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We sought to assess the presence and reporting quality of peer-reviewed literature concerning the accuracy, precision, and reliability of home monitoring technologies for vital signs and glucose determinations in older adult populations.
A narrative literature review was undertaken searching the databases Medline, Embase, and Compendex. Peer-reviewed publications with keywords related to vital signs, monitoring devices and technologies, independent living, and older adults were searched. Publications between the years 2012 and 2018 were included. Two reviewers independently conducted title and abstract screening, and four reviewers independently undertook full-text screening and data extraction with all disagreements resolved through discussion and consensus.
Two hundred nine articles were included. Our review showed limited assessment and low-quality reporting of evidence concerning the accuracy, precision, and reliability of home monitoring technologies. Of 209 articles describing a relevant device, only 45 percent (n = 95) provided a citation or some evidence to support their validation claim. Of forty-eight articles that described the use of a comparator device, 65 percent (n = 31) used low-quality statistical methods, 23 percent (n = 11) used moderate-quality statistical methods, and only 12 percent (n = 6) used high-quality statistical methods.
Our review found that current validity claims were based on low-quality assessments that do not provide the necessary confidence needed by clinicians for medical decision-making purposes. This narrative review highlights the need for standardized health technology reporting to increase health practitioner confidence in these devices, support the appropriate adoption of such devices within the healthcare system, and improve health outcomes.
The goal of this study was to evaluate the ability of semantic (animal naming) and phonemic (FAS) fluency in their ability to discriminate between normal aging, amnestic-Mild Cognitive Impairment (a-MCI), and Alzheimer’s disease (AD).
We used binary logistic regressions, multinomial regressions, and discriminant analysis to evaluate the predictive value of semantic and phonemic fluency in regards to specific diagnostic classifications.
Outpatient geriatric neuropsychology clinic.
232 participants (normal aging = 99, a-MCI = 90, AD = 43; mean age = 65.75 years).
Mini-mental State Examination (MMSE), Controlled Oral Word Association Test
Results indicate that semantic and phonemic fluency were significant predictors of diagnostic classification, and semantic fluency explained a greater amount of the discriminant ability of the model.
These results suggest that verbal fluency, particularly semantic fluency, may be an accurate and efficient tool in screening for early dementia in time-limited medical settings.
The aim of the study was to determine the main factors (sociodemographic, anthropometric, lifestyle and health status) associated with high Na excretion in a representative population of Chile.
Na excretion (g/d), a valid marker of Na intake, was determined by urine analysis and Tanaka’s formulas. Blood pressure was measured by trained staff and derived from the mean of three readings recorded after 15 min rest. The associations of Na excretion with blood pressure and the primary correlates of high Na excretion were determined using logistic regression.
Chileans aged ≥15 years.
Participants (n 2913) from the Chilean National Health Survey 2009–2010.
Individuals aged 25 years or over, those who were obese and those who had hypertension, diabetes or metabolic syndrome were more likely to have higher Na excretion. The odds for hypertension increased by 10·2 % per 0·4 g/d increment in Na excretion (OR=1·10; 95 % CI 1·06, 1·14; P < 0·0001). These findings were independent of major confounding factors.
Age, sex, adiposity, sitting behaviours and existing co-morbidities such as diabetes were associated with higher Na excretion levels in the Chilean population. These findings could help policy makers to implement public health strategies tailored towards individuals who are more likely to consume high levels of dietary salt.
In Iraq, where Islamic State of Iraq and Syria (ISIS) and other groups have contributed to escalating violence in recent years, understanding the epidemiology of intentional firearm-related fatalities is essential for public health action.
The Iraqi Ministry of Health (MoH; Baghdad, Iraq) compiles surveillance of fatal injuries in eight of Iraq’s 18 governorates (Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya). Information is collected from coroner’s reports and interviews with family members. Analysis was performed on intentional firearm-related injuries, excluding injuries from intentional self-harm or negligent discharges, that occurred during 2010-2013, a subset of all fatal injuries, and compared to previously published explosive-related fatalities.
