[Angiopoietins predict long-term outcomes after aneurysmal subarachnoid hemorrhage during an early period].

Science.gov (United States)

Wang, Yi; Wang, Dong; Wei, Huijie; Tian, Ye; Jiang, Rongcai; Yue, Shuyuan; Zhang, Jianning

2015-05-19

To evaluate the association between serum levels of angiopoietins (Ang) during an early period (within 72 h) and clinical outcomes after aneurysmal subarachnoid haemorrhage (aSAH). This prospective study was conducted at Department of Neurosurgery, Tianjin Medical University General Hospital. Blood samples from 37 aSAH patients were collected at 8 h (or GOSE). Those with GOSE > 5 were counted as a good outcome while those with GOSE ≤ 5 had a poor outcome. A total of 37 patients with aSAH and 39 healthy controls (HC) were enrolled. The aSAH patients showed a significant rise of Ang-1 within 8 h as compared with HC. The outcomes were good (n = 15) and poor (n = 22). Serum Ang-1 at 8 h (or < 8 h), 24 h and 72 h in good outcomers showed significantly higher than that in poor outcomers [(52 ± 24) vs (37 ± 17) mg/L, (62 ± 26) vs (45 ± 17) mg/L, (107 ± 27) vs (72 ± 18) mg/L]. The serum level of Ang-1 at 8 h and 24 h was one of independent risk factors for aSAH patients by multiariable Logistic regression analysis [adjected OR (95% CI) 1.095 (1.015-1.181) and 1.109 (1.016-1.211)] (P < 0.05). High serum level of Ang-1 during an early period (within 72 h) was associated with good outcomers (r = 0.627, P < 0.001). The serum levels of angiopoietins are significantly altered in aSAH patients, especially higher in good outcomers. And abnormal levels of angiopoietins may affect early brain injury (EBI) after SAH, structural integrity and recovery of blood-brain barrier (BBB) and long-term outcomes in aSAH patients.

Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes.

Science.gov (United States)

Quan, Samuel; Frolkis, Alexandra; Milne, Kaylee; Molodecky, Natalie; Yang, Hong; Dixon, Elijah; Ball, Chad G; Myers, Robert P; Ghosh, Subrata; Hilsden, Robert; van Zanten, Sander Veldhuyzen; Kaplan, Gilaad G

2014-12-14

To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD). Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI. The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95

Effect of Mastery Learning on Senior Secondary School Students' Cognitive Learning Outcome in Quantitative Chemistry

Science.gov (United States)

Mitee, Telimoye Leesi; Obaitan, Georgina N.

2015-01-01

The cognitive learning outcome of Senior Secondary School chemistry students has been poor over the years in Nigeria. Poor mathematical skills and inefficient teaching methods have been identified as some of the major reasons for this. Bloom's theory of school learning and philosophy of mastery learning assert that virtually all students are…

Do school context, student composition and school leadership affect school practice and outcomes in secondary education?

NARCIS (Netherlands)

Opdenakker, M.C.; van Damme, J

This study examined effects of school context, student composition and school leadership on school practice and outcomes in secondary education in Flanders. The study reveals that relations between school characteristics do exist and that it is possible to explain an important part of the

[Perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture: clinical outcomes and influence on the patient's quality of life].

Science.gov (United States)

Wang, Yong-Quan; Zhang, Heng; Shen, Wen-Hao; Li, Long-Kun; Li, Wei-Bing; Xiong, En-Qing

2012-04-01

To investigate the outcomes of perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture and assess its influence on the patient's quality of life. We retrospectively analyzed 54 cases of ultralong urethral stricture treated by perineal urethrostomy from 2000 to 2010. The mean age of the patients was 40 years, and the average length of stricture was 6.5 cm. We evaluated the patients'quality of life by questionnaire investigation and the clinical outcomes based on IPSS, Qmax, the necessity of urethral dilation and satisfaction of the patients. The mean Qmax of the 54 patients was (14.0 +/- 4.7) ml/min. Of the 34 cases that underwent secondary urethroplasty, 22 (64.7%) achieved a mean Qmax of (12.0 +/- 3.5) ml/min, 8 (23.5%) needed regular urethral dilatation and 4 (11.8%) received internal urethrotomy because of restenosis. IPSS scores were 5.4 +/- 2.1 and 8.5 +/- 5.8 after perineal urethrostomy and secondary urethroplasty, respectively. Fifty of the total number of patients (92.6%) were satisfied with the results of perineal urethrostomy, and 22 of the 34 (64.7%) with the results of secondary urethroplasty. Perineal urethrostomy plus secondary urethroplasty is safe and effective for ultralong urethral stricture, and affects very little the patient's quality of life.

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Directory of Open Access Journals (Sweden)

Cem Kaan Parsak

2014-03-01

Full Text Available Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study. Methods: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. Results: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016. No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT and in three patients in the subtotal parathyroidectomy group (subtotal PTX. Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10 days. Including nine patients who underwent successful renal transplantation pre-operative bone

Clinical Outcomes Used in Clinical Pharmacy Intervention Studies in Secondary Care

Directory of Open Access Journals (Sweden)

Lene Juel Kjeldsen

2017-05-01

Full Text Available The objective was to investigate type, frequency and result of clinical outcomes used in studies to assess the effect of clinical pharmacy interventions in inpatient care. The literature search using Pubmed.gov was performed for the period up to 2013 using the search phrases: “Intervention(s” and “pharmacist(s” and “controlled” and “outcome(s” or “effect(s”. Primary research studies in English of controlled, clinical pharmacy intervention studies, including outcome evaluation, were selected. Titles, abstracts and full-text papers were assessed individually by two reviewers, and inclusion was determined by consensus. In total, 37 publications were included in the review. The publications presented similar intervention elements but differed in study design. A large variety of outcome measures (135 had been used to evaluate the effect of the interventions; most frequently clinical measures/assessments by physician and health care service use. No apparent pattern was established among primary outcome measures with significant effect in favour of the intervention, but positive effect was most frequently related to studies that included power calculations and sufficient inclusion of patients (73% vs. 25%. This review emphasizes the importance of considering the relevance of outcomes selected to assess clinical pharmacy interventions and the importance of conducting a proper power calculation.

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

Science.gov (United States)

Matta, Sumathi; Park, Jiwon; Palamaner Subash Shantha, Ghanshyam; Khanna, Rohit C; Rao, Gullapalli N

2016-01-01

To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity gender discrimination in terms of outcome continues to be an issue and needs further investigation.

Non-Resident Fathers' Relationships with Their Secondary School Age Children: Determinants and Children's Mental Health Outcomes

Science.gov (United States)

Flouri, Eirini

2006-01-01

Data from 520 British secondary school age children were used to explore determinants of and mental health outcomes (measured with the Strengths and Difficulties Questionnaire) from their non-resident fathers' relationships (child-reported father's involvement and frequency of contact) with them. Frequency of contact was negatively related to time…

Exploring longitudinal course and treatment-baseline severity interactions in secondary outcomes of smoking cessation treatment in individuals with attention-deficit hyperactivity disorder.

Science.gov (United States)

Luo, Sean X; Wall, Melanie; Covey, Lirio; Hu, Mei-Chen; Scodes, Jennifer M; Levin, Frances R; Nunes, Edward V; Winhusen, Theresa

2018-01-25

A double blind, placebo-controlled randomized trial (NCT00253747) evaluating osmotic-release oral system methylphenidate (OROS-MPH) for smoking-cessation revealed a significant interaction effect in which participants with higher baseline ADHD severity had better abstinence outcomes with OROS-MPH while participants with lower baseline ADHD severity had worse outcomes. This current report examines secondary outcomes that might bear on the mechanism for this differential treatment effect. Longitudinal analyses were conducted to evaluate the effect of OROS-MPH on three secondary outcomes (ADHD symptom severity, nicotine craving, and withdrawal) in the total sample (N = 255, 56% Male), and in the high (N = 134) and low (N = 121) baseline ADHD severity groups. OROS-MPH significantly improved ADHD symptoms and nicotine withdrawal symptoms in the total sample, and exploratory analyses showed that in both higher and lower baseline severity groups, OROS-MPH statistically significantly improved these two outcomes. No effect on craving overall was detected, though exploratory analyses showed statistically significantly decreased craving in the high ADHD severity participants on OROS-MPH. No treatment by ADHD baseline severity interaction was detected for the outcomes. Methylphenidate improved secondary outcomes during smoking cessation independent of baseline ADHD severity, with no evident treatment-baseline severity interaction. Our results suggest divergent responses to smoking cessation treatment in the higher and lower severity groups cannot be explained by concordant divergence in craving, withdrawal and ADHD symptom severity, and alternative hypotheses may need to be identified.

The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

Science.gov (United States)

Elliott, Naomi; Begley, Cecily; Kleinpell, Ruth; Higgins, Agnes

2014-05-01

To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners. In many countries, advanced practitioners in nursing and midwifery have responsibility as leaders for health care development, but without having leadership outcome measures available they are unable to demonstrate the results of their activities. In Ireland, a sequential mixed method research study was used to develop a validated tool for the evaluation of clinical specialists and advanced practitioners. Despite strong evidence of leadership activities, few leadership-specific outcomes were generated from the primary analysis. Secondary analysis of a multiple case study data set. Data set comprised 23 case studies of advanced practitioner/clinical specialists from 13 sites across each region in Ireland from all divisions of the Nursing Board Register. Data were collected 2008-2010. Data sources included non-participant observation (n = 92 hours) of advanced practitioners in practice, interviews with clinicians (n = 21), patients (n = 20) and directors of nursing/midwifery (n = 13) and documents. Analysis focused on leadership outcome-indicator development in line with the National Health Service's Good Indicators Guide. The four categories of leadership outcomes for advanced practitioner developed were as follows: (i) capacity and capability building of multidisciplinary team; (ii) measure of esteem; (iii) new initiatives for clinical practice and healthcare delivery; and (iv) clinical practice based on evidence. The proposed set of leadership outcome-indicators derived from a secondary analysis captures the complexity of leadership in practice. They add to existing clinical outcomes measuring advanced practice. © 2013 John Wiley & Sons Ltd.

The Emotional Resources Group: Provisional outcome data for a pilot six-session emotion regulation programme for secondary care.

Science.gov (United States)

Bacon, Thomas; Doughty, Caitriona; Summers, Andrew; Wiffen, Benjamin; Stanley, Zoe; McAlpine, Susan

2018-06-01

To examine the effectiveness of a new, six-session emotion regulation group intervention designed for the secondary care setting: The Emotional Resources Group (ERG). In this pilot study, participants were recruited by referral from secondary care mental health services. Forty-seven individuals participated in the study. Participants who attended the ERG were compared on measures of emotion regulation, well-being, and self-efficacy, pre- and post-intervention. Intent-to-treat analyses indicated highly statistically significant improvements in measures of emotion regulation, well-being, and self-efficacy, accompanied by large effect sizes. In addition, improvements in emotion regulation produced good rates of both reliable and clinically significant change. The ERG may be an effective, brief intervention to improve emotion regulation in the secondary care setting, worthy of further evaluation. Clinical implications Emotion regulation may be an appropriate treatment target to improve well-being and self-efficacy in a transdiagnostic population. The ERG may be effective as a brief emotion regulation intervention for secondary care mental health settings. Outcomes of the ERG appear to be equivalent to other more intensive group-based emotion regulation interventions. The ERG's tailored design may be responsible for positive outcomes. Limitations There was a small sample size. There was no control group. There was no follow-up data. © 2018 The British Psychological Society.

Long-term secondary prevention of acute myocardial infarction (SEPAT) - guidelines adherence and outcome.

Science.gov (United States)

Ergatoudes, Constantinos; Thunström, Erik; Rosengren, Annika; Björck, Lena; Bengtsson Boström, Kristina; Falk, Kristin; Fu, Michael

2016-11-17

A number of registry studies have reported suboptimal adherence to guidelines for cardiovascular prevention during the first year after acute myocardial infarction (AMI). However, only a few studies have addressed long-term secondary prevention after AMI. This study evaluates prevention guideline adherence and outcome of guideline-directed secondary prevention in patients surviving 2 years after AMI. Patients aged 18-85 years at the time of their index AMI were consecutively identified from hospital discharge records between July 2010 and December 2011 in Gothenburg, Sweden. All patients who agreed to participate in the study (16.2%) were invited for a structured interview, physical examinations and laboratory analysis 2 years after AMI. Guideline-directed secondary preventive goals were defined as optimally controlled blood pressure, serum cholesterol, glucose, regular physical activity, smoking cessation and pharmacological treatment. The mean age of the study cohort (n = 200) at the index AMI was 63.0 ± 9.7 years, 79% were men. Only 3.5% of the cohort achieved all six guideline-directed secondary preventive goals 2 years after infarction. LDL therapy was used by 97% of the patients, beta-blockers by 83.0%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers by 76.5% and statins by 88.5%. During follow-up, non-fatal adverse cardiovascular events (cardiac hospitalization, recurrent acute coronary syndrome, angina pectoris, new percutaneous coronary intervention, new onset of atrial fibrillation, post-infarct heart failure, pacemaker implantation, stroke/transient ischemic attack (TIA), cardiac surgery and cardiac arrest) occurred in 47% of the cohort and readmission due to cardiac causes in 30%. Our data showed the failure of secondary prevention in our daily clinical practice and high rate of non-fatal adverse cardiovascular events 2 years after AMI.

[Nurse involvement in primary care: it is the key to improve the outcomes in primary and secondary prevention?].

Science.gov (United States)

Scardi, Sabino; Gori, Pierpaolo; Umari, Paolo

2010-06-01

Difficulties in management of risk factors, lifestyle and medications adherence to achieve secondary prevention of ischemic heart disease were described. Many studies indicate that the benefit of cardiac rehabilitation therapy after acute coronary events is only partially maintained during the following year. Thereafter, new strategies of medical care are needed to improve the long-term outcomes in coronary patients. Nurse co-ordinated, multidisciplinary cardiac rehabilitative programme could help patients to improve their lifestyle, to control their risk factors and to achieve their therapeutic goals for secondary prevention of ischemic heart disease.

Imaging findings, prevalence and outcome of de novo and secondary malignant fibrous histiocytoma of bone

Energy Technology Data Exchange (ETDEWEB)

Koplas, Monica C.; Ilaslan, Hakan; Sundaram, Murali [Cleveland Clinic, Imaging Institute/A21, Cleveland, OH (United States); Lefkowitz, Robert A.; Landa, Jonathan [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Bauer, Thomas W. [Cleveland Clinic, Anatomic Pathology/L25, Cleveland, OH (United States); Joyce, Michael J. [Cleveland Clinic, Orthopaedic and Rheumatologic Institute/A41, Cleveland, OH (United States)

2010-08-15

To evaluate the radiographic and magnetic resonance (MR) imaging features of primary and secondary malignant fibrous histiocytoma in bone and determine the demographics, prevalence and outcome of patients with this tumor. A retrospective search of files from two institutions identified 28 patients with malignant fibrous histiocytoma (MFH) of bone. Microscope slides were reviewed to confirm diagnosis and identify any pre-existing lesions. Medical records were reviewed with respect to patients' demographic characteristics and outcomes. Radiographic features demonstrated an aggressive osteolytic lesion with a permeative pattern of bone destruction. Periosteal reaction was seen in three of 13 lesions. T1-weighted images (T1WIs) demonstrated signal intensity iso- to slightly hyperintense to muscle. T2-weighted images (T2WIs) demonstrated mildly higher signal intensity than that of muscle. The 5-year survival rate was 53%. The tumor arose secondarily in pre-existing lesions in 43% of patients. Metastases occurred in 46% of patients during the course of the disease, with pulmonary and osseous metastases being the most common. Secondary MFH of bone was slightly less common than primary MFH and had a prognosis similar to that of primary MFH of bone. MR imaging showed variable and somewhat unusual low to intermediate T2 signal characteristics for a radiographically malignant osteolytic lesion. (orig.)

Imaging findings, prevalence and outcome of de novo and secondary malignant fibrous histiocytoma of bone

International Nuclear Information System (INIS)

Koplas, Monica C.; Ilaslan, Hakan; Sundaram, Murali; Lefkowitz, Robert A.; Landa, Jonathan; Bauer, Thomas W.; Joyce, Michael J.

2010-01-01

To evaluate the radiographic and magnetic resonance (MR) imaging features of primary and secondary malignant fibrous histiocytoma in bone and determine the demographics, prevalence and outcome of patients with this tumor. A retrospective search of files from two institutions identified 28 patients with malignant fibrous histiocytoma (MFH) of bone. Microscope slides were reviewed to confirm diagnosis and identify any pre-existing lesions. Medical records were reviewed with respect to patients' demographic characteristics and outcomes. Radiographic features demonstrated an aggressive osteolytic lesion with a permeative pattern of bone destruction. Periosteal reaction was seen in three of 13 lesions. T1-weighted images (T1WIs) demonstrated signal intensity iso- to slightly hyperintense to muscle. T2-weighted images (T2WIs) demonstrated mildly higher signal intensity than that of muscle. The 5-year survival rate was 53%. The tumor arose secondarily in pre-existing lesions in 43% of patients. Metastases occurred in 46% of patients during the course of the disease, with pulmonary and osseous metastases being the most common. Secondary MFH of bone was slightly less common than primary MFH and had a prognosis similar to that of primary MFH of bone. MR imaging showed variable and somewhat unusual low to intermediate T2 signal characteristics for a radiographically malignant osteolytic lesion. (orig.)

INFRARED SPECTROSCOPY OF SYMBIOTIC STARS. VII. BINARY ORBIT AND LONG SECONDARY PERIOD VARIABILITY OF CH CYGNI

International Nuclear Information System (INIS)

Hinkle, Kenneth H.; Joyce, Richard R.; Fekel, Francis C.

2009-01-01

High-dispersion spectroscopic observations are used to refine orbital elements for the symbiotic binary CH Cyg. The current radial velocities, added to a previously published 13 year time series of infrared velocities for the M giant in the CH Cyg symbiotic system, more than double the length of the time series to 29 years. The two previously identified velocity periods are confirmed. The long period, revised to 15.6 ± 0.1 yr, is shown to result from a binary orbit with a 0.7 M sun white dwarf and 2 M sun M giant. Mass transfer to the white dwarf is responsible for the symbiotic classification. CH Cyg is the longest period S-type symbiotic known. Similarities with the longer period D-type systems are noted. The 2.1 year period is shown to be on Wood's sequence D, which contains stars identified as having long secondary periods (LSP). The cause of the LSP variation in CH Cyg and other stars is unknown. From our review of possible causes, we identify g-mode nonradial pulsation as the leading mechanism for LSP variation in CH Cyg. If g-mode pulsation is the cause of the LSPs, a radiative region is required near the photosphere of pulsating asymptotic giant branch stars.

Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus: International Insights From the TECOS Trial (Trial Evaluating Cardiovascular Outcomes With Sitagliptin).

Science.gov (United States)

Pagidipati, Neha J; Navar, Ann Marie; Pieper, Karen S; Green, Jennifer B; Bethel, M Angelyn; Armstrong, Paul W; Josse, Robert G; McGuire, Darren K; Lokhnygina, Yuliya; Cornel, Jan H; Halvorsen, Sigrun; Strandberg, Timo E; Delibasi, Tuncay; Holman, Rury R; Peterson, Eric D

2017-09-26

Intensive risk factor modification significantly improves outcomes for patients with diabetes mellitus and cardiovascular disease. However, the degree to which secondary prevention treatment goals are achieved in international clinical practice is unknown. Attainment of 5 secondary prevention parameters-aspirin use, lipid control (low-density lipoprotein cholesterol diabetes mellitus and known cardiovascular disease at entry into TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin). Logistic regression was used to evaluate the association between individual and regional factors and secondary prevention achievement at baseline. Cox proportional hazards regression analysis was used to determine the association between baseline secondary prevention achievement and cardiovascular death, myocardial infarction, or stroke. Overall, 29.9% of patients with diabetes mellitus and cardiovascular disease achieved all 5 secondary prevention parameters at baseline, although 71.8% achieved at least 4 parameters. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of ≈25%. Individually, blood pressure control (57.9%) had the lowest overall attainment, whereas nonsmoking status had the highest (89%). Over a median 3.0 years of follow-up, a higher baseline secondary prevention score was associated with improved outcomes in a step-wise graded relationship (adjusted hazard ratio, 0.60; 95% confidence interval, 0.47-0.77 for those patients achieving all 5 measures versus those achieving ≤2). In an international trial population, significant opportunities exist to improve the quality of cardiovascular secondary prevention care among patients with diabetes mellitus and cardiovascular disease, which in turn could lead to reduced risk of downstream cardiovascular events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00790205. © 2017 American Heart Association, Inc.

Early Outcomes of Endoscopic Vein Harvesting during the Initial Learning Period

Directory of Open Access Journals (Sweden)

Do Yeon Kim

2015-06-01

Full Text Available Background: The endoscopic vein harvesting (EVH method has been used in coronary artery bypass surgery in many countries. We started using the EVH method recently, and investigated the results during the early learning period. Methods: Between March 2012 and June 2014, 75 patients (31 patients in the EVH method group, and 44 patients in the open method group who underwent isolated first-time coronary artery bypass grafting using vein grafts were retrospectively analyzed with respect to the early outcomes including graft patency and risk factors for leg wound complications. For assessing the patency of vein graft, we performed coronary computed tomography angiography during the immediate postoperative period and 6 months later. Results: Mean harvesting time of endoscopic method was about 15 minutes. Patency rate during the immediate operative period and the 6-month patency rate were similar between the two groups (postoperative period: EVH 100% vs. open method 94.4%, p=0.493; at 6 months: EVH 93.3% vs. open method 90.9%, p=0.791. Leg wound complications occurred more frequently in the open method group (EVH 3.2% vs. open method 13.6%, p=0.127. According to the analysis, age was an independent risk factor for leg wound complications. Conclusion: EVH is a feasible method even for beginners and can be performed satisfactorily during their learning period.

Variability of blood pressure and blood glucose during perioperative period for patients with secondary neovascular glaucoma after silicone oil removed in PDR

Directory of Open Access Journals (Sweden)

Fu-Lin Gao

2015-06-01

Full Text Available AIM:To research blood pressure and blood glucose variability during peroperative period for patients with secondary neovasular glaucoma(NVGafter silicone oil removed in proliferative diabetic retinaopathy(PDR.METHODS: Totally, 271 patients(271 eyesundergone surgery of vitrectomy and silicon-oil tamponade combined with cataract were respective analyzed. Fourteen patients(14 eyeswith secondary NVG after silicon oil removed and randomly controlled group of no NVG according with ages, operation method in the same time were studied. The blood pressure and blood glucose variability during peroperative period was analyzed, and did comparison after excluded contralateral eye. The complications of 271 patients were surveyed in following-up period 1～12mo. The incidence of NVG, the time, blood pressure, blood glucose and glycated hemoglobin(Hbc%variability during peroperative period was statisticed and compared by software of SPSS 11.0.RESULTS: Fourteen eyes(5.2%of 271 cases was with secondary NVG(female: 4 eyes, 28.6%; male: 10 eyes, 71.4%, average ages was 57.07 years(49～68 years. NVG presented in the 107～ 135d after vitrectomy and 7～45d(average 31.78dafter silicon-oil removed. Diabetes mellitus was 10～15(average 13.2a. In NVG group, the variability of blood glucose was 4.0～10.2mmol/L(mean 8.52±3.24mmol/L, variable coefficient was 0.48. In NNVG group, the variability of blood glucose was 5.0～8.2mmol/L(mean 7.22±0.24mmol/L, variable coefficient was 0.43. It was significantly difference in comparison in variable coefficient(PPPPCONCLUSION: There are significant variability on fasting blood glucose, daytime SBP and night DBP during perioperative in PDR patients with secondary NVG. It might be occurred 1wk after silicone oil removal surgery.

The impact of completing upper secondary education - a multi-state model for work, education and health in young men.

Science.gov (United States)

Hoff, Rune; Corbett, Karina; Mehlum, Ingrid S; Mohn, Ferdinand A; Kristensen, Petter; Hanvold, Therese N; Gran, Jon M

2018-04-27

Completing upper secondary education is associated with higher work participation and less health-related absence from work. Although these outcomes are closely interrelated, most studies focus on single outcomes, using cross-sectional designs or short follow-up periods. As such, there is limited knowledge of the long-term outcomes, and how paths for completers and non-completers unfold over time. In this paper, we use multi-state models for time-to-event data to assess the long-term effects of completing upper secondary education on employment, tertiary education, sick leave, and disability pension over twelve and a half years for young men. Baseline covariates and twelve and a half years of follow-up data on employment, tertiary education, sick leave and disability pension were obtained from national registries for all males born in Norway between 1971 and 1976 (n =184951). The effects of completing upper secondary education (by age 23) were analysed in a multi-state framework, adjusting for both individual and family level confounders. All analyses were done separately for general studies and vocational tracks. Completers do better on a range of outcomes compared to non-completers, for both fields of upper secondary education, but effects of completion change over time. The largest changes are for tertiary education and work, with the probability of work increasing reciprocally to the probability of education. Vocational students are quicker to transfer to the labour market, but tend to have more unemployment, sick leave and disability, and the absolute effects of completion on these outcomes are largest for vocational tracks. However, the relative effects of completion are larger for general studies. Completing upper secondary education increases long-term work participation and lowers health-related absence for young men, but effects diminish over time. Studies that have used shorter follow-up periods could be overstating the negative effects of dropout on

The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

LENUS (Irish Health Repository)

Elliott, Naomi

2014-05-01

To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners.

Aerobic Interval vs. Continuous Training in Patients with Coronary Artery Disease or Heart Failure: An Updated Systematic Review and Meta-Analysis with a Focus on Secondary Outcomes.

Science.gov (United States)

Pattyn, Nele; Beulque, Randy; Cornelissen, Véronique

2018-05-01

In a previous meta-analysis including nine trials comparing aerobic interval training with aerobic continuous training in patients with coronary artery disease, we found a significant difference in peak oxygen uptake favoring aerobic interval training. The objective of this study was to (1) update the original meta-analysis focussing on peak oxygen uptake and (2) evaluate the effect on secondary outcomes. We conducted a systematic review with a meta-analysis by searching PubMed and SPORTDiscus databases up to March 2017. We included randomized trials comparing aerobic interval training and aerobic continuous training in patients with coronary artery disease or chronic heart failure. The primary outcome was change in peak oxygen uptake. Secondary outcomes included cardiorespiratory parameters, cardiovascular risk factors, cardiac and vascular function, and quality of life. Twenty-four papers were identified (n = 1080; mean age 60.7 ± 10.7 years). Aerobic interval training resulted in a higher increase in peak oxygen uptake compared with aerobic continuous training in all patients (1.40 mL/kg/min; p aerobic interval training in all patients. Other cardiorespiratory parameters, cardiovascular risk factors, and quality of life were equally affected. This meta-analysis adds further evidence to the clinically significant larger increase in peak oxygen uptake following aerobic interval training vs. aerobic continuous training in patients with coronary artery disease and chronic heart failure. More well-designed randomized controlled trials are needed to establish the safety of aerobic interval training and the sustainability of the training response over longer periods.

Borderline Personality Disorder in the perinatal period: early infant and maternal outcomes.

Science.gov (United States)

Blankley, Gaynor; Galbally, Megan; Snellen, Martien; Power, Josephine; Lewis, Andrew J

2015-12-01

This study examines pregnancy and early infant outcomes of pregnant women with a clinical diagnosis of Borderline Personality Disorder presenting for obstetric services to a major metropolitan maternity hospital in Victoria, Australia. A retrospective case review of pregnancy and early infant outcomes on 42 women who had been diagnosed with Borderline Personality Disorder via psychiatric assessment using DSM-IV-R criteria was undertaken. Outcomes were compared with a control group of 14,313 consisting of women and infants of non-affected women from the same hospital over the same period of time. Women presenting for obstetric services with a clinical diagnosis of Borderline Personality Disorder experienced considerable psychosocial impairment. They anticipated birth as traumatic and frequently requested early delivery. High comorbidity with substance abuse was found and high rates of referral to child protective services. Mothers with Borderline Personality Disorder were significantly more likely to have negative birth outcomes such as lowered Apgar scores, prematurity and special care nursery referral when compared with controls. These findings offer preliminary evidence to be considered by clinicians in developing treatments and services for the perinatal care of women with Borderline Personality Disorder and their infants. Further research is required in order to develop evidence informed clinical guidelines for the management of women with Borderline Personality Disorder and their infants. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Effect of Programmed Instruction on Students' Attitude towards Structure of the Atom and the Periodic Table among Kenyan Secondary Schools

Science.gov (United States)

Wangila, M. J.; Martin, W.; Ronald, M.

2015-01-01

This study examined the effect of Programmed Instruction on students' attitude towards Structure of the Atom and the Periodic Table (SAPT) among mixed (co-educational) secondary schools of Butere district, Kakamega county, Kenya. The quasi-experimental research design was adopted, using the nonrandomized Solomon four-group as a model. The sample…

Prognosis following cancer surgery during holiday periods.

Science.gov (United States)

Lagergren, Jesper; Mattsson, Fredrik; Lagergren, Pernilla

2017-11-15

Surgery is the mainstay curative treatment in most cancer. We aimed to test the new hypothesis that cancer surgery performed during holiday periods is associated with worse long-term prognosis than for non-holiday periods. This nationwide Swedish population-based cohort study included 228,927 patients during 1997-2014 who underwent elective resectional surgery for a cancer where the annual number of resections was over 100. The 16 eligible cancer sites were grouped into 10 cancer groups. The exposure, holiday periods, was classified as wide (14-weeks) or narrow (7-weeks). Surgery conducted inside versus outside holiday periods was compared regarding overall disease-specific (main outcome) and overall all-cause (secondary outcome) mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, comorbidity, hospital volume, calendar period and tumor stage. Surgery conducted during wide and narrow holiday periods were associated with increased HRs of disease-specific mortality for cancer of the breast (HR 1.08, 95% CI 1.03-1.13 and HR 1.06, 95% CI 1.01-1.12) and possibly of cancer of the liver-pancreas-bile ducts (HR 1.09, 95% CI 0.99-1.20 and HR 1.12, 95% CI 0.99-1.26). Sub-groups with cancer of the colon-rectum, head-and-neck, prostate, kidney-urine bladder and thyroid also experienced statistically significantly worse prognosis following surgery conducted during holiday periods. No influence of surgery during holiday was detected for cancer of the esophagus-stomach, lung or ovary-uterus. All-cause HRs were similar to the disease-specific HRs. The prognosis following cancer surgery might not be fully maintained during holiday periods for all cancer sites. © 2017 UICC.

The writing approaches of secondary students.

Science.gov (United States)

Lavelle, Ellen; Smith, Jennifer; O'Ryan, Leslie

2002-09-01

Research with college students has supported a model of writing approaches that defines the relationship between a writer and writing task along a deep and surface process continuum (Biggs, 1988). Based on that model, Lavelle (1993) developed the Inventory of Processes in College Composition which reflects students' motives and strategies as related to writing outcomes. It is also important to define the approaches of secondary students to better understand writing processes at that level, and development in written composition. This study was designed to define the writing approaches of secondary students by factor analysing students' responses to items regarding writing beliefs and writing strategies, and to compare the secondary approaches to those of college students. A related goal was to explore the relationships of the secondary writing approaches to perceived self-regulatory efficacy for writing (Zimmerman & Bandura, 1994), writing preferences, and writing outcomes. The initial, factor analytic phase involved 398 junior level high school students (11th grade) enrolled in a mandatory language arts class at each of three large Midwestern high schools (USA). Then, 49 junior level students enrolled in two language arts classes participated as subjects in the second phase. Classroom teachers administered the Inventory of Processes in College Composition (Lavelle, 1993), which contained 72 true-or-false items regarding writing beliefs and strategies, during regular class periods. Data were factor analysed and the structure compared to that of college students. In the second phase, the new inventory, Inventory of Processes in Secondary Composition, was administered in conjunction with the Perceived Self-Regulatory Efficacy for Writing Inventory (Zimmerman & Bandura, 1994), and a writing preferences survey. A writing sample and grade in Language Arts classes were obtained and served as outcome variables. The factor structure of secondary writing reflected three

Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery

DEFF Research Database (Denmark)

Madsen, Michael Tvilling; Voigt Hansen, Melissa; Andersen, Lærke Toftegård

2016-01-01

STUDY OBJECTIVES: To investigate whether administration of an oral dose of 6 mg melatonin before bedtime perioperatively in breast cancer surgery could change sleep outcomes measured by actigraphy. METHODS: This paper reports secondary outcomes from a double-blind, placebo-controlled, randomized...... clinical trial where patients received 6 mg melatonin (n = 27) or placebo (n = 21) approximately 60 minutes before bedtime 3 nights preoperatively until at least one week postoperatively. Participants were monitored in the entire period with actigraphy, and were instructed to complete visual analogue scale...... significantly changed sleep efficiency and wake after sleep onset after surgery, but had no effects on other objective sleep outcomes or on subjective sleep quality (VAS and KSS)....

Effects of Alzheimer’s Disease in the Prediagnosis Period on Financial Outcomes

Science.gov (United States)

2017-10-01

diagnosis period ( T2 ) for individuals diagnosed with AD. (Completed) Major Task 3: Construct variables and perform analyses. Anticipated Timeline: Months 5...investigator for a grant funded by the National Cancer Institute to evaluate treatment patterns and health outcomes among women with newly diagnosed ductal...University Massive Data Institute Seed Grant: This project ended in June 2016. • AHRQ funded grant “ Evaluation of ASC Specialization, Costs and Payment

Randomised controlled trial of a secondary prevention program for myocardial infarction patients ('ProActive Heart': study protocol. Secondary prevention program for myocardial infarction patients

Directory of Open Access Journals (Sweden)

Taylor C Barr

2009-05-01

Full Text Available Abstract Background Coronary heart disease (CHD is a significant cause of health and economic burden. Secondary prevention programs play a pivotal role in the treatment and management of those affected by CHD although participation rates are poor due to patient, provider, health system and societal-level barriers. As such, there is a need to develop innovative secondary prevention programs to address the treatment gap. Telephone-delivered care is convenient, flexible and has been shown to improve behavioural and clinical outcomes following myocardial infarction (MI. This paper presents the design of a randomised controlled trial to evaluate the efficacy of a six-month telephone-delivered secondary prevention program for MI patients (ProActive Heart. Methods 550 adult MI patients have been recruited over a 14 month period (December 2007 to January 2009 through two Brisbane metropolitan hospitals, and randomised to an intervention or control group (n = 225 per group. The intervention commences within two weeks of hospital discharge delivered by study-trained health professionals ('health coaches' during up to 10 × 30 minute scripted telephone health coaching sessions. Participants also receive a ProActive Heart handbook and an educational resource to use during the health coaching sessions. The intervention focuses on appropriate modification of CHD risk factors, compliance with pharmacological management, and management of psychosocial issues. Data collection occurs at baseline or prior to commencement of the intervention (Time 1, six months follow-up or the completion of the intervention (Time 2, and at 12 months follow-up for longer term outcomes (Time 3. Primary outcome measures include quality of life (Short Form-36 and physical activity (Active Australia Survey. A cost-effective analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the

Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

Science.gov (United States)

Abalos, E; Cuesta, C; Carroli, G; Qureshi, Z; Widmer, M; Vogel, J P; Souza, J P

2014-03-01

To assess the incidence of hypertensive disorders of pregnancy and related severe complications, identify other associated factors and compare maternal and perinatal outcomes in women with and without these conditions. Secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health (WHOMCS) database. Cross-sectional study implemented at 357 health facilities conducting 1000 or more deliveries annually in 29 countries from Africa, Asia, Latin America and the Middle East. All women suffering from any hypertensive disorder during pregnancy, the intrapartum or early postpartum period in the participating hospitals during the study period. We calculated the proportion of the pre-specified outcomes in the study population and their distribution according to hypertensive disorders' severity. We estimated the association between them and maternal deaths, near-miss cases, and severe maternal complications using a multilevel logit model. Hypertensive disorders of pregnancy. Potentially life-threatening conditions among maternal near-miss cases, maternal deaths and cases without severe maternal outcomes. Overall, 8542 (2.73%) women suffered from hypertensive disorders. Incidences of pre-eclampsia, eclampsia and chronic hypertension were 2.16%, 0.28% and 0.29%, respectively. Maternal near-miss cases were eight times more frequent in women with pre-eclampsia, and increased to up to 60 times more frequent in women with eclampsia, when compared with women without these conditions. The analysis of this large database provides estimates of the global distribution of the incidence of hypertensive disorders of pregnancy. The information on the most frequent complications related to pre-eclampsia and eclampsia could be of interest to inform policies for health systems organisation. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Transabdominal amnioinfusion for improving fetal outcomes after oligohydramnios secondary to preterm prelabour rupture of membranes before 26 weeks.

Science.gov (United States)

Van Teeffelen, Stijn; Pajkrt, Eva; Willekes, Christine; Van Kuijk, Sander M J; Mol, Ben Willem J

2013-08-03

Preterm prelabour rupture of membranes (PPROM) before 26 weeks can delay lung development and can cause pulmonary hypoplasia, as a result of oligohydramnios. Restoring the amniotic fluid volume by transabdominal amnioinfusion might prevent abnormal lung development and might have a protective effect for neurological complications, fetal deformities and neonatal sepsis. To assess the effectiveness of transabdominal amnioinfusion in improving perinatal outcome in women with oligohydramnios secondary to rupture of fetal membranes before 26 weeks. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013). All randomised controlled trials comparing transabdominal amnioinfusion with no transabdominal amnioinfusion. Cluster- or quasi-randomised trials were not eligible for inclusion. In cases where only an abstract was available, we attempted to find the full articles. Two review authors assessed trials for inclusion. No eligible trials were identified. There are no included studies. There is currently no evidence to evaluate the use of transabdominal amnioinfusion in women with oligohydramnios secondary to rupture of fetal membranes before 26 weeks for improving perinatal outcome. Further research examining the effects of this intervention is needed. Two randomised controlled trials are ongoing but final data have not yet been published.

Impact of Interactive Engagement on Reducing the Gender Gap in Quantum Physics Learning Outcomes among Senior Secondary School Students

Science.gov (United States)

Adegoke, Benson Adesina

2012-01-01

In this study, the author examines the extent to which an interactive engagement approach can reduce the gender gap in senior secondary school (SSS) (age 16-18 years) students' learning outcomes in quantum physics. One hundred and twenty one (male = 65; female = 56) SSS 3 students participated in this study. They were randomly selected from two…

Short-term efficacy of surgical treatment of secondary hyperparathyroidism.

Science.gov (United States)

Liang, Y; Sun, Y; Ren, L; Qi, X-W; Li, Y; Zhang, F

2015-10-01

We wished to explore short-term efficacy of surgical treatment of secondary hyperparathyroidism in patients with the end-stage renal disease. The treatment methods were subtotal or total parathyroidectomy, or total parathyroidectomy and autotransplantation. 63 patients with secondary hyperparathyroidism were randomly divided into three groups which were respectively treated with subtotal parathyroidectomy (SPTX group), total parathyroidectomy (TPTX group), or total parathyroidectomy and autotransplantation (TPTX+AT group). The surgical outcomes included operating time, transoperative bleeding volume, length of stay, and cost of hospitalization. In addition, complication (e.g., postoperative wound infection, hematoma, hypocalcemia in perioperative period) rates were compared among groups. Blood levels of calcium and parathyroid hormone were assessed before the surgery, and 1 day, 1 months, 3 months and 6 months after the surgery. The follow-up period comprised 6 months. Surgical outcomes were the lowest in SPTX group and the highest in in TPTX+AT group. There were no significant differences among groups in treatment efficacy. Complication rates were also comparable among the three groups. The occurrence of hypocalcemia was the lowest in SPTX group (p < 0.05 vs. other groups). However, postoperative relapse rate was the highest in this group (p < 0.05 vs. other groups). There were no correlations between the levels of blood calcium and PTH preoperatively and postoperatively. Appropriate surgical treatment is selected in accordance with the patient's condition and willingness, with the attention paid to the prevention of hypocalcemia.

Unfavorable surgical outcomes in partial epilepsy with secondary bilateral synchrony: Intracranial electroencephalography study.

Science.gov (United States)

Sunwoo, Jun-Sang; Byun, Jung-Ick; Moon, Jangsup; Lim, Jung-Ah; Kim, Tae-Joon; Lee, Soon-Tae; Jung, Keun-Hwa; Park, Kyung-Il; Chu, Kon; Kim, Manho; Chung, Chun-Kee; Jung, Ki-Young; Lee, Sang Kun

2016-05-01

Secondary bilateral synchrony (SBS) indicates bilaterally synchronous epileptiform discharges arising from a focal cortical origin. The present study aims to investigate SBS in partial epilepsy with regard to surgical outcomes and intracranial EEG findings. We retrospectively reviewed consecutive patients who underwent epilepsy surgery following extraoperative intracranial electroencephalography (EEG) study from 2008 to 2012. The presence of SBS was determined based upon the results of scalp EEG monitoring performed for presurgical evaluations. We reviewed scalp EEG, neuroimaging, intracranial EEG findings, and surgical outcomes in patients with SBS. We found 12 patients with SBS who were surgically treated for intractable partial epilepsy. Nine (75%) patients had lateralized ictal semiology and only two (16.6%) patients showed localized ictal onset in scalp EEG. Brain MRI showed epileptogenic lesion in three (25%) patients. Intracranial EEG demonstrated that ictal onset zone was widespread or non-localized in six (50%) patients. Low-voltage fast activity was the most common ictal onset EEG pattern. Rapid propagation of ictal onset was noted in 10 (83.3%) patients. Eleven patients underwent resective epilepsy surgery and only two patients (18.2%) achieved seizure-freedom (median follow-up 56 months). MRI-visible brain lesions were associated with favorable outcomes (p=0.024). Patients with SBS, compared to frontal lobe epilepsy without SBS, showed lesser localization in ictal onset EEG (p=0.029) and more rapid propagation during evolution of ictal rhythm (p=0.015). The present results suggested that resective surgery for partial epilepsy with SBS should be decided carefully, especially in case of nonlesional epilepsy. Poor localization and rapid spread of ictal onset were prominent in intracranial EEG, which might contribute to incomplete resection of the epileptogenic zone and poor surgical outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

Improved long-term outcomes after resection of pancreatic adenocarcinoma: a comparison between two time periods.

Science.gov (United States)

Serrano, Pablo E; Cleary, Sean P; Dhani, Neesha; Kim, Peter T W; Greig, Paul D; Leung, Kenneth; Moulton, Carol-Anne; Gallinger, Steven; Wei, Alice C

2015-04-01

Despite reduced perioperative mortality and routine use of adjuvant therapy following pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), improvement in long-term outcome has been difficult to ascertain. This study compares outcomes in patients undergoing resection for PDAC within a single, high-volume academic institution over two sequential time periods. Retrospective review of patients with resected PDAC, in two cohorts: period 1 (P1), 1991-2000; and period 2 (P2), 2001-2010. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine prognostic factors associated with long-term survival. Survival was evaluated using Kaplan-Meier analyses. A total of 179 pancreatectomies were performed during P1 and 310 during P2. Perioperative mortality was 6.7 % (12/179) in P1 and 1.6 % (5/310) in P2 (p = 0.003). P2 had a greater number of lymph nodes resected (17 [0-50] vs. 7 [0-31]; p P2 (p P2 (p < 0.001). Factors associated with improved long-term survival remain comparable over time. Short- and long-term survival for patients with resected PDAC has improved over time due to decreased perioperative mortality and increased use of adjuvant therapy, although the proportion of 5-year survivors remains small.

Secondary Traumatization in Psychiatric Mental Health Nurses: Validation of Five Key Concepts.

Science.gov (United States)

Hubbard, Grace B; Beeber, Linda; Eves, Erin

2017-04-01

The purpose of this study was to validate five concepts central to secondary traumatization (ST) using narratives of psychiatric mental health advanced practice nurses. The study was designed as a directed content analysis of narrative notes (N-30). Consistency was found between narrative notes and the concepts. This study revealed that exposure and vulnerability precede empathic engagement, reaction, and alteration/transformation. The bidirectional outcome of alteration/transformation suggested that conditions leading to ST could have a positive outcome. Failure to recognize symptoms of ST and provide reflective supervision may compromise the nurse's ability to maintain a work-life balance and provide quality patient care. © 2015 Wiley Periodicals, Inc.

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.

Epidemiology, disease burden and outcomes of cirrhosis in a large secondary care hospital in South Auckland, New Zealand.

Science.gov (United States)

Hsiang, J C; Bai, W W; Raos, Z; Stableforth, W; Upton, A; Selvaratnam, S; Gane, E J; Gerred, S J

2015-02-01

Liver cirrhosis is an important cause of morbidity and mortality; however, little is known about its impact in New Zealand. We aim to determine the disease burden, epidemiology and outcomes of cirrhotic patients. This is a retrospective study of cirrhosis patients under secondary public hospital care in a geographically defined region, between the years 2000 and 2011. Cirrhosis complications and mortality was recorded. Poisson log-linear regression analysis was performed for incidence rate ratio (IRR) and Cox regression analysis was used to analyse time-related events. Seven hundred and forty-six cirrhotic patients were analysed; most were European/Other (39.9%), Pacific islanders (21.6%), Southeast Asian/Chinese (17.8%) and Maori (12.3%). 68.4% were male. The common primary aetiologies for cirrhosis were chronic hepatitis B (CHB) cirrhosis (37.3%), alcoholic liver disease (ALD) cirrhosis (24.1%), chronic hepatitis C (CHC) cirrhosis (22.3%) and non-alcoholic fatty liver disease (NAFLD) cirrhosis (16.4%). The hepatocellular carcinoma (HCC) mortality rates were highest in NAFLD and CHB cirrhosis groups (3.0 and 3.1 per 100 patient-year respectively), compared with ALD and CHC groups (2.2 and 1.4 per 100 patient-year, all P < 0.05 respectively). Patients with ALD and NAFLD cirrhosis had the highest all-cause and non-HCC mortality rate compared with viral hepatitis cirrhosis groups. The IRR for HCC incidence, liver-related mortality and HCC mortality were 1.087, 1.098 and 1.114, respectively (all P < 0.001), suggesting increasing incidence and disease burden over the study period. The number of cirrhotic patients in secondary care is increasing steadily. Cirrhosis complications and mortality rates are also rising, particularly the incidence and mortality of HCC. © 2014 Royal Australasian College of Physicians.

Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: a meta-analysis.

Science.gov (United States)

Mehta, Swati; McIntyre, Amanda; Dijkers, Marcel; Loh, Eldon; Teasell, Robert W

2014-11-01

To examine the effectiveness of gabapentin and pregabalin in diminishing neuropathic pain and other secondary conditions in individuals with spinal cord injury (SCI). A systematic search was conducted using multiple databases for relevant articles published from 1980 to June 2013. Controlled and uncontrolled trials involving gabapentin and pregabalin for treatment of neuropathic pain, with ≥3 subjects and ≥50% of study population with SCI, were included. Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference (SMD), SE, and 95% confidence interval (CI) for primary (pain) and secondary outcomes (anxiety, depression, sleep interference) was conducted. Eight studies met inclusion criteria. There was a significant reduction in the intensity of neuropathic pain at pain with gabapentin (SMD=1.20±.16; 95% CI, .88-1.52; Ppain and other secondary conditions after SCI. Effectiveness comparative to other analgesics has not been studied. Patients need to be monitored closely for side effects. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Improving ultrasound for appendicitis through standardized reporting of secondary signs.

Science.gov (United States)

Partain, Kristin N; Patel, Adarsh U; Travers, Curtis; Short, Heather L; Braithwaite, Kiery; Loewen, Jonathan; Heiss, Kurt F; Raval, Mehul V

2017-08-01

Our aim was to implement a standardized US report that included secondary signs of appendicitis (SS) to facilitate accurate diagnosis of appendicitis and decrease the use of computed tomography (CT) and admissions for observation. A multidisciplinary team implemented a quality improvement (QI) intervention in the form of a standardized US report and provided stakeholders with monthly feedback. Outcomes including report compliance, CT use, and observation admissions were compared pretemplate and posttemplate. We identified 387 patients in the pretemplate period and 483 patients in the posttemplate period. In the posttemplate period, the reporting of SS increased from 5.4% to 79.5% (pappendicitis also improved in the posttemplate period. A focused QI initiative led to high compliance rates of utilizing the standardized US report and resulted in lower CT use and fewer admissions for observation. Study of a Diagnostic Test Level of Evidence: 1. Copyright © 2017 Elsevier Inc. All rights reserved.

Five year outcomes of Boston type I keratoprosthesis as primary versus secondary penetrating corneal procedure in a matched case control study.

Directory of Open Access Journals (Sweden)

Kai B Kang

Full Text Available Despite improved retention and reduced complication rates paving the way for the current expansion of applications and surge in prevalence for the Boston type I Keratoprosthesis (KPro, the most frequent indication for its implantation today remains prior graft failure. The purpose of this study is to evaluate the long-term outcomes of primary KPro and compare to secondary implantation in a matched cohort study. This study included patients who underwent KPro implantation in a single center by two surgeons between July 2008 and October 2014. All eyes with KPro implantation as the primary procedure with a minimum follow up of 12 months were matched with eyes with same preoperative diagnoses that underwent secondary KPro implantation. Main outcomes included visual acuity and device retention. A total of 56 eyes were included with 28 eyes in each group. Mean follow up was 5.0 years for both groups. Twenty-nine percent (8 of the eyes in the primary group had a diagnosis of chemical or thermal injuries, 25% (7 aniridia, 18% (5 autoimmune disease, 4% (1 infectious keratitis/neurotrophic cornea, 7% (2 gelatinous corneal dystrophy, 7% (2 ectrodactyly ectodermal dysplasia/limbal stem cell deficiency, and 11% (3 uveitis/hypotony. Sixty-one percent (17 of the eyes in the primary group and 39% (11 in the secondary group maintained a final best-corrected visual acuity of 20/200 or better at a mean follow up of 5.0 years; the probability of maintaining best-corrected vision is 0.83 and 0.49 for primary and secondary groups at 5.0 years (p = 0.02. There is no statistically significant difference between groups in device retention (p = 0.22 or postoperative complication rates (p >0.05. This study demonstrates that Boston KPro implantation may be successful as a primary procedure in patients at high risk of failure with traditional penetrating keratoplasty. The device has a good long-term retention rate and visual outcomes are promising however a larger study is

Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study.

Science.gov (United States)

Tentori, Francesca; Wang, Mia; Bieber, Brian A; Karaboyas, Angelo; Li, Yun; Jacobson, Stefan H; Andreucci, Vittorio E; Fukagawa, Masafumi; Frimat, Luc; Mendelssohn, David C; Port, Friedrich K; Pisoni, Ronald L; Robinson, Bruce M

2015-01-07

Elevated parathyroid hormone levels may be associated with adverse clinical outcomes in patients on dialysis. After the introduction of practice guidelines suggesting higher parathyroid hormone targets than those previously recommended, changes in parathyroid hormone levels and treatment regimens over time have not been well documented. Using data from the international Dialysis Outcomes and Practice Patterns Study, trends in parathyroid hormone levels and secondary hyperparathyroidism therapies over the past 15 years and the associations between parathyroid hormone and clinical outcomes are reported; 35,655 participants from the Dialysis Outcomes and Practice Patterns Study phases 1-4 (1996-2011) were included. Median parathyroid hormone increased from phase 1 to phase 4 in all regions except for Japan, where it remained stable. Prescriptions of intravenous vitamin D analogs and cinacalcet increased and parathyroidectomy rates decreased in all regions over time. Compared with 150-300 pg/ml, in adjusted models, all-cause mortality risk was higher for parathyroid hormone=301-450 (hazard ratio, 1.09; 95% confidence interval, 1.01 to 1.18) and >600 pg/ml (hazard ratio, 1.23; 95% confidence interval, 1.12 to 1.34). Parathyroid hormone >600 pg/ml was also associated with higher risk of cardiovascular mortality as well as all-cause and cardiovascular hospitalizations. In a subgroup analysis of 5387 patients not receiving vitamin D analogs or cinacalcet and with no prior parathyroidectomy, very low parathyroid hormone (secondary hyperparathyroidism treatments changed over time. Very low and very high parathyroid hormone levels were associated with adverse outcomes. In the absence of definitive evidence in support of a specific parathyroid hormone target, there is an urgent need for additional research to inform clinical practice. Copyright © 2015 by the American Society of Nephrology.

Plasma-Sheath Instability in Hall Thrusters Due to Periodic Modulation of the Energy of Secondary Electrons in Cyclotron Motion

International Nuclear Information System (INIS)

Sydorenko, D.; Smolyakov, A.; Kaganovich, I.; Raitses, Y.

2008-01-01

Particle-in-cell simulation of Hall thruster plasmas reveals a plasma-sheath instability manifesting itself as a rearrangement of the plasma sheath near the thruster channel walls accompanied by a sudden change of many discharge parameters. The instability develops when the sheath current as a function of the sheath voltage is in the negative conductivity regime. The major part of the sheath current is produced by beams of secondary electrons counter-streaming between the walls. The negative conductivity is the result of nonlinear dependence of beam-induced secondary electron emission on the plasma potential. The intensity of such emission is defined by the beam energy. The energy of the beam in crossed axial electric and radial magnetic fields is a quasi-periodical function of the phase of cyclotron rotation, which depends on the radial profile of the potential and the thruster channel width. There is a discrete set of stability intervals determined by the final phase of the cyclotron rotation of secondary electrons. As a result, a small variation of the thruster channel width may result in abrupt changes of plasma parameters if the plasma state jumps from one stability interval to another

Moderating Influence of Curriculum, Pedagogy, and Assessment Practices on Learning Outcomes in Indonesian Secondary Education

Directory of Open Access Journals (Sweden)

Ida Umami

2018-03-01

Full Text Available The purpose of this research was to examine the current situation and problems faced by Indonesian schools in curriculum, pedagogy, and assessment practices despite government’s several legal initiatives. A questionnaire comprising both open and closed-ended questions was sent to the teachers and public education officers of the Indonesian education department. Out of a total of 200 questionnaires distributed in three secondary schools of Papua and Bandung and the headquarters of Indonesian Education Department at Jakarta, only 170 respondents retuned the questionnaire. For the purpose of quantitative analysis, percentage, mean and standard deviation were calculated while content analysis method was utilized for qualitative data. The questions dealt with curriculum, pedagogy and assessment and their combined role in the achievement of learning outcomes of secondary education in Indonesia. Evidence collected from teacher’s questionnaire show that most participants held a good knowledge of curriculum, pedagogy and assessment practices gained through long experience in the education sector. The implications of this study have wide perspectives as its findings would be beneficial for policy making. Recommendations of the study focus on the implementation of good practices.

Painful menstrual periods

Science.gov (United States)

Menstruation - painful; Dysmenorrhea; Periods - painful; Cramps - menstrual; Menstrual cramps ... into two groups, depending on the cause: Primary dysmenorrhea Secondary dysmenorrhea Primary dysmenorrhea is menstrual pain that ...

Transcranial Direct Current Stimulation Does Not Improve Language Outcome in Subacute Poststroke Aphasia.

Science.gov (United States)

Spielmann, Kerstin; van de Sandt-Koenderman, W Mieke E; Heijenbrok-Kal, Majanka H; Ribbers, Gerard M

2018-04-01

The aim of the present study is to investigate the effect of transcranial direct current stimulation on word-finding treatment outcome in subacute poststroke aphasia. In this multi-center, double-blind, randomized controlled trial with 6-month follow-up, we included 58 patients with subacute aphasia (transcranial direct current stimulation (1 mA, 20 minutes; experimental group) or sham transcranial direct current stimulation (control group) over the left inferior frontal gyrus. The primary outcome measure was the Boston Naming Test. Secondary outcome measures included naming performance for trained/untrained picture items and verbal communication. Both the experimental (n=26) and the control group (n=32) improved on the Boston Naming Test over the intervention period and 6-month follow-up; however, there were no significant differences between groups. Also for the secondary outcome measures, no significant differences were found. The results of the present study do not support an effect of transcranial direct current stimulation as an adjuvant treatment in subacute poststroke aphasia. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp. Unique identifier: NTR4364. © 2018 American Heart Association, Inc.

Associations of Incident Cardiovascular Events With Restless Legs Syndrome and Periodic Leg Movements of Sleep in Older Men, for the Outcomes of Sleep Disorders in Older Men Study (MrOS Sleep Study).

