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101	Patient and other factors influencing the prescribing of cardiovascular prevention therapy in the general practice setting with and without nurse assessment Mohammed, Mohammed A., El Sayed, C., Marshall, T. January 2012 (has links) Although guidelines indicate when patients are eligible for antihypertensives and statins, little is known about whether general practitioners (GPs) follow this guidance. To determine the factors influencing GPs decisions to prescribe cardiovascular prevention drugs. DESIGN OF STUDY: Secondary analysis of data collected on patients whose cardiovascular risk factors were measured as part of a controlled study comparing nurse-led risk assessment (four practices) with GP-led risk assessment (two practices). SETTING: Six general practices in the West Midlands, England. PATIENTS: Five hundred patients: 297 assessed by the project nurse, 203 assessed by their GP. MEASUREMENTS: Cardiovascular risk factor data and whether statins or antihypertensives were prescribed. Multivariable logistic regression models investigated the relationship between prescription of preventive treatments and cardiovascular risk factors. RESULTS: Among patients assessed by their GP, statin prescribing was significantly associated only with a total cholesterol concentration >/= 7 mmol/L and antihypertensive prescribing only with blood pressure >/= 160/100 mm Hg. Patients prescribed an antihypertensive by their GP were five times more likely to be prescribed a statin. Among patients assessed by the project nurse, statin prescribing was significantly associated with age, sex, and all major cardiovascular risk factors. Antihypertensive prescribing was associated with blood pressures >/= 140/90 mm Hg and with 10-year cardiovascular risk. LIMITATIONS: Generalizability is limited, as this is a small analysis in the context of a specific cardiovascular prevention program. CONCLUSIONS: GP prescribing of preventive treatments appears to be largely determined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more consistent with established guidelines. Adult Aged Antihypertensive agents Cardiovascular diseases Drug therapy Nursing Prevention & control Communication Confidence intervals Decision making England Female General Practitioners Humans Logistic models Male Middle aged Nursing diagnosis Odds ratio Physician's practice patterns Physician-patient relations Practice guidelines as topic Prescribing Primary health care Risk assessment REF 2014
102	Tidal sedimentology and geomorphology in the central Salish Sea straits, British Columbia and Washington State Mullan, Sean 03 January 2018 (has links) Intra-archipelago waterways, including tidal strait networks, present a complex set of barriers to, and conduits for sediment transport between marine basins. Tidal straits may also be the least well understood tide-dominated sedimentary environment. To address these issues, currents, sediment transport pathways, and seabed sedimentology & geomorphology were studied in the central Salish Sea (Gulf and San Juan Islands region) of British Columbia, Canada and Washington State, USA. A variety of data types were integrated: 3D & 2D tidal models, multibeam bathymetry & backscatter, seabed video, grab samples, cores and seismic reflection. This dissertation included the first regional sediment transport modelling study of the central Salish Sea. Lagrangian particle dispersal simulations were driven by 2D tidal hydrodynamics (~59-days). It was found that flood-tide dominance through narrow intra-archipelago connecting straits resulted in the transfer of sediment into the inland Strait of Georgia, an apparent sediment sink. The formative/maintenance processes at a variety of seabed landforms, including a banner bank with giant dunes, were explained with modelled tides and sediment transport. Deglacial history and modern lateral sedimentological and morphological transitions were also considered. Based on this modern environment, adjustments to the tidal strait facies model were identified. In addition, erosion and deposition patterns across the banner bank (dune complex) were monitored with 8-repeat multibeam sonar surveys (~10 years). With these data, spatially variable bathymetric change detection techniques were explored: A) a cell-by-cell probabilistic depth uncertainty-based threshold (t-test); and B) coherent clusters of change pixels identified with the local Moran's Ii spatial autocorrelation statistic. Uncertainty about volumetric change is a considerable challenge in seabed change research, compared to terrestrial studies. Consideration of volumetric change confidence intervals tempers interpretations and communicates metadata. Techniques A & B may both be used to restrict volumetric change calculations in area, to exclude low relative bathymetric change signal areas. / Graduate / 2018-12-07 tidal strait networks sediment transport pathways seabed sedimentology marine geomorphology Salish Sea Gulf Islands San Juan Islands multibeam bathymetry Lagrangian particle dispersal tidal hydrodynamics Strait of Georgia Strait of Juan de Fuca banner bank giant dunes tidal strait facies model bathymetric change detection t-test local Moran's Ii depth uncertainty volumetric change confidence intervals deglacial history repeat surveys sand dynamics tides sonar marine renewable energy offshore pipelines and cables benthic habitat spatial autocorrelation spatial analysis and statistics geographic information system (GIS) finite element method (FEM)
103	Minority Adult Survivors of Childhood Cancer: A Comparison of Long-Term Outcomes, Health Care Utilization, and Health-Related Behaviors From the Childhood Cancer Survivor Study Castellino, Sharon M., Casillas, Jacqueline, Hudson, Melissa M., Mertens, Ann C., Whitton, John, Brooks, Sandra L., Zeltzer, Lonnie K., Ablin, Arthur, Castleberry, Robert, Hobbie, Wendy, Kaste, Sue, Robison, Leslie L., Oeffinger, Kevin C. 20 September 2005 (has links) PURPOSE: To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS). PATIENTS AND METHODS: Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors. RESULTS: Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking. CONCLUSION: Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care. adolescent adult age distribution attitude to health (ethnology) blacks (statistics & numerical data) child child preschool cohort studies confidence intervals female humans infant male middle aged neoplasms (diagnosis ethnology mortality therapy) odds ratio patient compliance retrospective studies risk factors sex distribution socioeconomic factors survival rate survivors United States whites (statistics & numerical data) Pediatrics

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