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Sample records for accepted treatment modality

  1. Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents

    PubMed Central

    Saffan, Abdulrahman Al; AlHobail, Sultan; Bin Salem, Fares; AlFuraih, AlBara; AlTamimi, Mohammad

    2016-01-01

    Background and Aim. Esthetic concerns in primary teeth have been studied mainly from the point of view of parents. The aim of this study was to study compare the opinions of children aged 5–8 years to have an opinion regarding the changes in appearance of their teeth due to dental caries and the materials used to restore those teeth. Methodology. A total of 107 children and both of their parents (n = 321), who were seeking dental treatment, were included in this study. A tool comprising a questionnaire and pictures of carious lesions and their treatment arranged in the form of a presentation was validated and tested on 20 children and their parents. The validated tool was then tested on all participants. Results. Children had acceptable validity statistics for the tool suggesting that they were able to make informed decisions regarding esthetic restorations. There was no difference between the responses of the children and their parents on most points. Zirconia crowns appeared to be the most acceptable full coverage restoration for primary anterior teeth among both children and their parents. Conclusion. Within the limitations of the study it can be concluded that children in their sixth year of life are capable of appreciating the esthetics of the restorations for their anterior teeth. PMID:27446212

  2. Conservative treatment modalities in retinoblastoma.

    PubMed

    Chawla, Bhavna; Jain, Amit; Azad, Rajvardhan

    2013-09-01

    Retinoblastoma is the most common primary intraocular malignancy of childhood. A potentially curable cancer, its treatment has improved significantly over the last few decades. The purpose of this article is to review the literature on various conservative treatment modalities available for the treatment of retinoblastoma and their effectiveness, when used alone or in combination. Pubmed, Medline, Embase, and the Cochrane library were searched through 2012 for published peer reviewed data on conservative treatment modalities for retinoblastoma. Various studies show that while enucleation remains the standard of care for advanced intraocular tumors, conservative modalities that can result in globe salvage and preservation of useful vision are being increasingly employed. Such modalities include systemic chemotherapy, focal consolidation with transpupillary thermotherapy, laser photocoagulation and cryotherapy, plaque brachytherapy, and delivery of local chemotherapy using subconjunctival, sub-tenon, or intra-arterial routes. When used alone or in combination, these treatment modalities can help in avoidance of external beam radiotherapy or enucleation, thus reducing the potential for long-term side effects, while salvaging useful vision. Radioactive plaque brachytherapy has an established role in selected patients with intraocular retinoblastoma. Local injections of chemotherapeutic agents via the sub-tenon or sub-conjunctival route have been used with varying degrees of success, usually as an adjunct to systemic chemotherapy. Intra-arterial ophthalmic artery delivery of melphalan has shown promising results. It is important to recognize that today, several treatment options are available that can obviate the need for enucleation, and cure the cancer with preservation of functional vision. A thorough knowledge and understanding of these conservative treatment modalities is essential for appropriate management.

  3. Treatment modalities for primary incisors.

    PubMed

    Weinberger, S J

    1989-10-01

    The present article reviewed some of the treatment modalities for restoring anterior teeth in the primary dentition. It divided the treatment types into three classifications based on the severity of the carious lesions or injury. Treatments that are not usually found in current textbooks were outlined and commented upon. It was suggested that dentists have to consider a wide range of treatment options since factors such as the age of the child, ability to cope with treatment and cost of treatment have to be taken into account.

  4. Further Conceptualization of Treatment Acceptability

    ERIC Educational Resources Information Center

    Carter, Stacy L.

    2008-01-01

    A review and extension of previous conceptualizations of treatment acceptability is provided in light of progress within the area of behavior treatment development and implementation. Factors including legislation, advances in research, and service delivery models are examined as to their relationship with a comprehensive conceptualization of…

  5. Plantar fasciitis: current diagnostic modalities and treatments.

    PubMed

    Healey, Kevin; Chen, Katherine

    2010-07-01

    Plantar fasciitis is a common cause of heel pain. The diagnosis is made clinically and validated with different diagnostic modalities ranging from ultrasound to magnetic resonance imaging. Treatments vary from stretching exercises to different surgical options. No single treatment is guaranteed to alleviate the heel pain.

  6. Treatment modalities for early gastric cancer

    PubMed Central

    Espinel, Jesús; Pinedo, Eugenia; Ojeda, Vanesa; del Rio, Maria Guerra

    2015-01-01

    Different treatment modalities have been proposed in the treatment of early gastric cancer (EGC). Endoscopic resection (ER) is an established treatment that allows curative treatment, in selected cases. In addition, ER allows for an accurate histological staging, which is crucial when deciding on the best treatment option for EGC. Recently, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have become alternatives to surgery in early gastric cancer, mainly in Asian countries. Patients with “standard” criteria can be successfully treated by EMR techniques. Those who meet “expanded” criteria may benefit from treatment by ESD, reducing the need for surgery. Standardized ESD training system is imperative to promulgate effective and safe ESD technique to practices with limited expertise. Although endoscopic resection is an option in patients with EGC, surgical treatment continues to be a widespread therapeutic option worldwide. In this review we tried to point out the treatment modalities for early gastric cancer. PMID:26380052

  7. Multiple sclerosis - New treatment modalities

    PubMed Central

    Totaro, Rocco; Di Carmine, Caterina; Marini, Carmine; Carolei, Antonio

    2015-01-01

    Ever since the introduction of the first disease modifying therapies, the concept of multiple sclerosis treatment algorithms developed ceaselessly. The increasing number of available drugs is paralleled by impelling issue of ensuring the most appropriate treatment to the right patient at the right time. The purpose of this review is to describe novel agents recently approved for multiple sclerosis treatment, namely teriflunomide, alemtuzumab and dimethylfumarate, focusing on mechanism of action, efficacy data in experimental setting, safety and tolerability. The place in therapy of newer treatment implies careful balancing of risk-benefit profile as well as accurate patient selection. Hence the widening of therapeutic arsenal provides greater opportunity for personalized therapy but also entails a complex trade-off between efficacy, tolerability, safety and eventually patient preference. PMID:26831413

  8. Treatment modalities and evaluation models for periodontitis

    PubMed Central

    Tariq, Mohammad; Iqbal, Zeenat; Ali, Javed; Baboota, Sanjula; Talegaonkar, Sushama; Ahmad, Zulfiqar; Sahni, Jasjeet K

    2012-01-01

    Periodontitis is the most common localized dental inflammatory disease related with several pathological conditions like inflammation of gums (gingivitis), degeneration of periodontal ligament, dental cementum and alveolar bone loss. In this perspective, the various preventive and treatment modalities, including oral hygiene, gingival irrigations, mechanical instrumentation, full mouth disinfection, host modulation and antimicrobial therapy, which are used either as adjunctive treatments or as stand-alone therapies in the non-surgical management of periodontal infections, have been discussed. Intra-pocket, sustained release systems have emerged as a novel paradigm for the future research. In this article, special consideration is given to different locally delivered anti-microbial and anti inflammatory medications which are either commercially available or are currently under consideration for Food and Drug Administration (FDA) approval. The various in vitro dissolution models and microbiological strain investigated to impersonate the infected and inflamed periodontal cavity and to predict the in vivo performance of treatment modalities have also been thrashed out. Animal models that have been employed to explore the pathology at the different stages of periodontitis and to evaluate its treatment modalities are enlightened in this proposed review. PMID:23373002

  9. Treatment modalities for bleeding esophagogastric varices.

    PubMed

    Yoshida, Hiroshi; Mamada, Yasuhiro; Taniai, Nobuhiko; Yoshioka, Masato; Hirakata, Atsushi; Kawano, Youichi; Mizuguchi, Yoshiaki; Shimizu, Tetsuya; Ueda, Junji; Uchida, Eiji

    2012-01-01

    Bleeding from esophageal varices (EVs) or gastric varices (GVs) is a catastrophic complication of chronic liver disease. In this paper, we review the management of bleeding EVs and GVs. DIAGNOSIS OF EVS AND GVS: The grading system for esophagogastric varices proposed by the Japan Society for Portal Hypertension classifies GVs into those involving the cardia (Lg-c), the fundus (Lg-f), and both the cardia and the fundus (Lg-cf). In this review, we divide GVs into 2 categories: Lg-c (cardiac varices: CVs) and Lg-cf or Lg-f (fundal varices: FVs). TREATMENT MODALITIES FOR EVS AND GVS: Treatment modalities for EVs and GVs include placement of a Sengstaken-Blakemore tube, pharmacologic therapy, surgery, interventional radiology, and endoscopic treatment. MANAGEMENT OF BLEEDING EVS AND GVS: In Japan, endoscopic treatment has recently become the therapy of choice for bleeding EVs or GVs. In other countries, especially the United States, vasoactive drugs and endoscopic treatment are routinely used to manage variceal hemorrhage. BLEEDING EVS: Endoscopic variceal ligation is useful for controlling bleeding from EVs. However, confirmation of ligation precisely at the site of bleeding is usually difficult in patients with massive variceal bleeding. The site of acute bleeding can generally be identified by means of water instillation and suction. Ligation is then performed at the bleeding point. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube is used as a temporary bridge to other treatments. Transportal obliteration is useful for blocking variceal blood flow. BLEEDING GVS: Endoscopic injection sclerotherapy with a tissue adhesive, such as N-butyl-cyanoacrylate or isobutyl-2-cyanoacrylate, is effective for acute bleeding from GVs. However, bleeding from the GV injection site and rebleeding from the rupture point have been reported in patients receiving endoscopic injection sclerotherapy. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube

  10. Review of Recent Treatment Acceptability Research

    ERIC Educational Resources Information Center

    Carter, Stacy L.

    2007-01-01

    With recent increases in the use of positive approaches to treatment for individuals with developmental disabilities, it seems appropriate to review the variables that have been found to influence the acceptability of various treatments. Programmatic treatments for problematic behaviors that incorporate primarily positive (reinforcement)…

  11. [Selection of treatment modalities in patients with spasticity].

