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Selected AbstractsTwo-Dimensional Assessment of Right Ventricular Function: An Echocardiographic,MRI Correlative StudyECHOCARDIOGRAPHY, Issue 5 2007Nagesh S. Anavekar M.D. Background: While echocardiography is used most frequently to assess right ventricular (RV) function in clinical practice, echocardiography is limited in its ability to provide an accurate measure of RV ejection fraction (RVEF). Hence, quantitative estimation of RV function has proven difficult in clinical practice. Objective: We sought to determine which commonly used echocardiographic measures of RV function were most accurate in comparison with an MRI-derived estimate of RVEF. Methods: We analyzed RV function in 36 patients who had cardiac MRI studies and echocardiograms within a 24 hour period. 2D parameters of RV function,right ventricular fractional area change (RVFAC), tricuspid annular motion (TAM), and transverse fractional shortening (TFS) were obtained from the four-chamber view. RV volumes and EFs were derived from volumetric reconstruction based on endocardial tracing of the RV chamber from the short axis images. Echocardiographic assessment of RV function was correlated with MRI findings. Results: RVFAC measured by echocardiography correlated best with MRI-derived RVEF (r = 0.80, P < 0.001). Neither TAM (r = 0.17; P = 0.30) nor TFC (r = 0.12; p< 0.38) were significantly correlated with RVEF. Conclusions: RVFAC is the best of commonly utilized echocardiographic 2D measure of RV function and correlated best with MRI-derived RV ejection fraction. Condensed Abstract: While echocardiography is used most frequently to assess RV function in clinical practice, echocardiography is limited in its ability to provide an accurate measure of RV ejection fraction (RVEF). Using cardiac MRI, RV fractional area change (RVFAC), determined either by MRI or echocardiography, was found to correlate best with MRI-derived RVEF. [source] The Effects of the Absence of Emergency Medicine Residents in an Academic Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2002Daniel French MD Objective: What are the quality effects of an emergency medicine (EM) residency, and the associated 24/7 supervision of residents by faculty, in an academic emergency department (ED)? The authors evaluated activity and quality indicators when there were no EM residents present. The hypothesis of the study was that there was no difference between the patient care provided by faculty supervising EM residents and that with an alternative model without EM residents (AbsenceEMResident). Methods: To support the weekly residency educational program (Thursday), EM residents are not scheduled clinically for a 24-hour period (ConfDay). Emergency medicine resident coverage (mean 62.7 hours) was replaced with incremental faculty and mid-level providers (mean 41.0 hours). This study was limited to adult patients (22,527 visits of 39,190 ED total) for six months (January,June 2001) and compared indicators for ConfDay (n = 23) with all other days (NotConfDay, n = 158). Results: Comparing ConfDay (2,842 visits) with NotConfDay (19,685 visits), there was no difference in mean daily visits, inpatient admissions, intensive care unit admissions, or emergency medical services arrivals. ConfDay decision-to-admit time (333 vs. 313 min, p = 0.03) and length of stay for admissions (490 vs. 445 min, p = 0.000) were longer, with no difference for treat/release patients. There was no difference in the numbers of laboratory or radiology tests, consultations, unscheduled return visits, or patient satisfaction. Conclusion: During the study period, there was no measurable difference for most of the quality indicators studied. The AbsenceEMResident model is less efficient in admitting patients. Faculty supervision results in the same number of laboratory and radiology tests and consultations. Other specialties may consider this model if off-hours care becomes a concern. [source] Tolerability and Safety of Frovatriptan With Short- and Long-term Use for Treatment of Migraine and in Comparison With SumatriptanHEADACHE, Issue 2002Gilles Géraud MD Objective.,To evaluate the tolerability and safety of frovatriptan 2.5 mg in patients with migraine. Background.,Frovatriptan is a new, selective serotonin agonist (triptan) developed for the acute treatment of migraine. Dose range-finding studies identified 2.5 mg as the dose that conferred the optimal combination of efficacy and tolerability. Methods.,The tolerability and safety of frovatriptan 2.5 mg were assessed during controlled, acute migraine treatment studies, including a study that compared frovatriptan 2.5 mg with sumatriptan 100 mg, as well as a 12-month open-label study during which patients could take up to three doses of frovatriptan 2.5 mg within a 24-hour period. Safety and tolerability were assessed through the collection of adverse events, monitoring of heart rate and blood pressure performance of 12-lead electrocardiogram, hematology screen, and blood chemistry studies. Results.,In the short-term studies, 1554 patients took frovatriptan 2.5 mg and 838 took placebo. In the 12-month study, 496 patients treated 13 878 migraine attacks. Frovatriptan was well tolerated in the short- and long-term studies with 1% of patients in the short-term studies and 5% of patients in the long-term study withdrawing due to lack of tolerability. The incidence of adverse events was higher in the frovatriptan-treated patients than in the patients who took placebo (47% versus 34%) and the spectrum of adverse events was similar. When compared to sumatriptan 100 mg, significantly fewer patients taking frovatriptan experienced adverse events (43% versus 36%; P=.03) and the number of adverse events was lower (0.62 versus 0.91), there were also fewer adverse events suggestive of cardiovascular symptoms in the frovatriptan group. Analysis of the entire clinical database (n=2392) demonstrated that frovatriptan was well tolerated by the patients regardless of their age, gender, race, concomitant medication, or the presence of cardiovascular risk factors. No effects of frovatriptan on heart rate, blood pressure, 12-lead electrocardiogram, hematology screen, or blood chemistry were observed. No patient suffered any treatment-related serious adverse event. Conclusions.,Short- and long-term use of frovatriptan 2.5 mg was well tolerated by a wide variety of patients. Frovatriptan treatment produced an adverse events profile similar to that of placebo, and in a direct comparison study was better tolerated than sumatriptan 100 mg. [source] Use of Percutaneous Electrical Nerve Stimulation (PENS) in the Short-term Management of HeadacheHEADACHE, Issue 4 2000Hesham E. Ahmed MD Objective.,To evaluate the short-term effects of percutaneous electrical nerve stimulation (PENS) in the management of three types of chronic headache. Background.,Traditional electroanalgesic therapies have been reported to be effective in the management of acute headache symptoms. However, no controlled studies have been performed in patients with chronic headache. Methods.,Thirty patients with either tension headache, migraine, or posttraumatic headache symptoms of at least 6 months' duration were randomized to receive PENS (needles with electricity) or "needles alone" according to a crossover study design. All treatments were administered for 30 minutes, three times a week for 2 consecutive weeks with 1 week off between the two different treatments. For the PENS treatments, an alternating electrical stimulation frequency of 15 and 30 Hz was used. Pain, activity, and sleep scores were assessed using a 10-cm visual analog scale, with 0 corresponding to the best and 10 to the worst, during the 48-hour period prior to the beginning of the two treatments, immediately before and after each treatment session, and 48 hours after completing each treatment modality. Results.,Compared with the needles alone, PENS therapy was significantly more effective in decreasing the overall VAS pain scores for tension-type headache, migraine and posttraumatic headache (58%, 59%, and 52% versus 20%, 15%, and 20%, respectively). Similarly, PENS therapy produced greater improvement in the patients' physical activity (41% to 58% for PENS versus 11% to 21% for needles only) and quality of sleep (41% to 48% for PENS versus 12% to 20% for needles only). However, there were no differences in the pattern of the response to PENS therapy among the three headache groups. Conclusions.,Percutaneous electrical nerve stimulation appears to be a useful complementary therapy to analgesic and antimigraine drugs for the short-term management of headache. Interestingly, the analgesic response to PENS therapy appears to be independent of the origin of the headache symptoms. [source] The Prevalence of Lying in America: Three Studies of Self-Reported LiesHUMAN COMMUNICATION RESEARCH, Issue 1 2010Kim B. Serota This study addresses the frequency and the distribution of reported lying in the adult population. A national survey asked 1,000 U.S. adults to report the number of lies told in a 24-hour period. Sixty percent of subjects report telling no lies at all, and almost half of all lies are told by only 5% of subjects; thus, prevalence varies widely and most reported lies are told by a few prolific liars. The pattern is replicated in a reanalysis of previously published research and with a student sample. Substantial individual differences in lying behavior have implications for the generality of truth,lie base rates in deception detection experiments. Explanations concerning the nature of lying and methods for detecting lies need to account for this variation. L'importance du mensonge aux États-Unis : trois études de mensonges auto-déclarés Kim B. Serota, Timothy R. Levine, Franklin J. Boster Cette étude aborde la fréquence et la distribution des mensonges déclarés par la population adulte. Un sondage national a demandéŕ 1 000 adultes américains de déclarer le nombre de mensonges racontés dans une période de 24 heures. 60 % des sujets ont rapporté ne pas avoir dit de mensonge du tout et prčs de la moitié de ces mensonges sont racontés par 5 % des sujets. L'importance des mensonges varie donc largement et la plupart des mensonges déclarés sont formulés par un petit nombre de menteurs prolifiques. Cette tendance se retrouve également dans une nouvelle analyse de recherches déjŕ publiées et dans l'échantillon étudiant. Des différences individuelles importantes dans les comportements mensongers ont également des conséquences pour la généralité d'un taux de référence vérité,mensonge dans les expériences de détection de la tromperie. Les explications concernant la nature du mensonge et les méthodes de détection de mensonges doivent prendre en compte cette variation. Mots clés : tromperie, mensonge, différences individuelles The Prevalence of Lying in America: Three Studies of Self-Reported Lies Research Question: This study addresses the frequency and the distribution of reported lying in the adult population. Significance: In the deception literature, consensus is that most people lie on a daily basis. Yet this view is founded on very little empirical evidence. This research tests the question of lying prevalence. Method: Survey research techniques and descriptive analysis are used to establish base rates and frequency distributions for reported lying behavior. Data source: A national survey asked 1,000 U.S. adults to report the number of lies told in a 24 hour period. Cross-validation is provided by re-analysis of previously reported diary and experimental data and by replication using a sample of 225 students. Findings: The oft-repeated average (arithmetic mean) of one to two lies per day is replicated but the study finds the distribution is highly skewed. On a typical day, 60% of subjects report telling no lies at all, and almost half or all lies are told by only 5% of subjects; thus, prevalence varies widely and most reported lies are told by a few prolific liars. The pattern is replicated in the re-analysis of previously published research and with the student sample. Implications: The findings of a highly skewed distribution render the average number of lies per day misleading. Substantial individual differences in lying behavior also have implications for the generality of truth-lie base-rates in deception detection experiments. Explanations concerning the nature of lying and methods for detecting lies need to account for this variation. Keywords: deception, lies, lying, communication, individual differences Die Prävalenz von Lügen in Amerika. Drei Studien zu selbstberichteten Lügen Forschungsfrage: Diese Studie untersucht die Häufigkeit und Verteilung von Lügen in der erwachsenen Bevölkerung. Zentralität: In der Literatur zu Täuschung besteht Konsens darüber, dass Menschen täglich Lügen. Allerdings basiert diese Feststellung auf wenigen empirischen Daten. Diese Untersuchung testet die Frage nach der Prävalenz von Lügen. Methode: Umfrage und beschreibende Analyse wurden angewandt, um eine Basisrate und Häufigkeitsdistribution für selbstberichtetes Lügenverhalten zu gewinnen. Datenquelle: In einer nationalen Umfrage wurden 1.000 US-amerikanische Erwachsene zur Zahl der Lügen befragt, die sie in 24 Stunden erzählten. Validiert wurden diese Aussagen durch eine erneute Analyse von bereits dokumentierten Tagebuchdaten und Experimentaldaten und durch die Replikation mit einer Stichprobe von 225 Studierenden. Ergebnisse: Der oft wiederholte Durchschnitt (arithmetische Mittel) von ein bis zwei Lügen pro Tag wurde in der Studie repliziert, allerdings zeigte sich auch, dass diese Verteilung schief ist. 60% der Befragten gaben an, an einem typischen Tag keine Lügen zu erzählen, fast die Hälfte aller Lügen wird von nur 5% der Befragten erzählt; die Prävalenz variiert stark und die meisten der berichteten Lügen werden durch wenige produktive Lügner erzählt. Dieses Muster wurde bei einer erneuten Analyse von vorher publizierten Daten und in der Studentenstichprobe repliziert. Implikationen: Die Ergebnisse dieser stark schiefen Verteilung zeigen, dass die durchschnittliche Zahl von Lügen pro Tag irreführend ist. Substantielle individuelle Unterschiede im Lügenverhalten haben Implikationen für die Verallgemeinerbarkeit von Wahrheit-Lüge-Basisraten in Täuschungserfassungs-Experimenten. Erklärungen zur Natur von Lügen und Methoden zur Erfassung von Lügen müssen diese Variation bedenken. Schlüsselworte: Täuschung, Lüge, Lügen, Kommunikation, individuelle Unterschiede La Prevalencia de la Mentira en América: Tres Estudios de Auto-reportes de Mentiras Kim B. Serota, Timothy R. Levine, Franklin J. Boster Michigan State University The authors thank Deborah Kashy Resumen Este estudio trata sobre la frecuencia y la distribución de los reportes de las mentiras de la población adulta. Una encuesta nacional preguntó a 1,000 adultos Estadounidenses que reporten el número de mentiras contadas en un período de 24-horas. 