bluuebunny/crossref_metadata_2025 huggingface dataset:
The Predictive Value of Self-Report Questions in a Clinical Decision Rule for Pediatric Lead Poisoning Screening
Authors: Kaplowitz Stan A. , Perlstadt Harry , D'Onofrio Gail , Melnick Edward R. , Baum Carl R. , Kirrane Barbara M. , Post Lori A.
Published: July 2017

Objective.

We derived a clinical decision rule for determining which young children need testing for lead poisoning. We developed an equation that combines lead exposure self-report questions with the child's census-block housing and socioeconomic characteristics, personal demographic characteristics, and Medicaid status. This equation better predicts elevated blood lead level (EBLL) than one using ZIP code and Medicaid status.

Methods.

A survey regarding potential lead exposure was administered from October 2001 to January 2003 to Michigan parents at pediatric clinics ( n=3,396). These self-report survey data were linked to a statewide clinical registry of blood lead level (BLL) tests. Sensitivity and specificity were calculated and then used to estimate the cost-effectiveness of the equation.

Results.

The census-block group prediction equation explained 18.1% of the variance in BLLs. Replacing block group characteristics with the self-report questions and dichotomized ZIP code risk explained only 12.6% of the variance. Adding three self-report questions to the census-block group model increased the variance explained to 19.9% and increased specificity with no loss in sensitivity in detecting EBLLs of ≥10 micrograms per deciliter.

Conclusions.

Relying solely on self-reports of lead exposure predicted BLL less effectively than the block group model. However, adding three of 13 self-report questions to our clinical decision rule significantly improved prediction of which children require a BLL test. Using the equation as the clinical decision rule would annually eliminate more than 7,200 unnecessary tests in Michigan and save more than $220,000.
Implementing a Novel Citywide Rapid HIV Testing Campaign in Washington, D.C.: Findings and Lessons Learned
Authors: Castel Amanda D. , Magnus Manya , Peterson James , Anand Karishma , Wu Charles , Martin Marsha , Sansone Marie , Rocha Nestor , Jolaosho Titilola , West Tiffany , Hader Shannon , Greenberg Alan E.
Published: July 2017

Objectives.

In June 2006, the District of Columbia (DC) Department of Health launched a citywide rapid HIV screening campaign. Goals included raising HIV awareness, routinizing rapid HIV screening, identifying previously unrecognized infections, and linking positives to care. We describe findings from this seminal campaign and identify lessons learned.

Methods.

We applied a mixed-methods approach using quantitative analysis of client data forms (CDFs) and qualitative evaluation of focus groups with DC residents. We measured characteristics and factors associated with client demographics, test results, and community perceptions regarding the campaign.

Results.

Data were available on 38,586 participants tested from July 2006 to September 2007. Of those, 68% had previously tested for HIV (44% within the last 12 months) and 23% would not have sought testing had it not been offered. Overall, 662 (1.7%) participants screened positive on the OraQuick® Advance™ rapid HIV test, with non-Hispanic black people, transgenders, and first-time testers being significantly more likely to screen positive for HIV than white people, males, and those tested within the last year, respectively. Of those screening positive for HIV, 47% had documented referrals for HIV care and treatment services. Focus groups reported continued stigma regarding HIV and minimal community saturation of the campaign.

Conclusions.

This widespread campaign tested thousands of people and identified hundreds of HIV-infected individuals; however, referrals to care were lower than anticipated, and awareness of the campaign was limited. Lessons learned through this scale-up of population-based HIV screening resulted in establishing citywide HIV testing processes that laid the foundation for the implementation of test-and-treat activities in DC.
Provision of Test Results and Posttest Counseling at STD Clinics in 24 Health Departments: U.S., 2007
Authors: Begley Elin , VanHandel Michelle
Published: July 2017

Objective.

We determined the demographic and HIV test characteristics of tests conducted in CDC-funded sexually transmitted disease (STD) clinics with provision of test results and posttest counseling.

Methods.

We used CDC's HIV Counseling and Testing System data from 2007 for the 24 U.S. health departments that reported test-level data from STD clinics. We calculated and analyzed newly identified HIV positivity and the percentage of tests with provision of test results and posttest counseling (provision of posttest counseling), by demographic and HIV-related characteristics.

Results.

Of 372,757 tests conducted among people without a previous HIV diagnosis by self-report, provision of posttest counseling was documented for 191,582 (51.4%) HIV tests overall and 1,922 (71.2%) newly identified HIV-positive test results. At these STD clinics, provision of posttest counseling varied by HIV serostatus, age, race/ethnicity, test type, and risk category; however, documentation of posttest counseling was missing for more than 20% of tests. The newly identified HIV positivity among all testers was 0.7%.

Conclusions.

