies considered, and the set of predictors. RESULTS This research confirms the impact of a higher age of the mother on Down syndrome and on other chromosomal anomalies. Paternal age is not associated with chromosomal anomalies and, in this Czech population, has a rather slight effect on some of the congenital anomalies examined. Another finding of the present study is the possible role of various other maternal characteristics on congenital malformations. CONCLUSIONS Based on a large data set, this study concludes that both parental ages can be associated with congenital anomalies of the child, and that maternal characteristics other than age have also to be considered. COMMENTS Risk factors can be tentatively proposed if they are based on a plausible and suitably tested explanatory mechanism. Unfortunately, in the majority of individual cases of congenital anomaly, the cause of the condition is still unknown and suspected to be an interaction of multiple environmental and genetic factors.

  20. Seafood consumption among pregnant and non-pregnant women of childbearing age in the United States, NHANES 1999–2006

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    Hilda Razzaghi

    2014-06-01

    Full Text Available Objectives: Long-chain polyunsaturated fatty acids found in seafood are essential for optimal neurodevelopment of the fetus. However, concerns about mercury contamination of seafood and its potential harm to the developing fetus have created uncertainty about seafood consumption for pregnant women. We compared fish and shellfish consumption patterns, as well as their predictors, among pregnant and non-pregnant women of childbearing age in the US. Methods: Data from 1,260 pregnant and 5,848 non-pregnant women aged 16–49 years from the 1999 to 2006 National Health and Nutrition Examination Survey (NHANES were analyzed. Frequency and type of seafood consumed and adjusted associations of multiple characteristics with seafood consumption were estimated for pregnant and non-pregnant women, separately. Time trends were also examined. Results: There were no significant differences in the prevalence of fish or shellfish consumption, separately or combined, between pregnant and non-pregnant women using either the 30-day questionnaire or the Day 1, 24-h recall. Seafood consumption was associated with higher age, income, and education among pregnant and non-pregnant women, and among fish consumers these groups were more likely to consume ≥3 servings in the past 30 days. Tuna and shrimp were the most frequently reported fish and shellfish, respectively, among both pregnant and non-pregnant women. We observed no significant time trends. Conclusion: There were no differences in seafood consumption between pregnant and non-pregnant women, and the factors related to seafood consumption were similar for both groups. Our data suggest that many women consume less than the recommended two servings of seafood a week.

  1. A planning study of radiotherapy dose escalation of PET-active tumour volumes in non-small cell lung cancer patients

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    Sloth Moeller, Ditte; Hoffmann, Lone (Dept. of Medical Physics, Aarhus Univ. Hospital, Aarhus (Denmark)), e-mail: dittmoel@rm.dk; Khalil, Azza Ahmed; Marquard Knap, Marianne (Dept. of Oncology, Aarhus Univ. Hospital, Aarhus (Denmark)); Muren, Ludvig Paul (Dept. of Medical Physics, Aarhus Univ. Hospital, Aarhus (Denmark); Dept. of Oncology, Aarhus Univ. Hospital, Aarhus (Denmark))

    2011-08-15

    Background. Patients with non-small cell lung cancer (NSCLC) have poor prognosis partly because of high local failure rates. Escalating the dose to the tumour may decrease the local failure rates and thereby, improve overall survival, but the risk of complications will limit the possibility to dose-escalate a broad range of patients. Escalating only PET-active areas of the tumour may increase the potential for reaching high doses for a variety of tumour sizes and locations. Material and methods. Ten patients were randomly chosen for a dose escalation planning study. A planning target volume (PTV) was defined on the mid-ventilation scan of a four-dimensional computed tomography (4D-CT) scan and a boost planning target volume (PTV-boost) was defined based on a positron emission tomography computed tomography (PET-CT) scan. Treatment plans were created aiming to reach the highest achievable of 74 Gy, 78 Gy or 82 Gy in 2 Gy per fraction prescribed to the PTV-boost without compromising normal tissue constraints and with the PTV prescribed in all cases a biological equivalent dose in 2 Gy fractions of 66 Gy. Results. Nine of ten patients could be escalated to the highest dose level (82 Gy), while one patient was limited by the oesophagus dose constraint and could only reach 74 Gy. Four patients could be dose-escalated above 82 Gy without compromising normal tissue constraints. Conclusion. Dose-escalating only the PET-active areas of lung tumours to doses of 82 Gy while respecting normal tissue constraints is feasible, also in a series of unselected patients including cases with relatively large tumours

  2. Is Androgen Deprivation Therapy Necessary in All Intermediate-Risk Prostate Cancer Patients Treated in the Dose Escalation Era?

    Energy Technology Data Exchange (ETDEWEB)

    Castle, Katherine O., E-mail: kocastle@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hoffman, Karen E.; Levy, Lawrence B.; Lee, Andrew K.; Choi, Seungtaek; Nguyen, Quynh N.; Frank, Steven J.; Pugh, Thomas J.; McGuire, Sean E.; Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-03-01

    Purpose: The benefit of adding androgen deprivation therapy (ADT) to dose-escalated radiation therapy (RT) for men with intermediate-risk prostate cancer is unclear; therefore, we assessed the impact of adding ADT to dose-escalated RT on freedom from failure (FFF). Methods: Three groups of men treated with intensity modulated RT or 3-dimensional conformal RT (75.6-78 Gy) from 1993-2008 for prostate cancer were categorized as (1) 326 intermediate-risk patients treated with RT alone, (2) 218 intermediate-risk patients treated with RT and ≤6 months of ADT, and (3) 274 low-risk patients treated with definitive RT. Median follow-up was 58 months. Recursive partitioning analysis based on FFF using Gleason score (GS), T stage, and pretreatment PSA concentration was applied to the intermediate-risk patients treated with RT alone. The Kaplan-Meier method was used to estimate 5-year FFF. Results: Based on recursive partitioning analysis, intermediate-risk patients treated with RT alone were divided into 3 prognostic groups: (1) 188 favorable patients: GS 6, ≤T2b or GS 3+4, ≤T1c; (2) 71 marginal patients: GS 3+4, T2a-b; and (3) 68 unfavorable patients: GS 4+3 or T2c disease. Hazard ratios (HR) for recurrence in each group were 1.0, 2.1, and 4.6, respectively. When intermediate-risk patients treated with RT alone were compared to intermediate-risk patients treated with RT and ADT, the greatest benefit from ADT was seen for the unfavorable intermediate-risk patients (FFF, 74% vs 94%, respectively; P=.005). Favorable intermediate-risk patients had no significant benefit from the addition of ADT to RT (FFF, 94% vs 95%, respectively; P=.85), and FFF for favorable intermediate-risk patients treated with RT alone approached that of low-risk patients treated with RT alone (98%). Conclusions: Patients with favorable intermediate-risk prostate cancer did not benefit from the addition of ADT to dose-escalated RT, and their FFF was nearly as good as patients with low-risk disease

  3. Dietary adequacy of vitamin D and calcium among Inuit and Inuvialuit women of child-bearing age in Arctic Canada: a growing concern.

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    Fariba Kolahdooz

    Full Text Available BACKGROUND: Arctic populations are at an increased risk of vitamin D inadequacy due to geographic latitude and a nutrition transition. This study aimed to assess the adequacy of dietary vitamin D and calcium among women of child-bearing age in Arctic Canada. METHODS: This study collected data from 203 randomly selected women of child-bearing age (19-44 years in Nunavut and the Northwest Territories of Arctic Canada. Cross-sectional surveys using a validated quantitative food frequency questionnaire were analysed to determine the dietary adequacy of vitamin D and calcium and summarize the top foods contributing to vitamin D and calcium intake among traditional food eaters (TFE and non-traditional food eaters (NTFE. RESULTS: The response rate was between 69-93% depending on the community sampled. Mean BMIs for both TFE and NTFE were above the normal range. Traditional food eaters had a significantly higher median vitamin D intake compared with non-traditional eaters (TFE=5.13 ± 5.34 µg/day; NTFE=3.5 ± 3.22 µg/day, p=0·004. The majority of women (87% were below the Estimated Average Requirements (EAR for vitamin D. Despite adequate median daily calcium intake in both TFE (1,299 ± 798 mg/day and NTFE (992 ± 704 mg/day; p=0.0005, 27% of the study population fell below the EAR for calcium. Dairy products contributed the most to intake of vitamin D (TFE=30.7%; NTFE=39.1% and calcium (TFE=25.5%; NTFE=34.5%. CONCLUSIONS: Inadequate dietary vitamin D intake is evident among Inuit and Inuvialuit women of child-bearing age in Arctic Canada. Promotion of nutrient-rich sources of traditional foods, supplementation protocols and/or expanded food fortification should be considered to address this nutrition concern.

  4. Racial/Ethnic Differences in Sleep Disorders and Reporting of Trouble Sleeping Among Women of Childbearing Age in the United States.

    Science.gov (United States)

    Amyx, Melissa; Xiong, Xu; Xie, Yiqiong; Buekens, Pierre

    2017-02-01

    Objectives Whether racial/ethnic differences in prevalence/reporting of sleep disorders exist in pregnant women/women of child-bearing age is unknown. Study objectives were to estimate prevalence of sleep disorders and to examine racial/ethnic differences in sleep disorders, reporting of sleep issues, and amount of sleep among women of child-bearing age (15-44 years) in the US. Methods Through a secondary analysis of the National Health and Nutrition Examination Survey 2005-2010 (3175 non-pregnant, 432 pregnant women in main analysis), prevalence of sleep disorders, reporting of sleep disorders to a physician/health professional, and amount of sleep were estimated overall, by pregnancy status, and by race/ethnicity stratified by pregnancy status. Racial/ethnic differences in reporting of trouble sleeping by pregnancy status were examined using univariate and multivariate logistic regression. Results Prevalence of diagnosed sleep disorders among women of childbearing age was 4.9 % [3.9 % pregnant; 5.1 % non-pregnant (p sleep (7-8 h) than non-Hispanic white (white) women (p sleeping were significantly higher for white compared to black (aOR 0.47 [95 % CI 0.36, 0.61]) or Mexican-American women (aOR 0.29 [95 % CI 0.21, 0.41]); non-pregnant minority women were also significantly less likely to report trouble sleeping than white women when controlling for amount of sleep. Among pregnant women, these same trends were found. Discussion Compared to white women, minority women, despite reporting less adequate sleep, are less likely to report trouble sleeping, providing evidence of an important health disparity.

  5. Increased Hepatitis C Virus (HCV) Detection in Women of Childbearing Age and Potential Risk for Vertical Transmission - United States and Kentucky, 2011-2014.

    Science.gov (United States)

    Koneru, Alaya; Nelson, Noele; Hariri, Susan; Canary, Lauren; Sanders, Kathy J; Maxwell, Justine F; Huang, Xiaohua; Leake, John A D; Ward, John W; Vellozzi, Claudia

    2016-07-22

    Hepatitis C virus (HCV) infection is a leading cause of liver-related morbidity and mortality (1). Transmission of HCV is primarily via parenteral blood exposure, and HCV can be transmitted vertically from mother to child. Vertical transmission occurs in 5.8% (95% confidence interval = 4.2%-7.8%) of infants born to women who are infected only with HCV and in up to twice as many infants born to women who are also infected with human immunodeficiency virus (HIV) (2) or who have high HCV viral loads (3,4); there is currently no recommended intervention to prevent transmission of infection from mother to child (3). Increased reported incidence of HCV infection among persons aged ≤30 years (5,6) with similar increases among women and men in this age group (6), raises concern about increases in the number of pregnant women with HCV infection, and in the number of infants who could be exposed to HCV at birth. Data from one large commercial laboratory and birth certificate data were used to investigate trends in HCV detection among women of childbearing age,* HCV testing among children aged ≤2 years, and the proportions of infants born to HCV-infected women nationally and in Kentucky, the state with the highest incidence of acute HCV infection during 2011-2014 (6). During 2011-2014, commercial laboratory data indicated that national rates of HCV detection (antibody or RNA positivity(†)) among women of childbearing age increased 22%, and HCV testing (antibody or RNA) among children aged ≤2 years increased 14%; birth certificate data indicated that the proportion of infants born to HCV-infected mothers increased 68%, from 0.19% to 0.32%. During the same time in Kentucky, the HCV detection rate among women of childbearing age increased >200%, HCV testing among children aged ≤2 years increased 151%, and the proportion of infants born to HCV-infected women increased 124%, from 0.71% to 1.59%. Increases in the rate of HCV detection among women of childbearing age

  6. Prevention of Mother-to-Child Transmission-Precarious Hopes and Childbearing Choices Among HIV-Infected Women in a Northern Province of Vietnam

    DEFF Research Database (Denmark)

    Hạnh, Nguyễn Thị Thúy; Rasch, Vibeke; Chi, Bùi Kim

    2012-01-01

    . The results reported here are derived from ethnographic research conducted in a northern province of Vietnam in 2007. The authors interviewed 32 HIV-positive women, exploring the hopes that they invested in prevention of mother-to-child transmission, and examining how this new technology enhanced the women......'s faith in their futures and childbearing capacities. Based on the findings, the authors discuss the new forms of gendered uncertainty that arise in the era of HIV/AIDS in Vietnam. They conclude that prevention of mother-to-child transmission, including the counseling offered by health providers, plays...

  7. Knowledge and use of folic acid for birth defect prevention among women of childbearing age in Shanghai, China: A prospective cross-sectional study

    OpenAIRE

    Liang, Huan; Ma, Duan; Zhou, Shu-Feng; Li, Xiaotian

    2011-01-01

    Summary Background This study aimed to assess the knowledge, attitude, and practice of folic acid intake for prevention of birth defects in Chinese women of child-bearing age. Material/Methods In this prospective cross-sectional study, a total of 1,338 women aged 20?45 years were randomly selected for interview. Data on folic acid knowledge and information on folic acid intake in the subjects were collected. Age, education, contraception, and status of family planning were used as the indepen...

  8. Knowledge and use of folic acid for birth defect prevention among women of childbearing age in Shanghai, China: A prospective cross-sectional study

    OpenAIRE

    Liang, Huan; MA, DUAN; Zhou, Shu-Feng; Li, Xiaotian

    2011-01-01

    Summary Background This study aimed to assess the knowledge, attitude, and practice of folic acid intake for prevention of birth defects in Chinese women of child-bearing age. Material/Methods In this prospective cross-sectional study, a total of 1,338 women aged 20–45 years were randomly selected for interview. Data on folic acid knowledge and information on folic acid intake in the subjects were collected. Age, education, contraception, and status of family planning were used as the indepen...

  9. Clinical and laboratory issues associated with persistent low-level elevations of hCG in a female of childbearing age.

