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1.
Am J Obstet Gynecol ; 222(4): 348.e1-348.e9, 2020 04.
Article in English | MEDLINE | ID: mdl-31629727

ABSTRACT

BACKGROUND: Several states require that abortions be provided in ambulatory surgery centers. Supporters of such laws argue that they make abortions safer, yet previous studies have found no differences in abortion-related morbidities or adverse events for abortions performed in ambulatory surgery centers versus office-based settings. However, little is known about how costs of abortions provided in ambulatory surgery centers differ from those provided in office-based settings. OBJECTIVE: To compare healthcare expenditures for abortions performed in ambulatory surgery centers versus office-based settings using a large national private insurance claims database. MATERIALS AND METHODS: A retrospective cohort study compared expenditures for abortions performed in ambulatory surgery centers versus office-based settings. Data on women who had abortions in an ambulatory surgery center or office-based setting between January 1, 2011, and December 31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database. The sample was limited to women who were continuously enrolled in their insurance plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare expenditures were assessed separately for the index abortion and the 6-week period after the abortion. Costs were measured from the perspective of the healthcare system and included all payments to the provider, including insurance company payments and any patient out-of-pocket payments. RESULTS: Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication, and 26% second-trimester or later abortions. Most abortions (89%) were provided in office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted mean index abortion costs were higher in ambulatory surgery centers than in office-based settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs of index abortions were $772 higher (95% confidence interval, $746-$797), total follow-up costs for abortions that had any follow-up care were $1099 higher (95% confidence interval, $1004-$1,195), and total follow-up costs for abortions that had an abortion-related morbidity or adverse event were not significantly different in ambulatory surgery centers compared to office-based settings. There were also no significant differences in the likelihood of having any follow-up care or abortion-related event follow-up care. CONCLUSION: Abortions performed at ambulatory surgery centers are significantly more costly than those performed in office-based settings, with no difference in the likelihood of receiving follow-up care. Laws requiring that abortions be provided in ambulatory surgery centers may only result in increased costs for abortions, with no effect on abortion safety.


Subject(s)
Abortion, Induced/economics , Ambulatory Surgical Procedures/economics , Health Care Costs/statistics & numerical data , Physicians' Offices/economics , Surgicenters/economics , Abortion, Induced/adverse effects , Abortion, Induced/statistics & numerical data , Administrative Claims, Healthcare/statistics & numerical data , Adult , Ambulatory Surgical Procedures/statistics & numerical data , Databases, Factual , Female , Health Expenditures/statistics & numerical data , Humans , Insurance, Health, Reimbursement/statistics & numerical data , Physicians' Offices/statistics & numerical data , Postoperative Complications/economics , Pregnancy , Pregnancy Trimester, First , Pregnancy Trimester, Second , Retrospective Studies , Surgicenters/statistics & numerical data , Young Adult
2.
Am J Public Health ; 108(4): 486-492, 2018 04.
Article in English | MEDLINE | ID: mdl-29470114

ABSTRACT

OBJECTIVES: To compare the prevalence and characteristics of facility laws governing abortion provision specifically (targeted regulation of abortion providers [TRAP] laws); office-based surgeries, procedures, sedation or anesthesia (office interventions) generally (OBS laws); and other procedures specifically. METHODS: We conducted cross-sectional legal assessments of state facility laws for office interventions in effect as of August 1, 2016. We coded characteristics for each law and compared characteristics across categories of laws. RESULTS: TRAP laws (n = 55; in 34 states) were more prevalent than OBS laws (n = 25; in 25 states) or laws targeting other procedures (n = 1; in 1 state). TRAP laws often regulated facilities that would not be regulated under OBS laws (e.g., all TRAP laws, but only 2 OBS laws, applied regardless of sedation or anesthesia used). TRAP laws imposed more numerous and more stringent requirements than OBS laws. CONCLUSIONS: Many states regulate abortion-providing facilities differently, and more stringently, than facilities providing other office interventions. The Supreme Court's 2016 decision in Whole Woman's Health v Hellerstedt casts doubt on the legitimacy of that differential treatment.


