Lower Severity Levels Research Articles

Port safety and the container revolution: A statistical study on human factor and occupational accidents over the long period

Several factors can affect occupational accident frequency, namely economical factors, technologies used (low automation, discontinuous operating) job design, organization of work/environmental conditions and human factors. In particular, technological advances in industrial activities can give rise to improvement in productivity and in occupational health and safety, but not necessarily simultaneously. The beginning of the container transport dates back to 50 years ago, but while containerization changed everything, from ships and ports to patterns of global trade, its impact on work injuries was not explored at all. The aim of this paper is to investigate the relationship between work organization, job experience, productivity and occupational accidents, from the starting of the container expansion to nowadays, considering Genoa port (Italy), one of the largest of the Mediterranean Sea. In order to minimize possible reporting biases, such as underreporting or reclassification to a lower level of severity, injury statistics are elaborated starting from data collected directly on-site, from internal accident or medical-aid reports. An in-depth statistical analysis on occupational injuries in the years 1980–2006 is carried out, with reference to frequency indexes, mechanism of injury and material causes. The increase of container-ships traffic and, consequently, the sharp change in port infrastructure involved a rapid modification also in the work organization, with particular reference to the number and characteristics of workforce (decrease from 5783 to nearly 1000 employees and increase of low experience workers from 28% to 74%). The striking high percentage increase of young or low experienced workers in handling container (and performing correlated new tasks) caused a remarkable increase of the risk for occupational injuries. In the studied port, we recorded an increase of the frequency index (injuries per hundred thousand hours worked) from 13.0 to 29.7. It results that the increased expansion of shipping container utilization is not connected to a correspondent human factor safety implementation. Main risk factors are pointed out, revealing an increase of accidents due to transport vehicle (+8.3%) and a reduction of accidents caused by substance or materials (−4.5%). These factors show a statistical significant correlation with the new job tasks. Consideration of these findings may enable managerial solutions and workplace organization interventions for the prevention of injuries and safety performance improvement in port activities.

An Item Response Theory Modeling of Alcohol and Marijuana Dependences: A National Drug Abuse Treatment Clinical Trials Network Study

The aim of this study was to examine psychometric properties of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostics criteria for alcohol and marijuana dependences among 462 alcohol users and 311 marijuana users enrolled in two multisite trials of the National Drug Abuse Treatment Clinical Trials Network. Diagnostic questions were assessed by the DSM-IV checklist. Data were analyzed by the item response theory and the multiple indicators-multiple causes method procedures. Criterion symptoms of alcohol and marijuana dependences exhibited a high level of internal consistency. All individual symptoms showed good discrimination in distinguishing alcohol or marijuana users between high and low severity levels of the continuum. In both groups, "withdrawal" appeared to measure the most severe symptom of the dependence continuum. There was little evidence of measurement nonequivalence in assessing symptoms of dependence by gender, age, race/ethnicity, and educational level. These findings highlight the clinical utility of the DSM-IV checklist in assessing alcohol- and marijuana dependence syndromes among treatment-seeking substance users.

Parkinson's disease epidemiology in the Northampton District, England, 1992.

In a population of 302,000, in a Midlands district of England, the estimated prevalence of idiopathic Parkinson's disease (IPD) increased from 108 to 121 per 100,000 from 1982 to 1992. Individual general practice prevalence ranged quite widely. Webster ratings were significantly more often scored in 1992, but at a lower level of severity, suggesting earlier diagnosis. Incidence in 1992 was estimated as 12 per 100,000 per annum. Micrographia, when copying interlocking pentagons, was significantly related to Hoehn & Yahr scores. Over the 10-year period, there has been a considerable change in prescribing: a positive response to medication was confirmed as a good diagnostic indicator. Progression of symptoms and an increase of physical disability was noted in those of the 1982 study alive in 1992.

