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Vaccine Mandates and Cultural Safety. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:719-730. [PMID: 38165556 DOI: 10.1007/s11673-023-10319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 01/04/2024]
Abstract
The issues and problems of mandatory vaccination policy and roll out in First Nations communities are unique and do not concern the safety and effectiveness of vaccines. These issues are also independent of more specific arguments of mandatory vaccination of healthcare workers as a condition of employment. As important as these issues are, they do not consider the complex politics of ongoing settler colonialism and First Nations community relations. In this paper, we also set aside the very real problems of disinformation, hesitancy, scientific and health illiteracy, and other concerns that drive vaccine hesitancy and refusal. These affect all communities, including First Nations communities. We, instead describe the dominant arguments in favour of mandatory vaccination and critique them in terms of the disputed legitimacy of Settler-Colonial decision-making as it impacts First Nations communities. We contend cultural responsiveness and safety-not state compulsion-must remain the first principles of any engagement-including vaccination-with First Nations Peoples, families, and communities.
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Trial analysis by treatment allocated or by treatment received? Origins of 'the intention-to-treat principle' to reduce allocation bias: Part 2. J R Soc Med 2023; 116:386-394. [PMID: 37975723 PMCID: PMC10686203 DOI: 10.1177/01410768231203936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
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Trial analysis by treatment allocated or by treatment received? Origins of 'the intention-to-treat principle' to reduce allocation bias: Part 1. J R Soc Med 2023; 116:343-350. [PMID: 37961883 PMCID: PMC10695151 DOI: 10.1177/01410768231203922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
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Comorbid mental health issues in patients with pemphigus vulgaris and pemphigus foliaceus. Clin Exp Dermatol 2021; 47:24-29. [PMID: 34459019 DOI: 10.1111/ced.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/02/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
The term 'pemphigus' refers to chronic autoimmune skin disorders that cause blistering erosions on the skin and oral mucosa. The two major clinical forms are pemphigus vulgaris and pemphigus foliaceus. Although rare, they confer a stark symptomatic burden upon patients that significantly impacts daily life. Comorbid mental health issues are not routinely screened for in patients with pemphigus, and current UK guidance provides no formal provision for the identification and treatment of psychological issues. This review is the first of its kind, to our knowledge, to systematically examine the available evidence on mental health issues in pemphigus. Published work suggests that the incidence of anxiety and depression is much higher in patients with pemphigus compared with both the general population and with patients having other chronic skin disorders. Disease severity appears to be closely linked to mental health, with worsening of pemphigus associated with deteriorations in psychological wellbeing. Corticosteroids, which are associated with depression in chronic use, are the current first-line therapy for pemphigus and have been identified as a potential confounder and independent risk factor for mental health comorbidity in pemphigus. Current evidence is unclear whether a bidirectional relationship exists between mental health and pemphigus severity, and more thorough research is required to develop understanding of this issue. In conclusion, we have identified a high incidence of mental health comorbidity in pemphigus, and recommend routine screening of patients with pemphigus for mental health issues and signposting toward mental health services as an initial measure to address this.
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The art of observation: visual literacy for dermatologists. J Eur Acad Dermatol Venereol 2021; 35:e809-e811. [PMID: 34236732 DOI: 10.1111/jdv.17501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
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Overriding water table control on managed peatland greenhouse gas emissions. Nature 2021; 593:548-552. [PMID: 33882562 DOI: 10.1038/s41586-021-03523-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
Global peatlands store more carbon than is naturally present in the atmosphere1,2. However, many peatlands are under pressure from drainage-based agriculture, plantation development and fire, with the equivalent of around 3 per cent of all anthropogenic greenhouse gases emitted from drained peatland3-5. Efforts to curb such emissions are intensifying through the conservation of undrained peatlands and re-wetting of drained systems6. Here we report eddy covariance data for carbon dioxide from 16 locations and static chamber measurements for methane from 41 locations in the UK and Ireland. We combine these with published data from sites across all major peatland biomes. We find that the mean annual effective water table depth (WTDe; that is, the average depth of the aerated peat layer) overrides all other ecosystem- and management-related controls on greenhouse gas fluxes. We estimate that every 10 centimetres of reduction in WTDe could reduce the net warming impact of CO2 and CH4 emissions (100-year global warming potentials) by the equivalent of at least 3 tonnes of CO2 per hectare per year, until WTDe is less than 30 centimetres. Raising water levels further would continue to have a net cooling effect until WTDe is within 10 centimetres of the surface. Our results suggest that greenhouse gas emissions from peatlands drained for agriculture could be greatly reduced without necessarily halting their productive use. Halving WTDe in all drained agricultural peatlands, for example, could reduce emissions by the equivalent of over 1 per cent of global anthropogenic emissions.
