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Years

Distribution by Scientific Domains
Medical Sciences58%
Life Sciences14%
Humanities and Social Sciences6%
Earth and Environmental Science5%
Business, Economics, Finance and Accounting3%
Psychology3%
Chemistry2%
Engineering2%
6 Other Domains7%
Distribution within Medical Sciences
Dermatology5%
Cardiovascular Disease3%
113 Other Subdomains78%

Kinds of Years

  • academic year
  • additional year
  • adolescent year
  • adult year
  • age 31 year
  • average year
  • billion year
  • birth year
  • calendar year
  • case year
  • census year
  • childbearing year
  • childhood year
  • clinical year
  • cm year
  • cold year
  • college year
  • coming year
  • consecutive year
  • crisis year
  • crop year
  • current year
  • different year
  • disability-adjusted life year
  • drought year
  • dry year
  • early year
  • el niño year
    		•
  • ensuing year
  • entire year
  • experimental year
  • few year
  • fewer year
  • fifth year
  • final year
  • financial year
  • first postoperative year
  • first year
  • fiscal year
  • five hundred year
  • follow-up year
  • formative year
  • fourth year
  • full year
  • future year
  • half year
  • hundred year
  • hydrological year
  • increased year
  • individual year
  • initial year
  • intern year
  • international year
  • intervening year
  • interwar year
  • last 500 year
    		•
  • last several year
  • last year
  • least one year
  • life year
  • m year
  • many year
  • mast year
  • mean age 31 year
  • multiple year
  • new year
  • next year
  • niño year
  • one year
  • other year
  • pack year
  • past several year
  • past year
  • patient year
  • person year
  • post-war year
  • postgraduate year
  • postoperative year
  • pre-clinical year
  • preceding year
  • preschool year
  • previous year
  • prior year
  • publication year
    		•
  • quality-adjusted life year
  • recent year
  • release year
  • reproductive year
  • same year
  • sampling year
  • school year
  • second year
  • senior year
  • several year
  • single year
  • study year
  • subsequent year
  • successive year
  • ten year
  • third year
  • thirty year
  • three year
  • treatment year
  • twenty year
  • war year
  • water year
  • wet year
  • whole year

    • Terms modified by Years

  • year a number
  • year age group
  • year age groups
  • year analysis
  • year bp
  • year class
  • year data
  • year decreased
  • year dental student
  • year duration
  • year effects
  • year experience
  • year follow-up
    		•
  • year group
  • year groups
  • year growth
  • year history
  • year increase
  • year interaction
  • year interval
  • year level
  • year medical student
  • year old
  • year old boy
  • year old child
  • year old girl
    		•
  • year old male
  • year old presenting
  • year old woman
  • year older
  • year only
  • year outcome
  • year period
  • year post-transplant
  • year post-treatment
  • year postpartum
  • year posttransplant
  • year posttransplantation
  • year prior
    		•
  • year regardless
  • year resident
  • year round
  • year student
  • year study
  • year survival
  • year treatment
  • year v
  • year vs.
  • year younger

    • Selected Abstracts

    Annual Direct and Indirect Health Costs of the Congenital Ichthyoses

    PEDIATRIC DERMATOLOGY, Issue 4 2010
    Andrew R. Styperek M.B.A.
    We conducted a cost analysis through an online survey posted on the Foundation for Ichthyosis and Related Skin Types Website. We assessed cutaneous disease severity, via the previously validated Congenital Ichthyosis Severity Index (CISIÔ), demographics, and CI type. We estimated direct health care costs: prescription and over-the-counter medications, outpatient visits, and emergency department and hospital visit costs; and indirect costs: earnings lost owing to absences from work because of CI-related illness. The CI subjects of our study (n = 224) consumed a mean (SD) of $3,192 ($7,915) annually. Direct costs accounted for 90%, whereas indirect costs accounted for 10%. These costs resulted in an estimated annual cost of $37MM/year (excluding ichthyosis vulgaris) of which $17MM is borne out-of-pocket by patients. Depending on the CI diagnosis, patients were responsible for 30,51 cents of every dollar of mean annual medical care costs. Our estimated annual CI costs are comparable to cutaneous lymphoma. More effective treatments for CI would help minimize this burden. Traditional insurance products do not appear to substantially alleviate the financial burden of disease, as a significant amount is from out-of-pocket expenses. [source]

    Long-Term Variability of Markers of Bone Turnover in Postmenopausal Women and Implications for Their Clinical Use: The OFELY Study,

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2003
    Patrick Garnero
    Abstract Bone marker variability has raised concern for its use in individual patients. Serum osteocalcin (formation) and CTX (resorption) were measured every year for 4 years in 268 postmenopausal women. Seventy percent to 80% of women classified as having high bone turnover at baseline were similarly classified by the same methods 4 years later. Introduction: High bone marker levels are a risk factor for osteoporosis in postmenopausal women, but variability of measurements has raised doubts about their clinical use in an individual patient. Methods: We studied 268 untreated postmenopausal women (50,81 years of age) belonging to a population-based prospective cohort. We collected fasting morning blood samples every year for 4 years to measure serum intact osteocalcin (OC) and serum C-terminal cross-linked telopeptide of type I collagen (CTX) as bone formation and resorption markers, respectively. Results: Serum OC and CTX remained stable during follow-up (+1.2%/year, p = 0.003 and ,0.13%/year, p = 0.70 for OC and S-CTX, respectively). At baseline, women were classified as having low (tertile 1), intermediate (tertile 2), or high (tertile 3) bone turnover. Agreement of classification between baseline and 4-year measurements was moderate (, [95% CI]: 0.51 [0.43,0.59] and 0.52 [0.44,0.60] for OC and S-CTX, respectively). Less than 10% of women in tertile 1 or 3 of either marker at baseline were found in the opposite tertile 4 years later. When the two markers were combined, only 2% of women at high turnover at baseline,defined as OC and/or S-CTX in tertile 3,were classified at low turnover 4 years later. Among women classified at high bone turnover at baseline (tertile 3), 70,80 % were also found at high turnover 4 years later. Among women in tertile 2, only 51% and 43% for OC and CTX, respectively, remained in the same tertile at the second measurement. Conclusions: Serum levels of bone formation and resorption markers are stable over 4 years in postmenopausal women, on average. The majority of women classified as having high bone turnover were similarly classified by the same methods 4 years later. However, 20,30 % of these women at risk for fracture would be incorrectly classified, suggesting that further investigation would be required to reduce the number of patients who would be treated unnecessarily if the decision was made on bone marker measurement. For women with intermediate levels, classification may be improved by a second measurement or by combining two markers. [source]

    Methemoglobinemia Following Transesophageal Echocardiography: A Case Report and Review

