Evaluating clinically meaningful change on the ITP-PAQ: preliminary estimates of minimal important differences.

PubMed

Mathias, Susan D; Gao, Sue K; Rutstein, Mark; Snyder, Claire F; Wu, Albert W; Cella, David

2009-02-01

Interpretation of data from health-related quality of life (HRQoL) questionnaires can be enhanced with the availability of minimally important difference (MID) estimates. This information will aid clinicians in interpreting HRQoL differences within patients over time and between treatment groups. The Immune Thrombocytopenic Purpura (ITP)-Patient Assessment Questionnaire (PAQ) is the only comprehensive HRQoL questionnaire available for adults with ITP. Forty centers from within the US and Europe enrolled ITP patients into one of two multicenter, randomized, placebo-controlled, double-blind, 6-month, phase III clinical trials of romiplostim. Patients enrolled in these studies self-administered the ITP-PAQ and two items assessing global change (anchors) at baseline and weeks 4, 12, and 24. Using data from the ITP-PAQ and these two anchors, an anchor-based estimate was computed and combined with the standard error of measurement and standard deviation to compute a distribution-based estimate in order to provide an MID range for each of the 11 scales of the ITP-PAQ. A total of 125 patients participated in these clinical trials and provided data for use in these analyses. Combining results from anchor- and distribution-based approaches, MID values were computed for 9 of the 11 scales. MIDs ranged from 8 to 12 points for Symptoms, Bother, Psychological, Overall QOL, Social Activity, Menstrual Symptoms, and Fertility, while the range was 10 to 15 points for the Fatigue and Activity scales of the ITP-PAQ. These estimates, while slightly higher than other published MID estimates, were consistent with moderate effect sizes. These MID estimates will serve as a useful tool to researchers and clinicians using the ITP-PAQ, providing guidance for interpretation of baseline scores as well as changes in ITP-PAQ scores over time. Additional work should be done to finalize these initial estimates using more appropriate anchors that correlate more highly with the ITP-PAQ scales.

Minimal clinically important difference in the fibromyalgia impact questionnaire.

PubMed

Bennett, Robert M; Bushmakin, Andrew G; Cappelleri, Joseph C; Zlateva, Gergana; Sadosky, Alesia B

2009-06-01

The Fibromyalgia Impact Questionnaire (FIQ) is a disease-specific composite instrument that measures the effect of problems experienced by patients with fibromyalgia (FM). Utilization of the FIQ in measuring changes due to interventions in FM requires derivation of a clinically meaningful change for that instrument. Analyses were conducted to estimate the minimal clinically important difference (MCID), and to propose FIQ severity categories. Data from 3 similarly designed, 3-month placebo-controlled, clinical treatment trials of pregabalin 300, 450, and 600 mg/day in patients with FM were modeled to estimate the change in the mean FIQ total and stiffness items corresponding to each category on the Patient Global Impression of Change. FIQ severity categories were modeled and determined using established pain severity cutpoints as an anchor. A total of 2228 patients, mean age 49 years, 93% women, with a mean baseline FIQ total score of 62 were treated in the 3 studies. Estimated MCID on a given measure were similar across the studies. In a pooled analysis the estimated MCID (95% confidence interval) was 14% (13; 15) and for FIQ stiffness it was 13% (12; 14). In the severity analysis a FIQ total score from 0 to <39 was found to represent a mild effect, >or= 39 to <59 a moderate effect, and >or=59 to 100 a severe effect. The analysis indicates that a 14% change in the FIQ total score is clinically relevant, and results of these analyses should enhance the clinical utility of the FIQ in research and practice.

Minimal change disease in a patient with myasthenia gravis: A case report.

PubMed

Tsai, Jun-Li; Tsai, Shang-Feng

2016-09-01

Myasthenia gravis superimposed with proteinuria is a very rare disorder with only 39 cases reported so far. Of these cases, the most commonly associated disorder is minimal change disease. Myasthenia gravis and minimal change disease are both related to the dysfunction of T lymphocytes and hence the 2 disorders may be connected. Here we report the first case on a patient diagnosed with myasthenia gravis concurrently with the minimal change disease, and it was presented in the absence of thymoma or thymic hyperplasia. Treatment for myasthenia gravis also lowered proteinuria of minimal change disease. He ever experienced good control for myasthenia gravis and minimal change disease. However, pneumonia related septic shock occurred to him and finally he was dead. Minimal change disease is generally considered to occur subsequent to the onset of myasthenia gravis with causal association. After extensive literature review, we noted only 47.8% minimal change disease had occurred after the onset of myasthenia gravis. Minimal change disease mostly occurs in children and if diagnosed in adults, clinicians should search for a potential cause such as myasthenia gravis and other associated thymic disorders.

Estimating minimally important difference (MID) in PROMIS pediatric measures using the scale-judgment method.

PubMed

Thissen, David; Liu, Yang; Magnus, Brooke; Quinn, Hally; Gipson, Debbie S; Dampier, Carlton; Huang, I-Chan; Hinds, Pamela S; Selewski, David T; Reeve, Bryce B; Gross, Heather E; DeWalt, Darren A

2016-01-01

To assess minimally important differences (MIDs) for several pediatric self-report item banks from the National Institutes of Health Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)). We presented vignettes comprising sets of two completed PROMIS questionnaires and asked judges to declare whether the individual completing those questionnaires had an important change or not. We enrolled judges (including adolescents, parents, and clinicians) who responded to 24 vignettes (six for each domain of depression, pain interference, fatigue, and mobility). We used item response theory to model responses to the vignettes across different judges and estimated MID as the point at which 50 % of the judges would declare an important change. We enrolled 246 judges (78 adolescents, 85 parents, and 83 clinicians). The MID estimated with clinician data was about 2 points on the PROMIS T-score scale, and the MID estimated with adolescent and parent data was about 3 points on that same scale. The MIDs enhance the value of PROMIS pediatric measures in clinical research studies to identify meaningful changes in health status over time.

Monitoring somatic symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the Somatic Symptom Scale - 8 (SSS-8).

PubMed

Gierk, Benjamin; Kohlmann, Sebastian; Hagemann-Goebel, Marion; Löwe, Bernd; Nestoriuc, Yvonne

2017-09-01

The SSS-8 is a brief questionnaire for the assessment of somatic symptom burden. This study examines its sensitivity to change and the minimal clinically important difference (MCID) in patients with mental disorders. 55 outpatients with mental disorders completed the SSS-8 and measures of anxiety, depression, and disability before and after receiving treatment. Effect sizes and correlations between the change scores were calculated. The MCID was estimated using a one standard error of measurement threshold and the change in disability as an external criterion. There was a medium decline in somatic symptom burden for the complete sample (n=55, d z =0.53) and a large decline in a subgroup with very high somatic symptom burden at baseline (n=11, d z =0.94). Decreases in somatic symptom burden were associated with decreases in anxiety (r=0.68, p<0.001), depression (r=0.62, p<0.001) and disability (r=0.51, p<0.001). The MCID was estimated as a 3-point decrease. The SSS-8 is sensitive to change. A 3-point decrease reflects a clinically important improvement. Due to its brevity and sound psychometric properties, the SSS-8 is useful for monitoring somatic symptom burden. Copyright © 2017 Elsevier Inc. All rights reserved.

Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders.

PubMed

Mattos, Jose L; Schlosser, Rodney J; Mace, Jess C; Smith, Timothy L; Soler, Zachary M

2018-05-02

Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS). Changes in the QOD-NS after treatment can be difficult to interpret since there is no standardized definition of clinically meaningful improvement. Patients with chronic rhinosinusitis (CRS) completed the QOD-NS. Four distribution-based methods were used to calculate the minimal clinically important difference (MCID): (1) one-half standard deviation (SD); (2) standard error of the mean (SEM); (3) Cohen's effect size (d) of the smallest unit of change; and (4) minimal detectable change (MDC). We also averaged all 4 of the scores together. Finally, the likelihood of achieving a MCID after sinus surgery using these methods, as well as average QOD-NS scores, was stratified by normal vs abnormal baseline QOD-NS scores. Outcomes were examined on 128 patients. The mean ± SD improvement in QOD-NS score after surgery was 4.3 ± 11.0 for the entire cohort and 9.6 ± 12.9 for those with abnormal baseline scores (p < 0.001). The MCID values using the different techniques were: (1) SD = 6.5; (2) SEM = 3.1; (3) d = 2.6; and (4) MDC = 8.6. The MCID score was 5.2 on average. For the total cohort analysis, the likelihood of reporting a MCID ranged from 26% to 51%, and 49% to 70% for patients reporting preoperative abnormal olfaction. Distribution-based MCID values of the QOD-NS range between 2.6 and 8.6 points, with an average of 5.2. When stratified by preoperative QOD-NS scores the majority of patients reporting abnormal preoperative QOD-NS scores achieved a MCID. © 2018 ARS-AAOA, LLC.

Chronic Lyme borreliosis associated with minimal change glomerular disease: a case report.

PubMed

Florens, N; Lemoine, S; Guebre-Egziabher, F; Valour, F; Kanitakis, J; Rabeyrin, M; Juillard, L

2017-02-06

There are only few cases of renal pathology induced by Lyme borreliosis in the literature, as this damage is rare and uncommon in humans. This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis. A 65-year-old Caucasian woman was admitted for an acute edematous syndrome related to a nephrotic syndrome. Clinical examination revealed violaceous skin lesions of the right calf and the gluteal region that occurred 2 years ago. Serological tests were positive for Lyme borreliosis and skin biopsy revealed lesions of chronic atrophic acrodermatitis. Renal biopsy showed minimal change glomerular disease. The skin lesions and the nephrotic syndrome resolved with a sequential treatment with first ceftriaxone and then corticosteroids. We report here the first case of minimal change disease associated with Lyme borreliosis. The pathogenesis of minimal change disease in the setting of Lyme disease is discussed but the association of Lyme and minimal change disease may imply a synergistic effect of phenotypic and bacterial factors. Regression of proteinuria after a sequential treatment with ceftriaxone and corticosteroids seems to strengthen this conceivable association.

Federal public health strategies to minimize the importation of communicable diseases into Canada

PubMed Central

Bhatia, N; Sarwal, S; Robinson, H; Geduld, J; Huneault, F; Schreiner, H; Collins, S; Hickey, R

2015-01-01

Background The global spread of communicable diseases is a growing concern largely as a result of increased international travel. In Canada, although most public health management of communicable diseases occurs at the front line, the federal government also takes actions to prevent and mitigate their importation. Objective To describe the role of the Public Health Agency of Canada (PHAC) in minimizing the importation of communicable diseases through preventive measures taken before travellers leave Canada and through early detection and prompt containment measures taken when travellers arrive in the country with a potential communicable disease. Interventions PHAC works to minimize the importation of communicable diseases into Canada by developing evidence-based travel health advice and targeted outreach activities geared to the public and to health care professionals. On the basis of the Quarantine Act and the International Health Regulations (2005), PHAC also conducts inspections of conveyances such as aircraft and boats and works with partners to conduct border screening to assess ill travellers entering the country. Conclusion PHAC plays an important role in preventing and minimizing the importation of communicable diseases into Canada in conjunction with clinicians, public health authorities at all levels of government and other federal government departments. PMID:29769971

Adult-onset Minimal Change Disease with IgA Nephropathy and Hepatitis C

PubMed Central

Chowdhury, Waliul; Saleem, Tahira Sabeen; Lodhi, Muhammad Uzair; Syed, Intekhab Askari; Iqbal, Hafiz Imran

2018-01-01

Minimal change disease (MCD) is one of the most common causes of nephrotic syndrome in children, leading to heavy proteinuria and edema. However, it is not as common in adults. Adult-onset minimal change disease with IgA nephropathy is rare. The initial presentation of heavy proteinuria and edema with effacement of podocytes on electron microscopy (EM) should lead the physician to suspect minimal change disease regardless of age. We present a 44-year-old male patient with a history of hepatitis C virus (HCV) who presented with sudden onset of lower extremity edema and 6.6 grams (g) of proteinuria per day. PMID:29682437

Responsiveness and minimal clinically important changes for the Tampa Scale of Kinesiophobia after lumbar fusion during cognitive behavioral rehabilitation.

PubMed

Monticone, Marco; Ambrosini, Emilia; Rocca, Barbara; Foti, Calogero; Ferrante, Simona

2017-06-01

The Tampa Scale of Kinesiophobia (TSK) is a commonly-used measure for the assessment of fear of movement beliefs in chronic complaints, but its responsiveness in subjects after lumbar fusion has been never reported. Evaluating the responsiveness and minimal clinically important differences (MCIDs) for the TSK and its subscales after lumbar fusion. Population-based cohort study. Secondary care rehabilitation hospital. In-patients undergoing rehabilitation after lumbar fusion. At the beginning and end of a four-week motor and cognitive-behavioral rehabilitation program, 180 patients completed the TSK. After the intervention, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the TSK and its subscales were calculated by distribution (effect size [ES], standardized response mean [SRM]) and anchor-based methods (receiver operating characteristics (ROC) curves; correlations between change scores of the TSK and its subscales and GPE). ROC curves were also used to compute MCID values. The ES ranged from 1.63 to 1.77 and the SRM from 1.25 to 1.39 for TSK and its subscales. The ROC analyses revealed a value of area under the curve (0.999 [95% CI: 0.978; 1.000], 0.998 [95% CI: 0.975; 1.000], 0.990 [95% CI: 0.962; 0.999] for the TSK, Harm and Activity Avoidance subscales, respectively). MCID values greater than 6 (95% CI: >5; >6), 4 (95% CI: >3; >5), and 2 (95% CI: >2; >2) were achieved for the TSK, Harm and Activity Avoidance subscales, respectively. Correlations between change scores of the TSK and its subscales and GPE were high (0.786-0.830). The TSK and its subscales were sensitive in detecting clinical changes in subjects undergoing rehabilitation after lumbar fusion. The obtained MCID values will help in the design of future randomized controlled trials and in the interpretation of the clinical impact of a rehabilitation program after lumbar fusion.

Minimally important difference for the Expanded Prostate Cancer Index Composite Short Form.

PubMed

Skolarus, Ted A; Dunn, Rodney L; Sanda, Martin G; Chang, Peter; Greenfield, Thomas K; Litwin, Mark S; Wei, John T

2015-01-01

To establish a score threshold that constitutes a clinically relevant change for each domain of the Expanded Prostate Cancer Index Composite (EPIC) Short Form (EPIC-26). Although its use in clinical practice and clinical trials has increased worldwide, the clinical interpretation of this 26-item disease-specific patient-reported quality of life questionnaire for men with localized prostate cancer would be facilitated by characterization of score thresholds for clinically relevant change (the minimally important differences [MIDs]). We used distribution- and anchor-based approaches to establish the MID range for each EPIC-26 domain (urinary, sexual, bowel, and vitality/hormonal) based on a prospective multi-institutional cohort of 1201 men treated for prostate cancer between 2003 and 2006 and followed up for 3 years after treatment. For the anchor-based approach, we compared within-subject and between-subject score changes for each domain to an external "anchor" measure of overall cancer treatment satisfaction. We found the bowel and vitality/hormonal domains to have the lowest MID range (a 4-6 point change should be considered clinically relevant), whereas the sexual domain had the greatest MID values (10-12). Urinary incontinence appeared to have a greater MID range (6-9) than the urinary irritation/obstruction domain (5-7). Using 2 independent approaches, we established the MIDs for each EPIC-26 domain. A definition of these MID values is essential for the researcher or clinician to understand when changes in symptom burden among prostate cancer survivors are clinically relevant. Copyright © 2015 Elsevier Inc. All rights reserved.

Minimal Clinically Important Difference of Berg Balance Scale in People With Multiple Sclerosis.

PubMed

Gervasoni, Elisa; Jonsdottir, Johanna; Montesano, Angelo; Cattaneo, Davide

2017-02-01

To identify the minimal clinically important difference (MCID) to define clinically meaningful patient's improvement on the Berg Balance Scale (BBS) in people with multiple sclerosis (PwMS) in response to rehabilitation. Cohort study. Neurorehabilitation institute. PwMS (N=110). This study comprised inpatients and outpatients who participated in research on balance and gait rehabilitation. All received 20 rehabilitation sessions with different intensities. Inpatients received daily treatments over a period of 4 weeks, while outpatients received 2 to 3 treatments per week for 10 weeks. An anchor-based approach using clinical global impression of improvement in balance (Activities-specific Balance Confidence [ABC] Scale) was used to determine the MCID of the BBS. The MCID was defined as the minimum change in the BBS total score (postintervention - preintervention) that was needed to perceive at least a 10% improvement on the ABC Scale. Receiver operating characteristic curves were used to define the cutoff of the optimal MCID of the BBS discriminating between improved and not improved subjects. The MCID for change on the BBS was 3 points for the whole sample, 3 points for the inpatients, and 2 points for the outpatients. The area under the curve was .65 for the whole sample, .64 for inpatients, and .68 for outpatients. The MCID for improvement in balance as measured by the BBS was 3 points, meaning that PwMS are likely to perceive that as a reproducible and clinically important change in their balance performance. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Identifying Minimal Changes in Nonerosive Reflux Disease: Is the Pay Worth the Labor?

PubMed

Gabbard, Scott L; Fass, Ronnie; Maradey-Romero, Carla; Gingold Belfer, Rachel; Dickman, Ram

2016-01-01

Gastroesophageal reflux disease has a variable presentation on upper endoscopy. Gastroesophageal reflux disease can be divided into 3 endoscopic categories: Barrett's esophagus, erosive esophagitis, and normal mucosa/nonerosive reflux disease (NERD). Each of these phenotypes behave in a distinct manner, in regards to symptom response to treatment, and risk of development of complications such as esophageal adenocarcinoma. Recently, it has been proposed to further differentiate NERD into 2 categories: those with and those without "minimal changes." These minimal changes include endoscopic abnormalities, such as villous mucosal surface, mucosal islands, microerosions, and increased vascularity at the squamocolumnar junction. Although some studies have shown that patients with minimal changes may have higher rates of esophageal acid exposure compared with those without minimal changes, it is currently unclear if these patients behave differently than those currently categorized as having NERD. The clinical utility of identifying these lesions should be weighed against the cost of the requisite equipment and the additional time required for diagnosis, compared with conventional white light endoscopy.

The minimal clinically important difference of six-minute walk in Asian older adults.

PubMed

Kwok, Boon Chong; Pua, Yong Hao; Mamun, Kaysar; Wong, Wai Pong

2013-03-06

Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Data from the "Evaluation of the Frails' Fall Efficacy by Comparing Treatments" study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cut-off values of 6MWD (in meters) for GROC rating of "a little bit better" (+2), based on feedback from participants. The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC ≥ 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population.

Cultural change and support of waste minimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boylan, M.S.

1991-12-31

The process of bringing a subject like pollution prevention to top of mind awareness, where designed to prevent waste becomes part of business as usual, is called cultural change. With Department of Energy orders and management waste minimization commitment statements on file, the REAL work is just beginning at the Idaho National Engineering Laboratory (INEL); shaping the attitudes of 11,000+ employees. The difficulties of such a task are daunting. The 890 square mile INEL site and in-town support offices mean a huge diversity of employee jobs and waste streams; from cafeteria and auto maintenance wastes to high-level nuclear waste casks.more » INEL is pursuing a three component cultural change strategy: training, publicity, and public outreach. To meet the intent of DOE orders, all INEL employees are slated to receive pollution prevention orientation training. More technical training is given to targeted groups like purchasing and design engineering. To keep newly learned pollution prevention concepts top-of-mind, extensive site-wide publicity is being developed and conducted, culminating in the April Pollution Prevention Awareness Week coinciding with Earth Day 1992. Finally, news of INEL pollution prevention successes is shared with the public to increase their overall environmental awareness and their knowledge of INEL activities. An important added benefit is the sense of pride the program instills in INEL employees to have their successes displayed so publicly.« less

Determining the Minimal Clinically Important Difference for Six-Minute Walk Distance in Fibromyalgia

PubMed Central

Kaleth, Anthony S.; Slaven, James E.; Ang, Dennis C.

2016-01-01

Objective To estimate the minimal clinically important difference (MCID) for 6-minute walk distance (6MWD) in patients with fibromyalgia (FM). Design Data from a recently completed trial that included 187 patients who completed the 6-minute walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 weeks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain (SF36-PF) as clinical anchors. Results The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (p<0.001). The anchor-based MCID’s for the 6MWD were 156 m and 167 m for the FIQ and SF36-PF, respectively. These MCID’s correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-PF (10 point increase). Conclusion The MCID for 6MWD in patients with FM was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with FM. PMID:27003201

Determining the Minimal Clinically Important Difference for 6-Minute Walk Distance in Fibromyalgia.

PubMed

Kaleth, Anthony S; Slaven, James E; Ang, Dennis C

2016-10-01

The aim of this study was to estimate the minimal clinically important difference (MCID) for 6-min walk distance (6MWD) in patients with fibromyalgia. Data from a recently completed trial that included 187 patients who completed the 6-min walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 wks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain as clinical anchors. The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (P < 0.001). The anchor-based MCIDs for the 6MWD were 156 and 167 m for the FIQ and SF36-physical function domain, respectively. These MCIDs correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-physical function domain (10-point increase). The MCID for 6MWD in patients with fibromyalgia was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with fibromyalgia.

Inhomogeneous Jacobi equation for minimal surfaces and perturbative change in holographic entanglement entropy

NASA Astrophysics Data System (ADS)

Ghosh, Avirup; Mishra, Rohit

2018-04-01

The change in holographic entanglement entropy (HEE) for small fluctuations about pure anti-de Sitter (AdS) is obtained by a perturbative expansion of the area functional in terms of the change in the bulk metric and the embedded extremal surface. However it is known that change in the embedding appears at second order or higher. It was shown that these changes in the embedding can be calculated in the 2 +1 dimensional case by solving a "generalized geodesic deviation equation." We generalize this result to arbitrary dimensions by deriving an inhomogeneous form of the Jacobi equation for minimal surfaces. The solutions of this equation map a minimal surface in a given space time to a minimal surface in a space time which is a perturbation over the initial space time. Using this we perturbatively calculate the changes in HEE up to second order for boosted black brane like perturbations over AdS4.

The Patient-Oriented Eczema Measure in young children: responsiveness and minimal clinically important difference.

PubMed

Gaunt, D M; Metcalfe, C; Ridd, M

2016-11-01

The Patient-Oriented Eczema Measure (POEM) has been recommended as the core patient-reported outcome measure for trials of eczema treatments. Using data from the Choice of Moisturiser for Eczema Treatment randomized feasibility study, we assess the responsiveness to change and determine the minimal clinically important difference (MCID) of the POEM in young children with eczema. Responsiveness to change by repeated administrations of the POEM was investigated in relation to change recalled using the Parent Global Assessment (PGA) measure. Five methods of determining the MCID of the POEM were employed; three anchor-based methods using PGA as the anchor: the within-patient score change, between-patient score change and sensitivity and specificity method, and two distribution-based methods: effect size estimate and the one half standard deviation of the baseline distribution of POEM scores. Successive POEM scores were found to be responsive to change in eczema severity. The MCID of the POEM change score, in relation to a slight improvement in eczema severity as recalled by parents on the PGA, estimated by the within-patient score change (4.27), the between-patient score change (2.89) and the sensitivity and specificity method (3.00) was similar to the one half standard deviation of the POEM baseline scores (2.94) and the effect size estimate (2.50). The Patient-Oriented Eczema Measure as applied to young children is responsive to change, and the MCID is around 3. This study will encourage the use of POEM and aid in determining sample size for future randomized controlled trials of treatments for eczema in young children. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

Minimal clinically important difference of voice handicap index-10 in vocal fold paralysis.

PubMed

Young, VyVy N; Jeong, Kwonho; Rothenberger, Scott D; Gillespie, Amanda I; Smith, Libby J; Gartner-Schmidt, Jackie L; Rosen, Clark A

2018-06-01

The Voice Handicap Index-10 (VHI-10) is commonly used to measure patients' perception of vocal handicap. Clinical consensus has previously defined clinically meaningful improvement as a decrease ≥5. This study determines the minimal clinically important difference (MCID) for VHI-10 in patients with unilateral vocal fold paralysis (UVFP) using anchor-based methodology. Prospective cohort questionnaire analysis. Two hundred eighty-one UVFP patients completed the VHI-10 on two consecutive visits (within 3 months). At the follow-up visit, patients answered an 11-point Global Rating of Change Questionnaire (GRCQ) scored from -5 to +5. Relationship between the GRCQ and change in VHI-10 was quantified using analysis of variance, and MCID for the VHI-10 was determined using receiver operating characteristic (ROC) curve analysis. Overall mean VHI-10 change was -3.71 (standard deviation [SD] = 8.89) and mean GRCQ was 1.37 (SD = 2.51). Average interval between measurements was 1.73 months (SD = 0.83). Mean changes in VHI-10 scores were -7.45, -0.53, and +4.40 for patients whose GRCQ scores indicated improvement, no change, and worsening, respectively. Differences between mean scores were statistically significant (P < .001). Area under the ROC curve was 0.80, demonstrating the classification accuracy of VHI-10 change scores. A VHI-10 change of -4 was determined to be the optimal threshold that discriminated between improvement and no improvement (sensitivity and specificity 0.62 and 0.88, respectively). The MCID for improvement in VHI-10 in UVFP patients is a decrease of 4. This information improves understanding of patients' response to treatment and allows comparison between different treatments. Future research should determine MCID for VHI-10 across all voice disorders. 4. Laryngoscope, 128:1419-1424, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Biological variation, reference change value (RCV) and minimal important difference (MID) of inspiratory muscle strength (PImax) in patients with stable chronic heart failure.

PubMed

Täger, Tobias; Schell, Miriam; Cebola, Rita; Fröhlich, Hanna; Dösch, Andreas; Franke, Jennifer; Katus, Hugo A; Wians, Frank H; Frankenstein, Lutz

2015-10-01

Despite the widespread application of measurements of respiratory muscle force (PImax) in clinical trials there is no data on biological variation, reference change value (RCV), or the minimal important difference (MID) for PImax irrespective of the target cohort. We addressed this issue for patients with chronic stable heart failure. From the outpatients' clinic of the University of Heidelberg we retrospectively selected three groups of patients with stable systolic chronic heart failure (CHF). Each group had two measurements of PImax: 90 days apart in Group A (n = 25), 180 days apart in Group B (n = 93), and 365 days apart in Group C (n = 184). Stability was defined as (a) no change in NYHA class between visits and (b) absence of cardiac decompensation 3 months prior, during, and 3 months after measurements. For each group, we determined within-subject (CVI), between-subject (CVG), and total (CVT) coefficient of variation (CV), the index of individuality (II), RCV, reliability coefficient, and MID of PImax. CVT was 8.7, 7.5, and 6.9 % for groups A, B, and C, respectively. The II and RCV were 0.21, 0.20, 0.16 and 13.6, 11.6, 10.8 %, respectively. The reliability coefficient and MID were 0.83, 0.87, 0.88 and 1.44, 1.06, 1.12 kPa, respectively. Results were similar between age, gender, and aetiology subgroups. In patients with stable CHF, measurements of PImax are highly stable for intervals up to 1 year. The low values for II suggest that evaluation of change in PImax should be performed on an individual (per patient) basis. Individually significant change can be assumed beyond 14 % (RCV) or 1.12 kPa (MID).

Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data.

PubMed

Basra, M K A; Salek, M S; Camilleri, L; Sturkey, R; Finlay, A Y

2015-01-01

To determine the minimal clinically important difference (MCID) of the Dermatology Life Quality Index (DLQI) and its responsiveness to change in inflammatory skin diseases. A longitudinal study: at stage 1, patients completed the DLQI and a disease severity global question; at stage 2, a global rating of change in quality of life (QoL; Global Rating of Change Questionnaire, GRCQ) was added and used as an anchor to measure the MCID of the DLQI. 192 patients completed stage 1 and 107 completed stage 2. The mean DLQI score at stage 1 was 9.8 and 7.4 at stage 2 with a mean change of 2.4 (p < 0.0001). 31 patients experienced a 'small change' in their QoL (±3 and ±2) on the GRCQ. The mean corresponding change in DLQI scores was 3.3, which is regarded as the approximate MCID. Previous estimates of the MCID of the DLQI have varied from 3 to 5. Although this study demonstrated a MCID of 3.3, we recommend that the MCID in inflammatory skin diseases should be 4. © 2015 S. Karger AG, Basel.

Renal manifestations of human brucellosis: First report of minimal change disease.

PubMed

Sabanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Tsotsiou, Eleni; Kalaitzoglou, Asterios; Kavlakoudis, Christos; Vasileiou, Sotirios

2016-05-01

Human brucellosis is considered a great example of the complexity of clinical manifestations possibly affecting multiple organs or systems. Renal manifestations of human brucellosis have been documented in few case reports and one case series. Herein, we present a case of Nephrotic syndrome (NS) due to minimal change disease in the course of acute brucellosis. A 53-year-old male farmer was admitted to our department with acute brucellosis and NS. Renal biopsy revealed minimal change disease. Combined treatment with prednisone (1 mg/kg), rifampicin (600 mg/day), and doxycycline (200 mg/day) was initiated. Complete remission of NS was achieved at the end of the fourth week. One year later, the patient remained in complete remission of NS without any sign of relapse of brucellosis.

Quantitative EEG analysis in minimally conscious state patients during postural changes.

PubMed

Greco, A; Carboncini, M C; Virgillito, A; Lanata, A; Valenza, G; Scilingo, E P

2013-01-01

Mobilization and postural changes of patients with cognitive impairment are standard clinical practices useful for both psychic and physical rehabilitation process. During this process, several physiological signals, such as Electroen-cephalogram (EEG), Electrocardiogram (ECG), Photopletysmography (PPG), Respiration activity (RESP), Electrodermal activity (EDA), are monitored and processed. In this paper we investigated how quantitative EEG (qEEG) changes with postural modifications in minimally conscious state patients. This study is quite novel and no similar experimental data can be found in the current literature, therefore, although results are very encouraging, a quantitative analysis of the cortical area activated in such postural changes still needs to be deeply investigated. More specifically, this paper shows EEG power spectra and brain symmetry index modifications during a verticalization procedure, from 0 to 60 degrees, of three patients in Minimally Consciousness State (MCS) with focused region of impairment. Experimental results show a significant increase of the power in β band (12 - 30 Hz), commonly associated to human alertness process, thus suggesting that mobilization and postural changes can have beneficial effects in MCS patients.

Minimal Change Disease

PubMed Central

Massella, Laura; Ruggiero, Barbara; Emma, Francesco

2017-01-01

Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS), characterized by intense proteinuria leading to edema and intravascular volume depletion. In adults, it accounts for approximately 15% of patients with idiopathic NS, reaching a much higher percentage at younger ages, up to 70%–90% in children >1 year of age. In the pediatric setting, a renal biopsy is usually not performed if presentation is typical and the patient responds to therapy with oral prednisone at conventional doses. Therefore, in this setting steroid-sensitive NS can be considered synonymous with MCD. The pathologic hallmark of disease is absence of visible alterations by light microscopy and effacement of foot processes by electron microscopy. Although the cause is unknown and it is likely that different subgroups of disease recognize a different pathogenesis, immunologic dysregulation and modifications of the podocyte are thought to synergize in altering the integrity of the glomerular basement membrane and therefore determining proteinuria. The mainstay of therapy is prednisone, but steroid-sensitive forms frequently relapse and this leads to a percentage of patients requiring second-line steroid-sparing immunosuppression. The outcome is variable, but forms of MCD that respond to steroids usually do not lead to chronic renal damage, whereas forms that are unresponsive to steroids may subsequently reveal themselves as FSGS. However, in a substantial number of patients the disease is recurrent and requires long-term immunosuppression, with significant morbidity because of side effects. Recent therapeutic advances, such as the use of anti-CD20 antibodies, have provided long-term remission off-therapy and suggest new hypotheses for disease pathogenesis. PMID:27940460

Spray spectrum modifications through changes in airspeed to minimize drift

USDA-ARS?s Scientific Manuscript database

Management of droplet size is one of the key components to minimizing spray drift, which can be accomplished in-flight by changing airspeed. Studies were conducted measuring spray droplet spectra parameters across airspeeds ranging from 100-140 mph (in 5 mph increments). In general the volume medi...

Using ROC Curves to Choose Minimally Important Change Thresholds when Sensitivity and Specificity Are Valued Equally: The Forgotten Lesson of Pythagoras. Theoretical Considerations and an Example Application of Change in Health Status

PubMed Central

Froud, Robert; Abel, Gary

2014-01-01

Background Receiver Operator Characteristic (ROC) curves are being used to identify Minimally Important Change (MIC) thresholds on scales that measure a change in health status. In quasi-continuous patient reported outcome measures, such as those that measure changes in chronic diseases with variable clinical trajectories, sensitivity and specificity are often valued equally. Notwithstanding methodologists agreeing that these should be valued equally, different approaches have been taken to estimating MIC thresholds using ROC curves. Aims and objectives We aimed to compare the different approaches used with a new approach, exploring the extent to which the methods choose different thresholds, and considering the effect of differences on conclusions in responder analyses. Methods Using graphical methods, hypothetical data, and data from a large randomised controlled trial of manual therapy for low back pain, we compared two existing approaches with a new approach that is based on the addition of the sums of squares of 1-sensitivity and 1-specificity. Results There can be divergence in the thresholds chosen by different estimators. The cut-point selected by different estimators is dependent on the relationship between the cut-points in ROC space and the different contours described by the estimators. In particular, asymmetry and the number of possible cut-points affects threshold selection. Conclusion Choice of MIC estimator is important. Different methods for choosing cut-points can lead to materially different MIC thresholds and thus affect results of responder analyses and trial conclusions. An estimator based on the smallest sum of squares of 1-sensitivity and 1-specificity is preferable when sensitivity and specificity are valued equally. Unlike other methods currently in use, the cut-point chosen by the sum of squares method always and efficiently chooses the cut-point closest to the top-left corner of ROC space, regardless of the shape of the ROC curve. PMID

A randomized prospective study of desflurane versus isoflurane in minimal flow anesthesia using “equilibration time” as the change-over point to minimal flow

PubMed Central

Mallik, Tanuja; Aneja, S; Tope, R; Muralidhar, V

2012-01-01

Background: In the administration of minimal flow anesthesia, traditionally a fixed time period of high flow has been used before changing over to minimal flow. However, newer studies have used “equilibration time” of a volatile anesthetic agent as the change-over point. Materials and Methods: A randomized prospective study was conducted on 60 patients, who were divided into two groups of 30 patients each. Two volatile inhalational anesthetic agents were compared. Group I received desflurane (n = 30) and group II isoflurane (n = 30). Both the groups received an initial high flow till equilibration between inspired (Fi) and expired (Fe) agent concentration were achieved, which was defined as Fe/Fi = 0.8. The mean (SD) equilibration time was obtained for both the agent. Then, a drift in end-tidal agent concentration during the minimal flow anesthesia and recovery profile was noted. Results: The mean equilibration time obtained for desflurane and isoflurane were 4.96 ± 1.60 and 16.96 ± 9.64 min (P < 0.001). The drift in end-tidal agent concentration over time was minimal in the desflurane group (P = 0.065). Recovery time was 5.70 ± 2.78 min in the desflurane group and 8.06 ± 31 min in the isoflurane group (P = 0.004). Conclusion: Use of equilibration time of the volatile anesthetic agent as a change-over point, from high flow to minimal flow, can help us use minimal flow anesthesia, in a more efficient way. PMID:23225926

Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population.

PubMed

Purcell, Amanda; Fleming, Jennifer; Bennett, Sally; Burmeister, Bryan; Haines, Terry

2010-03-01

The Multidimensional Fatigue Inventory (MFI) is a commonly used cancer-related fatigue assessment tool. Unlike other fatigue assessments, there are no published minimal clinically important difference (MCID) criteria for the MFI in cancer populations. MCID criteria determine the smallest change in scores that can be regarded as important, allowing clinicians and researchers to interpret the meaning of changes in patient's fatigue scores. This research aims to improve the clinical utility of the MFI by establishing MCID criteria for the MFI sub-scales in a radiotherapy population. Two hundred ten patients undergoing radiotherapy were recruited to a single-centre prospective cohort study. Patients were assessed at three time points, at the start of radiotherapy, the end of radiotherapy and 6 weeks after radiotherapy completion. Assessment consisted of four clinically relevant constructs: (1) treatment impact on fatigue, (2) health-related quality of life, (3) performance status and (4) occupational productivity. These constructs were used as external or anchor-based measures to determine MCIDs for each sub-scale of the MFI. Multiple MCIDs were identified, each from a different perspective based on the constructs cited. Researchers seeking to use a generic MCID may wish to use a two-point reference for each MFI sub-scale as it was consistent across the pre- and post-radiotherapy comparison and occupational productivity anchors. MCIDs validated in this study allow better interpretation of changes in MFI sub-scale scores and allow effect size calculations for determining sample size in future studies.

Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication

DOE Office of Scientific and Technical Information (OSTI.GOV)

Conijn, Anne P., E-mail: a.p.conijn@amc.nl; Jonkers, Wilma, E-mail: wilma.jonkers@achmea.nl; Rouwet, Ellen V., E-mail: e.rouwet@erasmusmc.nl

PurposeThe minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment questionnaire (WIQ) for patients with intermittent claudication (IC).MethodsIn this multicenter study, we recruited 294 patients with IC between July and October 2012. Patients completed the VascuQol, with scores ranging from 1 to 7 (worst to best), and the WIQ, with scores ranging from 0 to 1 (worst to best) at first visit and after 4 months follow-up. Inmore » addition, patients answered an anchor-question rating their health status compared to baseline, as being improved, unchanged, or deteriorated. The MID for improvement and deterioration was calculated by an anchor-based approach, and determined with the upper and lower limits of the 95 % confidence interval of the mean change of the group who had not changed according to the anchor-question.ResultsFor the MID analyses of the VascuQol and WIQ, 163 and 134 patients were included, respectively. The MID values for the VascuQol (mean baseline score 4.25) were 0.87 for improvement and 0.23 for deterioration. For the WIQ (mean baseline score 0.39), we found MID values of 0.11 and −0.03 for improvement and deterioration, respectively.ConclusionIn this study, we calculated the MID for the VascuQol and the WIQ. Applying these MID facilitates better interpretation of treatment outcomes and can help to set treatment goals for individual care.« less

9 CFR 94.19 - Restrictions on importation from BSE minimal-risk regions of meat and edible products from...

Code of Federal Regulations, 2010 CFR

2010-01-01

... minimal-risk regions of meat and edible products from ruminants. 94.19 Section 94.19 Animals and Animal... BSE minimal-risk regions of meat and edible products from ruminants. Except as provided in § 94.18 and this section, the importation of meat, meat products, and edible products other than meat (excluding...

Quality of Life After Cardiac Surgery Based on the Minimal Clinically Important Difference Concept.

PubMed

Grand, Nathalie; Bouchet, Jean Baptiste; Zufferey, Paul; Beraud, Anne Marie; Awad, Sahar; Sandri, Fabricio; Campisi, Salvator; Fuzellier, Jean François; Molliex, Serge; Vola, Marco; Morel, Jerome

2018-03-23

Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac surgery and to identify specific predictors of poor HRQOL. In this prospective, single-center study, HRQOL was evaluated before and 6 months after surgery using the SF-36 questionnaire and its two components: the physical component summary (PCS) and the mental component summary (MCS). We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac surgery were included. 326 patients completed the preoperative and postoperative SF-36 questionnaires and 24 patients died before completing follow-up questionnaires. Based on the definition used, clinically significant deterioration of HRQOL was observed in 93 patients (26.6%) for PCS and 99 patients (28.2%) for MCS. Renal replacement for acute renal failure and mechanical ventilation for longer than 48 hours were independent risk factors for PCS and MCS worsening or death. Although our study showed overall improvement of QOL after cardiac surgery, over a quarter of the patients manifested deterioration of HRQOL at 6 months post-surgery. The findings from this study should help clinicians to inform patients about their likely postoperative functional status and quality of life. Copyright © 2018. Published by Elsevier Inc.

Longitudinal psychometric attributes, responsiveness, and importance of change: An approach using the SCOPA-Psychosocial questionnaire.

PubMed

Martínez-Martin, Pablo; Carod-Artal, Francisco Javier; da Silveira Ribeiro, Luciola; Ziomkowski, Sofia; Vargas, Antonio Pedro; Kummer, Wladimir; Mesquita, Hudson Mourão

2008-08-15

The objective of this study was to illustrate the analysis of longitudinal validity, responsiveness, and importance of change, using the SCOPA-Psychosocial Questionnaire (SCOPA-PS) as a source of empirical data. Sixty-seven patients with PD in Hoehn and Yahr (HY) stage 2 were followed up for 1 year and assessed by means of the Schwab and England Scale, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale (HADS), PDQ-39, and SCOPA-PS. A range of methods was applied to enable each of the target attributes to be analyzed from different conceptual stances. The SCOPA-PS displayed satisfactory acceptability (no floor or ceiling effect), internal consistency (alpha = 0.80-0.84), convergent validity (r(S) = 0.70-0.82 with PDQ-39), and precision (SEM = 8.80), both at baseline and at the end of follow-up. The threshold value for significant change ranged from 17.25 (1.96 SEM) to 24.39 (Smallest real difference and Reliable change index). Threshold values for a clinically meaningful change were 0.73-1.26 (effect size, standardized response mean, responsiveness statistic). Change in SCOPA-PS scores correlated strongly with change in total UPDRS, HADS, and PDQ-39 scores, and reliably detected 70% of cases that worsened according to the PDQ-39. The minimally important change (MIC) for "minimally impaired" patients as per the PDQ39 was 8.30-9.10 points. Indices such as 1.96 SEM, effect size, and correlation with the change in other measures provide useful information about different concepts of responsiveness. The MIC should be determined for each specific setting, using distribution- and anchor-based methods. The SCOPA-PS showed satisfactory longitudinal attributes and responsiveness in stage-2 Brazilian patients with PD across 1 year of follow-up. (c) 2008 Movement Disorder Society.

The minimally important difference for the health assessment questionnaire in rheumatoid arthritis clinical practice is smaller than in randomized controlled trials.

PubMed

Pope, Janet E; Khanna, Dinesh; Norrie, Deborah; Ouimet, Janine M

2009-02-01

Patient-reported outcomes are used in clinical practice and trials. We studied a large clinical practice to determine the minimally important difference (MID) estimates for (1) the Health Assessment Questionnaire-Damage Index (HAQ-DI): improvement and worsening using patient global assessment anchor; and (2) pain using a patient-reported pain anchor. Patients with rheumatoid arthritis (RA; N = 225) had clinic visits at 2 timepoints within 1 year, completed the HAQ-DI and pain visual analog scale (VAS; 0-100 mm), and answered the question, "How would you describe your overall status/overall pain since the last visit?", as much worsened, somewhat worsened, the same, somewhat improved, or much improved. If rated as somewhat improved or worsened, they were defined as the minimally changed subgroups. Eighty-three percent were women, mean age 60 years, with disease duration 11.7 +/- 10.7 years. The baseline HAQ-DI was 0.97 +/- SD 0.76, and at followup 1.0 +/- 0.77 (mean change +0.03 +/- 0.40). The baseline pain VAS was 42.3 +/- 28.8, and at followup 38.5 +/- 27.9 (mean change -2.8 +/- 25.9). The mean (SD) HAQ-DI change score was -0.09 (0.42) for somewhat improved and 0.15 (0.33) for somewhat worsened. The HAQ-DI change for somewhat/much better was -0.20 +/- 0.52, and for somewhat/much worse +0.21 +/- 0.33. For pain, somewhat improved changed by -11.9 mm on the VAS, and somewhat worsened by 6.8 mm. Estimates for HAQ-DI and pain were larger than the for no-change group, 0.03 (0.32) and -3.2 (20.9). The MID for HAQ-DI in clinical practice is smaller than it is in trials. This may have implications for observational studies and clinical care.

Minimally Clinically Important Change in the Activity Measure for Post-Acute Care (AM-PAC), a Generic Patient-Reported Outcome Tool, in People With Low Back Pain.

PubMed

Lee, Natalie; Thompson, Nicolas R; Passek, Sandra; Stilphen, Mary; Katzan, Irene L

2017-11-01

The Activity Measure for Post-Acute Care (AM-PAC) is a generic metric of patient-reported functional status. The minimal clinically important difference (MCID) in the AM-PAC score has not been determined. The study objective was to determine the MCID for AM-PAC in people with low back pain. This was a retrospective cohort study. Anchor-based and distribution-based methods were used to estimate the MCID. The Modified Low Back Pain Disability Questionnaire was used as the anchor. Adults who had a primary ICD-9 code for low back pain in at least 1 outpatient physical therapist visit during an episode of care and who completed both the AM-PAC and the Modified Low Back Pain Disability Questionnaire in at least 2 visits during the care episode were included. The MCID was calculated for the AM-PAC basic mobility version as well its adapted version, which the Cleveland Clinic uses for patients 65 years old or older. A total of 1,271 participants were eligible for study. For the AM-PAC basic mobility version, anchor-based methods yielded MCID estimates of between 3.4 and 5.1, whereas distribution-based methods yielded estimates of 1.7 to 4.2. The minimal detectable change (MDC) for the AM-PAC basic mobility version was 3.3. For the adapted AM-PAC basic mobility version, the MCID was estimated to be between 2.9 and 4.0 via anchor-based methods and between 1.2 to 3.5 via distribution-based methods. The MDC for the adapted AM-PAC basic mobility version was 3.5. The estimated MCID was designed for people with low back pain only. The MCID ranged from 3.3 to 5.1 for the AM-PAC basic mobility version and 3.5 to 4 for the adapted version, with the MDC as the lower limit. Changes in the AM-PAC for people with low back pain may be interpreted using the estimated MCID. Future studies are needed to determine the AM-PAC MCID for populations other than those with low back pain. © 2017 American Physical Therapy Association

Patient-reported questionnaires in MS rehabilitation: responsiveness and minimal important difference of the multiple sclerosis questionnaire for physiotherapists (MSQPT).

PubMed

van der Maas, Nico Arie

2017-03-16

The Multiple Sclerosis Questionnaire for Physical Therapists (MSQPT) is a patient-rated outcome questionnaire for evaluating the rehabilitation of persons with multiple sclerosis (MS). Responsiveness was evaluated, and minimal important difference (MID) estimates were calculated to provide thresholds for clinical change for four items, three sections and the total score of the MSQPT. This multicentre study used a combined distribution- and anchor-based approach with multiple anchors and multiple rating of change questions. Responsiveness was evaluated using effect size, standardized response mean (SRM), modified SRM and relative efficiency. For distribution-based MID estimates, 0.2 and 0.33 standard deviations (SD), standard error of measurement (SEM) and minimal detectable change were used . Triangulation of anchor- and distribution-based MID estimates provided a range of MID values for each of the four items, the three sections and the total score of the MSQPT. The MID values were tested for their sensitivity and specificity for amelioration and deterioration for each of the four items, the three sections and the total score of the MSQPT. The MID values of each item and section and of the total score with the best sensitivity and specificity were selected as thresholds for clinical change. The outcome measures were the MSQPT, Hamburg Quality of Life Questionnaire for Multiple Sclerosis (HAQUAMS), rating of change questionnaires, Expanded Disability Status Scale, 6-metre timed walking test, Berg Balance Scale and 6-minute walking test. The effect size ranged from 0.46 to 1.49. The SRM data showed comparable results. The modified SRM ranged from 0.00 to 0.60. Anchor-based MID estimates were very low and were comparable with SD- and SEM-based estimates. The MSQPT was more responsive than the HAQUAMS in detecting improvement but less responsive in finding deterioration. The best MID estimates of the items, sections and total score, expressed in percentage of their

Minimal Clinically Important Difference and Substantial Clinical Benefit After Revision Hip Arthroscopy.

PubMed

Nwachukwu, Benedict U; Chang, Brenda; Rotter, Ben-Zion; Kelly, Bryan T; Ranawat, Anil S; Nawabi, Danyal H

2018-06-01

To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in revision hip arthroscopy. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered to revision hip arthroscopy patients. At 1 year postoperatively, patients graded their hip function based on anchor responses. SCB was defined as both a net change and an absolute value. Receiver operating characteristic analysis with area under the curve was used to confirm psychometric values. A distribution-based method was used for MCID. Forty-nine patients were included with a mean age of 29.7 (±8.6) years. The most common indication for revision hip arthroscopy was residual femoroacetabular impingement (FAI; N = 34; 69.4%) followed by capsular management (N = 8; 16.3%). At 1-year follow-up, 34 patients reported feeling improved. Outcome score change corresponding to MCID and SCB net change for the mHHS, HOS Activities of Daily Living (ADL), HOS Sports, and iHOT-33 was 7.9/23.1, 7.9/16.2, 13.1/25.0, and 12.8/25.5, respectively. A higher proportion of patients with residual FAI achieved MCID compared with patients with other diagnoses. On the preoperative HOS ADL, HOS Sports, and iHOT-33, patients scoring below 67.7 (0.78), 55.6 (0.81), and 35.7 (0.73) were significantly more likely to achieve SCB postoperatively. Thirty-four patients (73.9%) were classified as receiving physical function improvement, and on the HOS Sports, MCID was achieved by 65% whereas 43% met the SCB criteria. MCID values ranged from 7.9 on the mHHS and the HOS ADL to 13.1 on the HOS Sports. SCB net change ranged from 16.2 on the HOS ADL to 25.2 on the iHOT-33, whereas absolute SCB ranged from 82.4 on the iHOT-33 to 84.7 on the mHHS. Residual FAI and capsular management were the most common indications for revision surgery with patients who underwent surgery for the former found to be most likely to achieve clinically significant

Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire

PubMed Central

Kocks, JWH; Tuinenga, MG; Uil, SM; van den Berg, JWK; Ståhl, E; van der Molen, T

2006-01-01

Background Patient-reported outcomes (PRO) questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID). This study aimed to identify the MCID for the clinical COPD questionnaire (CCQ) in terms of patient referencing, criterion referencing, and by the standard error of measurement (SEM). Methods Patients were ≥40 years of age, diagnosed with COPD, had a smoking history of >10 pack-years, and were participating in a randomized, controlled clinical trial comparing intravenous and oral prednisolone in patients admitted with an acute exacerbation of COPD. The CCQ was completed on Days 1–7 and 42. A Global Rating of Change (GRC) assessment was taken to establish the MCID by patient referencing. For criterion referencing, health events during a period of 1 year after Day 42 were included in this analysis. Results 210 patients were recruited, 168 completed the CCQ questionnaire on Day42. The MCID of the CCQ total score, as indicated by patient referencing in terms of the GRC, was 0.44. The MCID of the CCQ in terms of criterion referencing for the major outcomes was 0.39, and calculation of the SEM resulted in a value of 0.21. Conclusion This investigation, which is the first to determine the MCID of a PRO questionnaire via more than one approach, indicates that the MCID of the CCQ total score is 0.4. PMID:16603063

Responsiveness and Minimally Important Differences for 4 Patient-Reported Outcomes Measurement Information System Short Forms: Physical Function, Pain Interference, Depression, and Anxiety in Knee Osteoarthritis.

PubMed

Lee, Augustine C; Driban, Jeffrey B; Price, Lori Lyn; Harvey, William F; Rodday, Angie Mae; Wang, Chenchen

2017-09-01

Patient-Reported Outcomes Measurement Information System (PROMIS) instruments can provide valid, interpretable measures of health status among adults with osteoarthritis (OA). However, their ability to detect meaningful change over time is unknown. We evaluated the responsiveness and minimally important differences (MIDs) for 4 PROMIS Short Forms: Physical Function, Pain Interference, Depression, and Anxiety. We analyzed adults with symptomatic knee OA from our randomized trial comparing Tai Chi and physical therapy. Using baseline and 12-week scores, responsiveness was evaluated according to consensus standards by testing 6 a priori hypotheses of the correlations between PROMIS and legacy change scores. Responsiveness was considered high if ≥5 hypotheses were confirmed, and moderate if 3 or 4 were confirmed. MIDs were evaluated according to prospective change for people achieving previously-established MID on legacy comparators. The lowest and highest MIDs meeting a priori quality criteria formed a MID range for each PROMIS Short Form. Among 165 predominantly female (70%) and white (57%) participants, mean age was 61 years and body mass index was 33. PROMIS Physical Function had 5 confirmed hypotheses and Pain Interference, Depression, and Anxiety had 3 or 4. MID ranges were: Depression = 3.0 to 3.1; Anxiety = 2.3 to 3.4; Physical Function = 1.9 to 2.2; and Pain Interference = 2.35 to 2.4. PROMIS Physical Function has high responsiveness, and Depression, Anxiety, and Pain Interference have moderate responsiveness among adults with knee OA. We established the first MIDs for PROMIS in this population, and provided an important standard of reference to better apply or interpret PROMIS in future trials or clinical practice. This study examined whether PROMIS Short Form instruments (Physical Function, Pain Interference, Depression, and Anxiety) were able to detect change over time among adults with knee OA, and provided minimally important change estimates

Asthma Symptom Utility Index: Reliability, validity, responsiveness and the minimal important difference in adult asthma patients

PubMed Central

Bime, Christian; Wei, Christine Y.; Holbrook, Janet T.; Sockrider, Marianna M.; Revicki, Dennis A.; Wise, Robert A.

2012-01-01

Background The evaluation of asthma symptoms is a core outcome measure in asthma clinical research. The Asthma Symptom Utility Index (ASUI) was developed to assess frequency and severity of asthma symptoms. The psychometric properties of the ASUI are not well characterized and a minimal important difference (MID) is not established. Objectives We assessed the reliability, validity, and responsiveness to change of the ASUI in a population of adult asthma patients. We also sought to determine the MID for the ASUI. Methods Adult asthma patients (n = 1648) from two previously completed multicenter randomized trials were included. Demographic information, spirometry, ASUI scores, and other asthma questionnaire scores were obtained at baseline and during follow-up visits. Participants also kept a daily asthma diary. Results Internal consistency reliability of the ASUI was 0.74 (Cronbach’s alpha). Test-retest reliability was 0.76 (intra-class correlation). Construct validity was demonstrated by significant correlations between ASUI scores and Asthma Control Questionnaire (ACQ) scores (Spearman correlation r = −0.79, 95% CI [−0.85, −0.75], P<0.001) and Mini Asthma Quality of Life Questionnaire (Mini AQLQ) scores (r = 0.59, 95% CI [0.51, 0.61], P<0.001). Responsiveness to change was demonstrated, with significant differences between mean changes in ASUI score across groups of participants differing by 10% in the percent predicted FEV1 (P<0.001), and by 0.5 points in ACQ score (P < 0.001). Anchor-based methods and statistical methods support an MID for the ASUI of 0.09 points. Conclusions The ASUI is reliable, valid, and responsive to changes in asthma control over time. The MID of the ASUI (range of scores 0–1) is 0.09. PMID:23026499

Determination of the minimal clinically important difference for seven fatigue measures in rheumatoid arthritis

PubMed Central

Pouchot, Jacques; Kherani, Raheem B.; Brant, Rollin; Lacaille, Diane; Lehman, Allen J.; Ensworth, Stephanie; Kopec, Jacek; Esdaile, John M.; Liang, Matthew H.

2008-01-01

Objective To estimate the minimal clinically important difference (MCID) of seven measures of fatigue in rheumatoid arthritis. Study Design and Setting A cross-sectional study design based on inter-individual comparisons was used. Six to eight subjects participated in a single meeting and completed seven fatigue questionnaires (nine sessions were organized and 61 subjects participated). After completion of the questionnaires, the subjects had five one-on-one 10-minute conversations with different people in the group to discuss their fatigue. After each conversation, each patient compared their fatigue to their conversational partner’s on a global rating. Ratings were compared to the scores of the fatigue measures to estimate the MCID. Both non-parametric and linear regression analyses were used. Results Non-parametric estimates for the MCID relative to “little more fatigue” tended to be smaller than those for “little less fatigue”. The global MCIDs estimated by linear regression were: FSS 20.2, VT 14.8, MAF 18.7, MFI 16.6, FACIT–F 15.9, CFS 9.9, RS 19.7, for normalized scores (0 to 100). The standardized MCIDs for the seven measures were roughly similar (0.67 to 0.76). Conclusion These estimates of MCID will help to interpret changes observed in a fatigue score and will be critical in estimating sample size requirements. PMID:18359189

Minimal clinically important difference of the Modified Fatigue Impact Scale in Parkinson's disease.

PubMed

Kluger, Benzi M; Garimella, Sanjana; Garvan, Cynthia

2017-10-01

Fatigue is a common and debilitating symptom of Parkinson's disease (PD) with no evidence-based treatments. While several fatigue scales are partially validated in PD the minimal clinically important difference (MCID) is unknown for any scale but is an important psychometric value to design and interpret therapeutic trials. We thus sought to determine the MCID for the Modified Fatigue Impact Scale (MFIS). This is a secondary data analysis from 94 PD participants in an acupuncture trial for PD fatigue. Standard psychometric approaches were used to establish validity and an anchor-based approach was used to determine the MCID. The MFIS demonstrated good concurrent validity with other outcome measures and high internal consistency. MCIDs values were found to be 13.8, 6.8 and 6.2 for the MFIS total, MFIS cognitive, and MFIS physical subscores respectively. The MFIS is a valid multidimensional measure of fatigue in PD with demonstrable MCID. Copyright © 2017 Elsevier Ltd. All rights reserved.

Responsiveness and Minimal Important Changes of the Scoliosis Research Society-22 Patient Questionnaire in Subjects With Mild Adolescent and Moderate Adult Idiopathic Scoliosis Undergoing Multidisciplinary Rehabilitation.

PubMed

Monticone, Marco; Ambrosini, Emilia; Rocca, Barbara; Foti, Calogero; Ferrante, Simona

2017-06-01

Single-center, prospective study. Evaluating the responsiveness and minimal important changes (MICs) for the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) in adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AS). Despite the SRS-22 properties have been investigated in various different languages, there is still a lack of information concerning responsiveness and MIC, limiting the use of SRS-22 for clinical and research purposes. At the beginning and end of multidisciplinary rehabilitation programs, 149 subjects with mild AIS (Cobb angle <25°) and 140 subjects with moderate AS (Cobb angle <35°) completed the SRS-22. Upon completing the programs, subjects also performed the global perceived effect (GPE) scales test, which was divided to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated for all SRS-22 domains but satisfaction with management by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic [ROC] curves; correlations between change scores of the SRS-22 and GPE). ROC curves were also used to compute the MICs. The effect size ranged from 1.23 to 1.50 in AIS and from 1.02 to 1.37 in AS. The standardized response mean ranged from 0.95 to 1.27 in AIS and from 0.66 to 0.90 in AS. The ROC analyses revealed the following MIC values (area under the curve; sensitivity; specificity): function, 0.70 (0.739;66;70) for AIS and 0.60 (0.842;84;76) for AS; pain, 0.70 (0.731;71;70) for AIS and 0.40 (0.817;81;70) for AS; mental health, 0.50 (0.708;83;58) for AIS and 0.55 (0.750;69;78) for AS; self-perceived image, 0.40 (0.609;79;42) for AIS and 0.60 (0.751;61;82) for AS. Correlations between change scores of the SRS-22 domains and GPE were low to moderate, ranging from -0.347 to -0.667. The SRS-22 was sensitive in detecting clinical changes in subjects with adolescent and adult scoliosis. We recommend taking the MICs provided into account when

Weight change among people randomized to minimal intervention control groups in weight loss trials.