    Science.gov (United States)

    Bjornson, Loring K; Rangan, Aruna; Fenster, Tamatha B; Magotra, Minoti; Nimaroff, Michael

    2014-03-20

    Persistent low-level elevations of serum concentrations of hCG in a non-pregnant female of childbearing age were investigated by a number of laboratory techniques including heterophile blocking reagents, polyethylene glycol precipitation, serial dilutions and hCG measurements on several different instrument/reagent systems. The results of these studies indicated that this patient had immunoreactive hCG in her serum that was not the intact hCG molecule but primarily the free β-hCG subunit. Differential diagnoses are discussed along with recommendation for continued surveillance of serum hCG concentrations. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression.

    Science.gov (United States)

    Price, Owen; Baker, John; Bee, Penny; Lovell, Karina

    2015-06-01

    De-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness. To conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training. The review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis. A total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and deescalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results. It is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects. © The Royal College of Psychiatrists 2015.

  11. Prospective evaluation of a hydrogel spacer for rectal separation in dose-escalated intensity-modulated radiotherapy for clinically localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Eckert Franziska

    2013-01-01

    Full Text Available Abstract Background As dose-escalation in prostate cancer radiotherapy improves cure rates, a major concern is rectal toxicity. We prospectively assessed an innovative approach of hydrogel injection between prostate and rectum to reduce the radiation dose to the rectum and thus side effects in dose-escalated prostate radiotherapy. Methods Acute toxicity and planning parameters were prospectively evaluated in patients with T1-2 N0 M0 prostate cancer receiving dose-escalated radiotherapy after injection of a hydrogel spacer. Before and after hydrogel injection, we performed MRI scans for anatomical assessment of rectal separation. Radiotherapy was planned and administered to 78 Gy in 39 fractions. Results From eleven patients scheduled for spacer injection the procedure could be performed in ten. In one patient hydrodissection of the Denonvillier space was not possible. Radiation treatment planning showed low rectal doses despite dose-escalation to the target. In accordance with this, acute rectal toxicity was mild without grade 2 events and there was complete resolution within four to twelve weeks. Conclusions This prospective study suggests that hydrogel injection is feasible and may prevent rectal toxicity in dose-escalated radiotherapy of prostate cancer. Further evaluation is necessary including the definition of patients who might benefit from this approach. Trial registration: German Clinical Trials Register DRKS00003273.

  12. O conhecimento tático declarativo e processual em jogadores de futebol de diferentes escalões

    Directory of Open Access Journals (Sweden)

    Diogo Schüler Giacomini

    2011-03-01

    Full Text Available A qualidade na prestação esportiva, nos jogos esportivos coletivos, relaciona-se com as capacidades cognitivas, especificamente com o conhecimento. Esse estudo verificou a associação entre o conhecimento tático processual convergente e divergente, assim como as associações entre o conhecimento tático processual e declarativo. Participaram do estudo 221 jogadores de futebol de campo, do sexo masculino, do escalão sub-14, sub-15 e sub-17. O conhecimento tático processual foi avaliado através da aplicação do teste KORA-OO no parâmetro “oferecer-se” e “orientar-se”. O conhecimento tático declarativo foi avaliado através de cenas-situação do futebol. Os resultados indicaram uma alta associação entre o conhecimento tático processual, convergente e divergente, geral e especifico por escalão, além de uma baixa associação entre o conhecimento tático declarativo e processual (convergente e divergente. Esses dados suportam a idéia de que os conhecimentos progridem serialmente do declarativo ao processual.

  13. Stair descending exercise using a novel automatic escalator: effects on muscle performance and health-related parameters.

    Science.gov (United States)

    Paschalis, Vassilis; Theodorou, Anastasios A; Panayiotou, George; Kyparos, Antonios; Patikas, Dimitrios; Grivas, Gerasimos V; Nikolaidis, Michalis G; Vrabas, Ioannis S

    2013-01-01

    A novel automatic escalator was designed, constructed and used in the present investigation. The aim of the present investigation was to compare the effect of two repeated sessions of stair descending versus stair ascending exercise on muscle performance and health-related parameters in young healthy men. Twenty males participated and were randomly divided into two equal-sized groups: a stair descending group (muscle-damaging group) and a stair ascending group (non-muscle-damaging group). Each group performed two sessions of stair descending or stair ascending exercise on the automatic escalator while a three week period was elapsed between the two exercise sessions. Indices of muscle function, insulin sensitivity, blood lipid profile and redox status were assessed before and immediately after, as well as at day 2 and day 4 after both exercise sessions. It was found that the first bout of stair descending exercise caused muscle damage, induced insulin resistance and oxidative stress as well as affected positively blood lipid profile. However, after the second bout of stair descending exercise the alterations in all parameters were diminished or abolished. On the other hand, the stair ascending exercise induced only minor effects on muscle function and health-related parameters after both exercise bouts. The results of the present investigation indicate that stair descending exercise seems to be a promising way of exercise that can provoke positive effects on blood lipid profile and antioxidant status.

  14. Parents' and older siblings' smoking during childhood: changing influences on smoking acquisition and escalation over the course of adolescence.

    Science.gov (United States)

    Bricker, Jonathan B; Peterson, Arthur V; Andersen, M Robyn; Sarason, Irwin G; Rajan, K Bharat; Leroux, Brian G

    2007-09-01

    This study investigated prospectively the change in the influence of parents' and older siblings' smoking at the start of the childhood and adolescent smoking acquisition period (i.e., 3rd grade, or age 8) on the initiation and escalation of smoking over the course of adolescence. In a sample of 5,520 individuals in 3rd grade, we measured parents' and older siblings' smoking. Individuals' smoking data were provided at four grade intervals over the course of adolescence. The influence of parents' smoking, measured at 3rd grade, was stable and significant for the transition to trying smoking and increased over the course of adolescence for the transition from monthly to daily smoking (p = .001). In contrast, we found no evidence that influence of older siblings' smoking, measured at 3rd grade, changed (p>.05) across the grade intervals for any adolescent smoking transition. The results suggest that the influence of parents' smoking on smoking initiation is stable and enduring whereas it increases substantially for smoking escalation occurring over the course of adolescence.

  15. Impact of obesity on outcomes after definitive dose-escalated intensity-modulated radiotherapy for localized prostate cancer.

    Science.gov (United States)

    Wang, Lora S; Murphy, Colin T; Ruth, Karen; Zaorsky, Nicholas G; Smaldone, Marc C; Sobczak, Mark L; Kutikov, Alexander; Viterbo, Rosalia; Horwitz, Eric M

    2015-09-01

    Previous publications have demonstrated conflicting results regarding body mass index (BMI) and prostate cancer (CaP) outcomes after definitive radiotherapy (RT) before the dose escalation era. The goal of the current study was to determine whether increasing BMI was associated with outcomes in men with localized CaP who were treated with dose-escalated RT. The authors identified patients with localized (T1b-T4N0M0) CaP who were treated with definitive intensity-modulated RT and image-guided RT from 2001 through 2010. BMI was analyzed as a continuous variable. Adjusting for confounders, multivariable competing risk and Cox proportional hazards regression models were used to assess the association between BMI and the risk of biochemical failure (BF), distant metastases (DM), cause-specific mortality (CSM), and overall mortality. Of the 1442 patients identified, approximately 20% had a BMI prostate-specific antigen level (P = .018). On multivariable analysis, increasing BMI was associated with an increased risk of BF (hazard ratio [HR], 1.03; 95% confidence interval [95% CI], 1.00-1.07 [P = .042]), DM (HR, 1.07; 95% CI, 1.02-1.11 [P = .004]), CSM (HR, 1.15; 95% CI, 1.07-1.23 [PCancer Society.

  16. Steepness of the radiation dose-response curve for dose-per-fraction escalation keeping the number of fractions fixed.

    Science.gov (United States)

    Bentzen, Søren M

    2005-01-01

    Clinically, there is growing interest in strategies for intensifying radiation therapy by escalating the dose per fraction. This paper considers the steepness of the dose-response curve in this case. The steepness of a radiation dose-response curve is most conveniently quantified by the normalized dose-response gradient, gamma. Under the assumption of a linear-quadratic dose-effect model, a simple analytical relationship is derived between the gamma-value for a dose-response curve generated by varying the total dose while keeping the number of fractions constant, i.e. escalating the dose per fraction, and the gamma-value for a dose-response curve generated by varying the total dose while keeping the dose per fraction constant. This formulation is compared with clinical dose-response data from the literature and shown to be in good agreement with the observations. Some implications of this formulation for non-uniform dose distributions delivered using 3D conformal radiotherapy or intensity modulated radiotherapy (IMRT) are briefly discussed.

  17. Optimizing Collimator Margins for Isotoxically Dose-Escalated Conformal Radiation Therapy of Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Samantha, E-mail: Samantha.warren@oncology.ox.ac.uk [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom); Panettieri, Vanessa [William Buckland Radiotherapy Centre, Alfred Hospital, Commercial Road, Melbourne (Australia); Panakis, Niki; Bates, Nicholas [Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom); Lester, Jason F. [Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff (United Kingdom); Jain, Pooja [Clatterbridge Cancer Centre, Clatterbridge Road, Wirral (United Kingdom); Landau, David B. [Department of Radiotherapy, Guy' s and St. Thomas' NHS Foundation Trust, London (United Kingdom); Nahum, Alan E.; Mayles, W. Philip M. [Clatterbridge Cancer Centre, Clatterbridge Road, Wirral (United Kingdom); Fenwick, John D. [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom)

    2014-04-01

    Purpose: Isotoxic dose escalation schedules such as IDEAL-CRT [isotoxic dose escalation and acceleration in lung cancer chemoradiation therapy] (ISRCTN12155469) individualize doses prescribed to lung tumors, generating a fixed modeled risk of radiation pneumonitis. Because the beam penumbra is broadened in lung, the choice of collimator margin is an important element of the optimization of isotoxic conformal radiation therapy for lung cancer. Methods and Materials: Twelve patients with stage I-III non-small cell lung cancer (NSCLC) were replanned retrospectively using a range of collimator margins. For each plan, the prescribed dose was calculated according to the IDEAL-CRT isotoxic prescription method, and the absolute dose (D{sub 99}) delivered to 99% of the planning target volume (PTV) was determined. Results: Reducing the multileaf collimator margin from the widely used 7 mm to a value of 2 mm produced gains of 2.1 to 15.6 Gy in absolute PTV D{sub 99}, with a mean gain ± 1 standard error of the mean of 6.2 ± 1.1 Gy (2-sided P<.001). Conclusions: For NSCLC patients treated with conformal radiation therapy and an isotoxic dose prescription, absolute doses in the PTV may be increased by using smaller collimator margins, reductions in relative coverage being offset by increases in prescribed dose.

  18. A Phase I trial of dose escalation of topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer

    Institute of Scientific and Technical Information of China (English)

    Xiaohui Ge; Wenyan Zhao; Xiaocang Ren; Yongqiang Wang; Zhigang Li; Yanqi Li; Yuee Liu; Qiang Lin

    2012-01-01

    Objective: The aim of this study was to define the maximum-tolerated dose (MTD) and observe the toxicity of escalating topotecan combined whole brain radiotherapy for brain metastasis in lung cancer. Methods: Patients with brain metastasis of lung cancer received conventional fractionation radiotherapy, with 5 daily fractions of 2 Gy per week, the total radiation dose was 40 Gy, while the larger lesions were boosted to 50-60 Gy. The initial dose of topotecan was 1.0 mg/m2. Escalation dose was 0.25 mg/m2. Every cohort contained at least 3 patients.If no dose-limiting toxicity (DLT) was observed,the next dose level was opened for entry. These courses were repeated until DLT appeared. MTD was declared as one dose level below which DLT appeared. Results: Eighteen patients were recruited. Two cases of grade 3 leucopenia/neutropenia was observed as DLT at the level of topotecan 2.0 mg/m2. MTD of topotecan was defined as 1.75 mg/m2.The major side effects were leucopenia/neutropenia, nausea and vomiting. Conclusion: Topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer is well tolerated. Maximum-tolerated dose of topotecan is 1.75 mg/m2, once a week of a total of four.

  19. Community perceptions of childbearing and use of safer conception strategies among HIV-discordant couples in Kisumu, Kenya.

    Science.gov (United States)

    Breitnauer, Brooke T; Mmeje, Okeoma; Njoroge, Betty; Darbes, Lynae A; Leddy, Anna; Brown, Joelle

    2015-01-01

    Safer conception strategies (SCS) have the potential to decrease HIV transmission among HIV-discordant couples who desire children. Community perceptions of SCS may influence the scale-up and uptake of these services, but little is known about how communities will react to these strategies. Without community support for SCS, their success as an HIV prevention tool may be limited. The objective of this study is to characterize community perceptions of SCS for HIV-discordant couples in Kisumu, Kenya, to inform ongoing and future safer conception intervention studies in low-resource settings. We conducted six focus group discussions and 11 in-depth-interviews in Kisumu, Kenya, among a diverse group (N=59) of community members, including men, women, youth (age 19-25), community health workers and local leaders. An iterative qualitative analysis using a grounded theory approach was employed. All participants emphasized the importance of childbearing in their society and the right to have children, regardless of an individual's HIV status. While most participants believed that HIV-discordant couples should be allowed to have children, they discussed several barriers to the uptake of SCS such as HIV-related stigma, fear of HIV transmission to the uninfected partner and child, fear of unfamiliar medical procedures and lack of information among community members and health care providers about HIV prevention interventions that allow safer conception. Access to information, community experiences with successful safer conception interventions, healthcare provider training, male engagement and community mobilization may help overcome these barriers. Though assisted reproduction strategies generated the most negative reactions from participants, our results suggest that with education and explanation of these services, participants express interest in these strategies and want them to be offered in their community. Many community members noted a need and desire for safer

  20. Community perceptions of childbearing and use of safer conception strategies among HIV-discordant couples in Kisumu, Kenya

    Directory of Open Access Journals (Sweden)

    Brooke T Breitnauer

    2015-06-01

    Full Text Available Introduction: Safer conception strategies (SCS have the potential to decrease HIV transmission among HIV-discordant couples who desire children. Community perceptions of SCS may influence the scale-up and uptake of these services, but little is known about how communities will react to these strategies. Without community support for SCS, their success as an HIV prevention tool may be limited. The objective of this study is to characterize community perceptions of SCS for HIV-discordant couples in Kisumu, Kenya, to inform ongoing and future safer conception intervention studies in low-resource settings. Methods: We conducted six focus group discussions and 11 in-depth-interviews in Kisumu, Kenya, among a diverse group (N=59 of community members, including men, women, youth (age 19–25, community health workers and local leaders. An iterative qualitative analysis using a grounded theory approach was employed. Results and discussion: All participants emphasized the importance of childbearing in their society and the right to have children, regardless of an individual's HIV status. While most participants believed that HIV-discordant couples should be allowed to have children, they discussed several barriers to the uptake of SCS such as HIV-related stigma, fear of HIV transmission to the uninfected partner and child, fear of unfamiliar medical procedures and lack of information among community members and health care providers about HIV prevention interventions that allow safer conception. Access to information, community experiences with successful safer conception interventions, healthcare provider training, male engagement and community mobilization may help overcome these barriers. Though assisted reproduction strategies generated the most negative reactions from participants, our results suggest that with education and explanation of these services, participants express interest in these strategies and want them to be offered in their

  1. A phase I dose-escalation study of MSC1992371A, an oral inhibitor of aurora and other kinases, in advanced hematologic malignancies.

