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Background/Objective Neurostimulants may improve or accelerate cognitive and functional recovery after intracerebral hemorrhage (ICH), ischemic stroke (IS), or subarachnoid hemorrhage (SAH), but few studies have described their safety and effectiveness in the intensive care unit (ICU). The objective of this study was to describe amantadine and modafinil administration practices during acute stroke care starting in the ICU and to evaluate safety and effectiveness. Methods Consecutive adult ICU patients treated with amantadine and/or modafinil following acute non-traumatic IS, ICH, or SAH were evaluated. Neurostimulant administration data were extracted from the electronic medication administration record, including medication (amantadine, modafinil, or both), starting dose, time from stroke to initiation, and whether the neurostimulant was continued at hospital discharge. Patients were considered responders if they met two of three criteria within 9 days of neurostimulant initiation: increase in Glasgow coma scale (GCS) score ≥ 3 points from pre-treatment baseline, improved wakefulness or participation documented in caregiver notes, or clinical improvement documented in physical or occupational therapy notes. Potential confounders of the effectiveness assessment and adverse drug effects were also recorded. Results A total of 87 patients were evaluable during the 3.7-year study period, including 41 (47%) with ICH, 29 (33%) with IS, and 17 (20%) with SAH. The initial neurostimulant administered was amantadine in 71 (82%) patients, modafinil in 13 (15%), or both in 3 (3%) patients. Neurostimulants were initiated a median of 7 (4.25, 12.75) days post-stroke (range 1–27 days) for somnolence (77%), not following commands (32%), lack of eye opening (28%), or low GCS (17%). The most common starting dose was 100 mg twice daily for both amantadine (86%) and modafinil (54%). Of the 79 patients included in the effectiveness evaluation, 42 (53%) were considered responders, including 34/62 (55%) receiving amantadine monotherapy and 8/24 (33%) receiving both amantadine and modafinil at the time they met the definition of a responder. No patient receiving modafinil monotherapy was considered a responder. The median time from initiation to response was 3 (2, 5) days. Responders were more frequently discharged home or to acute rehabilitation compared to non-responders (90% vs 62%, p = 0.006). Among survivors, 63/72 (88%) were prescribed a neurostimulant at hospital discharge. The most common potential adverse drug effect was sleep disruption (16%). Conclusions Neurostimulant administration during acute stroke care may improve wakefulness. Future controlled studies with a neurostimulant administration protocol, prospective evaluation, and discretely defined response and safety criteria are needed to confirm these encouraging findings. Electronic supplementary material The online version of this article (10.1007/s12028-020-00986-4) contains supplementary material, which is available to authorized users.

Amantadine and modafinil are neurostimulants that may improve cognitive and functional recovery post-stroke, but the existing study results vary, and no comprehensive review has been published. This systematic review describes amantadine and modafinil administration practices post-stroke, evaluates timing and impact on clinical effectiveness measures, and identifies the incidence of potential adverse drug effects. A librarian-assisted search of the MEDLINE (PubMed) and EMBASE databases identified all English-language publications with “amantadine” or “modafinil” in the title or abstract from inception through February 1, 2020. Publications meeting predefined Patient, Intervention, Comparator, Outcome (PICO) criteria were included: Patients (≥ 18 years of age post-stroke); Intervention (amantadine or modafinil administration); Comparison (pretreatment baseline or control group); Outcomes (cognitive or functional outcome). Amantadine and modafinil administration practices, cognitive and functional outcomes, and incidence of potential adverse drug effects were collected following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidance. Quantitative analyses were not performed due to heterogeneity in the clinical effectiveness measures; descriptive data are presented as number (percent) or median (interquartile range). Of 12,620 publications initially identified, 10 amantadine publications (n = 121 patients) and 12 modafinil publications (n = 120 patients) were included. Amantadine was initiated 39 (16, 385) days post-stroke, with most common initial doses of 100 mg once or twice daily (range 100–200 mg/day), and final daily dose of 200 (188, 200) mg/day. Modafinil was initiated 170 (17, 496) days post-stroke, with initial and final daily doses of 100 (100, 350) mg/day and 200 (100, 350) mg/day, respectively. The most common indication was consciousness disorders for amantadine (n = 3/10 publications; 30%) and fatigue for modafinil (n = 5/12; 42%). Forty unique clinical effectiveness measures (1.8 per study) with 141 domains (6.4 per study) were described across all studies. A positive response in at least one clinical effectiveness measure was reported in 70% of amantadine publications and 83% of modafinil publications. Only one publication each for amantadine (10%; n = 5 patients) and modafinil (8%; n = 21 patients) studied acutely hospitalized or ICU patients; both were randomized studies showing improvements in neurocognitive function for amantadine and fatigue for modafinil. Potential adverse drug effects were reported in approximately 50% of publications, most commonly visual hallucinations with amantadine (2% of patients) and dizziness (5% of patients) and dry eyes or mouth (5% of patients). Amantadine and modafinil may improve cognitive and functional recovery post-stroke, but higher-quality data are needed to confirm this conclusion, especially in the acute care setting.