Overall, the dataset included 7,985 firearm-related fatalities. Yearly fatalities were: 2010=1,706; 2011=1,642; 2012=1,662; and 2013=2,975. Among fatalities, 86.0% were men and 13.7% women; 83.4% were adults and 6.2% children <18 years of age. Where age and sex were both known, men aged 20-39 years accounted for 56.3% of fatalities. Three “high-burden” governorates had the highest fatality rate per 100,000 population—Baghdad (12.9), Ninevah (17.0), and Al-Anbar (14.6)—accounting for 85.9% of fatalities recorded in the eight governorates. Most fatalities occurred in the street (56.3%), followed by workplace (12.2%), home (11.3%), and farm/countryside (8.4%). Comparing the ratio of firearm-related fatalities to explosives-related fatalities revealed an overall ratio of 2.8:1. The ratio in Baghdad more than doubled from 2.9 in 2010 to 6.1 in 2013; the highest ratios were seen outside the high-burden governorates.
Firearm-related fatalities remained relatively stable throughout 2010-2012, and almost doubled in 2013, correlating with increased ISIS activity. Three governorates contributed the majority of fatalities and experienced the highest fatality rates; these saw high levels of conflict. Firearm-related fatalities disproportionately affected younger men, who historically are over-represented as victims and perpetrators of violence. More than one-half of fatalities occurred in the street, indicating this as a common environment for conflict involving firearms. Firearms appear to account for more fatalities in Iraq than explosives and largely accounted for escalating violence in Baghdad during the study period. The high ratio observed outside the high-burden governorates is reflective of very low numbers of explosives-related fatalities; thus, violence in these governorates is likely non-conflict-related. These observations provide valuable public health information for targeted intervention to prevent violence.
NerlanderMP, LeidmanE, HassanA, SultanASS, HussainSJ, BrowneLB, BilukhaOO. Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013. Prehosp Disaster Med. 2017;32(5):548–555.
Many studies use radiocarbon dates on estuarine shell material to build age-depth models of sediment accumulation in estuaries in California, USA. Marine 14C ages are typically older than dates from contemporaneous terrestrial carbon and local offsets (ΔR) from the global average marine offset need to be calculated to ensure the accuracy of calibrated dates. We used accelerator mass spectrometry (AMS) 14C dating on 40 pre-1950 salt marsh snail and clam shells previously collected from four California estuaries. The average ΔR and standard deviation of 217 ± 129 14C yr is consistent with previous calculations using mixed estuarine and marine samples, although the standard deviation and resulting age uncertainty was higher for our estuarine calculations than previous studies. There was a slight but significant difference (p = 0.024) in ΔR between epifaunal snails (ΔR = 171 ± 154 14C yr) and infaunal clams (ΔR = 263 ± 77 14C yr), as well as between samples from individual estuaries. However, a closer examination of the data shows that even for the same species, at the same estuary, ΔR can vary as much as ∼500 14C yr. In some cases, the bulk of this variation occurs between samples collected by different collectors at different times, potentially indicating time dependence in carbon sources and ΔR variation. These variations could also be attributed to differences in collection location within a single estuary and resulting spatial differences in carbon sources. Intertidal specimens located in the high marsh may have lower ΔR than fully marine counterparts because of increased terrestrial 14C input. The large variations in ΔR here highlight the need for conservative chronological interpretations, as well as the assumption of wide uncertainties, when dating samples from estuarine sources.
Background: Over half of children in the general population report unusual or “psychotic-like” experiences (PLEs). The development of a later at-risk mental state is associated with persistent, distressing, PLEs, which are appraised negatively and hard to cope with. We have designed a novel, manualized, cognitive behavioural intervention for children aged 9 to 14 years, which aims to reduce emotional problems, improve coping and resilience, and help children manage PLEs, before an identifiable psychosis risk develops. We report on the feasibility, acceptability and clinical impact of the intervention. Method: Four children who reported PLEs and emotional problems in a community survey completed the intervention, and gave detailed feedback. Clinical outcomes were assessed before, during, and after therapy. Results: Emotional problems, PLE frequency, and PLE impact all decreased during the intervention. Child and therapist satisfaction with the treatment was high. Conclusions: It is feasible, acceptable and helpful to offer psychological interventions to children who report emotional distress and PLEs, prior to the emergence of clear risk factors. Our intervention has the potential to increase resilience to the development of future mental health problems. A larger, randomized controlled evaluation is underway.
The conductivity of hygroscopic salt deposits containing Na+, K+, NO3– and Cl– ions was measured in air as a function of relative humidity at constant temperatures. The deliquescence relative humidity (DRH) of multicomponent salts containing Na+, K+, NO3– and Cl– was also determined experimentally. The results of the conductivity experiments show that the conductivity of initially dry salt deposits start to increase after reaching a relative humidity value that is 15 to 20% lower than the DRH of the salt. When the DRH is reached, the conductivity increases dramatically as the salt dissolves and transforms into a saturated aqueous phase. The increase in conductivity at humidities below the DRH is attributed to the adsorption of water on the surface of the salt particles. Because of the increase in conductivity, the initiation of aqueous corrosion of metals in contact with hygroscopic salts may occur at a relative humidity much lower than the DRH of the salt. Thus, the onset of aqueous corrosion of metallic nuclear waste package and the drip shield may be earlier, the duration may be longer, and the temperature at which it occurs may be higher than assumed based on the DRH of the salt. The results of the DRH experiments show that the DRH of a salt mixture is usually significantly lower than that of any of its component pure salt.
Thermodynamic calculations were conducted to determine the deliquescence behavior of salt mixtures and to simulate the evaporation of Yucca Mountain groundwaters. The results are consistent with published experimental data that show the deliquescence points of salt mixtures are lower than that of individual salts. For mixtures of NaCl and KCl salts, the deliquescence point of pure NaNO3 salt is an appropriate lower bound. However, mixtures containing magnesium and calcium salts have much lower deliquescence points than pure NaNO3. If magnesium and calcium salts are deposited on waste package and drip shield surfaces, it could lead to earlier initiation of aqueous corrosion than assumed by the DOE in its performance assessment abstractions. Such salt mixtures can be formed by evaporation of waters with compositions similar to some Yucca Mountain porewaters and would be characterized by low deliquescence relative humidity, high chloride concentration, and low concentrations of anions such as free (uncomplexed) nitrate and sulfate that could mitigate against the chloride-enhanced corrosion of the waste package. Evaporation of Yucca Mountain groundwaters also could lead to fluoride concentrations that are above the threshold for accelerated corrosion of the titanium drip shield.
We define four distinct thermohydrochemical environments for drip shield and waste package corrosion in the potential nuclear waste repository, referred to here as the Dry, Seepage + Evaporation, Seepage + Condensation + Evaporation, and the Seepage + Condensation environments. These environments are bounded by temperature and relative humidity conditions at drift wall and drip shield/waste package surfaces judged most likely to initiate fundamental changes in the quantity and/or chemistry of in-drift waters. The duration in which different environments might exist is evaluated by comparing simulated, time-dependent temperature and relative humidity curves for three different locations within repository drift 25. In-drift conditions and processes postulated to cause drip shield/waste package corrosion are evaluated within the context of the thermohydrochemical environments by various means, including analytical calculations and geochemical simulations. Of the four environments considered here, the Seepage + Evaporation environment presents the most significant potential for aqueous corrosion of drip shield and waste package materials, and may persist for approximately 500 years in center drift locations. The likelihood for corrosion in other thermohydrochemical environments is significantly lower, but may increase with the acquisition of new data or the demonstration of extenuating circumstances.
In-situ coupled multielectrode array sensors were used to measure the non-uniform corrosion of carbon steel and stainless steel materials under KCl salt deposit in simulated dry repository environments. It was found that the initiation of non-uniform corrosion occurs at a relative humidity that is 14% lower than the deliquescence relative humidity of the chloride salt. It was found also that once significant corrosion had occurred, the non-uniform corrosion process for the carbon steel material under the salt deposit continues at relative humidities as low as 27%.
Analytical pore water compositions from Yucca Mountain were evaluated for internal thermodynamic consistency. Significant ionic charge imbalances, unequilibrated aqueous speciation relationships, and erratic variability with depth in some species concentrations were found. Thermodynamic consistency was restored by introducing measured CO2 gas pressure as a constraint, imposing equilibrium aqueous speciation, and adjusting pH to achieve charge balance. Reinterpreted water chemistry data were used to evaluate and interpret vertical and lateral variations in water chemistry, differences between unsaturated zone pore and perched water compositions, and water-rock equilibria.
Simplicity of construction and operation are advantages of iTMC (ionic transition metal complex) OLEDs compared with multi-layer OLED devices. Unfortunately, lifetimes do not compare favorably with the best multi-layer devices. We have previously shown for Ru(bpy)3(PF6)2 based iTMC OLEDs that electrical drive produces emission-quenching dimers of the active species. We report evidence here that a chemical process may also be implicated in degradation of devices based on Ir(ppy)2(dtb-bpy)PF6 albeit by a very different mechanism. It appears that degradation of operating devices made with this Ir-based complex is related to current-induced heating of the organic layer, resulting in loss of the dtb-bpy ligand. (The dtb-bpy ligand is labile compared with the cyclometallated ppy ligands.) Morphological changes observed in electrically driven Ir(ppy)2(dtb-bpy)PF6 OLEDs provide evidence of substantial heating during device operation. Evidence from UV-vis spectra in the presence of an electric field as well as MALDI-TOF mass spectra of the OLED materials before and after electrical drive add support for this model of the degradation process.
