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Sample records for prescribing indicators related

  1. Statin prescribing according to gender, age and indication

    DEFF Research Database (Denmark)

    Wallach-Kildemoes, Helle; Støvring, Henrik; Holme Hansen, Ebba

    2016-01-01

    RATIONALES, AIMS AND OBJECTIVES: The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing...... patterns to evidence on beneficial and adverse effects. METHODS: A cohort of Danish inhabitants (n = 4 424 818) was followed in nationwide registries for dispensed statin prescriptions and hospital discharge information. We calculated incidence rates (2005-2009), prevalence trends (2000-2010) and absolute...... numbers of statin users according to register proxies for indication, gender and age. RESULTS: In 2010, the prevalence became highest for ages 75-84 and was higher in men than women (37% and 33%, respectively). Indication-specific incidences and prevalences peaked at ages around 65-70, but in myocardial...

  2. Factor analysis improves the selection of prescribing indicators

    DEFF Research Database (Denmark)

    Rasmussen, Hanne Marie Skyggedal; Søndergaard, Jens; Sokolowski, Ineta

    2006-01-01

    OBJECTIVE: To test a method for improving the selection of indicators of general practitioners' prescribing. METHODS: We conducted a prescription database study including all 180 general practices in the County of Funen, Denmark, approximately 472,000 inhabitants. Principal factor analysis was us...... appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns....

  3. A Validation Study of Homeopathic Prescribing and Patient Care Indicators

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    Munmun Koley

    2014-10-01

    Full Text Available A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H, Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items and patient care indicators (5 items. Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791. The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65 to 0.74 (95% CI: 0.69-0.78. The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48 to 0.82 (95% CI: 0.78-0.85. The instrument also showed high discriminant validity (prescribing indicators P<0.0001 and patient care indicators P<0.0001. Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

  4. A Validation Study of Homeopathic Prescribing and Patient Care Indicators

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    Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy; Nag, Goutam; Kundu, Monojit; Mondal, Ramkumar; Purkait, Rajib; Patra, Supratim

    2014-01-01

    A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development. PMID:25379474

  5. Indicators for the automated analysis of drug prescribing quality.

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    Coste, J; Séné, B; Milstein, C; Bouée, S; Venot, A

    1998-01-01

    Irrational and inconsistent drug prescription has considerable impact on morbidity, mortality, health service utilization, and community burden. However, few studies have addressed the methodology of processing the information contained in these drug orders used to study the quality of drug prescriptions and prescriber behavior. We present a comprehensive set of quantitative indicators for the quality of drug prescriptions which can be derived from a drug order. These indicators were constructed using explicit a priori criteria which were previously validated on the basis of scientific data. Automatic computation is straightforward, using a relational database system, such that large sets of prescriptions can be processed with minimal human effort. We illustrate the feasibility and value of this approach by using a large set of 23,000 prescriptions for several diseases, selected from a nationally representative prescriptions database. Our study may result in direct and wide applications in the epidemiology of medical practice and in quality control procedures.

  6. Drug use evaluation of antibiotics prescribed in a Jordanian hospital outpatient and emergency clinics using WHO prescribing indicators

    International Nuclear Information System (INIS)

    Al-Niemat, Sahar I.; Bloukh, Diana T.; Al-Harasis, Manal D.; Al-Fanek, Alen F.; Salah, Rehab K.

    2008-01-01

    Objective was to evaluate the use of antibiotics prescribed in hospital outpatient and emergency clinics in King Hussein Medical Centre (KHMC) using WHO prescribing indicators in an attempt to rationalize the use of antibiotics in the Royal Medical Services. We retrospectively surveyed a sample of 187,822 antibiotic prescriptions obtained from 5 outpatient pharmacies in KHMC written over the period of 3 consecutive months May 2007 to July 2007. The percentage of encounters of an antibiotic prescribed was calculated using the methodology recommended by the WHO. An additional indicator, the percentage share of different antibiotics was also included to identify the frequency prescribed from those antibiotics. The average percentage of prescriptions involving antibiotics was 35.6% out of 187,822 prescriptions surveyed. From these, 65,500 antibiotic prescriptions were observed. Penicillins most frequently amoxcillins and Quinolones most frequently ciprofloxacinllin and norfloxacillin were the most commonly prescribed antibiotics with an average percentage of 31.8% and 27.5%. The average prescribing rate for the other antibiotic categories was as follows: macrolides 5.2%, cephalosporins 16% and amoxcillins/clavulanate 5.4%. The high percentage of prescriptions involving antibiotics observed in KHMC pharmacies requires rational use of antibiotics and judicious prescribing by Military prescribers. An insight into factors influencing antibiotic prescribing patterns and adherence to antibiotic prescribing guidelines by the Military prescribers is warranted. (author)

  7. Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications?

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    Koyuncuoglu, Cenker Z; Aydin, Mehtap; Kirmizi, N Ipek; Aydin, Volkan; Aksoy, Mesil; Isli, Fatma; Akici, Ahmet

    2017-08-01

    There are concerns regarding appropriate use of antibiotics in dentistry practice. Data on dental antibiotic prescribing patterns by dentists is relatively limited. This nationwide study aimed to examine dentists' antibiotic prescriptions in a diagnosis-based manner in Turkey. This retrospective study on utilization of systemic antibiotics for dental problems was based on the national health data of the dentists obtained from Prescription Information System between January 2013 and August 2015. Only those prescriptions containing single diagnosis and at least one systemic antibiotic were included in the study. Antibiotic prescribing was compared by diagnoses and expertise of dentists. A total of 9,293,410 antibiotics were detected in 9,214,956 prescriptions that contained "single diagnosis and at least one antibiotic." The number of antibiotics per prescription was 1.01. "Periapical abscess without sinus" (28.1%), "dental examination" (20.7%), and "dental caries" (16.2%) were the three most common indications in which antibiotics were prescribed by dentists. While only 3.4% of antibiotics were prescribed upon the single and appropriate "cellulitis and abscess of mouth" diagnosis, the remaining 96.6% was prescribed for irrational/uncertain indications. Consistent in all diagnoses, "amoxicillin + enzyme inhibitor" (58.6%) was the mainly prescribed antibiotic. Analysis of the most preferred "amoxicillin + enzyme inhibitor" prescriptions by expertise of dentists showed significantly much higher prescription rates among Group A specialists and Group B specialists (67.0 and 67.8%, respectively) than those in unidentified dental practitioners (58.2%, p < 0.0001). This study showed that dentists prescribed antibiotics in an arbitrary and mostly unnecessary manner. In general, their antibiotic choices for examined diagnoses could be regarded as irrational. These results indicate the urgent need for improvement of rational antibiotic prescribing habits of dentists.

  8. Using relative humidity to predict spotfire probability on prescribed burns

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    John R. Weir

    2007-01-01

    Spotfires have and always will be a problem that burn bosses and fire crews will have to contend with on prescribed burns. Weather factors (temperature, wind speed and relative humidity) are the main variables burn bosses can use to predict and monitor prescribed fire behavior. At the Oklahoma State University Research Range, prescribed burns are conducted during...

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  10. Comparison of prescribing indicators of academic versus non-academic specialist physicians in Urmia, Iran

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    Sadigh-Rad, Laya; Majdi, Leila; Javaezi, Mehrnush; Delirrad, Mohammad

    2015-01-01

    Objective: As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran. Methods: In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations. Findings: Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients’ encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant. Conclusion: Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences. PMID:25984540

  11. Development and initial validation of prescribing quality indicators for patients with chronic kidney disease

    NARCIS (Netherlands)

    Smits, Kirsten P J; Sidorenkov, Grigory; Bilo, Henk J G; Bouma, Margriet; van Ittersum, Frans J; Voorham, Jaco; Navis, Gerjan; Denig, Petra

    2016-01-01

    BACKGROUND: Quality assessment is a key element for improving the quality of care. Currently, a comprehensive indicator set for measuring the quality of medication treatment in patients with chronic kidney disease (CKD) is lacking. Our aim was to develop and validate a set of prescribing quality

  12. Comparison of indicators assessing the quality of drug prescribing for asthma

    NARCIS (Netherlands)

    Veninga, C.C.M.; Denig, P.; Pont, L.G.; Haaijer-Ruskamp, F.M.

    Objective. To compare different indicators for assessing the quality of drug prescribing and establish their agreement in identifying doctors who may not adhere to treatment guidelines. Data Sources/Study Setting. Data from 181 general practitioners (GPs) from The Netherlands. The case of asthma is

  13. How useful are prescribing indicators based on the DU90% method to distinguish the quality of prescribing between pharmacotherapy audit meetings with different levels of functioning?

    NARCIS (Netherlands)

    Teichert, M.; Aalst, A. van der; Wit, H. de; Stroo, M.; Smet, P.A.G.M. de

    2007-01-01

    OBJECTIVES: The objective of the study was to assess the association between the quality of drug prescribing based on three indicator types derived from the DU90% method and different levels of functioning in pharmacotherapy audit meetings (PTAMs). MATERIALS AND METHODS: The level of functioning in

  14. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, L.; Markhorst, J.; Denig, P.; Haaijer-Ruskamp, F.M.; Braspenning, J.C.

    2012-01-01

    BACKGROUND: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  15. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, Liana; Markhorst, Joekie; Denig, Petra; Haaijer-Ruskamp, Flora M.; Braspenning, Joze

    2012-01-01

    Background: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  16. Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine

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    Acheampong, Paul; Cooper, Gill; Khazaeli, Behshad; Lupton, David J; White, Sue; May, Margaret T; Thomas, Simon H L

    2013-01-01

    Aims To ascertain the effects of the Medicines and Healthcare products Regulatory Agency's (MHRA) safety update in June 2010 on the volume of prescribing of quinine and on indices of quinine toxicity. Methods We analysed quarterly primary care total and quinine prescribing data for England and quinine prescribing volume for individual Primary Care Trusts in the North East of England from 2007/8 to 2011/12 obtained from the ePACT.net database. We also analysed quinine toxicity enquiries to the National Poisons Information Service (NPIS) via Toxbase® and by telephone between 2004/5 and 2011/12. Joinpoint regression and Pearson's correlation tests were used to ascertain changes in trends in prescribing and indices of toxicity and associations between prescribing and indices of toxicity, respectively. Results Total prescribing continued to increase, but annual growth in quinine prescribing in England declined from 6.0 to −0.6% following the MHRA update [difference −0.04 (95% confidence interval −0.07 to −0.01) quinine prescriptions per 100 patients per quarter, P = 0.0111]. Much larger reductions were observed in Primary Care Trusts that introduced comprehensive prescribing reviews. The previously increasing trend in Toxbase® quinine searches was reversed [difference −19.76 (95% confidence interval −39.28 to −9.20) user sessions per quarter, P = 0.0575]. Telephone enquiries to NPIS for quinine have declined, with stabilization of the proportion of moderate to severe cases of quinine poisoning since the update. Conclusions The MHRA advice was followed by limited reductions in the growth in quinine prescribing and in indicators of quinine overdose and toxicity. Quinine prescribing, however, remains common, and further efforts are needed to reduce availability and use. PMID:23594200

  17. What do Australian consumers, pharmacists and prescribers think about documenting indications on prescriptions and dispensed medicines labels?: A qualitative study.

    Science.gov (United States)

    Garada, Mona; McLachlan, Andrew J; Schiff, Gordon D; Lehnbom, Elin C

    2017-11-15

    Documenting the indication on prescriptions and dispensed medicines labels is not standard practice in Australia. However, previous studies that have focused on the content and design of dispensed medicines labels, have suggested including the indication as a safety measure. The aim of this study was to investigate the perspectives of Australian consumers, pharmacists and prescribers on documenting the indication on prescriptions and dispensed medicines labels. Semi-structured interviews were conducted and mock-up of dispensed medicines labels were designed for participants. Consumers (n = 19) and pharmacists (n = 7) were recruited by convenience sample at community pharmacies in Sydney (Australia) and prescribers (n = 8), including two medical students, were recruited through snowballing. Thirty-four participants were interviewed. Most participants agreed that documenting the indication would be beneficial especially for patients who are forgetful or take multiple medications. Participants also believed it would improve consumers' medication understanding and adherence. Prescribers and pharmacists believed it could help reduce prescribing and dispensing errors by matching the drug/dosage to the correct indication. Prescribers refrained from documenting the indication to protect patients' privacy; however, most patients did not consider documenting the indication as a breach of privacy. Prescribers raised concerns about the extra time to include indications on prescriptions and best language to document indications, using plain language as opposed to medical terminology. All interviewed stakeholders identified numerous benefits of documenting the indication on prescriptions and dispensed medicines labels. Whether these potential benefits can be realized remains unknown and addressing prescribers' concern regarding the time involved in documenting the indication on prescriptions remains a challenge for vendors of electronic medication management systems.

  18. What do Australian consumers, pharmacists and prescribers think about documenting indications on prescriptions and dispensed medicines labels?: A qualitative study

    Directory of Open Access Journals (Sweden)

    Mona Garada

    2017-11-01

    Full Text Available Abstract Background Documenting the indication on prescriptions and dispensed medicines labels is not standard practice in Australia. However, previous studies that have focused on the content and design of dispensed medicines labels, have suggested including the indication as a safety measure. The aim of this study was to investigate the perspectives of Australian consumers, pharmacists and prescribers on documenting the indication on prescriptions and dispensed medicines labels. Methods Semi-structured interviews were conducted and mock-up of dispensed medicines labels were designed for participants. Consumers (n = 19 and pharmacists (n = 7 were recruited by convenience sample at community pharmacies in Sydney (Australia and prescribers (n = 8, including two medical students, were recruited through snowballing. Results Thirty-four participants were interviewed. Most participants agreed that documenting the indication would be beneficial especially for patients who are forgetful or take multiple medications. Participants also believed it would improve consumers’ medication understanding and adherence. Prescribers and pharmacists believed it could help reduce prescribing and dispensing errors by matching the drug/dosage to the correct indication. Prescribers refrained from documenting the indication to protect patients’ privacy; however, most patients did not consider documenting the indication as a breach of privacy. Prescribers raised concerns about the extra time to include indications on prescriptions and best language to document indications, using plain language as opposed to medical terminology. Conclusions All interviewed stakeholders identified numerous benefits of documenting the indication on prescriptions and dispensed medicines labels. Whether these potential benefits can be realized remains unknown and addressing prescribers’ concern regarding the time involved in documenting the indication on prescriptions

  19. Indicators of prescribing quality in drug utilisation research : report of a European meeting (DURQUIM, 13-15 May 2004)

    NARCIS (Netherlands)

    Hoven, JL; Haaijer-Ruskamp, FM; Vander Stichele, RH

    An invitational expert meeting on indicators of prescribing quality was held on 13-15 May 2004, bringing together-from 19 European countries, the US, Canada, and Australia-40 researchers specialized in the development and application of indicators. The meeting was organized by the European Drug

  20. Derivation and validation of a multivariable model to predict when primary care physicians prescribe antidepressants for indications other than depression

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    Wong J

    2018-04-01

    Full Text Available Jenna Wong, Michal Abrahamowicz, David L Buckeridge, Robyn Tamblyn Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada Objective: Physicians commonly prescribe antidepressants for indications other than depression that are not evidence-based and need further evaluation. However, lack of routinely documented treatment indications for medications in administrative and medical databases creates a major barrier to evaluating antidepressant use for indications besides depression. Thus, the aim of this study was to derive a model to predict when primary care physicians prescribe antidepressants for indications other than depression and to identify important determinants of this prescribing practice. Methods: Prediction study using antidepressant prescriptions from January 2003–December 2012 in an indication-based electronic prescribing system in Quebec, Canada. Patients were linked to demographic files, medical billings data, and hospital discharge summary data to create over 370 candidate predictors. The final prediction model was derived on a random 75% sample of the data using 3-fold cross-validation integrated within a score-based forward stepwise selection procedure. The performance of the final model was assessed in the remaining 25% of the data. Results: Among 73,576 antidepressant prescriptions, 32,405 (44.0% were written for indications other than depression. Among 40 predictors in the final model, the most important covariates included the molecule name, the patient’s education level, the physician’s workload, the prescribed dose, and diagnostic codes for plausible indications recorded in the past year. The final model had good discrimination (concordance (c statistic 0.815; 95% CI, 0.787–0.847 and good calibration (ratio of observed to expected events 0.986; 95% CI, 0.842–1.136. Conclusion: In the absence of documented treatment indications, researchers may be able to use

  1. Nurse prescribing in general practice: a qualitative study of job satisfaction and work-related stress.

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    Cousins, Rosanna; Donnell, Christine

    2012-04-01

    Studies examining the impact nurse prescribing have largely focused on the efficacy of the service. It was suggested in pro-prescribing policy arguments that extending the nursing role to include prescribing would increase job satisfaction. This assertion has not been fully explored. To investigate the impact of independent prescribing for experienced nurse practitioners (NPs) working in general practice. In-depth interviews were conducted with six NPs who each had at least 3 years experience of independent prescribing in a busy inner city general practice. Analysis of interview data yielded two main themes: as independent prescribers NPs experienced increased levels of both job satisfaction and work-related stress. Increased satisfaction was associated with having greater autonomy and being able to provide more holistic care. Increased work-related stress emerged from greater job demands, perceived insufficient support and perceived effort-reward imbalance that centred upon the enhanced role not being recognized in terms of an increase in grade and pay. Independent prescribing increases job satisfaction for NPs in general practice, but there is also evidence of stressors associated with the role. It is important that NPs in general practice are encouraged and supported towards providing the effective patient-centred care in the community envisaged by current UK government. We acknowledge that the results presented in this paper are based on a sample limited to one city; however, it provides information that has important implications for the well being of NPs and ultimately patient care.

  2. Analysis of Out Door Patients' Prescriptions According to World Health Organization (WHO) Prescribing Indicators Among Private Hospitals in Western India.

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    Shelat, Prakash R; Kumbar, Shivaprasad Kalakappa

    2015-03-01

    Prescription is document through which doctor, patient and pharmacist are communicated. Many a times if these documents are not properly written or misinterpreted it can affect management of patients. WHO established prescribing indicators to analyse prescription and promoted rational use of drugs and better management of patients. To study the prescription pattern according to WHO prescribing indicators among private hospitals. The observational, prospective study carried out at different private hospitals at metro city in Western India to study the prescription pattern among private hospital. Study was conducted at different private hospitals of metro city. A total of 250 prescriptions of outdoor patients from various departments of private hospitals were collected for a period of three months (August to October) 2012 and evaluated. The study was analysed using Z-test. Patient details like age and gender was not written in all (100%) prescriptions. It was noticed that dose, direction of drug and duration of treatment was not completely written in 90%, 74% and 80% of prescriptions respectively. Abbreviations were used in all (100%) prescriptions. Doctor's medical registration number was mentioned in 0% prescriptions. Total 869 drugs were prescribed in 250 prescriptions. Average number of drug prescribed was 3.38±1.79 (Mean±SD). It was reported that Group II (3 to 4 encoutner) was significantly higher as compared to Group I (less than or equal to 2 encoutner) and Group III( more than four encounter). It was significantly (pprivate hospitals and antibiotics was commonly prescribed in private sector. Therefore, strict policy to good prescribing practice and strict antibiotic policy in outdoor patients are required to promote rational use of drugs.

  3. Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Siersma, Volkert Dirk; Sandholdt, Håkon

    2017-01-01

    practice-related factors driving high antibiotic prescribing rates. Results: We included 98% of general practices in Denmark (n = 1962) and identified a 10% group of high prescribers who accounted for 15% of total antibiotic prescriptions and 18% of critically important antibiotic prescriptions. Once case...... prescriptions issued over the phone compared with all antibiotic prescriptions; and a high number of consultations per 1000 patients. We also found that a low number of consultations per 1000 patients was associated with a reduced likelihood of being a high prescriber of antibiotics. Conclusions: An apparent...

  4. Endodontic treatment-related antibiotic prescribing patterns of South African oral health professionals.

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    Lalloo, R; Solanki, G; Ramphoma, K; Myburgh, N G

    2017-11-01

    To assess the antibiotic prescribing patterns of South African dentists for patients undergoing endodontic treatment. This study used data from 2013 health insurance claims submitted by South African oral health professionals to determine the antibiotic prescribing patterns related to endodontic treatment. A logistic regression model was used to test the fully adjusted statistical significance of the association between the exploratory variables (gender, age group, event type, abscess treatment, chronic health) and the dependent variable (antibiotic prescription). Odds ratios with 95% confidence intervals (CI) are reported, and a 95% CI excluding 1 was considered statistically significant. Almost 10% of endodontic treatments were prescribed an antibiotic. There were no significant differences in prescribing patterns by gender, age and chronic health status. Prescriptions were more common at the preparatory stage (9.4%) of root canal treatment compared to the therapy (4.7%) and canal filling (2%) stages. Patients who received apical surgery (OR = 2.28; 95% CI 1.38-3.76) and treatment of an abscess (OR = 2.57; 95% 1.82-3.63) had a significantly increased odds of being prescribed an antibiotic. Almost three-quarters of prescriptions were for narrow spectrum antibiotics. The frequency of antibiotic prescribing by South African dental practitioners for patients undergoing endodontic treatment is relatively low and predominantly involved narrow spectrum antibiotics. It, however, remains important that antibiotics are only prescribed when clinically essential, such as when there are obvious systemic effects. These include fever above 37 degrees, malaise, lymphadenopathy, trismus, increase swelling, cellulitis, osteomyelitis and persistent infection. The wider dissemination and adherence to clear evidence-based prescribing guidelines for antibiotics in this clinical area are important. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  5. First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands.

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    Dirac Twidwell

    Full Text Available Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed fire compared to mechanical techniques. This study tests the general perception that fire is a riskier technique relative to other land management options. Due to the lack of data available to directly test this notion, we use a combination of approaches including 1 a comparison of fatalities resulting from different occupations that are proxies for techniques employed in land management, 2 a comparison of fatalities resulting from wildland fire versus prescribed fire, and 3 an exploration of causal factors responsible for wildland fire-related fatalities. This approach establishes a first approximation of the relative risk of fatality to private citizens using prescribed fire compared to other management techniques that are readily used in ecosystem management. Our data do not support using risks of landowner fatalities as justification for the use of alternative land management techniques, such as mechanical (machine-related equipment, over prescribed fire. Vehicles and heavy machinery are consistently leading reasons for fatalities within occupations selected as proxies for management techniques employed by ranchers and agricultural producers, and also constitute a large proportion of fatalities among firefighters. Our study provides the foundation for agencies to establish data-driven decisions regarding the degree of support they provide for prescribed burning on private lands.

  6. Drug utilization according to reason for prescribing: a pharmacoepidemiologic method based on an indication hierarchy

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach; Hendriksen, Carsten; Morten, Andersen

    2011-01-01

    ABSTRACT Purpose To develop a pharmacoepidemiologic method for drug utilization analysis according to indication, gender, and age by means of register-based information. Statin utilization in 2005 was applied as an example. Methods Following the recommendations for statin therapy, we constructed ...

  7. Physician characteristics and prescribing for elderly people in New Brunswick: relation to patient outcomes.

    OpenAIRE

    Davidson, W; Molloy, D W; Bédard, M

    1995-01-01

    OBJECTIVE: To examine the relation between physician characteristics, prescribing behaviour and patient outcomes. DESIGN: Descriptive study linking four provincial databases. SETTING: New Brunswick. PARTICIPANTS: All 366 general practitioners (GPs) (accounting for 40% of all physicians with a general licence in New Brunswick) who ordered at least 200 prescriptions for elderly beneficiaries of the New Brunswick Prescription Drug Program and saw at least 20 elderly patients in an office setting...

  8. Seasonality and physician-related factors associated with antibiotic prescribing: A cross-sectional study in Isfahan, Iran

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    Leila Safaeian

    2015-01-01

    Conclusions: These findings showed the widespread use of antibiotics by general practitioners that was associated with the physicians′ gender, time since graduation and practice location and also season of prescribing. More researches are needed on other factors related to the overprescribing of antibiotics and they could be used to project educational programs for improvement of antibiotic prescribing quality in our country.

  9. High-Dose Opioid Prescribing and Opioid-Related Hospitalization: A Population-Based Study.

    Directory of Open Access Journals (Sweden)

    Kimberly Fernandes

    Full Text Available To examine the impact of national clinical practice guidelines and provincial drug policy interventions on prevalence of high-dose opioid prescribing and rates of hospitalization for opioid toxicity.Interventional time-series analysis.Ontario, Canada, from 2003 to 2014.Ontario Drug Benefit (ODB beneficiaries aged 15 to 64 years from 2003 to 2014.Publication of Canadian clinical practice guidelines for use of opioids in chronic non-cancer pain (May 2010 and implementation of Ontario's Narcotics Safety and Awareness Act (NSAA; November 2011.Three outcomes were explored: the rate of opioid use among ODB beneficiaries, the prevalence of opioid prescriptions exceeding 200 mg and 400 mg morphine equivalents per day, and rates of opioid-related emergency department visits and hospital admissions.Over the 12 year study period, the rate of opioid use declined 15.2%, from 2764 to 2342 users per 10,000 ODB eligible persons. The rate of opioid use was significantly impacted by the Canadian clinical practice guidelines (p-value = .03 which led to a decline in use, but no impact was observed by the enactment of the NSAA (p-value = .43. Among opioid users, the prevalence of high-dose prescribing doubled (from 4.2% to 8.7% over the study period. By 2014, 40.9% of recipients of long-acting opioids exceeded daily doses of 200 mg morphine or equivalent, including 55.8% of long-acting oxycodone users and 76.3% of transdermal fentanyl users. Moreover, in the last period, 18.7% of long-acting opioid users exceeded daily doses of 400 mg morphine or equivalent. Rates of opioid-related emergency department visits and hospital admissions increased 55.0% over the study period from 9.0 to 14.0 per 10,000 ODB beneficiaries from 2003 to 2013. This rate was not significantly impacted by the Canadian clinical practice guidelines (p-value = .68 or enactment of the NSAA (p-value = .59.Although the Canadian clinical practice guidelines for use of opioids in chronic non

  10. Prescribing procrastination

    Science.gov (United States)

    Thomson, George H.

    1979-01-01

    In his everyday work the family physician sees many patients whose problems have been diagnosed but for whom postponement of an active treatment plan is indicated. The physician must therefore prescribe procrastination in a carefully planned way. I describe some ideas and practical methods for doing this. PMID:529244

  11. Alternative indicators for monitoring the quality of a continuous intervention program on antibiotic prescribing during changing healthcare conditions.

    Science.gov (United States)

    Bantar, C; Franco, D; Heft, C; Vesco, E; Arango, C; Izaguirre, M; Alcázar, G; Boleas, M; Oliva, M E

    2005-06-01

    We recently published on the impact of a four-phase hospital-wide intervention program designed to optimize the quality of antibiotic use, where a multidisciplinary team (MDT) could modify prescription at the last phase. Because health care quality was changing during the last 5 years (late 1999 to early 2004), we developed certain indicators to monitor the quality of our intervention over time. Different periods were defined as baseline (pre-intervention), initial intervention-active control, pre-crisis control, crisis control, post-crisis control and end of crisis control. Major indicators were rates of prescription modification by the MDT; prescription for an uncertain infection and a novel index formula (RIcarb) to estimate the rationale for carbapenem use. We assessed 2115 antimicrobial prescriptions. Modification of prescription rate was 30% at the beginning and decreased thereafter up to stable levels. Rate of prescriptions ordered for cases of both uncertain infection and unknown source of infection decreased significantly after intervention (i.e. from baseline to active control). In contrast, a doubling of culture-directed prescriptions was observed between these periods. RIcarb values lower and higher than 60% (modal, cut-off) were assumed as carbapenem overuse and underuse, respectively. Overuse was observed at the pre-intervention, while pronounced underuse was shown during the crisis (RIcarb, 45% and 87%, respectively). The present study demonstrates that certain indicators, other than the widely adopted impact outcomes, are a suitable tool for monitoring the quality of a continuous, long-term, active intervention on antimicrobial prescribing practice, especially when applied in a changing healthcare setting.

  12. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N

    2012-06-01

    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  13. Shift in antibiotic prescribing patterns in relation to antibiotic expenditure in paediatrics

    NARCIS (Netherlands)

    Kimpen, JLL; van Houten, M.A.

    In paediatrics, antibiotics are among the most commonly prescribed drugs. Because of an overall rise in health care costs, lack of uniformity in drug prescribing and the emergence of antibiotic resistance, monitoring and control of antibiotic use is of growing concern and strict antibiotic policies

  14. The impact of socioeconomic and clinical factors on purchase of prescribed analgesics before and after hysterectomy on benign indication

    DEFF Research Database (Denmark)

    Daugbjerg, Signe Bennedbæk; Brandsborg, Birgitte; Ottesen, Bent Smedegaard

    2014-01-01

    OBJECTIVE:: Pelvic pain is a primary symptom of women referred for hysterectomy. This study identified risk factors for purchase of prescribed analgesics before and after hysterectomy and examined purchase changes after hysterectomy, specifically focusing on socioeconomic effects. METHODS:: Nearly...... socioeconomic factors and changes in analgesic purchase were assessed. RESULTS:: Analgesic purchase after hysterectomy was independently predicted by age below 35 or above 65 years, body mass index >29.9, high American Society of Anesthesiologists (ASA) score, uterus weight...

  15. Prescribing by pharmacists in Alberta and its relation to culture and personality traits.

    Science.gov (United States)

    Rosenthal, Meagen M; Houle, Sherilyn K D; Eberhart, Greg; Tsuyuki, Ross T

    2015-01-01

    As evidence for the efficacy of pharmacists' interventions, governments worldwide are developing legislation to formalize new practice approaches, including independent prescribing by pharmacists. Pharmacists in Alberta became the first in Canada availed of this opportunity; however, uptake of such has been slow. One approach to understanding this problem is through an examination of pharmacists who have already gained this ability. The primary objective of this study was to gain descriptive insight into the culture and personality traits of innovator, and early adopter, Alberta pharmacists with Additional Prescribing Authorization using the Organizational Culture Profile and Big Five Inventory. The study was a cross-sectional online survey of Alberta pharmacists who obtained Additional Prescribing Authorization (independent prescribing authority), in the fall of 2012. The survey contained three sections; the first contained basic demographic, background and practice questions; the second section contained the Organizational Culture Profile; and the third section contained the Big Five Inventory. Sixty-five survey instruments were returned, for a response rate of 39%. Respondents' mean age was 40 (SD 10) years. The top reason cited by respondents for applying for prescribing authority was to improve patient care. The majority of respondents perceived greater value in the cultural factors of competitiveness, social responsibility, supportiveness, performance orientation and stability, and may be more likely to exhibit behavior in line with the personality traits of extraversion, agreeableness, conscientiousness and openness. Inferential statistical analysis revealed a significant linear relationship between Organizational Culture Profile responses to cultural factors of social responsibility and competitiveness and the number of prescription adaptations provided. This insight into the experiences of innovators and early adopter pharmacist prescribers can be used to

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  18. The indications for polysomnography and related procedures.

    Science.gov (United States)

    Chesson, A L; Ferber, R A; Fry, J M; Grigg-Damberger, M; Hartse, K M; Hurwitz, T D; Johnson, S; Kader, G A; Littner, M; Rosen, G; Sangal, R B; Schmidt-Nowara, W; Sher, A

    1997-06-01

    This paper is a review of the literature on the use of polysomnography in the diagnosis of sleep disorders in the adult. It is based on a search of MEDLINE from January 1966 through April 1996. It has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association and provides the background for the accompanying ASDA Standards of Practice Committee's Parameters for the Practice of Sleep Medicine in North America. The diagnostic categories reviewed are: sleep-related breathing disorders; other respiratory disorders; narcolepsy; parasomnias and sleep-related epilepsy; restless legs syndrome and periodic limb movement disorders: insomnia; and circadian rhythm sleep disorders. Where appropriate, previously published practice parameters papers are cited and discussed. The relevant published peer-reviewed literature used as the basis for critical decisions was compiled into accompanying evidence tables and is analyzed in the text. In the section on the assessment of sleep apnea syndrome, options for estimating pretest probability to select high risk patients are also reviewed. Sleep-testing procedures other than standard polysomnography are also addressed (daytime polysomnography, split-night studies, oximetry, limited full respiratory recordings, and less-than-full respiratory recording) and treatment-related follow-up studies are discussed.

  19. Changing doctor prescribing behaviour

    DEFF Research Database (Denmark)

    Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.

    1999-01-01

    Collaboration on Effective Professional Practice. This register is kept up to date by searching the following databases for reports of relevant research: DHSS-DATA; EMBASE; MEDLINE; SIGLE; Resource Database in Continuing Medical Education (1975-1994), along with bibliographies of related topics, hand searching......The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...... of key journals and personal contact with content area experts. Randomised controlled trials and non-equivalent group designs with pre- and post-intervention measures were included. Outcome measures were those used by the study authors. For each study we determined whether these were positive, negative...

  20. Statin utilization according to indication and age: A Danish cohort study on changing prescribing and purchasing behaviour

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach; Vass, Mikkel; Hendriksen, Carsten

    2012-01-01

    indications and ages. Conclusion: While patent expiry and lower prices most likely boosted the general increase in statin utilization, the gradually altered indication and age pattern seems to be driven by guidelines, influencing both reimbursement rules and general healthcare policies. A media debate...... on statin side effects may have modified the general attitudes. (C) 2012 Elsevier Ireland Ltd. All rights reserved....

  1. An Integrative Review of Empirical Research on Perceptions and Behaviors Related to Prescribed Burning and Wildfire in the United States

    Science.gov (United States)

    Dupéy, Lauren Nicole; Smith, Jordan W.

    2018-06-01

    Social science research from a variety of disciplines has generated a collective understanding of how individuals prepare for, and respond to, the risks associated with prescribed burning and wildfire. We provide a systematic compilation, review, and quantification of dominant trends in this literature by collecting all empirical research conducted within the U.S. that has addressed perceptions and behaviors surrounding various aspects of prescribed burning and wildfire. We reviewed and quantified this literature using four thematic categories covering: (1) the theory and methods that have been used in previous research; (2) the psychosocial aspects of prescribed burning and wildfire that have been studied; (3) the biophysical characteristics of the fires which have been studied; and (4) the types of fire and management approaches that have been examined. Our integrative review builds on previous literature reviews on the subject by offering new insight on the dominant trends, underutilized approaches, and under-studied topics within each thematic category. For example, we found that a select set of theories (e.g., Protection Motivation Theory, Attribution Theory, etc.) and approaches (e.g., mixed-methods) have only been used sparingly in previous research, even though these theories and approaches can produce insightful results that can readily be implemented by fire-management professionals and decision makers. By identifying trends and gaps in the literature across the thematic categories, we were able to answer four questions that address how future research can make the greatest contribution to our understanding of perceptions and behaviors related to prescribed burning and wildfire.

  2. An Integrative Review of Empirical Research on Perceptions and Behaviors Related to Prescribed Burning and Wildfire in the United States.

    Science.gov (United States)

    Dupéy, Lauren Nicole; Smith, Jordan W

    2018-06-01

    Social science research from a variety of disciplines has generated a collective understanding of how individuals prepare for, and respond to, the risks associated with prescribed burning and wildfire. We provide a systematic compilation, review, and quantification of dominant trends in this literature by collecting all empirical research conducted within the U.S. that has addressed perceptions and behaviors surrounding various aspects of prescribed burning and wildfire. We reviewed and quantified this literature using four thematic categories covering: (1) the theory and methods that have been used in previous research; (2) the psychosocial aspects of prescribed burning and wildfire that have been studied; (3) the biophysical characteristics of the fires which have been studied; and (4) the types of fire and management approaches that have been examined. Our integrative review builds on previous literature reviews on the subject by offering new insight on the dominant trends, underutilized approaches, and under-studied topics within each thematic category. For example, we found that a select set of theories (e.g., Protection Motivation Theory, Attribution Theory, etc.) and approaches (e.g., mixed-methods) have only been used sparingly in previous research, even though these theories and approaches can produce insightful results that can readily be implemented by fire-management professionals and decision makers. By identifying trends and gaps in the literature across the thematic categories, we were able to answer four questions that address how future research can make the greatest contribution to our understanding of perceptions and behaviors related to prescribed burning and wildfire.

  3. Rationalising prescribing

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Bang, Lia Evi

    2015-01-01

    Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interac...

  4. Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial.

    Science.gov (United States)

    Bladh, Lina; Ottosson, Ellinor; Karlsson, John; Klintberg, Lars; Wallerstedt, Susanna M

    2011-09-01

    OBJECTIVE To evaluate the effects of a clinical pharmacist service on health-related quality of life (HRQL) and prescribing of drugs. METHODS A randomised controlled study was performed in two internal medicine wards. The intervention consisted of medication reviews with feedback to the physicians, drug treatment discussion with patients at discharge and medication reports. HRQL was evaluated at inclusion and after six months by self-rated global health (1: very poor; 5: very good) and by the EuroQol 5-dimension questionnaire (EQ-5D). Prescribing of drugs was analysed regarding three established drug-specific quality indicators (intervention and control patients) and potential drug-related problems (DRPs) during in-hospital care (intervention patients). RESULTS 345 patients (61% female; median age: 82) were analysed, 204 of whom (59%) completed the six-month HRQL follow-up. A total of 87 patients (53% of the intervention patients) received all parts of the intervention. Intention-to-treat analysis revealed no significant findings for any of the HRQL measures. Per-protocol analysis revealed significantly better HRQL in the intervention group at six-month follow-up as measured by global health (mean: 3.14 (SD: 0.87) vs 2.77 (0.94), p=0.020), but not as measured by summarised EQ-5D index (0.48 (0.36) vs 0.43 (0.37), p=0.57). The number of potentially inappropriate prescribings per patient according to the quality indicators (admission vs discharge) was 0.35 (0.73) versus 0.38 (0.72), p=0.47 (control patients), and 0.39 (0.83) versus 0.26 (0.56), p=0.039 (intervention patients who received the intervention). In the intervention group, 133 relevant potential DRPs were identified in 81 patients, 55 of which (41%) were acted upon by the attending physician. CONCLUSION A clinical pharmacist service during inpatient care may improve quality of prescribing and patients' HRQL. Trial registration clinicaltrials.gov Identifier: NCT01016301.

  5. Sparrow nest survival in relation to prescribed fire and woody plant invasion in a northern mixed-grass prairie

    Science.gov (United States)

    Murphy, Robert K.; Shaffer, Terry L.; Grant, Todd A.; Derrig, James L.; Rubin, Cory S.; Kerns, Courtney K.

    2017-01-01

    Prescribed fire is used to reverse invasion by woody vegetation on grasslands, but managers often are uncertain whether influences of shrub and tree reduction outweigh potential effects of fire on nest survival of grassland birds. During the 2001–2003 breeding seasons, we examined relationships of prescribed fire and woody vegetation to nest survival of clay-colored sparrow (Spizella pallida) and Savannah sparrow (Passerculus sandwichensis) in mixed-grass prairie at Des Lacs National Wildlife Refuge in northwestern North Dakota, USA. We assessed relationships of nest survival to 1) recent fire history, in terms of number of breeding seasons (2, 3, or 4–5) since the last prescribed fire, and 2) prevalence of trees and tall (>1.5 m) shrubs in the landscape and of low (≤1.5 m) shrubs within 5 m of nests. Nest survival of both species exhibited distinct patterns related to age of the nest and day of year, but bore no relationship to fire history. Survival of clay-colored sparrow nests declined as the amount of trees and tall shrubs within 100 m increased, but we found no relationship to suggest nest parasitism by brown-headed cowbirds (Molothrus ater) as an underlying mechanism. We found little evidence linking nest survival of Savannah sparrow to woody vegetation. Our results suggest that fire can be used to restore northern mixed-grass prairies without adversely affecting nest survival of ≥2 widespread passerine species. Survival of nests of clay-colored sparrow may increase when tall woody cover is reduced by fire. Our data lend support to the use of fire for reducing scattered patches of tall woody cover to enhance survival of nests of ≥1 grassland bird species in northern mixed-grass prairies, but further study is needed that incorporates experimental approaches and assessments of shorter term effects of fire on survival of nests of grassland passerines.

  6. Indicators related to the rational use of medicines and its associated factors

    Science.gov (United States)

    Lima, Marina Guimarães; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

    2017-01-01

    ABSTRACT OBJECTIVE To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units. METHOD This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators. RESULTS At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process. CONCLUSION The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services. PMID:29160461

  7. Prescribed fire research in Pennsylvania

    Science.gov (United States)

    Patrick Brose

    2009-01-01

    Prescribed fire in Pennsylvania is a relatively new forestry practice because of the State's adverse experience with highly destructive wildfires in the early 1900s. The recent introduction of prescribed fire raises a myriad of questions regarding its correct and safe use. This poster briefly describes the prescribed fire research projects of the Forestry Sciences...

  8. Bisphosphonate-related osteonecrosis of the jaw: historical, ethical, and legal issues associated with prescribing.

    Science.gov (United States)

    Faiman, Beth; Pillai, Aiswarya Lekshmi Pillai Chandran; Benghiac, Ana Gabriela

    2013-01-01

    The long-term effects of many drugs are unknown. Established risks are communicated to patients who participate in clinical trials during the informed consent process. However, unknown and unanticipated side effects of medications may occur years after treatment. Patients with metastatic bone cancer experience an imbalance between tumor cells and the bone marrow microenvironment. Increased cytokine release, osteoclastic activity, and uncoupled osteoblastic activity lead to weakened bone structure and osteolytic lesions. The bisphosphonates are a class of drugs available in IV and oral formulations to treat and prevent bone loss and decrease the risk of skeletal-related events. Intravenous bisphosphonates such as zoledronic acid and pamidronate disodium are approved by the US Food and Drug Administration for the treatment of bone pain and hypercalcemia of malignancy and the prevention of painful bone fractures in patients with metastatic bone cancer. Oral bisphosphonates such as alendronate, risedronate, and etidronate are used to reduce the risk of skeletal fractures in patients with osteoporosis and in breast cancer. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but painful complication of treatment characterized by infection, exposed bone, and poor wound healing. In this article, we discuss BRONJ and identify past, present, and future ethical and legal issues surrounding bisphosphonate administration.

  9. Prescribing Antibiotics

    DEFF Research Database (Denmark)

    Pedersen, Inge Kryger; Jepsen, Kim Sune

    2018-01-01

    The medical professions will lose an indispensable tool in clinical practice if even simple infections cannot be cured because antibiotics have lost effectiveness. This article presents results from an exploratory enquiry into “good doctoring” in the case of antibiotic prescribing at a time when...... the knowledge base in the healthcare field is shifting. Drawing on in-depth interviews about diagnosing and prescribing, the article demonstrates how the problem of antimicrobial resistance is understood and engaged with by Danish general practitioners. When general practitioners speak of managing “non......-medical issues,” they refer to routines, clinical expertise, experiences with their patients, and decision-making based more on contextual circumstances than molecular conditions—and on the fact that such conditions can be hard to assess. This article’s contribution to knowledge about how new and global health...

  10. Relative feather mass indices: are feather masses needed to ...

    African Journals Online (AJOL)

    Relative feather mass indices: are feather masses needed to estimate the percentage of new feather mass grown for moult regression models? ... As an alternative, it is here tested if feather mass indices may be sufficient replacements for species-specific feather masses. Thirty-five species of birds with known primary ...

  11. Assessing the effectiveness and cost-effectiveness of audit and feedback on physician’s prescribing indicators: study protocol of a randomized controlled trial with economic evaluation

    Science.gov (United States)

    2012-01-01

    Background Physician prescribing is the most frequent medical intervention with a highest impact on healthcare costs and outcomes. Therefore improving and promoting rational drug use is a great interest. We aimed to assess the effectiveness and cost-effectiveness of two forms of conducting prescribing audit and feedback interventions and a printed educational material intervention in improving physician prescribing. Method/design A four-arm randomized trial with economic evaluation will be conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm will be compared. Physicians working in outpatient practices are randomly allocated to one of the four arms using stratified randomized sampling. The interventions are developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing will be assessed in regression analyses. Cost data will be assessed from a health care provider’s perspective and incremental cost-effectiveness ratios will be calculated. Discussion This study will determine the effectiveness and cost-effectiveness of three interventions and allow us to determine the most effective interventions in improving prescribing pattern. If the interventions are cost-effective, they will likely be applied nationwide. Trial registration Iranian Registry of Clinical Trials Registration Number: IRCT201106086740N1Pharmaceutical Sciences Research Center of TUMS Ethics Committee Registration Number: 90-02-27-07 PMID:23351564

  12. Welfare indicators in laying hens in relation to nest exclusion

    DEFF Research Database (Denmark)

    Alm, M; Tauson, R; Holm, L

    2016-01-01

    Consumer concerns about the welfare of laying hens are increasing, leading to increased interest in identifying reliable ways to assess welfare. The present study evaluated invasive and non-invasive welfare indicators in relation to a stressful challenge. The study included 126 Lohmann Selected...

  13. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

    NARCIS (Netherlands)

    Klopotowska, J.E.; Kuiper, R.; van Kan, H.J.; de Pont, A.C.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Vroom, M.B.; Smorenburg, S.M.

    2010-01-01

    Introduction: Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an

  14. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

    NARCIS (Netherlands)

    Klopotowska, Joanna E.; Kuiper, Rob; van Kan, Hendrikus J.; de Pont, Anne-Cornelie; Dijkgraaf, Marcel G.; Lie-A-Huen, Loraine; Vroom, Margreeth B.; Smorenburg, Susanne M.

    2010-01-01

    Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As

  15. The documentation of health problems in relation to prescribed medication in people with profound intellectual and multiple disabilities

    NARCIS (Netherlands)

    van der Heide, D. C.; van der Putten, A. A. J.; van den Berg, P. B.; Taxis, K.; Vlaskamp, C.

    Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed.

  16. Matrix with Prescribed Eigenvectors

    Science.gov (United States)

    Ahmad, Faiz

    2011-01-01

    It is a routine matter for undergraduates to find eigenvalues and eigenvectors of a given matrix. But the converse problem of finding a matrix with prescribed eigenvalues and eigenvectors is rarely discussed in elementary texts on linear algebra. This problem is related to the "spectral" decomposition of a matrix and has important technical…

  17. Social determinants of prescribed and non-prescribed medicine use

    Directory of Open Access Journals (Sweden)

    García-Altés Anna

    2010-05-01

    Full Text Available Abstract Background The aim of the present study was to describe the use of prescribed and non prescribed medicines in a non-institutionalised population older than 15 years of an urban area during the year 2000, in terms of age and gender, social class, employment status and type of Primary Health Care. Methods Cross-sectional study. Information came from the 2000 Barcelona Health Interview Survey. The indicators used were the prevalence of use of prescribed and non-prescribed medicines in the two weeks prior to the interview. Descriptive analyses, bivariate and multivariate logistic regression analyses were carried out. Results More women than men took medicines (75.8% vs. 60% respectively. The prevalence of use of prescribed medicines increased with age while the prevalence of non-prescribed use decreased. These age differences are smaller among those with poor perceived health. In terms of social class, a higher percentage of men with good health in the more advantaged classes took non-prescribed medicines compared with disadvantaged classes (38.7% vs 31.8%. In contrast, among the group with poor health, more people from the more advantaged classes took prescribed medicines, compared with disadvantaged classes (51.4% vs 33.3%. A higher proportion of people who were either retired, unemployed or students, with good health, used prescribed medicines. Conclusion This study shows that beside health needs, there are social determinants affecting medicine consumption in the city of Barcelona.

  18. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications

    Directory of Open Access Journals (Sweden)

    Joshua Halpern

    2016-01-01

    Full Text Available There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.

  19. Relation of erythrocyte and iron indices to oral cancer growth

    International Nuclear Information System (INIS)

    Bhattathiri, Vasudevaru Narayanan

    2001-01-01

    Background and purpose: Anaemia is known to influence prognosis of head and neck cancer patients, but how anaemia and tumour growth influences each other is not clear. The present study investigates the relation of erythrocyte and iron indices of oral cancer patients to primary tumour size (Tsize), invasiveness and lymph node involvement. Materials and methods: The haemoglobin (Hb), erythrocyte count (RBC), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), Serum iron (SFe), transferrin iron-binding capacity (TIBC) and transferrin saturation (%Fe) were evaluated in 217 untreated patients with epidermoid cancer of the bucco-gingivo-palatine area. The association of erythrocyte and iron indices with sex, tumour size groups, invasion of adjacent structures and lymph node involvement, as well as the relation of SFe to Hb were analyzed. Results: Most of the patients were anaemic in terms of Hb (63%), RBC (43%) and PCV (48.4%) but almost all had normal or higher MCH (97.3%) and MCV (93.3%) though MCHC was less than normal in 70.7%. Normal or higher SFe was seen in nearly 70% and TIBC in 45% of patients. Hb, RBC and PCV were significantly lower in women, but there was no difference between men and women in the case of MCV, MCH and MCHC. Primary tumour size showed negative association with Hb, RBC and PCV but positive association with MCH ( 4 cm: 31. 7 pg; P=0.04) and MCHC ( 4 cm: 32.1; P=0.006). MCV, SFe, TIBC and %Fe did not show any relation to primary tumour size. None of the indices had any relation to invasion of adjacent structures or lymph node involvement. MCH, MCHC and MCV were not different in men and women but women had significantly lower Hb, RBC and PCV. The SFe showed poor correlation with Hb. Conclusions: The negative association of Hb, RBC and PCV with tumour size is most likely due to chronic RBC destruction, probably tumour induced, with the products of

  20. Drivers of Labor-Related Indicators across Diverse Mediterranean Fisheries

    Directory of Open Access Journals (Sweden)

    Jennifer Gee

    2017-11-01

    Full Text Available This regional case study is focused on employment, remuneration and labor productivity, with a particular emphasis on the interplay between labor productivity and other labor-related indicators and macroeconomic conditions in Italy, Egypt, Lebanon and Greece. Its value lies in the high degree of consistency and comparability of the data, owing to a shared data collection methodology. This has allowed for the compilation of both national and regional comparisons. The data is treated in two groups—the first group consists of national data that considers all the active vessels in a country; the second group focuses on the trawl segments of Italy and Egypt. These two countries present an interesting case study because they are so different in terms of labor productivity and remuneration performance. For instance, in Italy labor shortages have caused a shift in fishing strategies towards less labor-intensive operations to maintain the socioeconomic sustainability of the fisheries, while in Egypt macroeconomic conditions have resulted in a larger labor pool and strong incentives to work in the fisheries sector. The regional study demonstrates that labor-related indicators are interconnected and there is an inversely proportional relationship between labor productivity and remuneration and employment levels. This relationship necessitates a combined analysis. The results across and between the countries were compared, with particular attention given to labor productivity and remuneration in the respective countries with a discussion centred around the potential drivers of labor productivity.

  1. Sport-Related Concussion Alters Indices of Dynamic Cerebral Autoregulation

    Directory of Open Access Journals (Sweden)

    Alexander D. Wright

    2018-03-01

    Full Text Available Sport-related concussion is known to affect a variety of brain functions. However, the impact of this brain injury on cerebral autoregulation (CA is poorly understood. Thus, the goal of the current study was to determine the acute and cumulative effects of sport-related concussion on indices of dynamic CA. Toward this end, 179 elite, junior-level (age 19.6 ± 1.5 years contact sport (ice hockey, American football athletes were recruited for preseason testing, 42 with zero prior concussions and 31 with three or more previous concussions. Eighteen athletes sustained a concussion during that competitive season and completed follow-up testing at 72 h, 2 weeks, and 1 month post injury. Beat-by-beat arterial blood pressure (BP and middle cerebral artery blood velocity (MCAv were recorded using finger photoplethysmography and transcranial Doppler ultrasound, respectively. Five minutes of repetitive squat–stand maneuvers induced BP oscillations at 0.05 and 0.10 Hz (20- and 10-s cycles, respectively. The BP–MCAv relationship was quantified using transfer function analysis to estimate Coherence (correlation, Gain (amplitude ratio, and Phase (timing offset. At a group level, repeated-measures ANOVA indicated that 0.10 Hz Phase was significantly reduced following an acute concussion, compared to preseason, by 23% (−0.136 ± 0.033 rads at 72 h and by 18% (−0.105 ± 0.029 rads at 2 weeks post injury, indicating impaired autoregulatory functioning; recovery to preseason values occurred by 1 month. Athletes were cleared to return to competition after a median of 14 days (range 7–35, implying that physiologic dysfunction persisted beyond clinical recovery in many cases. When comparing dynamic pressure buffering between athletes with zero prior concussions and those with three or more, no differences were observed. Sustaining an acute sport-related concussion induces transient impairments in the capabilities of the cerebrovascular

  2. Sport-Related Concussion Alters Indices of Dynamic Cerebral Autoregulation.

    Science.gov (United States)

    Wright, Alexander D; Smirl, Jonathan D; Bryk, Kelsey; Fraser, Sarah; Jakovac, Michael; van Donkelaar, Paul

    2018-01-01

    Sport-related concussion is known to affect a variety of brain functions. However, the impact of this brain injury on cerebral autoregulation (CA) is poorly understood. Thus, the goal of the current study was to determine the acute and cumulative effects of sport-related concussion on indices of dynamic CA. Toward this end, 179 elite, junior-level (age 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes were recruited for preseason testing, 42 with zero prior concussions and 31 with three or more previous concussions. Eighteen athletes sustained a concussion during that competitive season and completed follow-up testing at 72 h, 2 weeks, and 1 month post injury. Beat-by-beat arterial blood pressure (BP) and middle cerebral artery blood velocity (MCAv) were recorded using finger photoplethysmography and transcranial Doppler ultrasound, respectively. Five minutes of repetitive squat-stand maneuvers induced BP oscillations at 0.05 and 0.10 Hz (20- and 10-s cycles, respectively). The BP-MCAv relationship was quantified using transfer function analysis to estimate Coherence (correlation), Gain (amplitude ratio), and Phase (timing offset). At a group level, repeated-measures ANOVA indicated that 0.10 Hz Phase was significantly reduced following an acute concussion, compared to preseason, by 23% (-0.136 ± 0.033 rads) at 72 h and by 18% (-0.105 ± 0.029 rads) at 2 weeks post injury, indicating impaired autoregulatory functioning; recovery to preseason values occurred by 1 month. Athletes were cleared to return to competition after a median of 14 days (range 7-35), implying that physiologic dysfunction persisted beyond clinical recovery in many cases. When comparing dynamic pressure buffering between athletes with zero prior concussions and those with three or more, no differences were observed. Sustaining an acute sport-related concussion induces transient impairments in the capabilities of the cerebrovascular pressure

  3. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

    LENUS (Irish Health Repository)

    Naughton, Corina

    2012-09-19

    AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients\\' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen\\'s kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

  4. Benefits of nurse prescribing for patients in pain: nurses' views.

    Science.gov (United States)

    Stenner, Karen; Courtenay, Molly

    2008-07-01

    This paper is a report of a study to explore nurses' views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings.

  5. 69-74 A Retrospective Analysis of Prescribing Prac

    African Journals Online (AJOL)

    user

    A Retrospective Analysis of Prescribing Practice Based on WHO Prescribing Indicators at Four. Selected Hospitals of West ... Key words: World Health Organization, prescribing indicators, rational drug use. INTRODUCTION. Indicators of ... factors, the risk of irrational prescribing could raise several folds. Irrational use of ...

  6. Performance indicators related to women’s health

    Directory of Open Access Journals (Sweden)

    Kaimi Pereira Costa

    2009-06-01

    Full Text Available The aim of this study was to determine performance indicators related to women’s health. Data were collected from 457 women living in the State of Parana, Brazil, classified according to age: 20-29 years (N=158, 30-39 years (N=171 and 40-49 years (N=128. The following variables were analyzed: height (m, body weight (kg, BMI, waist-hip ratio, abdominal strength (repetitions, flexibility (cm, and right and left hand grip strength (kgf. Descriptive statistics, one-factor ANOVA and the Tukey post-hoc test were used for statistical analysis (p ≤ 0.05. The results showed a significant difference (p ≤ 0.05 in all categories of the variables analyzed, except for right hand grip strength (good and excellent at age 30-39 years and left hand grip strength at age 40-49 years. There was a higher incidence of inadequate BMI and waist-hip ratio and low abdominal strength among women aged 40-49 years. Low flexibility was more frequent in the 20-29 year group. The differences in right and left hand grip strength between age groups were small.

  7. Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior.

    Science.gov (United States)

    Tang, Yan; Chang, Chung-Chou H; Lave, Judith R; Gellad, Walid F; Huskamp, Haiden A; Donohue, Julie M

    2016-03-01

    Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. Using 2011 data from Pennsylvania's Medicaid program, IMS Health's HCOSTM database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to 10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians' prescribing behavior and indicate that even among specialties

  8. The School Public Relations Practitioner: Indicator or Outlier?

    Science.gov (United States)

    Zoch, Lynn M.; And Others

    A study was conducted which focused on public relations practitioners in school districts in a southern state. It used survey research to investigate several questions relating to public relations role enactment, hierarchical level of the public relations function, salary, job satisfaction, and encroachment into public relations. Questionnaires…

  9. Relative performance of three stream bed stability indices as indicators of stream health.

    Science.gov (United States)

    Kusnierz, Paul C; Holbrook, Christopher M

    2017-10-16

    Bed stability is an important stream habitat attribute because it affects geomorphology and biotic communities. Natural resource managers desire indices of bed stability that can be used under a wide range of geomorphic conditions, are biologically meaningful, and are easily incorporated into sampling protocols. To eliminate potential bias due to presence of instream wood and increase precision of stability values, we modified a stream bed instability index (ISI) to include measurements of bankfull depth (d bf ) and median particle diameter (D 50 ) only in riffles and increased the pebble count to decrease variability (i.e., increase precision) in D 50 . The new riffle-based instability index (RISI) was compared to two established indices: ISI and the riffle stability index (RSI). RISI and ISI were strongly associated with each other but neither was closely associated with RSI. RISI and ISI were closely associated with both a diatom- and two macrovertebrate-based stream health indices, but RSI was only weakly associated with the macroinvertebrate indices. Unexpectedly, precision of D 50 did not differ between RISI and ISI. Results suggest that RISI is a viable alternative to both ISI and RSI for evaluating bed stability in multiple stream types. With few data requirements and a simple protocol, RISI may also better conform to riffle-based sampling methods used by some water quality practitioners.

  10. M-Polynomial and Related Topological Indices of Nanostar Dendrimers

    Directory of Open Access Journals (Sweden)

    Mobeen Munir

    2016-09-01

    Full Text Available Dendrimers are highly branched organic macromolecules with successive layers of branch units surrounding a central core. The M-polynomial of nanotubes has been vastly investigated as it produces many degree-based topological indices. These indices are invariants of the topology of graphs associated with molecular structure of nanomaterials to correlate certain physicochemical properties like boiling point, stability, strain energy, etc. of chemical compounds. In this paper, we first determine M-polynomials of some nanostar dendrimers and then recover many degree-based topological indices.

  11. Relative foraminiferan abundance as an indicator of seagrass sediment health:

    Science.gov (United States)

    Cajandig, P.; Quiros, A.; Nolan, H.; Tallman, R.; Cooper, N.; Ayala, J.; Courtier, C.