Science.gov (United States)

Winkelman, John W; Blackwell, Terri; Stone, Katie; Ancoli-Israel, Sonia; Redline, Susan

2017-04-01

Both restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS) may be associated with incident cardiovascular disease (CVD). However, the individual contributions of these factors to adverse CVD outcomes are unknown. During the MrOS Sleep Study, 2823 men (mean age = 76.3 years) participated in a comprehensive sleep assessment from 2000 to 2002. RLS was identified by self-report of a physician diagnosis of RLS. A periodic limb movement of sleep index (PLMI) was derived from unattended in-home polysomnography. Incident cardiovascular events were centrally adjudicated during 8.7 ± 2.6 years of follow-up. The primary outcome was all-cause CVD; secondary outcomes included incident myocardial infarction (MI) and cerebrovascular disease. Cox proportional hazards regression models were adjusted for multiple covariates, including PLMI, to examine if there were independent associations of RLS and PLMI to the outcomes. Physician-diagnosed RLS was reported by 2.2% and a PLMI ≥ 15 was found in 59.6% of men. RLS was not associated with the composite CVD outcome. RLS was significantly associated with incident MI (Hazard ratio [HR] = 2.02, 95% CI, 1.04-3.91) even after adjustment for multiple covariates. Results were only modestly attenuated when PLMI was added to the model. PLMI also was found to predict incident MI (per SD increase in PLMI, HR = 1.14, 95% CI, 1.00-1.30, p = .05), and was materially unchanged after addition of RLS. The independent risk that RLS confers for MI suggests a role for non-PLMS factors such as sleep disturbance, shared genetic factors, or PLM-independent sympathetic hyperactivity. © 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.

The Relationship Between Infant Feeding Outcomes and Maternal Emotional Well-being Among Mothers of Late Preterm and Term Infants: A Secondary, Exploratory Analysis.

Science.gov (United States)

Tully, Kristin P; Holditch-Davis, Diane; Silva, Susan; Brandon, Debra

2017-02-01

Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth. The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being. Participants were 105 mother-infant dyads (54 late preterm and 51 term) at a southeastern US medical center. Face-to-face data collection and telephone follow-up occurred during 2009-2012. Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at 1 month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety than among those exclusively providing formula and (2) exclusive provision of human milk at 1 month was associated with less severe depressive symptoms than among those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point. Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated healthcare needs. Prospective research is critical to document women's intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding goals.

Experiences of racism, racial/ethnic attitudes, motivated fairness and mental health outcomes among primary and secondary school students.

Science.gov (United States)

Priest, Naomi; Perry, Ryan; Ferdinand, Angeline; Paradies, Yin; Kelaher, Margaret

2014-10-01

While studies investigating the health effects of racial discrimination for children and youth have examined a range of effect modifiers, to date, relationships between experiences of racial discrimination, student attitudes, and health outcomes remain unexplored. This study uniquely demonstrates the moderating effects of vicarious racism and motivated fairness on the association between direct experiences of racism and mental health outcomes, specifically depressive symptoms and loneliness, among primary and secondary school students. Across seven schools, 263 students (54.4% female), ranging from 8 to 17 years old (M = 11.2, SD = 2.2) reported attitudes about other racial/ethnic groups and experiences of racism. Students from minority ethnic groups (determined by country of birth) reported higher levels of loneliness and more racist experiences relative to the majority group students. Students from the majority racial/ethnic group reported higher levels of loneliness and depressive symptoms if they had more friends from different racial/ethnic groups, whereas the number of friends from different groups had no effect on minority students' loneliness or depressive symptoms. Direct experiences of racism were robustly related to higher loneliness and depressive symptoms in multivariate regression models. However, the association with depressive symptoms was reduced to marginal significance when students reported low motivated fairness. Elaborating on the negative health effects of racism in primary and secondary school students provides an impetus for future research and the development of appropriate interventions.

Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

Directory of Open Access Journals (Sweden)

A. J. van der Ven

2014-01-01

Full Text Available Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1 labor onset and delivery in primary care; (2 labor onset in primary care and delivery in secondary care; (3 labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79. Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27 and low Apgar score (aOR 1.95; 95% CI 1.53–2.48 were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care.

Efficacy and safety of ultrasound-guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease.

Science.gov (United States)

Peng, Chengzhong; Zhang, Zhengxian; Liu, Jibin; Chen, Hongyu; Tu, Xiao; Hu, Rihong; Ni, Jun; Weng, Ning; Pang, Haisu; Xue, Zhengmei

2017-03-01

The purpose of this study was to determine if ultrasound-guided radiofrequency ablation (RFA) of hyperplastic parathyroid glands could be used to treat secondary hyperparathyroidism (HPT) in patients with chronic kidney disease. RFA of the hyperplastic parathyroid glands was performed in 34 patients with secondary HPT. Intact parathyroid hormone (iPTH), calcium, and phosphorus were measured. The outcome was based on the ablation extent (ie, 4, 3, and 1-2 glands). The iPTH, calcium, and phosphorus levels decreased in all groups after RFA. One year after ablation, these parameters remained significantly lower in the 4-gland ablation group compared with the 3-gland and 1 to 2-gland groups. The same tendency was observed for the symptom score. The iPTH levels of secondary HPT is feasible in selected patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 564-571, 2017. © 2016 Wiley Periodicals, Inc.

Educational Level, Anticoagulation Quality, and Clinical Outcomes in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study.

Science.gov (United States)

Hofmann, Eveline; Faller, Nicolas; Limacher, Andreas; Méan, Marie; Tritschler, Tobias; Rodondi, Nicolas; Aujesky, Drahomir

2016-01-01

Whether the level of education is associated with anticoagulation quality and clinical outcomes in patients with acute venous thromboembolism (VTE) is uncertain. We thus aimed to investigate the association between educational level and anticoagulation quality and clinical outcomes in elderly patients with acute VTE. We studied 817 patients aged ≥65 years with acute VTE from a Swiss prospective multicenter cohort study (09/2009-12/2013). We defined three educational levels: 1) less than high school, 2) high school, and 3) post-secondary degree. The primary outcome was the anticoagulation quality, expressed as the percentage of time spent in the therapeutic INR range (TTR). Secondary outcomes were the time to a first recurrent VTE and major bleeding. We adjusted for potential confounders and periods of anticoagulation. Overall, 56% of patients had less than high school, 25% a high school degree, and 18% a post-secondary degree. The mean percentage of TTR was similar across educational levels (less than high school, 61%; high school, 64%; and post-secondary, 63%; P = 0.36). Within three years of follow-up, patients with less than high school, high school, and a post-secondary degree had a cumulative incidence of recurrent VTE of 14.2%, 12.9%, and 16.4%, and a cumulative incidence of major bleeding of 13.3%, 15.1%, and 15.4%, respectively. After adjustment, educational level was neither associated with anticoagulation quality nor with recurrent VTE or major bleeding. In elderly patients with VTE, we did not find an association between educational level and anticoagulation quality or clinical outcomes.

The effect of an organizational level participatory intervention in secondary vocational education on work-related health outcomes: results of a controlled trial.

Science.gov (United States)

Schelvis, Roosmarijn M C; Wiezer, Noortje M; van der Beek, Allard J; Twisk, Jos W R; Bohlmeijer, Ernst T; Oude Hengel, Karen M

2017-01-31

Work-related stress is highly prevalent in the educational sector. The aim of the current study was to evaluate the effectiveness of an organizational level, participatory intervention on need for recovery and vitality in educational workers. It was hypothesized that the intervention would decrease need for recovery and increase vitality. A quasi-experiment was conducted at two secondary Vocational Education and Training schools (N = 356) with 12- and 24-months follow-up measurements. The intervention consisted of 1) a needs assessment phase, wherein staff and teachers developed actions for happy and healthy working under supervision of a facilitator, and 2) an implementation phase, wherein these actions were implemented by the management teams. Mixed model analysis was applied in order to assess the differences between the intervention and control group on average over time. All analyses were corrected for baseline values and several covariates. No effects of the intervention were found on need for recovery, vitality and most of the secondary outcomes. Two small, statistically significant effects were in unfavorable direction: the intervention group scored on average over time significantly lower on absorption (i.e. a subscale of work engagement) and organizational efficacy than the control group. Since no beneficial effects of this intervention were found on the primary and most of the secondary outcomes, further implementation of the intervention in its current form is not eligible. We recommend that future organizational level interventions for occupational health 1) incorporate an elaborate implementation strategy, 2) are more specific in relating actions to stressors in the context, and 3) are integrated with secondary preventive, individual focused stress management interventions. Netherlands Trial Register NTR3284 (date registered: February 14 2012).

Predictors for secondary therapy after surgical resection of nonfunctioning pituitary adenomas.

Science.gov (United States)

Ratnasingam, Jeyakantha; Lenders, Nele; Ong, Benjamin; Boros, Samuel; Russell, Anthony W; Inder, Warrick J; Ho, Ken K Y

2017-12-01

Factors determining recurrence of nonfunctioning pituitary adenomas (NFAs) that require further therapy are unclear as are postoperative follow-up imaging guidelines. We aimed to identify predictors for secondary therapy after surgical resection of NFAs and use this knowledge to inform postoperative management. A single-centre retrospective study of surgically resected NFAs in 108 patients followed for up to 15 years. Serial tumour images were analysed for size, location and growth rate (GR) and tissue analysed for hormone cell type and proliferation indices with secondary treatment as outcome measure. Twenty-four of 66 (36%) patients harbouring a postoperative remnant required secondary treatment, all occurring within 10 years. No secondary treatment was required in any of 42 patients with complete tumour resection. Age, gender, remnant volume and tumour histology were not different between patients requiring and not requiring secondary therapy. Remnant GRs in those requiring secondary therapy were more than 10-fold higher (Prisk for secondary therapy. Tumour GR in the first three postoperative years correlated significantly (r 2 =.6, P<.01) with GR during the period of follow-up. In surgically resected NFAs further treatment is dependent on the presence of residual tumour, growth rate and location but not tumour histology. Postoperative growth rate of NFAs in the first 3 years of imaging can be used to tailor long-term follow-up to optimize use of health resources. © 2017 John Wiley & Sons Ltd.

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.

Minimum period and the gap in periods of Cataclysmic binaries

International Nuclear Information System (INIS)

Paczynski, B.; Sienkiewicz, R.

1983-01-01

The 81 minute cutoff to the orbital periods of hydrogen-rich cataclysmic binaries is consistent with evolution of those systems being dominated by angular momentum losses due to gravitational radiation. Unfortunately, many uncertainties, mainly poorly known atmospheric opacities below 2000 K, make is physically impossible to verify the quadrupole formula for gravitational radiation by using the observed cutoff at 81 minutes. The upper boundary of the gap in orbital periods observed at about 3 hours is almost certainly due to enhanced angular momentum losses from cataclysmic binaries which have longer periods. The physical mechanism of those losses is not identified, but a possible importance of stellar winds is pointed out. The lower boundary of the gap may be explained with the oldest cataclysmic binaries, whose periods evolved past the minimum at 81 minutes and reached the value of 2 hours within about 12 x 10 9 years after the binary had formed. Those binaries should have secondary components of only 0.02 solar masses, and their periods could be used to estimate ages of the oldest cataclysmic stars, and presumably the age of Galaxy. An alternative explanation for the gap requires that binaries should be detached while crossing the gap. A possible mechanism for this phenomenon is discussed. It requires the secondary components to be about 0.2 solar masses in the binaries just below the gap

Secondary glaucoma in CAPN5-associated neovascular inflammatory vitreoretinopathy

Directory of Open Access Journals (Sweden)

Cham A

2016-06-01

Full Text Available Abdourahman Cham,1,2 Mayank Bansal,3 Himanshu K Banda,4 Young Kwon,1 Paul S Tlucek,1 Alexander G Bassuk,5 Stephen H Tsang,6,7 Warren M Sobol,8 James C Folk,1 Steven Yeh,4 Vinit B Mahajan1,2 1Department of Ophthalmology and Visual Sciences, 2Omics Laboratory, University of Iowa, Iowa City, IA, USA; 3Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 4Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, 5Department of Pediatrics, University of Iowa, Iowa City, IA, 6Barbara and Donald Jonas Laboratory of Stem Cells and Regenerative Medicine and Bernard and Shirlee Brown Glaucoma Laboratory, Department of Pathology and Cell Biology, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, 7Edward S Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 8Retina Physicians & Surgeons, Inc., Dayton, OH, USA Objective: The objective of this study was to review the treatment outcomes of patients with secondary glaucoma in cases of autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV, a hereditary autoimmune uveitis due to mutations in CAPN5. Patients and methods: A retrospective, observational case series was assembled from ADNIV patients with secondary glaucoma. The main outcome measures were intraocular pressure (IOP, visual acuity, use of antiglaucoma medications, ocular surgeries, and adverse outcomes. Perimetry and optic disk optical coherence tomography (OCT were also analyzed. Results: Nine eyes of five ADNIV patients with secondary glaucoma were reviewed. Each received a fluocinolone acetonide (FA implant for the management of posterior uveitis. Following implantation, no eyes developed neovascular glaucoma. Five eyes (in patients 1, 2, and 5 required Ahmed glaucoma valve surgery for the management of steroid-responsive glaucoma. Patient 2 also developed angle closure with iris bombe and underwent laser

Blood pressure variability in children with primary vs secondary hypertension.

Science.gov (United States)

Leisman, Daniel; Meyers, Melissa; Schnall, Jeremy; Chorny, Nataliya; Frank, Rachel; Infante, Lulette; Sethna, Christine B

2014-06-01

Increased blood pressure variability (BPV) is correlated with adverse cardiovascular (CV) events in adults. However, there has been limited research on its effect in the pediatric population. Additionally, BPV differences between primary and secondary hypertension (HTN) are not known. Children with primary and secondary HTN underwent 24-hour ambulatory blood pressure monitoring and echocardiography studies. BPV measures of standard deviation (SD), average real variability (ARV), and range were calculated for the 24-hour, daytime, and nighttime periods. Seventy-four patients (median age, 13.5 years; 74% boys) were examined, 40 of whom had primary HTN. Body mass index z score and age were independent predictors of systolic ARV (R(2) =0.14) and SD (R(2) =0.39). There were no statistically significant differences in overall or wake period BPV measures between secondary or primary HTN groups, but sleep period diastolic SD was significantly greater in the secondary HTN group (9.26±3.8 vs 7.1±2.8, P=.039). On multiple regression analysis, secondary HTN was associated with increased sleep period diastolic SD (P=.025). No metrics of BPV in the overall, wake, and sleep periods were found to be significantly associated with left ventricular hypertrophy (LVH). The results of this study do not show a strong relationship between overall or wake BPV with primary vs secondary HTN, but the association of secondary HTN with sleep period diastolic BPV deserves further exploration. Contrary to expectation, the findings of this study failed to indicate a relationship between BPV and LVH for all patients as well for primary hypertensive and secondary hypertensive patients. ©2014 Wiley Periodicals, Inc.

The Relationship Between Infant Feeding Outcomes and Maternal Emotional Well-Being Among Mothers of Late Preterm and Term Infants. A Secondary, Exploratory Analysis

Science.gov (United States)

Tully, Kristin P.; Holditch-Davis, Diane; Silva, Susan; Brandon, Debra

2016-01-01

Background Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth. Purpose The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being. Methods Participants were 105 mother-infant dyads (54 late preterm and 51 term) at a southeastern U.S. medical center. Face-to-face data collection and telephone follow up occurred during 2009-2012. Results Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at one month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety compared to those exclusively providing formula and (2) exclusive provision of human milk at one month was associated with less severe depressive symptoms relative to those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point. Implications for Practice Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated health care needs Implications for Research Prospective research is critical to document women’s intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding plans. PMID:27533332

Impact of parathyroidectomy on cardiovascular outcomes and survival in chronic hemodialysis patients with secondary hyperparathyroidism. A retrospective study of 50 cases prior to the calcimimetics era.

Science.gov (United States)

Conzo, Giovanni; Perna, Alessandra F; Savica, Vincenzo; Palazzo, Antonietta; Della Pietra, Cristina; Ingrosso, Diego; Satta, Ersilia; Capasso, Giovambattista; Santini, Luigi; Docimo, Giovanni

2013-01-01

In chronic hemodialysis patients with secondary hyperparathyroidism, pathological modifications of bone and mineral metabolism increase the risk of cardiovascular morbidity and mortality. Parathyroidectomy, reducing the incidence of cardiovascular events, may improve outcomes; however, its effects on long-term survival are still subject of active research. From January 2004 to December 2006, 30 hemodialysis patients, affected by severe and unresponsive secondary hyperparathyroidism, underwent parathyroidectomy - 15 total parathyroidectomy and 15 total parathyroidectomy + subcutaneous autoimplantation. During a 5-year follow-up, patients did not receive a renal transplantation and were evaluated for biochemical modifications and major cardiovascular events - death, cardiovascular accidents, myocardial infarction and peripheral vascular disease. Results were compared with those obtained in a control group of 20 hemodialysis patients, affected by secondary hyperparathyroidism, and refusing surgical treatment, and following medical treatment only. The groups were comparable in terms of age, gender, dialysis vintage, and comorbidities. Postoperative cardiovascular events were observed in 18/30 - 54% - surgical patients and in 4/20 - 20%- medical patients, with a mortality rate respectively of 23.3% in the surgical group vs. 15% in the control group. Parathyroidectomy was not associated with a reduced risk of cardiovascular morbidity and survival rate was unaffected by surgical treatment. In secondary hyperparathyroidism hemodialysis patients affected by severe cardiovascular disease, surgery did not modify cardiovascular morbidity and mortality rates. Therefore, in secondary hyperparathyroidism hemodialysis patients, resistant to medical treatment, only an early indication to calcimimetics, or surgery, in the initial stage of chronic kidney disease - mineral bone disorders, may offer a higher long-term survival. Further studies will be useful to clarify the role of

Subjective Outcome Evaluation of the Project P.A.T.H.S. (Secondary 2 Program: Views of the Program Participants

Directory of Open Access Journals (Sweden)

Daniel T. L. Shek

2009-01-01

Full Text Available A total of 196 secondary schools participated in the Secondary 2 Program of the Full Implementation Phase of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes. After completion of the Tier 1 Program, 30,731 students responded to the Subjective Outcome Evaluation Form (Form A to assess their perceptions of the program, instructors, and perceived effectiveness of the program. Based on the consolidated reports submitted by the schools to the funding body, the research team aggregated the consolidated data to form a “reconstructed” overall profile on the perceptions of the program participants. Findings demonstrated that high proportions of the respondents had positive perceptions of the program and the instructors, and roughly four-fifths of the respondents regarded the program as beneficial to them. Correlation analyses showed that perceived program and instructor characteristics were positively associated with perceived benefits of the program.

The health benefits of secondary education in adolescents and young adults: An international analysis in 186 low-, middle- and high-income countries from 1990 to 2013.

Science.gov (United States)

Viner, Russell M; Hargreaves, Dougal S; Ward, Joseph; Bonell, Chris; Mokdad, Ali H; Patton, George

2017-12-01

The health benefits of secondary education have been little studied. We undertook country-level longitudinal analyses of the impact of lengthening secondary education on health outcomes amongst 15-24 year olds. Exposures: average length of secondary and primary education from 1980 to 2013.Data/Outcomes: Country level adolescent fertility rate (AFR), HIV prevalence and mortality rate from 1989/90 to 2013 across 186 low-, middle- and high-income countries.Analysis: Longitudinal mixed effects models, entering secondary and primary education together, adjusted for time varying GDP and country income status. Longitudinal structural marginal models using inverse probability weighting (IPW) to take account of time varying confounding by primary education and GDP. Counterfactual scenarios of no change in secondary education since 1980/1990 were estimated from model coefficients for each outcome. Each additional year of secondary education decreased AFR by 8.4% in mixed effects models and 14.6% in IPW models independent of primary education and GDP. Counterfactual analyses showed the proportion of the reduction in adolescent fertility rate over the study period independently attributable to secondary education was 28% in low income countries. Each additional year of secondary education reduced mortality by 16.9% for 15-19 year and 14.8% for 20-24 year old young women and 11.4% for 15-19 year and 8.8% for 20-24 year old young men. Counterfactual scenarios suggested 12% and 23% of the mortality reduction for 15-19 and 20-24 year old young men was attributable to secondary education in low income countries. Each additional year of secondary education was associated with a 24.5% and 43.1% reduction in HIV prevalence amongst young men and women. The health benefits associated with secondary education were greater than those of primary education and were greatest amongst young women and those from low income countries. Secondary education has the potential to be a social vaccine

Secondary reconstruction of maxillofacial trauma.

Science.gov (United States)

Castro-Núñez, Jaime; Van Sickels, Joseph E

2017-08-01

Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex. The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue. Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

The effect of an organizational level participatory intervention in secondary vocational education on work-related health outcomes: results of a controlled trial

Directory of Open Access Journals (Sweden)

Roosmarijn M. C. Schelvis

2017-01-01

Full Text Available Abstract Background Work-related stress is highly prevalent in the educational sector. The aim of the current study was to evaluate the effectiveness of an organizational level, participatory intervention on need for recovery and vitality in educational workers. It was hypothesized that the intervention would decrease need for recovery and increase vitality. Methods A quasi-experiment was conducted at two secondary Vocational Education and Training schools (N = 356 with 12- and 24-months follow-up measurements. The intervention consisted of 1 a needs assessment phase, wherein staff and teachers developed actions for happy and healthy working under supervision of a facilitator, and 2 an implementation phase, wherein these actions were implemented by the management teams. Mixed model analysis was applied in order to assess the differences between the intervention and control group on average over time. All analyses were corrected for baseline values and several covariates. Results No effects of the intervention were found on need for recovery, vitality and most of the secondary outcomes. Two small, statistically significant effects were in unfavorable direction: the intervention group scored on average over time significantly lower on absorption (i.e. a subscale of work engagement and organizational efficacy than the control group. Conclusions Since no beneficial effects of this intervention were found on the primary and most of the secondary outcomes, further implementation of the intervention in its current form is not eligible. We recommend that future organizational level interventions for occupational health 1 incorporate an elaborate implementation strategy, 2 are more specific in relating actions to stressors in the context, and 3 are integrated with secondary preventive, individual focused stress management interventions. Trial registration Netherlands Trial Register NTR3284 (date registered: February 14 2012.

Regression analysis for secondary response variable in a case-cohort study.

Science.gov (United States)

Pan, Yinghao; Cai, Jianwen; Kim, Sangmi; Zhou, Haibo

2017-12-29

Case-cohort study design has been widely used for its cost-effectiveness. In any real study, there are always other important outcomes of interest beside the failure time that the original case-cohort study is based on. How to utilize the available case-cohort data to study the relationship of a secondary outcome with the primary exposure obtained through the case-cohort study is not well studied. In this article, we propose a non-parametric estimated likelihood approach for analyzing a secondary outcome in a case-cohort study. The estimation is based on maximizing a semiparametric likelihood function that is built jointly on both time-to-failure outcome and the secondary outcome. The proposed estimator is shown to be consistent, efficient, and asymptotically normal. Finite sample performance is evaluated via simulation studies. Data from the Sister Study is analyzed to illustrate our method. © 2017, The International Biometric Society.

Study of factors that influence the outcome of 131I treatment in hyperthyroidism secondary to nodular goitre.

Science.gov (United States)

Tabuenca-Dopico, O; Boente-Varela, R; Lamas-Ferreiro, J L

To assess the outcome after 131 I treatment in patients with multinodular (MNG) and nodular toxic goitre (NTG) according to the administered dose and other factors related to the patient, pathology, or previous treatments. A retrospective study was conducted on 108 patients (67 MNG and 41 NTG) treated in our department, with a follow-up period of at least 2 years. Development of hypothyroidism and treatment failure were evaluated along with their relationship with the administered dose and other factors such as age, sex, grade of hyperthyroidism, type of goitre, presence of autoimmunity, or previous antithyroid medication. More than one-third (36.9%) of MNG patients, and even higher proportion of NTG patients (51.2%) developed non-transient hypothyroidism, particularly in those receiving 740MBq (66.7%). No relationship was found with any other variable. The development of early hypothyroidism (before one year) was also not related to any variable. Treatment failure was not related to the dose, but in MNG there was a relationship with male gender, presence of autoimmunity, or previous antithyroid drugs use. The high rate of hypothyroidism obtained with high doses of 131 I in hyperthyroidism secondary to nodular goitre treatment suggests that lower doses might be sufficient to control the disease without an increase in treatment failures. Only patients with positive autoimmunity, in previous anti-thyroid medication, and perhaps male gender in MNG might be given higher doses, as the failure rate increases, but further studies are required. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Theoretical growth rates, periods, and pulsation constants for long-period variables

International Nuclear Information System (INIS)

Fox, M.W.; Wood, P.R.

1982-01-01

Theoretical values of the growth rate, period, and pulsation constant for the first three radial pulsation modes in red giants (Population II and galactic disk) and supergiants have been derived in the linear, nonadiabatic approximation. The effects of altering the surface boundary conditions, the effective temperature (or mixing length), and the opacity in the outer layers have been explored. In the standard models, the Q-value for the first overtone can be much larger (Q 1 1 roughly-equal0.04); in addition, the Q-value for the fundamental mode is reduced from previous values, as is the period ratio P 0 /P 1 . The growth rate for the fundamental mode is found to increase with luminosity on the giant branch while the growth rate for the first overtone decreases. Dynamical instabilities found in previous adiabatic models of extreme red giants do not occur when nonadiabatic effects are included in the models. In some massive, luminous models, period ratios P 0 /P 1 approx.7 occur when P 0 approx.2000--5000 days; it is suggested that the massive galactic supergiants and carbon stars which have secondary periods Papprox.2000--7000 days and primary periods Papprox.300--700 days are first-overtone pulsators in which the long secondary periods are due to excitation of the fundamental mode. Some other consequences of the present results are briefly discussed, with particular emphasis on the mode of pulsation of the Mira variables. Subject headings: stars: long-period variables: stars: pulsation: stars: supergiants

Painful periods (dysmenorrhea) (image)

Science.gov (United States)

Primary dysmenorrhea is a normal cramping of the lower abdomen caused by hormone-induced uterine contractions before the period. Secondary dysmenorrhea may be caused by abnormal conditions such as ...

Secondary Analysis and Integration of Existing Data to Elucidate the Genetic Architecture of Cancer Risk and Related Outcomes, R21 | Informatics Technology for Cancer Research (ITCR)

Science.gov (United States)

This funding opportunity announcement (FOA) encourages applications that propose to conduct secondary data analysis and integration of existing datasets and database resources, with the ultimate aim to elucidate the genetic architecture of cancer risk and related outcomes. The goal of this initiative is to address key scientific questions relevant to cancer epidemiology by supporting the analysis of existing genetic or genomic datasets, possibly in combination with environmental, outcomes, behavioral, lifestyle, and molecular profiles data.

Secondary Analysis and Integration of Existing Data to Elucidate the Genetic Architecture of Cancer Risk and Related Outcomes, R01 | Informatics Technology for Cancer Research (ITCR)

Science.gov (United States)

This funding opportunity announcement (FOA) encourages applications that propose to conduct secondary data analysis and integration of existing datasets and database resources, with the ultimate aim to elucidate the genetic architecture of cancer risk and related outcomes. The goal of this initiative is to address key scientific questions relevant to cancer epidemiology by supporting the analysis of existing genetic or genomic datasets, possibly in combination with environmental, outcomes, behavioral, lifestyle, and molecular profiles data.

Thyrotoxic periodic paralysis

OpenAIRE

Rojith Karandode Balakrishnan; Suresh Rama Chandran; Geetha Thirumalnesan; Nedumaran Doraisamy

2011-01-01

This article aims at highlighting the importance of suspecting thyrotoxicosis in cases of recurrent periodic flaccid paralysis; especially in Asian men to facilitate early diagnosis of the former condition. A case report of a 28 year old male patient with recurrent periodic flaccid paralysis has been presented. Hypokalemia secondary to thyrotoxicosis was diagnosed as the cause of the paralysis. The patient was given oral potassium intervention over 24 hours. The patient showed complete recove...

Secondary amenorrhea (image)

Science.gov (United States)

Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence ... as anxiety can be the root cause of amenorrhea. Treatment can range from behavior modification for excessive ...

PREVALENCE OF DEVASTATING OCULAR TRAUMA, IT’S EMERGENCY AND SECONDARY MANAGEMENT AND OUTCOME IN A TERTIARY CARE CENTRE

Directory of Open Access Journals (Sweden)

Jagadish Prasad Rou

2017-10-01

Full Text Available BACKGROUND Usually, young adults are the common victims of ocular trauma in their productive age. Severe ocular trauma most often leads to poor vision, at times total loss of vision, which is not only burden to their family, but also to the entire nation. Proper evaluation of severity of ocular trauma at the time of initial examination may help in planning for skillful management and help in prevention of severe visual morbidity. The aim of the study is to study the prevalence of ocular trauma and the visual outcome after one year of its emergency management and secondary management in selected cases in a tertiary care center. MATERIALS AND METHODS 89 cases of ocular trauma who presented to our tertiary care center of different age groups were studied prospectively from July 2016 to July 2017. Evaluation of all ocular trauma case was done primarily by slit-lamp examination, indirect ophthalmoscopy and 90D biomicroscopy, x-ray orbit, B-scan and CT scan orbit. All patients who required immediate admission and emergency management were included in the study and old cases of ocular trauma or underwent previous ocular surgical procedure and had ocular infections or any ocular pathology were excluded. All the subjects were managed either conservatively or surgically as and when required. Primary management like repair of lacerated lid injuries, corneal laceration and penetrating injury with or without iris prolapse, corneoscleral tear suturing, scleral tear suturing and removal of IOFB were done on emergency basis. Secondarily, patients were taken up for surgery for traumatic cataract extraction, posttraumatic glaucoma surgery, vitreoretinal surgery for vitreous haemorrhage, retinal haemorrhage and retinal detachment. RESULTS Out of 89 cases, 69 were males and 20 were females. Agricultural injury was the leading cause of ocular trauma in which injury from vegetative matter were the most common causative aetiology followed by objects like knife and

Primary vs. secondary antibody deficiency: clinical features and infection outcomes of immunoglobulin replacement.

Directory of Open Access Journals (Sweden)

Sai S Duraisingham

Full Text Available Secondary antibody deficiency can occur as a result of haematological malignancies or certain medications, but not much is known about the clinical and immunological features of this group of patients as a whole. Here we describe a cohort of 167 patients with primary or secondary antibody deficiencies on immunoglobulin (Ig-replacement treatment. The demographics, causes of immunodeficiency, diagnostic delay, clinical and laboratory features, and infection frequency were analysed retrospectively. Chemotherapy for B cell lymphoma and the use of Rituximab, corticosteroids or immunosuppressive medications were the most common causes of secondary antibody deficiency in this cohort. There was no difference in diagnostic delay or bronchiectasis between primary and secondary antibody deficiency patients, and both groups experienced disorders associated with immune dysregulation. Secondary antibody deficiency patients had similar baseline levels of serum IgG, but higher IgM and IgA, and a higher frequency of switched memory B cells than primary antibody deficiency patients. Serious and non-serious infections before and after Ig-replacement were also compared in both groups. Although secondary antibody deficiency patients had more serious infections before initiation of Ig-replacement, treatment resulted in a significant reduction of serious and non-serious infections in both primary and secondary antibody deficiency patients. Patients with secondary antibody deficiency experience similar delays in diagnosis as primary antibody deficiency patients and can also benefit from immunoglobulin-replacement treatment.

Primary vs. Secondary Antibody Deficiency: Clinical Features and Infection Outcomes of Immunoglobulin Replacement

Science.gov (United States)

Duraisingham, Sai S.; Buckland, Matthew; Dempster, John; Lorenzo, Lorena; Grigoriadou, Sofia; Longhurst, Hilary J.

2014-01-01

Secondary antibody deficiency can occur as a result of haematological malignancies or certain medications, but not much is known about the clinical and immunological features of this group of patients as a whole. Here we describe a cohort of 167 patients with primary or secondary antibody deficiencies on immunoglobulin (Ig)-replacement treatment. The demographics, causes of immunodeficiency, diagnostic delay, clinical and laboratory features, and infection frequency were analysed retrospectively. Chemotherapy for B cell lymphoma and the use of Rituximab, corticosteroids or immunosuppressive medications were the most common causes of secondary antibody deficiency in this cohort. There was no difference in diagnostic delay or bronchiectasis between primary and secondary antibody deficiency patients, and both groups experienced disorders associated with immune dysregulation. Secondary antibody deficiency patients had similar baseline levels of serum IgG, but higher IgM and IgA, and a higher frequency of switched memory B cells than primary antibody deficiency patients. Serious and non-serious infections before and after Ig-replacement were also compared in both groups. Although secondary antibody deficiency patients had more serious infections before initiation of Ig-replacement, treatment resulted in a significant reduction of serious and non-serious infections in both primary and secondary antibody deficiency patients. Patients with secondary antibody deficiency experience similar delays in diagnosis as primary antibody deficiency patients and can also benefit from immunoglobulin-replacement treatment. PMID:24971644

Outcomes of esophagectomy for esophageal achalasia in the United States.

Science.gov (United States)

Molena, Daniela; Mungo, Benedetto; Stem, Miloslawa; Feinberg, Richard L; Lidor, Anne O

2014-02-01

While the outcomes after Heller myotomy have been extensively reported, little is known about patients with esophageal achalasia who are treated with esophagectomy. This was a retrospective analysis using the Nationwide Inpatient Sample over an 11-year period (2000-2010). Patients admitted with a primary diagnosis of achalasia who underwent esophagectomy (group 1) were compared to patients with esophageal cancer who underwent esophagectomy (group 2) during the same time period. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay, postoperative complications, and total hospital charges. A propensity-matched analysis was conducted comparing the same outcomes between group 1 and well-matched controls in group 2. Nine hundred sixty-three patients with achalasia and 18,003 patients with esophageal cancer underwent esophagectomy. The propensity matched analysis showed a trend toward a higher mortality in group 2 (7.8 vs. 2.9 %, p = 0.08). Postoperative length of stay and complications were similar in both groups. Total hospital charges were higher for the achalasia group ($115,087 vs. $99, 654.2, p = 0.006). This is the largest study to date examining outcomes after esophagectomy in patients with achalasia. Based on our findings, esophagectomy can be considered a safe option, and surgeons should not be hindered by a perceived notion of prohibitive operative risk in this patient population.

Short-term outcome after intravitreal ranibizumab injections for the treatment of retinopathy of prematurity.

Science.gov (United States)

Castellanos, María Ana Martínez; Schwartz, Shulamit; García-Aguirre, Gerardo; Quiroz-Mercado, Hugo

2013-07-01

To evaluate ocular outcome in premature infants treated with intravitreal ranibizumab injections for retinopathy of prematurity (ROP) over a period of 3 years. An interventional case series. Premature infants with high-risk prethreshold or threshold ROP with plus disease received an off label monotherapy with intravitreal injections of ranibizumab. The primary outcome was treatment success defined as regression of neovascularisation (NV) and absence of recurrence. The secondary outcomes were ocular and systemic adverse events and visual acuity. Six eyes were included in the study and treated with intravitreal injections of ranibizumab. All showed complete resolution of NV after a single injection. The anti-angiogenic intravitreal injections allowed for continued normal vessel growth into the peripheral retina, without any signs of disease recurrence or progression during the follow up period. No ocular or systemic adverse effects were observed. Three years of follow up in a small series suggest that intravitreal ranibizumab injections for ROP result in apparently preserved ocular outcome. Further large scale studies are needed to address the long-term safety and efficacy.

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

Directory of Open Access Journals (Sweden)

Sumathi Matta

Full Text Available To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI, India.The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs and attached vision centres (VCs that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.Mean age was 61.8 years (SD: 8.9 years and 1,133 (55.3% surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%. The most common procedure was small incision cataract surgery (SICS with intraocular lens (IOL implantation (91.8%. Intraoperative complications were seen in 29 eyes (1.4%. At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA, 61.8% had a good outcome and based on best-corrected visual acuity (BCVA, 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30, in females (OR 1.58; 95% CI 1.04, 2.41, those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57, with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04, eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25 and those undergoing extracapsular cataract extraction (OR 9

An observational study of the hand hygiene initiative: a comparison of preintervention and postintervention outcomes

Science.gov (United States)

Mukerji, Amit; Narciso, Janet; Moore, Christine; McGeer, Allison; Kelly, Edmond; Shah, Vibhuti

2013-01-01

Objectives To evaluate the impact of implementing a simple, user-friendly eLearning module on hand hygiene (HH) compliance and infection rates. Design Preintervention and postintervention observational study. Participants All neonates admitted to the neonatal intensive care unit (NICU) over the study period were eligible for participation and were included in the analyses. A total of 3422 patients were admitted over a 36-month span (July 2009 to June 2012). Interventions In the preintervention and postintervention periods (phases I and II), all healthcare providers were trained on HH practices using an eLearning module. The principles of the ‘4 moments of HH’ and definition of ‘baby space’ were incorporated using interactive tools. The intervention then extended into a long-term sustainability programme (phase III), including the requirement of an annual recertification of the module and introduction of posters and screensavers throughout the NICU. Primary and secondary outcome measures The primary outcome was HH compliance rates among healthcare providers in the three phases. The secondary outcome was healthcare-associated infection rates in the NICU. Results HH compliance rates declined initially in phase II then improved in phase III with the addition of a long-term sustainability programme (76%, 67% and 76% in phases I, II and III, respectively (pchallenging to implement and sustain with the need for ongoing reinforcement and education. PMID:23793705

LONG-TERM OUTCOME IN PEDIATRIC TRICHOTILLOMANIA.

Science.gov (United States)

Schumer, Maya C; Panza, Kaitlyn E; Mulqueen, Jilian M; Jakubovski, Ewgeni; Bloch, Michael H

2015-10-01

To examine long-term outcome in children with trichotillomania. We conducted follow-up clinical assessments an average of 2.8 ± 0.8 years after baseline evaluation in 30 of 39 children who previously participated in a randomized, double-blind, placebo-controlled trial of N-acetylcysteine (NAC) for pediatric trichotillomania. Our primary outcome was change in hairpulling severity on the Massachusetts General Hospital Hairpulling Hospital Hairpulling Scale (MGH-HPS) between the end of the acute phase and follow-up evaluation. We also obtained secondary measures examining styles of hairpulling, comorbid anxiety and depressive symptoms, as well as continued treatment utilization. We examined both correlates and predictors of outcome (change in MGH-HPS score) using linear regression. None of the participants continued to take NAC at the time of follow-up assessment. No significant changes in hairpulling severity were reported over the follow-up period. Subjects reported significantly increased anxiety and depressive symptoms but improvement in automatic pulling symptoms. Increased hairpulling symptoms during the follow-up period were associated with increased depression and anxiety symptoms and increased focused pulling. Older age and greater focused pulling at baseline assessment were associated with poor long-term prognosis. Our findings suggest that few children with trichotillomania experience a significant improvement in trichotillomania symptoms if behavioral treatments are inaccessible or have failed to produce adequate symptom relief. Our findings also confirm results of previous cross-sectional studies that suggest an increased risk of depression and anxiety symptoms with age in pediatric trichotillomania. Increased focused pulling and older age among children with trichotillomania symptoms may be associated with poorer long-term prognosis. © 2015 Wiley Periodicals, Inc.

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

Science.gov (United States)

Lumbiganon, P; Laopaiboon, M; Intarut, N; Vogel, J P; Souza, J P; Gülmezoglu, A M; Mori, R

2014-03-01

To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. A total of 314 623 pregnant women admitted to the participating facilities. We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission. Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/2822; 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0; 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9; 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8; 95% CI 3.5-4.1). Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States.

Science.gov (United States)

Kim, Sun Moon; Long, Jin; Montez-Rath, Maria E; Leonard, Mary B; Norton, Jeffrey A; Chertow, Glenn M

2016-07-07

Secondary hyperparathyroidism is common among patients with ESRD. Although medical therapy for secondary hyperparathyroidism has changed dramatically over the last decade, rates of parathyroidectomy for secondary hyperparathyroidism across the United States population are unknown. We examined temporal trends in rates of parathyroidectomy, in-hospital mortality, length of hospital stay, and costs of hospitalization. Using the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, a representative national database on hospital stay regardless of age and payer in the United States, we identified parathyroidectomies for secondary hyperparathyroidism from 2002 to 2011. Data from the US Renal Data System reports were used to calculate the rate of parathyroidectomy. We identified 32,971 parathyroidectomies for secondary hyperparathyroidism between 2002 and 2011. The overall rate of parathyroidectomy was approximately 5.4/1000 patients (95% confidence interval [95% CI], 5.0/1000 to 6.0/1000). The rate decreased from 2003 (7.9/1000 patients; 95% CI, 6.2/1000 to 9.6/1000), reached a nadir in 2005 (3.3/1000 patients; 95% CI, 2.6/1000 to 4.0/1000), increased again through 2006 (5.4/1000 patients; 95% CI, 4.4/1000 to 6.4/1000), and remained stable since that time. Rates of in-hospital mortality decreased from 1.7% (95% CI, 0.8% to 2.6%) in 2002 to 0.8% (95% CI, 0.1% to 1.6%) in 2011 (P for trend secondary hyperparathyroidism have not declined in recent years. Copyright © 2016 by the American Society of Nephrology.

Blood pressure changes associated with sibutramine and weight management - an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes trial (SCOUT)

DEFF Research Database (Denmark)

Sharma, A M; Caterson, I D; Coutinho, W

2009-01-01

OBJECTIVE: To explore vital sign changes among patient subgroups during the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, double-blind, randomized, placebo-controlled outcome trial in overweight/obese patients at high risk of a cardi......OBJECTIVE: To explore vital sign changes among patient subgroups during the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, double-blind, randomized, placebo-controlled outcome trial in overweight/obese patients at high risk...... of a cardiovascular event. During the 6-week lead-in period, 10,742 patients received sibutramine and weight management. Vital sign changes were assessed post hoc by initial blood pressure (mmHg) categorized as normal (or=140/>or=90); weight change...... categories (weight gain/no weight change, >0 to 2.5% weight loss, >2.5 to 5% weight loss and >5% weight loss) and current antihypertensive medication class use (none, one, or two or more). To assess the impact of sibutramine on blood pressure and pulse rate, only patients (N = 10,025) who reported no change...

Secondary Data Analyses of Subjective Outcome Evaluation Data Based on Nine Databases

Directory of Open Access Journals (Sweden)

Daniel T. L. Shek

2012-01-01

Full Text Available The purpose of this study was to evaluate the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes in Hong Kong by analyzing 1,327 school-based program reports submitted by program implementers. In each report, program implementers were invited to write down five conclusions based on an integration of the subjective outcome evaluation data collected from the program participants and program implementers. Secondary data analyses were carried out by aggregating nine databases, with 14,390 meaningful units extracted from 6,618 conclusions. Results showed that most of the conclusions were positive in nature. The findings generally showed that the workers perceived the program and program implementers to be positive, and they also pointed out that the program could promote holistic development of the program participants in societal, familial, interpersonal, and personal aspects. However, difficulties encountered during program implementation (2.15% and recommendations for improvement were also reported (16.26%. In conjunction with the evaluation findings based on other strategies, the present study suggests that the Tier 1 Program of the Project P.A.T.H.S. is beneficial to the holistic development of the program participants.

Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial

NARCIS (Netherlands)

Magee, Laura A.; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo K.; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G.; Moutquin, Jean Marie

2016-01-01

Introduction. For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. Material and methods. This was a planned, secondary analysis

Community-Based Choirs of Sorsogon, Philippines: An Outcomes- Based Education Output of Bachelor of Secondary Education Major in Music, Arts, PE and Health

Directory of Open Access Journals (Sweden)

Alfonso Legaspi Garcia Jr.

2017-02-01

Full Text Available As a response to the call for an Outcomes- Based Education instructional design and initiatives by the Commission on Higher Education in the Teacher Education Curriculum, the Bachelor in Secondary Education major in Music, Arts Physical Education and Health (BSED-MAPEH of one state college in the Philippines, organized and trained community-based choirs in their localities in the province of Sorsogon, Philippines as an Outcomes-Based Education project/immersion. This observation-participatory qualitative research described and analyzed the four community- based choir organized by the Bachelor in Secondary Education Major in MAPEH fourth year students from Teacher Education department for the School Year 2015-2016. There were 15 key informants. Data are gathered through questionnaire, structured and unstructured interview, direct observation and participation and it was analyzed using triangulation, cross-matrix analysis, documentary (pictures and videos. Results show that the four-organized community-based choir groups have similarities and differences in terms of their vision, organizational structures, membership, song repertoire, practices, rehearsals and concert theme/presentation. It is also revealed that the students- organizers faced and hurdled challenges along; training of choir, leadership and management skills, Event management, resources management and communication skills (oral and written. And the activity as an Outcomes-Based Education practicum/immersion gave remarkable impacts on their personality development, choral music skills, communication skills, leadership, organization and management skills and financial or resource management.

A systematic review of post-secondary transition interventions for youth with disabilities.

Science.gov (United States)

Lindsay, Sally; Lamptey, De-Lawrence; Cagliostro, Elaine; Srikanthan, Dilakshan; Mortaji, Neda; Karon, Leora

2018-05-04

Youth with disabilities have lower rates of enrollment and completion of post-secondary education compared with youth without disabilities. The objective of this systematic review is to understand the best practices and components of post-secondary transition programs for youth with disabilities. Systematic searches of six international databases identified 18 studies meeting our inclusion criteria (youth with a disability, aged 15-30; focusing on post-secondary education program or intervention, published from 1997 to 2017). These studies were analyzed with respect to the characteristics of the participants, methodology, results, and quality of the evidence. Among the 18 studies, 2385 participants (aged 13-28, mean 17.7 years) were represented across three countries (US, Canada, and Australia). Although the outcomes of the post-secondary transition programs varied across the studies, all of them reported an improvement in at least one of the following: college enrollment, self-determination, self-confidence, social and vocational self-efficacy, autonomy, social support, career exploration, and transition skills. The post-secondary transition programs varied in duration, length, number of sessions, and delivery format which included curriculum-based, online, immersive residential experience, mentoring, simulation, self-directed, technology-based, and multi-component. Our findings highlight that post-secondary transition programs have the potential to improve self-determination, transition skills, and post-secondary outcomes among youth with disabilities. Implications for rehabilitation Post-secondary education interventions have a beneficial influence on post-secondary and related transition outcomes in youth with disabilities. Clinicians and educators should consider having multiple components, involving several sessions that include a curriculum, immersive college residential experience, mentoring, and/or simulations in their interventions for optimum program

Benefits of applying a proxy eligibility period when using electronic health records for outcomes research: a simulation study.

Science.gov (United States)

Yu, Tzy-Chyi; Zhou, Huanxue

2015-06-09

Electronic health records (EHRs) can provide valuable data for outcomes research. However, unlike administrative claims databases, EHRs lack eligibility tables or a standard way to define the benefit coverage period, which could lead to underreporting of healthcare utilization or outcomes, and could result in surveillance bias. We tested the effect of using a proxy eligibility period (eligibility proxy) when estimating a range of health resource utilization and outcomes parameters under varying degrees of missing encounter data. We applied an eligibility proxy to create a benchmark cohort of chronic obstructive pulmonary disease (COPD) patients with 12 months of follow-up, with the assumption of no missing encounter data. The benchmark cohort provided parameter estimates for comparison with 9,000 simulated datasets representing 10-90% of COPD patients (by 10th percentiles) with between 1 and 11 months of continuous missing data. Two analyses, one for datasets using an eligibility proxy and one for those without an eligibility proxy, were performed on the 9,000 datasets to assess estimator performance under increasing levels of missing data. Estimates for each study variable were compared with those from the benchmark dataset, and performance was evaluated using bias, percentage change, and root-mean-square error. The benchmark dataset contained 6,717 COPD patients, whereas the simulated datasets where the eligibility proxy was applied had between 671 and 6,045 patients depending on the percentage of missing data. Parameter estimates had better performance when an eligibility proxy based on the first and last month of observed activity was applied. This finding was consistent across a range of variables representing patient comorbidities, symptoms, outcomes, health resource utilization, and medications, regardless of the measures of performance used. Without the eligibility proxy, all evaluated parameters were consistently underestimated. In a large COPD patient

Using patient-reported outcomes in schizophrenia: the Scottish Schizophrenia Outcomes Study.

Science.gov (United States)

Hunter, Robert; Cameron, Rosie; Norrie, John

2009-02-01

The primary aim of the Scottish Schizophrenia Outcomes Study (SSOS) was to assess the feasibility and utility of routinely collecting outcome data in everyday clinical settings. Data were collected over three years in the Scottish National Health Service (NHS). There were two secondary aims of SSOS: first, to compare data from patient-rated, objective, and clinician-rated outcomes, and second, to describe trends in outcome data and service use across Scotland over the three years of the study (2002-2005). This study used a naturalistic, longitudinal, observational cohort design. A representative sample of 1,015 persons with ICD-10 F20-F29 diagnoses (schizophrenia, schizotypal disorders, or delusional disorders) was assessed annually using the clinician-rated measure, the Health of the Nation Outcome Scale (HoNOS), and the patient-reported assessment, the Avon Mental Health Measure (Avon). Objective outcomes data and information on services and interventions were collected. Data were analyzed with regression modeling. Of the 1,015 persons recruited, 78% of the cohort (N=789) completed the study. Over the study period, significant decreases were seen in the number of hospitalizations, incidence of attempted suicide and self-harm, and civil detentions. Avon scores indicated significant improvement on all subscales (behavior, social, access, and mental health) and on the total score. However, HoNOS scores on the behavior and symptom subscales did not change, scores on the impairment subscale increased significantly (indicating increased levels of impairment), and scores on the social subscale decreased significantly (indicating improved social functioning). This study has demonstrated that it is feasible within the Scottish NHS to routinely collect meaningful outcomes data in schizophrenia. Patient-reported assessments were also successfully collected and used in care plans. This model shows that it is possible to incorporate patient-reported assessments into routine

Efficacy of low-dose cinacalcet on alternate days for the treatment of secondary hyperparathyroidism in hemodialysis patients: a single-center study

Directory of Open Access Journals (Sweden)

Gojaseni P

2017-02-01

Full Text Available Pongsathorn Gojaseni, Dolnapa Pattarathitinan, Anutra Chittinandana Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand Introduction: Cinacalcet is effective in reducing serum parathyroid hormone (PTH in patients with secondary hyperparathyroidism (HPT. This study focused on testing whether a prescription of low-dose cinacalcet on alternate days could be an option for treatment of secondary HPT.Materials and methods: A retrospective clinical study was conducted on chronic maintenance hemodialysis patients. Patients with secondary HPT who received cinacalcet at a starting dose of 25 mg on alternate days were reviewed (low-dose group. Patients who were being treated with a standard dose of cinacalcet in the same period of time were selected as the control group. The primary outcome was difference in the percentage of patients achieving >30% reduction of intact parathyroid hormone (iPTH levels at 16 weeks. The changes of serum iPTH and other biochemical data were also tested.Results: A total of 30 patients (16 low doses and 14 controls took part in the study. Baseline iPTH levels in the low-dose and control group were 1,065.9±477.7 and 1,214.1±497.6 pg/mL, respectively (p=0.413. The analysis showed that the percentage of patients who achieved the primary outcome showed little or no difference (33.3% in the low-dose group compared with 38.5% in the control group, p=1.0. Serum iPTH reduction during 16 weeks of study period in the low-dose and control group was 253.5±316.1 and 243.4±561.3 pg/mL, respectively (p=0.957. There was no difference in the adverse events between both groups.Conclusion: Among patients with secondary HPT, initial treatment with cinacalcet 25 mg on alternate days can decrease serum PTH levels. The role of low-dose cinacalcet in secondary HPT should be further determined in large-scale, randomized controlled trials. Keywords

Piriformis muscle syndrome. A cross-sectional imaging study in 116 patients and evaluation of therapeutic outcome

Energy Technology Data Exchange (ETDEWEB)

Vassalou, Evangelia E. [Heraklion University Hospital, Department of Medical Imaging, Voutes, Crete (Greece); Katonis, Pavlos [University Hospital of Heraklion, Department of Orthopaedics, Voutes, Crete (Greece); Karantanas, Apostolos H. [Heraklion University Hospital, Department of Medical Imaging, Voutes, Crete (Greece); University of Crete, Department of Radiology, Voutes, Crete (Greece)

2018-02-15

To increase the clinical awareness of piriformis muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome. Within a 10-year-period, 116 patients referred for radiological evaluation of clinically suspected PMs, with excluded lumbar pathology related to symptomatology, were prospectively studied with MRI and/or computed tomography (CT). Piriformis muscle (PM), sciatic nerve (SN), piriformis region and sacroiliac joints were evaluated. PMs was categorised into primary/secondary, according to a reported classification system. Treatment decisions were recorded. Outcome was categorised using a 3-point-scale. Seventy-four patients (63.8%) exhibited pathologies related to PMs. Primary causes were detected in 12 and secondary in 62 patients. PM enlargement was found in 45.9% of patients, abnormal PM signal intensity/density in 40.5% and sciatic neuritis in 25.7%. Space-occupying lesions represented the most common related pathology. Treatment proved effective in 5/8 patients with primary and 34/51 patients with secondary PMs. In 34 patients, imaging revealed an unknown underlying medical condition and altered treatment planning. Secondary PMs aetiologies appear to prevail. In suspected PMs, PM enlargement represented the most common imaging finding and space-occupying lesions the leading cause. Imaging had the potential to alter treatment decisions. (orig.)

Piriformis muscle syndrome. A cross-sectional imaging study in 116 patients and evaluation of therapeutic outcome

International Nuclear Information System (INIS)

Vassalou, Evangelia E.; Katonis, Pavlos; Karantanas, Apostolos H.

2018-01-01

To increase the clinical awareness of piriformis muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome. Within a 10-year-period, 116 patients referred for radiological evaluation of clinically suspected PMs, with excluded lumbar pathology related to symptomatology, were prospectively studied with MRI and/or computed tomography (CT). Piriformis muscle (PM), sciatic nerve (SN), piriformis region and sacroiliac joints were evaluated. PMs was categorised into primary/secondary, according to a reported classification system. Treatment decisions were recorded. Outcome was categorised using a 3-point-scale. Seventy-four patients (63.8%) exhibited pathologies related to PMs. Primary causes were detected in 12 and secondary in 62 patients. PM enlargement was found in 45.9% of patients, abnormal PM signal intensity/density in 40.5% and sciatic neuritis in 25.7%. Space-occupying lesions represented the most common related pathology. Treatment proved effective in 5/8 patients with primary and 34/51 patients with secondary PMs. In 34 patients, imaging revealed an unknown underlying medical condition and altered treatment planning. Secondary PMs aetiologies appear to prevail. In suspected PMs, PM enlargement represented the most common imaging finding and space-occupying lesions the leading cause. Imaging had the potential to alter treatment decisions. (orig.)

Ambient Levels of Primary and Secondary Pollutants in a Residential Area: Population Risk and Hazard Index Calculation over a Three Years Study Period

OpenAIRE

S. Al-Salem; A. Al-Fadhlee

2007-01-01

This paper aims at presenting data collected over the period of three years (2004-2006) in a residential area in the state of Kuwait. The data collected include ambient levels of primary and secondary pollutants with a number of metrological parameters. A series of unfiltered and filtered concentration roses were plotted to determine the predominant sources as well as the prevailing winds affecting the area under investigation. Local and international air quality regulations were cross refere...

Food Choice Architecture: An Intervention in a Secondary School and its Impact on Students' Plant-based Food Choices.

Science.gov (United States)

Ensaff, Hannah; Homer, Matt; Sahota, Pinki; Braybrook, Debbie; Coan, Susan; McLeod, Helen

2015-06-02

With growing evidence for the positive health outcomes associated with a plant-based diet, the study's purpose was to examine the potential of shifting adolescents' food choices towards plant-based foods. Using a real world setting of a school canteen, a set of small changes to the choice architecture was designed and deployed in a secondary school in Yorkshire, England. Focussing on designated food items (whole fruit, fruit salad, vegetarian daily specials, and sandwiches containing salad) the changes were implemented for six weeks. Data collected on students' food choice (218,796 transactions) enabled students' (980 students) selections to be examined. Students' food choice was compared for three periods: baseline (29 weeks); intervention (six weeks); and post-intervention (three weeks). Selection of designated food items significantly increased during the intervention and post-intervention periods, compared to baseline (baseline, 1.4%; intervention 3.0%; post-intervention, 2.2%) χ(2)(2) = 68.1, p food items during the intervention period, compared to baseline. The study's results point to the influence of choice architecture within secondary school settings, and its potential role in improving adolescents' daily food choices.

