[AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders].

PubMed

Schlüter-Müller, Susanne

2017-07-01

AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders Personality disorders are patterns of maladaptive personality traits that have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe, but treatable mental disorder. Identity disturbance is seen as the central construct for detecting severe personality pathology - and, most notably, borderline personality disorder - in adults and adolescents. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning whereas identity diffusion is viewed as a lack of integration of the concept of the self and significant others. It is seen as the basis for subsequent personality pathology, including that of borderline personality disorder. Although BPD has its onset in adolescence and emerging adulthood the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Adolescent Identity Treatment (AIT) is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, a behavior-oriented homeplan and intensive family work is part of AIT.

Integrated treatment options for male perpetrators of intimate partner violence.

PubMed

Crane, Cory A; Easton, Caroline J

2017-01-01

Male-to-female intimate partner violence remains a worldwide public health issue with adverse physical and psychological consequences for victims, perpetrators and children. Personality disorders, addiction, trauma and mood symptoms are established risk factors for intimate partner violence perpetration and factor prominently into a recovery-oriented treatment approach. We reviewed the partner violence literature for detailed reports of traditional as well as innovative, integrated treatment approaches. Empirically based recommendations for intervention programs and the policies that guide intervention efforts are offered. Nascent research suggests that integrated treatment models utilising a holistic approach to account for psychological comorbidity and interventions that involve a motivational interviewing component appear promising in terms of significantly improving intimate partner violence treatment compliance and reducing subsequent acts of physical partner violence. Further, methodologically rigorous research is required to fully assess the benefits of traditional and integrated treatment options. We have advanced several recommendations, including the development of and exclusive reliance upon empirically supported treatments, conducting a thorough risk and needs assessment of the offender and the immediate family to facilitate appropriate treatment referrals, integrating content to foster the offender's internal motivation to change maladaptive behaviours, and attempting to minimise offender treatment burdens through the strategic use of integrated treatment models. Intimate partner violence is a complicated and nuanced problem that is perpetrated by a heterogeneous population and requires greater variability in integrated treatment options. [Crane CA, Easton CJ. Integrated treatment options for male perpetrators of intimate partner violence. Drug Alcohol Rev 2017;36:24-33]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Psychotherapy integration in the treatment of personality disorders: a commentary.

PubMed

Nelson, Dana L; Beutler, Larry E; Castonguay, Louis G

2012-02-01

Whereas research on the treatment of personality disorders over the past several decades has focused primarily on comparing the efficacy of various treatment packages associated with different theoretical models, there is increasing evidence that the field would benefit from focusing more attention on developing integrative treatments that are both informed by research and capable of scientific verification. The articles assembled for this special section each propose a different approach to integrative treatment for personality disorders. In this commentary, we outline a number of reasons for making such a shift to more integrative treatments, consider some of the potential challenges to integration, and discuss the different approaches to integration illustrated in these articles. We highlight some of the difficult tradeoffs that must be made in developing an integrative approach and discuss similarities and differences in the response to such challenges by the contributors to this special section. Finally, we point to several areas for future research that we believe will contribute to the development of increasingly effective treatments for individuals with personality disorders.

A Systematic Framework for Addressing Treatment Integrity in School Settings

ERIC Educational Resources Information Center

Kupzyk, Sara; Shriver, Mark D.

2016-01-01

School psychologists are tasked with ensuring treatment integrity because the level of intervention implementation affects decisions about student progress. Treatment integrity includes multiple dimensions that may impact the effectiveness of an intervention including adherence, dosage, quality, and engagement. Unfortunately, treatment integrity…

Barriers to Implementing Treatment Integrity Procedures in School Psychology Research: Survey of Treatment Outcome Researchers

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser; DiGennaro Reed, Florence D.

2012-01-01

Treatment integrity data are essential to drawing valid conclusions in treatment outcome studies. Such data, however, are not always included in peer-reviewed research articles in school psychology or related fields. To gain a better understanding of why treatment integrity data are lacking in the school psychology research, we surveyed the…

[Assessing environmental and economical benefits of integrated sewage treatment systems].

PubMed

Li, Jin-rong; Zhang, Xiao-hong; Zhang, Hang-bin; Pan, Heng-yu; Liu, Qiang

2015-08-01

Sewage treatment, treated water treatment and sludge treatment are three basic units of an integrated sewage treatment system. This work assessed the influence of reusing or discharge of treated water and sludge landfill or compost on the sustainability of an integrated sewage treatment system using emergy analysis and newly proposed emergy indicators. This system's value included its environmental benefits and the products. Environmental benefits were the differences of the environmental service values before and after sewage treatment. Due to unavailability of data of the exchanged substance and energy in the internal system, products' values were attained by newly proposed substitution values. The results showed that the combination of sewage treatment, treated water reuse and sludge landfill had the strongest competitiveness, while the combination of sewage treatment, treated water reuse and earthworm compost was the most sustainable. Moreover, treated water reuse and earthworm compost were helpful for improving the sustainability of the integrated sewage treatment system. The quality of treated water and local conditions should be also considered when implementing the treated water reuse or discharge. The resources efficiency of earthworm compost unit needed to be further improved. Improved emergy indices were more suitable for integrated sewage treatment systems.

An Evaluation of the Observer Effect on Treatment Integrity in a Day Treatment Center for Children

ERIC Educational Resources Information Center

Howard, Monica R.; Burke, Raymond V.; Allen, Keith D.

2013-01-01

Treatment integrity is an important concern in treatment centers but is often overlooked. Performance feedback is a well-established approach to improving treatment integrity, but is underused and undervalued. One way to increase its value to treatment centers may be to expose unrealized benefits on the observer who collects the performance…

[Home treatment--a treatment model of integrated care in Hamburg].

PubMed

Schöttle, Daniel; Ruppelt, Friederike; Karow, Anne; Lambert, Martin

2015-03-01

Treatment models like "Crisis Resolution and Hometreatment (CRHT)" or "Assertive Community Treatment" (ACT), were found to be effective, enhancing the qualitative level of treatment for patients with severe mental disorders. In Germany, these are implemented only sporadically until today, often as part of a cross-sectoral Integrated Care (IC) treatment system. We will present the implementation of an "Assertive Community Treatment" embedded into an IC-treatment model in Hamburg and discuss the 3-year-outcomes. The IC-treatment model has been designed for severe mentally ill patients with psychotic disorders. Since May 2007 the model is financed by different health insurances as a managed-care "capitation-model" and its effectiveness gets continuously evaluated. The model proved to be effective in earlier studies were compared with standard care low rates of service disengagement were found as well as significantly improved psychopathology, psychosocial functioning, quality of life, satisfaction with care and adherence, while being cost effective. The rates of involuntary admissions declined to 10% in comparison to the years before. In 2011 the model was specified to the indication "first-episode adolescents and young adults in the age of 12-29" in a government-funded study "Integrated Care in Early Psychosis, ICEP Study". In this study an interdisciplinary team of child, adolescent and adult psychiatrists was implemented and since 2012 it is financed by the involved health insurances throughout an expansion of the §140 SGB V agreement. © Georg Thieme Verlag KG Stuttgart · New York.

Effects of Verbal and Graphed Feedback on Treatment Integrity

ERIC Educational Resources Information Center

Zoder-Martell, Kimberly; Dufrene, Brad; Sterling, Heather; Tingstrom, Daniel; Blaze, John; Duncan, Neelima; Harpole, Lauren

2013-01-01

Treatment integrity is the degree to which an intervention is implemented as designed and is critical for concluding whether the intervention is responsible for treatment outcomes. This study aimed to add to the integrity literature by examining graphed performance feedback alone and in conjunction with verbal performance feedback for increasing…

An evaluation of programmed treatment-integrity errors during discrete-trial instruction.

PubMed

Carroll, Regina A; Kodak, Tiffany; Fisher, Wayne W

2013-01-01

This study evaluated the effects of programmed treatment-integrity errors on skill acquisition for children with an autism spectrum disorder (ASD) during discrete-trial instruction (DTI). In Study 1, we identified common treatment-integrity errors that occur during academic instruction in schools. In Study 2, we simultaneously manipulated 3 integrity errors during DTI. In Study 3, we evaluated the effects of each of the 3 integrity errors separately on skill acquisition during DTI. Results showed that participants either demonstrated slower skill acquisition or did not acquire the target skills when instruction included treatment-integrity errors. © Society for the Experimental Analysis of Behavior.

An Integrative Approach to Treatment-Resistant Obsessive-Compulsive Disorder.

PubMed

Woon, Luke Sy-Cherng; Kanapathy, Anita; Zakaria, Hazli; Alfonso, César A

2017-01-01

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes. An integrative approach can help patients gain insight, strengthen the therapeutic alliance, improve treatment adherence, and provide symptomatic relief when other treatments seem insufficient or have failed. We describe the treatment process of a person with treatment-resistant OCD who received pharmacotherapy, concurrent CBT/ERP, and a brief course of psychodynamic psychotherapy. Case formulations from cognitive behavioral and psychodynamic perspectives are presented. The authors discuss the advantages of doing a psychodynamic assessment and formulation in treatment refractory cases and the wisdom of integrating psychotherapy interventions for OCD, as well as the unique clinical features of cases that warrant a multimodal treatment approach.

Melting down the Ice Queen: an integrative treatment of anorexia nervosa

PubMed Central

Hartogs, Bregje M A; Eikmans, Kirsten M; Bartels-Velthuis, Agna A

2013-01-01

A 23-year-old woman with anorexia nervosa (AN) and a strong need for control was offered an integrative treatment, empowering the patient to be an active participant and advocating shared decision-making. To emphasise this, both the therapist and patient describe their views on the therapy. The integrative treatment resulted in more psychological flexibility and behavioural improvements, as is evident from an increased weight, a decreased dietary restriction and an increased valued action. The strength of this integrative treatment is based on accepting and encouraging patient's self-chosen treatment method, within healthy limits, and thereby creating a flexible, supportive and empowering therapeutic alliance. More research is needed to test the efficacy of combining complementary therapies within conventional treatments of AN. PMID:23531925

Integrated risk framework for onsite wastewater treatment systems.

PubMed

Carroll, Steven; Goonetilleke, Ashantha; Thomas, Evan; Hargreaves, Megan; Frost, Ray; Dawes, Les

2006-08-01

Onsite wastewater treatment systems (OWTS) are becoming increasingly important for the treatment and dispersal of effluent in new urbanised developments that are not serviced by centralised wastewater collection and treatment systems. However, the current standards and guidelines adopted by many local authorities for assessing suitable site and soil conditions for OWTS are increasingly coming under scrutiny due to the public health and environmental impacts caused by poorly performing systems, in particular septic tank-soil adsorption systems. In order to achieve sustainable onsite wastewater treatment with minimal impacts on the environment and public health, more appropriate means of assessment are required. This paper highlights an integrated risk based approach for assessing the inherent hazards associated with OWTS in order to manage and mitigate the environmental and public health risks inherent with onsite wastewater treatment. In developing a sound and cohesive integrated risk framework for OWTS, several key issues must be recognised. These include the inclusion of relevant stakeholders throughout framework development, the integration of scientific knowledge, data and analysis with risk assessment and management ideals, and identification of the appropriate performance goals for successful management and mitigation of associated risks. These issues were addressed in the development of the risk framework to provide a generic approach to assessing risk from OWTS. The utilisation of the developed risk framework for achieving more appropriate assessment and management techniques for OWTS is presented in a case study for the Gold Coast region, Queensland State, Australia.

Integrated Risk Framework for Onsite Wastewater Treatment Systems

NASA Astrophysics Data System (ADS)

Carroll, Steven; Goonetilleke, Ashantha; Thomas, Evan; Hargreaves, Megan; Frost, Ray; Dawes, Les

2006-08-01

Onsite wastewater treatment systems (OWTS) are becoming increasingly important for the treatment and dispersal of effluent in new urbanised developments that are not serviced by centralised wastewater collection and treatment systems. However, the current standards and guidelines adopted by many local authorities for assessing suitable site and soil conditions for OWTS are increasingly coming under scrutiny due to the public health and environmental impacts caused by poorly performing systems, in particular septic tank-soil adsorption systems. In order to achieve sustainable onsite wastewater treatment with minimal impacts on the environment and public health, more appropriate means of assessment are required. This paper highlights an integrated risk based approach for assessing the inherent hazards associated with OWTS in order to manage and mitigate the environmental and public health risks inherent with onsite wastewater treatment. In developing a sound and cohesive integrated risk framework for OWTS, several key issues must be recognised. These include the inclusion of relevant stakeholders throughout framework development, the integration of scientific knowledge, data and analysis with risk assessment and management ideals, and identification of the appropriate performance goals for successful management and mitigation of associated risks. These issues were addressed in the development of the risk framework to provide a generic approach to assessing risk from OWTS. The utilisation of the developed risk framework for achieving more appropriate assessment and management techniques for OWTS is presented in a case study for the Gold Coast region, Queensland State, Australia.

Treatment of pathological gambling - integrative systemic model.

PubMed

Mladenović, Ivica; Lažetić, Goran; Lečić-Toševski, Dušica; Dimitrijević, Ivan

2015-03-01

Pathological gambling was classified under impulse control disorders within the International Classification of Diseases (ICD-10) (WHO 1992), but the most recent Diagnostic and Statistical Manual, 5th edition (DSM-V), (APA 2013), has recognized pathological gambling as a first disorder within a new diagnostic category of behavioral addictions - Gambling disorder. Pathological gambling is a disorder in progression, and we hope that our experience in the treatment of pathological gambling in the Daily Hospital for Addictions at The Institute of Mental Health, through the original "Integrative - systemic model" would be of use to colleagues, dealing with this pathology. This model of treatment of pathological gambling is based on multi-systemic approach and it primarily represents an integration of family and cognitive-behavioral therapy, with traces of psychodynamic, existential and pharmacotherapy. The model is based on the book "Pathological gambling - with self-help manual" by Dr Mladenovic and Dr Lazetic, and has been designed in the form of a program that lasts 10 weeks in the intensive phase, and then continues for two years in the form of "extended treatment" ("After care"). The intensive phase is divided into three segments: educational, insight with initial changes and analysis of the achieved changes with the definition of plans and areas that need to be addressed in the extended treatment. "Extended treatment" lasts for two years in the form of group therapy, during which there is a second order change of the identified patient, but also of other family members. Pathological gambling has been treated in the form of systemic-family therapy for more than 10 years at the Institute of Mental Health (IMH), in Belgrade. For second year in a row the treatment is carried out by the modern "Integrative-systemic model". If abstinence from gambling witihin the period of one year after completion of the intensive phase of treatment is taken as the main criterion of

A view from Riggs: treatment resistance and patient authority-IX. Integrative psychodynamic treatment of psychotic disorders.

PubMed

Tillman, Jane G

2008-01-01

Psychotic spectrum disorders present treatment challenges for patients, families, and clinicians. This article addresses the history of the dualism in the field between biological and psychological approaches to mental disorders, and surveys the contemporary literature about the etiology and treatment of psychotic spectrum disorders. An integrative approach to treatment derived from work at Austen Riggs with previously treatment refractory patients with psychotic spectrum disorders is described that combines individual psycho- dynamic psychotherapy, psychopharmacology, family systems approaches, and intensive psychosocial engagement. Helping patients develop their own authority to join the treatment, use relationships for learning, and understand the meaning of their symptoms is central to the treatment at Austen Riggs. An extended case vignette of a patient diagnosed with a schizoaffective disorder is presented illustrating this integrative psychodynamic treatment approach.

Incorporating Applied Behavior Analysis to Assess and Support Educators' Treatment Integrity

ERIC Educational Resources Information Center

Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Fallon, Lindsay M.

2017-01-01

For evidence-based interventions to be effective for students they must be consistently implemented, however, many teachers struggle with treatment integrity and require support. Although many implementation support strategies are research based, there is little empirical guidance about the types of treatment integrity, implementers, and contexts…

An Evaluation of Programmed Treatment-integrity Errors during Discrete-trial Instruction

ERIC Educational Resources Information Center

Carroll, Regina A.; Kodak, Tiffany; Fisher, Wayne W.

2013-01-01

This study evaluated the effects of programmed treatment-integrity errors on skill acquisition for children with an autism spectrum disorder (ASD) during discrete-trial instruction (DTI). In Study 1, we identified common treatment-integrity errors that occur during academic instruction in schools. In Study 2, we simultaneously manipulated 3…

Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol

PubMed Central

Hogue, Aaron; Bobek, Molly; Tau, Gregory Z.; Levin, Frances R.

2014-01-01

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions. PMID:25505817

Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol.

PubMed

Hogue, Aaron; Bobek, Molly; Tau, Gregory Z; Levin, Frances R

2014-10-01

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions.

Integrated Treatment to Achieve Functional Recovery for First-Episode Psychosis

PubMed Central

Valencia, Marcelo; Juarez, Francisco; Ortega, Hector

2012-01-01

This study describes an integrated treatment approach that was implemented to enhance functional recovery in first-episode psychotic patients. Patients were randomized to two treatment conditions: either to an integrated treatment approach: pharmacotherapy, psychosocial treatment, and psychoeducation (experimental group: N = 39) or to medication alone (control group: N = 34). Patients were evaluated at baseline and after one year of treatment. Functional recovery was assessed according to symptomatic and functional remission. At the end of treatment, experimental patients showed a 94.9% of symptomatic remission compared to 58.8% of the control group. Functional remission was 56.4% for the experimental group and 3.6% for the control group, while 56.4% of the experimental group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9% of the control group. PMID:22970366

Integrated anaerobic/aerobic biological treatment for intensive swine production.

PubMed

Bortone, Giuseppe

2009-11-01

Manure processing could help farmers to effectively manage nitrogen (N) surplus load. Many pig farms have to treat wastewater. Piggery wastewater treatment is a complex challenge, due to the high COD and N concentrations and low C/N ratio. Anaerobic digestion (AD) could be a convenient pre-treatment, particularly from the energetic view point and farm income, but this causes further reduction of C/N ratio and makes denitrification difficult. N removal can only be obtained integrating anaerobic/aerobic treatment by taking into account the best use of electron donors. Experiences gained in Italy during development of integrated biological treatment approaches for swine manure, from bench to full scale, are reported in this paper. Solid/liquid separation as pre-treatment of raw manure is an efficient strategy to facilitate liquid fraction treatment without significantly lowering C/N ratio. In Italy, two full scale SBRs showed excellent efficiency and reliability. Current renewable energy policy and incentives makes economically attractive the application of AD to the separated solid fraction using high solid anaerobic digester (HSAD) technology. Economic evaluation showed that energy production can reduce costs up to 60%, making sustainable the overall treatment.

The costs and cost-effectiveness of an integrated sepsis treatment protocol.

PubMed

Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

2008-04-01

Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

Low-pressure membrane integrity tests for drinking water treatment: A review.

PubMed

Guo, H; Wyart, Y; Perot, J; Nauleau, F; Moulin, P

2010-01-01

Low-pressure membrane systems, including microfiltration (MF) and ultrafiltration (UF) membranes, are being increasingly used in drinking water treatments due to their high level of pathogen removal. However, the pathogen will pass through the membrane and contaminate the product if the membrane integrity is compromised. Therefore, an effective on-line integrity monitoring method for MF and UF membrane systems is essential to guarantee the regulatory requirements for pathogen removal. A lot of works on low-pressure membrane integrity tests have been conducted by many researchers. This paper provides a literature review about different low-pressure membrane integrity monitoring methods for the drinking water treatment, including direct methods (pressure-based tests, acoustic sensor test, liquid porosimetry, etc.) and indirect methods (particle counting, particle monitoring, turbidity monitoring, surrogate challenge tests). Additionally, some information about the operation of membrane integrity tests is presented here. It can be realized from this review that it remains urgent to develop an alternative on-line detection technique for a quick, accurate, simple, continuous and relatively inexpensive evaluation of low-pressure membrane integrity. To better satisfy regulatory requirements for drinking water treatments, the characteristic of this ideal membrane integrity test is proposed at the end of this paper.

Effects of video modeling on treatment integrity of behavioral interventions.

PubMed

Digennaro-Reed, Florence D; Codding, Robin; Catania, Cynthia N; Maguire, Helena

2010-01-01

We examined the effects of individualized video modeling on the accurate implementation of behavioral interventions using a multiple baseline design across 3 teachers. During video modeling, treatment integrity improved above baseline levels; however, teacher performance remained variable. The addition of verbal performance feedback increased treatment integrity to 100% for all participants, and performance was maintained 1 week later. Teachers found video modeling to be more socially acceptable with performance feedback than alone, but rated both positively.

An integrated treatment model for dual diagnosis of psychosis and addiction.

PubMed

Minkoff, K

1989-10-01

A model that integrates the treatment of patients with a dual diagnosis of psychosis and addiction has been developed on a general hospital psychiatric unit. The model emphasizes the parallels between the standard biopsychosocial illness-and-rehabilitation model for treatment of serious psychiatric disorders and the 12-step disease-and-recovery model of Alcoholics Anonymous for treatment of addiction. Dual-diagnosis patients are viewed as having two primary, chronic, biologic mental illnesses, each requiring specific treatment to stabilize acute symptoms and engage the patient in a recovery process. An integrated treatment program is described, as are the steps taken to alleviate psychiatric clinicians' concerns about patient involvement in AA and addiction clinicians' discomfort with patients' use of medication.

An Experimental Examination of the Impact of Choice of Treatment Components on Treatment Integrity

ERIC Educational Resources Information Center

Andersen, Melissa; Daly, Edward J., III

2013-01-01

Although there is a growing body of research on the use of performance feedback to improve treatment integrity, antecedent interventions have received little attention. Antecedent interventions are simple to use and have a strong research base. This study examined the effects of offering teachers choice of treatment components. A choice condition…

Evolution of the Treatment Integrity Concept: Current Status and Future Directions

ERIC Educational Resources Information Center

Gresham, Frank M.

2009-01-01

The concept of treatment integrity cuts across a diversity of fields involved with providing treatments or interventions to individuals. In medical treatments, the concept of "treatment compliance" or "treatment adherence" is an important and problematic issue. In the field of nutrition, the concept of "dietary adherence" is important for…

A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

PubMed Central

Addison, Laura R; Piazza, Cathleen C; Patel, Meeta R; Bachmeyer, Melanie H; Rivas, Kristi M; Milnes, Suzanne M; Oddo, Jackie

2012-01-01

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory-integration-based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important. PMID:23060661

Integration of second cancer risk calculations in a radiotherapy treatment planning system

NASA Astrophysics Data System (ADS)

Hartmann, M.; Schneider, U.

2014-03-01

Second cancer risk in patients, in particular in children, who were treated with radiotherapy is an important side effect. It should be minimized by selecting an appropriate treatment plan for the patient. The objectives of this study were to integrate a risk model for radiation induced cancer into a treatment planning system which allows to judge different treatment plans with regard to second cancer induction and to quantify the potential reduction in predicted risk. A model for radiation induced cancer including fractionation effects which is valid for doses in the radiotherapy range was integrated into a treatment planning system. From the three-dimensional (3D) dose distribution the 3D-risk equivalent dose (RED) was calculated on an organ specific basis. In addition to RED further risk coefficients like OED (organ equivalent dose), EAR (excess absolute risk) and LAR (lifetime attributable risk) are computed. A risk model for radiation induced cancer was successfully integrated in a treatment planning system. Several risk coefficients can be viewed and used to obtain critical situations were a plan can be optimised. Risk-volume-histograms and organ specific risks were calculated for different treatment plans and were used in combination with NTCP estimates for plan evaluation. It is concluded that the integration of second cancer risk estimates in a commercial treatment planning system is feasible. It can be used in addition to NTCP modelling for optimising treatment plans which result in the lowest possible second cancer risk for a patient.

Integrated ecotechnology approach towards treatment of complex wastewater with simultaneous bioenergy production.

PubMed

Hemalatha, Manupati; Sravan, J Shanthi; Yeruva, Dileep Kumar; Venkata Mohan, S

2017-10-01

Sequential integration of three stage diverse biological processes was studied by exploiting the individual process advantage towards enhanced treatment of complex chemical based wastewater. A successful attempt to integrate sequence batch reactor (SBR) with bioelectrochemical treatment (BET) and finally with microalgae treatment was studied. The sequential integration has showed individual substrate degradation (COD) of 55% in SBR, 49% in BET and 56% in microalgae, accounting for a consolidated treatment efficiency of 90%. Nitrates removal efficiency of 25% was observed in SBR, 31% in BET and 44% in microalgae, with a total efficiency of 72%. The SBR treated effluents fed to BET with the electrode intervention showed TDS removal. BET exhibited relatively higher process performance than SBR. The integration approach significantly overcame the individual process limitations along with value addition as biomass (1.75g/L), carbohydrates (640mg/g), lipids (15%) and bioelectricity. The study resulted in providing a strategy of combining SBR as pretreatment step to BET process and finally polishing with microalgae cultivation achieving the benefits of enhanced wastewater treatment along with value addition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Developing an integrated treatment for substance use and depression using cognitive-behavioral therapy.

PubMed

Osilla, Karen Chan; Hepner, Kimberly A; Muñoz, Ricardo F; Woo, Stephanie; Watkins, Katherine

2009-12-01

Providing a unified treatment approach to meet the substance abuse and mental health needs of clients is the preferred model for addressing co-occurring disorders. We developed a group-based cognitive-behavioral (CBT) integrated treatment for depression and substance use disorders (SUD) that could be delivered by counselors in SUD treatment settings and evaluated its feasibility and acceptability. We conducted an in-depth case study examining one implementation of the treatment using 15 focus groups with clients (n = 7) and semistructured interviews with counselors (n = 2) and administrators (n = 3). Using CBT as a treatment approach to integrate the treatment was widely accepted by clients, counselors, and administrators. Clients stated the treatment was applicable to multiple aspects of their lives and allowed them to recognize their clinical improvements over time. Counselors and administrators discussed challenges for long-term feasibility. Key decisions used to develop the treatment and recommendations for implementing integrated care in SUD settings are discussed.

Electrically Erasable Programmable Integrated Circuits for Replacement of Obsolete TTL Logic

DTIC Science & Technology

1991-12-01

different discrete devices" [7]. Fowler-Nordheim Tunneling Simplified Theory. Electrons in polysilicon are usually prevented from entering SiO 2 by an...overcomes the energy barrier, the tunneling electrons will not return to the polysilicon but will be carried by the electric field, causing a current to flow...Floating Gate Transistors A floating gate transistor is an insulated-gate field effect transistor (FET) that has a gate, usually made of polysilicon , which

Clinical guide to periodontology: part 3. Multidisciplinary integrated treatment.

PubMed

Palmer, R M; Ide, M; Floyd, P D

2014-05-01

The establishment of periodontal health should be a primary aim in all treatment plans. The methods by which this can be achieved have been dealt with in previous chapters, but there are a number of situations where integration of these treatment methods with other dental disciplines needs to be clarified. To simplify matters this chapter will consider periodontal implications in three main areas: treatment of drifted anterior teeth, pre-restorative procedures and replacement of missing teeth.

Assessing treatment integrity in cognitive-behavioral therapy: comparing session segments with entire sessions.

PubMed

Weck, Florian; Grikscheit, Florian; Höfling, Volkmar; Stangier, Ulrich

2014-07-01

The evaluation of treatment integrity (therapist adherence and competence) is a necessary condition to ensure the internal and external validity of psychotherapy research. However, the evaluation process is associated with high costs, because therapy sessions must be rated by experienced clinicians. It is debatable whether rating session segments is an adequate alternative to rating entire sessions. Four judges evaluated treatment integrity (i.e., therapist adherence and competence) in 84 randomly selected videotapes of cognitive-behavioral therapy for major depressive disorder, social anxiety disorder, and hypochondriasis (from three different treatment outcome studies). In each case, two judges provided ratings based on entire therapy sessions and two on session segments only (i.e., the middle third of the entire sessions). Interrater reliability of adherence and competence evaluations proved satisfactory for ratings based on segments and the level of reliability did not differ from ratings based on entire sessions. Ratings of treatment integrity that were based on entire sessions and session segments were strongly correlated (r=.62 for adherence and r=.73 for competence). The relationship between treatment integrity and outcome was comparable for ratings based on session segments and those based on entire sessions. However, significant relationships between therapist competence and therapy outcome were only found in the treatment of social anxiety disorder. Ratings based on segments proved to be adequate for the evaluation of treatment integrity. The findings demonstrate that session segments are an adequate and cost-effective alternative to entire sessions for the evaluation of therapist adherence and competence. Copyright © 2014. Published by Elsevier Ltd.

Verification of Fowler-Nordheim electron tunneling mechanism in Ni/SiO2/n-4H SiC and n+ poly-Si/SiO2/n-4H SiC MOS devices by different models

NASA Astrophysics Data System (ADS)

Kodigala, Subba Ramaiah

2016-11-01

This article emphasizes verification of Fowler-Nordheim electron tunneling mechanism in the Ni/SiO2/n-4H SiC MOS devices by developing three different kinds of models. The standard semiconductor equations are categorically solved to obtain the change in Fermi energy level of semiconductor with effect of temperature and field that extend support to determine sustainable and accurate tunneling current through the oxide layer. The forward and reverse bias currents with variation of electric field are simulated with help of different models developed by us for MOS devices by applying adequate conditions. The latter is quite different from former in terms of tunneling mechanism in the MOS devices. The variation of barrier height with effect of quantum mechanical, temperature, and fields is considered as effective barrier height for the generation of current-field (J-F) curves under forward and reverse biases but quantum mechanical effect is void in the latter. In addition, the J-F curves are also simulated with variation of carrier concentration in the n-type 4H SiC semiconductor of MOS devices and the relation between them is established.

Changing Donor Funding and the Challenges of Integrated HIV Treatment.

PubMed

Nattrass, Nicoli; Hodes, Rebecca; Cluver, Lucie

2016-07-01

Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as networks of policies requiring different degrees of integration into communities. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

Breast cancer patients' satisfaction with individual therapy goals and treatment in a standardized integrative medicine consultancy service.

PubMed

Hack, Carolin C; Antoniadis, Sophia; Hackl, Janina; Langemann, Hanna; Schwitulla, Judith; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-07-01

Complementary medicine services are nowadays usually quite heterogeneous, and little information is available on standards for running an integrative medicine consultancy service. This study aimed to assess patients' satisfaction with a standardized treatment service on integrative medicine. Using a cross-sectional design, 75 breast cancer patients from the integrative medicine consultancy service at the University Breast Center for Franconia were evaluated between January 2016 and March 2017. At primary consultation, patients answered a standardized questionnaire on their medical history and treatment goals regarding integrative medicine. In a subsequent interview, patients evaluated their satisfaction with the treatment service and individual treatment goals. 72% of the patients (n = 54) reported high satisfaction with the overall approach of the treatment service. 76% of the patients (n = 57) were very satisfied or satisfied with their individual treatment plans. The most frequently reported goals were to slow tumor progression (n = 64, 85.3%), reducing the side effects of conventional cancer treatments (n = 60, 80%), and a desire to participate actively in the treatment of breast cancer (n = 64, 85.3%). Using a standardized procedure in integrative medicine allows a high quality level to be offered to patients. Overall, breast cancer patients report very high satisfaction with the integrative medicine consultancy service and state long-term treatment goals. Hence, long-term treatment with integrative medicine methods should be taken into consideration.

Institutionalizing integrated treatment for concurrent disorders: creating new organizational discourse.

PubMed

Novotná, Gabriela

2013-01-01

The high overlap of mental health and substance use problems in the Canadian health care system and the subsequent demand for more effective services for clients with these high-risk issues have stimulated the debate on their integrated treatment. Although the idea of integration has been endorsed by decision makers at both programs and system levels, little attention has been paid to factors that have facilitated this process. In this article, the processes by which organizational texts, language, metaphors, and symbols have facilitated institutionalization of integrated treatment are identified and discussed. Findings from a qualitative case study of 2 treatment programs that were part of a large, urban hospital in Ontario providing services for populations with concurrent disorders are presented. Data were collected using semistructured interviews with professionals and clients, analysis of policy and organizational documents, and nonparticipant observations. Research evidence on comorbidity, government reports, and other organizational texts that were created and disseminated across the province has contributed to the dissemination of the concept of integration. Certain ideas might be successfully implemented when environments are conducive to change; such environmental catalysts include the status of professionals who support new discourse, the characteristics and importance of the problem being addressed, and the timing of implementation. The findings clearly demonstrate that the conditions of the wider institutional environment-the emergence of research evidence on comorbidity and the provincial health care reform, with its focus on rationalizing the existing health care system-supported the idea of integration. The ability to understand how discursive activities of program planners, clinicians, and policy makers contribute to making new ideas deeply embedded in organizational structures can become an important mechanism of effective decision

[Integration of nutritional care into cancer treatment: need for improvement].

PubMed

Joly, Caroline; Jacqueline-Ravel, Nathalie; Pugliesi-Rinaldi, Angela; Bigler-Perrotin, Lucienne; Chikhi, Marinette; Dietrich, Pierre-Yves; Dulguerov, Pavel; Miralbell, Raymond; Picard-Kossovsky, Michel; Seium, Yodit; Thériault, Michel; Pichard, Claude

2011-11-16

Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects.

Treatment Integrity Assessment of a Daily Report Card Intervention: A Preliminary Evaluation of Two Methods and Frequencies

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser; Chafouleas, Sandra M.; O'Keeffe, Breda V.; Kilgus, Stephen P.

2013-01-01

Although intuitively appealing, teacher self-report of treatment integrity is not currently recommended as a method for collecting treatment integrity data. Education researchers have not, however, evaluated features of a treatment integrity self-reporting system that may facilitate accurate self-report. In this preliminary investigation, four…

A close look at an integrative treatment package for Bell's palsy in Korea.

PubMed

Lee, Seung Min Kathy; Lee, Suji; Park, Jun Hyeong; Park, Jongbae J; Lee, Sanghoon

2017-02-01

To provide an overview of the integrative treatment package for Bell's palsy provided at Kyung Hee University Korean Medicine Hospital (KHU KMH). The Facial Palsy Center at KHU KMH has been providing integrative treatment for Bell's palsy patients during the past three decades. Within 72 h of symptom onset, corticosteroids are recommended but complementary treatment including acupuncture and herbal medicine can be used to help suppress inflammation and nerve degeneration. If patients suffer from postauricular pain, pharmacopuncture and cupping is utilized. During the subacute or chronic periods, different acupuncture types are selected accordingly, and herbal medicine and moxibustion helps to improve immune functions and relieve accessory symptoms. Qigong programs are also provided to help relieve facial tension and paralysis. Although rigorous research is warranted, with limited treatment options, we highly suggest that it is worth applying integrative medicine to Bell's palsy patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Treatment of cartilage with beta-aminopropionitrile accelerates subsequent collagen maturation and modulates integrative repair.

PubMed

McGowan, Kevin B; Sah, Robert L

2005-05-01

Integrative repair of cartilage was previously found to depend on collagen synthesis and maturation. beta-aminopropionitrile (BAPN) treatment, which irreversibly blocks lysyl oxidase, inhibited the formation of collagen crosslinks, prevented development of adhesive strength, and caused a buildup of GuHCl-extractable collagen crosslink precursors. This buildup of crosslink precursor in the tissue may be useful for enhancing integrative repair. We tested in vitro the hypothesis that pre-treatment of cartilage with BAPN, followed by washout before implantation, could be a useful therapeutic strategy to accelerate subsequent collagen maturation. In individual cartilage disks, collagen processing was reversibly blocked by BAPN treatment (0.1 mM) as indicated by a BAPN-induced increase in the total and proportion of incorporated radiolabel that was extractable by 4M guanidine-HCl, followed by a decrease, within 3-4 days of BAPN washout, in the proportion of extractable radiolabel to control levels. With a similar pattern, integration between pairs of apposed cartilage blocks was reversibly blocked by BAPN treatment, and followed by an enhancement of integration after BAPN washout. The low and high levels of integration were associated with enrichment in [(3)H]proline in a form that was susceptible and resistant, respectively, to extraction. With increasing duration up to 7 days after BAPN pre-treatment, the levels of [(3)H]proline extraction decreased, and the development of adhesive strength increased. Thus, BAPN can be used to modulate integrative cartilage repair.

Integrating Cognitive Behavioral Therapy and Pharmacotherapy in the Treatment of Adolescent Depression

ERIC Educational Resources Information Center

Ginsburg, Golda S.; Albano, Anne Marie; Findling, Robert L.; Kratochvil, Christopher; Walkup, John

2005-01-01

Recent evidence from the Treatment for Adolescents With Depression Study (TADS) suggests that combining cognitive behavioral and pharmacological treatments holds the most promise for ameliorating depression among adolescents. This article describes lessons learned during the TADS trial about how to integrate these two treatments in the care of…

Factors that Influence Treatment and Non-treatment Decision Making Among Individuals with Inflammatory Bowel Disease: An Integrative Review.

PubMed

Kamp, Kendra J; Brittain, Kelly

2018-06-01

Inflammatory bowel disease (IBD) is a chronic illness with periods of varying disease activity called flares and remissions. Since IBD impacts quality of life, patients make IBD disease management decisions every day. Previous research indicates limited insight about factors that influence decisions regarding disease management and the types of decisions IBD patients make. The purpose of this integrative review is to identify types of treatment and non-treatment decisions and the factors that influence decision making regarding disease management among individuals with IBD. An integrative literature review was performed based on the Whittemore and Knafl framework. PubMed, Web of Science, and PsychINFO were searched for relevant articles, from 2010-2016, using the key terms: decision making, patient preferences, self-management, self-care, nutrition, diet, stress, symptom, Colitis, Crohns, and IBD. Twenty-eight articles met the inclusion criteria. From these, research showed two types of decisions: treatment decisions related to medication and surgery, and non-treatment decisions focused on diet modification. Five themes that influence decisions were identified: experiencing symptoms, provider recommendations, convenience attributes, psychosocial factors, and informational needs. Most of the studies found a positive relationship between an increased number of symptoms and a patient's willingness to engage in treatment decisions. Although support from providers is highly influential for treatment decisions, most studies reported that provider recommendations did not align with patient preferences. Future work is needed to understand factors that influence decisions among recently diagnosed patients, to focus on non-treatment-related decisions, and to clarify the role of psychosocial factors in promoting disease decision making among IBD patients. This integrative review identified that, for patients, experiencing symptoms is the most important factor that influences

Integrated modeling and heat treatment simulation of austempered ductile iron

NASA Astrophysics Data System (ADS)

Hepp, E.; Hurevich, V.; Schäfer, W.

2012-07-01

The integrated modeling and simulation of the casting and heat treatment processes for producing austempered ductile iron (ADI) castings is presented. The focus is on describing different models to simulate the austenitization, quenching and austempering steps during ADI heat treatment. The starting point for the heat treatment simulation is the simulated microstructure after solidification and cooling. The austenitization model considers the transformation of the initial ferrite-pearlite matrix into austenite as well as the dissolution of graphite in austenite to attain a uniform carbon distribution. The quenching model is based on measured CCT diagrams. Measurements have been carried out to obtain these diagrams for different alloys with varying Cu, Ni and Mo contents. The austempering model includes nucleation and growth kinetics of the ADI matrix. The model of ADI nucleation is based on experimental measurements made for varied Cu, Ni, Mo contents and austempering temperatures. The ADI kinetic model uses a diffusion controlled approach to model the growth. The models have been integrated in a tool for casting process simulation. Results are shown for the optimization of the heat treatment process of a planetary carrier casting.

Performance Measurement for Substance Abuse Treatment Services. Integrated Evaluation Methods. Revised.

ERIC Educational Resources Information Center

Harwood, Henrick; Bazron, Barbara; Fountain, Douglas

This paper presents state-of-the-art models addressing issues related to coordination of treatment and evaluation activities, and integration of clinical, performance, and evaluation information. Specifically, this concept paper contains a discussion of the need for and types of cost analyses for CSAT treatment evaluation and knowledge-generating…

Integrating smoking cessation into substance use disorder treatment for military veterans: measurement and treatment engagement efforts.

PubMed

Shealy, Suzanne E; Winn, Jaime L

2014-02-01

Military personnel and veterans smoke at higher rates than the general population, compromising physical performance readiness and health (Committee on Smoking Cessation in Military and Veteran Populations & Institute of Medicine, 2009). While efforts are being made within both the Department of Defense and the Veterans' Administration (VA) hospitals to prevent onset, change the smoking culture, and promote smoking cessation; smoking rates are increasing among combat deployed service members, and smoking rates are particularly high among veterans with mental health and other substance use disorders (McFall, 2006). Recent research supports making smoking cessation widely available and integrated with other forms of care (Gierisch et al., 2012; McFall et al., 2010). This paper describes the efforts of one VA substance use disorder (SUD) treatment program to integrate smoking cessation in routine care, including assessment of tobacco use and motivation and intention to quit via the proposed Nic-BAM assessment. Our team was 100% successful in incorporating the Nic-BAM into our regular assessment of treatment program participants. This suggests that staff members are amenable to assessing for tobacco addiction alongside other substance addictions. Although smoking did not decrease according to the Nic-BAM, an increase in the use of nicotine-replacement products suggests that participants are willing to initiate a quit attempt during SUD treatment. The availability of new evidence-based approaches for integration of tobacco cessation with mental health and SUD treatment may help to enhance programmatic efforts. Environmental changes are needed to fully incorporate tobacco recovery into SUD programming, and additional resources may include peer support specialists. © 2013.

A pragmatic observational feasibility study on integrated treatment for musculoskeletal disorders: Design and protocol.

PubMed

Hu, Xiao-yang; Hughes, John; Fisher, Peter; Lorenc, Ava; Purtell, Rachel; Park, A-La; Robinson, Nicola

2016-02-01

Musculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting. To determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments. This is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment. We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.

Generalizability of Multiple Measures of Treatment Integrity: Comparisons among Direct Observation, Permanent Products, and Self-Report

ERIC Educational Resources Information Center

Gresham, Frank M.; Dart, Evan H.; Collins, Tai A.

2017-01-01

The concept of treatment integrity is an essential component to databased decision making within a response-to-intervention model. Although treatment integrity is a topic receiving increased attention in the school-based intervention literature, relatively few studies have been conducted regarding the technical adequacy of treatment integrity…

Primary healthcare-based integrated care with opioid agonist treatment: First experience from Ukraine.

PubMed

Morozova, Olga; Dvoriak, Sergey; Pykalo, Iryna; Altice, Frederick L

2017-04-01

Ukraine's HIV epidemic is concentrated among people who inject drugs (PWID), however, coverage with opioid agonist therapies (OATs) available mostly at specialty addiction clinics is extremely low. OAT integrated into primary healthcare clinics (PHCs) provides an opportunity for integrating comprehensive healthcare services and scaling up OAT. A pilot study of PHC-based integrated care for drug users conducted in two Ukrainian cities between 2014 and 2016 included three sub-studies: 1) cross-sectional treatment site preference assessment among current OAT patients (N=755); 2) observational cohort of 107 PWID who continued the standard of care versus transition of stabilized and newly enrolled PWID into PHC-based integrated care; and 3) pre/post analysis of attitudes toward PWID and HIV patients by PHC staff (N=26). Among 755 OAT patients, 53.5% preferred receiving OAT at PHCs, which was independently correlated with convenience, trust in physician, and treatment with methadone (vs. buprenorphine). In 107 PWID observed over 6 months, retention in treatment was high: 89% in PWID continuing OAT in specialty addiction treatment settings (standard of care) vs 94% in PWID transitioning to PHCs; and 80% among PWID newly initiating OAT in PHCs. Overall, satisfaction with treatment, subjective self-perception of well-being, and trust in physician significantly increased in patients prescribed OAT in PHCs. Among PHC staff, attitudes towards PWID and HIV patients significantly improved over time. OAT can be successfully integrated into primary care in low and middle-income countries and improves outcomes in both patients and clinicians while potentially scaling-up OAT for PWID. Copyright © 2017 Elsevier B.V. All rights reserved.

Integration of parenting skills education and interventions in addiction treatment.

PubMed

Arria, Amelia M; Mericle, Amy A; Rallo, Deanna; Moe, Jerry; White, William L; Winters, Ken C; O'Connor, Garrett

2013-01-01

Children of parents with substance use disorders are at risk for various adverse outcomes, and maladaptive parenting behaviors seem to be an important mediator of this risk. Although numerous research studies have highlighted the promise of parenting interventions in modifying parenting behavior, very little is known about the integration of parenting skills education and interventions into addiction treatment programs. In this study, a convenience sample of 125 addiction treatment programs in the United States was drawn. A key staff member was interviewed to gather basic information about the extent and nature of parenting skills education and interventions offered at their program. In addition, respondents were asked to rate the importance of parenting skills relative to other addiction treatment priorities. Descriptive analyses revealed that 43% reported some form of parenting classes, but few used a structured curriculum. Given the known beneficial influence of effective parenting practices on reducing adverse childhood outcomes, it is surprising that relatively few substance abuse treatment programs have adopted structured parenting skills interventions as part of their standard service offerings. More research is warranted on the extent to which parenting skills interventions are integrated into the continuum of services available to parents with a substance use disorder.

Hole injection and dielectric breakdown in 6H-SiC and 4H-SiC metal-oxide-semiconductor structures during substrate electron injection via Fowler-Nordheim tunneling

NASA Astrophysics Data System (ADS)

Samanta, Piyas; Mandal, Krishna C.

2015-12-01

Hole injection into silicon dioxide (SiO2) films (8-40 nm thick) is investigated for the first time during substrate electron injection via Fowler-Nordheim (FN) tunneling in n-type 4H- and 6H-SiC (silicon carbide) based metal-oxide-semiconductor (MOS) structures at a wide range of temperatures (T) between 298 and 598 K and oxide electric fields Eox from 6 to 10 MV/cm. Holes are generated in heavily doped n-type polycrystalline silicon (n+ -polySi) gate serving as the anode as well as in the bulk silicon dioxide (SiO2) film via hot-electron initiated band-to-band ionization (BTBI). In absence of oxide trapped charges, it is shown that at a given temperature, the hole injection rates from either of the above two mechanisms are higher in n-4H-SiC MOS devices than those in n-6H-SiC MOS structures when compared at a given Eox and SiO2 thickness (tox). On the other hand, relative to n-4H-SiC devices, n-6H-SiC structures exhibit higher hole injection rates for a given tox during substrate electron injection at a given FN current density je,FN throughout the temperature range studied here. These two observations clearly reveal that the substrate material (n-6H-SiC and n-4H-SiC) dependencies on time-to-breakdown (tBD) or injected charge (electron) to breakdown (QBD) of the SiO2 film depend on the mode of FN injections (constant field/voltage and current) from the substrate which is further verified from the rigorous device simulation as well.

Developing an Integrative Treatment Program for Cancer-Related Fatigue Using Stakeholder Engagement - A Qualitative Study.

PubMed

Canella, Claudia; Mikolasek, Michael; Rostock, Matthias; Beyer, Jörg; Guckenberger, Matthias; Jenewein, Josef; Linka, Esther; Six, Claudia; Stoll, Sarah; Stupp, Roger; Witt, Claudia M

2017-11-01

Although cancer-related fatigue (CRF) has gained increased attention in the past decade, it remains difficult to treat. An integrative approach combining conventional and complementary medicine interventions seems highly promising. Treatment programs are more likely to be effective if the needs and interests of the people involved are well represented. This can be achieved through stakeholder engagement. The aim of the study was to develop an integrative CRF treatment program using stakeholder engagement and to compare it to an expert version. In a qualitative study, a total of 22 stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5 nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a local Swiss Cancer League) were interviewed either face-to-face or in a focus group setting. For data analysis, qualitative content analysis was used. With stakeholder engagement, the integrative CRF treatment program was adapted to usual care using a prioritizing approach and allowing more patient choice. Unlike the expert version, in which all intervention options were on the same level, the stakeholder engagement process resulted in a program with 3 different levels. The first level includes mandatory nonpharmacological interventions, the second includes nonpharmacological choice-based interventions, and the third includes pharmacological interventions for severe CRF. The resulting stakeholder based integrative CRF treatment program was implemented as clinical practice guideline at our clinic (Institute for Complementary and Integrative Medicine, University Hospital Zurich). Through the stakeholder engagement approach, we integrated the needs and preferences of people who are directly affected by CRF. This resulted in an integrative CRF treatment program with graded recommendations for interventions and therefore potentially greater sustainability in a usual care setting.

Integrating play therapy in the treatment of children with obsessive-compulsive disorder.

PubMed

Gold-Steinberg, S; Logan, D

1999-10-01

While behavioral and psychopharmacological approaches are the most effective interventions for treating obsessive-compulsive disorder (OCD), psychodynamically oriented play therapy can enhance the treatment of children with this disorder. Play therapy techniques are useful in addressing treatment resistance, feelings of shame around OCD symptoms, negative self-concept, and issues of psychosocial adjustment. A case study illustrates this integrated approach to treatment.

White matter integrity as a predictor of response to treatment in first episode psychosis.

PubMed

Reis Marques, Tiago; Taylor, Heather; Chaddock, Chris; Dell'acqua, Flavio; Handley, Rowena; Reinders, A A T Simone; Mondelli, Valeria; Bonaccorso, Stefania; Diforti, Marta; Simmons, Andrew; David, Anthony S; Murray, Robin M; Pariante, Carmine M; Kapur, Shitij; Dazzan, Paola

2014-01-01

The integrity of brain white matter connections is central to a patient's ability to respond to pharmacological interventions. This study tested this hypothesis using a specific measure of white matter integrity, and examining its relationship to treatment response using a prospective design in patients within their first episode of psychosis. Diffusion tensor imaging data were acquired in 63 patients with first episode psychosis and 52 healthy control subjects (baseline). Response was assessed after 12 weeks and patients were classified as responders or non-responders according to treatment outcome. At this second time-point, they also underwent a second diffusion tensor imaging scan. Tract-based spatial statistics were used to assess fractional anisotropy as a marker of white matter integrity. At baseline, non-responders showed lower fractional anisotropy than both responders and healthy control subjects (P < 0.05; family-wise error-corrected), mainly in the uncinate, cingulum and corpus callosum, whereas responders were indistinguishable from healthy control subjects. After 12 weeks, there was an increase in fractional anisotropy in both responders and non-responders, positively correlated with antipsychotic exposure. This represents one of the largest, controlled investigations of white matter integrity and response to antipsychotic treatment early in psychosis. These data, together with earlier findings on cortical grey matter, suggest that grey and white matter integrity at the start of treatment is an important moderator of response to antipsychotics. These findings can inform patient stratification to anticipate care needs, and raise the possibility that antipsychotics may restore white matter integrity as part of the therapeutic response.

Borderline Personality Disorder Psychological Treatment: An Integrative Review.

PubMed

Reeves-Dudley, Beverly

2017-02-01

Borderline personality disorder (BPD) is a complex and at times debilitating mental disorder, treatment of which has eluded effective pharmacotherapy (Gunderson, 2007). Although once considered untreatable, psychodynamic therapy and cognitive therapy (two types of psychological therapies) have provided hope for better lives for patients with this diagnosis (Gunderson). The author performed an integrative review of the literature pertaining to the present role of evidence-based practice (EBP) using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) definition of BPD to identify symptoms of the disorder. Thirty-eight peer reviewed articles, mostly quasi-experimental, three meta-analyses, two books, and two national psychiatric guideline websites were reviewed. BPD treatment may be successful with a variety of psychological therapies. Application of empirical studies is only part of BPD treatment considerations. Heterogeneous symptom presentation requires much professional interpersonal interaction and the literature is scant on inductive research for BPD. This review is limited to psychological aspects of BPD treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Adaptive treatment-length optimization in spatiobiologically integrated radiotherapy

NASA Astrophysics Data System (ADS)

Ajdari, Ali; Ghate, Archis; Kim, Minsun

2018-04-01

Recent theoretical research on spatiobiologically integrated radiotherapy has focused on optimization models that adapt fluence-maps to the evolution of tumor state, for example, cell densities, as observed in quantitative functional images acquired over the treatment course. We propose an optimization model that adapts the length of the treatment course as well as the fluence-maps to such imaged tumor state. Specifically, after observing the tumor cell densities at the beginning of a session, the treatment planner solves a group of convex optimization problems to determine an optimal number of remaining treatment sessions, and a corresponding optimal fluence-map for each of these sessions. The objective is to minimize the total number of tumor cells remaining (TNTCR) at the end of this proposed treatment course, subject to upper limits on the biologically effective dose delivered to the organs-at-risk. This fluence-map is administered in future sessions until the next image is available, and then the number of sessions and the fluence-map are re-optimized based on the latest cell density information. We demonstrate via computer simulations on five head-and-neck test cases that such adaptive treatment-length and fluence-map planning reduces the TNTCR and increases the biological effect on the tumor while employing shorter treatment courses, as compared to only adapting fluence-maps and using a pre-determined treatment course length based on one-size-fits-all guidelines.

Is Specialized Integrated Treatment for Comorbid Anxiety, Depression and Alcohol Dependence Better than Treatment as Usual in a Public Hospital Setting?

PubMed

Morley, K C; Baillie, A; Leung, S; Sannibale, C; Teesson, M; Haber, P S

2016-07-01

To assess the effectiveness of a 12 week specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Out of 86 patients meeting the inclusion criteria for alcohol dependence with suspicion of comorbid anxiety and/or depressive disorder, 57 completed a 3-week stabilization period (abstinence or significantly reduced consumption). Of these patients, 37 (65%) met a formal diagnostic assessment of an anxiety and/or depressive disorder and were randomized to either (a) integrated intervention (cognitive behavioural therapy) for alcohol, anxiety and/or depression, or (b) usual counselling care for alcohol problems. Intention-to-treat analyses revealed a beneficial treatment effect of integrated treatment relative to usual counselling care for the number of days to relapse (χ(2) = 6.42, P < 0.05) and lapse (χ(2) = 10.73, P < 0.01). In addition, there was a significant interaction effect of treatment and time for percentage days of abstinence (P < 0.05). For heavy drinking days, the treatment effect was mediated by changes in DASS anxiety (P < 0.05). There were no significant treatment interaction effects for DASS depression or anxiety symptoms. These results provide support for integrated care in improving drinking outcomes for patients with alcohol dependence and comorbid depression/anxiety disorder. ClinicalTrials.gov Identifier: NCT01941693. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Effects of Video Modeling on Treatment Integrity of Behavioral Interventions

ERIC Educational Resources Information Center

DiGennaro-Reed, Florence D.; Codding, Robin; Catania, Cynthia N.; Maguire, Helena

2010-01-01

We examined the effects of individualized video modeling on the accurate implementation of behavioral interventions using a multiple baseline design across 3 teachers. During video modeling, treatment integrity improved above baseline levels; however, teacher performance remained variable. The addition of verbal performance feedback increased…

Integrated treatment approach improves cognitive function in demented and clinically depressed patients.

