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Murray A Mittleman - One of the best experts on this subject based on the ideXlab platform.
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physical exertion immediately prior to placental abruption a case Crossover Study
American Journal of Epidemiology, 2018Co-Authors: Murray A Mittleman, Malcolm Maclure, Harpreet S Chahal, Bizu Gelaye, Elizabeth Mostofsky, Sixto E Sanchez, Percy PacoraAbstract:While there is consistent evidence that episodes of physical exertion are associated with an immediately higher risk of acute ischemic vascular events, the risk of placental abruption immediately following episodes of physical exertion has not been studied. In a multicenter case-Crossover Study, we interviewed 663 women with placental abruption at 7 Peruvian hospitals between January 2013 and August 2015. We asked women about physical exertion in the hour before symptom onset and compared this with their frequency of physical exertion over the prior week. Compared with times with light or no exertion, the risk of placental abruption was 7.8 (95% confidence interval (CI): 5.5, 11.0) times greater in the hour following moderate or heavy physical exertion. The instantaneous incidence rate ratio of placental abruption within an hour of moderate or heavy physical exertion was lower for women who habitually engaged in moderate or heavy physical activity more than 3 times per week in the year before pregnancy (rate ratio (RR) = 3.0, 95% CI: 1.6, 5.9) compared with more sedentary women (RR = 17.3, 95% CI: 11.3, 26.7; P for homogeneity < 0.001), and the rate ratio was higher among women with preeclampsia/eclampsia (RR = 13.6, 95% CI: 7.0, 26.2) than among women without (RR = 6.7, 95% CI: 4.4, 10.0; P for homogeneity = 0.07).
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exposures to air pollution and risk of acute onset placental abruption a case Crossover Study
Epidemiology, 2018Co-Authors: Cande V Ananth, Murray A Mittleman, Marianthianna Kioumourtzoglou, Yongmei Huang, Zev Ross, Alexander M Friedman, Michelle A Williams, Shuang Wang, Joel SchwartzAbstract:Background Despite abruption's elusive etiology, knowledge of triggers that precede it by just a few days prior to delivery may help to understand the underpinnings of this acute obstetrical complication. We examine whether air pollution exposures immediately preceding delivery are associated with acute-onset abruptions. Methods We applied a bidirectional, time-stratified, case-Crossover design to births with an abruption diagnosis in New York City, 2008-2014. We measured ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2). We fit distributed lag nonlinear models based on conditional logistic regression to evaluate individual exposure and cumulative exposures over lags 0-7 days before abruption, adjusted for temperature and relative humidity (similar lags to the main exposures). Results We identified 1,190 abruption cases. We observed increased odds of abruption for exposure to PM2.5 (per 10 μg/m) on lag day 3 (odds ratio [OR] 1.19, 95% confidence interval [CI] = 0.98, 1.43), lag day 4 (OR 1.21, 95% CI = 1.01, 1.46), and lag day 5 (OR 1.17, 95% CI = 1.03, 1.33). Similarly, the odds of abruption increased with exposure to NO2 (per 5 ppb) on lag day 3 (OR 1.16, 95% CI = 0.98, 1.37), lag day 4 (OR 1.19, 95% CI = 1.02, 1.39), and lag day 5 (OR 1.16, 95% CI = 1.05, 1.27). Exposures to PM2.5 and NO2 at other lags, or cumulative exposures, were not associated with abruption of acute onset. Conclusions This case-Crossover Study showed evidence of an association between short-term ambient air pollution exposures and increased abruption risk of acute onset.
