Chagrin Highlands Health Center

The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees.Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT.For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter therapies and without indications for use of systemic HT, low-dose vaginal estrogen therapy or other therapies are recommended.This NAMS position statement has been endorsed by Academy of Women's Health, American Association of Clinical Endocrinologists, American Association of Nurse Practitioners, American Medical Women's Association, American Society for Reproductive Medicine, Asociación Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, Australasian Menopause Society, Chinese Menopause Society, Colegio Mexicano de Especialistas en Ginecologia y Obstetricia, Czech Menopause and Andropause Society, Dominican Menopause Society, European Menopause and Andropause Society, German Menopause Society, Groupe d'études de la ménopause et du vieillissement Hormonal, HealthyWomen, Indian Menopause Society, International Menopause Society, International Osteoporosis Foundation, International Society for the Study of Women's Sexual Health, Israeli Menopause Society, Japan Society of Menopause and Women's Health, Korean Society of Menopause, Menopause Research Society of Singapore, National Association of Nurse Practitioners in Women's Health, SOBRAC and FEBRASGO, SIGMA Canadian Menopause Society, Società Italiana della Menopausa, Society of Obstetricians and Gynaecologists of Canada, South African Menopause Society, Taiwanese Menopause Society, and the Thai Menopause Society. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool, June 2017. The British Menopause Society supports this Position Statement.

1. Seasonal dynamics of the exotic Daphnia lumholtzii and native macro‐zooplankton species were studied for 2 years in six inter‐connected lakes in Florida, U.S.A. The lakes ranged widely in pH, colour and trophic status, and were dominated by copepods. 2. All six lakes contained both D. lumholtzii and the native D. ambigua , but the two species did not overlap in time. D. ambigua was dominant in autumn–spring, coinciding with lower water temperature, higher transparency and lower nutrient and chlorophyll a (Chl a ) concentrations than in summer, when D. lumholtzii was dominant. 3. Based on the field observations, temperature optima were 24 °C for D. ambigua and 29 °C for D. lumholtzii , suggesting that temperature plays a role in determining dominance among the daphnids of subtropical Florida lakes. 4. D. lumholtzii has not displaced native cladocerans but occupies a ‘vacant’ seasonal niche, unexploited due to the inability of native taxa to tolerate high temperature. Furthermore, D. lumholtzii did not significantly alter algal–zooplankton interactions. There was evidence of top–down control by grazing, but it was primarily attributable to the native taxa.

Abstract The number of people wanting to use electrical tests to determine the transport properties of concrete has increased with advancements in the portability of hand-held testing devices. Electrical measurements are an attractive test method to quantify transport properties of cement-based materials since they can be performed rapidly. There is a high potential for using these tests in quality control or mixture qualification. However, electrical measurements can be significantly influenced by curing and storage conditions, which can impact the degree of saturation, degree of hydration, sample temperature, and pore solution chemistry. This study proposed a general equation that described the electrical resistivity measurements in cementitious systems and possible methods to account for some of these conditioning-induced changes. It is proposed that these tests are useful in the determination of the formation factor, a numerical quantification that describes the microstructure. A comparison of the formation factor obtained from rapid electrical measurements using the Nernst-Einstein relationship was compared to a migration test with the goal of proposing a curing methodology for rapid electrical tests that allows for the determination of a true transport property.

This study presents the long-term behavior of synthetic fiber–reinforced concrete pipe (SYNFRCP) in actual field conditions. Conventional reinforced concrete pipe (RCP) was tested for comparison purposes. The research program was twofold. First, the short-term relationships between the applied loads and the deflections of SYNFRCP were obtained on the basis of the ASTM C497 three-edge bearing test. Second, the changes in the deformations of the buried RCPs and SYNFRCPs under sustained loading were monitored for up to 4,200 h. Two fiber dosages of 8 lb/yd 3 (4.8 kg/m 3 ) and 12 lb/yd 3 (7.0 kg/m 3 ) were used during the pipe production. Two 24-in. (600-mm) and two 36-in. (900-mm) pipes were buried in trenches with a sustained load of 1,350 lb/ft/ft (65 kN/m/m). The pipes were initially backfilled with native soil up to 2 ft (600 mm) and 4 ft (1,200 mm) over the top of the pipe and then backfilled with 14 ft of pea gravel above this to simulate the maximum fill height sustained by a Class 3 Wall B precast concrete pipe on the basis of ASTM C76. Two displacement transducers were installed from the crown to the invert at two sections along the length of each pipe. All buried pipes were precracked until the first visible crack was observed. The precracking was done to evaluate the long-term performance of SYNFRCP in which fibers are engaged after cracking. The strength, the crack width, and the change in the vertical deformation of the buried SYNFRCP and RCP are compared and presented in this paper.