    ECHOCARDIOGRAPHY, Issue 4 2006
    Swarnalatha BheemReddy M.D.
    Benzocaine (ethyl aminobenzoate) is a topical anesthetic widely used for oropharyngeal anesthesia prior to transesophageal echocardiography (TEE). Topical anesthetics have been reported to cause methemoglobinemia, but this adverse event is extremely rare and has not been listed as one of the possible complications of TEE. However, recently the number of published case reports of TEE-associated methemoglobinemia has increased. Since its first description in 1950, 65 cases of methemoglobinemia have been reported including a recent report of five cases from a single center. Physicians who are not familiar with the association of TEE with benzocaine-induced methemoglobinemia may not recognize the idiosyncratic and often nonspecific characteristic of this condition. Recognition is critical, however, since left untreated methemoglobinemia can lead to cardiopulmonary compromise, neurological sequelae, and even death. The current report documents an additional case of TEE-associated methemoglobinemia from a high-volume (8000 cases /year including 400,450 TEE/year) echo lab. A review of the literature suggests that this complication may be more prevalent, than generally appreciated. This case report emphasizes the importance of appropriate dose, recognition, and the treatment of this entity to cardiologists performing TEE. [source]

    Potential role of human papillomavirus in the development of subsequent primary in situ and invasive cancers among cervical cancer survivors,,

    CANCER, Issue S10 2008
    Appathurai Balamurugan MD
    Abstract BACKGROUND. The recent licensure of human papillomavirus (HPV) vaccines will likely decrease the development of primary in situ and invasive cervical cancers and possibly other HPV-associated cancers such as vaginal, vulvar, and anal cancers. Because the HPV vaccine has the ability to impact the development of >1 HPV-associated cancer in the same individual, the risk of developing subsequent primary cancers among cervical cancer survivors was examined. METHODS. Using the 1992 through 2004 data from the Surveillance, Epidemiology, and End Results (SEER) program, 23,509 cervical cancer survivors were followed (mean of 4.8 person-years) for the development of subsequent primary cancers. The observed number (O) of subsequent cancers of all sites were compared with those expected (E) based on age-/race-/year-/site-specific rates in the SEER population. Standardized incidence ratios (SIRs = O/E) were considered statistically significant if they differed from 1, with an , level of 0.05. RESULTS. Among cervical cancer index cases, there was a significant elevated risk for subsequent in situ cancers of the vagina and vulva (SIRs of 53.8 and 6.6, respectively); and invasive vaginal, vulvar, and rectal cancers (SIRs of 29.9, 5.7, and 2.2, respectively). Significantly elevated risks were observed across race and ethnic populations for subsequent vaginal in situ (SIR for whites of 49.4; blacks, 52.8; Asian/Pacific Islander [API], 91.4; and Hispanics, 55.7) and invasive cancers (SIR for whites of 25.7; blacks, 34.5; API, 48.5; and Hispanics, 25.2). CONCLUSIONS. The results of the current study demonstrate a substantially increased risk of the development of subsequent primary in situ and invasive cancers among cervical cancer survivors and have implications for the development of prevention and early detection strategies as the role of HPV infection becomes evident. Cancer 2008;113(10 suppl):2919,25. Published 2008 by the American Cancer Society. [source]

    Single-Point Assessment of Warfarin Use and Risk of Osteoporosis in Elderly Men

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008
    Claudine Woo PhD
    OBJECTIVES: To determine whether warfarin use, assessed at a single point in time, is associated with bone mineral density (BMD), rates of bone loss, and fracture risk in older men. DESIGN: Secondary analysis of data from a prospective cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Five thousand five hundred thirty-three community-dwelling, ambulatory men aged 65 and older with baseline warfarin use data. MEASUREMENTS: Warfarin use was assessed as current use of warfarin at baseline using an electronic medication coding dictionary. BMD was measured at the hip and spine at baseline, and hip BMD was repeated at a follow-up visit 3.4 years later. Self-reported nonspine fractures were centrally adjudicated. RESULTS: At baseline, the average age of the participants was 73.6 ± 5.9, and 321 (5.8%) were taking warfarin. Warfarin users had similar baseline BMD as nonusers (n=5,212) at the hip and spine (total hip 0.966 ± 0.008 vs 0.959 ± 0.002 g/cm2, P=.37; total spine 1.079 ± 0.010 vs 1.074 ± 0.003 g/cm2, P=.64). Of subjects with BMD at both visits, warfarin users (n=150) also had similar annualized bone loss at the total hip as nonusers (n=2,683) (,0.509 ± 0.082 vs ,0.421 ± 0.019%/year, P=.29). During a mean follow-up of 5.1 years, the risk of nonspine fracture was similar in warfarin users and nonusers (adjusted hazard ratio=1.06, 95% confidence interval=0.68,1.65). CONCLUSION: In this cohort of elderly men, current warfarin use was not associated with lower BMD, accelerated bone loss, or higher nonspine fracture risk. [source]

    Guidelines for the antiviral therapy of hepatitis C virus carriers with normal serum aminotransferase based on platelet counts

    HEPATOLOGY RESEARCH, Issue 1 2008
    Takeshi Okanoue
    Aim:, We aimed to identify the candidates for antiviral therapy, among patients who are hepatitis C virus (HCV) carriers with normal serum aminotransferase (ALT), focused on the inhibition of hepatocellular carcinoma (HCC). Methods:, Four hundred and sixty-four HCV carriers with normal serum ALT and 129 HCV carriers with persistently normal ALT (PNALT) and platelet (PLT) counts ,150 000/,L who received liver biopsies were enrolled. HCV carriers with normal serum ALT were divided into four groups according to their ALT levels (,30 U/L or 31,40 U/L) and PLT counts (,150 000/,L or <150 000/,L). Results:, In 129 HCV carriers with PNALT, the rate of progression of fibrosis stage was 0.05/year and no HCC was detected during the follow up for 10 years. Approximately 20% of patients with ALT ,40 U/L and PLT counts ,150 000/,Lwere at stage F2,3; however, approximately 50% of patients with ALT , 40 U/L and PLT counts <150 000/,L were at stage F2,4. An algorithm for the management of HCV carriers with normal serum ALT was advocated based on ALT and PLT counts. Conclusion:, The combination of ALT and PLT counts is useful for evaluating the fibrosis stage in HCV carriers with normal serum ALT. Most patients with PLT counts <150 000/,L are candidates for antiviral therapy, especially those with ALT levels ,31 U/L when we focus on the inhibition of the development of HCC. [source]

    Long-Term Variability of Markers of Bone Turnover in Postmenopausal Women and Implications for Their Clinical Use: The OFELY Study,

