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Introduction: In the event-driven FREEDOM-EV trial, oral treprostinil delayed clinical worsening in patients with pulmonary arterial hypertension (PAH). Open-label extension studies offer additional data about tolerability, efficacy, and survival, especially for those initially assigned placebo. The aim of the current study was to determine if oral treprostinil changed survival when considering the parent and extension study, if treprostinil provides functional benefits for participants initially assigned to placebo, and if the benefits observed for those treated with treprostinil were durable. Methods: Both active and placebo participants from FREEDOM-EV could enroll in the FREEDOM-EV open-label extension (OLE) study after experiencing an investigator-assessed clinical worsening event or after parent study closure. All participants in the OLE were offered open-label oral treprostinil. Previously assigned placebo participants titrated to maximally tolerated doses; previously assigned treprostinil participants continued dose titration. We repeated assessments including functional class and 6-min walk distance (6MWD) at 12-week intervals and measured N-terminal pro-brain natriuretic peptide (NT-proBNP) at week 48. Survival was estimated by Kaplan–Meier analysis, and we estimated hazard ratio (HR) using Cox proportional hazards. Results: Of 690 FREEDOM-EV participants, 470 enrolled in the OLE; vital status was available for 89% of initial Freedom-EV participants. When considering the combined parent and open-label data, initial assignment to oral treprostinil reduced mortality (HR 0.64, 95% confidence interval 0.46–0.91, p = 0.013); absolute risk reduction was 9%. Participants randomized to placebo who initiated oral treprostinil after clinical worsening and tolerated treatment through week 48 demonstrated favorable shifts in functional class (p < 0.0001), 6MWD improvements of + 84 m (p < 0.0001), and a reduction in NT-proBNP of − 778 pg/mL (p = 0.02), compared to OLE baseline. Modest trends toward benefit were measured for those initially assigned placebo who did not have clinical worsening, and 132/144 (92%) of treprostinil assigned participants without clinical worsening remained on drug at week 48 in the OLE study. Adverse events were consistent with FREEDOM-EV. Conclusion: Initial treprostinil assignment improved survival in the entire data set; those who began treprostinil after a clinical worsening in the placebo arm and tolerated drug to week 48 enjoyed substantial functional gains. Clinical Trial Registration: ClinicalTrials.gov identifier NCT01560637. [ABSTRACT FROM AUTHOR]

Real risk status detection is an effective way to reflect risky or dangerous driving behaviors and therefore to prevent road traffic accidents. However, a driver's risk status is not only difficult to define but also uncontrollable and uncertain. In this study, a simulated experiment with 30 drivers was conducted using a driving simulator to collect the multi-sensor data of road conditions, humans, and vehicles. The driving risk status was classified into three states (0 - incident, 1 - near crash, or 2 - crash) on the basis of the playback system of the driving simulator. The experimental data were pre-processed using the cubic spline interpolation method and the time-windows theory. A driving risk status identification model was established using the C5.0 decision tree algorithm, and the receiver operating characteristic curve (ROC) was adopted to evaluate the performance of the identification model. The results indicated that respiration (RESP), vehicle speed (SPE), SM_FATIGUE, distance to the left lane (LLD), course angle (CA), and skin conductivity (SC) had a significant correlation (p < 0.05) with the driving risk status. The identification accuracy of the C5.0 decision tree algorithm was 78%, and the areas under the ROC were 0.934, 0.77, and 0.845, respectively. Moreover, compared with other four identification algorithms, the algorithm performance evaluation indexes TPR (0.780), precision (0.753), recall (0.78), F-measure (0.756), and kappa (0.884) of the C5.0 decision tree were all the best. The conclusion can provide reference evidence for danger warning systems and intelligent vehicle design. [ABSTRACT FROM AUTHOR]