For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy.
To examine mental healthcare service use and receipt of treatment in a sample of the UK military.
Participants were drawn from an existing UK military health cohort. The sample was stratified by reserve status and by participation in the main war-fighting period of the Iraq War. Participants completed a telephone-based structured diagnostic interview comprising the Patient Health Questionnaire and Primary Care Post-Traumatic Stress Disorder Screen (PC–PTSD), and a series of questions about service utilisation and treatment receipt.
Only 23% of those with common mental disorders and still serving in the military were receiving any form of medical professional help. Non-medical sources of help such as chaplains were more widely used. Among regular personnel in receipt of professional help, most were seen in primary care (79%) and the most common treatment was medication or counselling/psychotherapy. Few regular personnel were receiving cognitive–behavioural therapy (CBT). These findings are comparable with those reported for the general population.
In the UK armed forces, the majority of those with mental disorders are not currently seeking medical help for their symptoms. Further work to understand barriers to care is important and timely given that this is a group at risk of occupational psychiatric injury.
The dimensions of postconcussive symptoms (PCS) were examined in a prospective, longitudinal study of 186 8 to 15 year old children with mild traumatic brain injuries (TBI). Parents and children completed a 50-item questionnaire within 2 weeks of injury and again at 3 months after injury, rating the frequency of PCS on a 4-point scale. Common factor analysis with target rotation was used to rotate the ratings to four hypothesized dimensions, representing cognitive, somatic, emotional, and behavioral symptoms. The rotated factor matrix for baseline parent ratings was consistent with the target matrix. The rotated matrix for baseline child ratings was consistent with the target matrix for cognitive and somatic symptoms but not for emotional and behavioral symptoms. The rotated matrices for ratings obtained 3 months after injury were largely consistent with the target matrix derived from analyses of baseline ratings, except that parent ratings of behavioral symptoms did not cluster as before. Parent and child ratings of PCS following mild TBI yield consistent factors reflecting cognitive and somatic symptom dimensions, but dimensions of emotional and behavioral symptoms are less robust across time and raters. (JINS, 2009, 15, 19–30.)
Nutrigenomics is the study of how constituents of the diet interact with genes, and their products, to alter phenotype and, conversely, how genes and their products metabolise these constituents into nutrients, antinutrients, and bioactive compounds. Results from molecular and genetic epidemiological studies indicate that dietary unbalance can alter gene–nutrient interactions in ways that increase the risk of developing chronic disease. The interplay of human genetic variation and environmental factors will make identifying causative genes and nutrients a formidable, but not intractable, challenge. We provide specific recommendations for how to best meet this challenge and discuss the need for new methodologies and the use of comprehensive analyses of nutrient–genotype interactions involving large and diverse populations. The objective of the present paper is to stimulate discourse and collaboration among nutrigenomic researchers and stakeholders, a process that will lead to an increase in global health and wellness by reducing health disparities in developed and developing countries.
This study explores the value of Emergency Medical Services (EMS) experience for students applying to medical school. Methods: Surveys were sent to 67 medical schools in the eastern United States and Canada. Using a five-point Likert scale, the survey asked the respondent to rate the amount of consideration given to Emergency Medical Technician (EMT) or paramedic experience when making admissions decisions (1 = very little to 5 = strong), and to describe the influence of that experience (1 = very negative to 5 = very positive).
Usable responses were received from 21 schools. The median rating for the consideration given to EMS experience was “some consideration” for both EMT and paramedic experience, with 85.7% of respondents assigning that rating or higher. The median rating for the influence of that experience was “somewhat positive” for both EMT and paramedic experience. Only 14.3% of the returned surveys rated EMS experience as “neutral”, and no respondent reported EMS experience as a “negative”.
EMS experience receives at least some consideration during the admissions process at most of the responding institutions in the United States and Canada. Experiences at either the EMT or Paramedic level are viewed similarly. None of the responding institutions viewed EMS experience negatively.
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