High patient satisfaction after secondary rhinoplasty in cleft lip patients

NARCIS (Netherlands)

Hens, Greet; Picavet, Valerie A.; Poorten, Vincent Vander; Schoenaers, Joseph; Jorissen, Mark; Hellings, Peter W.

2011-01-01

We surveyed the subjective outcome of secondary rhinoplasty in cleft lip patients. Questionnaires were sent to 38 patients who had undergone a secondary rhinoplasty. A total of 30 questionnaires were returned and analyzed. Patients were asked to score their preoperative and postoperative nasal

Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial.

Science.gov (United States)

Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun

2014-03-26

Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Clinical

Clinical effectiveness of secondary interventions for restenosis after renal artery stenting

Science.gov (United States)

Simone, Thomas A.; Brooke, Benjamin S.; Goodney, Philip P.; Walsh, Daniel B.; Stone, David H.; Powell, Richard J.; Cronenwett, Jack L.; Nolan, Brian W.

2013-01-01

Objective Secondary interventions for renal artery restenosis (RAS) after renal artery stenting are common, despite limited data about their effectiveness. This study was designed to evaluate the outcomes of endovascular treatment of recurrent RAS. Methods We conducted a retrospective review of patients who underwent renal artery stenting between 2001 and 2011 at Dartmouth-Hitchcock Medical Center. Patients who required secondary interventions were compared with control patients who underwent only primary interventions for RAS. Multivariate regression models were used to identify factors associated with successful outcomes, as measured by changes in blood pressure, estimated glomerular filtration rate, and number of antihypertensive medications required. Results Sixty-five secondary (57 patients) renal interventions were undertaken for recurrent RAS associated with progressive hypertension or renal dysfunction and compared with outcomes after 216 primary (180 patients) renal artery stenting procedures. Patients undergoing primary vs secondary interventions did not differ significantly in the number of preoperative antihypertensive medications used, comorbid conditions, or blood pressure. All primary and secondary interventions were performed with stents and showed no difference in procedural complications. At a mean follow-up of 23 months (range, 1–128 months), similar improvements in renal function and blood pressure were found between patients undergoing primary and secondary interventions, and there was no difference in rates of restenosis or survival between cohorts. Regression models showed that the use of embolic protection devices was associated with improved renal function after primary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1–3.8; P < .05) and secondary (OR, 4.7; 95% CI, 1.7–12.5; P < .05) interventions, whereas statin therapy was associated with improved renal (OR, 2.0; 95% CI, 1.3–3.2; P < .05) and blood pressure response (OR, 4

Effect of inborn versus outborn delivery on clinical outcomes in ventilated preterm neonates: secondary results from the NEOPAIN trial.

Science.gov (United States)

Palmer, Kristine G; Kronsberg, Shari S; Barton, Bruce A; Hobbs, Charlotte A; Hall, Richard W; Anand, K J S

2005-04-01

The objective of this study was to evaluate the effect of birth center (inborn versus outborn) on morbidity and mortality for preterm neonates (23 to 32 weeks) using data collected prospectively within a uniform protocol. Secondary analyses of data from the NEurologic Outcomes and Pre-emptive Analgesia In Neonates (NEOPAIN) trial (n=898) were performed to evaluate the effect of inborn versus outborn delivery on neonatal outcomes, including the occurrence of severe intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), chronic lung disease (CLD), and mortality. Outborn babies were more likely to have severe IVH (p=0.0005); this increased risk persisted after controlling for severity of illness. When adjustments for antenatal steroids were added, the effect of birth center was no longer significant. Neither the occurrences of PVL or CLD nor mortality were significantly different between the inborn and outborn infants. Outborn babies are more likely to have severe IVH than inborn babies, perhaps because their mothers are less likely to receive antenatal steroids. Improvements in antenatal steroid administration to high-risk women may substantially reduce neonatal morbidity.

Further Results on Extended Delivery Time for Secondary Packet Transmission

KAUST Repository

Usman, Muneer

2017-07-10

Cognitive radio transceiver can opportunistically access the underutilized spectrum resource of primary systems for new wireless services. With interweave cognitive implementation, secondary transmission may be interrupted by primary transmission. To facilitate the packet delay analysis of such secondary transmission, we study the extended delivery time of secondary packet transmission. In particular, we derive the exact distribution function of extended delivery time of a fixed-size secondary packet with non-work-preserving strategy, where interrupted packets must be repeated. We also analyze the effect of imperfect periodic sensing, i.e., the secondary user periodically senses the spectrum for availability, with a chance of missing an available channel on a certain sensing attempt. These results complement previous work on work-preserving strategy with perfect sensing. Selected numerical and simulation results are presented for verifying the mathematical formulation.

Clinical and pathological analysis of 10 cases of secondary pneumothorax due to angiosarcoma of the scalp

International Nuclear Information System (INIS)

Goto, Hideto; Watanuki, Yuji; Miyazawa, Naoki; Kudo, Makoto; Inoue, Satoshi; Kobayashi, Nobuaki; Kaneko, Takeshi; Ishigatsubo, Yoshiaki

2008-01-01

Angiosarcoma of the scalp is a very rare disease. Secondary pneumothorax is known as a characteristic complication in this disease due to lung metastasis. In this study, 17 patients of angiosarcoma of the scalp, diagnosed at our hospital between 1996 and 2006, were analyzed. Secondary pneumothorax was observed in 10 of these patients, among which bilateral pneumothorax occurred in 5 relapse of pneumothorax occurred in 6 and pneumothorax with bloody pleural fluid occurred in 7 patients. Characteristic findings on chest CT were multiple thin-wall cavities and ground-glass attenuation around the cavity, located in bilateral subpleural lung fields. It is suggested that the subpleural thin-wall cavities cause pneumothorax. Although pleurosclerosis were performed in 5 patients and one of them bad a subsequent partial resection of the lung, pneumothorax reocurred within a short period of time in all patients. The average survival time from the first pneumothorax episode was only 4.1 months. Secondary pneumothorax caused by this disease was intractable, resulting in an unfavorable outcome. It is necessary to develop a proper treatment strategy for secondary pneumothorax to create a favorable prognosis in this disease. (author)

Paricalcitol for secondary hyperparathyroidism in renal transplantation.

Science.gov (United States)

Trillini, Matias; Cortinovis, Monica; Ruggenenti, Piero; Reyes Loaeza, Jorge; Courville, Karen; Ferrer-Siles, Claudia; Prandini, Silvia; Gaspari, Flavio; Cannata, Antonio; Villa, Alessandro; Perna, Annalisa; Gotti, Eliana; Caruso, Maria Rosa; Martinetti, Davide; Remuzzi, Giuseppe; Perico, Norberto

2015-05-01

Secondary hyperparathyroidism contributes to post-transplant CKD mineral and bone disorder. Paricalcitol, a selective vitamin D receptor activator, decreased serum parathyroid hormone levels and proteinuria in patients with secondary hyperparathyroidism. This single-center, prospective, randomized, crossover, open-label study compared the effect of 6-month treatment with paricalcitol (1 μg/d for 3 months and then uptitrated to 2 µg/d if tolerated) or nonparicalcitol therapy on serum parathyroid hormone levels (primary outcome), mineral metabolism, and proteinuria in 43 consenting recipients of renal transplants with secondary hyperparathyroidism. Participants were randomized 1:1 according to a computer-generated sequence. Compared with baseline, median (interquartile range) serum parathyroid hormone levels significantly declined on paricalcitol from 115.6 (94.8-152.0) to 63.3 (52.0-79.7) pg/ml (Psecondary hyperparathyroidism. Long-term studies are needed to monitor directly measured GFR, ensure that the bone remodeling and mineral effects are sustained, and determine if the reduction in proteinuria improves renal and cardiovascular outcomes. Copyright © 2015 by the American Society of Nephrology.

Peer and cyber aggression in secondary school students: the role of moral disengagement, hostile attribution bias, and outcome expectancies.

Science.gov (United States)

Pornari, Chrisa D; Wood, Jane

2010-01-01

This study investigated the relationship between cognitive mechanisms, applied by people to rationalize and justify harmful acts, and engagement in traditional peer and cyber aggression among school children. We examined the contribution of moral disengagement (MD), hostile attribution bias, and outcome expectancies, and we further explored the individual contribution of each MD mechanism. Our aim was to identify shared and unique cognitive factors of the two forms of aggression. Three hundred and thirty-nine secondary school children completed self-report measures that assessed MD, hostile attribution bias, outcome expectancies, and their roles and involvement in traditional and cyber aggression. We found that the MD total score positively related to both forms of peer-directed aggression. Furthermore, traditional peer aggression positively related to children's moral justification, euphemistic language, displacement of responsibility and outcome expectancies, and negatively associated with hostile attribution bias. Moral justification also related positively to cyber aggression. Cyber aggression and cyber victimization were associated with high levels of traditional peer aggression and victimization, respectively. The results suggest that MD is a common feature of both traditional and cyber peer aggression, but it seems that traditional forms of aggression demand a higher level of rationalization or justification. Moreover, the data suggest that the expectation of positive outcomes from harmful behavior facilitates engagement in traditional peer aggression. The differential contribution of specific cognitive mechanisms indicates the need for future research to elaborate on the current findings, in order to advance theory and inform existing and future school interventions tackling aggression and bullying. (c) 2009 Wiley-Liss, Inc.

Report of the Clinical and Functional Primary Outcomes in Men of the ACL-SPORTS Trial: Similar Outcomes in Men Receiving Secondary Prevention With and Without Perturbation Training 1 and 2 Years After ACL Reconstruction.

Science.gov (United States)

Arundale, Amelia J H; Cummer, Kathleen; Capin, Jacob J; Zarzycki, Ryan; Snyder-Mackler, Lynn

2017-10-01

Athletes often are cleared to return to activities 6 months after anterior cruciate ligament (ACL) reconstruction; however, knee function measures continue to improve up to 2 years after surgery. Interventions beyond standard care may facilitate successful return to preinjury activities and improve functional outcomes. Perturbation training has been used in nonoperative ACL injury and preoperative ACL reconstruction rehabilitation, but has not been examined in postoperative ACL reconstruction rehabilitation, specifically return to sport rehabilitation. The purpose of this study was to determine whether there were differences at 1 and 2 years after ACL reconstruction between the male SAP (strengthening, agility, and secondary prevention) and SAP+PERT (SAP protocol with the addition of perturbation training) groups with respect to (1) quadriceps strength and single-legged hop limb symmetry; (2) patient-reported knee outcome scores; (3) the proportion who achieve self-reported normal knee function; and (4) the time from surgery to passing return to sport criteria. Forty men who had completed ACL reconstruction rehabilitation and met enrollment criteria (3-9 months after ACL reconstruction, > 80% quadriceps strength limb symmetry, no pain, full ROM, minimal effusion) were randomized into the SAP or SAP+PERT groups of the Anterior Cruciate Ligament-Specialised Post-Operative Return to Sports trial (ACL-SPORTS), a single-blind randomized clinical study of secondary prevention and return to sport. Quadriceps strength, single-legged hopping, the International Knee Documentation Committee (IKDC) 2000 subjective knee form, Knee Injury and Osteoarthritis Outcome Score (KOOS)-sports and recreation, and KOOS-quality-of-life subscales were collected 1 and 2 years after surgery by investigators blind to group. Athletes were categorized as having normal or abnormal knee function at each time point based on IKDC score, and the time until athletes passed strict return

Uterine, but not ovarian, female reproductive organ involvement at presentation by diffuse large B-cell lymphoma is associated with poor outcomes and a high frequency of secondary CNS involvement

DEFF Research Database (Denmark)

El-Galaly, Tarec Christoffer; Cheah, Chan Y; Hutchings, Martin

2016-01-01

progression-free survival and overall survival compared to those without reproductive organ involvement, whereas ovarian DLBCL was not predictive of outcome. Secondary central nervous system (CNS) involvement (SCNS) occurred in 7/17 (41%) women with uterine DLBCL (two patients with concomitant ovarian DLBCL...

Brown tumor of secondary hyperparathyroidism: surgical approach and clinical outcome.

Science.gov (United States)

Queiroz, Isaac Vieira; Queiroz, Samara Pereira; Medeiros, Rui; Ribeiro, Rodolfo Bonfim; Crusoé-Rebello, Iêda Margarida; Leão, Jair Carneiro

2016-12-01

Secondary hyperparathyroidism is a frequent complication of chronic renal failure. The brown tumor is an unusual presentation of fibrous osteitis that represents a serious complication of renal osteodystrophy, affecting predominantly the hands, feet, skull, and facial bones. The aim of this paper is to describe the case of a 53-year-old female patient, with renal failure who has been on dialysis for 6 years and developed severe secondary hyperparathyroidism and brown tumor of the maxilla and mandible, confirmed by incisional biopsy. Parathyroidectomy was indicated as a result of rapid growth of the tumor and the maintenance of laboratory findings. Despite the normalization of serum parathyroid hormone and alkaline phosphatase, tumor regression was slow and patient's important functional and esthetic deficits persisted. Excision of the mandible tumor was conservative. Osteoplasty was recommended because during a 5-year follow-up there was regression of the lesion, decreased pain, bleeding, and tooth mobility.

Secondary injury in traumatic brain injury patients - A prospective ...

African Journals Online (AJOL)

Objective. Secondary insults of hypotension and hypoxia significantly impact on outcome in patients with traumatic brain injury (TBI). More than 4 hours' delay in evacuation of intracranial haematomas has been demonstrated to have an additional impact on outcome. The objective of this study was to document the ...

The linkage between secondary victimization by law enforcement and rape case outcomes.

Science.gov (United States)

Patterson, Debra

2011-01-01

Prior research has suggested that almost half of rape victims are treated by law enforcement in ways that they experience as upsetting (termed secondary victimization). However, it remains unknown why some victims have negative experiences with law enforcement and others do not. The purpose of this study is to explore victims' experiences with secondary victimization by detectives, comparing how these experiences vary in cases that were ultimately prosecuted by the criminal justice system to those that were not prosecuted. A total of 20 rape victims are interviewed within one county. The study uses grounded theory qualitative analysis, which showed that participants whose cases were eventually prosecuted described the detectives' treatment toward them considerably different than participants with nonprosecuted cases. The study findings further show that victims with cases that were not prosecuted primarily described their detectives as engaging in secondary victimization behaviors and that victims with cases that were ultimately prosecuted primarily described their detectives as responding compassionately toward them.

Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology.

Science.gov (United States)

Piepoli, Massimo F; Corrà, Ugo; Adamopoulos, Stamatis; Benzer, Werner; Bjarnason-Wehrens, Birna; Cupples, Margaret; Dendale, Paul; Doherty, Patrick; Gaita, Dan; Höfer, Stefan; McGee, Hannah; Mendes, Miguel; Niebauer, Josef; Pogosova, Nana; Garcia-Porrero, Esteban; Rauch, Bernhard; Schmid, Jean Paul; Giannuzzi, Pantaleo

2014-06-01

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice. © The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix : a secondary analysis of the HYPITAT and DIGITAT trials

NARCIS (Netherlands)

Bernardes, T. P.; Broekhuijsen, K.; Koopmans, C. M.; Boers, K. E.; van Wyk, L.; Tajik, P.; van Pampus, M. G.; Scherjon, S. A.; Mol, B. W.; Franssen, M. T.; Berg, van den P. P.; Groen, Henk

Objective To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term. Design Secondary analysis of data from two randomised clinical trials. Setting Data were collected in two nationwide Dutch

Quick Guide: Mental Health-Secondary Transition

Science.gov (United States)

National Technical Assistance Center on Transition, 2016

2016-01-01

Recently researchers have begun focusing on young adults with mental health disorders transitioning into adulthood. Research exploring the importance of mental health support in secondary transition have yielded positive outcomes. For example, strong collaboration between educational and mental health agencies ensuring academic, employment, and…

Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial.

Science.gov (United States)

Tita, Alan T; Doherty, Lindsay; Roberts, Jim M; Myatt, Leslie; Leveno, Kenneth J; Varner, Michael W; Wapner, Ronald J; Thorp, John M; Mercer, Brian M; Peaceman, Alan; Ramin, Susan M; Carpenter, Marshall W; Iams, Jay; Sciscione, Anthony; Harper, Margaret; Tolosa, Jorge E; Saade, George R; Sorokin, Yoram

2018-06-01

 To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB).  A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity.  Of 9,867 women, 10.4% ( N  = 1,038) were PTBs; 32.7% ( n  = 340) IPTBs and 67.3% ( n  = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB-4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4-11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1-3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times).  Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perception and Practice of Periodic Medical Checkup by Traders in ...

African Journals Online (AJOL)

Eke CO , Eke NO , Joe-Ikechebelu NN , Okoye. SC. ABSTRACT ... secondary school education and 1.2% had post secondary ... Age, gender and educational status were found not to ... to benefit maximally from periodic medical checkups.

Importance of secondary damage in downer cows.

Science.gov (United States)

Poulton, P J; Vizard, A L; Anderson, G A; Pyman, M F

2016-05-01

To investigate the relative importance in downer cows of the primary cause of recumbency in comparison with secondary complications. Downer dairy cows were monitored during their recumbency under field conditions in South Gippsland, Victoria, Australia. The cause of the original recumbency of the 218 cows was determined and secondary damage, status on day 7 and final outcome were recorded. Some type of secondary damage was found in 183/218 (84%) cows, of which 173/218 (79%) had damage deemed to be clinically important. By day 7, 52 (24%) had recovered and 69 (32%) eventually recovered. Of the 149 (68%) cows that were euthanased or died, 23 (15%) were deemed to have been lost solely from the primary cause, 107 (72%) from secondary damage and 19 (13%) from a combination of both. There was no difference in recovery among the five broad groups of causes of primary recumbency. Secondary damage was very common and presented in a large variety of ways, with many cows having multiple types of secondary damage concurrently. For most cows the secondary damage was more important than the initial primary damage in determining their fate. © 2016 Australian Veterinary Association.

Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair

DEFF Research Database (Denmark)

Andresen, K; Burcharth, J; Fonnes, S

2015-01-01

was to investigate if there were differences in early postoperative pain during the first 10 days between the Onstep and the Lichtenstein technique. METHODS: This was a double-blinded, randomized clinical trial conducted in five surgical departments in Denmark, from April 2013 to June 2014. Eligible participants...... for this study were male patients, >18 years, with a primary inguinal hernia. Experimental treatment in this study was the Onstep technique, which was compared with the Lichtenstein repair. Primary outcome was postoperative pain during the first 10 days following surgery. Secondary outcomes included duration...... of surgery, period for return to normal daily activities (days), and recurrence. Randomization was done in blocks and stratified on centers. Participants and study personnel handling questionnaires and analysis were blinded to the allocation. RESULTS: In total, 290 participants were randomized. We found...

Basis for selecting optimum antibiotic regimens for secondary peritonitis.

Science.gov (United States)

Maseda, Emilio; Gimenez, Maria-Jose; Gilsanz, Fernando; Aguilar, Lorenzo

2016-01-01

Adequate management of severely ill patients with secondary peritonitis requires supportive therapy of organ dysfunction, source control of infection and antimicrobial therapy. Since secondary peritonitis is polymicrobial, appropriate empiric therapy requires combination therapy in order to achieve the needed coverage for both common and more unusual organisms. This article reviews etiological agents, resistance mechanisms and their prevalence, how and when to cover them and guidelines for treatment in the literature. Local surveillances are the basis for the selection of compounds in antibiotic regimens, which should be further adapted to the increasing number of patients with risk factors for resistance (clinical setting, comorbidities, previous antibiotic treatments, previous colonization, severity…). Inadequate antimicrobial regimens are strongly associated with unfavorable outcomes. Awareness of resistance epidemiology and of clinical consequences of inadequate therapy against resistant bacteria is crucial for clinicians treating secondary peritonitis, with delicate balance between optimization of empirical therapy (improving outcomes) and antimicrobial overuse (increasing resistance emergence).

13. Device therapy in secondary hospital (without a cath lab: Feasibility, logistics and outcome

Directory of Open Access Journals (Sweden)

A. Jelani

2016-07-01

Full Text Available Device therapy for conduction abnormalities, heart failure, primary or secondary SCD preventions is under delivered to requiring patients. Most of these devices are implanted at tertiary care centers in major cities of most countries. This makes the availability of these guideline guided therapies to a very small percentage of needy patients. Implant of such devices at a secondary hospital (without a cardiac cath lab with training of previously novice hospital staff and available resources as well as support of the industry is an alternative and very viable option to have such important therapy delivered to requiring patients. The usage of simple-readily available-C-arm in operating theatre (OR or the interventional radiology suite can be utilized for this purpose. OR nursing staff and radiology technicians can be trained –with help of nursing education department– to help in such procedures over a relatively short period. Technical support utilized from the vendors representatives is an alternative to face the lack of EP technicians in local or international market. The follow up of these patients in OPD can be organized with help of the vendors on regular basis under supervision of trained cardiologist/s. This model can help establish device therapy service at a secondary hospital without huge expenditure on infrastructure or facing the lack of recruitment of specialized technical support that is difficult to find –especially for smaller cities–. We present our experience at a 250 bed secondary hospital, with a relatively small cardiac unit (3 consultants, 5 hospitalists, 10 cardiac ECG/Echo techs and no cath lab of introduction of this service with the help of nursing education department and vendors supplying these devices as well as OR and radiology departments. Training of radiology technicians and OR nursing staff on the basic procedural support with few in-service demonstration helped prepare adequate staff helping during implant

Comparison of outcomes for African Americans, Hispanics, and Non-Hispanic Whites in the CATIE study.

Science.gov (United States)

Arnold, Jodi Gonzalez; Miller, Alexander L; Cañive, José M; Rosenheck, Robert A; Swartz, Marvin S; Mintz, Jim

2013-06-01

Medication outcome literature in schizophrenia across racial-ethnic groups is sparse, with inconsistent findings. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study provided an opportunity for exploratory analyses of racial-ethnic outcomes. The study objective was to examine race-ethnicity outcomes for CATIE's main outcome (study discontinuation) and secondary outcomes. CATIE participants included whites (non-Hispanic) (N=722), African Americans (N=506), and Hispanics (N=170). Survival analyses and mixed-effects regression modeling were conducted, with adjustment for baseline sociodemographic differences and baseline scores of the secondary outcomes. Racial-ethnic groups had unique patterns of outcomes. Hispanics were much more likely to discontinue for lack of efficacy from perphenazine (64% versus 42% non-Hispanic whites and 24% African Americans) and ziprasidone (71% versus 40% non-Hispanic whites and 24% African Americans); Hispanics' quality of life also declined on these medications. Non-Hispanic whites were more likely to discontinue for lack of efficacy in general (averaging olanzapine, quetiapine, and risperidone discontinuation rates). African Americans were less likely to continue after the first phase (32% continuing versus 40% for non-Hispanic whites and 41% Hispanics). Discontinuations were driven by research burden, personal issues, and unspecified loss to follow-up. Non-Hispanic whites had higher depression scores during the follow-up period. African Americans had fewer side effects. CATIE results did not show disparities favoring non-Hispanic whites. CATIE may have provided state-of-the-art treatment and thus reduced disparate treatments observed in community clinics. African Americans discontinued even after consideration of socioeconomic differences. Why perphenazine and ziprasidone may be less effective with Hispanics should be explored.

Cue-elicited food seeking is eliminated with aversive outcomes following outcome devaluation.

Science.gov (United States)

Eder, Andreas B; Dignath, David

2016-01-01

In outcome-selective Pavlovian-to-instrumental transfer (PIT), stimuli that are predictive of specific outcomes prime instrumental responses that are associated with these outcomes. Previous human studies yielded mixed evidence in respect to whether the PIT effect is affected by a posttraining devaluation of an outcome, with the PIT effect being preserved after a devaluation of a primary reinforcer (food, drugs) but not following the devaluation of a secondary reinforcer (money). The present research examined whether outcome-selective transfer is eliminated when the devaluation of a primary (liquid) reinforcer is strong and aversive. Experiment 1 confirmed these expectations following a devaluation with bad tasting Tween 20. However, outcome-selective transfer was still observed when the earned (devalued) outcome was not consumed immediately after each test (Experiment 2). These results suggest that the capacity of a Pavlovian cue to motivate a specific response is affected by the incentive value of the shared outcome only when the devaluation yields an aversive outcome that is consumed immediately.

secondary injury in traumatic brain injury patients - a prospective study

African Journals Online (AJOL)

Objective. Secondary insults of hypotension and hypoxia significantly impact on outcome in patients with traumatic brain injury (TBI). More than 4 hours' delay in evacuation of intracranial haematomas has been demonstrated to have an additional impact on outcome. The objective of this study was to document the ...

Systemic Candidiasis in Extremely Low Birthweight (ELBW) Neonates Despite the Routine Use of Topical Miconazole Prophylaxis: Trends, Risk Factors and Outcomes over an 11-Year Period.

Science.gov (United States)

Sriram, Bhavani; Agarwal, Pratibha K; Tee, Nancy W S; Rajadurai, Victor S

2014-05-01

This study aims to determine the incidence, trends of systemic candidiasis and meningitis in extremely low birthweight (ELBW) neonates (candidiasis and meningitis over an 11-year period (1997 to 2007). Matched case control analyses were performed to determine the risk factors and comorbidities which were severe intraventricular haemorrhage (IVH), severe retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) requiring treatment, necrotising enterocolitis (NEC), chronic lung disease (CLD) and cholestatic jaundice. Mortality and end organ involvement secondary to systemic candidiasis were identified as adverse outcomes. Of the 757 ELBW neonates, 51 (6.7%) had evidence of systemic candidiasis with a significant 3-fold increase in trend noted in 2007 as compared against 1997 (12.1% vs 3.8%) (RR 1.2, 95% CI, 1.06 to 1.36, P candidiasis (0% in 1997 vs 7.1% in 2007, RR 1.40, 95% CI, 1.04 to 1.25, P = 0.005). On logistic regression analysis, decreasing gestational age was an independent risk factor for systemic candidiasis (OR 2.0, 95% CI, 1.52 to 2.63, P candidiasis despite routine use of topical miconazole prophylaxis is of concern and future studies comparing the use of systemic fl uconazole versus oral nystatin may need to be considered.

Implementing Resistance Training in Secondary Schools: A Cluster Randomized Controlled Trial.

Science.gov (United States)

Kennedy, Sarah G; Smith, Jordan J; Morgan, Philip J; Peralta, Louisa R; Hilland, Toni A; Eather, Narelle; Lonsdale, Chris; Okely, Anthony D; Plotnikoff, Ronald C; Salmon, J O; Dewar, Deborah L; Estabrooks, Paul A; Pollock, Emma; Finn, Tara L; Lubans, David R

2018-01-01

Guidelines recommend that young people engage in muscle-strengthening activities on at least 3 d·wk. The purpose of this study was to examine the effect of a school-based intervention focused on resistance training (RT) for adolescents. The "Resistance Training for Teens" intervention was evaluated using a cluster-randomized, controlled trial with 607 adolescents (50.1% girls; 14.1 ± 0.5 yr) from 16 secondary schools. Teachers were trained to deliver the intervention, which included the following: (i) an interactive student seminar; (ii) a structured physical activity program, focused on RT; (iii) lunchtime fitness sessions; and (iv) Web-based smartphone apps. The primary outcome was muscular fitness (MF) and secondary outcomes included body mass index, RT skill competency, flexibility, physical activity, self-efficacy, and motivation. Assessments were conducted at baseline, 6 months (postprogram; primary end point), and 12 months (follow-up). Outcomes were assessed using linear mixed models, with three potential moderators tested using interaction terms (and subgroup analyses where appropriate). For the primary outcome (MF), a group-time effect was observed at 6 months for the upper body (2.0 repetitions; 95% confidence interval (CI), 0.8-3.2), but not the lower body (-1.4 cm; 95% CI, -4.7-1.9). At 6 months, there were intervention effects for RT skill competency and self-efficacy, but no other secondary outcomes. Effects for upper body MF and RT skill competency were sustained at 12 months. Despite overall no effect for body mass index, there was a group-time effect at 12 months among students who were overweight/obese at baseline (-0.55 kg·m; 95% CI, -1.01 to -0.08). The school-based RT intervention resulted in immediate and sustained improvements in upper body MF and RT skill competency, demonstrating an effective and scalable approach to delivering RT within secondary schools.

Irrational antibiotic usage in boarding secondary school settings in ...

African Journals Online (AJOL)

Objective: To assess the prevalence of antibiotic misuse among boarding secondary school students in Dar es Salaam. Methodology: This descriptive cross-sectional study was conducted over 3-month period amongst boarding secondary school students. A randomized sample of students was recruited from at least 3 ...

Evaluation of secondary hyperparathyroidism in patients undergoing hemodialysis.

Science.gov (United States)

Rahimian, Mohammad; Sami, Ramin; Behzad, Fariba

2008-01-01

Renal osteodystrophy is a complication of chronic kidney disease (CKD) that present in low and high turnover patterns. This disorder has a key role in the disability of CKD patients in whom early diagnosis and treatment can result in better outcome. We studied hyperparathyroidism prevalence and its relationship with renal osteodystrophy in our advanced CKD population. We included 80 patients (of whom 44 (55%) were diabetic) during 6 months period. The patients answered a questionnaire about symptoms related to bone disease and blood levels of parathormone (PTH), calcium, phosphorus, and alkaline phosphatase were obtained, in addition to hand and skull radiographs in all the study patients. Prevalence of clinically evident hyperparathyroidism in our patients was 45%. Hyperparathyroidism had significant relationship with alkaline phosphatase and radiological findings, but did not have a significant relationship with dialysis duration, age, sex, familial history, diabetes mellitus, or hypertension. We conclude that secondary hyperparathyroidism is prevalent in our dialysis population and has high correlation with serum alkaline phosphatase levels and radiological changes.

Allochronic speciation, secondary contact, and reproductive character displacement in periodical cicadas (Hemiptera: Magicicada spp.): genetic, morphological, and behavioural evidence.

Science.gov (United States)

Cooley, J R; Simon, C; Marshall, D C; Slon, K; Ehrhardt, C

2001-03-01

Periodical cicadas have proven useful in testing a variety of ecological and evolutionary hypotheses because of their unusual life history, extraordinary abundance, and wide geographical range. Periodical cicadas provide the best examples of synchronous periodicity and predator satiation in the animal kingdom, and are excellent illustrations of habitat partitioning (by the three morphologically distinct species groups), incipient species (the year classes or broods), and cryptic species (a newly discovered 13-year species, Magicicada neotredecim). They are particularly useful for exploring questions regarding speciation via temporal isolation, or allochronic speciation. Recently, data were presented that provided strong support for an instance of allochronic speciation by life-cycle switching. This speciation event resulted in the formation of a new 13-year species from a 17-year species and led to secondary contact between two formerly separated lineages, one represented by the new 13-year cicadas (and their 17-year ancestors), and the other represented by the pre-existing 13-year cicadas. Allozyme frequency data, mitochondrial DNA (mtDNA), and abdominal colour were shown to be correlated genetic markers supporting the life-cycle switching/allochronic speciation hypothesis. In addition, a striking pattern of reproductive character displacement in male call pitch and female pitch preference between the two 13-year species was discovered. In this paper we report a strong association between calling song pitch and mtDNA haplotype for 101 individuals from a single locality within the M. tredecim/M. neotredecim contact zone and a strong association between abdomen colour and mtDNA haplotype. We conclude by reviewing proposed mechanisms for allochronic speciation and reproductive character displacement.

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.

Pre-service secondary school science teachers science teaching ...

African Journals Online (AJOL)

PROF.MIREKU

pre-service secondary science teachers' self-efficacy beliefs with regard to gender and educational .... outcome. As a consequence, instruments for the determination of self-efficacy ...... Sex Roles: A Journal of Research, 42, 119–31. Bursal, M.

[Consequence of secondary complications during the rehabilitation of patients with severe brain injury].

Science.gov (United States)

Dénes, Zoltán

2009-01-25

Recovery from brain injury is not only determined by the primary injury, but a very important element is the development of secondary complications which have a major role in determining the possibility of the achievement of available maximal functional abilities and the quality of life of the patients and their family after rehabilitation. This is why during medical treatment the prevention of secondary complications is at least as important as the prevention of primary injury. Determination of the most important secondary complications after severe brain injury, and observation of these effects on the rehabilitation process. Retrospective study in the Brain Injury Rehabilitation unit of the National Institute for Medical Rehabilitation in Hungary. 166 patients were treated with brain injury; the mean age of the patients was 33 (8-83) years in 2004. The majority of patients suffered traumatic brain injury in traffic accidents (125/166), while the rest of them through falls or acts of violence. Sixty-four patients were admitted directly from an intensive care unit, 18 from a second hospital ward (traumatology, neurosurgery or neurology) and the rest of the patients were treated in several different units before they were admitted for rehabilitation. The time that has elapsed between injury and rehabilitation admission was 50 days (21-177). At the time of admission 27 patients were in a vegetative state, 38 patients in a minimal conscious state, and 101 patients had already regained consciousness. 83 patients were hemiparetic, 54 presented tetraparesis, and 1 paraparesis, but 28 patients were not paretic. The most frequent complications in patients with severe brain injury at admission in our rehabilitation unit were: contractures (47%), pressure sores (35%), respiratory (14%) and urinary (11%) tract infections, malnutrition (20%). The functional outcome was worse in the cases arriving with secondary complications during the same rehabilitation period. The length of

The impact of assistive technology services in post-secondary education for students with disabilities: Intervention outcomes, use-profiles, and user-experiences.

Science.gov (United States)

Malcolm, Matthew P; Roll, Marla C

2017-01-01

The outcomes of assistive technology (AT) support services for post-secondary education students with disabilities are under-reported, and little is known about use-profiles and user experiences when AT interventions are applied to this rapidly growing population. We examined AT service outcomes related to performance and satisfaction of common academic tasks (using the Canadian Occupational Performance Measure [COPM]), as well as how students with disabilities use and experience AT and AT services (employing an AT-use survey). Three-hundred fifty-three students with disabilities completed the AT-use survey, with a subset of these (n = 216) also participating with pre-post AT intervention COPM assessment. COPM performance and satisfaction ratings significantly increased from pre- to post-AT intervention in all academic task categories (reading, writing, note-taking, test-taking, and studying; p impacted their academic success, and believed they would continue using AT post-graduation. The study findings contribute to evidence-base for AT services with a hope we may improve AT services to best meet the changing needs of the growing number of college students with disabilities.

Esophageal variceal ligation in the secondary prevention of variceal ...

African Journals Online (AJOL)

Pan African Medical Journal ... Introduction: Long-term outcome of patients after band ligation have been poorly defined. ... endoscopic band ligation, liver cirrhosis, complication of band ligation, esophageal varices, secondary prevention ...

Anatomical and functional outcomes following vitrectomy for dense vitreous hemorrhage related to Terson syndrome in children.

Science.gov (United States)

Sayman Muslubas, Isil; Karacorlu, Murat; Hocaoglu, Mumin; Ersoz, Mehmet Giray; Arf, Serra

2018-03-01

Our purpose was to assess anatomical and functional outcomes of vitrectomy in pediatric cases of Terson syndrome. A total of 11 eyes of seven children diagnosed with Terson syndrome secondary to traumatic brain injury and 17 eyes of 12 children diagnosed with Terson syndrome secondary to nontraumatic brain hemorrhage who had 20-gauge or 23-gauge pars plana or pars plicata vitrectomy were included in this retrospective study. The primary outcome was the change in visual acuity from the preoperative examination to postoperative final follow-up. Secondary outcomes were anatomic surgical success and postoperative complications. The mean time between diagnosis and surgery was 62 ± 35 days (range, 30-150), and the average age at the time of the surgery was 4.5 ± 6.4 years (range, 3 months to 17 years). The mean preoperative logarithm of the minimum angle of resolution (logMAR) (Snellen) best corrected visual acuity (BCVA) was 2.6 ± 0.7 (20/7260) (n = 9) and in the remaining 19 eyes it was recorded as noncentral, unsteady, nonmaintained fixation. The mean follow-up period was 50 ± 54 months (range, 12-192 months). At the last follow-up visit, the mean logMAR BCVA was 0.46 ± 0.6 (20/60) (n = 19) and in eight eyes it was recorded as fix-and-follow. One eye developed a retinal detachment 14 months after the first operation, and one eye developed an epiretinal membrane after 2 years. Anatomical success was recorded in all patients at the final visit. In children with massive vitreous hemorrhage secondary to Terson syndrome, vitrectomy is an effective procedure and offers a rapid visual improvement. Earlier surgical treatment prevents amblyopia and blood-related potential complications.

Secondary peritonitis - evaluation of 204 cases and literature review.

Science.gov (United States)

Doklestić, S K; Bajec, D D; Djukić, R V; Bumbaširević, V; Detanac, A D; Detanac, S D; Bracanović, M; Karamarković, R A

2014-06-15

Even at the beginning of the new millennium, secondary peritonitis presents a common life-threatening condition associated with high mortality and morbidity. This article comments on epidemiology, diagnosis and general principles of surgical management in patients with secondary peritonitis. The demographic data, clinical findings and surgical outcome of 204 patients who had a confirmed generalized secondary peritonitis were analyzed retrospectively. Our approach was laparotomy, surgical control of contamination, antibiotic therapy and modern intensive care support. Acid peptic disease was the most common cause of perforation peritonitis 60 (29,41%), following by the perforated appendicitis 45 ( 22,06%). The faecal peritonitis and colon perforation were found in 42 patients (20,59%). The morbidity rate was 50%; 41 (40,2%) patients had more than one complication. The morbidity rate was significantly the highest in patients with colon perforation (n=38, 90%) (Hi-square=40,1; pcases (23,81%), and 4(6,6%) deaths due to gastro-duodenal perforation (Hi-square=45,7; pclinical presentation and outcome of the secondary peritonitis depend on duration of abdominal infection, the site of perforation and the general condition of the patient. Rapid surgical source control, modern intensive care and sepsis therapy may offer the chance of decreased morbidity and mortality of the intra-abdominal infections.

Potential or problem? An investigation of secondary school teachers' attributions of the educational outcomes of students with specific learning difficulties.

Science.gov (United States)

Woodcock, Stuart; Hitches, Elizabeth

2017-10-01

Despite strong support for inclusive education in principle, many teachers and administrators still demonstrate mixed responses to the inclusion of certain students in their classrooms. Students with specific learning difficulties (SpLD) form a large group of students in inclusive classrooms yet some provincial, state and national jurisdictions fail to acknowledge the existence of these students. Not acknowledging and understanding these students can deny them the recognition and resources necessary for their genuine participation in education and, in turn, society. The aim of this study was to examine British in-service secondary teachers' attributional responses to students with and without specific learning difficulties. The participants included 122 British secondary school teachers who were surveyed in response to vignettes of hypothetical male students who had failed a class test. The study found that while teachers attributed more positive causes towards students without SpLD, they exhibited more negative causes towards students with SpLD. Teachers' causal attributional outcomes of students' level of achievement can impact upon the students' own attributions, with teachers' responses for students with SpLD having the potential to, unintentionally, influence students' own sense of self-efficacy and motivation. The paper concludes with a consideration of the implications of the research and recommendations for practice.

Corot 310266512: A Light Curve With Primary, Secondary And Tertiary Eclipses

Directory of Open Access Journals (Sweden)

Fernández Fernández Javier

2015-01-01

Full Text Available We present the photometric study of an interesting target in the CoRoT exoplanet database: CoRoT 310266512. Its light curve shows primary, secondary and tertiary eclipses that suggests the presence of at least three celestial bodies. The primary and secondary eclipses have the same orbital period, 7.42 days, and the tertiary eclipse has an orbital period of 3.27 days. Two of the tertiary eclipses fall within a primary eclipse and a secondary eclipse. The properties of the light curve indicate the presence of two physically separated systems. The primary and secondary eclipses corresponds to a binary system (System I. The tertiary eclipses correspond to a star-planet system or a star-dwarf system (System II. Some parameters of these two systems are obtained from JKTEBOP [1] program.

Trajectories of CKD-MBD biochemical parameters over a 2-year period following diagnosis of secondary hyperparathyroidism: a pharmacoepidemiological study.

Science.gov (United States)

Filipozzi, Pierre; Ayav, Carole; Ngueyon Sime, Willy; Laurain, Emmanuelle; Kessler, Michèle; Brunaud, Laurent; Frimat, Luc

2017-03-27

To define groups of patients according to the changes of biochemical parameters, that is, serum calcium, phosphate and parathyroid hormone (PTH), over a 2-year follow-up period using group-based multi-trajectory modeling (GBMM) among a cohort of dialysis patients with newly diagnosed secondary hyperparathyroidism (SHPT) (ie, PTH≥500 ng/L for the first time) and to compare their patient characteristics and treatments. Pharmacoepidemiological study. In the 12 dialysis units located in the French region of Lorraine. A total of 269 dialysis patients with newly diagnosed SHPT were prospectively included from December 2009 to May 2012 and followed-up for 2 years. We identified four distinct trajectory groups: 'rapid PTH drop' experiencing a rapid and sharp decrease (over weeks) in PTH level associated with decreasing phosphate level within normal range (n=34; 12.7%), 'gradual PTH decrease' experiencing a gradual and continuous decrease (over months) in PTH level and maintaining phosphate at a middle level throughout the study (n=98; 36.4%), 'slow PTH decrease with high phosphate' experiencing a slow decrease in PTH level associated with a relatively high phosphate level (n=105; 39.0%) and 'uncontrolled SHPT' with high levels of PTH and phosphate throughout the study (n=32; 11.9%). Patients in the 'uncontrolled SHPT' group were significantly (p<0.00001) younger than patients in other groups. Kidney Disease Improving Global Outcomes (KDIGO) targets for PTH, phosphate and calcium were reached simultaneously for 14.9% of patients at baseline and 16.7% at the end of the study. Patients were given cinacalcet more frequently at months 3 and 6 in the 'rapid PTH drop' and at month 24 in the 'uncontrolled SHPT' groups. Over 2 years following a new SHPT diagnosis, a younger age and a higher rate of alkaline phosphatase were associated to a continuous uncontrolled SHPT. Patients with the lowest PTH at the end of the follow-up tended to receive more often cinacalcet. Clinical

Steady Secondary Flows Generated by Periodic Compression and Expansion of an Ideal Gas in a Pulse Tube

Science.gov (United States)

Lee, Jeffrey M.

1999-01-01

This study establishes a consistent set of differential equations for use in describing the steady secondary flows generated by periodic compression and expansion of an ideal gas in pulse tubes. Also considered is heat transfer between the gas and the tube wall of finite thickness. A small-amplitude series expansion solution in the inverse Strouhal number is proposed for the two-dimensional axisymmetric mass, momentum and energy equations. The anelastic approach applies when shock and acoustic energies are small compared with the energy needed to compress and expand the gas. An analytic solution to the ordered series is obtained in the strong temperature limit where the zeroth-order temperature is constant. The solution shows steady velocities increase linearly for small Valensi number and can be of order I for large Valensi number. A conversion of steady work flow to heat flow occurs whenever temperature, velocity or phase angle gradients are present. Steady enthalpy flow is reduced by heat transfer and is scaled by the Prandtl times Valensi numbers. Particle velocities from a smoke-wire experiment were compared with predictions for the basic and orifice pulse tube configurations. The theory accurately predicted the observed steady streaming.

Prediction of primary vs secondary hypertension in children.

Science.gov (United States)

Baracco, Rossana; Kapur, Gaurav; Mattoo, Tej; Jain, Amrish; Valentini, Rudolph; Ahmed, Maheen; Thomas, Ronald

2012-05-01

Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. © 2012 Wiley Periodicals, Inc.

The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax.

Science.gov (United States)

Saito, Yoshitaro; Suzuki, Yohei; Demura, Ryo; Kawai, Hideki

2018-03-01

Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization. We retrospectively examined 61 patients with SSP, and evaluated the patients' characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization. There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38-21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44-31.06). Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization.

Food Choice Architecture: An Intervention in a Secondary School and its Impact on Students’ Plant-based Food Choices

Directory of Open Access Journals (Sweden)

Hannah Ensaff

2015-06-01

Full Text Available With growing evidence for the positive health outcomes associated with a plant-based diet, the study’s purpose was to examine the potential of shifting adolescents’ food choices towards plant-based foods. Using a real world setting of a school canteen, a set of small changes to the choice architecture was designed and deployed in a secondary school in Yorkshire, England. Focussing on designated food items (whole fruit, fruit salad, vegetarian daily specials, and sandwiches containing salad the changes were implemented for six weeks. Data collected on students’ food choice (218,796 transactions enabled students’ (980 students selections to be examined. Students’ food choice was compared for three periods: baseline (29 weeks; intervention (six weeks; and post-intervention (three weeks. Selection of designated food items significantly increased during the intervention and post-intervention periods, compared to baseline (baseline, 1.4%; intervention 3.0%; post-intervention, 2.2% χ2(2 = 68.1, p < 0.001. Logistic regression modelling also revealed the independent effect of the intervention, with students 2.5 times as likely (p < 0.001 to select the designated food items during the intervention period, compared to baseline. The study’s results point to the influence of choice architecture within secondary school settings, and its potential role in improving adolescents’ daily food choices.

Thyrotoxic periodic paralysis

Directory of Open Access Journals (Sweden)

Rojith Karandode Balakrishnan

2011-01-01

Full Text Available This article aims at highlighting the importance of suspecting thyrotoxicosis in cases of recurrent periodic flaccid paralysis; especially in Asian men to facilitate early diagnosis of the former condition. A case report of a 28 year old male patient with recurrent periodic flaccid paralysis has been presented. Hypokalemia secondary to thyrotoxicosis was diagnosed as the cause of the paralysis. The patient was given oral potassium intervention over 24 hours. The patient showed complete recovery after the medical intervention and was discharged after 24 hours with no residual paralysis. Thyrotoxic periodic paralysis (TPP is a complication of thyrotoxicosis, more common amongst males in Asia. It presents as acute flaccid paralysis in a case of hyperthyroidism with associated hypokalemia. The features of thyrotoxicosis may be subtle or absent. Thus, in cases of recurrent or acute flaccid muscle paralysis, it is important to consider thyrotoxicosis as one of the possible causes, and take measures accordingly.

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

Science.gov (United States)

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

2018-03-01

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

The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment

Directory of Open Access Journals (Sweden)

Loudon Annette

2012-05-01

Full Text Available Abstract Background Women who develop secondary arm lymphoedema subsequent to treatment associated with breast cancer require life-long management for a range of symptoms including arm swelling, heaviness, tightness in the arm and sometimes the chest, upper body impairment and changes to a range of parameters relating to quality of life. While exercise under controlled conditions has had positive outcomes, the impact of yoga has not been investigated. The aim of this study is to determine the effectiveness of yoga in the physical and psycho-social domains, in the hope that women can be offered another safe, holistic modality to help control many, if not all, of the effects of secondary arm lymphoedema. Methods and design A randomised controlled pilot trial will be conducted in Hobart and Launceston with a total of 40 women receiving either yoga intervention or current best practice care. Intervention will consist of eight weeks of a weekly teacher-led yoga class with a home-based daily yoga practice delivered by DVD. Primary outcome measures will be the effects of yoga on lymphoedema and its associated symptoms and quality of life. Secondary outcome measures will be range of motion of the arm and thoracic spine, shoulder strength, and weekly and daily physical activity. Primary and secondary outcomes will be measured at baseline, weeks four, eight and a four week follow up at week twelve. Range of motion of the spine, in a self-nominated group, will be measured at baseline, weeks eight and twelve. A further outcome will be the women’s perceptions of the yoga collected by interview at week eight. Discussion The results of this trial will provide information on the safety and effectiveness of yoga for women with secondary arm lymphoedema from breast cancer treatment. It will also inform methodology for future, larger trials. Trial registration ACTRN12611000202965

Weight and blood pressure response to weight management and sibutramine in diabetic and non-diabetic high-risk patients: an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial

DEFF Research Database (Denmark)

Van Gaal, L F; Caterson, I D; Coutinho, W

2010-01-01

To assess treatment responses to sibutramine and weight management in diabetic patients during the lead-in period of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial.......To assess treatment responses to sibutramine and weight management in diabetic patients during the lead-in period of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial....

Cup detachment during vacuum-assisted vaginal delivery and birth outcome.

Science.gov (United States)

Krispin, Eyal; Aviram, Amir; Salman, Lina; Chen, Rony; Wiznitzer, Arnon; Gabbay-Benziv, Rinat

2017-11-01

To determine the perinatal outcome associated with cup detachment during vacuum-assisted vaginal delivery (VAVD). A retrospective cohort study of all women attempting VAVD in a tertiary hospital (2012-2014). Singleton-term pregnancies were included. Antepartum fetal death and major fetal structural or chromosomal abnormalities were excluded. Primary outcome was neonatal birth trauma (subgaleal hematoma, subarachnoid hematoma, subdural hematoma, skull fracture, and/or erb's palsy). Secondary outcomes were maternal complications or other neonatal morbidities. Outcomes were compared between women after ≥1 cup detachment (study group) and the rest (control group). Logistic regression analysis was utilized to adjust results to potential confounders. Overall, 1779 women attempted VAVD during study period. Of them, in 146 (8.2%), the cup detached prior to delivery; 130/146 (89%) had a single detachment. After detachment, 4 (2.7%) delivered by cesarean section, 77 (52.7%) delivered after cup reapplication, and 65 (44.6%) delivered spontaneously. Women in the study group were more likely to undergo VAVD due to prolonged second stage, and were characterized by lower rates of metal cup use. Neonates in the detachment group had higher rates of subarachnoid hematoma and composite neonatal birth trauma (2.7 vs. 0.1% and 4.8 vs. 1.8%, respectively, p Cup detachment is associated with a higher rate of adverse neonatal outcome. Cup reapplication should be considered carefully.

Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial.

Science.gov (United States)

Leblanc, Judith; Hejblum, Gilles; Costagliola, Dominique; Durand-Zaleski, Isabelle; Lert, France; de Truchis, Pierre; Verbeke, Geert; Rousseau, Alexandra; Piquet, Hélène; Simon, François; Pateron, Dominique; Simon, Tabassome; Crémieux, Anne-Claude

2017-10-30

This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis. During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was €1,324 per additional new diagnosis. The combined strategy of targeted screening and diagnostic testing was effective. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Retropubic radical prostatectomy: Clinicopathological observations and outcome analysis of 428 consecutive patients

Directory of Open Access Journals (Sweden)

Jagdeesh N Kulkarni

2011-01-01

Full Text Available Aim : We report the outcome analysis of retropubic radical prostatectomy (RRP performed in 428 patients in terms of pathological findings, complications, and survival. Materials and Methods : Systematically recorded case reports forms of consecutive 428 RRPs done over a 14-year period were analyzed using the SPSS 14 software. Secondary analysis was done to evaluate era specific (pre and post 2002 changes in clinical features and survivals. Results : Seven-year overall survival (OAS, cancer-specific survival (CSS, and event-free survival (EFS was 83.2%, 82.8%, and 69.8% respectively in our series. Era-specific survival showed higher CSS post 2002, and there was an increase in presentation with organ-confined disease. Univariate and multivariate analysis showed statistically significant impact on era specific outcome. With the improvement in techniques decrease in complications rate and increase in quality of life was noted. Conclusions : Our series spanning over decade demonstrates that RRP is viable option to offer cure to organ-confined carcinoma prostate. Further, there is evidence of stage migration and improvements in outcome in post 2002 patients. Although our series is modest in number, the success rates and outcome data matches those reported in the literature.

Effectiveness of nurse-led patient-centered care behavioral risk modification on secondary prevention of coronary heart disease: A systematic review.

Science.gov (United States)

Chiang, Chung-Yan; Choi, Kai-Chow; Ho, Ka-Ming; Yu, Sau-Fung

2018-04-22

SF-36. Furthermore, from single-study results, the intervention was favorable in improving the patients' weight management and alcohol consumption. However, it did not show significant effects on improving the patient's dietary habits, certain cardiac physiological parameters, mortality and self-efficacy. Currently, no addition long-term benefit of the intervention on secondary cardiac prevention was identified. This review has systematically analyzed the effects of nurseledpatient-centered care on patients' behavioral risks, cardiacphysiological parameters, mortality, health-related quality of life and self-efficacy. Given limited quantity of existing evidence regarding certain outcomes and long-term follow-up period; cross-trial heterogeneity of the interventions, measurement methods and statistical results; high or unclear risk of bias in some quality dimensions, the effectiveness of the intervention on secondary cardiac prevention remains inconclusive and subject to additional trials and evidences. Copyright © 2018 Elsevier Ltd. All rights reserved.

Outcome of secondary high-grade glioma in children previously treated for a malignant condition: A study of the Canadian Pediatric Brain Tumour Consortium

International Nuclear Information System (INIS)

Carret, Anne-Sophie; Tabori, Uri; Crooks, Bruce; Hukin, Juliette; Odame, Isaac; Johnston, Donna L.; Keene, Daniel L.; Freeman, Carolyn; Bouffet, Eric

2006-01-01

Background and purpose: Reports of secondary high-grade glioma (HGG) in survivors of childhood cancer are scarce. The aim of this study was to review the pattern of diagnosis, the treatment, and outcome of secondary pediatric HGG. Patients and methods: We performed a multi-center retrospective study among the 17 paediatric institutions participating in the Canadian Pediatric Brain Tumour Consortium (CPBTC). Results: We report on 18 patients (14 males, 4 females) treated in childhood for a primary cancer, who subsequently developed a HGG as a second malignancy. All patients had previously received radiation therapy +/- chemotherapy for either acute lymphoblastic leukaemia (n = 9) or solid tumour (n = 9). All HGG occurred within the previous radiation fields. At the last follow-up, 17 patients have died and the median survival time is 9.75 months. Conclusion: Although aggressive treatment seems to provide sustained remissions in some patients, the optimal management is still to be defined. Further documentation of such cases is necessary in order to better understand the pathogenesis, the natural history and the prevention of these tumours

Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study.

Science.gov (United States)

McClure, Erin A; Campbell, Aimee N C; Pavlicova, Martina; Hu, Meichen; Winhusen, Theresa; Vandrey, Ryan G; Ruglass, Lesia M; Covey, Lirio S; Stitzer, Maxine L; Kyle, Tiffany L; Nunes, Edward V

2015-06-01

The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (aim #1), specifically among those in the experimental treatment group (aim #2), and the moderating effect of being a smoker on treatment outcomes (aim #3). Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Identification of Novel Signal Transduction, Immune Function, and Oxidative Stress Genes and Pathways by Topiramate for Treatment of Methamphetamine Dependence Based on Secondary Outcomes

Directory of Open Access Journals (Sweden)

Tianhua Niu

2017-12-01

Full Text Available BackgroundTopiramate (TPM is suggested to be a promising medication for treatment of methamphetamine (METH dependence, but the molecular basis remains to be elucidated.MethodsAmong 140 METH-dependent participants randomly assigned to receive either TPM (N = 69 or placebo (N = 71 in a previously conducted randomized controlled trial, 50 TPM- and 49 placebo-treated participants had a total 212 RNA samples available at baseline, week 8, and week 12 time points. Following our primary analysis of gene expression data, we reanalyzed the microarray expression data based on a latent class analysis of binary secondary outcomes during weeks 1–12 that provided a classification of 21 responders and 31 non-responders with consistent responses at both time points.ResultsBased on secondary outcomes, 1,381, 576, 905, and 711 differentially expressed genes at nominal P values < 0.05 were identified in responders versus non-responders for week 8 TPM, week 8 placebo, week 12 TPM, and week 12 placebo groups, respectively. Among 1,381 genes identified in week 8 TPM responders, 359 genes were identified in both week 8 and week 12 TPM groups, of which 300 genes were exclusively detected in TPM responders. Of them, 32 genes had nominal P values < 5 × 10−3 at either week 8 or week 12 and false discovery rates < 0.15 at both time points with consistent directions of gene expression changes, which include GABARAPL1, GPR155, and IL15RA in GABA receptor signaling that represent direct targets for TPM. Analyses of these 300 genes revealed 7 enriched pathways belonging to neuronal function/synaptic plasticity, signal transduction, inflammation/immune function, and oxidative stress response categories. No pathways were enriched for 72 genes exclusively detected in both week 8 and week 12 placebo groups.ConclusionThis secondary analysis study of gene expression data from a TPM clinical trial not only yielded consistent results with those of primary

Further Results on Extended Delivery Time for Secondary Packet Transmission

KAUST Repository

Usman, Muneer; Yang, Hong-Chuan; Alouini, Mohamed-Slim

2017-01-01

with non-work-preserving strategy, where interrupted packets must be repeated. We also analyze the effect of imperfect periodic sensing, i.e., the secondary user periodically senses the spectrum for availability, with a chance of missing an available

Functional outcome of microsurgical clipping compared to endovascular coiling.