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intensity of physical exertion and triggering of myocardial infarction a case Crossover Study
European Heart Journal, 2008Co-Authors: Stephanie Von Klot, Murray A Mittleman, Douglas W Dockery, Margit Heier, Christa Meisinger, Allmut Hormann, Erich H Wichmann, Annette PetersAbstract:Aims Acute myocardial infarction (AMI) can be precipitated or triggered by discrete transient exposures including physical exertion. We evaluated whether the risk of having an AMI triggered by physical exertion exhibits an exposure–response relationship, and whether it varies by ambient temperature or by taking place indoors or outdoors. Methods and results We conducted a case-Crossover Study within the Myocardial Infarction Registry in Augsburg, Germany in 1999–2003. One thousand three hundred and one patients reported levels of activity and time spent outdoors on the day of AMI and three preceding days in an interview. The case-Crossover analyses showed an association of physical exertion with AMI symptom onset within 2 h, which was strong for strenuous exertion (METs ≥ 6) [relative risk (RR) 5.7, 95% confidence interval (CI) 3.6–9.0), and still significant for moderate exertion (METs = 5) (RR 1.6, 95% CI 1.2–2.1) compared to very light or no exertion. Strenuous exertion outside was associated with a four-fold larger RR of AMI symptom onset than exertion performed indoors, which was not explained by temperature. Conclusion This Study confirms previous results and shows a graded exposure–response relationship between physical exertion intensity and triggering of AMI onset. These findings may have implications for behavioural guidance of people at risk of AMI.
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fatigue increases the risk of injury from sharp devices in medical trainees results from a case Crossover Study
Infection Control and Hospital Epidemiology, 2007Co-Authors: David N Fisman, Anthony D Harris, Michael Rubin, Gary S Sorock, Murray A MittlemanAbstract:Background. Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. Design. Case‐Crossover Study. Setting. Five academic medical centers in the United States and Canada. Participants. Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. Results. Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week ( \d...
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a case Crossover Study of occupational traumatic hand injury methods and initial findings
American Journal of Industrial Medicine, 2001Co-Authors: G S Par Sorock, David A Lombardi, Robert F Herrick, Ellen A Eisen, Russ Hauser, Murray A MittlemanAbstract:BACKGROUND: Acute hand injury is the leading cause of occupational injury treated in United States' hospital emergency departments (e.g., laceration, crush or fracture). To identify risk factors for traumatic hand injuries, we conducted a case-Crossover Study of transient exposures (e.g., being rushed) for acute occupational traumatic hand injury. METHODS: The case-Crossover method, which uses subjects as their own controls, was used to identify risk factors for occupational hand injury. Two hundred and thirty-two subjects were recruited from 17 occupational health clinics in New England and interviewed by telephone a median of 1.2 days after their injury. The a priori hazard period was defined as 10 min before the injury. Two control periods were used: one was 60-70 min prior to the injury (matched-pair interval analysis); the other was the total work-time exposed, on average, in the previous month (usual frequency analysis). RESULTS: In the usual frequency analysis, the relative risk for using malfunctioning or different-from-usual equipment or tools in the hazard period was 25.5 (95% confidence interval = 18.4-35.2). Relative risks were also significantly elevated for performing a task using an unusual work method, doing an unusual task, being distracted, or being rushed. Wearing gloves appeared to be protective (relative risk = 0.8, 95% CI = 0.5-1.2). Matched-pair interval analysis, where appropriate, provided similar findings but had much wider confidence intervals. CONCLUSIONS: This Study demonstrates that the case-Crossover design is a feasible and efficient method for Studying transient risk factors for sudden-onset traumatic occupational hand injury. The usual frequency analysis proved more useful than the match-pair approach to control period selection.
Jeanyves Maillard - One of the best experts on this subject based on the ideXlab platform.
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impact of antimicrobial wipes compared with hypochlorite solution on environmental surface contamination in a health care setting a double Crossover Study
American Journal of Infection Control, 2018Co-Authors: Harsha Siani, Rebecca Wesgate, Jeanyves MaillardAbstract:Objective Antimicrobial wipes are increasingly used in health care settings. This Study evaluates, in a clinical setting, the efficacy of sporicidal wipes versus a cloth soaked in a 1,000 ppm chlorine solution. Intervention A double-Crossover Study was performed on 2 different surgical and cardiovascular wards in a 1,000-bed teaching hospital over 29 weeks. The intervention period that consisted of surface decontamination with the preimpregnated wipe or cloth soaked in chlorine followed a 5-week baseline assessment of microbial bioburden on surfaces. Environmental samples from 11 surfaces were analyzed weekly for their microbial content. Results A total of 1,566 environmental samples and 1,591 ATP swabs were analyzed during the trial. Overall, there were significant differences in the recovery of total aerobic bacteria (P < .001), total anaerobic bacteria (P < .001), and ATP measurement (P < .001) between wards and between the different parts of the Crossover Study. Generally, the use of wipes produced the largest reduction in the total aerobic and anaerobic counts when compared with the baseline data or the use of 1,000 ppm chlorine. Collectively, the introduction of training plus daily wipe disinfection significantly reduced multidrug-resistant organisms recovered from surfaces. Reversion to using 1,000 ppm chlorine resulted in the number of sites positive for multidrug-resistant organisms rising again. Conclusions This double-Crossover Study is the first controlled field trial comparison of using preimpregnated wipes versus cotton cloth dipped into a bucket of hypochlorite to decrease surface microbial bioburden. The results demonstrate the superiority of the preimpregnated wipes in significantly decreasing microbial bioburden from high-touch surfaces.
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impact of antimicrobial wipes compared with hypochlorite solution on environmental surface contamination in a health care setting a double Crossover Study
American Journal of Infection Control, 2018Co-Authors: Harsha Siani, Rebecca Wesgate, Jeanyves MaillardAbstract:Objective Antimicrobial wipes are increasingly used in health care settings. This Study evaluates, in a clinical setting, the efficacy of sporicidal wipes versus a cloth soaked in a 1,000 ppm chlorine solution. Intervention A double-Crossover Study was performed on 2 different surgical and cardiovascular wards in a 1,000-bed teaching hospital over 29 weeks. The intervention period that consisted of surface decontamination with the preimpregnated wipe or cloth soaked in chlorine followed a 5-week baseline assessment of microbial bioburden on surfaces. Environmental samples from 11 surfaces were analyzed weekly for their microbial content. Results A total of 1,566 environmental samples and 1,591 ATP swabs were analyzed during the trial. Overall, there were significant differences in the recovery of total aerobic bacteria (P Conclusions This double-Crossover Study is the first controlled field trial comparison of using preimpregnated wipes versus cotton cloth dipped into a bucket of hypochlorite to decrease surface microbial bioburden. The results demonstrate the superiority of the preimpregnated wipes in significantly decreasing microbial bioburden from high-touch surfaces.
Fleischmann Edith - One of the best experts on this subject based on the ideXlab platform.
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Scientific Reports / Intravenous Fluid Challenge Decreases Intracellular Volume : A Bioimpedance Spectroscopy-Based Crossover Study in Healthy Volunteers
Nature, 2017Co-Authors: Hecking Manfred, Ernstbrunner Matthäus, Kabon Barbara, Zotti Oliver, Zeitlinger Markus, Berner Carolin, Hinterholzer Georg, Säemann Marcus, Frommlet Florian, Fleischmann EdithAbstract:The effects of intravenous fluid therapy on fluid compartments and hemodynamics of the human body remain enigmatic. We therefore tested the efficacy of bioimpedance spectroscopy in a Crossover Study, where 15 males received 0.5ml/kg/min ELO-MEL-isoton (osmolarity=302 mosmol/l) during 60minutes, or nothing at all. In group “Fluid”, fluid load increased from 0.21.0l extracellular volume at baseline to its maximum of 1.00.9l in minute 70, and remained continuously elevated throughout minute 300. In group “Zero”, fluid load decreased from 0.51.1l at baseline to its minimum of 1.11.1l in minute 300. In group “Fluid”, intracellular volume decreased from 26.83.9l at baseline to its minimum of 26.03.9l in minute 70, and remained continuously decreased throughout minute 300. In group “Zero”, intracellular volume increased from 26.53.8l at baseline to its maximum of 27.13.9l in minute 120, and decreased thereafter. In group “Fluid” compared to “Zero”, systolic blood pressure was significantly higher, from minute 5090. In conclusion, intravenous fluid therapy caused a clinically meaningful, sustained increase in fluid load, and a decrease in intracellular volume. These data raise interest in Studying fluid administration by the gastrointestinal route, perhaps even when managing critical illness.(VLID)461589
Manfred Hecking - One of the best experts on this subject based on the ideXlab platform.
