Subclinical hypothyroidism: summary of evidence in 2014

Subclinical hypothyroidism, which is defined as elevated thyroid-stimulating hormone (TSH) levels with free thyroxine concentrations within the reference range, is a common disorder that increases with age and affects up to 18% of the elderly, with a higher prevalence in women compared to men. Prospective data have shown an increased risk of coronary heart disease events, heart failure, and cardiovascular mortality among affected adults. Conflicting results have been found on the association between subclinical hypothyroidism and cognitive impairment, depression and the risk of fractures. Management strategies including screening and treatment of subclinical hypothyroidism are still controversial, while the ongoing European randomised controlled trial "TRUST" targets to solve these uncertainties. This narrative review aims to assess current evidence on the clinical aspects, as well as screening and treatment recommendations in adults with subclinical hypothyroidism.

Taking up national safety alerts to improve patient safety in hospitals: The perspective of healthcare quality and risk managers.

BACKGROUND National safety alert systems publish relevant information to improve patient safety in hospitals. However, the information has to be transformed into local action to have an effect on patient safety. We studied three research questions: How do Swiss healthcare quality and risk managers (qm/rm(1)) see their own role in learning from safety alerts issued by the Swiss national voluntary reporting and analysis system? What are their attitudes towards and evaluations of the alerts, and which types of improvement actions were fostered by the safety alerts? METHODS A survey was developed and applied to Swiss healthcare risk and quality managers, with a response rate of 39��% (n=116). Descriptive statistics are presented. RESULTS The qm/rm disseminate and communicate with a broad variety of professional groups about the alerts. While most respondents felt that they should know the alerts and their contents, only a part of them felt responsible for driving organizational change based on the recommendations. However, most respondents used safety alerts to back up their own patient safety goals. The alerts were evaluated positively on various dimensions such as usefulness and were considered as standards of good practice by the majority of the respondents. A range of organizational responses was applied, with disseminating information being the most common. An active role is related to using safety alerts for backing up own patient safety goals. CONCLUSIONS To support an active role of qm/rm in their hospital's learning from safety alerts, appropriate organizational structures should be developed. Furthermore, they could be given special information or training to act as an information hub on the issues discussed in the alerts.

A model for use by local public health departments to evaluate pandemic influenza plans

The events of the 1990's and early 2000's demonstrated the need for effective planning and response to natural and man-made disasters. One of those potential natural disasters is pandemic flu. Once defined, the CDC stated that program, or plan, effectiveness is improved through the process of program evaluation. (Centers for Disease Control and Prevention, 1999) Program evaluation should be accomplished not only periodically, but in the course of routine administration of the program. (Centers for Disease Control and Prevention, 1999) Accomplishing this task for a "rare, but significant event" is challenging. (Herbold, John R., PhD., 2008) To address this challenge, the RAND Corporation (under contract to the CDC) developed the "Facilitated Look-Backs" approach that was tested and validated at the state level. (Aledort et al., 2006).^ Nevertheless, no comprehensive and generally applicable pandemic influenza program evaluation tool or model is readily found for use at the local public health department level. This project developed such a model based on the "Facilitated Look-Backs" approach developed by RAND Corporation. (Aledort et al., 2006) Modifications to the RAND model included stakeholder additions, inclusion of all six CDC program evaluation steps, and suggestions for incorporating pandemic flu response plans in seasonal flu management implementation. Feedback on the model was then obtained from three LPHD's���one rural, one suburban, and one urban. These recommendations were incorporated into the final model. Feedback from the sites also supported the assumption that this model promotes the effective and efficient evaluation of both pandemic flu and seasonal flu response by reducing redundant evaluations of pandemic flu plans, seasonal flu plans, and funding requirement accountability. Site feedback also demonstrated that the model is comprehensive and flexible, so it can be adapted and applied to different LPHD needs and settings. It also stimulates evaluation of the major issues associated with pandemic flu planning. ^ The next phase in evaluating this model should be to apply it in a program evaluation of one or more LPHD's seasonal flu response that incorporates pandemic flu response plans.^

Disease risk factors and humoral antibody response to periodontal-associated pathogens: A model to evaluate periodontal disease in older adults