    Science.gov (United States)

    Graux, Carlos; Sonet, Anne; Maertens, Johan; Duyster, Justus; Greiner, Jochen; Chalandon, Yves; Martinelli, Giovanni; Hess, Dagmar; Heim, Dominik; Giles, Francis J; Kelly, Kevin R; Gianella-Borradori, Athos; Longerey, Blandine; Asatiani, Ekaterine; Rejeb, Narmyn; Ottmann, Oliver G

    2013-09-01

    A phase I dose-escalation study of MSC1992371A, an oral aurora kinase inhibitor, was carried out in patients with hematologic malignancies. Patients received escalating doses either on days 1-3 and 8-10 (n=36) or on days 1-6 (n=39) of a 21-day cycle. The maximum tolerated doses were 37 and 28 mg/m(2)/day, respectively. Dose-limiting toxicities included severe neutropenia with infection and sepsis, mucositis/stomatitis, and diarrhea. Complete responses occurred in 3 patients. Four disease-specific expansion cohorts then received the dose and schedule dictated by the escalation phase but the study was prematurely discontinued due to hematologic and gastrointestinal toxicity at clinically effective doses. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Finite Element Caiculation of the Escalator Truss%自动扶梯桁架结构的有限元分析

    Institute of Scientific and Technical Information of China (English)

    丁建新; 高静丹

    2011-01-01

    介绍了自动扶梯桁架有限元分析的应用,借助通用有限元软件对自动扶梯进行静载分析,研究自动扶梯在满载时的力学特性,得到自动扶梯满载时的挠度、安全系数等各种计算结果。%The finite element application of escalator truss is introduced and the dead weight of escalator truss is analyzed with software. The escalator mechanical characteristic is researched when it is under full load, The results of deflection, safety factor are obtained.

  3. Effect of health-promoting posters placed on the platforms of two train stations in Copenhagen, Denmark, on the choice between taking the stairs or the escalators

    DEFF Research Database (Denmark)

    Iversen, Mette Kathrine; Händel, M N; Nydal Jensen, Eva;

    2007-01-01

    OBJECTIVE: The purpose of this study was to determine whether posters placed on the platforms of two train stations in Copenhagen, promoting use of the stairs, would encourage people to use the stairs rather than the adjacent escalator. An additional purpose was to see if the effect of the interv......OBJECTIVE: The purpose of this study was to determine whether posters placed on the platforms of two train stations in Copenhagen, promoting use of the stairs, would encourage people to use the stairs rather than the adjacent escalator. An additional purpose was to see if the effect...... of the intervention was maintained for a week after the poster was removed. MEASUREMENTS: The number of people using stairs and escalators at Copenhagen Central Station and Østerport Train Station in Copenhagen was recorded before and during posters promoting stair use were placed on the platforms, and a week after...

  4. Teen Pregnancy and Childbearing

    Science.gov (United States)

    ... Between 1991 and 2015, the teen birth rate decreased by more than half in the United States ( ... 1] Despite this decline, the U.S. teen birth rate is still higher than that of many ... prevention programs , expanding access to Medicaid family planning ...

  5. Making Childbearing Choices

    Institute of Scientific and Technical Information of China (English)

    1994-01-01

    Southwestern Shangdong Province is a hilly and mountaingus area, which is an important place where the state sends aid to the poor. Before 1988, the average annual income was 150 yuan. Production techniques were very backward and people generally bore more children, placing their hopes on the increase of labor. Some had 5 or 6, some had 7 or 8. Consequently, the more they prod.uced, the poorer they became; and the poorer they were, the more they produced.

  6. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients.

    Science.gov (United States)

    Mauri Llerda, J A; Suller Marti, A; de la Peña Mayor, P; Martínez Ferri, M; Poza Aldea, J J; Gomez Alonso, J; Mercadé Cerdá, J M

    2015-10-01

    The characteristics of some population groups (patients with comorbidities, women of childbearing age, the elderly) may limit epilepsy management. Antiepileptic treatment in these patients may require adjustments. We searched articles in Pubmed, clinical practice guidelines for epilepsy, and recommendations by the most relevant medical societies regarding epilepsy in special situations (patients with comorbidities, women of childbearing age, the elderly). Evidence and recommendations are classified according to the prognostic criteria of Oxford Centre of Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic interventions. Epilepsy treatment in special cases of comorbidities must be selected properly to improve efficacy with the fewest side effects. Adjusting antiepileptic medication and/or hormone therapy is necessary for proper seizure management in catamenial epilepsy. Exposure to antiepileptic drugs (AED) during pregnancy increases the risk of birth defects and may affect fetal growth and/or cognitive development. Postpartum breastfeeding is recommended, with monitoring for adverse effects if sedative AEDs are used. Finally, the elderly are prone to epilepsy, and diagnostic and treatment characteristics in this group differ from those of other age groups. Although therapeutic limitations may be more frequent in older patients due to comorbidities, they usually respond better to lower doses of AEDs than do other age groups. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Knowledge and use of folic acid for birth defect prevention among women of childbearing age in Shanghai, China: a prospective cross-sectional study.

    Science.gov (United States)

    Lian, Huan; Ma, Duan; Zhou, Shu-Feng; Li, Xiaotian

    2011-12-01

    This study aimed to assess the knowledge, attitude, and practice of folic acid intake for prevention of birth defects in Chinese women of child-bearing age. In this prospective cross-sectional study, a total of 1,338 women aged 20-45 years were randomly selected for interview. Data on folic acid knowledge and information on folic acid intake in the subjects were collected. Age, education, contraception, and status of family planning were used as the independent variables in multivariate logistic regression. 55.6% of the subjects took contraception at all times, and 33.9% had pregnancy planning in the next six months. 49.7% of the interviewed women knew the benefits of folic acid and 34.6% realized the correct time of folic acid intake; and 14.9% of these women actually took folic acid daily. Planning to be pregnant in the next six months was associated with knowledge of folic acid benefits, correct time of folic acid intake and actual intake. A higher education level was correlated with the knowledge of folic acid benefits and correct time of folic acid intake, but was not linked to actual intake of folic acid. The knowledge and use of folic acid were at low to moderate levels in women at childbearing age in Shanghai, China, and general knowledge of folic acid benefits and correct time of folic acid intake should be conveyed to these women.

  8. 肥胖与育龄期女性生殖功能研究进展%Association between obesity and reproductive of women in childbearing age

    Institute of Scientific and Technical Information of China (English)

    宋荣

    2011-01-01

    The reproductive of women is dependent on many factors.Obesity is one of the most important factor which reduces the reproductive ability of women in childbearing age.Obese women of childbearing age may accompanied with menstrual disorders, oligo - anovulation or anovulation and even infertility.Obesity affects outcome of assisted reproductive technologies, higher risk of miscarriage and affects pregnancy outcome.We should appeal to avoid extra weight and improve fertility of obese women.%女性生殖功能受众多因素影响,肥胖是引起育龄期女性生殖能力降低的重要因素之一.育龄期肥胖女性可表现为月经紊乱,排卵障碍甚至不孕.肥胖与多囊卵巢综合征互为因果.肥胖影响辅助生殖技术的结局,使自然流产的风险增高,影响到妊娠的结局.避免超重及肥胖,积极控制多余体重,提高肥胖女性生育能力.

  9. Relationship between Knowledge and Attitudes with Contraceptive Use among Women of Childbearing Age at the Comoro Health Centre, Dili, Timor Leste

    Directory of Open Access Journals (Sweden)

    Marilia Juvi Gonçalves

    2014-08-01

    Full Text Available Background and purpose: Timor-Leste's population growth rate increased by 2.4%. Data in 2013 showed thecontraceptive use among women of childbearing is only 37.3%. This study was aimed to determine the relationshipbetween knowledge and attitudes with contraceptive use.Methods: A cross-sectional was conducted with 83 female respondents. The dependent variable was contraceptiveuse. Knowledge concerning contraceptive use and attitudes were the independent variables. Data were collectedthrough a self-administered questionnaire, however, for illiterate respondents, researcher assisted with questionnairecompletion. Data analysis was conducted in stages: univariate and bivariate (chi-squared test.Results: The majority of respondents 41 (49.4% were aged 25-34 years, 37 (44.6% respondents obtained high schooleducation, and 62 (74.7%, good knowledge regarding family planning (39.8% had positive attitude (45,8%. Resultsindicate that there was a significant relationship between maternal knowledge (p=0.006 and attitude (p=0.017 withcontraceptives use among women of childbearing age.Conclusion: Level of knowledge and attitude are correlated to contraceptive use among women at Comoro HealthCentre, Dili District, Timor Leste.Keywords: knowledge, attitudes, contraceptive use, Comoro Health Centre

  10. Serum Folate Shows an Inverse Association with Blood Pressure in a Cohort of Chinese Women of Childbearing Age: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Minxue Shen

    Full Text Available It has been reported that higher folate intake from food and supplementation is associated with decreased blood pressure (BP. The association between serum folate concentration and BP has been examined in few studies. We aim to examine the association between serum folate and BP levels in a cohort of young Chinese women.We used the baseline data from a pre-conception cohort of women of childbearing age in Liuyang, China, for this study. Demographic data were collected by structured interview. Serum folate concentration was measured by immunoassay, and homocysteine, blood glucose, triglyceride and total cholesterol were measured through standardized clinical procedures. Multiple linear regression and principal component regression model were applied in the analysis.A total of 1,532 healthy normotensive non-pregnant women were included in the final analysis. The mean concentration of serum folate was 7.5 ± 5.4 nmol/L and 55% of the women presented with folate deficiency (< 6.8 nmol/L. Multiple linear regression and principal component regression showed that serum folate levels were inversely associated with systolic and diastolic BP, after adjusting for demographic, anthropometric, and biochemical factors.Serum folate is inversely associated with BP in non-pregnant women of childbearing age with high prevalence of folate deficiency.

  11. Can we avoid dose escalation for intermediate-risk prostate cancer in the setting of short-course neoadjuvant androgen deprivation?

    Directory of Open Access Journals (Sweden)

    Shakespeare TP

    2016-03-01

    Full Text Available Thomas P Shakespeare,1,2 Shea W Wilcox,1 Noel J Aherne1,2 1Department of Radiation Oncology, North Coast Cancer Institute, 2Faculty of Medicine, Rural Clinical School, The University of New South Wales, Coffs Harbour, New South Wales, Australia Background: Both dose-escalated external beam radiotherapy (DE-EBRT and androgen deprivation therapy (ADT improve the outcomes in patients with intermediate-risk prostate cancer. Despite this, there are only few reports evaluating DE-EBRT for patients with intermediate-risk prostate cancer receiving neoadjuvant ADT, and virtually no studies investigating dose escalation >74 Gy in this setting. We aimed to determine whether DE-EBRT >74 Gy improved the outcomes for patients with intermediate-risk prostate cancer who received neoadjuvant ADT. Findings: In our institution, patients with intermediate-risk prostate cancer were treated with neoadjuvant ADT and DE-EBRT, with doses sequentially increasing from 74 Gy to 76 Gy and then to 78 Gy between 2006 and 2012. We identified 435 patients treated with DE-EBRT and ADT, with a median follow-up of 70 months. For the 74 Gy, 76 Gy, and 78 Gy groups, five-year biochemical disease-free survival rates were 95.0%, 97.8%, and 95.3%, respectively; metastasis-free survival rates were 99.1%, 100.0%, and 98.6%, respectively; and prostate cancer-specific survival rate was 100% for all three dose levels. There was no significant benefit for dose escalation either on univariate or multivariate analysis for any outcome. Conclusion: There was no benefit for DE-EBRT >74 Gy in our cohort of intermediate-risk prostate cancer patients treated with neoadjuvant ADT. Given the higher risks of toxicity associated with dose escalation, it may be feasible to omit dose escalation in this group of patients. Randomized studies evaluating dose de-escalation should be considered. Keywords: radiotherapy, IMRT, dose, dose escalation, dose de-escalation, androgen deprivation therapy

  12. Design and Analysis on Dalian Metro Station Escalators%大连地铁车站自动扶梯设计分析

    Institute of Scientific and Technical Information of China (English)

    孙晓亮

    2014-01-01

    Taking Dalian metro project as an example, the paper introduces the system design of metro station escalators. Focusing on three aspects of safety, comfort and performance, it makes a detailed analysis on the main design content of the escalators.%结合大连地铁项目,对地铁车站自动扶梯的设计进行了介绍,并针对安全性、乘坐舒适性和使用性能3个方面对自动扶梯的主要设计内容进行了详细的分析。

  13. Fatigue Design of Step Pin of the Escalator Chain%自动扶梯梯级链销轴的疲劳设计

    Institute of Scientific and Technical Information of China (English)

    王胜; 叶斌

    2012-01-01

    The normal type and structure of the escalator chain are introduced. Taking one type of the public transportation escalator as object, optimization design and three - dimensional modeling of step pin are carried out, the fatigue test of the design is carried out, and unlimited lifetime can he reached.%介绍梯级链常用型式和结构,选取公共交通型重载自动扶梯链为对象,对其梯级销轴进行三维建模和优化设计,并对设计进行疲劳测试,达到无限疲劳寿命.

