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Sample records for outcomes u-shaped associations

  1. Uric Acid Level Has a U-shaped Association with Clinical Outcomes in Patients with Vasospastic Angina.

    Science.gov (United States)

    Gwag, Hye Bin; Yang, Jeong Hoon; Park, Taek Kyu; Song, Young Bin; Hahn, Joo Yong; Choi, Jin Ho; Lee, Sang Hoon; Gwon, Hyeon Cheol; Choi, Seung Hyuk

    2017-08-01

    No data are available on the association of serum uric acid and vasospastic angina (VSA) which has endothelial dysfunction as a possible pathophysiologic mechanism. Low uric acid level might cause adverse outcomes in VSA in connection with endothelial dysfunction. We enrolled 818 VSA patients whose uric acid level was measured at admission. Patients were categorized according to tertiles of uric acid level: group I, ≤ 4.8 mg/dL; group II, 4.9-5.9 mg/dL; and group III, ≥ 6.0 mg/dL. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, acute myocardial infarction (MI), ischemic stroke, coronary revascularization, and rehospitalization for angina. Median follow-up duration was 49.2 months. Median uric acid values were 4.1 mg/dL for group I, 5.4 mg/dL for group II, and 6.7 mg/dL for group III. In the overall population, group II had a significantly lower incidence of MACE compared to group I (47 [17.1%] vs. 66 [24.6%]; hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.02-2.26; P = 0.040) and a tendency of lower incidence of MACEs compared to Group III (47 [17.1%] vs. 62 [22.5%]; HR, 1.44; 95% CI, 0.98-2.13; P = 0.067). Among group I patients, those who received nitrates had a higher incidence of MACEs than those without nitrate therapy (P uric acid level was associated with adverse clinical outcomes, while high uric acid level had a trend toward an increase in it. Use of nitrate in patients with low uric acid level might have adverse effects on clinical outcomes of VSA. © 2017 The Korean Academy of Medical Sciences.

  2. Visit-to-visit blood pressure variation is associated with outcomes in a U-shaped fashion in patients with myocardial infarction complicated with systolic dysfunction and/or heart failure: findings from the EPHESUS and OPTIMAAL trials.

    Science.gov (United States)

    Ferreira, João Pedro; Duarte, Kévin; Pitt, Bertram; Dickstein, Kenneth; McMurray, John J V; Zannad, Faiez; Rossignol, Patrick

    2018-04-21

    Visit-to-visit office blood pressure variation (BPV) has prognostic implications independent from mean BP across several populations in the cardiovascular field. The association of BPV with outcomes in patients with myocardial infarction (MI) with systolic dysfunction and/or heart failure is yet to be determined. Two independent cohorts were assessed: the EPHESUS and the OPTIMAAL trials with a total of more than 12 000 patients. The primary outcome was all-cause death. BPV was calculated as a coefficient of variation, that is, the ratio of the SD to the mean BP along the postbaseline follow-up. Cox regression models were used to determine the associations between BPV and events. Compared with the middle and lower BPV tertiles, patients in the upper BPV tertile were older, more often women, hypertensive, diabetic, with peripheral artery disease, and had more frequent use of loop diuretics and ACEi/ARBs. They also had lower LVEF, hemoglobin, and eGFR (all P < 0.001). BPV was independently associated with worse prognosis in a U-shaped manner. In the EPHESUS trial, both low and high BPV were associated with higher rates of death (and also cardiovascular death and the composite of cardiovascular death/ cardiovascular hospitalization): adjusted hazard ratio (95% CI) for the outcome of death is 1.99 (1.68-2.36) for high BPV and is 1.60 (1.35-1.90) for low BPV. Similar results were observed in the OPTIMAAL trial population. In two independent cohorts of MI patients with systolic dysfunction and/or heart failure, BPV was associated with worse prognosis in a U-shaped manner independently of the mean BP.

  3. U-shaped curve for risk associated with maternal hemoglobin, iron status, or iron supplementation.

    Science.gov (United States)

    Dewey, Kathryn G; Oaks, Brietta M

    2017-12-01

    Both iron deficiency (ID) and excess can lead to impaired health status. There is substantial evidence of a U-shaped curve between the risk of adverse birth outcomes and maternal hemoglobin concentrations during pregnancy; however, it is unclear whether those relations are attributable to conditions of low and high iron status or to other mechanisms. We summarized current evidence from human studies regarding the association between birth outcomes and maternal hemoglobin concentrations or iron status. We also reviewed effects of iron supplementation on birth outcomes among women at low risk of ID and the potential mechanisms for adverse effects of high iron status during pregnancy. Overall, we confirmed a U-shaped curve for the risk of adverse birth outcomes with maternal hemoglobin concentrations, but the relations differ by trimester. For low hemoglobin concentrations, the link with adverse outcomes is more evident when hemoglobin concentrations are measured in early pregnancy. These relations generally became weaker or nonexistent when hemoglobin concentrations are measured in the second or third trimesters. Associations between high hemoglobin concentration and adverse birth outcomes are evident in all 3 trimesters but evidence is mixed. There is less evidence for the associations between maternal iron status and adverse birth outcomes. Most studies used serum ferritin (SF) concentrations as the indicator of iron status, which makes the interpretation of results challenging because SF concentrations increase in response to inflammation or infection. The effect of iron supplementation during pregnancy may depend on initial iron status. There are several mechanisms through which high iron status during pregnancy may have adverse effects on birth outcomes, including oxidative stress, increased blood viscosity, and impaired systemic response to inflammation and infection. Research is needed to understand the biological processes that underlie the U-shaped curves

  4. The U-shaped association of body mass index with mortality

    DEFF Research Database (Denmark)

    Jørgensen, Terese Sara Høj; Osler, Merete; Ängquist, Lars Henrik

    2016-01-01

    OBJECTIVE: The U-shaped association between body mass index (BMI) and mortality may depend on other traits with permanent health effects. Whether the association between BMI and mortality depends on levels of health-related traits known to be inversely associated with mortality throughout adult...

  5. Is there a U-shaped association between physical activity and falling in older persons?

    NARCIS (Netherlands)

    Peeters, G.M.E.E.; van Schoor, N.M.; Pluijm, S.M.; Deeg, D.J.H.; Lips, P.T.A.M.

    2010-01-01

    Summary: This study tests whether the relationship between physical activity and (recurrent) falling is U-shaped. Among 1,337 community-dwelling older persons, no evidence for a nonlinear association was found. If all older persons increase their physical activity level with 100 units, 4% may be

  6. U-Shaped Association Between Serum Uric Acid Level and Risk of Mortality: A Cohort Study.

    Science.gov (United States)

    Cho, Sung Kweon; Chang, Yoosoo; Kim, Inah; Ryu, Seungho

    2018-04-25

    In addition to the controversy regarding the association of hyperuricemia with cardiovascular disease (CVD) mortality, few studies have examined the impact of a low uric acid level on mortality. We undertook the present study to evaluate the relationship between both low and high uric acid levels and the risk of all-cause and cause-specific mortality in a large sample of Korean adults over a full range of uric acid levels. A cohort study was performed in 375,163 South Korean men and women who underwent health check-ups from 2002 to 2012. Vital status and cause of death were ascertained from the national death records. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for mortality outcomes were estimated using Cox proportional hazards regression analysis. During a total of 2,060,721.9 person-years of follow-up, 2,020 participants died, with 287 CVD deaths and 963 cancer deaths. Low and high uric acid levels were associated with increased all-cause, CVD, and cancer mortality. The multivariable-adjusted HRs for all-cause mortality in the lowest uric acid categories (uric acid categories (≥9.5 mg/dl for men and ≥8.5 mg/dl for women) were 2.39 (95% CI 1.57-3.66) and 3.77 (95% CI 1.17-12.17), respectively. In this large cohort study of men and women, both low and high uric acid levels were predictive of increased mortality, supporting a U-shaped association between serum uric acid levels and adverse health outcomes. © 2018, American College of Rheumatology.

  7. The Association between BMI and Different Frailty Domains: A U-Shaped Curve?

    Science.gov (United States)

    Rietman, M L; van der A, D L; van Oostrom, S H; Picavet, H S J; Dollé, M E T; van Steeg, H; Verschuren, W M M; Spijkerman, A M W

    2018-01-01

    Previous studies showed a U-shaped association between BMI and (physical) frailty. We studied the association between BMI and physical, cognitive, psychological, and social frailty. Furthermore, the overlap between and prevalence of these frailty domains was examined. Cross-sectional study. The Doetinchem Cohort Study is a longitudinal population-based study starting in 1987-1991 examining men and women aged 20-59 with follow-up examinations every 5 yrs. For the current analyses, we used data from round 5 (2008-2012) with 4019 participants aged 41-81 yrs. Physical frailty was defined as having ≥ 2 of 4 frailty criteria from the Frailty Phenotype (unintentional weight loss, exhaustion, physical activity, handgrip strength). Cognitive frailty was defined as the BMI was divided into four classes. Analyses were adjusted for sex, age, level of education, and smoking. A U-shaped association was observed between BMI and physical frailty, a small linear association for BMI and cognitive frailty and no association between BMI and psychological and social frailty. The four frailty domains showed only a small proportion of overlap. The prevalence of physical, cognitive and social frailty increased with age, whereas psychological frailty did not. We confirm that not only underweight but also obesity is associated with physical frailty. Obesity also seems to be associated with cognitive frailty. Further, frailty prevention should focus on multiple domains and target individuals at a younger age (<65yrs).

  8. The U-shaped association of body mass index with mortality: Influence of the traits height, intelligence, and education.

    Science.gov (United States)

    Jørgensen, Terese Sara Høj; Osler, Merete; Ängquist, Lars Henrik; Zimmermann, Esther; Christensen, Gunhild Tidemann; Sørensen, Thorkild I A

    2016-10-01

    The U-shaped association between body mass index (BMI) and mortality may depend on other traits with permanent health effects. Whether the association between BMI and mortality depends on levels of health-related traits known to be inversely associated with mortality throughout adult life such as height, intelligence, and education was investigated. The study was based on a cohort of young men with data on weight, height, intelligence test score, and education from the Danish Conscription Database. In total, 346,500 men born 1939 to 1959 were followed until December 2013. The association between BMI and mortality was analyzed using Cox-regression models including interactions between BMI and height, intelligence, and education, respectively. BMI and mortality showed the U-shaped association from the start of the follow-up period, and it persisted through the subsequent 56 years. As expected, the mortality was inversely associated with height, intelligence, and education, but the U shape of the association between BMI and mortality was unaffected by the levels of these traits except at higher BMI values, where the slopes were steeper for men with higher levels of height, intelligence, and education. High and low BMI was associated with higher mortality throughout life regardless of the levels of height, intelligence, and education. © 2016 The Obesity Society.

  9. A U-shaped association between intensity of Internet use and adolescent health.

    Science.gov (United States)

    Bélanger, Richard E; Akre, Christina; Berchtold, André; Michaud, Pierre-André

    2011-02-01

    To examine the relationship between different Internet-use intensities and adolescent mental and somatic health. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative survey of adolescents aged 16 to 20 years in post-mandatory school. From a self-administered anonymous questionnaire, 3906 adolescent boys and 3305 girls were categorized into 4 groups according to their intensity of Internet use: heavy Internet users (HIUs; >2 hours/day), regular Internet users (RIUs; several days per week and ≤ 2 hours/day), occasional users (≤ 1 hour/week), and non-Internet users (NIUs; no use in the previous month). Health factors examined were perceived health, depression, overweight, headaches and back pain, and insufficient sleep. In controlled multivariate analysis, using RIUs as a reference, HIUs of both genders were more likely to report higher depressive scores, whereas only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep. Male NIUs and female NIUs and occasional users also were found at increased risk of higher depressive scores. Back-pain complaints were found predominantly among male NIUs. Our study provides evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. In addition, HIUs were confirmed at increased risk for somatic health problems. Thus, health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Also, they should consider regular Internet use as a normative behavior without major health consequence.

  10. Inverse U-shaped Association between Sleep Duration and Semen Quality: Longitudinal Observational Study (MARHCS) in Chongqing, China

    Science.gov (United States)

    Chen, Qing; Yang, Huan; Zhou, Niya; Sun, Lei; Bao, Huaqiong; Tan, Lu; Chen, Hongqiang; Ling, Xi; Zhang, Guowei; Huang, Linping; Li, Lianbing; Ma, Mingfu; Yang, Hao; Wang, Xiaogang; Zou, Peng; Peng, Kaige; Liu, Taixiu; Cui, Zhihong; Ao, Lin; Roenneberg, Till; Zhou, Ziyuan; Cao, Jia

    2016-01-01

    Study Objectives: To investigate the association between sleep duration and semen parameters as well as reproductive hormone levels. Methods: We designed a cohort of male college students in Chongqing, China. A total of 796 subjects were recruited in 2013 and 656 (82.4%) were followed up in 2014. Each time, semen and peripheral blood samples were collected for semen quality and reproductive hormone measurement. Sleep duration was estimated by revised Munich Chronotype Questionnaire. In 2014, sleep quality was also measured by Pittsburgh Sleep Quality Index (PSQI). Results: There was a substantial inverse U-shaped association between sleep duration and two semen parameters (semen volume and total sperm number), with 7.0–7.5 h/day of sleep showing highest parameters. Either longer or shorter sleep was associated with decreased semen parameters in a dose-response manner (P = 0.002 and 0.001, respectively). Sleeping > 9.0 h was associated with a 21.5% (95% confidence interval 9.2, 32.2) reduction in semen volume and 39.4% (23.3, 52.1) reduction in total sperm number; sleeping ≤ 6.5 h was associated with 4.6% (−10.5, 22.3) and 25.7% (−1.2, 60.1) reduction. Increase of the two parameters was found in those who changed sleep duration toward 7.0–7.5 h/day from 2013 to 2014. The U-shaped association was independent from PSQI and was replicated in another dataset of 1,346 males. No association found between sleep duration and reproductive hormone. Conclusions: Either restricted or excessive sleep may impair semen quality. Further research is needed to validate this finding. Citation: Chen Q, Yang H, Zhou N, Sun L, Bao H, Tan L, Chen H, Ling X, Zhang G, Huang L, Li L, Ma M, Yang H, Wang X, Zou P, Peng K, Liu T, Cui Z, Ao L, Roenneberg T, Zhou Z, Cao J. Inverse u-shaped association between sleep duration and semen quality: longitudinal observational study (MARHCS) in Chongqing, China. SLEEP 2016;39(1):79–86. PMID:26350472

  11. U-shaped associations between time in bed and the physical and mental functioning of Japanese civil servants: the roles of work, family, behavioral and sleep quality characteristics.

    Science.gov (United States)

    Sekine, M; Tatsuse, T; Cable, N; Chandola, T; Marmot, M

    2014-09-01

    This study aimed to evaluate (i) whether work, family, behavioral and sleep quality characteristics differ among individuals with different time in bed (TIB), and (ii) whether and how much the U-shaped associations between TIB and health can be explained by these characteristics. Participants were 3510 employees (2371 males and 1139 females) aged 20-65 years working in local government in Japan. They completed a questionnaire regarding work, family, and behavioral characteristics. Sleep quality and physical and mental functioning were evaluated using the Pittsburgh Sleep Quality Index and the Short Form 36. High job demands, long work hours, and high work-family conflict were more prevalent among those with short TIB. Those with long TIB had daily drinking habits. Whereas those with short TIB had poor sleep, mainly due to poor subjective sleep quality and daytime dysfunction, those with long TIB had poor sleep, mainly due to long sleep latency, poor sleep efficiency and sleep disturbances. The U-shaped associations between TIB and poor physical and mental health, with the best health observed in those spending ~8 h in bed, weakened considerably after adjustment for sleep quality, followed by work and family characteristics. After adjusting for behavioral characteristics and long-standing illnesses, the associations hardly changed. The U-shaped associations between TIB and health may be explained by U-shaped associations between TIB and poor sleep and psychosocial stress in work and family life. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Eating the right amount of fish: Inverted U-shape association between fish consumption and cognitive performance, and academic achievement in Dutch adolescents

    NARCIS (Netherlands)

    De Groot, Renate; Ouwehand, Carolijn; Jolles, Jelle

    2012-01-01

    De Groot, R. H. M., Ouwehand, C., & Jolles, J. (2011, 2 September). Eating the right amount of fish: Inverted U-shape association between fish consumption and cognitive performance and academic achievement in Dutch adolescents. Poster presented at the the 14th biannual EARLI conference, Exeter,

  13. Eating the right amount of fish: Inverted U-shape association between fish consumption and cognitive performance, and academic achievement in Dutch adolescents

    NARCIS (Netherlands)

    De Groot, Renate; Ouwehand, Carolijn; Jolles, Jelle

    2012-01-01

    De Groot, R. H. M., Ouwehand, C., & Jolles, J. (2012, May). Eating the right amount of fish: Inverted U-shape association between fish consumption and cognitive performance, and academic achievement in Dutch adolescents. Paper presented at the 10th Congress of the International Society for the Study

  14. Eating the right amount of fish: Inverted U-shape association between fish consumption and cognitive performance and academic achievement in Dutch adolescents

    NARCIS (Netherlands)

    De Groot, Renate; Ouwehand, Carolijn; Jolles, Jelle

    2012-01-01

    De Groot, R. H. M., Ouwehand, C., & Jolles, J. (2012). Eating the right amount of fish: Inverted U-shape association between fish consumption and cognitive performance and academic achievement in Dutch adolescents. Prostaglandins, Leukotrienes, and Essential Fatty Acids, 86(3), 113-117.

  15. U-shaped association between sleep duration and urinary albumin excretion in Korean adults: 2011-2014 Korea National Health and Nutrition Examination Survey.

    Directory of Open Access Journals (Sweden)

    Ji Hee Yu

    Full Text Available Although sleep duration has been extensively studied in metabolic diseases, few studies have investigated the impact of sleep duration on chronic kidney disease. The aim of this study was to examine the relationship between sleep duration and albuminuria in the general population. Among 24,948 adults who participated in the 2011-2014 KNHANES, a total of 19,994 subjects were included in this analysis. Subjects were categorized into the following five groups according to self-reported sleep duration: less than 5 h, 6 h, 7 h, 8 h, and more than 9 h. The association between sleep duration and urinary albumin-creatinine ratio (UACR was examined cross-sectionally. Subjects with both short and long sleep durations were significantly associated with higher UACR levels and higher proportions of patients with microalbuminuria (30-299 mg/g and macroalbuminuria (≥300 mg/g compared to those with a sleep duration of 7 hours. The U-shaped association between sleep duration and UACR remained significant even after adjustment for potential confounders, including age, sex, body mass index, smoking, alcohol, education, income, exercise, estimated glomerular filtration rate, diabetes mellitus, hypertension and hypercholesterolemia. The U-shaped association is more evident in the subgroup aged 65 or older, or in female subjects. Our findings suggest that both short and long sleep durations have a U-shaped association with UACR levels in the general population, independent of potential confounders.

  16. Reconstruing U-Shaped Functions

    Science.gov (United States)

    Werker, Janet F.; Hall, D. Geoffrey; Fais, Laurel

    2004-01-01

    U-shaped developmental functions, and their N-shaped cousins, have intrigued developmental psychologists for decades because they provide a compelling demonstration that development does not always entail a monotonic increase across age in a single underlying ability. Instead, the causes of development are much more complex. Indeed,…

  17. Neutrophil gelatinase-associated lipocalin levels are U-shaped in the Ludwigshafen Risk and Cardiovascular Health (LURIC study-Impact for mortality.

    Directory of Open Access Journals (Sweden)

    Rainer P Woitas

    Full Text Available Neutrophil gelatinase-associated lipocalin (NGAL is a glycoprotein released by damaged renal tubular cells and mature neutrophils. It is elevated in kidney injury, but also in patients with coronary artery disease (CAD and myocardial infarction. We investigated the prognostic value of NGAL for total and cardiovascular mortality in patients undergoing coronary angiography without history of renal insufficiency at inclusion into the study.The LURIC study is an ongoing prospective cohort study of patients referred for coronary angiography and is designed to evaluate determinants of cardiovascular health.NGAL was determined in plasma of 2997 persons (mean age: 62.7 years; 69.7% men with a follow up for 10 years. 2358 patients suffered from CAD and 638 did not-these patients served as controls. Stable CAD was found in 1408 and unstable CAD in 950 patients. Death rate from cardiovascular events and all causes was highest in patients within the 4th quartile of NGAL (≥56 ng/ml, p<0.001 vs third quartile, even after adjustment for age and gender. According to multivariable-adjusted Cox analysis adjusting for well-known cardiovascular risk factors, as well as lipid lowering therapy, angiographic CAD, and C-reactive protein we found patients in the highest NGAL quartile being at increased risk for cardiovascular (hazard ratio (HR 1.33, 95%CI 1.05-1.67, p = 0.016 and all cause mortality (HR 1.29 95%CI 1.07-1.55, p = 0.007 compared to those in the third quartile. The lowest risk was seen in the third quartile of NGAL (41-56 ng/ml suggesting a U-shaped relationship between NGAL and mortality. Further adjustment for creatinine abrogated the predictive effect of NGAL. However, the 3rd and 4th quartiles of NGAL were significantly associated with higher neutrophil counts, which were associated with CAD, non-ST elevation and ST-elevation myocardial infarction (p<0.05.Plasma NGAL concentrations are mainly derived from neutrophils and do not predict mortality

  18. U-Shaped Interest in U-Shaped Development--and What It Means

    Science.gov (United States)

    Siegler, Robert S.

    2004-01-01

    Interest in U-shaped development has itself undergone a U-shaped progression. Twenty-five years ago, interest in U-shaped development was high. This interest was evident at a 1978 conference in Tel Aviv on "U-shaped Behavioral Growth" that resulted in the publication of a book of the same title 4 years later (Strauss, 1982). The breadth…

  19. Mildly abnormal general movement quality in infants is associated with higher Mead acid and lower arachidonic acid and shows a U-shaped relation with the DHA/AA ratio.

    Science.gov (United States)

    van Goor, S A; Schaafsma, A; Erwich, J J H M; Dijck-Brouwer, D A J; Muskiet, F A J

    2010-01-01

    We showed that docosahexaenoic acid (DHA) supplementation during pregnancy and lactation was associated with more mildly abnormal (MA) general movements (GMs) in the infants. Since this finding was unexpected and inter-individual DHA intakes are highly variable, we explored the relationship between GM quality and erythrocyte DHA, arachidonic acid (AA), DHA/AA and Mead acid in 57 infants of this trial. MA GMs were inversely related to AA, associated with Mead acid, and associated with DHA/AA in a U-shaped manner. These relationships may indicate dependence of newborn AA status on synthesis from linoleic acid. This becomes restricted during the intrauterine period by abundant de novo synthesis of oleic and Mead acids from glucose, consistent with reduced insulin sensitivity during the third trimester. The descending part of the U-shaped relation between MA GMs and DHA/AA probably indicates DHA shortage next to AA shortage. The ascending part may reflect a different developmental trajectory that is not necessarily unfavorable. Copyright 2009 Elsevier Ltd. All rights reserved.

  20. Elastic stresses in u-shaped bellows

    International Nuclear Information System (INIS)

    Janzen, P.

    1980-05-01

    This report presents relations describing the meridional and circumferential elastic stress levels at the root and crown due to external pressure and axial deflection of U-shaped bellows. The derivation is based on a statistical analysis of theoretical data obtained from a finite element analysis of selected bellows configurations. The mathematical formulations and various graphical representations are proposed as aids to bellows design and analysis. (auth)

  1. The U-Shapes of Occupational Mobility

    DEFF Research Database (Denmark)

    Groes, Fane; Kircher, Philipp; Manovskii, Iourii

    Using administrative panel data on the entire Danish population we document a new set of facts characterizing occupational mobility. For most occupations, mobility is U-shaped and directional: both low and high wage earners within an occupation have a particularly large probability of leaving...... theories that are used to account for endogeneity in occupational choice, but it is shown analytically that the patterns are explained consistently within a theory of sorting under absolute advantage that includes learning about workers’ abilities....

  2. The U-Shapes of Occupational Mobility

    DEFF Research Database (Denmark)

    Groes, Fane Naja; Kircher, Philipp; Manovskii, Iourii

    2015-01-01

    Using administrative panel data on the entire Danish population we document a new set of facts characterizing occupational mobility. For most occupations, mobility is U-shaped and directional: not only low but also high wage earners within an occupation have a particularly large probability...... to leave. The facts conflict with several existing theories that are used to account for endogeneity in occupational choice, but it is shown analytically that the patterns are explained consistently within a theory of vertical sorting under absolute advantage that includes learning about workers' abilities....

  3. On the necessity of U-shaped learning.

    Science.gov (United States)

    Carlucci, Lorenzo; Case, John

    2013-01-01

    A U-shaped curve in a cognitive-developmental trajectory refers to a three-step process: good performance followed by bad performance followed by good performance once again. U-shaped curves have been observed in a wide variety of cognitive-developmental and learning contexts. U-shaped learning seems to contradict the idea that learning is a monotonic, cumulative process and thus constitutes a challenge for competing theories of cognitive development and learning. U-shaped behavior in language learning (in particular in learning English past tense) has become a central topic in the Cognitive Science debate about learning models. Antagonist models (e.g., connectionism versus nativism) are often judged on their ability of modeling or accounting for U-shaped behavior. The prior literature is mostly occupied with explaining how U-shaped behavior occurs. Instead, we are interested in the necessity of this kind of apparently inefficient strategy. We present and discuss a body of results in the abstract mathematical setting of (extensions of) Gold-style computational learning theory addressing a mathematically precise version of the following question: Are there learning tasks that require U-shaped behavior? All notions considered are learning in the limit from positive data. We present results about the necessity of U-shaped learning in classical models of learning as well as in models with bounds on the memory of the learner. The pattern emerges that, for parameterized, cognitively relevant learning criteria, beyond very few initial parameter values, U-shapes are necessary for full learning power! We discuss the possible relevance of the above results for the Cognitive Science debate about learning models as well as directions for future research. Copyright © 2013 Cognitive Science Society, Inc.

  4. Modeling U-Shaped Exposure-Response Relationships for Agents that Demonstrate Toxicity Due to Both Excess and Deficiency.

    Science.gov (United States)

    Milton, Brittany; Farrell, Patrick J; Birkett, Nicholas; Krewski, Daniel

    2017-02-01

    Essential elements such as copper and manganese may demonstrate U-shaped exposure-response relationships due to toxic responses occurring as a result of both excess and deficiency. Previous work on a copper toxicity database employed CatReg, a software program for categorical regression developed by the U.S. Environmental Protection Agency, to model copper excess and deficiency exposure-response relationships separately. This analysis involved the use of a severity scoring system to place diverse toxic responses on a common severity scale, thereby allowing their inclusion in the same CatReg model. In this article, we present methods for simultaneously fitting excess and deficiency data in the form of a single U-shaped exposure-response curve, the minimum of which occurs at the exposure level that minimizes the probability of an adverse outcome due to either excess or deficiency (or both). We also present a closed-form expression for the point at which the exposure-response curves for excess and deficiency cross, corresponding to the exposure level at which the risk of an adverse outcome due to excess is equal to that for deficiency. The application of these methods is illustrated using the same copper toxicity database noted above. The use of these methods permits the analysis of all available exposure-response data from multiple studies expressing multiple endpoints due to both excess and deficiency. The exposure level corresponding to the minimum of this U-shaped curve, and the confidence limits around this exposure level, may be useful in establishing an acceptable range of exposures that minimize the overall risk associated with the agent of interest. © 2016 Society for Risk Analysis.

  5. U-shaped sacral fractures: Surgical treatment and quality of life

    NARCIS (Netherlands)

    Gribnau, A. J. G.; Boele van Hensbroek, P.; Haverlag, R.; Ponsen, K. J.; Been, H. D.; Goslings, J. C.

    2009-01-01

    Background: U-shaped sacral fractures are rare and highly unstable pelvic ring fractures. They are not recognised in the standard classification systems of these fractures. The fracture pattern is associated with significant neurological injury and can lead to progressive deformity and chronic pain

  6. Association Between Employee Sleep With Workplace Health and Economic Outcomes.

    Science.gov (United States)

    Burton, Wayne N; Chen, Chin-Yu; Schultz, Alyssa B; Li, Xingquan

    2017-02-01

    Poor sleep can impact occupational functioning. The current study examines health risks, medical conditions, and workplace economic outcomes associated with self-reported hours of sleep among employees. Employees of a global financial services corporation were categorized on the basis of their self-reported average hours of sleep. Differences in health care costs, productivity measures, health risks, and medical conditions were analyzed by hours of sleep while controlling for confounding variables. A strong U-shaped relationship between health care costs, short-term disability, absenteeism, and presenteeism (on-the-job work loss) and the hours of sleep was found among employees. The nadir of the "U" occurs for 7 or 8 hours of sleep per night. Worksite wellness programs often address health risks and medical conditions and may benefit from incorporating sleep education.

  7. Association Between Sleep Duration and Health Outcome in Elderly Taiwanese

    Directory of Open Access Journals (Sweden)

    Meng-Ting Tsou

    2011-12-01

    Conclusion: A U-shaped relationship was observed between the self-reported sleep duration with risk prevalence and health outcome in the elderly population, although not all results showed a significant difference. A progressively higher change was observed during short and long sleep durations in our study.

  8. Mildly abnormal general movement quality in infants is associated with higher Mead acid and lower arachidonic acid and shows a U-shaped relation with the DHA/AA ratio

    NARCIS (Netherlands)

    van Goor, S. A.; Schaafsma, A.; Erwich, J. J. H. M.; Dijck-Brouwer, D. A. J.; Muskiet, F. A. J.

    We showed that docosahexaenoic acid (DHA) supplementation during pregnancy and lactation was associated with more mildly abnormal (MA) general movements (GMs) in the infants. Since this finding was unexpected and inter-individual DHA intakes are highly variable, we explored the relationship between

  9. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies.

    Science.gov (United States)

    König, M A; Jehan, S; Boszczyk, A A; Boszczyk, B M

    2012-05-01

    U-shaped sacral fractures usually result from axial loading of the spine with simultaneous sacral pivoting due to a horizontal fracture which leads to a highly unstable spino-pelvic dissociation. Due to the rarity of these fractures, there is lack of an agreed treatment strategy. A thorough literature search was carried out to identify current treatment concepts. The studies were analysed for mechanism of injury, diagnostic imaging, associated injuries, type of surgery, follow-up times, complications, neurological, clinical and radiological outcome. Sixty-three cases were found in 12 articles. No Class I, II or III evidence was found in the literature. The most common mechanism of injury was a fall or jump from height. Pre-operative neurological deficit was noted in 50 (94.3%) out of 53 cases (not available in 10 patients). The most used surgical options were spino-pelvic fixation with or without decompression and ilio-sacral screws. Post-operative complications occurred in 24 (38.1%) patients. Average follow-up time was 18.6 months (range 2-34 months). Full neurological recovery was noted in 20 cases, partial recovery in 14 and 9 patients had no neurological recovery (5 patients were lost in follow-up). Fracture healing was mentioned in 7 articles with only 1 case of fracture reduction loss. From the current available data, an evidence based treatment strategy regarding outcome, neurological recovery or fracture healing could not be identified. Limited access and minimal-invasive surgery focussing on sacral reduction and restoration seems to offer comparable results to large spino-pelvic constructs with fewer complications and should be considered as the method of choice. If the fracture is highly unstable and displaced, spino-pelvic fixation might offer better stability.

  10. Load Testing of GFRP Composite U-Shape Footbridge

    Science.gov (United States)

    Pyrzowski, Łukasz; Miśkiewicz, Mikołaj; Chróścielewski, Jacek; Wilde, Krzysztof

    2017-10-01

    The paper presents the scope of load tests carried out on an innovative shell composite footbridge. The tested footbridge was manufactured in one production cycle and has no components made from materials other than GFRP laminates and PET foam. The load tests, performed on a 14-m long structure, were the final stage of a research program in the Fobridge project carried out in cooperation with: Gdańsk University of Technology (leader), Military University of Technology in Warsaw, and ROMA Co. Ltd.; and co-financed by NCBR. The aim of the tests was to confirm whether the complex U-shape sandwich structure behaves correctly. The design and technological processes involved in constructing this innovative footbridge required the solving of many problems: absence of standards for design of composite footbridges, lack of standardized material data, lack of guidelines for calculation and evaluation of material strength, and no guidelines for infusion of large, thick sandwich elements. Obtaining answers during the design process demanded extensive experimental tests, development of material models, validation of models, updating parameters and extensive numerical parametric studies. The technological aspects of infusion were tested in numerous trials involving the selection of material parameters and control of the infusion parameters. All scientific validation tests were successfully completed and market assessment showed that the proposed product has potential applications; it can be used for overcoming obstacles in rural areas and cities, as well as in regions affected by natural disasters. Load testing included static and dynamic tests. During the former, the span was examined at 117 independent measurement points. The footbridge was loaded with concrete slabs in different configurations. Their total weight ranged from 140 kN up to 202 kN. The applied load at the most heavily loaded structural points caused an effect from 89% to 120%, compared to the load specified by

  11. Income Inequality and Happiness: An Inverted U-Shaped Curve.

    Science.gov (United States)

    Yu, Zonghuo; Wang, Fei

    2017-01-01

    Numerous studies agree that income inequality, rather than absolute income, is an important predictor of happiness. However, its specific role has been controversial. We argue that income inequality and happiness should exhibit an inverted U-shaped relationship due to the dynamic competing process between two effects: when income inequality is relatively low, the signal effect will be the dominating factor, in which individuals feel happy because they consider income inequality as a signal of social mobility and expect upward mobility; however, if income inequality level increases beyond a critical point, the jealousy effect will become the dominating factor, in which individuals tend to be unhappy because they are disillusioned about the prospect of upward mobility and jealous of their wealthier peers. This hypothesis is tested in a longitudinal dataset on the United States and a cross-national dataset on several European countries. In both datasets, the Gini coefficient (a common index of a society's income inequality) and its quadratic term were significant predictors of personal happiness. Further examinations of the quadratic relationships showed that the signal effect was only presented in the European data, while the jealousy effect was presented in both datasets. These findings shed new light on our understanding of the relationship between income inequality and personal happiness.

  12. Income Inequality and Happiness: An Inverted U-Shaped Curve

    Directory of Open Access Journals (Sweden)

    Zonghuo Yu

    2017-11-01

    Full Text Available Numerous studies agree that income inequality, rather than absolute income, is an important predictor of happiness. However, its specific role has been controversial. We argue that income inequality and happiness should exhibit an inverted U-shaped relationship due to the dynamic competing process between two effects: when income inequality is relatively low, the signal effect will be the dominating factor, in which individuals feel happy because they consider income inequality as a signal of social mobility and expect upward mobility; however, if income inequality level increases beyond a critical point, the jealousy effect will become the dominating factor, in which individuals tend to be unhappy because they are disillusioned about the prospect of upward mobility and jealous of their wealthier peers. This hypothesis is tested in a longitudinal dataset on the United States and a cross-national dataset on several European countries. In both datasets, the Gini coefficient (a common index of a society’s income inequality and its quadratic term were significant predictors of personal happiness. Further examinations of the quadratic relationships showed that the signal effect was only presented in the European data, while the jealousy effect was presented in both datasets. These findings shed new light on our understanding of the relationship between income inequality and personal happiness.

  13. U-shaped curve of psychosis according to cannabis use: New evidence from a snowball sample.

    Science.gov (United States)

    Brañas, Antía; Barrigón, María L; Garrido-Torres, Nathalia; Perona-Garcelán, Salvador; Rodriguez-Testal, Juan F; Lahera, Guillermo; Ruiz-Veguilla, Miguel

    2016-12-01

    The aim of this study was to investigate the relationship between psychotic-like experiences (PLEs) assessed using the Community Assessment of Psychic Experience (CAPE) questionnaire and the pattern of cannabis use in a non-clinical sample collected by snowball sampling. Our sample was composed of 204 subjects, distributed into three groups by their cannabis use pattern: 68 were non-cannabis users, 40 were moderate cannabis users and 96 were daily cannabis users. We assessed the psychotic experiences in each group with the CAPE questionnaire; and then controlled for the effect of possible confounding factors like sex, age, social exclusion, age of onset of cannabis use, alcohol use and other drug use. We found a significant quadratic association between the frequency of cannabis use and positive (β = -1.8; p = 0.004) and negative dimension scores (β = -1.2; p = 0.04). The first-rank and mania factors showed a significant quadratic association (p < 0.05), while the voices factor showed a trend (p = 0.07). Scores for the different groups tended to maintain a U-shape in their values for the different factors. When we adjusted for gender, age, social exclusion, age of onset of cannabis use, and use of alcohol and other drugs, only the first-rank experiences remained significant. We found there was a U-shaped curve in the association between cannabis use and the positive and negative dimensions of the CAPE score. We also found this association in mania and first-rank experiences. © The Author(s) 2016.

  14. Inverted U-shaped model: How frequent repetition affects perceived risk

    OpenAIRE

    Xi Lu; Xiaofei Xie; Lu Liu

    2015-01-01

    We asked how repeated media reports on technological hazards influence an individual's risk perception. We looked for two contradictory effects, an increasing effect of repetition on perceived risk with the first few repetitions and a decreasing effect with later repetitions, leading to the inverted U-shaped pattern. In an experiment, we demonstrated the inverted U-shaped relationship between the repetition and perceived risk in the context of food risk. The finding broaden...

  15. Professional development for nurses: mentoring along the u-shaped curve.

    Science.gov (United States)

    Johnson, Joyce E; Billingsley, Molly; Crichlow, Tori; Ferrell, Eileen

    2011-01-01

    Shortages of nurses are expected to continue throughout the coming decade. To meet the demand, nursing leaders must develop creative approaches for nurturing and sustaining nursing talent. Traditionally, nursing has embraced a variety of development strategies to enhance the leadership abilities of nurses and to fill the leadership ranks with top talent. We describe the rationale, design, and impact of a 3-pronged organizational approach to mentoring nursing talent at Georgetown University Hospital, the first Magnet hospital in Washington, District of Columbia. The design of these programs was driven by the demographics of our nursing staff. Analysis of length of tenure revealed a modified "U-shaped curve" with the majority of new nurses with tenure less than 5 years, few in the middle between 5 and 15 years, and a moderate number with 15 or more years. Investment in all our nurses' leadership development required integrating a diverse developmental process into our organizational culture, which values personal growth and mastery. A strong mentoring program makes good business sense in terms of employee job satisfaction, improved cost control, and better patient outcomes. Our experience suggests that voluntary mentoring programs work synergistically to further the development of a mentoring culture in today's hospitals.

  16. Inverted U-Shaped Curvilinear Relationship between Challenge and One's Intrinsic Motivation: Evidence from Event-Related Potentials.

    Science.gov (United States)

    Ma, Qingguo; Pei, Guanxiong; Meng, Liang

    2017-01-01

    The balance between task demand and one's competence is critical for the maintenance of intrinsic motivation. According to Flow theory and Self-determination theory, optimal challenge gives rise to the maximum intrinsic motivation, and an inverted U-shaped curvilinear relationship between perceived challenge and one's intrinsic motivation is suggested. In order to provide direct experimental evidences for predictions of these theories, in this study, we employed the two-player StopWatch game that we previously designed, which made references to the game format of a badminton tournament. According to our manipulation, a male participant was defeated by the same-sex player paired with him (played by a well-trained confederate of the experimenter) in two matches, one with a wide margin (the complete defeat condition) and another with a narrow one (the near miss condition). Participants performed better and reported to enjoy the near miss match to a greater extent. Besides, an enlarged Stimulus-preceding negativity was elicited when participants were actively anticipating outcomes in the near miss condition, suggesting greater anticipatory attention toward the outcome and an enhanced intrinsic motivation to win. Thus, converging electrophysiological evidences from this study and our former study confirmed the inverted U-shaped curvilinear relationship between perceived challenge and one's intrinsic motivation.

  17. Fat Mass Follows a U-Shaped Distribution Based on Estradiol Levels in Postmenopausal Women

    Directory of Open Access Journals (Sweden)

    Georgia Colleluori

    2018-07-01

    Full Text Available ObjectiveEstradiol (E2 regulates adipose tissue resulting in increased fat mass (FM with declining E2. However, increased visceral fat and hyperestrogenemia are features of obese individuals. It is possible that adipocytes in obese individuals are less sensitive to E2 resulting in higher FM. Our objective is to identify the range of serum E2 for which postmenopausal women have the lowest FM and best body composition.MethodsCross-sectional data from 252 community-dwelling postmenopausal women, 42–90 years old. Subjects were stratified into categories of E2 (pg/ml: (1 ≤10.5; (2 10.6–13.9; (3 14.0–17.4; and (4 ≥17.5. Body composition by dual-energy X-ray absorptiometry. Serum E2 by radioimmunoassay. Between-group comparisons by analysis of covariance.ResultsE2 linearly increased with increasing body weight and body mass index (r = 0.15 and p = 0.01 for both, but not with total FM (kg or % FM (r = 0.07, p = 0.34 and r = −0.04, p = 0.56, respectively. However, total FM (kg followed a U-shaped distribution and was significantly lower in group 3 (27.6 ± 10.6, compared with groups 1: (34.6 ± 12.5, 2: (34.0 ± 12.4, and 4: (37.0 ± 10.6, p = 0.005. % FM was also lowest in group 3. While fat-free mass (FFM, kg increased with increasing E2 (p < 0.001, % FFM was highest in group 3.ConclusionIn our population of postmenopausal women, FM followed a U-shaped distribution according to E2 levels. E2 between 14.0 and 17.4 pg/ml is associated with the best body composition, i.e., lowest total and % FM and highest % FFM. Given the role of E2 in regulating body fat, high FM at the high end of the E2 spectrum may suggest reduced E2 sensitivity in adipocytes among obese postmenopausal women.Clinical TrialsClinicalTrials.gov identifier: NCT00146107.

  18. A U-Shaped Relationship between Body Mass Index and Dysmenorrhea: A Longitudinal Study.

    Science.gov (United States)

    Ju, Hong; Jones, Mark; Mishra, Gita D

    2015-01-01

    Both obesity and dysmenorrhea are prevalent among women. Few population-based longitudinal studies investigate the association between body mass index (BMI) and dysmenorrhea yielding mixed results, especially for obesity. This study aims to investigate the long-term association between BMI and dysmenorrhea. 9,688 women from a prospective population-based cohort study were followed for 13 years. Data were collected through self-reported questionnaires. The longitudinal association between dysmenorrhea and BMI or BMI change was investigated by logistic regression analysis using generalized estimating equations to account for the repeated measures. When the women were aged 22 to 27 years, approximately 11% were obese, 7% underweight, and 25% reported dysmenorrhea. Compared to women with a normal weight, significantly higher odds of reporting dysmenorrhea were detected for both women who were underweight (odds ratio (OR) 1.34, 95% confidence interval (CI) 1.15, 1.57) and obese (OR 1.22, 95% CI 1.11, 1.35). Compared to women who remained at normal weight or overweight over time, significant risk was detected for women who: remained underweight or obese (OR 1.33, 95% CI 1.20, 1.48), were underweight despite weight gain (OR 1.33, 95% CI 1.12, 1.58), became underweight (OR 1.28, 95% CI 1.02, 1.61). However the higher risk among obese women disappeared when they lost weight (OR 1.06, 95% CI 0.85, 1.32). A U-shaped association was revealed between dysmenorrhea and BMI, revealing a higher risk of dysmenorrhea for both underweight and obese women. Maintaining a healthy weight over time may be important for women to have pain-free periods.

  19. Thinking about U : Theorizing and testing U - and inverted U-shaped relationships in strategy research

    NARCIS (Netherlands)

    Haans, Richard; Pieters, Constant; He, Zilin

    U- and inverted U-shaped relationships are increasingly explored in strategy research, with 11 percent of all articles published in Strategic Management Journal (SMJ) in 2008–2012 investigating such quadratic relationships. Moreover, a movement towards introducing moderation to quadratic

  20. A Few Simple Classroom Experiments with a Permanent U-Shaped Magnet

    Science.gov (United States)

    Babovic, Miloš; Babovic, Vukota

    2017-01-01

    A few simple experiments in the magnetic field of a permanent U-shaped magnet are described. Among them, pin oscillations inside the magnet are particularly interesting. These easy to perform and amusing measurements can help pupils understand magnetic phenomena and mutually connect knowledge of various physics branches.

  1. Dryout characteristics and flow behavior of gas-water two-phase flow through U-shaped and inverted U-shaped bends

    International Nuclear Information System (INIS)

    Takemura, T.; Roko, K.; Shiraha, M.; Midoriyama, S.

    1986-01-01

    Experimental results are presented on the flow behavior, pressure drop characteristics, and dryout characteristics by joule heating for the gas-water flow through U-shaped and inverted U-shaped tubes invertical plane. The height of the vertical straight section of the test tube is 4100 mm, and two bend radii, 116 mm and 435 mm, are chosen for the experiments. The test tubes used are of transparent acrylic resin for the flow behavior test, and of stainless steel for the other tests, inside diameter being 18 mm for the former and 18.5 mm for the latter. Flow patterns in the vertical upflow and downflow sections are shown on the diagram of the superficial gas velocity versus liquid velocity. Further, the flow behavior in the bend section is made clear in relation to flow rates of gas and liquid. The pressure drop between inlet and outlet of the test tube for the made clear in relation to flow rates of gas and liquid. The pressure drop between inlet and outlet of the test tube for the two-phase flow is shown in comparison with that for the single-phase flow of water. The threshold conditions of dryout in the bend section by joule heatig are shown on the diagram of the superficial gas velocity versus liquid velocity. The location of the dryout in the bend section is also clarified. (orig.)

  2. Pendant unit effect on electron tunneling in U-shaped molecules

    International Nuclear Information System (INIS)

    Liu Min; Chakrabarti, Subhasis; Waldeck, David H.; Oliver, Anna M.; Paddon-Row, Michael N.

    2006-01-01

    The electron transfer reactions of three U-shaped donor-bridge-acceptor molecules with different pendant groups have been studied in different solvents as a function of temperature. Analysis of the electron transfer kinetics in nonpolar and weakly polar solvents provides experimental reaction Gibbs energies that are used to parameterize a molecular solvation model. This solvation model is then used to predict energetic parameters in the electron transfer rate constant expression and allow the electronic coupling between the electron donor and electron acceptor groups to be determined from the rate data. The U-shaped molecules differ by alkylation of the aromatic pendant group, which lies in the 'line-of-sight' between the donor and acceptor groups. The findings show that the electronic coupling through the pendant group is similar for these molecules

  3. A U-Shaped Slot UWB Antenna with Flexible and Wide Tunable Dual Notch Band

    Directory of Open Access Journals (Sweden)

    Zhang Zhongmin

    2016-01-01

    Full Text Available A coplanar waveguide (CPW fed ultra-wideband (UWB antenna with flexible and wide tunable dual bandnotched characteristics is proposed in this paper. The dual band-notched function is achieved by using an U-shaped slot inserted into the ellipse radiation patch and by using an elliptic parasitic slit placed near the ground plane. The wide tunable band-notched characteristic is implemented by adjusting the length of U-shaped slot and by adjusting the length of ellipse parasitic slit. The design aims to achieve wide reconfigurable band-notched features on the UWB antenna. The simulated results indicate that the proposed antenna has a wide bandwidth (VSWR under 2 from 2.9GHz to 12.6GHz with fractional bandwidth of 125%, and has a wide tunable notch band center frequency from 4.5GHz to 12.4GHz.

  4. U-shaped micro-groove fiber based on femtosecond laser processing for humidity sensing

    Science.gov (United States)

    Fu, Gui; Ma, Li-li; Su, Fu-fang; Shi, Meng

    2018-05-01

    A novel optical fiber sensor with a U-shaped micro-groove structure ablated by femtosecond laser on single-mode fiber for measuring air relative humidity (RH) is reported in this paper. In order to improve the accuracy of sensor, a graphene oxide (GO)/polyvinyl alcohol (PVA) composite film is coated on the surface of micro-groove structure. In the U-shaped micro-groove structure, the remaining core and micro-cavity in the micro-groove make up two major optical propagation paths, forming a Mach-Zehnder interferometer (MZI). The sensor has a good linear response within the RH range of 30%—85%, and the maximum sensitivity can reach 0.638 1 nm/%RH. The effect of temperature on the overall performance of the humidity sensor is also investigated. As a new type of all-fiber device, the sensor shows excellent sensitivity and stability.

  5. U-shaped relationship between current and pitch in helicene molecules

    OpenAIRE

    Guo, Yan-Dong; Yan, Xiao-Hong; Xiao, Yang; Liu, Chun-Sheng

    2015-01-01

    The helicene is constructed by twisted benzene or other aromatic rings, exhibiting a helical structure. Using first-principles calculations, we investigate the electronic transport of helicenes under stretching or compressing. Interestingly, a U-shaped curve of the current against d (the pitch of a helicene) is observed. Further analysis shows that, it is the result of the nonmonotonic change of HOMO-LUMO gap with d. The change of overlap between orbitals induced by conformational deformation...

  6. Glucose Sensor Using U-Shaped Optical Fiber Probe with Gold Nanoparticles and Glucose Oxidase.

    Science.gov (United States)

    Chen, Kuan-Chieh; Li, Yu-Le; Wu, Chao-Wei; Chiang, Chia-Chin

    2018-04-16

    In this study, we proposed a U-shaped optical fiber probe fabricated using a flame heating method. The probe was packaged in glass tube to reduce human factors during experimental testing of the probe as a glucose sensor. The U-shaped fiber probe was found to have high sensitivity in detecting the very small molecule. When the sensor was dipped in solutions with different refractive indexes, its wavelength or transmission loss changed. We used electrostatic self-assembly to bond gold nanoparticles and glucose oxidase (GOD) onto the sensor’s surface. The results over five cycles of the experiment showed that, as the glucose concentration increased, the refractive index of the sensor decreased and its spectrum wavelength shifted. The best wavelength sensitivity was 2.899 nm/%, and the linearity was 0.9771. The best transmission loss sensitivity was 5.101 dB/%, and the linearity was 0.9734. Therefore, the proposed U-shaped optical fiber probe with gold nanoparticles and GOD has good potential for use as a blood sugar sensor in the future.

  7. Weak-link-induced thermoelectricity in U-shaped BSCCO superconductor

    International Nuclear Information System (INIS)

    Doyle, R.A.; Gridin, V.V.

    1992-01-01

    The recently reported weak-link-induced analogue of the Fountain effect in high-Tc superconductors involves measurement of the response of a micro-bridge-shaped sample to superimposed electrical and thermal gradients. This geometry is however asymmetric since the current contacts are always at different temperatures. Consequently doubts might be expressed about the interference of Peltier effects at the current contacts with the measured symmetry in the I-V characteristics of the sample. We have studied the temrature dependence of the voltage response of U-shaped samples of polycrystalline BSCCO 2212 superconductor in the presence of a parallel applied temperature gradient and applied current when the current direction is reversed. It is shown that this method is directly complementary to the measurement of asymmetry in critical current density by use of I-V characteristics at fixed temperature. The U-shaped geometry employed here allows the current electrodes to be held equipotential and at the same temperature. Our results show that the Fountain effect, which is due to supercurrent-induced phase differences across weak links in the sample, is apparent in this material when measured using the U-shaped geometry. This provides further support for the importance of weak-link-related thermoelectric effects in high-temperature superconductors. (orig.)

  8. Is the relationship between BMI and mortality increasingly U-shaped with advancing age? A 10-year follow-up of persons aged 70-95 years

    DEFF Research Database (Denmark)

    Thinggaard, Mikael; Jacobsen, Rune; Jeune, Bernard

    2010-01-01

    BACKGROUND: In the call for papers (Alley DE, Ferrucci L, Barbagallo M, Studenski SA, Harris TB. A research agenda: the changing relationship between body weight and health in aging. J Gerontol A Biol Sci Med Sci. 2008;63(11):1257-1259.), it is assumed that the association between body mass index...... (BMI [kilogram per square meter]) and mortality becomes increasingly U-shaped with advancing age. The aim of this study is to examine the association between BMI and mortality and to test whether the association is changing with advancing age for persons aged 70-95 years in Denmark. METHODS: The study...

  9. U-Shaped and Surface Functionalized Polymer Optical Fiber Probe for Glucose Detection.

    Science.gov (United States)

    Azkune, Mikel; Ruiz-Rubio, Leire; Aldabaldetreku, Gotzon; Arrospide, Eneko; Pérez-Álvarez, Leyre; Bikandi, Iñaki; Zubia, Joseba; Vilas-Vilela, Jose Luis

    2017-12-25

    In this work we show an optical fiber evanescent wave absorption probe for glucose detection in different physiological media. High selectivity is achieved by functionalizing the surface of an only-core poly(methyl methacrylate) (PMMA) polymer optical fiber with phenilboronic groups, and enhanced sensitivity by using a U-shaped geometry. Employing a supercontinuum light source and a high-resolution spectrometer, absorption measurements are performed in the broadband visible light spectrum. Experimental results suggest the feasibility of such a fiber probe as a low-cost and selective glucose detector.

  10. Management of Chronic Recurrent Dislocation of Temporomandibular Joint Using 'U' Shaped Graft: A New Restrictive Technique.

    Science.gov (United States)

    Gadre, Kiran; Singh, Divya; Gadre, Pushkar; Halli, Rajshekhar

    2017-06-01

    Numerous procedures have been described for the treatment of chronic recurrent dislocation of the temporo-mandibular joint (TMJ), either in the form of enhancement or restriction of the condylar movement, with their obvious merits and demerits. We present a new technique of using U shaped iliac bone graft to restrict the condylar movement and its advantages over the conventional techniques.We have used this technique successfully in 8 cases where Dautrey's procedure had failed with follow up period of 2 years. No patient complained of recurrent dislocation postoperatively. This a very simple and effective technique where other procedures have failed.

  11. Stress analysis and torsional buckling analysis of U-shaped bellows

    International Nuclear Information System (INIS)

    Watanabe, Osamu; Ohtsubo, Hideomi.

    1986-01-01

    This paper presents analysis of elastic stress and torsional buckling of U-shaped bellows using ring elements. The expansion joint is considered to be composed of the two toroidal sections and inner-connecting annular plates. The general thin shell theory is employed to derive strain-displacement relations of shells and plates, valid for any loadings. Numerical examples under internal pressure or axial loading are described and compared with the results of existing appropriate analysis. The fundamental aspects of torsional buckling, which have not been studied previously, will also be investigated. (author)

  12. Multiple-band reflective polarization converter using U-shaped metamaterial

    International Nuclear Information System (INIS)

    Huang, Xiaojun; Yang, Dong; Yang, Helin

    2014-01-01

    A multiple-band metamaterial reflective polarization converter (RPC) is proposed, which is composed of the dielectric substrate sandwiched with U-shaped metallic patterns and continuous metal film. The proposed U-shaped metamaterial RPC (UMM-RPC) can convert a linearly polarized wave to its cross polarized wave at the three resonant frequencies, which also can convert the linearly polarized wave to circularly polarized wave at other three resonant frequencies. Furthermore, the proposed UMM-RPC can maintain the same conversional direction at the three resonant frequencies when incident on a circularly polarized wave. The simulated and measured results are in agreement in the entire frequency range, and the polarization conversion ratio is over 90% for both linear and circular polarizations. The surface current distributions of the UMM-RPC are discussed to look into the physical mechanism. The proposed UMM-RPC has simple geometry but more operating frequency bands compared to the previous designs and can be used in applications such as antenna radome, remote sensors, and radiometer

  13. Gradient elution behavior of proteins in hydrophobic interaction chromatography with U-shaped retention factor curves.

    Science.gov (United States)

    Creasy, Arch; Lomino, Joseph; Barker, Gregory; Khetan, Anurag; Carta, Giorgio

    2018-04-27

    Protein retention in hydrophobic interaction chromatography is described by the solvophobic theory as a function of the kosmostropic salt concentration. In general, an increase in salt concentration drives protein partitioning to the hydrophobic surface while a decrease reduces it. In some cases, however, protein retention also increases at low salt concentrations resulting in a U-shaped retention factor curve. During gradient elution the salt concentration is gradually decreased from a high value thereby reducing the retention factor and increasing the protein chromatographic velocity. For these conditions, a steep gradient can overtake the protein in the column, causing it to rebind. Two dynamic models, one based on the local equilibrium theory and the other based on the linear driving force approximation, are presented. We show that the normalized gradient slope determines whether the protein elutes in the gradient, partially elutes, or is trapped in the column. Experimental results are presented for two different monoclonal antibodies and for lysozyme on Capto Phenyl (High Sub) resin. One of the mAbs and lysozyme exhibit U-shaped retention factor curves and for each, we determine the critical gradient slope beyond which 100% recovery is no longer possible. Elution with a reverse gradient is also demonstrated at low salt concentrations for these proteins. Understanding this behavior has implications in the design of gradient elution since the gradient slope impacts protein recovery. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Vibrational structures in electron-CO2 scattering below the 2Πu shape resonance

    International Nuclear Information System (INIS)

    Allan, Michael

    2002-01-01

    Structures of vibrational origin were discovered in vibrationally inelastic electron-CO 2 cross sections in the energy range 0.4-0.9 eV, well below the 2 Π u shape resonance. They appear in the excitation of higher vibrational levels, in particular the highest members of the Fermi polyads of the type (n, 2m, 0) with n+m=2-4. The lowest two structures, at 0.445 and 0.525 eV, are narrow; higher-lying structures are broader and boomerang-like. The structures are absent when the antisymmetric stretch is co-excited. The structures are interpreted in terms of a wavepacket of the nuclei reflected from a potential surface of the CO 2 - anion in a bent and stretched geometry. A state emerging from the virtual state upon bending and stretching and the state resulting from bending the 2 Π u shape resonance are discussed as possibly being responsible for the structures. (author). Letter-to-the-editor

  15. Multiple-band reflective polarization converter using U-shaped metamaterial

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Xiaojun [College of Physical Science and Technology, Central China Normal University, Wuhan 430079 (China); Department of Physics, Kashgar Teachers College, Kashgar 844000 (China); Yang, Dong [College of Physics and Electronics Science, Hubei Normal University, Huangshi 435002 (China); Yang, Helin, E-mail: emyang@mail.ccnu.edu.cn [College of Physical Science and Technology, Central China Normal University, Wuhan 430079 (China)

    2014-03-14

    A multiple-band metamaterial reflective polarization converter (RPC) is proposed, which is composed of the dielectric substrate sandwiched with U-shaped metallic patterns and continuous metal film. The proposed U-shaped metamaterial RPC (UMM-RPC) can convert a linearly polarized wave to its cross polarized wave at the three resonant frequencies, which also can convert the linearly polarized wave to circularly polarized wave at other three resonant frequencies. Furthermore, the proposed UMM-RPC can maintain the same conversional direction at the three resonant frequencies when incident on a circularly polarized wave. The simulated and measured results are in agreement in the entire frequency range, and the polarization conversion ratio is over 90% for both linear and circular polarizations. The surface current distributions of the UMM-RPC are discussed to look into the physical mechanism. The proposed UMM-RPC has simple geometry but more operating frequency bands compared to the previous designs and can be used in applications such as antenna radome, remote sensors, and radiometer.

  16. Coplanar UHF RFID tag antenna with U-shaped inductively coupled feed for metallic applications.

    Directory of Open Access Journals (Sweden)

    Karrar Naji Salman

    Full Text Available In this paper, we present a novel compact, coplanar, tag antenna design for metallic objects. Electrically small antenna has designed for a UHF RFID (860-960 MHz based on a proximity-coupled feed through. Furthermore, two symmetrical Via-loaded coplanar grounds fed by a U-shaped inductively coupled feed through an embedded transmission line. This configuration results in an antenna with dimensions of 31 × 19.5 × 3.065 mm3 at 915 MHz, and the total gain for the antenna is 0.12 dBi. The Via-loaded coplanar and U-shaped inductively coupled feeds allow the antenna to provide flexible tuning in terms of antenna impedance. In addition, a figure of merit is applied for the proposed tag antenna, and the results are presented. The read range is measured to be 4.2 m, which is very close to simulated values. This antenna measurement shows very good agreement with simulations.

  17. Association of education level with dialysis outcome.

    Science.gov (United States)

    Khattak, Muhammad; Sandhu, Gurprataap S; Desilva, Ranil; Goldfarb-Rumyantzev, Alexander S

    2012-01-01

    The impact of education on health care outcome has been studied in the past, but its role in the dialysis population is unclear. In this report, we evaluated this association. We used the United States Renal Data System data of end-stage renal disease patients aged 18 years. Education level at the time of end-stage renal disease onset was the primary variable of interest. The outcome of the study was patient mortality. We used four categories of education level: 0 = less than 12 years of education; 1 = high school graduate; 2 = some college; 3 = college graduate. Subgroups based on age, race, sex, donor type, and diabetic status were also analyzed. After adjustments for covariates in the Cox model, using individuals with less than 12 years of education as a reference, patients with college education showed decreased mortality with hazard ratio of 0.81 (95% confidence interval 0.69–0.95), P = 0.010. In conclusion, we showed that higher education level is associated with improved survival of patients on dialysis.

  18. Analysis of spring-in in U-shaped composite laminates: Numerical and experimental results

    Science.gov (United States)

    Bellini, Costanzo; Sorrentino, Luca; Polini, Wilma; Parodo, Gianluca

    2018-05-01

    The phenomena that happen during the cure process of a composite material laminate are responsible for the rise of residual stresses and, consequently, for the deformation at the end of the manufacturing process. The most analyzed deformation is the spring-in, that represent the flange-to-flange angle deviance from the theoretical value. In this work, the influence of some parameters, such as the laminate thickness, the stacking sequence and the mold radius, on the spring-in angle of a U-shaped laminate was studied exploring a full factorial plan through numerical simulations. First of all, a numerical model proper for cure simulation was introduced and its suitability to simulate the deformation behavior was demonstrated. As a result, only the stacking sequence influenced the spring-in value, while the effect of the tool radius and laminate thickness was minimal.

  19. U-shaped relationship between current and pitch in helicene molecules

    Science.gov (United States)

    Guo, Yan-Dong; Yan, Xiao-Hong; Xiao, Yang; Liu, Chun-Sheng

    2015-11-01

    The helicene is constructed by twisted benzene or other aromatic rings, exhibiting a helical structure. Using first-principles calculations, we investigate the electronic transport of helicenes under stretching or compressing. Interestingly, a U-shaped curve of the current against d (the pitch of a helicene) is observed. Further analysis shows that, it is the result of the nonmonotonic change of HOMO-LUMO gap with d. The change of overlap between orbitals induced by conformational deformation is found to be the underlying mechanism. Moreover, the U-curve phenomenon is an intrinsic feature of the helicene molecules, being robust to the electrode materials or doping. This U-curve behavior is expected to be extended to helical graphene or other related structures, showing great application potential.

  20. Millipede-inspired locomotion through novel U-shaped piezoelectric motors

    International Nuclear Information System (INIS)

    Avirovik, Dragan; Butenhoff, Bryan; Priya, Shashank

    2014-01-01

    We report a novel piezoelectric motor that operates at a resonance frequency of 144 Hz, much lower than that of conventional ultrasonic motors, and meets the displacement and gait requirements for designing the locomotion mechanism of a millipede-inspired robot (millibot). The motor structure consists of two piezoelectric bimorphs arranged in a U-shaped configuration. Using the first bending mode for both the piezoelectric bimorphs an elliptical motion was obtained at the tip which led to the successful implementation of millipede inspired locomotion. At an input voltage of 70.7 V rms , the piezoelectric motor operating at resonance frequency was able to generate torque of 0.03 mN m, mechanical power of 0.84 mW and maximum velocity of 62 rad s −1 . Detailed discussion is provided about the principle of operation of the millibot. (technical note)

  1. A U-shaped linear ultrasonic motor using longitudinal vibration transducers with double feet.

    Science.gov (United States)

    Liu, Yingxiang; Liu, Junkao; Chen, Weishan; Shi, Shengjun

    2012-05-01

    A U-shaped linear ultrasonic motor using longitudinal vibration transducers with double feet was proposed in this paper. The proposed motor contains a horizontal transducer and two vertical transducers. The horizontal transducer includes two exponential shape horns located at the leading ends, and each vertical transducer contains one exponential shape horn. The horns of the horizontal transducer and the vertical transducer intersect at the tip ends where the driving feet are located. Longitudinal vibrations are superimposed in the motor and generate elliptical motions at the driving feet. The two vibration modes of the motor are discussed, and the motion trajectories of driving feet are deduced. By adjusting the structural parameters, the resonance frequencies of two vibration modes were degenerated. A prototype motor was fabricated and measured. Typical output of the prototype is no-load speed of 854 mm/s and maximum thrust force of 40 N at a voltage of 200 V(rms).

  2. A gate enhanced power U-shaped MOSFET integrated with a Schottky rectifier

    International Nuclear Information System (INIS)

    Wang Ying; Jiao Wen-Li; Hu Hai-Fan; Liu Yun-Tao; Cao Fei

    2012-01-01

    An accumulation gate enhanced power U-shaped metal-oxide-semiconductor field-effect-transistor (UMOSFET) integrated with a Schottky rectifier is proposed. In this device, a Schottky rectifier is integrated into each cell of the accumulation gate enhanced power UMOSFET. Specific on-resistances of 7.7 mΩ·mm 2 and 6.5 mΩ·mm 2 for the gate bias voltages of 5 V and 10 V are achieved, respectively, and the breakdown voltage is 61 V. The numerical simulation shows a 25% reduction in the reverse recovery time and about three orders of magnitude reduction in the leakage current as compared with the accumulation gate enhanced power UMOSFET. (condensed matter: structural, mechanical, and thermal properties)

  3. Volvulus U-Shaped transverse colonic duplication: Report of a case and literature review

    Directory of Open Access Journals (Sweden)

    Ruankha Bilommi

    2017-05-01

    Full Text Available Tubular duplication of the colon is very rare especially in adulthood, because it is frequently symptomatic earlier in newborn life, so only few cases are reported in literature. Several theories are proposed to explain the onset and the evolution of gut malformations as the aberrant lumen recanalization or the diverticular theory, the alteration of the lateral closure of the embryonal disk or finally the dorsal protrusion of the yolk-sac for herniation or adhesion to the ectoderm for an abnormality of the longitudinal line, but none clarifies the exact genesis of duplication [1–3]. U Shaped transverse colonic duplication with volvulus has never been reported before and very rare in condition in gastrointestinal duplication.

