Agency: European Commission | Branch: FP7 | Program: CP-FP-SICA | Phase: ENV.2011.1.1.5-1 | Award Amount: 4.76M | Year: 2011
AMAZALERT will enable raising the alert about critical feedbacks between climate, society, land-use change, vegetation change, water availability and policies in Amazonia. We will: 1) analyze and improve coupled models of global climate and Amazon, land use, vegetation and socio-economic drivers to quantify anthropogenic and climate induced land-use and land cover change and non-linear, irreversible feedbacks among these components 2) assess the role of regional and global policies and societal responses in the Amazon region for altering the trajectory of land-use change in the face of climate change and other anthropogenic factors and finally 3) propose i) an Early Warning System for detecting any imminent irreversible loss of Amazon ecosystem services, ii) policy response strategies to prevent such loss. We first prioritise the functions of Amazonia and threats to these. We then will analyse uncertainties in biogeochemistry, land cover (vegetation), land-use change and regional hydrology , as well as nonlinear responses and feedbacks using existing and new simulations from state of the art models in which land surface is coupled to global climate. The way in which policies and possible future response strategies of policy makers, trade and economy will affect land-use change will be modelled. This will lead to (A) understanding the impact on and effectiveness of a range of international and regional policy options, including REDD\; and (B) identification of both biophysical and socio-economic indicators of irreversible change. AMAZALERT integrates the multidisciplinary knowledge and research of world-renowned, highly influential climate, land cover, land use change scientists and also policy analysts from 14 European and South-American institutions that have been collaborating for 10 to 30 years. Thus, this project can achieve maximum impact on EU (2020 climate goals), international and South-American strategies, including REDD
Towfighi A.,University of Southern California |
Towfighi A.,Amigos y Amigos |
Markovic D.,University of California at Los Angeles |
Ovbiagele B.,Medical University of South Carolina
Stroke | Year: 2014
BACKGROUND AND PURPOSE-: Blood pressure (BP) reduction lowers vascular risk after stroke; however, little is known about the relationship between consistency of BP control and risk of subsequent vascular events. METHODS-: In this post hoc analysis of the Vitamin Intervention for Stroke Prevention trial (n=3680), individuals with recent (<120 days) stroke, followed up for 2 years, were divided according to proportion of visits in which BP was controlled (<140/90 mm Hg): <25%, 25% to 49%, 50% to 74%, and ?75%. Multivariable models adjusting for demographic and clinical variables determined the association between consistency of BP control versus primary (stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes. RESULTS-: Only 30% of participants had BP controlled ?75% of the time. Consistency of BP control affected outcomes in individuals with baseline systolic BP >132 mm Hg. Among individuals with baseline systolic BP >75th percentile (>153 mm Hg), risks of primary and secondary outcomes were lower in those with BP controlled ?75% versus <25% of visits (adjusted hazard ratio, 0.46; 95% confidence interval, 0.26-0.84 and adjusted hazard ratio, 0.51; 95% confidence interval, 0.32-0.82). Individuals with mean follow-up BP <140/90 mm Hg had lower risk of primary and secondary outcomes than those with BP ?140/90 mm Hg (adjusted hazard ratio, 0.76; 95% confidence interval, 0.59-0.98 and adjusted hazard ratio, 0.76; 95% confidence interval, 0.62-0.92). CONCLUSIONS-: In this rigorous clinical trial, fewer than one third of patients with stroke had BP controlled ?75% of the time for 2 years. Furthermore, consistency of BP control among those with elevated baseline systolic BP was linked to reduction in risk of recurrent stroke and stroke, myocardial infarction, and vascular death. © 2014 American Heart Association, Inc.
Towfighi A.,University of Southern California |
Towfighi A.,Amigos y Amigos |
Saver J.L.,University of California at Los Angeles
Stroke | Year: 2011
Background and Purpose-Stroke recently declined from the third to the fourth leading cause of death in the United States, its first rank transition among sources of American mortality in nearly 75 years. Methods-This is a narrative review supplemented by new analyses of Centers for Disease Control and Prevention National Vital Statistics Reports from 1931 to 2008. Results-Historically, stroke transitioned from the second to the third leading cause of death in the United States in 1937, but stroke death rates were essentially stable from 1930 to 1960. Then a long, great decline began, moderate in the 1960s, precipitous in the 1970s and 1980s, and moderate again in the 1990s and 2000s. By 2008, age-adjusted annual death rates from stroke were three fourths less than the historic 1931 to 1960 norm (40.6 versus 175.0 per 100 000). Total actual stroke deaths in the United States declined from a high of 214 000 in 1973 to 134 000 in 2008. Improved stroke prevention, through control of hypertension, hyperlipidemia, and tobacco, contributed most greatly to the mortality decline with a lesser but still substantial contribution of improved acute stroke care. Persisting challenges include race-ethnicity, sex, and geographic disparities in stroke mortality; the burden of stroke disability; the expanding obesity epidemic and aging of the US population; and the epidemic of cerebrovascular disease in low-and middle-income countries worldwide. Conclusions-The recent rank decline of stroke among leading causes of American death is testament to a half century of societal progress in cerebrovascular disease prevention and acute care. Renewed commitments are needed to preserve and broaden this historic achievement. © 2011 American Heart Association, Inc.
