Detecting contaminated birthdates using generalized additive models.

Erroneous patient birthdates are common in health databases. Detection of these errors usually involves manual verification, which can be resource intensive and impractical. By identifying a frequent manifestation of birthdate errors, this paper presents a principled and statistically driven procedure to identify erroneous patient birthdates

Detecting Rates, Trends and Determinants of Cesarean Section Deliveries in Iran Using Generalized Additive Mixed Models

Background: The present study aimed to investigate the trend of cesarean section and its related factors through the recent years. Methods: The study data containing delivery information from Hamadan hospitals and are recorded from 2001 to 2014. The data were analyzed through the generalized additive mixed models using R software (v. 3.2.2). Results: cesarean rate in this study was about 42%. According to the results, the trend of cesarean deliveries almost increased in the recent years. A significant relationship was found between the average age and elective cesarean rate, but, the pregnancy rate didn’t have a significant effect on the elective cesarean rate. Conclusion: Cesarean section rate was more than the allowed limit by world health organization (WHO) that is 15%. Although cesarean delivery is preferred to natural vaginal delivery in the case the mother’s or infant’s life is in danger, it should not replace natural delivery for any reason. Natural vaginal delivery can be promoted by providing the society with the knowledge about the advantages of natural delivery and complications of cesarean section

Hookworm infection in the Australian sea lion (Neophoca cinerea)

For the Australian sea lion (Neophoca cinerea), an endangered keystone predator that demonstrates high rates of pup mortality and limited population recovery, an understanding of the role of infectious disease in influencing pup health, and how it may contribute towards shaping population demography, is a key knowledge gap. This thesis investigated the taxonomy, epidemiology, clinical impact, and management of hookworm infection in N. cinerea to address the hypothesis that hookworm infection is a significant cause of disease and mortality in this species. Hookworms collected from N. cinerea pups were identified and described as a novel species (Uncinaria sanguinis). Transmammary transmission in the immediate post-parturient period was implicated as the predominant route leading to patent hookworm infection in pups; however, in contrast to the fundamental role that colony substrate appears to play in shaping the epidemiology of hookworm infection in other otariid hosts, this thesis determined that all N. cinerea pups are infected with U. sanguinis irrespective of the type of colony substrate and that the intensity of hookworm infection appears to be influenced by colony-specific seasonal differences in host behaviour. The clinical impact of hookworm infection in pups was quantified and the occurrence of seasonal patterns in health parameters and the magnitude of colony pup mortality were related to the dynamics of hookworm infection. In addition, the effectiveness of ivermectin to eliminate hookworm infection was investigated. This thesis determined that U. sanguinis is an important cause of disease and mortality in N. cinerea; this thesis contributes towards an improved understanding of the role of infectious disease in influencing the health status and population demography of this endangered species, informing conservation management and providing a solid foundation for further investigations of the effect of disease on the health status of free-ranging species

Hookworm infection in the Australian sea lion (Neophoca cinerea)

For the Australian sea lion (Neophoca cinerea), an endangered keystone predator that demonstrates high rates of pup mortality and limited population recovery, an understanding of the role of infectious disease in influencing pup health, and how it may contribute towards shaping population demography, is a key knowledge gap. This thesis investigated the taxonomy, epidemiology, clinical impact, and management of hookworm infection in N. cinerea to address the hypothesis that hookworm infection is a significant cause of disease and mortality in this species. Hookworms collected from N. cinerea pups were identified and described as a novel species (Uncinaria sanguinis). Transmammary transmission in the immediate post-parturient period was implicated as the predominant route leading to patent hookworm infection in pups; however, in contrast to the fundamental role that colony substrate appears to play in shaping the epidemiology of hookworm infection in other otariid hosts, this thesis determined that all N. cinerea pups are infected with U. sanguinis irrespective of the type of colony substrate and that the intensity of hookworm infection appears to be influenced by colony-specific seasonal differences in host behaviour. The clinical impact of hookworm infection in pups was quantified and the occurrence of seasonal patterns in health parameters and the magnitude of colony pup mortality were related to the dynamics of hookworm infection. In addition, the effectiveness of ivermectin to eliminate hookworm infection was investigated. This thesis determined that U. sanguinis is an important cause of disease and mortality in N. cinerea; this thesis contributes towards an improved understanding of the role of infectious disease in influencing the health status and population demography of this endangered species, informing conservation management and providing a solid foundation for further investigations of the effect of disease on the health status of free-ranging species

Veterans and Agent Orange: Update 11 (2018) (2018)

Contents ACRONYMS AND ABBREVIATIONS xvii SUMMARY 1 1 INTRODUCTION 17 Previous Veterans and Agent Orange Reports, 18 Charge to the Committee, 19 Information Gathering, 20 Organization of the Report, 21 2 BACKGROUND 25 The Current Population of Vietnam Veterans,25 Military Use of Herbicides in Vietnam, 27 Exposure of Different Groups of Vietnam Veterans, 30 Characterizing Exposure, 38 Determining Increased Risk in Vietnam Veterans, 4

Opioid and stimulant use among a sample of corrections-involved drug users : seeking an understanding of high-risk drug decisions within a system of constraint.

