Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “RAILROADS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 775 records · Page 43Linked to original sources

Medicare program; reduction in Medicare Part B premiums as additional benefits under Medicare+Choice plans. Final rule.

This final rule revises the regulations to provide for a Medicare+Choice organization to offer a reduction in the standard Medicare Part B premium as an additional benefit under one or more Medicare+Choice (M+C) plans. The legislation specifies that the reduction to the Medicare Part B premium cannot exceed the standard Medicare Part B premium amount and cannot be applied to surcharges. Surcharges are increased premiums for late enrollment and for reenrollment. The Medicare Part B premium may be collected by a variety of methods: Paid directly to the Centers of Medicare & Medicaid Services by the beneficiary; collected as an adjustment to any Social Security, Railroad Retirement, or Civil Service Retirement benefits; paid by an employer as part of an annuity package; or, paid by the State for individuals enrolled in a qualifying State Medicaid program. This legislation applies to benefits under Medicare M+C plans offered by an M+C organization electing this option, beginning January 1, 2003. This final rule revises the regulations to set out the basic rules under section 606 of the Medicare, Medicaid, and SCHIP Benefits Improvement Protection Act of 2000 (BIPA) for adjustment and payment of the Medicare Part B premium.

Centers for Medicare and Medicaid Services, U.S.↗

Circadian alertness simulator for fatigue risk assessment in transportation: application to reduce frequency and severity of truck accidents.

The Circadian Alertness Simulator (CAS) was developed as a practical tool for assessing the risk of diminished alertness at work. Applications of CAS include assessment of operational fatigue risk, work schedule optimization, and fatigue-related accident investigation. Based on the documented work schedules of employees, sleep and alertness patterns are estimated and a cumulative fatigue score is calculated. The risk assessment algorithms are based on physiological sleep/wake principles including homeostatic and circadian processes. The free parameters of the algorithms were optimized using over 10,000 d of sleep and alertness data sets collected from transportation workers performing their regular jobs. The validity and applicability of the CAS fatigue score was then tested using work/rest and accident data from three trucking operations. Heavy truck drivers involved in DOT-recordable or high-cost accidents were found to have significantly higher CAS fatigue risk scores than accident-free drivers. Implementing a risk-informed, performance-based safety program in a 500 power-unit trucking fleet, where dispatchers and managers were held accountable for minimizing driver CAS fatigue risk scores, significantly reduced the frequency and severity of truck accidents. Further examination of CAS risk assessment validity using scenarios provided in a fatigue modeling workshop indicated that the CAS Model also performed well in estimating alertness with a real-world transportation scenario of railroad locomotive engineer work/rest patterns.

Accidents, Traffic↗

Topography as a contextual variable in infectious disease transmission.

OBJECTIVE: This paper examines whether or not topography is a contextual variable that indirectly influences the transmission of infectious diseases. Age, gender, race/ethnicity, education level, economic status, injection drug use, and high-risk sexual behavior are known to influence infectious diseases transmission, but the effects of topography are often overlooked. DESIGN: A sample of 395 drug users were chosen from census tracts based upon a target profile of drug use behavior and demographics for the city of Houston. HIV was chosen as the infectious disease used to test this hypothesis. SETTING: Residents of 16 census tracts in Houston, Texas participated in this study. RESULTS: The findings revealed that census tracts that were 'isolated' by topographic barriers, such as bayous, parks, railroad tracks, railway yards, major thoroughfares, freeways, and unique street grids had fewer cases of HIV than census tracks that were more accessible to thru-traffic. CONCLUSION: The research findings suggest that future research studies should consider topography as being contextually related to infectious disease transmission.

Adolescent↗

[A minimum medical GIS database (MMDb) for Europe].

Geographic information systems (GIS) and remote sensing (RS) technologies are being used increasingly to study the spatial and temporal patterns of some parasitic diseases of medical and veterinary importance. At the same time, the incorporation of GIS in this field shows the scarcity of the data and images available, which sometime discourage researchers that still look at GIS as a system too difficult and unusable for medical study. Aware of this problem and supported by success of earlier MMDb's for Africa, Asia and South America, the authors' aim is to construct and offer an MMDb for Europe. The initial MMDb is composed with vector images covering an area situated from -11 degrees-70 degrees N to 58 degrees-30 degrees E. Specifically, data layers include: a) Global Moderate-Resolution Imaging Spectroradiometer (MODIS) Normalized Difference Vegetation Index (NDVI) 16 days at 250 m spatial resolution designed to provide consistent spatial and temporal comparisons of vegetation conditions, supplied in the MMDb as seasonal and annual composite images from 2000 to 2003, b) MODIS Land Surface Temperature (LST) calculated from daytime and nighttime observations at 8 day intervals at 1 km spatial resolution, supplied in the MMDb as seasonal and annual composites images for day (maximum) temperatures, night (minimum) temperatures from 2000 to 2003, c) GTOPO30 Digital Elevation Model (DEM) at 1 km spatial resolution, d) United States Geological Survey (USGS) Land use/land cover scheme, e) USGS actual and potential evapotranspiration supplied for all 12 months as a grid at 50 km spatial resolution, f) USGS precipitation showing the amount of rainfall for all 12 months supplied as a grid at 50 km spatial resolution, g) USGS shapefiles of administrative and political boundaries, cities, towns, villages, lakes, rivers, streams, road, railroads and more. The MMDb projection will be in geographic latitude-longitude, decimal degree format. This global format is most commonly used for public access map database resources and can be readily re-projected as needed for compatibility with various national mapping systems. There is no "required" software, and end users need only common commercial GIS software packages that have mutual import-export functions. Additionally, the MMDb is meant to be a dynamic resource that end users may improve and modify with other regional data.

Animals↗

[The beginnings of trauma management in Mexico City. 1847-1914].

We describe how surgical trauma was managed in Mexico City from 1847 to 1912. Management included minimal interventions, generally ending with the patient's death. Other more radical procedures such as abdomen trauma proposed in 1874 anld performed in 1898 are also described. A variety of techniques employed and type of trauma cases registered that yielded more radical attitudes that brought about the creation of public emergency rooms (the Cruz Verde) and military surgical rooms in railroad cars that oversaw the care of soldiers during the revalutionary period are discussed.

History, 19th Century↗

Reigniting the charge for IT. Leavitt will spearhead federal effort to develop national healthcare IT network, but question remains: who will pay?

HHS Secretary Mike Leavitt, left, confronted the IT challenge last week by announcing he will oversee efforts to establish a nationwide healthcare IT system. "I believe we have to transform healthcare just as the railroads transformed transportation in America," Leavitt said, when announcing his plans at a HIMSS meeting. His new advisory committee, the American Health Information Community, will help set standards.

Financing, Organized↗

Muallem endo-tracheal tube introducer: (METTI)--an aid for the difficult airway.

This is a brief report evaluating a new single use endotracheal tube introducer (METTI) which has a soft curved atraumatic tip. The introducer was tried in 44 patients, whose direct laryngoscopic view was simulated to Cormack IIIb score, and in six patients with real Cormack III score. The overall success rate of railroading of the tracheal tube over the introducer was 94% from the first attempt.

Adult↗

[Carcinogenic risk of automobile exhaust: a review].

The increasing number of motor vehicles is associated with diffuse exposure to their exhausts, formed by mixtures of hundreds of chemical compounds. Some of these compounds cause chronic irritation of the respiratory mucosa, while others are carcinogenic in experimental animals, particularly polycyclic aromatic hydrocarbons and nitroarenes. This review aims to describe epidemiologic evidences of carcinogenicity of engine exhausts. The study of the effects in humans of the exposure at issue is impaired by several difficulties: widespread exposure of a large part of the population, with low levels of exposure; aspecific effects, shared with other exposures; concurrent exposures acting on the same targets, particularly the respiratory mucosa (smoking, occupational exposures); difficulties in the quantitation of exposure to exhaust. We review the epidemiologic studies concerning occupational exposures published up to June, 1988. Overall, excess risks for lung and bladder cancers and for hematolymphopoietic malignancies have been reported, particularly in people exposed to diesel exhaust. Excesses are modest, and their interpretation is often impaired by lacking or inadequate consideration of the effects of potential confounders. The review considers, for each study, enrollment procedures, information on exposure, and inclusion of potential confounders. In addition, aspects concerning internal coherence, such as a dose-response relationship, are considered. Particularly relevant are two studies on USA railroad workers, showing a relative risk of 1.4 among those exposed to diesel exhaust. The authors used, in the estimation of exposure, actual measurement of dose in recent years for some jobs and workplaces. Levels of exposure to respirable dusts were around 82-330 micrograms/m3, after allowing for cigarette smoking. According to the International Agency for Research on Cancer, these is limited evidence of carcinogenicity in humans of diesel exhaust, and inadequate evidence for gasoline exhaust.

Case-Control Studies↗

AIDS and the physician's duty to warn (Part I).

The protective privilege ends where the public peril begins: Tarasoff v Regents of the University of California. The risk reasonably to be perceived defines the duty to be obeyed: Palsgraf v Long Island Railroad Co. This article analyzes the conflicting obligations (to maintain patient confidentiality and to warn those at risk) that a physician faces when confronted with an HIV-infected patient who is unable, or unwilling, to notify close contacts that they may have been, or will be, exposed to the AIDS virus. The ethical basis, the common law development, and the statutory establishment of each of these duties are examined, first in general, and then specifically, in regard to AIDS and HIV infection. The focus is placed on the patient's sexual partners (as persons at risk) although it is important to realize that this issue also applies to many other categories of close, and not so close, contacts.

Acquired Immunodeficiency Syndrome↗

Primary adenocarcinoma of the nasal cavity and paranasal sinuses.

Eight cases of primary adenocarcinoma of the nasal cavity associated with wood dust exposure are reported. The patients include seven men and one woman between the ages of 31 and 81 years. All the patients had a history of wood dust exposure. Carpentry was the occupation in four patients; inspector for railroad boxcars in one; teacher in a wood-work shop in another and worker in a desk factory in the other. The only female patient was a school teacher whose husband had a wood-work shop at home. Clinically, epistaxis and/or nasal obstruction were the most common symptoms. The histology of the tumors varied and consisted of well differentiated adenocarcinoma, clear cell adenocarcinoma, papillary-mucinous adenocarcinoma, and "colonic-type" adenocarcinoma. Follow-up data showed that three patients were alive of whom two had either recurrent or metastatic disease at one and three years following the initial diagnosis, respectively. The third patient was alive and well four years after initial diagnosis. Three other patients died but a direct cause of death was not identified. The remaining two patients were lost to follow-up.

Adenocarcinoma↗

[Characteristics of glycosylated hemoglobin distribution].

On the basis of 1518 values of concentration of glycosylated Hb in blood of workers responsible for safety in railroad transportation authors tried to calculate the range of normal values of this parameter. It was assumed that distribution of GHb in a healthy part of population is normal. From the primary set of data, values most distant from the arithmetic mean were gradually discarded until distribution of values was as close to the normal distribution as attainable. The best fit to the normal distribution was obtained for 1486 values. The normal range was then 4.6 to 8.6% (mean +/- 2 SD). The normal range was in a good agreement with published data as well as with own analytical experience.

Adult↗

The role of physicians as medical review officers in workplace drug testing programs. In pursuit of the last nanogram.

In discussing the role of physicians in workplace drug testing programs, I focus on the recent Department of Transportation regulations that require drug testing in such regulated industries as interstate trucking, air transportation, mass transit, and the railroads. These regulations require that applicable drug testing programs employ physicians as medical review officers to evaluate positive tests that have been screened and confirmed by different techniques to determine if there is a legal medical explanation for the result. The drug testing program tests for the presence of amphetamine, cocaine, tetrahydrocannabinol, opiates, and phencyclidine. If an employee testing positive has an acceptable medical explanation, the result is to be reported as negative. Little practical advice exists for medical review officers, and they must be aware of key elements of the regulations and potential trouble spots.

Confidentiality↗

[A statistical survey of medico-legal activities for the traffic accidental death].

Out of a total number of judicial autopsies handled in the Department of Legal Medicine, Kurume University School of Medicine during the period from Jan. 1963 to Mar. 1987, the traffic accidental death was recorded 278 cases including 216 cases for male and 62 cases for female respectively being specified as followings: 1) Victims-pedestrians: 168 cases, violent falling from two-wheelers (bicycle or motor-cycle, caused by the rider's faults: 21 cases, collision between two-wheelers in motion and motorcar: 50 cases, motorcar in motion: 30 cases (18 drivers and 12 fellow passengers), airplane accident: 1 case, railroad accident: 1 case, and 2 cases other than those. 2) Judicial autopsies specified by the month. Jan-31 cases, Feb, Mar, Jul and Dec-26 cases each, Oct-25 cases, May and Sep-24 cases each, Apr-20 cases, Jun and Nov-17 cases each, and Aug-16 cases. 3) Frequency of accidents specified by the time. 0 hr-0600 hrs: 78 cases, 0600 hrs-1200 hrs: 40 cases, 1200 hrs-1800 hrs: 34 cases, 1800 hrs-2400 hrs: 119 cases and unidentified hrs: 7 cases. 4) Under the influence of liquor 110 cases in total or 39.6% including 108 cases by male and 2 cases by female. 5) In addition to the primary impact injuries some remarks to be taken account in performance of judicial autopsies were discussed.

Accidents, Traffic↗

[Tick-borne encephalitis in a northern zone of coniferous and broad-leaved forests of a focal region of the Amur River basin].

The geographical variability of the population of tick-borne encephalitis (TBE) virus in the northern part of the zone of combined coniferous and broad-leaved forests was established; this variability was manifested by higher virulence and homogeneity of TBE virus strains, as shown in experiments on white mice receiving the virus extraneurally, in comparison with the southern part of the zone and by higher virus carriership of the ticks Ixodes persulcatus. With the epizootic situation remaining tense and the danger of TBE virus infection still present, TBE morbidity and mortality rates decreased in the years of the construction of the Baikal-Amur Railroad, which was due to greater attention given to measures for the prophylaxis of TBE during this period.