  4. Scalable nanofabrication of U-shaped nanowire resonators with tunable optical magnetism.

    Science.gov (United States)

    Zhou, Fan; Wang, Chen; Dong, Biqin; Chen, Xiangfan; Zhang, Zhen; Sun, Cheng

    2016-03-21

    Split ring resonators have been studied extensively in reconstituting the diminishing magnetism at high electromagnetic frequencies in nature. However, breakdown in the linear scaling of artificial magnetism is found to occur at the near-infrared frequency mainly due to the increasing contribution of self-inductance while reducing dimensions of the resonators. Although alternative designs have enabled artificial magnetism at optical frequencies, their sophisticated configurations and fabrication procedures do not lend themselves to easy implementation. Here, we report scalable nanofabrication of U-shaped nanowire resonators (UNWRs) using the high-throughput nanotransfer printing method. By providing ample area for conducting oscillating electric current, UNWRs overcome the saturation of the geometric scaling of the artificial magnetism. We experimentally demonstrated coarse and fine tuning of LC resonances over a wide wavelength range from 748 nm to 1600 nm. The added flexibility in transferring to other substrates makes UNWR a versatile building block for creating functional metamaterials in three dimensions.

  5. Excitation and analytical characteristics of an ethanol loaded U-shaped arc

    Directory of Open Access Journals (Sweden)

    MIRJANA TRIPKOVIC

    2003-02-01

    Full Text Available The effect of the ethanol load on the discharge and analytical parameters of an argon stabilised U-shaped DC arc has been recorded. Measurements of the radial distribution of the apparent temperatures and the electron number density of the DC plasma showed that ethanol addition causes a decrease in both plasma parameters. The changes in the plasma characteristics, as well as in transport and atomisation processes of the analyte cause a general change in the spectral line intensities, which depends on the physical characteristics of the analyte and the quantity of ethanol loaded into the plasma. Improved detection limits were obtained for V and Mn when a 10 % (v/v water–ethanol solution was nebulized into the plasma.

  6. Numerical and experimental study on atmospheric pressure ionization waves propagating through a U-shape channel

    International Nuclear Information System (INIS)

    Yan, Wen; Xia, Yang; Bi, Zhenhua; Song, Ying; Liu, Dongping; Wang, Dezhen; Sosnin, Eduard A; Skakun, Victor S

    2017-01-01

    A 2D computational study of ionization waves propagating in U-shape channels at atmospheric pressure was performed, with emphasis on the effect of voltage polarity and the curvature of the bend. The discharge was ignited by a HV needle electrode inside the channel, and power was applied in the form of a trapezoidal pulse lasting 2 µ s. We have shown that behavior of ionization waves propagating in U-shape channels was quite different with that in straight tubes. For positive polarity of applied voltage, the ionization waves tended to propagate along one side of walls rather than filling the channel. The propagation velocity of ionization waves predicted by the simulation was in good agreement with the experiment results; the velocity was first increasing rapidly in the vicinity of the needle tip and then decreasing with the increment of propagation distance. Then we have studied the influence of voltage polarity on discharge characteristics. For negative polarity, the ionization waves tended to propagate along the opposite side of the wall, while the discharge was more diffusive and volume-filling compared with the positive case. It was found that the propagation velocity for the negative ionization wave was higher than that for the positive one. Meanwhile, the propagation of the negative ionization wave depended less on the pre-ionization level than the positive ionization wave. Finally, the effect of the radius of curvature was studied. Simulations have shown that the propagation speeds were sensitive to the radii of the curvature of the channels for both polarities. Higher radii of curvature tended to have higher speed and longer length of plasma. The simulation results were supported by experimental observations under similar discharge conditions. (paper)

  7. Long sleep duration is associated with lower cognitive function among middle-age adults – the Doetinchem Cohort Study

    NARCIS (Netherlands)

    van Oostrom, Sandra H.; Nooyens, Astrid C.J.; van Boxtel, Martin P.J.; Verschuren, W. M.Monique

    2018-01-01

    Objectives In older adults, both short and long sleep duration are associated with lower cognitive function, suggesting an inverted U-shaped association between sleep duration and cognitive outcomes. This study examined whether sleep duration is associated with (changes in) cognitive function in a

  8. Association between periodontal disease and pregnancy outcomes.

    Science.gov (United States)

    Soroye, M; Ayanbadejo, P; Savage, K; Oluwole, A

    2015-12-01

    To evaluate the association between periodontal disease and pregnancy outcomes like preterm birth and low birth weight. Interviewer-administered questionnaires were completed by the subjects who attended the antenatal clinic of the Lagos University Teaching Hospital, Lagos. Information obtained included; maternal age, gestational age, marital status, educational status, occupation and expected date of delivery. After delivery, the questionnaire was completed with baby's weight at birth and the actual date of delivery. Clinical assessment of the periodontium was done using Oral Hygiene Index (OHI) and Community Periodontal Index of Treatment Needs (CPITN). Participants were divided into three groups: Test, Control I and Control II groups. Scaling and polishing were done for all patients with periodontal disease before (Test group) and after delivery (Control I). All Control II participants (those without periodontal disease) were given Oral hygiene instructions. Descriptive and comparative analyses were done using Epi info version 2008. Four hundred and fifty women received the questionnaire but the response rate was 94%, giving an actual sample size of 423 participants. Maternal age range was between 18 and 34 years with mean age of 29.67 (± 3.37). Gestational age at the point of recruitment was between 10 weeks and 26 weeks with mean of 23.34 (± 4.05). The prevalence of periodontal disease among the study group was 33.38%. About 71% of the participants attained tertiary level of education; only 0.7% had no formal education. There was 9.9% use of alcohol among the participants. The mean oral hygiene score for the participants was 1.94 (± 1.31). The prevalences for preterm deliveries, low birth weight and spontaneous abortion were 12.5%, 12.1% and 1.42% respectively. This study confirms periodontal disease as a probable risk for adverse pregnancy outcomes such as preterm delivery and low birth weight. Therefore, health workers should be encouraged to promote good

  9. Research of Effective Width of FRP U-shaped Hoop Reinforcement Properties of Concrete Beams by Shear

    Directory of Open Access Journals (Sweden)

    Li Baokun

    2015-01-01

    Full Text Available The paste fiber reinforced composite material (hereinafter referred to as FRP U-shaped hoop of reinforced concrete beams interfacial debonding is an important reinforcement technology research. For the effective width of the CFRP U-shaped hoop reinforcement, it is still a lack of in-depth research, only relying on the test research huge workload, this article (ANSYS and the numerical simulation in the whole process of the shear load release properties of finite element calculation software. According to the results of finite element analysis, the author studied the CFRP U-shaped hoop to increase the width of the shear capacity of reinforced concrete beams by the impact.

  10. Fasting plasma glucose and serum uric acid levels in a general Chinese population with normal glucose tolerance: A U-shaped curve.

    Directory of Open Access Journals (Sweden)

    Yunyang Wang

    Full Text Available Although several epidemiological studies assessed the relationship between fasting plasma glucose (FPG and serum uric acid (SUA levels, the results were inconsistent. A cross-sectional study was conducted to investigate this relationship in Chinese individuals with normal glucose tolerance.A total of 5,726 women and 5,457 men with normal glucose tolerance were enrolled in the study. All subjects underwent a 75-g oral glucose tolerance test. Generalized additive models and two-piecewise linear regression models were applied to assess the relationship.A U-shaped relationship between FPG and SUA was observed. After adjusting for potential confounders, the inflection points of FPG levels in the curves were 4.6 mmol/L in women and 4.7 mmol/L in men respectively. SUA levels decreased with increasing fasting plasma glucose concentrations before the inflection points (regression coefficient [β] = -36.4, P < 0.001 for women; β = -33.5, P < 0.001 for men, then SUA levels increased (β = 17.8, P < 0.001 for women; β = 13.9, P < 0.001 for men. Additionally, serum insulin levels were positively associated with FPG and SUA (P < 0.05.A U-shaped relationship between FPG and SUA levels existed in Chinese individuals with normal glucose tolerance. The association is partly mediated through serum insulin levels.

  11. Optimization and Analysis of a U-Shaped Linear Piezoelectric Ultrasonic Motor Using Longitudinal Transducers.

    Science.gov (United States)

    Yu, Hongpeng; Quan, Qiquan; Tian, Xinqi; Li, He

    2018-03-07

    A novel U-shaped piezoelectric ultrasonic motor that mainly focused on miniaturization and high power density was proposed, fabricated, and tested in this work. The longitudinal vibrations of the transducers were excited to form the elliptical movements on the driving feet. Finite element method (FEM) was used for design and analysis. The resonance frequencies of the selected vibration modes were tuned to be very close to each other with modal analysis and the movement trajectories of the driving feet were gained with transient simulation. The vibration modes and the mechanical output abilities were tested to evaluate the proposed motor further by a prototype. The maximum output speed was tested to be 416 mm/s, the maximum thrust force was 21 N, and the maximum output power was 5.453 W under frequency of 29.52 kHz and voltage of 100 V rms . The maximum output power density of the prototype reached 7.59 W/kg, which was even greater than a previous similar motor under the exciting voltage of 200 V rms . The proposed motor showed great potential for linear driving of large thrust force and high power density.

  12. Heuristics comparison for u-shaped assembly line balancing in the apparel factory

    Directory of Open Access Journals (Sweden)

    Nuchsara Kriengkorakot

    2014-06-01

    Full Text Available In recent year, many industries have adopted a Just-in-time (JIT approach to manufacturing. One of the important changes resulting from JIT implementation is the replacement of the traditional straight lines with Ushaped assembly lines. The important characteristic of these new configurations is that multiskilled workers perform various tasks of different stations along the production line. This research is to improve the assembly line balancing in apparel factory in case study of T-shirt style 53287. The efficiency of production line was 55.48%, the factory balanced line with the traditional method in straight line. Then, the u-shaped assembly line balancing problem (UALBP is to be performed instead of straight line. By using the heuristics of Maximum Task Time, Minimum Task Time, Maximum Ranked Positional Weight (RPWmax and Greedy Randomized to determine the optimal solutions related to the number of stations and line efficiency. The results indicate that two heuristics have given the good solution which have produced by the use of Maximum Task Time and Greedy Randomized. The minimum number of stations have reduced from 17 stations to 11 stations in UALB and the line efficiency was increased from 55.48% to 85.75%. The U-line configuration frequently improves the line efficiency and has fewer work stations compared to the traditional lines.

  13. Superelastic SMA U-shaped dampers with self-centering functions

    Science.gov (United States)

    Wang, Bin; Zhu, Songye

    2018-05-01

    As high-performance metallic materials, shape memory alloys (SMAs) have been investigated increasingly by the earthquake engineering community in recent years, because of their remarkable self-centering (SC) and energy-dissipating capabilities. This paper systematically presents an experimental study on a novel superelastic SMA U-shaped damper (SMA-UD) with SC function under cyclic loading. The mechanical properties, including strength, SC ability, and energy-dissipating capability with varying loading amplitudes and strain rates are evaluated. Test results show that excellent and stable flag-shaped hysteresis loops are exhibited in multiple loading cycles. Strain rate has a negligible effect on the cyclic behavior of the SMA-UD within the dynamic frequency range of typical interest in earthquake engineering. Furthermore, a numerical investigation is performed to understand the mechanical behavior of the SMA-UD. The numerical model is calibrated against the experimental results with reasonable accuracy. Then, the stress–strain states with different phase transformations are also discussed.

  14. The improvement of the detection power of a U-shaped DC plasma

    Directory of Open Access Journals (Sweden)

    DRAGAN MARKOVIC

    2001-04-01

    Full Text Available Optimization of the operating parameters of U-shpaed DC arc plasma and spectrometer parameters has been undertaken to explore the possibilities of improving its detection power. It is demonstrated, with a U-shaped arc as an example, that the limits of detection, in addition to well-defined parameters as described by Boumans and Winge, depend on the signal integration time. It is shown that with increasing integration time, the limits of detection are decreased within some limits and that the precision and concentration sensitivity are improved as well. A mathematical expression for the dependence of the detection limit on the integration time is presented. To increase the reliability of the measurement of the mentioned parameters, the working conditions were optimized for the following analytes: Ag, Al, Au, Cr, Fe, Mn, Ni, Pb, Pd, Pt, and V. The obtained limits of detection are comparable or better than those obtained by ICP for the elements studied. Itwas estimed that the possibility exists for their further improvement up to 10 times.

  15. U-Shaped Fiber-Optic Detection Elements for Investigation of Photocatalytic Decomposition of Toluene Dissolved in Water

    Czech Academy of Sciences Publication Activity Database

    Matějec, Vlastimil; Bartoň, Ivo; Mrázek, Jan; Podrazký, Ondřej

    2014-01-01

    Roč. 27, May (2014), s. 244-252 ISSN 2306-8515 R&D Projects: GA ČR GAP102/12/2361 Institutional support: RVO:67985882 Keywords : Toluene detection * Photocatalytic decomposition * U-Shaped fiber Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering

  16. Is there a U-shaped relationship between physical activity in leisure time and risk of chronic low back pain? A follow-up in the HUNT Study

    Directory of Open Access Journals (Sweden)

    Ingrid Heuch

    2016-04-01

    Full Text Available Abstract Background Physical activity in leisure time is often considered to have favourable effects on the risk of low back pain (LBP, but demonstrating a definite association in epidemiological studies has proven difficult. The purpose of the present study was to explore associations between physical activity and risk of chronic LBP in an adult population and to investigate whether relationships are limited to certain age groups or to females or males. A particular objective was to determine whether support could be found for a U-shaped relationship, with both low and high activity levels carrying greater risk. Methods The relationship between physical activity and risk of chronic LBP was examined in a Norwegian prospective study using data from the community-based HUNT2 and HUNT3 surveys. Participants were 9616 women and 8452 men without LBP at baseline, who reported after 11 years whether they suffered from LBP. Associations between baseline physical activity in leisure time and risk of chronic LBP at end of follow-up were evaluated by generalized linear modelling with adjustment for potential confounders. Results Significant associations between leisure time physical activity and risk were observed in both sexes after age adjustment, mainly suggesting inverse relationships. Women participating in hard physical activity 1–2 h per week had a relative risk (RR of chronic LBP of 0.81 (95 % CI 0.71–0.93 compared to those with only light physical activity less than 1 h per week. The corresponding RR in men was 0.71 (95 % CI 0.60–0.85. After adjustment for education, employment, occupational activity, body mass index (BMI and smoking, significant relationships could only be demonstrated in those aged 50 years or more at baseline. The associations differed between female educational groups, with more U-shaped relationships being observed among women with basic education only. Conclusion No strong support was found overall for U-shaped

  17. NUMERICAL AND EXPERIMENTAL ANALYSIS OF UNSTEADY WORK OF U-SHAPE BOREHOLE HEAT EXCHANGER

    Directory of Open Access Journals (Sweden)

    S. A. Filatau

    2014-01-01

    Full Text Available Unsteady numerical model of borehole heat exchanger heat regime was developed. General numerical modeling results are borehole heat flux, heat carrier inlet temperature and average soil temperature distribution. Proposed model is based on solution of heat conduction equation in transient plane axially symmetric formulation with boundary conditions for borehole heat exchanger and undisturbed soil domain. Solution method is finite difference method. Numerical model is verified with comparisons numerical results and experimental data from developed laboratory installation for simulation unsteady heat regime of horizontal positioned U-shape ground heat exchanger in sand medium.Cooling of water is organized in ground exchanger in experiment. Experiment includes two steps. Thermal properties of sand is determined at the first stage. Thermal conductivity of sand is determined by stationary plate method, thermal diffusivity is determined by regular regime method using cylindrical calorimeter. Determined properties are used further in processing of experimental results at second step for analysis of transient work of ground heat exchanger. Results of four experiments are analyzed with different duration and time behavior of mass flow and heat carrier temperature. Divergences of experimental and simulated results for temperature of heat carrier changes in the range 0,5–1,8 %, for sand temperature in the range 1,0–2,3 %, for heat flux in the range 3,6–5,4 %. Experimental results can be used for validation of other simulation methods of ground heat exchangers. Presented numerical model can be used for analyzing of heat supply systems with heat pumps.

  18. Association between seizures after ischemic stroke and stroke outcome

    OpenAIRE

    Xu, Tao; Ou, Shu; Liu, Xi; Yu, Xinyuan; Yuan, Jinxian; Huang, Hao; Chen, Yangmei

    2016-01-01

    Abstract A systematic review and meta-analysis were performed to investigate a potential association between post-ischemic stroke seizures (PISS) and subsequent ischemic stroke (IS) outcome. A systematic search of two electronic databases (Medline and Embase) was conducted to identify studies that explored an association between PISS and IS outcome. The primary and secondary IS outcomes of interest were mortality and disability, respectively, with the latter defined as a score of 3 to 5 on th...

  19. 6. Outcomes and Factors Associated with Adolescent Pregnancies ...

    African Journals Online (AJOL)

    user

    ABSTRACT. Objectives: These were to determine obstetric outcomes associated with adolescent pregnancies and those of older women at the UTH, identify factors associated with and compare the obstetric outcomes between the two age groups with determining the scale of adolescent pregnancy. Materials and methods: ...

  20. Comparison of short-circuit characteristics of trench gate and planar gate U-shaped channel SOI-LIGBTs

    Science.gov (United States)

    Zhang, Long; Zhu, Jing; Sun, Weifeng; Zhao, Minna; Huang, Xuequan; Chen, Jiajun; Shi, Longxing; Chen, Jian; Ding, Desheng

    2017-09-01

    Comparison of short-circuit (SC) characteristics of 500 V rated trench gate U-shaped channel (TGU) SOI-LIGBT and planar gate U-shaped channel (PGU) SOI-LIGBT is made for the first time in this paper. The on-state carrier profile of the TGU structure is reshaped by the dual trenches (a gate trench G1 and a hole barrier trench G2), which leads to a different conduction behavior from that of the PGU structure. The TGU structure exhibits a higher latchup immunity but a severer self-heating effect. At current density (JC) 640 A/cm2. Comparison of layouts and fabrication processes are also made between the two types of devices.

  1. Characterization of working fluid in vertically mounted finned U-shape twin heat pipe for electronic cooling

    International Nuclear Information System (INIS)

    Elnaggar, Mohamed H.A.; Abdullah, M.Z.; Abdul Mujeebu, M.

    2012-01-01

    Highlights: ► Detailed characterization of working fluid of vertical finned U-shape heat pipe. ► The present configuration, considering the working fluid, was not studied previously. ► The low difference in evaporator and condenser temperatures enhances heat transfer. ► The high pressure drop across the porous wick causes easy return flow of the liquid. ► The predicted evaporator and condenser temperatures are validated by experiment. - Abstract: As part of the ongoing research on finned U-shape heat pipes for CPU cooling, the present work focuses on the characterization of working fluid in vertically oriented twin U-shape heat pipe, by taking into account the gravity of flow. Two-dimensional FE simulation is performed under natural and forced convection modes, by using ANSYS-FLOTRAN. The best heat input and coolant velocity for the simulations are determined experimentally, corresponding to the least thermal resistance. The wall temperatures at the evaporator, adiabatic and condenser sections, and the velocity and pressure distributions of vapor and liquid, are analyzed. The total heat input for minimum thermal resistance in both natural and forced convection is found to be 50 W, and the coolant velocity is 3 m/s. The predicted and experimental wall temperatures are found in excellent match. It is observed that for the present U-shape heat pipe configuration, the difference in evaporator and condenser temperatures is significantly small, resulting in enhanced heat transfer compared to the conventional heat pipes. The sintered copper wick has a small pore size, resulting in low wick permeability, leading to the generation of high capillary forces for anti-gravity applications.

  2. Seismic and Power Generation Performance of U-Shaped Steel Connected PV-Shear Wall under Lateral Cyclic Loading

    OpenAIRE

    Zhang, Hongmei; Dong, Jinzhi; Duan, Yuanfeng; Lu, Xilin; Peng, Jinqing

    2014-01-01

    BIPV is now widely used in office and residential buildings, but its seismic performance still remained vague especially when the photovoltaic (PV) modules are installed on high-rise building facades. A new form of reinforced concrete shear wall integrated with photovoltaic module is proposed in this paper, aiming to apply PV module to the facades of high-rise buildings. In this new form, the PV module is integrated with the reinforced concrete wall by U-shaped steel connectors through embedd...

  3. Associations of prenatal exposure to phenols with birth outcomes

    International Nuclear Information System (INIS)

    Tang, Rong; Chen, Min-jian; Ding, Guo-dong; Chen, Xiao-jiao; Han, Xiu-mei; Zhou, Kun; Chen, Li-mei; Xia, Yan-kai; Tian, Ying; Wang, Xin-ru

    2013-01-01

    Many phenols are known to mimic or antagonize hormonal activities and may adversely affect fetal growth. A study of 567 pregnant women was conducted to investigate the relationship between prenatal phenol exposure and birth outcomes, including birth weight, length, and gestational age. We measured the concentrations of bisphenol A, benzophenone-3, 4-n-octylphenol and 4-n-nonylphenol in maternal urine and examine their association with birth outcomes. Categories of urinary benzophenone-3 concentration were associated with decreased gestational age in all infants (p for trend = 0.03). Between middle and low exposure groups, we also found bisphenol A was negatively associated with gestational duration (β adjusted = −0.48 week; 95% confidence interval: −0.91, −0.05). After stratification by gender, we found the consistent results in infant boys with those in all infants, but we did not observe significant association for girls. In conclusion, we found prenatal phenol exposure was sex-specifically related to birth outcomes. -- Highlights: •We examined relationship of prenatal exposure to phenols with birth outcomes. •We determined urinary concentrations of various phenols. •BP-3 and BPA were negatively associated with gestational age. •There was sex-specific association between phenol exposure and birth outcomes. -- Prenatal phenol exposure was sex-specifically related to birth outcomes

  4. [Effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults].

    Science.gov (United States)

    Pu, Xiaobing; Yang, Shuangshi; Cao, Haiquan; Jing, Xingquan; Yin, Jun

    2014-03-01

    To investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. Between January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0 +/- 1.1 and 75.3 +/- 11.2, respectively. The operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0 +/- 0.5 and 17.6 +/- 3.4, respectively, showing significant differences when compared with preoperative ones (t = 30.523, P = 0.000; t = 45.312, P = 0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. The U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.

  5. Self-Assembled TiO2 Nanotube Arrays with U-Shaped Profile by Controlling Anodization Temperature

    Directory of Open Access Journals (Sweden)

    Jingfei Chen

    2010-01-01

    Full Text Available TiO2 nanotube arrays with uniform diameter from top to bottom were fabricated. The synthesizing approach is based on the investigation of the influence of electrolyte temperature on the tube diameter. We found that the inner diameter of the tubes increased with the electrolyte temperature. Accordingly, we improved the tube profile from the general V shape to U shape by raising the electrolyte temperature gradually. This is a simple and fast approach to fabricate uniform TiO2 nanotubes in diameter. The improved TiO2 nanotube arrays may show better properties and have broad potential applications.

  6. Research on alarm triggered fault-diagnosis expert system for U-shaped tube breaking accident of steam generators

    International Nuclear Information System (INIS)

    Qian Hong; Luo Jianbo; Jin Weixiao; Zhou Jinming; Wang Du

    2015-01-01

    According to the U-shaped tube breaking accident of steam generator (SGTR), this paper designs a fault-diagnosis expert system based on the alarm triggering. By analyzing the fault mechanism of SGTR accidents, the fault symptom is obtained. The parameters of the belief rule are set up based on the simulation experiment. The information fusion is conducted on the fault-diagnosis results from multiple expert systems to obtain the final diagnose result. The test result shows that the expert system can diagnose the SGTR accident accurately and rapidly, and provide with the operation guidance. (authors)

  7. The structural innovative design of DN400 experimental facility with inversed U-shaped twin tower for uranium ion exchange

    International Nuclear Information System (INIS)

    Li Geng; Lei Ze'nan; Liu Qing

    2012-01-01

    A DN400 experimental facility with inversed U-shaped twin towers for uranium ion exchange is designed and developed to solve the existing problems in ion exchange equipment, such as easy agglomeration on the upper layer of resin bed, much resin abrasion, high sensitiveness for mud and sand, and difficulty in producing ideal plug flow in back-wash process. The facility combined with the valve control principle, cross flow type sieve plate and the unique inlet and outlet structures can solve the above problems, and the efficiency of uranium extraction can be improved significantly. (authors)

  8. The association between endometriosis and survival outcomes of ...

    African Journals Online (AJOL)

    Background: Although it is generally recognized that endometriosis was significantly associated with higher risk of ovarian cancer, the association between endometriosis and the cancer survival outcomes is still not clear. This meta‑analysis aims to pool previous studies and to make an update estimate. Methods: Relevant ...

  9. Ischemic stroke subtype is associated with outcome in thrombolyzed patients

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Ziegler; Svendsen, M L

    2017-01-01

    OBJECTIVES: The impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator (IV-tPA) is sparsely examined. We studied the association between stroke subtype and clinical outcome in magnetic resonance imaging (MRI)-evaluated patients...... patients were more likely to achieve early neurological improvement and favorable outcome compared with LVD stroke following MRI-based IV-tPA treatment. This finding may reflect a difference in the effect of IV-tPA among stroke subtypes....

  10. A microfluidic chip with a U-shaped microstructure array for multicellular spheroid formation, culturing and analysis

    International Nuclear Information System (INIS)

    Fu, Chien-Yu; Chang, Hwan-You; Tseng, Sheng-Yang; Yang, Shih-Mo; Hsu, Long; Liu, Cheng-Hsien

    2014-01-01

    Multicellular spheroids (MCS), formed by self-assembly of single cells, are commonly used as a three-dimensional cell culture model to bridge the gap between in vitro monolayer culture and in vivo tissues. However, current methods for MCS generation and analysis still suffer drawbacks such as being labor-intensive and of poor controllability, and are not suitable for high-throughput applications. This study demonstrates a novel microfluidic chip to facilitate MCS formation, culturing and analysis. The chip contains an array of U-shaped microstructures fabricated by photopolymerizing the poly(ethylene glycol) diacrylate hydrogel through defining the ultraviolet light exposure pattern with a photomask. The geometry of the U-shaped microstructures allowed trapping cells into the pocket through the actions of fluid flow and the force of gravity. The hydrogel is non-adherent for cells, promoting the formation of MCS. Its permselective property also facilitates exchange of nutrients and waste for MCS, while providing protection of MCS from shearing stress during the medium perfusion. Heterotypic MCS can be formed easily by manipulating the cell trapping steps. Subsequent drug susceptibility analysis and long-term culture could also be achieved within the same chip. This MCS formation and culture platform can be used as a micro-scale bioreactor and applied in many cell biology and drug testing studies. (paper)

  11. Optimum radii and heights of U-shaped baffles in a square duct heat exchanger using surrogate-assisted optimization

    Directory of Open Access Journals (Sweden)

    Kittinan Wansasueb

    2017-06-01

    Full Text Available In this paper, optimum U-shaped baffles in a square channel heat exchanger using air as a working fluid were developed using surrogate-assisted optimization. The design problem is set to maximize heat transfer performance and simultaneously minimize pressure loss across the channel. Design variables determine the radii and heights of the baffles, whereas the optimization problem is treated as box-constrained optimization. The work in this paper is aimed at finding an appropriate surrogate model for designing such a heat exchanger system. Function evaluations are performed by means of computational fluid dynamics (CFD. The computations are based on the finite volume method and are carried out at a Reynolds number of 4000. It has been found that the use of U-shaped baffles as heat transfer enhancement devices improves the thermal performance of the heat exchanger. Comparative results reveal that the Kriging model is the most accurate surrogate model, however, the surrogate model giving the best result is support vector regression.

  12. Prediction of Heat Transfer Performance on Horizontal U-Shaped Heat Exchanger in Passive Safety System Using MARS

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Seong-Su; Hong, Soon-Joon [FNC Tech, Yongin (Korea, Republic of); Cho, Hyoung-Kyu; Park, Goon-Cherl [Seoul National University, Seoul (Korea, Republic of)

    2015-10-15

    The design and the safety analysis of the passive safety systems are performed mainly using the best-estimate thermal-hydraulic analysis codes such as RELAP5 and MARS. This study developed the heat transfer model package for the horizontal U-shaped HX submerged in a pool by improving the horizontal in-tube condensation model and developing the outside-tube natural convective nucleate boiling model. This paper presents the HX model package and the validation results against the passive safety system-related experimental data of PASCAL and ATLAS-PAFS. This study developed the heat transfer model package of the horizontal U-shaped HX submerged in a pool in order to obtain a reliable prediction of the HX heat removal performance of the passive safety system, especially PAFS, using MARS. From the validation results, the proposed model package provided the improved prediction of HX performance (condensation, natural convective nucleate boiling, and heat removal rate of the HX) compared to the default model in MARS.

  13. Seismic and Power Generation Performance of U-Shaped Steel Connected PV-Shear Wall under Lateral Cyclic Loading

    Directory of Open Access Journals (Sweden)

    Hongmei Zhang

    2014-01-01

    Full Text Available BIPV is now widely used in office and residential buildings, but its seismic performance still remained vague especially when the photovoltaic (PV modules are installed on high-rise building facades. A new form of reinforced concrete shear wall integrated with photovoltaic module is proposed in this paper, aiming to apply PV module to the facades of high-rise buildings. In this new form, the PV module is integrated with the reinforced concrete wall by U-shaped steel connectors through embedded steel plates. The lateral cyclic loading test is executed to investigate the seismic behavior and the electric and thermal performance with different drift angles. The seismic behavior, including failure pattern, lateral force-top displacement relationship, and deformation capacity, was investigated. The power generation and temperature variation on the back of the PV module and both sides of the shear wall were also tested. Two main results are demonstrated through the experiment: (1 the U-shaped steel connectors provide enough deformation capacity for the compatibility of the PV module to the shear wall during the whole cyclic test; (2 the electricity generation capacity is effective and stable during this seismic simulation test.

  14. Association between Systemic Diseases and Endodontic Outcome: A Systematic Review.

    Science.gov (United States)

    Aminoshariae, Anita; Kulild, James C; Mickel, Andre; Fouad, Ashraf F

    2017-04-01

    To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. Does conflict help or hurt cognitive control? Initial evidence for an inverted U-shape relationship between perceived task difficulty and conflict adaptation.

    Science.gov (United States)

    van Steenbergen, Henk; Band, Guido P H; Hommel, Bernhard

    2015-01-01

    Sequential modulation of congruency effects in conflict tasks indicates that cognitive control quickly adapts to changing task demands. We investigated in four experiments how this behavioral congruency-sequence effect relates to different levels of perceived task difficulty in a flanker and a Stroop task. In addition, online measures of pupil diameter were used as a physiological index of effort mobilization. Consistent with motivational accounts predicting that increased levels of perceived task difficulty will increase effort mobilization only up to a certain limit, reliable dynamic conflict-driven adjustment in cognitive control was only observed when task difficulty was relatively low. Instead, tasks tentatively associated with high levels of difficulty showed no or reversed conflict adaptation. Although the effects could not be linked consistently to effects in self-reported task difficulty in all experiments, regression analyses showed associations between perceived task difficulty and conflict adaptation in some of the experiments, which provides some initial evidence for an inverted U-shape relationship between perceived difficulty and adaptations in cognitive control. Furthermore, high levels of task difficulty were associated with a conflict-driven reduction in pupil dilation, suggesting that pupil dilation can be used as a physiological marker of mental overload. Our findings underscore the importance of developing models that are grounded in motivational accounts of cognitive control.

  16. Does conflict help or hurt cognitive control? Initial evidence for an inverted U-shape relationship between perceived task difficulty and conflict adaptation

    Directory of Open Access Journals (Sweden)

    Henk eVan Steenbergen

    2015-07-01

    Full Text Available Sequential modulation of congruency effects in conflict tasks indicates that cognitive control quickly adapts to changing task demands. We investigated in four experiments how this behavioral congruency-sequence effect relates to different levels of perceived task difficulty in a flanker and a Stroop task. In addition, online measures of pupil diameter were used as a physiological index of effort mobilization. Consistent with motivational accounts predicting that increased levels of perceived task difficulty will increase effort mobilization only up to a certain limit, reliable dynamic conflict-driven adjustment in cognitive control was only observed when task difficulty was relatively low. Instead, tasks tentatively associated with high levels of difficulty showed no or reversed conflict adaptation. Although the effects could not be linked consistently to effects in self-reported task difficulty in all experiments, regression analyses showed associations between perceived task difficulty and conflict adaptation in some of the experiments, which provides some initial evidence for an inverted U-shape relationship between perceived difficulty and adaptations in cognitive control. Furthermore, high levels of task difficulty were associated with a conflict-driven reduction in pupil dilation, suggesting that pupil dilation can be used as a physiological marker of mental overload. Our findings underscore the importance of developing models that are grounded in motivational accounts of cognitive control.

  17. Brain potentials associated with the outcome processing in framing effects.

    Science.gov (United States)

    Ma, Qingguo; Feng, Yandong; Xu, Qing; Bian, Jun; Tang, Huixian

    2012-10-24

    Framing effect is a cognitive bias referring to the phenomenon that people respond differently to different but objectively equivalent descriptions of the same problem. By measuring event-related potentials, the present study aimed to investigate the neural mechanisms underlying the framing effect, especially how the negative and positive frames influence the outcome processing in our brain. Participants were presented directly with outcomes framed either positively in terms of lives saved or negatively in terms of lives lost in large and small group conditions, and were asked to rate the favorableness of each of them. The behavioral results showed that the framing effect occurred in both group size conditions, with more favorable evaluations associated with positive framing. Compared with outcomes in positive framing condition, a significant feedback-related negativity (FRN) effect was elicited by outcomes in negative framing condition, even though the outcomes in different conditions were objectively equivalent. The results are explained in terms of the associative model of attribute framing effect which states that attribute framing effect occurs as a result of a valence-based associative processing. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Dengue infection associated hemophagocytic syndrome: Therapeutic interventions and outcome.

    Science.gov (United States)

    Wan Jamaludin, Wan Fariza; Periyasamy, Petrick; Wan Mat, Wan Rahiza; Abdul Wahid, S Fadilah

    2015-08-01

    Infection associated hemophagocytic syndrome is increasingly recognized as a potentially fatal complication of dengue fever. It should be suspected with prolonged fever beyond seven days associated with hepatosplenomegaly, hyperferritinemia, worsening cytopenias and development of multiorgan dysfunction. Surge of similar pro-inflammatory cytokines observed in dengue associated hemophagocytic syndrome and multiorgan dysfunction may indicate they are part of related inflammatory spectrum. A proportion of patients recovered with supportive therapy, however most required interventions with corticosteroids, intravenous immunoglobulin or chemotherapy. We report three cases of dengue associated IAHS with good outcome following early recognition and treatment with dexamethasone and intravenous immunoglobulin. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Maternal or neonatal infection: association with neonatal encephalopathy outcomes.

    Science.gov (United States)

    Jenster, Meike; Bonifacio, Sonia L; Ruel, Theodore; Rogers, Elizabeth E; Tam, Emily W; Partridge, John Colin; Barkovich, Anthony James; Ferriero, Donna M; Glass, Hannah C

    2014-07-01

    Perinatal infection may potentiate brain injury among children born preterm. The objective of this study was to examine whether maternal and/or neonatal infection are associated with adverse outcomes among term neonates with encephalopathy. This study is a cohort study of 258 term newborns with encephalopathy whose clinical records were examined for signs of maternal infection (chorioamnionitis) and infant infection (sepsis). Multivariate regression was used to assess associations between infection, pattern, and severity of injury on neonatal magnetic resonance imaging, as well as neurodevelopment at 30 mo (neuromotor examination, or Bayley Scales of Infant Development, second edition mental development index encephalopathy, chorioamnionitis was associated with a lower risk of brain injury and adverse outcomes, whereas signs of neonatal sepsis carried an elevated risk. The etiology of encephalopathy and timing of infection and its associated inflammatory response may influence whether infection potentiates or mitigates injury in term newborns.

  20. Clinical Features and the Factors Associated with Poor Outcome of ...

    African Journals Online (AJOL)

    Clinical Features and the Factors Associated with Poor Outcome of. Measles Patients at Queen Elizabeth Central Hospital. Robin L Broadhead. Paul Courtright. Lincy Misoya. Affiliation: 1. Department of Paediatrics College of. Medicine University of Malawi. 2. International Eye FoundatiQn. 3. Department of Paediatrics ...

  1. Association of the Duration of Active Pushing With Obstetric Outcomes.

    Science.gov (United States)

    Grobman, William A; Bailit, Jennifer; Lai, Yinglei; Reddy, Uma M; Wapner, Ronald J; Varner, Michael W; Caritis, Steve N; Prasad, Mona; Tita, Alan T N; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Blackwell, Sean C; Tolosa, Jorge E

    2016-04-01

    To estimate the associations between the duration of active pushing during the second stage of labor and maternal and neonatal outcomes. We performed an observational study in which data were obtained by trained abstractors from maternal and neonatal charts of deliveries at 25 hospitals over a 3-year period. In this secondary analysis, women with no prior cesarean delivery who had a term, singleton, cephalic gestation and reached complete dilation were analyzed. The duration of pushing, defined as the time from initiation of pushing to either vaginal delivery or the decision to proceed with a cesarean delivery, was determined. The primary maternal outcome was cesarean delivery and the primary neonatal outcome was a composite that included: mechanical ventilation, proven sepsis, brachial plexus palsy, clavicular fracture, skull fracture, other fracture, seizures, hypoxic-ischemic encephalopathy, or death. Nulliparous and parous women were analyzed separately in univariable and then multivariable analyses. A total of 53,285 women were analyzed. In both nulliparous and parous women, longer duration of pushing was associated with increased odds of both cesarean delivery and the neonatal adverse outcome composite. Nevertheless, even after 4 hours of pushing, approximately 78% of nulliparous women who continued with active pushing had a vaginal delivery and more than 97% did not have the composite adverse neonatal outcome. Similarly, after more than 2 hours of pushing, approximately 82% of parous women who continued active pushing delivered vaginally and more than 97% did not have the adverse neonatal outcome. A longer duration of pushing is associated with an increased relative risk, but small absolute difference in risk, of neonatal complications. Approximately 78% of nulliparous women delivered vaginally even after 4 hours of pushing.

  2. Inverted U-Shaped Dose-Response Curve of the Anxiolytic Effect of Cannabidiol during Public Speaking in Real Life.

    Science.gov (United States)

    Zuardi, Antonio W; Rodrigues, Natália P; Silva, Angélica L; Bernardo, Sandra A; Hallak, Jaime E C; Guimarães, Francisco S; Crippa, José A S

    2017-01-01

    The purpose of this study was to investigate whether the anxiolytic effect of cannabidiol (CBD) in humans follows the same pattern of an inverted U-shaped dose-effect curve observed in many animal studies. Sixty healthy subjects of both sexes aged between 18 and 35 years were randomly assigned to five groups that received placebo, clonazepam (1 mg), and CBD (100, 300, and 900 mg). The subjects were underwent a test of public speaking in a real situation (TPSRS) where each subject had to speak in front of a group formed by the remaining participants. Each subject completed the anxiety and sedation factors of the Visual Analog Mood Scale and had their blood pressure and heart rate recorded. These measures were obtained in five experimental sessions with 12 volunteers each. Each session had four steps at the following times (minutes) after administration of the drug/placebo, as time 0: -5 (baseline), 80 (pre-test), 153 (speech), and 216 (post-speech). Repeated-measures analyses of variance showed that the TPSRS increased the subjective measures of anxiety, heart rate, and blood pressure. Student-Newman-Keuls test comparisons among the groups in each phase showed significant attenuation in anxiety scores relative to the placebo group in the group treated with clonazepam during the speech phase, and in the clonazepam and CBD 300 mg groups in the post-speech phase. Clonazepam was more sedative than CBD 300 and 900 mg and induced a smaller increase in systolic and diastolic blood pressure than CBD 300 mg. The results confirmed that the acute administration of CBD induced anxiolytic effects with a dose-dependent inverted U-shaped curve in healthy subjects, since the subjective anxiety measures were reduced with CBD 300 mg, but not with CBD 100 and 900 mg, in the post-speech phase.

  3. Inverted U-Shaped Dose-Response Curve of the Anxiolytic Effect of Cannabidiol during Public Speaking in Real Life

    Directory of Open Access Journals (Sweden)

    Antonio W. Zuardi

    2017-05-01

    Full Text Available The purpose of this study was to investigate whether the anxiolytic effect of cannabidiol (CBD in humans follows the same pattern of an inverted U-shaped dose-effect curve observed in many animal studies. Sixty healthy subjects of both sexes aged between 18 and 35 years were randomly assigned to five groups that received placebo, clonazepam (1 mg, and CBD (100, 300, and 900 mg. The subjects were underwent a test of public speaking in a real situation (TPSRS where each subject had to speak in front of a group formed by the remaining participants. Each subject completed the anxiety and sedation factors of the Visual Analog Mood Scale and had their blood pressure and heart rate recorded. These measures were obtained in five experimental sessions with 12 volunteers each. Each session had four steps at the following times (minutes after administration of the drug/placebo, as time 0: -5 (baseline, 80 (pre-test, 153 (speech, and 216 (post-speech. Repeated-measures analyses of variance showed that the TPSRS increased the subjective measures of anxiety, heart rate, and blood pressure. Student-Newman-Keuls test comparisons among the groups in each phase showed significant attenuation in anxiety scores relative to the placebo group in the group treated with clonazepam during the speech phase, and in the clonazepam and CBD 300 mg groups in the post-speech phase. Clonazepam was more sedative than CBD 300 and 900 mg and induced a smaller increase in systolic and diastolic blood pressure than CBD 300 mg. The results confirmed that the acute administration of CBD induced anxiolytic effects with a dose-dependent inverted U-shaped curve in healthy subjects, since the subjective anxiety measures were reduced with CBD 300 mg, but not with CBD 100 and 900 mg, in the post-speech phase.

  4. Association of Gestational Weight Gain With Maternal and Infant Outcomes

    DEFF Research Database (Denmark)

    Goldstein, Rebecca F; Abell, Sally K; Ranasinha, Sanjeeva

    2017-01-01

    -11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes. Data Sources and Study Selection: Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies...... gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes....

  5. The association between EMS workplace safety culture and safety outcomes.

    Science.gov (United States)

    Weaver, Matthew D; Wang, Henry E; Fairbanks, Rollin J; Patterson, Daniel

    2012-01-01

    Prior studies have highlighted wide variation in emergency medical services (EMS) workplace safety culture across agencies. To determine the association between EMS workplace safety culture scores and patient or provider safety outcomes. We administered a cross-sectional survey to EMS workers affiliated with a convenience sample of agencies. We recruited these agencies from a national EMS management organization. We used the EMS Safety Attitudes Questionnaire (EMS-SAQ) to measure workplace safety culture and the EMS Safety Inventory (EMS-SI), a tool developed to capture self-reported safety outcomes from EMS workers. The EMS-SAQ provides reliable and valid measures of six domains: safety climate, teamwork climate, perceptions of management, working conditions, stress recognition, and job satisfaction. A panel of medical directors, emergency medical technicians and paramedics, and occupational epidemiologists developed the EMS-SI to measure self-reported injury, medical errors and adverse events, and safety-compromising behaviors. We used hierarchical linear models to evaluate the association between EMS-SAQ scores and EMS-SI safety outcome measures. Sixteen percent of all respondents reported experiencing an injury in the past three months, four of every 10 respondents reported an error or adverse event (AE), and 89% reported safety-compromising behaviors. Respondents reporting injury scored lower on five of the six domains of safety culture. Respondents reporting an error or AE scored lower for four of the six domains, while respondents reporting safety-compromising behavior had lower safety culture scores for five of the six domains. Individual EMS worker perceptions of workplace safety culture are associated with composite measures of patient and provider safety outcomes. This study is preliminary evidence of the association between safety culture and patient or provider safety outcomes.

  6. U-shape suppressive effect of phenol red on the epileptiform burst activity via activation of estrogen receptors in primary hippocampal culture.

    Directory of Open Access Journals (Sweden)

    Xu Liu

    Full Text Available Phenol red is widely used in cell culture as a pH indicator. Recently, it also has been reported to have estrogen-like bioactivity and be capable of promoting cell proliferation in different cell lines. However, the effect of phenol red on primary neuronal culture has never been investigated. By using patch clamp technique, we demonstrated that hippocampal pyramidal neurons cultured in neurobasal medium containing no phenol red had large depolarization-associated epileptiform bursting activities, which were rarely seen in neurons cultured in phenol red-containing medium. Further experiment data indicate that the suppressive effect of the phenol red on the abnormal epileptiform burst neuronal activities was U-shape dose related, with the most effective concentration at 28 µM. In addition, this concentration related inhibitory effect of phenol red on the epileptiform neuronal discharges was mimicked by 17-β-estradiol, an estrogen receptor agonist, and inhibited by ICI-182,780, an estrogen receptor antagonist. Our results suggest that estrogen receptor activation by phenol red in the culture medium prevents formation of abnormal, epileptiform burst activity. These studies highlight the importance of phenol red as estrogen receptor stimulator and cautions of careful use of phenol red in cell culture media.

  7. Association of maternal periodontal health with adverse pregnancy outcome.

    Science.gov (United States)

    Kumar, Ashok; Basra, Minu; Begum, Nargis; Rani, Vigya; Prasad, Sudha; Lamba, Arundeep Kaur; Verma, Mahesh; Agarwal, Sarita; Sharma, Shashi

    2013-01-01

    The present study aims to determine the association of periodontal disease (identified early in pregnancy) and adverse pregnancy outcomes in a North Indian population.   A total of 340 primigravida women, aged 20-35 years with single live pregnancy were recruited at 14-20 weeks period of gestation from the antenatal clinic. These women had undergone periodontal examination at time of recruitment. The pregnancy outcomes were recorded. Out of 340 primigravida women, 147 (43.23%) women had gingivitis and 61 (17.94%) women had periodontitis. Periodontitis was found to be significantly associated with pre-eclampsia, intrauterine growth restriction, preterm delivery, and low birthweight with odds ratios (95% confidence interval) of 7.48 (2.72-22.42), 3.35 (1.20-9.55), 2.72 (1.30-5.68) and 3.03 (1.53-5.97), respectively. The study shows a significant association between periodontitis (but not with gingivitis) and adverse pregnancy outcomes. Maternal periodontitis is associated with an increased risk of pre-eclampsia, intrauterine growth restriction, preterm delivery and low birthweight infants. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  8. Systematic review of pediatric health outcomes associated with childhood adversity.

    Science.gov (United States)

    Oh, Debora Lee; Jerman, Petra; Silvério Marques, Sara; Koita, Kadiatou; Purewal Boparai, Sukhdip Kaur; Burke Harris, Nadine; Bucci, Monica

    2018-02-23

    Early detection of and intervention in childhood adversity has powerful potential to improve the health and well-being of children. A systematic review was conducted to better understand the pediatric health outcomes associated with childhood adversity. PubMed, PsycArticles, and CINAHL were searched for relevant articles. Longitudinal studies examining various adverse childhood experiences and biological health outcomes occurring prior to age 20 were selected. Mental and behavioral health outcomes were excluded, as were physical health outcomes that were a direct result of adversity (i.e. abusive head trauma). Data were extracted and risk of bias was assessed by 2 independent reviewers. After identifying 15940 records, 35 studies were included in this review. Selected studies indicated that exposure to childhood adversity was associated with delays in cognitive development, asthma, infection, somatic complaints, and sleep disruption. Studies on household dysfunction reported an effect on weight during early childhood, and studies on maltreatment reported an effect on weight during adolescence. Maternal mental health issues were associated with elevated cortisol levels, and maltreatment was associated with blunted cortisol levels in childhood. Furthermore, exposure to childhood adversity was associated with alterations of immune and inflammatory response and stress-related accelerated telomere erosion. Childhood adversity affects brain development and multiple body systems, and the physiologic manifestations can be detectable in childhood. A history of childhood adversity should be considered in the differential diagnosis of developmental delay, asthma, recurrent infections requiring hospitalization, somatic complaints, and sleep disruption. The variability in children's response to adversity suggests complex underlying mechanisms and poses a challenge in the development of uniform diagnostic guidelines. More large longitudinal studies are needed to better

  9. Structural aspects of cold-formed steel section designed as U-shape composite beam

    Science.gov (United States)

    Saggaff, Anis; Tahir, Mahmood Md.; Azimi, Mohammadamin; Alhajri, T. M.

    2017-11-01

    Composite beam construction usually associated with old-style Hot-Rolled Steel Section (HRSS) has proven to act much better in compare with Cold-Formed Steel Section (CFSS) sections due to thicker section. Due, it's getting popular to replace HRSS with CFSS in some aspects as a composite beam. The advantages such as lightweight, cost effective and easy to install have contributed to the apply CFSS as a preferred construction material for composite beam. There is a few technical data available regarding the application of the usage of CFSS as a composite system, despite the potentials use for residential and light-weight industrial constructions. This paper presents an experimental tests results which have been conducted using CFSS as composite beam. Composite action of CFSS arranged as double beam with Self-Compacting Concrete (SCC) slab are integrated together with bolted shear connectors were used. A full-scale test comprised of 3 proposed composite beam specimens with bolted shear connector spaced at 300 mm interval of grade 8.8 was using single nut with washer on flange of CFS, cast to the slab and loaded until failed. The test show that the bolted shear connector yielded better capacity of ultimate strength and ultimate moment for the proposed composite beam. It can be concluded that, bolted shear connectors of 16 mm in diameter performed better than the other diameter size of bolted shear connectors.

  10. Sliding down the U-shape? A dynamic panel investigation of the age-well-being relationship, focusing on young adults.

    Science.gov (United States)

    Piper, Alan T

    2015-10-01

    Much of the work within economics attempting to understand the relationship between age and well-being has focused on the U-shape, whether it exists and, more recently, potential reasons for its existence. This paper focuses on one part of the lifecycle rather than the whole: young people. This focus offers a better understanding of the age-well-being relationship for young people, and helps with increasing general understanding regarding the U-shape itself. The empirical estimations employ both static and dynamic panel estimations, with the latter preferred for several reasons. The empirical results are in line with the U-shape, and the results from the dynamic analysis indicate that this result is a lifecycle effect. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. An Analysis of Radiation Penetration through the U-Shaped Cast Concrete Joints of Concrete Shielding in the Multipurpose Gamma Irradiator of BATAN

    Science.gov (United States)

    Ardiyati, Tanti; Rozali, Bang; Kasmudin

    2018-02-01

    An analysis of radiation penetration through the U-shaped joints of cast concrete shielding in BATAN’s multipurpose gamma irradiator has been carried out. The analysis has been performed by calculating the radiation penetration through the U-shaped joints of the concrete shielding using MCNP computer code. The U-shaped joints were a new design in massive concrete construction in Indonesia and, in its actual application, it is joined by a bonding agent. In the MCNP simulation model, eight detectors were located close to the observed irradiation room walls of the concrete shielding. The simulation results indicated that the radiation levels outside the concrete shielding was less than the permissible limit of 2.5 μSv/h so that the workers could safely access electrical room, control room, water treatment facility and outside irradiation room. The radiation penetration decreased as the density of material increased.

  12. Association between seizures after ischemic stroke and stroke outcome

    Science.gov (United States)

    Xu, Tao; Ou, Shu; Liu, Xi; Yu, Xinyuan; Yuan, Jinxian; Huang, Hao; Chen, Yangmei

    2016-01-01

    Abstract A systematic review and meta-analysis were performed to investigate a potential association between post-ischemic stroke seizures (PISS) and subsequent ischemic stroke (IS) outcome. A systematic search of two electronic databases (Medline and Embase) was conducted to identify studies that explored an association between PISS and IS outcome. The primary and secondary IS outcomes of interest were mortality and disability, respectively, with the latter defined as a score of 3 to 5 on the modified Rankin Scale. A total of 15 studies that were published between 1998 and 2015 with 926,492 participants were examined. The overall mortality rates for the patients with and without PISS were 34% (95% confidence interval [CI], 27–42%) and 18% (95% CI, 12–23%), respectively. The pooled relative ratio (RR) of mortality for the patients with PISS was 1.97 (95% CI, 1.48–2.61; I2 = 88.6%). The overall prevalence rates of disability in the patients with and without PISS were 60% (95% CI, 32–87%) and 41% (95% CI, 25–57%), respectively. Finally, the pooled RR of disability for the patients with PISS was 1.64 (95% CI, 1.32–2.02; I2 = 66.1%). PISS are significantly associated with higher risks of both mortality and disability. PISS indicate poorer prognoses in patients experiencing IS. PMID:27399117

  13. Clinical Operations Variables are Associated With Blood Pressure Outcomes.

    Science.gov (United States)

    Kressin, Nancy R; Lasser, Karen E; Paasche-Orlow, Michael; Allison, Jeroan; Ash, Arlene S; Adams, William G; Shanahan, Christopher W; Legler, Aaron; Pizer, Steven D

    2015-06-01

    Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes. To assess clinical operations factors' effects on normalization of uncontrolled BP. Observational cohort study. Patients diagnosed with hypertension from a large urban clinical practice (2005-2009). We obtained clinical data on BP, organized by person-month, and administrative data on primary care provider (PCP) staffing. We assessed the resolution of an episode of uncontrolled BP as a function of time-varying covariates including practice-level appointment volume, individual clinicians' appointment volume, overall practice-level PCP staffing, and number of unique PCPs. Among the 7409 unique patients representing 50,403 person-months, normalization was less likely for the patients in whom the episode starts during months when the number of unique PCPs were high [the top quintile of unique PCPs was associated with a 9 percentage point lower probability of normalization (Ppercentage point reduction in the probability of normalization (P=0.01)]. Neither clinician appointment volume nor practice clinician staffing levels were significantly associated with the probability of normalization. Findings suggest that clinical operations factors can affect clinical outcomes like BP normalization, and point to the importance of considering outcome effects when organizing clinical care.

  14. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Herrera, Christina Annette; Manuck, Tracy A; Stoddard, Gregory J; Varner, Michael W; Esplin, Sean; Clark, Erin A S; Silver, Robert M; Eller, Alexandra G

    2018-07-01

    The objective of this study is to examine perinatal outcomes associated with cholestasis of pregnancy according to bile acid level and antenatal testing practice. Retrospective cohort study of women with symptoms and bile acid testing from 2005 to 2014. Women were stratified by bile acid level: no cholestasis (<10 μmol/L), mild (10-39 μmol/L), moderate (40-99 μmol/L), and severe (≥100 μmol/L). The primary outcome was composite neonatal morbidity (hypoxic ischemic encephalopathy, severe intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, or death). 785 women were included; 487 had cholestasis (347 mild, 108 moderate, 32 severe) and 298 did not. After controlling for gestational age (GA), severe cholestasis was associated with the composite neonatal outcome (aRR 5.6, 95% CI 1.3-23.5) and meconium-stained fluid (aRR 4.82, 95%CI 1.6-14.2). Bile acid levels were not correlated with the frequency of testing (p = .50). Women who underwent twice weekly testing were delivered earlier (p = .016) than women tested less frequently, but the difference in GA was ≤4 d. Abnormal testing prompting delivery was uncommon. Among women with cholestasis, there were three stillbirths. One of these women was undergoing antenatal testing, which was normal 1 d prior to the fetal demise. Severe cholestasis is associated with neonatal morbidity which antenatal testing may not predict.

  15. Factors associated with poor outcomes of continuous renal replacement therapy.

    Directory of Open Access Journals (Sweden)

    Chih-Chin Kao

    Full Text Available Continuous renal replacement therapy (CRRT is one of the dialysis modalities for critically ill patients. Despite intensive dialysis care, a high mortality rate is found in these patients. Our objective was to investigate the factors associated with poor outcomes in these patients. We conducted a retrospective cohort study using the National Health Insurance Research Database. Records of critically ill patients who received CRRT between 2007 and 2011 were retrieved, and the patients were categorized into two groups: those with acute kidney injury (AKI and those with history of end-stage renal disease (ESRD. Our primary and secondary outcomes were in-hospital mortality and long-term survival and non-renal recovery (long-term dialysis dependence, respectively, in the AKI group. We enrolled 15,453 patients, with 13,204 and 2249 in the AKI and ESRD groups, respectively. Overall, 66.5% patients died during hospitalization. In-hospital mortality did not differ significantly between groups (adjusted odds ratio, 0.93; 95% CI, 0.84-1.02. Age, chronic liver disease, and cancer history were identified as independent risk factors for in-hospital mortality in both groups. Hypertension was associated with higher risk of in-hospital mortality in patients with AKI. Age, coronary artery disease, and admission to the medical intensive care unit (MICU were risk factors for long-term dialysis dependence in patients with AKI. Patients with AKI and ESRD have similarly poor outcomes after CRRT. Older age and presence of chronic liver disease and cancer were associated with higher mortality. Older age, presence of coronary artery disease, and admission to MICU were associated with lower renal recovery rate in patients with AKI.

  16. Association between exposure to suicide and suicidality outcomes in youth.

    Science.gov (United States)

    Swanson, Sonja A; Colman, Ian

    2013-07-09

    Ecological studies support the hypothesis that suicide may be "contagious" (i.e., exposure to suicide may increase the risk of suicide and related outcomes). However, this association has not been adequately assessed in prospective studies. We sought to determine the association between exposure to suicide and suicidality outcomes in Canadian youth. We used baseline information from the Canadian National Longitudinal Survey of Children and Youth between 1998/99 and 2006/07 with follow-up assessments 2 years later. We included all respondents aged 12-17 years in cycles 3-7 with reported measures of exposure to suicide. We included 8766 youth aged 12-13 years, 7802 aged 14-15 years and 5496 aged 16-17 years. Exposure to a schoolmate's suicide was associated with ideation at baseline among respondents aged 12-13 years (odds ratio [OR] 5.06, 95% confidence interval [CI] 3.04-8.40), 14-15 years (OR 2.93, 95% CI 2.02-4.24) and 16-17 years (OR 2.23, 95% CI 1.43-3.48). Such exposure was associated with attempts among respondents aged 12-13 years (OR 4.57, 95% CI 2.39-8.71), 14-15 years (OR 3.99, 95% CI 2.46-6.45) and 16-17 years (OR 3.22, 95% CI 1.62-6.41). Personally knowing someone who died by suicide was associated with suicidality outcomes for all age groups. We also assessed 2-year outcomes among respondents aged 12-15 years: a schoolmate's suicide predicted suicide attempts among participants aged 12-13 years (OR 3.07, 95% CI 1.05-8.96) and 14-15 years (OR 2.72, 95% CI 1.47-5.04). Among those who reported a schoolmate's suicide, personally knowing the decedent did not alter the risk of suicidality. We found that exposure to suicide predicts suicide ideation and attempts. Our results support school-wide interventions over current targeted interventions, particularly over strategies that target interventions toward children closest to the decedent.

  17. Major malformation risk, pregnancy outcomes, and neurodevelopmental outcomes associated with metformin use during pregnancy.

    Science.gov (United States)

    Andrade, Chittaranjan

    2016-04-01

    There are several reasons why metformin treatment may be considered for women in neuropsychiatric practice. These include prevention or attenuation of antipsychotic-associated weight gain, prevention or treatment of gestational diabetes mellitus (GDM), treatment of type 2 diabetes mellitus, and improvement of conception chances and pregnancy outcomes in the presence of polycystic ovarian disease (PCOD). This article examines the benefits and risks associated with metformin use during pregnancy. The available data suggest that metformin exposure during the first trimester is not associated with major congenital malformations; that metformin reduces the risk of early pregnancy loss, preeclampsia, preterm delivery, and GDM in women with PCOD; that metformin is associated with at least comparable benefits relative to insulin treatment in women with mild GDM; and that neurodevelopmental outcomes at age 1.5-2.5 years are comparable after gestational exposure to metformin and insulin. Whereas study designs were not always ideal and sample sizes were mostly small to modest, the study findings are more encouraging than discouraging and can guide shared decision-making in women who are receiving or may need metformin during pregnancy. © Copyright 2016 Physicians Postgraduate Press, Inc.

  18. Interactions between the amnioserosa and the epidermis revealed by the function of the u-shaped gene

    Directory of Open Access Journals (Sweden)

    Karolina Lada

    2012-02-01

    Dorsal closure (DC is an essential step during Drosophila development whereby a hole is sealed in the dorsal epidermis and serves as a model for cell sheet morphogenesis and wound healing. It involves the orchestrated interplay of transcriptional networks and dynamic regulation of cell machinery to bring about shape changes, mechanical forces, and emergent properties. Here we provide insight into the regulation of dorsal closure by describing novel autonomous and non-autonomous roles for U-shaped (Ush in the amnioserosa, the epidermis, and in mediation of communication between the tissues. We identified Ush by gene expression microarray analysis of Dpp signaling targets and show that Ush mediates some DC functions of Dpp. By selectively restoring Ush function in either the AS or the epidermis in ush mutants, we show that the AS makes a greater (Ush-dependent contribution to closure than the epidermis. A signal from the AS induces epidermal cell elongation and JNK activation in the DME, while cable formation requires Ush on both sides of the leading edge, i.e. in both the AS and epidermis. Our study demonstrates that the amnioserosa and epidermis communicate at several steps during the process: sometimes the epidermis instructs the amnioserosa, other times the AS instructs the epidermis, and still other times they appear to collaborate.

  19. Photoelectric characteristics of an inverse U-shape buried doping design for crosstalk suppression in pinned photodiodes

    International Nuclear Information System (INIS)

    Cao Chen; Zhang Bing; Li Xin; Wu Longsheng; Wang Junfeng

    2014-01-01

    A design of an inverse U-shape buried doping in a pinned photodiode (PPD) of CMOS image sensors is proposed for electrical crosstalk suppression between adjacent pixels. The architecture achieves no extra fill factor consumption, and proper built-in electric fields can be established according to the doping gradient created by the injections of the extremely low P-type doping buried regions in the epitaxial layer, causing the excess electrons to easily drift back to the photosensitive area rarely with a diffusion probability; the overall junction capacitance and photosensitive area extensions for a full well capacity (FWC) and internal quantum efficiency (IQE) improving are achieved by the injection of a buried N-type doping. By considering the image lag issue, the process parameters of all the injections have been precisely optimized. Optical simulation results based on the finite difference time domain method show that compared to the conventional PPD, the electrical crosstalk rate of the proposed architecture can be decreased by 60%–80% at an incident wavelength beyond 450 nm, IQE can be clearly improved at an incident wavelength between 400 and 600 nm, and the FWC can be enhanced by 107.5%. Furthermore, the image lag performance is sustained to a perfect low level. The present study provides important guidance on the design of ultra high resolution image sensors. (semiconductor devices)

  20. Welding feasibility study of U-shape lips at ITER Port-Plug with new laser beam sources

    Energy Technology Data Exchange (ETDEWEB)

    Behr, W., E-mail: w.behr@fz-juelich.de; Faidel, D.; Fischer, K.; Pap, M.; Offermanns, G.

    2013-10-15

    A “Cut and weld feasibility study of U shape lips” shown on June 2007 was initial of the following investigations. A new solution for Port Plug sealing at ITER was demanded and the experience in laser beam welding of the ZAT (Central Institute of Technology) in Jülich (Research Centre Jülich) offered an alternative solution. Up to now mechanically fixed sealing or sealing by TIG welding is used with typical benefits and problems, as heat input, shrinkage or limited room for tools. New disc-laser application for tight welding (leakage rate < 10{sup −9} mbar l/s) of the sealing lips is presented in the following. Both in the metallographic investigation and by means of leakage rate investigation the suitability of the selected procedure as seal alternative at the ITER Port Plug could be pointed out. The distance between two connections can be reduced to approx. 5 mm. The presented milling process for weld seam removal offers an option additionally to laser beam cutting. Final tests with a new disc-laser source offered additional benefits concerning seam quality, process stability and seam geometry. The distance between two connections will be reduced to less than 3 mm in next investigations. Construction unit near investigations and a demo part in original size underline finally the industrial suitability of the laser-welding-process for Port-Plug sealing at ITER.

  1. Determination of As in tree-rings of poplar (Populus alba L.) by U-shaped DC arc.

    Science.gov (United States)

    Marković, D M; Novović, I; Vilotić, D; Ignjatović, Lj

    2009-04-01

    An argon-stabilized U-shaped DC arc with a system for aerosol introduction was used for determination of As in poplar (Populus alba L.) tree-rings. After optimization of the operating parameters and selection of the most appropriate signal integration time (30 s), the limit of detection for As was reduced to 15.0 ng/mL. This detection limit obtained with the optimal integration time was compared with those for other methods: inductively coupled plasma-atomic emission spectrometry (ICP-AES), direct coupled plasma-atomic emission spectrometry (DCP-AES), microwave induced plasma-atomic emission spectrometry (MIP-AES) and improved thermospray flame furnace atomic absorption spectrometry (TS-FF-AAS). Arsenic is toxic trace element which can adversely affect plant, animal and human health. As an indicator of environment pollution we collected poplar tree-rings from two locations. The first area was close to the "Nikola Tesla" (TENT-A) power plant, Obrenovac, while the other was in the urban area of Novi Sad. In all cases elevated average concentrations of As were registered in poplar tree-rings from the Obrenovac location.

  2. In-center hemodialysis absenteeism: prevalence and association with outcomes

    Directory of Open Access Journals (Sweden)

    Gray KS

    2017-05-01

    Full Text Available Kathryn S Gray, Dena E Cohen, Steven M Brunelli DaVita Clinical Research, Minneapolis, MN, USA Objective: The aim of this study was to determine the rate of missed treatments among hemodialysis (HD patients, and the association between treatment nonadherence and clinical outcomes.Data source: The data used in this study were based on electronic medical records and Medicare claims.Study design: This is a retrospective, observational study.Principal findings: HD patients miss 9.9% of all treatments. Approximately half of the missed treatments are due to observable medical events, predominantly hospitalizations, while half result from nonadherence (“absence”. A single absence is associated with a 1.4-fold greater risk of hospitalization, and a 2.2-fold greater risk of death in the subsequent 30 days.Conclusion: Treatment nonadherence is common among HD patients and is associated with adverse outcomes. Interventions that improve adherence may improve patient health and reduce costs. Keywords: Medicare, ambulatory/outpatient care, epidemiology, chronic disease

  3. The association between smoking and breast cancer characteristics and outcome.

    Science.gov (United States)

    Goldvaser, Hadar; Gal, Omer; Rizel, Shulamith; Hendler, Daniel; Neiman, Victoria; Shochat, Tzippy; Sulkes, Aaron; Brenner, Baruch; Yerushalmi, Rinat

    2017-09-06

    Smoking is associated with an increased incidence of hormone receptor positive breast cancer. Data regarding worse breast cancer outcome in smokers are accumulating. Current literature regarding the impact of smoking on breast cancer characteristics is limited. We evaluated the impact of smoking on breast cancer characteristics and outcome. This was a retrospective single center study. All women diagnosed from 4/2005 through 3/2012 and treated in our institute for early, estrogen receptor positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer, whose tumors were sent for Oncotype DX analysis were included. Medical records were reviewed for demographics, clinico-pathological parameters, treatment and outcome. Data regarding smoking were retrieved according to patients' history at the first visit in the oncology clinic. Patients were grouped and compared according to smoking history (ever smokers vs. never smokers), smoking status (current vs. former and never smokers) and smoking intensity (pack years ≥30 vs. the rest of the cohort). Outcomes were adjusted in multivariate analyses and included age, menopausal status, ethnicity, tumor size, nodal status and grade. A total of 662 women were included. 28.2% had a history of smoking, 16.6% were current smokers and 11.3% were heavy smokers. Smoking had no impact on tumor size, nodal involvement and Oncotype DX recurrence score. Angiolymphatic and perineural invasion rates were higher in current smokers than in the rest of the cohort (10.4% vs. 5.1%, p = 0.045, 8.3% vs. 3.5%, p = 0.031, respectively). Smoking had no other impact on histological characteristics. Five-year disease free survival and overall survival rates were 95.7% and 98.5%, respectively. Smoking had no impact on outcomes. Adjusted disease free survival and overall survival did not influence the results. Smoking had no clinically significant influence on tumor characteristics and outcome among women with estrogen receptor

  4. Longitudinal Associations between Physical Activity and Educational Outcomes.

    Science.gov (United States)

    Kari, Jaana T; Pehkonen, Jaakko; Hutri-Kähönen, Nina; Raitakari, Olli T; Tammelin, Tuija H

    2017-11-01

    This longitudinal study examined the role of leisure-time physical activity in academic achievement at the end of compulsory basic education and educational attainment in adulthood. The data were drawn from the ongoing longitudinal Cardiovascular Risk in Young Finns Study, which was combined with register-based data from Statistics Finland. The study consisted of children who were 12 yr (n = 1723, 49% boys) and 15 yr (n = 2445, 48% boys) of age at the time when physical activity was measured. The children were followed up until 2010, when their mean age was 40 yr. Physical activity was self-reported and included several measurements: overall leisure-time physical activity outside school hours, participation in sports club training sessions, and participation in sports competitions. Individuals' educational outcomes were measured with the self-reported grade point average at age 15 yr and register-based information on the years of completed postcompulsory education in adulthood. Ordinary least squares models and the instrumental variable approach were used to analyze the relationship between physical activity and educational outcomes. Physical activity in adolescence was positively associated with educational outcomes. Both the physical activity level at age 15 yr and an increase in the physical activity level between the ages of 12 and 15 yr were positively related to the grade point average at age 15 yr and the years of postcompulsory education in adulthood. The results were robust to the inclusion of several individual and family background factors, including health endowments, family income, and parents' education. The results provide evidence that physical activity in adolescence may not only predict academic success during compulsory basic education but also boost educational outcomes later in life.

  5. Anti-prothrombin antibodies are associated with adverse pregnancy outcome.

    Science.gov (United States)

    Marozio, Luca; Curti, Antonella; Botta, Giovanni; Canuto, Emilie M; Salton, Loredana; Tavella, Anna Maria; Benedetto, Chiara

    2011-11-01

    Women with antiphospholipid antibodies (aPL) such as lupus anticoagulant, anticardiolipin antibodies, and anti-β(2) glycoprotein-1 antibodies are at high risk of late pregnancy complications, such as severe pre-eclampsia, placental insufficiency, and fetal loss. It has been observed that aPL consists of a heterogeneous group of antibodies targeting several phospholipid-binding plasma proteins, including also anti-prothrombin (anti-PT), anti-protein S (anti-PS), and anti-protein C (anti-PC) antibodies. Their potential role in late pregnancy complications is not known. The aim of this work was to investigate the association between those autoantibodies and histories for adverse pregnancy outcome. Anti-PT, anti-PS, and anti-PC antibodies were evaluated in 163 patients with previous severe pre-eclampsia, fetal death, and/or placental abruption and in as many women with previous uneventful pregnancies, negative for aPL. The prevalence of anti-PT antibodies was higher in cases than in controls (OR, 95% CI: 10.92, 4.52-26.38). The highest prevalence was observed in subjects with fetal death. Anti-PT antibodies appear to be associated with adverse pregnancy outcome, irrespectively of aPL. © 2011 John Wiley & Sons A/S.

  6. Experimental investigation on the effect of nanofluid on the thermal performance of symmetric sintered U shaped heat pipe

    Science.gov (United States)

    Nazarimanesh, Meysam; Yousefi, Tooraj; Ashjaee, Mehdi

    2016-07-01

    In this study, the impact of Entrance Power and Silver nanofluid concentration (with base fluid ethanol and DI-water) on heat pipe thermal performance are considered. In order to reach the aim a U-shaped sintered heat pipe is utilized which causes occupied space to decline. The length of the heat pipe is 135 mm in each branch. On account of recognition the effect of working fluid on heat pipe thermal performance, thermal resistance and overall heat transfer coefficient in base working fluid and nano-colloidal silver are measured in the shape of thermosyphon. The working fluid is with volume percentages of 70 ethanol and 30 distilled water. The average size pertaining to the nanoparticle applied is 40 nm. In addition, the influences of nanofluid concentrations are measured by comparing three concentrations 0.001, 0.005, 0.1 vol%. The range of entrance power is from 10 to 40 W and the temperature of coolant has been changed from 20 to 40 °C. The results of the experiment indicate that by increasing entrance power, the temperatures of the condenser, evaporator and working temperature experience a rise. Furthermore, this causes a decrease of thermal resistance and an increase of overall heat transfer coefficient. A comparison of three concentrations reveals that in concentration of 50 ppm, thermal resistance compared to the base fluid has decreased to 42.26 % and overall heat transfer coefficient has gone up to 1883 (W/m2·°K) . Also, due to unexpected changes in concentration of 1000 ppm, the existence of an optimized concentration for the silver nanofluid in this heat pipe with this geometry has been clear.

  7. Clinical features and outcomes of ANCA-associated renal vasculitis

    Directory of Open Access Journals (Sweden)

    Sidy Mohamed Seck

    2012-01-01

    Full Text Available To determine the patterns and outcomes of the pauci-immune vasculitis in the nephrology department at hospital La Conception in Marseille, we conducted a retrospective study including all patients with diagnosis of pauci-immune renal vasculitis between January 1, 2000 and December 31, 2007. Among 33 cases, 25 were diagnosed as Wegener granulomatosis (WG, seven as microscopic polyangitis (MPA and one as Churg-Strauss syndrome (SCS. The median age of the patients was 57.7 years and the sex-ratio (M/F was 1.6. The visceral mani-festations included kidneys (100% of patients, lungs (75%, ENT (52% of WG, and nervous system (57% of MPA. The mean serum creatinine at admission was 3.3 mg/dL. Renal biopsies revealed a pauci-immune crescentic gromerulonephritis in 96% of the cases. Two patients with WG received plasmapheresis and seven patients required emergency hemodialysis. Induction therapy comprised cyclophosphamide IV and corticosteroids, while maintenance therapy included azathioprine for the majority of patients. Eighty four percent of the patients experienced complete remission after induction therapy. During maintenance therapy relapses were more frequent among patients with MPA (28% compared to WG cases (12%. After 35 months of follow-up, eight patients ended on chronic hemodialysis, and five patients died. ANCA associated vasculitis are frequent in our patients. Long-term outcomes are relatively good despite a mortality rate of 15% and 25% of the patients entering dialysis after three years of follow-up.

  8. Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery.

    LENUS (Irish Health Repository)

    McKenny, M

    2011-05-01

    This study investigated the hypothesis that storage age of transfused red blood cells (RBCs) is associated with adverse outcome after cardiac surgery, and examined association between volume of RBC transfusions and outcome after cardiac surgery.

  9. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Nucci Luciana Bertoldi

    2001-01-01

    Full Text Available INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at aproximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI, according to World Health Organization (WHO criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%, overweight 19.2% (18.1%-20.3%, and obesity 5.5% (4.9%-6.2%. Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

  10. CKD Self-management: Phenotypes and Associations With Clinical Outcomes.

    Science.gov (United States)

    Schrauben, Sarah J; Hsu, Jesse Y; Rosas, Sylvia E; Jaar, Bernard G; Zhang, Xiaoming; Deo, Rajat; Saab, Georges; Chen, Jing; Lederer, Swati; Kanthety, Radhika; Hamm, L Lee; Ricardo, Ana C; Lash, James P; Feldman, Harold I; Anderson, Amanda H

    2018-03-24

    To slow chronic kidney disease (CKD) progression and its complications, patients need to engage in self-management behaviors. The objective of this study was to classify CKD self-management behaviors into phenotypes and assess the association of these phenotypes with clinical outcomes. Prospective cohort study. Adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. 3,939 participants in the CRIC Study recruited between 2003 and 2008 served as the derivation cohort and 1,560 participants recruited between 2013 and 2015 served as the validation cohort. CKD self-management behavior phenotypes. CKD progression, atherosclerotic events, heart failure events, death from any cause. Latent class analysis stratified by diabetes was used to identify CKD self-management phenotypes based on measures of body mass index, diet, physical activity, blood pressure, smoking status, and hemoglobin A 1c concentration (if diabetic); Cox proportional hazards models. 3 identified phenotypes varied according to the extent of implementation of recommended CKD self-management behaviors: phenotype I characterized study participants with the most recommended behaviors; phenotype II, participants with a mixture of recommended and not recommended behaviors; and phenotype III, participants with minimal recommended behaviors. In multivariable-adjusted models for those with and without diabetes, phenotype III was strongly associated with CKD progression (HRs of 1.82 and 1.49), death (HRs of 1.95 and 4.14), and atherosclerotic events (HRs of 2.54 and 1.90; each P diabetes. No consensus definition of CKD self-management; limited to baseline behavior data. There are potentially 3 CKD self-management behavior phenotypes that distinguish risk for clinical outcomes. These phenotypes may inform the development of studies and guidelines regarding optimal self-management. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights

  11. Association of Safety Culture with Surgical Site Infection Outcomes.

    Science.gov (United States)

    Fan, Caleb J; Pawlik, Timothy M; Daniels, Tania; Vernon, Nora; Banks, Katie; Westby, Peggy; Wick, Elizabeth C; Sexton, J Bryan; Makary, Martin A

    2016-02-01

    Hospital workplace culture may have an impact on surgical outcomes; however, this association has not been established. We designed a study to evaluate the association between safety culture and surgical site infection (SSI). Using the Hospital Survey on Patient Safety Culture and National Healthcare Safety Network definitions, we measured 12 dimensions of safety culture and colon SSI rates, respectively, in the surgical units of Minnesota community hospitals. A Pearson's r correlation was calculated for each of 12 dimensions of surgical unit safety culture and SSI rate and then adjusted for surgical volume and American Society of Anesthesiologists (ASA) classification. Seven hospitals participated in the study, with a mean survey response rate of 43%. The SSI rates ranged from 0% to 30%, and surgical unit safety culture scores ranged from 16 to 92 on a scale of 0 to 100. Ten dimensions of surgical unit safety culture were associated with colon SSI rates: teamwork across units (r = -0.96; 95% CI [-0.76, -0.99]), organizational learning (r = -0.95; 95% CI [-0.71, -0.99]), feedback and communication about error (r = -0.92; 95% CI [-0.56, -0.99]), overall perceptions of safety (r = -0.90; 95% CI [-0.45, -0.99]), management support for patient safety (r = -0.90; 95% CI [-0.44, -0.98]), teamwork within units (r = -0.88; 95% CI [-0.38, -0.98]), communication openness (r = -0.85; 95% CI [-0.26, -0.98]), supervisor/manager expectations and actions promoting safety (r = -0.85; 95% CI [-0.25, -0.98]), non-punitive response to error (r = -0.78; 95% CI [-0.07, -0.97]), and frequency of events reported (r = -0.76; 95% CI [-0.01, -0.96]). After adjusting for surgical volume and ASA classification, 9 of 12 dimensions of surgical unit safety culture were significantly associated with lower colon SSI rates. These data suggest an important role for positive safety and teamwork culture and engaged hospital management in producing high-quality surgical

  12. [Dynamics of a vortex with the U-shaped filament in the heart of a ground squirrel].

    Science.gov (United States)

    Kukushkin, N I; Gorbacheva, K N; Sklifas, A N

    2009-01-01

    The dynamics of an electrical scroll wave with the U-shaped filament with both ends of the filament being "anchored" on the endocardial surface and the dependence of the structure of pseudoECG on the dynamics of the vortex during the development of polymorphic tachysystolia have been studied by applying premature stimuli to the "target phase" with subsequent registration of the spatial and temporal distribution of electrical potential throughout the surface (endocardial and epicardial) of a thin (approximately 1 mm) preparation. It was found that (1) the psedoECG of the polymorphic form during the tachysystolia attack can be observed in the case that the position of the filament ends on the surfaces of the preparation does not practically change from turn to turn (filament ends are "anchored"); (2) the thread of a scroll wave during this attack can twist and untwin (twisted filament), just as it was the case for scroll waves with a straight filament; (3) in the case of pseudoECG of polymorphic form, the twisting and untwining of the filament were stronger (the angle of maximal twisting was 120 degrees and more), and the angle of twisting changed by a substantially greater value from turn to turn as compared with the pseudoECG of monomorphic form; (4) in the case of pseudoECG of polymorphic form, the time interval between the appearance of waves on the surfaces of the preparation (Tepi-endo) was substantially greater and changed to a greater extent from turn to turn of the vortex; and (5) simultaneously with the appearance of pseudoECG of polymorphic form and the onset of changes in the twisting of the scroll and the Tepi-endo interval indicated in (2-4), significant changes in the patterns of coverage of the surface by excitation occurred. Based on the results obtained, an explanation of the reasons for the appearance of excitation breakdown patterns on the surface of the myocardium was proposed, which differs from the traditional viewpoint. These patterns may be

  13. The association between prenatal sleep quality and obstetric outcome.

    Science.gov (United States)

    Hung, Hsuan-Man; Ko, Shu-Hua; Chen, Chung-Hey

    2014-09-01

    Pregnancy-associated sleep disorder is a new category on the latest version of the International Classification of Sleep Disorders. It is a significant problem for pregnant women. The present follow-up study assesses the association between sleep quality during the second and third trimesters of pregnancy and obstetric-neonatal outcomes. A prospective follow-up study design was used. Follow-up examination of the obstetric birth records in the immediate postpartum period were carried out on 128 second-trimester and 120 third-trimester women and their newborns in two hospitals in Taiwan. Poor sleep quality was identified using the Pittsburgh Sleep Quality Index. Data were collected from October 2007 to June 2008. The prevalence of poor sleepers (Pittsburgh Sleep Quality Index score > 5) was 58% for second-trimester participants and 66% for third-trimester participants; participants who were unemployed reported a significantly higher prevalence of poor sleep quality than those who were employed. Subsequent review of the participant's obstetric birth records revealed that third-trimester poor sleepers were more likely to have had a vacuum-assisted delivery. This study identified poor sleep quality during the third trimester as a novel risk factor for vacuum-assisted delivery. We suggest that prenatal healthcare providers focus greater attention to the sleep disturbance condition of pregnant women and provide proactive sleep counseling to facilitate pregnant women's adjustment to the new psychosocial and physiological demands of motherhood.

  14. Treatment Outcome Of Seizures Associated With Intracranial Cavernous Angiomas

    Directory of Open Access Journals (Sweden)

    Nievera Conrad C

    1999-01-01

    Full Text Available Seizures are among the typical presentations of intracranial cavernous angiomas (ICA. Twenty-one patients (age range: 2 to 53 years treated for seizures associated with ICA between 1983 and 1997 were restrospectively studied to evaluate their outcome following medical or surgical intervention. The mean interval between seizure onset and initial presentation at our institution was 7.6 years. Seizures were simple partial in 3 patients, complex partial in 15 and secondarily generalized tonic-clonic in 13. The commonest site of the lesion was the temporal lobe (52%. Multiple angiomas were observed in 5 (24% patients. Seven (32% patients were medically-managed with antiepileptic therapy and 14 (68% underwent either lesionectomy with resection of the epileptogenic zone (9 patients or temporal lobectomy (5 patients. Mean follow-up time was 4 years (range: 3 months to 14 years. Of the medically-managed patients, 3 (43% remained seizure-free whereas 4 (57% continued to have seizures with an average frequency of one per day. Of the surgically-managed patients, 12 (86% became seizure-free and 2 (14% had no more than two seizures per year. Surgery appears to be extremely effective in the management of seizures associated with ICA and should receive a strong and early consideration in patients who fail medical therapy.

  15. The association of cannabis use on inpatient psychiatric hospital outcomes.

    Science.gov (United States)

    Rylander, Melanie; Winston, Helena R; Medlin, Haley; Hull, Madelyne; Nussbaum, Abraham

    2018-01-01

    The associations between cannabis use and psychosis are well documented in numerous studies. There is a need to evaluate the impact of cannabis use on inpatient psychiatric utilization and outcomes. To evaluate the impact of cannabis use on psychiatric hospital outcomes. This study was conducted between April 20, 2015 and October 20, 2015. All patients (n = 120) admitted to Denver Health with psychotic symptoms were administered a urine toxicology screening testing for the presence of 11-nor-9-carboxy-Δ 9 -tetrahydrocannabinol (THC-COOH, the active metabolite of cannabis). Patients with positive tests were compared to those with negative tests on several measures, including length of stay, presence or lack of 30-day readmission, Brief Psychotic Rating Scale (BPRS) score, and use of antipsychotics and/or sedatives/anxiolytics. There were 120 patients. Twenty nine were women and 91 were men. Patients testing positive for THC-COOH had a shorter length of stay compared to patients testing negative for THC-COOH, after adjusting for age, prior psychiatric admissions, history of a psychotic-spectrum disorder, and comorbid additional substance use (p = 0.02). There were no differences in 30-day readmissions, 30-day post-discharge presentation to the Denver Health psychiatric emergency department, BPRS scores, and medication administration. Patients presenting with psychotic symptoms and cannabis use require shorter inpatient psychiatric hospitalizations. This study is the first to quantify this observation and highlights the need for future clinical decision-making tools that would ideally correlate cannabis use with the degree of potential need for expensive and scarce mental health resources, such as psychiatric hospitalization.

  16. Association between intracranial plasmacytoma and multiple myeloma: clinicopathological outcome study.

    Science.gov (United States)

    Schwartz, T H; Rhiew, R; Isaacson, S R; Orazi, A; Bruce, J N

    2001-11-01

    Intracranial plasmacytomas are rare lesions that can arise from the calvarium, dura, or cranial base and exhibit a benign course unless associated with myeloma. Attention has recently been focused on the role of the cell adhesion molecules CD56 and CD31 in the pathogenesis of myeloma. No such information is available for intracranial plasmacytomas and myeloma-associated lesions. We investigated the relationship between CD56 and CD31 expression, intracranial location, and progression to myeloma for a series of nine intracranial plasmacytomas (three dural, one calvarial, and five cranial base lesions). These parameters were also correlated with proliferation indices, as assessed by MIB-1 immunostaining of the histological sections. A single pathologist (AO) performed immunohistochemical analyses and reviewed all slides. Intracranial plasmacytomas presented more commonly in female patients (89%). The three dural lesions were CD56- and CD31-negative and exhibited MIB-1 staining of less than 10%; no patient developed myeloma or recurrence. Of the five cranial base lesions, three were CD56-positive, none was CD31-positive, and two exhibited MIB-1 labeling of more than 45%, with plasmablastic morphological features. Compared with other intracranial plasmacytomas, five of five patients with cranial base lesions developed bone marrow biopsy-proven myeloma (P myeloma soon after diagnosis. Both of the two highly proliferative plasmablastic lesions recurred, one after gross total resection without radiotherapy and the other after a biopsy and 2000-cGy radiotherapy. Among intracranial plasmacytomas, cranial base location was the strongest predictor of the development of multiple myeloma. Expression of the cell adhesion molecules CD31 and CD56 was not predictive of outcome. Extramedullary dural-based lesions were CD56-negative and were not associated with myeloma. A high proliferation index and plasmablastic morphological features were predictive of a short time to recurrence

  17. Biomechanical CT Metrics Are Associated With Patient Outcomes in COPD

    Science.gov (United States)

    Bodduluri, Sandeep; Bhatt, Surya P; Hoffman, Eric A.; Newell, John D.; Martinez, Carlos H.; Dransfield, Mark T.; Han, Meilan K.; Reinhardt, Joseph M.

    2017-01-01

    Background Traditional metrics of lung disease such as those derived from spirometry and static single-volume CT images are used to explain respiratory morbidity in patients with chronic obstructive pulmonary disease (COPD), but are insufficient. We hypothesized that the mean Jacobian determinant, a measure of local lung expansion and contraction with respiration, would contribute independently to clinically relevant functional outcomes. Methods We applied image registration techniques to paired inspiratory-expiratory CT scans and derived the Jacobian determinant of the deformation field between the two lung volumes to map local volume change with respiration. We analyzed 490 participants with COPD with multivariable regression models to assess strengths of association between traditional CT metrics of disease and the Jacobian determinant with respiratory morbidity including dyspnea (mMRC), St Georges Respiratory Questionnaire (SGRQ) score, six-minute walk distance (6MWD), and the BODE index, as well as all-cause mortality. Results The Jacobian determinant was significantly associated with SGRQ (adjusted regression co-efficient β = −11.75,95%CI −21.6 to −1.7;p=0.020), and with 6MWD (β=321.15, 95%CI 134.1 to 508.1;p<0.001), independent of age, sex, race, body-mass-index, FEV1, smoking pack-years, CT emphysema, CT gas trapping, airway wall thickness, and CT scanner protocol. The mean Jacobian determinant was also independently associated with the BODE index (β= −0.41, 95%CI −0.80 to −0.02; p = 0.039), and mortality on follow-up (adjusted hazards ratio = 4.26, 95%CI = 0.93 to 19.23; p = 0.064). Conclusion Biomechanical metrics representing local lung expansion and contraction improve prediction of respiratory morbidity and mortality and offer additional prognostic information beyond traditional measures of lung function and static single-volume CT metrics. PMID:28044005

  18. Risk Factors and Outcome Associated with Polyhydramnios in Sudanese Women

    Energy Technology Data Exchange (ETDEWEB)

    Hassan, O I [Postgraduate Medical Studies Board, Faculty of Medicine, University of Khartoum, Khartoum (Sudan)

    2002-10-01

    This is a prospective descriptive study to find out the associated risk factors and the outcome in cases of polyhydramnios. It was carried out in the period from 1/4/2001 to 1/6/2002 in Soba University hospital. Objectives: To detect the associated risk factors, the role of ultrasound in the antenatal diagnosis and fetal out in cases of polyhydramnios. Setting: Soba University Hospital. Subject: 100 patients of confirmed polyhydramnios who had been followed in the fetomaternal unit in Soba University Hospital from 1/4/2001 to 1/6/2002. Results: Polyhydramnios increased with advanced age, (42%) of the patients were grandmultiparae. Twenty percent of them had bad obstetrical history. Most of the patients(78%) were diagnosed after the gestational age of 28 weeks. Seventy nine percent o the patients had mild polyhydramnios, (15%) had moderate polyhydramnios and (6%) of the cases polyhydramnios were severe. Thirty nine percent of the patients had associated risk factors in the current pregnancy. these risk factors were as follows:- diabetes in (16%), Rhesus iso- immunization complicated with hydrops fetalis in (4%), congenital malformation in (15%) and 4% ha multiple pregnancy. Sixty five percent of the cases had no complication and did not need any treatment, those with complications were managed by different methods such as control of diabetes, Amnioreduction and Indomethacin therapy. Thirty eight percent of the patients delivered preterm, (44%) delivered by caesarean section, most of them were emergency caesarean section. Twenty five percent of the neoborns more than 4 Kg. Fifteen percent of them had apparent congenital malformation, 43% of the them needed different types of special management. Perinatal mortality was found to be (19.2%). (Author)

  19. Inverted U-shaped curve relationship between red blood cell distribution width and hypertension in a large health checkup population in China.

    Science.gov (United States)

    Jiang, Mingfei; Zha, Xiaojuan; Wu, Zewei; Zhu, Xinying; Li, Wenbo; Wu, Huan; Ma, Jun; Wang, Shuyi; Wen, Yufeng

    2018-03-10

    This study was aimed at investigating the relationship between red blood cell distribution width (RDW) and hypertension in a large health check up population in China. A population of 302,527 subjects from Wuhu was enrolled in this cross-sectional health check up study between 2011 and 2016. They consisted of 126,369 women (41.78%) and 176,158 men (58.23%) with mean age of 46.9 ± 13.4 and 48.1 ± 13.7 years, respectively. The investigations included information on demographic characteristics, physical examination, and laboratory testing. Inverted U-shape relationships were observed between RDW and hypertension with peak RDW values of 14.2 (women) and 15.2 (men). After stratification by sex and adjusted with body mass index, age, white blood cells, and high-density lipoprotein cholesterol, inverted U-shape relationships were also established between RDW and hypertension, systolic blood pressure, and diastolic blood pressure, with peak RDW of 14.2, 14.5, 14.5 in women and 14.2, 16.0, 14.5 in men. Inverted U-shape relationship exists between RDW and hypertension, systolic blood pressure, and diastolic blood pressure among the Chinese health check up population studied. Copyright © 2018 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  20. Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Jan Yi-Yin

    2006-01-01

    rate was 11% (1/9. Surgery-related mortality was 0%. Conclusion Angiography is valuable in localizing bleeding pseudoaneurysms. In this limited series, patients with bleeding pseudoaneurysms associated with chronic pancreatitis treated surgically seemingly obtained good outcomes.

  1. Arthroscopic repair of large U-shaped rotator cuff tears without margin convergence versus repair of crescent- or L-shaped tears.

    Science.gov (United States)

    Park, Jin-Young; Jung, Seok Won; Jeon, Seung-Hyub; Cho, Hyoung-Weon; Choi, Jin-Ho; Oh, Kyung-Soo

    2014-01-01

    For large-sized tears of the rotator cuff, data according to the tear shape have not yet been reported for repair methodology, configuration, and subsequent integrity. The retear rate after the repair of large mobile tears, such as crescent- or L-shaped tears, is believed to be lower compared with retear rates after the repair of large U-shaped tears that are accompanied by anterior or posterior leaves of the rotator cuff. Cohort study; Level of evidence, 3. Data were collected and analyzed from 95 consecutive patients with a large-sized rotator cuff tear who underwent arthroscopic suture-bridge repair. Patients were divided into 2 groups: those having crescent- or L-shaped tears (mobile tear group, 53 patients) and those having U-shaped tears (U-shaped tear group, 42 patients). The integrity of the repaired constructs was determined by ultrasonography at 4.5, 12, and 24 months. Moreover, clinical evaluations were performed by using the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and muscle strength at intervals of 3, 6, 12, and 24 months postoperatively. On ultrasonography at 4.5, 12, and 24 months, a retear was detected in 6, 2, and 1 patients in the mobile tear group and in 5, 2, and 1 patients in the U-shaped tear group, respectively. Significant differences in retear rates were not detected between the groups overall or at each time point. Moreover, clinical scores were similar between groups, except for the presence of a temporarily higher Constant score at 12 months in the mobile tear group. With regard to shoulder strength, between-group comparisons indicated no statistically significant difference, either in abduction or external rotation, except for the presence of temporarily higher external rotation strength at 3 months in the mobile tear group. Arthroscopic repair of large-sized rotator cuff tears yielded substantial improvements in shoulder function, regardless of tear retraction, during midterm follow-up. Moreover, the

  2. Associated injuries, management, and outcomes of blunt abdominal aortic injury.

    Science.gov (United States)

    de Mestral, Charles; Dueck, Andrew D; Gomez, David; Haas, Barbara; Nathens, Avery B

    2012-09-01

    Blunt abdominal aortic injury (BAAI) is very rare, and current literature is limited to case series of single-center experience. Through an analysis of the National Trauma Data Bank, the largest aggregation of United States trauma registry data, our aim was to characterize the associated injury pattern, contemporary management, and in-hospital outcomes of patients with BAAI. We used a nested case-control design. The overall cohort consisted of adult patients (age ≥ 16 years) severely injured (Injury Severity Score ≥ 16) after blunt trauma who were treated at a level 1 or 2 trauma center in years 2007 to 2009. Cases were patients with BAAI and were frequency-matched by age group and mechanism to randomly selected controls at a one-to-five ratio. Multivariable matched analysis (conditional logistic regression) was used to derive adjusted measures of association between BAAI and adjacent arterial, intra-abdominal, and bony injuries. We identified 436 patients with BAAI from 180 centers. The mean Injury Severity Score was 35 ± 14, and most patients were injured in motor vehicle crashes (84%). Multivariable analysis showed injury to the thoracic aorta, renal and iliac artery, small bowel, colon, liver, pancreas, and kidney, as well as lumbar spine fractures were independently associated with BAAI. A total of 394 patients (90%) were managed nonoperatively, and 42 (10%) underwent repair. Of these 42 patients, 29 (69%) underwent endovascular repair, with 11 patients undergoing open aortic repair and two extra-anatomic bypasses. Median time from admission to repair was 1 day (interquartile range, 1-2 days). Overall mortality was 29%. A total of 271 (69%) patients managed nonoperatively survived to hospital discharge. The index of suspicion for BAAI should be raised in severely injured patients by the presence of injuries to the lumbar spine, bowel, retroperitoneal organs, and adjacent major arteries. Although endovascular repair is the most common intervention, most

  3. Outcomes After Lumbar Disc Herniation in the National Basketball Association.

    Science.gov (United States)

    Minhas, Shobhit V; Kester, Benjamin S; Hsu, Wellington K

    2016-01-01

    Professional basketball players are at risk for lumbar disc herniation (LDH), yet the evidence guiding treatment after operative or nonoperative management of this condition in the National Basketball Association (NBA) is limited. NBA players with LDH will have different performance outcomes based on treatment type. Case-control study. Level 4. Athletes in the NBA with an LDH were identified through team injury reports, transaction records, and public sports archives. A 1:2 case-control study was performed in which LDH players and players without LDH were matched for player variables. Statistical analysis was employed to compare pre- and postindex season performance (games played and player efficiency rating [PER]) and career longevity between test subjects and controls in the operatively treated (OT) and nonoperatively treated (NOT) cohorts. A total of 61 NBA players with LDH were included, of whom 34 underwent discectomy and 27 were managed nonoperatively. Return-to-play (RTP) rates did not differ between NOT and OT players (77.8% vs. 79.4%). When compared with controls, OT players played significantly fewer games and had a lower PER than controls during the first postoperative season, but no difference was seen 2 and 3 years after surgery, with no difference in postoperative career length. In contrast, no difference in games played or PER was seen between NOT players and controls, although NOT players played significantly fewer postindex seasons. NBA players have a high RTP rate regardless of type of treatment for LDH; however, postindex performance differs between surgically and nonoperatively managed patients when compared with players without an LDH. However, further studies with a larger sample size are required for more definitive recommendations. There is a high RTP rate after LDH in the NBA, although postindex performance may differ based on operative versus nonoperative treatment. © 2015 The Author(s).

  4. Housing improvements for health and associated socio-economic outcomes.

    Science.gov (United States)

    Thomson, Hilary; Thomas, Sian; Sellstrom, Eva; Petticrew, Mark

    2013-02-28

    identified. These were studies of warmth improvements (n = 7) and rehousing (n = 5). Three qualitative studies were excluded from the synthesis due to lack of clarity of methods. Six of the included qualitative studies also reported quantitative data which was included in the review.Very little quantitative synthesis was possible as the data were not amenable to meta-analysis. This was largely due to extreme heterogeneity both methodologically as well as because of variations in the intervention, samples, context, and outcome; these variations remained even following grouping of interventions and outcomes. In addition, few studies reported data that were amenable to calculation of standardized effect sizes. The data were synthesised narratively.Data from studies of warmth and energy efficiency interventions suggested that improvements in general health, respiratory health, and mental health are possible. Studies which targeted those with inadequate warmth and existing chronic respiratory disease were most likely to report health improvement. Impacts following housing-led neighbourhood renewal were less clear; these interventions targeted areas rather than individual households in most need. Two poorer quality LMIC studies reported unclear or small health improvements. One better quality study of rehousing from slums (pre-1960) reported some improvement in mental health. There were few reports of adverse health impacts following housing improvement. A small number of studies gathered data on social and socio-economic impacts associated with housing improvement. Warmth improvements were associated with increased usable space, increased privacy, and improved social relationships; absences from work or school due to illness were also reduced.Very few studies reported differential impacts relevant to equity issues, and what data were reported were not amenable to synthesis. Housing investment which improves thermal comfort in the home can lead to health improvements, especially

  5. Factors associated with health care access and outcome.

    Science.gov (United States)

    Paek, Min-So; Lim, Jung-Won

    2012-01-01

    This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.

  6. ADVERSE PREGNANCY OUTCOMES ASSOCIATED WITH MATERNAL ENALAPRIL ANTIHYPERTENSIVE TREATMENT

    Science.gov (United States)

    Enalapril, one of several antihypertensive drugs that act as angiotensin-converting enzyme (ACE) inhibitors, is often used for treatment of hypertension in women of reproductive age. Adverse birth outcomes following the use of ACE inhibitors, including enalapril, during pregnanc...

  7. 5. Factors associated with Outcome in Patients Admitted with ...

    African Journals Online (AJOL)

    RICHY

    in-hospital outcomes of Traumatic Brain Injury (TBI) ... percentage points lower than an earlier study done at ... Severity of injury; this is determined by use of ..... 10. Management Protocol in head injured patients at. UTH. Neurosurgical unit ...

  8. Outcome of Induction and Associated Factors among Term and Post

    African Journals Online (AJOL)

    GB

    354 records ... The purpose of this study was to analyze outcome of induction with ... (PROM), post-term pregnancy, maternal medical ... restriction, iso-immunization), preeclampsia, and .... provides services for approximately 9000 inpatient.

  9. U-shape rotating anti-cathode compact X-ray generator: 20 times stronger than the commercially available X-ray source

    Energy Technology Data Exchange (ETDEWEB)

    Sakabe, N., E-mail: sakabe-dsb@sbsp.jp; Sakabe, K. [High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba 305-0801 (Japan); Foundation for Advancement of International Science (FAIS), Kasuga 3-chome, Tsukuba, Ibaraki 305-0821 (Japan); Ohsawa, S.; Sakai, T.; Kobayakawa, H.; Sugimura, T.; Ikeda, M.; Tawada, M. [High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801 (Japan); Watanabe, N.; Sasaki, K. [Nagoya University, Chikusa, Nagoya, Aichi 464-8603 (Japan); Wakatsuki, M. [National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Higashi, Tsukuba, Ibaraki 305-8568 (Japan)

    2013-11-01

    A new type of U-shape anti-cathode X-ray generator in which the inner surface of a cylindrical target is irradiated by an electron beam has been made by modifying a conventional rotating anti-cathode X-ray generator whose brightness in the catalog is 12 kW mm{sup −2}. A brightness of 129 kW mm{sup −2} was thereby obtained with this new U-shape-type X-ray generator. This new X-ray generator is expected to be of keen interest for applications in academia, industry and in hospitals. A new type of U-shape anti-cathode X-ray generator in which the inner surface of a cylindrical target is irradiated by an electron beam has been made by modifying a conventional rotating anti-cathode X-ray generator whose brightness in the catalog is 12 kW mm{sup −2}. The target material (Cu), target radius (50 mm) and rotating speed (6000 r.p.m.) were not changed in this modification. A brightness of 52 kW mm{sup −2} was obtained by this U-shape-type X-ray generator. This means that the brightness of the new type is 4.3 times greater than that of the old unmodified one. Furthermore, the new-type X-ray generator yielded a brightness of 129 kW mm{sup −2} by adding a carbon coating on the Cu target. This means an overall increase of brightness of ten times. The original generator has the highest brightness in the generators of the same class (having a radius of 50 mm and rotation speed of 6000 r.p.m.). Observations showed that Cu Kα counts at vertical incidence of the electron beam onto the surface of the new target, which is initially optically smooth, decrease as the surface is roughened by a severe thermal stress caused by strong electron beam exposure. Further observation reveals, however, that oblique incidence of the electron beam onto the roughened surface drastically increased the X-ray output and amounts to twice as much as that from a smooth surface at vertical incidence. Thus, at the present stage, an overall increase of brightness has been realised at a level 20 times

  10. Association between perceived self-efficacy, outcome expectations and outcome evaluation and fruit and vegetables consumption in adolescent girls

    Directory of Open Access Journals (Sweden)

    Ali Ramezankhani

    2017-05-01

    Full Text Available Unfortunately just a few number of children and adolescents use sufficient amounts of fruit and vegetables. This study aimed to investigate the association between fruit and vegetables consumption and perceived self-efficacy, outcome expectations and outcome evaluation in adolescent girls in Shahrekord city.This is a descriptive analytic study conducted on 308 high school girls (first grade who were selected by cluster sampling method in Shahrekord, Iran in 2013-2014. A researcher made questionnaire was used to collect the needed data like demographic variables, substructures of perceived self-efficacy, outcome expectations and outcome evaluation. In order to investigate the fruit and vegetables consumption status, the standard questionnaire of FFQ was used. The collected data was analyzed by SPSS 18 software, using descriptive and analytic tests such as one way variance analysis, Pearson and Spearman correlation. The mean scores of fruit and vegetables consumption and vegetables consumption were reported as 1.45±0.68 and 1.47±0.95 respectively as well. There was a direct significant association between adolescents’ perceived self-efficacy and outcome expectations. A direct significant association was also observed between fruit consumption and both outcome evaluation and perceived self-efficacy Regarding the status of fruit and vegetables consumption and the mean scores of outcome evaluation, outcome expectations and perceived self-efficacy in adolescents which was low, and also the importance of promoting healthy diet in the critical period of adolescence, it seems necessary to use efficient patterns and theories of health education and promotion in which the roles of individuals, family and environment has been considered.

  11. Clinical profile and outcome of parathyroid adenoma-associated pancreatitis

    Directory of Open Access Journals (Sweden)

    Mohsin Aslam

    2018-01-01

    Conclusions: Estimating serum calcium after an episode of unexplained pancreatitis is important and can help minimize delay in diagnosing primary hyperparathyroidism, and possibly prevent the progression of pancreatitis. Parathyroidectomy improves the clinical outcome of primary hyperparathyroidism and prevents further attacks of pancreatitis.

  12. Association between depression and hospital outcomes among older men

    NARCIS (Netherlands)

    Prina, A.M.; Huisman, M.; Yeap, B.Y.; Hankey, G.J.; Flicker, L.; Brayne, C.; Almeida, O.P.

    2013-01-01

    Background: Studies that have investigated the relation between depression and the type, nature, extent and outcome of general hospital admissions have been limited by their retrospective designs and focus on specific clinical populations. We explored this relation prospectively in a large,

  13. Evaluating herbivore management outcomes and associated vegetation impacts

    Directory of Open Access Journals (Sweden)

    Rina C.C. Grant

    2011-05-01

    Conservation implications: In rangeland, optimising herbivore numbers to achieve the management objectives without causing unacceptable or irreversible change in the vegetation is challenging. This manuscript explores different avenues to evaluate herbivore impact and the outcomes of management approaches that may affect vegetation.

  14. Association between breakfast consumption and educational outcomes in 9?11-year-old children

    OpenAIRE

    Littlecott, Hannah J; Moore, Graham F; Moore, Laurence; Lyons, Ronan A; Murphy, Simon

    2015-01-01

    Objective Breakfast consumption has been consistently associated with health outcomes and cognitive functioning in schoolchildren. Evidence of direct links with educational outcomes remains equivocal. We aimed to examine the link between breakfast consumption in 9–11-year-old children and educational outcomes obtained 6–18 months later.\\ud Design Data on individual-level free school meal entitlement and educational outcomes (Statutory Assessment Tests (SATs) at Key Stage 2) were obtained via ...

  15. High temperature collecting performance of a new all-glass evacuated tubular solar air heater with U-shaped tube heat exchanger

    International Nuclear Information System (INIS)

    Wang, Pin-Yang; Guan, Hong-Yang; Liu, Zhen-Hua; Wang, Guo-San; Zhao, Feng; Xiao, Hong-Sheng

    2014-01-01

    Highlights: • A novel solar air heater with simplified CPC and U-type heat exchanger is designed and tested. • The system is made up of 10 linked collecting panels. • Simplified CPC has a much lower cost at the expense of slight efficiency loss. • The air heater can propose the heated air exceeding 200 °C with great air flow rate. - Abstract: Experiment and simulation are conducted on a new-type all-glass evacuated tubular solar air heater with simplified compound parabolic concentrator (CPC). The system is made up of 10 linked collecting panels and each panel includes a simplified CPC and an all-glass evacuated tube with a U-shaped copper tube heat exchanger installed inside. Air is gradually heated when passing through each U-shaped copper tube. The heat transfer model of the solar air heater is established and the outlet air temperature, the heat power and heat efficiency are calculated. Calculated and experimental results show that the present experimental system can provide the heated air exceeding 200 °C. The whole system has an outstanding high-temperature collecting performance and the present heat transfer model can meet the general requirements of engineering calculations

  16. Poor final visual outcome after traumatic hyphema: A retrospective study of associated factors

    Directory of Open Access Journals (Sweden)

    Ayda Khalfan Al Ali

    2012-09-01

    Full Text Available OBJECTIVES: To determine the factors associated with a poor final visual outcome following a non-perforating traumatic hyphema. METHODS: The in-patient records of all traumatic hyphema patients admitted to the Department of Ophthalmology of the Hamad Medical Centre (HMC in Doha, Qatar, were retrospectively reviewed for a four-year period from January 2004 to March 2008. One hundred and seventeen patients who did not meet the exclusion criteria were divided into two groups based on their final visual outcome post-treatment. Group 1 (good outcome consisted of 100 patients with a visual acuity (VA of 6/18 or better and group 2 (worse outcome consisted of 17 patients with a VA of less than 6/18. The two groups were compared to determine the factors associated with a poor final visual outcome. RESULTS: Group 2 patients had an 82.3% incidence of complications after a traumatic hyphema compared with a 21% incidence in group 1. Of these complications, secondary glaucoma and rebleeding were significantly associated with a worse final visual outcome. Trauma from projectiles or blows did not differ significantly in their effect on the final visual outcome, although blow injuries had a greater impact on the final visual outcome. Posterior segment injuries were associated with a worse visual outcome. CONCLUSION: It was concluded that secondary glaucoma, rebleeding, and posterior segment injuries are factors associated with a poor final visual outcome.

  17. Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis

    DEFF Research Database (Denmark)

    Heiligenhaus, Arnd; Foeldvari, Ivan; Edelsten, Clive

    2012-01-01

    To develop a set of core outcome measures for use in randomized controlled trials (RCTs) and longitudinal observational studies in juvenile idiopathic arthritis (JIA)-associated uveitis.......To develop a set of core outcome measures for use in randomized controlled trials (RCTs) and longitudinal observational studies in juvenile idiopathic arthritis (JIA)-associated uveitis....

  18. Towards a sustainable healthy working life : associations between chronological age, functional age and work outcomes

    NARCIS (Netherlands)

    Koolhaas, Wendy; van der Klink, Jac J. L.; Groothoff, Johan W.; Brouwer, Sandra

    Background: The aims of this study were: (i) to determine the relation between chronological and functional age; (ii) to examine the association between chronological age and work outcomes; and (iii) to examine the association between functional age and work outcomes. An overview of the most

  19. Costs and outcomes associated with IVF using recombinant FSH.

    Science.gov (United States)

    Ledger, W; Wiebinga, C; Anderson, P; Irwin, D; Holman, A; Lloyd, A

    2009-09-01

    Cost and outcome estimates based on clinical trial data may not reflect usual clinical practice, yet they are often used to inform service provision and budget decisions. To expand understanding of assisted reproduction treatment in clinical practice, an economic evaluation of IVF/intracytoplasmic sperm injection (ICSI) data from a single assisted conception unit (ACU) in England was performed. A total of 1418 IVF/ICSI cycles undertaken there between October 2001 and January 2006 in 1001 women were analysed. The overall live birth rate was 22% (95% CI: 19.7-24.2), with the 30- to 34-year age group achieving the highest rate (28%). The average recombinant FSH (rFSH) dose/cycle prescribed was 1855 IU. Average cost of rFSH/cycle was 646 pound(SD: 219 pound), and average total cost/cycle was 2932 pound (SD: 422 pound). Economic data based on clinical trials informing current UK guidance assumes higher doses of rFSH dose/cycle (1750-2625 IU), higher average cost of drugs/cycle (1179 pound), and higher average total cost/cycle (3266 pound). While the outcomes in this study matched UK averages, total cost/cycle was lower than those cited in UK guidelines. Utilizing the protocols and (lower) rFSH dosages reported in this study may enable other ACU to provide a greater number of IVF/ICSI cycles to patients within given budgets.

  20. Change in Body Mass Index Associated With Lowest Mortality in Denmark, 1976-2013

    DEFF Research Database (Denmark)

    Afzal, Shoaib; Tybjærg-Hansen, Anne; Jensen, Gorm B

    2016-01-01

    IMPORTANCE: Research has shown a U-shaped pattern in the association of body mass index (BMI) with mortality. Although average BMI has increased over time in most countries, the prevalence of cardiovascular risk factors may also be decreasing among obese individuals over time. Thus, the BMI...... came first. EXPOSURES: For observational studies, BMI was modeled using splines and in categories defined by the World Health Organization. Body mass index was calculated as weight in kilograms divided by height in meters squared. MAIN OUTCOMES AND MEASURES: Main outcome was all-cause mortality...

  1. The association between patient-therapist MATRIX congruence and treatment outcome.

    Science.gov (United States)

    Mendlovic, Shlomo; Saad, Amit; Roll, Uri; Ben Yehuda, Ariel; Tuval-Mashiah, Rivka; Atzil-Slonim, Dana

    2018-03-14

    The present study aimed to examine the association between patient-therapist micro-level congruence/incongruence ratio and psychotherapeutic outcome. Nine good- and nine poor-outcome psychodynamic treatments (segregated by comparing pre- and post-treatment BDI-II) were analyzed (N = 18) moment by moment using the MATRIX (total number of MATRIX codes analyzed = 11,125). MATRIX congruence was defined as similar adjacent MATRIX codes. the congruence/incongruence ratio tended to increase as the treatment progressed only in good-outcome treatments. Progression of MATRIX codes' congruence/incongruence ratio is associated with good outcome of psychotherapy.

  2. Outcomes Associated With Familial Versus Nonfamilial Atrial Fibrillation

    DEFF Research Database (Denmark)

    Gundlund, Anna; Olesen, Jonas Bjerring; Staerk, Laila

    2016-01-01

    and multivariable Cox models, we examined the risk of long-term outcomes. We identified 8658 AF patients (4329 matched pairs) with and without familial AF. The median age was 50 years (interquartile range 43-54 years), and 21.4% were women. Compared with nonfamilial AF patients, those with familial AF had slightly...... less comorbid illness but similar overall CHA2DS2-VASc score (P=0.155). Median follow-up was 3.4 years (interquartile range 1.5-6.5 years). Patients with familial AF had risk of death and thromboembolism similar to those with nonfamilial AF (adjusted hazard ratio 0.91 [95% CI 0.79-1.04] for death and 0...

  3. Prospective association of common eating disorders and adverse outcomes.

    Science.gov (United States)

    Field, Alison E; Sonneville, Kendrin R; Micali, Nadia; Crosby, Ross D; Swanson, Sonja A; Laird, Nan M; Treasure, Janet; Solmi, Francesca; Horton, Nicholas J

    2012-08-01

    Anorexia nervosa and bulimia nervosa (BN) are rare, but eating disorders not otherwise specified (EDNOS) are relatively common among female participants. Our objective was to evaluate whether BN and subtypes of EDNOS are predictive of developing adverse outcomes. This study comprised a prospective analysis of 8594 female participants from the ongoing Growing Up Today Study. Questionnaires were sent annually from 1996 through 2001, then biennially through 2007 and 2008. Participants who were 9 to 15 years of age in 1996 and completed at least 2 consecutive questionnaires between 1996 and 2008 were included in the analyses. Participants were classified as having BN (≥ weekly binge eating and purging), binge eating disorder (BED; ≥ weekly binge eating, infrequent purging), purging disorder (PD; ≥ weekly purging, infrequent binge eating), other EDNOS (binge eating and/or purging monthly), or nondisordered. BN affected ∼1% of adolescent girls; 2% to 3% had PD and another 2% to 3% had BED. Girls with BED were almost twice as likely as their nondisordered peers to become overweight or obese (odds ratio [OR]: 1.9 [95% confidence interval: 1.0-3.5]) or develop high depressive symptoms (OR: 2.3 [95% confidence interval: 1.0-5.0]). Female participants with PD had a significantly increased risk of starting to use drugs (OR: 1.7) and starting to binge drink frequently (OR: 1.8). PD and BED are common and predict a range of adverse outcomes. Primary care clinicians should be made aware of these disorders, which may be underrepresented in eating disorder clinic samples. Efforts to prevent eating disorders should focus on cases of subthreshold severity.

  4. Serotonin affects association of aversive outcomes to past actions.

    Science.gov (United States)

    Tanaka, Saori C; Shishida, Kazuhiro; Schweighofer, Nicolas; Okamoto, Yasumasa; Yamawaki, Shigeto; Doya, Kenji

    2009-12-16

    Impairment in the serotonergic system has been linked to action choices that are less advantageous in a long run. Such impulsive choices can be caused by a deficit in linking a given reward or punishment with past actions. Here, we tested the effect of manipulation of the serotonergic system by tryptophan depletion and loading on learning the association of current rewards and punishments with past actions. We observed slower associative learning when actions were followed by a delayed punishment in the low serotonergic condition. Furthermore, a model-based analysis revealed a positive correlation between the length of the memory trace for aversive choices and subjects' blood tryptophan concentration. Our results suggest that the serotonergic system regulates the time scale of retrospective association of punishments to past actions.

  5. Associations between the peer support relationship, service satisfaction and recovery-oriented outcomes: a correlational study.

    Science.gov (United States)

    Thomas, Elizabeth C; Salzer, Mark S

    2017-12-18

    The working alliance between non-peer providers and mental health consumers is associated with positive outcomes. It is hypothesized that this factor, in addition to other active support elements, is also positively related to peer support service outcomes. This study evaluates correlates of the peer-to-peer relationship and its unique association with service satisfaction and recovery-oriented outcomes. Participants were 46 adults with serious mental illnesses taking part in a peer-brokered self-directed care intervention. Pearson correlation analyses examined associations among peer relationship factors, services-related variables and recovery-oriented outcomes (i.e. empowerment, recovery and quality of life). Hierarchical multiple regression analyses evaluated associations between relationship factors and outcomes over time, controlling for other possible intervention effects. The peer relationship was not related to number of contacts. There were robust associations between the peer relationship and service satisfaction and some recovery-oriented outcomes at 24-months, but not at 12-months. These associations were not explained by other possible intervention effects. This study contributes to a better understanding of the positive, unique association between the peer-to-peer relationship and outcomes, similar to what is found in non-peer-delivered interventions. Implications for program administrators and policymakers seeking to integrate peer specialists into mental health service systems are discussed.

  6. Anca associated vasculitis : occurrence, prediction, prevention, and outcome of relapses

    NARCIS (Netherlands)

    Boomsma, Maarten Michiel

    2001-01-01

    During follow-up, relapses of disease activity occur in the majority of patients with ANCA associated vasculitis. The general objective brought together in this thesis was to further elucidate the characteristics and consequences of these relapses. Investigated items are the occurrence, the

  7. Incidence and outcome of ventilator-associated pneumonia in Inkosi ...

    African Journals Online (AJOL)

    pneumonia in Inkosi Albert Luthuli and King Edward VIII. Hospital surgical ... Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has ... microbial flora.[5] ... or confirmed community-acquired or .... Patients' baseline function, comorbidities, injury severity score and.

  8. Motivational Profiles and Their Associations with Achievement Outcomes

    Science.gov (United States)

    Shen, Bo; McCaughtry, Nate; Martin, Jeffrey J.; Fahlman, Mariane M.

    2009-01-01

    With the belief that theoretical integration in motivation may help us better understand motivational behavior, we designed this study to explore adolescents' motivational profiles and their associations with knowledge acquisition, leisure-time exercise behaviors, and cardiorespiratory fitness. Middle school students from a large urban inner-city…

  9. Resilience, Bullying, and Mental Health: Factors Associated with Improved Outcomes

    Science.gov (United States)

    Moore, Brian; Woodcock, Stuart

    2017-01-01

    Resilience is associated with bouncing back from adversity, and the term currently enjoys significant popular appeal. However, understanding of resilience is often superficial. The current paper examined 105 primary and high school students' experiences of resilience and bullying, and considered resilience as a hierarchical factorial model. The…

  10. Associations between therapists' occupational burnout and their patients' depression and anxiety treatment outcomes.

    Science.gov (United States)

    Delgadillo, Jaime; Saxon, David; Barkham, Michael

    2018-05-02

    Occupational burnout is common in mental health professionals, but its impact on patient outcomes is as yet uncertain. This study aimed to investigate associations between therapist-level burnout and patient-level treatment outcomes after psychological therapy. We used multilevel modeling using depression (PHQ-9) and anxiety (GAD-7) outcomes data from 2,223 patients nested within 49 therapists. Therapists completed a survey including the Oldenburg Burnout Inventory (OLBI) and a job satisfaction scale (JDSS). After controlling for case-mix, around 5% of variability in treatment outcomes was explained by therapist effects (TE). Higher therapist OLBI-disengagement and lower JDSS scores were significantly associated with poorer treatment outcomes, explaining between 31 and 39% of the TE estimate. Higher OLBI scores were also correlated with lower job satisfaction ratings. Therapist burnout has a negative impact on treatment outcomes and could be the target of future preventive and remedial action. © 2018 Wiley Periodicals, Inc.

  11. Association between neurological assessment and developmental outcome in preterm toddlers

    Directory of Open Access Journals (Sweden)

    Jana Kodrič

    2011-01-01

    Full Text Available There has been an increase in prevalence of low severity dysfunctions such as minor neurological dysfunction and cognitive deficits which consequently lead to school and behavior problems. The study presents the outcomes of a small group of preterm children with different medical complications at birth on follow-up at toddler age. In the neonatal period and at three months corrected age the neurological examination by the Amiel-Tison neurological assessment and the assessment of general movements was done. Both measures were compared with the criterion measure Bayley Scales of Infant Development - II. Results of the preterm group were compared with results of the normative group. According to results for both methods of neurological examination, children were classified into different categories meaning optimal or different degrees of non-optimal neurological results. The results of the children from different categories of neurological functioning were compared with the criterion measure. Children from the preterm group attained lower results on the developmental test compared to normative data. Children from groups with the lowest birth weight and gestational age attained the lowest results. These findings suggest that children from less optimal or non-optimal categories according to both methods of neurological examination attained lower developmental scores. The difference between groups was higher on the mental scale than on the motor scale of the developmental test.

  12. Prior Cannabis Use Is Associated with Outcome after Intracerebral Hemorrhage.

    Science.gov (United States)

    Di Napoli, Mario; Zha, Alicia M; Godoy, Daniel A; Masotti, Luca; Schreuder, Floris H B M; Popa-Wagner, Aurel; Behrouz, Réza

    2016-01-01

    Recent evidence suggests that a potential harmful relationship exists between cannabis use and ischemic stroke. The purpose of this study was to determine the implications of cannabis use in intracerebral hemorrhage (ICH) patients. An analysis of an international, multicenter, observational database of consecutive patients with spontaneous ICH was conducted. We extracted the following characteristics on presentation: demographics, risk factors, antiplatelet or anticoagulant use, Glasgow Coma Scale, ICH score, neuroimaging parameters, and urine toxicology screen (UTS) results. Modified Rankin Scale (mRS) score was utilized for determination of outcome at discharge. Adjusted logistic ordinal regression was used as shift analysis to assess the impact of cannabis use on mRS score at discharge. The adjusted common OR measured the likelihood that cannabis use would lead to lower mRS scores. Within a cohort of 725 spontaneous ICH patients, UTS was positive for cannabinoids in 8.6%. Cannabinoids-positive (CB+) patients were more frequently Caucasian (p cannabis use was discovered in nearly 10% of patients with spontaneous ICH. Although there was no relationship between cannabis use and specific ICH characteristics, CB+ patients had milder ICH presentation and less disability at discharge. © 2016 S. Karger AG, Basel.

  13. Technique-associated outcomes in horses following large colon resection.

    Science.gov (United States)

    Pezzanite, Lynn M; Hackett, Eileen S

    2017-11-01

    To compare survival and complications in horses undergoing large colon resection with either sutured end-to-end or stapled functional end-to-end anastomoses. Retrospective cohort study. Twenty-six client-owned horses with gastrointestinal disease. Retrospective data were retrieved from the medical records of 26 horses undergoing colectomy, including 14 horses with sutured end-to-end and 12 horses with stapled functional end-to-end anastomoses, between 2003 and 2016. Records were evaluated for signalment, medical and surgical treatments, and survival to hospital discharge. Long-term follow-up was obtained through owner contact. Continuous variables were compared with Mann-Whitney tests. Fisher's exact testing was used to compare survival to hospital discharge. Survival time was compared by constructing Kaplan-Meier survival curves and performing log-rank curve comparison testing. Mean age of horses undergoing colectomy was 13 years. Reason for colectomy was prophylaxis (12) or salvage (14). Mean surgical time was 169 minutes. Mean hospitalization time was 9 days, which did not differ with anastomosis type (P = .62). Nine of 12 horses undergoing stapled functional end-to-end anastomosis and 12 of 14 horses undergoing sutured end-to-end anastomosis survived to hospital discharge (P = .63). Survival time did not differ with anastomosis technique (P = .35). Short- and long-term survival outcomes are not different between sutured end-to-end or stapled functional end-to-end anastomoses in horses undergoing colectomy. © 2017 The American College of Veterinary Surgeons.

  14. Clinical Outcomes Associated with a Failed Infant Car Seat Challenge.

    Science.gov (United States)

    Shah, Malika D; Dookeran, Keith A; Khan, Janine Y

    2017-01-01

    To assess comorbid conditions and clinical outcomes among late preterm and low birth weight term infants (Baby Unit. This was a retrospective chart review of consecutive infants who failed ICSC on the Mother-Baby Unit and were subsequently admitted to the neonatal intensive care unit at Prentice Women's Hospital between January 1, 2009, and December 31, 2015. Regression models were used to estimate risk differences (RDs) with 95% CIs for factors related to length of stay. A total of 148 infants were studied (43% male; 37% delivered via cesarean). ICSC failure in the Mother-Baby Unit was due to desaturation, bradycardia, and tachypnea in 59%, 37%, and 4% of infants, respectively. During monitoring on the neonatal intensive care unit, 39% of infants experienced apnea (48% in preterm vs 17% in term infants) in the supine position, 19% received phototherapy, and 2% and 6.8% received nasogastric and thermoregulatory support, respectively. Univariate predictors of increased duration of stay (days) were younger gestational age, apnea, nasogastric support, intravenous fluids, and antibiotics (all P < .05). In multivariable analysis adjusted for gestational age and discharge weight, only apnea (RD, 4.87; 95% CI, 2.99-6.74; P < .001), administration of antibiotics (RD, 3.25; 95% CI, 0.29-6.21; P < .032), and intravenous fluid support (RD, 4.87; 95% CI, 0.076-9.66; P < .047) remained independent predictors of a longer duration of stay. Infants who failed ICSC were at risk for comorbid conditions that prolonged hospital stay beyond the neonatal intensive care unit observation period. Almost one-half of late preterm infants who failed ICSC had apnea events in the supine position. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Isolated abducens nerve palsy with hyperhomocysteinemia: Association and outcomes

    Directory of Open Access Journals (Sweden)

    Virender Sachdeva

    2013-01-01

    Full Text Available Ischemic abducens nerve palsy usually presents as isolated cranial nerve palsy in the middle aged and elderly patients with known risk factors such as diabetes mellitus, hypertension, dyslipidemia, carotid artery disease, etc., In this report, we describe four patients with isolated abducens nerve palsy who presented with an acute onset diplopia whose detailed history and examination were suggestive of an ischemic etiology. Detailed systemic and laboratory evaluation revealed hyperhomocysteinemia as the only potential risk factor. To the best of our knowledge this is the first report of association of hyperhomocysteinemia and isolated abducens nerve palsy.

  16. Outcome of HIV-1-associated cryptococcal meningitis, Denmark 1988-2008

    DEFF Research Database (Denmark)

    Mathiesen, Inger Hee Mabuza; Knudsen, Jenny Dahl; Gerstoft, Jan

    2012-01-01

    Abstract Introduction: The risk of HIV-1-associated Cryptococcus neoformans meningitis (CM) has decreased and the outcome has improved with the use of combination antiretroviral therapy (cART). Outcome has not been reported in Denmark in the cART era. Methods: A review of all cases of HIV-1...

  17. Outcomes of Global Education: External and Internal Change Associated with Study Abroad

    Science.gov (United States)

    Miller-Perrin, Cindy; Thompson, Don

    2014-01-01

    This chapter provides an overview of external and internal changes associated with collegiate study abroad experiences. A brief review of the research literature is included along with recent research that sheds light on potential mechanisms associated with study abroad-related change. Recommendations for enhancing outcomes associated with study…

  18. Does Self-Esteem Moderate the Associations between Protective Behavioral Strategies and Negative Outcomes Associated with Alcohol Consumption?

    Science.gov (United States)

    Zeigler-Hill, Virgil; Madson, Michael B.; Ricedorf, Amy

    2012-01-01

    Previous research has shown that protective behavioral strategies tend to be associated with lower levels of alcohol consumption and fewer negative alcohol-related consequences. The purpose of the present study was to examine whether self-esteem would moderate the association between protective behavioral strategies and alcohol-related outcomes.…

  19. Associations between rejection sensitivity and mental health outcomes : A meta-analytic review

    NARCIS (Netherlands)

    Gao, S.; Assink, M.; Cipriani, A.; Lin, K.

    2017-01-01

    Rejection sensitivity is a personality disposition characterized by oversensitivity to social rejection. Using a three-level meta-analytic model, 75 studies were reviewed that examined associations between rejection sensitivity and five mental health outcomes: depression, anxiety, loneliness,

  20. The Nature and Outcomes for Women of Stressors Associated With Military Life

    National Research Council Canada - National Science Library

    Jordan, Kathleen

    1999-01-01

    The study of The Nature and Outcomes for Women of Stressors Associated with Military Life will obtain data that will enable us to assess the distribution of stress exposure across women in the major...

  1. The Nature and Outcomes for Women of Stressors Associated with Military Life

    National Research Council Canada - National Science Library

    Jordan, B

    1998-01-01

    The study of The Na turn and Outcomes for Women of Stressors Associated with Military Life will obtain data that will enable us to assess the distribution of stress exposure across women in the major...

  2. Association of perpetrator relationship to abusive head trauma clinical outcomes.

    Science.gov (United States)

    Scribano, Philip V; Makoroff, Kathi L; Feldman, Kenneth W; Berger, Rachel P

    2013-10-01

    The diagnosis of abusive head trauma (AHT) remains a significant public health problem with limited prevention success. Providing protection from further harm is often challenged by the difficulty in identifying the alleged perpetrator (AP) responsible for this pediatric trauma. The objective of this study was to evaluate demographic and clinical characteristics of children with AHT and the relationship between APs and their victims in a large, multi-site sample. Understanding the AHT risks from various caregivers may help to inform current prevention strategies. A retrospective review of all cases of AHT diagnosed by child protection teams (CPT) from 1/1/04 to 6/30/09 at four children's hospitals was conducted. Clinical characteristics of children with AHT injured by non-parental perpetrators (NPP) were compared to parental perpetrators (PP). There were 459 children with AHT; 313 (68%) had an identified AP. The majority of the 313 children were <1 year of age (76%), Caucasian (63%), male (58%), receiving public assistance (80%), and presented without a history of trauma (62%); mortality was 19%. Overall, APs were: father (53%), parent partner (22%), mother (8%), babysitter (8%), other adult caregiver (5%); NPP accounted for 39% of APs. NPPs were more likely to cause AHT in children ≥ 1 year (77% vs. 23%, p<0.001) compared to PP. Independent associations to NPP included: older child, absence of a history of trauma, retinal hemorrhages, and male perpetrator gender. While fathers were the most common AP in AHT victims, there is a significant association for increased risk of AHT by NPPs in the older child, who presents with retinal hemorrhages, in the hands of a male AP. Further enhancement of current prevention strategies to address AHT risks of non-parental adults who provide care to children, especially in the post-infancy age seems warranted. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Outcome Expectations and Osteoarthritis: Association of Perceived Benefits of Exercise With Self-Efficacy and Depression.

    Science.gov (United States)

    Marszalek, Jolanta; Price, Lori Lyn; Harvey, William F; Driban, Jeffrey B; Wang, Chenchen

    2017-04-01

    Outcome expectancy is recognized as a determinant of exercise engagement and adherence. However, little is known about which factors influence outcome expectations for exercise among people with knee osteoarthritis (OA). This is the first study to examine the association of outcome expectations for exercise with demographic, physical, and psychosocial outcomes in individuals with knee OA. We performed a cross-sectional analysis of the baseline data from a randomized trial of tai chi versus physical therapy in participants with symptomatic knee OA. Knee pain was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcome expectations for exercise, self-efficacy, depression, anxiety, stress, and social support were measured using standard instruments. Logistic regression models were utilized to determine associations with outcome expectations. There were 262 participants, with a mean age of 59.8 years and a mean body mass index of 32.1 kg/m 2 ; 69.1% of the participants were female, 51.5% were white, the mean disease duration was 8.6 years, and the mean WOMAC knee pain and function scores were 260.8 and 906.8, respectively. Higher outcome expectations for exercise were associated with greater self-efficacy (odds ratio [OR] 1.25 [95% confidence interval (95% CI) 1.11-1.41]; P = 0.0004), as well as with fewer depressive symptoms (OR 0.84 for each 5-point increase [95% CI 0.73-0.97]; P = 0.01). Outcome expectancy was not significantly associated with sex, race, education, pain, function, radiographic severity, social support, anxiety, or stress. Our results suggest significant associations between outcome expectations for exercise and self-efficacy and depression. Future studies should examine how these relationships longitudinally affect long-term clinical outcomes of exercise-based treatment for knee OA. © 2016, American College of Rheumatology.