Comparison of Foliar Spray Efficacy of Electrolytically Ozonated Water and Acidic Electrolyzed Oxidizing Water for Controlling Powdery Mildew Infection on Cucumber Leaves

We investigated and compared the effects of foliar sprays of electrolytically ozonated water (OW) and acidic electrolyzed oxidizing water (AEOW) on severity of powdery mildew infection (PMI) and occurrence of visible physiological disorder on cucumber leaves. Foliar spray of OW contained severity of PMI to almost the same level as the initial value, without any visible physiological disorder. Although severity of PMI on AEOW-sprayed leaves was significantly lower than on OW-sprayed leaves, the leaves showed a visible physiological disorder after the first spray. These results indicate that OW is a viable option for controlling PMI on cucumber leaves at low initial severity levels, or for prevention of PMI, and that AEOW can be used for controlling PMI with special efforts taken against a visible physiological disorder.

Food Security, Poverty, and Human Development in the United States

Access to food is essential to optimal development and function in children and adults. Food security, food insecurity, and hunger have been defined and a U.S. Food Security Scale was developed and is administered annually by the Census Bureau in its Current Population Survey. The eight child-referenced items now make up a Children's Food Security Scale. This review summarizes the data on household and children's food insecurity and its relationship with children's health and development and with mothers' depressive symptoms. It is demonstrable that food insecurity is a prevalent risk to the growth, health, cognitive, and behavioral potential of America's poor and near-poor children. Infants and toddlers in particular are at risk from food insecurity even at the lowest levels of severity, and the data indicate an "invisible epidemic" of a serious condition. Food insecurity is readily measured and rapidly remediable through policy changes, which a country like the United States, unlike many others, is fully capable of implementing. The food and distribution resources exist; the only constraint is political will.

Factors That Influence Quality of Life in Rural Children With Asthma and Their Parents

Introduction Among rural children with asthma and their parents, this study examined the relationship between parental and child reports of quality of life and described the relationship of several factors such as asthma severity, missed days of work, and asthma education on their quality of life. Methods Two hundred one rural families with asthma were enrolled in a school-based educational program. Intervention parents and children participated in interactive asthma workshop(s) and received asthma devices and literature. Parent and child quality of life measurements were obtained before and after the intervention using Juniper's Paediatric Caregivers Quality of Life and Juniper's Paediatric Quality of Life Questionnaires. Asthma severity was measured using criteria from the National Asthma Education and Prevention Program guidelines. Results There was no association between parent and child total quality of life scores, and mean parental total quality of life scores were higher at baseline and follow-up than those of the children. All the parents' quality of life scores were correlated with parental reports of missed days of work. For all children, emotional quality of life (EQOL) was significantly associated with parental reports of school days missed ( P = .03) and marginally associated with parental reports of hospitalizations due to asthma ( P = .08). Parent's EQOL and activity quality of life (AQOL) were significantly associated with children's asthma severity (EQOL, P = .009; AQOL, P = .03), but not the asthma educational intervention. None of the child quality of life measurements was associated with asthma severity. Discussion Asthma interventions for rural families should help families focus on gaining and maintaining low asthma severity levels to enjoy an optimal quality of life. Health care providers should try to assess the child's quality of life at each asthma care visit independently of the parents.

Review of noise in neonatal intensive care units – regional analysis

This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja.Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies.Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed.

Evaluation of diagnostic criteria for panic attack using item response theory: Findings from the National Comorbidity Survey in USA

Background The dichotomous diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) lose much important information concerning what each symptom can offer. This study explored the characteristics and performances of DSM-IV and ICD-10 diagnostic criteria items for panic attack using modern item response theory (IRT). Methods The National Comorbidity Survey used the Composite International Diagnostic Interview to assess 14 DSM-IV and ICD-10 panic attack diagnostic criteria items in the general population in the USA. The dimensionality and measurement properties of these items were evaluated using dichotomous factor analysis and the two-parameter IRT model. Results A total of 1213 respondents reported at least one subsyndromal or syndromal panic attack in their lifetime. Factor analysis indicated that all items constitute a unidimensional construct. The two-parameter IRT model produced meaningful and interpretable results. Among items with high discrimination parameters, the difficulty parameter for “palpitation” was relatively low, while those for “choking,” “fear of dying” and “paresthesia” were relatively high. Several items including “dry mouth” and “fear of losing control” had low discrimination parameters. Limitations The item characteristics of diagnostic criteria among help-seeking clinical populations may be different from those that we observed in the general population and deserve further examination. Conclusions “Paresthesia,” “choking” and “fear of dying” can be thought to be good indicators of severe panic attacks, while “palpitation” can discriminate well between cases and non-cases at low level of panic attack severity. Items such as “dry mouth” would contribute less to the discrimination.