One of the main goals of HIV counseling and testing is to inform people of their HIV status, because knowledge of one's HIV-positive serostatus can result in a reduction in risk behaviors and allow the person to access HIV medical care and treatment. STD clinics offering HIV testing may need to further their emphasis on increasing the proportion of clients who are provided posttest counseling and on improving documentation of this information.
Correlates of Unmet Dental Care Need among HIV-Positive People
Authors: Jeanty Yves , Cardenas Gabriel , Fox Jane E. , Pereyra Margaret , Diaz Chanelle , Bednarsh Helene , Reznik David A. , Abel Stephen N. , Bachman Sara S. , Metsch Lisa R.
Published: July 2017

Objectives.

We analyzed the characteristics of people living with HIV/AIDS (PLWHA) who reported unmet oral health needs since testing positive and compared those characteristics with people reporting no unmet health needs. We also identified barriers to accessing oral health care for PLWHA.

Methods.

We collected data from 2,469 HIV-positive patients who had not received oral health care in the previous 12 months and who had accessed care at Health Resources and Service Administration-funded Special Projects of National Significance Innovations in Oral Health Care Initiative demonstration sites. The outcome of interest was prior unmet oral health needs. We explore barriers to receiving oral health care, including cost, access, logistics, and personal factors. Bivariate tests of significance and generalized estimating equations were used in analyses.

Results.

Nearly half of the study participants reported unmet dental care needs since their HIV diagnosis. People reporting unmet needs were more likely to be non-Hispanic white, U.S.-born, and HIV-positive for more than one year, and to have ever used crack cocaine or crystal methamphetamine. The top three reported barriers to oral care were cost, access to dental care, and fear of dental care. Additional reported barriers were indifference to dental care and logistical issues.

Conclusion.

Innovative strategies are needed to increase access to and retention in oral health care for PLWHA. Key areas for action include developing strategies to reduce costs, increase access, and reduce personal barriers to receiving dental care, particularly considering the impact of poor oral health in this population.
Retention of People Living with HIV/AIDS in Oral Health Care
Authors: Tobias Carol R. , Fox Jane E. , Walter Angela W. , Lemay Celeste A. , Abel Stephen N.
Published: July 2017

Objective.

We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes.

Methods.

We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care.

Results.

In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums.

Conclusions.

Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term.
Access to Oral Health Care and Self-Reported Health Status among Low-Income Adults Living with HIV/AIDS
Authors: Bachman Sara S. , Walter Angela W. , Umez-Eronini Amarachi
Published: July 2017

Objective.

We identified factors associated with improved self-reported health status in a sample of people living with HIV/AIDS (PLWHA) following enrollment in oral health care.

Methods.

Data were collected from 1,499 enrollees in the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative. Data were gathered from 2007–2010 through in-person interviews at 14 sites; self-reported health status was measured using the SF-8™ Health Survey's physical and mental health summary scores. Utilization records of oral health-care services provided to enrollees were also obtained. Data were analyzed using general estimating equation linear regression.

Results.

Between baseline and follow-up, we found that physical health status improved marginally while mental health status improved to a greater degree. For change in physical health status, a decrease in oral health problems and lack of health insurance were significantly associated with improved health status. Improved mental health status was associated with a decrease in oral health problems at the last available visit and no pain or distress in one's teeth or gums at the last available visit.

Conclusion.

For low-income PLWHA, engagement in a program to increase access to oral health care was associated with improvement in overall well-being as measured by change in the SF-8 Health Survey. These results contribute to the knowledge base about using the SF-8 to assess the impact of clinical interventions. For public health practitioners working with PLWHA, findings suggest that access to oral health care can help promote well-being for this vulnerable population.
Patient Perspectives on Improving Oral Health-Care Practices among People Living with HIV/AIDS
Authors: Rajabiun Serena , Fox Jane E. , McCluskey Amanda , Guevara Ernesto , Verdecias Niko , Jeanty Yves , Demayo Michael , Mofidi Mahyar
Published: July 2017

This qualitative study explored the impact on oral health-care knowledge, attitudes, and practices among 39 people living with HIV/AIDS (PLWHA) participating in a national initiative aimed at increasing access to oral health care. Personal values and childhood dental experiences, beliefs about the importance of oral health in relation to HIV health, and concerns for appearance and self-esteem were found to be determinants of oral health knowledge and practice. Program participation resulted in better hygiene practices, improved self-esteem and appearance, relief of pain, and better physical and emotional health. In-depth exploration of the causes for these changes revealed a desire to continue with dental care due to the dental staff and environmental setting, and a desire to maintain overall HIV health, including oral health. Our findings emphasize the importance of addressing both personal values and contextual factors in providing oral health-care services to PLWHA.
Physical Activity Patterns among U.S. Adults with and without Serious Psychological Distress
Authors: Okoro Catherine A. , Stoodt Georjean , Rohrer James E. , Strine Tara W. , Li Chaoyang , Balluz Lina S.
Published: July 2017

Objective.