PubMed

Johns, David J; Hartmann-Boyce, Jamie; Jebb, Susan A; Aveyard, Paul

2016-04-01

Evidence on the effectiveness of behavioral weight management programs often comes from uncontrolled program evaluations. These frequently make the assumption that, without intervention, people will gain weight. The aim of this study was to use data from minimal intervention control groups in randomized controlled trials to examine the evidence for this assumption and the effect of frequency of weighing on weight change. Data were extracted from minimal intervention control arms in a systematic review of multicomponent behavioral weight management programs. Two reviewers classified control arms into three categories based on intensity of minimal intervention and calculated 12-month mean weight change using baseline observation carried forward. Meta-regression was conducted in STATA v12. Thirty studies met the inclusion criteria, twenty-nine of which had usable data, representing 5,963 participants allocated to control arms. Control arms were categorized according to intensity, as offering leaflets only, a single session of advice, or more than one session of advice from someone without specialist skills in supporting weight loss. Mean weight change at 12 months across all categories was -0.8 kg (95% CI -1.1 to -0.4). In an unadjusted model, increasing intensity by moving up a category was associated with an additional weight loss of -0.53 kg (95% CI -0.96 to -0.09). Also in an unadjusted model, each additional weigh-in was associated with a weight change of -0.42 kg (95% CI -0.81 to -0.03). However, when both variables were placed in the same model, neither intervention category nor number of weigh-ins was associated with weight change. Uncontrolled evaluations of weight loss programs should assume that, in the absence of intervention, their population would weigh up to a kilogram on average less than baseline at the end of the first year of follow-up. © 2016 The Authors Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 1 2010-10-01 2010-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION, SALE...

50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 1 2013-10-01 2013-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION, SALE...

50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 1 2012-10-01 2012-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION, SALE...

50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 1 2011-10-01 2011-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION, SALE...

50 CFR 14.32 - Permits to import or export wildlife at nondesignated port to minimize deterioration or loss.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 1 2014-10-01 2014-10-01 false Permits to import or export wildlife at nondesignated port to minimize deterioration or loss. 14.32 Section 14.32 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING, POSSESSION, TRANSPORTATION, SALE...

Minimal time change detection algorithm for reconfigurable control system and application to aerospace

NASA Technical Reports Server (NTRS)

Kim, Sungwan

1994-01-01

System parameters should be tracked on-line to build a reconfigurable control system even though there exists an abrupt change. For this purpose, a new performance index that we are studying is the speed of adaptation- how quickly does the system determine that a change has occurred? In this paper, a new, robust algorithm that is optimized to minimize the time delay in detecting a change for fixed false alarm probability is proposed. Simulation results for the aircraft lateral motion with a known or unknown change in control gain matrices, in the presence of doublet input, indicate that the algorithm works fairly well. One of its distinguishing properties is that detection delay of this algorithm is superior to that of Whiteness Test.

Prospective Cohort Study Investigating Changes in Body Image, Quality of Life, and Self-Esteem Following Minimally Invasive Cosmetic Procedures.

PubMed

Sobanko, Joseph F; Dai, Julia; Gelfand, Joel M; Sarwer, David B; Percec, Ivona

2018-04-13

Minimally invasive cosmetic injectable procedures are increasingly common. However, a few studies have investigated changes in psychosocial functioning following these treatments. To assess changes in body image, quality of life, and self-esteem following cosmetic injectable treatment with soft tissue fillers and neuromodulators. Open, prospective study of 75 patients undergoing cosmetic injectable procedures for facial aging to evaluate changes in psychosocial functioning within 6 weeks of treatment. Outcome measures included the Derriford appearance scale (DAS-24), body image quality of life inventory (BIQLI), and the Rosenberg self-esteem scale. Body image dissatisfaction, as assessed by the DAS-24, improved significantly 6 weeks after the treatment. Body image quality of life, as assessed by the BIQLI, improved, but the change did not reach statistical significance. Self-esteem was unchanged after the treatment. Minimally invasive cosmetic injectable procedures were associated with reductions in body image dissatisfaction. Future research, using recently developed cosmetic surgery-specific instruments, may provide further insight into the psychosocial benefits of minimally invasive procedures.

The minimally important difference for the fatigue visual analog scale in patients with rheumatoid arthritis followed in an academic clinical practice.

PubMed

Khanna, Dinesh; Pope, Janet E; Khanna, Puja P; Maloney, Michelle; Samedi, Nooshin; Norrie, Debbie; Ouimet, Gillian; Hays, Ron D

2008-12-01

To estimate the minimally important difference (MID) for a fatigue visual analog scale (VAS) using patient-reported anchors (fatigue, pain, and overall health). Patients with rheumatoid arthritis (RA; n = 307) had 2 clinic visits at a median of 5.9 months apart. They completed a fatigue VAS (0-10 scale) and the retrospective anchor items, "How would you describe your overall fatigue/pain/overall health since the last visit?" with response options: Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened. The mean [standard deviation (SD)] age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) Health Assessment Questionnaire-Disability Index score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at followup was 4.3 (2.8) [mean change of -0.07 (2.5); p = not significant]. The fatigue change score (0-10 scale) for Somewhat better and Somewhat worsened for the fatigue anchor averaged -1.12 and 1.26, respectively. Using the pain anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.87 and 1.13; and using the global anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.82 and 1.17, respectively. Effect size estimates using 3 anchors were small for the Somewhat better (range 0.27-0.39) and Somewhat worsened (0.40-0.44) groups, but larger than for the no-change group (0.03-0.08). The MID for fatigue VAS is between -0.82 for -1.12 for improvement and is 1.13 to 1.26 for worsening on a 0-10 scale in a large RA clinical practice, and is similar to that seen in RA clinical trials. This information can aid in interpreting fatigue VAS in day-to-day care in clinical practice.

Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

PubMed Central

Paulsen, Aksel

2014-01-01

Background and purpose The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D. Patients and methods THA patients from 16 different departments received 2 PROs and additional questions preoperatively and 1 year postoperatively. The PROs included were the HOOS subscales pain (HOOS Pain), physical function short form (HOOS-PS), and hip-related quality of life (HOOS QoL), and the EQ-5D. MCII and PASS were estimated using multiple anchor-based approaches. Results Of 1,837 patients available, 1,335 answered the preoperative PROs, and 1,288 of them answered the 1-year follow-up. The MCIIs and PASSs were estimated to be: 24 and 91 (HOOS Pain), 23 and 88 (HOOS-PS), 17 and 83 (HOOS QoL), 0.31 and 0.92 (EQ-5D Index), and 23 and 85 (EQ-VAS), respectively. MCIIs corresponded to a 38–55% improvement from mean baseline PRO score and PASSs corresponded to absolute follow-up scores of 57–91% of the maximum score in THA patients 1 year after surgery. Interpretation This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide for future MCII and PASS estimations in other contexts. The cutoff points may serve as reference values in registry settings. PMID:24286564

Limited responsiveness related to the minimal important difference of patient-reported outcomes in rare diseases.

PubMed

Johnston, Bradley C; Miller, Patricia A; Agarwal, Arnav; Mulla, Sohail; Khokhar, Rabia; De Oliveira, Kyle; Hitchcock, Christine L; Sadeghirad, Behnam; Mohiuddin, Mukarram; Sekercioglu, Nigar; Seweryn, Michal; Koperny, Magdalena; Bala, Malgorzata M; Adams-Webber, Thomasin; Granados, Alicia; Hamed, Alaa; Crawford, Mark W; van der Ploeg, Ans T; Guyatt, Gordon H

2016-11-01

To explore the responsiveness of patient-reported outcomes (PROs) in interventional studies involving patients with rare lysosomal storage diseases (LSDs). We searched eight databases for experimental and nonexperimental studies. Pairs of trained reviewers independently screened articles and subsequently extracted data from the eligible studies. Among studies with 10 or more patients using a valid PRO, we assessed the responsiveness of PROs based on a reanalysis of the data using minimal important difference estimates. Our analyses focused on statistically significant within-group differences in PROs for observational studies or the statistically significant between-group differences in PRO scores for controlled studies. Of 2,679 unique records, 62 interventional studies addressing patients with Fabry (55%), Gaucher (19%), Pompe (16%), and mucopolysaccharidoses (11%) proved eligible. The most frequently used PROs were the Short-Form-36 (25 studies), Brief Pain Inventory (20 studies), EuroQoL-5D (9 studies), and the Fatigue Severity Scale (6 studies). Observational studies suggest that PROs sometimes detect significant within-group changes when present. Randomized trials raise questions regarding the responsiveness of PROs to small differences between groups. Most studies have relied on generic PROs to evaluate quality of life and symptoms in patients with rare LSDs. PROs appear more responsive in observational studies than randomized trials. Copyright © 2016 Elsevier Inc. All rights reserved.

Importance of polarity change in the electrical discharge machining

NASA Astrophysics Data System (ADS)

Schulze, H.-P.

2017-10-01

The polarity change in the electrical discharge machining is still a problem and is often performed completely unmotivated or randomly. The polarity must be designated primarily, i.e. the anodic part must be clearly assigned to the tool or the workpiece. Normally, the polarity of the workpiece electrode is named. In paper, will be shown which determine fundamental causes the structural behavior of the cathode and anode, and when it makes sense to change the polarity. The polarity change is primarily dependent on the materials that are used as cathode and anode. This distinction must be made if there are pure metals or complex materials. Secondary of the polarity change is also affected by the process energy source (PES) and the supply line. The polarity change is mostly influenced by the fact that the removal is to be maximized on the workpiece while the tool is minimal removal (wear) occur. A second factor that makes a polarity change needed is the use of electrical discharge in combination with other machining methods, such as electrochemical machining (ECM).

Asymmetry of Neuronal Combinatorial Codes Arises from Minimizing Synaptic Weight Change.

PubMed

Leibold, Christian; Monsalve-Mercado, Mauro M

2016-08-01

Synaptic change is a costly resource, particularly for brain structures that have a high demand of synaptic plasticity. For example, building memories of object positions requires efficient use of plasticity resources since objects can easily change their location in space and yet we can memorize object locations. But how should a neural circuit ideally be set up to integrate two input streams (object location and identity) in case the overall synaptic changes should be minimized during ongoing learning? This letter provides a theoretical framework on how the two input pathways should ideally be specified. Generally the model predicts that the information-rich pathway should be plastic and encoded sparsely, whereas the pathway conveying less information should be encoded densely and undergo learning only if a neuronal representation of a novel object has to be established. As an example, we consider hippocampal area CA1, which combines place and object information. The model thereby provides a normative account of hippocampal rate remapping, that is, modulations of place field activity by changes of local cues. It may as well be applicable to other brain areas (such as neocortical layer V) that learn combinatorial codes from multiple input streams.

Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference.

PubMed

du Bois, Roland M; Weycker, Derek; Albera, Carlo; Bradford, Williamson Z; Costabel, Ulrich; Kartashov, Alex; Lancaster, Lisa; Noble, Paul W; Sahn, Steven A; Szwarcberg, Javier; Thomeer, Michiel; Valeyre, Dominique; King, Talmadge E

2011-05-01

The 6-minute-walk test (6MWT) is a practical and clinically meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases. Performance characteristics in patients with idiopathic pulmonary fibrosis (IPF) have not been systematically evaluated. To assess the reliability, validity, and responsiveness of the 6MWT and estimate the minimal clinically important difference (MCID) in patients with IPF. The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b (n = 822). Six-minute walk distance (6MWD) and other parameters were measured at baseline and at 24-week intervals using a standardized protocol. Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function, dyspnea, and health-related quality of life. Both distribution-based and anchor-based methods were used to estimate the MCID. Comparison of two proximal measures of 6MWD (mean interval, 24 d) demonstrated good reliability (coefficient = 0.83; P < 0.001). 6MWD was weakly correlated with measures of physiologic function and health-related quality of life; however, values were consistently and significantly lower for patients with the poorest functional status, suggesting good construct validity. Importantly, change in 6MWD was highly predictive of mortality; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year (hazard ratio, 4.27; 95% confidence interval, 2.57- 7.10; P < 0.001). The estimated MCID was 24-45 m. The 6MWT is a reliable, valid, and responsive measure of disease status and a valid endpoint for clinical trials in IPF.

Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method.

PubMed

Altenburg, Wytske A; Duiverman, Marieke L; Ten Hacken, Nick H T; Kerstjens, Huib A M; de Greef, Mathieu H G; Wijkstra, Peter J; Wempe, Johan B

2015-02-19

Although the endurance shuttle walk test (ESWT) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation (PR) for COPD, the minimally important difference (MID) has not yet been established. We aimed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR. Data were derived from a randomized controlled trial, investigating the value of noninvasive positive pressure ventilation added to PR. Fifty-five patients with stable COPD, GOLD stage IV, with chronic respiratory failure were included (mean (SD) FEV1 31.1 (12.0) % pred, age 62 (9) y). MID estimates of the ESWT in seconds, percentage and meters change were calculated with anchor based and distribution based methods. Six minute walking distance (6MWD), peak work rate on bicycle ergometry (Wpeak) and Chronic Respiratory Questionnaire (CRQ) were used as anchors and Cohen's effect size was used as distribution based method. The estimated MID of the ESWT with the different anchors ranged from 186-199 s, 76-82% and 154-164 m. Using the distribution based method the MID was 144 s, 61% and 137 m. Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure. Therefore we recommend using a range of 186-199 s, 76-82% or 154-164 m as MID of the ESWT in COPD patients with chronic respiratory failure. Further research in larger populations should elucidate whether this cut-off value is also valid in other COPD populations and with other interventions. ClinicalTrials.Gov (ID NCT00135538).

Importance of impacts scenarios for the adaptation of agriculture to climate change

NASA Astrophysics Data System (ADS)

Zullo, J.; Macedo, C.; Pinto, H. S.; Assad, E. D.; Koga Vicente, A.

2012-12-01

The great possibility that the climate is already changing, and the most drastic way possible, increases the challenge of agricultural engineering, especially in environmentally vulnerable areas and in regions where agriculture has a high economic and social importance. Knowledge of potential impacts that may be caused by changes in water and thermal regimes in coming decades is increasingly strategic, as they allow the development of techniques to adapt agriculture to climate change and therefore minimizes the risk of undesirable impacts, for example, in food and nutritional security. Thus, the main objective of this paper is to describe a way to generate impacts scenarios caused by anomalies of precipitation and temperature in the definition of climate risk zoning of an agricultural crop very important in the tropics, such as the sugar cane, especially in central-southern Brazil, which is one of its main world producers. A key point here is the choice of the climate model to be used, considering that 23 different models were used in the fourth IPCC report published in 2007. The number and range of available models requires the definition of criteria for choosing the most suitable for the preparation of the impacts scenarios. One way proposed and used in this work is based on the definition of two groups of models according to 27 technical attributes of them. The clustering of 23 models in two groups, with a model representing each group (UKMO_HadCM3 and MIROC3.2_medres), assists the generation and comparison of impacts scenarios, making them more representative and useful. Another important aspect in the generation of impacts scenarios is the estimate of the relative importance of the anomalies of precipitation and temperature, which are the most commonly used. To assess the relative importance of the anomalies are generated scenarios considering an anomaly at a time and both together. The impacts scenarios for a high emission of greenhouse gases (A2), from 2010

Defining the minimal detectable change in scores on the eight-item Morisky Medication Adherence Scale.

PubMed

Muntner, Paul; Joyce, Cara; Holt, Elizabeth; He, Jiang; Morisky, Donald; Webber, Larry S; Krousel-Wood, Marie

2011-05-01

Self-report scales are used to assess medication adherence. Data on how to discriminate change in self-reported adherence over time from random variability are limited. To determine the minimal detectable change for scores on the 8-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 was administered twice, using a standard telephone script, with administration separated by 14-22 days, to 210 participants taking antihypertensive medication in the CoSMO (Cohort Study of Medication Adherence among Older Adults). MMAS-8 scores were calculated and participants were grouped into previously defined categories (<6, 6 to <8, and 8 for low, medium, and high adherence). The mean (SD) age of participants was 78.1 (5.8) years, 43.8% were black, and 68.1% were women. Overall, 8.1% (17/210), 16.2% (34/210), and 51.0% (107/210) of participants had low, medium, and high MMAS-8 scores, respectively, at both survey administrations (overall agreement 75.2%; 158/210). The weighted κ statistic was 0.63 (95% CI 0.53 to 0.72). The intraclass correlation coefficient was 0.78. The within-person standard error of the mean for change in MMAS-8 scores was 0.81, which equated to a minimal detectable change of 1.98 points. Only 4.3% (9/210) of the participants had a change in MMAS-8 of 2 or more points between survey administrations. Within-person changes in MMAS-8 scores of 2 or more points over time may represent a real change in antihypertensive medication adherence.

The Minimally Important Difference for the Fatigue Visual Analog Scale in Patients with Rheumatoid Arthritis followed in an Academic Clinical Practice

PubMed Central

Khanna, Dinesh; Pope, Janet; Khanna, Puja P.; Maloney, Michelle; Samedi, Nooshin; Norrie, Debbie; Ouimet, Gillian; Hays, Ron D

2011-01-01

Introduction Fatigue is a common symptom in RA and used as an outcome measure in RA clinical trials. We studied a large academic clinical practice to estimate the minimally important difference (MID) for a fatigue visual analog scale using patient-reported anchors (fatigue, pain and overall health). Methods RA patients (N=307) had clinic visits at 2 time points at a median of 5.9 months apart. They completed fatigue visual analog scale (VAS; 0–10) and retrospective anchor items, “How would you describe your overall fatigue/pain/overall health since the last visit?” Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/ overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened. Results The mean (SD) age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) HAQ-DI score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at follow up was 4.3 (2.8) (mean change of −0.07 [2.5], p=NS). The fatigue change score (0–10 scale) for somewhat better and somewhat worsened for fatigue anchor averaged −1.12 and 1.26, respectively. Using pain anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.87 and 1.13 and using global anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.82 and 1.17, respectively. Effect size (ES) estimates using 3 anchors were small for somewhat better (range: 0.27 to 0.39) and somewhat worsened (range: 0.40 to 0.44) groups but larger than the no-change group (range: 0.03 to 0.08). Conclusions The MID for fatigue VAS is between −0.82 to −1.12 for improvement and 1.13 to 1.26 for worsening on 0–10 scale in a large RA clinical practice and similar to that seen in RA clinical trials. This information can aid in

78 FR 69288 - Import Administration; Change of Agency Name

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-19

...] RIN 0625-AA98 Import Administration; Change of Agency Name AGENCY: Foreign-Trade Zones Board, International Trade Administration, Commerce. ACTION: Final rule; nomenclature change. SUMMARY: Effective... orders, changed the name of ``Import Administration'' to ``Enforcement and Compliance.'' Consistent with...

Minimal pneumothorax with dynamic changes in ST segment similar to myocardial infarction.

PubMed

Yeom, Seok-Ran; Park, Sung-Wook; Kim, Young-Dae; Ahn, Byung-Jae; Ahn, Jin-Hee; Wang, Il-Jae

2017-08-01

Pneumothorax can cause a variety of electrocardiographic changes. ST segment elevation, which is mainly observed in myocardial infarction, can also be induced by pneumothorax. The mechanism is presumed to be a decrease in cardiac output, due to increased intra-thoracic pressure. We encountered a patient with ST segment elevation with minimal pneumothorax. Coronary angiography with ergonovine provocation test and echocardiogram had normal findings. The ST segment elevation was normalized by decreasing the amount of pneumothorax. We reviewed the literature and present possible mechanisms for this condition. Copyright © 2017 Elsevier Inc. All rights reserved.

The estimation of the thyroid volume before surgery--an important prerequisite for minimally invasive thyroidectomy.

PubMed

Ruggieri, M; Fumarola, A; Straniero, A; Maiuolo, A; Coletta, I; Veltri, A; Di Fiore, A; Trimboli, P; Gargiulo, P; Genderini, M; D'Armiento, M

2008-09-01

Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV). In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years. Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases. We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two

Changes in private alcohol importation after alcohol tax reductions and import allowance increases in Denmark

PubMed Central

Grittner, Ulrike; Bloomfield, Kim

2010-01-01

AIMS This paper examines changes in alcohol import in Denmark between 2003 and 2006, after the excise tax on spirits in Denmark was lowered by 45% on October 1, 2003 and travellers’ allowances for alcohol import were increased on January1, 2004. Additionally, the paper seeks to develop a profile of alcohol importers and analyse the relation between the distance to the German border and import behaviour, as Germany is the main alcohol import country for Denmark. DATA Cross-sectional and panel data from Denmark, from 2003 to 2006, were analyzed. Samples were collected by telephone interviews, using random digit dialing. RESULTS While the percentage of people who imported alcohol fell over time, the amount of alcohol purchased rose for those who did import. Distance to the German border was inversely related to the likelihood of importing and the level of imported amounts. Heavy drinkers and those with higher incomes were more likely to import, and heavy drinkers imported higher amounts than moderate drinkers or abstainers. CONCLUSION Distance of residence from the German border, socio-economic status and drinking behaviour are related to private alcohol import in Denmark. Policy changes resulted in a shift to fewer people importing higher amounts of alcohol so that the overall import level did not change substantially. PMID:21532978

Increased PD-1+CD154+ Tfh cells are possibly the most important functional subset of PD-1+ T follicular helper cells in adult patients with minimal change disease.

PubMed

Li, Tao; Shi, Yunpeng; Sun, Weixia; Wang, Haifeng; Wang, Quan; Jiang, Yanfang

2018-02-01

T follicular helper (Tfh) cells, especially programmed cell death protein 1 (PD-1) + Tfh cells, exert important functions in the normal immune response. The purpose of this study was to determine the frequency of different subsets of PD-1 + Tfh cells and their functional effects in adult patients with minimal change disease (MCD). The frequencies of circulating PD-1 + , PD-1 + CD154 + , and PD-1 + interleukin (IL)-21 + Tfh cells, and CD38 + CD19 + and CD38 + CD19 + CD40 + B cells, as well as serum IL-2, IL-4, IL-17A, IL-6, IL-21, and interferon (IFN)-γ were significantly increased in the MCD patients compared with the healthy controls (HCs) (P < 0.05). However, no significant difference was found in PD-1 + BCL-6 + or PD-1 + ICOS + Tfh cells. Furthermore, the percentages of PD-1 + Tfh and PD-1 + CD154 + Tfh cells were negatively correlated with the estimated glomerular filtration rate (eGFR), but positively correlated with the 24-h urinary protein concentration and serum IL-21 level. The percentages of PD-1 + Tfh and PD-1 + CD154 + Tfh cells were positively correlated with the percentages of CD38 + plasma cells and active CD38 + CD40 + plasma cells, respectively. After an 8-12-week treatment with prednisolone, the percentages of PD-1 + , PD-1 + CD154 + , and PD-1 + IL-21 + Tfh cells as well as the serum level of IL-21 were significantly reduced; in contrast, the serum levels of IL-4 and IL-10 were increased (P < 0.05). We conclude that increased PD-1 + CD154 + Tfh cells are possibly the most important functional subset of PD-1 + Tfh cells and may contribute towards the pathogenesis of MCD. Copyright © 2017 Elsevier Ltd. All rights reserved.

Distribution-based estimates of minimal important difference for hospital anxiety and depression scale and impact of event scale-revised in survivors of acute respiratory failure.

PubMed

Chan, Kitty S; Aronson Friedman, Lisa; Bienvenu, O Joseph; Dinglas, Victor D; Cuthbertson, Brian H; Porter, Richard; Jones, Christina; Hopkins, Ramona O; Needham, Dale M

2016-01-01

This study will estimate distribution-based minimal important difference (MID) for the Hospital Anxiety and Depression Scale anxiety (HADS-A) and depression (HADS-D) subscales, and the Impact of Event Scale-Revised (IES-R) in survivors of acute respiratory failure (ARF). Secondary analyses of data from two US and three UK studies of ARF survivors (total N=1223). HADS-D and HADS-A were used to assess depression and anxiety symptoms. IES-R assessed post-traumatic stress disorder symptoms. Standard error of measurement, minimal detectable change90, 0.5 standard deviation (S.D.), and 0.2 S.D. were used to estimate MID for the combined sample, by studies, 6- and 12-month follow-ups, country and mental health condition. Overall, MID estimates converged to 2.0-2.5 for the HADS-A, 1.9-2.3 for the HADS-D and 0.17-0.18 for the IES-R. MID estimates were comparable across studies, follow-up, country and mental health condition. Among ARF survivors, 2.0-2.5 is a reasonable range for the MID for both HADS subscales, and 0.2 is reasonable for IES-R. Until anchor-based MIDs for these instruments are available, these distribution-based estimates can help researchers plan future studies and interpret the clinical importance of findings in ARF patient populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality of Life Questionnaire-Bronchiectasis: final psychometric analyses and determination of minimal important difference scores.

PubMed

Quittner, Alexandra L; O'Donnell, Anne E; Salathe, Matthias A; Lewis, Sandra A; Li, Xiaoming; Montgomery, A Bruce; O'Riordan, Thomas G; Barker, Alan F

2015-01-01

The Quality of Life-Bronchiectasis (QOL-B), a self-administered, patient-reported outcome measure assessing symptoms, functioning and health-related quality of life for patients with non-cystic fibrosis (CF) bronchiectasis, contains 37 items on 8 scales (Respiratory Symptoms, Physical, Role, Emotional and Social Functioning, Vitality, Health Perceptions and Treatment Burden). Psychometric analyses of QOL-B V.3.0 used data from two double-blind, multicentre, randomised, placebo-controlled, phase III trials of aztreonam for inhalation solution (AZLI) in 542 patients with non-CF bronchiectasis and Gram-negative endobronchial infection. Excellent internal consistency (Cronbach's α ≥0.70) and 2-week test-retest reliability (intraclass correlation coefficients ≥0.72) were demonstrated for each scale. Convergent validity with 6 min walk test was observed for Physical and Role Functioning scores. No floor or ceiling effects (baseline scores of 0 or 100) were found for the Respiratory Symptoms scale (primary endpoint of trials). Baseline Respiratory Symptoms scores discriminated between patients based on baseline FEV₁% predicted in only one trial. The minimal important difference score for the Respiratory Symptoms scale was 8.0 points. AZLI did not show efficacy in the two phase III trials. QOL-B responsivity to treatment was assessed by examining changes from baseline QOL-B scores at study visits at which protocol-defined pulmonary exacerbations were reported. Mean Respiratory Symptoms scores decreased 14.0 and 14.2 points from baseline for placebo-treated and AZLI-treated patients with exacerbations, indicating that worsening respiratory symptoms were reflected in clinically meaningful changes in QOL-B scores. Previously established content validity, reliability and responsivity of the QOL-B are confirmed by this final validation study. The QOL-B is available for use in clinical trials and routine clinical practice. Published by the BMJ Publishing Group Limited

The Effectiveness of an Educational Brochure as a Risk Minimization Activity to Communicate Important Rare Adverse Events to Health-Care Professionals.

PubMed

Bester, Nicolette; Di Vito-Smith, Michelle; McGarry, Theresa; Riffkin, Michael; Kaehler, Stefan; Pilot, Richard; Bwire, Robert

2016-02-01

Educational brochures are an important tool for communicating risk to health-care professionals. It is important to evaluate the impact of any risk minimization tool to understand the effectiveness of the strategy. The objective of this study was to assess the effectiveness (i.e., respondents' awareness and understanding of the communication) of a targeted educational brochure distributed to health-care professionals (HCPs) as a risk minimization strategy for the communication of new rare and important adverse events (AEs). A prospective, non-interventional, online survey was performed following distribution of a specifically designed brochure highlighting new and important adverse events to a targeted HCP population, consisting of known users of the target medicine, as represented by a commercial database. Predefined multiple-choice survey questions assessed overall HCP awareness of the brochure and understanding and retention of information in those HCPs who reported receiving the brochure. The educational brochure was sent to a total of 565 HCPs; 121 (21.4%) responded to the survey. The majority of respondents (95.0%) had previously prescribed or dispensed the target medicine. In all, 88 (72.7%) respondents said they had received the educational brochure, of whom 95.5% stated they had at least scanned the main points. More participants who had received the brochure (86.4% to 96.6%) answered the five individual survey questions correctly compared with those who did not (51.5% to 97.0%); this was significant for four out of five questions (P ≤ 0.005). Significantly more HCPs who received the brochure achieved the predefined pass rate (at least four of five questions answered correctly) compared with HCPs who did not receive the brochure (93.2% vs 57.6%, respectively; P = 0.000003). Distribution of targeted educational brochures may be an effective risk minimization strategy to raise HCP awareness of new rare and important AEs; educational brochures may also be

Minimal important difference for 6-minute walk test distances among patients with chronic heart failure.

PubMed

Täger, Tobias; Hanholz, Wiebke; Cebola, Rita; Fröhlich, Hanna; Franke, Jennifer; Doesch, Andreas; Katus, Hugo A; Wians, Frank H; Frankenstein, Lutz

2014-09-01

The 6-minute walk test (6 WT) is an established tool in the assessment of endurance and prognosis in patients with chronic heart failure (CHF). For these patients there is very limited data on biological variation of 6 WT distances. We determined the minimal important difference (MID) for the 6 WT in patients with stable systolic CHF. Two cohorts of patients with stable systolic CHF were included from the outpatients' clinic of the University of Heidelberg. In these cohorts, two 6 WT measurements were performed - in cohort 1 (n=461) 180 days and in cohort 2 (n=512) 365 days apart. Stability was defined as the absence of clinical events (3 months before the first test, between both tests, and 6 months after the second test) and stability of symptoms (NYHA) between tests. Using a standard error of measurement (SEM)-based approach, we determined the MID for both cohorts. The intraclass correlation coefficient was 0.89 at 180 days and 0.88 at 365 days. The results were consistent for groups stratified for age, gender, etiology of CHF, and individual NYHA class. The MID for the 6 WT in stable CHF patients was 35 m and 37 m between presentation and 180 and 365 days, respectively. Submaximal exercise capacity as represented by the 6 WT varies little in stable CHF patients for up to 1-year intervals. The MID for changes in 6 WT values in patients with stable CHF over a period of 6 to 12 months is ~ 36 m. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

78 FR 62417 - Import Administration; Change of Agency Name

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... DEPARTMENT OF COMMERCE International Trade Administration 19 CFR Parts 351, 354, and 356 RIN 0625-AA97 [Docket No. 130927845-3845-01] Import Administration; Change of Agency Name AGENCY: Import Administration, International Trade Administration, Commerce. ACTION: Final rule; nomenclature change. SUMMARY...

Functional Status Score for the Intensive Care Unit (FSS-ICU): An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference

PubMed Central

Huang, Minxuan; Chan, Kitty S.; Zanni, Jennifer M.; Parry, Selina M.; Neto, Saint-Clair G. B.; Neto, Jose A. A.; da Silva, Vinicius Z. M.; Kho, Michelle E.; Needham, Dale M.

2017-01-01

Objective To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the Intensive Care Unit (FSS-ICU), a physical function measure designed for the intensive care unit (ICU). Design Clinimetric analysis. Settings Five international data sets from the United States, Australia, and Brazil. Patients 819 ICU patients. Intervention None. Measurements and Main Results Clinimetric analyses were initially conducted separately for each data source and time point to examine generalizability of findings, with pooled analyses performed thereafter to increase power of analyses. The FSS-ICU demonstrated good to excellent internal consistency. There was good convergent and discriminant validity, with significant and positive correlations (r = 0.30 to 0.95) between FSS-ICU and other physical function measures, and generally weaker correlations with non-physical measures (|r| = 0.01 to 0.70). Known group validity was demonstrated by significantly higher FSS-ICU scores among patients without ICU-acquired weakness (Medical Research Council sumscore ≥48 versus <48) and with hospital discharge to home (versus healthcare facility). FSS-ICU at ICU discharge predicted post-ICU hospital length of stay and discharge location. Responsiveness was supported via increased FSS-ICU scores with improvements in muscle strength. Distribution-based methods indicated a minimal important difference of 2.0 to 5.0. Conclusions The FSS-ICU has good internal consistency and is a valid and responsive measure of physical function for ICU patients. The estimated minimal important difference can be used in sample size calculations and in interpreting studies comparing the physical function of groups of ICU patients. PMID:27488220

Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study.

PubMed

Zhou, Yang; Li, Zili; Wang, Xiaoxia; Zou, Bingshuang; Zhou, Yanheng

2016-02-01

In this study, we aimed to compare treatment efficacy and postsurgical stability between minimal presurgical orthodontics and conventional presurgical orthodontics for patients with skeletal Class III malocclusion. Forty patients received minimal presurgical orthodontics (n = 20) or conventional presurgical orthodontics (n = 20). Lateral cephalograms were obtained before treatment, before orthognathic surgery, and at 1 week, 3 months, 6 months, and 12 months after surgery. Changes of overjet and mandibular incisal angle before surgery were greater in the conventional presurgical orthodontics group than in the minimal presurgical orthodontics group. Postsurgical horizontal changes in Points A and B, overjet, and mandibular incisal angle showed significant differences among the time points. Most of the horizontal and vertical relapses in the maxilla and the mandible occurred within the first 6 months in both groups. Minimal presurgical orthodontics and conventional presurgical orthodontics showed similar extents and directions of skeletal changes in patients with Class III malocclusion. However, orthodontists and surgeons should preoperatively consider the postsurgical counterclockwise rotation of the mandible when using minimal presurgical orthodontics. Close and frequent observations are recommended in the early postsurgical stages. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Minimally invasive surgery for atrial fibrillation

PubMed Central

Suwalski, Piotr

2013-01-01

Atrial fibrillation (AF) remains the most common cardiac arrhythmia, affecting nearly 2% of the general population worldwide. Minimally invasive surgical ablation remains one of the most dynamically evolving fields of modern cardiac surgery. While there are more than a dozen issues driving this development, two seem to play the most important role: first, there is lack of evidence supporting percutaneous catheter based approach to treat patients with persistent and long-standing persistent AF. Paucity of this data offers surgical community unparalleled opportunity to challenge guidelines and change indications for surgical intervention. Large, multicenter prospective clinical studies are therefore of utmost importance, as well as honest, clear data reporting. Second, a collaborative methodology started a long-awaited debate on a Heart Team approach to AF, similar to the debate on coronary artery disease and transcatheter valves. Appropriate patient selection and tailored treatment options will most certainly result in better outcomes and patient satisfaction, coupled with appropriate use of always-limited institutional resources. The aim of this review, unlike other reviews of minimally invasive surgical ablation, is to present medical professionals with two distinctly different, approaches. The first one is purely surgical, Standalone surgical isolation of the pulmonary veins using bipolar energy source with concomitant amputation of the left atrial appendage—a method of choice in one of the most important clinical trials on AF—The Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) Trial. The second one represents the most complex approach to this problem: a multidisciplinary, combined effort of a cardiac surgeon and electrophysiologist. The Convergent Procedure, which includes both endocardial and epicardial unipolar ablation bonds together minimally invasive endoscopic surgery with electroanatomical mapping, to deliver best of

The minimal important difference of exercise tests in severe COPD

PubMed Central

Puhan, M.A.; Chandra, D.; Mosenifar, Z.; Ries, A.; Make, B.; Hansel, N.N.; Wise, R.A.; Sciurba, F.

2017-01-01

Our aim was to determine the minimal important difference (MID) for 6-min walk distance (6MWD) and maximal cycle exercise capacity (MCEC) in patients with severe chronic obstructive pulmonary disease (COPD). 1,218 patients enrolled in the National Emphysema Treatment Trial completed exercise tests before and after 4–6 weeks of pre-trial rehabilitation, and 6 months after randomisation to surgery or medical care. The St George’s Respiratory Questionnaire (domain and total scores) and University of California San Diego Shortness of Breath Questionnaire (total score) served as anchors for anchor-based MID estimates. In order to calculate distribution-based estimates, we used the standard error of measurement, Cohen’s effect size and the empirical rule effect size. Anchor-based estimates for the 6MWD were 18.9 m (95% CI 18.1–20.1 m), 24.2 m (95% CI 23.4–25.4 m), 24.6 m (95% CI 23.4–25.7 m) and 26.4 m (95% CI 25.4–27.4 m), which were similar to distribution-based MID estimates of 25.7, 26.8 and 30.6 m. For MCEC, anchor-based estimates for the MID were 2.2 W (95% CI 2.0–2.4 W), 3.2 W (95% CI 3.0–3.4 W), 3.2 W (95% CI 3.0–3.4 W) and 3.3 W (95% CI 3.0–3.5 W), while distribution-based estimates were 5.3 and 5.5 W. We suggest a MID of 26±2 m for 6MWD and 4±1 W for MCEC for patients with severe COPD. PMID:20693247

The re-emergence of the minimal running shoe.

PubMed

Davis, Irene S

2014-10-01

The running shoe has gone through significant changes since its inception. The purpose of this paper is to review these changes, the majority of which have occurred over the past 50 years. Running footwear began as very minimal, then evolved to become highly cushioned and supportive. However, over the past 5 years, there has been a reversal of this trend, with runners seeking more minimal shoes that allow their feet more natural motion. This abrupt shift toward footwear without cushioning and support has led to reports of injuries associated with minimal footwear. In response to this, the running footwear industry shifted again toward the development of lightweight, partial minimal shoes that offer some support and cushioning. In this paper, studies comparing the mechanics between running in minimal, partial minimal, and traditional shoes are reviewed. The implications for injuries in all 3 conditions are examined. The use of minimal footwear in other populations besides runners is discussed. Finally, areas for future research into minimal footwear are suggested.

The German version of the Expanded Prostate Cancer Index Composite (EPIC): translation, validation and minimal important difference estimation.

PubMed

Umbehr, Martin H; Bachmann, Lucas M; Poyet, Cedric; Hammerer, Peter; Steurer, Johann; Puhan, Milo A; Frei, Anja

2018-02-20

No official German translation exists for the 50-item Expanded Prostate Cancer Index Composite (EPIC), and no minimal important difference (MID) has been established yet. The aim of the study was to translate and validate a German version of the EPIC with cultural adaptation to the different German speaking countries and to establish the MID. We translated and culturally adapted the EPIC into German. For validation, we included a consecutive subsample of 92 patients with localized prostate cancer undergoing radical prostatectomy who participated the Prostate Cancer Outcomes Cohort. Baseline and follow-up assessments took place before and six weeks after prostatectomy in 2010 and 2011. We assessed the EPIC, EORTC QLQ-PR25, Feeling Thermometer, SF-36 and a global rating of health state change variable. We calculated the internal consistency, test-retest reliability, construct validity, responsiveness and MID. For most EPIC domains and subscales, our a priori defined criteria for reliability were fulfilled (construct reliability: Cronbach's alpha 0.7-0.9; test-retest reliability: intraclass-correlation coefficient ≥ 0.7). Cross-sectional and longitudinal correlations between EPIC and EORTC QLQ-PR25 domains ranged from 0.14-0.79, and 0.06-0.5 and 0.08-0.72 for Feeling Thermometer and SF-36, respectively. We established MID values of 10, 4, 12, and 6 for the urinary, bowel, sexual and hormonal domain. The German version of the EPIC is reliable, responsive and valid to measure HRQL in prostate cancer patients and is now available in German language. With the suggested MID we provide interpretation to what extent changes in HRQL are clinically relevant for patients. Hence, study results are of interest beyond German speaking countries.

Linking the Tinnitus Questionnaire and the subjective Clinical Global Impression: Which differences are clinically important?

PubMed Central

2012-01-01

Background Development of new tinnitus treatments requires prospective placebo-controlled randomized trials to prove their efficacy. The Tinnitus Questionnaire (TQ) is a validated and commonly used instrument for assessment of tinnitus severity and has been used in many clinical studies. Defining the Minimal Clinically Important Difference (MCID) for TQ changes is an important step to a better interpretation of the clinical relevance of changes observed in clinical trials. In this study we aimed to estimate the minimum change of the TQ score that could be considered clinically relevant. Methods 757 patients with chronic tinnitus were pooled from the TRI database and the RESET study. An anchor-based approach using the Clinical Global Impression (CGI) scale and distributional approaches were used to estimate MCID. Receiver Operating Characteristic (ROC) curves were calculated to define optimal TQ change cutoffs discriminating between minimally changed and unchanged subjects. Results The relationship between TQ change scores and CGI ratings of change was good (r = 0.52, p < 0.05). Mean change scores associated with minimally better and minimally worse CGI categories were −6.65 and +2.72 respectively. According to the ROC method MCID for improvement was −5 points and for deterioration +1 points. Conclusion Distribution and anchor-based methods yielded comparable results in identifying MCIDs. ΔTQ scores of −5 and +1 points were identified as the minimal clinically relevant change for improvement and worsening respectively. The asymmetry of the MCIDs for improvement and worsening may be related to expectation effects. PMID:22781703

Minimally invasive periodontal therapy

PubMed Central

Dannan, Aous

2011-01-01

Minimally invasive dentistry is a concept that preserves dentition and supporting structures. However, minimally invasive procedures in periodontal treatment are supposed to be limited within periodontal surgery, the aim of which is to represent alternative approaches developed to allow less extensive manipulation of surrounding tissues than conventional procedures, while accomplishing the same objectives. In this review, the concept of minimally invasive periodontal surgery (MIPS) is firstly explained. An electronic search for all studies regarding efficacy and effectiveness of MIPS between 2001 and 2009 was conducted. For this purpose, suitable key words from Medical Subject Headings on PubMed were used to extract the required studies. All studies are demonstrated and important results are concluded. Preliminary data from case cohorts and from many studies reveal that the microsurgical access flap, in terms of MIPS, has a high potential to seal the healing wound from the contaminated oral environment by achieving and maintaining primary closure. Soft tissues are mostly preserved and minimal gingival recession is observed, an important feature to meet the demands of the patient and the clinician in the esthetic zone. However, although the potential efficacy of MIPS in the treatment of deep intrabony defects has been proved, larger studies are required to confirm and extend the reported positive preliminary outcomes. PMID:22368356

Critical Care Nurses' Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years.

PubMed

Beckstrand, Renea L; Hadley, Kacie Hart; Luthy, Karlen E; Macintosh, Janelle L B

Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients. The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published. Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation. Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

[Possible changes in energy-minimizer mechanisms of locomotion due to chronic low back pain - a literature review].

PubMed

de Carvalho, Alberito Rodrigo; Andrade, Alexandro; Peyré-Tartaruga, Leonardo Alexandre

2015-01-01

One goal of the locomotion is to move the body in the space at the most economical way possible. However, little is known about the mechanical and energetic aspects of locomotion that are affected by low back pain. And in case of occurring some damage, little is known about how the mechanical and energetic characteristics of the locomotion are manifested in functional activities, especially with respect to the energy-minimizer mechanisms during locomotion. This study aimed: a) to describe the main energy-minimizer mechanisms of locomotion; b) to check if there are signs of damage on the mechanical and energetic characteristics of the locomotion due to chronic low back pain (CLBP) which may endanger the energy-minimizer mechanisms. This study is characterized as a narrative literature review. The main theory that explains the minimization of energy expenditure during the locomotion is the inverted pendulum mechanism, by which the energy-minimizer mechanism converts kinetic energy into potential energy of the center of mass and vice-versa during the step. This mechanism is strongly influenced by spatio-temporal gait (locomotion) parameters such as step length and preferred walking speed, which, in turn, may be severely altered in patients with chronic low back pain. However, much remains to be understood about the effects of chronic low back pain on the individual's ability to practice an economic locomotion, because functional impairment may compromise the mechanical and energetic characteristics of this type of gait, making it more costly. Thus, there are indications that such changes may compromise the functional energy-minimizer mechanisms. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

Validity, Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Change of "Pediatric Balance Scale" in Children with Cerebral Palsy

ERIC Educational Resources Information Center

Chen, Chia-ling; Shen, I-hsuan; Chen, Chung-yao; Wu, Ching-yi; Liu, Wen-Yu; Chung, Chia-ying

2013-01-01

This study examined criterion-related validity and clinimetric properties of the pediatric balance scale ("PBS") in children with cerebral palsy (CP). Forty-five children with CP (age range: 19-77 months) and their parents participated in this study. At baseline and at follow up, Pearson correlation coefficients were used to determine…

Item response theory analysis to evaluate reliability and minimal clinically important change of the Roland-Morris Disability Questionnaire in patients with severe disability due to back pain from vertebral compression fractures.

PubMed

Lee, Minji K; Yost, Kathleen J; McDonald, Jennifer S; Dougherty, Ryne W; Vine, Roanna L; Kallmes, David F

2017-06-01

The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability. To evaluate the psychometric quality of the RMDQ in patients with severe disability. Observational clinical study. The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty. The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up. With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID). Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods. Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ. Copyright © 2017 Elsevier Inc. All rights reserved.

Responsiveness and Minimally Important Difference of the 6-Minute Stepper Test in Patients with Chronic Obstructive Pulmonary Disease.

PubMed

Pichon, Romain; Couturaud, Francis; Mialon, Philippe; Le Ber-Moy, Catherine; Péran, Loïc; Lochon, Chantal; Nowak, Emmanuel; Beaumont, Marc

2016-01-01

The validity and reproducibility of the 6-minute stepper test (6MST) have already been demonstrated in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the responsiveness of the 6MST to pulmonary rehabilitation (PR) in patients with COPD, to determine a minimal important difference (MID) for the 6MST, and to compare the 6MST and the 6-minute walk test (6MWT). Sixty-two patients with COPD were included in a prospective experimental study. Participants underwent a 3-week inpatient PR program. The primary outcome was the change in the number of steps during the 6MST measured before and after PR. The secondary outcome included the change in the 6-minute walking distance (6MWD) pulse oximetry, heart rate, dyspnea, and leg discomfort during the tests measured before and after PR. MID was determined by anchor-based and distribution approaches. After PR, we observed a significant increase in the number of steps during the 6MST (22.5 steps; 95% CI 13.8-31.3; p < 0.0001) and in the 6MWD (26.6 m; 95% CI 17.6-35.5; p < 0.0001). The 6MST and 6MWT were improved by 10.1 and 6.5%, respectively. The number of steps during the 6MST was significantly correlated with the 6MWD before (r = 0.72; p < 0.0001) and after PR (r = 0.66; p < 0.0001). MID was estimated to be around 20 steps. The 6MST appears to be as responsive as the 6MWT in assessing functional improvement during PR in patients with COPD. The 6MST is a low-cost assessment and requires limited space. © 2016 S. Karger AG, Basel.

Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation.

PubMed

Chen, Poyu; Lin, Keh-Chung; Liing, Rong-Jiuan; Wu, Ching-Yi; Chen, Chia-Ling; Chang, Ku-Chou

2016-06-01

To examine the criterion validity, responsiveness, and minimal clinically important difference (MCID) of the EuroQoL 5-Dimensions Questionnaire (EQ-5D-5L) and visual analog scale (EQ-VAS) in people receiving rehabilitation after stroke. The EQ-5D-5L, along with four criterion measures-the Medical Research Council scales for muscle strength, the Fugl-Meyer assessment, the functional independence measure, and the Stroke Impact Scale-was administered to 65 patients with stroke before and after 3- to 4-week therapy. Criterion validity was estimated using the Spearman correlation coefficient. Responsiveness was analyzed by the effect size, standardized response mean (SRM), and criterion responsiveness. The MCID was determined by anchor-based and distribution-based approaches. The percentage of patients exceeding the MCID was also reported. Concurrent validity of the EQ-Index was better compared with the EQ-VAS. The EQ-Index has better power for predicting the rehabilitation outcome in the activities of daily living than other motor-related outcome measures. The EQ-Index was moderately responsive to change (SRM = 0.63), whereas the EQ-VAS was only mildly responsive to change. The MCID estimation of the EQ-Index (the percentage of patients exceeding the MCID) was 0.10 (33.8 %) and 0.10 (33.8 %) based on the anchor-based and distribution-based approaches, respectively, and the estimation of EQ-VAS was 8.61 (41.5 %) and 10.82 (32.3 %). The EQ-Index has shown reasonable concurrent validity, limited predictive validity, and acceptable responsiveness for detecting the health-related quality of life in stroke patients undergoing rehabilitation, but not for EQ-VAS. Future research considering different recovery stages after stroke is warranted to validate these estimations.

Conscious visual memory with minimal attention.

PubMed

Pinto, Yair; Vandenbroucke, Annelinde R; Otten, Marte; Sligte, Ilja G; Seth, Anil K; Lamme, Victor A F

2017-02-01

Is conscious visual perception limited to the locations that a person attends? The remarkable phenomenon of change blindness, which shows that people miss nearly all unattended changes in a visual scene, suggests the answer is yes. However, change blindness is found after visual interference (a mask or a new scene), so that subjects have to rely on working memory (WM), which has limited capacity, to detect the change. Before such interference, however, a much larger capacity store, called fragile memory (FM), which is easily overwritten by newly presented visual information, is present. Whether these different stores depend equally on spatial attention is central to the debate on the role of attention in conscious vision. In 2 experiments, we found that minimizing spatial attention almost entirely erases visual WM, as expected. Critically, FM remains largely intact. Moreover, minimally attended FM responses yield accurate metacognition, suggesting that conscious memory persists with limited spatial attention. Together, our findings help resolve the fundamental issue of how attention affects perception: Both visual consciousness and memory can be supported by only minimal attention. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

76 FR 30550 - Federal Management Regulation; Change in Consumer Price Index Minimal Value

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-26

... Minimal Value AGENCY: Office of Governmentwide Policy, GSA. ACTION: Final rule. SUMMARY: Pursuant to 5 U.S.C. 7342, at three-year intervals following January 1, 1981, the minimal value for foreign gifts must... required consultation has been completed and the minimal value has been increased to $350 or less as of...

Minimal clinically important difference and the effect of clinical variables on the ankle osteoarthritis scale in surgically treated end-stage ankle arthritis.

PubMed

Coe, Marcus P; Sutherland, Jason M; Penner, Murray J; Younger, Alastair; Wing, Kevin J

2015-05-20

There is much debate regarding the best outcome tool for use in foot and ankle surgery, specifically in patients with ankle arthritis. The Ankle Osteoarthritis Scale (AOS) is a validated, disease-specific score. The goals of this study were to investigate the clinical performance of the AOS and to determine a minimal clinically important difference (MCID) for it, using a large cohort of 238 patients undergoing surgery for end-stage ankle arthritis. Patients treated with total ankle arthroplasty or ankle arthrodesis were prospectively followed for a minimum of two years at a single site. Data on demographics, comorbidities, AOS score, Short Form-36 results, and the relationship between expectations and satisfaction were collected at baseline (preoperatively), at six and twelve months, and then yearly thereafter. A linear regression analysis examined the variables affecting the change in AOS scores between baseline and the two-year follow-up. An MCID in the AOS change score was then determined by employing an anchor question, which asked patients to rate their relief from symptoms after surgery. Surgical treatment of end-stage ankle arthritis resulted in a mean improvement (and standard deviation) of 31.2 ± 22.7 points in the AOS score two years after surgery. The MCID of the AOS change score was a mean of 28.0 ± 17.9 points. The change in AOS score was significantly affected by the preoperative AOS score, smoking, back pain, and age. Patients undergoing arthroplasty or arthrodesis for end-stage ankle arthritis experienced a mean improvement in AOS score that was greater than the estimated MCID (31.2 versus 28.0 points). Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Estimating minimal important differences for several scales assessing function and quality of life in patients with attention-deficit/hyperactivity disorder.

PubMed

Hodgkins, Paul; Lloyd, Andrew; Erder, M Haim; Setyawan, Juliana; Weiss, Margaret D; Sasané, Rahul; Nafees, Beenish

2017-02-01

Defining minimal important difference (MID) is critical to interpreting patient-reported outcomes data and treatment efficacy in clinical trials. This study estimates the MID for the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) and the Child Health and Illness Profile-Parent Report (CHIP-CE-PRF76) among parents of young people with attention-deficit/hyperactivity disorder (ADHD) in the UK. Parents of children (6-12 years; n=100) and adolescents (13-17 years; n=117) with ADHD completed a socio-demographic form, the CHIP-CE-PRF76, the WFIRS-P, and the Pediatric Quality of Life scale at baseline and 4 weeks later. At follow-up, a subset of parents completed anchor questions measuring change in the child/adolescent from baseline. MIDs were estimated using anchor-based and distribution-based methods, and separately for children and adolescents. The MID estimates for overall change in the WFIRS-P total score ranged from 11.31 (standard error of measurement) to 13.47 (anchor) for the total sample. The range of MID estimates for the CHIP-CE-PRF76 varied by domain: 6.80-7.41 (satisfaction), 6.18-7.34 (comfort), 5.60-6.72 (resilience), 6.06-7.57 (risk avoidance), and 4.00-5.63 (achievement) for the total sample. Overall, MID estimates for WFIRS-P MID and CHIP-CE-PRF76 were slightly higher for adolescents than for children. This study estimated MIDs for these instruments using several methods. The observed convergence of the MID estimates increases confidence in their reliability and could assist clinicians and decision makers in deriving meaningful interpretations of observed changes in the WFIRS-P and CHIP-CE in clinical trials and practice.

Minimizing the regrets of long-term urban floodplain management decisions under deeply uncertain climate change

NASA Astrophysics Data System (ADS)

Hecht, J. S.; Kirshen, P. H.; Vogel, R. M.

2016-12-01

Making long-term floodplain management decisions under uncertain climate change is a major urban planning challenge of the 21stcentury. To support these efforts, we introduce a screening-level optimization model that identifies adaptation portfolios by minimizing the regrets associated with their flood-control and damage costs under different climate change trajectories that are deeply uncertain, i.e. have probabilities that cannot be specified plausibly. This mixed integer program explicitly considers the coupled damage-reduction impacts of different floodwall designs and property-scale investments (first-floor elevation, wet floodproofing of basements, permanent retreat and insurance), recommends implementation schedules, and assesses impacts to stakeholders residing in three types of homes. An application to a stylized municipality illuminates many nonlinear system dynamics stemming from large fixed capital costs, infrastructure design thresholds, and discharge-depth-damage relationships. If stakeholders tolerate mild damage, floodwalls that fully protect a community from large design events are less cost-effective than portfolios featuring both smaller floodwalls and property-scale measures. Potential losses of property tax revenue from permanent retreat motivate municipal property-tax initiatives for adaptation financing. Yet, insurance incentives for first-floor elevation may discourage locally financed floodwalls, in turn making lower-income residents more vulnerable to severe flooding. A budget constraint analysis underscores the benefits of flexible floodwall designs with low incremental expansion costs while near-optimal solutions demonstrate the scheduling flexibility of many property-scale measures. Finally, an equity analysis shows the importance of evaluating the overpayment and under-design regrets of recommended adaptation portfolios for each stakeholder and contrasts them to single-scenario model results.

PUBLISHER'S ANNOUNCEMENT: Important changes for 2008

NASA Astrophysics Data System (ADS)

2008-02-01

As a result of reviewing several aspects of our content, both in print and online, we have made some changes for 2008. These changes are described below. Article numbering Inverse Problems has moved from sequential page numbering to an article numbering system, offering important advantages and flexibility by speeding up the publication process. Articles in different issues or sections can be published online as soon as they are ready, without having to wait for a whole issue or section to be allocated page numbers. The bibliographic citation will change slightly. Articles should be referenced using the six-digit article number in place of a page number, and this number must include any leading zeros. For instance: Surname X and Surname Y 2008 Inverse Problems 24 015001 Articles will continue to be published on the web in advance of the print edition. A new look and feel We have taken the opportunity to refresh the design of Inverse Problems' cover in order to modernise the typography and create a consistent look and feel across IOP Publishing's range of publications. We hope you like the new cover. If you have any questions or comments about any of these changes, please contact us at ip@iop.org Kate Watt Publisher, Inverse Problems

Sonic-boom minimization.

NASA Technical Reports Server (NTRS)

Seebass, R.; George, A. R.

1972-01-01

There have been many attempts to reduce or eliminate the sonic boom. Such attempts fall into two categories: (1) aerodynamic minimization and (2) exotic configurations. In the first category changes in the entropy and the Bernoulli constant are neglected and equivalent body shapes required to minimize the overpressure, the shock pressure rise and the impulse are deduced. These results include the beneficial effects of atmospheric stratification. In the second category, the effective length of the aircraft is increased or its base area decreased by modifying the Bernoulli constant a significant fraction of the flow past the aircraft. A figure of merit is introduced which makes it possible to judge the effectiveness of the latter schemes.

The minimally important difference for the Japanese version of the health assessment questionnaire in patients with rheumatoid arthritis in daily practice.

PubMed

Shidara, Kumi; Nakajima, Ayako; Inoue, Eisuke; Hoshi, Daisuke; Sugimoto, Naoki; Seto, Yohei; Tanaka, Eiichi; Ikari, Katsunori; Taniguchi, Atsuo; Yamanaka, Hisashi

2017-05-01

To validate the minimally important difference (MID) of physical function using the Japanese version of the Health Assessment Questionnaire (J-HAQ) in a cohort of rheumatoid arthritis (RA). Patients who participated in a cohort study in both October 2008 and April 2009 were analyzed. Patients self-rated their change in overall status over 6 months using a 5-point Likert scale ("much better", "somewhat better", "same", "somewhat worse", or "much worse"). The MID for J-HAQ score was defined as the mean J-HAQ score change in patients who rated themselves "somewhat better". An effect size (ES) of 0.2-0.5 was considered to be suitable for MID. A total of 4560 patients were analyzed. The mean (standard deviation [SD]) MID for J-HAQ score was -0.06 (0.29), corresponding to an ES of 0.08. As exploratory analysis, 1999 patients with a J-HAQ score ≥0.5 and 28-joint disease activity score (DAS28) ≥ 2.6 at baseline were assessed. The mean (SD) MID for J-HAQ score of these patients was 0.13 (0.01), corresponding to an ES of 0.21. The MID for J-HAQ score was 0.13 in patients with baseline J-HAQ score ≥0.5 and DAS28 ≥ 2.6. The MID for J-HAQ score was influenced by disease status and functional disability.

Favorable locations for piezo actuators in plates with good control effectiveness and minimal change in system dynamics

NASA Astrophysics Data System (ADS)

Dhuri, K. D.; Seshu, P.

2007-12-01

Placement and sizing of piezo actuators is normally based on control effectiveness. However, retrofitting of piezoelectric actuators alters the inherent stiffness/mass properties of the parent structure. In rotating structures, the additional mass due to piezo patches contributes to the centrifugal stiffening force. The parent structure is originally designed to have a certain natural frequency spectrum in relation to the disturbance excitation. In the event of failure of the active system, the dynamics of the structure with piezos (now rendered passive) will therefore become significant. Thus it will be helpful to determine locations for mounting piezo patches based on minimal natural frequency change yet with good control authority. In this study, a finite element based procedure for plate structures is presented. Favorable locations for mounting piezos based on minimal natural frequency changes are iteratively evolved from an initial configuration wherein the whole plate is covered with piezos. A modal controllability approach has been used for finding piezo mounting locations from a good controllability perspective. The procedure is demonstrated for simply supported square, swept-back, circular and rotating rectangular plates considering the first four modes.

Reliability, Validity, and Minimal Detectable Change of Four-Step Stair Climb Power Test in Community-Dwelling Older Adults.

PubMed

Ni, Meng; Brown, Lorna G; Lawler, Danielle; Bean, Jonathan F

2017-07-01

Stair climb power is an important clinical measure of lower-extremity power. The stair climb power test (SCPT) was validated by requiring individuals to climb a full flight of stairs. A 4-step SCPT (4SCPT) would be more clinically feasible and easier to perform, yet its reliability and validity are unknown. To evaluate reliability, validity, and minimal detectable change of 4SCPT among community-dwelling older adults. This study is a cross-sectional analysis of baseline data from a clinical trial. Fifty older adults ≥65 years of age, at risk for mobility decline, consented to participate in this ancillary study. Test-retest reliability was derived from 2 measurements within each participant measured by a single assessor. Pearson correlation analyses among leg power measures (4SCPT, SCPT, single leg press power at 40% and 70% of the 1-repetition maximum [SLP40, SLP70]) were performed. Separate multivariate linear regressions were conducted evaluating the associations between each leg power measure and 2 mobility outcomes, the Short Physical Performance Battery (SPPB) and habitual gait speed (HGS). Minimal detectable change was based on a 90% confidence interval (MDC 90 ). The 4SCPT had excellent test-retest reliability (ICC(2,1) = 0.951), and strong correlation with SCPT, SLP40, and SLP70 ( r = 0.85-0.96). The 4SCPT explained a greater amount of variance in the SPPB (R 2 = 0.31) than other leg power measurements (R 2 = 0.23-0.25). The 4SCPT (R 2 = 0.41) and SCPT (R 2 = 0.42) described equivalent amounts of variance in HGS, and greater than that with SLP40 (R 2 = 0.28) and SLP70 (R 2 = 0.30). The MDC 90 for 4SCPT was 44.0 watts. This was a cross-sectional analysis within a small, nonrepresentative sample. Interrater reliability was not evaluated. The 4SCPT shows scientific promise as a valid and reliable leg power measurement among community-dwelling older adults. © 2017 American Physical Therapy Association

Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

PubMed

Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

2017-05-01

The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value

Jerk Minimization Method for Vibration Control in Buildings

NASA Technical Reports Server (NTRS)

Abatan, Ayo O.; Yao, Leummim

1997-01-01

In many vibration minimization control problems for high rise buildings subject to strong earthquake loads, the emphasis has been on a combination of minimizing the displacement, the velocity and the acceleration of the motion of the building. In most cases, the accelerations that are involved are not necessarily large but the change in them (jerk) are abrupt. These changes in magnitude or direction are responsible for most building damage and also create discomfort like motion sickness for inhabitants of these structures because of the element of surprise. We propose a method of minimizing also the jerk which is the sudden change in acceleration or the derivative of the acceleration using classical linear quadratic optimal controls. This was done through the introduction of a quadratic performance index involving the cost due to the jerk; a special change of variable; and using the jerk as a control variable. The values of the optimal control are obtained using the Riccati equation.