Naltrexone versus acamprosate in the treatment of alcohol dependence: a multi‐centre, randomized, double‐blind, placebo‐controlled trial

To compare the efficacy of acamprosate and naltrexone in the treatment of alcohol dependence. A double-blind, placebo-controlled trial. Three treatment centres in Australia. A total of 169 alcohol dependent subjects were given naltrexone (50 mg/day), acamprosate (1998 mg/day) or placebo for 12 weeks. All subjects were offered manualized compliance therapy, a brief intervention that targets problems that may affect treatment compliance such as ambivalence and misperceptions about medication. Time to the first drink, time to first relapse, drinks per drinking day and cumulative abstinence. In intention-to-treat analyses, there were no differences between groups on outcome measures of drinking, craving or biochemical markers. Similarly, analyses of the 94 subjects that completed the study in full and demonstrated 80% compliance, revealed no significant treatment effects. Differential treatment effects were identified after stratification according to scores on the Alcohol Dependence Scale (ADS) and Depression Anxiety and Stress Scale (DASS). A significant beneficial treatment effect on time to first relapse was revealed for subjects with 'no depression' allocated to naltrexone (n = 56; P < 0.01). In addition, a significant beneficial treatment effect was revealed in subjects with 'low dependence' allocated to naltrexone (n = 34; P < 0.05). The results of this study support the efficacy of naltrexone in the relapse prevention of alcoholism amongst those with low levels of clinical depression and alcohol dependence severity. No effect of acamprosate was found in our sample.

Epidemiological Characteristics of Angular Leaf Spot of Bean: A Systems Analysis

In this review, available knowledge on angular leaf spot (ALS) of bean, caused by Phaeoisariopsis griseola, is analysed and synthesised. This is done through a systems-analytical approach, and successive flowcharts of the system, in order to identify knowledge gaps and guide further research. Six connected sub-models of the ALS monocycle are used as a framework: lesion establishment, lesion extension, defoliation, sporulation, spore liberation, and spore deposition. Each of the sub-models enables the linking of processes to various effects of environmental (physical and host) factors. Disease-induced defoliation is one feature of the pathosystem, leading to a depletion of infectious tissues from the canopy, which are transferred to the ground. Consequences of defoliation may include: strong reductions of the amount of inoculum and of vacant sites in the canopy, limited maximum disease severity, and progressive accumulation of inoculum below the canopy, which may become important a later stage of disease epidemics. These elements are hypothesised to explain the typical behaviour of ALS epidemics in the field, especially late onset, high apparent rate of disease increase, and low level of terminal disease severity in the standing canopy. Epidemiological consequences of lesion expansion, sporulation, and survival of spores deposited onto the canopy are other knowledge gaps in this pathosystem.

Effect of Nozzle Type and Pressure on the Efficacy of Spray Applications of the Bioherbicidal Fungus Microsphaeropsis amaranthi1

The effect of application technology on efficacy has been thoroughly investigated for sprays of chemical pesticide but not biological pesticides. This study investigates the effect of applying conidia of Microsphaeropsis amaranthi, a candidate bioherbicide for Amaranthus spp., with a range of different hydraulic nozzle tips. The nozzle tips were selected to deliver sprays with different spectra of droplet sizes deployed at different angles. We found that sprays of large droplets gave poor coverage of the target and resulted in low levels of disease severity on common waterhemp. The most effective nozzle tip tested was a hollow cone nozzle tip, such as is commonly used for the application of fungicides. This nozzle tip deployed large numbers of fine droplets that swirled within the plant canopy, provided good coverage of all plant parts, and resulted in the highest levels of disease severity, particularly on stems. Nomenclature: Common waterhemp, Amaranthus rudis Sauer, #3 AMATA. Additional index words: Bi...