Animals↗

[Intracerebral calcifications associated with intrathecal methotrexate therapy in acute lymphocytic leukemia (author's transl)].

A case of a child with acute lymphocytic Leukemia is reported. The roentgenograms of the skull show intracerebral "railroad-track-like" calcifications mimicking those seen in Sturge-Weber syndrome. These calcifications are described and their etiology is discussed. The frequency of such observations in cases of acute lymphocytic leukemia with CNS-treatment is increasing.

Brain Diseases↗

Extrahepatic portal hypertension--long-term results.

This report reviews 164 cases derived from 2 Australian and 3 U.S. centres. There were 128 direct operations and 63 shunts. There were 16 deaths (10% mortality) but 3 were due to unrelated causes. Direct procedures; In the long term these appear of little value. 37 of 48 children having splenectomy subsequently rebled. Almost all children having ligation of varices and direct operations on the stomach rebled subsequently. Acute bleeding can almost always be controlled by conservative measures and direct operations would appear to offer no benefit over non-operative management except in the occasional case of catastrophic management that cannot be controlled conservatively. Shunts; A properly performed decompressive shunt offers the best hope of long term control for bleeding varices. Meso-caval shunts seem to give somewhat better results than splenorenal shunts. About two-thirds of the patients undergoing shunts remain free of any further bleeding. Non-operative management; 27 children have had no surgery performed and all are alive except for one child who subsequently died in a railroad accident. Bleeding episodes become less frequent after the age of 15 years and there are a number of reasons for this including the progressive development of natural shunts. We are not aware of any deaths or major complications from hypersplenism. Growth and development of all children in this series has been normal, although other have commented on a significant incidence of encephalopathy. Conclusions; 1. GIT bleeding becomes progressively less after the age of 15 years. 2. Direct operations have little place in treatment. 3. Decompressive shunts are the most effective method of controlling continuing bleeding but require a shunt of at least 1 cm diameter. 4. Splenomegaly and hypersplenism are not serious problems. 5. One can anticipate the progressive development of natural shunts. 6. Splenectomy should be avoided in this disease unless accompanied by a shunt.

Adolescent↗

The inter-relationships of physical activity, physical fitness, and body measurements.

While several measures of physical activity have been used in research, it is not clear how these measures relate to each other or to measures of fitness and fatness. The purpose of this study was to examine the relationships of three commonly used indicators of physical activity to determine how they relate to each other as well as to measures of physical fitness and anthropometric measurements related to body fatness. Data from white adult men working for U.S. railroad companies in 1957 to 1960, who were free of pre-existing cardiovascular disease (N = 2,356), were used to study these relationships cross-sectionally. Total and intense leisure time activity and occupational activity were directly related to caloric intake. Total leisure time activity was inversely related to exercise test heart rate and directly related to body mass index, but not related to resting heart rate or skinfold thickness. Intense leisure time activity was significantly related to all fitness measures and not significantly related to fatness. Caloric intake was directly related to measures of fitness and inversely related to fatness. Occupational activity was directly related to measures of fitness and body mass index, and inversely related to skinfold thickness. These results provide a better understanding of methods appropriate to ascertaining physical activity in epidemiologic research as well as assisting in the comparison of results from studies which have used different physical activity indicators.

Adult↗

A comparison of two definitions of abnormality on pulmonary outcome in epidemiologic studies.

Definition of abnormal outcome on lung function testing has not been well standardized. Observed test results have been compared with predicted values based on age, height, and sex in 2 ways: as percent of the predicted (PP) and in relation to limits established by the 95% confidence interval around the predicted (CI). The present study examines these 2 methods of comparison with respect to effect on pulmonary outcome in 377 railroad workers and 193 pipefitters exposed to asbestos. Using accepted PP and CI criteria to define abnormal test results, we classified subjects as restricted or obstructed or normal by each method. The proportion restricted or obstructed was higher (p = 0.0001) if definitions were based on PP rather than on CI: restriction, 12.5% by PP versus 7.2% by CI; obstruction, 18.4% by PP versus 16.0% by CI. Twenty-seven percent (n = 47) of those abnormal by PP were normal by CI. Independent indicators of disease were used to compare this discordant group with groups normal (n = 391) or abnormal (n = 129) by both criteria. The subjects in the discordant group were older, with more years of asbestos exposure, longer latency, and more pleural plaques (p less than 0.05). The occurrence of chronic bronchitis and dyspnea was similar to that in the abnormal group. In our study, the method of comparison had a significant effect on outcome; PP appeared a better measure of disease. Our findings suggest that age and underlying risk of the study population should be considered in selecting a method of comparison in epidemiologic studies of respiratory disease.

Humans↗