    2013-12-01

    Authors: Patrick Cajandig*, Jose Ayala**, Nathaniel Cooper**, Catherine Courtier**, Hannah Nolan**, Rachelle Tallman**, T.E. Angela L. Quiros** * Davis High-School CA, **University of California Santa Cruz, Ecology and Evolutionary Biology Department Seagrasses are a key component in coastal ecosystems. Found in shallow marine environments, they make a large contribution to coastal ecosystem health by sustaining water quality, stabilizing the sea bottom, and providing habitat as well as food for other organisms. Seagrasses accumulate tiny grains of sediment, increasing water clarity. Just like barren hills are prone to erosion compared to vegetated, rooted down hills, we find a similar situation in the ocean. Seagrasses have broad roots that extend vertically and horizontally to help stabilize the seabed. Seagrasses support a whole ecosystem, because some organisms feed off of the seagrass alone, while others feed off the inhabitants of the seagrass. The quality of sediment is a vital part of seagrass health, just like nutrient rich soils are important to land plants. But what in seagrass sediment is a good indication of health? We hypothesize that seagrass health measures such as percent cover and seagrass species diversity are related to the abundance of foraminiferans relative to other seagrass sediment components. My mentor, T. E. Angela L. Quiros, from the University of California, Santa Cruz (UCSC), collected the sediment samples from seagrass beds in the Philippines. Samples were dried and brought to UCSC for sediment sieving. We used different sized sieves to sort the sediment. These sieves ranged from coarse to very fine sieves (Phi -2.0 (coarse) through +3.0 (fine) going in 0.5 intervals on a log scale). We weighed the sediment that was caught in each tray and separated them into bags of different size classes. To analyze each sample, we subsampled four size classes (Phi's -2.0, -1.5,-1.0, 0.0), and used a dissecting scope to identify and then weigh the

  12. Behavioral Indicators and Behaviors Related to Sexting among Undergraduate Students

    Science.gov (United States)

    Hudson, Heather K.; Fetro, Joyce V.; Ogletree, Roberta

    2014-01-01

    Background: Empirical studies on sexting are limited, and many sexting studies only assessed sexting behaviors. Few studies have assessed attitudes, subjective norms, or behavioral intentions related to sexting. Purpose: The purpose of this study was to assess attitudes, subjective norms, behavioral intentions, and behaviors related to sexting…

  13. Estimating relative demand for wildlife: Conservation activity indicators

    Science.gov (United States)

    Gray, Gary G.; Larson, Joseph S.

    1982-09-01

    An alternative method of estimating relative demand among nonconsumptive uses of wildlife and among wildlife species is proposed. A demand intensity score (DIS), derived from the relative extent of an individual's involvement in outdoor recreation and conservation activities, is used as a weighting device to adjust the importance of preference rankings for wildlife uses and wildlife species relative to other members of a survey population. These adjusted preference rankings were considered to reflect relative demand levels (RDLs) for wildlife uses and for species by the survey population. This technique may be useful where it is not possible or desirable to estimate demand using traditional economic means. In one of the findings from a survey of municipal conservation commission members in Massachusetts, presented as an illustration of this methodology, poisonous snakes were ranked third in preference among five groups of reptiles. The relative demand level for poisonous snakes, however, was last among the five groups.

  14. On the selection of Secondary Indices in Relational Databases

    NARCIS (Netherlands)

    Choenni, R.S.; Blanken, Henk; Chang, Thiel

    1993-01-01

    An important problem in the physical design of databases is the selection of secondary indices. In general, this problem cannot be solved in an optimal way due to the complexity of the selection process. Often use is made of heuristics such as the well-known ADD and DROP algorithms. In this paper it

  15. Identifying Indicators Related to Constructs for Engineering Design Outcome

    Science.gov (United States)

    Wilhelmsen, Cheryl A.; Dixon, Raymond A.

    2016-01-01

    This study ranked constructs articulated by Childress and Rhodes (2008) and identified the key indicators for each construct as a starting point to explore what should be included on an instrument to measure the engineering design process and outcomes of students in high schools that use the PLTW and EbDTM curricula in Idaho. A case-study design…

  16. Indications, medical conditions and services related to gastrostomy ...

    African Journals Online (AJOL)

    gastrostomy, is used in paediatric patients when long-term enteral feeding is required.1 This form of ... Gastrostomy feeding may also be indicated in paediatric patients with structural abnormalities, or those who ... with cardiac defects may have difficulty with feeding endurance, resulting in poor weight gain and the need for.

  17. On the relation between Zenkevich and Wiener indices of alkanes

    Directory of Open Access Journals (Sweden)

    ZARKO BOSKOVIC

    2004-04-01

    Full Text Available A relatively complicated relation was found to exist between the quantity U, recently introduced by Zenkevich (providing a measure of internal molecular energy, and the Wiener index W (measuring molecular surface area and intermolecular forces. We now report a detailed analysis of this relation and show that, in the case of alkanes, its main features are reproduced by the formula U = –aW + b + gn1; where n1 is the number of methyl groups, and a, b and g are constants, depending only on the number of carbon atoms. Thus, for isomeric alkanes with the same number of methyl groups, U and W are linearly correlated.

  18. Novel Complexity Indicator of Manufacturing Process Chains and Its Relations to Indirect Complexity Indicators

    Directory of Open Access Journals (Sweden)

    Vladimir Modrak

    2017-01-01

    Full Text Available Manufacturing systems can be considered as a network of machines/workstations, where parts are produced in flow shop or job shop environment, respectively. Such network of machines/workstations can be depicted as a graph, with machines as nodes and material flow between the nodes as links. The aim of this paper is to use sequences of operations and machine network to measure static complexity of manufacturing processes. In this order existing approaches to measure the static complexity of manufacturing systems are analyzed and subsequently compared. For this purpose, analyzed competitive complexity indicators were tested on two different manufacturing layout examples. A subsequent analysis showed relevant potential of the proposed method.

  19. Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework.

    Directory of Open Access Journals (Sweden)

    Rob Horne

    Full Text Available BACKGROUND: Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs and concerns about the potential adverse consequences of taking it. OBJECTIVE: To assess the utility of the NCF in explaining nonadherence to prescribed medicines. DATA SOURCES: We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles. STUDY ELIGIBILITY CRITERIA: Studies using the Beliefs about Medicines Questionnaire (BMQ to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication. PARTICIPANTS: Patients with long-term conditions. STUDY APPRAISAL AND SYNTHESIS METHODS: Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models. RESULTS: We identified 3777 studies, of which 94 (N = 25,072 fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used. LIMITATIONS: Few prospective longitudinal studies using objective adherence measures were identified. CONCLUSIONS: The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in

  20. Socioeconomic impact indicators relating to water and hydrological policies

    International Nuclear Information System (INIS)

    Garcia Lorca, A.

    2009-01-01

    The work approaches one of the principal problematic ones in order the development of the arid, semiarid and sub humid dry regions, since it is the case of the land management and in I make concrete of that of hydrological management. For it, one presents an offer of design and construction of indicators, from the conceptual perspective of the sustainability, to evaluate the values corresponding to the socioeconomic productivity of the water, in order to motivate the public action in case of the territorial policies in general and sectorial especially. (Author) 4 refs.

  1. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    LENUS (Irish Health Repository)

    Lockwood, Emily B

    2008-10-01

    AIM: Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. BACKGROUND: The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. METHOD: A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. RESULTS AND CONCLUSIONS: Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. IMPLICATIONS FOR NURSING MANAGEMENT: While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers

  2. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    Science.gov (United States)

    Lockwood, Emily B; Fealy, Gerard M

    2008-10-01

    Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers new understandings on the views of senior clinicians concerning nurse prescribing at a

  3. Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views.

    Science.gov (United States)

    Stenner, Karen; Carey, Nicola; Courtenay, Molly

    2009-04-01

    This paper is a report of a study conducted to explore doctor and non-prescribing nurse views about nurse prescribing in the light of their experience in dermatology. The cooperation of healthcare professionals and peers is of key importance in enabling and supporting nurse prescribing. Lack of understanding of and opposition to nurse prescribing are known barriers to its implementation. Given the important role they play, it is necessary to consider how the recent expansion of nurse prescribing rights in England impacts on the views of healthcare professionals. Interviews with 12 doctors and six non-prescribing nurses were conducted in 10 case study sites across England between 2006 and 2007. Participants all worked with nurses who prescribed for patients with dermatological conditions in secondary or primary care. Thematic analysis was conducted on the interview data. Participants were positive about their experiences of nurse prescribing having witnessed benefits from it, but had reservations about nurse prescribing in general. Acceptance was conditional upon the nurses' level of experience, awareness of their own limitations and the context in which they prescribed. Fears that nurses would prescribe beyond their level of competence were expected to reduce as understanding and experience of nurse prescribing increased. Indications are that nurse prescribing can be acceptable to doctors and nurses so long as it operates within recommended parameters. Greater promotion and assessment of standards and criteria are recommended to improve understanding and acceptance of nurse prescribing.

  4. Indications for primary cesarean delivery relative to body mass index

    Science.gov (United States)

    Kawakita, Tetsuya; Reddy, Uma M.; Landy, Helain J.; Iqbal, Sara N.; Huang, Chun-Chih; Grantz, Katherine L.

    2016-01-01

    Background Obesity is a known risk factor for cesarean delivery. Limited data are available regarding the reasons for the increased rate of primary cesarean in obese women. It is important to identify the factors leading to an increased risk of cesarean to identify opportunities to reduce the primary cesarean rate. Objective We evaluated indications for primary cesarean across body mass index kg/m2 classes to identify the factors contributing to the increase rate of cesarean among obese women. Study design In the Consortium of Safe Labor study between 2002 and 2008, we calculated indications for primary cesarean including failure to progress or cephalopelvic disproportion, non-reassuring fetal heart tracing, malpresentation, elective, hypertensive disease, multiple gestation, placenta previa or vasa previa, failed induction, human immunodeficiency virus or active herpes simplex virus, history of uterine scar, fetal indication, placental abruption, chorioamnionitis, macrosomia, and failed operative delivery. For women with primary cesarean for failure to progress or cephalopelvic disproportion, dilation at the last recorded cervical examination was evaluated. Women were categorized according to body mass index on admission: normal weight (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), II (35.0-39.9), and III (≥40). Cochran-Armitage Trend Test and Chi-square tests were performed. Results Of 66,502 nulliparous and 76,961 multiparous women in the study population, 19,431 nulliparous (29.2%) and 7,329 multiparous women (9.5%) underwent primary cesarean. Regardless of parity, malpresentation, failure to progress or cephalopelvic disproportion, and non-reassuring fetal heart tracing were the common indications for primary cesarean. Regardless of parity, the rates of primary cesarean for failure to progress or cephalopelvic disproportion increased with increasing body mass index (normal weight, class I, II and III obesity in nulliparous: 33.2%, 41.6%, 46

  5. Learning from prescribing errors

    OpenAIRE

    Dean, B

    2002-01-01

    

 The importance of learning from medical error has recently received increasing emphasis. This paper focuses on prescribing errors and argues that, while learning from prescribing errors is a laudable goal, there are currently barriers that can prevent this occurring. Learning from errors can take place on an individual level, at a team level, and across an organisation. Barriers to learning from prescribing errors include the non-discovery of many prescribing errors, lack of feedback to th...

  6. Indication-related dosing for magnetic resonance contrast media

    International Nuclear Information System (INIS)

    Yuh, W.T.C.; Parker, J.R.; Carvlin, M.J.

    1997-01-01

    This presentation reviews the issue of contrast media dosing and imaging protocols for the optimal MR imaging detection and characterization of pathology. The cumulative clinical experience gained in performing contrast-enhanced MR examinations with gadolinium chelates indicates that a dose of 0.1 mmol/kg body weight provides safe and effective enhancement of most CNS pathology. Doses lower than 0.1 mmol/kg have been shown to be inadequate for delineating all but selected types of CNS pathology, such as masses with a high lesion to background ratio on post-contrast images (acoustic neuromas) or lesions located in areas in which the normal tissue very rapidly takes up contrast agent (e. g. microadenomas in the pituitary gland). Recent clinical studies have suggested a role for high dose gadolinium administration (up to 0.3 mmol/kg) for the optimal detection and delineation of cerebral metastases or other small or poorly enhancing lesions. Differences in the histopathologic characteristics (capillary permeability, vascularity, location, size) of specific diseased tissues may require varying doses or even a different contrast agent to be used for optimal imaging results. As new MR contrast agents and new scanning techniques are introduced, the specific diagnostic question posed will likely determine the choice of pulse sequence, contrast agent and dose used. (orig.)

  7. Relative frequencies and significance of faecal coliforms as indicators related to water temperature.

    Science.gov (United States)

    Auban, E G; Ripolles, A A; Domarco, M J

    1983-01-01

    The faecal coliforms at different sites of a hypereutrophic lake near Valencia (Albufera) were identified and their relative amounts established along an annual cycle. Using lauryl tryptose broth at 35 degrees C, followed by incubation at 44.4 degrees C in 2% brilliant green bile, Escherichia coli and Klebsiella pneumoniae are practically the only coliforms present. A positive correlation was found between the water temperature and the relative amount of these two coliforms: K. pneumoniae predominates at high water temperatures, whereas E. coli shows preponderance during the cold period. The role of K. pneumoniae as the only faecal indicator under the circumstances described in the work is emphasized and discussed.

  8. Association between use of self-prescribed complementary and alternative medicine and menopause-related symptoms: a cross-sectional study.

    Science.gov (United States)

    Peng, Wenbo; Sibbritt, David W; Hickman, Louise; Adams, Jon

    2015-10-01

    To examine the association between self-prescribed complementary and alternative medicine use and menopause-related symptoms, stratified by menopausal status. Data were obtained from a cross-sectional survey of a nationally representative sample of 10,011 menopausal women from the Australian Longitudinal Study on Women's Health, conducted in 2010. Multivariable logistic regression models were applied to identify if the use of selected self-prescribed complementary and alternative medicine was significantly associated with a range of menopause-related symptoms. Vitamins/minerals were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.20) and/or stiff/painful joints (adjusted OR=1.16). Yoga/meditation was more likely to be used by women with hysterectomy (adjusted OR=1.76) or natural menopausal women (adjusted OR=1.38) experiencing anxiety. Herbal medicines were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.22), tiredness (adjusted OR=1.20), and/or stiff/painful joints (adjusted OR=1.17), and by women with oophorectomy experiencing tiredness (adjusted OR=1.45). Aromatherapy oils were more likely to be used by natural menopausal women experiencing night sweats (adjusted OR=1.25) and by women with hysterectomy experiencing anxiety (adjusted OR=2.02). Chinese medicines were more likely to be used by women with oophorectomy experiencing stiff/painful joints (adjusted OR=4.06) and/or palpitations (adjusted OR=3.06). Our study will help improve the patient-provider communication regarding complementary and alternative medicine use for menopause, and we conclude that menopausal status should be taken into account by providers for menopause care. The women's experience and motivations of such use warrant further research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Treatment Related Thoughts Based on Health Belief Model and Medication Nonadherence in Patients who Prescribed Anxiolytics and Antidepressants

    Directory of Open Access Journals (Sweden)

    Meltem Meric

    2010-10-01

    Full Text Available AIM: The purpose of this study was to evaluate the relationship between treatment adherence and treatment related thoughts based on health belief model in patients who currently take medication due to depression and anxiety disorder. METHOD: The present study was performed at the Psychiatry Department of a teaching hospital. The sample of the study consisted from 112 individuals who take medications due to depression and anxiety disorder. Personal information form and an inquiry form including treatment related thoughts based on health belief model were used to collect data. Chi- Square and Percentages were used for statistical analysis. RESULTS: Of the patients, 58.9% were diagnosed as depression and 41.1% anxiety disorder. 60.7% stated that they had a non-adherence experience in the past. Of these non-adherent patients, 29.5% stopped to take the medication with the idea “I can do it without medication” and 14.3% stopped the medication because of the side effects. Gender, age, marital status and education level were not related to the non-adherence. Only two treatment related thoughts based on health belief concepts were significantly related to the non adherence experience. These thoughts were “If I do not take the medications properly the problems may be permanent” and “If I do not take the medications properly my illness may get worse”. Most of the patients marked “agree” options of the items under the perceived severity, self-efficacy, benefits, susceptibility and health motivation subheads. CONCLUSION: The results of this study showed that the thoughts and perceptions based on health belief concepts helps to identify and express the thoughts related to treatment adherence. These concepts can be used to describe and classify the thoughts about the treatments of patients. However, prospective and qualitative studies may be useful to clarify the influence of the health beliefs on treatment adherence. [TAF Prev Med Bull 2010; 9

  10. Prescribing Patterns and Cost of Antihypertensive Drugs in Private ...

    African Journals Online (AJOL)

    Nx 6110

    Antihypertensive agents are used to prevent morbidity and mortality related to hypertension. Prescribing patterns and the cost of some antihypertensive were studied for 600 patients attending medical clinics in four private hospitals in Dar es. Salaam using the WHO drug use indicator forms. The average number of drugs ...

  11. A study of antibiotic prescribing

    DEFF Research Database (Denmark)

    Jaruseviciene, L.; Radzeviciene-Jurgute, R.; Jurgutis, A.

    2012-01-01

    Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated...... clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients' faith in antibiotics as medication for upper respiratory tract infections......; patient potential to influence a GP's decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing...

  12. Utilisation of hepatocellular carcinoma screening in Australians at risk of hepatitis B virus-related carcinoma and prescribed anti-viral therapy.

    Science.gov (United States)

    Sheppard-Law, Suzanne; Zablotska-Manos, Iryna; Kermeen, Melissa; Holdaway, Susan; Lee, Alice; George, Jacob; Zekry, Amany; Maher, Lisa

    2018-07-01

    To investigate hepatocellular carcinoma screening utilisation and factors associated with utilisation among patients prescribed hepatitis B virus anti-viral therapy and at risk of hepatocellular carcinoma. The incidence of hepatocellular carcinoma has increased in Australia over the past three decades with chronic hepatitis B virus infection a major contributor. hepatocellular carcinoma surveillance programs aim to detect cancers early enabling curative treatment options, longer survival and longer times to recurrence. Multi-site cross-sectional survey. An online study questionnaire was administered to eligible participants attending three Sydney tertiary hospitals. Data were grouped into six mutually exclusive hepatocellular carcinoma risk factor categories as per American Association for the Study of Liver Diseases guidelines. All analyses were undertaken in STATA. Logistic regression was used to assess the associations between covariates and screening utilisation. Multivariate models described were assessed using the Hosmer-Lemeshow goodness of fit. Of the 177 participants, 137 (77.4%) self-reported that US had been performed in the last six months. Awareness that screening should be performed and knowing the correct frequency of US screening were independently associated with screening utilisation. Participants who knew that screening should be undertaken were three times more likely to have had pretreatment education or were prescribed hepatitis B virus anti-viral treatment for >4 years. Participants reporting a family history of hepatocellular carcinoma were less likely to know that screening should be undertaken every 6 months. While utilisation of hepatocellular carcinoma surveillance programs was higher in this study than in previous reports, strategies to further improve surveillance remain necessary. Findings from this research form the basis for proposing strategies to improve utilisation of hepatocellular carcinoma screening, inform hepatitis B virus-related

  13. Prevalence and Predictors of Inappropriate Medications Prescribing ...

    African Journals Online (AJOL)

    Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...

  14. A validated specific stability-indicating RP-HPLC assay method for Ambrisentan and its related substances.

    Science.gov (United States)

    Narayana, M B V; Chandrasekhar, K B; Rao, B M

    2014-09-01

    A validated specific stability-indicating reverse-phase liquid chromatographic method was developed for the quantitative determination of Ambrisentan as well as its related substances in bulk samples, pharmaceutical dosage forms in the presence of degradation products and its related impurities. Forced degradation studies were performed on bulk samples of Ambrisentan as per the ICH-prescribed stress conditions using acid, base, oxidative, thermal stress and photolytic degradation to show the stability-indicating power of the LC method. Significant degradation in acidic, basic stress conditions was observed and no degradation was observed in other stress conditions. The chromatographic method was optimized using the samples generated from the forced degradation studies and the impurity-spiked solution. Good resolution between the peaks corresponds to Ambrisentan-related impurities and degradation products from the analyte were achieved on a SunFire C18 column using a mobile phase consisting of a mixture of potassium dihydrogen orthophosphate at a pH adjusted to 2.5 with ortho-phosphoric acid in water and a mixture of acetonitrile:methanol using a simple linear gradient. The detection was carried out at 225 nm. The limit of detection and the limit of quantification for the Ambrisentan and its related impurities were established. The stressed test solutions were assayed against the qualified working standard of Ambrisentan and the mass balance in each case was between 98.9 and 100.3%, indicating that the developed LC method was stability indicating. Validation of the developed LC method was carried out as per the ICH requirements. The developed method was found to be suitable to check the quality of bulk samples of Ambrisentan at the time of batch release and also during its storage (long-term and accelerated stability). © The Author [2013]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Prevalence of mind and body exercises (MBE in relation to demographics, self-rated health, and purchases of prescribed psychotropic drugs and analgesics.

    Directory of Open Access Journals (Sweden)

    Lina Rådmark

    Full Text Available This study aims to identify any differences regarding gender, age, socioeconomic status (SES, self-rated health, perceived stress and the purchase of prescribed drugs among people who practice mind and body exercises (MBE extensively compared to people who do not.The study includes 3,913 men and 4,803 women aged 20-72 who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH. The respondents were divided into three groups depending on frequency of MBE practice (never/seldom/often. Measures regarding MBE practice, health behaviors, self-rated health, and illnesses were drawn from the SLOSH questionnaire, while more objective measures of socioeconomic status and education were derived from registry data. In addition, data on purchases of prescription drugs for all respondents were included in the study. These data were obtained from the Swedish Prescribed Drug Register, which contains information about prescription drugs dispensed at Swedish pharmacies. Separate analyses were performed for mental MBE (mindfulness, meditation, relaxation techniques and physical MBE (yoga, Tai Chi, Qi Gong, respectively.A high intensity MBE practice is cross-sectionally related to poor self-assessed health (sleeping problems, pain, depressive symptoms, mental disorders, high levels of stress, and high levels of purchases of psychotropic drugs and analgesics. These cross-sectional relationships are generally stronger for mental MBE than for bodily-directed MBE. More women than men are practicing MBE on a regular basis, and physically active people participate to a greater extent in MBE compared with the physically inactive.Overall, the study shows that frequent participation in mind and body exercises is associated with high levels of purchases of psychotropic drugs and analgesics as well as with poor self-assessed health and high levels of stress. However, since this is a cross-sectional study, it is impossible to establish cause and effect

  16. Association between respiratory prescribing, air pollution and deprivation, in primary health care.

    Science.gov (United States)

    Sofianopoulou, Eleni; Rushton, Stephen P; Diggle, Peter J; Pless-Mulloli, Tanja

    2013-12-01

    We investigated the association between respiratory prescribing, air quality and deprivation in primary health care. Most previous studies have used data from secondary and tertiary care to quantify air pollution effects on exacerbations of asthma and chronic obstructive pulmonary disease (COPD). However, these outcomes capture patients who suffer from relatively severe symptoms. This is a population-based ecological study. We analysed respiratory medication (salbutamol) prescribed monthly by 63 primary care practices, UK. Firstly, we captured the area-wide seasonal variation in prescribing. Then, using the area-wide variation in prescribing as an offset, we built a mixed-effects model to assess the remaining variation in relation to air quality and demographic variables. An increase of 10 μg/m(3) in ambient PM10 was associated with an increase of 1% (95% CI: 0.1-2%) in salbutamol prescribing. An increase of 1 SD in income and employment deprivation was associated with an increase of 20.5% (95% CI: 8.8-33.4%) and 14.7% (95% CI: 4.3-26.2%) in salbutamol prescribing rate, respectively. The study provides evidence that monthly respiratory prescribing in primary care is a useful indicator of the extent to which air pollution exacerbates asthma and COPD symptoms. Respiratory prescribing was higher on deprived populations.

  17. Opioid Prescribing PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.

  18. A survey of the criteria for prescribing in cases of borderline refractive errors

    Directory of Open Access Journals (Sweden)

    Einat Shneor

    2016-01-01

    Conclusions: The prescribing criteria found in this study are broadly comparable with those in previous studies and with published prescribing guidelines. Subtle indications suggest that optometrists may become more conservative in their prescribing criteria with experience.

  19. Heart failure guidelines and prescribing in primary care across Europe

    Directory of Open Access Journals (Sweden)

    Hobbs FD Richard

    2005-08-01

    Full Text Available Abstract Background Major international differences in heart failure treatment have been repeatedly described, but the reasons for these differences remain unclear. National guideline recommendations might be a relevant factor. This study, therefore, explored variation of heart failure guideline recommendations in Europe. Methods Treatment recommendations of 14 national guidelines published after 1994 were analyzed in relation to the heart failure treatment guideline of the European Society of Cardiology. To test potential relations between recommendations and prescribing, national prescribing patterns as obtained by a European study in primary care (IMPROVEMENT-HF were related to selected recommendations in those countries. Results Besides the 14 national guidelines used by primary care physicians in the countries contacted, the European guideline was used in four countries, and separate guidelines for specialists and primary care were available in another four countries. Two countries indicated that no guideline was used up to 2000. Comprehensiveness of the guidelines varied with respect to length, literature included and evidence ratings. Relevant differences in treatment recommendations were seen only in drug classes where evidence had changed recently (β-blockers and spironolactone. The relation between recommendation and prescribing for selected recommendations was inconsistent among countries. Conclusion Differences in guideline recommendations are not sufficient to explain variation of prescribing among countries, thus other factors must be considered.

  20. New users of antipsychotic medication: A population-based cohort study of occupational outcome measures in relation to antipsychotic on-label and off-label prescribing practices

    DEFF Research Database (Denmark)

    Baandrup, L; Kruse, M

    2016-01-01

    BACKGROUND: Treatment with antipsychotic medication is thoroughly investigated in schizophrenia and bipolar disorder but is also widely applied for a diversity of off-label conditions, despite an uncertain risk-benefit ratio. This study examined the relationship between antipsychotic prescribing ...

  1. Electronic prescribing reduces prescribing error in public hospitals.

    Science.gov (United States)

    Shawahna, Ramzi; Rahman, Nisar-Ur; Ahmad, Mahmood; Debray, Marcel; Yliperttula, Marjo; Declèves, Xavier

    2011-11-01

    To examine the incidence of prescribing errors in a main public hospital in Pakistan and to assess the impact of introducing electronic prescribing system on the reduction of their incidence. Medication errors are persistent in today's healthcare system. The impact of electronic prescribing on reducing errors has not been tested in developing world. Prospective review of medication and discharge medication charts before and after the introduction of an electronic inpatient record and prescribing system. Inpatient records (n = 3300) and 1100 discharge medication sheets were reviewed for prescribing errors before and after the installation of electronic prescribing system in 11 wards. Medications (13,328 and 14,064) were prescribed for inpatients, among which 3008 and 1147 prescribing errors were identified, giving an overall error rate of 22·6% and 8·2% throughout paper-based and electronic prescribing, respectively. Medications (2480 and 2790) were prescribed for discharge patients, among which 418 and 123 errors were detected, giving an overall error rate of 16·9% and 4·4% during paper-based and electronic prescribing, respectively. Electronic prescribing has a significant effect on the reduction of prescribing errors. Prescribing errors are commonplace in Pakistan public hospitals. The study evaluated the impact of introducing electronic inpatient records and electronic prescribing in the reduction of prescribing errors in a public hospital in Pakistan. © 2011 Blackwell Publishing Ltd.

  2. Reducing antibiotic prescribing in Australian general practice: time for a national strategy.

    Science.gov (United States)

    Del Mar, Christopher B; Scott, Anna Mae; Glasziou, Paul P; Hoffmann, Tammy; van Driel, Mieke L; Beller, Elaine; Phillips, Susan M; Dartnell, Jonathan

    2017-11-06

    In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult. Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to "no repeats" in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for individual GPs), interventions that GPs can individually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self-administered audit), supporting GPs' access to near-patient diagnostic testing, and public awareness campaigns. Many unanswered clinical research questions remain, including research into optimal implementation methods. Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support.

  3. Antibiotic prescribing in dental practice in Belgium.

    Science.gov (United States)

    Mainjot, A; D'Hoore, W; Vanheusden, A; Van Nieuwenhuysen, J-P

    2009-12-01

    To assess the types and frequency of antibiotic prescriptions by Belgian dentists, the indications for antibiotic prescription, and dentists' knowledge about recommended practice in antibiotic use. In this cross-sectional survey, dental practitioners were asked to record information about all antibiotics prescribed to their patients during a 2-week period. The dental practitioners were also asked to complete a self-administered questionnaire regarding demographic data, prescribing practices, and knowledge about antibiotic use. A random sample of 268 Belgian dentists participated in the survey. During the 2-week period, 24 421 patient encounters were recorded; 1033 patients were prescribed an antibiotic (4.2%). The median number of prescriptions per dentist for the 2 weeks was 3. Broad spectrum antibiotics were most commonly prescribed: 82% of all prescriptions were for amoxycillin, amoxycillin-clavulanic acid and clindamycin. Antibiotics were often prescribed in the absence of fever (92.2%) and without any local treatment (54.2%). The most frequent diagnosis for which antibiotics were prescribed was periapical abscess (51.9%). Antibiotics were prescribed to 63.3% of patients with periapical abscess and 4.3% of patients with pulpitis. Patterns of prescriptions were confirmed by the data from the self-reported practice. Discrepancies between observed and recommended practice support the need for educational initiatives to promote rational use of antibiotics in dentistry in Belgium.

  4. Out-Patient Prescribing Practices at Mbagathi District Hospital ...

    African Journals Online (AJOL)

    On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an ...

  5. Opioid Prescribing PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2017-07-06

    This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.  Created: 7/6/2017 by Centers for Disease Control and Prevention (CDC).   Date Released: 7/6/2017.

  6. Nurse practitioner prescribing: an international perspective

    Directory of Open Access Journals (Sweden)

    Fong J

    2015-10-01

    Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and

  7. Longitudinal analysis of associations between women's consultations with complementary and alternative medicine practitioners/use of self-prescribed complementary and alternative medicine and menopause-related symptoms, 2007-2010.

    Science.gov (United States)

    Peng, Wenbo; Adams, Jon; Hickman, Louise; Sibbritt, David W

    2016-01-01

    This study aims to determine associations between consultations with complementary and alternative medicine (CAM) practitioners/use of self-prescribed CAM and menopause-related symptoms. Data were obtained from the Australian Longitudinal Study on Women's Health. Generalized estimating equations were used to conduct longitudinal data analyses, which were restricted to women born in 1946-1951 who were surveyed in 2007 (survey 5; n = 10,638) and 2010 (survey 6; n = 10,011). Women with menopause-related symptoms were more likely to use self-prescribed CAM but were not more likely to consult a CAM practitioner. Overall, CAM use was lower among women who had undergone hysterectomy or women who had undergone oophorectomy, compared with naturally postmenopausal women, and decreased with increasing age of postmenopausal women. Weak associations between CAM use and hot flashes were observed. Women experiencing hot flashes were more likely to consult a massage therapist (odds ratio, 1.09; 95% CI, 1.00-1.20) and/or use self-prescribed herbal medicines (odds ratio, 1.13; 95% CI, 1.03-1.23) than women not experiencing hot flashes. Consultations with CAM practitioners and use of self-prescribed CAM among naturally or surgically postmenopausal women are associated with menopause-related symptoms. Our study findings should prompt healthcare providers, in particular family medicine practitioners, to be cognizant of clinical evidence for CAM typically used for the management of common menopause-related symptoms in their aim to provide safe, effective, and coordinated care for women.

  8. Hair 2010 Documentation: Calculating risk indicators related to agricultural use of pesticides within the European Union

    NARCIS (Netherlands)

    Kruijne, R.; Deneer, J.W.; Lahr, J.; Vlaming, J.

    2011-01-01

    The HAIR instrument calculates risk indicators related to the agricultural use of pesticides in EU Member States. HAIR combines databases and models for calculating potential environmental environmental effects expressed by the exposure toxicity ratio.

  9. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  10. Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies

    Science.gov (United States)

    2014-01-01

    Background This protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various ‘levels’ across the system. Methods/Design The method we propose is use of Bayesian ideas as a philosophical guide. Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit – the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events, resulting from deployment of the intervention in a hospital with extensive decision support. The experts will have been briefed with quantitative and qualitative data from the study and external data sources prior to elicitation. Following this, there will be a process of deliberative dialogues so that experts can “re-calibrate” their subjective probability estimates. The consolidated densities assembled from the repeat elicitation exercise will then be used to populate a health economic model, along with salient utilities. The credible limits from these densities can define thresholds for sensitivity analyses. Discussion The

  11. Association of water spectral indices with plant and soil water relations in contrasting wheat genotypes.

    Science.gov (United States)

    Gutierrez, Mario; Reynolds, Matthew P; Klatt, Arthur R

    2010-07-01

    Spectral reflectance indices can be used to estimate the water status of plants in a rapid, non-destructive manner. Water spectral indices were measured on wheat under a range of water-deficit conditions in field-based yield trials to establish their relationship with water relations parameters as well as available volumetric soil water (AVSW) to indicate soil water extraction patterns. Three types of wheat germplasm were studied which showed a range of drought adaptation; near-isomorphic sister lines from an elite/elite cross, advanced breeding lines, and lines derived from interspecific hybridization with wild relatives (synthetic derivative lines). Five water spectral indices (one water index and four normalized water indices) based on near infrared wavelengths were determined under field conditions between the booting and grain-filling stages of crop development. Among all water spectral indices, one in particular, which was denominated as NWI-3, showed the most consistent associations with water relations parameters and demonstrated the strongest associations in all three germplasm sets. NWI-3 showed a strong linear relationship (r(2) >0.6-0.8) with leaf water potential (psi(leaf)) across a broad range of values (-2.0 to -4.0 MPa) that were determined by natural variation in the environment associated with intra- and inter-seasonal affects. Association observed between NWI-3 and canopy temperature (CT) was consistent with the idea that genotypes with a better hydration status have a larger water flux (increased stomatal conductance) during the day. NWI-3 was also related to soil water potential (psi(soil)) and AVSW, indicating that drought-adapted lines could extract more water from deeper soil profiles to maintain favourable water relations. NWI-3 was sufficiently sensitive to detect genotypic differences (indicated by phenotypic and genetic correlations) in water status at the canopy and soil levels indicating its potential application in precision

  12. [Preventable drug-related morbidity: determining valid indicators for primary care in Portugal].

    Science.gov (United States)

    Guerreiro, Mara Pereira; Cantrill, Judith A; Martins, Ana Paula

    2007-01-01

    Preventable drug-related morbidity (PDRM) indicators are operational measures of therapeutic risk management. These clinical indicators, which cover a wide range of drugs, combine process and outcome in the same instrument. They were developed in the US and have been validated for primary care settings in the US, UK and Canada. This study is part of a research programme; it aimed to determine a valid set of PDRM indicators for adult patients in primary care in Portugal. Face validity of 61 US and UK-derived indicators translated to Portuguese was preliminarily determined by means of a postal questionnaire using a purposive sample of four Portuguese pharmacists with different backgrounds. Preliminary content validity of indicators approved in the previous stage was determined by cross-checking each definition of PDRM with standard drug information sources in Portugal. Face and content validity of indicators yielded by preliminary work were then established by a 37 expert panel (20 community pharmacists and 17 general practitioners) using a two-round Delphi survey. Data were analysed using SPSS release 11.5. Nineteen indicators were ruled out in preliminary validation. Changes were made in the content of eight of the remaining 42 indicators; these were related to differences in the drugs being marketed and patterns of drug monitoring between countries. Thirty-five indicators were consensus approved as PDRM for adult patients in Portuguese primary care by the Delphi panel.

  13. Relative Release-to-Birth Indicators for Investigating TRISO Fuel Fission Gas Release Models

    International Nuclear Information System (INIS)

    Harp, Jason M.; Hawari, Ayman I.

    2008-01-01

    TRISO microsphere fuel is the fundamental fuel unit for Very High Temperature Reactors (VHTR). A single TRISO particle consists of an inner kernel of uranium dioxide or uranium oxycarbide surrounded by layers of pyrolytic carbon and silicon carbide. If the silicon carbide layer fails, fission products, especially the noble fission gases Kr and Xe, will begin to escape the failed particle. The release of fission gas is usually quantified by measuring the ratio of the released activity (R) to the original birth activity (B), which is designated as the R/B ratio. In this work, relative Release-to-Birth indicators (I) are proposed as a technique for interpreting the results of TRISO irradiation experiments. By implementing a relative metric, it is possible to reduce the sensitivity of the indicators to instrumental uncertainties and variations in experimental conditions. As an example, relative R/B indicators are applied to the interpretation of representative data from the Advanced Gas Reactor-1 TRISO fuel experiment that is currently taking place at the Advanced Test Reactor of Idaho National Laboratory. It is shown that the comparison of measured to predicted relative R/B indicators (I) gives insight into the physics of release and helps validate release models. Different trends displayed by the indicators are related to the mechanisms of fission gas release such as diffusion and recoil. The current analysis shows evidence for separate diffusion coefficients for Kr and Xe and supports the need to account for recoil release. (authors)

  14. Leading product-related environmental performance indicators: a selection guide and database

    DEFF Research Database (Denmark)

    Issa, Isabela I.; Pigosso, Daniela Cristina Antelmi; McAloone, Tim C.

    2015-01-01

    Ecodesign is a proactive environmental management and improvement approach employed in the product development process, which aims to minimize the environmental impacts caused during a product's life cycle and thus improve its environmental performance. The establishment of measurable environmental...... in the selection and application of environmental performance indicators - a more structured approach is still lacking. This paper presents the efforts made to identify and systematize existing leading product-related environmental performance indicators, based on a systematic literature review, and to develop...

  15. Precipitation extremes and their relation to climatic indices in the Pacific Northwest USA

    Science.gov (United States)

    Zarekarizi, Mahkameh; Rana, Arun; Moradkhani, Hamid

    2018-06-01

    There has been focus on the influence of climate indices on precipitation extremes in the literature. Current study presents the evaluation of the precipitation-based extremes in Columbia River Basin (CRB) in the Pacific Northwest USA. We first analyzed the precipitation-based extremes using statistically (ten GCMs) and dynamically downscaled (three GCMs) past and future climate projections. Seven precipitation-based indices that help inform about the flood duration/intensity are used. These indices help in attaining first-hand information on spatial and temporal scales for different service sectors including energy, agriculture, forestry etc. Evaluation of these indices is first performed in historical period (1971-2000) followed by analysis of their relation to large scale tele-connections. Further we mapped these indices over the area to evaluate the spatial variation of past and future extremes in downscaled and observational data. The analysis shows that high values of extreme indices are clustered in either western or northern parts of the basin for historical period whereas the northern part is experiencing higher degree of change in the indices for future scenario. The focus is also on evaluating the relation of these extreme indices to climate tele-connections in historical period to understand their relationship with extremes over CRB. Various climate indices are evaluated for their relationship using Principal Component Analysis (PCA) and Singular Value Decomposition (SVD). Results indicated that, out of 13 climate tele-connections used in the study, CRB is being most affected inversely by East Pacific (EP), Western Pacific (WP), East Atlantic (EA) and North Atlaentic Oscillation (NAO).

  16. Generating relations of multi-variable Tricomi functions of two indices using Lie algebra representation

    Directory of Open Access Journals (Sweden)

    Nader Ali Makboul Hassan

    2014-01-01

    Full Text Available This paper is an attempt to stress the usefulness of the multi-variable special functions. In this paper, we derive certain generating relations involving 2-indices 5-variables 5-parameters Tricomi functions (2I5V5PTF by using a Lie-algebraic method. Further, we derive certain new and known generating relations involving other forms of Tricomi and Bessel functions as applications.

  17. Personal and professional challenges of nurse prescribing in Ireland.

    Science.gov (United States)

    McBrien, Barry

    This article presents the challenges regarding the development of a collaborative practice agreement in order to undertake nurse prescribing in an emergency department in a large teaching hospital. Nurse prescribing has been introduced quite recently in Ireland. Although there is a plethora of knowledge regarding the topic, there are many personal and professional challenges in relation to this emerging role. The nurse prescribing initiative in Ireland is continually developing and many nurses now have the authority to prescribe from almost the same range of medicines as doctors. Prescribing has the potential to improve job satisfaction, autonomy and ultimately improves patient outcomes. However, nurses need to be cognisant of the impact it can have on the dynamics of the healthcare team. An analysis of some complexities of nurse prescribing is given, in conjunction with reflective thoughts on a clinical incident in the area of morphine prescribing.

  18. HON label and DISCERN as content quality indicators of health-related websites.

    Science.gov (United States)

    Khazaal, Yasser; Chatton, Anne; Zullino, Daniele; Khan, Riaz

    2012-03-01

    Content quality indicators are warranted in order to help patients and consumers to judge the content quality of health-related on-line information. The aim of the present study is to evaluate web-based information on health topics and to assess particular content quality indicators like HON (Health on the Net) and DISCERN. The present study is based on the analysis of data issued from six previous studies which assessed with a standardized tool the general and content quality (evidence-based health information) of health-related websites. Keywords related to Social phobia, bipolar disorders, pathological gambling as well as cannabis, alcohol and cocaine addiction were entered into popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality (evidence-based information). "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of 874 websites identified, 388 were included. Despite an observed association with higher content quality scores, the HON label fails to predict good content quality websites when used in a multiple regression. Sensibility and specificity of a DISCERN score >40 in the detection of good content quality websites were, respectively, 0.45 and 0.96. The DISCERN is a potential quality indicator with a relatively high specificity. Further developments in this domain are warranted in order to facilitate the identification of high-quality information on the web by patients.

  19. Trends in Ambulatory Prescribing of Antiplatelet Therapy among US Ischemic Stroke Patients: 2000–2007

    Directory of Open Access Journals (Sweden)

    Sudeep Karve

    2012-01-01

    Full Text Available Objective. Study objectives were to assess temporal trends and identify patient- and practice-level predictors of the prescription of antiplatelet medications in a national sample of ischemic stroke (IS patients seeking ambulatory care. Methods. IS-related outpatient visits by adults were identified using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey for the years 2000–2007. We assessed prescribing of antiplatelet medications using the generic drug code and drug entry codes in these data. Temporal trends in antiplatelet prescribing were assessed using the Cochran-Mantel-Haenszel test for trend. Results. We identified 9.5 million IS-related ambulatory visits. Antiplatelet medications were prescribed at 35.5% of visits. Physician office prescribing of the clopidogrel-aspirin combination increased significantly from 0.5% in 2000 to 22.0% in 2007 (P=0.05, whereas prescribing of aspirin decreased from 17.9% to 7.0% (P=0.50 during the same period. Conclusion. We observed a continued increase in prescription of the aspirin-clopidogrel combination from 2000 to 2007. Clinical trial evidence suggests that the aspirin-clopidogrel combination does not provide any additional benefit compared with clopidogrel alone; however, our study findings indicate that even with lack of adequate clinical evidence physician prescribing of this combination has increased in real-world community settings.

  20. CT MEASUREMENTS OF TWO CEREBROVENTRICULAR INDICES AND THEIR RELATION WITH AGE

    Directory of Open Access Journals (Sweden)

    Ambili Puthanveettil

    2017-01-01

    Full Text Available BACKGROUND Cerebroventricular Indices are the relative measurements of the size of lateral ventricle to that of brain. A normal study of these indices are necessary in order to understand any changes in size of the ventricles or other associated abnormalities of the brain. The study uses measurements from Computerised Tomography (CT which is uniformly calibrated, has reproducible data and is less expensive than MRI. MATERIALS AND METHODS CT scans of 186 apparently healthy normal individuals of age group 1 to 85 years were taken and the subjects were categorized into age intervals of 10 years; males and females taken separately. The linear measurements of lateral ventricle and brain were taken directly from the screen. The cerebrovascular indices were calculated. The mean values in each group were compared with age and sex, using appropriate statistical tests. RESULTS Mean value for Bifrontal index was 0.31±0.03 and that of Bicaudate index was 0.12±0.02. Both indices showed a positive correlation with age. The relative size of the lateral ventricle with the brain did not show any gender difference. CONCLUSION The study results coincide with previous similar studies. Both the indices showed positive correlation with age, of which the Bicaudate index was more sensitive.

  1. Different indicators of socioeconomic status and their relative importance as determinants of health in old age.

    Science.gov (United States)

    Darin-Mattsson, Alexander; Fors, Stefan; Kåreholt, Ingemar

    2017-09-26

    Socioeconomic status has been operationalised in a variety of ways, most commonly as education, social class, or income. In this study, we also use occupational complexity and a SES-index as alternative measures of socioeconomic status. Studies show that in analyses of health inequalities in the general population, the choice of indicators influence the magnitude of the observed inequalities. Less is known about the influence of indicator choice in studies of older adults. The aim of this study is twofold: i) to analyse the impact of the choice of socioeconomic status indicator on the observed health inequalities among older adults, ii) to explore whether different indicators of socioeconomic status are independently associated with health in old age. We combined data from two nationally representative Swedish surveys, providing more than 20 years of follow-up. Average marginal effects were estimated to compare the association between the five indicators of SES, and three late-life health outcomes: mobility limitations, limitations in activities of daily living (ADL), and psychological distress. All socioeconomic status indicators were associated with late-life health; there were only minor differences in the effect sizes. Income was most strongly associated to all indicators of late-life health, the associations remained statistically significant when adjusting for the other indicators. In the fully adjusted models, education contributed to the model fits with 0-3% (depending on the outcome), social class with 0-1%, occupational complexity with 1-8%, and income with 3-18%. Our results indicate overlapping properties between socioeconomic status indicators in relation to late-life health. However, income is associated to late-life health independently of all other variables. Moreover, income did not perform substantially worse than the composite SES-index in capturing health variation. Thus, if the primary objective of including an indicator of socioeconomic

  2. Developing Health-Related Indicators of Climate Change: Australian Stakeholder Perspectives.

    Science.gov (United States)

    Navi, Maryam; Hansen, Alana; Nitschke, Monika; Hanson-Easey, Scott; Pisaniello, Dino

    2017-05-22

    Climate-related health indicators are potentially useful for tracking and predicting the adverse public health effects of climate change, identifying vulnerable populations, and monitoring interventions. However, there is a need to understand stakeholders' perspectives on the identification, development, and utility of such indicators. A qualitative approach was used, comprising semi-structured interviews with key informants and service providers from government and non-government stakeholder organizations in South Australia. Stakeholders saw a need for indicators that could enable the monitoring of health impacts and time trends, vulnerability to climate change, and those which could also be used as communication tools. Four key criteria for utility were identified, namely robust and credible indicators, specificity, data availability, and being able to be spatially represented. The variability of risk factors in different regions, lack of resources, and data and methodological issues were identified as the main barriers to indicator development. This study demonstrates a high level of stakeholder awareness of the health impacts of climate change, and the need for indicators that can inform policy makers regarding interventions.

  3. Developing an indicator for the chronic health impact of traffic-related pollutant emissions

    International Nuclear Information System (INIS)

    Lépicier, Véronique; Chiron, Mireille; Joumard, Robert

    2013-01-01

    The goal of this study is to develop an emission based indicator for the health impact of the air pollution caused by traffic. This indicator must make it possible to compare different situations, for example different Urban Travel Plans, or technical innovations. Our work is based on a literature survey of methods for evaluating health impacts and, more particularly, those which relate to the atmospheric pollution caused by transport. We then define a health impact indicator based on the traffic emissions, named IISCEP for Chronic health impact indicator of pollutant emission. Here health is understood in a restricted meaning, excluding well-being. Only primary pollutants can be considered, as the inputs are emission data and an indicator must be simple. The indicator is calculated as the sum of each pollutant emission multiplied by a dispersion and exposition factor and a substance specific toxicity factor taking account of the severity. Last, two examples are shown using the IISCEP: comparison between petrol and diesel vehicles, and Nantes urban district in 2008 vs 2002. Even if it could still be improved, IISCEP is a straightforward indicator which can be used to gauge the chronic effects of inhaling primary pollutants. It can only be used in comparisons, between different scenarios or different technologies. The quality of the emissions data and the choice of the pollutants that are considered are the two essential factors that determine its validity and reliability. - Highlights: ► The goal of the study is to develop an emission based indicator for the health impact of the air pollution caused by traffic. ► It is based on a literature survey of methods for evaluating health impacts related to the atmospheric pollution. ► We define a composite indicator based on the traffic emissions and on local data as dispersion conditions and population. ► The indicator is a combination of pollutant emission, dispersion, exposition factor, and substance specific

  4. A systematic review of diet quality indices in relation to obesity.

    Science.gov (United States)

    Asghari, Golaleh; Mirmiran, Parvin; Yuzbashian, Emad; Azizi, Fereidoun

    2017-04-01

    Tools, called 'diet/dietary quality indices', evaluate the level of adherence to a specified pattern or a set of recommendations in populations. Yet, there are no review studies providing unanimous comprehensive results of dietary indices on obesity. We reviewed observational studies, focusing on the association of diet quality indices with general obesity or abdominal obesity in adults. We systematically conducted a search in all English language publications available on MEDLINE, ISI Web of Science and Embase between January 1990 and January 2016. Among the wide variety of indices and weight-derived variables, studies with dietary-guideline-based indices and mean changes for weight gain or OR for general obesity and abdominal obesity were selected. From a total of 479 articles, thirty-four studies were selected for the current review, ten of which had prospective designs and twenty-six had cross-sectional designs. Associations of weight status with the original Healthy Eating Index (HEI) and other versions of the HEI including alternative HEI, HEI-2005 and HEI-05 were examined in thirteen studies, with ten studies revealing significant associations. The HEI was a better general obesity predictor in men than in women. Diet scores lacked efficacy in assessing overall diet quality and demonstrated no significant findings in developing countries, in comparison with US populations. In addition, indices based on dietary diversity scores were directly associated with weight gain. Despite the insufficient evidence to draw definitive conclusions about the relation between dietary indices and obesity, HEI was found to be inversely associated with obesity and diversity-based indices were positively associated with obesity.

  5. Characteristics of prescribers whose patients shop for opioids: results from a cohort study.

    Science.gov (United States)

    Cepeda, M Soledad; Fife, Daniel; Berlin, Jesse A; Mastrogiovanni, Gregory; Yuan, Yingli

    2012-01-01

    Little is known about the prevalence of opioid shoppers in clinical practices and the relation between prescriber characteristics and the risk of having opioid shoppers. Describe the prevalence of opioid shoppers in prescribers' practices. Assess the relation between prescribers' characteristics and patient opioid shopping behavior. Retrospective cohort study using a large US retail prescription database. Patients with ≥1 opioid dispensing were followed 18 months. These patients' prescribers are the focus of the study. A patient was a "shopper" if he or she had opioid prescriptions written by ≥1 prescriber with ≥1 day of overlap filled at ≥3 pharmacies and a "heavy shopper" if he or she had ≥5 shopping episodes. The proportions of shoppers by prescriber and the proportion of prescribers with ≥1 shopper or heavy shopper were calculated. Among 858,290 opioid prescribers, most (87 percent) had no shoppers and 98 percent had no heavy shoppers. Prescribers who were aged 70-79 years, male, or who prescribed schedule II opioids had an increased likelihood of having shoppers. As the number of patients for whom a prescriber prescribed opioids increased, the proportion of shoppers also increased. Prescribers with 66 or more patients receiving opioids, who represented 25 percent of prescribers, prescribed for 82 percent of all shoppers. The great majority of opioid prescribers appear to have no shoppers in their practice. Any educational program will be more cost effective if targeted to prescribers of schedule II opioids with a large volume of patients requiring opioids.

  6. Growth of nurse prescribing competence: facilitators and barriers during education.

    Science.gov (United States)

    Hopia, Hanna; Karhunen, Anne; Heikkilä, Johanna

    2017-10-01

    To describe facilitators and barriers in relation to the growth of nurse prescribing competence from the perspective of the nurses studying in a prescribing programme. The number of nurses enrolled in a nurse prescribing programme is rapidly increasing in Finland. However, few studies on nurse prescribing education are available and therefore research is needed, particularly from the point of view of nurses studying in the programme. The descriptive, qualitative study used the text of student online learning diaries as data during a 14-month prescribing programme. The sample consisted of 31 nurses, public health nurses or midwives enrolled in a prescribing programme at a university of applied sciences. The data were analysed using the inductive analysis method. The growth of nurses' prescribing competence was facilitated by learning clinical examination of the patient, networking with peers, receiving support from the workplace and supervisors, doctors' positive attitude towards nurse prescribing and being able to apply competencies directly to nursing practice. The barriers to the growth of nurses' prescribing competence were unclear job description, incomplete care plans and concerns about how consultation with doctors will be organised and realised. The results show that, for the purpose of developing the new role and position of nurse prescribers, educators and nursing managers must invest more in staff awareness of nurse prescribing education and also offer more support to nurse prescribers in their workplaces. The results of this study can be used especially in countries where nurse prescribing education is only in the process of being planned or has just been started. Heads of nursing and educators in prescribing education will benefit from the results when creating expanded job descriptions for nurses and supporting networking between students during the period of training. © 2016 John Wiley & Sons Ltd.

  7. Relationship between diet-related indicators and overweight and obesity in older adults in rural Japan.

    Science.gov (United States)

    Ishikawa, M; Moriya, S; Yokoyama, T

    2017-01-01

    To identify the relationship between diet-related indicators and overweight and obesity in older adults in rural Japan. Cross-sectional survey. Obira, Hokkaido, Japan. Local residents aged between 65 and 74 years, except for those with poor health, were included. A health- and diet-related questionnaire was applied to participants house-to-house by trained health professionals. The following indicators were examined: number of meals, number of balanced meals, food diversity, food group diversity, chewing ability, alcohol intake habit, smoking habit, instrumental activities of daily living scores, age, and residing alone or with family. Of 550 residents, 317 residents completely responded to the questionnaire. Of these, 41 were had low body mass index (BMI≤20) and were excluded. This resulted in a sample of 307 subjects comprising 117 men and 190 women; 37.6% and 46.8% of men and women were classified as obese (BMI≥25), respectively. Women with a normal BMI (20diet-related indicators compared with women with high BMI. The mean number of meals per day of normal men was significantly higher than of obese men. Using logistic regression analysis (stepwise), it was found that the number of meals per day was associated with obesity in men (OR=3.02; 95% CI 0.91-9.98; P=0.071), and food diversity was significantly associated with obesity in women (OR=1.95; 95% CI 1.12-3.38; P=0.018). The associations between dietary indicators and obesity differed by sex. Food diversity may be a potential indicator to measure nutritional status in women.

  8. Recovery-related indicators of motor network plasticity according to impairment severity after stroke.

    Science.gov (United States)

    Lee, J; Park, E; Lee, A; Chang, W H; Kim, D-S; Kim, Y-H

    2017-10-01

    Brain connectivity analysis has been widely used to investigate brain plasticity and recovery-related indicators of patients with stroke. However, results remain controversial because of interindividual variability of initial impairment and subsequent recovery of function. In this study, we aimed to investigate the differences in network plasticity and motor recovery-related indicators according to initial severity. We divided participants (16 males and 14 females, aged 54.2 ± 12.0 years) into groups of different severity by Fugl-Mayer Assessment score, i.e. moderate (50-84), severe (20-49) and extremely severe (impairment groups. Longitudinal resting-state functional magnetic resonance imaging data were acquired at 2 weeks and 3 months after onset. The differences in network plasticity and recovery-related indicators between groups were investigated using network distance and graph measurements. As the level of impairment increased, the network balance was more disrupted. Network balance, interhemispheric connectivity and network efficiency were recovered at 3 months only in the moderate impairment group. However, this was not the case in the extremely severe impairment group. A single connection strength between the ipsilesional primary motor cortex and ventral premotor cortex was implicated in the recovery of motor function for the extremely severe impairment group. The connections of the ipsilesional primary motor cortex-ventral premotor cortex were positively associated with motor recovery as the patients were more severely impaired. Differences in plasticity and recovery-related indicators of motor networks were noted according to impairment severity. Our results may suggest meaningful implications for recovery prediction and treatment strategies in future stroke research. © 2017 EAN.

  9. Geomorphic indices and relative tectonic uplift in the Guerrero sector of the Mexican forearc

    Directory of Open Access Journals (Sweden)

    Krzysztof Gaidzik

    2017-07-01

    The results of the applied landscape analysis reveal considerable variations in relief, topography and geomorphic indices values along the Guerrero sector of the Mexican subduction zone. We argue that the reported differences are indicative of tectonic deformation and of variations in relative tectonic uplift along the studied forearc. A significant drop from central and eastern parts of the study area towards the west in values of RVA (from ∼500 to ∼300, SL (from ∼500 to ca. 400, maximum SL (from ∼1500–2500 to ∼1000 and ksn (from ∼150 to ∼100 denotes a decrease in relative tectonic uplift in the same direction. We suggest that applied geomorphic indices values and forearc topography are independent of climate and lithology. Actual mechanisms responsible for the observed variations and inferred changes in relative forearc tectonic uplift call for further studies that explain the physical processes that control the forearc along strike uplift variations and that determine the rates of uplift. The proposed methodology and results obtained through this study could prove useful to scientists who study the geomorphology of forearc regions and active subduction zones.

  10. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    Barry, Patrick J

    2012-02-03

    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  11. Health and health-related indicators in slum, rural, and urban communities: a comparative analysis

    Science.gov (United States)

    Mberu, Blessing U.; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C.

    2016-01-01

    Background It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality

  12. Health and health-related indicators in slum, rural, and urban communities: a comparative analysis.

    Science.gov (United States)

    Mberu, Blessing U; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C

    2016-01-01

    It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality outcomes. They bear a disproportionately

  13. Performance indicators related to points scoring and winning in international rugby sevens.

    Science.gov (United States)

    Higham, Dean G; Hopkins, Will G; Pyne, David B; Anson, Judith M

    2014-05-01

    Identification of performance indicators related to scoring points and winning is needed to inform tactical approaches to international rugby sevens competition. The aim of this study was to characterize team performance indicators in international rugby sevens and quantify their relationship with a team's points scored and probability of winning. Performance indicators of each team during 196 matches of the 2011/2012 International Rugby Board Sevens World Series were modeled for their linear relationships with points scored and likelihood of winning within (changes in team values from match to match) and between (differences between team values averaged over all matches) teams. Relationships were evaluated as the change and difference in points and probability of winning associated with a two within- and between-team standard deviations increase in performance indicator values. Inferences about relationships were assessed using a smallest meaningful difference of one point and a 10% probability of a team changing the outcome of a close match. All indicators exhibited high within-team match-to-match variability (intraclass correlation coefficients ranged from 0.00 to 0.23). Excluding indicators representing points-scoring actions or events occurring on average less than once per match, 13 of 17 indicators had substantial clear within-team relationships with points scored and/or likelihood of victory. Relationships between teams were generally similar in magnitude but unclear. Tactics that increase points scoring and likelihood of winning should be based on greater ball possession, fewer rucks, mauls, turnovers, penalties and free kicks, and limited passing. Key pointsSuccessful international rugby sevens teams tend to maintain ball possession; more frequently avoid taking the ball into contact; concede fewer turnovers, penalties and free kicks; retain possession in scrums, rucks and mauls; and limit passing the ball.Selected performance indicators may be used to

  14. Health and health-related indicators in slum, rural, and urban communities: a comparative analysis

    Directory of Open Access Journals (Sweden)

    Blessing U. Mberu

    2016-12-01

    Full Text Available Background: It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective: The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design: We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results: In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to

  15. Profile of mood states and stress-related biochemical indices in long-term yoga practitioners

    Directory of Open Access Journals (Sweden)

    Sudo Nobuyuki

    2011-06-01

    Full Text Available Abstract Background Previous studies have shown the short-term or intermediate-term practice of yoga to be useful for ameliorating several mental disorders and psychosomatic disorders. However, little is known about the long-term influences of yoga on the mental state or stress-related biochemical indices. If yoga training has a stress-reduction effect and also improves an individual's mental states for a long time, long-term yoga practitioners may have a better mental state and lower stress-related biochemical indices in comparison to non-experienced participants. This study simultaneously examined the differences in mental states and urinary stress-related biochemical indices between long-term yoga practitioners and non-experienced participants. Methods The participants were 38 healthy females with more than 2 years of experience with yoga (long-term yoga group and 37 age-matched healthy females who had not participated in yoga (control group. Their mental states were assessed using the Profile of Mood States (POMS questionnaire. The level of cortisol, 8-hydroxydeoxyguanosine (8-OHdG and biopyrrin in urine were used as stress-related biochemical indices. Results The average self-rated mental disturbance, tension-anxiety, anger-hostility, and fatigue scores of the long-term yoga group were lower than those of the control group. There was a trend toward a higher vigor score in the long-term yoga group than that in the control group. There were no significant differences in the scores for depression and confusion in the POMS between the two groups. The urine 8-OHdG concentration showed a trend toward to being lower in the long-term yoga group in comparison to the control group. There were no significant differences in the levels of urine biopyrrin or cortisol. Conclusions The present findings suggest that long-term yoga training can reduce the scores related to mental health indicators such as self-rated anxiety, anger, and fatigue.