  14. Uncertainty "escalation" and use of machine learning to forecast residual and data model uncertainties

    Science.gov (United States)

    Solomatine, Dimitri

    2016-04-01

    some variant of the Monte Carlo simulation when values of parameters or inputs are sampled from the assumed distributions and the model is run multiple times to generate multiple outputs. This is the most widely used approach. The data generated by Monte Carlo analysis can be used to build a machine learning model which will be able to make predictions of model uncertainty for the future his method is named MLUE (Machine Learning for Uncertainty Estimation) and is covered in [4,5] With this in mind, one may consider the following framework based on the stepwise "building up" (or "escalation") of the model uncertainty: • first consider the residual uncertainty of an optimal model M (X, p*) • then add and consider the model uncertainty due the parameters uncertainty (p) • then add and consider the model uncertainty due the data (mainly, input) uncertainty (X) • then add and consider the structural uncertainty of the model M (X, p). The paper presents the details of this framework and examples if its application in hydrological forecasting. This study is partly supported by the FP7 European Project WeSenseIt Citizen Water Observatory (www.http://wesenseit.eu/). References [1] Koenker, R., and G. Bassett (1978). Regression quantiles. Econometrica, 46(1), 33- 50, doi:10.2307/1913643. [2] D.L. Shrestha, D.P. Solomatine (2006). Machine learning approaches for estimation of prediction interval for the model output. Neural Networks J., 19(2), 225-235. [3] D.P. Solomatine, D.L. Shrestha (2009). A novel method to estimate model uncertainty using machine learning techniques. Water Resources Res. 45, W00B11. [4] D. L. Shrestha, N. Kayastha, and D. P. Solomatine. A novel approach to parameter uncertainty analysis of hydrological models using neural networks. Hydrol. Earth Syst. Sci., 13, 1235-1248, 2009. [5] F. Pianosi and L. Raso (2012). Dynamic modeling of predictive uncertainty by regression on absolute errors. WRR, 48, W03516. [6] Shrestha, D.L., Kayastha, N., Solomatine

  15. SU-E-T-183: Feasibility of Extreme Dose Escalation for Glioblastoma Multiforme Using 4π Radiotherapy

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    Nguyen, D; Rwigema, J; Yu, V; Kaprealian, T; Kupelian, P; Selch, M; Low, D; Sheng, K [Department of Radiation Oncology, UCLA, Los Angeles, CA (United States)

    2014-06-01

    Purpose: GBM recurrence primarily occurs inside or near the high-dose radiation field of original tumor site requiring greater than 100 Gy to significantly improve local control. We utilize 4π non-coplanar radiotherapy to test the feasibility of planning target volume (PTV) margin expansions or extreme dose escalations without incurring additional radiation toxicities. Methods: 11 GBM patients treated with VMAT to a prescription dose of 59.4 Gy or 60 Gy were replanned with 4π. Original VMAT plans were created with 2 to 4 coplanar or non-coplanar arcs using 3 mm hi-res MLC. The 4π optimization, using 5 mm MLC, selected and inverse optimized 30 beams from a candidate pool of 1162 beams evenly distributed through 4π steradians. 4π plans were first compared to clinical plans using the same prescription dose. Two more studies were then performed to respectively escalate the GTV and PTV doses to 100 Gy, followed by a fourth plan expanding the PTV by 5 mm and maintaining the prescription dose. Results: The standard 4π plan significantly reduced (p<0.01) max and mean doses to critical structures by a range of 47.0–98.4% and 61.0–99.2%, respectively. The high dose PTV/high dose GTV/expanded PTV studies showed a reduction (p<0.05) or unchanged* (p>0.05) maximum dose of 72.1%/86.7%/77.1% (chiasm), 7.2%*/27.7%*/30.7% (brainstem), 39.8%*/84.2%/51.9%* (spinal cord), 69.0%/87.0%/66.9% (L eye), 76.2%/88.1%/84.1% (R eye), 95.0%/98.6%/97.5% (L lens), 93.9%/98.8%/97.6% (R lens), 74.3%/88.5%/72.4% (L optical nerve), 80.4%/91.3%/75.7% (R optical nerve), 64.8%/84.2%/44.9%* (L cochlea), and 85.2%/93.0%/78.0% (R cochlea), respectively. V30 and V36 for both brain and (brain - PTV) were reduced for all cases except the high dose PTV plan. PTV dose coverage increased for all 4π plans. Conclusion: Extreme dose escalation or further margin expansion is achievable using 4π, maintaining or reducing OAR doses. This study indicates that clinical trials employing 4π delivery using

  16. Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Adkison, Jarrod B.; McHaffie, Derek R.; Bentzen, Soren M.; Patel, Rakesh R.; Khuntia, Deepak [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Petereit, Daniel G. [Department of Radiation Oncology, John T. Vucurevich Regional Cancer Care Institute, Rapid City Regional Hospital, Rapid City, SD (United States); Hong, Theodore S.; Tome, Wolfgang [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Ritter, Mark A., E-mail: ritter@humonc.wisc.edu [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States)

    2012-01-01

    Purpose: Toxicity concerns have limited pelvic nodal prescriptions to doses that may be suboptimal for controlling microscopic disease. In a prospective trial, we tested whether image-guided intensity-modulated radiation therapy (IMRT) can safely deliver escalated nodal doses while treating the prostate with hypofractionated radiotherapy in 5 Vulgar-Fraction-One-Half weeks. Methods and Materials: Pelvic nodal and prostatic image-guided IMRT was delivered to 53 National Comprehensive Cancer Network (NCCN) high-risk patients to a nodal dose of 56 Gy in 2-Gy fractions with concomitant treatment of the prostate to 70 Gy in 28 fractions of 2.5 Gy, and 50 of 53 patients received androgen deprivation for a median duration of 12 months. Results: The median follow-up time was 25.4 months (range, 4.2-57.2). No early Grade 3 Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events v.3.0 genitourinary (GU) or gastrointestinal (GI) toxicities were seen. The cumulative actuarial incidence of Grade 2 early GU toxicity (primarily alpha blocker initiation) was 38%. The rate was 32% for Grade 2 early GI toxicity. None of the dose-volume descriptors correlated with GU toxicity, and only the volume of bowel receiving {>=}30 Gy correlated with early GI toxicity (p = 0.029). Maximum late Grades 1, 2, and 3 GU toxicities were seen in 30%, 25%, and 2% of patients, respectively. Maximum late Grades 1 and 2 GI toxicities were seen in 30% and 8% (rectal bleeding requiring cautery) of patients, respectively. The estimated 3-year biochemical control (nadir + 2) was 81.2 {+-} 6.6%. No patient manifested pelvic nodal failure, whereas 2 experienced paraaortic nodal failure outside the field. The six other clinical failures were distant only. Conclusions: Pelvic IMRT nodal dose escalation to 56 Gy was delivered concurrently with 70 Gy of hypofractionated prostate radiotherapy in a convenient, resource-efficient, and well-tolerated 28-fraction schedule. Pelvic nodal dose

  17. Dose Escalation of Total Marrow Irradiation With Concurrent Chemotherapy in Patients With Advanced Acute Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Jeffrey Y.C., E-mail: jwong@coh.org [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States); Forman, Stephen; Somlo, George [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States); Rosenthal, Joseph [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States); Department of Pediatrics, City of Hope National Medical Center, Duarte, California (United States); Liu An; Schultheiss, Timothy; Radany, Eric [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States); Palmer, Joycelynne [Department of Biostatistics, City of Hope National Medical Center, Duarte, California (United States); Stein, Anthony [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States)

    2013-01-01

    Purpose: We have demonstrated that toxicities are acceptable with total marrow irradiation (TMI) at 16 Gy without chemotherapy or TMI at 12 Gy and the reduced intensity regimen of fludarabine/melphalan in patients undergoing hematopoietic cell transplantation (HCT). This article reports results of a study of TMI combined with higher intensity chemotherapy regimens in 2 phase I trials in patients with advanced acute myelogenous leukemia or acute lymphoblastic leukemia (AML/ALL) who would do poorly on standard intent-to-cure HCT regimens. Methods and Materials: Trial 1 consisted of TMI on Days -10 to -6, etoposide (VP16) on Day -5 (60 mg/kg), and cyclophosphamide (CY) on Day -3 (100 mg/kg). TMI dose was 12 (n=3 patients), 13.5 (n=3 patients), and 15 (n=6 patients) Gy at 1.5 Gy twice daily. Trial 2 consisted of busulfan (BU) on Days -12 to -8 (800 {mu}M min), TMI on Days -8 to -4, and VP16 on Day -3 (30 mg/kg). TMI dose was 12 (n=18) and 13.5 (n=2) Gy at 1.5 Gy twice daily. Results: Trial 1 had 12 patients with a median age of 33 years. Six patients had induction failures (IF), and 6 had first relapses (1RL), 9 with leukemia blast involvement of bone marrow ranging from 10%-98%, 5 with circulating blasts (24%-85%), and 2 with chloromas. No dose-limiting toxicities were observed. Eleven patients achieved complete remission at Day 30. With a median follow-up of 14.75 months, 5 patients remained in complete remission from 13.5-37.7 months. Trial 2 had 20 patients with a median age of 41 years. Thirteen patients had IF, and 5 had 1RL, 2 in second relapse, 19 with marrow blasts (3%-100%) and 13 with peripheral blasts (6%-63%). Grade 4 dose-limiting toxicities were seen at 13.5 Gy (stomatitis and hepatotoxicity). Stomatitis was the most frequent toxicity in both trials. Conclusions: TMI dose escalation to 15 Gy is possible when combined with CY/VP16 and is associated with acceptable toxicities and encouraging outcomes. TMI dose escalation is not possible with BU/VP16 due to

  18. Harmful Algal Blooms in Asia: an insidious and escalating water pollution phenomenon with effects on ecological and human health

    Directory of Open Access Journals (Sweden)

    Patricia M Glibert

    2014-02-01

    Full Text Available Harmful Algal Blooms (HABs, those proliferations of algae that causeenvironmental, economic, or human health problems, are increasing in frequency,duration, and geographic extent due to nutrient pollution. The scale of the HABproblem in Asia has escalated in recent decades in parallel with the increase in useof agricultural fertilizer, the development of aquaculture, and a growing population.Three examples, all from China but illustrative of the diversity of events and theirecological, economic, and human health effects throughout Asia, are highlightedhere. These examples include inland (Lake Tai or Taihu as well as offshore (EastChina Sea and Yellow Sea waters. The future outlook for controlling these bloomsis bleak. The effects of advancing industrialized agriculture and a continually growingpopulation will continue to result in more nutrient pollution and more HABs—-and more effects - in the foreseeable future.

  19. Escalation of methamphetamine-related crime and fatalities in the Dresden region, Germany, between 2005 and 2011.

    Science.gov (United States)

    Pietsch, J; Paulick, T; Schulz, K; Flössel, U; Engel, A; Schmitter, S; Schmidt, U

    2013-12-10

    Methamphetamine (MA), a central nervous system stimulating recreational drug, is a worldwide problem related to crime as well as forensic and health aspects. The data, exemplarily presented in this study for the Dresden region, Saxony, Germany, demonstrate the escalation of MA-related crime and fatalities between 2005 and 2011. Easy availability and an attractive price of MA in the Czech Republic are responsible for both the increase of the occurrence of MA in relation to the entire drug crime as well as the increase of the occurrence of MA-positive cases of driving under influence (DUI). Higher percentage of very pure MA on the Saxon drug market since 2010 seems to be the reason for the fatalities directly caused by MA in 2010 and 2011.

  20. The Tripartite Model of Neuroticism and the suppression of depression and anxiety within an escalation of commitment dilemma.

    Science.gov (United States)

    Moon, Henry; Hollenbeck, John R; Humphrey, Stephen E; Maue, Brian

    2003-06-01

    We found evidence of a mutual suppression effect between anxiety and depression on an individual's level of commitment within escalation dilemmas. On the one hand, our results demonstrate a positive relationship between anxiety and level of commitment; on the other, our results demonstrate a negative relationship between depression and level of commitment. Based on the opposing relationships between anxiety and depression and commitment, the broad factor of neuroticism does not demonstrate any relationship with level of commitment, and the significant effects of anxiety and depression on commitment is contingent upon partialling the effect of the other facet of neuroticism. Thus, we contend that applied psychologists, who have focused on neuroticism as a broad construct, should consider the large body of work among clinical psychologists, who argue that anxiety and depression have unique variance associated with them. We conclude by addressing organizational implications of measuring the broad trait of neuroticism more narrowly.

  1. Pelvic nodal dose escalation with prostate hypofractionation using conformal avoidance defined (H-CAD) intensity modulated radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S.; Tome, Wolfgang A.; Jaradat, Hazim; Raisbeck, Bridget M.; Ritter, Mark A. [Univ. of Wisconsin Medical School, Madison, WI (United States). Dept. of Human Oncology

    2006-09-15

    The management of prostate cancer patients with a significant risk of pelvic lymph node involvement is controversial. Both whole pelvis radiotherapy and dose escalation to the prostate have been linked to improved outcome in such patients, but it is unclear whether conventional whole pelvis doses of only 45-50 Gy are optimal for ultimate nodal control. The purpose of this study is to examine the dosimetric and clinical feasibility of combining prostate dose escalation via hypofractionation with conformal avoidance-based IMRT (H-CAD) dose escalation to the pelvic lymph nodes. One conformal avoidance and one conventional plan were generated for each of eight patients. Conformal avoidance-based IMRT plans were generated that specifically excluded bowel, rectum, and bladder. The prostate and lower seminal vesicles (PTV 70) were planned to receive 70 Gy in 2.5 Gy/fraction while the pelvic lymph nodes (PTV 56) were to concurrently receive 56 Gy in 2 Gy/fraction. The volume of small bowel receiving >45 Gy was restricted to 300 ml or less. These conformal avoidance plans were delivered using helical tomotherapy or LINAC-based IMRT with daily imaging localization. All patients received neoadjuvant and concurrent androgen deprivation with a planned total of two years. The conventional, sequential plans created for comparison purposes for all patients consisted of a conventional 4-field pelvic box prescribed to 50.4 Gy (1.8 Gy/fraction) followed by an IMRT boost to the prostate of 25.2 Gy (1.8 Gy/fraction) yielding a final prostate dose of 75.6 Gy. For all plans, the prescription dose was to cover the target structure. Equivalent uniform dose (EUD) analyses were performed on all targets and dose-volume histograms (DVH) were displayed in terms of both physical and normalized total dose (NTD), i.e. dose in 2 Gy fraction equivalents. H-CAD IMRT plans were created for and delivered to all eight patients. Analysis of the H-CAD plans demonstrates prescription dose coverage of >95

  2. The role of motivation, responsibility, and integrative complexity in crisis escalation: comparative studies of war and peace crises.