Science.gov (United States)

Premananda, R M; Ramesh, N; Hillol, K P

2012-12-01

Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. In a retrospective cohort review on the treatment methods of aneurysm rupture in Hospital Kuala Lumpur over the period of five years (2005-2009) a total of 268 patients were treated. These patients were broadly categorized into two groups based on their treatment mode for ruptured aneurysms. Statistical analysis was determined using Chi- Square tests to study these associations. In our study, 67.5% of patients presented with Good World Federation of Neurosurgical Societies (WFNS) grade (WFNS1-2) while 32.5% patients presented with Poor WFNS prior to intervention. In our outcome, it was noted that 60.4% had good functional outcome (mRS grade 0-2) as compared to 39.6% patients who had poor mRS(modified rankin scale) outcome (mRS 3-6). In the good WFNS group, 76% of patients in clipping group had a good mRS outcome while, 86.5% patients in coiling group had good mRS outcome (p=0.114). In poor WFNS presentation, it was noted that in 77.3% patients in clipping group, had poor mRS outcome. Similarly with poor WFNS presentation, 83.3% of patient in coiling group had poor outcome. (p=1.00). Hence when we control the WFNS group, there was no significant association between treatment group (clipping and coiling) and mRS outcome at 6 months. The outcome of patient is determined by initial clinical presentation (WFNS grade) and influenced by requirement of Extraventricular drain (EVD) in presence of hydrocephalus, CSF infection and pneumonia. Therefore the decision regarding treatment option needs to be individualized based on the presentation of the patient.

Outcome and Prognostic Factors for Traumatic Endophthalmitis over a 5-Year Period

Directory of Open Access Journals (Sweden)

Simona Delia Nicoară

2014-01-01

Full Text Available Purpose. To evaluate the outcome and identify the prognostic factors of traumatic endophthalmitis over a 5-year period. Methods. We reviewed the medical records of all the traumatic endophthalmities that we treated in our department over the last 5 years (2009–2013. We extracted the following parameters: age, gender, wound anatomy, associated ocular lesions, treatment, and initial and final visual acuities. We used the program SPSS version 20.0.0. for the statistical analysis of our data. Results. During the last 5 years, we treated 14 traumatic endophthalmities, representing 46.66% of all types of endophthalmities. The infection rate in open globe injuries was 8.13% and 34.78%, if an intraocular foreign body (IOFB was associated. All the patients were males with the median age of 37 years. Initial visual acuities varied between light perception and 0.4 and the timing of treatment from a few hours to 10 days. We administered antibiotic and anti-inflammatory drugs, systemically and intravitreally, in all cases. We performed pars plana vitrectomy in 64.28% of cases. In 57.14% of cases, the final visual acuity was 0.1 or more. Conclusions. IOFBs increased significantly the risk for endophthalmitis. The worse prognostic factors were retinal detachment at presentation and delayed treatment. This trial is registered with IRCT2014082918966N1.

Extended Delivery Time Analysis for Secondary Packet Transmission With Adaptive Modulation Under Interweave Cognitive Implementation

KAUST Repository

Wang, Wen-Jing

2017-05-02

Cognitive radio communication can opportunistically access underutilized spectrum for emerging wireless applications. With interweave cognitive implementation, a secondary user (SU) transmits only if primary user does not occupy the channel and waits for transmission otherwise. Therefore, secondary packet transmission involves both transmission periods and waiting periods. The resulting extended delivery time (EDT) is critical to the throughput analysis of secondary system. In this paper, we study the EDT of secondary packet transmission with adaptive modulation under interweave implementation to facilitate the delay analysis of such cognitive radio system. In particular, we propose an analytical framework to derive the probability density functions of EDT considering random-length SU transmission and waiting periods. We also present selected numerical results to illustrate the mathematical formulations and to verify our analytical approach.

Results of a Seven-Year, Single-Centre Experience of the Long-Term Outcomes of Bovine Ureter Grafts Used as Novel Conduits for Haemodialysis Fistulas

International Nuclear Information System (INIS)

Das, Neelan; Bratby, Mark J.; Shrivastava, Vivek; Cornall, Alison J.; Darby, Christopher R.; Boardman, Philip; Anthony, Susan; Uberoi, Raman

2011-01-01

Purpose: To report the long-term outcomes of bovine ureter grafts as novel conduits for haemodialysis fistulas. Materials and Methods: Thirty-five patients underwent placement of a total of 40 SynerGraft 100 (SG100; CryoLife Europa ® , Guildford, UK) bovine ureter grafts between April 2002 and February 2009. Prospective data were collected on all patients, including active surveillance with blood flow studies and 6-monthly duplex ultrasound studies. Main outcome measures were primary and secondary patency rates. Results: Mean follow-up time was 97 weeks (range 4–270). Thirteen patients died from unrelated causes during the study period; 12 of these patients had a functioning graft at the time of death. Five patients underwent transplantation, and all had a functioning graft at transplantation. Twelve patients had a functioning graft at the end of the study period. One hundred and ten stenoses were detected, and 97 venoplasty procedures were performed. Of the stenoses, 41.8% were located at the venous anastomosis, 12.7% within the graft, 17.3% in the outflow veins, and 28.1% in central veins. No arterial stenoses were detected. Primary patency rates were 53% at 6 months and 14% at 1 year. Secondary patency rates were 81% at 6 months, 75% at 1 year, and 56% at 2 years. Conclusions: Active surveillance and intervention was able to achieve satisfactory long-term secondary patency for these novel conduits compared with those made of PTFE seen in other studies.

Surgical Interventions for Organ and Limb Ischemia Associated With Primary and Secondary Antiphospholipid Antibody Syndrome With Arterial Involvement.

Science.gov (United States)

Hinojosa, Carlos A; Anaya-Ayala, Javier E; Bermudez-Serrato, Karla; García-Alva, Ramón; Laparra-Escareno, Hugo; Torres-Machorro, Adriana; Lizola, Rene

2017-11-01

The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined. Demographics, comorbidities, manifestations, procedures, complications, and other factors affecting outcomes were recorded. Fourteen patients (mean age 35 years old, standard deviation ±14) were evaluated and treated by our service. Six (43%) of them had primary APS and 8 (57%) had secondary APS; 11 (79%) were female. Two (14%) experienced distal aorta and iliac arteries involvement, 3 (21%) visceral vessels disease, 2 (14%) in upper and 7 (50%) in the lower extremity vasculatures. Thirteen (93%) patients underwent direct open revascularization and 1 with hand ischemia (Raynaud disease) underwent sympathectomy. During the mean follow-up period of 48 months, reinterventions included a revision of the proximal anastomosis of an aortobifemoral bypass graft, 1 (7%) abdominal exploration for bleeding, 1 (7%) graft thrombectomy, and 4 (29%) amputations (2 below the knee, 1 above the knee, and 1 transmetatarsal). One (7%) death occurred secondary to sepsis in a patient who had acute mesenteric ischemia. Significant differences in clinical manifestations and outcomes were not observed among patients with primary and secondary APS. All patients remained on systemic anticoagulation. APS is a prothrombotic disorder that may lead to arterial involvement with less frequency than the venous circulation but has significant morbidity and limb loss rate. Arterial reconstruction seems feasible in an attempt to salvage organs and limbs; however, research is necessary to establish the

SECONDARY AMYLOIDOSIS WITH LUNG INVOLVEMENT INA FEMALE PATIENT WITH RHEUMATOID ARTHRITIS

Directory of Open Access Journals (Sweden)

Irina Mikhailovna Marusenko

2009-01-01

Full Text Available The paper considers the problem of secondary amyloidosis that more frequently occurs in patients with various arthritides, both seropositive and seronegative. According to the data available in the literature, the most common manifestations of secondary amyloidosis are involvements of the kidney, liver, nervous system, and, less frequently, the lung. The authors describe their own observation of secondary amyloidosis in rheumatoid arthritis, which is accompanied by the involvement of the lung, kidney, and intestine, resulting in fatal outcome. The lifetime diagnosis of amyloidosis was histologically verified.

Deep brain stimulation for dystonia: patient selection and outcomes

NARCIS (Netherlands)

Speelman, J. D.; Contarino, M. F.; Schuurman, P. R.; Tijssen, M. A. J.; de Bie, R. M. A.

2010-01-01

In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For

Deep brain stimulation for dystonia : Patient selection and outcomes

NARCIS (Netherlands)

Speelman, J. D.; Contarino, M. F.; Schuurman, P. R.; Tijssen, M. A. J.; de Bie, R. M. A.

In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For

The relationship between child maltreatment and substance abuse treatment outcomes among emerging adults and adolescents.

Science.gov (United States)

Garner, Bryan R; Hunter, Brooke D; Smith, Douglas C; Smith, Jane Ellen; Godley, Mark D

2014-01-01

Emerging adulthood is the period of greatest risk for problematic substance use. The primary aim of the current study was to examine the relationship between a broad measure of child maltreatment and several key outcomes for a large clinical sample of emerging adults (n = 858) and adolescents (n = 2,697). The secondary aim was to examine the extent to which the relationship between child maltreatment and treatment outcomes differed between emerging adults and adolescents. Multilevel latent growth curve analyses revealed emerging adults and adolescents who experienced child maltreatment reported significantly greater reductions over time on several treatment outcomes (e.g., substance use, substance-related problems, and emotional problems). Overall, analyses did not support differential relationships between child maltreatment and changes over time in these substance use disorder treatment outcomes for emerging adults and adolescents. The one exception was that although emerging adults with child maltreatment did reduce their HIV risk over time, their improvements were not as great as were the improvements in HIV risk reported by adolescents who had experienced child maltreatment. © The Author(s) 2014.

A longitudinal study of risk and protective factors associated with successful transition to secondary school in youth with ADHD: prospective cohort study protocol.

Science.gov (United States)

Zendarski, Nardia; Sciberras, Emma; Mensah, Fiona; Hiscock, Harriet

2016-01-28

Attention-Deficit/Hyperactivity Disorder (ADHD) has a significant impact on child and adolescent development, especially in relation to school functioning and academic outcomes. Despite the transition to high school being a potentially critical period for children with ADHD, most research in this period has focused on academic outcomes. This study aims to extend previous research by describing academic, school engagement, behaviour and social-emotional outcomes for young people with ADHD in the first and third years of high school and to identify risk and protective factors predictive of differing outcomes across these four domains. The Moving Up study is a longitudinal, prospective cohort study of children with ADHD as they transition and adjust to high school (age 12-15 years). Data are collected through direct assessment and child, parent and teacher surveys. The primary outcome is academic achievement, obtained by linking to standardised test results. Secondary outcomes include measures of behaviour, ADHD symptoms, school engagement (attitudes and attendance), and social and emotional functioning, including depressive symptoms. The mean performance of the study cohort on each outcome measure will be compared to the population mean for same aged children, using t-tests. Risk and protective factors to be examined using multiple regression include a child, family and school factors know to impact academic and school functioning. The Moving up study is the first Australian study prospectively designed to measure a broad range of student outcomes for children with ADHD during the high school transition period. Examining both current (cross sectional) and earlier childhood (longitudinal) factors gives us the potential to learn more about risk and protective factors associated with school functioning in young people with ADHD. The richness and depth of this information could lead to more targeted and effective interventions that may alter academic and wellbeing

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

Subclinical thyrotoxicosis in an outpatient population - predictors of outcome.

Science.gov (United States)

Schouten, Belinda J; Brownlie, Bevan E W; Frampton, Chris M; Turner, John G

2011-02-01

Individuals with endogenous subclinical thyrotoxicosis (SCT) may subsequently require treatment for overt disease. We aimed to evaluate the frequency of progression to hyperthyroidism and factors influencing this outcome. This is a retrospective analysis of outcome in 96 consecutive patients (aged 16-91 years) diagnosed with SCT over a 6-year period. Individuals with secondary causes of TSH suppression were excluded. Mean follow-up was 3·8 years. The significance of age, gender, family history of thyrotoxicosis, symptoms at presentation, thyroid nodule(s) on clinical examination, entry TSH level, antithyroid antibody status and (99m) Tc pertechnetate thyroid imaging results on subsequent development of overt thyrotoxicosis was assessed. Progression to overt thyrotoxicosis was seen in 8% at 1 year, 16% at 2 years, 21% at 3 years and 26% at 5 years. Multivariate analysis determined that diagnosis as determined by scintiscan to be the only independent predictor of outcome (P = 0·003) with the cumulative percentage requiring therapy at 5 years being 9% for subclinical Graves' disease, 21% for multinodular goitre and 61% for the autonomous nodule subgroup. Progression of SCT to overt hyperthyroidism occurred at a rate of 5-8% per year with disease aetiology, as determined by thyroid scintigraphy, significantly influencing risk of progression. © 2011 Blackwell Publishing Ltd.

Critical reappraisal of embryo quality as a predictive parameter for pregnancy outcome: a pilot study.

Science.gov (United States)

Campo, R; Binda, M M; Van Kerkhoven, G; Frederickx, V; Serneels, A; Roziers, P; Lopes, A S; Gordts, S; Puttemans, P; Gordts, S

2010-01-01

Pilot study to analyse the efficacy and embryo morphology using a new human embryo culture medium (GM501) versus the conventional used medium (ISM1). Over a four-month period, all patients at the Leuven Institute of Fertility and Embryology (LIFE) were -randomly allocated to have their embryos cultured in either the standard sequential culture medium ISM1 (control) or in a new universal medium (GM501) (study group). Primary outcome parameters were clinical pregnancy and live birth rate. The secondary outcome parameter was the correlation of embryo fragmentation rate with pregnancy outcome. We did not observe any differences between the ISM1 control group and GM501 study group with regard to fertilization, pregnancy, implantation rates, ongoing pregnancy, and babies born. The number of embryos with a minimal fragmentation rate (less than 30%) was significantly higher in the GM501 study group. Although a significant higher embryo fragmentation rate was seen in In vitro culture of embryos in GM501, pregnancy outcome results were comparable to those of embryos cultured in ISM1. According to our results the value of embryo morphological criteria as a parameter for pregnancy outcome should be examined and discussed again.

Secondary hypertension in adults.

Science.gov (United States)

Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

2016-05-01

Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. Copyright: © Singapore Medical Association.

Disability differentials in educational attainment in England: primary and secondary effects.

Science.gov (United States)

Chatzitheochari, Stella; Platt, Lucinda

2018-04-17

Childhood disability has been largely overlooked in social stratification and life course research. As a result, we know remarkably little about mechanisms behind well-documented disability differentials in educational outcomes. This study investigates educational transitions of disabled youth using data from the Longitudinal Study of Young People in England. We draw on social stratification literature on primary and secondary effects as well as that on stigma and labelling in order to explain disabled young people's educational outcomes. We find that disability differentials in transition rates to full-time academic upper secondary education and to university are largely the result of primary effects, reflected in differences in school performance between disabled and non-disabled young people. However, we also find evidence for secondary effects, with similarly achieving disabled young people less likely to pursue full-time academic upper secondary education compared to their non-disabled peers. We examine the extent to which these effects can be explained by disabled youth's suppressed educational expectations as well as their experiences of being bullied at school, which we link to the stigma experienced by disabled young people and their families. We find that educational expectations play an important role at crucial transitions in the English school system, while the effect of bullying is considerably smaller. By drawing attention to different social processes contributing to disability differentials in attainment, our study moves beyond medical models that implicitly assume a naturalized association of disability with poor educational outcomes, and demonstrates the parallels of disability with other ascriptive inequalities. © London School of Economics and Political Science 2018.

Sexual risk during pregnancy and postpartum periods among HIV-infected and -uninfected South African women: Implications for primary and secondary HIV prevention interventions.

Science.gov (United States)

Joseph Davey, Dvora; Farley, Elise; Gomba, Yolanda; Coates, Thomas; Myer, Landon

2018-01-01

HIV acquisition in pregnancy and breastfeeding contributes significantly toward pediatric HIV infection. However, little is known about how sexual behavior changes during pregnancy and postpartum periods which will help develop targeted HIV prevention and transmission interventions, including pre-exposure prophylaxis (PrEP). Cross-sectional study in HIV-infected and uninfected pregnant and postpartum women in Cape Town, South Africa. Interviewers collected survey data on demographic, sexual behaviors, and alcohol use among pregnant and post-partum women. We report descriptive results of sexual behavior by trimester and postpartum period, and results of multivariable logistic regression stratified by pregnancy status. We enrolled 377 pregnant and postpartum women (56% pregnant, 40% HIV-infected). During pregnancy, 98% of women reported vaginal sex (8% anal sex, 44% oral sex) vs. 35% and 88% during the periods 0-6 and 7-12 months postpartum, respectively (p1 partner in the past 12-months compared to postpartum women (18% vs. 13%, respectively, p6-months postpartum (13 mean sex acts in first trimester; 17 mean sex acts >6-months postpartum). Pregnant women had increased odds of reporting condomless sex at last sex (aOR = 2.96;95%CI = 1.84-4.78) and ever having condomless sex in past 3-months (aOR = 2.65;95%CI = 1.30-5.44) adjusting for age, HIV status, and sex frequency compared to postpartum women. We identified that sexual behaviors and risk behaviors were high and changing during pregnancy and postpartum periods, presenting challenges to primary and secondary HIV prevention efforts, including PrEP delivery to pregnant and breastfeeding women.

Implications of the Secondary Eclipse of Exoplanet HAT-P-11b

Science.gov (United States)

Barry, Richard K.; Deming, L. D.; Bakos, G.; Harrington, J.; Madhusudhan, N.; Noyes, R.; Seager, S.

2010-01-01

We observed exoplanet HAT-P-11b and have successfully detected its secondary eclipse. We conducted observations using the Spitzer Space Telescope in the post-cryo mission at 3.6 microns for a period of 22 hours centered on the anticipated secondary eclipse time, to detect the eclipse and determine its phase. Having detected the secondary eclipse, we are at present making a more focused series of observations in both the 3.6 and 4.5 micron bands to fully characterize it. HAT-P-11b is one of only two known exo-Neptunes and has a period of 4.8878 days, radius of 0.422 RJ, mass of 0.081 MJ and semi-major axis 0.053 AU. Measurements of the secondary eclipse will serve to clarify two key issues; 1) the planetary brightness temperature and the nature of its atmosphere, and 2) the eccentricity of its orbit, with implications for its dynamical evolution. We discuss implications of these observations.

Secondary precipitation in an Al-Mg-Si-Cu alloy

International Nuclear Information System (INIS)

Buha, J.; Lumley, R.N.; Crosky, A.G.; Hono, K.

2007-01-01

Interruption of a conventional T6 heat treatment at 177 deg. C for the Al-Mg-Si-Cu alloy 6061 after a short period of time (20 min), by inserting a dwell period at a lower temperature (e.g. 65 deg. C), promotes secondary precipitation of Guinier-Preston (GP) zones. As a consequence, a much greater number of precursors to the β'' precipitates are produced so that a finer and denser dispersion of this phase is formed when T6 ageing is resumed. This change in microstructure causes significant and simultaneous improvements in tensile properties and fracture toughness. Secondary precipitation of GP zones occurs through a gradual evolution of a large number of Mg-Si(-Cu)-vacancy co-clusters formed during the initial ageing at 177 deg. C. The precise mechanism of secondary precipitation has been revealed by three-dimensional atom probe microscopy supplemented by transmission electron microscopy and differential scanning calorimetry

Spontaneous subarachnoid haemorrhage and outcome--results from Tan Tock Seng Hospital, Singapore.

Science.gov (United States)

Wong, S H; Yeo, T T; Seow, W T; Tan, K K; Ong, P L

1999-07-01

To ascertain the number of cases of spontaneous (aneurysmal) subarachnoid haemorrhage presenting to Tan Tock Seng Hospital, Singapore, over a one year period, the demographics of the patients involved, their treatment and their eventual outcome. A retrospective study from June 1995 to June 1996. There were 62 patients admitted over this period with an average of 5 patients per month. Their ages ranged from 9 to 85 years with a mean of 54 years. All 62 patients underwent 4-vessel cerebral angiograms. Forty-three patients (69%) underwent clipping of their aneurysms. Twelve patients (19%) had negative angiograms. Four patients (6%) underwent coiling of their aneurysms via interventional neuroradiology techniques. Patients with subarachnoid haemorrhage of Grades 1 to 3 on the WFNS (World Federation of Neurological Surgeons) grading had a favourable outcome (Glasgow Outcome Score of 4 and 5) in 85% of the cases. The overall mortality rate for the operated group (all grades) was 11%. However for the group with good WFNS grading, namely the Grade 1 to 2 groups, there were no deaths. Twenty-four percent of patients developed clinically symptomatic vasospasm. Eighteen percent of patients required ventriculo-peritoneal shunting for hydrocephalus secondary to the subarachnoid haemorrhage. The overall management mortality (operated and non-operated cases) was 14% for proven aneurysmal and angiographically-negative spontaneous subarachnoid haemorrhage. These results are comparable to that of other reputable centers reported in the literature.

Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics.

Science.gov (United States)

Kheterpal, Sachin; Martin, Lizabeth; Shanks, Amy M; Tremper, Kevin K

2009-04-01

There are no existing data regarding risk factors for impossible mask ventilation and limited data regarding its incidence. The authors sought to determine the incidence, predictors, and outcomes associated with impossible mask ventilation. The authors performed an observational study over a 4-yr period. For each adult patient undergoing a general anesthetic, preoperative patient characteristics, detailed airway physical exam, and airway outcome data were collected. The primary outcome was impossible mask ventilation defined as the inability to exchange air during bag-mask ventilation attempts, despite multiple providers, airway adjuvants, or neuromuscular blockade. Secondary outcomes included the final, definitive airway management technique and direct laryngoscopy view. The incidence of impossible mask ventilation was calculated. Independent (P impossible mask ventilation were identified by performing a logistic regression full model fit. Over a 4-yr period from 2004 to 2008, 53,041 attempts at mask ventilation were recorded. A total of 77 cases of impossible mask ventilation (0.15%) were observed. Neck radiation changes, male sex, sleep apnea, Mallampati III or IV, and presence of beard were identified as independent predictors. The receiver-operating-characteristic area under the curve for this model was 0.80 +/- 0.03. Nineteen impossible mask ventilation patients (25%) also demonstrated difficult intubation, with 15 being intubated successfully. Twelve patients required an alternative intubation technique, including two surgical airways and two patients who were awakened and underwent successful fiberoptic intubation. Impossible mask ventilation is an infrequent airway event that is associated with difficult intubation. Neck radiation changes represent the most significant clinical predictor of impossible mask ventilation in the patient dataset.

Service time analysis of secondary packet transmission with opportunistic channel access

KAUST Repository

Usman, Muneer; Yang, Hongchuan; Alouini, Mohamed-Slim

2014-01-01

Cognitive radio transceiver can opportunistically access the underutilized channels of primary systems for new wireless services. The secondary transmission may be interrupted by the primary user's transmission. To facilitate the delay analysis of such secondary packet transmission, we study the resulting extended delivery time for a fixed-size secondary packet that includes both transmission time and waiting time. In particular we derive the exact distribution functions of extended delivery time of secondary transmission for both continuous sensing and periodic sensing cases. Selected numerical results are presented for illustrating the mathematical formulation.

Service time analysis of secondary packet transmission with opportunistic channel access

KAUST Repository

Usman, Muneer

2014-09-01

Cognitive radio transceiver can opportunistically access the underutilized channels of primary systems for new wireless services. The secondary transmission may be interrupted by the primary user\\'s transmission. To facilitate the delay analysis of such secondary packet transmission, we study the resulting extended delivery time for a fixed-size secondary packet that includes both transmission time and waiting time. In particular we derive the exact distribution functions of extended delivery time of secondary transmission for both continuous sensing and periodic sensing cases. Selected numerical results are presented for illustrating the mathematical formulation.

Comparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995-2005 and 2006-2016 periods.

Science.gov (United States)

Alvanforoush, N; Palamara, J; Wong, R H; Burrow, M F

2017-06-01

Composites are increasing in popularity as restorative materials. This growing role indicates the necessity of studies on their clinical outcome. In this study, clinical studies published on the performance of posterior composite restorations were included except those of less than a 24-month assessment period. Results of non-vital, anterior or primary teeth and cervical single-surface restorations were also excluded. Records about composite type, number of final recall restorations, failure/survival rate, assessment period and failure reasons were analysed for each decade. Overall survival/failure rates for studies in 1995-2005 were 89.41%/10.59% and for 2006-2016 were 86.87%/13.13%, respectively. In 1995-2005, the reasons for failure were secondary caries (29.47%) and composite fracture (28.84%) with low tooth fracture (3.45%) compared with reasons of failure in 2006-2016, which were secondary caries (25.68%), composite fracture (39.07%), and tooth fracture (23.76%). An increase in incidence of composite fracture, tooth fracture and need for endodontic treatment as failure reasons was noted in the latter decade in addition to a decrease in secondary caries, postoperative sensitivity, unsatisfactory marginal adaptation and wear. The overall rates of failure showed little difference, but the causes showed a notable change. This is believed to be a reflection of increased use of composites for larger restorations and possibly changes of material characteristics. © 2016 Australian Dental Association.

Impact of gastrectomy procedural complexity on surgical outcomes and hospital comparisons.

Science.gov (United States)

Mohanty, Sanjay; Paruch, Jennifer; Bilimoria, Karl Y; Cohen, Mark; Strong, Vivian E; Weber, Sharon M

2015-08-01

Most risk adjustment approaches adjust for patient comorbidities and the primary procedure. However, procedures done at the same time as the index case may increase operative risk and merit inclusion in adjustment models for fair hospital comparisons. Our objectives were to evaluate the impact of surgical complexity on postoperative outcomes and hospital comparisons in gastric cancer surgery. Patients who underwent gastric resection for cancer were identified from a large clinical dataset. Procedure complexity was characterized using secondary procedure CPT codes and work relative value units (RVUs). Regression models were developed to evaluate the association between complexity variables and outcomes. The impact of complexity adjustment on model performance and hospital comparisons was examined. Among 3,467 patients who underwent gastrectomy for adenocarcinoma, 2,171 operations were distal and 1,296 total. A secondary procedure was reported for 33% of distal gastrectomies and 59% of total gastrectomies. Six of 10 secondary procedures were associated with adverse outcomes. For example, patients who underwent a synchronous bowel resection had a higher risk of mortality (odds ratio [OR], 2.14; 95% CI, 1.07-4.29) and reoperation (OR, 2.09; 95% CI, 1.26-3.47). Model performance was slightly better for nearly all outcomes with complexity adjustment (mortality c-statistics: standard model, 0.853; secondary procedure model, 0.858; RVU model, 0.855). Hospital ranking did not change substantially after complexity adjustment. Surgical complexity variables are associated with adverse outcomes in gastrectomy, but complexity adjustment does not affect hospital rankings appreciably. Copyright © 2015 Elsevier Inc. All rights reserved.

Detection of the Secondary Eclipse of Exoplanet HAT P-11b

Science.gov (United States)

Barry, R. K.; Deming, L. D.; Bakos, G.; Harrington, J.; Madhusudhan, N.; Noyes, R.; Seager, S.

2010-01-01

We have successfully conducted secondary eclipse observations of exoplanet HAT-P-11b using the Spitzer Space Telescope. HAT-P-11b was, until very recently, the smallest transiting extrasolar planet yet found and one of only two known exo-Neptunes. We observed the system at 3.6 microns for a period of 22 hours centered on the anticipated secondary eclipse time, to detect the eclipse and determine its phase. Having detected the secondary eclipse, we are at present making a more focused series of observations in both the 3.6 and 4.5 micron bands to fully characterize it. HAT-P-11b has a period of 4.8878 days, radius of 0.422 RJ, mass of 0.081 MJ and semi-major axis 0.053 AU. Measurements of the secondary eclipse will serve to clarify two key issues; 1) the planetary brightness temperature and the nature of its atmosphere, and 2) the eccentricity of its orbit, with implications for its dynamical evolution. A precise determination of the orbit phase for the secondary eclipse will also be of great utility for Kepler observations of this system at visible wavelengths.

Long-Term Performance of Primary and Secondary Electroactive Biofilms Using Layered Corrugated Carbon Electrodes

International Nuclear Information System (INIS)

Baudler, André; Riedl, Sebastian; Schröder, Uwe

2014-01-01

The performance of primary and secondary electroactive biofilms grown on layered corrugated carbon (LCC) electrodes was studied over a period of several months. With an average projected current density of 6.7 mA cm −2 , the studied secondary electroactive biofilms outperformed the primary biofilms (3.0 mA cm −2 ) over the entire experimental period. At the same time, both, primary and secondary biofilms, exhibited a constant Coulomb efficiency of about 89%. The study further illustrates that three-dimensional electrodes such as LCC allow a sustained long-term performance without significant decrease in electrode performance.

Long-Term Performance of Primary and Secondary Electroactive Biofilms Using Layered Corrugated Carbon Electrodes

Energy Technology Data Exchange (ETDEWEB)

Baudler, André; Riedl, Sebastian; Schröder, Uwe, E-mail: uwe.schroeder@tu-bs.de [Institute of Environmental and Sustainable Chemistry, Technische Universität Braunschweig, Braunschweig (Germany)

2014-07-30

The performance of primary and secondary electroactive biofilms grown on layered corrugated carbon (LCC) electrodes was studied over a period of several months. With an average projected current density of 6.7 mA cm{sup −2}, the studied secondary electroactive biofilms outperformed the primary biofilms (3.0 mA cm{sup −2}) over the entire experimental period. At the same time, both, primary and secondary biofilms, exhibited a constant Coulomb efficiency of about 89%. The study further illustrates that three-dimensional electrodes such as LCC allow a sustained long-term performance without significant decrease in electrode performance.

Theoretical Perspectives on Critical Thinking Teaching: Reflections from Field Experiences from a Norwegian Lower Secondary School in Comparison to Tanzanian Secondary School Teaching Practices

Directory of Open Access Journals (Sweden)

Leatitia Gabriel Mashaza

2017-08-01

Full Text Available This paper presents the theoretical perspectives relevant to critical thinking as my topic of research during my teaching practice period which was conducted from 12th -28th October 2015 at Eidsvag secondary school in Bergen, Norway. As a requirement for Masters’ degree in social science education, all master students were required to engage in teaching practice in different Norwegian primary and secondary schools. Importantly, every student teacher was given a topic of concentration as a mini-research for the whole teaching practice period. My topic of research focused at exploring and gaining the theoretical and practical perspectives on critical thinking teaching by drawing some experiences from a Norwegian lower secondary school (Eidsvag skole in reflection to secondary school teaching practice experiences in Tanzania. Therefore, in this paper, my reflections with regard to the conditions favoring the possibility for critical thinking teaching and how it was enhanced by teachers at my practice school will be discussed. Further to that, I will also present the observed challenges of which, in my view, in way or another intervened the possibility for effective critical thinking teaching to take place.

Pediatric Digital Necrosis Secondary to Dressing Application: A Case Series.

Science.gov (United States)

Bjorklund, Kim A; Rice, Dahlia M; Amalfi, Ashley N

2018-04-01

Pediatric digital necrosis resulting in revision amputation is a devastating outcome following digital dressing application. We report a series of 4 pediatric patients (age: 21 months-11 years) who presented for surgical consultation related to digital ischemia and irreversible necrosis following the application of Coban digital dressings. A review of the literature demonstrated that such injuries had not previously been described. In our case series, Coban dressing was utilized as a deterrent for thumb sucking, fingertip tuft fractures with nail bed lacerations, and a phalanx fracture secondary to crush injury. All 4 children suffered digital necrosis secondary to Coban dressings and ultimately required revision amputation. We discuss risks factors, application practices, and strategies to minimize complications with digital dressings in the pediatric population with the intent of creating awareness among hand surgeons to help promote safe practices and improve patient outcomes.

Comparison of outcomes of permanently closed and periodically harvested coral reef reserves.

Science.gov (United States)

Bartlett, C Y; Manua, C; Cinner, J; Sutton, S; Jimmy, R; South, R; Nilsson, J; Raina, J

2009-12-01

In many areas of the developing world, the establishment of permanent marine reserves is inhibited by cultural norms or socioeconomic pressures. Community conserved areas that are periodically harvested are increasingly being implemented as fisheries management tools, but few researchers have empirically compared them with permanently closed reserves. We used a hierarchical control-impact experimental design to compare the abundance and biomass of reef fishes, invertebrates, and substrate composition in periodically harvested and permanent reserves and in openly fished (control sites) of the South Pacific island country of Vanuatu. Fished species had significantly higher biomass in periodically harvested reserves than in adjacent openly fished areas. We did not detect differences in substratum composition between permanent reserves and openly fished areas or between permanent reserves and periodically harvested reserves. Giant clams (tridacnids) and top shells (Trochus niloticus) were vulnerable to periodic harvest, and we suggest that for adequate management of these species, periodically harvested community conservation areas be used in conjunction with other management strategies. Periodic harvest within reserves is an example of adaptive and flexible management that may meet conservation goals and that is suited to the social, economic, and cultural contexts of many coastal communities in the developing world.

Hypofractionated radiotherapy for primary or secondary oligometastatic lung cancer using Tomotherapy

International Nuclear Information System (INIS)

Chang, Heng-Jui; Ko, Hui-Ling; Lee, Cheng-Yen; Wu, Ren-Hong; Yeh, Yu-Wung; Jiang, Jiunn-Song; Kao, Shang-Jyh; Chi, Kwan-Hwa

2012-01-01

To retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy. Between April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8–16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy), and the median total dose was 49.5 Gy (range, 45–72 Gy). The median estimated biological effective dose at 10 Gy (BED 10 ) was 71.8 Gy (range, 65.3–119.0 Gy), and that at 3 Gy (BED 3 ) was 123.8 Gy (range, 112.5–233.3 Gy). The mean lung dose (MLD) was constrained mainly under 1200 cGy. The median gross tumor volume (GTV) was 27.9 cm 3 (range: 2.5–178.1 cm 3 ). The median follow-up period was 25.8 months (range, 3.0–60.7 months). The median overall survival (OS) time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD) was 11.2 months versus >50 months (not reached) in the patients without EPD (p < 0.001). Those patients with smaller GTV (≦27.9 cm 3 ) had a better survival than those with larger GTV (>27.9 cm 3 ): >40 months versus 12.85 months (p = 0.047). The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065). The 2-year local control (LC) rate was 94.7%. Only 2 patients (6.1%) developed ≧grade 3 radiation pneumonitis. Using Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with EPD. Moreover, GTV is more significant than

Hypofractionated radiotherapy for primary or secondary oligometastatic lung cancer using Tomotherapy

Science.gov (United States)

2012-01-01

Background To retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy. Methods Between April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8–16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy), and the median total dose was 49.5 Gy (range, 45–72 Gy). The median estimated biological effective dose at 10 Gy (BED10) was 71.8 Gy (range, 65.3–119.0 Gy), and that at 3 Gy (BED3) was 123.8 Gy (range, 112.5–233.3 Gy). The mean lung dose (MLD) was constrained mainly under 1200 cGy. The median gross tumor volume (GTV) was 27.9 cm3 (range: 2.5–178.1 cm3). Results The median follow-up period was 25.8 months (range, 3.0–60.7 months). The median overall survival (OS) time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD) was 11.2 months versus >50 months (not reached) in the patients without EPD (p 27.9 cm3): >40 months versus 12.85 months (p = 0.047). The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065). The 2-year local control (LC) rate was 94.7%. Only 2 patients (6.1%) developed ≧grade 3 radiation pneumonitis. Conclusion Using Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with EPD. Moreover, GTV is more significant than lesion number in

Status epilepticus: Aetiology and D outcome in children

International Nuclear Information System (INIS)

Siddiqui, T.S.; Rehman, A.U.; Wazeer, M.S.

2008-01-01

Convulsing Status Epilepticus (CSE) is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus (SE) and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen (12%) patients expired while neurological complications secondary to brain injury developed in 10(8%) cases. Mean seizure duration was 4.92+-9.18 hours in children with normal outcome, 5.93+-5.76 hours in children who died, and 12.85+-12.91 hours in children with abnormal neurological outcome at discharge (p>0.05). Correlation between age and duration of seizure was not significant (p>0.05). SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE. (author)

Status epilepticus: Aetiology and D outcome in children

Energy Technology Data Exchange (ETDEWEB)

Siddiqui, T S; Rehman, A U [Ayub Medical College, Abbottabad (Pakistan). Dept. of Paediatrics; Wazeer, M S [Saidu Group of Hospital, Swat (Pakistan). Dept. of Community Medicine

2008-07-15

Convulsing Status Epilepticus (CSE) is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus (SE) and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen (12%) patients expired while neurological complications secondary to brain injury developed in 10(8%) cases. Mean seizure duration was 4.92+-9.18 hours in children with normal outcome, 5.93+-5.76 hours in children who died, and 12.85+-12.91 hours in children with abnormal neurological outcome at discharge (p>0.05). Correlation between age and duration of seizure was not significant (p>0.05). SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE. (author)

Clinical outcomes of a diabetes education program for patients with diabetes mellitus in the Micronesian community in Hawaii.

Science.gov (United States)

Chong, Mok Thoong

2016-01-01

Hawaii has diverse population made up of a cultural mix of different races. Due to different cultural and social influences and language barrier, many of the under-served population who migrated to Hawaii and having diabetes mellitus may be susceptible to long-term complications due to uncontrolled hyperglycemia and medication nonadherence. The purpose of this study was to evaluate the impact of a diabetes education program on the clinical outcomes in patients with diabetes mellitus in the Micronesian community of Hawaii. This study included patients over age 18 years, with a diagnosis of type 2 diabetes mellitus. The diabetes education program was customized for its weekly classes to fit to the under-served population. Data were collected on participants on the 1(st) day and then 6 months after attending the education program. Data on primary and secondary endpoints were collected and analyzed. The mean glycosylated hemoglobin A1c, fasting blood glucose, and triglyceride levels of participants fell significantly from baseline after attending the diabetes education program for 6 months. No significant changes were observed in other secondary outcomes during the study time period. Based on our findings, the diabetes education program that was tailored to the Micronesian population was successful in achieving glycemic goals, enhancing medication adherence, improving clinical outcomes, and also preventing long-term complications among its participants.

Initiating Nutritional Support Before 72 Hours Is Associated With Favorable Outcome After Severe Traumatic Brain Injury in Children: A Secondary Analysis of a Randomized, Controlled Trial of Therapeutic Hypothermia.

Science.gov (United States)

Meinert, Elizabeth; Bell, Michael J; Buttram, Sandra; Kochanek, Patrick M; Balasubramani, Goundappa K; Wisniewski, Stephen R; Adelson, P David

2018-04-01

To understand the relationship between the timing of initiation of nutritional support in children with severe traumatic brain injury and outcomes. Secondary analysis of a randomized, controlled trial of therapeutic hypothermia (Pediatric Traumatic Brain Injury Consortium: Hypothermia, also known as "the Cool Kids Trial" (NCT 00222742). Fifteen clinical sites in the United States, Australia, and New Zealand. Inclusion criteria included 1) age less than 18 years, 2) postresuscitation Glasgow Coma Scale less than or equal to 8, 3) Glasgow Coma Scale motor score less than 6, and 4) available to be randomized within 6 hours after injury. Exclusion criteria included normal head CT, Glasgow Coma Scale equals to 3, hypotension for greater than 10 minutes ( 30 min), pregnancy, penetrating injury, and unavailability of a parent or guardian to consent at centers without emergency waiver of consent. Therapeutic hypothermia (32-33°C for 48 hr) followed by slow rewarming for the primary study. For this analysis, the only intervention was the extraction of data regarding nutritional support from the existing database. Timing of initiation of nutritional support was determined and patients stratified into four groups (group 1-no nutritional support over first 7 d; group 2-nutritional support initiated group 3-nutritional support initiated 48 to group 4-nutritional support initiated 72-168 hr after injury). Outcomes were also stratified (mortality and Glasgow Outcomes Scale-Extended for Pediatrics; 1-4, 5-7, 8) at 6 and 12 months. Mixed-effects models were performed to define the relationship between nutrition and outcome. Children (n = 90, 77 randomized, 13 run-in) were enrolled (mean Glasgow Coma Scale = 5.8); the mortality rate was 13.3%. 57.8% of subjects received hypothermia Initiation of nutrition before 72 hours was associated with survival (p = 0.01), favorable 6 months Glasgow Outcomes Scale-Extended for Pediatrics (p = 0.03), and favorable 12 months Glasgow

An evaluation of surgical outcome of bilateral cleft lip surgery using a modified Millard′s (Fork Flap technique

Directory of Open Access Journals (Sweden)

W L Adeyemo

2013-01-01

Full Text Available Background: The central third of the face is distorted by the bilateral cleft of the lip and palate and restoring the normal facial form is one of the primary goals for the reconstructive surgeons. The history of bilateral cleft lip repair has evolved from discarding the premaxilla and prolabium and approximating the lateral lip elements to a definitive lip and primary cleft nasal repair utilising the underlying musculature. The aim of this study was to review surgical outcome of bilateral cleft lip surgery (BCLS done at the Lagos University Teaching Hospital. Materials and Methods: A review of all cases of BCLS done between January 2007 and December 2012 at the Lagos University Teaching Hospital was done. Data analysis included age and sex of patients, type of cleft deformity and type of surgery (primary or secondary and whether the cleft deformity was syndromic and non-syndromic. Techniques of repair, surgical outcome and complications were also recorded. Results: A total of 39 cases of BCLS involving 21 males and 18 females were done during the period. This constituted 10% (39/390 of all cases of cleft surgery done during the period. There were 5 syndromic and 34 non-syndromic cases. Age of patients at time of surgery ranged between 3 months and 32 years. There were 24 bilateral cleft lip and palate deformities and 15 bilateral cleft lip deformities. Thirty-one of the cases were primary surgery, while 8 were secondary (revision surgery. The most common surgical technique employed was modified Fork flap (Millard technique, which was employed in 37 (95% cases. Conclusion: Bilateral cleft lip deformity is a common cleft deformity seen in clinical practice, surgical repair of which can be a challenge to an experienced surgeon. A modified Fork flap technique for repair of bilateral cleft lip is a reliable and versatile technique associated with excellent surgical outcome.

Photometric Analysis and Period Investigation of the EW Type ...

Indian Academy of Sciences (India)

Photometric Analysis and Period Investigation of the EW Type. Eclipsing ... binary with the less massive secondary component filling the inner Roche lobe. ..... Cox 2000) assuming that the primary component is a normal main sequence star.

Developing an Appropriate Goalball Unit for Secondary Physical Education

Science.gov (United States)

Laughlin, Michael K.; Happel, Kathleen

2016-01-01

Goalball, a sport designed for those with visual impairments, is a competitive and recreational sport enjoyed by athletes around the world. Students with and without visual impairments can experience positive outcomes when teachers appropriately include a goalball unit as part of their inclusive secondary physical education curriculum. This…

SPECKLE INTERFEROMETRY OF SECONDARY COMPONENTS IN NEARBY VISUAL BINARIES

International Nuclear Information System (INIS)

Tokovinin, Andrei; Horch, Elliott P.

2016-01-01

Statistical characterization of secondary subsystems in binaries helps to distinguish between various scenarios of multiple-star formation. The Differential Speckle Survey Instrument was used at the Gemini-N telescope for several hours in 2015 July to probe the binarity of 25 secondary components in nearby solar-type binaries. Six new subsystems were resolved, with meaningful detection limits for the remaining targets. The large incidence of secondary subsystems agrees with other similar studies. The newly resolved subsystem HIP 115417 Ba,Bb causes deviations in the observed motion of the outer binary from which an astrometric orbit of Ba,Bb with a period of 117 years is deduced.

The Transition Period in Soccer: A Window of Opportunity.

Science.gov (United States)

Silva, Joao Renato; Brito, Joao; Akenhead, Richard; Nassis, George P

2016-03-01

The aim of this paper is to describe the physiological changes that occur during the transition period in soccer players. A secondary aim is to address the issue of utilizing the transition period to lay the foundation for the succeeding season. We reviewed published peer-reviewed studies if they met the following three selection criteria: (1) the studied population comprised adult soccer players (aged >18 years), (2) time points of physiological and performance assessments were provided, and (3) appropriate statistics for the calculation of effect sizes were reported. Following two selection phases, 12 scientific publications were considered, involving a total sample of 252 players. The transition period elicits small to moderate negative changes in body composition, a moderate decline in sprint performance with and without changes of direction, and small to moderate decrements in muscle power. Detraining effects are also evident for endurance-related physiological and performance outcomes: large decrements in maximal oxygen consumption V̇O2max) and time to exhaustion, and moderate to very large impairments have been observed in intermittent-running performance. Off-season programs should be characterized by clear training objectives, a low frequency of training sessions, and simple training tools in order to facilitate compliance. The program suggested here may constitute the 'minimum effective dose' to maintain or at least attenuate the decay of endurance- and neuromuscular-related performance parameters, as well as restore an adequate strength profile (reduce muscle strength imbalances). This periodization strategy may improve the ability of players to cope with the elevated training demands of pre-season training and therefore reduce the risk of injury. Moreover, this strategy will favor a more efficient development of other relevant facets of performance during the pre-competition phase (e.g., tactical organization). We contend that the transition period

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

The Relationship between Parent Expectations and Postschool Outcomes of Adolescents with Disabilities

Science.gov (United States)

Doren, Bonnie; Gau, Jeff M.; Lindstrom, Lauren E.

2012-01-01

A secondary analysis was conducted of the National Longitudinal Transition Study-2 to examine (a) main effects of parents' school and postschool outcome expectations on the actual outcomes achieved, (b) demographic moderators, and (c) adolescent autonomy as a mediator of parent expectations and outcomes. Parent expectations were found to…

Clinical significance of determination serum sex hormones levels in patients with secondary amenorrhea

International Nuclear Information System (INIS)

Jiang Hua

2007-01-01

Objective: To explore the clinical significance of changes of serum sex hormones levels in patients with secondary amenorrhea. Methods: Serum levels of E 2 , FSH, LH, PRL and P were detected with RIA in 33 patients with secondary amenorrhea and 30 controls. Results: In the patients, the serum E 2 levels were significantly lower and FSH, LH, PRL and P levels were significantly higher than those in controls (P 2 , FSH, LH, PRL and P levels is of help for assessment of severity of secondary amenorrhea as well as outcome prediction. (authors)

Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis.

Science.gov (United States)

Savitr Sastri, B V; Arivazhagan, A; Sinha, Sanjib; Mahadevan, Anita; Bharath, R D; Saini, J; Jamuna, R; Kumar, J Keshav; Rao, S L; Chandramouli, B A; Shankar, S K; Satishchandra, P

2014-05-15

Mesial temporal sclerosis (MTS) is the most common cause of drug resistant epilepsy amenable for surgical treatment and seizure control. This study analyzed the outcome of patients with MTS following anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH) over 10 years and correlated the electrophysiological and radiological factors with the post operative seizure outcome. Eighty seven patients were included in the study. Sixty seven (77.2%) patients had an Engel Class 1 outcome, 9 (11.4%) had Class 2 outcome. Engel's class 1 outcome was achieved in 89.9% at 1 year, while it reduced slightly to 81.9% at 2 years and 76.2% at 5 year follow up. Seventy seven (88.5%) patients had evidence of hippocampal sclerosis on histopathology. Dual pathology was observed in 19 of 77 specimens with hippocampal sclerosis, but did not influence the outcome. Factors associated with an unfavorable outcome included male gender (p=0.04), and a higher frequency of pre-operative seizures (p=0.005), whereas the presence of febrile seizures (p=0.048) and loss of hippocampal neurons in CA4 region on histopathology (p=0.040) were associated with favorable outcome. The effect of CA4 loss on outcome is probably influenced by neuronal loss in other subfields as well since isolated CA4 loss was rare. Abnormal post operative EEG at the end of 1 week was found to be a significant factor predicting unfavorable outcome (p=0.005). On multivariate analysis, the pre-operative seizure frequency was the only significant factor affecting outcome. The present study observed excellent seizure free outcome in a carefully selected cohort of patients with MTS with refractory epilepsy. The presence of dual pathology did not influence the outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

LAMURU CORN SEED QUALITY IN DIFFERENT STORE PERIOD WITH SOME STUDIES METHOD

Directory of Open Access Journals (Sweden)

Rahmawati

2014-01-01

Full Text Available Research quality of seed executed at green house and laboratory of seed, Hall of Research of Crop of Serealia Maros in May 2013. Maize used is Lamuru coming from warehouse of UPBS Balitsereal with period keep 12 and 23 month. Research conducted by using RCD four replicated. Result: test by using sand media show percentage germinate, speed growth, length root, amount root of secondary, long of shoot and seed of sprout do not differ significant. Examinatied by piercing paper test to show percentage germinated, speed growth and dry wight of sprout differ significant, while length root, amount secondary root and seed shoot not significant. Use of Brick gravel test to show same result by is piercing paper test except dry weight of sprout at brick gravel test to show result which do not significant. Seed with period keep 12 month have percentage germinate, dry weight sprout, long root primary, sum up root secondary and same seed length at all method test, while speed growth to differ significant at piercing paper test. Seed with period keep 23 month show different result by 12 month. Dry weight sprout, long root primary, sum up root secondary and seed length shoot show same result, while speed growth show different result at third test method. Percentage germinate obtained by piercing paper test to differ significant by brick is gravel test and sand media.

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.

Variation among cleft centres in the use of secondary surgery for children with cleft palate: a retrospective cohort study

Science.gov (United States)

Sitzman, Thomas J; Hossain, Monir; Carle, Adam C; Heaton, Pamela C; Britto, Maria T

2017-01-01

Objectives To test whether cleft centres vary in their use of secondary cleft palate surgery, also known as revision palate surgery, and if so to identify modifiable hospital factors and surgeon factors that are associated with use of secondary surgery. Design Retrospective cohort study. Setting Forty-three paediatric hospitals across the USA. Patients Children with cleft lip and palate who underwent primary cleft palate repair from 1999 to 2013. Main outcome measures Time from primary cleft palate repair to secondary palate surgery. Results We identified 4939 children who underwent primary cleft palate repair. At 10 years after primary palate repair, 44% of children had undergone secondary palate surgery. Significant variation existed among hospitals (ppalate repair before 9 months of age was associated with an increased hazard of secondary palate surgery (initial HR 6.74, 95% CI 5.30 to 8.73). Postoperative antibiotics, surgeon procedure volume and hospital procedure volume were not associated with time to secondary surgery (p>0.05). Of the outcome variation attributable to hospitals and surgeons, between-hospital differences accounted for 59% (ppalate surgery exists depending on a child’s age at primary palate repair and the hospital and surgeon performing their repair. Performing primary palate repair before 9 months of age substantially increases the hazard of secondary surgery. Further research is needed to identify other factors contributing to variation in palate surgery outcomes among hospitals and surgeons. PMID:29479567

Outcomes of endodontic therapy in general practice

Science.gov (United States)

Bernstein, Susan D.; Horowitz, Allan J.; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A.; Collie, Damon; Matthews, Abigail G.; Curro, Frederick A.; Thompson, Van P.; Craig, Ronald G.

2014-01-01

Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for

Pattern and outcome of infertility in Enugu: the need to improve diagnostic facilities and approaches to management.

Science.gov (United States)

Ugwu, E O; Onwuka, C I; Okezie, O A

2012-01-01

In Nigeria, infertility is a social for the childless couple due to the high premium placed on propagating oneself. To determine the pattern of infertility among women attending the gynaecological clinic of university of Nigeria Teaching Hospital, Enugu and to examine the outcome of management. A descriptive retrospective design study based on findings from the folders of infertile couples presenting at the gynaecological clinic of University of Nigeria Teaching Hospital over a five year period (2004 - 2008). The data were collected from all documented and laboratory findings. The data extracted from the case records were the socio-demographic characteristics of the patients, the type of infertility whether primary or secondary, the causes, and the treatment in the years under review. The outcome of management was also evaluated. These were analyzed using SPSS 12.0.1 for window version. The mean age of the women was 34.1 +/- 4.9 range 21 - 46) years. The prevalence of infertility was 5.5% of all outpatient gynaecological consultations. The cause of infertility could not be determined in 39.4% of cases, female factors were identified as the sole causes in 28.7% of cases, male factors as sole causes in 11.5% of cases, and combined male/female factors in 20.4% of cases. Secondary infertility accounted for 76.8% of infertility and primary infertility 23.2%. The age of the women and the educational level did not significantly influence the type of infertility the women presented with (P > 0.05). Tubal factor was identified in majority of cases and pregnancy was recorded in only 17.0% of the women. Secondary infertility is more prevalent in Enugu with tubal factor accounting for majority of the cases with identifiable causes. The outcome of treatment of infertility is poor. There is need to improve infertility diagnostic and treatment facilities and approaches in Enugu, Nigeria.

PARTICULARITIES OF HUMAN RESOURCE MANAGEMENT IN THE ROMANIAN SECONDARY EDUCATION

Directory of Open Access Journals (Sweden)

MONICAăLOGOF;TU

2016-12-01

Full Text Available Professional skills of teachers, their level of engagement in fulfilling the responsibilities of educating pupils is a crucial key in the educational process. Need to understand the particularities of management is given by increasing efficiency, effectiveness of achieving the aims of education, and not only by providing resources and effective directing the activities. In this paperwork we performed an analysis of the particularities of human resource management in secondary education and a quantitative research of human resource management aspects in secondary education at the local level in rural areas from Romania. In order to improve pupil outcomes, secondary schools need a strong and ambitious strategy for improving the educational process, in which human resource management acquire strategic dimensions.

Clinical Outcomes of Gap Balancing vs Measured Resection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis Involving 2259 Subjects.

Science.gov (United States)

Li, Shuxiang; Luo, Xiaomin; Wang, Peng; Sun, Han; Wang, Kun; Sun, Xiaoliang

2018-03-17

The argument on the clinical effects between gap balancing (GB) and measured resection (MR) in total knee arthroplasty remains to be resolved. A systematic review and meta-analysis was performed to investigate which technique in total knee arthroplasty has better clinical effect. A total of 20 studies involving 2259 cases were included in the meta-analysis. The primary outcome measure was Knee Society Score (KSS), whereas the secondary outcomes included other function assessment systems (eg, range of motion, Western Ontario and McMaster University Osteoarthritis Index), radiological outcomes (eg, femoral component rotation, total outliers), revision rate, complications (eg, infection, loosening, instability), and surgical time. The GB technique was associated with statistically significant increases in the primary outcomes of KSS-function in 1 year. However, a mean difference of 2.12 points was below the minimal clinically important difference of 6 points. No differences were found in the analyses of KSS-knee and KSS-function in any other follow-up periods. Secondary outcome assessments showed significant decreased surgical time (mean difference, 16.18; P < .00001) for MR. Although statistically significant difference in favor of GB was identified in total outliers (risk ratio, 1.72, P = .0004), the 2 techniques were comparable in range of motion, Western Ontario and McMaster University Osteoarthritis Index, femoral component rotation, complications, and revision rate. We conclude that both techniques can result in equivalent results when done properly, and each surgeon must understand the strengths and weaknesses of each technique. Copyright © 2018 Elsevier Inc. All rights reserved.

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

Science.gov (United States)

Algarra, Nelson N; Lele, Abhijit V; Prathep, Sumidtra; Souter, Michael J; Vavilala, Monica S; Qiu, Qian; Sharma, Deepak

2017-07-01

Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score Secondary insults examined were: systemic hypotension (systolic blood pressurehypertension (ICP>20 mm Hg), cerebral hypotension (cerebral perfusion pressure40 mm Hg), hypocarbia (end-tidal CO2hypertension), hyperglycemia (glucose>200 mg/dL), hypoglycemia (glucose38°C). A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (Psecondary insults were common during orthopedic surgery in patients with TBI and were associated with postoperative escalation of care. Strategies to minimize intraoperative secondary insults are needed.

Fetomaternal outcome in triplet pregnancy

International Nuclear Information System (INIS)

Mazhar, S.B.; Furukh, T; Rahim, F.