We report the development and field validation of 2 ELISAs for the detection of Ancylostoma caninum or Toxocara canis coproantigens in the feces of dogs with experimental and natural infections, and evidence of cross-reactivity with respective feline counterparts. A. caninum–specific coproantigens were detected in feces of experimentally infected dogs starting at 9 d post-infection (dpi), whereas eggs were not seen until 23 dpi. T. canis–specific coproantigens were detected in 3 of 5 experimentally infected dogs by 31 dpi, and 4 of the 5 animals by 38 dpi. T. canis eggs were seen in feces of 4 of the 5 animals by 38 dpi. One dog had delayed coproantigen detection and low egg output. Additionally, 817 canine and 183 feline fecal samples from naturally infected animals tested by flotation were subjected to coproantigen ELISA testing. Of these 1,000 canine and feline samples, 13 and 23 samples, respectively, were positive for “hookworm” or “roundworm” eggs; 19 and 26 samples were ELISA positive, respectively. The T. canis ELISA detected T. cati coproantigen in cat fecal samples. Discrepant ELISA and flotation results were obtained for 16 hookworm- and 13 roundworm-positive samples. Re-examination of the egg-positive, ELISA-negative samples indicated several instances of possible misidentification or coprophagy, whereas detection of antigen in samples without egg observations is likely a reflection of true infection status with egg shedding below detection levels. There is good indication, based on accumulated field data, that these antigen tests also detect other hookworm and ascarid species.

The public perception of social work in the early twentieth century, often indeterminate and laden with sentimental overtones, was one that practitioners sought to change to a perception of scientific expertise. A close link between science and professionalism was strongly desired, which did not bode well for women in the field. A close reading of popular articles and social work publications from the heady days of the field’s early efforts at professionalization suggest that women were marginalized and not always welcomed, contrary to the historical narrative. Considered unscientific and emotional, women were circumscribed by the public discussion over social work’s definition and purpose and found that institutions sought men for their paid positions, paid women less when they did receive salaries, and granted them limited status, due to a tangled web of gender roles and expectations. Though social work was a field open to women, this openness had fierce limitations.