  16. Antiepileptic drug prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel; Garne, Ester; Wang, Hao

    2015-01-01

    and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated. Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy...... co-prescribed with high-dose folic acid: ranging from 1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales. Conclusion The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co......-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care....

  17. [The association between socioeconomic indicators andadolescents'physical activity and health-related fitness].

    Science.gov (United States)

    Constantino-Coledam, Diogo H; Ferraiol, Philippe Fanelli; Arruda, Gustavo Aires de; Pires-Júnior, Raymundo; Teixeira, Marcio; Greca, João Paulo de Aguiar; Oliveira, Arli Ramos de

    2013-01-01

    This study was aimed at analysing the association between socioeconomic indicators and adolescents' physical activity and health-related fitness. The study involved 716 adolescents from both genders whose age ranged from 10 to 18 years-old (46.8% male) who answered a questionnaire for estimating their habitual physical activity, socioeconomic status; two health-related physical fitness tests were also performed. The socioeconomic indicators analysed concerned their parents' educational level and the number of bathrooms, TVs, cars, housemaids, refrigerators and freezers in their homes. A positive association was found between paternal education (PR=1.61 (range 1.27-2.10) and 1.41 (1.10-1.83)) and housemaids (PR=1.97 (1.04-3.81) and 1.92 (1.05-3.52)) with recommended physical activity and leisure time physical activity, respectively. The number of cars (PR=1.48: 1.02-2.19) and freezers (PR=1.88: 1.12-3.18) was positively associated with leisure time physical activity and the number of TVs negatively so (PR=0.75: 0.63-0.89). The number of TVs (PR=0.80: 0.67-0.96) and cars (PR=0.70: 0.55-0.89) was negatively associated with cardiorespiratory fitness whilst paternal education (PR=1.17: 1.00-1.37) and the number of bathrooms in the home (PR=1.25: 1.02-1.54) were positively associated with muscular strength. Physical activity and health-related physical fitness were associated with socioeconomic status. However, such association depended on the socioeconomic indicator being analysed. Caution should be taken when analysing studies which use different socioeconomic indicators.

  18. Provider-patient interaction in rural Cameroon--how it relates to the patient's understanding of diagnosis and prescribed drugs, the patient's concept of illness, and access to therapy.

    Science.gov (United States)

    Labhardt, Niklaus Daniel; Schiess, Kaspar; Manga, Engelbert; Langewitz, Wolf

    2009-08-01

    This cross-sectional survey examines the relation between provider-patient interaction and several patient-outcomes in a rural health district in Cameroon. We used structured patient interviews and the Roter Interaction Analysis System (RIAS) for analysis of audio-recorded consultations. Data from 130 primary care consultations with 13 health-care providers were analysed. 51% of patients correctly named their diagnoses after the consultation; in 47% of prescribed drugs patients explained correctly the purpose. Patients' ability to recall diagnoses was related to the extent of clarity a provider used in mentioning it during consultation (recall rates: 87.5% if mentioned explicitly, 56.7% if mentioned indirectly and 19.2% if not mentioned at all; pbuy prescribed drugs, discussion about financial issues was very rare during consultations. Providers issued financial questions in 32%, patients in 21% of consultations. This study shows that provider-patient interaction in primary health care in a rural Cameroon district deserves more attention. It might improve the patients' knowledge about their health condition and support them in beneficial health behaviour. Our findings should encourage providers to give more medical explanation, to discuss patients' health beliefs in a non-judgmental manner, and to consider financial issues more carefully.

  19. Paleo sea-level changes and relative sea-level indicators: Precise measurements, indicative meaning and glacial isostatic adjustment perspectives from Mallorca (Western Mediterranean)

    NARCIS (Netherlands)

    Lorscheid, T; Stocchi, P.; Casella, E.; Gómez-Pujolf, L.; Vacchi, M.; Mann, T.; Rovere, A.

    2017-01-01

    Paleo relative sea-level (RSL) indicators formed during the Marine Isotope Stage (MIS) 5e have been reported bya large number of studies worldwide. Despite this, three main aspects are seldom reported: (1) use of high-precisionsurvey techniques applied to MIS 5e RSL indicators; (2) application of

  20. The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing.

    Science.gov (United States)

    Livorsi, Daniel J; Linn, Carrie M; Alexander, Bruce; Heintz, Brett H; Tubbs, Traviss A; Perencevich, Eli N

    2018-01-01

    OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits. DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared. SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center. RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider's volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; P<.01) and the primary care setting (r=0.82; P=0.03). CONCLUSIONS In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider's rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers. Infect Control Hosp Epidemiol 2018;39:64-70.

  1. Blueprint for prescriber continuing education program.

    Science.gov (United States)

    2012-06-01

    On October 25, 2011, the Center for Drug Evaluation and Research (CDER) of the Food and Drug Administration (FDA) posted online this Blueprint for Prescriber Continuing Education, labeled "final," relating to extended-release and long-acting opioids. The pending FDA Risk Evaluation Management Strategy (REMS) requires prescriber education. This document provides guidance to sponsors of these dosage forms in developing the prescvriber education component of their REMS. This report was posted online by the federal agency on October 25, 2011 at: http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm277916.pdf. It is in the public domain.

  2. Relation of muscle indices with metabolic parameters and C-peptide in type 2 diabetes mellitus

    International Nuclear Information System (INIS)

    Tuzun, S.; Oner, C.; Dabak, M.R.; Kasikci, H.O.; Sargin, M.

    2017-01-01

    Objective: To assess the relation between bioimpedance measurements and metabolic parameters and C-peptide in patient with type 2 diabetes mellitus (DM). Study Design: Cross-sectional study. Place and Duration of Study: Kartal Dr Lutfi Kirdar Training and Research Hospital, Pendik Kaynarca Diabetes Center, Exercise and Metabolism Unit, between January and March 2015. Methodology: Patients with DM, aged less than 65 years, were assessed for bioimpedance analysis, fasting plasma glucose (FPG), HbA1c, C-peptide levels, triglyceride levels, LDL-cholesterol, and HDL-cholesterol levels. Skeletal muscle index, total muscle index, skeletal muscle percentage, and total muscle percentage were used for muscle-related analyses. Mann-Whitney U-test or independent t-test were used to compare differences between two independent groups. Pearson correlation test or Spearman correlation test were used to find out correlation between variables. Results: A total of 359 DM patients were enrolled in the study. Mean age was 51.6+-8.0 years, and 278 (77.7%) of the participants were females. After adjusting age and gender variables, there was no relation between muscle-related measurements and FPG, triglyceride, LDL-cholesterol (p>0.05). However, there was muscle-related indexes (MRI) positively correlation with C-peptide and inversely associated with HDL-cholesterol (p<0.05). Conclusion: Muscle-related indices positively correlated with C-peptide, which showed endogenous insulin reserve. (author)

  3. Relating life cycle assessment indicators to gross value added for Dutch dairy farms

    International Nuclear Information System (INIS)

    Thomassen, M.A.; Dolman, M.A.; Van Calker, K.J.; De Boer, I.J.M.

    2009-01-01

    Sustainable dairy production requires farms that are economically viable, environmentally sound and socially acceptable. A low environmental impact of milk production is not necessarily associated with an economically viable farm. To gain insight into a possible trade-off between economic and environmental sustainability, the relation between the environmental and economic indicators of dairy farms was quantified, and farm characteristics that influence this relation were identified. Economic and environmental indicators were quantified for 119 specialized dairy farms in 2005, based on data from the Dutch Farm Accountancy Data Network (FADN). Economic indicators used were: gross value added expressed per kg fat-and-protein-corrected milk (FPCM) or expressed per unit of labour, i.e. labour productivity. Environmental indicators used were: land use per kg FPCM, energy use per kg FPCM, global warming potential per kg FPCM, eutrophication and acidification potential per kg FPCM or per ha of land. Environmental indicators were deduced from a life cycle assessment. High labour productivity on dairy farms was associated with low on-farm energy use, total and on-farm land use, total and on-farm global warming potential, and total and off-farm acidification potential per kg FPCM. High labour productivity, however, was associated also with high on-farm eutrophication and acidification potential per hectare. From partial least squares regression analysis, it was concluded that relations between economic and environmental indicators were affected mainly by milk production per ha, annual milk production per cow, farm size, and amount of concentrates per kg FPCM. An increase in annual milk production per cow, for example, not only increased labour productivity, reduced energy use and global warming potential per kg FPCM but also, in the case of an unchanged stocking density, increased eutrophication and acidification per ha. To be economically and environmentally sustainable

  4. IAEA activities related to safety indicators, time frames and reference scenarios

    International Nuclear Information System (INIS)

    Batandjieva, B.; Hioki, K.; Metcalf, P.

    2002-01-01

    The fundamental principles for the safe management of radioactive waste have been agreed internationally and form the basis for the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management that entered into force in June 2001. Protection of human health and the environment and safety of facilities (including radioactive waste disposal facilities) are widely recognised principles to be followed and demonstrated in post-closure safety assessment of waste repositories. Dose and risk are at present internationally agreed safety criteria, used for judging the acceptability of such facilities. However, there have been a number of activities initiated and co-ordinated by the International Atomic Energy Agency (IAEA) which have provided an international forum for discussion and consensus building on the use safety indicators which are complementary to dose and risk. The Agency has been working on the definition of other safety indicators, such as flux, time, environmental concentration, etc.; the desired characteristics, and use of these indicators in different time frames. The IAEA has focused on safety indicators related to geological disposal, exploring their role in the development of a safety case, evaluating the advantages and disadvantages of using other safety indicators and how they complement the dose and risk indicators. The use of these indicators have been discussed also from regulatory perspective, mainly in terms of achieving reasonable assurance and confidence in safety assessments for waste repositories and decision making in the presence of uncertainty in the context of disposal of long-lived waste. Considerable effort has also been expended by the Agency on the development and application of principles for defining critical groups and biospheres for deep geological repositories. One of the important and successful IAEA programmes in this field is the Biosphere Modelling and Assessment (BIOMASS) project

  5. The relative value of safety and performance indicators and qualitative arguments in different time frames

    International Nuclear Information System (INIS)

    Alonso, J.; Rohlig, K.J.; Batandjieva, B.; Griffault, L.; Regent, A.; Schneider, J.; Storck, R.; Umeki, H.

    2002-01-01

    Indicators complementary to dose or risk are of great importance for the provision of multiple lines of reasoning at different time frames and therefore for the building of confidence within a safety case and that regulations should acknowledge this fact. They are also of great value with regard to the understanding of the safety case by and the communication to different audiences. The relative value of such indicators changes with time. For longer timescales qualitative information becomes more important. The meaning of calculated dose or risk is different for different timescales (ranging from expected performance to illustration) but dose or risk remains a valuable and central information for any time considered in a Safety Assessment. Certain indicators (concentrations and fluxes) can provide information by avoiding certain uncertainties which increase remarkably with time (biosphere, dilution) but apart from that no generic opinion or recommendation can be derived since the value of specific indicators and the required degree of aggregation (over different nuclides or even of consequence and probability) strongly depends on the many parameter. (authors)

  6. Drinking water and sanitation: progress in 73 countries in relation to socioeconomic indicators.

    Science.gov (United States)

    Luh, Jeanne; Bartram, Jamie

    2016-02-01

    To assess progress in the provision of drinking water and sanitation in relation to national socioeconomic indicators. We used household survey data for 73 countries - collected between 2000 and 2012 - to calculate linear rates of change in population access to improved drinking water (n = 67) and/or sanitation (n = 61). To enable comparison of progress between countries with different initial levels of access, the calculated rates of change were normalized to fall between -1 and 1. In regression analyses, we investigated associations between the normalized rates of change in population access and national socioeconomic indicators: gross national income per capita, government effectiveness, official development assistance, freshwater resources, education, poverty, Gini coefficient, child mortality and the human development index. The normalized rates of change indicated that most of the investigated countries were making progress towards achieving universal access to improved drinking water and sanitation. However, only about a third showed a level of progress that was at least half the maximum achievable level. The normalized rates of change did not appear to be correlated with any of the national indicators that we investigated. In many countries, the progress being made towards universal access to improved drinking water and sanitation is falling well short of the maximum achievable level. Progress does not appear to be correlated with a country's social and economic characteristics. The between-country variations observed in such progress may be linked to variations in government policies and in the institutional commitment and capacity needed to execute such policies effectively.

  7. Age Related Differences in Diffusion Tensor Indices and Fiber Architecture in the Medial and Lateral Gastrocnemius

    Science.gov (United States)

    Sinha, Usha; Csapo, Robert; Malis, Vadim; Xue, Yanjie; Sinha, Shantanu

    2014-01-01

    Purpose To investigate age related changes in diffusion tensor indices and fiber architecture of the medial and lateral gastrocnemius (MG and LG) muscles using diffusion tensor imaging (DTI). Materials and Methods The lower leg of five young and five senior subjects was scanned at 3T and DTI indices extracted using three methods: ROI, histogram and tract based. Tracked fibers were automatically edited to ensure physiologically relevant tracks. Pennation angles were measured with respect to the deep and superficial aponeuroses of both muscles. Results The three methods provided internally consistent measures of the DTI indices (correlation coefficient in the range of 0.90-0.99). The primary, secondary and tertiary eigenvalues in the MG and LG increased significantly in the senior cohort (p<0.05), while the small increase in fractional anisotropy (FA) with age was not significant (MG/LG: p=0.39/0.85; 95% CI:[ −0.059/-0.056, 0.116/0.064]). Fiber lengths of MG fibers originating distally were significantly decreased in seniors (p<0.05) while pennation angles decreased with age in the MG and LG but this was not significant. Conclusion Fiber atrophy and increased fibrosis have opposing effects on the diffusion indices resulting in a complicated dependence with aging. Fiber architectural changes could play a role in determining aging muscle function. PMID:24771672

  8. A validated stability-indicating RP-HPLC method for levofloxacin in the presence of degradation products, its process related impurities and identification of oxidative degradant.

    Science.gov (United States)

    Lalitha Devi, M; Chandrasekhar, K B

    2009-12-05

    The objective of current study was to develop a validated specific stability indicating reversed-phase liquid chromatographic method for the quantitative determination of levofloxacin as well as its related substances determination in bulk samples, pharmaceutical dosage forms in the presence of degradation products and its process related impurities. Forced degradation studies were performed on bulk sample of levofloxacin as per ICH prescribed stress conditions using acid, base, oxidative, water hydrolysis, thermal stress and photolytic degradation to show the stability indicating power of the method. Significant degradation was observed during oxidative stress and the degradation product formed was identified by LCMS/MS, slight degradation in acidic stress and no degradation was observed in other stress conditions. The chromatographic method was optimized using the samples generated from forced degradation studies and the impurity spiked solution. Good resolution between the peaks corresponds to process related impurities and degradation products from the analyte were achieved on ACE C18 column using the mobile phase consists a mixture of 0.5% (v/v) triethyl amine in sodium dihydrogen orthophosphate dihydrate (25 mM; pH 6.0) and methanol using a simple linear gradient. The detection was carried out at 294 nm. The limit of detection and the limit of quantitation for the levofloxacin and its process related impurities were established. The stressed test solutions were assayed against the qualified working standard of levofloxacin and the mass balance in each case was in between 99.4 and 99.8% indicating that the developed LC method was stability indicating. Validation of the developed LC method was carried out as per ICH requirements. The developed LC method was found to be suitable to check the quality of bulk samples of levofloxacin at the time of batch release and also during its stability studies (long term and accelerated stability).

  9. Florida panther habitat use response to prescribed fire

    Science.gov (United States)

    Dees, Catherine S.; Clark, Joseph D.; van Manen, Frank T.

    2001-01-01

    The Florida panther (Puma concolor coryi) is one of the most endangered mammals in the world, with only 30-50 adults surviving in and around Florida Panther National Wildlife Refuge and the adjacent Big Cypress National Preserve. Managers at these areas conduct annual prescribed burns in pine (Pinus sp.) as a cost-effective method of managing wildlife habitat. Our objectives were to determine if temporal and spatial relationships existed between prescribed fire an panther use of pine. to accomplish this, we paired fire-event data from the Refuge an the Preserve with panther radiolocations collected between 1989 and 1998, determined the time that had elapsed since burning had occurred in management units associated with the radiolocations, and generated a frequency distribution based on those times. We then generated ant expected frequency distribution, based on random use relative to time since burning. This analysis revealed that panther use of burned pine habitats was greatest during the first year after a management unit was burned. Also, compositional analysis indicated that panthers were more likely to position their home ranges in areas that contained pine. We conclude that prescribed burning is important to panther ecology. We suggest that panthers were attracted to effects of shorter burning intervals on vegetation composition and evaluate the landscape-scale changes that would result. 

  10. Impact of prescribed burning on a heathland inhabiting spider community

    Directory of Open Access Journals (Sweden)

    Krause, Rolf Harald

    2016-04-01

    Full Text Available Heathlands can provide refuge for many stenotopic and endangered arthropods, if habitat management practices are applied. A management measure that is rarely being used today, but which has the potential to support diversity of arthropod communities, is prescribed burning. In this study we investigated the effects of prescribed burning on spider assemblages on a burned site with Calluna vulgaris in the nature reserve Lueneburg Heath, northwest Germany. We used pitfall trapping with a sampling design of 39 traps over a period of one year and 17 sampling intervals on a burned and a control site. We compared overall species richness, activity abundance patterns and community composition of the two sites, with a particular focus on stenotopic and endangered species. We collected 5116 adult spiders and 99 species altogether in a relatively small sampling area. This number of species represents nearly one third of the regional species pool of heathland spider species. Twelve species occurred exclusively on the burned site in contrast to 28 species exclusively found on the unburned site. Although we found more than twice as many spider individuals and higher mean species richness on the control site than on the burned site, the species richness of red-listed spiders was higher on the burned site. Especially the fact that we found 24 endangered species on the burned site and only 20 on the control site indicates that the applied measure of prescribed burning can foster certain endangered spider species and contribute to preserving the overall biodiversity of heathland ecosystems.

  11. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

  12. A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

    Science.gov (United States)

    Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

    2017-08-01

    Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use

  13. Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems

    Directory of Open Access Journals (Sweden)

    Alba Luz Rodríguez-Acelas

    Full Text Available Objective.Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Methods. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Results. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. Conclusion. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.

  14. Biochemical aspects of the neoplastic cell in relation to positive indicators

    International Nuclear Information System (INIS)

    Strom, R.

    1975-01-01

    In scintigraphic diagnoses with positive indicators, the capacity of these indicators to fix themselves or to selectively concentrate in the neoplastic tissue is utilized. This selectivity could be due to several biochemical peculiarities of the tumor cells in relation to surrounding cells: the presence on the membrane of particular chemical groups which allow these cells to invade adjacent tissue without being subject to contact inhibition; the presence on these same membranes of antigenic determinants which are particular to these cells and which can be revealed with specific antibodies; a high concentration of nucleic acid in tumor cells, with the associated possibility of fixing substances having a particular tropism for nucleic acids or for their chemical constituents; an elevated rate of nucleic acid synthesis, with an associated increase in the incorporation of precursors and also of substances which specifically interfere with this biochemical pathway; in numerous cases, tumor cells produce high quantities of acidic metabolites which must be neutralized by equivalent quantities of anions, the latter entering the cells by active transport phenomena; in tumors which develop particularly rapidly, there is a development of degenerative processes with an accumulation of degradation products; in metastatic tumors, the cells have metabolic and biosynthetic activities which are a function of the original tissue, with the possiblity of a clear metabolic difference in relation to adjacent tissues [fr

  15. Changes in health indicators related to health promotion and microcredit programs in the Dominican Republic.

    Science.gov (United States)

    Dohn, Anita L; Chávez, Andrea; Dohn, Michael N; Saturria, Luis; Pimentel, Carlos

    2004-03-01

    , given that the parallel microcredit and health promotion programs resulted in greater change in the measured health indicators than either program alone. As far as we authors know, this is the first published study to quantify changes in health indicators related to parallel health promotion and microcredit programs as compared to control communities with only a health promotion program or a microcredit program.

  16. Does mental health staffing level affect antipsychotic prescribing? Analysis of Italian national statistics.

    Science.gov (United States)

    Starace, Fabrizio; Mungai, Francesco; Barbui, Corrado

    2018-01-01

    In mental healthcare, one area of major concern identified by health information systems is variability in antipsychotic prescribing. While most studies have investigated patient- and prescriber-related factors as possible reasons for such variability, no studies have investigated facility-level characteristics. The present study ascertained whether staffing level is associated with antipsychotic prescribing in community mental healthcare. A cross-sectional analysis of data extracted from the Italian national mental health information system was carried out. For each Italian region, it collects data on the availability and use of mental health facilities. The rate of individuals exposed to antipsychotic drugs was tested for evidence of association with the rate of mental health staff availability by means of univariate and multivariate analyses. In Italy there were on average nearly 60 mental health professionals per 100,000 inhabitants, with wide regional variations (range 21 to 100). The average rate of individuals prescribed antipsychotic drugs was 2.33%, with wide regional variations (1.04% to 4.01%). Univariate analysis showed that the rate of individuals prescribed antipsychotic drugs was inversely associated with the rate of mental health professionals available in Italian regions (Kendall's tau -0.438, p = 0.006), with lower rates of antipsychotic prescriptions in regions with higher rates of mental health professionals. After adjustment for possible confounders, the total availability of mental health professionals was still inversely associated with the rate of individuals exposed to antipsychotic drugs. The evidence that staffing level was inversely associated with antipsychotic prescribing indicates that any actions aimed at decreasing variability in antipsychotic prescribing need to take into account aspects related to the organization of the mental health system.

  17. Gaseous and particulate emissions from prescribed burning in Georgia.

    Science.gov (United States)

    Lee, Sangil; Baumann, Karsten; Schauer, James J; Sheesley, Rebecca J; Naeher, Luke P; Meinardi, Simone; Blake, Donald R; Edgerton, Eric S; Russell, Armistead G; Clements, Mark

    2005-12-01

    Prescribed burning is a significant source of fine particulate matter (PM2.5) in the southeastern United States. However, limited data exist on the emission characteristics from this source. Various organic and inorganic compounds both in the gas and particle phase were measured in the emissions of prescribed burnings conducted at two pine-dominated forest areas in Georgia. The measurements of volatile organic compounds (VOCs) and PM2.5 allowed the determination of emission factors for the flaming and smoldering stages of prescribed burnings. The VOC emission factors from smoldering were distinctly higher than those from flaming except for ethene, ethyne, and organic nitrate compounds. VOC emission factors show that emissions of certain aromatic compounds and terpenes such as alpha and beta-pinenes, which are important precursors for secondary organic aerosol (SOA), are much higher from active prescribed burnings than from fireplace wood and laboratory open burning studies. Levoglucosan is the major particulate organic compound (POC) emitted for all these studies, though its emission relative to total organic carbon (mg/g OC) differs significantly. Furthermore, cholesterol, an important fingerprint for meat cooking, was observed only in our in situ study indicating a significant release from the soil and soil organisms during open burning. Source apportionment of ambient primary fine particulate OC measured at two urban receptor locations 20-25 km downwind yields 74 +/- 11% during and immediately after the burns using our new in situ profile. In comparison with the previous source profile from laboratory simulations, however, this OC contribution is on average 27 +/- 5% lower.

  18. Evaluating signal-to-noise ratios, loudness, and related measures as indicators of airborne sound insulation.

    Science.gov (United States)

    Park, H K; Bradley, J S

    2009-09-01

    Subjective ratings of the audibility, annoyance, and loudness of music and speech sounds transmitted through 20 different simulated walls were used to identify better single number ratings of airborne sound insulation. The first part of this research considered standard measures such as the sound transmission class the weighted sound reduction index (R(w)) and variations of these measures [H. K. Park and J. S. Bradley, J. Acoust. Soc. Am. 126, 208-219 (2009)]. This paper considers a number of other measures including signal-to-noise ratios related to the intelligibility of speech and measures related to the loudness of sounds. An exploration of the importance of the included frequencies showed that the optimum ranges of included frequencies were different for speech and music sounds. Measures related to speech intelligibility were useful indicators of responses to speech sounds but were not as successful for music sounds. A-weighted level differences, signal-to-noise ratios and an A-weighted sound transmission loss measure were good predictors of responses when the included frequencies were optimized for each type of sound. The addition of new spectrum adaptation terms to R(w) values were found to be the most practical approach for achieving more accurate predictions of subjective ratings of transmitted speech and music sounds.

  19. Food shopping habits, physical activity and health-related indicators among adults aged ≥70 years.

    Science.gov (United States)

    Thompson, Janice L; Bentley, Georgina; Davis, Mark; Coulson, Jo; Stathi, Afroditi; Fox, Kenneth R

    2011-09-01

    To investigate the food shopping habits of older adults in the UK and explore their potential associations with selected health-related indicators. A cross-sectional study including objectively measured physical activity levels, BMI, physical function and self-reported health status and dietary intake. Bristol, UK. A total of 240 older adults aged ≥70 years living independently. Mean age was 78·1 (sd 5·7) years; 66·7 % were overweight or obese and 4 % were underweight. Most (80·0 %) carried out their own food shopping; 53·3 % shopped at least once weekly. Women were more likely to shop alone (P driven (P car at least once weekly at large supermarket chains, with most finding high-quality fruit, vegetables and low-fat products easily accessible. Higher levels of physical function and physical activity and better self-reported health are important in supporting food shopping and maintaining independence.

  20. Differential response of peripheral arterial compliance-related indices to a vasoconstrictive stimulus.

    Science.gov (United States)

    Guerrisi, Maria; Vannucci, Italo; Toschi, Nicola

    2009-01-01

    Peripheral arterial elastic properties are greatly affected by cardiovascular as well as other pathologies, and their assessment can provide useful diagnostic indicators. The photoplethysmographic technique can provide finger blood volume and pressure waveforms non-invasively, which can then be processed statically or beat-to-beat to characterize parameters of the vessel wall mechanics. We employ an occlusion-deflation protocol in 48 healthy volunteers to study peripheral artery compliance-related indices over positive and negative transmural pressure values as well as under the influence of a valid vasoconstrictor (cigarette smoking). We calculate beat-to-beat indices (compliance index CI, distensibility index DI, three viscoelastic model parameters (compliance C, viscosity R and inertia L), pressure-volume loop areas A and damping factor DF as well as symmetrical (C(max)) and asymmetrical (C(A)(max)) static compliance estimates, and their distributions over transmural pressure. All distributions are bell-shaped and centred on negative transmural pressure values. Distribution heights were significantly lower in the smoking group (w.r.t. the non-smoking group) for C, CI, DI and significantly higher in R and DF. The estimated volume signal time lag was also significantly lower in the smoking group. Left and right distribution widths were significantly different in all parameters/groups but DI (both groups), C(A)(max), A (smoking group) and L (non-smoking group), and positions of maxima/minima were significantly altered in C(A)(max), R and DF. C, DF and CI are seen to be most sensitive under this protocol, while C(max) and C(A)(max) are seen to be insensitive. These quantities provide complementary, time- and transmural pressure-dependent information about arterial wall mechanics, and the choice of index should depend on the physiological conditions at hand as well as relevant time resolution and transmural pressure range.

  1. Differential response of peripheral arterial compliance-related indices to a vasoconstrictive stimulus

    International Nuclear Information System (INIS)

    Guerrisi, Maria; Vannucci, Italo; Toschi, Nicola

    2009-01-01

    Peripheral arterial elastic properties are greatly affected by cardiovascular as well as other pathologies, and their assessment can provide useful diagnostic indicators. The photoplethysmographic technique can provide finger blood volume and pressure waveforms non-invasively, which can then be processed statically or beat-to-beat to characterize parameters of the vessel wall mechanics. We employ an occlusion–deflation protocol in 48 healthy volunteers to study peripheral artery compliance-related indices over positive and negative transmural pressure values as well as under the influence of a valid vasoconstrictor (cigarette smoking). We calculate beat-to-beat indices (compliance index CI, distensibility index DI, three viscoelastic model parameters (compliance C, viscosity R and inertia L), pressure–volume loop areas A and damping factor DF as well as symmetrical (C max ) and asymmetrical (C A max ) static compliance estimates, and their distributions over transmural pressure. All distributions are bell-shaped and centred on negative transmural pressure values. Distribution heights were significantly lower in the smoking group (w.r.t. the non-smoking group) for C, CI, DI and significantly higher in R and DF. The estimated volume signal time lag was also significantly lower in the smoking group. Left and right distribution widths were significantly different in all parameters/groups but DI (both groups), C A max , A (smoking group) and L (non-smoking group), and positions of maxima/minima were significantly altered in C A max , R and DF. C, DF and CI are seen to be most sensitive under this protocol, while C max and C A max are seen to be insensitive. These quantities provide complementary, time- and transmural pressure-dependent information about arterial wall mechanics, and the choice of index should depend on the physiological conditions at hand as well as relevant time resolution and transmural pressure range

  2. Weed-Species Abundance and Diversity Indices in Relation to Tillage Systems and Fertilization

    Directory of Open Access Journals (Sweden)

    Ilias S. Travlos

    2018-04-01

    Full Text Available Weeds pose a major threat to world agriculture by reducing detrimentally crop yield and quality. However, at the same time, weeds are major interacting components of the agroecosystems. Abundance and diversity of weeds vary significantly among the several communities. In order to evaluate each community's structure and the interactions among them, several population indices are used as key tools. In parallel, various cultivation and land management strategies, such as tillage and fertilization, are commonly used in terms of integrated weed management. Estimating the response of weed species on those practices is crucial for both biodiversity maintenance and alternative weed control methods. Many experiments have confirmed the fundamental role of tillage intensity and nutrition supply in weed species' abundance and diversity. For instance, in some studies, the abundance of perennial weeds was doubled under reduced tillage intensity. In addition, higher values of Shannon-Weiner and Pielou indices were reported in the PK fertilization treatment compared to the control and NK fertilization treatments. The objective of this paper is to provide a brief overview of the key results of these experiments and summarize the part of the literature related to the effect of tillage systems and fertilization on weed species abundance and diversity. Such knowledge could contribute to the sound design and implementation of integrated weed management programs which in turn may lead to a decrease in the density of serious and noxious weeds and an increase in the overall balance of agroecosystems.

  3. Indicators of childhood quality of education in relation to cognitive function in older adulthood.

    Science.gov (United States)

    Crowe, Michael; Clay, Olivio J; Martin, Roy C; Howard, Virginia J; Wadley, Virginia G; Sawyer, Patricia; Allman, Richard M

    2013-02-01

    The association between years of education and cognitive function in older adults has been studied extensively, but the role of quality of education is unknown. We examined indicators of childhood educational quality as predictors of cognitive performance and decline in later life. Participants included 433 older adults (52% African American) who reported living in Alabama during childhood and completed in-home assessments of cognitive function at baseline and 4 years later. Reports of residence during school years were matched to county-level data from the 1935 Alabama Department of Education report for school funding (per student), student-teacher ratio, and school year length. A composite measure of global cognitive function was utilized in analyses. Multilevel mixed effects models accounted for clustering of educational data within counties in examining the association between cognitive function and the educational quality indices. Higher student-teacher ratio was associated with worse cognitive function and greater school year length was associated with better cognitive function. These associations remained statistically significant in models adjusted for education level, age, race, gender, income, reading ability, vascular risk factors, and health behaviors. The observed associations were stronger in those with lower levels of education (≤12 years), but none of the education quality measures were related to 4-year change in cognitive function. Educational factors other than years of schooling may influence cognitive performance in later life. Understanding the role of education in cognitive aging has substantial implications for prevention efforts as well as accurate identification of older adults with cognitive impairment.

  4. Marathon performance in relation to body fat percentage and training indices in recreational male runners

    Directory of Open Access Journals (Sweden)

    Tanda G

    2013-05-01

    Full Text Available Giovanni Tanda,1 Beat Knechtle2,31DIME, Università degli Studi di Genova, Genova, Italy; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3Institute of General Practice and Health Services Research, University of Zurich, Zurich, SwitzerlandBackground: The purpose of this study was to investigate the effect of anthropometric characteristics and training indices on marathon race times in recreational male marathoners.Methods: Training and anthropometric characteristics were collected for a large cohort of recreational male runners (n = 126 participating in the Basel marathon in Switzerland between 2010 and 2011.Results: Among the parameters investigated, marathon performance time was found to be affected by mean running speed and the mean weekly distance run during the training period prior to the race and by body fat percentage. The effect of body fat percentage became significant as it exceeded a certain limiting value; for a relatively low body fat percentage, marathon performance time correlated only with training indices.Conclusion: Marathon race time may be predicted (r = 0.81 for recreational male runners by the following equation: marathon race time (minutes = 11.03 + 98.46 exp(−0.0053 mean weekly training distance [km/week] + 0.387 mean training pace (sec/km + 0.1 exp(0.23 body fat percentage [%]. The marathon race time results were valid over a range of 165–266 minutes.Keywords: endurance, exercise, anthropometry

  5. Marathon performance in relation to body fat percentage and training indices in recreational male runners.

    Science.gov (United States)

    Tanda, Giovanni; Knechtle, Beat

    2013-01-01

    The purpose of this study was to investigate the effect of anthropometric characteristics and training indices on marathon race times in recreational male marathoners. Training and anthropometric characteristics were collected for a large cohort of recreational male runners (n = 126) participating in the Basel marathon in Switzerland between 2010 and 2011. Among the parameters investigated, marathon performance time was found to be affected by mean running speed and the mean weekly distance run during the training period prior to the race and by body fat percentage. The effect of body fat percentage became significant as it exceeded a certain limiting value; for a relatively low body fat percentage, marathon performance time correlated only with training indices. Marathon race time may be predicted (r = 0.81) for recreational male runners by the following equation: marathon race time (minutes) = 11.03 + 98.46 exp(-0.0053 mean weekly training distance [km/week]) + 0.387 mean training pace (sec/km) + 0.1 exp(0.23 body fat percentage [%]). The marathon race time results were valid over a range of 165-266 minutes.

  6. On indicators of genetic relation between uranium-bearing bitumen with oil-like substances

    International Nuclear Information System (INIS)

    Pen'kov, V.F.

    1980-01-01

    Mineralogical indicators are considered which confirm that uranium-bearing (containing pitchblende) solid carbon substrates in the process of their formation had a stage of liquid-viscous state, and were sedimented in a close association with solid oil bitumens. The following cases are studied: 1) in concentrated macroextracts of uranium-bearing bitumens fine relicts of coloured oreless bitumens, less oxidated and carbonizated, are found sporadically in the passing light; 2) indicators of the development of black uranium-bearing bitumen along separate extracts or joint agregates of kerito- and asphalt-like substrates are observed in passing light within the veinlets of solid bitumens being in carbonate rocks; 3) linses of solid bitumens of fragmentary rock have zone structure according to the observation in passing light. The direct relation between black uranium-bearing bitumens and solid hydrocarbons which can form out of oil-like substances. Initial substances for them were defferent; resinous bitumens in the first case, kerito- and asphalt-like substances - in the second one, and paraffin substances - in the third one. It shows the nonselective character of the formation out of them of black uranium-bearing bitumens due to the processes of oxidation and carbonization [ru

  7. Cannabis in Chinese Medicine: Are Some Traditional Indications Referenced in Ancient Literature Related to Cannabinoids?

    Science.gov (United States)

    Brand, E. Joseph; Zhao, Zhongzhen

    2017-01-01

    Cannabis sativa L. (Cannabaceae) has a long history of utilization as a fiber and seed crop in China, and its achenes (“seeds”) as well as other plant parts have been recorded in Chinese medical texts for nearly 2000 years. While the primary applications of cannabis in Chinese medicine center around the use of the achenes, ancient indications for the female inflorescence, and other plant parts include conditions such as pain and mental illness that are the subject of current research into cannabinoids such as cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC). However, little previous research has been conducted to analyze the Chinese medical literature in light of recent advances in the pharmacology and taxonomy of cannabis, and most of the relevant Chinese historical records have not yet been translated into Western languages to facilitate textual research. Furthermore, many key questions remain unresolved in the Chinese literature, including how various traditional drug names precisely correspond to different plant parts, as well as the implications of long-term selection for fiber-rich cultivars on the medical applications of cannabis in Chinese medicine. In this article, prominent historical applications of cannabis in Chinese medicine are chronologically reviewed, and indications found in ancient Chinese literature that may relate to cannabinoids such as CBD and Δ9-THC are investigated. PMID:28344554

  8. Anthropometric, cardiovascular and functional variables as indicators of health related physical fitness in university professors

    Directory of Open Access Journals (Sweden)

    Osvaldo Costa Moreira

    Full Text Available AbstractObjective To verify the behavior of anthropometric, cardiovascular and functional variables as indicators of health-related physical fitness in university professors and perform a comparison of these variables between sexes.Materials and methods We conducted an observational epidemiological cross-sectional study in 145 professors (45.86 ± 9.7 years, 103 men (71.03%, which were evaluated by measuring heart rate (HR and systolic (SBP and diastolic (DBP pressure at rest, body weight, height, body mass index (BMI, body fat percentage (BF%, handgrip strength (HGS, flexibility and cardiorespiratory fitness (CRF. We proceeded to the descriptive analysis, Student t-test for comparison between sexes and multiple regression analysis to verify the association between the variables analyzed. It was adopted a significance level of p < 0.05.Results The sex affected all variables. Women had better levels of BMI, flexibility, SBP and DBP. The BF% and CRF were associated with SBP and BMI in both sexes.Conclusion The behavior of anthropometric, cardiovascular and functional variables indicated unsatisfactory values for flexibility, HGS and BMI, with the worst levels among men. Furthermore, the variables that showed better association with HRPF were BF% and CRF.

  9. Behaviour of biological indicators of cadmium in relation to occupational exposure

    Energy Technology Data Exchange (ETDEWEB)

    Ghezzi, I; Toffoletto, F; Sesana, G; Fagioli, M G; Micheli, A; Di Silvestro, P; Zocchetti, C; Alessio, L

    1985-01-01

    Cadmium in blood (CdB), cadmium in urine (CdU) and beta 2-microglobulins (beta 2MU) were determined in 83 male workers exposed to cadmium fumes. The behaviour of the biological indicators of cadmium was assessed in relation to degree of current exposure, length of exposure and cumulative exposure (computed as concentration of cadmium at the workplace multiplied by duration of exposure). CdB values were significantly higher in the subgroups of subjects with higher current cadmium exposure and in the subgroups of subjects with greater cumulative exposure, but the test levels were not influenced by duration of exposure. CdU levels were significantly higher in the subgroup of subjects with greater cumulative exposure, but were less influenced by current exposure or duration of exposure. Considering the entire population, a rather close correlation was observed between CdB and CdU. When the population was divided according to level of current exposure, a close relationship was observed between the two indicators in all subgroups; nevertheless, for identical CdU values, the CdB values were higher in the subjects with heavier current exposure. The data confirm that CdU is prevalently influenced by the body burden of metal, but they also suggest that the CdB levels are not influenced solely by the intensity of current exposure but also depend to a considerable degree on the body burden.

  10. SAR Ground Moving Target Indication Based on Relative Residue of DPCA Processing

    Directory of Open Access Journals (Sweden)

    Jia Xu

    2016-10-01

    Full Text Available For modern synthetic aperture radar (SAR, it has much more urgent demands on ground moving target indication (GMTI, which includes not only the point moving targets like cars, truck or tanks but also the distributed moving targets like river or ocean surfaces. Among the existing GMTI methods, displaced phase center antenna (DPCA can effectively cancel the strong ground clutter and has been widely used. However, its detection performance is closely related to the target’s signal-to-clutter ratio (SCR as well as radial velocity, and it cannot effectively detect the weak large-sized river surfaces in strong ground clutter due to their low SCR caused by specular scattering. This paper proposes a novel method called relative residue of DPCA (RR-DPCA, which jointly utilizes the DPCA cancellation outputs and the multi-look images to improve the detection performance of weak river surfaces. Furthermore, based on the statistics analysis of the RR-DPCA outputs on the homogenous background, the cell average (CA method can be well applied for subsequent constant false alarm rate (CFAR detection. The proposed RR-DPCA method can well detect the point moving targets and distributed moving targets simultaneously. Finally, the results of both simulated and real data are provided to demonstrate the effectiveness of the proposed SAR/GMTI method.

  11. Stability-indicating UPLC method for determining related substances and degradants in dronedarone.

    Science.gov (United States)

    Pydimarry, Surya Prakash Rao; Cholleti, Vijay Kumar; Vangala, Ranga Reddy

    2014-08-01

    A simple, sensitive and reproducible method was developed on ultra-performance liquid chromatography coupled with photodiode array detection for the quantitative determination of dronedarone hydrochloride (DRO) in drug substance and pharmaceutical dosage forms. The method is applicable for the quantification of related substances and assays of drug substances. Chromatographic separation was achieved on Acquity UPLC BEH C8 100 mm, 2.1 mm and 1.7 µm columns, using gradient elution within a short run time of 10.0 min. The eluted compounds were monitored at 288 nm, the flow rate was 0.5 mL/min and the column oven temperature was maintained at 40°C. The resolution of DRO and 11 impurities (potentials and by-products) was greater than 2.0 for all pairs of components. The high correlation coefficient value (>0.9995) indicates the clear correlations between the concentrations of investigated compound and their peak areas within the test ranges. The repeatability and intermediate precision, expressed by the relative standard deviation, were less than 2.5%. The accuracy and validity of the method were further ascertained by performing recovery studies via a spike method. The accuracy of the method, expressed as relative error, was satisfactory. No interference was observed from concomitant substances normally added to the tablets. DRO was subjected to the stress conditions of oxidative, acid, base, hydrolytic, thermal and photolytic degradation. DRO was found to degrade significantly in acid and base stress conditions and to remain stable in thermal, photolytic degradation, oxidative and hydrolytic conditions. The degradation products were well resolved from primary peak and its impurities, proving that the method is stability indicating. The developed method was validated as per International Conference on Harmonization guidelines with respect to specificity, limit of detection, limit of quantification, linearity, accuracy, precision, solution stability and robustness

  12. Prescribed burning: a topical issue

    Directory of Open Access Journals (Sweden)

    Bovio G

    2013-11-01

    Full Text Available Prescribed burning is a promising technique for the prevention of forest fires in Italy. The research deepened several ecological and operative aspects. However, legal issues need to be thoroughly investigated.

  13. Safe prescribing: a titanic challenge.

    Science.gov (United States)

    Routledge, Philip A

    2012-10-01

    The challenge to achieve safe prescribing merits the adjective 'titanic'. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the 'Seven C's'. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. © 2012 The Author. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  14. Safe prescribing: a titanic challenge

    Science.gov (United States)

    Routledge, Philip A

    2012-01-01

    The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

  15. Comparison between model-predicted tumor oxygenation dynamics and vascular-/flow-related Doppler indices.

    Science.gov (United States)

    Belfatto, Antonella; Vidal Urbinati, Ailyn M; Ciardo, Delia; Franchi, Dorella; Cattani, Federica; Lazzari, Roberta; Jereczek-Fossa, Barbara A; Orecchia, Roberto; Baroni, Guido; Cerveri, Pietro

    2017-05-01

    Mathematical modeling is a powerful and flexible method to investigate complex phenomena. It discloses the possibility of reproducing expensive as well as invasive experiments in a safe environment with limited costs. This makes it suitable to mimic tumor evolution and response to radiotherapy although the reliability of the results remains an issue. Complexity reduction is therefore a critical aspect in order to be able to compare model outcomes to clinical data. Among the factors affecting treatment efficacy, tumor oxygenation is known to play a key role in radiotherapy response. In this work, we aim at relating the oxygenation dynamics, predicted by a macroscale model trained on tumor volumetric data of uterine cervical cancer patients, to vascularization and blood flux indices assessed on Ultrasound Doppler images. We propose a macroscale model of tumor evolution based on three dynamics, namely active portion, necrotic portion, and oxygenation. The model parameters were assessed on the volume size of seven cervical cancer patients administered with 28 fractions of intensity modulated radiation therapy (IMRT) (1.8 Gy/fraction). For each patient, five Doppler ultrasound tests were acquired before, during, and after the treatment. The lesion was manually contoured by an expert physician using 4D View ® (General Electric Company - Fairfield, Connecticut, United States), which automatically provided the overall tumor volume size along with three vascularization and/or blood flow indices. Volume data only were fed to the model for training purpose, while the predicted oxygenation was compared a posteriori to the measured Doppler indices. The model was able to fit the tumor volume evolution within 8% error (range: 3-8%). A strong correlation between the intrapatient longitudinal indices from Doppler measurements and oxygen predicted by the model (about 90% or above) was found in three cases. Two patients showed an average correlation value (50-70%) and the remaining

  16. The Relation between Diverse Phenotypes of PCOS with Clinical Manifestations, Anthropometric Indices and Metabolic Characteristics.

    Science.gov (United States)

    Shahrami, Seyedeh Hajar; Abbasi Ranjbar, Zahra; Milani, Forozan; Kezem-Nejad, Ehsan; Hassanzadeh Rad, Afagh; Dalil Heirat, Seyedeh Fatemeh

    2016-02-01

    Critical issue regarding to variation of findings based on different phenotypes led investigators to define whether they are distinct features or overlapping ones. Therefore, we aimed to investigate the association between diverse phenotypes of PCOS (Poly Cystic Ovary Syndrome) with clinical manifestations, anthropometric indices, and metabolic characteristics. This was a descriptive cross-sectional study conducted in 15-39 years old women with PCOS referred to infertility clinics in the north part of Iran, Rasht during 2010-2011. Data were gathered through an interview by a form consisted of demographic characteristics, laboratory findings, ovarian volume and anthropometric indices. A total of 214 patients consisted of 161 PCOS (cases) and 53 normal women (controls) participated in this study. The most prevalent phenotype in PCOS population was IM/PCO/HA (54%), followed by IM/HA (28%) and IM/PCO (13%). PCO/HA was present only in 6 PCOS patients (5%). PCOS patients were significantly younger than controls (P=0.07). Results showed that increased ovarian volume were higher in PCOS group in comparison with controls and IM/PCO/HA, and IM/PCO had respectively the largest ovarian volumes. Also, a significant relation was observed based on Cholesterol, 17OHP, LH, TG, 2hpp, and LH/FSH between patients with PCOS and control groups. There were significant differences in demographic, anthropometric, hormonal and ultrasound findings between PCOS and controls. Therefore, it seems that classification of the characteristics of each phenotype could offer an appropriate guide for screening risks of PCOS and may facilitate performing most favorable treatment for these complications.

  17. Introduction to prescribed fires in Southern ecosystems

    Science.gov (United States)

    Thomas A. Waldrop; Scott L. Goodrick

    2012-01-01

    This publication is a guide for resource managers on planning and executing prescribed burns in Southern forests and grasslands. It includes explanations of reasons for prescribed burning, environmental effects, weather, and techniques as well as general information on prescribed burning.

  18. Water-stress-induced breakdown of carbon-water relations: indicators from diurnal FLUXNET patterns

    Science.gov (United States)

    Nelson, Jacob A.; Carvalhais, Nuno; Migliavacca, Mirco; Reichstein, Markus; Jung, Martin

    2018-04-01

    Understanding of terrestrial carbon and water cycles is currently hampered by an uncertainty in how to capture the large variety of plant responses to drought. In FLUXNET, the global network of CO2 and H2O flux observations, many sites do not uniformly report the ancillary variables needed to study drought response physiology. To this end, we outline two data-driven indicators based on diurnal energy, water, and carbon flux patterns derived directly from the eddy covariance data and based on theorized physiological responses to hydraulic and non-stomatal limitations. Hydraulic limitations (i.e. intra-plant limitations on water movement) are proxied using the relative diurnal centroid (CET*), which measures the degree to which the flux of evapotranspiration (ET) is shifted toward the morning. Non-stomatal limitations (e.g. inhibitions of biochemical reactions, RuBisCO activity, and/or mesophyll conductance) are characterized by the Diurnal Water-Carbon Index (DWCI), which measures the degree of coupling between ET and gross primary productivity (GPP) within each day. As a proof of concept we show the response of the metrics at six European sites during the 2003 heat wave event, showing a varied response of morning shifts and decoupling. Globally, we found indications of hydraulic limitations in the form of significantly high frequencies of morning-shifted days in dry/Mediterranean climates and savanna/evergreen plant functional types (PFTs), whereas high frequencies of decoupling were dominated by dry climates and grassland/savanna PFTs indicating a prevalence of non-stomatal limitations in these ecosystems. Overall, both the diurnal centroid and DWCI were associated with high net radiation and low latent energy typical of drought. Using three water use efficiency (WUE) models, we found the mean differences between expected and observed WUE to be -0.09 to 0.44 µmol mmol-1 and -0.29 to -0.40 µmol mmol-1 for decoupled and morning-shifted days, respectively, compared

  19. Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems.

    Science.gov (United States)

    Rodríguez-Acelas, Alba Luz; Reich, Rejane; de Abreu Almeida, Miriam; Oliveira Crossetti, Maria da Graça; de Fátima Lucena, Amália

    2016-04-01

    Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC) related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.Objetivo.Construir definições conceituais para alguns indicadores do resultado de enfermagem Gravidade de Infecção da Nursing Outcomes Classification (NOC) relacionados aos problemas respiratórios, a partir de evidências científicas sobre sinais e sintomas de infecção em pessoas adultas. Métodos. Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL, LILACS e SCOPUS. Foram incluídos estudos com textos na integra, publicados em espanhol, português ou inglês, usando os descritores gravidade da infecção, classificação dos resultados de enfermagem da NOC, infecções respiratórias, e sinais e sintomas respiratórios. Resultados. Analisaram-se nove publicações que embasaram a elaboração das definições conceituais de oitos indicadores do Resultado de Enfermagem Gravidade de Infec

  20. Influence of repeated prescribed fire on tree growth and mortality in Pinus resinosa forests, northern Minnesota

    Science.gov (United States)

    Bottero, Alessandra; D'Amato, Anthony W.; Palik, Brian J.; Kern, Christel C.; Bradford, John B.; Scherer, Sawyer S.

    2017-01-01

    Prescribed fire is widely used for ecological restoration and fuel reduction in fire-dependent ecosystems, most of which are also prone to drought. Despite the importance of drought in fire-adapted forests, little is known about cumulative effects of repeated prescribed burning on tree growth and related response to drought. Using dendrochronological data in red pine (Pinus resinosa Ait.)-dominated forests in northern Minnesota, USA, we examined growth responses before and after understory prescribed fires between 1960 and 1970, to assess whether repeated burning influences growth responses of overstory trees and vulnerability of overstory tree growth to drought. We found no difference in tree-level growth vulnerability to drought, expressed as growth resistance, resilience, and recovery, between areas receiving prescribed fire treatments and untreated forests. Annual mortality rates during the period of active burning were also low (less than 2%) in all treatments. These findings indicate that prescribed fire can be effectively integrated into management plans and climate change adaptation strategies for red pine forest ecosystems without significant short- or long-term negative consequences for growth or mortality rates of overstory trees.

  1. Predicted effects of prescribed burning and harvesting on forest recovery and sustainability in southwest Georgia, USA.

    Science.gov (United States)

    Garten, Charles T

    2006-12-01

    A model-based analysis of the effect of prescribed burning and forest thinning or clear-cutting on stand recovery and sustainability was conducted at Fort Benning, GA, in the southeastern USA. Two experiments were performed with the model. In the first experiment, forest recovery from degraded soils was predicted for 100 years with or without prescribed burning. In the second experiment simulations began with 100 years of predicted stand growth, then forest sustainability was predicted for an additional 100 years under different combinations of prescribed burning and forest harvesting. Three levels of fire intensity (low, medium, and high), that corresponded to 17%, 33%, and 50% consumption of the forest floor C stock by fire, were evaluated at 1-, 2-, and 3-year fire return intervals. Relative to the control (no fire), prescribed burning with a 2- or 3-year return interval caused only a small reduction in predicted steady state soil C stocks (burns did adversely impact forest recovery and sustainability (after harvesting) on less sandy soils, but not on more sandy soils that had greater N availability. Higher intensity and frequency of ground fires increased the chance that tree biomass would not return to pre-harvest levels. Soil N limitation was indicated as the cause of unsustainable forests when prescribed burns were too frequent or too intense to permit stand recovery.

  2. Response to capacitating stimuli indicates extender-related differences in boar sperm function.

    Science.gov (United States)

    Schmid, S; Henning, H; Petrunkina, A M; Weitze, K F; Waberski, D

    2013-10-01

    Spermatozoa, especially those of the porcine species, are highly susceptible to in vitro chilling and ageing. Extenders are continuously developed to protect boar spermatozoa from chilling injury. New semen extenders and other modified preservation strategies require sensitive testing for essential sperm functions. The key process on the pathway of fertilization is capacitation. The aim of the present study was to examine whether the specific response to capacitating stimuli is sensitive enough to indicate different preservation capacities of extenders during hypothermic storage of boar spermatozoa. Semen was diluted in Beltsville Thawing Solution (BTS) and Androstar Plus and kept for 3 h at 22°C or stored at 17°C, 10°C, and 5°C. Semen was analyzed at 24 and 96 h of storage. Motility and membrane integrity remained at high levels, except for lower values when stored in BTS at 5°C. Washed subsamples were incubated in capacitating medium (Tyrode) and control medium and were assessed for intracellular calcium concentration and integrity of plasma membranes using a flow cytometer. On the basis of the loss of low-calcium live cells in a kinetic approach, the specific response to capacitation stimuli was determined. There was a higher loss of response in semen stored hypothermically in the standard extender BTS compared to Androstar Plus. Assessment of the extent of phospholipid disorder under capacitating and control conditions by use of merocyanine staining did not reveal any significant extender-related differences. A field insemination trial with 778 sows was performed to relate in vitro results to fertility. Fertility parameters did not differ in semen stored up to 48 h at 10°C in Androstar Plus compared to controls stored at 17°C in BTS. In conclusion, assessment of specific reactivity to capacitating stimuli appears to be a sensitive tool for detection of extender-dependent alterations in functionality of chilled boar spermatozoa.

  3. Vegan lifestyle behaviors: an exploration of congruence with health-related beliefs and assessed health indices.

    Science.gov (United States)

    Dyett, Patricia A; Sabaté, Joan; Haddad, Ella; Rajaram, Sujatha; Shavlik, David

    2013-08-01

    This study aimed to investigate health belief as a major motive for diet and lifestyle behaviors of 100 vegans in the United States; and to determine congruence with selected health and nutrition outcomes. Response data from an administered questionnaire was analyzed. Statistical analyses determined the most common factors influencing diet choice; the number of vegans practicing particular lifestyle behaviors; body mass index; and prevalence of self-reported chronic disease diagnoses. Nutrient intakes were analyzed and assessed against Dietary Reference Intakes. Health was the most reported reason for diet choice (47%). In the health belief, animal welfare, and religious/other motive categories, low percentages of chronic disease diagnoses were reported: 27%, 11%, and 15%, respectively. There were no significant differences in health behaviors and indices among vegan motive categories, except for product fat content choices. Within the entire study population, health-related vegan motive coincided with regular exercise; 71% normal BMI (mean=22.6); minimal alcohol and smoking practices; frequently consumed vegetables, nuts, and grains; healthy choices in meal types, cooking methods, and low-fat product consumption; and adequate intakes for most protective nutrients when compared to reference values. But incongruence was found with 0% intake adequacy for vitamin D; and observation of excessive sodium use. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. heat-induced biological changes as heat tolerance indices related to growth performance in buffaloes

    International Nuclear Information System (INIS)

    Kaldes, M.Z.N.

    2004-01-01

    the main objective of this study was to predict new heat tolerance indices related to hot summer growth performance, depending on heat - induced changes in some physiological and biochemical parameters of young water buffalo calves. the present study was carried out on 8 egyptian male buffalo calves of 6 months old and 106.8 kg mean body weight (B W), and on the same animals of 12 months old and 179.5 kg mean B W. the animals were maintained in a climatic chamber of the egyptian atomic energy authority. the animals were maintained in metabolic cages inside a climatic chamber for 3 weeks under mild climate (20-24 c and 50-60% Rh, equivalent to 62-72 THI) for 6 hours daily as adjustment period,followed by 5 and 7 days in the 6- and 12-month old calves, respectively at the same climatic conditions as a control period.this was followed by 6 hours of acute heat exposure period (33-43 c and 40-60% Rh, equivalent to 85-93 Thi), then by chronic heat exposure period of the same climatic conditions for 5 and 7 days in the 6- and 12- month old calves, respectively.Rectal temperature (RT) and respiration rate (RR) were estimated daily, whereas BW was estimated at the beginning and the end of each exposure period

  5. Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries.

    Science.gov (United States)

    Morgan, Steven G; Lee, Augustine

    2017-01-31

    To assess the effects of costs on access to medicines in 11 developed countries offering different levels of prescription drug coverage for their populations. Cross-sectional study of data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults. Telephone survey conducted in 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA. 22 532 adults aged 55 and older and living in the community in studied countries. Self-reported cost-related non-adherence (CRNA) in the form of either not filling a prescription or skipping doses within the last 12 months because of out-of-pocket costs. Estimated prevalence of CRNA among all older adults varied from Norway, Sweden, Switzerland and the UK to 16.8% in the USA. Canada had the second highest national prevalence of CRNA (8.3%), followed by Australia (6.8%). Older adults in the USA were approximately six times more likely to report CRNA than older adults in the UK (adjusted OR=6.09; 95% CI 3.60 to 10.20). Older adults in Australia and Canada were also statistically significantly more likely to report CRNA than older adults in the UK. Across most countries, the prevalence of CRNA was higher among lower income residents and lower among residents over age 65. Observed differences in national prevalence of CRNA appear to follow lines of availability of prescription drug coverage and the extent of direct patient charges for prescriptions under available drug plans. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P

    2012-02-03

    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  7. An analysis and comparison of commonly available United Kingdom prescribing resources.

    Science.gov (United States)

    Cox, A R; Butt, T F; Ferner, R E

    2010-08-01

    Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high-quality information to support their practice. Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end-users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their

  8. Off-label psychotropic prescribing for young persons in medium security.

    Science.gov (United States)

    Haw, C; Stubbs, J

    2010-10-01

    Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.