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The Impact of a Registered Dietitian in an Urban Safety Net Oncology Clinic. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Age and Ageing to introduce a new category of paper: healthcare improvement science. Age Ageing 2019; 48:178-184. [PMID: 30395169 DOI: 10.1093/ageing/afy175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/03/2018] [Indexed: 12/29/2022] Open
Abstract
Age and Ageing is now inviting papers on healthcare improvement for older people. In this article we outline the nature and scope of healthcare improvement and reference improvement models and the tools and methods of improvement science. We emphasise the issues of sustainability, including scale and spread; evaluation - including associated ethical consideration and the involvement of patients and the public in healthcare improvement and associated research. Throughout we refer to resources the authors have found useful in their own work, and provide a bibliography of sources and web-links which will provide essential guidance and support for potential contributors to this new category of submission to Age and Ageing.
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OLDER AND LESS DEVIANT? A MEDIATED MODERATION MODEL OF AGE, COGNITIVE REAPPRAISAL, AND ABUSIVE SUPERVISION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Are routine blood tests required after total knee and hip arthroplasty? Asia Pac J Sports Med Arthrosc Rehabil Technol 2018. [DOI: 10.1016/j.asmart.2018.06.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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The market value of sleep: using economic input-output analysis to shift society's views on sleep loss. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Selective progesterone receptor modulator (SPRM) ulipristal acetate (UPA) and its effects on the human endometrium. Hum Reprod 2017; 32:531-543. [PMID: 28130434 PMCID: PMC5400066 DOI: 10.1093/humrep/dew359] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/30/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION What is the impact of administration of the selective progesterone receptor modulator (SPRM), ulipristal acetate (UPA) on the endometrium of women with fibroids? SUMMARY ANSWER UPA administration altered expression of sex-steroid receptors and progesterone-regulated genes and was associated with low levels of glandular and stromal cell proliferation. WHAT IS KNOWN ALREADY Administration of all SPRM class members results in PAEC (progesterone receptor modulator associated endometrial changes). Data on the impact of the SPRM UPA administration on endometrial sex-steroid receptor expression, progesterone (P)-regulated genes and cell proliferation are currently lacking. STUDY DESIGN SIZE, DURATION Observational study with histological and molecular analyses to delineate impact of treatment with UPA on endometrium. Endometrial samples (n = 9) were collected at hysterectomy from women aged 39 to 49 with uterine fibroids treated with UPA (oral 5 mg daily) for 9-12 weeks. Control proliferative (n = 9) and secretory (n = 9) endometrium from women aged 38-52 with fibroids were derived from institutional tissue archives. PARTICIPANTS/MATERIALS, SETTING, METHODS Study setting was a University Research Institute. Endometrial biopsies were collected with institutional ethical approval and written informed consent. Concentrations of mRNAs encoded by steroid receptors, P-regulated genes and factors in decidualised endometrium were quantified with qRT-PCR. Immunohistochemistry was employed for localization of progesterone (PR, PRB), androgen (AR), estrogen (ERα) receptors and expression of FOXO1, HAND2, HOXA10, PTEN homologue. Endometrial glandular and stromal cell proliferation was objectively quantified using Ki67. MAIN RESULTS AND THE ROLE OF CHANCE UPA induced morphological changes in endometrial