60% de los sujetos reportaron que no dicen mentiras para nada, y casi la mitad son contadas por solo un 5% de los sujetos; así, la prevalencia varía enormemente y muchos reportaron que las mentiras son contadas por pocos mentirosos prolíficos. La pauta es replicada en el re-análisis de investigación previamente publicada y con una muestra de estudiantes. Las diferencias individuales sustanciales en el comportamiento mentiroso tienen implicaciones también para la generalidad del índice basado en la verdad-mentira en los experimentos de detección de decepción. Las explicaciones concernientes a la naturaleza de la mentira y los métodos de detección de mentiras necesitan responder a esta variación. Palabras Claves: decepción, mentiras, mentir, comunicación, diferencias individuales [source] Diel Changes in Phytoplankton Composition and Abundance in the Surface and Sub-Surface Strata from a Shallow Eutrophic PondINTERNATIONAL REVIEW OF HYDROBIOLOGY, Issue 1 2009bieta Wilk-Wo, niak Abstract Representative phytoplankton assemblages were identified in a eutrophic pond over a 24 hour period. One assemblage characterized species in the surface (neuston) layer and another consisted of algae from 2, 5, and 20 cm sub-surface depths. The surface layer (0 cm) included a similar, but less diverse assemblage of species, and a lower abundance of cells per unit volume, than those at the lower depths. At each of the sub-surface depths (2,20 cm), the major phytoplankton components initially followed similar patterns of abundance in reference to the time and depth of sample collections then later differed in their abundance levels. The dominant algae were chlorophytes, cryptophytes, diatoms, and cyanobacteria. Mean concentrations of total phytoplankton, over the 24 hours for the surface, were 3.3 × 103 cells ml,1, compared to 36.9 × 103 cells ml,1 for depths 2,20 cm. The autotrophic picoplankton abundance was recorded separately from the phytoplankton with mean concentrations of 472.9 × 103 cells ml,1 in the surface layer and 623.0 × 103 cells ml,1 for the three sub-surface depths. Photos of representative species from these surface layers are presented. (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] A Cluster-Randomized Trial of an Educational Intervention to Reduce the Use of Physical Restraints with Psychogeriatric Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009Anna R. Huizing PhD RN OBJECTIVES: To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents. DESIGN: Cluster-randomized trial. SETTING: Fifteen psychogeriatric nursing home wards in the Netherlands. PARTICIPANTS: In total, 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation; 404 consented, and 371 of these were available at baseline. Two hundred forty-one from 14 wards had complete data and were included in the data analyses. INTERVENTION: The nursing home wards were assigned at random to educational intervention or control status. The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist (registered nurse (RN) level). MEASUREMENTS: Data were collected at baseline and 1, 4, and 8 months postintervention. At each measurement, the use of physical restraints was measured using observations of blinded, trained observers on four separate occasions over a 24-hour period. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set. RESULTS: Logistic and linear regression analyses showed no treatment effect on restraint status, restraint intensity, or multiple restraint use in any of the three postintervention measurements. Furthermore, only small changes occurred in the types of restraints used with residents in the experimental group. CONCLUSION: An educational program for nursing staff combined with consultation with a nurse specialist (RN level) had no effect on the use of physical restraints with psychogeriatric nursing home residents. In addition to restraint education and consultation, new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed. [source] Fluctuation in Autonomic Tone is a Major Determinant of Sustained Atrial Arrhythmias in Patients with Focal Ectopy Originating from the Pulmonary VeinsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2001MARC ZIMMERMANN M.D. Autonomic Variations in Focal AF. Introduction: This study was designed to analyze dynamic changes in autonomic tone preceding the onset of sustained atrial arrhythmias in patients with focal atrial fibrillation (AF) to determine why patients with frequent discharge from the arrhythmogenic foci develop sustained AF. Methods and Results: Holter tapes from 13 patients (10 men and 3 women; mean age 53 ± 5 years) with paroxysmal "lone" AF (mean 18 ± 13 episodes per week) and a proven focal origin (pulmonary veins in all cases) were analyzed. A total of 38 episodes of sustained AF (> 30 min) were recorded and submitted to frequency-domain heart rate variability analysis. Six periods were studied using repeated measures analysis of variance: the 24,hour period, the hour preceding AF, and the 20 minutes before AF divided into four 5,minute periods. A significant increase in high-frequency (HF, HF-NU) components was observed during the 20 minutes preceding AF (P = 0.003 and 0.002, respectively), together with a progressive decrease in normalized low-frequency (LF-NU) components (P = 0.035). An increase in LF/HF ratio followed by a linear decrease starting 15 minutes before sustained AF also was observed, indicating fluctuations in autonomic tone, with a primary increase in adrenergic drive followed by a marked modulation toward vagal predominance immediately before AF onset. Conclusion: In patients with focal ectopy originating from the pulmonary veins, sustained episodes of atrial arrhythmias are mainly dependent on variations of autonomic tone, with a significant shift toward vagal predominance before AF onset. [source] Crushed Clopidogrel Administered via Nasogastric Tube Has Faster and Greater Absorption than Oral Whole TabletsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2009M. UROOJ ZAFAR M.B.B.S. Objectives: To compare the absorption of 300 mg clopidogrel administered crushed via nasogastric (NG) tube versus whole tablets taken orally in healthy volunteers. Background: Earlier antiplatelet therapy has proven benefits in treatment of myocardial infarction and in patients undergoing PCI. Aspirin can be delivered early in crushed form via NG tube after CABG surgery to prevent graft occlusion. If clopidogrel given crushed via NG tube provides faster absorption, it could allow earlier clopidogrel loading. Methods: Nine healthy human subjects (34.7 ± 11.1 years, 5 males) were given 300 mg clopidogrel in crushed form via NG tube with 30 mL water after 8 hours of fasting. Plasma levels of the primary circulating inactive clopidogrel metabolite SR26334 were measured after 20 minutes, 40 minutes, 1, 2, 4, 8, 12, and 24 hours of dosing. Following ,2 week washout, same subjects swallowed 300 mg clopidogrel (four 75 mg tablets) after an 8-hour fasting and SR26334 levels were measured at the same time points. Results: Plasma SR26334 concentrations peaked earlier after crushed delivery than after oral intake (44 vs. 70 minutes, P = 0.023) and the median peak was 80% higher (13,083 vs. 7,255 ng/mL, respectively, P = 0.021). At 40 minutes, area under the curve was almost twofold greater with NG administration than oral administration (geometric means ratio = 0.5299, 95% CI = 0.28,0.99, P = 0.048), but was similar over the 24-hour period with both administration methods (geometric means ratio = 1.05, 95% CI = 0.84,1.32, P = 0.646). Conclusions: A 300 mg loading dose of crushed clopidogrel administered via NG tube provides faster and greater bioavailability than an equal dose taken orally as whole tablets. The clinical benefits of this strategy need to be investigated. [source] The Interaction of Reward Genes With Environmental Factors in Contribution to Alcoholism in Mexican AmericansALCOHOLISM, Issue 12 2009Yanlei Du Background:, Alcoholism is a polygenic disorder resulting from reward deficiency; polymorphisms in reward genes including serotonin transporter (5-HTT)-linked polymorphic region (5-HTTLPR), A118G in opioid receptor mu1 (OPRM1), and ,141C Insertion/Deletion (Ins/Del) in dopamine receptor D2 (DRD2) as well as environmental factors (education and marital status) might affect the risk of alcoholism. Objective of the current study was to examine the main and interacting effect of these 3 polymorphisms and 2 environmental factors in contribution to alcoholism in Mexican Americans. Methods:, Genotyping of 5-HTTLPR, OPRM1 A118G, and DRD2-141C Ins/Del was performed in 365 alcoholics and 338 nonalcoholic controls of Mexican Americans who were gender- and age-matched. Alcoholics were stratified according to tertiles of MAXDRINKS, which denotes the largest number of drinks consumed in one 24-hour period. Data analysis was done in the entire data set and in each alcoholic stratum. Multinomial logistic regression was conducted to explore the main effect of 3 polymorphisms and 2 environmental factors (education and marital status); classification tree, generalized multifactor dimensionality reduction (GMDR) analysis, and polymorphism interaction analysis version 2.0 (PIA 2) program were used to study factor interaction. Results:, Main effect of education, OPRM1, and DRD2 was detected in alcoholic stratum of moderate and/or largest MAXDRINKS with education ,12 years, OPRM1 118 A/A, and DRD2 ,141C Ins/Ins being risk factors. Classification tree analysis, GMDR analysis, and PIA 2 program all supported education*OPRM1 interaction in alcoholics of largest MAXDRINKS with education ,12 years coupled with OPRM1 A/A being a high risk factor; dendrogram showed synergistic interaction between these 2 factors; dosage-effect response was also observed for education*OPRM1 interaction. No definite effect of marital status and 5-HTTLPR in pathogenesis of alcoholism was observed. Conclusions:, Our results suggest main effect of education background, OPRM1 A118G, and DRD2 ,141C Ins/Del as well as education*OPRM1 interaction in contribution to moderate and/or severe alcoholism in Mexican Americans. Functional relevance of these findings still needs to be explored. [source] Fetal Ethanol Exposure Disrupts the Daily Rhythms of Splenic Granzyme B, IFN- ,, and NK Cell Cytotoxicity in AdulthoodALCOHOLISM, Issue 6 2006Alvaro Arjona Background: Circadian (and daily) rhythms are physiological events that oscillate with a 24-hour period. Circadian disruptions may hamper the immune response against infection and cancer. Several immune mechanisms, such as natural killer (NK) cell function, follow a daily rhythm. Although ethanol is known to be a potent toxin for many systems in the developing fetus, including the immune system, the long-term effects of fetal ethanol exposure on circadian immune function have not been explored. Methods: Daily rhythms of cytotoxic factors (granzyme B and perforin), interferon- , (IFN- ,), and NK cell cytotoxic activity were determined in the spleens of adult male rats obtained from mothers who were fed during pregnancy with chow food or an ethanol-containing liquid diet or pair-fed an isocaloric liquid diet. Results: We found that adult rats exposed to ethanol during their fetal life showed a significant alteration in the physiological rhythms of granzyme B and IFN- , that was associated with decreased NK cell cytotoxic activity. Conclusion: These data suggest that fetal ethanol exposure causes a permanent alteration of specific immune rhythms that may in part underlie the immune impairment observed in children prenatally exposed to alcohol. [source] The X-ray variability of the Seyfert 1 galaxy MCG,6-30-15 from long ASCA and RXTE observationsMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 3 2000Julia C. Lee We present an analysis of the long Rossi X-ray Timing Explorer (RXTE) observation of the Seyfert 1 galaxy MCG,6-30-15, taken in 1997 July. We have previously used the data to place constraints for the first time on the iron abundance,reflection fraction relationship, and now expand the analysis to investigate in detail the spectral X-ray variability of the object. Our results show that the behaviour is complicated. We find clear evidence from colour ratios and direct spectral fitting that changes to the intrinsic photon index are taking place. In general, spectral hardening is evident during periods of diminished intensity, and in particular, a general trend for harder spectra is seen in the period following the hardest RXTE flare. Flux-correlated studies further show that the 3,10 keV photon index ,3,10 steepens, while that in the 10,20 keV band, ,10,20, flattens with flux. The largest changes come from the spectral index below 10 keV; however, changes in the intrinsic power-law slope (shown by changes in ,3,10), and reflection (shown by changes in ,10,20) both contribute in varying degrees to the overall spectral variability. We find that the iron-line flux FK, is consistent with being constant over large time intervals on the order of days (although tentative evidence exists which show that FK, changes on shorter time intervals of order ,10 ks during time periods surrounding flare events), and has an equivalent width which anticorrelates with the continuum flux and reflection fraction. A possible interpretation for the iron-line flux constancy and the relative Compton reflection increase with flux from the flux-correlated data is an increasing ionization of the emitting disc surface, while spectral analysis of short time intervals surrounding flare events hints tentatively at observed spectral responses to the flare. We present a simple model for partial ionization where the bulk of the variability comes from within 6rg. Temporal analysis further provides evidence for possible time (,1000 s) and phase (,,0.6 rad) lags. Finally, we report an apparent break in the power density spectrum (,4,5×10,6 Hz) and a possible 33-hour period. Estimates for the mass of the black hole in MCG,6-30-15 are discussed in the context of spectral and temporal findings. [source] Steady-State versus Non-Steady-State QT-RR Relationships in 24-hour Holter RecordingsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2000GILLES LANDE The aim of the present study was to investigate the QT-RR interval relationship in ambulatory ECG recordings with special emphasis on the physiological circumstances under which the QT-RR intervals follow a linear relation. Continuous ECG recordings make it possible to automatically measure QT duration in individual subjects under various physiological circumstances. However, identification of QT prolongation in Holter recordings is hampered by the rate dependence of QT duration. Comparison of QT duration and QT interval rate dependence between different individuals implies that the nature of the QT-RR relationship is defined in ambulatory ECG. Holter recordings were performed in healthy volunteers at baseline and after administration of dofetilide, a Class III antiarrhythmic drug. After dofetilide, beat-to-beat automated QT measurements on Holter tapes were compared with manually measured QT intervals on standard ECGs matched by time. The QT-RR relationship was analyzed at baseline in individual and group data during three different periods: 24-hour, daytime, and nighttime. Data were collected under steady-state or non-steady-state conditions of cycle length and fitted with various correction formulae. Our study demonstrated an excellent agreement between manually and automated measurements. The classic Bazett correction formula did not fit the QT-RR data points in individual or group data. When heart beats were selected for a steady rhythm during the preceding minute, QT-RR intervals fit a linear relationship during the day and night