    PubMed

    Ota, Tetsuo

    2014-09-01

    Spasticity is the most common abnormality of muscle tone. Typically, oral antispastic drugs, phenol blocks, motor-point blocks, selective dorsal rhizotomies, and selective peripheral neurotomies are used to reduce muscle tone and/or improve ranges of motion. Recently, botulinum toxin injections and intrathecal baclofen have been used as treatment modalities. The selection of the most appropriate treatment modality by doctors treating patients with spasticity is critical. Furthermore, rehabilitation techniques, such as physiotherapy, occupational therapy, therapeutic electrical nerve stimulation, and orthosis, are useful as combination therapy for the treatment of spasticity. The purpose of this study was to outline the various modalities that are currently used for the treatment of spasticity. Regardless of the modality selected, it is imperative that treatment goals are carefully identified. The reduction of spasticity is not an appropriate treatment goal. Appropriate goals include improving gait, activities of daily living, and the quality of life.

  12. Children acceptance of laser dental treatment

    NASA Astrophysics Data System (ADS)

    Lazea, Andreea; Todea, Carmen

    2016-03-01

    Objectives: To evaluate the dental anxiety level and the degree of acceptance of laser assisted pedodontic treatments from the children part. Also, we want to underline the advantages of laser use in pediatric dentistry, to make this technology widely used in treating dental problems of our children patients. Methods: Thirty pediatric dental patients presented in the Department of Pedodontics, University of Medicine and Pharmacy "Victor Babeş", Timişoara were evaluated using the Wong-Baker pain rating scale, wich was administered postoperatory to all patients, to assess their level of laser therapy acceptance. Results: Wong-Baker faces pain rating scale (WBFPS) has good validity and high specificity; generally it's easy for children to use, easy to compare and has good feasibility. Laser treatment has been accepted and tolerated by pediatric patients for its ability to reduce or eliminate pain. Around 70% of the total sample showed an excellent acceptance of laser dental treatment. Conclusions: Laser technology is useful and effective in many clinical situations encountered in pediatric dentistry and a good level of pacient acceptance is reported during all laser procedures on hard and soft tissues.

  13. Treatment Acceptability among Mexican American Parents

    ERIC Educational Resources Information Center

    Borrego, Joaquin, Jr.; Ibanez, Elizabeth S.; Spendlove, Stuart J.; Pemberton, Joy R.

    2007-01-01

    There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for…

  14. MINERVA - A Multi-Modal Radiation Treatment Planning System

    SciTech Connect

    D. E. Wessol; C. A. Wemple; D. W. Nigg; J. J. Cogliati; M. L. Milvich; C. Frederickson; M. Perkins; G. A. Harkin

    2004-10-01

    Recently, research efforts have begun to examine the combination of BNCT with external beam photon radiotherapy (Barth et al. 2004). In order to properly prepare treatment plans for patients being treated with combinations of radiation modalities, appropriate planning tools must be available. To facilitiate this, researchers at the Idaho National Engineering and Environmental Laboratory (INEEL)and Montana State University (MSU) have undertaken development of a fully multi-modal radiation treatment planning system.

  15. Multi-Modal Treatment of Nocturnal Enuresis.

    ERIC Educational Resources Information Center

    Mohr, Caroline; Sharpley, Christopher F.

    1988-01-01

    The article reports a multimodal treatment of nocturnal enuresis and anxious behavior in a mildly mentally retarded woman. Behavioral treatment and removal of caffeine from the subject's diet eliminated both nocturnal enuresis and anxious behavior. (Author/DB)

  16. Pharmacologic modalities in the treatment of osteoradionecrosis of the jaw.

    PubMed

    McCaul, James Anthony

    2014-05-01

    Managing osteoradionecrosis (ORN) of the facial bones is a challenge in maxillofacial head and neck surgery. Changes in understanding of ORN of the jaws has led to new studies using novel therapeutic modalities to manage this disorder. These treatment regimens may allow medical management to replace major reconstructive surgery for some patients who have already undergone chemoradiotherapy or combined modality therapy for head and neck cancer.

  17. Continuation of Weight Loss Treatment Is Associated with the Number of Self-Selected Treatment Modalities

    ERIC Educational Resources Information Center

    Martin, Corby K.; Drab-Hudson, Danae L.; York-Crowe, Emily; Mayville, Stephen B.; Yu, Ying; Greenway, Frank L.

    2007-01-01

    Behavior therapy is a cornerstone of weight loss treatment and behaviorists help direct patients' treatment. A novel design was used that allowed participants to choose different treatment modalities during behavioral weight loss treatment. The association between the selection of different treatment modalities and program completion was examined…

  18. Treatment Modalities of Necrobiosis Lipoidica: A Concise Systematic Review

    PubMed Central

    Feily, Amir; Mehraban, Shadi

    2015-01-01

    Necrobiosis lipoidica (NL) is a rare inflammatory granulomatous skin disorder closely associated with diabetes mellitus. The aim of this paper is to review and discuss all the treatment modalities proposed and tested for this disease. A systematic review of the existing literature was conducted to investigate all the available data and summarize all the clinical trials, case reports and original articles on NL. Two major databases (PubMed and Google Scholar) were used. We have examined about 70 articles. Numerous treatment modalities have been currently investigated to compare recalcitrant NL. Being rare, most of the studies regarding this disease are case reports or small-scale clinical trials. We have found that, in spite of plentiful investigations carried out during the years, there is no treatment modality that has proved to be utterly satisfactory in treating NL. PMID:26236446

  19. Therapy for ankylosing spondylitis: new treatment modalities.

    PubMed

    Braun, J; Breban, Maxime; Maksymowych, Walter P

    2002-09-01

    The therapeutic options for patients suffering from the more severe forms of spondyloarthritis (SpA) have been rather limited in recent decades. There is now accumulating evidence that anti-tumour necrosis factor (anti-TNF) therapy is highly effective in SpA, especially in ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Based on the data recently published on more than 200 AS patients, and more than 100 PsA patients, this treatment seems to be even more effective than it is in rheumatoid arthritis (RA). The two major anti-TNF-alpha agents currently available, infliximab (Remicade) and etanercept (Enbrel), are approved for the treatment of RA in Europe and in the USA. The situation in SpA is different from RA because there is an unmet medical need, especially in AS, because disease-modifying anti-rheumatic therapy is not available for severely affected patients. Thus, TNF blockers might even be considered first-line immunosuppressive treatment in patients with active AS who are not sufficiently treated with non-steroidal anti-inflammatory drugs (NSAIDs). For infliximab, a dose of 5mg/kg was required, and intervals between 6 and 12 weeks were necessary for constant suppression of disease activity - a major aim also for long-term treatment. However, it remains to be shown whether patients benefit from long-term therapy and whether radiological progression and ankylosis can be stopped. The optimal doses of infliximab might well be determined individually. Allergic reactions and increased susceptibility to tuberculosis are rare side-effects which need to be recognized early. As it stands now, the benefits of anti-TNF therapy in AS seem to outweigh these shortcomings. The efficacy of etanercept was first demonstrated in PsA. A double-blind study has now been performed in AS - with similar results. There is preliminary evidence that both agents also work in other SpA such as undifferentiated SpA. Hopefully, both agents will be approved soon for the short

  20. Diagnostic and treatment modalities for autoimmune pancreatitis.

    PubMed

    Rao, Atul S; Palazzo, Francesco; Chung, Joanne; Hager, Eric; Abdollahi, Hamid; Yeo, Charles J

    2006-09-01

    Since the recognition of autoimmune pancreatitis (AIP) as a clinical entity, many advances have been made in defining clinical, radiologic, histologic, and laboratory parameters to assist in a complete definition of the disease. Despite all these efforts, a preoperative diagnosis still remains a clinical challenge but is of paramount importance, as these cases have been reported to be steroid-responsive; therefore, early treatment may obviate the need for surgical resection. Although the utilization of recently proposed guidelines by the Japanese Pancreas Society and an Italian study group may further assist the clinician and prompt the initiation of steroid treatment, the response to therapy should be observed within 2 to 4 weeks and reflected in progressive resolution of the presenting radiologic and laboratory abnormalities. Should these fail to demonstrate improvement, the diagnosis of AIP should undergo re-evaluation, and consideration for surgical exploration should be made, as the patient may be harboring a malignancy. Surgical resection in the form of pylorus-preserving pancreaticoduodenectomy remains the optimal solution in the attempt to clarify the diagnosis and offer treatment with low complication rates.

  1. Treatment modality preferences and adherence to group treatment for panic disorder with agoraphobia.

    PubMed

    Perreault, Michel; Julien, Dominic; White, Noé Djawn; Bélanger, Claude; Marchand, André; Katerelos, Theodora; Milton, Diana

    2014-06-01

    To examine the relationship between preference for group psychotherapy and adherence to group cognitive-behavioral therapy (CBT) for clients with panic disorder with agoraphobia (PDA), 109 participants experiencing PDA completed a questionnaire measuring preference for group treatment (PGTQ) before beginning CBT groups. A t test was used to compare preference scores for group treatment to investigate whether participants who completed treatment differed from those who abandoned treatment. Participants who completed group therapy expressed higher preference for group treatment than participants who dropped out of treatment (t[107] = 1.99; p < 0.05). The PGTQ-4 presented adequate psychometric properties. Reliability analyses of the items retained after factorization demonstrated an acceptable level of internal consistency (Cronbach's alpha of 0.76). Preference for individual or group therapy appears to impact treatment retention for patients with PDA. Matching patients' preferences to the type of treatment modality used appears to be pertinent, especially for the treatment of anxiety disorders. In terms of practical implications, the rationale and benefits of group therapy should be explained to participants reluctant to engage in group therapy. Individual intervention or a combination of group and individual treatment could be considered for clients who are likely to drop out of group therapy.

  2. Breast cancer. Part 2: present and future treatment modalities.

    PubMed

    Harmer, Victoria

    This is the second article in a series of three on breast cancer. Part 1 discussed breast anatomy, the principles behind breast awareness and breast health, detailing common benign breast diseases, types of breast cancer and staging. In this article, treatment for breast cancer is discussed. The article will follow the usual order of modalities in the trajectory, starting with surgery, then chemotherapy, radiotherapy and endocrine treatment, finishing with a discussion of future and biological treatments.