tissue consistent with PAEC. A striking change in expression patterns of PR and AR was detected compared with either proliferative or secretory phase samples. There were significant changes in pattern of expression of mRNAs encoded by IGFBP-1, FOXO1, IL-15, HAND2, IHH and HOXA10 compared with secretory phase samples consistent with low agonist activity in endometrium. Expression of mRNA encoded by FOXM1, a transcription factor implicated in cell cycle progression, was low in UPA-treated samples. Cell proliferation (Ki67 positive nuclei) was lower in samples from women treated with UPA compared with those in the proliferative phase. LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION A small number of well-characterized patients were studied in-depth. The impacts on morphology, molecular and cellular changes with SPRM, UPA administration on symptom control remains to be determined. WIDER IMPLICATIONS OF THE FINDINGS P plays a pivotal role in endometrial function. P-action is mediated through interaction with the PR. These data provide support for onward development of the SPRM class of compounds as effective long-term medical therapy for heavy menstrual bleeding. STUDY FUNDING/COMPETING INTEREST(S) H.O.D.C. received has clinical research support for laboratory consumables and staff from Bayer Pharma Ag and provides consultancy advice (no personal remuneration) for Bayer Pharma Ag, PregLem SA, Gedeon Richter, Vifor Pharma UK Ltd, AbbVie Inc.; A.R.W.W. has received consultancy payments from Bayer, Gedeon Richter, Preglem SA, HRA Pharma; L.H.R.W., A.A.M., R.M., G.S. and P.T.K.S. have no conflicts of interest. Study funded in part from each of: Medical Research Council (G1002033; G1100356/1; MR/N022556/1); National Health Institute for Health Research (12/206/520) and TENOVUS Scotland.
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Utility of 18F sodium fluoride PET/CT imaging in the evaluation of postoperative pain following surgical spine fusion. Musculoskelet Surg 2017; 101:159-166. [PMID: 28164254 DOI: 10.1007/s12306-017-0465-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN A retrospective case review of patients who underwent 18F sodium fluoride PET/CT imaging of the spine with postoperative pain following vertebral fusion. OBJECTIVE To determine the benefit of 18F sodium fluoride PET/CT imaging in the diagnosis of persistent pain in the postoperative spine. The diagnosis of pain generators in the postoperative spine has proven to be a diagnostic challenge. The conventional radiologic evaluation of persistent pain after spine surgery with the use of plain radiographs, MRI, and CT can often fall short of diagnosis in the complex patient. 18F sodium fluoride PET/CT imaging is an alternative tool to accurately identify a patient's source of pain in the difficult patient. METHODS This retrospective study looked at 25 adult patients who had undergone 18F sodium fluoride PET/CT imaging. All patients had persistent or recurrent back pain over the course of a 15-month period after having undergone spinal fusion surgery. All patients had inconclusive dedicated MRI. The clinical accuracy of PET/CT in identifying the pain generator and contribution to altering the decision making process was compared to the use of CT scan alone. RESULTS Of the 25 patients studied, 17 patients had increased uptake on the 18F sodium fluoride PET/CT fusion images. There was a high-level correlation of radiotracer uptake to the patients' pain generator. Overall 88% of the studies were considered beneficial with either PET/CT altering the clinical diagnosis and treatment plan of the patient or confirming unnecessary surgery. CONCLUSION 18F sodium fluoride PET/CT proves to be a useful tool in the diagnosis of complex spine pathology of the postoperative patients. In varied cases, a high correlation of metabolic activity to the source of the patient's pain was observed.