A physically active lifestyle is recommended for overall health— both physical and mental. Serious psychological distress (SPD) is associated with adverse health behaviors. We compared patterns of physical activity (PA) among adults with and without SPD using current public health guidelines for PA and examined whether adults with SPD were physically active at recommended levels.

Methods.

We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to assess SPD using the Kessler 6 (K6) scale of nonspecific psychological distress and PA categories based on the 2008 U.S. Department of Health and Human Services guidelines. Complete data were available for 78,886 adults in 16 states that used an optional BRFSS mental illness and stigma module containing the K6 scale. We performed multiple logistic regression analyses to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results.

The unadjusted prevalence of SPD was 3.9% (95% CI 3.6, 4.2), and the age-adjusted prevalence of SPD was 3.8% (95% CI 3.5, 4.1). After adjusting for age, sex, race/ethnicity, education, employment, body mass index, smoking status, and heavy drinking, adults with SPD were significantly less likely to be physically active at recommended levels than adults without SPD. PRs were attenuated but remained significant after further adjustment for limitations to PA.

Conclusion.

Adults with SPD are less likely to meet current PA recommendations than adults without SPD, highlighting the need for targeted interventions.
Automated Influenza-like Illness Reporting—An Efficient Adjunct to Traditional Sentinel Surveillance
Authors: Yih W. Katherine , Cocoros Noelle M. , Crockett Molly , Klompas Michael , Kruskal Benjamin A. , Kulldorff Martin , Lazarus Ross , Madoff Lawrence C. , Morrison Monica J. , Smole Sandra , Platt Richard
Published: July 2017

Objectives.

We compared an electronic health record-based influenza-like illness (ILI) surveillance system with manual sentinel surveillance and virologic data to evaluate the utility of the automated system for routine ILI surveillance.

Methods.

We obtained weekly aggregate ILI reports from the Electronic medical record Support for Public Health (ESP) disease-detection and reporting system, which used an automated algorithm to identify ILI visits among a patient population of about 700,000 in Eastern Massachusetts. The percentage of total visits for ILI (“percent ILI”) in ESP, percent ILI in the Massachusetts Department of Public Health's sentinel surveillance system, and percentage of laboratory specimens submitted to participating Massachusetts laboratories that tested positive for influenza were compared for the period October 2007–September 2011. We calculated Spearman's correlation coefficients and compared ESP and sentinel surveillance systems qualitatively, in terms of simplicity, flexibility, data quality, acceptability, timeliness, and usefulness.

Results.

ESP and sentinel surveillance percent ILI always peaked within one week of each other. There was 80% correlation between the two and 71%–73% correlation with laboratory data. Sentinel surveillance percent ILI was higher than ESP percent ILI during influenza seasons. The amplitude of variation in ESP percent ILI was greatest for 5- to 49-year-olds and typically peaked for the 5- to 24-year-old age group before the others.

Conclusions.

The ESP system produces percent ILI data of similar quality to sentinel surveillance and offers the advantages of shifting disease reporting burden from clinicians to information systems, allowing tracking of disease by age group, facilitating efficient surveillance for very large populations, and producing consistent and timely reports.
Validation of Self-Reported Veteran Status among Two Sheltered Homeless Populations
Authors: Metraux Stephen , Stino Magdi , Culhane Dennis P.
Published: July 2017

Objectives.

We assessed the accuracy of self-reported veteran status among sheltered homeless adults to assess the reliability of using self-report to determine the number of veterans in homeless populations and examine whether there are demographic correlates to inaccurate reporting of veteran status.

Methods.

Records on 5,860 sheltered adults from Columbus, Ohio, and 16,346 sheltered adults from New York City (NYC) were matched with U.S. Department of Veterans Affairs (VA) records. We analyzed the agreement between veteran self-reporting and official records using descriptive measures, diagnostic tests, and logistic regression.

Results.

The degree of concordance was moderate. Using VA records rather than self-report data to determine veteran status increased homeless veteran prevalence rates by 27% in Columbus and 39% in NYC. Veterans with discordant veteran status (i.e., false positive or false negative) showed lower levels of services use in the VA (both cities) and in the municipal shelter system (NYC only). Younger veterans and women were at higher risk of not being identified as veterans.

Conclusion.

Administrative records can help to more accurately identify homeless veterans and to connect them to available services and benefits.
Understanding the Burden of Tuberculosis among American Indians/Alaska Natives in the U.S.: A Validation Study
Authors: Podewils Laura Jean , Alexy Emily , Driver Stephani Jean , Cheek James E. , Holman Robert C. , Haberling Dana , Brett Meghan , McCray Eugene , Redd John T.
Published: July 2017

Objective.

We validated cases of active tuberculosis (TB) recorded in the Indian Health Service (IHS) National Patient Information Reporting System (NPIRS) and evaluated the completeness of TB case reporting from IHS facilities to state health departments.

Methods.

We reviewed the medical records of American Indian/Alaska Native (AI/AN) patients at IHS health facilities who were classified as having active TB using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes from 2006 to 2009 for clinical and laboratory evidence of TB disease. Individuals were reclassified as having active TB disease; recent latent TB infection (LTBI); past positive tuberculin skin test (TST) only; or as having no evidence of TB, LTBI, or a past positive TST. We compared validated active TB cases with corresponding state records to determine if they were reported.

Results.

The study included 596 patients with active TB as per ICD-9-CM codes. Based on chart review, 111 (18.6%) had active TB; 156 (26.2%) had LTBI; 104 (17.4%) had a past positive TST; and 221 (37.1%) had no evidence of TB disease, LTBI, or a past positive TST. Of the 111 confirmed cases of active TB, 89 (80.2%) resided in participating states; 81 of 89 (91.2%) were verified as reported TB cases.

Conclusions.

ICD-9-CM codes for active TB disease in the IHS NPIRS do not accurately reflect the burden of TB among AI/ANs. Most confirmed active TB cases in the IHS health system were reported to the state; the national TB surveillance system may accurately represent the burden of TB in the AI/AN population.
What Predicts Dissemination Efforts among Public Health Researchers in the United States?
Authors: Tabak Rachel G. , Stamatakis Katherine A. , Jacobs Julie A. , Brownson Ross C.
Published: July 2017

Objectives.

We identified factors related to dissemination efforts by researchers to non-research audiences to reduce the gap between research generation and uptake in public health practice.

Methods.

We conducted a cross-sectional study of 266 researchers at universities, the National Institutes of Health (NIH), and CDC. We identified scientists using a search of public health journals and lists from government-sponsored research. The scientists completed a 35-item online survey in 2012. Using multivariable logistic regression, we compared self-rated effort to disseminate findings to non-research audiences (excellent/good vs. poor) across predictor variables in three categories: perceptions or reasons to disseminate, perceived expectation by employer/funders, and professional training and experience.

Results.

One-third of researchers rated their dissemination efforts as poor. Many factors were significantly related to whether a researcher rated him/herself as excellent/good, including obligation to disseminate findings (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1, 6.8), dissemination important for their department (OR=2.3, 95% CI 1.2, 4.5), dissemination expected by employer (OR=2.0, 95% CI 1.2, 3.2) or by funder (OR=2.1, 95% CI 1.3, 3.2), previous work in a practice/policy setting (OR=4.4, 95% CI 2.1, 9.3), and university researchers with Prevention Research Center affiliation vs. NIH researchers (OR=4.7, 95% CI 1.4, 15.7) With all variables in the model, dissemination expected by funder (OR=2.0, 95% CI 1.2, 3.1) and previous work in a practice/policy setting (OR=3.5, OR 1.7, 7.1) remained significant.

Conclusions.

These findings support the need for structural changes to the system, including funding agency priorities and participation of researchers in practice- and policy-based experiences, which may enhance efforts to disseminate by researchers.
Estimating the Cost to U.S. Health Departments to Conduct HIV Surveillance
Authors: Shrestha Ram K. , Sansom Stephanie L. , Laffoon Benjamin T. , Farnham Paul G. , Shouse R. Luke , MacMaster Karen , Hall H. Irene
Published: July 2017

Objectives.

HIV case surveillance is a primary source of information for monitoring HIV burden in the United States and guiding the allocation of prevention and treatment funds. While the number of people living with HIV and the need for surveillance data have increased, little is known about the cost of surveillance. We estimated the economic cost to health departments of conducting high-quality HIV case surveillance.

Methods.

We collected primary data on the unit cost and quantity of resources used to operate the HIV case surveillance program in Michigan, where HIV burden (i.e., the number of HIV cases) is moderate to high ( n=14,864 cases). Based on Michigan's data, we projected the expected annual HIV surveillance cost for U.S., state, local, and territorial health departments. We based our cost projection on the variation in the number of new and established cases, area-specific wages, and potential economies of scale.

Results.

We estimated the annual total HIV surveillance cost to the Michigan health department to be $1,286,524 ($87/case), the annual total cost of new cases to be $108,657 ($133/case), and the annual total cost of established cases to be $1,177,867 ($84/case). Our projected median annual HIV surveillance cost per health department ranged from $210,600 in low-HIV burden sites to $1,835,000 in high-HIV burden sites.

Conclusions.

Our analysis shows that a systematic approach to costing HIV surveillance at the health department level is feasible. For HIV surveillance, a substantial portion of total surveillance costs is attributable to maintaining established cases.
Odors from Sewage Sludge and Livestock: Associations with Self-Reported Health
Authors: Wing Steve , Lowman Amy , Keil Alex , Marshall Stephen W.
Published: July 2017

Objectives.

Class B treated sewage sludge (TSS) contains microbes and toxicants and is applied to land in areas where livestock wastes may be present. We evaluated relationships of reports of TSS and livestock odors with acute symptoms and excessive flies.

Methods.

A total of 158 adults living near liquid TSS application sites, 85 living near cake TSS application sites, and 188 living in comparison areas responded to a household survey regarding odors, health, and demographics. We identified symptom groups using factor analysis. We used generalized estimating equations to fit linear models for associations between factor scores and odors, and Poisson models for associations with specific symptoms.

Results.

Most factor scores were similar between exposure groups. Covariate-adjusted z-scores for lower respiratory symptoms were 0.28 (95% confidence interval [CI] −0.10, 0.65) higher among residents who reported moderate to very strong liquid TSS odor than among residents in comparison areas, and 0.28 (95% CI 0.05, 0.50) higher among residents who reported moderate to very strong livestock odor compared with residents reporting no or faint livestock odor. The factor score for dermatologic conditions was higher among residents who reported higher liquid sludge odor (0.27, 95% CI −0.13, 0.68), primarily due to skin rash (prevalence ratio = 2.21, 95% CI 1.13, 4.32). Excessive flies were reported twice as commonly among respondents who reported moderate to very strong TSS odor than among other residents.

Conclusions.

Reported odors from TSS and livestock were associated with some acute symptoms. Health departments should monitor land applications of human and animal wastes and conduct surveillance of health problems reported by neighbors.
Newport, Rhode Island — America's First Resort: Lessons in Sustainable Tourism
Authors: Evans Michael R.
Published: July 2017

Newport, Rhode Island, seems to have learned the basic lessons in sustainable tourism development. The current slogan for the Newport County Convention and Visitors Bureau is “Newport: Americas First Resort.” The purpose of this article was to answer the question: How has Newport been able to position, sustain, and thus manage itself as a fashionable tourism destination for over 300 years? Newport seems to have met its economic development needs without compromising the opportunity of future generations. The article explains how combined community efforts of various Newport civic groups specializing in heritage, cultural, nature, and adventure tourism and special events and festivals have produced a unique, sustainable tourism product.
Serum Albumin and Nutritional Status
Authors: Forse R. Armour , Shizgal Harry M.
Published: July 2017

Serum albumin concentration is frequently used to define nutritional status. To validate this relationship, 161 body composition studies were performed on 102 patients simultaneously with protein electrophoresis. The body cell mass represented by the exchangeable potassium to total body water ratio correlated significantly (p < 0.001) with the serum albumin concentration (r = 0.59) and significantly (p < 0.001) to total protein (r = 0.59). However, in both cases the 95% confidence limits about the regression were wide. In 24 of 54 patients (44%) with a normal nutritional state, as defined by body composition, the serum albumin was abnormal. In 12 of 107 (11.2%) patients with malnutrition, the serum albumin was normal. Patients with more than one study were divided into 3 groups depending on the changes in their nutritional state as defined by their body composition. Serum albumin did not consistently reflect the significant body compositional changes observed. The data indicate that serum albumin is a valid measure of nutritional state for epidemiological surveys. However, due to the low sensitivity and specificity it is a poor parameter for evaluating the individual patient's nutritional state.
Protein Conversion to Glucose: An Evaluation of the Quantitative Aspects
Authors: Wolman Stephen L. , Fields Anthony L. A. , Cheema‐Dhadli Surinder , Halperin Mitchell L.
Published: July 2017

The amount of glucose that can be synthesized from a protein depends on its amino acid (AA) composition. This value is about 60 g from 100 g of liver or muscle protein and is based on a knowledge of the total AA content and the proportion of each AA that can be converted to pyruvate. The maximum quantity of glucose in grams that can be synthesized from administered AA solutions is the sum of the products of the number of moles of each AA times its percent convertible to pyruvate times the molecular weight of that AA.
Perioperative Stabilization of Glucose Levels in Patients Supported with Total Parenteral Nutrition
Authors: Newmark Stephen R. , Key John C. , Roberts John
Published: July 2017

Fourteen nondiabetic and 6 diabetic patients were maintained on total parenteral nutrition during major surgery. Glucose levels when compared to preoperative levels increased during and after surgery although there were no significant differences between the diabetic and nondiabetic groups. Serum sodium demonstrated a slight decrease and serum potassium a slight increase after surgery in both groups. Total parenteral nutrition can be maintained during surgery provided glucose and electrolyte levels are observed and appropriate insulin doses are administered to diabetic patients.
Nomograms for Predicting Resting Energy Expenditure of Hospitalized Patients
Authors: Gay Rainey‐MacDonald C. , Holliday Ronald L. , Wells G.A.
Published: July 2017

Using the Harris‐Benedict equation for basal metabolic rate, nomograms were designed for the purpose of estimating the resting energy expenditure of male and female patients. These nomograms were applied to data from a sample of 63 patients having wide ranges in height, weight, and age. The results matched calculated values (± 5 kcal/day). We recommend the use of these nomograms for easy calculation of resting energy expenditure at the bedside.
Interaction between Regional and Industrial Policies: Evidence from Four Countries
Authors: Markusen Ann
Published: July 2017

After World War II, policies to promote industrialization-both to substitute for manufactured imports and to encourage exports based on unskilled labor-often successfully complemented regional polices to better distribute economic activity. The recent shift toward high technology, however, has strongly favored major urban areas, undermining efforts at regional decentralization and stabilization. Furthermore, countries are increasingly abandoning top-down regional policy and passing on responsibility for development to provincial and local levels, setting off vigorous interregional competition for economic activity and often favoring a few, relatively well-endowed regions. Evidence from Brazil, Japan, the Republic of Korea, and the United States shows how the recent emphasis on high-tech exports and decentralized regional policy may reinforce polarization and slow progress toward eliminating regional growth and income differentials.
Cost Effectiveness of the Aprofam Program for Voluntary Surgical Contraception in Guatemala
Authors: McBride Mark E. , Bertrand Jane T. , Santiso Roberto , Fernandez Victor Hugo
Published: July 2017

This study examines the relative cost effectiveness of five alternative service delivery methods for providing voluntary surgical contraception (VSC) in Guatemala. The study focuses primarily on the relative effectiveness of providing VSC in the country's interior using fixed facilities with local doctors or mobile teams. A retrospective cost-effectiveness analysis finds that the mobile teams are relatively more expensive than using local doctors. This result was tempered by an analysis of the monthly cost and service statistics using statistical cost techniques. The alternative approach explicitly recognizes the dynamic nature of a family planning organization by relating the variations in monthly program costs to the monthly variations in service levels. The alternative analysis revealed that, at the margin, with the given stock of capital the mobile teams are relatively cheaper to use, and that the fixed facilities need high demand levels (which are unlikely to occur in the interior) to achieve low costs at the margin. The alternative analysis led to the funding agency retaining the mobile team model.
The Impact Profile Approach to Policy Merit
Authors: Mohr Lawrence B.
Published: July 2017

In writings on the theory of valuing, many take the position that impacts on the relevant outcome dimensions should be aggregated to arrive at one summary assessment of program merit. A contrary position is taken here, specifying that the impacts should be kept separate and unweighted and expressed only in their own original measurement scales. All impacts, however, should be portrayed, including those for which no rigorous data analysis has been carried out. It is argued that aggregating, even by the individual stakeholder, is both futile and misleading. An extensive evaluation of the effects of research grants on the university is included as a full-scale illustration of the method. Financial impacts are considered, as well as impacts on faculty and student quality, on university prestige, and on the quality of instruction.
Psycholinguistic profiling of a hearing-impaired child
Authors: Ebbels Susan
Published: July 2017

The speech and language processing abilities of a 10 year old with a severe hearing impairment and additional word retrieval difficulties are examined at a single word level using Stackhouse and Wells’ psycholinguistic framework. Performance on a variety of output tasks is compared and input processing is investigated in detail. Evidence is found for a breakdown in processing at several levels. The specific point of breakdown for individual contrasts is identified. It is shown to be possible and informative to use a psycholinguistic framework with a child with a hearing impairment to produce a detailed profile which could inform therapy decisions.
Primary care professionals’ knowledge and attitudes on speech disfluency in pre-school children
Authors: Lees Roberta , Stark Cameron , Baird Jan , Birse Susan
Published: July 2017

Early intervention in fluency disorders such as stammering is desirable but this depends on early referral of disfluent children to speech and language therapists. The willingness to refer young disfluent children depends on, among other things, the knowledge and attitudes of primary care practitioners who are likely to be the main sources of referral. A postal questionnaire survey was carried out of all general practitioners (GPs) and health visitors (HVs) in the area of the former Highland Community NHS Trust to elicit this information. The results indicated that these professionals were more likely to refer young disfluent children to speech and language therapy if they themselves had received some post-graduate training about this disorder. More GPs than HVs were uncertain about the natural history of the disorder and about whether young disfluent children should be enrolled for therapy. GPs were more inclined to believe that there were personality traits characteristic of those who stammer and they were also more influenced by waiting lists in their decisions about referral. It would seem that some primary care professionals may have beliefs about stammering which were acquired in their training and which have not been updated. Appropriate post-graduate training seems to increase referral numbers. Training programmes that meet the needs of primary care professionals should be supported and evaluated.
The Pathogenesis of Persistent Turbinate Atrophy Induced by Toxigenic Pasteurella multocida in Pigs
Authors: Elling F. , Pedersen K. B.
Published: July 2017