PubMed

Bragin, Valentin; Chemodanova, Marina; Dzhafarova, Narmina; Bragin, Ilya; Czerniawski, Jennifer L; Aliev, Gjumrakch

2005-01-01

The purpose of this study was to evaluate the efficacy of an integrative treatment approach on cognitive performance. The study sample comprised 35 medically ill patients (20 male, 15 female) with an average age of 71.05, who were diagnosed with mild dementia and depression. These patients were evaluated at baseline and at six, 12, and 24 months of treatment, which included antidepressants (sertraline, citalopram, or venlafaxine XR, alone or in combination with bupropion XR), cholinesterase inhibitors (donepezil, rivastigmine or galantamine), as well as vitamins and supplements (multivitamins, vitamin E, alpha-lipoic acid, omega-3 and coenzyme Q-10). Patients were encouraged to modify their diet and lifestyle and perform mild physical exercises. Results show that the integrative treatment not only protracted cognitive decline for 24 months but even improved cognition, especially memory and frontal lobe functions.

SensInDenT-Noncontact Sensors Integrated Into Dental Treatment Units.

PubMed

Teichmann, Daniel; Teichmann, Maren; Weitz, Philippe; Wolfart, Stefan; Leonhardt, Steffen; Walter, Marian

2017-02-01

This paper presents the first system design (SensInDenT) for noncontact cardiorespiratory monitoring during dental treatment. The system is integrated into a dental treatment unit, and combines sensors based on electromagnetic, optical, and mechanical coupling at different sensor locations. The measurement principles and circuits are described and a system overview is presented. Furthermore, a first proof of concept is provided by taking measurements in healthy volunteers under laboratory conditions.

Integrating substance abuse treatment and criminal justice supervision.

PubMed

Marlowe, Douglas B

2003-08-01

Proponents of a pure public safety perspective on the drug problem hold that drug-involved offenders require consistent and intensive supervision by criminal justice authorities in order to stay off drugs and out of trouble. In contrast, proponents of a thoroughgoing public health perspective commonly argue that clients perform better if they are left alone to develop an effective therapeutic alliance with counselors. Both may be correct, but with respect to different groups of offenders. One approach has shown consistent promise for reducing drug use and criminal recidivism: an integrated public health-public safety strategy that combines community-based drug abuse treatment with ongoing criminal justice supervision. This article presents promising findings from programs implementing this strategy and discusses best treatment practices to meet the needs of both low-risk and high-risk clients.

Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials.

PubMed

Hu, Xiao-Yang; Chen, Ni-Ni; Chai, Qian-Yun; Yang, Guo-Yan; Trevelyan, Esmé; Lorenc, Ava; Liu, Jian-Ping; Robinson, Nicola

2015-10-26

Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP. A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous. Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported. Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).

Integration of chemical and biological treatments for textile industry wastewater: a possible zero-discharge system.

PubMed

Lee, H H; Chen, G; Yue, P L

2001-01-01

Theoretical and experimental studies have established that integrated treatment systems (mostly chemical and biological) for various industrial wastewaters can achieve better quality of treatment and can be cost-effective. In the present study, the objective is to minimize the use of process water in the textile industry by an economical recycle and reuse scheme. The textile wastewater was first characterized in terms of COD, BOD5, salinity and color. In order to recycle such wastewater, the contaminants should be mineralized and/or removed according to the reusable textile water quality standards. Typical results show that this is achievable. An economic analysis has been conducted on the proposed integrated system. The economic analysis shows that the integrated system is economically more attractive than any of the single treatment technologies for achieving the same target of treatment. The information presented in this paper provides a feasible option for the reduction of effluent discharges in the textile industry.

Performance evaluation of integrated solid-liquid wastes treatment technology in palm oil industry

NASA Astrophysics Data System (ADS)

Amelia, J. R.; Suprihatin, S.; Indrasti, N. S.; Hasanudin, U.; Fujie, K.

2017-05-01

The oil palm industry significantly contributes to environmental degradation if without waste management properly. The newest alternative waste management that might be developed is by utilizing the effluent of POME anaerobic digestion with EFB through integrated anaerobic decomposition process. The aim of this research was to examine and evaluate the integrated solid-liquid waste treatment technology in the view point of greenhouse gasses emission, compost, and biogas production. POME was treated in anaerobic digester with loading rate about 1.65 gCOD/L/day. Treated POME with dosis of 15 and 20 L/day was sprayed to the anaerobic digester that was filled of 25 kg of EFB. The results of research showed that after 60 days, the C/N ratio of EFB decreased to 12.67 and 10.96 for dosis of treated POME 15 and 20 L/day, respectively. In case of 60 day decomposition, the integrated waste treatment technology could produce 51.01 and 34.34 m3/Ton FFB which was equivalent with 636,44 and 466,58 kgCO2e/ton FFB for dosis of treated POME 15 and 20 L/day, respectively. The results of research also showed that integrated solid-liquid wastes treatment technology could reduce GHG emission about 421.20 and 251.34 kgCO2e/ton FFB for dosis of treated POME 15 and 20 L/day, respectively.

An integrative treatment approach of a patient with cervical radiculitis: A case report

PubMed Central

Apfelbeck, Leanne

2005-01-01

Abstract Objective To describe a case report of the use of 3 treatment methods for treatment of cervical radiculitis; manual intermittent traction, instrumental chiropractic spinal manipulation, and interferential therapy. Clinical Features A 54-year-old man experienced neck and left arm pain with positive orthopedic tests indicating cervical spinal nerve root involvement; he was diagnosed with cervical radiculitis Intervention and Outcome The patient received 10 treatments over a period of 8 weeks. Instrumental spinal manipulation, manual intermittent traction, and interferential therapy were integrated as a treatment plan for the patient. The patient's condition appeared to resolve. Outcome measures were evaluated at baseline, weeks 3, 5, and 8. Neck Disability Index scores were 32%, 14%, 8%, and 4% respectively, and the Visual Analog Scales were 8.5/10, 2.0/10, 1.0/10, and 0.5/10. The symptoms of cervical radiculitis was resolved in an 8 week period after 10 treatments. Conclusion The integration of instrumental spinal manipulation, manual intermittent traction, and interferential may work well together for patients with similar signs and symptoms as presented in this case. PMID:19674652

A Comparison of Treatment Integrity Assessment Methods for Behavioral Intervention

ERIC Educational Resources Information Center

Koh, Seong A.

2010-01-01

The purpose of this study was to examine the similarity of outcomes from three different treatment integrity (TI) methods, and to identify the method which best corresponded to the assessment of a child's behavior. Six raters were recruited through individual contact via snowball sampling. A modified intervention component list and 19 video clips…

Treatment Integrity Enhancement via Performance Feedback Conceptualized as an Exercise in Social Influence

ERIC Educational Resources Information Center

Erchul, William P.

2013-01-01

This commentary is in response to the article "Effects of Verbal and Written Performance Feedback on Treatment Adherence" (Kaufman, Codding, Markus, Tryon, & Kyse, this issue). The overall recommendation to those who study treatment integrity using performance feedback methods is to incorporate theories and research on social…

Integrated Passive Biological Treatment System/ Mine Waste Technology Program Report #16

EPA Science Inventory

This report summarizes the results of the Mine Waste Technology Program (MWTP) Activity III, Project 16, Integrated, Passive Biological Treatment System, funded by the United States Environmental Protection Agency (EPA) and jointly administered by EPA and the United States Depar...

Integrating Substance Abuse Treatment and Criminal Justice Supervision

PubMed Central

Marlowe, Douglas B.

2003-01-01

Proponents of a pure public safety perspective on the drug problem hold that drug-involved offenders require consistent and intensive supervision by criminal justice authorities in order to stay off drugs and out of trouble. In contrast, proponents of a thoroughgoing public health perspective commonly argue that clients perform better if they are left alone to develop an effective therapeutic alliance with counselors. Both may be correct, but with respect to different groups of offenders. One approach has shown consistent promise for reducing drug use and criminal recidivism: an integrated public health-public safety strategy that combines community-based drug abuse treatment with ongoing criminal justice supervision. This article presents promising findings from programs implementing this strategy and discusses best treatment practices to meet the needs of both low-risk and high-risk clients. PMID:18552716

An innovative integrated oxidation ditch with vertical circle (IODVC) for wastewater treatment.

PubMed

Xia, Shi-bin; Liu, Jun-xin

2004-01-01

The oxidation ditch process is economic and efficient for wastewater treatment, but its application is limited in case where land is costly due to its large land area required. An innovative integrated oxidation ditch with vertical circle (IODVC) system was developed to treat domestic and industrial wastewater aiming to save land area. The new system consists of a single-channel divided into two ditches(the top one and the bottom one by a plate), a brush, and an innovative integral clarifier. Different from the horizontal circle of the conventional oxidation ditch, the flow of IODVC system recycles from the top zone to the bottom zone in the vertical circle as the brush is running, and then the IODVC saved land area required by about 50% compared with a conventional oxidation ditch with an intrachannel clarifier. The innovative integral clarifier is effective for separation of liquid and solids, and is preferably positioned at the opposite end of the brush in the ditch. It does not affect the hydrodynamic characteristics of the mixed liquor in the ditch, and the sludge can automatically return to the down ditch without any pump. In this study, experiments of domestic and dye wastewater treatment were carried out in bench scale and in full scale, respectively. Results clearly showed that the IODVC efficiently removed pollutants in the wastewaters, i.e., the average of COD removals for domestic and dye wastewater treatment were 95% and 90%, respectively, and that the IODVC process may provide a cost effective way for full scale dye wastewater treatment.

Decentralized peri-urban wastewater treatment technologies assessment integrating sustainability indicators.

PubMed

Mena-Ulecia, Karel; Hernández, Heykel Hernández

2015-01-01

Selection of treatment technologies without considering the environmental, economic and social factors associated with each geographical context risks the occurrence of negative impacts that were not properly foreseen, working against the sustainable performance of the technology. The principal aim of this study was to evaluate 12 technologies for decentralized treatment of domestic wastewater applicable to peri-urban communities using sustainability approaches and, at the same time, continuing a discussion about how to address a more integrated assessment of overall sustainability. For this, a set of 13 indicators that embody the environmental, economic and social approach for the overall sustainability assessment were used by means of a target plot diagram as a tool for integrating indicators that represent a holistic analysis of the technologies. The obtained results put forward different degrees of sustainability, which led to the selection of: septic tank+land infiltration; up-flow anaerobic reactor+high rate trickling filter and septic tank+anaerobic filter as the most sustainable and attractive technologies to be applied in peri-urban communities, according to the employed indicators.

An integrated anaerobic digestion and UV photocatalytic treatment of distillery wastewater.

PubMed

Apollo, Seth; Onyango, Maurice S; Ochieng, Aoyi

2013-10-15

Anaerobic up-flow fixed bed reactor and annular photocatalytic reactor were used to study the efficiency of integrated anaerobic digestion (AD) and ultraviolet (UV) photodegradation of real distillery effluent and raw molasses wastewater (MWW). It was found that UV photodegradation as a stand-alone technique achieved colour removal of 54% and 69% for the distillery and MWW, respectively, with a COD reduction of <20% and a negligible BOD reduction. On the other hand, AD as a single treatment technique was found to be effective in COD and BOD reduction with efficiencies of above 75% and 85%, respectively, for both wastewater samples. However, the AD achieved low colour removal efficiency, with an increase in colour intensity of 13% recorded when treating MWW while a colour removal of 51% was achieved for the distillery effluent. The application of UV photodegradation as a pre-treatment method to the AD process reduced the COD removal and biogas production efficiency. However, an integration in which UV photodegradation was employed as a post-treatment to the AD process achieved high COD removal of above 85% for both wastewater samples, and colour removal of 88% for the distillery effluent. Thus, photodegradation can be employed as a post-treatment technique to an AD system treating distillery effluent for complete removal of the biorecalcitrant and colour imparting compounds. Copyright © 2013 Elsevier B.V. All rights reserved.

Implementation of integrated therapies for comorbid post-traumatic stress disorder and substance use disorders in community substance abuse treatment programs.

PubMed

Killeen, Therese K; Back, Sudie E; Brady, Kathleen T

2015-05-01

The high prevalence of trauma and post-traumatic stress disorder (PTSD) in individuals with substance use disorders (SUDs) presents a number of treatment challenges for community treatment providers and programs in the USA. Although several evidence-based, integrated therapies for the treatment of comorbid PTSD/SUD have been developed, rates of utilisation of such practices remain low in community treatment programs. The goal of this article was to review the extant literature on common barriers that prevent adoption and implementation of integrated treatments for PTSD/SUD among substance abuse community treatment programs. Organisational, provider-level and patient-level factors that drive practice decisions were discussed, including organisational philosophy of care policies, funding and resources, as well as provider and patient knowledge and attitudes related to implementation of new integrated treatments for comorbid PTSD and SUD. Understanding and addressing these community treatment challenges may facilitate use of evidence-based integrated treatments for comorbid PTSD and SUD. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment

PubMed Central

Jeffers, Abra; Smith, Mark W.; Chow, Bruce K.; McFall, Miles; Saxon, Andrew J.

2016-01-01

Abstract Introduction: We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD). Methods: Smoking veterans receiving care for PTSD ( N = 943) were randomized to care integrated with smoking cessation versus referral to a smoking cessation clinic. Smoking cessation services, health care cost and utilization, quality of life, and biochemically-verified abstinence from cigarettes were assessed over 18-months of follow-up. Clinical outcomes were combined with literature on changes in smoking status and the effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness over a lifetime horizon. We discounted cost and outcomes at 3% per year and report costs in 2010 US dollars. Results: The mean of smoking cessation services cost was $1286 in those randomized to integrated care and $551 in those receiving standard care ( P < .001). There were no significant differences in the cost of mental health services or other care. After 12 months, prolonged biochemically verified abstinence was observed in 8.9% of those randomized to integrated care and 4.5% of those randomized to standard care ( P = .004). The model projected that Integrated Care added $836 in lifetime cost and generated 0.0259 quality adjusted life years (QALYs), an incremental cost-effectiveness ratio of $32 257 per QALY. It was 86.0% likely to be cost-effective compared to a threshold of $100 000/QALY. Conclusions: Smoking cessation integrated with treatment for PTSD was cost-effective, within a broad confidence region, but less cost-effective than most other smoking cessation programs reported in the literature. PMID:25943761

Integrated forward osmosis-membrane distillation process for human urine treatment.

PubMed

Liu, Qianliang; Liu, Caihong; Zhao, Lei; Ma, Weichao; Liu, Huiling; Ma, Jun

2016-03-15

This study demonstrated a forward osmosis-membrane distillation (FO-MD) hybrid system for real human urine treatment. A series of NaCl solutions at different concentrations were adopted for draw solutions in FO process, which were also the feed solutions of MD process. To establish a stable and continuous integrated FO-MD system, individual FO process with different NaCl concentrations and individual direct contact membrane distillation (DCMD) process with different feed temperatures were firstly investigated separately. Four stable equilibrium conditions were obtained from matching the water transfer rates of individual FO and MD processes. It was found that the integrated system is stable and sustainable when the water transfer rate of FO subsystem is equal to that of MD subsystem. The rejections to main contaminants in human urine were also investigated. Although individual FO process had relatively high rejection to Total Organic Carbon (TOC), Total Nitrogen (TN) and Ammonium Nitrogen (NH4(+)-N) in human urine, these contaminants could also accumulate in draw solution after long term performance. The MD process provided an effective rejection to contaminants in draw solution after FO process and the integrated system revealed nearly complete rejection to TOC, TN and NH4(+)-N. This work provided a potential treatment process for human urine in some fields such as water regeneration in space station and water or nutrient recovery from source-separated urine. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrating Art into Group Treatment for Adults with Post-Traumatic Stress Disorder from Childhood Sexual Abuse: A Pilot Study

ERIC Educational Resources Information Center

Becker, Carol-Lynne J.

2015-01-01

Current research supports the use of exposure-based treatments for posttraumatic stress disorder (PTSD) and integrated treatments show potential for enhanced symptom reduction. This pilot study developed a manualized group treatment integrating art interventions with exposure, grounding, and narrative therapy for five adults with PTSD who were…

An investigation of multidisciplinary complex health care interventions - steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

PubMed Central

2012-01-01

Background The Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004–2010 at a specialized Multiple Sclerosis (MS) hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model. Discussion The collaborative work towards an integrative treatment model for people with MS, involved six steps: 1) Working with an initial model 2) Unfolding the different treatment philosophies 3) Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme) 4) Phrasing the common assumptions for an integrative MS program theory 5) Developing the integrative MS program theory 6) Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment. Summary An integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients’ resources and competences on a physical, an emotional and a cognitive level. PMID:22524586

What the patient wants: Addressing patients' treatment targets in an integrative group psychotherapy programme.

PubMed

Kealy, David; Joyce, Anthony S; Weber, Rainer; Ehrenthal, Johannes C; Ogrodniczuk, John S

2018-02-13

Limited empirical attention has been devoted to individualized treatment objectives in intensive group therapy for personality dysfunction. This study investigated patients' ratings of distress associated with individual therapy goals - referred to as target object severity - in an intensive Evening Treatment Programme for patients with personality dysfunction. Change in target objective severity was examined in a sample of 81 patients who completed treatment in an intensive, integrative group therapy programme. Correlation and regression analyses were used to examine associations between change in target object severity and patients' pre-treatment diagnosis, symptom distress, and treatment outcome expectancy, and between change in target objective severity and patients' ratings of group therapy process (group climate, therapeutic alliance, group cohesion). The relationship between change in target objective severity and longer-range life satisfaction was also examined in a subsample of patients who rated life satisfaction at follow-up. While change in target objective severity was not significantly related to pre-treatment variables, significant associations were found with several aspects of group therapy process. Patients' experience of a highly engaged group climate was uniquely associated with improvement in target object severity. Such improvement was significantly related to longer-term life satisfaction after controlling for general symptom change. The working atmosphere in group therapy contributes to patients' progress regarding individual treatment targets, and such progress is an important factor in later satisfaction. Attention to individualized treatment targets deserves further clinical and research attention in the context of integrative group therapy for personality dysfunction. This study found that patients attending an integrative group treatment programme for personality dysfunction experienced significant improvement in severity of distress

Integrated Psychosocial and Opioid-Antagonist Treatment for Alcohol Dependence: A Systematic Review of Controlled Evaluations

ERIC Educational Resources Information Center

Vaughn, Michael G.; Howard, Matthew O.

2004-01-01

Methodological characteristics and outcomes of 14 controlled clinical investigations of integrated psychosocial and opioid-antagonist alcohol dependence treatment were evaluated. The 14 studies were identified through computerized bibliographic and manual literature searches. Clients receiving integrated psychosocial and opioid-antagonist…

A Comparison of Performance Feedback Procedures on Teachers' Treatment Implementation Integrity and Students' Inappropriate Behavior in Special Education Classrooms

PubMed Central

DiGennaro, Florence D; Martens, Brian K; Kleinmann, Ava E

2007-01-01

This study examined the extent to which treatment integrity of 4 special education teachers was affected by goal setting, performance feedback regarding student or teacher performance, and a meeting cancellation contingency. Teachers were trained to implement function-based treatment packages to address student problem behavior. In one condition, teachers set a goal for student behavior and received daily written feedback about student performance. In a second condition, teachers received daily written feedback about student performance as well as their own accuracy in implementing the intervention and would be able to avoid meeting with a consultant to practice missed steps by implementing the intervention with 100% integrity. This latter package increased treatment integrity the most above baseline levels. Higher levels of treatment integrity were significantly correlated with lower levels of student problem behavior for 3 of the 4 teacher–student dyads. Three of the 4 teachers also rated both feedback procedures as highly acceptable. Implications for increasing and maintaining treatment integrity by teachers via a consultation model are discussed. PMID:17970259

Evaluating an Integrated Support Model for Increasing Treatment Plan Implementation Following Consultation in Schools

ERIC Educational Resources Information Center

Noell, George H.; Volz, Jennifer R.; Henderson, Marie Y.; Williams, Kashunda L.

2017-01-01

This study examined the percentage of steps implemented from treatment plans following consultation with teachers. Interventions were implemented for 39 elementary school students referred for consultation and treatment for challenging behavior or academic deficits. An integrated support model that included antecedent social influence and planning…

Automated radiotherapy treatment plan integrity verification

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

Yang Deshan; Moore, Kevin L.

2012-03-15

Purpose: In our clinic, physicists spend from 15 to 60 min to verify the physical and dosimetric integrity of radiotherapy plans before presentation to radiation oncology physicians for approval. The purpose of this study was to design and implement a framework to automate as many elements of this quality control (QC) step as possible. Methods: A comprehensive computer application was developed to carry out a majority of these verification tasks in the Philips PINNACLE treatment planning system (TPS). This QC tool functions based on both PINNACLE scripting elements and PERL sub-routines. The core of this technique is the method ofmore » dynamic scripting, which involves a PERL programming module that is flexible and powerful for treatment plan data handling. Run-time plan data are collected, saved into temporary files, and analyzed against standard values and predefined logical rules. The results were summarized in a hypertext markup language (HTML) report that is displayed to the user. Results: This tool has been in clinical use for over a year. The occurrence frequency of technical problems, which would cause delays and suboptimal plans, has been reduced since clinical implementation. Conclusions: In addition to drastically reducing the set of human-driven logical comparisons, this QC tool also accomplished some tasks that are otherwise either quite laborious or impractical for humans to verify, e.g., identifying conflicts amongst IMRT optimization objectives.« less

Evaluating integrated strategies for robust treatment of high saline piggery wastewater.

PubMed

Kim, Hyun-Chul; Choi, Wook Jin; Chae, A Na; Park, Joonhong; Kim, Hyung Joo; Song, Kyung Guen

2016-02-01

In this study, we integrated physicochemical and biological strategies for the robust treatment of piggery effluent in which high levels of organic constituents, inorganic nutrients, color, and salts remained. Piggery effluent that was stabilized in an anaerobic digester was sequentially coagulated, micro-filtered, and air-stripped prior to biological treatment with mixotrophic algal species that showed tolerance to high salinity (up to 4.8% as Cl(-)). The algae treatment was conducted with continuous O2 supplementation instead of using the combination of high lighting and CO2 injection. The microalga Scenedesmus quadricauda employed as a bio-agent was capable of assimilating both nitrogen (222 mg N g cell(-1) d(-1)) and phosphorus (9.3 mg P g cell(-1) d(-1)) and utilizing dissolved organics (2053 mg COD g cell(-1) d(-1)) as a carbon source in a single treatment process under the heterotrophic growth conditions. The heterotrophic growth of S. quadricauda proceeded rapidly by directly incorporating organic substrate in the oxidative assimilation process, which coincided with the high productivity of algal biomass, accounting for 2.4 g cell L(-1) d(-1). The algae-treated wastewater was subsequently ozonated to comply with discharge permits that limit color in the effluent, which also resulted in improved biodegradability of residual organics. The integrated treatment scheme proposed in this study also achieved 89% removal of COD, 88% removal of TN, and 60% removal of TP. The advantage of using the hybrid configuration suggests that this would be a promising strategy in full-scale treatment facilities for piggery effluent. Copyright © 2015 Elsevier Ltd. All rights reserved.

Treatment integrity of school-based interventions with children in the journal of applied behavior analysis 1991-2005.

PubMed

McIntyre, Laura Lee; Gresham, Frank M; DiGennaro, Florence D; Reed, Derek D

2007-01-01

We reviewed all school-based experimental studies with individuals 0 to 18 years published in the Journal of Applied Behavior Analysis (JABA) between 1991 and 2005. A total of 142 articles (152 studies) that met review criteria were included. Nearly all (95%) of these experiments provided an operational definition of the independent variable, but only 30% of the studies provided treatment integrity data. Nearly half of studies (45%) were judged to be at high risk for treatment inaccuracies. Treatment integrity data were more likely to be included in studies that used teachers, multiple treatment agents, or both. Although there was a substantial increase in reporting operational definitions of independent variables, results suggest that there was only a modest improvement in reported integrity over the past 30 years of JABA studies. Recommendations for research and practice are discussed.

Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment.

PubMed

Barnett, Paul G; Jeffers, Abra; Smith, Mark W; Chow, Bruce K; McFall, Miles; Saxon, Andrew J

2016-03-01

We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD). Smoking veterans receiving care for PTSD (N = 943) were randomized to care integrated with smoking cessation versus referral to a smoking cessation clinic. Smoking cessation services, health care cost and utilization, quality of life, and biochemically-verified abstinence from cigarettes were assessed over 18-months of follow-up. Clinical outcomes were combined with literature on changes in smoking status and the effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness over a lifetime horizon. We discounted cost and outcomes at 3% per year and report costs in 2010 US dollars. The mean of smoking cessation services cost was $1286 in those randomized to integrated care and $551 in those receiving standard care (P < .001). There were no significant differences in the cost of mental health services or other care. After 12 months, prolonged biochemically verified abstinence was observed in 8.9% of those randomized to integrated care and 4.5% of those randomized to standard care (P = .004). The model projected that Integrated Care added $836 in lifetime cost and generated 0.0259 quality adjusted life years (QALYs), an incremental cost-effectiveness ratio of $32 257 per QALY. It was 86.0% likely to be cost-effective compared to a threshold of $100 000/QALY. Smoking cessation integrated with treatment for PTSD was cost-effective, within a broad confidence region, but less cost-effective than most other smoking cessation programs reported in the literature. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Effects of integrated trauma treatment on outcomes in a racially/ethnically diverse sample of women in urban community-based substance abuse treatment.

PubMed

Amaro, Hortensia; Dai, Jianyu; Arévalo, Sandra; Acevedo, Andrea; Matsumoto, Atsushi; Nieves, Rita; Prado, Guillermo

2007-07-01

This study presents findings from a quasiexperimental, nonequivalent, group-design study with repeated measures that explored the effects of integrated trauma-informed services on the severity of substance abuse, mental health, posttraumatic stress disorder (PTSD) symptomatology among women with histories of trauma in urban, community-based substance abuse treatment. The study also explored if the model of integrated services was equally beneficial for women of various racial/ethnic groups. Participants in the study were 342 women receiving substance abuse treatment in intervention and comparison sites. Results indicated that at 6 and 12 month follow-ups, those in the trauma-informed intervention group, in contrast to the comparison group, had significantly better outcomes in drug abstinence rates in the past 30 days as well as in mental health and PTSD symptomatology. Results also showed that, overall, integrated services were beneficial for women across the different racial/ethnic groups in substance abuse treatment, although some differences appear to exist across racial/ethnic groups in improving addiction severity and mental health and PTSD symptomatology.

Effects of Integrated Trauma Treatment on Outcomes in a Racially/Ethnically Diverse Sample of Women in Urban Community-based Substance Abuse Treatment

PubMed Central

Dai, Jianyu; Arévalo, Sandra; Acevedo, Andrea; Matsumoto, Atsushi; Nieves, Rita; Prado, Guillermo

2007-01-01

This study presents findings from a quasiexperimental, nonequivalent, group-design study with repeated measures that explored the effects of integrated trauma-informed services on the severity of substance abuse, mental health, posttraumatic stress disorder (PTSD) symptomatology among women with histories of trauma in urban, community-based substance abuse treatment. The study also explored if the model of integrated services was equally beneficial for women of various racial/ethnic groups. Participants in the study were 342 women receiving substance abuse treatment in intervention and comparison sites. Results indicated that at 6 and 12 month follow-ups, those in the trauma-informed intervention group, in contrast to the comparison group, had significantly better outcomes in drug abstinence rates in the past 30 days as well as in mental health and PTSD symptomatology. Results also showed that, overall, integrated services were beneficial for women across the different racial/ethnic groups in substance abuse treatment, although some differences appear to exist across racial/ethnic groups in improving addiction severity and mental health and PTSD symptomatology. PMID:17356904

The Effect of Sensory Integration Treatment on Children with Multiple Disabilities.

ERIC Educational Resources Information Center

Din, Feng S.; Lodato, Donna M.

Six children with multiple disabilities (ages 5 to 8) participated in this evaluation of the effect of sensory integration treatment on sensorimotor function and academic learning. The children had cognitive abilities ranging from sub-average to significantly sub-average, three were non-ambulatory, one had severe behavioral problems, and each…

Clinical practice guidelines on the evidence-based use of integrative therapies during and following breast cancer treatment

PubMed Central

Greenlee, Heather; DuPont-Reyes, Melissa J.; Balneaves, Lynda G.; Carlson, Linda E.; Cohen, Misha R.; Deng, Gary; Johnson, Jillian A.; Mumber, Matthew; Seely, Dugald; Zick, Suzanna; Boyce, Lindsay; Tripathy, Debu

2018-01-01

Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. PMID:28436999

Treatment Integrity of Elaborated Semantic Feature Analysis Aphasia Therapy Delivered in Individual and Group Settings

ERIC Educational Resources Information Center

Kladouchou, Vasiliki; Papathanasiou, Ilias; Efstratiadou, Eva A.; Christaki, Vasiliki; Hilari, Katerina

2017-01-01

Background & Aims: This study ran within the framework of the Thales Aphasia Project that investigated the efficacy of elaborated semantic feature analysis (ESFA). We evaluated the treatment integrity (TI) of ESFA, i.e., the degree to which therapists implemented treatment as intended by the treatment protocol, in two different formats:…

Fidelity and outcomes in six integrated dual disorders treatment programs.

PubMed

Chandler, Daniel W

2011-02-01

Fidelity scores and outcomes were measured in six outpatient programs in California which implemented Integrated Dual Disorders Treatment (IDDT). Outcomes were measured for 1 year in four sites and 2 years in two sites; fidelity was assessed at 6 month intervals. Three of the six sites achieved high fidelity (at least a 4 on a 5 point fidelity scale) and three moderate fidelity (at least a 3). Retention in treatment, mental health functioning, stage of substance abuse treatment, abstinence, and psychiatric hospitalization were measured. Outcomes for individual programs were generally positive but not consistent within programs or across programs. Using pooled data in a longitudinal regression model with random effects at person level and adjustment of standard errors for clustering by site, change over time was not statistically significant for the primary outcomes. Fidelity scores had limited association with positive outcomes.

Improving proton therapy accessibility through seamless electronic integration of remote treatment planning sites.

PubMed

Belard, Arnaud; Dolney, Derek; Zelig, Tochner; McDonough, James; O'Connell, John

2011-06-01

Proton radiotherapy is a relatively scarce treatment modality in radiation oncology, with only nine centers currently operating in the United States. Funded by Public Law 107-248, the University of Pennsylvania and the Walter Reed Army Medical Center have developed a remote proton radiation therapy solution with the goals of improving access to proton radiation therapy for Department of Defense (DoD) beneficiaries while minimizing treatment delays and time spent away from home/work (time savings of up to 3 weeks per patient). To meet both Health Insurance Portability and Accountability Act guidelines and the more stringent security restrictions imposed by the DoD, our program developed a hybrid remote proton radiation therapy solution merging a CITRIX server with a JITIC-certified (Joint Interoperability Test Command) desktop videoconferencing unit. This conduit, thoroughly tested over a period of 6 months, integrates both institutions' radiation oncology treatment planning infrastructures into a single entity for DoD patients' treatment planning and delivery. This telemedicine solution enables DoD radiation oncologists and medical physicists the ability to (1) remotely access a proton therapy treatment planning platform, (2) transfer patient plans securely to the University of Pennsylvania patient database, and (3) initiate ad-hoc point-to-point and multipoint videoconferences to dynamically optimize and validate treatment plans. Our robust and secure remote treatment planning solution grants DoD patients not only access to a state-of-the-art treatment modality, but also participation in the treatment planning process by Walter Reed Army Medical Center radiation oncologists and medical physicists. This telemedicine system has the potential to lead to a greater integration of military treatment facilities and/or satellite clinics into regional proton therapy centers.

Integrated Educational and Mental Health Services within a Day Treatment Setting.

ERIC Educational Resources Information Center

Francis, Greta; Radka, Dale F.

This paper discusses the integration of educational and mental health services for children and adolescents within a psychiatric day treatment setting at the Bradley School housed in a private psychiatric hospital affiliated with Brown University in Rhode Island. A full range of mental health services are used, and therapies are delivered in the…

Assessing Treatment Integrity in Acceptance and Commitment Therapy: Strategies and Suggestions

ERIC Educational Resources Information Center

Plumb, Jennifer C.; Vilardaga, Roger

2010-01-01

In this paper, we briefly review the current literature on treatment integrity and discuss the relevance of this procedure for detecting, measuring and ensuring that the proposed mechanisms of change in cognitive behavior therapy, in this case of acceptance and commitment therapy (ACT; S.C. Hayes, Strosahl, & Wilson, 1999), take place. We discuss…

Integrating Antiretroviral Strategies for Human Immunodeficiency Virus Prevention: Post- and Pre-Exposure Prophylaxis and Early Treatment.

PubMed

Grant, Robert M; Smith, Dawn K

2015-12-01

Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment of HIV infection. We reviewed research evidence and current normative guidelines to identify best practices for integrating these high-impact prevention strategies. More sensitive HIV tests used for screening enable earlier diagnosis and treatment of HIV infection, more appropriate counseling, and help limit drug resistance. A fully suppressive PEP regimen should be initiated based on exposure history or physical findings when sensitive diagnostic testing is delayed or not available and antibody tests are negative. Transitions from PEP to PrEP are often warranted because HIV exposure events may continue to occur. This algorithmic approach to integrating PEP, PrEP, and early treatment decisions may increase the uptake of these interventions by a greater number and diversity of knowledgeable healthcare providers.

Integrating Antiretroviral Strategies for Human Immunodeficiency Virus Prevention: Post- and Pre-Exposure Prophylaxis and Early Treatment

PubMed Central

Grant, Robert M.; Smith, Dawn K.

2015-01-01

Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment of HIV infection. We reviewed research evidence and current normative guidelines to identify best practices for integrating these high-impact prevention strategies. More sensitive HIV tests used for screening enable earlier diagnosis and treatment of HIV infection, more appropriate counseling, and help limit drug resistance. A fully suppressive PEP regimen should be initiated based on exposure history or physical findings when sensitive diagnostic testing is delayed or not available and antibody tests are negative. Transitions from PEP to PrEP are often warranted because HIV exposure events may continue to occur. This algorithmic approach to integrating PEP, PrEP, and early treatment decisions may increase the uptake of these interventions by a greater number and diversity of knowledgeable healthcare providers. PMID:26512356

Surface characteristics of bioactive Ti fabricated by chemical treatment for cartilaginous-integration.

PubMed

Miyajima, Hiroyuki; Ozer, Fusun; Imazato, Satoshi; Mante, Francis K

2017-09-01

Artificial hip joints are generally expected to fail due to wear after approximately 15years and then have to be replaced by revision surgery. If articular cartilage can be integrated onto the articular surfaces of artificial joints in the same way as osseo-integration of titanium dental implants, the wear of joint implants may be reduced or prevented. However, very few studies have focused on the relationship between Ti surface and cartilage. To explore the possibility of cartilaginous-integration, we fabricated chemically treated Ti surfaces with H 2 O 2 /HCl, collagen type II and SBF, respectively. Then, we evaluated surface characteristics of the prepared Ti samples and assessed the cartilage formation by culturing chondrocytes on the Ti samples. When oxidized Ti was immersed in SBF for 7days, apatite was formed on the Ti surface. The surface characteristics of Ti indicated that the wettability was increased by all chemical treatments compared to untreated Ti, and that H 2 O 2 /HCl treated surface had significantly higher roughness compared to the other three groups. Chondrocytes produced significantly more cartilage matrix on all chemically treated Ti surfaces compared to untreated Ti. Thus, to realize cartilaginous-integration and to prevent wear of the implants in joints, application of bioactive Ti formed by chemical treatment would be a promising and effective strategy to improve durability of joint replacement. Copyright © 2017 Elsevier B.V. All rights reserved.

Challenges in treatment of posttraumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture-sensitive perspectives

PubMed Central

Drožđek, Boris

2015-01-01

Background Research shows that trauma-focused therapy and multimodal interventions are the two most often used strategies in treatment of refugees suffering from posttraumatic stress disorder (PTSD). While preliminary evidence suggests that trauma-focused approaches may have some efficacy, this could not be established for multimodal interventions. However, it may be that multimodal interventions have been studied in more treatment-resistant refugees with very high levels of psychopathology, disability, and chronicity. In the past decades, various models for understanding of the complex relationship between mental health problems and well-being have emerged. They aim at framing mental health problems in individualized, contextual, epigenetic, and culturally sensitive ways, and may be useful in tailoring content and timing of multimodal interventions. Objective To draw clinicians’ attention to the possibility of using the Integrative Contextual Model for understanding and assessment of posttrauma mental health sequelae while tailoring multimodal interventions; to present a possible way of combining multimodal with evidence-based trauma-focused approaches; and to improve the understanding and treatment of PTSD and other mental health problems in refugee survivors of prolonged and repeated trauma. Method Based on literature, clinical experience, and presentation of a fictional case, the use of the Integrative Contextual Model in tailoring the treatment of severe PTSD in a refugee patient is presented and discussed. Results The Integrative Contextual Model for understanding and assessing factors, which may play a role in causing and maintaining of PTSD and comorbidity in refugees, may help tailoring of multimodal interventions. These interventions can be combined with evidence-based trauma-focused treatments. Conclusion The field of refugee mental health intervention and clinical practice with traumatized refugees may be enriched with the use of contextual and

Integrative Therapies in Anxiety Treatment with Special Emphasis on the Gut Microbiome.

PubMed

Schnorr, Stephanie L; Bachner, Harriet A

2016-09-01

Over the past decade, research has shown that diet and gut health affects symptoms expressed in stress related disorders, depression, and anxiety through changes in the gut microbiota. Psycho-behavioral function and somatic health interaction have often been ignored in health care with resulting deficits in treatment quality and outcomes. While mental health care requires the professional training in counseling, psychotherapy and psychiatry, complimentary therapeutic strategies, such as attention to a nutritional and diverse diet and supplementation of probiotic foods, may be integrated alongside psychotherapy treatment models. Development of these alternative strategies is predicated on experimental evidence and diligent research on the biology of stress, fear, anxiety-related behaviors, and the gut-brain connection. This article provides a brief overview on biological markers of anxiety and the expanding nutritional literature relating to brain health and mental disorders. A case study demonstrates an example of a biopsychosocial approach integrating cognitive psychotherapy, dietary changes, and mindfulness activities, in treating symptoms of anxiety. This case study shows a possible treatment protocol to explore the efficacy of targeting the gut-brain-axis that may be used as an impetus for future controlled studies.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

PubMed

Greenlee, Heather; DuPont-Reyes, Melissa J; Balneaves, Lynda G; Carlson, Linda E; Cohen, Misha R; Deng, Gary; Johnson, Jillian A; Mumber, Matthew; Seely, Dugald; Zick, Suzanna M; Boyce, Lindsay M; Tripathy, Debu

2017-05-06

Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society. © 2017 American Cancer Society.

Integrated Specialized Early-Course Psychosis Treatment Services - University Psychiatric Hospital Vrapce Model.

PubMed

Ostojić, DraŽenka; Čulo, Ilaria; Silić, Ante; Kos, Suzana; Savić, Aleksandar

2018-06-01

First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

Advantages, Disadvantages, and Trend of Integrative Medicine in the Treatment of Heart Failure.

PubMed

Zhang, PeiYing

2015-06-01

Integrative medicine therapy using traditional Chinese medicine (TCM) combined with western medicine has shown some advantages in treating heart failure (HF), such as holistic concept; multi-target treatment; dialectical logic; personalized therapy; formulae compatibility; and reduction of side effects of western medicine. However, problems still exist in TCM treatment of HF, including non-uniformed categorization of TCM, lack of standardized syndrome differentiation and lack of an evidence base. The future of treatment of HF seems to be focused on reversing ventricular remodeling, improving cardiac rehabilitation, and accelerating experimental research and drug discovery in TCM.

[Integrated intensive treatment of tinnitus: method and initial results].

PubMed

Mazurek, B; Georgiewa, P; Seydel, C; Haupt, H; Scherer, H; Klapp, B F; Reisshauer, A

2005-07-01

In recent years, no major advances have been made in understanding the mechanisms underlying the development of tinnitus. Hence, the present therapeutic strategies aim at decoupling the subconscious from the perception of tinnitus. Mindful of the lessons drawn from existing tinnitus retraining and desensitisation therapies, a new integrated day hospital strategy of treatment lasting 7-14 days has been developed at the Charité Hospital and is presented in the present paper. The strategy for treating tinnitus in the proximity of patient domicile is designed for patients who feel disturbed in their world of perception and their efficiency due to tinnitus and give evidence of mental and physical strain. In view of the etiologically non-uniform and multiple events connected with tinnitus, consideration was also given to the fact that somatic and psychosocial factors are equally involved. Therefore, therapy should aim at diagnosing and therapeutically influencing those psychosocial factors that reduce the hearing impression to such an extent that the affected persons suffer from strain. The first results of therapy-dependent changes of 46 patients suffering from chronic tinnitus are presented. The data were evaluated before and after 7 days of treatment and 6 months after the end of treatment. Immediately after the treatment, the scores of both the tinnitus questionnaire (Goebel and Hiller) and the subscales improved significantly. These results were maintained during the 6-month post-treatment period and even improved.

Integrating modern dermatology and Ayurveda in the treatment of vitiligo and lymphedema in India.

PubMed

Narahari, Saravu R; Ryan, Terence J; Bose, Kuthaje S; Prasanna, Kodimoole S; Aggithaya, Guruprasad M

2011-03-01

Globally, governments have recognized the growing popularity of Complementary and Alternative Medicines and the possibility of their combined use with biomedicine. Decisions within the Government of India have led to a conducive environment for conducting clinical studies, to achieve integration of more than one system of medicine, so that their combined benefits can be brought to bear on chronic, difficult-to-treat conditions. To develop integrative dermatology treatment protocols for patients with long-standing skin diseases who have received treatment from many centers. A team of doctors from modern dermatology, Ayurveda, yoga therapy, and homeopathy studied recruited patients to develop mutual orientation on each therapeutic system and a working knowledge of approach to their clinical diagnosis. Six-hundred thirty-eight patients affected by lower limb lymphedema requiring skin care as a major part of treatment were treated integrating modern dermatology and Ayurveda. Three-hundred eighty-one vitiligo patients were examined and treated to understand the clinical presentations and treatment options in Ayurveda. A two-step cluster analysis performed by SPSS Version 16 showed average volume reductions of 13.3% and 23% on day 14, 19.7% and 31.1% on day 45, and 23.4% and 39.7% on day 90 of treatment in small and large lymphedematous limbs. Inflammatory episodes before the onset on this treatment was reported by 79.5% of our lymphedema patients, and 9.4% reported this at the end of three months after our treatment. Among vitiligo patients, we found that 39.6% of patients had kapha, 39.8% pitta, 10.8% had vatha and 0.52% has tridoshaja presentation. There are over 100 treatment options available in Ayurveda to treat vitiligo. Each system of medicine recognizes the same disease albeit with minor difference in description. Skin care procedures like washing and emollients restore the barrier function and skin health. We have converged Ayurvedic skin care with that of

Collaborative behavioral management: integration and intensification of parole and outpatient addiction treatment services in the Step’n Out study

PubMed Central

Rhodes, Anne G.; Taxman, Faye S.

2009-01-01

Integration of community parole and addiction treatment holds promise for optimizing the participation of drug-involved parolees in re-entry services, but intensification of services might yield greater rates of technical violations. Collaborative behavioral management (CBM) integrates the roles of parole officers and treatment counselors to provide role induction counseling, contract for pro-social behavior, and to deliver contingent reinforcement of behaviors consistent with contracted objectives. Attendance at both parole and addiction treatment are specifically reinforced. The Step’n Out study of the Criminal Justice–Drug Abuse Treatment Studies (CJ-DATS) randomly allocated 486 drug-involved parolees to either collaborative behavioral management or traditional parole with 3-month and 9-month follow-up. Bivariate and multivariate regression models found that, in the first 3 months, the CBM group had more parole sessions, face-to-face parole sessions, days on which parole and treatment occurred on the same day, treatment utilization and individual counseling, without an increase in parole violations. We conclude that CBM integrated parole and treatment as planned, and intensified parolees’ utilization of these services, without increasing violations. PMID:19960114

Longitudinal effects of integrated treatment on alcohol use for persons with serious mental illness and substance use disorders.

PubMed

Herman, S E; Frank, K A; Mowbray, C T; Ribisl, K M; Davidson, W S; BootsMiller, B; Jordan, L; Greenfield, A L; Loveland, D; Luke, D A

2000-08-01

A randomized experimental design was used to assign participants to an integrated mental health and substance use treatment program or to standard hospital treatment. A multilevel, nonlinear model was used to estimate hospital treatment effects on days of alcohol use for persons with serious mental illness and substance use disorders over 18 months. The integrated treatment program had a significant effect on the rate of alcohol use at 2 months postdischarge, reducing the rate of use by 54%. Motivation for sobriety at hospital discharge, posttreatment self-help attendance, and social support for sobriety were also found to reduce the rate of use during the follow-up period. Implications for mental health treatment and aftercare support are discussed.

Integrating algaculture into small wastewater treatment plants: process flow options and life cycle impacts.

PubMed

Steele, Muriel M; Anctil, Annick; Ladner, David A

2014-05-01

Algaculture has the potential to be a sustainable option for nutrient removal at wastewater treatment plants. The purpose of this study was to compare the environmental impacts of three likely algaculture integration strategies to a conventional nutrient removal strategy. Process modeling was used to determine life cycle inventory data and a comparative life cycle assessment was used to determine environmental impacts. Treatment scenarios included a base case treatment plant without nutrient removal, a plant with conventional nutrient removal, and three other cases with algal unit processes placed at the head of the plant, in a side stream, and at the end of the plant, respectively. Impact categories included eutrophication, global warming, ecotoxicity, and primary energy demand. Integrating algaculture prior to activated sludge proved to be most beneficial of the scenarios considered for all impact categories; however, this scenario would also require primary sedimentation and impacts of that unit process should be considered for implementation of such a system.

[An integrated model for examination of aphasic patients and evaluation of treatment results].

PubMed

Ansink, B J; Vanneste, J A; Endtz, L J

1980-02-01

This article is an overview of the literature on integrated, multidisciplinar examination of aphasic patients, its consequences for treatment and the evaluation of the results thereof; the need of virtually standardized methods of investigation for each language is stressed.

Primary Prevention Programs at the Elementary Level: Issues of Treatment Integrity, Systematic Screening, and Reinforcement

ERIC Educational Resources Information Center

Lane, Kathleen Lynne; Kalberg, Jemma Robertson; Bruhn, Allison Leigh; Mahoney, Michelle E.; Driscoll, Steven A.

2008-01-01

This study examined issues of treatment integrity, systematic screenings, and access to reinforcement relative to school-wide positive behavior support programs (SW-PBS) implemented in two rural elementary schools during the first year of program implementation. Results suggested that treatment fidelity, as measured by self-report and direct…

Increasing Treatment Integrity through Negative Reinforcement: Effects on Teacher and Student Behavior

ERIC Educational Resources Information Center

DiGennaro, Florence D.; Martens, Brian K.; McIntyre, Laura Lee

2005-01-01

The current study examined the extent to which treatment integrity was increased and maintained for 4 teachers in their regular classroom settings as a result of performance feedback and negative reinforcement. Teachers received daily written feedback about their accuracy in implementing an intervention and were able to avoid meeting with a…

Non-communicable diseases and HIV care and treatment: models of integrated service delivery.

PubMed

Duffy, Malia; Ojikutu, Bisola; Andrian, Soa; Sohng, Elaine; Minior, Thomas; Hirschhorn, Lisa R

2017-08-01

Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients. © 2017 John Wiley & Sons Ltd.

Quality-of-life outcomes in patients with gynecologic cancer referred to integrative oncology treatment during chemotherapy.

PubMed

Ben-Arye, Eran; Samuels, Noah; Schiff, Elad; Raz, Orit Gressel; Sharabi, Ilanit Shalom; Lavie, Ofer

2015-12-01

Integrative oncology incorporates complementary medicine (CM) therapies in patients with cancer. We explored the impact of an integrative oncology therapeutic regimen on quality-of-life (QOL) outcomes in women with gynecological cancer undergoing chemotherapy. A prospective preference study examined patients referred by oncology health care practitioners (HCPs) to an integrative physician (IP) consultation and CM treatments. QOL and chemotherapy-related toxicities were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire, at baseline and at a 6-12-week follow-up assessment. Adherence to the integrative care (AIC) program was defined as ≥ 4 CM treatments, with ≤ 30 days between each session. Of 128 patients referred by their HCP, 102 underwent IP consultation and subsequent CM treatments. The main concerns expressed by patients were fatigue (79.8%), gastrointestinal symptoms (64.6%), pain and neuropathy (54.5 %), and emotional distress (45.5%). Patients in both AIC (n = 68) and non-AIC (n = 28) groups shared similar demographic, treatment, and cancer-related characteristics. ESAS fatigue scores improved by a mean of 1.97 points in the AIC group on a scale of 0-10 and worsened by a mean of 0.27 points in the non-AIC group (p = 0.033). In the AIC group, MYCAW scores improved significantly (p < 0.0001) for each of the leading concerns as well as for well-being, a finding which was not apparent in the non-AIC group. An IP-guided CM treatment regimen provided to patients with gynecological cancer during chemotherapy may reduce cancer-related fatigue and improve other QOL outcomes.

A Two-site Randomized Clinical Trial of Integrated Psychosocial Treatment for ADHD-Inattentive Type

PubMed Central

Pfiffner, Linda J.; Hinshaw, Stephen P.; Owens, Elizabeth; Zalecki, Christine; Kaiser, Nina M.; Villodas, Miguel; McBurnett, Keith

2014-01-01

Objective This study evaluated the efficacy of the Child Life and Attention Skills (CLAS) program, a behavioral psychosocial treatment integrated across home and school, for youth with Attention Deficit Hyperactivity Disorder-Inattentive Type (ADHD-I). Method In a two-site randomized controlled trial, 199 children (ages 7-11) were randomized to CLAS (N=74), parent-focused treatment (PFT, N=74), or treatment as usual (TAU, N=51). We compared groups on parent and teacher ratings of inattention symptoms, organizational skills, social skills, and global improvement at post-treatment, and also at follow-up during the subsequent school year. Results CLAS resulted in greater improvements in teacher-reported inattention, organizational skills, social skills, and global functioning relative to both PFT and TAU at post-treatment. Parents of children in CLAS reported greater improvement in organizational skills than PFT and greater improvements on all outcomes relative to TAU at post-treatment. Differences between CLAS and TAU were maintained at follow-up for most parent-reported measures but were not significant for teacher-reported outcomes. Conclusions These findings extend support for CLAS across two study sites, revealing that integrating parent, teacher, and child treatment components, specifically adapted for ADHD-I, is superior to parent training alone and to usual care. Direct involvement of teachers and children in CLAS appears to amplify effects at school and home and underscores the importance of coordinating parent, teacher, and child treatment components for cross-setting effects on symptoms and impairment associated with ADHD-I. PMID:24865871

The Protected Addiction: Exploring Staff Beliefs toward Integrating Tobacco Dependence into Substance Abuse Treatment Services

ERIC Educational Resources Information Center

Teater, Barbra; Hammond, Gretchen Clark

2009-01-01

Survey research was used to explore the beliefs of 963 staff members regarding the myths to treating tobacco dependence and the integration of tobacco dependence into substance abuse treatment programs. The staff represented a mixture of residential, outpatient, and prevention-based gender-specific (women only) treatment centers throughout Ohio.…

Therapist-child interaction in the middle minutes of sensory integration treatment.

PubMed

Dunkerley, E; Tickle-Degnen, L; Coster, W J

1997-01-01

The purpose of this study was to describe the management of challenge during therapist-child interaction in sensory integration treatment. This descriptive and relational study of the middle minutes of treatment sessions partially replicated an earlier study of the beginning minutes. One-minute videotape clips taken from the middle minutes of 38 treatment sessions were shown to therapist judges who rated qualities of therapist and child behavior. Two patterns emerged from the correlations of ratings: work and playfulness. Work for the child involved trying hard, cooperating and seeking assistance, whereas work for the therapist involved assisting and guiding the child. Play for the child included enjoying the activity, being successful and confident, and trying hard. For the therapist, play involved being creative and behaving playfully. Patterns of work and play were different across different levels of challenge to the child.

EXPANDING INFANT MENTAL HEALTH TREATMENT SERVICES TO AT-RISK PRESCHOOLERS AND THEIR FAMILIES THROUGH THE INTEGRATION OF RELATIONAL PLAY THERAPY.

PubMed

Farley, Jennifer L; Whipple, Ellen E

2017-09-01

The expansion of infant mental health (IMH) to at-risk preschoolers and their families has contributed to the integration of relational play therapy (RPT) into IMH treatment services for this population. Integrating RPT allows access to specialized play and expressive techniques specific to preschool and family development, which improves the clinical ability to meet the multiple and complex needs of at-risk parent-child dyads and their families. This article will examine the RPT literature and explore the similarities and differences between IMH and RPT. In addition, two case studies will highlight a five-phase, integrative clinical-treatment process and provide insight into how IMH clinicians are integrating RPT models and maintaining adherence to the IMH treatment approach. © 2017 Michigan Association for Infant Mental Health.

Human health benefits and burdens of a pharmaceutical treatment: Discussion of a conceptual integrated approach.

PubMed

Debaveye, Sam; De Soete, Wouter; De Meester, Steven; Vandijck, Dominique; Heirman, Bert; Kavanagh, Shane; Dewulf, Jo

2016-01-01

The effects of a pharmaceutical treatment have until now been evaluated by the field of Health Economics on the patient health benefits, expressed in Quality-Adjusted Life Years (QALYs) versus the monetary costs. However, there is also a Human Health burden associated with this process, resulting from emissions that originate from the pharmaceutical production processes, Use Phase and End of Life (EoL) disposal of the medicine. This Human Health burden is evaluated by the research field of Life Cycle Assessment (LCA) and expressed in Disability-Adjusted Life Years (DALYs), a metric similar to the QALY. The need for a new framework presents itself in which both the positive and negative health effects of a pharmaceutical treatment are integrated into a net Human Health effect. To do so, this article reviews the methodologies of both Health Economics and the area of protection Human Health of the LCA methodology and proposes a conceptual framework on which to base an integration of both health effects. Methodological issues such as the inclusion of future costs and benefits, discounting and age weighting are discussed. It is suggested to use the structure of an LCA as a backbone to cover all methodological challenges involved in the integration. The possibility of monetizing both Human Health benefits and burdens is explored. The suggested approach covers the main methodological aspects that should be considered in an integrated assessment of the health effects of a pharmaceutical treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

PubMed Central

2011-01-01

Background There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this. Methods An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate. Results A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who

The Effects of Varying Levels of Treatment Integrity on Child Compliance during Treatment with a Three-Step Prompting Procedure

ERIC Educational Resources Information Center

Wilder, David A.; Atwell, Julie; Wine, Byron

2006-01-01

The effects of three levels of treatment integrity (100%, 50%, and 0%) on child compliance were evaluated in the context of the implementation of a three-step prompting procedure. Two typically developing preschool children participated in the study. After baseline data on compliance to one of three common demands were collected, a therapist…

A pathway to personalization of integrated treatment: informatics and decision science in psychiatric rehabilitation.