The burden of cardiovascular disease (CVD) has been on the rise in developing countries like Nigeria recently. Studies on perceived CVD risk and the risk status of adults in Ibadan are not readily available, hence this study. A mixed-method design involving a cross-sectional survey and an exploratory qualitative study was utilized. Convenience sampling was used to recruit 418 participants (209 from rural and 209 from urban) for the cross-sectional survey, while purposive sampling was used to recruit 14 participants for the qualitative aspect. The INTERHEART risk score and the Perception of Risk of Heart Disease Scale were used to investigate participants' CVD risk status and perceived risk, respectively. The data from the cross-sectional survey were summarized by using descriptive statistics, and the data were then analyzed by using the chi-square test of association and a multiple logistic regression model, while content thematic analysis was used to analyze the qualitative data. In the rural and urban area s, respectively, 39.7% and 52.2% had a positive perception of CVD risk. In the rural and urban areas, 44% and 41.6% of individuals respectively had moderate-to-high risk of CVD. Participants with at least secondary school education [2.66 (0.61-11.53)] and participants in the urban area [2.62 (0.78-7.08)] had twice higher odds of positive CVD risk perception. Males [3.91 (1.58-9.68)], adults aged 40 and above [1.59 (0.63-4.00)] and urban dwellers [1.21 (0.33-4.39)] had higher odds of a high CVD risk status. The qualitative aspect of the study corroborated the findings from the survey, as many participants did not perceive themselves as being at risk of CVD. The majority of the participants in this study were found to have a moderate-to-high risk of CVD, and many had a negative perception of their risk. Health education and CVD prevention programs are required to curb the burden of CVD. [ABSTRACT FROM AUTHOR]

According to the sexually abused-abuser hypothesis, childhood sexual victimization (CSV) among males increases the likelihood of later sexual offending against children. Why CSV is related to sexual offending against children, however, has yet to be determined. To explore mechanisms that may link CSV to sexual offending, we tested the relationship between CSV and the two main risk domains: pedophilic interest and antisocial orientation. In four studies, men convicted of sexual offences against children under 15 who reported experiencing CSV were generally more sexually interested in children—especially male children—and were more antisocial than those who did not report experiencing CSV. A meta-analysis of the results across our four studies showed that CSV was moderately associated with greater antisociality, but less so with pedophilic interests. Future research should test the extent to which pedophilic interest and antisocial orientation explain the relationship between CSV and sexual offending against children among convicted sexual offenders. [ABSTRACT FROM AUTHOR]

The purposes of this study were to (a) assess the efficacy of a universal classroom-based mental health and social skills program for primary school students in Vietnam, and (b) given the universal nature of the intervention, assess outcomes as a function of risk status (high versus low). RECAP-VN is a semi-structured program that provides students with classroom social skills training, and teachers with in-classroom consultation on program implementation and classroom-wide behavior management. Project data were collected at three time-points across the academic year from 443 second grade students in regards to their social skills and mental health functioning, in the Vietnamese cities of Hanoi and Danang. Mental health functioning (emotional and behavioral mental health problems) was the ultimate outcome target (at Time 3), with social skills intermediate (at Time 2) outcomes targeted to improve mental health functioning. Significant treatment effects were found on both social skills and mental health functioning. However, although program effects on mental health functioning were significant for both low and high risk status groups, program effects on social skills were only significant for low risk status students, suggesting that different mechanisms may underlie program effects for high and low risk status students. Overall the results of this study, one of the first to assess directly the effects of a school-based program on mental health functioning in a low or middle income country, provide some support for the value of using school-based programs to address the substantial child mental health treatment gap found in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Methods Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Results Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Conclusions Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. [ABSTRACT FROM AUTHOR]

Purpose: The burden of community-acquired pneumonia (CAP) is not well described in the US Veterans Health Administration (VHA). Methods: CAP was defined as having a pneumonia diagnosis with evidence of chest X-ray, and no evidence of prior (90 days) hospitalization/long-term care. We calculated incidence rates of adult CAP occurring in inpatient or outpatient VHA settings in 2011. We also estimated the proportion of VHA CAP patients who were hospitalized, were readmitted within 30 days of hospital discharge, and died (any cause) in the year following diagnosis. Incremental costs during the 90 days following a CAP diagnosis were estimated from the perspective of the VHA. Results: In 2011, 34,101 Veterans developed CAP (35,380 episodes) over 7,739,757 VHA person-years. Median age of CAP patients was 65 years (95 % male). CAP incidence rates were higher for those aged ≥50 years. A majority of Veterans aged 50-64 (53 %) and ≥65 (66 %) years had ≥1 chronic medical (moderate risk) or immunocompromising (high risk) condition. Compared to those at low-risk (healthy), moderate- and high-risk Veterans were >3 and >6 times more likely to develop CAP, respectively. The percentage of CAP patients who were hospitalized was 45 %, ranging from 12 % (age 18-49, low risk) to 57 % (age ≥65, high risk). One-year all-cause mortality rates ranged from 1 % (age 18-49, low risk) to 36 % (age ≥65, high risk). Annual VHA medical expenditure related to CAP was estimated to be $750 million (M) ($415M for those aged ≥65 years). Conclusion: A focus on CAP prevention among older Veterans and those with comorbid or immunocompromising conditions is important. [ABSTRACT FROM AUTHOR]