Subject(s)
Ambulatory Care Facilities/legislation & jurisprudence , State Government , Abortion, Legal/legislation & jurisprudence , Ambulatory Care Facilities/standards , Government Regulation , Humans , United States
3.
Am J Perinatol ; 33(9): 873-81, 2016 07.
Article in English | MEDLINE | ID: mdl-27031054

ABSTRACT

Objective The aim of the study is to evaluate clinical interventions to significantly reduce maternal mortality from prolonged labor, obstructed labor, and prolonged obstructed labor (PL/OL/POL) in sub-Saharan Africa (SSA). Methods A mathematical model-Maternal and Neonatal Directed Assessment of Technology ("MANDATE")-was created for SSA with estimated prevalence for PL/OL/POL and case fatality rates from hemorrhage, infection, and uterine rupture. Based on a literature review and expert opinion, the model was populated with estimated likelihoods of the current healthcare system ability to diagnose, transfer, and treat women with these conditions. Impact on maternal mortality of improved diagnosis, transfer, and delivery to relieve PL/OL/POL was assessed. Results Without current technologies, the model estimated 8,464 maternal deaths annually in SSA from these conditions. Imputing current diagnosis, transfer, and treatment of PL/OL/POL, an estimated 7,033 maternal deaths occur annually from these complications. With improved PL/OL/POL diagnosis and improved transfer, 1,700 and 740 lives could be saved, respectively. Improved diagnosis, transfer, and treatment for PL/OL/POL reduce the mortality rate to 864 maternal deaths annually, saving 6,169 lives. If improved transfusion and antibiotic use were added, only 507 women per year would die from PL/OL/POL in SSA. Conclusion In SSA, increasing diagnostics, transfer to higher care, and operative delivery could substantially reduce maternal mortality from PL/OL/POL. Synopsis A computerized model of obstructed labor in SSA was created to explore the interventions necessary to reduce maternal mortality from this condition.


Subject(s)
Maternal Health Services , Maternal Mortality , Obstetric Labor Complications/mortality , Africa South of the Sahara/epidemiology , Developing Countries , Female , Humans , Models, Theoretical , Pregnancy
4.
Bioresour Technol ; 192: 461-70, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26080103

ABSTRACT

Seasonal foaming in full-scale egg-shaped digesters (ESD) at the Oceanside Water Pollution Control Plant was investigated over a two-year period. The causes and contributors of anaerobic digestion (AD) foaming, namely, Gordonia amarae filaments and mixing effects were evaluated in these ESDs. The seasonal presence of high levels of G. amarae as a primary cause and excessive induced mixing as an important contributor of AD foaming has been established. The induced mixing frequency in the ESDs was gradually reduced and eventually shut off in a series of controlled experimental phases. Total solids and temperature profiles indicated that reducing mixing frequency did not significantly impact digester performance or disrupt the homogeneity of digester contents, although it did reduce the occurrence of foam in the digesters. Excessive induced mixing, a contributor to foaming, increased foam events at G. amarae thresholds above 10(6)intersections/mg VSS in the mixed liquor.


Subject(s)
Bioreactors , Waste Disposal, Fluid/instrumentation , Anaerobiosis , Bioreactors/microbiology , Equipment Design , Gordonia Bacterium/genetics , In Situ Hybridization, Fluorescence , Sewage , Surface Properties , Temperature , Waste Disposal, Fluid/methods
5.
Matern Child Health J ; 19(8): 1853-63, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25656720

ABSTRACT

To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.