PubMed

Spaulding, William; Deogun, Jitender

2011-09-01

Personalization of treatment is a current strategic goal for improving health care. Integrated treatment approaches such as psychiatric rehabilitation benefit from personalization because they involve matching diverse arrays of treatment options to individually unique profiles of need. The need for personalization is evident in the heterogeneity of people with severe mental illness and in the findings of experimental psychopathology. One pathway to personalization lies in analysis of the judgments and decision making of human experts and other participants as they respond to complex circumstances in pursuit of treatment and rehabilitation goals. Such analysis is aided by computer simulation of human decision making, which in turn informs development of computerized clinical decision support systems. This inspires a research program involving concurrent development of databases, domain ontology, and problem-solving algorithms, toward the goal of personalizing psychiatric rehabilitation through human collaboration with intelligent cyber systems. The immediate hurdle is to demonstrate that clinical decisions beyond diagnosis really do affect outcome. This can be done by supporting the hypothesis that a human treatment team with access to a reasonably comprehensive clinical database that tracks patient status and treatment response over time achieves better outcome than a treatment team without such access, in a controlled experimental trial. Provided the hypothesis can be supported, the near future will see prototype systems that can construct an integrated assessment, formulation, and rehabilitation plan from clinical assessment data and contextual information. This will lead to advanced systems that collaborate with human decision makers to personalize psychiatric rehabilitation and optimize outcome.

Evaluation of an integrated group cognitive-behavioral treatment for comorbid mood, anxiety, and substance use disorders: A pilot study.

PubMed

Milosevic, Irena; Chudzik, Susan M; Boyd, Susan; McCabe, Randi E

2017-03-01

This paper presents the development and preliminary evaluation of an integrated group cognitive-behavioral treatment (CBT) for comorbid mood, anxiety, and substance use disorders. The 12-session, manualized treatment was developed collaboratively by a mental health program in a teaching hospital and a community-based addictions service and administered in both settings. Results from an uncontrolled effectiveness trial of 29 treatment completers suggest that integrated group CBT may reduce stress and alcohol use symptoms and improve substance refusal self-efficacy. Changes in symptoms of anxiety, depression, and drug use were not significant, although the effect size for anxiety reduction was in the medium range. Nonetheless, the clinical significance of treatment effects on mood, anxiety, and substance use symptoms was modest. Changes in coping skills and quality of life were not significant, although medium-to-large effects were observed for changes in several coping skills. Participants reported being highly satisfied with treatment, found the treatment strategies to be useful, and noted an improvement in their functioning, particularly socially. Methodological and sample size limitations warrant more rigorous follow-up investigations of this treatment. Results are considered in the context of the current literature on integrated psychological treatments for these common comorbidities. Copyright © 2016 Elsevier Ltd. All rights reserved.

A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment.

PubMed

Pienaar, Elsje; Cilfone, Nicholas A; Lin, Philana Ling; Dartois, Véronique; Mattila, Joshua T; Butler, J Russell; Flynn, JoAnne L; Kirschner, Denise E; Linderman, Jennifer J

2015-02-21

While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic. Here we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. Finally, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome. Copyright © 2014 Elsevier Ltd. All rights reserved.

A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment

DOE PAGES

Pienaar, Elsje; Cilfone, Nicholas A.; Lin, Philana Ling; ...

2014-12-08

While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic.more » In this paper, we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. In conclusion, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome.« less

A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment

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

Pienaar, Elsje; Cilfone, Nicholas A.; Lin, Philana Ling

While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic.more » In this paper, we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. In conclusion, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome.« less

A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder.

PubMed

Kelly, John F; Kaminer, Yifrah; Kahler, Christopher W; Hoeppner, Bettina; Yeterian, Julie; Cristello, Julie V; Timko, Christine

2017-12-01

The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF. Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n = 30) or a novel integrated TSF (iTSF; n = 29), with follow-up assessments at 3, 6 and 9 months following treatment entry. Out-patient addiction clinic in the United States. Adolescents [n = 59; mean age = 16.8 (1.7) years; range = 14-21; 27% female; 78% white]. The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD. Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms. Primary outcome: PDA was not significantly different across treatments [b = 0.08, 95% confidence interval (CI) = -0.08 to 0.24, P = 0.33; Bayes' factor = 0.28). during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b = -0.87; 95% CI = -1.67 to 0.07, P = 0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b = -0.42; 95% CI = -0.80 to -0.04, P < 0.05; effect size range d = 0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r = 0.39, P = 0.008), and early following (r = 0.30, P = 0

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa.

PubMed

Mathibe, Maphuthego D; Hendricks, Stephen J H; Bergh, Anne-Marie

2015-10-02

Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Workload, staff development and support for integration affected clinicians' performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

Research on common methods for evaluating the operation effect of integrated wastewater treatment facilities of iron and steel enterprises

NASA Astrophysics Data System (ADS)

Bingsheng, Xu

2017-04-01

Considering the large quantities of wastewater generated from iron and steel enterprises in China, this paper is aimed to research the common methods applied for evaluating the integrated wastewater treatment effect of iron and steel enterprises. Based on survey results on environmental protection performance, technological economy, resource & energy consumption, services and management, an indicator system for evaluating the operation effect of integrated wastewater treatment facilities is set up. By discussing the standards and industrial policies in and out of China, 27 key secondary indicators are further defined on the basis of investigation on main equipment and key processes for wastewater treatment, so as to determine the method for setting key quantitative and qualitative indicators for evaluation indicator system. It is also expected to satisfy the basic requirements of reasonable resource allocation, environmental protection and sustainable economic development, further improve the integrated wastewater treatment effect of iron and steel enterprises, and reduce the emission of hazardous substances and environmental impact.

The MICA Case Conference Program at Tewksbury Hospital, Mass.: an integrated treatment model.

PubMed

Clodfelter, Reynolds C; Albanese, Mark J; Baker, Gregg; Domoto, Katherine; Gui, Amy L; Khantzian, Edward J

2003-01-01

This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, Massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated. An expert clinician focuses on the interplay between psychological pain, characterological traits, defenses, and the patient's drug of choice. Patients who have participated in the program have reported positive experiences. The staff reported that the program has resulted in facility improvement in assessment and treatment of complex dual diagnosis patients.

An integrated system for the online monitoring of particle therapy treatment accuracy

NASA Astrophysics Data System (ADS)

Fiorina, E.; INSIDE Collaboration

2016-07-01

Quality assurance in hadrontherapy remains an open issue that can be addressed with reliable monitoring of treatment accuracy. The INSIDE (INnovative SolutIons for DosimEtry in hadrontherapy) project aims to develop an integrated online monitoring system based on two dedicated PET panels and a tracking system, called Dose Profiler. The proposed solution is designed to operate in-beam and provide an immediate feedback on the particle range acquiring both photons produced by β+ decays and prompt secondary particle signals. Monte Carlo simulations cover an important role both in the system development, by confirming the design feasibility, and in the system operation, by understanding data. A FLUKA-based integrated simulation was developed taking into account the hadron beam structure, the phantom/patient features and the PET detector and Dose Profiler specifications. In addition, to reduce simulation time in signal generation on PET detectors, a two-step technique has been implemented and validated. The first PET modules were tested in May 2015 at the Centro Nazionale Adroterapia Oncologica (CNAO) in Pavia (Italy) with very satisfactory results: in-spill, inter-spill and post-treatment PET images were reconstructed and a quantitative agreement between data and simulation was found.

Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: a randomized controlled trial.

PubMed

Rapee, Ronald M; MacLeod, Colin; Carpenter, Leigh; Gaston, Jonathan E; Frei, Jacqueline; Peters, Lorna; Baillie, Andrew J

2013-05-01

The aim of the current study was to integrate recent developments in the retraining of attentional biases towards threat into a standard cognitive behavioural treatment package for social phobia. 134 participants (M age-32.4: 53% female) meeting DSM-IV criteria for social phobia received a 12-week cognitive behavioural treatment program. They were randomly allocated to receive on a daily basis using home practice, either an additional computerised probe procedure designed to train attentional resource allocation away from threat, or a placebo variant of this procedure. Measures included diagnostic severity, social anxiety symptoms, life interference, and depression as well as state anxiety in response to a laboratory social threat. At the end of treatment there were no significant differences between groups in attentional bias towards threat or in treatment response (all p's>0.05). Both groups showed similar and highly significant reductions in diagnostic severity, social anxiety symptoms, depression symptoms, and life interference at post-treatment that was maintained and in most cases increased at 6 month follow-up (uncontrolled effect sizes ranged from d=0.34 to d=1.90). The current results do not indicate that integration of information processing-derived attentional bias modification procedures into standard treatment packages as conducted in this study augments attentional change or enhances treatment efficacy. Further refinement of bias modification techniques, and better methods of integrating them with conventional approaches, may be needed to produce better effects. Copyright © 2013 Elsevier Ltd. All rights reserved.

Control of aliphatic halogenated DBP precursors with multiple drinking water treatment processes: Formation potential and integrated toxicity.

PubMed

Zhang, Yimeng; Chu, Wenhai; Yao, Dechang; Yin, Daqiang

2017-08-01

The comprehensive control efficiency for the formation potentials (FPs) of a range of regulated and unregulated halogenated disinfection by-products (DBPs) (including carbonaceous DBPs (C-DBPs), nitrogenous DBPs (N-DBPs), and iodinated DBPs (I-DBPs)) with the multiple drinking water treatment processes, including pre-ozonation, conventional treatment (coagulation-sedimentation, pre-sand filtration), ozone-biological activated carbon (O 3 -BAC) advanced treatment, and post-sand filtration, was investigated. The potential toxic risks of DBPs by combing their FPs and toxicity values were also evaluated. The results showed that the multiple drinking water treatment processes had superior performance in removing organic/inorganic precursors and reducing the formation of a range of halogenated DBPs. Therein, ozonation significantly removed bromide and iodide, and thus reduced the formation of brominated and iodinated DBPs. The removal of organic carbon and nitrogen precursors by the conventional treatment processes was substantially improved by O 3 -BAC advanced treatment, and thus prevented the formation of chlorinated C-DBPs and N-DBPs. However, BAC filtration leads to the increased formation of brominated C-DBPs and N-DBPs due to the increase of bromide/DOC and bromide/DON. After the whole multiple treatment processes, the rank order for integrated toxic risk values caused by these halogenated DBPs was haloacetonitriles (HANs)≫haloacetamides (HAMs)>haloacetic acids (HAAs)>trihalomethanes (THMs)>halonitromethanes (HNMs)≫I-DBPs (I-HAMs and I-THMs). I-DBPs failed to cause high integrated toxic risk because of their very low FPs. The significant higher integrated toxic risk value caused by HANs than other halogenated DBPs cannot be ignored. Copyright © 2017. Published by Elsevier B.V.

A systematic review of yoga interventions as integrative treatment in breast cancer.

PubMed

Sharma, Manoj; Lingam, Vimala Charitha; Nahar, Vinayak K

2016-12-01

Breast cancer is a significant public health problem all over the world. The treatment of breast cancer has many side effects. Yoga has been suggested as an integrative form of therapy for breast cancer. The purpose of this study was to systematically review yoga interventions for breast cancer and determine the efficacy of these interventions as integrative modalities of treatment in altering various outcomes related to breast cancer. Studies were included if (1) exclusively targeted breast cancer patients; (2) published between 2013 and May 2016; (3) written in the English language; (4) published in a peer-reviewed journals indexed in MEDLINE (PubMed), CINAHL, ERIC and Alt Health Watch; (5) they used any type of yoga as a part of or the whole intervention; and (6) utilized a quantitative design for evaluation. A total of 23 interventions met the inclusion criteria. Majority of the studies had been done in USA (n = 9), followed by Germany (n = 3), India (n = 3) and Turkey (n = 2). One study each was from Australia, Canada, Iran, Taiwan, Poland, and UK. Twenty-two of the 23 interventions had statistically significant changes in studied outcome measures. Despite the limitations of wide variabilities in sample size, lack of standardized approach in conducting yoga, multiplicity of outcome measures, varying durations of interventions and lack of using behavioral theories, yoga as an integrative form of therapy for breast cancer is a promising approach. More interventions utilizing yoga need to be tested.

Integration of Family Planning Services into HIV Care and Treatment Services: A Systematic Review.

PubMed

Haberlen, Sabina A; Narasimhan, Manjulaa; Beres, Laura K; Kennedy, Caitlin E

2017-06-01

Evidence on the feasibility, effectiveness, and cost-effectiveness of integrating family planning (FP) and HIV services has grown significantly since the 2004 Glion Call to Action. This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Fourteen studies met our inclusion criteria, eight of which were published after the last systematic review on the topic in 2013. Overall, integration was associated with higher modern method contraceptive prevalence and knowledge, although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy. Evidence for change in unmet need for FP was limited, although two of the three evaluations that measured unmet need suggested possible improvements associated with integrated services. However, improving access to FP services through integration was not always sufficient to increase the use of more effective (noncondom) modern methods among women who wanted to prevent pregnancy. Integration efforts, particularly in contexts where contraceptive use is low, must address community-wide and HIV-specific barriers to using effective FP methods alongside improving access to information, commodities, and services within routine HIV care. © 2017 The Population Council, Inc.

Self-aligned gated field emission devices using single carbon nanofiber cathodes

NASA Astrophysics Data System (ADS)

Guillorn, M. A.; Melechko, A. V.; Merkulov, V. I.; Hensley, D. K.; Simpson, M. L.; Lowndes, D. H.

2002-11-01

We report on the fabrication and operation of integrated gated field emission devices using single vertically aligned carbon nanofiber (VACNF) cathodes where the gate aperture has been formed using a self-aligned technique based on chemical mechanical polishing. We find that this method for producing gated cathode devices easily achieves structures with gate apertures on the order of 2 mum that show good concentric alignment to the VACNF emitter. The operation of these devices was explored and field emission characteristics that fit well to the Fowler-Nordheim model of emission was demonstrated.

Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial.

PubMed

Bogner, Hillary R; Morales, Knashawn H; de Vries, Heather F; Cappola, Anne R

2012-01-01

Depression commonly accompanies diabetes, resulting in reduced adherence to medications and increased risk for morbidity and mortality. The objective of this study was to examine whether a simple, brief integrated approach to depression and type 2 diabetes mellitus (type 2 diabetes) treatment improved adherence to oral hypoglycemic agents and antidepressant medications, glycemic control, and depression among primary care patients. We undertook a randomized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care. Patients were randomly assigned to an integrated care intervention or usual care. Integrated care managers collaborated with physicians to offer education and guideline-based treatment recommendations and to monitor adherence and clinical status. Adherence was assessed using the Medication Event Monitoring System (MEMS). We used glycated hemoglobin (HbA(1c)) assays to measure glycemic control and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression. Intervention and usual care groups did not differ statistically on baseline measures. Patients who received the intervention were more likely to achieve HbA(1c) levels of less than 7% (intervention 60.9% vs. usual care 35.7%; P < .001) and remission of depression (PHQ-9 score of less than 5: intervention 58.7% vs. usual care 30.7%; P < .001) in comparison with patients in the usual care group at 12 weeks. A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources.

Implementation Planning to Promote Parents' Treatment Integrity of Behavioral Interventions for Children with Autism

ERIC Educational Resources Information Center

Fallon, Lindsay M.; Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Feinberg, Adam B.; Kratochwill, Thomas R.

2016-01-01

Behavioral interventions delivered across home and school settings can promote positive outcomes for youth with autism spectrum disorders (ASD). Yet, stakeholders who deliver these interventions may struggle to implement interventions as intended. Low levels of treatment integrity can undermine potentially positive intervention outcomes. One way…

An Integrated Model for Identifying Linkages Between the Management of Fuel Treatments, Fire and Ecosystem Services

NASA Astrophysics Data System (ADS)

Bart, R. R.; Anderson, S.; Moritz, M.; Plantinga, A.; Tague, C.

2015-12-01

Vegetation fuel treatments (e.g. thinning, prescribed burning) are a frequent tool for managing fire-prone landscapes. However, predicting how fuel treatments may affect future wildfire risk and associated ecosystem services, such as forest water availability and streamflow, remains a challenge. This challenge is in part due to the large range of conditions under which fuel treatments may be implemented, as response is likely to vary with species type, rates of vegetation regrowth, meteorological conditions and physiographic properties of the treated site. It is also due to insufficient understanding of how social factors such as political pressure, public demands and economic constraints affect fuel management decisions. To examine the feedbacks between ecological and social dimensions of fuel treatments, we present an integrated model that links a biophysical model that simulates vegetation and hydrology (RHESSys), a fire spread model (WMFire) and an empirical fuel treatment model that accounts for agency decision-making. We use this model to investigate how management decisions affect landscape fuel loads, which in turn affect fire severity and ecosystem services, which feedback to management decisions on fuel treatments. We hypothesize that this latter effect will be driven by salience theory, which predicts that fuel treatments are more likely to occur following major wildfire events. The integrated model provides a flexible framework for answering novel questions about fuel treatments that span social and ecological domains, areas that have previously been treated separately.

Provision of integrated psychosocial services for cancer survivors post-treatment

PubMed Central

Recklitis, Christopher J; Syrjala, Karen L

2018-01-01

Meeting the psychosocial needs of patients with cancer has been recognised as a priority within oncology care for several decades. Many approaches that address these needs have been developed and described; however, until recently much of this work had focused on patients during treatment and end-of-life care. With continued improvement in therapies, the population of cancer survivors who can expect to live for 5 or more years after cancer diagnosis has increased dramatically, as have associated concerns about how to meet their medical, psychosocial, and health behaviour needs after treatment. Guidelines and models for general survivorship care routinely address psychosocial needs, and similar guidelines for psychosocial care of patients with cancer are being extended to address the needs of survivors. In this Series paper, we summarise the existing recommendations for the provision of routine psychosocial care to survivors, as well as the challenges present in providing this care. We make specific recommendations for the integration of psychosocial services into survivorship care. PMID:28049576

Review of Use and Integration of Mobile Apps Into Psychiatric Treatments.

PubMed

Chan, Steven; Godwin, Haley; Gonzalez, Alvaro; Yellowlees, Peter M; Hilty, Donald M

2017-10-30

Mental health practitioners should understand the features of current, publicly available apps; the features of novel, research apps; and issues behind the integration of mobile apps and digital health services into clinical workflows. The review is based on a research literature and the authors' clinical and healthcare administration experiences. Articles searched-on telepsychiatry, telemental health, mobile mental health, informatics, cellular phone, ambulatory monitoring, telemetry, and algorithms-were restricted to 2016 and 2017. Technologies are used in a variety of clinical settings, including patients with varying mental illness severity, social supports, and technological literacy. Good practices for evaluating apps, understanding user needs, and training and educating users can increase success rates. Ethics and risk management should be considered. Mobile apps are versatile. Integrating apps into psychiatric treatment requires addressing both patient and clinical workflows, design and usability principles, accessibility, social concerns, and digital health literacy.

Integrating Tobacco Treatment into Cancer Care: Study Protocol for a Randomized Controlled Comparative Effectiveness Trial

PubMed Central

Park, Elyse R.; Ostroff, Jamie S.; Perez, Giselle K.; Hyland, Kelly A.; Rigotti, Nancy A.; Borderud, Sarah; Regan, Susan; Muzikansky, Alona; Friedman, Emily R.; Levy, Douglas E.; Holland, Susan; Eusebio, Justin; Peterson, Lisa; Rabin, Julia; Miller-Sobel, Jacob; Gonzalez, Irina; Malloy, Laura; O’Brien, Maureen; de León-Sanchez, Suhana; Will Whitlock, C.

2016-01-01

Background Despite the well-established risks of persistent smoking, 10-30% of cancer patients continue to smoke after diagnosis. Evidence based tobacco treatment has yet to be integrated into routine oncology care. This paper describes the protocol, manualized treatment, evaluation plan, and overall study design of comparing the effectiveness and cost of two treatments across two major cancer centers. Methods/Design A two-arm, two-site randomized controlled comparative effectiveness trial is testing the hypothesis that an Intensive Treatment (IT) intervention is more effective than a Standard Treatment (ST) intervention in helping recently diagnosed cancer patients quit smoking. Both interventions include 4 weekly counseling sessions and FDA-approved smoking cessation medication advice. The IT includes an additional 4 biweekly and 3 monthly booster sessions as well as dispensal of the recommended FDA-approved smoking cessation medication at no cost. The trial is enrolling patients with suspected or newly diagnosed cancer who have smoked a cigarette in the past 30 days. Participants are randomly assigned to receive the ST or IT condition. Tobacco cessation outcomes are assessed at 3 and 6 months. The primary study outcome is 7-day point prevalence biochemically-validated tobacco abstinence. Secondary study outcomes include the incremental cost-effectiveness of the IT vs. ST. Discussion This trial will answer key questions about delivering tobacco treatment interventions to newly diagnosed cancer patients. If found to be efficacious and cost-effective, this treatment will serve as a model to be integrated into oncology care settings nation-wide, as we strive to improve treatment outcomes and quality of life for cancer patients. PMID:27444428

Integrated omics for the identification of key functionalities in biological wastewater treatment microbial communities.

PubMed

Narayanasamy, Shaman; Muller, Emilie E L; Sheik, Abdul R; Wilmes, Paul

2015-05-01

Biological wastewater treatment plants harbour diverse and complex microbial communities which prominently serve as models for microbial ecology and mixed culture biotechnological processes. Integrated omic analyses (combined metagenomics, metatranscriptomics, metaproteomics and metabolomics) are currently gaining momentum towards providing enhanced understanding of community structure, function and dynamics in situ as well as offering the potential to discover novel biological functionalities within the framework of Eco-Systems Biology. The integration of information from genome to metabolome allows the establishment of associations between genetic potential and final phenotype, a feature not realizable by only considering single 'omes'. Therefore, in our opinion, integrated omics will become the future standard for large-scale characterization of microbial consortia including those underpinning biological wastewater treatment processes. Systematically obtained time and space-resolved omic datasets will allow deconvolution of structure-function relationships by identifying key members and functions. Such knowledge will form the foundation for discovering novel genes on a much larger scale compared with previous efforts. In general, these insights will allow us to optimize microbial biotechnological processes either through better control of mixed culture processes or by use of more efficient enzymes in bioengineering applications. © 2015 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

A Comparison of Sensory Integrative and Behavioral Therapies as Treatment for Pediatric Feeding Disorders

ERIC Educational Resources Information Center

Addison, Laura R.; Piazza, Cathleen C.; Patel, Meeta R.; Bachmeyer, Melanie H.; Rivas, Kristi M.; Milnes, Suzanne M.; Oddo, Jackie

2012-01-01

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory…

Identity: empirical contribution. Changes in the identity integration of adolescents in treatment for personality disorders.

PubMed

Feenstra, Dine J; Hutsebaut, Joost; Verheul, Roel; van Limbeek, Jacques

2014-02-01

A renewed interest in identity as one of the core markers of personality disorders has been introduced by the DSM-5 Level of Personality Functioning Scale. However, little is known about the utility of the construct of identity in children and adolescents. This study aimed to broaden the knowledge of identity integration as a core component of personality functioning in adolescents. The authors investigated levels of identity integration, as measured by the Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008), in adolescents in both normal (n = 406) and clinical populations (n = 285). Furthermore, changes in levels of identity integration during treatment were investigated in a clinical subsample (n = 76). Levels of identity integration were not associated with age. They were, however, associated with the absence or presence of personality pathology. Most adolescents receiving inpatient psychotherapy gradually changed toward more healthy levels of identity integration; a significant number, however, remained at maladaptive levels of identity functioning after intensive psychotherapy.

Asynchronous collision integrators: Explicit treatment of unilateral contact with friction and nodal restraints

PubMed Central

Wolff, Sebastian; Bucher, Christian

2013-01-01

This article presents asynchronous collision integrators and a simple asynchronous method treating nodal restraints. Asynchronous discretizations allow individual time step sizes for each spatial region, improving the efficiency of explicit time stepping for finite element meshes with heterogeneous element sizes. The article first introduces asynchronous variational integration being expressed by drift and kick operators. Linear nodal restraint conditions are solved by a simple projection of the forces that is shown to be equivalent to RATTLE. Unilateral contact is solved by an asynchronous variant of decomposition contact response. Therein, velocities are modified avoiding penetrations. Although decomposition contact response is solving a large system of linear equations (being critical for the numerical efficiency of explicit time stepping schemes) and is needing special treatment regarding overconstraint and linear dependency of the contact constraints (for example from double-sided node-to-surface contact or self-contact), the asynchronous strategy handles these situations efficiently and robust. Only a single constraint involving a very small number of degrees of freedom is considered at once leading to a very efficient solution. The treatment of friction is exemplified for the Coulomb model. Special care needs the contact of nodes that are subject to restraints. Together with the aforementioned projection for restraints, a novel efficient solution scheme can be presented. The collision integrator does not influence the critical time step. Hence, the time step can be chosen independently from the underlying time-stepping scheme. The time step may be fixed or time-adaptive. New demands on global collision detection are discussed exemplified by position codes and node-to-segment integration. Numerical examples illustrate convergence and efficiency of the new contact algorithm. Copyright © 2013 The Authors. International Journal for Numerical Methods in

Advanced treatment of biologically pretreated coal gasification wastewater by a novel integration of catalytic ultrasound oxidation and membrane bioreactor.

PubMed

Jia, Shengyong; Han, Hongjun; Zhuang, Haifeng; Xu, Peng; Hou, Baolin

2015-01-01

Laboratorial scale experiments were conducted to investigate a novel system integrating catalytic ultrasound oxidation (CUO) with membrane bioreactor (CUO-MBR) on advanced treatment of biologically pretreated coal gasification wastewater. Results indicated that CUO with catalyst of FeOx/SBAC (sewage sludge based activated carbon (SBAC) which loaded Fe oxides) represented high efficiencies in eliminating TOC as well as improving the biodegradability. The integrated CUO-MBR system with low energy intensity and high frequency was more effective in eliminating COD, BOD5, TOC and reducing transmembrane pressure than either conventional MBR or ultrasound oxidation integrated MBR. The enhanced hydroxyl radical oxidation, facilitation of substrate diffusion and improvement of cell enzyme secretion were the mechanisms for CUO-MBR performance. Therefore, the integrated CUO-MBR was the promising technology for advanced treatment in engineering applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

Synthesis and Integration of Pre-treatment Results from the Missouri Ozark Forest Ecosystem Project

Treesearch

Wendy K. Gram; Victoria L. Sork; Robert J. Marquis

1997-01-01

Integrating results across disciplines is a critical component of ecosystem management and research. The common research sites, landscape-scale experimental design, and breadth of research subjects in Missouri Ozark Forest Ecosystem Project provide circumstances conducive for addressing multidisciplinary questions. Our objectives were to (1) summarize the treatment and...

Oral antioxidant treatment partly improves integrity of human sperm DNA in infertile grade I varicocele patients.

PubMed

Gual-Frau, Josep; Abad, Carlos; Amengual, María J; Hannaoui, Naim; Checa, Miguel A; Ribas-Maynou, Jordi; Lozano, Iris; Nikolaou, Alexandros; Benet, Jordi; García-Peiró, Agustín; Prats, Juan

2015-09-01

Infertile males with varicocele have the highest percentage of sperm cells with damaged DNA, compared to other infertile groups. Antioxidant treatment is known to enhance the integrity of sperm DNA; however, there are no data on the effects in varicocele patients. We thus investigated the potential benefits of antioxidant treatment specifically in grade I varicocele males. Twenty infertile patients with grade I varicocele were given multivitamins (1500 mg L-Carnitine, 60 mg vitamin C, 20 mg coenzyme Q10, 10 mg vitamin E, 200 μg vitamin B9, 1 μg vitamin B12, 10 mg zinc, 50 μg selenium) daily for three months. Semen parameters including total sperm count, concentration, progressive motility, vitality, and morphology were determined before and after treatment. In addition, sperm DNA fragmentation and the amount of highly degraded sperm cells were analyzed by Sperm Chromatin Dispersion. After treatment, patients showed an average relative reduction of 22.1% in sperm DNA fragmentation (p = 0.02) and had 31.3% fewer highly degraded sperm cells (p = 0.07). Total numbers of sperm cells were increased (p = 0.04), but other semen parameters were unaffected. These data suggest that sperm DNA integrity in grade I varicocele patients may be improved by oral antioxidant treatment.

Integrating sequencing batch reactor with bio-electrochemical treatment for augmenting remediation efficiency of complex petrochemical wastewater.

PubMed

Yeruva, Dileep Kumar; Jukuri, Srinivas; Velvizhi, G; Naresh Kumar, A; Swamy, Y V; Venkata Mohan, S

2015-01-01

The present study evaluates the sequential integration of two advanced biological treatment methods viz., sequencing batch reactor (SBR) and bioelectrochemical treatment systems (BET) for the treatment of real-field petrochemical wastewater (PCW). Initially two SBR reactors were operated in aerobic (SBR(Ae)) and anoxic (SBR(Ax)) microenvironments with an organic loading rate (OLR) of 9.68 kg COD/m(3)-day. Relatively, SBR(Ax) showed higher substrate degradation (3.34 kg COD/m(3)-day) compared to SBR(Ae) (2.9 kg COD/m(3)-day). To further improve treatment efficiency, the effluents from SBR process were fed to BET reactors. BET(Ax) depicted higher SDR (1.92 kg COD/m(3)-day) with simultaneous power generation (17.12 mW/m(2)) followed by BET(Ae) (1.80 kg COD/m(3)-day; 14.25 mW/m(2)). Integrating both the processes documented significant improvement in COD removal efficiency due to the flexibility of combining multiple microenvironments sequentially. Results were supported with GC-MS and FTIR, which confirmed the increment in biodegradability of wastewater. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nonpharmacological Treatments for Post-Stroke Depression: An Integrative Review of the Literature.

PubMed

Hadidi, Niloufar Niakosari; Huna Wagner, Roberta L; Lindquist, Ruth

2017-07-01

Stroke is the fifth leading cause of death and the number one cause of long-term disability. Seventy-five percent of annual stroke victims are older than 65. Post-stroke depression (PSD) is a common consequence of stroke, with the estimated prevalence ranging from 25% to 79%. Although several studies have investigated the impact of pharmacological interventions on PSD, there is a significant gap in knowledge regarding the efficacy of nonpharmacological measures for treatment of PSD. The purpose of the current integrative literature review was to synthesize the state of knowledge on selected nonpharmacological treatments for PSD and present findings regarding the efficacy of investigated treatments. Twenty-one studies published from 1992-2016 were identified and synthesized. Results indicated that studies demonstrating improvement in depressive symptoms included ecosystem-focused therapy, life review therapy, problem solving therapy, meridian acupressure, repetitive transcranial magnetic stimulation, music therapy, exercise, light therapy, motivational interviewing, and robotic-assisted neurorehabilitation. [Res Gerontol Nurs. 2017; 10(4):182-195.]. Copyright 2017, SLACK Incorporated.

Integrated Diagnostic and Treatment Devices for Enroute Critical Care of Patients within Theater

DTIC Science & Technology

2010-04-01

are all indicated for both adult and pediatric patients, are lightweight systems designed to attach either directly to a NATO litter or attach to a...external defibrillator and blood chemistry analysis system. Figure 1: Patient Being Transported with the Life Support for Trauma and Transport...be difficult to replace or refill. The LSTAT was also designed to accept external oxygen sources. Integrated Diagnostic and Treatment Devices for

Integration of biotechnological wastewater treatment units in textile finishing factories: from end of the pipe solutions to combined production and wastewater treatment units.

PubMed

Feitkenhauer, H; Meyer, U

2001-08-23

Increasing costs for water, wastewater and energy put pressure on textile finishing plants to increase the efficiency of wet processing. An improved water management can decrease the use of these resources and is a prerequisite for the integration of an efficient, anaerobic on-site pretreatment of effluents that will further cut wastewater costs. A two-phase anaerobic treatment is proposed, and successful laboratory experiments with model effluents from the cotton finishing industry are reported. The chemical oxygen demand of this wastewater was reduced by over 88% at retention times of 1 day or longer. The next step to boost the efficiency is to combine the production and wastewater treatment. The example of cotton fabric desizing (removing size from the fabric) illustrates how this final step of integration uses the acidic phase bioreactor as a part of the production and allows to close the water cycle of the system.

Effect of a Complementary/Integrative Medicine Treatment Program on Taxane-Induced Peripheral Neuropathy: A Brief Report.

PubMed

Ben-Arye, Eran; River, Yaron; Keshet, Yael; Lavie, Ofer; Israeli, Pesi; Samuels, Noah

2018-06-01

Peripheral neuropathy is a common complication of cancer treatment impairing quality of life and function. This study explored the impact of a complementary and integrative medicine (CIM) program on taxane-induced peripheral neuropathy (TIPN). Taxane-treated female patients with breast and gynecological cancer reporting TIPN-related symptoms were referred to an integrative physician, followed by patient-tailored CIM treatments (acupuncture with/without other modalities). Assessment of study outcomes at 6 to 12 weeks was conducted using the Measure Yourself Concerns and Wellbeing, which documented free-text narratives about patients' experience during the CIM treatment process. Content was analyzed using ATLAS.Ti software. Of the 125 patients treated with taxanes, 69 had been referred for CIM treatment of TIPN-associated symptoms. Multidisciplinary narrative analysis identified 2 groups of CIM-treated patients: those with an apparently moderate improvement in symptoms (n = 35) and those with either only an apparent mild or no improvement at all. For 10 patients, assessment of their response to treatment was unclear. The 2 identified groups had similar demographic, cancer-related, and quality of life-related parameters at baseline. Content analysis of patients with an apparent moderate improvement suggested a short-term (24-48 hours) effect with acupuncture treatment, either alone or combined with manual, mind-body, and anthroposophic music therapies. Symptoms showing improvement included paresthesia and numbness. Acupuncture and other CIM therapies may result in a short-term and transitory reduction in TIPN-related symptoms.

Integrating Multiscale Modeling with Drug Effects for Cancer Treatment.

PubMed

Li, Xiangfang L; Oduola, Wasiu O; Qian, Lijun; Dougherty, Edward R

2015-01-01

In this paper, we review multiscale modeling for cancer treatment with the incorporation of drug effects from an applied system's pharmacology perspective. Both the classical pharmacology and systems biology are inherently quantitative; however, systems biology focuses more on networks and multi factorial controls over biological processes rather than on drugs and targets in isolation, whereas systems pharmacology has a strong focus on studying drugs with regard to the pharmacokinetic (PK) and pharmacodynamic (PD) relations accompanying drug interactions with multiscale physiology as well as the prediction of dosage-exposure responses and economic potentials of drugs. Thus, it requires multiscale methods to address the need for integrating models from the molecular levels to the cellular, tissue, and organism levels. It is a common belief that tumorigenesis and tumor growth can be best understood and tackled by employing and integrating a multifaceted approach that includes in vivo and in vitro experiments, in silico models, multiscale tumor modeling, continuous/discrete modeling, agent-based modeling, and multiscale modeling with PK/PD drug effect inputs. We provide an example application of multiscale modeling employing stochastic hybrid system for a colon cancer cell line HCT-116 with the application of Lapatinib drug. It is observed that the simulation results are similar to those observed from the setup of the wet-lab experiments at the Translational Genomics Research Institute.

Epidermal growth factor treatment decreases mortality and is associated with improved gut integrity in sepsis.

PubMed

Clark, Jessica A; Clark, Andrew T; Hotchkiss, Richard S; Buchman, Timothy G; Coopersmith, Craig M

2008-07-01

Epidermal growth factor (EGF) is a cytoprotective peptide that has healing effects on the intestinal mucosa. We sought to determine whether systemic administration of EGF after the onset of sepsis improved intestinal integrity and decreased mortality. FVB/N mice were subjected to either sham laparotomy or 2 x 23 cecal ligation and puncture (CLP). Septic mice were further randomized to receive injection of either 150 microg kg(-1) d(-1) (i.p.) EGF or 0.9% saline (i.p.). Circulating EGF levels were decreased after CLP compared with sham animals but were unaffected by giving exogenous EGF treatment. In contrast, intestinal EGF levels increased after CLP and were further augmented by exogenous EGF treatment. Intestinal EGF receptor was increased after CLP, whether assayed by immunohistochemistry, real-time polymerase chain reaction, or Western blot, and exogenous EGF treatment decreased intestinal EGF receptor. Villus length decreased 2-fold between sham and septic animals, and EGF treatment resulted in near total restitution of villus length. Sepsis decreased intestinal proliferation and increased intestinal apoptosis. This was accompanied by increased expression of the proapoptotic proteins Bid and Fas-associated death domain, as well as the cyclin-dependent kinase inhibitor p21 cip1/waf Epidermal growth factor treatment after the onset of sepsis restored both proliferation and apoptosis to levels seen in sham animals and normalized expression of Bid, Fas-associated death domain, and p21 cip1/waf . To determine whether improvements in gut homeostasis were associated with a decrease in sepsis-induced mortality, septic mice with or without EGF treatment after CLP were followed 7 days for survival. Mortality decreased from 60% to 30% in mice treated with EGF after the onset of sepsis (P < 0.05). Thus, EGF may be a potential therapeutic agent for the treatment of sepsis in part due to its ability to protect intestinal integrity.

Epidermal growth factor treatment decreases mortality and is associated with improved gut integrity in sepsis

PubMed Central

Clark, Jessica A.; Clark, Andrew T.; Hotchkiss, Richard S.; Buchman, Timothy G.; Coopersmith, Craig M.

2007-01-01

Epidermal growth factor (EGF) is a cytoprotective peptide that has healing effects on the intestinal mucosa. We sought to determine whether systemic administration of EGF following the onset of sepsis improved intestinal integrity and decreased mortality. FVB/N mice were subjected to either sham laparotomy or 2×23 cecal ligation and puncture (CLP). Septic mice were further randomized to receive intraperitoneal injection of either 150 μg/kg/day EGF or 0.9% saline. Circulating EGF levels were decreased following CLP compared to sham animals but were unaffected by giving exogenous EGF treatment. In contrast, intestinal EGF levels increased following CLP, and were further augmented by exogenous EGF treatment. Intestinal EGF-receptor (EGF-R) was increased following CLP whether assayed by immunohistochemistry, real-time PCR or western blot, and exogenous EGF treatment decreased intestinal EGF-R. Villus length decreased 2-fold between sham and septic animals, and EGF treatment resulted in near total restitution of villus length. Sepsis decreased intestinal proliferation and increased intestinal apoptosis. This was accompanied by increased expression of the pro-apoptotic proteins Bid and FADD, as well as the cyclin-dependent kinase inhibitor p21cip1/waf. EGF treatment after the onset of sepsis restored both proliferation and apoptosis to levels seen in sham animals and normalized expression of Bid, FADD, and p21cip1/waf. To determine whether improvements in gut homeostasis were associated with a decrease in sepsis-induced mortality, septic mice with or without EGF treatment after CLP were followed seven days for survival. Mortality decreased from 60% to 30% in mice treated with EGF after the onset of sepsis (p<0.05). EGF may thus be a potential therapeutic agent for the treatment of sepsis, in part due to its ability to protect intestinal integrity. PMID:18004230

Integration of intensive care treatment and neurorehabilitation in patients with disorders of consciousness: a program description and case report.

PubMed

Eifert, Bernd; Maurer-Karattup, Petra; Schorl, Martin

2013-10-01

Severe brain injuries frequently result in disorders of consciousness, requiring intensive care unit treatment. We present a rehabilitative system that integrates neurorehabilitation into intensive care treatment. The system will be described using the case report of a young man who was in a vegetative state after a severe traumatic brain injury that resulted in major medical problems and complications. Despite these challenges, interdisciplinary therapies can be applied throughout the rehabilitative process. The patient in our case report showed significant improvements and functional gains during the course of treatment. Additional data from other patients support the feasibility of this system and show that integrating neurorehabilitation into intensive care treatment is possible and can lead to improved outcomes in this patient population. We will discuss the advantages, special features, and limitations of the system. Additional studies are needed to further demonstrate the efficacy of this approach compared with standard treatment. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Development of an Integrated Wastewater Treatment System/water reuse/agriculture model

NASA Astrophysics Data System (ADS)

Fox, C. H.; Schuler, A.

2017-12-01

Factors like increasing population, urbanization, and climate change have made the management of water resources a challenge for municipalities. By understanding wastewater recycling for agriculture in arid regions, we can expand the supply of water to agriculture and reduce energy use at wastewater treatment plants (WWTPs). This can improve management decisions between WWTPs and water managers. The objective of this research is to develop a prototype integrated model of the wastewater treatment system and nearby agricultural areas linked by water and nutrients, using the Albuquerque Southeast Eastern Reclamation Facility (SWRF) and downstream agricultural system as a case study. Little work has been done to understand how such treatment technology decisions affect the potential for water ruse, nutrient recovery in agriculture, overall energy consumption and agriculture production and water quality. A holistic approach to understanding synergies and tradeoffs between treatment, reuse, and agriculture is needed. For example, critical wastewater treatment process decisions include options to nitrify (oxidize ammonia), which requires large amounts of energy, to operate at low dissolved oxygen concentrations, which requires much less energy, whether to recover nitrogen and phosphorus, chemically in biosolids, or in reuse water for agriculture, whether to generate energy from anaerobic digestion, and whether to develop infrastructure for agricultural reuse. The research first includes quantifying existing and feasible agricultural sites suitable for irrigation by reuse wastewater as well as existing infrastructure such as irrigation canals and piping by using GIS databases. Second, a nutrient and water requirement for common New Mexico crop is being determined. Third, a wastewater treatment model will be utilized to quantify energy usage and nutrient removal under various scenarios. Different agricultural reuse sensors and treatment technologies will be explored. The

Integrated, Home-based Treatment for MDR-TB and HIV in Rural South Africa: An Alternate Model of Care

PubMed Central

Brust, James C.M.; Shah, N. Sarita; Scott, Michelle; Chaiyachati, Krisda; Lygizos, Melissa; van der Merwe, Theo L.; Bamber, Sheila; Radebe, Zanele; Loveday, Marian; Moll, Anthony P.; Margot, Bruce; Lalloo, Umesh G.; Friedland, Gerald H.; Gandhi, Neel R.

2012-01-01

SUMMARY Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, inpatient treatment programs struggle to cope with rising prevalence and HIV co-infection rates. A new treatment model is needed to expand treatment capacity and improve MDR-TB and HIV outcomes. We describe the design and preliminary results of an integrated, home-based MDR-TB/HIV treatment program created in rural KwaZulu-Natal. In 2008, a decentralized center was established to provide outpatient MDR-TB and HIV treatment. Nurses, community health workers, and family supporters have been trained to administer injections, provide adherence support, and monitor adverse reactions in patients’ homes. Physicians assess clinical response, adherence, and adverse reaction severity to MDR-TB and HIV therapy at monthly follow-up visits. Treatment outcomes are assessed by monthly cultures and CD4 and viral load every 6 months. Eighty patients initiated MDR-TB therapy from 2/2008–4/2010; 66 were HIV co-infected. Retention has been high (only 5% defaults, 93% of visits attended) and preliminary outcomes have been favorable (77% cured/still on treatment, 82% undetectable viral load). Few patients have required escalation of care (9%), had severe adverse events (8%), or died (6%). Integrated, home-based treatment for MDR-TB and HIV is a promising treatment model to expand capacity and achieve improved outcomes in rural, resource-poor, and high-HIV prevalent settings. PMID:22668560

Treatment Integrity of Interventions with Children in the School Psychology Literature from 1995 to 2008

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser; Gritter, Katie L.; Dobey, Lisa M.

2011-01-01

Increased accountability in education has resulted in a focus on implementing interventions with strong empirical support. Both student outcome and treatment integrity data are needed to draw valid conclusions about intervention effectiveness. Reviews of the literature in other fields (e.g., applied behavior analysis, prevention science) suggest…

Integrating Fenton's process and ion exchange for olive mill wastewater treatment and iron recovery.

PubMed

Reis, Patrícia M; Martins, Pedro J M; Martins, Rui C; Gando-Ferreira, Licínio M; Quinta-Ferreira, Rosa M

2018-02-01

A novel integrated methodology involving Fenton's process followed by ion exchange (IE) was proposed for the treatment of olive mill wastewater. Fenton's process was optimized and it was able to remove up to 81% of chemical oxygen demand when pH 3.5, reaction time 1 h, [Fe 2+ ] = 50 mg L -1 and [Fe 2+ ]/[H 2 O 2 ] = 0.002 were applied. In spite of the potential of this treatment approach, final iron removal from the liquid typically entails pH increase and iron sludge production. The integration of an IE procedure using Lewatit TP 207 resin was found to be able to overcome this important environmental shortcoming. The resin showed higher affinity toward Fe 3+ than to Fe 2+ . However, the iron removal efficiency of an effluent coming from Fenton's was independent of the type of the initial iron used in the process. The presence of organic matter had no significant effect over the resin iron removal efficiency. Even if some efficiency decrease was observed when a high initial iron load was applied, the adsorbent mass quantity can be easily adapted to reach the desired iron removal. The use of IE is an interesting industrial approach able to surpass Fenton's peroxidation drawback and will surely boost its full-scale application in the treatment of bio-refractory effluents.

An integrated prediction and optimization model of biogas production system at a wastewater treatment facility.

PubMed

Akbaş, Halil; Bilgen, Bilge; Turhan, Aykut Melih

2015-11-01

This study proposes an integrated prediction and optimization model by using multi-layer perceptron neural network and particle swarm optimization techniques. Three different objective functions are formulated. The first one is the maximization of methane percentage with single output. The second one is the maximization of biogas production with single output. The last one is the maximization of biogas quality and biogas production with two outputs. Methane percentage, carbon dioxide percentage, and other contents' percentage are used as the biogas quality criteria. Based on the formulated models and data from a wastewater treatment facility, optimal values of input variables and their corresponding maximum output values are found out for each model. It is expected that the application of the integrated prediction and optimization models increases the biogas production and biogas quality, and contributes to the quantity of electricity production at the wastewater treatment facility. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial.

PubMed

Meyer, Björn; Berger, Thomas; Caspar, Franz; Beevers, Christopher G; Andersson, Gerhard; Weiss, Mario

2009-05-11

Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training. To evaluate the effectiveness of the Web-based intervention in a randomized controlled trial. There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Complete analyses and intention-to-treat analyses were performed. Of 396 participants, 216 (55%) completed the post-measurement 9 weeks later. Available case analyses revealed a significant reduction in depression severity (BDI), Cohen's d = .64 (CI 95% = 0.33 - 0.94), and significant improvement in social functioning (WSA), Cohen's d = .64, 95% (CI 95% = 0.33 - 0.95). These improvements were maintained at 6-month follow-up. Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements (BDI: Cohen's d = .30, CI 95% = 0.05 - 0.55; WSA: Cohen's d = .36, CI 95% = 0.10 - 0.61). Moreover, a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms (BDI: odds ratio [OR] = 6.8, CI 95% = 2.90 - 18.19) and recovered more often (OR = 17.3, 95% CI 2.3 - 130). More than 80% of

The integration of nutrients, cyanobacterial biomass and toxins: from a multi-use reservoir through water treatment

EPA Science Inventory

This presentation is an integrated evaluation of cyanobacterial growth and toxin production, from a reservoir through drinking water treatment - where biomass and toxin removal are achieved. Data is generated by a variety of methods: online instrumentation for chlorophyll, diss...

Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

PubMed Central

Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

2015-01-01

Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

Wastewater Treatment Energy Recovery Potential For Adaptation To Global Change: An Integrated Assessment

NASA Astrophysics Data System (ADS)

Breach, Patrick A.; Simonovic, Slobodan P.

2018-04-01

Approximately 20% of wastewaters globally do not receive treatment, whereas wastewater discharges are projected to increase, thereby leading to excessive water quality degradation of surface waters on a global scale. Increased treatment could help alleviate water quality issues by constructing more treatment plants; however, in many areas there exist economic constraints. Energy recovery methods including the utilization of biogas and incineration of biosolids generated during the treatment process may help to alleviate treatment costs. This study explores the potential for investments in energy recovery from wastewater to increase treatment levels and thus improve surface water quality. This was done by examining the relationships between nutrient over-enrichment, wastewater treatment, and energy recovery at a global scale using system dynamics simulation as part of the ANEMI integrated assessment model. The results show that a significant amount of energy can be recovered from wastewater, which helps to alleviate some of the costs of treatment. It was found that wastewater treatment levels could be increased by 34%, helping to offset the higher nutrient loading from a growing population with access to improved sanitation. The production of renewable natural gas from biogas was found to have the potential to prolong the depletion of natural gas resources used to produce electricity and heat. It is recommended that agricultural nutrient discharges be better managed to help reduce nutrient over-enrichment on global scale. To increase the utility of the simulation, a finer spatial scale should be used to consider regional treatment, economic, and water quality characteristics.

Wastewater Treatment Energy Recovery Potential For Adaptation To Global Change: An Integrated Assessment.

PubMed

Breach, Patrick A; Simonovic, Slobodan P

2018-04-01

Approximately 20% of wastewaters globally do not receive treatment, whereas wastewater discharges are projected to increase, thereby leading to excessive water quality degradation of surface waters on a global scale. Increased treatment could help alleviate water quality issues by constructing more treatment plants; however, in many areas there exist economic constraints. Energy recovery methods including the utilization of biogas and incineration of biosolids generated during the treatment process may help to alleviate treatment costs. This study explores the potential for investments in energy recovery from wastewater to increase treatment levels and thus improve surface water quality. This was done by examining the relationships between nutrient over-enrichment, wastewater treatment, and energy recovery at a global scale using system dynamics simulation as part of the ANEMI integrated assessment model. The results show that a significant amount of energy can be recovered from wastewater, which helps to alleviate some of the costs of treatment. It was found that wastewater treatment levels could be increased by 34%, helping to offset the higher nutrient loading from a growing population with access to improved sanitation. The production of renewable natural gas from biogas was found to have the potential to prolong the depletion of natural gas resources used to produce electricity and heat. It is recommended that agricultural nutrient discharges be better managed to help reduce nutrient over-enrichment on global scale. To increase the utility of the simulation, a finer spatial scale should be used to consider regional treatment, economic, and water quality characteristics.

Energy-nutrients-water nexus: integrated resource recovery in municipal wastewater treatment plants.

PubMed

Mo, Weiwei; Zhang, Qiong

2013-09-30

Wastewater treatment consumes large amounts of energy and materials to comply with discharge standards. At the same time, wastewater contains resources, which can be recovered for secondary uses if treated properly. Hence, the goal of this paper is to review the available resource recovery methods onsite or offsite of municipal wastewater treatment plants. These methods are categorized into three major resource recovery approaches: onsite energy generation, nutrient recycling and water reuse. Under each approach, the review provides the advantages and disadvantages, recovery potentials and current application status of each method, as well as the synthesized results of the life cycle studies for each approach. From a comprehensive literature review, it was found that, in addition to technology improvements, there is also a need to evaluate the applications of the resource recovery methods in wastewater treatment plants from a life cycle perspective. Future research should investigate the integration of the resource recovery methods to explore the combined benefits and potential tradeoffs of these methods under different scales. Copyright © 2013 Elsevier Ltd. All rights reserved.

Integration of membrane separation and Fenton processes for sanitary landfill leachate treatment.

PubMed

Santos, Amanda Vitória; Andrade, Laura Hamdan de; Amaral, Míriam Cristina Santos; Lange, Liséte Celina

2018-04-06

The appropriate treatment of sanitary landfill leachate is one of the greatest challenges nowadays due to the large volumes of solid waste generated. Thus, the aim of this study is to evaluate the performance of different routes involving the integration of advanced oxidation processes based on Fenton's reagents (AOP-Fenton) and microfiltration (MF) and nanofiltration (NF) membrane processes for the treatment of landfill leachate. MF module configuration (submerged or sidestream) and MF and NF recovery rate were evaluated. The combination of AOP-Fenton, MF and NF proved to be an effective treatment for landfill leachate. High removal efficiencies of chemical oxidation demand (94-96%) and colour (96-99%) were obtained. The configuration named route 3, composed of MF of raw landfill leachate (MF1), POA-Fenton-MF2 of the MF1 concentrate and NF of both MF1 and MF2 permeates, showed a higher global water recovery and was responsible for lower waste generation. It was considered the best one in terms of environmental, technical and economical aspects.

A novel integration of spectral-domain optical-coherence-tomography and laser-ablation system for precision treatment.

PubMed

Fan, Yingwei; Zhang, Boyu; Chang, Wei; Zhang, Xinran; Liao, Hongen

2018-03-01

Complete resection of diseased lesions reduces the recurrence of cancer, making it critical for surgical treatment. However, precisely resecting residual tumors is a challenge during operation. A novel integrated spectral-domain optical-coherence-tomography (SD-OCT) and laser-ablation therapy system for soft-biological-tissue resection is proposed. This is a prototype optical integrated diagnosis and therapeutic system as well as an optical theranostics system. We develop an optical theranostics system, which integrates SD-OCT, a laser-ablation unit, and an automatic scanning platform. The SD-OCT image of biological tissue provides an intuitive and clear view for intraoperative diagnosis and monitoring in real time. The effect of laser ablation is analyzed using a quantitative mathematical model. The automatic endoscopic scanning platform combines an endoscopic probe and an SD-OCT sample arm to provide optical theranostic scanning motion. An optical fiber and a charge-coupled device camera are integrated into the endoscopic probe, allowing detection and coupling of the OCT-aiming beam and laser spots. The integrated diagnostic and therapeutic system combines SD-OCT imaging and laser-ablation modules with an automatic scanning platform. OCT imaging, laser-ablation treatment, and the integration and control of diagnostic and therapeutic procedures were evaluated by performing phantom experiments. Furthermore, SD-OCT-guided laser ablation provided precision laser ablation and resection for the malignant lesions in soft-biological-tissue-lesion surgery. The results demonstrated that the appropriate laser-radiation power and duration time were 10 W and 10 s, respectively. In the laser-ablation evaluation experiment, the error reached approximately 0.1 mm. Another validation experiment was performed to obtain OCT images of the pre- and post-ablated craters of ex vivo porcine brainstem. We propose an optical integrated diagnosis and therapeutic system. The primary

Addressing the unique psychosocial barriers to breast cancer treatment experienced by African-American women through integrative navigation.