  4. Outcome of thyroid associated ophthalmopathy treated by radiation therapy

    International Nuclear Information System (INIS)

    Abboud, Mirna; Arabi, Asma; Salti, Ibrahim; Geara, Fady

    2011-01-01

    Thyroid associated orbitopathy is a common manifestation of Graves disease. Many options can be considered for treatment. In this case series, we reviewed the medical records of 17 patients who received radiation therapy (RT) for GO in a tertiary care center between 1997 and 2007. All patients received 20 Gy to both orbits and 12 of them (71%) had already received one or more trials of steroid therapy prior to RT. After a median follow-up of 2 years, a subjective improvement in exophthalmos and vision was reported by all patients at the end of RT but only 3 patients reported a decrease in their diplopia immediately after therapy. Symptoms continued to improve with time in many patients: 22% had complete reversal of their symptoms and signs, and the remaining 78% had partial improvement. Two patients developed recurrent signs and symptoms, both of them were smokers who continued to smoke after treatment. About 60-65% of patients responded favorably to RT alone which increased to 87-97% when RT is combined with steroids. No patients developed late toxicity during the follow-up period. We conclude that RT is an effective treatment option in GO even in patients who failed previous treatment with steroids or surgical decompression. Based on our own clinical experiences and the literature data, the combination of RT and intravenous corticosteroid administration may improve the response rate

  5. High vitamin B12 level and good treatment outcome may be associated in major depressive disorder

    Directory of Open Access Journals (Sweden)

    Tanskanen Antti

    2003-12-01

    Full Text Available Abstract Background Despite of an increasing body of research the associations between vitamin B12 and folate levels and the treatment outcome in depressive disorders are still unsolved. We therefore conducted this naturalistic prospective follow-up study. Our aim was to determine whether there were any associations between the vitamin B12 and folate level and the six-month treatment outcome in patients with major depressive disorder. Because vitamin B12 and folate deficiency may result in changes in haematological indices, including mean corpuscular volume, red blood cell count and hematocrit, we also examined whether these indices were associated with the treatment outcome. Methods Haematological indices, erythrocyte folate and serum vitamin B12 levels were determined in 115 outpatients with DSM-III-R major depressive disorder at baseline and serum vitamin B12 level again on six-month follow-up. The 17-item Hamilton Depression Rating Scale was also compiled, respectively. In the statistical analysis we used chi-squared test, Pearson's correlation coefficient, the Student's t-test, analysis of variance (ANOVA, and univariate and multivariate linear regression analysis. Results Higher vitamin B12 levels significantly associated with a better outcome. The association between the folate level and treatment outcome was weak and probably not independent. No relationship was found between haematological indices and the six-month outcome. Conclusion The vitamin B12 level and the probability of recovery from major depression may be positively associated. Nevertheless, further studies are suggested to confirm this finding.

  6. Performance Outcomes After Metacarpal Fractures in National Basketball Association Players.

    Science.gov (United States)

    Guss, Michael S; Begly, John P; Ramme, Austin J; Hinds, Richard M; Karia, Raj J; Capo, John T

    2016-12-01

    Background: The aim was to determine whether players in the National Basketball Association (NBA) who sustain metacarpal fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. Methods: Data for 32 NBA players with metacarpal fractures incurred over 11 seasons (2002-2003 to 2012-2013) were obtained from injury reports, press releases, and player profiles (www.nba.com and www.basketballreference.com). Player age, body mass index (BMI), position, shooting hand, number of years in the league, and treatment (surgical vs nonsurgical) were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury, including player efficiency rating (PER), were obtained. Thirty-two controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. Results: Mean age at the time of injury was 27 years with an average player BMI of 24. Players had a mean 5.6 seasons of NBA experience prior to injury. There was no significant change in PER when preinjury and postinjury performances were compared. Neither injury to their shooting hand nor operative management of the fracture led to a decrease in performance during the 2 seasons after injury. When compared with matched controls, no significant decline in performance in PER the first season and second season after injury was found. Conclusion: NBA players sustaining metacarpal fractures can reasonably expect to return to their preinjury performance levels following appropriate treatment.

  7. Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes.

    Science.gov (United States)

    Vieira, C L; Coeli, C M; Pinheiro, R S; Brandão, E R; Camargo, K R; Aguiar, F P

    2012-06-01

    The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes. A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction. Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes. Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  8. Neurosurgeon academic impact is associated with clinical outcomes after clipping of ruptured intracranial aneurysms.

    Science.gov (United States)

    Alotaibi, Naif M; Ibrahim, George M; Wang, Justin; Guha, Daipayan; Mamdani, Muhammad; Schweizer, Tom A; Macdonald, R Loch

    2017-01-01

    Surgeon-dependent factors such as experience and volume are associated with patient outcomes. However, it is unknown whether a surgeon's research productivity could be related to outcomes. The main aim of this study is to investigate the association between the surgeon's academic productivity and clinical outcomes following neurosurgical clipping of ruptured aneurysms. We performed a post-hoc analysis of 3567 patients who underwent clipping of ruptured intracranial aneurysms in the randomized trials of tirilazad mesylate from 1990 to 1997. These trials included 162 centers and 156 surgeons from 21 countries. Primary and secondary outcomes were: Glasgow outcome scale score and mortality, respectively. Total publications, H-index, and graduate degrees were used as academic indicators for each surgeon. The association between outcomes and academic factors were assessed using a hierarchical logistic regression analysis, adjusting for patient covariates. Academic profiles were available for 147 surgeons, treating a total of 3307 patients. Most surgeons were from the USA (62, 42%), Canada (18, 12%), and Germany (15, 10%). On univariate analysis, the H-index correlated with better functional outcomes and lower mortality rates. In the multivariate model, patients under the care of surgeons with higher H-indices demonstrated improved neurological outcomes (p = 0.01) compared to surgeons with lower H-indices, without any significant difference in mortality. None of the other academic indicators were significantly associated with outcomes. Although prognostication following surgery for ruptured intracranial aneurysms primarily depends on clinical and radiological factors, the academic impact of the operating neurosurgeon may explain some heterogeneity in surgical outcomes.

  9. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals

    Directory of Open Access Journals (Sweden)

    Stephen Trzeciak MD, MPH

    2016-03-01

    Full Text Available Objective: In 2015, the Centers for Medicare and Medicaid Services (CMS released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. Methods: We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. Results: We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Conclusion: Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  10. Associations between nine family dinner frequency measures and child weight, dietary and psychosocial outcomes

    Science.gov (United States)

    Fulkerson, Jayne A.; Friend, Sarah E.; Neumark-Sztainer, Dianne

    2015-01-01

    Background Family meal frequency has been consistently and significantly associated with positive youth dietary and psychosocial outcomes but less consistently associated with weight outcomes. Family meal frequency measurement has varied widely and it is unclear how this variation may impact relationships with youth weight, dietary, and psychosocial outcomes. Objective This study assesses how five parent/caregiver-reported and four child-reported family dinner frequency measures correlate with each other and are associated with health-related outcomes. Design/Participants This secondary, cross-sectional analysis uses baseline, parent/caregiver (n=160) and 8–12 year old child (n=160) data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus trial (collected 2011–2012). Data were obtained from objective measurements, dietary recall interviews, and psychosocial surveys. Outcome measures Outcomes included child body mass index z-scores (BMIz), fruit, vegetable and sugar-sweetened beverage intake, dietary quality (Healthy Eating Index-2010 [HEI-2010]), family connectedness, and meal conversations. Statistical analyses performed Pearson correlations and general linear models were used to assess associations between family dinner frequency measures and outcomes. Results All family dinner frequency measures had comparable means and were correlated within and across parent/caregiver- and child-reporters (r=0.17–0.94, pdinner frequency measures were significantly associated with BMIz scores and 100% were significantly associated with fruit/vegetable intake and HEI-2010. In adjusted models, most significant associations with dietary and psychosocial outcomes remained but associations with child BMIz remained significant only for parent/caregiver- (β±SE= −0.07±0.03; pdinner frequency measures asking about ‘sitting and eating’ dinner. Conclusions In spite of phrasing variations in family dinner frequency measures (e.g., which family members

  11. Assessment of complete unilateral cleft lip and palate treatment outcome using EUROCRAN index and associated factors.

    Science.gov (United States)

    Arshad, Anas Imran; Alam, Mohammad Khursheed; Khamis, Mohd Fadhli

    2017-09-01

    Assessment of treatment outcome is the only non-invasive approach to identify the effects of cleft lip and palate repair and modify management accordingly. Here the aim is to assess the outcome of complete unilateral cleft lip and palate (CUCLP) patients using EUROCRAN index and to check whether there are any factors associated with the treatment outcome. It is a retrospective cross sectional study. Dental models were collected from archives of two cleft referral centers in Pakistan. Five blinded examiners scored 101 models twice at two week interval. The primary outcome was mean EUROCRAN scores based on dental arch relationships and palatal surface morphology. A mean(SD) score of 2.72 (0.76) and 2.20 (0.73) was determined based on dental arch relationships and palatal surface morphology, respectively. According to the final logistic regression model, modified Millard technique (cheiloplasty) and Veau-Wardill-Kilners' method (palatoplasty) had higher odds of producing unfavorable treatment outcome. Present study determined a fair and a fair to poor treatment outcome based on dental arch relationships and palatal surface morphology, respectively. Our study suggests a significant association between treatment outcome and primary surgical techniques for lip and palate. These findings could warrant a modification of management protocols to ensure improvement in future cleft outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Association between socioeconomic status, learned helplessness, and disease outcome in patients with inflammatory polyarthritis.

    Science.gov (United States)

    Camacho, E M; Verstappen, S M M; Symmons, D P M

    2012-08-01

    Independent investigations have shown that socioeconomic status (SES) and learned helplessness (LH) are associated with poor disease outcome in patients with rheumatoid arthritis (RA). Our aim was to investigate the cross-sectional relationship between SES, LH, and disease outcome in patients with recent-onset inflammatory polyarthritis (IP), the broader group of conditions of which RA is the major constituent. SES was measured using the Index of Multiple Deprivation 2007 for 553 patients consecutively recruited to the Norfolk Arthritis Register. Patients also completed the Rheumatology Attitudes Index, a measure of LH. SES and LH were investigated as predictors of disease outcome (functional disability [Health Assessment Questionnaire (HAQ)] and disease activity [Disease Activity Score in 28 joints]) in a regression analysis, adjusted for age, sex, and symptom duration. The role of LH in the relationship between SES and disease outcome was then investigated. Compared to patients of the highest SES, those of the lowest SES had a significantly worse outcome (median difference in HAQ score 0.42; 95% confidence interval [95% CI] 0.08, 0.75). Compared to patients with normal LH, patients with low LH had a significantly better outcome and patients with high LH had a significantly worse outcome (median difference in HAQ score 1.12; 95% CI 0.82, 1.41). There was a significant likelihood that LH mediated the association between SES and disease outcome (P = 0.04). LH is robustly associated with cross-sectional disease outcome in patients with IP, and appears to mediate the relationship between SES and disease outcome. As LH is potentially modifiable, these findings have potential clinical implications. Copyright © 2012 by the American College of Rheumatology.

  13. Association of HIV diversity and virologic outcomes in early antiretroviral treatment: HPTN 052.

    Directory of Open Access Journals (Sweden)

    Philip J Palumbo

    Full Text Available Higher HIV diversity has been associated with virologic outcomes in children on antiretroviral treatment (ART. We examined the association of HIV diversity with virologic outcomes in adults from the HPTN 052 trial who initiated ART at CD4 cell counts of 350-550 cells/mm3. A high resolution melting (HRM assay was used to analyze baseline (pre-treatment HIV diversity in six regions in the HIV genome (two in gag, one in pol, and three in env from 95 participants who failed ART. We analyzed the association of HIV diversity in each genomic region with baseline (pre-treatment factors and three clinical outcomes: time to virologic suppression after ART initiation, time to ART failure, and emergence of HIV drug resistance at ART failure. After correcting for multiple comparisons, we did not find any association of baseline HIV diversity with demographic, laboratory, or clinical characteristics. For the 18 analyses performed for clinical outcomes evaluated, there was only one significant association: higher baseline HIV diversity in one of the three HIV env regions was associated with longer time to ART failure (p = 0.008. The HRM diversity assay may be useful in future studies exploring the relationship between HIV diversity and clinical outcomes in individuals with HIV infection.

  14. Association of HIV diversity and virologic outcomes in early antiretroviral treatment: HPTN 052.

    Science.gov (United States)

    Palumbo, Philip J; Wilson, Ethan A; Piwowar-Manning, Estelle; McCauley, Marybeth; Gamble, Theresa; Kumwenda, Newton; Makhema, Joseph; Kumarasamy, Nagalingeswaran; Chariyalertsak, Suwat; Hakim, James G; Hosseinipour, Mina C; Melo, Marineide G; Godbole, Sheela V; Pilotto, Jose H; Grinsztejn, Beatriz; Panchia, Ravindre; Chen, Ying Q; Cohen, Myron S; Eshleman, Susan H; Fogel, Jessica M

    2017-01-01

    Higher HIV diversity has been associated with virologic outcomes in children on antiretroviral treatment (ART). We examined the association of HIV diversity with virologic outcomes in adults from the HPTN 052 trial who initiated ART at CD4 cell counts of 350-550 cells/mm3. A high resolution melting (HRM) assay was used to analyze baseline (pre-treatment) HIV diversity in six regions in the HIV genome (two in gag, one in pol, and three in env) from 95 participants who failed ART. We analyzed the association of HIV diversity in each genomic region with baseline (pre-treatment) factors and three clinical outcomes: time to virologic suppression after ART initiation, time to ART failure, and emergence of HIV drug resistance at ART failure. After correcting for multiple comparisons, we did not find any association of baseline HIV diversity with demographic, laboratory, or clinical characteristics. For the 18 analyses performed for clinical outcomes evaluated, there was only one significant association: higher baseline HIV diversity in one of the three HIV env regions was associated with longer time to ART failure (p = 0.008). The HRM diversity assay may be useful in future studies exploring the relationship between HIV diversity and clinical outcomes in individuals with HIV infection.

  15. Associations between HIV and schizophrenia and their effect on HIV treatment outcomes

    DEFF Research Database (Denmark)

    Helleberg, Marie; Pedersen, Marianne G; Pedersen, Carsten B

    2015-01-01

    BACKGROUND: Associations between HIV and schizophrenia in people with and without substance use disorders and the effect on timeliness of HIV diagnosis, antiretroviral therapy (ART), and treatment outcomes are poorly understood. We aimed to assess the association between HIV and schizophrenia and...

  16. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes

    DEFF Research Database (Denmark)

    Lawlor, Debbie A; Mortensen, Laust; Andersen, Anne-Marie Nybo

    2011-01-01

    The mechanisms underlying the association between maternal age (both young and older maternal age) and adverse perinatal outcomes are unclear. Methods We examined the association of maternal age at first birth with preterm birth (<37 weeks gestation) and small for gestational age (SGA) in a cohor...

  17. The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU.

    Science.gov (United States)

    Mahl, Sukhy; Lee, Shoo K; Baker, G Ross; Cronin, Catherine M G; Stevens, Bonnie; Ye, Xiang Y

    2015-01-01

    Studies of adult patient populations suggest that organizational culture is associated with quality improvement (QI) implementation, as well as patient outcomes. However, very little research on organizational culture has been performed in neonatal patient populations. This combined cross-sectional survey and retrospective cohort study assessed employee perceptions of organizational culture and QI implementation within 18 Canadian neonatal intensive care units. The associations between these data and neonatal outcomes in extremely preterm infants (born at culture and QI implementation varied according to occupation and age. Higher hierarchical culture was associated with increased survival without major morbidities (odds ratio, 1.04; 95% confidence interval, 1.01-1.06), as were higher QI implementation scores (odds ratio range, 1.20-1.36 by culture type). Our data suggest that organizational culture, particularly hierarchical culture, and level of QI implementation may play a role in neonatal outcomes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  18. Closing the achievement gap: the association of racial climate with achievement and behavioral outcomes.

    Science.gov (United States)

    Mattison, Erica; Aber, Mark S

    2007-09-01

    This study investigated the relationship between school racial climate and students' self-reports of academic and discipline outcomes, including whether racial climate mediated and/or moderated the relationship between race and outcomes. Using the Racial Climate Survey-High School Version (M. Aber et al., unpublished), data were gathered from African American (n = 382) and European American students (n = 1456) regarding their perceptions of racial climate. About 18% of the respondents were low-income and approximately 50% were male. Positive perceptions of the racial climate were associated with higher student achievement and fewer discipline problems. Further, race moderated the relationship between racial climate and both achievement and discipline outcomes. Finally, racial differences in students' grades and discipline outcomes were associated with differences in perceptions of racial climate. Results suggest careful attention should be given to the racial climate of secondary schools, particularly for adolescents who perceive schools as unfair.

  19. Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke.

    Science.gov (United States)

    Senda, Joe; Ito, Keiichi; Kotake, Tomomitsu; Kanamori, Masahiko; Kishimoto, Hideo; Kadono, Izumi; Suzuki, Yoshiro; Katsuno, Masahisa; Nishida, Yoshihiro; Ishiguro, Naoki; Sobue, Gen

    2016-01-01

    We investigated the factors influencing inpatient convalescent rehabilitation outcomes in patients with ischemic stroke, particularly severity of leukoaraiosis on magnetic resonance imaging. Participants included 520 patients with ischemic stroke (317 men and 203 women; mean age, 72.8±8.4 years) who were transferred from acute care hospitals for inpatient convalescent rehabilitation. Ischemic stroke subtypes included lacunar infarction (n=41), atherothrombosis (n=223), artery-to-artery embolism (n=67), cardiogenic embolism (n=97), undetermined embolism (n=76), and uncategorized ischemic stroke (n=16). Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on magnetic resonance imaging. Functional Independence Measure scores were assessed on admission and at discharge. Multiple regression analysis revealed that rehabilitation outcomes, measured as total Functional Independence Measure scores, were significantly associated with leukoaraiosis estimated by PVH grade. This association was observed after adjustment for factors such as severity, age, and poststroke history. In all patients, PVH grades were associated with Functional Independence Measure motor scores (Prehabilitation outcome in patients with ischemic stroke. Furthermore, the PVH grade was associated with motor function outcome, whereas the deep white matter hyperintensity grade correlated with cognitive function outcome, likely because the progression patterns and anatomic backgrounds of PVH and deep white matter hyperintensity differ according to ischemic stroke subtype. © 2015 American Heart Association, Inc.

  20. Population-based investigations to study the association of cardiovascular polymorphisms and adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Langhoff-Roos, Jens; Young, Bradford

    2007-01-01

    growth restriction, and placental abruption, requires rigorous epidemiological studies involving large cohorts of patients with sufficient numbers of the adverse pregnancy outcomes in question. Such is the case with the Denmark National Birth Cohort, which was initiated in 1996 and followed pregnant......Adverse pregnancy outcome refers to placenta-mediated complications that may share a common etiopathogenesis in some cases. Unraveling associations between prothrombotic genetic predispositions and these pregnancy disorders, namely recurrent fetal loss, stillbirth, severe preeclampsia, intrauterine...

  1. Population-based investigations to study the association of cardiovascular polymorphisms and adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Langhoff-Roos, Jens; Young, Bradford

    2007-01-01

    Adverse pregnancy outcome refers to placenta-mediated complications that may share a common etiopathogenesis in some cases. Unraveling associations between prothrombotic genetic predispositions and these pregnancy disorders, namely recurrent fetal loss, stillbirth, severe preeclampsia, intrauteri......-thrombotic and cardiovascular genetic polymorphisms. These studies are urgently needed to accurately assess the linkage between family history, presence of adverse pregnancy outcome, and long-term cardiovascular risk....

  2. SCIRehab uses practice-based evidence methodology to associate patient and treatment characteristics with outcomes.

    Science.gov (United States)

    Whiteneck, Gale G; Gassaway, Julie

    2013-04-01

    To describe the application of practice-based evidence (PBE) methodology to spinal cord injury (SCI) rehabilitation in the SCIRehab study, and to summarize associations of patient characteristics and treatment interventions to outcomes. Prospective observational study. Six SCI rehabilitation centers. Patients with traumatic SCI (N=1376) admitted for first rehabilitation. Not applicable. FIM and residence at discharge, and FIM, residence, Craig Handicap Assessment and Reporting Technique, work/school status, Patient Health Questionnaire-9, Diener Satisfaction with Life Scale, rehospitalization, and presence of pressure ulcers at 1 year postinjury. Patient demographic and injury characteristics explained significant variation in rehabilitation outcomes, particularly functional outcomes. Regression modeling also identified a large number of significant associations with outcomes when total time in each discipline was modeled and when models were developed for each discipline, examining time spent in the many specific interventions provided by each discipline. The application of PBE methodology in the SCIRehab study provided extensive information about the process of inpatient SCI rehabilitation. While patient demographic and injury characteristics explain substantial variation in rehabilitation outcomes, particularly functional outcomes, significant relations also were found between the type and quantity of treatment interventions delivered by each rehabilitation discipline and a broad range of outcomes. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Investigation of the pressure drop inside a rectangular channel with a built-in U-shaped tube bundle heat exchanger

    Directory of Open Access Journals (Sweden)

    Xi-yue Liu

    2017-01-01

    Full Text Available A simplified approach which utilizes an isotropic porous medium model has been widely adopted for modeling the flow through a compact heat exchanger. With respect to situations where the compact heat exchangers are partially installed inside a channel, such as the application of recuperators in an intercooled recuperative engine, the use of an isotropic porous medium model needs to be carefully assessed because the flow passing through the heat exchanger is very complicated. For this purpose, in this study the isotropic porous medium model is assessed together with specific pressure–velocity relationships for flow field modeling inside a rectangular channel with a built-in double-U-shaped tube bundle heat exchanger. Firstly, experiments were conducted using models to investigate the relationship between the pressure drop and the inlet velocity for a specific heat exchanger with different installation angles inside a rectangular channel. Secondly, a series of numerical computations were carried out using the isotropic porous medium model and the pressure–velocity relationship was then modified by introducing correction coefficients empirically. Finally, a three-dimensional (3-D direct computation was made using a computational fluid dynamics (CFD method for the comparison of detailed flow fields. The results suggest that the isotropic porous medium model is capable of making precise pressure drop predictions given the reasonable pressure–velocity relationship but is unable to precisely simulate the detailed flow features.

  4. Determination of Fe, Hg, Mn, and Pb in three-rings of poplar (Populus alba L.) by U-shaped DC arc

    Science.gov (United States)

    Marković, D. M.; Novović, I.; Vilotić, D.; Ignjatović, Lj.

    2007-09-01

    The U-shaped DC arc with aerosol supply was applied for the determination of Fe, Hg, Mn, and Pb in poplar (Populus alba L.) tree-rings. By optimization of the operating parameters and by selection of the most appropriate signal integration time (20 s for Fe, Mn, and Pb and 30 s for Hg), the obtained limits of detection for Fe, Hg, Mn, and Pb are 5.8, 2.6, 1.6, and 2.0 ng/ml, respectively. The detection limits achieved by this method for Fe, Hg, Mn, and Pb are comparable with the detection limits obtained for these elements by such methods as inductively coupled plasma-atomic emission spectrometry (ICP-AES), direct coupled plasmatomic emission spectrometry (DCP-AES), and microwave-induced plasma-atomic emission spectrometry (MIP-AES). We used the tree-rings of poplar from two different locations. The first one is in the area close to the power plant “Nikola Tesla” TENT A, Obrenovac, while the other one is in the urban area of Novi Sad. In almost all cases, samples from the location at Obrenovac registered elevated average concentrations of Fe, Hg, Mn, and Pb in the tree-rings of poplar.

  5. Biostatistical approaches for modeling U-shaped dose-response curves and study design considerations in assessing the biological effects of low doses

    International Nuclear Information System (INIS)

    Downs, T.

    1992-01-01

    The demonstration of hormetic effects is rendered difficult for a number of reasons: The spontaneous rate must be large enough for a difference to be detectable. In contrast with detrimental effects, there is a limited range of doses over which beneficial effects are likely to be found. Publication bias hampers publication of low-dose beneficial effects and discourages research in the area. Some scientists actually believe that hormetic effects are contary to reason. All these factors contribute to lessen the chances of detecting hormetic effects through synthesis of the scientific literature. The extra statistical power obtained from mathematical modeling is not available for hormetic studies when appropriate models are not available. Even a simple statistical device such as a test for linear trend does not work well for U-shaped data. The first part of this two-part chapter deals with the probabilities of determining qualitatively what kinds of health effects may result from exposures to substances, and the second part with characterizing quantitative relationships between such health effects and exposures. The health effects may be beneficial in some situations, and detrimental in others

  6. A high performance Ge/Si0.5Ge0.5/Si heterojunction dual sources tunneling transistor with a U-shaped channel

    Science.gov (United States)

    Li, Wei; Liu, Hongxia; Wang, Shulong; Wang, Qianqiong; Chen, Shupeng

    2017-06-01

    In this paper, a new Ge/Si0.5Ge0.5/Si heterojunction dual sources tunneling transistor with a U-shaped channel (Ge_DUTFET) is proposed and investigated by Silvaco-Atlas simulation. The line tunneling perpendicular to channel and point tunneling parallel to channel simultaneously occur on both sides of the gate. The Ge is chosen as the source region material to increase the line tunneling current. The designed heterojunction between the Ge source and Si channel decreases the point tunneling barrier width to enhance the point tunneling current. And this heterojunction can also promote the Ge_DUTFET to occur point tunneling at the small gate voltage, which makes it obtain the smaller turn-on voltage. Furthermore, the Si0.5Ge0.5 buffer layer is also helpful for the enhancement of performance. The simulation results reveal that Ge_DUTFET has the better performance compared with the Si_DUTFET. The on-state current and average subthreshold swing of Ge_DUTFET are 1.11 × 10-5A/μm and 35.1mV/dec respectively. The max cut-off frequency (fT) and gain bandwidth product (GBW) are 26.6 GHz and 16.6 GHz respectively. The fT and GBW of the Ge_DUTFET are respectively increased by ∼27.4% and ∼84.3% compared with the Si_DUTFET.

  7. Position of the American Dietetic Association and American Society for Nutrition: obesity, reproduction, and pregnancy outcomes.

    Science.gov (United States)

    Siega-Riz, Anna Maria; King, Janet C

    2009-05-01

    Given the detrimental influence of maternal overweight and obesity on reproductive and pregnancy outcomes for the mother and child, it is the position of the American Dietetic Association and the American Society for Nutrition that all overweight and obese women of reproductive age should receive counseling on the roles of diet and physical activity in reproductive health prior to pregnancy,during pregnancy, and in the inter conceptional period, in order to ameliorate these adverse outcomes. The effect of maternal nutritional status prior to pregnancy on reproduction and pregnancy outcomes is of great public health importance. Obesity in the United States and worldwide has grown to epidemic proportions, with an estimated 33% of US women classified as obese. This position paper has two objectives: (a) to help nutrition professionals become aware of the risks and possible complications of overweight and obesity for fertility,the course of pregnancy, birth outcomes, and short- and long-term maternal and child health outcomes;and (b) related to the commitment to research by the American Dietetic Association and the American Society for Nutrition, to identify the gaps in research to improve our knowledge of the risks and complications associated with being overweight and obese before and during pregnancy.Only with an increased knowledge of these risks and complications can health care professionals develop effective strategies that can be implemented before and during pregnancy as well as during the inter conceptional period to ameliorate adverse outcomes.

  8. High glucose variability is associated with poor neurodevelopmental outcomes in neonatal hypoxic ischemic encephalopathy.

    Science.gov (United States)

    Al Shafouri, N; Narvey, M; Srinivasan, G; Vallance, J; Hansen, G

    2015-01-01

    In neonatal hypoxic ischemic encephalopathy (HIE), hypo- and hyperglycemia have been associated with poor outcomes. However, glucose variability has not been reported in this population. To examine the association between serum glucose variability within the first 24 hours and two-year neurodevelopmental outcomes in neonates cooled for HIE. In this retrospective cohort study, glucose, clinical and demographic data were documented from 23 term newborns treated with whole body therapeutic hypothermia. Severe neurodevelopmental outcomes from planned two-year assessments were defined as the presence of any one of the following: Gross Motor Function Classification System levels 3 to 5, Bayley III Motor Standard Score neurodevelopmental outcomes from 8 of 23 patients were considered severe, and this group demonstrated a significant increase of mean absolute glucose (MAG) change (-0.28 to -0.03, 95% CI, p = 0.032). There were no significant differences between outcome groups with regards to number of patients with hyperglycemic means, one or multiple hypo- or hyperglycemic measurement(s). There were also no differences between both groups with mean glucose, although mean glucose standard deviation was approaching significance. Poor neurodevelopmental outcomes in whole body cooled HIE neonates are significantly associated with MAG changes. This information may be relevant for prognostication and potential management strategies.

  9. Association between in vitro susceptibility to natamycin and voriconazole and clinical outcomes in fungal keratitis.

    Science.gov (United States)

    Sun, Catherine Q; Lalitha, Prajna; Prajna, N Venkatesh; Karpagam, Rajarathinam; Geetha, Manoharan; O'Brien, Kieran S; Oldenburg, Catherine E; Ray, Kathryn J; McLeod, Stephen D; Acharya, Nisha R; Lietman, Thomas M

    2014-08-01

    To assess the association between minimum inhibitory concentration (MIC) and clinical outcomes in a fungal keratitis clinical trial. Experimental study using data from a randomized comparative trial. Of the 323 patients enrolled in the trial, we were able to obtain MIC values from 221 patients with monocular fungal keratitis. The Mycotic Ulcer Treatment Trial I was a randomized, double-masked clinical trial comparing clinical outcomes of monotherapy with topical natamycin versus voriconazole for the treatment of fungal keratitis. Speciation and determination of MIC to natamycin and voriconazole were performed according to Clinical and Laboratory Standards Institute guidelines. The relationship between MIC and clinical outcome was assessed. The primary outcome was 3-month best spectacle-corrected visual acuity. Secondary outcomes included 3-month infiltrate or scar size; corneal perforation and/or therapeutic penetrating keratoplasty; and time to re-epithelialization. A 2-fold increase in MIC was associated with a larger 3-month infiltrate or scar size (0.21 mm; 95% confidence interval [CI], 0.10-0.31; P < 0.001) and increased odds of perforation (odds ratio, 1.32; 95% CI, 1.04-1.69; P = 0.02). No correlation was found between MIC and 3-month visual acuity. For natamycin-treated cases, an association was found between higher natamycin MIC with larger 3-month infiltrate or scar size (0.29 mm; 95% CI, 0.15-0.43; P < 0.001) and increased perforations (odds ratio, 2.41; 95% CI, 1.46-3.97; P < 0.001). Among voriconazole-treated cases, the voriconazole MIC did not correlate with any of the measured outcomes in the study. Decreased susceptibility to natamycin was associated with increased infiltrate or scar size and increased odds of perforation. There was no association between susceptibility to voriconazole and outcome. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  10. Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review.

    Science.gov (United States)

    Wang, Jingyi; Mann, Farhana; Lloyd-Evans, Brynmor; Ma, Ruimin; Johnson, Sonia

    2018-05-29

    The adverse effects of loneliness and of poor perceived social support on physical health and mortality are established, but no systematic synthesis is available of their relationship with the outcomes of mental health problems over time. In this systematic review, we aim to examine the evidence on whether loneliness and closely related concepts predict poor outcomes among adults with mental health problems. We searched six databases and reference lists for longitudinal quantitative studies that examined the relationship between baseline measures of loneliness and poor perceived social support and outcomes at follow up. Thirty-four eligible papers were retrieved. Due to heterogeneity among included studies in clinical populations, predictor measures and outcomes, a narrative synthesis was conducted. We found substantial evidence from prospective studies that people with depression who perceive their social support as poorer have worse outcomes in terms of symptoms, recovery and social functioning. Loneliness has been investigated much less than perceived social support, but there is some evidence that greater loneliness predicts poorer depression outcome. There is also some preliminary evidence of associations between perceived social support and outcomes in schizophrenia, bipolar disorder and anxiety disorders. Loneliness and quality of social support in depression are potential targets for development and testing of interventions, while for other conditions further evidence is needed regarding relationships with outcomes.

  11. The association between expressive grammar intervention and social and emergent literacy outcomes for preschoolers with SLI.

    Science.gov (United States)

    Washington, Karla N

    2013-02-01

    To determine whether (a) expressive grammar intervention facilitated social and emergent literacy outcomes better than no intervention and (b) expressive grammar gains and/or initial expressive grammar level predicted social and emergent literacy outcomes. This investigation was a follow-up to a recently published study exploring the impact of grammatical language intervention on expressive grammar outcomes for preschoolers with specific language impairment (SLI). Twenty-two 3- to 5-year-old preschoolers received ten 20-minute intervention sessions addressing primary deficits in grammatical morphology. Participants' social and emergent literacy skills were not targeted. Twelve children awaiting intervention, chosen from the same selection pool as intervention participants, served as controls. Blind assessments of social and emergent literacy outcomes were completed at preintervention, immediately postintervention, and 3 months postintervention. Only intervention participants experienced significant gains in social and emergent literacy outcomes and maintained these gains for 3 months postintervention. Expressive grammar gains was the only single significant predictor of these outcomes. Expressive grammar intervention was associated with broad impacts on social and emergent literacy outcomes that were maintained beyond the intervention period. Gains in expressive grammar predicted these outcomes. Social and emergent literacy skills were positively affected for preschoolers with SLI during a grammatical language intervention program.

  12. Instagram Unfiltered: Exploring Associations of Body Image Satisfaction, Instagram #Selfie Posting, and Negative Romantic Relationship Outcomes.

    Science.gov (United States)

    Ridgway, Jessica L; Clayton, Russell B

    2016-01-01

    The purpose of this study was to examine the predictors and consequences associated with Instagram selfie posting. Thus, this study explored whether body image satisfaction predicts Instagram selfie posting and whether Instagram selfie posting is then associated with Instagram-related conflict and negative romantic relationship outcomes. A total of 420 Instagram users aged 18 to 62 years (M = 29.3, SD = 8.12) completed an online survey questionnaire. Analysis of a serial multiple mediator model using bootstrapping methods indicated that body image satisfaction was sequentially associated with increased Instagram selfie posting and Instagram-related conflict, which related to increased negative romantic relationship outcomes. These findings suggest that when Instagram users promote their body image satisfaction in the form of Instagram selfie posts, risk of Instagram-related conflict and negative romantic relationship outcomes might ensue. Findings from the current study provide a baseline understanding to potential and timely trends regarding Instagram selfie posting.

  13. Single Nucleotide Polymorphisms Associated with Reading Ability Show Connection to Socio-Economic Outcomes.

    Science.gov (United States)

    Luciano, Michelle; Hagenaars, Saskia P; Cox, Simon R; Hill, William David; Davies, Gail; Harris, Sarah E; Deary, Ian J; Evans, David M; Martin, Nicholas G; Wright, Margaret J; Bates, Timothy C

    2017-09-01

    Impairments in reading and in language have negative consequences on life outcomes, but it is not known to what extent genetic effects influence this association. We constructed polygenic scores for difficulties with language and learning to read from genome-wide data in ~6,600 children, adolescents and young adults, and tested their association with health, socioeconomic outcomes and brain structure measures collected in adults (maximal N = 111,749). Polygenic risk of reading difficulties was associated with reduced income, educational attainment, self-rated health and verbal-numerical reasoning (p intelligence) and 0.70 (educational attainment) with reading ability. Mendelian randomization approaches will be important to dissociate any causal and moderating effects of reading and related traits on social outcomes.

  14. Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients.

    Science.gov (United States)

    Leung, John S L; Seto, Alfred; Li, George K H

    2017-04-01

    Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.

  15. Impact of previous ART and of ART initiation on outcome of HIV-associated tuberculosis.

    Science.gov (United States)

    Girardi, Enrico; Palmieri, Fabrizio; Angeletti, Claudio; Vanacore, Paola; Matteelli, Alberto; Gori, Andrea; Carbonara, Sergio; Ippolito, Giuseppe

    2012-01-01

    Combination antiretroviral therapy (cART) has progressively decreased mortality of HIV-associated tuberculosis .To date, however, limited data on tuberculosis treatment outcomes among coinfected patients who are not ART-naive at the time of tuberculosis diagnosis are available. A multicenter, observational study enrolled 246 HIV-infected patients diagnosed with tuberculosis, in 96 Italian infectious diseases hospital units, who started tuberculosis treatment. A polytomous logistic regression model was used to identify baseline factors associated with the outcome. A Poisson regression model was used to explain the effect of ART during tuberculosis treatment on mortality, as a time-varying covariate, adjusting for baseline characteristics. Outcomes of tuberculosis treatment were as follows: 130 (52.8%) were successfully treated, 36 (14.6%) patients died in a median time of 2 months (range: 0-16), and 80 (32.6%) had an unsuccessful outcome. Being foreign born or injecting drug users was associated with unsuccessful outcomes. In multivariable Poisson regression, cART during tuberculosis treatment decreased the risk of death, while this risk increased for those who were not ART-naive at tuberculosis diagnosis. ART during tuberculosis treatment is associated with a substantial reduction of death rate among HIV-infected patients. However, patients who are not ART-naive when they develop tuberculosis remain at elevated risk of death.

  16. Association between breakfast consumption and educational outcomes in 9-11-year-old children.

    Science.gov (United States)

    Littlecott, Hannah J; Moore, Graham F; Moore, Laurence; Lyons, Ronan A; Murphy, Simon

    2016-06-01

    Breakfast consumption has been consistently associated with health outcomes and cognitive functioning in schoolchildren. Evidence of direct links with educational outcomes remains equivocal. We aimed to examine the link between breakfast consumption in 9-11-year-old children and educational outcomes obtained 6-18 months later. Data on individual-level free school meal entitlement and educational outcomes (Statutory Assessment Tests (SATs) at Key Stage 2) were obtained via the SAIL databank and linked to earlier data collected on breakfast consumption. Multilevel modelling assessed associations between breakfast consumption and SATs. Trial of the Primary School Free Breakfast Initiative in Wales. Year 5 and 6 students, n 3093 (baseline) and n 3055 (follow-up). Significant associations were found between all dietary behaviours and better performance in SATs, adjusted for gender and individual- and school-level free school meal entitlement (OR=1·95; CI 1·58, 2·40 for breakfast, OR=1·08; CI 1·04, 1·13 for healthy breakfast items). No association was observed between number of unhealthy breakfast items consumed and educational performance. Association of breakfast consumption with educational performance was stronger where the measure of breakfast consumption was more proximal to SATs tests (OR=2·02 measured 6 months prior to SATs, OR=1·61 measured 18 months prior). Significant positive associations between self-reported breakfast consumption and educational outcomes were observed. Future research should aim to explore the mechanisms by which breakfast consumption and educational outcomes are linked, and understand how to promote breakfast consumption among schoolchildren. Communicating findings of educational benefits to schools may help to enhance buy-in to efforts to improve health behaviours of pupils.

  17. Outcome of Fetal Omphalocele According to Omphalocele Content Combined with Associated Anomaly

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Sung Il; Cho, Jeong Yeon; Ryu, Jung Kyu [SungKyunKwan University College of Medicine Samsung Cheil Hospital, Seoul (Korea, Republic of)

    2005-06-15

    To evaluate the risk of chromosomal abnormality and outcome of fetal omphalocele according to the omphalocele contents combined with associated anomalies. We retrospectively reviewed the sonograms and case records of 39 fetuses with an omphalocele prenatally detected by ultrasound between 1996 and 2004. We categorized them into two groups according to the omphalocele contents, and the two groups were further subdivided according to the presence or absence of associated anomalies on the prenatal ultrasound. We compared the risk of chromosomal abnormality and fetal outcome according to the omphalocele contents combined with associated anomalies. We categorized the 39 fetuses with an omphalocele into 20 cases with a liver- and bowel containing (group I) omphalocele and 19 cases with a bowel-only (group II) omphalocele. Seven of 20 (35%) fetuses with group I omphalocele and 17 of 19 (89%) with group II omphalocele had associated anomalies. Fetal karyotyping was performed in 31 of the 39 fetuses: in group II omphalocele, 13 of the 14 tested fetuses (93%) had chromosomal abnormalities, while in group I omphalocele, one of the 17 tested fetuses (6%) had chromosomal abnormalities. All 13 group II omphalocele with associated anomaly showed abnormal karyotype. Fourteen of 39 (36%) fetuses survived, including 13 fetuses with group I omphalocele (13/20, 65%) and one with group II omphalocele (1/19, 5%). Eleven of 13 (85%) fetuses with isolated group I omphalocele showed good outcome, while no group II omphalocele with associated anomaly survived. The bowel-only omphalocele with associated anomalies suggests a very high risk of chromosomal abnormality and a poor outcome. The isolated liver- and bowel-containing omphalocele has a good outcome with a low risk of chromosomal abnormality. Sonographic evaluation of the omphalocele contents and associated anomalies is essential to predict the prognosis of the fetal omphalocele

  18. Outcome of Fetal Omphalocele According to Omphalocele Content Combined with Associated Anomaly

    International Nuclear Information System (INIS)

    Jung, Sung Il; Cho, Jeong Yeon; Ryu, Jung Kyu

    2005-01-01

    To evaluate the risk of chromosomal abnormality and outcome of fetal omphalocele according to the omphalocele contents combined with associated anomalies. We retrospectively reviewed the sonograms and case records of 39 fetuses with an omphalocele prenatally detected by ultrasound between 1996 and 2004. We categorized them into two groups according to the omphalocele contents, and the two groups were further subdivided according to the presence or absence of associated anomalies on the prenatal ultrasound. We compared the risk of chromosomal abnormality and fetal outcome according to the omphalocele contents combined with associated anomalies. We categorized the 39 fetuses with an omphalocele into 20 cases with a liver- and bowel containing (group I) omphalocele and 19 cases with a bowel-only (group II) omphalocele. Seven of 20 (35%) fetuses with group I omphalocele and 17 of 19 (89%) with group II omphalocele had associated anomalies. Fetal karyotyping was performed in 31 of the 39 fetuses: in group II omphalocele, 13 of the 14 tested fetuses (93%) had chromosomal abnormalities, while in group I omphalocele, one of the 17 tested fetuses (6%) had chromosomal abnormalities. All 13 group II omphalocele with associated anomaly showed abnormal karyotype. Fourteen of 39 (36%) fetuses survived, including 13 fetuses with group I omphalocele (13/20, 65%) and one with group II omphalocele (1/19, 5%). Eleven of 13 (85%) fetuses with isolated group I omphalocele showed good outcome, while no group II omphalocele with associated anomaly survived. The bowel-only omphalocele with associated anomalies suggests a very high risk of chromosomal abnormality and a poor outcome. The isolated liver- and bowel-containing omphalocele has a good outcome with a low risk of chromosomal abnormality. Sonographic evaluation of the omphalocele contents and associated anomalies is essential to predict the prognosis of the fetal omphalocele

  19. Association between organisational and workplace cultures, and patient outcomes: systematic review.

    Science.gov (United States)

    Braithwaite, Jeffrey; Herkes, Jessica; Ludlow, Kristiana; Testa, Luke; Lamprell, Gina

    2017-11-08

    Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes. A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts. The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review. Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience. The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction. Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare

  20. Testing the association between psychosocial job strain and adverse birth outcomes--design and methods

    DEFF Research Database (Denmark)

    Larsen, Ann D; Hannerz, Harald; Obel, Carsten

    2011-01-01

    A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the r......A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated...... with the risk of giving birth to a child born preterm or small for gestational age....

  1. Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes.

    Science.gov (United States)

    Timko, Christine; Valenstein, Helen; Stuart, Gregory L; Moos, Rudolf H

    2015-11-01

    The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes. © 2014 John Wiley & Sons Ltd.

  2. Muscle Mass Depletion Associated with Poor Outcome of Sepsis in the Emergency Department.

    Science.gov (United States)

    Lee, YoonJe; Park, Hyun Kyung; Kim, Won Young; Kim, Myung Chun; Jung, Woong; Ko, Byuk Sung

    2018-05-08

    Muscle mass depletion has been suggested to predict morbidity and mortality in various diseases. However, it is not well known whether muscle mass depletion is associated with poor outcome in sepsis. We hypothesized that muscle mass depletion is associated with poor outcome in sepsis. Retrospective observational study was conducted in an emergency department during a 9-year period. Medical records of 627 patients with sepsis were reviewed. We divided the patients into 2 groups according to 28-day mortality and compared the presence of muscle mass depletion assessed by the cross-sectional area of the psoas muscle at the level of the third lumbar vertebra on abdomen CT scans. Univariate and multivariate logistic regression analyses were conducted to examine the association of scarcopenia on the outcome of sepsis. A total of 274 patients with sepsis were finally included in the study: 45 (16.4%) did not survive on 28 days and 77 patients (28.1%) were identified as having muscle mass depletion. The presence of muscle mass depletion was independently associated with 28-day mortality on multivariate logistic analysis (OR 2.79; 95% CI 1.35-5.74, p = 0.01). Muscle mass depletion evaluated by CT scan was associated with poor outcome of sepsis patients. Further studies on the appropriateness of specific treatment for muscle mass depletion with sepsis are needed. © 2018 S. Karger AG, Basel.

  3. Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65.

    Science.gov (United States)

    Uray, Thomas; Mayr, Florian B; Fitzgibbon, James; Rittenberger, Jon C; Callaway, Clifton W; Drabek, Tomas; Fabio, Anthony; Angus, Derek C; Kochanek, Patrick M; Dezfulian, Cameron

    2015-08-01

    In a prior study of seven North American cities Pittsburgh had the highest crude rate of cardiac arrest deaths in patients 18 to 64 years of age, particularly in neighborhoods with lower socioeconomic status (SES). We hypothesized that lower SES, associated poor health behaviors (e.g., illicit drug use) and pre-existing comorbid conditions (grouped as socioeconomic factors [SE factors]) could affect the type and severity of cardiac arrest, thus outcomes. We retrospectively identified patients aged 18 to 64 years treated for in-hospital (IHCA) and out-of hospital arrest (OHCA) at two Pittsburgh hospitals between January 2010 and July 2012. We abstracted data on baseline demographics and arrest characteristics like place of residence, insurance and employment status. Favorable cerebral performance category [CPC] (1 or 2) was our primary outcome. We examined the associations between SE factors, cardiac arrest variables and outcome as well as post-resuscitation care. Among 415 subjects who met inclusion criteria, unfavorable CPC were more common in patients who were unemployed, had a history of drug abuse or hypertension. In OHCA, favorable CPC was more often associated with presentation with ventricular fibrillation/tachycardia (OR 3.53, 95% CI 1.43-8.74, p = 0.006) and less often associated with non-cardiovascular arrest etiology (OR 0.22, 95% CI 0.08-0.62, p = 0.004). We found strong associations between specific SE factors and arrest factors associated with outcome in OHCA patients only. Significant differences in post-resuscitation care existed based on injury severity, not on SES. SE factors strongly influence type and severity of OHCA but not IHCA resulting in an association with outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Specific Infectious Organisms Associated With Poor Outcomes in Treatment for Hip Periprosthetic Infection.

    Science.gov (United States)

    Cunningham, Daniel J; Kavolus, Joseph J; Bolognesi, Michael P; Wellman, Samuel S; Seyler, Thorsten M

    2017-06-01

    Periprosthetic hip infection treatment remains a significant challenge for orthopedics. Some studies have suggested that methicillin resistance and gram-negative organism type are associated with increased treatment failure. The aim of this research is to determine if specific organisms were associated with poor outcomes in treatment for hip periprosthetic infection. Records were reviewed of all patients between 2005 and 2015 who underwent treatment for infected partial or total hip arthroplasty. Characteristics of each patient's treatment course were determined including baseline characteristics, infecting organism(s), infection status at final follow-up, surgeries for infection, and time in hospital. Baseline characteristics and organisms that were associated with clinical outcomes in univariate analysis were incorporated into multivariable outcomes models. When compared with patients infected with other organism(s), patients infected with the following organisms had significantly decreased infection-free rates: Pseudomonas, methicillin-resistant Staphylococcus aureus (MRSA), and Proteus. Infection with certain organisms was associated with 1.13-2.58 additional surgeries: methicillin-sensitive S aureus, coagulase-negative Staphylococcus, MRSA, Pseudomonas, Peptostreptococcus, Klebsiella, Candida, diphtheroids, Propionibacterium acnes, and Proteus species. Specific organisms were associated with 8.56-24.54 additional days in hospital for infection: methicillin-sensitive S aureus, coagulase-negative Staphylococcus, Proteus, MRSA, Enterococcus, Pseudomonas, Klebsiella, beta-hemolytic Streptococcus, and diphtheroids. Higher comorbidity score was also associated with greater length of hospitalization. MRSA, Pseudomonas, and Proteus were associated with all 3 outcomes of lower infection-free rate, more surgery, and more time in hospital in treatment for hip periprosthetic infection. Organism-specific outcome information may help individualize patient

  5. Duration of Agitation, Fluctuations of Consciousness, and Associations with Outcome in Patients with Subarachnoid Hemorrhage.

    Science.gov (United States)

    Reznik, Michael E; Mahta, Ali; Schmidt, J Michael; Frey, Hans-Peter; Park, Soojin; Roh, David J; Agarwal, Sachin; Claassen, Jan

    2018-01-08

    Agitation is common after subarachnoid hemorrhage (SAH) and may be independently associated with outcomes. We sought to determine whether the duration of agitation and fluctuating consciousness were also associated with outcomes in patients with SAH. We identified all patients with positive Richmond Agitation Sedation Scale (RASS) scores from a prospective observational cohort of patients with SAH from 2011 to 2015. Total duration of agitation was extrapolated for each patient using available RASS scores, and 24-h mean and standard deviation (SD) of RASS scores were calculated for each patient. We also calculated each patient's duration of substantial fluctuation of consciousness, defined as the number of days with 24-h RASS SD > 1. Patients were stratified by 3-month outcome using the modified Rankin scale, and associations with outcome were assessed via logistic regression. There were 98 patients with at least one positive RASS score, with median total duration of agitation 8 h (interquartile range [IQR] 4-18), and median duration of substantially fluctuating consciousness 2 days (IQR 1-3). Unfavorable 3-month outcome was significantly associated with a longer duration of fluctuating consciousness (odds ratio [OR] per day, 1.51; 95% confidence interval [CI], 1.04-2.20; p = 0.031), but a briefer duration of agitation (OR per hour, 0.94; 95% CI, 0.89-0.99; p = 0.031). Though a longer duration of fluctuating consciousness was associated with worse outcomes in our cohort, total duration of agitation was not, and may have had the opposite effect. Our findings should therefore challenge the intensity with which agitation is often treated in SAH patients.

  6. Parents' childhood socioeconomic circumstances are associated with their children's asthma outcomes.

    Science.gov (United States)

    Chen, Edith; Shalowitz, Madeleine U; Story, Rachel E; Ehrlich, Katherine B; Manczak, Erika M; Ham, Paula J; Le, Van; Miller, Gregory E

    2017-09-01

    Previous literature documents associations between low socioeconomic status (SES) and poor health outcomes, including asthma. However, this literature has largely focused on the effects of current family circumstances. We sought to test an intergenerational hypothesis, that the childhood SES that parents experience will be associated with asthma outcomes in their children, independent of effects of current family SES. Second, we aimed to test whether this association is in part due to difficulties in current parent-child relationships. This was an observational study, whereby 150 parents were interviewed about their childhood SES and their children (physician-diagnosed asthma, ages 9-17 years) were interviewed about current family stress. Asthma control was assessed by parent report and child report (primary outcome), and blood was collected from children to measure cytokine production relevant to asthma (secondary outcomes). To the degree that parents had lower childhood SES, their offspring showed worse asthma outcomes across multiple indicators. This included lower asthma control scores (parent and child report, Ps childhood SES had current family relationships that were more stressful, and these difficulties, in turn, related to worse asthma control and greater cytokine production in children. These results suggest the potential "long reach" of low SES across generations, and the importance of expanding theories of how the social environment can affect childhood asthma to include characteristics of earlier generations. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. Association of baseline vitamin D levels with clinical parameters and treatment outcomes in chronic hepatitis B.

    Science.gov (United States)

    Chan, Henry Lik-Yuen; Elkhashab, Magdy; Trinh, Huy; Tak, Won Young; Ma, Xiaoli; Chuang, Wan-Long; Kim, Yoon Jun; Martins, Eduardo B; Lin, Lanjia; Dinh, Phillip; Charuworn, Prista; Foster, Graham R; Marcellin, Patrick

    2015-11-01

    The relationship between vitamin D levels and chronic hepatitis B (CHB) infection and treatment outcomes are poorly elucidated. We measured pre-treatment serum vitamin D (25-hydroxyvitamin D3; 25[OH]D3) levels and determined their association with clinical parameters and treatment outcomes in active CHB patients without advanced liver disease enrolled in a global clinical trial. Patients were randomly assigned to either 48 weeks of tenofovir disoproxil fumarate (TDF) plus peginterferon alfa-2a (PegIFN), TDF plus PegIFN for 16 weeks followed by TDF for 32 weeks, PegIFN for 48 weeks, or TDF for 120 weeks. Univariate and multivariate analyses were conducted to determine associations between vitamin D, baseline factors, and week 48 clinical outcome. Of 737 patients, 35% had insufficient (⩾20 but vitamin D levels. In univariate analysis, lower vitamin D levels were significantly associated with the following baseline parameters: younger age, lower uric acid levels, HBeAg-positive status, lower calcium levels, blood draw in winter or autumn, and HBV genotype D. On multivariate analysis, only HBV genotype, season of blood draw, calcium level, and age retained their association. High baseline level of vitamin D was associated with low HBV DNA, normal ALT and HBsAg at week 48 independent of treatment groups, but the association, with the exception of ALT, became statistically insignificant after adjusting for age, gender, HBeAg and HBV genotype. Abnormally low vitamin D levels are highly prevalent among untreated, active CHB patients. Baseline vitamin D levels are not associated with treatment outcomes, but were associated with normal ALT. Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  8. Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Hyemi Kwon

    2015-09-01

    Full Text Available BackgroundObesity is associated with aggressive pathological features and poor clinical outcomes in breast and prostate cancers. In papillary thyroid carcinoma (PTC, these relationships remain still controversial. This study aimed to evaluate the associations between body mass index (BMI and the clinical outcomes of patients with PTC.MethodsThis retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size. Clinical outcomes were evaluated and compared based on the BMI quartiles.ResultsThere were no significant associations between BMI quartiles and primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, or distant metastasis. However, an increase in mean age was associated with an increased BMI (P for trend <0.001. Multifocality and advanced tumor-node-metastasis (TNM stage (stage III or IV were significantly associated with increases of BMI (P for trend 0.02 and <0.001, respectively. However, these associations of multifocality and advanced TNM stage with BMI were not significant in multivariate analyses adjusted for age and gender. Moreover, there were no differences in recurrence-free survivals according to BMI quartiles (P=0.26.ConclusionIn the present study, BMI was not associated with the aggressive clinicopathological features or recurrence-free survivals in patients with PTC.

  9. Cultural effects on the association between election outcomes and face-based trait inferences.

    Directory of Open Access Journals (Sweden)

    Chujun Lin

    Full Text Available How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants' inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the

  10. Cultural effects on the association between election outcomes and face-based trait inferences.

    Science.gov (United States)

    Lin, Chujun; Adolphs, Ralph; Alvarez, R Michael

    2017-01-01

    How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants' inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of

  11. Cultural effects on the association between election outcomes and face-based trait inferences

    Science.gov (United States)

    Adolphs, Ralph; Alvarez, R. Michael

    2017-01-01

    How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants’ inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of

  12. Changes in Patient and Nurse Outcomes Associated with Magnet Hospital Recognition

    Science.gov (United States)

    Kutney-Lee, Ann; Stimpfel, Amy Witkoski; Sloane, Douglas M.; Cimiotti, Jeannie P.; Quinn, Lisa W.; Aiken, Linda H.

    2015-01-01

    Background Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes. Objective To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet. Research Design Retrospective, two-stage panel design using four secondary data sources. Subjects 136 Pennsylvania hospitals (11 “emerging” Magnets and 125 non-Magnets) Measures American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index Methods Fixed effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet. Results Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (pMagnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes. Conclusions In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals. PMID:25906016

  13. The association between interpersonal problems and treatment outcome in the eating disorders: A systematic review.

    Science.gov (United States)

    Jones, Allan; Lindekilde, Nanna; Lübeck, Marlene; Clausen, Loa

    2015-01-01

    To review systematically the eating disorder literature in order to examine the association between pre-treatment interpersonal problems and treatment outcome in people diagnosed with an eating disorder. Six relevant databases were searched for studies in which interpersonal problems prior to treatment were examined in relation to treatment outcome in patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS). Thirteen studies were identified (containing 764 AN, 707 BN and 48 EDNOS). The majority of studies indicated that interpersonal problems at the start of therapy were associated with a detrimental treatment outcome. Individuals with a binge/purge-type of eating disorder may be particularly vulnerable to interpersonal issues and these issues may lead to poorer treatment recovery by reducing the individual's ability to engage in the treatment process on a functional level. The clinical and research implications are discussed.

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

    Science.gov (United States)

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

    2017-08-01

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

  15. Poor oral status is associated with rehabilitation outcome in older people.

    Science.gov (United States)

    Shiraishi, Ai; Yoshimura, Yoshihiro; Wakabayashi, Hidetaka; Tsuji, Yuri

    2017-04-01

    Poor oral status is associated with increased physical dependency and cognitive decline. Malnutrition, a potential result of poor oral status, is associated with poorer rehabilitation outcome and physical function. However, the association between oral status and rehabilitation outcome is not fully understood. The present study investigated the association of poor oral status with rehabilitation outcome in older patients. A retrospective cohort study was carried out of 108 consecutive patients (mean age 80.5 ± 6.8 years; 50.9% men) who were admitted to convalescent rehabilitation wards. The Revised Oral Assessment Guide was used to evaluate oral status. Rehabilitation outcome was evaluated by the Functional Independence Measure (FIM) on discharge. Multivariate analyses were applied to examine the associations between poor oral status and motor-FIM on discharge. According to the Revised Oral Assessment Guide score, 14.8% of participants had normal oral status, 52.8% had slight to moderate oral problems and 32.4% had severe oral problems. The median scores of motor-FIM on admission and on discharge were 52 (interquartile range 25-70) and 75 (interquartile range 51-89), respectively. Multivariate analysis showed that the Revised Oral Assessment Guide score and the motor-/cognitive-FIM scores on admission were significant independent factors for motor-FIM on discharge, after adjusted for sex, age, length of stay, nutritional status, handgrip and causative diseases (P < 0.001). Poor oral status is associated with rehabilitation outcome in older people. Geriatr Gerontol Int 2017; 17: 598-604. © 2016 Japan Geriatrics Society.

  16. Associations of Military Divorce with Mental, Behavioral, and Physical Health Outcomes

    Science.gov (United States)

    2015-06-19

    sion was similar among recent divorcees and those who were single. Understanding the temporal proximity of the association between a recent divorce ...Shapiro E. Alcohol consumption and divorce : Which causes which? J Divorce . 1988;12(1):127–36. 60. Lee MR, Chassin L, Mackinnon D. The effect of marriage...Naval Health Research Center Associations of Military Divorce With Mental, Behavioral, and Physical Health Outcomes Lawrence Wang Amber Seelig

  17. Television viewing duration during childhood and long- association with adolescent neuropsychological outcomes.

    Science.gov (United States)

    O'Connor, Giselle; Piñero Casas, Maria; Basagaña, Xavier; Vicente, Mònica López; Davand, Payam; Torrent, Maties; Martínez-Murciano, David; García-Esteban, Raquel; Marinelli, Marcella; Sunyer, Jordi; Julvez, Jordi

    2016-12-01

    This study is aiming to evaluate the association between television viewing during childhood and long-term adolescent neuropsychological outcomes and the potential explanatory pathways. This is a longitudinal study based on 278 children participating in the INMA birth cohort (1998) in Menorca Island, Spain. The exposure is parent-reported duration of child television viewing (hours per week) at 6 and 9 years of age. Neuropsychological outcomes were assessed at 14 years of age using the N-back test. Behavioral outcomes at 14 years of age were assessed using the Strengths and Difficulties Questionnaire (SDQ) and school performance was assessed by the global school score. Regression models were developed to quantify the associations between duration of television viewing and neuropsychological outcomes adjusted for child and parents' characteristics. The average of weekly TV viewing from 6 to 9 years was 9.2 h (SD: 4.1). Only N-back test outcomes exhibited statistically significant differences in crude models. Children viewing > 14 h per week tended to show larger latencies in working memory reaction time (HRT in ms), beta (CI) = 53 (0-107). After adjusting for potential social confounders, the association weakened and became non-significant but adverse trends were slightly preserved. Early life TV viewing was not associated with adolescent neuropsychological outcomes after adjustment for potential confounders. Further research including larger and exhaustive population-based cohort studies is required in order to verify our conclusions.

  18. Television viewing duration during childhood and long- association with adolescent neuropsychological outcomes

    Directory of Open Access Journals (Sweden)

    Giselle O'Connor, MSc

    2016-12-01

    Full Text Available This study is aiming to evaluate the association between television viewing during childhood and long-term adolescent neuropsychological outcomes and the potential explanatory pathways. This is a longitudinal study based on 278 children participating in the INMA birth cohort (1998 in Menorca Island, Spain. The exposure is parent-reported duration of child television viewing (hours per week at 6 and 9 years of age. Neuropsychological outcomes were assessed at 14 years of age using the N-back test. Behavioral outcomes at 14 years of age were assessed using the Strengths and Difficulties Questionnaire (SDQ and school performance was assessed by the global school score. Regression models were developed to quantify the associations between duration of television viewing and neuropsychological outcomes adjusted for child and parents' characteristics. The average of weekly TV viewing from 6 to 9 years was 9.2 h (SD: 4.1. Only N-back test outcomes exhibited statistically significant differences in crude models. Children viewing >14 h per week tended to show larger latencies in working memory reaction time (HRT in ms, beta (CI = 53 (0–107. After adjusting for potential social confounders, the association weakened and became non-significant but adverse trends were slightly preserved. Early life TV viewing was not associated with adolescent neuropsychological outcomes after adjustment for potential confounders. Further research including larger and exhaustive population-based cohort studies is required in order to verify our conclusions.

  19. Material properties characterization of low carbon steel using TBW and PWHT techniques in smooth-contoured and U-shaped geometries

    International Nuclear Information System (INIS)

    Aloraier, Abdulkareem S.; Joshi, Suraj; Price, John W.H.; Alawadhi, Khaled

    2013-01-01

    This paper investigates the effects of the temper bead welding (TBW) technique and post weld heat treatment (PWHT) on mechanical properties of multi-layer welding on low carbon steel specimens using Charpy V-notch impact testing and tensile testing. Several samples of two different weld geometries, viz. (i) smooth-contoured, and (ii) U-shaped were made with multiple bead layers using both TBW and PWHT techniques. Impact testing showed that at room temperature and below, TBW gave an impact toughness in the Heat Affected Zone (HAZ) better than both PWHT and the parent material. At temperatures higher than the room temperature but below 60 °C, PWHT gave better impact toughness in the HAZ. Above 60 °C, both TBW and PWHT showed impact toughness lower than that of the parent material. In tensile testing, both TBW and PWHT weld metal specimens produced acceptable results; however, TBW gave yield and tensile strengths closer to that of the actual material than PWHT. -- Highlights: • Effects of post weld heat treatment (PWHT) and temper bead welding (TBW) on properties are tested. • Charpy V-notch impact and tensile testing was performed on multi-layer welding of low carbon steel. • At room temperature and below, TBW gave better impact toughness than both PWHT and parent material. • Above room temperature but below 60 °C, PWHT gave better impact toughness than TBW. • Above 60 °C, both TBW and PWHT showed impact toughness lower than that of parent material

  20. U-shaped Relation between Prestimulus Alpha-band and Poststimulus Gamma-band Power in Temporal Tactile Perception in the Human Somatosensory Cortex.

    Science.gov (United States)

    Wittenberg, Marc André; Baumgarten, Thomas J; Schnitzler, Alfons; Lange, Joachim

    2018-04-01

    Neuronal oscillations are a ubiquitous phenomenon in the human nervous system. Alpha-band oscillations (8-12 Hz) have been shown to correlate negatively with attention and performance, whereas gamma-band oscillations (40-150 Hz) correlate positively. Here, we studied the relation between prestimulus alpha-band power and poststimulus gamma-band power in a suprathreshold tactile discrimination task. Participants received two electrical stimuli to their left index finger with different SOAs (0 msec, 100 msec, intermediate SOA, intermediate SOA ± 10 msec). The intermediate SOA was individually determined so that stimulation was bistable, and participants perceived one stimulus in half of the trials and two stimuli in the other half. We measured neuronal activity with magnetoencephalography (MEG). In trials with intermediate SOAs, behavioral performance correlated inversely with prestimulus alpha-band power but did not correlate with poststimulus gamma-band power. Poststimulus gamma-band power was high in trials with low and high prestimulus alpha-band power and low for intermediate prestimulus alpha-band power (i.e., U-shaped). We suggest that prestimulus alpha activity modulates poststimulus gamma activity and subsequent perception: (1) low prestimulus alpha-band power leads to high poststimulus gamma-band power, biasing perception such that two stimuli were perceived; (2) intermediate prestimulus alpha-band power leads to low gamma-band power (interpreted as inefficient stimulus processing), consequently, perception was not biased in either direction; and (3) high prestimulus alpha-band power leads to high poststimulus gamma-band power, biasing perception such that only one stimulus was perceived.

  1. Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome

    NARCIS (Netherlands)

    Frencken, Jos F.; Donker, Dirk W; Spitoni, Cristian; Koster-Brouwer, Marlies E; Soliman, Ivo W; Ong, David S Y; Horn, Janneke; van der Poll, Tom; van Klei, Wilton A; Bonten, Marc J M; Cremer, Olaf L.

    BACKGROUND: Sepsis is frequently complicated by the release of cardiac troponin, but the clinical significance of this myocardial injury remains unclear. We studied the associations between troponin release during sepsis and 1-year outcomes. METHODS AND RESULTS: We enrolled consecutive patients with

  2. Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy

    NARCIS (Netherlands)

    Eijk, J.J.J. van; Dalton, H.R.; Ripellino, P.; Madden, R.G.; Jones, C.; Fritz, M.; Gobbi, C.; Melli, G.; Pasi, E.; Herrod, J.; Lissmann, R.F.; Ashraf, H.H.; Abdelrahim, M.; Masri, O.; Fraga, M.; Benninger, D.; Kuntzer, T.; Aubert, V.; Sahli, R.; Moradpour, D.; Blasco-Perrin, H.; Attarian, S.; Gerolami, R.; Colson, P.; Giordani, M.T.; Hartl, J.; Pischke, S.; Lin, N.X.; McLean, B.N.; Bendall, R.P.; Panning, M.; Peron, J.M.; Kamar, N.; Izopet, J.; Jacobs, B.C.; Alfen, N. van; Engelen, B.G.M. van

    2017-01-01

    OBJECTIVE: To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS: Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and

  3. Association of pretreatment neutrophil-lymphocyte ratio and outcome in emergency colorectal cancer care.

    Science.gov (United States)

    Palin, R P; Devine, A T; Hicks, G; Burke, D

    2018-04-01

    Introduction The association between the neutrophil-lymphocyte ratio (NLR) and outcome in elective colorectal cancer surgery is well established; the relationship between NLR and the emergency colorectal cancer patient is, as yet, unexplored. This paper evaluates the predictive quality of the NLR for outcome in the emergency colorectal cancer patient. Materials and Methods A total of 187 consecutive patients who underwent emergency surgery for colorectal cancer were included in the study. NLR was calculated from the haematological tests done on admission. Receiver operating characteristic analyses were used to determine the most suitable cut-off for NLR. Outcomes were assessed by mortality at 30 and 90 days using stepwise Cox proportional hazards regression. Results An NLR cut-off of 5 was found to have the highest sensitivity and specificity. At 30 days, age and time from admission to surgery were associated with increased mortality; a high NLR was associated with an increased risk of mortality in univariate but not multivariate analysis. At 90 days, age, NLR, time from admission to surgery and nodal status were all significantly associated with increased mortality on multivariate analysis. Conclusions Pre-operative NLR is a cheap, easily performed and useful clinical tool to aid prediction of outcome in the emergency colorectal cancer patient.