Six one-week-old piglets were pretreated with a 1% acetic acid solution for two days in one or both nostrils. Three piglets were not treated with acetic acid. Three days after treatment all nine piglets were inoculated in both nostrils with a toxigenic type D strain of Pasteurella multocida. Three piglets were killed seven days after inoculation; one died spontaneously 13 days after inoculation and the remaining pigs were killed at approximately 90 kg body weight, i.e., five to six months of age. All acetic acid-treated animals developed severe atrophy of the turbinates in the treated nostrils. Untreated nostrils were normal. The present results showed that toxigenic P. multocida can induce turbinate atrophy that persisted until 90 kg body weight when the lesions were similar to spontaneous atrophic rhinitis in pigs. The turbinate atrophy was not accompanied by inflammatory reaction, atrophy of other bone structures, or lesions in other organs. The experiment showed furthermore that toxigenic P. multocida may be present in the tonsils of control animals without causing turbinate atrophy. A pathogenesis for atrophic rhinitis in pigs is proposed.
Powassan Viral Encephalitis: A Review and Experimental Studies in the Horse and Rabbit
Authors: Little P. B. , Thorsen J. , Moore W. , Weninger N.
Published: July 2017

Powassan virus strain M794, a member of the Flavivirus genus known to infect man and animals in Canada, was inoculated intracerebrally into rabbits and horses. No clinical signs were observed in rabbits, but widespread encephalitis resulted, characterized by lymphoid perivascular cuffing, lymphocytic meningitis, and lymphocytic choroiditis. In horses, eight days after inoculation, prominent neurological signs occurred and lesions were those of non-suppurative encephalomyelitis, neuronal necrosis, and focal parenchymal necrosis. The virus could not be reisolated from the rabbit or horse brains. Pathologic features, useful in separating some of the common North American equine neurological diseases, are discussed.
Does H Advocate the Centralization of Worship?
Authors: Milgrom Jacob
Published: July 2017

Heretofore it has been taken for granted or allegedly proven from Lev. 17.1-7 that centralization of worship is a fundamental doctrine of the Priestly sources. Elsewhere ( Leviticus 1–16 [AB, 3; New York: Doubleday, 1991], pp. 29–34), I have argued that P allows for multiple sanctuaries. I now argue the same for H. Both textual and archaeological evidence demonstrate that multiple sanctuaries abounded in the time of H, eighth-century Judah. Hezekiah's reform was not based on H, but on political grounds. As for Lev. 17.1-7, its absolute ban on nonsacrificial slaughter could not be implemented if worship were limited to a single centralized sanctuary
Prices and Availability of Healthy Foods across St. Louis
Authors: Daepp Madeleine I. G.
Published: July 2017

“Food deserts” —low-income neighborhoods lacking grocery stores or supermarkets—may contribute to the high prevalence of diet-related disease among low-income populations. This study surveys forty grocery and convenience stores in St. Louis, Missouri, to assess the availability and prices of healthy foods. Access to healthy food is limited across the city's low-income neighborhoods, regardless of whether they meet the federal definition of the food desert. Prices are frequently higher in convenience stores, a result that may translate into higher prices for transportation-constrained city residents. This evidence suggests that policymakers should focus on reducing the income constraints likely contributing to variable food access, rather than on addressing the “food desert” symptom.
Damage Mechanics Formulation of the Crack Evolution Process in Composite Laminates under Plane Stress Conditions
Authors: Wada A. , Motogi S. , Fukuda T.
Published: July 2017

An analytical model to predict the constitutive behavior of laminated composites with cracking layers is developed in the framework of continuum damage mechanics. A new concept that a cracked lamina can be replaced with an equivalent uni form work-softening layer is proposed. With this new concept, the constitutive equations for a cracking layer are constructed according to the modern plasticity theory. A lamina damage surface, a threshold of crack evolution, is defined in the stress space, and the constitutive equations for a cracking layer are constructed along with the associated flow rule. Furthermore, the derived constitutive equations for a cracking layer are applied to the classical lamination theory to describe laminate constitutive behavior in the cracking process The validity of the constitutive model formulation is also verified comparing the analytical predictions to experimental results for some laminate configurations.
Experimental and Theoretical Study of the Thermoformability of Industrial Polymers
Authors: Laroche D. , Erchiqui F.
Published: July 2017

The processability of industrial polymers was experimentally and numerically investigated. The heating temperature of ABS and HIPS sheets was systematically varied in order to determine the minimum sheet temperature required for vacuum forming onto two different cavity moulds. Finite element simulations of the process using hyperelastic and viscoelastic constitutive equations were also performed in order to analyze the model's ability to predict thermoformability of polymers. Prediction of minimum required sheet temperature as well as the part thickness distribution were compared to experimental measurements.
Hybrid Composites: Models and Tests for Environmental Aging
Authors: Ochoa Ozden O. , Ross George R.
Published: July 2017