Use of a Mini‐Dome Bioassay and Grafting to Study Resistance of Chickpea to Ascochyta Blight

AbstractA mini‐dome bioassay was developed to study pathogenicity of Ascochyta rabiei and relative resistance of chickpea (Cicer arietanium). It was determined that the best condition for assaying pathogenicity of A. rabiei was to use 2 × 105 spores/ml as inoculum and to maintain a leaf wetness period of 24 h under mini‐domes at a temperature between 16 and 22°C. This mini‐dome pathogenicity assay was used to determine relative resistance of six chickpea cultivars (cvs) to isolates of two pathotypes of A. rabiei. Grafting was employed to detect any translocated factors produced in the chickpea plant that mediate disease response, which could help elucidate possible resistance mechanisms to Ascochyta blight. The six chickpea cv. were grafted in all possible scion–rootstock combinations, and then inoculated with isolates of two pathotypes of A. rabiei using the mini‐dome technique. Results showed that self‐grafted‐resistant plants remained resistant and self‐grafted‐susceptible plants stayed susceptible, indicating the grafting procedure did not alter host response to infection by A. rabiei. Susceptible scions always exhibited high and similar levels of disease severity regardless of rootstock genotypes, and resistant scions always showed low and similar levels of disease severity when they were grafted onto any of the six rootstock genotypes. Orthogonal contrasts showed that scion genotypes determined disease phenotype, and that rootstock genotypes had no contribution to disease phenotype of the scions. The pathogenicity assay did not detect any translocated disease‐mediating agents responsible for susceptibility or resistance in chickpea. Disease phenotypes of Ascochyta blight of chickpea were conditioned locally by scion genotypes.

Do American Ethnic Cultures Differ in Their Definitions of Child Sexual Abuse?

This study investigated whether the three largest ethnic/cultural populations in the United States—white Americans, African Americans and Hispanic Americans—entertain different notions of what constitutes Child Sexual Abuse (CSA). The study also investigated the circumstances under which individuals of these cultures deem an offense sufficiently severe to warrant reporting it to law enforcement agencies. Findings are that there are no significant differences between the ethnic groups' recognition of, or willingness to report, CSA except at the lowest levels of severity, where the two ethnic American minorities are somewhat more likely to recognize or report CSA than are white Americans.

Factors Predicting Pain Reduction in Chronic Back and Neck Pain After Multimodal Treatment

To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. A single blinded prospective cohort study based on patients with chronic musculoskeletal pain in the lower back (N = 167) or the neck (N = 136) who completed a 4-week multimodal rehabilitation program. At admission, each patient was evaluated on 17 potential predictors, including pain characteristics and physical, sociodemographic, and psychosocial-behavioral variables. Changes in self-reported pain intensity in the lower back or the neck between the pretreatment evaluation and those performed immediately after, and 12 months after the rehabilitation program, were assessed. Logistic regression models revealed that change in pain intensity could be predicted with good specificity but with poor sensitivity both for patients with chronic low back pain and chronic neck pain. Significant predictors among the neck pain patients were high endurance, low age, high pain intensity, few other symptoms, low need of being social, to do things with others, and to be helped, along with optimistic attitudes on how the pain will interfere with daily life. Among the low back pain patients, high pain intensity, low levels of pain severity, and high affective distress were important predictors. Variables such as sex, sick leave history, working status, accident, pain duration, and depressive symptoms demonstrated no predictive value. Short- and long-term pain outcome was equally predictable and predicted by almost the same variables. Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain.