Background: Despite strong research interest in psychosis risk identification and the potential for early intervention, few papers have sought to document the implementation and evaluation of specialised psychosis related services. Assessment of Ultra High Risk (UHR) has been given priority, but it is equally as important to identify appropriate comparison groups and other baseline differences. This largely descriptive service evaluation paper focuses on the ‘baseline characteristics’ of referred clients (i.e., previously assessed characteristics or those identified within the first two months following service presentation). Methods: Data are reported from a 10-year layered service audit of all presentations to a ‘Psychological Assistance Service’ for young people (PAS, Newcastle, Australia). Baseline socio-demographic and clinical characteristics (N =1,997) are described (including clients’ psychosis and UHR status, previous service contacts, hospitalisation rates, and diagnostic and comorbidity profiles). Key groups are identified and comparisons made between clients who received ongoing treatment and those who were primarily assessed and referred elsewhere. Results: Clients averaged 19.2 (SD =4.5) years of age and 59% were male. One-tenth of clients (9.6%) were categorised as UHR, among whom there were relatively high rates of attenuated psychotic symptoms (69.1%), comorbid depression (62.3%), anxiety (42.9%), and attentional and related problems (67.5%). Overall, one-fifth (19.8%) experienced a recent psychotic episode, while a further 14.5% were categorised as having an existing psychosis (46.7% with a schizophrenia diagnosis), amongst whom there were relatively high rates of comorbid substance misuse (52.9%), psychosocial (70.2%) and physical health (37.7%) problems. The largest group presenting to PAS were those with non-psychotic disorders (43.7%), who provide a valuable comparison group against which to contrast the health trajectories of those with UHR and recent psychosis. Ongoing treatment by PAS was preferentially given to those experiencing or at risk for psychosis and those reporting greater current distress or dysfunction. Conclusions: Whether or not UHR clients transition to psychosis, they displayed high rates of comorbid depression and anxiety at service presentation, with half receiving ongoing treatment from PAS. Although international comparisons with similar services are difficult, the socio-demographic and comorbidity patterns observed here were viewed as largely consistent with those reported elsewhere. [ABSTRACT FROM AUTHOR]

Sturgeon species worldwide have undergone population declines due to habitat alteration and overexploitation and many are listed by the International Union for Conservation of Nature (IUCN) and national agencies. Atlantic and shortnose sturgeon on the east coast of North America are listed as "endangered" or "threatened" over most of their ranges. It has been proposed, however, that IUCN risk categories are ambiguous and do not consider the threat status of a species in relation to a minimum viable population level. Here, we examine the Species Ability to Forestall Extinction (SAFE) Index, which is a heuristic measure of a species relative distance from extinction, and other available information on Atlantic and shortnose sturgeon with regard to the risk status of the two species. To move beyond a 'tipping point' designation of threatened, the SAFE Index requires a species abundance of 5000 adults (SAFE Index D 0.0). DNA and mark-recapture data for Atlantic sturgeon in Minas Basin, Canada indicates a USA/Canada mixed stock of ~10,000 fish aggregate there in summer. The SAFE Index for this population is 0.28 indicating abundance is within the "vulnerable" threshold range for the Index although it includes but a small portion of the Atlantic sturgeon in the western Atlantic. Estimates for the east coast of North America suggest the Atlantic sturgeon population could consist of ~177,000 sub adults and adults for a SAFE Index of 1.55. Additionally, the present spawning range of Atlantic sturgeon in North America is ~99% of the historically known range and the number of stocks is near the historic level (33C) which means the species does not meet IUCN criteria for listing. Similarly, shortnose sturgeon has an Atlantic coast population of 96,800 adults (SAFE Index of 1.29) and a species range and number of stocks (26C) that has not changed substantially from the historical situation. Since the abundance of Atlantic and shortnose sturgeon are well above the SAFE threshold for "threatened" and they lack other accepted criteria for endangered or threatened designation, we conclude that the risk status of both species should be reconsidered. [ABSTRACT FROM AUTHOR]

