Sex and Race Differences in Electrocardiogram Use (The National Hospital Ambulatory Medical Care Survey)

There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain should undergo electrocardiography (ECG) to rule out acute ischemia or infarction, regardless of sex or age. It is possible that sex and race differences exist in the administration of this important screening tool among patients with chest pain, possibly reflecting a lower suspicion of coronary heart disease in women (especially young women) and blacks. These management differences may result in failure to diagnose coronary heart disease and may explain why these subgroups are referred less often for cardiac catheterization. Therefore, the purpose of this study was to examine whether this basic guideline is being implemented uniformly in a national sample of patients presenting to the ED with chest pain. Specifically, we hypothesized that young women and blacks presenting with chest pain would be significantly less likely to undergo ECG relative to their white male counterparts

Emploi de la pré-ozonation pour augmenter la biodégradabilité d'un effluent secondaire dans un système de traitement par inflitration dans le sol

La réutilisation des eaux usées est reconnue comme une technique importante dans les régions arides et /ou grandes consommatrices d'eau. L'une des méthodes actuellement très employée consiste à recharger la nappe phréatique avec des effluents secondaires via des bassins d'infiltration. L'épuration biologique et / ou chimique à travers la zone non-saturée représente une caractéristique importante de cette technologie. Les procédés de ce type sont connus sous l'appellation de Soil Aquifer Treatment (SAT) ou géofiltration. Dans ce travail, le procédé a été étudié comme méthode de réhabilitation d'un effluent secondaire d'eaux usées jusqu'au stade d'eau potable. Cette recherche a été principalement axée sur le comportement, le transport des matières organiques (MO) de l'effluent et particulièrement sur leur rôle de précurseurs potentiels de sous-produits de désinfection lors de la réutilisation de la nappe. Dans la zone vadose, la matière organique est principalement éliminée par biodégradation, et à un degré moindre, par adsorption. Les simulations du procédé, en laboratoire, ont été réalisées en réacteurs recirculés aérobies, en mode cuvée, avec un biofilm acclimaté sur des particules de sable siliceux, afin de déterminer la fraction biodégradable des MO. L'évaluation de celle-ci est essentielle pour prédire leur potentiel de dégradation par la biomasse de la zone vadose. L'effluent mis en oeuvre est issu d'une station d'épuration de l'Arizona (États-Unis) avec biofiltre (lit filtrant à support plastique); sa concentration en carbone organique dissous (COD) se situe entre 10 et 15 mg/L.L'effluent mis 5 jours durant en contact avec le biofilm acclimaté du réacteur montre un abattement de 50-60 % du COD. Il a ainsi été déterminé qu'environ 80 % de l'élimination des MO de l'effluent survient dans les premières 24 heures d'expérimentation, alors que le reste, près de 20 %, est éliminé durant les 48 heures suivantes. Dans ces conditions, le délai de 5 jours apparait suffisant pour dégrader les MO présentes dans ces effluents. Les rendements observés augurent bien de la dégradation dans la zone vadose si l'on tient compte de la combinaison des taux et de la hauteur d'infiltration avec des temps de résidence de 2 à 14 jours ainsi qu'il est proposé dans le procédé. Afin d'accroître la biodégradabilité des MO, une ozonation a été effectuée, en amont du bio-traitement, avec un générateur d'ozone à l'échelle du banc d'essai fonctionnant en mode semi-continu (admission continue de gaz, volume stable de liquide). La pré-ozonation a permis d'accroître la biodégradation de 60-70 %. Bien qu'un fort pourcentage de MO soit éliminé dans ce schéma, il ressort que l'ozone n'a qu'un effet modeste sur la transformation des MO dissoutes non-biodégradables en matières biodégradables par rapport à des expériences similaires effectuées avec des matières organiques naturelles (MON) des eaux de surface. L'eau usée ainsi traitée présente des niveaux de COD comparables à ceux d'une eau de surface employée à des fins de consommation. Les caractéristiques des MO de l'effluent ont été comparées à celles des MON. Une ultrafiltration de l'effluent pour déterminer le poids moléculaire apparent des MO, donne une distribution bimodale de leur poids moléculaire par rapport à une distribution logarithmique normale observée avec des MON typiques. En utilisant des résines non- ioniques pour séparer les fractions hydrophobes et hydrophiles des MO, il ressort que l'ozonation ne transforme pas de façon significative la fraction hydrophobe des MO de l'effluent en fraction hydrophile, tel que cela a été observé durant l'ozonation des MON. Ces eaux ont été chlorées en pilote, selon des conditions similaires à celles des réseaux de distribution (CI2:COD=1:1mg/mg, période d'incubation=24 heures) afin de simuler la post-désinfection après récupération. Les sous-produits réglementés (Trihalométhanes THM) et ceux proposés (Acides holoacétiques, HAA6) ont été formés à des taux inférieurs ou proches des normes en vigueur (ou de celles proposées pour HAA6) pour l'eau potable aux États-Unis. Cependant, une nitrification significative a été observée dans nos simulations de traitement par le sol avec un effluent non-nitrifié, conduisant à des teneurs en nitrates supérieures à la norme américaine pour l'eau potable (10 mg/L).Soil Aquifer Treatment (SAT) is being studied as a means of water quality renovation of a secondary effluent for potable reuse. During SAT, infiltration of effluent through the vadose zone provides removal of effluent organic matter primarily through biodegradation, and to a lesser extent, through sorption. A major concern is that effluent organic matter can function as disinfection by-product (DBP) precursors upon recovery and post-disinfection. Through laboratory simulations of SAT, we have found that 50 - 60 % of the dissolved organic carbon (DOC) present in secondary effluent can potentially be removed by biodegradation, with preozonation increasing removal to 60 - 70 %. The resultant water contains DOC at levels comparable to a typical surface water used for potable purposes; moreover, upon chlorination, regulated DBPs are formed at levels below or near the United States of America's drinking water standards. However, significant nitrification was observed in our SAT simulations with an un-nitrified effluent, yielding levels of nitrate above the USA drinking water standard