  9. The relation between handedness indices and reproductive success in a non-industrial society.

    Directory of Open Access Journals (Sweden)

    Sara M Schaafsma

    Full Text Available The evolution of handedness in human populations has intrigued scientists for decades. However, whether handedness really affects Darwinian fitness is unclear and not yet studied in a non-industrial society where selection pressures on health and handedness are likely to be similar to the situation in which handedness has evolved. We measured both hand preference and asymmetry of hand skill (speed of fine motor control, measured by a pegboard task, and accuracy of throwing, as they measure different aspects of handedness. We investigated the associations between both the direction (left versus right and strength (the degree to which a certain preference or asymmetry in skill is manifested, independent of the direction of handedness. We analyzed to what extent these measures predict the number of offspring and self-reported illness in a non-industrial society in Papua, Indonesia. As it is known that body height and fitness are correlated, data on body height was also collected. Due to low numbers of left-handers we could not investigate the associations between direction of hand preference and measures of Darwinian fitness. We found a positive association between strength of asymmetry of hand skill (pegboard and the number of children men sired. We also found a positive association for men between strength of hand preference and number of children who died within the first three years of life. For women we found no such effects. Our results may indicate that strength of handedness, independent of direction, has fitness implications and that the persistence of the polymorphism in handedness may be ascribed to either balancing selection on strength of asymmetry of hand skill versus strength of hand preference, or sexual antagonistic selection. No relationships between health and handedness were found, perhaps due to disease related selective disappearance of subjects with a specific handedness.

  10. How to assess performance in cycling: the multivariate nature of influencing factors and related indicators

    Science.gov (United States)

    Castronovo, A. Margherita; Conforto, Silvia; Schmid, Maurizio; Bibbo, Daniele; D'Alessio, Tommaso

    2013-01-01

    Finding an optimum for the cycling performance is not a trivial matter, since the literature shows the presence of many controversial aspects. In order to quantify different levels of performance, several indexes have been defined and used in many studies, reflecting variations in physiological and biomechanical factors. In particular, indexes such as Gross Efficiency (GE), Net Efficiency (NE) and Delta Efficiency (DE) have been referred to changes in metabolic efficiency (EffMet), while the Indexes of Effectiveness (IE), defined over the complete crank revolution or over part of it, have been referred to variations in mechanical effectiveness (EffMech). All these indicators quantify the variations of different factors [i.e., muscle fibers type distribution, pedaling cadence, setup of the bicycle frame, muscular fatigue (MFat), environmental variables, ergogenic aids, psychological traits (PsychTr)], which, moreover, show high mutual correlation. In the attempt of assessing cycling performance, most studies in the literature keep all these factors separated. This may bring to misleading results, leaving unanswered the question of how to improve cycling performance. This work provides an overview on the studies involving indexes and factors usually related to performance monitoring and assessment in cycling. In particular, in order to clarify all those aspects, the mutual interactions among these factors are highlighted, in view of a global performance assessment. Moreover, a proposal is presented advocating for a model-based approach that considers all factors mentioned in the survey, including the mutual interaction effects, for the definition of an objective function E representing the overall effectiveness of a training program in terms of both EffMet and EffMech. PMID:23734130

  11. How to Assess Performance in Cycling: the Multivariate Nature of Influencing Factors and Related Indicators.

    Directory of Open Access Journals (Sweden)

    Anna Margherita eCastronovo

    2013-05-01

    Full Text Available Finding an optimum for the cycling performance is not a trivial matter, since the literature shows the presence of many controversial aspects. In order to quantify different levels of performance, several indexes have been defined and used in many studies, reflecting variations in physiological and biomechanical factors. In particular, indexes such as Gross Efficiency (GE, Net Efficiency (NE and Delta Efficiency (DE have been referred to changes in metabolic efficiency (EffMet, while the Indexes of Effectiveness (IE, defined over the complete crank revolution or over part of it, have been referred to variations in mechanical effectiveness (EffMech. All these indicators quantify the variations of different factors (i.e. muscle fibers type distribution, pedaling cadence, setup of the bicycle frame, muscular fatigue, environmental variables, ergogenic aids, psychological traits, which, moreover, show high mutual correlation. In the attempt of assessing cycling performance, most studies in the literature keep all these factors separated. This may bring to misleading results, leaving unanswered the question of how to improve cycling performance. This work provides an overview on the studies involving indexes and factors usually related to performance monitoring and assessment in cycling. In particular, in order to clarify all those aspects, the mutual interactions among these factors are highlighted, in view of a global performance assessment. Moreover, a proposal is presented advocating for a model-based approach that considers all factors mentioned in the survey, including the mutual interaction effects, for the definition of an objective function E representing the overall effectiveness of a training program in terms of both metabolic efficiency and mechanical effectiveness.

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  13. ELECTORAL PRESCRIBERS. WHO ARE THEY?

    Directory of Open Access Journals (Sweden)

    Constantin SASU

    2016-12-01

    Full Text Available The decision to vote and choosing among the candidates is an extremely important one with repercussions on everyday life by determining, in global mode, its quality for the whole society. Therefore the whole process by which the voter decides becomes a central concern. Prescribers, supposed to have a big influence on the electoral market, are a component of the microenvironment political organizations. These are people who occupy important positions that can influence the behavior of others. In the political environment, prescribers are known under the name of "opinion formers", "opinion leaders", "mediators" (Beciu, 2009 or "influencers" (Keller and Berry, 2003 Weimann, 1994. This paper aims to review the central opinions on what is the influence prescribers, opinion makers on voting behavior, voting and decisions on whether and how they act?

  14. To prescribe codeine or not to prescribe codeine?

    Science.gov (United States)

    Fleming, Marc L; Wanat, Matthew A

    2014-09-01

    A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting.

  15. Psychologists' right to prescribe – should prescribing privileges be ...

    African Journals Online (AJOL)

    Current changes in legislation regarding prescription rights increase the possibility of non-medical practitioners being authorised to presctibe medication. There has been ongoing debate about granting psychologists in South Africa a limited right to prescribe (RTP) psychotropic medication. The main reasons advanced for ...

  16. Relation between Wet-Bulb Globe Temperature and Thermal Work Limit Indices with Body Core Temperature

    Directory of Open Access Journals (Sweden)

    Mahdi Jalali

    2018-06-01

    Full Text Available Occupational exposure to heat stress in casting and smelting industries can cause adverse health effects on employees who working in such industries. The present study was set to assess the correlation and agreement of heat stress indices, including wet bulb globe temperature (WBGT, and thermal work limit (TWL, and the deep body temperature indices in workers of several casting and smelting industries located in the vicinity of Tehran, Iran. In This cross-sectional study 40 workers randomly selected and were examined. WBGT and TWL were the indices used for assessing heat stress, and the tympanic temperature and the oral temperature were measured as the heat strain indices. The correlation and agreement of indices were measured using SPSS vs.16. The results of the assessment of WBGT, TWL, the tympanic temperature, and oral temperature showed that 80, 17.5, 40, and 32.5 percent of workers exposed to heat stress higher than permissible limits proposed by standard bodies. Moreover, the present study showed that the significant correlation coefficient between heat stress and heat strain indices was in the range of 0.844- 0.869. Further, there was observed a good agreement between TWL and heat strain indices. The agreement between TWL and the oral temperature was 0.63 (P-value≤ 0.001 and between TWL and tympanic temperature was 0.612 (P-value≤ 0.001. However, the agreement between WBGT and heat strain indices was not satisfactory. These values were 0.154 (P-value ≥ 0.068 and 0.215 (P-value≥ 0.028 for the oral temperature and the tympanic temperature, respectively. The TWL index had a better agreement than WBGT with heat strain indices so TWL index is the better choice for assessing the heat stress in casting and metal smelting industries.

  17. Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians.

    Science.gov (United States)

    Van Cleven, Alexia; Sarrazin, Steven; de Rooster, Hilde; Paepe, Dominique; Van der Meeren, Sofie; Dewulf, Jeroen

    2018-03-17

    The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Antipsychotic prescribing in older people.

    Science.gov (United States)

    Neil, Wendy; Curran, Stephen; Wattis, John

    2003-09-01

    Antipsychotic medications have made a significant contribution to the care of the mentally ill people over the past 50 years, with good evidence that both typical and atypical agents are effective in the treatment of schizophrenia and related conditions. In addition they are widely used to good effect in other disorders including psychotic depression, dementia and delirium. Both typical and atypical agents may cause severe side-effects and, in the elderly in particular, there is an increased propensity for drug interactions. If used with care, antipsychotics are usually well tolerated, especially the atypical drugs. Although antipsychotics are effective at reducing psychotic symptoms their limitations should be recognised. They do not 'cure' the underlying illness, and the management of psychotic and behavioural symptoms must take into consideration treatment of physical illness as well as psychosocial interventions. In addition, the antipsychotic effect may take one to two weeks to be evident so doses should not be increased too rapidly. Often small doses are effective in the elderly if they are given sufficient time to work. As our understanding of the mechanisms of psychosis improves it is hoped that new drugs will be developed with novel mechanisms of action with improved efficacy and reduced side-effects. There are several drugs in development, some sharing similarities to currently available agents whilst others have novel mechanisms of actions involving glutamate and nicotinic receptors. Pharmacogenetics is also likely to be increasingly important over the next few years. As the genetic basis of many psychiatric disorders becomes more clearly established it is likely that drugs specifically designed for particular sub-groups of receptors will be developed. Finally, although the pharmacological treatment of psychotic disorders in younger people has been given considerable attention, there is a paucity of good quality research on antipsychotic drug use in

  19. Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Chabot Isabelle

    2006-03-01

    Full Text Available Abstract Background Drug utilization review (DUR programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing. Methods We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test. Results The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing. Conclusion Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs.

  20. The jumping action's indices of female volleyball players and their relation at some somatic characteristics

    Directory of Open Access Journals (Sweden)

    Stech M.

    2010-02-01

    Full Text Available In the paper the results of correlation analysis between of most significance jumping action's indices of high performance polish female volleyball players and their some somatic characteristics (stature, weight and body composition indices: BMI, FATkg, FAT%, FFMkg,FFM%, TBWkg and TBW% are presented. It has been found close correlation between of height of attack jump and stature (r=0,98, weight (r=0,76, FFMkg(r=0,88 and TBWkg (r=0,88. But correlation of height of attack jump with FFM% and TBW% was nonessential. Statistical essential correlation between basic indices of plyometric factor and FAT%, FFM% and TBW% indices (accordingly r = -0,65; 0,65 and 0,66 has been found. The results of the study may be taking into consideration in order to elaboration of effective jumping methods for volleyball players.

  1. Metabolic and Cardiovascular Ageing Indices in Relation to Glycated Haemoglobin in Healthy and Diabetic Subjects.

    Science.gov (United States)

    Suvarna H I, Shruthi; Moodithaya, Shailaja; Sharma, Raghava

    2017-01-01

    Ageing is a natural phenomenon that has tremendous amount of control over normal physiological functions. Diabetes mellitus and ageing share common symptoms like stiffness and loss of functioning of tissues due to cross-liked proteins and free radicals. Glycated Haemoglobin (HbA1c) is often used as a stable cumulative index of glycemic control and has shown that even in non-diabetic adults, there is a steady increase in HbA1c levels with age. Aim of the study is to evaluate the strength of association of HbA1c with metabolic and cardiovascular ageing indices in subjects between the age group of 40 to 60 yrs. A total of 220 subjects, with (n=110) and without (n=110) diabetes were assessed for the metabolic and cardiovascular ageing indices. BMI, waist hip ratio, fat percentage, Fasting blood sugar and HbA1c were assessed as metabolic ageing indices. The cardiovascular ageing indices measured were resting heart rate, blood pressure and heart rate variability. Ageing indices were compared between subjects with and without diabetes using independent' t' test and showed that the T2DM group exhibit significant accelerated ageing as compared to that of the controls. Pearson's and partial correlation coefficient was used to assess the association of HbA1c with the ageing indices without and with controlling for chronological age, indicated that, strength of association of levels of HBA1c with cardiovascular and other metabolic indices of ageing is statistically significant. The study concludes that the tightness of glycemic control has a significant impact on the biological ageing process. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  2. Perceived body image and health-related indicators among elderly women

    Directory of Open Access Journals (Sweden)

    Sheilla Tribess

    2006-08-01

    Full Text Available The aim of the study was to identify the association of the perceived body image, nutritional status, physical activity level, health indicators of and socio-demographic characteristics of elderly women. This cross-sectional study was also characterized as descriptive and correlacional, with a sample of 265 randomly selected women aged from 60 to 96 years, proportionally stratified by groups from the Friend’s Association, Groups for sharing live experiences and Open University for the Elderly of Jequié/BA. A questionnaire was used in an individual interview to obtain information on the socio-demographic characteristics (age, marital and economical status, family organization and income, and educational level, health indicators (subjective perceived health and self-reported health problems, physical activity level (IPAQ long version adapted for seniors and perceived body image (PBI, a nine-silhouette scale. The measurements of body mass and stature allowed for computing body mass index (BMI, used as a parameter for nutritional status. Data analyses consisted of the descriptive and nonparametric statistics, as well as measures of association, using the level of significant at 5%. Among the elderly, 47.5% was aged 60 to 69 years and 48.3% was widow. They lived in homes with three generations (38.1% and had low level of education: incomplete elementary school (88.7%. The elderly women were on retirement plan (58.5%, had monthly income up to minimum wage (51.7% and belonged to socioeconomic class D (55.8%. As for the PBI, 54% of the women were dissatisfied, mainly for body mass excess (35.1%. PBI was associated to the nutritional status, i.e., an increase in the BMI category raised the proportion of dissatisfied seniors. However, PBI was not associated with socio-demographic characteristics, health indicator or physical activity level. Comparing satisfied and dissatisfied women, no differences were noted in physical activity level, age or stature

  3. The pharmacist as prescriber: a discourse analysis of newspaper media in Canada.

    Science.gov (United States)

    Schindel, Theresa J; Given, Lisa M

    2013-01-01

    Legislation to expand the scope of practice for pharmacists to include authority to independently prescribe medications in Alberta, Canada was announced in 2006 and enacted in April 2007. To date, very little research has explored public views of pharmacist prescribing. This study analyzes newspaper media coverage of pharmacist prescribing 1 year before and 2 years after prescribing was implemented. News items related to pharmacist prescribing were retrieved from 2 national, Canadian newspapers and 5 local newspapers in Alberta over a 3-year period after the announcement of pharmacist prescribing. A purposive sample of 66 texts including news items, editorials, and letters were retrieved electronically from 2 databases, Newscan and Canadian Newsstand. This study uses social positioning theory as a lens for analyzing the discourse of pharmacist prescribing. The results demonstrate a binary positioning of the debate on pharmacist prescribing rights. Using social positioning theory as a lens for analysis, the results illustrate self- and other-positioning of pharmacists' expected roles as prescribers. Themes related to the discourse on pharmacist prescribing include qualifications, diagnosis, patient safety, physician support, and conflict of interest. Media representations of pharmacist prescribing point to polarized views that may serve to shape public, pharmacist, physician, and others' opinions of the issue. Multiple and contradictory views of pharmacist prescribing coexist. Pharmacists and pharmacy organizations are challenged to bring clarity and consistency about pharmacist prescribing to better serve the public interest in understanding options for health care services. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Influence of frailty-related diagnoses, high-risk prescribing in elderly adults, and primary care use on readmissions in fewer than 30 days for veterans aged 65 and older.

    Science.gov (United States)

    Pugh, Jacqueline A; Wang, Chen-Pin; Espinoza, Sara E; Noël, Polly H; Bollinger, Mary; Amuan, Megan; Finley, Erin; Pugh, Mary Jo

    2014-02-01

    To determine the effect of two variables not previously studied in the readmissions literature (frailty-related diagnoses and high-risk medications in the elderly (HRME)) and one understudied variable (volume of primary care visits in the prior year). Retrospective cohort study using data from a study designed to examine outcomes associated with inappropriate prescribing in elderly adults. All Veterans Affairs (VA) facilities with acute inpatient beds in fiscal year 2006 (FY06). All veterans aged 65 and older by October 1, 2005, who received VA care at least once per year between October 1, 2004, and September 30, 2006, and were hospitalized at least once during FY06 on a medical or surgical unit. A generalized linear interactive risk prediction model included demographic and clinical characteristics (mental health and chronic medical conditions, frailty-related diagnoses, number of medications) in FY05; incident HRME in FY06 before index hospitalization or readmission; chronic HRME in FY05; and FY05 emergency department (ED), hospital, geriatric, palliative, or primary care use. Facility-level variables were complexity, rural versus urban, and FY06 admission rate. The mean adjusted readmission rate was 18.3%. The new frailty-related diagnoses variable is a risk factor for readmission in addition to Charlson comorbidity score. Incident HRME use was associated with lower rates of readmission, as were higher numbers of primary care visits in the prior year. Frailty-related diagnoses may help to target individuals at higher risk of readmission to receive more-intensive care transition services. HRME use does not help in this targeting. A higher number of face-to-face primary care visits in the prior year, unlike ED and hospital use, correlates with fewer readmissions and may be another avenue for targeting prevention strategies. Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

  5. Prokinetics prescribing in paediatrics: evidence on cisapride, domperidone, and metoclopramide.

    Science.gov (United States)

    Mt-Isa, Shahrul; Tomlin, Stephen; Sutcliffe, Alastair; Underwood, Martin; Williamson, Paula; Croft, Nicholas M; Ashby, Deborah

    2015-04-01

    Domperidone and metoclopramide are prokinetics commonly prescribed off-label to infants and younger children in an attempt to treat gastro-oesophageal reflux symptoms. Another prokinetic drug, cisapride, was used but withdrawn in 2000 in the United Kingdom because of serious arrhythmic adverse events. Medicines and Healthcare Products Regulatory Agency issued safety warnings for domperidone in May 2012 and restricted its indications. We report here national primary care prescribing trends and safety signals of these drugs in children. We used data from the General Practice Research Database between 1990 and 2006 for children <18 years. Descriptive statistics and Poisson regressions were performed to characterise prescribing trends. We examined safety signals in nested case-control studies. The proportion of children <2 years old being prescribed one of the medications doubled during the study period. Prescriptions of domperidone increased 10-fold, mainly following the withdrawal of cisapride in 2000. Prescriptions of metoclopramide did not change significantly. Despite the increase in prescriptions of domperidone, no new safety signals were identified. These data showed dramatic changes in prescribing of cisapride and domperidone despite the lack of good-quality supporting evidence. It is possible that these prescribing trends were influenced by published guidelines. Even if produced without robust efficacy and safety evidence, published guidelines can influence clinicians and consequently affect prescribing. Therefore, improving the evidence base on prokinetics to inform future guidelines is vital. The lack of new safety signals during this period would support the development of suitable powered clinical studies.

  6. Health behavior-related indicator of lifestyle: application in the ELSA-Brasil study.

    Science.gov (United States)

    Patrão, Ana Luísa; Almeida, Maria-da-Conceição C; Alvim, Sheila; Chor, Dora; Aquino, Estela M L

    2018-05-01

    Various behaviors are considered health enhancing. Nevertheless, according to the current scientific literature, four health behaviors are considered particularly risky in view of their association with a group of chronic diseases: 1) smoking; 2) excessive alcohol consumption; 3) poor diet; and 4) lack of physical activity. Theoretically, it should be possible to make improvements to one's health by maximizing the number of healthy behaviors and minimizing the unhealthy ones. However, in reality, the different behaviors interconnect to create more complex lifestyles. Therefore, the objective of this paper is to present the construction of a lifestyle indicator based on health behaviors selected in the ELSA-Brazil study. This indicator revealed two lifestyles: less healthy and healthier lifestyles. The model proved adequate and was confirmed using latent class analysis (LCA). Agreement was 83.2 between the indicator and the LCA results, with a kappa coefficient of 0.65. Women were more likely to have a healthier lifestyle than men, reinforcing the scientific consistency of the indicator, since this finding is in agreement with data from the scientific literature. The indicator created to define lifestyle was found to have scientific consistency and validity; therefore, its use can be recommended for future population-based studies concerning the promotion of health and healthy lifestyles.

  7. Indicators of sarcopenia and their relation to intrinsic and extrinsic factors relating to falls among active elderly women

    OpenAIRE

    Rossetin, Liliana Laura; Rodrigues, Elisangela Valevein; Gallo, Luiza Herminia; Macedo, Darla Silvério; Schieferdecker, Maria Eliana Madalozzo; Pintarelli, Vitor Last; Rabito, Estela Iraci; Gomes, Anna Raquel Silveira

    2016-01-01

    Abstract Introduction: Musculoskeletal aging can impair functional performance increasing the risk of falls. Objective: To analyze the correlation between sarcopenia and the intrinsic and extrinsic factors involved in falls among community-dwelling elderly women. Method: A cross-sectional study evaluated the number of falls of 85 active community-dwelling elderly women in the previous year and then divided them into two groups: non-fallers (n=61) and fallers (n=24). The sarcopenia indic...

  8. Prescribed burning for understory restoration

    Science.gov (United States)

    Kenneth W. Outcalt

    2006-01-01

    Because the longleaf ecosystem evolved with and is adapted to frequent fire, every 2 to 8 years, prescribed burning is often useful for restoring understory communities to a diverse ground layer of grasses, herbs, and small shrubs. This restoration provides habitat for a number of plant and animal species that are restricted to or found mostly in longleaf pine...

  9. A methodological protocol for selecting and quantifying low-value prescribing practices in routinely collected data: an Australian case study.

    Science.gov (United States)

    Brett, Jonathan; Elshaug, Adam G; Bhatia, R Sacha; Chalmers, Kelsey; Badgery-Parker, Tim; Pearson, Sallie-Anne

    2017-05-03

    Growing imperatives for safety, quality and responsible resource allocation have prompted renewed efforts to identify and quantify harmful or wasteful (low-value) medical practices such as test ordering, procedures and prescribing. Quantifying these practices at a population level using routinely collected health data allows us to understand the scale of low-value medical practices, measure practice change following specific interventions and prioritise policy decisions. To date, almost all research examining health care through the low-value lens has focused on medical services (tests and procedures) rather than on prescribing. The protocol described herein outlines a program of research funded by Australia's National Health and Medical Research Council to select and quantify low-value prescribing practices within Australian routinely collected health data. We start by describing our process for identifying and cataloguing international low-value prescribing practices. We then outline our approach to translate these prescribing practices into indicators that can be applied to Australian routinely collected health data. Next, we detail methods of using Australian health data to quantify these prescribing practices (e.g. prevalence of low-value prescribing and related costs) and their downstream health consequences. We have approval from the necessary Australian state and commonwealth human research ethics and data access committees to undertake this work. The lack of systematic and transparent approaches to quantification of low-value practices in routinely collected data has been noted in recent reviews. Here, we present a methodology applied in the Australian context with the aim of demonstrating principles that can be applied across jurisdictions in order to harmonise international efforts to measure low-value prescribing. The outcomes of this research will be submitted to international peer-reviewed journals. Results will also be presented at national and

  10. Automation bias in electronic prescribing.

    Science.gov (United States)

    Lyell, David; Magrabi, Farah; Raban, Magdalena Z; Pont, L G; Baysari, Melissa T; Day, Richard O; Coiera, Enrico

    2017-03-16

    Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB. One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured. Compared to scenarios with no CDS, correct CDS reduced omission errors by 38.3% (p < .0001, n = 120), 46.6% (p < .0001, n = 70), and 39.2% (p < .0001, n = 120) for low, low + interrupt and high complexity scenarios respectively. Incorrect CDS increased omission errors by 33.3% (p < .0001, n = 120), 24.5% (p < .009, n = 82), and 26.7% (p < .0001, n = 120). Participants made commission errors, 65.8% (p < .0001, n = 120), 53.5% (p < .0001, n = 82), and 51.7% (p < .0001, n = 120). Task complexity and interruptions had no impact on AB. This study found evidence of AB omission and commission errors in e-prescribing. Verification of CDS alerts is key to avoiding AB errors. However, interventions focused on this have had limited success to date. Clinicians should remain vigilant to the risks of CDS failures and verify CDS.

  11. Modeling trends of health and health related indicators in Ethiopia (1995-2008: a time-series study

    Directory of Open Access Journals (Sweden)

    Nigatu Tilahun H

    2009-12-01

    Full Text Available Abstract Background The Federal Ministry of Health of Ethiopia has been publishing Health and Health related indicators of the country annually since 1987 E.C. These indicators have been of high importance in indicating the status of health in the country in those years. However, the trends/patterns of these indicators and the factors related to the trends have not yet been investigated in a systematic manner. In addition, there were minimal efforts to develop a model for predicting future values of Health and Health related indicators based on the current trend. Objectives The overall aim of this study was to analyze trends of and develop model for prediction of Health and Health related indicators. More specifically, it described the trends of Health and Health related indicators, identified determinants of mortality and morbidity indicators and developed model for predicting future values of MDG indicators. Methods This study was conducted on Health and Health related indicators of Ethiopia from the year 1987 E.C to 2000 E.C. Key indicators of Mortality and Morbidity, Health service coverage, Health systems resources, Demographic and socio-economic, and Risk factor indicators were extracted and analyzed. The trends in these indicators were established using trend analysis techniques. The determinants of the established trends were identified using ARIMA models in STATA. The trend-line equations were then used to predict future values of the indicators. Results Among the mortality indicators considered in this study, it was only Maternal Mortality Ratio that showed statistically significant decrement within the study period. The trends of Total Fertility Rate, physician per 100,000 population, skilled birth attendance and postnatal care coverage were found to have significant association with Maternal Mortality Ratio trend. There was a reversal of malaria parasite prevalence in 1999 E.C from Plasmodium Falciparum to Plasmodium Vivax. Based on

  12. Carbonaceous aerosols from prescribed burning of a boreal forest ecosystem

    International Nuclear Information System (INIS)

    Mazurek, M.A.; Cofer, W.R. III; Levine, J.S.

    1990-10-01

    The identity and ambient mass concentrations of radiatively important carbonaceous aerosols were measured for a boreal forest prescribed burn conducted in northern Ontario, CAN in August 1989. Nonsize-segregated airborne particles were collected for smoldering-fire and full-fire conditions using a helicopter sampling platform. Total carbon (TC), organic carbon (OC) and elemental carbon (EC) were measured. Smoke plume mass concentrations of the OC and EC particles were greatest for full-fire conditions and had ranges of 1.560 to 2.160 mg/m -1 (OC) and 0.120 to 0.160 mg/m -3 (EC) with OC:EC ratios of 10 to 18, respectively. Smoldering fire conditions showed smoke plume OC and EC levels of 0.570--1.030 mg/m -3 (OC) and 0.006--0.050 mg/m -3 (EC) and much higher ratios of OC:EC (21 to 95). These aerosol data indicate the formation of EC particles is greatest during full-fire combustion of boreal forest material relative to smoldering combustion. However, EC particles comprise a minor fraction of the particulate carbon smoke aerosols for both full-fire and smoldering conditions; the major component of carbonaceous smoke aerosols emitted during the prescribed burn is OC. Overall, the OC and EC in-plume smoke aerosol data show nonuniform production of these particles during various stages of the prescribed burn, and major differences in the type of carbonaceous aerosol that is generated (OC versus EC)

  13. Indicators for the total duration of premenopausal endogenous estrogen exposure in relation to BMD

    NARCIS (Netherlands)

    Hagemans, M.L.C.; Schouw, van der Y.T.; Kleijn, de M.J.J.; Staveren, van W.A.; Pop, V.J.M.; Leusink, G.L.; Grobbee, D.E.

    2004-01-01

    BACKGROUND: Previous studies have shown that age at menopause is an important indicator of duration of endogenous estrogen exposure. The present study investigates whether combining more information on reproductive factors is useful in estimating individual total duration of exposure to endogenous

  14. Farmers' identification of erosion indicators and related erosion damage in the Central Highlands of Kenya

    NARCIS (Netherlands)

    Sterk, G.; Okoba, B.O.

    2006-01-01

    Most soil and water conservation planning approaches rely on empirical assessment methods and hardly consider farmers' knowledge of soil erosion processes. Farmers' knowledge of on-site erosion indicators could be useful in assessing the site-specific erosion risk before planning any conservation

  15. Health services research related to performance indicators and benchmarking in Europe

    NARCIS (Netherlands)

    Klazinga, Niek; Fischer, Claudia; ten Asbroek, Augustinus

    2011-01-01

    Measuring quality of care through performance indicators and subsequently using these to compare, learn, and improve (benchmarking) has become a central component of health care policy. This paper aims to identify the main themes of health services research in this area and focuses on opportunities

  16. Smartphone apps to support hospital prescribing and pharmacology education: a review of current provision.

    Science.gov (United States)

    Haffey, Faye; Brady, Richard R W; Maxwell, Simon

    2014-01-01

    Junior doctors write the majority of hospital prescriptions but many indicate they feel underprepared to assume this responsibility and around 10% of prescriptions contain errors. Medical smartphone apps are now widely used in clinical practice and present an opportunity to provide support to inexperienced prescribers. This study assesses the contemporary range of smartphone apps with prescribing or related content. Six smartphone app stores were searched for apps aimed at the healthcare professional with drug, pharmacology or prescribing content. Three hundred and six apps were identified. 34% appeared to be for use within the clinical environment in order to aid prescribing, 14% out with the clinical setting and 51% of apps were deemed appropriate for both clinical and non-clinical use. Apps with drug reference material, such as textbooks, manuals or medical apps with drug information were the commonest apps found (51%), followed by apps offering drug or infusion rate dose calculation (26%). 68% of apps charged for download, with a mean price of £14.25 per app and a range of £0.62-101.90. A diverse range of pharmacology-themed apps are available and there is further potential for the development of contemporary apps to improve prescribing performance. Personalized app stores may help universities/healthcare organizations offer high quality apps to students to aid in pharmacology education. Users of prescribing apps must be aware of the lack of information regarding the medical expertise of app developers. This will enable them to make informed choices about the use of such apps in their clinical practice. © 2013 The British Pharmacological Society.

  17. Mobilized plasma lead as an index of lead body burden and its relation to the heme-related indices.

    Science.gov (United States)

    Sakai, T; Ushio, K; Ikeya, Y

    1998-07-01

    Plasma lead (Pb-P) from workers were distributed in two main fractions: a protein bound fraction and low molecular weight fractions. Lead mobilized into plasma by CaEDTA was mainly observed in the low molecular weight fraction corresponding to lead disodium ethylenediamine tetraacetic acid (PbEDTA). The peak levels of Pb-P was attained around 1.5 and 2.5 hours after the start of CaEDTA injection. Pb-P and blood lead levels (Pb-B) at 2 h after the injection were 4.26 (+/- 2.84) and 0.96 (+/- 0.27) fold of the initial levels just before the injection. Pb-P concentrations at 2 hours after the start of CaEDTA injection (MPb-P) were well correlated (r = 0.740) with amounts of lead excreted in urine for 24 h thereafter (MPb-U). log MPb-P as well as log MPb-U were correlated with Pb-B (r = 0.765 and 0.817, respectively). Correlation coefficients of lead body burden (MPb-P or MPb-U) vs the logarithms of the effect indices (delta-aminolevulinic acid (ALA) dehydratase, ALA in urine, coproporphyrin in urine, and erythrocyte zinc protoporphyrin) were higher than the correlation coefficients of exposure indices (Pb-B or Pb-U) vs the logarithms of the effect indices. Thus the biological effect monitoring is significant and reliable for evaluating the functional components of lead body burden (MPb-P or MPb-U).

  18. Evaluation of polar organic micropollutants as indicators for wastewater-related coastal water quality impairment

    International Nuclear Information System (INIS)

    Nödler, Karsten; Tsakiri, Maria; Aloupi, Maria; Gatidou, Georgia; Stasinakis, Athanasios S.; Licha, Tobias

    2016-01-01

    Results from coastal water pollution monitoring (Lesvos Island, Greece) are presented. In total, 53 samples were analyzed for 58 polar organic micropollutants such as selected herbicides, biocides, corrosion inhibitors, stimulants, artificial sweeteners, and pharmaceuticals. Main focus is the application of a proposed wastewater indicator quartet (acesulfame, caffeine, valsartan, and valsartan acid) to detect point sources and contamination hot-spots with untreated and treated wastewater. The derived conclusions are compared with the state of knowledge regarding local land use and infrastructure. The artificial sweetener acesulfame and the stimulant caffeine were used as indicators for treated and untreated wastewater, respectively. In case of a contamination with untreated wastewater the concentration ratio of the antihypertensive valsartan and its transformation product valsartan acid was used to further refine the estimation of the residence time of the contamination. The median/maximum concentrations of acesulfame and caffeine were 5.3/178 ng L"−"1 and 6.1/522 ng L"−"1, respectively. Their detection frequency was 100%. Highest concentrations were detected within the urban area of the capital of the island (Mytilene). The indicator quartet in the gulfs of Gera and Kalloni (two semi-enclosed embayments on the island) demonstrated different concentration patterns. A comparatively higher proportion of untreated wastewater was detected in the gulf of Gera, which is in agreement with data on the wastewater infrastructure. The indicator quality of the micropollutants to detect wastewater was compared with electrical conductivity (EC) data. Due to their anthropogenic nature and low detection limits, the micropollutants are superior to EC regarding both sensitivity and selectivity. The concentrations of atrazine, diuron, and isoproturon did not exceed the annual average of their environmental quality standards (EQS) defined by the European Commission. At two

  19. Validation of Brain Event-Related Potentials as Indicators of Cognitive Styles, Abilities, and Aptitudes.

    Science.gov (United States)

    1983-02-01

    1970; Callaway, 1973, 1975; Chalke & Ertl, 1965; Ertl, 1969; Ertl & Schafer, 1969; Galbraith, Gliddon, & Busk , 1970; Gucker, 1973; Marcus, 1970...related to intelligence--although not always (Bigum, Dustman, & Beck, 1970; Galbraith, Gliddon, & Busk , 1970; Perry, McCoy, Cunningham, Falgout...be directly related to intelligence--but not always (Bigum, Dustman, & Beck, 1970; Galbraith, Gliddon, & Busk , 1970; Perry, McCoy, Cunningham, Falgot

  20. Explanatory risk factors in the relations between schizotypy and indicators of suicide risk.

    Science.gov (United States)

    Jahn, Danielle R; DeVylder, Jordan E; Hilimire, Matthew R

    2016-04-30

    Schizotypy has been linked to suicide risk, but it is not known whether established suicide-related risk factors mediate this relation. The aim of this study was to assess the mediating effects of depressive symptoms, social anxiety, self-esteem, and intimate disclosure in peer relationships in the relation between interpersonal schizotypy and suicide ideation or lifetime suicide attempts. This aim was tested in 590 young adults using a nonparametric bootstrapping procedure. After inclusion of the mediators, interpersonal schizotypy was no longer directly associated with either suicide ideation or lifetime suicide attempts. Depression and self-esteem mediated the relation between interpersonal schizotypy and suicide ideation. No variables mediated the relation between interpersonal schizotypy and lifetime suicide attempts, and there were no significant direct relations when mediators were included. Schizotypy appears to be a distal risk factor for suicidal behavior; assessing depressive symptoms and self-esteem may provide more proximal information about suicide risk, and may be targets for mitigating suicide risk in individuals with schizotypy. Published by Elsevier Ireland Ltd.

  1. What are the qualities of dilemmas experienced when prescribing opioids in general practice?

    Science.gov (United States)

    Bendtsen, P; Hensing, G; Ebeling, C; Schedin, A

    1999-07-01

    The decision process preceding prescribing analgesics is complex and the physician is often struggling to balance several disparate considerations in order to work out what is rational. Several factors--medical, intellectual, emotional and logistic--influence the decision whether or not to prescribe, and the decision itself influences how the physicians feel about themselves. In this study the 'critical incident technique' was used for exploring the qualities of dilemmas among general physicians prior to prescribing analgesics to patients in primary health care. The study displayed two main types of problems in connection with prescription of opioids. The first main problem was a concern about abuse and addiction with no proper indication for the drug. The second main type of problem was related to the appropriateness of the drug, although the indication as such might be correct, i.e. acute or chronic pain. An important consequence of the dilemmas experienced influenced the physicians' self-esteem negatively, including failures in the patient-physician relationship. This results in emotional strain and is often experienced as a personal defeat. Only a few physicians denied prescription despite the experience of a dilemma, which might indicate an ambivalence or lack of knowledge among physicians with regard to proper indications for opioid prescription. However, it may also suggest that physicians need more training in saying no, or skills in deciding proper indications for opioids, which needs to be addressed during educational programmes.

  2. Marathon performance in relation to body fat percentage and training indices in recreational male runners

    OpenAIRE

    Tanda G; Knechtle B

    2013-01-01

    Giovanni Tanda,1 Beat Knechtle2,31DIME, Università degli Studi di Genova, Genova, Italy; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3Institute of General Practice and Health Services Research, University of Zurich, Zurich, SwitzerlandBackground: The purpose of this study was to investigate the effect of anthropometric characteristics and training indices on marathon race times in recreational male marathoners.Methods: Training and anthropometric characteristics were col...

  3. Indicators of the relative availability of healthy versus unhealthy foods in supermarkets: a validation study

    OpenAIRE

    Vandevijvere, Stefanie; Mackenzie, Tara; Mhurchu, Cliona Ni

    2017-01-01

    Background In-store availability of healthy and unhealthy foods may influence consumer purchases. Methods used to measure food availability, however, vary widely. A simple, valid, and reliable indicator to collect comparable data on in-store food availability is needed. Methods Cumulative linear shelf length of and variety within 22 healthy and 28 unhealthy food groups, determined based on a comparison of three nutrient profiling systems, were measured in 15 New Zealand supermarkets. Inter-ra...

  4. Energy indicators series: analyzing the energy-related evidence of economic transition in the Pacific Rim

    International Nuclear Information System (INIS)

    Paga, Enrique; Birol, Fatih

    1992-01-01

    In recent years, much attention has been focused upon the Asian Pacific countries as constituting an economic 'miracle' over the last two decades. Economic growth in the Pacific Rim has been higher than in any other area of the world. The rapid industrialization process and its impact on the economies of these countries, at both macro and micro levels, are discussed widely in the economic literature. Of particular interest are the fundamental structural changes these countries have experienced in their transition to industrialized economies. This instalment of the annual 'Energy indicators' series concentrates on Pacific Rim countries, namely Hong Kong, the Philippines, Singapore, South Korea, Taiwan and Thailand. Similar to other experiences, rapid economic growth in these countries has been accompanied by 'spectacular' growth in demand for energy. Therefore, this year's paper not only underlines certain trends in these six energy markets but also attempts to test the phenomenon 'threshold country', i.e., shifting from the developing to the industrialized world by using common indicators and methodologies. The analysis starts with a comparison of energy intensities. Section 2 provides an overview of the socio-economic and energy indicators of the Pacific Rim countries. Section 3 introduces a standard econometric model on the most dynamic consuming sector, namely transport. Section 4 presents the projections of consumption in this sector and discusses policy issues. Some concluding remarks in Section 6 complete the paper. (author)

  5. Auditory Warnings, Signal-Referent Relations, and Natural Indicators: Re-Thinking Theory and Application

    Science.gov (United States)

    Petocz, Agnes; Keller, Peter E.; Stevens, Catherine J.

    2008-01-01

    In auditory warning design the idea of the strength of the association between sound and referent has been pivotal. Research has proceeded via constructing classification systems of signal-referent associations and then testing predictions about ease of learning of different levels of signal-referent relation strength across and within different…

  6. Intrinsic symmetry of the scaling laws and generalized relations for critical indices

    International Nuclear Information System (INIS)

    Plechko, V.N.

    1982-01-01

    It is shown that the scating taws for criticat induces can be expressed as a consequence of a simple symmetry principle. Heuristic relations for critical induces of generalizing scaling laws for the case of arbitrary order parameters are presented, which manifestiy have a symmetric form and include the standard scalling laws as a particular case

  7. The distribution of cerebral activity related to visuomotor coordination indicating perceptual and executional specialization

    NARCIS (Netherlands)

    de Jong, BM; Frackowiak, RSJ; Willemsen, ATM; Paans, AMJ

    The distribution of increased regional cerebral blood flow (rCBF) related to visuomotor coordination was studied by means of positron emission tomography (PET) in normal subjects. An experimental condition, in which a vertically presented zigzag figure had to be copied in a horizontal orientation,

  8. Dairy product intake in relation to glucose regulation indices and risk of type 2 diabetes

    NARCIS (Netherlands)

    Struijk, E.A.; Heraclides, A.; Witte, D.R.; Soedamah-Muthu, S.S.; Geleijnse, J.M.; Toft, U.; Lau, C.J.

    2013-01-01

    Background and aim A high intake of dairy has been linked to lower risk of type 2 diabetes (T2D). The relationship between dairy intake and glucose metabolism is still not well understood. The aim of this study was to investigate the relation between the intake of total dairy and dairy subgroups and

  9. Managerial preferences in relation to financial indicators regarding the mitigation of global change.

    Science.gov (United States)

    Maroušek, Josef; Hašková, Simona; Zeman, Robert; Vaníčková, Radka

    2015-02-01

    Biochar is a soil-improving substrate made from phytomass pyrolysis. In Southeast Asia, its application decreases due to the long-term growth of biochar cost and thus caused further prolongation of the payback period. In the Euro-American civilization the biochar application is already almost forgotten once it has been much earlier recognized that the crop yields can be increased much faster with higher doses of nutrients and other agrochemicals. The payback period can be expected in decades. Such a long-time investment into soil fertility raises also many ethical questions. The final decision combines issues of social responsibility, risk and other financial indicators as well as personal preferences and more. The attitudes of Western and Central European decision makers in the agriculture business segment were analyzed on the basis of electronic questionnaire survey and a subsequent interview through their local unions. According to the data, most of them did not know about the possibilities of a more environmentally friendly approach to soil enhancement based on the addition of a fertilizer in the form of biochar. Among others, the collected data also shows that the decision makers from Western Europe have a much different ethical approach to the land and financial indicators than the Central Europeans.

  10. Scale indicators of social exchange relationships: a comparison of relative content validity.

    Science.gov (United States)

    Colquitt, Jason A; Baer, Michael D; Long, David M; Halvorsen-Ganepola, Marie D K

    2014-07-01

    Although social exchange theory has become one of the most oft-evoked theories in industrial and organizational psychology, there remains no consensus about how to measure its key mechanism: social exchange relationships (Blau, 1964). Drawing on Cropanzano and Byrne's (2000) review of contemporary social exchange theorizing, we examined the content validity of perceived support, exchange quality, affective commitment, trust, and psychological contract fulfillment as indicators of social exchange relationships. We used Hinkin and Tracey's (1999) quantitative approach to content validation, which asks participants to rate the correspondence between scale items and definitions of intended (and unintended) constructs. Our results revealed that some of the most frequently utilized indicators of social exchange relationships--perceived support and exchange quality--were significantly less content valid than rarely used options like affect-based trust. Our results also revealed that 2 direct measures--Bernerth, Armenakis, Feild, Giles, and Walker's (2007) scale and a scale created for this study--were content valid. We discuss the implications of these results for future applications of social exchange theory.

  11. The relationship between macroeconomic and industry-specific business cycle indicators and work-related injuris among Danish construction workers

    DEFF Research Database (Denmark)

    Nielsen, Kent Jacob; Lander, Flemming; Lauritsen, Jens

    2015-01-01

    Objectives The current study examines and compares the relationship between both macroeconomic and industry-specific business cycle indicators, and work-related injuries among construction workers in Denmark using emergency department (ED) injury data and also officially reported injuries...... (range 0.14–0.20) and WEA injuries (range 0.13–0.36). Furthermore, although there is some variability in the strength of the relationship of the different business cycle indicators, the relationships are generally not stronger for the WEA injuries than for the ED injuries, except for general unemployment....... Similarly, no substantial differences in strength of relation between industry-specific and macroeconomic indicators were identified. Conclusions The study shows that there was no difference in the relationship between business cycle indicators, and WEA and ED injury data. This indicates that changes...

  12. The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes.

    Science.gov (United States)

    Karlsen, Bjørg; Oftedal, Bjørg; Bru, Edvin

    2012-02-01

    This article is a report of a cross-sectional study examining the degree to which clinical indicators, coping styles and perceived support from healthcare professionals and family are related to diabetes-related distress. Many people with type 2 diabetes experience high levels of distress stemming from concerns and worries associated with their disease. Diabetes-related distress has predominantly been studied in relation to diabetes management and metabolic control, and to some extent in relation to coping styles and perceived social support. To date, little is known about the relative contribution of clinical indicators, coping styles and perceptions of social support to perceived distress among people with type 2 diabetes. A sample comprising 425 Norwegian adults, aged 30-70, with type 2 diabetes, completed questionnaires assessing coping styles, perceived social support from health professionals and family and diabetes-related distress assessed by the Problem Areas in Diabetes Scale. Demographical and clinical data were collected by self-report. Data were collected in October 2008.   Results from the regression analyses showed a greater variance in emotional distress accounted for by coping styles (21·3%) and perceived support (19·7%) than by clinical indicators (5·8%). FINDINGS may indicate that healthcare providers should pay more attention to non-clinical factors such as coping styles and social support, when addressing diabetes-related distress. They should also be aware that interventions based on psychosocial approaches may primarily influence distress, and not necessarily metabolic control. © 2011 Blackwell Publishing Ltd.

  13. Information and Communication Technologies (ICT) and Their Relation to Academic Results Indicators in State Public Universities in Mexico

    Science.gov (United States)

    Arcos-Vega, José L.; Ramiro Marentes, Fabiola; Algravez Uranga, Juan J.

    2017-01-01

    We present an analysis regarding Information and Communication Technologies (ICT) and their relation with indicators of academic results in bachelor's degree programs offered in state public universities in Mexico. This work is non experimental, cross-sectional, and correlational. The goal is to determine significant relations between variables:…

  14. Indices of slowness of information processing in head injury patients : Tests for selective attention related to ERP latencies

    NARCIS (Netherlands)

    Spikman, Jacoba M.; Naalt, van der Joukje; Weerden , van Tiemen; Zomeren , van Adriaan H.

    2004-01-01

    We explored the relation between neuropsychological (attention tests involving time constraints) and neurophysiological (N2 and P3 event-related potential (ERP) latencies) indices of slowness of information processing after closed head injury (CHI). A group of 44 CHI patients performed worse than

  15. Quantification of the relative age effect in three indices of physical performance.

    Science.gov (United States)

    Sandercock, Gavin R H; Taylor, Matthew J; Voss, Christine; Ogunleye, Ayodele A; Cohen, Daniel D; Parry, David A

    2013-12-01

    The relative age effect (RAE) describes the relationship between an individual's birth month and their level of attainment in sports. There is a clustering of birth dates just after the cutoff used for selection in age-grouped sports, and it is hypothesized that such relatively older sportspeople may enjoy maturational and physical advantages over their younger peers. There is, however, little empirical evidence of any such advantage. This study investigated whether schoolchildren's physical performance differed according to which quarter of the school year they were born in. Mass, stature, body mass index, cardiorespiratory fitness, strength, and power were measured in 10 to 16 year olds (n = 8,550, 53% male). We expressed test performance as age- and sex-specific z-scores based on reference data with age rounded down to the nearest whole year and also as units normalized for body mass. We then compared these values between yearly birth quarters. There were no significant main effects for differences in anthropometric measures in either sex. Girls born in the first quarter of the school year were significantly stronger than those born at other times when handgrip was expressed as a z-score. As z-scores, all measures were significantly higher in boys born in either the first or second yearly quarters. Relative to body mass, cardiorespiratory fitness was higher in boys born in the first quarter and power was higher in those born in the second quarter. The RAE does not appear to significantly affect girls' performance test scores when they are expressed as z-score or relative to body mass. Boys born in the first and second quarters of the year had a significant physical advantage over their relatively younger peers. These findings have practical bearing if coaches use fitness tests for talent identification and team selection. Categorizing test performance based on rounded down values of whole-year age may disadvantage children born later in the selection year. These

  16. Event-related potential indices of inter-individual and age differences in visual attention capacity

    DEFF Research Database (Denmark)

    Wiegand, Iris; Töllner, Thomas; Dyrholm, Mads

    The ‘Theory of Visual Attention’ quantifies an individual’s capacity of attentional resources in parameters visual processing speed C and vSTM storage capacity K. By combining TVA-based assessment with neurophysiology, we showed that distinct ERP components index inter-individual differences......-related changes in attentional capacities, these ERP markers of individual differences in processing speed and storage capacity were validated in an older group. Furthermore, additional components were related to performance exclusively in older inidividuals: Anterior N1 amplitudes were reduced for slower older...... that reorganization of attentional brain networks, including age-specific decline and compensation mechanisms, determines older individuals’ attention capacity. Furthermore, we show that the distinctiveness of the two functions, as defined in TVA, is preserved (or even increased) in older age....

  17. Different glassy states, as indicated by a violation of the generalized Cauchy relation

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, J K [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Britz, T [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Coutre, A le [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Baller, J [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Possart, W [Universitaet des Saarlandes, Fakultaet fuer Chemie, Pharmazie und Werkstoffwissenschaften 8.15, Gebaeude 22, D-66041 Saarbruecken (Germany); Alnot, P [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Sanctuary, R [Centre Universitaire de Luxembourg, Departement des Sciences, Laboratoire 1.19, 162a Avenue de la Faiencerie, L-1511, Luxembourg (Luxembourg)

    2003-07-01

    Using Brillouin spectroscopy as a probe for high-frequency clamped acoustic properties, a shear modulus c{sub 44}{sup {infinity}} can be measured in addition to the longitudinal modulus c{sub 11}{sup {infinity}} already well above the thermal glass transition. On slow cooling of the liquid through the thermal glass transition temperature T{sub g}, both moduli show a kink-like behaviour and the function c{sub 11}{sup {infinity}} = c{sub 11}{sup {infinity}}(c{sub 44}{sup {infinity}}) follows a generalized Cauchy relation (gCR) defined by the linear relation c{sub 11}{sup {infinity}} = 3c{sub 44}{sup {infinity}} + constant, which completely hides the glass transition. In this work we show experimentally that on fast cooling this linear transformation becomes violated within the glassy state, but that thermal ageing drives the elastic coefficients towards the gCR, i.e. towards a unique glassy state.

  18. Can we influence prescribing patterns?

    Science.gov (United States)

    Sbarbaro, J A

    2001-09-15

    A variety of programming techniques and methods of training have been employed to change physician behavior. Didactic continuing medical education lectures and clinical guidelines have had minimal impact, although endorsement of national professional guidelines by local opinion leaders appears to have a positive influence on the impact of professional guidelines. Interactive, hands-on workshops, performance reporting, and peer/patient feedback are also effective. Changing prescribing habits has been equally difficult. Drug utilization letters involving both pharmacist and physician have more impact than do letters sent only to the physician. Academic detailing, when properly executed, has been consistently effective. When combined with these strategies, closed formularies become a powerful tool in changing prescribing behavior.

  19. Oil spill risk assessment : relative impact indices by oil type and location

    International Nuclear Information System (INIS)

    French-McCay, D.; Beegle-Krause, C.J.; Rowe, J.; Rodriguez, W.; Schmidt Etkin, D.

    2009-01-01

    The aim of the study was to inform policies related to resource allocation for oil spill prevention, preparedness and response activities in Washington State. Oil spill reports and impact modelling studies were evaluated in order to determine major risk consequence factors including spill volume, location, timing, toxicity, persistence, and expected frequency of spills by sector. The Washington Compensation Schedule pre-assessment screening and oil spill compensation schedule regulations (WCS) designed to consider the sensitivity of oiled areas as well as the relative density and seasonal distributions of sensitive biota. Spill incidents were assigned per-gallon impact scores based on geographic location, oil type, and season. The WCS qualitative rating system was used to assess the potential impacts of spills in different geographic systems. Geographic zones were based on geography, circulation of currents, climate, and the WCS sub-regions in estuarine and marine areas on the Pacific coast of Washington State. Oil types included crude, heavy, and light oils; gasoline; jet fuel; and non-petroleum oils. A habitat index was calculated to represent existing stream conditions. It was concluded that the relative impact risk model is a reliable method for characterizing impacts based on spill volume, oil effects, and vulnerability rankings. 25 refs., 20 tabs., 3 figs

  20. Impacts of prescribed burning on soil greenhouse gas fluxes in a suburban native forest of south-eastern Queensland, Australia

    Science.gov (United States)

    Zhao, Y.; Wang, Y. Z.; Xu, Z. H.; Fu, L.

    2015-11-01

    Prescribed burning is a forest management practice that is widely used in Australia to reduce the risk of damaging wildfires. Prescribed burning can affect both carbon (C) and nitrogen (N) cycling in the forest and thereby influence the soil-atmosphere exchange of major greenhouse gases, i.e. carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O). To quantify the impact of a prescribed burning (conducted on 27 May 2014) on greenhouse gas exchange and the potential controlling mechanisms, we carried out a series of field measurements before (August 2013) and after (August 2014 and November 2014) the fire. Gas exchange rates were determined in four replicate plots which were burned during the combustion and in another four adjacent unburned plots located in green islands, using a set of static chambers. Surface soil properties including temperature, pH, moisture, soil C and N pools were also determined either by in situ measurement or by analysing surface 10 cm soil samples. All of the chamber measurements indicated a net sink of atmospheric CH4, with mean CH4 uptake ranging from 1.15 to 1.99 mg m-2 d-1. Prescribed burning significantly enhanced CH4 uptake as indicated by the significant higher CH4 uptake rates in the burned plots measured in August 2014. In the following 3 months, the CH4 uptake rate was recovered to the pre-burning level. Mean CO2 emission from the forest soils ranged from 2721.76 to 7113.49 mg m-2 d-1. The effect of prescribed burning on CO2 emission was limited within the first 3 months, as no significant difference was observed between the burned and the adjacent unburned plots in both August and November 2014. The CO2 emissions showed more seasonal variations, rather than the effects of prescribed burning. The N2O emission in the plots was quite low, and no significant impact of prescribed burning was observed. The changes in understory plants and litter layers, surface soil temperature, C and N substrate availability and microbial

  1. Indications for chlororespiration in relation to light regime in the marine diatom Thalassiosira weissflogii.

    Science.gov (United States)

    Dijkman, Nicole A; Kroon, Bernd M A

    2002-04-01

    The marine diatom Thalassiosira weissflogii was cultured under a light regime simulating the daily rise and fall of the sun. The light regime caused a daily cycle in non-photochemical quenching. Remarkable were the changes in fluorescence directly after a light-to-dark transition that occurred in addition to the changes induced by non-photochemical quenching. A transient non-photochemical reduction of PQ and of Q(A) was indicated by a transient increase in apparent F(o) and by changes in the shape of the fluorescence induction curve. The observed changes developed approximately the first 100-120 s after a light-to-dark transition and could be reversed by the application of far-red illumination. Chlororespiration is thought to cause the reduction of PQ and, as the PQ-pool is in equilibrium with Q(A), also a reduction of Q(A). The function and ecological relevance of chlororespiration are discussed.

  2. Which prosthetic foot to prescribe?

    OpenAIRE

    De Asha, AR; Barnett, CT; Struchkov, V; Buckley, JG

    2017-01-01

    Introduction: \\ud Clinicians typically use findings from cohort studies to objectively inform judgements regarding the potential (dis)advantages of prescribing a new prosthetic device. However, before finalising prescription a clinician will typically ask a patient to 'try out' a change of prosthetic device while the patient is at the clinic. Observed differences in gait when using the new device should be the result of the device’s mechanical function, but could also conceivably be due to pa...

  3. Prescribing patterns in premenstrual syndrome

    Directory of Open Access Journals (Sweden)

    Jones Paul W

    2002-06-01

    Full Text Available Abstract Background Over 300 therapies have been proposed for premenstrual syndrome. To date there has been only one survey conducted in the UK of PMS treatments prescribed by GPs, a questionnaire-based study by the National Association of Premenstrual Syndrome in 1989. Since then, selective serotonin re-uptake inhibitors have been licensed for severe PMS/PMDD, and governmental recommendations to reduce the dosage of vitamin B6 (the first choice over-the-counter treatment for many women with PMS have been made. This study investigates the annual rates of diagnoses and prescribing patterns for premenstrual syndrome (1993–1998 within a computerised general practitioner database. Methods Retrospective survey of prescribing data for premenstrual syndrome between 1993–1998 using the General Practice Research Database for the West Midlands Region which contains information on 282,600 female patients Results Overall the proportion of women with a prescription-linked diagnosis of premenstrual syndrome has halved over the five years. Progestogens including progesterone were the most commonly recorded treatment for premenstrual syndrome during the whole study period accounting for over 40% of all prescriptions. Selective serotonin-reuptake inhibitors accounted for only 2% of the prescriptions in 1993 but rose to over 16% by 1998, becoming the second most commonly recorded treatment. Vitamin B6 accounted for 22% of the prescriptions in 1993 but dropped markedly between 1997 and 1998 to 11%. Conclusions This study shows a yearly decrease in the number of prescriptions linked to diagnoses for premenstrual syndrome. Progestogens including progesterone, is the most widely prescribed treatment for premenstrual syndrome despite the lack of evidence demonstrating their efficacy.

  4. Health-related quality of life of adolescents in the context of selected somatic development indices

    Directory of Open Access Journals (Sweden)

    Jadwiga Krawczyńska

    2016-09-01

    Full Text Available Introduction: The measurement of health-related quality of life (HRQOL is nowadays one of the most important methods of self-assessment of health, which makes it possible to detect abnormalities in physical, mental, and social functioning. The weight-growth body mass index (BMI, which determines the degree of nourishment, is essential in the evaluation of the somatic development. Aim of the research: The assessment of HRQOL depending on the weight-growth rate and gender of the pupils. Material and methods : The study involved 588 pupils aged 16–18 years. The authors applied in the study the methods of survey and analysis of pupils’ health records. The KIDSCREEN-52, designed to test the health-related quality of life, was the research tool. Results : The BMI analysis showed a clear advantage of pupils with normal weight. Among boys the percentage of individuals suspected of overweight and obesity was higher, whereas among girls the higher percentage involved individuals with body weight deficit. The results of HRQOL show that obese boys evaluated the highest their financial resources, autonomy, and relationships with parents. The pupils with body weight deficit evaluated the lowest their self-image. The overweight boys evaluated their mental wellbeing the lowest in comparison to others, and the highest their self-image. Overweight girls evaluated the lowest their self-image, emotions, and the school environment. The girls with body weight deficit evaluated the highest their relations with parents, and the lowest their autonomy. Conclusions : The values of the BMI among the surveyed pupils show an explicit prevalence of individuals with normal body mass. The results of the pupils with eating disorders were lower in all categories of HRQOL. No dependence was confirmed between the BMIs of pupils and the results of the KIDSCREEN-52 questionnaire in any of the assessed category of HRQOL (p > 0.05.

  5. Reduced object related negativity response indicates impaired auditory scene analysis in adults with autistic spectrum disorder

    Directory of Open Access Journals (Sweden)

    Veema Lodhia

    2014-02-01

    Full Text Available Auditory Scene Analysis provides a useful framework for understanding atypical auditory perception in autism. Specifically, a failure to segregate the incoming acoustic energy into distinct auditory objects might explain the aversive reaction autistic individuals have to certain auditory stimuli or environments. Previous research with non-autistic participants has demonstrated the presence of an Object Related Negativity (ORN in the auditory event related potential that indexes pre-attentive processes associated with auditory scene analysis. Also evident is a later P400 component that is attention dependent and thought to be related to decision-making about auditory objects. We sought to determine whether there are differences between individuals with and without autism in the levels of processing indexed by these components. Electroencephalography (EEG was used to measure brain responses from a group of 16 autistic adults, and 16 age- and verbal-IQ-matched typically-developing adults. Auditory responses were elicited using lateralized dichotic pitch stimuli in which inter-aural timing differences create the illusory perception of a pitch that is spatially separated from a carrier noise stimulus. As in previous studies, control participants produced an ORN in response to the pitch stimuli. However, this component was significantly reduced in the participants with autism. In contrast, processing differences were not observed between the groups at the attention-dependent level (P400. These findings suggest that autistic individuals have difficulty segregating auditory stimuli into distinct auditory objects, and that this difficulty arises at an early pre-attentive level of processing.