periods, but not during the 24-hour period in both individual and group data. In contrast, in the absence of beat selection, data fit a more complex curvilinear relationship irrespective of the period. Our study provides the basis for comparison of QT interval durations and QT-RR relationships between individuals and between groups of subjects. [source] The effect of postoperative fasting on vomiting in children and their assessment of painPEDIATRIC ANESTHESIA, Issue 5 2009OLIVER C. RADKE MD PhD DEAA Summary Background:, Mandatory postoperative food intake has been shown to increase nausea and vomiting, and so postoperative fasting has become common practice even if patients request food or drink. Objective:, We sought to investigate whether postoperative fasting reduces the incidence of postoperative vomiting in children when compared with a liberal regimen in which they are allowed to eat and drink upon request. Methods:, One hundred forty-seven children scheduled for outpatient surgery were randomized to one of two groups. After anesthesia, patients in the ,fasting' group were expected to fast for 6 h. The children in the ,liberal' group were allowed to eat and drink according to their own needs. The incidence of vomiting and the children's well-being were recorded at several time points over a 24-hour period. Parents were also asked to rate, on a scale of 0,6, how much their children were bothered by fasting, pain, and nausea/vomiting. Results:, Age (4.8 ± 2.6 years), weight (20 ± 9 kg) and gender (73% boys) were comparable between the groups. The incidence of vomiting was 15% in the liberal and 22% in the fasting group (P = 0.39) and, between 1 and 12 h after extubation, children in the liberal group were significantly happier (P < 0.001). Children in the liberal group were significantly less bothered by their pain than those in the fasting group (P < 0.001). Conclusion:, Postoperative fasting did not reduce the incidence of vomiting after general anesthesia in children when compared with a liberal regimen. Furthermore, the ability to eat and drink at will decrease the bothersome aspects of pain and lead to happier patients. [source] Residential vapor-intrusion evaluation: Long-duration passive sampling vs. short-duration active samplingREMEDIATION, Issue 4 2008Joseph E. Odencrantz Sampling indoor air for potential vapor-intrusion impacts using current standard 24-hour sample collection methods may not adequately account for temporal variability and detect contamination best represented by long-term sampling periods. Henry Schuver of the U.S. Environmental Protection Agency Office of Solid Waste stated at the September 2007 Air & Waste Management Association vapor-intrusion conference that the US EPA may consider recommending longer-term vapor sampling to achieve more accurate time-weighted-average detections. In November 2007, indoor air at four residences was sampled to measure trichloroethene (TCE) concentrations over short- and long-duration intervals. A carefully designed investigation was conducted consisting of triplicate samplers for three different investigatory methods: dedicated 6-liter Summa canisters (US EPA Method TO-15), pump/sorbent tubes (US EPA Method TO-17), and passive diffusion samplers (MDHS 80). The first two methods collected samples simultaneously for a 24-hour period, and the third method collected samples for two weeks. Data collected using Methods TO-15 (canisters) and TO-17 (tubes) provided reliable short-duration TCE concentrations that agree with prior 24-hour sampling events in each of the residences; however, the passive diffusion samplers may provide a more representative time-weighted measurement. The ratio of measured TCE concentrations between the canisters and tubes are consistent with previous results and as much as 28.0 ,g/m3 were measured. A comparison of the sampling procedures, and findings of the three methods used in this study will be presented. © 2008 Wiley Periodicals, Inc. [source] Day Float: An Alternative to the Night Float Coverage System for Residency Programs,THE LARYNGOSCOPE, Issue 7 2008Amar C. Suryadevara MD Abstract Objectives: The Accreditation Council for Graduate Medical Education (ACGME) has mandated an 80-hour work week that has resulted in changes to many residency programs. In otolaryngology, most programs have switched to either home call or night float systems. Our department covers all of the maxillofacial trauma and backup airway calls, which has made it difficult to employ a home call system. Instead of a night float coverage system, our program implemented a day float coverage system that allows the residents to participate in a 24-hour call period. After call and sign-out, the residents go home; however, their clinical duties are covered by the day float resident. Study Design: A brief review of the literature pertaining to call coverage systems followed by a description of our day float system. Residents who have participated in either night float, day float, or both systems were then surveyed regarding their experiences or perceptions of both systems. Methods: A nine-question survey was handed out to our otolaryngology residents and their responses were recorded. Results: The averaged responses strongly favored the day float over the night float coverage system regardless of the level of training and the systems in which the residents have participated. Conclusions: The day float coverage system is favored by residents in our program. It allows for a more attending-like 24-hour period of call, continuity of care, attendance at educational activities, and more time with family. In addition, it eliminates a prolonged period devoid of clinical activities. [source] Physiologic Features of Vocal Fatigue: Electromyographic Spectral-Compression in Laryngeal MusclesTHE LARYNGOSCOPE, Issue 6 2006Victor J. Boucher PhD Abstract Objectives: This study addresses the problem of defining observable attributes of "vocal fatigue" as a physiologic condition. The aim was to determine the applicability of electromyography (EMG) spectral compression in observing fatigue in laryngeal muscles arising from prolonged vocal effort. Study Design: Single institution, nonrandomized, prospective analysis of subjects evaluated in an academic, tertiary care center. Methods: In adapting EMG techniques, we report pretest observations that bear on the choice of voicing tasks serving to induce and estimate muscle fatigue and the selection of muscles that are particularly involved in effortful vocalization. On this basis, an experiment was designed where intramuscular EMG was used to record lateral cricoarytenoid potentials of seven subjects at regular intervals across a 12 to 14 hour period (50 samples per subject). Between each of these samples, the participants were required to produce loud speech for 3 minutes with peaks of 74 dBA at 1 meter. Results: The results show fatigue-related spectral compression for all subjects and nonlinear changes across time indicating critical values beyond which fatigue is persistent. Conclusion: Spectral compression appears to present a robust attribute of fatigue-related changes in muscles involved in vocalization. There are several implications with respect to research on the prevention of acquired voice pathologies. [source] Prevention of Vomiting After Tonsillectomy in Children: Granisetron Versus RamosetronTHE LARYNGOSCOPE, Issue 2 2001Yoshitaka Fujii MD Abstract Objective/Hypothesis Granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting after tonsillectomy in children. Ramosetron (Nasea; Yamanouchi; Tokyo, Japan), another new antagonist of 5-hydroxytryptamione type 3 receptor, has more potent and longer-acting