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INTRODUCTION: Ongoing developments in prenatal anomaly screening necessitate continuous updating of counsellors' knowledge. We explored the effect of a refresher counselling course on participants' knowledge of prenatal screening. METHODS: We investigated the association between knowledge and counsellors' working experience. Also, the association between knowledge and counsellors' attitude towards prenatal screening was determined. All counsellors in the North-West region of the Netherlands were invited to attend a refresher counselling course and fill in both a pre-course and a post-course questionnaire. The participants consisted of midwifes, sonographers and gynaecologists. A 55-item questionnaire assessed pre-course (T0) and post-course (T1) knowledge. At T0, counsellors' attitude towards the prenatal screening program was assessed and its association with knowledge analysed. RESULTS: Of 387 counsellors, 68 (18%) attended the course and completed both questionnaires. Knowledge increased significantly from 77.7% to 84.6% (p

Background: Increased nuchal translucency (NT) is associated with aneuploidy. When the karyotype is normal, fetuses are still at risk for structural anomalies and genetic syndromes. Our study researched the diagnostic yield of prenatal microarray in a cohort of fetuses with isolated increased NT (defined as NT ≥ 3.5 mm) and questioned whether prenatal microarray is a useful tool in determining the adverse outcomes of the pregnancy.Materials and Methods: A prospective study was performed, in which 166 women, pregnant with a fetus with isolated increased NT (ranging from 3.5 to 14.3 mm with a mean of 5.4 mm) were offered karyotyping and subsequent prenatal microarray when karyotype was normal. Additionally, all ongoing pregnancies of fetuses with normal karyotype were followed up with regard to postnatal outcome. The follow-up time after birth was maximally 4 years.Results: Totally, 149 of 166 women opted for prenatal testing. Seventy-seven fetuses showed normal karyotype (52%). Totally, 73 of 77 fetuses with normal karyotype did not show additional anomalies on an early first trimester ultrasound. Totally, 40 of 73 fetuses received prenatal microarray of whom 3 fetuses had an abnormal microarray result: two pathogenic findings (2/40) and one incidental carrier finding. In 73 fetuses with an isolated increased NT, 21 pregnancies showed abnormal postnatal outcome (21/73, 28.8%), 29 had a normal outcome (29/73, 40%), and 23 were lost to follow-up (23/73, 31.5%). Seven out of 73 live-born children showed an adverse outcome (9.6%).Conclusions: Prenatal microarray in fetuses with isolated increased NT had a 5% (2/40) increased diagnostic yield compared to conventional karyotyping. Even with a normal microarray, fetuses with an isolated increased NT had a 28.8% risk of either pregnancy loss or an affected child.

Durch erhebliche versorgungsstrukturelle Defizite wird die Notwendigkeit einer moglichst fruhen Diagnose und Therapieeinleitung bei Rheumatoider Arthritis (RA) von der Mehrheit der Patienten in Deutschland verpasst. Die Herausforderung ist, den individuellen Anspruch eines bestmoglichen Therapieergebnisses mit einem gesellschaftlich tragfahigen Mittelaufwand in Einklang zu bringen. Das transsektorale Versorgungsnetzwerk ADAPTHERA zielt darauf ab, die fruhe RA-Diagnose und Behandlung in Rheinland-Pfalz zu verbessern. Fur die retrospektive Triage Analyse wurden 1045 Anfragen nachverfolgt. Zur Auswertung des klinischen Verlaufs wurde eine 143 Patienten umfassende Subkohorte analysiert. Quartalsweise wurden klinische und laborchemische Routineparameter erfasst, eine Batterie an Fragebogen ausgefullt und das therapeutische Regime bei Bedarf angepasst. Insgesamt konnten 454 Patienten eingeschlossen werden. Die mittlere Wartezeit betrug 23,9 (SD = 18) Tage. Der mittlere Beobachtungszeitraum in der Subkohorte lag bei 29,2 (SD = 12,7) Monaten, wobei die Halfte der Patienten binnen 3 Monaten vorstellig wurde. Fast 75 % der Patienten befanden sich nach 2 Jahren in Remission. Eine nachhaltige Remission konnte fur 74,8 % (6 Monate) respektive 53,5 % (12 Monate) beschrieben werden. Besonders Patienten mit rascher Remissionsinduktion profitierten im Sinne langerer Remissionen (p = 0,03). Ein sehr fruhes Krankheitsstadium (VERA) war mit einer seltener notwendigen Biologikatherapie assoziiert (p = 0,022). Der Ansatz eines Versorgungsnetzwerkes ist kein Allheilmittel, es kann aber eine deutliche Verbesserung der Versorgung bewirken. Kernpunkt zur Minimierung der kapazitaren Auslastung ist dabei eine moglichst zielgenaue Zuweisung und eine akkurate Triage.

