Population-based trends in pregnancy hypertension and pre-eclampsia: an international comparative study

Objective: The objective of this study was to compare international trends in pre-eclampsia rates and in overall pregnancy hypertension rates (including gestational hypertension, pre-eclampsia and eclampsia). Design: Population data (from birth and/or hospital records) on all women giving birth were available from Australia (two states), Canada (Alberta), Denmark, Norway, Scotland, Sweden and the USA (Massachusetts) for a minimum of 6 years from 1997 to 2007. All countries used the 10th revision of the International Classification of Diseases, except Massachusetts which used the 9th revision. There were no major changes to the diagnostic criteria or methods of data collection in any country during the study period. Population characteristics as well as rates of pregnancy hypertension and pre-eclampsia were compared. Results: Absolute rates varied across the populations as follows: pregnancy hypertension (3.6% to 9.1%), pre-eclampsia (1.4% to 4.0%) and early-onset preeclampsia (0.3% to 0.7%). Pregnancy hypertension and/or pre-eclampsia rates declined over time in most populations. This was unexpected given that factors associated with pregnancy hypertension such as prepregnancy obesity and maternal age are generally increasing. However, there was also a downward shift in gestational age with fewer pregnancies reaching 40 weeks. Conclusion: The rate of pregnancy hypertension and pre-eclampsia decreased in northern Europe and Australia from 1997 to 2007, but increased in Massachusetts. The use of a different International Classification of Diseases coding version in Massachusetts may contribute to the difference in trend. Elective delivery prior to the due date is the most likely explanation for the decrease observed in Europe and Australia. Also, the use of interventions that reduce the risk of pregnancy hypertension and/or progression to pre-eclampsia (low-dose aspirin, calcium supplementation and early delivery for mild hypertension) may have contributed to the decline

Optimization of Diltiazem hydrochloride osmotic formulation using QBD approach

Diltiazem hydrochloride (DLH) is a calcium channel blocker useful for the treatment of angina pectoris, arrhythmia, and hypertension. DLH having a short half-life needs frequent administration for successful treatment but this poses a problem of poor patient compliance. These requirements are served by elementary osmotic pump tablets (EOP) based controlled-release (CR) systems. Quality by design (QbD) approach assists in screening various factors with subsequent assessment of critical parameters that can have a major impact on the scalability of EOP. Tablets were formulated using wet granulation method followed by osmotic coating. Factorial design based QbD strategy aided in defining the risk assessment of influential variables such as hydrophilic polymers and osmotic coat component on the in-vitro release kinetics of the designed EOP tablets. These formulated EOP systems followed zero-order kinetics, a characteristic feature of EOPs. EOP tablets were formulated applying a systematic QbD statistical approach. The formulated DLH EOP systems with improved concentration-independent behavior helped to address the challenges of IR formulation. Application of QbD strategy in ascertaining the scalability of DLH EOP formulation would help pharmaceutical industries in the translation of EOP based drug delivery systems from R&D to market

Numerical and experimental investigation of unreinforced masonry wall retrofitted with timber panels