Viewpoint: Evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa

OBJECTIVE To describe an approach for evaluating the impact of malaria control efforts on malaria-associated mortality in sub-Saharan Africa, where disease-specific mortality trends usually cannot be measured directly and most malaria deaths occur among young children. METHODS Methods for evaluating changes in malaria-associated mortality are examined; advantages and disadvantages are presented. RESULTS All methods require a plausibility argument - i.e., an assumption that mortality reductions can be attributed to programmatic efforts if improvements are found in steps of the causal pathway between intervention scale-up and mortality trends. As different methods provide complementary information, they can be used together. We recommend following trends in the coverage of malaria control interventions, other factors influencing childhood mortality, malaria-associated morbidity (especially anaemia), and all-cause childhood mortality. This approach reflects decreases in malaria's direct and indirect mortality burden and can be examined in nearly all countries. Adding other information can strengthen the plausibility argument: trends in indicators of malaria transmission, information from demographic surveillance systems and sentinel sites where malaria diagnostics are systematically used, and verbal autopsies linked to representative household surveys. Health facility data on malaria deaths have well-recognized limitations; however, in specific circumstances, they could produce reliable trends. Model-based predictions can help describe changes in malaria-specific burden and assist with program management and advocacy. CONCLUSIONS Despite challenges, efforts to reduce malaria-associated mortality in Africa can be evaluated with trends in malaria intervention coverage and all-cause childhood mortality. Where there are resources and interest, complementary data on malaria morbidity and malaria-specific mortality could be added

Asthma Knowledge, Adherence, and Administration Techniques in Hispanic Caregivers of Pediatrics

7.5% of Hispanics in the United States suffer from asthma-related diseases, and Latino children are not as likely to use preventative asthma medications as compared with Caucasians. Educational interventions may reduce the number of visits to emergency-care. The reasons for non-adherence are currently unknown, and discovering these reasons will help to address the problem

Factors Influencing Emergency Contraception Use in Indigent Populations

Introduction: Indigent women are disproportionately affected by unwanted, unplanned pregnancies. Studies previously identified lack of knowledge about emergency contraception (EC) as a major deterrent from use. This study was performed to address three potential barriers to the use of EC in indigent populations: culture and religion, patient education, and cost. For the entirety of this study, EC refers to levonorgestrel (LNG). Objectives: To determine the impact of culture and religion, patient education, and cost on EC use in the indigent population. Methods: This study was a cross-sectional observational study to explore and investigate relationships between indigent populations and the use of EC. To be included in the study, participants had to be: at least 14 years old, female, and have an annual household income below the federal poverty line (FPL). Those excluded were less than 14 years old, male, and reported an annual household income above the FPL. A questionnaire consisting of 31 survey questions were utilized to assess the endpoints of the study. The study utilized both paper and electronic forms of the survey. Participants signed informed consent to enable them participate in the study. Out of 319 participants, 59 met all inclusion criteria and were used in statistical analyses. Results:Based on Kruskal-Wallis results, religious groups’ acceptance of EC influenced indigent women’s decision to use it (p=0.016). Level of education also influenced women’s understanding of EC as an abortifacient and knowledge of when LNG is effective. Spearman rho revealed correlations between participants’ willingness to pay for EC or routine birth control and knowing that EC was an option (coefficient 0.391; p-value 0.005). There was also a correlation between the cost of EC and ultimate use (coefficient -0.603; p-value Conclusion: Our research found that religious groups’ acceptance of EC use and knowledge about how LNG works does affect the decision to use EC. Neither cultural identification nor cost of EC appears to have a significant impact on the final decision to use

