Objectives: This retrospective analysis was conducted to derive national estimates of typical, atypical, and combination (typical-atypical) antipsychotic use and to examine factors associated with their use at adult (age ≫-18 years) ambulatory care visits by patients with mental health disorders in the United States. Methods: Data on adult visits with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a mental health disorder were extracted from the office-based National Ambulatory Medical Care Survey and the outpatient facilitybased National Hospital Ambulatory Medical Care Survey from 1996 through 2003. The visits were categorized according to whether use of a typical, atypical, or combination antipsychotic was mentioned (either prescribed, supplied, administered, ordered, or continued at the visits). Total weighted visit estimates, weighted visit percentages, and 95% CIs were calculated across the 3 types of visit groups. Bivariate analysis was performed on the association between selected characteristics and the 3 visit groups. Multivariate logistic regression was performed on factors associated with atypical versus typical antipsychotic use. Results: During the 8-year period, there were an estimated 47.7 million adult ambulatory care visits involving a mental health disorder and mention of an antipsychotic (weighted percent: 0.83%; 95% CI, 0.73-0.93). From 1996/1997 to 2002/2003, visits involving atypical and combination antipsychotics increased by 195% and 149%, respectively, and visits involving typical antipsychotics decreased by 71%. Men, blacks, and those with public insurance made more visits in which combination antipsychotics rather than typical or atypical antipsychotics were mentioned. Relative to typical or combination antipsychotic visits, more atypical antipsychotic visits involved antide-pressants (weighted percent: 61.23% atypical, 37.29% typical, and 38.32% combination). Fewer atypical antipsychotic visits compared with typical or combination antipsychotic visits involved psychotic disorders (weighted percent: 32.94%, 51.23%, and 69.93%, respectively) and medications for extrapyramidal symptoms (weighted percent: 6.69%, 29.95%, and 36.64%). In multivariate analyses controlling for sex, race, diagnosis of schizophrenia, region, diagnosis of anxiety, and recent years, atypical versus typical antipsychotic use was significantly less likely at visits by those aged 41 to 64 years compared with those aged 18 to 40 years (adjusted odds ratio [OR] = 0.63; 95% CI, 0.47-0.84; P = 0.002); significantly less likely at visits by those with public compared with private insurance (Medicare OR = 0.59 [95% CI, 0.40-0.88], P = 0.010; Medicaid OR = 0.44 [95% CI, 0.28-0.69], P < 0.001); and significantly more likely at visits associated with depression compared with those not associated with depression (OR = 1.92; 95% CI, 1.26-2.93; P = 0.003) and those associated with bipolar disorder compared with those not associated with bipolar disorder (OR = 2.10; 95% CI, 1.32-3.36; P = 0.002). Conclusions: This retrospective analysis found more atypical than typical or combination antipsychotic use at US ambulatory care visits by adults with mental health disorders other than schizophrenia or psychoses in the period studied. Atypical versus typical antipsychotic use was significantly less likely at visits by adults aged 41 to 64 years and those with public insurance, but significantly more likely at visits by those with depression or bipolar disorder.

Statistics show that approximately 30.6 million individuals in the United States had an ambulatory disability (AD), the most prevalent disability in the country. In 2010, 17.5% of the disabled population was employed, and only 5% of that employed population had an AD. The purpose of this multiple case study was to understand the decision-making process of small businesses owners in New Jersey when deciding on whether to hire those with AD. Ajzen's theory of planned behavior was utilized in this study to make predictions and explain why individuals engage in a behavior. Interviews were conducted with 16 participants and 22 questionnaires were completed by non-interview participants. The criteria of interview participants included ownership of small businesses within New Jersey and experience with hiring or interviewing an individual with an AD. Questionnaires were given to those businesses that exceeded employee size and lacked experience with AD. participation. Interview transcripts and questionnaires served as the raw data for analysis. Analysis of data consisted of coding using Nvivo software; to assist with identifying patterns and themes. Findings showed employers are willing to hire individuals with AD if they are able to perform the job duties. The results of this study can benefit businesses and individuals with AD seeking employment. Providing a knowledge base for those in the hiring position and those in the candidacy position serves to inform those about what candidates with AD can contribute as an employee and what employers are looking for in an employee. Such benefits may increase the employment opportunity for individuals with AD.

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No description available.