Periodontal diseases (PD) are infectious, inflammatory, and tissue destructive events which affect the periodontal ligament that surround and support the teeth. Periodontal diseases are the major cause of tooth loss after age 35, with gingivitis and periodontitis affecting 75% of the adult population. A select group of bacterial organisms are associated with periodontal pathogenesis. There is a direct association between oral hygiene and prevention of PD. The importance of genetic differences and host immune response capabilities in determining host, susceptibility or resistance to PD has not been established. This study examined the risk factors and serum (humoral) immune response to periodontal diseased-associated pathogens in a 55 to 80+ year old South Texas study sample with PD. This study sample was described by: age, sex, ethnicity, the socioeconomic factors marital status, income and occupation, IgG, IgA, IgM immunoglobulin status, and the autoimmune response markers rheumatoid factor (RF) and antinuclear antibody (ANA). These variables were used to determine the risk factors associated with development of PD. Serum IgG, IgA, IgM antibodies to bacterial antigens provided evidence for disease exposure.^ A causal model for PD was constructed from associations for risk factors (ethnicity, marital status, income, and occupation) with dental exam and periodontitis. The multiple correlation between PD and ethnicity, income and dental exam was significant. Hispanics of low income were least likely to have had a dental exam in the last year and most likely to have PD. The etiologic agents for PD, as evidenced by elevated humoral antibody responses, were the Gram negative microorganisms Bacteroides gingivalis, serotypes FDC381 and SUNYaBA7A1-28, and Wolinella recta. Recommendation for a PD prevention and control program are provided. ^

Comparing Campus Discipline Rates: A Multivariate Approach for Identifying Schools with Significantly Different than Expected Exclusionary Discipline Rates

Campus behavior management is important for ensuring classroom order and promoting positive academic outcomes. Previous studies have shown the importance of individual student and campus personnel characteristics and campus context for explaining campus discipline rates (e.g., rates of suspension and expulsion). Assessing campus discipline rates, while controlling for these individual and campus characteristics, is important for the monitoring, evaluation, and intervention role of policymakers as well as state and federal level education agencies. Systems or metrics exist that measure other student outcomes (i.e., academic performance) with controls for individual and campus characteristics, but none exist that monitor these differences for discipline rates across campuses. In this paper, we use a multivariate model to analyze a longitudinal, statewide dataset for all secondary students in Texas from 2000 to 2008 in order to examine how campus discipline rates differ across schools with statistically similar students, teachers, and campus characteristics. The findings are important for understanding that some schools with similar characteristics have significantly different exclusionary discipline rates, and they are important for informing policy and agency level decision-making. The methodology described can easily be used by monitoring agencies as well as local school districts.

Archivos y empresas : Un consenso ineludible

El art��culo que presentamos tiene por objeto analizar la necesaria presencia de un servicio de archivos en las empresas, en aras de la rentabilidad y la eficacia. Para ello, estructuramos el trabajo en dos apartados: por un lado, analizamos las propiedades que hoy caracterizan a la Archiv��stica y proponemos una definici��n de nuestra disciplina; por otro, nos centramos en la necesaria acci��n de la gesti��n documental en las empresas.��Tras describir en qu�� consiste dicha gesti��n documental, exponemos las fases para la planificaci��n de un sistema archiv��stico en cualquier organizaci��n empresarial (fase de an��lisis, elaboraci��n y dise��o, implantaci��n del sistema y control). Para esto ��ltimo, realizamos una comparaci��n sistem��tica de lo que dicen al respecto algunos autores

Archivos y empresas : Un consenso ineludible

El art��culo que presentamos tiene por objeto analizar la necesaria presencia de un servicio de archivos en las empresas, en aras de la rentabilidad y la eficacia. Para ello, estructuramos el trabajo en dos apartados: por un lado, analizamos las propiedades que hoy caracterizan a la Archiv��stica y proponemos una definici��n de nuestra disciplina; por otro, nos centramos en la necesaria acci��n de la gesti��n documental en las empresas.��Tras describir en qu�� consiste dicha gesti��n documental, exponemos las fases para la planificaci��n de un sistema archiv��stico en cualquier organizaci��n empresarial (fase de an��lisis, elaboraci��n y dise��o, implantaci��n del sistema y control). Para esto ��ltimo, realizamos una comparaci��n sistem��tica de lo que dicen al respecto algunos autores