We examined the changes in salivary immunoglobulin A (SIgA) and the incidence of upper respiratory syndrome (URS) throughout a college cross-country season as well as the acute effect of a VO2max test on SIgA. Subjects were 22 cross country athletes (XC) (20.7±0.3 years) and 23 matched controls (C) (20.4±0.2 years). Saliva samples were collected pre and post VO2max and at four training time points (August – November). Weekly logs indicating S&S of URS from which a total symptom score (TSS) was calculated were collected. There was a significant decrease in SIgA F(1,43)=10.742, p

Ziel des Rheuma-Netzwerks ADAPTHERA („risikoadaptierte Rheumatherapie“) ist es, eine flachendeckende Verbesserung der rheumatologischen Versorgung durch Koordination der Behandlung in einem landesweiten, transsektoralen Netzwerk zu erreichen. Begleitende biomedizinische Forschungsprojekte, Schulungskonzepte sowie der Aufbau eines Rheumaregisters (Daten- und Biomaterialsammlung) sollen daruber hinaus fur eine stetige und nachhaltige Optimierung der Versorgung sorgen. In der Pilotphase 2012–2015 lag der Fokus des als „Landesleitprojekt“ im Rahmen der Initiative Gesundheitswirtschaft Rheinland-Pfalz (RL-P) geforderten ADAPTHERA Netzwerkes auf der Optimierung der Fruhdiagnose der rheumatoiden Arthritis, bei der bekanntermasen ein erhebliches Versorgungsdefizit besteht. Durch die intensive, dauerhafte und koordinierte Kooperation aller Versorgungspartner auf dem Gebiet der Rheumatologie (niedergelassene Hausarzte und Orthopaden, niedergelassene Schwerpunktrheumatologen, das ACURA-Rheumazentrum RL-P, die Universitatsmedizin Mainz, die Rheumaorthopaden sowie die Arbeitsgemeinschaft Rheumatologie RL-P) ist ein bundesweit einzigartiges flachendeckendes Angebot mit nachweisbarer Versorgungsoptimierung in Rheinland-Pfalz entstanden. Unterstutzt wurde das Netzwerk dabei durch die hervorragende Zusammenarbeit mit der Kassenarztlichen Vereinigung RL-P und der Selbsthilfeorganisation Rheumaliga. Die bei Projektstart gesetzten Ziele werden am Ende der Pilotphase erreicht: - deutliche Verbesserung der Fruhdiagnostik der rheumatoiden Arthritis (durchschnittlich 23,7 Tage Dauer bis zur Diagnosestellung durch Rheumatologen) - krankenkassenubergreifender Zugang (unabhangig von einer bestimmten Kasse) - flachendeckend (nachweislich Teilnahme von Hausarzten aus ganz RL-P) - Aufbau von Daten- und Biomaterialiensammlung etabliert als Grundlage fur Biomarkerforschung und Aufbau eines Rheuma-Registers Rheinland-Pfalz.

Normalized Cut is a well-established divisive image segmentation method, which we adapt in this paper for the segmentation of laser point clouds in urban areas. Our focus is on polyhedral objects with planar surfaces. Due to its target function, Normalized Cut favours cuts with “short cut lines” or “small cut surfaces”, which is a drawback for our application. We therefore modify the target function, weighting the similarity measures with distance-dependent weights. We call the induced minimization problem “Distance-weighted Cut” ( DWCut ). The new target function leads to a generalized eigenvalue problem, which is slightly more complicated than the corresponding problem for the Normalized Cut; on the other hand, the new target function is easier to interpret and avoids some drawbacks of the Normalized Cut. We point out an efficient method for the numerical solution of the eigenvalue problem which is based on a Krylov subspace method. DWCut can be beneficially combined with an aggregation in order to reduce the computational effort and to avoid shortcomings due to insufficient plane parameters. We present examples for the successful application of the Distance-weighted Cut principle and evaluate its results by comparison with the results of corresponding manual segmentations.

The primary purpose of this study was to examine the effect of acute maximal exercise (VO2max test) on salivary immunoglobulin A (SIgA) responses in adolescent females. A secondary aim was to examine the relationship between resting SIgA levels and VO2max, physical activity, body composition, and diet.Fifty healthy female adolescents completed a laboratory-based VO2max test, assessment of body composition via hydrodensitometry, a validated physical activity questionnaire (PAQ-A), and a three-day food diary. Unstimulated saliva was collected before, and 5 and 120 minutes after VO2max testing. Absolute SIgA (µg/mL) concentration was determined using an enzyme-linked immunosorbent assay. Secretion rate of SIgA (µg/min) was calculated by multiplying absolute SIgA concentration by saliva flow rate (SFR, µL/min).A significant increase in absolute SIgA concentration (146.8±59.2 µg/mL) was noted immediately after VO2max testing (P0.05) and returned to pre-exercise levels (120.1±54.1 µg/mL) by 120-min post-exercise (P0.05). No significant VO2max test effects were observed for SIgA secretion rate and SFR (P0.05). VO2max values (41.92±6.36 mL/kg/min) were correlated with body fat percentage (r=-0.59; P0.01), PAQ-A total score (r=0.48; P0.01), and acute changes in absolute SIgA levels (r=0.28; P0.05). No significant associations were observed between dietary measures and resting SIgA levels or SFR (P0.05) except for dietary fiber which correlated with resting absolute SIgA concentration (r=0.29; P0.05).Findings indicate that acute graded maximal exercise results in a transient increase in absolute SIgA concentration and that these changes are associated with individual VO2max values.