Pascua L.A.M.,University of Nevada, Las Vegas |
Wulf G.,University of Nevada, Las Vegas |
Lewthwaite R.,Amigos y Amigos
Journal of Sports Sciences | Year: 2015
The authors examined the individual and combined influences of 2 factors that have been shown to benefit motor learning: an external focus of attention and enhanced performance expectancies. Another purpose of this study was to gain further insight into the mechanisms underlying these variables. In a factorial design, participants learning a novel motor skill (i.e., throwing with the non-dominant arm) were or were not given external focus instructions, and were or were not provided bogus positive social-comparative feedback to enhance their expectancies. This resulted in 4 groups: external focus, enhanced expectancy, external focus/enhanced expectancy and control. External focus instructions and enhanced expectancies had additive benefits for learning: the external focus/enhanced expectancy group demonstrated the greatest throwing accuracy on both retention and transfer tests, while the accuracy scores of the external focus and enhanced expectancy groups were lower, but higher than those of the control group. Furthermore, self-efficacy was increased by both external focus and enhanced expectancy, and predicted retention and transfer performance. Positive affect was heightened in the enhanced expectancy and external focus/enhanced expectancy groups after practice and predicted transfer performance. The findings suggest that the learning benefits of an external focus and enhanced expectancies mediate learning through partially different mechanisms. © 2014 Taylor & Francis.
Agency: European Commission | Branch: FP7 | Program: CP | Phase: ICT-2007.7.2 | Award Amount: 1.24M | Year: 2008
The aim of project REPLAY is to develop a gaming technology platform to provide young people who have become marginalised in society as a result of anti social behaviour with a learning environment to facilitate their reintegration into society. Although scalable to a range of marginalised groups such as immigrants, children with learning disabilities, retirees etc, REPLAY will focus on the rehabilitation of young people whose behaviour has become a problem for the communities in which they live.\nInteractive gaming technology is very popular amongst young people today and so the vision of REPLAY is to use this technology as a means of motivating young offenders into a better awareness of how and why they behave the way they do and encourage them to take greater responsibility for the consequences of their decisions and behaviour. The REPLAY solution will allow users to interact in a distributed gaming environment, share and exchange ideas, and cooperate in pursuit of common objectives. In this way, communication skills, the facility for mutual accountability and the ability to work in teams will be improved. \nProject REPLAY will prove that the concept of interactive gaming can be used to improve learning capabilities and provide users with an opportunity to replay their role in society following a dysfunctional start. The technology developed will provide users with a simulation in which they can learn by doing. Users will be able to implement decisions, observe and monitor the impact of their decisions in a given situation and learn from the experience. As such, the gaming environment will prepare young people for the challenges they will face as active and constructive contributors in society. Moreover, the technology will provide the social worker professional charged with monitoring their rehabilitation with a useful tool through which the rehabilitation process can be assessed and managed more effectively.
Ginsberg D.,University of Southern California |
Ginsberg D.,Amigos y Amigos
American Journal of Managed Care | Year: 2013
Neurogenic bladder is a disorder of the lower urinary tract created by damage to or diseases of the nervous system. Found in many patients with neurologic disorders, including multiple sclerosis, Parkinson's disease, spinal cord injury, and spina bifida among others, neurogenic bladder can lead to problematic symptoms and complications including urinary incontinence, frequency, and urgency, along with risk for infection and involvement of the upper urinary tract and kidney disease. The disorder can also create substantial embarrassment resulting in social isolation for affected patients. Healthcare utilization may be excessive in patients with neurogenic bladder, including office and emergency department visits and subsequent hospitalizations. Because of its significant effects on quality of life, it is important to reassess the epidemiology and physiology of neurogenic bladder, its diagnosis and assessment, and the impact of the symptoms and complications associated with it to better manage patients with this disorder and improve outcomes.
Mochari-Greenberger H.,Columbia University |
Towfighi A.,University of Southern California |
Towfighi A.,Amigos y Amigos |
Mosca L.,Columbia University
Stroke | Year: 2014
BACKGROUND AND PURPOSE - : Recognition of stroke warning signs may reduce treatment delays. The purpose of this study was to evaluate contemporary knowledge of stroke warning signs and knowledge to call 9-1-1, among a nationally representative sample of women, overall and by race/ethnic group. METHODS - : A study of cardiovascular disease awareness was conducted by the American Heart Association in 2012 among English-speaking US women ≥25 years identified through random-digit dialing (n=1205; 54% white, 17% black, 17% Hispanic, and 12% other). Knowledge of stroke warning signs, and what to do first if experiencing stroke warning signs, was assessed by standardized open-ended questions. RESULTS - : Half of women surveyed (51%) identified sudden weakness/numbness of face/limb on one side as a stroke warning sign; this did not vary by race/ethnic group. Loss of/trouble talking/understanding speech was identified by 44% of women, more frequently among white versus Hispanic women (48% versus 36%; P<0.05). Fewer than 1 in 4 women identified sudden severe headache (23%), unexplained dizziness (20%), or sudden dimness/loss of vision (18%) as warning signs, and 1 in 5 (20%) did not know 1 stroke warning sign. The majority of women said that they would call 9-1-1 first if they thought they were experiencing signs of a stroke (84%), and this did not vary among black (86%), Hispanic (79%), or white/other (85%) women. CONCLUSIONS - : Knowledge of stroke warning signs was low among a nationally representative sample of women, especially among Hispanics. In contrast, knowledge to call 9-1-1 when experiencing signs of stroke was high. © 2014 American Heart Association, Inc.
Rubayi S.,Amigos y Amigos
Plastic and Reconstructive Surgery | Year: 2011
Learning Objectives: After reading this article, the participant should be able to: 1. Describe the principles of wound closure, torso reconstruction, and pressure sore reconstruction. 2. Outline standard options to treat defects of the chest, abdomen, and back and pressure ulcers in all anatomical areas. 3. Manage and prevent pressure ulcers. Chest wall reconstruction is indicated following tumor resection, radiation wound breakdown, or intrathoracic sepsis. Principles of wound closure and chest wall stabilization, where indicated, are discussed. Principles of abdominal wall reconstruction continue to evolve with the introduction of newer bioprosthetics and the application of functional concepts for wound closure. The authors illustrate these principles using commonly encountered clinical scenarios and guidelines to achieve predictable results. Pressure ulcers continue to be devastating complications to patients health and a functional hazard when they occur in the bedridden, in patients with spinal cord injuries, and in patients with neuromuscular disease. Management of pressure ulcers is also very expensive. The authors describe standard options to treat defects of the chest, abdomen, and back and pressure ulcers in all anatomical areas. A comprehensive understanding of principles and techniques will allow practitioners to approach difficult issues of torso reconstruction and pressure sores with a rational confidence and an expectation of generally satisfactory outcomes. With pressure ulcers, prevention remains the primary goal. Patient education and compliance coupled with a multidisciplinary team approach can reduce their occurrence significantly. Surgical management includes appropriate patient selection, adequate débridement, soft-tissue coverage, and use of flaps that will not limit future reconstructions if needed. Postoperatively, a strict protocol should be adapted to ensure the success of the flap procedure. Several myocutaneous flaps commonly used for the surgical management of pressure are discussed. Commonly used flaps in chest and abdominal wall reconstruction are discussed and these should be useful for the practicing plastic surgeon. © 2011 by the American Society of Plastic Surgeons.
Sun G.H.,Amigos y Amigos
Otolaryngology - Head and Neck Surgery (United States) | Year: 2015
Variation in medicine and surgery is a critical contemporary health policy issue. Recent research demonstrates that variation in Medicare payments to otolaryngologists in a single metropolitan area was attributable to differences in health care resource utilization among physicians and that the hospital with the highest Medicare payments per physician had a higher proportion of office endoscopy-related relative value units than that of other providers, relying less on evaluation and management office visits for revenue. This study is the latest in a line of fascinating case records of variation in otolaryngology and other surgical specialties dating back to the work of J. Alison Glover in 1938. © 2015 American Academy of Otolaryngology - Head and Neck Surgery Foundation.
Nwosu K.,Amigos y Amigos
Spine | Year: 2016
STUDY DESIGN.: Retrospective chart review. OBJECTIVE.: Assess appropriate utilization of surgery for Civilian gunshot-induced spinal cord injuries (CGSWSCI) according to literature standards in a large cohort. SUMMARY OF BACKGROUND DATE.: CGSWSCI are mechanically stable injuries that rarely require surgery. Nonetheless, we continue to see high numbers of these patients undergo surgical treatment. This study compares indications for surgeries performed in a large cohort of CGSWSCI patients to established indications for surgical management of such injuries. The rate of over-utilization of surgical management was calculated. METHODS.: 489 CGSWSCI patients transferred for rehabilitation to our institution between 2000 and 2014 were identified. Retrospective chart review was performed to identify patients who underwent initial surgical treatment, the specific surgeries performed, and indications given. We assessed appropriateness of surgery according to literature standards. Patients treated surgically were followed to assess for complications and the need for additional intervention and compared to non-surgical patients. Secondarily, visual analog scale (VAS) pain scores (0–10) and patient perceived improvement were compared between surgical and non-surgical patients after telephone survey of both groups. RESULTS.: Of 489 patients, 91 (18%) underwent initial surgery. Of 91 surgeries, 69 (75%) were not indicated by literature standards. Five of 91 (5.5%) of initially operated patients required a secondary surgery compared to 2 of 398 (0.5%) of the non-operative group (p?=?0.003). Over-utilization rate of the entire cohort was 14.1%. No difference was seen for pain scores or patient perceived improvement between operative and non-operative patients. CONCLUSION.: We report a high overutilization rate (14%) of surgery for CGSWSCI in our cohort. Surgical management was associated with higher infection and secondary surgery rates compared to non-surgical management. Surgery done without a clear, demonstrable benefit poses unnecessary risk to patients and accumulates unwarranted healthcare costs.Level of Evidence: 3 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.