  3. Angiostatic Therapy: A New Treatment Modality for Prostate Cancer

    DTIC Science & Technology

    2000-01-01

    21702-5012. AUTHORITY USAMRMC ltr, 26 Nov 2002 THIS PAGE IS UNCLASSIFIED AD Award Number: DAMD17-99-1-9010 TITLE: Angiostatic Therapy : A New Treatment ...FUNDING NUMBERS Angiostatic Therapy : A New Treatment Modality for Prostate DAMD17-99-1-9010 Cancer 6. AUTHORIS) Per Borgstrom, Ph.D.* 7. PERFORMING...Cancer of the prostate is a major malignancy in men therapy , and hormonal treatment derives largely from in the Western world. After lung cancer, it is

  4. Review of treatment modalities for postmenopausal osteoporosis.

    PubMed

    Hamdy, Ronald C; Chesnut, Charles H; Gass, Margery L; Holick, Michael F; Leib, Edward S; Lewiecki, Michael E; Maricic, Michael; Watts, Nelson B

    2005-10-01

    This review summarizes and updates data presented at recent annual Southern Medical Association conferences on postmenopausal osteoporosis. As part of any osteoporosis treatment program, it is important to maintain adequate calcium and 25-hydroxyvitamin D levels either through diet or supplementation. Among the available pharmacologic therapies, the bisphosphonates alendronate and risedronate have demonstrated the most robust fracture risk reductions-approximately 40 to 50% reduction in vertebral fracture risk, 30 to 40% in nonvertebral fracture risk, and 40 to 60% in hip fracture risk. Ibandronate, a new bisphosphonate, has demonstrated efficacy in reducing vertebral fracture risk. Salmon calcitonin nasal spray and raloxifene demonstrated significant reductions in vertebral fracture risk in pivotal studies. Teriparatide significantly reduced vertebral and nonvertebral fracture risk. Drugs on the horizon include strontium ranelate, which has been shown to reduce vertebral and nonvertebral fracture risk, and zoledronic acid, an injectable bisphosphonate that increased bone density with once-yearly administration.

  5. Cancer in pregnancy: disentangling treatment modalities

    PubMed Central

    Zagouri, Flora; Dimitrakakis, Constantine; Marinopoulos, Spyridon; Tsigginou, Alexandra; Dimopoulos, Meletios-Athanassios

    2016-01-01

    Pregnancy-associated cancer constitutes an uncommon and difficult to manage clinical situation. It is defined as the cancer diagnosed from the first day of childbearing to 1 year post partum. Coexistence of cancer with pregnancy adds complexity to treatment recommendations, as both the mother and the fetus may be affected. The optimal therapeutic management of pregnant women with cancer diagnosis should take into account, apart from medical factors, a host of other parameters (ethical, psychological, religious, legal, etc). Unfortunately, this situation becomes more complex as more women delay childbearing, and consequently the incidence of cancer during pregnancy is constantly increasing. This manuscript summarises the general principles in managing pregnant patients with cancer and gives detailed instructions in the management of pregnant patients with breast cancer, ovarian cancer, melanoma, lymphoma, lung cancer, soft-tissue sarcoma and cervical cancer. Of note, management of pregnant women with cancer diagnosis should be performed in specialised centres with experience and all cases should be discussed in multidisciplinary meetings composed of multiple specialists (medical oncologists, obstetricians, surgeons, radiologists and paediatricians). PMID:27843602

  6. Treatment modalities of palmoplantar lichen planus: a brief review

    PubMed Central

    Yaghoobi, Reza; Nilforoushzadeh, Mohammad Ali

    2016-01-01

    Palmoplantar lichen planus is a localized and uncommon variant of lichen planus which is mostly resistant to treatment. Our purpose was to discuss all treatment modalities proposed and tested for palmoplantar lichen planus in the literature. A systematic review of the literature was conducted to evaluate evidence regarding all treatment modalities proposed and tested for palmoplantar lichen planus in the literature. Two major databases (PubMed, Google scholar) were searched. The review included all case reports, letters and original articles reporting any treatment for palmoplantar lichen planus but not treatment used in the other type of lichen planus, generalized lichen planus or other type of palmoplantar dermatoses. We have gone over more than 50 articles. There are many drugs that have been used in the treatment of lichen planus and generalized lichen planus but the palmoplantar type is a rare variety of lichen planus. That is why we could not find any clinical trial on the subject and just case reports have been described in this manuscript. In spite of plentiful investigations carried out on lichen planus, there is no treatment modality that has proved to be utterly satisfactory in treatment of palmoplantar lichen planus. PMID:28035216

  7. Treatment modalities of palmoplantar lichen planus: a brief review.

    PubMed

    Feily, Amir; Yaghoobi, Reza; Nilforoushzadeh, Mohammad Ali

    2016-12-01

    Palmoplantar lichen planus is a localized and uncommon variant of lichen planus which is mostly resistant to treatment. Our purpose was to discuss all treatment modalities proposed and tested for palmoplantar lichen planus in the literature. A systematic review of the literature was conducted to evaluate evidence regarding all treatment modalities proposed and tested for palmoplantar lichen planus in the literature. Two major databases (PubMed, Google scholar) were searched. The review included all case reports, letters and original articles reporting any treatment for palmoplantar lichen planus but not treatment used in the other type of lichen planus, generalized lichen planus or other type of palmoplantar dermatoses. We have gone over more than 50 articles. There are many drugs that have been used in the treatment of lichen planus and generalized lichen planus but the palmoplantar type is a rare variety of lichen planus. That is why we could not find any clinical trial on the subject and just case reports have been described in this manuscript. In spite of plentiful investigations carried out on lichen planus, there is no treatment modality that has proved to be utterly satisfactory in treatment of palmoplantar lichen planus.

  8. Effectiveness, usability, and acceptability of haptic-enabled virtual reality and mannequin modality simulators for surgical cricothyroidotomy.

    PubMed

    Proctor, Michael D; Campbell-Wynn, Lillian

    2014-03-01

    This research assesses the effectiveness, usability, and acceptability of mannequin and haptic-enabled virtual reality (VR) modality simulators by Army medics in a surgical cricothyroidotomy procedure. Research methods investigate through experimentation surgical task performance, technology acceptance, user recommendation, comparative analysis, and select cognitive task load results. Results indicate that the HapMed mannequin and CricSim VR simulators proved effective by meeting training task performance evaluation requirements. Both systems meet 95% user technology acceptance and 85% user recommendation levels. In conclusion, at those levels, either system may complement, reduce, or replace the use of some alternative training methods such as animals or cadavers. To raise recommendation rates, future research needs to reduce barriers to blending visualization with mannequin modalities and make further refinements within the modalities. One research pathway identified blends a mannequin with stereoscopic visualization and motion parallax, providing correlated, partially transparent visual layers of anatomy and of various medical procedures in virtual overlay with the mannequin. Future research also needs to clarify acceptable degrees of freedom levels by task for haptics VR in light of real-world degrees of freedom requirements. Finally, artificial skin may need research to achieve better replication of human skin on mannequins.

  9. Pharmacological and other treatment modalities for esophageal pain.

    PubMed

    Hoff, Dag Arne Lihaug; Brock, Christina; Farmer, Adam D; Dickman, Ram; Ruffle, James K; Shaker, Anisa; Drewes, Asbjørn M

    2016-09-01

    Treatment of esophageal pain remains a major challenge for the clinician. Although many patients have heartburn and may respond to proton pump inhibitors, there in an unmet need for other treatment modalities in patients where there are no obvious pathological findings. Although analgesics are the mainstay in esophageal pain treatment, many patients are nonresponders to these drugs. The current concise review focuses on other systems affecting pain processing, where better understanding may serve as a framework for therapy. These are the parasympathetic nervous system, exercise, and personality profiles. Finally, treatment with analgesics for functional chest pain remains a challenge, and an overview of treatment with antidepressive drugs is provided.

  10. Interventional modalities in the treatment of complex regional pain syndrome.

    PubMed

    Nambi-Joseph, Pushpa; Stanton-Hicks, Michael; Sferra, James J

    2004-06-01

    Complex regional pain syndrome (CRPS) applies to a variety of conditions in which symptoms such as allodynia and hyperalgesia predominate along with hyperpathia and vasomotor/sudomotor disturbances. The incidence of CRPS in the chronic pain population varies and is difficult to determine, though it appears to affect women more than men. Treatment is multidisciplinary, and recovery of function and the reduction of pain are the main goals of treatment;this article addresses some of the interventional modalities that are used.

  11. Therapy of auricular keloids: review of different treatment modalities and proposal for a therapeutic algorithm.

    PubMed

    Froelich, K; Staudenmaier, R; Kleinsasser, N; Hagen, R

    2007-12-01

    Keloids are abnormal wound reactions of connective tissue. Auricular keloids can develop as a result of, e.g., otoplasty, ear piercing, or skin trauma. A wide variety of therapeutic options exists, including surgery as primary treatment. Furthermore, there are medical, physical, radiotherapeutic and experimental options. The present paper focuses on the different techniques including the therapeutic outcome and quality rating for each chosen pathway. In addition to the experience of the university hospitals, a thorough review of the literature was performed in order to update and compare today's therapeutic options. Surgical techniques are customized to the lesion's specific localization and extent. They may include revision of otoplasty. With medical treatment, established modalities such as steroid injection have to be distinguished from experimental methods like interferon, 5-FU, verapamil, imiquimod, or mitomycin C. Radiation is generally accepted to be effective, especially applied accompanying surgery, but needs to be restricted due to possible side effects. Physical therapy, e.g., pressure in a variety of application modalities, has gained a profound position in the therapy of auricular keloids. The success rates of the different treatment modalities vary markedly, and the number of patients per study is considerably low. Resuming the results, a periodic follow-up and good patients' compliance are mandatory to early realize and treat auricular keloids. However, studies are needed to evaluate accepted and experimental therapies including larger number of patients.

