Papers by Mary luz Llalle ramos
The American Journal of Tropical Medicine and Hygiene, 2008
From June 2005 to May 2006, a clinic-based enhanced surveillance system for dengue was implemente... more From June 2005 to May 2006, a clinic-based enhanced surveillance system for dengue was implemented in a Puerto Rican municipality to provide a population-based measure of disease incidence and clinical outcomes. We obtained demographic and clinical information from suspected cases and performed serologic and virologic testing. We used World Health Organization (WHO) criteria to classify cases and applied a simplified case definition for severe dengue illness. There were 7.7 laboratory-positive cases of dengue per 1,000 population. The highest incidence, 13.4 per 1,000, was among 10 to 19 year olds. Of the 156 laboratory-positive cases, three patients (1.9%) met WHO criteria for dengue hemorrhagic fever, and 30 patients (19.2%) had at least one severe clinical manifestation of dengue infection. Our data suggest that in a community with endemic dengue, enhanced surveillance is useful for detecting symptomatic infections. Furthermore, the simplified case definition for severe dengue may be useful in clinic-based surveillance.
PLoS Neglected Tropical Diseases, 2014
Dengue is a major cause of morbidity in Puerto Rico and is well-known to its physicians. Early ca... more Dengue is a major cause of morbidity in Puerto Rico and is well-known to its physicians. Early case identification and timely initiation of treatment for patients with severe dengue can reduce medical complications and mortality. To determine clinical management and reporting practices, and assess knowledge of dengue and its management, a survey was sent to 2,512 physicians with a medical license in Puerto Rico. Of the 2,313 physicians who received the survey, 817 (35%) completed the questionnaire. Of the respondents, 708 were currently practicing medicine; 138 were board certified (Group 1), 282 were board eligible (Group 2), and 288 had not finished residency (Group 3). Although respondents clinically diagnosed, on average, 12 cases of dengue in the preceding three months, 31% did not report any suspected cases to public health officials while about half (56%) reported all cases. Overall, 29% of respondents correctly identified early signs of shock and 48% identified severe abdominal pain and persistent vomiting as warning signs for severe dengue with the proportion of correct respondents highest in Group 1. Reportedly about sixty percent (57%) appropriately never give corticosteroids or prophylactic platelet transfusions to dengue patients. One third (30%) of respondents correctly identified administration of intravenous colloid solution as the best treatment option for dengue patients with refractory shock and elevated hematocrit after an initial trial of intravenous crystalloids, and nearly one half (46%) correctly identified administration of a blood transfusion as the best option for dengue patients with refractory shock and decreased hematocrit after a trial of intravenous crystalloids. Even though dengue has been endemic in Puerto Rico for nearly 4 decades, knowledge of dengue management is still limited, compliance with WHO treatment guidelines is suboptimal, and underreporting is significant. These findings were used to design a post graduate training course to improve the clinical management of dengue.
2007 32nd IEEE/CPMT International Electronic Manufacturing Technology Symposium, 2007
QFN demand has dramatically increased during the past 3 years. It has been replacing older packag... more QFN demand has dramatically increased during the past 3 years. It has been replacing older packages like SOIC and TSSOP mainly because of the added thermal enhancements from the exposed pad, as well as the elimination of coplanarity issues. QFN is also being chosen for nextgeneration packages because it has a relatively bigger pad size, allowing more flexibility in accommodating bigger die size, die integration and the added advantage of thermal enhancement. However, as the package requires more I/O in a smaller footprint, current QFN structure will have some limitations. Currently, there is a solution for two rows of I/O but any higher than that, the available solution becomes more expensive-one solution requires laser cutting to isolate each row and another requires use of photo-imaging, develop and etching process to define the I/O. This paper describes an alternative methodology for making a low-cost QFN with multiple rows. The leadframe raw material that will be used will be solid copper, half etched on one side, with selective silver plating. The difference from existing QFN leadframes is that this does not need tape during molding. There will be two new processes introduced: selective copper etching and electroless plating. Although these processes are commonly used in other industries, the challenges and proposed solutions encountered in adopting them in IC packaging assembly will be discussed. Apart from the cost advantage, manufacturing and performance advantages and disadvantages related to these new methods will also be tackled.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2009
Early diagnosis of dengue is challenging because the initial symptoms are often non-specific, vir... more Early diagnosis of dengue is challenging because the initial symptoms are often non-specific, viraemia may be below detectable levels and serological tests confirm dengue late in the course of illness. Identifying dengue early in the clinical course could be useful in reducing dengue virus transmission in a community. This study analyzed data from 145 laboratory-positive and 293 laboratory-negative dengue cases in Puerto Rico to define the early clinical features of dengue infection in children and adults and to identify the clinical features that predict a laboratory-positive dengue infection. Among children, rash and age were independently associated with laboratory-positive dengue infection. Rash in the absence of cough had a positive predictive value of 100% and a negative predictive value of 82.4% as a paediatric dengue screen. Among adults, eye pain, diarrhoea and absence of upper respiratory symptoms were independently associated with laboratory-positive dengue infection. No useful early predictors of dengue infection among adults were found. Using clinical features may promote earlier identification of a subset of paediatric dengue patients in Puerto Rico. Laboratory confirmation is still necessary for the accurate diagnosis of dengue infection.
Research in Nursing & Health, 1989
Traditional values i n nursing dictate a high level of concern for the welfare of research partic... more Traditional values i n nursing dictate a high level of concern for the welfare of research participants. Initial attempts at setting minimal ethical standards stemmed from the quantitativeapproaches. As qualitative modalitiesare more widely used, nurses must become acutely aware of possible problems i n study design and planning, the dangers of coercion and deception, threats to confidentiality and trust, implications of the emergent design, a n d providing for a new concept of informed consent. The new character of the research relationship is examined i n light of possible strategies for protection of research participants while preserving the integrity of qualitative investigation. THE TRADITIONAL PARADIGM Laboratory-based scientific investigation was long considered the only model which could render Mory Carol Ramos, MS, MSN, RN, is o doctoral student at the University of Virginio School The author gratefully acknowledges Morcio Day Finney, M.A. for editoriol assistance.