PubMed

Chatman, Michelle C; Green, Rodney D

2011-12-01

African-American women face a disproportionally high breast cancer mortality rate and a significantly low five-year survival rate after breast cancer treatment. This study investigated, through a series of focus groups, how 32 African-American women (N = 32) breast cancer patients and survivors managed their cancer-related health needs. Participants also reported important barriers to care including problematic interactions with medical professionals, challenges in intimate relations, difficulties in handling the stigma and myths about breast cancer, and the psychological challenges that they faced. A patient navigation model was implemented at an eastern urban hospital that emphasized integrative therapies such as meditation, nutritional instruction, and yoga. Follow-up telephone interviews with 37 additional African-American participants (N = 37) indicated the rating of effectiveness to be at 3.8 to 3.9 out of 4 for the integrative patient navigation program. Over half of the survivors reported using some complementary techniques after treatment was completed, thus suggesting a long-term improvement in their quality of life as a result of the integrative techniques.

A Randomized, Controlled Trial of Integrated Home-School Behavioral Treatment for ADHD, Predominantly Inattentive Type

ERIC Educational Resources Information Center

Pfiffner, Linda J.; Mikami, Amori Yee; Huang-Pollock, Cynthia; Easterlin, Barbara; Zalecki, Christine; McBurnett, Keith

2007-01-01

Objective: To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school (Child Life and Attention Skills Program) with attention-deficit/hyperactivity disorder (ADHD) predominantly inattentive type (ADHD-I). Method: Sixty-nine children ages 7 to 11 years were randomized to the Child Life and Attention Skills…

An Assessment of Treatment Integrity in Behavioral Intervention Studies Conducted with Persons with Mental Retardation

ERIC Educational Resources Information Center

Wheeler, John J.; Mayton, Michael R.; Carter, Stacy L.; Chitiyo, Morgan; Menendez, Anthony L.; Huang, Ann

2009-01-01

The purpose of this study was to assess the degree to which behavioral intervention studies conducted with persons with mental retardation operationally defined the independent variables and evaluated and reported measures of treatment integrity. The study expands the previous work in this area reported by Gresham, Gansle, and Noell (1993) and…

ECEM (eye closure eye movements): integrating aspects of EMDR with hypnosis for treatment of trauma.

PubMed

Hollander, H E; Bender, S S

2001-01-01

The paper addresses distinctions between hypnotic interventions and Eye Movement Desensitizing and Reprocessing (EMDR) and discusses their effect on persons who have symptoms of Posttraumatic Stress Disorder (PTSD). Eye movements in hypnosis and EMDR are considered in terms of the different ways they may affect responses in treatment. A treatment intervention within hypnosis called ECEM (Eye Closure, Eye Movements) is described. ECEM can be used for patients with histories of trauma who did not benefit adequately from either interventions in hypnosis or the EMDR treatment protocol used separately. In ECEM the eye movement variable of EMDR is integrated within a hypnosis protocol to enhance benefits of hypnosis and reduce certain risks of EMDR.

Removal of organics and degradation products from industrial wastewater by a membrane bioreactor integrated with ozone or UV/H₂O₂ treatment.

PubMed

Laera, G; Cassano, D; Lopez, A; Pinto, A; Pollice, A; Ricco, G; Mascolo, G

2012-01-17

The treatment of a pharmaceutical wastewater resulting from the production of an antibacterial drug (nalidixic acid) was investigated employing a membrane bioreactor (MBR) integrated with either ozonation or UV/H(2)O(2) process. This was achieved by placing chemical oxidation in the recirculation stream of the MBR. A conventional configuration with chemical oxidation as polishing for the MBR effluent was also tested as a reference. The synergistic effect of MBR when integrated with chemical oxidation was assessed by monitoring (i) the main wastewater characteristics, (ii) the concentration of nalidixic acid, (iii) the 48 organics identified in the raw wastewater and (iv) the 55 degradation products identified during wastewater treatment. Results showed that MBR integration with ozonation or UV/H(2)O(2) did not cause relevant drawbacks to both biological and filtration processes, with COD removal rates in the range 85-95%. Nalidixic acid passed undegraded through the MBR and was completely removed in the chemical oxidation step. Although the polishing configuration appeared to give better performances than the integrated system in removing 15 out of 48 secondary organics while similar removals were obtained for 19 other compounds. The benefit of the integrated system was however evident for the removal of the degradation products. Indeed, the integrated system allowed higher removals for 34 out of 55 degradation products while for only 4 compounds the polishing configuration gave better performance. Overall, results showed the effectiveness of the integrated treatment with both ozone and UV/H(2)O(2).

Early increase in marker of neuronal integrity with antidepressant treatment of major depression: 1H-magnetic resonance spectroscopy of N-acetyl-aspartate.

PubMed

Taylor, Matthew J; Godlewska, Beata R; Norbury, Ray; Selvaraj, Sudhakar; Near, Jamie; Cowen, Philip J

2012-11-01

Increasing interest surrounds potential neuroprotective or neurotrophic actions of antidepressants. While growing evidence points to important early clinical and neuropsychological effects of antidepressants, the time-course of any effect on neuronal integrity is unclear. This study used magnetic resonance spectroscopy to assess effects of short-term treatment with escitalopram on N-acetyl-aspartate (NAA), a marker of neuronal integrity. Thirty-nine participants with major depression were randomly assigned to receive either 10 mg escitalopram or placebo daily in a double-blind, parallel group design. On the seventh day of treatment, PRESS data were obtained from a 30×30×20 mm voxel placed in medial frontal cortex. Age and gender-matched healthy controls who received no treatment were also scanned. Levels of NAA were significantly higher in patients treated with escitalopram than in either placebo-treated patients (p<0.01) or healthy controls (p<0.01). Our findings are consistent with the proposition that antidepressant treatment in depressed patients can produce early changes in neuronal integrity.

Integrating Motivational Interviewing and Cognitive Behavioral Therapy in the Treatment of Eating Disorders: Tailoring Interventions to Patient Readiness for Change

ERIC Educational Resources Information Center

Geller, Josie; Dunn, Erin C.

2011-01-01

This paper focuses on the integration of Motivational Interviewing (MI) and cognitive behavioral therapy (CBT) in the treatment of eating disorders. Although CBT is regarded as the treatment of choice in this population, it nevertheless has limitations: some patients fail to engage, drop out from treatment prematurely, or simply do not improve.…

Daily light integral and day light quality: Potentials and pitfalls of nighttime UV treatments on cucumber powdery mildew.

PubMed

Suthaparan, Aruppillai; Solhaug, Knut Asbjørn; Stensvand, Arne; Gislerød, Hans Ragnar

2017-10-01

Nighttime ultraviolet (UV) radiation, if applied properly, has a significant potential for management of powdery mildews in many crop species. In this study, the role of growth light duration, irradiance, a combination of both (daily light integral) and light spectral quality (blue or red) on the efficacy of UV treatments against powdery mildew caused by Podosphaera xanthii and the growth performance of cucumber plants was studied in growth chambers. Increasing daily light integral provided by high-pressure sodium lamps (HPS) decreased efficacy of nighttime UV treatments against P. xanthii, but it increased plant growth. Furthermore, the efficacy of nighttime UV decreased when day length was increased from 16 to 20h at a constant daily light integral. The efficacy of nighttime UV increased if red light was applied after UV treatment, showing the possibility of day length extension without reducing the effect of UV. Increasing the dose of blue light during daytime reduced the efficacy of nighttime UV in controlling the disease, whereas blue deficient growth light (<6% of blue) caused UV mediated curling of young leaves. Furthermore, application of blue light after nighttime UV reduced its disease control efficacy. This showed the importance of maintaining a minimum of blue light in the growth light before nighttime UV treatment. Findings from this study showed that optimization of nighttime UV for management of powdery mildew is dependent on the spectral composition of the photosynthetically active radiation. Copyright © 2017 Elsevier B.V. All rights reserved.

Complementary Therapies for Significant Dysfunction from Tinnitus: Treatment Review and Potential for Integrative Medicine.

PubMed

Wolever, Ruth Q; Price, Rebecca; Hazelton, A Garrett; Dmitrieva, Natalia O; Bechard, Elizabeth M; Shaffer, Janet K; Tucci, Debara L

2015-01-01

Tinnitus is a prevalent and costly chronic condition; no universally effective treatment exists. Only 20% of patients who report tinnitus actually seek treatment, and when treated, most patients commonly receive sound-based and educational (SBE) therapy. Additional treatment options are necessary, however, for nonauditory aspects of tinnitus (e.g., anxiety, depression, and significant interference with daily life) and when SBE therapy is inefficacious or inappropriate. This paper provides a comprehensive review of (1) conventional tinnitus treatments and (2) promising complementary therapies that have demonstrated some benefit for severe dysfunction from tinnitus. While there has been no systematic study of the benefits of an Integrative Medicine approach for severe tinnitus, the current paper reviews emerging evidence suggesting that synergistic combinations of complementary therapies provided within a whole-person framework may augment SBE therapy and empower patients to exert control over their tinnitus symptoms without the use of medications, expensive devices, or extended programs.

How Does Scale of Implementation Impact the Environmental Sustainability of Wastewater Treatment Integrated with Resource Recovery?

PubMed

Cornejo, Pablo K; Zhang, Qiong; Mihelcic, James R

2016-07-05

Energy and resource consumptions required to treat and transport wastewater have led to efforts to improve the environmental sustainability of wastewater treatment plants (WWTPs). Resource recovery can reduce the environmental impact of these systems; however, limited research has considered how the scale of implementation impacts the sustainability of WWTPs integrated with resource recovery. Accordingly, this research uses life cycle assessment (LCA) to evaluate how the scale of implementation impacts the environmental sustainability of wastewater treatment integrated with water reuse, energy recovery, and nutrient recycling. Three systems were selected: a septic tank with aerobic treatment at the household scale, an advanced water reclamation facility at the community scale, and an advanced water reclamation facility at the city scale. Three sustainability indicators were considered: embodied energy, carbon footprint, and eutrophication potential. This study determined that as with economies of scale, there are benefits to centralization of WWTPs with resource recovery in terms of embodied energy and carbon footprint; however, the community scale was shown to have the lowest eutrophication potential. Additionally, technology selection, nutrient control practices, system layout, and topographical conditions may have a larger impact on environmental sustainability than the implementation scale in some cases.

Effects of Varied Levels of Treatment Integrity on Appropriate Toy Manipulation in Children with Autism

ERIC Educational Resources Information Center

Groskreutz, Nicole C.; Groskreutz, Mark P.; Higbee, Thomas S.

2011-01-01

We assessed the effects of varying the treatment integrity of a prompting procedure on appropriate toy manipulation in two preschool-aged children with autism. Following an assessment to identify toys with high levels of inappropriate toy manipulation, each of three toys was associated with implementation of the prompting procedure at a different…

Integration of Cleaner Production and Waste Water Treatment on Tofu Small Industry for Biogas Production using AnSBR Reactor

NASA Astrophysics Data System (ADS)

Rahayu, Suparni Setyowati; Budiyono; Purwanto

2018-02-01

A research on developing a system that integrates clean production and waste water treatment for biogas production in tofu small industry has been conducted. In this research, tofu waste water was turned into biogas using an AnSBR reactor. Mud from the sewage system serves as the inoculums. This research involved: (1) workshop; (2) supervising; (3) technical meeting; (4) network meeting, and (5) technical application. Implementation of clean production integrated with waste water treatment reduced the amount of waste water to be treated in a treatment plant. This means less cost for construction and operation of waste water treatment plants, as inherent limitations associated with such plants like lack of fund, limited area, and technological issues are inevitable. Implementation of clean production prior to waste water treatment reduces pollution figures down to certain levels that limitations in waste water treatment plants can be covered. Results show that biogas in 16 days HRT in an AnSBR reactor contains CH4(78.26 %) and CO2 (20.16 %). Meanwhile, treatments using a conventional bio-digester result in biogas with 72.16 % CH4 and 18.12 % CO2. Hence, biogas efficiency for the AnSBR system is 2.14 times greater than that of a conventional bio-digester.

Integrated monitoring technologies for the management of a Soil-Aquifer-Treatment (SAT) system.

NASA Astrophysics Data System (ADS)

Papadopoulos, Alexandros; Kallioras, Andreas; Kofakis, Petros; Bumberger, Jan; Schmidt, Felix; Athanasiou, Georgios; Uzunoglou, Nikolaos; Amditis, Angelos; Dietrich, Peter

2016-04-01

Artificial recharge of groundwater has an important role to play in water reuse as treated wastewater effluent can be infiltrated into the ground for aquifer recharge. As the effluent moves through the soil and the aquifer, it undergoes significant quality improvements through physical, chemical, and biological processes in the underground environment. Collectively, these processes and the water quality improvement obtained are called soil-aquifer-treatment (SAT) or geopurification. The pilot site of Lavrion Technological & Cultural Park (LTCP) of the National Technical University of Athens (NTUA), involves the employment of plot infiltration basins at experimental scale, which will be using waters of impaired quality as a recharge source, and hence acting as a Soil-Aquifer-Treatment, SAT, system. Τhe LTCP site will be employed as a pilot SAT system complemented by new technological developments, which will be providing continuous monitoring of the quantitative and qualitative characteristics of infiltrating groundwater through all hydrologic zones (i.e. surface, unsaturated and saturated zone). This will be achieved by the development and installation of an integrated system of prototype sensing technologies, installed on-site, and offering a continuous evaluation of the performance of the SAT system. An integrated approach of the performance evaluation of any operating SAT system should aim at parallel monitoring of all hydrologic zones, proving the sustainability of all involved water quality treatment processes within unsaturated and saturated zone. Hence a prototype system of Time and Frequency Domain Reflectometry (TDR & FDR) sensors is developed and will be installed, in order to achieve continuous quantitative monitoring of the unsaturated zone through the entire soil column down to significant depths below the SAT basin. Additionally, the system contains two different radar-based sensing systems that will be offering (i) identification of preferential

Low-threshold field emission in planar cathodes with nanocarbon materials

NASA Astrophysics Data System (ADS)

Zhigalov, V.; Petukhov, V.; Emelianov, A.; Timoshenkov, V.; Chaplygin, Yu.; Pavlov, A.; Shamanaev, A.

2016-12-01

Nanocarbon materials are of great interest as field emission cathodes due to their low threshold voltage. In this work current-voltage characteristics of nanocarbon electrodes were studied. Low-threshold emission was found in planar samples where field enhancement is negligible (<10). Electron work function values, calculated by Fowler-Nordheim theory, are anomalous low (<1 eV) and come into collision with directly measured work function values in fabricated planar samples (4.1-4.4 eV). Non-applicability of Fowler-Nordheim theory for the nanocarbon materials was confirmed. The reasons of low-threshold emission in nanocarbon materials are discussed.

Development and preliminary evaluation of an integrated treatment targeting parenting and depressive symptoms in mothers of children with attention-deficit/hyperactivity disorder.

PubMed

Chronis-Tuscano, Andrea; Clarke, Tana L; O'Brien, Kelly A; Raggi, Veronica L; Diaz, Yamalis; Mintz, Abigail D; Rooney, Mary E; Knight, Laura A; Seymour, Karen E; Thomas, Sharon R; Seeley, John; Kosty, Derek; Lewinsohn, Peter

2013-10-01

More than 50% of mothers of children with attention-deficit/hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Patient-centered care in cancer treatment programs: the future of integrative oncology through psychoeducation.

PubMed

Garchinski, Christina M; DiBiase, Ann-Marie; Wong, Raimond K; Sagar, Stephen M

2014-12-01

The reciprocal relationship between the mind and body has been a neglected process for improving the psychosocial care of cancer patients. Emotions form an important link between the mind and body. They play a fundamental role in the cognitive functions of decision-making and symptom control. Recognizing this relationship is important for integrative oncology. We define psychoeducation as the teaching of self-evaluation and self-regulation of the mind-body process. A gap exists between research evidence and implementation into clinical practice. The patients' search for self-empowerment through the pursuit of complementary therapies may be a surrogate for inadequate psychoeducation. Integrative oncology programs should implement psychoeducation that helps patients to improve both emotional and cognitive intelligence, enabling them to better negotiate cancer treatment systems.

Advanced treatment of biologically pretreated coal gasification wastewater by a novel integration of heterogeneous catalytic ozonation and biological process.

PubMed

Zhuang, Haifeng; Han, Hongjun; Jia, Shengyong; Hou, Baolin; Zhao, Qian

2014-08-01

Advanced treatment of biologically pretreated coal gasification wastewater (CGW) was investigated employing heterogeneous catalytic ozonation integrated with anoxic moving bed biofilm reactor (ANMBBR) and biological aerated filter (BAF) process. The results indicated that catalytic ozonation with the prepared catalyst (i.e. MnOx/SBAC, sewage sludge was converted into sludge based activated carbon (SBAC) which loaded manganese oxides) significantly enhanced performance of pollutants removal by generated hydroxyl radicals. The effluent of catalytic ozonation process was more biodegradable and less toxic than that in ozonation alone. Meanwhile, ANMBBR-BAF showed efficient capacity of pollutants removal in treatment of the effluent of catalytic ozonation at a shorter reaction time, allowing the discharge limits to be met. Therefore, the integrated process with efficient, economical and sustainable advantages was suitable for advanced treatment of real biologically pretreated CGW. Copyright © 2014 Elsevier Ltd. All rights reserved.

Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy

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

Yang, Bo; Wei, Xian-ding; Zhao, Yu-tian

2014-07-01

To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed fieldmore » of 6-MV x-rays (16 Gy) and 9-MeV electrons (34 Gy) for the upper supraclavicular region. The common prescription dose was 50 Gy/25 Fx/5 W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V{sub 30} of the ipsilateral lung and V{sub 10}, V{sub 30}, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V{sub 5} and V{sub 10} of the ipsilateral lung and V{sub 5} of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region.« less

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment.

PubMed

Killeen, Therese; Hien, Denise; Campbell, Aimee; Brown, Chanda; Hansen, Cheri; Jiang, Huiping; Kristman-Valente, Allison; Neuenfeldt, Christine; Rocz-de la Luz, Nicci; Sampson, Royce; Suarez-Morales, Lourdes; Wells, Elizabeth; Brigham, Greg; Nunes, Edward

2008-10-01

A substantial number of women who enter substance abuse treatment have a history of trauma and meet criteria for posttraumatic stress disorder (PTSD). Fear regarding the extent to which PTSD treatment can evoke negative consequences remains a research question. This study explored adverse events related to the implementation of an integrated treatment for women with trauma and substance use disorder (Seeking Safety) compared with a nontrauma-focused intervention (Women's Health Education). Three hundred fifty-three women enrolled in community substance abuse treatment were randomized to 1 of the 2 study groups and monitored weekly for adverse events. There were no differences between the two intervention groups in the number of women reporting study-related adverse events (28 [9.6%] for the Seeking Safety group and 21[7.2%] for the Women's Health Education group). Implementing PTSD treatment in substance abuse treatment programs appears to be safe, with minimal impact on intervention-related adverse psychiatric and substance abuse symptoms. More research is needed on the efficacy of such interventions to improve outcomes of PTSD and substance use.

The Cost-Effectiveness of the Integration of Nalmefene within the UK Healthcare System Treatment Pathway for Alcohol Dependence.

PubMed

Laramée, Philippe; Bell, Melissa; Irving, Adam; Brodtkorb, Thor-Henrik

2016-05-01

To assess the cost-effectiveness of integrating nalmefene within the treatment pathway for alcohol dependence recommended by the National Institute for Health and Care Excellence in the UK. A Markov model, taking a UK NHS perspective, followed a cohort with alcohol dependence and high/very high drinking risk levels (HVHDRLs), who do not require immediate detoxification and who continue at HVHDRLs after initial assessment, for 5 years. Costs and quality-adjusted life years (QALYs) from treatment with nalmefene plus psychosocial support versus psychosocial support alone were modelled. The consequent incidence of alcohol-attributable harmful events and disease progression, with the possibility of requiring other options or recurrent treatment, were captured. Nalmefene plus psychosocial support dominated psychosocial support alone, with lower costs and increased QALYs after 5 years. Savings are driven by the higher response to nalmefene, and the subsequent lower cost accumulation for alternatives. Nalmefene represents a highly cost-effective treatment option in this population. The analysis shows that integrating nalmefene within the current UK clinical treatment pathway for alcohol dependence could reduce the economic burden on the NHS by limiting harmful events and disease progression. © The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Portal dosimetry for VMAT using integrated images obtained during treatment

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

Bedford, James L., E-mail: James.Bedford@icr.ac.uk; Hanson, Ian M.; Hansen, Vibeke Nordmark

2014-02-15

Purpose: Portal dosimetry provides an accurate and convenient means of verifying dose delivered to the patient. A simple method for carrying out portal dosimetry for volumetric modulated arc therapy (VMAT) is described, together with phantom measurements demonstrating the validity of the approach. Methods: Portal images were predicted by projecting dose in the isocentric plane through to the portal image plane, with exponential attenuation and convolution with a double-Gaussian scatter function. Appropriate parameters for the projection were selected by fitting the calculation model to portal images measured on an iViewGT portal imager (Elekta AB, Stockholm, Sweden) for a variety of phantommore » thicknesses and field sizes. This model was then used to predict the portal image resulting from each control point of a VMAT arc. Finally, all these control point images were summed to predict the overall integrated portal image for the whole arc. The calculated and measured integrated portal images were compared for three lung and three esophagus plans delivered to a thorax phantom, and three prostate plans delivered to a homogeneous phantom, using a gamma index for 3% and 3 mm. A 0.6 cm{sup 3} ionization chamber was used to verify the planned isocentric dose. The sensitivity of this method to errors in monitor units, field shaping, gantry angle, and phantom position was also evaluated by means of computer simulations. Results: The calculation model for portal dose prediction was able to accurately compute the portal images due to simple square fields delivered to solid water phantoms. The integrated images of VMAT treatments delivered to phantoms were also correctly predicted by the method. The proportion of the images with a gamma index of less than unity was 93.7% ± 3.0% (1SD) and the difference between isocenter dose calculated by the planning system and measured by the ionization chamber was 0.8% ± 1.0%. The method was highly sensitive to errors in monitor units

Performance evaluation of vinasse treatment plant integrated with physico-chemical methods.

PubMed

Ojha, Sanjay Kumar; Mishra, Snehasish; Kumar, Satish; Mohanty, Shakti Shankar; Sarkar, Biplab; Singh, Monika; Chaudhury, Gautam Roy

2015-11-01

With an objective to assess environmental management criteria of a vinasse treatment plant (VTP) and to evaluate the critical environmental parameters, a study was undertaken in a multi-product (packaged apple juice, distillery, brewery, packaged drinking water) brewery-cum-distillery unit. The facility with a volumetric loading rate of 11-15 kg COD m(-3).day, 3.6-4.5 h hydraulic retention time and 20 g l(-1) VSS had a scientifically managed technically sound effluent treatment system. While the water quality parameters were found within the acceptable limits, there was 99.07% reduction in BOD, from 43140.0 to 398.0 mg l(-1) and 98.61% reduction in COD from 98003.0 to 1357.0 mg l(-1). There was appreciable improvement in mixed liquor suspended solids (MLSS), mixed liquorvolatile suspended solids (MLVSS) and sludge volume index (SVI). A striking feature was the integrated aerobic-anaerobic highly efficient Up-flow Anaerobic Sludge Blanket (UASB) treatment for biodegradation and energy production that reduced energy and space needs, producing utilisable end-products and net savings on the operational cost. The end-point waste management included terminal products such as fertile sludge, cattle feed supplement, recyclable water and biogas. Vast lagoons with combined aerobic-anaerobic approaches, biogasification unit, sludge recovery, remediated irrigable water were the notable attributes.

Cultural sensitivity and supportive expressive psychotherapy: an integrative approach to treatment.

PubMed

White, Tracela M; Gibbons, Mary Beth Connolly; Schamberger, Megan

2006-01-01

Cultural sensitivity is a concept that has become increasingly important in psychotherapy research and practice. In response to the growing ethnic minority population and the increased demand for psychological services among minority clients, many therapists and researchers have attempted to identify competencies and guidelines for providing culturally sensitive approaches to treatment. However, many cultural sensitivity concepts are theoretical and have rarely been integrated into an established psychotherapeutic framework. The purpose of this manuscript is to operationalize the concepts of cultural sensitivity into specific therapeutic techniques using a manual-guided Supportive Expressive Psychotherapy approach. Developing these strategies may serve to further assist therapists with the delivery of mental health services to ethnic minority clients.

Towards integration of PET/MR hybrid imaging into radiation therapy treatment planning

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

Paulus, Daniel H., E-mail: daniel.paulus@imp.uni-erlangen.de; Thorwath, Daniela; Schmidt, Holger

2014-07-15

Purpose: Multimodality imaging has become an important adjunct of state-of-the-art radiation therapy (RT) treatment planning. Recently, simultaneous PET/MR hybrid imaging has become clinically available and may also contribute to target volume delineation and biological individualization in RT planning. For integration of PET/MR hybrid imaging into RT treatment planning, compatible dedicated RT devices are required for accurate patient positioning. In this study, prototype RT positioning devices intended for PET/MR hybrid imaging are introduced and tested toward PET/MR compatibility and image quality. Methods: A prototype flat RT table overlay and two radiofrequency (RF) coil holders that each fix one flexible body matrixmore » RF coil for RT head/neck imaging have been evaluated within this study. MR image quality with the RT head setup was compared to the actual PET/MR setup with a dedicated head RF coil. PET photon attenuation and CT-based attenuation correction (AC) of the hardware components has been quantitatively evaluated by phantom scans. Clinical application of the new RT setup in PET/MR imaging was evaluated in anin vivo study. Results: The RT table overlay and RF coil holders are fully PET/MR compatible. MR phantom and volunteer imaging with the RT head setup revealed high image quality, comparable to images acquired with the dedicated PET/MR head RF coil, albeit with 25% reduced SNR. Repositioning accuracy of the RF coil holders was below 1 mm. PET photon attenuation of the RT table overlay was calculated to be 3.8% and 13.8% for the RF coil holders. With CT-based AC of the devices, the underestimation error was reduced to 0.6% and 0.8%, respectively. Comparable results were found within the patient study. Conclusions: The newly designed RT devices for hybrid PET/MR imaging are PET and MR compatible. The mechanically rigid design and the reproducible positioning allow for straightforward CT-based AC. The systematic evaluation within this study

The role of integrative medicine and Kampo treatment in an aging society: experience with Kampo treatment during a natural disaster.

PubMed

Takayama, Shin; Numata, Takehiro; Iwasaki, Koh; Kuroda, Hitoshi; Kagaya, Yutaka; Ishii, Tadashi; Yaegashi, Nobuo

2014-01-01

After the Great East Japan Earthquake, elderly individuals, who are particularly vulnerable during natural disasters, experienced difficulty while evacuating the area. This report discusses the Kampo treatments provided to elderly individuals in the disaster areas, and the role of integrative medicine and Kampo treatment. The changes in symptoms and Kampo treatment contents were summarized using the medical records of treatments provided in the evacuation centers until 10 weeks after the earthquake. Infectious diseases, the common cold and hypothermia were frequently observed in most patients for first two weeks after the disaster. Allergies increased two weeks later, and mental distress was commonly observed six weeks later. We prescribed several Kampo formulas to treat the individual symptoms. Many elderly individuals were treated using Western medications, but the symptoms persisted; however, after Kampo formulas were included in the treatment, the symptoms of many patients improved. Unlike Western medications, Kampo formulas warmed the bodies of elderly individuals who often had a reduced basal metabolism and low body temperatures due to exposure to the cold tsunami waters. Therefore, the Kampo formulas may have improved the immunity of those who were under psychological and physical stress because they had spent several days in the evacuation centers. Many studies have reported the effectiveness of Kampo formulas. Therefore, the combined usage of both Western and Kampo medicine may be used in a mutually complementary manner, and these combination treatments may play an important role in preserving the victims overall health after natural disasters.

Utilization Pattern and Drug Use of Traditional Chinese Medicine, Western Medicine, and Integrated Chinese-Western Medicine Treatments for Allergic Rhinitis Under the National Health Insurance Program in Taiwan.

PubMed

Huang, Sheng-Kang; Lai, Chih-Sung; Chang, Yuan-Shiun; Ho, Yu-Ling

2016-10-01

Patients in Taiwan with allergic rhinitis seek not only Western medicine treatment but also Traditional Chinese Medicine treatment or integrated Chinese-Western medicine treatment. Various studies have conducted pairwise comparison on Traditional Chinese Medicine, Western medicine, and integrated Chinese-Western medicine treatments. However, none conducted simultaneous analysis of the three treatments. This study analyzed patients with allergic rhinitis receiving the three treatments to identify differences in demographic characteristic and medical use and thereby to determine drug use patterns of different treatments. The National Health Insurance Research Database was the data source, and included patients were those diagnosed with allergic rhinitis (International Classification of Diseases, Ninth Revision, Clinical Modification codes 470-478). Chi-square test and Tukey studentized range (honest significant difference) test were conducted to investigate the differences among the three treatments. Visit frequency for allergic rhinitis treatment was higher in female than male patients, regardless of treatment with Traditional Chinese Medicine, Western medicine, or integrated Chinese-Western medicine. Persons aged 0-19 years ranked the highest in proportion of visits for allergic rhinitis. Traditional Chinese Medicine treatment had more medical items per person-time and daily drug cost per person-time and had the lowest total expenditure per person-time. In contrast, Western medicine had the lowest daily drug cost per person-time and the highest total expenditure per person-time. The total expenditure per person-time, daily drug cost per person-time, and medical items per person-time of integrated Chinese-Western medicine treatment lay between those seen with Traditional Chinese Medicine and Western medicine treatments. Although only 6.82 % of patients with allergic rhinitis chose integrated Chinese-Western medicine treatment, the visit frequency per person-year of

Within-team Patterns of Communication and Referral in Multimodal Treatment of Chronic Low Back Pain Patients by an Integrative Care Team.

PubMed

O'Connor, Bonnie B; Eisenberg, David M; Buring, Julie E; Liang, Catherine L; Osypiuk, Kamila; Levy, Donald B; Wayne, Peter M

2015-03-01

Nonspecific chronic low back pain (CLBP) is a highly prevalent and costly public health problem with few treatment options that provide consistent and greater than modest benefits. Treatment of CLBP is shifting from unimodal to multimodal and multidisciplinary approaches, including biopsychosocially-based complementary and integrative care. Multidisciplinary approaches require unique levels of communication and coordination amongst clinicians; however, to date few studies have evaluated patterns of communication and decision making amongst clinicians collaborating in the care of challenging patients with CLBP. As part of an observational study evaluating the effectiveness and cost-effectiveness of an integrative, team-based care model for the treatment of CLBP, we used multiple qualitative research methods to characterize within-team cross-referral and communication amongst jointly-trained practitioners representing diverse biomedical and complementary disciplines. Patterns of communication and coordinated care are summarized for 3 cases of CLBP treated by multiple members (≥3) of an integrative medical team embedded within an academic hospital. Patients were aged from 36 to 88 years with varied comorbidities. Qualitative content analysis revealed 5 emergent themes regarding integrative patient care and treatment decision in this clinic: (1) the fundamental importance of the clinic's formal teamwork training; (2) the critical communicative and collaborative function of regular team meetings; (3) the importance to patient care goals of having the varied disciplines practicing "under one roof"; (4) a universal commitment to understanding and treating patients as whole persons; and (5) a shared philosophy of helping patients to help themselves. These key themes are all interconnected and form the foundation of the clinic's culture. Our qualitative findings provide context for current trends in enhancing patient-centered, coordinated, and team-based care; efforts

A biofilter integrated with gas membrane separation unit for the treatment of fluctuating styrene loads.

PubMed

Li, Lin; Lian, Jing; Han, Yunping; Liu, Junxin

2012-05-01

Biofiltration for volatile organic compound control in waste gas streams is best operated at steady contaminant loadings. To provide long-term stable operation of a biofilter under adverse contaminant feeding conditions, an integrated bioreactor system with a gas separation membrane module installed after a biofilter was proposed for styrene treatment. Styrene was treated effectively, with average styrene effluent concentrations maintained at less than 50 mg m(-3) and a total removal efficiency of over 96% achieved when the biofiltration column faced fluctuating loads. The maximum elimination capacity of the integrated bioreactor system was 93.8 g m(-3)h(-1), which was higher than that obtained with the biofiltration column alone. The combination of these two processes (microbial and chemical) led to more efficient elimination of styrene and buffering of the fluctuating loads. The factors on gas membrane separation, microbial characteristics in the integrated bioreactor and membrane fouling were also investigated in this study. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Relationship between Treatment Integrity and Acceptability of Reading Interventions for Children with Attention-Deficit/Hyperactivity Disorder

ERIC Educational Resources Information Center

Mautone, Jennifer A.; DuPaul, George J.; Jitendra, Asha K.; Tresco, Katy E.; Junod, Rosemary Vile; Volpe, Robert J.

2009-01-01

This study examined the relationship between treatment integrity and acceptability for reading interventions across two consultation models, intensive data-based academic intervention (IDAI) and traditional data-based academic intervention (TDAI). Participants included 83 first- through fourth-grade students who met research criteria for…

[Compliance with the treatment by patients with the co-infection HIV/tuberculosis: integrative literature review].

PubMed

Neves, Lis Aparecida de Souza; Reis, Renata Karina; Gir, Elucir

2010-12-01

This is an integrative review whose objective was to evaluate the evidences available in the literature about the factors associated to the compliance with the treatment by patients with the co-infection HIV/TB. Articles published in the period from 2002 to 2008, in the databases LILACS and MEDLINE were analyzed. The material was categorized according to the year of publication, periodical, study location and factors related to the compliance. The final sample included eight articles. The factors found, associated to the compliance with the treatment of the co-infection HIV/TB, related to: the individual and his lifestyle (previous TB treatment, fear of stigma and discrimination, use of chemical substances, depression, social support); the disease and the medication (type of medication regime, use of other medication, adverse effects, difficulty to diagnose TB in these patients); and the health services (operational problems to follow up the treatment, training of the professionals, supervision, different locations to treat TB and HIV).

Long-term impact of integration of household water treatment and hygiene promotion with antenatal services on maternal water treatment and hygiene practices in Malawi.

PubMed

Loharikar, Anagha; Russo, Elizabeth; Sheth, Anandi; Menon, Manoj; Kudzala, Amose; Tauzie, Blessius; Masuku, Humphreys D; Ayers, Tracy; Hoekstra, Robert M; Quick, Robert

2013-02-01

A clinic-based program to integrate antenatal services with distribution of hygiene kits including safe water storage containers, water treatment solution (brand name WaterGuard), soap, and hygiene education, was implemented in Malawi in 2007 and evaluated in 2010. We surveyed 389 participants at baseline in 2007, and found and surveyed 232 (60%) participants to assess water treatment, test stored drinking water for residual chlorine (an objective measure of treatment), and observe handwashing technique at follow-up in 2010. Program participants were more likely to know correct water treatment procedures (67% versus 36%; P < 0.0001), treat drinking water with WaterGuard (24% versus 2%; P < 0.0001), purchase and use WaterGuard (21% versus 1%; P < 0.001), and demonstrate correct handwashing technique (50% versus 21%; P < 0.001) at the three-year follow-up survey than at baseline. This antenatal-clinic-based program may have contributed to sustained water treatment and proper handwashing technique among program participants.

Examining the Influence of Treatment Integrity: Accuracy of Daily Report Card Intervention Implementation and Student Outcome

ERIC Educational Resources Information Center

Vujnovic, Rebecca Kate

2010-01-01

Given the deficits associated with ADHD and the significant prevalence, it is important to explore evidence based treatments for ADHD in the classroom and the efficacy with which the classroom teachers implement such interventions. The current investigation is a secondary analysis to investigate the integrity of a Daily Report Card (DRC)…

Fully integrated e-services for prevention, diagnosis, and treatment of sexually transmitted infections: results of a 4-county study in California.

PubMed

Spielberg, Freya; Levy, Vivian; Lensing, Shelly; Chattopadhyay, Ishita; Venkatasubramanian, Lalitha; Acevedo, Nincoshka; Wolff, Peter; Callabresi, Debra; Philip, Susan; Lopez, Teresa P; Padian, Nancy; Blake, Diane R; Gaydos, Charlotte A

2014-12-01

We examined the acceptability, feasibility, and cost of a fully integrated online system (eSTI) for sexually transmitted infection (STI) testing, treatment, and linkage to care with 4 Northern California health departments. In April 2012, we implemented the eSTI system, which provided education; testing of self-collected vaginal swabs for chlamydia, gonorrhea, and trichomoniasis; e-prescriptions; e-partner notification; and data integration with clinic electronic health records. We analyzed feasibility, acceptability, and cost measures. During a 3-month period, 217 women aged 18 to 30 years enrolled; 67% returned the kit. Of these, 92% viewed their results online. STI prevalence was 5.6% (chlamydia and trichomoniasis). All participants with STIs received treatment either the same day at a pharmacy (62%) or within 7 days at a clinic (38%). Among participants completing follow-up surveys, 99% would recommend the online eSTI system to a friend, and 95% preferred it over clinic-based testing within a study. The fully integrated eSTI system has the potential to increase diagnosis and treatment of STIs with higher patient satisfaction at a potentially lower cost.

TU-G-210-02: TRANS-FUSIMO - An Integrative Approach to Model-Based Treatment Planning of Liver FUS

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

Preusser, T.

Modeling can play a vital role in predicting, optimizing and analyzing the results of therapeutic ultrasound treatments. Simulating the propagating acoustic beam in various targeted regions of the body allows for the prediction of the resulting power deposition and temperature profiles. In this session we will apply various modeling approaches to breast, abdominal organ and brain treatments. Of particular interest is the effectiveness of procedures for correcting for phase aberrations caused by intervening irregular tissues, such as the skull in transcranial applications or inhomogeneous breast tissues. Also described are methods to compensate for motion in targeted abdominal organs such asmore » the liver or kidney. Douglas Christensen – Modeling for Breast and Brain HIFU Treatment Planning Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Learning Objectives: Understand the role of acoustic beam modeling for predicting the effectiveness of therapeutic ultrasound treatments. Apply acoustic modeling to specific breast, liver, kidney and transcranial anatomies. Determine how to obtain appropriate acoustic modeling parameters from clinical images. Understand the separate role of absorption and scattering in energy delivery to tissues. See how organ motion can be compensated for in ultrasound therapies. Compare simulated data with clinical temperature measurements in transcranial applications. Supported by NIH R01 HL172787 and R01 EB013433 (DC); EU Seventh Framework Programme (FP7/2007-2013) under 270186 (FUSIMO) and 611889 (TRANS-FUSIMO)(TP); and P01 CA159992, GE, FUSF and InSightec (UV)« less

[Integrated treatment of cooccurring mental and substance use disorders in urban populations : the situation in Montréal].

PubMed

Dubreucq, Simon; Chanut, Florence; Jutras-Aswad, Didier

2012-01-01

The prevalence of patients diagnosed with both a psychiatric and an addiction disorder is considerable. Like many other large urban centers, Montreal harbors many of these socially marginalized individuals. In spite of a wide range of resources for the treatment of each condition taken singly, there has been until recently an alarming dearth of programs aimed at providing integrated treatment models. In recent years, the CHUM has endeavored to implement such a program in order to address the multiple needs of a population often rendered vulnerable in many respects. In this article, the authors address the magnitude of this "dual diagnosis" problem, existing intervention models and the obstacles faced by this population in terms of access to health care ; they describe the steps leading to the establishment of an Addiction Psychiatric Unit at the CHUM and the challenges arising from the creation of a multidisciplinary integrated treatment model in an urban setting.

Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study

PubMed Central

Irwin, Kevin S.; Jones, Emlyn S.; Becker, William C.; Tetrault, Jeanette M.; Sullivan, Lynn E.; Hansen, Helena; O’Connor, Patrick G.; Schottenfeld, Richard S.; Fiellin, David A.

2008-01-01

BACKGROUND Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians’ attitudes towards this new medical practice has been largely neglected. OBJECTIVE To identify facilitators and barriers to the potential or actual implementation of BMT by office-based medical providers. DESIGN Qualitative study using individual and group semi-structured interviews. PARTICIPANTS Twenty-three practicing office-based physicians in New England. APPROACH Interviews were audiotaped, transcribed, and entered into a qualitative software program. The transcripts were thematically coded using the constant comparative method by a multidisciplinary team. RESULTS Eighty percent of the physicians were white; 55% were women. The mean number of years since graduating medical school was 14 (SD = 10). The primary areas of clinical specialization were internal medicine (50%), infectious disease (20%), and addiction medicine (15%). Physicians identified physician, patient, and logistical factors that would either facilitate or serve as a barrier to their integration of BMT into clinical practice. Physician facilitators included promoting continuity of patient care, positive perceptions of BMT, and viewing BMT as a positive alternative to methadone maintenance. Physician barriers included competing activities, lack of interest, and lack of expertise in addiction treatment. Physicians’ perceptions of patient-related barriers included concerns about confidentiality and cost, and low motivation for treatment. Perceived logistical barriers included lack of remuneration for BMT, limited ancillary support for physicians, not enough time, and a perceived low prevalence of opioid dependence in physicians’ practices. CONCLUSIONS Addressing physicians’ perceptions of facilitators and barriers to BMT is crucial to supporting the further expansion of BMT into primary care and office-based practices

Integration of alternative feedstreams for biomass treatment and utilization

DOEpatents

Hennessey, Susan Marie [Avondale, PA; Friend, Julie [Claymont, DE; Dunson, Jr., James B.; Tucker, III, Melvin P.; Elander, Richard T [Evergreen, CO; Hames, Bonnie [Westminster, CO

2011-03-22

The present invention provides a method for treating biomass composed of integrated feedstocks to produce fermentable sugars. One aspect of the methods described herein includes a pretreatment step wherein biomass is integrated with an alternative feedstream and the resulting integrated feedstock, at relatively high concentrations, is treated with a low concentration of ammonia relative to the dry weight of biomass. In another aspect, a high solids concentration of pretreated biomass is integrated with an alternative feedstream for saccharifiaction.

Feasibility of laser-integrated high intensity focused ultrasound (HIFU) treatment for bladder tumors: in vitro study (Conference Presentation)

NASA Astrophysics Data System (ADS)

Nguyen, Van Phuc; Park, Suhyun; Oh, Junghwan; Kang, Hyun Wook

2016-02-01

Previous studies have shown that photothemal therapy combined with high intensity focused ultrasound (HIFU) can provide a promising method to achieve rapid thermal coagulation during surgical procedures. The current study investigated the feasibility of the laser-integrated high intensity focused ultrasound (HIFU) application to treat bladder tumors by enhancing thermal effects and therapeutic depth in vitro. To generate thermal coagulation, a single element HIFU transducer with a central frequency of 2.0 MHz was used to transmit acoustic energy to 15 fresh porcine bladders injected with an artificial tumor (100 µl gelatin and hemoglobin solution) in vitro. Simultaneously, an 80-W 532-nm laser system was also implemented to induce thermal necrosis in the targeted tissue. The intensity of 570 W/cm2 at the focus of HIFU and laser energy of 0.9 W were applied to all the samples for 40 s. The temperature rise increased up to about 1.6 or 3 folds (i.e., ΔT=32±3.8 K for laser-integrated HIFU, ΔT=20±6.5 K for HIFU only, and ΔT=11±5.6 K for laser only). The estimated lesion depth also increased by 1.3 and 2 folds during the dual-thermal treatment, in comparison with the treatment by either HIFU or laser. The results indicated that the laser-integrated HIFU treatment can be an efficient hyperthermic method for tumor coagulation.

Effect of Practice Integration between Urologists and Radiation Oncologists on Prostate Cancer Treatment Patterns

PubMed Central

Bekelman, Justin E.; Suneja, Gita; Guzzo, Thomas; Evan Pollack, Craig; Armstrong, Katrina; Epstein, Andrew J.

2013-01-01

Purpose National attention has focused on whether urology-radiation oncology practice integration – known as integrated prostate cancer centers (IPCCs) – contributes to use of intensity-modulated radiation therapy (IMRT), a common and expensive treatment for prostate cancer. Methods We examined prostate cancer treatment patterns pre- and post-conversion of a urology practice to an IPCC in July, 2006. Using the SEER-Medicare database, we identified patients age ≥ 65 years diagnosed in one state-wide registry with non-metastatic prostate cancer between 2004 and 2007 and classified patients into 3 groups: (1) those seen by IPCC physicians (exposure group); (2) those living in the same hospital referral region (HRR) and not seen by IPCC physicians (HRR-control group); and (3) those living elsewhere in the state (state-control group). We compared changes in treatment among the 3 groups, adjusting for patient, clinical, and socio-economic factors. Results Compared with the 8.1 percentage point (ppt) increase in adjusted IMRT use in the state-control group, IMRT increased 20.3 ppts (95% confidence interval [CI] 13.4, 27.1) in the IPCC group and 19.2 ppts (95% CI 9.6, 28.9) in the HRR-control group. Androgen-deprivation therapy (ADT), for which Medicare reimbursement declined sharply, decreased similarly in the IPCC and HRR-control groups. Prostatectomy declined significantly in the IPCC group. Conclusions Coincident with the conversion of a urology group practice to an IPCC, we observed increases in IMRT and decreases in ADT among patients seen by IPCC physicians and those seen in the surrounding healthcare market that were not observed in the remainder of the state. PMID:23399652

An Integrated Water Treatment Technology Solution for Sustainable Water Resource Management in the Marcellus Shale

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

Matthew Bruff; Ned Godshall; Karen Evans

2011-04-30

This Final Scientific/ Technical Report submitted with respect to Project DE-FE0000833 titled 'An Integrated Water Treatment Technology Solution for Sustainable Water Resource Management in the Marcellus Shale' in support of final reporting requirements. This final report contains a compilation of previous reports with the most current data in order to produce one final complete document. The goal of this research was to provide an integrated approach aimed at addressing the increasing water resource challenges between natural gas production and other water stakeholders in shale gas basins. The objective was to demonstrate that the AltelaRain{reg_sign} technology could be successfully deployed inmore » the Marcellus Shale Basin to treat frac flow-back water. That objective has been successfully met.« less

Advanced treatment of biologically pretreated coal gasification wastewater by a novel integration of three-dimensional catalytic electro-Fenton and membrane bioreactor.

PubMed

Jia, Shengyong; Han, Hongjun; Hou, Baolin; Zhuang, Haifeng

2015-12-01

Laboratorial scale experiments were conducted to investigate a novel system three-dimensional catalytic electro-Fenton (3DCEF, catalyst of sewage sludge based activated carbon which loaded Fe3O4) integrating with membrane bioreactor (3DCEF-MBR) on advanced treatment of biologically pretreated coal gasification wastewater. The results indicated that 3DCEF-MBR represented high efficiencies in eliminating COD and total organic carbon, giving the maximum removal efficiencies of 80% and 75%, respectively. The integrated 3DCEF-MBR system significantly reduced the transmembrane pressure, giving 35% lower than conventional MBR after 30 days operation. The enhanced hydroxyl radical oxidation and bacteria self repair function were the mechanisms for 3DCEF-MBR performance. Therefore, the integrated 3DCEF-MBR was expected to be the promising technology for advanced treatment in engineering applications. Copyright © 2015. Published by Elsevier Ltd.

Integrative Treatment of Reflux and Functional Dyspepsia in Children

PubMed Central

Yeh, Ann Ming; Golianu, Brenda

2014-01-01

Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications—such as pain, asthma, aspiration pneumonia, or chronic cough. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture. PMID:27417471

Membrane-integrated physico-chemical treatment of coke-oven wastewater: transport modelling and economic evaluation.

PubMed

Kumar, Ramesh; Chakrabortty, Sankha; Pal, Parimal

2015-04-01

A modelling and simulation study with economic evaluation was carried out for an advanced membrane-integrated hybrid treatment process that ensures reuse of water with recovery of ammoniacal nitrogen as struvite from coke-oven wastewater. Linearized transport model was developed based on extended Nernst-Plank and concentration polarization modulus equation. Effects of pH, transmembrane pressure and cross-flow rate of interest on membrane charge density, solute rejection and solvent flux were investigated. The membrane module was successful in yielding a pure water flux as high as 120 L m(-2) h(-1) removing more than 95 and 96% of the cyanide and phenol, respectively, while permeating more than 90% NH4 (+)-N at a transmembrane pressure of only 15 × 10(2) KPa and at a pH of 10 for a volumetric cross-flow rate of 800 L h(-1). The Fenton's reagents were used to degrade more than 99% of pollutants present in the concentrated stream. The developed model could successfully predict the plant performance as reflected in the very low relative error (0.01-0.12) and overall high correlation coefficient (R(2) > 0.96). Economic analysis indicated that such a membrane-integrated hybrid system could be quite promising in coke wastewater treatment at low cost i.e. $0.934/m(2) of wastewater.

Treatment of Chemotherapy-Induced Peripheral Neuropathy in Integrative Oncology: A Survey of Acupuncture and Oriental Medicine Practitioners.

PubMed

Lu, Zhaoxue; Moody, Jennifer; Marx, Benjamin L; Hammerstrom, Tracy

2017-12-01

Complementary and alternative medicine is increasingly integrated into cancer care. We sought detail on the treatment of chemotherapy-induced peripheral neuropathy (CIPN) with acupuncture and oriental medicine (AOM) by surveying practitioners at integrative oncology (IO) sites across the United States. Online survey of licensed acupuncturists. IO sites in the United States. Fifteen licensed acupuncturists who completed the survey between February 2014 and June 2014. Demographics, IO setting characteristics, AOM treatment characteristics, and practitioner-reported outcomes. Respondents reported an average of 31.3 ± 17.2 patients per week, and one-third (10.1 mean; 7.2 standard deviation [SD]) were treated for CIPN. Medical doctors (86.7%) were the most common providers with whom respondents worked. Traditional Chinese medicine style acupuncture was utilized by a majority of respondents (86.7%), and the most commonly used points were local, typically in the hands and feet, such as Ba Feng, Ba Xie, LV3, and LI4. In addition to acupuncture, nutritional advice was the most frequent auxiliary modality provided by respondents (85.7%). On average, respondents provided 12.75 ± 4.17 treatments for CIPN patients, and a majority (53%) reported treating patients once per week. Timing of the treatments relative to chemotherapy infusion was evenly distributed between "1-2 days after infusion" (60%), "at time of infusion" (53.3%), and "1-2 days before infusion" (46.7%). Sixty percent of respondents rated outcomes as "moderately successful with moderate improvement seen." This survey provides detail regarding IO sites using acupuncture for CIPN as well as real-world treatment patterns, including common point combinations, visit characteristics, and practitioner-reported outcomes. This information contributes to the emerging evidence on the use of acupuncture to address unmet needs of CIPN patients, and supports the development of best practice guidelines for the treatment

Integration of Power to Methane in a waste water treatment plant - A feasibility study.

PubMed

Patterson, Tim; Savvas, Savvas; Chong, Alex; Law, Ian; Dinsdale, Richard; Esteves, Sandra

2017-12-01

The integration of a biomethanation system within a wastewater treatment plant for conversion of CO 2 and H 2 to CH 4 has been studied. Results indicate that the CO 2 could be utilised to produce an additional 13,420m 3 /day of CH 4 , equivalent to approximately 133,826kWh of energy. The whole conversion process including electrolysis was found to have an energetic efficiency of 66.2%. The currently un-optimised biomethanation element of the process had a parasitic load of 19.9% of produced energy and strategies to reduce this to <5% are identified. The system could provide strategic benefits such as integrated management of electricity and gas networks, energy storage and maximising the deployment and efficiency of renewable energy assets. However, no policy or financial frameworks exist to attribute value to these increasingly important functions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Development and assessment of an integrated ecological modelling framework to assess the effect of investments in wastewater treatment on water quality.

PubMed

Holguin-Gonzalez, Javier E; Boets, Pieter; Everaert, Gert; Pauwels, Ine S; Lock, Koen; Gobeyn, Sacha; Benedetti, Lorenzo; Amerlinck, Youri; Nopens, Ingmar; Goethals, Peter L M

2014-01-01

Worldwide, large investments in wastewater treatment are made to improve water quality. However, the impacts of these investments on river water quality are often not quantified. To assess water quality, the European Water Framework Directive (WFD) requires an integrated approach. The aim of this study was to develop an integrated ecological modelling framework for the River Drava (Croatia) that includes physical-chemical and hydromorphological characteristics as well as the ecological river water quality status. The developed submodels and the integrated model showed accurate predictions when comparing the modelled results to the observations. Dissolved oxygen and nitrogen concentrations (ammonium and organic nitrogen) were the most important variables in determining the ecological water quality (EWQ). The result of three potential investment scenarios of the wastewater treatment infrastructure in the city of Varaždin on the EWQ of the River Drava was assessed. From this scenario-based analysis, it was concluded that upgrading the existing wastewater treatment plant with nitrogen and phosphorus removal will be insufficient to reach a good EWQ. Therefore, other point and diffuse pollution sources in the area should also be monitored and remediated to meet the European WFD standards.

Fully Integrated e-Services for Prevention, Diagnosis, and Treatment of Sexually Transmitted Infections: Results of a 4-County Study in California

PubMed Central

Levy, Vivian; Lensing, Shelly; Chattopadhyay, Ishita; Venkatasubramanian, Lalitha; Acevedo, Nincoshka; Wolff, Peter; Callabresi, Debra; Philip, Susan; Lopez, Teresa P.; Padian, Nancy; Blake, Diane R.; Gaydos, Charlotte A.

2014-01-01

Objectives. We examined the acceptability, feasibility, and cost of a fully integrated online system (eSTI) for sexually transmitted infection (STI) testing, treatment, and linkage to care with 4 Northern California health departments. Methods. In April 2012, we implemented the eSTI system, which provided education; testing of self-collected vaginal swabs for chlamydia, gonorrhea, and trichomoniasis; e-prescriptions; e-partner notification; and data integration with clinic electronic health records. We analyzed feasibility, acceptability, and cost measures. Results. During a 3-month period, 217 women aged 18 to 30 years enrolled; 67% returned the kit. Of these, 92% viewed their results online. STI prevalence was 5.6% (chlamydia and trichomoniasis). All participants with STIs received treatment either the same day at a pharmacy (62%) or within 7 days at a clinic (38%). Among participants completing follow-up surveys, 99% would recommend the online eSTI system to a friend, and 95% preferred it over clinic-based testing within a study. Conclusions. The fully integrated eSTI system has the potential to increase diagnosis and treatment of STIs with higher patient satisfaction at a potentially lower cost. PMID:25320878

Implementation of integrated dual disorders treatment: a qualitative analysis of facilitators and barriers.