In the United States, high-risk drug use remains a significant social problem. Opioids and stimulants are two drug classes that have contributed to substantial recent increases in drug-related arrests, overdose, and mortality. Kentucky has been particularly devastated by high rates of opioid and stimulant use. Opioid and stimulant effects, while highly rewarding, can result in adverse consequences. Still, some people choose to use these drugs, and choose to continue using even after experiencing adverse consequences, such as incarceration. The aim of this study was to explore high-risk drug use among a sample of corrections-involved adults in Kentucky and to identify endogenous and exogenous factors with the potential to have influenced drug-related decision-making prior and subsequent to incarceration. Attention was paid to understanding concomitant opioid and stimulant use and heroin use. Survey data collected as part of an ongoing corrections-based substance use treatment program outcomes study were examined. The final sample (N=1,563) included adults released into Kentucky counties between 2012-2017. Non-parametric statistical tests and multinomial logistic regression were used to identify factors associated with opioid, stimulant, and concomitant use; binary logistic regression was used to identify factors associated with heroin use. Results indicate that opioid and stimulant use was endemic in this sample, though rates of use subsequent to incarceration were lower than pre-incarceration rates. During the 30-day period prior to incarceration, 29.0% of participants reported concomitant use, 28.5% reported opioid use, and 18.0% reported stimulant use. During the one-year post-release period, 11.9% of participants reported concomitant use, 12.5% reported opioid use, and 8.3% reported stimulant use. During this post-release period, 10.7% reported heroin use. Concomitant and heroin use positively correlated with many factors with the potential to adversely influence cognition and constrain choice. Similar relationships between many of these factors and outcomes involving other drug or no drug use were not observed. Behavioral economics, a molar view of choice and behavior, was used to conceptualize how factors in the lives of participants had the potential to influence and constrain decision-making in respect to high-risk drugs. Findings are discussed in light of how they may inform future research, policy, and practice

Family and social factors associated with depression and anxiety disorders in late adolescent girls

The study sought to establish the prevalence of self-reported mood disturbance and depressive and anxiety disorders in a community sample of girls aged 15-20 years. It was hypothesised that the onset of depressive/anxiety disorders would be preceded by stressful life events, and be more frequent in girls without strong maternal support. Subsidiary hypotheses concerned depression and anxiety disorders being more frequently found in families with poor personal relations, and in older age-groups. Drawn from the age-sex registers of eight General Practices in North and East London, a sample of 645 girls were approached for a screening interview. Of these, 529 (82.6%) accepted and were seen with their key relatives (92% mothers). Both key relatives and the girls completed self-report questionnaires on depressive and anxious mood, and also completed third-person versions on one another. At the same time they completed self-report and third person questionnaires on attitudes to eating and exercise; this work is not reported in this thesis. A sub-sample of girls with high self-report questionnaire scores and matched low scorers all of whom were living with their mothers was given a second interview: 153 of 176 eligible girls agreed. Girls and mothers were interviewed separately, but at the same time. The girl was given a psychiatric interview to establish ’caseness’ and diagnosis, and mothers and daughters were asked about stressful life events affecting the girl and personal relationships in the family. Using data from the screening interview, self-reported mood disturbance was found in 20.8% of the girls. The second interview established that there were 38 cases of psychiatric disorder, of which 34 were depressive and/or anxiety disorders. The four cases of conduct disorder were dropped from the analysis and the sample was reconstituted in order to obtain representative numbers of girls with high scores on the self-report eating disorders questionnaire. This left a sample of 139 girls with depressive and anxiety disorders and their controls, among whom it was found that depressive disorder was significantly associated with previous stressful life even ts. After statistical adjustment for an error in data collection, the hypothesised moderating effect of maternal support following stressful events was not confirmed for the depressed girls. Maternal depressed mood and the mother’s single parent status or poor quality marriage were independently related to depressive disorders in the daughters, and a confiding relationship with her mother did not moderate these significant effects. The number of girls with anxiety disorders proved to be small, and the hypotheses requiring multivariate analyses could not be tested

Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients