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As a consequence of demographic changes, hospitals are confronted with increasing numbers of elderly patients, who are at high risk of adverse events during hospitalization. Geriatric risk screening followed by comprehensive geriatric assessment (CGA) and treatment has been requested by geriatric societies and task forces to identify patients at risk. Since empirical evidence on factors predisposing to adverse hospital events is scarce, we now prospectively evaluated implications of geriatric risk screening followed by CGA in a university hospital department of orthopedics and trauma surgery.
Three hundred and eighty-one patients ≥75 years admitted to the Department of Orthopedics and Trauma Surgery of the University Hospital Essen received Identification of Seniors at Risk (ISAR) Screening followed by CGA via a geriatric liaison service in case of positive screening results. Associations between ISAR, CGA, comorbid risk factors and diseases, length of hospital stay, number of nursing and physiotherapy hours, and falls during hospital stay were analyzed.
Of 381 ISAR screenings, 327 (85.8%) were positive, confirming a high percentage of patients at risk of adverse events. Of these, 300 CGAs revealed 82.7% abnormal results, indicating activities of daily living impairment combined with cognitive, emotional or mobility disturbances. Abnormal CGA resulted in a longer hospital stay (14.0±10.3 days in ISAR+/CGA abnormal compared with 7.6±7.0 days in ISAR+/CGA normal and 8.1±5.4 days in ISAR-, both p<0.001), increased nursing hours (3.4±1.1 hours/day in ISAR+/CGA abnormal compared with 2.5±1.0 hours/day in ISAR+/CGA normal and 2.2±0.8 hours/day in ISAR-, both p<0.001), and increased falls (7.3% in ISAR+/CGA abnormal, 0% in ISAR+/CGA normal, 1.9% in ISAR-). Physiotherapy hours were only significantly increased in ISAR+/CGA abnormal (3.0±2.7 hours) compared with in ISAR+/CGA normal (1.6±1.4 hours, p<0.001) whereas the comparison with ISAR- (2.4±2.4 hours) did not reach significance (p = 0.368). In multivariable regressions, the CGA domains activities of daily living impairment (assessed by Barthel-Index) and signs of depression (assessed by geriatric depression scale) predicted longer length of hospital stay. High ISAR score, and impairment in activities of daily living and cognition (assessed by mini-mental state examination and clock-drawing test) predicted increased nursing hours, and impairment in activities of daily living and mobility predicted increased physiotherapy hours. Conclusions An abnormal geriatric screening and assessment is associated with longer hospital stay, more nursing and physiotherapy hours, and more falls.
Identification of hospitalized elderly patients at risk for adverse in-hospital outcomes in a university orthopedics and trauma surgery environment
Janine Gronewold, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Visualization, Writing - original draft,1 Christian Dahlmann, Conceptualization, Methodology, Project administration, Software, Visualization, Writing - review & editing,2 Marcus Jager, Conceptualization, Writing - review & editing,3 and Dirk M. Hermann, Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing - original draft1,* Yu Ru Kou, Editor
Women who do not receive regular mammograms are more likely than others to have breast cancer diagnosed at an advanced stage.
To examine predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic White women.
Baseline data were used from a larger study on cancer prevention in rural Washington State. In a sample of 20 communities, 537 women formed the sample for this study. The main outcomes were ever having had a mammogram and having had a mammogram within the past two years.
Ever having had a mammogram was inversely associated with lack of health insurance (OR=0.37, 95% CI: 0.16-0.84), ages under 50 years (OR=0.23, 95% CI: 0.12-0.45), high cost of exams (OR=0.48, 95% CI: 0.27 -0.87), and lack of mammography knowledge (OR=0.16, 95% CI: 0.07 -0.37), while increasing education levels were positively associated (OR=1.72, 95% CI: 1.09-2.70). Mammography use within the past two years was inversely associated with ages under 50 years (OR=0.49, 95% CI: 0.27 -0.88) and over 70 years (OR=0.47, 95% CI: 0.24 -0.94), lack of health insurance (OR=0.23, 95% CI: 0.10-0.50), and high cost of exams (OR=0.55, 95% CI: 0.35 -0.87).
Continued resources and programs for cancer screening are needed to improve mammography participation among women without health insurance or low levels of education.
Hispanic, Mexican, mammography, rural, predisposing and enabling factors
Predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic White women living in a rural area
Silvia Tejeda, PhD,1 Beti Thompson, PhD,2,3 Gloria Coronado, PhD,2,4 Diane P Martin, PhD,3 and Patrick J Heagerty, PhD5
2010 Jan 1
Large-scale genome-wide association analyses show an association between ADAMTS7 variations and coronary risk. However, the link between ADAMTS7 variability and ischaemic stroke (IS) has yet to be determined. This study evaluated ADAMTS7 variants with respect to the risk of IS. Genetic association analyses were performed in two independent case-control cohorts with 1279 patients with IS and 1268 age-matched healthy controls. Four variant genotypes of the ADAMTS7 gene were identified using the Multiplex SNaPshot assay. The rs3825807, rs11634042, and rs7173743 variants of ADAMTS7 were related to lower IS risk in both initial and replication cohort. The G-T-T-C and G-T-C-C haplotypes are significantly less prevalent in the IS group than in the control group. Further stratification according to IS subtypes indicated that carriers with the variant alleles of the rs3825807, rs11634042 and rs7173743 variants of ADAMTS7conferred a lower risk of developing large-artery atherosclerosis stroke subtype. Also, the mutated rs3825807 G allele, as well as the mutated rs11634042 T allele of ADAMTS7, are linked to a significant reduction of ADAMTS7 in patients with IS. Our findings confirm the role of ADAMTS7 in the pathophysiology of IS, with potentially significant implications for the prevention, treatment, and development of novel therapies for IS.
ADAMTS7, ischaemic stroke, variant, CIMT, risk
Genetic variants of ADAMTS7 confer risk for ischaemic stroke in the Chinese population
Linfa Chen,1,2,* Weidong Hu,1,2,* Shengnan Li,1,3,* Shaoyu Yao,4 Mengxu Wang,1,2 Xinglan Chen,1,2 Shaofeng Chen,1,2 Fu Deng,1,2 Peiyi Zhu,1,2 Keshen Li,1,3 Wangtao Zhong,2 Bin Zhao,1,3 Guoda Ma,corresponding author1,3 and You Licorresponding author1,3
2019 Aug 31