Objective: To study the pregnancy outcomes of women with a dichorionic triamniotic triplet pregnancy that was reduced to a singleton pregnancy and to review the literature. Methods: We performed a nationwide retrospective cohort study. We compared time to delivery and perinatal mortality in dichorionic triplet pregnancies reduced to singletons with ongoing dichorionic triplet pregnancies and primary singleton pregnancies. Additionally, we reviewed the literature on the subject. Results: We studied 46 women with a reduced dichorionic triplet pregnancy and 42 women with an ongoing dichorionic triplet pregnancy. Median gestational age at delivery was 38.7 vs. 32.8 weeks, respectively (p < 0.001). Delivery Conclusion: Multifetal pregnancy reduction in women with a dichorionic triplet pregnancy to a singleton pregnancy prolongs median gestational age at birth. No statistically significant association was found with miscarriage and perinatal survival rates.

The American College of Clinical Pharmacy (ACCP) and the American Society of Health-System Pharmacists (ASHP) share a common vision that all pharmacists involved with direct patient care will be required to complete a postgraduate residency prior to entering practice by 2020. This requirement will impact most pharmacy school graduates. The number of residency programs available will have to grow significantly; however, the current rate of growth is not nearly sufficient to create enough residency training programs by 2020. Barriers to increasing the number of residency positions include the cost of creating residency positions, the pharmacy residency teaching model, and the need for qualified preceptors. Solutions to overcome these barriers include the following: utilizing residents to provide needed services, coverage, and scholarship activity; converting to a residency model similar to the medical model, which allows for a 1:6 preceptor to resident ratio; developing preceptor training programs and standardizing teaching certificates, which could be accomplished by establishing relationships with colleges of pharmacy; and encouraging smaller community hospitals to develop residency programs, which could be accomplished by partnering with nearby academic medical centers or other community hospitals. Now is the time to embrace this opportunity for change and improvement in the pharmacy education system. Pharmacy professionals need to come together to overcome this challenge.

Background High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. Method Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. Results The majority of respondents identified the organization's high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. Conclusions This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies.

Pansharpening has proven to be a valuable method for resolution enhancement of multi-band images when spatially high-resolving panchromatic images are available in addition. In principle, pansharpening can beneficially be applied to hyperspectral images as well. But whereas the grey values of multi-spectral images comprise at most relative information about the registered intensities, calibrated hyperspectral images are supposed to provide absolute reflectivity values of the respective material surfaces. This physical significance of the hyperspectral data should be preserved within the pansharpening process as much as possible. In this paper we compare several common pansharpening methods such as Principal Component Fusion, Wavelet Fusion, Gram-Schmidt transform and investigate their applicability for hyperspectral data. Our focus is on the impact of the pansharpening on material classifications. Apart from applying common quality measures, we compare the results of material classifications from hyperspectral data, which were pansharpened by different methods. In addition we propose an alternative pansharpening method which is based on an initial segmentation of the panchromatic image with an additional use of map vector data.

Objective To determine the degree in variation of oral liquid pediatric compounding practices in Michigan pharmacies. Design Cross-sectional survey study. Setting All types of inpatient and outpatient pharmacies across the state of Michigan, excluding nuclear pharmacies and long-term care facilities. Participants 244 Michigan pharmacies. Intervention An online survey tool was used to assess the current compounding practices of 147 oral liquid pediatric medications. The survey was e-mailed or faxed to hospitals, chain pharmacies, and independent pharmacies. Pharmacists were also mailed a follow-up postcard, and the Michigan Pharmacists Association publicized the project through its journal and annual meeting. Main outcome measures Pharmacy demographics; number of compounding pharmacies; number of medications compounded; awareness of compounding errors; results of compounding errors; and number of concentrations compounded per medication. Results The majority of respondents were from outpatient pharmacies, but inpatient and other types of pharmacies were also represented. The majority of participating pharmacies compound fewer than five oral liquid medications per week. Awareness of errors was low overall, with no errors believed to result in permanent harm or death. The number of concentrations compounded per medication ranged from 1 to 9, with the majority of pharmacies compounding more than 3 concentrations per medication. Conclusion There is a considerable degree of variation in current oral pediatric liquid compounding practices in Michigan pharmacies. This variability poses a significant risk to patient safety.