Brief communication: use of the minimal important difference for a meta-analysis on exercise and anxiety in adults with arthritis.

PubMed

Kelley, George A; Kelley, Kristi S; Callahan, Leigh F

2018-07-01

A recent meta-analysis reported statistically significant improvements in anxiety as a result of exercise in adults with arthritis and other rheumatic diseases (AORD) using the traditional standardized mean difference (SMD) effect size (ES). The objective of this study was to use the more recently developed and clinically relevant minimal important difference (MID) approach to examine this association. Data from a previous meta-analysis of 14 randomized controlled trials representing 926 initially enrolled adults ≥ 18 years of age (539 exercise, 387 control) was used to calculate the ES using the MID approach. Minimal important difference data were derived from previously reported anchor-based values that represented the different instruments used to assess anxiety. Effect sizes were pooled using the inverse heterogeneity (IVhet) model. Overall, exercise resulted in a mean ES reduction in anxiety of - 0.80 (95% CI, - 1.60 to 0.001, p = 0.05; Q = 92.1, p < 0.001, I 2  = 83.7%, 95% CI, 74.9%, 89.5%), suggesting that overall, exercise may benefit an appreciable number of patients. Nonetheless, this effect spanned the range from many patients gaining important benefits to no patients improving. The clinically relevant effects of exercise on anxiety in adults with AORD are varied. However, these results should be interpreted with caution given the absence of anchor-based MID data specific to the instruments and questions used to assess anxiety in adults with AORD. A need exists for future research to establish instrument-specific, anchor-based MID values for questions assessing anxiety in adults with AORD.

Taxonomic minimalism.

PubMed

Beattle, A J; Oliver, I

1994-12-01

Biological surveys are in increasing demand while taxonomic resources continue to decline. How much formal taxonomy is required to get the job done? The answer depends on the kind of job but it is possible that taxonomic minimalism, especially (1) the use of higher taxonomic ranks, (2) the use of morphospecies rather than species (as identified by Latin binomials), and (3) the involvement of taxonomic specialists only for training and verification, may offer advantages for biodiversity assessment, environmental monitoring and ecological research. As such, formal taxonomy remains central to the process of biological inventory and survey but resources may be allocated more efficiently. For example, if formal Identification is not required, resources may be concentrated on replication and increasing sample sizes. Taxonomic minimalism may also facilitate the inclusion in these activities of important but neglected groups, especially among the invertebrates, and perhaps even microorganisms. Copyright © 1994. Published by Elsevier Ltd.

Evaluation of the effect of non-surgical periodontal treatment on oral health-related quality of life: estimation of minimal important differences 1 year after treatment.

PubMed

Jönsson, Birgitta; Öhrn, Kerstin

2014-03-01

To evaluate an individually tailored oral health educational programme on patient-reported outcome compared with a standard oral health educational programme, assess change over time and determine minimal important differences (MID) in change scores for two different oral health related quality of life (OHRQoL) instrument after non-surgical periodontal treatment (NSPT). In a randomized controlled trial evaluating two educational programmes, patients (n = 87) with chronic periodontitis completed a questionnaire at baseline and after 12 months. OHRQoL was assessed with the General Oral Health Assessment Index (GOHAI) and the UK oral health-related quality-of-life measure (OHQoL-UK). In addition, patients' global rating of oral health and socio-demographic variables were recorded. The MID was estimated with anchor-based and distributions-based methods. There were no differences between the two educational groups. The OHRQoL was significantly improved after treatment. The MID was approximately five for OHQoL-UK with a moderate ES, and three for GOHAI with a Small ES, and 46-50% of the patients showed improvements beyond the MID. Both oral health educational groups reported higher scores in OHRQoL after NSPT resulting in more positive well-being (OHQoL-UK) and less frequent oral problems (GOHAI). OHQoL-UK gave a greater effect size and mean change scores but both instruments were associated with the participants' self-rated change in oral health. The changes were meaningful for the patients supported by the estimated MID. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Minimally invasive surgery. Future developments.

PubMed

Wickham, J E

1994-01-15

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures.

Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations.

PubMed

Devji, Tahira; Guyatt, Gordon H; Lytvyn, Lyubov; Brignardello-Petersen, Romina; Foroutan, Farid; Sadeghirad, Behnam; Buchbinder, Rachelle; Poolman, Rudolf W; Harris, Ian A; Carrasco-Labra, Alonso; Siemieniuk, Reed A C; Vandvik, Per O

2017-05-11

To identify the most credible anchor-based minimal important differences (MIDs) for patient important outcomes in patients with degenerative knee disease, and to inform BMJ Rapid Recommendations for arthroscopic surgery versus conservative management DESIGN: Systematic review. Estimates of anchor-based MIDs, and their credibility, for knee symptoms and health-related quality of life (HRQoL). MEDLINE, EMBASE and PsycINFO. We included original studies documenting the development of anchor-based MIDs for patient-reported outcomes (PROs) reported in randomised controlled trials included in the linked systematic review and meta-analysis and judged by the parallel BMJ Rapid Recommendations panel as critically important for informing their recommendation: measures of pain, function and HRQoL. 13 studies reported 95 empirically estimated anchor-based MIDs for 8 PRO instruments and/or their subdomains that measure knee pain, function or HRQoL. All studies used a transition rating (global rating of change) as the anchor to ascertain the MID. Among PROs with more than 1 estimated MID, we found wide variation in MID values. Many studies suffered from serious methodological limitations. We identified the following most credible MIDs: Western Ontario and McMaster University Osteoarthritis Index (WOMAC; pain: 12, function: 13), Knee injury and Osteoarthritis Outcome Score (KOOS; pain: 12, activities of daily living: 8) and EuroQol five dimensions Questionnaire (EQ-5D; 0.15). We were able to distinguish between more and less credible MID estimates and provide best estimates for key instruments that informed evidence presentation in the associated systematic review and judgements made by the Rapid Recommendation panel. CRD42016047912. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

What Variables Appear Important in Changing Traditional Inservice Training Procedures.

ERIC Educational Resources Information Center

Sobol, Francis Thomas

Herein are discussed descriptive findings from the educational literature on the question of what variables appear important in changing traditional in-service training procedures. The question of the content versus the process of in-service training, important problems in in-service training programs, and implications of the important problems…

PUBLISHER'S ANNOUNCEMENT: Important changes for 2008 Important changes for 2008

NASA Astrophysics Data System (ADS)

Quin, Sarah

2008-01-01

As a result of reviewing several aspects of IOP journal content, both in print and online, we have made some changes for 2008, some of which benefit Journal of Physics D: Applied Physics. Article numbering In common with many other IOP journals, Journal of Physics D: Applied Physics has moved from sequential page numbering to an article numbering system which offers greater flexibility for faster publication of articles. The bibliographic citation will change slightly. Articles should be referenced using the six-digit article number in place of a page number, and this number must include any leading zeros. For instance: Surname X and Surname Y 2008 J. Phys. D: Appl. Phys. 41 015203 Faster online publication Articles will continue to be published on the web in advance of the print edition but the introduction of article numbering makes it possible to achieve more frequent online publication while retaining the established grouping of articles into subject sections, which was not possible with the former page numbering system. We now expect to publish a new batch of articles each week, instead of every two weeks as previously, with a consequent reduction in our already rapid publication time. A new look and feel Journal of Physics D: Applied Physics has changed from European A4 format to a slightly smaller size which is closer to US Letter format, and we have taken the opportunity to refresh the cover in order to modernize the typography and create a consistent look and feel across our range of publications. If you have any questions or comments about any of these changes, please contact us at jphysd@iop.org

β-Catenin transcriptional activity is minimal in canine osteosarcoma and its targeted inhibition results in minimal changes to cell line behaviour.

PubMed

Piskun, Caroline M; Stein, Timothy J

2016-06-01

Canine osteosarcoma (OS) is an aggressive malignancy associated with poor outcomes. Therapeutic improvements are likely to develop from an improved understanding of signalling pathways contributing to OS development and progression. The Wnt signalling pathway is of interest for its role in osteoblast differentiation, its dysregulation in numerous cancer types, and the relative frequency of cytoplasmic accumulation of β-catenin in canine OS. This study aimed to determine the biological impact of inhibiting canonical Wnt signalling in canine OS, by utilizing either β-catenin siRNA or a dominant-negative T-cell factor (TCF) construct. There were no consistent, significant changes in cell line behaviour with either method compared to parental cell lines. Interestingly, β-catenin transcriptional activity was three-fold higher in normal canine primary osteoblasts compared to canine OS cell lines. These results suggest canonical Wnt signalling is minimally active in canine OS and its targeted inhibition is not a relevant therapeutic strategy. © 2013 John Wiley & Sons Ltd.

Minimally invasive surgery. Future developments.

PubMed Central

Wickham, J. E.

1994-01-01

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:8312776

Age-related changes in tissue signal properties within cortical areas important for word understanding in 12- to 19-month-old infants.

PubMed

Travis, Katherine E; Curran, Megan M; Torres, Christina; Leonard, Matthew K; Brown, Timothy T; Dale, Anders M; Elman, Jeffrey L; Halgren, Eric

2014-07-01

Recently, our laboratory has shown that the neural mechanisms for encoding lexico-semantic information in adults operate functionally by 12-18 months of age within left frontotemporal cortices (Travis et al., 2011. Spatiotemporal neural dynamics of word understanding in 12- to 18-month-old-infants. Cereb Cortex. 8:1832-1839). However, there is minimal knowledge of the structural changes that occur within these and other cortical regions important for language development. To identify regional structural changes taking place during this important period in infant development, we examined age-related changes in tissue signal properties of gray matter (GM) and white matter (WM) intensity and contrast. T1-weighted surface-based measures were acquired from 12- to 19-month-old infants and analyzed using a general linear model. Significant age effects were observed for GM and WM intensity and contrast within bilateral inferior lateral and anterovental temporal regions, dorsomedial frontal, and superior parietal cortices. Region of interest (ROI) analyses revealed that GM and WM intensity and contrast significantly increased with age within the same left lateral temporal regions shown to generate lexico-semantic activity in infants and adults. These findings suggest that neurophysiological processes supporting linguistic and cognitive behaviors may develop before cellular and structural maturation is complete within associative cortices. These results have important implications for understanding the neurobiological mechanisms relating structural to functional brain development. © The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Reliability, minimal detectable change and responsiveness to change: Indicators to select the best method to measure sedentary behaviour in older adults in different study designs.

PubMed

Dontje, Manon L; Dall, Philippa M; Skelton, Dawn A; Gill, Jason M R; Chastin, Sebastien F M

2018-01-01

Prolonged sedentary behaviour (SB) is associated with poor health. It is unclear which SB measure is most appropriate for interventions and population surveillance to measure and interpret change in behaviour in older adults. The aims of this study: to examine the relative and absolute reliability, Minimal Detectable Change (MDC) and responsiveness to change of subjective and objective methods of measuring SB in older adults and give recommendations of use for different study designs. SB of 18 older adults (aged 71 (IQR 7) years) was assessed using a systematic set of six subjective tools, derived from the TAxonomy of Self report Sedentary behaviour Tools (TASST), and one objective tool (activPAL3c), over 14 days. Relative reliability (Intra Class Correlation coefficients-ICC), absolute reliability (SEM), MDC, and the relative responsiveness (Cohen's d effect size (ES) and Guyatt's Responsiveness coefficient (GR)) were calculated for each of the different tools and ranked for different study designs. ICC ranged from 0.414 to 0.946, SEM from 36.03 to 137.01 min, MDC from 1.66 to 8.42 hours, ES from 0.017 to 0.259 and GR from 0.024 to 0.485. Objective average day per week measurement ranked as most responsive in a clinical practice setting, whereas a one day measurement ranked highest in quasi-experimental, longitudinal and controlled trial study designs. TV viewing-Previous Week Recall (PWR) ranked as most responsive subjective measure in all study designs. The reliability, Minimal Detectable Change and responsiveness to change of subjective and objective methods of measuring SB is context dependent. Although TV viewing-PWR is the more reliable and responsive subjective method in most situations, it may have limitations as a reliable measure of total SB. Results of this study can be used to guide choice of tools for detecting change in sedentary behaviour in older adults in the contexts of population surveillance, intervention evaluation and individual care.

Communication growth in minimally verbal children with ASD: The importance of interaction.

PubMed

DiStefano, Charlotte; Shih, Wendy; Kaiser, Ann; Landa, Rebecca; Kasari, Connie

2016-10-01

Little is known about language development in children with Autism Spectrum Disorders (ASD) who remain minimally verbal past age 5. While there is evidence that children can develop language after age 5, we lack detailed information. Studies of this population generally focus on discrete language skills without addressing broader social-communication abilities. As communication and social deficits are both inherent to ASD, an examination of not only what language skills are acquired, but how those skills are used in interactions is relevant. Research in typical development has examined how communication interchanges (unbroken back-and-forth exchanges around a unified purpose) develop, which can be used as a framework for studying minimally verbal children. This study examined the interchange use by 55 children with ASD over the course of a 6-month play and engagement-based communication intervention. Half of the children received intervention sessions that also incorporated a speech-generating device (SGD). Interchanges were coded by: frequency, length, function, and initiator (child or adult). Results indicated that children initiated a large proportion of interchanges and this proportion increased over time. The average length and number of interchanges increased over time, with children in the SGD group showing even greater growth. Finally, children's total number of interchanges at baseline was positively associated with their spoken language gains over the course of intervention. This study supports the crucial relationship between social engagement and expressive language development, and highlights the need to include sustained communication interchanges as a target for intervention with this population. Autism Res 2016, 9: 1093-1102. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Validity, Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Change of the Pediatric Motor Activity Log in Children with Cerebral Palsy

ERIC Educational Resources Information Center

Lin, Keh-chung; Chen, Hui-fang; Chen, Chia-ling; Wang, Tien-ni; Wu, Ching-yi; Hsieh, Yu-wei; Wu, Li-ling

2012-01-01

This study examined criterion-related validity and clinimetric properties of the Pediatric Motor Activity Log (PMAL) in children with cerebral palsy. Study participants were 41 children (age range: 28-113 months) and their parents. Criterion-related validity was evaluated by the associations between the PMAL and criterion measures at baseline and…

Effects of different exercise programs and minimal detectable changes in hemoglobin A1c in patients with type 2 diabetes.

PubMed

de Lade, Carlos Gabriel; Marins, João Carlos Bouzas; Lima, Luciana Moreira; de Carvalho, Cristiane Junqueira; Teixeira, Robson Bonoto; Albuquerque, Maicon Rodrigues; Reis, Janice Sepúlveda; Amorim, Paulo Roberto Dos Santos

2016-01-01

The incidence of diabetes mellitus is increasing worldwide, resulting in a global epidemic. The most common type, the type 2 diabetes mellitus, constitutes of 90-95 % of the cases and is characterized by the action of and/or impaired insulin secretion. Regular exercise is a recommended strategy in several studies and guidelines for type 2 diabetes control and complications associated with it. Therefore, we evaluated and compared the effects of aerobic and strength exercise programs on the glycemic control in patients with type 2 diabetes. The selected patients were divided into groups which performed moderate strength training (ST) and aerobic training (AT). The study lasted 20 weeks and was divided into two 10 week phases with anthropometric (body mass index, waist, abdomen and hips circumferences, waist/hip ratio) and biochemical (glycemic and lipid profile) assessments at baseline, 10 weeks and 20 weeks. For intra and inter analyses a mixed ANOVA model was used. Individual changes were calculated using the minimum detectable change, based on a 90 % confidence interval. Eleven patients (five men and six women) completed the 20 weeks of training; five from the ST group and six from the AT. No significant changes were observed in any anthropometric variable in either group. Statistically significant differences were found in mean hemoglobin A1c in both groups between baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 10 weeks (AT: 7.2 ± 1.7; ST: 7.9 ± 1.2) (p = 0.03), and baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 20 weeks (AT: 7.5 ± 1.7; ST: 7.4 ± 0.9) (p = 0.01). For the minimal detectable changes, 40 % of the ST and 33 % of AT achieved these changes for hemoglobin A1c. Both aerobic and strength exercises can help the metabolic control in patients with type 2 diabetes, even without significant changes in anthropometry over the 20 weeks of training. However, this period was sufficient to cause changes in hemoglobin A1c values and

Kinetic changes during a six-week minimal footwear and gait-retraining intervention in runners.

PubMed

Warne, Joe P; Smyth, Barry P; Fagan, John O'C; Hone, Michelle E; Richter, Chris; Nevill, Alan M; Moran, Kieran A; Warrington, Giles D

2017-08-01

An evaluation of a six-week Combined minimal footwear transition and gait-retraining combination vs. gait retraining only on impact characteristics and leg stiffness. Twenty-four trained male runners were randomly assigned to either (1) Minimalist footwear transition Combined with gait-retraining over a six-week period ("Combined" group; n = 12) examined in both footwear, or (2) a gait-retraining group only with no minimalist footwear exposure ("Control"; n = 12). Participants were assessed for loading rate, impact peak, vertical, knee and ankle stiffness, and foot-strike using 3D and kinetic analysis. Loading rate was significantly higher in the Combined group in minimal shoes in pre-tests compared to a Control (P ≤ 0.001), reduced significantly in the Combined group over time (P ≤ 0.001), and was not different to the Control group in post-tests (P = 0.16). The impact peak (P = 0.056) and ankle stiffness reduced in both groups (P = 0.006). Loading rate and vertical stiffness was higher in minimalist footwear than conventional running shoes both pre (P ≤ 0.001) and post (P = 0.046) the intervention. There has a higher tendency to non-rearfoot strike in both interventions, but more acute changes in the minimalist footwear. A Combined intervention can potentially reduce impact variables. However, higher loading rate initially in minimalist footwear may increase the risk of injury in this condition.

Minimally important difference of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q)

PubMed Central

2011-01-01

Background A previous study has documented the reliability and validity of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) in exploring patient satisfaction with medicines for chronic health conditions in routine medical practice, but the minimally important difference (MID) of this tool is as yet unknown. The objective of this research was to estimate the MID for the SATMED-Q total score and six constituent domains. Methods The sample of patients (456 subjects, mean age 59 years, 53% male) used for testing psychometric properties was also used to assess MID. Item #14 of the Treatment Satisfaction Questionnaire for Medication (TSQM) was used as an anchor reference since it directly explores satisfaction with medicine on a 7-point ordinal scale (from extremely satisfied to extremely dissatisfied, with a neutral category). Patients were classified into four categories according to responses to this item (extremely satisfied/dissatisfied, very satisfied/dissatisfied, satisfied/dissatisfied, neither satisfied nor dissatisfied (neutral), and calculations were made for the total score and each domain of the SATMED-Q using standardised scores. The mean absolute differences in total score (and domains) between the neutral category and the satisfied/dissatisfied category were considered to be the MID. Effect sizes (ES) were also computed. Results The MID for the total score was 13.4 (ES = 0.91), while the domain values ranged from 10.3 (medical care domain, ES = 0.43) to 20.6 (impact on daily living, ES = 0.85). Mean differences in satisfaction (as measured by the total SATMED-Q score and domain scores) using the levels of satisfaction established by item #14 were significantly different, with F values ranging from 12.2 to 88.8 (p < 0.001 in all cases). Conclusion The SATMED-Q was demonstrated to be responsive to different levels of patient satisfaction with therapy in chronically ill subjects. The MID obtained was 13.4 points for the overall normalised

Minimal detectable change of the Personal and Social Performance scale in individuals with schizophrenia.

PubMed

Lee, Shu-Chun; Tang, Shih-Fen; Lu, Wen-Shian; Huang, Sheau-Ling; Deng, Nai-Yu; Lue, Wen-Chyn; Hsieh, Ching-Lin

2016-12-30

The minimal detectable change (MDC) of the Personal and Social Performance scale (PSP) has not yet been investigated, limiting its utility in data interpretation. The purpose of this study was to determine the MDCs of the PSP administered by the same rater or different raters in individuals with schizophrenia. Participants with schizophrenia were recruited from two psychiatric community rehabilitation centers to complete the PSP assessments twice, 2 weeks apart, by the same rater or 2 different raters. MDC values were calculated from the coefficients of intra- and inter-rater reliability (i.e., intraclass correlation coefficients). Forty patients (mean age 36.9 years, SD 9.7) from one center participated in the intra-rater reliability study. Another 40 patients (mean age 44.3 years, SD 11.1) from the other center participated in the inter-rater study. The MDCs (MDC%) of the PSP were 10.7 (17.1%) for the same rater and 16.2 (24.1%) for different raters. The MDCs of the PSP appeared appropriate for clinical trials aiming to determine whether a real change in social functioning has occurred in people with schizophrenia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Public Perception of Climate Change: The Importance of Knowledge and Cultural Worldviews.

PubMed

Shi, Jing; Visschers, Vivianne H M; Siegrist, Michael

2015-12-01

The importance of knowledge for lay people's climate change concerns has been questioned in recent years, as it had been suggested that cultural values are stronger predictors of concern about climate change than knowledge. Studies that simultaneously measured knowledge related to climate change and cultural values have, however, been missing. We conducted a mail survey in the German-speaking part of Switzerland (N = 1,065). Results suggested that cultural worldviews and climate-related knowledge were significantly related with people's concern about climate change. Also, cultural worldviews and climate-relevant knowledge appeared important for people's willingness to change behaviors and to accept climate change policies. In addition, different types of knowledge were found to have different impacts on people's concern about climate change, their willingness to change behaviors, and their acceptance of policies about climate change. Specifically, causal knowledge significantly increased concern about climate change and willingness to support climate-friendly policies. We therefore concluded that risk communication should focus on causal knowledge, provided this knowledge does not threaten cultural values. © 2015 Society for Risk Analysis.

Minimally invasive abdominal surgery: lux et veritas past, present, and future.

PubMed

Harrell, Andrew G; Heniford, B Todd

2005-08-01

Laparoscopic surgery has developed out of multiple technology innovations and the desire to see beyond the confines of the human body. As the instrumentation became more advanced, the application of this technique followed. By revisiting the historical developments that now define laparoscopic surgery, we can possibly foresee its future. A Medline search was performed of all the English-language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Minimally invasive surgery is becoming important in almost every facet of abdominal surgery. Optical improvements, miniaturization, and robotic technology continue to define the frontier of minimally invasive surgery. Endoluminal resection surgery, image-guided surgical navigation, and remotely controlled robotics are not far from becoming reality. These and advances yet to be described will change laparoscopic surgery just as the electric light bulb did over 100 years ago.

Next-to-minimal SOFTSUSY

NASA Astrophysics Data System (ADS)

Allanach, B. C.; Athron, P.; Tunstall, Lewis C.; Voigt, A.; Williams, A. G.

2014-09-01

renormalisation group equations must be consistent with boundary conditions on supersymmetry breaking parameters, as well as on the weak-scale boundary condition on gauge couplings, Yukawa couplings and the Higgs potential parameters. Solution method: Nested iterative algorithm and numerical minimisation of the Higgs potential. Reasons for new version: Major extension to include the next-to-minimal supersymmetric standard model. Summary of revisions: Added additional supersymmetric and supersymmetry breaking parameters associated with the additional gauge singlet. Electroweak symmetry breaking conditions are significantly changed in the next-to-minimal mode, and some sparticle mixing changes. An interface to NMSSMTools has also been included. Some of the object structure has also changed, and the command line interface has been made more user friendly. Restrictions: SOFTSUSY will provide a solution only in the perturbative regime and it assumes that all couplings of the model are real (i.e. CP-conserving). If the parameter point under investigation is non-physical for some reason (for example because the electroweak potential does not have an acceptable minimum), SOFTSUSY returns an error message. Running time: A few seconds per parameter point.

Reach-to-grasp movement as a minimization process.

PubMed

Yang, Fang; Feldman, Anatol G

2010-02-01

It is known that hand transport and grasping are functionally different but spatially coordinated components of reach-to-grasp (RTG) movements. As an extension of this notion, we suggested that body segments involved in RTG movements are controlled as a coherent ensemble by a global minimization process associated with the necessity for the hand to reach the motor goal. Different RTG components emerge following this process without pre-programming. Specifically, the minimization process may result from the tendency of neuromuscular elements to diminish the spatial gap between the actual arm-hand configuration and its virtual (referent) configuration specified by the brain. The referent configuration is specified depending on the object shape, localization, and orientation. Since the minimization process is gradual, it can be interrupted and resumed following mechanical perturbations, at any phase during RTG movements, including hand closure. To test this prediction of the minimization hypothesis, we asked subjects to reach and grasp a cube placed within the reach of the arm. Vision was prevented during movement until the hand returned to its initial position. As predicted, by arresting wrist motion at different points of hand transport in randomly selected trials, it was possible to halt changes in hand aperture at any phase, not only during hand opening but also during hand closure. Aperture changes resumed soon after the wrist was released. Another test of the minimization hypothesis was made in RTG movements to an object placed beyond the reach of the arm. It has previously been shown (Rossi et al. in J Physiol 538:659-671, 2002) that in such movements, the trunk motion begins to contribute to hand transport only after a critical phase when the shifts in the referent arm configuration have finished (at about the time when hand velocity is maximal). The minimization rule suggests that when the virtual contribution of the arm to hand transport is completed

Minimally inconsistent reasoning in Semantic Web.

PubMed

Zhang, Xiaowang

2017-01-01

Reasoning with inconsistencies is an important issue for Semantic Web as imperfect information is unavoidable in real applications. For this, different paraconsistent approaches, due to their capacity to draw as nontrivial conclusions by tolerating inconsistencies, have been proposed to reason with inconsistent description logic knowledge bases. However, existing paraconsistent approaches are often criticized for being too skeptical. To this end, this paper presents a non-monotonic paraconsistent version of description logic reasoning, called minimally inconsistent reasoning, where inconsistencies tolerated in the reasoning are minimized so that more reasonable conclusions can be inferred. Some desirable properties are studied, which shows that the new semantics inherits advantages of both non-monotonic reasoning and paraconsistent reasoning. A complete and sound tableau-based algorithm, called multi-valued tableaux, is developed to capture the minimally inconsistent reasoning. In fact, the tableaux algorithm is designed, as a framework for multi-valued DL, to allow for different underlying paraconsistent semantics, with the mere difference in the clash conditions. Finally, the complexity of minimally inconsistent description logic reasoning is shown on the same level as the (classical) description logic reasoning.

Seasonal species interactions minimize the impact of species turnover on the likelihood of community persistence.

PubMed

Saavedra, Serguei; Rohr, Rudolf P; Fortuna, Miguel A; Selva, Nuria; Bascompte, Jordi

2016-04-01

Many of the observed species interactions embedded in ecological communities are not permanent, but are characterized by temporal changes that are observed along with abiotic and biotic variations. While work has been done describing and quantifying these changes, little is known about their consequences for species coexistence. Here, we investigate the extent to which changes of species composition impact the likelihood of persistence of the predator-prey community in the highly seasonal Białowieza Primeval Forest (northeast Poland), and the extent to which seasonal changes of species interactions (predator diet) modulate the expected impact. This likelihood is estimated extending recent developments on the study of structural stability in ecological communities. We find that the observed species turnover strongly varies the likelihood of community persistence between summer and winter. Importantly, we demonstrate that the observed seasonal interaction changes minimize the variation in the likelihood of persistence associated with species turnover across the year. We find that these community dynamics can be explained as the coupling of individual species to their environment by minimizing both the variation in persistence conditions and the interaction changes between seasons. Our results provide a homeostatic explanation for seasonal species interactions and suggest that monitoring the association of interactions changes with the level of variation in community dynamics can provide a good indicator of the response of species to environmental pressures.

Mutations M287L and Q266I in the Glycine Receptor α1 Subunit Change Sensitivity to Volatile Anesthetics in Oocytes and Neurons, but Not the Minimal Alveolar Concentration in Knockin Mice

PubMed Central

Borghese, Cecilia M.; Xiong, Wei; Oh, S. Irene; Ho, Angel; Mihic, S. John; Zhang, Li; Lovinger, David M.; Homanics, Gregg E.; Eger, Edmond I; Harris, R. Adron

2012-01-01

Background Volatile anesthetics (VAs) alter the function of key central nervous system proteins but it is not clear which, if any, of these targets mediates the immobility produced by VAs in the face of noxious stimulation. A leading candidate is the glycine receptor, a ligand-gated ion channel important for spinal physiology. VAs variously enhance such function, and blockade of spinal GlyRs with strychnine affects the minimal alveolar concentration (an anesthetic EC50) in proportion to the degree of enhancement. Methods We produced single amino acid mutations into the glycine receptorα1 subunit that increased (M287L, third transmembrane region) or decreased (Q266I, second transmembrane region) sensitivity to isoflurane in recombinant receptors, and introduced such receptors into mice. The resulting knockin mice presented impaired glycinergic transmission, but heterozygous animals survived to adulthood, and we determined the effect of isoflurane on glycine-evoked responses of brain stem neurons from the knockin mice, and the minimal alveolar concentration for isoflurane and other VAs in the immature and mature knockin mice. Results Studies of glycine-evoked currents in brain stem neurons from knock-in mice confirmed the changes seen with recombinant receptors. No increases in the minimal alveolar concentration were found in knockin mice, but the minimal alveolar concentration for isoflurane and enflurane (but not halothane) decreased in 2-week-old Q266I mice. This change is opposite to the one expected for a mutation that decreases the sensitivity to volatile anesthetics. Conclusion Taken together, these results indicate that glycine receptors containing the α1 subunit are not likely to be crucial for the action of isoflurane and other VAs. PMID:22885675

Determining the importance of model calibration for forecasting absolute/relative changes in streamflow from LULC and climate changes

USGS Publications Warehouse

Niraula, Rewati; Meixner, Thomas; Norman, Laura M.

2015-01-01

Land use/land cover (LULC) and climate changes are important drivers of change in streamflow. Assessing the impact of LULC and climate changes on streamflow is typically done with a calibrated and validated watershed model. However, there is a debate on the degree of calibration required. The objective of this study was to quantify the variation in estimated relative and absolute changes in streamflow associated with LULC and climate changes with different calibration approaches. The Soil and Water Assessment Tool (SWAT) was applied in an uncalibrated (UC), single outlet calibrated (OC), and spatially-calibrated (SC) mode to compare the relative and absolute changes in streamflow at 14 gaging stations within the Santa Cruz River Watershed in southern Arizona, USA. For this purpose, the effect of 3 LULC, 3 precipitation (P), and 3 temperature (T) scenarios were tested individually. For the validation period, Percent Bias (PBIAS) values were >100% with the UC model for all gages, the values were between 0% and 100% with the OC model and within 20% with the SC model. Changes in streamflow predicted with the UC and OC models were compared with those of the SC model. This approach implicitly assumes that the SC model is “ideal”. Results indicated that the magnitude of both absolute and relative changes in streamflow due to LULC predicted with the UC and OC results were different than those of the SC model. The magnitude of absolute changes predicted with the UC and SC models due to climate change (both P and T) were also significantly different, but were not different for OC and SC models. Results clearly indicated that relative changes due to climate change predicted with the UC and OC were not significantly different than that predicted with the SC models. This result suggests that it is important to calibrate the model spatially to analyze the effect of LULC change but not as important for analyzing the relative change in streamflow due to climate change. This

MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM.

PubMed

Barchi, Leandro Cardoso; Jacob, Carlos Eduardos; Bresciani, Cláudio José Caldas; Yagi, Osmar Kenji; Mucerino, Donato Roberto; Lopasso, Fábio Pinatel; Mester, Marcelo; Ribeiro-Júnior, Ulysses; Dias, André Roncon; Ramos, Marcus Fernando Kodama Pertille; Cecconello, Ivan; Zilberstein, Bruno

2016-01-01

Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. To evaluate and summarize the current status of minimally invasive resection of gastric cancer. A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale. A cirurgia minimamente invasiva amplamente usada para tratar doenças benignas do aparelho digestivo, tornou-se o foco de intenso estudo nos últimos anos no campo da oncologia cirúrgica. Desde então, a experiência com este tipo de abordagem tem crescido, com o objetivo de fornecer os mesmos resultados oncológicos e sobrevivência à cirurgia convencional. Em relação ao câncer gástrico, o tratamento cirúrgico ainda é considerado o único tratamento curativo, considerando a extensão da

Non-minimal gravitational reheating during kination

NASA Astrophysics Data System (ADS)

Dimopoulos, Konstantinos; Markkanen, Tommi

2018-06-01

A new mechanism is presented which can reheat the Universe in non-oscillatory models of inflation, where the inflation period is followed by a period dominated by the kinetic density for the inflaton field (kination). The mechanism considers an auxiliary field non-minimally coupled to gravity. The auxiliary field is a spectator during inflation, rendered heavy by the non-minimal coupling to gravity. During kination however, the non-minimal coupling generates a tachyonic mass, which displaces the field, until its bare mass becomes important, leading to coherent oscillations. Then, the field decays into the radiation bath of the hot big bang. The model is generic and predictive, in that the resulting reheating temperature is a function only of the model parameters (masses and couplings) and not of initial conditions. It is shown that reheating can be very efficient also when considering only the Standard Model.

Sea level change since 2005: importance of salinity

NASA Astrophysics Data System (ADS)

Llovel, W.; Purkey, S.; Meyssignac, B.; Kolodziejczyk, N.; Blazquez, A.; Bamber, J. L.

2017-12-01

Sea level rise is one of the most important consequences of the actual global warming. Global mean sea level has been rising at a faster rate since 1993 (over the satellite altimetry era) than previous decades. This rise is expected to accelerate over the coming decades and century. At global scale, sea level rise is caused by a combination of freshwater increase from land ice melting and land water changes (mass component) and ocean warming (thermal expansion). Estimating the causes is of great interest not only to understand the past sea level changes but also to validate projections based on climate models. In this study, we investigate the global mass contribution to recent sea level changes with an alternative approach by estimating the global ocean freshening. For that purpose, we consider the unprecedented amount of salinity measurements from Argo floats for the past decade (2005-2015). We compare our results to the ocean mass inferred by GRACE data and based on a sea level budget approach. Our results bring new constrains on the global water cycle (ocean freshening) and energy budget (ocean warming) as well as on the global ocean mass directly inferred from GRACE data.

Minimally conscious state or cortically mediated state?

PubMed

Naccache, Lionel

2018-04-01

Durable impairments of consciousness are currently classified in three main neurological categories: comatose state, vegetative state (also recently coined unresponsive wakefulness syndrome) and minimally conscious state. While the introduction of minimally conscious state, in 2002, was a major progress to help clinicians recognize complex non-reflexive behaviours in the absence of functional communication, it raises several problems. The most important issue related to minimally conscious state lies in its criteria: while behavioural definition of minimally conscious state lacks any direct evidence of patient's conscious content or conscious state, it includes the adjective 'conscious'. I discuss this major problem in this review and propose a novel interpretation of minimally conscious state: its criteria do not inform us about the potential residual consciousness of patients, but they do inform us with certainty about the presence of a cortically mediated state. Based on this constructive criticism review, I suggest three proposals aiming at improving the way we describe the subjective and cognitive state of non-communicating patients. In particular, I present a tentative new classification of impairments of consciousness that combines behavioural evidence with functional brain imaging data, in order to probe directly and univocally residual conscious processes.

Minimally inconsistent reasoning in Semantic Web

PubMed Central

Zhang, Xiaowang

2017-01-01

Reasoning with inconsistencies is an important issue for Semantic Web as imperfect information is unavoidable in real applications. For this, different paraconsistent approaches, due to their capacity to draw as nontrivial conclusions by tolerating inconsistencies, have been proposed to reason with inconsistent description logic knowledge bases. However, existing paraconsistent approaches are often criticized for being too skeptical. To this end, this paper presents a non-monotonic paraconsistent version of description logic reasoning, called minimally inconsistent reasoning, where inconsistencies tolerated in the reasoning are minimized so that more reasonable conclusions can be inferred. Some desirable properties are studied, which shows that the new semantics inherits advantages of both non-monotonic reasoning and paraconsistent reasoning. A complete and sound tableau-based algorithm, called multi-valued tableaux, is developed to capture the minimally inconsistent reasoning. In fact, the tableaux algorithm is designed, as a framework for multi-valued DL, to allow for different underlying paraconsistent semantics, with the mere difference in the clash conditions. Finally, the complexity of minimally inconsistent description logic reasoning is shown on the same level as the (classical) description logic reasoning. PMID:28750030

PUBLISHER'S ANNOUNCEMENT: Important changes for 2008

NASA Astrophysics Data System (ADS)

2008-01-01

This issue, the first of 2008, sees a new innovation for Journal of Physics G: Nuclear and Particle Physics (J. Phys. G). J. Phys. G has moved from page numbering to an article numbering system, which offers important advantages to our authors. It increases flexibility and speeds up the publication process as papers in different issues or subject sections can now be published online as soon as they are ready, without having to wait for a whole issue or section to be allocated page numbers. The bibliographic citation style will therefore change for articles published from now on. Articles should be referenced using the six-digit article number in place of a page number. Please note that this number must include any leading zeros. For example: Smith J et al 2008 J. Phys. G: Nucl. Part. Phys. 35 015045 If you have any questions or comments about our new scheme, please contact us at http://jphysg@iop.org J. Phys. G Publishing Team

Minimal-change disease in adolescents and adults: epidemiology and therapeutic response

PubMed Central

Keskar, Vaibhav; Jamale, Tukaram Ekanath; Kulkarni, Manjunath Jeevanna; Kiggal Jagadish, Pradeep; Fernandes, Gwendolyn; Hase, Niwrutti

2013-01-01

Background Epidemiology of minimal-change disease (MCD) in adults differs from that in children and is not studied well in Indian population. Methods We retrospectively studied the records of 61 adult patients with MCD to assess clinical, laboratory and histopathological features, and to evaluate the response to treatment, course and complications of the disease and therapy. Results The male to female ratio was 1.17:1. Mean age was 30.46 years. Of the total, 6.55% had hypertension; 13.11% had microhaematuria. After initial treatment with steroids, 68.85% had complete remission (CR) and 13.1% had partial remission (PR). Twelve of 14 (85.71%) steroid-resistant cases had CR or PR after alternative immunosuppression with cyclophosphamide, or mycophenolate mofetil. Of all patients, 44.2% had at least one relapse; 8.19% were frequently relapsing and 26.22% were steroid dependent. After a mean follow-up of 149.9 weeks, 38 (61.29%) patients were in CR and 16 (26.22%) in PR with a mean proteinuria of 1.28 g/day, 3 being treated for relapse. Mean serum creatinine was 89.28 μmol/L (1.01 mg/dL). Fourteen (22.95%) had acute kidney injury (AKI). All but two recovered completely. Conclusions This single-centre study with a medium-term follow-up shows that majority of patients respond to steroids or alternative immunosuppressants. AKI is common and may not be completely reversible in some cases. PMID:26064510

Importance of coastal change variables in determining vulnerability to sea- and lake-level change

USGS Publications Warehouse

Pendleton, E.A.; Thieler, E.R.; Williams, S.J.

2010-01-01

In 2001, the U.S. Geological Survey began conducting scientific assessments of coastal vulnerability to potential future sea- and lake-level changes in 22 National Park Service sea- and lakeshore units. Coastal park units chosen for the assessment included a variety of geological and physical settings along the U.S. Atlantic, Pacific, Gulf of Mexico, Gulf of Alaska, Caribbean, and Great Lakes shorelines. This research is motivated by the need to understand and anticipate coastal changes caused by accelerating sea-level rise, as well as lake-level changes caused by climate change, over the next century. The goal of these assessments is to provide information that can be used to make long-term (decade to century) management decisions. Here we analyze the results of coastal vulnerability assessments for several coastal national park units. Index-based assessments quantify the likelihood that physical changes may occur based on analysis of the following variables: tidal range, ice cover, wave height, coastal slope, historical shoreline change rate, geomorphology, and historical rate of relative sea- or lake-level change. This approach seeks to combine a coastal system's susceptibility to change with its natural ability to adapt to changing environmental conditions, and it provides a measure of the system's potential vulnerability to the effects of sea- or lake-level change. Assessments for 22 park units are combined to evaluate relationships among the variables used to derive the index. Results indicate that Atlantic and Gulf of Mexico parks have the highest vulnerability rankings relative to other park regions. A principal component analysis reveals that 99% of the index variability can be explained by four variables: geomorphology, regional coastal slope, water-level change rate, and mean significant wave height. Tidal range, ice cover, and historical shoreline change are not as important when the index is evaluated at large spatial scales (thousands of kilometers

The minimal clinically important difference of the control of allergic rhinitis and asthma test (CARAT): cross-cultural validation and relation with pollen counts

PubMed Central

van der Leeuw, Sander; van der Molen, Thys; Dekhuijzen, PN Richard; Fonseca, Joao A; van Gemert, Frederik A; Gerth van Wijk, Roy; Kocks, Janwillem WH; Oosterom, Helma; Riemersma, Roland A; Tsiligianni, Ioanna G; de Weger, Letty A; Oude Elberink, Joanne NG; Flokstra-de Blok, Bertine MJ

2015-01-01

Background: The Control of Allergic Rhinitis and Asthma Test (CARAT) monitors control of asthma and allergic rhinitis. Aims: To determine the CARAT’s minimal clinically important difference (MCID) and to evaluate the psychometric properties of the Dutch CARAT. Methods: CARAT was applied in three measurements at 1-month intervals. Patients diagnosed with asthma and/or rhinitis were approached. MCID was evaluated using Global Rating of Change (GRC) and standard error of measurement (s.e.m.). Cronbach’s alpha was used to evaluate internal consistency. Spearman’s correlation coefficients were calculated between CARAT, the Asthma Control Questionnaire (ACQ5) and the Visual Analog Scale (VAS) on airway symptoms to determine construct and longitudinal validity. Test–retest reliability was evaluated with intra-class correlation coefficient (ICC). Changes in pollen counts were compared with delta CARAT and ACQ5 scores. Results: A total of 92 patients were included. The MCID of the CARAT was 3.50 based on GRC scores; the s.e.m. was 2.83. Cronbach’s alpha was 0.82. Correlation coefficients between CARAT and ACQ5 and VAS questions ranged from 0.64 to 0.76 (P<0.01). Longitudinally, correlation coefficients between delta CARAT scores and delta ACQ5 and VAS scores ranged from 0.41 to 0.67 (P<0.01). Test–retest reliability showed an ICC of 0.81 (P<0.01) and 0.80 (P<0.01). Correlations with pollen counts were higher for CARAT than for ACQ5. Conclusions: This is the first investigation of the MCID of the CARAT. The CARAT uses a whole-point scale, which suggests that the MCID is 4 points. The CARAT is a valid and reliable tool that is also applicable in the Dutch population. PMID:25569880

Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

PubMed Central

de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.; Dyer, Paul S.; Frisvad, Jens Christian; Geiser, David; Gräser, Yvonne; Guarro, Josep; Haase, Gerhard; Kwon-Chung, Kyung-Joo; Meyer, Wieland; Pitt, John I.; Samson, Robert A.; Tintelnot, Kathrin; Vitale, Roxana G.; Walsh, Thomas J.

2014-01-01

Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability. PMID:25297326

Reliability, validity, and minimal detectable change of the push-off test scores in assessing upper extremity weight-bearing ability.

PubMed

Mehta, Saurabh P; George, Hannah R; Goering, Christian A; Shafer, Danielle R; Koester, Alan; Novotny, Steven

2017-11-01

Clinical measurement study. The push-off test (POT) was recently conceived and found to be reliable and valid for assessing weight bearing through injured wrist or elbow. However, further research with larger sample can lend credence to the preliminary findings supporting the use of the POT. This study examined the interrater reliability, construct validity, and measurement error for the POT in patients with wrist conditions. Participants with musculoskeletal (MSK) wrist conditions were recruited. The performance on the POT, grip isometric strength of wrist extensors was assessed. The shortened version of the Disabilities of the Arm, Shoulder and Hand and numeric pain rating scale were completed. The intraclass correlation coefficient assessed interrater reliability of the POT. Pearson correlation coefficients (r) examined the concurrent relationships between the POT and other measures. The standard error of measurement and the minimal detectable change at 90% confidence interval were assessed as measurement error and index of true change for the POT. A total of 50 participants with different elbow or wrist conditions (age: 48.1 ± 16.6 years) were included in this study. The results of this study strongly supported the interrater reliability (intraclass correlation coefficient: 0.96 and 0.93 for the affected and unaffected sides, respectively) of the POT in patients with wrist MSK conditions. The POT showed convergent relationships with the grip strength on the injured side (r = 0.89) and the wrist extensor strength (r = 0.7). The POT showed smaller standard error of measurement (1.9 kg). The minimal detectable change at 90% confidence interval for the POT was 4.4 kg for the sample. This study provides additional evidence to support the reliability and validity of the POT. This is the first study that provides the values for the measurement error and true change on the POT scores in patients with wrist MSK conditions. Further research should examine the

Validity, cut-points, and minimally important differences for two hot flash-related daily interference scales.

PubMed

Carpenter, Janet S; Bakoyannis, Giorgos; Otte, Julie L; Chen, Chen X; Rand, Kevin L; Woods, Nancy; Newton, Katherine; Joffe, Hadine; Manson, JoAnn E; Freeman, Ellen W; Guthrie, Katherine A

2017-08-01

To conduct psychometric analyses to condense the Hot Flash-Related Daily Interference Scale (HFRDIS) into a shorter form termed the Hot Flash Interference (HFI) scale; evaluate cut-points for both scales; and establish minimally important differences (MIDs) for both scales. We analyzed baseline and postrandomization patient-reported data pooled across three randomized trials aimed at reducing vasomotor symptoms (VMS) in 899 midlife women. Trials were conducted across five MsFLASH clinical sites between July 2009 and October 2012. We eliminated HFRDIS items based on experts' content validity ratings and confirmatory factor analysis, and evaluated cut-points and established MIDs by mapping HFRDIS and HFI to other measures. The three-item HFI (interference with sleep, mood, and concentration) demonstrated strong internal consistency (alphas of 0.830 and 0.856), showed good fit to the unidimensional "hot flash interference factor," and strong convergent validity with HFRDIS scores, diary VMS, and menopausal quality of life. For both scales, cut-points of mild (0-3.9), moderate (4-6.9), and severe (7-10) interference were associated with increasing diary VMS ratings, sleep, and anxiety. The average MID was 1.66 for the HFRDIS and 2.34 for the HFI. The HFI is a brief assessment of VMS interference and will be useful in busy clinics to standardize VMS assessment or in research studies where response burden may be an issue. The scale cut-points and MIDs should prove useful in targeting those most in need of treatment, monitoring treatment response, and interpreting existing and future research findings.

The minimal scenario of leptogenesis

NASA Astrophysics Data System (ADS)

Blanchet, Steve; Di Bari, Pasquale

2012-12-01

We review the main features and results of thermal leptogenesis within the type I seesaw mechanism, the minimal extension of the Standard Model explaining neutrino masses and mixing. After presenting the simplest approach, the vanilla scenario, we discuss various important developments of recent years, such as the inclusion of lepton and heavy neutrino flavour effects, a description beyond a hierarchical heavy neutrino mass spectrum and an improved kinetic description within the density matrix and the closed-time-path formalisms. We also discuss how leptogenesis can ultimately represent an important phenomenological tool to test the seesaw mechanism and the underlying model of new physics.

Importance of sexuality in colorectal cancer: predictors, changes, and response to an intimacy enhancement intervention.

PubMed

Reese, Jennifer Barsky; Haythornthwaite, Jennifer A

2016-10-01

The primary objectives were (1) to examine the importance of sexuality within the self-view and cross-sectional correlates for 120 colorectal cancer patients and (2) to determine whether the importance of sexuality changed for 46 colorectal cancer patients and partners participating in an intimacy enhancement intervention. Two newly developed items assessed importance of sexuality within the self-view (1) currently and (2) before cancer; a calculated change score assessed perceived change. In the cross-sectional sample, associations between importance of sexuality and demographic and medical factors and sexual function status were examined. Intervention participants' importance ratings before and after participation were used to calculate effect sizes. For patients, importance of sexuality before cancer was greater (M = 65.7) than current importance (M = 56.8, p = .001). Greater current importance of sexuality was associated with partnered status, non-metastatic disease, and not being in treatment. Scoring in the sexually functional range was associated with greater current importance of sexuality for men and a smaller perceived change in importance for both men and women (p values <.05). Sexual function status also significantly predicted current importance independent of covariates. Small to medium effect sizes for intervention patients (.37) and partners (.60) were found for increases in importance of sexuality. Items showed evidence of test-retest reliability and construct validity. Coping with sexual concerns is important to those affected by colorectal cancer. Findings suggest that the importance of sexuality can decrease through colorectal cancer and associated sexual problems and can increase through participating in an intimacy-focused intervention.

[Expression of glomerular heparan sulfate domains in pediatric patients with minimal change nephrotic syndrome].

PubMed

Dong, Li-Qun; Wang, Zheng; Yu, Ping; Guo, Yan-Nan; Wu, Jin; Feng, Shi-Pin; Li, Sha

2009-01-01

To investigate the expression of glomerular heparin sulfate (HS) in paediatric patients with minimal change nephritic syndrome (MCNS). The kidyney tissues were collected by biopsy from 13 paediatric patients with MCNS, while 5 normal renal biopsy samples were used as control. HS in glomeruli was analysed by indirect immunofluorescence staining using four different monoclonal antibodies, Hepss1, 3G10, JM403 and 10E4, which all recognize distinct HS species and each interacts with a specific HS domain. The concentrations of urine heparan sulfate also were measured by enzyme-linked immunosorbent assay (Elisa). Expression of HS fine domains was aberrant in paediatric patients compared with control subjects. Children with MCNS in replase showed a decreased glomerular expression of 10E4, JM403 and Hepss1 (P < 0.05). The level of urinary HS was significantly increased in peadiatric patients with MCNS when compared with that in control subjects (P < 0.01). These results suggest that loss of heparan sulphate in renal tissue may play a role in the pathogenesis of MCNS proteinuria.

Designing a Minimal Intervention Strategy to Control Taenia solium.

PubMed

Lightowlers, Marshall W; Donadeu, Meritxell

2017-06-01

Neurocysticercosis is an important cause of epilepsy in many developing countries. The disease is a zoonosis caused by the cestode parasite Taenia solium. Many potential intervention strategies are available, however none has been able to be implemented and sustained. Here we predict the impact of some T. solium interventions that could be applied to prevent transmission through pigs, the parasite's natural animal intermediate host. These include minimal intervention strategies that are predicted to be effective and likely to be feasible. Logical models are presented which reflect changes in the risk that age cohorts of animals have for their potential to transmit T. solium. Interventions that include a combined application of vaccination, plus chemotherapy in young animals, are the most effective. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

A Qualitative Study on Perceptions of Changes Reported by Caregivers of Patients in Vegetative State and Minimally Conscious State: The “Time Gap Experience”

PubMed Central

Leonardi, Matilde; Sattin, Davide; Giovannetti, Ambra Mara

2014-01-01

Objective. Our purpose was to provide a comprehensive understanding of how women informal caregivers of patients in vegetative state (VS) or minimally conscious state (MCS) describe, represent, and experience changes that occurred in their life after the acute event of their family member. Methods. A qualitative study was conducted and fifteen women informal caregivers, mothers, or spouses of patients in VS or MCS were interviewed. Results. Caregivers' narratives revealed (1) important personal and interpersonal changes and (2) difficulties while facing the complex situation and integrating past, present, and future, defined as a “time gap experience.” This difficulty is expressed in two ways. First, the reduction of variety of roles into one, caregiver's role. Second, the relationship with the relative is characterised by fluctuation in the relational style between caregiver and relative; it shifts from an adult to adult interaction to an adult to child one. Another fluctuation can be observed in the mixed use of present and past tenses when caregivers speak about their relatives. Conclusions. Caregiving cause pervasive modifications in one's life. Targeted interventions aiming to empower the caregivers, to support them after the acute event in caregiving activities together with patient-focused interventions, and to promote their health should be implemented. PMID:25431794

The role of biogeochemical hotspots, landscape heterogeneity, and hydrological connectivity for minimizing forestry effects on water quality.

PubMed

Laudon, Hjalmar; Kuglerová, Lenka; Sponseller, Ryan A; Futter, Martyn; Nordin, Annika; Bishop, Kevin; Lundmark, Tomas; Egnell, Gustaf; Ågren, Anneli M

2016-02-01

Protecting water quality in forested regions is increasingly important as pressures from land-use, long-range transport of air pollutants, and climate change intensify. Maintaining forest industry without jeopardizing sustainability of surface water quality therefore requires new tools and approaches. Here, we show how forest management can be optimized by incorporating landscape sensitivity and hydrological connectivity into a framework that promotes the protection of water quality. We discuss how this approach can be operationalized into a hydromapping tool to support forestry operations that minimize water quality impacts. We specifically focus on how hydromapping can be used to support three fundamental aspects of land management planning including how to (i) locate areas where different forestry practices can be conducted with minimal water quality impact; (ii) guide the off-road driving of forestry machines to minimize soil damage; and (iii) optimize the design of riparian buffer zones. While this work has a boreal perspective, these concepts and approaches have broad-scale applicability.

Dendrin expression in glomerulogenesis and in human minimal change nephrotic syndrome.

PubMed

Dunér, Fredrik; Patrakka, Jaakko; Xiao, Zhijie; Larsson, Jenny; Vlamis-Gardikas, Alexios; Pettersson, Erna; Tryggvason, Karl; Hultenby, Kjell; Wernerson, Annika

2008-08-01

Dendrin is an 81-kD cytosolic protein hitherto described in the brain, where it is associated with the actin cytoskeleton. Recently, we found dendrin in foot processes of mouse glomerular podocytes. Here we describe its expression both during mouse glomerulogenesis and in the normal and diseased human kidney for the first time. Dendrin expression was characterized using RT-PCR and immunohistochemistry and semi-quantified using immunoelectron microscopy. In glomerulogenesis, dendrin mRNA and protein appeared first at the early capillary loop stage. It was concentrated to the pre-podocytes on the basal side of podocalyxin, an apical cell membrane marker. In human tissue, dendrin transcripts were detected in the brain and kidney. In the mature kidney dendrin localized solely in the podocytes, close to the filtration slit diaphragms. A comparison with the slit-associated protein zonula occludens-1 (ZO-1) was done in minimal change nephrotic syndrome (MCNS). Dendrin and ZO-1 were re-distributed from slit regions to the podocyte cytoplasm in areas with foot process effacement (FPE). In areas without FPE, dendrin and ZO-1 distributions were unchanged compared to controls. The total amounts of dendrin or ZO-1 markers were unchanged. This differs from nephrin that, according to our previous results, is also decreased in non-effaced areas. The expression of dendrin during glomerulogenesis and in the normal human kidney is similar to that previously shown for nephrin, which suggests that dendrin associates with the slit diaphragm complex. In MCNS patients, dendrin and ZO-1 are re-distributed within the podocytes. Whether this is a cause or a consequence of FPE remains unclear.

Comparative differential proteomic analysis of minimal change disease and focal segmental glomerulosclerosis.

PubMed

Pérez, Vanessa; López, Dolores; Boixadera, Ester; Ibernón, Meritxell; Espinal, Anna; Bonet, Josep; Romero, Ramón

2017-02-03

Minimal change disease (MCD) and primary focal segmental glomerulosclerosis (FSGS) are glomerular diseases characterized by nephrotic syndrome. Their diagnosis requires a renal biopsy, but it is an invasive procedure with potential complications. In a small biopsy sample, where only normal glomeruli are observed, FSGS cannot be differentiated from MCD. The correct diagnosis is crucial to an effective treatment, as MCD is normally responsive to steroid therapy, whereas FSGS is usually resistant. The purpose of our study was to discover and validate novel early urinary biomarkers capable to differentiate between MCD and FSGS. Forty-nine patients biopsy-diagnosed of MCD and primary FSGS were randomly subdivided into a training set (10 MCD, 11 FSGS) and a validation set (14 MCD, 14 FSGS). The urinary proteome of the training set was analyzed by two-dimensional differential gel electrophoresis coupled with mass spectrometry. The proteins identified were quantified by enzyme-linked immunosorbent assay in urine samples from the validation set. Urinary concentration of alpha-1 antitrypsin, transferrin, histatin-3 and 39S ribosomal protein L17 was decreased and calretinin was increased in FSGS compared to MCD. These proteins were used to build a decision tree capable to predict patient's pathology. This preliminary study suggests a group of urinary proteins as possible non-invasive biomarkers with potential value in the differential diagnosis of MCD and FSGS. These biomarkers would reduce the number of misdiagnoses, avoiding unnecessary or inadequate treatments.

Esophagectomy - minimally invasive

MedlinePlus

Minimally invasive esophagectomy; Robotic esophagectomy; Removal of the esophagus - minimally invasive; Achalasia - esophagectomy; Barrett esophagus - esophagectomy; Esophageal cancer - esophagectomy - laparoscopic; Cancer of the ...

Scaphoid tuberosity excursion is minimized during a dart-throwing motion: A biomechanical study.

PubMed

Werner, Frederick W; Sutton, Levi G; Basu, Niladri; Short, Walter H; Moritomo, Hisao; St-Amand, Hugo

2016-01-01

The purpose of this study was to determine whether the excursion of the scaphoid tuberosity and therefore scaphoid motion is minimized during a dart-throwing motion. Scaphoid tuberosity excursion was studied as an indicator of scaphoid motion in 29 cadaver wrists as they were moved through wrist flexion-extension, radioulnar deviation, and a dart-throwing motion. Study results demonstrate that excursion was significantly less during the dart-throwing motion than during either wrist flexion-extension or radioulnar deviation. If the goal of early wrist motion after carpal ligament or distal radius injury and reconstruction is to minimize loading of the healing structures, a wrist motion in which scaphoid motion is minimal should reduce length changes in associated ligamentous structures. Therefore, during rehabilitation, if a patient uses a dart-throwing motion that minimizes his or her scaphoid tuberosity excursion, there should be minimal changes in ligament loading while still allowing wrist motion. Bench research, biomechanics, and cross-sectional. Not applicable. The study was laboratory based. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Using silviculture to minimize gypsy moth impacts

Treesearch

Kurt W. Gottschalk

1991-01-01

Several studies are underway to test and evaluate the use of silvicultural treatments to minimize gypsy moth impacts. Treatment objectives are to change stand susceptibility to gypsy moth defoliation or stand vulnerability to damage after defoliation. Decision charts have been developed to help forest and land managers to select the appropriate treatment for their...

Minimizing cross-cultural maladaptation: How minority status facilitates change in international acculturation.