We adopt a fundamentally different approach to providing a dynamical description of the strange binary system SS433. Instead of relying solely upon the equations of motion of rigid bodies to obtain constraints on some of the parameters of the system, we make plausible physical assumptions concerning the nature of the system that allow the direct calculation of these parameters. Specifically, we assume that the free-body precession period is the same as the driven precession period, and we assume that the axial rotation period of the precessing object is tidally locked with its orbiting companion. These assumptions are fully consistent with earlier solutions of the full dynamical model, but provide a simpler set of constraints on the model, and yield a completely coherent picture of the components of this binary system. The free parameters of the model are the five physical parameters of the kinematic model plus the five parameters required to describe the 6-d nodding motion. The requirement that the precession results from Newtonian-driven precession then determines the oblateness of the precessing object and the mass ratio of the object to the total mass in the system. We also examine the impact of the discrete behaviour of the jet-bullets on the ability of any continuous model to fit the data, and re-examine the evidence for the location of the mean emitting region of the jets. This is followed by an analysis of the other possible periodicities in the system, particularly the 800–1000-d period suggested by some authors. We conclude that the precessional period of the system varies chaotically, possibly reflecting episodic mass transfer from the companion. Finally, we discuss what these results imply concerning the nature, origin and future of this unique system.

The children of parents with mental illness face numerous challenges. While there is abundant evidence of an increased risk for mental health problems, there has been less written about the immediate impact of experiencing a parent’s psychiatric crisis (e.g., hospitalisation). The current investigation aims to extend the current research literature by identifying clinical characteristics (i.e., symptoms of anxiety and/or depression), questions, and concerns reported by minor children when a significant caregiver in their life was hospitalised as the result of a serious mental illness. Standardised psychological tests of anxiety and depression were administered to 49 children, aged 7-17 years, at a time when a family member was admitted to a government-operated, psychiatric hospital. The children were also asked a set of structured questions in order to assess their concerns and questions at the time of a visit with their parent/relative at the hospital. Composite scores for the anxiety and depression scales fell within the normative range for the entire sample. However, roughly 40% of children produced at least one score that fell in the clinical range on anxiety subscales. Children reported that they were mainly happy to see their parent/relative in the hospital and eager to interact with them. The results are discussed in terms of ways to effectively meet the needs of a child whose parent or family member is hospitalised.

ABSTRACT This study uses neutron radiography to evaluate specimen preparation and test parameters that impact the depth of water penetration in concrete tested under water pressure. First, the impact of the boundary conditions (i.e., the dissipation of pressure that may build up at the lower side of the specimen) on the water penetration throughout the specimen depth was studied. Second, the impact of predrying the specimens (at 65°C) was examined. Third, the depth of water penetration is often measured by splitting the specimen at the end of the permeability test. The use of visual assessment to quantify the depth of water penetration was compared with neutron radiography measurements to determine the accuracy of visual inspection. It was concluded that care should be taken while designing the permeability apparatus to allow pressure dissipation at the lower section of the specimen. The predrying of the specimens at 65°C significantly impacts the permeability and microstructure of the concrete specimens. Finally, water can be seen by the eye when it fills voids with a pore radius greater than 46 nm (i.e., a relative humidity higher than 98.2 ± 0.5 % range, in concrete specimens with a water-to-cement ratio of 0.42 and an air content of 2.5 % content).

Mixed amphetamine salts extended release (MAS-XR) has been demonstrated in pediatric, adolescent and adult studies to be a well tolerated and effective treatment for attention-deficit hyperactivity disorder (ADHD). MAS-XR utilizes a double-pulse delivery system to replicate the pharmacokinetic properties of equal doses of immediate-release MAS administered 4 h apart. Doses of 20 mg MAS-XR produce significant reductions of core symptoms of ADHD over a 12-h period. Adverse effects observed in controlled studies include anorexia, weight loss, dry mouth, insomnia and abdominal pain, and rates of adverse effects are comparable to other stimulant agents approved for ADHD. At this time, there are no data to suggest that sudden death due to cardiovascular complications occurs more frequently in patients treated with MAS-XR than in the general population, but careful consideration of the risks and benefits of MAS-XR is warranted in patients with pre-existing structural heart disease and adult patients with a history of hypertension.

ABSTRACT ASTM G180-13, Standard Test Method for Corrosion Inhibiting Admixtures for Steel in Concrete by Polarization Resistance in Cementitious Slurries (Superseded), testing was used to determine the effectiveness of corrosion inhibiting admixtures. However, inconsistent results have been reported due to the polishing process. Although not standardized, polished metal specimens have been used to remove contaminants or native oxides prior to electrochemical measurements to acquire stabilized electrochemical measurements. Furthermore, the open circuit potential (OCP) delay before electrochemical testing was found to be critical to the consistency of the subsequent experiment. The goal of this study was to investigate the influence of polishing and environmental factors on the OCP value and its variation. The OCP of carbon steel in high pH simulated pore solutions was measured as functions of polishing, time, chloride content, and nitrite concentration. By using a full-factorial experimental design and regression analysis, the effects of the factors were studied on both the mean value and on the standard deviation of corrosion potential. The standard deviation of repeated tests was quantified and ranked to provide guidance on specimen preparation. The regression result showed that polishing does not influence the mean value of the OCP but that the OCP standard deviation heavily depends on the polishing consistency. Based on the experimental data and analysis, a suggestion was provided for specimen preparation to address the observed inconsistency in specimen preparation for ASTM G180-13 testing.