2008-01-01

To determine maternal outcome as antenatal and postnatal complications and neonatal outcome as birth weight, morbidity and mortality in triplet gestation. All the patients with triplet pregnancy beyond 28 weeks gestation, who delivered at the study place during above period were included in the study. The primary outcome measures were frequency of maternal complications and neonatal birth, weight and morbidity. Secondary outcome measures included the frequency of assisted conception in the studied cohart. Eighteen women had triplet pregnancy beyond 28 weeks. Nine were booked, 6 non-booked and 3 of them were referred. Mean duration of gestation was 237.8 days (33.8 weeks). The antenatal complications were preterm delivery in 50%, hypertension in 50%, anemia in 44.4% and obstetric cholestasis in 5.6%. Eight patients (44.4%) suffered postpartum hemorrhage. One patient had peripartum hysterectomy and later expired in intensive care unit after three weeks. Maternal mortality ratio was 5.6%. Fifty five percent women had induction of ovulation with Clomiphene, while none had In Vitro Fertilization (IVF) or Intracytoplasmic Insemination (ICSI) or received gonadotrophins. Fifteen sets of triplets were delivered abdominally. Mean birth weights of 1st, 2nd and 3rd triplet were 1651, 1640 and 1443 grams respectively. Five sets of triplets (27.8%) had more than 25% discordance for birth weight. The mean Apgar scores of the babies at 1 and 10 minutes after birth were 6.0 and 8.0, 5.6 and 7.5; and 5.2 and 7.0 respectively. Of the 54 infants, 18 required Neonatal Intensive Care Unit (NICU) admission and 14 were admitted in nursery. Two died shortly after birth. Total perinatal mortalities were 13 including 4 cases of intra-uterine demise. Three babies suffered from jaundice, 7 had sepsis and 8 had respiratory distress syndrome. Triplet gestation had a high rate of fetomaternal complications. Majority had history of assisted conception. (author)

[Secondary glaucoma in Paraguay. Etiology and incidence].

Science.gov (United States)

Strohl, A; Pozzi, S; Wattiez, R; Roesen, B; Miño de Kaspar, H; Klauss, V

1999-06-01

Glaucoma is the third-most-frequent cause of blindness in the world, with a total of 5.2 million blind people as a result of this disease; 80% live in developing countries. In Paraguay, after cataract it is the second-most-frequent-cause. Early detection of the risk factors and groups can help to avoid progress of this disease. Trauma, cataract and infectious uveitis represent special risks for developing secondary glaucoma, which is a more frequent cause of blindness in third-world countries than in industrialized nations. Until now there has been little data regarding the causes, disease course, and options for therapy. Therefore, secondary glaucoma was examined in Paraguay to obtain information on the situation in Latin America. The aim of the study was to explore the causes of secondary glaucoma for programs concerning prevention and therapy. From November 1996 to February 1997 patients with secondary glaucoma were examined at the University Hospital of Asunción, Paraguay. After the clinical examination the secondary glaucomas were classified. Patients with primary glaucoma were included in the same period of time as well in order to get the rate of secondary glaucoma. Altogether 293 patients were examined: 61 with secondary and 232 with primary glaucoma. The causes of secondary glaucoma in 73 eyes were: 20 (27%) with pseudoexfoliation glaucoma, 19 (26%) with post-traumatic glaucoma, 16 (22%) with neovascular glaucoma, 4 (5%) with lens-related glaucoma, 3 (4%) with glaucoma associated with ocular surgery, 2 (3%) with pigmentary and 2 (3%) with corticoid-induced glaucoma. A ratio of 4:1 primary glaucomas to secondary glaucomas was found. The development of special measures for prevention and early therapy is only possible if the causes of this severe disease are explored. The results of this study represent basic information and could help to introduce of prevention programs.

Prenatal Diagnosis of Transposition of the Great Arteries over a 20-Year Period: Improved but Imperfect

Science.gov (United States)

Escobar-Diaz, Maria C; Freud, Lindsay R; Bueno, Alejandra; Brown, David W; Friedman, Kevin; Schidlow, David; Emani, Sitaram; del Nido, Pedro; Tworetzky, Wayne

2015-01-01

Objective To evaluate temporal trends in prenatal diagnosis of transposition of the great arteries with intact ventricular septum (TGA/IVS) and its impact on neonatal morbidity and mortality. Methods Newborns with TGA/IVS referred for surgical management to our center over a 20-year period (1992 – 2011) were included. The study time was divided into 5 four-year periods, and the primary outcome was rate of prenatal diagnosis. Secondary outcomes included neonatal pre-operative status and perioperative survival. Results Of the 340 patients, 81 (24%) had a prenatal diagnosis. Prenatal diagnosis increased over the study period from 6% to 41% (p<0.001). Prenatally diagnosed patients underwent a balloon atrial septostomy (BAS) earlier than postnatally diagnosed patients (0 vs. 1 day, p<0.001) and fewer required mechanical ventilation (56% vs. 69%, p=0.03). There were no statistically significant differences in pre-operative acidosis (16% vs. 26%, p=0.1) and need for preoperative ECMO (2% vs. 3%, p=1.0). There was also no significant mortality difference (1 pre-operative and no post-operative deaths among prenatally diagnosed patients, as compared to 4 pre-operative and 6 post-operative deaths among postnatally diagnosed patients). Conclusion The prenatal detection rate of TGA/IVS has improved but still remains below 50%, suggesting the need for strategies to increase detection rates. The mortality rate was not statistically different between pre- and postnatally diagnosed patients; however, there were significant pre-operative differences with regard to earlier BAS and less mechanical ventilation. Ongoing study is required to elucidate whether prenatal diagnosis confers long-term benefit. PMID:25484180

Modeling secondary accidents identified by traffic shock waves.

Science.gov (United States)

Junhua, Wang; Boya, Liu; Lanfang, Zhang; Ragland, David R

2016-02-01

The high potential for occurrence and the negative consequences of secondary accidents make them an issue of great concern affecting freeway safety. Using accident records from a three-year period together with California interstate freeway loop data, a dynamic method for more accurate classification based on the traffic shock wave detecting method was used to identify secondary accidents. Spatio-temporal gaps between the primary and secondary accident were proven be fit via a mixture of Weibull and normal distribution. A logistic regression model was developed to investigate major factors contributing to secondary accident occurrence. Traffic shock wave speed and volume at the occurrence of a primary accident were explicitly considered in the model, as a secondary accident is defined as an accident that occurs within the spatio-temporal impact scope of the primary accident. Results show that the shock waves originating in the wake of a primary accident have a more significant impact on the likelihood of a secondary accident occurrence than the effects of traffic volume. Primary accidents with long durations can significantly increase the possibility of secondary accidents. Unsafe speed and weather are other factors contributing to secondary crash occurrence. It is strongly suggested that when police or rescue personnel arrive at the scene of an accident, they should not suddenly block, decrease, or unblock the traffic flow, but instead endeavor to control traffic in a smooth and controlled manner. Also it is important to reduce accident processing time to reduce the risk of secondary accident. Copyright © 2015 Elsevier Ltd. All rights reserved.

Primary versus secondary intraocular lens implantation in the management of congenital cataract

Directory of Open Access Journals (Sweden)

Thanaa H Mohamed

2016-01-01

Conclusion Primary IOL implantation was found to be safe and effective in the management of congenital cataract; it leads to lower incidence of complications and better visual outcomes compared with aphakia and secondary IOL implantation.

Classic Grounded Theory to Analyse Secondary Data: Reality and Reflections

Directory of Open Access Journals (Sweden)

Lorraine Andrews

2012-06-01

Full Text Available This paper draws on the experiences of two researchers and discusses how they conducted a secondary data analysis using classic grounded theory. The aim of the primary study was to explore first-time parents’ postnatal educational needs. A subset of the data from the primary study (eight transcripts from interviews with fathers was used for the secondary data analysis. The objectives of the secondary data analysis were to identify the challenges of using classic grounded theory with secondary data and to explore whether the re-analysis of primary data using a different methodology would yield a different outcome. Through the process of re-analysis a tentative theory emerged on ‘developing competency as a father’. Challenges encountered during this re-analysis included the small dataset, the pre-framed data, and limited ability for theoretical sampling. This re-analysis proved to be a very useful learning tool for author 1(LA, who was a novice with classic grounded theory.

An overview of curriculum development in the different periods of ...

African Journals Online (AJOL)

2005. ... The objective of this article is to overview the practices of elementary and secondary schools curriculum development in the different periods. ... Public and professional engagement in curriculum development is little or non-existent.

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...

Outcomes in registered, ongoing randomized controlled trials of patient education.

Directory of Open Access Journals (Sweden)

Cécile Pino

Full Text Available BACKGROUND: With the increasing prevalence of chronic noncommunicable diseases, patient education is becoming important to strengthen disease prevention and control. We aimed to systematically determine the extent to which registered, ongoing randomized controlled trials (RCTs evaluated an educational intervention focus on patient-important outcomes (i.e., outcomes measuring patient health status and quality of life. METHODS: On May 6, 2009, we searched for all ongoing RCTs registered in the World Health Organization International Clinical Trials Registry platform. We used a standardized data extraction form to collect data and determined whether the outcomes assessed were 1 patient-important outcomes such as clinical events, functional status, pain, or quality of life or 2 surrogate outcomes, such as biological outcome, treatment adherence, or patient knowledge. PRINCIPAL FINDINGS: We selected 268 of the 642 potentially eligible studies and assessed a random sample of 150. Patient-important outcomes represented 54% (178 of 333 of all primary outcomes and 46% (286 of 623 of all secondary outcomes. Overall, 69% of trials (104 of 150 used at least one patient-important outcome as a primary outcome and 66% (99 of 150 as a secondary outcome. Finally, for 31% of trials (46 of 150, primary outcomes were only surrogate outcomes. The results varied by medical area. In neuropsychiatric disorders, patient important outcomes represented 84% (51 of 61 of primary outcomes, as compared with 54% (32 of 59 in malignant neoplasm and 18% (4 of 22 in diabetes mellitus trials. In addition, only 35% assessed the long-term impact of interventions (i.e., >6 months. CONCLUSIONS: There is a need to improve the relevance of outcomes and to assess the long term impact of educational interventions in RCTs.

Concurrent hypokalemic periodic paralysis and bipolar disorder

Directory of Open Access Journals (Sweden)

Chia-Lin Lin

2015-01-01

Full Text Available Primary periodic paralysis is a rare autosomal dominant disorder of ion-channel dysfunction, manifested by episodic flaccid paresis secondary to abnormal sarcolemma excitability. Membrane destabilization involving Na, K-ATPase has been hypothesized to be a biological etiology of the bipolar disorder (BD and the mechanisms underlying lithium therapy have been linked to it. To date, there has been only one reported case of BD comorbid with periodic paralysis. Herein, we reported another case of concurrent bipolar mania and hypokalemic periodic paralysis (HPP, one special form of periodic paralysis. Consistent with the previous case, our patient responded well to lithium treatment for both bipolar mania and HPP. This might provide some support to the hypothesis that the therapeutic effects of lithium in both BD and HPP could be due to the correction of the underlying common pathophysiology.

Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness?

Science.gov (United States)

Mitchell, Geoffrey K; Burridge, Letitia; Zhang, Jianzhen; Donald, Maria; Scott, Ian A; Dart, Jared; Jackson, Claire L

2015-01-01

Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary-secondary care. Six elements were identified that were common to these models of integrated primary-secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary-secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.

Impact of General Practitioner Transient Ischemic Attack Training on 90-Day Stroke Outcomes: Secondary Analysis of a Cluster Randomized Controlled Trial.

Science.gov (United States)

Ranta, Annemarei; Dovey, Susan; Gommans, John; Tilyard, Murray; Weatherall, Mark

2018-07-01

Many patients with transient ischemic attack (TIA) receive initial assessments by general practitioners (GPs) who may lack TIA management experience. In a randomized controlled trial (RCT), we showed that electronic decision support for GPs improves patient outcomes and guideline adherence. Some stroke services prefer to improve referrer expertise through TIA/stroke education sessions instead of promoting TIA decision aids or triaging tools. This is a secondary analysis of whether a GP education session influenced TIA management and outcomes. Post hoc analysis of a multicenter, single blind, parallel group, cluster RCT comparing TIA/stroke electronic decision support guided GP management with usual care to assess whether a pretrial TIA/stroke education session also affected RCT outcomes. Of 181 participating GPs, 79 (43.7%) attended an education session and 140 of 291 (48.1%) trial patients were managed by these GPs. There were fewer 90-day stroke events and 90-day vascular events or deaths in patients treated by GPs who attended education; 2 of 140 (1.4%) and 10 of 140 (7.1%) respectively, compared with those who did not; 5 of 151 (3.3%), and 14 of 151 (9.3%), respectively. Logistic regression for association between 90-day stroke and 90-day vascular events or death and education, however, was nonsignificant (odds ratio [OR] .42 (.08 to 2.22), P = .29 and .59 (95% confidence interval [CI] .27 to 1.29), P = .18 respectively. Guideline adherence was not improved by the education session: OR .84 (95% CI .49 to 1.45), P = .54. In the described setting, a GP TIA/stroke education session did not significantly enhance guideline adherence or reduce 90-day stroke or vascular events following TIA. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Maintained intentional weight loss reduces cardiovascular outcomes: results from the Sibutramine Cardiovascular OUTcomes (SCOUT) trial.

Science.gov (United States)

Caterson, I D; Finer, N; Coutinho, W; Van Gaal, L F; Maggioni, A P; Torp-Pedersen, C; Sharma, A M; Legler, U F; Shepherd, G M; Rode, R A; Perdok, R J; Renz, C L; James, W P T

2012-06-01

The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. Overweight/obese subjects (N = 10 744), ≥55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight change to Month 12 was -4.18 kg (sibutramine) or -1.87 kg (placebo). Degree of weight loss during Lead-in Period or through Month 12 was associated with a progressive reduction in risk for the total population in primary outcome events and cardiovascular mortality over the 5-year assessment. Although more events occurred in the randomized sibutramine group, on an average, a modest weight loss of approximately 3 kg achieved in the Lead-in Period appeared to offset this increased event rate. Moderate weight loss (3-10 kg) reduced cardiovascular deaths in those with severe, moderate or mild cardiovascular disease. Modest weight loss over short-term (6 weeks) and longer-term (6-12 months) periods is associated with reduction in subsequent cardiovascular mortality for the following 4-5 years even in those with pre-existing cardiovascular disease. While the sibutramine group experienced more primary outcome events than the placebo group, greater weight loss reduced overall risk of these occurring in both groups. © 2011 Blackwell Publishing Ltd.

Periodization Strategies in Older Adults: Impact on Physical Function and Health.

Science.gov (United States)

Conlon, Jenny A; Newton, Robert U; Tufano, James J; Banyard, Harry G; Hopper, Amanda J; Ridge, Ashley J; Haff, G Gregory

2016-12-01

This study compared the effect of periodized versus nonperiodized (NP) resistance training (RT) on physical function and health outcomes in older adults. Forty-one apparently healthy untrained older adults (women = 21, men = 20; 70.9 ± 5.1 yr; 166.3 ± 8.2 cm; 72.9 ± 13.4 kg) were recruited and randomly stratified to a NP, block periodized, or daily undulating periodized training group. Outcome measures were assessed at baseline and after a 22-wk × 3 d·wk RT intervention, including; anthropometrics, body composition, blood pressure and biomarkers, maximal strength, functional capacity, balance confidence, and quality of life. Thirty-three subjects satisfied all study requirements and were included in analyses (women = 17, men = 16; 71.3 ± 5.4 yr; 166.3 ± 8.5 cm; 72.5 ± 13.7 kg). The main finding was that all three RT models produced significant improvements in several physical function and physiological health outcomes, including; systolic blood pressure, blood biomarkers, body composition, maximal strength, functional capacity and balance confidence, with no between-group differences. Periodized RT, specifically block periodization and daily undulating periodized, and NP RT are equally effective for promoting significant improvements in physical function and health outcomes among apparently healthy untrained older adults. Therefore, periodization strategies do not appear to be necessary during the initial stages of RT in this population. Practitioners should work toward increasing RT participation in the age via feasible and efficacious interventions targeting long-term adherence in minimally supervised settings.

Computer-delivered indirect screening and brief intervention for drug use in the perinatal period: A randomized trial.

Science.gov (United States)

Ondersma, Steven J; Svikis, Dace S; Thacker, Casey; Resnicow, Ken; Beatty, Jessica R; Janisse, James; Puder, Karoline

2018-04-01

Under-reporting of drug use in the perinatal period is well-documented, and significantly limits the reach of proactive intervention approaches. The Wayne Indirect Drug Use Screener (WIDUS) focuses on correlates of drug use rather than use itself. This trial tested a computer-delivered, brief intervention designed for use with indirect screen-positive cases, seeking to motivate reductions in drug use without presuming its presence. Randomized clinical trial with 500 WIDUS-positive postpartum women recruited between August 14, 2012 and November 19, 2014. Participants were randomly assigned to either a time control condition or a single-session, tailored, indirect brief intervention. The primary outcome was days of drug use over the 6-month follow-up period; secondary outcomes included urine and hair analyses results at 3- and 6-month follow-up. All outcomes were measured by blinded evaluators. Of the 500 participants (252 intervention and 248 control), 36.1% of participants acknowledged drug use in the 3 months prior to pregnancy, but 89% tested positive at the 6-month follow-up. Participants rated the intervention as easy to use (4.9/5) and helpful (4.4/5). Analyses revealed no between-group differences in drug use (52% in the intervention group, vs. 53% among controls; OR 1.03). Exploratory analyses also showed that intervention effects were not moderated by baseline severity, WIDUS score, or readiness to change. The present trial showed no evidence of efficacy for an indirect, single-session, computer-delivered, brief intervention designed as a complement to indirect screening. More direct approaches that still do not presume active drug use may be possible and appropriate. Copyright © 2018 Elsevier B.V. All rights reserved.

Emotional Laour in Teaching Secondary Physical Education

OpenAIRE

Ye Hoon Lee; Hyungil Harry Kwon; Hwajung Oh

2016-01-01

Background: Teaching physical education is an emotion-laden context which requires physical education teachers to engage in emotional labor in order to foster their well-being, as well as student’s outcomes. Objective: The purpose of this study was to investigate the predictability of emotional labour strategies on job satisfaction and emotional exhaustion among secondary physical education teachers in South Korea. Specifically, the four forms of emotional labour (i.e., surface acting, deep a...

Impact of Secondary Interactions in Asymmetric Catalysis

OpenAIRE

Frölander, Anders

2007-01-01

This thesis deals with secondary interactions in asymmetric catalysis and their impact on the outcome of catalytic reactions. The first part revolves around the metal-catalyzed asymmetric allylic alkylation reaction and how interactions within the catalyst affect the stereochemistry. An OH–Pd hydrogen bond in Pd(0)–π-olefin complexes of hydroxy-containing oxazoline ligands was identified by density functional theory computations and helped to rationalize the contrasting results obtained emplo...

Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States.

Science.gov (United States)

Zheng, Zhe; Zhang, Heng; Yuan, Xin; Rao, Chenfei; Zhao, Yan; Wang, Yun; Normand, Sharon-Lise; Krumholz, Harlan M; Hu, Shengshou

2017-06-01

Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals. Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P =0.059; and 3.12% versus 2.20%, P =0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P China and the United States. The longer length of stay in China may represent an opportunity for improvement. © 2017 The Authors.

Achieved Blood Pressure and Outcomes in the Secondary Prevention of Small Subcortical Strokes Trial.

Science.gov (United States)

Odden, Michelle C; McClure, Leslie A; Sawaya, B Peter; White, Carole L; Peralta, Carmen A; Field, Thalia S; Hart, Robert G; Benavente, Oscar R; Pergola, Pablo E

2016-01-01

Studies suggest a J-shaped association between blood pressure and cardiovascular events in the setting of intensive systolic blood pressure control; whether there is a similar association with stroke remains less well established. The Secondary Prevention of Small Subcortical Strokes was a randomized trial to evaluate higher (130-149 mm Hg) versus lower (blood pressure targets in participants with recent lacunar infarcts. We evaluated the association of mean achieved blood pressure, 6 months after randomization, and recurrent stroke, major vascular events, and all-cause mortality. After a mean follow up of 3.7 years, there was a J-shaped association between achieved blood pressure and outcomes; the lowest risk was at ≈124 and 67 mm Hg systolic and diastolic blood pressure, respectively. For example, above a systolic blood pressure of 124 mm Hg, 1 standard deviation higher (11.1 mm Hg) was associated with increased mortality (adjusted hazard ratio: 1.9; 95% confidence interval: 1.4, 2.7), whereas below this level, this relationship was inverted (0.29; 0.10, 0.79), Pblood pressure of 67 mm Hg, a 1 standard deviation higher (8.2 mm Hg) was associated with an increased risk of stroke (2.2; 1.4, 3.6), whereas below this level, the association was in the opposite direction (0.34; 0.13, 0.89), P=0.02 for interaction. The lowest risk of all events occurred at a nadir of ≈120 to 128 mm Hg systolic blood pressure and 65 to 70 mm Hg diastolic blood pressure. Future studies should evaluate the impact of excessive blood pressure reduction, especially in older populations with preexisting vascular disease. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059306. © 2015 American Heart Association, Inc.

Respiratory Outcomes of the Surfactant Positive Pressure and Oximetry Randomized Trial

Science.gov (United States)

Stevens, Timothy P.; Finer, Neil N.; Carlo, Waldemar A.; Szilagyi, Peter G.; Phelps, Dale L.; Walsh, Michele C.; Gantz, Marie G.; Laptook, Abbot R.; Yoder, Bradley A.; Faix, Roger G.; Newman, Jamie E.; Das, Abhik; Do, Barbara T.; Schibler, Kurt; Rich, Wade; Newman, Nancy S.; Ehrenkranz, Richard A.; Peralta-Carcelen, Myriam; Vohr, Betty R.; Wilson-Costello, Deanne E.; Yolton, Kimberly; Heyne, Roy J.; Evans, Patricia W.; Vaucher, Yvonne E.; Adams-Chapman, Ira; McGowan, Elisabeth C.; Bodnar, Anna; Pappas, Athina; Hintz, Susan R.; Acarregui, Michael J.; Fuller, Janell; Goldstein, Ricki F.; Bauer, Charles R.; O’Shea, T. Michael; Myers, Gary J.; Higgins, Rosemary D.

2014-01-01

Objective To explore the early childhood pulmonary outcomes of infants who participated in the NICHD SUPPORT Trial, using a factorial design that randomized extremely preterm infants to lower vs. higher oxygen saturation targets and delivery room CPAP vs. intubation/surfactant, found no significant difference in the primary composite outcome of death or BPD. Study design The Breathing Outcomes Study, a prospective secondary to SUPPORT, assessed respiratory morbidity at 6 month intervals from hospital discharge to 18–22 months corrected age (CA). Two pre-specified primary outcomes, wheezing more than twice per week during the worst 2 week period and cough longer than 3 days without a cold were compared between each randomized intervention. Results One or more interviews were completed for 918 of 922 eligible infants. The incidence of wheezing and cough were 47.9% and 31.0%, respectively, and did not differ between study arms of either randomized intervention. Infants randomized to lower vs. higher oxygen saturation targets had similar risks of death or respiratory morbidities (except for croup, treatment with oxygen or diuretics at home). Infants randomized to CPAP vs. intubation/surfactant had fewer episodes of wheezing without a cold (28.9% vs. 36.5%, pCPAP rather than intubation/surfactant is associated with less respiratory morbidity by 18–22 months CA. Longitudinal assessment of pulmonary morbidity is necessary to fully evaluate the potential benefits of respiratory interventions for neonates. PMID:24725582

The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

Science.gov (United States)

McIsaac, Daniel I; Moloo, Husein; Bryson, Gregory L; van Walraven, Carl

2017-05-01

Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested.

Secondary access based on sensing and primary ARQ feedback in spectrum sharing systems

KAUST Repository

Hamza, Doha R.

2012-04-01

In the context of primary/secondary spectrum sharing, we propose a randomized secondary access strategy with access probabilities that are a function of both the primary automatic repeat request (ARQ) feedback and the spectrum sensing outcome. The primary terminal operates in a time slotted fashion and is active only when it has a packet to send. The primary receiver can send a positive acknowledgment (ACK) when the received packet is decoded correctly. Lack of ARQ feedback is interpreted as erroneous reception or inactivity. We call this the explicit ACK scheme. The primary receiver may also send a negative acknowledgment (NACK) when the packet is received in error. Lack of ARQ feedback is interpreted as an ACK or no-transmission. This is called the explicit NACK scheme. Under both schemes, when the primary feedback is interpreted as a NACK, the secondary user assumes that there will be retransmission in the next slot and accesses the channel with a certain probability. When the primary feedback is interpreted as an ACK, the secondary user accesses the channel with either one of two probabilities based on the sensing outcome. Under these settings, we find the three optimal access probabilities via maximizing the secondary throughput given a constraint on the primary throughput. We compare the performance of the explicit ACK and explicit NACK schemes and contrast them with schemes based on either sensing or primary ARQ feedback only. © 2012 IEEE.

Absent menstrual periods - secondary

Science.gov (United States)

... tumors Drugs for cancer treatment Drugs to treat schizophrenia or psychosis Overactive thyroid gland Polycystic ovarian syndrome ... can include: Breast size changes Weight gain or weight loss Discharge from the breast or change in breast ...

The Advantages of Single-Sex Catholic Secondary Schooling: Selection Effects, School Effects, or "Much Ado About Nothing?"

Science.gov (United States)

LePore, Paul C.; Warren, John Robert

Data from the National Education Longitudinal Study of 1988 (NELS:88) were used to investigate whether there are differences between single-sex and coeducational Catholic secondary school students in academic and social psychological outcomes, whether any differences especially favor young women in single-sex Catholic secondary schools, and…

CARCINOMA OF UNKNOWN PRIMARY WITH SECONDARY METASTASIS TO NECKANALYSIS OF PATIENT AND DISEASE RELATED FACTORS PREDICTING SUPERIOR PATIENT OUTCOMES IN CUPS NECK

Directory of Open Access Journals (Sweden)

Preeti Singh

2017-11-01

Full Text Available BACKGROUND Carcinoma of unknown primary with secondary metastasis to neck (CUPS Neck is involvement of cervical nodes with squamous cell carcinoma without identifiable primary lesion in oral cavity, oropharynx and upper aerodigestive tract. Most commonly affects older male with history of tobacco and alcohol abuse. Commonly involved neck nodes are level II and III. Metastasis to these nodes usually comes from head and neck tumours. The aims of this study are to evaluate the factors (relating to patient and disease associated with improved outcomes following treatment in patients with metastatic squamous cell carcinoma of neck with unknown primary site. MATERIALS AND METHODS Study was done in ENT and Head Neck Centre, Base Hospital, Delhi Cantt. The investigation and treatment of such cases aim to detect a primary lesion, if possible in the upper aerodigestive tract (UADT and in any case to institute the optimal management protocol. Many factors impact the outcomes of treatment in terms of survival and quality of life. RESULTS After followup of 0.5 to 2 years data were compared among various groups, various disease related factors like volume of disease, staging of neck node, extracapsular spread in final HPE report and various patient related factors like age and sex of patient, performance status of patient, and presence of comorbidities were compared with final outcome in terms of recurrence or disease free survival with less complications. CONCLUSION 1. Most prominent tumour related prognostic factors were low volume nodal disease in the neck and absence of extracapsular spread. Patients with TNM stage I (T0N1M0 were associated with lower recurrence and less complication postoperatively as compared to advanced stage disease (T0N2M0 and T0N3M0. 2. In our study, patient related variables associated with superior patient outcomes in terms of locoregional recurrence or disease free survival were good performance status, females, young age

Secondary organic aerosol origin in an urban environment: influence of biogenic and fuel combustion precursors.

Science.gov (United States)

Minguillón, M C; Pérez, N; Marchand, N; Bertrand, A; Temime-Roussel, B; Agrios, K; Szidat, S; van Drooge, B; Sylvestre, A; Alastuey, A; Reche, C; Ripoll, A; Marco, E; Grimalt, J O; Querol, X

2016-07-18

Source contributions of organic aerosol (OA) are still not fully understood, especially in terms of quantitative distinction between secondary OA formed from anthropogenic precursors vs. that formed from natural precursors. In order to investigate the OA origin, a field campaign was carried out in Barcelona in summer 2013, including two periods characterized by low and high traffic conditions. Volatile organic compound (VOC) concentrations were higher during the second period, especially aromatic hydrocarbons related to traffic emissions, which showed a marked daily cycle peaking during traffic rush hours, similarly to black carbon (BC) concentrations. Biogenic VOC (BVOC) concentrations showed only minor changes from the low to the high traffic period, and their intra-day variability was related to temperature and solar radiation cycles, although a decrease was observed for monoterpenes during the day. The organic carbon (OC) concentrations increased from the first to the second period, and the fraction of non-fossil OC as determined by (14)C analysis increased from 43% to 54% of the total OC. The combination of (14)C analysis and Aerosol Chemical Speciation Monitor (ACSM) OA source apportionment showed that the fossil OC was mainly secondary (>70%) except for the last sample, when the fossil secondary OC only represented 51% of the total fossil OC. The fraction of non-fossil secondary OC increased from 37% of total secondary OC for the first sample to 60% for the last sample. This enhanced formation of non-fossil secondary OA (SOA) could be attributed to the reaction of BVOC precursors with NOx emitted from road traffic (or from its nocturnal derivative nitrate that enhances night-time semi-volatile oxygenated OA (SV-OOA)), since NO2 concentrations increased from 19 to 42 μg m(-3) from the first to the last sample.

[The effect of pre-surgical orthodontics on secondary alveolar bone grafting in the patients with complete cleft lip and palate].

Science.gov (United States)

Jia, Yi-lin; Fu, Min-kui; Ma, Lian

2004-05-01

To examine the effect of pre-surgical orthodontics on the outcome of the secondary alveolar bone grafting in the patients with complete cleft lip and palate. Sixteen complete cleft lip and palate patients (9 males and 7 females) with collapsed upper arch or severe mal-positioned upper incisors were selected. The cleft was not easily grafted because of the poor access. The total cleft sites were 22 (10 patients with UCLP and 6 patients with BCLP). The age range of the patients was from 8 to 22 years. Pre-surgical orthodontic treatment was mainly to expand the collapsed upper arch and correct the mal-positioned upper incisors. After the secondary alveolar bone grafting, the patients were followed up and anterior occlusal radiograph/intraoral panograph were taken regularly. The observation period was from 6 months to 4 years. Bergland criteria were used to evaluate the interdental septal height. Upper arch expansion and the correction of the mal-positioned upper incisors done by the orthodontic treatment made the bone grafting procedure easier. The clinically successful rate reached 86%. The severe upper arch collapse and mal-positioned upper incisors in the patients with complete cleft lip and palate should be corrected orthodontically before the secondary alveolar bone grafting.

Secondary Hypertension

Science.gov (United States)

Secondary hypertension Overview Secondary hypertension (secondary high blood pressure) is high blood pressure that's caused by another medical condition. Secondary hypertension can be caused by conditions that affect your kidneys, ...

Hypofractionated radiotherapy for primary or secondary oligometastatic lung cancer using Tomotherapy

Directory of Open Access Journals (Sweden)

Chang Heng-Jui

2012-12-01

Full Text Available Abstract Background To retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy. Methods Between April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8–16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy, and the median total dose was 49.5 Gy (range, 45–72 Gy. The median estimated biological effective dose at 10 Gy (BED10 was 71.8 Gy (range, 65.3–119.0 Gy, and that at 3 Gy (BED3 was 123.8 Gy (range, 112.5–233.3 Gy. The mean lung dose (MLD was constrained mainly under 1200 cGy. The median gross tumor volume (GTV was 27.9 cm3 (range: 2.5–178.1 cm3. Results The median follow-up period was 25.8 months (range, 3.0–60.7 months. The median overall survival (OS time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD was 11.2 months versus >50 months (not reached in the patients without EPD (p 3 had a better survival than those with larger GTV (>27.9 cm3: >40 months versus 12.85 months (p = 0.047. The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065. The 2-year local control (LC rate was 94.7%. Only 2 patients (6.1% developed ≧grade 3 radiation pneumonitis. Conclusion Using Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with

The health benefits of secondary education in adolescents and young adults: An international analysis in 186 low-, middle- and high-income countries from 1990 to 2013

OpenAIRE

Russell M. Viner; Dougal S. Hargreaves; Joseph Ward; Chris Bonell; Ali H. Mokdad; George Patton

2017-01-01

Background: The health benefits of secondary education have been little studied. We undertook country-level longitudinal analyses of the impact of lengthening secondary education on health outcomes amongst 15-24 year olds. Methods: Exposures: average length of secondary and primary education from 1980 to 2013. Data/Outcomes: Country level adolescent fertility rate (AFR), HIV prevalence and mortality rate from 1989/90 to 2013 across 186 low-, middle- and high-income countries. Analysi...

Period multiplication and chaotic phenomena in atmospheric dielectric-barrier glow discharges

International Nuclear Information System (INIS)

Wang, Y. H.; Zhang, Y. T.; Wang, D. Z.; Kong, M. G.

2007-01-01

In this letter, evidence of temporal plasma nonlinearity in which atmospheric dielectric-barrier discharges undergo period multiplication and chaos using a one-dimensional fluid model is reported. Under the conditions conducive for chaotic states, several frequency windows are identified in which period multiplication and secondary bifurcations are observed. Such time-domain nonlinearity is important for controlling instabilities in atmospheric glow discharges

Long-Period Variability in o Ceti

Science.gov (United States)

Templeton, Matthew R.; Karovska, Margarita

2009-02-01

We carried out a new and sensitive search for long-period variability in the prototype of the Mira class of long-period pulsating variables, o Ceti (Mira A), the closest and brightest Mira variable. We conducted this search using an unbroken light curve from 1902 to the present, assembled from the visual data archives of five major variable star observing organizations from around the world. We applied several time-series analysis techniques to search for two specific kinds of variability: long secondary periods (LSPs) longer than the dominant pulsation period of ~333 days, and long-term period variation in the dominant pulsation period itself. The data quality is sufficient to detect coherent periodic variations with photometric amplitudes of 0.05 mag or less. We do not find evidence for coherent LSPs in o Ceti to a limit of 0.1 mag, where the amplitude limit is set by intrinsic, stochastic, low-frequency variability of approximately 0.1 mag. We marginally detect a slight modulation of the pulsation period similar in timescale to that observed in the Miras with meandering periods, but with a much lower period amplitude of ±2 days. However, we do find clear evidence of a low-frequency power-law component in the Fourier spectrum of o Ceti's long-term light curve. The amplitude of this stochastic variability is approximately 0.1 mag at a period of 1000 days, and it exhibits a turnover for periods longer than this. This spectrum is similar to the red noise spectra observed in red supergiants.

Quality of life and functional outcome after resection of pancreatic cystic neoplasm

NARCIS (Netherlands)

van der Gaag, Niels A.; Berkhemer, Olvert A.; Sprangers, Mirjam A.; Busch, Olivier R. C.; Bruno, Marco J.; de Castro, Steve M.; van Gulik, Thomas M.; Gouma, Dirk J.

2014-01-01

The objectives of this study were to assess the long-term quality of life (QOL) after the resection of a primary pancreatic cyst and to determine predictors of outcome. Secondary outcomes were pancreatic function and survival. One hundred eight consecutive patients, who underwent resection between

Input, Process, and Learning in primary and lower secondary schools

DEFF Research Database (Denmark)

Larsen, Michael Søgaard; Nordenbo, Sven Erik; Holm, Anders

What do we want to know? What empirical research has been carried out to examine the relationship between factors in primary and lower secondary schools (inputs and processes) and the learning achieved by primary and lower secondary school pupils (outputs and outcomes)? What are the results...... with weight of evidence of this empirical research? Who wants to know and why? The project was commissioned by the Danish Evaluation Institute (Danmarks Evalueringsinstitut) and was performed on behalf of the Nordic Indicator Workgroup (DNI). DNI is a workgroup nominated by the Nordic Evaluation Network...... and development etc. within the primary and lower secondary school sector. What did we find? From 1990 to 2008, 109 studies were published on malleable school factors within school effectiveness research. Of these studies, 71 are of high or medium weight of evidence. Synthesising these studies establishes that 11...

Transversus abdominis plane block reduces morphine consumption in the early postoperative period following microsurgical abdominal tissue breast reconstruction: a double-blind, placebo-controlled, randomized trial.

Science.gov (United States)

Zhong, Toni; Ojha, M; Bagher, Shaghayegh; Butler, Kate; Srinivas, Coimbatore; McCluskey, Stuart A; Clarke, Hance; O'Neill, Anne C; Novak, Christine B; Hofer, Stefan O P

2014-11-01

The analgesic efficacy of the transversus abdominis plane peripheral nerve block following abdominal tissue breast reconstruction has not been studied in a randomized controlled trial. The authors conducted a double-blind, placebo-controlled, 1:1 allocation, two-arm parallel group, superiority design, randomized controlled trial in patients undergoing microsurgical abdominally based breast reconstruction. Intraoperatively, epidural catheters were inserted under direct vision through the triangle of Petit on both sides of the abdomen into the transversus abdominis plane just before rectus fascial closure. Patients received either bupivacaine (study group) or saline (placebo group) through the catheters for 2 postoperative days. All patients received hydromorphone by means of a patient-controlled analgesic pump. The primary outcome was the difference in the parenteral opioid consumption on each postoperative day between the groups. The secondary outcome measures included the following: total in-hospital opioid; antinausea medication; pain, nausea, and sedation scores; Quality of Recovery Score; time to ambulation; and hospital stay duration. Between September of 2011 and June of 2013, 93 patients were enrolled: 49 received bupivacaine and 44 received saline. There were 11 postoperative complications (13 percent); none were related to the catheter. Primary outcomes were completed by 85 of 93 patients (91.3 percent); the mean parenteral morphine consumption was significantly reduced on postoperative day 1 in the bupivacaine group (20.7±20.1 mg) compared with 30.0±19.1 mg in the control group (p=0.02). There were no significant differences in secondary outcomes. Following abdominally based breast reconstruction, transversus abdominis plane peripheral nerve block is safe and significantly reduces morphine consumption in the early postoperative period. Therapeutic, II.

Periodicity and positivity of a class of fractional differential equations.

Science.gov (United States)

Ibrahim, Rabha W; Ahmad, M Z; Mohammed, M Jasim

2016-01-01

Fractional differential equations have been discussed in this study. We utilize the Riemann-Liouville fractional calculus to implement it within the generalization of the well known class of differential equations. The Rayleigh differential equation has been generalized of fractional second order. The existence of periodic and positive outcome is established in a new method. The solution is described in a fractional periodic Sobolev space. Positivity of outcomes is considered under certain requirements. We develop and extend some recent works. An example is constructed.

Role of Cereal Secondary Metabolites Involved in Mediating the Outcome of Plant-Pathogen Interactions

Directory of Open Access Journals (Sweden)

Lauren A. Du Fall

2011-12-01

Full Text Available Cereal crops such as wheat, rice and barley underpin the staple diet for human consumption globally. A multitude of threats to stable and secure yields of these crops exist including from losses caused by pathogens, particularly fungal. Plants have evolved complex mechanisms to resist pathogens including programmed cell death responses, the release of pathogenicity-related proteins and oxidative bursts. Another such mechanism is the synthesis and release of secondary metabolites toxic to potential pathogens. Several classes of these compounds have been identified and their anti-fungal properties demonstrated. However the lack of suitable analytical techniques has hampered the progress of identifying and exploiting more of these novel metabolites. In this review, we summarise the role of the secondary metabolites in cereal crop diseases and briefly touch on the analytical techniques that hold the key to unlocking their potential in reducing yield losses.

Maternal nutrition and birth outcomes.

Science.gov (United States)

Abu-Saad, Kathleen; Fraser, Drora

2010-01-01

In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

Global patient outcomes after elective surgery

DEFF Research Database (Denmark)

2016-01-01

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective...... adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration...... to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low...

Elemental GCR Observations during the 2009-2010 Solar Minimum Period

Science.gov (United States)

Lave, K. A.; Israel, M. H.; Binns, W. R.; Christian, E. R.; Cummings, A. C.; Davis, A. J.; deNolfo, G. A.; Leske, R. A.; Mewaldt, R. A.; Stone, E. C.;

Personality Pathology Predicts Outcomes in a Treatment-Seeking Sample with Bipolar I Disorder

Directory of Open Access Journals (Sweden)

Susan J. Wenze

2014-01-01

Full Text Available We conducted a secondary analysis of data from a clinical trial to explore the relationship between degree of personality disorder (PD pathology (i.e., number of subthreshold and threshold PD symptoms and mood and functioning outcomes in Bipolar I Disorder (BD-I. Ninety-two participants completed baseline mood and functioning assessments and then underwent 4 months of treatment for an index manic, mixed, or depressed phase acute episode. Additional assessments occurred over a 28-month follow-up period. PD pathology did not predict psychosocial functioning or manic symptoms at 4 or 28 months. However, it did predict depressive symptoms at both timepoints, as well as percent time symptomatic. Clusters A and C pathology were most strongly associated with depression. Our findings fit with the literature highlighting the negative repercussions of PD pathology on a range of outcomes in mood disorders. This study builds upon previous research, which has largely focused on major depression and which has primarily taken a categorical approach to examining PD pathology in BD.

Examination of factors predicting secondary students' interest in tertiary STEM education

Science.gov (United States)

Chachashvili-Bolotin, Svetlana; Milner-Bolotin, Marina; Lissitsa, Sabina

2016-02-01

Based on the Social Cognitive Career Theory (SCCT), the study aims to investigate factors that predict students' interest in pursuing science, technology, engineering, and mathematics (STEM) fields in tertiary education both in general and in relation to their gender and socio-economic background. The results of the analysis of survey responses of 2458 secondary public school students in the fifth-largest Israeli city indicate that STEM learning experience positively associates with students' interest in pursuing STEM fields in tertiary education as opposed to non-STEM fields. Moreover, studying advanced science courses at the secondary school level decreases (but does not eliminate) the gender gap and eliminates the effect of family background on students' interest in pursuing STEM fields in the future. Findings regarding outcome expectations and self-efficacy beliefs only partially support the SCCT model. Outcome expectations and self-efficacy beliefs positively correlate with students' entering tertiary education but did not differentiate between their interests in the fields of study.

Early secondary alveoloplasty in cleft lip and palate.

Science.gov (United States)

Arangio, Paolo; Marianetti, Tito M; Tedaldi, Massimiliano; Ramieri, Valerio; Cascone, Piero

2008-09-01

The aims of this study were to present a personal surgical technique throughout the review of international literature concerning surgical techniques, objectives, and outcomes in early secondary alveoloplasty and to describe our personal surgical techniques in alveolar bone defect repair in cleft lip and palate.Throughout a literature analysis, it is now settled that early secondary alveoloplasty could reestablish the continuity of alveolar bone and prevent upper dental arch collapse after presurgical orthopedic upper maxilla expansion; it also might give a good bone support for teeth facing the cleft and allow the eruption of permanent elements with the bone graft and rebalance the symmetry of dental arch, improve facial aesthetic, guarantee an adequate amount of bone tissue for a further prosthetic reconstruction with implant, and finally close the eventual oronasal fistula.The surgical technique we are presenting permitted a total number of 35 early secondary alveoloplasty on which a long-term follow-up is still taking place.We can assess that early secondary alveoloplasty must be performed before permanent canine eruption. Iliac crest is the suggested donor site for bone grafting; orthopedic and orthodontic treatments must be performed in association with surgery, and if there is the dental element agenesia, an implantation treatment must be considered.

Unfavourable outcomes in orthognathic surgery

OpenAIRE

Krishnamurthy Bonanthaya; P Anantanarayanan

2013-01-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other di...

Prospects for research in haemophilia with real-world data-An analysis of German registry and secondary data.

Science.gov (United States)

Schopohl, D; Bidlingmaier, C; Herzig, D; Klamroth, R; Kurnik, K; Rublee, D; Schramm, W; Schwarzkopf, L; Berger, K

2018-02-28

Open questions in haemophilia, such as effectiveness of innovative therapies, clinical and patient-reported outcomes (PROs), epidemiology and cost, await answers. The aim was to identify data attributes required and investigate the availability, appropriateness and accessibility of real-world data (RWD) from German registries and secondary databases to answer the aforementioned questions. Systematic searches were conducted in BIOSIS, EMBASE and MEDLINE to identify non-commercial secondary healthcare databases and registries of patients with haemophilia (PWH). Inclusion of German patients, type of patients, data elements-stratified by use in epidemiology, safety, outcomes and health economics research-and accessibility were investigated by desk research. Screening of 676 hits, identification of four registries [national PWH (DHR), national/international paediatric (GEPARD, PEDNET), international safety monitoring (EUHASS)] and seven national secondary databases. Access was limited to participants in three registries and to employees in one secondary database. One registry asks for PROs. Limitations of secondary databases originate from the ICD-coding system (missing: severity of haemophilia, presence of inhibitory antibodies), data protection laws and need to monitor reliability. Rigorous observational analysis of German haemophilia RWD shows that there is potential to supplement current knowledge and begin to address selected policy goals. To improve the value of existing RWD, the following efforts are proposed: ethical, legal and methodological discussions on data linkage across different sources, formulation of transparent governance rules for data access, redefinition of the ICD-coding, standardized collection of outcome data and implementation of incentives for treatment centres to improve data collection. © 2018 John Wiley & Sons Ltd.

Unfavourable outcomes in orthognathic surgery

Science.gov (United States)

Bonanthaya, Krishnamurthy; Anantanarayanan, P.

2013-01-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution. PMID:24501454

Unfavourable outcomes in orthognathic surgery

Directory of Open Access Journals (Sweden)

Krishnamurthy Bonanthaya

2013-01-01

Full Text Available Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A Pre- Treatment B During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

Unfavourable outcomes in orthognathic surgery.

Science.gov (United States)

Bonanthaya, Krishnamurthy; Anantanarayanan, P

2013-05-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

Directory of Open Access Journals (Sweden)

Abbass, Ibrahim

2015-05-01

Full Text Available Introduction: The use of observation units (OUs following emergency departments (ED visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs and the one-year outcomes. Methods: The author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011 admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV to compare variations across OUs. Results: There was minimal variability in the initial costs of care (WCV=2.2%, while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6% followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3% and secondary outcomes (WCV=10%. Conclusion: Higher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3:395–400.

Does Secondary School Size Make a Difference? A Systematic Review

Science.gov (United States)

Newman, M.; Garrett, Z.; Elbourne, D.; Bradley, S.; Noden, P.; Taylor, J.; West, A.

2006-01-01

There is a vast body of literature on school size but comparatively few high quality empirical studies comparing outcomes in schools of different sizes. This systematic review synthesizes the results of the published research from 31 studies on the effects of secondary school size from OECD countries since 1990. Overall the directions and patterns…

Secondary flow in turbulent ducts with increasing aspect ratio

Science.gov (United States)

Vinuesa, R.; Schlatter, P.; Nagib, H. M.

2018-05-01

Direct numerical simulations of turbulent duct flows with aspect ratios 1, 3, 5, 7, 10, and 14.4 at a center-plane friction Reynolds number Reτ,c≃180 , and aspect ratios 1 and 3 at Reτ,c≃360 , were carried out with the spectral-element code nek5000. The aim of these simulations is to gain insight into the kinematics and dynamics of Prandtl's secondary flow of the second kind and its impact on the flow physics of wall-bounded turbulence. The secondary flow is characterized in terms of the cross-plane component of the mean kinetic energy, and its variation in the spanwise direction of the flow. Our results show that averaging times of around 3000 convective time units (based on duct half-height h ) are required to reach a converged state of the secondary flow, which extends up to a spanwise distance of around ≃5 h measured from the side walls. We also show that if the duct is not wide enough to accommodate the whole extent of the secondary flow, then its structure is modified as reflected through a different spanwise distribution of energy. Another confirmation of the extent of the secondary flow is the decay rate of kinetic energy of any remnant secondary motions for zc/h >5 (where zc is the spanwise distance from the corner) in aspect ratios 7, 10, and 14.4, which exhibits a decreasing level of energy with increasing averaging time ta, and in its rapid rate of decay given by ˜ta-1 . This is the same rate of decay observed in a spanwise-periodic channel simulation, which suggests that at the core, the kinetic energy of the secondary flow integrated over the cross-sectional area, , behaves as a random variable with zero mean, with rate of decay consistent with central limit theorem. Long-time averages of statistics in a region of rectangular ducts extending about the width of a well-designed channel simulation (i.e., extending about ≃3 h on each side of the center plane) indicate that ducts or experimental facilities with aspect ratios larger than 10 may

Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy.

Science.gov (United States)

Magrina, Javier F; Cetta, Rachel L; Chang, Yu-Hui; Guevara, Gregory; Magtibay, Paul M

2013-05-01

Analysis of perioperative outcomes and survival of patients with recurrent ovarian cancer undergoing secondary cytoreduction by robotics, laparoscopy, or laparotomy. Retrospective analysis of 52 selected patients with recurrent ovarian cancer undergoing secondary cytoreduction by laparoscopy (9), laparotomy (33) or robotics (10) between January 2006 and December 2010. Comparison was made by a total of 21 factors including age, BMI, number of previous surgeries, tumor type and grade, number of procedures, and 15 types of procedures performed at secondary cytoreduction. For all patients, the mean operating time was 213.8 min, mean blood loss 657.4 ml; and mean hospital stay 7.5 days. Complete debulking was achieved in 75% of patients. Postoperative complications were noted in 36.5% of patients. Overall and progression-free survival at 3-years were 58.8% and 34.1%, respectively. Laparoscopy and robotics had reduced blood loss and hospital stay, while no differences were observed among the three groups for operating time, complications, complete debulking, and survival. Selected patients with recurrent ovarian cancer benefit from a laparoscopic or robotic secondary cytoreduction without compromising survival. Robotics and laparoscopy provide similar perioperative outcomes, and reduced blood loss and shorter hospital stay as compared to laparotomy. Laparotomy seems preferable for patients with widespread peritoneal implants, multiple sites of recurrence, and/or extensive adhesions. Copyright © 2013 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2017-09-01

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

Clinical presentation and treatment of primary and secondary paranasal mucoceles

Directory of Open Access Journals (Sweden)

Jih-Chin Lee

2014-01-01

Full Text Available Background: This retrospective study was conducted to describe and compare the clinical characteristics of primary mucoceles occurring in patients without a previous history of sinus surgery, the cause of mucoceles and secondary mucoceles resulting as a complication following endoscopic sinus surgery, and the Caldwell-Luc operation. Materials and Methods: This study reviewed 18 cases of primary mucoceles and 21 cases of secondary mucoceles, who were diagnosed and had received surgical intervention between 1995 and 2012. Results: The most common presenting symptoms in primary mucoceles were: Visual disturbance (18.6%, nasal obstruction (12.5%, and headache (12.5%. In secondary mucoceles, the most common symptoms were: Nasal obstruction (27.5%, rhinorrhea (15%, and postnasal drip (12.5%. The most common sites of origin for primary mucoceles were the ethmoid sinus (31.5% and sphenoid sinus (31.5%. In secondary mucoceles, the maxillary sinus was the most common site of origin (40.7%, followed by the ethmoid sinus (29.6%. All patients with secondary mucoceles had a history of sinus surgery. Conclusions: Mucoceles are benign lesions of the paranasal sinus. Cases of secondary mucoceles that occur following sinus endoscopic surgery develop more frequently in the ethmoid sinus compared to those following the Caldwell-Luc procedure. Endoscopic intranasal surgery of mucoceles is a reliable therapeutic measure with a favorable long-term outcome.

Outcomes following prehospital airway management in severe ...

African Journals Online (AJOL)

Backgound. Prevention of hypoxia and thus secondary brain injury in traumatic brain injury (TBI) is critical. However there is controversy regarding the role of endotracheal intubation in the prehospital management of TBI. Objective. To describe the outcome of TBI with various airway management methods employed in the ...

A national day with near zero emissions and its effect on primary and secondary pollutants

Science.gov (United States)

Levy, Ilan

2013-10-01

Traffic related air pollution is a major health concern in many countries. The potential costs and benefits of different abatement policies are usually estimated by either models, case studies or previously implemented intervention measures. Such estimations have, however, limited ability to predict the effect of a reduction in primary pollutants' emissions on secondary pollutants such as ozone, because of the nonlinear nature of the photochemical reactions. This study examines the short term effects of a drastic change in emissions on a national scale during the Jewish holiday of Day of Atonement (DA) in Israel. During the holiday nearly all anthropogenic emission sources are ceased for a period of 25 h, including all vehicles, commercial, industrial and recreational activities. DAs during the 15 years period of 1998-2012 are analyzed at three sites with respect to primary and secondary air pollutants, and in greater details for 2001. A dramatic decrease in primary pollutants emissions (83-98% in NO) causes an 8 ppbv increase in ozone at the urban core. Downwind (27 km), ozone decreases by only 5 ppbv. Nighttime O3 is shown to increase to 20 ppbv at the urban sites and 30 ppbv downwind. In spite of the striking reduction in emissions, changes in ozone are not greater than what is reported in the literature about less significant events like the ozone weekend effect. Changes in ambient pollution levels observed during DA provide some indication to the possible outcomes of a major change in anthropogenic emissions. These may be considered as the best case scenario for emissions reduction intervention measures and thus aid policy makers in evaluating potential benefits of such measures.

Perspectives of pupils, parents, and teachers on mental health problems among Vietnamese secondary school pupils

NARCIS (Netherlands)

Nguyen, Dat Tan; Dedding, Christine; Pham, Tam Thi; Bunders-Aelen, J.G.F.

2013-01-01

Background: Secondary school can be a stressful period for adolescents, having to cope with many life changes. Very little research has been conducted on the mental health status of secondary school pupils in South East Asian countries, such as Vietnam.The study aimed to explore perceptions of

KOH mount as an aid in the management of infectious keratitis at secondary eye care centre.

Science.gov (United States)

Rathi, Varsha M; Thakur, Monica; Sharma, Savitri; Khanna, Rohit; Garg, Prashant

2017-11-01

To report the clinical outcome of infectious keratitis managed after doing 10% KOH mount of corneal smears and reporting done by an ophthalmologist in the secondary eye care centre in South India. 103 consecutive cases of microbial keratitis were studied. Inclusion criteria were presence of corneal infiltrate on slit lamp biomicroscopy. An ophthalmologist carried out microbiological evaluation of 10% KOH mount of corneal scrapings. No cultures were done at secondary centres. Antifungal therapy with 5% Natamycin was initiated when 10% KOH mount was positive for fungal filaments. Else, the patients were started on combined topical ciprofloxacin (0.3%) and fortified cefazolin (5%). 41/103 (39.8%) smears were positive for fungus and 62 (60.2%) were negative. 89 out of 103 patients (86.40%) healed with scarring at an average of 2.95±1.58 weeks. Healing was noted in 39/41 (95.12%) of patients at an average of 3.06±1.19 weeks in patients with KOH smear positive keratitis. 80.64% (50/62) healed with scarring at an average period of 2.86±1.86 weeks in KOH mount negative keratitis. Initial smear examination of KOH mount by an ophthalmologist helped in diagnosis of infectious keratitis caused by fungi and its management and 95.12% of KOH positive patients healed with scarring. Reading of KOH mount by an ophthalmologist helped in initiation of specific therapy with improved clinical outcome. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Secondary Hyperparathyroidism in Heart Failure.

Science.gov (United States)

Morsy, Mohamed S; Dishmon, Dwight A; Garg, Nadish; Weber, Karl T

2017-10-01

Secondary hyperparathyroidism (SHPT) is a well-known pathophysiologic feature of chronic renal failure. In recent years, SHPT has become recognized as a complication of the aldosteronism associated with congestive heart failure and where excretory Ca 2+ and Mg 2+ wasting results in plasma-ionized hypocalcemia and hypomagnesemia. Elevations in plasma parathyroid hormone have adverse systemic consequences, including intracellular Ca 2+ overloading of myocytes and vascular smooth muscle with the induction of oxidative stress. Herein, we briefly review the presence and adverse outcomes of SHPT in persons with heart failure. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Etiology and Outcome of Chronic Kidney Disease in Iranian Children

Directory of Open Access Journals (Sweden)

Neamatollah Ataei

2016-07-01

Full Text Available Background Considering the significant geographical and ethnical differences in pattern of incidence, etiology and outcome of chronic kidney disease (CKD, the present study aimed to assess the etiology and outcome of CKD in Iranian children. Materials and Methods In a cross-sectional study etiology and outcome of 372 children aged 3 months to 18 years with CKD was studied during the period 1991 –2014. Children (186 boys, 186 girls with Stage 3 to 5 CKDs, defined as a glomerular filtration rate below 60 ml/min per 1.73 m2body surface area, were identified. Results Etiology was congenital anomalies of the kidney and urinary tract in 125 (33.60%, cystic/ hereditary/ congenital diseases in 91 (24.46%, glomerulopathy in 73(19.62%, and cause unknown in 71 (19.09% patients. Forty-eight (13.22% were on conservative treatment, 174(47.93% had end-stage renal disease (ESRD with chronic hemodialysis, 24 (6.61% were on continuous ambulatory peritoneal dialysis. Sixty-eight (18.74% underwent on renal transplant which was successful in 52 (14.33% patients but was associated with abnormal renal function in 16(4.41% children. Finally, 49 (13.50% patients died. Conclusion A large number of children developed CKD secondary to congenital anomalies of the kidney and urinary tract. Planning for screening, early detection and instituting timely treatment of preventable causes could lead to a lower incidence of CKD in this group of children.