PubMed

Brunette, Mary F; Asher, Dianne; Whitley, Rob; Lutz, Wilma J; Wieder, Barbara L; Jones, Amanda M; McHugo, Gregory J

2008-09-01

Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers.

(+/-)-3,4-Methylenedioxymethamphetamine treatment in adult rats impairs path integration learning: a comparison of single vs once per week treatment for 5 weeks.

PubMed

Skelton, Matthew R; Able, Jessica A; Grace, Curtis E; Herring, Nicole R; Schaefer, Tori L; Gudelsky, Gary A; Vorhees, Charles V; Williams, Michael T

2008-12-01

3,4-Methlylenedioxymethamphetamine (MDMA) administration (4 x 15 mg/kg) on a single day has been shown to cause path integration deficits in rats. While most animal experiments focus on single binge-type models of MDMA use, many MDMA users take the drug on a recurring basis. The purpose of this study was to compare the effects of repeated single-day treatments with MDMA (4 x 15 mg/kg) once weekly for 5 weeks to animals that only received MDMA on week 5 and saline on weeks 1-4. In animals treated with MDMA for 5 weeks, there was an increase in time spent in the open area of the elevated zero maze suggesting a decrease in anxiety or increase in impulsivity compared to the animals given MDMA for 1 week and saline treated controls. Regardless of dosing regimen, MDMA treatment produced path integration deficits as evidenced by an increase in latency to find the goal in the Cincinnati water maze. Animals treated with MDMA also showed a transient hypoactivity that was not present when the animals were re-tested at the end of cognitive testing. In addition, both MDMA-treated groups showed comparable hyperactive responses to a later methamphetamine challenge. No differences were observed in spatial learning in the Morris water maze during acquisition or reversal but MDMA-related deficits were seen on reduced platform-size trials. Taken together, the data show that a single-day regimen of MDMA induces deficits similar to that of multiple weekly treatments.

Contributing factors for therapeutic diet adherence in patients receiving haemodialysis treatment: an integrative review.

PubMed

Oquendo, Lissete González; Asencio, José Miguel Morales; de Las Nieves, Candela Bonill

2017-12-01

The objective of this integrative review is to identify the factors that contribute to diet adherence in people suffering from kidney disease who are receiving haemodialysis treatment. Adherence to the therapeutic regimen determines therapeutic success, quality of life and survival in patients on haemodialysis. Lack of diet adherence ranges from 25%-86% in patients receiving haemodialysis treatment and affects patient morbidity and mortality. An integrative literature review was conducted based on the criteria of Whittemore & Knafl. A literature review was performed by two members of the team using twelve databases including PubMed, CUIDEN, CINAHL, The Cochrane Library and ScienceDirect. The main issues identified after analysing the results were as follows: the intrinsic barriers (age, dialysis time, motivation, perceived benefit, distorted perception of adherence) and facilitators (self-efficacy, perception of disease, perception of control), extrinsic barriers (family dysfunction, lack of social support, cultural patterns of consumption of food) and facilitators (social support, relationship with healthcare providers), and interventions to encourage diet adherence, such as the use of motivational interviewing in educational interventions, and the training and education of relevant professionals in communication skills. Diet nonadherence remains a serious health problem and suffers from a lack of solid criteria to identify this condition. The onset of depression signs and the level of social support available to the patient should be assessed, because these are important factors that determine adherence to treatment. Professionals should be trained in health education and communication techniques to contribute to the patient's self-management and motivation for diet adherence. Controlled and randomised clinical studies involving predialysis stages should be performed to investigate the impact of the assessment and control of barriers to diet adherence. © 2017

Effects of Mesalamine Treatment on Gut Barrier Integrity Following Burn Injury

PubMed Central

Cannon, Abigail R.; Akhtar, Suhail; Hammer, Adam M.; Morris, Niya L.; Javorski, Mike J.; Li, Xiaoling; Kennedy, Richard H.; Gamelli, Richard L.; Choudhry, Mashkoor A.

2016-01-01

Gut barrier disruption is often implicated in pathogenesis associated with burn and other traumatic injuries. In this study, we examined whether therapeutic intervention with mesalamine (5-ASA), a common anti-inflammatory treatment for patients with inflammatory bowel disease, reduces intestinal inflammation and maintains normal barrier integrity after burn injury. Male C57BL/6 mice were administered an ~20% total body surface area dorsal scald burn and resuscitated with either 1mL normal saline or 100mg/kg of 5-ASA dissolved in saline. We examined intestinal transit and permeability along with levels of small intestine epithelial cell pro-inflammatory cytokines and tight junction protein expression one day after burn injury in the presence or absence of 5-ASA. A significant decrease in intestinal transit was observed one day after burn injury, which accompanied a significant increase in gut permeability. We found a substantial increase in the levels of IL-6 (by ~1.5 fold) and IL-18 (by ~2.5 fold) in small intestine epithelial cells one day after injury. Furthermore, burn injury decreases expression of the tight junction proteins claudin-4, claudin-8, and occludin. Treatment with 5-ASA after burn injury prevented the burn induced increase in permeability, partially restored normal intestinal transit, normalized levels of the pro-inflammatory cytokines IL-6 and IL-18, and restored tight junction protein expression of claudin-4 and occludin to that of sham levels. Together these findings suggest that 5-ASA can potentially be used as treatment to decrease intestinal inflammation and normalize intestinal function after burn injury. PMID:27388883

Assessment of pesticides removal using two-stage Integrated Aerobic Treatment Plant (IATP) by Bacillus sp. isolated from agricultural field.

PubMed

Geed, S R; Shrirame, B S; Singh, R S; Rai, B N

2017-10-01

The biodegradation of synthetic wastewater containing Atrazine, Malathion and Parathion was studied in two stage Integrated Aerobic Treatment Plant using Bacillus sp. (consortia) isolated from agricultural field. The influent stream containing these pesticides with initial COD of 1232mg/L were fed to first reactor and treated effluent of first reactor was fed to second reactor. The maximum removal of pesticides in IATP was found to be greater than 90%. The various process parameters such as pH, DO, Redox potential and BOD 5 /COD were monitored during the treatment. The degradation of pesticides and its metabolites in the treated effluent were confirmed by GC-MS. Kinetic parameters such as first order rate constant (K obs ), cell yield (Y X/C ) and decay coefficients (K dp ) were evaluated and found to be 0.00425 per hr, 0.696mg of COD/mg MLSS and 0.0010 per hr respectively. This integrated process was found more effective than physico-chemical treatment of pesticides. Copyright © 2017 Elsevier Ltd. All rights reserved.

Integration of Treatment Innovation Planning and Implementation: Strategic Process Models and Organizational Challenges

PubMed Central

Lehman, Wayne E. K.; Simpson, D. Dwayne; Knight, Danica K.; Flynn, Patrick M.

2015-01-01

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A 2-phase procedural approach is therefore presented based on the integration of TCU models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. PMID:21443294

Life cycle assessment of nutrient removal technologies for the treatment of anaerobic digestion supernatant and its integration in a wastewater treatment plant.

PubMed

Rodriguez-Garcia, G; Frison, N; Vázquez-Padín, J R; Hospido, A; Garrido, J M; Fatone, F; Bolzonella, D; Moreira, M T; Feijoo, G

2014-08-15

The supernatant resulting from the anaerobic digestion of sludge generated by wastewater treatment plants (WWTP) is an attractive flow for technologies such as partial nitritation-anammox (CANON), nitrite shortcut (NSC) and struvite crystallization processes (SCP). The high concentration of N and P and its low flow rate facilitate the removal of nutrients under more favorable conditions than in the main water line. Despite their operational and economic benefits, the environmental burdens of these technologies also need to be assessed to prove their feasibility under a more holistic perspective. The potential environmental implications of these technologies were assessed using life cycle assessment, first at pilot plant scale, later integrating them in a modeled full WWTP. Pilot plant results reported a much lower environmental impact for N removal technologies than SCP. Full-scale modeling, however, highlighted that the differences between technologies were not relevant once they are integrated in a WWTP. The impacts associated with the WWTP are slightly reduced in all categories except for eutrophication, where a substantial reduction was achieved using NSC, SCP, and especially when CANON and SCP were combined. This study emphasizes the need for assessing wastewater treatment technologies as part of a WWTP rather than as individual processes and the utility of modeling tools for doing so. Copyright © 2014 Elsevier B.V. All rights reserved.

Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study

PubMed Central

2014-01-01

Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Methods/Design Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers’s diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods — pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance — with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation

Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study.

PubMed

Quanbeck, Andrew R; Gustafson, David H; Marsch, Lisa A; McTavish, Fiona; Brown, Randall T; Mares, Marie-Louise; Johnson, Roberta; Glass, Joseph E; Atwood, Amy K; McDowell, Helene

2014-05-29

Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers's diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods - pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance - with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of

Available clinical markers of treatment outcome integrated in mathematical models to guide therapy in HIV infection.

PubMed

Vergu, Elisabeta; Mallet, Alain; Golmard, Jean-Louis

2004-02-01

Because treatment failure in many HIV-infected persons may be due to multiple causes, including resistance to antiretroviral agents, it is important to better tailor drug therapy to individual patients. This improvement requires the prediction of treatment outcome from baseline immunological or virological factors, and from results of resistance tests. Here, we review briefly the available clinical factors that have an impact on therapy outcome, and discuss the role of a predictive modelling approach integrating these factors proposed in a previous work. Mathematical and statistical models could become essential tools to address questions that are difficult to study clinically and experimentally, thereby guiding decisions in the choice of individualized drug regimens.

Molecular dynamics simulations of field emission from a planar nanodiode

NASA Astrophysics Data System (ADS)

Torfason, Kristinn; Valfells, Agust; Manolescu, Andrei

2015-03-01

High resolution molecular dynamics simulations with full Coulomb interactions of electrons are used to investigate field emission in planar nanodiodes. The effects of space-charge and emitter radius are examined and compared to previous results concerning transition from Fowler-Nordheim to Child-Langmuir current [Y. Y. Lau, Y. Liu, and R. K. Parker, Phys. Plasmas 1, 2082 (1994) and Y. Feng and J. P. Verboncoeur, Phys. Plasmas 13, 073105 (2006)]. The Fowler-Nordheim law is used to determine the current density injected into the system and the Metropolis-Hastings algorithm to find a favourable point of emission on the emitter surface. A simple fluid like model is also developed and its results are in qualitative agreement with the simulations.

Integrative Treatment of Personality Disorder. Part I: Psychotherapy.

PubMed

Jovanovic, Mirjana Divac; Svrakic, Dragan

2017-03-01

In this paper, we outline the concept of integrative therapy of borderline personality, also referred to as fragmented personality, which we consider to be the core psychopathology underlying all clinical subtypes of personality disorder. Hence, the terms borderline personality, borderline disorder, fragmented personality, and personality disorder are used interchangeably, as synonyms. Our integrative approach combines pharmacotherapy and psychotherapy, each specifically tailored to accomplish a positive feedback modulation of their respective effects. We argue that pharmacotherapy and psychotherapy of personality disorder complement each other. Pharmacological control of disruptive affects clears the stage, in some cases builds the stage, for the psychotherapeutic process to take place. In turn, psychotherapy promotes integration of personality fragments into more cohesive structures of self and identity, ultimately establishing self-regulation of mood and anxiety. We introduce our original method of psychotherapy, called reconstructive interpersonal therapy (RIT). The RIT integrates humanistic-existential and psychodynamic paradigms, and is thereby designed to accomplish a deep reconstruction of core psychopathology within the setting of high structure. We review and comment the current literature on the strategies, goals, therapy process, priorities, and phases of psychotherapy of borderline disorders, and describe in detail the fundamental principles of RIT.

Assessment of integrated process based on hydrothermal and alkaline treatments for enzymatic saccharification of sweet sorghum stems.

PubMed

Sun, Shao-Long; Sun, Shao-Ni; Wen, Jia-Long; Zhang, Xue-Ming; Peng, Feng; Sun, Run-Cang

2015-01-01

In this study, sweet sorghum stem was subjected to hydrothermal pretreatment (HTP) and alkaline post-treatment to enhance its saccharification ratio by reducing its recalcitrance. The results showed that the HTP (110-210°C, 0.5-2.0h) significantly degraded hemicelluloses, and the pretreatment at the temperature higher than 190°C led to the partial degradation of the cellulose. As compared to the sole HTP, the integrated process removed most of lignin and hemicelluloses, which incurred a higher cellulose saccharification ratio. Under an optimum condition evaluated (HTP at 170°C for 0.5h and subsequent 2% NaOH treatment), 77.5% saccharification ratio was achieved, which was 1.8, 2.0 and 5.5 times as compared to the only HTP pretreated substrates, alkaline treated substrates alone and the raw material without pretreatment, respectively. Clearly, the integrated process can be considered as a promising approach to achieve an efficient conversion of lignocellulose to fermentable glucose. Copyright © 2014 Elsevier Ltd. All rights reserved.

The impact of lifetime alcohol use on hepatitis C treatment outcomes in privately insured members of an integrated health care plan.

PubMed

Russell, Marcia; Pauly, Mary Patricia; Moore, Charles Denton; Chia, Constance; Dorrell, Jennifer; Cunanan, Renee J; Witt, Gayle; Martin, Scott

2012-10-01

Treatment of chronic hepatitis C infection (HCV(+) ) has historically been shown to be less effective in patients with a heavy drinking history. The effect of moderate and heavy alcohol use on treatment with pegylated interferon-alpha and ribavirin (P/R) in an insured household population has not been previously reported. We investigated the effect of alcohol on treatment outcome in a cohort of 421 treatment-naïve HCV(+) patients, members of an integrated health care plan treated with P/R between January 2002 and June 2008. A detailed drinking history was obtained for 259 (61.5%) eligible patients. Regular drinking was reported by 93.1% of patients before HCV diagnosis, by 30.9% between HCV diagnosis and treatment, by 1.9% during treatment, and 11.6% after the end of treatment. Heavy drinking patterns were reported by 67.9%, 63.5% of patients drank more than 100 kg of ethanol before initiating HCV treatment, and 29.3% reported abstaining less than the required 6 months before treatment. Despite these reports of heavy drinking, sustained virological responses (SVRs) were obtained in 80.2% of patients with HCV genotypes 2 or 3 and 45.1% of patients with genotypes 1, 4, or 6. Pretreatment drinking patterns and total alcohol intake were both unrelated to SVR rates. Abstaining less than 6 months before treatment was related to lower SVR rates in moderate, but not heavy, drinkers. HCV treatment relapse was unrelated to drinking after treatment ended. The amount of alcohol consumed before HCV treatment did not have a negative effect on treatment outcomes in our population. A history of heavy drinking should not be considered a deterrent to HCV treatment in members of an integrated health care plan who are closely monitored. Copyright © 2012 American Association for the Study of Liver Diseases.

An integrated approach to the diagnosis and treatment of anxiety within the practice of cardiology.

PubMed

Janeway, David

2009-01-01

Coronary heart disease (CHD) is the leading cause of death and disability in the United States and in highly industrialized countries. Many modifiable psychosocial risk factors have been identified and can affect the course of cardiac illness. These include the negative emotional states of depression, anxiety, stress, anger/hostility, and social isolation. Anxiety has been found to increase the risk of developing CHD in healthy subjects and can lead to worsening of existing CHD. There is much overlap and confusion throughout the research literature between what authors define as anxiety, stress, Type A behavioral pattern, and anger/hostility.There is a need for better screening within the practice of cardiology for these psychosocial risk factors to ensure better integration of mental health services. Established screening tools such as the Beck Anxiety Inventory, Patient Health Questionnaire-9, Zung Self-Rating Anxiety Scale, and the Hamilton Anxiety Scale are described and compared with the newer Screening Tool for Psychologic Distress as part of the initial work-up of every cardiac patient. Recommendations are made using the author's Anxiety Treatment Algorithm regarding when to refer to a mental health professional along with how to reduce stigma and provide more integrated care. The diagnosis and treatment of anxiety disorders is reviewed, with attention to selective serotonin reuptake inhibitors, benzodiazepines, cognitive-behavioral therapy, stress reduction, and behavioral medicine group programs. These group programs are recommended because they help to overcome social isolation and counsel patients on how to adapt to a healthy lifestyle. Better clinical outcome research is needed that specifically addresses the question of whether the treatment of anxiety and anxiety disorders can affect the course of cardiac illness.

The BraveNet prospective observational study on integrative medicine treatment approaches for pain.

PubMed

Abrams, Donald I; Dolor, Rowena; Roberts, Rhonda; Pechura, Constance; Dusek, Jeffery; Amoils, Sandi; Amoils, Steven; Barrows, Kevin; Edman, Joel S; Frye, Joyce; Guarneri, Erminia; Kligler, Ben; Monti, Daniel; Spar, Myles; Wolever, Ruth Q

2013-06-24

Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (-23%) and interference (-28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. ClinicalTrials.gov, NCT01186341.

[Establishing the idea of holistic integrative medicine, optimizing the quality of health care service in prevention and treatment].

PubMed

Sun, Xing-guo

2015-07-01

Under background of reductionism in the modern science, physiology and medicine are stepwise refined into system, organ, disease, cell and gene etc. Although clinical medicine, only service in whole human object, obviously brought tremendous progress, it also appeared obvious defects and limits at the same time. Professionalized and specialized medicine not only needs to be integrated from basics to clinical fields, but also from prevention, health management, clinical treatment and functional rehabilitation medicine. People are indivisible organic whole. Professionalization, translation and integration must be combined. In order to provide the best quality and optimized medical service for the Chinese people and to lead in the world, we have to strengthen professional and technical knowledge, and have to establish the holistic integrative medical philosophy for physiology and medicine too.

Integration of advanced oxidation processes at mild conditions in wet scrubbers for odourous sulphur compounds treatment.

PubMed

Vega, Esther; Martin, Maria J; Gonzalez-Olmos, Rafael

2014-08-01

The effectiveness of different advanced oxidation processes on the treatment of a multicomponent aqueous solution containing ethyl mercaptan, dimethyl sulphide and dimethyl disulphide (0.5 mg L(-1) of each sulphur compound) was investigated with the objective to assess which one is the most suitable treatment to be coupled in wet scrubbers used in odour treatment facilities. UV/H2O2, Fenton, photo-Fenton and ozone treatments were tested at mild conditions and the oxidation efficiency obtained was compared. The oxidation tests were carried out in magnetically stirred cylindrical quartz reactors using the same molar concentration of oxidants (hydrogen peroxide or ozone). The results show that ozone and photo-Fenton are the most efficient treatments, achieving up to 95% of sulphur compounds oxidation and a mineralisation degree around 70% in 10 min. Furthermore, the total costs of the treatments taking into account the capital and operational costs were also estimated for a comparative purpose. The economic analysis revealed that the Fenton treatment is the most economical option to be integrated in a wet scrubber to remove volatile organic sulphur compounds, as long as there are no space constraints to install the required reactor volume. In the case of reactor volume limitation or retrofitting complexities, the ozone and photo-Fenton treatments should be considered as viable alternatives. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinical practice guidelines for the treatment of primary liver cancer with integrative traditional Chinese and Western medicine.

PubMed

Ling, Chang-Quan; Fan, Jia; Lin, Hong-Sheng; Shen, Feng; Xu, Zhen-Ye; Lin, Li-Zhu; Qin, Shu-Kui; Zhou, Wei-Ping; Zhai, Xiao-Feng; Li, Bai; Zhou, Qing-Hui

2018-05-17

Traditional Chinese medicine (TCM) is an important part of the treatment of primary liver cancer (PLC) in China; however, the current instructions for the integrative use of traditional Chinese and Western medicine for PLC are mostly based on expert opinion. There is no evidence-based guideline for clinical practice in this field. Therefore, the Shanghai Association of Chinese Integrative Medicine has established a multidisciplinary working group to develop this guideline, which focuses on the most important questions about the use of TCM during PLC treatment. This guideline was developed following the methodological process recommended by the World Health Organization Handbook for Guideline Development. Two rounds of questionnaire survey were performed to identify clinical questions; published evidence was searched; the Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the body of evidence; and recommendations were formulated by combining the quality of evidence, patient preferences and values, and other risk factors. The guideline was written based on the Reporting Items for Practice Guidelines in Healthcare tool. This guideline contains 10 recommendations related to 8 questions, including recommendations for early treatment by TCM after surgery, TCM combined with transcatheter arterial chemoembolization for advanced PLC, TCM drugs for external use, and acupuncture and moxibustion therapy. Copyright © 2018 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.

68Ga-PSMA-PET/CT imaging of localized primary prostate cancer patients for intensity modulated radiation therapy treatment planning with integrated boost.

PubMed

Thomas, Lena; Kantz, Steffi; Hung, Arthur; Monaco, Debra; Gaertner, Florian C; Essler, Markus; Strunk, Holger; Laub, Wolfram; Bundschuh, Ralph A

2018-07-01

The purpose of our study was to show the feasibility and potential benefits of using 68 Ga-PSMA-PET/CT imaging for radiation therapy treatment planning of patients with primary prostate cancer using either integrated boost on the PET-positive volume or localized treatment of the PET-positive volume. The potential gain of such an approach, the improvement of tumor control, and reduction of the dose to organs-at-risk at the same time was analyzed using the QUANTEC biological model. Twenty-one prostate cancer patients (70 years average) without previous local therapy received 68 Ga-PSMA-PET/CT imaging. Organs-at-risk and standard prostate target volumes were manually defined on the obtained datasets. A PET active volume (PTV_PET) was segmented with a 40% of the maximum activity uptake in the lesion as threshold followed by manual adaption. Five different treatment plan variations were calculated for each patient. Analysis of derived treatment plans was done according to QUANTEC with in-house developed software. Tumor control probability (TCP) and normal tissue complication probability (NTCP) was calculated for all plan variations. Comparing the conventional plans to the plans with integrated boost and plans just treating the PET-positive tumor volume, we found that TCP increased to (95.2 ± 0.5%) for an integrated boost with 75.6 Gy, (98.1 ± 0.3%) for an integrated boost with 80 Gy, (94.7 ± 0.8%) for treatment of PET-positive volume with 75 Gy, and to (99.4 ± 0.1%) for treating PET-positive volume with 95 Gy (all p < 0.0001). For the integrated boost with 80 Gy, a significant increase of the median NTCP of the rectum was found, for all other plans no statistical significant increase in the NTCP neither of the rectum nor the bladder was found. Our study demonstrates that the use of 68 Ga-PSMA-PET/CT image information allows for more individualized prostate treatment planning. TCP values of identified active tumor volumes were increased, while

[Recognition and thoughts for diagnosis and treatment of chronic prostatitis in integrated traditional Chinese and Western medicine].

PubMed

Song, Shu-qi; Zhang, Ya-qiang

2009-12-01

The etiology, pathogenesis, and diagnostic criteria of chronic prostatitis were reviewed in this article. Based on clinical practice, the authors systematically discussed the thoughts and methods for the treatment of chronic prostatitis by integrated traditional Chinese and Western medicine. Meanwhile, advice on disputed problems in clinical study of prostatits were given, such as curative effect estimation value of the number of leukocytes in expressed prostatic secretion (EPS) and bacterial culture in EPS, the opportunity and treatment course of antibiotics, National Institutes of Health chronic prostatitis symptom index, classification of syndromes of traditional Chinese medicine (TCM), TCM symptom score, and clinical study period.

Family Assessment/Treatment/Evaluation Methods Integrated for Helping Teen Suicide Attempters/Families in Short Term Psychiatric Hospitalization Programs.

ERIC Educational Resources Information Center

Shepard, Suzanne

The assessment process can be integrated with treatment and evaluation for helping teenage suicide attempters and families in short term psychiatric hospitalization programs. The method is an extremely efficient way for the therapist to work within a given time constraint. During family assessment sufficient information can be gathered to…

Marrying Step Feed with Secondary Clarifier Improvements to Significantly Increase Peak Wet Weather Treatment Capacity: An Integrated Methodology.

PubMed

Daigger, Glen T; Siczka, John S; Smith, Thomas F; Frank, David A; McCorquodale, J A

2017-08-01

  The need to increase the peak wet weather secondary treatment capacity of the City of Akron, Ohio, Water Reclamation Facility (WRF) provided the opportunity to test an integrated methodology for maximizing the peak wet weather secondary treatment capacity of activated sludge systems. An initial investigation, consisting of process modeling of the secondary treatment system and computational fluid dynamics (CFD) analysis of the existing relatively shallow secondary clarifiers (3.3 and 3.7 m sidewater depth in 30.5 m diameter units), indicated that a significant increase in capacity from 416 000 to 684 000 m3/d or more was possible by adding step feed capabilities to the existing bioreactors and upgrading the existing secondary clarifiers. One of the six treatment units at the WRF was modified, and an extensive 2-year testing program was conducted to determine the total peak wet weather secondary treatment capacity achievable. The results demonstrated that a peak wet weather secondary treatment capacity approaching 974 000 m3/d is possible as long as secondary clarifier solids and hydraulic loadings could be separately controlled using the step feed capability provided. Excellent sludge settling characteristics are routinely experienced at the City of Akron WRF, raising concerns that the identified peak wet weather secondary treatment capacity could not be maintained should sludge settling characteristics deteriorate for some reason. Computational fluid dynamics analysis indicated that the impact of the deterioration of sludge settling characteristics could be mitigated and the identified peak wet weather secondary treatment capacity maintained by further use of the step feed capability provided to further reduce secondary clarifier solids loading rates at the identified high surface overflow rates. The results also demonstrated that effluent limits not only for total suspended solids (TSS) and five-day carbonaceous biochemical oxygen demand (cBOD5) could be

An integrated approach to energy recovery from biomass and waste: Anaerobic digestion-gasification-water treatment.

PubMed

Milani, M; Montorsi, L; Stefani, M

2014-07-01

The article investigates the performance of an integrated system for the energy recovery from biomass and waste based on anaerobic digestion, gasification and water treatment. In the proposed system, the organic fraction of waste of the digestible biomass is fed into an anaerobic digester, while a part of the combustible fraction of the municipal solid waste is gasified. Thus, the obtained biogas and syngas are used as a fuel for running a cogeneration system based on an internal combustion engine to produce electric and thermal power. The waste water produced by the integrated plant is recovered by means of both forward and inverse osmosis. The different processes, as well as the main components of the system, are modelled by means of a lumped and distributed parameter approach and the main outputs of the integrated plant such as the electric and thermal power and the amount of purified water are calculated. Finally, the implementation of the proposed system is evaluated for urban areas with a different number of inhabitants and the relating performance is estimated in terms of the main outputs of the system. © The Author(s) 2014.

Treatment of vegetable oily wastewater using an integrated microfiltration-reverse osmosis system.

PubMed

Yu, Xiaoli; Zhong, Zhaoxiang; Xing, Weihong

2010-01-01

Vegetable oil processing plants and catering trade often generate a large amount of oil-containing wastewater, which causes serious environmental problems. The objective of this work was to explore the feasibility of vegetable oil wastewater treatment with an integrated microfiltration-reverse osmosis (MF-RO) process. The influence of operational parameters on the separation behaviors were investigated in MF process. In MF continuous process the steady flux was around 90 (L/m(2) h) when the concentrated multiple reached 16, and the oil content in permeate was less than 12 mg/L. In the RO continuous process, antifouling membrane was used to treat permeate from the ceramic membrane process in order to improve the water quality. The RO process had a permeate flux of 24 (L/m(2) h) and water recovery rate of 95%. The permeate from the RO stage was free of oil, and its TOC and conductivity were less than 0.6 mg/L and 50 micros/cm, respectively. The results demonstrated that the two stage membrane process combining MF and RO is highly efficient in the treatment of oil-containing wastewater.

Effects of Mesalamine Treatment on Gut Barrier Integrity After Burn Injury.

PubMed

Cannon, Abigail R; Akhtar, Suhail; Hammer, Adam M; Morris, Niya L; Javorski, Michael J; Li, Xiaoling; Kennedy, Richard H; Gamelli, Richard L; Choudhry, Mashkoor A

2016-01-01

Gut barrier disruption is often implicated in pathogenesis associated with burn and other traumatic injuries. In this study, the authors examined whether therapeutic intervention with mesalamine (5-aminosalicylic acid [5-ASA]), a common anti-inflammatory treatment for patients with inflammatory bowel disease, reduces intestinal inflammation and maintains normal barrier integrity after burn injury. Male C57BL/6 mice were administered an approximately 20% TBSA dorsal scald burn and resuscitated with either 1 ml normal saline or 100 mg/kg of 5-ASA dissolved in saline. The authors examined intestinal transit and permeability along with the levels of small intestine epithelial cell proinflammatory cytokines and tight junction protein expression 1 day after burn injury in the presence or absence of 5-ASA. A significant decrease in intestinal transit was observed 1 day after burn injury, which accompanied a significant increase in gut permeability. The authors found a substantial increase in the levels of interleukin (IL)-6 (by ~1.5-fold) and IL-18 (by ~2.5-fold) in the small intestine epithelial cells 1 day after injury. Furthermore, burn injury decreases the expression of the tight junction proteins claudin-4, claudin-8, and occludin. Treatment with 5-ASA after burn injury prevented the burn-induced increase in permeability, partially restored normal intestinal transit, normalized the levels of the proinflammatory cytokines IL-6 and IL-18, and restored tight junction protein expression of claudin-4 and occludin compared with that of sham levels. Together these findings suggest that 5-ASA can potentially be used as treatment to decrease intestinal inflammation and normalize intestinal function after burn injury.

Metallic wire grid behavior and testing in a low pressure gaseous noble elements detector

NASA Astrophysics Data System (ADS)

Ji, W.

2018-05-01

High voltage performance has been a challenge for noble element detectors. One piece of this challenge is the emission of electrons from metal electrodes when applying high voltage. This has become a major concern for low-background detectors such as LUX-ZEPLIN (LZ). LZ is a liquid xenon Time Projection Chamber (TPC) searching for Weakly Interactive Massive Particles (WIMPs). In this work, we demonstrate a method to measure electron emission from metallic electrode grids via detection of proportional scintillation light. We find consistency with Fowler-Nordheim emission with a surface parameter β = 1988 after electro-polishing treatment of a stainless steel grid.

[Effectiveness of an integrated treatment for severe personality disorders. A 36-month pragmatic follow-up].

PubMed

Lana, Fernando; Sánchez-Gil, Carmen; Ferrer, Laia; López-Patón, Nuria; Litvan, Lia; Marcos, Susana; Sierra, Ana C; Soldevilla, Joan M; Feixas, Guillem; Pérez, Víctor

2015-01-01

Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies. This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included. The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout. An integrated treatment for severe personality disorders could be effective in preventing reliance on readmissions, or prolonged hospital stays, when it is implemented by clinicians in ordinary clinical settings. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Errors of Omission and Commission during Alternative Reinforcement of Compliance: The Effects of Varying Levels of Treatment Integrity

ERIC Educational Resources Information Center

Leon, Yanerys; Wilder, David A.; Majdalany, Lina; Myers, Kristin; Saini, Valdeep

2014-01-01

We conducted two experiments to evaluate the effects of errors of omission and commission during alternative reinforcement of compliance in young children. In Experiment 1, we evaluated errors of omission by examining two levels of integrity during alternative reinforcement (20 and 60%) for child compliance following no treatment (baseline) versus…

Alpine infrastructure in Central Europe: integral evaluation of wastewater treatment systems at mountain refuges.

PubMed

Weissenbacher, N; Mayr, E; Niederberger, T; Aschauer, C; Lebersorger, S; Steinbacher, G; Haberl, R

2008-01-01

Planning, construction and operation of onsite wastewater treatment systems at mountain refuges is a challenge. Energy supply, costly transport, limited water resources, unfavourable climate and load variations are only some of the problems that have to be faced. Additionally, legal regulations are different between and even within countries of the Alps. To ensure sustainability, integrated management of the alpine infrastructure management is needed. The energy and water supply and the wastewater and waste disposal systems and the cross-relations between them were analysed for 100 mountain refuges. Wastewater treatment is a main part of the overall 'mountain refuge' system. The data survey and first analyses showed the complex interaction of the wastewater treatment with the other infrastructure. Main criteria for reliable and efficient operation are training, technical support, user friendly control and a relatively simple system set up. Wastewater temperature, alkalinity consumption and high peak loads have to be considered in the planning process. The availability of power in terms of duration and connexion is decisive for the choice of the system. Further, frequency fluctuations may lead to damages to the installed aerators. The type of water source and the type of sanitary equipment influence the wastewater quantity and quality. Biosolids are treated and disposed separately or together with primary or secondary sludge from wastewater treatment dependent on the legal requirements. IWA Publishing 2008.

Integration of treatment innovation planning and implementation: strategic process models and organizational challenges.

PubMed

Lehman, Wayne E K; Simpson, D Dwayne; Knight, Danica K; Flynn, Patrick M

2011-06-01

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A two-phase procedural approach is therefore presented based on the integration of Texas Christian University (TCU) models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Spiritually Integrated Cognitive Processing Therapy: A New Treatment for Post-traumatic Stress Disorder That Targets Moral Injury.

PubMed

Pearce, Michelle; Haynes, Kerry; Rivera, Natalia R; Koenig, Harold G

2018-01-01

Post-traumatic stress disorder (PTSD) is a debilitating disorder, and current treatments leave the majority of patients with unresolved symptoms. Moral injury (MI) may be one of the barriers that interfere with recovery from PTSD, particularly among current or former military service members. Given the psychological and spiritual aspects of MI, an intervention that addresses MI using spiritual resources in addition to psychological resources may be particularly effective in treating PTSD. To date, there are no existing empirically based individual treatments for PTSD and MI that make explicit use of a patient's spiritual resources, despite the evidence that spiritual beliefs/activities predict faster recovery from PTSD. To address this gap, we adapted Cognitive Processing Therapy (CPT), an empirically validated treatment for PTSD, to integrate clients' spiritual beliefs, practices, values, and motivations. We call this treatment Spiritually Integrated CPT (SICPT). This article describes this novel manualized therapeutic approach for treating MI in the setting of PTSD for spiritual/religious clients. We provide a description of SICPT and a brief summary of the 12 sessions. Then, we describe a case study in which the therapist helps a client use his spiritual resources to resolve MI and assist in the recovery from PTSD. SICPT may be a helpful way to reduce PTSD by targeting MI, addressing spiritual distress, and using a client's spiritual resources. In addition to the spiritual version (applicable for those of any religion and those who do not identify as religious), we have also developed 5 religion-specific manuals (Christianity, Judaism, Islam, Buddhism, and Hinduism) for clients who desire a more religion-specific approach.

Spiritually Integrated Cognitive Processing Therapy: A New Treatment for Post-traumatic Stress Disorder That Targets Moral Injury

PubMed Central

Pearce, Michelle; Haynes, Kerry; Rivera, Natalia R; Koenig, Harold G.

2018-01-01

Background Post-traumatic stress disorder (PTSD) is a debilitating disorder, and current treatments leave the majority of patients with unresolved symptoms. Moral injury (MI) may be one of the barriers that interfere with recovery from PTSD, particularly among current or former military service members. Objective Given the psychological and spiritual aspects of MI, an intervention that addresses MI using spiritual resources in addition to psychological resources may be particularly effective in treating PTSD. To date, there are no existing empirically based individual treatments for PTSD and MI that make explicit use of a patient’s spiritual resources, despite the evidence that spiritual beliefs/activities predict faster recovery from PTSD. Method To address this gap, we adapted Cognitive Processing Therapy (CPT), an empirically validated treatment for PTSD, to integrate clients’ spiritual beliefs, practices, values, and motivations. We call this treatment Spiritually Integrated CPT (SICPT). Results This article describes this novel manualized therapeutic approach for treating MI in the setting of PTSD for spiritual/religious clients. We provide a description of SICPT and a brief summary of the 12 sessions. Then, we describe a case study in which the therapist helps a client use his spiritual resources to resolve MI and assist in the recovery from PTSD. Conclusion SICPT may be a helpful way to reduce PTSD by targeting MI, addressing spiritual distress, and using a client’s spiritual resources. In addition to the spiritual version (applicable for those of any religion and those who do not identify as religious), we have also developed 5 religion-specific manuals (Christianity, Judaism, Islam, Buddhism, and Hinduism) for clients who desire a more religion-specific approach. PMID:29497585

Performance Evaluation of Integrated Constructed Wetland for Domestic Wastewater Treatment.

PubMed

Sehar, Shama; Naz, Iffat; Khan, Sumera; Naeem, Sana; Perveen, Irum; Ali, Naeem; Ahmed, Safia

2016-03-01

Simple, budget friendly, laboratory-scale integrated constructed wetland (ICW) was designed to assess domestic wastewater treatment performance at a loading rate of 75 mm/d, planted with native plant species: Veronica-angallis aquatica and compared with non-vegetative control system at various residence times of 4, 8, 12, 16, 20, 24, and 28 days. Results revealed that the vegetated ICW demonstrated superior performance over non-vegetated control: 69.12 vs 17.12%, 67.77 vs 16.04%, 68 vs 16.48%, 71.19 vs 6.56%, 71.54 vs 14.80%, and 72.04 vs 11.41% for total dissolved solids, total suspended solids, phosphates (PO4(-)), sulfate (SO4(-)), nitrate (NO3(-)), and nitrite (NO2(-)), respectively, at 20 days residence times. Reduction in bacterial counts (2.79 × 10(4) CFU/mL) and fecal pathogens (345.5 MPN index/100 mL) was observed in V. aquatica at 20 days residence time. Therefore, the present study highlights not only the presence of vegetation but also appropriate residence time in constructed wetlands for better performances.

Electronic health records: essential tools in integrating substance abuse treatment with primary care

PubMed Central

Tai, Betty; Wu, Li-Tzy; Clark, H Westley

2012-01-01

While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted. PMID:24474861

Corporate Culture Assessments in Integrative Oncology: A Qualitative Case Study of Two Integrative Oncology Centers

PubMed Central

Mittring, Nadine; Pérard, Marion; Witt, Claudia M.

2013-01-01

The offer of “integrative oncology” is one option for clinics to provide safe and evidence-based complementary medicine treatments to cancer patients. As known from merger theories, corporate culture and integration models have a strong influence on the success of such integration. To identify relevant corporate culture aspects that might influence the success in two highly visible integrative oncology clinics, we interviewed physicians, nurses, practitioners, and managers. All interviews (11 in a German breast cancer clinic and 9 in an integrative medicine cancer service in the USA) were audio-recorded, transcribed and analyzed with content analysis. According to the theoretical framework of mergers, each clinic selected a different integration type (“best of both worlds” and “linking”). Nonetheless, each developed a similar corporate culture that has a strong focus on research and safe and evidence-based treatments, and fosters a holistic and patient-centered approach. Structured communication within the team and with other departments had high relevance. Research was highlighted as a way to open doors and to facilitate a more general acceptance within the hospital. Conventional physicians felt unburdened by the provision of integrative medicine service but also saw problems in the time required for scheduled treatments, which often resulted in long waiting lists. PMID:23818923

Corporate culture assessments in integrative oncology: a qualitative case study of two integrative oncology centers.

PubMed

Mittring, Nadine; Pérard, Marion; Witt, Claudia M

2013-01-01

The offer of "integrative oncology" is one option for clinics to provide safe and evidence-based complementary medicine treatments to cancer patients. As known from merger theories, corporate culture and integration models have a strong influence on the success of such integration. To identify relevant corporate culture aspects that might influence the success in two highly visible integrative oncology clinics, we interviewed physicians, nurses, practitioners, and managers. All interviews (11 in a German breast cancer clinic and 9 in an integrative medicine cancer service in the USA) were audio-recorded, transcribed and analyzed with content analysis. According to the theoretical framework of mergers, each clinic selected a different integration type ("best of both worlds" and "linking"). Nonetheless, each developed a similar corporate culture that has a strong focus on research and safe and evidence-based treatments, and fosters a holistic and patient-centered approach. Structured communication within the team and with other departments had high relevance. Research was highlighted as a way to open doors and to facilitate a more general acceptance within the hospital. Conventional physicians felt unburdened by the provision of integrative medicine service but also saw problems in the time required for scheduled treatments, which often resulted in long waiting lists.

An integrated decision making approach for assessing healthcare waste treatment technologies from a multiple stakeholder.

PubMed

Shi, Hua; Liu, Hu-Chen; Li, Ping; Xu, Xue-Guo

2017-01-01

With increased worldwide awareness of environmental issues, healthcare waste (HCW) management has received much attention from both researchers and practitioners over the past decade. The task of selecting the optimum treatment technology for HCWs is a challenging decision making problem involving conflicting evaluation criteria and multiple stakeholders. In this paper, we develop an integrated decision making framework based on cloud model and MABAC method for evaluating and selecting the best HCW treatment technology from a multiple stakeholder perspective. The introduced framework deals with uncertain linguistic assessments of alternatives by using interval 2-tuple linguistic variables, determines decision makers' relative weights based on the uncertainty and divergence degrees of every decision maker, and obtains the ranking of all HCW disposal alternatives with the aid of an extended MABAC method. Finally, an empirical example from Shanghai, China, is provided to illustrate the feasibility and effectiveness of the proposed approach. Results indicate that the methodology being proposed is more suitable and effective to handle the HCW treatment technology selection problem under vague and uncertain information environment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of iron and calcium carbonate on the variation and cycling of carbon source in integrated wastewater treatments.

PubMed

Zhimiao, Zhao; Xinshan, Song; Yufeng, Zhao; Yanping, Xiao; Yuhui, Wang; Junfeng, Wang; Denghua, Yan

2017-02-01

Iron and calcium carbonate were added in wastewater treatments as the adjusting agents to improve the contaminant removal performance and regulate the variation of carbon source in integrated treatments. At different temperatures, the addition of the adjusting agents obviously improved the nitrogen and phosphorous removals. TN and TP removals were respectively increased by 29.41% and 23.83% in AC-100 treatment under 1-day HRT. Carbon source from dead algae was supplied as green microbial carbon source and Fe 2+ was supplied as carbon source surrogate. COD concentration was increased to 30mg/L and above, so the problem of the shortage of carbon source was solved. Dead algae and Fe 2+ as carbon source supplement or surrogate played significant role, which was proved by microbial community analysis. According to the denitrification performance in the treatments, dead algae as green microbial carbon source combined with iron and calcium carbonate was the optimal supplement carbon source in wastewater treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrated chemical treatment of municipal wastewater using waste hydrogen peroxide and ultraviolet light

NASA Astrophysics Data System (ADS)

Bhatti, Zulfiqar Ahmed; Mahmood, Qaisar; Raja, Iftikhar Ahmad; Malik, Amir Haider; Rashid, Naim; Wu, Donglei

Dilemmas like water shortage, rapid industrialization, growing human population and related issues have seriously affected human health and environmental sustainability. For conservation and sustainable use of our water resources, innovative methods for wastewater treatment are continuously being explored. Advance Oxidation Processes (AOPs) show a promising approach to meet specific objectives of municipal wastewater treatment (MWW). The MWW samples were pretreated with Al 2(SO 4) 4·8H 2O (Alum) at different doses 4, 8, 12-50 mg/L to enhance the sedimentation. The maximum COD removal was observed at alum treatments in range of 28-32 mg/L without increasing total dissolved solids (TDS). TDS were found to increase when the alum dose was increased from 32-40 mg/L. In the present study, the optimum alum dose of 30 mg/L for 3 h of sedimentation and subsequent integrated H 2O 2/UV treatment was applied (using 2.5 mL/L of 40% waste H 2O 2 and 35% fresh H 2O 2 separately). Organic and inorganic pollutants, contributing towards chemical oxygen demand (COD), biological oxygen demand (BOD), turbidity and total dissolved solids were degraded by H 2O 2/UV. About 93% COD, 90% BOD and 83% turbidity reduction occurred when 40% waste H 2O 2 was used. When using fresh H 2O 2, 63% COD, 68% BOD and 86% turbidity reduction was detected. Complete disinfection of coliform bacteria occurred by using 40% H 2O 2/UV. The most interesting part of this research was to compare the effectiveness of waste H 2O 2 with fresh H 2O 2. Waste H 2O 2 generated from an industrial process of disinfection was found more effective in the treatment of MWW than fresh 35% H 2O 2.

The Effects of Self-Monitoring and Performance Feedback on the Treatment Integrity of Behavior Intervention Plan Implementation and Generalization

ERIC Educational Resources Information Center

Mouzakitis, Angela; Codding, Robin S.; Tryon, Georgiana

2015-01-01

Accurate implementation of individualized behavior intervention plans (BIPs) is a critical aspect of evidence-based practice. Research demonstrates that neither training nor consultation is sufficient to improve and maintain high rates of treatment integrity (TI). Therefore, evaluation of ongoing support strategies is needed. The purpose of this…

Molecular dynamics simulations of field emission from a planar nanodiode

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

Torfason, Kristinn; Valfells, Agust; Manolescu, Andrei

High resolution molecular dynamics simulations with full Coulomb interactions of electrons are used to investigate field emission in planar nanodiodes. The effects of space-charge and emitter radius are examined and compared to previous results concerning transition from Fowler-Nordheim to Child-Langmuir current [Y. Y. Lau, Y. Liu, and R. K. Parker, Phys. Plasmas 1, 2082 (1994) and Y. Feng and J. P. Verboncoeur, Phys. Plasmas 13, 073105 (2006)]. The Fowler-Nordheim law is used to determine the current density injected into the system and the Metropolis-Hastings algorithm to find a favourable point of emission on the emitter surface. A simple fluid likemore » model is also developed and its results are in qualitative agreement with the simulations.« less

A test of the validity of the motivational interviewing treatment integrity code.

PubMed

Forsberg, Lars; Berman, Anne H; Kallmén, Håkan; Hermansson, Ulric; Helgason, Asgeir R

2008-01-01

To evaluate the Swedish version of the Motivational Interviewing Treatment Code (MITI), MITI coding was applied to tape-recorded counseling sessions. Construct validity was assessed using factor analysis on 120 MITI-coded sessions. Discriminant validity was assessed by comparing MITI coding of motivational interviewing (MI) sessions with information- and advice-giving sessions as well as by comparing MI-trained practitioners with untrained practitioners. A principal-axis factoring analysis yielded some evidence for MITI construct validity. MITI differentiated between practitioners with different levels of MI training as well as between MI practitioners and advice-giving counselors, thus supporting discriminant validity. MITI may be used as a training tool together with supervision to confirm and enhance MI practice in clinical settings. MITI can also serve as a tool for evaluating MI integrity in clinical research.

The enhancement of heavy metal removal from polluted river water treatment by integrated carbon-aluminium electrodes using electrochemical method

NASA Astrophysics Data System (ADS)

Yussuf, N. M.; Embong, Z.; Abdullah, S.; Masirin, M. I. M.; Tajudin, S. A. A.; Ahmad, S.; Sahari, S. K.; Anuar, A. A.; Maxwell, O.

2018-01-01

The heavy metal removal enhancement from polluted river water was investigated using two types of electrodes consist of integrated carbon-aluminium and a conventional aluminium plate electrode at laboratory-scale experiments. In the integrated electrode systems, the aluminium electrode surface was coated with carbon using mixed slurry containing carbon black, polyvinyl acetate and methanol. The electrochemical treatment was conducted on the parameter condition of 90V applied voltage, 3cm of electrode distance and 60 minutes of electrolysis operational time. Surface of both electrodes was investigated for pre and post electrolysis treatment by using SEM-EDX analytical technique. Comparison between both of the electrode configuration exhibits that more metals were accumulated on carbon integrated electrode surfaces for both anode and cathode, and more heavy metals were detected on the cathode. The atomic percentage of metals distributed on the cathode conventional electrode surface consist of Al (94.62%), Zn (1.19%), Mn (0.73%), Fe (2.81%) and Cu (0.64%), while on the anode contained O (12.08%), Al (87.63%) and Zn (0.29%). Meanwhile, cathode surface of integrated electrode was accumulated with more metals; O (75.40%), Al (21.06%), Zn (0.45%), Mn (0.22), Fe (0.29%), Cu (0.84%), Pb (0.47%), Na (0.94%), Cr (0.08%), Ni (0.02%) and Ag (0.22%), while on anode contain Al (3.48%), Fe (0.49 %), C (95.77%), and Pb (0.26%). According to this experiment, it was found that integrated carbon-aluminium electrodes have a great potential to accumulate more heavy metal species from polluted water compare to the conventional aluminium electrode. Here, heavy metal accumulation process obviously very significant on the cathode surface.

The efficacy and integrity of shape memory alloy staples and bone anchors with ligament tethers in the fusionless treatment of experimental scoliosis.

PubMed

Braun, John T; Akyuz, Ephraim; Ogilvie, James W; Bachus, Kent N

2005-09-01

Scoliosis is a complex three-dimensional deformity with limited treatment options. Current treatments present potential problems that may be addressed with use of fusionless techniques for the correction of scoliosis. However, there are few data comparing the efficacy of different fusionless implant strategies in controlling scoliosis or on the integrity of rigid compared with flexible devices in an in vivo setting over time. The objective of this study was to compare the efficacy and integrity of rigid and flexible anterior thoracic tethers used to treat experimental scoliosis. Experimental scoliosis was created in twenty-four Spanish Cross-X female goats and was subsequently treated with either anterior shape memory alloy staples or anterior ligament tethers attached to bone anchors. Serial radiographs were analyzed to determine the efficacy of the implants in controlling scoliosis progression as well as the integrity of the implants at study completion. After the goats were killed, the implants were analyzed with use of three quantitative indices of implant integrity and implant pullout testing. Over the treatment period, scoliosis progressed from 77.3 degrees to 94.3 degrees in the goats treated with staples and was corrected from 73.4 degrees to 69.9 degrees in the goats treated with bone anchors, with loosening of eighteen of forty-two staples (two of the eighteen dislodged) and evidence of drift in two of forty-nine anchors. Histologic sections revealed a consistent halo of fibrous tissue around the staple tines but well-fixed bone anchors at all sites. Pullout testing demonstrated that bone anchors had greater strength than staples initially and at the study completion, with an increase in bone anchor fixation over the course of the study. In this scoliosis model, the flexible ligament tethers attached to bone anchors demonstrated greater efficacy and integrity than the more rigid shape memory alloy staples.

Evaluation of an integrated treatment for active duty service members with comorbid posttraumatic stress disorder and major depressive disorder: Study protocol for a randomized controlled trial.

PubMed

Walter, Kristen H; Glassman, Lisa H; Michael Hunt, W; Otis, Nicholas P; Thomsen, Cynthia J

2018-01-01

Posttraumatic stress disorder (PTSD) commonly co-occurs with major depressive disorder (MDD) in both civilian and military/veteran populations. Existing, evidence-based PTSD treatments, such as cognitive processing therapy (CPT), often reduce symptoms of both PTSD and depression; however, findings related to the influence of comorbid MDD on PTSD treatment outcomes are mixed, and few studies use samples of individuals with both conditions. Behavioral activation (BA), an approach that relies on behavioral principles, is an effective treatment for depression. We have integrated BA into CPT (BA+CPT), a more cognitive approach, to address depressive symptoms among active duty service members with both PTSD and comorbid MDD. We describe an ongoing randomized controlled trial investigating the efficacy of our innovative, integrated BA+CPT intervention, compared with standard CPT, for active duty service members with PTSD and comorbid MDD. We detail the development of this integrated treatment, as well as the design and implementation of the randomized controlled trial, to evaluate its effect on symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

Alternative and Integrative Medicine

MedlinePlus

... Proton Therapy Alternative & Integrative Medicine Clinical Trials GBM AGILE TTFields – Optune™ Brain Tumor Treatment Locations Treatment Side Effects & their Management Support and Resources Caregiver Resource Center Pediatric Caregiver ...

The effects of various control and water treatment processes on the membrane integrity and toxin fate of cyanobacteria.

PubMed

Fan, Jiajia; Hobson, Peter; Ho, Lionel; Daly, Robert; Brookes, Justin

2014-01-15

Cyanobacterial blooms are one of the main contaminants that can degrade drinking water quality with the associated taste, odour and toxic compounds. Although a wide range of techniques have shown promise for cyanobacterial bloom control and cyanobacterial cell/metabolite removal in reservoirs and water treatment plants (WTPs), these treatments may have negative consequences through release of intracellular metabolites into the surrounding water. This study assessed the impact of copper sulphate (CuSO4), chlorine, potassium permanganate (KMnO4), hydrogen peroxide (H2O2) and ozone on Microcystis aeruginosa culture and the toxins it produced. All of these agents induced the loss of cyanobacterial membrane integrity. However, no associated increase in dissolved toxins was detected during chlorine and H2O2 treatments which may be due to faster toxin oxidation rates than release rates. KMnO4 doses of 1 and 3mgL(-1) degraded dissolved toxins while having no impact on cyanobacterial membrane integrity. In contrast, ozone induced a significant increase in extracellular toxins but it was unable to degrade these toxins to the same degree as the other oxidants which may due to the lack of residual. All chemicals, except CuSO4, were able to reduce cyanotoxins and chlorine was the most effective with a rate up to 2161M(-1)s(-1). Copyright © 2013 Elsevier B.V. All rights reserved.

Integrative intervention: a new perspective and brief review in aphasia.

PubMed

Marshall, Rebecca Shisler; Mohapatra, Bijoyaa

2017-09-01

While integrative treatment practices have become a popular treatment in different areas of study, its use in the field of aphasiology is still limited. The following paper is an attempt to address the different alternative practices that could potentially be used to remediate aphasia. A narrative review was completed regarding integrative intervention that could potentially apply to aphasia population. Through this article we have explored various treatment options for integrative health care in aphasiology. Integrative treatments including brain specific antioxidants, progesterone and estradiol therapy, nutrition, synbiotic treatment, exercise, yoga, meditation and positive mood states have demonstrated positive changes in health and behavior in healthy aging or disorders such as stroke and aphasia. Offering integrative treatment for people with aphasia allows potential for high impact gains when combined with current speech language therapeutic practices. This paper highlights the rehabilitation possibilities for aphasia therapy. Combining complementary and traditional treatment approaches could be viewed as one of the contemporary approaches to clinical practice and research for practitioners and health care systems. Implications for Rehabilitation There has been very little research that explores the potential of various types of integrative treatment for individuals with aphasia. An integrative approach to the treatment of aphasia has potential for future clinical application. Combining treatment approaches could be viewed as a viable approach to clinical practice and in the health care system.

Association of schizophrenia onset age and white matter integrity with treatment effect of D-cycloserine: a randomized placebo-controlled double-blind crossover study.