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2003
    Patrick Garnero
    Abstract Bone marker variability has raised concern for its use in individual patients. Serum osteocalcin (formation) and CTX (resorption) were measured every year for 4 years in 268 postmenopausal women. Seventy percent to 80% of women classified as having high bone turnover at baseline were similarly classified by the same methods 4 years later. Introduction: High bone marker levels are a risk factor for osteoporosis in postmenopausal women, but variability of measurements has raised doubts about their clinical use in an individual patient. Methods: We studied 268 untreated postmenopausal women (50,81 years of age) belonging to a population-based prospective cohort. We collected fasting morning blood samples every year for 4 years to measure serum intact osteocalcin (OC) and serum C-terminal cross-linked telopeptide of type I collagen (CTX) as bone formation and resorption markers, respectively. Results: Serum OC and CTX remained stable during follow-up (+1.2%/year, p = 0.003 and ,0.13%/year, p = 0.70 for OC and S-CTX, respectively). At baseline, women were classified as having low (tertile 1), intermediate (tertile 2), or high (tertile 3) bone turnover. Agreement of classification between baseline and 4-year measurements was moderate (, [95% CI]: 0.51 [0.43,0.59] and 0.52 [0.44,0.60] for OC and S-CTX, respectively). Less than 10% of women in tertile 1 or 3 of either marker at baseline were found in the opposite tertile 4 years later. When the two markers were combined, only 2% of women at high turnover at baseline,defined as OC and/or S-CTX in tertile 3,were classified at low turnover 4 years later. Among women classified at high bone turnover at baseline (tertile 3), 70,80 % were also found at high turnover 4 years later. Among women in tertile 2, only 51% and 43% for OC and CTX, respectively, remained in the same tertile at the second measurement. Conclusions: Serum levels of bone formation and resorption markers are stable over 4 years in postmenopausal women, on average. The majority of women classified as having high bone turnover were similarly classified by the same methods 4 years later. However, 20,30 % of these women at risk for fracture would be incorrectly classified, suggesting that further investigation would be required to reduce the number of patients who would be treated unnecessarily if the decision was made on bone marker measurement. For women with intermediate levels, classification may be improved by a second measurement or by combining two markers. [source]

    An echocardiographic and auscultation study of right heart responses to training in young National Hunt Thoroughbred horses

    EQUINE VETERINARY JOURNAL, Issue S36 2006
    G. LIGHTFOOT
    Summary Reasons for performing study: There are few data available to determine the effect of training on cardiac valve function. Objectives: To investigate the effect of commercial race training on right ventricular (RV) and tricuspid valve function in an untrained group of National Hunt Thoroughbreds (TB). Material and methods: Cardiac auscultation, guided M-mode echocardiography of the RV, and colour flow Doppler (CFD) tricuspid valve and right atrium were performed in 90 TB horses (age 2,7 years) 1998,2003. Forty horses were examined at least once and 48 horses were examined on at least 2 occasions. Examinations were then classified as: i) before commencement of race training, ii) after cantering exercise had been sustained for a period of 8,12 weeks and iii) at full race fitness. Tricuspid valve regurgitation (TR) murmurs were graded on a 1,6 scale and CFD echocardiography TR signals were graded on a 1,9 scale. Right ventricular internal diameter (RVID) in diastole and systole (RVIDd and RVIDs) was measured by guided M-mode. Associations between continuous RVID and TR measures and explanatory covariates of weight, age, heart rate, yard and stage of training were examined using general linear mixed models with horse-level random effects. Results: On average, RVIDd and RVIDs increased by 0.08 and 0.1 cm, respectively, per year increase in age (P=0.1 and 0.02) and by 0.3 and 0.4 cm, respectively between pre-training and race fitness (P = 0.07 and 0.005). Tricuspid regurgitation score by colour flow Doppler increased by 0.6/year with age (P<0.0001) and by 1.8 between pre-training and race fitness (P< 0.0001). No significant associations were found between any outcomes and weight, heart rate and training yard. Due to the high level of co-linearity between age and training, multivariable models including both terms were not interpretable. Conclusions and clinical relevance: Athletic training of horses exerts independent effects on both severity and prevalence of tricuspid valve incompetence. This effect should therefore be taken into account when examinations are performed. Dimensions of RV increase with age and training in TB horses in a manner that appears to be similar to that of the LV. [source]

    Brain atrophy rates in Parkinson's disease with and without dementia using serial magnetic resonance imaging

    MOVEMENT DISORDERS, Issue 12 2005
    Emma J. Burton PhD
    Abstract Increased rates of brain atrophy are seen in Alzheimer's disease, but whether rates are similarly increased in other dementias such as Parkinson's disease dementia (PDD) has not been well examined. We determined the rates of brain atrophy using serial magnetic resonance imaging (MRI) in PDD and compared this finding to rates seen in cognitively intact Parkinson's disease (PD) patients and age-matched control subjects. Thirty-one patients (PD = 18, PDD = 13) and 24 age-matched controls underwent serial volumetric 1.5 T MRI scans, approximately 1 year apart. Baseline and repeat scans were registered and quantification of the brain boundary shift integral was used to determine whole-brain atrophy rates. Rates of brain atrophy were significantly increased in PDD (1.12 ± 0.98%/year) compared to PD (0.31 ± 0.69%/year; P = 0.018) and control subjects (0.34 ± 0.76%/year; P = 0.015). There were no differences in atrophy rates between controls and PD (P = 0.79). No correlations between increased atrophy rates and age or dementia severity (Mini-Mental State Examination score) were observed. Serial MRI may be a useful tool for monitoring disease progression in PDD and further studies should investigate its utility for early diagnosis. © 2005 Movement Disorder Society [source]

    Effects of Current and Discontinued Estrogen Replacement Therapy on Hip Structural Geometry: The Study of Osteoporotic Fractures,

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 11 2001
    Thomas J. Beck
    Abstract It is assumed that estrogen influences bone strength and risk of fractures by affecting bone mineral density (BMD). However, estrogen may influence the mechanical strength of bones by altering the structural geometry in ways that may not be apparent in the density. Repeated dual energy X-ray absorptiometry (DXA) hip scan data were analyzed for bone density and structural geometry in elderly women participating in the Study of Osteoporotic Fractures (SOF). Scans were studied with a hip structural analysis program for the effects of estrogen replacement therapy (ERT) on BMD and structural geometry. Of the 3964 women with ERT-use data, 588 used ERT at both the start and end of the ,3.5-year study, 1203 had past use which was discontinued by clinic visit 4, and 2163 women had never used ERT. All groups lost BMD at the femoral neck, but the reduced BMD among users of ERT was entirely due to subperiosteal expansion and not bone loss, whereas both bone loss and expansion occurred in past or nonusers. BMD increased 0.8%/year at the femoral shaft among ERT users but decreased 0.8%/year among nonusers. Section moduli increased at both the neck and shaft among ERT users but remained unchanged in past and nonusers. Current, but not past, use of estrogen therapy in elderly women seems to increase mechanical strength of the proximal femur by improving its geometric properties. These effects are not evident from changes in femoral neck BMD. [source]

    Brain atrophy rates in Parkinson's disease with and without dementia using serial magnetic resonance imaging