The Impact of Digital Skills on Educational Outcomes: Evidence from Performance Tests

Science.gov (United States)

Pagani, Laura; Argentin, Gianluca; Gui, Marco; Stanca, Luca

2016-01-01

Digital skills are increasingly important for labour market outcomes and social participation. Do they also matter for academic performance? This paper investigates the effects of digital literacy on educational outcomes by merging data from the Italian National Assessment in secondary schools with an original data-set on performance tests of…

Is treatment outcome improved if patients match themselves to treatment options?

DEFF Research Database (Denmark)

Hell, Morten Ellegaard; Miller, William R; Nielsen, Bent

2018-01-01

standardized measures of alcohol problems: the Addiction Severity Index, Timeline Followback, the World Health Organization quality of life questionnaire, the NEO Five-Factor Inventory 3, and the Personal Happiness Form. For each outcome measure, two analyses will be conducted. Intention-to-treat analyses (ITT....... The primary outcome is decrease in number of monthly excessive drinking days 6 months after initiation of treatment. Secondary outcomes are compliance and 2 quality of life. The influence of personality traits on outcome will also be examined in both groups. DISCUSSION: The debate on matching patients...

Acute quadriplegia after interscalene block secondary to cervical body erosion and epidural abscess.

Science.gov (United States)

Porhomayon, Jahan; Nader, Nader D

2012-10-01

Although the incidence of neurological complications after shoulder surgery with regional anesthesia remains low but serious negative outcomes have been reported in the literature. Here we report a case of acute quadriplegia secondary to cervical epidural abscess and possible neck manipulation.

Music Listening--Romantic Period (1815-1914), Music: 5635.794.

Science.gov (United States)

Pearl, Jesse; Carter, Raymond

This secondary level Quinmester course is designed to teach the principal types of vocal, instrumental, and operatic compositions of the Romantic period through listening to the styles of different composers and acquiring recognition of their works. The course is intended for students who have participated in fine or performing arts and for pupils…

Amputation Surgery in a Secondary Healthcare Facility in Nigeria ...

African Journals Online (AJOL)

... our experience in amputation surgery over a ten – year period in a secondary healthcare facility in sub- Saharan Africa. A retrospective study of 117 patients that underwent amputation in the facility between January 1998 and December 2007. Trauma remains the commonest indication for amputation in our environment.

The Effects of Single-Sex and Coeducational Secondary Schooling on Girls' Achievement.

Science.gov (United States)

Daly, Peter

1996-01-01

The effect of coeducational and single-sex secondary schooling on female students' academic achievement was examined. Reexamination of earlier survey data from Northern Ireland studied six outcomes related to student performance on public examinations. Results indicated a small achievement advantage for single-sex schooling (not significant…

Teacher Thoughts on Infographics as Alternative Assessment: A Post-Secondary Educational Exploration

Science.gov (United States)

Gover, Glen Bruce

2017-01-01

This qualitative phenomenological case study is designed to investigate the learning outcomes, lived experiences, and perceptions of eight post-secondary teachers participating in a sketch-based infographic development training program. This research is designed to assess the viability of infographics as a learning and assessment strategy,…

[A study of relationship between occupational stress and diseases in secondary school teachers].

Science.gov (United States)

Zhang, Yang; Zhu, Tao; Tang, Liu; Li, Jian; Lan, Yajia

2015-10-01

To analyze the relationship between occupational stress and diseases in secondary school teachers in a city of Sichuan Province, and to provide a basis for the evaluation of the long-term effects of occupational stress in teachers. With secondary school teachers as the target population, the stratified cluster sampling was adopted to conduct three studies among 780, 119, and 689 secondary school teachers in a city of Sichuan Province in 1999, 2005, and 2009, respectively. The Occupational Stress Inventory-Revised Edition (OSI-R) and working ability index (WAI) were used to investigate occupational stress and diseases in secondary school teachers. The variation of occupational stress in secondary school teachers was compared between different periods and the relationship between the intensity of stress and diseases was evaluated, on the basis of which the variation of the relationship over time was analyzed. There were significant differences in occupational stress in secondary school teachers between different periods (Pstress and psychological stress were significantly higher in 2009 than in 1999 (Poccupational stress in 2009 changed with cardiovascular, respiratory, and mental diseases. The incidence of abnormal psychological stress was a risk factor for all chronic, respiratory, and mental diseases (OR: 1.88, 2.25, and 5.91). The time dependence of odds ratio was only found in the risk of respiratory diseases: occupational stress resulted in a significant increase in the risk of respiratory diseases over time (Pstress was a risk factor for mental diseases (OR=2.31). The intensity of occupational stress in secondary school teachers changes over time. Occupational stress elevates the risks of certain diseases and has a time-dependent effect on the risk of respiratory diseases. Occupational stress in secondary school teachers needs more attention and effective prevention.

Amino acid code of protein secondary structure.

Science.gov (United States)

Shestopalov, B V

2003-01-01

The calculation of protein three-dimensional structure from the amino acid sequence is a fundamental problem to be solved. This paper presents principles of the code theory of protein secondary structure, and their consequence--the amino acid code of protein secondary structure. The doublet code model of protein secondary structure, developed earlier by the author (Shestopalov, 1990), is part of this theory. The theory basis are: 1) the name secondary structure is assigned to the conformation, stabilized only by the nearest (intraresidual) and middle-range (at a distance no more than that between residues i and i + 5) interactions; 2) the secondary structure consists of regular (alpha-helical and beta-structural) and irregular (coil) segments; 3) the alpha-helices, beta-strands and coil segments are encoded, respectively, by residue pairs (i, i + 4), (i, i + 2), (i, i = 1), according to the numbers of residues per period, 3.6, 2, 1; 4) all such pairs in the amino acid sequence are codons for elementary structural elements, or structurons; 5) the codons are divided into 21 types depending on their strength, i.e. their encoding capability; 6) overlappings of structurons of one and the same structure generate the longer segments of this structure; 7) overlapping of structurons of different structures is forbidden, and therefore selection of codons is required, the codon selection is hierarchic; 8) the code theory of protein secondary structure generates six variants of the amino acid code of protein secondary structure. There are two possible kinds of model construction based on the theory: the physical one using physical properties of amino acid residues, and the statistical one using results of statistical analysis of a great body of structural data. Some evident consequences of the theory are: a) the theory can be used for calculating the secondary structure from the amino acid sequence as a partial solution of the problem of calculation of protein three

Secondary Sclerosing Cholangitis in Critically Ill Patients: Clinical Presentation, Cholangiographic Features, Natural History, and Outcome

Science.gov (United States)

Leonhardt, Silke; Veltzke-Schlieker, Wilfried; Adler, Andreas; Schott, Eckart; Eurich, Dennis; Faber, Wladimir; Neuhaus, Peter; Seehofer, Daniel

2015-01-01

Abstract Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is an important differential diagnosis in patients presenting with cholestasis and PSC-like cholangiographic changes in endoscopic retrograde cholangiography (ERC). As a relatively newly described entity, SSC-CIP is still underdiagnosed, and the diagnosis is often delayed. The present study aims to improve the early detection of SSC-CIP and the identification of its complications. A total of 2633 records of patients who underwent or were listed for orthotopic liver transplantation at the University Hospital Charité, Berlin, were analyzed retrospectively. The clinical presentation and outcome (mean follow-up 62.7 months) of the 16 identified SSC-CIP cases were reviewed. Cholestasis was the first sign of SSC-CIP. GGT was the predominant enzyme of cholestasis. Hypercholesterolemia occurred in at least 75% of the patients. SSC-CIP provoked a profound weight loss (mean 18 kg) in 94% of our patients. SSC-CIP was diagnosed by ERC in all patients. The 3 different cholangiographic features detected correspond roughly to the following stages: (I) evidence of biliary casts, (II) progressive destruction of intrahepatic bile ducts, and (III) picture of pruned tree. Biliary cast formation is a hallmark of SSC-CIP and was seen in 87% of our cases. In 75% of the patients, the clinical course was complicated by cholangiosepsis, cholangitic liver abscesses, acalculous cholecystitis, or gallbladder perforation. SSC-CIP was associated with worse prognosis; transplant-free survival was ∼40 months (mean). Because of its high rate of serious complications and unfavorable prognosis, it is imperative to diagnose SSC-CIP early and to differentiate SSC-CIP from other types of sclerosing cholangitis. Specific characteristics enable identification of SSC-CIP. Early cooperation with a transplant center and special attention to biliary complications are required after diagnosis of SSC-CIP. PMID:26656347

[Secondary hypertension].

Science.gov (United States)

Yoshida, Yuichi; Shibata, Hirotaka

2015-11-01

Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice.

Climatology and forest decay - stresses caused by dry periods

International Nuclear Information System (INIS)

Havlik, D.

1991-01-01

In the discussion of forest decline in the Eighties, stresses due to dry weather is often named as a secondary cause. The concept of 'climatological dry periods' is introduced in this article and applied to records for the Basel and Aachen regions. The time distribution of dry periods of different length and different water deficiency (40 mm, 60 mm, 100 mm) is analyzed. In the case of the Basel data, the dry periods are related to the 'forest damage caused by draught' recorded for the Basel region since 1930. The results support the theory that increasingly larger and more frequent dry periods with water shortage have contributed significantly to forest damage in the last 15 years. Apart from the 'dry stress' itself, also the enhanced production of photooxidants is a damaging mechanism. (orig.) [de

Costs, outcomes and challenges for diabetes care in Spain

OpenAIRE

Lopez-Bastida, Julio; Boronat, Mauro; Moreno, Juan Oliva; Schurer, Willemien

2013-01-01

Background Diabetes is becoming of increasing concern in Spain due to rising incidence and prevalence, although little information is known with regards to costs and outcomes. The information on cost of diabetes in Spain is fragmented and outdated. Our objective is to update diabetes costs, and to identify outcomes and quality of care of diabetes in Spain. Methods We performed systematic searches from secondary sources, including scientific literature and government data and reports. Results ...

Secondary and tertiary hyperparathyroidism in chronic kidney disease

Directory of Open Access Journals (Sweden)

Lilit V. Egshatyan

2017-12-01

Full Text Available In the treatment of secondary hyperparathyroidism of end-stage chronic kidney disease, vitamin D receptor activation and allosteric modulators of the calcium-sensing receptor – inhibit glandular hyperplasia, reduce parathyroid hormone levels, impact on bone turnover and mineral density. But the use of calcimimetic and vitamin D analogs or mimetics did not reduce the need for parathyroidectomy for refractory hyperparathyroidism. The enlarged parathyroid gland and gland nodular transformation became refractory to medical therapy and patient need for parathyroidectomy. Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone after a long period of secondary hyperparathyroidism and renal transplantation. In this article, we present the case of a Caucasian male with chronic kidney disease (end-stage on chronic hemodialysis and after kidney transplantation and different forms of hyperparathyroidism (secondary and tertiary. Our case study shows that only a multi-interventional strategy is likely to be more effective treatment in cases of severe and refractory to medical therapy hyperparathyroidism.

The Strategy of New Product Introduction in Durable Goods with Secondary Market: Application of the Optimization Method to Supply Chain Problem

Directory of Open Access Journals (Sweden)

Pei Zhao

2014-01-01

Full Text Available The aim of this paper is to address how the secondary market affects the strategy of the manufacturer’s new product introduction by using the optimization method. To do so, we develop a two-period model in which a monopolistic manufacturer sells its new durable products directly to end consumers in both periods, while an entrant operates a reverse channel selling used products in the secondary market. We assume that the manufacturer launches a higher quality product in the second period for the technological innovation. We find that the secondary market can actually increase the manufacturer’s profitability and drives the new product introduction in the second period. We also derive the effect of the durability and the degree of quality improvement on the pricing of supply chain partners.

STELLAR PULSATIONS AND PERIOD CHANGES IN THE SX PHOENICIS STAR XX CYGNI

International Nuclear Information System (INIS)

Yang, X. H.; Fu, J. N.; Zha, Q.

2012-01-01

Time-series photometric observations were made for the SX Phoenicis star XX Cyg between 2007 and 2011 at the Xinglong Station of National Astronomical Observatories of China. With the light curves derived from the new observations, we do not detect any secondary maximum in the descending portion of the light curves of XX Cyg, as reported in some previous work. Frequency analysis of the light curves confirms a fundamental frequency f 0 = 7.4148 cycles day –1 and up to 19 harmonics, 11 of which are newly detected. However, no secondary mode of pulsation is detected from the light curves. The O–C diagram, produced from 46 newly determined times of maximum light combined with those derived from the literature, reveals a continuous period increase with the rate of (1/P)(dP/dt) = 1.19(13) × 10 –8 yr -1 . Theoretical rates of period change due to the stellar evolution were calculated with a modeling code. The result shows that the observed rate of period change is fully consistent with period change caused by evolutionary behavior predicted by standard theoretical models.

History of a secondary side inspection tooling development

International Nuclear Information System (INIS)

Harris, W.

2012-01-01

This presentation provides a brief history (1980 to present day) of steam generator secondary side tooling requirements, tooling development, tooling available today and how and where this tooling has been implemented for steam generator secondary side inspections. History of Tooling Development discussion covers the relatively short time period from when the SGSS tooling was required and why as well the associated challenges with development through present day; Available Tooling discussion covers the actual tooling available today, locations in the steam generator where the tooling is used and how the tooling works; Implementation discussion covers where in the world this tooling has been deployed as well the benefits the tooling has provided. (author)

Organizational Climate, Services, and Outcomes in Child Welfare Systems

Science.gov (United States)

Glisson, Charles; Green, Philip

2011-01-01

Objective: This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and…

Secondary Intracranial Hypertension in Pediatric Patients With Leukemia.

Science.gov (United States)

Fernández-García, Miguel Ángel; Cantarín-Extremera, Verónica; Andión-Catalán, Maitane; Duat-Rodríguez, Anna; Jiménez-Echevarría, Saioa; Bermejo-Arnedo, Ignacio; Hortigüela-Saeta, Montesclaros; Rekarte-García, Saray; Babín-López, Lara; Ruano Domínguez, David

2017-12-01

We investigated the clinical characteristics of a pediatric population with hemato-oncological disease and intracranial hypertension, analyze the therapeutic response and outcome, and compare its characteristics with respect to a control group with idiopathic intracranial hypertension. We retrospectively analyzed patients with hemato-oncological disease and secondary intracranial hypertension in our center during the past five years. We compared these individuals with a historical cohort with idiopathic intracranial hypertension from our institution (control group). We identified eight patients, all with leukemia, and 21 controls. Mean age at diagnosis was 10.6 years, and 62% of individuals were female. Most of them were under treatment with drugs (62% corticosteroids, 75% active chemotherapy). Mean opening pressure of cerebrospinal fluid was 35 cm H 2 O. All had headache, but only 28% complained of visual symptoms. Only 12.5% exhibited papilledema at the time of diagnosis (versus 71% in controls). All of them were treated with acetazolamide, with average therapy duration of nine months, and all had a favorable outcome (versus 57% of controls who needed second-line treatment). None of them showed long-term visual complications (versus 20% of controls). Patients with hemato-oncological disease and secondary intracranial hypertension may not develop typical symptomatology. Thus, diagnosis and recognition of this entity among this cohort may be difficult. Associated factors are diverse and do not show an obvious causal relationship. A high index of suspicion must be maintained for diagnosis, because a favorable outcome is expected with prompt treatment. Acetazolamide is effective as a first-line therapy and caused few side effects. Copyright © 2017 Elsevier Inc. All rights reserved.

Educational attainment has a limited impact on disease management outcomes in heart failure.

Science.gov (United States)

Smith, Brad; Forkner, Emma; Krasuski, Richard A; Galbreath, Autumn Dawn; Freeman, Gregory L

2006-06-01

The objective of this study was to assess whether educational attainment moderates outcomes in the intervention group in a trial of disease management in heart failure (HF). Data were collected from a sample of 654 patients enrolled in the disease management arm of a community- based study of HF patients. The full sample was used to analyze two primary outcomes- all-cause mortality and cardiac event-free survival. Two other primary outcomes- rates of HF-related emergency department (ED) visits and inpatient admissions-and secondary outcomes (patient self-confidence in managing HF symptoms and daily dietary sodium intake in milligrams) were analyzed in a smaller sample of 602 patients who completed at least 6 months of disease management. One-way analysis of variance and chi (2) tests were used to assess differences in baseline demographic and clinical characteristics. Survival analyses were conducted with proportional hazards regression, while negative binomial regression was used to assess educational differences in ED usage and inpatient admissions. Repeated measures analysis of variance models were used to assess whether secondary outcomes differed across educational strata and/or over time. All outcome analyses were adjusted for confounders. Patients with the least education fared the poorest for all-cause mortality, but education- related differences failed to achieve statistical significance. No education-related differences were observed for cardiac event-free survival, or for the rates of inpatient admission and ED usage. For secondary outcomes, sodium intake differed significantly by education (p = 0.04), with the largest drop (-838 mg/day) observed in the least well-educated group. Confidence increased an approximately equal amount (2.1-3.0 points on a 100-point scale) across all educational strata (p = ns). Low educational attainment may not be a barrier to effective disease management.

Outcomes of malignant ovarian germ-cell tumors treated in Chiang Mai University Hospital over a nine year period.

Science.gov (United States)

Neeyalavira, Vithida; Suprasert, Prapaporn

2014-01-01

Malignant ovarian germ cell tumors (MOGCT) are rare neoplasms that most frequently occur in women at a young reproductive age. There have been limited data regarding this disease from Southeast Asian countries. We therefore conducted a retrospective study to analyze the clinical characteristics and the treatment outcomes of MOGCT treated at our institute between January, 2003 and December, 2012. Seventy-six patients were recruited from this period with the mean age of 21.6 years and 11.8% were pre-puberty. The two most common symptoms were pelvic mass and pelvic pain. Two-thirds of the studied patients presented at an early stage. The most common histology was immature teratoma (34.2%) followed by endodermal sinus tumor (28.9%), dysgerminoma (25%), mixed type (10.5%) and choriocarcinoma (1.3%). Over 80% of these patients received fertility sparing surgery and about 70% received adjuvant chemotherapy with the complete response rate at 73.3% and partial response at 11.1%. The most frequent chemotherapy was BEP regimen (bleomycin, etoposide, cisplatin). With the mean follow up time at 56.0 months, 12 patients (15.8%) developed recurrence and only an advanced stage was the independent prognostic factor. The ten year progression free survival (PFS) and overall survival rate of our study were 81.9% and 86.2%, respectively. In conclusion, MOGCT often occurs at a young age. Treatment with fertility sparing operations and adjuvant chemotherapy with a BEP regimen showed a good outcome. An advanced stage is a significant prognostic factor for recurrence.

Seasonal variations in secondary production of the Mandovi-Zuari estuarine system of Goa

Digital Repository Service at National Institute of Oceanography (India)

Selvakumar, R.A.; Nair, V.R.; Madhupratap, M.

. In general, the saline period was more productive (12.9 mg dry wt/m3/day) compared to the low saline period (11 mg dry wt/m3/day). The average secondary production in the estuarine system was 21.4 mg dry wt/m3/day or 1078 tonnes carbon/yr. The coefficient...

Which features of primary care affect unscheduled secondary care use? A systematic review.

Science.gov (United States)

Huntley, Alyson; Lasserson, Daniel; Wye, Lesley; Morris, Richard; Checkland, Kath; England, Helen; Salisbury, Chris; Purdy, Sarah

2014-05-23

To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Observational studies at primary care practice level. Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Secondary School Mathematics in Perspective: Conceptions of its Nature and Relevance.

Science.gov (United States)

Frid, Sandra; White, Loren

This study investigated the nature of secondary school students' and teachers' conceptions of what mathematics is, the purposes of school mathematics, and the outcomes of school mathematics. Interviews were conducted with a sample of grades 10, 11, and 12 students (n=40), teachers (n=19), counselors (n=2), and administrators (n=2) from a large…

Outcomes of vitrectomy for advanced diabetic retinopathy at Groote ...

African Journals Online (AJOL)

Background. Present limitations in primary and secondary prevention of diabetic retinopathy mean that many patients with diabetes present with advanced retinal complications, often requiring surgery (vitrectomy). Objectives. To determine the outcomes of vitrectomy for advanced diabetic retinopathy and to examine ...

Characteristics and generation of secondary jets and secondary gigantic jets

Science.gov (United States)

Lee, Li-Jou; Huang, Sung-Ming; Chou, Jung-Kung; Kuo, Cheng-Ling; Chen, Alfred B.; Su, Han-Tzong; Hsu, Rue-Rou; Frey, Harald U.; Takahashi, Yukihiro; Lee, Lou-Chuang

2012-06-01

Secondary transient luminous events (TLEs) recorded by the ISUAL-FORMOSAT2 mission can either be secondary jets or secondary gigantic jets (GJs), depending on their terminal altitudes. The secondary jets emerge from the cloud top beneath the preceding sprites and extend upward to the base of the sprites at ˜50 km. The secondary jets likely are negative electric discharges with vertically straight luminous columns, morphologically resembling the trailing jet of the type-I GJs. The number of luminous columns in a secondary jet seems to be affected by the size of the effective capacitor plate formed near the base of the preceding sprites and the charge distribution left behind by the sprite-inducing positive cloud-to-ground discharges. The secondary GJs originate from the cloud top under the shielding area of the preceding sprites, and develop upward to reach the lower ionosphere at ˜90 km. The observed morphology of the secondary GJs can either be the curvy shifted secondary GJs extending outside the region occupied by the preceding sprites or the straight pop-through secondary GJs developing through the center of the preceding circular sprites. A key factor in determining the terminal height of the secondary TLEs appears to be the local ionosphere boundary height that established by the preceding sprites. The abundance and the distribution of the negative charge in the thundercloud following the sprite-inducing positive cloud-to-ground discharges may play important role in the generation of the secondary TLEs.

THE PERIOD VARIATION OF AND A SPOT MODEL FOR THE ECLIPSING BINARY AR BOOTIS

International Nuclear Information System (INIS)

Lee, Jae Woo; Youn, Jae-Hyuck; Lee, Chung-Uk; Kim, Seung-Lee; Koch, Robert H.

2009-01-01

New CCD photometric observations of the eclipsing system AR Boo were obtained from 2006 February to 2008 April. The star's photometric properties are derived from detailed studies of the period variability and of all available light curves. We find that over about 56 yr the orbital period of the system has varied due to a combination of an upward parabola and a sinusoid rather than in a monotonic fashion. Mass transfer from the less massive primary to the more massive secondary component is likely responsible for at least a significant part of the secular period change. The cyclical variation with a period of 7.57 yr and a semi-amplitude of 0.0015 d can be produced either by a light-travel-time effect due to an unseen companion with a scaled mass of M 3 sin i 3 = 0.081 M sun or by a magnetic period modulation in the secondary star. Historical light curves of AR Boo, as well as our own, display season-to-season light variability, which are best modeled by including both a cool spot and a hot one on the secondary star. We think that the spots express magnetic dynamo-related activity and offer limited support for preferring the magnetic interpretation of the 7.57 yr cycle over the third-body interpretation. Our solutions confirm that AR Boo belongs to the W-subtype contact binary class, consisting of a hotter, less massive primary star with a spectral type of G9 and a companion of spectral type K1.

Perspectives of pupils, parents, and teachers on mental health problems among Vietnamese secondary school pupils

OpenAIRE

Nguyen, Dat Tan; Dedding, Christine; Pham, Tam Thi; Bunders-Aelen, J.G.F.

2013-01-01

Background: Secondary school can be a stressful period for adolescents, having to cope with many life changes. Very little research has been conducted on the mental health status of secondary school pupils in South East Asian countries, such as Vietnam.The study aimed to explore perceptions of mental health status, risk factors for mental health problems and strategies to improve mental health among Vietnamese secondary school students. Methods. A qualitative design was used to address the ma...

Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania.

Science.gov (United States)

Fieß, Achim; Shah, Peter; Sii, Freda; Godfrey, Furahini; Abbott, Joe; Bowman, Richard; Bauer, Jacqueline; Dithmar, Stefan; Philippin, Heiko

2017-07-01

The purpose is to describe the outcome of trabeculectomy with transscleral cyclophotocoagulation (TSCPC) as an initial intervention for secondary childhood glaucoma in Northern Tanzania. A retrospective, consecutive case series was analyzed of all children with secondary childhood glaucoma who underwent initial trabeculectomy or TSCPC between 2000 and 2013 at a referral eye unit in Northern Tanzania. Retrospective data were collected on causes of glaucoma, intraocular pressure (IOP), visual acuity, complications, and subsequent interventions. Outcomes were evaluated using Kaplan-Meier survival analysis and compared with Cox regression analysis. The main outcome measure was failure (IOP>21 mm Hg). Thirty-six eyes of 27 children (male, 21; median age, 9 y; range, 0.3 to 15 y) with secondary childhood glaucoma underwent trabeculectomy (19 eyes, 53%) or TSCPC (17 eyes, 47%). Causes included ocular trauma (13, 36%), previous cataract surgery (12, 33%), congenital aniridia (5, 14%), Sturge-Weber syndrome (2, 6%), steroid-induced glaucoma (2, 6%), uveitis (1, 3%), and unspecified leucoma (1, 3%). After 12 months, success was achieved in 48% after trabeculectomy and 18% after TSCPC, with visual acuity remaining unchanged in 11 of 14 (79%) and 4 of 5 eyes (80%), respectively. One third of the children did not return for follow-up after 1 year. Distance to the hospital (>100 km) was a significant risk factor for trabeculectomy failure (P=0.031). A high proportion of secondary childhood glaucoma in Northern Tanzania was caused by trauma and previous cataract surgery. Trabeculectomy was associated with better IOP control but also a higher complication rate. The ability to maintain visual function was comparable after both interventions. Failure was associated with a journey to the eye hospital (>100 km) possibly leading to late presentation with advanced disease and erratic follow-up.

Incentivizing Advanced Mathematics Study at Upper Secondary Level: The Case of Bonus Points in Ireland

Science.gov (United States)

Treacy, Páraic Thomas

2018-01-01

Secondary level mathematics education in Ireland has recently experienced a period of significant change with the introduction of new curricula and the addition of an incentive to study upper secondary mathematics at the most advanced level (Higher Level). This incentive, typically referred to as 'bonus points', appears to have aided a significant…

Adult Outcome of Children Reared for Long-Term Periods in Foster Families.

Science.gov (United States)

Dumaret, Annick-Camille; Coppel-Batsch, Marthe; Couraud, Simone

1997-01-01

Assessment of adult outcomes of 59 children from severely psychosocially dysfunctional families, who were placed in foster families for at least five years, found most had overcome their childhood adversities with 56% well-integrated socially and only 10% in situations of failure. Difficulties were linked to multiple family disturbances, traumatic…

Hyponatremic hypertensive syndrome secondary to renal ischemia – Case report

Directory of Open Access Journals (Sweden)

Joana Cunha Oliveira

2018-01-01

Full Text Available Hyponatremic hypertensive syndrome (HHS is characterized by hypertensive crisis, and hyponatremia secondary to unilateral renal damage with glomerular and tubular dysfunction. Elevated plasma levels of renin in most cases suggest that the stimulation of renin release from the ischemic kidney plays an important pathophysiologic role. Activation of the renin-angiotensin system results in hypertension and causes secondary hyperfiltration, pressure diuresis and sodium loss from contralateral non-damaged kidney. An elevated renin level is a pathognomonic finding in HHS. Potassium deficiency from hyperaldosteronism may further stimulate renin secretion and intensify this vicious circle.We report a female term newborn, who presented with hypertensive crisis on the seventh day after traumatic birth. The first three days of life were uneventful. Initial treatment with captopril resulted in severe hypotension and hemodynamic instability. Lab work revealed hyponatremia, hypokalemia, and elevated peripheral renin activity and aldosterone levels. Complementary sonography and magnetic resonance confirmed right adrenal gland hematoma and several ischemic areas in the upper pole of the right kidney. The diagnosis of HHS secondary to renal ischemia was evoked.HHS is a rare condition in the neonatal period, though still under-recognized. In the neonatal and early infancy period, renovascular disease is the most common cause of secondary hypertension. In this case, there was no sign of vascular disease, the renin-angiotensin system was activated secondary to direct renal ischemia and infarction. The intense renin stimulation and pressure through the contralateral normal kidney results in high pressure natriuresis facilitating a severe volume-depleted state. Although the use of renin-angiotensin system inhibitors is the treatment of choice, it is imperative to re-establish hydration and renal perfusion before starting this antihypertensive medication. We aimed to

The use of bicycle workstations to increase physical activity in secondary classrooms

Directory of Open Access Journals (Sweden)

Alicia Fedewa

2017-11-01

Full Text Available Background To date, the majority of interventions have implemented classroom-based physical activity (PA at the elementary level; however, there is both the potential and need to explore student outcomes at high-school level as well, given that very few studies have incorporated classroom-based PA interventions for adolescents. One exception has been the use of bicycle workstations within secondary classrooms. Using bicycle workstations in lieu of traditional chairs in a high school setting shows promise for enhancing adolescents’ physical activity during the school day. Participants and procedure The present study explored the effects of integrating bicycle workstations into a secondary classroom setting for four months in a sample of 115 adolescents using an A-B-A-B withdrawal design. The study took place in one Advanced Placement English classroom across five groups of students. Physical activity outcomes included average heart rate, and caloric expenditure. Behavioural outcomes included percentage of on-task/off-task behaviour and number of teacher prompts in redirecting off-task behaviour. Feasibility and acceptability data of using the bicycle workstations were also collected. Results Findings showed significant improvements in physical activity as measured by heart rate and caloric expenditure, although heart rate percentage remained in the low intensity range when students were on the bicycle workstations. No effects were found on students’ on-task behaviour when using the bicycle workstations. Overall, students found the bikes acceptable to use but noted disadvantages of them as well. Conclusions Using bicycle workstations in high-school settings appears promising for enhancing low-intensity physical activity among adolescents. The limitations of the present study and implications for physical activity interventions in secondary schools are discussed.

Outcomes of a National Cohort of Children with Acute Severe Ulcerative Colitis

Directory of Open Access Journals (Sweden)

Abisoye O. Akintimehin

2018-03-01

Full Text Available AimAll Irish children with ulcerative colitis (UC attend the National Centre for Paediatric Gastroenterology at Our Lady’s Children’s Hospital, Crumlin. The aim of this study was to determine the outcomes of children with acute severe ulcerative colitis (ASC and the impact of infliximab on these outcomes following its introduction for this indication in 2011.MethodsA retrospective chart review of all patients admitted with ASC between January 1, 2009 and December 31, 2015 was undertaken. Patients were identified from the departmental database cross-referenced with the hospital inpatient enquiry system. Inpatients with a paediatric ulcerative colitis activity index (PUCAI of ≥65 were included. Data collected included baseline demographic and laboratory data, concomitant treatments, PUCAI scores on days 3 and 5, second-line treatments, surgery, and discharge outcomes. Infliximab dose, frequency, and available therapeutic drug monitoring results were recorded, along with clinical response outcomes (remission, primary, and secondary loss of response. The cohort was sub-analysed to determine if there was any era effect pre- and post-introduction of infliximab (2009–2010 and 2011–2015, respectively.ResultsFifty-five patients (M:F = 1.4:1 were treated for acute severe colitis over the study period (8 in the pre-infliximab and 47 in the post-infliximab era and 46/55 (86% had steroid-refractory disease. Of these, 7/8 (88% required colectomy in the pre-infliximab era, compared with 15/47 (36% in the post-infliximab era. The remission rate with second-line infliximab was 61% at maximal follow-up. There were no identifiable factors that predicted likely success or failure of infliximab, including gender, CRP, day-3 and day-5 PUCAI scores. Of the 33 patients treated with infliximab, dose increase was required in 23/33 (70%; 21/33 (64% received an accelerated dose schedule, and 9/33 (27% eventually needed colectomy. Primary and secondary loss of

Extended Delivery Time Analysis for Cognitive Packet Transmission With Application to Secondary Queuing Analysis

KAUST Repository

Usman, Muneer

2015-05-21

Cognitive radio transceiver can opportunistically access the underutilized spectrum resource of primary systems for new wireless services. With interweave implementation, the secondary transmission may be interrupted by the primary user\\'s transmission. To facilitate the delay analysis of such secondary transmission for fixed-size secondary packets, we study the resulting extended delivery time that includes both transmission time and waiting time. In particular, we derive the exact distribution functions of extended delivery time of secondary transmission for both continuous sensing and periodic sensing cases. Selected numerical and simulation results are presented for illustrating the mathematical formulation. Finally, we consider an M/G/1 queueing set-up at the secondary transmitter and formulate the closed-form expressions for the expected delay with Poisson traffic. The analytical results will greatly facilitate the design of the secondary system for particular target application. © 2015 IEEE.

Implementation of sunshine sports in secondary schools in Tianjin ...

African Journals Online (AJOL)

A total of 450 physical education (PE) teachers in 34 secondary schools drawn from six districts in Tianjin participated in the study. ... schools in Tianjin met the official requirement for teaching sunshine sports, except during examination period in which 80% of PE classes were substituted by other 'academic' lessons. A total ...

Outcomes in chevron osteotomy for Hallux Valgus in a large cohort.

Science.gov (United States)

van Groningen, Bart; van der Steen, M C Marieke; Reijman, Max; Bos, Janneke; Hendriks, Johannes G E

2016-12-01

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details. Copyright © 2016 Elsevier Ltd. All rights

Impact of earthquakes and their secondary environmental effects on public health

Science.gov (United States)

Mavroulis, Spyridon; Mavrouli, Maria; Lekkas, Efthymios; Tsakris, Athanassios

2017-04-01

Earthquakes are among the most impressive geological processes with destructive effects on humans, nature and infrastructures. Secondary earthquake environmental effects (EEE) are induced by the ground shaking and are classified into ground cracks, slope movements, dust clouds, liquefactions, hydrological anomalies, tsunamis, trees shaking and jumping stones. Infectious diseases (ID) emerging during the post-earthquake period are considered as secondary earthquake effects on public health. This study involved an extensive and systematic literature review of 121 research publications related to the public health impact of 28 earthquakes from 1980 to 2015 with moment magnitude (Mw) from 6.1 to 9.2 and their secondary EEE including landslides, liquefaction and tsunamis generated in various tectonic environments (extensional, transform, compressional) around the world (21 events in Asia, 5 in America and one each in Oceania and Europe). The inclusion criteria were the literature type comprising journal articles and official reports, the natural disaster type including earthquakes and their secondary EEE (landslides, liquefaction, tsunamis), the population type including humans and the outcome measures characterized by disease incidence increase. The potential post-earthquake ID are classified into 14 groups including respiratory (detected after 15 of 28 earthquakes, 53.57%), water-borne (15, 53.57%), skin (8, 28.57%), vector-borne (8, 28.57%) wound-related (6, 21.43%), blood-borne (4, 14.29%), pulmonary (4, 14.29%), fecal-oral (3, 10.71%), food-borne (3, 10.71%), fungal (3, 10.71%), parasitic (3, 10.71%), eye (1, 3.57%), mite-borne (1, 3.57%) and soil-borne (1, 3.57%) infections. Based on age and genre data available for 15 earthquakes, the most vulnerable population groups are males, young children (age ≤ 10 years) and adults (age ≥ 65 years). Cholera, pneumonia and tetanus are the deadliest post-earthquake ID. The risk factors leading not only to disease

Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007.

Science.gov (United States)

Ranasinghe, Isuru; Naoum, Chris; Aliprandi-Costa, Bernadette; Sindone, Andrew P; Steg, P Gabriel; Elliott, John; McGarity, Bruce; Lefkovits, Jeffrey; Brieger, David

2012-05-01

The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time. A total of 5556 patients enrolled in the Australia-New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15-2.71], readmission post-discharge (OR 1.47, 95% CI 1.17-1.90), and 6-month mortality (OR 2.25, 95% CI 1.55-3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation. Acute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.

Single-Sex Schooling and Labour Market Outcomes

Science.gov (United States)

Sullivan, Alice; Joshi, Heather; Leonard, Diana

2011-01-01

One quarter of the 1958 British Birth cohort attended single-sex secondary schools. This paper asks whether sex-segregated schooling had any impact on the experience of gender differences in the labour market in mid-life. We examine outcomes at age 42, allowing for socio-economic origins and abilities measured in childhood. We find no net impact…

Intraclass correlation values for adolescent health outcomes in secondary schools in 21 European countries

Directory of Open Access Journals (Sweden)

N. Shackleton

2016-12-01

Full Text Available Background: Cluster randomised controlled trials (CRCTs are increasingly used to evaluate the effectiveness of interventions for improving health. A key feature of CRCTs is that individuals in clusters are often more alike than individuals in different clusters, irrespective of treatment. This similarity within clusters needs to be taken into account when planning CRCTs to obtain adequate sample sizes, and when analysing clustered data to obtain correct estimates. Methods: Nationally representative data from 15 to 16 year olds were analysed, from 21 of the 35 countries that participated in the 2007 European School Survey Project on Alcohol and Other Drugs. Within country school level intra-class correlation coefficients (ICCs were calculated for substance use (self-reported alcohol use, regular alcohol use, binge drinking, any smoking, regular smoking, and illicit drug use and psychosocial health (depressive mood and self-esteem. Unadjusted and adjusted ICCs are presented. ICCs are adjusted for student sex and socioeconomic status. Results: ICCs ranged from 0.01 to 0.21, with the highest (0.21 reported for regular smoking. Within country school level ICCs varied substantially across health outcomes, and among countries for the same health outcomes. Estimated ICCs were consistently higher for substance use (range 0.01–0.21, than for psychosocial health (range 0.01–0.07. Within country ICCs for health outcomes varied by changes in the measurement of particular health outcomes, for example the ICCs for regular smoking (range 0.06–0.21 were higher than those for having smoked at all in the last month (range 0.03–0.17. Conclusions: For school level ICCs to be effectively utilised in informing sample size requirements for CRCTs and adjusting estimates from meta-analyses, the school level ICCs need to be both country and outcome specific. Keywords: Intra-class correlation, Schools, Adolescents, Substance use, Mental health

Association of the 2011 ACGME resident duty hour reform with general surgery patient outcomes and with resident examination performance.

Science.gov (United States)

Rajaram, Ravi; Chung, Jeanette W; Jones, Andrew T; Cohen, Mark E; Dahlke, Allison R; Ko, Clifford Y; Tarpley, John L; Lewis, Frank R; Hoyt, David B; Bilimoria, Karl Y

2014-12-10

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident duty hour requirements beyond those established in 2003, leading to concerns about the effects on patient care and resident training. To determine if the 2011 ACGME duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance. Quasi-experimental study of general surgery patient outcomes 2 years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform. Teaching and nonteaching hospitals were compared using a difference-in-differences approach adjusted for procedural mix, patient comorbidities, and time trends. Teaching hospitals were defined based on the proportion of cases at which residents were present intraoperatively. Patients were those undergoing surgery at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). General surgery resident performance on the annual in-training, written board, and oral board examinations was assessed for this same period. National implementation of revised resident duty hour requirements on July 1, 2011, in all ACGME accredited residency programs. Primary outcome was a composite of death or serious morbidity; secondary outcomes were other postoperative complications and resident examination performance. In the main analysis, 204,641 patients were identified from 23 teaching (n = 102,525) and 31 nonteaching (n = 102,116) hospitals. The unadjusted rate of death or serious morbidity improved during the study period in both teaching (11.6% [95% CI, 11.3%-12.0%] to 9.4% [95% CI, 9.1%-9.8%], P adverse outcome. Mean (SD) in-training examination scores did not significantly change from 2010 to 2013 for first-year residents (499.7 [ 85.2] to 500.5 [84.2], P = .99), for residents from other postgraduate years, or for first-time examinees taking the written or oral board

Sedentary behaviour across the primary-secondary school transition: A systematic review.

Science.gov (United States)

Pearson, Natalie; Haycraft, Emma; P Johnston, Julie; Atkin, Andrew J

2017-01-01

The transition from primary/middle school to secondary/high school is likely to be a key period in children's development, characterised by significant changes in their social and physical environment. However, little is known about the changes in sedentary behaviour that accompany this transition. This review aimed to identify, critically appraise and summarise the evidence on changes in sedentary behaviour across the primary - secondary school transition. Published English language studies were located from computerised and manual searches in 2015. Inclusion criteria specified a longitudinal design, baseline assessment when children were in primary/middle school with at least one follow-up during secondary/high school and a measure of sedentary behaviour at both (or all) points of assessment. Based on data from 11 articles (19 independent samples), tracking coefficients were typically in the range of 0.3 to 0.5 and relatively consistent across the different sedentary behaviours examined and durations of follow-up. Both screen-based sedentary behaviour and overall sedentary time increased during the school transition. Overall there was an increase of approximately 10-20min per day per year in accelerometer-assessed sedentary time. Consistent with the broader age-related changes in behaviour observed during this period, sedentary behaviour increases during the transition from primary/middle to secondary/high school. Investigating features of the social and physical environment that might exacerbate or attenuate this trend would be a valuable next step. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Secondary Restoration Control of Islanded Microgrids With Decentralized Event-triggered Strategy

DEFF Research Database (Denmark)

Guerrero, Josep M.; Chen, Meng; Xiao, Xiangning

2018-01-01

in the feedback control laws, the proposed control strategies just require the communication between distributed secondary controllers at some particular instants while having frequency and voltage restoration function and accurate active power sharing. The stability and inter-event interval are also analyzed......Distributed cooperative control methods attract more and more attention in microgrid secondary control because they are more reliable and flexible. However, the traditional methods rely on the periodic communication, which is neither economic nor efficient due to its large communication burden...... in this paper. An islanded microgrid test system is built in PSCAD/EMTDC to validate the proposed control strategies. It shows that the proposed secondary control strategies based on event-triggered approach can highly reduce the inter-agent communication....

God imagery and affective outcomes in a spiritually integrative inpatient program.

Science.gov (United States)

Currier, Joseph M; Foster, Joshua D; Abernethy, Alexis D; Witvliet, Charlotte V O; Root Luna, Lindsey M; Putman, Katharine M; Schnitker, Sarah A; VanHarn, Karl; Carter, Janet

2017-08-01

Religion and/or spirituality (R/S) can play a vital, multifaceted role in mental health. While beliefs about God represent the core of many psychiatric patients' meaning systems, research has not examined how internalized images of the divine might contribute to outcomes in treatment programs/settings that emphasize multicultural sensitivity with R/S. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually integrative inpatient program over a two-year period, this study tested direct/indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes (positive and negative). When accounting for patients' demographic and religious backgrounds, structural equation modeling results revealed: (1) overall effects for God imagery at pre-treatment on post-treatment levels of both positive and negative affect; and (2) religious comforts and strains fully mediated these links. Secondary analyses also revealed that patients' generally experienced reductions in negative emotion in God imagery over the course of their admission. These findings support attachment models of the R/S-mental health link and suggest that religious comforts and strains represent distinct pathways to positive and negative domains of affect for psychiatric patients with varying experiences of God. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Impact Of Secondary-Primary Pumps Operating Sequence On The Electrical Power Supply System

International Nuclear Information System (INIS)

Suwoto; Rusdiyanto; Kiswanto

2001-01-01

The operating procedure of the reactor cooling system has decided that the primary cooling pump should be operated before secondary cooling pump as known primary-secondary pumps operating sequence. This decision is based on consideration that starting current of the primary pump is higher than secondary pump. Therefore, the primary-secondary pumps operating sequence can avoid the power supply system failure. However, this operating procedure has to take a consequence that in case of primary pump failure, the shutdown time period of the reaktor to be longer caused to re operate the primary pump has required that the running secondary pump should be shutted off. To solve this problem, an impact analysis of the secondary-primary pumps operating sequence on the electric power supply system was carried out to identify the revision possibility of the cooling pump operating procedure. The analysis by discussion of the measuring results of the secondary and primary pump starting current related to another electrical loads has been measured. From discussion it can be concluded that secondary-primary pumps operating sequence has no impact to failure in electric power supply system

Aphasia As a Predictor of Stroke Outcome.

Science.gov (United States)

Lazar, Ronald M; Boehme, Amelia K

2017-09-19

Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.

Secondary Channel Bifurcation Geometry: A Multi-dimensional Problem

Science.gov (United States)

Gaeuman, D.; Stewart, R. L.

2017-12-01

The construction of secondary channels (or side channels) is a popular strategy for increasing aquatic habitat complexity in managed rivers. Such channels, however, frequently experience aggradation that prevents surface water from entering the side channels near their bifurcation points during periods of relatively low discharge. This failure to maintain an uninterrupted surface water connection with the main channel can reduce the habitat value of side channels for fish species that prefer lotic conditions. Various factors have been proposed as potential controls on the fate of side channels, including water surface slope differences between the main and secondary channels, the presence of main channel secondary circulation, transverse bed slopes, and bifurcation angle. A quantitative assessment of more than 50 natural and constructed secondary channels in the Trinity River of northern California indicates that bifurcations can assume a variety of configurations that are formed by different processes and whose longevity is governed by different sets of factors. Moreover, factors such as bifurcation angle and water surface slope vary with discharge level and are continuously distributed in space, such that they must be viewed as a multi-dimensional field rather than a single-valued attribute that can be assigned to a particular bifurcation.

Liraglutide and Renal Outcomes in Type 2 Diabetes

DEFF Research Database (Denmark)

Mann, Johannes F E; Ørsted, David D; Brown-Frandsen, Kirstine

2017-01-01

BACKGROUND: In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal...... patients were assigned to receive liraglutide or placebo. The secondary renal outcome was a composite of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The risk of renal outcomes was determined with the use...

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.

Gait outcome following outpatient physiotherapy based on the Bobath concept in people post stroke.

Science.gov (United States)

Lennon, Sheila; Ashburn, Ann; Baxter, David

The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept. Nine patients, at least 6 weeks post stroke and recently discharged from a stroke unit, were measured before and after a period of outpatient physiotherapy (mean duration = 17.4 weeks). Therapy was documented using a treatment checklist for each patient. The primary outcome measures were a number of gait variables related to the therapists' treatment hypothesis, recorded during the gait cycle using the CODA motion analysis system. Other secondary outcome measures were the Motor Assessment Scale, Modified Ashworth Scale, subtests of the Sodring Motor Evaluation Scale, the Step test, a 10-m walk test, the Barthel Index and the London Handicap Score. Recovery of more normal gait patterns in the gait cycle (using motion analysis) did not occur. Significant changes in temporal parameters (loading response, single support time) for both legs, in one kinematic (dorsiflexion during stance) and one kinetic variable on the unaffected side (hip flexor moment), and most of the clinical measures of impairment, activity and participation (with the exception of the Modified Ashworth Scale and the 10-m walk) were noted. Study findings did not support the hypothesis that the Bobath approach restored more normal movement patterns to the gait cycle. Further research is required to investigate the treatment techniques that are effective at improving walking ability in people after stroke.

English Learners with Disabilities in High School: Population Characteristics, Transition Programs, and Postschool Outcomes

Science.gov (United States)

Trainor, Audrey; Murray, Angela; Kim, Hye-Jung

2016-01-01

Little is known about the characteristics, transition education, and postschool outcomes of English learners with disabilities (ELSWDs), despite that English learners are a rapidly growing group of U.S. students with consistently poor outcomes. This study examines a nationally representative sample of ELSWDs through a secondary analysis of the…

23. Epidemiological aspects and clinical outcomes of mitral valve prolapse in Saudi adults over a 10 year period

Directory of Open Access Journals (Sweden)

A. alkahtani

2016-07-01

Full Text Available Mitral valve prolapse (MVP is a well recognized clinical entity that is associated with significant morbidity. Epidemiology, echocardiographic (echo characteristics and clinical outcome of MVP in Saudi Arabia have not been studied. To determine the prevalence, echo features and clinical outcome of MVP among the adult Saudi patients who underwent echo evaluation over a 10-year period.Retrospective review of consecutive cases of MVP or any of its components as diagnose by echocardiogram. Study was conducted in King Abdulaziz Cardiac Center, Riyadh and included 121,419 adult echo studies done between January 2003 and December 2012. Study population consisted of 77,176 patients after removing duplicate studies. Echo parameters for all Saudi nationals ⩾14 y of age were collected from the Xcelera database. Mitral valve disease due to non-myxomatous prolapse were excluded. Among the study population (n = 77,176 600 patients were labled as having MVP or any of its echo features (0.7%. Mean age was 64 years and 62% were males. Majority of patients (54.4% had mild MVP, while moderate and severe prolapse were present in 21.1% and 24.5% respectively. Severe mitral regurgitation was present in 16.5% and chordal rupture was noted in 9%. Left ventricular size was moderately dilated in 7.6% and severely dilated in 1.3%.Prevalence of MVP in Saudi nationals at a referral cardiac center is less than the reported international figure of 1-3%. In contrary to published literature MVP in Saudi population seems to be more common in males and seems to be diagnosed at a later age.

The presentation and pregnancy outcome among teenage parturients in state specialist hospital, Asubiaro, Osogbo, Southwestern, Nigeria

Directory of Open Access Journals (Sweden)

Olalekan Olugbenga Awolola

2018-01-01

Full Text Available Background: Teenage pregnancies are pregnancies between the age group of 13 and 19 years. Such pregnancies are categorized as high-risk pregnancies worldwide. This makes monitoring during the antenatal, intrapartum, and puerperal periods highly important. Objectives: The aim of this study is to determine the incidence, the mode of presentation, and the materno-fetal outcome in teenage parturients and compare with a control group. Materials and Methods: this prospective case–control study, recruited 63 teenage parturients who presented in labor ward in active phase labour between February 2013 and January 2015. These teenage parturients were matched with a control group in terms of parity and cervical dilatation of not less than or more than 1 cm (+1 cm, but are of age, 22–30 years. Thus, a total number of 126 parturients were studied. The mothers and their babies were followed up until the first 7th day postpartum. Results: In this study, 39 (61.90% and 24 (38.10% were married and unmarried, respectively, among the teenage parturients, whereas 60 (95.24% and 3 (4.7% were married and unmarried among the control group. Majority of the teenage parturients, 57 (90.47% had only primary and secondary education, while 59 (93.47% among the controls had secondary and tertiary levels of education. There were statistically significant differences in the incidences of genital lacerations (9 [14.28%] and 2 [3.18%]: P < 0.05, and the incidences of anemia in pregnancy (9 [14.28%] vs. 2 [3.18%]: P < 0.05 in the teenage and the older parturients. The other outcome measures in the two groups were similar. Conclusion: This study showed that teenage pregnancies with good antenatal, intrapartum, and neonatal care, gives almost the same materno-fetal outcomes as the control group. The determining factors for poor maternal and fetal outcomes are poor socioeconomic status and lack or poor quality of antenatal, intrapartum, and puerperal care.

Long-Term Outcomes of Cognitive–Behavioral Treatments for Posttraumatic Stress Disorder Among Female Rape Survivors

Science.gov (United States)

Resick, Patricia A.; Williams, Lauren F.; Suvak, Michael K.; Monson, Candice M.; Gradus, Jaimie L.

2012-01-01

Objective We conducted a long-term follow-up (LTFU) assessment of participants from a randomized controlled trial comparing cognitive processing therapy (CPT) with prolonged exposure (PE) for posttraumatic stress disorder (PTSD). Competing hypotheses for positive outcomes (i.e., additional therapy, medication) were examined. Method Intention-to-treat (ITT) participants were assessed 5–10 years after participating in the study (M = 6.15, SD = 1.22). We attempted to locate the 171 original participants, women with PTSD who had experienced at least one rape. Of 144 participants located, 87.5% were reassessed (N = 126), which constituted 73.7% of the original ITT sample. Self-reported PTSD symptoms were the primary outcome. Clinician-rated PTSD symptoms, comorbid diagnoses, and self-reported depression were secondary outcomes. Results Substantial decreases in symptoms due to treatment (as reported in Resick, Nishith, Weaver, Astin, & Feuer, 2002) were maintained throughout the LTFU period, as evidenced by little change over time from posttreatment through follow-up (effect sizes ranging from pr = .03 to .14). No significant differences emerged during the LTFU between the treatment conditions (Cohen’s d = 0.06–0.29). The ITT examination of diagnostics indicated that 22.2% of CPT and 17.5% of PE participants met the diagnosis for PTSD according to the Clinician-Administered PTSD Scale (Blake et al., 1995) at the LTFU. Maintenance of improvements could not be attributed to further therapy or medications. Conclusions CPT and PE resulted in lasting changes in PTSD and related symptoms over an extended period of time for female rape victims with extensive histories of trauma. PMID:22182261

Using Misoprostol for Primary versus Secondary Prevention of Postpartum Haemorrhage - Do Costs Matter?

Science.gov (United States)

Chatterjee, Susmita; Sarkar, Anupam; Rao, Krishna D

2016-01-01

Postpartum heammorrhage (PPH), defined as blood loss greater than or equal to 500 ml within 24 hours after birth, is the leading cause of maternal deaths globally and in India. Misoprostol is an important option for PPH management in setting where oxytocin (the gold standard for PPH prevention and treatment) in not available or not feasible to use. For the substantial number of deliveries which take place at home or at lower level heatlh facilities in India, misoprostol pills can be adminstered to prevent PPH. The standard approach using misoprostol is to administer it prophylactically as primary prevention (600 mcg). An alternative strategy could be to administer misoprostol only to those who are at high risk of having PPH i.e. as secondary prevention. This study reports on the relative cost per person of a strategy involving primary versus secondary prevention of PPH using misoprostol. It is based on a randomized cluster trial that was conducted in Bijapur district in Karnataka, India between December 2011 and March 2014 among pregnant women to compare two community-level strategies for the prevention of PPH: primary and secondary. The analysis was conducted from the government perspective using an ingredient approach. The cluster trial showed that there were no significant differences in clinical outcomes between the two study arms. However, the results of the cost analysis show that there is a difference of INR 6 (US$ 0.1) per birth for implementing the strategies primary versus secondary prevention. In India where 14.9 million births take place at sub-centres and at home, this additional cost of INR 6 per birth translates to an additional cost of INR 94 (US$ 1.6) million to the government to implement the primary prevention compared to the secondary prevention strategy. As clinical outcomes did not differ significantly between the two arms in the trial, taking into account the difference in costs and potential issues with sustainability, secondary prevention

Using Misoprostol for Primary versus Secondary Prevention of Postpartum Haemorrhage - Do Costs Matter?

Directory of Open Access Journals (Sweden)

Susmita Chatterjee

Full Text Available Postpartum heammorrhage (PPH, defined as blood loss greater than or equal to 500 ml within 24 hours after birth, is the leading cause of maternal deaths globally and in India. Misoprostol is an important option for PPH management in setting where oxytocin (the gold standard for PPH prevention and treatment in not available or not feasible to use. For the substantial number of deliveries which take place at home or at lower level heatlh facilities in India, misoprostol pills can be adminstered to prevent PPH. The standard approach using misoprostol is to administer it prophylactically as primary prevention (600 mcg. An alternative strategy could be to administer misoprostol only to those who are at high risk of having PPH i.e. as secondary prevention.This study reports on the relative cost per person of a strategy involving primary versus secondary prevention of PPH using misoprostol. It is based on a randomized cluster trial that was conducted in Bijapur district in Karnataka, India between December 2011 and March 2014 among pregnant women to compare two community-level strategies for the prevention of PPH: primary and secondary. The analysis was conducted from the government perspective using an ingredient approach.The cluster trial showed that there were no significant differences in clinical outcomes between the two study arms. However, the results of the cost analysis show that there is a difference of INR 6 (US$ 0.1 per birth for implementing the strategies primary versus secondary prevention. In India where 14.9 million births take place at sub-centres and at home, this additional cost of INR 6 per birth translates to an additional cost of INR 94 (US$ 1.6 million to the government to implement the primary prevention compared to the secondary prevention strategy.As clinical outcomes did not differ significantly between the two arms in the trial, taking into account the difference in costs and potential issues with sustainability, secondary

Management of secondary hyperparathyroidism: practice patterns and outcomes of cinacalcet treatment with or without active vitamin D in Austria and Switzerland - the observational TRANSIT Study.