Serum Zinc Correlates with Parent- and Teacher-Rated Inattention in Children with Attention-Deficit/Hyperactivity Disorder

Objective: The aim of this study was to explore the relationship of zinc nutrition to the severity of attentiondeficit/ hyperactivity disorder (ADHD) symptoms in a middle-class American sample with well-diagnosed ADHD. Previous reports of zinc in ADHD, including two positive clinical trials of supplementation, have come mainly from countries and cultures with different diets and/or socioeconomic realities. Method: Children 5–10 years of age with DISC- and clinician-diagnosed ADHD had serum zinc determinations and parent and teacher ratings of ADHD symptoms. Zinc levels were correlated (Pearson’s and multiple regression) with ADHD symptom ratings. Results: Forty-eight children (37 boys, 11 girls; 33 combined type, 15 inattentive) had serum zinc levels with a median/mode at the lowest 30% of the laboratory reference range; 44 children also had parent/teacher ratings. Serum magnesium levels were normal. Nutritional intake by a parent-answered food frequency questionnaire was unremarkable. Serum zinc correlated at r = -0.45 (p = 0.004) with parent-teacher-rated inattention, even after controlling for gender, age, income, and diagnostic subtype, but only at r = -0.20 (p = 0.22) with CPT omission errors. In contrast, correlation with parent-teacher-rated hyperactivity-impulsivity was nonsignificant in the opposite direction. Conclusion: These findings add to accumulating evidence for a possible role of zinc in ADHD, even for middle-class Americans, and, for the first time, suggest a special relationship to inattentive symptoms. They do not establish either that zinc deficiency causes ADHD nor that ADHD should be treated with zinc. Hypothesis-testing clinical trials are needed

Covalent bond shortening and distortion induced by pressurization of thorium, uranium, and neptunium tetrakis aryloxides

Covalency involving the 5f orbitals is regularly invoked to explain the reactivity, structure and spectroscopic properties of the actinides, but the ionic versus covalent nature of metal-ligand bonding in actinide complexes remains controversial. The tetrakis 2,6-di-tert-butylphenoxide complexes of Th, U and Np form an isostructural series of crystal structures containing approximately tetrahedral MO(4) cores. We show that up to 3 GPa the Th and U crystal structures show negative linear compressibility as the OMO angles distort. At 3 GPa the angles snap back to their original values, reverting to a tetrahedral geometry with an abrupt shortening of the M-O distances by up to 0.1 Å. The Np complex shows similar but smaller effects, transforming above 2.4 GPa. Electronic structure calculations associate the M-O bond shortening with a change in covalency resulting from increased contributions to the M-O bonding by the metal 6d and 5f orbitals, the combination promoting MO(4) flexibility at little cost in energy

Development of Alcohol and Drug Use in Youth With Manic Symptoms

This analysis examined alcohol and drug use over a six-year follow-up of children in the Longitudinal Assessment of Manic Symptoms (LAMS) study

Vestibular Stimulation for ADHD: Randomized Controlled Trial of Comprehensive Motion Apparatus

Objective: This research evaluates effects of vestibular stimulation by Comprehensive Motion Apparatus (CMA) in ADHD. Method: Children ages 6 to 12 (48 boys, 5 girls) with ADHD were randomized to thrice-weekly 30-min treatments for 12 weeks with CMA, stimulating otoliths and semicircular canals, or a single-blind control of equal duration and intensity, each treatment followed by a 20-min typing tutorial. Results: In intent-to-treat analysis (n = 50), primary outcome improved significantly in both groups (p = .0001, d = 1.09 to 1.30), but treatment difference not significant (p = .7). Control children regressed by follow-up (difference p = .034, d = 0.65), but overall difference was not significant (p = .13, d = .47). No measure showed significant treatment differences at treatment end, but one did at follow-up. Children with IQ-achievement discrepancy ≥ 1 SD showed significantly more CMA advantage on three measures. Conclusion: This study illustrates the importance of a credible control condition of equal duration and intensity in trials of novel treatments. CMA treatment cannot be recommended for combined-type ADHD without learning disorder

Nonconstant electronic density of states tunneling inversion for A15 superconductors: Nb3Sn

We re-examine the tunneling data on A15 superconductors by performing a generalized McMillan-Rowell tunneling inversion that incorporates a nonconstant electronic density of states obtained from band-structure calculations. For Nb3Sn, we find that the fit to the experimental data can be slightly improved by taking into account the sharp structure in the density of states, but it is likely that such an analysis alone is not enough to completely explain the superconducting tunneling characteristics of this material. Nevertheless, the extracted Eliashberg function displays a number of features expected to be present for the highest quality Nb3Sn samples.Comment: 11 pages, 11 figure