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Sample records for united states patients

  1. United States

    Directory of Open Access Journals (Sweden)

    Stephen Bernow

    1998-12-01

    Full Text Available This paper presents and discusses an integrated set of policies designed to reduce U.S. carbon emissions over the next four decades. This innovation path also aims to promote environmental quality, particularly by reducing emissions of criteria air pollutants, to reduce U.S. dependence on imported oil, and to induce technological innovation and diffusion in energy production and consumption. The innovation path would reduce economy-wide carbon emissions by 26% below baseline projections for 2010 and by 62% below baseline projections for 2030; this translates into 10% below 1990 levels in 2010 and 45% below 1990 levels in 2030. Emissions of criteria pollutants also would be significantly reduced, as would petroleum imports by the United States. Moreover, the innovation path would yield cumulative net savings for the United States of $218 billion (1993 dollars through 2010, or $19 billion on a leveled annual basis, and would result in 800,000 additional jobs nationwide by 2010. Although the overall findings from the innovation path analysis are robust, the results should be taken as indicative, rather than precisely predictive, owing to uncertainties in future costs, prices, technology performance, and consumer behavior.

  2. Borrelia miyamotoi Infection in Patients from Upper Midwestern United States, 2014-2015.

    Science.gov (United States)

    Jobe, Dean A; Lovrich, Steven D; Oldenburg, Darby G; Kowalski, Todd J; Callister, Steven M

    2016-08-01

    We confirmed Borrelia miyamotoi infection in 7 patients who had contracted an illness while near La Crosse, Wisconsin, USA, an area where Ixodes scapularis ticks are endemic. B. miyamatoi infection should now be considered among differential diagnoses for patients from the midwestern United States who have signs and symptoms suggestive of tickborne illness.

  3. Access to Care for Methadone Maintenance Patients in the United States

    Science.gov (United States)

    Hettema, Jennifer E.; Sorensen, James L.

    2009-01-01

    This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more…

  4. Computer-delivered patient simulations in the United States Medical Licensing Examination (USMLE).

    Science.gov (United States)

    Dillon, Gerard F; Clauser, Brian E

    2009-01-01

    To obtain a full and unrestricted license to practice medicine in the United States, students and graduates of the MD-granting US medical schools and of medical schools located outside of the United States must take and pass the United States Medical Licensing Examination. United States Medical Licensing Examination began as a series of paper-and-pencil examinations in the early 1990s and converted to computer-delivery in 1999. With this change to the computerized format came the opportunity to introduce computer-simulated patients, which had been under development at the National Board of Medical Examiners for a number of years. This testing format, called a computer-based case simulation, requires the examinee to manage a simulated patient in simulated time. The examinee can select options for history-taking and physical examination. Diagnostic studies and treatment are ordered via free-text entry, and the examinee controls the advance of simulated time and the location of the patient in the health care setting. Although the inclusion of this format has brought a number of practical, psychometric, and security challenges, its addition has allowed a significant expansion in ways to assess examinees on their diagnostic decision making and therapeutic intervention skills and on developing and implementing a reasonable patient management plan.

  5. Computers in hospital management and improvements in patients care--new trends in the United States.

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    Pierskalla, W P; Woods, D

    1988-12-01

    This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.

  6. In-Patient Trends and Complications After Total Ankle Arthroplasty in the United States.

    Science.gov (United States)

    Zhou, Hanbing; Yakavonis, Mark; Shaw, Joshua J; Patel, Abhay; Li, Xinning

    2016-01-01

    The number of total ankle arthroplasties (TAAs) performed annually in the United States has increased. The purpose of this study was to evaluate the in-patient demographics, complications, and readmission rates of patients after TAA at academic medical centers in the United States. The University HealthSystems Consortium administrative database was searched for patients who underwent TAA in 2007 to 2011. A descriptive analysis of demographics was performed, followed by a similar analysis of clinical benchmarks, including hospital length of stay, hospital direct cost, in-hospital mortality, and 30-day readmission rates. The study included 2340 adult patients with a mean age of 62 years (47% men and 53% women) who underwent TAA. The majority of patients were Caucasian (2073; 88.5%). Average hospital length of stay was 2.2±1.26 days. Average total direct cost for the hospital was $16,212±7000 per case, with 49.7% of patients having private insurance. In-hospital mortality was less than 1%, and overall complications were 1.4%. Complications after discharge included deep venous thrombosis (2.3%), reoperation (0.7%), and infection (3.2%). A readmission rate of 2.7% within the first 30 days from the time of discharge occurred. Total ankle arthroplasty in the United States is a relatively safe procedure with low overall complication rates. Patients who are male, have a history of community-acquired pneumonia, and have a larger number of preoperative comorbidities had a significant increased risk of developing 1 complication within 30 days of surgery.

  7. Total elbow arthroplasty in the United States: evaluation of cost, patient demographics, and complication rates

    Directory of Open Access Journals (Sweden)

    Hanbing Zhou

    2016-03-01

    Full Text Available Total elbow arthroplasty (TEA is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated inpatient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS, hospital direct cost, inhospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers in the United States. The racial demographics included 2334 (74% Caucasian, 285 (9% black, 236 (7.5% Hispanic, 16 (0.5% Asian, and 283 (9% other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality <1%, DVT (0.8%, re-operation (0.5%, and infection (0.4%. The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries.

  8. Variation in Care for Patients with Irritable Bowel Syndrome in the United States.

    Directory of Open Access Journals (Sweden)

    Brian E Lacy

    Full Text Available Irritable bowel syndrome (IBS affects nearly one in seven Americans. Significant national variations in care may exist, due to a current lack of standardized diagnosis and treatment algorithms; this can translate into a substantial additional economic burden. The study examines healthcare resource utilization in patients with IBS and in the subset of IBS patients with constipation (IBS-C and analyzes the variation of IBS care for these patients across the United States (US.Healthcare resource use (HRU, including gastrointestinal (GI procedures and tests, all-cause and intestinal-related medical visits, GI specialist visits, and constipation or diarrhea pharmacy prescriptions for IBS patients enrolled in a large US administrative claims database (2001-2012 were analyzed for the 24-month period surrounding first diagnosis. Multivariate regression models, adjusting for age, gender, year of first diagnosis, insurance type, and Charlson comorbidity index, compared HRU across states (each state vs. the average of all other states.Of 201,322 IBS patients included, 77.2% were female. Mean age was 49.4 years. One in three patients had ≥3 distinct GI medical procedures or diagnostic tests; 50.1% visited a GI specialist. Significant HRU differences were observed in individual states compared to the national average. IBS-C patients had more medical visits, procedures, and pharmacy prescriptions for constipation/diarrhea than IBS patients without constipation.This study is the first to identify considerable regional variations in IBS healthcare across the US and to note a markedly higher HRU by IBS-C patients than by IBS patients without constipation. Identifying the reasons for these variations may improve quality of care and reduce the economic burden of IBS.

  9. Exercise and limitations in physical activity levels among new dialysis patients in the United States: an epidemiologic study.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2008-12-01

    Epidemiologic studies of physical activity among patients with end-stage renal disease (ESRD) are lacking. The aim of this study was to describe the patterns of physical activity among new dialysis patients in the United States.

  10. A Comparison of Patient-Centered Care in Pharmacy Curricula in the United States and Europe.

    Science.gov (United States)

    Nunes-da-Cunha, Ines; Arguello, Blanca; Martinez, Fernando Martinez; Fernandez-Llimos, Fernando

    2016-06-25

    Objective. To compare United States and European Higher Education Area (EHEA) undergraduate pharmacy curricula in terms of patient-centered care courses. Methods. Websites from all pharmacy colleges or schools in the United States and the 41 countries in the EHEA were retrieved from the FIP Official World List of Pharmacy Schools and investigated. A random sample of schools was selected and, based on analyses of course descriptions from syllabi, each course was classified into the following categories: social/behavioral/administrative pharmacy sciences, clinical sciences, experiential, or other/basic sciences. Results. Of 147 schools of pharmacy, 59 were included (23 in US and 36 in the EHEA). Differences existed in the percentages of credits/hours in all of the four subject area categories. Conclusion. Institutions in EHEA countries maintain a greater focus on basic sciences and a lower load of clinical sciences in pharmacy curricula compared to the United States. These differences may not be in accordance with international recommendations to educate future pharmacists focused on patient care.

  11. Patterns and Outcomes Associated with Patient Migration for Liver Transplantation in the United States.

    Directory of Open Access Journals (Sweden)

    Kristopher P Croome

    Full Text Available Traveling to seek specialized care such as liver transplantation (LT is a reality in the United States. Patient migration has been attributed to organ availability. The aims of this study were to delineate patterns of patient migration and outcomes after LT.All deceased donor LT between 2008-2013 were extracted from UNOS data. Migrated patients were defined as those patients who underwent LT at a center in a different UNOS region from the region in which they resided and traveled a distance > 100 miles.Migrated patients comprised 8.2% of 28,700 LT performed. Efflux and influx of patients were observed in all 11 UNOS regions. Regions 1, 5, 6, and 9 had a net efflux, while regions 2, 3, 4, 7, 10, and 11 had a net influx of patients. After multivariate adjustment for donor and recipient factors, graft (p = 0.68 and patient survival (p = 0.52 were similar between migrated and non-migrated patients.A significant number of patients migrated in patterns that could not be explained alone by regional variations in MELD score and wait time. Migration may be a complex interplay of factors including referral patterns, specialized services at centers of excellence and patient preference.

  12. Malaria Treatment (United States)

    Science.gov (United States)

    ... a CDC Malaria Branch clinician. malaria@cdc.gov Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

  13. Discontinuation of lipid modifying drugs among commercially insured United States patients in recent clinical practice.

    Science.gov (United States)

    Kamal-Bahl, Sachin J; Burke, Thomas; Watson, Douglas; Wentworth, Chuck

    2007-02-15

    Although several lipid-modifying drug (LMD) treatments and strategies are available to successfully manage patients at risk for cardiovascular events, the benefits of drug treatment can be realized only if these therapies are continued on a long-term basis. Previous observational studies examining rates of discontinuation with LMDs are not generalizable to current clinical practice in the United States. In this study, the discontinuation of newly initiated LMD classes in recent clinical practice was compared in a geographically diverse, commercially insured United States population. Administrative claims from the Ingenix Lab/Rx Database were used to identify patients aged >or=20 years who were newly prescribed statins, extended-release niacin, fibrates, bile acid sequestrants, or ezetimibe from January 1, 2001, to June 30, 2003. An LMD class was considered discontinued if a patient did not receive a prescription from the same LMD class within 180 days of the most recent prescription expiration date. The median time to discontinuation was 8.2 months in the bile acid sequestrant group, followed by 12 months in the extended-release niacin group, 17.4 months in the fibrate group, and 27.5 months in the statin group. By the end of 1 year, the adjusted cumulative incidence of discontinuation was 68.3% in bile acid sequestrant users, 55.4% in extended-release niacin users, 39.9% in fibrate users, 33.0% in ezetimibe users, and 28.9% in statin users (p LMD classes vs statins). In conclusion, despite the changes in lipid treatment paradigms and the importance of long-term lipid therapy, this study found high discontinuation rates of LMD classes in recent United States clinical practice.

  14. Patient recall in advanced education in prosthodontics programs in the United States.

    Science.gov (United States)

    Afshari, Fatemeh S; Koslow, Alyson H; Knoernschild, Kent L; Sukotjo, Cortino

    2010-06-01

    This study surveyed program directors of Advanced Education Programs in Prosthodontics (AEPP) in the United States to determine the extent, type, incidence, and perceived effectiveness of implemented recall systems. Surveys were sent to AEPP directors across the United States to assess their program's recall protocol. This survey first identified whether an active recall program existed. For programs with recall systems, rigor in promoting ongoing oral health was surveyed by focusing on recall frequency, patient tracking protocol, involved personnel, interaction with other university departments, provided clinical procedures, and therapy completion protocol. Whether the directors perceived that their recall system was successful was also investigated. Thirty-three of 46 programs responded, giving a response rate of 72%. Of these 33 programs, only 21 (64%) had an active recall system, although 30 (91%) believed recall to be important. Twelve (57%) directors with recall programs considered their system to be effective. Prosthodontic program directors felt their program's recall effectiveness could be improved. Due to the numerous potential benefits of an active recall system, AEPPs should consider implementing or enhancing their recall programs. Further studies are indicated to determine specific criteria that describe an effective recall system for prosthodontic programs within the context of patient health promotion, program curriculum, and financial ramifications.

  15. Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States.

    Science.gov (United States)

    Rasu, Rafia S; Vouthy, Kiengkham; Crowl, Ashley N; Stegeman, Anne E; Fikru, Bithia; Bawa, Walter Agbor; Knell, Maureen E

    2014-09-01

    Nonmalignant chronic pain (NMCP) is a public health concern. Among primary care appointments, 22% focus on pain management. The American Academy of Pain Medicine guidelines for NMCP recommend combination medication therapy (including analgesics, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, antidepressants, and anticonvulsants) as a key component to effective treatment for many chronic pain diagnoses. However, there has been little evidence outlining the costs of pain medications in adult patients with NMCP in the United States, an area that necessitates further consideration as the nation moves toward value-based benefit design. To estimate the cost of pain medication attributable to treating adult patients with NMCP in the United States and to analyze the trend of outpatient pain visits. This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) data from 2000-2007. The Division of Health Care Statistics, National Center for Health Statistics, and the Centers for Disease Control and Prevention conducted the survey. The study included patients aged ≥18 years with chronic pain diagnoses (identified by the ICD-9-CM codes: primary, secondary, and tertiary). Patients prescribed at least 1 pain medication were included in the cost analysis. Pain-related prescription medications prescribed during ambulatory care visits were retrieved by using NAMCS drug codes/National Drug Code numbers. National pain prescription frequencies (weighted) were obtained from NAMCS data, using the statistical software STATA. We created pain therapy categories (drug classes) for cost analysis based on national pain guidelines. Drug classes used in this analysis were opioids/opioid-like agents, analgesics/NSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, antirheumatics/immunologics, muscle relaxants, topical products, and corticosteroids. We calculated average prices based on the 3 lowest average wholesale prices reported in the

  16. Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States.

    Science.gov (United States)

    Chang, Chongwon; Lee, Seung Mi; Choi, Byoung Whui; Song, Jong Hwa; Song, Hee; Jung, Sujin; Bai, Yoon Kyeong; Park, Haedong; Jeung, Seungwon; Suh, Dong Churl

    2017-01-01

    To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. This study was conducted using the 2003-2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861-$895] and $257 (95% CI: $251-$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253-$260) and $26 (95% CI: $26-$27) per person per year, respectively. Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.

  17. Mortality Analysis of Trauma Patients in General Intensive Care Unit of a State Hospital

    Directory of Open Access Journals (Sweden)

    İskender Kara

    2015-08-01

    Full Text Available Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8 vs. 15 (13-15, p<0.0001, median APACHE II score was higher (20 (15-26 vs. 10 (8-13, p<0.0001 and median duration of ICU stay was longer (27 (5-62,5 vs. 2 (1-5, p<0.0001 than those in the survival group. The most common etiology of trauma was traffic accidents (47.2% and 52.7% of patients had head trauma. The rate of patients with any fracture was significantly higher in the survival group (66.7% vs. 33.3%, p=0.007. The rate of erythrocyte suspension, fresh frozen plasma, trombocyte suspension and albumin were 38.9%, 27.8%, 0.9% and 8.3%, respectively in all group. The number of patients invasive mechanically ventilated was 27.8% and median length of stay of these patients were 5 (1.75-33.5 days. The rate of operated patients was 42.6%. The rate of tracheostomy, renal replacement therapy, bronchoscopy and percutaneous endoscopic gastrostomy enforcements were higher in the death group. The advanced age (p=0.016, OR: 1.054; 95% CI: 1.010-1100 and low GCS (p<0.0001, OR: 0.583; 95% CI: 0.456-0.745 were found to be independent risk factors the ICU mortality of trauma patients in logistic regression analysis. Conclusion: We believe that the determination of these risk factors affecting

  18. Complex Type 2 Reactions in Three Patients with Hansen's Disease from a Southern United States Clinic.

    Science.gov (United States)

    Leon, Kristoffer E; Salinas, Jorge L; McDonald, Robert W; Sheth, Anandi N; Fairley, Jessica K

    2015-11-01

    In non-endemic countries, leprosy, or Hansen's disease (HD), remains rare and is often underrecognized. Consequently, the literature is currently lacking in clinical descriptions of leprosy complications in the United States. Immune-mediated inflammatory states known as reactions are common complications of HD. Type 1 reactions are typical of borderline cases and occur in 30% of patients and present as swelling and inflammation of existing skin lesions, neuritis, and nerve dysfunction. Type 2 reactions are systemic events that occur at the lepromatous end of the disease spectrum, and typical symptoms include fever, arthralgias, neuritis, and classic painful erythematous skin nodules known as erythema nodosum leprosum. We report three patients with lepromatous leprosy seen at a U.S. HD clinic with complicated type 2 reactions. The differences in presentations and clinical courses highlight the complexity of the disease and the need for increased awareness of unique manifestations of lepromatous leprosy in non-endemic areas. © The American Society of Tropical Medicine and Hygiene.

  19. Patient characteristics and comorbidities associated with cerebrovascular accident following acute myocardial infarction in the United States.

    Science.gov (United States)

    Naderi, Nassim; Masoomi, Hossein; Mozaffar, Tahseen; Malik, Shaista

    2014-08-01

    Although cerebrovascular accident (CVA) is a relatively infrequent complication of acute myocardial infarction (AMI), the occurrence of CVA in patients with AMI is associated with increased morbidity and mortality. We wanted to assess post-AMI CVA rate in the United States and identify the associated patient characteristics, comorbidities, type of AMI, and utilization of invasive procedures. This is an observational study from the Nationwide Inpatient Sample, 2006-2008. Using multivariate regression models, we assessed predictive risk factors for post-AMI CVA among patients admitted for AMI. Among the 1,924,413 patients admitted for AMI, the overall rate of CVA was 2% (ischemic stroke: 1.47%, transient ischemic attack [TIA]: 0.35% and hemorrhagic stroke: 0.21%). In this sample of AMI patient, higher incidence of CVA was associated with: CHF (adjusted odds ratio [AOR] 1.71; 95% confidence interval [CI], 1.58-1.84,), age over 65 AOR, 1.65; 95% CI, 1.60-1.70, alcohol abuse AOR, 1.60; 95% CI, 1.49-1.73, cocaine use AOR, 1.48; 95% CI, 1.29-1.70, atrial fibrillation AOR, 1.43; 95% CI, 1.39-1.46, Black race AOR, 1.35; 95% CI, 1.30-1.40, female gender AOR, 1.32; 95% CI, 1.29-1.35, peripheral vascular disease [PVD] AOR, 1.26; 95% CI, 1.22-1.30, coronary artery bypass graft (CABG) AOR, 1.22; 95% CI, 1.17-1.27, PCVA post-AMI. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. 31 CFR 535.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 535.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof including the Trust Territory...

  1. 31 CFR 515.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 515.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including the Trust Territory...

  2. 31 CFR 500.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 500.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including U.S. trust...

  3. A survey of dermatophytes from human patients in the United States from 1985 to 1987.

    Science.gov (United States)

    Sinski, J T; Kelley, L M

    1991-05-01

    A survey of dermatophytes isolated from patients seeking medical advice was made from 1985 to 1987 in the United States. The survey included 54 locations with data from 45 cities and one state. Listing of the isolated dermatophytes and the frequency given by percentage of the total follows: Trichophyton rubrum 54.8%, T. tonsurans 31.3%, T. mentagrophytes 6.0%, Microsporum canis 4.0%, Epidermophyton floccosum 2.0%, M. gypseum 0.6%, and T. verrucosum 0.2%. Out of a total of 14,696 isolates M. audouinii was cultured 13 times, T. violaceum 12 times, M. nanum 6 times, T. terrestre 4 times, and T. soudanense twice. Single isolations were made of M. fulvum, M. ferrugineum and T. schoenleinii. Collection of dermatophyte data in Tucson, Arizona, began in 1966. In 1987, the first case of tinea capitis caused by T. tonsurans was observed. Other isolates of this organism as the cause of tinea capitis were made in this city during that year. These infections were in black children. With the recent growth of Tucson, the percentage of blacks in the population increased and this pathogen was introduced into the general population.

  4. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  5. Postoperative mortality after surgery for brain tumors by patient insurance status in the United States

    NARCIS (Netherlands)

    Momin, E.N.; Adams, H.; Shinohara, R.T.; Frangakis, C.; Brem, H.; Quinones-Hinojosa, A.

    2012-01-01

    OBJECTIVE To examine whether being uninsured is associated with higher in-hospital postoperative mortality when undergoing surgery in the United States for a brain tumor. DESIGN Retrospective cohort study using the Nationwide Inpatient Sample, January 1, 1999, through December 31, 2008. SETTING The

  6. More Medical Comorbidities in Patients With Bipolar Disorder From the United States Than From the Netherlands and Germany

    NARCIS (Netherlands)

    Post, Robert M.; Altshuler, Lori L.; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trish; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

    2014-01-01

    Medical comorbidities are common in patients with bipolar (BP) disorder but have not been previously examined for differences between United States and Europe. More than 900 outpatients with BP I and BP II disorder (mean age, 41 years) filled out a questionnaire including the occurrence of 30 listed

  7. United States Attorney Prosecutions

    Science.gov (United States)

    1993-10-01

    Berceda, 572 F.2d 630 (9th Cir. 1978).. A mere request, such as that made by the defendant, is not sufficient; United States v. Trejo- Zambrano , 582 F.2d...a mere request and more than mere speculation that disclosure will be helpful. United States v. Trejo- Zambrano , 582 F.2d 460 (9th Cir. 1978), eect. dt...both known and unknown to the Grand Jury, including Lane Boudreau, Scott Willard Holland, James Allen Halperin, Maria Ximena Erlandsen, Derek Adrian

  8. Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States

    Science.gov (United States)

    Safavi, Kyan C.; Dharmarajan, Kumar; Kim, Nancy; Strait, Kelly M.; Li, Shu-Xia; Chen, Serene I.; Lagu, Tara; Krumholz, Harlan M.

    2013-01-01

    Background Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes. Methods and Results We identified 166,224 HF discharges from 341 hospitals in the 2009–10 Premier Perspective® database. We excluded hospitals with transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top-quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (Interquartile Range 6% to 16%; range 0% to 88%). In top-quartile hospitals, treatments requiring an ICU were used less often: percentage of ICU days receiving mechanical ventilation (6% top quartile versus 15% others), non-invasive positive pressure ventilation (8% versus 19%), vasopressors and/or inotropes (9% versus 16%), vasodilators (6% versus 12%), and any of these interventions (26% versus 51%). Overall HF in-hospital risk standardized mortality was similar (3.4% versus 3.5%; P = 0.2). Conclusions ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes. PMID:23355624

  9. Utility of electroencephalogram in altered states of consciousness in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Kapadia F

    2005-01-01

    Full Text Available BACKGROUND: EEG is an investigative tool for assessing cerebral activity. Although certain EEG patterns may have a specific diagnostic or prognostic inference, they may not be precise for any sole etiology in majority of cases and may need clinical correlation. OBJECTIVE: Aim of this study was to assess the severity and prognosis of cerebral dysfunction in patients admitted to Intensive Care Unit (ICU and to evaluate the incidence of non-convulsive status epilepticus (NCSE. DESIGN: A prospective study, wherein we analyzed EEG characteristics in a series of 70 patients. SETTING: A tertiary care hospital in Mumbai, India. PATIENTS: EEG characteristics of 70 patients admitted in ICU over a period of 9 months were comprehensively analyzed. These patients were clinically examined and a questionnaire was completed without knowledge of the EEG findings. EEGs were requested for by neurologist or intensivist and our inclusion criteria were (i patients with altered sensorium of varying etiology, (ii unconscious patients at risk for non-convulsive status epilepticus (those with a history of epilepsy, and (iii unconscious patients with involuntary jerky eye movements. RESULTS: Of the various clinical presentations on ICU admission, there were 20 patients with seizures, 15 with metabolic disorders, 13 with infective causes, 9 with hypoxia, 9 with cerebro-vascular accident on presentation, 1 patient with alcohol/drug overdose, 2 with intra-cerebral space occupying lesion and 1 with ambiguous etiology on admission (there being an overlap among the presentation. Mean duration from presentation to performing EEG was 13 hours. 64 (91.42% patients had abnormal EEGs. 32(50% patients had EEG slowing and 4(6.25% patient had electro cerebral inactivity. Eleven (21.87% patients had epileptiform activity on the EEG of which seven did not have overt seizures (NCSE. Follow-up EEGs of these patients showed resolution of the epileptiform activity. CONCLUSIONS: EEG is useful

  10. Barriers to kidney transplantation among adult Sudanese patients on maintenance hemodialysis in dialysis units in Khartoum state

    Directory of Open Access Journals (Sweden)

    Hisham H Abdelwahab

    2013-01-01

    Full Text Available Kidney transplantation remains the preferred modality of treatment for patients with end-stage renal disease. In Sudan, kidney transplantation accounted for 28% of the total provided renal replacement therapies. A cross-sectional, hospital-based study was conducted in hemodialysis (HD units in Khartoum State during the period from September 2010 to January 2011. It aimed to determine the main reasons for the currently low renal transplantation rate. Data were obtained by direct interviewing using a specifically pre-coded and pre-tested questionnaire following a pilot study. A total of 462 adult HD patients were randomly selected from the various HD units in Khartoum State; these patients accounted for 16.9% of the total HD population in Khartoum State. The mean age of the study patients was 48.5 ± 23.6 years and 312 (67.5% were males. Upon interviewing, only 316 patients (68.4% said that they had been counseled for kidney transplantation. One hundred and twenty-two patients (26.4% were on the active transplant list; of these, 50% preferred to have their kidney transplantation performed abroad, mostly due to the availability of commercial transplantation and/or a presumed better outcome. The low renal transplantation rate was due to financial constraints in 112 patients (24.2%, lack of medical fitness in 97 patients (21% and absence of a suitable kidney donor in 92 patients (20%, while 56 patients (12% were still having misperceptions regarding transplantation and preferred to continue on dialysis. To improve the kidney transplantation rate in Khartoum State, the Sudan program for organ transplantation is expected to take more initiatives to promote and improve the outcome of kidney transplants inside the country and, accordingly, regain the patients′ confidence on the health system.

  11. The Use of TKM-100802 and Convalescent Plasma in 2 Patients With Ebola Virus Disease in the United States

    Science.gov (United States)

    Kraft, Colleen S.; Hewlett, Angela L.; Koepsell, Scott; Winkler, Anne M.; Kratochvil, Christopher J.; Larson, LuAnn; Varkey, Jay B.; Mehta, Aneesh K.; Lyon, G. Marshall; Friedman-Moraco, Rachel J.; Marconi, Vincent C.; Hill, Charles E.; Sullivan, James N.; Johnson, Daniel W.; Lisco, Steven J.; Mulligan, Mark J.; Uyeki, Timothy M.; McElroy, Anita K.; Sealy, Tara; Campbell, Shelley; Spiropoulou, Christina; Ströher, Ute; Crozier, Ian; Sacra, Richard; Connor, Michael J.; Sueblinvong, Viranuj; Franch, Harold A.; Smith, Philip W.; Ribner, Bruce S.; Smith, Philip; Hewlett, Angela; Schwedhelm, Shelly; Boulter, Kate; Beam, Elizabeth; Gibbs, Shawn; Lowe, John; Kratochvil, Chris; Sullivan, James; Johnson, Dan; Lisco, Steve; Piquette, Craig; Bailey, Kristina; Auxier, Joseph; Boer, Brian; Hanson, Travis; Kaseman, Julia; Khan, M. Salman; Rhee, Ji Hyun; Wells, Adam; Florescu, Diana; Kalil, Andre; Rupp, Mark; Becker, Valerie; Boeckman, Bridget; Elder, Erica; Fitch, Abby; Flood, Elizabeth; Freml, Meagan; Frigge, Roman; Hanzlik, Kelly Ann; Jensen, Lois; Kraus, Nicole; Molacek, Drew; Nevins, Jerry; Parker, Alicia; Peters, Jeff; Rand, Cheryl; Roesler, Karen; Ryalls, Kendall; Shradar, Morgan; Strain, Amanda; Sunderman, Timothy; Sundermeier, Jennifer; Swanhorst, John; Vasa, Angela; Bellinghausen, Jean; Freihaut, Frank; Denny, Susan; Mainelli, Lauren; Pinkney, Dee; Ray, Deborah; Jevne, Jay; Knight, Kalen; McCroy, Derrick; Nadeau, Ralph; Nightser, Anna; Iwen, Pete; Sambol, Tony; Herrera, Vicki; Morgan, David; Trotter, Sarah; Kerby, Amy; Peters, Sue; Southern, Timothy; Murphy, Caitlin; Morris, Rosanna; Nuss, Sue; Franco, Theresa; Ogden, Connie; Lazure, Julie; Straub, Dawn; Koepsell, Scott; Hinrichs, Steve; Plumb, Troy; Florescu, Marius; Becker, John; Souchek, Jenna; Beck, Jon; Larson, Luann; Heires, Peggy; Gordon, Bruce; Paulsen, Gail; Wolford, Barb; Petersen, Jill; Marion, Nedra; Hayes, Kim; Tyner, Kate; Wilson, Taylor; Baltes, Paul; Nowatzke, Jenny; Nguyen, Jonathan; Turner, Paul; Boonstra, Barb; Jelden, Katelyn; Portrey, Randy; Stringfield, Doug; Scofield, Bryan; Svanda, Gary; Horihan, Jolene; Dahl, Chris; Bruno, Megan; Malm, Kelsey; Litz, Ron; Fehringer, Jessica; Paladino, Katie; Opp, Tammy; Bell, Sonia; Adams, Anne; Allen, Mary Beth; Bachman, Robert; Bornstein, William; Cantrell, Dee; Cosper, Pam; Feistritzer, Nancye; Fox, John; Gartland, Bryce; Goodman, Jen; Grant, Susan; Howard-Crow, Dallis; Horowitz, Ira; Pugh, David; Ritenour, Chad; Ash, Toni; Barnes, Christopher; Calhoun, Jason; Chapman, Lauren; Daye, Tracey; Durr, Haley; Evans, Shunasee; Gentry, Janice; Ginnane, Jan; Grant, Susan; Haynes, Chris; Hill, Carolyn; Hillis, Dustin; Johnson, Crystal; Loomis, Jessica; Mamora, Josia; Mitchell, Laura; Morgan, Jill; Osakwe, Nancy; Owen, Jacqueline; Piazza, Sarah; Shirley, Kristina; Siddens, Jodi; Silas, Carrie; Slabach, Jason; Tirador, Elaina; Todd, Donnette; Vanairsdale, Sharon; Brammer, Nicole; Buchanan, Juli; Burd, Eileen; Cardella, John; Eaves, Brenda; Evans, Crystal; Hostetler, Krista; Jenkins, Karen; Lindsey, Maureen; Magee, Jordan; Powers, Randall; Ritchie, James; Ryan, Emily; Bonds, Shannon; Emamifar, Amir; Kuban, Tish; Pack, Jan; Rogers, Susan; Golston, George; Kaufman, Sean; Olinger, Patricia; Olinger, Sean; Rengarajan, Kalpana; Thomaston, Scott; Beck, Emily; Desroches, Paula; Hall, Cynthia; Walker, Celeste; Bryant, Connie; Hackman, Betsy; Howard, Regina; Jones, Marolyn; Broughton, Jeff; Frisle, Brian; Jackson, Robert; Lewis, Jerry; Brown-Haithco, Robin; Gartin, Miranda Lynn; Geralds-Washington, Erica; James-Jones, Rhonda; Miller, Donald; Stark, Dan; McGee, Gentrice; Jones, Porcia; Scott-Harris, Linda; Cain, James; Davis, Roderick; Johnson, Tyrone; Pickett, Tyrone; Shaw, Anthony; Truesdale, Tenina; Blum, Jim; Hill, Laureen; Sevransky, Jon; Zivot, Joel; Walker, Seth; Klopman, Matthew; Matkins, Ricky; Meechan, Cathy; Meechan, Paul; Schwock, Kathy; Schuck, Jen; Stack, Kathy; Wolf, Francis; Bray, Bruce; Isakov, Alex; Shartar, Sam; Miles, Wade; Jamison, Aaro; Arevalo, John; Stallings, Gail; Christenbury, Janet; Dollard, Vince; De Gennaro, Melanie; Korschun, Holly; Seideman, Nancy; Ziegler, Tom; Griffith, Daniel P.; Dave, Nisha; Wall, Susan; Hall, Melida; McGhee, Dwania; Clarke, Tim; Vaught, Rachel; Peterson-Pileri, Katrina

    2015-01-01

    Background. The current West Africa Ebola virus disease (EVD) outbreak has resulted in multiple individuals being medically evacuated to other countries for clinical management. Methods. We report two patients who were transported from West Africa to the United States for treatment of EVD. Both patients received aggressive supportive care measures, as well as an investigational therapeutic (TKM-100802) and convalescent plasma. Results. While one patient experienced critical illness with multi-organ failure requiring mechanical ventilation and renal replacement therapy, both patients recovered without serious long-term sequelae to date. Conclusions. It is unclear what role the experimental drug and convalescent plasma had in the recovery of these patients. Prospective clinical trials are needed to delineate the role of investigational therapies in the care of patients with EVD. PMID:25904375

  12. A multicenter survey of Hispanic caregiver preferences for patient decision control in the United States and Latin America.

    Science.gov (United States)

    Yennurajalingam, Sriram; Noguera, Antonio; Parsons, Henrique Afonseca; Torres-Vigil, Isabel; Duarte, Eva Rosina; Palma, Alejandra; Bunge, Sofia; Palmer, J Lynn; Delgado-Guay, Marvin Omar; Bruera, Eduardo

    2013-07-01

    Understanding family caregivers' decisional role preferences is important for communication, quality of care, and patient and family satisfaction. The family caregiver has an important role in a patient's decisional role preferences. There are limited studies on family caregivers' preferences of the patient's decision control at the end of life among Hispanics. To identify Hispanic caregivers' preferences of the decision control of patients with advanced cancer and to compare the preferences of caregivers in Hispanic Latin American and Hispanic American caregivers. We surveyed patients and their family caregivers referred to outpatient palliative care clinics in the United States, Chile, Argentina, and Guatemala. Caregiver preferences of patient's decision control were evaluated using the Control Preference Scale. Caregivers' and patients' sociodemographic variables, patient performance status, and Hispanic American patient acculturation level were also collected. A total of 387 caregivers were surveyed: 100 (26%) in Chile, 99 (26%) in Argentina, 97 (25%) in Guatemala, and 91 (24%) in the United States. The median age was 56 years, and 59% were female. Caregiver preference of patient's decision control was passive, shared, and active for 10 (11%), 45 (52%), and 32 (37%) Hispanic American caregivers and 54 (19%), 178 (62%), and 55 (19%) Hispanic Latin American caregivers (p = 0.0023), respectively. Caregiver acculturation level did not affect the preferences of the Hispanic American sample (p = 0.60). Most Hispanic family caregivers preferred the patient to make shared decisions. Hispanic Latin American caregivers more frequently preferred patients to assume a passive decisional role. Acculturation did not influence the preferences of Hispanic American caregivers.

  13. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures.

    Science.gov (United States)

    Greenspon, Arnold J; Patel, Jasmine D; Lau, Edmund; Ochoa, Jorge A; Frisch, Daniel R; Ho, Reginald T; Pavri, Behzad B; Kurtz, Steven M

    2012-10-16

    This study sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. The Medicare National Coverage Determination for permanent pacemaker, which emphasized single-chamber pacing, has not changed significantly since 1985. We sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. We queried the Nationwide Inpatient Sample to identify permanent pacemaker implants between 1993 and 2009 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for dual-chamber (DDD), single-ventricular (VVI), single-atrial (AAI), or biventricular (BiV) devices. Annual permanent pacemaker implantation rates and patient demographics were analyzed. Between 1993 and 2009, 2.9 million patients received permanent pacemakers in the United States. Overall use increased by 55.6%. By 2009, DDD use increased from 62% to 82% (p pacemaker use fell from 36% to 14% (p = 0.01). Use of DDD devices was higher in urban, nonteaching hospitals (79%) compared with urban teaching hospitals (76%) and rural hospitals (72%). Patients with private insurance (83%) more commonly received DDD devices than Medicaid (79%) or Medicare (75%) recipients (p pacemakers in the United States. Although DDD device use is increasing, whereas single-chamber ventricular pacemaker use is decreasing. Patients are becoming older and have more medical comorbidities. These trends have important health care policy implications. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Elevated Cancer-Specific Mortality Among HIV-Infected Patients in the United States.

    Science.gov (United States)

    Coghill, Anna E; Shiels, Meredith S; Suneja, Gita; Engels, Eric A

    2015-07-20

    Despite advances in the treatment of HIV, HIV-infected people remain at increased risk for many cancers, and the number of non-AIDS-defining cancers is increasing with the aging of the HIV-infected population. No prior study has comprehensively evaluated the effect of HIV on cancer-specific mortality. We identified cases of 14 common cancers occurring from 1996 to 2010 in six US states participating in a linkage of cancer and HIV/AIDS registries. We used Cox regression to examine the association between patient HIV status and death resulting from the presenting cancer (ascertained from death certificates), adjusting for age, sex, race/ethnicity, year of cancer diagnosis, and cancer stage. We included 1,816,461 patients with cancer, 6,459 (0.36%) of whom were HIV infected. Cancer-specific mortality was significantly elevated in HIV-infected compared with HIV-uninfected patients for many cancers: colorectum (adjusted hazard ratio [HR], 1.49; 95% CI, 1.21 to 1.84), pancreas (HR, 1.71; 95% CI, 1.35 to 2.18), larynx (HR, 1.62; 95% CI, 1.06 to 2.47), lung (HR, 1.28; 95% CI, 1.17 to 1.39), melanoma (HR, 1.72; 95% CI, 1.09 to 2.70), breast (HR, 2.61; 95% CI, 2.06 to 3.31), and prostate (HR, 1.57; 95% CI, 1.02 to 2.41). HIV was not associated with increased cancer-specific mortality for anal cancer, Hodgkin lymphoma, or diffuse large B-cell lymphoma. After further adjustment for cancer treatment, HIV remained associated with elevated cancer-specific mortality for common non-AIDS-defining cancers: colorectum (HR, 1.40; 95% CI, 1.09 to 1.80), lung (HR, 1.28; 95% CI, 1.14 to 1.44), melanoma (HR, 1.93; 95% CI, 1.14 to 3.27), and breast (HR, 2.64; 95% CI, 1.86 to 3.73). HIV-infected patients with cancer experienced higher cancer-specific mortality than HIV-uninfected patients, independent of cancer stage or receipt of cancer treatment. The elevation in cancer-specific mortality among HIV-infected patients may be attributable to unmeasured stage or treatment differences as well

  15. A comparative study of patients' attitudes toward clinical research in the United States and urban and rural China.

    Science.gov (United States)

    Wu, Elizabeth; Wang, Tianyi; Lin, Tammy; Chen, Xisui; Guan, Zhe; Cao, Claudia; Rao, Huiying; Yang, Ming; Feng, Bo; Pui, Sandra; Chan, Melvin; Fu, Sherry; Lin, Andy; Wei, Lai; Lok, Anna S

    2015-04-01

    As the number of clinical trials conducted in China increases, understanding Chinese attitudes toward clinical research is critical for designing effective and ethical studies. Two survey studies were conducted in 2012 and 2013 to compare patient attitudes toward clinical research and factors affecting research participation in the United States and urban and rural China. We surveyed 525 patients in 2012 (186 US, 186 urban, 153 rural China) and 690 patients in 2013 (412 US, 206 urban, 72 rural China). US patients were more likely to have no concerns regarding research participation than Chinese patients. Most common concerns of US patients were safety, privacy and confidentiality, and time required. Safety was a top concern for many Chinese. Chinese patients, particularly rural Chinese, were more concerned about the likelihood of self-benefit, and receiving free medical care and financial incentive had greater influence on their participation. Being informed of the freedom to choose whether to participate or to leave a study was less important to Chinese patients. Our study provides important insights into Chinese patients' attitudes toward clinical research and the need to educate them about their rights. These findings help in designing cross-cultural clinical studies that maximize enrollment while upholding Western ethical standards.

  16. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance

    Directory of Open Access Journals (Sweden)

    Kumudha Ramasubbu

    2010-09-01

    Full Text Available Kumudha Ramasubbu1, Anita Deswal1, Cheryl Herdejurgen2, David Aguilar1, Adaani E Frost21Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA; 2Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USABackground: Pulmonary hypertension (PH, a disease which carries substantial morbidity and mortality, has been reported to occur in 25%–45% of dialysis patients. No prospective evaluation of the prevalence or clinical significance of PH in chronic dialysis patients in the United States (US has been undertaken.Methods: Echocardiograms were performed prospectively in chronic hemodialysis patients prior to dialysis at a single dialysis center. PH was defined as a tricuspid regurgitant jet ≥2.5 m/s and “more severe PH” as ≥3.0 m/s. Clinical outcomes recovered were all-cause hospitalizations and death at 12 months.Results: In a cohort of 90 patients, 42 patients (47% met the definition of PH. Of those, 18 patients (20% met the definition of more severe PH. At 12 months, mortality was significantly higher in patients with PH (26% compared with patients without PH (6%. All-cause hospitalizations were similar in patients with PH and without PH. Echocardiographic findings suggesting impaired left ventricular function and elevated pulmonary capillary wedge pressure were significantly associated with PH.Conclusion: This prospective cross-sectional study of a single dialysis unit suggests that PH may be present in nearly half of US dialysis patients and when present is associated with increased mortality. Echocardiographic findings demonstrate an association between elevated filling pressures, elevated pulmonary artery pressures, and higher mortality, suggesting that the PH may be secondary to diastolic dysfunction and compounded by volume overload.Keywords: renal failure, pulmonary hypertension, diastolic dysfunction

  17. Patient dosimetry activities in the United States: the nationwide evaluation of X-ray trends (NEXT) and tissue dose handbooks.

    Science.gov (United States)

    Suleiman, O H; Stern, S H; Spelic, D C

    1999-01-01

    In the United States the Food and Drug Administration (FDA) in collaboration with the Conference of Radiation Control Program Directors (CRCPD) and state and local government agencies surveys clinical facilities about X-ray system air kerma and ancillary data related to patient dosimetry for a variety of diagnostic X-ray examinations. The survey program is known as the Nationwide Evaluation of X-ray Trends (NEXT). The survey utilizes reference patient-equivalent phantoms in the collection of comprehensive technical information. With knowledge of the skin-entrance air kerma, specific tissue doses can be calculated. An overview of NEXT and previously published FDA tissue dose handbooks for diagnostic X-ray examinations is presented.

  18. Family history and disease outcomes in patients with Crohn's disease: A comparison between China and the United States.

    Science.gov (United States)

    Wang, Pei-Qi; Hu, Jun; Al Kazzi, Elie S; Akhuemonkhan, Eboselume; Zhi, Min; Gao, Xiang; de Paula Pessoa, Raquel Holand; Ghazaleh, Sami; Cornelius, Tuhina; Sabunwala, Suhel Abbas; Ghadermarzi, Shadi; Tripathi, Kartikeya; Lazarev, Mark; Hu, Pin-Jin; Hutfless, Susan

    2016-11-06

    To investigate the differences in family history of inflammatory bowel disease (IBD) and clinical outcomes among individuals with Crohn's disease (CD) residing in China and the United States. We performed a survey-based cross-sectional study of participants with CD recruited from China and the United States. We compared the prevalence of IBD family history and history of ileal involvement, CD-related surgeries and IBD medications in China and the United States, adjusting for potential confounders. We recruited 49 participants from China and 145 from the United States. The prevalence of family history of IBD was significantly lower in China compared with the United States (China: 4.1%, United States: 39.3%). The three most commonly affected types of relatives were cousin, sibling, and parent in the United States compared with child and sibling in China. Ileal involvement (China: 63.3%, United States: 63.5%) and surgery for CD (China: 51.0%, United States: 49.7%) were nearly equivalent in the two countries. The lower prevalence of familial clustering of IBD in China may suggest that the etiology of CD is less attributed to genetic background or a family-shared environment compared with the United States. Despite the potential difference in etiology, surgery and ileal involvement were similar in the two countries. Examining the changes in family history during the continuing rise in IBD may provide further insight into the etiology of CD.

  19. Woodrow Wilson's hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy.

    Science.gov (United States)

    Menger, Richard P; Storey, Christopher M; Guthikonda, Bharat; Missios, Symeon; Nanda, Anil; Cooper, John M

    2015-07-01

    World War I catapulted the United States from traditional isolationism to international involvement in a major European conflict. Woodrow Wilson envisaged a permanent American imprint on democracy in world affairs through participation in the League of Nations. Amid these defining events, Wilson suffered a major ischemic stroke on October 2, 1919, which left him incapacitated. What was probably his fourth and most devastating stroke was diagnosed and treated by his friend and personal physician, Admiral Cary Grayson. Grayson, who had tremendous personal and professional loyalty to Wilson, kept the severity of the stroke hidden from Congress, the American people, and even the president himself. During a cabinet briefing, Grayson formally refused to sign a document of disability and was reluctant to address the subject of presidential succession. Wilson was essentially incapacitated and hemiplegic, yet he remained an active president and all messages were relayed directly through his wife, Edith. Patient-physician confidentiality superseded national security amid the backdrop of friendship and political power on the eve of a pivotal juncture in the history of American foreign policy. It was in part because of the absence of Woodrow Wilson's vocal and unwavering support that the United States did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless without American support and was unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the United States assume its global leadership role and realize Wilson's visionary, yet contentious, groundwork for a Pax Americana. The authors describe Woodrow Wilson's stroke, the historical implications of his health decline, and its impact on United States foreign policy.

  20. Usage and perceptions of pen injectors for diabetes management: a survey of type 2 diabetes patients in the United States.

    Science.gov (United States)

    Toscano, Deborah; Brice, Jennifer; Alfaro, Christina

    2012-05-01

    This study was conducted to investigate type 2 diabetes mellitus (T2DM) patient perceptions of their pen injectors and determine which features were deemed most important to overall satisfaction. Frost & Sullivan conducted a Web-based survey of T2DM patients in the United States in November 2010. Survey participants were initially screened prior to full participation. A total of 1002 adult T2DM patients who were using a pen injector on a regular basis to administer their diabetes medication(s) were surveyed. The survey consisted of 24 questions focused on awareness and current usage of pen injectors by type and brand, specific features of pen injectors, and patients' preferences for and satisfaction with pen injectors. The majority of surveyed patients were using prefilled pen injectors as compared with durable pens. The LANTUS SoloSTAR (sanofi-aventis) was reported to be the most commonly used pen. The LANTUS SoloSTAR was also ranked highly for overall satisfaction and likelihood of continued usage. Regardless of brand, most surveyed patients reported that they were likely to continue using their current pen. In general, the single most important feature for user satisfaction was an easy push-button injection. Ease of self-administration is of highest priority to users of pen injectors. Important features facilitating ease of use, such as an easily depressed push-button injection, are likely to minimize the burden on T2DM patients, thereby improving compliance and clinical outcomes. © 2012 Diabetes Technology Society.

  1. Effects of Music Intervention on State Anxiety and Physiological Indices in Patients Undergoing Mechanical Ventilation in the Intensive Care Unit.

    Science.gov (United States)

    Lee, Chiu-Hsiang; Lee, Chien-Ying; Hsu, Ming-Yi; Lai, Chiung-Ling; Sung, Yi-Hui; Lin, Chung-Ying; Lin, Long-Yau

    2017-03-01

    Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention ( n = 41) or control group ( n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures ( p < .02) and pre-post differences ( p < .03) except for diastolic blood pressure. Because of music intervention's low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient's mood should be monitored after the music intervention.

  2. Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States' settings.

    Science.gov (United States)

    Lai, Anita; Tenpenny, Elliott; Nestler, David; Hess, Erik; Stiell, Ian G

    2016-03-01

    Introduction The objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients. This was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses. In total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0). The U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

  3. Characterization of nasal and blood culture isolates of methicillin-resistant Staphylococcus aureus from patients in United States Hospitals.

    Science.gov (United States)

    Tenover, Fred C; Tickler, Isabella A; Goering, Richard V; Kreiswirth, Barry N; Mediavilla, José R; Persing, David H

    2012-03-01

    A total of 299 nares and 194 blood isolates of methicillin-resistant Staphylococcus aureus (MRSA), each recovered from a unique patient, were collected from 23 U.S. hospitals from May 2009 to March 2010. All isolates underwent spa and staphylococcal cassette chromosome mec element (SCCmec) typing and antimicrobial susceptibility testing; a subset of 84 isolates was typed by pulsed-field gel electrophoresis (PFGE) using SmaI. Seventy-six spa types were observed among the isolates. Overall, for nasal isolates, spa type t002-SCCmec type II (USA100) was the most common strain type (37% of isolates), while among blood isolates, spa type t008-SCCmec type IV (USA300) was the most common (39%). However, the proportion of all USA100 and USA300 isolates varied by United States census region. Nasal isolates were more resistant to tobramycin and clindamycin than blood isolates (55.9% and 48.8% of isolates versus 36.6% and 39.7%, respectively; for both, P United States, were observed along with several unusual PFGE types, including CMRSA9, EMRSA15, and the PFGE profile associated with sequence type 239 (ST239) isolates. Typing data from this convenience sample suggest that in U.S. hospitalized patients, USA100 isolates of multiple spa types, while still common in the nares, have been replaced by USA300 isolates as the predominant MRSA strain type in positive blood cultures.

  4. Incidence of Exposure of Patients in the United States to Multiple Drugs for Which Pharmacogenomic Guidelines Are Available

    Science.gov (United States)

    Xu, Hong; Blagec, Kathrin; Empey, Philip E.; Malone, Daniel C.; Ahmed, Seid Mussa; Ryan, Patrick; Hofer, Sebastian; Boyce, Richard D.

    2016-01-01

    Pre-emptive pharmacogenomic (PGx) testing of a panel of genes may be easier to implement and more cost-effective than reactive pharmacogenomic testing if a sufficient number of medications are covered by a single test and future medication exposure can be anticipated. We analysed the incidence of exposure of individual patients in the United States to multiple drugs for which pharmacogenomic guidelines are available (PGx drugs) within a selected four-year period (2009–2012) in order to identify and quantify the incidence of pharmacotherapy in a nation-wide patient population that could be impacted by pre-emptive PGx testing based on currently available clinical guidelines. In total, 73 024 095 patient records from private insurance, Medicare Supplemental and Medicaid were included. Patients enrolled in Medicare Supplemental age > = 65 or Medicaid age 40–64 had the highest incidence of PGx drug use, with approximately half of the patients receiving at least one PGx drug during the 4 year period and one fourth to one third of patients receiving two or more PGx drugs. These data suggest that exposure to multiple PGx drugs is common and that it may be beneficial to implement wide-scale pre-emptive genomic testing. Future work should therefore concentrate on investigating the cost-effectiveness of multiplexed pre-emptive testing strategies. PMID:27764192

  5. HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

    Directory of Open Access Journals (Sweden)

    Agodoa Lawrence Y

    2003-07-01

    Full Text Available Abstract Background The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN, namely of angiotensin converting enzyme inhibitors (ACE and antiretroviral therapy, has not been reported for a national sample of dialysis patients. Methods We conducted a historical cohort study of the United States Renal Data System (USRDS Dialysis Morbidity and Mortality Study (DMMS Wave 2 to identify risk factors associated with increased mortality in these patients. Data were available for 3374 patients who started dialysis and were followed until March 2000. Cox Regression analysis was used to model adjusted hazard ratios (AHR with HIVAN as a cause of end stage renal disease (ESRD and its impact on mortality during the study period, adjusted for potential confounders. Results Of the 3374 patients who started dialysis, 36 (1.1% had ESRD as a result of HIVAN. Only 22 (61% of patients with HIVAN received antiretroviral agents, and only nine patients (25% received combination antiretroviral therapy, and only 14% received ACE inhibitors. Neither the use of multiple antiretroviral drugs (AHR, 0.62, 95% CI, 0.10, 3.86, p = 0.60, or ACE inhibitors were associated with a survival advantage. Patients with HIVAN had an increased risk of mortality (adjusted hazard ratio, 4.74, 95% Confidence Interval, 3.12, 7.32, p Conclusions Medications known to improve outcomes in HIV infected patients were underutilized in patients with HIVAN. Adjusted for other factors, a primary diagnosis of HIVAN was associated with increased mortality compared with other causes of ESRD.

  6. Decreasing Clostridium Difficile-Associated Fatality Rates among Hospitalized Patients in the Unites States: 2004-2014.

    Science.gov (United States)

    Shrestha, Manish P; Bime, Christian; Taleban, Sasha

    2017-08-08

    Clostridium difficile infection has emerged as a major public health problem in the United States over the last two decades. Several strategies have been implemented at the hospital, community, state and national levels to combat this infection. We examined the trends in the Clostridium difficile-associated fatality rate, hospital length of stay and hospital charges over the last decade. We used data from the National Inpatient Sample to identify patients with a principal diagnosis of Clostridium difficile infection from 2004-2014. Outcomes included in-hospital fatality rate, hospital length of stay and hospital charges. For each outcome, trends were also stratified by age categories as the risk of infection and associated mortality increase with age. Clostridium difficile infection discharges increased from 19.9/100,000 persons in 2004 to 33.8/100,000 persons in 2014. Clostridium difficile-associated fatality decreased from 3.6% in 2004 to 1.6% in 2014 (linear trend PClostridium difficile infection in the United States has decreased over two fold in the last decade despite increasing infection rates. Despite decreasing length of stay, the hospital charges of Clostridium difficile infection are increasing. Copyright © 2017. Published by Elsevier Inc.

  7. Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system.

    Science.gov (United States)

    Ouyang, Lijing; Bolen, Julie; Valdez, Rodolfo; Joseph, David; Baum, Michelle A; Thibadeau, Judy

    2015-02-01

    We describe the characteristics, treatments and survival of patients with spina bifida in whom end stage renal disease developed from 2004 through 2008 in the United States Renal Data System. We used ICD-9-CM code 741.* to identify individuals with spina bifida using hospital inpatient data from 1977 to 2010, and physician and facility claims from 2004 to 2008. We constructed a 5:1 comparison group of patients with end stage renal disease without spina bifida matched by age at first end stage renal disease service, gender and race/ethnicity. We assessed the risk of mortality and of renal transplantation while on dialysis using multivariate cause specific proportional hazards survival analysis. We also compared survival after the first renal transplant from the first end stage renal disease service to August 2011. We identified 439 patients with end stage renal disease and spina bifida in whom end stage renal disease developed at an average younger age than in patients without spina bifida (41 vs 62 years, p spina bifida those who had spina bifida showed a similar mortality hazard on dialysis and after transplantation. However, patients with end stage renal disease without spina bifida were more likely to undergo renal transplantation than patients with spina bifida (HR 1.51, 95% CI 1.13-2.03). Hospitalizations related to urinary tract infections were positively associated with the risk of death on dialysis in patients with end stage renal disease and spina bifida (HR 1.42, 95% CI 1.33-1.53). Spina bifida was not associated with increased mortality in patients with end stage renal disease on dialysis or after renal transplantation. Proper urological and bladder management is imperative in patients with spina bifida, particularly in adults. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada.

    Science.gov (United States)

    Lewis, Geraint; Wright, Lorraine; Vaithianathan, Rhema

    2012-10-01

    Virtual wards are a model for delivering multidisciplinary case management to people who are at high predicted risk of unplanned acute care hospitalization. First introduced in Croydon, England, in 2006, this concept has since been adopted and adapted by health care organizations in other parts of the United Kingdom and internationally. In this article, the authors review the model of virtual wards as originally described-with its twin pillars of (1) using a predictive model to identify people who are at high risk of future emergency hospitalization, and (2) offering these individuals a period of intensive, multidisciplinary preventive care at home using the systems, staffing, and daily routines of a hospital ward. The authors then describe how virtual wards have been modified and implemented in 6 sites in the United Kingdom, United States, and Canada where they are subject to formal evaluation. Like hospital wards, virtual wards vary in terms of patient selection, ward configuration, staff composition, and ward processes. Policy makers and researchers should be aware of these differences when considering the evaluation results of studies investigating the cost-effectiveness of virtual wards.

  9. Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.

    Science.gov (United States)

    Veinot, Tiffany C; Bosk, Emily A; Unnikrishnan, K P; Iwashyna, Theodore J

    2012-11-01

    Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (U.S.). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. Forty-four percent of patients with AMI who are admitted to a non-revascularization hospital in the U.S. are transferred to a hospital with that capacity. Yet, we know little about the process by which community hospitals complete these transfers, and why publicly available hospital quality data plays a small role in community hospitals' choice of transfer destinations. Therefore, we investigated how community hospital staff implement patient transfers and select destinations. We conducted a mixed methods study involving: interviews with staff at three community hospitals (n = 25) in a Midwestern state and analysis of U.S. national Medicare records for 1996-2006. Community hospitals in the U.S., including our field sites, typically had longstanding relationships with one key receiving hospital. Community hospitals addressed the need for rapid AMI patient transfers by routinizing the collective, interhospital work process. Routinization reduced staff uncertainty, coordinated their efforts and conserved their cognitive resources for patient care. While destination selection was nominally a physician role, the decision was routinized, such that staff immediately contacted a "usual" transfer destination upon AMI diagnosis. Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions. Copyright © 2012 Elsevier Ltd

  10. Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States.

    Science.gov (United States)

    Hosing, Chitra; Nash, Richard; McSweeney, Peter; Mineishi, Shin; Seibold, James; Griffith, Linda M; Shulman, Howard; Goldmuntz, Ellen; Mayes, Maureen; Parikh, Chirag R; Crofford, Leslie; Keyes-Elstein, Lynette; Furst, Daniel; Steen, Virginia; Sullivan, Keith M

    2011-05-01

    Recipients of hematopoietic cell transplantation may be at risk for developing acute kidney injury (AKI), and this risk may be increased in patients who undergo transplantation for severe systemic sclerosis (SSc) due to underlying scleroderma renal disease. AKI after transplantation can increase treatment-related mortality. To better define these risks, we analyzed 91 patients with SSc who were enrolled in 3 clinical trials in the United States of autologous or allogeneic hematopoietic cell transplantation (HCT). Eleven (12%) of the 91 patients with SSc in these studies (8 undergoing autologous HCT, 1 undergoing allogeneic HCT, 1 pretransplantation, 1 given i.v. cyclophosphamide on a transplantation trial) experienced AKI, of whom 8 required dialysis and/or therapeutic plasma exchange. AKI injury in the 9 HCT recipients developed a median of 35 days (range, 0-90 days) after transplantation. Ten of 11 patients with AKI received angiotensin-converting enzyme inhibitor (ACE-I) therapy. The etiology of AKI was attributed to scleroderma renal crisis in 6 patients (including 2 with normotensive renal crisis), to AKI of uncertain etiology in 2 patients, and to AKI superimposed on scleroderma kidney disease in 3 patients. Eight of the 11 patients died, one each because of progression of SSc, multiorgan failure, gastrointestinal and pulmonary bleeding, pericardial tamponade and pulmonary complications, diffuse alveolar hemorrhage, pulmonary embolism, graft-versus-host disease, and malignancy. Limiting nephrotoxins, cautious use of corticosteroids, renal shielding during total body irradiation, strict control of blood pressure, and aggressive use of ACE-Is may be of importance in preventing renal complications after HCT for SSc.

  11. Benzodiazepine use and mortality of incident dialysis patients in the United States.

    Science.gov (United States)

    Winkelmayer, W C; Mehta, J; Wang, P S

    2007-12-01

    Benzodiazepines and other omega-receptor agonists are frequently used for sleep and anxiety disorders. We studied the rates, correlates, and safety of individual benzodiazepines and zolpidem use from the records of 3690 patients in a national cohort of Dialysis Morbidity and Mortality Study Wave 2 data. We assessed drug utilization and an association between drug use and all-cause mortality. Overall, 14% of incident dialysis patients used a benzodiazepine or zolpidem. Women, Caucasians, current smokers, and patients with chronic obstructive pulmonary disease were more likely to use these drugs, whereas patients with cerebrovascular disease were less likely to use these drugs. In adjusted analyses, benzodiazepine or zolpidem use was associated with a 15% higher mortality rate. Chronic obstructive pulmonary disease significantly modified this association, suggesting that these patients were at higher risk. No association was found between benzodiazepine use and greater risk for hip fracture. We conclude that benzodiazepine or zolpidem use is common in incident dialysis patients and may be associated with greater mortality. Further studies are needed to elucidate the safety of these drugs in the dialysis population, which may lead to cautious and restrictive utilization of omega-receptor agonists in dialysis patients.

  12. Clinical and visual outcomes of patients with uveitis in the mid-Atlantic United States

    Directory of Open Access Journals (Sweden)

    Bajwa A

    2015-09-01

    Full Text Available Asima Bajwa,1 Chang Sup Lee,1 Jim Patrie,2 Wenjun Xin,2 Ashvini K Reddy1 1Department of Ophthalmology, 2Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA Purpose: To report the clinical outcomes of uveitis patients at the University of Virginia. Methods: Retrospective, observational study of uveitis patients seen at the University of Virginia from 1984 to 2014. Parametric and nonparametric methods were used to analyze the change in best-corrected visual acuity (BCVA in relation to demographics, diagnoses, management, and complications. Results: The study included 644 eyes of 491 patients. Patients with mild visual loss (logMAR <0.4 at presentation were younger than those with severe visual loss (SVL, logMAR >1.0 (P=0.002. Females were more likely to have mild visual loss as compared to males (P=0.025. Median overall BCVA was logMAR 0.18 at initial and final presentation (P=1.00. Vision loss at diagnosis was a predictor for moderate visual loss (MVL, logMAR 0.4 to <1.0 to SVL at last follow-up (P<0.001. Eyes with ocular hypertension were positively associated with MVL and SVL as compared to normotensive eyes (1.89 times at baseline, 2.62 times at last follow-up. Median BCVA was 0.18 logMAR for the anterior uveitis (AU and 0.48 logMAR for the non-AU patients (P<0.001. AU patients were less likely to have SVL than non-AU group (P<0.001. AU group received local corticosteroids more frequently and systemic corticosteroids less commonly than non-AU patients (P<0.001. AU patients with MVL to SVL were more likely to have ophthalmic surgery (cataract, glaucoma or pars plana vitrectomy [PPV] than those without MVL or SVL (P<0.001. Non-AU patients with MVL to SVL were more likely to have PPV than those without MVL or SVL (P=0.001. Conclusion: Mean overall BCVA remained stable. Favorable visual results were associated with younger age, female gender, and AU. Poor visual prognosis was concomitant with SVL at presentation

  13. Colon Cancer Screening among Patients Receiving Dialysis in the United States: Are We Choosing Wisely?

    Science.gov (United States)

    Carlos, Christopher A; McCulloch, Charles E; Hsu, Chi-Yuan; Grimes, Barbara; Pavkov, Meda E; Burrows, Nilka R; Shahinian, Vahakn B; Saran, Rajiv; Powe, Neil R; Johansen, Kirsten L

    2017-08-01

    The American Society of Nephrology recommends against routine cancer screening among asymptomatic patients receiving maintenance dialysis on the basis of limited survival benefit. To determine the frequency of colorectal cancer screening among patients on dialysis and the extent to which screening tests were targeted toward patients at lower risk of death and higher likelihood of receiving a kidney transplant, we performed a cohort study of 469,574 Medicare beneficiaries ages ≥50 years old who received dialysis between January 1, 2007 and September 30, 2012. We examined colorectal cancer screening tests according to quartiles of risk of mortality and kidney transplant on the basis of multivariable Cox modeling. Over a median follow-up of 1.5 years, 11.6% of patients received a colon cancer screening test (57.9 tests per 1000 person-years). Incidence rates of colonoscopy, flexible sigmoidoscopy, and fecal occult blood test were 27.9, 0.6, and 29.5 per 1000 person-years, respectively. Patients in the lowest quartile of mortality risk were more likely to be screened than those in the highest quartile (hazard ratio, 1.53; 95% confidence interval, 1.49 to 1.57; 65.1 versus 46.4 tests per 1000 person-years, respectively), amounting to a 33% higher rate of testing. Additionally, compared with patients least likely to receive a transplant, patients most likely to receive a transplant were more likely to be screened (hazard ratio, 1.68; 95% confidence interval, 1.64 to 1.73). Colon cancer screening is being targeted toward patients on dialysis at lowest risk of mortality and highest likelihood of transplantation, but absolute rates are high, suggesting overscreening. Copyright © 2017 by the American Society of Nephrology.

  14. 7 CFR 1160.104 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1160.104 Section 1160.104 Agriculture... Definitions § 1160.104 United States. United States means the 48 contiguous states in the continental United States and the District of Columbia, except that United States means the 50 states of the United......

  15. Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis.

    Science.gov (United States)

    Mathew, Anna; Obi, Yoshitsugu; Rhee, Connie M; Chen, Joline L T; Shah, Gaurang; Lau, Wei-Ling; Kovesdy, Csaba P; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

    2016-11-01

    Most patients with end-stage renal disease in the United States are initiated on thrice-weekly hemodialysis (HD) regimens. However, an incremental approach to HD may provide several patient benefits. We tested whether initiation of incremental HD does or does not compromise survival compared with a conventional HD regimen. The survival of 434 incremental, 50,162 conventional, and 160 frequent HD patients were compared using Cox regression analysis after matching for demographic and comorbid factors in a longitudinal national cohort of adult incident HD patients enrolled between January 2007 and December 2011. Sensitivity analysis included adjustment for residual kidney function. After adjustment for residual kidney function, all-cause mortality was not significantly different in the incremental compared with conventional HD group (hazard ratio 0.88, 95% confidence interval 0.72-1.08), but was higher in the frequent compared with the conventional HD group (hazard ratio, 1.56, 95% confidence interval 1.21-2.03). The comorbidity burden modified the association of treatment frequency and mortality, with higher comorbidity associated with higher mortality in the incremental HD group (hazard ratio, 1.77, 95% confidence interval 1.20-2.62) for a Charlson Comorbidity Index of ≥5. Thus, among incident HD patients with low or moderate comorbid disease, survival was similar for patients initiated on an incremental or conventional HD regimen. Clinical trials are needed to examine the safety and effectiveness of incremental HD and the selected patient populations who may benefit from an incremental approach to HDs initiation. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  16. Co-morbid infections in Hansen's disease patients in the United States: considerations for treatment.

    Science.gov (United States)

    Bilodeau, Madeline; Burns, Stephanie; Gawoski, John; Moschella, Samuel; Ooi, Winnie

    2013-10-01

    120 patients attending a Hansen's disease public health satellite clinic were evaluated for selected latent co-morbidities, consisting of strongyloidiasis, Chagas disease, hepatitis B, HIV, and tuberculosis, and potential exacerbation by immunosuppressive therapy. Implications for treatment of Hansen's disease are discussed.

  17. Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013

    Science.gov (United States)

    Herzog, Mackenzie M.; Marshall, Stephen W.; Lund, Jennifer L.; Pate, Virginia; Spang, Jeffrey T.

    2017-01-01

    Background: Despite the significance of anterior cruciate ligament (ACL) injuries, these conditions have been under-researched from a population-level perspective. It is important to determine the economic effect of these injuries in order to document the public health burden in the United States. Purpose: To describe the cost of outpatient arthroscopic ACL reconstruction and health care utilization among commercially insured beneficiaries in the United States. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The study used the Truven Health Analytics MarketScan Commercial Claims and Encounters database, an administrative claims database that contains a large sample (approximately 148 million) of privately insured individuals aged <65 years and enrolled in employer-sponsored plans. All claims with Current Procedural Terminology (CPT) code 29888 (arthroscopically aided ACL reconstruction or augmentation) from 2005 to 2013 were included. “Immediate procedure” cost was computed assuming a 3-day window of care centered on date of surgery. “Total health care utilization” cost was computed using a 9-month window of care (3 months preoperative and 6 months postoperative). Results: There were 229,446 outpatient arthroscopic ACL reconstructions performed over the 9-year study period. Median immediate procedure cost was $9399.49. Median total health care utilization cost was $13,403.38. Patients who underwent concomitant collateral ligament (medial [MCL], lateral [LCL]) repair or reconstruction had the highest costs for both immediate procedure ($12,473.24) and health care utilization ($17,006.34). For patients who had more than 1 reconstruction captured in the database, total health care utilization costs were higher for the second procedure than the first procedure ($16,238.43 vs $15,000.36), despite the fact that immediate procedure costs were lower for second procedures ($8685.73 vs $9445.26). Conclusion: These results provide a

  18. Medical Administration: Patient Regulating To and Within the Continental United States

    Science.gov (United States)

    1990-03-30

    surgical condi- tions of the forefoot . SCI Spinal Cord Injury See SURGERY /Neurosurgery. SSL Plastic Surgery Patients having, or suspected of having...Commanders notify Chief, Bureau of Medicine and Surgery , Attention: MED–33, Wash DC 20372–5120; and Air Force MTF commanders notify HQ US Air Force...or surgery date (if applicable), and approval authority number (if an exception to regulating policy has been granted by ASMRO). Information regarding

  19. Capecitabine treatment patterns in patients with gastroesophageal cancer in the United States

    Institute of Scientific and Technical Information of China (English)

    Muhammad Wasif Saif; Nianwen Shi; Susan Zelt

    2009-01-01

    AIM: To assess the use of capecitabine-based therapy and associated complication rates in patients with gastroesophageal cancer (GEC) in a real-world treatment setting.METHODS: Patients with claims between 2004 and 2005 were identified from the Thomson Reuters Mar-ketScan?databases. Capecitabine regimens were compared with 5-fluorouracil (5-FU) and other chemotherapy regimens, and were stratified by treatment setting.RESULTS: We identified 1013 patients with GEC: approximately half had treatment initiated with a 5-FU regimen, whereas 11% had therapy initiated with a capecitabine regimen. The mean capecitabine dose overall was 2382 ?118 mg/d, and capecitabine was used as monotherapy more often than in combination. Overall, 5-FU regimens were the most common treatment option in neoadjuvant and adjuvant settings, while other non-capecitabine regimens were used more widely in first- and second-line settings. The overall unadjusted complication rate for capecitabine regimens was about half of that seen with 5-FU regimens. In multivariate analyses, capecitabine recipients had a 51% (95% CI: 26%-81%) lower risk of developing any complication than 5-FU recipients did. The risk of developing bone marrow, constitutional, gastrointestinal tract, infectious, or skin complications was lowerwith capecitabine therapy than with 5-FU.CONCLUSION: Capecitabine appeared to have a favorable side effect profile compared with 5-FU, which indicates that it may be a treatment option for GEC.

  20. Patient-Reported Outcomes From the United States Clinical Trial for a Hybrid Cochlear Implant.

    Science.gov (United States)

    Kelsall, David C; Arnold, Renée J G; Lionnet, Leonard

    2017-10-01

    To assess patient-reported outcomes (PROs) in individuals with significant residual low-frequency hearing and severe-to-profound high-frequency sensorineural hearing loss (SNHL) who received the hybrid cochlear implant (CI). Prospective, multicenter, nonrandomized, single-arm repeated measures, single-subject design. Tertiary centers, ambulatory care. Fifty adults with severe-to-profound high-frequency SNHL and residual low-frequency hearing with aided word recognition scores between 10 and 60% in the ear to be implanted, and in the contralateral ear greater than or equal to implant ear less than or equal to 80%. Therapeutic; hybrid CI. Speech, spatial and qualities of hearing scale (SSQ), device use questionnaire (DUQ), University of Washington Clinical Assessment of Music Perception (UW-CAMP) assessed preoperatively and after 6 and 12 (SSQ and DUQ only) months of hybrid CI use. Significant improvements in mean SSQ ratings were demonstrated at 6 and 12 months postactivation overall and for domains related to speech hearing, spatial hearing, and sound quality. Significant improvement was also found for overall satisfaction on the DUQ and across a number of specific listening situations in addition to aspects related to social engagement. UW-CAMP pitch discrimination and melody and timbre recognition abilities were not compromised postoperatively, allowing hybrid subjects to maintain superior music perception abilities than typically observed with standard CIs. Patients who received the hybrid CI demonstrated significant PRO benefits on the SSQ and the DUQ after 6 and 12 months of CI use. In addition, given the opportunity to maintain useful low-frequency acoustic hearing, patients retained music listening abilities, as assessed by the UW-CAMP.

  1. Malignancy validation in a United States registry of rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    Fisher Mark C

    2012-05-01

    Full Text Available Abstract Background Physician reporting is commonly used to ascertain adverse events or outcomes measured in epidemiologic studies. However, little is known on the accuracy of physician reported malignancies compared to pertinent medical record review in large cohort studies. Methods The Consortium of Rheumatology Researchers of North America (CORRONA registry gathers physician-completed questionnaires for rheumatoid arthritis (RA patients, including request for information on incident malignancies, approximately every three months. For incident malignancies reported from October 1st, 2001, through December 31st, 2007, we retrospectively requested completion of a Targeted Adverse Event (TAE form for additional information as well as primary source documents to adjudicate the malignancy reports. CORRONA has employed a prospective request for source documentation for these events since 2008. We classified each malignancy as definite, probable, possible, or not a malignancy. Results From 20,837 RA patients enrolled in CORRONA, 461 incident malignancies were initially reported on physician questionnaires. After review of returned source documents with adjudication, 234 were deemed definite, 69 probable, 101 possible, and 57 not an incident malignancy. The positive predictive value (PPV of initial physician report of a malignancy versus “definite or probable” malignancy based on adjudication was 0.66 (95% CI 0.61 - 0.70. The PPV was 0.68 (95% CI 0.63 – 0.72 when the subsequent TAE form also confirmed the presence of malignancy. When possible malignancies were included, the PPV of physician-reported malignancies without a subsequent TAE form increased to 0.86 (0.83 – 0.89, and with a subsequent TAE form, 0.89 (0.85-0.91. Conclusion Twelve percent of initial physician reports of incident malignancy could not be confirmed with review of source documents. The most common reason for lack of confirmation was inability to obtain documents or

  2. Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

    Science.gov (United States)

    Tarantino, Michael D.; Danese, Mark; Klaassen, Robert J.; Duryea, Jennifer; Eisen, Melissa; Bussel, James

    2016-01-01

    Abstract To examine utilization and outcomes in pediatric immune thrombocytopenia (ITP) hospitalizations, we used ICD-9 code 287.31 to identify hospitalizations in patients with ITP in the 2009 HCUP KID, an all-payer sample of pediatric hospitalizations from US community hospitals. Diagnosis and procedure codes were used to estimate rates of ITP-related procedures, comorbidity prevalence, costs, length of stay (LOS), and mortality. In 2009, there were an estimated 4499 hospitalizations in children aged 6 months–17 years with ITP; 43% in children aged 1–5 years; and 47% with emergency department encounters. The mean hospitalization cost was $5398, mean LOS 2.0 days, with 0.3% mortality (n = 13). With any bleeding (15.2%, including gastrointestinal 2.0%, hematuria 1.3%, intracranial hemorrhage [ICH] 0.6%), mean hospitalization cost was $7215, LOS 2.5 days, with 1.5% mortality. For ICH (0.6%, n = 27), mean cost was $40 209, LOS 8.5 days, with 21% mortality. With infections (14%, including upper respiratory 5.2%, viral 4.9%, bacterial 1.9%), the mean cost was $6928, LOS 2.9 days, with 0.9% mortality. Septic shock was reported in 0.3% of discharges. Utilization included immunoglobulin administration (37%) and splenectomies (2.3%). Factors associated with higher costs included age >6 years, ICH, hematuria, transfusion, splenectomy, and bone marrow diagnostics (p < 0.05). In conclusion, of the 4499 hospitalizations with ITP, mortality rates of 1.5%, 21%, and 0.9% were seen with any bleeding, ICH, and infection, respectively. Higher costs were associated with clinically significant bleeding and procedures. Future analyses may reveal effects of the implementation of more recent ITP guidelines and use of additional treatments. PMID:26941022

  3. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey.

    Directory of Open Access Journals (Sweden)

    Sophia K Smith

    Full Text Available Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed.Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions.Survey respondents (n = 179 valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001. Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non-patient group respondents (all p < .05. Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01. Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non-patient group respondents (all p< .01.Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the

  4. Trends in Vascular Complications in High-Risk Patients Following Transcatheter Aortic Valve Replacement in the United States.

    Science.gov (United States)

    Ando, Tomo; Akintoye, Emmanuel; Telila, Tesfaye; Briasoulis, Alexandros; Takagi, Hisato; Grines, Cindy L; Afonso, Luis

    2017-02-10

    Vascular complications (VC) following transcatheter aortic valve replacement (TAVR) are associated with worse outcomes. The trend of VC incidence in patients considered high risk is unclear. We sought to assess the trend of VC after TAVR in patients at high risk. We investigated the VC trend in female, diabetes mellitus, and peripheral vascular disease (PVD) patients. Patients who underwent TAVR from 2011 to 2014 in the United States were identified using the International Classification of Diseases-Ninth Revision code 35.05 from the Nationwide Inpatient Sample database. Frequency of any VC (per 100 transcatheter aortic valve implantation procedure or hospital discharges) for each year from 2011 to 2014 was assessed for the overall population as well as within each category of high-risk cohorts. The overall VC rate was 6.0% (2,044/33,790). Patients who had VC were more likely to be female and had higher rates of PVD at baseline. The annual rate of VC in the overall population from 2011 to 2014 was 4.6%, 9.4%, 6.8%, and 4.4%, respectively. There was a significant increase in VC rate from 2011 to 2012 (p = 0.03), whereas there was a significant decrease in VC rate from 2012 to 2014 (p <0.001). The rate of VC between 2011 and 2014 was similar (p = 0.82). The rate of VC did not increase in any of the high-risk groups from 2011 to 2012. However, the rate of VC from 2012 to 2014 decreased significantly in all the high-risk groups. The VC rate was similar for groups between 2011 and 2014. The overall VC rate among TAVR patients initially increased from 2011 to 2012 but decreased thereafter. Similar trend in VC rate was found among high-risk patients except that the initial increase in rates from 2011 to 2012 did not reach statistical significance. Whether further reduction in VC with improvement in devices and operator/center experience for both overall and high-risk groups in TAVR occurs will require continuous longitudinal monitoring.

  5. 31 CFR 800.225 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 800.225 Section 800... TAKEOVERS BY FOREIGN PERSONS Definitions § 800.225 United States. The term United States or U.S. means the United States of America, the States of the United States, the District of Columbia, and any...

  6. A survey of dermatophytes isolated from human patients in the United States from 1979 to 1981 with chronological listings of worldwide incidence of five dermatophytes often isolated in the United States.

    Science.gov (United States)

    Sinski, J T; Flouras, K

    1984-03-15

    A survey of dermatophytes isolated from patients seeking medical advice was made from 1979 to 1981 in the United States. The survey included 54 locations with data from 40 cities and 2 states. Correlations of these data with that of the other localities of the world were made to illustrate the dynamic epidemiology of several common dermatophytes. The most often isolated dermatophyte in this survey was Trichophyton rubrum having 53.66% of the total for these three calendar years. In a chronological listing of ringworm infections caused by this organism, many areas of the world have reported similar increased incidence of this pathogen. Trichophyton tonsurans was isolated 27.85% of the total. A dramatic increase of this pathogen as a cause of tinea capitis has been observed in most cities of the United States. It has been isolated in 25 different countries of the world. The percentage of isolation of Trichophyton mentagrophytes was 8.56%. This percentage may not be near the true incidence of infection by this dermatophyte because the infections are mild and respond to treatment without the individual seeking medical advice. Since the 1950s the percentage of isolations of the total has dropped for T. mentagrophytes in the United States. Epidermophyton floccosum accounted for 4.36% of the total. In a few areas of the world it causes over 30% of the total of dermatophytoses. Microsporum canis was isolated 3.72% of the total in the United States. It has recently been reported to be the dominant agent of tinea capitis in several South American countries, Tucson, Arizona and Kuwait. Once the dominant pathogen of tinea capitis in children in the United States, it was replaced by Microsporum audouinii before 1960. Today in the United States, M. audouinii only accounts for 0.30% of the total. It is considered eliminated as a pathogen in England. In this survey, isolated less than 1.0% of the total were Microsporum gypseum. Microsporum ferrugineum , Microsporum nanum

  7. A Survey of the Practice of Patient Education with Spinal Cord Injured Patients in Rehabilitation Centers in the United States.

    Science.gov (United States)

    Mullins, June B.; Bendel, Judith G.

    Practices in patient education for spinal cord injured persons in 10 hospital rehabilitation centers were examined. Surveys revealed that a majority of the centers conducted patient education (designed to provide facts about the injury as well as psychological support). Findings revealed a large number of staff involved, but a wide difference in…

  8. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey.

    Science.gov (United States)

    Smith, Sophia K; Selig, Wendy; Harker, Matthew; Roberts, Jamie N; Hesterlee, Sharon; Leventhal, David; Klein, Richard; Patrick-Lake, Bray; Abernethy, Amy P

    2015-01-01

    Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed. Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions. Survey respondents (n = 179) valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p research is needed to define and optimize key success factors.

  9. Malaria Surveillance - United States, 2014.

    Science.gov (United States)

    Mace, Kimberly E; Arguin, Paul M

    2017-05-26

    . Less than 1.0% of patients were infected with two species. The infecting species was unreported or undetermined in 11.7% of cases. CDC provided diagnostic assistance for 14.2% of confirmed cases and tested 12.0% of P. falciparum specimens for antimalarial resistance markers. Of patients who reported purpose of travel, 57.5% were visiting friends and relatives (VFR). Among U.S. residents for whom information on chemoprophylaxis use and travel region was known, 7.8% reported that they initiated and adhered to a chemoprophylaxis drug regimen recommended by CDC for the regions to which they had traveled. Thirty-two cases were among pregnant women, none of whom had adhered to chemoprophylaxis. Among all reported cases, 17.0% were classified as severe illness, and five persons with malaria died. CDC received 137 P. falciparum-positive samples for the detection of antimalarial resistance markers (although some loci for chloroquine and mefloquine were untestable for up to nine samples). Of the 137 samples tested, 131 (95.6%) had genetic polymorphisms associated with pyrimethamine drug resistance, 96 (70.0%) with sulfadoxine resistance, 77 (57.5%) with chloroquine resistance, three (2.3%) with mefloquine drug resistance, one (https://www.cdc.gov/malaria/travelers/drugs.html). Malaria infections can be fatal if not diagnosed and treated promptly with antimalarial medications appropriate for the patient's age and medical history, likely country of malaria acquisition, and previous use of antimalarial chemoprophylaxis. Recent molecular laboratory advances have enabled CDC to identify and conduct molecular surveillance of antimalarial drug resistance markers (https://www.cdc.gov/malaria/features/ars.html) and improve the ability of CDC to track, guide treatment, and manage drug resistance in malaria parasites both domestically and globally. For this effort to be successful, specimens should be submitted for all cases diagnosed in the United States. Clinicians should consult CDC

  10. 7 CFR 1220.129 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.129 Section 1220.129... CONSUMER INFORMATION Soybean Promotion and Research Order Definitions § 1220.129 State and United States. The terms State and United States include the 50 States of the United States of America, the...

  11. 7 CFR 1220.615 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.615 Section 1220.615... CONSUMER INFORMATION Procedures To Request a Referendum Definitions § 1220.615 State and United States. State and United States include the 50 States of the United States of America, the District of...

  12. 75 FR 5373 - United States Mint

    Science.gov (United States)

    2010-02-02

    ... United States Mint ACTION: Notification of Pricing for 2010 United States Mint Presidential $1 Coin Proof Set. \\TM\\ SUMMARY: The United States Mint is announcing the price of the 2010 United States Mint Presidential $1 Coin Proof Set. The 2010 United States Mint Presidential $1 Coin Proof Set, featuring $1...

  13. Inpatient resource utilization, disease severity, mortality and insurance coverage for patients hospitalized for hepatitis C virus in the United States.

    Science.gov (United States)

    Younossi, Z M; Otgonsuren, M; Henry, L; Arsalla, Z; Stepnaova, M; Mishra, A; Venkatesan, C; Hunt, S

    2015-02-01

    Although the incidence of new hepatitis C virus (HCV) infection has fallen, HCV-related complications are on the rise. Our aim was to assess and describe the 2005-2009 national inpatient mortality and resource utilization trends for patients with HCV. Data from the National Inpatient Sample (NIS) and the National Hospital Discharge Survey (NHDS) between 2005 and 2009 were analyzed. Included were all adult hospital discharges with HCV-related ICD-9 codes. Incremental hospital charge, in-hospital mortality and length of stay (LOS) were estimated using n = 1000 bootstrap replicates clustered by unique hospital identifier. A total of 123 939 (0.38%) discharges were related to HCV (primary or secondary diagnosis). In-hospital mortality increased from 1.7% (2005) to 2.6% (2009) (P hospital costs ($6500) remaining stable while at the same time, hospital-to-hospital transfer admissions and disposition to home health care increased. HCV-related hepatocellular carcinoma predicted longer hospital stay and death; older age predicted death; and receiving more procedures predicted higher hospital costs. The percentage of patients with private insurance significantly decreased (4.7%), while government-sponsored insurance and uninsured increased by 2.5% and 2.1%, respectively (P hospitalization than those with government-sponsored insurance. HCV-related inpatient mortality and resource utilization have increased. HCC was the largest predictor for mortality and resource utilization. These data are consistent with the rising clinical and societal burden of chronic hepatitis C in the United States. © 2014 John Wiley & Sons Ltd.

  14. Characteristics of patient portals developed in the context of health information exchanges: Early policy effects of incentives in the meaningful use program in the United States

    NARCIS (Netherlands)

    E.T. Otte-Trojel (Eva Terese); A.A. de Bont (Antoinette); J.J. van de Klundert (Joris); T.G. Rundall (Thomas)

    2014-01-01

    textabstractBackground: In 2014, the Centers for Medicare & Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage patients onl

  15. Filicide in the United States.

    Science.gov (United States)

    Resnick, Phillip J

    2016-12-01

    In the United States the Accreditation Council of Graduate Medical Education determines the curriculum required for fellows in forensic psychiatry to become board certified as a subspecialist. Areas that must be covered during the one year fellowship include criminal issues, such as insanity; civil issues, such as tort law and Workers' Compensation; legal regulation of psychiatry, such as confidentiality and involuntary hospitalization; and correctional psychiatry issues, such as dual agency and prisoner's rights. Fellows are also expected to have knowledge about juvenile courts, the structure of the legal system, and child custody issues. In addition, fellows are required to analyze complex cases and write forensic reports which are well reasoned. Teaching methods include lectures, storytelling, use of video vignettes, and mock trials. Additional teaching methodologies include group supervision of fellows in their report writing and direct observation of giving testimony. During the year we see fellows evolve and shift their orientation from being an advocate for patients to perceiving their role as serving justice.

  16. Agricultural Water Pricing: United States

    OpenAIRE

    2010-01-01

    In summary, irrigation costs and prices are rising in most regions of the United States, due to a combination of increasing scarcity, changes in public preferences regarding water allocation among competing uses, increasing budget scrutiny in the national and state legislatures, rising energy prices, and increasing awareness of climate change and the potential implications for rainfall and the availability of surface water resources. These issues likely will continue encouraging public offici...

  17. Pharmaceutical sales representatives and patient safety: a comparative prospective study of information quality in Canada, France and the United States.

    Science.gov (United States)

    Mintzes, Barbara; Lexchin, Joel; Sutherland, Jason M; Beaulieu, Marie-Dominique; Wilkes, Michael S; Durrieu, Geneviève; Reynolds, Ellen

    2013-10-01

    The information provided by pharmaceutical sales representatives has been shown to influence prescribing. To enable safe prescribing, medicines information must include harm as well as benefits. Regulation supports this aim, but relative effectiveness of different approaches is not known. The United States (US) and France directly regulate drug promotion; Canada relies on industry self-regulation. France has the strictest information standards. This is a prospective cohort study in Montreal, Vancouver, Sacramento and Toulouse. We recruited random samples of primary care physicians from May 2009 to June 2010 to report on consecutive sales visits. The primary outcome measure was "minimally adequate safety information" (mention of at least one indication, serious adverse event, common adverse event, and contraindication, and no unqualified safety claims or unapproved indications). Two hundred and fifty-five physicians reported on 1,692 drug-specific promotions. "Minimally adequate safety information" did not differ: 1.7 % of promotions; range 0.9-3.0 % per site. Sales representatives provided some vs. no information on harm more often in Toulouse than in Montreal and Vancouver: 61 % vs. 34 %, OR = 4.0; 95 % CI 2.8-5.6, or Sacramento (39 %), OR = 2.4; 95 % CI 1.7-3.6. Serious adverse events were rarely mentioned (5-6 % of promotions in all four sites), although 45 % of promotions were for drugs with US Food and Drug Administration (FDA) "black box" warnings of serious risks. Nevertheless, physicians judged the quality of scientific information to be good or excellent in 901 (54 %) of promotions, and indicated readiness to prescribe 64 % of the time. "Minimally adequate safety information" did not differ in the US and Canadian sites, despite regulatory differences. In Toulouse, consistent with stricter standards, more harm information was provided. However, in all sites, physicians were rarely informed about serious adverse events, raising questions about

  18. Healthcare reform and the next generation: United States medical student attitudes toward the Patient Protection and Affordable Care Act.

    Directory of Open Access Journals (Sweden)

    Kristin M Huntoon

    Full Text Available CONTEXT: Over one year after passage of the Patient Protection and Affordable Care Act (PPACA, legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. OBJECTIVE: To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. DESIGN, SETTING, AND PARTICIPANTS: An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students between October-December 2010, with 1232 students responding and a response rate of 18%. MAIN OUTCOME MEASURES: Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. RESULTS: Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7% were unsure if quality will be improved. Two thirds (67.6% believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8% opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. CONCLUSION: The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment.

  19. 7 CFR 1250.308 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1250.308 Section 1250.308 Agriculture... Research and Promotion Order Definitions § 1250.308 United States. United States means the 48 contiguous States of the United States of America and the District of Columbia....

  20. 31 CFR 592.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 592.311 Section 592... § 592.311 United States. The term United States, when used in the geographic sense, means the several States, the District of Columbia, and any commonwealth, territory, or possession of the United States....

  1. 7 CFR 1205.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.23 Section 1205.23 Agriculture... Procedures for Conduct of Sign-up Period Definitions § 1205.23 United States. The term United States means the 50 states of the United States of America. Procedures...

  2. 7 CFR 1205.313 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.313 Section 1205.313 Agriculture... Research and Promotion Order Definitions § 1205.313 United States. United States means the 50 States of the United States of America....

  3. 22 CFR 120.13 - United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false United States. 120.13 Section 120.13 Foreign... United States. United States, when used in the geographical sense, includes the several states, the Commonwealth of Puerto Rico, the insular possessions of the United States, the District of Columbia,...

  4. 7 CFR 1219.26 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1219.26 Section 1219.26 Agriculture..., AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.26 United States. United States means collectively the several 50 States of the United States, the District...

  5. 7 CFR 1150.106 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1150.106 Section 1150.106 Agriculture... Order Definitions § 1150.106 United States. United States means the 48 contiguous States in the continental United States....

  6. Education in the United States

    Institute of Scientific and Technical Information of China (English)

    钱富奎

    2009-01-01

    As might be expected,educational institutions in the United States reflect the nation's basic values,especially the ideal of equality of opportunity.From elementary school through college,Americans believe that everyone deserves an equal opportunity to get a good education.

  7. United States Navy DL Perspective

    Science.gov (United States)

    2010-08-10

    United States Navy DL Perspective CAPT Hank Reeves Navy eLearning Project Director 10 August 2010 Report Documentation Page Form ApprovedOMB No...Marine Corps (USMC) Navy eLearning Ongoing Shared with USMC, Coast Guard 9 NeL Help Site https://ile-help.nko.navy.mil/ile/ https://s-ile

  8. Norovirus in the United States

    Centers for Disease Control (CDC) Podcasts

    2013-09-09

    Dr. Aron Hall, a CDC epidemiologist specializing in norovirus, discusses the impact of norovirus in the United States.  Created: 9/9/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/17/2013.

  9. Cholera in the United States

    Centers for Disease Control (CDC) Podcasts

    2011-11-08

    Anna Newton, Surveillance Epidemiologist at CDC, discusses cholera that was brought to the United States during an outbreak in Haiti and the Dominican Republic (Hispaniola).  Created: 11/8/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 11/8/2011.

  10. 7 CFR 1209.21 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1209.21 Section 1209.21... Definitions § 1209.21 State and United States. (a) State means any of the several States, the District of Columbia, and the Commonwealth of Puerto Rico. (b) United States means collectively the several States...

  11. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States

    Directory of Open Access Journals (Sweden)

    Youichi Yasui

    2017-01-01

    Full Text Available Introduction. Disorders of the Achilles tendon can be broadly classified into acute and chronic entities. Few studies have established chronic Achilles tendinopathy as a precursor to acute Achilles ruptures. In this study, we assessed the relationship between Achilles tendinopathy and rupture, clarifying the incidence of rupture in the setting of underlying tendinopathy. Methods. The United Healthcare Orthopedic Dataset from the PearlDiver Patient Record Database was used to identify patients with ICD-9 codes for Achilles rupture and/or Achilles tendinopathy. The number of patients with acute rupture, chronic tendinopathy, and rupture following a prior diagnosis of tendinopathy was assessed. Results. Four percent of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (7,232 patients. Older patients with tendinopathy were most vulnerable to subsequent rupture. Conclusions. The current study demonstrates that 4.0% of patients who were previously diagnosed with Achilles tendinopathy sustained an Achilles tendon rupture. Additionally, older patients with Achilles tendinopathy were most vulnerable. These findings are important as they can help clinicians more objectively council patients with Achilles tendinopathy.

  12. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States

    Science.gov (United States)

    Shimozono, Yoshiharu; Kawano, Hirotaka

    2017-01-01

    Introduction. Disorders of the Achilles tendon can be broadly classified into acute and chronic entities. Few studies have established chronic Achilles tendinopathy as a precursor to acute Achilles ruptures. In this study, we assessed the relationship between Achilles tendinopathy and rupture, clarifying the incidence of rupture in the setting of underlying tendinopathy. Methods. The United Healthcare Orthopedic Dataset from the PearlDiver Patient Record Database was used to identify patients with ICD-9 codes for Achilles rupture and/or Achilles tendinopathy. The number of patients with acute rupture, chronic tendinopathy, and rupture following a prior diagnosis of tendinopathy was assessed. Results. Four percent of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (7,232 patients). Older patients with tendinopathy were most vulnerable to subsequent rupture. Conclusions. The current study demonstrates that 4.0% of patients who were previously diagnosed with Achilles tendinopathy sustained an Achilles tendon rupture. Additionally, older patients with Achilles tendinopathy were most vulnerable. These findings are important as they can help clinicians more objectively council patients with Achilles tendinopathy. PMID:28540301

  13. Infection related never events in pediatric patients undergoing spinal fusion procedures in United States: prevalence and predictors.

    Directory of Open Access Journals (Sweden)

    Veerajalandhar Allareddy

    Full Text Available OBJECTIVE: To examine the prevalence and predictors of infection related never events (NE associated with spinal fusion procedures (SFP in children (age < = 18 years in the United States. METHODS: We performed a retrospective analysis of the Nationwide Inpatient Sample for the years 2004 to 2008. All pediatric hospitalizations that underwent SFP were selected for analysis. The main outcomes measures include occurrence of certain NE's. The association between the occurrence of a NE and factors (patient & hospital related were examined using multivariable logistic regression analysis. RESULTS: Of 56,465 hospitalizations, 61.7% occurred among females. The average age was 13.7 y and two-thirds were whites. The major insurance payer was private insurance (67.4%. About 82% of all hospitalizations occurred on an elective basis. Teaching hospitals accounted for a majority of hospitalizations (87.9%. Two-thirds were posterior fusion techniques, 52.3% had underlying musculoskeletal deformities, and the most frequently present co-morbid conditions (CMC included paralysis (10.9%, chronic pulmonary disease (9.7%, and fluid/electrolyte disorders (7.6%. Overall rate of occurrence of a NE was 4.8%. Post-operative pneumonia was the most frequently occurring NE (2.9%. Female gender (OR = 0.78 and elective admissions (OR = 0.66 were associated with lower risk of NE occurrence. Medicaid coverage (OR = 1.46, primary diagnosis of other acquired deformities (OR = 1.82, spinal cord injury (OR = 6.94, other nervous system disorders (OR = 2.84 were associated with higher risk of NE occurrence. Among CMC, those with chronic blood loss anemia (OR = 2.57, coagulopathy (OR = 1.97, depression (OR = 2, drug abuse (OR = 3.71, fluid/electrolyte disorders (OR = 2.62, neurological disorders (OR = 1.72, paralysis (OR = 1.75, renal failure (OR = 5.45, and weight loss (OR = 4.61 were risk factors for higher odds of a NE occurrence. Hospital teaching status, region, hospital size, and

  14. 75 FR 25925 - United States Mint

    Science.gov (United States)

    2010-05-10

    ... United States Mint ACTION: Notification of Citizens Coinage Advisory Committee May 25, 2010 Public Meeting. SUMMARY: Pursuant to United States Code, Title 31, section 5135(b)(8)(C), the United States Mint...: May 25, 2010. Time: 9 a.m. to 12 p.m. Location: 8th Floor Board Room, United States Mint, 801...

  15. 31 CFR 560.307 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 560.307 Section 560.307 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 560.307 United States. The term United States means the United States, including its territories...

  16. 31 CFR 547.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 547.310 Section 547.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 547.310 United States. The term United States means the United States,...

  17. 31 CFR 548.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 548.310 Section 548.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  18. 31 CFR 586.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 586.318 Section 586...) KOSOVO SANCTIONS REGULATIONS General Definitions § 586.318 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...

  19. 7 CFR 1212.31 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1212.31 Section 1212.31 Agriculture..., Consumer Education, and Industry Information Order Definitions § 1212.31 United States. “United States... territories and possessions of the United States....

  20. 31 CFR 543.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 543.310 Section 543.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 543.310 United States. The term United States means the United States, its territories...

  1. 31 CFR 546.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 546.310 Section 546.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  2. 31 CFR 538.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 538.314 Section 538.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 538.314 United States. The term United States means the United States, its territories and...

  3. 31 CFR 594.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 594.313 Section 594.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 594.313 United States. The term United States means the United States, its territories...

  4. 31 CFR 588.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 588.310 Section 588.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 588.310 United States. The term United States means the United States, its territories...

  5. 31 CFR 593.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 593.311 Section 593.311 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 593.311 United States. The term United States means the United States,...

  6. 31 CFR 537.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 537.318 Section 537.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....318 United States. The term United States means the United States, its territories and...

  7. 31 CFR 575.319 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 575.319 Section 575.319 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....319 United States. The term United States means the United States, its territories and...

  8. 31 CFR 595.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 595.314 Section 595.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 595.314 United States. The term United States means the United States, its territories and...

  9. 31 CFR 596.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 596.312 Section 596.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 596.312 United States. The term United States means the United States, including...

  10. 31 CFR 587.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 587.310 Section 587...) MILOSEVIC SANCTIONS REGULATIONS General Definitions § 587.310 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...

  11. 31 CFR 542.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 542.310 Section 542.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  12. 31 CFR 540.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 540.313 Section 540.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 540.313 United States. The term United States means the United States,...

  13. 31 CFR 597.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 597.318 Section 597.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 597.318 United States. The term United States means the United States,...

  14. 31 CFR 544.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 544.310 Section 544.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 544.310 United States. The term United States means the United States,...

  15. 31 CFR 545.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 545.313 Section 545.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 545.313 United States. The term United States means the United States, its territories...

  16. 31 CFR 585.316 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 585.316 Section 585.316 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 585.316 United States. The term United States means the United States,...

  17. 7 CFR 65.255 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false United States. 65.255 Section 65.255 Agriculture..., PEANUTS, AND GINSENG General Provisions Definitions § 65.255 United States. United States means the 50... United States....

  18. 31 CFR 536.315 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 536.315 Section 536.315 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 536.315 United States. The term United States means the United States, its territories...

  19. 31 CFR 541.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 541.310 Section 541.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 541.310 United States. The term United States means the United States, its territories and...

  20. 31 CFR 598.317 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 598.317 Section 598.317 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 598.317 United States. The term United States means the United States, its territories...

  1. 31 CFR 551.309 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 551.309 Section 551.309 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....309 United States. The term United States means the United States, its territories and...

  2. Masturbation in the United States.

    Science.gov (United States)

    Das, Aniruddha

    2007-01-01

    Using data from the nationally representative National Health and Social Life Survey, this study queried the correlates of masturbation in the United States in 1992. Among those aged 18-60, 38% (CI, 35-41) of women and 61% (CI, 57-65) of men reported any masturbation over the preceding year. The system of factors underlying masturbation was similar for both genders, consistent with a convergence in gender patterns of sexual expression in the United States. Among both women and men, masturbation responded to a stable sexualized personality pattern, catalyzed by early-life factors and manifested in current sexual traits. Strikingly, the masturbation-partnered sex linkage, often conceptualized either as compensating for unsatisfying sex or complementing a satisfactory sex life, appeared to be bimodal for both genders. For some, masturbation complemented an active and pleasurable sex life, while among others, it compensated for a lack of partnered sex or satisfaction in sex.

  3. 77 FR 48542 - United States

    Science.gov (United States)

    2012-08-14

    ... outside of the `reaches of the public interest'''); see generally United States v. SBC Commc'ns, Inc., 489... judicial power.'' SBC ] Commc'ns, 489 F. Supp. 2d at 14-15 (citing Microsoft, 56 F.3d at 1462). With... effect of proposed remedies. See, e.g., KeySpan, 763 F. Supp. 2d at 642; SBC Commc'ns, 489 F. Supp. 2d...

  4. President of the United States

    Institute of Scientific and Technical Information of China (English)

    蔡东丽

    2005-01-01

    President of the United States is the chief executive officer of the federal government, the leader of the executive branch1, and the corn man der-in-chief of the armed forces2. The president has the power to make treaties with other nations, with the advice and consent of two-thirds of the Senate3. The president also appoints4, with Senate's consent, diplomatic representatives ,Supreme Court judges5, and many other officials.

  5. Environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' effort to manage its environment including air, water nature, and biodiversity to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 40 figs., 21 tabs.

  6. HIV Testing in the United States

    Science.gov (United States)

    ... HIV/AIDS HIV Testing in the United States HIV Testing in the United States Jun 23, 2017 ... States or for refugees. 27 Insurance Coverage of HIV Testing HIV testing that is “medically necessary” – recommended ...

  7. Drought in Southwestern United States

    Science.gov (United States)

    2007-01-01

    The southwestern United States pined for water in late March and early April 2007. This image is based on data collected by the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite from March 22 through April 6, 2007, and it shows the Normalized Difference Vegetation Index, or NDVI, for the period. In this NDVI color scale, green indicates areas of healthier-than-usual vegetation, and only small patches of green appear in this image, near the California-Nevada border and in Utah. Larger areas of below-normal vegetation are more common, especially throughout California. Pale yellow indicates areas with generally average vegetation. Gray areas appear where no data were available, likely due to persistent clouds or snow cover. According to the April 10, 2007, update from the U.S. Drought Monitor, most of the southwestern United Sates, including Utah, Nevada, California, and Arizona, experienced moderate to extreme drought. The hardest hit areas were southeastern California and southwestern Arizona. Writing for the Drought Monitor, David Miskus of the Joint Agricultural Weather Facility reported that March 2007 had been unusually dry for the southwestern United States. While California's and Utah's reservoir storage was only slightly below normal, reservoir storage was well below normal for New Mexico and Arizona. In early April, an international research team published an online paper in Science noting that droughts could become more common for the southwestern United States and northern Mexico, as these areas were already showing signs of drying. Relying on the same computer models used in the Intergovernmental Panel on Climate Change (IPCC) report released in early 2007, the researchers who published in Science concluded that global warming could make droughts more common, not just in the American Southwest, but also in semiarid regions of southern Europe, Mediterranean northern Africa, and the Middle East.

  8. 7 CFR 1206.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1206.23 Section 1206.23 Agriculture... INFORMATION Mango Promotion, Research, and Information Order Definitions § 1206.23 United States. United... Rico, and the territories and possessions of the United States....

  9. Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and blaNDM-5, Causing a Complicated Urinary Tract Infection in a Patient from the United States

    Directory of Open Access Journals (Sweden)

    José R. Mediavilla

    2016-08-01

    Full Text Available Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene blaNDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1- and blaNDM-5-harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized.

  10. Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension--seven sites, United States, 2003-2006.

    Science.gov (United States)

    2007-03-02

    Pulmonary arterial hypertension (PAH) is a life-threatening disorder characterized by elevated pulmonary artery pressure and pulmonary vascular resistance. Continuous infusion of a prostanoid, which acts as a vasodilator and anti-proliferative agent, is indicated in the treatment of patients with severe PAH. Two prostanoids are approved for intravenous (IV) use in the United States: epoprostenol (epoprostenol sodium [brand name Flolan], Gilead, Foster City, California) and treprostinil (treprostinil sodium [brand name Remodulin], United Therapeutics, Silver Spring, Maryland). These drugs are administered to PAH patients at hundreds of treatment centers in the United States. In September 2006, CDC received a report from a PAH specialist of a suspected increase in the number of gram-negative bloodstream infections (BSIs) among PAH patients treated with IV treprostinil. CDC conducted a retrospective investigation with the assistance of several state health departments and the cooperation of seven PAH treatment centers to determine the relative rates of BSI in a sample of patients treated with IV treprostinil and IV epoprostenol during 2003--2006. This report describes the results of that investigation, which indicated that, based on combined data from seven separate PAH treatment centers, pooled mean rates of BSI (primarily gram-negative BSI) were significantly higher for patients on treprostinil than for those on epoprostenol. The results do not suggest intrinsic contamination of IV treprostinil as a cause of the infections; the difference in rates might have been caused by differences in preparation and storage of the two agents, differences in catheter care practices, or differences in the anti-inflammatory activity of the agents. Health-care providers who care for PAH patients should be aware of these findings. Further investigation is needed to determine the causes of the different infection rates at centers where this was observed and to determine whether such a

  11. 7 CFR 1280.127 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1280.127 Section 1280.127 Agriculture... INFORMATION ORDER Lamb Promotion, Research, and Information Order Definitions § 1280.127 United States. United States means collectively the 50 States and the District of Columbia....

  12. 7 CFR 1218.22 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1218.22 Section 1218.22 Agriculture... INFORMATION ORDER Blueberry Promotion, Research, and Information Order Definitions § 1218.22 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...

  13. 7 CFR 1215.20 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1215.20 Section 1215.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... United States. United States means all of the States. Popcorn Board...

  14. 7 CFR 1260.108 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1260.108 Section 1260.108 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Promotion and Research Order Definitions § 1260.108 United States. United States means the 50 States and...

  15. 7 CFR 1216.30 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1216.30 Section 1216.30 Agriculture... INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.30 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...

  16. 7 CFR 1221.32 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1221.32 Section 1221.32 Agriculture... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.32 United States. United States or U.S. means collectively the 50 States, the District of Columbia, the Commonwealth...

  17. Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease: An Analysis of Outcomes in the United States.

    Science.gov (United States)

    Maximus, Steven; Phelan, Michael; Joe, Victor C

    2016-01-01

    With the incidence of burns decreasing nationally, burn units are caring for more patients with nonburn conditions. The American Burn Association National Burn Repository does not currently report data regarding patients cared for in burn units without a diagnosis of burn. Using the National Inpatient Sample, we examined if there was a difference in characteristics and outcomes of patients admitted for burns compared with those with a primary admitting diagnosis of necrotizing skin infections and soft-tissue infections and exfoliative skin conditions. This is a retrospective study querying the National Inpatient Sample database to identify 56,102 patients from 2007 to 2012 who were admitted with a diagnosis of a burn (burn group). This group was then compared with 375,857 patients who had a primary admitting diagnosis of a necrotizing skin and/or soft-tissue infection or exfoliative skin conditions (nonburn group). Clinical and demographic variables were analyzed to determine characteristics of each patient group including length of stay, disposition, complications, comorbidities, and mortality. The average age of the nonburn group was 63.7 years, whereas the average age of the burn group was 40.1 years. Overall length of stay was higher in the nonburn patients than in burn patients (10.5 vs 8.4 days, P Burn patients were more likely to undergo a major operating room procedure (39.3% vs 28.1%) and routine discharge (68.4% vs 26.3%) compared with the nonburn group. Patients with necrotizing skin and soft-tissue infections and exfoliative skin conditions are older, have more comorbidities, higher complication rates, and higher mortality rates than burn patients. Given these findings, burn units may need to adjust their resource utilization, competencies, and research priorities to improve the quality of care being delivered to these two different populations.

  18. FORENSIC AND PHARMACEUTICAL RESEARCH OF ORGANIZATION OF AVAILABILITY OF THE MEDICINES FOR PATIENTS WITH MALIGNANCIES IN THE UNITED STATES

    Directory of Open Access Journals (Sweden)

    Shapovalov VV (Jr.

    2016-09-01

    Full Text Available Introduction. The incidence of cancer in recent years has increased significantly. It is therefore particularly important today is the issue of provision for patients with malignancies with drugs. It is important to research the level of organization of availability of the anesthetic therapy to ensure the availability of pharmacotherapy for cancer patients worldwide. Material and methods. For the purpose of the study analyzed legislation, regulations of some states in the US that provide availability of narcotic analgesic drugs for patients with malignant neoplasms. The paper used the following methods: comparative, documentary, legal, medical, pharmaceutical and graphical analysis. Results and discussion. Noted the increase in expenditure on pharmaceutical provision for patients with malignancies on an outpatient basis in the US. During the study of the legislative and regulatory acts of the USA found that payments for treatment possible by insurance companies as part of the agreement, which in turn depend on the patient’s age, number of family members, their total income and so on. Coupons can be used to pay for the cost of medicines, but not all pharmacies accept coupons. There are charities with funds which are partially covered for the cost of chemotherapy and adjuvant therapy (analgesics, antiemetic, antipsychotics, drugs. Found, that in New York doctor may prescribe analgesic medication to the patient without limitation in the frequency and dose. It is not therapeutic use of analgesics, their improper accounting, drug addiction patient has contraindications to the prescription of narcotic analgesic drugs with malignant neoplasms. Reviewed examples from forensic and pharmaceutical practice, pharmaceutical violation of the US laws that regulate the accessibility of patients with malignancies to narcotic analgesic drugs. So, there have been cases of fake prescriptions for narcotic drugs, selling drugs, the shelf life has expired. Police of

  19. Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and blaNDM-5, Causing a Complicated Urinary Tract Infection in a Patient from the United States.

    Science.gov (United States)

    Mediavilla, José R; Patrawalla, Amee; Chen, Liang; Chavda, Kalyan D; Mathema, Barun; Vinnard, Christopher; Dever, Lisa L; Kreiswirth, Barry N

    2016-08-30

    Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene blaNDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1- and blaNDM-5-harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized. Colistin has become the last line of defense for the treatment of infections caused by Gram-negative bacteria resistant to multiple classes of antibiotics, in particular carbapenem-resistant Enterobacteriaceae (CRE). Resistance to colistin, encoded by the plasmid-borne gene mcr-1, was first identified in animal and clinical samples from China in November 2015 and has subsequently been reported from numerous other countries. In April 2016, mcr-1 was identified in a carbapenem-susceptible Escherichia coli strain from a clinical sample in the United States, followed by a second report from a carbapenem-susceptible E. coli strain originally isolated in May 2015. We report the isolation and identification of

  20. ocial representation of family support for diabetic patients in users of a family medicine unit in Chalco, State of Mexico

    Directory of Open Access Journals (Sweden)

    Alejandra Rodríguez Torres

    2014-08-01

    Full Text Available OBJECTIVE The goal of this study is to compare and interpret the meaning of family support for diabetic patients and their families using social representations according to a structural approach of Abric’s theory. METHODS The study was carried out in a Family Medicine Center of the Chalco Municipality in Mexico State. The population studied comprised ten diabetic patient-family pairs. The first part of the study was a simple word association test that aimed to find terms or statements related to the concept of “family support”, as well as its frequency of appearance and range of association. Once the terms or statements were obtained, they were categorized according to their “support” capabilities. A semi-structured interview for each category was conducted as well as a graphic analysis of Friedman’s meanings. The discourse of diabetic patients was compared to that of the families in order to find similarities and differences. RESULTS Evocation of terms was done in the first part of the study, and it was found that the emotional domain was central to the discourse. However, in the second part of the study, when categorization and analysis of discourse is performed, there are differences in the centrality of terms and statements. The family tends to center in the active domain, whereas the patient centers in the emotional domain. CONCLUSIONS This study brings up the emotional needs of the patient as essential components of support efforts. This promotes reflection about changing strategies in the design of public healthcare programs in that they may include family support from the viewpoint of otherness.

  1. [Social representation of family support for diabetic patients in users of a family medicine unit in Chalco, State of Mexico].

    Science.gov (United States)

    Rodríguez, Alejandra; Camacho, Esteban Jaime; Escoto, María Del Consuelo; Contreras, Georgina; Casas, Donovan

    2014-08-27

    The goal of this study is to compare and interpret the meaning of family support for diabetic patients and their families using social representations according to a structural approach of Abric's theory. The study was carried out in a Family Medicine Center of the Chalco Municipality in Mexico State. The population studied comprised ten diabetic patient-family pairs. The first part of the study was a simple word association test that aimed to find terms or statements related to the concept of "family support", as well as its frequency of appearance and range of association. Once the terms or statements were obtained, they were categorized according to their "support" capabilities. A semi-structured interview for each category was conducted as well as a graphic analysis of Friedman's meanings. The discourse of diabetic patients was compared to that of the families in order to find similarities and differences. Evocation of terms was done in the first part of the study, and it was found that the emotional domain was central to the discourse. However, in the second part of the study, when categorization and analysis of discourse is performed, there are differences in the centrality of terms and statements. The family tends to center in the active domain, whereas the patient centers in the emotional domain. This study brings up the emotional needs of the patient as essential components of support efforts. This promotes reflection about changing strategies in the design of public healthcare programs in that they may include family support from the viewpoint of otherness.

  2. Geographic Distribution of Trauma Burden, Mortality, and Services in the United States: Does Availability Correspond to Patient Need?

    Science.gov (United States)

    Rios-Diaz, Arturo J; Metcalfe, David; Olufajo, Olubode A; Zogg, Cheryl K; Yorkgitis, Brian; Singh, Mansher; Haider, Adil H; Salim, Ali

    2016-12-01

    The association between the need for trauma care and trauma services has not been characterized previously. We compared the distribution of trauma admissions with state-level availability of trauma centers (TCs), surgical critical care (SCC) providers, and SCC fellowships, and assessed the association between trauma care provision and state-level trauma mortality. We obtained 2013 state-level data on trauma admissions, TCs, SCC providers, SCC fellowship positions, per-capita income, population size, and age-adjusted mortality rates. Normalized densities (per million population [PMP]) were calculated and generalized linear models were used to test associations between provision of trauma services (higher-level TCs, SCC providers, and SCC fellowship positions) and trauma burden, per-capita income, and age-adjusted mortality rates. There were 1,345,024 trauma admissions (4,250 PMP), 2,496 SCC providers (7.89 PMP), and 1,987 TCs across the country, of which 521 were Level I or II (1.65 PMP). There was considerable variation between the top 5 and bottom 5 states in terms of Level I/Level II TCs and SCC surgeon availability (approximately 8.0/1.0), despite showing less variation in trauma admission density (1.5/1.0). Distribution of trauma admissions was positively associated with SCC provider density and age-adjusted trauma mortality (p ≤ 0.001), and inversely associated with per-capita income (p distribution of trauma services across the US. Increases in the density of SCC providers are associated with decreases in mortality. There was no association between density of trauma admissions and location of Level I/Level II TCs. In the wake of efforts to regionalize TCs, additional efforts are needed to address disparities in the provision of quality care to trauma patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  3. 7 CFR 1210.315 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1210.315 Section 1210.315 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... PLAN Watermelon Research and Promotion Plan Definitions § 1210.315 United States. United States...

  4. Reflections: Mexico and the United States.

    Science.gov (United States)

    Paz, Octavio

    1980-01-01

    Illustrates how Mexico and the United States represent two versions of Western civilization that are profoundly different from one another. Concludes that the United States has always ignored minorities in foreign and domestic policy. Suggests that, to conquer its enemies, the United States must first conquer its historical attitude toward…

  5. Reflections: Mexico and the United States.

    Science.gov (United States)

    Paz, Octavio

    1980-01-01

    Illustrates how Mexico and the United States represent two versions of Western civilization that are profoundly different from one another. Concludes that the United States has always ignored minorities in foreign and domestic policy. Suggests that, to conquer its enemies, the United States must first conquer its historical attitude toward…

  6. The United States Revised Uniform Anatomical Gift Act (2006: New challenges to balancing patient rights and physician responsibilities

    Directory of Open Access Journals (Sweden)

    McGregor Joan L

    2007-09-01

    Full Text Available Abstract Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006 and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006 for legislation and remaining states are likely to follow soon. The Revised UAGA (2006 poses challenges to the Patient Self Determination Act (PSDA embodied in advance health care directives and individual expression about the use of life support systems at the end-of-life. The challenges are predicated on the UAGA revising the default choice to presumption of donation intent and the use of life support systems to ensure medical suitability of organs for transplantation. The default choice trumps the expressed intent in an individual's advance health care directive to withhold and/or withdraw life support systems at the end-of-life. The Revised UAGA (2006 overrides advance directives on utilitarian grounds, which is a serious ethical challenge to society. The subtle progression of the Revised UAGA (2006 towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative "duty to donate". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support

  7. What are the highly important and desirable patient engagement actions for self-care as perceived by individuals living in the southern United States?

    Science.gov (United States)

    Tzeng, Huey-Ming; Pierson, James Marcus

    2017-01-01

    Aim This exploratory survey study aimed to identify patient engagement actions that are the most frequently named as being highly important (top 30 by importance) or ones that they want to do (top 30 by desire) for community-dwelling adult patients living in the southern United States. Items not making the list of the top 30 by ability were also identified. Background Patient engagement is still an ambiguous term among population health and health care professionals in the United States as we lack a clear understanding of what it entails. Methods This 2015–2016 study used convenience sampling to recruit subjects in a university’s student health service department and in eight senior centers. Two hundred and fifty adult patients older than 18 years in the Upper Cumberland region of Tennessee participated in the study (82% response rate). A 57-item inventory, “The Patient Action Inventory for Self-Care,” was developed and used to ascertain patients’ self-designated preferences and capabilities in order to understand their needs for education and support. Results Respondents included 159 (63.6%) women, 62 (24.8%) men, and 29 (11.6%) who did not indicate their gender. Combining the list of the top 30 importance items and the list of the top 30 desired items yielded a list of 35 items; noteworthy is the fact that the list of the top 30 ability actions contained nine items that were not found in a previously mentioned list of 35 high-ranking importance and desired items. This study validated the necessity of analyzing patient engagement actions by importance, desirability, and ability to accomplish it. These three levels are distinct from each other. Conclusion Nurses may use future versions of the inventory to assist patients in identifying self-care actions to engage in. Use of the inventory will demonstrate respect for patients’ preferences and may thus improve engagement.

  8. The use of performance improvement methods to enhance emergency department patient satisfaction in the United States: a critical review of the literature and suggestions for future research.

    Science.gov (United States)

    Boudreaux, Edwin D; Cruz, Brian L; Baumann, Brigitte M

    2006-07-01

    The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence-based suggestions for clinical practice. Data sources consisted of searches through MEDLINE, CINAHL, PSYCHINFO, Cochrane Library, and Emergency Medicine Abstracts and a manual search of references. Articles were included if they reported a performance improvement intervention targeting patient satisfaction in the ED setting. Articles on studies not conducted in the United States or that failed to provide enough details to allow critical evaluation of the study were excluded. Two authors used structured evaluation criteria to independently review each retained study. Nineteen articles met all selection criteria. Three studies found varying levels of support for multicomponent interventions, predominantly focused on implementation of clinical practice guidelines for specific presenting complaints and process redesign. Sixteen studies evaluated single-component interventions, with the following having at least one supportive study: using alternating patient assignment to provider teams rather than "zone"-based assignment, enhancing provider communication and customer service skills, incorporating information delivery interventions (e.g., pamphlets, video) that target patient expectations, using preformatted charts, and establishing ED-based observation units for specific conditions such as asthma and chest pain. There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.

  9. State-ing the Facts: Exploring the United States.

    Science.gov (United States)

    Bay, Jennifer M.; Bledsoe, Ann M.; Reys, Robert E.

    1998-01-01

    Presents activities on estimation, scaling, area of nonstandard shapes, algebraic thinking, and real-life situations using the United States of America. These activities make it possible to integrate mathematics and social studies. Uses technology by employing geometry software packages such as The Geometer's Sketchpad, Cabri, and Geometric…

  10. United States Stateplane Zones - NAD27

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1927) represents the State Plane Coordinate System (SPCS) Zones for the 1927 North American Datum within United States.

  11. United States Stateplane Zones - NAD83

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1983) represents the State Plane Coordinate System (SPCS) Zones for the 1983 North American Datum within United States.

  12. Death in the United States, 2011

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...

  13. Cost-Effectiveness of LDL-C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States.

    Science.gov (United States)

    Gandra, Shravanthi R; Villa, Guillermo; Fonarow, Gregg C; Lothgren, Mickael; Lindgren, Peter; Somaratne, Ransi; van Hout, Ben

    2016-06-01

    Randomized trials have shown marked reductions in low-density lipoprotein cholesterol (LDL-C), a risk factor for cardiovascular disease (CVD), when evolocumab is administered. We hypothesized that evolocumab added to standard of care (SOC) vs SOC alone is cost-effective in the treatment of patients with heterozygous familial hypercholesterolemia (HeFH) or atherosclerotic CVD (ASCVD) with or without statin intolerance and LDL-C >100 mg/dL. Using a Markov cohort state transition model, primary and recurrent CVD event rates were predicted considering population-specific trial-based mean risk factors and calibrated against observed rates in the real world. The LDL-C-lowering effect from population-specific phase 3 randomized studies for evolocumab was used together with estimated LDL-C-lowering effect on CVD event rates per 38.67-mg/dL LDL-C lowering from a statin-trial meta-analysis. Costs and utilities were included from published sources. Evolocumab treatment was associated with both increased cost and improved quality-adjusted life-years (QALY): HeFH (incremental cost: US$153 289, incremental QALY: 2.02, incremental cost-effectiveness ratio: US$75 863/QALY); ASCVD (US$158 307, 1.12, US$141 699/QALY); and ASCVD with statin intolerance (US$136 903, 1.36, US$100 309/QALY). Evolocumab met both the American College of Cardiology/American Heart Association (ACC/AHA) and World Health Organization (WHO) thresholds in each population evaluated. Sensitivity and scenario analyses confirmed that model results were robust to changes in model parameters. Among patients with HeFH and ASCVD with or without statin intolerance, evolocumab added to SOC may provide a cost-effective treatment option for lowering LDL-C using ACC/AHA intermediate/high value and WHO cost-effectiveness thresholds. More definitive information on the clinical and economic value of evolocumab will be available from the forthcoming CVD outcomes study.

  14. United States Department of State Strategic Plan

    Science.gov (United States)

    1998-01-01

    targets for worldwide reduction or elimination of the cultiva- tion, production, and commercial-scale import of cocaine, opium, heroin, mari- juana ...international sanctions against state sponsors of terrorism and urges their strict enforcement. State presses state spon- sors to abandon their support for

  15. Economic evaluation of pooled solvent/detergent treated plasma versus single donor fresh-frozen plasma in patients receiving plasma transfusions in the United States.

    Science.gov (United States)

    Huisman, Eline L; de Silva, Shamika U; de Peuter, Maria A

    2014-08-01

    This study assessed the cost-effectiveness of Octaplas™ versus fresh frozen plasma (FFP) in patients receiving plasma transfusions in the United States (US). Acute and long-term complications of plasma transfusions were modelled in a decision tree followed by a Markov model, using a healthcare payer perspective. Over a lifetime time horizon, patients receiving Octaplas™ accumulate slightly more life years (0.00613 [95% uncertainty interval (95%UI): 0.00166-0.01561]) and quality-adjusted life years (QALY) (0.023 [95%UI: 0.012-0.044]) at lower cost compared with those treated with FFP. Octaplas™ demonstrated to be the dominant treatment option over FFP (95%UI: Dominant-US$ 15,764/QALY).

  16. Prevalence and illness beliefs of sleep paralysis among Chinese psychiatric patients in China and the United States.

    Science.gov (United States)

    Yeung, Albert; Xu, Yong; Chang, Doris F

    2005-03-01

    To investigate the prevalence and illness beliefs of sleep paralysis (SP) among Chinese patients in a psychiatric out-patient clinic, consecutive Chinese/Chinese-American patients who attended psychiatric out-patient clinics in Boston and Shanghai were asked about their lifetime prevalence, personal experience and perceptions regarding the causes, precipitating factors, consequences, and help-seeking of SP. During the 4-month study period, 42 non-psychotic psychiatric out-patients from the Boston site and 150 patients from the Shanghai site were interviewed. The prevalence of SP was found to be 26.2% in Boston and 23.3% in Shanghai. Patients with post-traumatic stress disorder (PTSD) or panic disorder reported a higher prevalence of SP than did patients without these disorders. Patients attributed SP to fatigue, stress, and other psychosocial factors. Although the experience has traditionally been labeled 'ghost oppression' among the Chinese, only two patients, one from each site, endorsed supernatural causes of their SP. Sleep paralysis is common among Chinese psychiatric out-patients. The endorsement of supernatural explanations for SP is rare among contemporary Chinese patients.

  17. The United States in the 1980's

    Directory of Open Access Journals (Sweden)

    D. Conradie

    2012-02-01

    Full Text Available The era of optimism which prevailed in the United States since the Korean War, came to an abrupt end after the debacle in Vietnam. By the end of the Seventies the United States was no longer the dominant military power. American foreign policy lacked consistence, coherence and a strategic sense. The United States became indecisive. Under these circumstances the Soviet Union successfully enforced its imperialistic designs upon countries far from its shores.

  18. Localized prostate cancer in Norway, the United States, and Spain: between-country differences of variables before treatment among patients eligible for curative treatment.

    Science.gov (United States)

    Storås, Anne Holck; Sanda, Martin G; Ferrer, Montse; Loge, Jon Håvard; Dahl, Alv A; Steinsvik, Eivind A S; Guedea, Ferran; Cvancarova, Milada; Fosså, Sophie D

    2014-08-01

    In men with PCa, large variations of PROs after RP or high-dose RAD might be related to between-country differences of medical and sociodemographic variables, and differences in PROs before treatment in the sexual and urinary domains. In 1908 patients with localized PCa from Norway, the United States, or Spain, the relation between medical (prostate-specific antigen, Gleason score, cT-category) and sociodemographic variables (age, education, marital status) before treatment was investigated. Using the Expanded Prostate Cancer Index Composite questionnaire, PROs before treatment within the sexual and urinary domains were also considered. Compared with the European patients, American patients were younger, fewer had comorbid conditions, and more had a high education level. Fifty-three percent of the US men eligible for RP had low-risk tumors compared with 42% and 31% among the Norwegian and the Spanish patients, respectively. Among the Spanish RAD patients, 54% had had low-risk tumors compared with 34% of the American and 21% of the Norwegian men planned for RAD, respectively. Compared with the European patients, significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups, the number of patients with sexual or urinary dysfunction exceeded that of patients with bother related to the reported dysfunction. Statistically significant between-country differences were observed in medical and sociodemographic variables, and in PROs before treatment within the sexual and urinary domains. Large differences between reported dysfunction and related problems within the sexual and urinary domains indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, might in part explain the large variation of side effects after treatment evident in the medical literature. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Healthcare Data Analytics for Parkinson’s Disease Patients: A Study of Hospital Cost and Utilization in the United States

    Science.gov (United States)

    Mukherjee, Sunanda; Wu, Huanmei; Jones, Josette

    2016-01-01

    Parkinson’s Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients. PMID:28269954

  20. Healthcare Data Analytics for Parkinson's Disease Patients: A Study of Hospital Cost and Utilization in the United States.

    Science.gov (United States)

    Mukherjee, Sunanda; Wu, Huanmei; Jones, Josette

    2016-01-01

    Parkinson's Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients.

  1. Abortion Surveillance - United States, 2013.

    Science.gov (United States)

    Jatlaoui, Tara C; Ewing, Alexander; Mandel, Michele G; Simmons, Katharine B; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen

    2016-11-25

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2013. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004-2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 664,435 abortions were reported to CDC for 2013. Of these abortions, 98.2% were from the 47 reporting areas that provided data every year during 2004-2013. Among these 47 reporting areas, the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 200 abortions per 1,000 live births. From 2012 to 2013, the total number, rate, and ratio of reported abortions decreased 5%. From 2004 to 2013, the total number, rate, and ratio of reported abortions decreased 20%, 21%, and 17%, respectively. In 2013, all three measures reached their lowest level for the entire period of analysis (2004-2013). In 2013 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2013, women aged 20-24 and 25-29 years accounted for 32.7% and 25.9% of all abortions, respectively, and had abortion rates of 21.8 and 18.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.8%, 9.2%, and 3.6% of all abortions, respectively, and had abortion rates of 11.8, 7.0, and 2

  2. Abortion Surveillance - United States, 2012.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Jamieson, Denise J

    2015-11-27

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2012. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2012, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2003-2012. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 699,202 abortions were reported to CDC for 2012. Of these abortions, 98.4% were from the 47 reporting areas that provided data every year during 2003-2012. Among these same 47 reporting areas, the abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 210 abortions per 1,000 live births. From 2011 to 2012, the total number and ratio of reported abortions decreased 4% and the abortion rate decreased 5%. From 2003 to 2012, the total number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively, and reached their lowest level in 2012 for the entire period of analysis (2003-2012). In 2012 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2012, women aged 20-24 and 25-29 years accounted for 32.8% and 25.4% of all abortions, respectively, and had abortion rates of 23.3 and 18.9 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.4%, 9.1%, and 3.7% of all abortions, respectively, and had abortion rates of

  3. Communicative Functions of the Nurse-Patient Relationship: Observations of Native and Non-Native Nurses in United States Hospitals.

    Science.gov (United States)

    Hadley, Jo Linda

    A study compared the nurse-patient communication of native and non-native English-speaking nurses. Examination of the literature on nurse-patient relationships and a brief survey of native nurses yielded an instrument for observation of nurses. Ten nurses were observed for 3 hourse each. Transcripts of the observations of the five non-native…

  4. Human prion diseases in the United States.

    Directory of Open Access Journals (Sweden)

    Robert C Holman

    Full Text Available BACKGROUND: Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD, occurs worldwide. Variant CJD (vCJD, a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy. This study describes the occurrence and epidemiology of CJD and vCJD in the United States. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of CJD and vCJD deaths using death certificates of US residents for 1979-2006, and those identified through other surveillance mechanisms during 1996-2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172-304 deaths. The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8% of the CJD deaths occurred among persons >or=65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%; the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively. Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States. CONCLUSION/SIGNIFICANCE: Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.

  5. Family medicine: its core principles and impact on patient care and medical education in the United States.

    Science.gov (United States)

    Jimbo, Masahito

    2004-06-01

    The specialty of family medicine arose out of a combination of American public and professional concerns regarding fragmentation of health care and was intended to foster a type of physician with a scope of clinical competence that would allow the patient, not the disease, to be the focus. Family physicians serve as the patient's personal physician and provide entry to the health care system, provide comprehensive care, maintain continuing responsibility for the patient including necessary coordination of care and referral, and provide care appropriate to the patient's physical, emotional, and social needs in the context of family and community. The specialty is currently second only to internal medicine in size, and makes a significant contribution to patient care and medical education. As family medicine looks to the future, some of its challenges include continuing to attract medical students to the specialty, refine research themes, and gain further acceptance in academic medical centers.

  6. RELATIONSHIP BETWEEN TIMING OF EMERGENCY PROCEDURES AND LIMB AMPUTATION IN PATIENTS WITH OPEN TIBIA FRACTURE: UNITED STATES, 2003 – 2009

    Science.gov (United States)

    Sears, Erika Davis; Davis, Matthew M.; Chung, Kevin C.