properties than granisetron (Kytril; Smith Kline Beecham, London, UK) against cisplatin-induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting after pediatric tonsillectomy. Study Design Prospective, randomized, double-blinded study. Methods Ninety pediatric patients, aged 4 to 10 years, received intravenously granisetron 40 ,g/kg or ramosetron 6 ,g/kg (n = 45 each) at the end of surgery. The same standard general anesthetic technique and postoperative analgesia were used throughout. Emetic episodes and safety assessment were performed during the first 24-hour period and the next 24-hour period after anesthesia. Results The rates of patients being emesis-free during the period from 0 to 24 hours after anesthesia were 89% with granisetron and 93% with ramosetron, respectively (P = .357); the corresponding rates during the period from 24 to 48 hours after anesthesia were 71% and 93%, respectively (P = .006). No clinically serious adverse events attributable to the study drugs were observed in any of the groups. Conclusion Ramosetron is a better antiemetic than granisetron for the long-term prevention of postoperative vomiting in children undergoing general anesthesia for tonsillectomy. [source] A ,-secretase inhibitor decreases amyloid-, production in the central nervous system,ANNALS OF NEUROLOGY, Issue 1 2009Randall J. Bateman MD Objective Accumulation of amyloid-, (A,) by overproduction or underclearance in the central nervous system (CNS) is hypothesized to be a necessary event in the pathogenesis of Alzheimer's disease. However, previously, there has not been a method to determine drug effects on A, production or clearance in the human CNS. The objective of this study was to determine the effects of a ,-secretase inhibitor on the production of A, in the human CNS. Methods We utilized a recently developed method of stable-isotope labeling combined with cerebrospinal fluid sampling to directly measure A, production during treatment of a ,-secretase inhibitor, LY450139. We assessed whether this drug could decrease CNS A, production in healthy men (age range, 21,50 years) at single oral doses of 100, 140, or 280mg (n = 5 per group). Results LY450139 significantly decreased the production of CNS A, in a dose-dependent fashion, with inhibition of A, generation of 47, 52, and 84% over a 12-hour period with doses of 100, 140, and 280mg, respectively. There was no difference in A, clearance. Interpretation Stable isotope labeling of CNS proteins can be utilized to assess the effects of drugs on the production and clearance rates of proteins targeted as potential disease-modifying treatments for Alzheimer's disease and other CNS disorders. Results from this approach can assist in making decisions about drug dosing and frequency in the design of larger and longer clinical trials for diseases such as Alzheimer's disease, and may accelerate effective drug validation. Ann Neurol 2009 [source] The Time Course of New T-Wave ECG Descriptors Following Single- and Double-Dose Administration of Sotalol in Healthy SubjectsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Fabrice Extramiana M.D., Ph.D. Introduction: The aim of the study was to assess the time course effect of IKr blockade on ECG biomarkers of ventricular repolarization and to evaluate the accuracy of a fully automatic approach for QT duration evaluation. Methods: Twelve-lead digital ECG Holter was recorded in 38 healthy subjects (27 males, mean age = 27.4 ± 8.0 years) on baseline conditions (day 0) and after administration of 160 mg (day 1) and 320 mg (day 2) of d-l sotalol. For each 24-hour period and each subject, ECGs were extracted every 10 minutes during the 4-hour period following drug dosage. Ventricular repolarization was characterized using three biomarker categories: conventional ECG time intervals, principal component analysis (PCA) analysis on the T wave, and fully automatic biomarkers computed from a mathematical model of the T wave. Results: QT interval was significantly prolonged starting 1 hour 20 minutes after drug dosing with 160 mg and 1 hour 10 minutes after drug dosing with 320 mg. PCA ventricular repolarization parameters sotalol-induced changes were delayed (>3 hours). After sotalol dosing, the early phase of the T wave changed earlier than the late phase prolongation. Globally, the modeled surrogate QT paralleled manual QT changes. The duration of manual QT and automatic surrogate QT were strongly correlated (R2= 0.92, P < 0.001). The Bland and Altman plot revealed a nonstationary systematic bias (bias = 26.5 ms ± 1.96*SD = 16 ms). Conclusions: Changes in different ECG biomarkers of ventricular repolarization display different kinetics after administration of a potent potassium channel blocker. These differences need to be taken into account when designing ventricular repolarization ECG studies. Ann Noninvasive Electrocardiol 2010;15(1):26,35 [source] Happiness and Stress Alter Susceptibility to Cardiac Events in Long QT SyndromeANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009Ph.D., Richard D. Lane M.D. Objective: We sought to determine whether the circumstances preceding an arrhythmic event differed from those preceding a prior control occasion in patients with Long QT Syndrome (LQTS), a well-characterized genetic disorder that puts affected individuals at risk for sudden cardiac death. Methods: Thirty-eight patients (89% female) with LQTS completed a "case-crossover interview" in which each patient served as his/her own control by reporting on circumstances preceding an arrhythmic event (syncope, aborted cardiac arrest, or defibrillator discharge) and preceding a control occasion (the next-to-last birthday). On average the interview was conducted 17 months after the cardiac event and control occasion. Results: During the 24-hour period preceding the cardiac event compared to the day before the control occasion, psychological stress was elevated, peak happiness was reduced, and peak exertion was not significantly different. Rated for the 6-month intervals preceding the event and control occasions, none of these three variables was significantly associated with events. Conclusions: Happiness is associated with a reduction in the 24-hour risk of cardiac events in patients with LQTS, with stress having an opposite effect. To our knowledge, this is the first report indicating that positive emotion may have a protective effect on life-threatening ventricular arrhythmias. This study lends further support to the role of emotions in influencing cardiac events in arrhythmia-prone patients. [source] Investigation into the occupational lives of healthy older people through their use of timeAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2010Rachel Chilvers Background/aim:,Older people are one of the largest groups using health-care services; therefore, it is important for occupational therapists to have an understanding of their occupational lives. Temporality is a key element of occupation, yet little research exists regarding older people and time use, despite the considerable temporal adjustments taking place at this lifestage. The aim of this study was to identify the occupational lives of healthy older people through the activities they undertake in a 24-hour period. Method:,Data analysis of time-use diaries from 90 older UK residents (aged 60,85 years) who considered themselves to be healthy was undertaken, using 15 activity codes and three pre-coded terms: necessary, enjoyable and personal. Results:,The participants spent most of their time sleeping and resting (34%), followed by performing domestic activities (13%), watching television, listening to the radio or music, or using computers (11%), eating