Research shows Mexican Americans typically have better cardiovascular health than European Americans, despite being relatively economically disadvantaged. Given research indicating the importance of relationship quality on one's health, the present study examined whether certain relationship orientations (e.g. communal or exchange) were more prevalent in different ethnic groups and if these orientations could help explain this Hispanic Paradox. 582 adults were recruited from the community. Participants were primarily European American (40%) and foreign-born Mexican Americans (55%). A cross-sectional designed was used where participants wore 24-hour ambulatory blood pressure (ABP) monitors and completed self-report measures of relationship satisfaction and relationship orientation. Results indicated that, contrary to predictions, European Americans tended to have more of a communal relationship orientation compared to foreign-born Mexican Americans. As expected however, communal orientation was predictive of higher relationship satisfaction, β = .29, SE = .07, p < .001, 95% CI [.15, .43], and while higher relationship satisfaction predicted lower systolic blood pressure, R2 = .02, β = -.16, SE = .07, p < .05, 95% CI [-.31, -.01], when ethnicity was added into the model this relationship was eliminated and foreign-born Mexican Americans had higher ABP compared to European Americans, β = 4.72, SE = 2.25, p < .05, 95% CI [.29, 9.14]. While there were these important differences, communal and exchange orientations had minimal direct or indirect effects on ABP. Even though communal and exchange relationship orientation don't seem to give us any more information to unravel the Hispanic Paradox, there are important ethnic differences in how we engage in marriage relationships and future research may consider other approaches to examine the health effects of these differences.

Impedance cardiography is an important tool in determining a person's hemodynamic properties. The makers obtained through thoracic impedance have been shown to be of great importance when monitoring critical care patients. Technological developments have made this process noninvasive and ambulatory, opening up new possibilities for potential use. A study was conducted by remotely monitoring healthy subjects (n=5), who performed an 8-minute mild-to-moderate aerobic exercise protocol, followed up by a four minute cognitive stress test. Testing was conducted onsite at Kennedy Space Center in association with the National Aeronautics and Space Administration using the MW1000A (MindWare Technologies LTD, Gahanna, OH) ambulatory impedance cardiography monitoring (ICG) device. The current study was conducted in order to establish the test-retest reliability of the ICG during aerobic exercise and cognitive stress across a 2 week period. For the purpose of this study Heart Rate (HR), Left Ventricular Ejection Time (LVET) Stroke Volume (SV), Cardiac Output (CO), and Pre-Ejection Period (PEP) were acquired and analyzed during three phases. The phases were, walking on a level treadmill, walking at incline, and an at rest mental arithmetic stress test. Testing has shown that the MW1000A device can provide accurate ambulatory impedance cardiography monitoring with no significant difference between testing intervals. The simple application of electrodes makes this device easy to use and requires little training. Its non-invasive properties render employing ICG both a simple and effective means of determining the hemodynamic properties of a subject.

No description available.

Injuries associated with fall accidents pose a significant health problem to society, both in terms of human suffering and economic losses. Existing fall intervention approaches are facing various limitations. This dissertation presented an effort to advance indirect type of injury prevention approach. The overall objective was to develop a new fall event detection algorithm and a new integrative ambulatory measurement (IAM) framework which could further improve the fall detection algorithm's performance in detecting slip-induced backward falls. This type of fall was chosen because slipping contributes to a major portion of fall-related injuries. The new fall detection algorithm was designed to utilize trunk angular kinematics information as measured by Inertial Measurement Units (IMU). Two empirical studies were conducted to demonstrate the utility of the new detection algorithm and the IAM framework in fall event detection. The first study involved a biomechanical analysis of trunk motion features during common Activities of Daily Living (ADLs) and slip-induced falls using an optical motion analysis system. The second study involved collecting laboratory data of common ADLs and slip-induced falls using ambulatory sensors, and evaluating the performance of the new algorithm in fall event detection. Results from the current study indicated that the backward falls were characterized by the unique, simultaneous occurrence of an extremely high trunk extension angular velocity and a slight trunk extension angle. The quadratic form of the two-dimensional discrimination function showed a close-to-ideal overall detection performance (AUC of ROCa = 0.9952). The sensitivity, specificity, and the average response time associated with the specific configuration of the new algorithm were found to be 100%, 95.65%, and 255ms, respectively. The individual calibration significantly improved the response time by 2.4% (6ms). Therefore, it was concluded that slip-induced backward fall was clearly distinguishable from ADLs in the trunk angular phase plot. The new algorithm utilizing a gyroscope and orientation sensor was able to detect backward falls prior to the impact, with a high level of sensitivity and specificity. In addition, individual calibration provided by the IAM framework was able to further enhance the fall detection performance. / Ph. D.

Yes / Ambulatory and/or home monitoring are recommended in the UK and North America for the diagnosis of hypertension but little is known about acceptability. To determine the acceptability of different methods of measuring blood pressure to people from different ethnic minority groups. Design and setting : Cross sectional study with focus groups in primary care. Methods: People with and without hypertension of different ethnicities were assessed for acceptability of clinic, home and ambulatory blood pressure measurement using completion rate, questionnaire and focus groups. Results: 770 participants were included comprising white British (n=300), South Asian (n=241) and African Caribbean (n=229). White British participants had significantly higher successful completion rates across all monitoring modalities compared to the other ethnic groups, especially for ambulatory monitoring: white British (277 completed, 92%[89-95%]) vs South Asian (171, 71%[65-76%], p<0.001 and African Caribbean (188, 82%[77-87%], p<0.001) respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared to white British. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input. Conclusions: Reduced acceptability and completion rates amongst minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring in general and ambulatory monitoring in particular. Selection of method for blood pressure monitoring should take into account clinical need and patient preference as well as consideration of potential cultural barriers to monitoring. / NIHR

2. A modified model of heart-arterial system was proposed for describing the timing of the second heart sound as a result of the heart-arterial interaction. Simulation results suggest that RS2 bears a significant negative correlation with both SBP and DBP as heart rate, cardiac contractility and peripheral resistance varies. The hypothesis was supported by the experimental data. To our knowledge, it is the first study describing the relation of the timing of S2 to BP by both the model-based study and experimental data. / 3. As a preliminary study, a linear predication model using RS2 with a novel calibration scheme was proposed for BP estimation and it has been evaluated in clinical test on 85 volunteers including 18 hypertensives. The results indicate that the approach has the potential to achieve the accuracy required for medical diagnosis. / Cuffless BP measurement has been proposed as a new concept in recent years to realize the continuous monitoring of BP. This research focuses on the investigation of cuffless BP monitoring technique using heart sound information. Specifically, the thesis proposes a new cuffless technique based on the timing of the second heart sound (S2), which will enable a novel wearable design of BP monitor, for instance, a multifunctional electronic stethoscope. / Finally, based on the findings on both theoretical and experimental studies, a linear prediction model with a novel calibration scheme has been proposed to estimate the BP using 1/RS2. The proposed method was evaluated in a clinical test on 85 volunteers aged 40+/-13 years, including 18 hypertensives. The average of BP measured by simultaneous ausculatory and oscillometric approaches was used as a reference. The results of clinical test shows that the RS2 based approach can estimate SBP and DBP within the 2.1+/-7.4 mmHg and 0.8+/-6.6 mmHg of the reference respectively, indicating the approach has the potential to achieve the accuracy required for medical diagnosis according to AAMI standard (mean error within +/-5mmHg and SD less than 8mmHg) and BHS protocol. / First, a mathematical model has been developed to investigate the effects of aortic BP on the aortic component (A2) in S2 produced by the vibration of the closed aortic valve. The nonlinear elasticity of aortic wall has been introduced to the model, reflecting the nature of aortic wall tissue and extending the model to the applications involving wide BP variations. The results of simulation show that the fundamental frequency and amplitude of A2 increases as aortic systolic blood pressure (SBP) is elevated, which is able to explain the 'accentuated S2' usually heard in the hypertensives. Nevertheless, the possibility of BP measurement using spectral information of externally recorded heart sounds still needs a careful examination because the frequency characteristics tends to be blurred during sound transmission. / Hypertension, known as 'a silent killer', is an important public health challenge, afflicting approximately 1 billion adults around the world. The monitoring of blood pressure (BP) is vitally important in order to identify hypertension and treat it earlier before serious health problems are developed. The conventional BP measurement provides only intermittent BP and causes circulatory interference if the cuff is inflated frequently. There is an urgent need to develop new devices which are fully wearable and unobtrusive for noninvasive and continuous monitoring of arterial BP in daily life. / Second, a modified model of heart-arterial system has been proposed in this thesis for describing the timing of aortic valve closure as a result of heart-arterial interaction. A timing parameter, RS2, was defined as the time delay from the peak of ECG R wave to the onset of S2. The study has investigated the relation between RS2 and aortic BP under varying peripheral resistance, arterial compliance, heart rate, cardiac contractility and preload. Based on the simulation results of parametric analysis, it is hypothesized that RS2 bears a significant negative correlation with both SBP and diastolic blood pressure (DBP) as the peripheral resistance, heart rate or cardiac contractility varies. / Third, in order to verify the findings of the model-based study, three experiments were carried out to explore the relationship between RS2 and BP. The alterations of RS2 in the dynamic-exercise experiments are mainly attributable to the interactive effect of the changes in heart rate, cardiac contractility and peripheral resistance, and the effect of heart rate is dominant. In two dynamic-exercise experiments, the timing parameter, RS2, exhibited a close inverse correlation with SBP (r =0.892 and r =0.845, p&lt;0.05 in both experiments) and a moderate inverse correlation with diastolic blood pressure (DBP) (r = 0.687, p&lt;0.05 and r =0.660, p>0.05). The correlations are comparable to those of PTT-based parameters. However, due to the restricted range of the BP variation, there was no significant correlation observed in long-term rest monitoring experiment. Moreover, the standard deviation (SD) of the errors for SBP and DBP estimated by linear fitting of 1/RS2 is close to that of PTT-based estimation. The results also suggest that the ability of RS2 on BP estimation is as good as that of the PTT based parameters. / To summarize, the original contributions of the thesis are: 1. By the introduction of the nonlinear elasticity of aortic wall, a mathematical model for the vibration of the closed aortic valve was improved and extended to the applications involving wide variations of BP To my knowledge, this represents the first study to look into the effects of aortic BP on the frequency characteristic of S2 from the theoretical point of view. / Zhang Xin-Yu. / "September 2006." / Adviser: Yuan-Ting Zhang. / Source: Dissertation Abstracts International, Volume: 68-09, Section: B, page: 6125. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.