  12. Drug Abuse Treatment: The Halfway House and Other Specially Supervised Modalities.

    ERIC Educational Resources Information Center

    Peck, David

    This research deals primarily with an overview of drug use and/or abuse, with specific discussion of the halfway house concept of treatment, including definition, historical framework, rationales, and inherent problems of halfway houses as modalities of treatment (i.e., economics of the treatment modality). Other special treatment modalities are…

  13. Silver: an age-old treatment modality in modern times.

    PubMed

    Spear, Marcia

    2010-01-01

    The use of silver as an antimicrobial for infection spans hundreds of years. The ancient Greeks and Romans used silver to disinfect their water and food supplies. Silver was also used in ancient times to treat burns and wounds as a wound dressing. Silver solutions were approved by the U.S. Food and Drug Administration in the 1920s. Since that time, silver has established itself as an effective and well-known treatment modality for and in the prevention of high-risk infection in clinical wound care (http://int.hansaplast.com/med-info/wound-care-beautiful-healing/silver-tech.html).

  14. Venous Thromboembolism – Current Diagnostic and Treatment Modalities

    PubMed Central

    Bosevski, Marijan; Srbinovska-Kostovska, Elizabeta

    2016-01-01

    BACKGROUND: Pulmonary embolism and deep venous thrombosis, known as venous thromboembolism (VTE), are associated with a high proportion of morbidity and mortality. AIM: Aim of this review is to emphasise current diagnostic and therapeutic modalities for VTE. RESULTS: No differences have been noticed in European and American guidelines in diagnostic approach of this disorder. Today there is enough clinical information for the use of heparin (either, unfractionated or low molecular) and vitamin K antagonists in the treatment of acute and chronic phases of VTE. Novel oral anticoagulants seem to have some advantages in the treatment of this disorder. Rivaroxaban has been approved widespread, for use as a single-drug approach of VTE. CONCLUSION: Both guidelines are almost similar and good basis for evidence-based treatment of this disorder. PMID:27703586

  15. Newer treatment modalities for pediatric obstructive sleep apnea.

    PubMed

    Tapia, Ignacio E; Marcus, Carole L

    2013-09-01

    The obstructive sleep apnea syndrome is common and its prevalence is expected to increase with the current obesity epidemic. If left untreated, it is associated with important morbidity such as growth failure, neurocognitive impairment, systemic and pulmonary hypertension, and endothelial dysfunction. Recent research has shown that many children, especially the obese or those with other underlying medical conditions, have residual obstructive sleep apnea after adenotonsillectomy (the primary treatment for childhood obstructive sleep apnea). These children could be effectively treated with continuous positive airway pressure but poor adherence is a significant limitation of this therapy. Therefore, new treatment modalities for the pediatric obstructive sleep apnea syndrome are needed. Current research has focused on newer therapies for pediatric obstructive sleep apnea, such as anti-inflammatories, dental treatments, high-flow nasal cannula, and weight loss. However, there are few randomized controlled trials assessing the effectiveness of these therapies. Further research is warranted.

  16. Treatment Acceptability of Healthcare Services for Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Dahl, Norm; Tervo, Raymond; Symons, Frank J.

    2007-01-01

    Background: Although treatment acceptability scales in intellectual and developmental disabilities research have been used in large- and small-scale applications, large-scale application has been limited to analogue (i.e. contrived) investigations. This study extended the application of treatment acceptability by assessing a large sample of care…

  17. Transarterial Therapy: An Evolving Treatment Modality of Hepatocellular Carcinoma

    PubMed Central

    Jazieh, Khalid A.; Arabi, Mohammad; Khankan, Azzam A.

    2014-01-01

    Liver cancer is the fifth most common cancer in men, the seventh most common in women, and the third most common cause of death from cancer worldwide. Only 30-40% of liver cancer patients present early enough to undergo curative treatments such as surgery or liver transplantation. Local treatment with radiofrequency ablation or ethanol injection is often reserved for non-surgical candidates with early stages of disease. Transarterial embolization has become a widely accepted treatment for asymptomatic patients with unresectable lesions. This review discusses in details the three major forms of transarterial therapies: Bland embolization, chemoembolization, and radioembolization. PMID:25434313

  18. Pressure ulcers: Current understanding and newer modalities of treatment.

    PubMed

    Bhattacharya, Surajit; Mishra, R K

    2015-01-01

    This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.

  19. Pressure ulcers: Current understanding and newer modalities of treatment

    PubMed Central

    Bhattacharya, Surajit; Mishra, R. K.

    2015-01-01

    This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described. PMID:25991879

  20. Light on Body Image Treatment: Acceptance Through Mindfulness

    ERIC Educational Resources Information Center

    Stewart, Tiffany M.

    2004-01-01

    The treatment of body image has to be multifaceted and should be directed toward the treatment of the whole individual - body, mind, and spirit - with an ultimate culmination of acceptance and compassion for the self. This article presents information on a mindful approach to the treatment of body image as it pertains to concerns with body size…

  1. Self-Injurious Behavior: A Bi-Modal Treatment Approach to Working with Adolescent Females.

    ERIC Educational Resources Information Center

    Stone, Judy A.; Sias, Shari M.

    2003-01-01

    The topic of self-injurious behavior (SIB), particularly among female adolescents, has been gaining widespread attention in mainstream culture. However, limited research has been generated examining effective treatment modalities. Given the lack of information concerning treatment models, this article presents a bi-modal treatment approach with a…

  2. Acceptability of Alternative Treatments for Deviant Child Behavior.

    ERIC Educational Resources Information Center

    Kazdin, Alan E.

    1980-01-01

    Cases of deviant child behavior were described to 88 undergraduate students along with four different treatments (reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock). Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from…

  3. Treatment Acceptability of Interventions Published in Six School Psychology Journals

    ERIC Educational Resources Information Center

    Villarreal, Victor; Ponce, Christopher; Gutierrez, Heveli

    2015-01-01

    Treatment acceptability (TA) is critical when selecting and implementing an intervention, as TA is associated with treatment outcomes. The significance of TA is reflected in school psychology models for services that state that school psychologists should address TA during development, implementation, and evaluation of interventions. However, the…

  4. Diagnostic methods and treatment modalities of dry eye conditions.

    PubMed

    Holly, F J

    1993-06-01

    One may view dry eye conditions as a group of diseases in which the ocular surface is adversely affected. Tear film instability invariably leads to some degree of cellular surface damage over the cornea and conjunctiva. In turn, ocular epitheliopathy may adversely affect tear film stability. The clinical presentation of the disease may not yield a clue as to its etiology. In recent years considerable progress was made both in the diagnosis and the treatment of the disease and promising studies are planned or are underway. The diagnostic techniques can be divided into four groups. The first is concerned with the clinical presentation. The second is concerned with the bulk properties of the aqueous tears including dynamic characteristics, composition, and colligative properties. The third is tear-film related and includes the film break-up time, evaporation rate, and lipid abnormality. The fourth is concerned with the ocular surface and includes vital staining, impression cytology, and surface microscopy. The most promising attempts are being made in the second group by attempting to elucidate the role of enzyme and enzyme activator activity and inhibitor contents as well as the tear protein profiles and correlating them with the specific disease states. The treatment modalities belong to three major groups aside from surgical intervention; the supplementation, preservation, and the stimulation of tears. The modern version of tear supplementation is expected to include the topical use of efficacious aqueous formulations that typically contain film stabilizing polymers, nutrients, and/or--in the future--biochemically active ingredients such as enzyme activators and inhibitors.

  5. Electrical modalities beyond pacing for the treatment of heart failure.

    PubMed

    Cornelussen, Richard N; Splett, Vincent; Klepfer, Ruth Nicholson; Stegemann, Berthold; Kornet, Lilian; Prinzen, Frits W

    2011-05-01

    In this review, we report on electrical modalities, which do not fit the definition of pacemaker, but increase cardiac performance either by direct application to the heart (e.g., post-extrasystolic potentiation or non-excitatory stimulation) or indirectly through activation of the nervous system (e.g., vagal or sympathetic activation). The physiological background of the possible mechanisms of these electrical modalities and their potential application to treat heart failure are discussed.

  6. Breast cancer and sexuality: multi-modal treatment options.

    PubMed

    Krychman, Michael L; Katz, Anne

    2012-01-01

    The sexual consequences of breast cancer and its treatments are well known and previously reviewed. Alterations in body image, with or without breast reconstruction, changes in sexual self-esteem and self-efficacy, vulvovaginal atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia and body image issues are common in survivors of breast cancer. Medications that are prescribed for long-term use including those in the class of aromatase inhibitors can have far-reaching implications on quality of life by contributing to vulvar and vaginal atrophic changes. While this is an important issue, there are few widely accepted treatments that have been evaluated for efficacy and safety for these sexual challenges in the breast cancer population. However, progress is being made in finding new and innovative solutions for many of the sexual problems faced by breast cancer survivors and their partners. Many institutions are now compelled to address survivorship concerns and addressing sexuality and intimacy are paramount issues in survivorship care. In this article, we present the evidence for the multimodal approach to the management of sexuality concerns in the breast cancer survivor. Pharmacologic, nonpharmacologic, and psychosocial interventions will be reviewed.

  7. Laser Phototherapy As Modality of Clinical Treatment in Bell's Palsy

    NASA Astrophysics Data System (ADS)

    Marques, A. M. C.; Soares, L. G. P.; Marques, R. C.; Pinheiro, A. L. B.; Dent, M.

    2011-08-01

    Bell's palsy is defined as a peripheral facial nerve palsy, idiophatic, and sudden onset and is considered the most common cause of this pathology. It is caused by damage to cranial nerves VII, resulting in complete or partial paralysis of the facial mimic. May be associated with taste disturbances, salivation, tearing and hyperacusis. It is diagnosed after ruling out all possible etiologies, because its cause is not fully understood.Some researches shows that herpes virus may cause this type of palsy due to reactivation of the virus or by imunnomediated post-viral nerve demielinization. Physical therapy, corticosteroids and antiviral therapy have become the most widely accepted treatments for Bell's palsy. Therapy with low-level laser (LLLT) may induce the metabolism of injured nerve tissue for the production of proteins associated with its growth and to improve nerve regeneration. The success of the treatment of Bell's palsy by using laser phototherapy isolated or in association with other therapeutic approach has been reported on the literature. In most cases, the recovery occurs without uneventfully (complications), the acute illness is not associated with serious disorders. We will present a clinical approach for treating this condition.