USE OF POPULATION VIABILITY ANALYSIS TO IDENTIFY MANAGEMENT PRIORITIES AND SUCCESS IN REINTRODUCING PRZEWALSKI'S HORSES TO SOUTHWESTERN MONGOLIA

The Przewalski's horse (Equus caballus przewalskii) became extinct in the wild in the 1960s. Since 1997, captive-bred horses have been released into the Gobi-B Strictly Protected Area (SPA) in southwestern Mongolia, and successful reproduction in the wild started in 1999. In 2002, the population formed 3 harem groups and 1 bachelor group (total 38) in the wild, and 3 harem groups (24) awaited release in summer 2003 within acclimatization enclosures, totaling 62 individuals. We used the stochastic population simulation model VORTEX to (1) identify key variables and their threshold values in population dynamics, (2) predict extinction risk, and (3) optimize project management and release regime by comparing model parameters with our population data. Maximum age of reproduction, foal mortality, and fecundity rates were key factors in population dynamics, while number of released animals, release interval, and duration of supplementation played lesser roles. The severity level of natural catastrophes had the greatest influence on extinction risk and population size according to VORTEX. Assuming a maximum reproductive age of 16 years, an initial population of >140 horses is necessary to achieve a 95% probability of survival over 100 years under the low-severity level of catastrophes scenario. The corresponding extinction risk for high-severity level of catastrophes is 37%, even for initial population sizes >500. The low natural growth rate of the Przewalski's horse may have been the essential prerequisite for extinction in this remote area of Mongolia. However, uncertainty of results was high and limits the predictive value of the model. Comparisons between model parameters with observed population characteristics over the past 10 years reveal some discrepancies that may require readjustment of the model if present trends continue. While our model currently underestimates reproductive rate and foal survival, adult mortality tends to be higher than estimated in the model. We believe that adult survival can be improved in the wild and that the reintroduction program has a realistic chance of success. We stress the importance of an intensive monitoring program of the Przewalski's horse population and consecutive modeling exercises to reevaluate success of this reintroduction program.

Management of brown recluse spider bites in primary care.

Treatment of brown recluse spider bites remains controversial; there are multiple options but little evidence of their effectiveness. Over a 5-year period, family physicians enrolled consecutive patients with suspected brown recluse spider bites. Usual care was provided based on physician preferences. Topical nitroglycerine patches and vitamin C tablets were provided at no cost for those who wished to use them. Baseline data were collected, and patients were followed-up weekly until healing occurred. Outcome measures included time to healing and occurrence of scarring. Regression methods were used to evaluate the impact of the 4 main treatment approaches (corticosteroids, dapsone, topical nitroglycerine, and high-dose vitamin C) after controlling for bite severity and other predictors. Two hundred and sixty-two patients were enrolled; outcomes were available for 189. The median healing time was 17 days. Only 21% had permanent scarring. One hundred seventy-four received a single treatment modality. Among this group, 12 different modalities were used. After controlling for other variables, predictors of more rapid healing included lower severity level, less erythema, and less necrosis at time of presentation, younger age, no diabetes, and earlier medical attention. Systemic corticosteroids and dapsone were associated with slower healing. Predictors of scarring were higher severity, presence of necrosis, and diabetes. Dapsone was associated with an increased probability of scarring. We found no evidence that commonly used treatment approaches reduced healing time or the likelihood of scarring in suspected brown recluse spider bites.

Search for partial resistance to leaf rust in a collection of ancient Spanish wheats.

A collection of 917 accessions of Spanish durum and bread wheat was screened for resistance to leaf rust (Puccinia triticina) under field conditions at three locations. Resistance levels ranged from very low to very high, high susceptibility being most frequent. Relative disease severity (referred to the most susceptible accession = 100%) was lower than 20% in about 6% of the accessions in each location. In the collection most of the lines (84%) displayed a susceptible infection type. A final selection of seven accessions (one of them durum) displaying low severity level in the field and high infection type in a growth chamber was chosen for further studies. High levels of partial resistant with longer latency period and high percentage of early aborted colonies without necrosis were found. They might be used in breeding programmes.