    2012-01-01

    Background We aimed to characterize patterns in the timing of initial emergency procedures for patients with open tibia fracture and examine the relationship between initial procedure timing and in-hospital amputation. Study Design Data were analyzed from the Nationwide Inpatient Sample, 2003–2009. Adult patients were included if they had a primary diagnosis code of open tibia fracture. Patients were excluded for the following: transferred from or to another hospital, an immediate amputation was performed, more than one amputation was performed, no emergency procedure was documented, or treated at a facility that did not perform any amputations. We evaluated the association between timing of the first procedure and the outcome of amputation using multiple logistic regression, controlled for patient risk factors and hospital characteristics. Results Of 7,560 patients included in the analysis, 1.3% (n=99 patients) underwent amputation on hospital day 2 or later. The majority of patients (52.6%) underwent first operative procedure on day 0 or 1. In adjusted analyses, timing of first operative procedure beyond the day of admission is associated with more than three times greater odds of amputation (day 1 OR 3.81, 95% CI 1.80–8.07). Conclusions Delay of first operative procedure beyond the day of admission appears to be associated with a significantly increased probability of amputation in patients with open tibia fracture. All practitioners involved in the management of patients with open tibia fracture should seek a solution for any barrier, other than medical stability of the patient, of achieving early operative intervention. PMID:22842411

  7. A comparative analysis of chiropractic and general practitioner patients in North America: Findings from the joint Canada/United States survey of health, 2002–03

    Directory of Open Access Journals (Sweden)

    Chiang Lu-May

    2006-04-01

    Full Text Available Abstract Background Scientifically rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published. The objective of this study is to compare care seekers of doctors of chiropractic (DCs and general practitioners (GPs in the United States and Canada on a comprehensive set of sociodemographic, quality of life, and health-related variables. Methods Data are from the Joint Canada/U.S. Survey of Health (JCUSH, 2002–03, a random sample of adults in Canada (N = 3505 and the U.S. (N = 5183. Respondents were categorized according to their pattern of health-care use in the past year. Distributions, percentages, and estimates (adjusted odds ratios weighted to reflect the complex survey design were produced. Results Nearly 80% of respondents sought care from GPs; 12% sought DC care. Compared with GP only patients, DC patients in both countries tend to be under 65 and white, with arthritis and disabling back or neck pain. U.S. DC patients are more likely than GP only patients to be obese and to lack a regular doctor; Canadian DC patients are more likely than GP only patients to be college educated, to have higher incomes, and dissatisfied with MD care. Compared with seekers of both GP and DC care, DC only patients in both countries have fewer chronic conditions, take fewer drugs, and have no regular doctor. U.S. DC only patients are more likely than GP+DC patients to be uninsured and dissatisfied with health care; Canadian DC only patients are more likely than GP+DC patients to be under 45, male, less educated, smokers, and not obese, without disabling back or neck pain, on fewer drugs, and lacking a regular doctor. Conclusion Chiropractic and GP patients are dissimilar in both Canada and the U.S., with key differences between countries and between DC patients who do and do not seek care from GPs. Such variation has broad and potentially far-reaching health policy and

  8. Antiretroviral Treatment Switching and Its Association With Economic Outcomes and Adverse Treatment Effects Among Commercially Insured and Medicaid-Enrolled Patients With HIV in the United States.

    Science.gov (United States)

    Korsnes, Jennifer S; Goodwin, Bridgett B; Murray, Miranda; Candrilli, Sean D

    2016-12-01

    Antiretroviral therapy (ART) of HIV typically involves the use of 2 nucleoside reverse transcriptase inhibitors plus a third agent (eg, protease inhibitor). It has been shown that over the course of treatment, a proportion of patients switch their ART for various reasons (eg, tolerability, long-term toxicities). We hypothesize that there is a relationship between ART treatment switching and economic and clinical outcomes among HIV patients. To determine whether switching ART regimens is associated with greater health care costs, resource use, and adverse treatment effects. Administrative health care claims were used to identify commercially insured and Medicaid-enrolled patients in the United States who had ≥2 claims containing an HIV/AIDS diagnosis from 2006 to 2011 and received an ART prescription from 2007 to 2010. The final population included patients who were ≥18 years old on their index date (ie, date of first ART prescription) and had continuous health plan enrollment for ≥12 months before and after their index date. Treatment characteristics (eg, switching), adverse treatment effects, and health care resource utilization and costs, were evaluated during a 12-month follow-up period. Multivariable models assessed the relationship between ART switching and economic outcomes (ie, costs, number of health care encounters) and adverse treatment effects. A total of 14 590 commercially insured patients met all inclusion criteria and 12% had an ART switch; further, 5744 Medicaid-enrolled patients met all inclusion criteria, and 14% switched treatment. After adjusting for confounders, ART switching was associated with 64% and 36% (P economic outcomes and certain adverse treatment effects. Efforts to put patients on an optimal ART regimen initially, therefore reducing the need for subsequent switching, may have a positive effect on patients specifically and the health care system in general. © The Author(s) 2016.

  9. Cost-effectiveness of olanzapine long-acting injection in the treatment of patients with schizophrenia in the United States: a micro-simulation economic decision model.

    Science.gov (United States)

    Furiak, Nicolas M; Ascher-Svanum, Haya; Klein, Robert W; Smolen, Lee J; Lawson, Anthony H; Montgomery, William; Conley, Robert R

    2011-04-01

    To compare, from the perspective of third-party payers in the United States health care system, the cost-effectiveness of olanzapine long-acting injection (LAI, depot) with alternative antipsychotic agents including risperidone-LAI, paliperidone-LAI, haloperidol-LAI, and oral olanzapine, in the treatment of patients with schizophrenia who have been non-adherent or partially adherent with oral antipsychotics. A 1-year micro-simulation economic decision model was developed to simulate the dynamics of usual care of patients with schizophrenia who continue, discontinue, switch, or restart their medication. The model uses a range of clinical and cost parameters including adherence levels, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment discontinuation rates by reason, treatment-emergent adverse events, suicide, health care resource utilization, and direct health care costs. Published medical literature and a clinical expert panel were used to develop baseline model assumptions. Key model outputs include annual total direct cost (US$) per treatment and incremental cost-effectiveness values per additional QALY gained. Model results found that the olanzapine-LAI treatment strategy was more effective (greater QALYs) and less costly than risperidone-LAI, paliperidone-LAI, and haloperidol-LAI. In addition, olanzapine-LAI was both more effective and more costly, with an estimated incremental cost/QALY of $26,824 compared to oral olanzapine. The base-case and multiple sensitivity analyses found olanzapine-LAI to remain within acceptable cost-effective ranges (micro-simulation model finds the olanzapine-LAI treatment strategy to result in better effectiveness and to be a cost-effective alternative compared to oral olanzapine and the LAI formulations of risperidone, paliperidone, and haloperidol in the treatment of non-adherent and partially adherent patients with schizophrenia in the United States. A key limitation is the assumption how

  10. [Prisoners in units for difficult patients].

    Science.gov (United States)

    Bouchard, Jean-Pierre; Brulin-Solignac, Diane; Lodetti, Célia

    2016-01-01

    Prisoners, on remand or convicted, can be placed for a variable amount of time in a unit for difficult patients if their pathological mental state so requires. For the most part, their therapeutic care does not depend on their status as prisoner. The treatments provided are those indicated for their psychological pathologies and their potential or known dangerousness. However, some administrative measures make a distinction between their treatment and that of non-prisoner patients placed in these secure psychiatric units. Copyright © 2016. Published by Elsevier Masson SAS.

  11. Adherence to antiretroviral treatment and correlation with risk of hospitalization among commercially insured HIV patients in the United States.

    Directory of Open Access Journals (Sweden)

    Paul E Sax

    Full Text Available PURPOSE: A lower daily pill burden may improve adherence to antiretroviral treatment (ART and clinical outcomes in patients with human immunodeficiency virus (HIV. This study assessed differences in adherence using the number of pills taken per day, and evaluated how adherence correlated with hospitalization. METHODOLOGY: Commercially insured patients in the LifeLink database with an HIV diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification code 042.xx between 6/1/2006 and 12/31/2008 and receipt of a complete ART regimen were selected for inclusion. Patients were grouped according to their daily pill count and remained on ART for at least 60 days. Outcomes included adherence and rates of hospitalization. Adherence was measured as the proportion of days between the start and end of the regimen in which the patient maintained supply of all initiated ART components. Logistic regressions assessed the relationship between pills per day, adherence, and hospitalization, controlling for demographics, comorbidities, and ART-naïve (vs. experienced status. RESULTS: 7,073 patients met the study inclusion criteria, and 33.4%, 5.8%, and 60.8% received an ART regimen comprising one, two, or three or more pills per day, respectively. Regression analysis showed patients receiving a single pill per day were significantly more likely to reach a 95% adherence threshold versus patients receiving three or more pills per day (odds ratio [OR] = 1.59; P<0.001. Regardless of the number of pills received per day, patients were over 40% less likely to have a hospitalization if they were adherent to therapy (OR = 0.57; P<0.001. Patients receiving a single pill per day were 24% less likely to have a hospitalization versus patients receiving three or more pills per day (OR = 0.76; P = 0.003. CONCLUSIONS: ART consisting of a single pill per day was associated with significantly better adherence and lower risk of hospitalization in patients

  12. Long-Term Survival of Dialysis Patients with Bacterial Endocarditis Undergoing Valvular Replacement Surgery in the United States

    Science.gov (United States)

    Leither, Maxwell D.; Shroff, Gautam R.; Ding, Shu; Gilbertson, David T.; Herzog, Charles A.

    2013-01-01

    Background Bacterial endocarditis in dialysis patients is associated with high mortality rates. The literature is limited regarding long-term outcomes of valvular replacement surgery and choice of prosthesis in dialysis patients with bacterial endocarditis. Methods and Results Dialysis patients hospitalized for bacterial endocarditis, 2004-2007, were studied retrospectively using data from the US Renal Data System. Long-term survival of patients undergoing valve replacement surgery with tissue or non-tissue valves was compared using the Kaplan-Meier method. A Cox proportional hazards model was used to identify independent predictors of mortality in patients undergoing valvular replacement surgery. During the study period, 11,156 dialysis patients were hospitalized for bacterial endocarditis and 1267 (11.4%) underwent valvular replacement surgery (tissue valve 44.3%, non-tissue valve 55.7%). In the valve replacement cohort, 60% were men, 50% white, 54% aged 45-64 years, and 36% diabetic. Estimated survival with tissue and non-tissue valves, respectively, at 0.5, 1, 2, and 3 years was 59% and 60%, 48% and 50%, 35% and 37%, and 25% and 30% (log rank P = 0.42). Staphylococcus was the predominant organism (66% of identified organisms). Independent predictors of mortality in patients undergoing valve replacement surgery included older age, diabetes as cause of end-stage renal disease, surgery during index hospitalization, staphylococcus as the causative organism, and dysrhythmias as a comorbid condition. Conclusions Valve replacement surgery is appropriate for well-selected dialysis patients with bacterial endocarditis, but is associated with high mortality rates. Survival does not differ with tissue or non-tissue prosthesis. PMID:23785002

  13. Complications of Trauma Patients Admitted to the ICU in Level I Academic Trauma Centers in the United States

    Directory of Open Access Journals (Sweden)

    Stefania Mondello

    2014-01-01

    Full Text Available Background. The aims of this study were to evaluate the complications that occur after trauma and the characteristics of individuals who develop complications, to identify potential risk factors that increase their incidence, and finally to investigate the relationship between complications and mortality. Methods. We did a population-based retrospective study of trauma patients admitted to ICUs of a level I trauma center. Logistic regression analyses were performed to determine independent predictors for complications. Results. Of the 11,064 patients studied, 3,451 trauma patients developed complications (31.2%. Complications occurred significantly more in younger male patients. Length of stay was correlated with the number of complications (R=0.435,P<0.0001. The overall death rate did not differ between patients with or without complications. The adjusted odds ratio (OR of developing complication for patients over age 75 versus young adults was 0.7 (P<0.0001. Among males, traumatic central nervous system (CNS injury was an important predictor for complications (adjusted OR 1.24. Conclusions. Complications after trauma were found to be associated with age, gender, and traumatic CNS injury. Although these are not modifiable factors, they may identify subjects at high risk for the development of complications, allowing for preemptive strategies for prevention.

  14. Trends in the Quality of Treatment for Patients With Intact Cervical Cancer in the United States, 1999 Through 2011

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Grace L. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Jiang, Jing [Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Giordano, Sharon H. [Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Meyer, Larissa A. [Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Gynecologic Oncology and Reproductive Medicine (LAM), The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eifel, Patricia J., E-mail: peifel@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2015-06-01

    Purpose: High-quality treatment for intact cervical cancer requires external radiation therapy, brachytherapy, and chemotherapy, carefully sequenced and completed without delays. We sought to determine how frequently current treatment meets quality benchmarks and whether new technologies have influenced patterns of care. Methods and Materials: By searching diagnosis and procedure claims in MarketScan, an employment-based health care claims database, we identified 1508 patients with nonmetastatic, intact cervical cancer treated from 1999 to 2011, who were <65 years of age and received >10 fractions of radiation. Treatments received were identified using procedure codes and compared with 3 quality benchmarks: receipt of brachytherapy, receipt of chemotherapy, and radiation treatment duration not exceeding 63 days. The Cochran-Armitage test was used to evaluate temporal trends. Results: Seventy-eight percent of patients (n=1182) received brachytherapy, with brachytherapy receipt stable over time (Cochran-Armitage P{sub trend}=.15). Among patients who received brachytherapy, 66% had high–dose rate and 34% had low–dose rate treatment, although use of high–dose rate brachytherapy steadily increased to 75% by 2011 (P{sub trend}<.001). Eighteen percent of patients (n=278) received intensity modulated radiation therapy (IMRT), and IMRT receipt increased to 37% by 2011 (P{sub trend}<.001). Only 2.5% of patients (n=38) received IMRT in the setting of brachytherapy omission. Overall, 79% of patients (n=1185) received chemotherapy, and chemotherapy receipt increased to 84% by 2011 (P{sub trend}<.001). Median radiation treatment duration was 56 days (interquartile range, 47-65 days); however, duration exceeded 63 days in 36% of patients (n=543). Although 98% of patients received at least 1 benchmark treatment, only 44% received treatment that met all 3 benchmarks. With more stringent indicators (brachytherapy, ≥4 chemotherapy cycles, and duration not exceeding 56

  15. Hepatitis A and B immunity and vaccination in chronic hepatitis B and C patients in a large United States cohort.

    Science.gov (United States)

    Henkle, Emily; Lu, Mei; Rupp, Lora B; Boscarino, Joseph A; Vijayadeva, Vinutha; Schmidt, Mark A; Gordon, Stuart C

    2015-02-15

    Hepatitis A and B vaccines are effective in preventing superinfection and sequelae in patients with chronic hepatitis B or C. We describe immunity and vaccination against hepatitis A and B in chronic hepatitis patients from the US Chronic Hepatitis Cohort Study. We identified chronic hepatitis B and C patients with healthcare utilization during 2006-2008 and 12 months of enrollment. We used electronic laboratory records to determine immunity and medical and billing records for vaccination history. Immunity against hepatitis A was defined by positive hepatitis A antibody or documented vaccination. Immunity against hepatitis B was defined as hepatitis B surface antibody level ≥10 mIU/mL or core antibody positive, or by documented vaccination. Among 1635 chronic hepatitis B patients, 978 (59.8%) were immune or vaccinated against hepatitis A, 122 (7.5%) had negative hepatitis A antibody tests, and 535 (32.7%) had no testing or vaccination record. Among 5328 chronic hepatitis C patients, 2998 (56.3%) were immune or vaccinated against hepatitis A, 659 (12.4%) had negative hepatitis A antibody tests, and 1671 (31.4%) had no testing or vaccination record. Additionally, 3150 (59.1%) chronic hepatitis C patients were immune or vaccinated against hepatitis B, 1003 (18.8%) had a negative test result, and 1175 (22.1%) were neither tested for nor vaccinated against hepatitis B. Approximately 40% of chronic hepatitis B and C patients are susceptible to or have no documented immunity or vaccination against hepatitis A or hepatitis B. Clinicians should consider antibody testing and vaccination for this vulnerable population. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  16. Trends and Variation in Use of Breast Reconstruction in Patients With Breast Cancer Undergoing Mastectomy in the United States

    Science.gov (United States)

    Jagsi, Reshma; Jiang, Jing; Momoh, Adeyiza O.; Alderman, Amy; Giordano, Sharon H.; Buchholz, Thomas A.; Kronowitz, Steven J.; Smith, Benjamin D.

    2014-01-01

    Purpose Concerns exist regarding breast cancer patients' access to breast reconstruction, which provides important psychosocial benefits. Patients and Methods Using the MarketScan database, a claims-based data set of US patients with employment-based insurance, we identified 20,560 women undergoing mastectomy for breast cancer from 1998 to 2007. We evaluated time trends using the Cochran-Armitage test and correlated reconstruction use with plastic-surgery workforce density and other treatments using multivariable regression. Results Median age of our sample was 51 years. Reconstruction use increased from 46% in 1998 to 63% in 2007 (P mastectomy also increased: from 3% in 1998 to 18% in 2007 (P mastectomy were more likely to receive reconstruction (odds ratio [OR], 2.3; P mastectomy (OR, 0.5; P < .001), or patients in the highest income quartile (OR, 0.7; P = .006). Delayed reconstruction was performed in 21% of patients who underwent reconstruction. Conclusion Breast reconstruction has increased over time, but it has wide geographic variability. Receipt of other treatments correlates with the use of and approaches toward reconstruction. Further research and interventions are needed to ensure equitable access to this important component of multidisciplinary treatment of breast cancer. PMID:24550418

  17. Differences in characteristics of patients with and without known risk factors for hepatocellular carcinoma in the United States

    Institute of Scientific and Technical Information of China (English)

    Jon D Dorfman; Richard Schulick; Michael A Choti; Jean-Francois H Geschwind; Ihab Kamel; Michael Torbenson; Paul J Thuluvath

    2007-01-01

    AIM: To examine the clinical characteristics of a subgroup of patients with hepatocellular carcinoma (HCC) and compare them to those with known risk factors.METHODS: We used the HCC database of 306 patients seen at our institution from January 1, 1995 to December 31, 2001. Of the 306 patients, 63 (20%, group 1) had no known risk factors (hepatitis C virus, hepatitis B virus,alcohol, hemochromatosis or cirrhosis from any cause)and 243 (group 2) had one or more risk factors.RESULTS: The median age was similar in both groups,but there were disproportionate numbers of younger (< 30 years old), older (> 80 years) patients, women (33% vs 18%), and Caucasians (81% vs 52%) in group 1 as compared to group 2. There were fewer Asians (2%vs 111%) and African Americans (113% vs 27%) in group 11. Abdominal pain (70% vs 37%) was more commonwhile gastrointestinal bleeding (0% vs 1111%) and ascites (4% vs 117%) were less common in group 11 compared to group 2. Group 11 had larger tumor burden (median size 9.4 cm vs 5.7 cm) at the time of presentation, but there were no differences in the site (right, left or bilateral lesions), or number of tumors between the two groups.CONCLUSION: HCC patients without identifiable risk factors have different characteristics and clinical presentation compared to those with known risk factors.Absence of cirrhosis and larger tumor burden may explain the differences in the presenting symptoms.

  18. Addressing the United States Debt and Deficit

    Science.gov (United States)

    2010-03-01

    current government approach to the economy , then examining the current projections for United States’ spending from 2009 through 2019 and examining...manner and thereby strengthen the economy of the United States, this paper concludes with three examples that are predicated on the synergistic benefits associated with small reforms.

  19. Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease - United States.

    Science.gov (United States)

    Marzec, Natalie S; Nelson, Christina; Waldron, Paul Ravi; Blackburn, Brian G; Hosain, Syed; Greenhow, Tara; Green, Gary M; Lomen-Hoerth, Catherine; Golden, Marjorie; Mead, Paul S

    2017-06-16

    The term "chronic Lyme disease" is used by some health care providers as a diagnosis for various constitutional, musculoskeletal, and neuropsychiatric symptoms (1,2). Patients with a diagnosis of chronic Lyme disease have been provided a wide range of medications as treatment, including long courses of intravenous (IV) antibiotics (3,4). Studies have not shown that such treatments lead to substantial long-term improvement for patients, and they can be harmful (1,5). This report describes cases of septic shock, osteomyelitis, Clostridium difficile colitis, and paraspinal abscess resulting from treatments for chronic Lyme disease. Patients, clinicians, and public health practitioners should be aware that treatments for chronic Lyme disease can carry serious risks.

  20. United States Strategy for Mexico

    Science.gov (United States)

    2005-03-18

    17 March 2005. 2 Homero Aridjis, "Survival of Indigenous Cultures in Mexico," 9 April 1998; available from <http://www.klys.se/worldconference/papers...HomeroAridjis.htm>;Internet; accessed 21 November 2004. 3Tania Carrasco, "Indigenous Peoples in the States of Chiapas, Guerrero and Oaxaca ," 2005...analysis by the State representatives from Chiapas, Guerrero and Oaxaca (3 Southern States). The plan reviewed possible options to reduce poverty and

  1. Neighborhood-level socioeconomic determinants impact outcomes in nonsmall cell lung cancer patients in the Southeastern United States.

    Science.gov (United States)

    Erhunmwunsee, Loretta; Joshi, Mary-Beth M; Conlon, Debbi H; Harpole, David H

    2012-10-15

    Studies examining the impact of lower socioeconomic status (SES) on the outcomes of patients with nonsmall cell lung cancer (NSCLC) are inconsistent. The objective of this study was to clearly elucidate the association between SES, education, and clinical outcomes among patients with NSCLC. The study population was derived from a consecutive, retrospective cohort of patients with NSCLC who received treatment within the Duke Health System between 1995 and 2007. SES determinants were based on the individual's census tract and corresponding 2000 Census data. Determinants included the percentage of the population living below poverty, the median household income, and the percentages of residents with at least a high school diploma and at least a bachelor's degree. The SES and educational variables were divided into quartiles. Statistical comparisons were performed using the 25th and 75th percentiles. Individuals who resided in areas with a low median household income or in which a high percentage of residents were living below the poverty line had a shorter cancer-specific 6-year survival than individuals who resided in converse areas (P = .0167 and P = .0067, respectively). Those living in areas in which a higher percentage of residents achieved a high school diploma had improved disease outcomes compared with those living in areas in which a lower percentage attained a high school diploma (P = .0033). A survival advantage also was observed for inhabitants of areas in which a higher percentage of residents attained a bachelor's degree (P = .0455). Low SES was identified as an independent prognostic factor for poor survival in patients with both early and advanced stage NSCLC. Patients who lived in areas with high poverty levels, low median incomes, and low education levels had worse mortality. Copyright © 2012 American Cancer Society.

  2. The potential influence of common viral infections diagnosed during hospitalization among critically ill patients in the United States.

    Directory of Open Access Journals (Sweden)

    Makesha Miggins

    Full Text Available Viruses are the most common source of infection among immunocompetent individuals, yet they are not considered a clinically meaningful risk factor among the critically ill. This work examines the association of viral infections diagnosed during the hospital stay or not documented as present on admission to the outcomes of ICU patients with no evidence of immunosuppression on admission. This is a population-based retrospective cohort study of University HealthSystem Consortium (UHC academic centers in the U.S. from the years 2006 to 2009. The UHC is an alliance of over 90% of the non-profit academic medical centers in the U.S. A total of 209,695 critically ill patients were used in this analysis. Eight hospital complications were examined. Patients were grouped into four cohorts: absence of infection, bacterial infection only, viral infection only, and bacterial and viral infection during same hospital admission. Viral infections diagnosed during hospitalization significantly increased the risk of all complications. There was also a seasonal pattern for viral infections. Specific viruses associated with poor outcomes included influenza, RSV, CMV, and HSV. Patients who had both viral and bacterial infections during the same hospitalization had the greatest risk of mortality RR 6.58, 95% CI (5.47, 7.91; multi-organ failure RR 8.25, 95% CI (7.50, 9.07; and septic shock RR 271.2, 95% CI (188.0, 391.3. Viral infections may play a significant yet unrecognized role in the outcomes of ICU patients. They may serve as biological markers or play an active role in the development of certain adverse complications by interacting with coincident bacterial infection.

  3. Economic burden and comorbidities of attention-deficit/hyperactivity disorder among pediatric patients hospitalized in the United States

    Directory of Open Access Journals (Sweden)

    Wietecha Linda

    2010-12-01

    Full Text Available Abstract Background This retrospective database analysis used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS to examine common primary diagnoses among children and adolescents hospitalized with a secondary diagnosis of attention- deficit/hyperactivity disorder (ADHD and assessed the burden of ADHD. Methods Hospitalized children (aged 6-11 years and adolescents (aged 12-17 years with a secondary diagnosis of ADHD were identified. The 10 most common primary diagnoses (using the first 3 digits of the ICD-9-CM code were reported for each age group. Patients with 1 of these conditions were selected to analyze demographics, length of stay (LOS, and costs. Control patients were selected if they had 1 of the 10 primary diagnoses and no secondary ADHD diagnosis. Patient and hospital characteristics were reported by cohort (i.e., patients with ADHD vs. controls, and LOS and costs were reported by primary diagnosis. Multivariable linear regression analyses were undertaken to adjust LOS and costs based on patient and hospital characteristics. Results A total of 126,056 children and 204,176 adolescents were identified as having a secondary diagnosis of ADHD. Among children and adolescents with ADHD, the most common diagnoses tended to be mental health related (i.e., affective psychoses, emotional disturbances, conduct disturbances, depressive disorder, or adjustment reaction. Other common diagnoses included general symptoms, asthma (in children only, and acute appendicitis. Among patients with ADHD, a higher percentage were male, white, and covered by Medicaid. LOS and costs were higher among children with ADHD and a primary diagnosis of affective psychoses (by 0.61 days and $51, adjustment reaction (by 1.71 days and $940, or depressive disorder (by 0.41 days and $124 versus controls. LOS and costs were higher among adolescents with ADHD and a primary diagnosis of affective psychoses (by 1.04 days and $352

  4. Predictors of Burden Among Informal Caregivers of Patients with Chemotherapy-Induced Anemia in the United States, France and Italy

    OpenAIRE

    2015-01-01

    PROBLEM: Informal caregivers of patients with chemotherapy-induced anemia (CIA) experience unaddressed burden. Previous research typically quantified burden with a score based on an instrument scale, but did not examine drivers or relative importance of clinical, demographic, and other characteristics on burden. As caregiver outcomes may be mediated by burden (a modifiable factor), research on predictors of burden are needed to identify points to target in designing interventions and policies...

  5. The implications of the Sequestosome 1 mutation P392L in patients with Paget's disease in a United States cohort

    Science.gov (United States)

    Seton, Margaret; Hansen, Marc; Solomon, Daniel H.

    2016-01-01

    Background Paget's disease of bone (PDB) is associated with a germline mutation in Sequestosome1 /p62 (SQSTM1) found in ≤ 16% of sporadic cases worldwide, and in 19-46% of those studied with familial PDB. The P392L is the most prevalent mutation identified to date. This mutation by itself does not confer PDB or define the phenotype of PDB in a given person. Environmental determinants remain elusive, although increasing age of the individual, other gene polymorphisms in the context of SQSTM1 mutations, and measles virus have been implicated. Measles exposure has been unexamined in this context. Objectives The goal of this study is to compare the background history and phenotype of patients with PDB carrying the SQSTM1 P392L mutation to those patients without. Focusing on age, ancestry, P329L mutation, family history, measles exposure, distribution of PDB and age of onset, we examined outcomes at 10 years. We postulated that aging may play a role in defining phenotype, and that this may become more visible in a well characterized cohort. Methods This is an observational study focused on a cohort of patients with PDB drawn from the New England Registry in whom environmental and family history has been catalogued, linked to radiographic data. Of the 217 persons who were enrolled in the Registry, 42 (19%) responded to a letter inviting them to participate in testing for the presence of the measles antibody, and in genetic testing for the P392L mutation. Results The mean age of the cohort in 2001 was 70 years (range 55-79); 27 were men (64%). The measles antibody was found in all cases tested. Nine patients had the P392L mutation (21%), 2 with familial PDB. In these persons, early diagnosis of disease and spinal stenosis marked the male phenotype only. European ancestry was noted in the minority of those with P392L mutation. Most deaths recorded occurred in the 9th decade of life or later. Conclusions Spinal stenosis emerges as a prominent phenotype in SQSTM1 P392L

  6. State Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the State boundaries of the United States, and the boundaries of Puerto Rico and the U.S. Virgin Islands. The map layer was created by...

  7. Psychometric validation of the Brief Pain Inventory-Short Form in patients with systemic lupus erythematosus in the United States.

    Science.gov (United States)

    Naegeli, A N; Tomaszewski, E L; Al Sawah, S

    2015-11-01

    This study evaluated the Brief Pain Inventory-Short Form (BPI-SF) in patients with moderate-to-severe systemic lupus erythematosus (SLE). Patients ≥18 years old who self-reported a physician diagnosis of SLE (confirmed by medical record review) and active SLE (Systemic Lupus Activity Questionnaire (SLAQ) score of ≥11) were included. The BPI-SF and Short Form Health Survey version 2 (SF-36v2) were administered electronically at baseline, week 2 and week 12. Psychometric properties of the BPI-SF were evaluated. Cronbach alphas were >0.9 for all BPI-SF items, domains and total score. Test-retest reliability correlations for responses between baseline and week 2 of the BPI-SF had intraclass correlation coefficients (ICCs) ≥0.5. The BPI-SF domains and total score were moderately positively correlated to the SLAQ score (r ≥ 0.4), but negatively correlated to the SF-36v2 bodily pain domain (r ≤ -0.6). The BPI-SF domains and total score were moderately negatively correlated to the SF-36v2 physical functioning domain and physical component summary (r ≤ -0.4), with low correlations between the BPI-SF severity domain and SF-36v2 mental component summary (r = -0.16). Assessment of pain, as measured by the BPI-SF, demonstrated validity and reliability in a sample of patients with moderate-to-severe SLE. © The Author(s) 2015.

  8. Climatography of the United States

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Numbered series of NOAA publications that contain environmental information climate summaries and station normals. Each series contains a volume for each state,...

  9. Patient survey (HCAHPS) - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of the state averages for the HCAHPS survey responses. HCAHPS is a national, standardized survey of hospital patients about their experiences during a recent...

  10. Increased Prevalence of Celiac Disease in Patients with Unexplained Infertility in the United States: A Prospective Study

    Science.gov (United States)

    Lebwohl, Benjamin; Wang, Jeffrey; Lee, Susie K.; Murray, Joseph A.; Sauer, Mark V.; Green, Peter H. R.

    2011-01-01

    Celiac disease is an autoimmune disorder which can present with a variety of non-gastrointestinal manifestations. In women, it may manifest with an assortment of gynecologic or obstetric disorders. Some reports have linked female infertility with undiagnosed celiac disease. Though there are a number of studies from Europe and the Middle East, only two prior American studies have examined the prevalence of “silent” celiac disease in a female infertility population. We prospectively performed serologic screening for celiac disease in 188 infertile women (ages 25–39). While we did not demonstrate an increased prevalence of celiac disease in our overall infertile female population, we were able to detect a significantly increased prevalence (5.9%) of undiagnosed celiac disease among women presenting with unexplained infertility (n=51). Our findings suggest the importance of screening infertile female patients, particularly those with unexplained infertility, for celiac disease. PMID:21682114

  11. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002

    Directory of Open Access Journals (Sweden)

    Thornsberry Clyde

    2004-05-01

    Full Text Available Abstract Background Bloodstream infections are associated with significant patient morbidity and mortality. Antimicrobial susceptibility patterns should guide the choice of empiric antimicrobial regimens for patients with bacteremia. Methods From January to December of 2002, 82,569 bacterial blood culture isolates were reported to The Surveillance Network (TSN Database-USA by 268 laboratories. Susceptibility to relevant antibiotic compounds was analyzed using National Committee for Clinical Laboratory Standards guidelines. Results Coagulase-negative staphylococci (42.0%, Staphylococcus aureus (16.5%, Enterococcus faecalis (8.3%, Escherichia coli (7.2%, Klebsiella pneumoniae (3.6%, and Enterococcus faecium (3.5% were the most frequently isolated bacteria from blood cultures, collectively accounting for >80% of isolates. In vitro susceptibility to expanded-spectrum β-lactams such as ceftriaxone were high for oxacillin-susceptible coagulase-negative staphylococci (98.7%, oxacillin-susceptible S. aureus (99.8%, E. coli (97.3%, K. pneumoniae (93.3%, and Streptococcus pneumoniae (97.2%. Susceptibilities to fluoroquinolones were variable for K. pneumoniae (90.3–91.4%, E. coli (86.0–86.7%, oxacillin-susceptible S. aureus (84.0–89.4%, oxacillin-susceptible coagulase-negative staphylococci (72.7–82.7%, E. faecalis (52.1%, and E. faecium (11.3%. Combinations of antimicrobials are often prescribed as empiric therapy for bacteremia. Susceptibilities of all blood culture isolates to one or both agents in combinations of ceftriaxone, ceftazdime, cefepime, piperacillin-tazobactam or ciprofloxacin plus gentamicin were consistent (range, 74.8–76.3% but lower than similar β-lactam or ciprofloxacin combinations with vancomycin (range, 93.5–96.6%. Conclusion Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread.

  12. 2010 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2010 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  13. Mineral operations outside the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Mineral facilities and operations outside the United States compiled by the National Minerals Information Center of the USGS. This representation combines source...

  14. CNPC Exports Drilling Equipment to United States

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    @@ Beijing Petroleum Machinery Plant(BPM) of CNPC and Rowan Drilling Company Inc, one of the most powerful drilling service and driller manufacturing companies in the United States signed a petroleum equipment contract on December 9 in Beijing.

  15. Rest Areas in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Rest areas in the western United States. Data was collected from various data sources including georeferenced locations obtained from other agencies, digitizied...

  16. United States Interagency Elevation Inventory (USIEI)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The U.S. Interagency Elevation Inventory displays high-accuracy topographic and bathymetric data for the United States and its territories. The project is a...

  17. Health, United States, 2012: Men's Health

    Science.gov (United States)

    ... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook NCHS Health, United States, 2015 - Men's Health ... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook File Formats Help: How do I view ...

  18. Agricultural Land in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Agricultural land cover for the western United States. This dataset was developed from Sagestitch, the Eastern Washington Shrubsteppe Mapping Project, and several...

  19. Hydrologic landscape regions of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Hydrologic landscape regions (HLRs) in the United States were delineated by using geographic information system (GIS) tools and statistical methods including...

  20. The Grand Strategy of the United States

    Science.gov (United States)

    2014-10-01

    United States both militarily and by setting the terms of trade. While cultural and ideological affinities with European democra- cies played...military establishments (Japan, Russia, India, South Korea, Vietnam, Taiwan, Indonesia , Malaysia, Singapore) can check possible military expansion when

  1. TB in Children in the United States

    Science.gov (United States)

    ... in Children Treatment Vaccines Statistics Related Links TB in Children in the United States TB disease in children under ... person with infectious TB disease. Testing for TB in Children In the absence of symptoms, usually the ...

  2. 2014 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2014 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  3. 2009 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2009 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  4. 2011 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2011 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  5. 2012 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2012 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  6. Terrestrial Ecosystems of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) modeled the distribution of terrestrial ecosystems for the contiguous United States using a standardized, deductive approach to...

  7. Anthropogenic Fragmentation in the western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — We evaluated the fragmentation of the western United States by anthropogenic features. The addition of roads, railroads, and power lines to wildlands, and the...

  8. Social Studies: United States. Grade 5.

    Science.gov (United States)

    Kellogg, E. G.

    This teachers guide attempts to facilitate the study of the United States through a conceptual approach and multimedia instruction in a spiral curriculum. There are five units: 1) Natural Setting --location, climate, terrain, water, soil, and economic and esthetic value, and conservation; 2) Historial Development --North American Indian cultures,…

  9. Party Formation in the United States

    OpenAIRE

    2013-01-01

    This dissertation is about how political parties formed in the world's first mass democracy, the United States. I trace the process of party formation from the bottom up. First, I ask: How do individuals become engaged in politics and develop political affiliations? In most states, throughout the antebellum era, the county was the primary unit of political administration and electoral representation. Owing to their small size, contiguity, and economic homogeneity, I expect that each county's ...

  10. Drought in Southeastern United States

    Science.gov (United States)

    2007-01-01

    May 2007 was a record-setting month in Georgia. Typically a dry month in this southern state, May 2007 was exceptionally so, with many locations setting record-low rainfall records and some receiving no rain at all, said state climatologist David Emory Stooksbury on GeorgiaDrought.org. The lack of rain slowed plant growth, as shown in this vegetation index image. The Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite collected the data used to make this image between May 9 and May 24, 2007. The image shows vegetation conditions compared to average conditions observed from 2000 through 2006. Areas in which plants are more sparse or are growing more slowly than average are brown, while better-than-average growth is green. Georgia and its neighbors (South Carolina, Alabama, and Florida) are all brown, an indication that the lack of rainfall is suppressing plant growth. The gray area in southern Georgia and northern Florida shows where MODIS could not collect valid vegetation measurements, either because of clouds or smoke. In this case, the area corresponds with land that burned during this period and was probably masked by smoke. NASA image created by Jesse Allen, Earth Observatory, using data provided by Inbal Reshef, Global Agricultural Monitoring Project.

  11. 31 CFR 596.313 - United States person.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 596.313 Section... General Definitions § 596.313 United States person. The term United States person means any United States... States, or any person in the United States....

  12. Temporal Trends in Use of Biologic DMARDs for Rheumatoid Arthritis in the United States: A Cohort Study of Publicly and Privately Insured Patients.

    Science.gov (United States)

    Desai, Rishi J; Solomon, Daniel H; Jin, Yinzhu; Liu, Jun; Kim, Seoyoung C

    2017-08-01

    Ten biologic disease-modifying antirheumatic drugs (bDMARDs) are available as treatment for rheumatoid arthritis (RA), but relatively little is known about population-level time trends in the use of these agents. To describe time trends in the use of bDMARDs in RA patients with private or public insurance in the United States. Claims data from private (Optum Clinformatics, 2004-2015) and public (Medicaid Analytic eXtract [MAX], 2000-2010) insurance programs were used. Patients with RA diagnosis codes and continuous health plan enrollment for 1-year baseline and 1-year follow-up periods were identified into 2 separate cohorts: (1) patients not using any bDMARD or (2) patients using a single bDMARD during the baseline period. Initiation of the first bDMARD from group 1 and switch to a second bDMARD from group 2 was identified as the outcome of interest during the 1-year follow-up period. Using mixed-effects regression models, we calculated yearly rates of initiation and switch for bDMARDs, adjusted for case-mix. We also described the proportion of all initiations and switches accounted for by each agent. There were 113,031 RA patients with public insurance and 97,751 RA patients with private insurance who were included in the study. The rates of initiation of bDMARDs (per 100 patients) increased significantly over time in Medicaid data for incident RA patients (from 1.1 to 3.1, P = 0.0006) and prevalent RA patients (from 4.6 to 10.9, P = 0.008). In Optum Clinformatics data, the rates were stable, with 7.7 to 8.3 per 100 incident RA patients (P = 0.10) and 11.0 to 11.5 per 100 prevalent RA patients (P = 0.12). The rates of switching (per 100 patients) increased over time from 6.4 to 16.0 (P = 0.04) in Medicaid data and 9.1 to 17.0 (P = 0.00003) in Optum Clinformatics data. Use of etanercept as the most common first-line agent was stable at approximately 50% of all biologic initiations, but use of infliximab decreased and the use of newer agents increased. More RA

  13. Estimated United States Transportation Energy Use 2005

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C A; Simon, A J; Belles, R D

    2011-11-09

    A flow chart depicting energy flow in the transportation sector of the United States economy in 2005 has been constructed from publicly available data and estimates of national energy use patterns. Approximately 31,000 trillion British Thermal Units (trBTUs) of energy were used throughout the United States in transportation activities. Vehicles used in these activities include automobiles, motorcycles, trucks, buses, airplanes, rail, and ships. The transportation sector is powered primarily by petroleum-derived fuels (gasoline, diesel and jet fuel). Biomass-derived fuels, electricity and natural gas-derived fuels are also used. The flow patterns represent a comprehensive systems view of energy used within the transportation sector.

  14. A multicenter, observational study of lanreotide depot/autogel (LAN) in patients with acromegaly in the United States: 2-year experience from the SODA registry.

    Science.gov (United States)

    Salvatori, Roberto; Gordon, Murray B; Woodmansee, Whitney W; Ioachimescu, Adriana G; Carver, Don W; Mirakhur, Beloo; Cox, David; Molitch, Mark E

    2017-07-24

    This analysis evaluates the 2-year effectiveness and safety of lanreotide depot/autogel (LAN), as well as treatment convenience and acromegaly symptom relief, from the Somatuline(®) Depot for Acromegaly (SODA) registry, a post-marketing, open-label, observational, multicenter, United States registry study. Patients with acromegaly treated with LAN were eligible for enrollment. Demographics, LAN dose, extended dosing interval (EDI) (interval of injections ≥42 days), insulin-like growth factor 1 (IGF-1), growth hormone (GH), glycated hemoglobin, adverse events (AEs), injection convenience, and symptom data were collected. As of September 29, 2014, 241 patients were enrolled in SODA. IGF-1 levels below age- and gender-adjusted upper normal limit (ULN) were achieved in 71.2% at month (M) 12 and 74.4% at M24; GH ≤2.5 µg/L in 83.3% at M12 and 80.0% at M24; GH <1.0 µg/L in 61.7% at M12 and 61.4% at M24. Both IGF-1 < ULN and GH ≤2.5 µg/L were achieved in 65.0% at M12 and 54.8% at M24; both IGF-1 < ULN and GH < 1.0 µg/L were achieved in 51.7 and 42.9% at M12 and M24, respectively. EDI regimen was 5.0% at baseline and 12.0% at M24. At M24, acromegaly symptoms appeared stable or improved. The most common AE was arthralgia (25.7%). Among 106 serious AEs reported by 42 patients, 10 were deemed related to therapy in 9 patients. At M24, 73.1% of patients rated LAN as convenient. SODA indicates 2-year biochemical control with majority of patients achieving both IGF-1 < ULN and GH ≤2.5 µg/L. LAN was generally well tolerated with no new or unexpected safety signals reported during the observation period. clinicaltrials.gov Clinical Trial Identifier: NCT00686348.

  15. Investigation of inhalation anthrax case, United States.

    Science.gov (United States)

    Griffith, Jayne; Blaney, David; Shadomy, Sean; Lehman, Mark; Pesik, Nicki; Tostenson, Samantha; Delaney, Lisa; Tiller, Rebekah; DeVries, Aaron; Gomez, Thomas; Sullivan, Maureen; Blackmore, Carina; Stanek, Danielle; Lynfield, Ruth

    2014-02-01

    Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.

  16. 31 CFR 560.314 - United States person.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 560.314 Section... § 560.314 United States person. The term United States person means any United States citizen, permanent resident alien, entity organized under the laws of the United States (including foreign branches), or...

  17. Red cell storage age policy for patients with sickle cell disease: A survey of transfusion service directors in the United States.

    Science.gov (United States)

    Karafin, Matthew S; Singavi, Arun K; Irani, Mehraboon S; Puca, Kathleen E; Baumann Kreuziger, Lisa; Simpson, Pippa; Field, Joshua J

    2016-02-01

    In patients with sickle cell disease (SCD), the effects of the red cell storage lesion are not well defined. The objective of this study was to determine the prevalence of transfusion services that limit red cell units by storage age for patients with SCD. We developed a 22 question survey of transfusion service director opinions and their corresponding blood bank policies. Target subjects were systematically identified on the AABB website. Responses were recorded in SurveyMonkey and summarized using standard statistical techniques. Ninety transfusion service directors responded to the survey. Response rate was 22%. Only 23% of respondents had storage age policies in place for patients with SCD, even though 36% of respondents consider older units to be potentially harmful in this patient population. Of those with a policy, a less-than 15 day storage age requirement was most often used (75%), but practices varied, and most respondents (65%) agreed that evidence-based guidelines regarding storage age are needed for patients with SCD. Policies, practices and opinions about the risks of older units for patients with SCD vary. As patients with SCD may have unique susceptibilities to features of the red cell storage lesion, prospective studies in this population are needed to determine best practice.