PubMed

Takiguchi, Kazuo; Uezato, Akihito; Itasaka, Michio; Atsuta, Hidenori; Narushima, Kenji; Yamamoto, Naoki; Kurumaji, Akeo; Tomita, Makoto; Oshima, Kazunari; Shoda, Kosaku; Tamaru, Mai; Nakataki, Masahito; Okazaki, Mitsutoshi; Ishiwata, Sayuri; Ishiwata, Yasuyoshi; Yasuhara, Masato; Arima, Kunimasa; Ohmori, Tetsuro; Nishikawa, Toru

2017-07-12

It has been reported that drugs which promote the N-Methyl-D-aspartate-type glutamate receptor function by stimulating the glycine modulatory site in the receptor improve negative symptoms and cognitive dysfunction in schizophrenia patients being treated with antipsychotic drugs. We performed a placebo-controlled double-blind crossover study involving 41 schizophrenia patients in which D-cycloserine 50 mg/day was added-on, and the influence of the onset age and association with white matter integrity on MR diffusion tensor imaging were investigated for the first time. The patients were evaluated using the Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), Brief Assessment of Cognition in Schizophrenia (BACS), and other scales. D-cycloserine did not improve positive or negative symptoms or cognitive dysfunction in schizophrenia. The investigation in consideration of the onset age suggests that D-cycloserine may aggravate negative symptoms of early-onset schizophrenia. The better treatment effect of D-cycloserine on BACS was observed when the white matter integrity of the sagittal stratum/ cingulum/fornix stria terminalis/genu of corpus callosum/external capsule was higher, and the better treatment effect on PANSS general psychopathology (PANSS-G) was observed when the white matter integrity of the splenium of corpus callosum was higher. In contrast, the better treatment effect of D-cycloserine on PANSS-G and SANS-IV were observed when the white matter integrity of the posterior thalamic radiation (left) was lower. It was suggested that response to D-cycloserine is influenced by the onset age and white matter integrity. UMIN Clinical Trials Registry (number UMIN000000468 ). Registered 18 August 2006.

Effectiveness of integrating individualized and generic complementary medicine treatments with standard care versus standard care alone for reducing preoperative anxiety.

PubMed

Attias, Samuel; Keinan Boker, Lital; Arnon, Zahi; Ben-Arye, Eran; Bar'am, Ayala; Sroka, Gideon; Matter, Ibrahim; Somri, Mostafa; Schiff, Elad

2016-03-01

Preoperative anxiety is commonly reported by people undergoing surgery. A significant number of studies have found a correlation between preoperative anxiety and post-operative morbidity. Various methods of complementary and alternative medicine (CAM) were found to be effective in alleviating preoperative anxiety. This study examined the relative effectiveness of various individual and generic CAM methods combined with standard treatment (ST) in relieving preoperative anxiety, in comparison with ST alone. Randomized controlled trial. Holding room area Three hundred sixty patients. Patients were randomly divided into 6 equal-sized groups. Group 1 received the standard treatment (ST) for anxiety alleviation with anxiolytics. The five other groups received the following, together with ST (anxiolytics): Compact Disk Recording of Guided Imagery (CDRGI); acupuncture; individual guided imagery; reflexology; and individual guided imagery combined with reflexology, based on medical staff availability. Assessment of anxiety was taken upon entering the holding room area (surgery preparation room) ('pre-treatment assessment'), and following the treatment, shortly before transfer to the operating room ('post-treatment assessment'), based on the Visual Analogue Scale (VAS) questionnaire. Data processing included comparison of VAS averages in the 'pre' and 'post' stages among the various groups. Preoperatively, CAM treatments were associated with significant reduction of anxiety level (5.54-2.32, p<0.0001). In contrast, no significant change was noted in the standard treatment group (4.92-5.44, p=0.15). Individualized CAM treatments did not differ significantly in outcomes. However, CDRGI was less effective than individualized CAM (P<0.001), but better than ST (p=0.005). Individual CAM treatments integrated within ST reduce preoperative anxiety significantly, compared to standard treatment alone, and are more effective than generic CDRGI. In light of the scope of preoperative

The BraveNet prospective observational study on integrative medicine treatment approaches for pain

PubMed Central

2013-01-01

Background Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. Methods Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. Results Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. Conclusions Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. Trial Registration ClinicalTrials.gov, NCT

Survey of integrative lumbar spinal stenosis treatment in Korean medicine doctors: preliminary data for clinical practice guidelines.

PubMed

Lee, Yoon Jae; Shin, Joon-Shik; Lee, Jinho; Kim, Me-Riong; Ahn, Yong-Jun; Shin, Ye-Sle; Park, Ki Byung; Shin, Byung-Cheul; Lee, Myeong Soo; Kim, Joo-Hee; Cho, Jae-Heung; Ha, In-Hyuk

2017-08-29

Considering that large variations exist amongst practitioners in lumbar disorder management and the significant costs that lumbar disorders incur, determining clinical practice patterns to provide preliminary data for standardization should be given higher priority. Lumbar spinal stenosis (LSS) is commonly treated using integrative non-surgical methods by Korean medicine doctors (KMDs) in Korea, and this is the first study to assess current Korean medicine practice trends for LSS. A survey on KMD diagnosis, treatment, prognosis and decision-making in LSS treatment was developed in a 3-step procedure of preliminary drafting, revision based on extramural expert opinion, and final editing. The survey was conducted at the internal conference of a spine-specialty Korean medicine hospital on January 25th, 2015. The response rate was high at 79.19% (n = 118/149). Participants replied that they treated 7.3 ± 6.8 LSS patients/day using a multimodal treatment method consisting of acupuncture, pharmacopuncture, herbal medicine, Chuna manipulation, and electroacupuncture. Acupuncture mainly used Ashi points and MSAT, and pharmacopuncture mainly Shinbaro solution. The most frequently prescribed herbal medicine was Chungpa-jun, and the most commonly applied Chuna techniques were sidelying lumbar extension dysfunction correction technique, and prone lumbosacral joint distraction method. Radiological findings were mainly referred to for diagnosis, and clinical symptoms, age, radiological findings, and medical history were regarded to be important for prognosis. Participants replied that 7.8 ± 3.3 weeks were required for 50% reduction in pain, and 16.1 ± 7.7 weeks for 80% reduction. These results suggest that KMDs in Korea combine a conventional approach to LSS and a Korean medicine approach to low back pain for integration of empirical- and evidence-based diagnosis and treatment. The findings may contribute in bridging the divide between evidence and clinical practice

Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline.

PubMed

Lyman, Gary H; Greenlee, Heather; Bohlke, Kari; Bao, Ting; DeMichele, Angela M; Deng, Gary E; Fouladbakhsh, Judith M; Gil, Brigitte; Hershman, Dawn L; Mansfield, Sami; Mussallem, Dawn M; Mustian, Karen M; Price, Erin; Rafte, Susan; Cohen, Lorenzo

2018-06-11

Purpose The Society for Integrative Oncology (SIO) produced an evidence-based guideline on use of integrative therapies during and after breast cancer treatment that was determined to be relevant to the American Society of Clinical Oncology (ASCO) membership. ASCO considered the guideline for endorsement. Methods The SIO guideline addressed the use of integrative therapies for the management of symptoms and adverse effects, such as anxiety and stress, mood disorders, fatigue, quality of life, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Interventions of interest included mind and body practices, natural products, and lifestyle modifications. SIO systematic reviews focused on randomized controlled trials that were published from 1990 through 2015. The SIO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor. On favorable review, an ASCO Expert Panel was convened to review the guideline contents and recommendations. Results The ASCO Expert Panel determined that the recommendations in the SIO guideline-published in 2017-are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the guideline with a few added discussion points. Recommendations Key recommendations include the following: Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-l-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy because of a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related adverse effects

Integration of Massage Therapy in Outpatient Cancer Care.

PubMed

Cowen, Virginia S; Tafuto, Barbara

2018-03-01

Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all-not even provision of information about massage to patients through the center website. The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care.

Integrating virtual reality with activity management for the treatment of fibromyalgia: acceptability and preliminary efficacy.

PubMed

Garcia-Palacios, Azucena; Herrero, Rocio; Vizcaíno, Yolanda; Belmonte, Miguel A; Castilla, Diana; Molinari, Guadalupe; Baños, Rosa Maria; Botella, Cristina

2015-06-01

Cognitive-behavioral therapies (CBT) for fibromyalgia syndrome (FMS) are important interventions in the management of this condition. Empirical evidence reports that although the results are promising, further research is needed to respond more appropriately to these patients. This study focuses on exploring the use of Virtual Reality (VR) as an adjunct to the activity management component. The aim of this study is to present the results of a small-sized randomized controlled trial to test the preliminary efficacy and acceptability of this component. The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology. The sample was randomly allocated to 2 conditions: VR treatment and treatment as usual. Participants in the VR condition achieved significant improvements in the primary outcome: disability measured with the FIQ. The improvement was also significant in secondary outcomes, such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory: task persistence and exercise. There were no differences in other secondary outcome measures like pain intensity and interference and depression. Participants reported high satisfaction with the VR component. The effects were related to the psychological aspects targeted in the treatment. The component was well accepted by FMS patients referred from a public hospital. These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS.

The place of psychodynamic psychotherapy in the integrated treatment of posttraumatic stress disorder and trauma recovery.

PubMed

Moss, Eric

2009-06-01

Psychodynamic psychotherapists treating posttraumatic stress disorder (PTSD) sufferers can draw on an accumulated body of trauma studies from their own field to guide their work. However, these reports, often based on case studies or conceptual reviews, do not have the same empirical conclusiveness as more recent evidence-based research demonstrating the efficacy of cognitive-behavioral and body-oriented therapies. In this article, a psychodynamic psychotherapist reflects on his treatment of an Israeli man who developed PTSD after enduring 4 terrorist attacks. The author shows how assimilative integration offered him a theory- and research-based model that helped him comfortably combine separate treatment interventions. He also shows how this model helped him locate with some precision the specific contribution of psychodynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The efficacy of treatment reminders of life with emphasis on integrative reminiscence on self-esteem and anxiety in widowed old men.

PubMed

Pishvaei, Malihe; Ataie Moghanloo, Roghayeh; Ataie Moghanloo, Vahid

2015-01-01

Loss of wife besides the phenomenon of aging could cause some psychological disorders and may shorten the duration of this stage of life. The aim of this study was to examine the efficacy of treatment reminders of life with emphasis on integrative reminiscence on self-esteem and anxiety in widowed old men. This was a clinical trial with pre-test and post-test design with a control group. The study population included All 60 to 80 year old men living in Meshginshahr; among whom, 34 participants were selected using convenience sampling method. They were randomly allocated into two equal groups (experimental and control). The experimental group participated in therapy sessions and the control group did not receive any intervention. The research instruments were Rosenberg Self-Esteem Scale and the General Anxiety Questionnaire. Data were analyzed using multivariable covariance analysis in SSPS-19. Statistical significance was set at P<0.05. MANCOVA results showed that the treatment positively affected the variables of self-esteem and anxiety in old widowed men (p<0.001). The reminders of life therapy with emphasis on integrative reminiscence may enhance self-esteem and reduce anxiety in widowed old men. This treatment gives better results compared to the traditional treatments and it is recommended to be implemented in nursing homes.

Simulation of integrated pollutant removal (IPR) water-treatment system using ASPEN Plus

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

Harendra, Sivaram; Oryshcyhn, Danylo; Ochs, Thomas

2013-01-01

Capturing CO2 from fossil fuel combustion provides an opportunity for tapping a significant water source which can be used as service water for a capture-ready power plant and its peripherals. Researchers at the National Energy Technology Laboratory (NETL) have patented a process—Integrated Pollutant Removal (IPR®)—that uses off-the-shelf technology to produce a sequestration ready CO2 stream from an oxy-combustion power plant. Water condensed from oxy-combustion flue gas via the IPR system has been analyzed for composition and an approach for its treatment—for in-process reuse and for release—has been outlined. A computer simulation model in ASPEN Plus has been developed to simulatemore » water treatment of flue gas derived wastewater from IPR systems. At the field installation, water condensed in the IPR process contains fly ash particles, sodium (largely from spray-tower buffering) and sulfur species as well as heavy metals, cations, and anions. An IPR wastewater treatment system was modeled using unit operations such as equalization, coagulation and flocculation, reverse osmosis, lime softening, crystallization, and pH correction. According to the model results, 70% (by mass) of the inlet stream can be treated as pure water, the other 20% yields as saleable products such as gypsum (CaSO4) and salt (NaCl) and the remaining portion is the waste. More than 99% of fly ash particles are removed in the coagulation and flocculation unit and these solids can be used as filler materials in various applications with further treatment. Results discussed relate to a slipstream IPR installation and are verified experimentally in the coagulation/flocculation step.« less

Treatment of high strength distillery wastewater (cherry stillage) by integrated aerobic biological oxidation and ozonation.

PubMed

Beltrán, F J; Alvarez, P M; Rodríguez, E M; García-Araya, J F; Rivas, J

2001-01-01

The performance of integrated aerobic digestion and ozonation for the treatment of high strength distillery wastewater (i.e., cherry stillage) is reported. Experiments were conducted in laboratory batch systems operating in draw and fill mode. For the biological step, activated sludge from a municipal wastewater treatment facility was used as inoculum, showing a high degree of activity to distillery wastewater. Thus, BOD and COD overall conversions of 95% and 82% were achieved, respectively. However, polyphenol content and absorbance at 254 nm (A(254)) could not be reduced more than 35% and 15%, respectively, by means of single biological oxidation. By considering COD as substrate, the aerobic digestion process followed a Contois' model kinetics, from which the maximum specific growth rate of microorganisms (mu(max)) and the inhibition factor, beta, were then evaluated at different conditions of temperature and pH. In the combined process, the effect of a post-ozonation stage was studied. The main goals achieved by the ozonation step were the removal of polyphenols and A(254). Therefore, ozonation was shown to be an appropriate technology to aid aerobic biological oxidation in the treatment of cherry stillage.

Selection of forward osmosis draw solutes for subsequent integration with anaerobic treatment to facilitate resource recovery from wastewater.

PubMed

Ansari, Ashley J; Hai, Faisal I; Guo, Wenshan; Ngo, Hao H; Price, William E; Nghiem, Long D

2015-09-01

Forward osmosis (FO) can be used to extract clean water and pre-concentrate municipal wastewater to make it amenable to anaerobic treatment. A protocol was developed to assess the suitability of FO draw solutes for pre-concentrating wastewater for potential integration with anaerobic treatment to facilitate resource recovery from wastewater. Draw solutes were evaluated in terms of their ability to induce osmotic pressure, water flux, and reverse solute flux. The compatibility of each draw solute with subsequent anaerobic treatment was assessed by biomethane potential analysis. The effect of each draw solute (at concentrations corresponding to the reverse solute flux at ten-fold pre-concentration of wastewater) on methane production was also evaluated. The results show that ionic organic draw solutes (e.g., sodium acetate) were most suitable for FO application and subsequent anaerobic treatment. On the other hand, the reverse solute flux of inorganic draw solutions could inhibit methane production from FO pre-concentrated wastewater. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Integration of Massage Therapy in Outpatient Cancer Care

PubMed Central

Cowen, Virginia S.; Tafuto, Barbara

2018-01-01

Background Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. Purpose The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. Setting This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Design Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. Main Outcome Measure The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. Results The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all—not even provision of information about massage to patients through the center website. Conclusions The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care. PMID:29593842

Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

PubMed Central

Heinz, Jürgen; Fiori, Wolfgang; Heusser, Peter

2013-01-01

Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. PMID:23431346

Integrative Therapeutic Approaches for the Management and Control of Nausea in Children Undergoing Cancer Treatment: A Systematic Review of Literature.

PubMed

Momani, Tha'er G; Berry, Donna L

Chemotherapy-induced nausea and vomiting (CINV) continues to be a common symptom experienced by children undergoing cancer treatment despite the use of contemporary antiemetics. Integrative therapeutic approaches in addition to standard pharmacologic antiemetic regimes offer potential to control CINV. The purpose of this review was to identify current evidence on integrative therapeutic approaches for the control of CINV in children with cancer. Online search engines (PubMed, CINAHL, PsychINFO) were queried using MESH terms. Titles, abstracts, and then full-text articles were reviewed for relevance to the review. The search resulted in 53 studies. Twenty-one studies met our review criteria. Integrative therapies identified included acupuncture/acupressure, aromatherapy, herbal supplements, hypnosis, and other cognitive behavioral interventions. Our review identified little information on the effectiveness and safety of most integrative therapeutic approaches for the control and management of CINV in children with cancer. However, evidence from adult cancer studies and some pediatric studies identify promising interventions for further testing.

Developing an Integrated Treatment Pathway for a Post-Coronary Artery Bypass Grating (CABG) Geriatric Patient with Comorbid Hypertension and Type 1 Diabetes Mellitus for Treating Acute Hypoglycemia and Electrolyte Imbalance.

PubMed

Naqvi, Atta Abbas; Shah, Amna; Ahmad, Rizwan; Ahmad, Niyaz

2017-01-01

The ailments afflicting the elderly population is a well-defined specialty of medicine. It calls for an immaculately designed health-care plan to treat diseases in geriatrics. For chronic illnesses such as diabetes mellitus (DM), coronary heart disease, and hypertension (HTN), they require proper management throughout the rest of patient's life. An integrated treatment pathway helps in treatment decision-making and improving standards of health care for the patient. This case describes an exclusive clinical pharmacist-driven designing of an integrated treatment pathway for a post-coronary artery bypass grafting (CABG) geriatric male patient with DM type I and HTN for the treatment of hypoglycemia and electrolyte imbalance. The treatment begins addressing the chief complaints which were vomiting and unconsciousness. Biochemical screening is essential to establish a diagnosis of electrolyte imbalance along with blood glucose level after which the integrated pathway defines the treatment course. This individualized treatment pathway provides an outline of the course of treatment of acute hypoglycemia, electrolyte imbalance as well as some unconfirmed diagnosis, namely, acute coronary syndrome and respiratory tract infection for a post-CABG geriatric patient with HTN and type 1 DM. The eligibility criterion for patients to be treated according to treatment pathway is to fall in the defined category.

Understanding Sensory Integration. ERIC Digest.

ERIC Educational Resources Information Center

DiMatties, Marie E.; Sammons, Jennifer H.

This brief paper summarizes what is known about sensory integration and sensory integration dysfunction (DSI). It outlines evaluation of DSI, treatment approaches, and implications for parents and teachers, including compensatory strategies for minimizing the impact of DSI on a child's life. Review of origins of sensory integration theory in the…

Online health information seeking: how people with multiple sclerosis find, assess and integrate treatment information to manage their health.

PubMed

Synnot, Anneliese J; Hill, Sophie J; Garner, Kerryn A; Summers, Michael P; Filippini, Graziella; Osborne, Richard H; Shapland, Sue D P; Colombo, Cinzia; Mosconi, Paola

2016-06-01

The Internet is increasingly prominent as a source of health information for people with multiple sclerosis (MS). But there has been little exploration of the needs, experiences and preferences of people with MS for integrating treatment information into decision making, in the context of searching on the Internet. This was the aim of our study. Sixty participants (51 people with MS; nine family members) took part in a focus group or online forum. They were asked to describe how they find and assess reliable treatment information (particularly online) and how this changes over time. Thematic analysis was underpinned by a coding frame. Participants described that there was both too much information online and too little that applied to them. They spoke of wariness and scepticism but also empowerment. The availability of up-to-date and unbiased treatment information, including practical and lifestyle-related information, was important to many. Many participants were keen to engage in a 'research partnership' with health professionals and developed a range of strategies to enhance the trustworthiness of online information. We use the term 'self-regulation' to capture the variations in information seeking behaviour that participants described over time, as they responded to their changing information needs, their emotional state and growing expertise about MS. People with MS have developed a number of strategies to both find and integrate treatment information from a range of sources. Their reflections informed the development of an evidence-based consumer web site based on summaries of MS Cochrane reviews. © 2014 John Wiley & Sons Ltd.

Integrating Fuel Treatments into Comprehensive Ecosystem Management

Treesearch

Kevin Hyde; Greg Jones; Robin Silverstein; Keith Stockmann; Dan Loeffler

2006-01-01

To plan fuel treatments in the context of comprehensive ecosystem management, forest managers must meet multiple-use and environmental objectives, address administrative and budget constraints, and reconcile performance measures from multiple policy directives. We demonstrate a multiple criteria approach to measuring success of fuel treatments used in the Butte North...

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment.

PubMed

Xie, Chenxi; Sifrim, Daniel; Li, Yuwen; Chen, Minhu; Xiao, Yinglian

2018-01-30

Esophageal baseline impedance, which is decreased in gastroesophageal reflux disease (GERD) patients, is related to the severity of acid reflux and the integrity of the esophageal mucosa. The study aims to compare the baseline impedance and the dilated intercellular spaces (DIS) within patients with typical reflux symptoms and to evaluate the correlation of baseline impedance with DIS, esophageal acid exposure, as well as the efficacy of proton pump inhibitor (PPI) treatment. Ninety-two patients and 10 healthy controls were included in the study. Erosive esophagitis (EE) was defined by esophageal mucosal erosion under upper endoscopy. Patients without mucosa erosion were divided into groups with pathologic acid reflux (non-erosive reflux disease [NERD]) or with hypersensitive esophagus. The biopsies of esophageal mucosa were taken 2-4 cm above the gastroesophageal junction Z-line during upper endoscopy for DIS measurement. All the patients received esomeprazole 20 mg twice-daily treatment for 8 weeks. The efficacy of esomeprazole was evaluated among all patients. The intercellular spaces were dilated in both EE and NERD patients ( P < 0.05). The value 0.73 µm could be used as the cut-off DIS value to distinguish patients from controls (area under the curve [AUC] = 0.849, P < 0.01). One thousand seven hundred sixty-four ohms could be used as the cut-off impedance values to distinguish patients from controls (AUC = 0.794, P < 0.01). The baseline impedance was decreased in both EE patients and NERD patients, and negatively correlated to the acid exposure time ( r = -0.527, P < 0.05). There was a weak correlation between DIS and baseline impedance ( r = -0.230, P < 0.05). "Baseline impedance > 1764 Ω" was an independent predictor for PPI failure (OR, 11.9; 95% CI, 2.4-58.9; P < 0.01). The DIS and decreased baseline impedance was observed in patients with mucosa erosion or pathological acid reflux. The baseline impedance reflected the mucosal integrity, it was more

Functional Analytic Psychotherapy Is a Framework for Implementing Evidence-Based Practices: The Example of Integrated Smoking Cessation and Depression Treatment

ERIC Educational Resources Information Center

Holman, Gareth; Kohlenberg, Robert J.; Tsai, Mavis; Haworth, Kevin; Jacobson, Emily; Liu, Sarah

2012-01-01

Depression and cigarette smoking are recurrent, interacting problems that co-occur at high rates and--especially when depression is chronic--are difficult to treat and associated with costly health consequences. In this paper we present an integrative therapeutic framework for concurrent treatment of these problems based on evidence-based…

A Three Month Comparative Evaluation of the Effect of Different Surface Treatment Agents on the Surface Integrity and Softness of Acrylic based Soft Liner: An In vivo Study

PubMed Central

Mahajan, Neerja; Naveen, Y. G.; Sethuraman, Rajesh

2017-01-01

Introduction Acrylic based soft liners are cost effective, yet are inferior in durability as compared to silicone based liners. Hence, this study was conducted to evaluate if the softness and surface integrity of acrylic based soft liner can be maintained by using different surface treatment agents. Aim To comparatively evaluate the effects of Varnish, Monopoly and Kregard surface treatment agents on the surface integrity and softness of acrylic based soft liner at baseline, at one month and after three months. Materials and Methods A total of 37 participants who required conventional maxillary dentures were selected according to the determined inclusion and exclusion criteria of the study. In the maxillary denture on the denture bearing surface, eight palatal recesses (5 mm x 3 mm) were made and filled with acrylic based soft liner (Permasoft). The soft liners in these recesses were given surface treatment and divided as control (uncoated), Varnish, Monopoly and Kregard groups. The hardness and surface integrity were evaluated with Shore A Durometer and Scanning Electron Microscope (SEM) respectively at baseline, one month and three months interval. Surface integrity between groups was compared using Kruskal-Wallis test. Intergroup comparison for hardness was done using ANOVA and Tukey’s HSD post-hoc tests. Results Amongst all the groups tested, surface integrity was maintained in the Kregard group, as compared to control, Varnish and Monopoly groups for all three time intervals (p< 0.001). Kregard treated samples also demonstrated significantly higher softness at all the time intervals (p<0.001). Conclusion Surface treatment with Kregard demonstrated better surface integrity and softness at all the time intervals. PMID:29207842

The comparative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) and substance abuse treatment alone: a randomized controlled trial

PubMed Central

2013-01-01

Background Research has shown that treatments that solely addressed intimate partner violence (IPV) perpetration were not very effective in reducing IPV, possibly due to neglecting individual differences between IPV perpetrators. A large proportion of IPV perpetrators is diagnosed with co-occurring substance use disorders and it has been demonstrated that successful treatment of alcohol dependence among alcohol dependent IPV perpetrators also led to less IPV. The current study investigated the relative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) to cognitive behavioral treatment addressing substance use disorders including only one session addressing partner violence (CBT-SUD+) among patients in substance abuse treatment who repeatedly committed IPV. Substance use and IPV perpetration were primary outcome measures. Method Patients who entered substance abuse treatment were screened for IPV. Patients who disclosed at least 7 acts of physical IPV in the past year (N = 52) were randomly assigned to either I-StoP or CBT-SUD+. Patients in both conditions received 16 treatment sessions. Substance use and IPV perpetration were assessed at pretreatment, halfway treatment and posttreatment in blocks of 8 weeks. Both completers and intention-to-treat (ITT) analyses were performed. Results Patients (completers and ITT) in both conditions significantly improved regarding substance use and IPV perpetration at posttreatment compared with pretreatment. There were no differences in outcome between conditions. Completers in both conditions almost fully abstained from IPV in 8 weeks before the end of treatment. Conclusions Both I-StoP and CBT-SUD+ were effective in reducing substance use and IPV perpetration among patients in substance abuse treatment who repeatedly committed IPV and self-disclosed IPV perpetration. Since it is more cost and time-effective to implement CBT-SUD+ than I-StoP, it is suggested to treat IPV perpetrators

Arthroscopic treatment for intratendinous rotator cuff tear results in satisfactory clinical outcomes and structural integrity.

PubMed

Cheon, Sang Jin; Lee, Hyo Yeol; Jeon, Woong Ki

2018-04-20

This study aimed to evaluate the clinical outcomes and structural integrity of arthroscopic repair of intratendinous rotator cuff tear. Patients who were diagnosed with an intratendinous tear but in whom conservative treatment failed were selected and underwent arthroscopic repair. Between 2008 and 2014, a total of 30 patients (6 men, 24 women; mean age, 59 ± 3.7 years) met the inclusion criteria and were followed up. The mean follow-up period was 26.3 ± 0.7 months. The results were evaluated using the University of California at Los Angeles (UCLA) score, the Society of the American Shoulder and Elbow Surgeons rating scale (ASES) questionnaire, and the visual analog scale (VAS) and range of motion (ROM) were measured preoperatively and at final follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 6.7 ± 0.2 months postoperatively. Postoperative MRI was performed on 27 out of 30 patients and analysed using the Sugaya classification. Corresponding to the preoperative MRI findings, arthroscopic findings of intratendinous tears were observed in all 30 patients. The mean active forward elevation ROM was 137.3° ± 15.4° before surgery and 168.8° ± 15.2° at the final follow-up. The internal and external rotations at abduction were 31.7° ± 5.1° and 63.0° ± 11.6° before surgery, respectively, and 60.5° ± 8.0° and 75.2° ± 10.8° after surgery, respectively. The UCLA score improved from of 20.1 ± 7.4 points preoperative to 28.4 ± 5.5 points at the final follow-up. The ASES score improved from 55.7 ± 15.3 points preoperative to 82.6 ± 9.7 points postoperatively. The VAS for pain score decreased from 6.4 ± 1.2 points preoperative to 1.6 ± 0.9 points postoperative. Satisfactory outcomes (excellent/good) in terms of UCLA and ASES scores were observed in 29 of 30 patients. Based on Sugaya classification, grades I, II, and III structural integrities were observed in 9

Advanced treatment of biologically pretreated coal gasification wastewater by a novel integration of heterogeneous Fenton oxidation and biological process.

PubMed

Xu, Peng; Han, Hongjun; Zhuang, Haifeng; Hou, Baolin; Jia, Shengyong; Xu, Chunyan; Wang, Dexin

2015-04-01

Laboratorial scale experiments were conducted in order to investigate a novel system integrating heterogeneous Fenton oxidation (HFO) with anoxic moving bed biofilm reactor (ANMBBR) and biological aerated filter (BAF) process on advanced treatment of biologically pretreated coal gasification wastewater (CGW). The results indicated that HFO with the prepared catalyst (FeOx/SBAC, sewage sludge based activated carbon (SBAC) which loaded Fe oxides) played a key role in eliminating COD and COLOR as well as in improving the biodegradability of raw wastewater. The surface reaction and hydroxyl radicals (OH) oxidation were the mechanisms for FeOx/SBAC catalytic reaction. Compared with ANMBBR-BAF process, the integrated system was more effective in abating COD, BOD5, total phenols (TPs), total nitrogen (TN) and COLOR and could shorten the retention time. Therefore, the integrated system was a promising technology for engineering applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

Structural elucidation of sorghum lignins from an integrated biorefinery process based on hydrothermal and alkaline treatments.

PubMed

Sun, Shao-Long; Wen, Jia-Long; Ma, Ming-Guo; Sun, Run-Cang

2014-08-13

An integrated process based on hydrothermal pretreatment (HTP) (i.e., 110-230 °C, 0.5-2.0 h) and alkaline post-treatment (2% NaOH at 90 °C for 2.0 h) has been performed for the production of xylooligosaccharide, lignin, and digestible substrate from sweet sorghum stems. The yield, purity, dissociation mechanisms, structural features, and structural transformations of alkali lignins obtained from the integrated process were investigated. It was found that the HTP process facilitated the subsequent alkaline delignification, releasing lignin with the highest yield (79.3%) and purity from the HTP residue obtained at 190 °C for 0.5 h. All of the results indicated that the cleavage of the β-O-4 linkages and degradation of β-β and β-5 linkages occurred under the harsh HTP conditions. Depolymerization and condensation reactions simultaneously occurred at higher temperatures (≥ 170 °C). Moreover, the thermostability of lignin was positively related to its molecular weight, but was also affected by the inherent structures, such as β-O-4 linkages and condensed units. These findings will enhance the understanding of structural transformations of the lignins during the integrated process and maximize the potential utilizations of the lignins in a current biorefinery process.

Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.

PubMed

Folbert, E C; Hegeman, J H; Vermeer, M; Regtuijt, E M; van der Velde, D; Ten Duis, H J; Slaets, J P

2017-01-01

To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4-5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1-2 OR 1.46, CCI 3-4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail

A Descriptive Evaluation of Long-Term Treatment Integrity

ERIC Educational Resources Information Center

Arkoosh, Maire Kathryn; Derby, K. Mark; Wacker, David P.; Berg, Wendy; McLaughlin, T. F.; Barretto, Anjali

2007-01-01

The validity of selecting treatment contingencies on the basis of the results obtained through functional analysis is well documented. However, a number of second-generation questions have emerged: For example, what are the parameters required to achieve desired treatment outcomes? More specifically, what is the degree of treatment integrity…

An integrated hypnotherapeutic model for the treatment of childhood sexual trauma: a case study.

PubMed

Fourie, Gerda; Guse, Tharina

2011-01-01

Sexual abuse appears to constitute a major risk factor for a variety of problems in adult life. The effects of abuse on adult living are not uniform therefore intervention strategies should be individualized to address unique symptom constellations. The purpose of this paper is to introduce an integrated Ericksonian and Ego state therapy approach, based on a strengths perspective for the treatment of survivors of childhood sexual abuse. The theoretical foundation for this model is described, followed by a case study. The case study demonstrates how application of this model enabled the client to resolve the experience of sexual abuse, as well as to enhance her sense of general psychological well-being.

Integrated monitoring and assessment of soil restoration treatments in the Lake Tahoe Basin.

PubMed

Grismer, M E; Schnurrenberger, C; Arst, R; Hogan, M P

2009-03-01

Revegetation and soil restoration efforts, often associated with erosion control measures on disturbed soils, are rarely monitored or otherwise evaluated in terms of improved hydrologic, much less, ecologic function and longer term sustainability. As in many watersheds, sediment is a key parameter of concern in the Tahoe Basin, particularly fine sediments less than about ten microns. Numerous erosion control measures deployed in the Basin during the past several decades have under-performed, or simply failed after a few years and new soil restoration methods of erosion control are under investigation. We outline a comprehensive, integrated field-based evaluation and assessment of the hydrologic function associated with these soil restoration methods with the hypothesis that restoration of sustainable function will result in longer term erosion control benefits than that currently achieved with more commonly used surface treatment methods (e.g. straw/mulch covers and hydroseeding). The monitoring includes cover-point and ocular assessments of plant cover, species type and diversity; soil sampling for nutrient status; rainfall simulation measurement of infiltration and runoff rates; cone penetrometer measurements of soil compaction and thickness of mulch layer depths. Through multi-year hydrologic and vegetation monitoring at ten sites and 120 plots, we illustrate the results obtained from the integrated monitoring program and describe how it might guide future restoration efforts and monitoring assessments.

Size Does Matter: An Integrative In Vivo-In Silico Approach for the Treatment of Critical Size Bone Defects

PubMed Central

Carlier, Aurélie; van Gastel, Nick; Geris, Liesbet; Carmeliet, Geert; Van Oosterwyck, Hans

2014-01-01

Although bone has a unique restorative capacity, i.e., it has the potential to heal scarlessly, the conditions for spontaneous bone healing are not always present, leading to a delayed union or a non-union. In this work, we use an integrative in vivo - in silico approach to investigate the occurrence of non-unions, as well as to design possible treatment strategies thereof. The gap size of the domain geometry of a previously published mathematical model was enlarged in order to study the complex interplay of blood vessel formation, oxygen supply, growth factors and cell proliferation on the final healing outcome in large bone defects. The multiscale oxygen model was not only able to capture the essential aspects of in vivo non-unions, it also assisted in understanding the underlying mechanisms of action, i.e., the delayed vascularization of the central callus region resulted in harsh hypoxic conditions, cell death and finally disrupted bone healing. Inspired by the importance of a timely vascularization, as well as by the limited biological potential of the fracture hematoma, the influence of the host environment on the bone healing process in critical size defects was explored further. Moreover, dependent on the host environment, several treatment strategies were designed and tested for effectiveness. A qualitative correspondence between the predicted outcomes of certain treatment strategies and experimental observations was obtained, clearly illustrating the model's potential. In conclusion, the results of this study demonstrate that due to the complex non-linear dynamics of blood vessel formation, oxygen supply, growth factor production and cell proliferation and the interactions thereof with the host environment, an integrative in silico-in vivo approach is a crucial tool to further unravel the occurrence and treatments of challenging critical sized bone defects. PMID:25375821

Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men

PubMed Central

Wolff, Nancy; Huening, Jessica; Shi, Jing; Frueh, B. Christopher; Hoover, Donald R.; McHugo, Gregory

2015-01-01

A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n = 230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n = 142) or by preference (n = 88) to receive SS or M-TREM, with a waitlist group of (n = 93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co

An integrated approach for monitoring efficiency and investments of activated sludge-based wastewater treatment plants at large spatial scale.

PubMed

De Gisi, Sabino; Sabia, Gianpaolo; Casella, Patrizia; Farina, Roberto

2015-08-01

WISE, the Water Information System for Europe, is the web-portal of the European Commission (EU) that disseminates the quality state of the receiving water bodies and the efficiency of the municipal wastewater treatment plants (WWTPs) in order to monitor advances in the application of both the Water Framework Directive (WFD) as well as the Urban Wastewater Treatment Directive (UWWTD). With the intention to develop WISE applications, the aim of the work was to define and apply an integrated approach capable of monitoring the efficiency and investments of activated sludge-based WWTPs located in a large spatial area, providing the following outcomes useful to the decision-makers: (i) the identification of critical facilities and their critical processes by means of a Performance Assessment System (PAS), (ii) the choice of the most suitable upgrading actions, through a scenario analysis. (iii) the assessment of the investment costs to upgrade the critical WWTPs and (iv) the prioritization of the critical facilities by means of a multi-criteria approach which includes the stakeholders involvement, along with the integration of some technical, environmental, economic and health aspects. The implementation of the proposed approach to a high number of municipal WWTPs highlighted how the PAS developed was able to identify critical processes with a particular effectiveness in identifying the critical nutrient removal ones. In addition, a simplified approach that considers the cost related to a basic-configuration and those for the WWTP integration, allowed to link the critical processes identified and the investment costs. Finally, the questionnaire for the acquisition of data such as that provided by the Italian Institute of Statistics, the PAS defined and the database on the costs, if properly adapted, may allow for the extension of the integrated approach on an EU-scale by providing useful information to water utilities as well as institutions. Copyright © 2015 Elsevier

Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur.

PubMed

Souza, Renato; Yasuda, Silvia; Cristofani, Susanna

2009-07-21

There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1-10.2) to 7.1 (95%CI 5.9-8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6-7.0) p < 0.0001. The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur

PubMed Central

Souza, Renato; Yasuda, Silvia; Cristofani, Susanna

2009-01-01

Background There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. Methods A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Results Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1–10.2) to 7.1 (95%CI 5.9–8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6–7.0) p < 0.0001. Conclusion The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility. PMID:19622151

Tracing pharmaceuticals in a municipal plant for integrated wastewater and organic solid waste treatment.

PubMed

Jelic, Aleksandra; Fatone, Francesco; Di Fabio, Silvia; Petrovic, Mira; Cecchi, Franco; Barcelo, Damia

2012-09-01

The occurrence and removal of 42 pharmaceuticals, belonging to different therapeutic groups (analgesics and anti-inflammatory drugs, anti-ulcer agent, psychiatric drugs, antiepileptic drug, antibiotics, ß-blockers, diuretics, lipid regulator and cholesterol lowering statin drugs and anti-histamines), were studied in the wastewater and sewage sludge trains of a full scale integrated treatment plant. The plant employs a biological nutrient removal (BNR) process for the treatment of municipal wastewater, and a single-stage mesophilic anaerobic co-digestion for the treatment of wasted activated sludge mixed with the organic fraction of municipal solid waste (OFMSW), followed by a short-cut nitrification-denitrification of the anaerobic supernatant in a sequential batch reactor. Influent and effluent wastewater, as well as thickened, digested and treated sludge were sampled and analyzed for the selected pharmaceuticals in order to study their presence and fate during the treatment. Twenty three compounds were detected in influent and effluent wastewater and eleven in sludge. Infiltration of groundwater in the sewer system led to a dilution of raw sewage, resulting in lower concentrations in wastewater (up to 0.7 μg/L in influent) and sludge (70 ng/g d.w.). Due to the dilution, overall risk quotient for the mixture of pharmaceuticals detected in effluent wastewater was less than one, indicating no direct risk for the aquatic environment. A wide range of removal efficiencies during the treatment was observed, i.e. <20% to 90%. The influent concentrations of the target pharmaceuticals, as polar compounds, were undoubtedly mostly affected by BNR process in the wastewater train, and less by anaerobic-co-digestion. Mass balance calculations showed that less than 2% of the total mass load of the studied pharmaceuticals was removed by sorption. Experimentally estimated distribution coefficients (<500 L/kg) also indicated that the selected pharmaceuticals preferably remain in

Teaching Ideas and Activities for Classroom: Integrating Technology into the Pedagogy of Integral Calculus and the Approximation of Definite Integrals

ERIC Educational Resources Information Center

Caglayan, Gunhan

2016-01-01

The purpose of this article is to offer teaching ideas in the treatment of the definite integral concept and the Riemann sums in a technology-supported environment. Specifically, the article offers teaching ideas and activities for classroom for the numerical methods of approximating a definite integral via left- and right-hand Riemann sums, along…

Efficacy of integrated school based de-worming and prompt malaria treatment on helminths -Plasmodium falciparum co-infections: A 33 months follow up study.

PubMed

Midzi, Nicholas; Mtapuri-Zinyowera, Sekesai; Sangweme, Davison; Paul, Noah H; Makware, Godfrey; Mapingure, Munyaradzi P; Brouwer, Kimberly C; Mudzori, James; Hlerema, Gibson; Chadukura, Vivian; Mutapi, Francisca; Kumar, Nirbhay; Mduluza, Takafira

2011-06-22

The geographical congruency in distribution of helminths and Plasmodium falciparum makes polyparasitism a common phenomenon in Sub Saharan Africa. The devastating effects of helminths-Plasmodium co-infections on primary school health have raised global interest for integrated control. However little is known on the feasibility, timing and efficacy of integrated helminths-Plasmodium control strategies. A study was conducted in Zimbabwe to evaluate the efficacy of repeated combined school based antihelminthic and prompt malaria treatment. A cohort of primary schoolchildren (5-17 years) received combined Praziquantel, albendazole treatment at baseline, and again during 6, 12 and 33 months follow up surveys and sustained prompt malaria treatment. Sustained prompt malaria treatment was carried out throughout the study period. Children's infection status with helminths, Plasmodium and helminths-Plasmodium co-infections was determined by parasitological examinations at baseline and at each treatment point. The prevalence of S. haematobium, S. mansoni, STH, malaria, helminths-Plasmodium co-infections and helminths infection intensities before and after treatment were analysed. Longitudinal data showed that two rounds of combined Praziquantel and albendazole treatment for schistosomiasis and STHs at 6 monthly intervals and sustained prompt malaria treatment significantly reduced the overall prevalence of S. haematobium, S. mansoni, hookworms and P. falciparum infection in primary schoolchildren by 73.5%, 70.8%, 67.3% and 58.8% respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001 respectively). More importantly, the prevalence of STH + schistosomes, P. f + schistosomes, and P. f + STHs + schistosomes co-infections were reduced by 68.0%, 84.2%, and 90.7%, respectively. The absence of anti-helminthic treatment between the 12 mth and 33 mth follow-up surveys resulted in the sharp increase in STHs + schistosomes co-infection from 3.3% at 12 months follow up survey to 10

Structural elucidation of Eucalyptus lignin and its dynamic changes in the cell walls during an integrated process of ionic liquids and successive alkali treatments.

PubMed

Li, Han-Yin; Wang, Chen-Zhou; Chen, Xue; Cao, Xue-Fei; Sun, Shao-Ni; Sun, Run-Cang

2016-12-01

An integrated process based on ionic liquids ([Bmim]Cl and [Bmim]OAc) pretreatment and successive alkali post-treatments (0.5, 2.0, and 4.0% NaOH at 90°C for 2h) was performed to isolate lignins from Eucalyptus. The structural features and spatial distribution of lignin in the Eucalyptus cell wall were investigated thoroughly. Results revealed that the ionic liquids pretreatment promoted the isolation of alkaline lignin from the pretreated samples without obvious structural changes. Additionally, the integrated process resulted in syringyl-rich lignin macromolecules with more β-O-4' linkages and less phenolic hydroxyl groups. Confocal Raman microscopy analysis showed that the dissolution behavior of lignin was varied in the morphologically distinct regions during the successive alkali treatments, and lignin dissolved was mainly stemmed from the secondary wall regions. These results provided some useful information for understanding the mechanisms of delignification during the integrated process and enhancing the potential utilizations of lignin in future biorefineries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evolving a model for integrated treatment in a residential setting for people with psychiatric and substance use disorders.

PubMed

Mayes, John; Handley, Samantha

2005-01-01

This paper discusses the implementation of a residential, integrated treatment program serving dually diagnosed people with histories of homelessness. Attention is focused on the program structure and how the program developed over time. Program modifications tended to relax program rules and embrace a motivational, stage-wise model using harm-reduction principles. Despite initial skepticism regarding these modifications, outcomes such as program retention, abstinence from substances, employment, and hospitalization improved.

The Intersystem Model of Psychotherapy: An Integrated Systems Treatment Approach

ERIC Educational Resources Information Center

Weeks, Gerald R.; Cross, Chad L.

2004-01-01

This article introduces the intersystem model of psychotherapy and discusses its utility as a truly integrative and comprehensive approach. The foundation of this conceptually complex approach comes from dialectic metatheory; hence, its derivation requires an understanding of both foundational and integrational constructs. The article provides a…

Integrative Health Services in School Health Clinics

PubMed Central

Milosavljevic, Nada

2015-01-01

Objective: Mental health treatment today incorporates neurobiology, genetics, neuro-imaging, and pharmacologic mechanisms, offering more options to patients. For some, these modern approaches are not viable choices due to reasons such as limited access to care, cost, intolerable side effects, and, in the pediatric population, fears of potential long-term effects. With the growing prevalence of chronic health conditions, concerns for age of onset, (McGorry, Purcell, Goldstone, & Amminger, 2011) and a growing population of mental health patients, cost-effective and evidence-based treatment options should be evaluated. Integrative treatments, also known as complementary and alternative medicine (CAM), may offer interventions that meet today’s clinical needs. Method: To evaluate evidence-based treatment options, we initiated the school-based integrative health program (IHP) in January 2011 at three high schools located in Massachusetts. Our goal was two-fold: first, to design a holistic treatment program and evaluate several integrative modalities, and; second, to determine the feasibility of providing a CAM health program through school clinics. Our protocol utilized three integrative treatments that addressed stress and anxiety conditions. Anxiety disorders are the most common mental illness affecting over 40 million adults in the US (Anxiety and Depression Association of America). Results: The program has been successfully implemented. Preliminary results indicate that this intervention decreased anxiety in these youth. Conclusion: Providing integrative techniques to students in the school setting has the potential to decrease barriers to accessing care, lowering treatment costs and decreasing school absenteeism by instituting care on-site. Offering a holistic approach to treatment in schools is feasible. Because utilizing these approaches involves their active participation, adolescents can acquire life-long skills that improve their ability to cope and confront

An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments.

PubMed

Vohs, Jenifer L; George, Sunita; Leonhardt, Bethany L; Lysaker, Paul H

2016-10-01

Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause. Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.

Integrated modelling of stormwater treatment systems uptake.

PubMed

Castonguay, A C; Iftekhar, M S; Urich, C; Bach, P M; Deletic, A

2018-05-24

Nature-based solutions provide a variety of benefits in growing cities, ranging from stormwater treatment to amenity provision such as aesthetics. However, the decision-making process involved in the installation of such green infrastructure is not straightforward, as much uncertainty around the location, size, costs and benefits impedes systematic decision-making. We developed a model to simulate decision rules used by local municipalities to install nature-based stormwater treatment systems, namely constructed wetlands, ponds/basins and raingardens. The model was used to test twenty-four scenarios of policy-making, by combining four asset selection, two location selection and three budget constraint decision rules. Based on the case study of a local municipality in Metropolitan Melbourne, Australia, the modelled uptake of stormwater treatment systems was compared with attributes of real-world systems for the simulation period. Results show that the actual budgeted funding is not reliable to predict systems' uptake and that policy-makers are more likely to plan expenditures based on installation costs. The model was able to replicate the cumulative treatment capacity and the location of systems. As such, it offers a novel approach to investigate the impact of using different decision rules to provide environmental services considering biophysical and economic factors. Copyright © 2018 Elsevier Ltd. All rights reserved.

Developing an Integrated, Brief Biobehavioral HIV Prevention Intervention for High-Risk Drug Users in Treatment: The Process and Outcome of Formative Research

PubMed Central

Shrestha, Roman; Altice, Frederick; Karki, Pramila; Copenhaver, Michael

2017-01-01

To date, HIV prevention efforts have largely relied on singular strategies (e.g., behavioral or biomedical approaches alone) with modest HIV risk-reduction outcomes for people who use drugs (PWUD), many of whom experience a wide range of neurocognitive impairments (NCI). We report on the process and outcome of our formative research aimed at developing an integrated biobehavioral approach that incorporates innovative strategies to address the HIV prevention and cognitive needs of high-risk PWUD in drug treatment. Our formative work involved first adapting an evidence-based behavioral intervention—guided by the Assessment–Decision–Administration–Production–Topical experts–Integration–Training–Testing model—and then combining the behavioral intervention with an evidence-based biomedical intervention for implementation among the target population. This process involved eliciting data through structured focus groups (FGs) with key stakeholders—members of the target population (n = 20) and treatment providers (n = 10). Analysis of FG data followed a thematic analysis approach utilizing several qualitative data analysis techniques, including inductive analysis and cross-case analysis. Based on all information, we integrated the adapted community-friendly health recovery program—a brief evidence-based HIV prevention behavioral intervention—with the evidence-based biomedical component [i.e., preexposure prophylaxis (PrEP)], an approach that incorporates innovative strategies to accommodate individuals with NCI. This combination approach—now called the biobehavioral community-friendly health recovery program—is designed to address HIV-related risk behaviors and PrEP uptake and adherence as experienced by many PWUD in treatment. This study provides a complete example of the process of selecting, adapting, and integrating the evidence-based interventions—taking into account both empirical evidence and input from target population members

Integrated electrocoagulation-electrooxidation process for the treatment of soluble coffee effluent: Optimization of COD degradation and operation time analysis.

PubMed

Ibarra-Taquez, Harold N; GilPavas, Edison; Blatchley, Ernest R; Gómez-García, Miguel-Ángel; Dobrosz-Gómez, Izabela

2017-09-15

Soluble coffee production generates wastewater containing complex mixtures of organic macromolecules. In this work, a sequential Electrocoagulation-Electrooxidation (EC-EO) process, using aluminum and graphite electrodes, was proposed as an alternative way for the treatment of soluble coffee effluent. Process operational parameters were optimized, achieving total decolorization, as well as 74% and 63.5% of COD and TOC removal, respectively. The integrated EC-EO process yielded a highly oxidized (AOS = 1.629) and biocompatible (BOD 5 /COD ≈ 0.6) effluent. The Molecular Weight Distribution (MWD) analysis showed that during the EC-EO process, EC effectively decomposed contaminants with molecular weight in the range of 10-30 kDa. In contrast, EO was quite efficient in mineralization of contaminants with molecular weight higher than 30 kDa. A kinetic analysis allowed determination of the time required to meet Colombian permissible discharge limits. Finally, a comprehensive operational cost analysis was performed. The integrated EC-EO process was demonstrated as an efficient alternative for the treatment of industrial effluents resulting from soluble coffee production. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessing the estrogenic potency in a Portuguese wastewater treatment plant using an integrated approach.

PubMed

Diniz, Mário S; Maurício, Rita; Petrovic, Mira; López de Alda, Maria J; Amaral, Leonor; Peres, Isabel; Barceló, Damiá; Santana, Fernando

2010-01-01

The estrogenic potency of a wastewater treatment plant (WWTP) was evaluated using chemical and biological analyses, which showed that after the station treatment processes some of the selected endocrine disruptor compounds (EDCs) were still present in the treated effluent (e.g., bisphenol A, alkylphenols, estrone). Thus, the most common endocrine EDCs were identified and quantified and the overall estrogenicity of the treated effluent assessed by integrating the results. Male goldfish (Carassius auratus) were used as biological indicators in a 28-day experiment. Vitellogenin (Vtg), gonadosomatic and hepatosomatic indices, steroids (17beta-estradiol and 11-ketotestosterone) and histopathology were biomarkers used in fish to evaluate WWTP treated effluent estrogenicity, in combination with instrumental analyses. The results showed a significant increase (P < 0.01) in plasma and liver Vtg, which were significantly correlated (r = 0.66; P < 0.01). The gonadosmatic index was significantly (P < 0.01) reduced in exposed fish. The steroid analyses revealed significant elevations in 17beta-estradiol and depressed 11-ketotestosterone concentrations. The histological examinations show changes in exposed fish gonads, such as regressed testes and in some cases (43% to 75%) the development of ovo-testis in fish exposed to 50% and 100% treated effluent.

A Comprehensive Definition for Integrative Oncology.

PubMed

Witt, Claudia M; Balneaves, Lynda G; Cardoso, Maria J; Cohen, Lorenzo; Greenlee, Heather; Johnstone, Peter; Kücük, Ömer; Mailman, Josh; Mao, Jun J

2017-11-01

Integrative oncology, which is generally understood to refer to the use of a combination of complementary medicine therapies in conjunction with conventional cancer treatments, has been defined in different ways, but there is no widely accepted definition. We sought to develop and establish a consensus for a comprehensive definition of the field of integrative oncology. We used a mixed-methods approach that included a literature analysis and a consensus procedure, including an interdisciplinary expert panel and surveys, to develop a comprehensive and acceptable definition for the term "integrative oncology." The themes identified in the literature and from the expert discussion were condensed into a two-sentence definition. Survey respondents had very positive views on the draft definition, and their comments helped to shape the final version. The final definition for integrative oncology is: "Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before,during, and beyond cancer treatment." This short and comprehensive definition for the term integrative oncology will facilitate a better understanding and communication of this emerging field. This definition will also drive focused and cohesive effort to advance the field of integrative oncology. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility.

PubMed

Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G

2004-01-01

The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

Integrative medicine in head and neck cancer

PubMed Central

Matovina, Chloe; Birkeland, Andrew C.; Zick, Suzanna; Shuman, Andrew G.

2017-01-01

Objective Complementary and alternative medicine (CAM), or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this manuscript is to use recent data to outline the decision-making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers’ understanding of integrative medicine. Data Sources Randomized controlled trials involving integrative medicine or CAM treatment for cancer patients. Review Methods Trials were drawn from a systematic PubMed database search categorized into cancer prevention, treatment, and symptom management. Conclusions Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine. Implications for Practice In the management of head and neck cancer, there is an increasing demand for awareness of, dialogue about, and research evaluating integrative medicine therapies. It is important for otolaryngologists to become aware of integrative therapy options, their risks and benefits, and resources for further information in order to effectively counsel their patients. PMID:27729559

Integrative Medicine in Head and Neck Cancer.

PubMed

Matovina, Chloe; Birkeland, Andrew C; Zick, Suzanna; Shuman, Andrew G

2017-02-01

Objective Complementary and alternative medicine, or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this article is to use recent data to outline the decision making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers' understanding of integrative medicine. Data Sources Randomized controlled trials involving integrative medicine or complementary and alternative medicine treatment for cancer patients. Review Methods Trials were drawn from a systematic PubMed database search categorized into cancer prevention, treatment, and symptom management. Conclusions Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine. Implications for Practice In the management of head and neck cancer, there is an increasing demand for awareness of, dialogue about, and research evaluating integrative medicine therapies. It is important for otolaryngologists to become aware of integrative therapy options, their risks and benefits, and resources for further information to effectively counsel their patients.