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Intravenous Fluid Challenge Decreases Intracellular Volume: A Bioimpedance Spectroscopy-Based Crossover Study in Healthy Volunteers
Scientific Reports, 2017Co-Authors: Matthäus Ernstbrunner, Barbara Kabon, Oliver Zotti, Markus Zeitlinger, Carolin Berner, Georg Hinterholzer, Marcus Säemann, Florian Frommlet, Edith Fleischmann, Manfred HeckingAbstract:The effects of intravenous fluid therapy on fluid compartments and hemodynamics of the human body remain enigmatic. We therefore tested the efficacy of bioimpedance spectroscopy in a Crossover Study, where 15 males received 0.5 ml/kg/min ELO-MEL-isoton (osmolarity = 302 mosmol/l) during 60 minutes, or nothing at all. In group “Fluid”, fluid load increased from −0.2 ± 1.0 l extracellular volume at baseline to its maximum of 1.0 ± 0.9 l in minute 70, and remained continuously elevated throughout minute 300. In group “Zero”, fluid load decreased from 0.5 ± 1.1 l at baseline to its minimum of −1.1 ± 1.1 l in minute 300. In group “Fluid”, intracellular volume decreased from 26.8 ± 3.9 l at baseline to its minimum of 26.0 ± 3.9 l in minute 70, and remained continuously decreased throughout minute 300. In group “Zero”, intracellular volume increased from 26.5 ± 3.8 l at baseline to its maximum of 27.1 ± 3.9 l in minute 120, and decreased thereafter. In group “Fluid” compared to “Zero”, systolic blood pressure was significantly higher, from minute 50–90. In conclusion, intravenous fluid therapy caused a clinically meaningful, sustained increase in fluid load, and a decrease in intracellular volume. These data raise interest in Studying fluid administration by the gastrointestinal route, perhaps even when managing critical illness.
Harpreet S Chahal - One of the best experts on this subject based on the ideXlab platform.
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physical exertion immediately prior to placental abruption a case Crossover Study
American Journal of Epidemiology, 2018Co-Authors: Murray A Mittleman, Malcolm Maclure, Harpreet S Chahal, Bizu Gelaye, Elizabeth Mostofsky, Sixto E Sanchez, Percy PacoraAbstract:While there is consistent evidence that episodes of physical exertion are associated with an immediately higher risk of acute ischemic vascular events, the risk of placental abruption immediately following episodes of physical exertion has not been studied. In a multicenter case-Crossover Study, we interviewed 663 women with placental abruption at 7 Peruvian hospitals between January 2013 and August 2015. We asked women about physical exertion in the hour before symptom onset and compared this with their frequency of physical exertion over the prior week. Compared with times with light or no exertion, the risk of placental abruption was 7.8 (95% confidence interval (CI): 5.5, 11.0) times greater in the hour following moderate or heavy physical exertion. The instantaneous incidence rate ratio of placental abruption within an hour of moderate or heavy physical exertion was lower for women who habitually engaged in moderate or heavy physical activity more than 3 times per week in the year before pregnancy (rate ratio (RR) = 3.0, 95% CI: 1.6, 5.9) compared with more sedentary women (RR = 17.3, 95% CI: 11.3, 26.7; P for homogeneity < 0.001), and the rate ratio was higher among women with preeclampsia/eclampsia (RR = 13.6, 95% CI: 7.0, 26.2) than among women without (RR = 6.7, 95% CI: 4.4, 10.0; P for homogeneity = 0.07).