Science.gov (United States)

Pronai, Wolfgang; Rosenkranz, Alexander R; Bock, Andreas; Klauser-Braun, Renate; Jäger, Christine; Pendl, Gunther; Hemetsberger, Margit; Lhotta, Karl

2017-05-01

Secondary hyperparathyroidism is a complex disorder requiring an individualized multicomponent treatment approach. This study was conducted to identify treatment combinations used in clinical practice in Austria and Switzerland and the potential to control this disorder. A total of 333 adult hemodialysis and peritoneal dialysis patients were analyzed. All patients received conventional care prior to initiation of a cinacalcet-based regimen. During the study, treatment components, e.g. cinacalcet, active vitamin D analogues and phosphate binders, were adapted to individual patient requirements and treatment dynamics were documented. Overall, the mean intact parathyroid hormone (iPTH) increased from 64.2 pmol/l to 79.6 pmol/l under conventional therapy and decreased after cinacalcet initiation to 44.0 pmol/l after 12 months (mean decrease between baseline and 12 months -45%). Calcium remained within the normal range throughout the study and phosphorus ranged around the upper limit of normal. The Kidney Disease: Improving Global Outcomes (KDIGO) target achievement for iPTH increased from 44.5% of patients at baseline to 65.7% at 12 months, corrected calcium from 58.9% to 51.9% and phosphorus from 18.4% to 24.4%. On average, approximately 30% of patients adapted their regimen from one observation period to the next. The reasons for changing a given regimen were to attain or maintain any of the bone mineral markers within recommended targets and to avoid developments to extreme values. Some regional differences in practice patterns were identified. No new safety signals emerged. In conclusion, cinacalcet appears to be a necessary treatment component to achieve recommended targets. The detailed composition of the treatment mix should be adapted to patient requirements and reassessed on a regular basis.

Triangulating Teacher Perception, Classroom Observations, and Student Work to Evaluate Secondary Writing Programs

Science.gov (United States)

Henderson, Daphne Carr; Rupley, William H.; Nichols, Janet Alys; Nichols, William Dee; Rasinski, Timothy V.

2018-01-01

Current professional development efforts in writing at the secondary level have not resulted in student improvement on large-scale writing assessments. To maximize funding resources and instructional time, school leaders need a way to determine professional development content for writing teachers that aligns with specific student outcomes. The…

CARDIAC TRANSPLANTATION IN YOUNG PATIENT WITH DILATED CARDIOMYOPATHY AND SECONDARY ANTIPHOSPHOLIPID SYNDROME

Directory of Open Access Journals (Sweden)

E. V. Shlyakhto

2013-01-01

Full Text Available Patients with congestive heart failure have an increased incidence of thromboembolic events. The choice of me- dical management in patients with antiphospholipid antibodies and generalized thrombosis due to hypercoagula- bility is complex issue. We report heart transplant outcome in 15 years old patient with dilated cardiomyopathy and secondary anti-phospholipid syndrome. 

Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial

Directory of Open Access Journals (Sweden)

Raquel Pei Chen Chan

2009-01-01

Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

Outcome of first-episode schizophrenia and the new antipsychotics

African Journals Online (AJOL)

associated w~h poor outcome ard predictors of relapse, and the use ... Although a muttitude of clinical trials has been conducted, no ... negative symptoms and side-effects, are alienated from society ... development of chronic or secondary symptoms are .... psychotropic drugs on negative symptoms in schizophrenia. J Clin.

Family business : a secondary brand in corporate brand management

OpenAIRE

Blombäck, Anna

2009-01-01

Why do firms allude to family involvement in their marketing efforts? How can such references influence marketing outcomes? In view of these questions, the current paper argues that the business format “family business” holds a brand of its own; a brand that can offer distinctiveness to brands on corporate as well as product level. Revisiting theory on secondary brand associations and image transfer, the paper interprets the function of references to family in corporate communications and cla...

Reflections on Teaching Periodic Table Concepts: A Case Study of Selected Schools in South Africa

Science.gov (United States)

Mokiwa, Hamza Omari

2017-01-01

The Periodic Table of Elements is central to the study of modern Physics and Chemistry. It is however, considered by teachers as difficult to teach. This paper reports on a case study exploring reflections on teaching periodic table concepts in five secondary schools from South Africa. Qualitative methodology of interviews and document analysis…

Employment outcomes of transition-aged adults with autism spectrum disorders: a state of the States report.

Science.gov (United States)

Burgess, Sloane; Cimera, Robert E

2014-01-01

The primary purpose of this study was to evaluate the employment outcomes of transition-aged adults with autism spectrum disorders (ASD) served by vocational rehabilitation services (VR) over the last 10 years by state. A secondary purpose was to compare employment outcomes of individuals with ASD to those of the overall transition-aged population served by VR for the same time period. Although there was variability both within and among states, the results of this study indicate that, over time, the number of young adults with ASD seeking VR services has increased; however, employment outcomes including the percent of adults with ASD achieving employment, the number of hours worked, and wages earned have not improved for this group. The cost to provide VR services to transition-aged adults with ASD was relatively stable over time. Transition-aged adults with ASD were more likely to become successfully employed as a result of receiving VR services than the overall population of transition-aged adults served by VR. However, the employed transition-aged adults consistently worked fewer hours and earned lower wages than those in the overall population. Factors that may influence variability within and among states, and between groups, and implications for research and practice are discussed.

Shock wave lithotripsy (SWL): outcomes from a national SWL database in New Zealand.

Science.gov (United States)

Alexander, Cameron E; Gowland, Stuart; Cadwallader, Jon; Reynard, John M; Turney, Benjamin W

2016-04-01

To present the national outcomes for New Zealand of over 9000 stone cases treated with SWL at 21 centres over a 20 year period. Stone cases treated with SWL on board the Mobile Medical Technology (MMT) vehicle between 19 June 1995 and 1 December 2014 were identified, and data collection undertaken prospectively for patient, stone and treatment characteristics, and retrospectively for treatment outcomes. The primary outcome was treatment success, defined as complete stone clearance or clinically insignificant residual fragments (CIRFs) of ≤4 mm. Secondary outcomes were stone free rate, complications and auxiliary procedures, and all statistical analyses were descriptive. 9538 stone cases (7769 patients) were included. The overall, cumulative success rate was 58.7%; this included 45.1% that were stone free and 13.5% in which there were CIRFs ≤4 mm. Success rates varied widely by stone size and location. Overall rates of urinary tract infection, perinephric haematoma, hospital admission and ureteral stent placement were 1.1%, 0.2%, 6.8% and 4.1%, respectively. Variations in SWL protocols across centres limits the overall reliability of our findings. SWL remains a low morbidity management option requiring careful patient selection. This study provides valuable data for patient counseling and the formation of evidence based guidelines in SWL. The MMT SWL service has demonstrated that is it possible to deliver a high volume specialist stone service without requiring patients to travel further for treatment. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Sensitization predicts asthma development among wheezing toddlers in secondary healthcare.

Science.gov (United States)

Boersma, Nienke A; Meijneke, Ruud W H; Kelder, Johannes C; van der Ent, Cornelis K; Balemans, Walter A F

2017-06-01

Some wheezing toddlers develop asthma later in childhood. Sensitization is known to predict asthma in birth cohorts. However, its predictive value in secondary healthcare is uncertain. This study examines the predictive value of sensitization to inhalant allergens among wheezing toddlers in secondary healthcare for the development of asthma at school age (≥6 years). Preschool children (1-3 years) who presented with wheezing in secondary healthcare were screened on asthma at school age with the International Study of Asthma and Allergies in Childhood questionnaire. The positive and negative predictive value (PPV and NPV) of specific IgE to inhalant allergens (cut-off concentration 0.35 kU/L) and several non-invasive variables from a child's history (such as hospitalization, eczema, and parental atopy) were calculated. The additional predictive value of sensitization when combined with non-invasive predictors was examined in multivariate analysis and by ROC curves. Of 116 included children, 63% developed asthma at school age. Sensitization to inhalant allergens was a strong asthma predictor. The odds ratio (OR), PPV and NPV were 7.4%, 86%, and 55%, respectively. Eczema (OR 3.4) and hospital admission (OR 2.6) were significant non-invasive determinants. Adding sensitization to these non-invasive predictors in multivariate analysis resulted in a significantly better asthma prediction. The area under the ROC curve increased from 0.70 with only non-invasive predictors to 0.79 after adding sensitization. Sensitization to inhalant allergens is a strong predictor of school age asthma in secondary healthcare and has added predictive value when combined with non-invasive determinants. Pediatr Pulmonol. 2017;52:729-736. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Postnatal outcomes of prenatally diagnosed 45,X/46,XX.

Science.gov (United States)

Tokita, Mari J; Sybert, Virginia P

2016-05-01

High quality information is critical for informed decision-making in pregnancy following a prenatal diagnosis of sex chromosome aneuploidy. The goal of this study was to define the spectrum of outcomes in patients with prenatally diagnosed 45,X/46,XX mosaic Turner syndrome in order to provide a better basis for genetic counseling at the time of intrauterine diagnosis. Phenotype data for twenty-five patients with prenatally diagnosed 45,X/46,XX mosaicism were collected by retrospective chart review and, when possible, semi-structured telephone interview. Existing data from a cohort of 58 patients with postnatally diagnosed 45,X/46,XX mosaicism were used for comparison. Relative to those diagnosed postnatally, prenatal patients were more likely to have normal growth and normal secondary sexual development, less likely to manifest distinctive Turner syndrome features such as nuchal webbing and edema, and had significantly fewer renal defects. These differences underscore the need for a nuanced approach to prenatal counseling in cases of 45,X/46,XX mosaicism. © 2016 Wiley Periodicals, Inc.

Teachers as Secondary Players: Involvement in Field Trips to Natural Environments

Science.gov (United States)

Alon, Nirit Lavie; Tal, Tali

2017-08-01

This study focused on field trips to natural environments where the teacher plays a secondary role alongside a professional guide. We investigated teachers' and field trip guides' views of the teacher's role, the teacher's actual function on the field trip, and the relationship between them. We observed field trips, interviewed teachers and guides, and administered questionnaires. We found different levels of teacher involvement, ranging from mainly supervising and giving technical help, to high involvement especially in the cognitive domain and sometimes in the social domain. Analysis of students' self-reported outcomes showed that the more students believe their teachers are involved, the higher the self-reported learning outcomes.

Secondary School under Educational Space Transformation in Modern Ukraine

Directory of Open Access Journals (Sweden)

A. Makhinko

2017-12-01

Full Text Available The article is dedicated to the reforms in secondary education of Ukraine during the period from establishment of the independent country in early 1990s till the beginning of the 21st Cent. The legislative and normative base, as well as practice of mplementing its key points, were analyzed. The author concludes that this period is characterized by an intensive reform and adjustment to global standards. A particular attention is paid to problems of high schools in the countryside. Conclusions focus mainly on the results of the high school development and prospects for subsequent modernization of this sphere.

Assessment methods as effective tools for learning outcomes of students in senior secondary schools in Ila-Orangun, south western Nigeria

Directory of Open Access Journals (Sweden)

Lamidi W.A

2013-06-01

Full Text Available Different methods of assessment on the students learning outcomes in Agricultural Science at five different secondary schools in Ila-Orangun, Osun State were studied. An arm of a class was used for each test; Continuous Assessment (CA and Conventional Method (CM were used for each arm. Students were taught during their normal school times for the maximum time of forty minutes thrice a week. There were ten objective questions weekly for each assessment of the students in the CA method for six weeks. The same questions were used throughout for all the schools, done simultaneously for CA. Also, sixty questions at once at the end of the sixth week for CM. Standard deviation and regression equations for the mean values were used in the analysis. The results show that CA could be adjudged to be better off than the CM because of its higher mean values in all the schools than the CM. The higher R2 values of 0.99 and 0.88 revealed stronger correlation between different methods of assessment and the targeted learners. The CA test should be used instead of CM; the CM does not make learners to gain much cognitive knowledge when compare with what CA does to students.

Investigating Differential Learning Outcomes of Students in Physics Using Animation and Textual Information Teaching Strategies in Ondo State Secondary School

Directory of Open Access Journals (Sweden)

Blessing Eguabor

2017-06-01

Full Text Available BackgroundThe study investigated the main effects of animation information and textual information on students'performance and improving students' attitude towards physics.Material and methodsThe study adopted the pre-test post-test control group design. The population was made up of SSS 2 students inOndo State. Three Local Government Areas were randomly selected from the 18 Local Government Areas ofOndo State. Simple random technique was used to select three schools in the selected Local Government Areas.The schools were randomly assigned to two experimental groups namely animation and, textual informationstrategy and one control group. Two instruments were used for the study.ResultsOne-way Analysis of Variance (ANOVA, Scheffe Post-Hoc pair-wise comparison Analysis, and two-way Analysisof Variance was used. The results showed that there was a significant main effect of animation and textual strategieson students performance in physics. The results also showed that there was a significant difference in the post testattitudinal score of students' exposed to the strategies with the effectiveness in the order of animation, textual, andconventional strategiesConclusionsThe study concluded that computer- based instruction such as animation and textual strategies could enhancelearning outcomes in Physics in senior secondary school irrespective of students' sex.

The Effects of Reducing the Entitlement Period to Unemployment Insurance Benefits

NARCIS (Netherlands)

de Groot, N.; van der Klaauw, B.

This paper exploits a substantial reform of the Dutch UI law to study the effect of the entitlement period on job finding and subsequent labor market outcomes. Using detailed administrative data covering the full population we find that reducing the entitlement period increases the job finding rate,

Secondary Forest Age and Tropical Forest Biomass Estimation Using TM

Science.gov (United States)

Nelson, R. F.; Kimes, D. S.; Salas, W. A.; Routhier, M.

1999-01-01

The age of secondary forests in the Amazon will become more critical with respect to the estimation of biomass and carbon budgets as tropical forest conversion continues. Multitemporal Thematic Mapper data were used to develop land cover histories for a 33,000 Square kM area near Ariquemes, Rondonia over a 7 year period from 1989-1995. The age of the secondary forest, a surrogate for the amount of biomass (or carbon) stored above-ground, was found to be unimportant in terms of biomass budget error rates in a forested TM scene which had undergone a 20% conversion to nonforest/agricultural cover types. In such a situation, the 80% of the scene still covered by primary forest accounted for over 98% of the scene biomass. The difference between secondary forest biomass estimates developed with and without age information were inconsequential relative to the estimate of biomass for the entire scene. However, in futuristic scenarios where all of the primary forest has been converted to agriculture and secondary forest (55% and 42% respectively), the ability to age secondary forest becomes critical. Depending on biomass accumulation rate assumptions, scene biomass budget errors on the order of -10% to +30% are likely if the age of the secondary forests are not taken into account. Single-date TM imagery cannot be used to accurately age secondary forests into single-year classes. A neural network utilizing TM band 2 and three TM spectral-texture measures (bands 3 and 5) predicted secondary forest age over a range of 0-7 years with an RMSE of 1.59 years and an R(Squared) (sub actual vs predicted) = 0.37. A proposal is made, based on a literature review, to use satellite imagery to identify general secondary forest age groups which, within group, exhibit relatively constant biomass accumulation rates.

Secondary Traumatic Stress and Burnout Among Refugee Resettlement Workers: The Role of Coping and Emotional Intelligence.

Science.gov (United States)

Akinsulure-Smith, Adeyinka M; Espinosa, Adriana; Chu, Tracy; Hallock, Ryan

2018-04-01

To promote a better understanding of the impact of refugee resettlement work on refugee resettlement workers, this study examined the prevalence rates of deleterious mental health and occupational outcomes, such as secondary traumatic stress and burnout, among a sample of 210 refugee resettlement workers at six refugee resettlement agencies in the United States. The study also explored coping mechanisms used by service providers to manage work-related stress and the influence of such strategies and emotional intelligence on secondary traumatic stress and burnout. Our findings show that certain coping strategies, including self-distraction, humor, venting, substance use, behavioral disengagement, and self-blame, were strongly related to deleterious outcomes, βs = .18 to .38, ps = .023 to < .001. Emotional intelligence was a negative correlate for all outcomes, βs = -.25 to -.30, ps < .001, above and beyond the effects of trauma, coping styles, job, and demographic characteristics. These findings have potential implications for clinical training and organizational policy regarding refugee mental health. Copyright © 2018 International Society for Traumatic Stress Studies.

Severe Adverse Maternal Outcomes among Women in Midwife-Led versus Obstetrician-Led Care at the Onset of Labour in the Netherlands: A Nationwide Cohort Study.

Directory of Open Access Journals (Sweden)

Ank de Jonge

Full Text Available To test the hypothesis that it is possible to select a group of low risk women who can start labour in midwife-led care without having increased rates of severe adverse maternal outcomes compared to women who start labour in secondary care.We conducted a nationwide cohort study in the Netherlands, using data from 223 739 women with a singleton pregnancy between 37 and 42 weeks gestation without a previous caesarean section, with spontaneous onset of labour and a child in cephalic presentation. Information on all cases of severe acute maternal morbidity collected by the national study into ethnic determinants of maternal morbidity in the Netherlands (LEMMoN study, 1 August 2004 to 1 August 2006, was merged with data from the Netherlands Perinatal Registry of all births occurring during the same period. Our primary outcome was severe acute maternal morbidity (SAMM, i.e. admission to an intensive care unit, uterine rupture, eclampsia or severe HELLP, major obstetric haemorrhage, and other serious events. Secondary outcomes were postpartum haemorrhage and manual removal of placenta.Nulliparous and parous women who started labour in midwife-led care had lower rates of SAMM, postpartum haemorrhage and manual removal of placenta compared to women who started labour in secondary care. For SAMM the adjusted odds ratio's and 95% confidence intervals were for nulliparous women: 0.57 (0.45 to 0.71 and for parous women 0.47 (0.36 to 0.62.Our results suggest that it is possible to identify a group of women at low risk of obstetric complications who may benefit from midwife-led care. Women can be reassured that we found no evidence that midwife-led care at the onset of labour is unsafe for women in a maternity care system with a well developed risk selection and referral system.

Teaching Design in Adolescent Environments: Twinning Secondary and Tertiary Learning Experiences

Directory of Open Access Journals (Sweden)

David Jones

2004-06-01

Full Text Available Increasingly our landscape architecture teaching and educational pedagogies are facing an internationalisation in approach and expectation. We are positioned within a tertiary learning layer in a tripartite educational system for which each layer assumes certain expectations and outcomes. But their vertical linkages are unclear, and we incorrectly assume continuity of knowledge and skill learning strategies. It is a horizontally stratified teaching setting that we have to work within and while we can think of internationalisation as occurring within our level we need to appreciate that internationalisation is also occurring at the secondary level. This paper discusses the educational environment within which globalisation is occurring, and reviews a project model that builds bridges vertically between secondary and tertiary learning environments. The project displays possibilities in both secondary and tertiary educational sectors, but especially in enhancing and improving the design fluency of our annual incoming cohorts who often possess a naive understanding of built environmental design. Commencing in 1998 as an experimental project, it has been recognised at the South Australian state level as a forward-thinking initiative that has radically transformed secondary school Design teacher's perspectives as to educational possibilities, and substantially matured attitudes to landscape design by both suites of participants. As a consequence, it is an educational project that has experienced requests from numerous secondary schools around the State to participate.

The influence of refugee status and secondary migration on preterm birth.

Science.gov (United States)

Wanigaratne, Susitha; Cole, Donald C; Bassil, Kate; Hyman, Ilene; Moineddin, Rahim; Urquia, Marcelo L

2016-06-01

It is unknown whether the risk of preterm birth (PTB) is elevated for forced (refugee) international migrants and whether prolonged displacement amplifies risk. While voluntary migrants who arrive from a country other than their country of birth (ie, secondary migrants) have favourable birth outcomes compared with those who migrated directly from their country of birth (ie, primary migrants), secondary migration may be detrimental for refugees who experience distinct challenges in transition countries. Our objectives were (1) to determine whether refugee status was associated with PTB and (2) whether the relation between refugee status and PTB differed between secondary and primary migrants. We conducted a retrospective population-based cohort study. Ontario immigration (2002-2010) and hospitalisation data (2002-2010) were linked to estimate adjusted cumulative odds ratios (ACOR) of PTB (22-31, 32-36, 37-41 weeks of gestation), with 95% CIs (95% CI) comparing refugees with non-refugees. We further included a product term between refugee status and secondary migration. Overall, refugees (N=12 913) had 17% greater cumulative odds of short gestation (ACOR=1.17, 95% CI 1.07 to 1.28) compared with non-refugees (N=110 640). Secondary migration modified the association between refugee status and PTB (p=0.007). Secondary refugees had 58% greater cumulative odds of short gestation (ACOR=1.58, 95% CI 1.25 to 2.00) than secondary non-refugees, while primary refugees had 12% greater cumulative odds of short gestation (ACOR=1.12, 95% CI 1.02 to 1.23) than primary non-refugee immigrants. Refugee status, jointly with secondary migration, influences PTB among migrants. 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/

Preconception stress and the secondary sex ratio in a population-based preconception cohort.

Science.gov (United States)

Bae, Jisuk; Lynch, Courtney D; Kim, Sungduk; Sundaram, Rajeshwari; Sapra, Katherine J; Buck Louis, Germaine M

2017-03-01

To examine the association between preconception parental stress and the secondary sex ratio, defined as the ratio of males to females at birth. A population-based preconception cohort. Not applicable. A total of 235 couples who were enrolled before conception in Michigan and Texas between 2005 and 2009 and who had a singleton birth during the follow-up period. Couples were interviewed separately at baseline to obtain information on perceived stress (Cohen's Perceived Stress Scale) and lifetime history of physician-diagnosed anxiety and/or mood disorders. Female partners were also trained to collect basal saliva samples for the measurement of salivary stress markers, alpha-amylase and cortisol. None. Birth outcome data including infant sex were collected upon delivery. Modified Poisson regression models were used to estimate the relative risks (RRs) of a male birth for each stress marker. After adjusting for potential confounders, we observed a 76% increase in the risk of fathering a male infant (RR 1.76; 95% confidence interval 1.17-2.65) in men diagnosed with anxiety disorders compared with those who were not diagnosed. When lifetime history of physician-diagnosed anxiety disorders was modeled jointly for the couple, the association was slightly strengthened (RR 2.03; 95% confidence interval 1.46-2.84). This prospective cohort study suggests that paternal lifetime history of physician-diagnosed anxiety disorders may be associated with an increase in the secondary sex ratio, resulting in an excess of male births. Copyright © 2016 American Society for Reproductive Medicine. All rights reserved.

"Why Single Me Out?" Peer Mentoring, Autism and Inclusion in Mainstream Secondary Schools

Science.gov (United States)

Bradley, Ryan

2016-01-01

The past decade has seen an increase in the number of students with autism attending mainstream educational provision. Improving outcomes for this group is a complex issue given the deficit of evidence-based practice. A new peer mentoring programme developed for students with autism in mainstream secondary schools was evaluated using a combination…

Enhancing Student Learning and Critical Thinking through Academic Controversy in Post Secondary Macroeconomics

Science.gov (United States)

Santicola, Craig F.

2011-01-01

There is a lack of student learning and critical thinking skills in post-secondary macroeconomics courses. The literature indicates that the lack of learning outcomes can be attributed to the reliance on traditional lecture and the failure to adopt innovative instructional techniques. The purpose of this study was to investigate the student…

Residency Patterns and Secondary Migration of Refugees: A State of the Information Paper.

Science.gov (United States)

Forbes, Susan

This paper synthesizes available research regarding the residence patterns of refugees in the United States. Information is presented on both initial placement and secondary migration. The first section traces the evolution of U.S. policy and outcomes from 1945 to the start of the Indochinese resettlement program in 1975. The second section…

Clinical evidence of inflammation driving secondary brain injury: A systematic review

Science.gov (United States)

Hinson, Holly E.; Rowell, Susan; Schreiber, Martin

2015-01-01

Background Despite advances in both prevention and treatment, traumatic brain injury (TBI) remains one of the most burdensome diseases; 2% of the US population currently lives with disabilities resulting from TBI. Recent advances in the understanding of inflammation and its impact on the pathophysiology of trauma have increased the interest in inflammation as a possible mediator in TBI outcome. Objectives The goal of this systematic review is to address the question: “What is the evidence in humans that inflammation is linked to secondary brain injury?” As the experimental evidence has been well described elsewhere, this review will focus on the clinical evidence for inflammation as a mechanism of secondary brain injury. Data Sources Medline database (1996-Week 1 June 2014), Pubmed and Google Scholar databases were queried for relevant studies. Study Eligibility Criteria Studies were eligible if participants were adults and/or children who sustained moderate or severe TBI in the acute phase of injury, published in English. Studies published in the last decade (since 2004) were preferentially included. Trials could be observational or interventional in nature. Appraisal and Synthesis Methods To address the quality of the studies retrieved, we applied the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria to assess the limitations of the included studies. Results Trauma initiates local central nervous system as well as systemic immune activation. Numerous observational studies describe elevation of pro-inflammatory cytokines that are associated with important clinical variables including neurologic outcome and mortality. A small number of clinical trials have included immunomodulating strategies, but no intervention to date has proven effective in improving outcomes after TBI. Limitations Inclusion of studies not initially retrieved by the search terms may have biased our results. Additionally, some reports may have been

Educational Outcomes After Serving with Electronic Monitoring

DEFF Research Database (Denmark)

Larsen, Britt Østergaard

2016-01-01

are based on a comprehensive longitudinal dataset (n = 1013) constructed from multiple official administrative registers and including a high number of covariates. Results The EM-program increases the completion rates of upper secondary education by 18 % points among program participants 3 years post......Objectives The paper explores the effects of electronic monitoring (EM) on young offenders’ educational outcomes and contributes to the evaluation of EM as a non-custodial sanction with a new outcome measure. Methods The study is based on a natural experiment exploiting a reform in Denmark in 2006...... introducing electronic monitoring to all offenders under the age of 25 with a maximum prison sentence of 3 months. Information on program participation is used to estimate instrument variable models in order to assess the causal effects of EM on young offenders’ educational outcomes. The empirical analyses...

Sonographic prediction of outcome of vacuum deliveries

DEFF Research Database (Denmark)

Kahrs, Birgitte H; Usman, Sana; Ghi, Tullio

2017-01-01

of vacuum extraction in relation to ultrasound measured head-perineum distance with a predefined cut-off of 25 mm, and 220 women were needed to discriminate between groups using a hazard ratio of 1.5 with 80% power and alpha 5%. Secondary outcomes were delivery mode and umbilical artery cord blood samples...... outcome in nulliparous women with prolonged second stage of labor. STUDY DESIGN: We performed a prospective cohort study in nulliparous women at term with prolonged second stage of labor in 7 European maternity units from 2013 through 2016. Fetal head position and station were determined using...... after birth. The time interval was evaluated using survival analyses, and the outcomes of delivery were evaluated using receiver operating characteristic curves and descriptive statistics. Results were analyzed according to intention to treat. RESULTS: The study population comprised 222 women...

Muslim Youth Experiences in Quebec Secondary Schools: Race, Racialization, and the 'Dangerous Muslim Man'

Directory of Open Access Journals (Sweden)

Naved Bakali

2016-10-01

Full Text Available This article examines the experiences of Muslim men who had attended the secondary schools in Quebec in the post-9/11 context. Employing a critical ethnographic approach stemming from institutional ethnography, this study presents biases/racism these men had experienced in their secondary schools in the aftermath of the 9/11 terror attacks and throughout the period of the War on Terror, and the possible causes for this treatment.

Maintained intentional weight loss reduces cardiovascular outcomes

DEFF Research Database (Denmark)

Caterson, I D; Finer, N; Coutinho, W

2012-01-01

Aim: The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. Methods: Overweight....../obese subjects (N = 10 744), =55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from...... randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). Results: For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight...

Shroud cutting techniques and collection systems for secondary radioactivity release

International Nuclear Information System (INIS)

Yokoi, H.; Watanabe, A.; Uetake, N.; Shimura, T.; Omote, T.; Adachi, H.; Murakami, S.; Kobayashi, H.; Gotoh, M.

2001-01-01

Replacement of in-core shroud has been conducted as part of the preventive maintenance program in Tsuruga-1. The EDM (electric discharged machining) and plasma cutting methods were applied to in-core shroud cutting and secondary cutting in the DSP (dryer/separator pool), respectively. The cutting systems were improved in order to decrease radioactive secondary products. 1) Fundamental EDM cutting tests: fundamental EDM cutting tests were carried out in order to study secondary products. It could be presumed that volatile Co-carbonyl compound was generated by using a carbon electrode. The Ag/W electrode was effective as EDM electrode for in-core shroud cutting to prevent generation of Co-carbonyl compound and to decrease the total amount of secondary products. 2) In-core shroud cutting in RPV (reactor pressure vessel): EDM cutting system with the Ag/W electrode and collection system could keep a good environment during in-core shroud cutting in Tsuruga-1. Activity concentration was lower value than limitation of mask charge level, 4E-6 Bq/cm 3 , even near the water surface. 3) Secondary plasma cutting in DSP: the secondary cutting work was successful in the point of reduction of working period and radiation exposure. The amount of radiation exposure was reduced to 60% of the planned value, because of adequate decontamination of the working environment and reduction of number of torch maintenance tasks by improvements of the underwater cutting device

Comparison of Registered and Reported Outcomes in Randomized Clinical Trials Published in Anesthesiology Journals.

Science.gov (United States)

Jones, Philip M; Chow, Jeffrey T Y; Arango, Miguel F; Fridfinnson, Jason A; Gai, Nan; Lam, Kevin; Turkstra, Timothy P

2017-10-01

Randomized clinical trials (RCTs) provide high-quality evidence for clinical decision-making. Trial registration is one of the many tools used to improve the reporting of RCTs by reducing publication bias and selective outcome reporting bias. The purpose of our study is to examine whether RCTs published in the top 6 general anesthesiology journals were adequately registered and whether the reported primary and secondary outcomes corresponded to the originally registered outcomes. Following a prespecified protocol, an electronic database was used to systematically screen and extract data from RCTs published in the top 6 general anesthesiology journals by impact factor (Anaesthesia, Anesthesia & Analgesia, Anesthesiology, British Journal of Anaesthesia, Canadian Journal of Anesthesia, and European Journal of Anaesthesiology) during the years 2007, 2010, 2013, and 2015. A manual search of each journal's Table of Contents was performed (in duplicate) to identify eligible RCTs. An adequately registered trial was defined as being registered in a publicly available trials registry before the first patient being enrolled with an unambiguously defined primary outcome. For adequately registered trials, the outcomes registered in the trial registry were compared with the outcomes reported in the article, with outcome discrepancies documented and analyzed by the type of discrepancy. During the 4 years studied, there were 860 RCTs identified, with 102 RCTs determined to be adequately registered (12%). The proportion of adequately registered trials increased over time, with 38% of RCTs being adequately registered in 2015. The most common reason in 2015 for inadequate registration was registering the RCT after the first patient had already been enrolled. Among adequately registered trials, 92% had at least 1 primary or secondary outcome discrepancy. In 2015, 42% of RCTs had at least 1 primary outcome discrepancy, while 90% of RCTs had at least 1 secondary outcome discrepancy

The perception of pre- and post-natal marijuana exposure on health outcomes: A content analysis of twitter messages.

Science.gov (United States)

Dakkak, H; Brown, R; Twynstra, J; Charbonneau, K; Seabrook, J A

2018-05-23

The prevalence of marijuana use during pregnancy ranges from 3- 30% , and most of this is for recreational purposes. Marijuana exposure during pregnancy has been linked with low birth weight babies and other adverse child health outcomes. Twitter is a popular news and social networking outlet, and is frequently used to access information about population health and behavior. The primary objective of this study was to investigate the types of messages disseminated on Twitter about marijuana use and infant and maternal health. The secondary objective was to describe the reported health outcomes associated with prenatal and postnatal marijuana use. Tweets were collected from the inception of Twitter (2006) until April 2017. If tweets included links, these links were examined to investigate the source of the message and to clarify the user's intent. In total, 550 tweets were captured, with most tweets (77.6%) having a neutral tweet tone, suggesting uncertainty about the health effects associated with pre- and post-natal marijuana exposure. The sources attached to the original tweets, however, were more likely to report on negative health outcomes. The most common health outcomes associated with prenatal marijuana exposure were: poor brain development (27.3%), inadequate development of the nervous system (23.6%), low birth weight (23.3%), poor behavioral outcomes (21.0%), and infant memory issues (19.3%). The inverse association between marijuana use and the quality and quantity of milk produced by the mother was the most commonly reported tweet for the lactation period.

Time trends, improvements and national auditing of rectal cancer management over an 18-year period.

Science.gov (United States)

Kodeda, K; Johansson, R; Zar, N; Birgisson, H; Dahlberg, M; Skullman, S; Lindmark, G; Glimelius, B; Påhlman, L; Martling, A

2015-09-01

The main aims were to explore time trends in the management and outcome of patients with rectal cancer in a national cohort and to evaluate the possible impact of national auditing on overall outcomes. A secondary aim was to provide population-based data for appraisal of external validity in selected patient series. Data from the Swedish ColoRectal Cancer Registry with virtually complete national coverage were utilized in this cohort study on 29 925 patients with rectal cancer diagnosed between 1995 and 2012. Of eligible patients, nine were excluded. During the study period, overall, relative and disease-free survival increased. Postoperative mortality after 30 and 90 days decreased to 1.7% and 2.9%. The 5-year local recurrence rate dropped to 5.0%. Resection margins improved, as did peri-operative blood loss despite more multivisceral resections being performed. Fewer patients underwent palliative resection and the proportion of non-operated patients increased. The proportions of temporary and permanent stoma formation increased. Preoperative radiotherapy and chemoradiotherapy became more common as did multidisciplinary team conferences. Variability in rectal cancer management between healthcare regions diminished over time when new aspects of patient care were audited. There have been substantial changes over time in the management of patients with rectal cancer, reflected in improved outcome. Much indirect evidence indicates that auditing matters, but without a control group it is not possible to draw firm conclusions regarding the possible impact of a quality control registry on faster shifts in time trends, decreased variability and improvements. Registry data were made available for reference. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

Gender differences in pain and secondary hyperalgesia after heat/capsaicin sensitization in healthy volunteers

DEFF Research Database (Denmark)

Jensen, Magnus Thorsten; Petersen, Karin Lottrup

2006-01-01

differences in development of secondary hyperalgesia. Cutaneous hyperalgesia was induced with the heat/capsaicin sensitization model. Outcome measures were areas of secondary hyperalgesia to brush and von Frey hair stimulation after heat and capsaicin sensitization, rating of pain during heat....../capsaicin sensitization, and heat pain detection thresholds. There was a trend toward smaller areas of secondary hyperalgesia in women. After adjusting for estimated gender differences in forearm surface area, areas to brush but not von Frey hair stimulation after capsaicin sensitization were larger in women. Peak pain......, but not total pain, during prolonged noxious thermal stimulation was higher in women. There was no gender difference in pain ratings during capsaicin sensitization or in heat pain detection thresholds. The results provided only limited support to the hypothesis that gender differences in clinical pain syndromes...

Changes in outcome and management of perforated diverticulitis over a 10 year period.

LENUS (Irish Health Repository)

O'Leary, D P

2013-03-04

Aggressive non-operative intervention and evolving surgical strategies have altered the treatment of perforated diverticulitis in the acute setting. These strategies have predominantly been implemented over the last decade. The aim of this study was to assess the impact of this on patient outcome during their index admission and subsequently.

Behavior of secondary particles in particulate matter collected at eastern Kanagawa

International Nuclear Information System (INIS)

Nishida, Tomohiro; Kikawada, Yoshikazu; Oi, Takao; Honda, Teruyuki

2008-01-01

The suspended particulate matters collected in 100 periods from 2002/10/28 to 2004/10/29 were separated into the water soluble and insoluble components and their main components were analyzed. The characteristics of atmosphere in the east part of Kagawa prefecture and of the secondary particulates were presumed. Therefore, it was considered that in the samples other than Mn the origins of water soluble and insoluble components are different each other from their behavior. The water-soluble part may be mostly ammonium salt (secondary particulate) from the measurement of NH 4 + . Furthermore, it became clear that the evolution of secondary particulate varies largely with season. Then, the variation with season was presumed by the main component analysis using the statistical software, SPSS adding to the correlation coefficient. This method has proved to be effective. (M.H.)

The effect of a health promotion intervention for construction workers on work-related outcomes: results from a randomized controlled trial.

Science.gov (United States)

Viester, Laura; Verhagen, Evert A L M; Bongers, Paulien M; van der Beek, Allard J

2015-08-01

The objective of the present study is to investigate the effects of a worksite health promotion intervention on musculoskeletal symptoms, physical functioning, work ability, work-related vitality, work performance, and sickness absence. In a randomized controlled design, 314 construction workers were randomized into an intervention group (n = 162) receiving personal coaching, tailored information, and materials, and a control group (n = 152) receiving usual care. Sickness absence was recorded continuously in company records, and questionnaires were completed before, directly after the 6-month intervention period, and 12 months after baseline measurements. Linear and logistic regression analyses were performed to determine intervention effects. No significant changes at 6 or 12 months of follow-up were observed in musculoskeletal symptoms, physical functioning, work ability, work-related vitality, work performance, and sickness absence as a result of the intervention. This study shows that the intervention was not statistically significantly effective on secondary outcomes. Although the intervention improved physical activity, dietary, and weight-related outcomes, it was not successful in decreasing musculoskeletal symptoms and improving other work-related measures. Presumably, more multifaceted interventions are required to establish significant change in these outcomes.

The first orbital parameters and period variation of the short-period eclipsing binary AQ Boo

Science.gov (United States)

Wang, Shuai; Zhang, Liyun; Pi, Qingfeng; Han, Xianming L.; Zhang, Xiliang; Lu, Hongpeng; Wang, Daimei; Li, TongAn

2016-10-01

We obtained the first VRI CCD light curves of the short-period contact eclipsing binary AQ Boo, which was observed on March 22 and April 19 in 2014 at Xinglong station of National Astronomical Observatories, and on January 20, 21 and February 28 in 2015 at Kunming station of Yunnan Observatories of Chinese Academy of Sciences, China. Using our six newly obtained minima and the minima that other authors obtained previously, we revised the ephemeris of AQ Boo. By fitting the O-C (observed minus calculated) values of the minima, the orbital period of AQ Boo shows a decreasing tendency P˙ = - 1.47(0.17) ×10-7 days/year. We interpret the phenomenon by mass transfer from the secondary (more massive) component to the primary (less massive) one. By using the updated Wilson & Devinney program, we also derived the photometric orbital parameters of AQ Boo for the first time. We conclude that AQ Boo is a near contact binary with a low contact factor of 14.43%, and will become an over-contact system as the mass transfer continues.

Secondary recrystallisation in 20 w/o Cr-25 w/o Ni-Nb stabilised stainless steel

International Nuclear Information System (INIS)

Healey, T.; Brown, A.F.; Speight, M.V.

1976-11-01

The fuel cladding material for the Commercial Advanced Gas Reactor is a fine grain 20 w/o Cr-25 w/o Ni niobium stabilised stainless steel. The grain structure stability of this alloy has been investigated as a function of carbon content over the temperature range 930 - 990 0 C. It is demonstrated that the primary grain structure is susceptible to abnormal growth due to secondary recrystallisation of the initial fine grain structure after a composition and temperature dependent incubation period. The magnitude of the incubation period is analysed on the basis that secondary recrystallisation commences when randomly dispersed niobium carbide particles have coarsened to a critical size. The validity of the analysis is tested by comparing the predictions with experimental observation. The model is subsequently used to evaluate the incubation period for conditions of temperature, composition and microstructure which differ from those defined in the experimental studies. (author)

Implementing CLT at Higher Secondary Level in Bangladesh: A Review of Change Management

Science.gov (United States)

Rahman, Md Shidur

2015-01-01

CLT (Communicative Language Teaching) was substituted for GTM (Grammar Translation Method) at higher secondary level in Bangladesh in 2001. This replacement of ELT method was a significant change in the English curriculum. This study aimed to determine that the mismanagement of the change is a prime cause of not getting expected CLT outcomes at…

Diverging Conclusions from the Same Meta-Analysis in Drug Safety: Source of Data (Primary Versus Secondary) Takes a Toll.

Science.gov (United States)

Prada-Ramallal, Guillermo; Takkouche, Bahi; Figueiras, Adolfo

2017-04-01

Meta-analyses of observational studies represent an important tool for assessing efficacy and safety in the pharmacoepidemiologic field. The data from the individual studies are either primary (i.e., collected through interviews or self-administered questionnaires) or secondary (i.e., collected from databases that were established for other purposes). So far, the origin of the data (primary vs. secondary) has not been systematically assessed as a source of heterogeneity in pharmacoepidemiologic meta-analyses. The aim was to assess the impact of considering the source of exposure data as a criterion in sensitivity and subgroup analysis on the conclusions of drug safety meta-analyses. We selected meta-analyses published between 2013 and 2015 in which the intake of frequently used over-the-counter medicines was either the main exposure or a concomitant treatment and the outcome had short latency and induction periods. We stratified the results by origin of data (primary vs. secondary) and compared the new results to those presented originally in the meta-analyses. We used four meta-analyses that fulfilled our criteria of inclusion. The results were selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: original estimate odds ratio (OR) = 1.71 [95% confidence interval (CI) 1.44-2.04], OR primary data = 1.19 (95% CI 0.90-1.58), OR secondary data = 1.81 (95% CI 1.50-2.17); proton pump inhibitors and cardiac events: original estimate hazard ratio (HR) = 1.35 (95% CI 1.18-1.54), HR primary data = 1.05 (95% CI 0.87-1.26), HR secondary data = 1.43 (95% CI 1.23-1.66); non-aspirin non-steroidal anti-inflammatory drugs and myocardial infarction: original estimate risk ratio (RR) = 1.08 (95% CI 0.95-1.22), RR primary data = 0.57 (95% CI 0.34-0.96), RR secondary data = 1.15 (95% CI 1.03-1.28); paracetamol during pregnancy and childhood asthma: original estimate OR = 1.32 (95% CI 1.14-1.52), OR primary data = 1.23 (95% CI 1.06-1.42), OR

Clinical Outcome Following Infra-Inguinal Percutaneous Transluminal Angioplasy for Critical Limb Ischemia

International Nuclear Information System (INIS)

Matsagas, Miltiadis I.; Rivera, Marco A.; Tran, Tan; Mitchell, Adam; Robless, Peter; Davies, Alun H.; Geroulakos, George

2003-01-01

Objective: The aim of this study was to assess the efficacy and durability of infra-inguinal PTA in patients with CLI, in terms of clinical outcome. Design:Retrospective study of 50 consecutive patients with CLI that were exclusively treated by infra-inguinal PTA. Methods: The indications for intervention were rest pain in seven (14%) patients,non-healing ulcers in 27 (54%), and gangrenous lesions in 16 (32%).Thirty-three (66%) of these patients presented with a single arterial lesion, and the remaining 17 (34%) with multilevel arterial lesions.Kaplan-Meier analysis was used to assess survival, patency,limb-salvage rates, and amputation-free survival. Results: A total of 67 endovascular procedures were performed and 59 (88.1%) of them were considered to be technically successful. The median follow-up period was 12 months (interquartilerange: 17 months). The 30-day mortality was 4%, while the cumulative survival rates at 12, 24, and 36 months were 73%, 67%, and 59%,respectively. The cumulative primary patency rates at 12 and 24 months were 63% and 52%, respectively, and remained unchanged thereafter.The estimated secondary patency rate was 72% at 36 months. There was only one below-knee amputation in the patients that were treated exclusively with infra-inguinal PTA. The cumulative amputation-free survival at the same period was estimated at 60%. Conclusions: Infra-inguinal PTA had a good early and late outcome in this series of patients with a limited life expectancy.These results are comparable to historical results of surgical revascularization in the treatment of CLI. There is need for a randomized study to determine the primary optimal interventional approach for patients with CLI

Sudden gains in the outpatient treatment of anorexia nervosa: A process-outcome study.

Science.gov (United States)

Cartwright, Anna; Cheng, Yat Ping; Schmidt, Ulrike; Landau, Sabine

2017-10-01

Sudden gains (SGs), broadly defined as sudden symptom reductions occurring between two consecutive treatment sessions, have been associated with improved treatment outcomes in anxiety and depression. The present study is the first to formally define SGs in anorexia nervosa and explore the characteristics, demographic and baseline clinical predictors, and clinical impact of SGs in anorexia nervosa. This is a secondary analysis of data from 89 outpatients with broadly defined anorexia nervosa who received one of two psychotherapeutic interventions as part of the MOSAIC trial (Schmidt et al., 2015). SGs were defined using session-by-session body mass index (BMI) measures. This study investigated whether SGs were associated with changes in BMI, eating disorder symptomology, general psychopathology, and psychosocial impairment between baseline and 6, 12, and 24 months follow-up. SGs, experienced by 61.8% of patients, mostly occurred during the early and middle phases of treatment. A larger proportion of SGs predicted larger increases in BMI between baseline and 6, 12, and 24 months follow-up. Amongst those experiencing at least one SG, fewer days between baseline and a patient's first SG predicted a larger increase in BMI between baseline and both 6 and 12 months follow-up. The proportion and timing of SGs did not predict changes in other outcome measures. SGs in BMI during the outpatient treatment of anorexia nervosa are clinically useful predictors of longer-term weight outcomes. © 2017 Wiley Periodicals, Inc.

Current neurotrauma treatment practice in secondary medical service centers

International Nuclear Information System (INIS)

Suehiro, Eiichi; Yoshino, Hiroko; Koizumi, Hiroyasu; Yoneda, Hiroshi; Suzuki, Michiyasu

2011-01-01

Despite neurotrauma treatment practices comprising a significant amount of neurosurgical work for secondary medical service centers, little attention has been placed on neurotrauma cases and evaluation of current neurotrauma treatment practices is limited. Therefore we investigated current neurotrauma practices in our hospital located in a Japanese suburban city. We analyzed 439 patients with traumatic brain injury (TBI) admitted to our hospital between April 2004 and October 2010. Patients were divided into three groups based on the Glasgow Coma Scale (GCS) score on admission: mild TBI (GCS 14-15) in 252 patients (57.4%), moderate TBI (GCS 9-13) in 116 patients (26.4%), and severe TBI (GCS 3-8) in 71 patients (16.2%). Age, gender, alcohol consumption, cause of injury, cranial CT findings, neurosurgical procedure, length of hospital stay, and clinical outcome were analyzed. The average age of the patients was 59.2 years old. Male patients comprised 65%. Alcohol consumption was reported in 81 cases (18.5%), most of them with moderate TBI. Fall (208 cases, 47.4%) was the most frequent cause of injury, followed by traffic accident (115 cases, 26.2%) and high fall (73 cases, 16.6%). Acute subdural hematoma (174 cases, 39.6%) was most frequently seen in cranial CT findings on admission, which significantly increased with severity. A neurosurgical procedure was performed for 70 cases (15.9%), of which 15 (6.0%) were mild TBI and 18 (15.5%) were moderate TBI. The average hospital stay was 20.8 days, which significantly increased with severity. The overall rate of favorable outcome was 82.7%, and mortality was 8.2%; outcome deteriorated with severity. Some mild and moderate TBI cases had deteriorated and required surgery or resulted in death. These findings suggest that cautious treatment is necessary even in mild to moderate TBI cases which are often encountered in secondary medical service centers. (author)

Secondary intracranial meningiomas after high-dose cranial irradiation: report of five cases and review of the literature

International Nuclear Information System (INIS)

Strojan, Primoz; Popovic, Mara; Jereb, Berta

2000-01-01

Purpose: To review cases of secondary intracranial meningiomas following high-dose cranial irradiation (≥ 10 Gy) identified in Slovenia between 1968 and 1998, to determine their histological profile and to review the literature on this topic. Methods and Materials: Personal files of patients treated for secondary intracranial meningioma during a 31-year period were reviewed. In cases which met the criteria for radiation-induced tumors, steroid hormone receptor and Ki-67 status were analyzed. For the literature review, computerized database systems and reference lists from respective publications were used. Results: Five patients (2 females, 3 males), 3-11 years old at the time of cranial irradiation, developed secondary meningioma after a latency period of 9.5-31.5 years. Three patients had multiple tumors and 2 developed recurrent disease. Of 9 histologically examined tumors, 5 were graded as benign and 4 as atypical meningiomas, with Ki-67 proliferative index 3.2 ± 3.6 and 10 ± 6, respectively. The ratio between positive and negative meningiomas regarding immunostaining for progesterone and estrogen receptors was eight-to-one and six-to-three, respectively. Cumulative actuarial risk of secondary meningioma in a cohort of 445 children 16 years or younger treated with high-dose cranial irradiation between 1968 and 1990 in Slovenia at 10, 20, and 25 years was 0.53%, 1.2%, and 8.18%, respectively. Out of 126 cases of radiation-induced meningiomas reported, 57% were females and 43% were males, with mean age at presentation 33 ± 17.3 years. The majority (68%) of patients was irradiated during childhood. The latency period was significantly shorter in those who aged 5 years or less at the time of cranial irradiation (p = 0.04), and in those with atypical/anaplastic tumor (p = 0.01). Correlation between radiation dose and latency period could not be found. Conclusion: Secondary meningiomas following high-dose cranial irradiation are characterized by younger age at

Clinical Long-Term Outcome and Reinterventional Rate After Uterine Fibroid Embolization with Nonspherical Versus Spherical Polyvinyl Alcohol Particles

Energy Technology Data Exchange (ETDEWEB)

Duvnjak, Stevo, E-mail: stevo.duvnjak@rsyd.dk [Odense University Hospital, Department of Radiology (Denmark); Ravn, Pernille [Odense University Hospital, Department of Gynecology (Denmark); Green, Anders [Odense University Hospital, Odense Patient Data Explorative Network (Denmark); Andersen, Poul Erik [Odense University Hospital, Department of Radiology (Denmark)

2016-02-15

PurposeThis study was designed to evaluate the long-term clinical outcome and frequency of reinterventions in patients with uterine fibroids treated with embolization at a single center using polyvinyl alcohol microparticles.MethodsThe study included all patients with symptomatic uterine fibroids treated with uterine fibroid embolization (UFE) with spherical (s-PVA) and nonspherical (ns-PVA) polyvinyl alcohol microparticles during the period January 2001 to January 2011. Clinical success and secondary interventions were examined. Hospital records were reviewed during follow-up, and symptom-specific questionnaires were sent to all patients.ResultsIn total, 515 patients were treated with UFE and 350 patients (67 %) were available for long-term clinical follow-up. Median time of follow-up was 93 (range 76–120.2) months. Eighty-five patients (72 %) had no reinterventions during follow-up in the group embolized with ns-PVA compared with 134 patients (58 %) treated with s-PVA. Thirty-three patients (28 %) underwent secondary interventions in the ns-PVA group compared with 98 patients (42 %) in s-PVA group (χ{sup 2} test, p < 0.01).ConclusionsSpherical PVA particles 500–700 µm showed high reintervention rate at long-term follow-up, and almost one quarter of the patients underwent secondary interventions, suggesting that this type of particle is inappropriate for UFE.

Comparison of outcomes of tricuspid annuloplasty with 3D-rigid versus flexible prosthetic ring for functional tricuspid regurgitation secondary to rheumatic mitral valve disease.

Science.gov (United States)

Wang, Haiping; Liu, Xiancheng; Wang, Xin; Lv, Zhenqian; Liu, Xiaojun; Xu, Ping

2016-11-01

Annuloplasty bands and rings are widely used for repairing functional tricuspid regurgitation (FTR). However, the question regarding which is the ideal annuloplasty device remains unclear. The aim of this study was to compare the efficacy and mid-term durability of tricuspid ring annuloplasty for FTR secondary to rheumatic mitral valve disease using flexible Cosgrove-Edwards band and the rigid Edwards MC3 ring (Edwards Lifesciences, LLC, Irvine, CA, USA). We retrospectively collected the clinical data of those who underwent mitral valve replacement (MVR) in concomitant with tricuspid ring annuloplasty from 2009 to 2013. The flexible band was used in 46 patients (flexible group), and the 3D rigid ring was used in 60 patients (rigid group). Echocardiographic evaluation of tricuspid function was performed preoperatively and postoperatively. The grade of TR was significantly improved compared to preoperative values in two groups. There was no significant difference regarding postoperative TR grade between the two groups at 1 week and 2-3 months but there was statistical significant difference at postoperative 6-12 months, and 2-3 years. During the follow up period, 25 of 46 patients (54.3%) in flexible group and 22 of 60 patients (30.3%) in rigid group developed recurrent TR. Freedom from recurrent TR in flexible group is significant lower than rigid group in each postoperative follow up period. These findings suggest that 3D rigid ring annuloplasty might be more effective for tricuspid ring annuloplasty in FTR in mid-term postoperative periods when compared to flexible band.

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

Science.gov (United States)

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

2013-04-01

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

Inspection of secondary cooling system piping of JMTR

International Nuclear Information System (INIS)

Hanawa, Yoshio; Izumo, Hironobu; Fukasaku, Akitomi; Nagao, Yoshiharu; Kawamura, Hiroshi

2008-06-01

Piping condition was inspected form the view point of long term utilization before the renewal work of the secondary cooling system in the JMTR on FY 2008. As the result, it was confirmed that cracks, swellings and exfoliations in inner lining of the piping could be observed, and corrosion, which was reached by piping ingot, or decrease of piping thickness could hardly be observed. It was therefore confirmed that the strength or the functionality of the piping had been maintained by usual operation and maintenance. Repair of inner lining of the piping during the refurbishment of the JMTR is necessary to long term utilization of the secondary cooling system after restart of the JMTR from the view point of preventive maintenance. In addition, a periodic inspection of inner lining condition is necessary after repair of the piping. (author)

Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction

NARCIS (Netherlands)

Schepers, Rutger H.; Kraeima, Joep; Vissink, Arjan; Lahoda, Lars U.; Roodenburg, Jan L. N.; Reintsema, Harry; Raghoebar, Gerry M.; Witjes, Max J.

Background: We compared the pre-operative 3D-surgical plan with the surgical outcome of complex two-stage secondary reconstruction of maxillofacial defects using inserted implants in the prefabricated fibula graft. Methods: Eleven reconstructions of maxillofacial defects with prefabricated fibulas

[Cryopyrine-associated periodic syndrome: CAPS seen from adulthood].

Science.gov (United States)

Koné-Paut, I

2015-04-01

Cryopyrin-associated periodic syndrome is a rare hereditary periodic fever syndrome for which, the genetic mechanism, mutation in the NLRP3 gene, has allowed to gather 3 clinical phenotypes (familial cold urticaria [FCAS], Muckle-Wells syndrome [MWS], and chronic infantile neurological cutaneous and articular syndrome [CINCA]) initially described independently, and to discover the NLRP3 inflammasome, a key receptor of the innate immunity, which regulates the interleukine-1β secretion into the mononuclear cells. The clinical manifestation of CAPS : urticaria-like skin rash, eyes redness, myalgia and sensory deafness are not specific, if considered separately, and that often leads to a wandering diagnosis through a complex medical journey including various specialists. The diagnostic delay is deleterious to patients compromising their quality of life and exposing them to neurosensory complications and renal failure by secondary amyloidosis. The paediatric onset of disease, the family history, the trigger of symptoms by the cold, and the recognition of the skin rash as neutrophilic are important clues before diagnostic confirmation by genetic testing. Interleukine-1 blockade is the only effective treatment of CAPS symptoms which often may stabilize (rarely regression) the sensory involvement and in some cases may allow the regression of secondary amyloidosis. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial.

Science.gov (United States)

Magee, Laura A; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo K; Logan, Alexander G; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G; Moutquin, Jean Marie

2016-07-01

For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48 h, or birthweight hypertension, preeclampsia, or delivery at blood pressure within 1 week before randomization. Continuous variables were represented continuously or dichotomized based on the smaller p-value in univariate analyses. An area-under-the-receiver-operating-curve (AUC ROC) of ≥0.70 was taken to reflect a potentially useful model. Point estimates for AUC ROC were hypertension (0.70, 95% CI 0.67-0.74) and delivery at hypertension develop an elevated blood pressure in pregnancy, or formerly normotensive women develop new gestational hypertension, maternal and current pregnancy clinical characteristics cannot predict adverse outcomes in the index pregnancy. © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions.