OBJECTIVE: The aim of this study was to compare screening performance for Down syndrome of the absolute risk (AR) method to the first trimester combined test (FCT) at different maternal ages. METHODS: There was a retrospective analysis of 32,448 FCT. AR was defined as final risk divided by maternal age risk. RESULTS: The likelihood of receiving a true prediction was comparable between both methods in all age groups. With the AR method, two extra Down syndrome cases were detected in women /=36 years, and the likelihood of receiving a false prediction decreased overall (OR 0.82, CI 0.77-0.87; P < 0.0001), in women aged 36-40 years (0.45, CI 0.41-0.51; P < 0.0001), in women aged 41-45 years (0.18, CI 0.13-0.26; P < 0.0001) and increased in women aged

Objective: To validate previously computed correction factors for free β-human chorionic gonadotrophin (fβ-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies with hormone treatment and to determine the effect on false-positive rate (FPR). Methods: Retrospective study on 249 IVF and 250 ICSI cases and 20,190 controls. Correction factors 1.42 (PAPP-A), 1.17 (fβ-hCG) in IVF; 1.56 (PAPP-A) in ICSI were applied on the absolute serum concentrations. Analysis was done on log10-transformed multiples of medians (MoMs). Results: In the controls, mean PAPP-A and fβ-hCG MoM were 1.004 and 1.062. Before correction, mean PAPP-A MoM was significantly lower in IVF (0.757; p < 0.001) and in ICSI (0.671; p < 0.001) and after correction comparable (1.071; p = 0.053 in IVF; 1.048; p = 0.178 in ICSI). Before correction, mean fβ-hCG MoM was comparable (1.054; p = 0.59 in IVF and 1.051; p = 0.56 in ICSI) and after correction significantly higher in IVF (1.241; p < 0.001). After correction the likelihood for receiving a false-positive result was 1.03 in IVF pregnancies (95% CI 0.98-1.09; p = 0.248) and 1.02 in ICSI pregnancies (95% CI 0.97-1.07; p = 0.448). Conclusions: After correction the FPR in IVF and ICSI pregnancies with hormone treatment reduces to the observed FPR in the controls.

Purpose The development, dissemination, and adoption of standard concentrations for compounded oral liquids for pediatric patients in Michigan are described. Summary A baseline assessment of current practices in Michigan revealed significant variations in the concentrations of commonly used oral liquid medicines for pediatric patients. A statewide collaborative initiative in Michigan was created to standardize the concentrations of compounded oral liquids for pediatric patients. Standard concentrations were proposed and adopted by key stakeholders. These standards were then disseminated across the state to prescribers and pharmacists, with encouragement to voluntarily adopt the standards as a patient safety measure. A follow-up survey was conducted to evaluate adoption of the standards. A total of 263 pharmacists responded to the survey. Standardization of the concentrations of compounded oral liquids in Michigan was welcomed by most pharmacies and is perceived to have reduced the risk for errors at transitions of care for children receiving compounded oral liquids. Awareness of the standardization initiative was acknowledged by 77% of survey respondents, and adoption of the standards was observed to some degree by 57% of survey respondents. In addition, 70% of survey respondents agreed or strongly agreed that adoption of the standards has improved patient safety in Michigan. Conclusion Standard drug concentrations for compounded oral liquids were developed for pediatric patients in Michigan. A survey after dissemination of the recommended standards confirmed general awareness of the initiative and adoption of the standards by a substantial proportion of respondents. Most respondents indicated a belief that creation of the standards improved patient safety.

As a part of a research project on the development of a low-cost sensor system for use on gyrocopters several investigations on the recording of aerial image blocks have been carried out during the last two years. The vibration of the gyrocopter platform is one of the critical factors that should be mitigated during the data collection. Apart from the wind-induced oscillation, the vibration induced by the motor, the propeller and the main rotor are prominent. To prevent negative impact to the imaging process, vibration absorbers are to be implemented on the sensor platform. One focus of this research is a comparison between the vibrations within the passenger area and the vibrations at the undercarriage of the gyrocopter. The comparison is based on the use of three synchronized micro-electro mechanical motion trackers (MEMS IMUs), one fixed on the gyrocopter floor and the others fixed on the struts of the gyrocopter. The results indicate that the propeller and rotorinduced vibrations are somewhat bigger within the passenger area. Fourier analysis shows that the rotor-induced vibration at a frequency of 12 Hz is predominant in all signals; its amplitude may vary strongly in time. Whereas the translational vibrations have negligible impact on the image quality, rotational vibrations around all three axes may effect significant blurring of aerial images according to common quality standards.

To evaluate the performance of the first-trimester combined test (FCT) in different maternal age groups and to discuss whether adjustments in screening policies should be made. In this retrospective study data (n = 26 274) from a fetal medicine center on FCT (maternal age, fetal NT, free β-human chorionic gonadotrophin, pregnancy-associated plasma protein-A) were studied. 70.6% of cases was