  18. The Knowledge-about-Older-Patients - Quiz (KOP-Q) for nurses: Cross-cultural validation between the Netherlands and United States of America.

    Science.gov (United States)

    Dikken, Jeroen; Hoogerduijn, Jita G; Klaassen, Sharon; Lagerwey, Mary D; Shortridge-Baggett, Lillie; Schuurmans, Marieke J

    2017-08-01

    The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed and validated in the Netherlands. Whether the KOP-Q can be used in other countries is unknown given the cultural and language differences. Investigate the level of measurement invariance of the KOP-Q between the Netherlands and United States of America (USA). A multicenter international cross-sectional design. Four general hospitals in the Netherlands and four general hospitals in the USA. Nurses from the Netherlands (n=201) and the USA (n=130) were invited to participate by email from the ward manager, distributing flyers and present messages on the online hospital communication boards. Questions of the KOP-Q were completed online. The level of measurement invariance (configural, metric or scalar invariance) across countries was tested by running increasingly constrained structural equation models, and testing whether these models fitted the data. Both the knowledge and certainty construct of the KOP-Q proved unidimensional in the Netherlands and USA sample. Test results of the measurement invariance across the Netherlands and USA indicated a stable, partial scalar invariance (15 items full scalar invariance) for the knowledge items and full scalar invariance for the certainty items. The KOP-Q shows to function uniformly across both language groups and can therefore be used to assess nurses' knowledge and their certainty about this knowledge which can be important for educational and/or quality improvement programs in the USA. Furthermore, the KOP-Q is suitable to make comparisons between the Netherlands and the USA using latent variable models. Before the KOP-Q can be used in other countries, cross-cultural tests should again be performed. Copyright © 2017 Elsevier Ltd. All

  19. High Rates of Psychiatric Comorbidity in Narcolepsy: Findings From the Burden of Narcolepsy Disease (BOND) Study of 9,312 Patients in the United States.

    Science.gov (United States)

    Ruoff, Chad M; Reaven, Nancy L; Funk, Susan E; McGaughey, Karen J; Ohayon, Maurice M; Guilleminault, Christian; Black, Jed

    2017-02-01

    To evaluate psychiatric comorbidity patterns in patients with a narcolepsy diagnosis in the United States. Truven Health Analytics MarketScan Research Databases were accessed to identify individuals ≥ 18 years of age with ≥ 1 ICD-9 diagnosis code(s) for narcolepsy continuously insured between 2006 and 2010 and non-narcolepsy controls matched 5:1 (age, gender, region, payer). Extensive subanalyses were conducted to confirm the validity of narcolepsy definitions. Narcolepsy subjects and controls were compared for frequency of psychiatric comorbid conditions (based on ICD-9 codes/Clinical Classification Software [CCS] level 2 categories) and psychiatric medication use. The final population included 9,312 narcolepsy subjects and 46,559 controls (each group, mean age = 46.1 years; 59% female). All categories of mental illness were significantly more prevalent in patients with narcolepsy versus controls, with the highest excess prevalence noted for CCS 5.8 Mood disorders (37.9% vs 13.8%; odds ratio [OR] = 4.0; 95% CI, 3.8-4.2), CCS 5.8.2 Depressive disorders (35.8% vs 13.0%; OR = 3.9; 95% CI, 3.7-4.1), and CCS 5.2 Anxiety disorders (25.1% vs 11.9%; OR = 2.5; 95% CI, 2.4-2.7). Excess prevalence of anxiety and mood disorders (narcolepsy vs controls) was higher in younger age groups versus older age groups. Psychiatric medication usage was higher in the narcolepsy group versus controls in the following categories: selective serotonin reuptake inhibitors (36% vs 17%), anxiolytic benzodiazepines (34% vs 19%), hypnotics (29% vs 13%), serotonin-norepinephrine reuptake inhibitors (21% vs 6%), and tricyclic antidepressants (13% vs 4%) (all P values Narcolepsy is associated with significant comorbid psychiatric illness burden and higher psychiatric medication usage compared with the non-narcolepsy population.

  20. An Analysis of Oppression and Health Education for Underserved Populations in the United States: The Issues of Acculturation, Patient-Provider Communication, and Health Education

    Science.gov (United States)

    Weaver, Shannon; Gull, Bethany; Ashby, Jeanie; Kamimura, Akiko

    2017-01-01

    The oppression of underserved populations is pervasive throughout the history of the United States (U.S.), especially in health care. Brazilian educator Paulo Freire's controversial ideas about systems of power can be aptly applied to health care. This paper focuses specifically on arguably the most medically underserved group in the U.S.…

  1. Characteristics of patient portals developed in the context of health information exchanges: Early policy effects of incentives in the meaningful use program in the United States

    NARCIS (Netherlands)

    E.T. Otte-Trojel (Eva Terese); A.A. de Bont (Antoinette); J.J. van de Klundert (Joris); T.G. Rundall (Thomas)

    2014-01-01

    markdownabstract__Background:__ In 2014, the Centers for Medicare & Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage

  2. Seoul virus infection in a Wisconsin patient with recent travel to China, March 2009: first documented case in the Midwestern United States.

    Science.gov (United States)

    Nielsen, Carrie F; Sethi, Vishal; Petroll, Andrew E; Kazmierczak, James; Erickson, Bobbie R; Nichol, Stuart T; Rollin, Pierre E; Davis, Jeffrey P

    2010-12-01

    Diagnosis of Seoul virus-associated hemorrhagic fever with renal syndrome (HFRS) cases among United States residents is rare. We describe confirmation of a Seoul virus infection in a 36-year-old scientist who worked with laboratory rats in Milwaukee, Wisconsin, but most likely acquired the infection during a trip to Shenyang, China.

  3. Toll Facilities in the United States - Toll Facilities in the United States

    Data.gov (United States)

    Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

  4. Analysis of United States’ Broadband Policy

    Science.gov (United States)

    2007-03-01

    glass fiber. The light signals are then decoded at the end of the fiber by a special optic decoder /encoder. This allows for the light signal to be...CDMA technology while Cingular offers it through the HSDPA/ GSM technology. One quarter of the United States’ Internet users have a cell phone that...well Cingular 900 Kbps 100 Kbps $79.00 HSDPA/ GSM 1 yr contract Table 13. Unlimited Cellular Broadband Plans in the United States (From PCWorld.com

  5. Natural aggregates of the conterminous United States

    Science.gov (United States)

    Langer, William H.

    1988-01-01

    Crushed stone and sand and gravel are the two main sources of natural aggregates. These materials are commonly used construction materials and frequently can be interchanged with one another. They are widely used throughout the United States, with every State except two producing crushed stone. Together they amount to about half the mining volume in the United States. Approximately 96 percent of sand and gravel and 77 percent of the crushed stone produced in the United States are used in the construction industry. Natural aggregates are widely distributed throughout the United States in a variety of geologic environments. Sand and gravel deposits commonly are the results of the weathering of bedrock and subsequent transportation and deposition of the material by water or ice (glaciers). As such, they commonly occur as river or stream deposits or in glaciated areas as glaciofluvial and other deposits. Crushed stone aggregates are derived from a wide variety of parent bedrock materials. Limestone and other carbonates account for approximately three quarters of the rocks used for crushed stone, with granite and other igneous rocks making up the bulk of the remainder. Limestone deposits are widespread throughout the Central and Eastern United States and are scattered in the West. Granites are widely distributed in the Eastern and Western United States, with few exposures in the Midwest. Igneous rocks (excluding granites) are largely concentrated in the Western United States and in a few isolated localities in the East. Even though natural aggregates are widely distributed throughout the United States, they are not universally available for consumptive use. Some areas are devoid of sand and gravel, and potential sources of crushed stone may be covered with sufficient unconsolidated material to make surface mining impractical. In some areas many aggregates do not meet the physical property requirements for certain uses, or they may contain mineral constituents that react

  6. Trends in outpatient breast cancer surgery among Medicare feefor-service patients in the United States from 1993 to 2002%Trends in outpatient breast cancer surgery among Medicare fee-for-service patients in the United States from 1993 to 2002

    Institute of Scientific and Technical Information of China (English)

    John Bian; Michael T. Halpern

    2011-01-01

    The practice of outpatient breast cancer surgery has been controversial in the United States. This study aimed to update time trends and geographic variation in outpatient breast cancer surgery among elderiy Medicare fee-for-service women in the United States. Using the 1993-2002 linked Surveillance, Epidemiology and End Results (SEER)-Medicare claims data and the Area Resource Files, we identified 2 study samples, including the women whose breast cancers were the first-ever-diagnosed cancer at age 65 years or older from 9 regions continuously covered by the SEER registries since 1993. The first sample included the women receiving unilateral mastectomy for stage 0-IV cancer; the second included the women receiving the breast-conserving surgery with lymph node dissection (BCS/LND) for stage 0-11 cancer. The proportions of patients receiving outpatient surgery increased from 3.2% to 19.4% for mastectomy and from 48.9% to 77.8% for BCS/LND from 1993 to 2002. We observed substantial geographic variation in the average proportion of the patients receiving outpatient surgery in the studied areas across the 10-year period, ranging from 3.9% in Connecticut to 27.2% in Utah for mastectomy and from 54.7% in Hawaii to 78.1% in Seattle, Washington, for BCS/LND. As the popularity of outpatient breast cancer surgery continues to grow, more evidence-based analyses related to quality and outcomes of outpatient breast cancer surgery among various populations are needed in order to facilitate the public debates about state and federal mandated health benefit legislations.

  7. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.

    NARCIS (Netherlands)

    Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.

    2012-01-01

    OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in

  8. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.

    NARCIS (Netherlands)

    Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.

    2012-01-01

    OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in gen

  9. Understanding human trafficking in the United States.

    Science.gov (United States)

    Logan, T K; Walker, Robert; Hunt, Gretchen

    2009-01-01

    The topic of modern-day slavery or human trafficking has received increased media and national attention. However, to date there has been limited research on the nature and scope of human trafficking in the United States. This article describes and synthesizes nine reports that assess the U.S. service organizations' legal representative knowledge of, and experience with, human trafficking cases, as well as information from actual cases and media reports. This article has five main goals: (a) to define what human trafficking is, and is not; (b) to describe factors identified as contributing to vulnerability to being trafficked and keeping a person entrapped in the situation; (c) to examine how the crime of human trafficking differs from other kinds of crimes in the United States; (d) to explore how human trafficking victims are identified; and, (e) to provide recommendations to better address human trafficking in the United States.

  10. Pakistan: Can the United States Secure an Insecure State?

    Science.gov (United States)

    2010-01-01

    Ethnocentrism is a problem. Pakistan lost Bangladesh in its 1971 civil war in part because West Pakistanis viewed Bengalis, who are the dominant ethnic...137. 64 Pakistan: Can the United States Secure an Insecure State? in the last few years of rapid growth, consumer price inflation surged to 25

  11. Employers mexican migrants in the United States

    Directory of Open Access Journals (Sweden)

    Eduardo Fernández Guzmán

    2013-09-01

    Full Text Available You might think that by definition the migrant labor plays in less profitable niches and meager social mobility. However, a large group of migrants in different economically developed countries have successfully launched businesses of diverse nature and volume. This is why entrepreneurship of migrants is an issue that has received increasing attention in recent years. Compared to other immigrant groups in the United States, Mexicans show low levels of entrepreneurial activity. The aim of this paper is to, through a general literature review of official statistical data, a preliminary analysis of mexican migrant entrepreneurship in the United States, that is to say in recent years has been growing in importance.

  12. Patient and trauma center characteristics associated with helicopter emergency medical services transport for patients with minor injuries in the United States.

    Science.gov (United States)

    Cheung, Brian H; Delgado, M Kit; Staudenmayer, Kristan L

    2014-11-01

    Helicopter emergency medical services (EMS) transport is expensive, and previous work has shown that cost-effective use of this resource is dependent on the proportion of minor injuries flown. To understand how overtriage to helicopter EMS versus ground EMS can be reduced, it is important to understand factors associated with helicopter transport of patients with minor injuries. The aim was to characterize patient and hospital characteristics associated with helicopter transport of patients with minor injuries. This was a retrospective analysis of adults ≥18 years who were transported by helicopter to Level I/II trauma centers from 2009 through 2010 as identified in the National Trauma Data Bank. Minor injuries were defined as all injuries scored at an Abbreviated Injury Scale (AIS) score of trauma (OR = 2.52, 95% CI = 2.12 to 3.00). Being flown with minor injuries was more likely if the patient was transported to a trauma center that also received a high proportion of patients with minor injuries by ground EMS (OR = 1.89, 95% CI = 1.58 to 2.26) or a high proportion of EMS traffic by helicopter (OR = 1.35, 95% CI = 1.02 to 1.78). No significant association with urban-rural scene location or EMS transport time was found. Better recognizing which patients with falls and penetrating trauma have serious injuries that could benefit from being flown may lead to the more cost-effective use of helicopter EMS. More research is needed to determine why patients without insurance, who are most at risk for high out-of-pocket expenses from helicopter EMS, are at higher risk for being flown when only having minor injuries. This suggests that interventions to optimize cost-effectiveness of helicopter transport will likely require an evaluation of helicopter triage guidelines in the context of regional and patient needs. © 2014 by the Society for Academic Emergency Medicine.

  13. United States Military Presence in Central Asia: Implications of United States Basing for Central Asian Stability

    Science.gov (United States)

    2006-06-01

    Europe and reducing the number of military personnel by 40,000 to 60,000. According to United States Air Force General Charles Wald , there are...The Deputy Secretary of Defense Paul Wolfowitz is quoted as saying United States presence “…may be more political than actually military” and that

  14. Estimated Water Flows in 2005: United States

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C A; Belles, R D; Simon, A J

    2011-03-16

    Flow charts depicting water use in the United States have been constructed from publicly available data and estimates of water use patterns. Approximately 410,500 million gallons per day of water are managed throughout the United States for use in farming, power production, residential, commercial, and industrial applications. Water is obtained from four major resource classes: fresh surface-water, saline (ocean) surface-water, fresh groundwater and saline (brackish) groundwater. Water that is not consumed or evaporated during its use is returned to surface bodies of water. The flow patterns are represented in a compact 'visual atlas' of 52 state-level (all 50 states in addition to Puerto Rico and the Virgin Islands) and one national water flow chart representing a comprehensive systems view of national water resources, use, and disposition.

  15. How High-Need Patients Experience Health Care in the United States. Findings from the 2016 Commonwealth Fund Survey of High-Need Patients.

    Science.gov (United States)

    Ryan, Jamie; Abrams, Melinda K; Doty, Michelle M; Shah, Tanya; Schneider, Eric C

    2016-12-01

    Issue: Health care costs are highly concentrated among people with multiple chronic conditions, behavioral health problems, and those with physical limitations or disabilities. With a better understanding of these patients’ challenges, health care systems and providers can address patients’ complex social, behavioral, and medical needs more effectively and efficiently. Goal: To investigate how the challenges faced by this population affect their experiences with the health care system and examine potential opportunities for improvement. Methods: Analysis of the 2016 Commonwealth Fund Survey of High-Need Patients, June–September 2016. Key findings and conclusions: The health care system is currently failing to meet the complex needs of these patients. High-need patients have greater unmet behavioral health and social issues than do other adults and require greater support to help manage their complex medical and nonmedical requirements. Results indicate that with better access to care and good patient–provider communication, high-need patients are less likely to delay essential care and less likely to go to the emergency department for nonurgent care, and thus less likely to accrue avoidable costs. For health systems to improve outcomes and lower costs, they must assess patients’ comprehensive needs, increase access to care, and improve how they communicate with patients.

  16. Eurabia: Strategic Implications for the United States

    Science.gov (United States)

    2010-03-01

    states of North Africa and the Middle East.5 Eurabia was the name of a journal published in the mid-1970s by the European Committee for...have her extradited to Switzerland so she could be prosecuted under Swiss anti- racism statute, Islamic groups successfully prevailed to have her...options. The United States can forge new relationships with emerging powers such as Brazil, Russia, India and China, the so called BRIC countries

  17. Following Zhang Wenjin to the United States

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    In 1937,Zhang Ying studied at the Lu Xun Art Institute in Yan’an.After graduation she began working in the art world under Zhou Enlai’s direction.In 1983, she followed her husband Zhang Wenjin to the United States as wife of the ambassador.During her two-year stay in the U.S., she came into close contact with many American women while working to promote mutual understanding and friendship between the people of the two countries.After her retirement in 1991,she sponsored the production of a 10-episode documentary TV program,"Zhou Enlai and the Arts."She also wrote a book about her experience in the United States,Called,Following Zhang Wenjin to the United States—Notes of an Ambassador’s Wife.The following are extracts from the book.

  18. Managing nuclear weapons in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.

    1993-03-16

    This report discusses the management and security of nuclear weapons in the post-cold war United States. The definition of what constitutes security is clearly changing in the US. It is now a much more integrated view that includes defense and the economy. The author tries to bring some semblance of order to these themes in this brief adaptation of a presentation.

  19. Veterinary Fusarioses within the United States

    Science.gov (United States)

    Multilocus DNA sequence data was used to retrospectively assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically dist...

  20. CTS United States experiments. A progress report

    Science.gov (United States)

    Robbins, W. H.; Donoughe, P. L.

    1976-01-01

    The results are presented of the United States experiments activity to date. Wide segments of the population are involved in the Experiments Program including the scientific community, other government agencies, industry, and the education and health entities. The experiments are associated with both technological objectives and the demonstration of new community and social services via satellite.

  1. Color Vision Deficiencies in Children. United States.

    Science.gov (United States)

    National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.

    Presented are prevalence data on color vision deficiencies (color blindness) in noninstitutionalized children, aged 6-11, in the United States, as estimated from the Health Examination Survey findings on a representative sample of over 7,400 children. Described are the two color vision tests used in the survey, the Ishihara Test for Color…

  2. Characterizing Hospice Services in the United States

    Science.gov (United States)

    Smith, Maureen A.; Seplaki, Christopher; Biagtan, Mark; DuPreez, Amanda; Cleary, James

    2008-01-01

    Purpose: Although caregivers desire specific information about hospice programs, there is little descriptive information available. We characterized agencies that provide formal or informal hospice care in the United States according to four types of services considered important by caregivers: medications and treatments; rehabilitative care;…

  3. United States Air Force Annual Financial Statements

    Science.gov (United States)

    2002-01-01

    gains and losses NRV = Net Realizable Value O = Other Inventory, Gross Value Revaluation Allowance Inventory, Net 2002 2001 United States Air Force...losses NRV = Net Realizable Value O = Other For the most part, DMAG is using the consumption method of accounting for OM&S, since OM&S is defined in the

  4. Ports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows major ports in the United States, Puerto Rico, and the U.S. Virgin Islands. A port is a city, town, or urban area with a harbor where ships load...

  5. Surveillance for Viral Hepatitis - United States, 2014

    Science.gov (United States)

    ... and Programs Resource Center Viral Hepatitis Surveillance for Viral Hepatitis – United States, 2014 Recommend on Facebook Tweet Share ... Cases Hepatitis A Hepatitis B Hepatitis C Discussion Hepatitis A virus Index PAGE DESCRIPTION Table 2.1 Reported ...

  6. Major land uses in the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a polygon coverage of major land uses in the United States. The source of the coverage is the map of major land uses in the National Atlas, pages 158-159,...

  7. EC 92 and the United States

    Science.gov (United States)

    1992-04-15

    34 Rheinischer Merkur (Bonn), January 17, 1992, 5. 17. Robert J. Samuelson, "Europe’s Boom Has Come and Cone," Washington Post, February 12, 1992, A23...34 Rheinischer Merkur (Bonn), January 17, 1992, 5. Riemer, Blanca. "’United States of Europe’? Don’t Hold Your Breath." Business Week, June 17, 1991, 50

  8. Airports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes airports in the United States, Puerto Rico and the U.S. Virgin Islands. The data were derived from an extract of the Public-Use Airports...

  9. AIDS Pandemic in the United States

    Science.gov (United States)

    Erickson, Amy H.; Melendez, Barbra S.; Ball, Daniel L.; Morse, Steven T.; Phillips, Geoffrey P.

    2010-01-01

    This project is one of four that were issued to first semester sophomore undergraduates at the United States Military Academy as part of an integrated learning experience at the end of their Calculus II course work. This project was used during a short, seven lesson block of instruction that was intended to capitalize on their recent academic…

  10. Orienteering: Growth Patterns in the United States.

    Science.gov (United States)

    Jeffery, Charles F.

    The history of orienteering in the United States includes both military and civilian interest, with the period of greatest growth between 1970 and 1980. To investigate growth patterns in orienteering, questionnaires were mailed to 42 civilian orienteering clubs and 286 universities supporting senior Reserve Office Training Corps (ROTC)…

  11. 31 CFR 539.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 539.312 Section 539.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY WEAPONS OF MASS DESTRUCTION TRADE CONTROL...

  12. Malignant Hyperthermia Association of the United States

    Science.gov (United States)

    ... Videos Blog Get Involved Shop Ask a question right here... MHAUS On Facebook Now view more On Twitter Now view more Tweets by @ ... Malignant Hyperthermia Association of the United States. All rights reserved. ... advertiser and not necessarily the views or opinions of MHAUS, its staff or its ...

  13. The United States and VIetnam: 1787 - 1941

    Science.gov (United States)

    1990-01-01

    almost totally unproductive ceremony and haggling with the Cochinchinese authorities. During his stay there, White developed an appreciation of the...British and French involvement with the warring sides in the United States and with French adventures in Mexico , not with events in far-off

  14. Social science findings in the United States

    Science.gov (United States)

    Sarah McCaffrey; Eric Toman; Melanie Stidham; Bruce. Shindler

    2015-01-01

    The rising number of acres burned annually and growing number of people living in or adjacent to fire-prone areas in the United States make wildfire management an increasingly complex and challenging problem. Given the prominence of social issues in shaping the current challenges and determining paths forward, it will be important to have an accurate understanding of...

  15. United States: Exploring the Marriage Debate

    Science.gov (United States)

    Carter, Julie H.

    2004-01-01

    As citizens of the United States respond to legislative and judicial actions that have challenged the prohibition against same-sex couples receiving marriage licenses, schools have a timely opportunity to engage students on this most important debate. Educators can help their students understand the full significance of this issue by encouraging…

  16. Geology of the Coterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — A digital version of the Geologic Map of the United States, originally published at a scale of 1:2,500,000 (King and Beikman, 1974b). It excludes Alaska and Hawaii.

  17. Immigration, parasitic infection, and United States religiosity.

    Science.gov (United States)

    Wall, Jaimie N; Shackelford, Todd K

    2012-04-01

    Fincher & Thornhill (F&T) present a powerful case for the relationship between parasite-stress and religiosity. We argue, however, that the United States may be more religious than can be accounted for by parasite-stress. This greater religiosity might be attributable to greater sensitivity to immigration, which may hyperactivate evolved mechanisms that motivate avoidance of potential carriers of novel parasites.

  18. Women's Music in the United States.

    Science.gov (United States)

    Lont, Cynthia M.

    The purpose of this presentation was to: (1) describe the history of women's music in the United States; (2) define women's music; (3) report on the status of the large women's recording companies; and (4) focus on a recent controversy in the women's music industry involving the desire for political purity versus the need for economic security.…

  19. Nursing continuing education in the united states

    OpenAIRE

    Robert, B.

    1981-01-01

    THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability

  20. Nursing continuing education in the united states

    Directory of Open Access Journals (Sweden)

    B Robert

    1981-09-01

    Full Text Available THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability

  1. Dengue Fever in the United States

    Centers for Disease Control (CDC) Podcasts

    2012-04-09

    Dr. Amesh Adalja, an associate at the Center for Biosecurity and clinical assistant professor at the University of Pittsburgh School, of Medicine, discusses dengue fever outbreaks in the United States.  Created: 4/9/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/16/2012.

  2. Fragmentation of eastern United States forest types

    Science.gov (United States)

    Kurt H. Riitters; John W. Coulston

    2013-01-01

    Fragmentation is a continuing threat to the sustainability of forests in the Eastern United States, where land use changes supporting a growing human population are the primary driver of forest fragmentation (Stein and others 2009). While once mostly forested, approximately 40 percent of the original forest area has been converted to other land uses, and most of the...

  3. CPAFFC Working Group Visits the United States

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    <正>From April 13 to 21, a CPAFFC working group led by Yao Mingyu, director general of the Department of American and Oceanian Affairs of the CPAFFC, visited the United States, attended the 18th Forum on US-China Relations sponsored by the US-China Peoples Friendship Association (USCPFA) and had talks with the USCPFA, the Richard Nixon Library & Birthplace Foundation, the Richard Nixon Centre, the Sister Cities International of the U.S., the National Conference of State Legislatures, the Council of State

  4. Antiabortion violence in the United States.

    Science.gov (United States)

    Russo, Jennefer A; Schumacher, Kristin L; Creinin, Mitchell D

    2012-11-01

    This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning. We used responses from a July 2010 survey of 357 abortion providers in 50 states to determine their experience of antiabortion harassment and violence. Their responses were grouped and analyzed in relation to a published grading of state laws in the United States (A, B, C, D and F) as they relate to restrictions on family planning services. Group by group comparison of respondents illustrates that the difference in the number of reported incidents of minor vandalism by group is statistically significant (A vs. C, p=.07; A vs. D, p=.017; A vs. F, p=.0002). Incidents of harassment follow a similar pattern. There were no differences noted overall for violence or major vandalism. Major violence, including eight murders, is a new occurrence in the last two decades. Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. 45 CFR 212.7 - Repayment to the United States.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Repayment to the United States. 212.7 Section 212... UNITED STATES CITIZENS RETURNED FROM FOREIGN COUNTRIES § 212.7 Repayment to the United States. (a) An..., any or all of the cost of such assistance to the United States, except insofar as it is...

  6. 31 CFR 592.305 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... General Definitions § 592.305 Importation into the United States. The term importation into the United States means the bringing of goods into the United States....

  7. 20 CFR 416.215 - You leave the United States.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for...

  8. 78 FR 32356 - United States-Korea Free Trade Agreement

    Science.gov (United States)

    2013-05-30

    ... 178 RIN 1515-AD86 United States-Korea Free Trade Agreement AGENCIES: U.S. Customs and Border... United States-Korea Free Trade Agreement entered into by the United States and the Republic of Korea... ``Korea'') signed the United States-Korea Free Trade Agreement (hereinafter ``UKFTA'' or the ``Agreement...

  9. 7 CFR 1212.32 - United States Customs Service.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States Customs Service. 1212.32 Section 1212... § 1212.32 United States Customs Service. “United States Customs Service” or “Customs” means the United States Customs and Border Protection, an agency of the Department of Homeland Security. Honey Packers...

  10. 32 CFR 575.6 - Catalogue, United States Military Academy.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Catalogue, United States Military Academy. 575.6... ADMISSION TO THE UNITED STATES MILITARY ACADEMY § 575.6 Catalogue, United States Military Academy. The latest edition of the catalogue, United States Military Academy, contains additional information...

  11. 75 FR 13345 - Pricing for Certain United States Mint Products

    Science.gov (United States)

    2010-03-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY United States Mint Pricing for Certain United States Mint Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of...

  12. 77 FR 27612 - Modifications to Definition of United States Property

    Science.gov (United States)

    2012-05-11

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK11 Modifications to Definition of United States Property... or clearing agency do not constitute United States property. These regulations affect United States...)) that invests certain earnings and profits in United States property (U.S. property) ``on the...

  13. Residual Effects of Sleep Medications Are Commonly Reported and Associated with Impaired Patient-Reported Outcomes among Insomnia Patients in the United States

    Directory of Open Access Journals (Sweden)

    Timothy Fitzgerald

    2015-01-01

    Full Text Available Study Objective. To measure the association of symptoms attributed to residual effects of sleep medication (e.g., drowsiness, difficulty concentrating, and impaired memory on self-reported functioning and satisfaction with these medications. Methods. Individuals using prescription medications for insomnia were invited to complete an Internet-based survey. Respondents were compared according to the presence of self-reported residual effects; relationships between severity of these effects and outcomes were modeled using regression. Measures included the Brief Insomnia Questionnaire, Work Productivity and Activity Impairment Questionnaire, and SATMED-Q. Subgroup analyses were conducted with patients aged ≥65 years. Approximately 80% reported experiencing ≥1 residual effect. The severity of residual effects was associated with increased residual effect-related work impairment, including absenteeism (RR = 1.46, p<0.001, presenteeism (RR = 1.12, p<0.001, overall work impairment (RR = 1.13, p<0.001, and nonwork activity impairment (RR = 1.11, p<0.001. More severe residual symptoms were also associated with increased difficulty in home management (Beta = .31, p<0.001, ability to work (Beta = .31, p<0.001, social relationships, (Beta = .32, p<0.001, close personal relationships (Beta = .30, p<0.001, and lower medication satisfaction (Beta = -.37, p<0.001. Conclusions. Individuals using medications for insomnia commonly experience symptoms considered as residual effects, and these symptoms are associated with greater interference of sleep-related problems at work, at home, and with social relationships.

  14. The State of Homeless Children in the United States

    Science.gov (United States)

    Kabler, Brenda; Weinstein, Elana

    2009-01-01

    Across America, the numbers of homeless children and families are growing as a result of many factors including the recent economic crisis, home foreclosures, and natural disasters. Because of an increase in the number of homeless children throughout the United States, this population has unmet needs that can be targeted in school settings under…

  15. [Undocumented migrant labor in the United States].

    Science.gov (United States)

    Dinand, J

    1985-09-01

    The author identifies two factors contributing to the increase in the number of illegal migrant workers in the United States. The first is the complex system of legal immigration, which contributes to massive evasion. The second is the preference by many employers for hiring illegal aliens. The author concludes that the proposed changes in U.S. immigration laws, even though they include employer sanctions, are likely to prove as ineffective as previous measures adopted in several states some 10 years ago that also penalized employers hiring illegal aliens. It is suggested that the economic pressures leading to large-scale labor immigration will prove stronger than political pressures to control such immigration

  16. Inclusive Education in the United States

    OpenAIRE

    C. Kenneth Tanner; Deborah Jan Vaughn Linscott; Susan Allan Galis

    1996-01-01

    School reform issues addressing inclusive education were investigated in this nationwide (United States) study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive ed...

  17. Summary of Notifiable Diseases, United States, 1993.

    Science.gov (United States)

    2007-11-02

    incidence of drug-resistant Streptococcus pneumoniae (DRSP) strains in the United States has created an emerging public health challenge. CDC...only 1,280 cases of Legionnaires’ disease were reported through NNDSS in 1993, data from recent prospective pneumonia studies suggest that between...surveillance data from 1992 indicated that the prevalence of pneumococcal strains that are highly resistant to penicillin increased 60-fold (from 0.02% to 1.3

  18. The United States Military and Humanitarian Operations

    Science.gov (United States)

    1995-01-01

    stated that, "The wave of the future will be putting together task forces that will be able to respond to crisis management or humanitarian...examine three options for the military’s role in humanitaria operations at home and abroad. Option 1: Virtually Eliminate Anv Military Role This is the...humanitarian aid in almost any crisis .36 The military resists the creation of specially designated units because such specialization reduces the

  19. Energy Security in the United States

    Science.gov (United States)

    2012-05-01

    increase the domestic price of those 41. Coal gasification is a process that converts solid coal—through several energy-intensive steps—into gasoline and...for switching to other fuels or reducing consumption of transportation fuels . In con- trast, electricity can be produced from several sources of...the prices of those fuels in the United States. Although the global nature of the market for oil makes U.S. consumers vulnerable to price

  20. West Coast, United States and Mexico

    Science.gov (United States)

    1990-01-01

    This view shows the west coast of the United States and Mexico (32.5N, 118.0W) and gives an indication of the range of view from orbital altitude. The visual range of this particular scene is from Skammon's Lagoon on Baja to the northern tip of California's Central Valley and Sierra Nevada, a range of over 15 degrees of latitude. Coastal fog drapes over southern California and northern Baja California. White Sands, New Mexico is at far right center.

  1. Continental United States Military Housing Inspections Southeast

    Science.gov (United States)

    2015-09-24

    standards. 3. Work with the privatized housing partner to ensure that fire protection inspection and maintenance plans are achieved. Deputy Assistant...Secretary stated that Hunt Military Communities and Patrick AFB civil engineers were working to correct all of the other fire protection system...create a plan for the performance of ongoing inspection and maintenance of all housing units to applicable electrical codes and standards. 3. Work

  2. United States of Europe, Dream or Possibility?

    Science.gov (United States)

    1966-04-08

    center between the United States and the Soviet Union. The method chosen to examine this trend is to review three major politico-military problems...de France, pp. 3-7. ൫ Supra-nationalism must go! De Gaulle’s heir presumptive, Georges Pompidou , has given voice to de Gaulle’s thoughts on... Pompidou said: Certainly we do not believe in integration as a method of approach to European unity, precisely because we believe that there can be no

  3. OECD environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' efforts to manage its environment including air, water, nature, and biodiversity; to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 47 figs., 20 tabs.

  4. Toxic plants of the Northeastern United States.

    Science.gov (United States)

    Bischoff, Karyn; Smith, Mary C

    2011-07-01

    This article lists commonly encountered toxic plants that affect ruminants in the Northeastern United States. Livestock are at risk for ingestion of a large variety of toxic plants. Plant poisonings are likely to be underdiagnosed because tests for most plant toxins are not routinely available at veterinary diagnostic laboratories. Prevention of access to poisonous plants is usually more effective and economical than treatment of plant poisonings. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. An Introduction to Medical Malpractice in the United States

    Science.gov (United States)

    2008-01-01

    Medical malpractice law in the United States is derived from English common law, and was developed by rulings in various state courts. Medical malpractice lawsuits are a relatively common occurrence in the United States. The legal system is designed to encourage extensive discovery and negotiations between adversarial parties with the goal of resolving the dispute without going to jury trial. The injured patient must show that the physician acted negligently in rendering care, and that such negligence resulted in injury. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Money damages, if awarded, typically take into account both actual economic loss and noneconomic loss, such as pain and suffering. PMID:19034593

  6. PERMITTING LEADERSHIP IN THE UNITED STATES

    Energy Technology Data Exchange (ETDEWEB)

    Ken Nemeth

    2002-09-01

    In accordance with the Southern States Energy Board (SSEB) proposal, as incorporated into NETL/DE-FC26-97FT34199, the objective of this agreement is to streamline the environmental technology permitting process site-to-site, state-to-state, and industry-to-industry to achieve remediation and waste processing faster, better and cheaper. SSEB is working with member Governors, legislators and regulators to build consensus on streamlining the permitting process for new and innovative technologies for addressing the legacy of environmental problems from 50 years of weapons research, development and production. This report reviews mechanisms whereby industry consortiums and the Department of Energy (DOE) have been working with State regulators and other officials in technology deployment decisions within the DOE complex. The historic development of relationships with State regulators is reviewed and the current nature of the relationships examined. The report contains observations from internal DOE reviews as well as recommendations from the General Accounting Office (GAO) and other external organizations. The report discusses reorganization initiatives leading up to a DOE Top-to-Bottom review of the Environmental Management (EM) Program and highlights points of consideration for maintaining effective linkages with State regulators. It notes how the proposed changes will place new demands upon the National Energy Technology Laboratory (NETL) and how NETL can leverage its resources by refocusing existing EM efforts specifically to states that have DOE facilities within their borders (host-states). Finally, the report discusses how SSEB's Permitting Leadership in the United States (PLUS) program can provide the foundation for elements of NETL's technical assistance program that are delivered to regulators and other decision- makers in host-states. As a regional compact commission, SSEB provides important direct linkages to regulators and stakeholders who need

  7. Taxation of United States general aviation

    Science.gov (United States)

    Sobieralski, Joseph Bernard

    General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and

  8. The state of amphibians in the United States

    Science.gov (United States)

    Muths, E.; Adams, M.J.; Grant, E.H.C.; Miller, D.; Corn, P.S.; Ball, L.C.

    2012-01-01

    More than 25 years ago, scientists began to identify unexplained declines in amphibian populations around the world. Much has been learned since then, but amphibian declines have not abated and the interactions among the various threats to amphibians are not clear. Amphibian decline is a problem of local, national, and international scope that can affect ecosystem function, biodiversity, and commerce. This fact sheet provides a snapshot of the state of the amphibians and introduces examples to illustrate the range of issues in the United States.

  9. 22 CFR 22.3 - Remittances in the United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Remittances in the United States. 22.3 Section...-DEPARTMENT OF STATE AND FOREIGN SERVICE § 22.3 Remittances in the United States. (a) Type of remittance. Remittances shall be in the form of: (1) Check or bank draft drawn on a bank in the United States; (2)...

  10. Maximum floodflows in the conterminous United States

    Science.gov (United States)

    Crippen, John R.; Bue, Conrad D.

    1977-01-01

    Peak floodflows from thousands of observation sites within the conterminous United States were studied to provide a guide for estimating potential maximum floodflows. Data were selected from 883 sites with drainage areas of less than 10,000 square miles (25,900 square kilometers) and were grouped into regional sets. Outstanding floods for each region were plotted on graphs, and envelope curves were computed that offer reasonable limits for estimates of maximum floods. The curves indicate that floods may occur that are two to three times greater than those known for most streams.

  11. United States/Canada electricity exchanges

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

    The United States and Canada have been cooperating in all areas of energy exchange for many years. Electrical energy has been chosen to be the focus of this study because substantial means for exchanges offer benefits that have not yet been fully exploited. There may be some bilateral benefits from additional interconnections because of the buffers which they represent against domestic imbalances. After the history of the electricity exchanges between the two countries is reviewed, opportunities and incentives and obstacles and constraints are discussed in the next two chapters. The final chapter examines procedures to resolve obstacles and minimize constraints. (MCW)

  12. Coordinating the United States Interagency Partnering Effort

    Science.gov (United States)

    2013-03-01

    stage over the last 6 years.7 The DoD is on the cutting edge of partnering and there have been valuable lessons learned at the tactical and...global stage . “3D are the three pillars that provide the foundation for promoting and protecting U.S. national security interests abroad.”33 DoD, DoS...operations now will mean throwing 18 away hard-fought gains, and expose the United States to new risks from across the globalising

  13. Contraceptive failure in the United States.

    Science.gov (United States)

    Trussell, James

    2011-05-01

    This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.

  14. Mobile satellite service in the United States

    Science.gov (United States)

    Agnew, Carson E.; Bhagat, Jai; Hopper, Edwin A.; Kiesling, John D.; Exner, Michael L.; Melillo, Lawrence; Noreen, Gary K.; Parrott, Billy J.

    1988-05-01

    Mobile satellite service (MSS) has been under development in the United States for more than two decades. The service will soon be provided on a commercial basis by a consortium of eight U.S. companies called the American Mobile Satellite Consortium (AMSC). AMSC will build a three-satellite MSS system that will offer superior performance, reliability and cost effectiveness for organizations requiring mobile communications across the U.S. The development and operation of MSS in North America is being coordinated with Telesat Canada and Mexico. AMSC expects NASA to provide launch services in exchange for capacity on the first AMSC satellite for MSAT-X activities and for government demonstrations.

  15. Wind Lidar Activities in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, Andrew; Newman, Jennifer; St. Pe, Alexandra; Iungo, G. Valerio; Wharton, Sonia; Herges, Tommy; Filippelli, Matthew; Pontbriand, Philippe; Osler, Evan

    2017-06-28

    IEA Wind Task 32 seeks to identify and mitigate the barriers to the adoption of lidar for wind energy applications. This work is partly achieved by sharing experience across researchers and practitioners in the United States and worldwide. This presentation is a short summary of some wind lidar-related activities taking place in the country, and was presented by Andrew Clifton at the Task 32 meeting in December 2016 in his role as the U.S. Department of Energy-nominated country representative to the task.

  16. Geothermal power generation in United States

    Science.gov (United States)

    Braun, Gerald W.; McCluer, H. K.

    1993-03-01

    Geothermal energy is an indigenous environmentally benign heat source with the potential for 5000-10,000 GWe of power generation in the United States. Approximately 2535 MWe of installed capacity is currently operating in the U.S. with contracted power costs down to 4.6 cents/kWh. This paper summarizes: 1) types of geothermal resources; 2) power conversion systems used for geothermal power generation; 3) environmental aspects; 4) geothermal resource locations, potential, and current power plant development; 5) hurdles, bottlenecks, and risks of geothermal power production; 6) lessons learned; and 7) ongoing and future geothermal research programs.

  17. Dialysis for undocumented immigrants in the United States.

    Science.gov (United States)

    Rodriguez, Rudolph A

    2015-01-01

    The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis. Emergent dialysis, offering dialysis only when urgent indications exist, is the treatment strategy in certain states. Differing interpretations of Emergency Medicaid statute by the courts and state and federal government have resulted in the geographic disparity in treatment strategies for undocumented immigrants with ESRD. The Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries. The difficult patient and provider decisions are explored in this review. The Renal Physicians Association Position Statement on uncompensated renal-related care for noncitizens is an excellent starting point for a framework to address this ethical dilemma. The practice of "emergent dialysis" will hopefully be found unacceptable in the future because of the fact that it is not cost effective, ethical, or humane. Published by Elsevier Inc.

  18. Clinical pathway for thoracic surgery in the United States

    OpenAIRE

    Wei, Benjamin; Cerfolio, Robert J.

    2016-01-01

    The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations.

  19. Clinical pathway for thoracic surgery in the United States

    Science.gov (United States)

    Wei, Benjamin

    2016-01-01

    The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations. PMID:26941967

  20. Hospital librarianship in the United States: at the crossroads.

    Science.gov (United States)

    Wolf, Diane G; Chastain-Warheit, Christine C; Easterby-Gannett, Sharon; Chayes, Marion C; Long, Bradley A

    2002-01-01

    This paper examines recent developments in hospital librarianship in the United States, including the current status of hospital-based clinical library services. Several examples of hospital library services are presented that demonstrate some characteristics of struggling and thriving services. The implications of the informationist concept are considered. The continuation of the hospital librarian's primary role in support of patient care is explored, as core competencies are reexamined for relevancy in the new millennium.

  1. An Update on Cardiac Transplantation in the United States.

    Science.gov (United States)

    Everly, Matthew J

    2014-01-01

    Heart transplantation in the United States remains an important option for those with heart failure. Survival rates over the last 25 years have improved with the advent of newer immunosuppressive agents, innovation, and a better understanding of managing risk. However, many patients continue to experience allograft failure after transplantation. Innovations in modalities to reduce acute and chronic rejection are needed to improve the long-term success of heart transplantation.

  2. State of stress in the conterminous United States

    Science.gov (United States)

    Zoback, Mary Lou; Zoback, Mark

    1980-11-01

    Inferring principal stress directions from geologic data, focal mechanisms, and in situ stress measurements, we have prepared a map of principal horizontal stress orientations for the conterminous United States. Stress provinces with linear dimensions which range between 100 and 2000 km were defined on the basis of the directions and relative magnitude of principal stresses. Within a given province, stress orientations appear quite uniform (usually within the estimated range of accuracy of the different methods used to determine stress). Available data on the transition in stress direction between the different stress provinces indicate that these transitions can be abrupt, occurring over characterized by high levels of seismicity and generally high heat flow, the stress pattern is complex, but numerous stress provinces can be well delineated. Despite relative tectonic quiescence in the eastern and central United States, a major variation in principal stress orientation is apparent between the Atlantic Coast and midcontinent areas. Most of the eastern United States is marked by predominantly compressional tectonism (combined thrust and strike slip faulting), whereas much of the region west of the southern Great Plains is characterized by predominantly extensional tectonism (combined normal and strike slip faulting). Deformation along the San Andreas fault and in parts of the Sierra Nevada is nearly pure strike slip. Exceptions to this general pattern include areas of compressional tectonics in the western United States (the Pacific Northwest, the Colorado Plateau interior, and the Big Bend segment of the San Andreas fault) and the normal growth faulting along the Gulf Coastal Plain. Sources of stress are constrained not only by the orientation and relative magnitude of the stresses within a given province but also by the manner of transition of the stress field from one province to another. Much of the modern pattern of stress in the western United States can be

  3. Regional and State Level Water Scarcity Report: Northeast United States

    Science.gov (United States)

    Nicoletti, C. K.; Lopez-Morales, C. A.; Hoover, J. H.; Voigt, B. G.; Vorosmarty, C. J.; Mohammed, I. N.