Subject(s)
Asphyxia Neonatorum/prevention & control , Obstetric Labor Complications/prevention & control , Perinatal Care/methods , Perinatal Mortality , Asphyxia Neonatorum/therapy , Female , Humans , Infant, Newborn , Obstetric Labor Complications/mortality , Perinatal Care/organization & administration , Perinatal Care/standards , Pregnancy
6.
Am J Perinatol ; 32(5): 469-74, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25289705

ABSTRACT

OBJECTIVE: Postpartum hemorrhage (PPH) is a major cause of maternal mortality, with almost 300,000 cases and ~72,000 PPH deaths annually in sub-Saharan Africa. Novel prevention methods practical in community settings are required. Tranexamic acid, a drug to reduce bleeding during surgical cases including postpartum bleeding, is potentially suitable for community settings. Thus, we sought to determine the impact of tranexamic acid on PPH-related maternal mortality in sub-Saharan Africa. STUDY DESIGN: We created a mathematical model to determine the impact of interventions on PPH-related maternal mortality. The model was populated with baseline birth rates and mortality estimates based on a review of current interventions for PPH in sub-Saharan Africa. Based on a systematic review of literature on tranexamic acid, we assumed 30% efficacy of tranexamic acid to reduce PPH; the model assessed prophylactic and treatment tranexamic acid use, for deliveries at homes, clinics, and hospitals. RESULTS: With tranexamic acid only in the hospitals, less than 2% of the PPH mortality would be reduced. However, if tranexamic acid were available in the home and clinic settings for PPH prophylaxis and treatment, a nearly 30% reduction (nearly 22,000 deaths per year) in PPH mortality is possible. CONCLUSION: These analyses point to the importance of preventive and treatment interventions compatible with home and clinic use, especially for sub-Saharan Africa, where the majority of births occur at home or community health clinics. Given its feasibility to be given in the home, tranexamic acid has potential to save many lives.


Subject(s)
Antifibrinolytic Agents/therapeutic use , Maternal Mortality , Models, Theoretical , Postpartum Hemorrhage/mortality , Postpartum Hemorrhage/prevention & control , Tranexamic Acid/therapeutic use , Africa South of the Sahara , Birth Rate , Community Health Centers , Developing Countries , Female , Humans , Pregnancy
7.
Acta Obstet Gynecol Scand ; 94(2): 148-55, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25353716

ABSTRACT

OBJECTIVE: Preeclampsia/eclampsia (PE/E) remains a major cause of maternal death in low-income countries. We evaluated interventions to reduce PE/E-related maternal mortality in sub-Saharan Africa. DESIGN: Mathematical model to assess impact of interventions on PE/E-related maternal morbidity and mortality. SETTING: Sub-Saharan Africa countries. POPULATION: Pregnant women in sub-Saharan Africa in 2012. METHODS: A systematic literature review populated a decision-tree mathematical model with interventions to diagnose, prevent, and treat women with PE/E. The impact of increased use of interventions [diagnostics, transfer to a hospital, magnesium sulfate (MgSO4 ) use, cesarean section/labor induction] on PE/E-related maternal mortality was analyzed. MAIN OUTCOME MEASURES: Prevalence of PE/E and PE/E-associated maternal mortality rates in sub-Saharan Africa. RESULTS: Without interventions, an estimated 20 570 PE/E-associated deaths would have occurred in sub-Saharan Africa in 2012. With current low rates of diagnosis, MgSO4 use, transfers and cesarean section/induction rates, about 17 520 maternal deaths were associated with PE/E in 2012. Higher use of MgSO4 would have prevented about 610 deaths. With high diagnostic levels, MgSO4 use, transfer and cesarean section/induction, mortality was reduced to 3750 annual deaths, saving about 13 770 maternal lives. If all MgSO4 use was removed from the model, 4060 maternal deaths would occur, increasing maternal deaths by only 310. CONCLUSIONS: In sub-Saharan Africa, our model suggests that increasing use of PE/E diagnostics, transfer to higher levels of care and increased hospitalization with cesarean section/induction of labor would substantially reduce maternal mortality from PE/E. Increasing use of MgSO4 would have a smaller impact on maternal mortality.