  8. [Role of urologists in the era of new treatment modalities for CRPC in Japan].

    PubMed

    Ozono, Seiichiro

    2014-07-01

    New medical treatment modalities for castration resistant prostate cancer(CRPC), including hormonal therapy and chemotherapy, will be approved in Japan. Here, we discuss the management of these new treatment strategies by urologists.

  9. Developing an Acceptability Assessment of Preventive Dental Treatments

    PubMed Central

    Hyde, Susan; Gansky, Stuart A.; Gonzalez-Vargas, Maria J.; Husting, Sheila R.; Cheng, Nancy F.; Millstein, Susan G.; Adams, Sally H.

    2012-01-01

    Objectives Early childhood caries (ECC) is very prevalent among young Hispanic children. ECC is amenable to a variety of preventive procedures, yet many Hispanic families underutilize dental services. Acceptability research may assist in health care planning and resource allocation by identifying patient preferences among efficacious treatments with the goal of improving their utilization. The purposes of this study were (a) to develop a culturally competent acceptability assessment instrument, directed toward the caregivers of young Hispanic children, for five preventive dental treatments for ECC and (b) to test the instrument's reliability and validity. Methods An instrument of five standard treatments known to prevent ECC was developed, translated, reviewed by focus groups, and pilot tested, then tested for reliability. The instrument included illustrated cards, brief video clips, and samples of the treatments and was culturally appropriate for low-income Hispanic caregivers. In addition to determining the acceptability of the five treatments individually, the treatments were also presented as paired comparisons. Results Focus groups and debriefing interviews following the pilot tests established that the instrument has good face validity. The illustrated cards, product samples, and video demonstrations of the five treatments resulted in an instrument possessing good content validity. The instrument has good to excellent test–retest reliability, with identical time 1–time 2 responses for each of the five treatments 92 percent of the time (range 87 to 97 percent), and the same treatment of the paired comparisons preferred 75 percent of the time (range 61 to 90 percent). Conclusions The acceptability instrument described is reliable and valid and may be useful in program planning efforts to identify and increase the utilization of preferred ECC preventive treatments for target populations. PMID:18662256

  10. A survey of treatment modalities used by mental health clinicians and activity therapists.

    PubMed

    Gibson, G L

    1975-07-01

    An art therapist conducted a survey of 150 mental health clinicians and activity therapists to find which of ten treatment modalities they preferred to use with ten types of psychiatric patients. The final sample consisted of 68 respondents: 34 clinicians, 17 activity therapists, and 17 art therapists. The three respondent groups agreed on the same optimum treatment modality for five patient groups. Art therapists felt art therapy was most effective in treating the youthful drug abuser, the child with educational problems, and the moderately depressed patient. Clinicians and activity therapists agreed on other treatment modalities for those patients.

  11. Effects of different treatment modalities on gait symmetry and clinical measures for sacroiliac joint patients.

    PubMed

    Herzog, W; Conway, P J; Willcox, B J

    1991-02-01

    The purpose of this study was to assess the effects of two different treatment modalities on the rehabilitation process of chronic sacroiliac joint patients. The treatment modalities included spinal manipulative therapy given by a chiropractor and a program of back school therapy given by a physiotherapist. The rehabilitation process was assessed using clinical and biomechanical measures. It was found that back school therapy was a better treatment modality than the spinal manipulative therapy, according to the clinical measures of rehabilitation. Precisely the opposite result was found for the biomechanical measures.

  12. Drug treatment program ownership, Medicaid acceptance, and service provision.

    PubMed

    McBride, Duane C; Chriqui, Jamie F; Terry-McElrath, Yvonne M; Mulatu, Mesfin S

    2012-03-01

    The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002-2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type.

  13. Risk Acceptance in Multiple Sclerosis Patients on Natalizumab Treatment

    PubMed Central

    Tur, Carmen; Tintoré, Mar; Vidal-Jordana, Ángela; Bichuetti, Denis; Nieto González, Pablo; Arévalo, María Jesús; Arrambide, Georgina; Anglada, Elisenda; Galán, Ingrid; Castilló, Joaquín; Nos, Carlos; Río, Jordi; Martín, María Isabel; Comabella, Manuel; Sastre-Garriga, Jaume; Montalban, Xavier

    2013-01-01

    Objective We aimed to investigate the ability of natalizumab (NTZ)-treated patients to assume treatment-associated risks and the factors involved in such risk acceptance. Methods From a total of 185 patients, 114 patients on NTZ as of July 2011 carried out a comprehensive survey. We obtained disease severity perception scores, personality traits’ scores, and risk-acceptance scores (RAS) so that higher RAS indicated higher risk acceptance. We recorded JC virus status (JCV+/-), prior immunosuppression, NTZ treatment duration, and clinical characteristics. NTZ patients were split into subgroups (A-E), depending on their individual PML risk. Some 22 MS patients on first-line drugs (DMD) acted as controls. Results No differences between treatment groups were observed in disease severity perception and personality traits. RAS were higher in NTZ than in DMD patients (p<0.01). Perception of the own disease as a more severe condition tended to predict higher RAS (p=0.07). Higher neuroticism scores predicted higher RAS in the NTZ group as a whole (p=0.04), and in high PML-risk subgroups (A-B) (p=0.02). In low PML-risk subgroups (C-E), higher RAS were associated with a JCV+ status (p=0.01). Neither disability scores nor pre-treatment relapse rate predicted RAS in either group. Conclusions Risk acceptance is a multifactorial phenomenon, which might be partly explained by an adaptive process, in light of the higher risk acceptance amongst NTZ-treated patients and, especially, amongst those who are JCV seropositive but still have low PML risk, but which seems also intimately related to personality traits. PMID:24340060

  14. The relationship between treatment modality, demographic characteristics, and staff perceptions concerning their jobs in 26 Philadelphia drug treatment centers.

    PubMed

    Bausell, R B; Rinkus, A; Watson, D D

    1979-01-01

    The staffs of 26 Philadelphia drug treatment centers, representing four major treatment modalities, were interviewed concerning their attitudes and perceptions of treatment and the treatment milieu. By employing canonical correlation, two basic modality contrasts were found that significantly differentiated these attitudes and perceptions: (1) staff in small therapeutic communities tended to manifest more positive attitudes than their counterparts in large methadone maintenance settings, and (2) outpatient drug-free staff tended to be more satisfied and optimistic than detoxification staff.

  15. Advances in Positive Airway Pressure Treatment Modalities for Hypoventilation Syndromes

    PubMed Central

    Combs, Dan; Shetty, Safal; Parthasarathy, Sairam

    2014-01-01

    SYNOPSIS Rationale Positive airway pressure therapy for hypoventilation syndromes can significantly improve health-related quality of life (HR-QOL), healthcare costs, and even mortality. The sleep-disordered breathing in such individuals are quite complex and require sophisticated devices with algorithms that are designed to accurately detect and effectively treat respiratory events that includes hypoventilation, upper airway obstruction, lower airway obstruction, central apneas and central hypopneas and reduce the work of breathing while maintaining breathing comfort. Objectives The therapeutic physiological rationale for the various advanced PAP modalities and the details about the principles of operation and technology implementation are provided here. Conclusions The physiological rationale for advanced PAP modalities is sound considering the complexity of sleep-disordered breathing in patients with hypoventilation syndromes. Although such devices are increasingly used in clinical practice, the supporting clinical evidence – specifically comparative-effectiveness studies in real-life conditions -- needs to be performed. Moreover, there is much opportunity for further refining these devices that include the ability of the device to reliably monitor gas-exchange, sleep-wakefulness state, and for reducing variability in device efficacy due to provider-selected device-settings. PMID:25346650

  16. Opinions about Treatment Modalities among Patients Involuntarily Committed to a Forensic Psychiatric Hospital in Finland

    ERIC Educational Resources Information Center

    Repo-Tiihonen, Eila; Vuorio, Osmo; Koivisto, Hanna; Paavola, Paula; Hakola, Panu

    2004-01-01

    Patient satisfaction studies concerning various treatment modalities are few among involuntary forensic psychiatric treatment. They indicate general satisfaction with medication, interactive treatment and occupational therapy but dissatisfaction with lack of privacy, insufficiently explained rules and inadequately explained reasons of seclusion.…

  17. [Multi-modal treatment of patients with multiple liver metastases caused by sigmoid cancer].

    PubMed

    Sawada, S; Nagata, K; Kato, T; Oshima, T; Yoshida, M; Kawa, S; Harima, K; Tanaka, Y; Nakamura, H

    1989-05-01

    A case of sigmoid cancer with multiple liver metastases (S2PON3 + H3) who was treated by multi-modal treatment was reported. The multi-modal treatment is including intra-arterial administration of anti-cancer drugs as a pre-surgery treatment, intra-arterial infusion chemotherapy lasting for three to five weeks (three times), hyperthermia treatment combined with intra-arterial administration of anti-cancer drugs and intra-arterial expandable metalic stent. The patients lived for 2 years and 4 months in good condition.