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Is any particular aspect of perceived quality associated with patients tending to promote a dental practice to their friends and colleagues? Br Dent J 2016; 218:E12. [PMID: 25812905 DOI: 10.1038/sj.bdj.2015.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 11/09/2022]
Abstract
AIMS To investigate the relationship between perceived quality and patients' tendencies to recommend a practice to friends and colleagues. METHODS Data from 64 practices using the Denplan Excel Patient Survey (DEPS) were analysed. The Net Promoter Score (NPS max score 100), developed by Reichheld, is reported to each practice using DEPS. It is claimed that the NPS measures the likelihood that patients will recommend the practice to friends and colleagues. A Patient Perception Index (PPI max score 100) is also reported to practices. The PPI is calculated from the responses to the ten core questions of DEPS on perceived quality. The 64 practices were placed into three groups for data analysis according to their NPS result: group one practices receiving an NPS of less than 80, group two practices receiving an NPS of 80-89 and group three practices receiving an NPS of greater than 89. These groups represented practices scoring statistically significantly (to 90% confidence) below the mean NPS (group one), practices close to the mean NPS (group two) and practices statistically significantly (to 90% confidence) above the mean NPS. RESULTS Group one practices scored a mean PPI of 73, group two scored a mean PPI of 76 and group three a mean PPI of 80. These differences in values of PPI between the groups are statistically significant (to 90% confidence). Of the ten constituent issues which contribute to PPI, the greatest difference in scoring between group one and group three was found to be around perceived value for money. CONCLUSION The probability of patients recommending a dental practice seems to rise in direct proportion to favourable perceptions of quality. A perception of 'ideal' value for money is the most highly correlated aspect with a high NPS.
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Abstract
AIM To compare the outcomes of a contemporary oral health status (OHS) scoring system with national oral health data from the 2009 Adult Dental Health Survey, and to explore the utility of the OHS in audit and service development. METHODS An OHS scoring system was developed as part of a previously reported comprehensive on-line patient assessment tool. The assessment tool also measured future disease risk and indicative capitation fee grading. The modified OHS score component was developed over 20 years of research and experience from the original Oral Health Index (Burke and Wilson 1995). The online tool was piloted by 25 volunteer dentists on 640 recall patients and qualitative and quantitative feedback provided. Anonymised data from the inputs and scores generated were collected centrally and analysed using descriptive statistics. RESULTS The modified OHS was reported to have good validity by the pilot group. Submitted data confirmed a mean age for the recall patients examined as 53 ± 15.8 years and an average oral health status score of 79.5 ± 10.8 where a score of 100 equates to perfect oral health. A breakdown of the scores into the eight principal components provided evidence of cross validation with the Adult Dental Health Survey (2009). CONCLUSIONS Scoring oral health status electronically offers valuable opportunities for clinical audit. The reported benchmark oral health score of 79.5 for recall patients can be updated as increased numbers of patients enter the centralised data recording system. Audit can be facilitated by this move from a paper-based system to an on-line tool with central data collection.
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Prognostic Factors and Outcome After SBRT for Stage I Non-Small Cell Lung Cancer (NSCLC) Using Different Fractionation Regimens From 2007 to 2013. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Long-term validity and reliability of a patient survey instrument designed for general dental practice. Br Dent J 2015; 219:337-41; discussion 342. [PMID: 26450250 DOI: 10.1038/sj.bdj.2015.749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/09/2022]
Abstract
AIM To consider the extent to which the validity and reliability of the Denplan Excel Patient Survey (DEPS) has been confirmed during its development and by its use in general dental practice and to explore methods by which any survey instrument used in general dental practice might be validated and tested for reliability. METHODS DEPS seeks to measure perceived practice performance on those issues considered to be of greatest importance to patients. Content validity was developed by a literature review and tested in a pilot study. Criterion validity was tested by comparing patient retention in a payment plan for practices achieving the highest DEPS scores with those attaining the lowest scores over a two year period (surveys completed between 2010 and 2012). Reliability was assessed using the test/re-test method for 23 practices with approximately a three year time interval between tests. Internal consistency was tested by comparing Net Promoter Scores (NPS - which is measured in DEPS) attained by practices with their Patient Perception Index (PPI) as measured by the ten core questions in DEPS. RESULTS Practices in the pilot study strongly endorsed the content validity of DEPS. The 12 practices with the highest scores in the DEPS slightly increased their number of patients registered in Denplan payment plans during a two year period. The 12 lowest scoring practices saw 7% of their patients de-register during the same period. The 23 practices selected for the test/re-test study averaged more than 250 responses for both the test and re-test phases. The magnitude and pattern of their results were similar in both phases, while, on average, a modest improvement in results was observed. Internal consistency was confirmed as NPS results in DEPS closely mapped PPI results. The higher the measurement of perceived quality (PPI) the more likely patients were to recommend the practice (NPS). CONCLUSION Both through its development and use over the last four years The DEPS has demonstrated good validity and reliability. The authors conclude that this level of validity and reliability is adequate for the clinical/general care audit purpose of DEPS and that it is therefore likely to reliably inform practices where further development are indicated. It is important and quite straightforward to both validate and check the reliability of patient surveys used in general dental practice so that dental teams can be confident in the instrument they are using.