A comprehensive analytical approach to evaluate the mechanical response of seawater aged hybrid composites is presented. The methodology accounts for the effects of multiple fiber reinforcement, matrix non-linearity and progressive damage to assess the stressstrain response and ultimate failure loads. The computational results compare well to data from tensile and bending tests of flat coupons and burst pressure tests of filament wound tubes.
Low Velocity Impact Response of Resin Infusion Molded Foam Filled Honeycomb Sandwich Composites
Authors: Vaidya U. K. , Kamath M. V. , Mahfuz H. , Jeelani S.
Published: July 2017

In this study the low-velocity impact and post-impact response of low-cost resin infusion molded sandwich composites utilizing a foam filled honeycomb core with graphite and S2-glass fabric facesheets (skins) has been investigated. The foam filled honeycomb core provides combined advantages of the traditional foam core and honeycomb sandwich composites in that it possesses high shear and bending stiffness, and cell wall stability. The low velocity impact response of 101.6 mm x 101.6 mm sandwich plates is studied at five energy levels representative of damage initiation and propagation. The low velocity damage is correlated to ultrasonic C-scan images, vibration resonance frequency and optical microscopy observations. The results indicate that the damage tolerance is enhanced by the foam filled honeycomb core and that load required to initiate damage is independent of the facesheet type for any specific core/facesheet thickness. The sandwich composites with S2-glass facesheets are found to possess more damage tolerance as compared to the graphite facesheets.
Filament Wound Retrofitting of Reinforced Concrete Bridge Structures
Authors: Mullen C. L. , Rice J. R. , Hackett R. M. , Ma G. L.
Published: July 2017

A methodology for circumferentially winding a graphite fiber-epoxy resin composite material around reinforced concrete columns for the purpose of the seismic-design retrofit of existing structures has gained approval for a major program of bridge retrofitting in California. A computational model employing three-dimensional finite element techniques is used for the purpose of simulating the response of such retrofitted columns to seismic loading. The filament-wound composite material is modeled as a linear orthotropic membrane, and the concrete is modeled as a nonlinear 3D continuum governed by 3D constitutive laws which account for smeared cracking. Concrete inside the confined region is allowed a different constitutive relation to account for the different failure surface. The steel reinforcement is modeled using bar elements with one-dimensional kinematic-hardening plasticity laws. The performance of non-retrofitted and of retrofitted columns is compared. Finally, the computed internal stress distributions of circular and rectangular sections of nominally the same flexural capacity are compared.
Analytical/Experimental Study on Composite Behavior in Strengthening Structures with Bonded Carbon Fiber Sheets
Authors: Wu Z. S. , Yoshizawa H.
Published: July 2017

In this paper, the first effort which focuses on the summary and discussion of a series of experimental investigations on various composite effects of RC tensile members strengthened with carbon fiber sheets (CFS) is performed. The variables of our experiment include different carbon FRP materials, strengths of concrete, thickness of concrete cover, reinforcing ratios of rebars, and layers of FRP sheets. We try also to investigate the bond mechanism along the FRP-concrete interface. Secondly, the fracture energy approach is adopted to predict the composite behavior of RC tensile specimens strengthened with CFS.
Effects of Saline Water Immersion on Glass Fibrelvinyl-Ester Wrapped Concrete Columns
Authors: Zhang Shi , Ye Lin , Mai Yiu-Wing
Published: July 2017

Development and use of polymer composite systems to strengthen concrete structures externally is becoming more and more attractive in both civil and maritime applications. The objective of this experimental study was to evaluate the environmental effect on strengthening efficiency of FRP wraps (glass woven roving or combined woven roving/chopped strand mat with a vinyl-ester resin) for concrete columns. Moisture absorption of FRP laminates immersed in saline water was investigated, and ultimate tensile and compressive strengths of glass/vinyl-ester laminates were characterised. FRP wrapped concrete columns were also immersed in saline water with the same conditions for the composite coupon specimens. The experimental results indicated that strengthening efficiency was reduced for the immersed columns, however, it still remained in an effective strengthening level. The combined woven roving/chopped strand mat wrap has less reduction in strengthening efficiency than the woven roving one.
Open Hole Tensile Behaviors of Knitted Fabric Composites
Authors: Kameo Koji , de Haan Joop , Nakai Asami , Hamada Hiroyuki
Published: July 2017

In composite structures, drilling of holes leads to local fracture of the area around the cutting plane. Therefore, to prevent composite structures from weakening due to cracks induced by cutting, knitted fabrics with knitted-in holes were manufactured. The advantage of this fabric is that the area around the hole is strengthened by an increased fiber volume fraction and an orientation of the fibers circumferential to the hole. The tensile properties of single layer knitted aramid fiber/epoxy composites with knitted hole were compared with drilled hole. For all specimens with a drilled hole, the region around the hole caused final failure. For composites with a knitted hole, however, in the case of specimens with the ratio of specimen width to hole diameter, WID > 3, the region around the hole mostly did not lead to final failure. Therefore, open hole strength with knitted hole was higher than that with drilled hole.