Estimation de l’incidence des événements iatrogènes médicamenteux dans les services de pneumologie de deux hôpitaux de Seine-Saint-Denis

The aim of this study was to explore the frequency and type of adverse drug reactions between January and June 2001 in hospitalised patients. A prospective study was conducted in two pneumology departments of public hospitals in the Seine-Saint-Denis area. Adverse drug reactions were collected by hospital pharmacists after spontaneous notification by nurses and physicians, except for deliberate drug overdose. The drugs implicated, causality and the severity of each adverse drug reaction were analysed. The mean age of patients was 69±15 years (63% male and 37% female). The total sample comprised 1598 patients. During the period of the study, 190 patients experienced at least one adverse drug reaction. This amounts to a prevalence of 12% (95% confidence interval [95% CI]: 7,4–16,6%). The percentage of severe adverse effects was 28,4% (95% CI: 25,1–31,6%) and adverse reactions were rated avoidable in 35,8% of cases (95% CI: 32,3–39,3%). Antibiotics (23%), corticosteroids (15%), analgesics (13%) and anticoagulants (9%) were the drugs most frequently implicated in adverse effects. Preventable adverse drug events were more serious than non-preventable adverse events (p=0.001). With regard to the level of severity, antibiotics, corticosteroids and bronchodilators were associated with a low severity level, whereas anticoagulants and antineoplastics were associated with a high severity level.

Gender Differences in Health‐Related Quality of Life Among Patients with Asthma

This study has a twofold objective: 1) to explore to what extent suffering from asthma affects the HRQL of men and women differently at several stages of disease severity and 2) to analyze whether the informed poorer HRQL of asthmatic women is related to their higher scores on instruments measuring emotionally disordered symptoms. One hundred fifty‐one outpatient asthmatics (84 women and 67 men) completed the Spanish versions of the Asthma Quality of Life questionnaire (AQL), as well as anxiety and depression inventories. A full history, physical examination, and pulmonary function test were performed on all subjects. Patients were classified into one of four asthma severity categories following the criteria of the Global Initiative on Asthma (GINA). There were no gender differences in sociodemographic variables, asthma duration, GINA, FEV1 or dyspnea. However, women showed a poorer HRQL than men, as well as high degrees of anxiety and depression. When these data were reanalyzed taking into account the four groups of asthma severity, women only reported a poorer HRQL than men at the intermittent asthma level. The gender differences on depression and anxiety scores were maintained at the three lower severity levels, but not at the most severe asthma degree. When depression and anxiety scores were partialed out, the AQL scores maintained significant relationships with asthma severity, dyspnea, and FEV1, both in women and men. Therefore, only in men were there also relationships among AQL and sociodemographic data. The best predictor of the women's HRQL was the dyspnea score, whereas in men it was the asthma severity (GINA).

Outcomes of homeless adults with mental illness in a housing program and in case management only.

The effectiveness of two types of service programs in ameliorating homelessness among individuals with severe mental illness was compared. Homeless persons with severe mental illness were recruited into the study on their entry into one of two types of homeless service programs. The first was a comprehensive housing program, in which consumers received guaranteed access to housing, housing support services, and case management. The second was a program of case management only, in which consumers received specialized case management services. In a quasi-experimental or nonrandom-assignment design, participants responded to instruments measuring housing status, mental health symptoms, substance use, physical health, and quality of life at baseline (program entry) and at six months and 12 months after entry. The baseline interview was completed by 152 participants and at least one of the two follow-up interviews by 108 participants. High-, medium-, and low-impairment subgroups, based on psychiatric symptoms and degree of alcohol and illegal drug use, were formed by means of a propensity score subclassification. Persons with high psychiatric symptom severity and high substance use achieved better housing outcomes with the comprehensive housing program than with case management alone. However, persons with low and medium symptom severity and low levels of alcohol and drug use did just as well with case management alone. The results suggest that the effectiveness, and ultimately the cost, of homeless services can be improved by matching the type of service to the consumer's level of psychiatric impairment and substance use rather than by treating mentally ill homeless persons as a homogeneous group.