Patient Education and Counseling, 2007
Objective: The impact of breast cancer is immense for all women, but the literature reveals an ev... more Objective: The impact of breast cancer is immense for all women, but the literature reveals an even greater impact on women of color and among socially and economically disadvantaged populations. Persistent differences in incidence and outcome are undoubtedly due to multiple factors, but one element in poor outcome may be treatment choice. Those treatments shown to be related to best outcomes are less likely to be chosen by certain groups of women. The effects of economic and cultural factors on breast cancer treatment choice have not been thoroughly explored; these factors must be understood if health care professionals are to intervene effectively to address disparities and improve breast cancer outcomes for all women. Methods: A review of the breast cancer literature was conducted in order to: (1) describe breast cancer disparities in the United States; (2) delineate factors that might contribute to those disparities; (3) assess possible mitigating factors for predominant causes; (4) begin to decide how health care interventions might allay the factors that contribute to disparities in breast cancer incidence and mortality. Results: Breast cancer incidence and outcome disparities in the United States are due to multiple interacting factors. These include information about treatment, different types of treatment, the emotional context of decision-making, and patient preference for level of involvement. Treatment decision-making is complex. Conclusion: Health literacy and level of decision-making involvement, both embedded in social and economic reality, are key components in breast cancer treatment decision-making and may contribute to breast cancer disparities in the United States. Current models of shared decision-making may not be generalizable to all breast cancer patients. Practice implications: Optimal breast cancer outcomes for all women depend on culturally and ethnically appropriate professional support.
Maternal and Child Health Journal, 2010
Journal of Wound, Ostomy and Continence Nursing, 1996
Those of us who have practiced for more years than we care to contemplate have seen team nursing ... more Those of us who have practiced for more years than we care to contemplate have seen team nursing come and go (and come again) and have seen scores of other "innovations" create new dilemmas and new work. Nursing Process Outlines, Nursing Care Plans, Interdisciplinary Standards, Multidisciplinary Data Bases, Care Protocols, and Guidelines have, in various decades, helped us to look at our practice and break it into its smallest components for analysis and (we hope) understanding. Professionals have used countless documents to outline patient care in an attempt to attain high quality. Currently, many work at developing and implementing documents called pathways.
Journal of Travel Medicine, 2010
Background. As the incidence of dengue increases globally, US travelers to endemic areas may be a... more Background. As the incidence of dengue increases globally, US travelers to endemic areas may be at an increased risk of travel-associated dengue. Methods. Data from the US Centers for Disease Control and Prevention's laboratory-based Passive Dengue Surveillance System (PDSS) were used to describe trends in travel-associated dengue reported from January 1, 1996 to December 31, 2005. The PDSS relies on provider-initiated requests for diagnostic testing of serum samples via state health departments. A case of travel-associated dengue was defined as a laboratory-positive dengue infection in a resident of the 50 US states and the District of Columbia who had been in a dengue-endemic area within 14 days before symptom onset. Dengue infection was confirmed by serologic and virologic techniques. Results. One thousand one hundred and ninety-six suspected travel-associated dengue cases were reported-334 (28%) were laboratory-positive, 597 (50%) were laboratory-negative, and 265 (22%) were laboratory-indeterminate. The incidence of laboratory-positive cases varied from 1996 to 2005, but had an overall increase with no significant trend (53.5 to 121.3 per 10 8 US travelers, p = 0.36). The most commonly visited regions were the Caribbean, Mexico and Central America, and Asia. The median age of laboratory-positive cases was 37 years (range: <1 to 75 y) and 166 (50%) were male. Of the 334 laboratory-positive cases, 41 (12%) were hospitalized, and 2 (1%) died. Conclusions. Residents of the US traveling to dengue-endemic regions are at risk of dengue infection and need to be instructed on appropriate prevention measures prior to travel. Especially in light of the potential transmissibility of dengue virus via blood transfusion, consistent reporting of travel-associated dengue infections is essential.
Journal of Travel Medicine, 2014
Journal of School Health, 2011
BACKGROUND-Handwashing in the school setting is important for infectious disease control, yet mai... more BACKGROUND-Handwashing in the school setting is important for infectious disease control, yet maintaining adequate handwashing supplies is often made difficult by lack of funds, limited staff time, and student vandalism. This study measured the availability of handwashing supplies for students in New Mexico public schools and determined the impact of scheduled school nurse inspections on the availability of handwashing supplies. METHODS-Participating school districts in New Mexico were matched by size and randomized into intervention and control groups. Baseline inspections were conducted in November 2008 followed by 2 subsequent bimonthly inspections. For each student bathroom, the presence or absence of soap and either paper towels or hand dryers was indicated on an inspection checklist. The intervention group reported findings to the New Mexico Department of Health (NMDOH) and to school administrative and custodial staff requesting that any identified problems be addressed. The control group reported inspection findings to the NMDOH only. Descriptive analyses were conducted to determine the proportion of bathrooms with soap and either paper towels or hand dryers. Comparisons were made between the intervention schools and the control schools at baseline and during the intervention period. RESULTS-The intervention group had significantly higher probability of bathrooms being supplied with soap (p < .05) and paper towels/hand dryers (p < .02) during the intervention period. CONCLUSIONS-Regularly scheduled school nurse inspections of hand hygiene supplies, with reporting to appropriate school officials, can improve the availability of handwashing supplies for students.
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Papers by Mary luz Llalle ramos