  4. Association between Autistic Traits in Preschool Children and Later Emotional/Behavioral Outcomes

    Science.gov (United States)

    Saito, Aya; Stickley, Andrew; Haraguchi, Hideyuki; Takahashi, Hidetoshi; Ishitobi, Makoto; Kamio, Yoko

    2017-01-01

    Although children with a greater number of autistic traits are likely to have other mental health problems, research on the association between earlier autistic traits in preschool children and later emotional/behavioral outcomes is scarce. Using data from 189 Japanese community-based children, this study examined whether autistic traits at age 5…

  5. Child characteristics associated with outcome for children with autism in a school-based behavioral intervention.

    Science.gov (United States)

    Pellecchia, Melanie; Connell, James E; Kerns, Connor M; Xie, Ming; Marcus, Steven C; Mandell, David S

    2016-04-01

    This study examined the extent to which clinical and demographic characteristics predicted outcome for children with autism spectrum disorder. Participants included 152 students with autism spectrum disorder in 53 kindergarten-through-second-grade autism support classrooms in a large urban public school district. Associations between child characteristics (including age, language ability, autism severity, social skills, adaptive behavior, co-occurring psychological symptoms, and restrictive and repetitive behavior) and outcome, as measured by changes in cognitive ability following one academic year of an intervention standardized across the sample were evaluated using linear regression with random effects for classroom. While several scales and subscales had statistically significant bivariate associations with outcome, in adjusted analysis, only age and the presence of symptoms associated with social anxiety, such as social avoidance and social fearfulness, as measured through the Child Symptom Inventory-4, were associated with differences in outcome. The findings regarding the role of social anxiety are new and have important implications for treatment. Disentangling the construct of social anxiety to differentiate between social fearfulness and social motivation has important implications for shifting the focus of early treatment for children with autism spectrum disorder. © The Author(s) 2015.

  6. Admission Hyperglycemia in Critically Ill Sepsis Patients: Association With Outcome and Host Response

    NARCIS (Netherlands)

    van Vught, Lonneke A.; Wiewel, Maryse A.; Klein Klouwenberg, Peter M. C.; Hoogendijk, Arie J.; Scicluna, Brendon P.; Ong, David S. Y.; Cremer, Olaf L.; Horn, Janneke; Bonten, Marc M. J.; Schultz, Marcus J.; van der Poll, Tom; de Beer, FrisoM; Bos, LieuweD J.; Frencken, JosF; Glas, GerieJ; van Hooijdonk, RoosmarijnT M.; Huson, Michaë laA M.; Schouten, LauraR A.; Straat, Marleen; Witteveen, Esther; Wieske, Luuk

    2016-01-01

    To investigate whether admission hyperglycemia is associated with the presentation and/or outcome of sepsis, what the influence of hyperglycemia is on key host responses to sepsis, and whether hyperglycemia differentially affects patients with diabetes mellitus. A substudy of a prospective

  7. The effect of the presence and characteristics of an outlying group on exposure-outcome associations

    NARCIS (Netherlands)

    Coenen, P.; Mathiassen, S.E.; Kingma, I.; Boot, C.R.L.; Bongers, P.M.; van Dieen, J.H.

    2015-01-01

    OBJECTIVES: Physical exposures (eg, lifting or bending) are believed to be risk factors for low-back pain (LBP), but the literature is inconsistent. Exposure and LBP prevalence differ considerably between occupations, and exposure-outcome associations could be severely modified by the presence of

  8. Association between oral nutritional supplementation and clinical outcomes among patients with ESRD.

    Science.gov (United States)

    Cheu, Christine; Pearson, Jeffrey; Dahlerus, Claudia; Lantz, Brett; Chowdhury, Tania; Sauer, Peter F; Farrell, Robert E; Port, Friedrich K; Ramirez, Sylvia P B

    2013-01-01

    Oral nutritional supplementation (ONS) was provided to ESRD patients with hypoalbuminemia as part of Fresenius Medical Care Health Plan's (FMCHP) disease management. This study evaluated the association between FMCHP's ONS program and clinical outcomes. Analyses included FMCHP patients with ONS indication (n=470) defined as 2-month mean albumin management setting.

  9. Teen Pregnancy : Are Pregnancies following an Elective Termination Associated with Increased Risk for Adverse Perinatal Outcomes?

    NARCIS (Netherlands)

    van Veen, Teelkien R.; Haeri, Sina; Baker, Arthur M.

    2015-01-01

    Study Objective: The authors sought to determine whether pregnancies in adolescents following an abortion of pregnancy is associated with an elevated risk for adverse perinatal outcomes. Methods: In a cohort study of all adolescent (younger than 18 years) deliveries over a 4-year period at 1

  10. Associations between Sexually Experienced Adolescents' Sources of Information about Sex and Sexual Risk Outcomes

    Science.gov (United States)

    Secor-Turner, Molly; Sieving, Renee E.; Eisenberg, Marla E.; Skay, Carol

    2011-01-01

    The objective of this study was to describe prevalent informal sources of information about sex and examine associations between informal sources of information about sex and sexual risk outcomes among sexually experienced adolescents. Work involved the secondary analysis of data from the Minnesota Student Survey, a statewide survey to monitor…

  11. Everolimus-induced pneumonitis associates with favourable outcome in patients with metastatic renal cell carcinoma

    DEFF Research Database (Denmark)

    Penttilä, P; Donskov, F; Rautiola, J

    2017-01-01

    BACKGROUND: Mammalian target of rapamycin inhibitors may induce pneumonitis. We analysed the association of pneumonitis with outcomes in everolimus treated metastatic renal cell carcinoma (mRCC) patients. PATIENTS AND METHODS: Eighty-five mRCC patients received everolimus at Helsinki University...

  12. Association between Intimate Partner Violence during Pregnancy and Adverse Pregnancy Outcomes in Vietnam

    DEFF Research Database (Denmark)

    Thanh Nguyen Hoang; Toan Ngo Van; Gammeltoft, Tine

    2016-01-01

    Background: Violence against pregnant women is an increasing public health concern particularly in low- and middle-income countries. The purpose of this study was to measure the association between intimate partner violence (IPV) during pregnancy and the risk of adverse birth outcomes. Methods: P...

  13. Persistent systemic inflammation is associated with poor clinical outcomes in COPD

    DEFF Research Database (Denmark)

    Agustí, Alvar; Edwards, Lisa D; Rennard, Stephen I

    2012-01-01

    Because chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed...

  14. Clinical Infectious Outcomes Associated with Biofilm-related Infections: a Retrospective Chart Review

    Science.gov (United States)

    2015-06-07

    infectious outcomes. Methods: 221 clinical isolates collected from 2005 to 2012 and previously characterized for biofilm formation were studied. Clinical...chronic infection on multivariate analysis. Conclusions: Bacteria species, but not clinical characteristics, were associated with biofilm formation on...the implication of biofilms in a majority of human infections [2]. Biofilm formation also has been linked with poor wound healing [3], burn wound

  15. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes : a systematic review

    NARCIS (Netherlands)

    Harmsen, Marissa J; Browne, Joyce L; Venter, Francois; Klipstein-Grobusch, Kerstin; Rijken, Marcus J

    2017-01-01

    BACKGROUND: Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes.

  16. WISC-IV Profiles Are Associated with Differences in Symptomatology and Outcome in Children with ADHD

    Science.gov (United States)

    Thaler, Nicholas S.; Bello, Danielle T.; Etcoff, Lewis M.

    2013-01-01

    Objective: The current study investigated the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) cluster profiles of children with ADHD to examine the association between IQ profiles and diagnostic frequency, symptomatology, and outcome in this population. Method: Hierarchical cluster analysis was conducted on 189 children with a…

  17. Fetal first trimester growth is not associated with kidney outcomes in childhood

    NARCIS (Netherlands)

    H. Bakker (Hanneke); R. Gaillard (Romy); A. Hofman (Albert); I.K.M. Reiss (Irwin); E.A.P. Steegers (Eric); V.W.V. Jaddoe (Vincent)

    2017-01-01

    textabstractBackground: Impaired fetal growth is associated with increased risks of kidney diseases in later life. Because human development rates are highest during the first trimester, this trimester may be a particularly critical period for kidney outcomes. We have therefore examined the

  18. Effect of physical activity on frailty and associated negative outcomes: the LIFE randomized trial

    Science.gov (United States)

    Background: Limited evidence suggests that physical activity may prevent frailty and associated negative outcomes in older adults. Definitive data from large, long-term, randomized trials are lacking. Objective: To determine whether a long-term structured moderate-intensity physical activity (PA) p...

  19. Child Characteristics Associated with Outcome for Children with Autism in a School-Based Behavioral Intervention

    Science.gov (United States)

    Pellecchia, Melanie; Connell, James E.; Kerns, Connor M.; Xie, Ming; Marcus, Steven C.; Mandell, David S.

    2016-01-01

    This study examined the extent to which clinical and demographic characteristics predicted outcome for children with autism spectrum disorder. Participants included 152 students with autism spectrum disorder in 53 kindergarten-through-second-grade autism support classrooms in a large urban public school district. Associations between child…

  20. CONSIDER - Core Outcome Set in IAD Research: study protocol for establishing a core set of outcomes and measurements in incontinence-associated dermatitis research.

    Science.gov (United States)

    Van den Bussche, Karen; De Meyer, Dorien; Van Damme, Nele; Kottner, Jan; Beeckman, Dimitri

    2017-10-01

    This study protocol describes the methodology for the development of a core set of outcomes and a core set of measurements for incontinence-associated dermatitis. Incontinence is a widespread disorder with an important impact on quality of life. One of the most common complications is incontinence-associated dermatitis, resulting from chemical and physical irritation of the skin barrier, triggering inflammation and skin damage. Managing incontinence-associated dermatitis is an important challenge for nurses. Several interventions have been assessed in clinical trials, but heterogeneity in study outcomes complicates the comparability and standardization. To overcome this challenge, the development of a core outcome set, a minimum set of outcomes and measurements to be assessed in clinical research, is needed. A project team, International Steering Committee and panelists will be involved to guide the development of the core outcome set. The framework of the Harmonizing Outcomes Measures for Eczema roadmap endorsed by Cochrane Skin Group Core Outcomes Set Initiative, is used to inform the project design. A systematic literature review, interviews to integrate the patients' perspective and a consensus study with healthcare researchers and providers using the Delphi procedure will be performed. The project was approved by the Ethics review Committee (April 2016). This is the first project that will identify a core outcome set of outcomes and measurements for incontinence-associated dermatitis research. A core outcome set will reduce possible reporting bias, allow results comparisons and statistical pooling across trials and strengthen evidence-based practice and decision-making. This project has been registered in the Core Outcome Measures in Effectiveness Trials (COMET) database and is part of the Cochrane Skin Group Core Outcomes Set Initiative (CSG-COUSIN). © 2016 John Wiley & Sons Ltd.

  1. Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes.

    Science.gov (United States)

    Rodriguez, A; García-Esteban, R; Basterretxea, M; Lertxundi, A; Rodríguez-Bernal, C; Iñiguez, C; Rodriguez-Dehli, C; Tardón, A; Espada, M; Sunyer, J; Morales, E

    2015-11-01

    To investigate the association of maternal circulating 25-hydroxyvitamin D3 [25(OH)D3] concentration with pregnancy and birth outcomes. Prospective cohort study. Four geographical areas of Spain, 2003-2008. Of 2382 mother-child pairs participating in the INfancia y Medio Ambiente (INMA) Project. Maternal circulating 25(OH)D3 concentration was measured in pregnancy (mean [SD] 13.5 [2.2] weeks of gestation). We tested associations of maternal 25(OH)D3 concentration with pregnancy and birth outcomes. Gestational diabetes mellitus (GDM), preterm delivery, caesarean section, fetal growth restriction (FGR) and small-for-gestational age (SGA), anthropometric birth outcomes including weight, length and head circumference (HC). Overall, 31.8% and 19.7% of women had vitamin D insufficiency [25(OH)D3 20-29.99 ng/ml] and deficiency [25(OH)D3 < 20 ng/ml], respectively. After adjustment, there was no association between maternal 25(OH)D3 concentration and risk of GDM or preterm delivery. Women with sufficient vitamin D [25(OH)D3 ≥ 30 ng/ml] had a decreased risk of caesarean section by obstructed labour compared with women with vitamin D deficiency [relative risk (RR) = 0.60, 95% CI 0.37, 0.97). Offspring of mothers with higher circulating 25(OH)D3 concentration tended to have smaller HC [coefficient (SE) per doubling concentration of 25(OH)D3, -0.10 (0.05), P = 0.038]. No significant associations were found for other birth outcomes. This study did not find any evidence of an association between vitamin D status in pregnancy and GDM, preterm delivery, FGR, SGA and anthropometric birth outcomes. Results suggest that sufficient circulating vitamin D concentration [25(OH)D3 ≥ 30 ng/ml] in pregnancy may reduce the risk of caesarean section by obstructed labour. © 2014 Royal College of Obstetricians and Gynaecologists.

  2. Collaborative activities and treatment outcomes in patients with HIV-associated tuberculosis in Viet Nam.

    Science.gov (United States)

    Huyen, T T T; Nhung, N V; Shewade, H D; Hoa, N B; Harries, A D

    2016-03-21

    The National Tuberculosis (TB) Programme in Viet Nam and Ho Chi Minh City (HCMC). To determine 1) at national level between 2011 and 2013, the relationship between human immunodeficiency virus (HIV) testing, uptake of TB-HIV interventions and adverse treatment outcomes among TB-HIV patients; and 2) in HCMC in 2013, patient characteristics associated with adverse outcomes. An ecological study reviewing aggregate nationwide data and a retrospective cohort review in HCMC. Nationwide, from 2011 to 2013, HIV testing increased in TB patients from 58% to 68% and antiretroviral therapy (ART) increased in TB-HIV patients from 54% to 63%. Adverse treatment outcomes in TB-HIV patients increased from 24% to 27%, largely due to transfer out (5-9% increase) and death. The Northern and Highland regions showed poor uptake of TB-HIV interventions. In HCMC, 303 (27%) of 1110 TB-HIV patients had adverse outcomes, with higher risks observed in those with previously treated TB, those diagnosed as HIV-positive before TB onset and those never placed on cotrimoxazole or ART. Despite improving HIV testing rates and TB-HIV interventions, adverse outcomes in TB-HIV patients remain at about 26%. Characteristics predicting higher risk of adverse outcomes must be addressed if Viet Nam wishes to end the TB epidemic by 2030.

  3. Education attainment is associated with patient-reported outcomes: findings from the Swedish Hip Arthroplasty Register.

    Science.gov (United States)

    Greene, Meridith E; Rolfson, Ola; Nemes, Szilard; Gordon, Max; Malchau, Henrik; Garellick, Göran

    2014-06-01

    Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known. We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, we evaluated level of education attainment against health-related quality of life (HRQoL), pain reduction, and satisfaction with treatment 1 year after THA. All THAs for osteoarthritis performed from 2005 through 2007 with complete patient-reported outcome measures (representing 49% of the THAs performed for this diagnosis) were selected from the Swedish Hip Arthroplasty Register. These cases were merged with national databases containing education attainment, marital status, and comorbidities (n = 11,464; mean age of patients, 64 years). The patient-reported outcome measure protocol included the HRQoL measure EuroQol five-dimension scale (EQ-5D), a VAS for pain, the Charnley classification survey, and a VAS addressing THA satisfaction. Linear regression analyses determined the association of preoperative patient factors with patient-reported outcomes. High education attainment was associated with higher HRQoL (EQ-5D index ß(high) = 0.03 ± 0.01; EQ VAS ß(high) = 2.6 ± 0.5) after THA, whereas those with low and medium education were at risk for lower HRQoL. High education was associated with less pain after treatment (ß(high) = -3.3 ± 0.05). Individuals with low or medium education were at risk for less satisfaction with THA (p education to a greater extent. Identification of patients who will benefit most from THA and educating those at risk for poorer outcomes, like patients with low and medium education, ultimately may improve patient satisfaction, HRQoL, pain, and the cost utility of THA. Level III

  4. Perceived match or mismatch on the Gottman conflict styles: associations with relationship outcome variables.

    Science.gov (United States)

    Busby, Dean M; Holman, Thomas B

    2009-12-01

    Gottman has proposed that there are 3 functional styles of conflict management in couple relationships, labeled Avoidant, Validating, and Volatile, and 1 dysfunctional style, labeled Hostile. Using a sample of 1,983 couples in a committed relationship, we test the association of perceived matches or mismatches on these conflict styles with relationship outcome variables. The results indicate that 32% of the participants perceive there is a mismatch with their conflict style and that of their partner. The Volatile-Avoidant mismatch was particularly problematic and was associated with more stonewalling, relationship problems, and lower levels of relationship satisfaction and stability than the Validating matched style and than other mismatched styles. The most problematic style was the Hostile style. Contrary to existing assumptions by Gottman, the 3 matched functional styles were not equivalent, as the Validating Style was associated with substantially better results on relationship outcome measures than the Volatile and Avoidant styles.

  5. Associations of military divorce with mental, behavioral, and physical health outcomes.

    Science.gov (United States)

    Wang, Lawrence; Seelig, Amber; Wadsworth, Shelley MacDermid; McMaster, Hope; Alcaraz, John E; Crum-Cianflone, Nancy F

    2015-06-19

    Divorce has been linked with poor physical and mental health outcomes among civilians. Given the unique stressors experienced by U.S. service members, including lengthy and/or multiple deployments, this study aimed to examine the associations of recent divorce on health and military outcomes among a cohort of U.S. service members. Millennium Cohort participants from the first enrollment panel, married at baseline (2001-2003), and married or divorced at follow-up (2004-2006), (N = 29,314). Those divorced were compared to those who remained married for mental, behavioral, physical health, and military outcomes using logistic regression models. Compared to those who remained married, recently divorced participants were significantly more likely to screen positive for new-onset posttraumatic stress disorder, depression, smoking initiation, binge drinking, alcohol-related problems, and experience moderate weight gain. However, they were also more likely be in the highest 15(th) percentile of physical functioning, and be able to deploy within the subsequent 3-year period after divorce. Recent divorce among military members was associated with adverse mental health outcomes and risky behaviors, but was also associated with higher odds of subsequent deployment. Attention should be given to those recently divorced regarding mental health and substance abuse treatment and prevention strategies.

  6. Functional Outcome of Anorectal Malformations and Associated Anomalies in Era of Krickenbeck Classification

    International Nuclear Information System (INIS)

    Qazi, S. H.; Faruque, A. V.; Khan, M. A. M.

    2016-01-01

    Objective: To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification. Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2002 to December 2012. Methodology: Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like age were reported as medians with interquartile ranges. Results: There were 84 children in study group. Most common associated anomaly was cardiac (38 percent), followed by urological anomaly (33 percent). All children were treated by Posterior Sagittal Anorectoplasty (PSARP). Fistula was present in 64 out of 84 (76 percent) cases. The most common fistula was rectourethral (33 percent), followed by recto vestibular (31 percent). According to Krickenbeck classification, continence was achieved in 62 percent children; however 27 percent children were constipated, followed by 12 percent children having fecal soiling. Conclusion: Functional outcome of anorectal malformation depends upon severity of disease. A thorough evaluation of all infants with ARM should be done with particular focus on cardiovascular (38 percent) and genitourinary abnormalities (33 percent). (author)

  7. Association between women's autonomy and family planning outcome in couples residing in Isfahan

    Science.gov (United States)

    Kohan, Shahnaz; Talebian, Ferdos; Ehsanpour, Soheila

    2014-01-01

    Background: One of the important factors in the prediction of family planning outcome is paying attention to women's role in decision making concerning fertility and household affairs. With the improvement of women's status and autonomy, their control over fertility is expected to increase. The present study aimed to investigate the association between women's autonomy and family planning outcome of the couples residing in Isfahan. Materials and Methods: This is cross-sectional study. Two hundred and seventy women of childbearing age, eligible for family planning and residing in Isfahan, were selected through random cluster sampling and they filled a researcher-made questionnaire. Women's autonomy was measured with the questions on their decision-making autonomy concerning household affairs and physical mobility autonomy. The association between women's autonomy and family planning outcome was analyzed through statistical methods. Results: The results showed that the mean of women's decision-making, physical mobility, and general autonomy was 50. Women's autonomy had a direct significant association with the type of contraception method (P = 0.01) and the length of usage of their present contraception method (P = 0.04) as well as where they received family planning services (P = 0.02). Conclusions: Analysis of data revealed women with higher autonomy used a more efficient contraception method and continued their contraception method for a longer time, which leads to improvement of couples’ family planning outcome. Therefore, family planning services should be planned and provided with women's autonomy under consideration. PMID:25400671

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

    Science.gov (United States)

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

    1994-04-01

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

  9. Association between Oxidative Stress and Outcome in Different Subtypes of Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Nai-Wen Tsai

    2014-01-01

    Full Text Available Objectives. This study investigated serum thiobarbituric acid-reactive substances (TBARS and free thiol levels in different subtypes of acute ischemic stroke (AIS and evaluated their association with clinical outcomes. Methods. This prospective study evaluated 100 AIS patients, including 75 with small-vessel and 25 with large-vessel diseases. Serum oxidative stress (TBARS and antioxidant (thiol were determined within 48 hours and days 7 and 30 after stroke. For comparison, 80 age- and sex-matched participants were evaluated as controls. Results. Serum TBARS was significantly higher and free thiol was lower in stroke patients than in the controls on days 1 and 7 after AIS. The level of free thiol was significantly lower in the large-vessel disease than in the small-vessel disease on day 7 after stroke. Using the stepwise logistic regression model for potential variables, only stroke subtype, NIHSS score, and serum TBARS level were independently associated with three-month outcome. Higher TBARS and lower thiol levels in the acute phase of stroke were associated with poor outcome. Conclusions. Patients with large-vessel disease have higher oxidative stress but lower antioxidant defense compared to those with small-vessel disease after AIS. Serum TBARS level at the acute phase of stroke is a potential predictor for three-month outcome.

  10. Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample

    Directory of Open Access Journals (Sweden)

    Gustavo C. Medeiros

    2016-03-01

    Full Text Available Objective: Bipolar disorder (BD is often left untreated for long periods, and this delay in treatment correlates with unfavorable prognosis. The present study sought to assess the magnitude of duration of untreated bipolar disorder (DUB in Brazil. We hypothesized that DUB would be longer in Brazil than in developed countries, and would be associated with poor clinical outcomes. Methods: One hundred and fifty-two psychiatric outpatients were evaluated for BD diagnosis, demographics, DUB, and clinical outcomes. Results: The mean age and mean DUB were, respectively, 38.9±10.8 and 10.4±9.8 years. An extended DUB was associated with early onset of BD (p < 0.001, depression as first mood episode (p = 0.04, and presence of BD in a first-degree relative (p = 0.012. Additionally, a longer DUB was associated with poorer clinical outcomes, such as elevated rates of rapid cycling (p = 0.004 and anxiety disorders (p = 0.016, as well as lower levels of current full remission (p = 0.021. Conclusion: As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.

  11. A systematic review of the association between family meals and adolescent risk outcomes.

    Science.gov (United States)

    Goldfarb, Samantha S; Tarver, Will L; Locher, Julie L; Preskitt, Julie; Sen, Bisakha

    2015-10-01

    To conduct a systematic review of the literature examining the relationship between family meals and adolescent health risk outcomes. We performed a systematic search of original empirical studies published between January 1990 and September 2013. Based on data from selected studies, we conducted logistic regression models to examine the correlates of reporting a protective association between frequent family meals and adolescent outcomes. Of the 254 analyses from 26 selected studies, most reported a significant association between family meals and the adolescent risk outcome-of-interest. However, model analyses which controlled for family connectedness variables, or used advanced empirical methods to account for family-level confounders, were less likely than unadjusted models to report significant relationships. The type of analysis conducted was significantly associated with the likelihood of finding a protective relationship between family meals and the adolescent outcome-of-interest, yet very few studies are using such methods in the literature. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  12. Association between classroom ventilation mode and learning outcome in Danish schools

    DEFF Research Database (Denmark)

    Toftum, Jørn; Kjeldsen, Birthe Uldahl; Wargocki, Pawel

    2015-01-01

    Associations between learning, ventilation mode, and other classroom characteristics were investigated with data from a Danish test scheme and two widespread cross-sectional studies examining air quality in Danish schools. An academic achievement indicator as a measure of the learning outcome...... concentrations and temperatures in 820 classrooms in 389 schools were available. In 56% and 66% of the classrooms included in the two studies, the measured CO2 concentration was higher than 1000ppm. The findings of this study add to the growing evidence that insufficient classroom ventilation have impacts...... on learning outcomes....

  13. Stressful life events are associated with a poor in vitro fertilization (IVF) - outcome: a prospective study

    DEFF Research Database (Denmark)

    Ebbesen, Signe Maria Schneevoigt; Zachariae, Robert; Mehlsen, Mimi Yung

    2009-01-01

    -fertility-related, naturally occurring stressors may influence IVF pregnancy chances. Our aim was to explore the association between IVF-outcome and negative, i.e. stressful, life-events during the previous 12 months. METHODS: Prior to IVF, 809 women (mean age: 31.2 years) completed the List of Recent Events (LRE...... number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end...

  14. Association between male circumcision and women's biomedical health outcomes: a systematic review.

    Science.gov (United States)

    Grund, Jonathan M; Bryant, Tyler S; Jackson, Inimfon; Curran, Kelly; Bock, Naomi; Toledo, Carlos; Taliano, Joanna; Zhou, Sheng; Del Campo, Jorge Martin; Yang, Ling; Kivumbi, Apollo; Li, Peizi; Pals, Sherri; Davis, Stephanie M

    2017-11-01

    Male circumcision reduces men's risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed to review all evidence on associations between male circumcision and women's health outcomes to benefit women's health programmes. In this systematic review we searched for peer-reviewed and grey literature publications reporting associations between male circumcision and women's health outcomes up to April 11, 2016. All biomedical (not psychological or social) outcomes in all study types were included. Searches were not restricted by year of publication, or to sub-Saharan Africa. Publications without primary data and not in English were excluded. We extracted data and assessed evidence on each outcome as high, medium, or low consistency on the basis of agreement between publications; outcomes found in fewer than three publications were indeterminate consistency. 60 publications were included in our assessment. High-consistency evidence was found for five outcomes, with male circumcision protecting against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. Medium-consistency evidence was found for male circumcision protecting against human papillomavirus and low-risk human papillomavirus. Although the evidence shows a protective association with HIV, it was categorised as low consistency, because one trial showed an increased risk to female partners of HIV-infected men resuming sex early after male circumcision. Seven outcomes including HIV had low-consistency evidence and six were indeterminate. Scale-up of male circumcision in sub-Saharan Africa has public health implications for several outcomes in women. Evidence that female partners are at decreased risk of several diseases is highly

  15. The Factors Associated with Outcomes in Surgically Managed Ruptured Cerebral Aneurysm.

    Science.gov (United States)

    Chee, Lai Chuang; Siregar, Johari Adnan; Ghani, Abdul Rahman Izani; Idris, Zamzuri; Rahman Mohd, Noor Azman A

    2018-02-01

    . The mean GCS of the patients subjected to surgical clipping was 13, with the majority falling into the good clinical grade (78.1%). The mean timing of the surgery after SAH was 5.3 days and this was further categorised into early (day one to day three, 45.3%), intermediate (day four to day ten, 56.2%), and late (after day ten, 9.5%). The total favourable outcome achieved at discharge was 59.0% as compared to 41.0% of the unfavourable outcome, with an overall mortality rate of 10.5%. At the six-month post surgery review ( n = 94), the patients with a favourable outcome constituted 71.3% as compared to 28.7% with an unfavourable outcome. The mortality, six months post surgery was 3.2%. On a univariate analysis of early surgical clipping, patients with a better GCS and good clinical grade had a significantly better outcome at discharge. Based on the univariate study, six months post surgery, the timing of the surgery and the clinical grade remained significant predictors of the outcome. On the basis of the multivariate analysis, male patients of younger age, with a good clinical grade, were associated with favourable outcomes, both at discharge and six months post surgery. In this study, we concluded that younger male patients with a good clinical grade were associated with a favourable outcome both at discharge and six months post surgery. We did not find the timing of the surgery, size of the aneurysm or duration of surgery to be associated with a patient's surgical outcome. Increasing age was not associated with the surgical outcome in a longer term of patient's follow up.

  16. Association between vitamin D levels and allergy-related outcomes vary by race and other factors.

    Science.gov (United States)

    Wegienka, Ganesa; Havstad, Suzanne; Zoratti, Edward M; Kim, Haejin; Ownby, Dennis R; Johnson, Christine Cole

    2015-11-01

    Allergy-related studies that include biological measurements of vitamin D preceding well-measured outcomes are needed. We sought to examine the associations between early-life vitamin D levels and the development of allergy-related outcomes in the racially diverse Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study birth cohort. 25-Hydroxyvitamin D (25[OH]D) levels were measured in stored blood samples from pregnancy, cord blood, and age 2 years. Logistic regression models were used to calculate odds ratios (ORs) with 95% CIs for a 5 ng/mL increase in 25(OH)D levels for the following outcomes at age 2 years: eczema, skin prick tests (SPTs), increased allergen-specific IgE level (≥ 0.35 IU/mL), and doctor's diagnosis of asthma (3-6 years). Prenatal 25(OH)D levels were inversely associated with eczema (OR, 0.85; 95% CI, 0.75-0.96). The association was stronger in white children (white children: OR, 0.79; 95% CI, 0.57-1.09; black children: OR, 0.96; 95% CI, 0.82-1.12), although this was not statistically significant. Cord blood 25(OH)D levels were inversely associated with having 1 or more positive SPT responses and aeroallergen sensitization. Both associations were statistically significant in white children (positive SPT response: OR, 0.50; 95% CI, 0.32-0.80; ≥ 1 aeroallergen sensitization: OR, 0.50; 95% CI, 0.28-0.92) in contrast with black children (positive SPT response: OR, 0.88; 95% CI, 0.68-1.14; ≥ 1 aeroallergen sensitization: OR, 0.85; 95% CI, 0.65-1.11). 25(OH)D levels measured concurrently with outcome assessment were inversely associated with aeroallergen sensitization (OR, 0.79; 95% CI, 0.66-0.96) only among black children (white children: OR, 1.21; 95% CI, 0.87-1.69). Prenatal and cord blood 25(OH)D levels were associated with some allergy-related outcomes, with a general pattern indicating that children with higher 25(OH)D levels tend to have fewer allergy-related outcomes. Copyright © 2015 American Academy of Allergy

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

    Science.gov (United States)

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

    2017-03-01

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

  18. Resilience of developing brain networks to interictal epileptiform discharges is associated with cognitive outcome.

    Science.gov (United States)

    Ibrahim, George M; Cassel, Daniel; Morgan, Benjamin R; Smith, Mary Lou; Otsubo, Hiroshi; Ochi, Ayako; Taylor, Margot; Rutka, James T; Snead, O Carter; Doesburg, Sam

    2014-10-01

    The effects of interictal epileptiform discharges on neurocognitive development in children with medically-intractable epilepsy are poorly understood. Such discharges may have a deleterious effect on the brain's intrinsic connectivity networks, which reflect the organization of functional networks at rest, and in turn on neurocognitive development. Using a combined functional magnetic resonance imaging-magnetoencephalography approach, we examine the effects of interictal epileptiform discharges on intrinsic connectivity networks and neurocognitive outcome. Functional magnetic resonance imaging was used to determine the location of regions comprising various intrinsic connectivity networks in 26 children (7-17 years), and magnetoencephalography data were reconstructed from these locations. Inter-regional phase synchronization was then calculated across interictal epileptiform discharges and graph theoretical analysis was applied to measure event-related changes in network topology in the peri-discharge period. The magnitude of change in network topology (network resilience/vulnerability) to interictal epileptiform discharges was associated with neurocognitive outcomes and functional magnetic resonance imaging networks using dual regression. Three main findings are reported: (i) large-scale network changes precede and follow interictal epileptiform discharges; (ii) the resilience of network topologies to interictal discharges is associated with stronger resting-state network connectivity; and (iii) vulnerability to interictal discharges is associated with worse neurocognitive outcomes. By combining the spatial resolution of functional magnetic resonance imaging with the temporal resolution of magnetoencephalography, we describe the effects of interictal epileptiform discharges on neurophysiological synchrony in intrinsic connectivity networks and establish the impact of interictal disruption of functional networks on cognitive outcome in children with epilepsy. The

  19. Level of consciousness at discharge and associations with outcome after ischemic stroke.

    Science.gov (United States)

    Reznik, Michael E; Yaghi, Shadi; Jayaraman, Mahesh V; McTaggart, Ryan A; Hemendinger, Morgan; Mac Grory, Brian C; Burton, Tina M; Cutting, Shawna M; Thompson, Bradford B; Wendell, Linda C; Mahta, Ali; Potter, N Stevenson; Daiello, Lori A; Kosar, Cyrus M; Jones, Richard N; Furie, Karen L

    2018-07-15

    Many factors may potentially complicate the stroke recovery process, including persistently impaired level of consciousness (LOC)-whether from residual stroke effects or from superimposed delirium. We aimed to determine the degree to which impaired LOC at hospital discharge is associated with outcomes after ischemic stroke. We conducted a single-center retrospective cohort study using prospectively-collected data from 2015 to 2017, collecting total NIHSS-LOC score at discharge as well as subscores for responsiveness (LOC-R), orientation questions (LOC-Q), and command-following (LOC-C). We determined associations between LOC scores and 3-month outcome using logistic regression, with discharge location (skilled nursing facility [SNF] vs. inpatient rehabilitation) representing a pre-specified secondary outcome. We identified 1003 consecutive patients with ischemic stroke who survived to discharge, of whom 32% had any LOC score > 0. Total LOC score at discharge was associated with unfavorable 3-month outcome (OR 4.9 [95% CI 2.4-9.8] for LOC = 1; OR 8.0 [2.7-23.9] for LOC = 2-3; OR 6.3 [2.1-18.5] for LOC = 4-5; all patients with LOC = 6-7 had poor outcomes), as were subscores for LOC-R (OR 5.3 [1.3-21.2] for LOC-R = 1; all patients with LOC-R = 2-3 had poor outcomes) and LOC-Q (OR 4.1 [2.1-8.3] for LOC-Q = 1; OR 4.9 [1.8-13.5] for LOC-Q = 2). Total LOC score (OR 2.6 [1.3-5.3] for LOC = 1; OR 3.1 [1.2-8.2] for LOC = 2-3) and LOC-Q (OR 3.3 [1.6-6.6] for LOC-Q = 1; OR 3.4 [1.3-9.0] for LOC-Q = 2) were also associated with discharge to SNF rather than to inpatient rehabilitation. The presence of impaired consciousness or disorientation at discharge is associated with markedly worse outcomes after ischemic stroke. Further studies are necessary to determine the separate effects of residual stroke-related LOC changes and those caused by superimposed delirium. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications.

    Science.gov (United States)

    Witt, Chance M; Lenz, Charles J; Shih, Henry H; Ebrille, Elisa; Rosenbaum, Andrew N; van Zyl, Martin; Aung, Htin; Manocha, Kevin K; Deshmukh, Abhishek J; Hodge, David O; Mulpuru, Siva K; Cha, Yong-Mei; Espinosa, Raul E; Asirvatham, Samuel J; Mcleod, Christopher J

    2017-08-01

    Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position. All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40% ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24% vs. 31%, P = 0.02). In patients with greater than 40% pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49% vs. 34%, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4% vs. 2%, P = 0.005) and need for revision (8% vs. 5%, P = 0.005). Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided. © 2017 Wiley Periodicals, Inc.

  1. Assessing Health Outcomes After Environmental Exposures Associated With Open Pit Burning in Deployed US Service Members.

    Science.gov (United States)

    Rohrbeck, Patricia; Hu, Zheng; Mallon, Col Timothy M

    2016-08-01

    This study assessed the long-term health impact of environmental exposures associated with open pit burning in deployed US service members. Two hundred individuals deployed to Balad, Iraq, and Bagram, Afghanistan, with known exposure to open pits, were matched to 200 non-deployed service members. Both cohorts were observed for adverse health outcomes after returning from deployment. Slight increased risks were observed for respiratory diseases in the Bagram cohort (adj RR: 1.259), and for cardiovascular disease in the Balad cohort (adj RR: 1.072), but the findings were not significant. The combined deployed cohort showed lower risks for adverse health outcomes, suggesting a healthy deployer effect. In conclusion, this study did not find significantly increased risks for selected health outcomes after burn pit exposure during deployment among two deployed cohorts compared with a non-deployed cohort.

  2. Associations between HIV-RNA-based indicators and virological and clinical outcomes

    DEFF Research Database (Denmark)

    Laut, Kamilla G; Shepherd, Leah C; Pedersen, Court

    2016-01-01

    OBJECTIVES: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes. DESIGN: Multinational cohort study. METHODS: We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load measureme......OBJECTIVES: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes. DESIGN: Multinational cohort study. METHODS: We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load...... measurements after baseline (the latest of 01/01/2001 or entry into EuroSIDA). Using multivariate Poisson regression, we modelled the association between short-term (resistance, triple-class failure) and long-term (all-cause mortality, any AIDS/non-AIDS clinical event) outcomes and the indicators: viraemia...

  3. Prostate tumor DNA methylation is associated with cigarette smoking and adverse prostate cancer outcomes.

    Science.gov (United States)

    Shui, Irene M; Wong, Chao-Jen; Zhao, Shanshan; Kolb, Suzanne; Ebot, Ericka M; Geybels, Milan S; Rubicz, Rohina; Wright, Jonathan L; Lin, Daniel W; Klotzle, Brandy; Bibikova, Marina; Fan, Jian-Bing; Ostrander, Elaine A; Feng, Ziding; Stanford, Janet L

    2016-07-15

    DNA methylation has been hypothesized as a mechanism for explaining the association between smoking and adverse prostate cancer (PCa) outcomes. This study was aimed at assessing whether smoking is associated with prostate tumor DNA methylation and whether these alterations may explain in part the association of smoking with PCa recurrence and mortality. A total of 523 men had radical prostatectomy as their primary treatment, detailed smoking history data, long-term follow-up for PCa outcomes, and tumor tissue profiled for DNA methylation. Ninety percent of the men also had matched tumor gene expression data. A methylome-wide analysis was conducted to identify differentially methylated regions (DMRs) by smoking status. To select potential functionally relevant DMRs, their correlation with the messenger RNA (mRNA) expression of corresponding genes was evaluated. Finally, a smoking-related methylation score based on the top-ranked DMRs was created to assess its association with PCa outcomes. Forty DMRs were associated with smoking status, and 10 of these were strongly correlated with mRNA expression (aldehyde oxidase 1 [AOX1], claudin 5 [CLDN5], early B-cell factor 1 [EBF1], homeobox A7 [HOXA7], lectin galactoside-binding soluble 3 [LGALS3], microtubule-associated protein τ [MAPT], protocadherin γ A [PCDHGA]/protocadherin γ B [PCDHGB], paraoxonase 3 [PON3], synaptonemal complex protein 2 like [SYCP2L], and zinc finger and SCAN domain containing 12 [ZSCAN12]). Men who were in the highest tertile for the smoking-methylation score derived from these DMRs had a higher risk of recurrence (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.42-3.72) and lethal disease (OR, 4.21; 95% CI, 1.65-11.78) in comparison with men in the lower 2 tertiles. This integrative molecular epidemiology study supports the hypothesis that smoking-associated tumor DNA methylation changes may explain at least part of the association between smoking and adverse PCa outcomes. Future studies

  4. Increased Heat Generation in Postcardiac Arrest Patients During Targeted Temperature Management Is Associated With Better Outcomes.

    Science.gov (United States)

    Uber, Amy J; Perman, Sarah M; Cocchi, Michael N; Patel, Parth V; Ganley, Sarah E; Portmann, Jocelyn M; Donnino, Michael W; Grossestreuer, Anne V

    2018-04-03

    Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (Ttarget) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to Ttarget and outcomes. Retrospective cohort study. Urban tertiary-care hospital. Successfully resuscitated targeted temperature management-treated adult postarrest patients between 2008 and 2015 with serial temperature data and Ttarget less than or equal to 34°C. None. Time to Ttarget was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation ("heat units") was calculated as inverse of average water temperature × hours between initiation and Ttarget × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3-5 generated less heat before reaching Ttarget (median, 8.1 heat units [interquartile range, 3.6-21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.3 hr [interquartile range, 1.5-4.0 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01) than patients with Cerebral Performance Category score 1-2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6-20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.2 hr [interquartile range, 1.5-3.8 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01). Controlling for average water temperature between initiation and Ttarget, the

  5. Game on… girls: associations between co-playing video games and adolescent behavioral and family outcomes.

    Science.gov (United States)

    Coyne, Sarah M; Padilla-Walker, Laura M; Stockdale, Laura; Day, Randal D

    2011-08-01

    Video game use has been associated with several behavioral and health outcomes for adolescents. The aim of the current study was to assess the relationship between parental co-play of video games and behavioral and family outcomes. Participants consisted of 287 adolescents and their parents who completed a number of video game-, behavioral-, and family-related questionnaires as part of a wider study. Most constructs included child, mother, and father reports. At the bivariate level, time spent playing video games was associated with several negative outcomes, including heightened internalizing and aggressive behavior and lowered prosocial behavior. However, co-playing video games with parents was associated with decreased levels of internalizing and aggressive behaviors, and heightened prosocial behavior for girls only. Co-playing video games was also marginally related to parent-child connectedness for girls, even after controlling for age-inappropriate games played with parents. This is the first study to show positive associations for co-playing video games between girls and their parents. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  6. The perceived importance of physical activity: associations with psychosocial and health-related outcomes.

    Science.gov (United States)

    Wójcicki, Thomas R; Szabo, Amanda N; White, Siobhan M; Mailey, Emily L; Kramer, Arthur F; McAuley, Edward

    2013-03-01

    The purpose of this study was to assess the extent to which participation in a 12-month exercise program changed the degree of importance that older adults attached to physical activity. In addition, associations among changes in physical activity importance and health-related and psychosocial outcomes were examined. Community-dwelling older adults (N = 179) were recruited to participate in a 12-month exercise trial examining the association between changes in physical activity and fitness with changes in brain structure and psychological health. Participants were randomly assigned to a walking condition or a flexibility, toning, and balance condition. Physical, psychological, and cognitive assessments were taken at months 0, 6, and 12. Involvement in a 12-month exercise program increased the importance that participants placed on physical activity; this positive change was similar across exercise condition and sex. Changes in importance, however, were only associated with changes in physical health status and outcome expectations for exercise midway through the intervention. There were no significant associations at the end of the program. Regular participation in physical activity can positively influence the perceived importance of the behavior itself. Yet, the implications of such changes on physical activity-related outcomes remain equivocal and warrant further investigation.

  7. Associations Between Maternal-Foetal Attachment and Infant Developmental Outcomes: A Systematic Review.

    Science.gov (United States)

    Branjerdporn, Grace; Meredith, Pamela; Strong, Jenny; Garcia, Jenniffer

    2017-03-01

    Objectives Infant developmental outcomes may be influenced by a range of prenatal maternal characteristics. While there is some evidence to suggest that maternal-foetal attachment may be associated with infant developmental outcomes, there is a need to systematically review this evidence to guide future research and clinical practice. Methods Five electronic databases were systematically scanned. Key journals and reference lists were hand-searched. Papers were included if: (1) pregnant women were assessed for maternal-foetal attachment; (2) the infants were later assessed, under 2 years old, for any developmental outcome (e.g., social-emotional, cognition, motor, language, adaptive behaviour); and (3) they were published in English. Two independent reviewers used the STROBE checklist to appraise the quality of each paper. Results Of the 968 papers identified, eight were included in the review, and four of these were of low quality (infant temperament (n = 5), adaptive behaviour (e.g., colic, sleep) (n = 2), and milestone attainment (n = 1). There is some evidence to suggest that lower maternal-foetal attachment is related to suboptimal developmental outcomes. However, these results should be interpreted with caution due to the limited and low quality studies available. Conclusions Although maternal-foetal attachment may be associated with infant developmental outcomes, future research is required which: (1) considers a range of developmental outcomes, (2) has increased scientific rigour, (3) assesses mother-infant dyads at different prenatal and postnatal time points, and (4) examines different target populations.

  8. Calcaneal Fractures in Non-Racing Dogs and Cats: Complications, Outcome, and Associated Risk Factors.

    Science.gov (United States)

    Perry, Karen L; Adams, Robert J; Woods, Samantha; Bruce, Mieghan

    2017-01-01

    To estimate the prevalence of complications and describe the outcome associated with calcaneal fractures in non-racing dogs and in cats. Retrospective multicenter clinical cohort study. Medical records of client-owned dogs and cats (2004-2013). Medical records were searched and 50 animals with calcaneal fractures were included for analysis. Complications were recorded and an outcome score applied to each fracture. Associations between putative risk factors and both major complications, and final outcome scores were explored. Complications occurred in 27/50 fractures (61%) including 23 major and 4 minor complications. At final follow-up, 4 animals (10%) were sound, 27 (64%) had either intermittent or consistent mild weight-bearing lameness, 7 (17%) had moderate weight-bearing lameness, and 1 (2%) had severe weight-bearing lameness. Fractures managed using plates and screws had a lower risk of complications than fractures managed using pin and tension band wire, lag or positional screws or a combination of these techniques (Relative risk 0.16, 95% CI 0.02-1.02, P=.052). Non-sighthounds had reduced odds of a poorer outcome score than sighthounds (Odds ratio 0.11, 95% CI 0.02-0.50, P=.005) and fractures with major complications had 13 times the odds of a poorer outcome score (Odds ratio 13.4, 95% CI 3.6-59.5, Pdogs and in cats, and a poorer outcome score was more likely in animals with complications. A more guarded prognosis should be given to owners of non-racing dogs or cats with calcaneal fractures than previously applied to racing Greyhounds with calcaneal fractures. © 2016 The American College of Veterinary Surgeons.

  9. The effect of the presence and characteristics of an outlying group on exposure-outcome associations.

    Science.gov (United States)

    Coenen, Pieter; Mathiassen, Svend Erik; Kingma, Idsart; Boot, Cécile R L; Bongers, Paulien M; van Dieën, Jaap H

    2015-01-01

    Physical exposures (eg, lifting or bending) are believed to be risk factors for low-back pain (LBP), but the literature is inconsistent. Exposure and LBP prevalence differ considerably between occupations, and exposure-outcome associations could be severely modified by the presence of particular occupational groups. We aimed to investigate the influence of such outlying groups on the properties of associations between exposure and LBP. Lifting and trunk flexion were observed for 371 of 1131 workers within 19 groups. LBP was obtained from all workers during three follow-up years. Both exposure variables were associated with LBP (Pexposures and LBP prevalence substantially affected the exposure-outcome association in the total population. In order to further examine this phenomenon, we assessed, by simulation, the influence of realistic sizes (n=4, 8, 16, 32, 64, 128), mean exposures (e=2000, 3000, 4000 lifts and e=30, 40, 50% trunk flexion time) and LBP prevalences (p=70, 80, 90, 100%) of the outlying group on the strength and certainty of the eventual relationship between exposure and LBP. For each combination of n, e and p, 3000 virtual studies were constructed, including the simulated group together with the other 18 original groups from the parent data-set. Average odds ratios (OR), 95% confidence limits, and power (Pexposure. The size and characteristics of a single group with high exposure and outcome prevalence can strongly influence both the OR point estimate and the likelihood of obtaining significant exposure-outcome associations in studies of large populations. These findings can guide interpretations of prior epidemiological studies and support informed design of future studies.

  10. Associations between health culture, health behaviors, and health-related outcomes: A cross-sectional study.

    Science.gov (United States)

    Jia, Yingnan; Gao, Junling; Dai, Junming; Zheng, Pinpin; Fu, Hua

    2017-01-01

    To examine the associations between demographic characteristics, health behaviors, workplace health culture, and health-related outcomes in Chinese workplaces. A total of 1508 employees from 10 administrative offices and 6 enterprises were recruited for a cross-sectional survey. Self-administered questionnaires mainly addressed demographic characteristics, health behaviors, workplace health culture, and health-related outcomes including self-rated health, mental health, and happiness. The proportion of participants who reported good health-related outcomes was significantly higher in those working in administrative offices than those working in enterprises. The result of the potential factors related to self-rated health (SRH), mental health, and happiness by logistic regression analyses showed that age and income were associated with SRH; type of workplace, age, smoking, and health culture at the workplace level were associated with mental health; and beneficial health effects of direct leadership was positively associated with happiness. Moreover, there were some similar results among 3 multivariate regression models. Firstly, good SRH (Odds Ratio (OR) = 1.744), mental health (OR = 1.891), and happiness (OR = 1.736) were more common among highly physically active participants compared with those physical inactive. Furthermore, passive smoking was negatively correlated with SRH (OR = 0.686), mental health (OR = 0.678), and happiness (OR = 0.616), while health culture at the individual level was positively correlated with SRH (OR = 1.478), mental health (OR = 1.654), and happiness (OR = 2.916). The present study indicated that workplace health culture, health behaviors, and demographic characteristics were associated with health-related outcomes. Furthermore, individual health culture, physical activity, and passive smoking might play a critical role in workplace health promotion.

  11. Factors associated with outcomes in ruptured aneurysmal patients: Clinical Study of 80 Patients

    Directory of Open Access Journals (Sweden)

    Alfotih Gobran Taha Ahmed

    2015-03-01

    Full Text Available Background: Due to insufficient data in the literature, the optimal timing for surgical intervention for ruptured intracranial aneurysms is still controversial. Some practitioners advocate early surgery, but others not. It is important to identify other factors that can be used to predict poor prognosis in ruptured intracranial aneurysm patients. Objective: To determine the influence of timing of clipping surgery, and other factors on the outcomes of ruptured intracranial aneurysms in Hunt & Hess I~III grade patients. Method: We have performed a retrospective study involving 80 patients who were surgically treated for ruptured intracranial aneurysm between 2007 and 2012. The patient population consisted of 50(62.5% females and 30(37.5% males, with an age range of 12 to 75 years old, mean age 52.33 ± 10.63 years. We measured association between the Glasgow Outcome Scores and Sex, timing of clipping surgery, aneurysm location and pre-operative patient's neurological condition using famous Hunt and Hess grade system. Results: We did not find any correlation between the outcomes of ruptured intracranial aneurysm patients and timing (early, intermediate, late stage of clipping, sex, aneurysm location. Whereas there is a significant correlation between patients outcomes and pre-operative patient neurological condition (Hunt & Hess grade. Conclusion: Timing of Surgery (early, intermediate, late does not affect outcomes in low Hunt and Hess grade patients I~III. Whereas neurological condition (Hunt & Hess has strong impact on postoperative outcomes. Others factors like sex, Age, Aneurysm location have no effect on outcomes in ruptured intracranial aneurysms.

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

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    Falk Delgado, Alberto; Falk Delgado, Anna

    2017-07-26

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

  13. Associations between Indigenous Australian oral health literacy and self-reported oral health outcomes

    Directory of Open Access Journals (Sweden)

    Jamieson Lisa M

    2010-03-01

    Full Text Available Abstract Objectives To determine oral health literacy (REALD-30 and oral health literacy-related outcome associations, and to calculate if oral health literacy-related outcomes are risk indicators for poor self-reported oral health among rural-dwelling Indigenous Australians. Methods 468 participants (aged 17-72 years, 63% female completed a self-report questionnaire. REALD-30 and oral health literacy-related outcome associations were determined through bivariate analysis. Multivariate modelling was used to calculate risk indicators for poor self-reported oral health. Results REALD-30 scores were lower among those who believed teeth should be infrequently brushed, believed cordial was good for teeth, did not own a toothbrush or owned a toothbrush but brushed irregularly. Tooth removal risk indicators included being older, problem-based dental attendance and believing cordial was good for teeth. Poor self-rated oral health risk indicators included being older, healthcare card ownership, difficulty paying dental bills, problem-based dental attendance, believing teeth should be brushed infrequently and irregular brushing. Perceived need for dental care risk indicators included being female and problem-based dental attendance. Perceived gum disease risk indicators included being older and irregular brushing. Feeling uncomfortable about oro-facial appearance risk indicators included problem-based dental attendance and irregular brushing. Food avoidance risk indicators were being female, difficulty paying dental bills, problem-based dental attendance and irregular brushing. Poor oral health-related quality of life risk indicators included difficulty paying dental bills and problem-based dental attendance. Conclusions REALD-30 was significantly associated with oral health literacy-related outcomes. Oral health literacy-related outcomes were risk indicators for each of the poor self-reported oral health domains among this marginalised population.

  14. Association between dietary intake and 'school-valued' outcomes: a scoping review.

    Science.gov (United States)

    Chan, H S K; Knight, C; Nicholson, M

    2017-02-01

    Approximately one in four Australian children aged 5-17 years are overweight or obese. Most of the health effects of overweight and obesity in childhood do not eventuate until into adulthood; therefore, motivation for children to have a healthy diet may be low. This scoping review examined the literature for associations between diet quality in 5-18 year olds and 'school-valued' outcomes including student attendance, academic performance, behaviour at school and mental health. A literature search for studies that assessed dietary intake and at least one 'school-valued' outcome in schoolchildren, in highly developed countries was conducted. After applying selection criteria, 35 studies were included examining academic performance (46%), behaviour (11%), mental health (31%) and 11% examining two of these outcomes each. No relevant studies addressed attendance. In general, dietary factors including consumption of fruit and vegetables, discretionary foods and/or beverages, or overall diet quality, were suggested to be correlates of the 'school-valued' outcomes. However, the evidence is not comprehensive. This review elucidates the extent and nature of available literature, and provides a basis for future research where the potential benefits of diet on 'school-valued' outcomes can be thoroughly explored. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  15. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome

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    Plett, Sara K.; Hackney, Lauren A.; Heilmeier, Ursula; Nardo, Lorenzo; Zhang, Chiyuan A.; Link, Thomas M. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); Yu, Aihong [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Beijing (China)

    2015-12-15

    To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures, bone marrow infarct, osteochondritis dissecans, or underlying tumor. Two board-certified musculoskeletal radiologists classified morphologic findings including lesion diameter, associated bone marrow edema pattern, and associated cartilage/meniscus damage. Electronic medical charts were evaluated for symptoms, risk factors, and longitudinal outcomes, including total knee arthroplasty (TKA). Imaging characteristics were correlated with clinical findings, and comparison of outcome groups was performed using a regression model adjusted for age. The majority of patients with FCIF were women (64.4 %, 47/73), on average 10 years older than men (66.28 ± 15.86 years vs. 56.54 ± 10.39 years, p = 0.005). The most common location for FCIF was the central weight-bearing surface of the medial femoral condyle; overlying full thickness cartilage loss (75.7 %, 53/70) and ipsilateral meniscal injury (94.1 %, 64/68) were frequently associated. Clinical outcomes were variable, with 23.9 % (11/46) requiring TKA. Cartilage WORMS score, adjacent cartilage loss, and contralateral meniscal injury, in addition to decreased knee range of motion at presentation, were significantly associated with progression to TKA (p < 0.05). FCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression. (orig.)

  16. Student learning outcomes associated with video vs. paper cases in a public health dentistry course.

    Science.gov (United States)

    Chi, Donald L; Pickrell, Jacqueline E; Riedy, Christine A

    2014-01-01

    Educational technologies such as video cases can improve health professions student learning outcomes, but few studies in dentistry have evaluated video-based technologies. The goal of this study was to compare outcomes associated with video and paper cases used in an introductory public health dentistry course. This was a retrospective cohort study with a historical control group. Based on dual coding theory, the authors tested the hypotheses that dental students who received a video case (n=37) would report better affective, cognitive, and overall learning outcomes than students who received a paper case (n=75). One-way ANOVA was used to test the hypotheses across ten cognitive, two affective, and one general assessment measures (α=0.05). Students in the video group reported a significantly higher overall mean effectiveness score than students in the paper group (4.2 and 3.3, respectively; p<0.001). Video cases were also associated with significantly higher mean scores across the remaining twelve measures and were effective in helping students achieve cognitive (e.g., facilitating good discussions, identifying public health problems, realizing how health disparities might impact their future role as dentists) and affective (e.g., empathizing with vulnerable individuals, appreciating how health disparities impact real people) goals. Compared to paper cases, video cases significantly improved cognitive, affective, and overall learning outcomes for dental students.

  17. [Maternal hemoglobin in Peru: regional differences and its association with adverse perinatal outcomes].

    Science.gov (United States)

    Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel; Carrillo, Carlos

    2011-01-01

    To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as well as rates of adverse perinatal outcomes. To analyze data the STATA program (versión 10.0,Texas, USA) was used. The results were considered significant at panemia rate was higher in the coast (25.8%) and low forest (26.2%). Moderate/severe anemia rate in low forest was 2.6% and at the coast was 1.0%. In the highland, the highest rate of moderate/severe anemia was in the southern highlands (0.6%). The highest rate of erythrocytocis was found in the central highland (23.7%), 11.9% in the southern highland and 9.5% in the north highland. Severe anemia and erythrocytocis were associated with adverse perinatal outcomes. There are differences by Peruvian geographical region in anemia rates. In the central highlands were found the highest rates of erythrocytocis due to hypoxia effect in the high altitudes; however in the southern highlands, erythrocytocis was lower. Severe anemia and erythrocytosis were associated with increased adverse perinatal outcomes.

  18. Associations between change in sedentary behavior and outcome in standard behavioral weight loss treatment.

    Science.gov (United States)

    Kerrigan, Stephanie G; Call, Christine; Schaumberg, Katherine; Forman, Evan; Butryn, Meghan L

    2018-03-01

    Sedentary behavior, particularly in prolonged periods, is an important determinant of health. Little research exploring changes in sedentary behavior during behavioral weight loss programs exists. This study evaluated the magnitude of changes in total and prolonged sedentary behavior and how these changes related to changes in weight and cardiovascular outcomes during a behavioral weight loss program. Participants (n = 450) in two lifestyle modification programs underwent assessments of sedentary behavior (by accelerometry), weight, waist circumference, blood pressure, and resting heart rate at baseline and after 6 months of treatment. Sedentary behavior was defined as both total and prolonged (≥30 continuous minutes) sedentary minutes/day. Reductions in total and prolonged sedentary time were significant and were accounted for by increases in moderate-to-vigorous physical activity (MVPA). Only changes in MVPA significantly predicted change in weight when entered into a model simultaneously with changes in sedentary behavior. Changes in total and prolonged sedentary time were not associated with changes in waist circumference, heart rate, or blood pressure. Change in sedentary time was not independently associated with change in health outcomes during a behavioral weight loss treatment. High variability in changes in sedentary time indicate that individual differences may be important to examine. Reducing sedentary time may not be powerful enough to impact these health outcomes above the effects of other changes made during these programs; alternatively, it may be that increasing focus in treatment on reducing sedentary time may engender greater decreases in sedentariness, which could lead to better health outcomes.

  19. The Prevalence Of Sexually Transmitted Infections On Teen Pregnancies And Their Association To Adverse Pregnancy Outcomes.

    Science.gov (United States)

    Rodriguez Gonzalez, Zaskia M; Leavitt, Karla; Martin, Jose; Benabe, Erika; Romaguera, Josefina; Negrón, Ivette

    2015-01-01

    Based on our population data, the teen pregnancy rate and the prevalence of sexually transmitted infections (STIs) reported during pregnancy are worrisome. STIs appear to pose a threat to pregnancy outcomes including preterm birth (PTB), neonatal low birth weight (NLBW) and premature rupture of membranes (PROM). The objective of this study is to determine the prevalence of STIs in pregnant teens and the association of this variable to adverse pregnancy outcomes. We performed a cross sectional study to assess the prevalence of STIs among pregnant teens during a 4-year period at our institution. Birth outcomes such as gestational age at delivery, PROM and NLBW were analyzed and compared with adults. In the four years of our study, teen pregnancy rate fluctuated from 21.7% in 2010 to 16.8% in 2013. The rate of STIs for adult and teen pregnancies was similar, 21% and 23%, respectively. Chlamydia was the most common STI (67.3%) for both groups. PTB was more prevalent among adults affected with STIs than teens, 13.8% and 11.5%, respectively. NLBW was similar among teens and adults with STIs. PROM complicated 9.1% of teen pregnancies with STIs, compared to 6.7% in adults. There was no significant correlation between the STIs and adverse pregnancy outcomes on teen pregnancies for our population, except for PROM. This age group is associated with a high-risk sexual behavior and poor adherence to treatment. They would benefit from efforts to prevent unintended pregnancies and infectious diseases.

  20. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review.

    Science.gov (United States)

    Ide, Mark; Papapanou, Panos N

    2013-04-01

    There is still debate regarding potential relationships between maternal periodontitis during pregnancy and adverse pregnancy outcomes. The aim of this systematic review was to synthesize the available epidemiological evidence on this association. Combined electronic and hand search of MEDLINE, EMBASE, WEB OF SCIENCE and Cochrane Central Register databases. Original publications reporting data from cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or preeclampsia. The search was not limited to publications in English. All selected studies provided data based on professional assessments of periodontal status, and outcome variables, including preterm birth (pregnancy loss or miscarriage, or pre-eclampsia. Pregnant women with or without periodontal disease, and with or without adverse pregnancy outcomes, assessed either during pregnancy or postpartum. No intervention studies were included. Study appraisal and synthesis methods - Publications were assessed based on predefined screening criteria including type of periodontal assessment, consistency in the timing of the periodontal assessment with respect to gestational age, examiner masking and consideration of additional exposures and confounders. Maternal periodontitis is modestly but significantly associated with LBW and preterm birth, but the use of a categorical or a continuous exposure definition of periodontitis appears to impact the findings: Although significant associations emerge from case-control and cross-sectional studies using periodontitis "case definitions," these were substantially attenuated in studies assessing periodontitis as a continuous variable. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia. There is a high degree of variability in study populations, recruitment

  1. Practices and perceptions of animal contact and associated health outcomes in pregnant women and new mothers

    Directory of Open Access Journals (Sweden)

    Hsin-Yi eWeng

    2016-02-01

    Full Text Available Companion animals play an important role in our society. However, pregnant women and new mothers might have specific concerns about animal-associated health outcomes because of their altered immune function and posture as well as their newborn babies. The study was conducted to collect baseline data for developing an evidence-based intervention for pregnant women and new mothers to help them adopt certain behaviors to prevent adverse animal-associated health outcomes. A survey, using the Health Belief Model as the theoretical framework, was developed and administered to 326 women attending the Women, Infants, and Children programs in Illinois and Indiana in 2015. Prevalence of dog and cat ownership was estimated to be 39% (95% CI 33%–45% and 26% (95% CI 21%–31%, respectively. Regardless of pet ownership, 74% of the respondents reported having some type of animal contact in the past month. Pregnancy or the birth of a child altered some animal contact practices among the study participants; particularly a discontinuation or decrease in cleaning cat litter boxes. Reports of diseases contracted from animals were low (4% in this study. By contrast, animal-associated injuries were prevalent (42%, and the majority were caused by animals the respondents owned (56%. Overall, respondents indicated that they appreciated the benefits of a program addressing animal-associated health outcomes and did not indicate strong resistance to adopting certain behaviors. The majority recognized human health-care providers as a source of information about animal contact and associated health outcomes but less frequently identified veterinarians as a source for such information. In addition, although most of the respondents felt that health-care providers and veterinarians should initiate discussions about preventing animal-associated illness and injuries, only 41% among those who had visited doctors or prenatal care services reported that their health-care providers

  2. Sibling relationship quality moderates the associations between parental interventions and siblings' independent conflict strategies and outcomes.

    Science.gov (United States)

    Recchia, Holly E; Howe, Nina

    2009-08-01

    This study extends research on sibling conflict strategies and outcomes by examining unique and interactive associations with age, relative birth order, sibling relationship quality, and caregivers' interventions into conflict. Each of 62 sibling dyads (older sibling mean age = 8.39 years; younger sibling mean age = 6.06 years) discussed 1 recurring conflict alone (dyadic negotiation) and a 2nd conflict with their primary parental caregiver (triadic negotiation). Negotiations were coded for children's conflict strategies, outcomes, and caregiver interventions; each family member provided ratings of sibling relationship quality. Results revealed that age was associated with siblings' constructive strategies, particularly in the dyadic negotiation. With age controlled, younger siblings referred more frequently to their own perspective. Caregivers' future orientation in the triadic negotiation was associated with children's future orientation in the dyadic negotiation; however, this association was most evident when sibling relationship quality was high. Similarly, caregivers' past orientation was positively associated with dyadic compromise, especially when relationship quality was high. Results reveal the value of simultaneously considering associations among parental, affective, and developmental correlates of sibling conflict strategies. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

  3. Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes.

    Science.gov (United States)

    Mahaney, Kelly B; Todd, Michael M; Bayman, Emine O; Torner, James C

    2012-06-01

    Subarachnoid hemorrhage (SAH) results in significant morbidity and mortality, even among patients who reach medical attention in good neurological condition. Many patients have neurological decline in the perioperative period, which contributes to long-term outcomes. The focus of this study is to characterize the incidence of, characteristics predictive of, and outcomes associated with acute postoperative neurological deterioration in patients undergoing surgery for ruptured intracranial aneurysm. The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) was a multicenter randomized clinical trial that enrolled 1001 patients and assesssed the efficacy of hypothermia as neuroprotection during surgery to secure a ruptured intracranial aneurysm. All patients had a radiographically confirmed SAH, were classified as World Federation of Neurosurgical Societies (WFNS) Grade I-III immediately prior to surgery, and underwent surgery to secure the ruptured aneurysm within 14 days of SAH. Neurological assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed preoperatively, at 24 and 72 hours postoperatively, and at time of discharge. The primary outcome variable was a dichotomized scoring based on an IHAST version of the Glasgow Outcome Scale (GOS) in which a score of 1 represents a good outcome and a score > 1 a poor outcome, as assessed at 90-days' follow-up. Data from IHAST were analyzed for occurrence of a postoperative neurological deterioration. Preoperative and intraoperative variables were assessed for associations with occurrence of postoperative neurological deterioration. Differences in baseline, intraoperative, and postoperative variables and in outcomes between patients with and without postoperative neurological deterioration were compared with Fisher exact tests. The Wilcoxon rank-sum test was used to compare variables reported as means. Multiple logistic regression was used to adjust for covariates associated with occurrence

  4. Education is associated with reduction in racial disparities in kidney transplant outcome.

    Science.gov (United States)

    Goldfarb-Rumyantzev, Alexander S; Sandhu, Gurprataap S; Barenbaum, Anna; Baird, Bradley C; Patibandla, Bhanu K; Narra, Akshita; Koford, James K; Barenbaum, Lev

    2012-01-01

    In this study, we hypothesized that higher level of education might be associated with reduced racial disparities in renal transplantation outcomes. We used data from the United States Renal Data System (September 1, 1990-September 1, 2007) (n=79,223) and analyzed two outcomes, graft loss and recipient mortality, using Cox models. Compared with whites, African Americans had increased risk of graft failure (HR, 1.48; peducation groups had inferior graft survival. Specifically, compared with college-graduated individuals, African Americans who never finished high school had the highest risk of graft failure (HR, 1.45; peducation (HR, 1.18; peducation (HR, 1.45; peducation was associated with reduced racial disparities in graft and recipient survival. © 2012 John Wiley & Sons A/S.

  5. Analysis of Genome-Wide Association Studies with Multiple Outcomes Using Penalization

    Science.gov (United States)

    Liu, Jin; Huang, Jian; Ma, Shuangge

    2012-01-01

    Genome-wide association studies have been extensively conducted, searching for markers for biologically meaningful outcomes and phenotypes. Penalization methods have been adopted in the analysis of the joint effects of a large number of SNPs (single nucleotide polymorphisms) and marker identification. This study is partly motivated by the analysis of heterogeneous stock mice dataset, in which multiple correlated phenotypes and a large number of SNPs are available. Existing penalization methods designed to analyze a single response variable cannot accommodate the correlation among multiple response variables. With multiple response variables sharing the same set of markers, joint modeling is first employed to accommodate the correlation. The group Lasso approach is adopted to select markers associated with all the outcome variables. An efficient computational algorithm is developed. Simulation study and analysis of the heterogeneous stock mice dataset show that the proposed method can outperform existing penalization methods. PMID:23272092

  6. The ratio of U-shaped inverted between competition and innovation, evidence for the Spanish case; La relacion en forma de U-Invertida entre competencia e innovacion. Evidencia para el caso espanol

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    Beneito, P.; Coscolla, P.; Rochina, M. E.; Sanchis, A.

    2012-07-01

    Following the approach of Aghion et al. (2005), this paper analyses the empirical relationship between competition and innovation at the industry level, using Spanish manufacturing firm level data from the Survey of Business Strategies (ESEE) for the period 1991-2006. Our results report the existence of an inverted U-shape relationship between competition and innovation incentives, although the industrial sectors in our sample are located mainly in the negative sloping part of the curve. (Author) 22 refs.

  7. Childhood Health and Educational Outcomes Associated With Maternal Sleep Apnea: A Population Record-Linkage Study.

    Science.gov (United States)

    Bin, Yu Sun; Cistulli, Peter A; Roberts, Christine L; Ford, Jane B

    2017-11-01

    Sleep apnea in pregnancy is known to adversely affect birth outcomes. Whether in utero exposure to maternal sleep apnea is associated with long-term childhood consequences is unclear. Population-based longitudinal study of singleton infants born during 2002-2012 was conducted using linked birth, hospital, death, developmental, and educational records from New South Wales, Australia. Maternal sleep apnea during pregnancy was identified from hospital records. Outcomes were mortality and hospitalizations up to age 6, developmental vulnerability in the first year of school (aged 5-6 years), and performance on standardized tests in the third year of school (aged 7-9 years). Cox proportional hazards and modified Poisson regression models were used to calculate hazard and risk ratios for outcomes in children exposed to maternal apnea compared with those not exposed. Two hundred nine of 626188 singleton infants were exposed to maternal sleep apnea. Maternal apnea was not significantly associated with mortality (Fisher's exact p = .48), developmental vulnerability (adjusted RR 1.29; 95% CI 0.75-2.21), special needs status (1.58; 0.61-4.07), or low numeracy test scores (1.03; 0.63-1.67) but was associated with low reading test scores (1.55; 1.08-2.23). Maternal apnea significantly increased hospitalizations in the first year of life (adjusted HR 1.81; 95% CI 1.40-2.34) and between the first and sixth birthdays (1.41; 1.14-1.75). This is partly due to admissions for suspected pediatric sleep apnea. Maternal sleep apnea during pregnancy is associated with poorer childhood health. Its impact on developmental and cognitive outcomes warrants further investigation. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  8. Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

    Science.gov (United States)

    Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

    2017-07-01

    Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

  9. Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Schweitzer, Andrew D.; Nemade, Ajay [Weill Cornell Medicine, Department of Radiology, New York, NY (United States); Parikh, Neal S.; Navi, Babak B. [Weill Cornell Medicine, Department of Neurology, New York, NY (United States); Weill Cornell Medicine, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (United States); Askin, Gulce [Weill Cornell Medicine, Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, New York, NY (United States); Lyo, John; Karimi, Sasan; Knobel, Anna; Young, Robert J. [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Gupta, Ajay [Weill Cornell Medicine, Department of Radiology, New York, NY (United States); Weill Cornell Medicine, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY (United States)

    2017-04-15

    Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes. We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge. We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR = 4.3; 95% CI: 1.4-36.3; p = 0.047) and mRS (OR = 3.6; 95% CI: 1.2-10.7; p = 0.019). Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes. (orig.)

  10. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia

    OpenAIRE

    Fang, Wen-Feng; Yang, Kuang-Yao; Wu, Chieh-Liang; Yu, Chong-Jen; Chen, Chang-Wen; Tu, Chih-Yen; Lin, Meng-Chih

    2011-01-01

    Introduction Healthcare-associated pneumonia (HCAP) is a relatively new category of pneumonia. It refers to infections that occur prior to hospital admission in patients with specific risk factors following contact or exposure to a healthcare environment. There is currently no scoring index to predict the outcomes of HCAP patients. We applied and compared different community acquired pneumonia (CAP) scoring indices to predict 30-day mortality and 3-day and 14-day intensive care unit (ICU) adm...

  11. Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome

    International Nuclear Information System (INIS)

    Schweitzer, Andrew D.; Nemade, Ajay; Parikh, Neal S.; Navi, Babak B.; Askin, Gulce; Lyo, John; Karimi, Sasan; Knobel, Anna; Young, Robert J.; Gupta, Ajay

    2017-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes. We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge. We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR = 4.3; 95% CI: 1.4-36.3; p = 0.047) and mRS (OR = 3.6; 95% CI: 1.2-10.7; p = 0.019). Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes. (orig.)

  12. Clinical Characteristics and Predictors of Outcome for Onconeural Antibody-Associated Disorders: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Shaohua Liao

    2017-11-01

    Full Text Available ObjectiveTo describe and analyze the clinical characteristics, laboratory data, management, and outcome of patients with onconeural antibody-associated disorders (OAAD and identify predictors for poor outcome.MethodsThis was a retrospective review of all patients with potential OAAD, who were hospitalized in Jinan General Hospital between September 2009 and July 2017. We clarified the diagnosis, collected comprehensive information and categorized patients into three groups: paraneoplastic neurological disorders (PNDs, autoimmune encephalitis (AE, and possible OAAD. Within the three groups, we analyzed a range of clinical and laboratory parameters and used univariate and multivariate regression analysis to identify predictors for poor outcome [modified Rankin Scale (mRS = 3–6].ResultsFrom 158 patients, we identified 70 who fulfilled the criteria for OAAD, including 44 men (62.9% and 26 women (37.1%. There were 38 patients (54.3% in the PNDs group, 14 patients (20% in the AE group, and 18 patients (25.7% in the possible OAAD group. After the last follow-up, 14 (36.8%, 9 (64.2%, and 12 (66.7% had a good outcome (mRS = 0–2. However, 6 (15.8%, 2 (14.3%, and 3 (16.7% died, respectively. Univariate analysis showed that duration prior to the hospital (p = 0.0224 and urinary incontinence/retention (p = 0.0043 were associated with poor outcome (mRS = 3–6. After multivariate regression analysis, urinary incontinence/retention (p = 0.0388 and an immunocompromised state (p = 0.0247 remained as significant factors for poor outcome.ConclusionUrinary incontinence/retention and an immunocompromised state represent significant predictors of a worse prognosis for patients with OAAD. By contrast, cerebrospinal fluid analysis showed that serum autoantibodies and tumor markers, the function of crucial organs, electrophysiology, and radiological findings were not associated with a poor outcome.

  13. Elevated outcome-anticipation and outcome-evaluation ERPs associated with a greater preference for larger-but-delayed rewards.

    Science.gov (United States)

    Pornpattananangkul, Narun; Nadig, Ajay; Heidinger, Storm; Walden, Keegan; Nusslock, Robin

    2017-06-01

    Although waiting for a reward reduces or discounts its value, some people have a stronger tendency to wait for larger rewards and forgo smaller-but-immediate rewards. This ability to delay gratification is captured by individual differences in so-called intertemporal choices in which individuals are asked to choose between larger-but-delayed versus smaller-but-immediate rewards. The current study used event-related potentials (ERPs) to examine whether enhancement in two neurocognitive processes, outcome anticipation and outcome evaluation, modulate individual variability in intertemporal responses. After completing a behavioral intertemporal choice task, 34 participants performed an ERP gambling task. From this ERP task, we separately examined individual differences in outcome anticipation (stimulus-preceding negativity; SPN), early outcome valuation (feedback-related negativity; FRN), and late outcome evaluation (P3). We observed that both elevated outcome-anticipation (SPN) and late outcome-evaluation (P3) neural processes predicted a stronger preference toward larger-but-delayed rewards. No relationship was observed between intertemporal responses and early outcome evaluation (FRN), indicating that the relationship between outcome evaluation and intertemporal responses was specific to the late outcome-evaluation processing stream. Moreover, multiple regression analyses indicated that the SPN and P3 independently modulate individual differences in intertemporal responses, suggesting separate mechanisms underlie the relationship between these two neurocognitive processes and intertemporal responses. Accordingly, we identify two potential neurocognitive modulators of individual variability in intertemporal responses. We discuss the mechanisms underlying these modulators in terms of anticipation-related processing (SPN) and a saliency bias toward gain (compared to loss) outcomes (P3).

  14. The associations among prior drinking consequences, subjective evaluations, and subsequent alcohol outcomes.

    Science.gov (United States)

    Zaso, Michelle J; Park, Aesoon; Kim, Jueun; Gellis, Les A; Kwon, Hoin; Maisto, Stephen A

    2016-05-01

    Although the many positive and negative psychosocial consequences of alcohol use are well documented, evidence of the association between prior drinking consequences and subsequent alcohol-related outcomes is mixed. Social learning theory highlights that cognitive appraisals of prior drinking consequences play a crucial intermediate role in the relation of prior drinking consequences with subsequent alcohol-related outcomes. This prospective study was designed to test the mediating effects of subjective evaluations (i.e., perceived valence and controllability) in the association of prior drinking consequences with change in binge drinking and drinking consequences over time. Participants were 171 college students (69% female, 74% White, M age = 18.95 years, SD = 1.35) who completed 2 online surveys, with an average interval of 68 days (SD = 10.22) between assessments. Path analyses of the data did not support mediational effects of perceived valence or controllability of prior drinking consequences on subsequent alcohol-related outcomes. Specifically, greater frequency of negative consequences was associated with lower perceived valence and controllability, and greater frequency of positive consequences was associated with lower perceived controllability of the experienced consequences. However, perceptions of valence and controllability were not in turn associated with subsequent binge drinking and drinking consequences. Instead, greater frequency of positive consequences was directly associated with greater subsequent frequency of binge drinking. Findings highlight the importance of prior positive consequences in the escalation of binge drinking over a short period of time, although this relation may not be accounted for by perceptions of valence and controllability of the prior drinking consequences. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. Molecular mechanisms of the 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced inverted U-shaped dose responsiveness in anchorage independent growth and cell proliferation of human breast epithelial cells with stem cell characteristics

    International Nuclear Information System (INIS)

    Ahn, Nam-Shik; Hu, Hongbo; Park, Jin-Sung; Park, Joon-Suk; Kim, Jong-Sik; An, Sungwhan; Kong, Gu; Aruoma, Okezie I.; Lee, Yong-Soon; Kang, Kyung-Sun

    2005-01-01

    Although 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) has a variety of carcinogenic and noncarcinogenic effects in experimental animals, its role in human carcinogenicity remain controversial. A simian virus 40-immortalized cell line from normal human breast epithelial cells with stem cells and luminal characteristics (M13SV1) was used to study whether TCDD can induce AIG positive colony formation and cause increased cell numbers in a inverted U-shaped dose-response manner. TCDD activated Akt, ERK2, and increased the expression of CYP1A1, PAI-2, IL-lb mRNA, and ERK2 protein levels. TCDD was able to increased phosphorylation and expression of ERK2 in same dose-response manner as AIG positive colony formation. Thus, TCDD induced tumorigenicity in M13SV1, possibly through the phosphorylation of ERK2 and/or Akt. Further, cDNA microarray with 7448 sequence-verified clones was used to profile various gene expression patterns after treatment of TCDD. Three clear patterns could be delineated: genes that were dose-dependently up-regulated, genes expressed in either U-shape and/or inverted U-shape. The fact that these genes are intrinsically related to breast epithelial cell proliferation and survival clearly suggests that they may be involved in the TCDD-induced breast tumorigenesis

  16. Association between seizures after ischemic stroke and stroke outcome: A systematic review and meta-analysis.

    Science.gov (United States)

    Xu, Tao; Ou, Shu; Liu, Xi; Yu, Xinyuan; Yuan, Jinxian; Huang, Hao; Chen, Yangmei

    2016-07-01

    A systematic review and meta-analysis were performed to investigate a potential association between post-ischemic stroke seizures (PISS) and subsequent ischemic stroke (IS) outcome.A systematic search of two electronic databases (Medline and Embase) was conducted to identify studies that explored an association between PISS and IS outcome. The primary and secondary IS outcomes of interest were mortality and disability, respectively, with the latter defined as a score of 3 to 5 on the modified Rankin Scale.A total of 15 studies that were published between 1998 and 2015 with 926,492 participants were examined. The overall mortality rates for the patients with and without PISS were 34% (95% confidence interval [CI], 27-42%) and 18% (95% CI, 12-23%), respectively. The pooled relative ratio (RR) of mortality for the patients with PISS was 1.97 (95% CI, 1.48-2.61; I = 88.6%). The overall prevalence rates of disability in the patients with and without PISS were 60% (95% CI, 32-87%) and 41% (95% CI, 25-57%), respectively. Finally, the pooled RR of disability for the patients with PISS was 1.64 (95% CI, 1.32-2.02; I = 66.1%).PISS are significantly associated with higher risks of both mortality and disability. PISS indicate poorer prognoses in patients experiencing IS.

  17. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia

    Science.gov (United States)

    Senturk, Mehmet Baki; Cakmak, Yusuf; Atac, Halit; Budak, Mehmet Sukru

    2015-01-01

    Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of labor should take into consideration the patient’s preference, together with the proper setting. PMID:26203286

  18. BAS-drive trait modulates dorsomedial striatum activity during reward response-outcome associations.

    Science.gov (United States)

    Costumero, Víctor; Barrós-Loscertales, Alfonso; Fuentes, Paola; Rosell-Negre, Patricia; Bustamante, Juan Carlos; Ávila, César

    2016-09-01

    According to the Reinforcement Sensitivity Theory, behavioral studies have found that individuals with stronger reward sensitivity easily detect cues of reward and establish faster associations between instrumental responses and reward. Neuroimaging studies have shown that processing anticipatory cues of reward is accompanied by stronger ventral striatum activity in individuals with stronger reward sensitivity. Even though establishing response-outcome contingencies has been consistently associated with dorsal striatum, individual differences in this process are poorly understood. Here, we aimed to study the relation between reward sensitivity and brain activity while processing response-reward contingencies. Forty-five participants completed the BIS/BAS questionnaire and performed a gambling task paradigm in which they received monetary rewards or punishments. Overall, our task replicated previous results that have related processing high reward outcomes with activation of striatum and medial frontal areas, whereas processing high punishment outcomes was associated with stronger activity in insula and middle cingulate. As expected, the individual differences in the activity of dorsomedial striatum correlated positively with BAS-Drive. Our results agree with previous studies that have related the dorsomedial striatum with instrumental performance, and suggest that the individual differences in this area may form part of the neural substrate responsible for modulating instrumental conditioning by reward sensitivity.

  19. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy

    DEFF Research Database (Denmark)

    Nohr, E.A.; Vaeth, M.; Baker, J.L.

    2008-01-01

    BACKGROUND: Although both maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) may affect birth weight, their separate and joint associations with complications of pregnancy and delivery and with postpartum weight retention are unclear. OBJECTIVES: We aimed to investigate...... the combined associations of prepregnancy BMI and GWG with pregnancy outcomes and to evaluate the trade-offs between mother and infant for different weight gains. DESIGN: Data for 60892 term pregnancies in the Danish National Birth Cohort were linked to birth and hospital discharge registers. Self...

  20. Carbonic anhydrase XII expression is associated with histologic grade of cervical cancer and superior radiotherapy outcome

    International Nuclear Information System (INIS)

    Yoo, Chong Woo; Nam, Byung-Ho; Kim, Joo-Young; Shin, Hye-Jin; Lim, Hyunsun; Lee, Sun; Lee, Su-Kyoung; Lim, Myong-Cheol; Song, Yong-Jung

    2010-01-01

    To investigate whether expression of carbonic anhydrase XII (CA12) is associated with histologic grade of the tumors and radiotherapy outcomes of the patients with invasive cervical cancer. CA12 expression was examined by immunohistochemical stains in cervical cancer tissues from 183 radiotherapy patients. Histological grading was classified as well (WD), moderately (MD) or poorly differentiated (PD). Oligonucleotide microarray experiment was performed using seven cervical cancer samples to examine differentially expressed genes between WD and PD cervical cancers. The association between CA12 and histological grade was analyzed by chi-square test. CA12 and histological grades were analyzed individually and as combined CA12 and histologic grade categories for effects on survival outcome. Immunohistochemical expression of CA12 was highly associated with the histologic grade of cervical cancer. Lack of CA12 expression was associated with PD histology, with an odds ratio of 3.9 (P = 0.01). Microarray analysis showed a fourfold reduction in CA12 gene expression in PD tumors. CA12 expression was marginally associated with superior disease-free survival. Application of the new combined categories resulted in further discrimination of the prognosis of patients with moderate and poorly differentiated tumor grade. Our study indicates that CA12 may be used as a novel prognostic marker in combination with histologic grade of the tumors

  1. Bias due to two-stage residual-outcome regression analysis in genetic association studies.

    Science.gov (United States)

    Demissie, Serkalem; Cupples, L Adrienne

    2011-11-01

    Association studies of risk factors and complex diseases require careful assessment of potential confounding factors. Two-stage regression analysis, sometimes referred to as residual- or adjusted-outcome analysis, has been increasingly used in association studies of single nucleotide polymorphisms (SNPs) and quantitative traits. In this analysis, first, a residual-outcome is calculated from a regression of the outcome variable on covariates and then the relationship between the adjusted-outcome and the SNP is evaluated by a simple linear regression of the adjusted-outcome on the SNP. In this article, we examine the performance of this two-stage analysis as compared with multiple linear regression (MLR) analysis. Our findings show that when a SNP and a covariate are correlated, the two-stage approach results in biased genotypic effect and loss of power. Bias is always toward the null and increases with the squared-correlation between the SNP and the covariate (). For example, for , 0.1, and 0.5, two-stage analysis results in, respectively, 0, 10, and 50% attenuation in the SNP effect. As expected, MLR was always unbiased. Since individual SNPs often show little or no correlation with covariates, a two-stage analysis is expected to perform as well as MLR in many genetic studies; however, it produces considerably different results from MLR and may lead to incorrect conclusions when independent variables are highly correlated. While a useful alternative to MLR under , the two -stage approach has serious limitations. Its use as a simple substitute for MLR should be avoided. © 2011 Wiley Periodicals, Inc.

  2. Long sleep duration is associated with lower cognitive function among middle-age adults - the Doetinchem Cohort Study.

    Science.gov (United States)

    van Oostrom, Sandra H; Nooyens, Astrid C J; van Boxtel, Martin P J; Verschuren, W M Monique

    2018-01-01

    In older adults, both short and long sleep duration are associated with lower cognitive function, suggesting an inverted U-shaped association between sleep duration and cognitive outcomes. This study examined whether sleep duration is associated with (changes in) cognitive function in a middle-aged population. In the Doetinchem Cohort Study, the cognitive function of 2970 men and women aged 41-75 years at baseline (1995-2007) was examined 2-3 times, with 5-year time intervals. Global cognitive function and the domains memory, information processing speed, and cognitive flexibility were assessed. In multivariable linear regression models, (change in) self-reported sleep duration was studied in association with the level and change in cognitive function. In a subsample of the population (n = 2587), the association of sleep duration and feeling rested with cognitive function was studied. Sleep duration of 9 h and more was statistically significantly associated with lower global cognitive function (p cognitive function. An inverted U-shaped association between sleep duration and cognitive function was observed for speed, flexibility, and global cognitive function. Sleep duration was not associated with change in cognitive function. Middle-age adults with long sleep duration had a lower cognitive function. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Geospatial association between adverse birth outcomes and arsenic in groundwater in New Hampshire, USA.

    Science.gov (United States)

    Shi, Xun; Ayotte, Joseph D; Onda, Akikazu; Miller, Stephanie; Rees, Judy; Gilbert-Diamond, Diane; Onega, Tracy; Gui, Jiang; Karagas, Margaret; Moeschler, John

    2015-04-01

    There is increasing evidence of the role of arsenic in the etiology of adverse human reproductive outcomes. Because drinking water can be a major source of arsenic to pregnant women, the effect of arsenic exposure through drinking water on human birth may be revealed by a geospatial association between arsenic concentration in groundwater and birth problems, particularly in a region where private wells substantially account for water supply, like New Hampshire, USA. We calculated town-level rates of preterm birth and term low birth weight (term LBW) for New Hampshire, by using data for 1997-2009 stratified by maternal age. We smoothed the rates by using a locally weighted averaging method to increase the statistical stability. The town-level groundwater arsenic probability values are from three GIS data layers generated by the US Geological Survey: probability of local groundwater arsenic concentration >1 µg/L, probability >5 µg/L, and probability >10 µg/L. We calculated Pearson's correlation coefficients (r) between the reproductive outcomes (preterm birth and term LBW) and the arsenic probability values, at both state and county levels. For preterm birth, younger mothers (maternal age arsenic level based on the data of probability >10 µg/L; for older mothers, r = 0.19 when the smoothing threshold = 3,500; a majority of county level r values are positive based on the arsenic data of probability >10 µg/L. For term LBW, younger mothers (maternal age arsenic concentration based on the data of probability >1 µg/L; for older mothers, r = 0.14 when the rates are smoothed with a threshold = 1,000 births and also adjusted by town median household income in 1999, and the arsenic values are the town minimum based on probability >10 µg/L. At the county level for younger mothers, positive r values prevail, but for older mothers, it is a mix. For both birth problems, the several most populous counties-with 60-80 % of the state's population and clustering at the

  4. Immediate coma and poor outcome in subarachnoid haemorrhage are independently associated with an aneurysmal origin.

    Science.gov (United States)

    Tsermoulas, Georgios; Flett, Lisa; Gregson, Barbara; Mitchell, Patrick

    2013-08-01

    Subarachnoid haemorrhage (SAH) may present with coma and this is known to be associated with aneurysmal origin and blood load. Aneurysmal origin is associated with increased blood load and existing data do not allow us to determine if the association between coma and aneurysmal SAH is wholly due to blood load or if aneurysmal origin has an additional independent effect. The objective of our study is to find if an aneurysmal origin is a predictor of acute onset of coma independent of blood load. A series of consecutive patients with spontaneous SAH were divided into two groups: aneurysmal (aSAH) and non-aneurysmal--angiographically negative SAH (naSAH). Blood load was quantified so that the effect of aneurysmal origin could be resolved from the effect of the amount of blood spilled. Non-parametric regression was used to relate blood load to coma and poor outcome rates for aneurysmal bleeds. We analysed a total of 421 patients presenting during the period 2009-2011. Ninety aneurysmal cases presented with coma, seventy immediately in the early phase and seven shortly after rebleeding. None of the naSAH cases presented with immediate coma and 1 developed delayed coma. Delayed coma was associated with acute hydrocephalus in both groups. Aneurysmal origin was found to be an independent determinant of immediate coma (p=0.02) and poor outcome (pcoma and poor outcome in SAH are associated with an aneurysmal origin and do not characterize naSAH. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Endotoxin predictors and associated respiratory outcomes differ with climate regions in the U.S.

    Science.gov (United States)

    Mendy, Angelico; Wilkerson, Jesse; Salo, Pӓivi M; Cohn, Richard D; Zeldin, Darryl C; Thorne, Peter S

    2018-03-01

    Although endotoxin is a recognized cause of environmental lung disease, how its relationship with respiratory outcomes varies with climate is unknown. To examine the endotoxin predictors as well as endotoxin association with asthma, wheeze, and sensitization to inhalant allergens in various US climate regions. We analyzed data on 6963 participants in the National Health and Nutrition Examination Survey. Endotoxin measurements of house dust from bedroom floor and bedding were performed at the University of Iowa. Linear and logistic regression analyses were used to identify endotoxin predictors and assess endotoxin association with health outcomes. The overall median house dust endotoxin was 16.2 EU/mg; it was higher in mixed-dry/hot-dry regions (19.7 EU/mg) and lower in mixed-humid/marine areas (14.8 EU/mg). Endotoxin predictors and endotoxin association with health outcomes significantly differed across climate regions. In subarctic/very cold/cold regions, log 10 -endotoxin was significantly associated with higher prevalence of wheeze outcomes (OR:1.48, 95% CI:1.19-1.85 for any wheeze, OR:1.48, 95% CI:1.22-1.80 for exercise-induced wheeze, OR:1.50, 95% CI:1.13-1.98 for prescription medication for wheeze, and OR:1.95, 95% CI:1.50-2.54 for doctor/ER visit for wheeze). In hot-humid regions, log 10 -endotoxin was positively associated with any wheeze (OR:1.66, 95% CI:1.04-2.65) and current asthma (OR:1.56, 95% CI:1.11-2.18), but negatively with sensitization to any inhalant allergens (OR:0.83, 95% CI:0.74-0.92). Endotoxin predictors and endotoxin association with asthma and wheeze differ across U.S. climate regions. Endotoxin is associated positively with wheeze or asthma in cold and hot-humid regions, but negatively with sensitization to inhalant allergens in hot-humid climates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome.

    Science.gov (United States)

    Gökçal, Elif; Niftaliyev, Elvin; Baran, Gözde; Deniz, Çiğdem; Asil, Talip

    2017-09-01

    It is important to predict progressive deficit (PD) in isolated pontine infarction, a relatively common problem of clinical stroke practice. Traditionally, lacunar infarctions are known with their progressive course. However, few studies have analyzed the branch atheromatous disease subtype as a subtype of lacunar infarction, separately. There are also conflicting results regarding the relationship with the topography of lesion and PD. In this study, we classified etiological subtypes and lesion topography in isolated pontine infarction and aimed to investigate the association of etiological subtypes, lesion topography and clinical outcome with PD. We analyzed demographics, laboratory parameters, and risk factors of 120 patients having isolated pontine infarction and admitted within 24 h retrospectively. PD was defined as an increase in the National Institutes of Health Stroke scale ≥2 units in 5 days after onset. Patients were classified as following: large artery disease (LAA), basilar artery branch disease (BABD) and small vessel disease (SVD). Upper, middle and lower pontine infarcts were identified longitudinally. Functional outcome at 3 months was determined according to modified Rankin scores. Of 120 patients, 41.7% of the patients were classified as BABD, 30.8% as SVD and 27.5% as LAA. 23 patients (19.2%) exhibited PD. PD was significantly more frequent in patient with BABD (p 0.006). PD was numerically higher in patients with lower pontine infarction. PD was associated with BABD and poor functional outcome. It is important to discriminate the BABD neuroradiologically from other stroke subtypes to predict PD which is associated with poor functional outcome in patients with isolated pontine infarctions.

  7. Treatment beliefs, health behaviors and their association with treatment outcome in type 2 diabetes

    Science.gov (United States)

    von Arx, Lill-Brith Wium; Gydesen, Helge; Skovlund, Søren

    2016-01-01

    Objective While the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is to examine the extent to which treatment beliefs and health behaviors predict diabetes health outcome as measured by glycated hemoglobin (HbA1c) level, blood pressure, and lipid profile. Research design and methods This was a large-scale cross-sectional, registry-based study involving a well-defined type 2 diabetes population, in the county of Funen, Denmark. Registry data were combined with a 27-item self-reported survey administered to all insulin-treated people in the registry (n=3160). The survey was constructed to operationalize key concepts of diabetes management, diabetes treatment beliefs, and health behaviors. Results In total, 1033 respondents answered the survey. The majority of treatment beliefs and health behaviors examined were predictors of glycemic control and, to a large extent, lipid profile. Absence from, or a low frequency of, self-measured blood glucose, non-adherence to general medical advice and the prescribed treatment, a low primary care utilization, and perceived low treatment efficacy were factors positively associated with HbA1c levels, s-cholesterol, and low-density lipoprotein. Conversely, infrequent self-measured blood glucose was associated with a significantly higher likelihood of having a blood pressure below 130/80 mm Hg. Perceived low treatment efficacy was the only health belief associated with poorer levels of health outcome other than HbA1c. Conclusions Health behaviors were stronger predictors for health outcomes than treatment beliefs. Self-reported adherence to either the treatment regimen or general medical advice most consistently predicted both glycemic control and cardiovascular risk factors. PMID:27110367

  8. Factors associated with occurrence and outcome of super-refractory status epilepticus.

    Science.gov (United States)

    Madžar, Dominik; Knappe, Ruben U; Reindl, Caroline; Giede-Jeppe, Antje; Sprügel, Maximilian I; Beuscher, Vanessa; Gollwitzer, Stephanie; Hamer, Hajo M; Huttner, Hagen B

    2017-11-01

    Super-refractory status epilepticus (SRSE) represents a challenging medical condition with high morbidity and mortality. In this study, we aimed to establish variables related to SRSE development and outcome. We retrospectively screened our databases for refractory SE (RSE) and SRSE episodes between January 2001 and January 2015. Baseline demographics, SE characteristics, and variables reflecting the clinical course were compared in order to identify factors independently associated with SRSE occurrence. Within the SRSE cohort, predictors of in-hospital mortality as well as good functional outcome in survivors to discharge were established through univariate and multivariable analyses. A total of 131 episodes were included, among those 46 (35.1%) meeting the criteria of SRSE. Comparison of RSE and SRSE episodes revealed a lower premorbid mRS score (odds ratio (OR) per mRS point, 0.769; p=0.039) and non-convulsive SE (NCSE) in coma (OR, 4.216; p=0.008) as independent predictors of SRSE. SRSE in-hospital mortality was associated with age (OR, 1.091 per increasing year; p=0.020) and worse premorbid functional status (OR, 1.938 per mRS point; p=0.044). Good functional outcome in survivors was independently related to shorter SRSE duration (OR, 0.714 per day; p=0.038). Better premorbid functional status and NCSE in coma as worst seizure type indicate a role of acute underlying etiologies in the development of SRSE. In-hospital mortality in SRSE is determined by nonmodifiable factors, while functional outcome in survivors depends on seizure duration underscoring the need of achieving rapid seizure termination. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  9. Association of housing first implementation and key outcomes among homeless persons with problematic substance use.

    Science.gov (United States)

    Davidson, Clare; Neighbors, Charles; Hall, Gerod; Hogue, Aaron; Cho, Richard; Kutner, Bryan; Morgenstern, Jon

    2014-11-01

    Housing First is a supportive housing model for persons with histories of chronic homelessness that emphasizes client-centered services, provides immediate housing, and does not require treatment for mental illness or substance abuse as a condition of participation. Previous studies of Housing First have found reduced governmental costs and improved personal well-being among participants. However, variations in real-world program implementation require better understanding of the relationship between implementation and outcomes. This study investigated the effects of Housing First implementation on housing and substance use outcomes. Study participants were 358 individuals with histories of chronic homelessness and problematic substance use. Clients were housed in nine scatter-site Housing First programs in New York City. Program fidelity was judged across a set of core Housing First components. Client interviews at baseline and 12 months were used to assess substance use. Clients in programs with greater fidelity to consumer participation components of Housing First were more likely to be retained in housing and were less likely to report using stimulants or opiates at follow-up. Consistently implemented Housing First principles related to consumer participation were associated with superior housing and substance use outcomes among chronically homeless individuals with a history of substance use problems. The study findings suggest that program implementation is central to understanding the potential of Housing First to help clients achieve positive housing and substance use outcomes.

  10. International Differences in Multiple Sclerosis Health Outcomes and Associated Factors in a Cross-sectional Survey

    Directory of Open Access Journals (Sweden)

    Grace D. Reilly

    2017-05-01

    Full Text Available Multiple sclerosis (MS is a major cause of disability and poor quality of life (QOL. Previous studies have shown differences in MS health outcomes between countries. This study aimed to examine the associations between international regions and health outcomes in people with MS. Self-reported data were taken from the Health Outcomes and Lifestyle In a Sample of people with Multiple Sclerosis online survey collected in 2012. The 2,401 participants from 37 countries were categorized into three regions: Australasia, Europe, and North America. Differences were observed between regions in disability, physical and mental health QOL, fatigue, and depression, but most of these disappeared after adjusting for sociodemographic, disease, and lifestyle factors in multivariable regression models. However, adjusted odds for disability were higher in Europe [odds ratio (OR: 2.17, 95% confidence interval (CI: 1.28 to 3.67] and North America (OR: 1.79, 95% CI: 1.28 to 2.51 compared to Australasia. There may be other unmeasured factors that vary between regions, including differences in access and quality of healthcare services, determining disability in MS. When assessing differences in MS health outcomes, lifestyle factors and medication use should be taken into consideration.

  11. Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes.

    Science.gov (United States)

    Lee, Phyllis; Zehgeer, Asima; Ginsburg, Golda S; McCracken, James; Keeton, Courtney; Kendall, Philip C; Birmaher, Boris; Sakolsky, Dara; Walkup, John; Peris, Tara; Albano, Anne Marie; Compton, Scott

    2017-04-27

    Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7-17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.

  12. Reduced Bearing Excursion After Mobile-Bearing Unicompartmental Knee Arthroplasty is Associated With Poor Functional Outcomes.

    Science.gov (United States)

    Wahal, Naman; Gaba, Sahil; Malhotra, Rajesh; Kumar, Vijay; Pegg, Elise C; Pandit, Hemant

    2018-02-01

    A small proportion of patients with mobile unicompartmental knee arthroplasty (UKA) report poor functional outcomes in spite of optimal component alignment on postoperative radiographs. The purpose of this study is to assess whether there is a correlation between functional outcome and knee kinematics. From a cohort of consecutive cases of 150 Oxford medial UKA, patients with fair/poor functional outcome at 1-year postsurgery (Oxford Knee Score [OKS] bearing position with knee flexion angle. Mean OKS in the fair/poor group was 29.9 and the mean OKS in the good/excellent group was 41.1. The tibial slope, time taken to complete the exercises, and patellar tendon angle trend over the flexion range were similar in both the groups; however, bearing position and the extent of bearing excursion differed significantly. The total bearing excursion in the OKS bearing was positioned 1.7 mm more posterior on the tibia in the OKS bearing excursion and positioning, are associated with worse functional outcomes after mobile UKA. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Association between prior vaginal birth after cesarean and subsequent labor outcome.

    Science.gov (United States)

    Krispin, Eyal; Hiersch, Liran; Wilk Goldsher, Yulia; Wiznitzer, Arnon; Yogev, Yariv; Ashwal, Eran

    2018-04-01

    To estimate the effect of prior successful vaginal birth after cesarean (VBAC) on the rate of uterine rupture and delivery outcome in women undergoing labor after cesarean. A retrospective cohort study of all women attempting labor after cesarean delivery in a university-affiliated tertiary-hospital (2007-2014) was conducted. Study group included women attempting vaginal delivery with a history of cesarean delivery and at least one prior VBAC. Control group included women attempting first vaginal delivery following cesarean delivery. Primary outcome was defined as the rate of uterine rupture. Secondary outcomes were delivery and maternal outcomes. Of 62,463 deliveries during the study period, 3256 met inclusion criteria. One thousand two hundred and eleven women had VBAC prior to the index labor and 2045 underwent their first labor after cesarean. Women in the study group had a significantly lower rate of uterine rupture 9 (0.7%) in respect to control 33 (1.6%), p = .036, and had a higher rate of successful vaginal birth (96 vs. 84.9%, p cesarean, prior VBAC appears to be associated with lower rate of uterine rupture and higher rate of successful vaginal birth.

  14. Childhood and current ADHD symptom dimensions are associated with more severe cannabis outcomes in college students.

    Science.gov (United States)

    Bidwell, L C; Henry, E A; Willcutt, E G; Kinnear, M K; Ito, T A

    2014-02-01

    Numerous studies have shown that attention deficit/hyperactivity disorder (ADHD) is associated higher risk of cannabis use disorders (CUD). However, these studies are limited in that most did not: (a) differentiate the role of hyperactivity-impulsivity (HI) and inattention (IN); (b) control for associated psychopathology; and (c) consider more fine-grained CUD-related measures. Our aim was to clarify the unique and interactive contributions of inattention and hyperactivity symptoms to age of cannabis initiation and DSM-IV cannabis dependence, craving, and severity of problems related to cannabis use while statistically controlling for symptoms of comorbid psychopathology in a non-clinical sample of young adults. Cannabis variables, current use of cigarettes and alcohol, current and childhood ADHD, and comorbid internalizing and externalizing psychopathology were assessed in 376 male and female undergraduates. Results indicate that current and childhood IN were independently associated with more severe cannabis use, craving, and problem use-related outcomes in young adulthood (p'scannabis (pcannabis use. Associations with ADHD symptom dimensions and current use of alcohol and cigarettes were also present. Thus, current and childhood inattention symptoms as well as childhood hyperactive-impulsive symptoms emerged as significant factors in cannabis-related outcomes in young adults, even after statistically controlling for important confounding variables. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Treatment outcomes of open pelvic fractures associated with extensive perineal injuries.

    Science.gov (United States)

    Hasankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad

    2013-12-01

    The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

  16. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients.

    Science.gov (United States)

    Hill, Amanda; Kiss, Nicole; Hodgson, Belinda; Crowe, Timothy C; Walsh, Adam D

    2011-02-01

    Patients with gastrointestinal cancers are susceptible to nutritional deterioration which may be compounded by radiotherapy treatment toxicities. This study aimed to determine whether nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy were associated with treatment toxicity and outcomes in gastrointestinal cancer patients. Seventy-three gastrointestinal cancer patients receiving curative radiotherapy underwent medical record audits assessing body weight, radiotherapy toxicity, unplanned treatment breaks or hospital admissions and completion of prescribed treatment/s. Nutritional status was assessed in a subset of patients (n = 11) using the Patient-Generated Subjective Global Assessment tool. Seventy-five percent of patients lost weight throughout radiotherapy. Weight loss was significantly greater in patients experiencing unplanned radiotherapy breaks (-3.1% vs -1.6%, p nutritional status during radiotherapy (as measured by weight loss) may be associated with poorer short-term treatment outcomes in gastrointestinal cancer patients. Patient numbers were too small to definitively determine the effect of nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy (defined by PG-SGA) on treatment outcomes. Further research is required to investigate this in larger, longer-term studies. Copyright © 2010. Published by Elsevier Ltd.

  17. Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Hollingsworth, John M; Funk, Russell J; Garrison, Spencer A; Owen-Smith, Jason; Kaufman, Samuel A; Pagani, Francis D; Nallamothu, Brahmajee K

    2016-11-01

    Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. © 2016 American Heart Association, Inc.

  18. Television viewing associated with adverse dietary outcomes in children ages 2-6.

    Science.gov (United States)

    Ford, C; Ward, D; White, M

    2012-12-01

    The aim of this paper was to systematically review the evidence for the association between television viewing and diet in children ages 2-6. Data sources included PubMed, PsycINFO, EMBASE, ERIC, SportDISCUS, Sociological Abstracts, Web of Science and hand searches of reference lists of relevant articles. Twelve studies were reviewed in which the relationship between television viewing and diet was assessed in children between the ages of 2 and 6. All but one study reported significant relationship between television viewing time and adverse dietary outcomes. Parent-reported television viewing time was used to assay child television viewing in all included studies. Food frequency survey was the most frequent method of dietary assessment, and parent served as proxies for children in all studies. Lower fruit and/or vegetable intake was the most frequently reported dietary outcome, followed by increased energy intake with increased television viewing. The majority of studies reported adverse dietary outcomes with as little as 1 h of daily television exposure. While these results are consistent with recommendations from child health advocates to limit television viewing in young children, they also suggest that further efforts to limit television viewing in young children may be needed to aid in obesity prevention. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

  19. General and abdominal fat outcomes in school-age children associated with infant breastfeeding patterns.

    Science.gov (United States)

    Durmuş, Büşra; Heppe, Denise H M; Gishti, Olta; Manniesing, Rashindra; Abrahamse-Berkeveld, Marieke; van der Beek, Eline M; Hofman, Albert; Duijts, Liesbeth; Gaillard, Romy; Jaddoe, Vincent W V

    2014-06-01

    Breastfeeding may have a protective effect on the development of obesity in later life. Not much is known about the effects of infant feeding on more-specific fat measures. We examined associations of breastfeeding duration and exclusiveness and age at the introduction of solid foods with general and abdominal fat outcomes in children. We performed a population-based, prospective cohort study in 5063 children. Information about infant feeding was obtained by using questionnaires. At the median age of 6.0 y (95% range: 5.7 y, 6.8 y), we measured childhood anthropometric measures, total fat mass and the android:gynoid fat ratio by using dual-energy X-ray absorptiometry, and preperitoneal abdominal fat by using ultrasound. We observed that, in the models adjusted for child age, sex, and height only, a shorter breastfeeding duration, nonexclusive breastfeeding, and younger age at the introduction of solid foods were associated with higher childhood general and abdominal fat measures (P-trend fat outcomes are explained by sociodemographic and lifestyle-related factors. Whether infant dietary composition affects specific fat outcomes at older ages should be further studied. © 2014 American Society for Nutrition.

  20. Selected perinatal outcomes associated with planned home births in the United States.

    Science.gov (United States)

    Cheng, Yvonne W; Snowden, Jonathan M; King, Tekoa L; Caughey, Aaron B

    2013-10-01

    More women are planning home birth in the United States, although safety remains unclear. We examined outcomes that were associated with planned home compared with hospital births. We conducted a retrospective cohort study of term singleton live births in 2008 in the United States. Deliveries were categorized by location: hospitals or intended home births. Neonatal outcomes were compared with the use of the χ(2) test and multivariable logistic regression. There were 2,081,753 births that met the study criteria. Of these, 12,039 births (0.58%) were planned home births. More planned home births had 5-minute Apgar score births (0.24%; adjusted odds ratio, 1.87; 95% confidence interval, 1.36-2.58) and neonatal seizure (0.06% vs 0.02%, respectively; adjusted odds ratio, 3.08; 95% confidence interval, 1.44-6.58). Women with planned home birth had fewer interventions, including operative vaginal delivery and labor induction/augmentation. Planned home births were associated with increased neonatal complications but fewer obstetric interventions. The trade-off between maternal preferences and neonatal outcomes should be weighed thoughtfully. Copyright © 2013 Mosby, Inc. All rights reserved.

  1. Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes.

    Science.gov (United States)

    Salow, Arturo D; Pool, Lindsay R; Grobman, William A; Kershaw, Kiarri N

    2018-03-01

    Previous analyses utilizing birth certificate data have shown environmental factors such as racial residential segregation may contribute to disparities in adverse pregnancy outcomes. However, birth certificate data are ill equipped to reliably differentiate among small for gestational age, spontaneous preterm birth, and medically indicated preterm birth. We sought to utilize data from electronic medical records to determine whether residential segregation among Black women is associated with an increased risk of adverse pregnancy outcomes. The study population was composed of 4770 non-Hispanic Black women who delivered during the years 2009 through 2013 at a single urban medical center. Addresses were geocoded at the level of census tract, and this tract was used to determine the degree of residential segregation for an individual's neighborhood. Residential segregation was measured using the Gi* statistic, a z-score that measures the extent to which the neighborhood racial composition deviates from the composition of the larger surrounding area. The Gi* statistic z-scores were categorized as follows: low (z  1.96). Adverse pregnancy outcomes included overall preterm birth, spontaneous preterm birth, medically indicated preterm birth, and small for gestational age. Hierarchical logistic regression models accounting for clustering by census tract and repeated births among mothers were used to estimate odds ratios of adverse pregnancy outcomes associated with segregation. In high segregation areas, the prevalence of overall preterm birth was significantly higher than that in low segregation areas (15.5% vs 10.7%, respectively; P < .001). Likewise, the prevalence of spontaneous preterm birth and medically indicated preterm birth were higher in high (9.5% and 6.0%) vs low (6.2% and 4.6%) segregation neighborhoods (P < .001 and P = .046, respectively). The associations of high segregation with overall preterm birth (odds ratio, 1.31; 95% confidence interval, 1

  2. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample.

    Science.gov (United States)

    Witherow, Marta Parkanyi; Chandraiah, Shambhavi; Seals, Samantha R; Sarver, Dustin E; Parisi, Kathryn E; Bugan, Antal

    2017-06-01

    Relational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability. To investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings. Using a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration. Patients completed the Female Sexual Function Index, the Couple's Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test. Mediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration. Findings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning. The importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are

  3. Correlation between smoking habit and surgical outcomes on viral-associated hepatocellular carcinomas.

    Science.gov (United States)

    Kai, Keita; Komukai, Sho; Koga, Hiroki; Yamaji, Koutaro; Ide, Takao; Kawaguchi, Atsushi; Aishima, Shinichi; Noshiro, Hirokazu

    2018-01-07

    To investigate the association between smoking habits and surgical outcomes in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) (B-HCC) and hepatitis C virus (HCV)-related HCC (C-HCC) and clarify the clinicopathological features associated with smoking status in B-HCC and C-HCC patients. We retrospectively examined the cases of the 341 consecutive patients with viral-associated HCC (C-HCC, n = 273; B-HCC, n = 68) who underwent curative surgery for their primary lesion. We categorized smoking status at the time of surgery into never, ex- and current smoker. We analyzed the B-HCC and C-HCC groups' clinicopathological features and surgical outcomes, i.e ., disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS). Univariate and multivariate analyses were performed using a Cox proportional hazards regression model. We also performed subset analyses in both patient groups comparing the current smokers to the other patients. The multivariate analysis in the C-HCC group revealed that current-smoker status was significantly correlated with both OS ( P = 0.0039) and DSS ( P = 0.0416). In the B-HCC patients, no significant correlation was observed between current-smoker status and DFS, OS, or DSS in the univariate or multivariate analyses. The subset analyses comparing the current smokers to the other patients in both the C-HCC and B-HCC groups revealed that the current smokers developed HCC at significantly younger ages than the other patients irrespective of viral infection status. A smoking habit is significantly correlated with the overall and disease-specific survivals of patients with C-HCC. In contrast, the B-HCC patients showed a weak association between smoking status and surgical outcomes.

  4. What Variables are Associated with Successful Weight Loss Outcomes for Bariatric Surgery After One Year?

    Science.gov (United States)

    Robinson, Athena H.; Adler, Sarah; Stevens, Helen B.; Darcy, Alison M.; Morton, John M.; Safer, Debra L.

    2014-01-01

    Background Prior evidence indicates that predictors of weight loss outcomes after gastric bypass surgery fall within 5 domains: 1) presurgical factors; 2) postsurgical psychosocial variables (e.g., support group attendance); 3) postsurgical eating patterns; 4) postsurgical physical activity; and 5) follow-up at postsurgical clinic. However, little data exist on which specific behavioral predictors are most associated with successful outcomes (e.g., ≥50% excess weight loss) when considering the 5 domains simultaneously. Objectives Specify the behavioral variables, and their respective cutoff points, most associated with successful weight loss outcomes. Setting On-line survey. Methods Signal Detection Analysis evaluated associations between 84 pre-and postsurgical behavioral variables (within the 5 domains) and successful weight loss at ≥1 year in 274 post-gastric bypass surgery patients. Results Successful weight loss was highest (92.6%) among those reporting dietary adherence of >3 on a 9 point scale (median=5) who grazed no more than once-per-day. Among participants reporting dietary adherence <3 and grazing daily or less, success rates more than doubled when highest lifetime Body Mass Index was <53.7 kg/m2. Success rates also doubled for participants with dietary adherence =3 if attending support groups. No variables from the physical activity or postsurgical follow-up domains were significant, nor were years since surgery. The overall model’s sensitivity =.62, specificity =.92. Conclusions To our knowledge, this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss. Such data may inform prospective study designs and postsurgical interventions. PMID:24913590

  5. Mental health in early pregnancy is associated with pregnancy outcome in women with pregestational diabetes

    DEFF Research Database (Denmark)

    Callesen, N F; Secher, A L; Cramon, P

    2015-01-01

    -related quality of life, anxiety, depression and locus of control were seen in women delivering large or appropriate for gestational age infants. CONCLUSIONS: Poor mental quality of life and the presence of depressive symptoms in early pregnancy were associated with preterm delivery in women with pregestational......AIM: To explore the role of early pregnancy health-related quality of life, anxiety, depression and locus of control for pregnancy outcome in women with pregestational diabetes. METHODS: This was a cohort study of 148 pregnant women with pregestational diabetes (118 with Type 1 diabetes and 30...... with Type 2 diabetes), who completed three internationally validated questionnaires: the 36-item Short-Form Health Survey, the Hospital Anxiety and Depression Scale and the Multidimensional Health Locus of Control survey at 8 weeks. Selected pregnancy outcomes were preterm delivery (

  6. Evaluation of the Health Rocks! Program: The Association of Youth Engagement with Program Outcomes

    Directory of Open Access Journals (Sweden)

    Yan Xia

    2017-01-01

    Full Text Available This evaluation research examined the relationship between program process and program outcome, specifically, youth engagement in the national 4-H Council Health Rocks! program and their program outcomes.  Based on program evaluation surveys completed after the program by participants, youths’ engagement in the program was associated with their gains in knowledge and skills about substance use, and personal assets related to avoiding risks.  When youth participants find a program interesting, are actively engaged in the program, and find the program staff friendly, they benefit more from the program.  Findings underscore the importance of engaging curriculum and friendly staff to the success of extension or afterschool youth programs. The evaluation method may offer an example of balancing rigor of evaluation design and feasibility of implementing an evaluation.

  7. Outcomes and Risk Factors Associated with Clostridium difficile Diarrhea in Hospitalized Adult Patients

    Directory of Open Access Journals (Sweden)

    Daniela Zilio Larentis

    2015-01-01

    Full Text Available Background. The epidemiology of Clostridium difficile infection has changed over time. Therefore, it is essential to monitor the characteristics of patients at risk of infection and factors associated with poor prognosis. Objective. To evaluate factors associated with C. difficile infection and with poor prognosis in those with documented C. difficile colitis. Methods. A retrospective case-control study of 75 patients with documented C. difficile colitis and 75 controls with hospital-acquired diarrhea of other causes. Stepwise multiple logistic regression was used to identify factors associated with C. difficile infection among patients with hospital-acquired diarrhea. Results. Previous antibiotic treatment (odds ratio (OR, 13.3; 95% confidence interval (CI, 1.40–126.90, abdominal distension (OR, 3.85; 95% CI, 1.35–10.98, and fecal leukocytes (OR, 8.79; 95% CI, 1.41–54.61 are considered as predictors of C. difficile colitis; anorexia was negatively associated with C. difficile infection (OR, 0.15; 95% CI, 0.03–0.66. Enteral tube feeding was independently associated with a composite outcome that included in-hospital mortality, intensive care unit admission, and treatment failure (OR, 3.75; 95%CI, 1.24–11.29. Conclusions. Previous antibiotic use and presence of fecal leukocytes in patients with hospital-acquired diarrhea are associated with C. difficile colitis and enteral tube support with complications associated with C. difficile colitis.

  8. Practice Variation in Management of Childhood Asthma Is Associated with Outcome Differences.

    Science.gov (United States)

    Garbutt, Jane M; Yan, Yan; Strunk, Robert C

    2016-01-01

    Although specialist asthma care improves children's asthma outcomes, the impact of primary care management is unknown. To determine whether variation in preventive and acute care for asthma in pediatric practices affects patients' outcomes. For 22 practices, we aggregated 12-month patient data obtained by chart review and parent telephone interviews for 948 children, 3 to 12 years old, diagnosed with asthma to obtain practice-level measures of preventive (≥1 asthma maintenance visit/year) and acute (≥1 acute asthma visit/year) asthma care. Relationships between practice-level measures and individual asthma outcomes (symptom-free days, parental quality of life, emergency department [ED] visits, and hospitalizations) were explored using generalized estimating equations, adjusting for seasonality, specialist care, Medicaid insurance, single-family status, and race. For every 10% increase in the proportion of children in the practice receiving preventive care, symptom-free days per child increased by 7.6 days (P = .02) and ED visits per child decreased by 16.5% (P = .002), with no difference in parental quality of life or hospitalizations. Only the association between more preventive care and fewer ED visits persisted in adjusted analysis (12.2% reduction; P = .03). For every 10% increase in acute care provision, ED visits per child and hospitalizations per child decreased by 18.1% (P = .02) and 16.5% (P asthma care had improved outcomes, both impairment and risk. Persistence of improved risk outcomes in the adjusted analyses suggests that practice-level interventions to increase asthma care may reduce childhood asthma disparities. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  9. Association between gestational weight gain and perinatal outcomes in women with chronic hypertension.

    Science.gov (United States)

    Yee, Lynn M; Caughey, Aaron B; Cheng, Yvonne W

    2017-09-01

    Gestational weight gain above or below the 2009 National Academy of Medicine guidelines has been associated with adverse maternal and neonatal outcomes. Although it has been well established that excess gestational weight gain is associated with the development of gestational hypertension and preeclampsia, the relationship between gestational weight gain and adverse perinatal outcomes among women with pregestational (chronic) hypertension is less clear. The objective of this study was to examine the relationship between gestational weight gain above and below National Academy of Medicine guidelines and perinatal outcomes in a large, population-based cohort of women with chronic hypertension. This is a population-based retrospective cohort study of women with chronic hypertension who had term, singleton, vertex births in the United States from 2012 through 2014. Prepregnancy body mass index was calculated using self-reported prepregnancy weight and height. Women were categorized into 4 groups based on gestational weight gain and prepregnancy body mass index: (1) weight gain less than, (2) weight gain within, (3) weight gain 1-19 lb in excess of, and (4) weight gain ≥20 lb in excess of the National Academy of Medicine guidelines. The χ 2 tests and multivariable logistic regression analysis were used for statistical comparisons. Stratified analyses by body mass index category were additionally performed. In this large birth cohort, 101,259 women met criteria for inclusion. Compared to hypertensive women who had gestational weight gain within guidelines, hypertensive women with weight gain ≥20 lb over National Academy of Medicine guidelines were more likely to have eclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54-2.42) and cesarean delivery (adjusted odds ratio, 1.60; 95% confidence interval, 1.50-1.70). Excess weight gain ≥20 lb over National Academy of Medicine guidelines was also associated with increased odds of 5-minute Apgar gain 1-19 lb

  10. Muscle function is associated with future patient-reported outcomes in young adults with ACL injury

    DEFF Research Database (Denmark)

    Flosadottir, Vala; Roos, Ewa M; Ageberg, Eva

    2016-01-01

    performance and worse postural orientation were associated with worse KOOS scores 2 years later (rsp≥0.280, p≤0.045). Worse muscle power was associated with lower future ARS scores (rsp=0.281, p=0.044). CONCLUSIONS: The moderate associations suggest that improving muscle function during rehabilitation could...... and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale...... improve present and future PROs....

  11. Characteristics of PR interval as predictor for atrial fibrillation: association with biomarkers and outcomes.

    Science.gov (United States)

    Schumacher, Katja; Dagres, Nikolaos; Hindricks, Gerhard; Husser, Daniela; Bollmann, Andreas; Kornej, Jelena

    2017-10-01

    The PR interval may be considered as a simple and easily obtainable predictor for adverse events, including atrial fibrillation (AF), pacemaker implantation, and mortality. Interestingly, both high and low extremes of the PR duration are associated with AF risk. However, the results regarding PR prolongation as a risk factor for AF are inconsistent. Some studies have analyzed the impact of P duration (as a part of the PR interval) and demonstrated that the P-duration contributes to the length of PR interval and adverse outcomes. The PR prolongation could be considered as a marker for cardiovascular degenerative aging caused by myocardial fibrosis and vascular inflammation. Furthermore, due to PR prolongation chronically raised intra-atrial pressure and consequential neuro-hormonal activation predispose systemic vascular endothelial dysfunction and explain the associations with adverse vascular events. In this review, we discuss the association between biomarkers with PR interval in AF.

  12. Failure to recognize preoperatively high-risk endometrial carcinoma is associated with a poor outcome.

    Science.gov (United States)

    Di Cello, Annalisa; Rania, Erika; Zuccalà, Valeria; Venturella, Roberta; Mocciaro, Rita; Zullo, Fulvio; Morelli, Michele

    2015-11-01

    To evaluate the misdiagnosis between endometrial biopsy and definitive surgical pathology and to assess whether the failure in recognizing preoperatively high-risk endometrial carcinoma (EC) can impact oncological outcomes. A retrospective study was conducted to evaluate patients with EC diagnosed by preoperative endometrial biopsy who subsequently underwent surgical staging between 2006 and 2013 at our institution. In patients with a surgical diagnosis of high-risk EC, histotype and grade change between the endometrial biopsy and surgical specimen (discordance diagnosis) were evaluated and correlated to survival outcomes. Cox's regression model for multivariable analysis was used to evaluate the effect of several variables (age, stage, discordance in diagnosis, co-morbidities, frozen section, extensive surgical staging and adjuvant chemotherapy) on the survival rate. Data from 447 patients were reviewed. Among 109 women with surgical diagnosis of high-risk EC, 35 (32.1%) were preoperatively misdiagnosed. Of these 35 women, 24 (68.6%) cases were upgraded to grade 3, and 11 (3.4%) were upgraded to serous or clear cell type in the definitive specimen. The 5-year overall survival (OS; 70.2 vs. 86.8%; p=0.029), disease-specific survival (DSS; 72.5 vs. 88.2%; p=0.039) and recurrence free survival (RFS; 62.6 vs. 82.5%; p=0.024) were significantly lower in the high-risk EC patients who were preoperatively undiagnosed in the endometrial biopsy compared with patients with an appropriate preoperative histological diagnosis. Controlling for age, stage, co-morbidities, frozen section, extensive surgical staging and adjuvant chemotherapy, multivariable analysis revealed that discordance in diagnosis was associated with poorer survival outcomes. Failure to recognize preoperatively high-risk ECs is associated with worse outcomes. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  13. Parameters Associated with Adverse Fetal Outcomes in Parvovirus B19 Congenital Infection.

    Science.gov (United States)

    Agra, Isabela Karine Rodrigues; Amorim Filho, Antonio Gomes; Lin, Lawrence Hsu; Biancolin, Sckarlet Ernandes; Francisco, Rossana Pulcineli Vieira; Brizot, Maria de Lourdes

    2017-11-01

    Objective  To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion. Methods  This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered non-recovery and categorized as an adverse outcome. Results  The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the non-recovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion. Conclusion  We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

  14. Malnutrition in Hospitalised Older Adults: A Multicentre Observational Study of Prevalence, Associations and Outcomes.

    Science.gov (United States)

    O'Shea, E; Trawley, S; Manning, E; Barrett, A; Browne, V; Timmons, S

    2017-01-01

    Malnutrition is common in older adults and is associated with high costs and adverse outcomes. The prevalence, predictors and outcomes of malnutrition on admission to hospital are not clear for this population. Prospective Cohort Study. Six hospital sites (five public, one private). In total, 606 older adults aged 70+ were included. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded. Socio-demographic and clinical data, including nutritional status (Mini-Nutritional Assessment - short form), was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and new institutionalisation. The mean age was 79.7; 51% were female; 29% were elective admissions; 67% were admitted to a medical specialty. Nutrition scores were available for 602/606; 37% had a 'normal' status, 45% were 'at-risk', and 18% were 'malnourished'. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/ separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition, compared to normal status (p Malnutrition was associated with outcomes including an increased length of stay (p < .001), new institutionalisation (p =<0.001) and in-hospital mortality (p < .001). These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all patients ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.

  15. Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies.

    Science.gov (United States)

    Sinkin, Joshua A; Craig, Wendy Y; Jones, Michael; Pinette, Michael G; Wax, Joseph R

    2018-02-01

    To evaluate perinatal outcomes in singleton and twin pregnancies with pathologically confirmed velamentous cord insertion without vasa previa. This retrospective case-control study included all nonanomalous singleton and twin pregnancies with pathologically confirmed velamentous cord insertion delivered in a single institution between January 1, 2005, and July 1, 2015, and having an ultrasound examination by maternal-fetal medicine. For each case, the next 2 consecutive deliveries matched for gestational age at delivery ± 1 week and, in twins, amnionicity and chorionicity served as controls. Primary outcomes included surgical delivery for a nonreassuring intrapartum fetal heart rate tracing, umbilical arterial cord pH of less than 7.2, 5-minute Apgar score of less than 7, birth weight below the 10th percentile, neonatal intensive care unit admission, fetal or neonatal death, and cord avulsion necessitating manual placental extraction. Outcomes were available for 53 singletons with 103 matched controls and 33 twin pregnancies with 65 matched controls. In singletons, velamentous cord insertion was associated with cord pH of less than 7.2 (odds ratio [OR] 3.5; 95% confidence interval [CI], 1.1-11.2; P = .039), 5-minute Apgar score of less than 7 (OR, 5.3; 95% CI, 0.99-28.1; P = .045), and cord avulsion requiring manual placental extraction (7.5% versus 0%; P = .012). Associations were suggested with increased surgical delivery for a nonreassuring intrapartum fetal heart rate tracing (OR, 2.4; 95% CI, 0.9-6.9; P = .14), birth weight below the 10th percentile (OR, 2.1; 95% CI, 0.8-5.9; P = .21), and fetal or neonatal death (3.8% versus 0%; P = .11). Velamentous cord insertions were also associated with placental abruption in singletons (7.5% versus 0%; P = .013). Among twins, velamentous cord insertion was associated with fetal or neonatal death (9.1% versus 0%; P = .036). Isolated confirmed velamentous cord insertion is associated

  16. The association between adherence and outcome in an Internet intervention for depression.

    Science.gov (United States)

    Fuhr, Kristina; Schröder, Johanna; Berger, Thomas; Moritz, Steffen; Meyer, Björn; Lutz, Wolfgang; Hohagen, Fritz; Hautzinger, Martin; Klein, Jan Philipp

    2018-03-15

    Adherence to Internet interventions is often reported to be rather low and this might adversely impact the effectiveness of these interventions. We investigated if patient characteristics are associated with adherence, and if adherence is associated with treatment outcome in a large RCT of an Internet intervention for depression, the EVIDENT trial. Patients were randomized to either care as usual (CAU) or CAU plus the Internet intervention Deprexis. A total of 509 participants with mild to moderate depressive symptoms were included in the intervention group and of interest for the present study. We assessed depression symptoms pre and post intervention (12 weeks). Patient characteristics, a self-rating screening for mental disorders, attitudes towards online interventions, and quality of life were assessed before randomization. Adherence in this study was good with on average seven hours of usage time and eight number of sessions spent with the intervention. Some of the patient characteristics (age, sex, depressive symptoms, and confidence in the effectiveness of the program) predicted higher number of sessions in different models (explaining in total between 15 and 25% of variance). Older age (β = .16) and higher depressive symptoms (β = .15) were associated with higher usage duration. Higher adherence to the program predicted a greater symptom reduction in depressive symptoms over 12 weeks (number of sessions: β = .13, usage duration: β = .14), however, this prediction could mostly be explained by receiving guidance (β = .27 and .26). Receiving guidance and symptom severity at baseline were confounded since only participants with a moderate symptom severity at baseline received e-mail support. Therefore no firm conclusions can be drawn from the association we observed between baseline symptom severity and usage intensity. We conclude that older age was associated with adherence and adherence was positively associated with outcome. The effects we have found

  17. Seizure burden is independently associated with short term outcome in critically ill children

    Science.gov (United States)

    Payne, Eric T.; Zhao, Xiu Yan; Frndova, Helena; McBain, Kristin; Sharma, Rohit; Hutchison, James S.

    2014-01-01

    Seizures are common among critically ill children, but their relationship to outcome remains unclear. We sought to quantify the relationship between electrographic seizure burden and short-term neurological outcome, while controlling for diagnosis and illness severity. Furthermore, we sought to determine whether there is a seizure burden threshold above which there is an increased probability of neurological decline. We prospectively evaluated all infants and children admitted to our paediatric and cardiac intensive care units who underwent clinically ordered continuous video-electroencephalography monitoring over a 3-year period. Seizure burden was quantified by calculating the maximum percentage of any hour that was occupied by electrographic seizures. Outcome measures included neurological decline, defined as a worsening Paediatric Cerebral Performance Category score between hospital admission and discharge, and in-hospital mortality. Two hundred and fifty-nine subjects were evaluated (51% male) with a median age of 2.2 years (interquartile range: 0.3 days–9.7 years). The median duration of continuous video-electroencephalography monitoring was 37 h (interquartile range: 21–56 h). Seizures occurred in 93 subjects (36%, 95% confidence interval = 30–42%), with 23 (9%, 95% confidence interval = 5–12%) experiencing status epilepticus. Neurological decline was observed in 174 subjects (67%), who had a mean maximum seizure burden of 15.7% per hour, compared to 1.8% per hour for those without neurological decline (P seizure burden threshold of 20% per hour (12 min), both the probability and magnitude of neurological decline rose sharply (P seizure burden. Seizure burden was not associated with mortality (odds ratio: 1.003, 95% confidence interval: 0.99–1.02, P = 0.613). We conclude that in this cohort of critically ill children, increasing seizure burden was independently associated with a greater probability and magnitude of neurological decline. Our

  18. Association between maternal socioeconomic factors and nutritional outcomes in children under 5 years of age.

    Science.gov (United States)

    Géa-Horta, Tatiane; Felisbino-Mendes, Mariana Santos; Ortiz, Renzo Joel Flores; Velasquez-Melendez, Gustavo

    To estimate the association between maternal socioeconomic factors and the occurrence of nutritional outcomes in children under five years of age in a representative sample of the Brazilian population. This was a cross-sectional study that evaluated data from the latest National Survey of Children and Women's Demographics and Health, carried out in Brazil in 2006-2007. Maternal employment and maternal level of schooling were the main exposures. The following nutritional outcomes in children were considered: height/age 2SD for overweight. Generalized estimating equations (GEE) were utilized as the regression method. After adjustments, it was observed that children whose mothers had low level of schooling had a higher chance of having short stature (OR=3.97, 95% CI, 1.23-12.80) and children whose mothers worked outside the home were more likely to have excess weight (OR=1.57, 95% CI, 1.02-2.42). Maternal employment was not associated with short stature in children (OR=1.09, 95% CI, 0.67-1.77). Maternal level of schooling was associated with short stature in children and maternal employment with overweight, indicating the need to take into account the socioeconomic factors when proposing programs and strategies aimed at health and nutrition improvement of children, considering inter-sectoral interventions. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  19. Association of rule of law and health outcomes: an ecological study

    Science.gov (United States)

    Pinzon-Rondon, Angela Maria; Attaran, Amir; Botero, Juan Carlos; Ruiz-Sternberg, Angela Maria

    2015-01-01

    Objectives To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes. Setting Global project. Participants Data set of 96 countries, comprising 91% of the global population. Primary and secondary outcome measures The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice. Results The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries’ level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (pconstitute a structural barrier to health improvement. PMID:26515684

  20. Dialysate temperature of 36 °C: association with clinical outcomes.

    Science.gov (United States)

    Gray, Kathryn S; Cohen, Dena E; Brunelli, Steven M

    2018-02-01

    Dialysate cooling, either individualized based upon patient body temperature, or to a standardized temperature below 37 °C, has been proposed to minimize hemodynamic insults and improve outcomes among hemodialysis patients. However, low dialysate temperatures (35-35.5 °C) are associated with patient discomfort, and individualized dialysate cooling is difficult to operationalize. Here, we tested whether a standardized dialysate temperature of 36 °C (dT36) was associated with improved clinical outcomes compared to the default temperature of 37 °C (dT37). Because patients with known hemodynamic instability may be selectively prescribed dT36, we minimized selection bias by considering only incident adult in-center hemodialysis patients who, between Jan 2011 and Dec 2013 received their first-ever hemodialysis treatment at a large dialysis organization. Exposure status was based on the treatment order for this first-ever treatment. 313 dT36 patients were identified and propensity-score matched (1:5) to 1565 dT37 controls. Death, hospitalization, and missed hemodialysis treatments were considered from the date of first-ever hemodialysis treatment until the earliest of death, loss to follow-up, crossover (month in which prescribed dialysate temperature was consistent with patient's exposure group for 36 °C. Individualized dialysate cooling may provide a more reliable approach to achieve the hemodynamic benefits associated with reduced dialysate temperature.

  1. Factors Associated with Klebsiella Bacteremia and Its Outcome in Under-Five Children Admitted with Diarrhea

    Directory of Open Access Journals (Sweden)

    Shamima Akhter

    2016-01-01

    Full Text Available Although Klebsiella bacteremia in children is perceived to be associated with fatal consequences, data are scarce on those children presenting with diarrhea. We evaluated the factors associated with Klebsiella bacteremia in such children. In this retrospective chart analysis, data of all diarrheal children was retrieved from electronic medical record system (named as SHEBA of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b, from January 1, 2010, to December 31, 2012, who had their blood culture done. This was a study having a case-control design where comparison of clinical and laboratory characteristics was done among children with Klebsiella bacteremia (cases = 30 and those without any bacteraemia (controls = 90. Controls were selected randomly. The cases more often had fatal outcome (p<0.001. In logistic regression analysis, after adjusting for potential confounders such as young age, severe dehydration, severe wasting, abnormal mentation, hypotension, and fast breathing, the cases were independently associated with hospital-acquired infection and positive stool growth (for all, p<0.05. The study highlights the importance of obtaining blood cultures in hospitalized children under five years old with diarrheal illness in the presence of either hospital-acquired infection or positive stool culture to have better outcome.

  2. Neurological outcome of patients with cryopyrin-associated periodic syndrome (CAPS).

    Science.gov (United States)

    Mamoudjy, Nafissa; Maurey, Hélène; Marie, Isabelle; Koné-Paut, Isabelle; Deiva, Kumaran

    2017-02-14

    To assess the neurological involvement and outcome, including school and professional performances, of adults and children with cryopyrin-associated periodic syndrome (CAPS). In this observational study, patients with genetically proven CAPS and followed in the national referral centre for autoinflammatory diseases at Bicêtre hospital were assessed. Neurological manifestations, CSF data and MRI results at diagnosis and during follow-up were analyzed. Twenty-four patients (15 adults and 9 children at diagnosis) with CAPS were included. The median age at disease onset was 0 year (birth) [range 0-14], the median age at diagnosis was 20 years [range 0-53] and the mean duration of follow-up was 10.4 ± 2 years. Neurological involvement at diagnosis, mostly headaches and hearing loss, was noted in 17 patients (71%). Two patients of the same family had abnormal brain MRI. A439V mutation is frequently associated with a non-neurological phenotype while R260W mutation tends to be associated with neurological involvement. Eleven adult patients (61%) and 3 children (50%) underwent school difficulties. Neurological involvement is frequent in patients with CAPS and the majority of patients presented difficulties in school performances with consequences in the professional outcome during adulthood. Further studies in larger cohorts of children with CAPS focusing in intellectual efficiency and school performances are necessary.

  3. The expression of podoplanin is associated with poor outcome in cutaneous squamous cell carcinoma.

    Science.gov (United States)

    Cañueto, Javier; Cardeñoso-Álvarez, Ester; Cosano-Quero, Adriana; Santos-Briz, Ángel; Fernández-López, Emilia; Pérez-Losada, Jesús; Román-Curto, Concepción

    2017-02-01

    Cutaneous squamous cell carcinoma (CSCC) is the second most frequent cancer in humans and can be both locally invasive and metastatic at distant sites. While research efforts have been made to predict poor outcome of CSCC, there is a lack of knowledge regarding molecular markers. Podoplanin has been associated with poor outcome in several types of cancer including CSCC, but this is controversial and only a few studies have evaluated the prognostic implications of podoplanin in the development of this tumor. We evaluated podoplanin expression in a series of 94 CSCCs, and searched for associations between podoplanin expression and histopathological characteristics and with events of poor clinical evolution of the disease. Podoplanin expression was observed in 48.9% of the cases and the expression was considered moderate to intense in 19 of the cases. Moderate/intense podoplanin was associated with infiltrative growth pattern, desmoplasia, lymphovascular invasion, higher risk of nodal progression (NP) and short disease-free survival, specifically with a short latency to NP. This article provides evidence supporting the implication of podoplanin expression as a marker of bad prognosis of CSCC. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Thicker endometrial linings are associated with better IVF outcomes: a cohort of 6331 women.

    Science.gov (United States)

    Holden, Emily C; Dodge, Laura E; Sneeringer, Rita; Moragianni, Vasiliki A; Penzias, Alan S; Hacker, Michele R

    2017-06-18

    Our objective was to determine if a correlation exists between endometrial thickness measured on the day of ovulation trigger during an in vitro fertilization (IVF) cycle and pregnancy outcomes among non-cancelled cycles. We performed a retrospective cohort study looking at 6331 women undergoing their first, fresh autologous IVF cycle from 1 May 2004 to 31 December 2012 at Boston IVF (Waltham, MA). Our primary outcome was the risk ratio (RR) of live birth and positive β-hCG. We found that thicker endometrial linings were associated with positive β-hCG and live birth rates. For each additional millimetre of endometrial thickness, we found a statistically significant increased risk of positive β-hCG (adjusted RR: 1.14; 95% CI: 1.09-1.18) and live birth (RR: 1.08; 95% CI: 1.05-1.11). There was no association between endometrial thickness and miscarriage (RR: 0.99; 95% CI: 0.91-1.07). Similar results were seen when categorizing endometrial thickness. Compared with an endometrial thickness >7 to <11 mm, the likelihood of a live birth was significantly higher for an endometrial thickness ≥11 mm (adjusted RR: 1.23; 95% CI: 1.11-1.37) and significantly lower for the ≤7 mm group (adjusted RR: 0.64; 95% CI: 0.45-0.90). In conclusion, thicker endometrial linings were associated with increased pregnancy and live birth rates.

  5. Initial management of pneumonia and sepsis: factors associated with improved outcome.

    Science.gov (United States)

    Menéndez, R; Torres, A; Reyes, S; Zalacain, R; Capelastegui, A; Aspa, J; Borderías, L; Martín-Villasclaras, J J; Bello, S; Alfageme, I; de Castro, F R; Rello, J; Molinos, L; Ruiz-Manzano, J

    2012-01-01

    Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.

  6. Fetal first trimester growth is not associated with kidney outcomes in childhood.

    Science.gov (United States)

    Bakker, Hanneke; Gaillard, Romy; Hofman, Albert; Reiss, Irwin K; Steegers, Eric A P; Jaddoe, Vincent W V

    2017-04-01

    Impaired fetal growth is associated with increased risks of kidney diseases in later life. Because human development rates are highest during the first trimester, this trimester may be a particularly critical period for kidney outcomes. We have therefore examined the association of fetal first trimester growth with kidney outcomes in childhood. This study was embedded in a prospective population-based cohort study among 1176 pregnant women and their children. We used fetal first trimester crown-length as the growth measure among mothers with a regular menstrual cycle and a known first day of the last menstrual period. At the childhood age of 6 (median 5.7-6.8) years, we measured combined kidney volume, microalbuminuria and estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C concentrations. No consistent associations of fetal first trimester crown-rump length with childhood combined kidney volume, eGFR and microalbuminuria were observed. Compared to children with a fetal first trimester crown-rump length in the highest quintile, those in the lowest quintile had a larger childhood combined kidney volume (difference 5.32 cm 3 , 95 % confidence interval 1.06 to 9.57), but no differences in kidney function. Our results do not support the hypothesis that fetal first trimester growth restriction affects kidney size and function in childhood. Further studies are needed to focus on critical periods in early life for kidney function and disease in later life.

  7. Association between maternal socioeconomic factors and nutritional outcomes in children under 5 years of age,

    Directory of Open Access Journals (Sweden)

    Tatiane Géa-Horta

    Full Text Available Abstract Objective: To estimate the association between maternal socioeconomic factors and the occurrence of nutritional outcomes in children under five years of age in a representative sample of the Brazilian population. Methods: This was a cross-sectional study that evaluated data from the latest National Survey of Children and Women's Demographics and Health, carried out in Brazil in 2006-2007. Maternal employment and maternal level of schooling were the main exposures. The following nutritional outcomes in children were considered: height/age 2SD for overweight. Generalized estimating equations (GEE were utilized as the regression method. Results: After adjustments, it was observed that children whose mothers had low level of schooling had a higher chance of having short stature (OR = 3.97, 95% CI, 1.23-12.80 and children whose mothers worked outside the home were more likely to have excess weight (OR = 1.57, 95% CI, 1.02-2.42. Maternal employment was not associated with short stature in children (OR = 1.09, 95% CI, 0.67-1.77. Conclusion: Maternal level of schooling was associated with short stature in children and maternal employment with overweight, indicating the need to take into account the socioeconomic factors when proposing programs and strategies aimed at health and nutrition improvement of children, considering inter-sectoral interventions.

  8. Fetal cardiac axis in tetralogy of Fallot: associations with prenatal findings, genetic anomalies and postnatal outcome.

    Science.gov (United States)

    Zhao, Y; Edington, S; Fleenor, J; Sinkovskaya, E; Porche, L; Abuhamad, A

    2017-07-01

    To compare prenatal findings, associated genetic anomalies and postnatal outcome in fetuses with tetralogy of Fallot (TOF) with normal cardiac axis (CAx) and those with abnormal CAx. In this retrospective cohort study, 85 cases diagnosed with TOF by prenatal ultrasound at our clinic between 2005 and 2015 were reviewed. Follow-up ultrasound and postnatal outcome were available for 68 cases. One case complicated with absent pulmonary valve syndrome and a further seven cases diagnosed postnatally with anomalies other than TOF were excluded from the study. The remaining 60 cases of postnatally confirmed TOF were divided according to CAx into two groups: those with normal CAx (n = 33) and those with abnormal CAx (n = 27). CAx was defined as the angle between the interventricular septum and midline of the fetal thorax at the level of the four-chamber view. CAx > 65° or < 25° was considered abnormal. Prenatal sonographic findings, associated genetic anomalies and postnatal outcome were compared between the two groups. Fetuses with TOF and abnormal CAx were more likely to have pulmonary atresia (40.7% vs 15.2%; P = 0.026) and right-sided aortic arch (48.1% vs 21.2%; P = 0.028) than those with normal CAx. Postnatal death occurred in 30.4% of infants with abnormal CAx vs 6.5% with normal CAx (P = 0.028). Incidence of tested genetic anomalies was similar between the two groups. In fetuses with TOF, abnormal CAx is associated with the presence of pulmonary atresia, right-sided aortic arch and a higher risk of postnatal death. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  9. Cellular islet autoimmunity associates with clinical outcome of islet cell transplantation.

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    Volkert A L Huurman

    2008-06-01

    Full Text Available Islet cell transplantation can cure type 1 diabetes (T1D, but only a minority of recipients remains insulin-independent in the following years. We tested the hypothesis that allograft rejection and recurrent autoimmunity contribute to this progressive loss of islet allograft function.Twenty-one T1D patients received cultured islet cell grafts prepared from multiple donors and transplanted under anti-thymocyte globulin (ATG induction and tacrolimus plus mycophenolate mofetil (MMF maintenance immunosuppression. Immunity against auto- and alloantigens was measured before and during one year after transplantation. Cellular auto- and alloreactivity was assessed by lymphocyte stimulation tests against autoantigens and cytotoxic T lymphocyte precursor assays, respectively. Humoral reactivity was measured by auto- and alloantibodies. Clinical outcome parameters--including time until insulin independence, insulin independence at one year, and C-peptide levels over one year--remained blinded until their correlation with immunological parameters. All patients showed significant improvement of metabolic control and 13 out of 21 became insulin-independent. Multivariate analyses showed that presence of cellular autoimmunity before and after transplantation is associated with delayed insulin-independence (p = 0.001 and p = 0.01, respectively and lower circulating C-peptide levels during the first year after transplantation (p = 0.002 and p = 0.02, respectively. Seven out of eight patients without pre-existent T-cell autoreactivity became insulin-independent, versus none of the four patients reactive to both islet autoantigens GAD and IA-2 before transplantation. Autoantibody levels and cellular alloreactivity had no significant association with outcome.In this cohort study, cellular islet-specific autoimmunity associates with clinical outcome of islet cell transplantation under ATG-tacrolimus-MMF immunosuppression. Tailored immunotherapy targeting cellular

  10. Child advocacy center multidisciplinary team decision and its association to child protective services outcomes.

    Science.gov (United States)

    Brink, Farah W; Thackeray, Jonathan D; Bridge, Jeffrey A; Letson, Megan M; Scribano, Philip V

    2015-08-01

    Limited studies exist evaluating the multidisciplinary team (MDT) decision-making process and its outcomes. This study evaluates the MDT determination of the likelihood of child sexual abuse (CSA) and its association to the outcome of the child protective services (CPS) disposition. A retrospective cohort study of CSA patients was conducted. The MDT utilized an a priori Likert rating scale to determine the likelihood of abuse. Subjects were dichotomized into high versus low/intermediate likelihood of CSA as determined by the MDT. Clinical and demographic characteristics were compared based upon MDT and CPS decisions. Fourteen hundred twenty-two patients were identified. A high likelihood for abuse was determined in 997 cases (70%). CPS substantiated or indicated the allegation of CSA in 789 cases (79%, Kappa 0.54). Any CSA disclosure, particularly moderate risk disclosure (AOR 59.3, 95% CI 26.50-132.80) or increasing total number of CSA disclosures (AOR 1.3, 95% CI 1.11-1.57), was independently associated with a high likelihood for abuse determination. Specific clinical features associated with discordant cases in which MDT determined high likelihood for abuse and CPS did not substantiate or indicate CSA included being white or providing a low risk CSA disclosure or other non-CSA disclosure. MDT determination regarding likelihood of abuse demonstrated moderate agreement to CPS disposition outcome. CSA disclosure is predictive of the MDT determination for high likelihood of CSA. Agreement between MDT determination and CPS protection decisions appear to be driven by the type of disclosures, highlighting the importance of the forensic interview in ensuring appropriate child protection plans. Published by Elsevier Ltd.

  11. The association of neighborhood social capital and ethnic (minority density with pregnancy outcomes in the Netherlands.

    Directory of Open Access Journals (Sweden)

    Vera L N Schölmerich

    Full Text Available BACKGROUND: Perinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, 'Western' women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age and preterm birth. We focused on the influence of neighborhood social capital--measured as informal socializing and social connections between neighbors--as well as ethnic (minority density. METHODS: Data on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000-2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth. RESULTS: We found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority density was stronger than that of neighborhood social capital. Moreover, ethnic (minority density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5 as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99. CONCLUSIONS: Our results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority density seems to be a protective factor for non-Western ethnic minority women

  12. The association of neighborhood social capital and ethnic (minority) density with pregnancy outcomes in the Netherlands.

    Science.gov (United States)

    Schölmerich, Vera L N; Erdem, Özcan; Borsboom, Gerard; Ghorashi, Halleh; Groenewegen, Peter; Steegers, Eric A P; Kawachi, Ichiro; Denktaş, Semiha

    2014-01-01

    Perinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, 'Western' women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age) and preterm birth. We focused on the influence of neighborhood social capital--measured as informal socializing and social connections between neighbors--as well as ethnic (minority) density. Data on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000-2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth. We found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority) density was stronger than that of neighborhood social capital. Moreover, ethnic (minority) density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5) as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99). Our results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority) density seems to be a protective factor for non-Western ethnic minority women, but not for Western women. This helps explain the

  13. Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes.

    Science.gov (United States)

    Reznik, Michael E; Schmidt, J Michael; Mahta, Ali; Agarwal, Sachin; Roh, David J; Park, Soojin; Frey, Hans Peter; Claassen, Jan

    2017-06-01

    Agitated delirium is frequent following acute brain injury, but data are limited in patients with subarachnoid hemorrhage (SAH). We examined incidence, risk factors, and consequences of agitation in these patients in a single-center retrospective study. We identified all patients treated with antipsychotics or dexmedetomidine from a prospective observational cohort of patients with spontaneous SAH. Agitation was confirmed by chart review. Outcomes were assessed at 12 months using the modified Rankin Scale (mRS), Telephone Interview for Cognitive Status (TICS), and Lawton IADL (Instrumental Activities of Daily Living) scores. Independent predictors were identified using logistic regression. From 309 SAH patients admitted between January 2011 and December 2015, 52 (17 %) developed agitation, frequently in the first 72 h (50 %) and in patients with Hunt-Hess grades 3-4 (12 % of grades 1-2, 28 % of grades 3-4, 8 % of grade 5). There was also a significant association between agitation and a history of cocaine use or prior psychiatric diagnosis. Agitated patients were more likely to develop multiple hospital complications; and in half of these patients, complications were diagnosed within 24 h of agitation onset. Agitation was associated with IADL impairment at 12 months (Lawton >8; p = 0.03, OR 2.7, 95 % CI, 1.1-6.8) in non-comatose patients (Hunt-Hess 1-4), but not with functional outcome (mRS >3), cognitive impairment (TICS ≤30), or ICU/hospital length of stay after controlling for other predictors. Agitation occurs frequently after SAH, especially in non-comatose patients with higher clinical grades. It is associated with the development of multiple hospital complications and may have an independent impact on long-term outcomes.

  14. The Association of Neighborhood Social Capital and Ethnic (Minority) Density with Pregnancy Outcomes in the Netherlands

    Science.gov (United States)

    Schölmerich, Vera L. N.; Erdem, Özcan; Borsboom, Gerard; Ghorashi, Halleh; Groenewegen, Peter; Steegers, Eric A. P.; Kawachi, Ichiro; Denktaş, Semiha

    2014-01-01

    Background Perinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, ‘Western’ women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age) and preterm birth. We focused on the influence of neighborhood social capital – measured as informal socializing and social connections between neighbors – as well as ethnic (minority) density. Methods Data on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000–2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth. Results We found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority) density was stronger than that of neighborhood social capital. Moreover, ethnic (minority) density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5) as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99). Conclusions Our results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority) density seems to be a protective factor for non-Western ethnic minority women, but

  15. Association between environmental contaminants and health outcomes in indigenous populations of the Circumpolar North

    DEFF Research Database (Denmark)

    Singh, Kavita; Bjerregaard, Peter; Chan, Hing Man

    2014-01-01

    populations. DESIGN: A literature search was conducted in OVID Medline (1946-January 2014) using search terms that combined concepts of contaminant and indigenous populations in the Arctic. No language or date restrictions were applied. The reference lists of review articles were hand-searched. RESULTS...... and health outcomes. The following research gaps should be addressed in future studies: association of contaminants and health in other Arctic regions (i.e. Inuvialuit Settlement Region, Nunavut, Nunatsiavut, Alaska, European North and Russian North); assessment of contaminants on chronic diseases; inclusion...

  16. Obesity in Mexico: prevalence, comorbidities, associations with patient outcomes, and treatment experiences

    OpenAIRE

    DiBonaventura, Marco D; Meincke, Henrik; Le Lay, Agathe; Fournier, Janine; Bakker, Erik; Ehrenreich, Allison

    2017-01-01

    Marco D DiBonaventura,1 Henrik Meincke,2 Agathe Le Lay,2 Janine Fournier,2 Erik Bakker,3 Allison Ehrenreich1 1Kantar Health, New York, NY, USA; 2Novo Nordisk, Copenhagen, Denmark; 3Novo Nordisk, Mexico City, Mexico Objective: The goal of this study is to investigate obesity and its concomitant effects including the prevalence of comorbidities, its association with patient-reported outcomes and costs, and weight loss strategies in a sample of Mexican adults. Methods: Mexican adults (N=2,511) ...

  17. Auditory verbal habilitation is associated with improved outcome for children with cochlear implant

    DEFF Research Database (Denmark)

    Percy-Smith, Lone; Tønning, Tenna Lindbjerg; Josvassen, Jane Lignel

    2018-01-01

    subjects, respectively. The two cohorts had different speech and language intervention following cochlear implantation, i.e. standard habilitation vs. auditory verbal (AV) intervention. Three tests of speech and language were applied covering language areas of receptive and productive vocabulary...... and language levels. CONCLUSION: Compared to standard intervention, AV intervention is associated with improved outcome for children with CI. Based on this finding, we recommend that all children with HI should be offered this intervention and it is, therefore, highly relevant when National boards of Health...

  18. Identification of novel biomarkers associated with poor patient outcomes in invasive breast carcinoma

    DEFF Research Database (Denmark)

    Canevari, Renata A; Marchi, Fabio A; Domingues, Maria A C

    2016-01-01

    Breast carcinoma (BC) corresponds to 23 % of all cancers in women, with 1.38 million new cases and 460,000 deaths worldwide annually. Despite the significant advances in the identification of molecular markers and different modalities of treatment for primary BC, the ability to predict its...... of patients with BC (47 with good outcomes and eight that presented metastasis). The expression of BCL2-associated agonist of cell death (BAD) protein was determined in 1276 BC tissue samples by immunohistochemistry and was consistent with the reduced BAD mRNA expression levels in metastatic cases...

  19. Measures of Maternal Socioeconomic Status in Yemen and Association with Maternal and Child Health Outcomes.

    Science.gov (United States)

    Alosaimi, Abdullah N; Luoto, Riitta; Al Serouri, Abdul Wahed; Nwaru, Bright I; Mouniri, Halima

    2016-02-01

    Reliable measurement of socioeconomic status (SES) in health research requires extensive resources and can be challenging in low-income countries. We aimed to develop a set of maternal SES indices and investigate their associations with maternal and child health outcomes in rural Yemen. We applied factor analysis based on principal component analysis extraction to construct the SES indices by capturing household attributes for 7295 women of reproductive age. Data were collected from a sub-national household survey conducted in six rural districts in four Yemeni provinces in 2008-2009. Logistic regression models were fitted to estimate the associations between the SES indices and maternal mortality, spontaneous abortion, stillbirth, neonatal and infant mortality. Three SES indices (wealth, educational and housing quality) were extracted, which together explained 54 % of the total variation in SES. Factor scores were derived and categorized into tertiles. After adjusting for potential confounding factors, higher tertiles of all the indices were inversely associated with spontaneous abortion. Higher tertiles of wealth and educational indices were inversely associated with stillbirth, neonatal and infant mortality. None of the SES indices was strongly associated with maternal mortality. By subjecting a number of household attributes to factor analysis, we derived three SES indices (wealth, educational, and housing quality) that are useful for maternal and child health research in rural Yemen. The indices were worthwhile in predicting a number of maternal and child health outcomes. In low-income settings, failure to account for the multidimensionality of SES may underestimate the influence of SES on maternal and child health.

  20. Factors associated with outcome of endovascular treatment of iliac occlusive disease: a single-center experience

    Directory of Open Access Journals (Sweden)

    Rafael de Athayde Soares

    2018-04-01

    Full Text Available Abstract Background Endovascular treatment (ET of iliac occlusive disease (IOD is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA, between January 2009 and January 2015. Patients with critical limb ischemia or incapacitating claudication were included. Results In total, 48 IA procedures were performed in 46 patients, with an initial technical success rate of 95.83%. Failure occurred in two patients, who were excluded, leaving 44 patients and 46 IA. The primary patency, secondary patency, limb salvage, and survival rates at 1200 days were 88%, 95.3%, 86.3%, and 69.9%, respectively. Univariate and multivariate Cox regression revealed that the primary patency rate was significantly worse in patients with TASC type C/D than in patients with TASC type A/B (p = 0.044. Analysis of factors associated with major amputation using Cox regression showed that the rate of limb loss was greater in patients with TASC type C/D (p = 0.043. Male gender was associated with reduced survival (p = 0.011. Conclusions TASC type C/D was associated with a higher number of reinterventions and with worse limb loss and primary patency rates. Male gender was associated with a worse survival rate after ET of IOD.

  1. The Association Between Secondhand Harms From Alcohol and Mental Health Outcomes Among Postsecondary Students.

    Science.gov (United States)

    Thompson, Kara; Davis-MacNevin, Parnell; Teehan, Michael; Stewart, Sherry

    2017-01-01

    There is a paucity of research on the prevalence and consequences of secondhand harms from alcohol. The current study (a) investigated whether secondhand harms can be clustered into latent factors that reflect distinct but related types of harms and (b) examined the associations between experiencing secondhand harms and mental health outcomes, including anxiety, depression, and subjective mental well-being, among first-year Canadian postsecondary students. The moderating effect of living arrangement (i.e., living on campus or not) on the associations was also tested. The sample included 1,885 first-year undergraduate students (49.8% female; mean age = 18.31 years) from three Canadian universities. Exploratory and confirmatory factor analyses were used to determine the factor structure of the harms measure. Path analysis was used to assess the association between harms and mental health outcomes. Models accounted for age, sex, and frequency of heavy drinking. Seventy-one percent of the sample reported experiencing at least one type of secondhand harm. The harms examined clustered into two distinct but related factors: strains (e.g., interrupted sleep) and threats (e.g., being harassed or insulted). Both threats and strains were associated with higher levels of anxiety and depression and poorer subjective well-being. Associations were stronger for threats and did not differ by living arrangement. Experiencing secondhand harms from alcohol, particularly threats, may have negative implications for student mental health over and above students' own drinking. Programs and policies on university campuses targeting both alcohol use and mental health should consider how to reduce both the prevalence and impact of secondhand harms from alcohol on students.

  2. Non-HLA gene polymorphisms in juvenile idiopathic arthritis: associations with disease outcome.

    Science.gov (United States)

    Alberdi-Saugstrup, M; Enevold, C; Zak, M; Nielsen, S; Nordal, E; Berntson, L; Fasth, A; Rygg, M; Müller, K

    2017-09-01

    To test the hypothesis that non-HLA single-nucleotide polymorphisms (SNPs) associated with the risk of juvenile idiopathic arthritis (JIA) are risk factors for an unfavourable disease outcome at long-term follow-up. The Nordic JIA cohort is a prospective multicentre study cohort of patients from the Nordic countries. In all, 193 patients met the inclusion criteria of having an 8 year follow-up assessment and available DNA sample. Seventeen SNPs met the inclusion criteria of having significant associations with JIA in at least two previous independent study cohorts. Clinical endpoints were disease remission, actively inflamed joints and joints with limitation of motion (LOM), articular or extra-articular damage, and history of uveitis. Evidence of associations between genotypes and endpoints were found for STAT4, ADAD1-IL2-IL21, PTPN2, and VTCN1 (p = 0.003-0.05). STAT4_rs7574865 TT was associated with the presence of actively inflamed joints [odds ratio (OR) 20.6, 95% confidence interval (CI) 2.2-> 100, p = 0.003] and extra-articular damage (OR 7.9, 95% CI 1-56.6, p = 0.057). ADAD1_rs17388568 AA was associated with a lower risk of having joints with LOM (OR 0.1, 95% CI 0-0.55, p = 0.016). PTPN2_rs1893217 CC was associated with a lower risk of having joints with LOM (OR 0.2, 95% CI 0-0.99, p = 0.026), while VTCN1_rs2358820 GA was associated with uveitis (OR 3.5, 95% CI 1-12.1, p = 0.029). This exploratory study, using a prospectively followed JIA cohort, found significant associations between long-term outcome and SNPs, all previously associated with development of JIA and involved in immune regulation and signal transduction in immune cells.

  3. Molecular subtypes of diffuse large B cell lymphoma are associated with distinct pathogenic mechanisms and outcomes.

    Science.gov (United States)

    Chapuy, Bjoern; Stewart, Chip; Dunford, Andrew J; Kim, Jaegil; Kamburov, Atanas; Redd, Robert A; Lawrence, Mike S; Roemer, Margaretha G M; Li, Amy J; Ziepert, Marita; Staiger, Annette M; Wala, Jeremiah A; Ducar, Matthew D; Leshchiner, Ignaty; Rheinbay, Ester; Taylor-Weiner, Amaro; Coughlin, Caroline A; Hess, Julian M; Pedamallu, Chandra S; Livitz, Dimitri; Rosebrock, Daniel; Rosenberg, Mara; Tracy, Adam A; Horn, Heike; van Hummelen, Paul; Feldman, Andrew L; Link, Brian K; Novak, Anne J; Cerhan, James R; Habermann, Thomas M; Siebert, Reiner; Rosenwald, Andreas; Thorner, Aaron R; Meyerson, Matthew L; Golub, Todd R; Beroukhim, Rameen; Wulf, Gerald G; Ott, German; Rodig, Scott J; Monti, Stefano; Neuberg, Donna S; Loeffler, Markus; Pfreundschuh, Michael; Trümper, Lorenz; Getz, Gad; Shipp, Margaret A

    2018-04-30

    Diffuse large B cell lymphoma (DLBCL), the most common lymphoid malignancy in adults, is a clinically and genetically heterogeneous disease that is further classified into transcriptionally defined activated B cell (ABC) and germinal center B cell (GCB) subtypes. We carried out a comprehensive genetic analysis of 304 primary DLBCLs and identified low-frequency alterations, captured recurrent mutations, somatic copy number alterations, and structural variants, and defined coordinate signatures in patients with available outcome data. We integrated these genetic drivers using consensus clustering and identified five robust DLBCL subsets, including a previously unrecognized group of low-risk ABC-DLBCLs of extrafollicular/marginal zone origin; two distinct subsets of GCB-DLBCLs with different outcomes and targetable alterations; and an ABC/GCB-independent group with biallelic inactivation of TP53, CDKN2A loss, and associated genomic instability. The genetic features of the newly characterized subsets, their mutational signatures, and the temporal ordering of identified alterations provide new insights into DLBCL pathogenesis. The coordinate genetic signatures also predict outcome independent of the clinical International Prognostic Index and suggest new combination treatment strategies. More broadly, our results provide a roadmap for an actionable DLBCL classification.

  4. Linezolid is Associated with Improved Early Outcomes of Childhood Tuberculous Meningitis.

    Science.gov (United States)

    Li, Huimin; Lu, Jie; Liu, Jinrong; Zhao, Yuhong; Ni, Xin; Zhao, Shunying

    2016-06-01

    Linezolid serves as an important component for the treatment of drug-resistant tuberculosis although there is little published data about linezolid use in children, especially in childhood tuberculous meningitis (TBM). In this study, we retrospectively reviewed records of childhood TBM patients who started treatment between January 2012 and August 2014. A total of 86 childhood TBM patients younger than 15 years old were enrolled. Out of 86 children, 36 (41.9%) received the regimen containing linezolid. Thirty-two (88.9%) of 36 linezolid-treated cases had favorable outcomes, and 35 (70.0%) cases were successfully treated in the control group. The frequency of favorable outcome of linezolid group was significantly higher than that of control group (P = 0.037). In addition, compared with cases with fever clearance time of 4 weeks (P = 0.000) than linezolid group. Furthermore, there was no significant difference in the frequency of adverse events between the two regimens (P = 0.896). In addition, the patients with adverse events were more likely to have treatment failure, the P value of which was 0.008. Our data demonstrate that linezolid improves early outcome of childhood TBM. The low frequency of linezolid-associated adverse effects highlights the promising prospects of its use for treatment of childhood TBM.

  5. Association of basal serum androgen levels with ovarian response and ICSI cycle outcome.

    Science.gov (United States)

    Abide Yayla, C; Ozkaya, E; Kayatas Eser, S; Sanverdi, I; Devranoglu, B; Kutlu, T

    2018-05-01

    The purpose of this study was to assess the predictive value of basal serum testosterone (T) and dehydroepiandrosterone sulfate (DHEAS) levels during follicular phase for ovarian response and outcome in intracytoplasmic sperm injection (ICSI) cycles of women with diminished ovarian reserve. We prospectively gathered data of basal serum androgen levels and ICSI cycle characteristics of 120 women with diminished ovarian reserve. Association of basal serum T and DHEAS levels with ovarian response was analyzed. Basal T and DHEAS levels were similar between pregnant and non-pregnant cases (P > 0.05). There were significant differences between groups with and without successful embryo implantation in terms of serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), gonadotropin starting and total dose, and peak estradiol level (P stimulation due to unresponsiveness (n = 26, 21.7%), no oocyte at oocyte pickup (n = 11, 9.2%), no mature oocyte (n = 6, 5%), and failure of fertilization or embryo development (n = 15, 12.5%). Basal androgen levels were not significant predictors for any of the cycle outcome. AMH level was a significant predictor for failure of fertilization or embryo development (AUC 0.722, P = 0.01) and cancelation of stimulation (AUC 0.801, P stimulation (AUC 0.774, P basal T and DHEAS levels have no value in predicting any of the cycle outcome parameters.

  6. Therapist adherence is associated with outcome in cognitive-behavioral therapy for bulimia nervosa.

    Science.gov (United States)

    Folke, Sofie; Daniel, Sarah I F; Gondan, Matthias; Lunn, Susanne; Tækker, Louise; Poulsen, Stig

    2017-06-01

    Studies of therapist adherence in relation to treatment outcome have produced mixed results. The aim of the present study was to investigate change in therapist adherence to cognitive-behavioral therapy (CBT) for bulimia nervosa over time, and to investigate the relationship between adherence and client outcome in early, middle, and late phases of treatment. Thirty-six clients received the focused form of "enhanced" CBT (CBT-E) for bulimia nervosa. Trained observers rated audiotapes of 92 full-length therapy sessions from early (Session 3), middle (Session 11), and late phases (Session 20) of treatment using the Cognitive-Behavioral Therapy Treatment Protocol Adherence Scale. Change in adherence across the 3 treatment phases was examined using multilevel analysis. The relationship between early, middle, and late adherence levels and end-of-treatment binging frequency was examined using multilevel Poisson regression analysis. Adherence decreased significantly over the course of treatment. Higher levels of therapist adherence in early and middle phases of treatment were associated with reduced binging frequency, whereas higher levels of adherence measured late in treatment was not. Results indicate that therapists' adherence to the CBT-E treatment protocol decreases over time and that high levels of protocol adherence in early and middle phases of treatment are more important for positive client outcomes than high levels of adherence in the end of treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  7. Association Between Race, Neighborhood, and Medicaid Enrollment and Outcomes in Medicare Home Health Care.

    Science.gov (United States)

    Joynt Maddox, Karen E; Chen, Lena M; Zuckerman, Rachael; Epstein, Arnold M

    2018-02-01

    More than 3 million Medicare beneficiaries use home health care annually, yet little is known about how vulnerable beneficiaries fare in the home health setting. This is particularly important given the recent launch of Medicare's Home Health Value-Based Purchasing model. The objective of this study was to determine odds of adverse clinical outcomes associated with dual enrollment in Medicaid and Medicare as a marker of individual poverty, residence in a low-income ZIP code tabulation area (ZCTA), and black race. Retrospective observational study using individuals-level logistic regression. Home health care. Fee-for-service Medicare beneficiaries from 2012 to 2014. Thirty- and 60-day clinical outcomes, including readmissions, admissions, and emergency department (ED) use. Home health agencies serving a high proportion of dually enrolled, low-income ZCTA, or black beneficiaries were less often high-quality. Dually-enrolled, low-income ZCTA, and Black beneficiaries receiving home health care after hospitalization had higher risk-adjusted odds of 30-day readmission (odds ratio [OR] = 1.08, P home health care without preceding hospitalization had higher 60-day admission (OR = 1.06, P home health services who are dually enrolled, live in a low-income neighborhood, or are black have higher rates of adverse clinical outcomes. These populations may be an important target for quality improvement under Home Health Value-Based Purchasing. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  8. Association between periodontal disease and adverse pregnancy outcomes in a cohort of pregnant women in Jordan.

    Science.gov (United States)

    Alchalabi, H A; Al Habashneh, R; Jabali, O Al; Khader, Y S

    2013-01-01

    The relationship between periodontal disease (PD) and adverse pregnancy outcomes remain unclear. The authors' objective was to assess the risk of adverse pregnancy outcomes in Jordanian women with periodontal disease compared to those without. Between April 2009 and June 2010, 277 pregnant women with no systemic diseases at gestational age Pregnancy outcomes were obtained by phone contact and review of medical records. The incidence of periodontal disease in the pregnant women enrolled was 31%. Women with PD were at higher risk for developing preeclampsia (PE), preterm birth (PB), and low birth weight (LBW). The rate of PE in women with PD was 18.6% compared to 7.3% in the control group (p = 0.005) (OR = 2.7, 95% CI: 1.2, 6.0). The OR for PB was (4.4, 95% CI: 1.7, 11.7) and for LBW was (3.5, 95% CI: 1.6, 7.5). PD is associated with increased risk of PE, PB, and LBW in healthy Jordanian women.

  9. Victorian Audit of Surgical Mortality is associated with improved clinical outcomes.

    Science.gov (United States)

    Beiles, C Barry; Retegan, Claudia; Maddern, Guy J

    2015-11-01

    Improved outcomes are desirable results of clinical audit. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM) and the Victorian Admitted Episodes Dataset (VAED) to highlight specific areas of clinical improvement and reduction in mortality over the duration of the audit process. This study used retrospective, observational data from VASM and VAED. VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Aggregated VAED data were supplied by the Victorian Department of Health. Assessment of outcomes was performed using chi-squared trend analysis over successive annual audit periods. Because initial collection of data was incomplete in the recruitment phase, statistical analysis was confined to the last 3-year period, 2010-2013. A 20% reduction in surgical mortality over the past 5 years has been identified from the VAED data. Progressive increase in both surgeon and hospital participation, significant reduction in both errors in management as perceived by assessors and increased direct consultant involvement in cases returned to theatre have been documented. The benefits of VASM are reflected in the association with a reduction of mortality and adverse clinical outcomes, which have clinical and financial benefits. It is a purely educational exercise and continued participation in this audit will ensure the highest standards of surgical care in Australia. This also highlights the valuable collaboration between the Victorian Department of Health and the RACS. © 2014 Royal Australasian College of Surgeons.

  10. Association between induced abortion history and later in vitro fertilization outcomes.

    Science.gov (United States)

    Wang, Yao; Sun, Yun; Di, Wen; Kuang, Yan-Ping; Xu, Bing

    2018-06-01

    To establish an effective and safe clinical fertility strategy by investigating the relationship between abortion history and pregnancy outcomes of in vitro fertilization (IVF) treatment. In the present retrospective cohort study, data from IVF treatment cycles performed at a reproductive center in China between October 1, 2014, and October 31, 2015, were assessed. Outcomes were compared between women with a history of induced abortion and those without. There were 1532 IVF treatment cycles included; 454 patients had a history of induced abortion and 1078 did not. The spontaneous abortion rate was significantly higher (30/170 [17.6%] vs 41/420 [9.8%]; P=0.002) and the endometrium was significantly thinner (8.8 ± 1.8 vs 9.7 ± 1.8 cm; P=0.001) among patients with a history of induced abortion compared with those without. In a subgroup analysis of patients with a history of induced abortion, women who had undergone surgical abortions had a lower live delivery rate compared with medical abortions (29/76 [38%] vs 101/378 [27%]; P=0.039). Further, women who had a history of more than two surgical abortions had lower live delivery and clinical pregnancy rates (both Pabortion was associated with worse IVF outcomes, especially a history of more than two surgical abortions. © 2018 International Federation of Gynecology and Obstetrics.

  11. Active Transportation to and on Campus is Associated With Objectively Measured Fitness Outcomes Among College Students.

    Science.gov (United States)

    Bopp, Melissa; Bopp, Christopher; Schuchert, Megan

    2015-03-01

    Active transportation (AT) has been associated with positive health outcomes, yet limited research has addressed this with college students, a population at-risk for inactivity. The purpose of this study was to examine the relationship between AT behavior and objectively measured fitness outcomes. A volunteer, convenience sample (n = 299) of college students from a large northeastern university completed a survey about their AT habits to and on campus and psychosocial constructs related to AT and participated in a laboratory-based fitness assessment (cardiovascular endurance, muscular strength and endurance, flexibility, body composition).Off-campus students were dichotomized as nonactive (0-1 AT trips/day) or active travelers (> 1 AT trips/day) to campus; t-tests compared nonactive and active travelers for psychosocial and fitness variables. Students were 56.3% male, 79.2% non-Hispanic White, and primarily living off-campus (87%). Most students (n = 177, 59.2%) reported active travel between classes. Off-campus students were primarily active travelers (76.1%). Active travelers to campus had greater cardiovascular fitness (P = .005), were more flexible (P = .006) and had lower systolic blood pressure (P = .05) compared with nonactive travelers. This study documents a relationship between AT behavior and objectively measured fitness among college students and provides a rationale for targeting this behavior as a method for improving health outcomes.

  12. Association between thymic function and allogeneic hematopoietic stem cell transplantation outcome: results of a pediatric study.

    Science.gov (United States)

    Saglio, Francesco; Cena, Silvia; Berger, Massimo; Quarello, Paola; Boccasavia, Viola; Ferrando, Federica; Pittana, Laura; Bruno, Benedetto; Fagioli, Franca

    2015-06-01

    Robust T cell function recovery has been shown to be crucial in determining allogeneic hematopoietic stem cell transplantation (HSCT) outcome, and there is growing evidence that the thymus plays a central role in regulating this process. We performed a long-term analysis of the role of thymic activity recovery in a population of pediatric patients undergoing allogeneic HSCT by signal joint T cell receptor excision circle (sjTREC) quantification. In this study, characterized by a long-term follow-up (median, 72 months), we found patients with higher levels of sjTRECs before transplantation had a statistically significant reduced risk of death compared with patients with lower values (relative risk, .31; 95% confidence interval, .30 to .32; P = .02), showing this different outcome was mainly related to a reduction of relapse incidence (14% versus 43%, P = .02). Unlike previous reports, we observed no correlation between sjTREC levels and lymphocyte recovery. Moreover, we confirmed that only graft-versus-host disease influenced thymic activity after transplantation. In conclusion, our results suggest an association between pretransplantation thymic activity and the long-term outcome of pediatric patients undergoing HSCT, mainly through a reduction of relapse opportunities. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  13. Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Starling, Rebecca M; Shekdar, Karuna; Licht, Dan; Nadkarni, Vinay M; Berg, Robert A; Topjian, Alexis A

    2015-07-01

    Head CT after out-of-hospital cardiac arrest is often obtained to evaluate intracranial pathology. Among children admitted to the PICU following pediatric out-of-hospital cardiac arrest, we hypothesized that loss of gray-white matter differentiation and basilar cistern and sulcal effacement are associated with mortality and unfavorable neurologic outcome. Retrospective, cohort study. Single, tertiary-care center PICU. Seventy-eight patients less than 18 years old who survived out-of-hospital cardiac arrest to PICU admission and had a head CT within 24 hours of return of spontaneous circulation were evaluated from July 2005 through May 2012. None. Median time to head CT from return of spontaneous circulation was 3.3 hours (1.0, 6.0). Median patient age was 2.3 years (0.4, 9.5). Thirty-nine patients (50%) survived, of whom 29 (74%) had favorable neurologic outcome. Nonsurvivors were more likely than survivors to have 1) loss of gray-white matter differentiation (Hounsfield unit ratios, 0.96 [0.88, 1.07] vs 1.1 [1.07, 1.2]; p pediatric out-of-hospital cardiac arrest. Select patients may have favorable outcomes despite these findings.

  14. The association between adverse pregnancy outcomes and maternal human papillomavirus infection: a systematic review protocol.

    Science.gov (United States)

    Niyibizi, Joseph; Zanré, Nadège; Mayrand, Marie-Hélène; Trottier, Helen

    2017-03-11

    Human papillomavirus (HPV) is the most prevalent genital infection, especially in young women of reproductive age. In vitro and animal model experiments provide compelling evidence of the harmful effect of HPV on pregnancy outcomes, but results from epidemiologic studies are inconclusive. We aim to determine the strength of the relationship between adverse pregnancy outcomes (APO) and HPV infection and assess its consistency across studies, by systematically reviewing the literature. The search strategy has been developed on the basis of the PICOS framework: Population (pregnant women); Exposure (HVP infection confirmed by HPV testing); Comparator (pregnant women without HPV infection); Outcomes (miscarriage, spontaneous preterm birth, low birth weight, preterm premature rupture of membranes, pregnancy-induced hypertensive disorders and intrauterine growth restriction) and Study design (observational studies). We will search three information sources: (1) electronic databases (MEDLINE, EMBASE, and EBM Reviews databases); (2) Grey literature (Google Scholar and Web of Science conference proceedings); and (3) citing and cited articles of included studies. Two reviewers (JN, NZ) will independently and in duplicate screen identified articles, select eligible studies, and extract data. Discrepancies will be resolved by consensus and otherwise by discussion with the other authors (MHM, HT). Quality of included studies will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. We will narratively synthesize extracted data whether meta-analysis is conducted or not. Meta-analysis of each outcome will be performed, and where appropriate, an average measure of association will be computed. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess and grade the strength of confidence in cumulative estimate. Comprehensive and high-quality evidence of a negative

  15. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data.

    Directory of Open Access Journals (Sweden)

    Lori Newman

    Full Text Available The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC coverage for women with syphilis.Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963 adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716 stillbirths (>28 wk or early fetal deaths (22 to 28 wk, 91,764 (76,141; 107,397 neonatal deaths, 65,267 (56,929; 73,605 preterm or low birth weight infants, and 151,547 (117,848; 185,245 infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage.Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and

  16. Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data

    Science.gov (United States)

    Newman, Lori; Kamb, Mary; Hawkes, Sarah; Gomez, Gabriela; Say, Lale; Seuc, Armando; Broutet, Nathalie

    2013-01-01

    Background The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for syphilis and ≥90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Methods and Findings Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was “probable active,” and for testing and treatment coverage. Conclusions Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that

  17. Cyclophilin B Expression Is Associated with In Vitro Radioresistance and Clinical Outcome after Radiotherapy

    Directory of Open Access Journals (Sweden)

    Paul D. Williams

    2011-12-01

    Full Text Available The tools for predicting clinical outcome after radiotherapy are not yet optimal. To improve on this, we applied the COXEN informatics approach to in vitro radiation sensitivity data of transcriptionally profiled human cells and gene expression data from untreated head and neck squamous cell carcinoma (HNSCC and bladder tumors to generate a multigene predictive model that is independent of histologic findings and reports on tumor radiosensitivity. The predictive ability of this 41-gene model was evaluated in patients with HNSCC and was found to stratify clinical outcome after radiotherapy. In contrast, this model was not useful in stratifying similar patients not treated with radiation. This led us to hypothesize that expression of some of the 41 genes contributes to tumor radioresistance and clinical recurrence. Hence, we evaluated the expression the 41 genes as a function of in vitro radioresistance in the NCI-60 cancer cell line panel and found cyclophilin B (PPIB, a peptidylprolyl isomerase and target of cyclosporine A (CsA, had the strongest direct correlation. Functional inhibition of PPIB by small interfering RNA depletion or CsA treatment leads to radiosensitization in cancer cells and reduced cellular DNA repair. Immunohistochemical evaluation of PPIB expression in patients with HNSCC was found to be associated with outcome after radiotherapy. This work demonstrates that a novel 41-gene expression model of radiation sensitivity developed in bladder cancer cell lines and human skin fibroblasts predicts clinical outcome after radiotherapy in head and neck cancer patients and identifies PPIB as a potential target for clinical radiosensitization.

  18. Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury.

    Science.gov (United States)

    Hernandez, Matthew C; Thiels, Cornelius A; Aho, Johnathon M; Habermann, Elizabeth B; Zielinski, Martin D; Stubbs, James A; Jenkins, Donald H; Zietlow, Scott P

    2017-09-01

    Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking. We retrospectively identified all patients with multiple injuries age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBCs) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow-up. Of 76 patients meeting inclusion criteria, 53% (n = 40) received prehospital pRBCs and 47% (n = 36) received thawed plasma. Age, gender, injury severity or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p > 0.05). Patients who received thawed plasma had an improved neurologic outcome compared to those receiving pRBCs (median GOSE 7 [7-8] vs. 5.5 [3-7], p plasma had improved functionality compared to pRBCs (median DRS 2 [1-3.5] vs. 9 [3-13], p plasma compared to pRBCs by both median GOSE (8 [7-8] vs. 6 [6-7], p plasma is associated with improved neurologic and functional outcomes at discharge and during follow-up compared to pRBCs alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. Therapeutic, level V.

  19. Pre-existing psychiatric disorder in the burn patient is associated with worse outcomes.

    Science.gov (United States)

    Hudson, Alexandra; Al Youha, Sarah; Samargandi, Osama A; Paletz, Justin

    2017-08-01

    To compare patient and burn characteristics between patients who had a pre-existing psychiatric diagnosis and patients who did not in a Burn Unit at an academic hospital. Psychosocial issues are common in patients recovering from a burn; however, little is known regarding hospital course and discharge outcomes in patients with a pre-existing psychiatric diagnosis presenting with a burn. Baseline medical comorbidities of burn patients have been shown to be a significant risk for in-hospital mortality. A retrospective chart review of 479 consecutive patients admitted to the Burn Unit of an academic hospital in Halifax, Nova Scotia between March 2nd 1995 and June 1st 2013 was performed. Extensive data regarding patient and burn characteristics and outcomes was collected. Patients with and without pre-existing psychiatric diagnoses at the time of hospital admission were compared. Sixty-three (13%) patients had a psychiatric diagnosis, with the most common being depression (52%). Forty-percent (n=25/63) of these patients had multiple pre-existing psychiatric diagnoses. Patients with a psychiatric diagnosis had a greater total-body-surface-area (TBSA)% covered by a third-degree burn (p=0.001), and were more likely to have an inhalation injury (pBurn Unit (p=0.01). The risk of death in burn patients with pre-existing psychiatric disorders was about three times the risk of death in patients with no psychiatric disorders when adjusting for other potential confounders (95% CI, 1.13-9.10; p-value 0.03). Presence of a pre-existing psychiatric disorder in the burn patient was associated with worse outcomes and was a significant predictor of death. Psychiatric diagnoses should be identified early in burn treatment and efforts should be made to ensure a comprehensive approach to inpatient support and patient discharge to reduce unfavorable burn outcomes and placement issues. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  20. The Association of Visual Impairment With Clinical Outcomes in Hemodialysis Patients.

    Science.gov (United States)

    Hong, Yu Ah; Kim, Suk Young; Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong-Lim; Kim, Yon-Su; Kang, Shin-Wook; Kim, Nam-Ho; Yang, Chul Woo; Kim, Yong Kyun

    2016-05-01

    Visual impairment limits people's ability to perform daily tasks and affects their quality of life. We evaluated the impact of visual impairment on clinical outcomes in hemodialysis (HD) patients.HD patients were selected from the Clinical Research Center registry a prospective cohort study on dialysis patients in Korea. Visual impairment was defined as difficulty in daily life due to decreased visual acuity or blindness. The primary outcome was all-cause mortality and the secondary outcomes were cardiovascular and infection-related hospitalization.A total of 3250 patients were included. Seven hundred thirty (22.5%) of the enrolled patients had visual impairment. The median follow-up period was 30 months. The Kaplan-Meier curve and log-rank test showed that all-cause mortality rates (P visual impairment than in patients without visual impairment. In the multivariable analysis, visual impairment had significant predictive power for all-cause mortality (Hazard ratio [HR], 1.77, 95% confidence interval [CI], 1.21-2.61, P = 0.004) and cardiovascular hospitalization (HR 1.45 [1.00-1.90], P = 0.008) after adjusting for confounding variables. Of these 3250 patients, 634 patients from each group were matched by propensity scores. In the propensity score matched analysis, patients with visual impairment had independently significant associations with increased all-cause mortality (HR 1.69 [1.12-2.54], P = 0.01) and cardiovascular hospitalization (HR 1.48 [1.08-2.02], P = 0.01) compared with patients without visual impairment after adjustment for confounding variables.Our data demonstrated that visual impairment was an independent risk factor for clinical adverse outcomes in HD patients.

  1. Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes.

    Science.gov (United States)

    Benyshek, Daniel C; Cheyney, Melissa; Brown, Jennifer; Bovbjerg, Marit L

    2018-05-02

    Limited systematic research on maternal placentophagy is available to maternity care providers whose clients/patients may be considering this increasingly popular practice. Our purpose was to characterize the practice of placentophagy and its attendant neonatal outcomes among a large sample of women in the United States. We used a medical records-based data set (n = 23 242) containing pregnancy, birth, and postpartum information for women who planned community births. We used logistic regression to determine demographic and clinical predictors of placentophagy. Finally, we compared neonatal outcomes (hospitalization, neonatal intensive unit admission, or neonatal death in the first 6 weeks) between placenta consumers and nonconsumers, and participants who consumed placenta raw vs cooked. Nearly one-third (31.2%) of women consumed their placenta. Consumers were more likely to have reported pregravid anxiety or depression compared with nonconsumers. Most (85.7%) placentophagic mothers consumed their placentas in encapsulated form, and nearly half (49.1%) consumed capsules containing dehydrated, uncooked placenta. Placentophagy was not associated with any adverse neonatal outcomes. Women with home births were more likely to engage in placentophagy than women with birth center births. The most common reason given (58.6%) for engaging in placentophagy was to prevent postpartum depression. The majority of women consumed their placentas in uncooked/encapsulated form and hoping to avoid postpartum depression, although no evidence currently exists to support this strategy. Preparation technique (cooked vs uncooked) did not influence adverse neonatal outcomes. Maternity care providers should discuss the range of options available to prevent/treat postpartum depression, in addition to current evidence with respect to the safety of placentophagy. © 2018 Wiley Periodicals, Inc.

  2. Teen Pregnancy: Are Pregnancies following an Elective Termination Associated with Increased Risk for Adverse Perinatal Outcomes?

    Science.gov (United States)

    van Veen, Teelkien R; Haeri, Sina; Baker, Arthur M

    2015-12-01

    The authors sought to determine whether pregnancies in adolescents following an abortion of pregnancy is associated with an elevated risk for adverse perinatal outcomes. In a cohort study of all adolescent (younger than 18 years) deliveries over a 4-year period at 1 institution, we compared nulliparous women with a history of a prior abortion (cases) to those without a spontaneous loss or abortion of pregnancy (referent) for adverse perinatal outcomes, including preterm birth and fetal growth restriction. Of the 654 included nulliparous adolescent deliveries, 102 (16%) had an abortion before the index pregnancy. Compared with the referent group, adolescents with a history of a abortion were older (17.8 ± 0.8 vs 16.7 ± 1.2 years, P = .0001), enrolled earlier for prenatal care (14.4 ± 5.6 vs 17.2 ± 7.6 weeks, P = .0004), along with a higher incidence of African American race (95% vs 88%, P = .05). The groups did not differ with respect to other maternal demographics. Perinatal outcomes, including spontaneous preterm birth, abnormal placentation, birth weight, and gestational age at delivery, did not differ between the 2 groups. Compared with adolescent women who had just delivered and did not have a prior abortion, women who had just delivered and had a previous abortion were more likely to be older at the age of their first pregnancy and more likely to initiate early prenatal care. Thus, having a prior abortion may improve the health of a pregnancy though adverse outcomes do not differ between the 2 groups. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  3. Association between organisational and workplace cultures, and patient outcomes: systematic review protocol.

    Science.gov (United States)

    Braithwaite, J; Herkes, J; Ludlow, K; Lamprell, G; Testa, L

    2016-12-01

    Despite widespread interest in the topic, no current synthesis of research is available analysing the linkages between organisational or workplace cultures on the one hand, and patient outcomes on the other. This protocol proposes a systematic review to analyse and synthesise the literature to date on this topic. The resulting review will discuss characteristics of included studies in terms of the type of healthcare settings researched, the measurements of organisational and workplace culture, patient outcomes measured and the influence of these cultures on patient outcomes. A systematic review will be conducted aiming to examine the associations between organisational and workplace cultures, and patient outcomes, guided by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. An English language search of abstracts will be executed using the following academic databases: CINAHL, EMBASE, Ovid MEDLINE, Web of Science and PsycINFO. The review will include relevant peer-reviewed articles from randomised controlled trials (RCTs), non-RCTs, controlled before and after studies, interrupted time series studies, cross-sectional analyses, qualitative studies and mixed-method studies. Multiple researchers will be involved in assessing the quality of articles for inclusion in the review. This protocol documents a detailed search strategy, including terms and inclusion criteria, which will form the basis of the subsequent systematic review. Ethics approval is not required as no primary data will be collected. Results will be disseminated through a peer-reviewed publication and conference presentations. 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/.

  4. Factors and outcomes associated with the induction of labour in Latin America.

    Science.gov (United States)

    Guerra, G V; Cecatti, J G; Souza, J P; Faúndes, A; Morais, S S; Gülmezoglu, A M; Parpinelli, M A; Passini, R; Carroli, G

    2009-12-01

    To describe the prevalence of labour induction, together with its risk factors and outcomes in Latin America. Analysis of the 2005 WHO global survey database. Eight selected Latin American countries. All women who gave birth during the study period in 120 participating institutions. Bivariate and multivariate analyses. Indications for labour induction per country, success rate per method, risk factors for induction, and maternal and perinatal outcomes. Of the 97,095 deliveries included in the survey, 11,077 (11.4%) were induced, with 74.2% occurring in public institutions, 20.9% in social security hospitals and 4.9% in private institutions. Induction rates ranged from 5.1% in Peru to 20.1% in Cuba. The main indications were premature rupture of membranes (25.3%) and elective induction (28.9%). The success rate of vaginal delivery was very similar for oxytocin (69.9%) and misoprostol (74.8%), with an overall success rate of 70.4%. Induced labour was more common in women over 35 years of age. Maternal complications included higher rates of perineal laceration, need for uterotonic agents, hysterectomy, ICU admission, hospital stay>7 days and increased need for anaesthetic/analgesic procedures. Some adverse perinatal outcomes were also higher: low 5-minute Apgar score, very low birthweight, admission to neonatal ICU and delayed initiation of breastfeeding. In Latin America, labour was induced in slightly more than 10% of deliveries; success rates were high irrespective of the method used. Induced labour is, however, associated with poorer maternal and perinatal outcomes than spontaneous labour.

  5. Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery.

    Science.gov (United States)

    Bhuskute, Aditi; Skirko, Jonathan R; Roth, Christina; Bayoumi, Ahmed; Durbin-Johnson, Blythe; Tollefson, Travis T

    2017-09-01

    Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care. To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL. Prospective descriptive cohort including children and young adults undergoing speech surgery for VPI in a tertiary academic center. Participants completed the validated VELO instrument before and after surgical treatment. The main outcome measures were preoperative and postoperative VELO scores and the perceptual speech assessment of speech intelligibility. The VELO scores are divided into subscale domains. Changes in VELO after surgery were analyzed using linear regression models. VELO scores were analyzed as a function of speech intelligibility adjusting for age and cleft type. The correlation between speech intelligibility rating and VELO scores was estimated using the polyserial correlation. Twenty-nine patients (13 males and 16 females) were included. Mean (SD) age was 7.9 (4.1) years (range, 4-20 years). Pharyngeal flap was used in 14 (48%) cases, Furlow palatoplasty in 12 (41%), and sphincter pharyngoplasty in 1 (3%). The mean (SD) preoperative speech intelligibility rating was 1.71 (1.08), which decreased postoperatively to 0.79 (0.93) in 24 patients who completed protocol (P Speech Intelligibility was correlated with preoperative and postoperative total VELO score (P speech intelligibility. Speech surgery improves VPI-specific quality of life. We confirmed validation in a population of untreated patients with VPI and included pharyngeal flap surgery, which had not previously been included in validation studies. The VELO instrument provides patient-specific outcomes, which allows a broader understanding of the

  6. Associations between Deceased-Donor Urine MCP-1 and Kidney Transplant Outcomes.

    Science.gov (United States)

    Mansour, S G; Puthumana, J; Reese, P P; Hall, I E; Doshi, M D; Weng, F L; Schröppel, B; Thiessen-Philbrook, H; Bimali, M; Parikh, C R

    2017-07-01

    Existing methods to predict recipient allograft function during deceased-donor kidney procurement are imprecise. Understanding the potential renal reparative role for monocyte chemoattractant protein-1 (MCP-1), a cytokine involved in macrophage recruitment after injury, might help predict allograft outcomes. We conducted a sub-study of the multicenter prospective Deceased Donor Study cohort, which evaluated deceased kidney donors from five organ procurement organizations from May 2010 to December 2013. We measured urine MCP-1 (uMCP-1) concentrations from donor samples collected at nephrectomy to determine associations with donor acute kidney injury (AKI), recipient delayed graft function (DGF), 6-month estimated GFR (eGFR), and graft failure. We also assessed perfusate MCP-1 concentrations from pumped kidneys for associations with DGF and 6-month eGFR. AKI occurred in 111 (9%) donors. Median (interquartile range) uMCP-1 concentration was higher in donors with AKI compared to donors without AKI (1.35 [0.41-3.93] ng/ml vs. 0.32 [0.11-0.80] ng/ml, p<0.001). DGF occurred in 756 (31%) recipients, but uMCP-1 was not independently associated with DGF. Higher donor uMCP-1 concentrations were independently associated with higher 6-month eGFR in those without DGF [0.77 (0.10, 1.45) ml/min/1.73m 2 per doubling of uMCP1]. However, there were no independent associations between uMCP-1 and graft failure over a median follow-up of about 2 years. Lastly, perfusate MCP-1 concentrations significantly increased during pump perfusion but were not associated with DGF or 6-month eGFR. Donor uMCP-1 concentrations were modestly associated with higher recipient 6-month eGFR in those without DGF. However, the results suggest that donor uMCP-1 has minimal clinical utility given no associations with graft failure.

  7. Association Between Blood Glucose and Functional Outcome in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zheng, Jun; Yu, Zhiyuan; Ma, Lu; Guo, Rui; Lin, Sen; You, Chao; Li, Hao

    2018-03-16

    Intracerebral hemorrhage (ICH) is a devastating subtype of stroke. Patients with ICH have poor functional outcomes. The association between blood glucose level and functional outcome in ICH remains unclear. This systematic review and meta-analysis aimed to investigate the association between blood glucose level and functional outcomes in patients with ICH. Literature was searched systemically in PubMed, EMBASE, Web of Science, and Cochrane Library. Published cohort studies evaluating the association between blood glucose and functional outcome in patients with ICH were included. This meta-analysis was performed using odds ratios (ORs) and 95% confidence intervals (CIs). A total of 16 studies were included in our meta-analysis. Our data show that hyperglycemia defined by cutoff values was significantly associated with unfavorable functional outcome (OR, 1.80; 95% CI, 1.36-2.39; P analysis also suggested a significant association between increased blood glucose levels and functional outcomes (OR, 1.05; 95% CI, 1.03-1.07; P functional outcome in ICH. Further studies with larger sample sizes, more time points, and longer follow-up times are necessary to confirm this association. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Educational attainment moderates the associations of diabetes education with health outcomes.

    Science.gov (United States)

    Kim, Su Hyun

    2016-10-01

    Diabetes education is a critical element of care for people with diabetes. However, the associations between diabetes education and self-care or health outcomes have not been clearly demonstrated at a national level. The aims of this study were to examine the associations of attendance of diabetes education classes with health behaviours and glycaemic control, and to understand whether these associations were moderated by level of educational attainment. Data were analysed for 456 adults from the 2012 Korea National Health and Nutrition Examination Survey V, collected from January 2010 to December 2012. No significant differences were observed between patients who had attended diabetes education classes and those who had never attended for factors such as smoking, drinking, exercise, nutrition therapy or glycaemic control. There was a significant interaction effect between receiving diabetes education and level of educational attainment on obtaining optimal glycaemic control. Attending diabetes education was positively associated with optimal glycaemic control among patients with more than a high school education but was negatively associated with it among those with less than middle school education. Diabetes education programmes need to be tailored to the needs and cognitive capacities of the target population. © 2016 John Wiley & Sons Australia, Ltd.