  6. Relations between decision indicators for implementing technology in healthcare logistics – a bed logistics case study

    DEFF Research Database (Denmark)

    Feibert, Diana Cordes; Jacobsen, Peter

    2015-01-01

    The cost of healthcare is rising and reforms have been introduced across Europe to address the cost issue in healthcare. There is potential to improve logistical processes within healthcare to save costs and at the same time provide services that support high quality patient care. Re......-designing processes and implementing technology can improve the efficiency of processes and reduce costs. A relations diagram has been developed that identifies the effects between the constructs Logistics, Technology, Procedure and Structure. Knowledge about how these constructs affect each other is important when...

  7. Biological indicators in relation to coastal pollution along Karnataka coast, India

    Digital Repository Service at National Institute of Oceanography (India)

    Verlecar, X.N.; Desai, S.R.; Sarkar, A.; Dalal, S.G.

    pollutants in relation to planktonic and benthic organisms were examined at two locations along Karnataka coast, one at Kulai (740 47.74? E and 120 55.16? N) receiving huge amount of industrial effluents from fertilizer, petroleum and chemical plants along... with t 0 45? E and 130 10? N) is located 20 kms away, which is a typically agricultural and fishing village having no stress of industrial discharges. Although the concentrations of dissolved oxygen (DO), nutrients and trace metals in water and sediment...

  8. SOME ASPECTS CONCERNING SOVEREIGN DEBT AND THE RELATIVITY OF INDEBTEDNESS INDICATORS

    Directory of Open Access Journals (Sweden)

    Deceanu Liviu-Daniel

    2015-07-01

    Full Text Available For quite a while, the economic world was concerned more and more about sovereign debt. Taking a brief look at economic history, we see that we are not dealing with anything new. Episodes in which states have entered into default occurred, even centuries ago. Moments like the one where Edward III refused to pay the debt to Italian bankers, the Mexican default of August 1982 or the Argentine one back in 2001, aiming at nearly 100 billion dollars, are well known. The current discussion about sovereign debt started with the so-called sovereign debt crisis, which has in the foreground the problem of the Greek state. In 2010 it became acute, Greece being unable to honor its external obligations. It took a strong intervention, supported internationally mainly by the European Union (and also the IMF, but the situation is not resolved even today. This crisis, which we would put on the account of the governance inconsistency and errors, starting with the unprepared entry in the European Union and hasty adoption of the Euro, and continuing with the serious fiscal disorder in the economy, put in difficulty even the single European currency and the economic and monetary union.Shortly after the start of the Greek crisis, which had as a "catalyst" the violent and pro-cyclical reaction of rating agencies, we found that the problem is much deeper, some other countries (the so-called "PIIGS", for example being affected by massive indebtedness. In this context, the construction of indicators, of alert thresholds and “early warning” mechanisms is an important gain for policy-makers, as well as for the various economic operators. The study of sovereign debt can take many forms; on one hand, using data covering a long period, we may create models containing key indicators: sovereign debt, GDP, inflation, foreign trade, economic growth. Assumptions about the relationship between variables and their testing will be done as a second phase. On the other hand, the

  9. [Developing indices for caloric restriction related to World War II--a pilot study].

    Science.gov (United States)

    Vin-Raviv, Neomi; Dekel, Rachel; Barchana, Micha; Linn, Shi; Keinan-Boker, Lital

    2011-04-01

    The vast numbers of studies regarding caloric restriction (CR) and breast cancer risk are based on war-related extreme situations. Studying the impact of CR in Jews during World War II (WW II) is challenging due to its variance and duration. To develop novel research tools in order to assess CR exposure in Jews that occurred more than 60 years ago during WW II. A pilot study based on Israeli women born in Europe in 1926-45, who lived there during WWII. Primary incident breast cancer patients and population-based controls were interviewed using a detailed questionnaire referring to demographic, obstetric factors and WW II experiences. Exposure to WWII-related CR was assessed by several proxy variables based on this information. The individual hunger score was higher in the exposed cases [mean score 141.06 vs. 130.07 in the controls). The same trend was observed for self perceived hunger score (mean score 2.75 in cases vs. 2.40 in controls) and hunger symptoms score (4.89 vs. 3.56, respectively). The novel research tools are appropriate for comparative assessment of CR exposure in case control studies.

  10. 11-Year Trends in Pregnancy-Related Health Indicators in Maine, 2000–2010

    Directory of Open Access Journals (Sweden)

    David E. Harris

    2014-01-01

    Full Text Available The objective of this study is to understand health and demographic trends among mothers and infants in Maine relative to the goals of Healthy People 2020. Pregnancy risk assessment monitoring system (PRAMS data from Maine for 2000–2010 were used to determine yearly values of pregnancy-related variables. Means (for continuous variables and percentages (for categorical variables were calculated using the survey procedures in SAS. Linear trend analysis was applied with study year as the independent variable. The slope and significance of the trend were then calculated. Over the study period, new mothers in Maine became better educated but the fraction of households with incomes <$20,000/year remained stagnant. Maternal prepregnancy BMI increased. Average pregnancy weight gain decreased but the number of women whose pregnancy weight gain was within the recommended range was unchanged. The rates of smoking and alcohol consumption (before and during pregnancy increased. The Caesarean section rate rose and the fraction of infants born premature (<37 wks gestation or underweight (<2500 gms remained unchanged. The fraction of infants who were breast-fed increased. These results suggest that, despite some positive trends, Maine faces significant challenges in meeting Healthy People 2020 goals.

  11. Foster home integration as a temporal indicator of relational well-being.

    Science.gov (United States)

    Waid, Jeffrey; Kothari, Brianne H; McBeath, Bowen M; Bank, Lew

    2017-12-01

    This study sought to identify factors that contribute to the relational well-being of youth in substitute care. Using data from the [BLIND] study, youth responded to a 9-item measure of positive home integration, a scale designed to assess the relational experiences of youth to their caregivers and their integration into the foster home. Data were collected from youth in six month intervals, for an 18-month period of time. Latent growth curve modeling procedures were employed to determine if child, family, and case characteristics influenced youth's home integration trajectories. Results suggest stability in youth reports of home integration over time; however, children who were older at the time of study enrollment and youth who experienced placement changes during the period of observation experienced decreased home integration during the 18-month period. Results suggest youth's perspectives of home integration may in part be a function of the child's developmental stage and their experiences with foster care placement instability. Implications for practice and future research are discussed.

  12. The auditory comprehension changes over time after sport-related concussion can indicate multisensory processing dysfunctions.

    Science.gov (United States)

    Białuńska, Anita; Salvatore, Anthony P

    2017-12-01

    Although science findings and treatment approaches of a concussion have changed in recent years, there continue to be challenges in understanding the nature of the post-concussion behavior. There is growing a body of evidence that some deficits can be related to an impaired auditory processing. To assess auditory comprehension changes over time following sport-related concussion (SRC) in young athletes. A prospective, repeated measures mixed-design was used. A sample of concussed athletes ( n  = 137) and the control group consisted of age-matched, non-concussed athletes ( n  = 143) were administered Subtest VIII of the Computerized-Revised Token Test (C-RTT). The 88 concussed athletes selected for final analysis (neither previous history of brain injury, neurological, psychiatric problems, nor auditory deficits) were evaluated after injury during three sessions (PC1, PC2, and PC3); controls were tested once. Between- and within-group comparisons using RMANOVA were performed on the C-RTT Efficiency Score (ES). ES of the SRC athletes group improved over consecutive testing sessions ( F  =   14.7, p   2.0, Ps integration and/or motor execution can be compromised after a concussion.

  13. The risk of disciplinary action by state medical boards against physicians prescribing opioids.

    Science.gov (United States)

    Richard, Jack; Reidenberg, Marcus M

    2005-02-01

    Concern of physicians about being disciplined for prescribing opioids for patients in pain is one cause for undertreatment of pain. This study was done to assess the actual risk of being disciplined by state medical boards. A review of records of actions by the New York State Board for Professional Medical Misconduct for 3 years and of all medical boards in the United States for 9 months was done to determine this risk. New York State, with 7.8% of U.S. physicians, had 10 physicians disciplined annually related to overprescribing opioids, while the total for the entire U.S. was 120 physicians annually. Most physicians disciplined had multiple violations in addition to overprescribing controlled substances. In the national sample, 43% were prescribing for themselves or for nonpatients, 12% prescribed for addicts without addressing the patients' problems of addiction, 42% had inadequate records, 19% prescribed without indication for opioids, 13% were incompetent in additional ways, and 8% were having sexual activity with patients. Not a single physician, for whom information was available, was disciplined solely for overprescribing opioids. The actual risk of an American physician being disciplined by a state medical board for treating a real patient with opioids for a painful medical condition is virtually nonexistent.

  14. Pro re nata prescribing in a population receiving palliative care: a prospective consecutive case note review.

    Science.gov (United States)

    Russell, Bethany J; Rowett, Debra; Currow, David C

    2014-09-01

    To document pro re nata (PRN) prescribing practices and to identify patterns with respect to clinical characteristics and the medications prescribed. Prospective consecutive case note review. Two interrelated consultative hospice and palliative care services in regional Victoria, Australia. Terminally ill inpatients and community-based individuals (N = 203) at the time of referral to a hospice or palliative care service. Number of medications that the referring physician prescribed on a PRN basis and on a regular basis for symptom control; comorbid disease, performance status, comorbidity burden, disease phase, and survival. Mean number of PRN medications prescribed was 3.0, with significantly higher rates in the last week of life (rate ratio (RR) = 1.30, 95% confidence interval (CI) = 1.07-1.59) and during the terminal phase of disease (RR = 1.36, 95% CI = 1.09-1.68). One-quarter of prescriptions were for medications that met the Beers consensus criteria for potentially inappropriate medication use in elderly persons. These descriptive baseline data are new. A mean of three different medications allows responsiveness to a variety of fluctuating symptoms, but there was a large range within the sample, indicating that some individuals and their caregivers have a high burden of administration-related decision-making. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  15. Rising relative fluctuation as a warning indicator of discontinuous transitions in symbiotic metapopulations

    Science.gov (United States)

    Lumi, Neeme; Laas, Katrin; Mankin, Romi

    2015-11-01

    The long-time limit behavior of the stochastic Lotka-Volterra model of a symbiotic metapopulation subjected to generalized Verhulst self-regulation is considered. The influence of a time-variable environment on the carrying capacities of subpopulations is modeled as a periodic deterministic part and a symmetric dichotomous noise. Relying on the mean-field approach it is established that at certain parameter regimes the mean field (average subpopulations size) exhibits hysteresis in respect to the noise correlation time, manifested in the appearance of colored-noise-induced discontinuous transitions. Especially, it is shown that the relative fluctuation of the subpopulation sizes exhibits accelerated increase prior to abrupt transitions of the metapopulation state. Moreover, in certain cases the autocorrelation function of the population sizes demonstrates anticorrelation at some values of the lag time.

  16. Bilateral IgG4-related ophthalmic disease: a strong indication for systemic imaging.

    Science.gov (United States)

    Wu, Albert; Andrew, Nicholas H; McNab, Alan A; Selva, Dinesh

    2016-10-01

    To investigate whether bilateral or unilateral IgG4-related ophthalmic disease (IgG4-ROD) is associated with extra-ophthalmic IgG4-related disease (IgG4-RD). Twin-centre retrospective observational case series of biopsy-confirmed IgG4-ROD. Clinical and radiology data were reviewed for laterality of IgG4-ROD and presence of extra-ophthalmic disease. The literature was reviewed for case series of IgG4-ROD. 40 IgG4-ROD cases were identified, with median follow-up of 36 months. At diagnosis of IgG4-ROD, all cases were screened for extra-ophthalmic disease with physical examination and blood testing. Systemic imaging was performed in 20 (50%) cases due to clinical suspicion of extra-ophthalmic disease. Of the 21 unilateral IgG4-ROD cases, 3 (14%) had extra-ophthalmic involvement. Of the 19 bilateral cases, 15 (79%) had extra-ophthalmic involvement. Extra-ophthalmic involvement was strongly associated with bilateral IgG4-ROD (pIgG4-ROD is strongly associated with extra-ophthalmic IgG4-RD. We recommend that imaging of the neck, chest, abdomen and pelvis be performed for all bilateral cases. Systemic imaging should also be considered in unilateral cases as a significant proportion of these patients will also have extra-ophthalmic disease. 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/

  17. Life cycle management on Swiss fruit farms. Relating environmental and income indicators for apple-growing

    Energy Technology Data Exchange (ETDEWEB)

    Mouron, Patrik; Scholz, Roland W.; Weber, Olaf [Swiss Federal Institute of Technology ETH, Department of Environmental Sciences, Institute for Human-Environment Systems, ETH Zentrum, HAD, CH-8092 Zurich (Switzerland); Nemecek, Thomas [Agroscope FAL Reckenholz, Swiss Federal Research Station of Agroecology and Agriculture, CH-8046 Zurich (Switzerland)

    2006-06-25

    Integrated fruit production (IFP) has been practiced in Switzerland on a large scale basis since the late 1980s, with the aim of improving sustainable farming. The guidelines of IFP emphasise an ecosystem approach that is based on scientific knowledge about self-regulatory mechanisms at the tree and orchard level. Empirical studies at the farm level are rare. An understanding of the relationship between income and environmental impacts at the farm level is a prerequisite for devising a robust system for orchard portfolio management. An income analysis based on full cost principle and environmental life cycle assessment were applied to 445 annual data sets of apple orchards, recorded on 12 specialised fruit farms over a period of 4 years. The main result was that environmental impacts such as ecotoxicity, eutrophication and non-renewable energy use did not necessarily increase when farms increased their income. A higher input level of pesticides, fertilisers and machinery did not lead to increased yields and receipts. In contrast, the choice of apple cultivars and high investment in pre-harvest labour hours were significantly correlated with high eco-efficiency and high farm income. The results of this study were summarised in a pyramid-shaped management model, providing key issues of successful orchard farming and attributing management rules to master them. The management pyramid indicates that cognitive competences such as distributional, conditional and non-linear thinking are crucial when knowledge from tree and orchard management is integrated at the farm level. A main recommendation is that more attention should be paid to improving management competence in order to contribute to sustainable farming. (author)

  18. Changes in relative fit of human heat stress indices to cardiovascular, respiratory, and renal hospitalizations across five Australian urban populations

    Science.gov (United States)

    Goldie, James; Alexander, Lisa; Lewis, Sophie C.; Sherwood, Steven C.; Bambrick, Hilary

    2018-03-01

    Various human heat stress indices have been developed to relate atmospheric measures of extreme heat to human health impacts, but the usefulness of different indices across various health impacts and in different populations is poorly understood. This paper determines which heat stress indices best fit hospital admissions for sets of cardiovascular, respiratory, and renal diseases across five Australian cities. We hypothesized that the best indices would be largely dependent on location. We fit parent models to these counts in the summers (November-March) between 2001 and 2013 using negative binomial regression. We then added 15 heat stress indices to these models, ranking their goodness of fit using the Akaike information criterion. Admissions for each health outcome were nearly always higher in hot or humid conditions. Contrary to our hypothesis that location would determine the best-fitting heat stress index, we found that the best indices were related largely by health outcome of interest, rather than location as hypothesized. In particular, heatwave and temperature indices had the best fit to cardiovascular admissions, humidity indices had the best fit to respiratory admissions, and combined heat-humidity indices had the best fit to renal admissions. With a few exceptions, the results were similar across all five cities. The best-fitting heat stress indices appear to be useful across several Australian cities with differing climates, but they may have varying usefulness depending on the outcome of interest. These findings suggest that future research on heat and health impacts, and in particular hospital demand modeling, could better reflect reality if it avoided "all-cause" health outcomes and used heat stress indices appropriate to specific diseases and disease groups.

  19. Changes in relative fit of human heat stress indices to cardiovascular, respiratory, and renal hospitalizations across five Australian urban populations.

    Science.gov (United States)

    Goldie, James; Alexander, Lisa; Lewis, Sophie C; Sherwood, Steven C; Bambrick, Hilary

    2018-03-01

    Various human heat stress indices have been developed to relate atmospheric measures of extreme heat to human health impacts, but the usefulness of different indices across various health impacts and in different populations is poorly understood. This paper determines which heat stress indices best fit hospital admissions for sets of cardiovascular, respiratory, and renal diseases across five Australian cities. We hypothesized that the best indices would be largely dependent on location. We fit parent models to these counts in the summers (November-March) between 2001 and 2013 using negative binomial regression. We then added 15 heat stress indices to these models, ranking their goodness of fit using the Akaike information criterion. Admissions for each health outcome were nearly always higher in hot or humid conditions. Contrary to our hypothesis that location would determine the best-fitting heat stress index, we found that the best indices were related largely by health outcome of interest, rather than location as hypothesized. In particular, heatwave and temperature indices had the best fit to cardiovascular admissions, humidity indices had the best fit to respiratory admissions, and combined heat-humidity indices had the best fit to renal admissions. With a few exceptions, the results were similar across all five cities. The best-fitting heat stress indices appear to be useful across several Australian cities with differing climates, but they may have varying usefulness depending on the outcome of interest. These findings suggest that future research on heat and health impacts, and in particular hospital demand modeling, could better reflect reality if it avoided "all-cause" health outcomes and used heat stress indices appropriate to specific diseases and disease groups.

  20. Medicare Provider Data - Part D Prescriber

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...

  1. Dutch Travel Health Nurses: Prepared to Prescribe?

    NARCIS (Netherlands)

    Overbosch, Femke W.; Koeman, Susan C.; van den Hoek, Anneke; Sonder, Gerard J. B.

    2012-01-01

    Background. In travel medicine, as in other specialties, independent prescribing of medication has traditionally been the domain of practitioners like physicians, dentists, and midwives. However, a 2011 ruling in the Netherlands expands independent prescribing and introduces supplementary

  2. The quality of outpatient antimicrobial prescribing

    DEFF Research Database (Denmark)

    Malo, Sara; Bjerrum, Lars; Feja, Cristina

    2013-01-01

    The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragón (in northeastern Spain), with the objective of assessing inappropriate prescribing....

  3. Event-related potentials indicate that fluency can be interpreted as familiarity.

    Science.gov (United States)

    Bruett, Heather; Leynes, P Andrew

    2015-11-01

    Recent evidence suggests that fluency may be capable of supporting recognition independently of familiarity. This hypothesis was further tested in the present study. 29 participants encoded name-brand and off-brand products in an incidental task. Participants then judged whether the product was old or new during two tests with products from one category (i.e., only name-brand or only off-brand products) and a mixed test (where both name-brand and off-brand products were shown). The ERP data elicited by off-brand products varied as a function of test format. During the mixed test, off-brand products were correlated with a FN400 effect, whereas a fluency ERP (old ERPs were more negative than new at parietal electrodes 225-400ms) was observed during the other test. Importantly, no FN400 was detected during this test. The ERP results suggest that viewing the off-brand products during the mixed test produced a familiarity experience; however, fluency supported recognition when viewing off-brand products on the other test. The results are strong evidence that top-down processing of visual features during recognition interprets the information relative to the context. This process results in either fluency or, in other contexts, it is interpreted as familiarity as the Discrepancy-Attribution Hypothesis (Whittlesea and Williams, 2001a, 2001b) contends. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Dairy product intake in relation to glucose regulation indices and risk of type 2 diabetes

    DEFF Research Database (Denmark)

    Struijk, E A; Heraclides, A; Witte, Daniel Rinse

    2013-01-01

    and milk products, cheese and fermented dairy. Fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), HbA(1c), insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B) were considered at 5-year follow-up. In the maximally-adjusted model (demographics, lifestyle factors, dietary factors and waist......), cheese intake was inversely associated with 2hPG (β = -0.048, 95% CI -0.095; -0.001). Fermented dairy intake was inversely associated with FPG (β = -0.028, 95% CI -0.048; -0.008) and HbA(1c) (β = -0.016, 95% CI -0.030; -0.001). Total dairy intake and the dairy subgroups were not related to HOMA-IR...... and HOMA-B in the maximally-adjusted model. Furthermore, there was no significant association between intake of total dairy or any of the dairy subgroups and incidence of T2D. CONCLUSION: Our data suggest a modest beneficial effect of cheese and fermented dairy on glucose regulation measures; however...

  5. Listening to patients' voices: linguistic indicators related to diabetes self-management.

    Science.gov (United States)

    Connor, Ulla; Anton, Marta; Goering, Elizabeth; Lauten, Kathryn; Hayat, Amir; Roach, Paris; Balunda, Stephanie

    2012-01-01

    A great deal of research in health care has examined a wide range of variables to better understand the degree to which patients follow the advice of medical professionals in managing their health, known as adherence. This paper explains the development of the linguistic systems to describe and evaluate two psychosocial constructs (i.e. control orientation and agency) that have been found to be related to adherence in previous research for subjects with diabetes (Trento et al. 2007; Wangberg 2007; O'Hea et al. 2009). The present data came from 43 semi-structured in-depth interviews of subjects with Type 2 diabetes. One-on-one interviews with open-ended questions elicited subjects' 'stories' about living with diabetes, and the transcribed interviews were analyzed to develop the linguistic systems of control orientation and agency. The resultant systems were applied to the 43 interviews by raters with high inter-rater reliability. The results showed demarcations of clearly identified codings of patient types. The paper presents the linguistic coding systems developed in the study, the results of their application to the patient interview data, and recommendations for improved communication with patients.

  6. Sorafenib prescribed by gastroenterologists and hepatologists for hepatocellular carcinoma

    Science.gov (United States)

    Kaplan, David E.; Mehta, Rajni; D’Addeo, Kathryn; Valderrama, Adriana; Taddei, Tamar H.

    2018-01-01

    Abstract Sorafenib is the only Food and Drug Administration (FDA)-approved first-line therapy shown to have survival benefit for patients with advanced hepatocellular carcinoma (HCC). Patients with advanced HCC are often but not exclusively transferred from non-oncologists to oncologists to initiate systemic therapy. The objective of this study was to assess whether sorafenib prescribing by non-oncologists has any impact on utilization, adverse effects, cost or outcome. This was a retrospective cohort study utilizing data from patients prescribed sorafenib for HCC within Veterans Health Administration hospitals with 100% chart abstraction to confirm HCC diagnosis, identify prescribing provider specialty (oncology versus gastroenterology/hepatology), and obtain data required for cancer staging by the Barcelona Clinic Liver Cancer (BCLC) system. The primary outcome was overall survival from the time of sorafenib prescription. A total of 4903 patients who prescribed sorafenib for HCC were identified, for whom 340 patients (6.9%) were prescribed drug by a non-oncologist (Onc). BCLC Stage, age, Child–Turcotte–Pugh score, and comorbidity indices were similar between patients prescribed sorafenib by oncologists and non-oncologists. Oncologists more often discontinued sorafenib due to progression, whereas non-oncologists were more likely to continue sorafenib until death resulting in greater pill utilization and cost. Overall survival in both unadjusted and multivariable models showed no significant impact of prescriber type on survival (222 vs 217 days, P = .96), confirmed with propensity-matched subcohorts. Similar survival outcomes were observed for patients with HCC prescribed sorafenib by non-oncologists and oncologists, suggesting that non-oncologists with expertise in the management of HCC can safely and effectively administer sorafenib. PMID:29369224

  7. Assessment of antibiotic prescribing in Latvian general practitioners

    Directory of Open Access Journals (Sweden)

    Dumpis Uga

    2013-01-01

    Full Text Available Abstract Background Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs. Methods GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period – (7 days one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. Results Two hundred forty eight forms out of the 600 (41% were returned by post. Antibiotics were prescribed in 6.4% (1711/26803 of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7% patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed, amoxicillin/clavulanate (18,7% and clarithromycin (7.6%. The most commonly treated indications were pharyngitis (29.8%, acute bronchitis (25.3% and rhinosinusitis (10.2%. Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%, amoxicillin (15.7% and clarithromycin (19.3%. Conclusions Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.

  8. Prevalence of rape-related pregnancy as an indication for abortion at two urban family planning clinics.

    Science.gov (United States)

    Perry, Rachel; Zimmerman, Lindsay; Al-Saden, Iman; Fatima, Aisha; Cowett, Allison; Patel, Ashlesha

    2015-05-01

    We sought to estimate the prevalence of rape-related pregnancy as an indication for abortion at two public Chicago facilities and to describe demographic and clinical correlates of women who terminated rape-related pregnancies. We performed a cross-sectional study of women obtaining abortion at the Center for Reproductive Health (CRH) at University of Illinois Health Sciences Center and Reproductive Health Services (RHS) at John H. Stroger, Jr. Hospital between August 2009 and August 2013. Gestational age limits at CRH and RHS were 23+6 and 13+6weeks, respectively. We estimated the prevalence of rape-related pregnancy based on billing code (CRH) or data from an administrative database (RHS), and examined relationships between rape-related pregnancy and demographic and clinical variables. Included were 19,465 visits for abortion. The majority of patients were Black (85.6%). Prevalence of abortion for rape-related pregnancy was 1.9%, and was higher at CRH (6.9%) than RHS (1.5%). Later gestational age was associated with abortion for rape-related pregnancy (median 12days, prape-related pregnancy at CRH only (prape-related pregnancy than among those terminating for other indications. Rape-related pregnancy as an indication for abortion had a low, but clinically significant prevalence at two urban Chicago family planning centers. Later gestational age was associated with abortion for rape-related pregnancy. Rape-related pregnancy may occur with higher prevalence among some subgroups of women seeking abortion than others. Efforts to address rape-related pregnancy in the abortion care setting are needed. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Prediction beyond the borders: ERP indices of boundary extension-related error.

    Science.gov (United States)

    Czigler, István; Intraub, Helene; Stefanics, Gábor

    2013-01-01

    Boundary extension (BE) is a rapidly occurring memory error in which participants incorrectly remember having seen beyond the boundaries of a view. However, behavioral data has provided no insight into how quickly after the onset of a test picture the effect is detected. To determine the time course of BE from neural responses we conducted a BE experiment while recording EEG. We exploited a diagnostic response asymmetry to mismatched views (a closer and wider view of the same scene) in which the same pair of views is rated as more similar when the closer item is shown first than vice versa. On each trial, a closer or wider view was presented for 250 ms followed by a 250-ms mask and either the identical view or a mismatched view. Boundary ratings replicated the typical asymmetry. We found a similar asymmetry in ERP responses in the 265-285 ms interval where the second member of the close-then-wide pairs evoked less negative responses at left parieto-temporal sites compared to the wide-then-close condition. We also found diagnostic ERP effects in the 500-560 ms range, where ERPs to wide-then-close pairs were more positive at centro-parietal sites than in the other three conditions, which is thought to be related to participants' confidence in their perceptual decision. The ERP effect in the 265-285 ms range suggests the falsely remembered region beyond the view-boundaries of S1 is rapidly available and impacts assessment of the test picture within the first 265 ms of viewing, suggesting that extrapolated scene structure may be computed rapidly enough to play a role in the integration of successive views during visual scanning.

  10. Dialysate bacterial endotoxin as a prognostic indicator of peritoneal dialysis related peritonitis.

    Science.gov (United States)

    Szeto, Cheuk-Chun; Lai, Ka-Bik; Chow, Kai-Ming; Kwan, Bonnie Ching-Ha; Law, Man-Ching; Pang, Wing-Fai; Ma, Terry King-Wing; Leung, Chi-Bon; Li, Philip Kam-Tao

    2016-12-01

    Peritonitis is the major complication of peritoneal dialysis (PD). The aim of our present study is to explore the prognostic value of endotoxin level in PD effluent for the prediction of treatment failure in PD-related peritonitis. We studied 325 peritonitis episodes in 223 patients. PD effluent (PDE) was collected every 5 days for endotoxin level and leukocyte count. Patients were followed for relapsing or recurrent peritonitis. We found 20 episodes (6.2%) had primary treatment failure; 41 (12.6%) developed relapsing, 19 (5.8%) had recurrent, and 22 (6.8%) had repeat episodes. Endotoxin was detectable in the PDE of 19 episodes (24.4%) caused by Gram negative organisms, 4 episodes (6.8%) of mixed bacterial growth, and none of the culture negative episodes or those by Gram positive organisms. For episodes caused by Gram negative bacteria, a detectable endotoxin level in PDE on day 5 had a sensitivity and specificity of 66.7% and 83.3%, respectively, for predicting primary treatment failure. In contrast, PDE leukocyte count > 1000 per mm3 on day 5 had a sensitivity and specificity of 88.9% and 89.1%, respectively; the addition of PDE endotoxin assay did not improve the sensitivity or specificity. We conclude that detectable endotoxin in PDE 5 days after antibiotic therapy might predict primary treatment failure in peritonitis episodes caused by Gram negative organisms. However, the sensitivity and specificity of PDE endotoxin assay was inferior to PDE leukocyte count. © 2016 Asian Pacific Society of Nephrology.

  11. Aspartame Intake Relates to Coronary Plaque Burden and Inflammatory Indices in Human Immunodeficiency Virus.

    Science.gov (United States)

    Hall, Leangelo N; Sanchez, Laura R; Hubbard, Jane; Lee, Hang; Looby, Sara E; Srinivasa, Suman; Zanni, Markella V; Stanley, Takara L; Lo, Janet; Grinspoon, Steven K; Fitch, Kathleen V

    2017-01-01

    Dietary sweeteners may contribute to metabolic dysregulation and cardiovascular disease (CVD), but this has not been assessed in human immunodeficiency virus (HIV). One hundred twenty-four HIV-infected and 56 non-HIV-infected participants, without history of known coronary artery disease were included. Dietary intake was assessed using a 4-day food record. Coronary plaque was determined using cardiac computed tomography angiography. Human immunodeficiency virus-infected participants had significantly greater intake of dietary sweeteners, including total sugar ( P = .03) and added sugar ( P = .009); intake of aspartame (artificial sweetener) was greater among aspartame consumers with HIV versus non-HIV consumers ( P = .03). Among HIV-infected participants, aspartame intake was significantly associated with coronary plaque ( P = .002) and noncalcified plaque ( P = .007) segments, as well as markers of inflammation/immune activation (monocyte chemoattractant protein 1 and lipoprotein-associated phospholipase A 2 ), which may contribute to increased atherogenesis. In multivariable regression modeling, aspartame remained an independent predictor of plaque in HIV. In contrast, among non-HIV-infected participants, no sweetener type was shown to relate to plaque characteristics. We demonstrate increased intake of dietary sweeteners and a potential novel association between aspartame intake, plaque burden, and inflammation in HIV. Our data suggest that aspartame may contribute to CVD risk in HIV. Further studies should address potential mechanisms by which aspartame may contribute to increased plaque burden and cardiovascular benefits of dietary strategies targeting aspartame intake in HIV. © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

  12. Ossification score is a better indicator of maturity related changes in eating quality than animal age.

    Science.gov (United States)

    Bonny, S P F; Pethick, D W; Legrand, I; Wierzbicki, J; Allen, P; Farmer, L J; Polkinghorne, R J; Hocquette, J-F; Gardner, G E

    2016-04-01

    Ossification score and animal age are both used as proxies for maturity-related collagen crosslinking and consequently decreases in beef tenderness. Ossification score is strongly influenced by the hormonal status of the animal and may therefore better reflect physiological maturity and consequently eating quality. As part of a broader cross-European study, local consumers scored 18 different muscle types cooked in three ways from 482 carcasses with ages ranging from 590 to 6135 days and ossification scores ranging from 110 to 590. The data were studied across three different maturity ranges; the complete range of maturities, a lesser range and a more mature range. The lesser maturity group consisted of carcasses having either an ossification score of 200 or less or an age of 987 days or less with the remainder in the greater maturity group. The three different maturity ranges were analysed separately with a linear mixed effects model. Across all the data, and for the greater maturity group, animal age had a greater magnitude of effect on eating quality than ossification score. This is likely due to a loss of sensitivity in mature carcasses where ossification approached and even reached the maximum value. In contrast, age had no relationship with eating quality for the lesser maturity group, leaving ossification score as the more appropriate measure. Therefore ossification score is more appropriate for most commercial beef carcasses, however it is inadequate for carcasses with greater maturity such as cull cows. Both measures may therefore be required in models to predict eating quality over populations with a wide range in maturity.

  13. EVALUATION OF QUALITY INDICATORS RELATED TO QUALITY BREAD WHEAT PROMISING LINES

    Directory of Open Access Journals (Sweden)

    Watson Munyanyi

    2014-01-01

    Full Text Available The bread waste is one of the important socio-economic's issues country now, the urgent need is feeling to improve the wheat quality. Therefore, using the methods of farming and breeding is necessary to improve the quality of this strategic product. As a result, tests of quality's traits in wheat promising lines in Isfahan climate took place. In this study, the choice 17 advanced lines of compare the performances,s experiments, an experiment was conducted for two consecutive cropping (2011-2012 at cultural experiment and research centre in Isfahan located in Kabutar Abad region. Randomized complete block designs with 3 replications were compared with Spring variety (for control. Traits including: 1000 grain weight, hectolitre weight, protein content, Zeleny sedimentation rate, bread volume, grain moisture content, grain hardness, water absorption, falling number, percentage of dry gluten, gluten index, sedimentation rates were SDS.The results of the combined analysis of variance qualitative characteristics,s for two consecutive cropping showed that treatments with compare together and control variety had significant influence in 1% probability.Correlation coefficients of two years showed that the compound test significant positive correlation within grain hardness index and protein content, wet gluten and dry deposition rates of SDS. Also, significant positive correlation with the percentage of protein content of dry gluten. In view of the high correlation with protein content of dry gluten (quantity. However, grain hardness and relatively high correlation with SDS sedimentation as an important measure of protein quality. Therefore, the test results of dry gluten grains can be tough to choose in order to improve the quality of wheat bread may be used.

  14. Comparing the Influence of Wildfire and Prescribed Burns on Watershed Nitrogen Biogeochemistry Using 15N Natural Abundance in Terrestrial and Aquatic Ecosystem Components

    Science.gov (United States)

    Stephan, Kirsten; Kavanagh, Kathleen L.; Koyama, Akihiro

    2015-01-01

    We evaluated differences in the effects of three low-severity spring prescribed burns and four wildfires on nitrogen (N) biogeochemistry in Rocky Mountain headwater watersheds. We compared paired (burned/unburned) watersheds of four wildfires and three spring prescribed burns for three growing seasons post-fire. To better understand fire effects on the entire watershed ecosystem, we measured N concentrations and δ15N in both the terrestrial and aquatic ecosystems components, i.e., soil, understory plants in upland and riparian areas, streamwater, and in-stream moss. In addition, we measured nitrate reductase activity in foliage of Spiraea betulifolia, a dominant understory species. We found increases of δ15N and N concentrations in both terrestrial and aquatic ecosystem N pools after wildfire, but responses were limited to terrestrial N pools after prescribed burns indicating that N transfer from terrestrial to aquatic ecosystem components did not occur in low-severity prescribed burns. Foliar δ15N differed between wildfire and prescribed burn sites; the δ15N of foliage of upland plants was enriched by 2.9 ‰ (difference between burned and unburned watersheds) in the first two years after wildfire, but only 1.3 ‰ after prescribed burns. In-stream moss δ15N in wildfire-burned watersheds was enriched by 1.3 ‰, but there was no response by moss in prescription-burned watersheds, mirroring patterns of streamwater nitrate concentrations. S. betulifolia showed significantly higher nitrate reductase activity two years after wildfires relative to corresponding unburned watersheds, but no such difference was found after prescribed burns. These responses are consistent with less altered N biogeochemistry after prescribed burns relative to wildfire. We concluded that δ15N values in terrestrial and aquatic plants and streamwater nitrate concentrations after fire can be useful indicators of the magnitude and duration of fire effects and the fate of post

  15. By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department.

    Science.gov (United States)

    Santistevan, Jamie R; Sharp, Brian R; Hamedani, Azita G; Fruhan, Scott; Lee, Andrew W; Patterson, Brian W

    2018-03-01

    Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry. We performed a retrospective observational study at a single academic, urban ED with 58,000 annual visits. We identified all adult patients (18 years or older) seen in the ED and discharged home with prescriptions for tablet forms of hydrocodone and oxycodone (including mixed formulations with acetaminophen). We compared the quantity of tablets prescribed per opioid prescription 12 months before and 10 months after the electronic order-entry prescription default quantity of 20 tablets was removed and replaced with no default quantity. No specific messaging was given to providers, to avoid influencing prescribing patterns. We used two-sample Wilcoxon rank-sum test, two-sample test of proportions, and Pearson's chi-squared tests where appropriate for statistical analysis. A total of 4,104 adult patients received discharge prescriptions for opioids in the pre-intervention period (151.6 prescriptions per 1,000 discharged adult patients), and 2,464 post-intervention (106.69 prescriptions per 1,000 discharged adult patients). The median quantity of opioid tablets prescribed decreased from 20 (interquartile ration [IQR] 10-20) to 15 (IQR 10-20) (pdefault quantity. While the most frequent quantity of tablets received in both groups was 20 tablets, the proportion of patients who received prescriptions on discharge that contained 20 tablets decreased from 0.5 (95% confidence interval [CI] [0.48-0.52]) to 0.23 (95% CI [0.21-0.24]) (pdefault quantity removal. Although the median number of tablets differed significantly

  16. Does fire severity influence shrub resprouting after spring prescribed burning?

    Science.gov (United States)

    Fernández, Cristina; Vega, José A.; Fonturbel, Teresa

    2013-04-01

    Prescribed burning is commonly used to reduce the risk of severe wildfire. However, further information about the associated environmental effects is required to help forest managers select the most appropriate treatment. To address this question, we evaluated if fire severity during spring prescribed burning significantly affects the resprouting ability of two common shrub species in shrubland under a Mediterranean climate in NW Spain. Fire behaviour and temperatures were recorded in tagged individuals of Erica australis and Pterospartum tridentatum during prescribed burning. The number and length of resprouted shoots were measured three times (6, 12 and 18 months) after the prescribed burning. The influence of a series of fire severity indicators on some plant resprouting vigour parameters was tested by canonical correlation analysis. Six months and one year after prescribed burning, soil burn severity (measured by the absolute reduction in depth of the organic soil layer, maximum temperatures in the organic soil layer and the mineral soil surface during burning and the post-fire depth of the organic soil layer) reduced the resprouting vigour of E. australis and P. tridentatum. In contrast, direct measurements of fire effects on plants (minimum branch diameter, duration of temperatures above 300 °C in the shrub crown and fireline intensity) did not affect the post-fire plant vigour. Soil burn severity during spring prescribed burning significantly affected the short-term resprouting vigour in a mixed heathland in Galicia. The lack of effects eighteen months after prescribed burning indicates the high resilience of these species and illustrates the need to conciliate fire prevention and conservation goals.

  17. Soil heating and impact of prescribed burning

    Science.gov (United States)

    Stoof, Cathelijne

    2016-04-01

    Prescribed burning is highly uncommon in the Netherlands, where wildfire awareness is increasing but its risk management does not yet include fuel management strategies. A major exception is on two military bases, that need to burn their fields in winter and spring to prevent wildfires during summer shooting practice. Research on these very frequent burns has so far been limited to effects on biodiversity, yet site managers and policy makers have questions regarding the soil temperatures reached during these burns because of potential impact on soil properties and soil dwelling fauna. In March 2015, I therefore measured soil and litter temperatures under heath and grass vegetation during a prescribed burn on military terrain in the Netherlands. Soil and litter moisture were sampled pre- and post-fire, ash was collected, and fireline intensity was estimated from flame length. While standing vegetation was dry (0.13 g water/g biomass for grass and 0.6 g/g for heather), soil and litter were moist (0.21 cm3/cm3 and 1.6 g/g, respectively). Soil heating was therefore very limited, with maximum soil temperature at the soil-litter interface remaining being as low as 6.5 to 11.5°C, and litter temperatures reaching a maximum of 77.5°C at the top of the litter layer. As a result, any changes in physical properties like soil organic matter content and bulk density were not significant. These results are a first step towards a database of soil heating in relation to fuel load and fire intensity in this temperate country, which is not only valuable to increase understanding of the relationships between fire intensity and severity, but also instrumental in the policy debate regarding the sustainability of prescribed burns.

  18. Effective School-Community Relations as a Key Performance Indicator for the Secondary School Administrator in Aba South District, Nigeria

    Science.gov (United States)

    Abraham, Nath. M.; Ememe, Ogbonna N.

    2012-01-01

    This study investigates Effective School-Community Relations as a key Performance Indicator (KPI) of Secondary Schools Administrator in Aba South District, Nigeria. Descriptive survey method was adopted. All the 248 teachers made up the population and sample in a purposive sampling technique representing 100% of the entire population as sample. A…

  19. The effect of federal and state off-label marketing investigations on drug prescribing: The case of olanzapine.

    Science.gov (United States)

    Wang, Bo; Studdert, David M; Sarpatwari, Ameet; Franklin, Jessica M; Landon, Joan; Kesselheim, Aaron S

    2017-01-01

    In the past decade, the federal government has frequently investigated and prosecuted pharmaceutical manufacturers for illegal promotion of drugs for indications not approved by the Food and Drug Administration (FDA) ("off-label" uses). State governments can choose to coordinate with the federal investigation, or pursue their own independent state investigations. One of the largest-ever off-label prosecutions relates to the atypical antipsychotic drug olanzapine (Zyprexa). In a series of settlements between 2008 and 2010, Eli Lilly paid $1.4 billion to the federal government and over $290 million to state governments. We examined the effect of these settlements on off-label prescribing of this medication, taking advantage of geographical differences in states' involvement in the investigations and the timing of the settlements. However, we did not find a reduction in off-label prescribing; rather, there were no prescribing changes among states that joined the federal investigation, those that pursued independent state investigations, and states that pursued no investigations at all. Since the settlements of state investigations of off-label prescribing do not appear to significantly impact prescribing rates, policymakers should consider alternate ways of reducing the prevalence of non-evidence-based off-label use to complement their ongoing investigations.

  20. The relationship between macroeconomic and industry-specific business cycle indicators and work-related injuries among Danish construction workers.

    Science.gov (United States)

    Nielsen, Kent Jacob; Lander, F; Lauritsen, J M

    2015-04-01

    The current study examines and compares the relationship between both macroeconomic and industry-specific business cycle indicators, and work-related injuries among construction workers in Denmark using emergency department (ED) injury data and also officially reported injuries to the Danish Working Environment Authority (WEA). The correlations between ED and WEA injury data from the catchment area of Odense University Hospital during the period 1984-2010 were tested separately for variability and trend with two general macroeconomic indicators (gross domestic product and the Danish unemployment rate) and two construction industry-specific indicators (gross value added and the number of employees). The results show that injury rates increase during economic booms and decrease during recessions. However, the regression coefficients were generally weak for both the ED (range 0.14-0.20) and WEA injuries (range 0.13-0.36). Furthermore, although there is some variability in the strength of the relationship of the different business cycle indicators, the relationships are generally not stronger for the WEA injuries than for the ED injuries, except for general unemployment. Similarly, no substantial differences in strength of relation between industry-specific and macroeconomic indicators were identified. The study shows that there was no difference in the relationship between business cycle indicators, and WEA and ED injury data. This indicates that changes in reporting behaviour do not seem to play a major role in the relation between the business cycle and workplace injuries in a Danish context. 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.

  1. Indicators of implicit and explicit social anxiety influence threat-related interpretive bias as a function of working memory capacity

    Directory of Open Access Journals (Sweden)

    Elske eSalemink

    2013-05-01

    Full Text Available Interpretive biases play a crucial role in anxiety disorders. The aim of the current study was to examine factors that determine the relative strength of threat-related interpretive biases that are characteristic of individuals high in social anxiety. Different (dual process models argue that both implicit and explicit processes determine information processing biases and behaviour, and that their impact is moderated by the availability of executive resources such as working memory capacity (WMC. Based on these models, we expected indicators of implicit social anxiety to predict threat-related interpretive bias in individuals low, but not high in WMC. Indicators of explicit social anxiety should predict threat-related interpretive bias in individuals high, but not low in WMC. As expected, WMC moderated the impact of implicit social anxiety on threat-related interpretive bias, although the simple slope for individuals low in WMC was not statistically significant. The hypotheses regarding explicit social anxiety (with fear of negative evaluation used as an indicator were fully supported. The clinical implications of these findings are discussed.

  2. Prescription drug abuse communication: A qualitative analysis of prescriber and pharmacist perceptions and behaviors.

    Science.gov (United States)

    Hagemeier, Nicholas E; Tudiver, Fred; Brewster, Scott; Hagy, Elizabeth J; Hagaman, Angela; Pack, Robert P

    Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. Despite the perceived importance of engaging in PDA communication, HCPs reported

  3. Drug prescribing data used in the assessment of general practitioners’ treatment of asthma and urinary tract infection – Experience from the European Drug Education Project

    Directory of Open Access Journals (Sweden)

    Per Lagerløv

    2009-11-01

    Full Text Available  ABSTRACTDescribing drug treatment given by general practitioners, and quantifying changes in their prescribingbehaviour due to educational intervention, were important parts of the method developed and appliedby the European Drug Education Project. Based on the physicians’ prescription data, individual patientswere defined as having either asthma or urinary tract infections. Prescribing indicators were establishedfor assessing the quality (acceptable or unacceptable of the drug treatment. The diagnose definitionsand prescribing indicators are discussed in more detail in relation to feeding back individual prescribingdata to educational groups of physicians to improve the quality of their drug therapy.

  4. Estimating the prevalence of 26 health-related indicators at neighbourhood level in the Netherlands using structured additive regression.

    Science.gov (United States)

    van de Kassteele, Jan; Zwakhals, Laurens; Breugelmans, Oscar; Ameling, Caroline; van den Brink, Carolien

    2017-07-01

    Local policy makers increasingly need information on health-related indicators at smaller geographic levels like districts or neighbourhoods. Although more large data sources have become available, direct estimates of the prevalence of a health-related indicator cannot be produced for neighbourhoods for which only small samples or no samples are available. Small area estimation provides a solution, but unit-level models for binary-valued outcomes that can handle both non-linear effects of the predictors and spatially correlated random effects in a unified framework are rarely encountered. We used data on 26 binary-valued health-related indicators collected on 387,195 persons in the Netherlands. We associated the health-related indicators at the individual level with a set of 12 predictors obtained from national registry data. We formulated a structured additive regression model for small area estimation. The model captured potential non-linear relations between the predictors and the outcome through additive terms in a functional form using penalized splines and included a term that accounted for spatially correlated heterogeneity between neighbourhoods. The registry data were used to predict individual outcomes which in turn are aggregated into higher geographical levels, i.e. neighbourhoods. We validated our method by comparing the estimated prevalences with observed prevalences at the individual level and by comparing the estimated prevalences with direct estimates obtained by weighting methods at municipality level. We estimated the prevalence of the 26 health-related indicators for 415 municipalities, 2599 districts and 11,432 neighbourhoods in the Netherlands. We illustrate our method on overweight data and show that there are distinct geographic patterns in the overweight prevalence. Calibration plots show that the estimated prevalences agree very well with observed prevalences at the individual level. The estimated prevalences agree reasonably well with the

  5. Prescribing medical cannabis in Canada: Are we being too cautious?

    Science.gov (United States)

    Lake, Stephanie; Kerr, Thomas; Montaner, Julio

    2015-04-30

    There has been much recent discussion and debate surrounding cannabis in Canada, including the prescribing of medical cannabis for therapeutic purposes. Certain commentators - including the Canadian Medical Association (CMA) - have denounced the prescribing of cannabis for medical purposes due to a perceived lack of evidence related to the drug's efficacy, harms, and mechanism of action. In this commentary, we present arguments in favour of prescribing medical cannabis in Canada. We believe the anti-cannabis position taken by CMA and other commentators is not entirely evidence-based. Using the example of neuropathic pain, we present and summarize the clinical evidence surrounding smoked or vapourized cannabis, including recent evidence pertaining to the effectiveness of cannabis in comparison to existing standard pharmacotherapies for neuropathy. Further, we outline how the concerns expressed regarding cannabis' mechanism of action are inconsistent with current decision-making processes related to the prescribing of many common pharmaceuticals. Finally, we discuss potential secondary public health benefits of prescribing cannabis for pain-related disorders in Canada and North America.

  6. SLC2A9 and ZNF518B polymorphisms correlate with gout-related metabolic indices in Chinese Tibetan populations.

    Science.gov (United States)

    Zhang, X Y; Geng, T T; Liu, L J; Yuan, D Y; Feng, T; Kang, L L; Jin, T B; Chen, C

    2015-08-19

    Current evidence suggests that heredity and metabolic syndrome contribute to gout progression. SLC2A9 and ZNF518B may play a role in gout progression in different populations, but no studies have focused on the Tibetan Chinese population. In this study, we determined whether variations in these 2 genes were correlated with gout-related indices in Chinese-Tibetan gout patients. We detected 6 single nucleotide polymorphisms in SLC2A9 and ZNF518B in 319 Chinese Tibetan gout patients. One-way analysis of variance was used to evaluate the polymorphisms' effects on gout based on mean serum levels of metabolism indicators. Polymorphisms in SLC2A9 and ZNF518B affected multiple risk factors related to gout development. Significant differences in serum triglyceride levels and high-density lipoprotein-cholesterol level were detected between different genotypic groups with SLC2A9 polymorphisms rs13129697 (P = 0.022), rs4447863 (P = 0.018), and rs1014290 (P = 0.045). Similarly in ZNF518B, rs3217 (P = 0.016) and rs10016022 (P = 0.046) were associated with high creatinine and glucose levels, respectively. This study is the first to investigate and identify positive correlations between SLC2A9 and ZNF518B gene polymorphisms and metabolic indices in Tibetan gout patients. We found significant evidence indicating that genetic polymorphisms affect gout-related factors in Chinese Tibetan populations.

  7. Indicators of accuracy of consumer health information on the Internet: a study of indicators relating to information for managing fever in children in the home.

    Science.gov (United States)

    Fallis, Don; Frické, Martin

    2002-01-01

    To identify indicators of accuracy for consumer health information on the Internet. The results will help lay people distinguish accurate from inaccurate health information on the Internet. Several popular search engines (Yahoo, AltaVista, and Google) were used to find Web pages on the treatment of fever in children. The accuracy and completeness of these Web pages was determined by comparing their content with that of an instrument developed from authoritative sources on treating fever in children. The presence on these Web pages of a number of proposed indicators of accuracy, taken from published guidelines for evaluating the quality of health information on the Internet, was noted. Correlation between the accuracy of Web pages on treating fever in children and the presence of proposed indicators of accuracy on these pages. Likelihood ratios for the presence (and absence) of these proposed indicators. One hundred Web pages were identified and characterized as "more accurate" or "less accurate." Three indicators correlated with accuracy: displaying the HONcode logo, having an organization domain, and displaying a copyright. Many proposed indicators taken from published guidelines did not correlate with accuracy (e.g., the author being identified and the author having medical credentials) or inaccuracy (e.g., lack of currency and advertising). This method provides a systematic way of identifying indicators that are correlated with the accuracy (or inaccuracy) of health information on the Internet. Three such indicators have been identified in this study. Identifying such indicators and informing the providers and consumers of health information about them would be valuable for public health care.

  8. Prescribing Data in General Practice Demonstration (PDGPD project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

    Directory of Open Access Journals (Sweden)

    Williamson Margaret

    2012-08-01

    Full Text Available Abstract Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1 hypertension (HT and 2 chronic heart failure (CHF. The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. Methods A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI intervention on prescribing practice among Australian general practitioners (GP in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion with each group undertaking the clinical topics (CHF and HT in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. Discussion This paper describes the study protocol for a

  9. Grip Strength as an Indicator of Health-Related Quality of Life in Old Age-A Pilot Study.

    Science.gov (United States)

    Musalek, Christina; Kirchengast, Sylvia

    2017-11-24

    Over the last century life expectancy has increased dramatically nearly all over the world. This dramatic absolute and relative increase of the old aged people component of the population has influenced not only population structure but also has dramatic implications for the individuals and public health services. The aim of the present pilot study was to examine the impact of physical well-being assessed by hand grip strength and social factors estimated by social contact frequency on health-related quality of life among 22 men and 41 women ranging in age between 60 and 94 years. Physical well-being was estimated by hand grip strength, data concerning subjective wellbeing and health related quality of life were collected by personal interviews based on the WHOQOL-BREF questionnaires. Number of offspring and intergenerational contacts were not related significantly to health-related quality of life, while social contacts with non-relatives and hand grip strength in contrast had a significant positive impact on health related quality of life among old aged men and women. Physical well-being and in particular muscle strength-estimated by grip strength-may increase health-related quality of life and is therefore an important source for well-being during old age. Grip strength may be used as an indicator of health-related quality of life.

  10. An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

    Directory of Open Access Journals (Sweden)

    Courtenay Molly

    2012-06-01

    Full Text Available Abstract Background Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP has been implemented within organisations across a strategic health authority (SHA. The aim of the study was to provide an overview of NMP across one SHA. Methods NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7% participants responded. Data was collected between November 2010 and February 2011. Results The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6% compared to community practitioner prescribers (198 or 22.4%, pharmacist independent supplementary prescribers (35 or 4%, and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%. Nearly all (over 90% of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p  Conclusion NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and

  11. An overiew of non medical prescribing across one strategic health authority: a questionnaire survey.

    Science.gov (United States)

    Courtenay, Molly; Carey, Nicola; Stenner, Karen

    2012-06-01

    Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA. NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011. The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p < 0.001). NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This

  12. Climate-related Indicators and Data Provenance: Evaluating Coupled Boundary Objects for Science, Innovation, and Decision-Making

    Science.gov (United States)

    Wiggins, A.; Young, A.; Brody, C.; Gerst, M.; Kenney, M. A.; Lamoureux, A.; Rice, A.; Wolfinger, F.

    2015-12-01

    Boundary object theory focuses on the role of artifacts, such as indicator images, in translation and communication across the boundaries of social groups. We use this framework for understanding how data can communicate across contexts to answer the question: Can coupling climate-related indicators with data provenance support scientific innovation and science translation? To address this question we conducted a study to understand the features and capabilities necessary for indicators and data provenance for scientific uses, using the recently online-released U.S. Global Change Research Program (USGCRP) Indicators and Global Change Information System (GCIS) as linked boundary objects. We conducted semi-structured interviews with professional researchers in which we asked the researchers to explore and describe what they observed that was useful or frustrating for a subset of the USGCRP Indicators, related GCIS content, and other similar indicator and metadata websites. Participants found these sites' navigation and the labeling and description of their assets frustrating and confusing, but were able to clearly articulate the metadata and provenance information they needed to both understand and trust the indicators. In addition to identifying desired features that are likely to be specific to this audience (e.g., references or citations for indicators), scientists wanted clear, easier-to-access provenance information of the type usually recommended for documenting research data. Notably, they felt the information would be best presented in a fashion accessible to a broader audience, as those with more technical expertise should be able to infer additional contextual details given the provenance information that they had identified as key. Such results are useful for the improvement of indicator systems, such as the prototype released by USGCRP. We note in particular that the consistency of responses across the multi-disciplinary sample, which included scholars in

  13. Ibuprofen in paediatrics: pharmacology, prescribing and controversies.

    Science.gov (United States)

    Moriarty, Camilla; Carroll, Will

    2016-12-01

    Ibuprofen, a propionic acid derivative, is a non-steroidal anti-inflammatory drug. The oral formulation is widely used in paediatric practice and after paracetamol it is one of the most common drugs prescribed for children in hospital. The treatment of fever with antipyretics such as ibuprofen is controversial as fever is the normal response of the body to infection and unless the child becomes distressed or symptomatic, fever alone should not be routinely treated. Combined treatment with paracetamol and ibuprofen is commonly undertaken but almost certainly is not helpful. This article aims to describe the indications and mode of action of the drug, outline its pharmacokinetics and highlight the important key messages regarding its use in clinical practice. 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/.

  14. Studying relations between radionuclide contents and water quality and quantity indices for Rivers Kura-Araks basin, Armenia

    Energy Technology Data Exchange (ETDEWEB)

    Nalbandyan, A.G.; Saghatelyan, A.K.; Kyureghyan, A.A; Mikayelyan, M.G.

    2008-07-01

    We initiated a research in late 2005 as a constituent and logical expansion of an ongoing NATO Science for Peace/OSCE project 'South Caucasus River Monitoring' which has been performed since 2002 and was initially focused on indication of river water quality and quantity indices and determination of heavy metals. It should be stressed that this radioactivity research is the first ever attempt of this kind and that all the data obtained are unique. This paper is focused on a study of relations between radionuclide contents and water quality and quantity indices for Armenia's section of Rivers Kura-Araks basin and highlights data obtained for the studied period 2006-2007 (author)(tk)

  15. Flourishing in New Zealand Workers: Associations With Lifestyle Behaviors, Physical Health, Psychosocial, and Work-Related Indicators.

    Science.gov (United States)

    Hone, Lucy C; Jarden, Aaron; Duncan, Scott; Schofield, Grant M

    2015-09-01

    To investigate the prevalence and associations of flourishing among a large sample of New Zealand workers. A categorical diagnosis of flourishing was applied to data from the Sovereign Wellbeing Index, a nationally representative sample of adults in paid employment (n = 5549) containing various lifestyle, physical, psychosocial, and work-related indicators. One in four New Zealand workers were categorized as flourishing. Being older and married, reporting greater income, financial security, physical health, autonomy, strengths awareness and use, work-life balance, job satisfaction, participation in the Five Ways to Well-being, volunteering, and feeling appreciated by others were all positively associated with worker flourishing independent of sociodemographics. Flourishing is a useful additional indicator for evaluating the prevalence, and identifying the drivers, of employee well-being. Employers may benefit from promoting these indicators among staff.

  16. Studying relations between radionuclide contents and water quality and quantity indices for Rivers Kura-Araks basin, Armenia

    International Nuclear Information System (INIS)

    Nalbandyan, A.G.; Saghatelyan, A.K.; Kyureghyan, A.A; Mikayelyan, M.G.

    2008-01-01

    We initiated a research in late 2005 as a constituent and logical expansion of an ongoing NATO Science for Peace/OSCE project 'South Caucasus River Monitoring' which has been performed since 2002 and was initially focused on indication of river water quality and quantity indices and determination of heavy metals. It should be stressed that this radioactivity research is the first ever attempt of this kind and that all the data obtained are unique. This paper is focused on a study of relations between radionuclide contents and water quality and quantity indices for Armenia's section of Rivers Kura-Araks basin and highlights data obtained for the studied period 2006-2007 (author)(tk)

  17. Inter-annual dynamics of the Barents Sea red king crab (Paralithodes camtschaticus) stock indices in relation to environmental factors

    Science.gov (United States)

    Dvoretsky, Alexander G.; Dvoretsky, Vladimir G.

    2016-12-01

    Knowledge of relationships between environmental variables and biological processes can greatly improve fisheries assessment and management in commercially important species. We analyzed the effects of environmental factors (climatic indices and water temperature) on the stock characteristics (total population number, number of pre-recruits and number of legal males) of the red king crab (Paralithodes camtschaticus), an introduced species in the Barents Sea. Stock trends in red king crab appear to be related to decadal climate shifts. Abundances were negatively related to the North Atlantic Oscillation index (NAO) in August and positively related to water temperature in late winter-early summer. Total and commercial stock abundance were negatively correlated with the lag-1 Arctic Oscillation index (AO) in August and the lag-2 winter NAO index. The total number of P. camtschaticus was most strongly associated with water temperature in spring and summer and NAO/AO indices in April and May. Lagged NAO indices in February and August (9 or 10 yr) had a positive relationship to the commercial stock of P. camtschaticus. These findings suggest that temperature conditions of current and previous year affect natural mortality of larvae and juvenile red king crabs. Warmer temperature conditions lead to increased biomass of red king crab food items. Negative correlations between climatic indices and the red king crab stocks may be associated with predator pressure on juvenile red king crabs or higher mortality because of predator or parasite pressure and diseases. The associations between stock indices and environmental variables could help better predict recruitment patterns of P. camtschaticus.