PubMed

Volpone, Sabrina D; Marquardt, Dennis J; Casper, Wendy J; Avery, Derek R

2018-03-01

Culturally savvy organizations recognize that selecting and developing people who can be effective in a global workforce is important in today's business environment. Nevertheless, many companies struggle to identify and develop talent who are happy and successful working and living outside their home country. We examine 1 factor that may foster success in a host country-minority status in 1's home country-as a predictor of change in acculturation over time. Specifically, we draw on the conservation of resources model to suggest that international students who have been a member of more minority groups in their home country have unique experiences working with dissimilar others that offer advantages when acculturating to new cultures and novel situations. Then, change in host country acculturation is explored as a mechanism to explain how minority status in the home country relates to intentions to leave the host country and psychological well-being 6 months after entry. Two moderators (cultural intelligence, perceived diversity climate of the host institution) of these relationships are also examined. Results revealed that the relationship between minority status in the home country and change in host country acculturation was positive and stronger for those with higher cultural intelligence. Further, the relationship between change in host country acculturation and psychological well-being was positive when perceived diversity climate of the host institution was high, but was not significant when perceived diversity climate was low. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Correlates of minimal dating.

PubMed

Leck, Kira

2006-10-01

Researchers have associated minimal dating with numerous factors. The present author tested shyness, introversion, physical attractiveness, performance evaluation, anxiety, social skill, social self-esteem, and loneliness to determine the nature of their relationships with 2 measures of self-reported minimal dating in a sample of 175 college students. For women, shyness, introversion, physical attractiveness, self-rated anxiety, social self-esteem, and loneliness correlated with 1 or both measures of minimal dating. For men, physical attractiveness, observer-rated social skill, social self-esteem, and loneliness correlated with 1 or both measures of minimal dating. The patterns of relationships were not identical for the 2 indicators of minimal dating, indicating the possibility that minimal dating is not a single construct as researchers previously believed. The present author discussed implications and suggestions for future researchers.

Graph cuts via l1 norm minimization.

PubMed

Bhusnurmath, Arvind; Taylor, Camillo J

2008-10-01

Graph cuts have become an increasingly important tool for solving a number of energy minimization problems in computer vision and other fields. In this paper, the graph cut problem is reformulated as an unconstrained l1 norm minimization that can be solved effectively using interior point methods. This reformulation exposes connections between the graph cuts and other related continuous optimization problems. Eventually the problem is reduced to solving a sequence of sparse linear systems involving the Laplacian of the underlying graph. The proposed procedure exploits the structure of these linear systems in a manner that is easily amenable to parallel implementations. Experimental results obtained by applying the procedure to graphs derived from image processing problems are provided.

Principle of minimal work fluctuations.

PubMed

Xiao, Gaoyang; Gong, Jiangbin

2015-08-01

Understanding and manipulating work fluctuations in microscale and nanoscale systems are of both fundamental and practical interest. For example, in considering the Jarzynski equality 〈e-βW〉=e-βΔF, a change in the fluctuations of e-βW may impact how rapidly the statistical average of e-βW converges towards the theoretical value e-βΔF, where W is the work, β is the inverse temperature, and ΔF is the free energy difference between two equilibrium states. Motivated by our previous study aiming at the suppression of work fluctuations, here we obtain a principle of minimal work fluctuations. In brief, adiabatic processes as treated in quantum and classical adiabatic theorems yield the minimal fluctuations in e-βW. In the quantum domain, if a system initially prepared at thermal equilibrium is subjected to a work protocol but isolated from a bath during the time evolution, then a quantum adiabatic process without energy level crossing (or an assisted adiabatic process reaching the same final states as in a conventional adiabatic process) yields the minimal fluctuations in e-βW, where W is the quantum work defined by two energy measurements at the beginning and at the end of the process. In the classical domain where the classical work protocol is realizable by an adiabatic process, then the classical adiabatic process also yields the minimal fluctuations in e-βW. Numerical experiments based on a Landau-Zener process confirm our theory in the quantum domain, and our theory in the classical domain explains our previous numerical findings regarding the suppression of classical work fluctuations [G. Y. Xiao and J. B. Gong, Phys. Rev. E 90, 052132 (2014)].

Neurophysiological model of tinnitus: dependence of the minimal masking level on treatment outcome.

PubMed

Jastreboff, P J; Hazell, J W; Graham, R L

1994-11-01

Validity of the neurophysiological model of tinnitus (Jastreboff, 1990), outlined in this paper, was tested on data from multicenter trial of tinnitus masking (Hazell et al., 1985). Minimal masking level, intensity match of tinnitus, and the threshold of hearing have been evaluated on a total of 382 patients before and after 6 months of treatment with maskers, hearing aids, or combination devices. The data has been divided into categories depending on treatment outcome and type of approach used. Results of analysis revealed that: i) the psychoacoustical description of tinnitus does not possess a predictive value for the outcome of the treatment; ii) minimal masking level changed significantly depending on the treatment outcome, decreasing on average by 5.3 dB in patients reporting improvement, and increasing by 4.9 dB in those whose tinnitus remained the same or worsened; iii) 73.9% of patients reporting improvement had their minimal masking level decreased as compared with 50.5% for patients not showing improvement, which is at the level of random change; iv) the type of device used has no significant impact on the treatment outcome and minimal masking level change; v) intensity match and threshold of hearing did not exhibit any significant changes which can be related to treatment outcome. These results are fully consistent with the neurophysiological interpretation of mechanisms involved in the phenomenon of tinnitus and its alleviation.

The reliability, minimal detectable change and concurrent validity of a gravity-based bubble inclinometer and iphone application for measuring standing lumbar lordosis.

PubMed

Salamh, Paul A; Kolber, Morey

2014-01-01

To investigate the reliability, minimal detectable change (MDC90) and concurrent validity of a gravity-based bubble inclinometer (inclinometer) and iPhone® application for measuring standing lumbar lordosis. Two investigators used both an inclinometer and an iPhone® with an inclinometer application to measure lumbar lordosis of 30 asymptomatic participants. ICC models 3,k and 2,k were used for the intrarater and interrater analysis, respectively. Good interrater and intrarater reliability was present for the inclinometer with Intraclass Correlation Coefficients (ICC) of 0.90 and 0.85, respectively and the iPhone® application with ICC values of 0.96 and 0.81. The minimal detectable change (MDC90) indicates that a change greater than or equal to 7° and 6° is needed to exceed the threshold of error using the iPhone® and inclinometer, respectively. The concurrent validity between the two instruments was good with a Pearson product-moment coefficient of correlation (r) of 0.86 for both raters. Ninety-five percent limits of agreement identified differences ranging from 9° greater in regards to the iPhone® to 8° less regarding the inclinometer. Both the inclinometer and iPhone® application possess good interrater reliability, intrarater reliability and concurrent validity for measuring standing lumbar lordosis. This investigation provides preliminary evidence to suggest that smart phone applications may offer clinical utility comparable to inclinometry for quantifying standing lumbar lordosis. Clinicians should recognize potential individual differences when using these devices interchangeably.

Backbone dynamics and global effects of an activating mutation in minimized Mtu RecA inteins.

PubMed

Du, Zhenming; Liu, Yangzhong; Ban, David; Lopez, Maria M; Belfort, Marlene; Wang, Chunyu

2010-07-23

Inteins mediate protein splicing, which has found many applications in biotechnology and protein engineering. A single valine-to-leucine mutation (V67L) can globally enhance splicing and related cleavage reactions in minimized Mycobacterium tuberculosis RecA inteins. However, V67L mutation causes little change in crystal structures. To test whether protein dynamics contribute to activity enhancement in the V67L mutation, we have studied the conformations and dynamics of the minimized and engineered intein DeltaDeltaIhh-V67CM and a single V67L mutant, DeltaDeltaIhh-L67CM, by solution NMR. Chemical shift perturbations established that the V67L mutation causes global changes, including changes at the N-terminus and C-terminus of the intein, which are active sites for protein splicing. The single V67L mutation significantly slows hydrogen-exchange rates globally, indicating a shift to more stable conformations and reduction in ensemble distribution. Whereas the V67L mutation causes little change for motions on the picosecond-to-nanosecond timescale, motions on the microsecond-to-millisecond timescale affect a region involving the conserved F-block histidine and C-terminal asparagine, which are residues important for C-terminal cleavage. The V67L mutation is proposed to activate splicing by reducing the ensemble distribution of the intein structure and by modifying the active sites. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Increasingly minimal bias routing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bataineh, Abdulla; Court, Thomas; Roweth, Duncan

2017-02-21

A system and algorithm configured to generate diversity at the traffic source so that packets are uniformly distributed over all of the available paths, but to increase the likelihood of taking a minimal path with each hop the packet takes. This is achieved by configuring routing biases so as to prefer non-minimal paths at the injection point, but increasingly prefer minimal paths as the packet proceeds, referred to herein as Increasing Minimal Bias (IMB).

How issue frames shape beliefs about the importance of climate change policy across ideological and partisan groups

PubMed Central

2017-01-01

We use an experiment to examine whether the way in which climate change is framed affects individuals’ beliefs about its importance as a policy issue. We employ frames that emphasize national security, human rights, and environmental importance about the consequences of climate change. We find no evidence that issue frames have an overall effect on opinions about the importance of climate change policy. We do find some evidence that the effect of issue frames varies across ideological and partisan groups. Most notably, issue frames can lead Republicans and those on the political right to view climate change policy as less important. We conclude by discussing our findings relative to extant literature and considering the implications of our findings for those who seek to address the issue of climate change. PMID:28727842

How issue frames shape beliefs about the importance of climate change policy across ideological and partisan groups.

PubMed

Singh, Shane P; Swanson, Meili

2017-01-01

We use an experiment to examine whether the way in which climate change is framed affects individuals' beliefs about its importance as a policy issue. We employ frames that emphasize national security, human rights, and environmental importance about the consequences of climate change. We find no evidence that issue frames have an overall effect on opinions about the importance of climate change policy. We do find some evidence that the effect of issue frames varies across ideological and partisan groups. Most notably, issue frames can lead Republicans and those on the political right to view climate change policy as less important. We conclude by discussing our findings relative to extant literature and considering the implications of our findings for those who seek to address the issue of climate change.

Global environmental change effects on ecosystems: the importance of land-use legacies.

PubMed

Perring, Michael P; De Frenne, Pieter; Baeten, Lander; Maes, Sybryn L; Depauw, Leen; Blondeel, Haben; Carón, María M; Verheyen, Kris

2016-04-01

One of the major challenges in ecology is to predict how multiple global environmental changes will affect future ecosystem patterns (e.g. plant community composition) and processes (e.g. nutrient cycling). Here, we highlight arguments for the necessary inclusion of land-use legacies in this endeavour. Alterations in resources and conditions engendered by previous land use, together with influences on plant community processes such as dispersal, selection, drift and speciation, have steered communities and ecosystem functions onto trajectories of change. These trajectories may be modulated by contemporary environmental changes such as climate warming and nitrogen deposition. We performed a literature review which suggests that these potential interactions have rarely been investigated. This crucial oversight is potentially due to an assumption that knowledge of the contemporary state allows accurate projection into the future. Lessons from other complex dynamic systems, and the recent recognition of the importance of previous conditions in explaining contemporary and future ecosystem properties, demand the testing of this assumption. Vegetation resurvey databases across gradients of land use and environmental change, complemented by rigorous experiments, offer a means to test for interactions between land-use legacies and multiple environmental changes. Implementing these tests in the context of a trait-based framework will allow biologists to synthesize compositional and functional ecosystem responses. This will further our understanding of the importance of land-use legacies in determining future ecosystem properties, and soundly inform conservation and restoration management actions. © 2015 John Wiley & Sons Ltd.

Change in Moral Outlook Is an Important Topic of Environmental Education

ERIC Educational Resources Information Center

Suohua, Li

2004-01-01

It is a common recognition that humankind is facing an ecological environmental crisis. In order to protect the ecological system, to protect nature and thus to safeguard the continued existence of humankind, not only technological, economic, and managerial measures are needed, but more importantly, a change must take place in people's thinking so…

Bacterial Stressors in Minimally Processed Food

PubMed Central

Capozzi, Vittorio; Fiocco, Daniela; Amodio, Maria Luisa; Gallone, Anna; Spano, Giuseppe

2009-01-01

Stress responses are of particular importance to microorganisms, because their habitats are subjected to continual changes in temperature, osmotic pressure, and nutrients availability. Stressors (and stress factors), may be of chemical, physical, or biological nature. While stress to microorganisms is frequently caused by the surrounding environment, the growth of microbial cells on its own may also result in induction of some kinds of stress such as starvation and acidity. During production of fresh-cut produce, cumulative mild processing steps are employed, to control the growth of microorganisms. Pathogens on plant surfaces are already stressed and stress may be increased during the multiple mild processing steps, potentially leading to very hardy bacteria geared towards enhanced survival. Cross-protection can occur because the overlapping stress responses enable bacteria exposed to one stress to become resistant to another stress. A number of stresses have been shown to induce cross protection, including heat, cold, acid and osmotic stress. Among other factors, adaptation to heat stress appears to provide bacterial cells with more pronounced cross protection against several other stresses. Understanding how pathogens sense and respond to mild stresses is essential in order to design safe and effective minimal processing regimes. PMID:19742126

Minimally Invasive Dentistry

MedlinePlus

... geta poker friv Home InfoBites Find an AGD Dentist Your Family's Oral Health About the AGD Dental ... structure. It focuses on prevention, remineralization, and minimal dentist intervention. Using scientific advances, minimally invasive dentistry allows ...

Quasiprobability Representations of Quantum Mechanics with Minimal Negativity

NASA Astrophysics Data System (ADS)

Zhu, Huangjun

2016-09-01

Quasiprobability representations, such as the Wigner function, play an important role in various research areas. The inevitable appearance of negativity in such representations is often regarded as a signature of nonclassicality, which has profound implications for quantum computation. However, little is known about the minimal negativity that is necessary in general quasiprobability representations. Here we focus on a natural class of quasiprobability representations that is distinguished by simplicity and economy. We introduce three measures of negativity concerning the representations of quantum states, unitary transformations, and quantum channels, respectively. Quite surprisingly, all three measures lead to the same representations with minimal negativity, which are in one-to-one correspondence with the elusive symmetric informationally complete measurements. In addition, most representations with minimal negativity are automatically covariant with respect to the Heisenberg-Weyl groups. Furthermore, our study reveals an interesting tradeoff between negativity and symmetry in quasiprobability representations.

Minimal-assumption inference from population-genomic data

NASA Astrophysics Data System (ADS)

Weissman, Daniel; Hallatschek, Oskar

Samples of multiple complete genome sequences contain vast amounts of information about the evolutionary history of populations, much of it in the associations among polymorphisms at different loci. Current methods that take advantage of this linkage information rely on models of recombination and coalescence, limiting the sample sizes and populations that they can analyze. We introduce a method, Minimal-Assumption Genomic Inference of Coalescence (MAGIC), that reconstructs key features of the evolutionary history, including the distribution of coalescence times, by integrating information across genomic length scales without using an explicit model of recombination, demography or selection. Using simulated data, we show that MAGIC's performance is comparable to PSMC' on single diploid samples generated with standard coalescent and recombination models. More importantly, MAGIC can also analyze arbitrarily large samples and is robust to changes in the coalescent and recombination processes. Using MAGIC, we show that the inferred coalescence time histories of samples of multiple human genomes exhibit inconsistencies with a description in terms of an effective population size based on single-genome data.

Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS)

PubMed Central

Anastasiadis, Kyriakos; Murkin, John; Antonitsis, Polychronis; Bauer, Adrian; Ranucci, Marco; Gygax, Erich; Schaarschmidt, Jan; Fromes, Yves; Philipp, Alois; Eberle, Balthasar; Punjabi, Prakash; Argiriadou, Helena; Kadner, Alexander; Jenni, Hansjoerg; Albrecht, Guenter; van Boven, Wim; Liebold, Andreas; de Somer, Fillip; Hausmann, Harald; Deliopoulos, Apostolos; El-Essawi, Aschraf; Mazzei, Valerio; Biancari, Fausto; Fernandez, Adam; Weerwind, Patrick; Puehler, Thomas; Serrick, Cyril; Waanders, Frans; Gunaydin, Serdar; Ohri, Sunil; Gummert, Jan; Angelini, Gianni; Falk, Volkmar; Carrel, Thierry

2016-01-01

Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice. The goal of this manuscript is to promote the use of MiECC systems into clinical practice as a multidisciplinary strategy involving cardiac surgeons, anaesthesiologists and perfusionists. PMID:26819269

Developmental changes in maternal education and minimal exposure effects on vocabulary in English- and Spanish-learning toddlers.

PubMed

Friend, Margaret; DeAnda, Stephanie; Arias-Trejo, Natalia; Poulin-Dubois, Diane; Zesiger, Pascal

2017-12-01

The current research follows up on two previous findings: that children with minimal dual-language exposure have smaller receptive vocabularies at 16months of age and that maternal education is a predictor of vocabulary when the dominant language is English but not when it is Spanish. The current study extends this research to 22-month-olds to assess the developmental effects of minimal exposure and maternal education on direct and parent-report measures of vocabulary size. The effects of minimal exposure on vocabulary size are no longer present at 22months of age, whereas maternal education effects remain but only for English speakers. Copyright © 2017 Elsevier Inc. All rights reserved.

There is more to accommodation of the eye than simply minimizing retinal blur

PubMed Central

Marín-Franch, I.; Del Águila-Carrasco, A. J.; Bernal-Molina, P.; Esteve-Taboada, J. J.; López-Gil, N.; Montés-Micó, R.; Kruger, P. B.

2017-01-01

Eyes of children and young adults change their optical power to focus nearby objects at the retina. But does accommodation function by trial and error to minimize blur and maximize contrast as is generally accepted? Three experiments in monocular and monochromatic vision were performed under two conditions while aberrations were being corrected. In the first condition, feedback was available to the eye from both optical vergence and optical blur. In the second, feedback was only available from target blur. Accommodation was less precise for the second condition, suggesting that it is more than a trial-and-error function. Optical vergence itself seems to be an important cue for accommodation. PMID:29082097

Cyclone Simulation via Action Minimization

NASA Astrophysics Data System (ADS)

Plotkin, D. A.; Weare, J.; Abbot, D. S.

2016-12-01

A postulated impact of climate change is an increase in intensity of tropical cyclones (TCs). This hypothesized effect results from the fact that TCs are powered subsaturated boundary layer air picking up water vapor from the surface ocean as it flows inwards towards the eye. This water vapor serves as the energy input for TCs, which can be idealized as heat engines. The inflowing air has a nearly identical temperature as the surface ocean; therefore, warming of the surface leads to a warmer atmospheric boundary layer. By the Clausius-Clapeyron relationship, warmer boundary layer air can hold more water vapor and thus results in more energetic storms. Changes in TC intensity are difficult to predict due to the presence of fine structures (e.g. convective structures and rainbands) with length scales of less than 1 km, while general circulation models (GCMs) generally have horizontal resolutions of tens of kilometers. The models are therefore unable to capture these features, which are critical to accurately simulating cyclone structure and intensity. Further, strong TCs are rare events, meaning that long multi-decadal simulations are necessary to generate meaningful statistics about intense TC activity. This adds to the computational expense, making it yet more difficult to generate accurate statistics about long-term changes in TC intensity due to global warming via direct simulation. We take an alternative approach, applying action minimization techniques developed in molecular dynamics to the WRF weather/climate model. We construct artificial model trajectories that lead from quiescent (TC-free) states to TC states, then minimize the deviation of these trajectories from true model dynamics. We can thus create Monte Carlo model ensembles that are biased towards cyclogenesis, which reduces computational expense by limiting time spent in non-TC states. This allows for: 1) selective interrogation of model states with TCs; 2) finding the likeliest paths for

Reducing robotic prostatectomy costs by minimizing instrumentation.

PubMed

Delto, Joan C; Wayne, George; Yanes, Rafael; Nieder, Alan M; Bhandari, Akshay

2015-05-01

Since the introduction of robotic surgery for radical prostatectomy, the cost-benefit of this technology has been under scrutiny. While robotic surgery professes to offer multiple advantages, including reduced blood loss, reduced length of stay, and expedient recovery, the associated costs tend to be significantly higher, secondary to the fixed cost of the robot as well as the variable costs associated with instrumentation. This study provides a simple framework for the careful consideration of costs during the selection of equipment and materials. Two experienced robotic surgeons at our institution as well as several at other institutions were queried about their preferred instrument usage for robot-assisted prostatectomy. Costs of instruments and materials were obtained and clustered by type and price. A minimal set of instruments was identified and compared against alternative instrumentation. A retrospective review of 125 patients who underwent robotically assisted laparoscopic prostatectomy for prostate cancer at our institution was performed to compare estimated blood loss (EBL), operative times, and intraoperative complications for both surgeons. Our surgeons now conceptualize instrument costs as proportional changes to the cost of the baseline minimal combination. Robotic costs at our institution were reduced by eliminating an energy source like the Ligasure or vessel sealer, exploiting instrument versatility, and utilizing inexpensive tools such as Hem-o-lok clips. Such modifications reduced surgeon 1's cost of instrumentation to ∼40% less compared with surgeon 2 and up to 32% less than instrumentation used by surgeons at other institutions. Surgeon 1's combination may not be optimal for all robotic surgeons; however, it establishes a minimally viable toolbox for our institution through a rudimentary cost analysis. A similar analysis may aid others in better conceptualizing long-term costs not as nominal, often unwieldy prices, but as percent changes in

Search for Minimal and Semi-Minimal Rule Sets in Incremental Learning of Context-Free and Definite Clause Grammars

NASA Astrophysics Data System (ADS)

Imada, Keita; Nakamura, Katsuhiko

This paper describes recent improvements to Synapse system for incremental learning of general context-free grammars (CFGs) and definite clause grammars (DCGs) from positive and negative sample strings. An important feature of our approach is incremental learning, which is realized by a rule generation mechanism called “bridging” based on bottom-up parsing for positive samples and the search for rule sets. The sizes of rule sets and the computation time depend on the search strategies. In addition to the global search for synthesizing minimal rule sets and serial search, another method for synthesizing semi-optimum rule sets, we incorporate beam search to the system for synthesizing semi-minimal rule sets. The paper shows several experimental results on learning CFGs and DCGs, and we analyze the sizes of rule sets and the computation time.

The Changing Importance of White Women's Economic Prospects for Assortative Mating

ERIC Educational Resources Information Center

Sweeney, Megan M.; Cancian, Maria

2004-01-01

Given recent changes in the labor force participation and economic standing of women, we ask whether a woman's position in the labor market has become a more important determinant of her position in the marriage market. Unlike much prior research on trends over time in assortative mating, we take an individual-level approach to the analysis and…

Importance of Gravity for Plant Growth and Behavior

NASA Technical Reports Server (NTRS)

Brown, A. H.

1985-01-01

Flight experiments on the importance of gravity to plant growth and behavior are reported. The following studies were undertaken: (1) hyperastic responses to incremental changes of an axially imposed centripetal force; (2) Spacelab-1 experiments, methods for preparing soil in flight hardware containers were impound, to ensure desired moisture content and minimal contamination probability; (3) mesocotyl growth patterns were established by Avena lore exposure to red light during early seedling outogency; (4) the development of flight hardware; (5) choice of member of seedlings in each cube; (6) data processing and reduction; (7) clinostat validation; circummutation in space was more vigorous than on Earth based clinostat.

Changes in cerebral metabolism in patients with a minimally conscious state responding to zolpidem

PubMed Central

Chatelle, Camille; Thibaut, Aurore; Gosseries, Olivia; Bruno, Marie-Aurélie; Demertzi, Athena; Bernard, Claire; Hustinx, Roland; Tshibanda, Luaba; Bahri, Mohamed A.; Laureys, Steven

2014-01-01

Background: Zolpidem, a short-acting non-benzodiazepine GABA agonist hypnotic, has been shown to induce paradoxical responses in some patients with disorders of consciousness (DOC), leading to recovery of arousal and cognitive abilities. We here assessed zolpidem-induced changes in regional brain metabolism in three patients with known zolpidem response in chronic post-anoxic minimally conscious state (MCS). Methods: [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) and standardized clinical assessments using the Coma Recovery Scale-Revised were performed after administration of 10 mg zolpidem or placebo in a randomized double blind 2-day protocol. PET data preprocessing and comparison with a healthy age-matched control group were performed using statistical parametric mapping (SPM8). Results: Behaviorally, all patients recovered functional communication after administration of zolpidem (i.e., emergence from the MCS). FDG-PET showed increased metabolism in dorsolateral prefrontal and mesiofrontal cortices after zolpidem but not after placebo administration. Conclusion: Our data show a metabolic activation of prefrontal areas, corroborating the proposed mesocircuit hypothesis to explain the paradoxical effect of zolpidem observed in some patients with DOC. It also suggests the key role of the prefrontal cortices in the recovery of functional communication and object use in hypoxic patients with chronic MCS. PMID:25520636

Glomerular malondialdehyde levels in patients with focal and segmental glomerulosclerosis and minimal change disease.

PubMed

Nezhad, Simin Torabi; Momeni, Babak; Basiratnia, Mitra

2010-09-01

Minimal change disease (MCD) and focal and segmental glomerulosclerosis (FSGS) are often studied together, because both present with heavy proteinuria and the nephrotic syndrome. The precise distinction between MCD and FSGS is sometimes difficult because of inadequate number of glomeruli for definite diagnosis. Some evidence suggests that markers of lipid peroxidation, such as malondialdehyde (MDA) is an index of free radical mediated injury and may be involved in the pathogenesis of FSGS. In this study, we assessed the immunoreactivity of MDA, the end product of lipid peroxidation in glomeruli of patients with idiopathic FSGS, MCD as well as normal controls (NC). Our results showed that the immunostaining level of MDA was significantly higher in patients with FSGS (mean = 1.5) than in either patients with MCD (mean = 0.16) or normal controls (mean = 0.11) with P value < 0.001. Glomerular MDA level correlated well with the degree of glomerulosclerosis in patients with idiopathic FSGS. Our data demonstrates that the glomerular level of MDA is higher in idiopathic FSGS than MCD. We suggest that MDA immunostaining can be helpful in differentiating between FSGS and MCD in problematic cases and when we do not have enough glomeruli for definite and correct diagnosis.

Minimizing Glovebox Glove Breaches, Part III: Deriving Service Lifetimes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cournoyer, M.E.; Wilson, K.V.; Maestas, M.M.

At the Los Alamos Plutonium Facility, various isotopes of plutonium along with other actinides are handled in a glove box environment. Weapons-grade plutonium consists mainly in Pu-239. Pu-238 is another isotope used for heat sources. The Pu-238 is more aggressive regarding gloves due to its higher alpha-emitting characteristic ({approx}300 times more active than Pu-239), which modifies the change-out intervals for gloves. Optimization of the change-out intervals for gloves is fundamental since Nuclear Materials Technology (NMT) Division generates approximately 4 m{sup 3}/yr of TRU waste from the disposal of glovebox gloves. To reduce the number of glovebox glove failures, the NMTmore » Division pro-actively investigates processes and procedures that minimize glove failures. Aging studies have been conducted that correlate changes in mechanical (physical) properties with degradation chemistry. This present work derives glovebox glove change intervals based on mechanical data of thermally aged Hypalon{sup R}, and Butasol{sup R} glove samples. Information from this study represent an important baseline in gauging the acceptable standards for polymeric gloves used in a laboratory glovebox environment and will be used later to account for possible presence of dose-rate or synergistic effects in 'combined-environment'. In addition, excursions of contaminants into the operator's breathing zone and excess exposure to the radiological sources associated with unplanned breaches in the glovebox are reduced. (authors)« less

Minimal Clinically Important Difference of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) for Fatigue Worsening in Asian Breast Cancer Patients.

PubMed

Chan, Alexandre; Yo, Tiffany Eri; Wang, Xiao Jun; Ng, Terence; Chae, Jung-Woo; Yeo, Hui Ling; Shwe, Maung; Gan, Yan Xiang

2018-03-01

The minimal clinically important difference (MCID) of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), a questionnaire that measures cancer-related fatigue, has not been established in patients with cancer. This study aims to determine the MCID of the MFSI-SF. Breast cancer patients completed the MFSI-SF and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) before chemotherapy and at least three weeks later. The EORTC-QLQ-C30 fatigue scale (EORTC-FA) was used as an anchor, and a receiver operating characteristic (ROC) curve was also used to identify the optimal MCID cut-off for fatigue deterioration. A distribution-based approach used one-third of the SD, half of the SD, and one SEM of the total MFSI-SF score to determine the MCID. A total of 201 patients were analyzed. Change scores of the MFSI-SF and EORTC-FA were moderately correlated (r = 0.47, P < 0.001). The EORTC-FA-anchored MCID was 8.69 points (95% CI: 4.03-13.34). The MCID attained from the ROC curve method was 4.50 points (sensitivity: 68.8%; specificity: 64.1%). For the distribution-based approach, the MCIDs corresponding to one-third of the SD, half of the SD, and one SEM were 5.39, 8.99, and 10.79 points, respectively. The MCID of the MFSI-SF identified by all approaches ranged from 4.50 to 10.79 points. The MCID can be used to interpret the clinical significance of fatigue deterioration in patients with breast cancer and to determine sample sizes for future clinical trials. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Estimating the Minimal Important Difference for the Western Ontario Rotator Cuff Index (WORC) in adults with shoulder pain associated with partial-thickness rotator cuff tears.

PubMed

Braun, Cordula; Handoll, Helen H

2018-06-01

Knowledge about Minimal Important Differences (MIDs) is essential for the interpretation of continuous outcomes, especially patient-reported outcome measures (PROMS). The aim of this study was to estimate the MID for the Western Ontario Rotator Cuff Index (WORC: score 0 (best) to 2100 (worst disability)) in adults with shoulder pain associated with partial-thickness rotator cuff tears, 'symptomatic PTTs', undergoing conservative treatment with physiotherapy. A prospectively-designed anchor-based MID analysis using data from a prospective prognostic study with a three-month follow-up conducted within an outpatient care setting in Germany. The MID was estimated using data from 64 adults with atraumatic symptomatic PTTs who underwent three months of conservative treatment with physiotherapy. The anchor was a seven-point Global Perceived Change (GPC) scale. Based on a definition of the MID being the threshold of "being (at least slightly) improved" with a probability nearest to 0.90 (i.e. 9 of 10 patients achieving the MID), the MID for the WORC was estimated as -300 for 'improved' shoulder-related disability in 9 out of 10 patients (95% CI 8 out of 10 patients to everyone) undergoing three months of exercise-based physiotherapy for symptomatic PTTs. This is the first published MID estimate for the WORC in adults with symptomatic PTTs of the rotator cuff undergoing typical treatment comprising conservative treatment with physiotherapy. The conceptual framework for interpretation facilitates its use in similar clinical contexts. Copyright © 2018. Published by Elsevier Ltd.

The Applicability of Standard Error of Measurement and Minimal Detectable Change to Motor Learning Research-A Behavioral Study.

PubMed

Furlan, Leonardo; Sterr, Annette

2018-01-01

Motor learning studies face the challenge of differentiating between real changes in performance and random measurement error. While the traditional p -value-based analyses of difference (e.g., t -tests, ANOVAs) provide information on the statistical significance of a reported change in performance scores, they do not inform as to the likely cause or origin of that change, that is, the contribution of both real modifications in performance and random measurement error to the reported change. One way of differentiating between real change and random measurement error is through the utilization of the statistics of standard error of measurement (SEM) and minimal detectable change (MDC). SEM is estimated from the standard deviation of a sample of scores at baseline and a test-retest reliability index of the measurement instrument or test employed. MDC, in turn, is estimated from SEM and a degree of confidence, usually 95%. The MDC value might be regarded as the minimum amount of change that needs to be observed for it to be considered a real change, or a change to which the contribution of real modifications in performance is likely to be greater than that of random measurement error. A computer-based motor task was designed to illustrate the applicability of SEM and MDC to motor learning research. Two studies were conducted with healthy participants. Study 1 assessed the test-retest reliability of the task and Study 2 consisted in a typical motor learning study, where participants practiced the task for five consecutive days. In Study 2, the data were analyzed with a traditional p -value-based analysis of difference (ANOVA) and also with SEM and MDC. The findings showed good test-retest reliability for the task and that the p -value-based analysis alone identified statistically significant improvements in performance over time even when the observed changes could in fact have been smaller than the MDC and thereby caused mostly by random measurement error, as opposed

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

PubMed

Kulkarni, Arvind Gopalrao; Patel, Ravish Shammi; Dutta, Shumayou

2016-12-01

Retrospective review of prospectively collected data. To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.

Perturbed Yukawa textures in the minimal seesaw model

NASA Astrophysics Data System (ADS)

Rink, Thomas; Schmitz, Kai

2017-03-01

We revisit the minimal seesaw model, i.e., the type-I seesaw mechanism involving only two right-handed neutrinos. This model represents an important minimal benchmark scenario for future experimental updates on neutrino oscillations. It features four real parameters that cannot be fixed by the current data: two CP -violating phases, δ and σ, as well as one complex parameter, z, that is experimentally inaccessible at low energies. The parameter z controls the structure of the neutrino Yukawa matrix at high energies, which is why it may be regarded as a label or index for all UV completions of the minimal seesaw model. The fact that z encompasses only two real degrees of freedom allows us to systematically scan the minimal seesaw model over all of its possible UV completions. In doing so, we address the following question: suppose δ and σ should be measured at particular values in the future — to what extent is one then still able to realize approximate textures in the neutrino Yukawa matrix? Our analysis, thus, generalizes previous studies of the minimal seesaw model based on the assumption of exact texture zeros. In particular, our study allows us to assess the theoretical uncertainty inherent to the common texture ansatz. One of our main results is that a normal light-neutrino mass hierarchy is, in fact, still consistent with a two-zero Yukawa texture, provided that the two texture zeros receive corrections at the level of O (10%). While our numerical results pertain to the minimal seesaw model only, our general procedure appears to be applicable to other neutrino mass models as well.

Ongoing change of site conditions important for sustainable forest management planning

NASA Astrophysics Data System (ADS)

Bidló, András; Horváth, Adrienn; Gulyás, Krisztina; Gálos, Borbála

2016-04-01

Observed tree mortality of the last decades has shown that the vulnerable forest ecosystems are especially affected by the recurrent, long lasting droughts, heat waves and their consequences. From all site conditions climate is changing the fastest, in this way it can be the largest threatening factor in the 21st century. Beyond climate, soil characteristics are playing an important influencing role. Until now, silvicultural technologies and species preferences of many countries are prescribed by binding regulation based on climate conditions that are assumed to be constant over time. Therefore the aim of our research was to investigate the ongoing and projected change of site conditions that are considered to be of primary importance in terms of tree species selection. For a case study region in Hungary (Keszthely Mountains, near to Lake Balaton) long-term climate tendencies have been determined for the period 1961-2100, as well as a detailed soil sample analysis has been carried out including ~100 sites. Results show a 0.5 degree increase of temperature and a 6-7 % decrease of the precipitation amount for the summer months in the last decades. For the future, significant warming and drying of summers is expected. Decrease of the summer precipitation sum can exceed 25 % until the end of the century, probability of extreme hot days may increase. These tendencies together with the unfavourable soil conditions and biotic damages can be the reason of the ongoing forest dieback. One of the characteristic soil type of the region is rendzina with a thin topsoil layer and an unfavourable water holding capacity. These properties are limiting the amount of available water for plants, especially in case of intense precipitation events. Black pine stands planted on rendzinas after many years of grazing; therefore erosion may have played a significant role. Not only microclimate conditions but also soil types show a large diversity within a relatively small distance. However

Tiny and Hidden but Changing Your World: The Importance of Soil Microbes to Climate Change

NASA Astrophysics Data System (ADS)

Waldo, N.; Neumann, R. B.

2017-12-01

When most people think about global climate change they think about massive power plants billowing smoke and expansive glaciers melting to nothingness. What the public often overlooks is how natural processes invisible to the naked eye can be changed by the climate, and the fact that the natural response to those changes can further alter the climate. Scientists call these reactions "feedback cycles", and understanding them is crucial to predicting the true impact of human activities. In our research, we study one particular feedback cycle: the effect of increased plant productivity on methane emissions from wetlands. Globally, wetlands account for about a third of annual emissions of methane, the second most important greenhouse gas after carbon dioxide. This heat-trapping gas is generated in the soil of wetlands by microscopic organisms that consume, among other things, proteins and sugars released by the roots of plants. As the atmosphere becomes warmer and richer in carbon dioxide, these plants will grow larger and faster, releasing more of this microbe food into the soil. Our current research seeks to understand how that will affect the microbial ecosystem, and through it the emissions of methane gas.

40 CFR 26.1110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-07-01

... kinds of research involving no more than minimal risk, and for minor changes in approved research. 26.1110 Section 26.1110 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROTECTION OF... kinds of research involving no more than minimal risk, and for minor changes in approved research. (a...

Evidence for surprise minimization over value maximization in choice behavior

PubMed Central

Schwartenbeck, Philipp; FitzGerald, Thomas H. B.; Mathys, Christoph; Dolan, Ray; Kronbichler, Martin; Friston, Karl

2015-01-01

Classical economic models are predicated on the idea that the ultimate aim of choice is to maximize utility or reward. In contrast, an alternative perspective highlights the fact that adaptive behavior requires agents’ to model their environment and minimize surprise about the states they frequent. We propose that choice behavior can be more accurately accounted for by surprise minimization compared to reward or utility maximization alone. Minimizing surprise makes a prediction at variance with expected utility models; namely, that in addition to attaining valuable states, agents attempt to maximize the entropy over outcomes and thus ‘keep their options open’. We tested this prediction using a simple binary choice paradigm and show that human decision-making is better explained by surprise minimization compared to utility maximization. Furthermore, we replicated this entropy-seeking behavior in a control task with no explicit utilities. These findings highlight a limitation of purely economic motivations in explaining choice behavior and instead emphasize the importance of belief-based motivations. PMID:26564686

Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

PubMed Central

Kim, Terrence T.; Johnson, J. Patrick; Pashman, Robert; Drazin, Doniel

2016-01-01

We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

The Importance of Three Physical Processes in a Minimal Three-Dimensional Tropical Cyclone Model.

NASA Astrophysics Data System (ADS)

Zhu, Hongyan; Smith, Roger K.

2002-06-01

The minimal three-dimensional tropical cyclone model developed by Zhu et al. is used to explore the role of shallow convection, precipitation-cooled downdrafts, and the vertical transport of momentum by deep convection on the dynamics of tropical cyclone intensification. The model is formulated in coordinates and has three vertical levels, one characterizing a shallow boundary layer, and the other two representing the upper and lower troposphere, respectively. It has three options for treating cumulus convection on the subgrid scale and a simple scheme for the explicit release of latent heat on the grid scale.In the model, as in reality, shallow convection transports air with low moist static energy from the lower troposphere to the boundary layer, stabilizing the atmosphere not only to itself, but also to deep convection. Also it moistens and cools the lower troposphere. For realistic parameter values, the stabilization in the vortex core region is the primary effect: it reduces the deep convective mass flux and therefore the rate of heating and drying in the troposphere. This reduced heating, together with the direct cooling of the lower troposphere by shallow convection, diminishes the buoyancy in the vortex core and thereby the vortex intensification rate.The effects of precipitation-cooled downdrafts depend on the closure scheme chosen for deep convection. In the two closures in which the deep cloud mass flux depends on the degree of convective instability, the downdrafts do not change the total mass flux of air that subsides into the boundary layer, but they carry air with a lower moist static energy into this layer than does subsidence outside downdrafts. As a result they decrease the rate of intensification during the early development stage. Nevertheless, by reducing the deep convective mass flux and the drying effect of compensating subsidence, they enable grid scale saturation, and therefore rapid intensification, to occur earlier than in calculations

What is Quantum Mechanics? A Minimal Formulation

NASA Astrophysics Data System (ADS)

Friedberg, R.; Hohenberg, P. C.

2018-03-01

This paper presents a minimal formulation of nonrelativistic quantum mechanics, by which is meant a formulation which describes the theory in a succinct, self-contained, clear, unambiguous and of course correct manner. The bulk of the presentation is the so-called "microscopic theory", applicable to any closed system S of arbitrary size N, using concepts referring to S alone, without resort to external apparatus or external agents. An example of a similar minimal microscopic theory is the standard formulation of classical mechanics, which serves as the template for a minimal quantum theory. The only substantive assumption required is the replacement of the classical Euclidean phase space by Hilbert space in the quantum case, with the attendant all-important phenomenon of quantum incompatibility. Two fundamental theorems of Hilbert space, the Kochen-Specker-Bell theorem and Gleason's theorem, then lead inevitably to the well-known Born probability rule. For both classical and quantum mechanics, questions of physical implementation and experimental verification of the predictions of the theories are the domain of the macroscopic theory, which is argued to be a special case or application of the more general microscopic theory.

PUBLISHER'S ANNOUNCEMENT: Important changes for 2008

NASA Astrophysics Data System (ADS)

Bedrock, Claire

2008-01-01

Having reviewed several aspects of IOP journal content, both in print and online, we have made some changes for 2008, some of which affect Semiconductor Science and Technology. Article numbering In common with many other IOP journals, Semiconductor Science and Technology has moved from sequential page numbering to an article numbering system. Articles will continue to be published on the web in advance of the print edition. The bibliographic citation will change slightly. Articles should be referenced using the six-digit article number in place of a page number, and this number must include any leading zeros. For instance: Surname X and Surname Y 2008 Semicond. Sci. Technol. 18 015003 A new look and feel Semiconductor Science and Technology has changed from European A4 format to a slightly smaller size, closer to US Letter format, and we have taken the opportunity to refresh the cover, in order to modernise the typography, and create a consistent look and feel across our range of publications. If you have any questions or comments about any of these changes, please contact us at sst@iop.org

National proficiency-gain curves for minimally invasive gastrointestinal cancer surgery.

PubMed

Mackenzie, H; Markar, S R; Askari, A; Ni, M; Faiz, O; Hanna, G B

2016-01-01

Minimal access surgery for gastrointestinal cancer has short-term benefits but is associated with a proficiency-gain curve. The aim of this study was to define national proficiency-gain curves for minimal access colorectal and oesophagogastric surgery, and to determine the impact on clinical outcomes. All adult patients undergoing minimal access oesophageal, colonic and rectal surgery between 2002 and 2012 were identified from the Hospital Episode Statistics database. Proficiency-gain curves were created using risk-adjusted cumulative sum analysis. Change points were identified, and bootstrapping was performed with 1000 iterations to identify a confidence level. The primary outcome was 30-day mortality; secondary outcomes were 90-day mortality, reintervention, conversion and length of hospital stay. Some 1696, 15 008 and 16 701 minimal access oesophageal, rectal and colonic cancer resections were performed during the study period. The change point in the proficiency-gain curve for 30-day mortality for oesophageal, rectal and colonic surgery was 19 (confidence level 98·4 per cent), 20 (99·2 per cent) and three (99·5 per cent) procedures; the mortality rate fell from 4·0 to 2·0 per cent (relative risk reduction (RRR) 0·50, P = 0·033), from 2·1 to 1·2 per cent (RRR 0·43, P < 0·001) and from 2·4 to 1·8 per cent (RRR 0·25, P = 0·058) respectively. The change point in the proficiency-gain curve for reintervention in oesophageal, rectal and colonic resection was 19 (98·1 per cent), 32 (99·5 per cent) and 26 (99·2 per cent) procedures respectively. There were also significant proficiency-gain curves for 90-day mortality, conversion and length of stay. The introduction of minimal access gastrointestinal cancer surgery has been associated with a proficiency-gain curve for mortality and major morbidity at a national level. Unnecessary patient harm should be avoided by appropriate training and monitoring of new surgical techniques. © 2015 BJS

28 CFR 46.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-07-01

... kinds of research involving no more than minimal risk, and for minor changes in approved research. 46... SUBJECTS § 46.110 Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has established, and...

16 CFR 1028.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-01-01

... kinds of research involving no more than minimal risk, and for minor changes in approved research. 1028... HUMAN SUBJECTS § 1028.110 Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has established...

22 CFR 225.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-04-01

... of research involving no more than minimal risk, and for minor changes in approved research. 225.110....110 Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has established, and published as a...

14 CFR 1230.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-01-01

... kinds of research involving no more than minimal risk, and for minor changes in approved research. 1230... HUMAN SUBJECTS § 1230.110 Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has established...

Minimal Impact Education: A New Approach To Walking Softly.

ERIC Educational Resources Information Center

Bauchop, Deborah; Parkin, Danny

2000-01-01

Introduces protected areas as opportunities for outdoor education and considers the possibility that outdoor education may contribute to the ecological degradation of these areas through overuse or poor outdoor practices. Provides a new approach to minimal impact education through the promotion of individual change. (Contains 24 references.)…

Hexavalent Chromium Minimization Strategy

DTIC Science & Technology

2011-05-01

Logistics 4 Initiative - DoD Hexavalent Chromium Minimization Non- Chrome Primer IIEXAVAJ ENT CHRO:M I~UMI CHROMIUM (VII Oil CrfVli.J CANCEfl HAnRD CD...Management Office of the Secretary of Defense Hexavalent Chromium Minimization Strategy Report Documentation Page Form ApprovedOMB No. 0704-0188...00-2011 4. TITLE AND SUBTITLE Hexavalent Chromium Minimization Strategy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6

Indirect measurement of the solid/liquid interface using the minimization technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Choi, H.; Chun, M.

1985-11-01

The phenomenon of solidification of a flowing fluid in a vertical tube is closely related to the relocation dynamics of molten nuclear fuels in hypothetical core-disruptive accidents of a liquid-metal fast breeder reactor. The knowledge of the transient shape and the position of the liquid/solid interface is of practical importance in analysis of phase change processes. Sparrow and Broadbent directly measured the solid liquid interface via experiments, whereas Viskanta observed the solid/liquid interface motion via a photographic method. In this paper, a new method to predict the transient position of the solid/liquid interface is developed. This method is based onmore » the minimization technique. To use this method one needs the temperature of the wall on which the phase change is to take place. The new technique is useful, in particular, for the case of inward solidification of a flowing fluid in a tube where direct measurement of the solid/liquid interface is not possible, whereas the tube wall temperature measurement is relatively easy.« less

15 CFR 27.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-01-01

... certain kinds of research involving no more than minimal risk, and for minor changes in approved research... HUMAN SUBJECTS § 27.110 Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has established, and...

45 CFR 690.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-10-01

... research involving no more than minimal risk, and for minor changes in approved research. 690.110 Section... PROTECTION OF HUMAN SUBJECTS § 690.110 Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has...

21 CFR 56.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-04-01

... uses an expedited review procedure shall adopt a method for keeping all members advised of research... research involving no more than minimal risk, and for minor changes in approved research. 56.110 Section 56... of research involving no more than minimal risk, and for minor changes in approved research. (a) The...

32 CFR 219.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-07-01

... adopt a method for keeping all members advised of research proposals which have been approved under the... research involving no more than minimal risk, and for minor changes in approved research. 219.110 Section... kinds of research involving no more than minimal risk, and for minor changes in approved research. (a...

32 CFR 219.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2011 CFR

2011-07-01

... adopt a method for keeping all members advised of research proposals which have been approved under the... research involving no more than minimal risk, and for minor changes in approved research. 219.110 Section... kinds of research involving no more than minimal risk, and for minor changes in approved research. (a...

Self-Averaging Property of Minimal Investment Risk of Mean-Variance Model.

PubMed

Shinzato, Takashi

2015-01-01

In portfolio optimization problems, the minimum expected investment risk is not always smaller than the expected minimal investment risk. That is, using a well-known approach from operations research, it is possible to derive a strategy that minimizes the expected investment risk, but this strategy does not always result in the best rate of return on assets. Prior to making investment decisions, it is important to an investor to know the potential minimal investment risk (or the expected minimal investment risk) and to determine the strategy that will maximize the return on assets. We use the self-averaging property to analyze the potential minimal investment risk and the concentrated investment level for the strategy that gives the best rate of return. We compare the results from our method with the results obtained by the operations research approach and with those obtained by a numerical simulation using the optimal portfolio. The results of our method and the numerical simulation are in agreement, but they differ from that of the operations research approach.

Self-Averaging Property of Minimal Investment Risk of Mean-Variance Model

PubMed Central

Shinzato, Takashi

2015-01-01

In portfolio optimization problems, the minimum expected investment risk is not always smaller than the expected minimal investment risk. That is, using a well-known approach from operations research, it is possible to derive a strategy that minimizes the expected investment risk, but this strategy does not always result in the best rate of return on assets. Prior to making investment decisions, it is important to an investor to know the potential minimal investment risk (or the expected minimal investment risk) and to determine the strategy that will maximize the return on assets. We use the self-averaging property to analyze the potential minimal investment risk and the concentrated investment level for the strategy that gives the best rate of return. We compare the results from our method with the results obtained by the operations research approach and with those obtained by a numerical simulation using the optimal portfolio. The results of our method and the numerical simulation are in agreement, but they differ from that of the operations research approach. PMID:26225761

21 CFR 56.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2011 CFR

2011-04-01

... research involving no more than minimal risk, and for minor changes in approved research. 56.110 Section 56... of research involving no more than minimal risk, and for minor changes in approved research. (a) The... categories of research that may be reviewed by the IRB through an expedited review procedure. The list will...

49 CFR 11.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2011 CFR

2011-10-01

... research involving no more than minimal risk, and for minor changes in approved research. 11.110 Section 11... Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has established, and published as a Notice in the...

Periodic minimal surfaces

NASA Astrophysics Data System (ADS)

Mackay, Alan L.

1985-04-01

A minimal surface is one for which, like a soap film with the same pressure on each side, the mean curvature is zero and, thus, is one where the two principal curvatures are equal and opposite at every point. For every closed circuit in the surface, the area is a minimum. Schwarz1 and Neovius2 showed that elements of such surfaces could be put together to give surfaces periodic in three dimensions. These periodic minimal surfaces are geometrical invariants, as are the regular polyhedra, but the former are curved. Minimal surfaces are appropriate for the description of various structures where internal surfaces are prominent and seek to adopt a minimum area or a zero mean curvature subject to their topology; thus they merit more complete numerical characterization. There seem to be at least 18 such surfaces3, with various symmetries and topologies, related to the crystallographic space groups. Recently, glyceryl mono-oleate (GMO) was shown by Longley and McIntosh4 to take the shape of the F-surface. The structure postulated is shown here to be in good agreement with an analysis of the fundamental geometry of periodic minimal surfaces.

Changes in the referent body location and configuration may underlie human gait, as confirmed by findings of multi-muscle activity minimizations and phase resetting.

PubMed

Feldman, Anatol G; Krasovsky, Tal; Baniña, Melanie C; Lamontagne, Anouk; Levin, Mindy F

2011-04-01

Locomotion is presumably guided by feed-forward shifts in the referent body location in the desired direction in the environment. We propose that the difference between the actual and the referent body locations is transmitted to neurons that virtually diminish this difference by appropriately changing the referent body configuration, i.e. the body posture at which muscles reach their recruitment thresholds. Muscles are activated depending on the gap between the actual and the referent body configurations resulting in a step being made to minimize this gap. This hypothesis implies that the actual and the referent leg configurations can match each other at certain phases of the gait cycle, resulting in minimization of leg muscle activity. We found several leg configurations at which EMG minima occurred, both during forward and backward gait. It was also found that the set of limb configurations associated with EMG minima can be changed by modifying the pattern of forward and backward gait. Our hypothesis predicts that, in response to perturbations of gait, the rate of shifts in the referent body location can temporarily be changed to avoid falling. The rate influences the phase of rhythmic limb movements during gait. Therefore, following the change in the rate of the referent body location, the whole gait pattern, for all four limbs, will irreversibly be shifted in time (long-lasting and global phase resetting) with only transient changes in the gait speed, swing and stance timing and cycle duration. Aside from transient changes in the duration of the swing and/or stance phase in response to perturbation, few previous studies have documented long-lasting and global phase resetting of human gait in response to perturbation. Such resetting was a robust finding in our study. By confirming the notion that feed-forward changes in the referent body location and configuration underlie human locomotion, this study solves the classical problem in the relationship between

An introduction to minimally invasive therapy.

PubMed

Wickham, J E

1993-01-01

Minimally invasive therapy (MIT) has as its basic premise the reduction of iatrogenic trauma to the patient by surgeon, physician or radiologist. This approach must also imply that the therapeutic procedure succeeds in its aim of cure in a manner no less effective than is currently achievable by established methods of treatment. Acceptance of this principal has many identifiable sequelae, including profound changes in hospital design, increasingly expensive technological instrumentation, more sophisticated teaching and learning patterns, and a massive redirection of health care financial resources. These changes cannot be contemplated at leisure, because they are dynamically imperative and progressing with relentless rapidity, being directly driven by the consumer. It is vital that this shift in clinical emphasis should be appreciated so that future planning can be undertaken with some rationality.

Randomization in clinical trials: stratification or minimization? The HERMES free simulation software.

PubMed

Fron Chabouis, Hélène; Chabouis, Francis; Gillaizeau, Florence; Durieux, Pierre; Chatellier, Gilles; Ruse, N Dorin; Attal, Jean-Pierre

2014-01-01

Operative clinical trials are often small and open-label. Randomization is therefore very important. Stratification and minimization are two randomization options in such trials. The first aim of this study was to compare stratification and minimization in terms of predictability and balance in order to help investigators choose the most appropriate allocation method. Our second aim was to evaluate the influence of various parameters on the performance of these techniques. The created software generated patients according to chosen trial parameters (e.g., number of important prognostic factors, number of operators or centers, etc.) and computed predictability and balance indicators for several stratification and minimization methods over a given number of simulations. Block size and proportion of random allocations could be chosen. A reference trial was chosen (50 patients, 1 prognostic factor, and 2 operators) and eight other trials derived from this reference trial were modeled. Predictability and balance indicators were calculated from 10,000 simulations per trial. Minimization performed better with complex trials (e.g., smaller sample size, increasing number of prognostic factors, and operators); stratification imbalance increased when the number of strata increased. An inverse correlation between imbalance and predictability was observed. A compromise between predictability and imbalance still has to be found by the investigator but our software (HERMES) gives concrete reasons for choosing between stratification and minimization; it can be downloaded free of charge. This software will help investigators choose the appropriate randomization method in future two-arm trials.

Implementing climate change mitigation in health services: the importance of context.

PubMed

Desmond, Sharon

2016-10-01

Academic interest in strategies to reduce the impact of health services on climate change is quickening. Research has largely focused on local innovations with little consideration of the contextual and systemic elements that influence sustainable development across health systems. A realistic framework specifically to guide decision-making by health care providers is still needed. To address this deficit, the literature is explored in relation to health services and climate change mitigation strategies, and the contextual factors that influence efforts to mitigate climate effects in health service delivery environments are highlighted. A conceptual framework is proposed that offers a model for the pursuit of sustainable development practice in health services. A set of propositions is advanced to provide a systems approach to assist decision-making by decoding the challenges faced in implementing sustainable health services. This has important implications for health care providers, funders and legislators since the financial, policy and regulatory environment of health care, along with its leadership and models of care generally conflict with carbon literacy and climate change mitigation strategies. © The Author(s) 2016.

Test-Retest Reliability and Minimal Detectable Change of the D2 Test of Attention in Patients with Schizophrenia.

PubMed

Lee, Posen; Lu, Wen-Shian; Liu, Chin-Hsuan; Lin, Hung-Yu; Hsieh, Ching-Lin

2017-12-08

The d2 Test of Attention (D2) is a commonly used measure of selective attention for patients with schizophrenia. However, its test-retest reliability and minimal detectable change (MDC) are unknown in patients with schizophrenia, limiting its utility in both clinical and research settings. The aim of the present study was to examine the test-retest reliability and MDC of the D2 in patients with schizophrenia. A rater administered the D2 on 108 patients with schizophrenia twice at a 1-month interval. Test-retest reliability was determined through the calculation of the intra-class correlation coefficient (ICC). We also carried out Bland-Altman analysis, which included a scatter plot of the differences between test and retest against their mean. Systematic biases were evaluated by use of a paired t-test. The ICCs for the D2 ranged from 0.78 to 0.94. The MDCs (MDC%) of the seven subscores were 102.3 (29.7), 19.4 (85.0), 7.2 (94.6), 21.0 (69.0), 104.0 (33.1), 105.0 (35.8), and 7.8 (47.8), which represented limited-to-acceptable random measurement error. Trends in the Bland-Altman plots of the omissions (E1), commissions (E2), and errors (E) were noted, presenting that the data had heteroscedasticity. According to the results, the D2 had good test-retest reliability, especially in the scores of TN, TN-E, and CP. For the further research, finding a way to improve the administration procedure to reduce random measurement error would be important for the E1, E2, E, and FR subscores. © The Author(s) 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Comprehensive Training Curricula for Minimally Invasive Surgery

PubMed Central

Palter, Vanessa N

2011-01-01

Background The unique skill set required for minimally invasive surgery has in part contributed to a certain portion of surgical residency training transitioning from the operating room to the surgical skills laboratory. Simulation lends itself well as a method to shorten the learning curve for minimally invasive surgery by allowing trainees to practice the unique motor skills required for this type of surgery in a safe, structured environment. Although a significant amount of important work has been done to validate simulators as viable systems for teaching technical skills outside the operating room, the next step is to integrate simulation training into a comprehensive curriculum. Objectives This narrative review aims to synthesize the evidence and educational theories underlining curricula development for technical skills both in a broad context and specifically as it pertains to minimally invasive surgery. Findings The review highlights the critical aspects of simulation training, such as the effective provision of feedback, deliberate practice, training to proficiency, the opportunity to practice at varying levels of difficulty, and the inclusion of both cognitive teaching and hands-on training. In addition, frameworks for integrating simulation training into a comprehensive curriculum are described. Finally, existing curricula on both laparoscopic box trainers and virtual reality simulators are critically evaluated. PMID:22942951

Minimal Marking: A Success Story

ERIC Educational Resources Information Center

McNeilly, Anne

2014-01-01

The minimal-marking project conducted in Ryerson's School of Journalism throughout 2012 and early 2013 resulted in significantly higher grammar scores in two first-year classes of minimally marked university students when compared to two traditionally marked classes. The "minimal-marking" concept (Haswell, 1983), which requires…

Utilization of biocatalysts in cellulose waste minimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woodward, J.; Evans, B.R.

1996-09-01

Cellulose, a polymer of glucose, is the principal component of biomass and, therefore, a major source of waste that is either buried or burned. Examples of biomass waste include agricultural crop residues, forestry products, and municipal wastes. Recycling of this waste is important for energy conservation as well as waste minimization and there is some probability that in the future biomass could become a major energy source and replace fossil fuels that are currently used for fuels and chemicals production. It has been estimated that in the United States, between 100-450 million dry tons of agricultural waste are produced annually,more » approximately 6 million dry tons of animal waste, and of the 190 million tons of municipal solid waste (MSW) generated annually, approximately two-thirds is cellulosic in nature and over one-third is paper waste. Interestingly, more than 70% of MSW is landfilled or burned, however landfill space is becoming increasingly scarce. On a smaller scale, important cellulosic products such as cellulose acetate also present waste problems; an estimated 43 thousand tons of cellulose ester waste are generated annually in the United States. Biocatalysts could be used in cellulose waste minimization and this chapter describes their characteristics and potential in bioconversion and bioremediation processes.« less

Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference.

