Disparities in Hospital Services Utilization Among Patients with Mental Health Issues: A Statewide Example Examining Insurance Status and Race Factors from 1999-2010

There exist many disconnects between the mental and general health care sectors. However, a goal of the Affordable Care Act (ACA) of 2010 is to change this by improving insurance access and the intersection of mental and general health care. As insurance status intersects with race, the present study examines how race, insurance status, and hospital mental health services utilization differ across groups within the state of New Jersey. The present study aims to determine trends in hospital mental health care utilization by insurance status and race from 1999 to 2010. The rate of self-pay for mental health disorders in the Black population was significantly higher than the rate for Whites and Asians during this period. However, though Asian mental health utilization increased the most over the 11-year period, the Asian population had the slowest growth in self-pay rates. ANOVA tests demonstrated significant differences in the rate of self-pay mental health cases between race groups (

A dimensional tolerancing knowledge management system using Nested Ripple Down Rules (NRDR)

This paper proposes to use a knowledge acquisition (KA) approach based on Nested Ripple Down Rules(NRDR) to assist in mechanical design focusing on dimensional tolerancing. A knowledge approach to incrementally model expert design processes is implemented. The knowledge is acquired in the context of its use, which substantially supports the KA process. The knowledge is captured which human designers utilize in order to specify dimensional tolerances on shafts and mating holes in order to meet desired classes of fit as set by relevant engineering standards in order to demonstrate the presented approach. The developed dimensional tolerancing knowledge management system would help mechanical designers become more effective in the time-consuming tolerancing process of theirdesigns in the future

Monotherapy Trials of New Antiepileptic Drugs

A number of clinical trials that test the efficacy and safety of the newer antiepileptic drugs (AEDs) have recently been concluded. Two dose-response trials in inpatients with refractory partial seizures and outpatients with newly diagnosed partial epilepsy established the efficacy of gabapentin as monotherapy. Lamotrigine was found to have efficacy similar to that of phenytoin and carbamazepine (CBZ) and to be better tolerated than CBZ in patients with newly diagnosed epilepsy. It was also shown to have efficacy as monotherapy in partial seizures, based on the results of an active controlled trial, and in the treatment of absence seizures, based on the results of a responder-enriched study. Topiramate as monotherapy was found to be efficacious for treatment of partial-onset seizures, based on the results of a single-center dose-response trial. A dose-response trial that tested the efficacy of tiagabine monotherapy in patients with refractory partial epilepsy was uninformative. Oxcarbazepine was found to be safe and efficacious in four comparative trials in patients with newly diagnosed epilepsy as well as in one placebo-controlled inpatient trial in patients with refractory partial seizures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65625/1/j.1528-1157.1997.tb05201.x.pd