    MOVEMENT DISORDERS, Issue 12 2005
    Emma J. Burton PhD
    Abstract Increased rates of brain atrophy are seen in Alzheimer's disease, but whether rates are similarly increased in other dementias such as Parkinson's disease dementia (PDD) has not been well examined. We determined the rates of brain atrophy using serial magnetic resonance imaging (MRI) in PDD and compared this finding to rates seen in cognitively intact Parkinson's disease (PD) patients and age-matched control subjects. Thirty-one patients (PD = 18, PDD = 13) and 24 age-matched controls underwent serial volumetric 1.5 T MRI scans, approximately 1 year apart. Baseline and repeat scans were registered and quantification of the brain boundary shift integral was used to determine whole-brain atrophy rates. Rates of brain atrophy were significantly increased in PDD (1.12 ± 0.98%/year) compared to PD (0.31 ± 0.69%/year; P = 0.018) and control subjects (0.34 ± 0.76%/year; P = 0.015). There were no differences in atrophy rates between controls and PD (P = 0.79). No correlations between increased atrophy rates and age or dementia severity (Mini-Mental State Examination score) were observed. Serial MRI may be a useful tool for monitoring disease progression in PDD and further studies should investigate its utility for early diagnosis. © 2005 Movement Disorder Society [source]

    Type 1 diabetes mellitus in Czech children diagnosed in 1990,1997: a significant increase in incidence and male predominance in the age group 0,4 years

    DIABETIC MEDICINE, Issue 1 2000
    O. Cinek
    Summary Aims To overview total, age-and sex-specific incidence rates of type 1 diabetes mellitus and their trends in Czech children 0,14 years of age in the period of 1990,1997. Methods Type 1 DM cases were ascertained by two independent sources, data of general population were obtained from the annual demographic reports of the State Statistic Bureau. Incidence rates were computed using both ascertainment sources combined. Results In the study period 1.1.1990,31.12.1997, the total incidence was 10.1 (95% CI 9.6,10.6) per 100 000/year in both sexes, 10.0 (95% CI 9.4,10.7) in boys, and 10.2 (95% CI 9.5,11.0) in girls. The total age-standardized incidence was 9.9 (95% CI 9.4,10.4). The total incidence had a significant increasing trend over the study period (P = 10,4, annual increment 4.3%). A significant increasing trend was also found in the groups of children 0,4 (P = 0.033, increment 6.9%) and 5,9 years at diagnosis (P = 0.038, increment 4.8%). Statistically significant male predominance was observed in the group diagnosed at age 0,4 years (boys/girls ratio of incidence 1.33, P = 0.035). Conclusions We report the first population-based epidemiological data on incidence of childhood Type 1 DM in the Czech Republic. The incidence has increased significantly during the last 8 years. The present incidence is at an intermediate level compared to other European countries. [source]

    The Epidemiology of Convulsive Status Epilepticus in Children: A Critical Review

    EPILEPSIA, Issue 9 2007
    Miquel Raspall-Chaure
    Summary:, There is ongoing debate regarding the most appropriate definition of status epilepticus. This depends upon the research question being asked. Based on the most widely used "30 min definition," the incidence of childhood convulsive status epilepticus (CSE) in developed countries is approximately 20/100,000/year, but will vary depending, among others, on socioeconomic and ethnic characteristics of the population. Age is a main determinant of the epidemiology of CSE and, even within the pediatric population there are substantial differences between older and younger children in terms of incidence, etiology, and frequency of prior neurological abnormalities or prior seizures. Overall, incidence is highest during the first year of life, febrile CSE is the single most common cause, around 40% of children will have previous neurological abnormalities and less than 15% will have a prior history of epilepsy. Outcome is mainly a function of etiology. However, the causative role of CSE itself on mesial temporal sclerosis and subsequent epilepsy or the influence of age, duration, or treatment on outcome of CSE remains largely unknown. Future studies should aim at clarifying these issues and identifying specific ethnic, genetic, or socioeconomic factors associated with CSE to pinpoint potential targets for its primary and secondary prevention. [source]

    Effect of Mandated Nurse,Patient Ratios on Patient Wait Time and Care Time in the Emergency Department

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2010
    Theodore C. Chan MD
    Abstract Objectives:, The objective was to evaluate the effect of mandated nurse,patient ratios (NPRs) on emergency department (ED) patient flow. Methods:, Two institutions implemented an electronic tracking system embedded within the electronic medical record (EMR) of two EDs (an academic urban, teaching medical center,Hospital A; and a suburban community hospital,Hospital B), with a combined census of 60,000/year, to monitor real-time NPRs and patient acuity, such that compliance with state-mandated ratios could be prospectively monitored. Data were queried for a 1-year period after implementation and included patient wait times (WTs), ED care time (EDCT), patient acuity, ED census, and NPR status for each nurse, patient, and the ED overall. Median WT and EDCT with interquartile ranges (IQRs) were analyzed to determine the effect of NPR status of each patient, nurse, and the ED overall. To control for factors that could affect the "within the mandated ratio" and the "outside of the mandated ratio" status, including patient volume and acuity, log-linear regression models were used controlling for specified factors for each hospital facility and combined. Results:, There were a total of 30,404 (50.9%) patients who waited in the waiting room prior to being placed in an ED bed (53.8% at Hospital A and 46.4% at Hospital B). Patients who waited at Hospital A waited a median duration of 55 minutes (IQR = 15,128 minutes), compared with 32 minutes (IQR = 12,67 minutes) at Hospital B with a combined median WT of 44 minutes (IQR = 13,101 minutes). In the log-linear regression analysis, WTs were 17% (95% confidence interval [CI] = 10% to 25%, p < 0.001) longer at Hospital A and 13% (95% CI = 3% to 24%, p = 0.008) longer at Hospital B (combined 16% [95% CI = 10% to 22%, p < 0.001] longer at both sites) when the ED overall was out-of-ratio compared to in-ratio. There were a total of 45,660 patients discharged from both EDs during the study period, from which EDCT data were collected (26,894 in Hospital A and 18,766 in Hospital B). Median EDCT was 184 minutes (IQR = 97,311 minutes) at Hospital A, compared to 120 minutes (IQR = 63,208 minutes) at Hospital B, for a combined median EDCT of 153 minutes (IQR = 81,269 minutes). In the log-linear regression analysis, the EDCT for patients whose nurse was out-of-ratio were 34% (95% CI = 30% to 38%, p < 0.001) longer at Hospital A and 42% (95% CI = 37% to 48%, p < 0.001) longer at Hospital B (combined 37% [95% CI = 34% to 41%, p < 0.001] longer at both sites) when compared to patients whose nurse was in-ratio. Conclusions:, In these two EDs, throughput measures of WT and EDCT were shorter when the ED nurse staffing were within state-mandated levels, after controlling for ED census and patient acuity. ACADEMIC EMERGENCY MEDICINE 2010; 17:545,552 © 2010 by the Society for Academic Emergency Medicine [source]

    Prevalence and incidence of cluster headache in the Republic of San Marino.