PubMed

Levy, David M; Kuhns, Benjamin D; Chahal, Jaskarndip; Philippon, Marc J; Kelly, Bryan T; Nho, Shane J

2016-09-01

To determine whether the hip arthroscopy literature to date has shown outcomes consistent with published patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) estimates. All clinical investigations of hip arthroscopy using modified Harris Hip Score (mHHS) and/or Hip Outcome Score (HOS) outcomes with at least 1 year of follow-up were reviewed. Ninety-one studies (9,746 hips) were included for review. Eighty-one studies (9,317 hips) contained only primary hip arthroscopies and were the primary focus of this review. The remaining studies (429 hips) did not exclude patients with prior surgical history and were thus considered separately. Mean mHHS, HOS-ADL (Activities of Daily Living) and HOS-SS (Sports-Specific) scores were compared with previously published PASS and MCID values. After 31 ± 20 months, 5.8% of study populations required revision arthroscopy and 5.5% total hip arthroplasty. A total of 88%, 25%, and 30% of study populations met PASS for mHHS, HOS-ADL, and HOS-SS, respectively, and 97%, 90%, and 93% met MCID. On bivariate analysis, increasing age was associated with significantly worse postoperative mHHS (P < .01, R(2) = 0.14), HOS-SS (P = .05, R(2) = 0.12), and rates of reoperation (P = .02, R(2) = 0.08). Increasing body mass index was associated with significantly worse HOS-ADL (P = .02, R(2) = 0.35) and HOS-SS (P = .03, R(2) = 0.30). In this meta-analysis of 81 studies of primary hip arthroscopy, we have found that more than 90% of study populations meet MCID standards for the most commonly used patient-reported outcomes measures in hip arthroscopy literature, mHHS and HOS. Eighty-eight percent meet PASS standards for the mHHS, but PASS standards are far more difficult to achieve for HOS-ADL (25%) and HOS-SS (30%) subscales. Differences in psychometric properties of the mHHS and HOS likely account for the discrepancies in PASS. Level IV, systematic review of Level I to IV studies. Copyright © 2016

Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry

PubMed Central

Soh, Kah Teong; Tario, Joseph D.; Wallace, Paul K.

2018-01-01

Synopsis Plasma cell dyscrasia (PCD) is a heterogeneous disease which has seen a tremendous change in outcomes due to improved therapies. Over the last few decades, multiparametric flow cytometry has played an important role in the detection and monitoring of PCDs. Flow cytometry is a high sensitivity assay for early detection of minimal residual disease (MRD) that correlates well with progression-free survival and overall survival. Before flow cytometry can be effectively implemented in the clinical setting sample preparation, panel configuration, analysis, and gating strategies must be optimized to ensure accurate results. Current consensus methods and reporting guidelines for MRD testing are discussed. PMID:29128071

[Precise application of Traditional Chinese Medicine in minimally-invasive techniques].

PubMed

Dong, Fu-Hui

2018-06-25

runs along the different layers of tissue. The types of stimulation include: meridian acupoint stimulation; cutaneous stimulation; fascia stimulation; mucle stimulation; periosteum stimulation. The clinical application of these techniques has enriched the drug-free therapies of traditional Chinese medicine and achieved excellent outcomes, but at the same time it also raises an important question. How can we apply these minimally invasive techniques to clinical practice so it can be safe and effective? In addition, how can practitioners, individually and further develop their understanding of this minimally invasive technique progressive manner? We make the following recommendations. (1)Clear diagnosis and precise application. Any approach has specific indications and choosing the correct technique comes from a comprehensive understanding of its advantages and disadvantages. Moreover, the accurate application of the technique depends the expertise of the practitioner. Through systematic review and clinical observation, we formulated the First Line Treatment, the Second Line Treatment, and the Third Line Treatment for specific conditions. Using the information gathered from research, practitioners can decide on which point is appropriate to use based on the stage of disease progression. For example, common conditions like the nerve ending tension pain(i.e. cutaneous nerve entrapment syndrome) is caused by stress concentration. There are two types of treatment for this condition: ¹Change in the response to stress state (i.e.non-invasive approach such as manual therapy and physiotherapy). ²Change in state of surrounding environment (i.e. invasive approach such as Pi Needle). Before tissue texture changes to pain point, cord, nodules, the former approach is effective. Once tissue texture changes, the latter approach is First Line Treatment. (2)Systematic training and disease progression training. The minimally invasive techniques of traditional Chinese medicine can treat

Minimally Invasive Surgery in Gastrointestinal Cancer: Benefits, Challenges, and Solutions for Underutilization

PubMed Central

Gusani, Niraj J.; Kimchi, Eric T.; Kavic, Stephen M.

2014-01-01

Background and Objectives: After the widespread application of minimally invasive surgery for benign diseases and given its proven safety and efficacy, minimally invasive surgery for gastrointestinal cancer has gained substantial attention in the past several years. Despite the large number of publications on the topic and level I evidence to support its use in colon cancer, minimally invasive surgery for most gastrointestinal malignancies is still underused. Methods: We explore some of the challenges that face the fusion of minimally invasive surgery technology in the management of gastrointestinal malignancies and propose solutions that may help increase the utilization in the future. These solutions are based on extensive literature review, observation of current trends and practices in this field, and discussion made with experts in the field. Results: We propose 4 different solutions to increase the use of minimally invasive surgery in the treatment of gastrointestinal malignancies: collaboration between surgical oncologists/hepatopancreatobiliary surgeons and minimally invasive surgeons at the same institution; a single surgeon performing 2 fellowships in surgical oncology/hepatopancreatobiliary surgery and minimally invasive surgery; establishing centers of excellence in minimally invasive gastrointestinal cancer management; and finally, using robotic technology to help with complex laparoscopic skills. Conclusions: Multiple studies have confirmed the utility of minimally invasive surgery techniques in dealing with patients with gastrointestinal malignancies. However, training continues to be the most important challenge that faces the use of minimally invasive surgery in the management of gastrointestinal malignancy; implementation of our proposed solutions may help increase the rate of adoption in the future. PMID:25489209

The R35 residue of the influenza A virus NS1 protein has minimal effects on nuclear localization but alters virus replication through disrupting protein dimerization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lalime, Erin N.; Pekosz, Andrew, E-mail: apekosz@jhsph.edu

The influenza A virus NS1 protein has a nuclear localization sequence (NLS) in the amino terminal region. This NLS overlaps sequences that are important for RNA binding as well as protein dimerization. To assess the significance of the NS1 NLS on influenza virus replication, the NLS amino acids were individually mutated to alanines and recombinant viruses encoding these mutations were rescued. Viruses containing NS1 proteins with mutations at R37, R38 and K41 displayed minimal changes in replication or NS1 protein nuclear localization. Recombinant viruses encoding NS1 R35A were not recovered but viruses containing second site mutations at position D39 inmore » addition to the R35A mutation were isolated. The mutations at position 39 were shown to partially restore NS1 protein dimerization but had minimal effects on nuclear localization. These data indicate that the amino acids in the NS1 NLS region play a more important role in protein dimerization compared to nuclear localization. - Highlights: • Mutations were introduced into influenza NS1 NLS1. • NS1 R37A, R38A, K41A viruses had minimal changes in replication and NS1 localization. • Viruses from NS1 R35A rescue all contained additional mutations at D39. • NS1 R35A D39X mutations recover dimerization lost in NS1 R35A mutations. • These results reaffirm the importance of dimerization for NS1 protein function.« less

Activity recognition from minimal distinguishing subsequence mining

NASA Astrophysics Data System (ADS)

Iqbal, Mohammad; Pao, Hsing-Kuo

2017-08-01

Human activity recognition is one of the most important research topics in the era of Internet of Things. To separate different activities given sensory data, we utilize a Minimal Distinguishing Subsequence (MDS) mining approach to efficiently find distinguishing patterns among different activities. We first transform the sensory data into a series of sensor triggering events and operate the MDS mining procedure afterwards. The gap constraints are also considered in the MDS mining. Given the multi-class nature of most activity recognition tasks, we modify the MDS mining approach from a binary case to a multi-class one to fit the need for multiple activity recognition. We also study how to select the best parameter set including the minimal and the maximal support thresholds in finding the MDSs for effective activity recognition. Overall, the prediction accuracy is 86.59% on the van Kasteren dataset which consists of four different activities for recognition.

Unbalanced and Minimal Point Equivalent Estimation Second-Order Split-Plot Designs

NASA Technical Reports Server (NTRS)

Parker, Peter A.; Kowalski, Scott M.; Vining, G. Geoffrey

2007-01-01

Restricting the randomization of hard-to-change factors in industrial experiments is often performed by employing a split-plot design structure. From an economic perspective, these designs minimize the experimental cost by reducing the number of resets of the hard-to- change factors. In this paper, unbalanced designs are considered for cases where the subplots are relatively expensive and the experimental apparatus accommodates an unequal number of runs per whole-plot. We provide construction methods for unbalanced second-order split- plot designs that possess the equivalence estimation optimality property, providing best linear unbiased estimates of the parameters; independent of the variance components. Unbalanced versions of the central composite and Box-Behnken designs are developed. For cases where the subplot cost approaches the whole-plot cost, minimal point designs are proposed and illustrated with a split-plot Notz design.

Minimal but non-minimal inflation and electroweak symmetry breaking

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marzola, Luca; Institute of Physics, University of Tartu,Ravila 14c, 50411 Tartu; Racioppi, Antonio

2016-10-07

We consider the most minimal scale invariant extension of the standard model that allows for successful radiative electroweak symmetry breaking and inflation. The framework involves an extra scalar singlet, that plays the rôle of the inflaton, and is compatibile with current experimental bounds owing to the non-minimal coupling of the latter to gravity. This inflationary scenario predicts a very low tensor-to-scalar ratio r≈10{sup −3}, typical of Higgs-inflation models, but in contrast yields a scalar spectral index n{sub s}≃0.97 which departs from the Starobinsky limit. We briefly discuss the collider phenomenology of the framework.

7 CFR 1c.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2011 CFR

2011-01-01

... research involving no more than minimal risk, and for minor changes in approved research. 1c.110 Section 1c... review procedures for certain kinds of research involving no more than minimal risk, and for minor changes in approved research. (a) The Secretary, HHS, has established, and published as a Notice in the...

Minimization of color shift generated in RGBW quad structure.

NASA Astrophysics Data System (ADS)

Kim, Hong Chul; Yun, Jae Kyeong; Baek, Heume-Il; Kim, Ki Duk; Oh, Eui Yeol; Chung, In Jae

2005-03-01

The purpose of RGBW Quad Structure Technology is to realize higher brightness than that of normal panel (RGB stripe structure) by adding white sub-pixel to existing RGB stripe structure. However, there is side effect called 'color shift' resulted from increasing brightness. This side effect degrades general color characteristics due to change of 'Hue', 'Brightness' and 'Saturation' as compared with existing RGB stripe structure. Especially, skin-tone colors show a tendency to get darker in contrast to normal panel. We"ve tried to minimize 'color shift' through use of LUT (Look Up Table) for linear arithmetic processing of input data, data bit expansion to 12-bit for minimizing arithmetic tolerance and brightness weight of white sub-pixel on each R, G, B pixel. The objective of this study is to minimize and keep Δu'v' value (we commonly use to represent a color difference), quantitative basis of color difference between RGB stripe structure and RGBW quad structure, below 0.01 level (existing 0.02 or higher) using Macbeth colorchecker that is general reference of color characteristics.

Building Environmental Awareness: Teaching Campers To Minimize Their Impact.

ERIC Educational Resources Information Center

Henchey, Kathy; Carvajal, Michelle

2000-01-01

Three activities are described to teach campers the importance of minimizing their impact on the environment. Soil Buggy Bingo shows fire's impact on living things in the soil; Food Web demonstrates how everything in an ecosystem is interconnected; and Camouflaging--Field versus Woods shows the difference between wooded and cleared areas in the…

Rationally reduced libraries for combinatorial pathway optimization minimizing experimental effort.

PubMed

Jeschek, Markus; Gerngross, Daniel; Panke, Sven

2016-03-31

Rational flux design in metabolic engineering approaches remains difficult since important pathway information is frequently not available. Therefore empirical methods are applied that randomly change absolute and relative pathway enzyme levels and subsequently screen for variants with improved performance. However, screening is often limited on the analytical side, generating a strong incentive to construct small but smart libraries. Here we introduce RedLibs (Reduced Libraries), an algorithm that allows for the rational design of smart combinatorial libraries for pathway optimization thereby minimizing the use of experimental resources. We demonstrate the utility of RedLibs for the design of ribosome-binding site libraries by in silico and in vivo screening with fluorescent proteins and perform a simple two-step optimization of the product selectivity in the branched multistep pathway for violacein biosynthesis, indicating a general applicability for the algorithm and the proposed heuristics. We expect that RedLibs will substantially simplify the refactoring of synthetic metabolic pathways.

Time-varying parameter models for catchments with land use change: the importance of model structure

NASA Astrophysics Data System (ADS)

Pathiraja, Sahani; Anghileri, Daniela; Burlando, Paolo; Sharma, Ashish; Marshall, Lucy; Moradkhani, Hamid

2018-05-01

Rapid population and economic growth in Southeast Asia has been accompanied by extensive land use change with consequent impacts on catchment hydrology. Modeling methodologies capable of handling changing land use conditions are therefore becoming ever more important and are receiving increasing attention from hydrologists. A recently developed data-assimilation-based framework that allows model parameters to vary through time in response to signals of change in observations is considered for a medium-sized catchment (2880 km2) in northern Vietnam experiencing substantial but gradual land cover change. We investigate the efficacy of the method as well as the importance of the chosen model structure in ensuring the success of a time-varying parameter method. The method was used with two lumped daily conceptual models (HBV and HyMOD) that gave good-quality streamflow predictions during pre-change conditions. Although both time-varying parameter models gave improved streamflow predictions under changed conditions compared to the time-invariant parameter model, persistent biases for low flows were apparent in the HyMOD case. It was found that HyMOD was not suited to representing the modified baseflow conditions, resulting in extreme and unrealistic time-varying parameter estimates. This work shows that the chosen model can be critical for ensuring the time-varying parameter framework successfully models streamflow under changing land cover conditions. It can also be used to determine whether land cover changes (and not just meteorological factors) contribute to the observed hydrologic changes in retrospective studies where the lack of a paired control catchment precludes such an assessment.

The importance of parameterization when simulating the hydrologic response of vegetative land-cover change

NASA Astrophysics Data System (ADS)

White, Jeremy; Stengel, Victoria; Rendon, Samuel; Banta, John

2017-08-01

Computer models of hydrologic systems are frequently used to investigate the hydrologic response of land-cover change. If the modeling results are used to inform resource-management decisions, then providing robust estimates of uncertainty in the simulated response is an important consideration. Here we examine the importance of parameterization, a necessarily subjective process, on uncertainty estimates of the simulated hydrologic response of land-cover change. Specifically, we applied the soil water assessment tool (SWAT) model to a 1.4 km2 watershed in southern Texas to investigate the simulated hydrologic response of brush management (the mechanical removal of woody plants), a discrete land-cover change. The watershed was instrumented before and after brush-management activities were undertaken, and estimates of precipitation, streamflow, and evapotranspiration (ET) are available; these data were used to condition and verify the model. The role of parameterization in brush-management simulation was evaluated by constructing two models, one with 12 adjustable parameters (reduced parameterization) and one with 1305 adjustable parameters (full parameterization). Both models were subjected to global sensitivity analysis as well as Monte Carlo and generalized likelihood uncertainty estimation (GLUE) conditioning to identify important model inputs and to estimate uncertainty in several quantities of interest related to brush management. Many realizations from both parameterizations were identified as behavioral in that they reproduce daily mean streamflow acceptably well according to Nash-Sutcliffe model efficiency coefficient, percent bias, and coefficient of determination. However, the total volumetric ET difference resulting from simulated brush management remains highly uncertain after conditioning to daily mean streamflow, indicating that streamflow data alone are not sufficient to inform the model inputs that influence the simulated outcomes of brush

The importance of hydrological uncertainty assessment methods in climate change impact studies

NASA Astrophysics Data System (ADS)

Honti, M.; Scheidegger, A.; Stamm, C.

2014-08-01

Climate change impact assessments have become more and more popular in hydrology since the middle 1980s with a recent boost after the publication of the IPCC AR4 report. From hundreds of impact studies a quasi-standard methodology has emerged, to a large extent shaped by the growing public demand for predicting how water resources management or flood protection should change in the coming decades. The "standard" workflow relies on a model cascade from global circulation model (GCM) predictions for selected IPCC scenarios to future catchment hydrology. Uncertainty is present at each level and propagates through the model cascade. There is an emerging consensus between many studies on the relative importance of the different uncertainty sources. The prevailing perception is that GCM uncertainty dominates hydrological impact studies. Our hypothesis was that the relative importance of climatic and hydrologic uncertainty is (among other factors) heavily influenced by the uncertainty assessment method. To test this we carried out a climate change impact assessment and estimated the relative importance of the uncertainty sources. The study was performed on two small catchments in the Swiss Plateau with a lumped conceptual rainfall runoff model. In the climatic part we applied the standard ensemble approach to quantify uncertainty but in hydrology we used formal Bayesian uncertainty assessment with two different likelihood functions. One was a time series error model that was able to deal with the complicated statistical properties of hydrological model residuals. The second was an approximate likelihood function for the flow quantiles. The results showed that the expected climatic impact on flow quantiles was small compared to prediction uncertainty. The choice of uncertainty assessment method actually determined what sources of uncertainty could be identified at all. This demonstrated that one could arrive at rather different conclusions about the causes behind

Collision-avoidance behaviors of minimally restrained flying locusts to looming stimuli

PubMed Central

Chan, R. WM.; Gabbiani, F.

2013-01-01

SUMMARY Visually guided collision avoidance is of paramount importance in flight, for instance to allow escape from potential predators. Yet, little is known about the types of collision-avoidance behaviors that may be generated by flying animals in response to an impending visual threat. We studied the behavior of minimally restrained locusts flying in a wind tunnel as they were subjected to looming stimuli presented to the side of the animal, simulating the approach of an object on a collision course. Using high-speed movie recordings, we observed a wide variety of collision-avoidance behaviors including climbs and dives away from – but also towards – the stimulus. In a more restrained setting, we were able to relate kinematic parameters of the flapping wings with yaw changes in the trajectory of the animal. Asymmetric wing flapping was most strongly correlated with changes in yaw, but we also observed a substantial effect of wing deformations. Additionally, the effect of wing deformations on yaw was relatively independent of that of wing asymmetries. Thus, flying locusts exhibit a rich range of collision-avoidance behaviors that depend on several distinct aerodynamic characteristics of wing flapping flight. PMID:23364572

The changing brain: Neuroscience and the enduring import of everyday experience

PubMed Central

Martin, Paul; Cunningham-Burley, Sarah

2015-01-01

Discourses of ‘neuroplasticity’ have become increasingly apparent in the neurosciences and wider society. These connect with broader narratives about the ‘changing brain’ throughout the life-course. Here, we explore their presence in the talk of a range of publics. Their presence is indicative of how novel neuroscience is accepted, or not, by our participants. In particular, we suggest that any acceptance of the science relates to their personal and/or professional experiences of change (to their own or others’ subjectivities) rather than to some intrinsic and widely-held significance of scientific concepts per se. Accordingly, we also submit that it is in part through the congruence of some neuroscientific claims to everyday experiences and perspectives that the former are rendered legible and salient. In this respect, ‘lay’ knowledge has considerable import for the wider cultural authorisation of that of ‘experts’. PMID:24598481

Sequentially reweighted TV minimization for CT metal artifact reduction.

PubMed

Zhang, Xiaomeng; Xing, Lei

2013-07-01

Metal artifact reduction has long been an important topic in x-ray CT image reconstruction. In this work, the authors propose an iterative method that sequentially minimizes a reweighted total variation (TV) of the image and produces substantially artifact-reduced reconstructions. A sequentially reweighted TV minimization algorithm is proposed to fully exploit the sparseness of image gradients (IG). The authors first formulate a constrained optimization model that minimizes a weighted TV of the image, subject to the constraint that the estimated projection data are within a specified tolerance of the available projection measurements, with image non-negativity enforced. The authors then solve a sequence of weighted TV minimization problems where weights used for the next iteration are computed from the current solution. Using the complete projection data, the algorithm first reconstructs an image from which a binary metal image can be extracted. Forward projection of the binary image identifies metal traces in the projection space. The metal-free background image is then reconstructed from the metal-trace-excluded projection data by employing a different set of weights. Each minimization problem is solved using a gradient method that alternates projection-onto-convex-sets and steepest descent. A series of simulation and experimental studies are performed to evaluate the proposed approach. Our study shows that the sequentially reweighted scheme, by altering a single parameter in the weighting function, flexibly controls the sparsity of the IG and reconstructs artifacts-free images in a two-stage process. It successfully produces images with significantly reduced streak artifacts, suppressed noise and well-preserved contrast and edge properties. The sequentially reweighed TV minimization provides a systematic approach for suppressing CT metal artifacts. The technique can also be generalized to other "missing data" problems in CT image reconstruction.

Qualitative properties of the minimal model of carbon circulation in the biosphere

NASA Astrophysics Data System (ADS)

Pestunov, Aleksandr; Fedotov, Anatoliy; Medvedev, Sergey

2014-05-01

Substantial changes in the biosphere during recent decades have caused legitimate concern in the international community. The fact that feedbacks between the atmospheric CO2 concentration, global temperature, permafrost, ocean CO2 concentration and air humidity increases the risk of catastrophic phenomena on the planetary scale. The precautionary principle allows us to consider greenhouse effect using the mathematical models of the biosphere-climate system. Minimal models do not allow us to make a quantitative description of the "biosphere-climate" system dynamics, which is determined by the aggregate effect of the set of known climatic and biosphere processes. However, the study of such models makes it possible to understand the qualitative mechanisms of biosphere processes and to evaluate their possible consequences. The global minimal model of long-term dynamics of carbon in biosphere is considered basing on assumption that anthropogenous carbon emissions in atmosphere are absent [1]. Qualitative analysis of the model shows that there exists a set of model parameters (taken from the current estimation ranges), such that the system becomes unstable. It is also shown that external influences on the carbon circulation can lead either to degradation of the biosphere or to global temperature change [2]. This work is aimed at revealing the conditions under which the biosphere model can become unstable, which can result in catastrophic changes in the Earth's biogeocenoses. The minimal model of the biosphere-climate system describes an improbable, but, nevertheless, a possible worst-case scenario of the biosphere evolution takes into consideration only the most dangerous biosphere mechanisms and ignores some climate feedbacks (such as transpiration). This work demonstrates the possibility of implementing the trigger mode in the biosphere, which can lead to dramatic changes in the state of the biosphere even without additional burning of fossil fuels. This mode

White Matter Integrity and Treatment-Based Change in Speech Performance in Minimally Verbal Children with Autism Spectrum Disorder.

PubMed

Chenausky, Karen; Kernbach, Julius; Norton, Andrea; Schlaug, Gottfried

2017-01-01

We investigated the relationship between imaging variables for two language/speech-motor tracts and speech fluency variables in 10 minimally verbal (MV) children with autism. Specifically, we tested whether measures of white matter integrity-fractional anisotropy (FA) of the arcuate fasciculus (AF) and frontal aslant tract (FAT)-were related to change in percent syllable-initial consonants correct, percent items responded to, and percent syllable insertion errors (from best baseline to post 25 treatment sessions). Twenty-three MV children with autism spectrum disorder (ASD) received Auditory-Motor Mapping Training (AMMT), an intonation-based treatment to improve fluency in spoken output, and we report on seven who received a matched control treatment. Ten of the AMMT participants were able to undergo a magnetic resonance imaging study at baseline; their performance on baseline speech production measures is compared to that of the other two groups. No baseline differences were found between groups. A canonical correlation analysis (CCA) relating FA values for left- and right-hemisphere AF and FAT to speech production measures showed that FA of the left AF and right FAT were the largest contributors to the synthetic independent imaging-related variable. Change in percent syllable-initial consonants correct and percent syllable-insertion errors were the largest contributors to the synthetic dependent fluency-related variable. Regression analyses showed that FA values in left AF significantly predicted change in percent syllable-initial consonants correct, no FA variables significantly predicted change in percent items responded to, and FA of right FAT significantly predicted change in percent syllable-insertion errors. Results are consistent with previously identified roles for the AF in mediating bidirectional mapping between articulation and acoustics, and the FAT in its relationship to speech initiation and fluency. They further suggest a division of labor between

[COMPARISON OF EFFECTIVENESS AND CHANGE OF SAGITTAL SPINO-PELVIC PARAMETERS BETWEEN MINIMALLY INVASIVE TRANSFORAMINAL AND CONVENTIONAL OPEN POSTERIOR LUMBAR INTERBODY FUSIONS IN TREATMENT OF LOW-DEGREE ISTHMIC LUMBAR SPONDYLOLISTHESIS].

PubMed

Sun, Xin; Zeng, Rong; Li, Guangsheng; Wei, Bo; Hu, Zibing; Lin, Hao; Chen, Guanghua; Chen, Siyuan; Sun, Jiecong

2015-12-01

To compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis. Between May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree I or II) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done. Primary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1 ± 1.6) days] was significantly shorter than that of open group [(7.2 ± 2.1) days] (t = 2.593, P = 0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53% ± 20.52% in minimally invasive group, and was 64.21% ± 30.21% in open group, showing no significant difference (t = 0.725, P = 0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The postoperative other sagittal spino

Using Isolated Mitochondria from Minimal Quantities of Mouse Skeletal Muscle for High throughput Microplate Respiratory Measurements.

PubMed

Boutagy, Nabil E; Rogers, George W; Pyne, Emily S; Ali, Mostafa M; Hulver, Matthew W; Frisard, Madlyn I

2015-10-30

Skeletal muscle mitochondria play a specific role in many disease pathologies. As such, the measurement of oxygen consumption as an indicator of mitochondrial function in this tissue has become more prevalent. Although many technologies and assays exist that measure mitochondrial respiratory pathways in a variety of cells, tissue and species, there is currently a void in the literature in regards to the compilation of these assays using isolated mitochondria from mouse skeletal muscle for use in microplate based technologies. Importantly, the use of microplate based respirometric assays is growing among mitochondrial biologists as it allows for high throughput measurements using minimal quantities of isolated mitochondria. Therefore, a collection of microplate based respirometric assays were developed that are able to assess mechanistic changes/adaptations in oxygen consumption in a commonly used animal model. The methods presented herein provide step-by-step instructions to perform these assays with an optimal amount of mitochondrial protein and reagents, and high precision as evidenced by the minimal variance across the dynamic range of each assay.

Important features of Sustainable Aggregate Resource Management

USGS Publications Warehouse

Solar, Slavko V.; Shields, Deborah J.; Langer, William H.

2004-01-01

Every society, whether developed, developing or in a phase of renewal following governmental change, requires stable, adequate and secure supplies of natural resources. In the latter case, there could be significant need for construction materials for rebuilding infrastructure, industrial capacity, and housing. It is essential that these large-volume materials be provided in a rational manner that maximizes their societal contribution and minimizes environmental impacts. We describe an approach to resource management based on the principles of sustainable developed. Sustainable Aggregate Resource Management offers a way of addressing the conflicting needs and interests of environmental, economic, and social systems. Sustainability is an ethics based concept that utilizes science and democratic processes to reach acceptable agreements and tradeoffs among interests, while acknowledging the fundamental importance of the environment and social goods. We discuss the features of sustainable aggregate resource management.

Minimally invasive surgery of the anterior skull base: transorbital approaches

PubMed Central

Gassner, Holger G.; Schwan, Franziska; Schebesch, Karl-Michael

2016-01-01

Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach. PMID:27453759

Minimizing impacts of land use change on ecosystem services using multi-criteria heuristic analysis.

PubMed

Keller, Arturo A; Fournier, Eric; Fox, Jessica

2015-06-01

Development of natural landscapes to support human activities impacts the capacity of the landscape to provide ecosystem services. Typically, several ecosystem services are impacted at a single development site and various footprint scenarios are possible, thus a multi-criteria analysis is needed. Restoration potential should also be considered for the area surrounding the permanent impact site. The primary objective of this research was to develop a heuristic approach to analyze multiple criteria (e.g. impacts to various ecosystem services) in a spatial configuration with many potential development sites. The approach was to: (1) quantify the magnitude of terrestrial ecosystem service (biodiversity, carbon sequestration, nutrient and sediment retention, and pollination) impacts associated with a suite of land use change scenarios using the InVEST model; (2) normalize results across categories of ecosystem services to allow cross-service comparison; (3) apply the multi-criteria heuristic algorithm to select sites with the least impact to ecosystem services, including a spatial criterion (separation between sites). As a case study, the multi-criteria impact minimization algorithm was applied to InVEST output to select 25 potential development sites out of 204 possible locations (selected by other criteria) within a 24,000 ha property. This study advanced a generally applicable spatial multi-criteria approach for 1) considering many land use footprint scenarios, 2) balancing impact decisions across a suite of ecosystem services, and 3) determining the restoration potential of ecosystem services after impacts. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Use of glutaraldehyde and benzalkonium chloride for minimizing post-harvest physio-chemical and microbial changes responsible for sucrose losses in sugar cane.

PubMed

Singh, Pushpa; Arya, Namita; Tiwari, Priyanka; Suman, Archna; Rai, R K; Shrivastava, A K; Solomon, S

2008-08-27

Sugar cane is sensitive to enormous sucrose losses induced by physio-chemical and microbial changes, the severity being increased during the time lag between harvest and crushing in the mills. Minimization of the sucrose losses in the field is essential for better sugar recovery and prevention of sucrose losses. An experiment was conducted to evaluate the efficacy of glutaraldehyde and benzalkonium chloride for their effects on the microbial counts and physio-chemical changes responsible for sucrose losses. Glutaraldehyde and benzalkonium chloride (1000 + 250 ppm) reduced the losses in sucrose content to 7.1% as compared to the 30.8% loss in the control, thus improving the performance by 76.9%. The application of chemicals reduced the acid invertase activity (by 60%), lowered weight loss, titrable acidity, reducing sugars content, dextran, ethanol, and ethylene production and respiration rates. The application led to the reduction in the total bacterial, fungal, Leuconostoc, and yeast counts by 67.92, 51.3%, 26.08, and 51.2%, respectively.

Multi-Objective Flight Control for Drag Minimization and Load Alleviation of High-Aspect Ratio Flexible Wing Aircraft

NASA Technical Reports Server (NTRS)

Nguyen, Nhan; Ting, Eric; Chaparro, Daniel; Drew, Michael; Swei, Sean

2017-01-01

As aircraft wings become much more flexible due to the use of light-weight composites material, adverse aerodynamics at off-design performance can result from changes in wing shapes due to aeroelastic deflections. Increased drag, hence increased fuel burn, is a potential consequence. Without means for aeroelastic compensation, the benefit of weight reduction from the use of light-weight material could be offset by less optimal aerodynamic performance at off-design flight conditions. Performance Adaptive Aeroelastic Wing (PAAW) technology can potentially address these technical challenges for future flexible wing transports. PAAW technology leverages multi-disciplinary solutions to maximize the aerodynamic performance payoff of future adaptive wing design, while addressing simultaneously operational constraints that can prevent the optimal aerodynamic performance from being realized. These operational constraints include reduced flutter margins, increased airframe responses to gust and maneuver loads, pilot handling qualities, and ride qualities. All of these constraints while seeking the optimal aerodynamic performance present themselves as a multi-objective flight control problem. The paper presents a multi-objective flight control approach based on a drag-cognizant optimal control method. A concept of virtual control, which was previously introduced, is implemented to address the pair-wise flap motion constraints imposed by the elastomer material. This method is shown to be able to satisfy the constraints. Real-time drag minimization control is considered to be an important consideration for PAAW technology. Drag minimization control has many technical challenges such as sensing and control. An initial outline of a real-time drag minimization control has already been developed and will be further investigated in the future. A simulation study of a multi-objective flight control for a flight path angle command with aeroelastic mode suppression and drag

Microenvironmental changes in the progression from adenocarcinoma in situ to minimally invasive adenocarcinoma and invasive lepidic predominant adenocarcinoma of the lung.

PubMed

Naito, Masahito; Aokage, Keiju; Saruwatari, Kouichi; Hisakane, Kakeru; Miyoshi, Tomohiro; Hishida, Tomoyuki; Yoshida, Junji; Masato, Sugano; Kojima, Motohiro; Kuwata, Takeshi; Fujii, Satoshi; Ochiai, Atsushi; Sato, Yukitoshi; Tsuboi, Masahiro; Ishii, Genichiro

2016-10-01

Invasive lepidic predominant adenocarcinoma (LPA) of the lung is thought to progress in a stepwise fashion from adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA). The aim of this study was to investigate the microenvironmental changes during the development from AIS to LPA. Clinicopathological characteristics of AIS (n=51), MIA (n=59), LPA smaller than 3cm (LPA-S, n=113), and LPA larger than 3cm (LPA-L, n=47) were analyzed. We then evaluated the expression levels of epithelial-mesenchymal transition (EMT)-related molecules (E-cadherin, S100A4), invasion-related molecules (laminin-5, ezrin), stem-cell-related molecules (ALDH-1), and growth factor receptors (c-Met, EGFR) in cancer cells of each group (n=20). The number of tumor-promoting stromal cells, including podoplanin-positive cancer-associated fibroblasts (PDPN+ CAFs), CD204-positive tumor-associated macrophages (CD204+ TAMs), and CD34+ microvessel cells, were also analyzed. No significant difference in these characteristics was found between LPA-S and LPA-L. Laminin-5 expression in the non-invasive carcinoma component of MIA was significantly higher than that of AIS (p<0.001). During the progression from MIA to LPA-S, the expression level of laminin-5 in the invasive carcinoma component was significantly elevated (p<0.01). Moreover, tumor-promoting stromal cells were more frequently recruited in the invasive area of LPA-S (PDPN+ CAFs; p<0.05, CD204+ TAMs; p<0.001, CD34+ microvessel; p<0.05). Ezrin expression in the invasive carcinoma component of LPA-L was significantly increased (p<0.05) compared to LPA-S; however, the number of tumor-promoting stromal cells were not different between these two groups. Our current results indicated that microenvironmental molecular changes occur during the progression from MIA to LPA-S and suggested that this process may play an important role in disease progression from AIS to LPA. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Dangerous climate change and the importance of adaptation for the Arctic's Inuit population

NASA Astrophysics Data System (ADS)

Ford, James D.

2009-04-01

The Arctic's climate is changing rapidly, to the extent that 'dangerous' climate change as defined by the United Nations Framework on Climate Change might already be occurring. These changes are having implications for the Arctic's Inuit population and are being exacerbated by the dependence of Inuit on biophysical resources for livelihoods and the low socio-economic-health status of many northern communities. Given the nature of current climate change and projections of a rapidly warming Arctic, climate policy assumes a particular importance for Inuit regions. This paper argues that efforts to stabilize and reduce greenhouse gas emissions are urgent if we are to avoid runaway climate change in the Arctic, but unlikely to prevent changes which will be dangerous for Inuit. In this context, a new policy discourse on climate change is required for Arctic regions—one that focuses on adaptation. The paper demonstrates that states with Inuit populations and the international community in general has obligations to assist Inuit to adapt to climate change through international human rights and climate change treaties. However, the adaptation deficit, in terms of what we know and what we need to know to facilitate successful adaptation, is particularly large in an Arctic context and limiting the ability to develop response options. Moreover, adaptation as an option of response to climate change is still marginal in policy negotiations and Inuit political actors have been slow to argue the need for adaptation assistance. A new focus on adaptation in both policy negotiations and scientific research is needed to enhance Inuit resilience and reduce vulnerability in a rapidly changing climate.

Structural changes in the minimal spanning tree and the hierarchical network in the Korean stock market around the global financial crisis

NASA Astrophysics Data System (ADS)

Nobi, Ashadun; Maeng, Seong Eun; Ha, Gyeong Gyun; Lee, Jae Woo

2015-04-01

This paper considers stock prices in the Korean stock market during the 2008 global financial crisis by focusing on three time periods: before, during, and after the crisis. Complex networks are extracted from cross-correlation coefficients between the normalized logarithmic return of the stock price time series of firms. The minimal spanning trees (MSTs) and the hierarchical network (HN) are generated from cross-correlation coefficients. Before and after the crisis, securities firms are located at the center of the MST. During the crisis, however, the center of the MST changes to a firm in heavy industry and construction. During the crisis, the MST shrinks in comparison to that before and that after the crisis. This topological change in the MST during the crisis reflects a distinct effect of the global financial crisis. The cophenetic correlation coefficient increases during the crisis, indicating an increase in the hierarchical structure during in this period. When crisis hits the market, firms behave synchronously, and their correlations are higher than those during a normal period.

The importance of role sending in the sensemaking of change agent roles.

PubMed

Tucker, Danielle A; Hendy, Jane; Barlow, James

2015-01-01

The purpose of this paper is to investigate what happens when a lack of role-sending results in ambiguous change agent roles during a large scale organisational reconfiguration. The authors consider the role of sensemaking in resolving role ambiguity of middle manager change agents and the consequences of this for organisational restructuring. Data were collected from a case study analysis of significant organisational reconfiguration across a local National Health Service Trust in the UK. Data consists of 82 interviews, complemented by analysis of over 100 documents and field notes from 51 hours of observations collected over five phases covering a three year period before, during and after the reconfiguration. An inductive qualitative analysis revealed the sensemaking processes by which ambiguity in role definition was resolved. The data explains how change agents collectively make sense of a role in their own way, drawing on their own experiences and views as well as cues from other organisational members. The authors also identified the organisational outcomes which resulted from this freedom in sensemaking. This study demonstrates that by leaving too much flexibility in the definition of the role, agents developed their own sensemaking which was subsequently very difficult to manipulate. In creating new roles, management first needs to have a realistic vision of the task and roles that their agents will perform, and second, to communicate these expectations to both those responsible for recruiting these roles and to the agents themselves. Much of the focus in sensemaking research has been on the importance of change agents' sensemaking of the change but there has been little focus on how change agents sensemake their own role in the change.

Ramadan and sport: minimizing effects upon the observant athlete.

PubMed

Shephard, Roy J

2013-12-01

exercise is impaired, but aerobic power and muscular strength show little change during Ramadan. Ratings of fatigue are increased, and vigilance and reaction times are impaired, particularly during the afternoon. Medical issues during Ramadan are few. Athletes with diabetes mellitus should seek a medical exemption from fasting, and prescribed drug schedules should be carefully maintained. There is no major increase of injury rates, but competitors may have difficulty in producing urine for doping controls. Logical measures to minimize the effects of Ramadan include the optimization of mood state, maintenance of training, minimization of sleep loss, appropriate adjustments of diet, and the monitoring of competitors for chronic dehydration. Future research should concentrate on the changes observed in top athletes, particularly women, with data collected in the late afternoon after a known period of fasting in a well defined environment. It will be important to ensure that the lifestyle of those studied has been optimized. Implications of chronic dehydration for doping control also merit further investigation. Current data suggest that the impact of Ramadan upon athletic performance is small relative to the precision of test procedures, although it may be sufficient to cause a loss of medals. Negative effects vary widely with the type of sport, the season when fasting is observed, the local culture and the discipline exercised by the athlete.

Minimally invasive treatment for localized prostate cancer.

PubMed

Porres, D; Pfister, D; Heidenreich, A

2012-12-01

The vast majority of men newly diagnosed with prostate cancer have clinically localized disease. Besides active surveillance in low risk cancers and open radical prostatectomy as the traditional gold standard more and more patients demand a effective tumor control through a minimally invasive approach. After the introduction of laparoscopy for the treatment of prostate cancer especially the robot-assisted radical prostatectomy gained in importance. In recent years the accuracy for cancer localisation within the prostate was considerably improved, which enables the increasing use of focal therapy techniques. In addition to the robot-assisted and conventional laparoscopic radical prostatectomy the current and future importance of cryotherapy, HIFU and vascular targeted photodynamic therapy for localized prostate cancer will be analyzed in the following review article.

The importance of parameterization when simulating the hydrologic response of vegetative land-cover change

USGS Publications Warehouse

White, Jeremy; Stengel, Victoria G.; Rendon, Samuel H.; Banta, John

2017-01-01

Computer models of hydrologic systems are frequently used to investigate the hydrologic response of land-cover change. If the modeling results are used to inform resource-management decisions, then providing robust estimates of uncertainty in the simulated response is an important consideration. Here we examine the importance of parameterization, a necessarily subjective process, on uncertainty estimates of the simulated hydrologic response of land-cover change. Specifically, we applied the soil water assessment tool (SWAT) model to a 1.4 km2 watershed in southern Texas to investigate the simulated hydrologic response of brush management (the mechanical removal of woody plants), a discrete land-cover change. The watershed was instrumented before and after brush-management activities were undertaken, and estimates of precipitation, streamflow, and evapotranspiration (ET) are available; these data were used to condition and verify the model. The role of parameterization in brush-management simulation was evaluated by constructing two models, one with 12 adjustable parameters (reduced parameterization) and one with 1305 adjustable parameters (full parameterization). Both models were subjected to global sensitivity analysis as well as Monte Carlo and generalized likelihood uncertainty estimation (GLUE) conditioning to identify important model inputs and to estimate uncertainty in several quantities of interest related to brush management. Many realizations from both parameterizations were identified as behavioral in that they reproduce daily mean streamflow acceptably well according to Nash–Sutcliffe model efficiency coefficient, percent bias, and coefficient of determination. However, the total volumetric ET difference resulting from simulated brush management remains highly uncertain after conditioning to daily mean streamflow, indicating that streamflow data alone are not sufficient to inform the model inputs that influence the simulated outcomes of brush

Radial Symmetry of p-Harmonic Minimizers

NASA Astrophysics Data System (ADS)

Koski, Aleksis; Onninen, Jani

2018-03-01

"It is still not known if the radial cavitating minimizers obtained by uc(Ball) (Philos Trans R Soc Lond A 306:557-611, 1982) (and subsequently by many others) are global minimizers of any physically reasonable nonlinearly elastic energy". This quotation is from uc(Sivaloganathan) and uc(Spector) (Ann Inst Henri Poincaré Anal Non Linéaire 25(1):201-213, 2008) and seems to be still accurate. The model case of the p-harmonic energy is considered here. We prove that the planar radial minimizers are indeed the global minimizers provided we prescribe the admissible deformations on the boundary. In the traction free setting, however, even the identity map need not be a global minimizer.

From medical images to minimally invasive intervention: Computer assistance for robotic surgery.

PubMed

Lee, Su-Lin; Lerotic, Mirna; Vitiello, Valentina; Giannarou, Stamatia; Kwok, Ka-Wai; Visentini-Scarzanella, Marco; Yang, Guang-Zhong

2010-01-01

Minimally invasive surgery has been established as an important way forward in surgery for reducing patient trauma and hospitalization with improved prognosis. The introduction of robotic assistance enhances the manual dexterity and accuracy of instrument manipulation. Further development of the field in using pre- and intra-operative imaging guidance requires the integration of the general anatomy of the patient with clear pathologic indications and geometrical information for preoperative planning and intra-operative manipulation. It also requires effective visualization and the recreation of haptic and tactile sensing with dynamic active constraints to improve consistency and safety of the surgical procedures. This paper describes key technical considerations of tissue deformation tracking, 3D reconstruction, subject-specific modeling, image guidance and augmented reality for robotic assisted minimally invasive surgery. It highlights the importance of adapting preoperative surgical planning according to intra-operative data and illustrates how dynamic information such as tissue deformation can be incorporated into the surgical navigation framework. Some of the recent trends are discussed in terms of instrument design and the usage of dynamic active constraints and human-robot perceptual docking for robotic assisted minimally invasive surgery. Copyright 2009 Elsevier Ltd. All rights reserved.

NAVAIR Hexavalent Chromium Minimization Status

DTIC Science & Technology

2010-11-01

NAVAIR  Hexavalent  Chromium Minimization Status  SERDP/ESTCP Symposium 2010 Cr6+ Session Bill C Nickerson AIR 4.3.4 Report Documentation Page Form...COVERED 00-00-2010 to 00-00-2010 4. TITLE AND SUBTITLE NAVAIR Hexavalent Chromium Minimization Status 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...ANSI Std Z39-18 Minimizing Hexavalent Chromium Use in DoD Operations Technical Session No. 2B C-39 NAVAIR NON-CHROMATE MATERIALS STATUS MR

Non-minimally coupled f(R) cosmology

NASA Astrophysics Data System (ADS)

Thakur, Shruti; Sen, Anjan A.; Seshadri, T. R.

2011-02-01

We investigate the consequences of non-minimal gravitational coupling to matter and study how it differs from the case of minimal coupling by choosing certain simple forms for the nature of coupling. The values of the parameters are specified at z=0 (present epoch) and the equations are evolved backwards to calculate the evolution of cosmological parameters. We find that the Hubble parameter evolves more slowly in non-minimal coupling case as compared to the minimal coupling case. In both the cases, the universe accelerates around present time, and enters the decelerating regime in the past. Using the latest Union2 dataset for supernova Type Ia observations as well as the data for baryon acoustic oscillation (BAO) from SDSS observations, we constraint the parameters of Linder exponential model in the two different approaches. We find that there is an upper bound on model parameter in minimal coupling. But for non-minimal coupling case, there is range of allowed values for the model parameter.

Minimal hepatic encephalopathy matters in daily life

PubMed Central

Bajaj, Jasmohan S

2008-01-01

Minimal hepatic encephalopathy is a neuro-cognitive dysfunction which occurs in an epidemic proportion of cirrhotic patients, estimated as high as 80% of the population tested. It is characterized by a specific, complex cognitive dysfunction which is independent of sleep dysfunction or problems with overall intelligence. Although named “minimal”, minimal hepatic encephalopathy (MHE) can have a far-reaching impact on quality of life, ability to function in daily life and progression to overt hepatic encephalopathy. Importantly, MHE has a profound negative impact on the ability to drive a car and may be a significant factor behind motor vehicle accidents. A crucial aspect of the clinical care of MHE patients is their driving history, which is often ignored in routine care and can add a vital dimension to the overall disease assessment. Driving history should be an integral part of care in patients with MHE. The lack of specific signs and symptoms, the preserved communication skills and lack of insight make MHE a difficult condition to diagnose. Diagnostic strategies for MHE abound, but are usually limited by financial, normative or time constraints. Recent studies into the inhibitory control and critical flicker frequency tests are encouraging since these tests can increase the rates of MHE diagnosis without requiring a psychologist. Although testing for MHE and subsequent therapy is not standard of care at this time, it is important to consider this in cirrhotics in order to improve their ability to live their life to the fullest. PMID:18595126

Population dynamics can be more important than physiological limits for determining range shifts under climate change.

PubMed

Fordham, Damien A; Mellin, Camille; Russell, Bayden D; Akçakaya, Reşit H; Bradshaw, Corey J A; Aiello-Lammens, Matthew E; Caley, Julian M; Connell, Sean D; Mayfield, Stephen; Shepherd, Scoresby A; Brook, Barry W

2013-10-01

Evidence is accumulating that species' responses to climate changes are best predicted by modelling the interaction of physiological limits, biotic processes and the effects of dispersal-limitation. Using commercially harvested blacklip (Haliotis rubra) and greenlip abalone (Haliotis laevigata) as case studies, we determine the relative importance of accounting for interactions among physiology, metapopulation dynamics and exploitation in predictions of range (geographical occupancy) and abundance (spatially explicit density) under various climate change scenarios. Traditional correlative ecological niche models (ENM) predict that climate change will benefit the commercial exploitation of abalone by promoting increased abundances without any reduction in range size. However, models that account simultaneously for demographic processes and physiological responses to climate-related factors result in future (and present) estimates of area of occupancy (AOO) and abundance that differ from those generated by ENMs alone. Range expansion and population growth are unlikely for blacklip abalone because of important interactions between climate-dependent mortality and metapopulation processes; in contrast, greenlip abalone should increase in abundance despite a contraction in AOO. The strongly non-linear relationship between abalone population size and AOO has important ramifications for the use of ENM predictions that rely on metrics describing change in habitat area as proxies for extinction risk. These results show that predicting species' responses to climate change often require physiological information to understand climatic range determinants, and a metapopulation model that can make full use of this data to more realistically account for processes such as local extirpation, demographic rescue, source-sink dynamics and dispersal-limitation. © 2013 John Wiley & Sons Ltd.

Deanol in minimal brain dysfunction.

PubMed

Lewis, J A; Lewis, B S

1977-12-01

The literature on minimal brain dysfunction is confused, confusing and controversial. The statements that the condition exists, needs treatment, and that treatment may be pharmacological, are more expressions of faith than accepted fact. We believe they are true (within limits not discussed in the article). Furthermore, there is evidence that some patients with MBD are hypo-aroused, while others are not. The role of deanol in the treatment of MBD is still unclear, because of the complexities of identifying appropriate patients in terms of levels of arousal, as well as identifying appropriate measures of response. There is sufficient support for an effect of deanol in the literature to justify further investigation. Further studies should attend to important methodological problems as discussed.

Role of media and peers on body change strategies among adult men: is body size important?

PubMed

McCabe, Marita P; McGreevy, Shauna J

2011-01-01

There has been limited previous research that has examined the role of sociocultural influences on body change strategies among adult men. The current study investigated the role of specific types of messages (encouragement, teasing and modelling) from peers and the media on the strategies to change weight among adult men. Differences were evaluated between 526 men aged from 18 to 60 years from three groups (normal weight, overweight and obese) on body image, body change strategies and messages about their body received from peers and the media. Men were primarily drawn from United States, Australia and Europe. Results showed that messages received by men regarding losing weight or increasing muscle size differed according to weight. Body image and media messages were the strongest predictors of losing weight, whereas body image importance and messages from peers were the strongest predictors of increasing muscles. These findings highlight the importance of sociocultural influences on body change strategies among adult males. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

Measuring and predicting prostate cancer related quality of life changes using EPIC for clinical practice.

PubMed

Chipman, Jonathan J; Sanda, Martin G; Dunn, Rodney L; Wei, John T; Litwin, Mark S; Crociani, Catrina M; Regan, Meredith M; Chang, Peter

2014-03-01

We expanded the clinical usefulness of EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) by evaluating its responsiveness to health related quality of life changes, defining the minimally important differences for an individual patient change in each domain and applying it to a sexual outcome prediction model. In 1,201 subjects from a previously described multicenter longitudinal cohort we modeled the EPIC-CP domain scores of each treatment group before treatment, and at short-term and long-term followup. We considered a posttreatment domain score change from pretreatment of 0.5 SD or greater clinically significant and p ≤ 0.01 statistically significant. We determined the domain minimally important differences using the pooled 0.5 SD of the 2, 6, 12 and 24-month posttreatment changes from pretreatment values. We then recalibrated an EPIC-CP based nomogram model predicting 2-year post-prostatectomy functional erection from that developed using EPIC-26. For each health related quality of life domain EPIC-CP was sensitive to similar posttreatment health related quality of life changes with time, as was observed using EPIC-26. The EPIC-CP minimally important differences in changes in the urinary incontinence, urinary irritation/obstruction, bowel, sexual and vitality/hormonal domains were 1.0, 1.3, 1.2, 1.6 and 1.0, respectively. The EPIC-CP based sexual prediction model performed well (AUC 0.76). It showed robust agreement with its EPIC-26 based counterpart with 10% or less predicted probability differences between models in 95% of individuals and a mean ± SD difference of 0.0 ± 0.05 across all individuals. EPIC-CP is responsive to health related quality of life changes during convalescence and it can be used to predict 2-year post-prostatectomy sexual outcomes. It can facilitate shared medical decision making and patient centered care. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc

Free-energy minimization and the dark-room problem.

PubMed

Friston, Karl; Thornton, Christopher; Clark, Andy

2012-01-01

Recent years have seen the emergence of an important new fundamental theory of brain function. This theory brings information-theoretic, Bayesian, neuroscientific, and machine learning approaches into a single framework whose overarching principle is the minimization of surprise (or, equivalently, the maximization of expectation). The most comprehensive such treatment is the "free-energy minimization" formulation due to Karl Friston (see e.g., Friston and Stephan, 2007; Friston, 2010a,b - see also Fiorillo, 2010; Thornton, 2010). A recurrent puzzle raised by critics of these models is that biological systems do not seem to avoid surprises. We do not simply seek a dark, unchanging chamber, and stay there. This is the "Dark-Room Problem." Here, we describe the problem and further unpack the issues to which it speaks. Using the same format as the prolog of Eddington's Space, Time, and Gravitation (Eddington, 1920) we present our discussion as a conversation between: an information theorist (Thornton), a physicist (Friston), and a philosopher (Clark).

Flight responses by a migratory soaring raptor to changing meteorological conditions.

PubMed

Lanzone, Michael J; Miller, Tricia A; Turk, Philip; Brandes, David; Halverson, Casey; Maisonneuve, Charles; Tremblay, Junior; Cooper, Jeff; O'Malley, Kieran; Brooks, Robert P; Katzner, Todd

2012-10-23

Soaring birds that undertake long-distance migration should develop strategies to minimize the energetic costs of endurance flight. This is relevant because condition upon completion of migration has direct consequences for fecundity, fitness and thus, demography. Therefore, strong evolutionary pressures are expected for energy minimization tactics linked to weather and topography. Importantly, the minute-by-minute mechanisms birds use to subsidize migration in variable weather are largely unknown, in large part because of the technological limitations in studying detailed long-distance bird flight. Here, we show golden eagle (Aquila chrysaetos) migratory response to changing meteorological conditions as monitored by high-resolution telemetry. In contrast to expectations, responses to meteorological variability were stereotyped across the 10 individuals studied. Eagles reacted to increased wind speed by using more orographic lift and less thermal lift. Concomitantly, as use of thermals decreased, variation in flight speed and altitude also decreased. These results demonstrate how soaring migrant birds can minimize energetic expenditures, they show the context for avian decisions and choices of specific instantaneous flight mechanisms and they have important implications for design of bird-friendly wind energy.

78 FR 77353 - Import Administration; Change of Agency Name for Supplies for Use in Emergency Relief Work

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-23

... Work AGENCY: Import Administration, Commerce. ACTION: Final rule; Nomenclature change. SUMMARY....'' Consistent with this action, this rule makes appropriate conforming changes in our regulations. The rule also sets forth a Savings Provision in SUPPLEMENTARY INFORMATION that preserves, under the new name, all...

Assessing the Vulnerability of Eco-Environmental Health to Climate Change

PubMed Central

Tong, Shilu; Mather, Peter; Fitzgerald, Gerry; McRae, David; Verrall, Ken; Walker, Dylan

2010-01-01

There is an urgent need to assess the vulnerability of eco-environmental health to climate change. This paper aims to provide an overview of current research, to identify knowledge gaps, and to propose future research needs in this challenging area. Evidence shows that climate change is affecting and will, in the future, have more (mostly adverse) impacts on ecosystems. Ecosystem degradation, particularly the decline of the life support systems, will undoubtedly affect human health and wellbeing. Therefore, it is important to develop a framework to assess the vulnerability of eco-environmental health to climate change, and to identify appropriate adaptation strategies to minimize the impact of climate change. PMID:20616990

New minimally access hydrocelectomy.

PubMed

Saber, Aly

2011-02-01

To ascertain the acceptability of minimally access hydrocelectomy through a 2-cm incision and the outcome in terms of morbidity reduction and recurrence rate. Although controversy exists regarding the treatment of hydrocele, hydrocelectomy remains the treatment of choice for hydroceles. However, the standard surgical procedures for hydrocele can cause postoperative discomfort and complications. A total of 42 adult patients, aged 18-56 years, underwent hydrocelectomy as an outpatient procedure using a 2-cm scrotal skin incision and excision of only a small disk of the parietal tunica vaginalis. The operative time was 12-18 minutes (mean 15). The outcome measures included patient satisfaction and postoperative complications. This procedure requires minor dissection and minimal manipulation during treatment. It also resulted in no recurrence and minimal complications and required a short operative time. Copyright © 2011 Elsevier Inc. All rights reserved.

Permafrost thaw and wildfire: Equally important drivers of boreal tree cover changes in the Taiga Plains, Canada

NASA Astrophysics Data System (ADS)

Helbig, M.; Pappas, C.; Sonnentag, O.

2016-02-01

Boreal forests cover vast areas of the permafrost zones of North America, and changes in their composition and structure can lead to pronounced impacts on the regional and global climate. We partition the variation in regional boreal tree cover changes between 2000 and 2014 across the Taiga Plains, Canada, into its main causes: permafrost thaw, wildfire disturbance, and postfire regrowth. Moderate Resolution Imaging Spectroradiometer Percent Tree Cover (PTC) data are used in combination with maps of historic fires, and permafrost and drainage characteristics. We find that permafrost thaw is equally important as fire history to explain PTC changes. At the southern margin of the permafrost zone, PTC loss due to permafrost thaw outweighs PTC gain from postfire regrowth. These findings emphasize the importance of permafrost thaw in controlling regional boreal forest changes over the last decade, which may become more pronounced with rising air temperatures and accelerated permafrost thaw.

Maintaining Low Voiding Solder Die Attach for Power Die While Minimizing Die Tilt

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hamm, Randy; Peterson, Kenneth A.

2015-10-01

This paper addresses work to minimize voiding and die tilt in solder attachment of a large power die, measuring 9.0 mm X 6.5 mm X 0.1 mm (0.354” x 0.256” x 0.004”), to a heat spreader. As demands for larger high power die continue, minimizing voiding and die tilt is of interest for improved die functionality, yield, manufacturability, and reliability. High-power die generate considerable heat, which is important to dissipate effectively through control of voiding under high thermal load areas of the die while maintaining a consistent bondline (minimizing die tilt). Voiding was measured using acoustic imaging and die tiltmore » was measured using two different optical measurement systems. 80Au-20Sn solder reflow was achieved using a batch vacuum solder system with optimized fixturing. Minimizing die tilt proved to be the more difficult of the two product requirements to meet. Process development variables included tooling, weight and solder preform thickness.« less

The minimal-ABC trees with B1-branches.

PubMed

Dimitrov, Darko; Du, Zhibin; Fonseca, Carlos M da

2018-01-01

The atom-bond connectivity index (or, for short, ABC index) is a molecular structure descriptor bridging chemistry to graph theory. It is probably the most studied topological index among all numerical parameters of a graph that characterize its topology. For a given graph G = (V, E), the ABC index of G is defined as [Formula: see text], where di denotes the degree of the vertex i, and ij is the edge incident to the vertices i and j. A combination of physicochemical and the ABC index properties are commonly used to foresee the bioactivity of different chemical composites. Additionally, the applicability of the ABC index in chemical thermodynamics and other areas of chemistry, such as in dendrimer nanostars, benzenoid systems, fluoranthene congeners, and phenylenes is well studied in the literature. While finding of the graphs with the greatest ABC-value is a straightforward assignment, the characterization of the tree(s) with minimal ABC index is a problem largely open and has recently given rise to numerous studies and conjectures. A B1-branch of a graph is a pendent path of order 2. In this paper, we provide an important step forward to the full characterization of these minimal trees. Namely, we show that a minimal-ABC tree contains neither 4 nor 3 B1-branches. The case when the number of B1-branches is 2 is also considered.

Quantitative evaluation of light scattering intensities of the crystalline lens for radiation related minimal change in interventional radiologists: a cross-sectional pilot study.

PubMed

Abe, Toshi; Furui, Shigeru; Sasaki, Hiroshi; Sakamoto, Yasuo; Suzuki, Shigeru; Ishitake, Tatsuya; Terasaki, Kinuyo; Kohtake, Hiroshi; Norbash, Alexander M; Behrman, Richard H; Hayabuchi, Naofumi

2013-03-01

To evaluate low-dose X-ray radiation effects on the eye by measuring the amount of light scattering in specific regions of the lens, we compared exposed subjects (interventional radiologists) with unexposed subjects (employees of medical service companies), as a pilot study. According to numerous exclusionary rules, subjects with confounding variables contributing to cataract formation were excluded. Left eye examinations were performed on 68 exposed subjects and 171 unexposed subjects. The eye examinations consisted of an initial screening examination, followed by Scheimpflug imaging of the lens using an anterior eye segment analysis system. The subjects were assessed for the quantity of light scattering intensities found in each of the six layers of the lens. Multiple stepwise regression analyses were performed with the stepwise regression for six variables: age, radiation exposure, smoking, drinking, wearing glasses and workplace. In addition, an age-matched comparison between exposed and unexposed subjects was performed. Minimal increased light scattering intensity in the posterior subcapsular region showed statistical significance. Our results indicate that occupational radiation exposure in interventional radiologists may affect the posterior subcapsular region of the lens. Since by its very nature this retrospective study had many limitations, further well-designed studies concerning minimal radiation-related lens changes should be carried out in a low-dose exposure group.

Minimizing off-Target Mutagenesis Risks Caused by Programmable Nucleases.