Objective To evaluate marker distribution of free β-human chorionic gonadotrophin (fβ-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in singleton pregnancies conceived by assisted reproduction techniques (ART). Methods In vitro fertilization (IVF) (n = 203) and intracytoplasmic sperm injection (ICSI) (n = 192) cases from a database of 14 645 first-trimester combined tests (overall study group) were selected and matched to 1164 controls for gestational age at sample date and maternal age. Results In the IVF group and ICSI group, lnPAPP-A was lower (IVF 6.74 vs 7.08; P = 0.0001; ICSI 6.59 vs 7.07; P = 0.0001) compared with the matched controls. Lnfβ-hCG was lower in the IVF group (3.75 vs 3.90; P = 0.005) but not significantly different in the ICSI group (3.87 vs 3.93; P = 0.27). The computed correction factors for PAPP-A and fβ-hCG were 1.42 and 1.17 for the IVF group and 1.56 and 1.05 for the ICSI group. The false-positive rate (FPR) in the IVF and ICSI group compared with the matched controls was higher (IVF 10.3% vs 8.6% and ICSI 10.9% vs 7.5%). In the overall age-biased [maternal age significantly lower compared with all ART and control groups] study group the FPR was 6.8%. Conclusion The increase in FPR in the ART groups can be explained by decreased PAPP-A values. Therefore, an adjustment in risk analysis for Down syndrome is suggested. Copyright © 2010 John Wiley & Sons, Ltd.

The purpose of this study was to determine if changes in heart rate variability during incremental exercise could be used to estimate lactate threshold and ventilatory threshold in healthy adults. Twenty-four adults performed graded maximal cycle ergometry to volitional fatigue. Blood lactate, heart rate, RR interval, and respiratory gas exchange were monitored. Heart rate variability was analyzed using time domain indices (standard deviation and mean successive difference). A marked RR interval deflection point was found in the region of lactate threshold and ventilatory threshold, and was identified as the heart rate variability threshold. Mean differences between heart rate variability threshold, ventilatory threshold, and lactate threshold ranged from 0.06 +/- 0.3 to 0.12 +/- 0.2 L.min (-1). Correlations between the different measures ranged from 0.82 - 0.89. A small but significant difference was found between ventilatory threshold and lactate threshold (p0.05). There was not a significant difference between heart rate variability threshold and lactate threshold (p0.05), nor between heart rate variability threshold and ventilatory threshold (p0.05). The data suggest the heart rate variability threshold coincides with lactate threshold and ventilatory threshold during graded exercise and can be used for the detection of lactate threshold in healthy adults.

Purpose An academic medical center’s strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). Methods The department’s pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Results Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was “improved measurement and reporting of the impact of PPMI programs on patient outcomes.” Conclusion A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects.

The purpose of this study was: (a) to evaluate secretory immunoglobulin A (s-IgA) over a 12-month time period in college football players, and (b) to assess which of the commonly used standard methods of reporting s-IgA, either alone or in combination, serves as the best predictor of incidence of upper respiratory tract infection (URTI).One hundred college-aged males (75 varsity college football athletes, 25 nonfootball controls) were studied at eight points over a 12-month period. Resting mucosal IgA, protein and osmolality levels were determined from saliva using established procedures. In addition, incidence of URTI over the 12-month study duration was calculated from completed standard research logs. Repeated-measures ANOVA were conducted on the dependent variables and eight separate stepwise multiple regression analyses were conducted to predict the dependent variable "number of colds" by the independent variables, s-IgA, saliva flow rate, secretion rate of s-IgA, protein, s-IgA:protein, osmolality and s-IgA:osmolality at each data collection point.There was a significant main effect for group, time, and the group x time interaction for s-IgA, the secretion rate of s-IgA, and the number of colds. In the regression model, the only variable that made a significant contribution to the variance at all time points was the secretion rate of s-IgA.These findings suggest that a season of training in American football results in a significant decrease in both s-IgA and the secretion rate of s-IgA as well as an increase in the incidence of URTI. Among the various methods commonly employed to express s- IgA levels, the secretion rate of s-IgA may be the most useful clinical biomarker to predict the incidence of URTI.

Objective. To describe the cases of 2 fetuses with aneurysms of the vein of Galen diagnosed prenatally. Methods. The techniques used were conventional sonography, three-dimensional sonography, and ultrafast magnetic resonance imaging. On the basis of these imaging modalities, prognostic factors, such as drainage and secondary damage, were assessed. Results. The first fetus had good prognostic indices, and embolization after birth was successful. According to the prognostic factors, a poor neonatal outcome was predicted for the second fetus. The neonate died soon after birth. Conclusions. Conventional sonography, color Doppler imaging, and magnetic resonance imaging appeared to be useful diagnostic tools. The prognostic factors can be useful in counseling patients and providing the best possible care after birth.

This study examined the efficacy of ginseng to modulate secretory immunoglobulin A (SIgA), exercise performance, and recovery from repeated bouts of strenuous physical exertion.Using a double-blind, placebo-controlled, randomized design, 38 active healthy adults supplemented their diets with a standardized ginseng concentrate (400 mg.d-1 of G115; equivalent to 2 g of Panax ginseng C.A. Meyer root material) or placebo (lactose) for 8 wk. Before and after the intervention, each subject performed three consecutive 30-s Wingate tests interspersed with 3-min recovery periods under controlled laboratory conditions. SIgA secretion rate (S-SIgA) and the relation of SIgA to total protein were calculated from measures of saliva flow rate (SFR), and absolute SIgA and salivary protein concentrations in timed, whole unstimulated saliva samples collected before and after exercise testing. Peak and mean mechanical power output (W.kg-1) was measured with an infrared-beam optical-sensor array, and exercise recovery heart rate (HRR) was determined electrocardiographically.Twenty-seven subjects (12 placebo, 15 ginseng) completed the study. Compared with rest, S-SIgA, SIgA:protein ratio, and SFR were lower after exercise at baseline (P0.05). Similarly, both peak and mean mechanical power output declined (P0.01) across consecutive Wingate tests. Postintervention minus preintervention change scores for salivary parameters, exercise performance, and HRR were similar between ginseng- and placebo-treated groups (P0.05).These findings do not support the hypothesis that ginseng may affect mucosal immunity as indicated by changes in secretory IgA at rest and after an exercise induced state of homeostatic disturbance. Supplementation with ginseng fails to improve physical performance and heart rate recovery of individuals undergoing repeated bouts of exhausting exercise.