    HEADACHE, Issue 3 2003
    C Tonon
    Neurology. 2002 May 14;58(9):1407-1409 Based on a preceding survey performed in 1985, the authors estimated the prevalence and incidence of cluster headache (CH) in the Republic of San Marino (26 628 inhabitants at 31 December 1999). All cases were diagnosed by direct interview according to International Headache Society criteria. The prevalence rate was 56/100 000 (95% CI 31.3 to 92.4), and the incidence rate was 2.5/100 000/year (95% CI 1.14 to 4.75). Most cases showed rare clusters. This is the first prospective study on the incidence of CH. Comment: There continues to be debate on the prevalence of cluster in the general population. Since San Marino is small, the entire cluster population, with a smaller denominator for the general population, could be estimated, making this a very important study. SJT [source]

    Smoking and risk for amyotrophic lateral sclerosis: Analysis of the EPIC cohort,

    ANNALS OF NEUROLOGY, Issue 4 2009
    Valentina Gallo MD
    Objective Cigarette smoking has been reported as "probable" risk factor for Amyotrophic Lateral Sclerosis (ALS), a poorly understood disease in terms of aetiology. The extensive longitudinal data of the European Prospective Investigation into Cancer and Nutrition (EPIC) were used to evaluate age-specific mortality rates from ALS and the role of cigarette smoking on the risk of dying from ALS. Methods A total of 517,890 healthy subjects were included, resulting in 4,591,325 person-years. ALS cases were ascertained through death certificates. Cox hazard models were built to investigate the role of smoking on the risk of ALS, using packs/years and smoking duration to study dose-response. Results A total of 118 subjects died from ALS, resulting in a crude mortality rate of 2.69 per 100,000/year. Current smokers at recruitment had an almost two-fold increased risk of dying from ALS compared to never smokers (HR = 1.89, 95% C.I. 1.14,3.14), while former smokers at the time of enrolment had a 50% increased risk (HR = 1.48, 95% C.I. 0.94,2.32). The number of years spent smoking increased the risk of ALS (p for trend = 0.002). Those who smoked more than 33 years had more than a two-fold increased risk of ALS compared with never smokers (HR = 2.16, 95% C.I. 1.33,3.53). Conversely, the number of years since quitting smoking was associated with a decreased risk of ALS compared with continuing smoking. Interpretation These results strongly support the hypothesis of a role of cigarette smoking in aetiology of ALS. We hypothesize that this could occur through lipid peroxidation via formaldehyde exposure. Ann Neurol 2009;65:378,385. [source]

    Cutaneous melanoma in New Zealand: 2000,2004

    ANZ JOURNAL OF SURGERY, Issue 5 2010
    Jennifer J. C. Liang
    Abstract Background:, In 2004, we published data on the trends in New Zealand (NZ) cutaneous melanoma (CM) for the period 1995,1999. The present report documents the trends in the next period from 2000 to 2004. Method:, Data were obtained from the New Zealand Cancer Registry by way of a computerized search of CM ICD-10 (172) codes from 2000 to 2004. Only one registration per person was made to avoid including patients with metastatic melanoma. The exclusion criteria were: incorrect or absent data; benign naevi; and melanoma in situ. Incidence rates were age standardised to the Segi world population. Results:, The total study population was 8262 patients. There was no increase found in the overall incidence rate over the time period, but men had a statistically higher overall incidence rate (P= 0.0002) and thicker CMs (P= 0.003) compared with women. This gender difference was particularly marked in those patients aged greater than 59 years. Breslow thickness increased from 0.7 to 0.8 mm. The incidence rates varied quite significantly among District Health Boards, with Taranaki having the highest rate (70.3/100 000/year) and Southland had the lowest rate (20.1/100 000). Overall, NZ had a CM incidence rate of 41.2/100 000/year). Conclusion:, The current study confirmed that NZ has the highest overall CM incidence rate in the world. Elderly men (>59 years old) have the highest risk of developing melanoma. The increase in melanoma thickness with its associated higher mortality risk is of grave concern. [source]

    Trends in paediatric injury rates using emergency department based injury surveillance

    AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010
    Michael Shepherd
    Abstract Objective: The primary aim of this study was to develop a method of calculating paediatric injury rate from Emergency Department injury surveillance data and use this to describe trends in paediatric injury. This study also aimed to establish whether triage category could be used as an indicator of severity. Methods: Prospective observational study of paediatric injury in Brisbane, Australia from 1998 to 2005 using Emergency Department injury surveillance data. Injury incidence was calculated using postcode restriction, census data and analysis of injury surveillance data quality and alternative hospital presentations. Results: The incidence of Emergency Department injury presentation increased by 56% between 1998 and 2005. The incidence of injury (adjusted for ascertainment and other hospital presentations) increased from 5,323/100,000/year to 8,316/100,000/year (p<0.01). The overall incidence of admission increased from 1,066/100,000/year to 1,238/100,000/year (p<0.01). The incidence of injury presentations triaged as urgent or above increased by 16% over the study period (2,348/100,000/year to 2,723/100,000/year, p<0.01). Conclusion: Injury incidence can be determined using Emergency Department injury surveillance data and triage category is a useful indicator of injury severity. Paediatric emergency department injury presentations, including serious injury, increased significantly between 1998 and 2005. Implications: The methodology used in this study is easily repeatable and could be used to evaluate injury prevention interventions. The prevention and management of injury should be directed by accurate injury incidence data. [source]

    Five-year incidence of surgery for idiopathic normal pressure hydrocephalus in Norway

    ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2009
    A. Brean
    Objectives ,, We have previously determined the incidence and prevalence of idiopathic normal pressure hydrocephalus (iNPH) in the county of Vestfold in Norway. This study aimed at determining the incidence of surgeries for iNPH. Materials and methods ,, Information about age, sex, operation year and operation type was collected retrospectively for all patients hospitalized from 2002 to 2006 with any diagnosis of iNPH and operated with insertion of a ventriculo-peritoneal or ventriculoatrial shunt system, or with endoscopic third ventriculostomy in any of Norway's five regional neurosurgical centers. Results ,, Two hundred fifty-two patients were operated during the 5-year period, making the total incidence 1.09/100,000/year. The yearly incidence ranged from a minimum of 0.84/100,000 in 2006 to a maximum of 1.47/100,000 in 2004. The incidence was highest in the age group 70,79 years. There were little regional differences regarding incidence, sex, and age and operation type. Conclusions ,, The data suggest that too few patients are being offered surgical treatment for iNPH in Norway. [source]

    Witnessing Intimate Partner Violence as a Child Does Not Increase the Likelihood of Becoming an Adult Intimate Partner Violence Victim