    Science.gov (United States)

    Winter, David G

    2007-05-01

    Drawing on D. G. Winter's (1993) comparison of 1914 and the Cuban Missile Crisis, the author identified 8 paired crises (1 escalating to war, 1 peacefully resolved). Documents (diplomatic messages, speeches, official media commentary) from each crisis were scored for power, affiliation, and achievement motivation; text measures of responsibility and activity inhibition; and integrative complexity. Aggregated effect-size results show that war crises had significantly higher levels of power motivation and responsibility, whereas peace crises showed trends toward higher integrative complexity and achievement motivation. Follow-up analyses suggested that these results are robust with respect to both sides in a crisis, type of material scored, and historical time. The power motive results extend previous findings, but the responsibility results suggest that responsibility plays a paradoxical role in war. Future research directions are sketched, and the role of psychological content analysis in monitoring the danger of war is discussed.

  3. Dose-Escalated Hypofractionated Intensity-Modulated Radiotherapy in High-Risk Carcinoma of the Prostate: Outcome and Late Toxicity

    Directory of Open Access Journals (Sweden)

    David Thomson

    2012-01-01

    Results. Median followup was 84 months. Five-year overall survival (OS was 83% and biochemical progression-free survival (bPFS was 50% for 57 Gy. Five-year OS was 75% and bPFS 58% for 60 Gy. At 7 years, toxicity by RTOG criteria was acceptable with no grade 3 or above toxicity. Compared with baseline, there was no significant change in urinary symptoms at 2 or 7 years. Bowel symptoms were stable between 2 and 7 years. All patients continued to have significant sexual dysfunction. Conclusion. In high-risk prostate cancer, dose-escalated hypofractionated radiotherapy using IMRT results in encouraging outcomes and acceptable late toxicity.

  4. A Phase I Clinical and Pharmacology Study Using Amifostine as a Radioprotector in Dose-escalated Whole Liver Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Mary, E-mail: maryfeng@umich.edu [Department of Radiation Oncology, School of Medicine, University of Michigan, Ann Arbor, Michigan (United States); Smith, David E. [Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan (United States); Normolle, Daniel P. [Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Knol, James A. [Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, Michigan (United States); Pan, Charlie C.; Ben-Josef, Edgar [Department of Radiation Oncology, School of Medicine, University of Michigan, Ann Arbor, Michigan (United States); Lu Zheng; Feng, Meihua R.; Chen Jun [Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan (United States); Ensminger, William [Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan (United States); Lawrence, Theodore S. [Department of Radiation Oncology, School of Medicine, University of Michigan, Ann Arbor, Michigan (United States)

    2012-08-01

    Purpose: Diffuse intrahepatic tumors are difficult to control. Whole-liver radiotherapy has been limited by toxicity, most notably radiation-induced liver disease. Amifostine is a prodrug free-radical scavenger that selectively protects normal tissues and, in a preclinical model of intrahepatic cancer, systemic amifostine reduced normal liver radiation damage without compromising tumor effect. We hypothesized that amifostine would permit escalation of whole-liver radiation dose to potentially control microscopic disease. We also aimed to characterize the pharmacokinetics of amifostine and its active metabolite WR-1065 to optimize timing of radiotherapy. Methods and Materials: We conducted a radiation dose-escalation trial for patients with diffuse, intrahepatic cancer treated with whole-liver radiation and intravenous amifostine. Radiation dose was assigned using the time-to-event continual reassessment method. A companion pharmacokinetic study was performed. Results: Twenty-three patients were treated, with a maximum dose of 40 Gy. Using a logistical regression model, compared with our previously treated patients, amifostine increased liver tolerance by 3.3 {+-} 1.1 Gy (p = 0.007) (approximately 10%) with similar response rates. Peak concentrations of WR-1065 were 25 {mu}M with an elimination half-life of 1.5 h; these levels are consistent with radioprotective effects of amifostine in patients. Conclusion: These findings demonstrate for the first time that amifostine is a normal liver radioprotector. They further suggest that it may be useful to combine amifostine with fractionated or stereotactic body radiation therapy for patients with focal intrahepatic cancer.

  5. Escalating dose pretreatment induces pharmacodynamic and not pharmacokinetic tolerance to a subsequent high-dose methamphetamine binge.

    Science.gov (United States)

    O'Neil, Meghan L; Kuczenski, Ronald; Segal, David S; Cho, Arthur K; Lacan, Goran; Melega, William P

    2006-11-01

    A major feature of human methamphetamine (METH) abuse is the gradual dose escalation that precedes high-dose exposure. The period of escalating doses (EDs) is likely associated with development of tolerance to aspects of METH's pharmacologic and toxic effects but the relative contributions of pharmacokinetic and pharmacodynamic factors have not been well defined. In our prior studies in rats, we showed that pretreatment with an ED-METH regimen (0.1-4.0 mg/kg over 14 days) attenuated the toxicity of a subsequently administered high-dose METH binge (4 x 6 mg/kg at 2 h interval) that itself produced behavioral stereotypy, increases in core temperature, and decreases in DA system phenotypic markers in caudate-putamen (CP). Using those ED-METH and binge protocols in the present studies, pharmacokinetic and pharmacodynamic parameters that may have contributed to the apparent neuroprotection afforded by ED-METH were assessed. The ED-METH regimen itself reduced [(3)H]WIN35,428 (WIN) binding to the dopamine transporter (DAT) by 15% in CP, but did not affect DA content. During the METH binge, ED-METH pretreated animals showed attenuated increases in core temperature while concurrent microdialysis studies in CP showed a reduced DA response despite unaltered extracellular levels of METH. At 1 h after the binge, concentrations of METH and its metabolite amphetamine in brain and plasma were unaffected by the ED-METH. The results show that ED-METH pretreatment produces reductions in DAT binding and the DA response during a subsequent METH binge by altering pharmacodynamic and not pharmacokinetic parameters.

  6. A Phase I Dose Escalation Study of Hypofractionated IMRT Field-in-Field Boost for Newly Diagnosed Glioblastoma Multiforme

    Energy Technology Data Exchange (ETDEWEB)

    Monjazeb, Arta M., E-mail: arta.monjazeb@ucdmc.ucdavis.edu [U.C. Davis School of Medicine, Department of Radiation Oncology, Sacramento, CA (United States); Ayala, Deandra; Jensen, Courtney [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Case, L. Douglas [Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Bourland, J. Daniel; Ellis, Thomas L. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); McMullen, Kevin P.; Chan, Michael D. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Tatter, Stephen B. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Lesser, Glen J. [Hematology Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Shaw, Edward G. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States)

    2012-02-01

    Objectives: To describe the results of a Phase I dose escalation trial for newly diagnosed glioblastoma multiforme (GBM) using a hypofractionated concurrent intensity-modulated radiotherapy (IMRT) boost. Methods: Twenty-one patients were enrolled between April 1999 and August 2003. Radiotherapy consisted of daily fractions of 1.8 Gy with a concurrent boost of 0.7 Gy (total 2.5 Gy daily) to a total dose of 70, 75, or 80 Gy. Concurrent chemotherapy was not permitted. Seven patients were enrolled at each dose and dose limiting toxicities were defined as irreversible Grade 3 or any Grade 4-5 acute neurotoxicity attributable to radiotherapy. Results: All patients experienced Grade 1 or 2 acute toxicities. Acutely, 8 patients experienced Grade 3 and 1 patient experienced Grade 3 and 4 toxicities. Of these, only two reversible cases of otitis media were attributable to radiotherapy. No dose-limiting toxicities were encountered. Only 2 patients experienced Grade 3 delayed toxicity and there was no delayed Grade 4 toxicity. Eleven patients requiring repeat resection or biopsy were found to have viable tumor and radiation changes with no cases of radionecrosis alone. Median overall and progression-free survival for this cohort were 13.6 and 6.5 months, respectively. One- and 2-year survival rates were 57% and 19%. At recurrence, 15 patients received chemotherapy, 9 underwent resection, and 5 received radiotherapy. Conclusions: Using a hypofractionated concurrent IMRT boost, we were able to safely treat patients to 80 Gy without any dose-limiting toxicity. Given that local failure still remains the predominant pattern for GBM patients, a trial of dose escalation with IMRT and temozolomide is warranted.

  7. BK channel β1 and β4 auxiliary subunits exert opposite influences on escalated ethanol drinking in dependent mice

    Directory of Open Access Journals (Sweden)

    Max eKreifeldt

    2013-12-01

    Full Text Available Large conductance calcium-activated potassium (BK channels play a key role in the control of neuronal activity. Ethanol is a potent activator of BK channel gating, but how this action may impact ethanol drinking still remains poorly understood. Auxiliary β subunits are known to modulate ethanol-induced potentiation of BK currents. In the present study, we investigated whether BK β1 and β4 subunits influence voluntary ethanol consumption using knockout mice. In a first experiment, mice were first subjected to continuous two-bottle choice (2BC and were then switched to intermittent 2BC, which progressively increased ethanol intake as previously described in wildtype mice. BK β1 or β4 subunit deficiency did not affect ethanol self-administration under either schedule of access. In a second experiment, mice were first trained to drink ethanol in a limited-access 2BC paradigm. BK β1 or β4 deletion did not affect baseline consumption. Weeks of 2BC were then alternated with weeks of chronic intermittent ethanol (CIE or air inhalation. As expected, a gradual escalation of ethanol drinking was observed in dependent wildtype mice, while intake remained stable in non-dependent wildtype mice. However, CIE exposure only produced a mild augmentation of ethanol consumption in BK β4 knockout mice. Conversely, ethanol drinking increased after fewer CIE cycles in BK β1 knockout mice than in wildtype mice. In conclusion, BK β1 or β4 did not influence voluntary ethanol drinking in non-dependent mice, regardless of the pattern of access to ethanol. However, deletion of BK β4 attenuated, while deletion of BK β1 accelerated, the escalation of ethanol drinking during withdrawal from CIE. Our data suggest that BK β1 and β4 subunits have an opposite influence on the negative reinforcing properties of ethanol withdrawal. Modulating the expression, distribution or interactions of BK channel auxiliary subunits may therefore represent a novel avenue for the

  8. Safety and immunogenicity of the PRAME cancer immunotherapeutic in metastatic melanoma: results of a phase I dose escalation study

    Science.gov (United States)

    Gutzmer, R; Rivoltini, L; Levchenko, E; Testori, A; Utikal, J; Ascierto, P A; Demidov, L; Grob, J J; Ridolfi, R; Schadendorf, D; Queirolo, P; Santoro, A; Loquai, C; Dreno, B; Hauschild, A; Schultz, E; Lesimple, T P; Vanhoutte, N; Salaun, B; Gillet, M; Jarnjak, S; De Sousa Alves, P M; Louahed, J; Brichard, V G; Lehmann, F F

    2016-01-01

    Purpose The PRAME tumour antigen is expressed in several tumour types but in few normal adult tissues. A dose-escalation phase I/II study (NCT01149343) assessed the safety, immunogenicity and clinical activity of the PRAME immunotherapeutic (recombinant PRAME protein (recPRAME) with the AS15 immunostimulant) in patients with advanced melanoma. Here, we report the phase I dose-escalation study segment. Patients and methods Patients with stage IV PRAME-positive melanoma were enrolled to 3 consecutive cohorts to receive up to 24 intramuscular injections of the PRAME immunotherapeutic. The RecPRAME dose was 20, 100 or 500 µg in cohorts 1, 2 and 3, respectively, with a fixed dose of AS15. Adverse events (AEs), including predefined dose-limiting toxicity (DLT) and the anti-PRAME humoral response (ELISA), were coprimary end points. Cellular immune responses were evaluated using in vitro assays. Results 66 patients were treated (20, 24 and 22 in the respective cohorts). AEs considered by the investigator to be causally related were mostly grade 1 or 2 injection site symptoms, fatigue, chills, fever and headache. Two DLTs (grade 3 brain oedema and proteinuria) were recorded in two patients in two cohorts (cohorts 2 and 3). All patients had detectable anti-PRAME antibodies after four immunisations. Percentages of patients with predefined PRAME-specific-CD4+T-cell responses after four immunisations were similar in each cohort. No CD8+ T-cell responses were detected. Conclusions The PRAME immunotherapeutic had an acceptable safety profile and induced similar anti-PRAME-specific humoral and cellular immune responses in all cohorts. As per protocol, the phase II study segment was initiated to further evaluate the 500 µg PRAME immunotherapeutic dose. Trial registration number NCT01149343, Results. PMID:27843625

  9. Genetic mapping of escalated aggression in wild-derived mouse strain MSM/Ms: association with serotonin-related genes

    Directory of Open Access Journals (Sweden)

    Aki eTakahashi

    2014-06-01

    Full Text Available The Japanese wild-derived mouse strain MSM/Ms (MSM retains a wide range of traits related to behavioral wildness, including high levels of emotionality and avoidance of humans. In this study, we observed that MSM showed a markedly higher level of aggression than the standard laboratory strain C57BL/6J. Whereas almost all MSM males showed high frequencies of attack bites and pursuit in the resident-intruder test, only a few C57BL/6J males showed aggressive behaviors, with these behaviors observed at only a low frequency. Sexually mature MSM males in their home cages killed their littermates, or sometimes female pair-mates. To study the genetic and neurobiological mechanisms that underlie the escalated aggression observed in MSM mice, we analyzed reciprocal F1 crosses and five consomic strains of MSM (Chr 4, 13, 15, X and Y against the background of C57BL/6J. We identified two chromosomes, Chr 4 and Chr 15, which were involved in the heightened aggression observed in MSM. These chromosomes had different effects on aggression: whereas MSM Chr 15 increased agitation and initiation of aggressive events, MSM Chr 4 induced a maladaptive level of aggressive behavior. Expression analysis of mRNAs of serotonin receptors, serotonin transporter and Tph2, an enzyme involved in serotonin synthesis in seven brain areas, indicated several differences among MSM, C57BL/6J, and their consomic strains. We found that Tph2 expression in the midbrain was increased in the Chr 4 consomic strain, as well as in MSM, and that there was a strong positive genetic correlation between aggressive behavior and Tph2 expression at the mRNA level. Therefore, it is possible that increased expression of the Tph2 gene is related to escalated aggression observed in MSM.

  10. Stereotactic Body Radiation Therapy for Prostate Cancer: Review of Experience of a Multicenter Phase I/II Dose Escalation Study

    Directory of Open Access Journals (Sweden)

    D. Nathan W. Kim

    2014-11-01

    Full Text Available Introduction: Stereotactic body radiation therapy (SBRT is an area of active investigation for treatment of prostate cancer. In our phase I dose escalation study maximum tolerated dose was not reached, and subsequently phase II study has been completed. The purpose of this article is to review our experiences of dose escalated SBRT for localized prostate cancer. Methods and Materials: Patients enrolled to phase I/II study from 2006-2011 were reviewed. Prescription dose groups were 45, 47.5 and 50 Gray (Gy in 5 fractions over 2.5 weeks. Toxicity and quality of life questionnaire data were collected and analyzed. Descriptive statistics were obtained in the form of means, medians, and ranges for the continuous variables, and frequencies and percentages for the categoric variables. Results: 91 patients were enrolled from five institutions. Median follow up for PSA evaluation was 42 months. PSA control remains at 99%. While the maximum tolerated dose was not reached in the phase I study, excess high grade rectal toxicity (10.6% was noted in the phase II study. The 13 patients treated to 50 Gy in the phase I study that did not have high grade rectal toxicity, in retrospect met these parameters and have not had further events on longer follow up. Conclusion: PSA control rate, even for patients with intermediate risk, is thus far excellent at these dose levels. This study provides a platform for exploration of SBRT based clinical trials aimed at optimizing outcome for intermediate and high risk patients. High grade toxicities specifically related to the rectum were observed in a small but meaningful minority at the highest dose level. Dose constraints based on physiologic parameters have been defined to mitigate this risk, and strategies to minimize rectal exposure to such doses are being explored.

  11. Ketamine augmentation for outpatients with treatment-resistant depression: Preliminary evidence for two-step intravenous dose escalation.

    Science.gov (United States)

    Cusin, Cristina; Ionescu, Dawn Flosnik; Pavone, Kara Jean; Akeju, Oluwaseun; Cassano, Paolo; Taylor, Norman; Eikermann, Matthias; Durham, Kelley; Swee, Michaela Ballentyne; Chang, Trina; Dording, Christina; Soskin, David; Kelley, John; Mischoulon, David; Brown, Emery Neal; Fava, Maurizio

    2017-01-01

    Preliminary evidence supports the safety and efficacy of subanesthetic ketamine as an experimental antidepressant, although its effects are often not sustained beyond one week. Studies are lacking that have examined the sustained effects of escalating ketamine doses as augmentation in outpatients with treatment-resistant depression. Therefore, the aims of this study were twofold: (1) to assess the safety and antidepressant efficacy of two-step, repeated-dose ketamine augmentation and (2) to assess the duration of ketamine's antidepressant efficacy as augmentation to ongoing antidepressant pharmacotherapy for 3 months after the final infusion. Fourteen patients with treatment-resistant depression were eligible to receive augmentation with six open-label intravenous ketamine infusions over 3 weeks. For the first three infusions, ketamine was administered at a dose of 0.5 mg/kg over 45 minutes; the dose was increased to 0.75 mg/kg over 45 minutes for the subsequent three infusions. The primary outcome measure was response (as measured on Hamilton Depression Rating Scale-28 items). After the completion of three ketamine infusions, 7.1% (1/14) responded; after all six ketamine infusions, 41.7% (5/12) completers responded and 16.7% (2/12) remitted. Intent-to-treat response and remission rates at the end of the final infusion were 35.7% (5/14) and 14.3% (2/14), respectively. However, all but one responder relapsed within 2 weeks after the final infusion. Repeated, escalating doses of intravenous ketamine augmentation were preliminarily found to be feasible, efficacious and well tolerated. Interaction with concomitant medications and elevated level of treatment resistance are possible factors for non-response.

  12. Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H.; Swanick, Cameron; Alvarado, Tina; Komaki, Ritsuko; Cox, James D.; Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-07-15

    Background: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. Methods and Materials: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. Results: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. Conclusion: Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.

  13. The power of social connection and support in improving health: lessons from social support interventions with childbearing women

    Directory of Open Access Journals (Sweden)

    Small Rhonda

    2011-11-01

    Full Text Available Abstract Background and objective Social support interventions have a somewhat chequered history. Despite evidence that social connection is associated with good health, efforts to implement interventions designed to increase social support have produced mixed results. The aim of this paper is to reflect on the relationship between social connectedness and good health, by examining social support interventions with mothers of young children and analysing how support was conceptualised, enacted and valued, in order to advance what we know about providing support to improve health. Context and approach First, we provide a brief recent history of social support interventions for mothers with young children and we critically examine what was intended by ‘social support’, who provided it and for which groups of mothers, how support was enacted and what was valued by women. Second, we examine the challenges and promise of lay social support approaches focused explicitly on companionship, and draw on experiences in two cluster randomised trials which aimed to improve the wellbeing of mothers. One trial involved a universal approach, providing befriending opportunities for all mothers in the first year after birth, and the other a targeted approach offering support from a ‘mentor mother’ to childbearing women experiencing intimate partner violence. Results Interventions providing social support to mothers have most often been directed to women seen as disadvantaged, or ‘at risk’. They have also most often been enacted by health professionals and have included strong elements of health education and/or information, almost always with a focus on improving parenting skills for better child health outcomes. Fewer have involved non-professional ‘supporters’, and only some have aimed explicitly to provide companionship or a listening ear, despite these aspects being what mothers receiving support have said they valued most. Our trial

  14. Feasibility of PET-CT based hypofractionated accelerated dose escalation in oropharyngeal cancers: Final dosimetric results of the VORTIGERN study. (Secondary endpoint of UK NCRI portfolio: MREC No: 08/H0907/127, UKCRN ID 7341

    Directory of Open Access Journals (Sweden)

    Sanjoy Chatterjee

    2015-01-01

    Conclusion: Hypofractionated, slightly accelerated dose escalation in oropharyngeal cancers is likely to be safe and the chance of trismus is not any higher than when standard dose radiotherapy is used. Active measures to reduce dose to the MA achieves acceptable dose volume parameters even at escalated doses.

  15. Exploring the Feasibility of Dose Escalation Positron Emission Tomography-Positive Disease with Intensity-Modulated Radiation Therapy and the Effects on Normal Tissue Structures for Thoracic Malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Turner, Lehendrick M., E-mail: lehendrickt@yahoo.com [University of Texas M. D. Anderson Cancer Center School of Health Professions, Medical Dosimetry Program, Houston, TX (United States); Howard, Joshua A.; Dehghanpour, Pouya; Barrett, Renee D. [University of Texas M. D. Anderson Cancer Center School of Health Professions, Medical Dosimetry Program, Houston, TX (United States); Rebueno, Neal; Palmer, Matthew [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Vedam, Sastry [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Klopp, Ann; Komaki, Ritsuko; Welsh, James W. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2011-01-01

    The pattern of failure is one of the major causes of mortality among thoracic patients. Studies have shown a correlation between local control and dose. Intensity-modulated radiation therapy (IMRT) has resulted in conformal dose distributions while limiting dose to normal tissue. However, thoracic malignancies treated with IMRT to highly conformal doses up to 70 Gy still have been found to fail. Thus, the need for dose escalation through simultaneous integrated boost (SIB) may prove effective in minimizing reoccurrences. For our study, 28 thoracic IMRT plans were reoptimized via dose escalation to the gross tumor volume (GTV) and planning target volume (PTV) of 79.2 Gy and 68.4 Gy, respectively. Reoccurrences in surrounding regions of microscopic disease are rare therefore, dose-escalating regional nodes (outside GTV) were not included. Hence, the need to edit GTV margins was acceptable for our retrospective study. A median dose escalation of approximately 15 Gy (64.8-79.2 Gy) via IMRT using SIB was deemed achievable with minimal percent differences received by critical structures compared with the original treatment plan. The target's mean doses were significantly increased based on p-value analysis, while the normal tissue structures were not significantly changed.

  16. Isotoxic dose escalation in the treatment of lung cancer by means of heterogeneous dose distributions in the presence of respiratory motion

    DEFF Research Database (Denmark)

    Baker, Mariwan; Nielsen, Morten; Hansen, Olfred;

    2011-01-01

    To test, in the presence of intrafractional respiration movement, a margin recipe valid for a homogeneous and conformal dose distribution and to test whether the use of smaller margins combined with heterogeneous dose distributions allows an isotoxic dose escalation when respiratory motion is con...

  17. Extended schedule, escalated dose temozolomide versus dacarbazine in stage IV melanoma: final results of a randomised phase III study (EORTC 18032)

    NARCIS (Netherlands)

    Patel, P.M.; Suciu, S.; Mortier, L.; Kruit, W.H.; Robert, C.; Schadendorf, D.; Trefzer, U.; Punt, C.J.A.; Dummer, R.; Davidson, N.; Becker, J.; Conry, R.; Thompson, J.A.; Hwu, W.J.; Engelen, K. van; Agarwala, S.S.; Keilholz, U.; Eggermont, A.M.M.; Spatz, A.

    2011-01-01

    PURPOSE: To compare the efficacy of an extended schedule escalated dose of temozolomide versus standard dose dacarbazine in a large population of patients with stage IV melanoma. PATIENTS AND METHODS: A total of 859 patients were randomised to receive oral temozolomide at 150 mg/m(2)/day for seven c

  18. Adaptation requirements due to anatomical changes in free-breathing and deep-inspiration breath-hold for standard and dose-escalated radiotherapy of lung cancer patients

    DEFF Research Database (Denmark)

    Sibolt, Patrik; Ottosson, Wiviann; Sjöström, David;

    2015-01-01

    Background. Radiotherapy of lung cancer patients is subject to uncertainties related to heterogeneities, anatomical changes and breathing motion. Use of deep-inspiration breath-hold (DIBH) can reduce the treated volume, potentially enabling dose-escalated (DE) treatments. This study was designed...

  19. A Phase I-II dose escalation study of fixed-dose rate gemcitabine, oxaliplatin and capecitabine every two weeks in advanced cholangiocarcinomas

    DEFF Research Database (Denmark)

    Lassen, Ulrik; Jensen, Lars Henrik; Sorensen, Morten;

    2011-01-01

    ) and capecitabine (C), and evaluate the safety and efficacy of this regimen in patients with advanced cholangiocarcinoma (CC). METHODS: In the Phase I part of the study a dose-escalation schedule of FDR G, O and C, administered every two weeks, was performed in patients with solid tumours and no other treatments...

  20. Vitamin B12 status in women of childbearing age in the UK and its relationship with national nutrient intake guidelines: results from two National Diet and Nutrition Surveys

    Science.gov (United States)

    Adaikalakoteswari, Antonysunil; Venkataraman, Hema; Maheswaran, Hendramoorthy; Saravanan, Ponnusamy

    2016-01-01

    Objective To assess serum B12, folate and the associated homocysteine (Hcy) levels among women of childbearing age in the UK and examine their association with dietary intake in relation to the UK Recommended Nutrient Intakes (RNIs) for B12 and folate. Design Cross-sectional study. Setting Data from two publicly available National Diet and Nutrition Surveys (NDNS 2000/2001 and 2008/2012) were used. These were population-based surveys of randomly selected samples of adults which were carried out in their households. Participants Women of childbearing age (aged 19–39 years), representative of the UK population. Those who were pregnant or breastfeeding were excluded. Outcome measures The associations between micronutrient intakes and blood levels of B12, folate and Hcy were assessed by correlation and stepwise linear regression. B12 intake was divided into quintiles and plotted against blood B12 and Hcy concentrations to determine the threshold of any associations. Results 299 women from the first NDNS cohort had complete intake and biomarker data. The prevalence of serum vitamin B12 (≤150 pmol/L) and serum folate (≤10 nmol/L) deficiency and hyperhomocysteinemia (≥12 µmol/L) was 12.4%, 6.4% and 21.2%, respectively, despite seemingly adequate B12 intakes (median 3.8 μg/day, 96% consumed more than the UK RNI of 1.5 μg/day). B12 concentrations increased across all quintiles of intake with serum levels in quintiles 4 and 5 (median intake 4.9 and 7.1 μg/day, respectively) significantly higher than quintile 1. However, Hcy concentrations levelled off between quintiles 4 and 5. Comparison of micronutrient intake between the two surveys found that folate intake has reduced in the more recent cohort. Conclusions The UK RNI for B12 intake should be increased for women of childbearing age with intakes of around 5–7 μg/day likely to be associated with stable biomarker levels. B12 levels should also be measured in women preconceptionally or in early

  1. Analysis of Gynecological Diseases Census of Women of Childbearing Age%育龄妇女妇科病普查情况分析

    Institute of Scientific and Technical Information of China (English)

    欧丽萍

    2013-01-01

    Objective:To investigate gynecological diseases census of women of childbearing age. Methods:Retrospective analysis of clinical data of 3458 cases of women of childbearing age in our hospital to participate in gynecological diseases census. Results:The prevalence rate is 45.7%;the main diseases is cervicitis and vaginitis;the prevalence of cervicitis and cervical erosion is down-ward trend with age increases;vaginitis is mainly with bacterial;breast disease is mainly with breast lobular hyperplasia. Conclu-sion:Popularize women's health knowledge, establish regular and abstemious habits, master and do regular breast self-examination, can make the self health care consciousness of women of childbearing age increased significantly, found the disease timely and treat-ment early, reduce the incidence of common diseases of women, improve the overall health and quality of life fundamentally.%  目的:探讨育龄妇女妇科病普查情况。方法:回顾性分析我院参与妇科病普查的3458例育龄妇女的临床资料。结果:患病率为45.7%;病种以宫颈炎、阴道炎为主;宫颈炎、宫颈糜烂患病率随年龄增加呈下降趋势;阴道炎以细菌性为主;乳腺疾病以乳腺小叶增生为主。结论:普及妇女保健知识,建立有规律、有节制的生活习惯,掌握并定期做乳房自检等,可使育龄妇女的自我保健意识显著提高,早期发现疾病并及时治疗,有效降低妇女多发病、常见病的发生率,从根本上提高整体健康水平和生活质量。

  2. 根据效率曲线及负载特点合理配置扶梯主机%Configuration of Escalator Machine Based on Efficiency Curve and Load Pattern

    Institute of Scientific and Technical Information of China (English)

    陈正

    2014-01-01

    叙述了扶梯的负载特点、扶梯主机效率曲线的应用、扶梯主机损耗和效率的影响因素、电机和减速箱的类型及其在扶梯中的应用特点,给扶梯主机的合理配置和节能应用提供了实用性的参考建议。%Describe escalator load pattern characters, escalator machine efficiency curve, escalator machine power loss and efficiency impact factors, analyze motor and gearbox type and respective application purpose for escalator, recommend practical reference comment for escalator machine reasonable configuration and energy-saving application.

  3. 轨道交通站内自动扶梯通行能力分析%Analysis of passenger capacity of escalator at metro station

    Institute of Scientific and Technical Information of China (English)

    孟宪强; 廖明军; 王凯英

    2012-01-01

    For the planning and configuration of escalator at metro station, the characteristics and the process of passengers who use escalator are surveyed; the passing behavior of passengers under different congestion and the factors that influence the capacity of escalators are analyzed. A computation model of the capacity of escalators is built based on the physical and operational characteristics of escalator, and two kinds of passing behavior are assumed; one is all the passengers standing still on the escalator, the other is half passengers standing and half passengers walking, and the passenger distribution coefficients on escalator under the two conditions are also assumed. The passenger flow on escalators of Shanghai metro stations during the rush hour is surveyed, and the observed capacity of passenger flow is got by using statistical method, and then the observed data is compared with the data that are provided by the manufacturers. The result shows that the capacity of escalator provided by the manufacturer and the metro des-gin code are greater than the observed data. Thus the recommended capacity of escalator with width of 1 m and the operating speed of 0.5 m/s is 5 200 persons/(h · m).%为规划和配置轨道交通站的自动扶梯,对轨道交通站内乘客使用自动扶梯的方式和过程进行观测,分析乘客在不同拥挤情况下通过自动扶梯的行为以及影响自动扶梯通行能力的因素;基于自动扶梯的物理和工作特性,假定乘客站立、一半站立和一半行走两种通过行为,以及乘客在自动扶梯上的分布系数,构建自动扶梯通行能力计算模型.在上海地铁站内,调查高峰期自动扶梯的流量,运用统计方法得到实际观测的自动扶梯通行能力,并将其与厂家提供的通行能力数据进行比较.结果表明,厂家和规范数据稍偏大.推荐设计速度为0.5 m/s,宽为1 m的自动扶梯的通行能力为5 200人/(h·m).

  4. 育龄妇女和孕妇阴道微生态环境的比较研究%Comparison and investigation on vaginal microenvironment between women of childbearing age and pregnant women

    Institute of Scientific and Technical Information of China (English)

    魏利杰; 方艳秋; 王锦卓; 郭杰

    2011-01-01

    Objective: To compare the vaginal microenvironment conditions between women of childbearing age and pregnant women. Methods: The samples of vaginal secretions were obtained from 800 women of childbearing age and 800 pregnant women, Gram staining was conducted; Nugent score was carried out after counting under microscope. Results: The positive rates of candida infection among women of childbearing age and pregnant women were 20. 4% and 8.9%, respectively; the positive rates of trichomonas infection among women of childbearing age and pregnant women were 4. 6% and 1. 1%, respectively; the positive rates of bacterial vaginosis among women of childbearing age and pregnant women were 33.9% and 8. 8%, respectively; the contents of lactobacillus among women of childbearing age and pregnant women were 63.6% and 84. 5%, respectively, there was significant difference between the two groups (P <0. 05) . Conclusion: Compared with the women of childbearing age, the pregnant women have a more healthy vaginal microenvironment and have a higher resistance to candida yeast, trichomoniasis, bacterial vaginosis and other more conventional diseases.%目的:对比育龄妇女和孕妇阴道内微生态状况.方法:分别取800例育龄妇女和孕妇的阴道分泌物标本,涂片后用革兰染色,显微镜下计数后进行Nugent评分分析.结果:育龄妇女和孕妇假丝酵母菌感染的阳性率分别为20.4%和8.9%,滴虫感染的阳性率分别为4.6%和1.1%,细菌性阴道病(BV)阳性率分别为33.9%和8.8%,乳酸杆菌的含量分别为63.6%和84.5%,两组之间差异均有统计学意义(P<0.05).结论:相较于育龄妇女,孕妇的阴道微生态状况更健康,对假丝酵母菌、滴虫和细菌性阴道病等常规疾病感染的抵抗力更强.

  5. Lack of benefit for the addition of androgen deprivation therapy to dose-escalated radiotherapy in the treatment of intermediate- and high-risk prostate cancer.

    LENUS (Irish Health Repository)

    Krauss, Daniel

    2012-02-01

    PURPOSE: Assessment of androgen deprivation therapy (ADT) benefits for prostate cancer treated with dose-escalated radiotherapy (RT). METHODS AND MATERIALS: From 1991 to 2004, 1,044 patients with intermediate- (n = 782) or high-risk (n = 262) prostate cancer were treated with dose-escalated RT at William Beaumont Hospital. Patients received external-beam RT (EBRT) alone, brachytherapy (high or low dose rate), or high dose rate brachytherapy plus pelvic EBRT. Intermediate-risk patients had Gleason score 7, prostate-specific antigen (PSA) 10.0-19.9 ng\\/mL, or Stage T2b-T2c. High-risk patients had Gleason score 8-10, PSA >\\/=20, or Stage T3. Patients were additionally divided specifically by Gleason score, presence of palpable disease, and PSA level to further define subgroups benefitting from ADT. RESULTS: Median follow-up was 5 years; 420 patients received ADT + dose-escalated RT, and 624 received dose-escalated RT alone. For all patients, no advantages in any clinical endpoints at 8 years were associated with ADT administration. No differences in any endpoints were associated with ADT administration based on intermediate- vs. high-risk group or RT modality when analyzed separately. Patients with palpable disease plus Gleason >\\/=8 demonstrated improved clinical failure rates and a trend toward improved survival with ADT. Intermediate-risk patients treated with brachytherapy alone had improved biochemical control when ADT was given. CONCLUSION: Benefits of ADT in the setting of dose-escalated RT remain poorly defined. This question must continue to be addressed in prospective study.

  6. Concept Design of the Double-spiral Escalator%关于双螺旋形自动扶梯的概念设计

    Institute of Scientific and Technical Information of China (English)

    田慧勇; 李玉翔

    2012-01-01

    在对三菱电机公司的螺旋形自动扶梯分析的基础上,指出了人们对螺旋形自动扶梯的功能和结构的认识误区;建议以新的空间观念、结构理念和机械手段来解决现有的螺旋形自动扶梯的设计和制造的理想度,基于Triz理论分析并提出了螺旋形自动扶梯的功能核心和技术难点。同时指出现有设计理念中螺旋形自动扶梯各个系统之间的问题,如空间结构、动力学模型、机构设置等,都是源于人们一直固守的链式传动机制。%According to the analysis of the spiral escalator made by Mitsubishi Electric Corporation, this paper points out the misunderstanding to the function and the construction of the spiral escalator and the current design concept for the spiral escalator such as its space construction, dynamic model and mechanism setting etc. originating from the chain transmission theory, and puts forward the core function and the technical difficulties of the spiral escalator design based on Triz theoretical analysis. It also suggests how to get the ideal of the spiral escalator design and the manufacture with the new space idea, the new structure concept and the new mechanical means.

  7. Prognostic Significance of Carbohydrate Antigen 19-9 in Unresectable Locally Advanced Pancreatic Cancer Treated With Dose-Escalated Intensity Modulated Radiation Therapy and Concurrent Full-Dose Gemcitabine: Analysis of a Prospective Phase 1/2 Dose Escalation Study

    Energy Technology Data Exchange (ETDEWEB)

    Vainshtein, Jeffrey M., E-mail: jvainsh@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Schipper, Matthew [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Zalupski, Mark M. [Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Lawrence, Theodore S. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Abrams, Ross [Department of Radiation Oncology, Rush Medical Center, Chicago, Illinois (United States); Francis, Isaac R. [Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Khan, Gazala [Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Leslie, William [Division of Hematology Oncology, Department of Internal Medicine, Rush Medical Center, Chicago, Illinois (United States); Ben-Josef, Edgar [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2013-05-01

    Purpose: Although established in the postresection setting, the prognostic value of carbohydrate antigen 19-9 (CA19-9) in unresectable locally advanced pancreatic cancer (LAPC) is less clear. We examined the prognostic utility of CA19-9 in patients with unresectable LAPC treated on a prospective trial of intensity modulated radiation therapy (IMRT) dose escalation with concurrent gemcitabine. Methods and Materials: Forty-six patients with unresectable LAPC were treated at the University of Michigan on a phase 1/2 trial of IMRT dose escalation with concurrent gemcitabine. CA19-9 was obtained at baseline and during routine follow-up. Cox models were used to assess the effect of baseline factors on freedom from local progression (FFLP), distant progression (FFDP), progression-free survival (PFS), and overall survival (OS). Stepwise forward regression was used to build multivariate predictive models for each endpoint. Results: Thirty-eight patients were eligible for the present analysis. On univariate analysis, baseline CA19-9 and age predicted OS, CA19-9 at baseline and 3 months predicted PFS, gross tumor volume (GTV) and black race predicted FFLP, and CA19-9 at 3 months predicted FFDP. On stepwise multivariate regression modeling, baseline CA19-9, age, and female sex predicted OS; baseline CA19-9 and female sex predicted both PFS and FFDP; and GTV predicted FFLP. Patients with baseline CA19-9 ≤90 U/mL had improved OS (median 23.0 vs 11.1 months, HR 2.88, P<.01) and PFS (14.4 vs 7.0 months, HR 3.61, P=.001). CA19-9 progression over 90 U/mL was prognostic for both OS (HR 3.65, P=.001) and PFS (HR 3.04, P=.001), and it was a stronger predictor of death than either local progression (HR 1.46, P=.42) or distant progression (HR 3.31, P=.004). Conclusions: In patients with unresectable LAPC undergoing definitive chemoradiation therapy, baseline CA19-9 was independently prognostic even after established prognostic factors were controlled for, whereas CA19-9 progression

  8. Balancing the benefits and costs of traditional food substitution by indigenous Arctic women of childbearing age: Impacts on persistent organic pollutant, mercury, and nutrient intakes.

    Science.gov (United States)

    Binnington, Matthew J; Curren, Meredith S; Chan, Hing Man; Wania, Frank

    2016-09-01

    For indigenous Arctic Canadians, traditional food consumption represents a key source of nutrients and environmental contaminants. Particularly, ingestion of marine mammal blubber and meat may lead to persistent organic pollutant levels and mercury intakes that exceed regulatory thresholds for sensitive populations. We investigated whether temporary adjustments to the consumption of traditional food derived from marine mammals appreciably impacted contaminant exposure and nutrient intakes among indigenous women of childbearing age. Such adjustments can be motivated by the desire to lower contaminant exposure or to increase nutrition, or by the diminishing availability of other traditional food sources. We combined the contaminant fate and transport model GloboPOP with the food chain bioaccumulation model ACC-Human Arctic to simulate polychlorinated biphenyl exposures in female 2007-08 Inuit Health Survey participants. We also calculated daily mercury and nutrient intake rates. Our results suggest that a temporary decrease in marine mammal consumption is largely ineffective at reducing exposure to polychlorinated biphenyls, because of their long elimination half-lives. In contrast, substitution of marine mammals was highly efficient at reducing mercury intake, but also appreciably lowered intakes of iron, manganese, selenium, and ω-3 polyunsaturated fatty acids. The impact of increasing intake of traditional food derived from marine mammals during childbearing age greatly depended on baseline consumption rates; replacement is ill-advised for those who already consume a lot of traditional food due to greater polychlorinated biphenyl and mercury exposures, while replacement was potentially beneficial for those with very limited marine mammal consumption due to increased nutrient intakes. Our calculations primarily suggest that considering baseline traditional food intake rates is critical to devising reproductive dietary adjustment strategies that maximize nutrient

  9. Investigating portable fluorescent microscopy (CyScope® as an alternative rapid diagnostic test for malaria in children and women of child-bearing age

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    Sousa-Figueiredo José

    2010-08-01

    Full Text Available Abstract Background Prompt and correct diagnosis of malaria is crucial for accurate epidemiological assessment and better case management, and while the gold standard of light microscopy is often available, it requires both expertise and time. Portable fluorescent microscopy using the CyScope® offers a potentially quicker, easier and more field-applicable alternative. This article reports on the strengths, limitations of this methodology and its diagnostic performance in cross-sectional surveys on young children and women of child-bearing age. Methods 552 adults (99% women of child-bearing age and 980 children (99% ≤ 5 years of age from rural and peri-urban regions of Ugandan were examined for malaria using light microscopy (Giemsa-stain, a lateral-flow test (Paracheck-Pf® and the CyScope®. Results from the surveys were used to calculate diagnostic performance (sensitivity and specificity as well as to perform a receiver operating characteristics (ROC analyses, using light microscopy as the gold-standard. Results Fluorescent microscopy (qualitative reads showed reduced specificity (400 parasites/μL blood: sensitivity of 64.2% and specificity of 86.0%. Overall, the diagnostic performance of the CyScope was found inferior to that of Paracheck-Pf®. Discussion Fluorescent microscopy using the CyScope® is certainly a field-applicable and relatively affordable solution for malaria diagnoses especially in areas where electrical supplies may be lacking. While it is unlikely to miss higher parasitaemia, its application in cross-sectional community-based studies leads to many false positives (i.e. small fluorescent bodies of presently unknown origin mistaken as malaria parasites. Without recourse to other technologies, arbitration of these false positives is presently equivocal, which could ultimately lead to over-treatment; something that should be further explored in future investigations if the CyScope® is to be more widely implemented.

  10. Strategies to reduce barriers in reporting herbal use to the health-care provider among women of childbearing age in two communities in Ogun state, Nigeria

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    Florence F Folami

    2017-01-01

    Full Text Available Background: The use of complementary and alternative medicine (CAM has increased tremendously in the past decades. Herbs in this study involved the use of plant products in their raw or cooked forms which have not been subjected to laboratory investigations for their safety and efficacy. Objective: To explore strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria. Materials and Methods: A descriptive cross-sectional survey was used to explore strategies to reduce barriers in reporting herbal use to the health-care provider. The study population constitutes childbearing age women that attend two private hospitals and one comprehensive health center in two communities of Ogun state, Nigeria. Out of the 270 patients who were randomly sampled for the study, 250 agreed to participate (response rate: 92.6%. Results: The mean age of the participants was 29.3 years ± 5.5 and 77.6% were married. The majority (69% had used herbal medicines in the last 6 months before seeking medical care, and 66% did not disclose the use of herbal medicines to health-care providers. Conclusion: Health-care professionals should routinely include herbal remedy category in the list of drug history when asking about the patient's drug. This will help identify herbal remedy use and assist to take precautions relating to safety. Patients and traditional birth attendants should be educated through community mobilization and educational programs about alternative medicines particularly herbal. The disclosure of CAM use and its adverse outcomes should be encouraged by health-care professionals.

  11. Limits of dose escalation in lung cancer: a dose-volume histogram analysis comparing coplanar and non-coplanar techniques

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    Derycke, S.; Van Duyse, B.; Schelfhout, J.; De Neve, W.