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De-functioning polymorphism in the inhibitory receptor FcγRIIB does not impact upon kidney allograft survival. Clin Exp Immunol 2015; 178 Suppl 1:159-61. [PMID: 25546804 DOI: 10.1111/cei.12553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Intracytoplasmic Sperm Injection (ICSI) of Sub-Optimal Sperm Increases The Risk of Sex-Chromosome, But Not Autosomal Aneuploidy among Embryos Evaluated with Comprehensive Chromosome Screening (CCS). Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2014.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Price per unit: the cost of alcohol-related admissions to a regional ICU. Crit Care 2014. [PMCID: PMC4068712 DOI: 10.1186/cc13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Clinical and demographic factors associated with fractures among older Americans. Osteoporos Int 2011; 22:1263-74. [PMID: 20559818 PMCID: PMC3767033 DOI: 10.1007/s00198-010-1300-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED Medicare claims data were used to investigate associations between history of previous fractures, chronic conditions, and demographic characteristics and occurrence of fractures at six anatomic sites. The study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures. INTRODUCTION This study investigates the associations of a history of fracture, comorbid chronic conditions, and demographic characteristics with incident fractures among Medicare beneficiaries. The majority of fracture incidence studies have focused on the hip and on white females. This study examines a greater variety of fracture sites and more population subgroups than prior studies. METHODS We used Medicare claims data to examine the incidence of fracture at six anatomic sites in a random 5% sample of Medicare beneficiaries during the time period 2000 through 2005. RESULTS For each type of incident fracture, women had a higher rate than men, and there was a positive association with age and an inverse association with income. Whites had a higher rate than nonwhites. Rates were lowest among African-Americans for all sites except ankle and tibia/fibula, which were lowest among Asian-Americans. Rates of hip and spine fracture were highest in the South, and fractures of other sites were highest in the Northeast. Fall-related conditions and depressive illnesses were associated with each type of incident fracture, conditions treated with glucocorticoids with hip and spine fractures and diabetes with ankle and humerus fractures. Histories of hip and spine fractures were associated positively with each site of incident fracture except ankle; histories of nonhip, nonspine fractures were associated with most types of incident fracture. CONCLUSIONS This study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.