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2007
    Amy A. Ernst MD
    ObjectivesTo determine whether adults who witnessed intimate partner violence (IPV) as children would have an increased rate of being victims of ongoing IPV, as measured by the Ongoing Violence Assessment Tool (OVAT), compared with adult controls who did not witness IPV as children. The authors also sought to determine whether there were differences in demographics in these two groups. MethodsThis was a cross sectional cohort study of patients presenting to a high-volume academic emergency department. Emergency department patients presenting from November 16, 2005, to January 5, 2006, during 46 randomized four-hour shifts were included. A confidential computer touch-screen data entry program was used for collecting demographic data, including witnessing IPV as a child and the OVAT. Main outcome measures were witnessing IPV as a child, ongoing IPV, and associated demographics. Assuming a prevalence of IPV of 20% and a clinically significant difference of 20% between adults who witnessed IPV as children and adult controls who did not witness IPV as children, the study was powered at 80%, with 215 subjects included. ResultsA total of 280 subjects were entered; 256 had complete data sets. Forty-nine percent of subjects were male, 45% were Hispanic, 72 (28%) were adults who witnessed IPV as children, and 184 (72%) were adult controls who did not witness IPV as children. Sixty-three (23.5%) were positive for ongoing IPV. There was no correlation of adults who witnessed IPV as children with the presence of ongoing IPV, as determined by univariate and bivariate analysis. Twenty-three of 72 (32%) of the adults who witnessed IPV as children, and 39 of 184 (21%) of the adult controls who did not witness IPV as children, were positive for IPV (difference, 11%; 95% confidence interval [CI] =,2% to 23%). Significant correlations with having witnessed IPV as a child included age younger than 40 years (odds ratio [OR], 4.2; 95% CI = 1.7 to 9.1), income less than 20,000/year (OR, 5.1; 95% CI = 1.6 to 12.5), and abuse as a child (OR, 9.1; 95% CI = 4.2 to 19.6). Other demographics were not significantly correlated with having witnessed IPV as a child. ConclusionsAdults who witnessed IPV as children were more likely to have a lower income, be younger, and have been abused as a child, but not more likely to be positive for ongoing IPV, when compared with patients who had not witnessed IPV. [source]

    The incidence of autoimmune thyroid disease: a systematic review of the literature

    CLINICAL ENDOCRINOLOGY, Issue 5 2008
    Anita McGrogan
    Summary Objective, To undertake a systematic review of literature published between 1980 and 2008 on the incidence of autoimmune thyroid disease. Design, All relevant papers found through searches of Medline, EMBASE and ScienceDirect were critically appraised and an assessment was made of the reliability of the reported incidence data. Results, The reported incidence of autoimmune hypothyroidism varied between 2·2/100 000/year (males) and 498·4/100 000/year (females) and for autoimmune hyperthyroidism, incidence ranged from 0·70/100 000/year (Black males) to 99/100 000/year (Caucasian females). Higher incidence rates were found in women compared to men for all types of autoimmune thyroid disease. The majority of studies included in the review investigated Caucasian populations mainly from Scandinavia, Spain, the UK and the USA. It is possible that nonautoimmune cases were included in the incidence rates reported here, which would give an overestimation in the incidence rates of autoimmune disease presented. Conclusion, To our knowledge this is the most comprehensive systematic review of autoimmune thyroid disease conducted in the past two decades. Studies of incidence of autoimmune thyroid disease have only been conducted in a small number of mainly western countries. Our best estimates of the incidence of hypothyroidism is 350/100 000/year in women and 80/100 000/year in men; the incidence of hyperthyroidism is 80/100 000/year in women and 8/100 000/year in men. [source]

    Acceleration of lung disease in children with cystic fibrosis after Pseudomonas aeruginosa acquisition

    PEDIATRIC PULMONOLOGY, Issue 4 2001
    Michael R. Kosorok PhD
    Abstract As part of the ongoing Wisconsin Cystic Fibrosis (CF) Neonatal Screening Project, we had the unique opportunity to study the longitudinal relationship between Pseudomonas aeruginosa (Pa) acquisition and infection and developing lung disease in children with CF. The primary objective was to determine whether acquisition of Pa was associated with a measurable change in the progression of lung disease. Two outcome measures were used to study 56 patients who were diagnosed through newborn screening: 1) Wisconsin additive chest radiograph score (WCXR), based on the average of scores from a pulmonologist and a radiologist, and 2) the highest forced expired volume in 1 sec (FEV1)/forced vital capacity (FVC) ratio. We used two measures of Pa acquisition: 1) time of first positive protocol-determined oropharyngeal (with cough) culture, and 2) the magnitude of antibody titer detected by ELISA assays, using as antigen a crude cell lysate, purified exotoxin A, or an elastase toxoid prepared from three Pa strains. Other predictor variables included age, pancreatic status, height-for age, and weight-for-age-percentiles. The best regression model for predicting changes in the WCXR included time to first positive culture and antibody titer for Pa elastase. Prior to Pa acquisition, WCXR worsened by 0.45 points/year (P,>,0.25); after Pa acquisition, the rate of worsening increased significantly (P,<,0.001) to 1.40 points/year. Each antibody titer level (log base 2) increased the score by 0.48 points (P,<,0.001). The best regression model for predicting change in the FEV1/FVC included only time to first positive culture. Prior to Pa acquisition, the FEV1/FVC ratio declined by 1.29%/year; after Pa infection, the rate of decrease significantly accelerated to 1.81%/year (P,=,0.001). Our data show that Pa acquisition is associated with declining pulmonary status in children with CF, and that this effect is probably gradual rather than precipitous. Because these patients were diagnosed and treated aggressively, our estimates of the effects of Pa acquisition may be conservative. We also conclude that the WCXR appears to be more sensitive than FEV1/FVC in detecting early changes in lung disease associated with CF. Pediatr Pulmonol. 2001; 32:277,287. © 2001 Wiley-Liss, Inc. [source]

    Long-Term Survival in Patients Treated with Cardiac Resynchronization Therapy: A 3-Year Follow-Up Study from the InSync/InSync ICD Italian Registry