    2010-12-01

    There are an abundance of large-scale, coarse resolution global water scarcity studies, but the existing literature fails to address regional and state specific scarcity measures. Moreover, while environmental water requirements are an integral factor in the development and implementation of sustainable water management practices, only recently has this notion been introduced to water scarcity research. In this paper, we argue that developing a preliminary measure of water scarcity, at the regional and state levels, will allow for more informed policy development. The goal of this study is to generate a more comprehensive understanding of water scarcity in the Northeast, by gathering fine scale data, applying a consistent methodology to the calculation of a scarcity index, and analyzing the results to see relative trends in spatio-temporal water scarcity. Public supply, irrigation, rural, industrial and thermo-power withdrawals have been compiled from USGS state water use publications from 1950 to 1985. Using the WBMplus water model runoff data, state specific in-stream environmental water requirements were calculated using the accepted hydro-ecological methodology. Water scarcity was then calculated as a ratio of water withdrawals to total available water minus environmental flow requirements for the system. In so doing, this study generates a spatially explicit and temporally varying water scarcity indicator (WSI) for the Northeastern United States between 1950 and 2000 at the regional and state levels at a five-year time interval. Calculation of a spatial and temporal water scarcity indicator enabled us to identify regions and specific states that were: slightly exploited (WSI 1.0). The minimum environmental water requirements to maintain in-stream aquatic and riparian ecosystems for the Northeastern states ranged between 27.5 to 36.3 percent of the mean annual runoff within Vermont and Maryland, respectively. The regional WSI values ranged between 0.199 in 1950

  4. Western United States beyond the Four Corners

    Science.gov (United States)

    2002-01-01

    The breathtaking beauty of the western United States is apparent in this image from the Multi-angle Imaging SpectroRadiometer on NASA's Terra spacecraft. Data from 16 different swaths acquired between April 2000 and September 2001by MISR's vertical-viewing (nadir) camera were used to create this cloud-free natural-color image mosaic. The image is draped over a 100-meter (328-foot)shaded relief Digital Terrain Elevation Model from the United States Geological Survey.Among the prominent features are the snow-capped Rocky Mountains traversing Montana, Wyoming, Colorado and New Mexico. In the northern portion of the image, the Columbia Plateau stretches across Washington, Oregon and Idaho. Many major rivers originate in this region, including the Missouri to the east of the Continental Divide, the Snake to the west, and the Colorado which wends across Utah and Arizona. The Colorado Plateau and vibrant red-colored rocks of the Painted Desert extend south from Utah into Arizona. In the southwestern portion of the image, California's San Joaquin Valley and the Mojave Desert of California and Nevada give way to the Los Angeles basin and the Pacific Ocean.The Terra spacecraft is part of NASA's Earth Science Enterprise, a long-term research and technology program designed to examine Earth's land, oceans, atmosphere, ice and life as a total integrated system.

  5. Renewable energy atlas of the United States.

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J.A.; Hlava, K.Greenwood, H.; Carr, A. (Environmental Science Division)

    2012-05-01

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. It is designed for the U.S. Department of Agriculture Forest Service (USFS) and other federal land management agencies to evaluate existing and proposed renewable energy projects. Much of the content of the Atlas was compiled at Argonne National Laboratory (Argonne) to support recent and current energy-related Environmental Impact Statements and studies, including the following projects: (1) West-wide Energy Corridor Programmatic Environmental Impact Statement (PEIS) (BLM 2008); (2) Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2010); (3) Supplement to the Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2011); (4) Upper Great Plains Wind Energy PEIS (WAPA/USFWS 2012, in progress); and (5) Energy Transport Corridors: The Potential Role of Federal Lands in States Identified by the Energy Policy Act of 2005, Section 368(b) (in progress). This report explains how to add the Atlas to your computer and install the associated software; describes each of the components of the Atlas; lists the Geographic Information System (GIS) database content and sources; and provides a brief introduction to the major renewable energy technologies.

  6. United States 2030 Food Loss and Waste Reduction Goal

    Science.gov (United States)

    On September 16, 2015, the United States Department of Agriculture (USDA) and the United States Environmental Protection Agency (EPA) announced the first ever domestic goal to reduce food loss and waste by half by the year 2030.

  7. Average annual runoff in the United States, 1951-80

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a line coverage of average annual runoff in the conterminous United States, 1951-1980. Surface runoff Average runoff Surface waters United States

  8. 78 FR 61446 - Schedule of Charges Outside the United States

    Science.gov (United States)

    2013-10-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Schedule of Charges Outside the United States AGENCY: Federal Aviation... for services of FAA Flight Standards Aviation Safety Inspectors outside the United States....

  9. Coal Fields of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows the coal fields of Alaska and the conterminous United States. Most of the material for the conterminous United States was collected from James...

  10. Abortion Policy in Britain and the United States.

    Science.gov (United States)

    Francome, Colin

    1980-01-01

    Compares the number of legal abortions performed in the United States and Britain. Reveals that the rate of abortion in the United States is more than twice that of Britain. Analyzes the reasons for the different rates. (Author)

  11. Satellite View of the Conterminous United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Satellite View of the Conterminous United States map layer is a 200- meter-resolution simulated-natural-color image of the United States. Vegetation is generally...

  12. Comparison of Constitutional Spirit Between United States and China

    Institute of Scientific and Technical Information of China (English)

    杨琅琅

    2007-01-01

    This paper compares the differences in constitutional spirit between United States and China, and then brings out the influence of the constitutional spirit in United States to the constitutional spirit in China.

  13. Weather pattern climatology of the United States

    Energy Technology Data Exchange (ETDEWEB)

    Barchet, W.R.; Davis, W.E.

    1984-01-01

    In this study the geographic domain covered the 48 conterminous states of the United States. The daily synoptic weather pattern was classified into nine types for the 10-year period January 1, 1969 to December 31, 1978. Weather pattern types were defined relative to the classical polar front model of a mid-latitude cyclonic storm system and its associated air masses. Guidelines for classifying weather patterns on an operational basis were developed. These were applied to 3652 daily surface weather maps to produce a time series of weather pattern type at 120 grid points of a 160 point, 3/sup 0/ latitude by 4/sup 0/ longitude array over the United States. Statistics on the frequency of occurrence, persistence and alternation of weather patterns were calculated for each grid point. Summary statistics for the entire grid and for six regions were also presented. Frequency of occurrence and persistence were found to depend on the size and speed of movement of the weather pattern. Large, slow moving air masses had higher frequency of occurrence and longer persistence than small (fronts) or rapidly moving (or changing) features (fronts, storm centers). Some types showed distinct regional preferences. The subtropical maritime high occurred mainly in the south central and southeast. An indeterminate weather pattern type accounted for those weather patterns that did not fit the polar front model or were too disorganized to be classified. The intermountain thermal low of the desert southwest was one such feature that dominated both frequency of occurrence and persistence in this region. Alternation from one weather pattern to another followed the polar front model of a moving cyclonic storm. The tendency for anticyclonic weather patterns to become disorganized as they weakened was seen in the high percentage of these patterns that changed to an indeterminate pattern as they aged.

  14. 27 CFR 479.89 - Transfers to the United States.

    Science.gov (United States)

    2010-04-01

    ... Transfers to the United States. A firearm may be transferred to the United States or any department... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Transfers to the United States. 479.89 Section 479.89 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL,...

  15. 46 CFR 67.97 - United States built.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false United States built. 67.97 Section 67.97 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DOCUMENTATION AND MEASUREMENT OF VESSELS DOCUMENTATION OF VESSELS Build Requirements for Vessel Documentation § 67.97 United States built. To be considered built in the United States a vessel...

  16. 26 CFR 1.993-7 - Definition of United States.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Definition of United States. 1.993-7 Section 1... (CONTINUED) INCOME TAXES Domestic International Sales Corporations § 1.993-7 Definition of United States. Under section 993(g), the term “United States” includes the States, the District of Columbia,...

  17. 31 CFR 593.411 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... TAYLOR SANCTIONS REGULATIONS Interpretations § 593.411 Importation into the United States. With respect to the prohibitions set forth in § 593.205, the term importation into the United States...

  18. 32 CFR 150.21 - Appeals by the United States.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Appeals by the United States. 150.21 Section 150... the United States. (a) Restricted filing. Only a representative of the government designated by the Judge Advocate General of the respective service may file an appeal by the United States under...

  19. 31 CFR 545.304 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... REGULATIONS General Definitions § 545.304 Importation into the United States. (a) With respect to goods, software, or technology, the term importation into the United States means the bringing of any...

  20. 26 CFR 1.953-2 - Actual United States risks.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Actual United States risks. 1.953-2 Section 1... (CONTINUED) INCOME TAXES Controlled Foreign Corporations § 1.953-2 Actual United States risks. (a) In general. For purposes of paragraph (a) of § 1.953-1, the term “United States risks” means risks described...

  1. 31 CFR 539.307 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... CONTROL REGULATIONS General Definitions § 539.307 Importation into the United States. The term importation into the United States means: (a) With respect to goods or technology, the bringing of any goods...

  2. 78 FR 70275 - United States Travel and Tourism Advisory Board

    Science.gov (United States)

    2013-11-25

    ... International Trade Administration United States Travel and Tourism Advisory Board AGENCY: International Trade... United States Travel and Tourism Advisory Board. SUMMARY: The Department of Commerce is currently seeking applications for membership on the United States Travel and Tourism Advisory Board (Board). The purpose of the...

  3. 78 FR 77103 - United States Travel and Tourism Advisory Board

    Science.gov (United States)

    2013-12-20

    ... International Trade Administration United States Travel and Tourism Advisory Board AGENCY: International Trade... on the United States Travel and Tourism Advisory Board. SUMMARY: On November 25, 2013, the Department... 70275) soliciting applications for membership on the United States Travel and Tourism Advisory Board...

  4. Framework for Naval Cooperation between Vietnam and the United States

    Science.gov (United States)

    2017-06-09

    the Vietnam-United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership... platform for future relationship between Vietnam and the United States. Finally, this research suggests a framework for naval cooperation between Vietnam...United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership Agreement signed

  5. 31 CFR 515.334 - United States national.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States national. 515.334 Section 515.334 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... of the United States, and which has its principal place of business in the United States....

  6. 76 FR 68067 - United States-Peru Trade Promotion Agreement

    Science.gov (United States)

    2011-11-03

    ... to trade in textile and apparel goods between Peru and the United States. The provisions within...] RIN 1515-AD79 United States-Peru Trade Promotion Agreement AGENCIES: U.S. Customs and Border... of the United States- Peru Trade Promotion Agreement. DATES: Interim rule effective November 3, 2011...

  7. 77 FR 27669 - Modifications to Definition of United States Property

    Science.gov (United States)

    2012-05-11

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK10 Modifications to Definition of United States Property... clearing agency do not constitute United States property. The text of the temporary regulations also serves... Federal Register establish an exception to the definition of United States property (within the meaning...

  8. Patient education in Europe: united differences.

    NARCIS (Netherlands)

    Visser, S.; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient

  9. Patient education in Europe: united differences

    NARCIS (Netherlands)

    Visser, Adriaan; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient

  10. Patient education in Europe: united differences.

    NARCIS (Netherlands)

    Visser, S.; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient

  11. China, Southeast Asia, and the United States

    Directory of Open Access Journals (Sweden)

    Lowell Dittmer

    2016-04-01

    Full Text Available Southeast Asia has historically been a meeting point between East Asia and South Asia before Western colonialism opened the region to the West and to the winds of global modernization. Since Japan’s coercive decolonization during the Second World War, the dominant outside influences have come from the United States and from the People’s Republic of China. The post-Cold War era began with a withdrawal of both China’s and US power projection from Southeast Asia, facilitating the configuration of a triangular ménage à trios, with ASEAN expanding to include all of Southeast Asia and introducing a number of extended forums intended to socialize the rest of East Asia into the ASEAN way. The “rise of China” occurred within this friendly context, though beginning around 2010 its strategic implications began to appear more problematic with the mounting dispute over the issue of the South China Sea.

  12. Inclusive Education in the United States

    Directory of Open Access Journals (Sweden)

    C. Kenneth Tanner

    1996-12-01

    Full Text Available School reform issues addressing inclusive education were investigated in this nationwide (United States study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive education and collaborative strategies. For example, principals and special education teachers were more positive about inclusive education than regular education teachers. Collaboration as an instructional strategy for "included" students was viewed as a high priority item. Responders who had taken two or more courses in school law rated the identified barriers to inclusive education higher than those with less formal training in the subject.

  13. Detailed gravimetric geoid for the United States.

    Science.gov (United States)

    Strange, W. E.; Vincent, S. F.; Berry, R. H.; Marsh, J. G.

    1972-01-01

    A detailed gravimetric geoid was computed for the United States using a combination of satellite-derived spherical harmonic coefficients and 1 by 1 deg mean gravity values from surface gravimetry. Comparisons of this geoid with astrogeodetic geoid data indicate that a precision of plus or minus 2 meters has been obtained. Translations only were used to convert the NAD astrogeodetic geoid heights to geocentric astrogeodetic heights. On the basis of the agreement between the geocentric astrogeodetic geoid heights and the gravimetric geoid heights, no evidence is found for rotation in the North American datum. The value of the zero-order undulation can vary by 10 to 20 meters, depending on which investigator's station positions are used to establish it.

  14. Electric trade in the United States 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1994, the wholesale trade market totaled 1.9 trillion kilowatthours, about 66% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1994 (ELECTRA), is the fifth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1994.

  15. Renewable Energy Atlas of the United States

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J. [Environmental Science Division; Hlava, K. [Environmental Science Division; Greenwood, H. [Environmentall Science Division; Carr, A. [Environmental Science Division

    2013-12-13

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. This report explains how to add the Atlas to your computer and install the associated software. The report also includes: A description of each of the components of the Atlas; Lists of the Geographic Information System (GIS) database content and sources; and A brief introduction to the major renewable energy technologies. The Atlas includes the following: A GIS database organized as a set of Environmental Systems Research Institute (ESRI) ArcGIS Personal GeoDatabases, and ESRI ArcReader and ArcGIS project files providing an interactive map visualization and analysis interface.

  16. Industry economics in the United States.

    Science.gov (United States)

    2004-04-01

    Demand for medical equipment in the United States (US) is projected to grow by 8% between 2001 and 2006, to reach 105 billion dollars. In 2001,the market was valued at 71.4 billion dollars, based on an annual growth of 7.5% between 1996 and 2001, according to The Freedonia Group. Product innovation and the growing ageing population is driving the industry, despite health-care cost containment measures. Medical and surgical instruments continue to be the largest sector, which is expected to grow to 30.5 billion dollars in 2006. However, electromedical/electrotherapeutic apparatus will remain the fastest growing sector, with annual gains of 10.8% predicted for this period.

  17. Eye on China and United States

    Directory of Open Access Journals (Sweden)

    Milad Mahyari

    2016-07-01

    Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on USimports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.

  18. Wet deposition in the northeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, J; Mohnen, V; Kadlecek, J

    1980-12-01

    Attempts are made to examine concentration and wet deposition of pollutant material at selected stations within the northeastern United States and to characterize as many events as possible with respect to air mass origin. Further attempts are made to develop a regional pattern for the deposition of dominant ion species. MAP3S (US Multistate Atmospheric Power Production Pollution Study) data for 1977 to 1979 are used to determine concentration and deposition on an event basis from which monthly, seasonal, annual, and cumulative averages are developed. The ARL-ATAD trajectory model is used to characterize individual events as to air mass origin. Case studies are examined to illustrate variability in the chemical composition of precipitation originating from distinctly different air mass trajectories. A difference in concentration of pollution-related ions in precipitation is noted between Midwest/Ohio Valley and Great Lakes/Canadian air mass origins for carefully selected cases. Total deposition of the major ions is examined in an effort to develop a regional pattern for deposition over a period of at least one year. For that purpose, total deposition is normalized to remove the variability in precipitation amounts for inter-station comparison. No marked gradient is noted in the normalized deposition totals within the northeast of the United States. The Adirondack region exhibited the lowest normalized ion deposition value, while the Illinois station showed the highest of the MAP3S network. The data analysis suggest that the acid rain phenomena covers the entire northeast. The concept of large scale mixing emerges to account for the lack of a significant gradient in the normalized deposition.

  19. Eye on China and United States

    Directory of Open Access Journals (Sweden)

    Milad Mahyari

    2011-10-01

    Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on US
    imports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.

  20. Wet deposition in the northeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, J; Mohnen, V; Kadlecek, J

    1980-12-01

    Attempts are made to examine concentration and wet deposition of pollutant material at selected stations within the northeastern United States and to characterize as many events as possible with respect to air mass origin. Further attempts are made to develop a regional pattern for the deposition of dominant ion species. MAP3S (US Multistate Atmospheric Power Production Pollution Study) data for 1977 to 1979 are used to determine concentration and deposition on an event basis from which monthly, seasonal, annual, and cumulative averages are developed. The ARL-ATAD trajectory model is used to characterize individual events as to air mass origin. Case studies are examined to illustrate variability in the chemical composition of precipitation originating from distinctly different air mass trajectories. A difference in concentration of pollution-related ions in precipitation is noted between Midwest/Ohio Valley and Great Lakes/Canadian air mass origins for carefully selected cases. Total deposition of the major ions is examined in an effort to develop a regional pattern for deposition over a period of at least one year. For that purpose, total deposition is normalized to remove the variability in precipitation amounts for inter-station comparison. No marked gradient is noted in the normalized deposition totals within the northeast of the United States. The Adirondack region exhibited the lowest normalized ion deposition value, while the Illinois station showed the highest of the MAP3S network. The data analysis suggest that the acid rain phenomena covers the entire northeast. The concept of large scale mixing emerges to account for the lack of a significant gradient in the normalized deposition.

  1. 76 FR 35017 - United States et al. v. United Regional Health Care System; Public Comments and Response on...

    Science.gov (United States)

    2011-06-15

    ... alone''); United States v. Mid-Am. Dairymen, Inc., 1977-1 Trade Cas. (CCH)11 61,508, at 71,980 (W.D. Mo... available to health-care providers.'' Without access to the profitable sources of business in the health... United Regional's total patient volume.'' Without access to the most profitable segment of the health...

  2. The intersection between cannabis and cancer in the United States.

    Science.gov (United States)

    Bowles, Daniel W; O'Bryant, Cindy L; Camidge, D Ross; Jimeno, Antonio

    2012-07-01

    In the last 15 years there has been a major shift in the laws governing medical use of cannabis in the United States. Corresponding with this change there has been escalating interest in the role that cannabis, commonly referred to as marijuana, and cannabinoids play in the care of patients with cancer. This review will examine cannabis' and cannabinoids' current and potential roles in cancer care. Specifically, we will examine five areas of cannabis medicine: (1) pharmacologic properties of cannabis; (2) its potential role in the development of human cancers, particularly smoking-related malignancies; (3) cannabinoids' potential as anti-cancer therapies; (4) cannabis and cannabinoids in the palliation of common cancer-associated symptoms; (5) current legal status of cannabis for medical purposes in the United States. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  3. Neglected parasitic infections in the United States: toxocariasis.

    Science.gov (United States)

    Woodhall, Dana M; Eberhard, Mark L; Parise, Monica E

    2014-05-01

    Toxocariasis is a preventable parasitic disease that is caused by the dog and cat roundworms Toxocara cani and T. cati, respectively. Humans become infected when they accidently ingest infectious Toxocara eggs commonly found in contaminated soil; children are most often affected. Clinical manifestations of Toxocara infection in humans include ocular toxocariasis and visceral toxocariasis. Although infection with Toxocara can cause devastating disease, the burden of toxocariasis in the United States population remains unknown. In addition, risk factors for acquiring infection need to be better defined, and research needs to be conducted to better understand the pathophysiology and clinical course of toxocariasis. Development of diagnostic tests would enable clinicians to detect active infection, and determination of optimal drug regiments would ensure patients were appropriately treated. Addressing these public health gaps is necessary to understand and address the impact of toxocariasis in the United States.

  4. Neglected Parasitic Infections in the United States: Chagas Disease

    Science.gov (United States)

    Montgomery, Susan P.; Starr, Michelle C.; Cantey, Paul T.; Edwards, Morven S.; Meymandi, Sheba K.

    2014-01-01

    Chagas disease, which is caused by the protozoan parasite Trypanosoma cruzi, can lead to severe cardiac and gastrointestinal disease. Most persons acquire this infection through contact with vector bugs carrying T. cruzi in endemic areas of Latin America. Infection can also be acquired by congenital, transfusion, transplantation, and foodborne transmission. Although an estimated 300,000 persons with Chagas disease live in the United States, little is known about the burden of chagasic heart disease. It is not known how often congenital or vector-borne transmission of T. cruzi occurs in the United States, although it is known that infected mothers and infected vector bugs are found in this country. Better diagnostic tests and treatment drugs are needed to improve patient care, and research is needed to define transmission risks and develop strategies to prevent new infections and reduce the burden of disease. PMID:24808250

  5. 78 FR 3398 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-01-16

    ... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). The Board will meet to present...

  6. 78 FR 70274 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-11-25

    ... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). This will be the last meeting of...

  7. Distance Traveled and Cross-State Commuting to Opioid Treatment Programs in the United States

    Directory of Open Access Journals (Sweden)

    Andrew Rosenblum

    2011-01-01

    Full Text Available This study examined commuting patterns among 23,141 methadone patients enrolling in 84 opioid treatment programs (OTPs in the United States. Patients completed an anonymous one-page survey. A linear mixed model analysis was used to predict distance traveled to the OTP. More than half (60% the patients traveled <10 miles and 6% travelled between 50 and 200 miles to attend an OTP; 8% travelled across a state border to attend an OTP. In the multivariate model (n=17,792, factors significantly (P<.05 associated with distance were, residing in the Southeast or Midwest, low urbanicity, area of the patient's ZIP code, younger age, non-Hispanic white race/ethnicity, prescription opioid abuse, and no heroin use. A significant number of OTP patients travel considerable distances to access treatment. To reduce obstacles to OTP access, policy makers and treatment providers should be alert to patients' commuting patterns and to factors associated with them.

  8. Distance Traveled and Cross-State Commuting to Opioid Treatment Programs in the United States

    Science.gov (United States)

    Rosenblum, Andrew; Cleland, Charles M.; Fong, Chunki; Kayman, Deborah J.; Tempalski, Barbara; Parrino, Mark

    2011-01-01

    This study examined commuting patterns among 23,141 methadone patients enrolling in 84 opioid treatment programs (OTPs) in the United States. Patients completed an anonymous one-page survey. A linear mixed model analysis was used to predict distance traveled to the OTP. More than half (60%) the patients traveled <10 miles and 6% travelled between 50 and 200 miles to attend an OTP; 8% travelled across a state border to attend an OTP. In the multivariate model (n = 17,792), factors significantly (P < .05) associated with distance were, residing in the Southeast or Midwest, low urbanicity, area of the patient's ZIP code, younger age, non-Hispanic white race/ethnicity, prescription opioid abuse, and no heroin use. A significant number of OTP patients travel considerable distances to access treatment. To reduce obstacles to OTP access, policy makers and treatment providers should be alert to patients' commuting patterns and to factors associated with them. PMID:21776440

  9. Brackish groundwater in the United States

    Science.gov (United States)

    Stanton, Jennifer S.; Anning, David W.; Brown, Craig J.; Moore, Richard B.; McGuire, Virginia L.; Qi, Sharon L.; Harris, Alta C.; Dennehy, Kevin F.; McMahon, Peter B.; Degnan, James R.; Böhlke, John Karl

    2017-04-05

    For some parts of the Nation, large-scale development of groundwater has caused decreases in the amount of groundwater that is present in aquifer storage and that discharges to surface-water bodies. Water supply in some areas, particularly in arid and semiarid regions, is not adequate to meet demand, and severe drought is affecting large parts of the United States. Future water demand is projected to heighten the current stress on groundwater resources. This combination of factors has led to concerns about the availability of freshwater to meet domestic, agricultural, industrial, mining, and environmental needs. To ensure the water security of the Nation, currently [2016] untapped water sources may need to be developed.Brackish groundwater is an unconventional water source that may offer a partial solution to current and future water demands. In support of the national census of water resources, the U.S. Geological Survey completed the national brackish groundwater assessment to better understand the occurrence and characteristics of brackish groundwater in the United States as a potential water resource. Analyses completed as part of this assessment relied on previously collected data from multiple sources; no new data were collected. Compiled data included readily available information about groundwater chemistry, horizontal and vertical extents and hydrogeologic characteristics of principal aquifers (regionally extensive aquifers or aquifer systems that have the potential to be used as a source of potable water), and groundwater use. Although these data were obtained from a wide variety of sources, the compiled data are biased toward shallow and fresh groundwater resources; data representing groundwater that is at great depths and is saline were not as readily available.One of the most important contributions of this assessment is the creation of a database containing chemical characteristics and aquifer information for the known areas with brackish groundwater

  10. Characterization of floods in the United States

    Science.gov (United States)

    Saharia, Manabendra; Kirstetter, Pierre-Emmanuel; Vergara, Humberto; Gourley, Jonathan J.; Hong, Yang

    2017-05-01

    Floods have gained increasing global significance in the recent past due to their devastating nature and potential for causing significant economic and human losses. Until now, flood characterization studies in the United States have been limited due to the lack of a comprehensive database matching flood characteristics such as peak discharges and flood duration with geospatial and geomorphologic information. The availability of a representative and long archive of flooding events spanning 78 years over a variety of hydroclimatic regions results in a spatially and temporally comprehensive flood characterization over the continental U.S. This study, for the first time, employs a large-event database that is based on actual National Weather Service (NWS) definitions of floods instead of the frequently-adopted case study or frequentist approach, allowing us to base our findings on real definitions of floods. It examines flooding characteristics to identify how space and time scales of floods vary with climatic regimes and geomorphology. Flood events were characterized by linking flood response variables in gauged basins to spatially distributed variables describing climatology, geomorphology, and topography. The primary findings of this study are that the magnitude of flooding is highest is regions such as West Coast and southeastern U.S. which experience the most extraordinary precipitation. The seasonality of flooding varies greatly from maxima during the cool season on the West Coast, warm season in the desert Southwest, and early spring in the Southeast. The fastest responding events tend to be in steep basins of the arid Southwest caused by intense monsoon thunderstorms and steep terrain. The envelope curves of unit peak discharge are consistent with those reported for Europe and worldwide. But significant seasonal variability was observed in floods of the U.S. compared to Europe that is attributed to the diversity of causative rainfall ranging from synoptic

  11. Effectiveness and Cost-Effectiveness of Sequential Treatment of Patients with Chronic Myeloid Leukemia in the United States: A Decision Analysis

    Directory of Open Access Journals (Sweden)

    Ursula Rochau

    2015-01-01

    Full Text Available Currently several tyrosine kinase inhibitors (TKIs are approved for treatment of chronic myeloid leukemia (CML. Our goal was to identify the optimal sequential treatment strategy in terms of effectiveness and cost-effectiveness for CML patients within the US health care context. We evaluated 18 treatment strategies regarding survival, quality-adjusted survival, and costs. For model parameters, the literature data, expert surveys, registry data, and economic databases were used. Evaluated strategies included imatinib, dasatinib, nilotinib, bosutinib, ponatinib, stem-cell transplantation (SCT, and chemotherapy. We developed a Markov state-transition model, which was analyzed as a cohort simulation over a lifelong time horizon with a third-party payer perspective and discount rate of 3%. Remaining life expectancies ranged from 5.4 years (3.9 quality-adjusted life years (QALYs for chemotherapy treatment without TKI to 14.4 years (11.1 QALYs for nilotinib→dasatinib→chemotherapy/SCT. In the economic evaluation, imatinib→chemotherapy/SCT resulted in an incremental cost-utility ratio (ICUR of $171,700/QALY compared to chemotherapy without TKI. Imatinib→nilotinib→chemotherapy/SCT yielded an ICUR of $253,500/QALY compared to imatinib→chemotherapy/SCT. Nilotinib→dasatinib→chemotherapy/SCT yielded an ICUR of $445,100/QALY compared to imatinib→nilotinib→chemotherapy/SCT. All remaining strategies were excluded due to dominance of the clinically superior strategies. Based on our analysis and current treatment guidelines, imatinib→nilotinib→chemotherapy/SCT and nilotinib→dasatinib→chemotherapy/SCT can be considered cost-effective for patients with CML, depending on willingness-to-pay.

  12. Invasive cancer incidence - United States, 2010.

    Science.gov (United States)

    Henley, S Jane; Singh, Simple; King, Jessica; Wilson, Reda; Ryerson, Blythe

    2014-03-28

    Cancer has many causes, some of which can, at least in part, be avoided through interventions known to reduce cancer risk. Healthy People 2020 objectives call for reducing colorectal cancer incidence to 38.6 per 100,000 persons, reducing late-stage breast cancer incidence to 41.0 per 100,000 women, and reducing cervical cancer incidence to 7.1 per 100,000 women. To assess progress toward reaching these Healthy People 2020 targets, CDC analyzed data from U.S. Cancer Statistics (USCS) for 2010. USCS includes incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System. In 2010, a total of 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009. Cancer incidence rates were higher among men (503) than women (405), highest among blacks (455), and ranged by state from 380 to 511 per 100,000 persons. Many factors, including tobacco use, obesity, insufficient physical activity, and human papilloma virus (HPV) infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors. These differences can be reduced through policy approaches such as the Affordable Care Act, which could increase access for millions of persons to appropriate and timely cancer preventive services, including help with smoking cessation, cancer screening, and vaccination against HPV.

  13. 20 CFR 404.1093 - Possession of the United States.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Possession of the United States. 404.1093... Income § 404.1093 Possession of the United States. In using the exclusions from gross income provided under section 931 of the Code (relating to income from sources within possessions of the United...

  14. 26 CFR 400.5-1 - Redemption by United States.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Redemption by United States. 400.5-1 Section... by United States. (a) Scope. The purpose of this section is to prescribe rules with respect to the provisions contained in section 7425(d), relating to redemption of real property by the United...

  15. 75 FR 41927 - Sentencing Guidelines for United States Courts

    Science.gov (United States)

    2010-07-19

    ... United States Sentencing Commission is an independent agency in the judicial branch of the United States..., and judicial branches of government, and other interested parties, to study the manner in which United... might be appropriate in light of the information obtained from that study. (12) Resolution of...

  16. 2011 floods of the central United States

    Science.gov (United States)

    ,

    2013-01-01

    The Central United States experienced record-setting flooding during 2011, with floods that extended from headwater streams in the Rocky Mountains, to transboundary rivers in the upper Midwest and Northern Plains, to the deep and wide sand-bedded lower Mississippi River. The U.S. Geological Survey (USGS), as part of its mission, collected extensive information during and in the aftermath of the 2011 floods to support scientific analysis of the origins and consequences of extreme floods. The information collected for the 2011 floods, combined with decades of past data, enables scientists and engineers from the USGS to provide syntheses and scientific analyses to inform emergency managers, planners, and policy makers about life-safety, economic, and environmental-health issues surrounding flood hazards for the 2011 floods and future floods like it. USGS data, information, and scientific analyses provide context and understanding of the effect of floods on complex societal issues such as ecosystem and human health, flood-plain management, climate-change adaptation, economic security, and the associated policies enacted for mitigation. Among the largest societal questions is "How do we balance agricultural, economic, life-safety, and environmental needs in and along our rivers?" To address this issue, many scientific questions have to be answered including the following: * How do the 2011 weather and flood conditions compare to the past weather and flood conditions and what can we reasonably expect in the future for flood magnitudes?

  17. Building the United States National Vegetation Classification

    Science.gov (United States)

    Franklin, S.B.; Faber-Langendoen, D.; Jennings, M.; Keeler-Wolf, T.; Loucks, O.; Peet, R.; Roberts, D.; McKerrow, A.

    2012-01-01

    The Federal Geographic Data Committee (FGDC) Vegetation Subcommittee, the Ecological Society of America Panel on Vegetation Classification, and NatureServe have worked together to develop the United States National Vegetation Classification (USNVC). The current standard was accepted in 2008 and fosters consistency across Federal agencies and non-federal partners for the description of each vegetation concept and its hierarchical classification. The USNVC is structured as a dynamic standard, where changes to types at any level may be proposed at any time as new information comes in. But, because much information already exists from previous work, the NVC partners first established methods for screening existing types to determine their acceptability with respect to the 2008 standard. Current efforts include a screening process to assign confidence to Association and Group level descriptions, and a review of the upper three levels of the classification. For the upper levels especially, the expectation is that the review process includes international scientists. Immediate future efforts include the review of remaining levels and the development of a proposal review process.

  18. Derecho Hazards in the United States.

    Science.gov (United States)

    Ashley, Walker S.; Mote, Thomas L.

    2005-11-01

    Convectively generated wind-storms occur over broad temporal and spatial scales; however, the more widespread and longer lived of these windstorms have been given the name "derecho." Utilizing an integrated derecho database, including 377 events from 1986 to 2003, this investigation reveals the amount of insured property losses, fatalities, and injuries associated with these windstorms in the United States. Individual derechos have been responsible for up to 8 fatalities, 204 injuries, forest blow-downs affecting over 3,000 km2 of timber, and estimated insured losses of nearly a $500 million. Findings illustrate that derecho fatalities occur more frequently in vehicles or while boating, while injuries are more likely to happen in vehicles or mobile homes. Both fatalities and injuries are most common outside the region with the highest derecho frequency. An underlying synthesis of both physical and social vulnerabilities is suggested as the cause of the unexpected casualty distribution. In addition, casualty statistics and damage estimates from hurricanes and tornadoes are contrasted with those from derechos to emphasize that derechos can be as hazardous as many tornadoes and hurricanes.

  19. Romantic Love in the United States

    Directory of Open Access Journals (Sweden)

    Victor C. de Munck

    2016-01-01

    Full Text Available We seek to advance cultural models theory by contributing to issues related to theory, methods, and testing the external validity of a cultural model. We propose that cultural models are learned as if they were truly properties of collectivities but have no primary existence except in individual representations of them. The shared aspect of cultural models also implies collective awareness of the if–then entailments of cultural models. We use inductive ethnographic methods of freelisting (n = 80 and pile sorting (n = 39 to derive a cultural model of romantic love in the United States. From these tasks, we developed a cultural model of successful romantic love consisting of normative scenarios. For successful romantic love relations, a person would feel excited about meeting their beloved; make passionate and intimate love as opposed to only physical love; feel comfortable with the beloved, behaving in a companionable, friendly way with one’s partner; listen to the other’s concerns, offering to help out in various ways if necessary; and, all the while, keeping a mental ledger of the degree to which altruism and passion are mutual. Our model is supported through an examination of two extended case studies. Further research is required, of course, but we believe we have a rather novel and dynamic cultural model that is falsifiable and predictive of successful love relationships. The model is unique in that it combines passion with comfort and friendship as properties of romantic love.

  20. Health System Reform in the United States

    Directory of Open Access Journals (Sweden)

    John E McDonough

    2014-01-01

    Full Text Available In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA. Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.

  1. United States and world energy sources

    Energy Technology Data Exchange (ETDEWEB)

    Berg, L.L.; Baird, L.M.; Varanini, E.E. III (eds.)

    1982-01-01

    This volume examines the economic, political, and social implications of the oil-dependence dilemma facing the United States. Most of the contributors are energy consultants in the public or private sector. Their analyses of the changing oil situation and its impact on other energy policies reflect either an international, national, or regional perspective with a unique combination of pragmatic insights and academic analyses of these complex issues. While examining the various aspects of the energy dependence dilemma presented here, one critical theme will probably recur to the reader. That is, given the inadequate nature of the US response to the 1973 and 1979 shortfalls in foreign oil supplies, how will we manage the projected future shortages in foreign oil supplies. The 18 papers of this volume were presented at a conference at Los Angeles in July 1980 and cosponsored by the University of Southern California and the California Energy Commission; a separate abstract was prepared for each paper. See also EAPA 7:3231 and Energy Research Abstracts (ERA) 6:18036.

  2. The United Mexican States: an update.

    Science.gov (United States)

    Hakkert, R; Aguirre, E J

    1988-09-01

    Although the popular North American opinion of Mexico is one that paints a picture of a poor, disadvantaged country, South America sees Mexico has a richer more prosperous nation. It is observed that only in the Latin American countries of Venezuela, Suriname and Trinidad and Tobago do consumers have higher incomes than Mexican consumers. Moreover, while millions of Mexicans migrate to the United States to seek a better standard of living, several thousand Central American refugees illegally migrate to Mexico in search of a better life. This better life includes an increased age of lie expectancy from 51 years in the 1950s to 64 years in the late 1970s. There have also been improvements in health care and school enrollments and in the low cost availability of education. Tourism and the prospect of the manufacturing of energy are significant, positive factors working in favor of an improved Mexican economy and a higher overall quality of life. However, Mexico faces serious problems such as a mounting foreign debt. Also rising is Mexico's population which has doubled since 1964 and which continues to grow at a rate of 1.9%. Economic programs and reforms and family development planning have been instituted in response to the countries' current recession and population growth and have begun to show positive results.

  3. United States Holocaust Museums: Pathos, Possession, Patriotism

    Directory of Open Access Journals (Sweden)

    Rob Baum

    2011-12-01

    Full Text Available This article examines the role of United States holocaust museums in directing (American knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and the L.A. Riots of 1991, with references to other cultural catastrophes. While these projects are different, they are not opposed; both museums locate the American perspective of events and their meanings at the forefront. American holocaust museums seem to challenge spaces between memory and its direction, vision and revision. Within the gruesome context of holocaust portrayal, interrogate the valences of memory’s play and expose American holocaust museums as theatres of pornographic memory. The seduction of feeling does not invite change so much as purgation, what Aristotle identified as catharsis — an emotional and physical release, unfortunately replicating the seductive techniques used by Goebbels for the glorification of Hitler. Through manipulation of viewers as automatic audiences, these museums function as centres for pathos I question the policy and polity of presenting genocide as an entertainment leading to catharsis, recognizing that the final act of purgation is all too easily negation.

  4. USEEIO: a New and Transparent United States ...

    Science.gov (United States)

    National-scope environmental life cycle models of goods and services may be used for many purposes, not limited to quantifying impacts of production and consumption of nations, assessing organization-wide impacts, identifying purchasing hot spots, analyzing environmental impacts of policies, and performing streamlined life cycle assessment. USEEIO is a new environmentally extended input-output model of the United States fit for such purposes and other sustainable materials management applications. USEEIO melds data on economic transactions between 389 industry sectors with environmental data for these sectors covering land, water, energy and mineral usage and emissions of greenhouse gases, criteria air pollutants, nutrients and toxics, to build a life cycle model of 385 US goods and services. In comparison with existing US input-output models, USEEIO is more current with most data representing year 2013, more extensive in its coverage of resources and emissions, more deliberate and detailed in its interpretation and combination of data sources, and includes formal data quality evaluation and description. USEEIO was assembled with a new Python module called the IO Model Builder capable of assembling and calculating results of user-defined input-output models and exporting the models into LCA software. The model and data quality evaluation capabilities are demonstrated with an analysis of the environmental performance of an average hospital in the US. All USEEIO f

  5. Electric trade in the United States, 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1996, the wholesale trade market totaled 2.3 trillion kilowatthours, over 73% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1996 (ELECTRA), is the sixth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1996. The electric trade data collected and presented in this report furnish important information on the wholesale structure found within the US electric power industry. The patterns of interutility trade in the report support analyses of wholesale power transactions and provide input for a broader understanding of bulk power market issues that define the emerging national electric energy policies. The report includes information on the quantity of power purchased, sold, exchanged, and wheeled; the geographical locations of transactions and ownership classes involved; and the revenues and costs. 1 fig., 43 tabs.

  6. United States orbital transfer vehicle programs

    Science.gov (United States)

    Gunn, Charles R.

    The United States will rely on five orbital transfer vehicles to carry spacecraft to higher energy orbits than achievable by the Space Shuttle or various Expendable Launch Vehicles (ELV). These vehicles are the Payload Assist Module-Delta (PAM-D), an upgraded version designated PAM-DII, the Inertial Upper Stage (IUS), the Transfer Orbit Stage (TOS), and the Orbital Maneuvering Vehicle (OMV). Development of these vehicles have evolved through contrasting cultures of government and commercial management. The spectrum of their capabilities range from providing spacecraft with only a preprogrammed perigee velocity additions to man-in-the-loop remote controlled spacecraft rendezvous, docking, retrieval and return to a space base; either the Shuttle or the Space Station Freedom. The PAM-D, PAM-DII, and IUS are now nearing maturity. Their characteristics, flight record, costs, and projected future uses are defined. The TOS and OMV are currently in development with first uses scheduled in 1992 and 1993, respectively. The TOS is being commercially developed while the OMV is government developed. The TOS and OMV capabilities, constraints, and costs are reviewed.

  7. Russian: United States Environmental Restoration Workshop

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    The Russian - United States Environmental Restoration Workshop, held in Washington, D.C., and Richland, Washington, from April 5 through 18, 1993, was the first extended collaborative information exchange between the US Department of Energy (DOE) and Russian scientists at the site level. In addition to the Russian scientists, workshop participants included scientists and staff from DOE, Pacific Northwest Laboratory (PNL), Westinghouse Hanford Company (WHC), the US Environmental Training Institute (USETI), universities, and the private sector. The first week (April 5 through 10) of the workshop took place in Washington, D.C., where the Russian and US participants were presented with a US perspective on environmental restoration and remediation issues from representatives in DOE and the US Environmental Protection Agency (EPA). The second week (April 11 through 18) occurred in Richland, Washington, where the participants were presented with site-specific environmental restoration and remediation issues related to Hanford Site cleanup. This report is a compilation of the presentations, discussions, and experiences shared during the second week of the workshop in Richland, Washington.

  8. Japanese encephalitis in two children--United States, 2010.

    Science.gov (United States)

    2011-03-11

    Japanese encephalitis virus (JEV) is the leading cause of vaccine-preventable encephalitis in Asia and the western Pacific. JEV is maintained in an enzootic cycle involving mosquitoes and amplifying vertebrate hosts, mainly pigs and wading birds. The virus is transmitted to humans primarily by Culex mosquitoes, which breed in flooded rice fields and pools of stagnant water and most often feed outdoors during the evening and night. JEV transmission occurs mainly in rural agricultural areas, but occasional human cases occur in urban areas. Japanese encephalitis (JE) in persons who have traveled or lived overseas is diagnosed infrequently in the United States, with only four cases identified from 1992 (when a JE vaccine was first licensed in the United States) to 2008. This report describes the only cases diagnosed in the United States and reported to CDC since then. The first was a fatal case in a U.S. child who had visited relatives in the Philippines. The other occurred in a refugee who became ill while traveling from Thailand to the United States and whose diagnosis was complicated by concurrent neurocysticercosis. JE should be considered in the differential diagnosis for any patient with an acute neurologic infection who recently has been in a JE-endemic country. Travelers to JE-endemic countries should be advised of the risk for JE and the importance of personal protective measures to prevent mosquito bites. JE vaccine should be considered for travelers who might be at greater risk based on the season, location, and duration of their visit and their planned activities.

  9. Leptospirosis-associated hospitalizations, United States, 1998-2009.

    Science.gov (United States)

    Traxler, Rita M; Callinan, Laura S; Holman, Robert C; Steiner, Claudia; Guerra, Marta A

    2014-08-01

    A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998-2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease-associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.

  10. 77 FR 60005 - Schedule of Charges Outside the United States

    Science.gov (United States)

    2012-10-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Schedule of Charges Outside the United States AGENCY: Federal Aviation... of charges for services of FAA Flight Standards Aviation Safety Inspectors outside the United...

  11. Continental Divide of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the Continental Divide of the United States. The map layer was created by extracting Hydrologic Unit Boundary line features from an existing...

  12. Global Map: Ports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes Global Map data showing ferry ports in the United States and Puerto Rico. The data are a modified version of the National Atlas of the United...

  13. Cities and Towns of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes cities in the United States, Puerto Rico and the U.S. Virgin Islands. These cities were collected from the 1970 National Atlas of the United...