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Selenium toxicosis in sheep associated with excessive sodium selenite in a commercial supplement. Vet Rec 2010; 167:707-8. [DOI: 10.1136/vr.c5121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Assessment of clinical trials knowledge and beliefs in cancer patients treated in an urban public hospital serving predominantly African American patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Changing Protocol to All Day 5 Embryo Transfers Regardless of Number of Embryos Available on Day 3 Increases Implantation Rate and Reduces the Number of Embryos Transferred. Fertil Steril 2010. [DOI: 10.1016/j.fertnstert.2010.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Medical problems among dental patients at the school of dentistry, the university of the West Indies. J Dent Educ 2009; 73:1408-1414. [PMID: 20007497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study ascertained demographic information and prevalence rates of medical problems among 571 new and consecutive dental patients attending the emergency clinic of the School of Dentistry, The University of the West Indies. Patients were interviewed by specially trained and calibrated dental students and interns. Various medical problems of patients were recorded in individual open-ended case sheets, maintaining their privacy and confidentiality. This information was then transcribed into a specially designed and pretested form. The data were entered into a Microsoft Excel spreadsheet and analyzed using the SPSS statistical package to obtain the prevalence rates of medical conditions, which were then cross-tabulated with gender, age, ethnicity, and other variables. Significance of differences, if any, was evaluated by chi-square test. In all, 303 medical conditions were encountered in 239 individuals, giving a prevalence rate of 42 percent. Hypertension (12.6 percent), diabetes (6.1 percent), asthma (5.8 percent), arthritis (4.7 percent), and various allergies (8.3 percent) constituted an important segment of the problems. Gender, ethnic, and age differences were also evident for some diseases. In this study-which was the first of this kind in the West Indies-vital information on medical problems among dental patients was obtained by interviews conducted by dental students and interns, forming an important part of their dental education.
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Estimated prevalence and patterns of presumed osteoporosis among older Americans based on Medicare data. Osteoporos Int 2009; 20:1507-15. [PMID: 19189165 PMCID: PMC3767011 DOI: 10.1007/s00198-009-0835-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 11/24/2008] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Estimates of osteoporosis (OP) prevalence based on bone mineral density testing and fracture occurrence may be imprecise for small demographic groups. Medicare data are a useful supplemental source of information on OP. METHODS We studied people ages > or = 65 years covered by Medicare 2005. Cases of presumed OP were beneficiaries with physician services or inpatient claims for OP or for an associated fracture (hip, distal forearm, spine) in 1999-2005. RESULTS Among 911,327 beneficiaries with 6 or 7 years of Medicare coverage, the overall prevalence of OP and associated fractures was 29.7%. Prevalence was four times higher for women than men, increased with age, and was two times higher for whites, Hispanic Americans, and Asian Americans than African Americans. Among people with OP-associated fracture claims, the proportion with an OP diagnosis was 49.7% overall (women, 57.1%; men, 21.9%) and was lower for men than women and for African Americans than other ethnic groups. CONCLUSIONS The low proportion of beneficiaries who had an OP-associated fracture and also had an OP diagnosis, particularly among men and African American women, suggests suboptimal recognition and management of OP. Study limitations included lack of validation of our definition of OP and potential misclassification of race/ethnicity.
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Real time workload classification from an ambulatory wireless EEG system using hybrid EEG electrodes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:5871-5. [PMID: 19164053 DOI: 10.1109/iembs.2008.4650550] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper describes a compact, lightweight and ultra-low power ambulatory wireless EEG system based upon QUASAR's innovative noninvasive bioelectric sensor technologies. The sensors operate through hair without skin preparation or conductive gels. Mechanical isolation built into the harness permits the recording of high quality EEG data during ambulation. Advanced algorithms developed for this system permit real time classification of workload during subject motion. Measurements made using the EEG system during ambulation are presented, including results for real time classification of subject workload.
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Marginal abatement cost curves for UK agriculture, forestry, land-use and land-use change sector out to 2022. ACTA ACUST UNITED AC 2009. [DOI: 10.1088/1755-1307/6/24/242002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Presentation of the β -Carboxamidophosphonate Arrangement in Substrate Structures Targeting HIV-1 PR. LETT DRUG DES DISCOV 2009. [DOI: 10.2174/157018009787582660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Oocyte Vitrification Is a Viable Option for Achieving Pregnancies and Preventing Multiple Gestation When Excess Oocytes Develop During Controlled Ovarian Hyperstimulation With Gonadotropins and IUI. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Efungumab and caspofungin: pre-clinical data supporting synergy. J Antimicrob Chemother 2008; 61:1132-9. [DOI: 10.1093/jac/dkn075] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Practically speaking, bedside ultrasound is well within the scope of emergency physicians (EPs) and is gaining acceptance. The literature supports the use of limited, goal-directed ultrasound in the diagnosis of many emergent conditions. EPs should use ultrasound as a tool to answer specific questions (e.g., Is there blood in the belly?); they should not surf the body for clues. ED ultrasound offers rapid evaluation of potentially life-threatening conditions
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The Curies: A Biography of the Most Controversial Family in Science. J Nucl Med 2007. [DOI: 10.2967/jnumed.107.041780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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The reproducibility of the Denplan Oral Health Score (OHS) in general dental practitioners. COMMUNITY DENTAL HEALTH 2007; 24:105-10. [PMID: 17615826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To assess the reproducibility of the Denplan Oral Health Score (OHS) and to examine whether general dental practitioners are more reproducible at measuring oral health when they use the OHS than when they use their usual method of examining patients. DESIGN This was a single centre study designed to compare dentists' reproducibility using the Oral Health Score with their reproducibility when using the method of examination that they normally employ in general practice. SETTING The study was carried out at The University of Birmingham School of Dentistry during 2001. PARTICIPANTS Ten local general dental practitioners were recruited by advertising. The patients were selected from various clinics in the University of Birmingham School of Dentistry to provide a broad spectrum of oral health. MAIN OUTCOME MEASURES The dentists scored oral health by two methods; firstly on a 10 cm linear scale after using their everyday method of examination and secondly using the structured format of the OHS examination, where the Oral Health Scores were expressed as a percentage. RESULTS Overall, the majority of the participating dentists demonstrated better intra-examiner reproducibility with the OHS than with their own method of examination. There was also higher inter-examiner reproducibility with the OHS than with the dentists' own method.
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Development and testing of a questionnaire to measure patient satisfaction with intermediate care. Qual Saf Health Care 2007; 15:314-9. [PMID: 17074865 PMCID: PMC2565811 DOI: 10.1136/qshc.2005.016642] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Individual trials have suggested high levels of general patient satisfaction with intermediate care, but this topic has not been examined in detail. AIMS To identify the key elements of patient satisfaction with intermediate care, and to see whether these can be validly measured using a questionnaire. METHOD A questionnaire was developed on the basis of a literature review and piloting with patients and staff on participating schemes (phase I). In phase II, the questionnaire was tested for validity and reliability in a group of patients recently discharged from two "hospital-at-home" intermediate-care schemes. In phase III, a shortened version of the questionnaire was psychometrically tested in five sites taking part in a national evaluation of intermediate care. RESULTS 96 patients with an average age of 76.5 years took part in phase II. Test-retest reliability was evaluated by repeating the questionnaire 2 weeks later in a subsample of 42 patients. This was "moderate" (kappa 0.4-0.6) for 12 questions, "fair" (kappa 0.2-0.4) for 6 questions and "poor" (kappa 0.1-0.2) for 5 questions. Scores correlated well with the Client Satisfaction Questionnaire (Spearman's r = 0.75, p<0.001). 843 patients (57% of those eligible) from five intermediate-care schemes took part in phase III. Principal components analysis suggested six factors or subscales: general satisfaction, affective response, cognitive response, timing of discharge, coordination after discharge, and access to pain relief, although the last three factors comprised only one question each. The intraclass correlation coefficients in the first three subscales varied from 0.82 to 0.89. Scores for all subscales differed by scheme, suggesting construct validity. Only one question (on general satisfaction) was found to be redundant. CONCLUSION The questionnaire, with some minor amendments to improve performance, could be used as a validated tool for audit and research in intermediate care. An amended version and scoring programme is available from us on request.
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The action of light on the eye: Part I. The discharge of impulses in the optic nerve and its relation to the electric changes in the retina. J Physiol 2007; 63:378-414. [PMID: 16993896 PMCID: PMC1514941 DOI: 10.1113/jphysiol.1927.sp002410] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
AIMS To evaluate cancer incidence among workers at two facilities in the USA that made semiconductors and electronic storage devices. METHODS 89 054 men and women employed by International Business Machines (IBM) were included in the study. We compared employees' incidence rates with general population rates and examined incidence patterns by facility, duration of employment, time since first employment, manufacturing era, potential for exposure to workplace environments other than offices and work activity. RESULTS For employees at the semiconductor manufacturing facility, the standardised incidence ratio (SIR) for all cancers combined was 81 (1541 observed cases, 95% confidence interval (CI) 77 to 85) and for those at the storage device manufacturing facility the SIR was 87 (1319 observed cases, 95% CI 82 to 92). The subgroups of employees with > or =15 years since hiring and > or =5 years worked had 6-16% fewer total incidents than expected. SIRs were increased for several cancers in certain employee subgroups, but analyses of incidence patterns by potential exposure and by years spent and time since starting in specific work activities did not clearly indicate that the excesses were due to occupational exposure. CONCLUSIONS This study did not provide strong or consistent evidence of causal associations with employment factors. Data on employees with long potential induction time and many years worked were limited. Further follow-up will allow a more informative analysis of cancer incidence that might be plausibly related to workplace exposures in the cohort.
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Nitrous oxide emissions during storage of broiler litter and following application to arable land. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ics.2006.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
AIM This study evaluated the mortality experience of workers from the styrene-butadiene industry. METHODS The authors added seven years of follow up to a previous investigation of mortality among 17 924 men employed in the North American synthetic rubber industry. Analyses used the standardised mortality ratios (SMRs) to compare styrene-butadiene rubber workers' cause specific mortality (1943-98) with those of the United States and the Ontario general populations. RESULTS Overall, the observed/expected numbers of deaths were 6237/7242 for all causes (SMR = 86, 95% CI 84 to 88) and 1608/1741 for all cancers combined (SMR = 92, 95% CI 88 to 97), 71/61 for leukaemia, 53/53 for non-Hodgkin's lymphoma, and 26/27 for multiple myeloma. The 16% leukaemia increase was concentrated in hourly paid subjects with 20-29 years since hire and 10 or more years of employment in the industry (19/7.4, SMR = 258, 95% CI 156 to 403) and in subjects employed in polymerisation (18/8.8, SMR = 204, 95% CI 121 to 322), maintenance labour (15/7.4, SMR = 326, 95% CI 178 to 456), and laboratory operations (14/4.3, SMR = 326, 95% CI 178-546). CONCLUSION The study found that some subgroups of synthetic rubber workers had an excess of mortality from leukaemia that was not limited to a particular form of leukaemia. Uncertainty remains about the specific agent(s) that might be responsible for the observed excesses and about the role of unidentified confounding factors. The study did not find any clear relation between employment in the industry and other forms of lymphohaematopoietic cancer. Some subgroups of subjects had more than expected deaths from colorectal and prostate cancers. These increases did not appear to be related to occupational exposure in the industry.
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The political ecology of health: perceptions of environment, economy, health and well-being among ‘Namgis First Nation. Health Place 2005; 11:349-65. [PMID: 15886143 DOI: 10.1016/j.healthplace.2004.04.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2004] [Indexed: 10/26/2022]
Abstract
Informed by Mayer's (Progr. Hum. Geogr 20 (1996) 441) political ecology of disease framework, this paper investigates First Nation's perceptions of the links between environment, economy and health and well-being. A case study of 'Namgis First Nation (Alert Bay, British Columbia, Canada) is used to explore the risks and benefits of salmon aquaculture for British Columbia's First Nations. Analysis of interview data (n = 23) indicates strong links between reduced access to environmental resources, marginal participation in the economy, and declining community health and well being. Results suggest that aquaculture development has further decreased the community's access to environmental resources, thereby restricting those economic, social, and cultural activities that determine good health and well-being for this community.
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