  18. The genetic basis of new treatment modalities in melanoma.

    PubMed

    Kunz, Manfred

    2015-01-01

    In recent years, intracellular signal transduction via RAS-RAF-MEK-ERK has been successfully targeted in new treatment approaches for melanoma using small molecule inhibitors against activated BRAF (V600E mutation) and activated MEK1/2. Also mutated c-KIT has been identified as a promising target. Meanwhile, evidence has been provided that combinations between BRAF inhibitors and MEK1/2 inhibitors are more promising than single-agent treatments. Moreover, new treatment algorithms favor sequential treatment using BRAF inhibitors and newly developed immunotherapies targeting common T lymphocyte antigen 4 (CTLA-4) or programmed cell death 1 (PD-1). In depth molecular analyses have uncovered new mechanisms of treatment resistance and recurrence, which may impact on future treatment decisions. Moreover, next-generation sequencing data have shown that recurrent lesions harbor specific genetic aberrations. At the same time, high throughput sequencing studies of melanoma unraveled a series of new treatment candidates for future treatment approaches such as ERBB4, GRIN2A, GRM3, and RAC1. More recent bioinformatic technologies provided genetic evidence for extensive tumor heterogeneity and tumor clonality of solid tumors, which might also be of relevance for melanoma. However, these technologies have not yet been applied to this tumor. In this review, an overview on the genetic basis of current treatment of melanoma, treatment resistance and recurrences including new treatment perspectives based on recent high-throughput sequencing data is provided. Moreover, future aspects of individualized treatment based on each patient's individual mutational landscape are discussed.

  19. Sportsman hernia; the review of current diagnosis and treatment modalities

    PubMed Central

    Paksoy, Melih; Sekmen, Ümit

    2016-01-01

    Groin pain is an important clinical entity that may affect a sportsman’s active sports life. Sportsman’s hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman’s hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman’s hernia at our hospital between 2011–2014, in light of current literature. PMID:27436937

  20. Sportsman hernia; the review of current diagnosis and treatment modalities.

    PubMed

    Paksoy, Melih; Sekmen, Ümit

    2016-01-01

    Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.

  1. The longevity of temporomandibular disorder improvements after active treatment modalities.

    PubMed

    Steed, Pamela A

    2004-04-01

    Of concern to practitioners and patients alike are the long-term results following temporomandibular disorder/craniofacial pain (TMD/CP) treatments. This paper examines 270 patients who underwent active TMD/CP treatment and had follow-up an average of 41 months after the termination of treatment when the patients had reached maximum medical improvement (MMI). Data show that, notwithstanding a mild degree of recrudescence, overall levels remain significantly lower than initial baseline symptoms, indicating a long-term benefit from active treatment. It could not be determined whether the recrudescent symptom levels were related to the conditions for which patients initially sought treatment or to new pathological states. Possible considerations for relapse may be the function of aging, musculoskeletal structural adaptation, resorting to parafunctional habits, and/or a change in psychosocial status. No significant differences were found between males and females regarding symptom levels and outcomes. Clinical experience suggests that TMD/CP symptoms do not resolve spontaneously and generally require active treatment. Unfortunately, most studies to date have largely measured symptom changes immediately (or very shortly) after the completion of treatment. This article, however, finds that the benefits of appropriate active TMD treatments remain long after treatment completion.

  2. Impact of different orthodontic treatment modalities on Airway: A literature review.

    PubMed

    Qahtani, Nasser D Al

    2016-01-01

    This review focused on airway dysfunctions and orthodontic treatment modalities. A systematic search of the dental literature was performed using PubMed and Web of Science library database. Different combinations of search terms related to airway and orthodontic treatment were used. Any Non-English articles were excluded. Among titles found, abstract and full articles were reviewed. References from all the relevant articles were hand-searched to include more articles. Forty articles which were found relevant were included in the review. Surgical, orthopedic and fixed appliance therapy has been advocated by clinicians to treat patients with airway dysfunctions. These treatment modalities differ from patient to patient and have to be considered based on lot of criterion. The reviewed studies were not convincing in providing information about the orthodontic treatment modalities; further research regarding the same could be encouraging.

  3. Impact of different orthodontic treatment modalities on Airway: A literature review

    PubMed Central

    Qahtani, Nasser D. Al

    2016-01-01

    This review focused on airway dysfunctions and orthodontic treatment modalities. A systematic search of the dental literature was performed using PubMed and Web of Science library database. Different combinations of search terms related to airway and orthodontic treatment were used. Any Non-English articles were excluded. Among titles found, abstract and full articles were reviewed. References from all the relevant articles were hand-searched to include more articles. Forty articles which were found relevant were included in the review. Surgical, orthopedic and fixed appliance therapy has been advocated by clinicians to treat patients with airway dysfunctions. These treatment modalities differ from patient to patient and have to be considered based on lot of criterion. The reviewed studies were not convincing in providing information about the orthodontic treatment modalities; further research regarding the same could be encouraging. PMID:27022385

  4. Intermediate hepatocellular carcinoma: How to choose the best treatment modality?

    PubMed

    Di Costanzo, Giovan Giuseppe; Tortora, Raffaella

    2015-05-28

    Intermediate stage, or stage B according to Barcelona Clinic Liver Cancer classification, of hepatocellular carcinoma (HCC) comprises a heterogeneous population with different tumor burden and liver function. This heterogeneity is confirmed by the large variability of treatment choice and disease-relate survival. The aim of this review was to highlight the existing evidences regarding this specific topic. In a multidisciplinary evaluation, patients with large (> 5 cm) solitary HCC should be firstly considered for liver resection (LR). When LR is unfeasible, locoregional treatments are evaluable therapeutic options, being transarterial chemoembolization (TACE), the most used procedure. Percutaneous ablation can be an evaluable treatment for large HCC. However, the efficacy of all ablative procedures decrease as tumor size increases over 3 cm. In clinical practice, a combination treatment strategy [TACE or transarterial radioembolization (TARE)-plus percutaneous ablation] is "a priori" preferred in a relevant percentage of these patients. On the other hands, sorafenib is the treatment of choice in patients who are unsuitable to surgery and/or with a contraindication to locoregional treatments. In multifocal HCC, TACE is the first-line treatment. The role of TARE is still undefined. Surgery may have also a role in the treatment of multifocal HCC in selected cases (patients with up to three nodules, multifocal HCC involving 2-3 adjacent liver segments). In some patients with bilobar disease the combination of LR and ablative treatment may be a valuable option. The choice of the best treatment in the patient with intermediate stage HCC should be "patient-tailored" and made by a multidisciplinary team.

  5. Intermediate hepatocellular carcinoma: How to choose the best treatment modality?

    PubMed Central

    Di Costanzo, Giovan Giuseppe; Tortora, Raffaella

    2015-01-01

    Intermediate stage, or stage B according to Barcelona Clinic Liver Cancer classification, of hepatocellular carcinoma (HCC) comprises a heterogeneous population with different tumor burden and liver function. This heterogeneity is confirmed by the large variability of treatment choice and disease-relate survival. The aim of this review was to highlight the existing evidences regarding this specific topic. In a multidisciplinary evaluation, patients with large (> 5 cm) solitary HCC should be firstly considered for liver resection (LR). When LR is unfeasible, locoregional treatments are evaluable therapeutic options, being transarterial chemoembolization (TACE), the most used procedure. Percutaneous ablation can be an evaluable treatment for large HCC. However, the efficacy of all ablative procedures decrease as tumor size increases over 3 cm. In clinical practice, a combination treatment strategy [TACE or transarterial radioembolization (TARE)-plus percutaneous ablation] is “a priori” preferred in a relevant percentage of these patients. On the other hands, sorafenib is the treatment of choice in patients who are unsuitable to surgery and/or with a contraindication to locoregional treatments. In multifocal HCC, TACE is the first-line treatment. The role of TARE is still undefined. Surgery may have also a role in the treatment of multifocal HCC in selected cases (patients with up to three nodules, multifocal HCC involving 2-3 adjacent liver segments). In some patients with bilobar disease the combination of LR and ablative treatment may be a valuable option. The choice of the best treatment in the patient with intermediate stage HCC should be “patient-tailored” and made by a multidisciplinary team. PMID:26019734

  6. Influences of Mood, Depression History, and Treatment Modality on Outcomes in Smoking Cessation.

    ERIC Educational Resources Information Center

    Haas, Amie L.; Munoz, Ricardo F.; Humfleet, Gary L.; Reus, Victor I.; Hall, Sharon M.

    2004-01-01

    The relationship between major depressive disorder (MDD), treatment modality, and mood was evaluated in smokers participating in cessation programs. Participants (N = 549, 53.7% women, 46.3% men, 28% endorsing past MDD episodes) were randomly assigned to a cognitive-behavioral treatment (CBT) or health education (HE) intervention. Participants…

  7. Nepalese patients’ perceptions of treatment modalities for type 2 diabetes

    PubMed Central

    Sapkota, Sujata; Brien, Jo-anne E; Aslani, Parisa

    2016-01-01

    Background Perceptions and beliefs about treatment can influence patients’ adherence to treatment regimens. Perceptions, in turn, are often shaped by patients’ sociocultural context. Nepal and the Nepalese have unique sociocultural traditions and beliefs, and their perceptions of diabetes treatment remain largely unexplored. This study explored Nepalese participants’ perceptions of diabetes treatment, and whether perceptions differed between the Nepalese living in Australia and Nepal. Methods Face-to-face qualitative interviews (n=48) were conducted with Nepalese participants with type 2 diabetes in Sydney and Kathmandu. All interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Results Perceptions of diabetes treatment were similar among Nepalese participants in Australia and Nepal. There was a general reluctance to start oral antidiabetic medications and an even greater reluctance to commence parenteral (insulin) therapy. Participants preferred to try lifestyle modifications and alternative treatments such as herbs and “traditional” medicines, particularly as a first step. Unwillingness to take medications was primarily associated with the belief that, once started, these medications needed to be taken for life, and perceptions of long-term harms caused by such medications. Even when commenced on medication, participants were averse to any type of therapy escalation, for example, moving to insulin therapy. Insulin was perceived as the “last option” available for diabetes treatment. Most participants, however, did not find medication taking challenging once they had commenced treatment. Conclusion Antidiabetic medications were perceived to be harmful and unstoppable once initiated. These perceptions significantly impacted participants’ willingness to commence antidiabetic medications and therefore have the potential to adversely affect their medication-taking behavior. This study therefore highlights the need to explore