  14. United States Military in Central Asia: Beyond Operation Enduring Freedom

    Science.gov (United States)

    2009-10-23

    Malinowski , advocacy director for Human Rights Watch, stated, “the United States is most effective in promoting liberty around the world when people...26 U.S. President, The National Security Strategy of the United States of America, page? 27 Thomas Malinowski , “Testimony

  15. Environmental Assessment: Interim Western United States C-17 Landing Zone

    Science.gov (United States)

    2008-05-01

    RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENEGGER GOVERNOR January 7, 2008 Doug Allbright U.S. Air Force Headquarters Air...STATE OF CALIFORNIA GoVERNOR’S OFFICE of PLANNING AND RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENBGGER. CYNTHJABRYANT DIRECTOR

  16. 26 CFR 31.3121(e)-1 - State, United States, and citizen.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false State, United States, and citizen. 31.3121(e)-1... § 31.3121(e)-1 State, United States, and citizen. (a) When used in the regulations in this subpart, the... is used in a geographical sense. The term “citizen of the United States” includes a citizen of the...

  17. Airport geomagnetic surveys in the United States

    Science.gov (United States)

    Berarducci, A.

    2006-01-01

    The Federal Aviation Administration (FAA) and the United States military have requirements for design, location, and construction of compass calibration pads (compass roses), these having been developed through collaboration with US Geological Survey (USGS) personnel. These requirements are detailed in the FAA Advisory Circular AC 150/5300-13, Appendix 4, and in various military documents, such as Handbook 1021/1, but the major requirement is that the range of declination measured within 75 meters of the center of a compass rose be less than or equal to 30 minutes of arc. The USGS Geomagnetism Group has developed specific methods for conducting a magnetic survey so that existing compass roses can be judged in terms of the needed standards and also that new sites can be evaluated for their suitability as potentially new compass roses. First, a preliminary survey is performed with a total-field magnetometer, with differences over the site area of less than 75nT being sufficient to warrant additional, more detailed surveying. Next, a number of survey points are established over the compass rose area and nearby, where declination is to be measured with an instrument capable of measuring declination to within 1 minute of arc, such as a Gurley transit magnetometer, DI Flux theodolite magnetometer, or Wild T-0. The data are corrected for diurnal and irregular effects of the magnetic field and declination is determined for each survey point, as well as declination range and average of the entire compass rose site. Altogether, a typical survey takes about four days to complete. ?? 2006 Springer.

  18. Veterinary Fusarioses within the United States

    Science.gov (United States)

    Sutton, Deanna A.; Wiederhold, Nathan; Robert, Vincent A. R. G.; Crous, Pedro W.; Geiser, David M.

    2016-01-01

    Multilocus DNA sequence data were used to assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically distinct species, all but two of which were previously known to infect humans, distributed among eight species complexes. The majority of the veterinary isolates (47/67 = 70.1%) were nested within the Fusarium solani species complex (FSSC), and these included 8 phylospecies and 33 unique 3-locus sequence types (STs). Three of the FSSC species (Fusarium falciforme, Fusarium keratoplasticum, and Fusarium sp. FSSC 12) accounted for four-fifths of the veterinary strains (38/47) and STs (27/33) within this clade. Most of the F. falciforme strains (12/15) were recovered from equine keratitis infections; however, strains of F. keratoplasticum and Fusarium sp. FSSC 12 were mostly (25/27) isolated from marine vertebrates and invertebrates. Our sampling suggests that the Fusarium incarnatum-equiseti species complex (FIESC), with eight mycoses-associated species, may represent the second most important clade of veterinary relevance within Fusarium. Six of the multilocus STs within the FSSC (3+4-eee, 1-b, 12-a, 12-b, 12-f, and 12-h) and one each within the FIESC (1-a) and the Fusarium oxysporum species complex (ST-33) were widespread geographically, including three STs with transoceanic disjunctions. In conclusion, fusaria associated with veterinary mycoses are phylogenetically diverse and typically can only be identified to the species level using DNA sequence data from portions of one or more informative genes. PMID:27605713

  19. Indonesian and United States of American Economic Partnership Agreement Effect

    Directory of Open Access Journals (Sweden)

    Tajerin Tajerin

    2011-09-01

    Full Text Available The paper analyzes fisheries trade effects from the implementation of Indonesian and the UnitedStates of American Economic Partnership Agreement (IUSEPA. The analysis is performed on theintegrated world trade databases owned by World Trade Organization, United Nations Conferenceon Trade and Development, and United Nations Statistics Division, using Wits software packagedeveloped by the World Bank. The result indicates that in the future, Indonesian government as aparty that will conduct bilateral economic partnership agreement with the United states, needs topropose or negotiate fishery import tariffs that imposed by the United States ranges from 0 to 7percent.Keywords: Bilateral economic agreement, fisheries, trade effect

  20. United States Federal Guidance on Witness Protection in Human Trafficking

    Science.gov (United States)

    2015-06-12

    UNITED STATES FEDERAL GUIDANCE ON WITNESS PROTECTION IN HUMAN TRAFFICKING A thesis presented to the Faculty of the U.S. Army...JUN 2015 4. TITLE AND SUBTITLE United States Federal Guidance on Witness Protection in Human Trafficking 5a. CONTRACT NUMBER 5b. GRANT NUMBER...United States needs overarching federal guidance on witness protection for human trafficking victims/witnesses in order to enhance their safety and

  1. Characterization of transsphenoidal complications in patients with acromegaly: an analysis of inpatient data in the United States from 2002 to 2010.

    Science.gov (United States)

    Raikundalia, Milap D; Pines, Morgan J; Svider, Peter F; Baredes, Soly; Folbe, Adam J; Liu, James K; Eloy, Jean Anderson

    2015-05-01

    Transsphenoidal surgery (TSS) is a common procedure for a variety of pituitary lesions. This procedure can be associated with complications related to the surgery or specific pathology. In this study, we evaluate inpatient postoperative complications among patients who underwent TSS for growth hormone adenomas using a nationally representative database, and compare patient characteristics and complications to patients who underwent TSS for other benign pituitary neoplasms. Analysis of the Nationwide Inpatient Sample revealed 13,070 TSS patients (including 892 with acromegaly) between 2002 and 2010. Complication rates, outcomes, patient demographics, hospital stay, and total charges were evaluated among TSS patients with and without acromegaly. There was an increase in TSS performed in both cohorts from 2002 to 2010. Acromegaly patients were younger, had shorter hospital stays, and incurred fewer charges. Acromegaly patients had a lower occurrence of postoperative urinary/renal complications (0.2% vs 1.1%), thromboembolic events (0% vs 0.4%), fluid/electrolyte abnormalities (5.7% vs 9.1%), and iatrogenic hypopituitarism (0.3% vs 1.1%) compared to other TSS patients (all p acromegaly patients was 2.6% vs 1.7% in non-acromegaly patients, a result that did not reach significance (p = 0.054). Upon comparison of inpatient hospitalizations for patients undergoing TSS for growth hormone adenomas and other benign pituitary neoplasms, acromegaly patients had a significantly lower occurrence of postoperative fluid/electrolyte abnormalities. Acromegaly patients had shorter hospitalizations and subsequently fewer total charges. © 2015 ARS-AAOA, LLC.

  2. 1:2,000,000-scale Hydrologic Units of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set has been superseded by huc2m. This file contains hydrologic unit boundaries and codes for the conterminous United States along with Alaska, Hawaii,...

  3. (SUPERSEDED) 1:2,000,000-scale Hydrologic Units of the United States (SUPERSEDED)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This file contains hydrologic unit boundaries and codes for the conterminous United States along with Alaska, Hawaii, Puerto Rico and the U.S. Virgin Islands. It was...

  4. Abortion surveillance--United States, 2009.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Zane, Suzanne B; Burley, Kim D; Jamieson, Denise J

    2012-11-23

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2009. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2009, data were received from 48 reporting areas. For the purpose of trend analysis, abortion data were evaluated from the 45 areas that reported data every year during 2000-2009. Census and natality data, respectively, were used to calculated abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 784,507 abortions were reported to CDC for 2009. Of these abortions, 772,630 (98.5%) were from the 45 reporting areas that provided data every year during 2000-2009. Among these same 45 reporting areas, the abortion rate for 2009 was 15.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 227 abortions per 1,000 live births. Compared with 2008, the total number and rate of reported abortions for 2009 decreased 5%, representing the largest single year decrease for the entire period of analysis. The abortion ratio decreased 2%. From 2000 to 2009, the total number, rate, and ratio of reported abortions decreased 6%, 7%, and 8%, respectively, to the lowest levels for 2000-2009. In 2009 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, whereas women aged ≥30 years accounted for a much smaller percentage of abortions and had lower abortion rates. In 2009, women aged 20-24 and 25-29 years accounted for 32.7% and 24.4% of all abortions, respectively, and had an abortion rate of 27.4 abortions per 1,000 women aged 20-24 years and 20.4 abortions per 1,000 women aged 25-29 years. In contrast, women aged 30-34, 35-39, and ≥40 years

  5. Multidisciplinary management of patients with haemophilia with inhibitors undergoing surgery in the United States: perspectives and best practices derived from experienced treatment centres.

    Science.gov (United States)

    Escobar, M; Maahs, J; Hellman, E; Donkin, J; Forsyth, A; Hroma, N; Young, G; Valentino, L A; Tachdjian, R; Cooper, D L; Shapiro, A D

    2012-11-01

    Since the 1980s, major surgical interventions in patients with congenital haemophilia with inhibitors have been performed utilizing bypassing agents for haemostatic coverage. While reports have focused on perioperative management and haemostasis, the US currently lacks consensus guidelines for the management of patients with inhibitors during the surgical procedure, and pre- and postoperatively. Many haemophilia treatment centres (HTCs) have experience with surgery in haemophilia patients, including those with inhibitors, with approximately 50% of these HTCs having performed orthopaedic procedures. The aim of this study was to present currently considered best practices for multidisciplinary care of inhibitor patients undergoing surgery in US HTCs. Comprehensive haemophilia care in the US is provided by ~130 federally designated HTCs staffed by multidisciplinary teams of healthcare professionals. Best practices were derived from a meeting of experts from leading HTCs examining the full care spectrum for inhibitor patients ranging from identification of the need for surgery through postoperative rehabilitation. HTCs face challenges in the care of inhibitor patients requiring surgery due to the limited number of surgeons willing to operate on this complex population. US centres of excellence have developed their own best practices around an extended comprehensive care model that includes preoperative planning, perioperative haemostasis and postoperative rehabilitation. Best practices will benefit patients with inhibitors and allow improvement in the overall care of these patients when undergoing surgical procedures. In addition, opportunities for further education and outcomes assessment in the care of this patient population have been identified.

  6. Trends in hospitalization for takotsubo cardiomyopathy in the United States.

    Science.gov (United States)

    Khera, Rohan; Light-McGroary, KellyAnn; Zahr, Firas; Horwitz, Phillip A; Girotra, Saket

    2016-02-01

    Takotsubo (or stress induced) cardiomyopathy is characterized by transient left ventricular systolic dysfunction. Recent trends in patient volume, characteristics, and outcomes in the United States are unknown. Using 2007-2012 National Inpatient Sample data, we identified 22,005 adults (≥18 years) with a primary and 31,942 adults with a secondary discharge diagnosis of takotsubo cardiomyopathy (International Classification of Diseases, Ninth Revision, code 429.83) who underwent diagnostic coronary angiography. During 2007 to 2012, the incidence of takotsubo cardiomyopathy increased over 3-fold: 52/million discharges in 2007 to 178/million in 2012 (P takotsubo cardiomyopathy in the United States in recent years, suggesting higher incidence than prior reports. Although outcomes have remained favorable, there is an increasing burden of cardiovascular and psychiatric disorders in this population with growing cost of care. Risk of mortality is higher in men and in patients with underlying critical illness. The excess mortality in these groups appears to be mediated by greater severity of disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. The United States of America country update

    Energy Technology Data Exchange (ETDEWEB)

    Lund, John W.; Bloomquist, R. Gordon; Boyd, Tonya L.; Renner, Joel

    2005-01-01

    Geothermal energy is used for electric power generation and direct utilization in the United States. The present installed capacity (gross) for electric power generation is 2,534 MWe with about 2,000 MWe net delivering power to the grid producing approximately 17,840 GWh per year for a 80.4% gross capacity factor. Geothermal electric power plants are located in California, Nevada, Utah and Hawaii. The two largest concentrations of plants are at The Geysers in northern California and the Imperial Valley in southern California. The latest development at The Geysers, starting in 1998, is injecting recycled wastewater from two communities into the reservoir, which presently has recovered about 100 MWe of power generation. The second pipeline from the Santa Rosa area has just come on line. The direct utilization of geothermal energy includes the heating of pools and spas, greenhouses and aquaculture facilities, space heating and district heating, snow melting, agricultural drying, industrial applications and groundsource heat pumps. The installed capacity is 7,817 MWt and the annual energy use is about 31,200 TJ or 8,680 GWh. The largest application is ground-source (geothermal) heat pumps (69% of the energy use), and the next largest direct-uses are in space heating and agricultural drying. Direct utilization (without heat pumps) is increasing at about 2.6% per year; whereas electric power plant development is almost static, with only about 70 MWe added since 2000 (there were errors in the WGC2000 tabulation). A new 185-MWe plant being proposed for the Imperial Valley and about 100 MWe for Glass Mountain in northern California could be online by 2007-2008. Several new plants are proposed for Nevada totaling about 100 MWe and projects have been proposed in Idaho, New Mexico, Oregon and Utah. The total planned in the next 10 years is 632 MWe. The energy savings from electric power generation, direct-uses and ground-source heat pumps amounts to almost nine million tonnes

  8. The United States of America Country Update

    Energy Technology Data Exchange (ETDEWEB)

    Lund, John W. (1); Bloomquist, R. Gordon (2); Boyd, Tonya L. (1); Renner, Joel (3); (1) Geo-Heat Center, Oregon Institute of Technology, Klamath Falls, OR; (2) Washington State University Energy Program, Olympia, WA; (3) Idaho National Engineering and Environmental Laboratory, Idaho Falls, ID

    0001-01-01

    Geothermal energy is used for electric power generation and direct utilization in the United States. The present installed capacity (gross) for electric power generation is 2,534 MWe with about 2,000 MWe net delivering power to the grid producing approximately 17,840 GWh per year for a 80.4% gross capacity factor. Geothermal electric power plants are located in California, Nevada, Utah and Hawaii. The two largest concentrations of plants are at The Geysers in northern California and the Imperial Valley in southern California. The latest development at The Geysers, starting in 1998, is injecting recycled wastewater from two communities into the reservoir, which presently has recovered about 100 MWe of power generation. The second pipeline from the Santa Rosa area has just come on line. The direct utilization of geothermal energy includes the heating of pools and spas, greenhouses and aquaculture facilities, space heating and district heating, snow melting, agricultural drying, industrial applications and groundsource heat pumps. The installed capacity is 7,817 MWt and the annual energy use is about 31,200 TJ or 8,680 GWh. The largest application is ground-source (geothermal) heat pumps (69% of the energy use), and the next largest direct-uses are in space heating and agricultural drying. Direct utilization (without heat pumps) is increasing at about 2.6% per year; whereas electric power plant development is almost static, with only about 70 MWe added since 2000 (there were errors in the WGC2000 tabulation). A new 185-MWe plant being proposed for the Imperial Valley and about 100 MWe for Glass Mountain in northern California could be online by 2007-2008. Several new plants are proposed for Nevada totaling about 100 MWe and projects have been proposed in Idaho, New Mexico, Oregon and Utah. The total planned in the next 10 years is 632 MWe. The energy savings from electric power generation, direct-uses and ground-source heat pumps amounts to almost nine million tonnes

  9. The Human Rights Record of the United States in 2006

    Institute of Scientific and Technical Information of China (English)

    THE INFORMATION OFFICE OF THE STATE COUNCIL OF THE

    2007-01-01

    @@ EDITOR'S NOTE: On March 8, the Information Office of the State Council of the People's Republic of China published a document entitled the Human Rights Record of the United States in 2006. Following is the full text.

  10. 1990 County Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the 1990 State and county boundaries of the United States, Puerto Rico, and the U.S. Virgin Islands. The map layer was created by extracting...

  11. Major Roads of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set portrays the major roads in the United States, Puerto Rico, and the U.S. Virgin Islands. The file was produced by joining the individual State roads...

  12. NCHS - Births and General Fertility Rates: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset includes crude birth rates and general fertility rates in the United States since 1909. The number of states in the reporting area differ historically....

  13. 2000 County Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the 2000 State and county boundaries of the United States, Puerto Rico, and the U.S. Virgin Islands. The map layer was created by extracting...

  14. ICU Occupancy and mechanical ventilator use in the United States

    Science.gov (United States)

    Wunsch, Hannah; Wagner, Jason; Herlim, Maximilian; Chong, David; Kramer, Andrew; Halpern, Scott D.

    2013-01-01

    Objectives Detailed data on occupancy and use of mechanical ventilators in United States intensive care units (ICU) over time and across unit types, are lacking. We sought to describe the hourly bed occupancy and use of ventilators in US ICUs to improve future planning of both the routine and disaster provision of intensive care. Design Retrospective cohort study. We calculated mean hourly bed occupancy in each ICU and hourly bed occupancy for patients on mechanical ventilators. We assessed trends in overall occupancy over the three years. We also assessed occupancy and mechanical ventilation rates across different types and sizes of ICUs. Setting 97 US ICUs participating in Project IMPACT from 2005–07. Patients 226,942 consecutive admissions to ICUs. Interventions None. Measurements and Main Results Over the three years studied, total ICU occupancy ranged from 57.4% to 82.1% and the number of beds filled with mechanically ventilated patients ranged from 20.7% to 38.9%. There was no change in occupancy across years and no increase in occupancy during influenza seasons. Mean hourly occupancy across ICUs was 68.2% SD ± 21.3, and was substantially higher in ICUs with fewer beds (mean 75.8% (± 16.5) for 5–14 beds versus 60.9% (± 22.1) for 20+ beds, P = 0.001), and in academic hospitals (78.7% (± 15.9) versus 65.3% (± 21.3) for community not-for profit hospitals, P beds available more than half the time. The mean percentage of ICU patients receiving mechanical ventilation in any given hour was 39.5% (± 15.2), and a mean of 29.0% (± 15.9) of ICU beds were filled with a patient on a ventilator. Conclusions Occupancy of US ICUs was stable over time, but there is uneven distribution across different types and sizes of units. Only three out of ten beds were filled at any time with mechanically ventilated patients, suggesting substantial surge capacity throughout the system to care for acutely critically ill patients. PMID:23963122

  15. The Knowledge-about-Older-Patients - Quiz (KOP-Q) for nurses : Cross-cultural validation between the Netherlands and United States of America

    NARCIS (Netherlands)

    Dikken, Jeroen; Hoogerduijn, Jita G.; Klaassen, Sharon; Lagerwey, Mary D; Shortridge-Baggett, Lillie; Schuurmans, Marieke J.

    2017-01-01

    Background The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed

  16. Landfills in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Locations of landfills and waste transfer stations in 11 western states. Data was obtained from state and federal agencies in GIS, tabular, and map format.

  17. Adalimumab improves health-related quality of life in patients with moderate to severe plaque psoriasis compared with the United States general population norms: Results from a randomized, controlled Phase III study

    Directory of Open Access Journals (Sweden)

    Harnam Neesha

    2008-10-01

    Full Text Available Abstract Objective To evaluate the impact of adalimumab on health-related quality of life (HRQOL for patients with moderate to severe plaque psoriasis. Background Psoriasis is a chronic, inflammatory, immune-mediated disease that has a significant impact on patients' HRQOL. Adalimumab is a fully human monoclonal antibody that blocks tumor necrosis factor, a pro-inflammatory cytokine, and is effective and well-tolerated for patients with moderate to severe psoriasis. Methods Data were obtained for a secondary analysis of patients in a randomized, controlled Phase III trial evaluating the effect of adalimumab in patients with psoriasis (N = 1,205. Patients with moderate to severe psoriasis were randomized in a 2:1 ratio to adalimumab 80 mg (two 40 mg injections administered subcutaneously at baseline followed by one 40 mg injection every other week from Week 1 to Week 15 or placebo. Short Form-36 (SF-36 Health Survey scores of psoriasis patients were used to assess HRQOL and were compared with United States (US population norms at baseline and Week 16. Results Baseline Physical Component Summary (PCS scores for the placebo and adalimumab groups were similar to the general US population. Baseline mean Mental Component Summary (MCS scores were significantly lower for the adalimumab and placebo groups compared with the general population (47.4, 47.7, and 50.8 points, respectively; p Conclusion Psoriasis has a broad impact on patient functioning and well-being. Improvement in skin lesions and joint symptoms associated with adalimumab treatment was accompanied by improvements in HRQOL to levels that were similar to or greater than those of the general US population. Trial registration Clinicaltrials.gov NCT00237887

  18. Principal thorium resources in the United States

    Science.gov (United States)

    Staatz, Mortimer Hay; Armbrustmacher, T.J.; Olson, J.C.; Brownfield, I.K.; Brock, M.R.; Lemons, J.F.; Coppa, L.V.; Clingan, B.V.

    1979-01-01

    Resources were assessed for thorium in the higher grade and better known deposits in the United States in: (1) veins, (2) massive carbonatites, (3) stream placers of North and South Carolina, and (4) disseminated deposits. Thorium resources for the first three categories were divided into reserves and probable potential resources. Each of these then were separated into the following cost categories: (1) the amount of ThO2 producible at less than $15 per pound, (2) the amount producible at between $15 and $30 per pound, and (3) the amount producible at more than $50 per pound. The type of mining and milling needed at each deposit determines the capital, operating, and fixed costs of both mining and milling. Costs start with the clearing of land and are carried through to the final product, which for all deposits is ThO2. Capital costs of mining are affected most by the type of mining and the size of the mine. Those of milling are affected most by the kind of mill, its size, and whether or not extra circuits are needed for the separation of rare earths or some other byproduct. Veins, massive carbonatites, and stream placers of North and South Carolina have reserves of 188,000 short tons of ThO2 and probable potential resources of 505,000 tons of ThO2. Approximately half of the reserves and probable potential resources can be produced at less than $30 per pound of ThO2. Veins are the highest grade source in the United States and have total reserves of 142,000 tons of ThO2 and probable potential resources of 343,000 tons. About 90 percent of the reserves and 91 percent of the probable potential resources can be produced at less than $15 per pound of ThO2. Seven vein districts were evaluated: (1) Lemhi Pass, Mont.-Idaho, (2) Wet Mountains, Colo., (3) Powderhorn, Colo., (4) Hall Mountain, Idaho, (5) Diamond Creek, Idaho, (6) Bear Lodge Mountains, Wyo. and (7) Mountain Pass, Calif. Eighty-seven percent of the total reserves and probable potential resources are in the

  19. Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization.

    Science.gov (United States)

    Dalal, Mehul R; Kazemi, Mahmood; Ye, Fen; Xie, Lin

    2017-08-04

    Hypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). This study aimed to determine the impact of hypoglycemia soon after basal insulin initiation on treatment discontinuation and economic outcomes in patients with T2D. Hypoglycemic events within 6 months of basal insulin initiation were identified using retrospective cohort data from patients with T2D, at least 18 years of age, initiated on basal insulin therapy in the Clinformatics™ Data Mart for Multiplan claims database from January 1, 2008, through August 31, 2012. Data were adjusted for baseline characteristics. Discontinuation was established for patients with 12-month follow-up data, while discontinuation risk was assessed in the extended analysis (6- to 24-month follow-up) by Cox regression analysis. Healthcare use and costs were determined. Of 55,608 patients, 4.5% experienced hypoglycemia within 6 months of basal insulin initiation. Patients with hypoglycemia were more likely to discontinue basal insulin within 12 months of initiation (79.0% vs. 74.2%; P cause ($30,719 vs. $19,079; P < 0.001) healthcare costs. US patients with T2D who experienced hypoglycemia within 6 months of basal insulin initiation were more likely to discontinue treatment, accompanied by a greater healthcare burden. Sanofi US, Inc.

  20. Disease features and outcomes in United States lupus patients of Hispanic origin and their Mestizo counterparts in Latin America: a commentary.

    Science.gov (United States)

    Ugarte-Gil, Manuel F; Pons-Estel, Guillermo J; Molineros, Julio; Wojdyla, Daniel; McGwin, Gerald; Nath, Swapan K; Pons-Estel, Bernardo A; Alarcón-Riquelme, Marta; Alarcón, Graciela S

    2016-03-01

    To evaluate disease features and outcomes in two populations with significant Amerindian ancestry. Hispanic patients (from Texas) from the Lupus in Minorities: Nature versus Nurture (LUMINA) cohort and Mestizo patients from the Grupo Latino Americano De Estudio del Lupus or Latin American Group for the Study of Lupus (GLADEL) cohort were included. Disease features and outcomes were evaluated at baseline and last visit. Admixture informative markers of Mestizo Genoma de Lupus Eritematoso Sistémico Network consortium (GENLES) patients and Hispanic LUMINA patients were compared. Univariable analyses were performed using Chi square or Student's t test as appropriate. Multivariable analyses adjusting for possible confounders were carried out using Poisson, logistic or Cox regression models as appropriate. A total of 114 LUMINA and 619 GLADEL patients were included. GLADEL patients had accrued more damage at baseline, but the opposite was the case at last visit. Being from LUMINA was a risk factor for damage accrual, even after adjusting for possible confounders [relative risk (RR) 1.33, 95% CI 1.12, 1.58]. Also, LUMINA patients have a higher risk of mortality than GLADEL patients [hazard ratio (HR) 2.37, 95% CI 1.10, 5.15], having 5-year survival of 85.6% and 94.5%, respectively. In addition, 79 LUMINA patients and 744 Mestizo GENLES patients were evaluated in order to compare genetic ancestry between the two groups; GENLES patients had a higher proportion of European ancestry (48.5% vs 43.3%, P = 0.003) and a lower proportion of Asian ancestry (3.7% vs 4.9%, P = 0.048), but the proportions of Amerindian and African ancestry were comparable in both. USA Hispanic patients seemed to have a poorer prognosis than their counterparts from Latin America, despite having a comparable genetic background. Socioeconomic factors may account for these observations. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights

  1. 78 FR 27857 - United States Standards for Wheat

    Science.gov (United States)

    2013-05-13

    ... Standards for Wheat AGENCY: Grain Inspection, Packers and Stockyards Administration, USDA. ACTION: Final... United States Standards for Wheat under the United States Grain Standards Act (USGSA) to change the definition of Contrasting classes (CCL) in the class Hard White wheat. This change will help facilitate the...

  2. 12 CFR 561.53 - United States Treasury General Account.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false United States Treasury General Account. 561.53 Section 561.53 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY DEFINITIONS FOR REGULATIONS AFFECTING ALL SAVINGS ASSOCIATIONS § 561.53 United States Treasury General Account. The...

  3. 76 FR 18198 - European Union-United States Atlantis Program

    Science.gov (United States)

    2011-04-01

    ... European Union-United States Atlantis Program AGENCY: Office of Postsecondary Education, Department of... (IFLE): Fund for the Improvement of Postsecondary Education (FIPSE)--Special Focus Competition: European Union-(EU) United States (U.S.) Atlantis Program Notice inviting applications for new awards for...

  4. 19 CFR 10.46 - Articles for the United States.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles for the United States. 10.46 Section 10... THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. General Provisions Articles for Institutions § 10.46 Articles for the United States. Pursuant to subheadings 9808.00.10 and...

  5. Foreign Students and Scholars and the United States Tax System.

    Science.gov (United States)

    Williams, David, II.

    1994-01-01

    During the 1992-93 school year more than 425,000 foreign students were studying in the United States. In addition, hundreds of foreign nationals were in the United States as visiting research scholars, lecturers, and professors. Offers a guide to help foreign nationals comply with the tax system while affording them the least possible tax…

  6. Forest management and water in the United States [Chapter 13

    Science.gov (United States)

    Daniel G. Neary

    2017-01-01

    This chapter outlines a brief history of the United States native forests and forest plantations. It describes the past and current natural and plantation forest distribution (map, area, main species), as well as main products produced (timber, pulp, furniture, etc.). Integrated into this discussion is a characterization of the water resources of the United States and...

  7. The United States Today: An Atlas of Reproducible Pages.

    Science.gov (United States)

    World Eagle, Inc., Wellesley, MA.

    Black and white maps, graphs and tables that may be reproduced are presented in this volume focusing on the United States. Some of the features of the United States depicted are: size, population, agriculture and resources, manufactures, trade, citizenship, employment, income, poverty, the federal budget, energy, health, education, crime, and the…

  8. United States’ Interests in the Horn of Africa.

    Science.gov (United States)

    1986-04-23

    while Haile Selassie intended to ensure that the United States had a vested interest in the survival of his regime. "There was never an alliance between...company; and he sent troops to fight in Korea. Emperor Haile Selassie’s political manuevering achieved the establishment of a United States vested

  9. 7 CFR 65.260 - United States country of origin.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) COUNTRY OF ORIGIN LABELING... 7 Agriculture 3 2010-01-01 2010-01-01 false United States country of origin. 65.260 Section 65.260..., PEANUTS, AND GINSENG General Provisions Definitions § 65.260 United States country of origin....

  10. Immigration to the United States: 1996 Update. Executive Summary.

    Science.gov (United States)

    Keuffel, Eric; Pemberton, Alissa

    Immigration, both legal and illegal, has a profound impact on the United States. The public policy implications of immigration include the impact on population growth, employment, wages, taxes, and social spending. In 1994, a net total of between 900,000 and 1.1 million immigrants were added to the foreign-born population of the United States.…

  11. 31 CFR 560.319 - United States depository institution.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States depository institution. 560.319 Section 560.319 Money and Finance: Treasury Regulations Relating to Money and Finance... associations, credit unions, trust companies and United States bank holding companies)....

  12. Civic Engagement in the United States: Roots and Branches

    Science.gov (United States)

    Imel, Susan

    2012-01-01

    The adult education and civic education movements are not synonymous, but the two were intertwined during the early years of adult education's formation as a field in the United States. This chapter traces the development of adult civic education in the United States, focusing on the 1920s through the 1950s. First, the roots of civic education…

  13. Pine Engraver, Ips pini, in the Western United States (FIDL)

    Science.gov (United States)

    Sandra J. Kegley; R. Ladd Livingston; Kenneth E. Gibson

    1997-01-01

    The pine engraver, Ips pini (Say), is one of the most common and widely distributed bark beetles in North America. It occurs from southern Appalachia north to Maine and Quebec, westward across the northern United States and Canada, into the interior of Alaska, throughout the Pacific Coast States and the Rocky Mountain region, to northern Mexico. In the western United...

  14. The Organization of Paralympic Sport in the United States

    Science.gov (United States)

    Walsh, Joe; Mushett, Mike

    2012-01-01

    In the United States, Paralympic sport is governed by the United States Olympic Committee (USOC), as set forth in the Ted Stevens Olympic and Amateur Sports Act of 1998. The USOC formed a dedicated Paralympic Division in 2001 to manage this responsibility in close cooperation with other USOC divisions and many of the sport-specific national…

  15. Preparation of School Psychologists in the United States

    Science.gov (United States)

    Joyce-Beaulieu, Diana; Rossen, Eric

    2014-01-01

    School psychology in the United States continues to evolve in response to shifts in the country's demographic characteristics, an increasing focus on the importance of child mental health, together with health and education reforms. The landscape of school psychological services in the United States also is shaped through the changing roles and…

  16. Preparation of School Psychologists in the United States

    Science.gov (United States)

    Joyce-Beaulieu, Diana; Rossen, Eric

    2014-01-01

    School psychology in the United States continues to evolve in response to shifts in the country's demographic characteristics, an increasing focus on the importance of child mental health, together with health and education reforms. The landscape of school psychological services in the United States also is shaped through the changing roles and…

  17. 78 FR 26425 - Sentencing Guidelines for United States Courts

    Science.gov (United States)

    2013-05-06

    ..., the simple movement of a stolen trade secret within a domestic multinational company (e.g., from a United States office to an overseas office of the same company) may not pose the same risks or harms. More generally, the Commission heard that foreign actors increasingly target United States companies...

  18. Inpatient Financial Burden of Atopic Dermatitis in the United States

    DEFF Research Database (Denmark)

    Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

    2017-01-01

    Little is known about the inpatient burden of atopic dermatitis (AD). We sought to determine the risk factors and financial burden of hospitalizations for AD in the United States. Data were analyzed from the 2002-2012 National Inpatient Sample, including a 20% representative sample of all......, there is a substantial inpatient financial burden of AD in the United States....

  19. Hospitalization for esophageal achalasia in the United States

    Institute of Scientific and Technical Information of China (English)

    Daniela; Molena; Benedetto; Mungo; Miloslawa; Stem; Anne; O; Lidor

    2015-01-01

    AIM: To assess the outcome of different treatments in patients admitted for esophageal achalasia in the United States.METHODS: This is a retrospective analysis using the Nationwide Inpatient Sample over an 8-year period(2003-2010). Patients admitted with a primary diagnosis of achalasia were divided into 3 groups based on their treatment:(1) Group 1: patients who underwent Heller myotomy during their hospital stay;(2) Group 2: patients who underwent esophagectomy; and(3) Group 3: patients not undergoing surgical treatment. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay(LOS), discharge destination and total hospital charges.RESULTS: Among 27141 patients admitted with achalasia, nearly half(48.5%) underwent Heller myotomy, 2.5% underwent esophagectomy and 49.0% had endoscopic or other treatment. Patients in group 1 were younger, healthier, and had the lowest mortality when compared with the other two groups. Group 2 had the highest LOS and hospital charges among all groups. Group 3 had the highest mortality(1.2%, P < 0.001) and the lowest home discharge rate(78.8%) when compared to the other groups. The most frequently performed procedures among group 3 were esophageal dilatation(25.9%) and injection(13.3%). Among patients who died in this group the most common associated morbidities included acute respiratory failure, sepsis and aspiration pneumonia. CONCLUSION: Surgery for achalasia carries exceedingly low mortality in the modern era; however, in complicated patients, even less invasive treatments are burdened bysignificant mortality and morbidity.

  20. Sociodemographic and Geographic Predictors of Quality of Care in United States Patients With End-Stage Renal Disease Due to Lupus Nephritis

    Science.gov (United States)

    Plantinga, Laura C.; Drenkard, Cristina; Patzer, Rachel E.; Klein, Mitchel; Kramer, Michael R.; Pastan, Stephen; Lim, S. Sam; McClellan, William M.

    2017-01-01

    Objective To describe end-stage renal disease (ESRD) quality of care (receipt of pre-ESRD nephrology care, access to kidney transplantation, and placement of permanent vascular access for dialysis) in US patients with ESRD due to lupus nephritis (LN-ESRD) and to examine whether quality measures differ by patient sociodemographic characteristics or US region. Methods National surveillance data on patients in the US in whom treatment for LN-ESRD was initiated between July 2005 and September 2011 (n = 6,594) were analyzed. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were determined for each quality measure, according to sociodemographic factors and US region. Results Overall, 71% of the patients received nephrology care prior to ESRD. Black and Hispanic patients were less likely than white patients to receive pre-ESRD care (OR 0.73 [95% CI 0.63–0.85] and OR 0.73 [95% CI 0.60–0.88], respectively) and to be placed on the kidney transplant waitlist within the first year after the start of ESRD (HR 0.78 [95% CI 0.68–0.91] and HR 0.82 [95% CI 0.68–0.98], respectively). Those with Medicaid (HR 0.51 [95% CI 0.44–0.58]) or no insurance (HR 0.36 [95% CI 0.29–0.44]) were less likely than those with private insurance to be placed on the waitlist. Only 24% had a permanent vascular access, and placement was even less likely among the uninsured (OR 0.62 [95% CI 0.49–0.79]). ESRD quality-of-care measures varied 2–3-fold across regions of the US, with patients in the Northeast and Northwest generally having higher probabilities of adequate care. Conclusion LN-ESRD patients have suboptimal ESRD care, particularly with regard to placement of dialysis vascular access. Minority race/ethnicity and lack of private insurance are associated with inadequate ESRD care. Further studies are warranted to examine multilevel barriers to, and develop targeted interventions to improve delivery of, care among patients with LN-ESRD. PMID:25692867

  1. United States Automotive Materials Partnership LLC (USAMP)

    Energy Technology Data Exchange (ETDEWEB)

    United States Automotive Materials Partnership

    2011-01-31

    The United States Automotive Materials Partnership LLC (USAMP) was formed in 1993 as a partnership between Chrysler Corporation, Ford Motor Company, and General Motors Corporation. Since then the U.S. Department of Energy (DOE) has supported its activities with funding and technical support. The mission of the USAMP is to conduct vehicle-oriented research and development in materials and materials processing to improve the competitiveness of the U.S. Auto Industry. Its specific goals are: (1) To conduct joint research to further the development of lightweight materials for improved automotive fuel economy; and (2) To work with the Federal government to explore opportunities for cooperative programs with the national laboratories, Federal agencies such as the DOE and universities. As a major component of the DOE's Office of FreedomCAR and Vehicle Technologies Program (FCVT) collaboration with the USAMP, the Automotive Lightweighting Materials (ALM) program focuses on the development and validation of advanced materials and manufacturing technologies to significantly reduce automotive vehicle body and chassis weight without compromising other attributes such as safety, performance, recyclability, and cost. The FCVT was announced in FY 2002 and implemented in FY 2003, as a successor of the Partnership for a New Generation of Vehicles (PNGV), largely addressed under the first Cooperative Agreement. This second USAMP Cooperative Agreement with the DOE has expanded a unique and valuable framework for collaboratively directing industry and government research efforts toward the development of technologies capable of solving important societal problems related to automobile transportation. USAMP efforts are conducted by the domestic automobile manufacturers, in collaboration with materials and manufacturing suppliers, national laboratories, universities, and other technology or trade organizations. These interactions provide a direct route for implementing newly

  2. Changes in Characteristics and Treatment Patterns of Patients with Newly Diagnosed Type 2 Diabetes in a Large United States Integrated Health System between 2008 and 2013

    Science.gov (United States)

    Pantalone, Kevin M.; Hobbs, Todd M.; Wells, Brian J.; Kong, Sheldon X.; Kattan, Michael W.; Bouchard, Jonathan; Chagin, Kevin M.; Yu, Changhong; Sakurada, Brian; Milinovich, Alex; Weng, Wayne; Bauman, Janine M.; Zimmerman, Robert S.

    2016-01-01

    To assess changes in the clinical characteristics and treatment patterns of patients with newly diagnosed type 2 diabetes (T2D), the electronic health record system at Cleveland Clinic was used to create cross-sectional summaries of all patients with new-onset T2D in 2008 and 2013. Differences between the 2008 and 2013 data sets were assessed after adjusting for age, gender, race, and income. Approximately one-third of patients with newly diagnosed T2D in 2008 and 2013 had an A1C ≥8%, suggesting the continued presence of a delayed recognition of the disease. Patients with newly diagnosed T2D in 2008 were older than those in 2013. Hypertension, cardiovascular disease, and neuropathy were highly prevalent among patients diagnosed with T2D. The prevalence of neuropathy, cerebrovascular disease, and peripheral vascular disease increased from 2008 to 2013. Metformin was the most commonly prescribed antidiabetic medication. Sulfonylurea usage remained unchanged, while use of thiazolidinediones decreased considerably. PMID:27398040

  3. The Impact of Race in Male Breast Cancer Treatment and Outcome in the United States: A Population-Based Analysis of 4,279 Patients

    Directory of Open Access Journals (Sweden)

    Jacob Y. Shin

    2014-01-01

    Full Text Available The purpose of this study is to compare the racial differences in treatment and overall survival (OS of male breast cancer (MBC patients. Data were extracted from the NCI SEER database that included population-based registries from 1988 to 2010 and analyzed using SPSS 20.0. 4,279 MBC patients were identified. 3,266 (76.3% patients were White, 552 (12.9% Black, 246 (5.7% Hispanic, and 215 (5.0% Asian. Black patients were more likely to be diagnosed at younger age (P<0.001, have advanced stage disease (P=0.001, and be unmarried (P<0.001 and less likely to undergo lymph node dissection (P=0.006. When stratified by stage, there was no difference in receipt of primary treatment by race. The 5-year OS for White, Black, Hispanic, and Asian races was 73.8%, 66.3%, 74.0%, and 85.3% (P<0.001. This significant worse 5-year OS for Blacks persisted regardless of age, stage II or III disease, and grade 2 or 3 disease. On multivariate analysis, Black race was a significant independent prognostic factor for worse OS. Blacks were less likely to receive lymph node dissection of which patients may derive benefit, though we did not observe receipt of primary treatment, after stratifying for disease stage, to be an underlying factor contributing to racial outcome differences.

  4. Does racism affect health? Evidence from the United States and the United Kingdom.

    Science.gov (United States)

    Muennig, Peter; Murphy, Michael

    2011-02-01

    Blacks have worse overall health than whites in both the United States and the United Kingdom. However, the relative difference in health between the two groups within each cultural context differs between each context. In this article, we attempt to glean insights into these health disparities. We do so by first examining what is currently known about differences in morbidity and mortality for blacks and whites in the United States and the United Kingdom. We then turn to medical examination data by race and country of birth in an attempt to further untangle the complex interplay of socioeconomic status (SES), race, and racism as determinants of health in the United States and the United Kingdom. We find that (1) longer exposure of blacks to the recipient country is a risk for mortality in the United States but not in the United Kingdom; (2) adjustment for SES matters a good deal for mortality in the United States, but less so in the United Kingdom; (3) morbidity indicators do not paint a clear picture of black disadvantage relative to whites in either context; and (4) were one to consider medical examination data alone, differences between the two groups exist only in the United States. Taken together, we conclude that it is possible that the "less racist" United Kingdom provides a healthier environment for blacks than the United States. However, there remain many mysteries that escape simple explanation. Our findings raise more questions than they answer, and the health risks and health status of blacks in the United States are much more complex than previously thought.

  5. Leveling of Tuberculosis Incidence - United States, 2013-2015.

    Science.gov (United States)

    Salinas, Jorge L; Mindra, Godwin; Haddad, Maryam B; Pratt, Robert; Price, Sandy F; Langer, Adam J

    2016-03-25

    After 2 decades of progress toward tuberculosis (TB) elimination with annual decreases of ≥0.2 cases per 100,000 persons (1), TB incidence in the United States remained approximately 3.0 cases per 100,000 persons during 2013-2015. Preliminary data reported to the National Tuberculosis Surveillance System indicate that TB incidence among foreign-born persons in the United States (15.1 cases per 100,000) has remained approximately 13 times the incidence among U.S.-born persons (1.2 cases per 100,000). Resuming progress toward TB elimination in the United States will require intensification of efforts both in the United States and globally, including increasing U.S. efforts to detect and treat latent TB infection, strengthening systems to interrupt TB transmission in the United States and globally, accelerating reductions in TB globally, particularly in the countries of origin for most U.S.

  6. National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011

    Science.gov (United States)

    Ho, Allen L.; Li, Alexander Y.; Sussman, Eric S.; Pendharkar, Arjun V.; Iyer, Aditya; Thompson, Patricia A.; Tayag, Armine T.; Chang, Steven D.

    2016-01-01

    Purpose This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Methods and materials Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 – 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Results Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. Conclusions As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are

  7. Introduction of Eucalyptus spp. into the United States with Special Emphasis on the Southern United States

    Directory of Open Access Journals (Sweden)

    R. C. Kellison

    2013-01-01

    Full Text Available Introduction of Eucalyptus spp. into the United States from Australia on a significant scale resulted from the gold rush into California in 1849. Numerous species were evaluated for fuel, wood products, and amenity purposes. The first recorded entry of eucalyptus into the southern United Stated was in 1878. Subsequent performance of selected species for ornamental purposes caused forest industry to visualize plantations for fiber production. That interest led the Florida Forestry Foundation to initiate species-introduction trials in 1959. The results were sufficiently promising that a contingent of forest products companies formed a cooperative to work with the USDA Forest Service, Lehigh Acres, FL, USA, on genetic improvement of selected species for fiber production. The Florida initiative caused other industrial forestry companies in the upper South to establish plantations regardless of the species or seed source. The result was invariably the same: failure. Bruce Zobel, Professor of Forestry, North Carolina State University, initiated a concerted effort to assess the potential worth of eucalyptus for plantation use. The joint industrial effort evaluated 569 sources representing 103 species over a 14-year period. The three levels of testing, screening, in-depth, and semioperational trials led to identification of some species and sources that offered promise for adaptation, but severe winter temperatures in late 1983 and early 1984 and 1985 terminated the project. Despite the failed attempt valuable silvicultural practices were ascertained that will be beneficial to other researchers and practitioners when attempts are again made to introduce the species complex into the US South.