and drinking (9%) and socialising (6%). Enjoyable activities occupied most of their time (42% of the day), followed by necessary (34%) and personal activities (16%). Conclusion:,These data contribute to the growing evidence base regarding older people as occupational beings, indicating that they are a diverse group of individuals who are meeting their needs with dynamic, positive activities. This highlights the importance of a client-centred approach to occupational therapy, as it enables the clients to have choice, control and diversity in their activities when meeting their needs. [source] Pediatric Emergency Department Overcrowding and Impact on Patient Flow OutcomesACADEMIC EMERGENCY MEDICINE, Issue 9 2008Nathan L. Timm MD Abstract Background:, Understanding the impact of overcrowding in pediatric emergency departments (PEDs) on quality of care is a growing concern. Boarding admitted patients in the PED and increasing emergency department (ED) visits are two potentially significant factors affecting quality of care. Objectives:, The objective was to describe the impact ED boarding time and daily census have on the timeliness of care in a PED. Methods:, Pediatric ED boarding time and daily census were determined each day from July 2003 to July 2007. Outcome measures included mean length of stay (LOS), time to triage, time to physician, and patient elopement during a 24-hour period. Results:, For every 50 patients seen above the average daily volume of 250, LOS increased 14.8 minutes, time to triage increased 6.6 minutes, time to physician increased 18.2 minutes, and number of patient elopements increased by three. For each increment of 24 hours to total ED boarding time, LOS increased 7.6 minutes, time to triage increased 0.6 minutes, time to physician increased 3 minutes, and number of patient elopements increased by 0.6 patients. Conclusions:, ED boarding time and ED daily census show independent associations with increasing overall LOS, time to triage, time to physician, and number of patient elopements in a PED. [source] 2357: Autonomic nervous system and endothelial peripheral dysfunction in normal tension glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2010J WIERZBOWSKA Purpose To define parameters of autonomic nervous system activity and peripheral vascular reactive hyperemia in normal tension glaucoma patients. Methods Ambulatory 24-hour electrocardiogram and blood pressure (BP) monitoring by using Lifecard CF and SpaceLab 90207-30 combined with occlusion provocation test were carried out in 54 NTG patients (44 women, mean age 59.7) and 43 matched control subjects (34 women, mean age 57.0). Heart rate variability (HRV) time and frequency domain parameters [low-frequency (LF), high-frequency (HR) and LF/HF ratio], and blood pressure variability (BPV) were calculated and analyzed for both study groups. Postocclusive hyperemia response parameters (TM - time to peak flow, TH ,half-time hyperaemia, TR ,time to rest flow, BZ-biological zero and MAX , maximum hyperemic response) were compared for patients with a nocturnal fall in mean BP (MPB) of less than 10% (non-dippers), of 10-20% (dippers) and of more than 20% (over-dippers) Results NTG patients demonstrated higher LF and LF/HF values for 24-hour period, day-time and night time than control subjects. There was no difference in BPV between study groups (10.4 ± 1.9 vs. 10.5 ± 2.1, p=0.790). In NTG patients, TH was significantly higher (79.0 ± 80.9 s vs. 51.5 ± 35.3 s, p=0.028) and BZ was significantly lower (2.3 ± 1.0 vs. 3.1 ± 2.0, p=0.009) as compared to the control group. There was statistically significant difference between NTG non-dippers, dippers and over,dippers in the BZ parameter (2.3 ± 0.9 vs. 2.7 ± 1.3 vs. 1.4 ± 0.4 p=0.024). Conclusion NTG patients exhibit abnormal ANS system activity and a different systemic hyperemia response as compared with healthy subjects. [source] Circadian Activity Rhythms and Mortality: The Study of Osteoporotic FracturesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2010Gregory J. Tranah PhD OBJECTIVES: To determine whether circadian activity rhythms are associated with mortality in community-dwelling older women. DESIGN: Prospective study of mortality. SETTING: A cohort study of health and aging. PARTICIPANTS: Three thousand twenty-seven community-dwelling women from the Study of Osteoporotic Fractures cohort (mean age 84). MEASUREMENTS: Activity data were collected using wrist actigraphy for a minimum of three 24-hour periods, and circadian activity rhythms were computed. Parameters of interest included height of activity peak (amplitude), midline estimating statistic of rhythm (mesor), strength of activity rhythm (robustness), and time of peak activity (acrophase). Vital status, with cause of death adjudicated through death certificates, was prospectively ascertained. RESULTS: Over an average of 4.1 years of follow-up, there were 444 (14.7%) deaths. There was an inverse association between peak activity height and all-cause mortality rates, with higher mortality rates observed in the lowest activity quartile (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.63,2.92) than in the highest quartile after adjusting for age, clinic site, race, body mass index, cognitive function, exercise, instrumental activity of daily living impairments, depression, medications, alcohol, smoking, self-reported health status, married status, and comorbidities. A greater risk of mortality from all causes was observed for those in the lowest quartiles of mesor (HR=1.71, 95% CI=1.29,2.27) and rhythm robustness (HR=1.97, 95% CI=1.50,2.60) than for those in the highest quartiles. Greater mortality from cancer (HR=2.09, 95% CI=1.04,4.22) and stroke (HR=2.64, 95% CI=1.11,6.30) was observed for later peak activity (after 4:33 p.m.; >1.5 SD from mean) than for the mean peak range (2:50,4:33 p.m.). CONCLUSION: Older women with weak circadian activity rhythms have higher mortality risk. If confirmed in other cohorts, studies will be needed to test whether interventions (e.g., physical activity, bright light exposure) that regulate circadian activity rhythms will improve health outcomes in older adults. [source] Detection of patterns in noisy time seriesTHE CANADIAN JOURNAL OF STATISTICS, Issue 2 2001M. A. Tingley Abstract In the context of a research project in ergonomy, myoelectric signals monitored over two to three hour periods gave rise to long noisy time series, which were smoothed using running medians. Tests developed by the authors show that the patterns displayed by the smoothed time series are not artifacts of smoothed white noise. Indeed, the smoothed series show amplitude fluctuations and short-term correlations which are larger than those obtained by applying running medians to independent, identically distributed data. The key idea is that of reduction of data to binary signals. [source] Point-of-care Glucose and Hemoglobin A1c in Emergency Department Patients without Known Diabetes: Implications for Opportunistic ScreeningACADEMIC EMERGENCY MEDICINE, Issue 12 2008Adit A. Ginde MD Abstract Objectives:, The objectives were to evaluate the correlation between random glucose and hemoglobin A1c (HbA1c) in emergency department (ED) patients without known diabetes and to determine the ability of diabetes screening in the ED to predict outpatient diabetes. Methods:, This was a cross-sectional study at an urban academic ED. The authors enrolled consecutive adult patients without known diabetes during eight 24-hour periods. Point-of-care (POC) random capillary glucose and HbA1c levels were tested, as well as laboratory HbA1c in a subset of patients. Participants with HbA1c , 6.1% were scheduled for