Archivos y empresas : Un consenso ineludible

El art��culo que presentamos tiene por objeto analizar la necesaria presencia de un servicio de archivos en las empresas, en aras de la rentabilidad y la eficacia. Para ello, estructuramos el trabajo en dos apartados: por un lado, analizamos las propiedades que hoy caracterizan a la Archiv��stica y proponemos una definici��n de nuestra disciplina; por otro, nos centramos en la necesaria acci��n de la gesti��n documental en las empresas.��Tras describir en qu�� consiste dicha gesti��n documental, exponemos las fases para la planificaci��n de un sistema archiv��stico en cualquier organizaci��n empresarial (fase de an��lisis, elaboraci��n y dise��o, implantaci��n del sistema y control). Para esto ��ltimo, realizamos una comparaci��n sistem��tica de lo que dicen al respecto algunos autores

An approach to stakeholders involvement in the preparedness for nuclear and radiological emergency response & recovery in Spain

The elaboration of a generic decision-making strategy to address the evolution of an emergency situation, from the stages of response to recovery, and including a planning stage, can facilitate timely, effective and consistent decision making by the response organisations at every level within the emergency management structure and between countries, helping to ensure optimal protection of health, environment, and society. The degree of involvement of stakeholders in this process is a key strategic element for strengthening the local preparedness and response and can help a successful countermeasures strategy. A significant progress was made with the multi-national European project EURANOS (2004-2009) which brought together best practice, knowledge and technology to enhance the preparedness for Europe's response to any radiation emergency and long term contamination. The subsequent establishment of a European Technology Platform and the recent launch of the research project NERIS-TP ("Towards a self sustaining European Technology Platform (NERIS-TP) on Preparedness for Nuclear and Radiological Emergency Response and Recovery") are aimed to continue with the remaining tasks for gaining appropriate levels of emergency preparedness at local level in most European countries. One of the objectives of the NERIS-TP project is: Strengthen the preparedness at the local/national level by setting up dedicated fora and developing new tools or adapting the tools developed within the EURANOS projects (such as the governance framework for preparedness, the handbooks on countermeasures, the RODOS system, and the MOIRA DSS for long term contamination in catchments) to meet the needs of local communities. CIEMAT and UPM in close interaction with the Nuclear Safety Council will explore, within this project, the use and application in Spain of such technical tools, including other national tools and information and communication strategies to foster cooperation between local, national and international stakeholders. The aim is identify and involve relevant stakeholders in emergency preparedness to improve the development and implementation of appropriate protection strategies as part of the consequence management and the transition to recovery. In this paper, an overview of the "state of the art" on this area in Spain and the methodology and work Plan proposed by the Spanish group within the project NERIS to grow the stakeholder involvement in the preparedness to emergency response and recovery is presented.

Capacidades y potencialidades end��genas, de los centros y laboratorios de investigaci��n y desarrollo tecnol��gico, en las ��reas de materiales y mec��nica de Ciudad Guayana, Venezuela

El Estado Bol��var cuenta con una super���cie de 238.000 Kms2 se encuentra ubicado al sur-este de Venezuela y su capital es Ciudad Bol��var. La regi��n se ha caracterizado a nivel mundial por poseer una gran riqueza que se mani���esta en las reservas de los principales recursos minerales tales como oro, diamante, manganeso, hierro y bauxita, estos dos ��ltimos han permitido la instalaci��n de empresas b��sicas para el desarrollo de la industria sider��rgica y del aluminio, ubicados en Ciudad Guayana, Adem��s cuenta con el parque industrial metalmec��nico m��s grande del pa��s concentrando un gran numero de Peque��as y Medianas Industrias (PYMIS). En tal sentido el sector productivo de Guayana no se ha desarrollado integralmente, debido a que no ha orientando sus esfuerzos, en desarrollar e innovar en nuevos productos o mejoras de procesos debido a la poca capacidad y baja inversi��n en Investigaci��n y Desarrollo Tecnol��gico (I&DT), para transformar nuestras materias primas y generar productos competitivo con un alto valor agregado. El presente proyecto se planteo como objetivo principal Dise��ar Estrategias para Desarrollar las Capacidades y Potencialidades End��genas, de los Centros y Laboratorios de Investigaci��n y Desarrollo, para la Vinculaci��n y Fortalecimiento de las PYMIS de Manufacturas en las ��reas de Materiales y Mec��nica.

Efficient algorithms for dynamic probabilistic safety assessment. An application to convex damage domain.