  8. Adherence and persistence in patients with type 2 diabetes mellitus newly initiating canagliflozin, dapagliflozin, dpp-4s, or glp-1s in the United States.

    Science.gov (United States)

    Cai, Jennifer; Divino, Victoria; Burudpakdee, Chakkarin

    2017-07-01

    Sodium-glucose co-transporter 2 inhibitors were first approved in the US in 2013; therefore, real-world (RW) studies describing outcomes are limited. This retrospective study evaluated adherence and persistence among patients initiating canagliflozin (CANA), dapagliflozin (DAPA), GLP-1 agonists (GLP-1s), and DPP-4 inhibitors (DPP-4s) over a 12-month follow-up from a US managed care perspective. Patients newly initiating CANA, DAPA, GLP-1s, or DPP-4s from February 1, 2014-June 30, 2014 were identified from the QuintilesIMS PharMetrics Plus Database. The first fill defined the index date/drug. Patients were required to have a T2DM diagnosis (ICD-9-CM 250.x[0,2]) and ≥12 months of continuous enrollment pre- and post-index (follow-up). Main outcome measures were adherence (proportion of days covered, PDC; medication possession ratio, MPR) and persistence on index therapy. PDC or MPR ≥0.80 was considered adherent. Patients were considered persistent until evidence of discontinuation (gap ≥90 days between two subsequent index therapy prescriptions). Kaplan-Meier (KM) analysis assessed time to discontinuation, while a Cox proportional hazards model (PHM) evaluated risk of discontinuation. Logistic regression models evaluated the likelihood of non-adherence. The final sample consisted of 23,702 patients (6,546 CANA, 3,087 DAPA, 6,273 GLP-1s, and 7,796 DPP-4s; 56% male, and mean [SD] age = 55 [9.1] years). Mean PDC ranged from 0.56 (GLP-1), to 0.71 (CANA), with 33-56% adherent, respectively; MPR results were similar. Fifty-two per cent (GLP-1) to 68% (CANA) were persistent over the follow-up. CANA patients had the longest time to discontinuation. In regression analyses, compared to CANA 100 mg, DAPA, DPP-4, and GLP-1 patients had a significantly higher likelihood of non-adherence and a significantly higher risk of discontinuation. CANA 300 mg patients had a significantly lower likelihood of non-adherence and a significantly lower risk of discontinuation

  9. Concussions Among United States High School and Collegiate Athletes

    Science.gov (United States)

    Gessel, Luke M; Fields, Sarah K; Collins, Christy L; Dick, Randall W; Comstock, R. Dawn

    2007-01-01

    Context: An estimated 300 000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States. Sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury among people aged 15 to 24 years. Objective: To investigate the epidemiology of concussions in a nationally representative sample of high school athletes and to compare rates of concussion among high school and collegiate athletes. Design: Descriptive epidemiologic study Setting: 100 United States high schools and 180 US colleges. Patients or Other Participants: United States high school and collegiate athletes. Main Outcome Measure(s): Data from 2 injury surveillance systems, High School Reporting Information Online (RIO) and the National Collegiate Athletic Association Injury Surveillance System, were analyzed to calculate rates, describe patterns, and evaluate potential risk factors for sport-related concussion. Results: Concussions represented 8.9% (n = 396) of all high school athletic injuries and 5.8% (n = 482) of all collegiate athletic injuries. Among both groups, rates of concussions were highest in the sports of football and soccer. In high school sports played by both sexes, girls sustained a higher rate of concussions, and concussions represented a greater proportion of total injuries than in boys. In all sports, collegiate athletes had higher rates of concussion than high school athletes, but concussions represented a greater proportion of all injuries among high school athletes. Conclusions: Sport-related injury surveillance systems can provide scientific data to drive targeted injury-prevention projects. Developing effective sport-related concussion preventive measures depends upon increasing our knowledge of concussion rates, patterns, and risk factors. PMID:18174937

  10. Patient education in Europe: united differences.

    Science.gov (United States)

    Visser, A; Deccache, A; Bensing, J

    2001-07-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education is defined as all the educational activities directed to patients, including aspects of therapeutic education, health education and clinical health promotion. Five important factors are identified in the development of patient education: (1) research and evidence based standards; (2) the organization of care; (3) training and methodological support; (4) professional values; and (5) acknowledgment, funding and place of patient education in health policy. Several of the discussed common orientations and priorities in the patient education in the reviewed countries are highlighted in this issue. And finally, an example of the possible integrated international practice in patient education in the field of diabetes is described in this issue. Several conclusions are drawn concerning future development of communication in health care within the framework of patient education in Europe.

  11. Forest Resources of the United States, 2002

    Science.gov (United States)

    W. Brad Smith; Patrick D. Miles; John S. Vissage; Scott A. Pugh

    2004-01-01

    Forest resource growth, harvests, and land use conversion can change inventories within States, among regions, and even among countries, and can significantly influence the future performance of resources. This could affect the State, regional, and national economies that depend on the affected resources, as well as the resource environments. Periodic surveys provide...

  12. Competitive Electricity Market Regulation in the United States: A Primer

    Energy Technology Data Exchange (ETDEWEB)

    Flores-Espino, Francisco [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tian, Tian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, Mackay [National Grid, Warwick (United Kingdom)

    2016-12-01

    The electricity system in the United States is a complex mechanism where different technologies, jurisdictions and regulatory designs interact. Today, two major models for electricity commercialization operate in the United States. One is the regulated monopoly model, in which vertically integrated electricity providers are regulated by state commissions. The other is the competitive model, in which power producers can openly access transmission infrastructure and participate in wholesale electricity markets. This paper describes the origins, evolution, and current status of the regulations that enable competitive markets in the United States.

  13. Draft Genome Sequences of Three Clinical Isolates of Tannerella forsythia Isolated from Subgingival Plaque from Periodontitis Patients in the United States

    OpenAIRE

    Stafford, G.P.; Chaudhuri, R. R.; Haraszthy, V.; Friedrich, V.; Schäffer, C.; Ruscitto, A.; Honma, K.; Sharma, A.

    2016-01-01

    We report the genome sequences of three clinical isolates of Tannerella forsythia from the subgingival plaque of periodontitis patients attending clinics at the School of Dental Medicine, University at Buffalo. The availability of these genome sequences will aid the understanding of the pathogenesis of periodontitis.

  14. Draft Genome Sequences of Three Clinical Isolates of Tannerella forsythia Isolated from Subgingival Plaque from Periodontitis Patients in the United States.

    Science.gov (United States)

    Stafford, Graham P; Chaudhuri, Roy R; Haraszthy, Violet; Friedrich, Valentin; Schäffer, Christina; Ruscitto, Angela; Honma, Kiyonobu; Sharma, Ashu

    2016-12-01

    We report the genome sequences of three clinical isolates of Tannerella forsythia from the subgingival plaque of periodontitis patients attending clinics at the School of Dental Medicine, University at Buffalo. The availability of these genome sequences will aid the understanding of the pathogenesis of periodontitis.

  15. Medical tourism services available to residents of the United States.

    Science.gov (United States)

    Alleman, Brandon W; Luger, Tana; Reisinger, Heather Schacht; Martin, Rene; Horowitz, Michael D; Cram, Peter

    2011-05-01

    There are growing reports of United States (US) residents traveling overseas for medical care, but empirical data about medical tourism are limited. To characterize the businesses and business practices of entities promoting medical tourism and the types and costs of procedures being offered. DESIGN, PARTICIPANTS, AND OUTCOMES: Between June and August 2008, we conducted a telephone survey of all businesses engaged in facilitating overseas medical travel for US residents. We collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. We identified 63 medical tourism companies and 45 completed our survey (71%). Companies had a mean of 9.8 employees and had referred an average of 285 patients overseas (a total of approximately 13,500 patients). 35 (79%) companies reported requiring accreditation of foreign providers, 22 (50%) collected patient outcome data, but only 17 (39%) described formal medical records security policies. The most common destinations were India (23 companies, 55%), Costa Rica (14, 33%), and Thailand (12, 29%). The most common types of care included orthopedics (32 companies, 73%), cardiac care (23, 52%), and cosmetic surgery (29, 66%). 20 companies (44%) offered treatments not approved for use in the US--most commonly stem cell therapy. Average costs for common procedures, CABG ($18,600) and knee arthroplasty ($10,800), were similar to previous reports. The number of Americans traveling overseas for medical care with assistance from medical tourism companies is relatively small. Attention to medical records security and patient outcomes is variable and cost-savings are dependent on US prices. That said, overseas medical care can be a reasonable alternative for price sensitive patients in need of relatively common, elective medical

  16. Impact of patient adherence on the cost-effectiveness of noninvasive tests for the initial diagnosis of Helicobacter pylori infection in the United States

    Directory of Open Access Journals (Sweden)

    Boklage SH

    2016-01-01

    Full Text Available Susan H Boklage,1 Allen W Mangel,2 Varun Ramamohan,2 Deirdre Mladsi,2 Tao Wang1 1Otsuka America Pharmaceutical Inc, Princeton, NJ, 2RTI Health Solutions, Research Triangle Park, NC, USA Objective: Previous US-based economic models of noninvasive tests for diagnosis of Helicobacter pylori infection did not consider patient adherence or downstream costs of continuing infection. This analysis evaluated the long-term cost-effectiveness of the urea breath test (UBT, fecal antigen test (FAT, and serology for diagnosis of H. pylori infection after incorporating information regarding test adherence.Materials and methods: A decision-analytic model incorporating adherence information evaluated the cost-effectiveness of the UBT, FAT, and serology for diagnosis of H. pylori infection. Positive test results led to first-line triple therapy; no further action was taken for nonadherence or negative results. Excess lifetime costs and reduced quality-adjusted life-years (QALYs were estimated for patients with continuing H. pylori infection.Results: In the base-case scenario with estimated adherence rates of 86%, 48%, and 86% for the UBT, monoclonal FAT, and serology, respectively, corresponding expected total costs were US$424.99, $466.41, and $404.98/patient. Test costs were higher for the UBT, but were fully or partially offset by higher excess lifetime costs for the monoclonal FAT and serology. The QALYs gained/patient with the UBT vs monoclonal FAT and serology were 0.86 and 0.27, respectively. The UBT was dominant vs the monoclonal FAT, leading to lower costs and higher QALYs; the UBT was cost-effective vs serology (incremental cost/QALY gained $74.Conclusion: Based on a comprehensive modeled analysis that included consideration of patient test adherence and long-term consequences resulting from continuing H. pylori infection, the UBT provided the greatest economic value among noninvasive tests for diagnosis of H. pylori infection, because of high patient

  17. A comparison of stigma among patients with leprosy in rural Tanzania and urban United States: a role for public health in dermatology.

    Science.gov (United States)

    Roosta, Neda; Black, David S; Rea, Thomas H

    2013-04-01

      Leprosy is a chronic infection of the skin and peripheral nerves caused by the bacterium Mycobacterium leprae, which causes peripheral insensitivity and disfigurements of the skin, limbs, and digits. Social stigma is a common consequence of leprosy and may differ according to level of physical disfigurement and geographic location. The objective of this study was to assess social stigma encountered by patients with leprosy in clinical settings located in rural Tanzania and urban USA and to compare the social stigma reported in these regions.   A total of 56 respondents were recruited from one leprosy inpatient facility in Shirati, Tanzania (n = 28), and one outpatient clinic in Los Angeles, USA (n = 28). Cross-sectional data were obtained from face-to-face interviews, which were conducted with respondents at each clinic location. Measures of perceived stigma were assessed in family relationship, vocational, social interaction, and interpersonal contexts.   Patients in Tanzania, as compared with those in the USA, reported significantly higher levels of stigma in family relationship and vocational contexts. Tanzanian patients also reported higher levels of stigma in social interaction and self-esteem contexts, but these differences were marginally significant and may reflect the small sample size.   Leprosy-related social stigma is a major problem in regions of both developed and developing countries; however, patients with leprosy in developing countries reported higher levels of stigma in four social contexts. A public health role in dermatology is discussed as an agent of early diagnosis, control, and education in order to reduce social stigma and promote social rehabilitation. © 2013 The International Society of Dermatology.

  18. Impact of the healthcare payment system on patient access to oral anticancer drugs: an illustration from the French and United States contexts

    OpenAIRE

    Benjamin, Laure; Buthion, Valérie; Vidal-Trécan, Gwenaëlle; Briot, Pascal

    2014-01-01

    Background Oral anticancer drugs (OADs) allow treating a growing range of cancers. Despite their convenience, their acceptance by healthcare professionals and patients may be affected by medical, economical and organizational factors. The way the healthcare payment system (HPS) reimburses OADs or finances hospital activities may impact patients’ access to such drugs. We discuss how the HPS in France and USA may generate disincentives to the use of OADs in certain circumstances. Discussion Fre...

  19. Impact of the increased adoption of prenatal cfDNA screening on non-profit patient advocacy organizations in the United States.

    Science.gov (United States)

    Meredith, Stephanie; Kaposy, Christopher; Miller, Victoria J; Allyse, Megan; Chandrasekharan, Subhashini; Michie, Marsha

    2016-08-01

    The 'Stakeholder Perspectives on Noninvasive Prenatal Genetic Screening' Symposium was held in conjunction with the 2015 annual meeting of the International Society for Prenatal Diagnosis. During the day-long meeting, a panel of patient advocacy group (PAG) representatives discussed concerns and challenges raised by prenatal cell-free DNA (cfDNA) screening, which has resulted in larger demands upon PAGs from concerned patients receiving prenatal cfDNA screening results. Prominent concerns included confusion about the accuracy of cfDNA screening and a lack of patient education resources about genetic conditions included in cfDNA screens. Some of the challenges faced by PAGs included funding limitations, lack of consistently implemented standards of care and oversight, diverse perspectives among PAGs and questions about neutrality, and lack of access to training and genetic counselors. PAG representatives also put forward suggestions for addressing these challenges, including improving educational and PAG funding and increasing collaboration between PAGs and the medical community. © 2016 John Wiley & Sons, Ltd.

  20. North Atlantic Treaty Organization, the United States, and International Legitimacy

    Science.gov (United States)

    2014-05-22

    8. 42Following the signing of the Treaty of Versailles in 1919, the Albanian State was created but with only one-half of the Albanian population...NORTH ATLANTIC TREATY ORGANIZATION, THE UNITED STATES, AND INTERNATIONAL LEGITIMACY A Monograph by MAJ Mark Van Gelder...North Atlantic Treaty Organization, The United States, and International Legitimacy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT

  1. Geothermal overviews of the western United States

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, D.N.; Axtell, L.H. (comps.)

    1972-01-01

    This compendium presents data on geothermal resources for all those western states with geothermal potential. Individual sections, which have been processed separately for inclusion in the EDB data base, are devoted to each of the following states: Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. A separate section is also devoted to the U.S. Bureau of Reclamation Imperial Valley Project. Maps and references are included for each section. (JGB)

  2. United States Automotive Materials Partnership LLC (USAMP)

    Energy Technology Data Exchange (ETDEWEB)

    United States Automotive Materials Partnership

    2011-01-31

    The United States Automotive Materials Partnership LLC (USAMP) was formed in 1993 as a partnership between Chrysler Corporation, Ford Motor Company, and General Motors Corporation. Since then the U.S. Department of Energy (DOE) has supported its activities with funding and technical support. The mission of the USAMP is to conduct vehicle-oriented research and development in materials and materials processing to improve the competitiveness of the U.S. Auto Industry. Its specific goals are: (1) To conduct joint research to further the development of lightweight materials for improved automotive fuel economy; and (2) To work with the Federal government to explore opportunities for cooperative programs with the national laboratories, Federal agencies such as the DOE and universities. As a major component of the DOE's Office of FreedomCAR and Vehicle Technologies Program (FCVT) collaboration with the USAMP, the Automotive Lightweighting Materials (ALM) program focuses on the development and validation of advanced materials and manufacturing technologies to significantly reduce automotive vehicle body and chassis weight without compromising other attributes such as safety, performance, recyclability, and cost. The FCVT was announced in FY 2002 and implemented in FY 2003, as a successor of the Partnership for a New Generation of Vehicles (PNGV), largely addressed under the first Cooperative Agreement. This second USAMP Cooperative Agreement with the DOE has expanded a unique and valuable framework for collaboratively directing industry and government research efforts toward the development of technologies capable of solving important societal problems related to automobile transportation. USAMP efforts are conducted by the domestic automobile manufacturers, in collaboration with materials and manufacturing suppliers, national laboratories, universities, and other technology or trade organizations. These interactions provide a direct route for implementing newly

  3. Toxaphene in the United States: 1. Usage gridding

    Science.gov (United States)

    Li, Y. F.

    2001-08-01

    Toxaphene, as a general-purpose insecticide, was widely used in the United States. The use of toxaphene in the United States can be divided into four different periods between 1947 and 1986, with total usage of about 490 kt, and total production around 720 kt. Inventories of gridded usage of toxaphene in the United States with 1/6° by 1/4° latitude/longitude resolution have been created by using different gridded cropland and cattle as surrogate data. The intensive use of toxaphene on croplands was concentrated in the southeastern part of the United States with the highest usage of 2 kt per grid cell. The results show that the state of Alabama was the largest user of toxaphene, reaching as much as 87 kt, followed by Mississippi at 60 kt. The total usage in the top 10 states is 410 kt, 84% of the national usage in the United States. The use in the first six states, Alabama, Mississippi, Georgia, Arkansas, Texas, and South Carolina, is 350 kt, 71% of the national usage in the United States.

  4. Clinical and economic burden of chemotherapy-induced nausea and vomiting among patients with cancer in a hospital outpatient setting in the United States.

    Science.gov (United States)

    Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

    2011-01-01

    This study evaluated the overall burden of illness of chemotherapy-induced nausea and vomiting (CINV) and associated all-cause costs from a hospital's perspective (costs to the hospital) in patients with cancer treated with chemotherapy (CT) in the US hospital outpatient setting. Patients with a cancer diagnosis aged ≥18 years initiating CT in a hospital outpatient setting for the first time between April 1 2007 and March 31 2009 were extracted from the Premier Perspective Database. Patients were followed through eight CT cycles or 6 months post-index date, whichever occurred first. Within each CT cycle, the follow-up time for CINV event estimation was from day 1 (except rescue medication use that was identified from day 2) to cycle end. A multivariate regression model was developed to predict the CINV event rate per CT cycle in the study follow-up period. Associated total all-cause costs of managing CINV from a hospital's perspective were analyzed descriptively. Event rate and associated costs were estimated in the entire hospital setting (outpatient, inpatient, and emergency room). All-cause costs included inpatient, hospital outpatient, and ER visit costs (identified through a primary or secondary diagnosis code for nausea, vomiting, and/or volume depletion) and pharmacy cost (rescue medications for CINV treatment). All physician costs and non CINV-related treatment (pharmacy) costs were excluded from the analyses. Among 11,495 study patients, 8,806 patients (76.6%) received prophylaxis for all cycles in the follow-up period. The overall base population had an average age of 63.3 years, was 51.0% female, and 72.7% White. The distribution of emetogenicity for cycle 1 CT cycle was 26.0% HEC, 46.1% MEC, and 26.4% LEC/MinEC combined. In the follow-up period, a total of 47,988 CINV events with an associated total all-cause treatment cost of $89 million were observed. Average daily treatment cost for all care settings was $1854.7. The regression model predicted a 20

  5. Incidence rates and deaths of tuberculosis in HIV-negative patients in the United States and Germany as analyzed by new predictive model for infection.

    Science.gov (United States)

    Ren, Yudong; Ding, Fan; Suo, Siqingaowa; Bu, Ri-e; Zarlenga, Dante S; Ren, Xiaofeng

    2012-01-01

    Incidence and mortality due to tuberculosis (TB) have been decreasing worldwide. Given that TB is a cosmopolitan disease, proper surveillance and evaluation are critical for controlling dissemination. Herein, mathematical modeling was performed in order to: 1) demonstrate a correlation between the incidence of TB in HIV-free patients in the US and Germany, and their corresponding mortality rates; 2) show the utility of the newly developed D-R algorithm for analyzing and predicting the incidence of TB in both countries; and 3) inform us on population death rates due to TB in HIV-negative patients. Using data published by the World Health Organization between 1990 and 2009, the relationship between incidence and mortality that could not be ascribed to HIV infection was evaluated. Using linear, quadratic and cubic curves, we found that a cubic function provided the best fit with the data in both the US (Y = 2.3588+2.2459X+61.1639X(2)-60.104X(3)) and Germany (Y = 1.9271+9.4967X+18.3824X(2)-10.350X(3)) where the correlation coefficient (R) between incidence and mortality was 0.995 and 0.993, respectively. Second, we demonstrated that fitted curves using the D-R model were equal to or better than those generated using the GM(1,1) algorithm as exemplified in the relative values for Sum of Squares of Error, Relative Standard Error, Mean Absolute Deviation, Average Relative Error, and Mean Absolute Percentage Error. Finally, future trends using both the D-R and the classic GM(1,1) models predicted a continued decline in infection and mortality rates of TB in HIV-negative patients rates extending to 2015 assuming no changes to diagnosis or treatment regimens are enacted.

  6. Borrelia mayonii sp. nov., a member of the Borrelia burgdorferi sensu lato complex, detected in patients and ticks in the upper midwestern United States.

    Science.gov (United States)

    Pritt, Bobbi S; Respicio-Kingry, Laurel B; Sloan, Lynne M; Schriefer, Martin E; Replogle, Adam J; Bjork, Jenna; Liu, Gongping; Kingry, Luke C; Mead, Paul S; Neitzel, David F; Schiffman, Elizabeth; Hoang Johnson, Diep K; Davis, Jeffrey P; Paskewitz, Susan M; Boxrud, David; Deedon, Alecia; Lee, Xia; Miller, Tracy K; Feist, Michelle A; Steward, Christopher R; Theel, Elitza S; Patel, Robin; Irish, Cole L; Petersen, Jeannine M

    2016-11-01

    Lyme borreliosis (LB) is a multisystem disease caused by spirochetes in the Borrelia burgdorferisensu lato (Bbsl) genospecies complex. We previously described a novel Bbsl genospecies (type strain MN14-1420T) that causes LB among patients with exposures to ticks in the upper midwestern USA. Patients infected with the novel Bbsl genospecies demonstrated higher levels of spirochetemia and somewhat differing clinical symptoms as compared with those infected with other Bbsl genospecies. The organism was detected from human specimens using PCR, microscopy, serology and culture. The taxonomic status was determined using an eight-housekeeping-gene (uvrA, rplB, recG, pyrG, pepX, clpX, clpA and nifS) multi-locus sequence analysis (MLSA) and comparison of 16S rRNA gene, flaB, rrf-rrl, ospC and oppA2 nucleotide sequences. Using a system threshold of 98.3 % similarity for delineation of Bbsl genospecies by MLSA, we demonstrated that the novel species is a member of the Bbsl genospecies complex, most closely related to B. burgdorferisensu stricto (94.7-94.9 % similarity). This same species was identified in Ixodes scapularis ticks collected in Minnesota and Wisconsin. This novel species, Borrelia mayonii sp. nov, is formally described here. The type strain, MN14-1420, is available through the Deutsche Sammlung von Mikroorganismen und Zelkulturen GmbH (DSM 102811) and the American Type Culture Collection (ATCC BAA-2743).

  7. United States Geological Survey, programs in Nevada

    Science.gov (United States)

    ,

    1995-01-01

    The U.S. Geological Survey (USGS) has been collecting and interpreting natural-resources data in Nevada for more than 100 years. This long-term commitment enables planners to manage better the resources of a State noted for paradoxes. Although Nevada is one of the most sparsely populated States in the Nation, it has the fastest growing population (fig. 1). Although 90 percent of the land is rural, it is the fourth most urban State. Nevada is the most arid State and relies heavily on water resources. Historically, mining and agriculture have formed the basis of the economy; now tourism and urban development also have become important. The USGS works with more than 40 local, State, and other Federal agencies in Nevada to provide natural-resources information for immediate and long-term decisions.Subjects included in this fact sheet:Low-Level Radioactive-Waste DisposalMining and Water in the Humboldt BasinAquifer Systems in the Great BasinWater Allocation in Truckee and Carson BasinsNational Water-Quality Assessment ProgramMinerals Assessment for Land ManagementIrrigation DrainageGround-Water Movement at Nevada Test SiteOil and Gas ResourcesNational Mapping ProgramDigital Mapping and Aerial PhotographyCollection of Hydrologlc DataGeologic MappingEarthquake HazardsAssessing Mineral Resources of the SubsurfaceEarth Observation DataCooperative Programs

  8. A Comparison of Brain Death Criteria between China and the United States

    Directory of Open Access Journals (Sweden)

    Ze-Yu Ding

    2015-01-01

    Full Text Available Background: Criteria for determining brain death (BD vary between China and the United States. We reported the results of an investigation designed to compare procedures to determine BD in two countries. Methods: The latest criteria in the United states were published in 2010. The latest criteria in China were published in 2009. We used these two types of BD criteria to evaluate patients who were considered to be BD. The time, cost, and accuracy of the diagnosis were compared. Results: From January 1, 2012 to October 8, 2013, there were 37 patients which were applied for BD evaluation in the Neurological Intensive Care Unit of Beijing Tiantan Hospital. The cause of coma were known as subarachnoid hemorrhage (18 patients, 48.6%, intracerebral hemorrhage (8 patients, 21.6%, cerebral ischemia (9 patients, 24.3%, brain stem tumor (1 patient, 2.7%, and intracranial infection (1 patient, 2.7%. The clinical examinations were done for all of the patients except 1 patient who had low blood pressure. Three patients had brainstem reflexes that were excluded from BD. Twenty-five patients had apnea tests, and 20 tests were completed that were all positive. Confirmatory tests were completed differently: Transcranial Doppler (30 patients, positive rate 86.7%, electroencephalogram (25 patients, positive rate 100%, and somatosensory evoked potential (16 patients, positive rate 100%. Thirty-three patients were diagnosed BD by criteria of the United States. Only 9 patients were diagnosed BD by Chinese criteria. The use of time and money in the USA criteria was obviously fewer than those in Chinese criteria (P = 0.000. Conclusion: Compared with BD criteria of the United States, Chinese criteria were stricter, lower positive rate, more cost in money and time, and more reliable by families and doctors.

  9. 76 FR 13209 - United States and State of Texas v. United Regional Health Care System; Proposed Final Judgment...

    Science.gov (United States)

    2011-03-10

    ... those patients; and (3) reducing quality competition between United Regional and its competitors. In... ``existing in a county with a population of more than 100,000 and a municipality with a population of more... those ] patients; and (3) reduced quality competition between United Regional and its competitors. (1...

  10. Progress toward sodium reduction in the United States.

    Science.gov (United States)

    Levings, Jessica; Cogswell, Mary; Curtis, Christine J; Gunn, Janelle; Neiman, Andrea; Angell, Sonia Y

    2012-10-01

    The average adult in the United States of America consumes well above the recommended daily limit of sodium. Average sodium intake is about 3 463 mg/day, as compared to the 2010 dietary guidelines for Americans recommendation of sodium reduction policies and programs in the United States at the federal, state, and local levels; efforts to monitor the health impact of sodium reduction; ways to assess consumer knowledge, attitudes, and behavior; and how these activities depend on and inform global efforts to reduce sodium intake. Reducing excess sodium intake is a public health opportunity that can save lives and health care dollars in the United States and globally. Future efforts, including sharing successes achieved and barriers identified in the United States and globally, may quicken and enhance progress.

  11. 76 FR 697 - United States-Oman Free Trade Agreement

    Science.gov (United States)

    2011-01-06

    ... States--Oman Free Trade Agreement AGENCY: U.S. Customs and Border Protection, Department of Homeland... Free Trade Agreement entered into by the United States and the Sultanate of Oman. DATES: Interim rule...'') entered into the U.S.--Oman Free Trade Agreement (``OFTA'' or ``Agreement''). The stated objectives of the...

  12. A Comparative Analysis of Indian Gaming in the United States

    Science.gov (United States)

    Ackerman, William V.; Bunch, Rick L.

    2012-01-01

    Previous research on Indian gaming in South Dakota discovered very restrictive and unfavorable tribal-state compacts that appear to border on economic racism. This article expands this previous research by exploring the influence of tribal-state Indian gaming compacts for the Indian casinos located in the contiguous United States. The purpose is…

  13. Babesiosis among Elderly Medicare Beneficiaries, United States, 2006–2008

    Science.gov (United States)

    Anderson, Steven A.; Izurieta, Hector S.; Kumar, Sanjai; Burwen, Dale R.; Gibbs, Jonathan; Kropp, Garner; Erten, Tugce; MaCurdy, Thomas E.; Worrall, Christopher M.; Kelman, Jeffrey A.; Walderhaug, Mark O.

    2012-01-01

    We used administrative databases to assess babesiosis among elderly persons in the United States by year, sex, age, race, state of residence, and diagnosis months during 2006–2008. The highest babesiosis rates were in Connecticut, Rhode Island, New York, and Massachusetts, and findings suggested babesiosis expansion to other states. PMID:22257500

  14. Long-term aridity changes in the western United States.

    Science.gov (United States)

    Cook, Edward R; Woodhouse, Connie A; Eakin, C Mark; Meko, David M; Stahle, David W

    2004-11-01

    The western United States is experiencing a severe multiyear drought that is unprecedented in some hydroclimatic records. Using gridded drought reconstructions that cover most of the western United States over the past 1200 years, we show that this drought pales in comparison to an earlier period of elevated aridity and epic drought in AD 900 to 1300, an interval broadly consistent with the Medieval Warm Period. If elevated aridity in the western United States is a natural response to climate warming, then any trend toward warmer temperatures in the future could lead to a serious long-term increase in aridity over western North America.

  15. Geothermal Energy Potential in Western United States

    Science.gov (United States)

    Pryde, Philip R.

    1977-01-01

    Reviews types of geothermal energy sources in the western states, including hot brine systems and dry steam systems. Conversion to electrical energy is a major potential use of geothermal energy, although it creates environmental disruptions such as noise, corrosion, and scaling of equipment. (AV)

  16. Geothermal Energy Potential in Western United States

    Science.gov (United States)

    Pryde, Philip R.

    1977-01-01

    Reviews types of geothermal energy sources in the western states, including hot brine systems and dry steam systems. Conversion to electrical energy is a major potential use of geothermal energy, although it creates environmental disruptions such as noise, corrosion, and scaling of equipment. (AV)

  17. Forest Resources of the United States, 2007

    Science.gov (United States)

    W. Brad, tech. coord. Smith; Patrick D., data coord. Miles; Charles H., map coord. Perry; Scott A., Data CD coord. Pugh

    2009-01-01

    Forest resource statistics from the 2000 Resources Planning Act (RPA) Assessment were updated to provide current information on the Nation's forests. Resource tables present estimates of forest area, volume, mortality, growth, removals, and timber products output in various ways, such as by ownership, region, or State. Current resource data and trends are analyzed...

  18. Forest Resources of the United States, 1997

    Science.gov (United States)

    W. Brad Smith; John S. Vissage; David R. Darr; Raymond M. Sheffield

    2001-01-01

    Forest resource statistics from the 1987 Resources Planning Act (RPA) Assessment were updated to 1997 to provide current information on the Nation`s forests. Resource tables present estimates of forest area, volume, mortality, growth, removals, and timber products output in various ways, such as by ownership, region, or State. Current resource data are analyzed and...

  19. End-of-life care beliefs among Hindu physicians in the United States.

    Science.gov (United States)

    Ramalingam, Vijaya Sivalingam; Saeed, Fahad; Sinnakirouchenan, Ramapriya; Holley, Jean L; Srinivasan, Sinnakirouchenan

    2015-02-01

    Several studies from the United States and Europe showed that physicians' religiosity is associated with their approach to end-of-life care beliefs. No such studies have focused exclusively on Hindu physicians practicing in the United States. A 34-item questionnaire was sent to 293 Hindu physicians in the United States. Most participants believed that their religious beliefs do not influence their practice of medicine and do not interfere with withdrawal of life support. The US practice of discussing end-of-life issues with the patient, rather than primarily with the family, seems to have been adopted by Hindu physicians practicing in the United States. It is likely that the ethical, cultural, and patient-centered environment of US health care has influenced the practice of end-of-life care by Hindu physicians in this country. © The Author(s) 2013.

  20. Patient-reported prevalence and symptomatic burden of uterine fibroids among women in the United States: findings from a cross-sectional survey analysis

    Directory of Open Access Journals (Sweden)

    Fuldeore MJ

    2017-06-01

    Full Text Available Mahesh J Fuldeore, Ahmed M Soliman Health Economics and Outcomes Research, AbbVie Inc., North Chicago, IL, US Purpose: To estimate the prevalence of women diagnosed with uterine fibroids and the associated symptom burden in the US.Patients and methods: Responses of women aged 18–54 years, who completed an online survey, were analyzed. Data were weighted based on age, education, race, geographic region, income, and propensity score to derive national estimates of the prevalence of women diagnosed with uterine fibroids and associated symptom burden. Weighted means and percentages were reported. Prevalence across age and ethnic groups was examined. Symptom burden among women with and without uterine fibroids was compared using weighted logistic regressions.Results: Of 59,411 respondents who met study inclusion criteria, 7.7% reported receiving a diagnosis of uterine fibroids. Of these, 5,670 women (1,402 in the uterine fibroid group and 4,268 in the control group were excluded from analysis because they had a hysterectomy. Among the non-hysterectomized study participants, 3,031 self-reported a diagnosis of uterine fibroids (prevalence: 5.8%, 95% confidence interval [CI]: 5.5%–6.1%; prevalence increased as women aged and was greatest in the 50–54 age group (11.4%; 95% CI: 10.4%–12.4%. In addition, prevalence was greater in black vs white women (9.8%; 95% CI: 8.7%–11.0% vs 5.4%; 95% CI: 5.1%–5.7%. A greater percentage of women with uterine fibroids (vs those without experienced severe heavy menstrual bleeding (16.7% vs 7.7%, severe constipation/bloating/diarrhea (7.7% vs 4.7%, severe passage of clots (6.7% vs 2.4%, severe spotting/bleeding between periods (1.7% vs 1.0%, and severe pelvic pressure (1.6% vs 0.6%. Among uterine fibroid patients with these typical uterine fibroid-related symptoms, 56.4%, 32.3%, 26.4%, 25.8%, and 20.4% reported heavy menstrual bleeding, passage of clots, spotting/bleeding between periods, constipation

  1. Co-infection of hepatitis B and hepatitis C virus in human immunodeficiency virus-infected patients in New York City, United States

    Institute of Scientific and Technical Information of China (English)

    Jong Hun Kim; George Psevdos Jr; Jin Suh; Victoria Lee Sharp

    2008-01-01

    AIM:To study the prevalence and risk factors associated with triple infection with human immunodeficiency virus (HIV)/hepatitis B virus (HBV)/hepatitis C virus (HCV) in an urban clinic population.METHODS:Retrospective chart review of 5639 patients followed at St.Luke's-Roosevelt Hospital HIV Clinic (Center for Comprehensive Care) in New York City,USA from January 1999 to May 2007.The following demographic characteristics were analyzed:age,sex,race and HIV risk factors.A multiple logistic regression analysis was performed to evaluate the influence of demographic factors on acquisition of these viruses.RESULTS:HIV/HBV,HIV/HCV and HIV/HBV/HCVinfections were detected in 252/5639 (4.47%),1411/5639 (25.02%) and 89/5639 (1.58%) patients,respectively.HIV/HBV co-infections were associated with male gender (OR 1.711; P=0.005),black race (OR 2.091; P < 0.001),men having sex with men (MSM)(OR 1.747; P=0.001),intravenous drug use (IDU) (OR 0.114; P < 0.001),IDU and heterosexual activity (OR 0.247; P=0.018),or unknown (OR 1.984; P=0.004).HIV/HCV co-infections were associated with male gender (OR 1.241; P=0.011),black race (OR 0.788;P=0.036),MSM(OR 0.565; P < 0.001),IDU (OR 8.956;P < 0.001),IDU and heterosexual activity (OR 9.106;P < 0.001),IDU and MSM (OR 9.179; P < 0.001),or transfusion (OR 3.224; P < 0.001).HIV/HBV/HCV coinfections were associated with male gender (OR 2.156;P=0.015),IDU (OR 6.345; P < 0.001),IDU and heterosexual activity (OR 9.731; P < 0.001),IDU and MSM (OR 9.228; P < 0.001),or unknown (OR 4.219;P=0.007).CONCLUSION:Our study demonstrates that coinfection with HBV/HCV/HIV is significantly associated with IDU.These results highlight the need to intensify education and optimal models of integrated care,particularly for populations with IDU,to reduce the risk of viral transmission.

  2. Kidney Disease Statistics for the United States

    Science.gov (United States)

    ... High blood pressure and diabetes are the main causes of CKD. Almost half of individuals with CKD also have ... without CKD. However, rates of both overall and cause-specific admissions increased with advancing stages of CKD. Hospitalizations increased among CKD patients with the presence ...

  3. Explaining the United States-Israel Relationship

    Science.gov (United States)

    2013-06-01

    influxes of Ethiopian Jews during and Soviet Jews after the Cold War. Loan guarantees have been 77...and Saudi Arabia .88 President Bill Clinton stated that America’s interests in the Middle East are: “pursuing a comprehensive breakthrough to Middle...been, at least to some extent, an asset to the Arab regimes, as a strategic counterweight to radicalism.”136 Saudi Arabia and the members of the Gulf

  4. United States Food Loss and Waste 2030 Champions

    Science.gov (United States)

    U.S. Food Loss and Waste 2030 Champions are businesses and organizations that have made a public commitment to reduce food loss and waste in their own operations in the United States by 50 percent by the year 2030.

  5. Real Estate Across the United States (REXUS) (Lease)

    Data.gov (United States)

    General Services Administration — Real Estate Across the United States (REXUS) is the primary tool used by PBS to track and manage the government's real property assets and to store inventory data,...

  6. 1:100,000-scale Counties of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a coverage of the county boundaries of the conterminous United States (AK, HI and Puerto Rico are available separately). The lines were extracted from U.S....

  7. National Wilderness Preservation System of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer consists of National Wilderness Preservation System areas of 640 acres or more, in the United States, Puerto Rico, and the U.S. Virgin Islands. The...

  8. Sand and Gravel Operations in the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes sand and gravel operations in the United States. These data were obtained from information reported voluntarily to the USGS by the aggregate...

  9. Quaternary Fault and Fold Database of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Quaternary Fault and Fold Database contains the results of thousands of scientific assessments of faults and associated folds in the United States that...

  10. Plant and Animal Phenology Data for the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — As of January 1, 2013, the dataset contains phenology data on 591 species of plants and animals, with 7,512 locations registered across the United States. Protocols...

  11. United States Average Annual Precipitation, 2000-2004 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows polygons of average annual precipitation in the contiguous United States, for the climatological period 2000-2004. Parameter-elevation...

  12. United States Coast Pilot (volume 1 through 9)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The United States Coast Pilot is a series of 9 nautical books that cover a wide variety of information important to navigators of U.S. coastal and intercoastal...

  13. Use of the Internet for Health Information: United States, 2009

    Science.gov (United States)

    ... National Technical Information Service NCHS Use of the Internet for Health Information: United States, 2009 Recommend on ... more likely than men to have used the Internet for health information. Women were more likely than ...

  14. Real Estate Across the United States (REXUS) Inventory (Building)

    Data.gov (United States)

    General Services Administration — Real Estate Across the United States (REXUS) is the primary tool used by PBS to track and manage the government's real property assets and to store inventory data,...

  15. Global Map: Railroad Stations of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes Global Map data showing Amtrak intercity railroad terminals in the United States. The data are a modified version of the National Atlas of...

  16. Costly Regional Landslide Events in the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer contains information on costly regional landslide events in the 50 United States and Puerto Rico. The extents of the regional events were drawn from...

  17. Arsenic in Ground Water of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This image shows national-scale patterns of naturally occurring arsenic in potable ground-water resources of the continental United States. The image was generated...

  18. US Forest Service Forest Carbon Stocks Contiguous United States

    Data.gov (United States)

    US Forest Service, Department of Agriculture — Through application of a nearest-neighbor imputation approach, mapped estimates of forest carbon density were developed for the contiguous United States using the...

  19. Indian Lands of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows Indian lands of the United States. Only areas of 640 acres or more are included. Federally-administered lands within a reservation are included...

  20. Barack Obama’s infrastructure policies for the United States

    NARCIS (Netherlands)

    Auger, J.F.

    2008-01-01

    The new president of the United States, Barack Obama, has set his policies on infrastructures. To carry them out, he will resort mostly to economics incentives and, to a lesser extent, regulatory constraints.

  1. United States Mortality Database, 1988-1992 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer contains mortality information for United States Health Service Areas (805 groups of counties). Included are mortality rates by sex and race (white...

  2. Protected Areas Database of the United States (PAD-US)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The USGS Protected Areas Database of the United States (PAD-US) is the nation's inventory of protected areas, including public open space and voluntarily provided,...

  3. Human Population in the Western United States (1900 - 2000)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Map containing historical census data from 1900 - 2000 throughout the western United States at the county level. Data includes total population, population density,...

  4. Adult Cigarette Smoking in the United States: Current Estimates

    Science.gov (United States)

    ... of Reproductive Health More CDC Sites Current Cigarette Smoking Among Adults in the United States Recommend on ... reported smoking every day or some days. Current Smoking Among Adults in 2015 (Nation) By Gender 2 ...

  5. Terrestrial Ecosystems - Topographic Moisture Potential of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) has generated topographic moisture potential classes for the contiguous United States. These topographic moisture potential classes...

  6. Map service: United States Decadal Production History Cells

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map service displays present and past oil and gas production in the United States, as well as the location and intensity of exploratory drilling outside...

  7. Streamflow Gaging Stations of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows selected streamflow gaging stations of the United States, Puerto Rico, and the U.S. Virgin Islands, in 2013. Gaging stations, or gages, measure...

  8. Premature death rates diverge in the United States

    Science.gov (United States)

    An NCI press release on a study that shows premature death rates have declined in the United States among Hispanics, blacks, and Asian/Pacific Islanders but increased among whites and American Indian/Alaska Natives.

  9. Elevation in the Western United States (90 meter DEM)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Elevation in the western United States obtained from the National Elevation Dataset. Data was converted from float point to integer format and resampled from 30m...

  10. Territorial Acquisitions of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the major acquisitions of territory by the United States of America. Only areas in North America, the Caribbean, and Hawaii are included....

  11. 1990 point population coverage for the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a point coverage of the 1990 Census of Population and Housing for the conterminous United States. (Alaska and Hawaii are available separately). The coverage...

  12. Streams and Waterbodies of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows areal and linear water features of the United States, Puerto Rico, and the U.S. Virgin Islands. The original file was produced by joining the...

  13. Terrestrial Ecosystems - Surficial Lithology of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) has generated a new classification and map of the lithology of surficial materials for the contiguous United States. This was...

  14. United States Earthquake Intensity Database, 1638-1985

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The United States Earthquake Intensity Database is a collection of damage and felt reports for over 23,000 U.S. earthquakes from 1638-1985. The majority of...

  15. NCHS - Births to Unmarried Women by Age Group: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset includes number of births to unmarried women by age group in the United States since 1940. Methods for collecting information on marital status changed...

  16. Base-flow index grid for the conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This 1-kilometer raster (grid) dataset for the conterminous United States was created by interpolating base-flow index (BFI) values estimated at U.S. Geological...

  17. United States Average Annual Precipitation, 2005-2009 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows polygons of average annual precipitation in the contiguous United States, for the climatological period 2005-2009. Parameter-elevation...

  18. Seismic Hazard Map for the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows seismic hazard in the United States. The data represent a model showing the probability that ground motion will reach a certain level. This map...

  19. Global Map: Airports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes Global Map data showing airports in the United States, Puerto Rico and the U.S. Virgin Islands. The data are a modified version of the...

  20. United States Crimes Database 1994-2000 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows crime statistics for the United States for the years 1994-2000, drawn from the Uniform Crime Reporting Program data compiled by the Federal...