Item does not contain fulltext OBJECTIVE: The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. STUDY DESIGN: This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. RESULTS: We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P < .001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins. CONCLUSION: In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.

Objective Ginseng is a popular, commercially available dietary supplement that is purported to have a number of psychological benefits. The purpose of this study was to examine these claims, with specific reference to ginseng's effects on affect and mood. Design Prospective, double-blind, placebo-controlled, randomized clinical trial. Participants/setting Eighty-three adults (40 women, 43 men) participated in this study (mean age=25.7 year). Participants were recruited from within a university community and at area health clubs. Intervention Participants were randomly assigned to one of three experimental conditions: placebo (lactose), 200mg ginseng, or 400mg ginseng. The ginseng preparation used in this study consisted of the Panax ginseng C A Meyer concentrate G115 in capsular format. Each participant was given a 60-day allotment of their respective supplement along with written instructions about the proper intake and storage of the capsules during the 8-week study period. Main outcome measures Positive affect, negative affect, and total mood disturbance. Measures were obtained pre- and post-intervention. Statistical analyses performed Repeated measures multivariate analysis of variance was used. Because there were three dependent variables, and in an effort to minimize the experimentwise-error rate, α was adjusted using the Bonferroni technique (ie, P P Results Ginseng supplementation had no effect on positive affect, negative affect, or total mood disturbance (all P >.016). Conclusion The present findings do not support claims that chronic ginseng supplementation—at either its clinically recommended level or at twice that level—enhances affect or mood in healthy young adults. J Am Diet Assoc. 2001;101:655-660 .

Objective. To evaluate the implementation of an integrated medicinal chemistry/pharmacology course sequence and its alignment with a therapeutics series. Design. Each topic was divided into modules consisting of 2-hour blocks, and the content was integrated and aligned with the therapeutics series. Recitation sessions emphasizing application skills in an interactive environment followed each of three 2-hour blocks. To ensure that students achieved competency in each unit, students failing any unit examination were encouraged to undergo remediation. Assessment. Student feedback was collected by an independent researcher through social media and focus groups and relayed anonymously to course directors for midcourse improvements. Responses from surveys, interviews, and student ratings of faculty members and of courses were used to implement changes for future editions of the courses. Conclusion. The majority of students and faculty members felt the integration and alignment processes were beneficial changes to the curriculum. Elements of the new sequence, including remediation, were viewed positively by students and faculty members as well.

Objective To study the effect of different government prenatal screening (PNS) policies on the uptake of PNS and prenatal diagnostic testing (PND) over the periods 2001-2003 (PNS on request), 2004-2006 (permission to offer the first-trimester combined test (FCT) to women of advanced maternal age (AMA), with women aged

Introduction: The objective of this study was to evaluate the performance of first-trimester Down syndrome (DS) screening with serum sampling at different weeks of gestation. Material and Methods: We studied 35,431 singleton pregnancies (2005-2011), including 145 DS cases. Screening performance was determined in different maternal age groups with serum sampling between weeks 9 + 0 and 13 + 6. Results: No significant differences were found between the detection rates at different gestational weeks. The false-positive rate (FPR) in week 9 (6%) was comparable to the FPR in week 10 (6.5%; p = 0.214), whereas it was significantly lower compared to weeks 11 (7.2%; p = 0.007), 12 (7.4%; p = 0.003) and 13 (8.5%; p < 0.001). The odds of receiving a false-positive result was significantly increased with serum sampling in week 11 (OR 1.32, 95% CI 1.08-1.63; p = 0.008) for women ≥36 years and from week 12 onwards (OR 1.28, 95% CI 1.01-1.61; p = 0.04) for women 10 multiple of the median values of pregnancy-associated plasma protein-A, free β-human chorionic gonadotrophin or nuchal translucency between both age groups, nor in mean maternal age between the different gestational weeks in either age group. Discussion: Early serum sampling (