The design of nuclear power plant has to follow a number of regulations aimed at limiting the risks inherent in this type of installation. The goal is to prevent and to limit the consequences of any possible incident that might threaten the public or the environment. To verify that the safety requirements are met a safety assessment process is followed. Safety analysis is as key component of a safety assessment, which incorporates both probabilistic and deterministic approaches. The deterministic approach attempts to ensure that the various situations, and in particular accidents, that are considered to be plausible, have been taken into account, and that the monitoring systems and engineered safety and safeguard systems will be capable of ensuring the safety goals. On the other hand, probabilistic safety analysis tries to demonstrate that the safety requirements are met for potential accidents both within and beyond the design basis, thus identifying vulnerabilities not necessarily accessible through deterministic safety analysis alone. Probabilistic safety assessment (PSA) methodology is widely used in the nuclear industry and is especially effective in comprehensive assessment of the measures needed to prevent accidents with small probability but severe consequences. Still, the trend towards a risk informed regulation (RIR) demanded a more extended use of risk assessment techniques with a significant need to further extend PSA���s scope and quality. Here is where the theory of stimulated dynamics (TSD) intervenes, as it is the mathematical foundation of the integrated safety assessment (ISA) methodology developed by the CSN(Consejo de Seguridad Nuclear) branch of Modelling and Simulation (MOSI). Such methodology attempts to extend classical PSA including accident dynamic analysis, an assessment of the damage associated to the transients and a computation of the damage frequency. The application of this ISA methodology requires a computational framework called SCAIS (Simulation Code System for Integrated Safety Assessment). SCAIS provides accident dynamic analysis support through simulation of nuclear accident sequences and operating procedures. Furthermore, it includes probabilistic quantification of fault trees and sequences; and integration and statistic treatment of risk metrics. SCAIS comprehensively implies an intensive use of code coupling techniques to join typical thermal hydraulic analysis, severe accident and probability calculation codes. The integration of accident simulation in the risk assessment process and thus requiring the use of complex nuclear plant models is what makes it so powerful, yet at the cost of an enormous increase in complexity. As the complexity of the process is primarily focused on such accident simulation codes, the question of whether it is possible to reduce the number of required simulation arises, which will be the focus of the present work. This document presents the work done on the investigation of more efficient techniques applied to the process of risk assessment inside the mentioned ISA methodology. Therefore such techniques will have the primary goal of decreasing the number of simulation needed for an adequate estimation of the damage probability. As the methodology and tools are relatively recent, there is not much work done inside this line of investigation, making it a quite difficult but necessary task, and because of time limitations the scope of the work had to be reduced. Therefore, some assumptions were made to work in simplified scenarios best suited for an initial approximation to the problem. The following section tries to explain in detail the process followed to design and test the developed techniques. Then, the next section introduces the general concepts and formulae of the TSD theory which are at the core of the risk assessment process. Afterwards a description of the simulation framework requirements and design is given. Followed by an introduction to the developed techniques, giving full detail of its mathematical background and its procedures. Later, the test case used is described and result from the application of the techniques is shown. Finally the conclusions are presented and future lines of work are exposed.

Transactional failure recovery for a distributed key-value store

With the advent of cloud computing, many applications have embraced the ensuing paradigm shift towards modern distributed key-value data stores, like HBase, in order to benefit from the elastic scalability on offer. However, many applications still hesitate to make the leap from the traditional relational database model simply because they cannot compromise on the standard transactional guarantees of atomicity, isolation, and durability. To get the best of both worlds, one option is to integrate an independent transaction management component with a distributed key-value store. In this paper, we discuss the implications of this approach for durability. In particular, if the transaction manager provides durability (e.g., through logging), then we can relax durability constraints in the key-value store. However, if a component fails (e.g., a client or a key-value server), then we need a coordinated recovery procedure to ensure that commits are persisted correctly. In our research, we integrate an independent transaction manager with HBase. Our main contribution is a failure recovery middleware for the integrated system, which tracks the progress of each commit as it is flushed down by the client and persisted within HBase, so that we can recover reliably from failures. During recovery, commits that were interrupted by the failure are replayed from the transaction management log. Importantly, the recovery process does not interrupt transaction processing on the available servers. Using a benchmark, we evaluate the impact of component failure, and subsequent recovery, on application performance.