Subject(s)
Eclampsia/mortality , Maternal Mortality , Pre-Eclampsia/mortality , Adult , Africa South of the Sahara/epidemiology , Anticonvulsants/therapeutic use , Cesarean Section/statistics & numerical data , Developing Countries , Female , Humans , Labor, Induced/statistics & numerical data , Magnesium Sulfate/therapeutic use , Pregnancy
8.
Int J Gynaecol Obstet ; 121(1): 5-9, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23313144

ABSTRACT

OBJECTIVE: To create a comprehensive model of the comparative impact of various interventions on maternal, fetal, and neonatal (MFN) mortality. METHODS: The major conditions and sub-conditions contributing to MFN mortality in low-resource areas were identified, and the prevalence and case fatality rates documented. Available interventions were mapped to these conditions, and intervention coverage and efficacy were identified. Finally, a computer model developed by the Maternal and Neonatal Directed Assessment of Technology (MANDATE) initiative estimated the potential of current and new interventions to reduce mortality. RESULTS: For PPH, the sub-causes, prevalence, and MFN case fatality rates were calculated. Available interventions were mapped to these sub-causes. Most available interventions did not prevent or treat the overall condition of PPH, but rather sub-conditions associated with hemorrhage and thus prevented only a fraction of the associated deaths. CONCLUSION: The majority of current interventions address sub-conditions that cause death, rather than the overall condition; thus, the potential number of lives saved is likely to be overestimated. Additionally, the location at which mother and infant receive care affects intervention effectiveness and, therefore, the potential to save lives. A comprehensive view of MFN conditions is needed to understand the impact of any potential intervention.


Subject(s)
Computer Simulation , Models, Theoretical , Postpartum Hemorrhage/prevention & control , Technology Assessment, Biomedical/methods , Developing Countries , Female , Fetal Mortality , Humans , Infant Mortality , Infant, Newborn , Maternal Mortality , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/etiology , Pregnancy , Prevalence
9.
Prog Community Health Partnersh ; 6(3): 339-48, 2012.
Article in English | MEDLINE | ID: mdl-22982847

ABSTRACT

THE PROBLEM: A disconnect exists between research resources and the health and health care needs of people those resources are designed to serve. While a great deal of research is being produced at academic institutions across the country, the topics investigated are often driven by researchers' interests or by funding announcements focused on specific research areas of interest to the funder. PURPOSE OF THE ARTICLE: The purpose of this article is to describe a process that connects community identified health priorities with research funds as well as capacity building efforts. KEY POINTS: The North Carolina Translational and Clinical Sciences Institute (NC TraCS) developed a process to identify the health priorities of North Carolina communities through a partnership with the network of county Healthy Carolinians partnerships. The priorities identified were obesity, youth issues, healthcare delivery/access, mental health/ substance abuse, specific chronic diseases, cancer/tobacco, and injury/ violence. NC TraCS then used these research priorities to guide pilot funding and facilitate research capacity building. CONCLUSIONS: Tapping into an established community-based network and linking researchers to community-identified priorities ensures that NC TraCS addresses the most pressing health needs of North Carolina's residents.


Subject(s)
Community-Based Participatory Research/organization & administration , Community-Institutional Relations , Health Priorities/organization & administration , Translational Research, Biomedical/organization & administration , Capacity Building , Community Networks , Health Services Research/organization & administration , Humans
10.
J Empir Res Hum Res Ethics ; 7(2): 3-19, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22565579

ABSTRACT

Community engagement is increasingly becoming an integral part of research. "Community-engaged research" (CEnR) introduces new stakeholders as well as unique challenges to the protection of participants and the integrity of the research process. We--a group of representatives of CTSA-funded institutions and others who share expertise in research ethics and CEnR--have identified gaps in the literature regarding (1) ethical issues unique to CEnR; (2) the particular instructional needs of academic investigators, community research partners, and IRB members; and (3) best practices for teaching research ethics. This paper presents what we know, as well as what we still need to learn, in order to develop quality research ethics educational materials tailored to the full range of stakeholder groups in CEnR.


Subject(s)
Community Participation , Ethics, Research/education , Research Design , Residence Characteristics , Benchmarking , Ethics Committees, Research , Humans , Research Personnel/education
11.
Med Educ ; 44(6): 570-6, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20604853

ABSTRACT

OBJECTIVES Three domains comprise the field of human assessment: ability, motive and personality. Differences in personality and cognitive abilities between generations have been documented, but differences in motive between generations have not been explored. This study explored generational differences in medical students regarding motives using the Thematic Apperception Test (TAT). METHODS Four hundred and twenty six students (97% response rate) at one medical school (Generation X = 229, Millennials = 197) who matriculated in 1995 & 1996 (Generation X) or in 2003 & 2004 (Millennials) wrote a story after being shown two TAT picture cards. Student stories for each TAT card were scored for different aspects of motives: Achievement, Affiliation, and Power. RESULTS A multiple analysis of variance (p < 0.05) showed significant differences between Millennials' and Generation X-ers' needs for Power on both TAT cards and needs for Achievement and Affiliation on one TAT card. The main effect for gender was significant for both TAT cards regarding Achievement. No main effect for ethnicity was noted. CONCLUSIONS Differences in needs for Achievement, Affiliation and Power exist between Millennial and Generation X medical students. Generation X-ers scored higher on the motive of Power, whereas Millennials scored higher on the motives of Achievement and Affiliation.


Subject(s)
Motivation , Students, Medical/psychology , Thematic Apperception Test , Achievement , Age Factors , Cohort Effect , Female , Humans , Male , Multivariate Analysis , Personality Assessment , Power, Psychological , Students, Medical/classification
12.
Med Teach ; 31(12): 1086-8, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19995172

ABSTRACT

BACKGROUND: Given changing trends in specialty choices among medical students coupled with continued challenges associated with medical specialty decision-making, it is important for medical educators to understand how students make decisions about their medical career. Medical educators should be aware of how medical school-based experiences and interactions such as faculty, courses, and services impact students' specialty choices and decisions. AIM: The study determined if differences in influences on specialty decision-making exist for students entering person-oriented specialties versus technique-oriented specialties. METHODS: Three hundred and fifty-six fourth-year medical students completed a questionnaire about how the faculty, curriculum, student services, mentoring and professional development programs, lifestyle considerations, family/friends, and other factors influenced their choice of specialty. RESULTS: Chi-square analyses indicated that students pursuing person-oriented specialties compared to technique-oriented specialties were moderately more likely to be influenced by their personal physician, by school faculty, and by medical school activities; slightly more likely to be influenced by medical school offices and services; and slightly less likely to be influenced by income expectations. CONCLUSIONS: Students interested in person-oriented specialties versus technique-oriented specialties indicate differences in what influences their specialty choice. This study may be helpful to medical educators and advisors who work with students on specialty decision-making.


Subject(s)
Career Choice , Education, Medical, Undergraduate/methods , Specialization/trends , Students, Medical/psychology , Chi-Square Distribution , Decision Making , Female , Humans , Male , Midwestern United States , Surveys and Questionnaires
13.
Am J Public Health ; 99(4): 623-30, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19197087

ABSTRACT

Many women need access to abortion care in the second trimester. Most of this care is provided by a small number of specialty clinics, which are increasingly targeted by regulations including bans on so-called partial birth abortion and requirements that the clinic qualify as an ambulatory surgical center. These regulations cause physicians to change their clinical practices or reduce the maximum gestational age at which they perform abortions to avoid legal risks. Ambulatory surgical center requirements significantly increase abortion costs and reduce the availability of abortion services despite the lack of any evidence that using those facilities positively affects health outcomes. Both types of laws threaten to further reduce access to and quality of second-trimester abortion care.


Subject(s)
Abortion, Induced/legislation & jurisprudence , Abortion, Legal , Attitude to Health , Health Services Accessibility/legislation & jurisprudence , Pregnancy Trimester, Second , Abortion, Induced/economics , Ambulatory Care Facilities , Female , Health Services Accessibility/economics , Humans , Mississippi , Organizational Case Studies , Pregnancy , Supreme Court Decisions , United States , Voluntary Health Agencies
14.
Med Educ Online ; 14: 4, 2009 Feb 19.
Article in English | MEDLINE | ID: mdl-20165518

ABSTRACT

BACKGROUND: Students' selection of a specialty is an important decision in their career as a physician. While distinguishing primary care physicians from non-primary care specialists has served a purpose for how medicine is practiced and managed, considering alternative ways of grouping specialties is appropriate when exploring specialty decisions. PURPOSE: This study explored how early specialty preferences correspond to eventual specialty choice using the person-oriented versus technique-oriented taxonomy. METHOD: Participants were 349 students who completed a career plan survey during the first semester of medical school and later graduated. RESULTS: Chi-square analysis showed a statistically significant difference between students' early preference for a person-oriented or technique-oriented specialty and the specialty they chose for their residency. CONCLUSION: Students with an early preference for person-oriented specialties were more likely to choose a person-oriented specialty, whereas students with an early preference for technique-oriented specialties were less likely to enter a technique-oriented specialty.


Subject(s)
Career Choice , Internship and Residency , Specialization , Students, Medical/psychology , Chi-Square Distribution , Decision Making , Female , Humans , Male , Medical Laboratory Science , Sex Factors
15.
Int Immunopharmacol ; 8(8): 1112-8, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18550015

ABSTRACT

Aldehyde modified proteins have been associated with the development and/or progression of alcoholic liver disease (ALD). These protein adducts are capable of initiating many immunological responses that are harmful to the normal homeostasis of organism function. Previous studies have shown that malondialdehyde (MDA) and acetaldehyde (AA) synergistically form a unique adduct (MAA) with soluble proteins, which are capable of inducing cytokine release, T-cell proliferation, and antibody production. The purpose of this study was to determine whether MAA adduction can elicit similar responses to cells using a well-defined tumor model. The mouse mastocytoma P815 tumor cell line was modified with MAA (P815-MAA) or left unmodified (P815) and 10(6) irradiated cells were injected into DBA/2 mice once a week for 5 weeks. Serum was collected and tested for antibody responses to P815 cells and the MAA epitope. Immunization of MAA adducted P815 cells into syngeneic DBA/2 mice induced a strong antibody response to the MAA epitope as determined by ELISA on Alb and MAA-Alb (508 microg/ml and 1092 microg/ml, respectively). In addition, antibody to unmodified P815 cells was detected by fluorescent technique. Mice immunized with P815 cells or PBS showed little or no reactivity to the MAA epitope or P815 cells. Studies to assess IL-12 stimulation showed that peritoneal macrophages from P815 and PBS immunized animals produced modest amounts of IL-12 (20 and 35 pg/ml) when stimulated with Alb or MAA-Alb. However, macrophage from P815-MAA immunized mice responded to soluble MAA adduct (142 pg/ml). Finally, in tumor survival studies the mean survival was 14.25 days in PBS treated mice; 15.75 days with P815 immunized mice and 18.25 days with P815-MAA immunized mice. Therefore, these data strongly suggest that antibody responses are induced by P815 cells modified with MAA adducts. This may be a possible tool to begin looking at how alcohol metabolites potentially modify cells and/or cellular components making them recognizable to the immune system as foreign. It is thought that these studies define a model system that will be useful in assessing antibody and potentially T-cell responses to cells that are modified by MAA.


Subject(s)
Acetaldehyde/metabolism , Antibodies, Neoplasm/blood , Interleukin-12/metabolism , Macrophages, Peritoneal/immunology , Malondialdehyde/metabolism , Mastocytoma/immunology , Acetaldehyde/immunology , Animals , Antibodies, Neoplasm/immunology , Cell Line, Tumor , Immunization , Interleukin-12/immunology , Macrophages, Peritoneal/metabolism , Malondialdehyde/immunology , Mastocytoma/metabolism , Mastocytoma/mortality , Mice , Mice, Inbred DBA , Neoplasm Transplantation
16.
Water Environ Res ; 78(9): 920-9, 2006 Sep.
Article in English | MEDLINE | ID: mdl-17120452

ABSTRACT

Solids retention time (SRT), biological scum trapping and recycle, and the dynamic equilibrium between Nocardioform populations in the foam and the mixed liquor are the controlling factors in activated sludge foaming events caused by Nocardioform bacteria. For the operating modes described in this paper, a cured mixed liquor foaming condition (filament counts of approximately 10(5) intersections/g volatile suspended solids) was only achieved when SRT control, selective wasting, and polymer addition were in effect. Solids retention time control, with the SRT remaining below 1.5 days, and selective wasting will cure a severely foaming mixed liquor, but effects will only be observed after 3 or 4 months after implementation. The combined wastage of Nocardioform bacteria from selective wasting and SRT control can ensure long-term foam control to the operation of a pure-oxygen activated sludge system with foam-trapping features. An SRT of 0.3 days will result in the complete washout of Nocardioform bacteria from the activated sludge system, which can then operate at an SRT of 3 days free of Nocardioform. Polymer addition to mixed liquor is only effective for foam control when a large portion of the system biomass exists as a heavy layer of foam above the mixed liquor.


Subject(s)
Bacteria, Aerobic/metabolism , Gram-Positive Bacteria/metabolism , Refuse Disposal/methods , Sewage/microbiology , Oxygen , Polymers/chemistry
17.
Acad Med ; 81(6): 571-6, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16728812

ABSTRACT

PURPOSE: Two main generational cohorts comprising students enrolled in medical schools today are Generation Xers (born 1965-1980) and Millennial students (born 1981-1999). A subset is Cuspars (born 1975-1980), who share traits with both generations. Population theorists ascribe different personal characteristics, attitudes, and preferences to each group. The authors examined whether selected characteristics describing Generation X and Millennial students were quantifiable using a personality measure. Differences among Generation X, Millennial, and Cuspar medical students were investigated. METHOD: Eight hundred and nine medical students (399 females and 410 males) who matriculated between 1989-94 and 2001-04 at the Northeastern Ohio Universities College of Medicine completed the 16 Personality Factor Questionnaire (16PF). Differences in responses to the 16PF among the three generations were analyzed using multivariate analysis of variance (MANOVA). RESULTS: Analyses showed significant differences for Generation X versus Millennial students on 10 of the 16 personality factors. Millennial students scored significantly higher than Generation X students on factors including Rule-Consciousness, Emotional Stability, and Perfectionism; Generation X students scored higher than Millennials on Self-Reliance. Millennials also were significantly different from Generation Xers on several other factors. Significant differences were noted among Cuspars, Generation Xers, and Millennials. CONCLUSIONS: The 16PF is a useful tool to examine differences among these groups and to help understand the factors that constitute their personalities. Given differences among the generational groups, the authors forecast possible educational implications for medical school academic affairs and student services, and suggest areas for future research.


Subject(s)
Personality , Students, Medical/classification , Adolescent , Adult , Cohort Effect , Female , Humans , Male , Multivariate Analysis , Ohio , Students, Medical/psychology , Students, Medical/statistics & numerical data , Surveys and Questionnaires
19.
Nurs Forum ; 40(1): 38-40, 2005.
Article in English | MEDLINE | ID: mdl-15839843
20.
Teach Learn Med ; 16(3): 226-32, 2004.
Article in English | MEDLINE | ID: mdl-15388376

ABSTRACT

BACKGROUND: Like all medical schools, Northeastern Ohio Universities College of Medicine (NEOUCOM) has an elaborate committee system for academic review and promotions (ARP). Little research exists locally or nationally on this system. PURPOSE: E-mail invitations to all 420 NEOUCOM currently enrolled students were sent seeking their participation in a qualitative study that involved interviewing students who had appeared before an ARP committee at any time for any reason to understand how they experienced the process. METHOD: NUD*IST software was used to analyze the data generated by the interviews. RESULTS: The invitation drew 19 volunteers from the pool of 84 students who, at the time of the messages, had appeared before an ARP committee at least once. Themes were discovered surrounding students' perceptions of the committee's purpose, their experience of it, their beliefs about students' honesty when appearing before the committee, how they felt about themselves after a committee appearance, and how they would improve the process of academic review.


Subject(s)
Attitude , Education, Medical, Undergraduate/standards , Peer Review/methods , Professional Staff Committees/standards , Schools, Medical/organization & administration , Students, Medical/psychology , Adult , Anecdotes as Topic , Humans , Interprofessional Relations , Interviews as Topic , Ohio , Qualitative Research , Surveys and Questionnaires
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