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2006
    MAURIZIO GASPARINI
    Background: Studies reporting the long-term survival of patients treated with cardiac resynchronization therapy (CRT) outside the realm of randomized controlled trials are still lacking. The aim of this study was to quantify the survival of patients treated with CRT in clinical practice and to investigate the long-term effects of CRT on clinical status and echocardiographic parameters. Methods: The study population consisted of 317 consecutive patients with implanted CRT devices from eight Italian University/Teaching Hospitals. The patients were enrolled in a national observational registry and had a minimum follow-up of 2 years. A visit was performed in surviving patients and mortality data were obtained by hospital file review or direct telephone contact. Results: During the study period, 83 (26%) patients died. The rate of all-cause mortality was significantly higher in ischemic than nonischemic patients (14% vs 8%, P = 0.002). Multivariate analysis showed that ischemic etiology (HR 1.72, CI 1.06,2.79; P = 0.028) and New York Heart Association (NYHA) class IV (HR 2.87, CI 1.24,6.64; P = 0.014) were the strongest predictors of all-cause mortality. The effects of CRT persisted at long-term follow-up (for at least 2 years) in terms of NYHA class improvement, increase of left ventricular ejection fraction, decrease of QRS duration (all P = 0.0001), and reduction of left ventricular end-diastolic and end-systolic diameters (P = 0.024 and P = 0.011, respectively). Conclusions: During long-term (3 years) follow-up after CRT, total mortality rate was 10%/year. The outcome of ischemic patients was worse mainly due to a higher rate of death from progressive heart failure. Ischemic etiology along with NYHA class IV was identified as predictors of death. Benefits of CRT in terms of clinical function and echocardiographic parameters persisted at the time of long-term follow-up. [source]

    Assessment of Changes in Kidney Allograft Function Using Creatinine-Based Estimates of Glomerular Filtration Rate

    AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2007
    M. Gera
    These analyses assessed whether creatinine based estimates of glomerular filtration rate (eGFR) accurately represent (1) graft function at different times post-transplant and (2) changes in function over time. These analyses compared iothalamate GFR to eGFR in 684 kidney allograft recipients. Changes in graft function over time (GFR slope) were measured in 360 of 459 recipients (78%) who were followed for at least 3 years. Ninety-five percent of the patients were Caucasians and 72% received kidneys from living donors. All eGFR calculations correlated significantly with GFR at all time points. However, eGFR were less precise and less accurate during the first-year post-transplant than thereafter. The average rate of GFR change (slope) was ,2.93 ± 11.3%/year (,1.06 ± 5.3 mL/min/1.73m2/year). Fifty-four percent of patients had stable or positive GFR slopes. The GFR and eGFR slopes were highly correlated. However, eGFR slope, particularly when calculated by MDRD, significantly underestimated the number of patients with declining graft function. For example, 165 out of 360 patients (46%) lost GFR faster than ,1 mL/min/1.73m2/year. eMDRD identified only 83 of these patients (50%) while the eMayo formula identified 134 (81%). In conclusion, eGFR correlate with GFR but they have relatively low precision and accuracy particularly early post-transplant. eGFR slopes underestimate graft functional loss although some formulas are significantly better than others for this calculation. [source]

    Patterns and trends in alcohol-related hospitalizations in Victoria, Australia, 1987/88,1995/96

    DRUG AND ALCOHOL REVIEW, Issue 4 2000
    KIRSTEN HANLIN
    Abstract The objective of this study was to examine patterns and yearly trends in alcohol-related hospitalization rates during the period 1987/88,1995/96 for men and women living in metropolitan and rural/remote Victoria. Alcohol-related hospitalizations were extracted from the Victorian Inpatient Minimum Dataset (VMD) for the years 1987/88,1995/96 (public hospitals) and 1993/94,1995/96 (private hospitals), and adjusted by the appropriate aetiological fractions. Sex-specific age-adjusted rates we expressed per 10000 residents/year. During 1993/94,1995/96, alcohol-related hospitalizations comprised 1.0% of all Victorian hospitalizations (about 12000/year), with men accounting for over two-thirds of alcohol-related hospitalizations. Approximately half of the alcohol-related hospitalizations were for disease conditions and the other half for external cause (injury) conditions. About 80% of all alcohol-related hospitalizations were to public hospitals, with the exception of alcohol dependence (63% to private hospitals). Alcohol-related hospitalization rates were generally higher for people living in rural/remote areas compared to urban areas. During 1987/88,1995/96, the age-adjusted alcohol-related hospitalization rates in public hospitals did not change significantly for disease conditions (14.8,14.7 for men and 6.3,6.4 for women) or female external cause conditions (6.7,6.1), but decreased for external cause conditions (18.4,15.5). In private hospitals during 1993/94,1995/96, the age-adjusted alcohol-related hospitalization rates for disease conditions decreased (5.4,4.1 for men and 3.7,3.0 for women) but increased for external cause conditions (1.8,2.4 for men and 1.0,1.2 for women). These patterns and time-trends in Victorian alcohol-related hospitalizations reflect a combination of alcohol-related morbidity levels, hospital admission practices and patterns and levels of service provision. They suggest a potential need to focus on services and programmes in rural/remote Victoria. [source]

    Epidemiology of primary systemic vasculitis in the Australian Capital Territory and south-eastern New South Wales

    INTERNAL MEDICINE JOURNAL, Issue 11 2008
    A. S. Ormerod
    Abstract Background:, The aim of the study was to determine the epidemiology of primary systemic vasculitis in the Australian Capital Territory and the surrounding rural region between 1995 and 2005. Methods:, Cases were ascertained by a medical record search according to international consensus classification criteria. For antineutrophil cytoplasmic antibody-associated vasculitides, ascertainment was corroborated by a search of all positive antineutrophil cytoplasmic antibody serology during the study period. Denominators were obtained from region-specific census data collected during the study period. Prevalence, incidence and patient characteristics for primary systemic vasculitides were determined for two 5-year periods, 1995,1999 and 2000,2004. Results:, We identified 41 cases of primary systemic vasculitides (Wegener's granulomatosis (WG), microscopic polyangiitis (MPA), Churg,Strauss syndrome or polyarteritis nodosa) between 1995 and 1999 and 67 between 2000 and 2004, giving prevalences of 95/million (95% confidence interval (CI) 76.9,116.1) and 148/million (95%CI 125.1,173.9), respectively. Annual incidence was similar in both periods (approximately 17/year per million adult population). Disease-specific incidences (per million per year) for each of the two periods were 8.8 and 8.4 for WG, 2.3 and 5.0 for MPA, 2.3 and 2.2 for Churg,Strauss syndrome and 2.3 and 1.1 for polyarteritis nodosa. The rural incidence of MPA was 13.9 (95%CI 7.7,23.5) compared with 1.6 (95%CI 0.2,7.2) in the city and there was a trend towards a higher incidence of WG in rural than urban areas. Conclusion:, The overall incidence of primary systemic vasculitides is similar to that reported from other developed countries. WG is more common in south-eastern Australia than in southern Europe, whereas MPA is less common. There was a trend towards higher incidence of antineutrophil cytoplasmic antibody-associated vasculitides in rural than urban areas. [source]

    Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment

    BIPOLAR DISORDERS, Issue 5p2 2006
    Ana Gonzalez-Pinto
    Objectives:, Among the well-established treatments for bipolar disorder (BPD), lithium continues to offer an unusually broad spectrum of benefits that may include reduction of suicidal risk. Methods:, We examined the association of suicidal acts with adherence to long-term lithium maintenance treatment and other potential risk factors in 72 BP I patients followed prospectively for up to 10 years at a Mood Disorders Research Center in Spain. Results:, The observed rates of suicide were 0.143, and of attempts, 2.01%/year, with a 5.2-fold (95% CI: 1.5,18.6) greater risk among patients consistently rated poorly versus highly adherent to lithium prophylaxis (11.4/2.2 acts/100 person-years). Treatment non-adherence was associated with substance abuse, being unmarried, being male, and having more hypomanic,manic illness and hospitalizations. Suicidal risk was higher with prior attempts, more depression and hospitalization, familial mood disorders, and being single and younger, as well as treatment non-adherence, but with neither sex nor substance abuse. In multivariate analysis, suicidal risk was associated with previous suicidality > poor treatment adherence > more depressive episodes > younger age. Conclusions:, The findings support growing evidence of lower risk of suicidal acts during closely monitored and highly adherent, long-term treatment with lithium and indicate that treatment adherence is a potentially modifiable factor contributing to antisuicidal benefits. [source]

    The kidney disease wasting: Inflammation, oxidative stress, and diet-gene interaction

    HEMODIALYSIS INTERNATIONAL, Issue 4 2006
    Kamyar KALANTAR-ZADEH
    Abstract The 350,000 maintenance hemodialysis (MHD) patients in the United States have an unacceptably high mortality rate of >20%/year. Almost half of all deaths are assumed to be cardiovascular. Markers of kidney disease wasting (KDW) such as hypoalbuminemia, anorexia, body weight and fat loss, rather than traditional cardiovascular risk factors, appear to be the strongest predictors of early death in these patients. The KDW is closely related to oxidative stress (SOX). Such SOX markers as serum myeloperoxidase are associated with pro-inflammatory cytokines and poor survival in MHD patients. Identifying the conditions that modulate the KDW/SOX-axis may be the key to improving outcomes in MHD patients. Dysfunctional lipoproteins such as a higher ratio of the high-density lipoprotein inflammatory index (HII) may engender or aggravate the KDW, whereas functionally intact or larger lipoprotein pools, as in hypercholesterolemia and obesity, may mitigate the KDW in MHD patients. Hence, a reverse epidemiology or "bad-gone-good" phenomenon may be observed. Diet and gene and their complex interaction may lead to higher proportions of pro-inflammatory or oxidative lipoproteins such as HII, resulting in the aggravation of the SOX and inflammatory processes, endothelial dysfunction, and subsequent atherosclerotic cardiovascular disease and death in MHD patients. Understanding the factors that modulate the KDW/SOX complex and their associations with genetic polymorphism, nutrition, and outcomes in MHD patients may lead to developing more effective strategies to improve outcomes in this and the 20 to 30 million Americans with chronic disease states such as individuals with chronic heart failure, advanced age, malignancies, AIDS, or cachexia. [source]

    The feasibility and validity of forced spirometry in ataxia telangiectasia,,

    PEDIATRIC PULMONOLOGY, Issue 10 2010
    Daphna Vilozni PhD
    Abstract Objectives To explore the feasibility and validity of forced spirometry in patients with ataxia telangiectasia (A-T). Study design Twenty-eight patients (aged 3.7,19.3 years) performed spirometry on 47 occasions. Parameters studied were technical quality and relation to: predicted values, pulmonary illness. Results Start of test criteria for correct expiratory effort was significantly prolonged (183,±,115,ms; P,<,0.001). The rise-time to peak flow in children free of respiratory symptoms (Group-FRS; n,=,8) increased by 16.2,±,12.5,ms/year above recommended and in children having recurrent infections (n,=,8) 30.4,±,16.1,ms/year, P,<,0.01. Expiration-time was significantly shorter than requested (1.21,±,0.47,sec) and was ended abruptly in 57% of the patients. FEV1 could not be established by 8/20 patients. The intra-subject reproducibility met criteria (4.4,±,2.7%, 5.2,±,2.8%, 2.9,±,3.2%, 6.3,±,5.3%, for FVC, FEV0.5, PEF, FEF25,75, respectively). Group-FRS showed yearly deterioration in FVC of 2.2%, while patients with hyper-reactive airways (Group-HRA; n,=,12) had a deterioration rate of 3.6%/year. FEV0.5 deterioration rate was similar in both groups (2.2 and 2.0, respectively), but baseline values in Group-HRA were significantly lower than those of Group-FRS (P,=,0.029) in similar young ages, indicating airway obstruction at early ages in Group-HRA. FEV0.5 values deterioration also correlated with body mass index (P,<,0.017). Conclusion Forced spirometry in A-T patients is reproducible and has a distinct pattern, although curves do not meet other recommendations for acceptable criteria. The study insinuates that a rapid deterioration in lung function occurs in A-T patients with recurrent respiratory infection, suggesting that early intervention may prevent further deterioration or improve their lung function. Further studies are needed to confirm our results. Pediatr Pulmonol. 2010; 45:1030,1036. © 2010 Wiley-Liss, Inc. [source]

    Graduate Medical Education Downsizing: Perceived Effects of Participating in the HCFA Demonstration Project in New York State

    ACADEMIC EMERGENCY MEDICINE, Issue 2 2001
    Linda L. Spillance MD
    Abstract. Objective: Financial support for graduate medical education (GME) is shrinking nationally as Medicare cuts GME funds. Thirty-nine hospitals in New York State (NYS) voluntarily participated in a Health Care Financing Administration demonstration project (HCFADP),the goal of which was to reduce total residency training positions by 4-5%/year over a five-year period, while increasing primary care positions. The objective of this study was to determine the effect of downsizing on emergency department (ED) staffing and emergency medicine (EM) residency training. Methods: Structured interviews and surveys of NYS program directors (PDs) were conducted in October,December 1999. Simple frequencies are reported. Results: One hundred percent of 17 PDs completed the interviews and seven of 12 participants in the HCFADP returned surveys. Twelve of 17 programs participated in HCFADP and two programs downsized outside HCFADP. Seven of 12 participants lost EM positions. Six of 12 programs were forced to exclude outside residents from rotating in their ED, leading to a need for one participating program and one non-participating program to find alternative sites for trauma. Five of 12 institutions provided resident staffing data, reporting a reduction in ED resident coverage in year 1 of the project of 9-40%. Programs compensated by increasing the number of shifts worked (4/12), increasing shift length (1/12), decreasing pediatric ED shifts (1/12), decreasing elective or research time (2/12), and decreasing off-service rotations (4/12). Six departments hired physician assistants or nurse practitioners, two hired faculty, and two hired resident moonlighters. Six of 12 programs withdrew from HCFADP and returned to previous resident numbers. Eight of 12 PDs thought that they had decreased time for clinical teaching. Conclusions: A 4-5% reduction in residency positions was associated with a marked reduction in ED resident staffing and EM residency curriculum changes. [source]