Retrofit of unreinforced masonry (URM) buildings is continually attracting the interest of masonry professionals. This is because there are enormous URM building stocks in different parts of the world that have shown vulnerability to damage against out-of-plane actions due to having limited flexural strength and deformation resistance. As such, there is a global trend of promoting the development of different retrofit techniques for URM wall. Thus, this study proposed an experimental and numerical investigation into the possibility of retrofitting URM wall using oriented strand board (OSB) timber-panel. The aim is to estimate the improvements in the out-of-plane capacity of URM wall retrofitted with OSB panel. The study focuses on investigating out-of-plane behaviour because out-of-plane failure mode has been identified as the most critical failure mode of URM walls. The proposed retrofitting approach is by securing an OSB/ type 3 timber-panel behind URM wall using threaded anchor rods together with an option of plastic plug or injection mortar. The methodologies adopted to deliver the overall aim and objectives of this study, as identified in this thesis were experimental tests and numerical analyses. Flexural strength in the form of four-point bending tests has been obtained on nine small-scale masonry prisms (615 x 215 x 102.5mm) and six larger-scale masonry walls (1115 x 1115 x 225mm). The effectiveness of the proposed OSB-panel retrofit technique has been assessed in term of flexural strength, absorbed energy (toughness), out-of-plane load capacity and displacement. The test results show that OSB type 3 can considerably increase the load and flexure capacity of retrofitted masonry walls by (1.4 & 1.8), limiting toughness by (1.6 & 2.4) and overall toughness by (16 & 10) times that of plain wall subjected to out-of-plane loading for retrofit application on single (i.e tensile side only) and double-sides of the wall respectively. It can be concluded that the application of the proposed OSB retrofit technique greatly influenced the out-of-plane performance of the retrofitted wall and also prevents its quasi-brittle collapse. Numerical analysis using commercial finite element software, ABAQUS was also performed and validated against the experimental data. The observed damage pattern and load-displacement plots compared with the experimental observations are in good agreement (within 5% difference). The calibrated model was then extended to parametric analysis to assess the model capability to simulate URM walls retrofitted with different OSB panel thickness, different connection spacing and different retrofit application position. The parametric analysis reveals that the thickness of the OSB timber is directly proportional to the out-of-plane load and displacement resistance of the system. It also shows that there is no enough composite action between the masonry and the OSB timber when the connection spacing is greater than 500mm. The parametric analyses revealed that the application of the retrofit on only the compression side does not improve the load capacity of the retrofitted walls significantly. Hence it is recommended that the application should be applied on the tensile sides of the wall or both sides where desirable. Interestingly, the cost of applying this proposed OSB technique on a square meter of a masonry wall (materials and labour) is estimated to be £47 as against £152 estimated for typical fibre-based retrofit applications on 1m2 masonry wall using the market prices in England. The proposed retrofit technique in comparison with the other existing fibre-based retrofit techniques performed well in terms of increased capacity and it is cheaper and easy to apply

Predictors of timely follow-up after abnormal cancer screening among women seeking care at urban community health centers

BACKGROUND: We sought to measure time and identify predictors of timely follow-up among a cohort of racially/ethnically diverse inner city women with breast and cervical cancer screening abnormalities. METHODS: Eligible women had an abnormality detected on a mammogram or Papanicolaou (Pap) test between January 2004 and December 2005 in 1 of 6 community health centers in Boston, Massachusetts. Retrospective chart review allowed us to measure time to diagnostic resolution. We used Cox proportional hazards models to develop predictive models for timely resolution (defined as definitive diagnostic services completed within 180 days from index abnormality). RESULTS: Among 523 women with mammography abnormalities and 474 women with Pap test abnormalities, \u3e90% achieved diagnostic resolution within 12 months. Median time to resolution was longer for Pap test than for mammography abnormalities (85 vs 27 days). Site of care, rather than any sociodemographic characteristic of individuals, including race/ethnicity, was the only significant predictor of timely follow-up for both mammogram and Pap test abnormalities. CONCLUSIONS: Site-specific community-based interventions may be the most effective interventions to reduce cancer health disparities when addressing the needs of underserved populations

Perceived Preparedness to Provide Preventive Counseling: Reports of Graduating Primary Care Residents at Academic Health Centers

OBJECTIVE: To assess the perceived preparedness of residents in adult primary care specialties to counsel patients about preventive care and psychosocial issues. DESIGN: Cross-sectional national mail survey of residents (63% response rate). PARTICIPANTS: Nine hundred twenty-eight final-year primary care residents in Internal Medicine (IM), family practice (FP), and Obstetrics/Gynecology (OB/GYN) at 162 U.S. academic health centers. MEASUREMENTS: Residents self-rated preparedness to counsel patients about smoking, diet and exercise, substance abuse, domestic violence, and depression. RESULTS: Residents felt better prepared to counsel about smoking (62%) and diet and exercise (53%) than about depression (37%), substance abuse (36%), or domestic violence (21%). In most areas, females felt better prepared than males. Rates of counseling preparedness varied significantly by specialty after adjustment for gender, race, medical school location, and percent of training spent in ambulatory settings. FP residents felt better prepared than OB/GYN residents to counsel about smoking, diet and exercise, and depression, while OB/GYN residents felt better prepared to address domestic violence than IM or FP residents. IM residents' perceptions of preparedness were between the other 2 specialties. Proportion of training spent in ambulatory settings was not associated with residents' perceived preparedness. CONCLUSIONS: Physicians completing residencies in adult primary care did not feel very well prepared to counsel patients about preventive and psychosocial issues. Significant differences exist among specialties, even after adjusting for differences in time spent in ambulatory settings. Increasing residency time in ambulatory settings may not alone be sufficient to ensure that residents emerge with adequate counseling skills