  8. Iatrogenic possibilities of orthodontic treatment and modalities of prevention

    PubMed Central

    Meeran, Nazeer Ahmed

    2013-01-01

    The benefits of orthodontic treatment are numerous and in most cases, the benefits outweigh the possible disadvantages. Orthodontic treatment can play an important role in enhancing esthetics, function, and self-esteem in patients. However, it carries with it the risks of enamel demineralization, tissue damage, root resorption, open gingival embrasures in the form of triangular spaces, allergic reactions to nickel, and treatment failure in the form of relapse. These potential complications are easily avoidable by undertaking certain precautions and timely interventions by both the orthodontist and the patient. The orthodontist must ensure that the patient is aware of the associated risks and stress the importance of the patient's role in preventing these untoward outcomes. The decision whether to proceed with the orthodontic treatment is essentially a risk-benefit analysis, where the perceived benefits of commencing treatment outweigh the potential risks. This article provides an overview of the iatrogenic possibilities of orthodontic treatment and the role of the patient as well as the orthodontist in preventing the associated risks. PMID:24987646

  9. A combination of nonoperative treatment modalities used for treatment of keloids.

    PubMed

    Yan, Daojin; Zhao, Bocheng; Yang, Haiping; Zhu, Bin; Wang, Jing

    2014-01-01

    Keloid is one abnormal wound healing that occurs commonly in predisposed individuals. Many treatment modalities have been tried, either alone or in variety, including surgical removal, laser therapy, radiation therapy, silicone cream or gel application, cryosurgery, and intralesional injection of various agents. These treatment options have been practiced with largely transient and limited success. In the present study, the present authors prospectively assessed the efficacy of combination methods of the treatment of recalcitrant keloid. One hundred fifty-one sites of keloids in 122 patients were chosen, age of patients varied between 15 and 60 years, size of scar more than 2 cm(2) with pain, itch, or other discomfort, and duration of more than 2 years. Keloids were treated with combination methods of lasers and (32) P radiation on originating scars. One hundred eleven of 151 evaluated sites scored "excellence" and 40 belonged to "effectiveness". These patients demonstrated local control and have remained free of local recurrence for more than 2 years. In addition, there were only 21 and 32 sites with pigmentation and depigmentation, respectively. Over the past 5 years, we established a treatment protocol combining laser with (32) P-patch contact brachyradiotherapy, which represents a safe and effective option in the treatment of keloids.

  10. Retrospective analysis of treatment modalities in diabetic muscle infarction

    PubMed Central

    Onyenemezu, Ikenna; Capitle, Eugenio

    2014-01-01

    Background Diabetic muscle infarction (DMI) is a spontaneous necrosis of skeletal muscle of unknown etiology. The major risk factor is longstanding uncontrolled diabetes mellitus (DM). Optimal treatment for DMI is not known. The purpose of this study was to analyze the outcome of surgical treatment, physiotherapy, and bed rest in DMI. Methods We searched Medline from its inception to April 2013. We selected cases that provided sufficient data on recovery duration, recurrences, and non-recurrences. Baseline characteristics, including age, sex, microvascular complications, lesion size estimated on magnetic resonance imaging, type of diabetes, and duration of diabetes were assessed. The primary outcome was mean time to recovery from initial treatment and secondary outcomes were mean time to recurrence and recurrence rate. Results Mean time to recovery was 149 (95% confidence interval [CI] 113–186), 71 (95% CI 47–96), and 43 (95% CI 30–57) days for surgery, physiotherapy and bed rest, respectively. These figures were statistically significant only for surgery versus physiotherapy and surgery versus bed rest (P<0.01). Mean time to recurrence was 30, 107, and 297 days for surgery, physiotherapy, and bed rest, respectively. The recurrence rate was 57%, 44%, and 24% for surgery, physiotherapy, and bed rest, respectively. Conclusion Our results show a similar outcome for physiotherapy as compared with bed rest. It also confirms nonsurgical treatment as a better therapeutic option compared with surgical treatment. PMID:27790029

  11. Laparoscopic Adjustable Gastric Band (LAGB) Migration - Endoscopic Treatment Modalities.

    PubMed

    Klimczak, Tomasz; Szewczyk, Tomasz; Janczak, Przemysław; Jurałowicz, Piotr

    2016-12-01

    Laparoscopic adjustible gastric binding (LAGB) is one of most common surgical methods of treating obesity. Gastric band migration (erosion) is a typical LAGB complication, with a frequency of about 1-4%. The aim of the study was to present the possibilities of endoscopic diagnosis and treatment of this complication.

  12. Creative Art Therapy Groups: A Treatment Modality for Psychiatric Outpatients

    ERIC Educational Resources Information Center

    Drapeau, Marie-Celine; Kronish, Neomi

    2007-01-01

    This brief report examines the benefits of a creative art therapy group program for outpatients suffering from psychiatric disorders. Included is a review of relevant treatment outcomes literature on the effectiveness of group art therapy. The authors describe the Creative Art Therapy Group Program offered to adult psychiatric outpatients that is…

  13. Hemifacial hypertrophy: Exploring new avenues of treatment modalities

    PubMed Central

    Nandimath, Santosh Ashok; Rajkumar, G. C.; Nayak, Tulasi; Ashwin, D. P.; Rudresh, K. B.; Prashanth, R.

    2016-01-01

    Congenital hemihyperplasia is a rare developmental disorder characterized by unilateral overgrowth of one or more body parts resulting in marked asymmetry. We are reporting here, a case of true hemifacial hypertrophy in a young female adult highlighting the clinical features and possible treatment options. PMID:28163490

  14. Angiostatic Therapy: A New Treatment Modality for Prostate Cancer

    DTIC Science & Technology

    2001-07-01

    could be a new innovative treatment regimen for hormone-refractory prostate cancer. This was to be achieved with human prostate cancer tissue and...indices, low cell death and a highly invasive phenotype. Using this model we identified surgical castration, COX-2 inhibition and dendritic cell based immunotherapy as effective mono and combined therapies for prostate carcinoma.

  15. Disparities in Prostate Cancer Treatment Modality and Quality of Life

    DTIC Science & Technology

    2010-11-01

    producing hormones) 1 0 10 11 B8f. Watchful waiting (no treatment, wait and see if your prostate cancer grows) 1 0 10 11 B8g. Cryotherapy (process...your prostate cancer grows) 7 Cryotherapy (process to freeze and destroy prostate tissue) 8 Chemotherapy (use of anti-cancer drugs) 9 Any other

  16. Treatment of Barrett's esophagus: update on new endoscopic surgical modalities.

    PubMed

    Kristo, I; Asari, R; Rieder, E; Riegler, V; Schoppmann, S F

    2015-04-01

    Barrett's esophagus represents a premalignant condition, which is strongly associated with the incidence of esophageal adenocarcinoma. Currently, there are no validated markers to extract exactly that certain patient that will proceed to neoplastic progression. Therefore, therapeutic options have to include a larger population to provide prophylaxis for affected patients. Recently developed endoscopic therapeutic approaches offer treatment options for prevention or even treatment of limited esophageal adenocarcinoma. At present, high eradication rates of intestinal metaplasia as well as dysplasia are observed, whereas low complication rates offer a convenient safety profile. These striking new methods symbolize a changing paradigm in a field, where minimal-invasive tissue ablating methods and tissue preserving techniques have led to modified regimens. This review will focus on current standards and newly emerging methods to treat Barrett's esophagus and its progression to cancer and will highlight their evolution, potential benefits and their limitations.

  17. Complementary and Alternative Medicine Modalities for the Treatment of Irritable Bowel Syndrome: Facts or Myths?

    PubMed Central

    2010-01-01

    Due to unsatisfactory results from conventional treatment of irritable bowel syndrome (IBS), complementary and alternative medicine (CAM) modalities are increasingly popular treatment alternatives. Unfortunately, most CAM clinical trials have been of poor quality, and the efficacies of these therapies have not been adequately elucidated, even through systematic reviews or meta-analyses. There is also a general lack of understanding of their mechanisms of action. Currently, insufficient evidence exists to support the use of traditional Chinese medicine, acupuncture, meditation, and reflexology for treatment of IBS. However, there is some evidence supporting the use of peppermint oil and gut-directed hypnotherapy for IBS treatment. Due to mounting evidence of the microbiologic and immunologic basis of IBS, probiotics and exclusion diets are also becoming promising treatment modalities. This paper will review the current literature on various CAM practices for IBS treatment and appraise their advantages and disadvantages in clinical practice. PMID:21437019

  18. Acupuncture as a treatment modality for back problems.

    PubMed

    Ridgway, K

    1999-04-01

    Concepts of acupuncture in traditional Chinese medicine are presented for clarity and contrast to Western medical concepts. Various acupuncture techniques and methods are discussed including dry needling, electroacupuncture, acupuncture using hypodermic needles, and injecting various solutions into the acupuncture sites. Potential complications and precautions are also presented. A type of chronic back pain is discussed that is possibly associated with a radiculopathically induced, hypersensitivity myofascial syndrome that presents as a fibromyalgia-like syndrome. Effective acupuncture treatment for the described chronic fibromyalgia-like syndrome is discussed.