PubMed

Ishida, Kentaro; Gee, Peter; Hotta, Akitsu

2015-10-16

Programmable nucleases, such as zinc finger nucleases (ZFNs), transcription activator like effector nucleases (TALENs), and clustered regularly interspersed short palindromic repeats associated protein-9 (CRISPR-Cas9), hold tremendous potential for applications in the clinical setting to treat genetic diseases or prevent infectious diseases. However, because the accuracy of DNA recognition by these nucleases is not always perfect, off-target mutagenesis may result in undesirable adverse events in treated patients such as cellular toxicity or tumorigenesis. Therefore, designing nucleases and analyzing their activity must be carefully evaluated to minimize off-target mutagenesis. Furthermore, rigorous genomic testing will be important to ensure the integrity of nuclease modified cells. In this review, we provide an overview of available nuclease designing platforms, nuclease engineering approaches to minimize off-target activity, and methods to evaluate both on- and off-target cleavage of CRISPR-Cas9.

Minimizing off-Target Mutagenesis Risks Caused by Programmable Nucleases

PubMed Central

Ishida, Kentaro; Gee, Peter; Hotta, Akitsu

2015-01-01

Programmable nucleases, such as zinc finger nucleases (ZFNs), transcription activator like effector nucleases (TALENs), and clustered regularly interspersed short palindromic repeats associated protein-9 (CRISPR-Cas9), hold tremendous potential for applications in the clinical setting to treat genetic diseases or prevent infectious diseases. However, because the accuracy of DNA recognition by these nucleases is not always perfect, off-target mutagenesis may result in undesirable adverse events in treated patients such as cellular toxicity or tumorigenesis. Therefore, designing nucleases and analyzing their activity must be carefully evaluated to minimize off-target mutagenesis. Furthermore, rigorous genomic testing will be important to ensure the integrity of nuclease modified cells. In this review, we provide an overview of available nuclease designing platforms, nuclease engineering approaches to minimize off-target activity, and methods to evaluate both on- and off-target cleavage of CRISPR-Cas9. PMID:26501275

Intensive cardiovascular risk reduction induces sustainable changes in expression of genes and pathways important to vascular function.

PubMed

Ellsworth, Darrell L; Croft, Daniel T; Weyandt, Jamie; Sturtz, Lori A; Blackburn, Heather L; Burke, Amy; Haberkorn, Mary Jane; McDyer, Fionnuala A; Jellema, Gera L; van Laar, Ryan; Mamula, Kimberly A; Chen, Yaqin; Vernalis, Marina N

2014-04-01

Healthy lifestyle changes are thought to mediate cardiovascular disease risk through pathways affecting endothelial function and progression of atherosclerosis; however, the extent, persistence, and clinical significance of molecular change during lifestyle modification are not well known. We examined the effect of a rigorous cardiovascular disease risk reduction program on peripheral blood gene expression profiles in 63 participants and 63 matched controls to characterize molecular responses and identify regulatory pathways important to cardiovascular health. Dramatic changes in dietary fat intake (-61%; P<0.001 versus controls) and physical fitness (+34%; P<0.001) led to significant improvements in cardiovascular disease risk factors. Analysis of variance with false discovery rate correction for multiple testing (P<0.05) identified 26 genes after 12 weeks and 143 genes after 52 weeks that were differentially expressed from baseline in participants. Controls showed little change in cardiovascular disease risk factors or gene expression. Quantitative reverse transcription polymerase chain reaction validated differential expression for selected transcripts. Lifestyle modification effectively reduced expression of proinflammatory genes associated with neutrophil activation and molecular pathways important to vascular function, including cytokine production, carbohydrate metabolism, and steroid hormones. Prescription medications did not significantly affect changes in gene expression. Successful and sustained modulation of gene expression through lifestyle changes may have beneficial effects on the vascular system not apparent from traditional risk factors. Healthy lifestyles may restore homeostasis to the leukocyte transcriptome by downregulating lactoferrin and other genes important in the pathogenesis of atherosclerosis. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01805492.

The minimal axion minimal linear σ model

NASA Astrophysics Data System (ADS)

Merlo, L.; Pobbe, F.; Rigolin, S.

2018-05-01

The minimal SO(5) / SO(4) linear σ model is extended including an additional complex scalar field, singlet under the global SO(5) and the Standard Model gauge symmetries. The presence of this scalar field creates the conditions to generate an axion à la KSVZ, providing a solution to the strong CP problem, or an axion-like-particle. Different choices for the PQ charges are possible and lead to physically distinct Lagrangians. The internal consistency of each model necessarily requires the study of the scalar potential describing the SO(5)→ SO(4), electroweak and PQ symmetry breaking. A single minimal scenario is identified and the associated scalar potential is minimised including counterterms needed to ensure one-loop renormalizability. In the allowed parameter space, phenomenological features of the scalar degrees of freedom, of the exotic fermions and of the axion are illustrated. Two distinct possibilities for the axion arise: either it is a QCD axion with an associated scale larger than ˜ 105 TeV and therefore falling in the category of the invisible axions; or it is a more massive axion-like-particle, such as a 1 GeV axion with an associated scale of ˜ 200 TeV, that may show up in collider searches.

Longitudinal brain white matter alterations in minimal hepatic encephalopathy before and after liver transplantation.

PubMed

Lin, Wei-Che; Chou, Kun-Hsien; Chen, Chao-Long; Chen, Hsiu-Ling; Lu, Cheng-Hsien; Li, Shau-Hsuan; Huang, Chu-Chung; Lin, Ching-Po; Cheng, Yu-Fan

2014-01-01

Cerebral edema is the common pathogenic mechanism for cognitive impairment in minimal hepatic encephalopathy. Whether complete reversibility of brain edema, cognitive deficits, and their associated imaging can be achieved after liver transplantation remains an open question. To characterize white matter integrity before and after liver transplantation in patients with minimal hepatic encephalopathy, multiple diffusivity indices acquired via diffusion tensor imaging was applied. Twenty-eight patients and thirty age- and sex-matched healthy volunteers were included. Multiple diffusivity indices were obtained from diffusion tensor images, including mean diffusivity, fractional anisotropy, axial diffusivity and radial diffusivity. The assessment was repeated 6-12 month after transplantation. Differences in white matter integrity between groups, as well as longitudinal changes, were evaluated using tract-based spatial statistical analysis. Correlation analyses were performed to identify first scan before transplantation and interval changes among the neuropsychiatric tests, clinical laboratory tests, and diffusion tensor imaging indices. After transplantation, decreased water diffusivity without fractional anisotropy change indicating reversible cerebral edema was found in the left anterior cingulate, claustrum, postcentral gyrus, and right corpus callosum. However, a progressive decrease in fractional anisotropy and an increase in radial diffusivity suggesting demyelination were noted in temporal lobe. Improved pre-transplantation albumin levels and interval changes were associated with better recoveries of diffusion tensor imaging indices. Improvements in interval diffusion tensor imaging indices in the right postcentral gyrus were correlated with visuospatial function score correction. In conclusion, longitudinal voxel-wise analysis of multiple diffusion tensor imaging indices demonstrated different white matter changes in minimal hepatic encephalopathy patients

Minimal modeling of the extratropical general circulation

NASA Technical Reports Server (NTRS)

O'Brien, Enda; Branscome, Lee E.

1989-01-01

The ability of low-order, two-layer models to reproduce basic features of the mid-latitude general circulation is investigated. Changes in model behavior with increased spectral resolution are examined in detail. Qualitatively correct time-mean heat and momentum balances are achieved in a beta-plane channel model which includes the first and third meridional modes. This minimal resolution also reproduces qualitatively realistic surface and upper-level winds and mean meridional circulations. Higher meridional resolution does not result in substantial changes in the latitudinal structure of the circulation. A qualitatively correct kinetic energy spectrum is produced when the resolution is high enough to include several linearly stable modes. A model with three zonal waves and the first three meridional modes has a reasonable energy spectrum and energy conversion cycle, while also satisfying heat and momentum budget requirements. This truncation reproduces the basic mechanisms and zonal circulation features that are obtained at higher resolution. The model performance improves gradually with higher resolution and is smoothly dependent on changes in external parameters.

22 CFR 225.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2011 CFR

2011-04-01

... of research proposals which have been approved under the procedure. (d) The department or agency head... of research involving no more than minimal risk, and for minor changes in approved research. 225.110....110 Expedited review procedures for certain kinds of research involving no more than minimal risk, and...

The Importance of Contexts in Strategies of Environmental Organizations with Regard to Climate Change

PubMed

Pleune

1997-09-01

/ The purpose of the study was to investigate the extent to which strategies of environmental organizations depend on contexts. I examined this dependence by analyzing the strategies of five environmental organizations in the Netherlands with regard to climate change. These strategies were investigated over time and compared with the strategies these organizations had used in relation to ozone depletion and acidification. The results indicate that several of the organizations changed their strategies with respect to climate change over time. Furthermore, different strategies were used simultaneously in relation to the three problems. The findings suggest that strategies concerning climate change were to a considerable extent determined by the dominant framing of the problem in society. This framing was defined mainly by actors other than environmental organizations. The initial framing of climate change as a CO2 problem, which brought the issue into the energy debate, as well as the more general definition of the problem in the late 1980s as a greenhouse problem, were very important for determining the strategies of the organizations. It can be concluded that strategies of Dutch environmental organizations with regard to climate change were strongly dependent on the context.KEY WORDS: Environmental organization; Strategy; Climate change; Man-nature relationship; Problem definition; Context

Prochlorococcus: Advantages and Limits of Minimalism

NASA Astrophysics Data System (ADS)

Partensky, Frédéric; Garczarek, Laurence

2010-01-01

Prochlorococcus is the key phytoplanktonic organism of tropical gyres, large ocean regions that are depleted of the essential macronutrients needed for photosynthesis and cell growth. This cyanobacterium has adapted itself to oligotrophy by minimizing the resources necessary for life through a drastic reduction of cell and genome sizes. This rarely observed strategy in free-living organisms has conferred on Prochlorococcus a considerable advantage over other phototrophs, including its closest relative Synechococcus, for life in this vast yet little variable ecosystem. However, this strategy seems to reach its limits in the upper layer of the S Pacific gyre, the most oligotrophic region of the world ocean. By losing some important genes and/or functions during evolution, Prochlorococcus has seemingly become dependent on co-occurring microorganisms. In this review, we present some of the recent advances in the ecology, biology, and evolution of Prochlorococcus, which because of its ecological importance and tiny genome is rapidly imposing itself as a model organism in environmental microbiology.

Prochlorococcus: advantages and limits of minimalism.

PubMed

Partensky, Frédéric; Garczarek, Laurence

2010-01-01

Prochlorococcus is the key phytoplanktonic organism of tropical gyres, large ocean regions that are depleted of the essential macronutrients needed for photosynthesis and cell growth. This cyanobacterium has adapted itself to oligotrophy by minimizing the resources necessary for life through a drastic reduction of cell and genome sizes. This rarely observed strategy in free-living organisms has conferred on Prochlorococcus a considerable advantage over other phototrophs, including its closest relative Synechococcus, for life in this vast yet little variable ecosystem. However, this strategy seems to reach its limits in the upper layer of the S Pacific gyre, the most oligotrophic region of the world ocean. By losing some important genes and/or functions during evolution, Prochlorococcus has seemingly become dependent on co-occurring microorganisms. In this review, we present some of the recent advances in the ecology, biology, and evolution of Prochlorococcus, which because of its ecological importance and tiny genome is rapidly imposing itself as a model organism in environmental microbiology.

An Investigation of Organizational Culture Changes and Effectiveness at Jefferson College: 1963-Present

ERIC Educational Resources Information Center

McCaffrey, Dena M.

2012-01-01

A fundamental factor in the internal dynamics of a college is its culture. Central to understanding organizational culture is to minimize the occurrence and consequences of cultural conflict and help foster the development of shared goals. Modifying organizational culture is important. Without culture change, there is little hope of enduring…

Pest management under climate change: The importance of understanding tritrophic relations.

PubMed

Castex, V; Beniston, M; Calanca, P; Fleury, D; Moreau, J

2018-03-01

Plants and insects depend on climatic factors (temperature, solar radiation, precipitations, relative humidity and CO 2 ) for their development. Current knowledge suggests that climate change can alter plants and insects development and affect their interactions. Shifts in tritrophic relations are of particular concern for Integrated Pest Management (IPM), because responses at the highest trophic level (natural enemies) are highly sensitive to warmer temperature. It is expected that natural enemies could benefit from better conditions for their development in northern latitudes and IPM could be facilitated by a longer period of overlap. This may not be the case in southern latitudes, where climate could become too warm. Adapting IPM to future climatic conditions requires therefore understanding of changes that occur at the various levels and their linkages. The aim of this review is to assess the current state of knowledge and highlights the gaps in the existing literature concerning how climate change can affect tritrophic relations. Because of the economic importance of wine production, the interactions between grapevine, Vitis vinifera (1st), Lobesia botrana (2nd) and Trichogramma spp., (3rd), an egg parasitoid of Lobesia botrana, are considered as a case study for addressing specific issues. In addition, we discuss models that could be applied in order quantify alterations in the synchrony or asynchrony patterns but also the shifts in the timing and spatial distribution of hosts, pests and their natural enemies. Copyright © 2017 Elsevier B.V. All rights reserved.

Lyapunov Exponents of Minimizing Measures for Globally Positive Diffeomorphisms in All Dimensions

NASA Astrophysics Data System (ADS)

Arnaud, M.-C.

2016-05-01

The globally positive diffeomorphisms of the 2 n-dimensional annulus are important because they represent what happens close to a completely elliptic periodic point of a symplectic diffeomorphism where the torsion is positive definite. For these globally positive diffeomorphisms, an Aubry-Mather theory was developed by Garibaldi and Thieullen that provides the existence of some minimizing measures. Using the two Green bundles {G_-} and {G_+} that can be defined along the support of these minimizing measures, we will prove that there is a deep link between: the angle between {G_-} and {G_+} along the support of the considered measure {μ};

Minimal Reduplication

ERIC Educational Resources Information Center

Kirchner, Jesse Saba

2010-01-01

This dissertation introduces Minimal Reduplication, a new theory and framework within generative grammar for analyzing reduplication in human language. I argue that reduplication is an emergent property in multiple components of the grammar. In particular, reduplication occurs independently in the phonology and syntax components, and in both cases…

Cross-Cultural Comparisons of the Perceived Importance of Conversational Constraints.

ERIC Educational Resources Information Center

Kim, Min-Sun

1994-01-01

Investigates how cultural groups differ in the relative importance they attach to conversational constraints. Suggests that the perceived importance of clarity is higher in the more individualistic cultures but that the perceived importance of avoiding hurting the hearer's feelings and of minimizing imposition is higher in the more collectivistic…

Minimally invasive lumbar foraminotomy.

PubMed

Deutsch, Harel

2013-07-01

Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA.

34 CFR 97.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-07-01

... research involving no more than minimal risk, and for minor changes in approved research. 97.110 Section 97... Policy for the Protection of Human Subjects (Basic ED Policy for Protection of Human Research Subjects) § 97.110 Expedited review procedures for certain kinds of research involving no more than minimal risk...

49 CFR 11.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-10-01

... an expedited review procedure shall adopt a method for keeping all members advised of research... research involving no more than minimal risk, and for minor changes in approved research. 11.110 Section 11... Expedited review procedures for certain kinds of research involving no more than minimal risk, and for minor...

28 CFR 46.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2011 CFR

2011-07-01

... of research proposals which have been approved under the procedure. (d) The department or agency head... kinds of research involving no more than minimal risk, and for minor changes in approved research. 46... SUBJECTS § 46.110 Expedited review procedures for certain kinds of research involving no more than minimal...

Total pancreatectomy with islet cell autotransplantation as the initial treatment for minimal-change chronic pancreatitis.

PubMed

Wilson, Gregory C; Sutton, Jeffrey M; Smith, Milton T; Schmulewitz, Nathan; Salehi, Marzieh; Choe, Kyuran A; Brunner, John E; Abbott, Daniel E; Sussman, Jeffrey J; Ahmad, Syed A

2015-03-01

Patients with minimal-change chronic pancreatitis (MCCP) are traditionally managed medically with poor results. This study was conducted to review outcomes following total pancreatectomy with islet cell autotransplantation (TP/IAT) as the initial surgical procedure in the treatment of MCCP. All patients submitted to TP/IAT for MCCP were identified for inclusion in a single-centre observational study. A retrospective chart review was performed to identify pertinent preoperative, perioperative and postoperative data. A total of 84 patients with a mean age of 36.5 years (range: 15-60 years) underwent TP/IAT as the initial treatment for MCCP. The most common aetiology of chronic pancreatitis in this cohort was idiopathic (69.0%, n = 58), followed by aetiologies associated with genetic mutations (16.7%, n = 14), pancreatic divisum (9.5%, n = 8), and alcohol (4.8%, n = 4). The most common genetic mutations pertained to CFTR (n = 9), SPINK1 (n = 3) and PRSS1 (n = 2). Mean ± standard error of the mean preoperative narcotic requirements were 129.3 ± 18.7 morphine-equivalent milligrams (MEQ)/day. Overall, 58.3% (n = 49) of patients achieved narcotic independence and the remaining patients required 59.4 ± 10.6 MEQ/day (P < 0.05). Postoperative insulin independence was achieved by 36.9% (n = 31) of patients. The Short-Form 36-Item Health Survey administered postoperatively demonstrated improvement in all tested quality of life subscales. The present report represents one of the largest series demonstrating the benefits of TP/IAT in the subset of patients with MCCP. © 2014 International Hepato-Pancreato-Biliary Association.

Optimal Inspection of Imports to Prevent Invasive Pest Introduction.

PubMed

Chen, Cuicui; Epanchin-Niell, Rebecca S; Haight, Robert G

2018-03-01

The United States imports more than 1 billion live plants annually-an important and growing pathway for introduction of damaging nonnative invertebrates and pathogens. Inspection of imports is one safeguard for reducing pest introductions, but capacity constraints limit inspection effort. We develop an optimal sampling strategy to minimize the costs of pest introductions from trade by posing inspection as an acceptance sampling problem that incorporates key features of the decision context, including (i) simultaneous inspection of many heterogeneous lots, (ii) a lot-specific sampling effort, (iii) a budget constraint that limits total inspection effort, (iv) inspection error, and (v) an objective of minimizing cost from accepted defective units. We derive a formula for expected number of accepted infested units (expected slippage) given lot size, sample size, infestation rate, and detection rate, and we formulate and analyze the inspector's optimization problem of allocating a sampling budget among incoming lots to minimize the cost of slippage. We conduct an empirical analysis of live plant inspection, including estimation of plant infestation rates from historical data, and find that inspections optimally target the largest lots with the highest plant infestation rates, leaving some lots unsampled. We also consider that USDA-APHIS, which administers inspections, may want to continue inspecting all lots at a baseline level; we find that allocating any additional capacity, beyond a comprehensive baseline inspection, to the largest lots with the highest infestation rates allows inspectors to meet the dual goals of minimizing the costs of slippage and maintaining baseline sampling without substantial compromise. © 2017 Society for Risk Analysis.

Minimal Network Topologies for Signal Processing during Collective Cell Chemotaxis.

PubMed

Yue, Haicen; Camley, Brian A; Rappel, Wouter-Jan

2018-06-19

Cell-cell communication plays an important role in collective cell migration. However, it remains unclear how cells in a group cooperatively process external signals to determine the group's direction of motion. Although the topology of signaling pathways is vitally important in single-cell chemotaxis, the signaling topology for collective chemotaxis has not been systematically studied. Here, we combine mathematical analysis and simulations to find minimal network topologies for multicellular signal processing in collective chemotaxis. We focus on border cell cluster chemotaxis in the Drosophila egg chamber, in which responses to several experimental perturbations of the signaling network are known. Our minimal signaling network includes only four elements: a chemoattractant, the protein Rac (indicating cell activation), cell protrusion, and a hypothesized global factor responsible for cell-cell interaction. Experimental data on cell protrusion statistics allows us to systematically narrow the number of possible topologies from more than 40,000,000 to only six minimal topologies with six interactions between the four elements. This analysis does not require a specific functional form of the interactions, and only qualitative features are needed; it is thus robust to many modeling choices. Simulations of a stochastic biochemical model of border cell chemotaxis show that the qualitative selection procedure accurately determines which topologies are consistent with the experiment. We fit our model for all six proposed topologies; each produces results that are consistent with all experimentally available data. Finally, we suggest experiments to further discriminate possible pathway topologies. Copyright © 2018 Biophysical Society. Published by Elsevier Inc. All rights reserved.

Minimal detectable change of the actual amount of use test and the motor activity log: the EXCITE Trial.

PubMed

Chen, Shuya; Wolf, Steven L; Zhang, Qin; Thompson, Paul A; Winstein, Carolee J

2012-06-01

Efficacy of task-oriented training can be reliably trusted only when the inherent measurement variability is determined. The Actual Amount of Use Test (AAUT) and the Motor Activity Log (MAL) have been used together as measures of spontaneous arm use after an intervention; however, the minimal detectable change (MDC) of AAUT and MAL has not been addressed. To compare the MDC₉₀ of the AAUT and the MAL in the context of a randomized controlled trial of a neurorehabilitation intervention, the Extremity Constraint-Induced Therapy Evaluation trial. A preplanned secondary analysis was conducted using pre-post test data from the control group. Estimated MDC₉₀ were normalized to the maximum value of the scale of the AAUT and the MAL for each subscale: amount of use (AAUTa, MALa) and quality of movement (AAUTq, MALq). . The MDC₉₀ of the AAUTq and the MALq were 14.4% and 15.4%, respectively. However, the MDC₉₀ required greater change for the AAUTa (24.2%) than the MALa (16.8%). The training-induced spontaneous arm use exceeded the MDC₉₀ for the MAL but fell below that for the AAUT immediately after the intervention and at 1-year follow-up visit. The greater variability and insensitivity to treatment effect for the AAUTa is likely because of the low resolution of its scoring system. As such, there is a considerable need to develop valid and reliable tools that capture purposeful arm use outside the laboratory, perhaps through leveraging new sensing technologies with objective activity monitoring.

Minimal Detectable Change of the Actual Amount of Use Test and the Motor Activity Log: The EXCITE Trial

PubMed Central

Chen, Shuya; Wolf, Steven L.; Zhang, Qin; Thompson, Paul A.; Winstein, Carolee J.

2013-01-01

Background Efficacy of task-oriented training can be reliably trusted only when the inherent measurement variability is determined. The Actual Amount of Use Test (AAUT) and the Motor Activity Log (MAL) have been used together as measures of spontaneous arm use after an intervention; however, the minimal detectable change (MDC) of AAUT and MAL has not been addressed. Objective To compare the MDC90 of the AAUT and the MAL in the context of a randomized controlled trial of a neurorehabilitation intervention, the Extremity Constraint-Induced Therapy Evaluation trial. Methods A preplanned secondary analysis was conducted using pre–post test data from the control group. Estimated MDC90 were normalized to the maximum value of the scale of the AAUT and the MAL for each subscale: amount of use (AAUTa, MALa) and quality of movement (AAUTq, MALq). Results The MDC90 of the AAUTq and the MALq were 14.4% and 15.4%, respectively. However, the MDC90 required greater change for the AAUTa (24.2%) than the MALa (16.8%). The training-induced spontaneous arm use exceeded the MDC90 for the MAL but fell below that for the AAUT immediately after the intervention and at 1-year follow-up visit. Conclusions The greater variability and insensitivity to treatment effect for the AAUTa is likely because of the low resolution of its scoring system. As such, there is a considerable need to develop valid and reliable tools that capture purposeful arm use outside the laboratory, perhaps through leveraging new sensing technologies with objective activity monitoring. PMID:22275157

Middle and High School Students' Conceptions of Climate Change Mitigation and Adaptation Strategies

ERIC Educational Resources Information Center

Bofferding, Laura; Kloser, Matthew

2015-01-01

Both scientists and policy-makers emphasize the importance of education for influencing pro-environmental behavior and minimizing the effects of climate change on biological and physical systems. Education has the potential to impact students' system knowledge--their understanding of the variables that affect the climate system--and action…

77 FR 15847 - Bovine Spongiform Encephalopathy; Importation of Bovines and Bovine Products

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

...We are proposing to amend the regulations that govern the importation of animals and animal products to revise the conditions for the importation of live bovines and products derived from bovines with regard to bovine spongiform encephalopathy (BSE). We are proposing to base importation conditions on the inherent risk of BSE infectivity in specified commodities, as well as on the BSE risk status of the region from which the commodities originate. We are proposing to establish a system for classifying regions as to BSE risk that is consistent with the system employed by the World Organization for Animal Health (OIE), the international standard-setting organization for guidelines related to animal health. The conditions we are proposing for the importation of specified commodities are based on internationally accepted scientific literature and, except in a few instances, are consistent with guidelines set out in the OIE's Terrestrial Animal Health Code. We are also proposing to classify certain specified countries as to BSE risk and are proposing to remove BSE restrictions on the importation of cervids and camelids and products derived from such animals. We are proposing to make these amendments after conducting a thorough review of relevant scientific literature and a comprehensive evaluation of the issues and concluding that the proposed changes to the regulations would continue to guard against the introduction of BSE into the United States, while allowing the importation of additional animals and animal products into this country. In this document we are also affirming the position we took in removing the delay of applicability of certain provisions of the rule entitled ``Bovine Spongiform Encephalopathy; Minimal-Risk Regions and Importation of Commodities,'' published in the Federal Register on January 4, 2005 (70 FR 460-553). The delay of applicability was removed in a final rule entitled ``Bovine Spongiform Encephalopathy; Minimal-Risk Regions; Importation

Determination of the minimal clinically important difference for seven measures of fatigue in Swedish patients with systemic lupus erythematosus.

PubMed

Pettersson, S; Lundberg, I E; Liang, M H; Pouchot, J; Henriksson, E Welin

2015-05-01

To estimate the minimal clinically important difference (MCID) in seven self-administered measures assessing fatigue in Swedish patients with systemic lupus erythematosus (SLE). The participants (n = 51, women 98%, age 52.8 ± 12.1 years, disease duration 18.7 ± 13.6 years) met in groups of six to nine persons. After completing seven fatigue questionnaires [the Fatigue Severity Scale (FSS); the Multidimensional Assessment of Fatigue (MAF) scale; the 20-item Multidimensional Fatigue Inventory (MFI); the Chalder Fatigue Scale (CFS); the Short Form-36 Vitality subscale (VT); the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) scale; and the Numeric Rating Scale (NRS)], each respondent had a minimum of five face-to-face discussions, followed by an individual comparative assessment of their own level of fatigue (seven-grade scale). This method resulted in 260 contrasting assessments; MCIDs were first calculated using the paired differences and then established by a regression approach. Patients were asked to comment on their experience with the questionnaires and whether they captured their fatigue adequately. The paired approach (using 'little more fatigue' as an anchor for MCID during the face-to-face comparative assessments) provided estimates of 4.6-17.0; the regression approach provided estimates of 4.3-10.8. Estimates using the regression approach were consistently lower than those using the paired model. The MCID estimates were least favourable and fewer respondents supported the use of the NRS compared to the other self-reported questionnaires. All seven instruments detect MCIDs for fatigue in Swedish patients with SLE. However, the single-question measure was not supported by the MCID estimates or by comments from the respondents.

The importance of considering shifts in seasonal changes in discharges when prediciting future phosphorus loads in streams

USDA-ARS?s Scientific Manuscript database

In this work, we hypothesize that phosphorus (P) concentrations in streams vary seasonally and with streamflow and that it is important to incorporate this variation when predicting changes in P loading associated with climate change. Our study area includes 14 watersheds with a range of land uses t...

Nutritional input from dinoflagellate symbionts in reef-building corals is minimal during planula larval life stage

PubMed Central

Kopp, Christophe; Domart-Coulon, Isabelle; Barthelemy, Dominique; Meibom, Anders

2016-01-01

Dispersion of larval offspring is of fundamental ecological importance to sessile marine organisms. Photosymbiotic planulae emitted by many reef-forming corals may travel over large distances before settling to form a new colony. It is not clear whether the metabolic requirements of these planula larvae are met exclusively with lipid and protein reservoirs inherited from the mother colony or when metabolic inputs from their endosymbiotic dinoflagellates become important. Pulse-chase experiments using [13C]bicarbonate and [15N]nitrate, combined with subcellular structural and isotopic imaging of freshly emitted symbiotic larvae from the coral Pocillopora damicornis, show that metabolic input from the dinoflagellates is minimal in the planulae compared with adult colonies. The larvae are essentially lecithotrophic upon emission, indicating that a marked shift in metabolic interaction between the symbiotic partners takes place later during ontogeny. Understanding the cellular processes that trigger and control this metabolic shift, and how climate change might influence it, is a key challenge in coral biology. PMID:27051861

Interactions of Climate Change and Nitrogen Management for Optimizing Crop Productivity and Food Security while Minimizing Nitrogen Pollution and Greenhouse Gas Emissions

NASA Astrophysics Data System (ADS)

Davidson, E. A.; Suddick, E. C.

2012-12-01

Producing food, transportation, and energy for seven billion people has led to huge increases in use of synthetic nitrogen (N) fertilizers and fossil fuels, resulting in large releases of N as air and water pollution. In its numerous chemical forms, N plays a critical role in all aspects of climate change, including mitigation, adaptation, and impacts. Here we report on a multi-authored, interdisciplinary technical report on climate-nitrogen interactions submitted to the US National Climate Assessment as part of a Research Coordination Network activity. Management of the N cycle not only affects emissions of nitrous oxide (N2O) and nitrogen oxides (NOX), but also impacts carbon dioxide (CO2) and methane (CH4), through effects on carbon cycling processes in forests and soils and the effects on atmospheric reactions of ozone (O3) and CH4. While some of these direct and indirect N effects have a short-term cooling effect, the warming effects of N2O dominate at long time scales. The challenges of mitigating N2O emissions are substantially different from those for CO2 and CH4, because N is essential for food production, and over 80% of anthropogenic N2O emissions are from the agricultural sector. On one hand, improved agricultural nutrient management can confer some adaptive capacity of crops to climatic variability, but, on the other hand, increased climatic variability will render the task more difficult to manage nutrients for the optimization of crop productivity while minimizing N losses to the environment. Higher air temperatures will result in a "climate penalty" for air quality mitigation efforts, because larger NOX emissions reductions will be needed to achieve the same reductions of O3 pollution under higher temperatures, thus imposing further challenges to avoid harmful impacts on human health and crop productivity. Changes in river discharge, due to summer drought and to extreme precipitation events, will affect the transport of N from agricultural fields to

[Minimally invasive approach for cervical spondylotic radiculopathy].

PubMed

Ding, Liang; Sun, Taicun; Huang, Yonghui

2010-01-01

To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). The recent literature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. There were two techniques of minimally invasive approach for CSR at present: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneous puncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopic discectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local ligamentum flavum thickening and spondylotic foraminal stenosis. The minimally invasive procedure has the advantages of simple handling, minimally invasive and low incidence of complications. But the scope of indications is relatively narrow at present.

Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

PubMed Central

Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

2015-01-01

Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures. PMID:26336491

Project management: importance for diagnostic laboratories.

PubMed

Croxatto, A; Greub, G

2017-07-01

The need for diagnostic laboratories to improve both quality and productivity alongside personnel shortages incite laboratory managers to constantly optimize laboratory workflows, organization, and technology. These continuous modifications of the laboratories should be conducted using efficient project and change management approaches to maximize the opportunities for successful completion of the project. This review aims at presenting a general overview of project management with an emphasis on selected critical aspects. Conventional project management tools and models, such as HERMES, described in the literature, associated personal experience, and educational courses on management have been used to illustrate this review. This review presents general guidelines of project management and highlights their importance for microbiology diagnostic laboratories. As an example, some critical aspects of project management will be illustrated with a project of automation, as experienced at the laboratories of bacteriology and hygiene of the University Hospital of Lausanne. It is important to define clearly beforehand the objective of a project, its perimeter, its costs, and its time frame including precise duration estimates of each step. Then, a project management plan including explanations and descriptions on how to manage, execute, and control the project is necessary to continuously monitor the progression of a project to achieve its defined goals. Moreover, a thorough risk analysis with contingency and mitigation measures should be performed at each phase of a project to minimize the impact of project failures. The increasing complexities of modern laboratories mean clinical microbiologists must use several management tools including project and change management to improve the outcome of major projects and activities. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Minimal string theories and integrable hierarchies

NASA Astrophysics Data System (ADS)

Iyer, Ramakrishnan

Well-defined, non-perturbative formulations of the physics of string theories in specific minimal or superminimal model backgrounds can be obtained by solving matrix models in the double scaling limit. They provide us with the first examples of completely solvable string theories. Despite being relatively simple compared to higher dimensional critical string theories, they furnish non-perturbative descriptions of interesting physical phenomena such as geometrical transitions between D-branes and fluxes, tachyon condensation and holography. The physics of these theories in the minimal model backgrounds is succinctly encoded in a non-linear differential equation known as the string equation, along with an associated hierarchy of integrable partial differential equations (PDEs). The bosonic string in (2,2m-1) conformal minimal model backgrounds and the type 0A string in (2,4 m) superconformal minimal model backgrounds have the Korteweg-de Vries system, while type 0B in (2,4m) backgrounds has the Zakharov-Shabat system. The integrable PDE hierarchy governs flows between backgrounds with different m. In this thesis, we explore this interesting connection between minimal string theories and integrable hierarchies further. We uncover the remarkable role that an infinite hierarchy of non-linear differential equations plays in organizing and connecting certain minimal string theories non-perturbatively. We are able to embed the type 0A and 0B (A,A) minimal string theories into this single framework. The string theories arise as special limits of a rich system of equations underpinned by an integrable system known as the dispersive water wave hierarchy. We find that there are several other string-like limits of the system, and conjecture that some of them are type IIA and IIB (A,D) minimal string backgrounds. We explain how these and several other string-like special points arise and are connected. In some cases, the framework endows the theories with a non

Hope and Climate Change: The Importance of Hope for Environmental Engagement among Young People

ERIC Educational Resources Information Center

Ojala, Maria

2012-01-01

Although many young people think climate change is an important societal issue, studies indicate that pessimism is quite common. Finding ways to instill hope could therefore be seen as vital. However, is hope positively related to engagement or is it only a sign of illusory optimism? The aim of the study was to explore if hope concerning climate…

The importance of considering shifts in seasonal changes in discharges when predicting future phosphorus loads in streams

USGS Publications Warehouse

LaBeau, Meredith B.; Mayer, Alex S.; Griffis, Veronica; Watkins, David Jr.; Robertson, Dale M.; Gyawali, Rabi

2015-01-01

In this work, we hypothesize that phosphorus (P) concentrations in streams vary seasonally and with streamflow and that it is important to incorporate this variation when predicting changes in P loading associated with climate change. Our study area includes 14 watersheds with a range of land uses throughout the U.S. Great Lakes Basin. We develop annual seasonal load-discharge regression models for each watershed and apply these models with simulated discharges generated for future climate scenarios to simulate future P loading patterns for two periods: 2046–2065 and 2081–2100. We utilize output from the Coupled Model Intercomparison Project phase 3 downscaled climate change projections that are input into the Large Basin Runoff Model to generate future discharge scenarios, which are in turn used as inputs to the seasonal P load regression models. In almost all cases, the seasonal load-discharge models match observed loads better than the annual models. Results using the seasonal models show that the concurrence of nonlinearity in the load-discharge model and changes in high discharges in the spring months leads to the most significant changes in P loading for selected tributaries under future climate projections. These results emphasize the importance of using seasonal models to understand the effects of future climate change on nutrient loads.

Minimal agent based model for financial markets I. Origin and self-organization of stylized facts

NASA Astrophysics Data System (ADS)

Alfi, V.; Cristelli, M.; Pietronero, L.; Zaccaria, A.

2009-02-01

We introduce a minimal agent based model for financial markets to understand the nature and self-organization of the stylized facts. The model is minimal in the sense that we try to identify the essential ingredients to reproduce the most important deviations of price time series from a random walk behavior. We focus on four essential ingredients: fundamentalist agents which tend to stabilize the market; chartist agents which induce destabilization; analysis of price behavior for the two strategies; herding behavior which governs the possibility of changing strategy. Bubbles and crashes correspond to situations dominated by chartists, while fundamentalists provide a long time stability (on average). The stylized facts are shown to correspond to an intermittent behavior which occurs only for a finite value of the number of agents N. Therefore they correspond to finite size effects which, however, can occur at different time scales. We propose a new mechanism for the self-organization of this state which is linked to the existence of a threshold for the agents to be active or not active. The feedback between price fluctuations and number of active agents represents a crucial element for this state of self-organized intermittency. The model can be easily generalized to consider more realistic variants.

Anesthesia for minimally invasive neurosurgery.

PubMed

Prabhakar, Hemanshu; Mahajan, Charu; Kapoor, Indu

2017-10-01

With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration.

Parenteral glutamine supplement has synergic effects in minimally invasive surgery of subtotal gastrectomy patients.

PubMed

Chen, Chien-Chia; Chang, Tung-Cheng; Wang, Ming-Yang; Wu, Ming-Hsun; Lin, Ming-Tsan

2012-09-01

Exogenous glutamine supplement is known to improve morbidity and mortality of critically-ill patients. This study was conducted to elucidate the role of glutamine in minimally invasive surgery. We retrospectively reviewed subtotal gastrectomy patients in National Taiwan University Hospital from Dec 2005 to Dec 2008. The patients were divided into three groups. Group 1 underwent subtotal gastrectomy by laparotomy without glutamine supplement, group 2 underwent subtotal gastrectomy by laparotomy with glutamine supplement and group 3 underwent gasless laparoscopy-assisted subtotal gastrectomy with parenteral glutamine supplement. There were 155 patients in total; 85 patients in group 1, 17 in group 2 and 53 in group 3. The mean flatus days after operation are 3.6, 3.1 and 2.8 for groups 1, 2 and 3, respectively (p=0.001). Oral intake after operation was commenced after 6.7, 5.0 and 4.7 days (p=0.006). The body temperature had borderline differences between groups 3 and 1. There were significant differences in postoperative systemic responses including heart rates (p<0.001) and tenderness (p=0.011) 5 days after operation for group 3 vs. group 1. Minimally invasive surgery was a negative factor for postoperative body temperature change. Glutamine was a significant factor for postoperative heart rate change and reduction of tenderness. Glutamine supplement may have synergic effects of rapid recovery in minimal invasive surgery for subtotal gastrectomy patients by minimizing the postoperative systemic response and accelerating recovery.

Solar array stepping to minimize array excitation

NASA Technical Reports Server (NTRS)

Bhat, Mahabaleshwar K. P. (Inventor); Liu, Tung Y. (Inventor); Plescia, Carl T. (Inventor)

1989-01-01

Mechanical oscillations of a mechanism containing a stepper motor, such as a solar-array powered spacecraft, are reduced and minimized by the execution of step movements in pairs of steps, the period between steps being equal to one-half of the period of torsional oscillation of the mechanism. Each pair of steps is repeated at needed intervals to maintain desired continuous movement of the portion of elements to be moved, such as the solar array of a spacecraft. In order to account for uncertainty as well as slow change in the period of torsional oscillation, a command unit may be provided for varying the interval between steps in a pair.

Free energy minimization to predict RNA secondary structures and computational RNA design.

PubMed

Churkin, Alexander; Weinbrand, Lina; Barash, Danny

2015-01-01

Determining the RNA secondary structure from sequence data by computational predictions is a long-standing problem. Its solution has been approached in two distinctive ways. If a multiple sequence alignment of a collection of homologous sequences is available, the comparative method uses phylogeny to determine conserved base pairs that are more likely to form as a result of billions of years of evolution than by chance. In the case of single sequences, recursive algorithms that compute free energy structures by using empirically derived energy parameters have been developed. This latter approach of RNA folding prediction by energy minimization is widely used to predict RNA secondary structure from sequence. For a significant number of RNA molecules, the secondary structure of the RNA molecule is indicative of its function and its computational prediction by minimizing its free energy is important for its functional analysis. A general method for free energy minimization to predict RNA secondary structures is dynamic programming, although other optimization methods have been developed as well along with empirically derived energy parameters. In this chapter, we introduce and illustrate by examples the approach of free energy minimization to predict RNA secondary structures.

HLAs in children with minimal change disease and other types of nephrotic syndrome in the southern part of Turkey.

PubMed

Karabay-Bayazit, A; Noyan, A; Bayazit, Y; Ozel, A; Anarat, A

2001-01-01

The aim of this study was to investigate the human leukocyte antigen (HLA) profile of children with nephrotic syndrome in the southern part of Turkey. Seventy-eight children with nephrotic syndrome were studied for the frequency of class I and class II human leukocyte antigens. Forty-seven of them were steroid sensitive nephrotic syndrome (minimal change disease-MCD) and 31 were other types of nephrotic syndrome. The results were compared with 133 healthy subjects for HLA groups. HLA B13, Cw5, Cw7, DR4, DR7, DRw10, Drw15(2) and DQ2 in the MCD group and HLA A31, B8, B13, B17, Cw2, Cw6, Cw7, DRw10 and DRw12 in the non-MCD group were found significantly increased when compared to healthy controls. MCD patients with frequent relapses had higher frequencies of both Cw6 and DR1 (p < 0.005) and MCD patients with infrequent relapses had a higher frequency of Cw7 (p < 0.05). In conclusion, HLA groups may help in the early diagnosis of these variants.

Controlling molecular transport in minimal emulsions

NASA Astrophysics Data System (ADS)

Gruner, Philipp; Riechers, Birte; Semin, Benoît; Lim, Jiseok; Johnston, Abigail; Short, Kathleen; Baret, Jean-Christophe

2016-01-01

Emulsions are metastable dispersions in which molecular transport is a major mechanism driving the system towards its state of minimal energy. Determining the underlying mechanisms of molecular transport between droplets is challenging due to the complexity of a typical emulsion system. Here we introduce the concept of `minimal emulsions', which are controlled emulsions produced using microfluidic tools, simplifying an emulsion down to its minimal set of relevant parameters. We use these minimal emulsions to unravel the fundamentals of transport of small organic molecules in water-in-fluorinated-oil emulsions, a system of great interest for biotechnological applications. Our results are of practical relevance to guarantee a sustainable compartmentalization of compounds in droplet microreactors and to design new strategies for the dynamic control of droplet compositions.

Rule extraction from minimal neural networks for credit card screening.

PubMed

Setiono, Rudy; Baesens, Bart; Mues, Christophe

2011-08-01

While feedforward neural networks have been widely accepted as effective tools for solving classification problems, the issue of finding the best network architecture remains unresolved, particularly so in real-world problem settings. We address this issue in the context of credit card screening, where it is important to not only find a neural network with good predictive performance but also one that facilitates a clear explanation of how it produces its predictions. We show that minimal neural networks with as few as one hidden unit provide good predictive accuracy, while having the added advantage of making it easier to generate concise and comprehensible classification rules for the user. To further reduce model size, a novel approach is suggested in which network connections from the input units to this hidden unit are removed by a very straightaway pruning procedure. In terms of predictive accuracy, both the minimized neural networks and the rule sets generated from them are shown to compare favorably with other neural network based classifiers. The rules generated from the minimized neural networks are concise and thus easier to validate in a real-life setting.

John Wickham’s New Surgery: ‘Minimally Invasive Therapy’, Innovation, and Approaches to Medical Practice in Twentieth-century Britain

PubMed Central

Frampton, Sally; Kneebone, Roger L.

2017-01-01

Abstract The term ‘minimally invasive’ was coined in 1986 to describe a range of procedures that involved making very small incisions or no incision at all for diseases traditionally treated by open surgery. We examine this major shift in British medical practice as a means of probing the nature of surgical innovation in the twentieth century. We first consider how concerns regarding surgical invasiveness had long been present in surgery, before examining how changing notions of post-operative care formed a foundation for change. We then go on to focus on a professional network involved in the promotion of minimally invasive therapy led by the urologist John Wickham. The minimally invasive movement, we contend, brought into focus tensions between surgical innovation and the evidence-based model of medical practice. Premised upon professional collaborations beyond surgery and a re-positioning of the patient role, we show how the movement elucidated changing notions of surgical authority. PMID:29713119

Teachers' Perceptions about Minimal Hearing Loss: A Role for Educational Audiologists

ERIC Educational Resources Information Center

Richburg, Cynthia McCormick; Goldberg, Lynette R.

2005-01-01

A 25-item survey was administered to 45 teachers to identify what they knew about Minimal Hearing Loss (MHL) and to verify or refute five possible misperceptions reported earlier by Goldberg and McCormick Richburg (2004). Results support the importance of an educational audiologist on the service delivery team to help teachers understand the…

Minimal second language exposure, SES, and early word comprehension: New evidence from a direct assessment*

PubMed Central

Deanda, Stephanie; Arias-Trejo, Natalia; Poulin-Dubois, Diane; Zesiger, Pascal; Friend, Margaret

2015-01-01

Although the extant literature provides robust evidence of the influence of language exposure and socioeconomic status (SES) on language acquisition, it is unknown how sensitive the early receptive vocabulary system is to these factors. The current study investigates effects of minimal second language exposure and SES on the comprehension vocabulary of 16-month-old children in the language in which they receive the greatest exposure. Study 1 revealed minimal second language exposure and SES exert significant and independent effects on a direct measure of vocabulary comprehension in English-dominant and English monolingual children (N = 72). In Study 2, we replicated the effect of minimal second language exposure in Spanish-dominant and Spanish monolingual children (N = 86), however no effect of SES on vocabulary was obtained. Our results emphasize the sensitivity of the language system to minimal changes in the environment in early development. PMID:26957947

Industrial wastewater minimization using water pinch analysis: a case study on an old textile plant.

PubMed

Ujang, Z; Wong, C L; Manan, Z A

2002-01-01

Industrial wastewater minimization can be conducted using four main strategies: (i) reuse; (ii) regeneration-reuse; (iii) regeneration-recycling; and (iv) process changes. This study is concerned with (i) and (ii) to investigate the most suitable approach to wastewater minimization for an old textile industry plant. A systematic water networks design using water pinch analysis (WPA) was developed to minimize the water usage and wastewater generation for the textile plant. COD was chosen as the main parameter. An integrated design method has been applied, which brings the engineering insight using WPA that can determine the minimum flowrate of the water usage and then minimize the water consumption and wastewater generation as well. The overall result of this study shows that WPA has been effectively applied using both reuse and regeneration-reuse strategies for the old textile industry plant, and reduced the operating cost by 16% and 50% respectively.

Comparing the effects of minimal handling protocols on the physiological parameters of preterm infants receiving exogenous surfactant therapy

PubMed Central

Cabral, Laura A.; Velloso, Marcelo

2014-01-01

Background The practice of minimal handling is recommended for preterm infants (PTIs). However, few studies have investigated the effects of this practice among these infants or the time needed to ensure greater physiological stability, especially after exogenous surfactant treatments. Objective The current study compared the effects of two protocols of minimal handling on the physiological variables of PTIs after surfactant therapy. Method An exploratory prospective observational study was performed with 40 PTIs weighing less than 1,500 g. The infants were divided into two groups and monitored for 72 hours. One group received the standard minimal handling procedure during the first 12 hours after surfactant therapy; the other group (i.e., the modified group) received minimal handling within 72 hours after surfactant therapy. Infant heart rate (HR), oxygen saturation, body temperature, and the adverse events associated with changes to these variables were monitored every 10 minutes. Results Significant between-group differences were not found with regard to the occurrence of the adverse events associated with physiological changes (p>0.05). Conclusion The practice of minimal handling among very low birth weight infants did not alter their physiological stability when performed either 12 or 72 hours after surfactant therapy. PMID:24839044

A global approach for using kinematic redundancy to minimize base reactions of manipulators

NASA Technical Reports Server (NTRS)

Chung, C. L.; Desa, S.

1989-01-01

An important consideration in the use of manipulators in microgravity environments is the minimization of the base reactions, i.e. the magnitude of the force and the moment exerted by the manipulator on its base as it performs its tasks. One approach which was proposed and implemented is to use the redundant degree of freedom in a kinematically redundant manipulator to plan manipulator trajectories to minimize base reactions. A global approach was developed for minimizing the magnitude of the base reactions for kinematically redundant manipulators which integrates the Partitioned Jacobian method of redundancy resolution, a 4-3-4 joint-trajectory representation and the minimization of a cost function which is the time-integral of the magnitude of the base reactions. The global approach was also compared with a local approach developed earlier for the case of point-to-point motion of a three degree-of-freedom planar manipulator with one redundant degree-of-freedom. The results show that the global approach is more effective in reducing and smoothing the base force while the local approach is superior in reducing the base moment.

Economic impact of minimally invasive lumbar surgery.

PubMed

Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

2015-03-18

Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures.

Risedronate therapy for the prevention of steroid-induced osteoporosis in patients with minimal-change nephrotic syndrome.

PubMed

Takei, Takashi; Itabashi, Mitsuyo; Tsukada, Misao; Sugiura, Hidekazu; Moriyama, Takahito; Kojima, Chiari; Shiohira, Shunji; Shimizu, Ari; Karasawa, Kazunori; Amemiya, Nobuyuki; Kawanishi, Kunio; Ogawa, Tetsuya; Uchida, Keiko; Tsuchiya, Ken; Nitta, Kosaku

2010-01-01

Minimal-change nephrotic syndrome (MCNS) is treated by the administration of prednisolone (PSL) at high doses. Steroid-induced osteoporosis is a serious adverse effect of this drug. Patients with MCNS were randomly assigned to two groups, the risedronate (2.5 mg/day) + alfacalcidol (0.25 µg/day) group (n=20) and the alfacalcidol (0.25 µg/day)-alone group (n=20). All the patients had received PSL and the clinical characteristics were compared between the two groups at baseline and at 12 months. A significant decrease of the mean bone mineral density (BMD) of the lumbar spine from 0.710±0.162 (g/cm(2)) to 0.588±0.125 was observed in the alfacalcidol-alone group (p=0.02), while no such decrease of the bone mineral density was found in the risedronate + alfacalcidol group (0.663±0.169 at baseline and 0.626±0.129 at 12 months). No significant differences in the results of other biochemical tests performed at the baseline and at 12 months were observed between the two groups. The likelihood of development of steroid-induced osteoporosis was influenced by the cumulative dose of PSL, the mean BMD at the baseline, occurrence of disease relapse, and risedronate therapy. Risedronate appears to be effective in preventing steroid-induced osteoporosis. It is necessary to use bisphosphonates to maintain the BMD in patients with MCNS receiving prolonged steroid therapy.

Water and wastewater minimization plan in food industries.

PubMed

Ganjidoust, H; Ayati, B

2002-01-01

Iran is one of the countries located in a dry and semi-dry area. Many provinces like Tehran are facing problems in recent years because of less precipitation. For reduction in wastewater treatment cost and water consumption, many research works have been carried out. One of them concerns food industries group, which consumes a great amount of water in different units. For example, in beverage industries, washing of glass bottles seven times requires large amounts of water but use of plastic bottles can reduce water consumption. Another problem is leakage from pipelines, valves, etc. Their repair plays an important role in the wastage of water. The non-polluted wasted water can be used in washing halls, watering green yards, recycling to the process or reusing in cooling towers. In this paper, after a short review of waste minimization plans in food industries, problems concerning water consuming and wastewater producing units in three Iranian food industries have been investigated. At the end, some suggestions have been given for implementing the water and wastewater minimization plan in the companies.

[Research on fuzzy proportional-integral-derivative control of master-slave minimally invasive operation robot driver].

PubMed

Zhao, Ximei; Ren, Chengyi; Liu, Hao; Li, Haogyi

2014-12-01

Robotic catheter minimally invasive operation requires that the driver control system has the advantages of quick response, strong anti-jamming and real-time tracking of target trajectory. Since the catheter parameters of itself and movement environment and other factors continuously change, when the driver is controlled using traditional proportional-integral-derivative (PID), the controller gain becomes fixed once the PID parameters are set. It can not change with the change of the parameters of the object and environmental disturbance so that its change affects the position tracking accuracy, and may bring a large overshoot endangering patients' vessel. Therefore, this paper adopts fuzzy PID control method to adjust PID gain parameters in the tracking process in order to improve the system anti-interference ability, dynamic performance and tracking accuracy. The simulation results showed that the fuzzy PID control method had a fast tracking performance and a strong robustness. Compared with those of traditional PID control, the feasibility and practicability of fuzzy PID control are verified in a robotic catheter minimally invasive operation.

Minimally invasive surgery for thyroid eye disease.

PubMed

Naik, Milind Neilkant; Nair, Akshay Gopinathan; Gupta, Adit; Kamal, Saurabh

2015-11-01

Thyroid eye disease (TED) can affect the eye in myriad ways: proptosis, strabismus, eyelid retraction, optic neuropathy, soft tissue changes around the eye and an unstable ocular surface. TED consists of two phases: active, and inactive. The active phase of TED is limited to a period of 12-18 months and is mainly managed medically with immunosuppression. The residual structural changes due to the resultant fibrosis are usually addressed with surgery, the mainstay of which is orbital decompression. These surgeries are performed during the inactive phase. The surgical rehabilitation of TED has evolved over the years: not only the surgical techniques, but also the concepts, and the surgical tools available. The indications for decompression surgery have also expanded in the recent past. This article discusses the technological and conceptual advances of minimally invasive surgery for TED that decrease complications and speed up recovery. Current surgical techniques offer predictable, consistent results with better esthetics.

What's a Good Job? The Importance of Employment Relationships. CPRN Study. Changing Employment Relationships Series.

ERIC Educational Resources Information Center

Lowe, Graham S.; Schellenberg, Grant

The Changing Employment Relationships Project examined the importance of good employment relationships for workers, employers, and public policy. A nationally representative sample of 2,500 employed Canadians was surveyed, and 8 focus groups were conducted. The research findings were analyzed to explain the multidimensional nature of the…

An efficient graph theory based method to identify every minimal reaction set in a metabolic network

PubMed Central

2014-01-01

Background Development of cells with minimal metabolic functionality is gaining importance due to their efficiency in producing chemicals and fuels. Existing computational methods to identify minimal reaction sets in metabolic networks are computationally expensive. Further, they identify only one of the several possible minimal reaction sets. Results In this paper, we propose an efficient graph theory based recursive optimization approach to identify all minimal reaction sets. Graph theoretical insights offer systematic methods to not only reduce the number of variables in math programming and increase its computational efficiency, but also provide efficient ways to find multiple optimal solutions. The efficacy of the proposed approach is demonstrated using case studies from Escherichia coli and Saccharomyces cerevisiae. In case study 1, the proposed method identified three minimal reaction sets each containing 38 reactions in Escherichia coli central metabolic network with 77 reactions. Analysis of these three minimal reaction sets revealed that one of them is more suitable for developing minimal metabolism cell compared to other two due to practically achievable internal flux distribution. In case study 2, the proposed method identified 256 minimal reaction sets from the Saccharomyces cerevisiae genome scale metabolic network with 620 reactions. The proposed method required only 4.5 hours to identify all the 256 minimal reaction sets and has shown a significant reduction (approximately 80%) in the solution time when compared to the existing methods for finding minimal reaction set. Conclusions Identification of all minimal reactions sets in metabolic networks is essential since different minimal reaction sets have different properties that effect the bioprocess development. The proposed method correctly identified all minimal reaction sets in a both the case studies. The proposed method is computationally efficient compared to other methods for finding minimal

7 CFR 1c.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-01-01

... an expedited review procedure shall adopt a method for keeping all members advised of research... research involving no more than minimal risk, and for minor changes in approved research. 1c.110 Section 1c... review procedures for certain kinds of research involving no more than minimal risk, and for minor...

Rovers minimize human disturbance in research on wild animals.

PubMed

Le Maho, Yvon; Whittington, Jason D; Hanuise, Nicolas; Pereira, Louise; Boureau, Matthieu; Brucker, Mathieu; Chatelain, Nicolas; Courtecuisse, Julien; Crenner, Francis; Friess, Benjamin; Grosbellet, Edith; Kernaléguen, Laëtitia; Olivier, Frédérique; Saraux, Claire; Vetter, Nathanaël; Viblanc, Vincent A; Thierry, Bernard; Tremblay, Pascale; Groscolas, René; Le Bohec, Céline

2014-12-01

Investigating wild animals while minimizing human disturbance remains an important methodological challenge. When approached by a remote-operated vehicle (rover) which can be equipped to make radio-frequency identifications, wild penguins had significantly lower and shorter stress responses (determined by heart rate and behavior) than when approached by humans. Upon immobilization, the rover-unlike humans-did not disorganize colony structure, and stress rapidly ceased. Thus, rovers can reduce human disturbance of wild animals and the resulting scientific bias.

9 CFR 93.436 - Ruminants from regions of minimal risk for BSE.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Ruminants from regions of minimal risk for BSE. 93.436 Section 93.436 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE EXPORTATION AND IMPORTATION OF ANIMALS (INCLUDING POULTRY) AND ANIMAL PRODUCTS...

9 CFR 93.436 - Ruminants from regions of minimal risk for BSE.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Ruminants from regions of minimal risk for BSE. 93.436 Section 93.436 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE EXPORTATION AND IMPORTATION OF ANIMALS (INCLUDING POULTRY) AND ANIMAL PRODUCTS...

Late post-treatment radiographic changes 3 years following chemoradiation for glioma: the importance of histopathology.

PubMed

Galante, Joao R; Rodriguez, Fausto; Grossman, Stuart A; Strowd, Roy E

2017-07-18

Treatment-related changes can mimic brain tumor progression both clinically and radiographically. Distinguishing these two entities represents a major challenge in neuro-oncology. No single imaging modality is capable of reliably achieving such distinction. While histopathology remains the gold standard, definitive pathological criteria are also lacking which can further complicate such cases. We report a patient with high-grade glioma who, after initially presenting with histopathologically confirmed pseudoprogression 10 months following treatment, re-presented 3 years following concurrent chemoradiation with clinical and radiographic changes that were most consistent with progressive disease but for which histopathology revealed treatment effects without active glioma. This case highlights the potential late onset of treatment-related changes and underscores the importance of histopathologic assessment even years following initial therapy.

The relative importance among anthropogenic forcings of land use/land cover change in affecting temperature extremes

NASA Astrophysics Data System (ADS)

Chen, Liang; Dirmeyer, Paul A.

2018-05-01

Land use/land cover change (LULCC) exerts significant influence on regional climate extremes, but its relative importance compared with other anthropogenic climate forcings has not been thoroughly investigated. This study compares land use forcing with other forcing agents in explaining the simulated historical temperature extreme changes since preindustrial times in the CESM-Last Millennium Ensemble (LME) project. CESM-LME suggests that the land use forcing has caused an overall cooling in both warm and cold extremes, and has significantly decreased diurnal temperature range (DTR). Due to the competing effects of the GHG and aerosol forcings, the spatial pattern of changes in 1850-2005 climatology of temperature extremes in CESM-LME can be largely explained by the land use forcing, especially for hot extremes and DTR. The dominance of land use forcing is particularly evident over Europe, eastern China, and the central and eastern US. Temporally, the land-use cooling is relatively stable throughout the historical period, while the warming of temperature extremes is mainly influenced by the enhanced GHG forcing, which has gradually dampened the local dominance of the land use effects. Results from the suite of CMIP5 experiments partially agree with the local dominance of the land use forcing in CESM-LME, but inter-model discrepancies exist in the distribution and sign of the LULCC-induced temperature changes. Our results underline the overall importance of LULCC in historical temperature extreme changes, implying land use forcing should be highlighted in future climate projections.

Changes of minimal erythema dose after water and salt water baths.

PubMed

Gambichler, T; Schröpl, F

1998-01-01

Knowledge about the influence of salt water baths on UV irradiation, especially balneophototherapy, is incomplete. The aim of this study was to investigate the influence of various concentrated salt solutions on the minimal erythema dose (MED). We determined the MEDdry (UVB) in 24 healthy, previously UV unexposed subjects on the inner forearm. Subjects were divided randomly into two groups of 12. Subsequently, the MEDwet was assessed on each forearm after 30 min tap water or 5% salt water bath (group A), respectively, or after 30 min 10% or 20% salt water bath (group B), respectively. Compared with the MEDdry, a significantly decreased MEDwet, was observed after all exposures (group A==>F = 18.94; P < 0.001; group B==>F = 11.73; P < 0.006). A maximal relative decrease in MEDdry of about 51.4% was observed after the 10% salt water bath. The 5% salt solution caused a modest relative decrease in MEDwet of 23.4%. We observed a markedly increased photosensitivity to UVB after all exposures, without a linear correlation between the MED and the salt water concentration. A determination of MED during balneophototherapy should be carried out after bathing in order to reduce the cumulative UV dose and to prevent acute photodamage.