Despite the prolific implementation of manufacturing systems, JIT principles, Kaizen events, and cycle time reduction programs over the past few years, high inventories still plague many companies. The assumption that implementing these principles and techniques will automatically result in inventory levels that satisfy management frequently proves to be false. Events like mergers, introduction of new competition, and a dropoff in business often trigger edicts to cut inventories. The cost of inventories also extends beyond the traditional accounting measurements to include hidden operating costs that everyone should want to eliminate. This article looks at the reasons for inventories and explores strategies for reducing them.

An Interview with Prof. Rosita Gabbianelli

Despite widespread recognition that mental and emotional concerns in childhood have risen to an unprecedented high, there continues to be a sense of hesitancy in approaching mental and emotional development in pediatrics. This hesitancy is related to pervasive barriers including lack of comfort, time, and perhaps most importantly, lack of resources to offer families. However, research supports that families benefit from interventions that foster healthy relationships and whole health throughout development, which are fundamental to pediatric practice. Pediatricians are skilled in addressing whole health as they support the physical, mental, emotional, developmental, and social well-being of families from the birth of a child to their transition into adulthood. They are also accustomed to assessing health on a spectrum that includes prevention, early identification, treatment, and support as they work through concerns and diagnoses with families in an iterative manner and over the long-term. This type of practice that focuses less on expeditiously arriving at diagnoses and narrow treatments for concerns is important for mental and emotional development. This report presents a reframe of mental and emotional development as part of whole health as opposed to a condition that should only be diagnosed and treated when something is "wrong." The report also provides a stepped approach that may be helpful for addressing mental and emotional health concerns in pediatrics and acknowledges the advocacy that is needed to expand mental and emotional resources widely.

Alkali–silica reaction (ASR) is a major concrete durability problem. The occurrence of ASR results in significant maintenance and reconstruction costs to concrete infrastructures all over the world. Current market solutions for preventing ASR are not always sustainable, such as hauling non-reactive aggregates or fly ash from a long distance; or using of Li-based chemical admixture that is facing the challenge of raw material’s availability. The current article will present an ASR preventing technical solution, which is based on the abundant soluble Ca 2+ ions. However, the current ASTM C1567 [1] test method is not suitable for assessing the effectiveness of this new ASR preventing technology due to the leaching of soluble Ca 2+ ions into the soak solution. Two new ASR expansion test methods have been developed to address the leaching issue: (1) single mortar bar in sealed pipe with 10 mL H 2 O and additional NaOH in mortar, and (2) ASTM C1567 with additional Ca 2+ in soak solution to buffer leaching. The effect of ASR prevention of this innovative technology was evaluated and compared with these two new test methods for mortars made with several ASR reactive aggregates. The ASTM C1567 with additional Ca 2+ in soak solution was selected as the test method for the assessment of the new ASR-preventing technology based on soluble Ca 2+ ions.

Health Physics: December 2011 - Volume 101 - Issue 6 - p 655-656 doi: 10.1097/HP.0b013e3182287ba5

Aims: Indawgyi Lake, in northern Myanmar, is the country’s largest lake and among the largest in Southeast Asia. Although the lake’s fishery provides an important source of food and livelihoods, relatively little is known about the status of its fishery and how human actions are affecting it. Further, some basic information on fish populations has not been documented, such as the extent to which fish migrate, either downstream toward the Ayeyarwady River or into the lake’s tributaries. Similar to other lakes in the region (e.g., Inle Lake in central Myanmar), the fishing practices of Indawgyi Lake appear to be intensifying. Thus, improved understanding of the lake’s fishery and fish-migration patterns can inform future management.
 Study Design: To gather preliminary information, we surveyed 6 villages around Indawgyi Lake collecting Traditional Ecological Knowledge (TEK) about the migratory behavior of fish and current state of the fishery.
 Place and Duration of Study: Hepa, Hepu, Lone Ton, Lonsant, Mamon Kaing, and Nyaung Bin along Indawgyi Lake in Myanmar
 Methodology: We interviewed fishermen in large groups at 6 villages (approximately 60 fishermen overall), aggregating results into the six village groups due to the consensus style of interviews. We performed additional spatial analyses using Google Earth Engine.
 Results: Fishermen reported that nearly all the fish they commonly catch are migratory, with most using upstream tributaries for spawning during the wet season. Fishermen also reported that, although most tributaries remained in good condition, several have been severely impacted by land-use changes, including gold mining. Fishermen consistently reported that harvest levels have declined dramatically in the past two decades even as they deploy more nets. Across the villages interviewed, the top recommendation to combat declines was to increase/strengthen enforcement of regulations.
 Conclusion: This research demonstrates the utility of TEK to provide preliminary information on poorly studied systems that can inform conservation and management.

of Bragana (IPB), Portugal.His research focuses on the chemistry and bioactivity of natural products, the valorization of agri-food by-products into biobased ingredients,