Enhanced group-based wireless ad-hoc sensor network protocol

[EN] Communication is the major energy consumption source in wireless ad-hoc sensor networks. Thus, an efficient tradeoff between the energy cost of the communication and network's performance is a key challenge in conceiving a wireless ad-hoc sensor network. In this article, we propose an improved group-based architecture for wireless ad-hoc sensor networks. An optimized group forming procedure and an efficient communication operation are introduced. In order to validate the proposed approach, we suggest a group-based strategy to monitor pharmaceutical drugs during transportation. Real measurements of temperature and vibration were performed to validate the effectiveness of our approach.Khedher, M.; Lloret, J.; Douik, A. (2016). Enhanced group-based wireless ad-hoc sensor network protocol. International Journal of Distributed Sensor Networks. 12(7):1-18. https://doi.org/10.1177/1550147716659427S118127Dargie, W., & Poellabauer, C. (2010). Fundamentals of Wireless Sensor Networks. doi:10.1002/9780470666388Singh, S. P., & Sharma, S. C. (2015). A Survey on Cluster Based Routing Protocols in Wireless Sensor Networks. Procedia Computer Science, 45, 687-695. doi:10.1016/j.procs.2015.03.133Liao, Y., Qi, H., & Li, W. (2013). Load-Balanced Clustering Algorithm With Distributed Self-Organization for Wireless Sensor Networks. IEEE Sensors Journal, 13(5), 1498-1506. doi:10.1109/jsen.2012.2227704Peng, I.-H., & Chen, Y.-W. (2013). Energy consumption bounds analysis and its applications for grid based wireless sensor networks. Journal of Network and Computer Applications, 36(1), 444-451. doi:10.1016/j.jnca.2012.04.014Lloret, J., Garcia, M., Tomás, J., & Boronat, F. (2008). GBP-WAHSN: A Group-Based Protocol for Large Wireless Ad Hoc and Sensor Networks. Journal of Computer Science and Technology, 23(3), 461-480. doi:10.1007/s11390-008-9147-6Lloret, J., García, M., Boronat, F., & Tomás, J. (s. f.). MANET Protocols Performance in Group-based Networks. IFIP International Federation for Information Processing, 161-172. doi:10.1007/978-0-387-84839-6_13Lloret, J., Garcia, M., & Tomas, J. (s. f.). Improving Mobile and Ad-hoc Networks performance using Group-Based Topologies. Wireless Sensor and Actor Networks II, 209-220. doi:10.1007/978-0-387-09441-0_18Lloret, J., Palau, C., Boronat, F., & Tomas, J. (2008). Improving networks using group-based topologies. Computer Communications, 31(14), 3438-3450. doi:10.1016/j.comcom.2008.05.030Garcia, M., Sendra, S., Lloret, J., & Canovas, A. (2011). Saving energy and improving communications using cooperative group-based Wireless Sensor Networks. Telecommunication Systems, 52(4), 2489-2502. doi:10.1007/s11235-011-9568-3Garcia, M., & Lloret, J. (2009). A Cooperative Group-Based Sensor Network for Environmental Monitoring. Cooperative Design, Visualization, and Engineering, 276-279. doi:10.1007/978-3-642-04265-2_41Shaikh, R. A., Jameel, H., d’ Auriol, B. J., Heejo Lee, Sungyoung Lee, & Young-Jae Song. (2009). Group-Based Trust Management Scheme for Clustered Wireless Sensor Networks. IEEE Transactions on Parallel and Distributed Systems, 20(11), 1698-1712. doi:10.1109/tpds.2008.258Chen, Y.-S., Hsu, C.-S., & Lee, H.-K. (2014). An Enhanced Group Mobility Protocol for 6LoWPAN-Based Wireless Body Area Networks. IEEE Sensors Journal, 14(3), 797-807. doi:10.1109/jsen.2013.2287895Yao-Chung Chang, Zhi-Sheng Lin, & Jiann-Liang Chen. (2006). Cluster based self-organization management protocols for wireless sensor networks. IEEE Transactions on Consumer Electronics, 52(1), 75-80. doi:10.1109/tce.2006.1605028Fazio, P., De Rango, F., Sottile, C., & Santamaria, A. F. (2013). Routing Optimization in Vehicular Networks: A New Approach Based on Multiobjective Metrics and Minimum Spanning Tree. International Journal of Distributed Sensor Networks, 9(11), 598675. doi:10.1155/2013/598675Saravanan, M., & Madheswaran, M. (2014). A Hybrid Optimized Weighted Minimum Spanning Tree for the Shortest Intrapath Selection in Wireless Sensor Network. Mathematical Problems in Engineering, 2014, 1-8. doi:10.1155/2014/71342

<span class="italic">n</span>–3 Fatty acids, hypertension and risk of cognitive decline among older adults in the Atherosclerosis Risk in Communities (ARIC) study

OBJECTIVE: Recent research indicates that n-3 fatty acids can inhibit cognitive decline, perhaps differentially by hypertensive status. DESIGN: We tested these hypotheses in a prospective cohort study (the Atherosclerosis Risk in Communities). Dietary assessment using a food-frequency questionnaire and plasma fatty acid exposure by gas chromatography were completed in 1987-1989 (visit 1), while cognitive assessment with three screening tools--the Delayed Word Recall Test, the Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale-Revised and the Word Fluency Test (WFT)--was completed in 1990-1992 (visit 2) and 1996-1998 (visit 4). Regression calibration and simulation extrapolation were used to control for measurement error in dietary exposures. SETTING: Four US communities--Forsyth County (North Carolina), Jackson (Mississippi), suburbs of Minneapolis (Minnesota) and Washington County (Maryland). SUBJECTS: Men and women aged 50-65 years at visit 1 with complete dietary data (n = 7814); white men and women in same age group in the Minnesota field centre with complete plasma fatty acid data (n = 2251). RESULTS: Findings indicated that an increase of one standard deviation in dietary long-chain n-3 fatty acids (% of energy intake) and balancing long-chain n-3/n-6 decreased the risk of 6-year cognitive decline in verbal fluency with an odds ratio (95% confidence interval) of 0.79 (0.66-0.95) and 0.81 (0.68-0.96), respectively, among hypertensives. An interaction with hypertensive status was found for dietary long-chain n-3 fatty acids (g day-1) and WFT decline (likelihood ratio test, P = 0.06). This exposure in plasma cholesteryl esters was also protective against WFT decline, particularly among hypertensives (OR = 0.51, P < 0.05). CONCLUSION: One implication from our study is that diets rich in fatty acids of marine origin should be considered for middle-aged hypertensive subjects. To this end, randomised clinical trials are needed

Dairy food products: good or bad for cardiometabolic disease?