34 CFR 97.406 - Research involving greater than minimal risk and no prospect of direct benefit to individual...

Code of Federal Regulations, 2013 CFR

2013-07-01

... conducts or funds research in which the IRB finds that more than minimal risk to children is presented by..., only if the IRB finds that— (a) The risk represents a minor increase over minimal risk; (b) The... or condition that is of vital importance for the understanding or amelioration of the subjects...

34 CFR 97.406 - Research involving greater than minimal risk and no prospect of direct benefit to individual...

Code of Federal Regulations, 2012 CFR

2012-07-01

... conducts or funds research in which the IRB finds that more than minimal risk to children is presented by..., only if the IRB finds that— (a) The risk represents a minor increase over minimal risk; (b) The... or condition that is of vital importance for the understanding or amelioration of the subjects...

34 CFR 97.406 - Research involving greater than minimal risk and no prospect of direct benefit to individual...

Code of Federal Regulations, 2014 CFR

2014-07-01

... conducts or funds research in which the IRB finds that more than minimal risk to children is presented by..., only if the IRB finds that— (a) The risk represents a minor increase over minimal risk; (b) The... or condition that is of vital importance for the understanding or amelioration of the subjects...

34 CFR 97.406 - Research involving greater than minimal risk and no prospect of direct benefit to individual...

Code of Federal Regulations, 2011 CFR

2011-07-01

... conducts or funds research in which the IRB finds that more than minimal risk to children is presented by..., only if the IRB finds that— (a) The risk represents a minor increase over minimal risk; (b) The... or condition that is of vital importance for the understanding or amelioration of the subjects...

Minimizing quality changes of cloudy apple juice: The use of kiwifruit puree and high pressure homogenization.

PubMed

Yi, Junjie; Kebede, Biniam; Kristiani, Kristiani; Grauwet, Tara; Van Loey, Ann; Hendrickx, Marc

2018-05-30

Cloud loss, enzymatic browning, and flavor changes are important quality defects of cloudy fruit juices determining consumer acceptability. The development of clean label options to overcome such quality problems is currently of high interest. Therefore, this study investigated the effect of kiwifruit puree (clean label ingredient) and high pressure homogenization on quality changes of cloudy apple juice using a multivariate approach. The use of kiwifruit puree addition and high pressure homogenization resulted in a juice with improved uniformity and cloud stability by reducing particle size and increasing viscosity and yield stress (p < 0.01). Furthermore, kiwifruit puree addition reduced enzymatic browning (ΔE ∗  < 3), due to the increased ascorbic acid and contributed to a more saturated and bright yellow color, a better taste balance, and a more fruity aroma of juice. This work demonstrates that clean label options to control quality degradation of cloudy fruit juice might offer new opportunities. Copyright © 2018 Elsevier Ltd. All rights reserved.

Joint Dictionary Learning for Multispectral Change Detection.

PubMed

Lu, Xiaoqiang; Yuan, Yuan; Zheng, Xiangtao

2017-04-01

Change detection is one of the most important applications of remote sensing technology. It is a challenging task due to the obvious variations in the radiometric value of spectral signature and the limited capability of utilizing spectral information. In this paper, an improved sparse coding method for change detection is proposed. The intuition of the proposed method is that unchanged pixels in different images can be well reconstructed by the joint dictionary, which corresponds to knowledge of unchanged pixels, while changed pixels cannot. First, a query image pair is projected onto the joint dictionary to constitute the knowledge of unchanged pixels. Then reconstruction error is obtained to discriminate between the changed and unchanged pixels in the different images. To select the proper thresholds for determining changed regions, an automatic threshold selection strategy is presented by minimizing the reconstruction errors of the changed pixels. Adequate experiments on multispectral data have been tested, and the experimental results compared with the state-of-the-art methods prove the superiority of the proposed method. Contributions of the proposed method can be summarized as follows: 1) joint dictionary learning is proposed to explore the intrinsic information of different images for change detection. In this case, change detection can be transformed as a sparse representation problem. To the authors' knowledge, few publications utilize joint learning dictionary in change detection; 2) an automatic threshold selection strategy is presented, which minimizes the reconstruction errors of the changed pixels without the prior assumption of the spectral signature. As a result, the threshold value provided by the proposed method can adapt to different data due to the characteristic of joint dictionary learning; and 3) the proposed method makes no prior assumption of the modeling and the handling of the spectral signature, which can be adapted to different data.

The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures.

PubMed

Walenkamp, Monique M J; de Muinck Keizer, Robert-Jan; Goslings, J Carel; Vos, Lara M; Rosenwasser, Melvin P; Schep, Niels W L

2015-10-01

The Patient-rated Wrist Evaluation (PRWE) is a commonly used instrument in upper extremity surgery and in research. However, to recognize a treatment effect expressed as a change in PRWE, it is important to be aware of the minimum clinically important difference (MCID) and the minimum detectable change (MDC). The MCID of an outcome tool like the PRWE is defined as the smallest change in a score that is likely to be appreciated by a patient as an important change, while the MDC is defined as the smallest amount of change that can be detected by an outcome measure. A numerical change in score that is less than the MCID, even when statistically significant, does not represent a true clinically relevant change. To our knowledge, the MCID and MDC of the PRWE have not been determined in patients with distal radius fractures. We asked: (1) What is the MCID of the PRWE score for patients with distal radius fractures? (2) What is the MDC of the PRWE? Our prospective cohort study included 102 patients with a distal radius fracture and a median age of 59 years (interquartile range [IQR], 48-66 years). All patients completed the PRWE questionnaire during each of two separate visits. At the second visit, patients were asked to indicate the degree of clinical change they appreciated since the previous visit. Accordingly, patients were categorized in two groups: (1) minimally improved or (2) no change. The groups were used to anchor the changes observed in the PRWE score to patients' perspectives of what was clinically important. We determined the MCID using an anchor-based receiver operator characteristic method. In this context, the change in the PRWE score was considered a diagnostic test, and the anchor (minimally improved or no change as noted by the patients from visit to visit) was the gold standard. The optimal receiver operator characteristic cutoff point calculated with the Youden index reflected the value of the MCID. In our study, the MCID of the PRWE was 11.5 points

Minimization of lumen depreciation in LED lamps using thermal transient behavior analysis and design optimizations.

PubMed

Khan, M Nisa

2016-02-10

We expansively investigate thermal behaviors of various general-purpose light-emitting diode (LED) lamps and apply our measured results, validated by simulation, to establish lamp design rules for optimizing their optical and thermal properties. These design rules provide the means to minimize lumen depreciation over time by minimizing the periods for lamps to reach thermal steady-state while maintaining their high luminous efficacy and omnidirectional light distribution capability. While it is well known that minimizing the junction temperature of an LED leads to a longer lifetime and an increased lumen output, our study demonstrates, for the first time, to the best of our knowledge, that it is also important to minimize the time it takes to reach thermal equilibrium because doing so minimizes lumen depreciation and enhances light output and color stability during operation. Specifically, we have found that, in addition to inadequate heat-sink fin areas for a lamp configuration, LEDs mounted on multiple boards, as opposed to a single board, lead to longer periods for reaching thermal equilibrium contributing to larger lumen depreciation.

Importance sampling variance reduction for the Fokker–Planck rarefied gas particle method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Collyer, B.S., E-mail: benjamin.collyer@gmail.com; London Mathematical Laboratory, 14 Buckingham Street, London WC2N 6DF; Connaughton, C.

The Fokker–Planck approximation to the Boltzmann equation, solved numerically by stochastic particle schemes, is used to provide estimates for rarefied gas flows. This paper presents a variance reduction technique for a stochastic particle method that is able to greatly reduce the uncertainty of the estimated flow fields when the characteristic speed of the flow is small in comparison to the thermal velocity of the gas. The method relies on importance sampling, requiring minimal changes to the basic stochastic particle scheme. We test the importance sampling scheme on a homogeneous relaxation, planar Couette flow and a lid-driven-cavity flow, and find thatmore » our method is able to greatly reduce the noise of estimated quantities. Significantly, we find that as the characteristic speed of the flow decreases, the variance of the noisy estimators becomes independent of the characteristic speed.« less

Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis

PubMed Central

Feigel, Amanda; Sylla, Patricia

2016-01-01

Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resection have reported equivalent conversion and morbidity rates between reoperative and non-reoperative cases, and series evaluating the impact of laparoscopy in reoperative cases have demonstrated improved short-term outcomes with laparoscopy. The data overall highlight the importance of case selection, careful preoperative preparation and planning, and the critical role of surgeons' expertise in advanced laparoscopic techniques. Challenges to the widespread adoption of minimally invasive techniques in reoperative colorectal cases include the longer learning curve and longer operative time. However, with the steady increase in adoption of minimally invasive techniques worldwide, minimally invasive surgery (MIS) is likely to continue to be applied in the management of increasingly complex reoperative colorectal cases in an effort to improve patient outcomes. In the hands of experienced MIS surgeons and in carefully selected cases, laparoscopy is both safe and efficacious for reoperative procedures in the abdomen and pelvis, with measurable short-term benefits. PMID:28642675

Comparisons of Adolescent and Parent Willingness to Participate in Minimal and Above Minimal Risk Pediatric Asthma Research Protocols

PubMed Central

Brody, Janet L.; Annett, Robert D.; Scherer, David G.; Perryman, Mandy L.; Cofrin, Keely M. W.

2007-01-01

Purpose Much has been written about conceptual concern for voluntary assent with children and adolescents. However, little empirical data exists examining the frequency with which, or context in which, adolescents and parents disagree on research participation decisions. The purpose of this study was to compare parent and adolescent willingness to participate in minimal and above minimal risk pediatric asthma research protocols. Method 36 adolescents diagnosed with asthma and one of their parents independently rated their willingness to participate in 9 pediatric asthma research protocol vignettes. The selected protocols were chosen by an expert panel as representative of typical minimal and above minimal risk pediatric asthma studies. Results Parents and adolescents were significantly less likely to agree to enroll in above minimal risk studies. However, this was qualified by a finding that adolescents were significantly more willing than parents to enroll in above minimal risk research. Across all 9 studies, parents and adolescents held concordant views on participation decisions approximately 60% of the time. Perception of potential study benefit was the most frequent reason provided for participation decisions by both parents and adolescents. Conclusion Parents and their adolescents report a consistent 40% discordance in their views about participating in asthma research across a variety of asthma research protocols, with adolescents more willing than their parents to enroll in above minimal risk studies. These differences of opinion highlight the need to carefully consider the process by which families are offered the option of adolescent research participation. PMID:16109343

Minimal measures on surfaces of higher genus

NASA Astrophysics Data System (ADS)

Wang, Fang

We study the minimal measures for positive definite autonomous Lagrangian systems defined on the tangent bundles of compact surfaces with genus greater than one. We present some results on the structure of minimal measures on compact surfaces. Specifically, we give a finer description of the structure of minimal measures with rational rotation vectors for geodesic flows on compact surfaces.

Climate change and human health: Indian context.

PubMed

Singh, Poonam K; Dhiman, Ramesh C

2012-06-01

The article reviews the issue of climate change and health in the Indian context. The importance of climate change leading to estimated loss of above 2.5 million DALYs in southeast Asia, mortality due to heat waves, and the importance of air quality related respiratory diseases, disasters due to excessive floods, malnutrition due to reduction in rice, maize and sorghum crops etc. Latest work undertaken in India, vis-a-vis current scenario and need for further work has been discussed. There is felt need of further studies on assessing the impact on dengue and chikungunya as the transmission dynamics of these diseases involve water availability, storage and life style, etc. Uncertainties and knowledge gaps identified in the studies undertaken so far have also been highlighted. As regards to vector borne diseases, there is a need to concentrate in the areas which are presently free from malaria and with use of best available tools of interventions in already disease endemic areas like northeastern states, the risk of climate change impacts can be minimized.

Comparison of anchor-based and distributional approaches in estimating important difference in common cold.

PubMed

Barrett, Bruce; Brown, Roger; Mundt, Marlon

2008-02-01

Evaluative health-related quality-of-life instruments used in clinical trials should be able to detect small but important changes in health status. Several approaches to minimal important difference (MID) and responsiveness have been developed. To compare anchor-based and distributional approaches to important difference and responsiveness for the Wisconsin Upper Respiratory Symptom Survey (WURSS), an illness-specific quality of life outcomes instrument. Participants with community-acquired colds self-reported daily using the WURSS-44. Distribution-based methods calculated standardized effect size (ES) and standard error of measurement (SEM). Anchor-based methods compared daily interval changes to global ratings of change, using: (1) standard MID methods based on correspondence to ratings of "a little better" or "somewhat better," and (2) two-level multivariate regression models. About 150 adults were monitored throughout their colds (1,681 sick days.): 88% were white, 69% were women, and 50% had completed college. The mean age was 35.5 years (SD = 14.7). WURSS scores increased 2.2 points from the first to second day, and then dropped by an average of 8.2 points per day from days 2 to 7. The SEM averaged 9.1 during these 7 days. Standard methods yielded a between day MID of 22 points. Regression models of MID projected 11.3-point daily changes. Dividing these estimates of small-but-important-difference by pooled SDs yielded coefficients of .425 for standard MID, .218 for regression model, .177 for SEM, and .157 for ES. These imply per-group sample sizes of 870 using ES, 616 for SEM, 302 for regression model, and 89 for standard MID, assuming alpha = .05, beta = .20 (80% power), and two-tailed testing. Distribution and anchor-based approaches provide somewhat different estimates of small but important difference, which in turn can have substantial impact on trial design.

Minimal Increase Network Coding for Dynamic Networks.

PubMed

Zhang, Guoyin; Fan, Xu; Wu, Yanxia

2016-01-01

Because of the mobility, computing power and changeable topology of dynamic networks, it is difficult for random linear network coding (RLNC) in static networks to satisfy the requirements of dynamic networks. To alleviate this problem, a minimal increase network coding (MINC) algorithm is proposed. By identifying the nonzero elements of an encoding vector, it selects blocks to be encoded on the basis of relationship between the nonzero elements that the controls changes in the degrees of the blocks; then, the encoding time is shortened in a dynamic network. The results of simulations show that, compared with existing encoding algorithms, the MINC algorithm provides reduced computational complexity of encoding and an increased probability of delivery.

Minimal Increase Network Coding for Dynamic Networks

PubMed Central

Wu, Yanxia

2016-01-01

Because of the mobility, computing power and changeable topology of dynamic networks, it is difficult for random linear network coding (RLNC) in static networks to satisfy the requirements of dynamic networks. To alleviate this problem, a minimal increase network coding (MINC) algorithm is proposed. By identifying the nonzero elements of an encoding vector, it selects blocks to be encoded on the basis of relationship between the nonzero elements that the controls changes in the degrees of the blocks; then, the encoding time is shortened in a dynamic network. The results of simulations show that, compared with existing encoding algorithms, the MINC algorithm provides reduced computational complexity of encoding and an increased probability of delivery. PMID:26867211

Change in Water Cycle- Important Issue on Climate Earth System

NASA Astrophysics Data System (ADS)

Singh, Pratik

Change in Water Cycle- Important Issue on Climate Earth System PRATIK KUMAR SINGH1 1BALDEVRAM MIRDHA INSTITUTE OF TECHNOLOGY,JAIPUR (RAJASTHAN) ,INDIA Water is everywhere on Earth and is the only known substance that can naturally exist as a gas, liquid, and solid within the relatively small range of air temperatures and pressures found at the Earth's surface.Changes in the hydrological cycle as a consequence of climate and land use drivers are expected to play a central role in governing a vast range of environmental impacts.Earth's climate will undergo changes in response to natural variability, including solar variability, and to increasing concentrations of green house gases and aerosols.Further more, agreement is widespread that these changes may profoundly affect atmospheric water vapor concentrations, clouds and precipitation patterns.As we know that ,a warmer climate, directly leading to increased evaporation, may well accelerate the hydrological cycle, resulting in an increase in the amount of moisture circulating through the atmosphere.The Changing Water Cycle programmer will develop an integrated, quantitative understanding of the changes taking place in the global water cycle, involving all components of the earth system, improving predictions for the next few decades of regional precipitation, evapotranspiration, soil moisture, hydrological storage and fluxes.The hydrological cycle involves evaporation, transpiration, condensation, precipitation, and runoff. NASA's Aqua satellite will monitor many aspects of the role of water in the Earth's systems, and will do so at spatial and temporal scales appropriate to foster a more detailed understanding of each of the processes that contribute to the hydrological cycle. These data and the analyses of them will nurture the development and refinement of hydrological process models and a corresponding improvement in regional and global climate models, with a direct anticipated benefit of more accurate weather and

Increasing measurement accuracy of age-related BOLD signal change: Minimizing vascular contributions by resting-state-fluctuation-of-amplitude scaling

PubMed Central

Kannurpatti, Sridhar S.; Motes, Michael A.; Rypma, Bart; Biswal, Bharat B.

2012-01-01

In this report we demonstrate a hemodynamic scaling method with resting-state fluctuation of amplitude (RSFA) in healthy adult younger and older subject groups. We show that RSFA correlated with breath hold (BH) responses throughout the brain in groups of younger and older subjects, that RSFA and BH performed comparably in accounting for age-related hemodynamic coupling changes, and yielded more veridical estimates of age-related differences in task-related neural activity. BOLD data from younger and older adults performing motor and cognitive tasks were scaled using RSFA and BH related signal changes. Scaling with RSFA and BH reduced the skew of the BOLD response amplitude distribution in each subject and reduced mean BOLD amplitude and variability in both age groups. Statistically significant differences in intra-subject amplitude variation across regions of activated cortex, and inter-subject amplitude variation in regions of activated cortex were observed between younger and older subject groups. Intra- and inter-subject variability differences were mitigated after scaling. RSFA, though similar to BH in minimizing skew in the un-scaled BOLD amplitude distribution, attenuated the neural activity related BOLD amplitude significantly less than BH. The amplitude and spatial extent of group activation were lower in the older than in the younger group prior to and after scaling. After accounting for vascular variability differences through scaling, age-related decreases in activation volume were observed during the motor and cognitive tasks. The results suggest that RSFA-scaled data yield age-related neural activity differences during task performance with negligible effects from non-neural (i.e., vascular) sources. PMID:20665721

Increasing measurement accuracy of age-related BOLD signal change: minimizing vascular contributions by resting-state-fluctuation-of-amplitude scaling.

PubMed

Kannurpatti, Sridhar S; Motes, Michael A; Rypma, Bart; Biswal, Bharat B

2011-07-01

In this report we demonstrate a hemodynamic scaling method with resting-state fluctuation of amplitude (RSFA) in healthy adult younger and older subject groups. We show that RSFA correlated with breath hold (BH) responses throughout the brain in groups of younger and older subjects which RSFA and BH performed comparably in accounting for age-related hemodynamic coupling changes, and yielded more veridical estimates of age-related differences in task-related neural activity. BOLD data from younger and older adults performing motor and cognitive tasks were scaled using RSFA and BH related signal changes. Scaling with RSFA and BH reduced the skew of the BOLD response amplitude distribution in each subject and reduced mean BOLD amplitude and variability in both age groups. Statistically significant differences in intrasubject amplitude variation across regions of activated cortex, and intersubject amplitude variation in regions of activated cortex were observed between younger and older subject groups. Intra- and intersubject variability differences were mitigated after scaling. RSFA, though similar to BH in minimizing skew in the unscaled BOLD amplitude distribution, attenuated the neural activity-related BOLD amplitude significantly less than BH. The amplitude and spatial extent of group activation were lower in the older than in the younger group before and after scaling. After accounting for vascular variability differences through scaling, age-related decreases in activation volume were observed during the motor and cognitive tasks. The results suggest that RSFA-scaled data yield age-related neural activity differences during task performance with negligible effects from non-neural (i.e., vascular) sources. Copyright © 2010 Wiley-Liss, Inc.

Clinical concentrations of chemically diverse general anesthetics minimally affect lipid bilayer properties.

PubMed

Herold, Karl F; Sanford, R Lea; Lee, William; Andersen, Olaf S; Hemmings, Hugh C

2017-03-21

General anesthetics have revolutionized medicine by facilitating invasive procedures, and have thus become essential drugs. However, detailed understanding of their molecular mechanisms remains elusive. A mechanism proposed over a century ago involving unspecified interactions with the lipid bilayer known as the unitary lipid-based hypothesis of anesthetic action, has been challenged by evidence for direct anesthetic interactions with a range of proteins, including transmembrane ion channels. Anesthetic concentrations in the membrane are high (10-100 mM), however, and there is no experimental evidence ruling out a role for the lipid bilayer in their ion channel effects. A recent hypothesis proposes that anesthetic-induced changes in ion channel function result from changes in bilayer lateral pressure that arise from partitioning of anesthetics into the bilayer. We examined the effects of a broad range of chemically diverse general anesthetics and related nonanesthetics on lipid bilayer properties using an established fluorescence assay that senses drug-induced changes in lipid bilayer properties. None of the compounds tested altered bilayer properties sufficiently to produce meaningful changes in ion channel function at clinically relevant concentrations. Even supra-anesthetic concentrations caused minimal bilayer effects, although much higher (toxic) concentrations of certain anesthetic agents did alter lipid bilayer properties. We conclude that general anesthetics have minimal effects on bilayer properties at clinically relevant concentrations, indicating that anesthetic effects on ion channel function are not bilayer-mediated but rather involve direct protein interactions.

Clinical concentrations of chemically diverse general anesthetics minimally affect lipid bilayer properties

PubMed Central

Herold, Karl F.; Sanford, R. Lea; Lee, William; Andersen, Olaf S.; Hemmings, Hugh C.

2017-01-01

General anesthetics have revolutionized medicine by facilitating invasive procedures, and have thus become essential drugs. However, detailed understanding of their molecular mechanisms remains elusive. A mechanism proposed over a century ago involving unspecified interactions with the lipid bilayer known as the unitary lipid-based hypothesis of anesthetic action, has been challenged by evidence for direct anesthetic interactions with a range of proteins, including transmembrane ion channels. Anesthetic concentrations in the membrane are high (10–100 mM), however, and there is no experimental evidence ruling out a role for the lipid bilayer in their ion channel effects. A recent hypothesis proposes that anesthetic-induced changes in ion channel function result from changes in bilayer lateral pressure that arise from partitioning of anesthetics into the bilayer. We examined the effects of a broad range of chemically diverse general anesthetics and related nonanesthetics on lipid bilayer properties using an established fluorescence assay that senses drug-induced changes in lipid bilayer properties. None of the compounds tested altered bilayer properties sufficiently to produce meaningful changes in ion channel function at clinically relevant concentrations. Even supra-anesthetic concentrations caused minimal bilayer effects, although much higher (toxic) concentrations of certain anesthetic agents did alter lipid bilayer properties. We conclude that general anesthetics have minimal effects on bilayer properties at clinically relevant concentrations, indicating that anesthetic effects on ion channel function are not bilayer-mediated but rather involve direct protein interactions. PMID:28265069

A Survey of Runners' Attitudes Toward and Experiences With Minimally Shod Running.

PubMed

Cohler, Marissa H; Casey, Ellen

2015-08-01

To investigate the characteristics, perceptions, motivating factors, experiences, and injury rates of runners who practice minimally shod running. Survey. web-based questionnaire. Five-hundred sixty-six members of the Chicago Area Runner's Association. A link to a 31-question online survey was e-mailed to members of Chicago Area Runner's Association. Questions covered demographic information, use of minimalist-style running shoes (MSRS), injury rates, and change in pain. Use of MSRS, occurrence or improvement of injury/pain, regions of injury/pain, reasons for or for not using MSRS. One-hundred seventy-five (31%) respondents had practiced minimally shod running, and the most common motivating factor was to decrease injuries and/or pain. Fifty-one respondents (29%) suffered an injury or pain while wearing MSRS, with the most common body part involved being the foot. Fifty-four respondents (31%) had an injury that improved after adopting minimally shod running; the most common area involved was the knee. One-hundred twenty respondents (69%) were still using MSRS. Of those who stopped using MSRS, the main reason was development of an injury or pain. The most common reason that respondents have not tried minimally shod running is a fear of developing an injury. This survey-based study demonstrated that the use of MSRS is common, largely as the result of a perception that they may reduce injuries or pain. Reductions and occurrences of injury/pain with minimally shod running were reported in approximately equal numbers. The most common site of reported injury/pain reduction was the knee, whereas the most common reported site of injury/pain occurrence was the foot. Fear of developing pain or injury is the most common reason runners are reluctant to try minimally shod running. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

DD genotype of ACE gene in boys: may it be a risk factor for minimal change nephrotic syndrome?

PubMed

Alasehirli, Belgin; Balat, Ayşe; Büyükçelik, Mithat

2012-01-01

It has been shown that angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism affects the circulating and cellular levels of ACE and may be a risk factor in several renal diseases. We analyzed the association of ACE gene I/D polymorphism with the clinical presentation of minimal change nephrotic syndrome (MCNS) in a Turkish child population. This study consisted of 97 children with MCNS and 144 healthy controls. Genotyping of ACE gene was performed using polymerase chain reaction (PCR). The distributions of ACE genotypes were II in 13%, ID in 49%, and DD in 38% in patient group, and 9%, 49%, and 42% in control group, respectively. The frequency of the D allele was 63% and that of the I allele was 37% in patients. There were no relevant differences in the allele frequencies and genotypes of ACE I/D polymorphism between patients and controls. However, DD genotype was higher in boys in children with MCNS (78.4%. vs. 50.0%, p = 0.004). The frequencies of DD genotype and D allele in boys were 7.25 and 2.56 times higher than II genotype and I allele in the patient group, respectively. We suggest that DD genotype in boys may be one of the risk factors for MCNS.

Evolving technologies in robotic surgery for minimally invasive treatment of gynecologic cancers.

PubMed

Levinson, Kimberly L; Auer, Melinda; Escobar, Pedro F

2013-09-01

Since the introduction of robotic technology, there have been significant changes to the field of gynecologic oncology. The number of minimally invasive procedures has drastically increased, with robotic procedures rising remarkably. With recent evidence suggesting that minimally invasive techniques should be the standard of care for early endometrial and cervical cancers, the push for new technology and advancements has continued. Several emerging robotic technologies have significant potential in the field of gynecologic oncology. The single-site robotic platform enables robotic surgery through a single incision; the Firefly camera detects the fluorescent dye indocyanine green, which may improve sensitivity in sentinel lymph node biopsy; and a robotic vessel-sealing device and stapler will continue to improve efficiency of the robotic surgeon.

The Oral Minimal Model Method

PubMed Central

Cobelli, Claudio; Dalla Man, Chiara; Toffolo, Gianna; Basu, Rita; Vella, Adrian; Rizza, Robert

2014-01-01

The simultaneous assessment of insulin action, secretion, and hepatic extraction is key to understanding postprandial glucose metabolism in nondiabetic and diabetic humans. We review the oral minimal method (i.e., models that allow the estimation of insulin sensitivity, β-cell responsivity, and hepatic insulin extraction from a mixed-meal or an oral glucose tolerance test). Both of these oral tests are more physiologic and simpler to administer than those based on an intravenous test (e.g., a glucose clamp or an intravenous glucose tolerance test). The focus of this review is on indices provided by physiological-based models and their validation against the glucose clamp technique. We discuss first the oral minimal model method rationale, data, and protocols. Then we present the three minimal models and the indices they provide. The disposition index paradigm, a widely used β-cell function metric, is revisited in the context of individual versus population modeling. Adding a glucose tracer to the oral dose significantly enhances the assessment of insulin action by segregating insulin sensitivity into its glucose disposal and hepatic components. The oral minimal model method, by quantitatively portraying the complex relationships between the major players of glucose metabolism, is able to provide novel insights regarding the regulation of postprandial metabolism. PMID:24651807

[Advantages and disadvantages of minimally invasive surgery in colorectal cancer surgery].

PubMed

Zheng, Minhua; Ma, Junjun

2017-06-25

Since the emergence of minimally invasive technology twenty years ago, as a surgical concept and surgical technique for colorectal cancer surgery, its obvious advantages have been recognized. Laparoscopic technology, as one of the most important technology platform, has got a lot of evidence-based support for the oncological safety and effectiveness in colorectal cancer surgery Laparoscopic technique has advantages in terms of identification of anatomic plane and autonomic nerve, protection of pelvic structure, and fine dissection of vessels. But because of the limitation of laparoscopic technology there are still some deficiencies and shortcomings, including lack of touch and lack of stereo vision problems, in addition to the low rectal cancer, especially male, obese, narrow pelvis, larger tumors, it is difficult to get better view and manipulating triangle in laparoscopy. However, the emergence of a series of new minimally invasive technology platform is to make up for the defects and deficiencies. The robotic surgical system possesses advantages, such as stereo vision, higher magnification, manipulator wrist with high freedom degree, filtering of tremor and higher stability, but still has disadvantages, such as lack of haptic feedback, longer operation time, high operation cost and expensive price. 3D system of laparoscopic surgery has similar visual experience and feelings as robotic surgery in the 3D view, the same operating skills as 2D laparoscopy and a short learning curve. The price of 3D laparoscopy is also moderate, which makes the 3D laparoscopy more popular in China. Transanal total mesorectal excision (taTME) by changing the traditional laparoscopic pelvic surgery approach, may have certain advantages for male cases with narrow pelvic and patients with large tumor, and it is in accordance with the technical concept of natural orifice, with less minimally invasive and better cosmetics, which can be regarded as a supplemental technique of the

Optimal design method to minimize users' thinking mapping load in human-machine interactions.

PubMed

Huang, Yanqun; Li, Xu; Zhang, Jie

2015-01-01

The discrepancy between human cognition and machine requirements/behaviors usually results in serious mental thinking mapping loads or even disasters in product operating. It is important to help people avoid human-machine interaction confusions and difficulties in today's mental work mastered society. Improving the usability of a product and minimizing user's thinking mapping and interpreting load in human-machine interactions. An optimal human-machine interface design method is introduced, which is based on the purpose of minimizing the mental load in thinking mapping process between users' intentions and affordance of product interface states. By analyzing the users' thinking mapping problem, an operating action model is constructed. According to human natural instincts and acquired knowledge, an expected ideal design with minimized thinking loads is uniquely determined at first. Then, creative alternatives, in terms of the way human obtains operational information, are provided as digital interface states datasets. In the last, using the cluster analysis method, an optimum solution is picked out from alternatives, by calculating the distances between two datasets. Considering multiple factors to minimize users' thinking mapping loads, a solution nearest to the ideal value is found in the human-car interaction design case. The clustering results show its effectiveness in finding an optimum solution to the mental load minimizing problems in human-machine interaction design.

Blackfolds, plane waves and minimal surfaces

NASA Astrophysics Data System (ADS)

Armas, Jay; Blau, Matthias

2015-07-01

Minimal surfaces in Euclidean space provide examples of possible non-compact horizon geometries and topologies in asymptotically flat space-time. On the other hand, the existence of limiting surfaces in the space-time provides a simple mechanism for making these configurations compact. Limiting surfaces appear naturally in a given space-time by making minimal surfaces rotate but they are also inherent to plane wave or de Sitter space-times in which case minimal surfaces can be static and compact. We use the blackfold approach in order to scan for possible black hole horizon geometries and topologies in asymptotically flat, plane wave and de Sitter space-times. In the process we uncover several new configurations, such as black helicoids and catenoids, some of which have an asymptotically flat counterpart. In particular, we find that the ultraspinning regime of singly-spinning Myers-Perry black holes, described in terms of the simplest minimal surface (the plane), can be obtained as a limit of a black helicoid, suggesting that these two families of black holes are connected. We also show that minimal surfaces embedded in spheres rather than Euclidean space can be used to construct static compact horizons in asymptotically de Sitter space-times.

Reliability, Concurrent Validity, and Minimal Detectable Change for iPhone Goniometer App in Assessing Knee Range of Motion.

PubMed

Mehta, Saurabh P; Barker, Katherine; Bowman, Brett; Galloway, Heather; Oliashirazi, Nicole; Oliashirazi, Ali

2017-07-01

Much of the published works assessing the reliability of smartphone goniometer apps (SG) have poor generalizability since the reliability was assessed in healthy subjects. No research has established the values for standard error of measurement (SEM) or minimal detectable change (MDC) which have greater clinical utility to contextualize the range of motion (ROM) assessed using the SG. This research examined the test-retest reproducibility, concurrent validity, SEM, and MDC values for the iPhone goniometer app (i-Goni; June Software Inc., v.1.1, San Francisco, CA) in assessing knee ROM in patients with knee osteoarthritis or those after total knee replacement. A total of 60 participants underwent data collection which included the assessment of active knee ROM using the i-Goni and the universal goniometer (UG; EZ Read Jamar Goniometer, Patterson Medical, Warrenville, IL), knee muscle strength, and assessment of pain and lower extremity disability using quadruple numeric pain rating scale (Q-NPRS) and lower extremity functional scale (LEFS), respectively. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of the knee ROM assessed using the i-Goni and UG. Bland and Altman technique examined the agreement between these knee ROM. The SEM and MDC values were calculated for i-Goni assessed knee ROM to characterize the error in a single score and the index of true change, respectively. Pearson correlation coefficient examined concurrent relationships between the i-Goni and other measures. The ICC values for the knee flexion/extension ROM were superior for i-Goni (0.97/0.94) compared with the UG (0.95/0.87). The SEM values were smaller for i-Goni assessed knee flexion/extension (2.72/1.18 degrees) compared with UG assessed knee flexion/extension (3.41/1.62 degrees). Similarly, the MDC values were smaller for both these ROM for the i-Goni (6.3 and 2.72 degrees) suggesting smaller change required to infer true change in knee ROM. The i

Urinary CD80 as a Replacement for Renal Biopsy for Diagnosis of Pediatric Minimal Change Disease.

PubMed

Ahmed, Heba Mostafa; Ezzat, Dina Ahmed; Doudar, Noha A; Adel, Mai

2018-03-01

Early diagnosis of minimal change disease (MCD) is challenging in nephrotic children. CD80 is a protein expressed on the surface of podocytes associated with nephrotic syndrome and it is implicated in the induction of proteinuria. This study aimed to investigate the use of urinary CD80 for the diagnosis of MCD. Urinary CD80 levels were evaluated in 36 children with nephrotic syndrome and normal glomerular filtration rate. They were divided into three groups of MCD (n = 21), focal segmental glomerulosclerosis (n = 9), and other glomerulopathies (n = 6). The MCD group was subdivided into 2 of those with remission (n = 11) and those in the active stage (n = 10). Forty healthy children were included as controls. The urinary CD80 level was significantly higher in the MCD group (3.5 ± 2.1 ng/mg creatinine) than in the focal segmental glomerulosclerosis group (1.2 ± 0.5 ng/mg creatinine, P < .001), the other glomerulopathies group (1.4 ± 0.7 ng/mg creatinine, P < .001), and the control group (0.7 ± 0.2 ng/mg creatinine, P < .001), while it showed no significant difference among the non-MCD groups. There was no significant difference between MCD in remission and MCD in relapse, either. A urinary CD80 cutoff value of 1.5 ng/gm creatinine showed a sensitivity of 100% and a specificity of 86% for diagnosis of MCD. Urinary CD80 levels were significantly higher in the children with MCD than in the controls and patients with other causes of nephrotic syndrome.

The minimizing style: perceptions of psychological abuse and quality of past and current relationships.

PubMed

Varia, R; Abidin, R R

1999-11-01

The goals of this current project were to expand and elaborate on the results of Varia, Abidin, and Dass' (1996) study to better understand what historical parenting factors may contribute in creating a "Minimizing" perception of childhood psychological abuse. A second objective included examining the association between perceptual styles and adult ratings of adult relationship satisfaction. Ninety individuals from a non-clinical adult sample completed self-report questionnaires regarding psychological maltreatment and adult relationship satisfaction. Three groups were created and compared using analysis of variance. The groups were (I) "Non-Abused," consistent reporters of no abuse; (II) "Acknowledgers," consistent reporters of abuse; and (III) "Minimizers," reporters of abuse, but do not label themselves as having been abused. Results indicated a continuum effect with the Non-Abused individuals reporting the highest level of maternal warmth and affection, the Acknowledgers reporting the lowest, with the Minimizers in the middle. The Non-Abused group reported the healthiest adjustment in terms of adult relationship satisfaction. While Minimizers and Acknowledgers reported similar levels of psychologically abusive experiences, Acknowledgers reported more difficulties with adult relationships. This study highlights the importance of studying Minimizers, a group which describes abusive events but minimizes the meaning and scope of these experiences. The relatively higher levels of maternal care which the Minimizers reported is hypothesized to be associated with their perceptions that they were not abused and acted as a protective factor associated with better quality adult relationships. The varying degrees of nurturance and care in the early family environment of abused individuals is speculated to be associated with distinct perceptual styles.

Hardware accelerator design for change detection in smart camera

NASA Astrophysics Data System (ADS)

Singh, Sanjay; Dunga, Srinivasa Murali; Saini, Ravi; Mandal, A. S.; Shekhar, Chandra; Chaudhury, Santanu; Vohra, Anil

2011-10-01

Smart Cameras are important components in Human Computer Interaction. In any remote surveillance scenario, smart cameras have to take intelligent decisions to select frames of significant changes to minimize communication and processing overhead. Among many of the algorithms for change detection, one based on clustering based scheme was proposed for smart camera systems. However, such an algorithm could achieve low frame rate far from real-time requirements on a general purpose processors (like PowerPC) available on FPGAs. This paper proposes the hardware accelerator capable of detecting real time changes in a scene, which uses clustering based change detection scheme. The system is designed and simulated using VHDL and implemented on Xilinx XUP Virtex-IIPro FPGA board. Resulted frame rate is 30 frames per second for QVGA resolution in gray scale.

THE 6-MINUTE WALK TEST AND OTHER CLINICAL ENDPOINTS IN DUCHENNE MUSCULAR DYSTROPHY: RELIABILITY, CONCURRENT VALIDITY, AND MINIMAL CLINICALLY IMPORTANT DIFFERENCES FROM A MULTICENTER STUDY

PubMed Central

McDonald, Craig M; Henricson, Erik K; Abresch, R Ted; Florence, Julaine; Eagle, Michelle; Gappmaier, Eduard; Glanzman, Allan M; Spiegel, Robert; Barth, Jay; Elfring, Gary; Reha, Allen; Peltz, Stuart W

2013-01-01

Introduction: An international clinical trial enrolled 174 ambulatory males ≥5 years old with nonsense mutation Duchenne muscular dystrophy (nmDMD). Pretreatment data provide insight into reliability, concurrent validity, and minimal clinically important differences (MCIDs) of the 6-minute walk test (6MWT) and other endpoints. Methods: Screening and baseline evaluations included the 6-minute walk distance (6MWD), timed function tests (TFTs), quantitative strength by myometry, the PedsQL, heart rate–determined energy expenditure index, and other exploratory endpoints. Results: The 6MWT proved feasible and reliable in a multicenter context. Concurrent validity with other endpoints was excellent. The MCID for 6MWD was 28.5 and 31.7 meters based on 2 statistical distribution methods. Conclusions: The ratio of MCID to baseline mean is lower for 6MWD than for other endpoints. The 6MWD is an optimal primary endpoint for Duchenne muscular dystrophy (DMD) clinical trials that are focused therapeutically on preservation of ambulation and slowing of disease progression. Muscle Nerve 48: 357–368, 2013 PMID:23674289

Reliability and minimal detectable change of physical performance measures in individuals with pre-manifest and manifest Huntington disease.

PubMed

Quinn, Lori; Khalil, Hanan; Dawes, Helen; Fritz, Nora E; Kegelmeyer, Deb; Kloos, Anne D; Gillard, Jonathan W; Busse, Monica

2013-07-01

Clinical intervention trials in people with Huntington disease (HD) have been limited by a lack of reliable and appropriate outcome measures. The purpose of this study was to determine the reliability and minimal detectable change (MDC) of various outcome measures that are potentially suitable for evaluating physical functioning in individuals with HD. This was a multicenter, prospective, observational study. Participants with pre-manifest and manifest HD (early, middle, and late stages) were recruited from 8 international sites to complete a battery of physical performance and functional measures at 2 assessments, separated by 1 week. Test-retest reliability (using intraclass correlation coefficients) and MDC values were calculated for all measures. Seventy-five individuals with HD (mean age=52.12 years, SD=11.82) participated in the study. Test-retest reliability was very high (>.90) for participants with manifest HD for the Six-Minute Walk Test (6MWT), 10-Meter Walk Test, Timed "Up & Go" Test (TUG), Berg Balance Scale (BBS), Physical Performance Test (PPT), Barthel Index, Rivermead Mobility Index, and Tinetti Mobility Test (TMT). Many MDC values suggested a relatively high degree of inherent variability, particularly in the middle stage of HD. Minimum detectable change values for participants with manifest HD that were relatively low across disease stages were found for the BBS (5), PPT (5), and TUG (2.98). For individuals with pre-manifest HD (n=11), the 6MWT and Four Square Step Test had high reliability and low MDC values. The sample size for the pre-manifest HD group was small. The BBS, PPT, and TUG appear most appropriate for clinical trials aimed at improving physical functioning in people with manifest HD. Further research in people with pre-manifest HD is necessary.

Minimally Invasive Mitral Valve Procedures: The Current State

PubMed Central

Ritwick, Bhuyan; Chaudhuri, Krishanu; Crouch, Gareth; Edwards, James R. M.; Worthington, Michael; Stuklis, Robert G.

2013-01-01

Since its early days, cardiac surgery has typically involved large incisions with complete access to the heart and the great vessels. After the popularization of the minimally invasive techniques in general surgery, cardiac surgeons began to experiment with minimal access techniques in the early 1990s. Although the goals of minimally invasive cardiac surgery (MICS) are fairly well established as decreased pain, shorter hospital stay, accelerated recuperation, improved cosmesis, and cost effectiveness, a strict definition of minimally invasive cardiac surgery has been more elusive. Minimally invasive cardiac surgery started with mitral valve procedures and then gradually expanded towards other valve procedures, coronary artery bypass grafting, and various types of simple congenital heart procedures. In this paper, the authors attempt to focus on the evolution, techniques, results, and the future perspective of minimally invasive mitral valve surgery (MIMVS). PMID:24382998

Guide for minimizing the effect of preservative-treated wood on sensitive environments

Treesearch

Stan T. Lebow; Michael Tippie

2001-01-01

Preservative-treated wood is often used for construction of highway and foot bridges, wetland boardwalks, and other structures in or over water or sensitive environments. In these applications it is important that release of preservative from the wood into the environment is minimized. This publication addresses this concern by describing the various types of pressure-...

Matthew Arnold and Minimal Competency Testing.

ERIC Educational Resources Information Center

Tuman, Myron C.

1979-01-01

Presents arguments by Robert Lowe and Matthew Arnold on the 19th century British "Payment by Results" Plan, whereby schools received funds for students who passed minimal competency tests. Emphasizes that the Victorian experience produced acrimonious teachers with low morale and encourages contemporary minimal testing advocates not to…

Minimal intervention dentistry - a new frontier in clinical dentistry.

PubMed

Mm, Jingarwar; Nk, Bajwa; A, Pathak

2014-07-01

Minimally invasive procedures are the new paradigm in health care. Everything from heart bypasses to gall bladder, surgeries are being performed with these dynamic new techniques. Dentistry is joining this exciting revolution as well. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralisation and minimal intervention for the placement and replacement of restorations. Minimally invasive dentistry reaches the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. This paper reviews in brief the concept of minimal intervention in dentistry.

Estimating the Effect of Climate Change on Crop Yields and Farmland Values: The Importance of Extreme Temperatures

EPA Pesticide Factsheets

This is a presentation titled Estimating the Effect of Climate Change on Crop Yields and Farmland Values: The Importance of Extreme Temperatures that was given for the National Center for Environmental Economics

The importance of employee participation and perceptions of changes in procedures in a teamworking intervention

PubMed Central

Nielsen, Karina; Randall, Raymond

2012-01-01

The powerful positive results of implementing teamwork are not always achieved. It has been suggested that attempts to implement theories regarding teamwork do not always lead to those theories being put into practice, and as a result positive outcomes are not always found. The participation of employees in the development and implementation of an intervention may help to ensure that changes take place. In this longitudinal study (N = 583) of teamwork implementation in Denmark we examined the links between pre-intervention working conditions and well-being, levels of participation in planning and implementation, employees’ reports of changes in procedures, and intervention outcomes. Pre-intervention levels of autonomy and job satisfaction predicted the degree of employee participation in the planning and implementation of the intervention. Pre-intervention well-being and social support were linked directly to the degree to which employees reported changes in existing work practices concerning teamwork. In addition, participation and changes in work procedures were significantly associated with post-intervention autonomy, social support and well-being. The results indicate that employee participation in intervention processes is crucial in what appears to be an important association with perceived changes in procedures and, therefore, in intervention outcomes. PMID:22745519

78 FR 72570 - Import Administration; Change of Agency Name for Instruments and Apparatus for Educational and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-03

... [Docket No.: 131114957-3957-01] Import Administration; Change of Agency Name for Instruments and Apparatus... apparatus for educational and scientific institutions. 15 CFR Part 303 Watches, Watch movements and jewelry program. PART 301--INSTRUMENTS AND APPARATUS FOR EDUCATIONAL AND SCIENTIFIC INSTITUTIONS 0 1. The...

TELMA: Technology-enhanced learning environment for minimally invasive surgery.

PubMed

Sánchez-González, Patricia; Burgos, Daniel; Oropesa, Ignacio; Romero, Vicente; Albacete, Antonio; Sánchez-Peralta, Luisa F; Noguera, José F; Sánchez-Margallo, Francisco M; Gómez, Enrique J

2013-06-01

Cognitive skills training for minimally invasive surgery has traditionally relied upon diverse tools, such as seminars or lectures. Web technologies for e-learning have been adopted to provide ubiquitous training and serve as structured repositories for the vast amount of laparoscopic video sources available. However, these technologies fail to offer such features as formative and summative evaluation, guided learning, or collaborative interaction between users. The "TELMA" environment is presented as a new technology-enhanced learning platform that increases the user's experience using a four-pillared architecture: (1) an authoring tool for the creation of didactic contents; (2) a learning content and knowledge management system that incorporates a modular and scalable system to capture, catalogue, search, and retrieve multimedia content; (3) an evaluation module that provides learning feedback to users; and (4) a professional network for collaborative learning between users. Face validation of the environment and the authoring tool are presented. Face validation of TELMA reveals the positive perception of surgeons regarding the implementation of TELMA and their willingness to use it as a cognitive skills training tool. Preliminary validation data also reflect the importance of providing an easy-to-use, functional authoring tool to create didactic content. The TELMA environment is currently installed and used at the Jesús Usón Minimally Invasive Surgery Centre and several other Spanish hospitals. Face validation results ascertain the acceptance and usefulness of this new minimally invasive surgery training environment. Copyright © 2013 Elsevier Inc. All rights reserved.

40 CFR 26.110 - Expedited review procedures for certain kinds of research involving no more than minimal risk...

Code of Federal Regulations, 2010 CFR

2010-07-01

... kinds of research involving no more than minimal risk, and for minor changes in approved research. 26.110 Section 26.110 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROTECTION OF... risk, and for minor changes in approved research. (a) The Secretary, HHS, has established, and...

75 FR 1269 - Vegetable Import Regulations; Modification of Potato Import Regulations; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-11

... C] Vegetable Import Regulations; Modification of Potato Import Regulations; Correction AGENCY... modified the import regulations for Irish potatoes and made minor administrative changes to the potato...

Sediment flocculation in the Mekong River estuary, Vietnam, an important driver of geomorphological changes

NASA Astrophysics Data System (ADS)

Gratiot, Nicolas; Bildstein, Audrey; Anh, Tran Tuan; Thoss, Heiko; Denis, Hervé; Michallet, Hervé; Apel, Heiko

2017-10-01

Over the past several decades, major hydro-sedimentary changes have occurred in both continental and coastal regions of the Mekong Delta, and this has severely impacted coastal erosion. A good characterization of floc properties and of their changes over time is necessary to gain comprehensive understanding and modelling of hydrodynamics and of the associated geomorphological changes. This paper quantifies the influence of sediment concentration, turbulence and differential particle settling on flocculation through field and laboratory investigations of the Mekong estuary. For concentrations lower than 200 mg·L-1, the particles do not exhibit a dynamic response to their environment, while for higher concentrations (up to 3-4 g·L-1), particle size and settling velocity increased by more than one order of magnitude. Flocculation by differential settling has not been sufficiently investigated yet, but this study reveals it as a predominant factor for siltation in quiescent environments such as the ones existing in the inner mangrove fringe. Such results are important to provide realistic simulations of the coastal evolution.

Improving the performance of minimizers and winnowing schemes

PubMed Central

Marçais, Guillaume; Pellow, David; Bork, Daniel; Orenstein, Yaron; Shamir, Ron; Kingsford, Carl

2017-01-01

Abstract Motivation: The minimizers scheme is a method for selecting k-mers from sequences. It is used in many bioinformatics software tools to bin comparable sequences or to sample a sequence in a deterministic fashion at approximately regular intervals, in order to reduce memory consumption and processing time. Although very useful, the minimizers selection procedure has undesirable behaviors (e.g. too many k-mers are selected when processing certain sequences). Some of these problems were already known to the authors of the minimizers technique, and the natural lexicographic ordering of k-mers used by minimizers was recognized as their origin. Many software tools using minimizers employ ad hoc variations of the lexicographic order to alleviate those issues. Results: We provide an in-depth analysis of the effect of k-mer ordering on the performance of the minimizers technique. By using small universal hitting sets (a recently defined concept), we show how to significantly improve the performance of minimizers and avoid some of its worse behaviors. Based on these results, we encourage bioinformatics software developers to use an ordering based on a universal hitting set or, if not possible, a randomized ordering, rather than the lexicographic order. This analysis also settles negatively a conjecture (by Schleimer et al.) on the expected density of minimizers in a random sequence. Availability and Implementation: The software used for this analysis is available on GitHub: https://github.com/gmarcais/minimizers.git. Contact: gmarcais@cs.cmu.edu or carlk@cs.cmu.edu PMID:28881970

Improving the performance of minimizers and winnowing schemes.

PubMed

Marçais, Guillaume; Pellow, David; Bork, Daniel; Orenstein, Yaron; Shamir, Ron; Kingsford, Carl

2017-07-15

The minimizers scheme is a method for selecting k -mers from sequences. It is used in many bioinformatics software tools to bin comparable sequences or to sample a sequence in a deterministic fashion at approximately regular intervals, in order to reduce memory consumption and processing time. Although very useful, the minimizers selection procedure has undesirable behaviors (e.g. too many k -mers are selected when processing certain sequences). Some of these problems were already known to the authors of the minimizers technique, and the natural lexicographic ordering of k -mers used by minimizers was recognized as their origin. Many software tools using minimizers employ ad hoc variations of the lexicographic order to alleviate those issues. We provide an in-depth analysis of the effect of k -mer ordering on the performance of the minimizers technique. By using small universal hitting sets (a recently defined concept), we show how to significantly improve the performance of minimizers and avoid some of its worse behaviors. Based on these results, we encourage bioinformatics software developers to use an ordering based on a universal hitting set or, if not possible, a randomized ordering, rather than the lexicographic order. This analysis also settles negatively a conjecture (by Schleimer et al. ) on the expected density of minimizers in a random sequence. The software used for this analysis is available on GitHub: https://github.com/gmarcais/minimizers.git . gmarcais@cs.cmu.edu or carlk@cs.cmu.edu. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Adopting a plant-based diet minimally increased food costs in WHEL Study.

PubMed

Hyder, Joseph A; Thomson, Cynthia A; Natarajan, Loki; Madlensky, Lisa; Pu, Minya; Emond, Jennifer; Kealey, Sheila; Rock, Cheryl L; Flatt, Shirley W; Pierce, John P

2009-01-01

To assess the cost of adopting a plant-based diet. Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n=1145) group; baseline and 12-month data on diet and grocery costs. At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit: 6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3% of E). The intervention change was associated with a significant increase of $1.22/ person/week (multivariate model, P=0.027). A major change to a plant-based diet was associated with a minimal increase in grocery costs.

On inflation with non-minimal coupling

NASA Astrophysics Data System (ADS)

Hertzberg, Mark P.

2010-11-01

A simple realization of inflation consists of adding the following operators to the Einstein-Hilbert action: ( ∂ϕ)2, λϕ 4, and ξϕ 2 R , with ξ a large non-minimal coupling. Recently there has been much discussion as to whether such theories make sense quantum mechanically and if the inflaton ϕ can also be the Standard Model Higgs. In this work we answer these questions. Firstly, for a single scalar ϕ, we show that the quantum field theory is well behaved in the pure gravity and kinetic sectors, since the quantum generated corrections are small. However, the theory likely breaks down at m Pl /ξ due to scattering provided by the self-interacting potential λϕ 4. Secondly, we show that the theory changes for multiple scalars overrightarrow φ with non-minimal coupling ξ overrightarrow φ \\cdot overrightarrow φ mathcal{R} , since this introduces qualitatively new interactions which manifestly generate large quantum corrections even in the gravity and kinetic sectors, spoiling the theory for energies ≳ m Pl /ξ. Since the Higgs doublet of the Standard Model includes the Higgs boson and 3 Goldstone bosons, it falls into the latter category and therefore its validity is manifestly spoiled. We show that these conclusions hold in both the Jordan and Einstein frames and describe an intuitive analogy in the form of the pion Lagrangian. We also examine the recent claim that curvature-squared inflation models fail quantum mechanically. Our work appears to go beyond the recent discussions.

Changes in physiological and some nutritional, nutraceuticals, chemical-physical, microbiological and sensory quality of minimally processed cactus pears cvs 'Bianca', 'Gialla' and 'Rossa' stored under passive modified atmosphere.

PubMed

Palma, Amedeo; Continella, Alberto; La Malfa, Stefano; D'Aquino, Salvatore

2018-03-01

The objective of this study was to compare the overall quality changes of minimally processed cactus pears cvs 'Bianca', Gialla' and 'Rossa' stored at 4 °C for 10 days. Periodically in-package CO 2 , O 2 and C 2 H 4 were determined and fruit were assessed for overall quality changes (pH, acidity, sugars, phenolics, betacyanins and betaxanthines, antioxidant capacity, colour, firmness, microbiological population and sensory attributes). In a preliminary study three different polymeric films were tested to select the most suitable to design a package with a short lag time to achieve steady-state conditions. Results showed marked differences between measured in-package CO 2 and O 2 values and those calculated based on respiration of peeled fruit and film permeance to CO 2 and O 2 provided by manufactures. The sensory evaluation of packed fruit indicated in film BBT-Bolphane, which created a steady-state in-package partial pressure for CO 2 of 4.3-4.8 kPa and for O 2 of 4.8-5.5 kPa, as the best film. Results of in-package gas composition with the three cultivars were similar to those achieved in cv. 'Gialla' with the preliminary test. All measured qualitative parameters changed slightly over the storage period for all cultivars and followed the same trend, despite significant differences existing among cultivars. This study clearly showed a similar physiological behavior of minimally processed 'Bianca', 'Gialla' and 'Rossa' cactus pears. Storage conditions optimal for one cultivar fit well for the others; thus mixing fruit of different cultivars in a package designed for one specific cultivar does not lead to relevant deviation from expected results. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Anterior Longitudinal Ligament Release From the Minimally Invasive Lateral Retroperitoneal Transpsoas Approach: Technical Note.

PubMed

Beckman, Joshua M; Marengo, Nicola; Murray, Gisela; Bach, Konrad; Uribe, Juan S

2016-09-01

The technique for minimally invasive anterior longitudinal ligament release is a major advancement in lateral access surgery. This method provides hypermobility of lumbar segments to allow for aggressive lordosis restoration while maintaining the benefits of indirect decompression and minimally invasive access. To provide video demonstration of the lateral retroperitoneal transpsoas approach with anterior longitudinal ligament sectioning. A detailed surgical technique of the minimally invasive anterior column release is described and illustrated in an elderly patient with adult spinal deformity and low back pain (visual analog scale, 8 of 10) refractory to conservative measures. The 3-foot standing radiographs demonstrated a lumbar lordosis of 54.4°, pelvic incidence of 63.7°, and pelvic tilt of 17.5°. Computed tomography and magnetic resonance imaging showed generalized lumbar spondylosis and degenerative disc changes from L2 to L5. The patient underwent a multilevel minimally invasive deformity correction with an anterior longitudinal ligament release at the L3/L4 level through the lateral retroperitoneal transpsoas approach. Lumbar lordosis increased from 54.4° to 77° with a global improvement in sagittal vertical axis from 4.37 cm to 0 cm. Total blood loss was less than 25 mL, and there were no major neurological or vascular complications. The anterior longitudinal ligament release using the minimally invasive lateral approach allows for deformity correction without the morbidity and blood loss encountered by traditional open posterior approaches. However, the risk of major vascular/visceral complication warrants only experts in minimally invasive lateral surgery to attempt this technique.

Quantifying area changes of internationally important wetlands due to water consumption in LCA.

PubMed

Verones, Francesca; Pfister, Stephan; Hellweg, Stefanie

2013-09-03

Wetlands harbor diverse species assemblages but are among the world's most threatened ecosystems. Half of their global area was lost during the last century. No approach currently exists in life cycle impact assessment that acknowledges the vulnerability and importance of wetlands globally and provides fate factors for water consumption. We use data from 1184 inland wetlands, all designated as sites of international importance under the Ramsar Convention, to develop regionalized fate factors (FF) for consumptive water use. FFs quantify the change of wetland area caused per m(3)/yr water consumed. We distinguish between surface water-fed and groundwater-fed wetlands and develop FFs for surface water and groundwater consumption. FFs vary over 8 (surface water-fed) and 6 (groundwater-fed) orders of magnitude as a function of the site characteristics, showing the importance of local conditions. Largest FFs for surface water-fed wetlands generally occur in hyper-arid zones and smallest in humid zones, highlighting the dependency on available surface water flows. FFs for groundwater-fed wetlands depend on hydrogeological conditions and vary largely with the total amount of water consumed from the aquifer. Our FFs translate water consumption into wetland area loss and thus become compatible with life cycle assessment methodologies of land use.

Adaptations Required for Mitochondrial Import following Mitochondrial to Nucleus Gene Transfer of Ribosomal Protein S101[w

PubMed Central

Murcha, Monika W.; Rudhe, Charlotta; Elhafez, Dina; Adams, Keith L.; Daley, Daniel O.; Whelan, James

2005-01-01

The minimal requirements to support protein import into mitochondria were investigated in the context of the phenomenon of ongoing gene transfer from the mitochondrion to the nucleus in plants. Ribosomal protein 10 of the small subunit is encoded in the mitochondrion in soybean and many other angiosperms, whereas in several other species it is nuclear encoded and thus must be imported into the mitochondrial matrix to function. When encoded by the nuclear genome, it has adopted different strategies for mitochondrial targeting and import. In lettuce (Lactuca sativa) and carrot (Daucus carota), Rps10 independently gained different N-terminal extensions from other genes, following transfer to the nucleus. (The designation of Rps10 follows the following convention. The gene is indicated in italics. If encoded in the mitochondrion, it is rps10; if encoded in the nucleus, it is Rps10.) Here, we show that the N-terminal extensions of Rps10 in lettuce and carrot are both essential for mitochondrial import. In maize (Zea mays), Rps10 has not acquired an extension upon transfer but can be readily imported into mitochondria. Deletion analysis located the mitochondrial targeting region to the first 20 amino acids. Using site directed mutagenesis, we changed residues in the first 20 amino acids of the mitochondrial encoded soybean (Glycine max) rps10 to the corresponding amino acids in the nuclear encoded maize Rps10 until import was achieved. Changes were required that altered charge, hydrophobicity, predicted ability to form an amphiphatic α-helix, and generation of a binding motif for the outer mitochondrial membrane receptor, translocase of the outer membrane 20. In addition to defining the changes required to achieve mitochondrial localization, the results demonstrate that even proteins that do not present barriers to import can require substantial changes to acquire a mitochondrial targeting signal. PMID:16040655

Minimizing the Sum of Completion Times with Resource Dependant Times

NASA Astrophysics Data System (ADS)

Yedidsion, Liron; Shabtay, Dvir; Kaspi, Moshe

2008-10-01

We extend the classical minimization sum of completion times problem to the case where the processing times are controllable by allocating a nonrenewable resource. The quality of a solution is measured by two different criteria. The first criterion is the sum of completion times and the second is the total weighted resource consumption. We consider four different problem variations for treating the two criteria. We prove that this problem is NP-hard for three of the four variations even if all resource consumption weights are equal. However, somewhat surprisingly, the variation of minimizing the integrated objective function is solvable in polynomial time. Although the sum of completion times is arguably the most important scheduling criteria, the complexity of this problem, up to this paper, was an open question for three of the four variations. The results of this research have various implementations, including efficient battery usage on mobile devices such as mobile computer, phones and GPS devices in order to prolong their battery duration.