    1995-12-01

    To evaluate the feasibility of dose escalation in radiotherapy of inoperable lung cancer, a dose-volume histogram analysis was performed comparing standard coplanar (2D) with non-coplanar (3D) beam arrangements on a non-selected group of 20 patients planned by Sherouse`s GRATISTM 3D-planning system. Serial CT-scanning was performed and 2 Target Volumes (Tvs) were defined. Gross Tumor Volume (GTV) defined a high-dose Target Volume (TV-1). GTV plus location of node stations with > 10% probability of invasion (Minet et al.) defined an intermediate-dose Target Volume (TV-2). However, nodal regions which are incompatible with cure were excluded from TV-2. These are ATS-regions 1, 8, 9 and 14 all left and right as well as heterolateral regions. For 3D-planning, Beam`s Eye View selected (by an experienced planner) beam arrangements were optimised using Superdot, a method of target dose-gradient annihilation developed by Sherouse. A second 3D-planning was performed using 4 beam incidences with maximal angular separation. The linac`s isocenter for the optimal arrangement was located at the geometrical center of gravity of a tetraheder, the tetraheder`s comers being the consecutive positions of the virtual source. This ideal beam arrangement was approximated as close as possible, taking into account technical limitations (patient-couch-gantry collisions). Criteria for tolerance were met if no points inside the spinal cord exceeded 50 Gy and if at least 50% of the lung volume received less than 20Gy. If dose regions below 50 Gy were judged acceptable at TV-2, 2D- as well as 3D-plans allow safe escalation to 80 Gy at TV-1. When TV-2 needed to be encompassed by isodose surfaces exceeding 50Gy, 3D-plans were necessary to limit dose at the spinal cord below tolerance. For large TVs dose is limited by lung tolerance for 3D-plans. An analysis (including NTCP-TCP as cost functions) of rival 3D-plans is being performed.

  12. Trigeminal Neuralgia Treated With Stereotactic Radiosurgery: The Effect of Dose Escalation on Pain Control and Treatment Outcomes.

    Science.gov (United States)

    Kotecha, Rupesh; Kotecha, Ritesh; Modugula, Sujith; Murphy, Erin S; Jones, Mark; Kotecha, Rajesh; Reddy, Chandana A; Suh, John H; Barnett, Gene H; Neyman, Gennady; Machado, Andre; Nagel, Sean; Chao, Samuel T

    2016-09-01

    To analyze the effect of dose escalation on treatment outcome in patients undergoing stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). A retrospective review was performed of 870 patients who underwent SRS for a diagnosis of TN from 2 institutions. Patients were typically treated using a single 4-mm isocenter placed at the trigeminal nerve dorsal root entry zone. Patients were divided into groups based on treatment doses: ≤82 Gy (352 patients), 83 to 86 Gy (85 patients), and ≥90 Gy (433 patients). Pain response was classified using a categorical scoring system, with fair or poor pain control representing treatment failure. Treatment-related facial numbness was classified using the Barrow Neurological Institute scale. Log-rank tests were performed to test differences in time to pain failure or development of facial numbness for patients treated with different doses. Median age at first pain onset was 63 years, median age at time of SRS was 71 years, and median follow-up was 36.5 months from the time of SRS. A majority of patients (827, 95%) were clinically diagnosed with typical TN. The 4-year rate of excellent to good pain relief was 87% (95% confidence interval 84%-90%). The 4-year rate of pain response was 79%, 82%, and 92% in patients treated to ≤82 Gy, 83 to 86 Gy, and ≥90 Gy, respectively. Patients treated to doses ≤82 Gy had an increased risk of pain failure after SRS, compared with patients treated to ≥90 Gy (hazard ratio 2.0, P=.0007). Rates of treatment-related facial numbness were similar among patients treated to doses ≥83 Gy. Nine patients (1%) were diagnosed with anesthesia dolorosa. Dose escalation for TN to doses >82 Gy is associated with an improvement in response to treatment and duration of pain relief. Patients treated at these doses, however, should be counseled about the increased risk of treatment-related facial numbness. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions.

    Science.gov (United States)

    Johnson, Mae; Whyte, Martin; Loveridge, Robert; Yorke, Richard; Naleem, Shairana

    2017-01-01

    The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. A unifying paper based form was successfully piloted in the Acute Medical Unit, introducing the TEP and bringing together decision making around both treatment escalation and CPR status. Subsequently an electronic order-set for CPR status and treatment escalation was launched in April 2015 which led to a highly visible CPR and escalation status banner on the main screen at the top of the patient's electronic record. Ultimately due to further iterations in the electronic process by December 2016, all escalation decisions for acutely admitted patients now have high quality supporting, explanatory documentation with 100% having TEPs in place. There is now widespread multidisciplinary engagement in the process of defining limits of care for acutely admitted medical patients within the first 14 hours of admission and a strategy for rolling this process out across all the divisions of the hospital through our Deteriorating Patient Group (DPG). The collaborative design with acute medical, palliative and intensive care teams and the high visibility provided by the electronic process in the Electronic Patient Record (EPR) has enhanced communication with these teams, patients, nursing staff and the multidisciplinary team by ensuring clarity through a universally understood process about escalation and CPR. Clarity and

  14. Gut hormone release and appetite regulation in healthy non-obese participants following oligofructose intake. A dose-escalation study.

    Science.gov (United States)

    Pedersen, Camilla; Lefevre, Solenne; Peters, Véronique; Patterson, Michael; Ghatei, Mohammad A; Morgan, Linda M; Frost, Gary S

    2013-07-01

    Prevention of weight gain in adults is a major public health target. Animal experiments have consistently demonstrated a relationship between fermentable carbohydrate intake, such as oligofructose, anorectic gut hormones, and appetite suppression and body weight control. This study was designed to determine the dose of oligofructose which would augment the release of anorectic gut hormones and reduce appetite consistently in non-obese humans. Twelve non-obese participants were recruited for a 5-week dose-escalation study. Following a 9-14-day run-in, participants increased their daily oligofructose intake every week from 15, 25, 35, 45, to 55 g daily. Subjective appetite and side effects were monitored daily. Three-day food diaries were completed every week. Appetite study sessions explored the acute effects of 0, 15, 35, and 55 g oligofructose on appetite-related hormones, glycaemia, subjective appetite, and energy intake. In the home environment, oligofructose suppressed hunger, but did not affect energy intake. Oligofructose dose-dependently increased peptide YY, decreased pancreatic polypeptide and tended to decrease ghrelin, but did not significantly affect appetite profile, energy intake, glucose, insulin, or glucagon-like peptide 1 concentrations during appetite study sessions. In conclusion, oligofructose supplementation at ≥ 35 g/day increased peptide YY and suppressed pancreatic polypeptide and hunger; however, energy intake did not change significantly.

  15. Imatinib dose escalation versus sunitinib as a second line treatment in KIT exon 11 mutated GIST: a retrospective analysis.

    Science.gov (United States)

    Vincenzi, Bruno; Nannini, Margherita; Fumagalli, Elena; Bronte, Giuseppe; Frezza, Anna Maria; De Lisi, Delia; Spalato Ceruso, Mariella; Santini, Daniele; Badalamenti, Giuseppe; Pantaleo, Maria Abbondanza; Russo, Antonio; Dei Tos, Angelo Paolo; Casali, Paolo; Tonini, Giuseppe

    2016-10-25

    We retrospectively reviewed data from 123 patients (KIT exon 11 mutated) who received sunitinib or dose-escalated imatinib as second line.All patients progressed on imatinib (400 mg/die) and received a second line treatment with imatinib (800 mg/die) or sunitinib (50 mg/die 4 weeks on/2 off or 37.5 mg/day). Deletion versus other KIT 11 mutation was recorded, correlated with clinical benefits.64% received imatinib, 36% sunitinib. KIT exon 11 mutation was available in 94 patients. With a median follow-up of 61 months, median time to progression (TTP) in patients receiving sunitinib and imatinib was 10 (95% CI 9.7-10.9) and 5 months (95% CI 3.6-6.7) respectively (P = 0.012). No difference was found in overall survival (OS) (P = 0.883). In imatinib arm, KIT exon 11 deletions was associated with a shorter TTP (7 vs 17 months; P = 0.02), with a trend in OS (54 vs 71 months P = 0.063). No difference was found in patients treated with sunitinib (P = 0.370).A second line with sunitinib was associated with an improved TTP in KIT exon 11 mutated patients progressing on imatinib 400 mg/die. Deletions in exon 11 seemed to be correlated with worse outcome in patients receiving imatinib-based second line.

  16. Validation of the French version of the Acceptability E-scale (AES) for mental E-health systems.

    Science.gov (United States)

    Micoulaud-Franchi, Jean-Arthur; Sauteraud, Alain; Olive, Jérôme; Sagaspe, Patricia; Bioulac, Stéphanie; Philip, Pierre

    2016-03-30

    Despite the increasing use of E-health systems for mental-health organizations, there is a lack of psychometric tools to evaluate their acceptability by patients with mental disorders. Thus, this study aimed to translate and validate a French version of the Acceptability E-scale (AES), a 6-item self-reported questionnaire that evaluates the extent to which patients find E-health systems acceptable. A forward-backward translation of the AES was performed. The psychometric properties of the French AES version, with construct validity, internal structural validity and external validity (Pearson's coefficient between AES scores and depression symptoms on the Beck Depression Inventory II) were analyzed. In a sample of 178 patients (mean age=46.51 years, SD=12.91 years), the validation process revealed satisfactory psychometric properties: factor analysis revealed two factors: "Satisfaction" (3 items) and "Usability" (3 items) and Cronbach's alpha was 0.7. No significant relation was found between AES scores and depression symptoms. The French version of the AES revealed a two-factor scale that differs from the original version. In line with the importance of acceptability in mental health and with a view to E-health systems for patients with mental disorders, the use of the AES in psychiatry may provide important information on acceptability (i.e., satisfaction and usability).

  17. Project Plans, Constraints to Growth and the Impact of Cost Escalation through The Middle East and North Africa (MENA) Prism

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-01

    MENA national oil companies (NOCs) are targeting ambitious energy expansion, with mid-term plans for a 5.8 million b/d net boost to crude capacity, 1.9 million b/d more NGLs and 400 Bcm/year more gas, alongside significant refining and LNG additions. Nevertheless, a review of historical project delivery sounds a note of caution over timing - with a number of countries prone to delays and others, outright deferrals, even if market leaders, Saudi Arabia and Qatar, remain more resolutely on course. Cost escalation since 2002 has compounded the regional tendency towards delays, although the impact on project delivery has been moderated by a willingness to increase budgets where project economics remain sound. That leaves political factors as the principal constraint to regional expansion, complicated in part by increasing pluralism in political participation and valid concerns about the management of resources for long-term sustainability, rather than near-term profit. With most constraints to development expected to remain at the political level, there is a clear case for consumers to be more explicit about future needs. There is also a need to engage with growing constituencies in some states favouring a 'go slow' approach to hydrocarbon development where policymakers have made the case for considered expansion.

  18. Dose-Escalated Stereotactic Body Radiation Therapy for Prostate Cancer: Quality of Life Comparison of Two Prospective Trials

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    Harvey Charles Quon

    2016-08-01

    Full Text Available IntroductionThe optimal prostate stereotactic body radiation therapy (SBRT dose-fractionation scheme is controversial. This study compares long-term quality of life (QOL from two prospective trials of prostate SBRT to investigate the effect of increasing dose (NCT01578902 and NCT01146340.Material and MethodsPatients with localized prostate cancer received SBRT 35 or 40 Gy delivered in 5 fractions, once per week. QOL was measured using the Expanded Prostate Cancer Index Composite (EPIC at baseline and every 6 months. Fisher’s exact test and generalized estimating equations were used to analyze proportions of patients with clinically significant change and longitudinal changes in QOL.Results114 patients were included, 84 treated to 35 Gy and 30 treated to 40 Gy. Median QOL follow-up was 56 months (interquartile range [IQR] 46-60 and 38 months (IQR 32-42, respectively. The proportion of patients reporting clinically significant declines in average urinary, bowel, and sexual scores were not significantly different between dose levels, and were 20.5 vs. 24.1% (p=0.60, 26.8 vs. 41.4% (p=0.16, and 42.9 vs. 38.5% (p=0.82, respectively. Similarly, longitudinal analysis did not identify significant differences in QOL between treatment groups.ConclusionDose-escalated prostate SBRT from 35 to 40 Gy in 5 fractions was not associated with significant decline in long-term QOL.

  19. Acute and late toxicity in prostate cancer patients treated by dose escalated intensity modulated radiation therapy and organ tracking

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    Behrensmeier Frank

    2008-10-01

    Full Text Available Abstract Background To report acute and late toxicity in prostate cancer patients treated by dose escalated intensity-modulated radiation therapy (IMRT and organ tracking. Methods From 06/2004 to 12/2005 39 men were treated by 80 Gy IMRT along with organ tracking. Median age was 69 years, risk of recurrence was low 18%, intermediate 21% and high in 61% patients. Hormone therapy (HT was received by 74% of patients. Toxicity was scored according to the CTC scale version 3.0. Median follow-up (FU was 29 months. Results Acute and maximal late grade 2 gastrointestinal (GI toxicity was 3% and 8%, late grade 2 GI toxicity dropped to 0% at the end of FU. No acute or late grade 3 GI toxicity was observed. Grade 2 and 3 pre-treatment genitourinary (GU morbidity (PGUM was 20% and 5%. Acute and maximal late grade 2 GU toxicity was 56% and 28% and late grade 2 GU toxicity decreased to 15% of patients at the end of FU. Acute and maximal late grade 3 GU toxicity was 8% and 3%, respectively. Decreased late ≥ grade 2 GU toxicity free survival was associated with higher age (P = .025, absence of HT (P = .016 and higher PGUM (P Discussion GI toxicity rates after IMRT and organ tracking are excellent, GU toxicity rates are strongly related to PGUM.

  20. Single motherhood and low birthweight in Spain: Narrowing social inequalities in health?

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    Teresa Castro-Martin

    2010-05-01

    Full Text Available Nonmarital childbearing is becoming an increasingly common path to family formation in Spain. The proportion of births to unmarried mothers has increased from 2Š in 1975 to 30.2Š in 2007. Along with this marked increase, there has been an important shift in the sociodemographic profile of unmarried mothers. This study focuses on the impact of mothers' marital status on the health status of their newborns, using low birthweight as an indicator. We are interested in examining how the impact of mothers' unmarried status on birth outcomes changes as nonmarital childbearing shifts from a marginal to a relatively common behaviour. The results of the analysis reveal that the health disadvantage gap between marital and nonmarital births has narrowed significantly over the past decade in Spain. We argue that diminishing selection processes and increasing social acceptance could explain the declining significance of marital status as a risk factor for low birthweight.