Prevalence of type 2 diabetes mellitus (T2DM) is rapidly increasingly and is a key risk for CVD development, now recognised as the leading cause of death globally. Dietary strategies to reduce CVD development include reduction of saturated fat intake. Milk and dairy products are the largest contributors to dietary saturated fats in the UK and reduced consumption is often recommended as a strategy for risk reduction. However, overall evidence from prospective cohort studies does not confirm a detrimental association between dairy product consumption and CVD risk. The present review critically evaluates the current evidence on the association between milk and dairy products and risk of CVD, T2DM and the metabolic syndrome (collectively, cardiometabolic disease). The effects of total and individual dairy foods on cardiometabolic risk factors and new information on the effects of the food matrix on reducing fat digestion are also reviewed. It is concluded that a policy to lower SFA intake by reducing dairy food consumption to reduce cardiometabolic disease risk is likely to have limited or possibly negative effects. There remain many uncertainties, including differential effects of different dairy products and those of differing fat content. Focused and suitably designed and powered studies are needed to provide clearer evidence not only of the mechanisms involved, but how they may be beneficially influenced during milk production and processing

Bilateral dilation of the urinary tract due to iliopsoas pyomyositis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pyomyositis is an acute bacterial infection of the skeletal muscles that arises from hematogenous spread and is caused predominantly by Gram-positive cocci.</p> <p>Case presentation</p> <p>We report a case of iliopsoas pyomyositis in a 25-year-old Greek Caucasian woman with a history of intravenous drug use. Her condition was complicated by bilateral dilation of the ureters and renal calyces as a result of mechanical pressure from inflammation and edema of the involved muscle. The patient did not present aggravation of renal function and was treated successfully solely with intravenous antibiotics, without surgical intervention. This is the first case report describing iliopsoas pyomyositis with reversible bilateral dilation of the urinary tract that was treated successfully with intravenous antibiotics, without surgical intervention.</p> <p>Conclusion</p> <p>We present the first described case of iliopsoas pyomyositis with reversible bilateral hydroureteronephrosis that was treated successfully with intravenous antibiotics, without the necessity of surgical intervention. To our knowledge, this is the first report of its kind in the literature regarding an unexpected event in the course of treating a patient with iliopsoas pyomyositis, and it should be of particular interest to different clinical medical specialties such as internal medicine, infectious disease and urology.</p

Measurement error adjustment in essential fatty acid intake from a food frequency questionnaire: alternative approaches and methods

<p>Abstract</p> <p>Background</p> <p>We aimed at assessing the degree of measurement error in essential fatty acid intakes from a food frequency questionnaire and the impact of correcting for such an error on precision and bias of odds ratios in logistic models. To assess these impacts, and for illustrative purposes, alternative approaches and methods were used with the binary outcome of cognitive decline in verbal fluency.</p> <p>Methods</p> <p>Using the Atherosclerosis Risk in Communities (ARIC) study, we conducted a sensitivity analysis. The error-prone exposure – visit 1 fatty acid intake (1987–89) – was available for 7,814 subjects 50 years or older at baseline with complete data on cognitive decline between visits 2 (1990–92) and 4 (1996–98). Our binary outcome of interest was clinically significant decline in verbal fluency. Point estimates and 95% confidence intervals were compared between naïve and measurement-error adjusted odds ratios of decline with every SD increase in fatty acid intake as % of energy. Two approaches were explored for adjustment: (A) External validation against biomarkers (plasma fatty acids in cholesteryl esters and phospholipids) and (B) Internal repeat measurements at visits 2 and 3. The main difference between the two is that Approach B makes a stronger assumption regarding lack of error correlations in the structural model. Additionally, we compared results from regression calibration (RCAL) to those from simulation extrapolation (SIMEX). Finally, using structural equations modeling, we estimated attenuation factors associated with each dietary exposure to assess degree of measurement error in a bivariate scenario for regression calibration of logistic regression model.</p> <p>Results and conclusion</p> <p>Attenuation factors for Approach A were smaller than B, suggesting a larger amount of measurement error in the dietary exposure. Replicate measures (Approach B) unlike concentration biomarkers (Approach A) may lead to imprecise odds ratios due to larger standard errors. Using SIMEX rather than RCAL models tends to preserve precision of odds ratios. We found in many cases that bias in naïve odds ratios was towards the null. RCAL tended to correct for a larger amount of effect bias than SIMEX, particularly for Approach A.</p

A survey of security issue in multi-agent systems

Multi-agent systems have attracted the attention of researchers because of agents' automatic, pro-active, and dynamic problem solving behaviors. Consequently, there has been a rapid development in agent technology which has enabled us to provide or receive useful and convenient services in a variety of areas such as banking, transportation, e-business, and healthcare. In many of these services, it is, however, necessary that security is guaranteed. Unless we guarantee the security services based on agent-based systems, these services will face significant deployment problems. In this paper, we survey existing work related to security in multi-agent systems, especially focused on access control and trust/reputation, and then present our analyses. We also present existing problems and discuss future research challenges. © Springer Science+Business Media B.V 2011