[Further technical and digital development in minimally invasive and conventional surgery].

PubMed

Feussner, H; Reiser, S B; Bauer, M; Kranzfelder, M; Schirren, R; Kleeff, J; Wilhelm, D

2014-03-01

Technological innovations have initiated a fundamental change in invasive therapeutic approaches which has led to a welcome reduction of surgical trauma but was also associated with a declining role of conventional surgery. Active utilization of future technological developments is decisive to promote new therapeutic strategies and to avoid a further loss of importance of surgery. This includes individualized preoperative therapy planning as well as intraoperative diagnostic work-up and navigation and the use of new functional intelligent implants. The working environment "surgical operating room" has to be refurbished into an integrated cooperating functional system. The impact of new technological developments is particularly obvious in minimally invasive surgery. There is a clear tendency towards further reduction in trauma in the surgical access. The incision will become smaller and the number of ports will be further reduced, with the aim of ultimately having just one port (monoport surgery) or even via natural access routes (scarless surgery). Among others, improved visualization including, e.g. autostereoscopy, digital image processing and intelligent support systems, which are able to assist in a cooperative way, will enable these goals to be achieved.

One-dimensional Gromov minimal filling problem

NASA Astrophysics Data System (ADS)

Ivanov, Alexandr O.; Tuzhilin, Alexey A.

2012-05-01

The paper is devoted to a new branch in the theory of one-dimensional variational problems with branching extremals, the investigation of one-dimensional minimal fillings introduced by the authors. On the one hand, this problem is a one-dimensional version of a generalization of Gromov's minimal fillings problem to the case of stratified manifolds. On the other hand, this problem is interesting in itself and also can be considered as a generalization of another classical problem, the Steiner problem on the construction of a shortest network connecting a given set of terminals. Besides the statement of the problem, we discuss several properties of the minimal fillings and state several conjectures. Bibliography: 38 titles.

Social Media Ratings of Minimally Invasive Fat Reduction Procedures: Benchmarking Against Traditional Liposuction.

PubMed

Talasila, Sreya; Evers-Meltzer, Rachel; Xu, Shuai

2018-06-05

Minimally invasive fat reduction procedures are rapidly growing in popularity. Evaluate online patient reviews to inform practice management. Data from RealSelf.com, a popular online aesthetics platform, were reviewed for all minimally invasive fat reduction procedures. Reviews were also aggregated based on the primary method of action (e.g., laser, radiofrequency, ultrasound, etc.) and compared with liposuction. A chi-square test was used to assess for differences with the Marascuilo procedure for pairwise comparisons. A total of 13 minimally invasive fat reduction procedures were identified encompassing 11,871 total reviews. Liposuction had 4,645 total reviews and a 66% patient satisfaction rate. Minimally invasive fat reduction procedures had 7,170 aggregate reviews and a global patient satisfaction of 58%. Liposuction had statistically significantly higher patient satisfaction than cryolipolysis (55% satisfied, n = 2,707 reviews), laser therapies (61% satisfied, n = 3,565 reviews), and injectables (49% satisfied, n = 319 reviews) (p < .05). Injectables and cryolipolysis had statistically significantly lower patient satisfaction than radiofrequency therapies (63% satisfied, n = 314 reviews) and laser therapies. Ultrasound therapies had 275 reviews and a 73% patient satisfaction rate. A large number of patient reviews suggest that minimally invasive fat reduction procedures have high patient satisfaction, although liposuction still had the highest total patient satisfaction score. However, there are significant pitfalls in interpreting patient reviews, as they do not provide important data such as a patient's medical history or physician experience and skill.

Systems Biology Perspectives on Minimal and Simpler Cells

PubMed Central

Xavier, Joana C.; Patil, Kiran Raosaheb

2014-01-01

SUMMARY The concept of the minimal cell has fascinated scientists for a long time, from both fundamental and applied points of view. This broad concept encompasses extreme reductions of genomes, the last universal common ancestor (LUCA), the creation of semiartificial cells, and the design of protocells and chassis cells. Here we review these different areas of research and identify common and complementary aspects of each one. We focus on systems biology, a discipline that is greatly facilitating the classical top-down and bottom-up approaches toward minimal cells. In addition, we also review the so-called middle-out approach and its contributions to the field with mathematical and computational models. Owing to the advances in genomics technologies, much of the work in this area has been centered on minimal genomes, or rather minimal gene sets, required to sustain life. Nevertheless, a fundamental expansion has been taking place in the last few years wherein the minimal gene set is viewed as a backbone of a more complex system. Complementing genomics, progress is being made in understanding the system-wide properties at the levels of the transcriptome, proteome, and metabolome. Network modeling approaches are enabling the integration of these different omics data sets toward an understanding of the complex molecular pathways connecting genotype to phenotype. We review key concepts central to the mapping and modeling of this complexity, which is at the heart of research on minimal cells. Finally, we discuss the distinction between minimizing the number of cellular components and minimizing cellular complexity, toward an improved understanding and utilization of minimal and simpler cells. PMID:25184563

Systems biology perspectives on minimal and simpler cells.

PubMed

Xavier, Joana C; Patil, Kiran Raosaheb; Rocha, Isabel

2014-09-01

The concept of the minimal cell has fascinated scientists for a long time, from both fundamental and applied points of view. This broad concept encompasses extreme reductions of genomes, the last universal common ancestor (LUCA), the creation of semiartificial cells, and the design of protocells and chassis cells. Here we review these different areas of research and identify common and complementary aspects of each one. We focus on systems biology, a discipline that is greatly facilitating the classical top-down and bottom-up approaches toward minimal cells. In addition, we also review the so-called middle-out approach and its contributions to the field with mathematical and computational models. Owing to the advances in genomics technologies, much of the work in this area has been centered on minimal genomes, or rather minimal gene sets, required to sustain life. Nevertheless, a fundamental expansion has been taking place in the last few years wherein the minimal gene set is viewed as a backbone of a more complex system. Complementing genomics, progress is being made in understanding the system-wide properties at the levels of the transcriptome, proteome, and metabolome. Network modeling approaches are enabling the integration of these different omics data sets toward an understanding of the complex molecular pathways connecting genotype to phenotype. We review key concepts central to the mapping and modeling of this complexity, which is at the heart of research on minimal cells. Finally, we discuss the distinction between minimizing the number of cellular components and minimizing cellular complexity, toward an improved understanding and utilization of minimal and simpler cells. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

SASS wind ambiguity removal by direct minimization. [Seasat-A satellite scatterometer

NASA Technical Reports Server (NTRS)

Hoffman, R. N.

1982-01-01

An objective analysis procedure is presented which combines Seasat-A satellite scatterometer (SASS) data with other available data on wind speeds by minimizing an objective function of gridded wind speed values. The functions are defined as the loss functions for the SASS velocity data, the forecast, the SASS velocity magnitude data, and conventional wind speed data. Only aliases closest to the analysis were included, and a method for improving the first guess while using a minimization technique and slowly changing the parameters of the problem is introduced. The model is employed to predict the wind field for the North Atlantic on Sept. 10, 1978. Dealiased SASS data is compared with available ship readings, showing good agreement between the SASS dealiased winds and the winds measured at the surface. Expansion of the model to take in low-level cloud measurements, pressure data, and convergence and cloud level data correlations is discussed.

Shapes of embedded minimal surfaces

PubMed Central

Colding, Tobias H.; Minicozzi, William P.

2006-01-01

Surfaces that locally minimize area have been extensively used to model physical phenomena, including soap films, black holes, compound polymers, protein folding, etc. The mathematical field dates to the 1740s but has recently become an area of intense mathematical and scientific study, specifically in the areas of molecular engineering, materials science, and nanotechnology because of their many anticipated applications. In this work, we show that all minimal surfaces are built out of pieces of the surfaces in Figs. 1 and 2. PMID:16847265

Degradation changes in plant root cell wall structural molecules during extended decomposition of important agricultural crop and forage species

USDA-ARS?s Scientific Manuscript database

Little is known about the changes in the cell wall structural molecules lignin, cellulose and hemicellulose as plant roots decompose, despite their importance in the formation of soil organic matter. The objectives of this study were to quantify changes in root composition during 270 d incubations o...

Minimal entropy reconstructions of thermal images for emissivity correction

NASA Astrophysics Data System (ADS)

Allred, Lloyd G.

1999-03-01

Low emissivity with corresponding low thermal emission is a problem which has long afflicted infrared thermography. The problem is aggravated by reflected thermal energy which increases as the emissivity decreases, thus reducing the net signal-to-noise ratio, which degrades the resulting temperature reconstructions. Additional errors are introduced from the traditional emissivity-correction approaches, wherein one attempts to correct for emissivity either using thermocouples or using one or more baseline images, collected at known temperatures. These corrections are numerically equivalent to image differencing. Errors in the baseline images are therefore additive, causing the resulting measurement error to either double or triple. The practical application of thermal imagery usually entails coating the objective surface to increase the emissivity to a uniform and repeatable value. While the author recommends that the thermographer still adhere to this practice, he has devised a minimal entropy reconstructions which not only correct for emissivity variations, but also corrects for variations in sensor response, using the baseline images at known temperatures to correct for these values. The minimal energy reconstruction is actually based on a modified Hopfield neural network which finds the resulting image which best explains the observed data and baseline data, having minimal entropy change between adjacent pixels. The autocorrelation of temperatures between adjacent pixels is a feature of most close-up thermal images. A surprising result from transient heating data indicates that the resulting corrected thermal images have less measurement error and are closer to the situational truth than the original data.

Climate Change and the Central American Mid-summer Drought - The Importance of Changing Precipitation Patterns for Food and Water Security

NASA Astrophysics Data System (ADS)

Maurer, E. P.; Stewart, I. T.; Sundstrom, W.; Bacon, C. M.

2016-12-01

In addition to periodic long-term drought, much of Central America experiences a rainy season with two peaks separated by a dry period of weeks to over a month in duration, termed the mid-summer drought (MSD). Food and water security for smallholder farmers in the region hinge on accommodating this phenomenon, anticipating its arrival and estimating its duration. Model output from 1980 through the late 21st century projects changes in precipitation amount, variability, and timing, with potential to affect regional food production. Using surveys of farmer experiences in conjunction with gridded daily precipitation for a historic period on multiple scales, and with projections through the 21st century, we characterize the MSD across much of Central America using four measures: onset date, duration, intensity, and minimum, and test for significant changes. Our findings indicate that the most significant changes are for the duration, which, by the end of the century, is projected to increase by an average of over a week, and the MSD minimum precipitation, which is projected to decline by an average of over 26%, with statistically significant changes for most of Nicaragua, Honduras, El Salvador, and Guatemala (assuming a higher emissions pathway through the 21st century). These changes toward a longer and drier MSD have important implications for food and water security for vulnerable communities through the region. We find that for the four metrics the changes in interannual variability are small compared to historical variability, and are generally statistically insignificant. New farmer survey results are compared to findings from our climate analysis for the historic period, are used to interpret what MSD characteristics are of greatest interest locally, and are used for the development of adaptation strategies.

Minimal measures for Euler-Lagrange flows on finite covering spaces

NASA Astrophysics Data System (ADS)

Wang, Fang; Xia, Zhihong

2016-12-01

In this paper we study the minimal measures for positive definite Lagrangian systems on compact manifolds. We are particularly interested in manifolds with more complicated fundamental groups. Mather’s theory classifies the minimal or action-minimizing measures according to the first (co-)homology group of a given manifold. We extend Mather’s notion of minimal measures to a larger class for compact manifolds with non-commutative fundamental groups, and use finite coverings to study the structure of these extended minimal measures. We also define action-minimizers and minimal measures in the homotopical sense. Our program is to study the structure of homotopical minimal measures by considering Mather’s minimal measures on finite covering spaces. Our goal is to show that, in general, manifolds with a non-commutative fundamental group have a richer set of minimal measures, hence a richer dynamical structure. As an example, we study the geodesic flow on surfaces of higher genus. Indeed, by going to the finite covering spaces, the set of minimal measures is much larger and more interesting.

Irradiation treatment of minimally processed carrots for ensuring microbiological safety

NASA Astrophysics Data System (ADS)

Ashraf Chaudry, Muhammad; Bibi, Nizakat; Khan, Misal; Khan, Maazullah; Badshah, Amal; Jamil Qureshi, Muhammad

2004-09-01

Minimally processed fruits and vegetables are very common in developed countries and are gaining popularity in developing countries due to their convenience and freshness. However, minimally processing may result in undesirable changes in colour, taste and appearance due to the transfer of microbes from skin to the flesh. Irradiation is a well-known technology for elimination of microbial contamination. Food irradiation has been approved by 50 countries and is being applied commercially in USA. The purpose of this study was to evaluate the effect of irradiation on the quality of minimally processed carrots. Fresh carrots were peeled, sliced and PE packaged. The samples were irradiated (0, 0.5, 1.0, 2.0, 2.5, 3.0 kGy) and stored at 5°C for 2 weeks. The samples were analyzed for hardness, organoleptic acceptance and microbial load at 0, 7th and 15th day. The mean firmness of the control and all irradiated samples remained between 4.31 and 4.42 kg of force, showing no adverse effect of radiation dose. The effect of storage (2 weeks) was significant ( P< 0.05) with values ranging between 4.28 and 4.39 kg of force. The total bacterial counts at 5°C for non-irradiated and 0.5 kGy irradiated samples were 6.3×10 5 cfu/g, 3.0×10 2 and few colonies(>10) in all other irradiated samples(1.0, 2.0, 2.5 and 3.0 kGy) after 2 weeks storage. No coliform or E. coli were detected in any of the samples (radiated or control) immediately after irradiation and during the entire storage period in minimally processed carrots. A dose of 2.0 kGy completely controlled the fungal and bacterial counts. The irradiated samples (2.0 kGy) were also acceptable sensorially.

Space filling minimal surfaces and sphere packings

NASA Astrophysics Data System (ADS)

Elser, Veit

1994-05-01

A space filling minimal surface is defined to be any embedded minimal surface without boundary with the property that the area and genus enclosed by any large spherical region scales in proportion to the volume of the region. The triply periodic minimal surfaces are one realization, but not necessarily the only one. By using the genus per unit volume of the surface, a meaningful comparison of surface areas can be made even in cases where there is no unit cell. Of the known periodic minimal surfaces this measure of the surface area is smallest for Schoen's FRD surface. This surface is one of several that is closely related to packings of spheres. Its low area is largely due to the fact that the corresponding sphere packing (fcc) has the maximal kissing number.

Sound Power Minimization of Circular Plates Through Damping Layer Placement

NASA Astrophysics Data System (ADS)

Wodtke, H.-W.; Lamancusa, J. S.

1998-09-01

Damping layers, widely used for noise and vibration control of thin-walled structures, can be designed to provide an optimal trade-off between performance and weight which is of particular importance in the automotive and aircraft industry. The goal of the presented work is the minimization of sound power radiated from plates under broadband excitation by redistribution of unconstrained damping layers. The total radiated sound power is assumed to be represented by the sound power radiated at the structural resonances. Resonance tracking is performed by means of single-degree-of-freedom (SDOF)-approximations based on near-resonance responses and their frequency derivatives. Axisymmetric vibrations of circular plates under several boundary and forcing conditions are considered. Frequency dependent Young's modulus and loss factor of the damping material are taken into account. Vibration analysis is based on the finite element method (FEM) while acoustic radiation is treated by means of Rayleigh's integral formula. It is shown that, starting from a uniform damping layer distribution, substantial reduction in radiated sound power can be achieved through redistribution of the damping layers. Depending on the given situation, these reductions are not only due to amplitude reductions but also to changes in vibration shapes and frequencies.

Cigarette Price-Minimization Strategies by U.S. Smokers

PubMed Central

Xu, Xin; Pesko, Michael F.; Tynan, Michael A.; Gerzoff, Robert B.; Malarcher, Ann M.; Pechacek, Terry F.

2015-01-01

Background Smokers may react to cigarette excise tax increases by engaging in price-minimization strategies (i.e., finding ways to reduce the cost of cigarette smoking) rather than by quitting or reducing their cigarette use, thereby reducing the public health benefits of such tax increases. Purpose To evaluate the state and national prevalence of five common cigarette price-minimization strategies and the size of price reductions obtained from these strategies. Methods Using data from the 2009–2010 National Adult Tobacco Survey, the prevalence of five common price-minimization strategies by type of strategy and by smoker’s cigarette consumption level were estimated. The price reductions associated with these price-minimization strategies also were evaluated. Analyses took place in November 2012. Results Approximately 55.4% of U.S. adult smokers used at least one of five price-minimization strategies in the previous year, with an average reduction of $1.27 per pack (22.0%). Results varied widely by state. Conclusions Cigarette price-minimization strategies are practiced widely among current smokers, and resulting price reductions are relatively large. Policies that decrease opportunities to effectively apply cigarette price-minimization strategies would increase the public health gains of cigarette excise tax increases. PMID:23597810

Minimization and management of wastes from biomedical research.

PubMed Central

Rau, E H; Alaimo, R J; Ashbrook, P C; Austin, S M; Borenstein, N; Evans, M R; French, H M; Gilpin, R W; Hughes, J; Hummel, S J; Jacobsohn, A P; Lee, C Y; Merkle, S; Radzinski, T; Sloane, R; Wagner, K D; Weaner, L E

2000-01-01

Several committees were established by the National Association of Physicians for the Environment to investigate and report on various topics at the National Leadership Conference on Biomedical Research and the Environment held at the 1--2 November 1999 at the National Institutes of Health in Bethesda, Maryland. This is the report of the Committee on Minimization and Management of Wastes from Biomedical Research. Biomedical research facilities contribute a small fraction of the total amount of wastes generated in the United States, and the rate of generation appears to be decreasing. Significant reductions in generation of hazardous, radioactive, and mixed wastes have recently been reported, even at facilities with rapidly expanding research programs. Changes in the focus of research, improvements in laboratory techniques, and greater emphasis on waste minimization (volume and toxicity reduction) explain the declining trend in generation. The potential for uncontrolled releases of wastes from biomedical research facilities and adverse impacts on the general environment from these wastes appears to be low. Wastes are subject to numerous regulatory requirements and are contained and managed in a manner protective of the environment. Most biohazardous agents, chemicals, and radionuclides that find significant use in research are not likely to be persistent, bioaccumulative, or toxic if they are released. Today, the primary motivations for the ongoing efforts by facilities to improve minimization and management of wastes are regulatory compliance and avoidance of the high disposal costs and liabilities associated with generation of regulated wastes. The committee concluded that there was no evidence suggesting that the anticipated increases in biomedical research will significantly increase generation of hazardous wastes or have adverse impacts on the general environment. This conclusion assumes the positive, countervailing trends of enhanced pollution prevention

Cosmological dynamics with non-minimally coupled scalar field and a constant potential function

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hrycyna, Orest; Szydłowski, Marek, E-mail: orest.hrycyna@ncbj.gov.pl, E-mail: marek.szydlowski@uj.edu.pl

2015-11-01

Dynamical systems methods are used to investigate global behaviour of the spatially flat Friedmann-Robertson-Walker cosmological model in gravitational theory with a non-minimally coupled scalar field and a constant potential function. We show that the system can be reduced to an autonomous three-dimensional dynamical system and additionally is equipped with an invariant manifold corresponding to an accelerated expansion of the universe. Using this invariant manifold we find an exact solution of the reduced dynamics. We investigate all solutions for all admissible initial conditions using theory of dynamical systems to obtain a classification of all evolutional paths. The right-hand sides of themore » dynamical system depend crucially on the value of the non-minimal coupling constant therefore we study bifurcation values of this parameter under which the structure of the phase space changes qualitatively. We found a special bifurcation value of the non-minimal coupling constant which is distinguished by dynamics of the model and may suggest some additional symmetry in matter sector of the theory.« less

Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis.

PubMed

Holtmann, Laura C; Eckstein, Anja; Stähr, Kerstin; Xing, Minzhi; Lang, Stephan; Mattheis, Stefan

2017-08-01

Peripheral paralysis of the facial nerve is the most frequent of all cranial nerve disorders. Despite advances in facial surgery, the functional and aesthetic reconstruction of a paralyzed face remains a challenge. Graduated minimally invasive facial reanimation is based on a modular principle. According to the patients' needs, precondition, and expectations, the following modules can be performed: temporalis muscle transposition and facelift, nasal valve suspension, endoscopic brow lift, and eyelid reconstruction. Applying a concept of a graduated minimally invasive facial reanimation may help minimize surgical trauma and reduce morbidity. Twenty patients underwent a graduated minimally invasive facial reanimation. A retrospective chart review was performed with a follow-up examination between 1 and 8 months after surgery. The FACEgram software was used to calculate pre- and postoperative eyelid closure, the level of brows, nasal, and philtral symmetry as well as oral commissure position at rest and oral commissure excursion with smile. As a patient-oriented outcome parameter, the Glasgow Benefit Inventory questionnaire was applied. There was a statistically significant improvement in the postoperative score of eyelid closure, brow asymmetry, nasal asymmetry, philtral asymmetry as well as oral commissure symmetry at rest (p < 0.05). Smile evaluation revealed no significant change of oral commissure excursion. The mean Glasgow Benefit Inventory score indicated substantial improvement in patients' overall quality of life. If a primary facial nerve repair or microneurovascular tissue transfer cannot be applied, graduated minimally invasive facial reanimation is a promising option to restore facial function and symmetry at rest.

Minimal T-wave representation and its use in the assessment of drug arrhythmogenicity.

PubMed

Shakibfar, Saeed; Graff, Claus; Kanters, Jørgen K; Nielsen, Jimmi; Schmidt, Samuel; Struijk, Johannes J

2017-05-01

Recently, numerous models and techniques have been developed for analyzing and extracting features from the T wave which could be used as biomarkers for drug-induced abnormalities. The majority of these techniques and algorithms use features that determine readily apparent characteristics of the T wave, such as duration, area, amplitude, and slopes. In the present work the T wave was down-sampled to a minimal rate, such that a good reconstruction was still possible. The entire T wave was then used as a feature vector to assess drug-induced repolarization effects. The ability of the samples or combinations of samples obtained from the minimal T-wave representation to correctly classify a group of subjects before and after receiving d,l-sotalol 160 mg and 320 mg was evaluated using a linear discriminant analysis (LDA). The results showed that a combination of eight samples from the minimal T-wave representation can be used to identify normal from abnormal repolarization significantly better compared to the heart rate-corrected QT interval (QTc). It was further indicated that the interval from the peak of the T wave to the end of the T wave (Tpe) becomes relatively shorter after I K r inhibition by d,l-sotalol and that the most pronounced repolarization changes were present in the ascending segment of the minimal T-wave representation. The minimal T-wave representation can potentially be used as a new tool to identify normal from abnormal repolarization in drug safety studies. © 2016 Wiley Periodicals, Inc.

Medical Maximizing-Minimizing Preferences Predict Responses to Information about Prostate-Specific Antigen Screening.

PubMed

Scherer, Laura D; Kullgren, Jeffrey T; Caverly, Tanner; Scherer, Aaron M; Shaffer, Victoria A; Fagerlin, Angela; Zikmund-Fisher, Brian J

2018-06-01

The recently developed Medical Maximizer-Minimizer Scale (MMS) assesses individual differences in preferences for active v. passive medical treatment. We hypothesized that men's maximizing-minimizing preferences might have relevance in the case of prostate-specific antigen (PSA) screening, since there is considerable variability in men's preference for being screened even among men who are informed that harm is more likely than benefit. The current research examined whether MMS preferences predict how men respond to didactic information and narrative stories about PSA screening. US men 40+ years old ( N = 1208) participated in an online survey. Men viewed information about PSA screening in 3 phases and provided their preference for screening after each phase. Phase 1 described what PSA screening is. Phase 2 added didactic information about screening risks and benefits. Phase 3 added narrative stories; men were randomized to receive stories about 1) physical harm, 2) emotional harm, 3) overdiagnosis, or 4) all 3 stories. Participants also completed the validated MMS. After receiving basic information, 76.8% of men wanted PSA screening. After receiving information about risks and benefits, 54.8% wanted screening (a significant reduction, P < 0.001). Men who changed their preferences were significantly more likely to be minimizers than maximizers; most men with maximizing tendencies wanted screening after both the didactic information and narratives, whereas most men with minimizing tendencies did not want the test after receiving information. Men who prefer a more minimizing approach to medicine are more responsive to evidence supporting limiting or forgoing screening than men who prefer a maximizing approach.

Graphical approach for multiple values logic minimization

NASA Astrophysics Data System (ADS)

Awwal, Abdul Ahad S.; Iftekharuddin, Khan M.

1999-03-01

Multiple valued logic (MVL) is sought for designing high complexity, highly compact, parallel digital circuits. However, the practical realization of an MVL-based system is dependent on optimization of cost, which directly affects the optical setup. We propose a minimization technique for MVL logic optimization based on graphical visualization, such as a Karnaugh map. The proposed method is utilized to solve signed-digit binary and trinary logic minimization problems. The usefulness of the minimization technique is demonstrated for the optical implementation of MVL circuits.

AO/NAO Response to Climate Change. 1; Respective Influences of Stratospheric and Tropospheric Climate Changes

NASA Technical Reports Server (NTRS)

Rind, D.; Perlwitz, J.; Lonergan, P.

2005-01-01

We utilize the GISS Global Climate Middle Atmosphere Model and 8 different climate change experiments, many of them focused on stratospheric climate forcings, to assess the relative influence of tropospheric and stratospheric climate change on the extratropical circulation indices (Arctic Oscillation, AO; North Atlantic Oscillation, NAO). The experiments are run in two different ways: with variable sea surface temperatures (SSTs) to allow for a full tropospheric climate response, and with specified SSTs to minimize the tropospheric change. The results show that tropospheric warming (cooling) experiments and stratospheric cooling (warming) experiments produce more positive (negative) AO/NAO indices. For the typical magnitudes of tropospheric and stratospheric climate changes, the tropospheric response dominates; results are strongest when the tropospheric and stratospheric influences are producing similar phase changes. Both regions produce their effect primarily by altering wave propagation and angular momentum transports, but planetary wave energy changes accompanying tropospheric climate change are also important. Stratospheric forcing has a larger impact on the NAO than on the AO, and the angular momentum transport changes associated with it peak in the upper troposphere, affecting all wavenumbers. Tropospheric climate changes influence both the A0 and NAO with effects that extend throughout the troposphere. For both forcings there is often vertical consistency in the sign of the momentum transport changes, obscuring the difference between direct and indirect mechanisms for influencing the surface circulation.

Minimal entropy approximation for cellular automata

NASA Astrophysics Data System (ADS)

Fukś, Henryk

2014-02-01

We present a method for the construction of approximate orbits of measures under the action of cellular automata which is complementary to the local structure theory. The local structure theory is based on the idea of Bayesian extension, that is, construction of a probability measure consistent with given block probabilities and maximizing entropy. If instead of maximizing entropy one minimizes it, one can develop another method for the construction of approximate orbits, at the heart of which is the iteration of finite-dimensional maps, called minimal entropy maps. We present numerical evidence that the minimal entropy approximation sometimes outperforms the local structure theory in characterizing the properties of cellular automata. The density response curve for elementary CA rule 26 is used to illustrate this claim.

Unraveling the Importance of Climate Change Resilience in Planning the Future Sustainable Energy System

NASA Astrophysics Data System (ADS)

Tarroja, B.; AghaKouchak, A.; Forrest, K.; Chiang, F.; Samuelsen, S.

2017-12-01

In response to concerns regarding the environmental impacts of the current energy resource mix, significant research efforts have been focused on determining the future energy resource mix to meet emissions reduction and environmental sustainability goals. Many of these studies focus on various constraints such as costs, grid operability requirements, and environmental performance, and develop different plans for the rollout of energy resources between the present and future years. One aspect that has not yet been systematically taken into account in these planning studies, however, is the potential impacts that changing climates may have on the availability and performance of key energy resources that compose these plans. This presentation will focus on a case study for California which analyzes the impacts of climate change on the greenhouse gas emissions and renewable resource utilization of an energy resource plan developed by Energy Environmental Economics for meeting the state's year 2050 greenhouse gas goal of 80% reduction in emissions by the year 2050. Specifically, climate change impacts on three aspects of the energy system are investigated: 1) changes in hydropower generation due to altered precipitation, streamflow and runoff patterns, 2) changes in the availability of solar thermal and geothermal power plant capacity due to shifting water availability, and 3) changes in the residential and commercial electric building loads due to increased temperatures. These impacts were discovered to cause the proposed resource plan to deviate from meeting its emissions target by up to 5.9 MMT CO2e/yr and exhibit a reduction in renewable resource penetration of up to 3.1% of total electric energy. The impacts of climate change on energy system performance were found to be mitigated by increasing the flexibility of the energy system through increased storage and electric load dispatchability. Overall, this study highlights the importance of taking into account and

The importance of chill rate when characterising colour change of lamb meat during retail display.

PubMed

Jacob, R H; Thomson, K L

2012-02-01

An experiment was conducted to compare the effect of two chilling rates (Con and Fast) on colour change of lamb meat during simulated retail display. Measurements were made on 3 muscles; LD (m. longisimuss dorsi), SM (m semimembranosus) and ST (m. semitendinous). Meat samples from 32 Merino crossbred lambs were vacuum packed and stored for 5 days at 2 °C, then cut and overwrapped in polyvinyl chloride film on black polystyrene trays, stored in a display cabinet at 4 °C with lights on and measured twice daily for 4 days, using a Hunterlab minilab 45/20L D65, aperture 10°. Sarcomere length was shorter, shear force higher and colour change greater in meat from the Fast treatment compared to the Con treatment. Colour differences between treatments were likely due to oxygenation (bloom) as well as oxidation effects. Chill rate is important when characterising colour change during display and should be considered in measurement protocols. Copyright © 2011 Elsevier Ltd. All rights reserved.

Minimalism in Art, Medical Science and Neurosurgery.

PubMed

Okten, Ali Ihsan

2018-01-01

The word "minimalism" is a word derived from French the word "minimum". Whereas the lexical meaning of minimum is "the least or the smallest quantity necessary for something", its expression in mathematics can be described as "the lowest step a variable number can descend, least, minimal". Minimalism, which advocates an extreme simplicity of the artistic form, is a current in modern art and music whose origins go to 1960s and which features simplicity and objectivity. Although art, science and philosophy are different disciplines, they support each other from time to time, sometimes they intertwine and sometimes they copy each other. A periodic schools or teaching in one of them can take the others into itself, so, they proceed on their ways empowering each other. It is also true for the minimalism in art and the minimal invasive surgical approaches in science. Concepts like doing with less, avoiding unnecessary materials and reducing the number of the elements in order to increase the effect in the expression which are the main elements of the minimalism in art found their equivalents in medicine and neurosurgery. Their equivalents in medicine or neurosurgery have been to protect the physical integrity of the patient with less iatrogenic injury, minimum damage and the same therapeutic effect in the most effective way and to enable the patient to regain his health in the shortest span of time. As an anticipation, we can consider that the minimal approaches started by Richard Wollheim and Barbara Rose in art and Lars Leksell, Gazi Yaşargil and other neurosurgeons in neurosurgery in the 1960s are the present day equivalents of the minimalist approaches perhaps unconsciously started by Kazimir Malevich in art and Victor Darwin L"Espinasse in neurosurgery in the early 1900s. We can also consider that they have developed interacting with each other, not by chance.

Do drivers of biodiversity change differ in importance across marine and terrestrial systems - Or is it just different research communities' perspectives?

PubMed

Knapp, Sonja; Schweiger, Oliver; Kraberg, Alexandra; Asmus, Harald; Asmus, Ragnhild; Brey, Thomas; Frickenhaus, Stephan; Gutt, Julian; Kühn, Ingolf; Liess, Matthias; Musche, Martin; Pörtner, Hans-O; Seppelt, Ralf; Klotz, Stefan; Krause, Gesche

2017-01-01

Cross-system studies on the response of different ecosystems to global change will support our understanding of ecological changes. Synoptic views on the planet's two main realms, the marine and terrestrial, however, are rare, owing to the development of rather disparate research communities. We combined questionnaires and a literature review to investigate how the importance of anthropogenic drivers of biodiversity change differs among marine and terrestrial systems and whether differences perceived by marine vs. terrestrial researchers are reflected by the scientific literature. This included asking marine and terrestrial researchers to rate the relevance of different drivers of global change for either marine or terrestrial biodiversity. Land use and the associated loss of natural habitats were rated as most important in the terrestrial realm, while the exploitation of the sea by fishing was rated as most important in the marine realm. The relevance of chemicals, climate change and the increasing atmospheric concentration of CO 2 were rated differently for marine and terrestrial biodiversity respectively. Yet, our literature review provided less evidence for such differences leading to the conclusion that while the history of the use of land and sea differs, impacts of global change are likely to become increasingly similar. Copyright © 2016 Office national des forêts. Published by Elsevier B.V. All rights reserved.

On eco-efficient technologies to minimize industrial water consumption

NASA Astrophysics Data System (ADS)

Amiri, Mohammad C.; Mohammadifard, Hossein; Ghaffari, Ghasem

2016-07-01

Purpose - Water scarcity will further stress on available water systems and decrease the security of water in many areas. Therefore, innovative methods to minimize industrial water usage and waste production are of paramount importance in the process of extending fresh water resources and happen to be the main life support systems in many arid regions of the world. This paper demonstrates that there are good opportunities for many industries to save water and decrease waste water in softening process by substituting traditional with echo-friendly methods. The patented puffing method is an eco-efficient and viable technology for water saving and waste reduction in lime softening process. Design/methodology/approach - Lime softening process (LSP) is a very sensitive process to chemical reactions. In addition, optimal monitoring not only results in minimizing sludge that must be disposed of but also it reduces the operating costs of water conditioning. Weakness of the current (regular) control of LSP based on chemical analysis has been demonstrated experimentally and compared with the eco-efficient puffing method. Findings - This paper demonstrates that there is a good opportunity for many industries to save water and decrease waste water in softening process by substituting traditional method with puffing method, a patented eco-efficient technology. Originality/value - Details of the required innovative works to minimize industrial water usage and waste production are outlined in this paper. Employing the novel puffing method for monitoring of lime softening process results in saving a considerable amount of water while reducing chemical sludge.

Sequential changes from minimal pancreatic inflammation to advanced alcoholic pancreatitis.

PubMed

Noronha, M; Dreiling, D A; Bordalo, O

1983-11-01

A correlation of several clinical parameters and pancreatitis morphological alterations observed in chronic alcoholics with and without pancreatic is presented. Three groups of patients were studied: asymptomatic chronic alcoholics (24); non-alcoholic controls (10); and cases with advanced chronic pancreatitis (6). Clinical, biochemical and functional studies were performed. Morphological studies were made on surgical biopsy specimens in light and electron microscopy. The results of this study showed: 1) fat accumulates within pancreatic acinar cells in alcoholics drinking more than 80 g of ethanol per day; 2) ultrastructural changes found in acinar cells of the alcoholics are similar to those described for liver cells; 3) the alterations found in alcoholics without pancreatitis are also observed in those with advanced chronic pancreatitis. An attempt to correlate the sequential changes in the histopathology of alcoholic pancreatic disease with the clinical picture and secretory patterns was made. According to these observations, admitting the ultrastructural similarities between the liver and the pancreas and the recently demonstrated abnormalities of lipid metabolism in pancreatic cells in experimental animal research, the authors postulate a toxic-metabolic mechanism as a likely hypothesis for the pathogenesis of chronic alcoholic inflammation of the pancreas.

Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease.

PubMed

Ries, Julie D; Echternach, John L; Nof, Leah; Gagnon Blodgett, Michelle

2009-06-01

With the increasing incidence of Alzheimer disease (AD), determining the validity and reliability of outcome measures for people with this disease is necessary. The goals of this study were to assess test-retest reliability of data for the Timed "Up & Go" Test (TUG), the Six-Minute Walk Test (6MWT), and gait speed and to calculate minimal detectable change (MDC) scores for each outcome measure. Performance differences between groups with mild to moderate AD and moderately severe to severe AD (as determined by the Functional Assessment Staging [FAST] scale) were studied. This was a prospective, nonexperimental, descriptive methodological study. Background data collected for 51 people with AD included: use of an assistive device, Mini-Mental Status Examination scores, and FAST scale scores. Each participant engaged in 2 test sessions, separated by a 30- to 60-minute rest period, which included 2 TUG trials, 1 6MWT trial, and 2 gait speed trials using a computerized gait assessment system. A specific cuing protocol was followed to achieve optimal performance during test sessions. Test-retest reliability values for the TUG, the 6MWT, and gait speed were high for all participants together and for the mild to moderate AD and moderately severe to severe AD groups separately (intraclass correlation coefficients > or = .973); however, individual variability of performance also was high. Calculated MDC scores at the 90% confidence interval were: TUG=4.09 seconds, 6MWT=33.5 m (110 ft), and gait speed=9.4 cm/s. The 2 groups were significantly different in performance of clinical tests, with the participants who were more cognitively impaired being more physically and functionally impaired. A single researcher for data collection limited sample numbers and prohibited blinding to dementia level. The TUG, the 6MWT, and gait speed are reliable outcome measures for use with people with AD, recognizing that individual variability of performance is high. Minimal detectable change

Gaze-contingent control for minimally invasive robotic surgery.

PubMed

Mylonas, George P; Darzi, Ara; Yang, Guang Zhong

2006-09-01

Recovering tissue depth and deformation during robotically assisted minimally invasive procedures is an important step towards motion compensation, stabilization and co-registration with preoperative data. This work demonstrates that eye gaze derived from binocular eye tracking can be effectively used to recover 3D motion and deformation of the soft tissue. A binocular eye-tracking device was integrated into the stereoscopic surgical console. After calibration, the 3D fixation point of the participating subjects could be accurately resolved in real time. A CT-scanned phantom heart model was used to demonstrate the accuracy of gaze-contingent depth extraction and motion stabilization of the soft tissue. The dynamic response of the oculomotor system was assessed with the proposed framework by using autoregressive modeling techniques. In vivo data were also used to perform gaze-contingent decoupling of cardiac and respiratory motion. Depth reconstruction, deformation tracking, and motion stabilization of the soft tissue were possible with binocular eye tracking. The dynamic response of the oculomotor system was able to cope with frequencies likely to occur under most routine minimally invasive surgical operations. The proposed framework presents a novel approach towards the tight integration of a human and a surgical robot where interaction in response to sensing is required to be under the control of the operating surgeon.

Feature-based registration of historical aerial images by Area Minimization

NASA Astrophysics Data System (ADS)

Nagarajan, Sudhagar; Schenk, Toni

2016-06-01

The registration of historical images plays a significant role in assessing changes in land topography over time. By comparing historical aerial images with recent data, geometric changes that have taken place over the years can be quantified. However, the lack of ground control information and precise camera parameters has limited scientists' ability to reliably incorporate historical images into change detection studies. Other limitations include the methods of determining identical points between recent and historical images, which has proven to be a cumbersome task due to continuous land cover changes. Our research demonstrates a method of registering historical images using Time Invariant Line (TIL) features. TIL features are different representations of the same line features in multi-temporal data without explicit point-to-point or straight line-to-straight line correspondence. We successfully determined the exterior orientation of historical images by minimizing the area formed between corresponding TIL features in recent and historical images. We then tested the feasibility of the approach with synthetic and real data and analyzed the results. Based on our analysis, this method shows promise for long-term 3D change detection studies.

Identifying Time Periods of Minimal Thermal Gradient for Temperature-Driven Structural Health Monitoring.

PubMed

Reilly, John; Glisic, Branko

2018-03-01

Temperature changes play a large role in the day to day structural behavior of structures, but a smaller direct role in most contemporary Structural Health Monitoring (SHM) analyses. Temperature-Driven SHM will consider temperature as the principal driving force in SHM, relating a measurable input temperature to measurable output generalized strain (strain, curvature, etc.) and generalized displacement (deflection, rotation, etc.) to create three-dimensional signatures descriptive of the structural behavior. Identifying time periods of minimal thermal gradient provides the foundation for the formulation of the temperature-deformation-displacement model. Thermal gradients in a structure can cause curvature in multiple directions, as well as non-linear strain and stress distributions within the cross-sections, which significantly complicates data analysis and interpretation, distorts the signatures, and may lead to unreliable conclusions regarding structural behavior and condition. These adverse effects can be minimized if the signatures are evaluated at times when thermal gradients in the structure are minimal. This paper proposes two classes of methods based on the following two metrics: (i) the range of raw temperatures on the structure, and (ii) the distribution of the local thermal gradients, for identifying time periods of minimal thermal gradient on a structure with the ability to vary the tolerance of acceptable thermal gradients. The methods are tested and validated with data collected from the Streicker Bridge on campus at Princeton University.

Identifying Time Periods of Minimal Thermal Gradient for Temperature-Driven Structural Health Monitoring

PubMed Central

Reilly, John; Glisic, Branko

2018-01-01

Temperature changes play a large role in the day to day structural behavior of structures, but a smaller direct role in most contemporary Structural Health Monitoring (SHM) analyses. Temperature-Driven SHM will consider temperature as the principal driving force in SHM, relating a measurable input temperature to measurable output generalized strain (strain, curvature, etc.) and generalized displacement (deflection, rotation, etc.) to create three-dimensional signatures descriptive of the structural behavior. Identifying time periods of minimal thermal gradient provides the foundation for the formulation of the temperature–deformation–displacement model. Thermal gradients in a structure can cause curvature in multiple directions, as well as non-linear strain and stress distributions within the cross-sections, which significantly complicates data analysis and interpretation, distorts the signatures, and may lead to unreliable conclusions regarding structural behavior and condition. These adverse effects can be minimized if the signatures are evaluated at times when thermal gradients in the structure are minimal. This paper proposes two classes of methods based on the following two metrics: (i) the range of raw temperatures on the structure, and (ii) the distribution of the local thermal gradients, for identifying time periods of minimal thermal gradient on a structure with the ability to vary the tolerance of acceptable thermal gradients. The methods are tested and validated with data collected from the Streicker Bridge on campus at Princeton University. PMID:29494496

Influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: a systematic review.

PubMed

Imadojemu, Sotonye; Sarwer, David B; Percec, Ivona; Sonnad, Seema S; Goldsack, Jennifer E; Berman, Morgan; Sobanko, Joseph F

2013-11-01

Millions of surgical and minimally invasive cosmetic procedures of the face are performed each year, but objective clinical measures that evaluate surgical procedures, such as complication rates, have limited utility when applied to cosmetic procedures. While there may be subjective improvements in appearance, it is important to determine if these interventions have an impact on patients in other realms such as psychosocial functioning. This is particularly important in light of the Patient Protection and Affordable Care Act and its emphasis on patient-centered outcomes and effectiveness. To review the literature investigating the impact of facial cosmetic surgery and minimally invasive procedures on relevant psychological variables to guide clinical practice and set norms for clinical performance. English-language randomized clinical trials and prospective cohort studies that preoperatively and postoperatively assessed psychological variables in at least 10 patients seeking surgical or minimally invasive cosmetic procedures of the face. Only 1 study investigating minimally invasive procedures was identified. Most studies reported modest improvement in psychosocial functioning, which included quality of life, self-esteem, and body image. Unfortunately, the overall quality of evidence is limited owing to an absence of control groups, short follow-up periods, or loss to follow-up. The current literature suggests that a number of psychosocial domains may improve following facial cosmetic surgery, although the quality of this evidence is limited (grade of recommendation 2A). Despite the dramatic rise in nonsurgical cosmetic procedures, there is a paucity of information regarding the impact of chemodenervation and soft-tissue augmentation on psychosocial functioning.

Minimal change disease related to rifampicin presenting with acute renal failure during treatment for latent tuberculosis infection: A case report.

PubMed

Kim, Jee-Seon; Kim, Kyong-Ju; Choi, Eun-Young

2018-06-01

The standard drugs used to treat tuberculosis are rifampicin and isoniazid. These agents are usually safe and inexpensive for short-term use in treatment of latent tuberculosis infection, but sometimes cause adverse renal effects, including minimal change disease (MCD). Here, we report a 51-year-old woman with latent tuberculosis infection who developed nephrotic syndrome during treatment with rifampicin and isoniazid for 25 days. Renal biopsy findings were compatible with MCD, and she had no relevant medical history and was not taking other medications. A diagnosis of anti-tuberculosis drug- induced MCD was made. This is the first report of acute renal failure due to rifampicin and/or isoniazid-induced MCD. After cessation of rifampicin and isoniazid, however, acute renal failure progressed and she was treated with temporary dialysis and oral prednisolone. The patient achieved complete remission after cessation of rifampicin and isoniazid with steroid therapy. This case demonstrates that rifampicin and/or isoniazid can cause nephrotic syndrome with acute renal failure during the first months of continuous latent tuberculosis therapy. Therefore, renal function and proteinuria should be monitored carefully in all patients taking rifampicin and isoniazid, especially during the first few months of therapy.

Entropy Generation Minimization in Dimethyl Ether Synthesis: A Case Study

NASA Astrophysics Data System (ADS)

Kingston, Diego; Razzitte, Adrián César

2018-04-01

Entropy generation minimization is a method that helps improve the efficiency of real processes and devices. In this article, we study the entropy production (due to chemical reactions, heat exchange and friction) in a conventional reactor that synthesizes dimethyl ether and minimize it by modifying different operating variables of the reactor, such as composition, temperature and pressure, while aiming at a fixed production of dimethyl ether. Our results indicate that it is possible to reduce the entropy production rate by nearly 70 % and that, by changing only the inlet composition, it is possible to cut it by nearly 40 %, though this comes at the expense of greater dissipation due to heat transfer. We also study the alternative of coupling the reactor with another, where dehydrogenation of methylcyclohexane takes place. In that case, entropy generation can be reduced by 54 %, when pressure, temperature and inlet molar flows are varied. These examples show that entropy generation analysis can be a valuable tool in engineering design and applications aiming at process intensification and efficient operation of plant equipment.

Inferring the Minimal Genome of Mesoplasma florum by Comparative Genomics and Transposon Mutagenesis.

PubMed

Baby, Vincent; Lachance, Jean-Christophe; Gagnon, Jules; Lucier, Jean-François; Matteau, Dominick; Knight, Tom; Rodrigue, Sébastien

2018-01-01

The creation and comparison of minimal genomes will help better define the most fundamental mechanisms supporting life. Mesoplasma florum is a near-minimal, fast-growing, nonpathogenic bacterium potentially amenable to genome reduction efforts. In a comparative genomic study of 13 M. florum strains, including 11 newly sequenced genomes, we have identified the core genome and open pangenome of this species. Our results show that all of the strains have approximately 80% of their gene content in common. Of the remaining 20%, 17% of the genes were found in multiple strains and 3% were unique to any given strain. On the basis of random transposon mutagenesis, we also estimated that ~290 out of 720 genes are essential for M. florum L1 in rich medium. We next evaluated different genome reduction scenarios for M. florum L1 by using gene conservation and essentiality data, as well as comparisons with the first working approximation of a minimal organism, Mycoplasma mycoides JCVI-syn3.0. Our results suggest that 409 of the 473 M. mycoides JCVI-syn3.0 genes have orthologs in M. florum L1. Conversely, 57 putatively essential M. florum L1 genes have no homolog in M. mycoides JCVI-syn3.0. This suggests differences in minimal genome compositions, even for these evolutionarily closely related bacteria. IMPORTANCE The last years have witnessed the development of whole-genome cloning and transplantation methods and the complete synthesis of entire chromosomes. Recently, the first minimal cell, Mycoplasma mycoides JCVI-syn3.0, was created. Despite these milestone achievements, several questions remain to be answered. For example, is the composition of minimal genomes virtually identical in phylogenetically related species? On the basis of comparative genomics and transposon mutagenesis, we investigated this question by using an alternative model, Mesoplasma florum, that is also amenable to genome reduction efforts. Our results suggest that the creation of additional minimal

The Minimal Cost of Life in Space

NASA Astrophysics Data System (ADS)

Drysdale, A.; Rutkze, C.; Albright, L.; Ladue, R.

Life in space requires protection from the external environment, provision of a suitable internal environment, provision of consumables to maintain life, and removal of wastes. Protection from the external environment will mainly require shielding from radiation and meteoroids. Provision of a suitable environment inside the spacecraft will require provision of suitable air pressure and composition, temperature, and protection from environmental toxins (trace contaminants) and pathogenic micro-organisms. Gravity may be needed for longer missions to avoid excessive changes such as decalcification and muscle degeneration. Similarly, the volume required per crewmember will increase as the mission duration increases. Consumables required include oxygen, food, and water. Nitrogen might be required, depending on the total pressure and non-metabolic losses. We normally provide these consumables from the Earth, with a greater or lesser degree of regeneration. In principle, all consumables can be regenerated. Water and air are easiest to regenerate. At the present time, food can only be regenerated by using plants, and higher plants at that. Waste must be removed, including carbon dioxide and other metabolic waste as well as trash such as food packaging, filters, and expended spare parts. This can be done by dumping or regeneration. The minimal cost of life in space would be to use a synthesis process or system to regenerate all consumables from wastes. As the efficiency of the various processes rises, the minimal cost of life support will fall. However, real world regeneration requires significant equipment, power, and crew time. Make-up will be required for those items that cannot be economically regenerated. For very inefficient processes, it might be cheaper to ship all or part of the consumables. We are currently far down the development curve, and for short missions it is cheaper to ship consumables. For longer duration missions, greater closure is cost effective

Minimal invasive treatments for liver malignancies.

PubMed

Orsi, Franco; Varano, Gianluca

2015-11-01

Minimal invasive therapies have proved useful in the management of primary and secondary hepatic malignancies. The most relevant aspects of all these therapies are their minimal toxicity profiles and highly effective tumor responses without affecting the normal hepatic parenchyma. These unique characteristics coupled with their minimally invasive nature provide an attractive therapeutic option for patients who previously may have had few alternatives. Combination of these therapies might extend indications to bring curative treatment to a wider selected population. The results of various ongoing combination trials of intraarterial therapies with targeted therapies are awaited to further improve survival in this patient group. This review focuses on the application of ablative and intra-arterial therapies in the management of hepatocellular carcinoma and hepatic colorectal metastasis. Copyright © 2015 Elsevier B.V. All rights reserved.

Political Minimalism and Social Debates: The Case of Human-Enhancement Technologies.

PubMed

Rodríguez-Alcázar, Javier

2017-09-01

A faulty understanding of the relationship between morality and politics encumbers many contemporary debates on human enhancement. As a result, some ethical reflections on enhancement undervalue its social dimensions, while some social approaches to the topic lack normative import. In this essay, I use my own conception of the relationship between ethics and politics, which I call "political minimalism," in order to support and strengthen the existing social perspectives on human-enhancement technologies.

Minimally-aggressive gestational trophoblastic neoplasms.

PubMed

Cole, Laurence A

2012-04-01

We have previously defined a new syndrome "Minimally-aggressive gestational trophoblastic neoplasms" in which choriocarcinoma or persistent hydatidiform mole has a minimal growth rate and becomes chemorefractory. Previously we described a new treatment protocol, waiting for hCG rise to >3000 mIU/ml and disease becomes more advanced, then using combination chemotherapy. Initially we found this treatment successful in 8 of 8 cases, here we find this protocol appropriate in a further 16 cases. Initially we used hyperglycosylated hCG, a limited availability test, to identify this syndrome. Here we propose also using hCG doubling rate to detect this syndrome. Minimally aggressive gestational trophoblastic disease can be detected by chemotherapy resistance or low hyperglycosylated hCG, <40% of total hCG. It can also be identified by hCG doubling rate, with doubling time greater than 2 weeks. Nineteen new cases were identified as having minimally aggressive gestational trophoblastic disease by hyperglycosylated hCG and by hCG doubling test. All were recommended to hold off further chemotherapy until hCG >3000mIU/ml. One case died prior to the start of the study, one case withdrew because of a lung nodule and one withdrew refusing the suggested combination chemotherapy. The remaining 16 women were all successfully treated. A total of 8 plus 16 or 24 of 24 women were successfully treated using the proposed protocol, holding back on chemotherapy until hCG >3000mIU/ml. Copyright © 2011 Elsevier Inc. All rights reserved.

Minimizing electrode contamination in an electrochemical cell

DOEpatents

Kim, Yu Seung; Zelenay, Piotr; Johnston, Christina

2014-12-09

An electrochemical cell assembly that is expected to prevent or at least minimize electrode contamination includes one or more getters that trap a component or components leached from a first electrode and prevents or at least minimizes them from contaminating a second electrode.

Is there really a clinical benefit of using minimized extracorporeal circulation for coronary artery bypass grafting?

PubMed

Schöttler, J; Lutter, G; Böning, A; Soltau, D; Bein, B; Caliebe, D; Haake, N; Schoeneich, F; Cremer, J

2008-03-01

Minimized extracorporeal circulation is intended to reduce the negative effects associated with cardiopulmonary bypass. This prospective study was performed to evaluate whether minimized extracorporeal circulation has a clinical benefit for coronary artery surgery patients compared to standard extracorporeal circulation. Sixty patients were randomized into two study groups: 30 patients underwent coronary artery bypass grafting using minimized extracorporeal circulation and 30 patients were operated using standard extracorporeal circulation. Baseline characteristics, intraoperative details, postoperative data, perioperative blood chemistry determinations of hematocrit, platelets, muscle-brain fraction of the creatine kinase, cardiac troponin T and colloid osmotic pressure as measurements of intrathoracic blood volume index and extravascular lung water index were compared. Baseline characteristics and intraoperative details of both groups were similar. Patients who underwent minimized extracorporeal circulation showed more short-term dependency on norepinephrine ( P < 0.01). Their maximal postoperative muscle-brain fraction of the creatine kinase was lower ( P < 0.05) and their hematocrit on arrival in the intensive care unit was higher ( P < 0.01). No other significant differences were found. In both collectives, values for hematocrit ( P < 0.001), platelets ( P < 0.001), colloid osmotic pressure ( P < 0.001) and intrathoracic blood volume index ( P < 0.05) decreased, while the extravascular lung water index did not change significantly during cardiopulmonary bypass. A clinical advantage of minimized over standard extracorporeal circulation was not found. Furthermore, a higher number of patients in the minimized extracorporeal circulation group required postoperative norepinephrine infusions for hemodynamic stabilization. In summary, the presumed superiority of minimized extracorporeal circulation for coronary artery bypass grafting in standard patients could not be

Minimally invasive aortic valve replacement surgery through lower half sternotomy

PubMed Central

Fenton, James R.

2013-01-01

Less invasive approaches to aortic valve surgery frequently rely upon the development of new technology and instrumentation. While not suitable for every patient requiring an aortic valve procedure, these less invasive operations can offer certain clinical benefits and are becoming an important part of the modern cardiothoracic surgeon’s skillset. A lower partial sternotomy approach provides excellent visualization of the operative field, efficient execution of the operation and many of the benefits of minimally invasive surgery. Importantly, the lower partial sternotomy requires no new or unusual instruments and presents a familiar view to the surgeon. The technique, therefore, lends itself well to being adapted and utilized quickly with a potentially shorter “learning curve” for maximal surgical flexibility and patient benefit. PMID:24251024

A Prospective Randomized Study on Operative Treatment for Simple Distal Tibial Fractures-Minimally Invasive Plate Osteosynthesis Versus Minimal Open Reduction and Internal Fixation.

PubMed

Kim, Ji Wan; Kim, Hyun Uk; Oh, Chang-Wug; Kim, Joon-Woo; Park, Ki Chul

2018-01-01

To compare the radiologic and clinical results of minimally invasive plate osteosynthesis (MIPO) and minimal open reduction and internal fixation (ORIF) for simple distal tibial fractures. Randomized prospective study. Three level 1 trauma centers. Fifty-eight patients with simple and distal tibial fractures were randomized into a MIPO group (treatment with MIPO; n = 29) or a minimal group (treatment with minimal ORIF; n = 29). These numbers were designed to define the rate of soft tissue complication; therefore, validation of superiority in union time or determination of differences in rates of delayed union was limited in this study. Simple distal tibial fractures treated with MIPO or minimal ORIF. The clinical outcome measurements included operative time, radiation exposure time, and soft tissue complications. To evaluate a patient's function, the American Orthopedic Foot and Ankle Society ankle score (AOFAS) was used. Radiologic measurements included fracture alignment, delayed union, and union time. All patients acquired bone union without any secondary intervention. The mean union time was 17.4 weeks and 16.3 weeks in the MIPO and minimal groups, respectively. There was 1 case of delayed union and 1 case of superficial infection in each group. The radiation exposure time was shorter in the minimal group than in the MIPO group. Coronal angulation showed a difference between both groups. The American Orthopedic Foot and Ankle Society ankle scores were 86.0 and 86.7 in the MIPO and minimal groups, respectively. Minimal ORIF resulted in similar outcomes, with no increased rate of soft tissue problems compared to MIPO. Both MIPO and minimal ORIF have high union rates and good functional outcomes for simple distal tibial fractures. Minimal ORIF did not result in increased rates of infection and wound dehiscence. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Minimally Invasive Surgery (MIS) Approaches to Thoracolumbar Trauma.

PubMed

Kaye, Ian David; Passias, Peter

2018-03-01

Minimally invasive surgical (MIS) techniques offer promising improvements in the management of thoracolumbar trauma. Recent advances in MIS techniques and instrumentation for degenerative conditions have heralded a growing interest in employing these techniques for thoracolumbar trauma. Specifically, surgeons have applied these techniques to help manage flexion- and extension-distraction injuries, neurologically intact burst fractures, and cases of damage control. Minimally invasive surgical techniques offer a means to decrease blood loss, shorten operative time, reduce infection risk, and shorten hospital stays. Herein, we review thoracolumbar minimally invasive surgery with an emphasis on thoracolumbar trauma classification, minimally invasive spinal stabilization, surgical indications, patient outcomes, technical considerations, and potential complications.

Mesonic spectroscopy of minimal walking technicolor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Del Debbio, Luigi; Lucini, Biagio; Patella, Agostino

2010-07-01

We investigate the structure and the novel emerging features of the mesonic nonsinglet spectrum of the minimal walking technicolor theory. Precision measurements in the nonsinglet pseudoscalar and vector channels are compared to the expectations for an IR-conformal field theory and a QCD-like theory. Our results favor a scenario in which minimal walking technicolor is (almost) conformal in the infrared, while spontaneous chiral symmetry breaking seems less plausible.

Minimal Intervention Dentistry – A New Frontier in Clinical Dentistry

PubMed Central

NK., Bajwa; A, Pathak

2014-01-01

Minimally invasive procedures are the new paradigm in health care. Everything from heart bypasses to gall bladder, surgeries are being performed with these dynamic new techniques. Dentistry is joining this exciting revolution as well. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralisation and minimal intervention for the placement and replacement of restorations. Minimally invasive dentistry reaches the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. This paper reviews in brief the concept of minimal intervention in dentistry. PMID:25177659