  18. Association of nutritional status-related indices and chemotherapy-induced adverse events in gastric cancer patients.

    Science.gov (United States)

    Seo, Seung Hee; Kim, Sung-Eun; Kang, Yoon-Koo; Ryoo, Baek-Yeol; Ryu, Min-Hee; Jeong, Jae Ho; Kang, Shin Sook; Yang, Mihi; Lee, Jung Eun; Sung, Mi-Kyung

    2016-11-18

    Malnutrition in gastrectomized patients receiving chemotherapy is associated with the susceptibility to chemotherapy-related adverse events. This study evaluated pre-operative nutritional status-related indices associated with adverse events in post-operation gastric cancer patients receiving chemotherapy. Medical records of 234 gastrectomized patients under adjuvant tegafur/gimeracil/oteracil chemotherapy with extended lymph node dissection were analyzed. Nutritional status assessment included Patient-Generated Subjective Global Assessment (PG-SGA), body weight, body mass index, serum albumin concentration, and Nutrition Risk Index (NRI). Chemotherapy-originated adverse events were determined using Common Terminology Criteria for Adverse Events. PG-SGA indicated 59% of the patients were malnourished, and 27.8% of the patients revealed serious malnutrition with PG-SGA score of ≥9. Fifteen % of patients lost ≥10% of the initial body weight, 14.5% of the patients had hypoalbuminemia (cancer patients.

  19. Refractive indices of human skin tissues at eight wavelengths and estimated dispersion relations between 300 and 1600 nm

    International Nuclear Information System (INIS)

    Ding Huafeng; Lu, Jun Q; Wooden, William A; Kragel, Peter J; Hu Xinhua

    2006-01-01

    The refractive index of human skin tissues is an important parameter in characterizing the optical response of the skin. We extended a previously developed method of coherent reflectance curve measurement to determine the in vitro values of the complex refractive indices of epidermal and dermal tissues from fresh human skin samples at eight wavelengths between 325 and 1557 nm. Based on these results, dispersion relations of the real refractive index have been obtained and compared in the same spectral region

  20. Smile satisfaction and its related indicators in students of School of Dentistry, Qazvin University of Medical Sciences (2013-2014)

    OpenAIRE

    B. Ranjbar Omidi; A. Zakerzadeh; S. Arab; Sh. Afshartabar; F. Nouri

    2015-01-01

    Background: Smile is one of the most important factors determining the attractiveness of a person and has an important role in his mood and influence on others. Objective: The aim of this study was to evaluate the smile satisfaction and its related indicators in the students of School of Dentistry affiliated to Qazvin University of Medical Sciences. Methods: This cross sectional study was conducted on 80 students of School of Dentistry in Qazvin during 2013-2014. Digital photograph was ...

  1. Relations of biological indicators to nutrient data for lakes and streams in Pennsylvania and West Virginia, 1990-98

    Science.gov (United States)

    Brightbill, Robin A.; Koerkle, Edward H.

    2003-01-01

    depth, and pH. In all cases, Secchi depth was inversely related to the chlorophyll a concentrations in a lake. Nutrient ecoregion VIII had too few samples for any type of analysis.Streams within the different nutrient ecoregions had many variables that were significantly related to periphyton chlorophyll a concentrations. These variables consisted of total nitrogen, total phosphorus, drainage area, percent forest cover, several macroinvertebrate indices, pH, basin slope, total residue, total suspended solids, and water temperature. Nutrients were not significantly related to periphyton chlorophyll a in streams within nutrient ecoregions VII or IX but were in nutrient ecoregion XI. Drainage area, percent forest cover, and several invertebrate indices were significant variables in nutrient ecoregion VII. Percent forest cover and several invertebrate indices had a negative relation with chlorophyll a concentrations in these streams. Percent forest cover and basin slope had a negative effect on periphyton in nutrient ecoregion IX streams. Light availability was more critical to periphyton growth in streams than nutrients.Ecoregion XI had enough samples to do seasonal analyses. Summer-season periphyton chlorophyll a concentrations in nutrient ecoregion XI streams were positively related to total phosphorus and drainage area but negatively related to percent forest cover. Summer-season phytoplankton in streams was related to different variables within the same nutrient ecoregion. Both total nitrogen and total phosphorus were positively related with chlorophyll a concentrations as well as basin slope, total residue, and total suspended solids but negatively related to pH. The winter stream phytoplankton chlorophyll a concentrations were related to water temperature only.

  2. Effects of seasonal change and parity on raw milk composition and related indices in Chinese Holstein cows in northern China.

    Science.gov (United States)

    Yang, L; Yang, Q; Yi, M; Pang, Z H; Xiong, B H

    2013-01-01

    This study was to investigate the effects of seasonal change and parity on milk composition and related indices, and to analyze the relationships among milk indices in Chinese Holstein cows from an intensive dairy farm in northern China. The 6,520 sets of complete Dairy Herd Improvement data were obtained and grouped by natural month and parity. The data included daily milk yield (DMY), milk solids percentage (MSP), milk fat percentage (MFP), milk protein percentage (MPP), milk lactose percentage (MLP), somatic cell count (SCC), somatic cell score (SCS), milk production loss (MPL), and fat-to-protein ratio (FPR). Data analysis showed that the above 9 indices were affected by both seasonal change and parity. However, the interaction between parity and seasonal change showed effects on MLP, SCS, MPL, and DMY, but no effects on MFP, MPP, MSP, and FPR. Duncan's multiple comparison on seasonal change showed that DMY (23.58 kg/d), MSP (12.35%), MPP (3.02%), and MFP (3.81%) were the lowest in June, but SCC (288.7 × 10(3)/mL) and MPL (0.69 kg/d) were the lowest in January; FPR (1.32) was the highest in February. Meanwhile, Duncan's multiple comparison on parities showed that MSP, MPP, and MLP were reduced rapidly in the fourth lactation, but SCC and MPL increased with increasing parities. The canonical correlation analysis for indices showed that SCS had high positive correlation with MPL (0.8360). Therefore, a few models were developed to quantify the effects of seasonal change and parity on raw milk composition using the Wood model. The changing patterns of milk composition and related indices in different months and parities could provide scientific evidence for improving feeding management and nutritional supplementation of Chinese Holstein cows. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  3. Prescribing Safety in Ambulatory Care: Physician Perspectives

    National Research Council Canada - National Science Library

    Rundall, Thomas G; Hsu, John; Lafata, Jennifer E; Fung, Vicki; Paez, Kathryn A; Simpkins, Jan; Simon, Steven R; Robinson, Scott B; Uratsu, Connie; Gunter, Margaret J; Soumerai, Stephen B; Selby, Joseph V

    2005-01-01

    .... We asked about current safety practices, perceptions of ambulatory prescribing safety. Using a content analysis approach, three investigators independently coded responses into thematic categories...

  4. Indicadores de riesgo de morbilidad prevenible causada por medicamentos Risk indicators of preventable morbidity related to drug utilization

    Directory of Open Access Journals (Sweden)

    Ana Dago Martínez

    2007-02-01

    Full Text Available Objetivos: Seleccionar y estudiar la aceptabilidad, en términos de relevancia y pertinencia, de ciertas situaciones clínicas que puedan usarse como indicadores de riesgo de morbilidad prevenible causada por medicamentos y que sean utilizables en las farmacias comunitarias. Método: Método Delphi, en 2 rondas, con un panel de 14 expertos médicos y farmacéuticos que valoraron la relevancia y pertinencia de 68 tipos de situaciones clínicas como indicadores de morbilidad potencial relacionada con medicamentos, detectable por el profesional en su medio, con evidencia científica de resultado adverso previsible, frecuentes en el medio ambulatorio y con causa y resultado controlables. Resultados: Se consideraron utilizables y pertinentes 43 de los 68 indicadores estudiados, que se referían a 3 ámbitos: tipo de medicamento (medicamentos de estrecho margen terapéutico, con dosis individualizada y con reacciones adversas frecuentes y graves, problema de salud (problemas crónicos, especialmente asma, enfermedad cardíaca, tiroidea, prostática y dolor y tipo de paciente (ancianos y/o polimedicados. Los farmacéuticos sobrevaloraron sistemáticamente ciertos indicadores en relación con los médicos, aunque las diferencias no fueron significativas. Conclusiones: Se identificaron 43 indicadores de morbilidad potencial relacionada con los medicamentos e identificables por los profesionales en su entorno.Objective: To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance. Methods: We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable

  5. Sex-Related Differences in Hematological Parameters and Organosomatic Indices of Oreochromis niloticus Exposed to Aflatoxin B1 Diet

    Directory of Open Access Journals (Sweden)

    Esther Marijani

    2017-01-01

    Full Text Available A 24-week feeding experiment was conducted to assess whether males and females of Oreochromis niloticus exhibit differences in their hematological responses and organosomatic indices to dietary AFB1 contamination. Triplicate groups of O. niloticus (initial body weight: 24.1 ± 0.6 g were fed with four diets (Diets 1 to 4 containing 0, 20, 200, and 2,000 μg AFB1 kg−1. A significant decrease (P<0.05 in hemoglobin (Hb, red blood cells (RBC, and hematocrit (Hct was observed in AFB1 exposure groups, with the lowest levels recorded in the 2000 μg AFB1 kg−1 treatment. A significant increase in mean white blood cells (WBC, neutrophils, and lymphocytes was observed in AFB1 exposure groups. No sex-related differences in RBC, WBC, lymphocytes, monocytes, and neutrophils levels were observed. However, hemoglobin and hematocrit values for female O. niloticus were significantly lower than those for male O. niloticus. Organosomatic indices showed that the relative liver, kidney, and spleen weights were significantly higher (P<0.05 in the AFB1 supplemented group than in the control group. However, the effect of aflatoxin on organosomatic indices does not depend on sex but rather depends on the dose of aflatoxin in the diet. These results provide useful information for monitoring changes in the health status of male and female O. niloticus.

  6. Stakeholder views on the impact of nurse prescribing on dermatology services.

    Science.gov (United States)

    Carey, Nicola; Stenner, Karen; Courtenay, Molly

    2010-02-01

    To explore stakeholder views on the impact of nurse prescribing on dermatology services. Nurse led care enhances the services that dermatology patients receive. Research indicates that care delivered by nurse prescribers can improve efficiency and access to medicines. There is no evidence exploring the impact of nurse prescribing on the configuration of dermatology services. Case study. A collective case study of 10 practice settings across England where nurses prescribed medicines for dermatology patients. A thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were qualified nurse prescribers, administrative staff, doctors and non-nurse prescribers. Nurse prescribing was reported to support and facilitate the modernisation of dermatology services. It enabled nurses to make effective use of their knowledge and skills, overcome delays in treatment and provide faster access to medicines. However several organisational issues restricted the success of the initiative. Nurse prescribing is successfully being used to support and deliver a range of services to dermatology patients. Stakeholders reported that both patients and staff had benefited by the adoption of this role by nurses. However issues over support and access to CPD and capacity of the workforce were identified as potential barriers which could affect the contribution of nurse prescribing to dermatology patients. Nurse prescribing contributes to the services provided to dermatology patients; Nurse supplementary prescribing contributes to the ability of dermatology nurse specialists to work in teams and prescribe complex medicines; Provision of adequate support and strategic planning are essential if the impact of nurse prescribing is to be fully realised.

  7. Prescribed and self-reported seasonal training of distance runners.

    Science.gov (United States)

    Hewson, D J; Hopkins, W G

    1995-12-01

    A survey of 123 distance-running coaches and their best runners was undertaken to describe prescribed seasonal training and its relationship to the performance and self-reported training of the runners. The runners were 43 females and 80 males, aged 24 +/- 8 years (mean +/- S.D.), training for events from 800 m to the marathon, with seasonal best paces of 86 +/- 6% of sex- and age-group world records. The coaches and runners completed a questionnaire on typical weekly volumes of interval and strength training, and typical weekly volumes and paces of moderate and hard continuous running, for build-up, pre-competition, competition and post-competition phases of a season. Prescribed training decreased in volume and increased in intensity from the build-up through to the competition phase, and had similarities with 'long slow distance' training. Coaches of the faster runners prescribed longer build-ups, greater volumes of moderate continuous running and slower relative paces of continuous running (r = 0.19-0.36, P training close to competition pace. The mean training volumes and paces prescribed by the coaches were similar to those reported by the runners, but the correlations between prescribed and reported training were poor (r = 0.2-0.6). Coaches may therefore need to monitor their runners' training more closely.

  8. Variations in Metformin Prescribing for Type 2 Diabetes.

    Science.gov (United States)

    Goldberg, Tiffany; Kroehl, Miranda E; Suddarth, Kathleen Heist; Trinkley, Katy E

    2015-01-01

    Reasons for suboptimal metformin prescribing are unclear, but may be due to perceived risk of lactic acidosis. The purpose of this study is to describe provider attitudes regarding metformin prescribing in various patient situations. An anonymous, electronic survey was distributed electronically to 76 health care providers across the nation. The 14-item survey contained demographic questions and questions related to prescribing of metformin for T2DM in various patient situations, including suboptimal glycemic control, alcohol use, history of lactic acidosis, and varying degrees of severity for certain health conditions, including renal and hepatic dysfunction, chronic obstructive pulmonary disease, and heart failure. There were a total of 100 respondents. For suboptimal glycemic control, most providers (75%) would increase metformin from 1500 to 2000 mg daily; however, 25% would add an alternate agent, such as a sulfonylurea (18%) or dipeptidyl peptidase-4 inhibitor (7%). Although 51% of providers would stop metformin based on serum creatinine thresholds, the remainder would rely on glomerular filtration rate thresholds of <60 mL/min (15%), <30 mL/min (33%), or <15 mL/min (1%) to determine when to stop metformin. For heart failure, 45% of providers would continue metformin as currently prescribed regardless of severity. Most providers would adjust metformin for varying severity of hepatic dysfunction (74%) and alcohol abuse (40%). Despite evidence supporting the cardiovascular benefits of metformin, provider attitudes toward prescribing metformin are suboptimal in certain patient situations and vary greatly by provider. © Copyright 2015 by the American Board of Family Medicine.

  9. Age-related differences in diffusion tensor indices and fiber architecture in the medial and lateral gastrocnemius.

    Science.gov (United States)

    Sinha, Usha; Csapo, Robert; Malis, Vadim; Xue, Yanjie; Sinha, Shantanu

    2015-04-01

    To investigate age related changes in diffusion tensor indices and fiber architecture of the medial and lateral gastrocnemius (MG and LG) muscles using diffusion tensor imaging (DTI). The lower leg of five young and five senior subjects was scanned at 3 Tesla and DTI indices extracted using three methods: region of interest, histogram, and tract based. Tracked fibers were automatically edited to ensure physiologically relevant tracks. Pennation angles were measured with respect to the deep and superficial aponeuroses of both muscles. The three methods provided internally consistent measures of the DTI indices (correlation coefficient in the range of 0.90-0.99). The primary, secondary, and tertiary eigenvalues in the MG and LG increased significantly in the senior cohort (P < 0.05), while the small increase in fractional anisotropy with age was not significant (MG/LG: P = 0.39/0.85; 95% confidence interval: [-0.059/-0.056, 0.116/0.064]). Fiber lengths of MG fibers originating distally were significantly decreased in seniors (P < 0.05) while pennation angles decreased with age in the MG and LG but this was not significant. Fiber atrophy and increased fibrosis have opposing effects on the diffusion indices resulting in a complicated dependence with aging. Fiber architectural changes could play a role in determining aging muscle function. © 2014 Wiley Periodicals, Inc.

  10. Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

    LENUS (Irish Health Repository)

    Cahir, Caitriona

    2010-05-01

    Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP.

  11. Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital.

    Science.gov (United States)

    Mulcahy, Kimberly B; Trigoboff, Eileen; Opler, Lewis; Demler, Tammie Lee

    2016-01-01

    Vitamin D supplementation has become an increasingly popular prescribing practice, despite our limited knowledge of both the definition and degree of deficiency as well as the expected benefits or risks of exogenous administration. Many of the hypothesized benefits of vitamin D supplementation include a variety of improvements in mental health; however, these claims are not consistently or robustly supported by current research. In this paper, we provide a brief overview of what is currently known about vitamin D deficiency and about outcomes of supplementation as well as a summary of the data relative to prescribing practices for inpatients in an urban psychiatric hospital.

  12. The use of remote sensors to relate biological and physical indicators to environmental and public health problems

    Science.gov (United States)

    1972-01-01

    Relationships between biological, ecological and botanical structures, and disease organisms and their vectors which might be detected and measured by remote sensing are determined. In addition to the use of trees as indicators of disease or potential disease, an attempt is made to identify environmental factors such as soil moisture and soil and water temperatures as they relate to disease or health problems and may be detected by remote sensing. The following three diseases and one major health problem are examined: Malaria, Rocky Mountain spotted fever, Encephalitis and Red Tide. It is shown that no single species of vascular plant nor any one environmental factor can be used as the indicator of disease or health problems. Entire vegetation types, successional stages and combinations of factors must be used.

  13. Comprehensive Analysis of Large Sets of Age-Related Physiological Indicators Reveals Rapid Aging around the Age of 55 Years.

    Science.gov (United States)

    Lixie, Erin; Edgeworth, Jameson; Shamir, Lior

    2015-01-01

    While many studies show a correlation between chronological age and physiological indicators, the nature of this correlation is not fully understood. To perform a comprehensive analysis of the correlation between chronological age and age-related physiological indicators. Physiological aging scores were deduced using principal component analysis from a large dataset of 1,227 variables measured in a cohort of 4,796 human subjects, and the correlation between the physiological aging scores and chronological age was assessed. Physiological age does not progress linearly or exponentially with chronological age: a more rapid physiological change is observed around the age of 55 years, followed by a mild decline until around the age of 70 years. These findings provide evidence that the progression of physiological age is not linear with that of chronological age, and that periods of mild change in physiological age are separated by periods of more rapid aging. © 2015 S. Karger AG, Basel.

  14. Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator.

    Science.gov (United States)

    Abeare, Christopher A; Messa, Isabelle; Zuccato, Brandon G; Merker, Bradley; Erdodi, Laszlo

    2018-03-12

    Estimated base rates of invalid performance on baseline testing (base rates of failure) for the management of sport-related concussion range from 6.1% to 40.0%, depending on the validity indicator used. The instability of this key measure represents a challenge in the clinical interpretation of test results that could undermine the utility of baseline testing. To determine the prevalence of invalid performance on baseline testing and to assess whether the prevalence varies as a function of age and validity indicator. This retrospective, cross-sectional study included data collected between January 1, 2012, and December 31, 2016, from a clinical referral center in the Midwestern United States. Participants included 7897 consecutively tested, equivalently proportioned male and female athletes aged 10 to 21 years, who completed baseline neurocognitive testing for the purpose of concussion management. Baseline assessment was conducted with the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT), a computerized neurocognitive test designed for assessment of concussion. Base rates of failure on published ImPACT validity indicators were compared within and across age groups. Hypotheses were developed after data collection but prior to analyses. Of the 7897 study participants, 4086 (51.7%) were male, mean (SD) age was 14.71 (1.78) years, 7820 (99.0%) were primarily English speaking, and the mean (SD) educational level was 8.79 (1.68) years. The base rate of failure ranged from 6.4% to 47.6% across individual indicators. Most of the sample (55.7%) failed at least 1 of 4 validity indicators. The base rate of failure varied considerably across age groups (117 of 140 [83.6%] for those aged 10 years to 14 of 48 [29.2%] for those aged 21 years), representing a risk ratio of 2.86 (95% CI, 2.60-3.16; P indicator and the age of the examinee. The strong age association, with 3 of 4 participants aged 10 to 12 years failing validity indicators, suggests that the

  15. "Psychiatry is not a science like others" - a focus group study on psychotropic prescribing in primary care.

    Science.gov (United States)

    Hedenrud, Tove M; Svensson, Staffan A; Wallerstedt, Susanna M

    2013-08-12

    Psychotropic drug prescribing is problematic and knowledge of factors affecting the initiation and maintenance of such prescribing is incomplete. Such knowledge could provide a basis for the design of interventions to change prescribing patterns for psychotropics. The aim of this study was to explore the views of general practitioners (GPs), GP interns, and heads of primary care units on factors affecting the prescribing of psychotropic drugs in primary care. We performed four focus group discussions in Gothenburg, Sweden, with a total of 21 participants (GPs, GP interns, and heads of primary care units). The focus group discussions were transcribed verbatim and analyzed using manifest content analysis. Three different themes emerged from the focus group discussions. The first theme Seeking care for symptoms, reflects the participants' understanding of why patients approach primary care and comprised categories such as knowledge, attitudes, and society and the media. The second theme, Lacking a framework, resources, and treatment alternatives, which reflects the conditions for the physician-patient interaction, comprised categories such as economy and resources, technology, and organizational aspects. The third theme, Restricting or maintaining prescriptions, with the subthemes Individual factors and External influences, reflects the physicians' internal decision making and comprised categories such as emotions, knowledge, and pharmaceutical industry. The results of the present study indicate that a variety of factors may affect the prescribing of psychotropic medications in primary care. Many factors were related to characteristics of the patient, the physician or their interaction, rather than the patients' medical needs per se. The results may be useful for interventions to improve psychotropic prescribing in primary care.

  16. Impacts of prescribed fire on soil loss and soil quality

    NARCIS (Netherlands)

    Shakesby, Richard A.; Martins Bento, Celia; Ferreira, Carla S.S.; Ferreira, António J.D.; Stoof, C.R.; Urbanek, Emilia; Walsh, Rory P.D.

    2015-01-01

    Prescribed (controlled) fire has recently been adopted as an important wildfire-fighting strategy in the Mediterranean. Relatively little research, however, has assessed its impacts on soil erosion and soil quality. This paper investigates hillslope-scale losses of soil, organic matter and

  17. Molecular phylogeny and comparative morphology indicate that odontostomatids (Alveolata, Ciliophora) form a distinct class-level taxon related to Armophorea.

    Science.gov (United States)

    Fernandes, Noemi M; Vizzoni, Vinicius F; Borges, Bárbara do N; A G Soares, Carlos; Silva-Neto, Inácio D da; S Paiva, Thiago da

    2018-04-18

    The odontostomatids are among the least studied ciliates, possibly due to their small sizes, restriction to anaerobic environments and difficulty in culturing. Consequently, their phylogenetic affinities to other ciliate taxa are still poorly understood. In the present study, we analyzed newly obtained ribosomal gene sequences of the odontostomatids Discomorphella pedroeneasi and Saprodinium dentatum, together with sequences from the literature, including Epalxella antiquorum and a large assemblage of ciliate sequences representing the major recognized classes. The results show that D. pedroeneasi and S. dentatum form a deep-diverging branch related to metopid and clevelandellid armophoreans, corroborating the old literature. However E. antiquorum clustered with the morphologically discrepant plagiopylids, indicating that either the complex odontostomatid body architecture evolved convergently, or the positioning of E. antiquorum as a plagiopylid is artifactual. A new ciliate class, Odontostomatea n. cl., is proposed based on molecular analyses and comparative morphology of odontostomatids with related taxa. Copyright © 2018. Published by Elsevier Inc.

  18. Comparative usefulness of inflammatory markers to indicate bacterial infection-analyzed according to blood culture results and related clinical factors.

    Science.gov (United States)

    Nishikawa, Hirokazu; Shirano, Michinori; Kasamatsu, Yu; Morimura, Ayumi; Iida, Ko; Kishi, Tomomi; Goto, Tetsushi; Okamoto, Saki; Ehara, Eiji

    2016-01-01

    To assess relationships of inflammatory markers and 2 related clinical factors with blood culture results, we retrospectively investigated inpatients' blood culture and blood chemistry findings that were recorded from January to December 2014 using electronic medical records and analyzed the data of 852 subjects (426 culture-positive and 426 culture-negative). Results suggested that the risk of positive blood culture statistically increased as inflammatory marker levels and the number of related factors increased. Concerning the effectiveness of inflammatory markers, when the outcome definition was also changed for C-reactive protein (CRP), the odds ratio had a similar value, whereas when the outcome definition of blood culture positivity was used for procalcitonin (PCT), the greatest effectiveness of that was detected. Therefore, the current results suggest that PCT is more useful than CRP as an auxiliary indication of bacterial infection. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Medication errors: prescribing faults and prescription errors.

    Science.gov (United States)

    Velo, Giampaolo P; Minuz, Pietro

    2009-06-01

    1. Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients. 2. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. 3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. 4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. 5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.

  20. Psychiatric Prescribers' Experiences With Doctor Shoppers.

    Science.gov (United States)

    Worley, Julie; Johnson, Mary; Karnik, Niranjan

    2015-01-01

    Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs. © The Author(s) 2015.

  1. Differential expression of cyclin Dl in human pituitary tumors: relation to MIB-1 and p27/Kipl labeling indices

    International Nuclear Information System (INIS)

    Hewedi, I.H.; Osman, W.M.; El Mahdy, M.M.

    2011-01-01

    Pituitary tumors are a common form of endocrine neoplasia. However few studies assessed the expression of the principal cyclin regulating checkpoint exit, cyclin Dl. Cyclin Dl expression in pituitary tumors and its possible relation to MIB-1 and p27/K.ipl labeling indices (Us) was explored. Design: We studied a total of 199 pituitaries, including normal pituitaries (n = 7), pituitary adenomas (n = 187), and pituitary carcinoma (n = 5). All tissues were tested as cores of archived tissue microarrays that were immuno stained for cyclin Dl, MIB-1 and p27 using a standard technique. Tissue cores were subjected to automated analysis to evaluate the staining LIs, Results: No cyclin Dl positive cells in the normal anterior pituitary gland was found. Sparse nuclear staining was noted in pituitary tumors. Higher expression of cyclin Dl was noted in pituitary carcinomas compared to adenomas (p < 0.001), in non-functioning adenomas compared to functioning ones (p < 0.001) in macroadenomas versus micro adenomas (p — 0.017) and in recurrent non recurrent adenomas (p < 0.001). Cyclin Dl LI and MIB-1 LI were related among adenomas (p < 0.001) and carcinomas (p = 0.041). p27 LI was neither related to pituitary adenoma recurrence nor invasion. Conclusions: Expression of cyclin Dl in pituitary tumors is related to cell proliferation, recurrence, and metastatic potential. Nuclear cyclin Dl expression is a good marker of aggressive behavior in pituitary tumors

  2. DOE Safety Metrics Indicator Program (SMIP) Fiscal Year 2000 Annual Report of Packaging- and Transportation-related Occurrences

    International Nuclear Information System (INIS)

    Dickerson, L.S.

    2001-01-01

    The U.S. Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS) is an interactive computer system designed to support DOE-owned or -operated facilities in reporting and processing information concerning occurrences related to facility operations. The Oak Ridge National Laboratory has been charged by the DOE National Transportation Program Albuquerque (NTPA) with the responsibility of retrieving reports and information pertaining to packaging and transportation (P and T) incidents from the centralized ORPS database. These selected reports are analyzed for safety concerns, trends, potential impact on P and T operations, and ''lessons learned'' in P and T safety. To support this analysis and trending, the Safety Metrics Indicator Program (SMIP) was established by the NTPA in fiscal year (FY) 1998. Its chief goal is to augment historical reporting of occurrence-based information by providing (1) management notification of those incidents that require attention, (2) an accurate picture of contractors' P and T-related performance, and (3) meaningful statistics on occurrences at particular sites, including comparisons among different contractor sites and between DOE and the private sector. This annual report contains information on those P and T-related occurrences reported to the ORPS during the period from October 1, 1999, through September 30, 2000. Only those incidents that occur in preparation for transport, during transport, and during unloading of hazardous material are considered as packaging- or transportation-related occurrences

  3. Care centre visits to married people living with HIV: an indicator for measuring AIDS-related stigma & discrimination.

    Science.gov (United States)

    Green, D A; Devi, S; Paulraj, L S

    2007-08-01

    We tested whether observation of the presence and relationship of attendants (i.e. those that accompany upon admission) and visitors to a sample of 230 (128 male, 102 female) married HIV-positive people in an HIV care centre provides an indicator of caregiving, AIDS-related stigma and discrimination. Sensitivity to gender, location (urban vs. rural), age (35) and source of infection (spouse vs. non-spouse) were factors considered to modulate AIDS-related stigma and assess discrimination. HIV-positive people were accompanied by their spouse (53%), mother (14%), father (7%), with only 7% attending alone. Immediate family most commonly accompanied on admission (80%), but visitors were mainly from the 'extended' family (32%) with many receiving no visitors (48%). Females (11%) were more likely than males to attend alone (11% vs. 4%; prate of no visitors than persons not infected by their spouse (54% vs. 40%; pdiscrimination. The measure appears particularly sensitive to the gender of the HIV-positive person. Such a measure may aid healthcare professionals to focus resources such as relational counselling upon the family and close friends of people experiencing AIDS-related stigma and discrimination, with the aim of improving the provision of care within the community.

  4. Serum Adiponectin and Leptin Concentrations in Relation to Body Fat Distribution, Hematological Indices and Lipid Profile in Humans

    Directory of Open Access Journals (Sweden)

    Anna Lubkowska

    2015-09-01

    Full Text Available The purpose of the study was to evaluate the relationship between serum adiponectin and leptin concentrations and body composition, hematological indices and lipid profile parameters in adults. The study involved 95 volunteers (BMI from 23.3 to 53 kg/m2. Anthropometric parameters were measured: body weight and height, waist and hip circumference, waist-to-hip ratio, body fat mass (BMF, subcutaneous and visceral fat mass (SFM, VFM, lean body mass (LBM, skeletal muscle mass (SMM. In serum we determined adiponectin and leptin concentrations, extracellular hemoglobin, total bilirubin, as well as lipid metabolism (TCh, HDL-Ch, LDL-Ch, TG. Mean adipokine levels were significantly higher in women (p ≤ 0.01, adiponectin significantly negatively correlated with body height and weight, systolic blood pressure and absolute LBM and SMM values. The same relation was observed for erythroid system indicators and lipid indicators. A positive correlation was exceptionally found between adiponectin and HDL-Ch. LEP negatively correlated with some percentage rates (%LBM, %SMM. Only in women, we observed a positive correlation between LEP and body weight, BMI and WHR. Studies on ADPN and the ADPN/LEP ratio as a valuable complementary diagnostic element in the prediction and prevention of cardiovascular diseases need to be continued.

  5. Analysis of climate change indices in relation to wine production: A case study in the Douro region (Portugal

    Directory of Open Access Journals (Sweden)

    Blanco-Ward Daniel

    2017-01-01

    Full Text Available Climate change is of major relevance to wine production as most of the wine-growing regions of the world, in particular the Douro region, are located within relatively narrow latitudinal bands with average growing season temperatures limited to 13–21°C. This study focuses on the incidence of climate variables and indices that are relevant both for climate change detection and for grape production with particular emphasis on extreme events (e.g. cold waves, storms, heat waves. Dynamical downscaling of MPI-ESM-LR global data forced with RCP8.5 climatic scenario is performed with the Weather Research and Forecast (WRF model to a regional scale including the Douro valley of Portugal for recent-past (1986–2005 and future periods (2046–2065; 2081–2100. The number, duration and intensity of events are superimposed over critical phenological phases of the vine (dormancy, bud burst, flowering, véraison, and maturity in order to assess their positive or negative implications on wine production in the region. An assessment on the statistical significance of climatic indices, their differences between the recent-past and the future scenarios and the potential impact on wine production is performed. Preliminary results indicate increased climatic stress on the Douro region wine production and increased vulnerability of its vine varieties. These results will provide evidence for future strategies aimed to preserve the high-quality wines in the region and their typicality in a sustainable way.

  6. Work-related stress risk assessment in Italy: the validation study of health safety and executive indicator tool.

    Science.gov (United States)

    Rondinone, Bruna Maria; Persechino, Benedetta; Castaldi, Tiziana; Valenti, Antonio; Ferrante, Pierpaolo; Ronchetti, Matteo; Iavicoli, Sergio

    2012-01-01

    In compliance with the Italian occupational health and safety regulatory framework, as provided by the Lgs. Decree 81/2008, the "work-related stress" risk assessment should follow the same principles as other risk assessments, in accordance with the European Agreement of 8 October 2004; therefore, validated and scientifically proven methodological tools are needed to conduct an adequate work-related stress risk assessment. The UK's Health Safety and Executive (HSE) Indicator Tool (IT) is used for assessing the risk of work-related stress. The aim of this study is to test the factor structure of IT as a measure of work-related stress in a sample of Italian workers. Data collected from 65 Italian organizations (6378 workers) was used for a Confirmatory Factor Analysis (CFA) on the 35-item seven-factor model. The results showed acceptable fit to the data (CFI .90; TLI .89, RMSEA .045). A second CFA was done to test a 35-item six-factor model (CFI .89, TLI .87, RMSEA .047). Both models were tested after removing six items (factor loadings less than .50.), resulting in a 29-item model. Here again, there was an acceptable fit to the data (29-item seven-factor model: CFI .93, TLI .91, RMSEA .044; 29-item six-factor model: CFI .92, TLI .90, RMSEA .046). These findings show that the HSE model satisfactorily adapts to use in a sample of Italian workers. One of the most important innovations introduced in the assessment of work-related stress with the HSE IT is the global approach for identifying work-related stress risk factors, aimed at establishing the best strategy from the viewpoints of prevention officers and also of workers.

  7. Effect of oral administration of probiotics on growth performance, apparent nutrient digestibility and stress-related indicators in Holstein calves.

    Science.gov (United States)

    Zhang, R; Zhou, M; Tu, Y; Zhang, N F; Deng, K D; Ma, T; Diao, Q Y

    2016-02-01

    This study aimed to investigate the effect of dietary supplementation with Lactobacillus plantarum and Bacillus subtilis on growth performance, apparent nutrient digestibility and stress-related indicators in dairy calves. Twenty-four neonatal Holstein calves were randomly allocated to three treatments: a basal diet with no supplementation (control), the basal diet supplemented with 1.7 × 10(10) CFU per head per day (CFU/h.d) of L. plantarum GF103 (LB group) or the basal diet supplemented with a mixture of L. plantarum GF103 (1.7 × 10(10) CFU/h.d) and B. subtilis B27 (1.7 × 10(8) CFU/h.d) (LBS group). Dry matter intake (DMI), average daily gain (ADG), feed conversation ratio (FCR), apparent digestibility of nutrients and stress-related indicators were measured in this trail. The result indicated that no significant differences were observed in DMI or ADG (p > 0.05), but the FCR was improved in the LB group over the first 12 weeks (p > 0.05). The apparent digestibility of nutrients was not altered by probiotics in week 6 (p > 0.05), but the apparent digestibility of total phosphorus was significantly greater in the LB and LBS groups in week 8 (p > 0.05); additionally, an increase in the apparent digestibility of crude protein was detected in the LBS group (p > 0.05). Oral administration of L. plantarum alone improved the T-lymphocyte transformation rate on days 58 and 62 (p > 0.05), while adding the mixture of L. plantarum and B. subtilis increased the T-lymphocyte transformation rate (p > 0.05) but decreased the content of cortisol on day 58 (p > 0.05). No significant differences were detected between the LB and LBS groups in growth performance, apparent digestibility of nutrients and stress-related indicators (p > 0.05). The results suggested that oral administration of L. plantarum improved growth performance, nutrient digestibility and relieved weaning stress in calves, but no additional effect was obtained by supplementation with B. subtilis. Journal of

  8. Effect of nitrogen supply on some indices of plant-water relations of beans (Phaseolus vulgaris L. )

    Energy Technology Data Exchange (ETDEWEB)

    Shimshi, D

    1970-01-01

    The effect of nitrogen supply on some indices of plant-water relations was studied on potted bean plants. When soil moisture was relatively high, the leaves of N-deficient plants transpired less than those of N-supplied plants, the transpiration rate being closely associated with the chlorophyll content of the leaves of various ages. In detached leaves which were saturated by floating over distilled water, stomatal width was markedly wider in N-supplied than in N-deficient plants. Throughout the available moisture range, the water saturation deficit was higher in N-supplied leaves. In the dry range of soil moisture, chlorotic leaves transpired more than normal green leaves; N-deficient plants failed to exhibit a sharp rise in the content of soluble metabolites in the sap, when approaching the wilting range. The content of cell wall materials was higher in N-deficient plants. The relationships between these indices is discussed; it is tentatively concluded that nitrogen deficiency impairs the ability of the plants to adjust their water status to changes in soil moisture by regulation of stomatal transpiration and of sap solute concentration. 21 references, 2 tables.

  9. The Urban Exploitation Platform - An instrument for the global provision of indicators related to sustainable cities and communities

    Science.gov (United States)

    Esch, Thomas; Asamer, Hubert; Hirner, Andreas; Marconcini, Mattia; Metz, Annekatrin; Uereyen, Soner; Zeidler, Julian; Boettcher, Martin; Permana, Hans; Boissier, Enguerran; Mathot, Emmanuel; Soukop, Tomas; Balhar, Jakub; Svaton, Vaclav; Kuchar, Stepan

    2017-04-01

    The Sentinel fleet will provide a so-far unique coverage with Earth Observation (EO) data and therewith new opportunities for the implementation of methodologies to generate innovative geo-information products and services supporting the SDG targets. It is here where the TEP Urban project is supposed to initiate a step change by providing an open and participatory platform that allows any interested user to easily exploit large-volume EO data pools, in particular those of the European Sentinel and the US Landsat missions, and derive thematic geo-information, metrics and indicators related to the status and development of the built environment. Key component of TEP Urban initiative is the implementation of a web-based platform (https://urban-tep.eo.esa.int) employing distributed high-level computing infrastructures and providing key functionalities for i) high-performance access to satellite imagery and other data sources such as statistics or topographic data, ii) state-of-the-art pre-processing, analysis, and visualization techniques, iii) customized development and dissemination of algorithms, products and services, and iv) networking and communication. This contribution introduces the main facts about the TEP Urban platform, including a description of the general objectives, the platform systems design and functionalities, and the available portfolio of products and services that can directly serve the global provision of indicators for SDG targets, in particular related to SDG 11.

  10. Influences on the prescribing of new drugs.

    Science.gov (United States)

    Tobin, Luke; de Almedia Neto, Abelio C; Wutzke, Sonia; Patterson, Craig; Mackson, Judith; Weekes, Lynn; Williamson, Margaret

    2008-01-01

    The aim of this study was to identify the factors that influence prescribing of new drugs among general practitioners, endocrinologists and psychiatrists. Four focus groups were conducted with GPs, endocrinologists and psychiatrists on sources of awareness and influences on prescribing of new drugs. Pharmaceutical companies were the most important source for becoming aware of new drugs. There were many influences on the decision to prescribe a new drug, the most important being efficacy, safety, cost and advantage over existing therapies. Endocrinologists placed greater emphasis on evidence from clinical trials and scientific conferences, and psychiatrists and GPs placed more weight on pharmaceutical representatives, colleagues and specialists. New drug prescribing occurs in a complex environment with many influences. Effective interventions to promote rational, safe and effective prescribing of new drugs will need to be cognisant of these factors.

  11. Indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle: 95 cases (1999-2011).

    Science.gov (United States)

    Hartnack, Amanda K; Niehaus, Andrew J; Rousseau, Marjolaine; Pentecost, Rebecca L; Miesner, Matt D; Anderson, David E

    2015-09-15

    To evaluate indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle. Retrospective case series. 95 cattle that underwent rumenotomy or rumenostomy. Medical records for 95 cattle that underwent either rumenostomy or rumenotomy at 2 veterinary teaching hospitals in 1999 through 2011 were analyzed. Reasons for the procedures were noted. Long-term outcome was determined during telephone interviews with owners. 42 (44%) bovids underwent rumenostomy and 53 (56%) bovids underwent rumenotomy. Among the 42 animals undergoing rumenostomy, 18 (43%) had rumen cannulas placed during elective procedures. Other indications for rumenostomy included ruminal tympany (bloat [n = 20]), esophageal obstruction (choke [1]), grain overload (1), and provision of access for administration of enteral nutrition (2). Indications for rumenotomy included traumatic reticuloperitonitis (n = 31), bloat (9), foreign body (6), choke (5), and other (2). Long-term follow-up data were available for 31 of 42 (74%) bovids that underwent rumenostomy. Of those 31 animals, 17 (55%) were still in the herd, 4 (13%) had been culled, and 10 (32%) had died or were euthanized. Long-term follow-up data were available for 38 of 53 (72%) bovids that underwent rumenotomy. Of those 38 animals, 13 (34%) were still in the herd, 14 (37%) had been culled, and 11 (29%) had died or been euthanized. Results indicated that rumenotomy and rumenostomy can be effective in treating or relieving complications secondary to forestomach disorders in cattle. Bovids undergoing rumen surgery had a favorable prognosis for survival and a fair prognosis for potential return to production.

  12. Antibiotic prescribing practices for catheter urine culture results.

    Science.gov (United States)

    Chiu, Jonathan; Thompson, G William; Austin, Thomas W; Hussain, Zafar; John, Michael; Bombassaro, Anne Marie; Connelly, Sarah E; Elsayed, Sameer

    2013-01-01

    The literature suggests that positive results of catheter urine cultures frequently lead to unnecessary antimicrobial prescribing, which therefore represents an important target for stewardship. To assess the appropriateness of antibiotic prescribing in response to the results of urine cultures from patients with indwelling urinary catheters. This retrospective study was conducted at a tertiary care centre and involved adults with indwelling urinary catheters from whom urine specimens were obtained for culture. Patients with positive or negative culture results were identified from microbiology laboratory reports. The medical records of consecutive patients were screened to select a sample of 80 inpatients (40 per group). Abstracted patient histories were independently evaluated by an expert panel of 3 infectious diseases consultants blinded to the decisions of prescribers and of fellow panelists. The primary end point was concordance of each patient's treatment decision (with respect to the indication) between the expert panel (based on majority agreement, i.e., at least 2 of the 3 expert panelists) and the prescriber. The secondary end points were unnecessary days of therapy and selected outcomes over a predefined period after urine was obtained for culture. A total of 591 charts were screened to generate the targeted number of patients. Baseline demographic characteristics were comparable for the 2 groups, except antibiotic exposure before urine collection was significantly more frequent for the group with negative culture results. The treatment decision was concordant in 40% (16/40) of the patients with a positive culture result and 85% (34/40) of those with a negative culture result (p < 0.001). The most common reason for discordance was administration of antibiotics when not indicated (23 of 24 patients with a positive result and 5 of 6 patients with a negative result), which accounted for 165 and 32 unnecessary days of therapy per 1000 inpatient

  13. Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans

    Science.gov (United States)

    Theou, Olga; Brothers, Thomas D.; Rockwood, Michael R.; Haardt, David; Mitnitski, Arnold; Rockwood, Kenneth

    2013-01-01

    Background: on an individual level, lower-income has been associated with disability, morbidity and death. On a population level, the relationship of economic indicators with health is unclear. Objective: the purpose of this study was to evaluate relative fitness and frailty in relation to national income and healthcare spending, and their relationship with mortality. Design and setting: secondary analysis of data from the Survey of Health, Ageing and Retirement in Europe (SHARE); a longitudinal population-based survey which began in 2004. Subjects: a total of 36,306 community-dwelling people aged 50 and older (16,467 men; 19,839 women) from the 15 countries which participated in the SHARE comprised the study sample. A frailty index was constructed as the proportion of deficits present in relation to the 70 deficits available in SHARE. The characteristics of the frailty index examined were mean, prevalence of frailty and proportion of the fittest group. Results: the mean value of the frailty index was lower in higher-income countries (0.16 ± 0.12) than in lower-income countries (0.20 ± 0.14); the overall mean frailty index was negatively correlated with both gross domestic product (r = −0.79; P < 0.01) and health expenditure (r = −0.63; P < 0.05). Survival in non-frail participants at 24 months was not associated with national income (P = 0.19), whereas survival in frail people was greater in higher-income countries (P < 0.05). Conclusions: a country's level of frailty and fitness in adults aged 50+ years is strongly correlated with national economic indicators. In higher-income countries, not only is the prevalence of frailty lower, but frail people also live longer. PMID:23443511

  14. The viability of prescribed fire for mitigating the soil degradational impacts of wildfire

    Science.gov (United States)

    Shakesby, R. A.; Bento, C. P. M.; Ferreira, C. S. S.; Ferreira, A. J. D.; Stoof, C. R.; Urbanek, E.; Walsh, R. P. D.

    2012-04-01

    Prescribed (controlled) fire has become an important strategy primarily to limit the likelihood of more devastating wildfire. The considerable increase in wildfire activity in recent decades throughout the Mediterranean, and in Portugal in particular, has meant that this strategy has become increasingly popular despite inherent fears of people about fire of any sort. Despite many studies of the impact of wildfire on soil erosion and degradation, relatively little research has assessed impacts of prescribed fire on soil in Portugal or elsewhere in the Mediterranean. As part of the DESIRE research programme, this paper addresses this research gap by investigating hillslope-scale losses of soil, soil organic matter and selected nutrients before and after an experimental fire (representing a 'worst case-scenario' prescribed fire) in a shrub-vegetated catchment in central Portugal. Comparison is provided by post-fire monitoring of a nearby hillslope affected by a wildfire of moderate severity. Hillslope-scale measurements were carried out over c. 3 years using sediment fences with contributing areas of up to c. 0.5 ha. Eroded sediment was periodically removed from the fences both before and after the fire at intervals ranging from a few weeks to several months depending on rainfall characteristics and logistics. Erosion expressed as g/m2 and g/m2/mm of rainfall was determined. Figures for long-term (c. 10 years) erosion under unburnt conditions for this vegetation type were obtained from a small bounded plot and from sediment accumulating in a weir pool draining a sub-catchment within the prescribed-fire catchment. In addition, soil organic matter and selected nutrients, including K2O, P2O5 and Total N, were measured in the eroded sediment and in the pre-burn and post-burn in situ soil. The results indicate that both the wildfire and prescribed fire caused erosion that was orders of magnitude higher than for long-term plot-scale and hillslope-scale erosion recorded

  15. A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety.

    Science.gov (United States)

    Page, N; Baysari, M T; Westbrook, J I

    2017-09-01

    To assess the evidence of the effectiveness of different categories of interruptive medication prescribing alerts to change prescriber behavior and/or improve patient outcomes in hospital computerized provider order entry (CPOE) systems. PubMed, Embase, CINAHL and the Cochrane Library were searched for relevant articles published between January 2000 and February 2016. Studies were included if they compared the outcomes of automatic, interruptive medication prescribing alert/s to a control/comparison group to determine alert effectiveness. Twenty-three studies describing 32 alerts classified into 11 alert categories were identified. The most common alert categories studied were drug-condition interaction (n=6), drug-drug interaction alerts (n=6) and corollary order alerts (n=6). All 23 papers investigated the effect of the intervention alert on at least one outcome measure of prescriber behavior. Just over half of the studies (53%, n=17) reported a statistically significant beneficial effect from the intervention alert; 34% (n=11) reported no statistically significant effect, and 6% (n=2) reported a significant detrimental effect. Two studies also evaluated the effect of alerts on patient outcome measures; neither finding that patient outcomes significantly improved following alert implementation (6%, n=2). The greatest volume of evidence relates to three alert categories: drug-condition, drug-drug and corollary order alerts. Of these, drug-condition alerts had the greatest number of studies reporting positive effects (five out of six studies). Only two of six studies of drug-drug interaction and one of six of corollary alerts reported positive benefits. The current evidence-base does not show a clear indication that particular categories of alerts are more effective than others. While the majority of alert categories were shown to improve outcomes in some studies, there were also many cases where outcomes did not improve. This lack of evidence hinders decisions

  16. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial.

    Science.gov (United States)

    Meeker, Daniella; Knight, Tara K; Friedberg, Mark W; Linder, Jeffrey A; Goldstein, Noah J; Fox, Craig R; Rothfeld, Alan; Diaz, Guillermo; Doctor, Jason N

    2014-03-01

    "Nudges" that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice. To investigate the use of a behavioral "nudge" based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections (ARIs). Randomized clinical trial in 5 outpatient primary care clinics. A total of 954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention). The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks. These letters, featuring clinician photographs and signatures, stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status. Baseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, we found that the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). There was no evidence of diagnostic coding shift, and rates of appropriate antibiotic prescriptions did not diminish over time. Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more

  17. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management.

    Science.gov (United States)

    Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L

    2014-01-01

    To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management. Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

  18. A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency.

    Science.gov (United States)

    Russ, Alissa L; Chen, Siying; Melton, Brittany L; Johnson, Elizabette G; Spina, Jeffrey R; Weiner, Michael; Zillich, Alan J

    2015-09-01

    Drug-drug interactions (DDIs) are common in clinical care and pose serious risks for patients. Electronic health records display DDI alerts that can influence prescribers, but the interface design of DDI alerts has largely been unstudied. In this study, the objective was to apply human factors engineering principles to alert design. It was hypothesized that redesigned DDI alerts would significantly improve prescribers' efficiency and reduce prescribing errors. In a counterbalanced, crossover study with prescribers, two DDI alert designs were evaluated. Department of Veterans Affairs (VA) prescribers were video recorded as they completed fictitious patient scenarios, which included DDI alerts of varying severity. Efficiency was measured from time-stamped recordings. Prescribing errors were evaluated against predefined criteria. Efficiency and prescribing errors were analyzed with the Wilcoxon signed-rank test. Other usability data were collected on the adequacy of alert content, prescribers' use of the DDI monograph, and alert navigation. Twenty prescribers completed patient scenarios for both designs. Prescribers resolved redesigned alerts in about half the time (redesign: 52 seconds versus original design: 97 seconds; p<.001). Prescribing errors were not significantly different between the two designs. Usability results indicate that DDI alerts might be enhanced by facilitating easier access to laboratory data and dosing information and by allowing prescribers to cancel either interacting medication directly from the alert. Results also suggest that neither design provided adequate information for decision making via the primary interface. Applying human factors principles to DDI alerts improved overall efficiency. Aspects of DDI alert design that could be further enhanced prior to implementation were also identified.

  19. Specialist pediatric palliative care prescribing practices: A large 5-year retrospective audit

    Directory of Open Access Journals (Sweden)

    Anuja Damani

    2016-01-01

    Full Text Available Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010-2014 to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%, and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription

  20. Fire hazard after prescribed burning in a gorse shrubland: implications for fuel management.

    Science.gov (United States)

    Marino, Eva; Guijarro, Mercedes; Hernando, Carmen; Madrigal, Javier; Díez, Carmen

    2011-03-01

    Prescribed burning is commonly used to prevent accumulation of biomass in fire-prone shrubland in NW Spain. However, there is a lack of knowledge about the efficacy of the technique in reducing fire hazard in these ecosystems. Fire hazard in burned shrubland areas will depend on the initial capacity of woody vegetation to recover and on the fine ground fuels existing after fire. To explore the effect that time since burning has on fire hazard, experimental tests were performed with two fuel complexes (fine ground fuels and regenerated shrubs) resulting from previous prescribed burnings conducted in a gorse shrubland (Ulex europaeus L.) one, three and five years earlier. A point-ignition source was used in burning experiments to assess ignition and initial propagation success separately for each fuel complex. The effect of wind speed was also studied for shrub fuels, and several flammability parameters were measured. Results showed that both ignition and initial propagation success of fine ground fuels mainly depended on fuel depth and were independent of time since burning, although flammability parameters indicated higher fire hazard three years after burning. In contrast, time since burning increased ignition and initial propagation success of regenerated shrub fuels, as well as the flammability parameters assessed, but wind speed had no significant effect. The combination of results of fire hazard for fine ground fuels and regenerated shrubs according to the variation in relative coverage of each fuel type after prescribed burning enabled an assessment of integrated fire hazard in treated areas. The present results suggest that prescribed burning is a very effective technique to reduce fire hazard in the study area, but that fire hazard will be significantly increased by the third year after burning. These results are valuable for fire prevention and fuel management planning in gorse shrubland areas. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. Neuropharmacology and mental health nurse prescribers.

    Science.gov (United States)

    Skingsley, David; Bradley, Eleanor J; Nolan, Peter

    2006-08-01

    To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they

  2. An overview of prescribed fire in Arkansas and Oklahoma over the last 40 years

    Science.gov (United States)

    Roger D. Fryar

    2012-01-01

    Over the last 40 years, prescribed fire programs on National Forest lands have grown from relatively insignificant to a major emphasis area of natural resource management. During this same period, social, economic, and cultural values have greatly changed. The public's environmental awareness has likewise grown. How prescribed fire programs in Arkansas and...

  3. Tree-centered spot firing - a technique for prescribed burning beneath standing trees.

    Science.gov (United States)

    C. Phillip Weatherspoon; George A. Almond; Carl N. Skinner

    1989-01-01

    Prescribed burning beneath standing trees normally requires efforts to protect residual trees from excessive fire damage. Damage to both crowns and boles is strongly influenced by flame length, a fire characteristic functionally related to fireline intensity (Albini 1976). In a good prescribed burn, therefore, the prescription specifies desired or maximum flame lengths...

  4. Smile satisfaction and its related indicators in students of School of Dentistry, Qazvin University of Medical Sciences (2013-2014

    Directory of Open Access Journals (Sweden)

    B. Ranjbar Omidi

    2015-12-01

    Full Text Available Background: Smile is one of the most important factors determining the attractiveness of a person and has an important role in his mood and influence on others. Objective: The aim of this study was to evaluate the smile satisfaction and its related indicators in the students of School of Dentistry affiliated to Qazvin University of Medical Sciences. Methods: This cross sectional study was conducted on 80 students of School of Dentistry in Qazvin during 2013-2014. Digital photograph was provided from students’ smile. Smile esthetics of pictures was evaluated by three faculty members of restorative and orthodontics departments based on visual analogue scale. Smile satisfaction was evaluated by the students. Smile line ratio, buccal corridor ratio and symmetric ratio were measured by Photo shop CS5 software. Data were analyzed using Pearson’s correlation coefficient. Findings: Mean smile esthetics score was 59±10.5 and 71±9.4 in male and female students, respectively and the difference was statistically significant. Mean self-reported smile satisfaction was 73.7±7.8% and 72.4±17.9% in male and female students, respectively and the difference was not statistically significant. Smile line ratio was significantly different between male and female students, but the differences in buccal corridor ratio and symmetric ratio was not statistically significant. There was positive significant correlation between smile line ratio and smile esthetics score. Among the morphometric indices, only smile line ratio had significant correlation with smile satisfaction in male students. Conclusion: The correlation between smile line ratio and smile satisfaction indicates the high capability of this morphometric index for evaluating smile satisfaction.

  5. Impact of stimulus-related factors and hearing impairment on listening effort as indicated by pupil dilation

    DEFF Research Database (Denmark)

    Ohlenforst, Barbara; Zekveld, Adriana A.; Lunner, Thomas

    2017-01-01

    Previous research has reported effects of masker type and signal-to-noise ratio (SNR) on listening effort, as indicated by the peak pupil dilation (PPD) relative to baseline during speech recognition. At about 50% correct sentence recognition performance, increasing SNRs generally results...... in declining PPDs, indicating reduced effort. However, the decline in PPD over SNRs has been observed to be less pronounced for hearing-impaired (HI) compared to normal-hearing (NH) listeners. The presence of a competing talker during speech recognition generally resulted in larger PPDs as compared......-talker masker) on the PPD during speech perception. Twenty-five HI and 32 age-matched NH participants listened to sentences across a broad range of SNRs, masked with speech from a single talker (-25 dB to +15 dB SNR) or with stationary noise (-12 dB to +16 dB). Correct sentence recognition scores and pupil...

  6. Evaluating the quality of Websites related to Hospital-Based Home Care: The Credibility Indicator as a prognostic factor

    Directory of Open Access Journals (Sweden)

    María Sanz-Lorente

    2017-04-01

    Full Text Available Objective: To evaluate the documental quality of websites related to Home Care Services. Method: This is a descriptive cross-sectional study of websites based on Home Care Services, using searches on Google to access the study population. The “fallacy sample” of this search engine was take into account. The quality was studied thought the 8 variables of the Credibility Indicator (CI. Results: A total of 215 active websites, mainly belonging to the media, were evaluated. None of the websites met all 8 items in the CI. Mean of 2,12 ± 0,07; Minimum of 0 and Maximum of 5; Median equal to 3. Within the studied websites, 74 (34,42% presented both authorship and affiliation. There was an association between the CI accomplishment and websites that had these 2 variables (p <0.001. Conclusions: The quality of websites covering issues of Hospital-Based Home Care services is still poor. It is confirmed that identifying authorship and affiliation is an important factor in predicting the quality of the information. The Credibility Indicator is a useful aid when determining the quality of a website.

  7. The relation between indicators of low employment quality and attendance behavior in countries of the European Union.

    Science.gov (United States)

    Janssens, Heidi; Braeckman, Lutgart; De Clercq, Bart; De Bacquer, Dirk; Clays, Els

    2017-12-01

    Previous research demonstrated an association between low employment quality and lower sickness absence, which may be explained by presenteeism. Therefore, this study aimed exploring the relation between three indicators of employment quality (long working hours, precarious employment, job insecurity) and attendance behavior. The association between employment quality and attendance behavior was investigated in 28.999 workers (mean age: 40.0 years, 53% males) of the fifth wave of the European Working Conditions Survey, using multilevel multinomial logistic regression analysis. Attendance behavior was operationalized as different combinations of sickness absence and presenteeism. Those working >48 h/week, had a higher risk to report presenteeism (with or without sickness absence). They had a lower risk to report sickness absence without presenteeism. Workers with a precarious contract had a lower risk to report absenteeism without presenteeism and the combination of both presenteeism and absenteeism. Finally, for workers perceiving job insecurity, the risk for presenteeism without sickness absence was significantly higher. Several indicators of low employment quality were associated with attendance behavior, suggesting a complex behavioral mechanism in workers facing low job quality employment. Therefore, policy makers are recommended to re-establish the indefinite contractual employment as the standard, avoiding long working hours. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  8. Can examination of WWW usage statistics and other indirect quality indicators distinguish the relative quality of medical web sites?

    Science.gov (United States)

    Hernández-Borges, A A; Macías-Cervi, P; Gaspar-Guardado, M A; Torres-Alvarez de Arcaya, M L; Ruiz-Rabaza, A; Jiménez-Sosa, A

    1999-01-01

    The Internet offers a great amount of health related websites, but concern has been raised about their reliability. Several subjective evaluation criteria and websites rating systems have been proposed as a help for the Internet users to distinguish among web resources with different quality, but their efficacy has not been proven. To evaluate the agreement of a subset of Internet rating systems editorial boards regarding their evaluations of a sample of pediatric websites. To evaluate certain websites characteristics as possible quality indicators for pediatric websites. Comparative survey of the Results of systematic evaluations of the contents and formal aspects of a sample of pediatric websites, with the number of daily visits to those websites, the time since their last update, the impact factor of their authors or editors, and the number of websites linked to them. 363 websites were compiled from eight rating systems. Only 25 were indexed and evaluated by at least two rating systems. This subset included more updated and more linked websites. There was no correlation among the Results of the evaluation of these 25 websites by the rating systems. The number of inbound links to the websites significantly correlated with their updating frequency (pquality indicators. On the other hand, the citation analysis on the Web by the quantification of inbound links to medical websites could be an objective and feasible tool in rating great amounts of websites.