We report the results of a genomewide scan for age-related macular degeneration (AMD) in 158 multiplex families. AMD classification was based on fundus photography and was assigned a grade ranging from 1 (no disease) to 5 (exudative disease). Genotyping was performed by the National Heart, Lung, and Blood Institute Mammalian Genotyping Service at Marshfield (404 short tandem repeat markers). The sample included 158 families with two or more siblings with AMD, 490 affected individuals, 101 unaffected individuals, and 38 whose affection status was unknown. Relative pairs included 511 affected sibling, 28 avuncular, 53 cousin, 7 grandparent-grandchild, and 9 grand-avuncular pairs. Two-point parametric and multipoint parametric and nonparametric analyses were performed. Maximum two-point LOD scores of 1.0-2.0 were found for markers on chromosomes 1, 2, 8, 10, 14, 15, and 22. Multipoint analyses were consistent with the two-point results for chromosomes 1, 2, 8, 10, and 22 and provided evidence for additional linkage regions on chromosomes 3, 6, 8, 12, 16, and X. Our signals on chromosomes 1q, 6p, and 10q are consistent with some other previously published results. Significant linkage to AMD was found for one marker on chromosome 2, two adjacent markers on chromosome 3, two adjacent markers on chromosome 6, and seven contiguous markers on chromosome 8, with empirical P values of .00001. The consistency of many of the other signals across both two-point and multipoint, as well as parametric and nonparametric, analyses indicate several other regions worthy of follow-up.

Purpose The relationships between reproductive risk factors, including use of hormone replacement therapy and oral contraceptives and severity of age-related maculopathy (ARM) among postmenopausal women were evaluated. We hypothesized that exposure to endogenous or exogenous estrogens would be associated with a reduced risk of advanced ARM. Design Cross-sectional study. Methods The 394 subjects were postmenopausal women with ARM. Logistic regression analysis was used to compare the effects of several reproductive factors across two groups: 193 subjects with nonadvanced ARM and 201 subjects with advanced ARM. Results Women with ARM who had used postmenopausal estrogen therapy in the past had significantly lower odds of advanced ARM than nonusers, after controlling for other known and potential risk factors (odds ratio [OR] = 0.5, 95% confidence interval [CI] = 0.30 to 0.98). Older age at menarche was associated with increased odds of advanced ARM (OR = 1.16, 95% CI = 1.00 to 1.35). Conclusions These findings suggest that exposure to exogenous estrogens may have a beneficial effect of reducing the risk of advanced types of ARM in postmenopausal women with ARM. Few therapeutic or preventive measures currently exist for ARM; therefore, these results deserve further evaluation.

Purpose: To guide the development of an intervention to reduce the incidence of sexually transmitted diseases (STDs) in urban, adolescent girls, we investigated such girls' reasons for deciding to have or not to have sexual intercourse. Methods: Consecutive girls ≥14 years of age attending an urban adolescent clinic were invited to complete an anonymous survey about sexual decision-making. In this pilot study, girls were asked: (a) whether they agreed with a statement that they had or had not had sexual intercourse "because of my values and beliefs"; and (b) to select from a list one or more specific reasons why they had or had not had intercourse. The girls were categorized by self-report as either "virgins," "currently inactive" (no intercourse in the preceding 3 months), or "currently active" (had intercourse during the preceding 3 months). Results: Usable surveys were obtained from 197 adolescents whose age (18.2 ± 2.6 years) and race (69% black) were comparable to those of clinic attendees in general. Forty girls (20%; age 16.1 ± 2.1 years) were virgins, 25 girls (13%; age 17.8 ± 2.3 years) were inactive, and 132 girls (67%; age 18.9 ± 2.5 years) were currently active. "Values and beliefs" were cited as the reason for decisions about sexual behavior by 53% of the virgins, but only by 24% of the sexually inactive and 24% of the sexually active girls ( p = .002). Virgins were more likely than inactive girls to cite three specific reasons for not having sex: "not the right thing for me now" (82% vs. 50%, p = .007), "waiting until I am older" (69% vs. 8%, p = .001), and "waiting until I am married" (67% vs. 38%, p = .02). The reason "against my religious beliefs" was cited by 23% of virgins and 13% of inactive girls ( p = not significant). Personal values were implicit in the two specific reasons for having sex that active girls chose most frequently, namely, "I like/love the person" (86%) and "I like having sex" (37%), although only 24% of these girls had explicitly cited "values and beliefs" as their reason for having sex. Conclusions: Our data indicate that urban girls, both those who have had sexual intercourse and those who have not, view their sexual behavior as being based on personal (although infrequently religious) values. Many of the virginal urban, adolescent girls we surveyed hold abstinence as a personal value. The sexually active adolescents perceive the decision to have sexual intercourse as being based affirmatively on their personal values rather than on the chance occurrence of opportunities to have intercourse. These data may be useful in the development of new strategies for reducing urban adolescent girls' risk of acquiring sexually transmitted diseases.