oral glucose tolerance test (OGTT). Results:, The 265 enrolled patients were 47% female and 80% white, with a median age of 42 years. Median glucose and HbA1c levels were 93 mg/dL (interquartile range [IQR] = 82,108) and 5.8% (IQR = 5.5,6.2), respectively. The correlation between POC and laboratory HbA1c was r = 0.96, with mean difference 0.33% (95% confidence interval [CI] = 0.27% to 0.39%). Glucose threshold , 120 mg/dL had 89% specificity and 26% sensitivity for predicting the 76 (29%) patients with abnormal HbA1c; , 140 mg/dL had 98% specificity and 14% sensitivity. The correlation between random glucose and HbA1c was moderate (r = 0.60) and was affected by age, gender, prandial status, corticosteroid use, and current injury. Only 38% of participants with abnormal HbA1c returned for OGTTs; 38% had diabetes, 34% had impaired fasting glucose/impaired glucose tolerance, and 28% had normal glucose tolerance. Conclusions:, ED patients have a high prevalence of undiagnosed diabetes. Although screening with POC random glucose and HbA1c is promising, improvement in follow-up with confirmatory testing and initiation of treatment is needed before opportunistic ED screening can be recommended. [source] Multicenter Study of Limited Health Literacy in Emergency Department PatientsACADEMIC EMERGENCY MEDICINE, Issue 6 2008Adit A. Ginde MD Abstract Objectives:, The objective was to evaluate the prevalence of limited health literacy and its association with sociodemographic variables in emergency department (ED) patients. Methods:, This was a cross-sectional survey in three Boston EDs. The authors enrolled consecutive adult patients during two 24-hour periods at each site. They measured health literacy by the short version of the Test of Functional Health Literacy in Adults (S-TOFHLA). Using multivariate logistic regression, the authors evaluated associations between sociodemographic variables and limited health literacy, as classified by S-TOFHLA scores. Results:, The authors enrolled 300 patients (77% of eligible). Overall, 75 (25%; 95% confidence interval [CI] = 20% to 30%) of participants had limited health literacy. Limited health literacy was independently associated with older age (compared to 18,44 years, odds ratio [OR] 4.3 [95% CI = 2.0 to 9.2] for 45,64 years and OR 3.4 [95% CI = 1.4 to 8.5] for ,65 years), less education (compared to high school graduates, OR 2.7 [95% CI = 1.1 to 7.3] for some high school or lower and OR 0.43 [95% CI = 0.21 to 0.88] for some college or higher), and lower income (OR 2.8 [95% CI = 1.2 to 6.6] for ,$40,000 compared to >$40,000). Although ethnicity, race, and language were associated with limited health literacy in unadjusted analyses, the associations were not significant on multivariate analysis. Conclusions:, In this sample, one-quarter of ED patients would be expected to have difficulty understanding health materials and following prescribed treatment regimens. Advanced age and low socioeconomic status were independently associated with limited health literacy. The ability of a significant subgroup of ED patients to understand health information, especially during illness or injury, requires further study. [source] Compliance with Recommended Cancer Screening among Emergency Department Patients: A Multicenter SurveyACADEMIC EMERGENCY MEDICINE, Issue 5 2008Adit A. Ginde MD Abstract Objectives:, The objectives were to measure compliance with, and possible sociodemographic disparities for, cancer screening among emergency department (ED) patients. Methods:, This was a cross-sectional survey in three academic EDs in Boston. The authors enrolled consecutive adult patients during two 24-hour periods at each site. Self-reported compliance with standard recommendations for cervical, breast, testicular, and prostate cancer screening were measured. The chi-square test was used test to evaluate associations between demographic variables and cancer screening compliance. Results:, The authors enrolled 387 patients (81% of those eligible). The participants had a mean (±standard deviation) age of 44 (±18) years and were 52% female, 16% Hispanic, and 65% white. Sixty-seven percent (95% confidence interval [CI] = 60% to 73%) of all women reported Pap smear examinations in the past 3 years, 92% (95% CI = 85% to 96%) of women aged ,40 years reported clinical breast examinations, and 88% (95% CI = 81% to 94%) of women aged ,40 years reported mammography. Fifty-one percent (95% CI = 40% to 61%) of men aged 18,39 years reported testicular self-examinations, and among men aged ,40 years, 79% (95% CI = 69% to 87%) reported digital rectal examinations (DREs) and 51% (95% CI = 40% to 61%) reported prostate-specific antigen (PSA) testing. Racial and ethnic minorities reported slightly lower rates of clinical breast examinations and testicular self-examinations. Conclusions:, Most women and a majority of men in our ED-based study were compliant with recommended measures of cervical, breast, testicular, and prostate cancer screening. No large sociodemographic disparities in our patient population were identified. Based on these data, and the many other pressing public health needs of our ED population, the authors would be reluctant to promote ED-based cancer screening initiatives at this time. [source] Multicenter Study of Preferences for Health Education in the Emergency Department PopulationACADEMIC EMERGENCY MEDICINE, Issue 6 2010M. Kit Delgado MD Abstract Objectives:, Emergency departments (EDs) are increasingly proposed as high-yield venues for providing preventive health education to a population at risk for unhealthy behaviors and unmet primary care needs. This study sought to determine the preferred health education topics and teaching modality among ED patients and visitors. Methods:, For two 24-hour periods, patients aged 18 years and older presenting to four Boston EDs were consecutively enrolled, and waiting room visitors were surveyed every 3 hours. The survey assessed interest in 28 health conditions and topics, which were further classified into nine composite health education categories. Also assessed was the participants' preferred teaching modality. Results:, Among 1,321 eligible subjects, 1,010 (76%) completed the survey, of whom 56% were patients and 44% were visitors. Among the health conditions, respondents were most interested in learning about stress and depression (32%). Among the health topics, respondents were most interested in exercise and nutrition (43%). With regard to learning modality, 34% of subjects chose brochures/book, 25% video, 24% speaking with an expert, 14% using a computer, and 3% another mode of learning (e.g., a class). Speaking with an expert was the overall preferred modality for those with less than high school education and Hispanics, as well as those interested in HIV screening, youth violence, and stroke. Video was the preferred modality for those interested in learning more about depression, alcohol, drugs, firearm safety, and smoke detectors. Conclusions:, Emergency department patients and visitors were most interested in health education on stress, depression, exercise, and nutrition, compared to topics more commonly targeted to the ED population such as substance abuse, sexual health (including HIV testing), and injury prevention. Despite many recent innovations in health education, most ED patients and visitors in our study preferred the traditional form of books and brochures. Future ED health education efforts may be optimized by taking into account the learning preferences of the target ED population. ACADEMIC EMERGENCY MEDICINE 2010; 17:652,658 © 2010 by the Society for Academic Emergency Medicine [source] | |||||||||||||||||||||||||