  9. Associated fauna and effects of epibiotic barnacles on the relative growth and reproductive indices of Stramonita haemastoma (Gastropoda: Muricidae

    Directory of Open Access Journals (Sweden)

    Tahani El Ayari

    2015-06-01

    Full Text Available To better understand the impacts of biofouling on the biological processes of the basibiont, the effects of epibiotic barnacles on the relative growth and reproductive indices of Stramonita haemastoma (Linnaeus, 1767 were assessed. A total of 1035 specimens were collected monthly for one year from Bizerta Channel (northern Tunisia. Endobiotic species comprised the lithophagous bivalves Lithophaga aristata and Rocellaria dubia of different sizes, communicating with the outside through tiny perforations. Intra-shell tunnels and galleries also sheltered annelids and sipunculids. Epibiotic species comprised algae and highly diversified invertebrates represented by crustaceans, polychaetes, molluscs, echinoderms, ascidians, sponges, bryozoans and sipunculids, with barnacles being the most common group. Comparison of growth features between non-fouled and fouled S. haemastoma revealed higher growth in non-fouled specimens. Differences in reproductive condition indices were detected in few months, being mostly higher in non-fouled snails, but showed no asynchrony in the spawning period for either fouled or non-fouled gastropods hosts.

  10. Processing of visual semantic information to concrete words: temporal dynamics and neural mechanisms indicated by event-related brain potentials( ).

    Science.gov (United States)

    van Schie, Hein T; Wijers, Albertus A; Mars, Rogier B; Benjamins, Jeroen S; Stowe, Laurie A

    2005-05-01

    Event-related brain potentials were used to study the retrieval of visual semantic information to concrete words, and to investigate possible structural overlap between visual object working memory and concreteness effects in word processing. Subjects performed an object working memory task that involved 5 s retention of simple 4-angled polygons (load 1), complex 10-angled polygons (load 2), and a no-load baseline condition. During the polygon retention interval subjects were presented with a lexical decision task to auditory presented concrete (imageable) and abstract (nonimageable) words, and pseudowords. ERP results are consistent with the use of object working memory for the visualisation of concrete words. Our data indicate a two-step processing model of visual semantics in which visual descriptive information of concrete words is first encoded in semantic memory (indicated by an anterior N400 and posterior occipital positivity), and is subsequently visualised via the network for object working memory (reflected by a left frontal positive slow wave and a bilateral occipital slow wave negativity). Results are discussed in the light of contemporary models of semantic memory.

  11. Nonattendance to medical specialists’ appointments and its relation to regional environmental and socioeconomic indicators in the Chilean public health system

    Directory of Open Access Journals (Sweden)

    Elizabeth Angélica Salinas Rebolledo

    2014-10-01

    Full Text Available INTRODUCTION Medical care provided by medical specialists is one of the scarcest resources in the public system. It is costly and difficult to access for the general population. Availability and accessibility of specialized care is related to economic, social and cultural aspects that vary among geographical areas. An aggravating factor for this situation is patients’ failure to appear on the date of their appointment, which is defined as the nonattendance of patients to medical specialist appointments without notice. OBJECTIVES To measure and analyze the phenomenon of nonattendance of patients to medical appointments with specialists in the public healthcare system of Chile and its relationship with environmental and socioeconomic regional indicators. METHODS Ecological design study, using medical care records in the public system and environmental and socioeconomic regional indicators potentially related to the absence of patients, between the years 2005-2010. Poisson regression models with random components were used for assessing associations. RESULTS There is 16.5% of nonattendance of patients, with a range between regions from 8.8 to 20.2%. Nonattendance is higher in the specialties of dermatology, geriatrics and nutrition (20.0%, in children (3.1% more than in adults, in areas with highest indigenous population (RR=1.3, in areas with low diversity of specialties (RR=1.1 and in the months of February, July, November and December (RR>1.1. CONCLUSIONS In Chile, socioeconomic factors and the management of healthcare resources have greater influence on the nonattendance of patients to medical specialists’ appointments than environmental factors; therefore, this phenomenon may be avoidable.

  12. Further development of the environment related sustainability indicators and environment core indicator system for balancing the progress in the German sustainability strategy; Weiterentwicklung der umweltbezogenen Nachhaltigkeitsindikatoren und des Umwelt-Kernindikatorensystems zur Bilanzierung der Fortschritte in der deutschen Nachhaltigkeitsstrategie

    Energy Technology Data Exchange (ETDEWEB)

    Schoenthaler, Konstanze; Pieck, Sonja [Bosch und Partner GmbH, Muenchen (Germany)

    2013-05-15

    The Core Set of Environmental Indicators (KIS) presented by the Federal Environment Agency aims to inform policy makers and the interested public in an updated and concise form about environmental progress for a sustainable development in Germany. The Core Set completes the environmental indicators of the National Sustainability Indicator Set by several additional indicators describing environmental impacts and their causes. New legal regulations and political programs as well as innovations in the field of indicator development on the international and national level make a revision of the over ten-years-old Core Set of Environmental Indicators necessary. The project makes structural and content related proposals for such a revision. Following these proposals the Core Indicators shall cover a broader spectrum of environmental themes and problems in order to display cause-and-effect relationships in a more detailed way. The indicator set, which is proposed for the revised edition of KIS, comprises a total of 92 indicators, 49 out of them are directly focused on environmental issues. 43 indicators describe the activities of different economic sectors having relevant impacts on the environment. Furthermore the project offers a new thematic structure for the indicator set and a new classification of the indicators which shall facilitate the orientation and more effective search for themes and indicators within the system. A proposal for a metadata information system consisting of indicators and data factsheets was elaborated to better handle flow of information within the Federal Environment Agency.

  13. Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life

    Directory of Open Access Journals (Sweden)

    Dubois Marie-France

    2005-11-01

    Full Text Available Abstract Background Measures of multimorbidity are often applied to source data, populations or outcomes outside the scope of their original developmental work. As the development of a multimorbidity measure is influenced by the population and outcome used, these influences should be taken into account when selecting a multimorbidity index. The aim of this study was to compare the strength of the association of health-related quality of life (HRQOL with three multimorbidity indices: the Cumulative Illness Rating Scale (CIRS, the Charlson index (Charlson and the Functional Comorbidity Index (FCI. The first two indices were not developed in light of HRQOL. Methods We used data on chronic diseases and on the SF-36 questionnaire assessing HRQOL of 238 adult primary care patients who participated in a previous study. We extracted all the diagnoses for every patient from chart review to score the CIRS, the FCI and the Charlson. Data for potential confounders (age, sex, self-perceived economic status and self-perceived social support were also collected. We calculated the Pearson correlation coefficients (r of the SF-36 scores with the three measures of multimorbidity, as well as the coefficient of determination, R2, while controlling for confounders. Results The r values for the CIRS (range: -0.55 to -0.18 were always higher than those for the FCI (-0.47 to -0.10 and Charlson (-0.31 to -0.04 indices. The CIRS explained the highest percent of variation in all scores of the SF-36, except for the Mental Component Summary Score where the variation was not significant. Variations explained by the FCI were significant in all scores of SF-36 measuring physical health and in two scales evaluating mental health. Variations explained by the Charlson were significant in only three scores measuring physical health. Conclusion The CIRS is a better choice as a measure of multimorbidity than the FCI and the Charlson when HRQOL is the outcome of interest. However

  14. 'It's showed me the skills that he has': pharmacists' and mentors' views on pharmacist supplementary prescribing.

    Science.gov (United States)

    Lloyd, Fran; Parsons, Carole; Hughes, Carmel M

    2010-02-01

    Supplementary prescribing has seen pharmacists assume greater responsibility for prescribing in collaboration with doctors. This study explored the context and experiences, in relation to the practice of supplementary prescribing, of pharmacists and physicians (who acted as their training mentors) at least 12 months after pharmacists had qualified as supplementary prescribers. The setting was primary and secondary healthcare sectors in Northern Ireland. Pharmacists and mentors who had participated in a pre-training study were invited to take part. All pharmacists (n = 47) were invited to participate in focus groups, while mentors (n = 35) were asked to participate in face-to-face semi-structured interviews. The research took place between May 2005 and September 2007. All discussions and interviews were audiotaped, transcribed and analysed using constant comparison. Nine pharmacist focus groups were convened (number per group ranging from three to six; total n = 40) and 31 semi-structured interviews with mentors were conducted. The six main themes that emerged were optimal practice setting, professional progression for prescribing pharmacists, outcomes for prescribing pharmacists, mentors and patients, relationships, barriers to implementation and the future of pharmacist prescribing. Where practised, pharmacist prescribing had been accepted, worked best for chronic disease management, was perceived to have reduced doctors' workload and improved continuity of care for patients. However, three-quarters of pharmacists qualified to practise as supplementary prescribers were not actively prescribing, largely due to logistical and organisational barriers rather than inter-professional tensions. Independent prescribing was seen as contentious by mentors, particularly because of the diagnostic element. Supplementary prescribing has been successful where it has been implemented but a number of barriers remain which are preventing the wider acceptance of this practice

  15. Solar Indices

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  16. Terrestrially derived glomalin-related soil protein quality as a potential ecological indicator in a peri-urban watershed.

    Science.gov (United States)

    Sui, Xueyan; Wu, Zhipeng; Lin, Chen; Zhou, Shenglu

    2017-07-01

    Glomalin, which sequesters substantial amounts of carbon, plays a critical role in sustaining terrestrial biome functions and contributes to the fate of many pollutants from terrestrial to aquatic ecosystems. Despite having focused on the amount of glomalin produced, very few attempts have been made to understand how landscapes and environmental conditions influence glomalin composition and characteristics. This study focused on glomalin-related soil protein (GRSP) exported as storm runoff including eroded sediment and water that was collected before flowing to surface waters in a peri-urban watershed. GRSP characteristics were assessed by Bradford protein analysis, fluorescence spectroscopy combined with parallel factor analysis (PARAFAC), and the determination of aromaticity based on the specific ultraviolet absorption value (280 nm) and molecular weight. General linear models (GLMs) was established by integrating microbial activity, land cover, water temperature, precipitation, and other solution chemical properties to explain the variations in GRSP characteristics. Results showed that a higher GRSP concentration in agricultural reference sites was produced in the form of specific materials with low molecular weight and aromaticity, as well as high percentage of C1 and C5 components which indicate microbial-processed sources, relative to urbanized and forested sites. Compared with forested land, urbanized land clearly produced runoff GRSP with low molecular weight and aromaticity, as well as more degradation of humic-like materials (C3 component). The highest GLM explaining 89% of the variables, including significant variables (p watershed management and thus protecting aquatic ecosystems.

  17. Indication for pharmacological treatment is often lacking

    DEFF Research Database (Denmark)

    Skoog, Jessica; Midlöv, Patrik; Beckman, Anders

    2015-01-01

    depending on gender, age, multimorbidity level and income were calculated. RESULTS: On average 45.1 % (range 12.9 % - 75.8 %) of the patients' prescribed drugs had indication. Proton pump inhibitors were associated with the lowest level of indication (12.9 %) and digoxin was associated with the highest......, if there are any differences in indication for treatment depending on gender, age, level of multimorbidity and income. METHOD: Data were collected on individuals aged 65 years or older in Östergötland County in Sweden. To estimate the individual level of multimorbidity the Johns Hopkins ACG Case-Mix System...... level of indication for treatment (75.8 %). Patients aged 80 years or older had the lowest odds ratios of having indication for treatment. CONCLUSION: On average, there was indication for treatment in less than half of the prescription drugs studied. The quality was highest in relation to multimorbidity...

  18. out-patient prescribing practices at mbagathi district hospital-nairobi

    African Journals Online (AJOL)

    2013-12-01

    Dec 1, 2013 ... Objective: To assess medicine use practices by using WHO prescribing and patient care indicators in .... from the hospital administration and ethics approval ..... additional funds to purchase medicines and medical supplies.

  19. Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system.

    Science.gov (United States)

    Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz

    2014-01-01

    Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling "As-Is" business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems.

  20. Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette".

    Science.gov (United States)

    Charani, E; Castro-Sanchez, E; Sevdalis, N; Kyratsis, Y; Drumright, L; Shah, N; Holmes, A

    2013-07-01

    There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of "noninterference" in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a "prescribing etiquette," which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.

  1. Prescribing Practices and Polypharmacy in Kitovu Hospital

    African Journals Online (AJOL)

    admin

    1Division of Medicine and Therapeutics, Centre for Medical Education, The Queen's ... This audit of prescribing practices explores recent trends at Kitovu Hospital, Uganda ..... This creates a cycle of poor ... interventions to remedy these is vital.

  2. The social act of electronic medication prescribing

    NARCIS (Netherlands)

    J.E.C.M. Aarts (Jos)

    2013-01-01

    markdownabstract__Abstract__ Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of

  3. Customization in prescribing for bipolar disorder.

    Science.gov (United States)

    Hodgkin, Dominic; Volpe-Vartanian, Joanna; Merrick, Elizabeth L; Horgan, Constance M; Nierenberg, Andrew A; Frank, Richard G; Lee, Sue

    2012-06-01

    For many disorders, patient heterogeneity requires physicians to customize their treatment to each patient's needs. We test for the existence of customization in physicians' prescribing for bipolar disorder, using data from a naturalistic clinical effectiveness trial of bipolar disorder treatment (STEP-BD), which did not constrain physician prescribing. Multinomial logit is used to model the physician's choice among five combinations of drug classes. We find that our observed measure of the patient's clinical status played only a limited role in the choice among drug class combinations, even for conditions such as mania that are expected to affect class choice. However, treatment of a patient with given characteristics differed widely depending on which physician was seen. The explanatory power of the model was low. There was variation within each physician's prescribing, but the results do not suggest a high degree of customization in physicians' prescribing, based on our measure of clinical status. Copyright © 2011 John Wiley & Sons, Ltd.

  4. Individual exposure to NO2 in relation to spatial and temporal exposure indices in Stockholm, Sweden: the INDEX study.

    Directory of Open Access Journals (Sweden)

    Tom Bellander

    Full Text Available Epidemiology studies of health effects from air pollution, as well as impact assessments, typically rely on ambient monitoring data or modelled residential levels. The relationship between these and personal exposure is not clear. To investigate personal exposure to NO(2 and its relationship with other exposure metrics and time-activity patterns in a randomly selected sample of healthy working adults (20-59 years living and working in Stockholm. Personal exposure to NO(2 was measured with diffusive samplers in sample of 247 individuals. The 7-day average personal exposure was 14.3 µg/m(3 and 12.5 µg/m(3 for the study population and the inhabitants of Stockholm County, respectively. The personal exposure was significantly lower than the urban background level (20.3 µg/m(3. In the univariate analyses the most influential determinants of individual exposure were long-term high-resolution dispersion-modelled levels of NO(2 outdoors at home and work, and concurrent NO(2 levels measured at a rural location, difference between those measured at an urban background and rural location and difference between those measured in busy street and at an urban background location, explaining 20, 16, 1, 2 and 4% (R(2 of the 7-day personal NO(2 variation, respectively. A regression model including these variables explained 38% of the variation in personal NO(2 exposure. We found a small improvement by adding time-activity variables to the latter model (R(2 = 0.44. The results adds credibility primarily to long-term epidemiology studies that utilise long-term indices of NO(2 exposure at home or work, but also indicates that such studies may still suffer from exposure misclassification and dilution of any true effects. In contrast, urban background levels of NO(2 are poorly related to individual exposure.

  5. National Estimates of Marijuana Use and Related Indicators - National Survey on Drug Use and Health, United States, 2002-2014.

    Science.gov (United States)

    Azofeifa, Alejandro; Mattson, Margaret E; Schauer, Gillian; McAfee, Tim; Grant, Althea; Lyerla, Rob

    2016-09-02

    In the United States, marijuana is the most commonly used illicit drug. In 2013, 7.5% (19.8 million) of the U.S. population aged ≥12 years reported using marijuana during the preceding month. Because of certain state-level policies that have legalized marijuana for medical or recreational use, population-based data on marijuana use and other related indicators are needed to help monitor behavioral health changes in the United States. 2002-2014. The National Survey on Drug Use and Health (NSDUH) is a national- and state-level survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects information about the use of illicit drugs, alcohol, and tobacco; initiation of substance use; frequency of substance use; substance dependence and abuse; perception of substance harm risk or no risk; and other related behavioral health indicators. This report describes national trends for selected marijuana use and related indicators, including prevalence of marijuana use; initiation; perception of harm risk, approval, and attitudes; perception of availability and mode of acquisition; dependence and abuse; and perception of legal penalty for marijuana possession. In 2014, a total of 2.5 million persons aged ≥12 years had used marijuana for the first time during the preceding 12 months, an average of approximately 7,000 new users each day. During 2002-2014, the prevalence of marijuana use during the past month, past year, and daily or almost daily increased among persons aged ≥18 years, but not among those aged 12-17 years. Among persons aged ≥12 years, the prevalence of perceived great risk from smoking marijuana once or twice a week and once a month decreased and the prevalence of perceived no risk increased. The prevalence of past year marijuana dependence and abuse decreased, except among persons aged ≥26 years. Among persons aged ≥12 years, the percentage reporting that marijuana was fairly easy or very easy

  6. Off-label prescribing patterns of antiemetics in children: a multicenter study in Italy.

    Science.gov (United States)

    Zanon, Davide; Gallelli, Luca; Rovere, Francesca; Paparazzo, Rossella; Maximova, Natalia; Lazzerini, Marzia; Reale, Antonio; Corsetti, Tiziana; Renna, Salvatore; Emanueli, Tullia; Mannelli, Francesco; Manteghetti, Francesco; Da Dalt, Liviana; Palleria, Caterina; Banchieri, Nicola; Urbino, Antonio; Miglietta, Mario; Cardoni, Giovanni; Pompilio, Adriana; Arrighini, Alberto; Lazzari, Clara; Messi, Gianni

    2013-03-01

    Acute gastroenteritis (AG) represents both the main cause of acute vomiting in children under 3 years old and a major cause of access to the emergency department. Even if several drugs may be able to reduce the emesis, the pharmacological treatment of vomiting in children remains a controversial issue, and several drugs are prescribed outside their authorized drug label with respect dosage, age, indication, or route of administration and are named as off-label. The aim of present study was to assess the off-label use of antiemetic drugs in patients less than 18 years with vomiting related to AG. This study was carried out in eight pediatric emergency departments in Italy. The following data were obtained crossing the pharmacy distribution records with emergency departments' patient data: sex and age of the patients and detailed information for each drug used (indication, dose, frequency, and route of administration). We recorded that antiemetic drugs were prescribed in every year, particularly in children up to 2 years old, and compared with both literature data and data sheet; 30 % of the administered antiemetics were used off-label. In particular, domperidone was the only antiemetic used labeled for AG treatment in pediatric patients, while metoclopramide and ondansetron have been off-label for both age and indications (i.e., AG treatment). In conclusion, we documented an off-label use of antiemetics in children, and this could represents a problem of safety for the patient and a legal risk for the prescribing physician if patients have an unwanted or bad outcome from treatment.

  7. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    Gallagher Paul F

    2009-01-01

    Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  8. Inappropriate prescribing and adverse drug events in older people.

    LENUS (Irish Health Repository)

    Hamilton, Hilary J

    2009-01-01

    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  9. Nurse prescribing ethics and medical marketing.

    Science.gov (United States)

    Adams, J

    This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers.

  10. Prescribing for pain--how do nurses contribute? A national questionnaire survey.

    Science.gov (United States)

    Stenner, Karen; Carey, Nicola; Courtenay, Molly

    2012-12-01

    To provide information on the profile and practice of nurses in the UK who prescribe medication for pain. Pain is widely under-reported and under-treated and can have negative consequences for health and psychosocial well-being. Indications are that nurses can improve treatment and access to pain medications when they prescribe. Whilst nurses working in many practice areas treat patients with pain, little is known about the profile, prescribing practice or training needs of these nurses. A descriptive questionnaire survey. An online questionnaire was used to survey 214 nurses who prescribed for pain in the UK between May and July 2010. Data were analysed using descriptive statistics and non-parametric tests. Half the participants (50%) worked in primary care, 32% in secondary care and 14% worked across care settings. A range of services were provided, including general practice, palliative care, pain management, emergency care, walk-in-centres and out-of-hours. The majority (86%) independently prescribed 1-20 items per week. Non-opioid and weak opioids analgesics were prescribed by most (95%) nurses, whereas fewer (35%) prescribed strong opioids. Training in pain had been undertaken by 97% and 82% felt adequately trained, although 28% had problems accessing training. Those with specialist training prescribed a wider range of pain medications, were more likely to prescribe strong opioids and were more often in pain management roles. Nurses prescribe for pain in a range of settings with an emphasis on the treatment of minor ailments and acute pain. A range of medications are prescribed, and most nurses have access to training. The nursing contribution to pain treatment must be acknowledged within initiatives to improve pain management. Access to ongoing training is required to support nurse development in this area of practice to maximise benefits. © 2012 Blackwell Publishing Ltd.

  11. Cancer survivorship and opioid prescribing rates: A population-based matched cohort study among individuals with and without a history of cancer.

    Science.gov (United States)

    Sutradhar, Rinku; Lokku, Armend; Barbera, Lisa

    2017-11-01

    Little is known about opioid prescribing among individuals who have survived cancer. Our aim is to examine a predominantly socio-economically disadvantaged population for differences in opioid prescribing rates among cancer survivors compared with matched controls without a prior diagnosis of cancer. This was a retrospective population-wide matched cohort study. Starting in 2010, individuals residing in Ontario, Canada, who were 18 to 64 years of age and at least 5 years past their cancer diagnosis were matched to controls without a prior cancer diagnosis based on sex and calendar year of birth. Follow-up was terminated at any indication of cancer recurrence, second malignancy, or new cancer diagnosis. To examine the association between survivorship and the rate of opioid prescriptions, an Andersen-Gill recurrent event regression model was implemented, adjusting for numerous individual-level characteristics and also accounting for the matched design. The rate of opioid prescribing was 1.22 times higher among survivors than among their corresponding matched controls (adjusted relative rate, 1.22; 95% CI, 1.11-1.34). Individuals from lower income quintiles who were younger, were from rural neighborhoods, and had more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates. This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis (compared with their controls). This study demonstrates substantially higher opioid prescribing rates among cancer survivors, even long after attaining survivorship. This raises concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment. Cancer 2017;123:4286-4293. © 2017 American Cancer Society. © 2017 American Cancer Society.

  12. Operational indicators

    International Nuclear Information System (INIS)

    2010-01-01

    The chapter presents the operational indicators related to budget, travel costs and tickets, the evolution of the annual program for regulatory inspection, the scientific production, requested patents and the numbers related to the production of the services offered by the Institution

  13. The social act of electronic medication prescribing.

    Science.gov (United States)

    Aarts, Jos

    2013-01-01

    Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of guidelines and protocols based on the outcomes of clinical studies. These notions of cost-effectiveness and evidence-based medicine have also been embedded in technology such as electronic prescribing systems. Such constraining systems may clash with the reality of clinical practice, where formal boundaries of responsibility and authorization are often blurred. Such systems may therefore even impede patient care. Medication is seen as the essence of medical practice. Prescribing is a social act. In a hospital medications may be aimed at treating a patient for a specific condition, in primary care the professional often meets the patient with her or his social and cultural notions of a health problem. The author argues that the design and implementation of electronic prescribing systems should address the social and cultural context of prescribing. Especially in primary care, where health problems are often ill defined and evidence-based medicine guidelines do not always work as intended, studies need to take into account the sociotechnical character of electronic prescribing systems.

  14. Overweight and weight dissatisfaction related to socio-economic position, integration and dietary indicators among south Asian immigrants in Oslo.

    Science.gov (United States)

    Råberg, Marte; Kumar, Bernadette; Holmboe-Ottesen, Gerd; Wandel, Margareta

    2010-05-01

    To investigate how socio-economic position, demographic factors, degree of integration and dietary indicators are related to BMI/waist:hip ratio (WHR) and to weight dissatisfaction and slimming among South Asians in Oslo, Norway. Cross-sectional study consisting of a health check including anthropometric measures and two self-administered questionnaires. Oslo, Norway. Pakistanis and Sri Lankans (n 629), aged 30-60 years, residing in Oslo. BMI was positively associated with female gender (P = 0.004) and Pakistani origin (P integration (measured by a composite index, independent of duration of residence; P = 0.017). One-third of those with normal weight and most of those obese were dissatisfied with their weight. Among these, about 40 % had attempted to slim during the past year. Dissatisfaction with weight was positively associated with education in women (P = 0.006) and with integration in men (P = 0.026), and inversely associated with physical activity (P = 0.044) in men. Women who had made slimming attempts had breakfast and other meals less frequently than others (P < 0.05). Weight dissatisfaction exists among South Asian immigrants. More research is needed regarding bodily dissatisfaction and the relationship between perception of weight and weight-change attempts among immigrants in Norway, in order to prevent and treat both obesity and eating disorders.

  15. The application of VMEbus system to the safety related parameters indication and alarm system for nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chul Kwon; Koo, In Soo; Jang, Gwi Sook; Shin, Jae Hwal

    1996-12-01

    This report presents the basic feature, the status of technical development, and it`s application for the VMEbus which has been utilized in industrial application such as controller, robotics, automation control. The application software of VMEbus is also reviewed. The design considerations are presented when applying the system to the instrumentation and control technique of nuclear power plants. The conceptual design of safety related parameter using the integrated VMEbus system. The results indicate that the application of VMEbus has advantages such as easy maintenance, accurate and reliable operation, easy expansion and upgrade. Also, the integrated VMEbus system is capable of limited real-time processing because it can be processed by multi-processors and can reduce the effort of software development by using off-the-shelf software. However, the adoption of digital system is produced problems such as software common mode failure, EMI and RFI, and verification and validation methods of off-the-shelf hardware and software. To resolve these problems in the future, further research are required. (author). 7 tabs., 19 figs., 24 refs.

  16. Reference Values of Reticulocyte Hemoglobin Content and Their Relation With Other Indicators of Iron Status in Healthy Children.

    Science.gov (United States)

    López-Ruzafa, Encarnación; Vázquez-López, Maria A; Lendinez-Molinos, Francisco; Poveda-González, Juan; Galera-Martínez, Rafael; Bonillo-Perales, Antonio; Martín-González, Manuel

    2016-10-01

    Reticulocyte hemoglobin content (CHr) is considered an indicator of functional iron deficiency, but is understudied in children. The goals of this study are to determine the reference intervals for CHr in healthy children, and their relation with iron parameters, erythropoiesis, and individual conditions. A total of 902 children without iron deficiency, aged 1 to 11 years were analyzed in a cross-sectional study. Besides a physical examination of the subjects and a questionnaire completed by their parents, the complete blood count, serum transferrin receptor, ferritin, transferrin saturation, erythrocyte protoporphyrin, serum erythropoietin, C-reactive protein, and CHr levels were measured. Changes in CHr, iron status, and erythropoiesis at different age intervals were analyzed and linear multiple regression was used to identify the factors that determine CHr variability. Mean value obtained for CHr was 30.9±1.8 pg (P2.5-P97.5: 26.9 to 34.3 pg), but the influence of age on CHr (the values increased with age) and on the iron parameters justified the establishment of different reference ranges. In addition to age, nutritional status, hematologic measurements, reticulocytes, transferrin saturation, and erythrocyte protoporphyrin accounted for 39% of CHr variability.

  17. The application of VMEbus system to the safety related parameters indication and alarm system for nuclear power plants

    International Nuclear Information System (INIS)

    Lee, Chul Kwon; Koo, In Soo; Jang, Gwi Sook; Shin, Jae Hwal.

    1996-12-01

    This report presents the basic feature, the status of technical development, and it's application for the VMEbus which has been utilized in industrial application such as controller, robotics, automation control. The application software of VMEbus is also reviewed. The design considerations are presented when applying the system to the instrumentation and control technique of nuclear power plants. The conceptual design of safety related parameter using the integrated VMEbus system. The results indicate that the application of VMEbus has advantages such as easy maintenance, accurate and reliable operation, easy expansion and upgrade. Also, the integrated VMEbus system is capable of limited real-time processing because it can be processed by multi-processors and can reduce the effort of software development by using off-the-shelf software. However, the adoption of digital system is produced problems such as software common mode failure, EMI and RFI, and verification and validation methods of off-the-shelf hardware and software. To resolve these problems in the future, further research are required. (author). 7 tabs., 19 figs., 24 refs

  18. After-effects of human-computer interaction indicated by P300 of the event-related brain potential.

    Science.gov (United States)

    Trimmel, M; Huber, R

    1998-05-01

    After-effects of human-computer interaction (HCI) were investigated by using the P300 component of the event-related brain potential (ERP). Forty-nine subjects (naive non-users, beginners, experienced users, programmers) completed three paper/pencil tasks (text editing, solving intelligence test items, filling out a questionnaire on sensation seeking) and three HCI tasks (text editing, executing a tutor program or programming, playing Tetris). The sequence of 7-min tasks was randomized between subjects and balanced between groups. After each experimental condition ERPs were recorded during an acoustic discrimination task at F3, F4, Cz, P3 and P4. Data indicate that: (1) mental after-effects of HCI can be detected by P300 of the ERP; (2) HCI showed in general a reduced amplitude; (3) P300 amplitude varied also with type of task, mainly at F4 where it was smaller after cognitive tasks (intelligence test/programming) and larger after emotion-based tasks (sensation seeking/Tetris); (4) cognitive tasks showed shorter latencies; (5) latencies were widely location-independent (within the range of 356-358 ms at F3, F4, P3 and P4) after executing the tutor program or programming; and (6) all observed after-effects were independent of the user's experience in operating computers and may therefore reflect short-term after-effects only and no structural changes of information processing caused by HCI.

  19. Mobilisation of heavy metals into the urine by CaEDTA: relation to erythrocyte and plasma concentrations and exposure indicators.

    Science.gov (United States)

    Araki, S; Aono, H; Murata, K

    1986-09-01

    To investigate the effects of calcium disodium ethylenediamine tetra-acetate (CaEDTA) on the urinary excretion, erythrocyte, and plasma concentrations and exposure indicators of seven heavy metals, CaEDTA was administered by intravenous infusion to 20 workers exposed to lead, zinc, and copper. The workers' blood lead concentrations ranged from 22 to 59 micrograms/dl (mean 38 micrograms/dl (1.8 mumol/l]. The 24 hour urinary excretion of metals after CaEDTA administration (mobilisation yield) was on average 13 times the background excretion for lead, 11 times for zinc, 3.8 times for manganese, 3.4 times for cadmium, 1.3 times for copper, and 1.1 times for chromium; no significant increase was found for mercury. The mobilisation yield of lead (MPb) was significantly correlated with whole blood and erythrocyte concentrations and the urinary excretion of lead but not with its plasma concentration; similarly, the mobilisation yield of cadmium was significantly correlated with its erythrocyte concentration. In addition, MPb was significantly correlated with intra-erythrocytic enzyme delta-aminolaevulinic acid dehydratase activity and urinary coproporphyrin excretion. The relation between the mobilisation yield of heavy metals and their body burden (and toxic signs) is discussed in the light of these findings.

  20. Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

    Science.gov (United States)

    Tonna, Antonella; McCaig, Dorothy; Diack, Lesley; West, Bernice; Stewart, Derek

    2014-10-01

    The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. To develop consensus guidance to facilitate service redesign around pharmacist prescribing. UK hospital practice. The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic 'service development' (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and 'pharmacist prescribing role development' (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.

  1. Intraclass Correlation Coefficients for Obesity Indicators and Energy Balance-Related Behaviors Among New York City Public Elementary Schools.

    Science.gov (United States)

    Gray, Heewon Lee; Burgermaster, Marissa; Tipton, Elizabeth; Contento, Isobel R; Koch, Pamela A; Di Noia, Jennifer

    2016-04-01

    Sample size and statistical power calculation should consider clustering effects when schools are the unit of randomization in intervention studies. The objective of the current study was to investigate how student outcomes are clustered within schools in an obesity prevention trial. Baseline data from the Food, Health & Choices project were used. Participants were 9- to 13-year-old students enrolled in 20 New York City public schools (n= 1,387). Body mass index (BMI) was calculated based on measures of height and weight, and body fat percentage was measured with a Tanita® body composition analyzer (Model SC-331s). Energy balance-related behaviors were self-reported with a frequency questionnaire. To examine the cluster effects, intraclass correlation coefficients (ICCs) were calculated as school variance over total variance for outcome variables. School-level covariates, percentage students eligible for free and reduced-price lunch, percentage Black or Hispanic, and English language learners were added in the model to examine ICC changes. The ICCs for obesity indicators are: .026 for BMI-percentile, .031 for BMIz-score, .035 for percentage of overweight students, .037 for body fat percentage, and .041 for absolute BMI. The ICC range for the six energy balance-related behaviors are .008 to .044 for fruit and vegetables, .013 to .055 for physical activity, .031 to .052 for recreational screen time, .013 to .091 for sweetened beverages, .033 to .121 for processed packaged snacks, and .020 to .083 for fast food. When school-level covariates were included in the model, ICC changes varied from -95% to 85%. This is the first study reporting ICCs for obesity-related anthropometric and behavioral outcomes among New York City public schools. The results of the study may aid sample size estimation for future school-based cluster randomized controlled trials in similar urban setting and population. Additionally, identifying school-level covariates that can reduce cluster

  2. Prescribed Travel Schedules for Fatigue Management

    Science.gov (United States)

    Whitmire, Alexandra; Johnston, Smith; Lockley, Steven

    2011-01-01

    The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.

  3. Characterization of Phenolic Compounds in Pinus laricio Needles and Their Responses to Prescribed Burnings

    Directory of Open Access Journals (Sweden)

    Lila Ferrat

    2007-07-01

    Full Text Available Fire is a dominant ecological factor in Mediterranean-type ecosystems. Management strategies include prescribed (controlled burning, which has been used in the management of several species, such as Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. The effects of prescribed burning on Pinus laricio have been little studied. The first aim of this study was to characterize total and simple phenolic compounds in Pinus laricio. The second aim was to understand: i the short term (one to three months and medium term (three years effects of prescribed burning, and ii the effects of periodic prescribed burning on the production of phenolic compounds in Pinus laricio. The first result of this study is the presence of total and simple phenolic compounds in the needles of Pinus laricio. 3-Vanillyl propanol is the major compound. After a prescribed burning, the synthesis of total phenolic compounds increases in Pinus laricio for a period of three months. Total phenolic compounds could be used as bioindicators for the short-term response of Pinus laricio needles to prescribed burning. Simple phenolic compounds do not seem to be good indicators of the impact of prescribed burning because prescribed burnings are low in intensity.

  4. Characterization of phenolic compounds in Pinus laricio needles and their responses to prescribed burnings.

    Science.gov (United States)

    Cannac, Magali; Pasqualini, Vanina; Greff, Stéphane; Fernandez, Catherine; Ferrat, Lila

    2007-07-30

    Fire is a dominant ecological factor in Mediterranean-type ecosystems. Management strategies include prescribed (controlled) burning, which has been used in the management of several species, such as Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. The effects of prescribed burning on Pinus laricio have been little studied. The first aim of this study was to characterize total and simple phenolic compounds in Pinus laricio. The second aim was to understand: i) the short term (one to three months) and medium term (three years) effects of prescribed burning, and ii) the effects of periodic prescribed burning on the production of phenolic compounds in Pinus laricio. The first result of this study is the presence of total and simple phenolic compounds in the needles of Pinus laricio. 3-Vanillyl propanol is the major compound. After a prescribed burning, the synthesis of total phenolic compounds increases in Pinus laricio for a period of three months. Total phenolic compounds could be used as bioindicators for the short-term response of Pinus laricio needles to prescribed burning. Simple phenolic compounds do not seem to be good indicators of the impact of prescribed burning because prescribed burnings are low in intensity.

  5. Indicators of abdominal size relative to height associated with sex, age, socioeconomic position and ancestry among US adults.

    Science.gov (United States)

    Kahn, Henry S; Bullard, Kai McKeever

    2017-01-01

    The supine sagittal abdominal diameter (SAD) and standing waist circumference (WC) describe abdominal size. The SAD/height ratio (SADHtR) or WC/height ratio (WHtR) may better identify cardiometabolic disorders than BMI (weight/height2), but population-based distributions of SADHtR and WHtR are not widely available. Abdominal adiposity may differ by sociodemographic characteristics. Anthropometry, including SAD by sliding-beam caliper, was performed on 9894 non-pregnant adults ≥20 years in the US National Health and Nutrition Examination Surveys of 2011-2014. Applying survey design factors and sampling weights, we estimated nationally representative SADHtR and WHtR distributions by sex, age, educational attainment, and four ancestral groups. The median (10th percentile, 90th percentile) for men's SADHtR was 0.130 (0.103, 0.165) and WHtR 0.569 (0.467, 0.690). For women, median SADHtR was 0.132 (0.102, 0.175) and WHtR 0.586 (0.473, 0.738). Medians for SADHtR and WHtR increased steadily through age 79. The median BMI, however, reached maximum values at ages 40-49 (men) or 60-69 (women) and then declined. Low educational attainment, adjusted for age and ancestry, was associated with elevated SADHtR more strongly than elevated BMI. While non-Hispanic Asians had substantially lower BMI compared to all other ancestral groups (adjusted for sex, age and education), their relative reductions in SADHtR and WHtR, were less marked. These cross-sectional data are consistent with monotonically increasing abdominal adipose tissue through the years of adulthood but decreasing mass in non-abdominal regions beyond middle age. They suggest also that visceral adipose tissue, estimated by SADHtR, expands differentially in association with low socioeconomic position. Insofar as Asians have lower BMIs than other populations, employing abdominal indicators may attenuate the adiposity differences reported between ancestral groups. Documenting the distribution and sociodemographic features

  6. The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey.

    Science.gov (United States)

    Carey, Nicola; Courtenay, Molly; Stenner, Karen

    2013-07-01

    To explore the practice of nurses who prescribe medication for patients with skin conditions. Nurses have lead roles in dermatology services. In the United Kingdom, nurses in primary care frequently prescribe medicines for skin conditions, but there are concerns about role preparation and access to continuing professional development. The prescribing practices of nurse independent supplementary prescribers who care for patients with skin conditions are under-researched. Cross-sectional survey. An online questionnaire was used to survey 186 nurses who prescribed for skin conditions from May-July 2010. Data were analysed using descriptive statistics and nonparametric tests. The majority worked in primary care (78%) and general practice (111, 59.7%). Twenty (10.8%) had specialist modules (at diploma, degree or master's level), 104 (55.9%) had dermatology training (e.g. study days), 44 (23.7%) had no training, and a further 18 (9.6%) did not respond. Oral antibiotics, topical antifungal and antibacterial drugs were frequently prescribed. Nurses with specialist dermatology training used their qualification in a greater number of ways, prescribed the broadest range of products and prescribed more items per week. Over 70% reporting on continuing professional development had been able to access it. A large number of nurses in primary care prescribe medicines for skin conditions and are involved in medicines management activities. Lack of specialist dermatology training is a concern and associated with lower prescribing-related activities. Access to dermatology training and continuing professional development are required to support nurse development in this area of practice and maximise benefits. Nurse prescribers' involvement in medicines management activities has important implications in terms of improving access to services, efficiency and cost savings. To maximise their contribution, improved provision of specialist dermatology training is required. This will be of

  7. A UK clinical audit addressing the quality of prescribing of sodium valproate for bipolar disorder in women of childbearing age.

    Science.gov (United States)

    Paton, Carol; Cookson, John; Ferrier, I Nicol; Bhatti, Sumera; Fagan, Elizabeth; Barnes, Thomas R E

    2018-04-12

    To review prescribing practice concerning valproate, an established human teratogen, for the management of bipolar disorder in women of childbearing age. The Prescribing Observatory for Mental Health conducted a baseline clinical audit in the UK, as part of a quality improvement programme. Six hundred and forty-eight clinical teams from 55 mental health Trusts submitted retrospective treatment data relating to patients with a diagnosis of bipolar disorder. Of the audit sample of 6705 patients, 3854 were 50 years of age or younger. Valproate was prescribed for 24% of women and 43% men in this age group, and the mean dose of valproate was lower in women (1196 mg) than in men (1391 mg). For only half of such women was there documented evidence that information had been provided on the risks for the unborn child and the need for adequate contraception. Valproate was more often used in men to treat mania and aggression, while the most common treatment targets in women were hypomania and relapse prevention. Despite explicit recommendations in national treatment guidelines and published safety alerts and warnings regarding the use of valproate in women of childbearing age, current prescribing of this medication to such women in the context of the treatment of bipolar disorder falls short of best practice, particularly with regard to provision of information regarding the risks associated with exposure to valproate during pregnancy. While women younger than 50 years of age were less likely to be prescribed valproate than men in the same age group, and at a lower dosage, it is unclear to what extent this reflects clinicians' concerns about teratogenicity or is driven by perceptions of the indication for valproate, and the dosage required, for the treatment of different phases of the disorder in men and women. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless

  8. Prescribing under the Influence: The Business of Breastmilk Substitutes

    Directory of Open Access Journals (Sweden)

    Rosa Rios

    2016-09-01

    Full Text Available This study draws on a general theoretical framework comprising of a decision maker (a doctor, perceived moral intensity of the issue (breastfeeding substitute prescription, and the situational environment (hospital policy, pharma company promotions, and mother’s beliefs regarding breastfeeding to explain the physician’s role and influence on mothers’ infant feeding choices when prescribing infant formula in Kuwait, Middle East. Moral intensity is an issue-contingent model that suggests ethical decisions vary in terms of how much a moral imperative is present in a situation. The moral intensity of the issue is assessed using six components. Path Least Squares results indicate the following moral intensity components have significant impact on prescription behavior: magnitude of consequences, probability of effect, and temporal immediacy. Company promotion and hospital policy also significantly influence doctor’s prescription of infant formula. Doctors appear to disengage from the consequences of over prescribing infant formula.

  9. Age-related changes in electrophysiological and neuropsychological indices of working memory, attention control, and fluid intelligence

    Directory of Open Access Journals (Sweden)

    Carrie Brumback Peltz

    2011-08-01

    Full Text Available Older adults exhibit great variability in their cognitive abilities, with some maintaining high levels of performance on executive control tasks and others showing significant deficits. Previous event-related potential (ERP work has shown that some of these performance differences are correlated with persistence of the novelty/frontal P3 in older adults elicited by task-relevant events, presumably reflecting variability in the capacity to suppress orienting to unexpected but no longer novel events. In recent ERP work in young adults, we showed that the operation-span task (OSPAN, a measure of attention control is predictive of the ability of individuals to keep track of stimulus sequencing and to maintain running mental representations of task stimuli, as indexed by the parietally-distributed P300 (or P3b. Both of these phenomena reflect aspects of frontal function (cognitive flexibility and attention control, respectively. To investigate these phenomena we sorted both younger and older adults into low- and high-working memory spans and low- and high-cognitive flexibility subgroups, and examined ERPs during an equal-probability choice reaction-time task. For both age groups (a participants with high OSPAN scores were better able to keep track of stimulus sequencing, as indicated by their smaller P3b to sequential changes; and (b participants with lower cognitive flexibility had larger P3a than their high-scoring counterparts. However, these two phenomena did not interact suggesting that they manifest dissociable control mechanisms. Further, the fact that both effects are already visible in younger adults suggests that at least some of the brain mechanisms underlying individual differences in cognitive aging may already operate early in life.

  10. Ranging behavior relates to welfare indicators pre- and post-range access in commercial free-range broilers.

    Science.gov (United States)

    Taylor, Peta S; Hemsworth, Paul H; Groves, Peter J; Gebhardt-Henrich, Sabine G; Rault, Jean-Loup

    2018-06-01

    Little is known about the effect of accessing an outdoor range on chicken welfare. We tracked individual ranging behavior of 538 mixed-sex Ross 308 chickens on a commercial farm across 4 flocks in winter and summer. Before range access, at 17 to 19 d of age, and post-range access, at 30 to 33 and 42 to 46 d of age in winter and summer flocks respectively, welfare indicators were measured on chickens (pre-range: winter N = 292; summer N = 280; post-range: winter N = 131; summer N = 140), including weight, gait score, dermatitis and plumage condition. Post-ranging autopsies were performed (winter: N = 170; summer: N = 60) to assess breast burn, leg health, and ascites. Fewer chickens accessed the range in winter flocks (32.5%) than summer flocks (82.1%). Few relationships between welfare and ranging were identified in winter, likely due to minimal ranging and the earlier age of post-ranging data collection compared to summer flocks. In summer flocks prior to range access, chickens that accessed the range weighed 4.9% less (P = 0.03) than chickens that did not access the range. Pre-ranging weight, gait score, and overall plumage cover predicted the amount of range use by ranging chickens in summer flocks (P ranging behavior. In summer flocks post-range access, ranging chickens weighed 12.8% less than non-ranging chickens (P range visits were associated with lower weight (P range was associated with lower weight (P range in summer is partly related to changes in broiler chicken welfare. Further investigations are required to determine causation.

  11. Insights about health-related quality of life in cancer patients indicate demands for better pharmaceutical care.

    Science.gov (United States)

    Ibrahim, Nagwa A; Björnsdottir, Ingunn; Al Alwan, Ashraf S; Honore, Per Hartvig

    2014-08-01

    To highlight the health-related quality of life scale scores for Saudi patients with different types of cancer, to get understanding and foundation for improvements. To suggest suitable plans for quality of life improvement based on study outcome. The role of oncology pharmacy will be stressed. A cross-sectional descriptive study was conducted at a tertiary regional hospital using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Attendees were patients diagnosed with any type of cancer and eligible for active anticancer treatment and/or palliative care. Quality of life was evaluated for 87 participants. Most of patients were aged between 51 and 60 years; and 50% had active treatment with chemotherapy. Patients seemed to perform well with respect to average scores in both the symptoms and the functional health status scales. The mean score for the global quality of life scale was 47.2 ± 27.1, while the range of mean scores for the five function subscales was 59.0 ± 27.1 to 81.6 ± 13.8, indicating average level of general wellbeing with above average to high level of functional health status, while >50% of the patients met the operational criterion having less severe symptoms. Outpatients generally had somewhat higher scores as compared to hospitalized patients. The general quality of life seemed satisfactory, but there is still need to improve care. Based on results from other studies, oncology pharmacists' roles are essential to improve quality of life through treatment counseling, follow-up on drug support therapy, stress on patient's education through specific programs, review and update the local guidelines, and conduct more research. © Prince Sultan Military Medical City, Saudi Arabia 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Detecting land-cover change using mappable vegetation related indices: A case study from Sinharaja Man and the Biosphere Reserve

    Directory of Open Access Journals (Sweden)

    BD Madurapperuma

    2014-06-01

    Full Text Available This study evaluates multi-year changes of vegetation in the Sinharaja Man and the Biosphere (MAB reserve using mappable vegetation related indices viz., Normalized Difference Vegetation Index (NDVI and Burn Index (BI. Land-cover changes in the Sinharaja MAB reserve were detected using Landsat 7 ETM+ images for 1993, 2001, and 2005. Seven individual bands of each image were converted to new multiband files by layer stacking using ENVI® 4.5. Then the multiband files were re-projected to UTM Zone 44 North, WGS-84 Datum. Each data set was exported to ENVI® EX software package to detect the changes between time steps based on NDVI and BI using an image difference tool. Land-cover data, which were obtained from the DIVA GIS web portal, were compared with Landsat image data. Results of BI showed that the Sinharaja MAB reserve fringe was vulnerable to forest fire. For example, from 1993- 2001, 160 ha identified as burned area. In contrast, from 2001-2005, 79 ha burned, and for the entire period of 1993-2005, 10 ha burned. NDVI resulted in a 962 ha increase of vegetation prime at the western Sinharaja from 2001-2005. In addition, there was a 15 ha decrease in vegetation from 1993-2005. The results were visualized using an embedded 3D render window of Google Earth and 2D view of ArcGIS explorer online. In conclusion, in-situ ground truthing data is needed for the fire-influenced area for implementing sustainable forest resource management at the Sinharaja MAB reserve. Normal 0 false false false EN-GB X-NONE X-NONE

  13. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.

    Science.gov (United States)

    Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

    2007-08-01

    To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (pMedical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; chi(2) test). A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

  14. The impact of a closed‐loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before‐and‐after study

    Science.gov (United States)

    Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

    2007-01-01

    Objectives To assess the impact of a closed‐loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants Before‐and‐after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention Closed‐loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results Prescribing errors were identified in 3.8% of 2450 medication orders pre‐intervention and 2.0% of 2353 orders afterwards (pMedical staff required 15 s to prescribe a regular inpatient drug pre‐intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre‐intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions A closed‐loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication‐related tasks increased. PMID:17693676

  15. Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy.

    Science.gov (United States)

    Nanji, Karen C; Rothschild, Jeffrey M; Boehne, Jennifer J; Keohane, Carol A; Ash, Joan S; Poon, Eric G

    2014-01-01

    Electronic prescribing systems have often been promoted as a tool for reducing medication errors and adverse drug events. Recent evidence has revealed that adoption of electronic prescribing systems can lead to unintended consequences such as the introduction of new errors. The purpose of this study is to identify and characterize the unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in an outpatient pharmacy. A multidisciplinary team conducted direct observations of workflow in an independent pharmacy and semi-structured interviews with pharmacy staff members about their perceptions of the unrealized potential and residual consequences of electronic prescribing systems. We used qualitative methods to iteratively analyze text data using a grounded theory approach, and derive a list of major themes and subthemes related to the unrealized potential and residual consequences of electronic prescribing. We identified the following five themes: Communication, workflow disruption, cost, technology, and opportunity for new errors. These contained 26 unique subthemes representing different facets of our observations and the pharmacy staff's perceptions of the unrealized potential and residual consequences of electronic prescribing. We offer targeted solutions to improve electronic prescribing systems by addressing the unrealized potential and residual consequences that we identified. These recommendations may be applied not only to improve staff perceptions of electronic prescribing systems but also to improve the design and/or selection of these systems in order to optimize communication and workflow within pharmacies while minimizing both cost and the potential for the introduction of new errors.

  16. Assessment of prescribing information for generic drugs manufactured in the Middle East and marketed in Saudi Arabia

    International Nuclear Information System (INIS)

    Gebran, N.; Al-Haldari, K.

    2006-01-01

    Little research has assessed the quality of manufacturer provided prescribing information or documented difference in key aspects of drug information among different marketed generic products of the same drug particularly in Middle East and Arabian Gulf. We assessed the quality of written prescribing information for selected generic drugs marketed in Saudi Arabia and manufactured in various countries of Middle East. We assessed the correctness and completeness of information pertaining to indications, dosage cautions/contraindications, side effects and drug interactions in 37 packages inserts for generic products registered in Saudi Arabia and manufactured in the Middle East, including atenolol (6 inserts), fluoxetine (4 inserts), ciprofloxacin (11 inserts), melformin (7 inserts) and omeprazole (9 inserts). We also described deficiencies in quality and quantity of manufacturers provided information that could be misleading to patients and prescribes. We found substantial disagreement in information between generic packages inserts versus the British National Formulary and the package insert of the brand product marketed in Saudi Arabia. A cumulative average of 63.16% of drug information indicators were in agreement with these standard references. Section headings with the least conformity with study references were those related to dosage (57, 28%) and side effects (54+-30%). Our results indicate that national authorities should implement appropriate measures aimed at removing misleading and incorrect information in generic package inserts and incorporating crucial prescribing information that is missing. National authorities in the Middle East and Arabian Gulf should strengthen collaboration and information interchange among each other and with international agencies to maintain common quality standards for delivering information through package inserts. (author)

  17. Air Pollution Episodes Associated with Prescribed Burns

    Science.gov (United States)

    Hart, M.; Di Virgilio, G.; Jiang, N.

    2017-12-01

    Air pollution events associated with wildfires have been associated with extreme health impacts. Prescribed burns are an important tool to reduce the severity of wildfires. However, if undertaken during unfavourable meteorological conditions, they too have the capacity to trigger extreme air pollution events. The Australian state of New South Wales has increased the annual average area treated by prescribed burn activities by 45%, in order to limit wildfire activity. Prescribed burns need to be undertaken during meteorological conditions that allow the fuel load to burn, while still allowing the burn to remain under control. These conditions are similar to those that inhibit atmospheric dispersion, resulting in a fine balance between managing fire risk and managing ambient air pollution. During prescribed burns, the Sydney air shed can experience elevated particulate matter concentrations, especially fine particulates (PM2.5) that occasionally exceed national air quality standards. Using pollutant and meteorological data from sixteen monitoring stations in Sydney we used generalized additive model and CART analyses to profile the meteorological conditions influencing air quality during planned burns. The insights gained from this study will help improve prescribed burn scheduling in order to reduce the pollution risk to the community, while allowing fire agencies to conduct this important work.

  18. Control of invasive weeds with prescribed burning

    Science.gov (United States)

    DiTomaso, Joseph M.; Brooks, Matthew L.; Allen, Edith B.; Minnich, Ralph; Rice, Peter M.; Kyser, Guy B.

    2006-01-01

    Prescribed burning has primarily been used as a tool for the control of invasive late-season annual broadleaf and grass species, particularly yellow starthistle, medusahead, barb goatgrass, and several bromes. However, timely burning of a few invasive biennial broadleaves (e.g., sweetclover and garlic mustard), perennial grasses (e.g., bluegrasses and smooth brome), and woody species (e.g., brooms and Chinese tallow tree) also has been successful. In many cases, the effectiveness of prescribed burning can be enhanced when incorporated into an integrated vegetation management program. Although there are some excellent examples of successful use of prescribed burning for the control of invasive species, a limited number of species have been evaluated. In addition, few studies have measured the impact of prescribed burning on the long-term changes in plant communities, impacts to endangered plant species, effects on wildlife and insect populations, and alterations in soil biology, including nutrition, mycorrhizae, and hydrology. In this review, we evaluate the current state of knowledge on prescribed burning as a tool for invasive weed management.

  19. The role of pharmaceutical marketing and other factors in prescribing decisions: the Yemeni experience.

    Science.gov (United States)

    Al-Areefi, Mahmoud Abdullah; Hassali, Mohamed Azmi; Mohamed Ibrahim, Mohamed Izham B

    2013-01-01

    Prescribing decisions are a complex phenomenon and influenced by many pharmacological and non-pharmacological factors. Little is known about the actual prescribing behaviors of physicians or the factors behind their prescribing decisions. The objective of this study was to explore the factors that influence physicians' prescribing decisions and the role of the marketing activities by pharmaceutical companies in this decision-making process. A semi-structured interview with the critical incident technique method was used to encourage physicians to describe the particular situations of prescribing for specific newly marketed drugs. All interviews were transcribed verbatim and thematic content analysis with systematic and comprehensive coding was employed to identify categories of physicians' reasons for either prescribing or not of the study drugs. Factors that influence prescribing of the study drugs (223 critical incidents) were categorized in six major themes. Drug characteristics, the most frequently mentioned by physicians as reasons of prescribe, were implicated in 70 (31.4%) incidents, followed by pharmaceutical company mentioned in 53 (23.8%) incidents, indications, 31 (13.9%) incidents, and patient contexts, 26 (11.7%) incidents. Environmental factors as information and evidence were implicated in 22 (9.9%) incidents, and physician factor, 21 (9.4%) incidents. Prescribing is a complex process and physicians integrate different factors. Although physicians make a considerable on patient contexts and treatment outcomes, they still rely on their personal experiences when making prescribing in addition to firms' source of information and firms' marketing activities. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Survival and Growth of Northern Red Oak Seedlings Following a Prescribed Burn

    Science.gov (United States)

    Paul S. Johnson

    1974-01-01

    Mortality of northern red oak seedlings in a spring prescribed burn was related to temperature near the root collar. Most of the 42 percent of seedlings that survived the burn developed new shoots from the root collar.

  1. The use of prescribed and non-prescribed medication by Dutch children.

    NARCIS (Netherlands)

    Dijk, L. van; Lindert, H. van

    2002-01-01

    Background: Most research on the use of medication focuses on adults. Children, however, use medication too, most of which is prescribed by GP's. Children also use non-prescribed medication (f.e. bought in the drugstore), but the extent to which is not known. Moreover, it is not known to what extent

  2. Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

    NARCIS (Netherlands)

    de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W

    Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs.

  3. Pharmaceutical marketing research and the prescribing physician.

    Science.gov (United States)

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

  4. The Quality of Prescribing for Psychiatric Patients

    DEFF Research Database (Denmark)

    Soerensen, A L; Nielsen, L P; Poulsen, B K

    2014-01-01

    The Quality of Prescribing for Psychiatric PatientsSoerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3......, Aalborg; Denmark OBJECTIVES: Prescribing for adult psychiatric patients is often highly complex due to the nature of psychiatric conditions, but also due to somatic comorbidity. Therefore, the aim of this study was to identify prevalence and types of potential inappropriate prescribing (PIP), asses...... the severity of potential clinical consequences and identify possible predictive factors of PIP.METHODS: The study was designed as a prospective study of PIP using medication reviews. Patients who were admitted during a 4 month period (August 2013 - November 2013) to a psychiatric university hospital were...

  5. The Quality of Prescribing for Psychiatric Patients

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

    2014-01-01

    The Quality of Prescribing for Psychiatric Patients Soerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3......, Aalborg; Denmark OBJECTIVES: Prescribing for adult psychiatric patients is often highly complex due to the nature of psychiatric conditions, but also due to somatic comorbidity. Therefore, the aim of this study was to identify prevalence and types of potential inappropriate prescribing (PIP), asses...... the severity of potential clinical consequences and identify possible predictive factors of PIP. METHODS: The study was designed as a prospective study of PIP using medication reviews. Patients who were admitted during a 4 month period (August 2013 - November 2013) to a psychiatric university hospital were...

  6. K Indices of Magnetic Activity Relative to an assumed Quiet-day for each 3-Hour Period

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The NOAA National Centers for Environmental Information (formerly National Geophysical Data Center) receives the K indices on a current basis from approximately 85...

  7. USE OF COMPETITIVE GENOMIC HYBRIDIZATION TO ENRICH FOR GENOME-SPECIFIC DIFFERENCES BETWEEN TWO CLOSELY RELATED HUMAN FECAL INDICATOR BACTERIA

    Science.gov (United States)

    Enterococci are frequently used as indicators of fecal pollution in surface waters. To accelerate the identification of Enterococcus faecalis-specific DNA sequences, we employed a comparative genomic strategy utilizing a positive selection process to compare E. faec...

  8. Salivary testosterone as a potential indicator for risky behaviour associated with smoking-related peer pressure in adolescents.

    Science.gov (United States)

    Idris, Adi; Ghazali, Nur B; Said, Nadzirah M; Steele, Michael; Koh, David; Tuah, Nik A

    2016-04-09

    Early smoking is considered an indicator for risky behaviour in adolescents. Although social indicators predicting adolescent smoking are known, biological indicators have not been defined. This study aimed to establish whether salivary testosterone could be used as a "predictive biomarker" for smoking-associated peer pressure. Saliva samples were collected from Bruneian adolescents (aged 13-17 years) by the passive drool method. Salivary testosterone concentration was determined by enzyme-linked immunosorbent assay. Salivary testosterone concentration and smoking-associated peer pressure indicators were compared between adolescent males and females and statistical significance was determined by an independent samples t-test. A significant positive relationship between smoking-associated peer pressure and salivary testosterone levels in adolescents was found. However, this relationship was not significant when males and females were considered separately. Our data suggest that students who have tried cigarette smoking and have friends who are cigarette smokers have higher salivary testosterone levels.

  9. e-Learning initiatives to support prescribing.