The US Department of Transportation (DOT) regulates on-the-job alcohol use by operators of certain categories of commercial transport. For aircraft, trains, and commercial vessels, operators are subject to sanctions for having > or = 0.04 g% blood alcohol concentration (BAC). This study examines the effects of alcohol (between 0.04 and 0.05 g% BAC) on simulated merchant ship handling. A two-group randomized factorial design was used to compare beverage alcohol to placebo while controlling for baseline performance on a previous day. The study was conducted in the Maritime Simulation Center at Maine Maritime Academy, Castine, ME. Participants were 38 volunteer deck officer cadets in their junior or senior year, at least 21 years of age, with previous experience on a bridge simulator. Following a baseline trial on Day 1, on Day 2 participants were randomized to receive alcohol (0.6 g/kg for males and 0.5 g/kg for females) or placebo. After allowing time for absorption, participants completed a bridge simulator task. For baseline and performance trials, participants were randomized to one of four bridge simulator scenarios, each representing passage of a fully loaded container vessel through a channel with commercial traffic. The aggregate scenario score given by blinded maritime educators measured performance. A main effect for alcohol was found indicating that performance was significantly impaired by this low dose of alcohol relative to performance in the placebo condition. These findings are consistent with current federal regulations that limit low-dose alcohol exposure for the operators of commercial transport vehicles. Further research is required to determine effects at lower BACs.

Objective: To use the Model of Human Occupation as a conceptual framework to assess the contribution falls self-efficacy makes to six measures of occupational adaptation.Methods: Two-hundred and seventy randomly selected senior housing residents, aged ▪62, were interviewed in their homes to collect information on demographics, fall history, fall risk factors, fear of falling, and measures of adaptation. The response rate was 63%. Linear regressions were conducted to achieve the study objective.Results: Fifty-five percent of respondents expressed fear of falling during the next year. Falls self-efficacy related to falling independently contributed to 5 out of 6 measures of occupational adaptation.Conclusions: Results suggest that falls self-efficacy significantly influences occupational adaptation among community-dwelling older adults, independent of the actual risk and history of falls. Although further verification of these results is needed, results of this study suggest use of interventions designed to...

Because of the threat of Fetal Alcohol Syndrome, pregnant women have been a primary target for interventions that provide information about the risk associated with drinking during pregnancy. In a general population sample of pregnant women, the relationships between alcohol consumption in pregnant women and exposure to four sources of health messages are investigated. Sources included alcohol beverage container labels, point of sale signs, advertisements, and personal conversations. Results from a five year cross-sectional U.S. national survey and a two year longitudinal study of women of childbearing age (18–40 yrs) indicate that the vast majority of the drinking women (80 percent) decrease their alcohol consumption during pregnancy, with 61 percent of the drinkers abstaining completely. Pregnant women who do drink reported consuming relatively low quantities of alcohol, with only four percent consuming more than three drinks in a single day. Unlike previous research, no differences were found ...