Copyright of Animal Genetic Resources is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective This study aimed to observe risk status on admission to hospital and change in risk status during labor. Design A prospective observational study allocating all women into low-risk and high-risk groups on admittance to hospital and during labor based on prespecified risk criteria. Setting Department of Obstetrics and Gynecology in a district hospital. Population All 6406 deliveries from 2 May 2004 to 30 September 2006. Methods A special form was filled out for all women admitted to the department in labor classifying them as either low or high risk. A change in risk status during labor was also recorded. Main outcome measures Risk status (low and high risk) on admittance to hospital and change in risk status during first stage of labor. Results On admittance, 67% of women with an intended vaginal delivery were low risk. During the first stage of labor, 41% of the low-risk women changed risk status. Use of epidural anesthesia gave rise to 73% of the risk changes during the first stage of labor and use of oxytocin caused 12%. Conclusions Two-thirds of the women were low risk before labor, and 39% of these remained low-risk at the end of the first stage of labor. The main reason for a change of risk status in the obstetric department was the use of epidural anesthesia. [ABSTRACT FROM AUTHOR]

Copyright of Animal Genetic Resources is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Animal Genetic Resources is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This preliminary investigation examined the effects of a computerized supplemental reading program on the oral reading fluency, reading growth rates, and comprehension of 8 African American first graders. Participants were selected for this study according to scores within risk categories on the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) oral reading fluency (ORF) winter benchmark, indicating the potential for reading failure. Participants engaged in a supplemental, computer-based reading program designed to improve reading fluency and comprehension. Treatment sessions were conducted 3-4 times per week, for 14-16 weeks. Following the treatment, each participant received the DIBELS ORF spring benchmark as a post-test measure. A pre-intervention/post-intervention analysis showed that all of the participants increased their reading fluency, 5 of the 8 participants reduced their risk status, and 7 of the 8 students increased their reading rate. All of the students improved their comprehension scores. The results support supplementary interventions and computer-based reading programs. The findings are discussed in the context of reading needs and instruction for African American primary-aged students. [ABSTRACT FROM AUTHOR]

Background: Nigeria has one of the worst maternal and child health indices globally. Aims: The objective of this study was to assess the risk status of pregnant women presenting for antenatal care in a rural health facility in Ebonyi State, South East Nigeria. Subjects and Method: This was a cross-sectional descriptive study of pregnant women selected by systematic random sampling. The study instrument was a pre-tested semi-structured interviewer-administered questionnaire. Result: The age range of the women in the study was 16-43 years. The mean age was 25.3 ± 1.3 years. According to the scoring system used, about one-fourth of the women (26%) had a high risk pregnancy while about a tenth (9.1%) had very high risk pregnancy. The vast majority of the women with at-risk pregnancies registered for antenatal care late: 58.9 % registered for antenatal care in the second trimester and 37.0 % registered for antenatal care in the third trimester of pregnancy. Of the women with an at-risk pregnancy, 79.5% had their last delivery at home and 67.1 % of them preferred to deliver at home in their current pregnancies. Conclusion: This study revealed that a substantial proportion of rural women with at-risk pregnancies go through their pregnancy period without significant modern antenatal care. The local government health department should intensify efforts through health enlightenment campaigns to educate rural pregnant women of the benefits of utilizing modern antenatal care services. [ABSTRACT FROM AUTHOR]

Background Estimated 25 million Indians are affected by Osteoporosis. It is eight times more common in women than in men. Objectives To determine the preventive practice and assessing the risk status (KPR) on osteoporosis, find the association between selected variables and key variables, find the relationship between practice and risk status in each group of women; comparing the mean among the groups on same. Methods A cross-sectional survey on 110 women, selected by convenience sampling at Hiriadka, Karnataka. Demographic proforma, self reported practice scale and risk assessment tool were used. Results There was positive correlation between age and risk status (p<0.05) in group1, whereas in group 2 it was negatively correlated. Preventive practices and risk status was negatively correlated in both groups (p<0.05). [ABSTRACT FROM AUTHOR]