    Science.gov (United States)

    Maxwell, Simon; Mucklow, John

    2012-10-01

    Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  10. e-Learning initiatives to support prescribing

    Science.gov (United States)

    Maxwell, Simon; Mucklow, John

    2012-01-01

    Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885

  11. "So, is that your 'relative' or mine?" A political-ecological critique of census-based area deprivation indices.

    Science.gov (United States)

    Fu, Mengzhu; Exeter, Daniel J; Anderson, Anneka

    2015-10-01

    Census-based deprivation indices have been widely used in Aotearoa/New Zealand, Canada and UK to measure area-based socio-economic inequalities. This paper examines the indicators used in census-based area deprivation indices using a political ecology approach. We question whether the current indicators of deprivation derived from census data are meaningful for the all age groups and minority groups in the population, with a particular focus on deprivation indicators used in New Zealand, Canada and the United Kingdom. We comparatively reviewed methodological papers and reports that describe the indicators of deprivation in Aotearoa/New Zealand, Canada and the UK from 1975 to 2014. We consider the relationship between the notion of standards of living and measurements of deprivation and explore how hegemonic cultural constructs are implicit in measures of deprivation that privilege a Eurocentric, ageist and gender normative construction of statistics. We argue for more political ecological analyses to studying the relationship between social inequalities, geographies, health inequities and political economy to transform structures of oppression and inequality. This requires turning the analytical gaze on the wealthy and privileged instead of defaulting into deficit models to account for inequality. Studies of deprivation and inequality would benefit from understanding the processes and operations of power in the (re)production of socio-economic and health inequities to inform holistic strategies for social justice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Nurse prescribing in Spain: The law and the curriculum.

    Science.gov (United States)

    Romero-Collado, Angel; Raurell-Torreda, Marta; Zabaleta-Del-Olmo, Edurne; Rascon-Hernan, Carolina; Homs-Romero, Erica

    2017-09-01

    In this cross-sectional study, we explored course content related to pharmacology and/or healthcare products and supplies in all nursing degree programs in Spain. Changes in nurse-prescribing legislation in Spain require that nurses take a certification course before prescribing over-the-counter products and medications. Using a cross-sectional descriptive study, between July and September 2014, the degree programs of all centers that offer a degree in nursing in Spain were examined, selecting those with course information available online. All centers offered at least one pharmacology course. One-third of the required courses had content related to pharmacology and healthcare products/supplies. The analysis showed that the course content and training received during the current nursing degree program provides the knowledge and skills needed to prescribe healthcare products/supplies and medications that do not now require a doctor's prescription, without the need for additional training and certification. It is essential that government regulation of nursing education be aligned with nursing competencies, curriculum standards, clinical practice, and evidence-based research to provide the maximum level of confidence for nursing professionals and their patients. © 2017 John Wiley & Sons Australia, Ltd.

  13. Evoking prescribed spike times in stochastic neurons

    Science.gov (United States)

    Doose, Jens; Lindner, Benjamin

    2017-09-01

    Single cell stimulation in vivo is a powerful tool to investigate the properties of single neurons and their functionality in neural networks. We present a method to determine a cell-specific stimulus that reliably evokes a prescribed spike train with high temporal precision of action potentials. We test the performance of this stimulus in simulations for two different stochastic neuron models. For a broad range of parameters and a neuron firing with intermediate firing rates (20-40 Hz) the reliability in evoking the prescribed spike train is close to its theoretical maximum that is mainly determined by the level of intrinsic noise.

  14. Building a Metaframework for Sustainable Transport Indicators

    DEFF Research Database (Denmark)

    Cornet, Yannick; Gudmundsson, Henrik

    2015-01-01

    Several recent papers presented at TRB and elsewhere seek to make sustainability manageable by suggesting indicators and performance measures as key tools to help conceptualize and operationalize sustainability for various levels of transportation-related planning and decision-making. These studies...... often prescribe frameworks that will allow sustainability indicators and measures to be selected and included in, for example, agency strategies and practices. Moreover, some suggest criteria for selection of individual indicators and performance measures. The studies do however not always agree on what...... of the paper is first to provide a theoretical elaboration of the underlying notion of ‘frameworks’, and then to conduct a review of the selected recent key scientific studies on sustainable transportation indicator frameworks in terms of what they propose for building the meta-framework and for identifying...

  15. The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain.

    Science.gov (United States)

    Stenner, Karen; Courtenay, Molly

    2008-08-01

    This paper is a report of a study to explore nurse prescribers' views on the role of inter-professional relationships and other means of support for nurse prescribing for patients in acute and chronic pain. Research indicates that good team relationships are important for supporting nurse prescribing but that poor understanding of the role by other healthcare professionals can act as a barrier. While collaborative working is central to the role of pain nurses, there is a lack of research on the impact of nurse prescribing on inter-professional working or the support needs of these nurses. A qualitative approach was adopted using thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were 26 nurses who prescribed medicines for patients with acute and/or chronic pain. Nurses' believed that prescribing encouraged collaborative working and sharing of knowledge across professional boundaries and that this helped to broaden understanding of the wider remit of pain management. Collaboration with doctors served a number of functions, including support and continuous learning. Barriers to effective nurse prescribing were a lack of understanding of its role amongst healthcare professionals and inadequate support. Formal support structures, such as regular clinical supervision, were seen as crucial to meeting nurses' ongoing learning. Factors that promote understanding of nurse prescribing and support inter-professional relationships are likely to have a positive impact on the effectiveness of nurse prescribing. A more consistent approach is required within organisations to support nurse prescribing.

  16. Antimalarial prescribing patterns in state hospitals and selected ...

    African Journals Online (AJOL)

    slowdown of progression to resistance could be achieved by improving prescribing practice, drug quality, and patient compliance. Objective: To determine the antimalarial prescribing pattern and to assess rational prescribing of chloroquine by prescribers in government hospitals and parastatals in Lagos State. Methods: ...

  17. Relationship Between Elderly Body Composition Indices and Static and Dynamic Balance in Relation to Their Rate of Falling

    Directory of Open Access Journals (Sweden)

    Elham Azimzadeh

    2013-01-01

    Full Text Available Objectives: The purpose of this study was to investigate relationship between body composition indices with static and dynamic balance and rate of falling in active elderly people. Methods & Materials: This research was a correlation study. Active elderly women volunteered for participation in this research (n=45. Body composition indices (body fat mass, fat free mass, body mass index, waist to hip ratio measured with the body composition analyzer. Static and dynamic balance measured by Biodex, with postural stability and fall risk tests, respectively. Also, the rate of falling in the previous 1- year asked for subjects. Statically analyses performed with the Pearson correlation test, significant level was set at P≤0.05. SPSS software was used. Results: The results of this study showed all of body composition indices have significant correlation with static and dynamic balance and rate of falling (P≤0.05. Conclusion: The finding of this research showed that all of body composition indices have significant correlation with static and dynamic balance and rate of falling in active elderly people. Therefore, it seems physical activity through improvement of body composition indices in active elderly people, causes improvement of static and dynamic balance and lowering the rate of falling.

  18. Prescribing smoked cannabis for chronic noncancer pain

    Science.gov (United States)

    Kahan, Meldon; Srivastava, Anita; Spithoff, Sheryl; Bromley, Lisa

    2014-01-01

    Objective To offer preliminary guidance on prescribing smoked cannabis for chronic pain before the release of formal guidelines. Quality of evidence We reviewed the literature on the analgesic effectiveness of smoked cannabis and the harms of medical and recreational cannabis use. We developed recommendations on indications, contraindications, precautions, and dosing of smoked cannabis, and categorized the recommendations based on levels of evidence. Evidence is mostly level II (well conducted observational studies) and III (expert opinion). Main message Smoked cannabis might be indicated for patients with severe neuropathic pain conditions who have not responded to adequate trials of pharmaceutical cannabinoids and standard analgesics (level II evidence). Smoked cannabis is contraindicated in patients who are 25 years of age or younger (level II evidence); who have a current, past, or strong family history of psychosis (level II evidence); who have a current or past cannabis use disorder (level III evidence); who have a current substance use disorder (level III evidence); who have cardiovascular or respiratory disease (level III evidence); or who are pregnant or planning to become pregnant (level II evidence). It should be used with caution in patients who smoke tobacco (level II evidence), who are at increased risk of cardiovascular disease (level III evidence), who have anxiety or mood disorders (level II evidence), or who are taking higher doses of opioids or benzodiazepines (level III evidence). Cannabis users should be advised not to drive for at least 3 to 4 hours after smoking, for at least 6 hours after oral ingestion, and for at least 8 hours if they experience a subjective “high” (level II evidence). The maximum recommended dose is 1 inhalation 4 times per day (approximately 400 mg per day) of dried cannabis containing 9% delta-9-tetrahydrocannabinol (level III evidence). Physicians should avoid referring patients to “cannabinoid” clinics (level

  19. Diagnosis of aged prescribed burning plumes impacting an urban area.

    Science.gov (United States)

    Lee, Sangil; Kim, Hyeon K; Yan, Bo; Cobb, Charles E; Hennigan, Chris; Nichols, Sara; Chamber, Michael; Edgerton, Eric S; Jansen, John J; Hu, Yongtao; Zheng, Mei; Weber, Rodney J; Russell, Armistead G

    2008-03-01

    An unanticipated wind shift led to the advection of plumes from two prescribed burning sites that impacted Atlanta, GA, producing a heavy smoke event late in the afternoon on February 28, 2007. Observed PM2.5 concentrations increased to over 140 microg/m3 and O3 concentrations up to 30 ppb in a couple of hours, despite the late hour in February when photochemistry is less vigorous. A detailed investigation of PM2.5 chemical composition and source apportionment analysis showed that the increase in PM2.5 mass was driven mainly by organic carbon (OC). However, both results from source apportionment and an observed nonlinear relationship between OC and PM2.5 potassium (K) indicate that the increased OC was not due solely to primary emissions. Most of the OC was water-soluble organic carbon (WSOC) and was dominated by hydrophobic compounds. The data are consistent with large enhancements in isoprenoid (isoprene and monoterpenes) and other volatile organic compounds emitted from prescribed burning that led to both significant O3 and secondary organic aerosol (SOA) production. Formation of oligomers from oxidation products of isoprenoid compounds or condensation of volatile organic compounds (VOCs) with multiple functional groups emitted during prescribed burning appears to be a major component of the secondary organic contributor of the SOA. The results from this study imply that enhanced emissions due to the fire itself and elevated temperature in the burning region should be considered in air quality models (e.g., receptor and emission-based models) to assess impacts of prescribed burning emissions on ambient air quality.

  20. Scientific journals in the SciELO database, indicators of impact and the relative position of Ambiente & Água

    Directory of Open Access Journals (Sweden)

    Nelson Wellausen Dias

    2010-12-01

    Full Text Available This editorial describes the process of periodic evaluation by CAPES, based on commercial indices proposed by companies such as the ISI FI by Thomson Reuters and SCImago by Scopus and public indices as proposed by SciELO and other freely calculated indices based on Google Scholar and investigates the impact position of the journal Ambiente & Agua compared with journals from the SciELO base. Results show that Ambiente & Agua is in the right path in the search for quality. Its editorial board strongly recommends that Brazilian public scientific agencies consider tools that are cost free and have large coverage for impact evaluation to allow the impact assessment of a range of emerging journals in a common and wide basis for all scientific journals.

  1. Indicators of implicit and explicit social anxiety influence threat-related interpretive bias as a function of working memory capacity

    NARCIS (Netherlands)

    Salemink, E.; Friese, M.; Drake, E.; Mackintosh, B.; Hoppitt, L.

    2013-01-01

    Interpretive biases play a crucial role in anxiety disorders. The aim of the current study was to examine factors that determine the relative strength of threat-related interpretive biases that are characteristic of individuals high in social anxiety. Different (dual process) models argue that both

  2. Association between mortality and indicators of traffic-related air pollution in the Netherlands: A cohort study

    NARCIS (Netherlands)

    Hoek, G.; Brunekreef, B.; Goldbohm, S.; Fischer, P.; Brandt, P.A. van den

    2002-01-01

    Background: Long-term exposure to particulate matter air pollution has been associated with increased cardiopulmonary mortality in the USA. We aimed to assess the relation between traffic-related air pollution and mortality in participants of the Netherlands Cohort study on Diet and Cancer (NLCS),

  3. Age-Related Shifts in the Density and Distribution of Genetic Marker Water Quality Indicators in Cow and Calf Feces

    Science.gov (United States)

    Recent studies have shown that different adult bovine animal feeding practices dramatically influence fecal indicator bacteria shedding, however very little is known about juvenile milk-fed calves. Calves (≤ 6 months of age) make up about 16% of the current bovine population in ...

  4. Assessing Space Utilisation Relative to Key Performance Indicators--How Well, Not How Much, Space Is Used

    Science.gov (United States)

    Fleming, Simon; Apps, Nathan; Harbon, Paul; Baldock, Clive

    2012-01-01

    Efficient use of resources, including space, is critical in academic departments. Traditional space auditing simply assesses occupancy levels. We present a novel approach which assesses not just the extent to which space is used, but also how well it is used. We link space use quantitatively to key performance indicators in a research-intensive…

  5. TREE-RING INDICES AND ISOTOPE SIGNATURES OF PINUS PONDEROSA RELATED TO HISTORIC OZONE CHANGES OUTSIDE LOS ANGELES

    Science.gov (United States)

    Ozone concentrations in the Los Angeles (LA) basin were at historic highs in the late 1970s. Since that time Clean Air regulations have helped lower ozone, but little is known of the long-term vegetation responses. Extensive research has used tree-ring indices together with the...

  6. Physicians' intention to prescribe hydrocodone combination products after rescheduling: A theory of reasoned action approach.

    Science.gov (United States)

    Fleming, Marc L; Driver, Larry; Sansgiry, Sujit S; Abughosh, Susan M; Wanat, Matthew; Sawant, Ruta V; Ferries, Erin; Reeve, Kathleen; Todd, Knox H

    The U.S. Drug Enforcement Administration (DEA) rescheduled hydrocodone combination products (HCPs) in an attempt to mitigate the prescription opioid epidemic. Many in the medical and pharmacy community expressed concerns of unintended consequences as a result of rescheduling. This study examined physicians' intentions to prescribe HCPs after rescheduling using the framework of the theory of reasoned action (TRA). A cover letter containing a link to the online questionnaire was sent to physicians of the Texas Medical Association who were likely to prescribe opioids. The questionnaire assessed physicians' intentions to prescribe HCPs after rescheduling. Predictor variables included attitude toward rescheduling, subjective norm toward HCP prescribing, and past prescribing behavior of schedule II prescriptions. All variables were measured on a 7-point, Likert-type scale. Intention to prescribe as a dependent variable was regressed over TRA variables and respondent characteristics. A total of 1176 usable responses were obtained, yielding a response rate of 13.3%. Mean (M) age was 53.07 ± 11 and most respondents were male (70%) and Caucasian (75%). Physicians held a moderately positive intention to prescribe HCPs (M = 4.36 ± 2.08), held a moderately negative attitude towards rescheduling, M = 4.68 ± 1.51 (reverse coded). Subjective norm was moderately low, M = 3.06 ± 1.78, and past prescribing behavior M = 2.43 ± 1.21. The linear regression analysis indicated that attitude (β = 0.10; P = 0.006), subjective norm (β = 0.35; P < 0.0001) and past prescribing behavior (β = 0.59; P < 0.0001) were significant predictors of intention to prescribe HCPs after rescheduling. TRA was shown to be a predictive model of physicians' intentions to prescribe HCPs after rescheduling. Overall, physicians held a moderately positive intention to prescribe HCPs. Past behavior concerning schedule II prescribing was found to be the most significant predictor

  7. Learning from escaped prescribed fire reviews

    Science.gov (United States)

    Anne E. Black; Dave Thomas; James Saveland; Jennifer D. Ziegler

    2011-01-01

    The U.S. wildland fire community has developed a number of innovative methods for conducting a review following escape of a prescribed fire (expanding on the typical regional or local reviews, to include more of a learning focus - expanded After Action Reviews, reviews that incorporate High Reliability Organizing, Facilitated Learning Analyses, etc). The stated purpose...

  8. Optimization of electronic prescribing in pediatric patients

    NARCIS (Netherlands)

    Maat, B.

    2014-01-01

    Improving pediatric patient safety by preventing medication errors that may result in adverse drug events and consequent healthcare expenditure,is a worldwide challenge to healthcare. In pediatrics, reported medication error rates in general, and prescribing error rates in particular, vary between

  9. Prescribing Behavior of General Practitioners : Competition Matters!

    NARCIS (Netherlands)

    Schaumans, C.B.C.

    2014-01-01

    Background: General Practitioners have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives: We investigate whether GPs exhibit different prescribing behavior (volume and value of

  10. Prescribing behavior of general practitioners : Competition matters!

    NARCIS (Netherlands)

    Schaumans, C.B.C.

    Background General Practitioners (GP) have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives I investigate whether GPs prescribe more units when confronted with more competition. As

  11. Antimalarial Drugs for Pediatrics - Prescribing and Dispensing ...

    African Journals Online (AJOL)

    Purpose: To assess dispensing and prescribing practices with regard to antimalarial drugs for pediatrics in private pharmacies and public hospitals in Dar es Salaam, Tanzania. Methods: This was a cross-sectional, descriptive study that assessed the knowledge and practice of 200 drug dispensers in the private community ...

  12. Cost Evaluation of Commonly Prescribed Antihypertensive Drugs ...

    African Journals Online (AJOL)

    It was also concluded that generic prescription should be encouraged among prescribers to lessen the financial burden of patients because drugs marketed under generic names are usually cheaper than those with brand names. Key words: Brand, Generic,Prescription, Antihypertensives,Cost. [Nig. Jnl Health & Biomedical ...

  13. PRESCRIBING PATTERN OF NON-STEROIDAL ANTI ...

    African Journals Online (AJOL)

    2015-03-01

    Mar 1, 2015 ... Design: A total of 3800 prescriptions containing. NSAIDs were analyzed for information on drug name, the number of NSAIDs per prescription, the presence of ACE inhibitors and diuretics alongside. NSAIDs and NSAIDs prescribed in generic or brand names. Results: The results showed that Aspirin was ...

  14. Prescribing Patterns of Methylphenidate and Atomoxetine for ...

    African Journals Online (AJOL)

    Purpose: To determine the prescribing pattern of methylphenidate and atomoxetine to patients with. Attention-Deficit/Hyperactivity Disorder (ADHD) in South Africa. Methods: A retrospective, cross-sectional pharmacoepidemiological study was conducted based on the data from a medical aid administrator in South Africa for ...

  15. Prescribing Patterns of Methylphenidate and Atomoxetine for ...

    African Journals Online (AJOL)

    Purpose: To determine the prescribing pattern of methylphenidate and atomoxetine to patients with Attention-Deficit/Hyperactivity Disorder (ADHD) in South Africa. Methods: A retrospective, cross-sectional pharmacoepidemiological study was conducted based on the data from a medical aid administrator in South Africa for ...

  16. An atmospheric dispersion index for prescribed burning

    Science.gov (United States)

    Leonidas G. Lavdas

    1986-01-01

    A numerical index that estimates the atmosphere's capacity to disperse smoke from prescribed burning is described. The physical assumptions and mathematical development of the index are given in detail. A preliminary interpretation of dispersion index values is offered. A FORTRAN subroutine package for computing the index is included.

  17. [Prescribing, the perspectives of health professionals].

    Science.gov (United States)

    Debout, Christophe; Lescot, Thomas; Loyer, Frédérique; Ambrosino, Florence

    2016-10-01

    While, in France, various health professionals are authorised to prescribe, they approach this activity in a different way, depending on the professional category to which they belong. The areas and products concerned are specific to each profession, and inevitably evolve. This article presents the different perspectives of a doctor, a midwife and a nurse. Copyright © 2016. Published by Elsevier Masson SAS.

  18. USE OF COMPETITIVE DNA HYBRIDIZATION TO IDENTIFY DIFFERENCES IN THE GENOMES OF TWO CLOSELY RELATED FECAL INDICATOR BACTERIA

    Science.gov (United States)

    Although recent technological advances in DNA sequencing and computational biology now allow scientists to compare entire microbial genomes, comparisons of closely related bacterial species and individual isolates by whole-genome sequencing approaches remains prohibitively expens...

  19. Impact of Prior Therapeutic Opioid Use by Emergency Department Providers on Opioid Prescribing Decisions

    Directory of Open Access Journals (Sweden)

    Adam C Pomerleau

    2016-11-01

    Full Text Available INTRODUCTION: Our study sought to examine the opioid analgesic (OA prescribing decisions of emergency department (ED providers who have themselves used OA therapeutically and those who have not. A second objective was to determine if OA prescribing decisions would differ based on the patient's relationship to the provider. METHODS: We distributed an electronic survey to a random sample of ED providers at participating centers in a nationwide research consortium. Question topics included provider attitudes about OA prescribing, prior personal therapeutic use of OAs (indications, dosing, and disposal of leftover medication, and hypothetical analgesic-prescribing decisions for their patients, family members, and themselves for different painful conditions. RESULTS: The total survey population was 957 individuals; 515 responded to the survey, a 54% response rate. Prior personal therapeutic OA use was reported in 63% (95% CI = [58-68]. A majority of these providers (82%; 95% CI = [77-87] took fewer than half the number of pills prescribed. Regarding provider attitudes towards OA prescribing, 66% (95% CI = [61-71] agreed that OA could lead to addiction even with short-term use. When providers were asked if they would prescribe OA to a patient with 10/10 pain from an ankle sprain, 21% (95% CI = [17-25] would for an adult patient, 13% (95% CI = [10-16] would for an adult family member, and 6% (95% CI = [4-8] indicated they themselves would take an opioid for the same pain. When the scenario involved an ankle fracture, 86% (95% CI = [83-89] would prescribe OA for an adult patient, 75% (95% CI = [71-79] for an adult family member, and 52% (95% CI = [47-57] would themselves take OA. Providers who have personally used OA to treat their pain were found to make similar prescribing decisions compared to those who had not. CONCLUSION: No consistent differences in prescribing decisions were found between ED providers based on their prior therapeutic use of OA

  20. Improving antimicrobial prescribing in Irish primary care through electronic data collection and surveillance: a feasibility study.

    Science.gov (United States)

    Galvin, Sandra; Callan, Aoife; Cormican, Martin; Duane, Sinead; Bennett, Kathleen; Murphy, Andrew W; Vellinga, Akke

    2015-07-02

    The increase in the spread of antimicrobial resistance (AMR) in bacterial pathogens and limited availability of new antimicrobials places immense pressure on general practitioners (GPs) to prescribe appropriately. Currently, electronic antimicrobial prescribing data is not routinely collected from GPs in Ireland for surveillance purposes to assess regional specific fluctuations or trends in antimicrobial prescribing. The current study aimed to address this issue by assessing the feasibility of remotely extracting antimicrobial prescribing data from primary care practices in Ireland, for the purpose of assessing prescribing quality using the European Surveillance of Antimicrobial Consumption (ESAC) drug specific quality indicators. Participating practices (n = 30) uploaded data to the Irish Primary Care Research Network (IPCRN). The IPCRN data extraction facility is integrated within the practice patient management software system and permitted the extraction of anonymised patient prescriptions for a one year period, from October 2012 to October 2013. The quality of antimicrobial prescribing was evaluated using the twelve ESAC drug specific quality indicators using the defined daily dose (DDD) per 1,000 inhabitants per day (DID) methodology. National and European prescribing surveillance data (based on total pharmacy sales) was obtained for a comparative analysis. Antimicrobial prescriptions (n = 57,079) for 27,043 patients were obtained from the thirty study practices for a one year period. On average, study practices prescribed a greater proportion of quinolones (37 % increase), in summer compared with winter months, a variation which was not observed in national and European data. In comparison with national data, study practices prescribed higher proportions of β-lactamase-sensitive penicillins (4.98 % vs. 4.3 %) and a greater use of broad spectrum compared to narrow-spectrum antimicrobials (ratio = 9.98 vs. 6.26) was observed. Study practices exceeded the

  1. Beyond the basics: refills by electronic prescribing.

    Science.gov (United States)

    Goldman, Roberta E; Dubé, Catherine; Lapane, Kate L

    2010-07-01

    E-prescribing is part of a new generation of electronic solutions for the medical industry that may have great potential for improving work flow and communication between medical practices and pharmacies. In the US, it has been introduced with minimal monitoring of errors and general usability. This paper examines refill functionality in e-prescribing software. A mixed method study including focus groups and surveys was conducted. Qualitative data were collected in on-site focus groups or individual interviews with clinicians and medical office staff at 64 physician office practices. Focus group participants described their experiences with the refill functionality of e-prescribing software, provided suggestions for improving it, and suggested improvements in office procedures and software functionality. Overall, approximately 50% reduction in time spent each day on refills was reported. Overall reports of refill functionality were positive; but clinicians and staff identified numerous difficulties and glitches associated managing prescription refills. These glitches diminished over time. Benefits included time saved as well as patient convenience. Potential for refilling without thought because of the ease of use was noted. Clinicians and staff appreciated the ability to track whether patients are filling and refilling prescriptions. E-prescribing software for managing medication refills has not yet reached its full potential. To reduce work flow barriers and medication errors, software companies need to develop error reporting systems and response teams to deal effectively with problems experienced by users. Examining usability issues on both the medical office and pharmacy ends is required to identify the behavioral and cultural changes that accompany technological innovation and ease the transition to full use of e-prescribing software. 2010 Elsevier Ireland Ltd. All rights reserved.

  2. Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study.

    Science.gov (United States)

    Liang, Sophie Hsin-Yi; Yang, Yao-Hsu; Kuo, Ting-Yu; Liao, Yin-To; Lin, Tzu-Chin; Lee, Yena; McIntyre, Roger S; Kelsen, Brent A; Wang, Tsu-Nai; Chen, Vincent Chin-Hung

    2018-01-01

    Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. To investigate the MPH usage and the risk of suicide attempt among ADHD youths. We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Nonstationarity in the occurrence rate of floods in the Tarim River basin, China, and related impacts of climate indices

    Science.gov (United States)

    Gu, Xihui; Zhang, Qiang; Singh, Vijay P.; Chen, Xi; Liu, Lin

    2016-07-01

    Amplification of floods in the Xinjiang, China, has been observed, but reports on their changing properties and underlying mechanisms are not available. In this study, occurrence rates of floods in the Tarim River basin, the largest inland arid river basin in China, were analyzed using the Kernel density estimation technique and bootstrap resampling method. Also analyzed were the occurrence rates of precipitation extremes using the POT (Peak over Threshold)-based sampling method. Both stationary and non-stationary models were developed using GAMLSS (Generalized Additive Models for Location, Scale and Shape) to model flood frequency with time, climate index, precipitation and temperature as major predictors. Results indicated: (1) two periods with increasing occurrence of floods, i.e., the late 1960s and the late 1990s with considerable fluctuations around 2-3 flood events during time intervals between the late 1960s and the late 1990s; (2) changes in the occurrence rates of floods were subject to nonstationarity. A persistent increase of flood frequency and magnitude was observed during the 1990s and reached a peak value; (3) AMO (Atlantic Multidecadal Oscillation) and AO (Atlantic Oscillation) in winter were the key influencing climate indices impacting the occurrence rates of floods. However, NAO (North Atlantic Oscillation) and SOI (South Oscillation Index) are two principle factors that influence the occurrence rates of regional floods. The AIC (Akaike Information Criterion) values indicated that compared to the influence of climate indices, occurrence rates of floods seemed to be more sensitive to temperature and precipitation changes. Results of this study are important for flood management and development of mitigation measures.

  4. Does Cyberbullying Prevalence Among Adolescents Relate With Country Socioeconomic and Development Indicators? An Ecological Study of 31 Countries.

    Science.gov (United States)

    Soares, Sara; Brochado, Sandra; Barros, Henrique; Fraga, Sílvia

    2017-10-01

    In addition to individual characteristics, it is also important to evaluate how the environment may influence the dynamics of cyberbullying. We aim to study the correlation between cyberbullying prevalence among adolescents and selected country-level indicators. We used two different data sources: data from a previously published literature review, to identify information on cyberbullying prevalence across countries, and data from the World Bank databases, to extract information on country-level indicators. A correlation matrix was used to present the association between the selected country-level indicators and the prevalence of cyberbullying. We observed a statistically significant negative correlation between cyberbullying victimization (cybervictims and cyberbully-victims, respectively) and gross domestic product (r = -.474 and -.842), gross national income (r = -.485 and -.758), enrollment in secondary (r = -.446 and -.898) and tertiary education (r = -.222 and -.881), the number of secure Internet servers (r = -.118 and -.794), and the number of Internet users (r = -.190 and -.818). A country's educational level seems to be an important contributor to the occurrence of cyberbullying.

  5. ORGANIC CARBON AND CARBON STOCK: RELATIONS WITH PHYSICAL INDICATORS AND SOIL AGGREGATION IN AREAS CULTIVATED WITH SUGAR CANE

    Directory of Open Access Journals (Sweden)

    Diego Tolentino de Lima

    2017-08-01

    Full Text Available Soil organic carbon and carbon stock influence, directly or indirectly, most of soil aggregate stability indicators. The objective of this study was to quantify the production of dry biomass (DB, total organic carbon (TOC and carbon stock (CStk in soil, and to evaluate their influence on some indicators of aggregation in an Oxisol at a Cerrado biome in Uberaba-MG, Brazil. The design was completely randomized blocks, in two evaluation periods: three and six cuts, at six depths (0-0.1, 0.1-0.2, 0.2-0.3, 0.3-0.4, 0.4-0.5 and 0.5-0.6 m. It was evaluated: soil density (SD, volumetric humidity (VH, aggregate stability index (AEI, weighted mean diameter (WDA, mean diameter (GDA, index of aggregates with diameter greater than 2 mm (AI and sensitivity index (SI, replicated by 4. The best AEI of the soil and the highest TOC contents were found in the most superficial layers, 0 to 0.2 m, for both cuttings. The greater values of TOC and CStk, occurred at the sixth cut area, where there was a higher amount of DB on soil surface. The higher levels of organic matter did not provide higher AEI in the area of sixth cut, when compared to that of the third cut. The TOC and CStk levels in both areas generally had a positive influence on soil aggregation indicators for both cuts.

  6. Study of relief changes related to active doming in the eastern Moroccan Rif (Morocco) using geomorphological indices

    Science.gov (United States)

    Barcos, L.; Jabaloy, A.; Azdimousa, A.; Asebriy, L.; Gómez-Ortiz, D.; Rodríguez-Peces, M. J.; Tejero, R.; Pérez-Peña, J. V.

    2014-12-01

    This work studies the influence of active tectonics in the drainage networks and topography of the eastern Rif belt, eastern Middle Atlas, and Rekkame high plateau. We have performed a trend-topographic surface analysis at small to medium scales, several landscape analyses at medium scale, and the slope analysis of the relief. Furthermore, we have determined several geomorphic indices in the drainage networks of the study area: hypsometric curve analysis and normalised stream-length gradient (SLk) estimations. The trend-topography surface analysis identifies a NE-SW trending undulation that correspond to the positive topography of the Middle and High Atlas mountain ranges and the Rekkame high plateau as well as an E-W elongated dome in the eastern Rif-Beni Snassen massif. The geomorphologic indices indicate that drainage network is strongly deformed in the vicinity of the Trougout-Nekor active fault system. Furthermore, the Oued Molouya catchment is deformed in the northern limit of the Beni Snassen massif by active deformations accommodating a roughly N-S shortening. According to the available geochronological data from volcanic rocks as well as from Neogene to Quaternary sediments, the most likely age for the deformation of the drainage network producing the anomalous high geomorphic indexes was Placenzian to Present.

  7. Stress indicators in the post-partum period and their relation with women’s mood in the puerperium

    Directory of Open Access Journals (Sweden)

    Dolores Marín Morales

    2013-01-01

    Full Text Available The aim of this research project is to study the relationships among physiological indicators of stress, maternal hormone levels and mood in the early postpartum, and their possible association with psychological problems during the puerperium. This observational, longitudinal and correlational study will be carried in a sample of voluntary women belonging to area 9 of health services of the Community of Madrid, the participants will be recruited during their childbirth hospitalization. To evaluate the target variables structured and validated questionnaires would be applied and analysis of biological indicators taken at two time points:-In the early postpartum: anxiety, depression and childbirth satisfaction, physiological indicators of the stress response (cortisol in saliva, plasma norepinephrine and epinephrine, and seric oxytocin and gonadotropin hormone levels. -During the puerperal period up to three months after delivery: perceived stress,anxiety and depression. Socio-demographic information as well as clinical data on the progress of labor, and status of maternal and neonatal health condition will be also obtained and included in the study.

  8. South African medical students’ perceptions and knowledge about antibiotic resistance and appropriate prescribing: Are we providing adequate training to future prescribers?

    Directory of Open Access Journals (Sweden)

    Sean Wasserman,

    2017-05-01

    Full Text Available Background. Education of medical students has been identified by the World Health Organization as an important aspect of antibiotic resistance (ABR containment. Surveys from high-income countries consistently reveal that medical students recognise the importance of antibiotic prescribing knowledge, but feel inadequately prepared and require more education on how to make antibiotic choices. The attitudes and knowledge of South African (SA medical students regarding ABR and antibiotic prescribing have never been evaluated. Objective. To evaluate SA medical students’ perceptions, attitudes and knowledge about antibiotic use and resistance, and the perceived quality of education relating to antibiotics and infection. Methods. This was a cross-sectional survey of final-year students at three medical schools, using a 26-item self-administered questionnaire. The questionnaires recorded basic demographic information, perceptions about antibiotic use and ABR, sources, quality, and usefulness of current education about antibiotic use, and questions to evaluate knowledge. Hard-copy surveys were administered during whole-class lectures. Results. A total of 289 of 567 (51% students completed the survey. Ninety-two percent agreed that antibiotics are overused and 87% agreed that resistance is a significant problem in SA – higher proportions than those who thought that antibiotic overuse (63% and resistance (61% are problems in the hospitals where they had worked (p<0.001. Most reported that they would appreciate more education on appropriate use of antibiotics (95%. Only 33% felt confident to prescribe antibiotics, with similar proportions across institutions. Overall, prescribing confidence was associated with the use of antibiotic prescribing guidelines (p=0.003, familiarity with antibiotic stewardship (p=0.012, and more frequent contact with infectious diseases specialists (p<0.001. There was an overall mean correct score of 50% on the knowledge

  9. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    Directory of Open Access Journals (Sweden)

    Hanna T

    2014-03-01

    Full Text Available Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG by three expert researchers. Results: In seven of nine scenarios (78%, the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency in the majority of scenarios. Due to this, only 47% (76/162 of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162 of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusion: Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

  10. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    Science.gov (United States)

    Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.

    Objective To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusions Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way. PMID:24644524

  11. Relative Efficiency Indicators of the Credit Management Process in a Colombian Bank by Means of Data Envelopment Analysis (DEA)

    OpenAIRE

    Sánchez-Gooding, Sandra Paola; Universidad Nacional de Colombia; Rodríguez-Lozano, Gloria Isabel; Universidad Nacional de Colombia

    2017-01-01

    The purpose of this work is to measure the relative efficiency of the units that take part in the credit management process in a Colombian bank by means of the use of Data Envelopment Analysis (DEA). Using a doublé optimization process, this advanced linear programmingmethodology generates a single relative efficiency index for each one of the units being studied, although it is capable of including multiple resources and multiple outputs. In the bank that was used as the object of this study...

  12. Actual Therapeutic Indication of an Old Drug: Urea for Treatment of Severely Symptomatic and Mild Chronic Hyponatremia Related to SIADH

    Directory of Open Access Journals (Sweden)

    Guy Decaux

    2014-09-01

    Full Text Available Oral urea has been used in the past to treat various diseases like gastric ulcers, liver metastases, sickle cell disease, heart failure, brain oedema, glaucoma, Meniere disease, etc. We have demonstrated for years, the efficacy of urea to treat euvolemic (SIADH or hypervolemic hyponatremia. We briefly describe the indications of urea use in symptomatic and paucisymptomatic hyponatremic patients. Urea is a non-toxic, cheap product, and protects against osmotic demyelinating syndrome (ODS in experimental studies. Prospective studies showing the benefit to treat mild chronic hyponatremia due to SIADH and comparing water restriction, urea, high ceiling diuretics, and antivasopressin antagonist antagonist should be done.

  13. Mobilisation of heavy metals into the urine by CaEDTA: relation to erythrocyte and plasma concentrations and exposure indicators.

    OpenAIRE

    Araki, S; Aono, H; Murata, K

    1986-01-01

    To investigate the effects of calcium disodium ethylenediamine tetra-acetate (CaEDTA) on the urinary excretion, erythrocyte, and plasma concentrations and exposure indicators of seven heavy metals, CaEDTA was administered by intravenous infusion to 20 workers exposed to lead, zinc, and copper. The workers' blood lead concentrations ranged from 22 to 59 micrograms/dl (mean 38 micrograms/dl (1.8 mumol/l]. The 24 hour urinary excretion of metals after CaEDTA administration (mobilisation yield) w...

  14. Nephrotoxicity of mercapturic acids of three structurally related 2,2-difluoroethylenes in the rat. Indications for different bioactivation mechanisms.

    NARCIS (Netherlands)

    Commandeur, J.N.M.; Brakenhoff, J.P.G.; de Kanter, F.J.J.; Vermeulen, N.P.E.

    1988-01-01

    The biotransformation and the hepato- and nephrotoxicity of the mercapturic acids (N-acetyl-1-cysteine S-conjugates) of three structurally related 2,2-difluoroethylenes were investigated in vivo in the rat. All mercapturic acids appeared to cause nephrotoxicity, without any measureable effect on the

  15. Aerobic Fitness and Cognitive Development: Event-Related Brain Potential and Task Performance Indices of Executive Control in Preadolescent Children

    Science.gov (United States)

    Hillman, Charles H.; Buck, Sarah M.; Themanson, Jason R.; Pontifex, Matthew B.; Castelli, Darla M.

    2009-01-01

    The relationship between aerobic fitness and executive control was assessed in 38 higher- and lower-fit children (M[subscript age] = 9.4 years), grouped according to their performance on a field test of aerobic capacity. Participants performed a flanker task requiring variable amounts of executive control while event-related brain potential…

  16. Processing of visual semantic information to concrete words : temporal dynamics and neural mechanisms indicated by event-related brain potentials

    NARCIS (Netherlands)

    van Schie, Hein T.; Wijers, Albertus A.; Mars, Rogier B.; Benjamins, Jeroen S.; Stowe, Laurie A.

    2005-01-01

    Event-related brain potentials were used to study the retrieval of visual semantic information to concrete words, and to investigate possible structural overlap between visual object working memory and concreteness effects in word processing. Subjects performed an object working memory task that

  17. Processing of visual semantic information to concrete words: temporal dynamics and neural mechanisms indicated by event-related brain potentials

    NARCIS (Netherlands)

    Schie, H.T. van; Wijers, A.A.; Mars, R.B.; Benjamins, J.S.; Stowe, L.A.

    2005-01-01

    Event-related brain potentials were used to study the retrieval of visual semantic information to concrete words, and to investigate possible structural overlap between visual object working memory and concreteness effects in word processing. Subjects performed an object working memory task that

  18. How well are the climate indices related to the GRACE-observed total water storage changes in China?

    Science.gov (United States)

    Devaraju, B.; Vishwakarma, B.; Sneeuw, N. J.

    2017-12-01

    The fresh water availability over land masses is changing rapidly under the influence of climate change and human intervention. In order to manage our water resources and plan for a better future, we need to demarcate the role of climate change. The total water storage change in a region can be obtained from the GRACE satellite mission. On the other hand, many climate change indicators, for example ENSO, are derived from sea surface temperature. In this contribution we investigate the relationship between the total water storage change over China with the climate indices using statistical time-series decomposition techniques, such as Seasonal and Trend decomposition using Loess (STL), Principal Component Analysis (PCA) and Canonical Correlation Analysis (CCA). The anomalies in climate variables, such as sea surface temperature, are responsible for anomalous precipitation and thus an anomalous total water storage change over land. Therefore, it is imperative that we use a GRACE product that can capture anomalous water storage changes with unprecedented accuracy. Since filtering decreases the sensitivity of GRACE products substantially, we use the data-driven method of deviation for recovering the signal lost due to filtering. To this end, we are able to obtain the spatial fingerprint of individual climate index on total water storage change observed over China.

  19. Does the number of siblings affect health in midlife? Evidence from the Swedish Prescribed Drug Register

    Directory of Open Access Journals (Sweden)

    Anna Baranowska-Rataj

    2016-11-01

    Full Text Available Background: In many societies, growing up in a large family is associated with receiving less parental time, attention, and financial support. As a result, children with a large number of siblings may have worse physical and mental health outcomes than children with fewer siblings. Objective: Our objective is to examine the long-term causal effects of sibship size on physical and mental health in modern Sweden. Methods: We employ longitudinal data covering the entire Swedish population from the Multigenerational Register and the Medical Birth Register. This data includes information on family size and on potential confounders such as parental background. We use the Prescribed Drug Register to identify the medicines that have been prescribed and dispensed. We use instrumental variable models with multiple births as instruments to examine the causal effects of family size on the health outcomes of children, as measured by receiving medicines at age 45. Results: Our results indicate that in Sweden, growing up in a large family does not have a detrimental effect on physical and mental health in midlife. Contribution: We provide a systematic overview of the health-related implications of growing up in a large family. We adopt a research design that gives us the opportunity to make causal inferences about the long-term effects of family size. Moreover, our paper provides evidence on the links between family size and health outcomes in the context of a developed country that implements policies oriented towards reducing social inequalities in health and other living conditions.

  20. Long term repeated prescribed burning increases evenness in the basidiomycete laccase gene pool in forest soils.

    Science.gov (United States)

    Artz, Rebekka R E; Reid, Eileen; Anderson, Ian C; Campbell, Colin D; Cairney, John W G

    2009-03-01

    Repeated prescribed burning alters the biologically labile fraction of nutrients and carbon of soil organic matter (SOM). Using a long-term (30 years) repeated burning experiment where burning has been carried out at a 2- or 4-year frequency, we analysed the effect of prescribed burning on gross potential C turnover rates and phenol oxidase activity in relation to shifts in SOM composition as observed using Fourier-transform infrared spectroscopy. In tandem, we assessed the genetic diversity of basidiomycete laccases. While the overall effect of burning was a decline in phenol oxidase activity, Shannon diversity and evenness of laccases was significantly higher in burned sites. Co-correspondence analysis of SOM composition and laccase operational taxonomic unit frequency data also suggested a strong correlation. While this correlation could indicate that the observed increase in laccase genetic diversity due to burning is due to increased resource diversity, a temporal replacement of the most abundant members of the assembly by an otherwise dormant pool of fungi cannot be excluded. As such, our results fit the intermediate disturbance hypothesis. Effects were stronger in plots burned in 2-year rotations, suggesting that the 4-year burn frequency may be a more sustainable practice to ensure the long-term stability of C cycling in such ecosystems.

  1. Shrub resprouting response after fuel reduction treatments: comparison of prescribed burning, clearing and mastication.

    Science.gov (United States)

    Fernández, Cristina; Vega, José A; Fonturbel, Teresa

    2013-03-15

    Fuel reduction treatments are commonly used to reduce the risk of severe wildfire. However, more information about the effects on plant resprouting is needed to help land managers select the most appropriate treatment. To address this question, we evaluated the resprouting ability of five shrub species after the application of different types of fuel reduction methods (prescribed burning, clearing and mastication) in two contrasting shrubland areas in northern Spain. The shrub species were Erica australis, Pterospartum tridentatum and Halimium lasianthum spp. alyssoides, Ulex gallii and Erica cinerea. For most of the species under study (E. australis, P. tridentatum, H. lasianthum spp. alyssoides and U. gallii), neither plant mortality nor the number nor length of sprouted shoots per plant differed between treatments, although in E. cinerea the number of shoots was more negatively affected by prescribed burning than by clearing or mastication. The pre-treatment plant size did not affect plant mortality or plant resprouting response, suggesting that this parameter alone is not a good indicator of plant resprouting after fuel reduction treatments. Stem minimum diameter after treatments, a proxy of treatment severity, was not related to plant mortality, number or length of resprouted shoots. The duration of temperatures higher than 300 °C during burning in plant crown had a negative effect on the length of resprouted shoots, only in E. cinerea. The results show that fuel reduction treatments did not prevent shrub response in any case. Some reflections on the applicability of treatments are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Economic value of big game habitat production from natural and prescribed fire

    Science.gov (United States)

    Armando Gonzalez-Caban; John B. Loomis; Dana Griffin; Elen Wu; Daniel McCollum; Jane McKeever; Diane Freeman

    2003-01-01

    A macro time-series model and a micro GIS model were used to estimate a production function relating deer harvest response to prescribed fire, holding constant other environmental variables. The macro time-series model showed a marginal increase in deer harvested of 33 for an increase of 1,100 acres of prescribed burn. The marginal deer increase for the micro GIS model...

  3. Analysis of papaya cell wall-related genes during fruit ripening indicates a central role of polygalacturonases during pulp softening.

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    João Paulo Fabi

    Full Text Available Papaya (Carica papaya L. is a climacteric fleshy fruit that undergoes dramatic changes during ripening, most noticeably a severe pulp softening. However, little is known regarding the genetics of the cell wall metabolism in papayas. The present work describes the identification and characterization of genes related to pulp softening. We used gene expression profiling to analyze the correlations and co-expression networks of cell wall-related genes, and the results suggest that papaya pulp softening is accomplished by the interactions of multiple glycoside hydrolases. The polygalacturonase cpPG1 appeared to play a central role in the network and was further studied. The transient expression of cpPG1 in papaya results in pulp softening and leaf necrosis in the absence of ethylene action and confirms its role in papaya fruit ripening.

  4. Are optical indices good proxies of seasonal changes in carbon fluxes and stress-related physiological status in a beech forest?

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    Nestola, E; Scartazza, A; Di Baccio, D; Castagna, A; Ranieri, A; Cammarano, M; Mazzenga, F; Matteucci, G; Calfapietra, C

    2018-01-15

    This study investigates the functionality of a Mediterranean-mountain beech forest in Central Italy using simultaneous determinations of optical measurements, carbon (C) fluxes, leaf eco-physiological and biochemical traits during two growing seasons (2014-2015). Meteorological variables showed significant differences between the two growing seasons, highlighting a heat stress coupled with a reduced water availability in mid-summer 2015. As a result, a different C sink capacity of the forest was observed between the two years of study, due to the differences in stressful conditions and the related plant physiological status. Spectral indices related to vegetation (VIs, classified in structural, chlorophyll and carotenoid indices) were computed at top canopy level and used to track CO 2 fluxes and physiological changes. Optical indices related to structure (EVI 2, RDVI, DVI and MCARI 1) were found to better track Net Ecosystem Exchange (NEE) variations for 2014, while indices related to chlorophylls (SR red edge, CL red edge, MTCI and DR) provided better results for 2015. This suggests that when environmental conditions are not limiting for forest sink capacity, structural parameters are more strictly connected to C uptake, while under stress conditions indices related to functional features (e.g., chlorophyll content) become more relevant. Chlorophyll indices calculated with red edge bands (SR red edge, NDVI red edge, DR, CL red edge) resulted to be highly correlated with leaf nitrogen content (R 2 >0.70), while weaker, although significant, correlations were found with chlorophyll content. Carotenoid indices (PRI and PSRI) were strongly correlated with both chlorophylls and carotenoids content, suggesting that these indices are good proxies of the shifting pigment composition related to changes in soil moisture, heat stress and senescence. Our work suggests the importance of integrating different methods as a successful approach to understand how changing climatic

  5. Acute nicotine fails to alter event-related potential or behavioral performance indices of auditory distraction in cigarette smokers.

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    Knott, Verner J; Scherling, Carole S; Blais, Crystal M; Camarda, Jordan; Fisher, Derek J; Millar, Anne; McIntosh, Judy F

    2006-04-01

    Behavioral studies have shown that nicotine enhances performance in sustained attention tasks, but they have not shown convincing support for the effects of nicotine on tasks requiring selective attention or attentional control under conditions of distraction. We investigated distractibility in 14 smokers (7 females) with event-related brain potentials (ERPs) and behavioral performance measures extracted from an auditory discrimination task requiring a choice reaction time response to short- and long-duration tones, both with and without embedded deviants. Nicotine gum (4 mg), administered in a randomized, double-blind, placebo-controlled crossover design, failed to counter deviant-elicited behavioral distraction (i.e., slower reaction times and increased response errors), and it did not influence the distracter-elicited mismatch negativity, the P300a, or the reorienting negativity ERP components reflecting acoustic change detection, involuntary attentional switching, and attentional reorienting, respectively. Results are discussed in relation to a stimulus-filter model of smoking and in relation to future research directions.

  6. Age-related differences during simple working memory decisions: ERP indices of early recognition and compensation failure.

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    Tays, William J; Dywan, Jane; Capuana, Lesley J; Segalowitz, Sidney J

    2011-06-01

    Imaging data has identified frontal cortical activation in older adults during simple recognition tasks that relates positively with performance and could, therefore, be considered compensatory. However, in a previous electrophysiological study involving a Sternberg task with proactive interference manipulations, we observed a frontal positive scalp potential between 400 and 500 ms that was unique to older adults and predictive of poorer performance. These results led us to ask whether unique frontal activation in older adults serves a compensatory role only during relatively simple tasks when stimulus familiarity provides an unambiguous basis for response selection. In the current study, we tested this hypothesis by having younger and older adults complete a verbal Sternberg task without interference manipulations. In younger adults, we observed an early posterior negativity (90-120 ms) that predicted performance accuracy. Older adults failed to show this early negativity but did produce the expected frontal positivity. However, the frontal positivity was again associated with poorer performance. These data support the view that younger adults are able to bias early target discrimination to benefit response selection whereas older adults rely on later controlled processes that are not always effective in buffering against normative age-related decline. Copyright © 2011 Elsevier B.V. All rights reserved.

  7. Obstacle-negotiating gait and related physical measurement indicators for the community-dwelling elderly in Japan.

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    Sun, Wei; Watanabe, Misuzu; Hirota, Chika; Tanimoto, Yoshimi; Kono, Rei; Takasaki, Kyosuke; Kono, Koichi

    2010-01-01

    The aim of this study is to assess obstacle-negotiating gait (ONG) and explore its related physical factors. Subjects comprised 571 community-dwelling persons (195 men and 376 women) age>or=65 years and without cognitive impairment. ONG, timed up and go (TUG), and stair-climbing were measured and their relations were assessed. Walking ability (usual walking speed=UWS and daily walking steps=DWS), balance deficiency, and musculoskeletal function (handgrip strength and bone health) were examined objectively to explore ONG related physical factors. Logistic regression and general linear model analysis were performed with adjustment for age and body mass index (BMI). Time of ONG was 7.72s in men and 8.93s in women. Logistic regression analysis showed that the fast tertiles of ONG corresponding to the fast levels of TUG and stair-climbing had the highest odds ratio values. General linear model analysis showed that ONG was significantly associated with UWS and balance deficiency (no) in men, and with UWS, handgrip strength, DWS and balance deficiency (no) in women. Overall, ONG was considerably associated with falls screening tools and its determinants were also the main causes of falls. Training in ONG could be an attractive strategy for the prevention of falls among the elderly. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  8. Sex-related differences in hemato-biochemical indices of adult Vanaraja chickens during summer and winter seasons

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    Kuldeep Kumar Panigrahy

    2017-02-01

    Full Text Available Aim: The objective of this study was to evaluate the changes in hemato-biochemical indices in male and female Vanaraja chickens under tropical environment during summer and winter season. Materials and Methods: A total of 120 day-old sexed Vanaraja chicks were selected as experimental chickens and distributed equally in two groups having 60 female and 60 male chickens in each group, respectively. The experiment was continued for 8 weeks (56 days and both male and female chickens were slaughtered by cervical dislocation method. All parameters were estimated at the end of the experiment in both seasons. Results: Male had higher blood glucose, Ca and P level. Blood glucose level significantly (p0.05 effect in most of the observed parameters. Hence, Vanaraja chickens are adaptable to local tropical climate and can be reared efficiently as backyard poultry.

  9. Temporal analysis of vegetation indices related to biophysical parameters using Sentinel 2A images to estimate maize production

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    Macedo, Lucas Saran; Kawakubo, Fernando Shinji

    2017-10-01

    Agricultural production is one of the most important Brazilian economic activities accounting for about 21,5% of total Gross Domestic Product. In this scenario, the use of satellite images for estimating biophysical parameters along the phenological development of agricultural crops allows the conclusion about the sanity of planting and helps the projection on design production trends. The objective of this study is to analyze the temporal patterns and variation of six vegetion indexes obtained from the bands of Sentinel 2A satellite, associated with greenness (NDVI and ClRE), senescence (mARI and PSRI) and water content (DSWI and NDWI) to estimate maize production. The temporal pattern of the indices was analyzed in function of productivity data collected in-situ. The results obtained evidenced the importance of the SWIR and Red Edge ranges with Pearson correlation values of the temporal mean for NDWI 0.88 and 0.76 for CLRE.

  10. Pattern description and reliability parameters of six force-time related indices measured with plantar pressure measurements.

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    Deschamps, Kevin; Roosen, Philip; Bruyninckx, Herman; Desloovere, Kaat; Deleu, Paul-Andre; Matricali, Giovanni A; Peeraer, Louis; Staes, Filip

    2013-09-01

    Functional interpretation of plantar pressure measurements is commonly done through the use of ratios and indices which are preceded by the strategic combination of a subsampling method and selection of physical quantities. However, errors which may arise throughout the determination of these temporal indices/ratio calculations (T-IRC) have not been quantified. The purpose of the current study was therefore to estimate the reliability of T-IRC following semi-automatic total mapping (SATM). Using a repeated-measures design, two experienced therapists performed three subsampling sessions on three left and right pedobarographic footprints of ten healthy participants. Following the subsampling, six T-IRC were calculated: Rearfoot-Forefoot_fti, Rearfoot-Midfoot_fti, Forefoot medial/lateral_fti, First ray_fti, Metatarsal 1-Metatarsal 5_fti, Foot medial-lateral_fti. Patterns of the T-IRC were found to be consistent and in good agreement with corresponding knowledge from the literature. The inter-session errors of both therapists were similar in pattern and magnitude. The lowest peak inter-therapist error was found in the First ray_fti (6.5 a.u.) whereas the highest peak inter-therapist error was observed in the Forefoot medial/lateral_fti (27.0 a.u.) The magnitude of the inter-session and inter-therapist error varied over time, precluding the calculation of a simple numerical value for the error. The difference between both error parameters of all T-IRC was negligible which underscores the repeatability of the SATM protocol. The current study reports consistent patterns for six T-IRC and similar inter-session and inter-therapist error. The proposed SATM protocol and the T-IRC may therefore serve as basis for functional interpretation of footprint data. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Comparing two survey methods of measuring health-related indicators: Lot Quality Assurance Sampling and Demographic Health Surveys.

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    Anoke, Sarah C; Mwai, Paul; Jeffery, Caroline; Valadez, Joseph J; Pagano, Marcello

    2015-12-01

    Two common methods used to measure indicators for health programme monitoring and evaluation are the demographic and health surveys (DHS) and lot quality assurance sampling (LQAS); each one has different strengths. We report on both methods when utilised in comparable situations. We compared 24 indicators in south-west Uganda, where data for prevalence estimations were collected independently for the two methods in 2011 (LQAS: n = 8876; DHS: n = 1200). Data were stratified (e.g. gender and age) resulting in 37 comparisons. We used a two-sample two-sided Z-test of proportions to compare both methods. The average difference between LQAS and DHS for 37 estimates was 0.062 (SD = 0.093; median = 0.039). The average difference among the 21 failures to reject equality of proportions was 0.010 (SD = 0.041; median = 0.009); among the 16 rejections, it was 0.130 (SD = 0.010, median = 0.118). Seven of the 16 rejections exhibited absolute differences of 0.10 and 0.20 (mean = 0.261, SD = 0.083). There is 75.7% agreement across the two surveys. Both methods yield regional results, but only LQAS provides information at less granular levels (e.g. the district level) where managerial action is taken. The cost advantage and localisation make LQAS feasible to conduct more frequently, and provides the possibility for real-time health outcomes monitoring. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  12. Drug Use Evaluation of Three Widely Prescribed Antibiotics in a

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    Mehdi Mohammadi

    2015-10-01

    Full Text Available Background: Drug utilization studies are helpful in understanding the current practice. We have conducted a retrospective study to evaluate the relevant use of a group of most commonly prescribed antibiotics in a teaching hospital in Iran.  The results of this study may be of help for clinicians to improve the patient care.Methods: Patients who received parenteral ceftazidim, vancomycin and amikacin from December2010 to May 2011 were enrolled in this study. Patient’s data including demographic, length of Hospital stay, drug allergy, first and final diagnosis were recorded in a predesigned data collection form. American Hospital Formulary Services (AHFS book were used as a reference for evaluation of study drug indication and dosing according to diagnosis and microbiological culture. Defined Daily Dose (DDD of each drug extracted from Anatomic and Therapeutic Chemical classification system (ATC/DDD and drug usage data evaluated by calculating the ratio of prescribed drug to its DDD.Results: The ratio of prescribed daily dose to DDD was 0.78, 0.95 and 0.86 for amikacin, ceftazidime and vancomycin respectively. Between amikacin group, 43 patients (86% received drug empirically, the number of empiric treatments for ceftazidim and vancomycin were 45(90% and 44 patients (88%. The renal function tests (Blood Urea Nitrogen, Serum Creatinin were evaluated in 56% of amikacin group, 64% in ceftazidime group and 78% in vancomycin group.Conclusion: The results of this study indicate the need to establish continuing medical education (CME courses for physicians to familiarize them with standards required to use and monitor these agents.

  13. Connecting primary care clinics and community pharmacies through a nationwide electronic prescribing network: A qualitative study

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    Marie-Pierre Gagnon

    2015-10-01

    Full Text Available Background The use of medication is at the heart of primary care, but is also the cause for major health concerns. It is therefore important to examine the prescription of medication process.Objective This study identifies the barriers and facilitators perceived by community pharmacists and primary care physicians concerning the adoption of a nationwide electronic prescribing (e-prescribing network in the province of Quebec, Canada.Methods We used purposive sampling to identify the most intensive users of the e-prescribing network. We conducted phone and in-person interviews. Interviews were transcribed, and we analysed their content with NVivo, using the clinical adoption framework (CAF for the codification of the data.Results We interviewed 33 pharmacists, 2 pharmacy technicians, 11 physicians and 3 clinic managers. Adoption of the e-prescribing network was fairly low. The respondents underlined adaptation of their work environment, openness to change and perception of benefits as facilitators to the adoption of the network. However, important barriers were perceived, including system quality issues and paper prescriptions being the only legal document in the prescribing process. Even if respondents recognised that the e-prescribing network can offer substantial benefits to the prescribing process, issues still persisted and raised barriers to the full use of such a network, especially in a context where different local information systems are connected within a nationwide e-prescribing network.Conclusion This study, based on the CAF, provides a better understanding of the factors related to the adoption of a nationwide e-prescribing network connecting primary care clinics and community pharmacies. 

  14. Age-related worm load and worm fecundity patterns in human populations, as indicated by schistosome circulating antigens

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    Polman Katja

    1998-01-01

    Full Text Available Recently, our group determined the relationship between serum CAA levels and fecal egg counts in two foci with very intense Schistosoma mansoni transmission: Maniema (Zaire, an area endemic for S. mansoni since several decades, and Ndombo (Senegal, where transmission has only been established since a few years. The objective was to study and compare age-related worm load and worm fecundity patterns in these two different endemic settings. Here, we will summarize the mos