Context Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among older individuals in many parts of the world. The relative importance of genes and environment in the etiology of this major public health problem is not well understood. Objective To investigate the impact of genetic and environmental factors. Participants Living twins in the National Academy of Sciences–National Research Council World War II Veteran Twin Registry born between 1917 and 1927. Methods Twins were surveyed for the known presence of macular degeneration. Enrolled twins underwent a standardized examination and fundus photography. Age-related macular degeneration evaluation was completed for 840 elderly male twins, 210 monozygotic and 181 dizygotic complete twin pairs, both concordant and discordant for presence or absence of AMD, and 58 singletons. A bivariate twin model incorporating initial screening ascertainment and age effects was employed to partition variation in liability to AMD and signs of maculopathy into additive genetic, common environment, and unique environment components. Main Outcome Measure Heritability of AMD grade and signs of maculopathy based on clinical examination and fundus photographs. Results Of the 840 twins, 331 had no signs of maculopathy and 241 had early signs, while 162 had intermediate AMD and 106 had advanced AMD. Heritability (additive genetic) estimates were significant for overall AMD grade (0.46) and for intermediate (0.67) and advanced (0.71) AMD. Significant unique environmental proportions of variance were also observed for these AMD variables (0.37, 0.19, and 0.24, respectively). Shared or common environmental contributions were not significant (0.05-0.17). For specific macular drusen and retinal pigment epithelial characteristics, significant genetic (0.26-0.71) and unique environmental (0.28-0.64) proportions of variance were detected. Conclusions Genetic factors play a substantial role in the etiology of AMD and associated macular characteristics, explaining 46% to 71% of the variation in the overall severity of the disease. Environmental factors unique to each twin also contribute to the occurrence of this disease. This quantification of relative genetic and environmental contributions to the development of AMD should guide future research on this important cause of blindness.

The Gilded Age and Progressive Era—spanning the period from Reconstruction's end in the 1870s until the First World War in the mid-1910s—is an extraordinarily complicated period in American history...

Background Individuals with early or intermediate stages of age-related macular degeneration (AMD) make up a large, growing segment of the elderly population. Evidence is sparse regarding modifiable factors that may decrease the risk of progression to the advanced forms of AMD. Objective To advise patients with a high risk for advanced forms of AMD about preventive measures through our evaluation of the relationship between dietary fat intake and the progression of early or intermediate AMD to the advanced stages of the disease associated with visual loss. Design A prospective cohort study with an average follow-up time of 4.6 years. Setting A hospital-based clinical retinal practice specializing in macular degeneration. Patients The 261 participants were aged 60 years and older and had some sign of nonexudative AMD and visual acuity of 20/200 or better in at least 1 eye. Main Outcome Measure Progression to advanced AMD, which was defined as having geographic atrophy or neovascular disease. Results Higher total fat intake increased the risk of progression to the advanced forms of AMD, with a relative risk (RR) of 2.90 (95% confidence interval, 1.15-7.32) for the highest fat-intake quartile relative to the lowest fat-intake quartile, after controlling for other factors ( P trend= .01). Animal fat intake was associated with a 2-fold increased risk of progression(RR, 2.29 for the highest quartile compared with the lowest quartile; 95% confidence interval, 0.91-5.72), although the trend for increasing risk with higher animal fat intake was not significant ( P =.09). Higher vegetable fat intake had a stronger relationship with increased risk of AMD progression with an RR of 3.82 (95% confidence interval, 1.58-9.28) for the highest quartile compared with the lowest quartile ( P trend = .003). Saturated, monounsaturated, polyunsaturated, and transunsaturated fats increased the likelihood of progression (RR, 2.09 and P trend = .08; RR, 2.21 and P trend = .04; RR, 2.28 and P trend = .04; RR, 2.39 and P trend = .008, respectively). Higher fish intake was associated with a lower risk of AMD progression among subjects with lower linoleic acid intake. Processed baked goods, which are higher in some of these fats, increased the rate of AMD progression approximately 2-fold, and nuts were protective. Conclusions Among individuals with the early or intermediate stages of AMD, total and specific types of fat intake, as well as some fat-containing food groups, modified the risk of progression to advanced AMD. Fish intake and nuts reduced risk. Since advanced AMD is associated with visual loss and reduced quality of life, these preventive measures deserve additional research and greater emphasis.