Objective To assess the effects of chronic supplementation with two different dosages of Panax ginseng C.A. Meyer on physiologic and psychological responses during graded maximal aerobic exercise. Design Randomized, double-blind, placebo-controlled trial. Subjects Thirty-six healthy men consuming an otherwise supplement-free diet who maintained their usual activity level. Intervention A standardized P ginseng C.A. Meyer concentrate (G115) was added to the normal diet of study participants at a dosage level of either 200 or 400 mg/day, where 100 mg of the preparation is equivalent to 500 mg P ginseng root. Main outcome measures Submaximal and maximal aerobic exercise responses before and after an 8-week trial intervention. Statistical analyses performed Analysis of variance. Results Thirty-one subjects completed the study. Supplementation with ginseng had no effect on the following physiologic and psychological parameters: oxygen consumption (mL/kg per minute), respiratory exchange ratio, minute ventilation (L/min), blood lactic acid concentration (mmol/L), heart rate (beats/min), and perceived exertion ( P >.05). Conclusions Our data in healthy men do not offer support for claims that P ginseng C.A. Meyer is an ergogenic aid to improve submaximal and maximal aerobic exercise performance. J Am Diet Assoc. 1997;97:1110–1115.

Ginseng has long been used for various medicinal reasons in East Asia and has recently also become a popular nutritional supplement in Western countries. Although commonly alleged to increase work performance by enhancing the body resistance to stress and fatigue, human experimental research evidence to either support or refute these claims is limited and conflicting. Therefore, this randomized, double-blind, placebo-controlled study served to examine a group of healthy adult females who for eight weeks added 200 mg·day −1 of a concentrated extract of Panax Ginseng C.A. Meyer (n=10) or placebo (n=9) to their otherwise supplement-free normal diet. Before and after the trial intervention, each subject performed a graded maximal cycle ergometry test to exhaustion and completed a standard habitual physical activity questionnaire. It was observed that chronic ginseng supplementation had no effect on maximal work performance (J) and resting, exercise, and recovery oxygen uptake (VO 2 , ml·kg −1 ·min −1 ), respiratory exchange ratio (RER), minute ventilation (VE, L·min −1 ), heart rate (beats·min −1 ), and blood lactic acid (mmol·L −1 ) levels (p>0.05). Habitual physical activity scores of study participants were found to be similar between the placebo and ginseng treatment groups and at the beginning and end of the eight week trial period (p>0.05). The present data in healthy adult females indicate that chronic dietary supplementation with a standardized extract of Panax Ginseng C.A. Meyer does not result in an enhancement of work performance or a change in energy metabolism and improvement of the recovery response from maximal physical work.

This study examined the acute physiological responses to steady-rate walking with additional weight carried at shoulder level. Sixteen healthy subjects completed two treadmill walking bouts with and without a 4.54-kg shoulder-worn load carriage system in place. Addition of the external shoulder weights resulted in small increases in level walking oxygen uptake (+0.44 ml.kg-1.min-1; +0.03 L.min-1) and minute ventilation volumes (+0.81 L.min-1) (p0.05). RER values, heart rate (+3 beats.min-1), and blood pressure responses [systolic blood pressure (SBP) + 4.5 mm Hg, diastolic blood pressure (DBP) + 1.3 mm Hg] were not significantly changed (p0.05). These findings indicate that the efficacy of shoulder-worn exercise weights to augment the physiological demand of walking exercise is marginal at best.

The effect of adding external weights to the body of participants in a 10‐week low‐impact aerobic dance program (3 days/week, 50 minutes/session, 60 to 90% of maximum heart rate [HRmax]) on aerobic power and body composition was studied in 20 college women. Subjects were randomly assigned to either a regular low‐impact aerobic dance group (NWT) or to a low‐impact aerobic dance group (WT) whose participants also carried added weights (1.5 lb/ankle; 3.0 lb/hand) during training. Pre‐ and post‐training aerobic power and body composition measurements were made on 17 subjects who completed the program. A repeated measures ANOVA revealed a significant overall reduction in body fat percentage (‐2.9%) and fat weight, and an increase in maximum oxygen consumption (VO2max; 3.2 mL‐kg‐1 min‐1; 0.2 L‐min‐1), maximum minute ventilation VEmax; 10.1 L‐min‐1) and fat‐free weight following training (p ≤ 0.05). However, there was no group mean difference between any of the same variables in the WT and NWT groups. In additio...

32 postmenopausal women were randomized to a 16-week home-based walking program or control group. Before and after the intervention, each subject completed a graded maximal treadmill test to establish VO(2)max and resting saliva was collected to determine levels of salivary immunoglobulin A. The 16-week walking program resulted in an increase in VO(2)max (+10.4%; p

Caffeine has many diverse physiological effects including central nervous system stimulation. Ventilatory threshold and a recently described heart rate variability threshold both have a relationship with autonomic control that could be altered by caffeine consumption. The purpose of this investigation was to determine the influence of caffeine on lactate, ventilatory, and heart rate variability thresholds during progressive exercise. Using a randomized placebo controlled, double-blind study design, 10 adults performed 2 graded maximal cycle ergometry tests with and without caffeine (5 mg·kg⁻¹). Respiratory gas exchange, blood lactate concentrations, and heart rate variability data were obtained at baseline and throughout exercise.At rest, caffeine (p0.05) increased blood lactate, oxygen consumption, carbon dioxide production, and minute ventilation. For indices of heart rate variability at rest, caffeine increased (p0.05) the coefficient of variation, while standard deviation, and mean successive difference displayed non-significant increases. During progressive exercise, minute ventilation volumes were higher in caffeine trials but no other parameters were significantly different compared to placebo tests.These data demonstrate the robustness of the lactate, ventilatory and heart rate variability thresholds when challenged by a physiological dose of caffeine.

The approach of this priority crop wild relatives (CWR) and landraces (LR) conservation exercise was to use the skills and knowledge of 52 ECPGR in situ and on-farm conservation network members and other conference delegates, representing a broad European range of PGR-related academic, research and NGO organizations, to identify the short- and longer-term issues that are/will impact on European CW…

This article describes the results of a survey among employees at Wayne State University that were designed to determine the desire for and willingness to participate in a campus wellness program. All 4,300 employees were mailed a questionnaire during the period March-June 1989. Among the 2,401 respondents (56% response rate), 81% felt a wellness program should be offered and 57% indicated an intention to participate. A significantly higherpercentage ofBlacks (77%) and women (62%) stated they would participate as compared to Whites (51%) and men (51%). There was an inverse relationship between desire for the program and income level; those who held commercial health club memberships and resided closerto campus showed higher interest. In the overall sample, lunchtime activities were the most requested. Types of services most requested included health screening (e.g., cholesterol testing and fitness assessment) and exercise classes.

The purpose of this investigation was to determine the effect of an acute bout of high-volume, full-body resistance training with an eccentric concentration on resting energy expenditure (REE) and indicators of delayed-onset muscle soreness (DOMS). Eight resistance trained (RT) and eight untrained (UT) participants (mean: age = 23.5 years; height = 180.76 cm; weight = 87.58 kg; body fat = 19.34%; lean mass = 68.71 kg) were measured on four consecutive mornings for REE and indicators of DOMS: creatine kinase (CK) and rating of perceived muscle soreness (RPMS). Delayed-onset muscle soreness was induced by performing eight exercises, eight sets, and six repetitions using a 1-second concentric and 3-second eccentric muscle action duration. A two-factor repeated-measures analysis of variance revealed that REE was significantly (p < 0.05) elevated at 24, 48, and 72 hours post compared with baseline measures for both UT and RT groups. Ratings of perceived muscle soreness were significantly elevated within groups for UT and RT at 24 and 48 hours post and for UT only at 72 hours post compared with baseline (p < 0.05). Nonparametric analyses revealed that CK was significantly increased at 24 hours post for both UT and RT and at 48 and 72 hours post for UT only compared with baseline (p < 0.05). Resting energy expenditure and indicators of DOMS were higher in UT compared with RT on all measures, but no significant differences were determined. The main finding of this investigation is that full-body resistance training with an eccentric concentration significantly increased REE up to 72 hours postexercise in UT and RT participants.

Objectives To construct reference intervals for fetal lung volumes measured longitudinally using three-dimensional (3D) ultrasound, and to evaluate the effect of gender on lung size. Methods This was a prospective, longitudinal study in the obstetric outpatient department of the VU University Medical Center, Amsterdam. Seventy-eight women with uncomplicated pregnancies were scanned three to four times at gestational ages of 18–34 weeks. 3D models of the lung were constructed using the ultrasound machine's software. After the infants were delivered the entire group was reanalyzed with regard to fetal gender. Centiles for the lung volumes of the entire group and for each gender separately were estimated using multilevel modeling. Results Charts and tables of right and left fetal lung volumes, using gestational age and estimated fetal weight as the independent variables, are presented. There was a significant difference in lung volume between male and female fetuses at each gestational age. Charts and tables of right and left fetal lung volumes for each gender at gestational ages of 18–34 weeks are also presented. Conclusions We present valid references for volumetric measurements of the right and left fetal lungs in male and female fetuses. The feasibility and reliability of fetal lung volume measurements using 3D ultrasound is good. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.

This study examined the effectiveness of a unique extracurricular after-school initiative designed to promote healthy diets and exercise in urban African Americans. The Students and Parents Actively Involved in Being Fit after-school program was offered for 12 weeks to students and their parents/guardians at an urban middle school. Specific aims of the intervention were to increase participants' vegetable and fruit intake by using established 5 A Day for Better Health educational resource materials/activities and to affect their health-related fitness through dance, games, and fitness activities. Fifty-six children and 25 parents/guardians completed a standard battery of evaluations before and after the program. Pre-post pairwise t test revealed that both children and their parents/guardians showed an increase in fruit consumption and a reduction in diastolic blood pressure (P.05). Moreover, children showed improvements in systolic blood pressure and fruit juice, salad, and nonfried potato consumption while parents/guardians showed a decrease in body fat, body mass index, and endurance walk/run time (P.05). Overall, findings indicate that children tended to gain more diet-related benefits while parents/guardians tended to derive more fitness-related benefits. After-school programs like the Students and Parents Actively Involved in Being Fit initiative can potentially contribute to improved health levels in urban African Americans.