Efficacy of integrated school based de-worming and prompt malaria treatment on helminths -Plasmodium falciparum co-infections: A 33 months follow up study

PubMed Central

2011-01-01

Background The geographical congruency in distribution of helminths and Plasmodium falciparum makes polyparasitism a common phenomenon in Sub Saharan Africa. The devastating effects of helminths-Plasmodium co-infections on primary school health have raised global interest for integrated control. However little is known on the feasibility, timing and efficacy of integrated helminths-Plasmodium control strategies. A study was conducted in Zimbabwe to evaluate the efficacy of repeated combined school based antihelminthic and prompt malaria treatment. Methods A cohort of primary schoolchildren (5-17 years) received combined Praziquantel, albendazole treatment at baseline, and again during 6, 12 and 33 months follow up surveys and sustained prompt malaria treatment. Sustained prompt malaria treatment was carried out throughout the study period. Children's infection status with helminths, Plasmodium and helminths-Plasmodium co-infections was determined by parasitological examinations at baseline and at each treatment point. The prevalence of S. haematobium, S. mansoni, STH, malaria, helminths-Plasmodium co-infections and helminths infection intensities before and after treatment were analysed. Results Longitudinal data showed that two rounds of combined Praziquantel and albendazole treatment for schistosomiasis and STHs at 6 monthly intervals and sustained prompt malaria treatment significantly reduced the overall prevalence of S. haematobium, S. mansoni, hookworms and P. falciparum infection in primary schoolchildren by 73.5%, 70.8%, 67.3% and 58.8% respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001 respectively). More importantly, the prevalence of STH + schistosomes, P. f + schistosomes, and P. f + STHs + schistosomes co-infections were reduced by 68.0%, 84.2%, and 90.7%, respectively. The absence of anti-helminthic treatment between the 12 mth and 33 mth follow-up surveys resulted in the sharp increase in STHs + schistosomes co-infection from 3.3% at 12 months

Integrated bicarbonate-form ion exchange treatment and regeneration for DOC removal: Model development and pilot plant study.

PubMed

Hu, Yue; Boyer, Treavor H

2017-05-15

The application of bicarbonate-form anion exchange resin and sodium bicarbonate salt for resin regeneration was investigated in this research is to reduce chloride ion release during treatment and the disposal burden of sodium chloride regeneration solution when using traditional chloride-form ion exchange (IX). The target contaminant in this research was dissolved organic carbon (DOC). The performance evaluation was conducted in a completely mixed flow reactor (CMFR) IX configuration. A process model that integrated treatment and regeneration was investigated based on the characteristics of configuration. The kinetic and equilibrium experiments were performed to obtain required parameters for the process model. The pilot plant tests were conducted to validate the model as well as provide practical understanding on operation. The DOC concentration predicted by the process model responded to the change of salt concentration in the solution, and showed a good agreement with pilot plant data with less than 10% difference in terms of percentage removal. Both model predictions and pilot plant tests showed over 60% DOC removal by bicarbonate-form resin for treatment and sodium bicarbonate for regeneration, which was comparable to chloride-form resin for treatment and sodium chloride for regeneration. Lastly, the DOC removal was improved by using higher salt concentration for regeneration. Copyright © 2017 Elsevier Ltd. All rights reserved.

Integrated HIV care is associated with improved engagement in treatment in an urban methadone clinic.

PubMed

Simeone, Claire; Shapiro, Brad; Lum, Paula J

2017-08-22

Persons living with HIV and unhealthy substance use are often less engaged in HIV care, have higher morbidity and mortality and are at increased risk of transmitting HIV to uninfected partners. We developed a quality-improvement tracking system at an urban methadone clinic to monitor patients along the HIV care continuum and identify patients needing intervention. To evaluate patient outcomes along the HIV Care Continuum at an urban methadone clinic and explore the relationship of HIV primary care site and patient demographic characteristics with retention in HIV treatment and viral suppression. We reviewed electronic medical record data from 2015 for all methadone clinic patients with known HIV disease, including age, gender, race, HIV care sites, HIV care visit dates and HIV viral load. Patients received either HIV primary care at the methadone clinic, an HIV specialty clinic located in the adjacent building, or a community clinic. Retention was defined as an HIV primary care visit in both halves of the year. Viral suppression was defined as an HIV viral load <40 copies/ml at the last lab draw. The population (n = 65) was 63% male, 82% age 45 or older and 60% non-Caucasian. Of these 65 patients 77% (n = 50) were retained in care and 80% (n = 52) were virologically suppressed. Viral suppression was significantly higher for women (p = .022) and patients 45 years or older (p = .034). There was a trend towards greater retention in care and viral suppression among patients receiving HIV care at the methadone clinic (93, 93%) compared to the HIV clinic (74, 79%) or community clinics (62, 62%). Retention in HIV care and viral suppression are high in an urban methadone clinic providing integrated HIV services. This quality improvement analysis supports integrating HIV primary care with methadone treatment services for this at-risk population.

The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico.

PubMed

Leff, Jared A; Hernández, Diana; Teixeira, Paul A; Castellón, Pedro C; Feaster, Daniel J; Rodriguez, Allan E; Santana-Bagur, Jorge L; De León, Sandra Miranda; Vidot, José Vargas; Metsch, Lisa R; Schackman, Bruce R

2017-03-23

HIV prevalence in Puerto Rico is nearly twice that of the mainland United States, a level that was substantially fueled by injection drug use. Puerto Rico has a longstanding history of health provision by the public sector that directly affects how HIV and substance use disorder (SUD) treatment services are provided and funded. As part of pre-implementation research for a randomized trial of a community-level intervention to enhance HIV care access for substance users in San Juan, Puerto Rico, we sought to understand the structural and health policy environment for providing HIV and SUD treatments. We conducted semi-structured qualitative interviews (n = 8) with government and program administrators in English and Spanish. Data were analyzed to identify dominant and recurrent themes. Participants discussed how lack of integration among medical and mental health service providers, lack of public transportation, and turnover in appointed government officials were barriers to integrated HIV and SUD treatment. Federal funding for support services for HIV patients was a facilitator. The Affordable Care Act has limited impact in Puerto Rico because provisions related to health insurance reform do not apply to U.S. territories. Implications for intervention design include the need to provide care coordination for services from multiple providers, who are often physically separated and working in different reimbursement systems, and the potential for mobile and patient transportation services to bridge these gaps. Continuous interaction with political leaders is needed to maintain current facilitators. These findings are relevant as the current economic crisis in Puerto Rico affects funding, and may be relevant for other settings with substance use-driven epidemics.

Retroviral DNA Integration

PubMed Central

2016-01-01

The integration of a DNA copy of the viral RNA genome into host chromatin is the defining step of retroviral replication. This enzymatic process is catalyzed by the virus-encoded integrase protein, which is conserved among retroviruses and LTR-retrotransposons. Retroviral integration proceeds via two integrase activities: 3′-processing of the viral DNA ends, followed by the strand transfer of the processed ends into host cell chromosomal DNA. Herein we review the molecular mechanism of retroviral DNA integration, with an emphasis on reaction chemistries and architectures of the nucleoprotein complexes involved. We additionally discuss the latest advances on anti-integrase drug development for the treatment of AIDS and the utility of integrating retroviral vectors in gene therapy applications. PMID:27198982

Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study.

PubMed

Maier, Johannes; Knott, Bernadette; Maerz, Manuel; Loeschel, Rainer; Koelbl, Oliver; Dobler, Barbara

2016-08-31

The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer. An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. Significantly best target coverage and homogeneity was achieved using VMAT FFF with V95% = (98.7 ± 0.8) % and HI = (8.2 ± 0.9) % for the SIB and V95% = (98.3 ± 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a Dmean of (0.7 ± 0.1) Gy for the contralateral lung, (1.0 ± 0.2) Gy for the contralateral breast and (1.4 ± 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 ± 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 ± 0:07) min. Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning

Measuring the degree of integration for an integrated service network

PubMed Central

Ye, Chenglin; Browne, Gina; Grdisa, Valerie S; Beyene, Joseph; Thabane, Lehana

2012-01-01

Background Integration involves the coordination of services provided by autonomous agencies and improves the organization and delivery of multiple services for target patients. Current measures generally do not distinguish between agencies’ perception and expectation. We propose a method for quantifying the agencies’ service integration. Using the data from the Children’s Treatment Network (CTN), we aimed to measure the degree of integration for the CTN agencies in York and Simcoe. Theory and methods We quantified the integration by the agreement between perceived and expected levels of involvement and calculated four scores from different perspectives for each agency. We used the average score to measure the global network integration and examined the sensitivity of the global score. Results Most agencies’ integration scores were <65%. As measured by the agreement between every other agency’s perception and expectation, the overall integration of CTN in Simcoe and York was 44% (95% CI: 39%–49%) and 52% (95% CI: 48%–56%), respectively. The sensitivity analysis showed that the global scores were robust. Conclusion Our method extends existing measures of integration and possesses a good extent of validity. We can also apply the method in monitoring improvement and linking integration with other outcomes. PMID:23593050

Integrative approach for the treatment of PTSD in 9/11 first responders: Three core techniques

PubMed Central

Haugen, Peter T.; Splaun, Allison Keisler; Evces, Mark R.; Weiss, Daniel S.

2014-01-01

We describe an integrative psychotherapy for first responders to the September 11, 2001 terrorist attack, including those who continue to be psychologically impacted by these events, most of whom meet criteria for a diagnosis of PTSD. Three core techniques utilized in this treatment are described: (a) an emphasis on meaning making, particularly regarding the traumatic event; (b) focus on the most affect-laden components of the traumatic exposure; and (c) identifying and challenging the implicit strategies used by individuals to avoid discussion of components of their traumatic memories and the attendant negative affect. For each intervention, a theoretical rationale and the presumed mechanism of operation are presented. We discuss the clinical and research implications of this intervention. PMID:24000847

One System Integrated Project Team: Retrieval and Delivery of Hanford Tank Wastes for Vitrification in the Waste Treatment Plant - 13234

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

Harp, Benton J.; Kacich, Richard M.; Skwarek, Raymond J.

The One System Integrated Project Team (IPT) was formed in late 2011 as a way for improving the efficiency of delivery and treatment of highly radioactive waste stored in underground tanks at the U.S. Department of Energy's (DOE's) 586-square-mile Hanford Site in southeastern Washington State. The purpose of the One System IPT is to improve coordination and integration between the Hanford's Waste Treatment Plant (WTP) contractor and the Tank Operations Contractor (TOC). The vision statement is: One System is a WTP and TOC safety-conscious team that, through integrated management and implementation of risk-informed decision and mission-based solutions, will enable themore » earliest start of safe and efficient treatment of Hanford's tank waste, to protect the Columbia River, environment and public. The IPT is a formal collaboration between Bechtel National, Inc. (BNI), which manages design and construction of the WTP for the U.S. Department of Energy's Office of River Protection (DOEORP), and Washington River Protection Solutions (WRPS), which manages the TOC for ORP. More than fifty-six (56) million gallons of highly radioactive liquid waste are stored in one hundred seventy-seven (177) aging, underground tanks. Most of Hanford's waste tanks - one hundred forty-nine (149) of them - are of an old single-shell tank (SST) design built between 1944 and 1964. More than sixty (60) of these tanks have leaked in the past, releasing an estimated one million gallons of waste into the soil and threatening the nearby Columbia River. There are another twenty-eight (28) new double-shelled tanks (DSTs), built from 1968 to 1986, that provide greater protection to the environment. In 1989, DOE, the U.S. Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology) signed a landmark agreement that required Hanford to comply with federal and state environmental standards. It also paved the way for agreements that set deadlines for retrieving the

One System Integrated Project Team: Retrieval And Delivery Of The Hanford Tank Wastes For Vitrification In The Waste Treatment Plant

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

Harp, Benton J.; Kacich, Richard M.; Skwarek, Raymond J.

The One System Integrated Project Team (IPT) was formed in late 2011 as a way for improving the efficiency of delivery and treatment of highly radioactive waste stored in underground tanks at the U.S. Department of Energy's (DOE's) 586-square-mile Hanford Site in southeastern Washington State. The purpose of the One System IPT is to improve coordination and integration between the Hanford's Waste Treatment Plant (WTP) contractor and the Tank Operations Contractor (TOC). The vision statement is: One System is a WTP and TOC safety conscious team that, through integrated management and implementation of risk-informed decision and mission-based solutions, will enablemore » the earliest start of safe and efficient treatment of Hanford's tank waste, to protect the Columbia River, environment and public. The IPT is a formal collaboration between Bechtel National, Inc. (BNI), which manages design and construction of the WTP for the U.S. Department of Energy's Office of River Protection (DOEORP), and Washington River Protection Solutions (WRPS), which manages the TOC for ORP. More than fifty-six (56) million gallons of highly radioactive liquid waste are stored in one hundred seventy-seven (177) aging, underground tanks. Most of Hanford's waste tanks - one hundred forty-nine (149) of them - are of an old single-shell tank (SST) design built between 1944 and 1964. More than sixty (60) of these tanks have leaked in the past, releasing an estimated one million gallons of waste into the soil and threatening the nearby Columbia River. There are another twenty-eight (28) new double-shelled tanks (DSTs), built from 1968 to 1986, that provide greater protection to the environment. In 1989, DOE, the U.S. Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology) signed a landmark agreement that required Hanford to comply with federal and state environmental standards. It also paved the way for agreements that set deadlines for retrieving the

Efficient treatment of phenolic wastewater with high salinity using a novel integrated system of magnetically immobilized cells coupling with electrodes.

PubMed

Jiang, Bei; Shi, Shengnan; Song, Lun; Tan, Liang; Li, Meidi; Liu, Jiaxin; Xue, Lanlan

2016-10-01

A novel integrated system in which magnetically immobilized cells coupled with a pair of stainless iron meshes-graphite plate electrodes has been designed and operated to enhance the treatment performance of phenolic wastewater under high salinity. With NaCl concentration increased, phenol, o-cresol, m-cresol, p-cresol and COD removal rates by integrated system increased significantly, which were obviously higher than the sum of removal rates by single magnetically immobilized cells and electrode reaction. This integrated system exhibited higher removal rates for all the compounds than that by single magnetically immobilized cells during six cycles for reuse, and it still performed better, even when the voltage was cut off. These results indicated that there was a coupling effect between biodegradation and electrode reaction. The investigation of phenol hydroxylase activity and cells concentration confirmed that electrode reaction played an important role in this coupling effect. Copyright © 2016 Elsevier Ltd. All rights reserved.

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss

PubMed Central

Smid, Geert E.; Kleber, Rolf J.; de la Rie, Simone M.; Bos, Jannetta B. A.; Gersons, Berthold P. R.; Boelen, Paul A.

2015-01-01

Background Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD) with comorbid (symptoms of) posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) following confrontation with a traumatic loss. Trauma survivors, who are frequently from different cultural backgrounds, have often experienced multiple losses and ambiguous loss (missing family members or friends). Current evidence-based treatments for PTSD do not focus on traumatic grief. Objective To develop a treatment for traumatic grief combining treatment interventions for PTSD and PCBD that may accommodate cultural aspects of grief. Method To provide a rationale for treatment, we propose a cognitive stress model of traumatic grief. Based on this model and on existing evidence-based treatments for PTSD and complicated grief, we developed Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) for the treatment of patients with traumatic grief. The treatment is presented along with a case vignette. Results Processes contributing to traumatic grief include inadequately integrating the memory of the traumatic loss, negative appraisal of the traumatic loss, sensitivity to matching triggers and new stressors, and attempting to avoid distress. BEP-TG targets these processes. The BEP-TG protocol consists of five parts with proven effectiveness in the treatment of PCBD, PTSD, and MDD: information and motivation, grief-focused exposure, memorabilia and writing assignments, finding meaning and activation, and a farewell ritual. Conclusion Tailored to fit the needs of trauma survivors, BEP-TG can be used to address traumatic grief symptoms related to multiple losses and ambiguous loss, as well as cultural aspects of bereavement through its different components. PMID:26154434

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss.

PubMed

Smid, Geert E; Kleber, Rolf J; de la Rie, Simone M; Bos, Jannetta B A; Gersons, Berthold P R; Boelen, Paul A

2015-01-01

Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD) with comorbid (symptoms of) posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) following confrontation with a traumatic loss. Trauma survivors, who are frequently from different cultural backgrounds, have often experienced multiple losses and ambiguous loss (missing family members or friends). Current evidence-based treatments for PTSD do not focus on traumatic grief. To develop a treatment for traumatic grief combining treatment interventions for PTSD and PCBD that may accommodate cultural aspects of grief. To provide a rationale for treatment, we propose a cognitive stress model of traumatic grief. Based on this model and on existing evidence-based treatments for PTSD and complicated grief, we developed Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) for the treatment of patients with traumatic grief. The treatment is presented along with a case vignette. Processes contributing to traumatic grief include inadequately integrating the memory of the traumatic loss, negative appraisal of the traumatic loss, sensitivity to matching triggers and new stressors, and attempting to avoid distress. BEP-TG targets these processes. The BEP-TG protocol consists of five parts with proven effectiveness in the treatment of PCBD, PTSD, and MDD: information and motivation, grief-focused exposure, memorabilia and writing assignments, finding meaning and activation, and a farewell ritual. Tailored to fit the needs of trauma survivors, BEP-TG can be used to address traumatic grief symptoms related to multiple losses and ambiguous loss, as well as cultural aspects of bereavement through its different components.

Palm oil mill effluent treatment using a two-stage microbial fuel cells system integrated with immobilized biological aerated filters.

PubMed

Cheng, Jia; Zhu, Xiuping; Ni, Jinren; Borthwick, Alistair

2010-04-01

An integrated system of two-stage microbial fuel cells (MFCs) and immobilized biological aerated filters (I-BAFs) was used to treat palm oil mill effluent (POME) at laboratory scale. By replacing the conventional two-stage up-flow anaerobic sludge blanket (UASB) with a newly proposed upflow membrane-less microbial fuel cell (UML-MFC) in the integrated system, significant improvements on NH(3)-N removal were observed and direct electricity generation implemented in both MFC1 and MFC2. Moreover, the coupled iron-carbon micro-electrolysis in the cathode of MFC2 further enhanced treatment efficiency of organic compounds. The I-BAFs played a major role in further removal of NH(3)-N and COD. For influent COD and NH(3)-N of 10,000 and 125 mg/L, respectively, the final effluents COD and NH(3)-N were below 350 and 8 mg/L, with removal rates higher than 96.5% and 93.6%. The GC-MS analysis indicated that most of the contaminants were satisfactorily biodegraded by the integrated system. Copyright 2009 Elsevier Ltd. All rights reserved.

Risk assessment of Giardia from a full scale MBR sewage treatment plant caused by membrane integrity failure.

PubMed

Zhang, Yu; Chen, Zhimin; An, Wei; Xiao, Shumin; Yuan, Hongying; Zhang, Dongqing; Yang, Min

2015-04-01

Membrane bioreactors (MBR) are highly efficient at intercepting particles and microbes and have become an important technology for wastewater reclamation. However, many pathogens can accumulate in activated sludge due to the long residence time usually adopted in MBR, and thus may pose health risks when membrane integrity problems occur. This study presents data from a survey on the occurrence of water-borne Giardia pathogens in reclaimed water from a full-scale wastewater treatment plant with MBR experiencing membrane integrity failure, and assessed the associated risk for green space irrigation. Due to membrane integrity failure, the MBR effluent turbidity varied between 0.23 and 1.90 NTU over a period of eight months. Though this turbidity level still met reclaimed water quality standards (≤5 NTU), Giardia were detected at concentrations of 0.3 to 95 cysts/10 L, with a close correlation between effluent turbidity and Giardia concentration. All β-giardin gene sequences of Giardia in the WWTP influents were genotyped as Assemblages A and B, both of which are known to infect humans. An exponential dose-response model was applied to assess the risk of infection by Giardia. The risk in the MBR effluent with chlorination was 9.83×10(-3), higher than the acceptable annual risk of 1.0×10(-4). This study suggested that membrane integrity is very important for keeping a low pathogen level, and multiple barriers are needed to ensure the biological safety of MBR effluent. Copyright © 2015. Published by Elsevier B.V.

Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men.

PubMed

Wolff, Nancy; Huening, Jessica; Shi, Jing; Frueh, B Christopher; Hoover, Donald R; McHugo, Gregory

2015-03-01

A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n=230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n=142) or by preference (n=88) to receive SS or M-TREM, with a waitlist group of (n=93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD

Treatment with integrase inhibitor suggests a new interpretation of HIV RNA decay curves that reveals a subset of cells with slow integration

DOE PAGES

Cardozo, Erwing Fabian; Andrade, Adriana; Mellors, John W.; ...

2017-07-05

The kinetics of HIV-1 decay under treatment depends on the class of antiretrovirals used. Mathematical models are useful to interpret the different profiles, providing quantitative information about the kinetics of virus replication and the cell populations contributing to viral decay. We modeled proviral integration in short- and long-lived infected cells to compare viral kinetics under treatment with and without the integrase inhibitor raltegravir (RAL). We fitted the model to data obtained from participants treated with RAL-containing regimes or with a four-drug regimen of protease and reverse transcriptase inhibitors. Our model explains the existence and quantifies the three phases of HIV-1more » RNA decay in RAL-based regimens vs. the two phases observed in therapies without RAL. Our findings indicate that HIV-1 infection is mostly sustained by short-lived infected cells with fast integration and a short viral production period, and by long-lived infected cells with slow integration but an equally short viral production period. We propose that these cells represent activated and resting infected CD4+ T-cells, respectively, and estimate that infection of resting cells represent ~4% of productive reverse transcription events in chronic infection. RAL reveals the kinetics of proviral integration, showing that in short-lived cells the pre-integration population has a half-life of ~7 hours, whereas in long-lived cells this half-life is ~6 weeks. We also show that the efficacy of RAL can be estimated by the difference in viral load at the start of the second phase in protocols with and without RAL. Altogether, we provide a mechanistic model of viral infection that parsimoniously explains the kinetics of viral load decline under multiple classes of antiretrovirals.« less

Treatment with integrase inhibitor suggests a new interpretation of HIV RNA decay curves that reveals a subset of cells with slow integration

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

Cardozo, Erwing Fabian; Andrade, Adriana; Mellors, John W.

The kinetics of HIV-1 decay under treatment depends on the class of antiretrovirals used. Mathematical models are useful to interpret the different profiles, providing quantitative information about the kinetics of virus replication and the cell populations contributing to viral decay. We modeled proviral integration in short- and long-lived infected cells to compare viral kinetics under treatment with and without the integrase inhibitor raltegravir (RAL). We fitted the model to data obtained from participants treated with RAL-containing regimes or with a four-drug regimen of protease and reverse transcriptase inhibitors. Our model explains the existence and quantifies the three phases of HIV-1more » RNA decay in RAL-based regimens vs. the two phases observed in therapies without RAL. Our findings indicate that HIV-1 infection is mostly sustained by short-lived infected cells with fast integration and a short viral production period, and by long-lived infected cells with slow integration but an equally short viral production period. We propose that these cells represent activated and resting infected CD4+ T-cells, respectively, and estimate that infection of resting cells represent ~4% of productive reverse transcription events in chronic infection. RAL reveals the kinetics of proviral integration, showing that in short-lived cells the pre-integration population has a half-life of ~7 hours, whereas in long-lived cells this half-life is ~6 weeks. We also show that the efficacy of RAL can be estimated by the difference in viral load at the start of the second phase in protocols with and without RAL. Altogether, we provide a mechanistic model of viral infection that parsimoniously explains the kinetics of viral load decline under multiple classes of antiretrovirals.« less

Current from a nano-gap hyperbolic diode using shape-factors: Theory

NASA Astrophysics Data System (ADS)

Jensen, Kevin L.; Shiffler, Donald A.; Peckerar, Martin; Harris, John R.; Petillo, John J.

2017-08-01

Quantum tunneling by field emission from nanoscale features or sharp field emission structures for which the anode-cathode gap is nanometers in scale ("nano diodes") experience strong deviations from the planar image charge lowered tunneling barrier used in the Murphy and Good formulation of the Fowler-Nordheim equation. These deviations alter the prediction of total current from a curved surface. Modifications to the emission barrier are modeled using a hyperbolic (prolate spheroidal) geometry to determine the trajectories along which the Gamow factor in a WKB-like treatment is undertaken; a quadratic equivalent potential is determined, and a method of shape factors is used to evaluate the corrected total current from a protrusion or wedge geometry.

Restoring Balance for People with Cancer Through Integrative Oncology.

PubMed

Fulop, Judy A; Grimone, Ania; Victorson, David

2017-06-01

Integrative Oncology incorporates conventional and western cancer treatment approaches with the best of ancient and traditional medicine including nutrition, supplements, Qigong, herbal medicine, mind-body practices, and more. This article offers a guiding conceptual paradigm from an integrative perspective based on the principles of balance and imbalance. An integrative approach is used to help improve quality of life, enhance lifestyle choices and mitigate symptoms and side effects from conventional treatments. By supporting the patient's mind, body and spirit throughout the cancer treatment journey, the primary care physician is in a key position to work with their patient's oncologist to provide supportive care and recommendations during cancer treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Electric field distribution and current emission in a miniaturized geometrical diode

NASA Astrophysics Data System (ADS)

Lin, Jinpu; Wong, Patrick Y.; Yang, Penglu; Lau, Y. Y.; Tang, W.; Zhang, Peng

2017-06-01

We study the electric field distribution and current emission in a miniaturized geometrical diode. Using Schwarz-Christoffel transformation, we calculate exactly the electric field inside a finite vacuum cathode-anode (A-K) gap with a single trapezoid protrusion on one of the electrode surfaces. It is found that there is a strong field enhancement on both electrodes near the protrusion, when the ratio of the A-K gap distance to the protrusion height d /h <2. The calculations are spot checked against COMSOL simulations. We calculate the effective field enhancement factor for the field emission current, by integrating the local Fowler-Nordheim current density along the electrode surfaces. We systematically examine the electric field enhancement and the current rectification of the miniaturized geometrical diode for various geometric dimensions and applied electric fields.

[Integral treatment for bedridden patients].

PubMed

García-Verdugo, M Fernanda Arroyo; Garrido Hernández, M Teresa; Rosell Palomo, Ricardo

2007-05-01

Spinal cord injuries are one of the traumatic injuries which produce the greatest number of patients who are bedridden or incapacitated. Physical effects acquire such importance that one can not forget to attend to aspects as basic as hygiene, correct posture during their bedridden stay or the daily task to transfer patients to the various support elements they need to utilize. Nursing care for patients suffering spinal cord injuries comprise the fundamental axis on which a correct recuperation rotates. At the same time, proper treatment care will lead to a future improvement in a patient's quality of life.

Commissioning of an integrated platform for time-resolved treatment delivery in scanned ion beam therapy by means of optical motion monitoring.

PubMed

Fattori, G; Saito, N; Seregni, M; Kaderka, R; Pella, A; Constantinescu, A; Riboldi, M; Steidl, P; Cerveri, P; Bert, C; Durante, M; Baroni, G

2014-12-01

The integrated use of optical technologies for patient monitoring is addressed in the framework of time-resolved treatment delivery for scanned ion beam therapy. A software application has been designed to provide the therapy control system (TCS) with a continuous geometrical feedback by processing the external surrogates tridimensional data, detected in real-time via optical tracking. Conventional procedures for phase-based respiratory phase detection were implemented, as well as the interface to patient specific correlation models, in order to estimate internal tumor motion from surface markers. In this paper, particular attention is dedicated to the quantification of time delays resulting from system integration and its compensation by means of polynomial interpolation in the time domain. Dedicated tests to assess the separate delay contributions due to optical signal processing, digital data transfer to the TCS and passive beam energy modulation actuation have been performed. We report the system technological commissioning activities reporting dose distribution errors in a phantom study, where the treatment of a lung lesion was simulated, with both lateral and range beam position compensation. The zero-delay systems integration with a specific active scanning delivery machine was achieved by tuning the amount of time prediction applied to lateral (14.61 ± 0.98 ms) and depth (34.1 ± 6.29 ms) beam position correction signals, featuring sub-millimeter accuracy in forward estimation. Direct optical target observation and motion phase (MPh) based tumor motion discretization strategies were tested, resulting in 20.3(2.3)% and 21.2(9.3)% median (IQR) percentual relative dose difference with respect to static irradiation, respectively. Results confirm the technical feasibility of the implemented strategy towards 4D treatment delivery, with negligible percentual dose deviations with respect to static irradiation.

Integration of a kraft pulping mill into a forest biorefinery: pre-extraction of hemicellulose by steam explosion versus steam treatment.

PubMed

Martin-Sampedro, Raquel; Eugenio, Maria E; Moreno, Jassir A; Revilla, Esteban; Villar, Juan C

2014-02-01

Growing interest in alternative and renewable energy sources has brought increasing attention to the integration of a pulp mill into a forest biorefinery, where other products could be produced in addition to pulp. To achieve this goal, hemicelluloses were extracted, either by steam explosion or by steam treatment, from Eucalyptus globulus wood prior to pulping. The effects of both pre-treatments in the subsequent kraft pulping and paper strength were evaluated. Results showed a similar degree of hemicelluloses extraction with both options (32-67% of pentosans), which increased with the severity of the conditions applied. Although both pre-treatments increased delignification during pulping, steam explosion was significantly better: 12.9 kappa number vs 22.6 for similar steam unexploded pulps and 40.7 for control pulp. Finally, similar reductions in paper strength were found regardless of the type of treatment and conditions assayed, which is attributed to the increase of curled and kinked fibers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Neuromodulation integrating rTMS and neurofeedback for the treatment of autism spectrum disorder: an exploratory study.

PubMed

Sokhadze, Estate M; El-Baz, Ayman S; Tasman, Allan; Sears, Lonnie L; Wang, Yao; Lamina, Eva V; Casanova, Manuel F

2014-12-01

Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social interaction, language, stereotyped behaviors, and restricted range of interests. In previous studies low frequency repetitive transcranial magnetic stimulation (rTMS) has been used, with positive behavioral and electrophysiological results, for the experimental treatment in ASD. In this study we combined prefrontal rTMS sessions with electroencephalographic (EEG) neurofeedback (NFB) to prolong and reinforce TMS-induced EEG changes. The pilot trial recruited 42 children with ASD (~14.5 years). Outcome measures included behavioral evaluations and reaction time test with event-related potential (ERP) recording. For the main goal of this exploratory study we used rTMS-neurofeedback combination (TMS-NFB, N = 20) and waitlist (WTL, N = 22) groups to examine effects of 18 sessions of integrated rTMS-NFB treatment or wait period) on behavioral responses, stimulus and response-locked ERPs, and other functional and clinical outcomes. The underlying hypothesis was that combined TMS-NFB will improve executive functions in autistic patients as compared to the WTL group. Behavioral and ERP outcomes were collected in pre- and post-treatment tests in both groups. Results of the study supported our hypothesis by demonstration of positive effects of combined TMS-NFB neurotherapy in active treatment group as compared to control WTL group, as the TMS-NFB group showed significant improvements in behavioral and functional outcomes as compared to the WTL group.

Neuromodulation integrating rTMS and neurofeedback for the treatment of autism spectrum disorder: An exploratory study

PubMed Central

Sokhadze, Estate M.; El-Baz, Ayman S.; Tasman, Allan; Sears, Lonnie L.; Wang, Yao; Lamina, Eva V.; Casanova, Manuel F.

2014-01-01

Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social interaction, language, stereotyped behaviors, and restricted range of interests. In previous studies low frequency repetitive transcranial magnetic stimulation (rTMS) has been used, with positive behavioral and electrophysiological results, for the experimental treatment in ASD. In this study we combined prefrontal rTMS sessions with electroencephalographic (EEG) neurofeedback (NFB) to prolong and reinforce TMS-induced EEG changes. The pilot trial recruited 42 children with ASD (~14.5 yrs). Outcome measures included behavioral evaluations and reaction time test with event-related potential (ERP) recording. For the main goal of this exploratory study we used rTMS-neurofeedback combination (TMS-NFB, N=20) and waitlist (WTL, N=22) groups to examine effects of 18 sessions of integrated rTMS-NFB treatment or wait period) on behavioral responses, stimulus and response-locked ERPs, and other functional and clinical outcomes. The underlying hypothesis was that combined TMS-NFB will improve executive functions in autistic patients as compared to the waitlist group. Behavioral and ERP outcomes were collected in pre- and post-treatment tests in both groups. Results of the study supported our hypothesis by demonstration of positive effects of combined TMS-NFB neurotherapy in active treatment group as compared to control waitlist group, as the TMS-NFB group showed significant improvements in behavioral and functional outcomes as compared to the waitlist group. PMID:25267414

A flux-enhancing forward osmosis-nanofiltration integrated treatment system for the tannery wastewater reclamation.

PubMed

Pal, Parimal; Chakrabortty, Sankha; Nayak, Jayato; Senapati, Suman

2017-06-01

Effective treatment of tannery wastewater prior to discharge to the environment as per environmental regulations remains a big challenge despite efforts to bring down the concentrations of the pollutants which are often quite high as measured in terms of chemical oxygen demand (7800 mg/L), total dissolved solids (5400 mg/L), chloride (4260 mg/L), sulphides (250 mg/L) and chromium. A pilot-scale forward osmosis and nanofiltration integrated closed loop system was developed for continuous reclamation of clean water from tannery wastewater at a rate of 52-55 L/m 2 /h at 1.6 bar pressure. The low-cost draw solution was 0.8 M NaCl solution. Continuous recovery for recycling the draw solute was done by nanofiltration of diluted draw solution at an operating pressure of 12 bar and volumetric cross-flow rate of 700 L/h. Fouling study revealed that the specific flat-sheet design of cross-flow forward osmosis module with counter current flow of feed and draw solution prevents the build-up of concentration polarization, thus enabling long-term filtration in continuous mode of operation without significant membrane fouling. This study culminates in the development of a compact, efficient and low-cost industrial wastewater treatment and reclamation technology.

Perchlorate and nitrate treatment by ion exchange integrated with biological brine treatment.

PubMed

Lehman, S Geno; Badruzzaman, Mohammad; Adham, Samer; Roberts, Deborah J; Clifford, Dennis A

2008-02-01

Groundwater contaminated with perchlorate and nitrate was treated in a pilot plant using a commercially available ion exchange (IX) resin. Regenerant brine concentrate from the IX process, containing high perchlorate and nitrate, was treated biologically and the treated brine was reused in IX resin regeneration. The nitrate concentration of the feed water determined the exhaustion lifetime (i.e., regeneration frequency) of the resin; and the regeneration condition was determined by the perchlorate elution profile from the exhausted resin. The biological brine treatment system, using a salt-tolerant perchlorate- and nitrate-reducing culture, was housed in a sequencing batch reactor (SBR). The biological process consistently reduced perchlorate and nitrate concentrations in the spent brine to below the treatment goals of 500 microg ClO4(-)/L and 0.5mg NO3(-)-N/L determined by equilibrium multicomponent IX modeling. During 20 cycles of regeneration, the system consistently treated the drinking water to below the MCL of nitrate (10 mgNO3(-)-N/L) and the California Department of Health Services (CDHS) notification level of perchlorate (i.e., 6 microg/L). A conceptual cost analysis of the IX process estimated that perchlorate and nitrate treatment using the IX process with biological brine treatment to be approximately 20% less expensive than using the conventional IX with brine disposal.

Nutrient removal and biogas upgrading by integrating freshwater algae cultivation with piggery anaerobic digestate liquid treatment.

PubMed

Xu, Jie; Zhao, Yongjun; Zhao, Guohua; Zhang, Hui

2015-08-01

An integrated approach that combined freshwater microalgae Scenedesmus obliquus (FACHB-31) cultivation with piggery anaerobic digestate liquid treatment was investigated in this study. The characteristics of algal growth, biogas production, and nutrient removal were examined using photobioreactor bags (PBRbs) to cultivate S. obliquus (FACHB-31) in digestate with various digestate dilutions (the concentration levels of 3200, 2200, 1600, 1200, 800, and 400 mg L(-1) chemical oxygen demand (COD)) during 7-day period. The effects of the level of pollutants on nutrient removal efficiency and CO2 removal process were investigated to select the optimum system for effectively upgrade biogas and simultaneously reduce the nutrient content in digestate. The treatment performance displayed that average removal rates of COD, total nitrogen (TN), total phosphorous (TP), and CO2 were 61.58-75.29, 58.39-74.63, 70.09-88.79, and 54.26-73.81 %, respectively. All the strains grew well under any the dilution treatments. With increased initial nutrient concentration to a certain range, the CO4 content (v/v) of raw biogas increased. Differences in the biogas enrichment of S. obliquus (FACHB-31) in all treatments mainly resulted from variations in biomass productivity and CO2 uptake. Notably, the diluted digestate sample of 1600 mg L(-1) COD provided an optimal nutrient concentration for S. obliquus (FACHB-31) cultivation, where the advantageous nutrient and CO2 removals, as well as the highest productivities of biomass and biogas upgrading, were revealed. Results showed that microalgal biomass production offered real opportunities to address issues such as CO2 sequestration, wastewater treatment, and biogas production.

Evaluating the Role of Seed Treatments in Canola/Oilseed Rape Production: Integrated Pest Management, Pollinator Health, and Biodiversity

PubMed Central

Sekulic, Gregory; Rempel, Curtis B.

2016-01-01

The use patterns and role of insecticide seed treatments, with focus on neonicotinoid insecticides, were examined for canola/oilseed rape production in Canada and the EU. Since nearly all planted canola acres in Western Canada and, historically, a majority of planted oilseed acres in the EU, use seed treatments, it is worth examining whether broad use of insecticidal seed treatments (IST) is compatible with principles of integrated pest management (IPM). The neonicotinoid insecticide (NNI) seed treatment (NNI ST) use pattern has risen due to effective control of several early season insect pests, the most destructive being flea beetles (Phyllotreta sp.). Negative environmental impact and poor efficacy of foliar applied insecticides on flea beetles led growers to look for better alternatives. Due to their biology, predictive models have been difficult to develop for flea beetles, and, therefore, targeted application of seed treatments, as part of an IPM program, has contributed to grower profitability and overall pollinator success for canola production in Western Canada. Early evidence suggests that the recent restriction on NNI may negatively impact grower profitability and does not appear to be having positive impact on pollinator health. Further investigation on impact of NNI on individual bee vs. hive health need to be conducted. Predictive models for flea beetle emergence/feeding activity in canola/oilseed rape need to be developed, as broad acre deployment of NNI seed treatments may not be sustainable due to concerns about resistance/tolerance in flea beetles and other pest species. PMID:27527233

Chronic Hepatitis C Treatment in Patients with Drug Injection History: Findings of the INTEGRATE Prospective, Observational Study.

PubMed

Robaeys, Geert; Christensen, Stefan; Lucidarme, Damien; Arain, Amber; Bruggmann, Philip; Kunkel, Jan; Keim, Sofia; Jäkel, Martin; DeMasi, Ralph; Liu, Chris; Lonjon-Domanec, Isabelle; Foster, Graham R

2017-06-01

People who inject drugs represent an under-treated chronic hepatitis C virus (HCV)-infected patient population. INTEGRATE was a prospective, observational study investigating the effectiveness, safety, and adherence in routine clinical practice to telaprevir in combination with peg-interferon and ribavirin (Peg-IFN/RBV) in patients with history of injecting drug use chronically infected with genotype 1 HCV. A total of 46 patients were enrolled and included in the intent-to-treat (ITT) population. Among heroin and/or cocaine users (n = 37; 80%), 22% reported use in the past month; 74% (34/46) of patients were on opioid substitution therapy in the pre-treatment phase, and 43% (20/46) discontinued HCV treatment prematurely. Sustained virologic response rate was 54% (25/46) in the ITT population and 74% (25/34) in the per protocol (evaluable-for-effectiveness) population. The main reason for failure in the ITT analysis was loss to follow-up (n = 8; 17%). Adverse events occurred in 91% (42/46) of patients. Mean patient-reported adherence to study drugs was >89% at Week 4, Week 12 and end of treatment. Despite a high rate of treatment discontinuation (including loss to follow-up), self-reported adherence to treatment was good and virologic cure rates were similar to those reported in large real-world cohorts. Our findings suggest that people with a history of injecting drug use should be considered for treatment of chronic HCV infection, and highlight the need for improvements in patient support to boost retention in care and, in turn, help to prevent reinfection and transmission. Clinicaltrials.gov identifier, NCT01980290. Janssen Pharmaceuticals.

Factors in Teacher Adherence to Treatment.

ERIC Educational Resources Information Center

Gum, Louann

Treatment integrity, a measure of how accurately a treatment is carried out, is integral to the concept of effective behavioral analysis and intervention. This study sought to correlate teachers' perceptions of the functional behavior assessment and behavior intervention process (FBA/BIP) with their confidence that the process is an effective and…

Studies on the integration of nanofiltration and soil treatment for municipal effluent reclamation as a groundwater supplement.

PubMed

Linlin, Wu; Xuan, Zhao; Meng, Zhang

2010-01-01

Water shortage leads to increasing attention to artificial groundwater recharge by reclaimed water. An injection well is the most common recharge approach. In this paper, a new kind of integrated technology-short-term vadose soil treatment followed by nanofiltration-is recommended as pretreatment for artificial groundwater recharge by an injection well. Laboratory-scale experiments demonstrate that the short-term vadose soil can remove approximately 30% of the total dissolved organic carbon (DOC) content and 40% of dissolved organic matter with a molecular weight less than 1 kDa. As a compensatory process of soil treatment, nanofiltration offers a favorable desalination and additional organics removal. The removal efficiencies for total dissolved solids and conductivity amount to 45 and 48%, respectively. The residual DOC in the final effluent is below 1.0 mg/L. In addition, short-term vadose soil offers effective elimination of aromatic protein-like and polysaccharide-like substances, which are detected as components of the membrane foulant.

Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: results of a case-control systemic research.

PubMed

Onnis, L; Barbara, E; Bernardini, M; Caggese, A; Di Giacomo, S; Giambartolomei, A; Leonelli, A; Mule', A M; Nicoletti, P G; Vietri, A

2012-03-01

This article presents the results of a broader clinical research into the effectiveness of integrated treatments in teenage eating disorders, carried out at the Complex Operative Unit of Psychotherapy (Unità Operativa Complessa or U.O.C.) of the Department of Psychiatric Sciences and Psychological Medicine in collaboration with the Department of Neuropsychiatric Science for Child Development (Dipartimento di Scienze Neuropsichiatriche dell'Età Evolutiva), both at the "La Sapienza" University of Rome. The hypothesis of this research project is that in diagnosticable situations such as anorexia or bulimia, an integrated and multidisciplinary treatment, which combines medical-nutritional interventions and family psychotherapy, allows better results than a single kind of treatment, which is the usual medical- nutritional intervention supported by psychiatric counselling. Twenty-eight cases (16 of bulimia and 12 of anorexia) were selected and then subdivided, with a randomized distribution, into two (experimental and control) homogeneous groups of 14 patients. The grouping variables were the diagnosis, the disorder's seriousness and duration, BMI, gender, age, family composition and social status. The variables which have been examined in this article are the clinical parameters, which were valuated in accordance with the DSM IV-TR criteria, and relational parameters which were explored through the use of the W.F.T. Test (Wiltwyck Family Tasks). These parameters were tested at beginning as well as at the end of the therapies, in both the experimental group and the control group. Statistical analysis has shown that the experimental group, which was followed with the integrated treatment, experienced a significant improvement of the parameters as related to dysfunctional family interaction modalities, and that this improvement was correlated to the positive evolution of the clinical parameters. This improvement was not present or not of the same degree in the control

Changes in implicit and explicit measures of ego functions and distress among two eating disorder subgroups: outcomes of integrative treatment.

PubMed

Rothschild, Lily; Lacoua, Liza; Stein, Daniel

2009-01-01

The study examined changes in ego functions and mental distress among eating disorder (ED) adolescent inpatients following integrative treatment. Participants included 31 restricting anorexia nervosa and 25 bingeing/purging spectrum ED inpatients. Rorschach Comprehensive System (CS; Exner, 2003) and self-report measures were administered on admission and discharge. We found that improvement in ego functions, mental distress and ED symptomatology occurred in both ED groups at discharge. Nevertheless, the two ED subgroups exhibited different configurations of change as well as varying patterns of relations between changes in mental distress and ego functions and improvement in ED symptoms. These data further indicate that the restricting and bingeing/purging patients may require different treatment approaches.

Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

PubMed

Naidoo, Kogieleum; Gengiah, Santhanalakshmi; Yende-Zuma, Nonhlanhla; Padayatchi, Nesri; Barker, Pierre; Nunn, Andrew; Subrayen, Priashni; Abdool Karim, Salim S

2017-11-13

A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implementation has resulted in TB and HIV remaining the commonest causes of death in several countries in sub-Saharan Africa, including South Africa. This study aims to reduce mortality due to TB-HIV co-infection through a quality improvement strategy for scaling up of TB and HIV treatment integration in rural primary healthcare clinics in South Africa. The study is designed as an open-label cluster randomized controlled trial. Sixteen clinic supervisors who oversee 40 primary health care (PHC) clinics in two rural districts of KwaZulu-Natal, South Africa will be randomized to either the control group (provision of standard government guidance for TB-HIV integration) or the intervention group (provision of standard government guidance with active enhancement of TB-HIV care integration through a quality improvement approach). The primary outcome is all-cause mortality among TB-HIV patients. Secondary outcomes include time to antiretroviral therapy (ART) initiation among TB-HIV co-infected patients, as well as TB and HIV treatment outcomes at 12 months. In addition, factors that may affect the intervention, such as conditions in the clinic and staff availability, will be closely monitored and documented. This study has the potential to address the gap between the establishment of TB-HIV care integration policies and guidelines and their implementation in the provision of integrated care in PHC clinics. If successful, an evidence-based intervention comprising change ideas, tools, and approaches for quality improvement could inform the future rapid scale up, implementation, and sustainability of improved TB-HIV integration across sub-Sahara Africa and other resource

An Integrated Neuroscience Perspective on Formulation and Treatment Planning for Posttraumatic Stress Disorder: An Educational Review.

PubMed

Ross, David A; Arbuckle, Melissa R; Travis, Michael J; Dwyer, Jennifer B; van Schalkwyk, Gerrit I; Ressler, Kerry J

2017-04-01

Posttraumatic stress disorder (PTSD) is a common psychiatric illness, increasingly in the public spotlight in the United States due its prevalence in the soldiers returning from combat in Iraq and Afghanistan. This educational review presents a contemporary approach for how to incorporate a modern neuroscience perspective into an integrative case formulation. The article is organized around key neuroscience "themes" most relevant for PTSD. Within each theme, the article highlights how seemingly diverse biological, psychological, and social perspectives all intersect with our current understanding of neuroscience. Any contemporary neuroscience formulation of PTSD should include an understanding of fear conditioning, dysregulated circuits, memory reconsolidation, epigenetics, and genetic factors. Fear conditioning and other elements of basic learning theory offer a framework for understanding how traumatic events can lead to a range of behaviors associated with PTSD. A circuit dysregulation framework focuses more broadly on aberrant network connectivity, including between the prefrontal cortex and limbic structures. In the process of memory reconsolidation, it is now clear that every time a memory is reactivated it becomes momentarily labile-with implications for the genesis, maintenance, and treatment of PTSD. Epigenetic changes secondary to various experiences, especially early in life, can have long-term effects, including on the regulation of the hypothalamic-pituitary-adrenal axis, thereby affecting an individual's ability to regulate the stress response. Genetic factors are surprisingly relevant: PTSD has been shown to be highly heritable despite being definitionally linked to specific experiences. The relevance of each of these themes to current clinical practice and its potential to transform future care are discussed. Together, these perspectives contribute to an integrative, neuroscience-informed approach to case formulation and treatment planning. This may

Eye Movement Desensitization and Reprocessing (EMDR) and the anxiety disorders: clinical and research implications of an integrated psychotherapy treatment.

PubMed

Shapiro, F

1999-01-01

Four recent, independent, rigorously controlled studies of Eye Movement Desensitization and Reprocessing (EMDR) have reported that 84 to 100% of single-trauma victims no longer maintain the posttraumatic stress disorder diagnosis after the equivalent of three 90-minute sessions. The rapidity of EMDR treatment effects makes many ancillary research opportunities available. Specifically, the increased number of cases resolved in a relatively short period of time allows investigation of neurophysiological phenomena, patterns of cognitive and emotional processing, component analyses of a large range of procedural factors, and evaluation of the efficacy of application to diverse clinical populations. Unfortunately, some research has been conducted that has been severely hampered by insufficient treatment fidelity and lack of clinical validity. Consequently, this article will attempt to describe the procedures and protocols that are believed to contribute to EMDR's clinical effects and are, therefore, suggested for the EMDR treatment and research of the anxiety disorders. This is particularly relevant given the misconceptions that have abounded due to the unfortunate naming of the procedure after the eye movements, which have proved to be only one of many useful types of stimulation, and only one of many components of this complex, integrated treatment.

Integrative medicine for chronic pain

PubMed Central

Saha, Felix J.; Brüning, Alexander; Barcelona, Cyrus; Büssing, Arndt; Langhorst, Jost; Dobos, Gustav; Lauche, Romy; Cramer, Holger

2016-01-01

Abstract Introduction: Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Methods: Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients’ pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. Results: A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P < 0.05). Ability to change and implementation, disease acceptance, mindfulness, life and health satisfaction, and light heartedness/easiness likewise improved (all P < 0.05). Improved outcomes were associated with increases in process variables, mainly ability to change and implementation, disease acceptance, life and health satisfaction, and light heartedness/easiness (R2 = 0.03–0.40). Conclusions: Results of this study suggest that a 2-week integrative medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction. PMID:27399133

Real-life Experience for Integration of PET-CT in the Treatment of Hodgkin Lymphoma in Lebanon.

PubMed

Sakr, Riwa; Massoud, Marcel; Kerbage, Fouad; Rached, Layale; Zeghondy, Jean; Akoury, Elie; Nasr, Fady; Chahine, Georges

2017-07-01

Hodgkin lymphoma (HL) is a highly curable disease; < 80% of patients will achieve long-term survival. Positron emission tomography-computed tomography (PET-CT) has played a major role in the evaluation of both disease staging and response and has become an essential component in tailoring patients' treatment. We report the effect of integrating PET-CT into the management of HL in Lebanon. We analyzed the data regarding the usage of PET-CT at diagnosis, during treatment (interim PET), and at the end of treatment. We also analyzed the PET-CT findings from 2009 to 2015. The first PET-CT system was introduced in Lebanon in April 2002 but was not used for the evaluation of HL. Early in 2009, we started to incorporate PET-CT into the treatment of HL. By the end of 2009, 70% of patients were undergoing PET-CT at diagnosis and at the end of treatment. This proportion remained constant until 2013, when an increase occurred, with ≤ 94% of patients undergoing PET-CT at diagnosis. The usage of CT at diagnosis decreased significantly from 70% before 2009 to 52% after 2015. In contrast, CT usage at the end of treatment has fluctuated from 10% in 2009 to 0% in 2012, 2013, and 2014 and 11.76% in 2015. Functional imaging techniques are increasing in popularity compared with anatomic imaging. The usage of PET-CT has emerged as a highly valuable staging and follow-up method in the treatment of HL 8 years after the introduction of PET in Lebanon. PET was used first to improve the staging, then to evaluate the treatment response, and, recently, to tailor therapy according to the response. Copyright © 2017 Elsevier Inc. All rights reserved.

Integration of Neuropsychology in Primary Care.

PubMed

Lanca, Margaret

2018-05-01

The field of neuropsychology is making inroads in primary care as the importance of cognition in physical health is increasingly acknowledged. With neuropsychology primary care integration, patients receive a range of cognitive assessments (e.g., screens, brief neuropsychological assessments, treatment recommendations through provider-to-neuropsychologist consultations) based on a stepped model of care which can more efficiently diagnose cognitive disorders/problems and assist with treatment. Two case studies are described to illuminate this process. Information is provided to illustrate how neuropsychology integration was introduced in two primary care clinics at a community-based hospital system.

Integrated Care for Pediatric Substance Abuse.

PubMed

Barclay, Rebecca P; Hilt, Robert J

2016-10-01

Integrated care is a way to improve the prevention, identification, and treatment of mental health difficulties, including substance abuse, in pediatric care. The pediatrician's access, expertise in typical development, focus on prevention, and alignment with patients and families can allow successful screening, early intervention, and referral to treatment. Successful integrated substance abuse care for youth is challenged by current reimbursement systems, information exchange, and provider role adjustment issues, but these are being addressed as comfort with this care form and resources to support its development grow. Copyright © 2016 Elsevier Inc. All rights reserved.

Alcohol and drug treatment involvement, 12-step attendance and abstinence: 9-year cross-lagged analysis of adults in an integrated health plan.

PubMed

Witbrodt, Jane; Ye, Yu; Bond, Jason; Chi, Felicia; Weisner, Constance; Mertens, Jennifer

2014-04-01

This study explored causal relationships between post-treatment 12-step attendance and abstinence at multiple data waves and examined indirect paths leading from treatment initiation to abstinence 9-years later. Adults (N = 1945) seeking help for alcohol or drug use disorders from integrated healthcare organization outpatient treatment programs were followed at 1-, 5-, 7- and 9-years. Path modeling with cross-lagged partial regression coefficients was used to test causal relationships. Cross-lagged paths indicated greater 12-step attendance during years 1 and 5 and were casually related to past-30-day abstinence at years 5 and 7 respectfully, suggesting 12-step attendance leads to abstinence (but not vice versa) well into the post-treatment period. Some gender differences were found in these relationships. Three significant time-lagged, indirect paths emerged linking treatment duration to year-9 abstinence. Conclusions are discussed in the context of other studies using longitudinal designs. For outpatient clients, results reinforce the value of lengthier treatment duration and 12-step attendance in year 1. Copyright © 2014 Elsevier Inc. All rights reserved.

Clonal Integration Enhances the Performance of a Clonal Plant Species under Soil Alkalinity Stress

PubMed Central

Sun, Juanjuan; Chen, Jishan; Zhang, Yingjun

2015-01-01

Clonal plants have been shown to successfully survive in stressful environments, including salinity stress, drought and depleted nutrients through clonal integration between original and subsequent ramets. However, relatively little is known about whether clonal integration can enhance the performance of clonal plants under alkalinity stress. We investigated the effect of clonal integration on the performance of a typical rhizomatous clonal plant, Leymus chinensis, using a factorial experimental design with four levels of alkalinity and two levels of rhizome connection treatments, connected (allowing integration) and severed (preventing integration). Clonal integration was estimated by comparing physiological and biomass features between the rhizome-connected and rhizome-severed treatments. We found that rhizome-connected treatment increased the biomass, height and leaf water potential of subsequent ramets at highly alkalinity treatments but did not affect them at low alkalinity treatments. However, rhizome-connected treatment decreased the root biomass of subsequent ramets and did not influence the photosynthetic rates of subsequent ramets. The biomass of original ramets was reduced by rhizome-connected treatment at the highest alkalinity level. These results suggest that clonal integration can increase the performance of clonal plants under alkalinity stress. Rhizome-connected plants showed dramatically increased survival of buds with negative effects on root weight, indicating that clonal integration influenced the resource allocation pattern of clonal plants. A cost-benefit analysis based on biomass measures showed that original and subsequent ramets significantly benefited from clonal integration in highly alkalinity stress, indicating that clonal integration is an important adaptive strategy by which clonal plants could survive in local alkalinity soil. PMID:25790352

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout.