Aims. Under current US Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having ≥ 00. 04 g% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between 0.04 and 0.05 g% BAC) on the simulated operation of a commercial ship's power plant. Design. A balanced placebo design was used in which alcohol administration was fully crossed with expectancy that alcohol was administrated. Setting. The study was conducted at the Massachusetts Maritime Academy, Buzzards Bay, MA, USA. Participants. Participants were 18 volunteer engineering students in their senior year, at least 21 years of age, with previous experience on the diesel simulator. Intervention. Following a baseline trial on day 1, on day 2 participants were randomized to expectancy (told alcohol or placebo) and beverage (receive alcohol or placebo). The dosage was 0.6 g/kg for males and 0.5 g/kg for females. In both baseline and performance days, participants were randomized to one of four diesel simulator scenarios, each replicating a system failure in a power plant subsystem (e.g. main propulsion, electrical generating). Measurement. Performance was measured by time required for problem identification and remediation. Findings. A main effect for alcohol administration was found. In the alcohol condition, simulator performance time was almost twice as long (351 sec) as on the placebo condition (186 sec). The expectancy effect was not significant. Conclusion. These findings support the current federal policy on the hazards of this low alcohol level within the context of commercial shipping.

With a sample survey (N = 266) of elderly adults residing in six housing developments in Massachusetts, we used logistic regression to: (a) identify covariates of fear of falling among all subjects and (b) identify covariates of activity curtailment among the subset of subjects who were afraid of falling. Fifty-five percent of respondents were afraid of falling; of those who were afraid, 56% had curtailed activity due to this fear. Factors associated with fear of falling were: being female, having had previous falls, and having fewer social contacts. Factors associated with activity curtailment among those who were afraid were: not communicating about falls; having less social support; and knowing someone who had fallen. Falls history appears an important contributor to fear of falling, whereas the impact of this fear on activities appears more a function of social support. These findings suggest different strategies for the primary and secondary prevention of fear of falling.

Background Individuals with early or intermediate stages of age-related macular degeneration (AMD) make up a large and growing segment of our elderly population. To advise these high-risk patients regarding preventive measures, we evaluated anthropomorphic, behavioral, and medical factors associated with progression to the advanced stages of AMD associated with visual loss. Methods The design was a prospective cohort study in a hospital-based retinal practice. The 261 participants were 60 years or older, with some sign of nonadvanced AMD and visual acuity of 20/200 or better in at least 1 eye. The average follow-up time was 4.6 years, and the total person-years of follow-up was 1198. Factors associated with rates of progression to advanced AMD were assessed by the Cox proportional hazards model. Outcome Measures Progression to geographic atrophy and neovascular disease. Results Higher body mass index (calculated as weight in kilograms divided by the square of height in meters) increased the risk for progression to the advanced forms of AMD. Relative risk (RR) was 2.35 (95% confidence interval[CI], 1.27-4.34) for a body mass index of at least 30, and 2.32 (95% CI, 1.32-4.07) for a body mass index of 25 to 29, relative to the lowest category ( P = .007 for trend). Higher waist circumference was associated with a 2-fold increased risk for progression (RR for the highest tertile compared with the lowest, 2.04; 95% CI, 1.12-3.72), with a significant trend for increasing risk with a greater waist circumference ( P = .02). Higher waist-hip ratio also increased the risk for progression (RR, 1.84; 95% CI, 1.07-3.15) for the highest tertile compared with lowest ( P = .02 for trend). More physical activity tended to be associated with a reduced rate of progression (25% reduction for 3 times per week vigorous activity vs none, P = .05 to P = .07). Relative risks for smoking ranged from 1.48 to 1.99, but were not statistically significant. Conclusions Results provide new information regarding modifiable factors for individuals with the early or intermediate stages of this disease. Overall and abdominal obesity increased the risk for progression to advanced AMD, and more physical activity tended to decrease risk. These preventive measures deserve additional research and greater emphasis.

Personal Values about Sex among Virginal and Experienced Urban Adolescent Girls: Implications for Reducing STD Rates