Science.gov (United States)

Baril, Donald T; Marone, Luke K; Kim, Justine; Go, Michael R; Chaer, Rabih A; Rhee, Robert Y

2008-09-01

To evaluate outcomes of endovascular interventions on femoropopliteal occlusive disease and determine predictors of restenosis of Trans Atlantic Inter-Societal Consensus (TASC) II B and C lesions. All patients undergoing endovascular interventions for femoropopliteal occlusive disease between May 2003 and July 2007 were reviewed. Patient demographics, pre- and post-procedure ankle-brachial indices (ABI), and anatomic factors (including categorization by TASC II classification, lesion length, and runoff vessel status) were analyzed. Outcomes evaluated included freedom from restenoses, freedom from re-intervention, overall patency, and assisted-patency. A total of 237 total limbs were treated during the period reviewed. The study group included 108 TASC B and 32 TASC C limbs in 125 patients (mean age 73.1 +/- 10.4 years, male sex: 59%). Seventy-one percent of patients were Rutherford classification 2/3 while the remaining 29% were Rutherford classification 4/5. Mean follow-up period was 12.7 months (range, 1-52 m). Forty-one (41) limbs experienced restenosis or occlusion at a mean time of 8 months (range, 1-24 m). Freedom from restenosis/occlusion was 58.9% at 12 months and 47.9% at 24 months. Predictors of restenosis included a preoperative ABI <0.5 (hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.36-6.86, P = .007) and hypercholesterolemia (HR 2.42, 95% CI 1.11-5.25, P = .025). Lesion length as a continuous variable (per centimeter) also correlated with a higher risk of restenosis (HR 1.06, 95% CI 1.00-1.12, P = .057). The overall assisted-primary and secondary-patency rates were 87% and 94% respectively at 3 years with no significant differences between TASC B and TASC C limbs. Endovascular interventions for TASC II B and C lesions are associated with restenosis/occlusion rates that are at least as good as those of open femoropopliteal bypass surgery from historical, previously published series. Furthermore, overall assisted-patency rates are excellent

Secondary Student Perspectives on Musical and Educational Outcomes from Participation in Band Festivals

Science.gov (United States)

Gouzouasis, Peter; Henderson, Alan

2012-01-01

While it seems many music educators share an enthusiasm for music festivals, others do not. Discrepancies seem to be rooted in the perceived educational outcomes in terms of musical knowledge gained, motivation, competition, psychological impact and social considerations. Advocates believe competitive festivals provide a "superlative"…

The Implementation of the New Lower Secondary Science Curriculum in Three Schools in Rwanda

Science.gov (United States)

Nsengimana, Théophile; Ozawa, Hiroaki; Chikamori, Kensuke

2014-01-01

In 2006, Rwanda began implementing an Outcomes Based Education (OBE) lower secondary science curriculum that emphasises a student-centred approach. The new curriculum was designed to transform Rwandan society from an agricultural to a knowledge-based economy, with special attention to science and technology education. Up until this point in time…

[Treatment with the use of microcurrent lymphatic drainage physiotherapy during the postoperative period following rhinoplastic surgery].

Science.gov (United States)

Aleksanyan, T A; Kazantsev, E V

The objective of the present study was to evaluate the effectiveness of the combined treatment of the patients who had undergone either primary or secondary rhinoplastic surgery with the use of photo- and magnetic therapy in comparison with the effectiveness of phototherapy in the combination with microcurrent therapy. The patients were divided into four groups depending on the type of the surgical intervention and the mode of the combined physiotherapeutic treatment. All the patients were given combined physiotherapeutic treatment in addition to the standard pharmacotherapy starting from the second day of the postoperative period. The patients of groups 1 and 3 received phototherapy in the combination with magnetic therapy while those in groups 2 and 4 were treated by phototherapy in the combination with microcurrent lymphatic drainage physiotherapy. It was shown that the different combinations of physiotherapeutic modalities during the postoperative period following primary «closed» rhinoplasty were not different significantly in terms of effectiveness. After secondary «closed» rhinoplasty, the combination of phototherapy with the application of microcurrents looks more preferable. It is concluded that microcurrent lymphdraining physiotherapy should be regarded as the priority component of the combined physiotherapeutic treatment during the postoperative period following secondary «closed» rhinoplasty.

NPP Temelin automatic monitoring and diagnostic system of secondary side of the unit 1

International Nuclear Information System (INIS)

Heidenreich, S.; Pisl, M.; Drab, F.

1997-01-01

Two measuring and evaluating systems by SKODA PRAHA are described, designed for the Temelin nuclear power plant: a permanent secondary side diagnostic system for technology monitoring in the period of startup and operation; and the system of physical and power starting-up for monitoring during the first and repeated startup. The purposes of both systems are outlined. The scope of diagnostics covered and the functioning of the secondary side system is dealt with in some detail. (A.K.)

Seasonality of primary and secondary production in an Arctic river

Science.gov (United States)

Kendrick, M.; Huryn, A.; Deegan, L.

2011-12-01

Rivers and streams that freeze solid for 8-9 months each year provide excellent examples of the extreme seasonality of arctic habitats. The communities of organisms inhabiting these rivers must complete growth and development during summer, resulting in a rapid ramp-up and down of production over the short ice-free period. The effects of recent shifts in the timing of the spring thaw and autumn freeze-up on the duration and pattern of the period of active production are poorly understood. We are currently investigating: 1) the response of the biotic community of the Kuparuk River (Arctic Alaska) to shifts in the seasonality of the ice-free period, and 2) the community response to increases in phosphorous (P) supply anticipated as the volume of the permafrost active-layer increases in response to climate warming. Here algal production supports a 2-tier web of consumers. We tracked primary and secondary production from the spring thaw through mid-August in a reference reach and one receiving low-level P fertilization. Gross primary production/community respiration (GPP/R) ratios for both reaches were increasing through mid-July, with higher GPP/R in response to the P addition. Understanding the degree of synchrony between primary and secondary production in this Arctic river system will enhance further understanding of how shifts in seasonality affect trophic dynamics.

A 12 MINUTE ORBITAL PERIOD DETACHED WHITE DWARF ECLIPSING BINARY

International Nuclear Information System (INIS)

Brown, Warren R.; Kilic, Mukremin; Kenyon, Scott J.; Hermes, J. J.; Winget, D. E.; Prieto, Carlos Allende

2011-01-01

We have discovered a detached pair of white dwarfs (WDs) with a 12.75 minute orbital period and a 1315 km s -1 radial velocity amplitude. We measure the full orbital parameters of the system using its light curve, which shows ellipsoidal variations, Doppler boosting, and primary and secondary eclipses. The primary is a 0.25 M sun tidally distorted helium WD, only the second tidally distorted WD known. The unseen secondary is a 0.55 M sun carbon-oxygen WD. The two WDs will come into contact in 0.9 Myr due to loss of energy and angular momentum via gravitational wave radiation. Upon contact the systems may merge (yielding a rapidly spinning massive WD), form a stable interacting binary, or possibly explode as an underluminous Type Ia supernova. The system currently has a gravitational wave strain of 10 -22 , about 10,000 times larger than the Hulse-Taylor pulsar; this system would be detected by the proposed Laser Interferometer Space Antenna gravitational wave mission in the first week of operation. This system's rapid change in orbital period will provide a fundamental test of general relativity.

Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care.

Science.gov (United States)

Burn, Anne-Marie; Fleming, Jane; Brayne, Carol; Fox, Chris; Bunn, Frances

2018-03-17

In 2012-2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. Qualitative study involving interviews, focus groups and thematic content analysis. Primary care and secondary care across six counties in the East of England. Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs' lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care

Effects of Asymmetric Secondary Eyewall on Tropical Cyclone Evolution in Hurricane Ike (2008)

Science.gov (United States)

Zhang, Guosheng; Perrie, William

2018-02-01

The secondary eyewall plays an important role in tropical cyclone evolution and intensification and is routinely assumed to be axisymmetric. A unique opportunity to investigate the characteristics of the secondary eyewall in two dimensions is provided by the high spatial resolution (about 1 km) sea surface winds that were observed by spaceborne synthetic aperture radar over Hurricane Ike (2008). Here we extract the asymmetric characteristics using our Symmetric Hurricane Estimates for Winds model and analyze the related hurricane evolution by comparisons with aircraft measurements. Compared to the classic eyewall replacement cycle theory, our investigation finds that the primary eyewall did not weaken and the secondary eyewall did not shrink over a period of more than 30 hr. We suggest that the reason for this persistence is that a boundary layer inflow pathway is provided by the relatively low winds in the asymmetric secondary eyewall area, as observed by synthetic aperture radar.

Outcomes of secondary self-expandable metal stents versus surgery after delayed initial palliative stent failure in malignant colorectal obstruction.

Science.gov (United States)

Yoon, Jin Young; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

2013-01-01

When re-intervention is required due to an occluded first colorectal self-expanding metal stent for malignant colorectal obstruction, serious controversies exist regarding whether to use endoscopic re-stenting or surgery. To compare the clinical outcomes in patients who underwent stent re-insertion versus palliative surgery as a second intervention. A total of 115 patients who received either self-expandable metal stent (SEMS) insertion or palliative surgery for treatment of a second occurrence of malignant colorectal obstruction after the first SEMS placement were retrospectively studied between July 2005 and December 2009. The median overall survival (8.2 vs. 15.5 months) and progression-free survival (4.0 vs. 2.7 months) were not significantly different between the stent and surgery groups (p = 0.895 and 0.650, respectively). The median lumen patency in the stent group was 3.4 months and that in the surgery group was 7.9 months (p = 0.003). The immediate complication rate after second stent insertion was 13.9% and late complication rate was observed in 12 of 79 (15.2%) patients. There was no mortality related to the SEMS procedure. The complication and mortality rates associated with palliative surgery were 3.5% (2/57) and 12.3% (7/57), respectively. Although there is no significant difference in the overall survival between stenting and surgery, a secondary stent insertion had a lower mortality rate despite a shorter duration of temporary colorectal decompression compared to that of palliative surgery.

Prestroke physical activity is associated with good functional outcome and arterial recanalization after stroke due to a large vessel occlusion.

Science.gov (United States)

Ricciardi, Ana Clara; López-Cancio, Elena; Pérez de la Ossa, Natalia; Sobrino, Tomás; Hernández-Pérez, María; Gomis, Meritxell; Munuera, Josep; Muñoz, Lucía; Dorado, Laura; Millán, Mónica; Dávalos, Antonio; Arenillas, Juan F

2014-01-01

Although multiple studies and meta-analyses have consistently suggested that regular physical activity (PhA) is associated with a decreased stroke risk and recurrence, there is limited data on the possible preconditioning effect of prestroke PhA on stroke severity and prognosis. We aimed to study the association of prestroke PhA with different outcome variables in patients with acute ischemic stroke due to an anterior large vessel occlusion. The Prestroke Physical Activity and Functional Recovery in Patients with Ischemic Stroke and Arterial Occlusion trial is an observational and longitudinal study that included consecutive patients with acute ischemic stroke admitted to a single tertiary stroke center. Main inclusion criteria were: anterior circulation ischemic stroke within 12 h from symptom onset; presence of a confirmed anterior large vessel occlusion, and functional independence previous to stroke. Prestroke PhA was evaluated with the International Physical Activity Questionnaire and categorized into mild, moderate and high levels by means of metabolic equivalent (MET) minutes per week thresholds. The primary outcome measure was good functional outcome at 3 months (modified Rankin scale ≤2). Secondary outcomes were severity of stroke at admission, complete early recanalization, early dramatic neurological improvement and final infarct volume. During the study period, 159 patients fulfilled the above criteria. The mean age was 68 years, 62% were men and the baseline NIHSS score was 17. Patients with high levels of prestroke PhA were younger, had more frequently distal occlusions and had lower levels of blood glucose and fibrinogen at admission. After multivariate analysis, a high level of prestroke PhA was associated with a good functional outcome at 3 months. Regarding secondary outcome variables and after adjustment for relevant factors, a high level of prestroke PhA was independently associated with milder stroke severity at admission, early dramatic

Etiology and outcome of acute renal failure in pregnancy.

Science.gov (United States)

Hassan, Irfana; Junejo, Abdul Manan; Dawani, Manohar Lal

2009-11-01

To determine the etiology and outcome of Acute Renal Failure (ARF) in pregnancy. A case series. Nephrology Department of the Jinnah Postgraduate Medical Centre, Karachi, from August 2007 to July 2008. Pregnant women who were healthy previously and had developed ARF, diagnosed on oliguria (urine output 2 mg%) were included in the study. Percutaneous renal biopsy was performed for delayed recovery, i.e. after three weeks. Patients were followed up for a period of 6 months. Percentages were calculated for qualitative variables i.e. causes of ARF, mortality, morbidity and outcome in form of complete recovery, partial recovery, demise and non-recovery. A total of 43 patients with pregnancy-related ARF were included in the study. The puerperal group comprised 36 patients (83.7%). Haemorrhage was the etiology for ARF in 25 (58.1%), antepartum haemorrhage APH in 8 (18.6%) and postpartum haemorrhage PPH in 16 (37.2%) of patients. In 12 (27.9%), puerperal sepsis was the etiological factor, while 4 (9.3%) patients had DIC on presentation. Pre-eclampsia, eclampsia and HELLP syndrome accounted for 5 (11.6%). While 1 (2.3%) was diagnosed with hemolytic uremic syndrome and another one was diagnosed as ARF secondary to hypotension produced by hyperemesis gravidarum. Renal biopsy was performed in 31 patients showing that 10 had acute cortical necrosis and 21 had acute tubular necrosis. Maternal mortality was 16.2% (n=7). Of the 36 (83.7%) surviving patients, 18 (41.4%) had complete recovery of renal function; 12 (27.9%) had partial recovery; and 6 (13.9%) required chronic dialysis. Pregnancy-related ARF was associated with poor outcome. Antepartum and postpartum haemorrhage were the most common cause of ARF in pregnancy.

A Conceptual Model for School-Based Management Operation and Quality Assurance in Nigerian Secondary Schools

Science.gov (United States)

Ayeni, Adeolu Joshua; Ibukun, Williams Olusola

2013-01-01

This paper examined the School-Based Management Committee's (SBMC) involvement and effectiveness in school governance, curriculum implementation and students' learning outcomes in Nigerian secondary schools; the major challenges facing effective operation of SBMCs were identified as low capacity of key members of the SBMCs; poor attendance of…

The Use of Episiotomy in a Low-Risk Population in The Netherlands : A Secondary Analysis

NARCIS (Netherlands)

Seijmonsbergen-Schermers, A. E.; Geerts, C. C.; Prins, M.; van Diem, M. T.; Klomp, T.; Lagro-Janssen, A. L. M.

2013-01-01

Background: To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices. Methods: Secondary analysis of two prospective cohort studies (n=3,404). Results: The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for

Secondary tracheoesophageal puncture in-office using Seldinger technique.

Science.gov (United States)

Britt, Christopher J; Lippert, Dylan; Kammer, Rachael; Ford, Charles N; Dailey, Seth H; McCulloch, Timothy; Hartig, Gregory

2014-05-01

Evaluate the safety and efficacy of in-office secondary tracheoesophageal puncture (TEP) technique using transnasal esophagoscopy (TNE) and the Seldinger technique in conjunction with a cricothyroidotomy kit for placement. Case series with chart review. Academic medical center. A retrospective chart review was performed on 83 subjects who underwent in-office secondary TEP. Variables that were examined included disease site, staging, histologic diagnosis, extent of resection and reconstruction, chemoradiation, functional voice status (as assessed by speech pathologist in most recent note), and complications directly related to the procedure. Eighty-three individuals from our institution met our criteria for in-office secondary TEP from 2005 to August 2012. Of these, 97.6% (81/83) had no complications of TEP. The overall complication rate was 2.4% (2/83). Complications included bleeding from puncture site and closure of puncture site after dislodgement of prosthesis at the time of puncture. Fluent conversational speech was achieved in 69.9% of all patients (58/83), and an additional 19.3% (16/83) achieved functional/intelligible speech; of those, 3.6% (3/83) were unable to achieve fluent conversational speech due to anatomic defects from previous surgery. An in-office TEP can be safely performed using the Seldinger technique with direct visualization using TNE, despite the extent of resection or reconstruction, with functional speech outcomes comparable to other studies available in the literature.

Main Clinical Outcomes of Feldspathic Porcelain and Glass-Ceramic Laminate Veneers: A Systematic Review and Meta-Analysis of Survival and Complication Rates.

Science.gov (United States)

Morimoto, Susana; Albanesi, Rafael Borges; Sesma, Newton; Agra, Carlos Martins; Braga, Mariana Minatel

2016-01-01

The aim of this study was to perform a systematic review and meta-analysis based on clinical trials that evaluated the main outcomes of glass-ceramic and feldspathic porcelain laminate veneers. A systematic search was carried out in Cochrane and PubMed databases. From the selected studies, the survival rates for porcelain and glass-ceramic veneers were extracted, as were complication rates of clinical outcomes: debonding, fracture/chipping, secondary caries, endodontic problems, severe marginal discoloration, and influence of incisal coverage and enamel/dentin preparation. The Cochran Q test and the I(2) statistic were used to evaluate heterogeneity. Out of the 899 articles initially identified, 13 were included for analysis. Metaregression analysis showed that the types of ceramics and follow-up periods had no influence on failure rate. The estimated overall cumulative survival rate was 89% (95% CI: 84% to 94%) in a median follow-up period of 9 years. The estimated survival for glass-ceramic was 94% (95% CI: 87% to 100%), and for feldspathic porcelain veneers, 87% (95% CI: 82% to 93%). The meta-analysis showed rates for the following events: debonding: 2% (95% CI: 1% to 4%); fracture/chipping: 4% (95% CI: 3% to 6%); secondary caries: 1% (95% CI: 0% to 3%); severe marginal discoloration: 2% (95% CI: 1% to 10%); endodontic problems: 2% (95% CI: 1% to 3%); and incisal coverage odds ratio: 1.25 (95% CI: 0.33 to 4.73). It was not possible to perform meta-analysis of the influence of enamel/dentin preparation on failure rates. Glass-ceramic and porcelain laminate veneers have high survival rates. Fracture/ chipping was the most frequent complication, providing evidence that ceramic veneers are a safe treatment option that preserve tooth structure.

Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review.

Science.gov (United States)

Gaudry, Stéphane; Messika, Jonathan; Ricard, Jean-Damien; Guillo, Sylvie; Pasquet, Blandine; Dubief, Emeline; Boukertouta, Tanissia; Dreyfuss, Didier; Tubach, Florence

2017-12-01

Intensivists' clinical decision making pursues two main goals for patients: to decrease mortality and to improve quality of life and functional status in survivors. Patient-important outcomes are gaining wide acceptance in most fields of clinical research. We sought to systematically review how well patient-important outcomes are reported in published randomized controlled trials (RCTs) in critically ill patients. Literature search was conducted to identify eligible trials indexed from January to December 2013. Articles were eligible if they reported an RCT involving critically ill adult patients. We excluded phase II, pilot and physiological crossover studies. We assessed study characteristics. All primary and secondary outcomes were collected, described and classified using six categories of outcomes including patient-important outcomes (involving mortality at any time on the one hand and quality of life, functional/cognitive/neurological outcomes assessed after ICU discharge on the other). Of the 716 articles retrieved in 2013, 112 RCTs met the inclusion criteria. Most common topics were mechanical ventilation (27%), sepsis (19%) and nutrition (17%). Among the 112 primary outcomes, 27 (24%) were patient-important outcomes (mainly mortality, 21/27) but only six (5%) were patient-important outcomes besides mortality assessed after ICU discharge (functional disability = 4; quality of life = 2). Among the 598 secondary outcomes, 133 (22%) were patient-important outcomes (mainly mortality, 92/133) but only 41 (7%) were patient-important outcomes besides mortality assessed after ICU discharge (quality of life = 20, functional disability = 14; neurological/cognitive performance = 5; handicap = 1; post-traumatic stress = 1). Seventy-three RCTs (65%) reported at least one patient-important outcome but only 11 (10%) reported at least one patient-important outcome besides mortality assessed after ICU discharge. Patient-important outcomes are rarely primary

Impact of the Project P.A.T.H.S. in the Junior Secondary School Years: Objective Outcome Evaluation Based on Eight Waves of Longitudinal Data

Directory of Open Access Journals (Sweden)

Daniel T. L. Shek

2012-01-01

Full Text Available To assess the effectiveness of the Tier 1 Program of the Project P.A.T.H.S., a randomized group trial with eight waves of data collected was carried out. At the fifth year of data collection, 19 experimental schools (n=2, 662 students and 24 control schools (n=3, 272 students participated in the study. Analyses based on individual growth curve modeling showed that participants in the experimental schools displayed better positive youth development than did participants in the control schools in terms of different indicators derived from the Chinese Positive Youth Development Scale, including moral competence and behavioral competence and cognitive behavioral competencies. Significant results were also found when examining the trajectories of psychological development among control and experimental participants who perceived the program to be beneficial. Findings based on longitudinal objective outcome evaluation strongly suggest that the Project P.A.T.H.S. is effective in promoting positive development in Hong Kong secondary school students.

Impact of the Project P.A.T.H.S. in the junior secondary school years: objective outcome evaluation based on eight waves of longitudinal data.

Science.gov (United States)

Shek, Daniel T L; Ma, Cecilia M S

2012-01-01

To assess the effectiveness of the Tier 1 Program of the Project P.A.T.H.S., a randomized group trial with eight waves of data collected was carried out. At the fifth year of data collection, 19 experimental schools (n = 2, 662 students) and 24 control schools (n = 3, 272 students) participated in the study. Analyses based on individual growth curve modeling showed that participants in the experimental schools displayed better positive youth development than did participants in the control schools in terms of different indicators derived from the Chinese Positive Youth Development Scale, including moral competence and behavioral competence and cognitive behavioral competencies. Significant results were also found when examining the trajectories of psychological development among control and experimental participants who perceived the program to be beneficial. Findings based on longitudinal objective outcome evaluation strongly suggest that the Project P.A.T.H.S. is effective in promoting positive development in Hong Kong secondary school students.

Discounting Models for Outcomes over Continuous Time

DEFF Research Database (Denmark)

Harvey, Charles M.; Østerdal, Lars Peter

Events that occur over a period of time can be described either as sequences of outcomes at discrete times or as functions of outcomes in an interval of time. This paper presents discounting models for events of the latter type. Conditions on preferences are shown to be satisfied if and only if t...... if the preferences are represented by a function that is an integral of a discounting function times a scale defined on outcomes at instants of time....

Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?

NARCIS (Netherlands)

Legemate, Jaap D.; Zanetti, Stefano P.; Baard, Joyce; Kamphuis, Guido M.; Montanari, Emanuele; Traxer, Olivier; de la Rosette, Jean Jmch

2017-01-01

To compare intra- and post-operative outcomes of endourological live surgical demonstrations (LSDs) and routine surgical practice (RSP) for urinary stones. Consecutive ureterorenoscopic (URS) and percutaneous (PNL) urinary stone procedures over a 5-year period were reviewed. Procedures were divided

Partnership for fragility bone fracture care provision and prevention program (P4Bones: study protocol for a secondary fracture prevention pragmatic controlled trial

Directory of Open Access Journals (Sweden)

Gaboury Isabelle

2013-01-01

Full Text Available Abstract Background Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs. Methods/design This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers. The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants’ perceptions of care integration, expectations and satisfaction with the program; and participants’ compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated

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…

A longitudinal study of self-control at the transition to secondary school: Considering the role of pubertal status and parenting.

Science.gov (United States)

Ng-Knight, Terry; Shelton, Katherine H; Riglin, Lucy; McManus, I C; Frederickson, Norah; Rice, Frances

2016-07-01

Higher self-control in children and adolescents is associated with a range of positive outcomes in adulthood. However, little is known about the naturalistic development of self-control during early adolescence and the factors that affect this. We examined the role of puberty and parenting style as theoretically important influences on stability and change in self-control. A longitudinal (3 waves), multiple-informant dataset of children entering early adolescence (M = 11 years) was used to explore longitudinal change in self-control using latent growth curve modelling. Children's self-control declined during the one-year study period and declines were associated with children's behavioural and social functioning. Associations with self-control were found for pubertal status and parental warmth and hostility, but not for parental discipline. The findings suggest that during early adolescence, when children make the transition to secondary school, self-control declines. This is particularly the case for those experiencing puberty earlier than their peers. Parent warmth influences the trajectory of self-control during this period. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Results of the secondary side chemical cleaning of the steam generators

International Nuclear Information System (INIS)

Doma, A.; Patek, G.

2001-01-01

A significant amount of deposit has developed on the secondary side of the heat transfer tubes of the steam generators (SG) of the Paks Nuclear Power Plant units in course of the years. More than 99.5% of the deposit is made up of magnetite (Fe 3 O 4 ) generated in the secondary circuit of the power plant. Those deposits lead to the decrease of the heat transfer. Even more important is its role from the point of view of operational reliability of the steam generators, leak tightness between the primary and secondary sides. The first series of cleaning took place following 8-9 years of operation of the units. Following the first cleaning cycle the transport of the corrosion products into the steam generators did not change, and thus obviously new cleaning was required. Periodical cleaning of the steam generators shall be assured. (R.P.)

Teacher–student relationship, student mental health, and dropout from upper secondary school: A literature review

OpenAIRE

Krane, Vibeke; Karlsson, Bengt; Ness, Ottar; Kim, Hesook Suzie

2016-01-01

The purpose of this study was to assess the status of knowledge regarding the association between teacher–student relationship (TSR), dropout from upper secondary school, and student mental health. A literature search was conducted in Eric, PsycInfo, Medline, Scopus, Norart, and Idunn covering the period spanning 2000 to 2015. Sixteen articles were identified for review. These articles were analyzed via thematic analysis. The results indicate that the TSR in upper secondary school is associat...

Designing a Curriculum Model for the Teaching of the Bible in UK Jewish Secondary Schools: A Case Study

Science.gov (United States)

Kohn, Eli

2012-01-01

This paper describes the process of designing a curriculum model for Bible teaching in UK Jewish secondary schools. This model was designed over the period 2008-2010 by a team of curriculum specialists from the Jewish Curriculum Partnership UK in collaboration with a group of teachers from Jewish secondary schools. The paper first outlines the…

Temperament and character profiles are associated with depression outcome in psychiatric secondary care patients with harmful drinking.

Science.gov (United States)

Paavonen, Vesa; Luoto, Kaisa; Lassila, Antero; Leinonen, Esa; Kampman, Olli

2018-04-07

Temperament and character profiles have been associated with depression outcome and alcohol abuse comorbidity in depressed patients. How harmful alcohol use modifies the effects of temperament and character on depression outcome is not well known. Knowledge of these associations could provide a method for enhancing more individualized treatment strategies for these patients. We screened 242 depressed patients with at least moderate level of depressive symptoms. The Alcohol Use Disorders Identification Test (AUDIT) was used for identifying patients with marked alcohol use problems (AUP, AUDIT≥11). After 6 weeks of antidepressive treatment 173 patients were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Temperament and Character Inventory (TCI-R). Outcome of depression (MADRS scores across three follow-up points at 6 weeks, 6 months and 24 months) was predicted with AUP, gender, and AUP x Gender and AUP x Time interactions together with temperament and character dimension scores in a linear mixed effects model. Poorer outcome of depression (MADRS scores at 6 weeks, 6 months and 24 months) was predicted by AUP × Time interaction (p = 0.0002) together with low Reward Dependence (p = 0.003). Gender and all other temperament and character traits were non-significant predictors of the depression outcome in the mixed effects model. Possibly due to the modifying effect of alcohol use problems, high Reward Dependence was associated with better depression treatment outcome at 6 months. Harm Avoidance and Self-Directedness did not predict depression outcome when alcohol use problems were controlled. Copyright © 2018 Elsevier Inc. All rights reserved.

To the problem of DQ Herculis orbital period variations.

Science.gov (United States)

Dmitrienko, E. S.

The eclipses of the primary component by the secondary one in DQ Her (Nova Her 1934) were analyzed using the light curves obtained by photometrical observations in 1982 - 1986. It is suspected that the value O-C is varying with time according to a sinusoidal law with the period of about 5 years and the amplitude ≡3 - 4 min. The secondary minimum is not shown up on the UBVRI-light curves of DQ Her. That is why the two hypotheses - the apsidal motion and the third component in the system - would seem adequate to explain the sinusoidal change of the value "O-C". By assuming that a probable sinusoidal dependence O-C on time occurs due to apsidal motion, it can be a result of deformation of the secondary component shape, since the contribution from the relativistic motion does not exceed 5%. The obtained value of k2 for the models with zero viscosity is (1 - 5)×10-3 that corresponds to a very high concentration of stellar matter toward the centre of the star. Application of models with the viscosity not equal to zero must lead to the increase of the k2 parameter.

Long-Term Outcomes of Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder.

Science.gov (United States)

Krebs, Georgina; de la Cruz, Lorena Fernández; Monzani, Benedetta; Bowyer, Laura; Anson, Martin; Cadman, Jacinda; Heyman, Isobel; Turner, Cynthia; Veale, David; Mataix-Cols, David

2017-07-01

Emerging evidence suggests that cognitive-behavioral therapy (CBT) is an efficacious treatment for adolescent body dysmorphic disorder (BDD) in the short term, but longer-term outcomes remain unknown. The current study aimed to follow up a group of adolescents who had originally participated in a randomized controlled trial of CBT for BDD to determine whether treatment gains were maintained. Twenty-six adolescents (mean age = 16.2, SD = 1.6) with a primary diagnosis of BDD received a course of developmentally tailored CBT and were followed up over 12 months. Participants were assessed at baseline, midtreatment, posttreatment, 2-, 6-, and 12-month follow-up. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD. Secondary outcomes included measures of insight, depression, quality of life, and global functioning. BDD symptoms decreased significantly from pre- to posttreatment and remained stable over the 12-month follow-up. At this time point, 50% of participants were classified as responders and 23% as remitters. Participants remained significantly improved on all secondary outcomes at 12-month follow-up. Neither baseline insight nor baseline depression predicted long-term outcomes. The positive effects of CBT appear to be durable up to 12-month follow-up. However, the majority of patients remained symptomatic and vulnerable to a range of risks at 12-month follow-up, indicating that longer-term monitoring is advisable in this population. Future research should focus on enhancing the efficacy of CBT in order to improve long-term outcomes. Copyright © 2017. Published by Elsevier Ltd.

Critical gastrointestinal bleed due to secondary aortoenteric fistula

Directory of Open Access Journals (Sweden)

Mohammad U. Malik

2015-12-01

Full Text Available Secondary aortoenteric fistula (SAEF is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A. The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates

DEFF Research Database (Denmark)

Safai, Narges; Carstensen, Bendix; Vestergaard, Henrik

2018-01-01

), blood pressure (BP) and low-density lipoprotein (LDL) cholesterol as well as proportion reaching treatment targets. Our secondary outcome was to investigate changes in antidiabetic, antihypertensive and lipid-lowering treatment, together with the impact on estimated CVD risk. Linear mixed model....... SETTING: Tertiary diabetes centre in Denmark. PARTICIPANTS: Patients with type 2 diabetes (n=4299) referred to a programme with focus on treatment of hyperglycaemia, hypertension and dyslipidaemia between 1 January 2001 and 1 April 2016. OUTCOMES: Primary outcomes were changes in haemoglobin A1c (HbA1c...

One-year postpartum outcomes following a weight management intervention in pregnant women with obesity

Science.gov (United States)

Vesco, Kimberly K.; Leo, Michael C.; Karanja, Njeri; Gillman, Matthew W.; McEvoy, Cindy T.; King, Janet C.; Eckhardt, Cara L.; Smith, K. Sabina; Perrin, Nancy; Stevens, Victor J.

2016-01-01

Objective This analysis focuses on 1-year maternal and infant follow-up of a randomized trial that tested a weight management intervention conducted during pregnancy. Methods We randomly assigned 114 women with obesity (mean BMI 36.7 kg/m2) at a mean of 15 weeks’ gestation to a weight management intervention or usual care control condition. The intervention ended at delivery and resulted in less gestational weight gain and a lower proportion of large-for-gestational age newborns among intervention compared to control participants. The primary outcome at 12 months postpartum was maternal weight. Secondary outcomes included infant weight-for-age and weight-for-length z-scores. Results At 1 year, mothers in the intervention group weighed 96.3±18.6 kg, and in the control group, 99.7±19.2 kg. There was no significant difference between groups in change in weight from randomization to 1-year postpartum (b=-0.47, 95% CI [-4.03, 3.08]. There was a significant main effect of group for infant weight-for-age z-score (b=-0.40, 95% CI [-0.75,-0.05]) but not infant weight-for-length z-scores (b=-0.20, 95% CI [-0.59,0.20]. Conclusions A gestational weight management intervention did not influence maternal weight or infant weight-for-length at 1-year postpartum. Future studies may be warranted to determine if extending prenatal interventions into the postpartum period would be beneficial for maternal and infant outcomes. PMID:27670399

Evolution of Secondary Software Businesses: Understanding Industry Dynamics

Science.gov (United States)

Tyrväinen, Pasi; Warsta, Juhani; Seppänen, Veikko

Primary software industry originates from IBM's decision to unbundle software-related computer system development activities to external partners. This kind of outsourcing from an enterprise internal software development activity is a common means to start a new software business serving a vertical software market. It combines knowledge of the vertical market process with competence in software development. In this research, we present and analyze the key figures of the Finnish secondary software industry, in order to quantify its interaction with the primary software industry during the period of 2000-2003. On the basis of the empirical data, we present a model for evolution of a secondary software business, which makes explicit the industry dynamics. It represents the shift from internal software developed for competitive advantage to development of products supporting standard business processes on top of standardized technologies. We also discuss the implications for software business strategies in each phase.

A survey for very short-period planets in the Kepler data

Energy Technology Data Exchange (ETDEWEB)

Jackson, Brian; Stark, Christopher C.; Chambers, John [Carnegie Institution for Science, 5241 Broad Branch Road NW, Washington, DC 20015 (United States); Adams, Elisabeth R. [Planetary Science Institute, 1700 East Fort Lowell, Suite 106, Tucson, AZ 85719 (United States); Deming, Drake, E-mail: bjackson@dtm.ciw.edu [Department of Astronomy, University of Maryland at College Park, College Park, MD 20742 (United States)

2013-12-20

We conducted a search for very short-period transiting objects in the publicly available Kepler data set. Our preliminary survey has revealed four planetary candidates, all with orbital periods less than 12 hr. We have analyzed the data for these candidates using photometric models that include transit light curves, ellipsoidal variations, and secondary eclipses to constrain the candidates' radii, masses, and effective temperatures. Even with masses of only a few Earth masses, the candidates' short periods mean that they may induce stellar radial velocity signals (a few m s{sup –1}) detectable by currently operating facilities. The origins of such short-period planets are unclear, but we discuss the possibility that they may be the remnants of disrupted hot Jupiters. Whatever their origins, if confirmed as planets, these candidates would be among the shortest-period planets ever discovered. Such planets would be particularly amenable to discovery by the planned TESS mission.

A survey for very short-period planets in the Kepler data

International Nuclear Information System (INIS)

Jackson, Brian; Stark, Christopher C.; Chambers, John; Adams, Elisabeth R.; Deming, Drake

2013-01-01

We conducted a search for very short-period transiting objects in the publicly available Kepler data set. Our preliminary survey has revealed four planetary candidates, all with orbital periods less than 12 hr. We have analyzed the data for these candidates using photometric models that include transit light curves, ellipsoidal variations, and secondary eclipses to constrain the candidates' radii, masses, and effective temperatures. Even with masses of only a few Earth masses, the candidates' short periods mean that they may induce stellar radial velocity signals (a few m s –1 ) detectable by currently operating facilities. The origins of such short-period planets are unclear, but we discuss the possibility that they may be the remnants of disrupted hot Jupiters. Whatever their origins, if confirmed as planets, these candidates would be among the shortest-period planets ever discovered. Such planets would be particularly amenable to discovery by the planned TESS mission.

GOTHIC MODEL OF BWR SECONDARY CONTAINMENT DRAWDOWN ANALYSES

International Nuclear Information System (INIS)

Hansen, P.N.

2004-01-01

This article introduces a GOTHIC version 7.1 model of the Secondary Containment Reactor Building Post LOCA drawdown analysis for a BWR. GOTHIC is an EPRI sponsored thermal hydraulic code. This analysis is required by the Utility to demonstrate an ability to restore and maintain the Secondary Containment Reactor Building negative pressure condition. The technical and regulatory issues associated with this modeling are presented. The analysis includes the affect of wind, elevation and thermal impacts on pressure conditions. The model includes a multiple volume representation which includes the spent fuel pool. In addition, heat sources and sinks are modeled as one dimensional heat conductors. The leakage into the building is modeled to include both laminar as well as turbulent behavior as established by actual plant test data. The GOTHIC code provides components to model heat exchangers used to provide fuel pool cooling as well as area cooling via air coolers. The results of the evaluation are used to demonstrate the time that the Reactor Building is at a pressure that exceeds external conditions. This time period is established with the GOTHIC model based on the worst case pressure conditions on the building. For this time period the Utility must assume the primary containment leakage goes directly to the environment. Once the building pressure is restored below outside conditions the release to the environment can be credited as a filtered release

Outcome of total parathyroidectomy and autotransplantation as treatment of secondary and tertiary hyperparathyroidism in children and adults.

NARCIS (Netherlands)

Kievit, A.J.; Tinnemans, J.G.; Idu, M.M.; Groothoff, J.W.; Surachno, S.; Aronson, D.C.

2010-01-01

BACKGROUND: Treatment safety and effectiveness of total parathyroidectomy and autotransplantation for secondary and tertiary hyperparathyroidism have been extensively proven in adults; the evidence for children, however, is scarce. Children and adolescents cannot simply be seen as young adults in

Effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome

Science.gov (United States)

Zeng, Xian-Ling; Zhang, Ya-Fei; Tian, Quan; Xue, Yan; An, Rui-Fang

2016-01-01

Abstract Aim: The aim of the study is to evaluate the effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome (PCOS). Methods: We searched electronic databases and bibliographies of relevant papers to identify studies comparing the pregnancy outcomes in the metformin group with those in the placebo or blank control group. Then, we did this meta-analysis based on the PRISMA guidelines. The primary outcomes included early pregnancy loss (EPL), preterm delivery, term delivery, and gestational diabetes mellitus (GDM). Secondary outcomes included pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR), fetal malformation, vaginal delivery (VD), cesarean section (CS), and metformin's side effects, such as nausea or gastrointestinal discomfort. Certainly, data about neonatal death and macrosomia were analyzed if data available. Results: Finally, 13 studies including 5 randomized controlled trials (RCT) and 8 cohort studies involving 1606 pregnant women with PCOS were analyzed. The pooled OR of EPL was 0.19 with obvious statistical significance, manifesting that metformin help to lower the rate of EPL (95% CI 0.12–0.28, P metformin showed the advantage of reducing the prevalence of preterm delivery (OR 0.37, 95% CI 0.20–0.68, P = 0.002). In addition, metformin could promote term delivery greatly and the pooled OR was 5.23 with sharp statistical difference (95% CI 3.12–8.75, P Metformin treatment in women with PCOS throughout pregnancy could increase the possibility of term delivery, VD and reduce the risk of EPL, preterm labor, pregnancy complications such as GDM and PIH, with no serious side effects. Moreover, metformin was not teratogenic based on the limited data. So we may recommend metformin treatment for women with PCOS during the whole pregnancy period for it is quite beneficial and safe for both mothers and babies. PMID:27603343

In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

Science.gov (United States)

Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar J; Patel, Samir V; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy; Badheka, Apurva O

2016-02-15

Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcome measures in studies on the use of oxytocin for the treatment of delay in labour: A systematic review.

LENUS (Irish Health Repository)

Begley, Cecily M

2014-07-01

to identify primary and secondary outcome measures in randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in the first and second stages of labour, and to identify any positive health-focussed outcomes used.

Navigation with ECDIS: Choosing the Proper Secondary Positioning Source

Directory of Open Access Journals (Sweden)

D. Brčic

2015-09-01

Full Text Available The completion of ECDIS mandatory implementation period on-board SOLAS vessels requires certain operational, functional and educational gaping holes to be solved. It especially refers to positioning and its redundancy, which represents fundamental safety factor on-board navigating vessels. The proposed paper deals with primary and secondary positioning used in ECDIS system. Standard positioning methods are described, discussing possibilities of obtained positions’ automatic and manual implementation in ECDIS, beside default methods. With the aim of emphasizing the need and importance of using secondary positioning source in ECDIS, positioning issue from the standpoint of end-users was elaborated, representing a practical feedback of elaborated topic. The survey was conducted in the form of international questionnaire placed among OOWs, ranging from apprentice officers to captains. The result answers and discussion regarding (nonusage of secondary positioning sources in ECDIS were analysed and presented. Answers and statements were elaborated focusing not only in usage of the secondary positioning system in ECDIS, but in navigation in general. The study revealed potential risks arising from the lack of knowledge and even negligence. The paper concludes with summary of findings related to discrepancies between theoretical background, good seamanship practice and real actions taken by OOWs. Further research activities are pointed out, together with planned practical actions in raising awareness regarding navigation with ECDIS.

NANDA Diagnoses, NIC Interventions, and NOC Outcomes Used in an Electronic Health Record with Elementary School Children

Science.gov (United States)

Lunney, Margaret

2006-01-01

This is a report of a secondary analysis of data from a published quasi-experimental feasibility study of the effects of implementing diagnoses from North American Nursing Diagnosis Association International, interventions from the Nursing Interventions Classification, and outcomes from the Nursing Outcomes Classification (referred to as NNN) on…

Outcome of 28 open pilon fractures with injury severity-based fixation.

Science.gov (United States)

Danoff, Jonathan R; Saifi, Comron; Goodspeed, David C; Reid, J Spence

2015-04-01

Open pilon fracture management and treatment poses a significant challenge to orthopedic surgeons. The purpose of this study was to determine patient outcomes for open pilon fractures based on wound complication and infection rates, as well as subjective outcome instruments. This was a retrospective consecutive case series of 28 fractures with Orthopaedic Trauma Association (OTA)-type 43-B and 43-C open pilon fractures. Mean length of follow-up was 36 months and minimum of 1 year. Ten fractures were Gustilo and Anderson grade IIIB, and the remaining fractures were grades I-IIIA. Patients were initially treated with spanning external fixation and staged wound debridement followed by osteosynthesis of the articular surface. Metaphyseal fixation was by either plate fixation or Ilizarov frame. The primary outcome was the incidence of deep tissue infection requiring surgery. Secondary outcomes included the incidence of other complications (nonunion, malunion, amputation) and functional outcomes (Short Musculoskeletal Functional Assessment Questionnaire and AAOS Foot and Ankle Questionnaire). Four patients developed deep tissue infections, three in the internal fixation group and one in the Ilizarov group, and all were treated successfully with staged debridement. There were two delayed unions required bone grafting, and infection-free union was ultimately achieved in all fractures. Two patients underwent arthrodesis secondary to post-traumatic arthritis, while no patients experienced malunions or amputations. The use of staged wound debridement in conjunction with either plate fixation or Ilizarov frame achieves low rates of wound infection and stable fixation after anatomic joint reconstruction for OTA-type 43-B and 43-C open pilon fractures.

Mesoporous magnetic secondary nanostructures as versatile adsorbent for efficient scavenging of heavy metals

Science.gov (United States)

Bhattacharya, Kakoli; Parasar, Devaborniny; Mondal, Bholanath; Deb, Pritam

2015-01-01

Porous magnetic secondary nanostructures exhibit high surface area because of the presence of plentiful interparticle spaces or pores. Mesoporous Fe3O4 secondary nanostructures (MFSNs) have been studied here as versatile adsorbent for heavy metal scavenging. The porosity combined with magnetic functionality of the secondary nanostructures has facilitated efficient heavy metal (As, Cu and Cd) remediation from water solution within a short period of contact time. It is because of the larger surface area of MFSNs due to the porous network in addition to primary nanostructures which provides abundant adsorption sites facilitating high adsorption of the heavy metal ions. The brilliance of adsorption property of MFSNs has been realized through comprehensive adsorption studies and detailed kinetics. Due to their larger dimension, MFSNs help in overcoming the Brownian motion which facilitates easy separation of the metal ion sorbed secondary nanostructures and also do not get drained out during filtration, thus providing pure water. PMID:26602613

Diurnal Periodicity in the Supply of Cell Wall Components during Wood Cell Wall Formation

OpenAIRE

細尾, 佳宏

2012-01-01

This review summarizes recent studies on the diurnal periodicity in wood cell wall formation, with a major focus on those that we have conducted. Differences in the innermost surface of developing secondary walls of differentiating conifer tracheids can be seen from day to night Cellulose microfibrils are clearly evident during the day, and amorphous material containing abundant hemicelluloses is prevalent at night. These findings suggest a diurnal periodicity in the supply of cell wall compo...

Outcome of Total Parathyroidectomy and Autotransplantation as Treatment of Secondary and Tertiary Hyperparathyroidism in Children and Adults

NARCIS (Netherlands)

Kievit, A. J.; Tinnemans, J. G. M.; Idu, M. M.; Groothoff, J. W.; Surachno, S.; Aronson, D. C.

2010-01-01

Treatment safety and effectiveness of total parathyroidectomy and autotransplantation for secondary and tertiary hyperparathyroidism have been extensively proven in adults; the evidence for children, however, is scarce. Children and adolescents cannot simply be seen as young adults in the case of

Cranial Paget's disease - clinical case of symptomatic secondary basilar impression

International Nuclear Information System (INIS)

Gagov, E.; Gabrovsky, N.; Gabrovsky, S.

2010-01-01

A clinical case of 52 years old woman with history of periodic headaches for many years. The headache became more intensive and constant during the last 4-6 months. Instability by walking and stagger occurred as well as weakness in all 4 extremities, difficult swallowing and speech changes. Bulbar, quadripyramidal and archicerebellar symptoms were in hand. Pagets disease was ascertained engaging the skull with secondary basilar impression and compression of the cerebellum and the brain-stem leading to the above described clinical signs. Decompressive median suboccipital craniectomy was performed with laminectomy of C1. Occipital squama was thickened and highly vascularized.. Secondary basilar impression could occur in cranial Pagets disease with clinical symptoms resulting from the compression of the cerebellum and the brain-stem

A mutation in the KCNE3 potassium channel gene is associated with susceptibility to thyrotoxic hypokalemic periodic paralysis

OpenAIRE

Dias-da-Silva, Magnus Régios [UNIFESP; Cerutti, Janete Maria [UNIFESP; Arnaldi, Liliane Aparecida Teixeira [UNIFESP; Maciel, Rui Monteiro de Barros [UNIFESP

2002-01-01

Hypokalemic Periodic Paralyses comprise diverse diseases characterized by acute and reversible attacks of severe muscle weakness, associated with low serum potassium. the most common causes are Familial Hypokalemic Periodic Paralysis (FHypoKPP), an autosomal dominant disease, and Thyrotoxic Hypokalemic Periodic Paralysis (THypoKPP), secondary to thyrotoxicosis. Symptoms of paralysis are similar in both diseases, distinguished by thyrotoxicosis present in THypoKPP. FHypoKPP is caused by mutati...

Guillain-Barre Syndrome in Postpartum Period: Rehabilitation Issues and Outcome - Three Case Reports.

Science.gov (United States)

Gupta, Anupam; Patil, Maitreyi; Khanna, Meeka; Krishnan, Rashmi; Taly, Arun B

2017-01-01

We report three females who developed Guillain-Barre Syndrome in postpartum period (within 6 weeks of delivery) and were admitted in the Neurological Rehabilitation Department for rehabilitation after the initial diagnosis and treatment in the Department of Neurology. The first case, axonal variant (acute motor axonal neuropathy [AMAN]) had worst presentation at the time of admission, recovered well by the time of discharge. The second case, acute motor sensory axonal neuropathy variant and the third case, AMAN variant presented at the late postpartum period. Medical treatment was sought much later due to various reasons and both the patients had an incomplete recovery at discharge. Apart from their presentations, rehabilitation management is also discussed in some detail.

Learning outcomes evaluation of a simulation-based introductory course to anaesthesia.

Science.gov (United States)

Rábago, J L; López-Doueil, M; Sancho, R; Hernández-Pinto, P; Neira, N; Capa, E; Larraz, E; Redondo-Figuero, C G; Maestre, J M

2017-10-01

An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants

OpenAIRE

Lee, Iris; Neil, Jeffrey J.; Huettner, Phyllis C.; Smyser, Christopher D.; Rogers, Cynthia E.; Shimony, Joshua S.; Kidokoro, Hiroyuki; Mysorekar, Indira U.; Inder, Terrie E.

2014-01-01

Objective Determine the association of prenatal and neonatal infections with neurodevelopmental outcomes in very preterm infants. Study Design Secondary retrospective analysis of 155 very preterm infants at a single tertiary referral center. General linear or logistic regression models were used to evaluate the association with hospital factors; brain injury, growth, and development; and neurobehavioral outcome. Result Necrotizing enterocolitis with sepsis was associated with reduced transcer...

Perspective of the Westinghouse steam generator secondary side maintenance approach

Energy Technology Data Exchange (ETDEWEB)

Ramaley, D. [Westinghouse Electric Company LLC, Cranberry Township, Pennsylvania (United States)

2012-07-01

Historically, Westinghouse had developed a set of steam generator secondary maintenance guidelines focused around performing recurring activities each outage without direct regards to the age, deposit loading, operational status, or corrosion status of the steam generator. Through the evolution of steam generator design and steam generator condition data, Westinghouse now uses a proactive assessment and planning approach for utilities. Westinghouse works with utilities to develop steam generator secondary maintenance plans for long term steam generator viability. Westinghouse has developed a portfolio of products to allow utilities to optimize steam generator operability and develop programs aimed at maintaining the steam generator secondary side in a favorable condition for successful long term operation. Judicious use of the means available for program development should allow for corrosion free operation, long term full power operation at optimum thermal efficiency, and leveling of outage expenditures over a long period of time. This paper will review the following required elements for an effective steam generator secondary side strategy: • Assessment: In order to develop an appropriate maintenance strategy, actions must be taken to obtain an accurate picture of the SG secondary side condition. • Forecasting: Using available data predictions are developed for future steam generator conditions and required maintenance actions. • Action: Cost effective engineering and maintenance actions must be completed at the appropriate time as designated by the plan. • Evaluation of Results: Following execution of maintenance tactics, it is necessary to revise strategy and develop technology enhancements as appropriate. (author)

Agent Orange and long-term outcomes after radical prostatectomy.

Science.gov (United States)

Ovadia, Aaron E; Terris, Martha K; Aronson, William J; Kane, Christopher J; Amling, Christopher L; Cooperberg, Matthew R; Freedland, Stephen J; Abern, Michael R

2015-07-01

To investigate the association between Agent Orange (AO) exposure and long-term prostate cancer (PC) outcomes. Data from 1,882 men undergoing radical prostatectomy for PC between 1988 and 2011 at Veterans Affairs Health Care Facilities were analyzed from the Shared Equal Access Regional Cancer Hospital database. Men were stratified by AO exposure (binary). Associations between AO exposure and biopsy and pathologic Gleason sum (GS) and pathologic stage were determined by logistic regression models adjusted for preoperative characteristics. Hazard ratios for biochemical recurrence (BCR), secondary treatment, metastases, and PC-specific mortality were determined by Cox models adjusted for preoperative characteristics. There were 333 (17.7%) men with AO exposure. AO-exposed men were younger (median 59 vs. 62 y), had lower preoperative prostate-specific antigen levels (5.8 vs. 6.7 ng/ml), lower clinical category (25% vs. 38% palpable), and higher body mass index (28.2 vs. 27.6 kg/m(2)), all P<0.01. Biopsy GS, pathologic GS, positive surgical margins, lymph node positivity, and extracapsular extension did not differ with AO exposure. At a median follow-up of 85 months, 702 (37.4%) patients had BCR, 603 (32.2%) patients received secondary treatment, 78 (4.1%) had metastases, and 39 (2.1%) died of PC. On multivariable analysis, AO exposure was not associated with BCR, secondary treatment, metastases, or PC mortality. AO exposure was not associated with worse preoperative characteristics such as elevated prostate-specific antigen levels or biopsy GS nor with BCR, secondary treatment, metastases, or PC death. Thus, as data on AO-exposed men mature, possible differences in PC outcomes observed previously are no longer apparent. Copyright © 2015 Elsevier Inc. All rights reserved.

Secondary Instability of Stationary Crossflow Vortices in Mach 6 Boundary Layer Over a Circular Cone

Science.gov (United States)

Li, Fei; Choudhari, Meelan M.; Paredes-Gonzalez, Pedro; Duan, Lian

2015-01-01

Hypersonic boundary layer flows over a circular cone at moderate incidence can support strong crossflow instability. Due to more efficient excitation of stationary crossflow vortices by surface roughness, such boundary layer flows may transition to turbulence via rapid amplification of the high-frequency secondary instabilities of finite amplitude stationary crossflow vortices. The amplification characteristics of these secondary instabilities are investigated for crossflow vortices generated by an azimuthally periodic array of roughness elements over a 7-degree half-angle circular cone in a Mach 6 free stream. Depending on the local amplitude of the stationary crossflow mode, the most unstable secondary disturbances either originate from the second (i.e., Mack) mode instabilities of the unperturbed boundary layer or correspond to genuine secondary instabilities that reduce to stable disturbances at sufficiently small amplitudes of the stationary crossflow vortex. The predicted frequencies of dominant secondary disturbances are similar to those measured during wind tunnel experiments at Purdue University and the Technical University of Braunschweig, Germany.

Acquired ectropion uveae and secondary glaucoma due to trauma: report of 3 cases.

Science.gov (United States)

Markovic, Vujica; Vukovic, Dragan; Radosavljevic, Aleksandra; Marjanovic, Ivan

2017-01-19

To investigate the possible association between acquired ectropion uveae and blunt trauma to the eye. We present 3 cases of acquired ectropion uveae that occurred after blunt trauma to the eye. There are no previously published data on possible association of these conditions. A retrospective review was conducted of patients with ectropion uveae and eye injury at University Eye Hospital over a 10-year period (2006-2016). We analyzed medical records and clinical findings. Three eyes of 3 male patients with ocular trauma and ectropion uveae, ages 71, 68, and 5 years, were reviewed. The period between the eye injury and the diagnosis of ectropion uveae ranged from 10 to 36 months. All 3 eyes developed clinical evidence of secondary glaucoma with moderately to severely elevated intraocular pressure (IOP) (ranging from 29 to 48 mm Hg). Surgical treatment (trabeculectomy) was needed in 2 cases in order to control secondary glaucoma and conservative treatment was sufficient in 1 case. Mean patient follow-up was 19.3 ± 4.6 months. Trauma can be considered as a cause of acquired ectropion uveae. Acquired ectropion uveae following eye trauma may be associated with significant increase in IOP. All patients in our series had secondary glaucoma and 2 of 3 required surgical treatment for IOP control.

Rape treatment outcome research: empirical findings and state of the literature.

Science.gov (United States)

Vickerman, Katrina A; Margolin, Gayla

2009-07-01

This article reviews empirical support for treatments targeting women sexually assaulted during adolescence or adulthood. Thirty-two articles were located using data from 20 separate samples. Of the 20 samples, 12 targeted victims with chronic symptoms, three focused on the acute period post-assault, two included women with chronic and acute symptoms, and three were secondary prevention programs. The majority of studies focus on posttraumatic stress disorder (PTSD), depression, and/or anxiety as treatment targets. Cognitive Processing Therapy and Prolonged Exposure have garnered the most support with this population. Stress Inoculation Training and Eye Movement Desensitization and Reprocessing also show some efficacy. Of the four studies that compared active treatments, few differences were found. Overall, cognitive behavioral interventions lead to better PTSD outcomes than supportive counseling does. However, even in the strongest treatments more than one-third of women retain a PTSD diagnosis at post-treatment or drop out of treatment. Discussion highlights the paucity of research in this area, methodological limitations of examined studies, generalizability of findings, and important directions for future research at various stages of trauma recovery.

Rape Treatment Outcome Research: Empirical Findings and State of the Literature

Science.gov (United States)

Vickerman, Katrina A.; Margolin, Gayla

2009-01-01

This article reviews empirical support for treatments targeting women sexually assaulted during adolescence or adulthood. Thirty-two articles were located using data from 20 separate samples. Of the 20 samples, 12 targeted victims with chronic symptoms, three focused on the acute period post-assault, two included women with chronic and acute symptoms, and three were secondary prevention programs. The majority of studies focus on posttraumatic stress disorder (PTSD), depression, and/or anxiety as treatment targets. Cognitive Processing Therapy and Prolonged Exposure have garnered the most support with this population. Stress Inoculation Training and Eye Movement Desensitization and Reprocessing also show some efficacy. Of the four studies that compared active treatments, few differences were found. Overall, cognitive behavioral interventions lead to better PTSD outcomes than supportive counseling does. However, even in the strongest treatments more than one-third of women retain a PTSD diagnosis at post-treatment or drop out of treatment. Discussion highlights the paucity of research in this area, methodological limitations of examined studies, generalizability of findings, and important directions for future research at various stages of trauma recovery. PMID:19442425

Secondary prevention of stroke in Saskatchewan, Canada: hypertension control.