  9. Ups and downs in mood and energy: Associations with academic outcomes in higher education

    Directory of Open Access Journals (Sweden)

    Ben Bullock

    2015-08-01

    Full Text Available Individual differences in mood and energy may affect academic outcomes in higher education. With little previous research investigating this relationship it is not known whether mood and energy traits help or hinder academic performance. The current study addresses this gap in the literature by investigating ups (high mood and energy and downs (low mood and energy in a small sample of University students in their first year of a psychology degree. The results suggest that low mood and energy traits may be detrimental to academic performance. High mood and energy traits however, were not associated with academic performance. Implications of the findings, in particular those regarding low mood and energy, are that, unlike the trait itself, the behaviours associated with the trait (e.g., procrastination, distraction, low motivation are amenable to change through psychological interventions. Several of these interventions are discussed. 

  10. Insurance Coverage for Rehabilitation Therapies and Association with Social Participation Outcomes among Low-Income Children.

    Science.gov (United States)

    Mirza, Mansha; Kim, Yoonsang

    2016-01-01

    (1) To profile children's health insurance coverage rates for specific rehabilitation therapies; (2) to determine whether coverage for rehabilitation therapies is associated with social participation outcomes after adjusting for child and household characteristics; (3) to assess whether rehabilitation insurance differentially affects social participation of children with and without disabilities. We conducted a cross-sectional analysis of secondary survey data on 756 children (ages 3-17) from 370 households living in low-income neighborhoods in a Midwestern U.S. city. Multivariate mixed effects logistic regression models were estimated. Significantly higher proportions of children with disabilities had coverage for physical therapy, occupational therapy, and speech and language pathology, yet gaps in coverage were noted. Multivariate analysis indicated that rehabilitation insurance coverage was significantly associated with social participation (OR = 1.67, 95% CI: 1.013-2.75). This trend was sustained in subgroup analysis. Findings support the need for comprehensive coverage of all essential services under children's health insurance programs.

  11. Apolipoprotein D is associated with long-term outcome in patients with schizophrenia

    DEFF Research Database (Denmark)

    Hansen, T; Hemmingsen, R P; Wang, A G

    2006-01-01

    Accumulating evidence implicates deficiencies in apolipoprotein D (ApoD) function and arachidonic acid signaling in schizophrenic disorders. We addressed two hypotheses in relation to ApoD: first, polymorphisms in the ApoD gene confer susceptibility to or are markers of disease, and, second, gene......D alleles, genotypes or haplotypes to be associated with disease. However, we did find that long-term clinical outcome was associated with the ApoD polymorphism rs7659 (P = 0.041) following adjustment for lifetime clinical global impression, age at first admission and gender.......Accumulating evidence implicates deficiencies in apolipoprotein D (ApoD) function and arachidonic acid signaling in schizophrenic disorders. We addressed two hypotheses in relation to ApoD: first, polymorphisms in the ApoD gene confer susceptibility to or are markers of disease, and, second...

  12. Association between ulcer site and outcome in complicated peptic ulcer disease

    DEFF Research Database (Denmark)

    Lolle, Ida; Møller, Morten Hylander; Rosenstock, Steffen Jais

    2016-01-01

    OBJECTIVE: Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU). MATERIALS AND METHODS: DESIGN: a nationwide cohort study with prospective...... and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis. RESULTS: Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality...... was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30-1.67); p 

  13. Genome-wide Analysis Identifies Novel Loci Associated with Ovarian Cancer Outcomes

    DEFF Research Database (Denmark)

    Johnatty, Sharon E; Tyrer, Jonathan P; Kar, Siddhartha

    2015-01-01

    PURPOSE: Chemotherapy resistance remains a major challenge in the treatment of ovarian cancer. We hypothesize that germline polymorphisms might be associated with clinical outcome. EXPERIMENTAL DESIGN: We analyzed approximately 2.8 million genotyped and imputed SNPs from the iCOGS experiment...... for progression-free survival (PFS) and overall survival (OS) in 2,901 European epithelial ovarian cancer (EOC) patients who underwent first-line treatment of cytoreductive surgery and chemotherapy regardless of regimen, and in a subset of 1,098 patients treated with ≥ 4 cycles of paclitaxel and carboplatin...... at standard doses. We evaluated the top SNPs in 4,434 EOC patients, including patients from The Cancer Genome Atlas. In addition, we conducted pathway analysis of all intragenic SNPs and tested their association with PFS and OS using gene set enrichment analysis. RESULTS: Five SNPs were significantly...

  14. FACTORS ASSOCIATED WITH VISUAL OUTCOME AFTER MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT SURGERY.

    Science.gov (United States)

    Park, Dae Hyun; Choi, Kyung Seek; Sun, Hae Jung; Lee, Sung Jin

    2018-01-01

    To evaluate preoperative factors influencing the visual outcome and postoperative factors associated with the changes in visual acuity, after reattachment surgery to treat macula-off rhegmatogenous retinal detachment. A total of 180 eyes of 180 patients who underwent reattachment surgery to treat macula-off rhegmatogenous retinal detachment, and who were followed up for more than 12 months, were reviewed retrospectively. Preoperative and postoperative characteristics, including optical coherence tomography findings, were comprehensively analyzed using univariate and multivariate models to evaluate preoperative factors influencing best-corrected visual acuity 12 months after macula-off rhegmatogenous retinal detachment surgery and postoperative factors associated with changes in best-corrected visual acuity after surgery. Preoperatively, the extent of detachment (P = 0.037), macula-off duration (P macula-off rhegmatogenous retinal detachment surgery were the extent of detachment, macula-off duration, and external limiting membrane integrity. Postoperatively, predictive factors were the outer retinal microstructures, particularly the photoreceptor outer segment layer.

  15. The post hoc use of randomised controlled trials to explore drug associated cancer outcomes

    DEFF Research Database (Denmark)

    Stefansdottir, Gudrun; Zoungas, Sophia; Chalmers, John

    2013-01-01

    on public health before proper regulatory action can be taken. This paper aims to discuss challenges of exploring drug-associated cancer outcomes by post-hoc analyses of Randomised controlled trials (RCTs) designed for other purposes. METHODOLOGICAL CHALLENGES TO CONSIDER: We set out to perform a post......-hoc nested case-control analysis in the ADVANCE trial in order to examine the association between insulin use and cancer. We encountered several methodological challenges that made the results difficult to interpret, including short duration of exposure of interest, lack of power, and correlation between...... exposure and potential confounders. Considering these challenges, we concluded that using the data would not enlighten the discussion about insulin use and cancer risk and only serve to further complicate any understanding. Therefore, we decided to use our experience to illustrate methodological challenges...

  16. Abdominal Wall Reconstruction with Concomitant Ostomy-Associated Hernia Repair: Outcomes and Propensity Score Analysis.

    Science.gov (United States)

    Mericli, Alexander F; Garvey, Patrick B; Giordano, Salvatore; Liu, Jun; Baumann, Donald P; Butler, Charles E

    2017-03-01

    The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is unclear. We hypothesized that the rate of ventral hernia recurrence in patients undergoing a combined ventral hernia repair and stomal-site herniorraphy would not differ clinically from the ventral hernia recurrence rate in patients undergoing an isolated ventral hernia repair. We also hypothesized that bridged ventral hernia repairs result in worse outcomes compared with reinforced repairs, regardless of stomal hernia. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions performed with acellular dermal matrix (ADM) at a single center between 2000 and 2015. We compared patients who underwent a ventral hernia repair alone (AWR) and those who underwent both a ventral hernia repair and ostomy-associated herniorraphy (AWR+O). We conducted a propensity score matched analysis to compare the outcomes between the 2 groups. Multivariable Cox proportional hazards and logistic regression models were used to study associations between potential predictive or protective reconstructive strategies and surgical outcomes. We included 499 patients (median follow-up 27.2 months; interquartile range [IQR] 12.4 to 46.6 months), 118 AWR+O and 381 AWR. After propensity score matching, 91 pairs were obtained. Ventral hernia recurrence was not statistically associated with ostomy-associated herniorraphy (adjusted hazard ratio [HR] 0.7; 95% CI 0.3 to 1.5; p = 0.34). However, the AWR+O group experienced a significantly higher percentage of surgical site occurrences (34.1%) than the AWR group (18.7%; adjusted odds ratio 2.3; 95% CI 1.4 to 3.7; p < 0.001). In the AWR group, there were significantly fewer ventral hernia recurrences when the repair was reinforced compared with bridged (5.3% vs 38.5%; p < 0.001). There was no statistically significant difference in ventral hernia recurrence between the AWR and AWR+O groups. Bridging was associated

  17. TBI Patient, Injury, Therapy, and Ancillary Treatments Associated with Outcomes at Discharge and 9 Months Post-discharge

    Science.gov (United States)

    Horn, Susan D.; Corrigan, John D.; Beaulieu, Cynthia L.; Bogner, Jennifer; Barrett, Ryan S.; Giuffrida, Clare G.; Ryser, David K.; Cooper, Kelli; Carroll, Deborah M.; Deutscher, Daniel

    2015-01-01

    Objective To examine associations of patient and injury characteristics, inpatient rehabilitation therapy activities, and neurotropic medications with outcomes at discharge and 9 months post-discharge for patients with traumatic brain injury (TBI) Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) Participants Consecutive patients (n=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after an index TBI injury Interventions Not applicable Main Outcome Measures Rehabilitation length of stay, discharge to home, and Functional Independence Measure (FIM) at discharge and 9 months post-discharge Results The admission FIM Cognitive score was used to create 5 relatively homogeneous subgroups for subsequent analysis of treatment outcomes. Within each subgroup, significant associations were found between outcomes and patient and injury characteristics, time spent in therapy activities, and medications used. Patient and injury characteristics explained on average 35.7% of the variation in discharge outcomes and 22.3% in 9-month outcomes. Adding time spent and level of effort in therapy activities, as well as percent of stay using specific medications, explained approximately 20.0% more variation for discharge outcomes and 12.9% for 9-month outcomes. After patient, injury, and treatment characteristics were used to predict outcomes, center differences added only approximately 1.9% additional variance explained. Conclusions At discharge, greater effort during therapy sessions, time spent in more complex therapy activities, and use of specific medications were associated with better outcomes for patients in all admission FIM Cognitive subgroups. At 9 months post-discharge, similar but less pervasive associations were observed for therapy activities, but not classes of medications. Further research is warranted to examine more specific combinations of therapy activities and medications that

  18. Factors associated with poor outcome for aneurysmal subarachnoid haemorrhage in a series of 334 patients.

    Science.gov (United States)

    Rivero Rodríguez, D; Scherle Matamoros, C; Fernández Cúe, L; Miranda Hernández, J L; Pernas Sánchez, Y; Pérez Nellar, J

    This study evaluates care-related sociodemographic, clinical, and imaging factors and influences associated with outcome at discharge in patients with aneurismal subarachnoid haemorrhage. Retrospective cohort study in 334 patients treated at Hospital Hermanos Ameijeiras in Havana, Cuba between October 2005 and June 2014. Logistic regression analysis determined that the following factors were associated with higher risk of poor outcome: age older than 65 years (OR 3.51, 95% CI 1.79-5.7, P=.031), female sex (OR 2.17, 95% CI 1.22-3.84, P=.0067), systolic hypertension (OR 4.82, 95% CI 2.27-9.8, P=.0001), and hyperglycaemia at admission (OR 3.93, 95% CI 2.10-7.53, P=.0003). Certain complications were also associated with poor prognosis, including respiratory infection (OR 2.73, 95% CI 1.27-5.85, P=.0085), electrolyte disturbances (OR 3.33, 95% CI 1.33-8.28, P=.0073), hydrocephalus (OR 2.21, 95% CI 1.05-4.63, P=.0039), rebleeding (OR 16.50, 95% CI 8.24-41.24, P=.0000), symptomatic vasospasm (OR 19.00, 95% CI 8.86-41.24, P=.0000), cerebral ischaemia (OR 3.82, 95% CI 1.87-7.80, P=.000) and multiplex rebleeding (OR 6.69, 95% CI 1.35-36.39, P=.0019). Grades of iii and iv on the World Federation of Neurological Surgeons (OR 2.09, 95% CI 1.12-3.91, P=.0021) and Fisher scales (OR 5.18, 95% CI 2.65-10.29, P=.0008) were also related to poor outcome. Outcome of aneurysmal subarachnoid haemorrhage was related to age, sex, clinical status at admission to the stroke unit, imaging findings according to the Fisher scale, blood pressure, glycaemia and such complications as electrolyte disturbances, hydrocephalus, rebleeding, and multiplex rebleeding. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Posttraumatic Stress Symptoms and Their Association With Smoking Outcome Expectancies Among Homeless Smokers in Boston.

    Science.gov (United States)

    Baggett, Travis P; Campbell, Eric G; Chang, Yuchiao; Magid, Leah M; Rigotti, Nancy A

    2016-06-01

    Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston. We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist-Civilian version and considered scores at least 14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression. Eighty-six percent of eligible individuals participated (N = 306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger (P = .001), more likely to report fair/poor health (P = .01), chronic obstructive pulmonary disease (P = .02), and past-month hallucinations (P = .004), and had greater drug (P smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment. In this study of homeless cigarette smokers in Boston, over two-thirds of participants screened positive for PTSD. PTSD screen-positive respondents more strongly endorsed multiple positive smoking outcome expectancies than screen-negative individuals. These findings suggest that the psychological sequelae of trauma may be a pervasive but under-recognized factor impacting the persistence of smoking among homeless people. Tobacco cessation programs for this population should consider screening for PTSD, fostering a trauma-sensitive treatment environment, and incorporating strategies that have

  20. Psychological Empowerment Among Urban Youth: Measurement Model and Associations with Youth Outcomes.

    Science.gov (United States)

    Eisman, Andria B; Zimmerman, Marc A; Kruger, Daniel; Reischl, Thomas M; Miller, Alison L; Franzen, Susan P; Morrel-Samuels, Susan

    2016-12-01

    Empowerment-based strategies have become widely used method to address health inequities and promote social change. Few researchers, however, have tested theoretical models of empowerment, including multidimensional, higher-order models. We test empirically a multidimensional, higher-order model of psychological empowerment (PE), guided by Zimmerman's conceptual framework including three components of PE: intrapersonal, interactional, and behavioral. We also investigate if PE is associated with positive and negative outcomes among youth. The sample included 367 middle school youth aged 11-16 (M = 12.71; SD = 0.91); 60% female, 32% (n = 117) white youth, 46% (n = 170) African-American youth, and 22% (n = 80) identifying as mixed race, Asian-American, Latino, Native American, or other ethnic/racial group; schools reported 61-75% free/reduced lunch students. Our results indicated that each of the latent factors for the three PE components demonstrate a good fit with the data. Our results also indicated that these components loaded on to a higher-order PE factor (X 2  = 32.68; df: 22; p = .07; RMSEA: 0.04; 95% CI: .00, .06; CFI: 0.99). We found that the second-order PE factor was negatively associated with aggressive behavior and positively associated with prosocial engagement. Our results suggest that empowerment-focused programs would benefit from incorporating components addressing how youth think about themselves in relation to their social contexts (intrapersonal), understanding social and material resources needed to achieve specific goals (interactional), and actions taken to influence outcomes (behavioral). Our results also suggest that integrating the three components and promoting PE may help increase likelihood of positive behaviors (e.g., prosocial involvement); we did not find an association between PE and aggressive behavior. Implications and future directions for empowerment research are discussed. © Society for Community Research and

  1. TMPRSS2-ERG gene fusion is not associated with outcome in patients treated by prostatectomy

    Science.gov (United States)

    Gopalan, Anuradha; Leversha, Margaret A.; Satagopan, Jaya M.; Zhou, Qin; Al-Ahmadie, Hikmat A.; Fine, Samson W.; Eastham, James A.; Scardino, Peter T.; Scher, Howard I.; Tickoo, Satish K.; Reuter, Victor E.; Gerald, William L.

    2009-01-01

    A significant number of prostate cancers have been shown to have recurrent chromosomal rearrangements resulting in the fusion of the androgen regulated TMPRSS2 promoter to a member of the ETS transcription factor family, most commonly ERG. This results in ERG overexpression which may have a direct causal role in prostate tumorigenesis or progression. However, the clinical significance of the rearrangement is unclear and, in particular, relationship to outcome has been inconsistent in recent reports. We analyzed TMPRSS2-ERG gene rearrangement status by fluorescence in situ hybridization (FISH) in 521 cases of clinically localized surgically treated prostate cancer with 95 months median follow-up and also in 40 unmatched metastases. 42% of primary tumors and 40% of metastases had rearrangements. 11% had copy number increase (CNI) of the TMPRRS2-ERG region. Rearrangement alone was associated with lower grade, but not with stage, biochemical recurrence, metastases or death. CNI with and without rearrangement was associated with high grade and advanced stage. Further, a subgroup of cancers with CNI and rearrangement by deletion, with two or more copies of the deleted locus, tended to be more clinically aggressive. DNA index assessment revealed that the majority of tumors with CNI of TMPRSS2-ERG had generalized aneuploidy/ tetraploidy in contrast to tumors without TMPRSS2-ERG CNI, which were predominantly diploid. We therefore conclude that translocation of TMPRSS2-ERG is not associated with outcome and the aggressive clinical features associated with CNI of chromosome 21 reflect generalized aneuploidy and are not due to CNI specifically of rearranged TMPRSS2-ERG. PMID:19190343

  2. The Association Between Major Depressive Disorder and Outcomes in Older Veterans Hospitalized With Pneumonia.

    Science.gov (United States)

    DeWaters, Ami L; Chansard, Matthieu; Anzueto, Antonio; Pugh, Mary Jo; Mortensen, Eric M

    2018-01-01

    Major depressive disorder ("depression") has been identified as an independent risk factor for mortality for many comorbid conditions, including heart failure, cancer and stroke. Major depressive disorder has also been linked to immune suppression by generating a chronic inflammatory state. However, the association between major depression and pneumonia has not been examined. The aim of this study was to examine the association between depression and outcomes, including mortality and intensive care unit admission, in Veterans hospitalized with pneumonia. We conducted a retrospective national study using administrative data of patients hospitalized at any Veterans Administration acute care hospital. We included patients ≥65 years old hospitalized with pneumonia from 2002-2012. Depressed patients were further analyzed based on whether they were receiving medications to treat depression. We used generalized linear mixed effect models to examine the association of depression with the outcomes of interest after controlling for potential confounders. Patients with depression had a significantly higher 90-day mortality (odds ratio 1.12, 95% confidence interval 1.07-1.17) compared to patients without depression. Patients with untreated depression had a significantly higher 30-day (1.11, 1.04-1.20) and 90-day (1.20, 1.13-1.28) mortality, as well as significantly higher intensive care unit admission rates (1.12, 1.03-1.21), compared to patients with treated depression. For older veterans hospitalized with pneumonia, a concurrent diagnosis of major depressive disorder, and especially untreated depression, was associated with higher mortality. This highlights that untreated major depressive disorder is an independent risk factor for mortality for patients with pneumonia. Published by Elsevier Inc.

  3. Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Rosell Ortiz, Fernando; García Del Águila, Javier; Fernández Del Valle, Patricia; J Mellado-Vergel, Francisco; Vergara-Pérez, Santiago; R Ruiz-Montero, María; Martínez-Lara, Manuela; J Gómez-Jiménez, Francisco; Gonzáez-Lobato, Ismael; García-Escudero, Guillermo; Ruiz-Bailén, Manuel; Caballero-García, Auxiliadora; Vivar-Díaz, Itziar; Olavarría-Govantes, Luis

    2018-06-01

    To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

  4. 22q11.2 Deletion syndrome is associated with perioperative outcome in tetralogy of Fallot.

    Science.gov (United States)

    Mercer-Rosa, Laura; Pinto, Nelangi; Yang, Wei; Tanel, Ronn; Goldmuntz, Elizabeth

    2013-10-01

    We sought to investigate the impact of 22q11.2 deletion on perioperative outcome in tetralogy of Fallot. We conducted a retrospective review of patients with tetralogy of Fallot who underwent complete surgical reconstruction at The Children's Hospital of Philadelphia between 1995 and 2006. Inclusion criteria included diagnosis of tetralogy of Fallot and known genotype. Fisher exact and Mann-Whitney tests were used for categoric and continuous variables, respectively. Regression analysis was used to determine whether deletion status predicts outcome. We studied 208 subjects with tetralogy of Fallot, 164 (79%) without and 44 (20%) with 22q11.2 deletion syndrome. There were no differences in sex, race, gestational age, age at diagnosis, admission weight, and duration of mechanical ventilation. Presenting anatomy, survival, complications and reoperations were also comparable between patients with and without 22q11.2 deletion syndrome. Those with 22q11.2 deletion syndrome had more aortopulmonary shunts preceding complete surgical repair (21% vs 7%, P = .02). This association was present after adjustment for presenting anatomy (stenosis, atresia, or absence of pulmonary valve and common atrioventricular canal) and surgical era. In addition, those with 22q11.2 deletion syndrome had longer cardiopulmonary bypass time (84 vs 72 minutes, P = .02) and duration of intensive care (6 vs 4 days, P = .007). Genotype affects early operative outcomes in tetralogy of Fallot resulting, in particular, in longer duration of intensive care. Future studies are required to determine factors contributing to such differences in this susceptible population. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  5. Outcomes associated with breach and fulfillment of the psychological contract of safety.

    Science.gov (United States)

    Walker, Arlene

    2013-12-01

    The study investigated the outcomes associated with breach and fulfillment of the psychological contract of safety. The psychological contract of safety is defined as the beliefs of individuals about reciprocal employer and employee safety obligations inferred from implicit or explicit promises. When employees perceive that safety obligations promised by the employer have not been met, a breach of the psychological contract occurs, termed employer breach of obligations. The extent to which employees fulfill their safety obligations to the employer is termed employee fulfillment of obligations. Structural equation modeling was used to test a model of safety that investigated the positive and negative outcomes associated with breach and fulfillment of the psychological contract of safety. Participants were 424 health care workers recruited from two hospitals in the State of Victoria, Australia. Following slight modification of the hypothesized model, a good fitting model resulted. Being injured in the workplace was found to lower perceptions of trust in the employer and increase perceptions of employer breach of safety obligations. Trust in the employer significantly influenced perceived employer breach of safety obligations such that lowered trust resulted in higher perceptions of breach. Perceptions of employer breach significantly impacted employee fulfillment of safety obligations with high perceptions of breach resulting in low employee fulfillment of obligations. Trust and perceptions of breach significantly influenced safety attitudes, but not safety behavior. Fulfillment of employee safety obligations significantly impacted safety behavior, but not safety attitudes. Implications of these findings for safety and psychological contract research are explored. A positive emphasis on social exchange relationships in organizations will have positive outcomes for safety climate and safety behavior. © 2013.

  6. Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

    Directory of Open Access Journals (Sweden)

    Gonzales GF

    2013-10-01

    Full Text Available Gustavo F Gonzales,1–2 Vilma L Tapia,2 Alfredo L Fort,3 Ana Pilar Betran31Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, 2Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru; 3Department of Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandAbstract: A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01. The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01. On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01. More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes.Keywords: elective cesarean, emergency cesarean, geographical regions, cesarean rates over time, adverse outcomes, developing country

  7. Association between environmental contaminants and health outcomes in indigenous populations of the Circumpolar North.

    Science.gov (United States)

    Singh, Kavita; Bjerregaard, Peter; Chan, Hing Man

    2014-01-01

    Since the 1990s, research has been carried out to monitor environmental contaminants and their effects on human health in the Arctic. Although evidence shows that Arctic indigenous peoples are exposed to higher levels of contaminants and do worse on several dimensions of health compared with other populations, the contribution of such exposures on adverse outcomes is unclear. The purpose of this review is to provide a synopsis of the published epidemiological literature that has examined association between environmental contaminants and health outcomes in Arctic indigenous populations. A literature search was conducted in OVID Medline (1946-January 2014) using search terms that combined concepts of contaminant and indigenous populations in the Arctic. No language or date restrictions were applied. The reference lists of review articles were hand-searched. Of 559 citations, 60 studies were relevant. The studies fell under the following categories: paediatric (n=18), reproductive health (n=18), obstetrics and gynaecology (n=9), cardiology (n=7), bone health (n=2), oncology (n=2), endocrinology (n=2) and other (n=2). All studies, except one from Arctic Finland, were either from Nunavik or Greenland. Most studies assessed polychlorinated biphenyls (n=43) and organochlorine pesticides (n=29). Fewer studies examined heavy metals, perfluorinated compounds, or polybrominated diphenyl ethers. Details of study results for each health category are provided. It is difficult to make conclusive statements about the effects of environmental contaminants on health due to mixed results, small number of studies and studies being restricted to a small number of regions. Meta-analytical synthesis of the evidence should be considered for priority contaminants and health outcomes. The following research gaps should be addressed in future studies: association of contaminants and health in other Arctic regions (i.e. Inuvialuit Settlement Region, Nunavut, Nunatsiavut, Alaska, European

  8. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes: a systematic review.

    Science.gov (United States)

    Harmsen, Marissa J; Browne, Joyce L; Venter, Francois; Klipstein-Grobusch, Kerstin; Rijken, Marcus J

    2017-07-11

    Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes. A systematic search was conducted in five electronic databases to obtain articles that measured serum lipid concentrations or the incidence of dyslipidaemia in HIV-infected pregnant women. Included articles were assessed for quality according to the Cochrane Risk of Bias Tool. The extracted data was analysed through descriptive analysis. Of the 1264 articles screened, 17 articles were included in this review; eleven reported the incidence of dyslipidaemia, and twelve on maternal serum lipid concentrations under the influence of HIV-infection and ART. No articles reported pregnancy outcomes in relation to serum lipids. Articles were of acceptable quality, but heterogenic in methods and study design. Lipid levels in HIV-infected women increased 1.5-3 fold over the trimesters of pregnancy, and remained within the physiological reference range. The percentage of women with dyslipidaemia was variable between the studies [0-88.9%] and highest in the groups on first generation protease inhibitors and for women on ART at conception. This systematic review observed physiologic concentrations of serum lipids for HIV-infected women receiving ART during pregnancy. Serum lipids were increased in users of first generation protease inhibitors and for those on treatment at conception. There was no information available about pregnancy outcomes. Future studies are needed which include HIV-uninfected control groups, control for potential confounders, and overcome limitations associated with included studies.

  9. Association of Gender With Outcome and Host Response in Critically Ill Sepsis Patients.

    Science.gov (United States)

    van Vught, Lonneke A; Scicluna, Brendon P; Wiewel, Maryse A; Hoogendijk, Arie J; Klein Klouwenberg, Peter M C; Ong, David S Y; Cremer, Olaf L; Horn, Janneke; Franitza, Marek; Toliat, Mohammad R; Nürnberg, Peter; Bonten, Marc M J; Schultz, Marcus J; van der Poll, Tom

    2017-11-01

    To determine the association of gender with the presentation, outcome, and host response in critically ill patients with sepsis. A prospective observational cohort study in the ICU of two tertiary hospitals between January 2011 and January 2014. All consecutive critically ill patients admitted with sepsis, involving 1,815 admissions (1,533 patients). The host response was evaluated on ICU admission by measuring 19 plasma biomarkers reflecting organ systems implicated in sepsis pathogenesis (1,205 admissions) and by applying genome-wide blood gene expression profiling (582 admissions). Sepsis patients admitted to the ICU were more frequently males (61.0%; p < 0.0001 vs females). Baseline characteristics were not different between genders. Urosepsis was more common in females; endocarditis and mediastinitis in men. Disease severity was similar throughout ICU stay. Mortality was similar up to 1 year after ICU admission, and gender was not associated with 90-day mortality in multivariate analyses in a variety of subgroups. Although plasma proteome analyses (including systemic inflammatory and cytokine responses, and activation of coagulation) were largely similar between genders, females showed enhanced endothelial cell activation; this difference was virtually absent in patients more than 55 years old. More than 80% of the leukocyte blood gene expression response was similar in male and female patients. The host response and outcome in male and female sepsis patients requiring ICU admission are largely similar.

  10. Factors associated with long-term functional outcomes and psychological sequelae in Guillain-Barre syndrome.

    Science.gov (United States)

    Khan, F; Pallant, J F; Ng, L; Bhasker, A

    2010-12-01

    To examine factors impacting long-term health-related outcomes in survivors of Guillain-Barre syndrome (GBS). Seventy-six consecutive patients with definite GBS admitted to the Royal Melbourne Hospital (1996-2009) were reviewed in the neurorehabilitation clinics. They underwent a structured interview designed to assess the impact of GBS on their current activity and restriction in participation using validated questionnaires: Functional Independence Measure (FIM), Perceived Impact of Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS). Their sociodemographic and disease severity data were obtained from the medical record. The 76 patients [60% male, mean age 56 years, median time since GBS 6 years (range 1-14 years)] showed good functional recovery (median motor FIM score 90). However, 16% reported moderate to extreme impact on their ability to participate in work, family, and social activities; and 22% substantial impact on mood, confidence and ability to live independently. More reported moderate to extreme depression (18%), anxiety (22%) and stress (17%) compared with the normative Australian population (13%). Factors associated with poorer current level of functioning and wellbeing included: females, older patients (57+ years), acute hospital stay (>11 days), those treated in intensive care and those discharged to rehabilitation. No associations were found between the Medical Research Council (MRC) Motor Scale Rating scores at admission, nor time since GBS diagnosis (≤6 vs. >6 years) on outcomes used. GBS is complex and requires long-term management of psychological sequelae impacting activity and participation.

  11. Serum Concentrations of Trace Elements in Patients with Tuberculosis and Its Association with Treatment Outcome

    Directory of Open Access Journals (Sweden)

    Rihwa Choi

    2015-07-01

    Full Text Available Deficiencies in essential trace elements are associated with impaired immunity in tuberculosis infection. However, the trace element concentrations in the serum of Korean patients with tuberculosis have not yet been investigated. This study aimed to compare the serum trace element concentrations of Korean adult patients with tuberculosis with noninfected controls and to assess the impact of serum trace element concentration on clinical outcome after antituberculosis treatment. The serum concentrations of four trace elements in 141 consecutively recruited patients with tuberculosis and 79 controls were analyzed by inductively coupled plasma-mass spectrometry. Demographic characteristics were also analyzed. Serum cobalt and copper concentrations were significantly higher in patients with tuberculosis compared with controls, while zinc and selenium concentrations were significantly lower (p < 0.01. Moreover, serum selenium and zinc concentrations were positively correlated (ρ = 0.41, p < 0.05. A high serum copper concentration was associated with a worse clinical outcome, as assessed after one month of antituberculosis therapy. Specifically, culture-positive patients had higher serum copper concentrations than culture-negative patients (p < 0.05. Patients with tuberculosis had altered serum trace element concentrations. Further research is needed to elucidate the roles of individual trace elements and to determine their clinical impact on patients with tuberculosis.

  12. Dimensions of Socioeconomic Status and Childhood Asthma Outcomes: Evidence for Distinct Behavioral and Biological Associations.

    Science.gov (United States)

    Chen, Edith; Shalowitz, Madeleine U; Story, Rachel E; Ehrlich, Katherine B; Levine, Cynthia S; Hayen, Robin; Leigh, Adam K K; Miller, Gregory E

    The objective of this study was to investigate 2 key dimensions of socioeconomic status (SES)-prestige and resources-and their associations with immune, behavioral, and clinical outcomes in childhood asthma. Children ages 9 to 17 years with a physician's diagnosis of asthma (N = 150), and one of their parents participated in this study. Children and parents completed interviews and questionnaires about SES (prestige = parent education; resources = family assets), environmental exposures, and clinical asthma measures. Spirometry was conducted to assess children's pulmonary function, and blood was collected to measure cytokine production in response to nonspecific stimulation, allergen-specific stimulation, and microbial stimulation. Higher scores on both dimensions of childhood SES were associated with better clinical outcomes in children (β's from |.18 to .27|, p values childhood family environments have different implications for behavioral and immunological processes relevant to childhood asthma. They also suggest that childhood SES relates to multiple aspects of immunologic regulation of relevance to the pathophysiology of asthma.

  13. Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

    Science.gov (United States)

    Gonzales, Gustavo F; Tapia, Vilma L; Fort, Alfredo L; Betran, Ana Pilar

    2013-01-01

    A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P cesarean than vaginal deliveries (P cesarean section (P cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes. PMID:24124393

  14. Geospatial association between adverse birth outcomes and arsenic in groundwater in New Hampshire, USA

    Science.gov (United States)

    Xun Shi,; Ayotte, Joseph; Akikazu Onda,; Stephanie Miller,; Judy Rees,; Diane Gilbert-Diamond,; Onega, Tracy L; Gui, Jiang; Karagas, Margaret R.; Moeschler, John B

    2015-01-01

    There is increasing evidence of the role of arsenic in the etiology of adverse human reproductive outcomes. Because drinking water can be a major source of arsenic to pregnant women, the effect of arsenic exposure through drinking water on human birth may be revealed by a geospatial association between arsenic concentration in groundwater and birth problems, particularly in a region where private wells substantially account for water supply, like New Hampshire, USA. We calculated town-level rates of preterm birth and term low birth weight (term LBW) for New Hampshire, by using data for 1997–2009 stratified by maternal age. We smoothed the rates by using a locally weighted averaging method to increase the statistical stability. The town-level groundwater arsenic probability values are from three GIS data layers generated by the US Geological Survey: probability of local groundwater arsenic concentration >1 µg/L, probability >5 µg/L, and probability >10 µg/L. We calculated Pearson’s correlation coefficients (r) between the reproductive outcomes (preterm birth and term LBW) and the arsenic probability values, at both state and county levels. For preterm birth, younger mothers (maternal age based on the data of probability >10 µg/L; for older mothers, r = 0.19 when the smoothing threshold = 3,500; a majority of county level r values are positive based on the arsenic data of probability >10 µg/L. For term LBW, younger mothers (maternal age based on the data of probability >1 µg/L; for older mothers, r = 0.14 when the rates are smoothed with a threshold = 1,000 births and also adjusted by town median household income in 1999, and the arsenic values are the town minimum based on probability >10 µg/L. At the county level for younger mothers, positive r values prevail, but for older mothers, it is a mix. For both birth problems, the several most populous counties—with 60–80% of the state’s population and clustering at the southwest

  15. 2008 Key Student Outcomes Indicators for BC Diploma, Associate Degree, and Certificate Programs: Survey Results by Institution

    Science.gov (United States)

    Ministry of Advanced Education and Labour Market Development, 2009

    2009-01-01

    The BC Diploma, Associate Degree, and Certificate Student Outcomes (DACSO) Survey (formerly the BC College and Institute Student Outcomes Survey) collects and disseminates information about former students' post-secondary experiences and their subsequent labour market and further education experiences. The survey is administered annually to former…

  16. Association between funding, risk of bias, and outcome of randomised controlled trials in oral and maxillofacial surgery

    NARCIS (Netherlands)

    Oomens, M.A.E.M.; Lazzari, S.; Heymans, M.W.; Forouzanfar, T.

    2016-01-01

    The influence of funding on the main outcome of a random control trial (RCT) is important, as it could potentially lead to bias towards industry, and results that are too optimistic. We investigated the association between funding, the published outcome, and the risk of bias in trials in oral and

  17. Associated genetic syndromes and extracardiac malformations strongly influence outcomes of fetuses with congenital heart diseases.

    Science.gov (United States)

    Bensemlali, Myriam; Bajolle, Fanny; Ladouceur, Magalie; Fermont, Laurent; Lévy, Marilyne; Le Bidois, Jérôme; Salomon, Laurent J; Bonnet, Damien

    2016-05-01

    Congenital heart disease (CHD) is often associated with extracardiac malformations (ECMs) and genetic syndromes. To determine the effect of cytogenetic anomalies and/or ECMs associated with CHD on parental decision to choose termination of pregnancy (TOP) or compassionate care (CC), as well as on the outcome of children born alive. This 10-year retrospective study included all prenatally diagnosed cases of CHD in a single tertiary referral centre. From January 2002 to December 2011, 2036 consecutive cases of fetal CHD (798 TOPs and 1238 live births, including 59 with postnatal CC) were included. CHD was associated with a known cytogenetic anomaly in 9.8% of cases and a major ECM in 11.7% of cases. The proportion of prenatally identified associated cytogenetic anomalies was significantly lower in the live-birth group than in the TOP plus CC group (4.2% vs 17.5%; P<0.001); this was also true for ECMs (8.1% vs 16.7%; P<0.001). The mortality rate was higher in the group with an associated cytogenetic anomaly or ECM (29.1%) than in cases with isolated CHD; a 2.4-fold increase in the death rate was observed (95% confidence interval 1.34-4.38; P=0.003). These associations remained significant after multivariable analysis, including the severity of the CHD (uni- or biventricular physiology). Prenatal diagnosis of a known cytogenetic anomaly or major ECM strongly influences parental decision to choose TOP or postnatal CC. Genetic syndromes and ECMs are associated with a higher mortality rate, independent of the complexity of the CHD. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. The Association Between Learning Climate and Adverse Obstetrical Outcomes in 16 Nontertiary Obstetrics-Gynecology Departments in the Netherlands.

    Science.gov (United States)

    Smirnova, Alina; Ravelli, Anita C J; Stalmeijer, Renée E; Arah, Onyebuchi A; Heineman, Maas Jan; van der Vleuten, Cees P M; van der Post, Joris A M; Lombarts, Kiki M J M H

    2017-12-01

    To investigate the association between learning climate and adverse perinatal and maternal outcomes in obstetrics-gynecology departments. The authors analyzed 23,629 births and 103 learning climate evaluations from 16 nontertiary obstetrics-gynecology departments in the Netherlands in 2013. Multilevel logistic regressions were used to calculate the odds of adverse perinatal and maternal outcomes, by learning climate score tertile, adjusting for maternal and department characteristics. Adverse perinatal outcomes included fetal or early neonatal mortality, five-minute Apgar score Learning climate scores were significantly associated with increased odds of adverse perinatal outcomes (aOR 2.06, 95% CI 1.14-3.72). Compared with the lowest tertile, departments in the middle tertile had 46% greater odds of adverse perinatal outcomes (aOR 1.46, 95% CI 1.09-1.94); departments in the highest tertile had 69% greater odds (aOR 1.69, 95% CI 1.24-2.30). Learning climate was not associated with adverse maternal outcomes (middle vs. lowest tertile: OR 1.04, 95% CI 0.93-1.16; highest vs. lowest tertile: OR 0.98, 95% CI 0.88-1.10). Learning climate was associated with significantly increased odds of adverse perinatal, but not maternal, outcomes. Research in similar clinical contexts is needed to replicate these findings and explore potential mechanisms behind these associations.

  19. Is shock index associated with outcome in children with sepsis/septic shock?*.

    Science.gov (United States)

    Yasaka, Yuki; Khemani, Robinder G; Markovitz, Barry P

    2013-10-01

    To investigate the association between PICU shock index (the ratio of heart rate to systolic blood pressure) and PICU mortality in children with sepsis/septic shock. To explore cutoff values for shock index for ICU mortality, how change in shock index over the first 6 hours of ICU admission is associated with outcome, and how the use of vasoactive therapy may affect shock index and its association with outcome. Retrospective cohort. Single-center tertiary PICU. Five hundred forty-four children with the diagnosis of sepsis/septic shock. None. From January 2003 to December 2009, 544 children met International Pediatric Sepsis Consensus Conference of 2005 criteria for sepsis/septic shock. Overall mortality was 23.7%. Among all patients, hourly shock index was associated with mortality: odds ratio of ICU mortality at 0 hour, 1.08, 95% CI (1.04-1.12); odds ratio at 1 hour, 1.09 (1.04-1.13); odds ratio at 2 hours, 1.09 (1.05-1.13); and odds ratio at 6 hours, 1.11 (1.06-1.15). When stratified by age, early shock index was associated with mortality only in children 1-3 and more than or equal to 12 years old. Area under the receiver operating characteristic curve in age 1-3 and more than or equal to 12 years old for shock index at admission was 0.69 (95% CI, 0.58-0.80) and 0.62 (95% CI, 0.52-0.72) respectively, indicating a fair predictive marker. Although higher shock index was associated with increased risk of mortality, there was no particular cutoff value with adequate positive or negative likelihood ratios to identify mortality in any age group of children. The improvement of shock index in the first 6 hours of ICU admission was not associated with outcome when analyzed in all patients. However, among patients whose shock index were above the 50th percentile at ICU admission for each age group, improvement of shock index was associated with lower ICU mortality in children between 1-3 and more than or equal to 12 years old (p = 0.02 and p = 0.03, respectively). When

  20. The association of polymorphisms in 5-fluorouracil metabolism genes with outcome in adjuvant treatment of colorectal cancer

    DEFF Research Database (Denmark)

    Shoaib, Afzal; Gusella, Milena; Jensen, Søren Astrup

    2011-01-01

    The purpose of this study was to investigate whether specific combinations of polymorphisms in 5-fluorouracil (5-FU) metabolism-related genes were associated with outcome in 5-FU-based adjuvant treatment of colorectal cancer....

  1. A functional single nucleotide polymorphism in the thrombin-activatable fibrinolysis inhibitor (TAFI) gene associates with outcome of meningococcal disease

    NARCIS (Netherlands)

    Kremer Hovinga, J. A.; Franco, R. F.; Zago, M. A.; ten Cate, Hugo; Westendorp, R. G. J.; Reitsma, P. H.

    2004-01-01

    In meningococcal sepsis, disseminated intravascular coagulation with deposition of fibrin and formation of microthrombi occurs in various organs and enhanced inhibition of fibrinolysis is associated with adverse outcome. Recently, TAFI (thrombin-activatable fibrinolysis inhibitor) was identified as

  2. High Intrapatient Variability of Tacrolimus Levels and Outpatient Clinic Nonattendance Are Associated With Inferior Outcomes in Renal Transplant Patients

    Directory of Open Access Journals (Sweden)

    Dawn L. Goodall, MSc

    2017-08-01

    Conclusions. This study shows that high tacrolimus IPV and clinic nonattendance are associated with inferior allograft survival. Interventions to minimize the causes of high variability, particularly nonadherence are essential to improve long-term allograft outcomes.

  3. National socioeconomic indicators are associated with outcomes after aneurysmal subarachnoid hemorrhage: a hierarchical mixed-effects analysis.

    Science.gov (United States)

    Guha, Daipayan; Ibrahim, George M; Kertzer, Joshua D; Macdonald, R Loch

    2014-11-01

    Although heterogeneity exists in patient outcomes following subarachnoid hemorrhage (SAH) across different centers and countries, it is unclear which factors contribute to such disparities. In this study, the authors performed a post hoc analysis of a large international database to evaluate the association between a country's socioeconomic indicators and patient outcome following aneurysmal SAH. An analysis was performed on a database of 3552 patients enrolled in studies of tirilazad mesylate for aneurysmal SAH from 1991 to 1997, which included 162 neurosurgical centers in North and Central America, Australia, Europe, and Africa. Two primary outcomes were assessed at 3 months after SAH: mortality and Glasgow Outcome Scale (GOS) score. The association between these outcomes, nation-level socioeconomic indicators (percapita gross domestic product [GDP], population-to-neurosurgeon ratio, and health care funding model), and patientlevel covariates were assessed using a hierarchical mixed-effects logistic regression analysis. Multiple previously identified patient-level covariates were significantly associated with increased mortality and worse neurological outcome, including age, intraventricular hemorrhage, and initial neurological grade. Among national-level covariates, higher per-capita GDP (p funding model was not a significant predictor of either primary outcome. Higher per-capita gross GDP and population-to-neurosurgeon ratio were associated with improved outcome after aneurysmal SAH. The former result may speak to the availability of resources, while the latter may be a reflection of better outcomes with centralized care. Although patient clinical and radiographic phenotypes remain the primary predictors of outcome, this study shows that national socioeconomic disparities also explain heterogeneity in outcomes following SAH.

  4. Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes.

    Science.gov (United States)

    Wade, Shari L; Cassedy, Amy E; Fulks, Lauren E; Taylor, H Gerry; Stancin, Terry; Kirkwood, Michael W; Yeates, Keith O; Kurowski, Brad G

    2017-08-01

    To examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI). Cross-sectional evaluation of pretreatment data from a randomized controlled trial. Four children's hospitals and 1 general hospital, with level 1 trauma units. Youth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153). Problem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures. The TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (Pproblem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (PProblem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on functional outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  5. Association of PTP1B with Outcomes of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy.

    Science.gov (United States)

    Rivera Franco, Monica M; Leon Rodriguez, Eucario; Martinez Benitez, Braulio; Villanueva Rodriguez, Luisa G; de la Luz Sevilla Gonzalez, Maria; Armengol Alonso, Alejandra

    2016-01-01

    PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR). Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5%) and overexpression (≥5%). Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR ( P = 0.2). However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens ( P = 0.02). Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B over-expression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

  6. Association of PTP1B with Outcomes of Breast Cancer Patients who Underwent Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Monica M. Rivera Franco

    2016-01-01

    Full Text Available PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR. Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5% and overexpression (≥5%. Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR (P = 0.2. However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens (P = 0.02. Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B overexpression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

  7. Comparative genomics of Helicobacter pylori strains of China associated with different clinical outcome.

    Directory of Open Access Journals (Sweden)

    Yuanhai You

    Full Text Available In this study, a whole-genome CombiMatrix Custom oligonucleotide tiling microarray with 90,000 probes covering six sequenced Helicobacter pylori (H. pylori genomes was designed. This microarray was used to compare the genomic profiles of eight unsequenced strains isolated from patients with different gastroduodenal diseases in Heilongjiang province of China. Since significant genomic variation was found among these strains, an additional 76 H. pylori strains associated with different clinical outcomes were isolated from various provinces of China. These strains were tested by polymerase chain reaction to demonstrate this distinction. We identified several highly variable regions in strains associated with gastritis, gastric ulceration, and gastric cancer. These regions are associated with genes involved in the bacterial type I, type II, and type III R-M systems. They were also associated with the virB gene, which lies on the well-studied cag pathogenic island. While previous studies have reported on the diverse genetic characterization of this pathogenic island, in this study, we find that it is conserved in all strains tested by microarray. Moreover, a number of genes involved in the type IV secretion system, which is related to horizontal DNA transfer between H. pylori strains, were identified in the comparative analysis of the strain-specific genes. These findings may provide insight into new biomarkers for the prediction of gastric diseases.

  8. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome?

    Science.gov (United States)

    Mazor-Dray, Efrat; Levy, Amalia; Schlaeffer, Francisc; Sheiner, Eyal

    2009-02-01

    This population-based study was aimed to determine whether there is an association between urinary tract infections (UTI) during pregnancy, among patients in whom antibiotic treatment was recommended, and maternal and perinatal outcome. A retrospective population-based study comparing all singleton pregnancies of patients with and without UTI was performed. Multiple logistic regression models were performed to control for confounders. Out of 199,093 deliveries, 2.3% (n = 4742) had UTI during pregnancy and delivery. Patients with UTI had significantly higher rates of intra-uterine growth restriction (IUGR), pre-eclampsia, caesarean deliveries (CD) and pre-term deliveries (either before 34 weeks or 37 weeks of gestation). Although controlling for possible confounders such as maternal age and parity, using multivariable analyses, the significant association between UTI and IUGR, pre-eclampsia, CD and preterm deliveries persisted. In contrast, no significant differences in 5-min Apgar scores less than 7 or perinatal mortality were noted between the groups (0.6% vs. 0.6%; p = 0.782, and 1.5% vs. 1.4%; p = 0.704, respectively). Maternal UTI is independently associated with pre-term delivery, pre-eclampsia, IUGR and CD. Nevertheless, it is not associated with increased rates of perinatal mortality compared with women without UTI.

  9. Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome

    International Nuclear Information System (INIS)

    Koo, Hyun Jung; Do, Kyung-Hyun; Chae, Eun Jin; Kim, Hwa Jung; Song, Joon Seon; Jang, Se Jin; Hong, Sang-Bum; Huh, Jin Won; Lee, En; Hong, Soo-Jong

    2017-01-01

    To identify clinical and radiologic findings that affect disease severity and short-term prognosis of humidifier disinfectant-associated lung injury in adults and to compare computed tomography (CT) findings between the patients with and without death or lung transplantation. Fifty-nine adults (mean age, 34 years; M/F = 12:47) were enrolled in this retrospective study. Medical records and prospective surveillance data were used to assess clinical and radiological factors associated with a poor clinical outcome. Multivariate generalized estimating equation models were used to analyse serial CT findings. Overall cumulative major events including lung transplantation and mortality were assessed using the Kaplan-Meier method. Almost half needed ICU admission (47.5 %) and 17 died (28.8 %). Young age, peripartum and low O_2 saturation were factors associated with ICU admission. On initial chest radiographs, consolidation (P < 0.001) and ground-glass opacity (P = 0.01) were significantly noted in patients who required ICU admission. CT findings including consolidation (odds ratio (OR), 1.02), pneumomediastinum (OR, 1.66) and pulmonary interstitial emphysema (OR, 1.61) were the risk factors for lung transplantation and mortality. Clinical and radiologic findings are related to the risks of lung transplantation and mortality of humidifier disinfectant-associated lung injury. Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings. (orig.)

  10. Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Koo, Hyun Jung; Do, Kyung-Hyun; Chae, Eun Jin [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul (Korea, Republic of); Kim, Hwa Jung [University of Ulsan College of Medicine, Cancer Center, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul (Korea, Republic of); Song, Joon Seon; Jang, Se Jin [University of Ulsan College of Medicine, Department of Pathology, Asan Medical Center, Seoul (Korea, Republic of); Hong, Sang-Bum; Huh, Jin Won [University of Ulsan College of Medicine, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, En [Inje University Haundae Paik Hospital, Department of Pediatrics, Busan (Korea, Republic of); Hong, Soo-Jong [University of Ulsan College of Medicine, Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, Seoul (Korea, Republic of)

    2017-01-15

    To identify clinical and radiologic findings that affect disease severity and short-term prognosis of humidifier disinfectant-associated lung injury in adults and to compare computed tomography (CT) findings between the patients with and without death or lung transplantation. Fifty-nine adults (mean age, 34 years; M/F = 12:47) were enrolled in this retrospective study. Medical records and prospective surveillance data were used to assess clinical and radiological factors associated with a poor clinical outcome. Multivariate generalized estimating equation models were used to analyse serial CT findings. Overall cumulative major events including lung transplantation and mortality were assessed using the Kaplan-Meier method. Almost half needed ICU admission (47.5 %) and 17 died (28.8 %). Young age, peripartum and low O{sub 2} saturation were factors associated with ICU admission. On initial chest radiographs, consolidation (P < 0.001) and ground-glass opacity (P = 0.01) were significantly noted in patients who required ICU admission. CT findings including consolidation (odds ratio (OR), 1.02), pneumomediastinum (OR, 1.66) and pulmonary interstitial emphysema (OR, 1.61) were the risk factors for lung transplantation and mortality. Clinical and radiologic findings are related to the risks of lung transplantation and mortality of humidifier disinfectant-associated lung injury. Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings. (orig.)

  11. Treatment Outcome in Male Gambling Disorder Patients Associated with Alcohol Use

    Science.gov (United States)

    Jiménez-Murcia, Susana; Del Pino-Gutiérrez, Amparo; Fernández-Aranda, Fernando; Granero, Roser; Hakänsson, Anders; Tárrega, Salomé; Valdepérez, Ana; Aymamí, Neus; Gómez-Peña, Mónica; Moragas, Laura; Baño, Marta; Sauvaget, Anne; Romeu, Maria; Steward, Trevor; Menchón, José M.

    2016-01-01

    Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment (post intervention) in male patients with gambling disorder enrolled in a group cognitive behavioral therapy (CBT) program. Methods: The sample consisted of 111 male individuals with a diagnosis of Gambling Disorder, with a mean age of 45 years (SD = 12.2). All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10–14 patients attending 16 weekly outpatient sessions lasting 90 min each. Results: The highest mean pre- and post-therapy differences were recorded for the alcohol risk/dependence group on the obsessive/compulsive and anxiety dimensions of the SCL-90-R. As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes. Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology (measured by the SCL-90-R) were associated with increased risk of alcohol abuse. Alcohol abuse was also associated with poor response to treatment. PMID:27065113

  12. NTP Monograph: Developmental Effects and Pregnancy Outcomes Associated With Cancer Chemotherapy Use During Pregnancy.

    Science.gov (United States)

    2013-05-01

    The National Toxicology Program (NTP) Office of Health Assessment and Translation (OHAT) conducted an evaluation of the developmental effects and pregnancy outcomes associated with cancer chemotherapy use during pregnancy in humans. The final NTP monograph was completed in May 2013 (available at http:// ntp.niehs.nih.gov/go/36495). The incidence of cancer during pregnancy has been reported to occur from 17 to 100 per 100,000 pregnant women. Chemotherapy is a common treatment for cancer; however, most chemotherapy agents are classified as known or suspected human teratogens. Cancer chemotherapy use during pregnancy was selected for evaluation by the NTP because of the: (1) paucity of comprehensive reviews on the pregnancy outcomes following cancer chemotherapy use during pregnancy in humans, including the integration of the developmental animal toxicology literature with the observational studies in humans, and (2) growing public interest in the developmental effects of chemotherapy on offspring exposed to cancer chemotherapy during gestation due to the expected incidence of cancer diagnosed during pregnancy as women delay pregnancy to later ages. Of the approximately 110 cancer chemotherapeutic agents currently in use, the NTP monograph includes data on 56 agents used during 1,261 pregnancies for which pregnancy outcomes were documented. Overall, the NTP evaluation found that treatment with chemotherapy for cancer appeared to be associated with: (1) a higher rate of major malformations following exposure during the first trimester compared to exposure in the second and/or third trimester; (2) an increase the rate of stillbirth following exposure in the second and/ or third trimester; abnormally low levels of amniotic fluid (primarily attributable to Trastuzumab); and (3), also data are insufficient, impaired fetal growth and myelosuppression. Treatment with chemotherapy for cancer during pregnancy did not appear to increase spontaneous preterm birth, or impair

  13. Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin.

    Science.gov (United States)

    Navar, Ann Marie; Gallup, Dianne S; Lokhnygina, Yuliya; Green, Jennifer B; McGuire, Darren K; Armstrong, Paul W; Buse, John B; Engel, Samuel S; Lachin, John M; Standl, Eberhard; Van de Werf, Frans; Holman, Rury R; Peterson, Eric D

    2017-11-01

    Systolic blood pressure (SBP) treatment targets for adults with diabetes mellitus remain unclear. SBP levels among 12 275 adults with diabetes mellitus, prior cardiovascular disease, and treated hypertension were evaluated in the TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin) randomized trial of sitagliptin versus placebo. The association between baseline SBP and recurrent cardiovascular disease was evaluated using multivariable Cox proportional hazards modeling with restricted cubic splines, adjusting for clinical characteristics. Kaplan-Meier curves by baseline SBP were created to assess time to cardiovascular disease and 2 potential hypotension-related adverse events: worsening kidney function and fractures. The association between time-updated SBP and outcomes was examined using multivariable Cox proportional hazards models. Overall, 42.2% of adults with diabetes mellitus, cardiovascular disease, and hypertension had an SBP ≥140 mm Hg. The association between SBP and cardiovascular disease risk was U shaped, with a nadir ≈130 mm Hg. When the analysis was restricted to those with baseline SBP of 110 to 150 mm Hg, the adjusted association between SBP and cardiovascular disease risk was flat (hazard ratio per 10-mm Hg increase, 0.96; 95% confidence interval, 0.91-1.02). There was no association between SBP and risk of fracture. Above 150 mm Hg, higher SBP was associated with increasing risk of worsening kidney function (hazard ratio per 10-mm Hg increase, 1.10; 95% confidence interval, 1.02-1.18). Many patients with diabetes mellitus have uncontrolled hypertension. The U-shaped association between SBP and cardiovascular disease events was largely driven by those with very high or low SBP, with no difference in cardiovascular disease risk between 110 and 150 mm Hg. Lower SBP was not associated with higher risks of fractures or worsening kidney function. © 2017 American Heart Association, Inc.

  14. Clinical outcomes associated with comorbid posttraumatic stress disorder among patients with bipolar disorder.

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    Passos, Ives C; Jansen, Karen; Cardoso, Taiane de A; Colpo, Gabriela D; Zeni, Cristian P; Quevedo, Joao; Kauer-Sant'Anna, Márcia; Zunta-Soares, Giovanna; Soares, Jair C; Kapczinski, Flavio

    2016-05-01

    To assess clinical outcomes associated with the presence of a lifetime history of comorbid posttraumatic stress disorder in subjects with bipolar disorder. This cross-sectional study of 284 subjects with bipolar disorder (DSM-IV) assessed the association between lifetime comorbid posttraumatic stress disorder (DSM-IV) and clinical characteristics. Participants were included from January 2006 to June 2009. We assessed age at onset, number of mood episodes, presence of rapid cycling, first drug use, suicide attempts, hospitalizations, functional impairment, and quality of life. Diagnostic, clinical, and functional assessments were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders, patient edition (SCID-I/P), the Functioning Assessment Short Test, and the World Health Organization Quality of Life scale. The number of manic episodes as assessed by SCID-I/P was the primary outcome. The prevalence of lifetime comorbid posttraumatic stress disorder was 19.7% (56 subjects). Subjects with bipolar disorder and posttraumatic stress disorder had an accelerated course of illness, with a lower age at onset of manic/hypomanic episodes (P = .009) and earlier initiation of illicit drug use (P = .008). In addition, they were more likely to be younger when they received the diagnosis of bipolar disorder (P = .036) and had a higher number of manic/hypomanic episodes (P = .01). Quality of life was worse in all domains among subjects who presented the comorbidity, and rates of functional impairment were higher. Comorbid posttraumatic stress disorder was associated with increased morbidity and accelerated illness progression among subjects with bipolar disorder. © Copyright 2016 Physicians Postgraduate Press, Inc.

  15. Gait Change Is Associated with Cognitive Outcome after an Acute Ischemic Stroke

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    Sharmila Sagnier

    2017-05-01

    Full Text Available Background: Cognition and gait have often been studied separately after stroke whereas it has been suggested that these two domains could interact through a cognitive-motor interference.Objective: To evaluate the influence of gait changes on cognitive outcome after an ischemic stroke (IS.Methods: We conducted a prospective and monocentric study including patients admitted for an acute supratentorial IS with a National Institute of Health Stroke Score ≤ 15. Cognition, gait and motor disability were evaluated at baseline, 3 months and 1 year post-stroke, using the Montreal Cognitive Assessment (MoCA, the 10-m walking test (10-MWT and the Fugl-Meyer motor assessment (FMMA. The effect of changes in 10-MWT over the year of follow-up on MoCA changes was estimated using a generalized linear mixed model with FMMA, age and gender as covariates.Results: Two hundred and Twelve patients were included (71% male, age 64 ± 13 years old. 10-MWT improved from baseline to 1 year (p < 0.001, as did MoCA (p < 0.001 and FMMA (p < 0.001 scores. Ninety-nine patients (47% had a MoCA <26 at 1 year. Changes in 10-MWT were independently associated with changes in MoCA (β = −0.2, 95% CI −0.24 to −0.07, Bonferroni-corrected p-value = 0.002. Analyses of MoCA sub-scores suggested that changes in gait performance was associated with changes in executive functions and recall.Conclusion: Gait performance is associated with cognitive outcome after a mild to moderate IS, suggesting that they should be managed together to improve post-stroke independence.

  16. Obesity in Mexico: prevalence, comorbidities, associations with patient outcomes, and treatment experiences

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    DiBonaventura MD

    2017-12-01

    Full Text Available Marco D DiBonaventura,1 Henrik Meincke,2 Agathe Le Lay,2 Janine Fournier,2 Erik Bakker,3 Allison Ehrenreich1 1Kantar Health, New York, NY, USA; 2Novo Nordisk, Copenhagen, Denmark; 3Novo Nordisk, Mexico City, Mexico Objective: The goal of this study is to investigate obesity and its concomitant effects including the prevalence of comorbidities, its association with patient-reported outcomes and costs, and weight loss strategies in a sample of Mexican adults. Methods: Mexican adults (N=2,511 were recruited from a combination of Internet panels and street intercepts using a random-stratified sampling framework, with strata defined by age and sex, so that they represent the population. Participants responded to a survey consisting of a range of topics including sociodemographics, health history, health-related quality of life (HRQoL, work productivity, health care resource use, and weight loss. Results: The sample consisted of 50.6% male with a mean age of 40.7 years (SD=14.5; 38.3% were overweight, and 24.4% were obese. Increasing body mass index (BMI was associated with increased rates of type 2 diabetes, prediabetes, and hypertension, poorer HRQoL, and decreased work productivity. Of the total number of respondents, 62.2% reported taking steps to lose weight with 27.6% and 17.1% having used an over-the-counter/herbal product and a prescription medication, respectively. Treatment discontinuation rates were high. Conclusion: Findings indicated that 62% of participants reported, at least, being overweight and that they were experiencing the deleterious effects associated with higher BMI despite the desire to lose weight. Given the rates of obesity, and its impact on humanistic and societal outcomes, improved education, prevention, and management could provide significant benefits. Keywords: obesity, quality of life, costs, treatment patterns, weight loss

  17. Associations between renaming schizophrenia and stigma-related outcomes: A systematic review.

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    Yamaguchi, Sosei; Mizuno, Masashi; Ojio, Yasutaka; Sawada, Utako; Matsunaga, Asami; Ando, Shuntaro; Koike, Shinsuke

    2017-06-01

    Renaming schizophrenia is a potential strategy to reduce the stigma attached to people with schizophrenia. However, the overall associations between renaming schizophrenia and stigma-related outcomes have not been fully elucidated. We conducted a systematic review of studies that empirically examined the outcomes between new or alternative terms and old or existing terms for schizophrenia. We searched for relevant articles in eight bibliographic databases, conducted a Google search, examined reference lists, and contacted relevant experts. We found a total of 2601 reference records, and 23 articles were included in this review. Overall, in countries where schizophrenia has been renamed, the name changes may be associated with improvements in adults' attitudes toward people with schizophrenia, and with increased diagnosis announcement. However, studies conducted in countries where schizophrenia has not been renamed report inconsistent findings. In addition, renaming may not influence portrayals of schizophrenia in the media. Most studies included in our review had a risk of bias in their methodology, and we employed a vote-counting method to synthesize study results; therefore, the impacts of renaming are still inconclusive. Future studies are needed to address the following issues: use of univariate descriptive statistics, adjustment for confounding variables, use of reliable measures, and employing a question that addresses the image of split or multiple personalities. Evidence is limited regarding the associations between renaming and stigma experienced by both people with schizophrenia and their families (e.g., perceived stigma, self-stigma, discrimination experience, and burden). Further research in these populations is needed to confirm the effects of renaming schizophrenia. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.

  18. Association of rule of law and health outcomes: an ecological study.

    Science.gov (United States)

    Pinzon-Rondon, Angela Maria; Attaran, Amir; Botero, Juan Carlos; Ruiz-Sternberg, Angela Maria

    2015-10-29

    To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes. Global project. Data set of 96 countries, comprising 91% of the global population. The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice. The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries' level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (plaw remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population. It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  19. Personalized risk assessment of drug-related harm is associated with health outcomes.

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    Andrea A Jones

    Full Text Available The Independent Scientific Committee on Drugs (ISCD assigned quantitative scores for harm to 20 drugs. We hypothesized that a personalized, ISCD-based Composite Harm Score (CHS would be associated with poor health outcomes in polysubstance users.A prospective community sample (n=293 of adults living in marginal housing was assessed for substance use. The CHS was calculated based on the ISCD index, and the personal substance use characteristics over four weeks. Regression models estimated the association between CHS and physical, psychological, and social health outcomes.Polysubstance use was pervasive (95.8%, as was multimorbid illness (median 3, possible range 0-12. The median CHS was 2845 (interquartile range 1865-3977. Adjusting for age and sex, every 1000-unit CHS increase was associated with greater mortality (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.07-2.01, p = 0.02, and persistent hepatitis C infection (OR 1.29, 95% CI 1.02-1.67, p = 0.04. The likelihood of substance-induced psychosis increased 1.39-fold (95% CI 1.13-1.67, p = 0.001. The amount spent on drugs increased 1.51-fold (1.40-1.62, p < 0.001 and the odds of having committed a crime increased 1.74-fold (1.46-2.10, p < 0.001. Multimorbid illness increased 1.43-fold (95% CI 1.26-1.63, p < 0.001.Greater CHS predicts poorer physical, psychological, and social health, and may be a useful quantitative, personalized measure of risk for drug-related harm.

  20. Association between the outcome of traumatic brain injury patients and cerebrovascular autoregulation, cerebral perfusion pressure, age, and injury grades

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    Vytautas Petkus

    2016-01-01

    Conclusions: The association of the GOS score with CPP, CA impairment conditions, age and diffuse axonal injury (DAI grade showed that the outcomes of TBI patients were associated with patient-specific CPP management and better outcomes were obtained for younger patients, for patients having lower DAI grade and for patients whose CPP was kept within the range from the optimal CPP to the optimal CPP + 10 mmHg.

  1. Association of Incident Obstructive Sleep Apnea with Outcomes in a Large Cohort of US Veterans

    Science.gov (United States)

    Molnar, Miklos Z; Mucsi, Istvan; Novak, Marta; Szabo, Zoltan; Freire, Amado X; Huch, Kim M; Arah, Onyebuchi A; Ma, Jennie Z; Lu, Jun L; Sim, John J; Streja, Elani; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P

    2015-01-01

    Rationale There is a paucity of large cohort studies examining the association of obstructive sleep apnea(OSA) with clinical outcomes including all-cause mortality, coronary heart disease(CHD), strokes and chronic kidney disease(CKD). Objectives We hypothesized that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes. Methods, Measurements In a nationally representative cohort of over 3 million(n=3,079,514) US veterans(93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73m2, we examined the association between the diagnosis of incident OSA, treated and untreated with continuous positive airway pressure(CPAP), and: 1) all-cause mortality, 2) incident CHD, 3) incident strokes, 4)incident CKD defined as eGFR<60 ml/min/1.73m2, and 5)slopes of eGFR. Main Results Compared to OSA negative patients, untreated and treated OSA was associated with 86% higher mortality risk,(adjusted hazard ratio and 95% confidence interval: 1.86(1.81-1.91)) and 35% (1.35(1.21-1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times(3.54(3.40-3.69)) and 3 times(3.06(2.62-3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes(3.48(3.28-3.64) and 3.50(2.92-4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated(2.27(2.19-2.36)) and treated(2.79(2.48-3.13)) OSA patients. The median (interquartile range) of the eGFR slope was −0.41(−2.01 - 0.99), −0.61(