PubMed

Szafranski, Derek D; Snead, Alexandra; Allan, Nicholas P; Gros, Daniel F; Killeen, Therese; Flanagan, Julianne; Pericot-Valverde, Irene; Back, Sudie E

2017-10-01

High rates of comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) have been noted in veteran populations. Fortunately, there are a number of evidence-based psychotherapies designed to address comorbid PTSD and SUD. However, treatments targeting PTSD and SUD simultaneously often report high dropout rates. To date, only one study has examined predictors of dropout from PTSD/SUD treatment. To address this gap in the literature, this study aimed to 1) examine when in the course of treatment dropout occurred, and 2) identify predictors of dropout from a concurrent treatment for PTSD and SUD. Participants were 51 male and female veterans diagnosed with current PTSD and SUD. All participants completed at least one session of a cognitive-behavioral treatment (COPE) designed to simultaneously address PTSD and SUD symptoms. Of the 51 participants, 22 (43.1%) dropped out of treatment prior to completing the full 12 session COPE protocol. Results indicated that the majority of dropout (55%) occurred after session 6, with the largest amount of dropout occurring between sessions 9 and 10. Results also indicated a marginally significant relationship between greater baseline PTSD symptom severity and premature dropout. These findings highlight inconsistencies related to timing and predictors of dropout, as well as the dearth of information noted about treatment dropout within PTSD and SUD literature. Suggestions for procedural changes, such as implementing continual symptom assessments during treatment and increasing dialog between provider and patient about dropout were made with the hopes of increasing consistency of findings and eventually reducing treatment dropout. Published by Elsevier Ltd.

Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use.

PubMed

Bartels, Stephen J; Coakley, Eugenie H; Zubritsky, Cynthia; Ware, James H; Miles, Keith M; Areán, Patricia A; Chen, Hongtu; Oslin, David W; Llorente, Maria D; Costantino, Giuseppe; Quijano, Louise; McIntyre, Jack S; Linkins, Karen W; Oxman, Thomas E; Maxwell, James; Levkoff, Sue E

2004-08-01

The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

Designing a concept for an IT-infrastructure for an integrated research and treatment center.

PubMed

Stäubert, Sebastian; Winter, Alfred; Speer, Ronald; Löffler, Markus

2010-01-01

Healthcare and medical research in Germany are heading to more interconnected systems. New initiatives are funded by the German government to encourage the development of Integrated Research and Treatment Centers (IFB). Within an IFB new organizational structures and infrastructures for interdisciplinary, translational and trans-sectoral working relationship between existing rigid separated sectors are intended and needed. This paper describes how an IT-infrastructure of an IFB could look like, what major challenges have to be solved and what methods can be used to plan such a complex IT-infrastructure in the field of healthcare. By means of project management, system analyses, process models, 3LGM²-models and resource plans an appropriate concept with different views is created. This concept supports the information management in its enterprise architecture planning activities and implies a first step of implementing a connected healthcare and medical research platform.

Integrated catalytic wet air oxidation and biological treatment of wastewater from Vitamin B 6 production

NASA Astrophysics Data System (ADS)

Kang, Jianxiong; Zhan, Wei; Li, Daosheng; Wang, Xiaocong; Song, Jing; Liu, Dongqi

This study investigated the feasibility of coupling a catalytic wet air oxidation (CWAO), with CuO/Al 2O 3 as catalyst, and an anaerobic/aerobic biological process to treat wastewater from Vitamin B 6 production. Results showed that the CWAO enhanced the biodegradability (BOD 5/COD) from 0.10 to 0.80. The oxidized effluents with COD of 10,000 mg l -1 was subjected to subsequent continuous anaerobic/aerobic oxidation, and 99.3% of total COD removal was achieved. The quality of the effluent obtained met the discharge standards of water pollutants for pharmaceutical industry Chemical Synthesis Products Category (GB21904-2008), and thereby it implies that the integrated CWAO and anaerobic/aerobic biological treatment may offer a promising process to treat wastewater from Vitamin B 6 production.

A Translational Model of Research-Practice Integration

PubMed Central

Vivian, Dina; Hershenberg, Rachel; Teachman, Bethany A.; Drabick, Deborah A. G.; Goldfried, Marvin R.; Wolfe, Barry

2013-01-01

We propose a four-level, recursive Research-Practice Integration framework as a heuristic to (a) integrate and reflect on the articles in this Special Section as contributing to a bidirectional bridge between research and practice, and (b) consider additional opportunities to address the research–practice gap. Level 1 addresses Treatment Validation studies and includes an article by Lochman and colleagues concerning the programmatic adaptation, implementation, and dissemination of the empirically supported Coping Power treatment program for youth aggression. Level 2 translation, Training in Evidence-Based Practice, includes a paper by Hershenberg, Drabick, and Vivian, which focuses on the critical role that predoctoral training plays in bridging the research–practice gap. Level 3 addresses the Assessment of Clinical Utility and Feedback to Research aspects of translation. The articles by Lambert and Youn, Kraus, and Castonguay illustrate the use of commercial outcome packages that enable psychotherapists to integrate ongoing client assessment, thus enhancing the effectiveness of treatment implementation and providing data that can be fed back to researchers. Lastly, Level 4 translation, the Cross-Level Integrative Research and Communication, concerns research efforts that integrate data from clinical practice and all other levels of translation, as well as communication efforts among all stakeholders, such as researchers, psychotherapists, and clients. Using a two-chair technique as a framework for his discussion, Wolfe's article depicts the struggle inherent in research–practice integration efforts and proposes a rapprochement that highlights advancements in the field. PMID:22642522

Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India: a non randomized interventional study.

PubMed

Narahari, Saravu R; Bose, Kuthaje S; Aggithaya, Madhur G; Swamy, Gaddam Kumara; Ryan, Terence J; Unnikrishnan, Bhaskaran; Washington, Reynold G; Rao, Balu Palicheralu Sreenivasa; Rajagopala, Shrikrishna; Manjula, Kadengodlu; Vandana, Usha; Sreemol, Thaivalath Anandan; Rojith, Mathew; Salimani, Shanappa Y; Shefuvan, Mohammed

2013-09-01

Currently there is no global program to manage lymphoedema as a result of lymphatic filariasis (LF). The primary aim of this study was to determine the efficacy of a previously proposed integrative treatment protocol, using locally available resources to address the morbidity, in a community village setting. Two LF endemic districts of south India, Gulbarga in Karnataka (GK) and Alleppey in Kerala (AK), were selected for the study. All known patients were invited to an LF camp. Patients with grade two late or three lymphoedema were enrolled. All patients were given training in the integrative procedure which involved patient education and the domiciliary protocol. A total of 730 patients (851 limbs) completed the three and half month follow up. There was a statistically significant (1%) reduction up to mid thigh level volume measurement for both small (0.7-1.1 liters) and large (1.8-5.0 liters) limbs, p < 0.000. In AK inflammatory episodes at the three months interval reduced from 37.5% (127 patients) to 28.3% (96 patients) and in GK from 37.6% (147 patients) to 10.2% (40 patients), p < 0.000. All patients had reduced bacterial entry points. There was an overall improvement in quality of life in all domains of LF specific quality of life questionnaire p < 0.000. Self care and integrative treatment is possible in resource poor Indian village settings. Further work is needed to explore factors leading to better compliance by randomizing the interventions such as washing and emollient compression vs Ayurvedic and yoga interventions before integrative treatment is considered for national health programmes in developing countries.

Waste treatment integration in space

NASA Technical Reports Server (NTRS)

Baresi, L.; Kern, R.

1991-01-01

The circumstances and criteria for space-based waste treatment bioregenerative life-support systems differ in many ways from those needed in terrestrial applications. In fact, the term "waste" may not even be appropriate in the context of nearly closed, cycling, ecosystems such as those under consideration. Because of these constraints there is a need for innovative approaches to the problem of "materials recycling". Hybrid physico-chemico-biological systems offer advantages over both strictly physico-chemico or biological approaches that would be beneficial to material recycling. To effectively emulate terrestrial cycling, the use of various microbial consortia ("assemblies of interdependent microbes") should be seriously considered for the biological components of such systems. This paper will examine the use of consortia in the context of a hybrid-system for materials recycling in space.

Highly integrated hybrid process with ceramic ultrafiltration-membrane for advanced treatment of drinking water: a pilot study.

PubMed

Guo, Jianning; Wang, Lingyun; Zhu, Jia; Zhang, Jianguo; Sheng, Deyang; Zhang, Xihui

2013-01-01

This article presents a highly integrated hybrid process for the advanced treatment of drinking water in dealing with the micro-polluted raw water. A flat sheet ceramic membrane with the pore size of 50∼60 nm for ultrafiltration (UF) is used to integrate coagulation and ozonation together. At the same time, biological activated carbon filtration (BAC) is used to remove the ammonia and organic pollutants in raw water. A pilot study in the scale of 120 m(3)/d has been conducted in Southern China. The mainly-analyzed parameters include turbidity, particle counts, ammonia, total organic carbon (TOC), UV254, biological dissolved organic carbon (BDOC), dissolved oxygen (DO) as well as trans-membrane pressure (TMP). The experiments demonstrated that ceramic UF-membrane was able to remove most of turbidity and suspended particulate matters. The final effluent turbidity reached to 0.14 NTU on average. BAC was effective in removing ammonia and organic matters. Dissolved oxygen (DO) is necessary for the biodegradation of ammonia at high concentration. The removal efficiencies reached to 90% for ammonia with the initial concentration of 3.6 mg/L and 76% for TOC with the initial concentration of 3.8 mg/L. Ozonation can alter the molecular structure of organics in terms of UV254, reduce membrane fouling, and extend the operation circle. It is believed the hybrid treatment process developed in this article can achieve high performance with less land occupation and lower cost compared with the conventional processes. It is especially suitable for the developing countries in order to obtain high-quality drinking water in a cost-effective way.

HIV treatment and reproductive health in the health system in Burkina Faso: resource allocation and the need for integration.

PubMed

Windisch, Ricarda; de Savigny, Don; Onadja, Geneviève; Somda, Antoine; Wyss, Kaspar; Sié, Ali; Kouyaté, Bocar

2011-11-01

Organizational changes, increased funding and the demands of HIV antiretroviral (ARV) treatment create particular challenges for governance in the health sector. We assess resource allocation, policy making and integration of the national responses to ARV provision and reproductive health in Burkina Faso, using national and district budgets related to disease burden, policy documents, organizational structures, and coordination and implementation processes. ARV provision represents the concept of a "crisis scenario", in which reforms are pushed due to a perception of urgent need, whereas the national reproductive health programme, which is older and more integrated, represents a "politics-as-usual scenario". Findings show that the early years of the national response to HIV and AIDS were characterized by new institutions with overlapping functions, and failure to integrate with and strengthen existing structures. National and district budget allocations for HIV compared to other interventions were disproportionately high when assessed against burden of disease. Strategic documents for ARV provision were relatively less developed and referred to, compared to those of the Ministry of Health Directorates for HIV and for Family Health and district health planning teams for reproductive health services. Imbalances and new structures potentially trigger important adverse effects which are difficult to remedy and likely to increase due to the dynamics they create. It therefore becomes crucial, from the outset, to integrate HIV/AIDS funding and responses into health systems. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Probabilistic evaluation of integrating resource recovery into wastewater treatment to improve environmental sustainability

PubMed Central

Wang, Xu; McCarty, Perry L.; Liu, Junxin; Ren, Nan-Qi; Lee, Duu-Jong; Yu, Han-Qing; Qian, Yi; Qu, Jiuhui

2015-01-01

Global expectations for wastewater service infrastructure have evolved over time, and the standard treatment methods used by wastewater treatment plants (WWTPs) are facing issues related to problem shifting due to the current emphasis on sustainability. A transition in WWTPs toward reuse of wastewater-derived resources is recognized as a promising solution for overcoming these obstacles. However, it remains uncertain whether this approach can reduce the environmental footprint of WWTPs. To test this hypothesis, we conducted a net environmental benefit calculation for several scenarios for more than 50 individual countries over a 20-y time frame. For developed countries, the resource recovery approach resulted in ∼154% net increase in the environmental performance of WWTPs compared with the traditional substance elimination approach, whereas this value decreased to ∼60% for developing countries. Subsequently, we conducted a probabilistic analysis integrating these estimates with national values and determined that, if this transition was attempted for WWTPs in developed countries, it would have a ∼65% probability of attaining net environmental benefits. However, this estimate decreased greatly to ∼10% for developing countries, implying a substantial risk of failure. These results suggest that implementation of this transition for WWTPs should be studied carefully in different temporal and spatial contexts. Developing countries should customize their approach to realizing more sustainable WWTPs, rather than attempting to simply replicate the successful models of developed countries. Results derived from the model forecasting highlight the role of bioenergy generation and reduced use of chemicals in improving the sustainability of WWTPs in developing countries. PMID:25605884

Probabilistic evaluation of integrating resource recovery into wastewater treatment to improve environmental sustainability.

PubMed

Wang, Xu; McCarty, Perry L; Liu, Junxin; Ren, Nan-Qi; Lee, Duu-Jong; Yu, Han-Qing; Qian, Yi; Qu, Jiuhui

2015-02-03

Global expectations for wastewater service infrastructure have evolved over time, and the standard treatment methods used by wastewater treatment plants (WWTPs) are facing issues related to problem shifting due to the current emphasis on sustainability. A transition in WWTPs toward reuse of wastewater-derived resources is recognized as a promising solution for overcoming these obstacles. However, it remains uncertain whether this approach can reduce the environmental footprint of WWTPs. To test this hypothesis, we conducted a net environmental benefit calculation for several scenarios for more than 50 individual countries over a 20-y time frame. For developed countries, the resource recovery approach resulted in ∼154% net increase in the environmental performance of WWTPs compared with the traditional substance elimination approach, whereas this value decreased to ∼60% for developing countries. Subsequently, we conducted a probabilistic analysis integrating these estimates with national values and determined that, if this transition was attempted for WWTPs in developed countries, it would have a ∼65% probability of attaining net environmental benefits. However, this estimate decreased greatly to ∼10% for developing countries, implying a substantial risk of failure. These results suggest that implementation of this transition for WWTPs should be studied carefully in different temporal and spatial contexts. Developing countries should customize their approach to realizing more sustainable WWTPs, rather than attempting to simply replicate the successful models of developed countries. Results derived from the model forecasting highlight the role of bioenergy generation and reduced use of chemicals in improving the sustainability of WWTPs in developing countries.

Development of an integrative algorithm for the treatment of various stages of full-thickness burns of the first commissure of the hand.

PubMed

Yuste, Valentin; Delgado, Julio; Agullo, Alberto; Sampietro, Jose Mauel

2017-06-01

Burns of the first commissure of the hand can evolve into an adduction contracture of the thumb. We decided to conduct a review of the existing literature on the treatment of full-thickness burns of the first commissure in order to develop a treatment algorithm that integrates the various currently available procedures. A search of the existing literature was conducted, focusing on the treatment of a burn of the first commissure in its chronic and acute phases. A total of 29 relevant articles were selected; 24 focused exclusively on the chronic contracture stage, while 3 focused exclusively on the acute burn stage, and 2 articles studied both stages. A therapeutic algorithm for full-thickness burns of the first commissure of the hand was developed. With this algorithm we sought to relate each degree and stage of the burn with a treatment. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Colour and toxic characteristics of metakaolinite–hematite pigment for integrally coloured concrete, prepared from iron oxide recovered from a water treatment plant of an abandoned coal mine

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

Sadasivam, Sivachidambaram, E-mail: sadasivams@cardiff.ac.uk; Thomas, Hywel Rhys

A metakaolinite-hematite (KH) red pigment was prepared using an ocherous iron oxide sludge recovered from a water treatment plant of an abandoned coal mine. The KH pigment was prepared by heating the kaolinite and the iron oxide sludge at kaolinite's dehydroxylation temperature. Both the raw sludge and the KH specimen were characterised for their colour properties and toxic characteristics. The KH specimen could serve as a pigment for integrally coloured concrete and offers a potential use for the large volumes of the iron oxide sludge collected from mine water treatment plants. - Graphical abstract: A kaolinite based red pigment wasmore » prepared using an ocherous iron oxide sludge recovered from an abandoned coal mine water treatment plant. Display Omitted - Highlights: • A red pigment was prepared by heating a kaolinite and an iron oxide sludge. • The iron oxide and the pigment were characterised for their colour properties. • The red pigment can be a potential element for integrally coloured concrete.« less

Complementary and Integrative Medicine

MedlinePlus

... medical treatments that are not part of mainstream medicine. When you are using these types of care, it may be called complementary, integrative, or alternative medicine. Complementary medicine is used together with mainstream medical ...

Systems Pharmacology Dissection of the Integrated Treatment for Cardiovascular and Gastrointestinal Disorders by Traditional Chinese Medicine

NASA Astrophysics Data System (ADS)

Zhang, Wenjuan; Tao, Qin; Guo, Zihu; Fu, Yingxue; Chen, Xuetong; Shar, Piar Ali; Shahen, Mohamed; Zhu, Jinglin; Xue, Jun; Bai, Yaofei; Wu, Ziyin; Wang, Zhenzhong; Xiao, Wei; Wang, Yonghua

2016-09-01

Though cardiovascular diseases (CVDs) and gastrointestinal disorders (GIDs) are different diseases associated with different organs, they are highly correlated clinically. Importantly, in Traditional Chinese Medicine (TCM), similar treatment strategies have been applied in both diseases. However, the etiological mechanisms underlying them remain unclear. Here, an integrated systems pharmacology approach is presented for illustrating the molecular correlations between CVDs and GIDs. Firstly, we identified pairs of genes that are associated with CVDs and GIDs and found that these genes are functionally related. Then, the association between 115 heart meridian (HM) herbs and 163 stomach meridian (SM) herbs and their combination application in Chinese patent medicine was investigated, implying that both CVDs and GIDs can be treated by the same strategy. Exemplified by a classical formula Sanhe Decoration (SHD) treating chronic gastritis, we applied systems-based analysis to introduce a drug-target-pathway-organ network that clarifies mechanisms of different diseases being treated by the same strategy. The results indicate that SHD regulated several pathological processes involved in both CVDs and GIDs. We experimentally confirmed the predictions implied by the effect of SHD for myocardial ischemia. The systems pharmacology suggests a novel integrated strategy for rational drug development for complex associated diseases.

Systems Pharmacology Dissection of the Integrated Treatment for Cardiovascular and Gastrointestinal Disorders by Traditional Chinese Medicine

PubMed Central

Zhang, Wenjuan; Tao, Qin; Guo, Zihu; Fu, Yingxue; Chen, Xuetong; Shar, Piar Ali; Shahen, Mohamed; Zhu, Jinglin; Xue, Jun; Bai, Yaofei; Wu, Ziyin; Wang, Zhenzhong; Xiao, Wei; Wang, Yonghua

2016-01-01

Though cardiovascular diseases (CVDs) and gastrointestinal disorders (GIDs) are different diseases associated with different organs, they are highly correlated clinically. Importantly, in Traditional Chinese Medicine (TCM), similar treatment strategies have been applied in both diseases. However, the etiological mechanisms underlying them remain unclear. Here, an integrated systems pharmacology approach is presented for illustrating the molecular correlations between CVDs and GIDs. Firstly, we identified pairs of genes that are associated with CVDs and GIDs and found that these genes are functionally related. Then, the association between 115 heart meridian (HM) herbs and 163 stomach meridian (SM) herbs and their combination application in Chinese patent medicine was investigated, implying that both CVDs and GIDs can be treated by the same strategy. Exemplified by a classical formula Sanhe Decoration (SHD) treating chronic gastritis, we applied systems-based analysis to introduce a drug-target-pathway-organ network that clarifies mechanisms of different diseases being treated by the same strategy. The results indicate that SHD regulated several pathological processes involved in both CVDs and GIDs. We experimentally confirmed the predictions implied by the effect of SHD for myocardial ischemia. The systems pharmacology suggests a novel integrated strategy for rational drug development for complex associated diseases. PMID:27597117

The integration of nutrients, cyanobacterial biomass and ...

EPA Pesticide Factsheets

This presentation is an integrated evaluation of cyanobacterial growth and toxin production, from a reservoir through drinking water treatment - where biomass and toxin removal are achieved. Data is generated by a variety of methods: online instrumentation for chlorophyll, dissolved oxygen, temperature and pH; enzyme linked immune substrate (ELISA) and liquid chromatography/mass spectrometric (LC/MS) methods for toxin analysis; microscopic methods for species identification; quantitative PCR methods for species identification; and bench-scale engineering studies for removal of toxins and biomass through drinking water treatment. This presentation is an integrated evaluation of cyanobacterial growth and toxin production, from a reservoir through drinking water treatment. The content will be useful for EPA regional office staff, state primacy personnel, state and local health personnel, drinking water treatment managers and consulting engineers.

The Short-Term Effect of Integrated Complementary and Alternative Medicine Treatment in Inpatients Diagnosed with Lumbar Intervertebral Disc Herniation: A Prospective Observational Study.

PubMed

Shin, Joon-Shik; Lee, Jinho; Kim, Me-Riong; Jung, Jaehoon; Shin, Byung-Cheul; Lee, Myeong Soo; Ha, In-Hyuk

2016-07-01

This study aimed to investigate the short-term effect of hospital-based intensive nonsurgical treatment in lumbar intervertebral disc herniation (IDH) inpatients admitted to an integrated hospital that offers both complementary and alternative medicine (CAM) and conventional medicine treatment. A prospective observational study. A private Korean medicine hospital inpatient setting in Korea. A total of 524 inpatients diagnosed with lumbar IDH admitted from June 1, 2012, to May 31, 2013. The participants received treatment according to a CAM treatment protocol (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation) and conventional medicine treatment as needed. Numeric rating scale (NRS) of low back pain (LBP) and leg pain, Oswestry Disability Index (ODI), and patient global impression of change. The study also assessed whether improvement was obtained over minimal clinically important difference (MCID) in LBP or leg pain. The average hospital stay was 24.4 ± 13.2 days. The majority of patients received CAM treatment and a few selected conventional medicine, such as pain killers (22.7%; 4.2 ± 3.0 administrations) or nerve blocks (14.1%; 1.4 ± 0.7 sessions). At discharge, the average reduction in NRS was 3.18 ± 2.29 (95% confidence interval [CI], 2.99-3.38) for LBP and 2.61 ± 2.60 (95% CI, 2.38-2.83) for leg pain the average reduction in ODI was 19.45 ± 19.53 (95% CI, 17.77-21.12). Two-hundred and seventy patients (51.5%) showed improvement over MCID in both NRS and ODI, 150 (28.6%) in either NRS or ODI, and 104 (19.8%) in neither. Integrated CAM treatment during hospitalization was effective for patients with lumbar IDH who had severe LBP and disability. However, these results must be investigated further to assess whether the effects surpass those seen with placebo and are cost-effective.

Evaluation of 5536 patients treated in an integrative outpatient tinnitus treatment center-immediate effects and a modeling approach for sustainability.

PubMed

Ostermann, Thomas; Boehm, Katja; Kusatz, Martin

2016-08-11

Tinnitus is an increasingly serious problem for health care systems. According to epidemiological data, 7-14 % of outpatients have asked their physician about tinnitus and management strategies. Integrative outpatient treatments are currently regarded as promising therapeutic approaches for managing tinnitus. In this article we report on the treatment success of an outpatient tinnitus treatment center in Germany. This cohort study included pre-post data of 5536 outpatients which were treated between 2003 and 2010 in the tinnitus-therapy center, Krefeld-Düsseldorf (TTZ). The intervention consisted of psychological immunization training as well as an auditory stimulation therapy component. The main outcome parameter was the score of the Tinnitus Questionnaire (TQ) which was assessed before and after a 9 days treatment and (in a small subsample) at a 6 months follow-up. Missing data were multiply imputed. Pre-post effect sizes were calculated and adjusted for regression to the mean (RTM). RTM-adjusted treatment effects at the end of treatment were estimated as -18.6 (CI: -18.9 to 18.2, p < 0.001) score points which corresponds to a standardized effect of d = -1.03 (CI: -1.05 to -1.01). These effects can be corroborated in various subgroups and all subscales of the TQ (d ranging from -0.31 to -0.97). The study suggests the effectiveness of this outpatient tinnitus therapy concept. Multiple imputations techniques and RTM analysis were helpful in carving out true treatment effects.

Ethnic disparities in accessing treatment for depression and substance use disorders in an integrated health plan.

PubMed

Satre, Derek D; Campbell, Cynthia I; Gordon, Nancy S; Weisner, Constance

2010-01-01

This study examined ethnic differences in accessing treatment for depression and substance use disorders (SUDs) among men and women in a large integrated health plan, and explored factors potentially contributing to health care disparities. Participants were 22,543 members ages 20 to 65 who responded to health surveys in 2002 and 2005. Survey questions were linked to provider-assigned diagnoses, electronic medication, psychiatry, and chemical dependency program records. Among women diagnosed with depression, Latinas (p < .01) and Asian-Americans (p < .001) were less likely than Whites to fill an antidepressant prescription. Among men diagnosed with depression, African Americans (p < .01) were less likely than Whites to do so. Among women diagnosed with an SUD, African Americans (p < .05) were less likely than Whites to have one or more chemical dependency program visits. Results demonstrated ethnic differences in accessing depression and SUD treatment among patients diagnosed with these disorders, which persisted after controlling for education, income, having a regular health care provider and length of health plan enrollment. Findings highlight potential gender differences in ethnic disparities, lower antidepressant utilization among Asian Americans, and the effects of co-occurring disorders in accessing behavioral health care.

Impact of telemonitoring approaches on integrated HIV and TB diagnosis and treatment interventions in sub-Saharan Africa: a scoping review.

PubMed

Yah, Clarence S; Tambo, Ernest; Khayeka-Wandabwa, Christopher; Ngogang, Jeanne Y

2017-01-01

Background: This paper explores telemonitoring/mhealth approaches as a promising real time and contextual strategy in overhauling HIV and TB interventions quality access and uptake, retention,adherence and coverage impact in endemic and prone-epidemic prevention and control in sub-Sahara Africa. Methods: The scoping review method was applied in acknowledged journals indexing platforms including Medline, Embase, Global Health, PubMed, MeSH PsycInfo, Scopus and Google Scholar to identify relevant articles pertaining to telemonitoring as a proxy surrogate method in reinforcing sustainability of HIV/TB prevention/treatment interventions in sub-Saharan Africa. Full papers were assessed and those selected that fosters evidence on telemonitoring/mhealth diagnosis, treatment approaches and strategies in HIV and TB prevention and control were synthesized and analyzed. Results: We found telemonitoring/mhealth approach as a more efficient and sustained proxy in HIV and TB risk reduction strategies for early diagnosis and prompt quality clinical outcomes. It can significantly contribute to decreasing health systems/patients cost, long waiting time in clinics, hospital visits, travels and time off/on from work. Improved integrated HIV and TB telemonitoring systems sustainability hold great promise in health systems strengthening including patient centered early diagnosis and care delivery systems, uptake and retention to medications/services and improving patients' survival and quality of life. Conclusion: Telemonitoring/mhealth (electronic phone text/video/materials messaging)acceptability, access and uptake are crucial in monitoring and improving uptake, retention,adherence and coverage in both local and national integrated HIV and TB programs and interventions. Moreover, telemonitoring is crucial in patient-providers-health professional partnership, real-time quality care and service delivery, antiretroviral and anti-tuberculous drugs improvement, susceptibility monitoring

Integration of National Laboratory and Low-Activity Waste Pre-Treatment System Technology Service Providers - 16435

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

Subramanian, Karthik H.; Thien, Michael G.; Wellman, Dawn M.

The National Laboratories are a critical partner and provide expertise in numerous aspects of the successful execution of the Direct-Feed Low Activity Waste Program. The National Laboratories are maturing the technologies of the Low-Activity Waste Pre-Treatment System (LAWPS) consistent with DOE Order 413.3B “Program and Project Management for the Acquisition of Capital Assets” expectations. The National Laboratories continue to mature waste forms, i.e. glass and secondary waste grout, for formulations and predictions of long-term performance as inputs to performance assessments. The working processes with the National Laboratories have been developed in procurements, communications, and reporting to support the necessary delivery-basedmore » technology support. The relationship continues to evolve from planning and technology development to support of ongoing operations and integration of multiple highly coordinated facilities.« less

[Evaluation of therapeutical appropriateness in psychiatric treatment of schizophrenia, by integrating computer data records with clinical audit results].

PubMed

Farina, Giuseppina; Menditto, Enrica; Corea, Gabriella; Manna, Sonia; Pagliaro, Claudia; Troncone, Chiara; Linguiti, Claudio; Orlando, Valentina; Putignano, Daria; Tari, Daniele Ugo; Buffardi, Gianfranco

2015-01-01

The aim is to evaluate prescriptive patterns of atypical antipsychotic drugs for the treatment of schizophrenia in the LHU Caserta in 2011-2013, and to indicate potentially inappropriate therapy; to plan or schedule corrective/preventive activities to support the continuous improvement of health services. Retrospective cohort study, based on integration of health records and clinical audit. The study was performed in the following steps: data retrieval and analysis; comparison of data with international literature; editing of the Diagnostic-Therapeutic Path. The analysis was performed by using the administrative database of drug prescriptions and treatment plans in the SANIARP portal, a web platform available to specialist facilities and private and public pharmacies of LHU Caserta. The subject of our analysis was to gain information about the diagnosis and treatment of users of atypical antipsychotics in the LHU of Caserta in the years 2011-2013. We identified 2,768 patients with at least one prescription of atypical antipsychotics and diagnosis coded in the study period. Schizophrenia is the most frequent diagnosis (31.1%) and the most common drug in use is olanzapine (29.1%). About 70% of schizophrenics were on monotherapy with no change in drug, 23.6% were under polytherapy and 7.9% made a switch. Our findings were a starting point for editing Diagnostic and Therapeutic Paths aimed at raising the awareness of the scientific community about the appropriateness of diagnosis and treatment in schizophrenia. Pharmacological treatment of schizophrenia should be focused on improving the overall quality of life aimed at remission and possible recovery, although difficult.

Enhancing the Developmental Appropriateness of Treatment for Depression in Youth: Integrating the Family in Treatment

PubMed Central

Tompson, Martha C.; Boger, Kathryn Dingman; Asarnow, Joan R.

2016-01-01

Youth depression is an impairing and frequently recurrent and persistent disorder that impacts current and later development, resulting in high social and economic costs. Depression and interpersonal stress are frequently transactional, with depression powerfully negatively impacting relationships and relationship stress negatively impacting the course and outcome of depression. In this context, treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article has three objectives. It first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on the role of family involvement in treatment. Second, it discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Third, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt. PMID:22537731

Atomic Calculations with a One-Parameter, Single Integral Method.

ERIC Educational Resources Information Center

Baretty, Reinaldo; Garcia, Carmelo

1989-01-01

Presents an energy function E(p) containing a single integral and one variational parameter, alpha. Represents all two-electron integrals within the local density approximation as a single integral. Identifies this as a simple treatment for use in an introductory quantum mechanics course. (MVL)

Randomized Trial of Supported Employment Integrated With Assertive Community Treatment for Rural Adults With Severe Mental Illness

PubMed Central

Gold, Paul B; Meisler, Neil; Santos, Alberto B; Carnemolla, Mark A; Williams, Olivia H; Keleher, Jennie

2006-01-01

Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely linked, and geographically dispersed. In addition, SE's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending Assertive Community Treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI (N = 143; 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64 versus 26%; p < .001, effect size [ES] = 0.38) and earned more income (median [Mdn] = $549, interquartile range [IQR] = $0–$5,145, versus Mdn = $0, IQR = $0–$40; p < .001, ES = 0.70) than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills. PMID:16177278

Radiobiological and treatment planning study of a simultaneously integrated boost for canine nasal tumors using helical tomotherapy.

PubMed

Gutíerrez, Alonso N; Deveau, Michael; Forrest, Lisa J; Tomé, Wolfgang A; Mackie, Thomas R

2007-01-01

Feasibility of delivering a simultaneously integrated boost to canine nasal tumors using helical tomotherapy to improve tumor control probability (TCP) via an increase in total biological equivalent uniform dose (EUD) was evaluated. Eight dogs with varying size nasal tumors (5.8-110.9 cc) were replanned to 42 Gy to the nasal cavity and integrated dose boosts to gross disease of 45.2, 48.3, and 51.3 Gy in 10 fractions. EUD values were calculated for tumors and mean normalized total doses (NTD(mean)) for organs at risk (OAR). Normal Tissue Complication Probability (NTCP) values were obtained for OARs, and estimated TCP values were computed using a logistic dose-response model and based on deliverable EUD boost doses. Significant increases in estimated TCP to 54%, 74%, and 86% can be achieved with 10%, 23%, and 37% mean relative EUD boosts to the gross disease, respectively. NTCP values for blindness of either eye and for brain necrosis were < 0.01% for all boosts. Values for cataract development were 31%, 42%, and 46% for studied boost schemas, respectively. Average NTD(mean) to eyes and brain for mean EUD boosts were 10.2, 11.3, and 12.1 Gy3, and 7.5, 7.2, and 7.9 Gy2, respectively. Using helical tomotherapy, simultaneously integrated dose boosts can be delivered to increase the estimated TCP at 1-year without significantly increasing the NTD(mean) to eyes and brain. Delivery of these treatments in a prospective trial may allow quantification of a dose-response relationship in canine nasal tumors.

Comparative cost analysis of inpatient integrative medicine-Results of a pilot study.

PubMed

Ostermann, Thomas; Lauche, Romy; Cramer, Holger; Dobos, Gustav

2017-06-01

Costs of integrative treatment alone and in comparison with other treatment approaches have scarcely been reported in the past. This study presents results of a comparative cost analysis of an inpatient integrative medicine treatment costs. Data from 2006 for inpatients referred to a Department of Integrative Medicine in Germany were used. Case-related treatment costs were calculated, and transformed into Casemix-Indices and revenues per DRG. Costs were compared between departments at the same hospital and between different hospitals using univariate statistics and Chi-Square tests. In total 1253 inpatients (81.4% female, 61.1±14.4years) were included in the current analysis. Most patients were treated for diseases of the musculoskeletal system (57.2%), followed by diseases of the digestive system (11.4%), and diseases of the nervous system (10.4%). The department received an additional payment for most of the patients (88.0%), which led to an effective appreciation of 10.8% per case compared to the standardized Casemix-Index. In-house comparisons with other departments found the department in close vicinity to the departments of Internal medicine with regards to CMI and mean revenue, however the Patient Clinical Complexity Level was significantly lower in the Integrative medicine department. The interhospital comparison revealed comparable Casemix-Index and DRG-revenue, however the additional payment increased the mean revenue significantly. Modern integrative in-patient treatment is mostly cost-equivalent to conventional treatment. Cost effectiveness studies should be considered to further investigate the potential of integrative in patient treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrating a Humanistic Approach in Outpatient Sex Offender Groups

ERIC Educational Resources Information Center

Bauman, Sheri; Kopp, T. Gregory

2006-01-01

Cognitive-behavioral and relapse prevention models are currently the treatments of choice among sex offender treatment providers. This article recommends integrating humanistic principles within treatment programs in order to maximize the power of group psychotherapy. Humanistic treatment processes and therapist characteristics that improve…

Integrative oncology: an overview.

PubMed

Deng, Gary; Cassileth, Barrie

2014-01-01

Integrative oncology, the diagnosis-specific field of integrative medicine, addresses symptom control with nonpharmacologic therapies. Known commonly as "complementary therapies" these are evidence-based adjuncts to mainstream care that effectively control physical and emotional symptoms, enhance physical and emotional strength, and provide patients with skills enabling them to help themselves throughout and following mainstream cancer treatment. Integrative or complementary therapies are rational and noninvasive. They have been subjected to study to determine their value, to document the problems they ameliorate, and to define the circumstances under which such therapies are beneficial. Conversely, "alternative" therapies typically are promoted literally as such; as actual antitumor treatments. They lack biologic plausibility and scientific evidence of safety and efficacy. Many are outright fraudulent. Conflating these two very different categories by use of the convenient acronym "CAM," for "complementary and alternative therapies," confuses the issue and does a substantial disservice to patients and medical professionals. Complementary and integrative modalities have demonstrated safety value and benefits. If the same were true for "alternatives," they would not be "alternatives." Rather, they would become part of mainstream cancer care. This manuscript explores the medical and sociocultural context of interest in integrative oncology as well as in "alternative" therapies, reviews commonly-asked patient questions, summarizes research results in both categories, and offers recommendations to help guide patients and family members through what is often a difficult maze. Combining complementary therapies with mainstream oncology care to address patients' physical, psychologic and spiritual needs constitutes the practice of integrative oncology. By recommending nonpharmacologic modalities that reduce symptom burden and improve quality of life, physicians also enable

Impairments in Skin Integrity.

PubMed

Murphree, Rose W

2017-09-01

Altered skin integrity increases the chance of infection, impaired mobility, and decreased function and may result in the loss of limb or, sometimes, life. Skin is affected by both intrinsic and extrinsic factors. Intrinsic factors can include altered nutritional status, vascular disease issues, and diabetes. Extrinsic factors include falls, accidents, pressure, immobility, and surgical procedures. Ensuring skin integrity in the elderly requires a team approach and includes the individual, caregivers, and clinicians. The twenty-first century clinician has several online, evidence-based tools to assist with optimal treatment plans. Understanding best practices in addressing skin integrity issues can promote positive outcomes with the elderly. Copyright © 2017 Elsevier Inc. All rights reserved.

A 10-year follow-up study of completers versus dropouts following treatment with an integrated cognitive-behavioral group therapy for eating disorders.

PubMed

Okamoto, Yuri; Miyake, Yoshie; Nagasawa, Ichie; Shishida, Kazuhiro

2017-01-01

Cognitive-behavioral therapy (CBT) has been recommended for the treatment of eating disorders, and group therapy is known to have certain advantages over individual therapy. The aim of the current study was to compare the 10-year prognosis of patients who completed integrated group CBT with those who dropped out and to examine the effect of completion of group CBT on the prognosis. The participants were 65 adult patients with eating disorders. All patients were women and Japanese. The average age (19-37) of the patients was 25.1 ± 3.8 years, and the average body mass index (BMI) was 17.7 ± 2.0. We conducted integrated group CBT with the patients and compared eating disorder symptoms, mood states, coping styles, and self-esteem before and after therapy. Furthermore, we compared clinical features and the 10-year prognosis of patients who completed the treatment and those who dropped out. After 10 sessions of group therapy, Eating Attitudes Test scores, Profile of Mood States depression scores, and Coping Inventory for Stressful Situations emotion-oriented scores decreased, while Rosenberg's Self-Esteem Scale scores increased. Regarding the results of the 10-year follow up, the completer group had more patients with a good prognosis. In contrast, the dropout group had more patients with a poor prognosis. Those who completed the integrated group CBT had a good prognosis. Group therapy gives the patients an opportunity to form peer relationships, and helps them to develop communication and socialization skills. Furthermore, in the group therapy sessions, the patients develop self-awareness by listening to other members of the group and they also develop interpersonal relationships. This effect may be temporary, but experience of group therapy may provide hope for the patient and increase the chance of the patient continuing treatment. Retrospectively registered in University Hospital Medical Information Network in Japan: No. 000028868 (May 19th, 2017).

Whole-body hybrid imaging concept for the integration of PET/MR into radiation therapy treatment planning.

PubMed

Paulus, Daniel H; Oehmigen, Mark; Grüneisen, Johannes; Umutlu, Lale; Quick, Harald H

2016-05-07

Modern radiation therapy (RT) treatment planning is based on multimodality imaging. With the recent availability of whole-body PET/MR hybrid imaging new opportunities arise to improve target volume delineation in RT treatment planning. This, however, requires dedicated RT equipment for reproducible patient positioning on the PET/MR system, which has to be compatible with MR and PET imaging. A prototype flat RT table overlay, radiofrequency (RF) coil holders for head imaging, and RF body bridges for body imaging were developed and tested towards PET/MR system integration. Attenuation correction (AC) of all individual RT components was performed by generating 3D CT-based template models. A custom-built program for μ-map generation assembles all AC templates depending on the presence and position of each RT component. All RT devices were evaluated in phantom experiments with regards to MR and PET imaging compatibility, attenuation correction, PET quantification, and position accuracy. The entire RT setup was then evaluated in a first PET/MR patient study on five patients at different body regions. All tested devices are PET/MR compatible and do not produce visible artifacts or disturb image quality. The RT components showed a repositioning accuracy of better than 2 mm. Photon attenuation of  -11.8% in the top part of the phantom was observable, which was reduced to  -1.7% with AC using the μ-map generator. Active lesions of 3 subjects were evaluated in terms of SUVmean and an underestimation of  -10.0% and  -2.4% was calculated without and with AC of the RF body bridges, respectively. The new dedicated RT equipment for hybrid PET/MR imaging enables acquisitions in all body regions. It is compatible with PET/MR imaging and all hardware components can be corrected in hardware AC by using the suggested μ-map generator. These developments provide the technical and methodological basis for integration of PET/MR hybrid imaging into RT planning.

Effects of iron and calcium carbonate on contaminant removal efficiencies and microbial communities in integrated wastewater treatment systems.

PubMed

Zhao, Zhimiao; Song, Xinshan; Zhang, Yinjiang; Zhao, Yufeng; Wang, Bodi; Wang, Yuhui

2017-12-01

In the paper, we explored the influences of different dosages of iron and calcium carbonate on contaminant removal efficiencies and microbial communities in algal ponds combined with constructed wetlands. After 1-year operation of treatment systems, based on the high-throughput pyrosequencing analysis of microbial communities, the optimal operating conditions were obtained as follows: the ACW10 system with Fe 3+ (5.6 mg L -1 ), iron powder (2.8 mg L -1 ), and CaCO 3 powder (0.2 mg L -1 ) in influent as the adjusting agents, initial phosphorus source (PO 4 3- ) in influent, the ratio of nitrogen to phosphorus (N/P) of 30 in influent, and hydraulic retention time (HRT) of 1 day. Total nitrogen (TN) removal efficiency and total phosphorus (TP) removal efficiency were improved significantly. The hydrolysis of CaCO 3 promoted the physicochemical precipitation in contaminant removal. Meanwhile, Fe 3+ and iron powder produced Fe 2+ , which improved contaminant removal. Iron ion improved the diversity, distribution, and metabolic functions of microbial communities in integrated treatment systems. In the treatment ACW10, the dominant phylum in the microbial community was PLANCTOMYCETES, which positively promoted nitrogen removal. After 5 consecutive treatments in ACW10, contaminant removal efficiencies for TN and TP respectively reached 80.6% and 57.3% and total iron concentration in effluent was 0.042 mg L -1 . Copyright © 2017 Elsevier Ltd. All rights reserved.

An Integrated Human/Murine Transcriptome and Pathway Approach To Identify Prenatal Treatments For Down Syndrome.

PubMed

Guedj, Faycal; Pennings, Jeroen LA; Massingham, Lauren J; Wick, Heather C; Siegel, Ashley E; Tantravahi, Umadevi; Bianchi, Diana W

2016-09-02

Anatomical and functional brain abnormalities begin during fetal life in Down syndrome (DS). We hypothesize that novel prenatal treatments can be identified by targeting signaling pathways that are consistently perturbed in cell types/tissues obtained from human fetuses with DS and mouse embryos. We analyzed transcriptome data from fetuses with trisomy 21, age and sex-matched euploid controls, and embryonic day 15.5 forebrains from Ts1Cje, Ts65Dn, and Dp16 mice. The new datasets were compared to other publicly available datasets from humans with DS. We used the human Connectivity Map (CMap) database and created a murine adaptation to identify FDA-approved drugs that can rescue affected pathways. USP16 and TTC3 were dysregulated in all affected human cells and two mouse models. DS-associated pathway abnormalities were either the result of gene dosage specific effects or the consequence of a global cell stress response with activation of compensatory mechanisms. CMap analyses identified 56 molecules with high predictive scores to rescue abnormal gene expression in both species. Our novel integrated human/murine systems biology approach identified commonly dysregulated genes and pathways. This can help to prioritize therapeutic molecules on which to further test safety and efficacy. Additional studies in human cells are ongoing prior to pre-clinical prenatal treatment in mice.

Integrating cervical cancer with HIV healthcare services: A systematic review

PubMed Central

Sigfrid, Louise; Murphy, Georgina; Haldane, Victoria; Chuah, Fiona Leh Hoon; Ong, Suan Ee; Cervero-Liceras, Francisco; Watt, Nicola; Alvaro, Alconada; Otero-Garcia, Laura; Balabanova, Dina; Hogarth, Sue; Maimaris, Will; Buse, Kent; Mckee, Martin; Piot, Peter; Perel, Pablo

2017-01-01

Background Cervical cancer is a major public health problem. Even though readily preventable, it is the fourth leading cause of death in women globally. Women living with HIV are at increased risk of invasive cervical cancer, highlighting the need for access to screening and treatment for this population. Integration of services has been proposed as an effective way of improving access to cervical cancer screening especially in areas of high HIV prevalence as well as lower resourced settings. This paper presents the results of a systematic review of programs integrating cervical cancer and HIV services globally, including feasibility, acceptability, clinical outcomes and facilitators for service delivery. Methods This is part of a larger systematic review on integration of services for HIV and non-communicable diseases. To be considered for inclusion studies had to report on programs to integrate cervical cancer and HIV services at the level of service delivery. We searched multiple databases including Global Health, Medline and Embase from inception until December 2015. Articles were screened independently by two reviewers for inclusion and data were extracted and assessed for risk of bias. Main results 11,057 records were identified initially. 7,616 articles were screened by title and abstract for inclusion. A total of 21 papers reporting interventions integrating cervical cancer care and HIV services met the criteria for inclusion. All but one study described integration of cervical cancer screening services into existing HIV services. Most programs also offered treatment of minor lesions, a ‘screen-and-treat’ approach, with some also offering treatment of larger lesions within the same visit. Three distinct models of integration were identified. One model described integration within the same clinic through training of existing staff. Another model described integration through co-location of services, with the third model describing programs of integration

Ortho-perio integrated approach in periodontally compromised patients

PubMed Central

Ramachandra, C. S.; Shetty, Pradeep Chandra; Rege, Sanyukta; Shah, Chitrang

2011-01-01

It is an undisputed fact that sound and strong periodontal health is a must in patients seeking orthodontic treatment. Does this mean that we are going to deny orthodontic treatment for those adults whose number is rising, more often secondary to periodontal deterioration and pathological migration of teeth resulting in aesthetic and functional problems? Need of the hour is to have an integrated approach where in periodontal treatment precedes orthodontic treatment to restore periodontal health. Orthodontic treatment should be performed under strict plaque control measures to place the teeth in a structurally balanced and functionally efficient position. Aim of this article is to familiarize the practicing clinicians both in the field of orthodontics and periodontics with current thoughts and successful clinical techniques used in the field of periodontology to regenerate lost periodontal structures. Furthermore, it aims to integrate such techniques into the orthodontic treatment of patients with severe bone loss. PMID:22368371

13A. Integrative Cancer Care: The Life Over Cancer Model

PubMed Central

Block, Keith; Block, Penny; Shoham, Jacob

2013-01-01

Focus Areas: Integrative Algorithms of Care Integrative cancer treatment fully blends conventional cancer treatment with integrative therapies such as diet, supplements, exercise and biobehavioral approaches. The Life Over Cancer model comprises three spheres of intervention: improving lifestyle, improving biochemical environment (terrain), and improving tolerance of conventional treatment. These levels are applied within the context of a life-affirming approach to cancer patients and treatment. Clinical staff involved include MDs, psychosocial, physical therapy, and dietetic professionals, all located in a single private clinic, the Block Center for Integrative Cancer Treatment. This session will describe the rationale and operation of the clinical model. An outpatient chemotherapy unit is incorporated in the clinic. Chronomodulated chemotherapy is used for selected chemotherapy drugs. Physical care includes massage, exercise and other therapies as directed by the center's physical therapy staff. Notably, cancer patients who are physically active have lower mortality and recurrence risks. Behavioral approaches are being shown increasingly to affect physiological parameters and expression of genes potentially related to cancer. Thus, biobehavioral approaches such as relaxed abdominal breathing and comfort space imagery are taught to patients by a staff including a clinical psychologist and other practitioners. Nutrition is also emerging as a relevant area of intervention in cancer, with recent guidelines from the American Cancer Society. A team of registered dietitians counsels patients individually and conducts cooking classes. Finally, the Life Over Cancer model includes analysis of multiple biological parameters relevant to cancer and general health, with standard laboratory tests. Inflammation, glycemic variables, immune functioning and other variables are regularly monitored. Dietary changes and where necessary supplements are suggested when laboratory results

Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone.

PubMed

Sajid, Ayesha; Whiteman, Aaron; Bell, Richard L; Greene, Marion S; Engleman, Eric A; Chambers, R Andrew

2016-10-01

Fourfold increases in opioid prescribing and dispensations over 2 decades in the U.S. has paralleled increases in opioid addictions and overdoses, requiring new preventative, diagnostic, and treatment strategies. This study examines Prescription Drug Monitoring Program (PDMP) tracking as a novel measure of opioid addiction treatment outcomes in a university-affiliated integrated mental health-addiction treatment clinic. Repeated measure parametrics examined PDMP and urine drug screening (UDS) data before and after first injection for all patients (N = 68) who received at least one long-acting naltrexone injection (380 mg/IM) according to diagnostic groupings of having either (i) alcohol (control); (ii) opioid; or (iii) combined alcohol and opioid use disorders. There were no group differences post-injection in treatment days, injections delivered, or treatment service encounters. UDS and PDMP measures of opioid exposures were greater in opioid compared to alcohol-only patients. Post-first injection, UDS's positive for opioids declined (p < .05) along with PDMP measures of opioid prescriptions (p < .001), doses (p < .01), types (p < .001), numbers of dispensing prescribers (p < .001) and pharmacies (p < .001). Opioid patients without alcohol disorders showed the best outcomes with 50% to 80% reductions in PDMP-measures of opioids, down to levels of alcohol-only patients. This study shows PDMP utility for measuring opioid addiction treatment outcomes, supporting the routine use of PDMPs in clinical and research settings. These findings demonstrate that opioid addiction in patients with complex addictions and mental illnesses comorbidities can show effective treatment responses as measured by PDMP tracking of decreases in opioid prescriptions to those patients. (Am J Addict 2016;25:557-564). © 2016 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction

Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone

PubMed Central

Sajid, Ayesha; Whiteman, Aaron; Bell, Richard L.; Greene, Marion S.; Engleman, Eric A.

2016-01-01

Background and Objectives Fourfold increases in opioid prescribing and dispensations over 2 decades in the U.S. has paralleled increases in opioid addictions and overdoses, requiring new preventative, diagnostic, and treatment strategies. This study examines Prescription Drug Monitoring Program (PDMP) tracking as a novel measure of opioid addiction treatment outcomes in a university‐affiliated integrated mental health‐addiction treatment clinic. Methods Repeated measure parametrics examined PDMP and urine drug screening (UDS) data before and after first injection for all patients (N = 68) who received at least one long‐acting naltrexone injection (380 mg/IM) according to diagnostic groupings of having either (i) alcohol (control); (ii) opioid; or (iii) combined alcohol and opioid use disorders. Results There were no group differences post‐injection in treatment days, injections delivered, or treatment service encounters. UDS and PDMP measures of opioid exposures were greater in opioid compared to alcohol‐only patients. Post‐first injection, UDS's positive for opioids declined (p < .05) along with PDMP measures of opioid prescriptions (p < .001), doses (p < .01), types (p < .001), numbers of dispensing prescribers (p < .001) and pharmacies (p < .001). Opioid patients without alcohol disorders showed the best outcomes with 50% to 80% reductions in PDMP‐measures of opioids, down to levels of alcohol‐only patients. Conclusions This study shows PDMP utility for measuring opioid addiction treatment outcomes, supporting the routine use of PDMPs in clinical and research settings. Scientific Significance These findings demonstrate that opioid addiction in patients with complex addictions and mental illnesses comorbidities can show effective treatment responses as measured by PDMP tracking of decreases in opioid prescriptions to those patients. (Am J Addict 2016;25:557–564) PMID:27647699

Integration of Basic Sciences in Health's Courses

ERIC Educational Resources Information Center

Azzalis, L. A.; Giavarotti, L.; Sato, S. N.; Barros, N. M. T.; Junqueira, V. B. C.; Fonseca, F. L. A.

2012-01-01

Concepts from disciplines such as Biochemistry, Genetics, Cellular and Molecular Biology are essential to the understanding and treatment of an elevated number of illnesses, but often they are studied separately, with no integration between them. This article proposes a model for basic sciences integration based on problem-based learning (PBL) and…

Effective cancer laser-therapy design through the integration of nanotechnology and computational treatment planning models

NASA Astrophysics Data System (ADS)

Fisher, Jessica W.; Rylander, Marissa Nichole

2008-02-01

Laser therapies can provide a minimally invasive treatment alternative to surgical resection of tumors. However, the effectiveness of these therapies is limited due to nonspecific heating of target tissue which often leads to healthy tissue injury and extended treatment durations. These therapies can be further compromised due to heat shock protein (HSP) induction in tumor regions where non-lethal temperature elevation occurs, thereby imparting enhanced tumor cell viability and resistance to subsequent chemotherapy and radiation treatments. Introducing multi-walled nanotubes (MWNT) into target tissue prior to laser irradiation increases heating selectivity permitting more precise thermal energy delivery to the tumor region and enhances thermal deposition thereby increasing tumor injury and reducing HSP expression induction. This study investigated the impact of MWNT inclusion in untreated and laser irradiated monolayer cell culture and cell phantom model. Cell viability remained high for all samples with MWNT inclusion and cells integrated into alginate phantoms, demonstrating the non-toxic nature of both MWNTs and alginate phantom models. Following, laser irradiation samples with MWNT inclusion exhibited dramatic temperature elevations and decreased cell viability compared to samples without MWNT. In the cell monolayer studies, laser irradiation of samples with MWNT inclusion experienced up-regulated HSP27, 70 and 90 expression as compared to laser only or untreated samples due to greater temperature increases albeit below the threshold for cell death. Further tuning of laser parameters will permit effective cell killing and down-regulation of HSP. Due to optimal tuning of laser parameters and inclusion of MWNT in phantom models, extensive temperature elevations and cell death occurred, demonstrating MWNT-mediated laser therapy as a viable therapy option when parameters are optimized. In conclusion, MWNT-mediated laser therapies show great promise for effective