  19. Treatment of early uterine sarcomas: disentangling adjuvant modalities

    PubMed Central

    Zagouri, Flora; Dimopoulos, Athanasios-Meletios; Fotiou, Stelios; Kouloulias, Vassilios; Papadimitriou, Christos A

    2009-01-01

    Uterine sarcomas are a rare group of neoplasms with aggressive clinical course and poor prognosis. They are classified into four main histological subtypes in order of decreasing incidence: carcinosarcomas, leiomyosarcomas, endometrial stromal sarcomas and "other" sarcomas. The pathological subtype demands a tailored approach. Surgical resection is regarded as the mainstay of treatment. Total abdominal hysterectomy and bilateral salpingo-oophorectomy represents the standard treatment of uterine sarcomas. Pelvic and para-aortic lymph node dissection in carcinosarcomas is recommended, given their high incidence of lymph node metastases, and may have a role in endometrial stromal sarcomas. Adjuvant radiation therapy has historically been of little survival value, but it appears to improve local control and may delay recurrence. Regarding adjuvant chemotherapy, there is little evidence in the literature supporting its use except for carcinosarcomas. However, more trials are needed to address these issues, especially, their sequential application. Patients with uterine sarcomas should be referred to large academic centers for participation in clinical trials. PMID:19356236

  20. Camptocormia in Parkinson's disease: definition, epidemiology, pathogenesis and treatment modalities.

    PubMed

    Srivanitchapoom, Prachaya; Hallett, Mark

    2016-01-01

    Camptocormia is an axial postural deformity characterised by abnormal thoracolumbar spinal flexion. The symptom usually presents while standing, walking or exercising and is alleviated while sitting, lying in a recumbent position, standing against a wall or using walking support. There is no consensus on the degree of thoracolumbar flexion to define camptocormia. However, most authors usually use an arbitrary number of at least 45° flexion of the thoracolumbar spine when the individual is standing or walking. Aetiologies of camptocormia are heterogeneous, and Parkinson's disease (PD) is one of its many causes. The prevalence of camptocormia in PD ranges from 3% to 18%. Central and peripheral mechanisms might both contribute to its pathogenesis. Although there is no established consensus for treatment of camptocormia in PD, there are non-pharmacological, pharmacological and surgical approaches that can be used.

  1. Esophageal adenocarcinoma: treatment modalities in the era of targeted therapy.

    PubMed

    Mukherjee, Kaushik; Chakravarthy, A Bapsi; Goff, Laura W; El-Rifai, Wael

    2010-12-01

    Esophageal adenocarcinoma is an aggressive malignancy with a poor outcome, and its incidence continues to rise at an alarming rate. Current treatment strategies combining chemotherapy, radiation, and surgery are plagued with high rates of recurrence and metastasis. Multiple molecular pathways including the epidermal growth factor receptor, vascular endothelial growth factor, v-erb-b2 erythroblastic leukemia viral oncogene homolog (ERBB2), and Aurora kinase pathways are activated in many esophageal adenocarcinomas. In many cases, these pathways have critical roles in tumor progression. Research on the mechanisms by which these pathways contribute to disease progression has resulted in numerous biologic agents and small molecules with the potential to improve outcome. The promise of targeted therapy and personalized medicine in improving the clinical outcome is now closer than it has ever been.

  2. ESOPHAGEAL ADENOCARCINOMA: TREATMENT MODALITIES IN THE ERA OF TARGETED THERAPY

    PubMed Central

    Mukherjee, Kaushik; Chakravarthy, A. Bapsi; Goff, Laura W.; El-Rifai, Wael

    2010-01-01

    Esophageal adenocarcinoma is an aggressive malignancy with a poor outcome, and its incidence continues to rise at alarming rates. Current treatment strategies combining chemotherapy, radiation, and surgery are plagued with high rates of recurrence and metastasis. Multiple molecular pathways including the epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), v-erb-b2 erythroblastic leukemia viral oncogene homolog (ERBB2), and Aurora kinases’ (AURK) pathways are activated in many esophageal adenocarcinomas. In many cases, these pathways have critical roles in tumor progression. Research on the mechanisms by which these pathways contribute to disease progression has resulted in numerous biologic agents and small molecules with the potential to improve outcome. The promise of targeted therapy and personalized medicine in improving the clinical outcome is now closer than it has ever been. PMID:20300841

  3. Management of spastic cerebral palsy through multiple Ayurveda treatment modalities

    PubMed Central

    Bhinde, Sagar M.; Patel, Kalpana S.; Kori, Virendra Kumar; Rajagopala, S.

    2014-01-01

    Background: Cerebral palsy (CP) is a leading cause of childhood disability affecting function and development. The global incidence of CP is 2:1000. It has been reported that children with CP and their caretaker have impaired health-related quality of life (QOL). Of the many types and subtypes of CP, none has any known cure. For a detailed description of the disease CP, though, there is no one to one correlation in Ayurvedic classics; it can be taken as Vata Vyadhi as far as its etiology and symptomatology are concerned. Aim: To assess the effect of certain Panchakarma procedures in the management of CP. Materials and Methods: Total 8 patients were registered and treated with 5 days of Udvartana, 5 days of Abhyanga followed by Sarvanga Swedana and then 8 days of Yoga Basti. The same course of treatment has been repeated for 3 times with an interval of 14 days. Ashtanga Ghrita was given during whole procedures as internal medication. Results of treatment were assessed with anthropometrical measurement, developmental milestone, Modified Ashworth Scale, spasm scale, reflex scale, and muscle power grading. Result: This Ayurvedic management shows good result in CP patients, especially by improving growth (height, weight, chest circumference) and development (head holding and sitting), reducing spasticity of left upper limb and muscle spasm. Conclusion: Multisystem approach is needed to improve the condition of the patient. Panchakarma along with internal medication should be given to improve all the facets of spastic CP. Yoga Basti acts by their own mode of action and can be used freely for such disease conditions. PMID:26195914

  4. Development of Advanced Multi-Modality Radiation Treatment Planning Software

    SciTech Connect

    Nigg, D W; Hartmann Siantar, C

    2002-02-19

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software product system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. SERA is at a mature level in its life cycle, it has been licensed for research use worldwide, and it has become well established as a computational tool for research. However, along with its strengths, SERA also has some limitations in its structure and computational methodologies. More specifically, it is optimized only for neutron-based applications. Although photon transport can be computed with SERA, the simplified model that is used is designed primarily for photons produced in the neutron transport process. Thus SERA is not appropriate for applications to, for example, standard external-beam photon radiotherapy, which is by far more commonly used in the clinic than neutron based therapy.

  5. Further identification and treatment modalities in telephone mediated lightning strike

    NASA Technical Reports Server (NTRS)

    Andrews, Christopher J.; Darveniza, Mat

    1991-01-01

    The results are presented of a prospective survey of people injured by lightning impulses transmitted by the public telephone system. The results are compared with those of a previous retrospective survey. Various deficiencies in the methodology of the latter survey are addressed. A division into a population with severe injury and a population with mild injury is made based on medical history and examination taken immediately after a strike. The best predictors of severe injury were found to be the presence of symptoms beyond one week after the strike, and also the initial presence of musculoskeletal injuries. Psychological upset is also seen to be a significant factor in severe injury. The only physical parameter of strike which could be used as a predictor of severe injury was the presence of concomitant power system damage. The importance of earth bonding between power and telephone system is thus supported in a protection strategy. One author draws on experience in treating patients with these injuries to propose a treatment regimen for those with ongoing symptoms. The importance of evaluating and treating psychological and physical aspects is stressed.

  6. Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures.

    PubMed

    Loh, Sook Y; Mcleod, Robert W J; Elhassan, Hassan A

    2017-03-25

    The aim of this review was to compare systematically the subjective measure of trismus between different interventions to treat head and neck cancer, particularly those of the oropharynx. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Guidelines, Six databases were searched for the text using various terms which include "oropharyngeal/head and neck cancer", "trismus/mouth opening" and the various treatment modalities. Included in the review were clinical studies (> or =10 patients). Three observers independently assessed the papers identified. Among the six studies reviewed, five showed a significantly worst outcome with regard to the quality-of-life questionnaire scores for a radiotherapy or surgery and radiotherapy (RT) ± chemotherapy or chemoradiotherapy when compared to surgery alone. Only one study showed no significant difference between surgery alone and other treatment modalities. Subjective quality-of-life measures are a concurrent part of modern surgical practice. Although subjective measures were utilised to measure post operative trismus successfully, there was no consensus as to which treatment modality had overall better outcomes, with conflicting studies in keeping with the current debate in this field. Larger and higher quality studies are needed to compare all three treatment modalities.

  7. A review of treatment modalities for Middle East Respiratory Syndrome.

    PubMed

    Mo, Yin; Fisher, Dale

    2016-12-01

    The Middle East Respiratory Syndrome coronavirus (MERS-CoV) has been a focus of international attention since its identification in 2012. Epidemiologically it is characterized by sporadic community cases, which are amplified by hospital-based outbreaks. Healthcare facilities in 27 countries from most continents have experienced imported cases, with the most significant outbreak involving 186 cases in Korea. The mortality internationally is 36% and guidance for clinical management has yet to be developed. Most facilities and healthcare providers outside of the Middle East receiving patients have no or little experience in the clinical management of MERS. When a case does occur there is likely little time for a critical appraisal of the literature and putative pharmacological options. We identified published literature on the management of both MERS-CoV and the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) through searches of PubMed and WHO and the US CDC websites up to 30 April 2016. A total of 101 publications were retrieved for critical appraisal. Most published literature on therapeutics for MERS are in vitro experiments, animal studies and case reports. Current treatment options for MERS can be categorized as: immunotherapy with virus-specific antibodies in convalescent plasma; polyclonal and monoclonal antibodies produced in vitro or in genetically modified animals; and antiviral agents. The use of any therapeutics in MERS-CoV remains investigational. The therapeutic agents with potential benefits and warranting further investigation include convalescent plasma, interferon-β/ribavirin combination therapy and lopinavir. Corticosteroids, ribavirin monotherapy and mycophenolic acid likely have toxicities that exceed potential benefits.

  8. Comparative effectiveness of imaging modalities to determine metastatic breast cancer treatment response.

    PubMed

    Lee, Christoph I; Gold, Laura S; Nelson, Heidi D; Chou, Roger; Ramsey, Scott D; Sullivan, Sean D

    2015-02-01

    We performed a systematic review to address the comparative effectiveness of different imaging modalities in evaluating treatment response among metastatic breast cancer patients. We searched seven multidisciplinary electronic databases for relevant publications (January 2003-December 2013) and performed dual abstraction of details and results for all clinical studies that involved stage IV breast cancer patients and evaluated imaging for detecting treatment response. Among 159 citations reviewed, 17 single-institution, non-randomized, observational studies met our inclusion criteria. Several studies demonstrate that changes in PET/CT standard uptake values are associated with changes in tumor volume as determined by bone scan, MRI, and/or CT. However, no studies evaluated comparative test performance between modalities or determined relationships between imaging findings and subsequent clinical decisions. Evidence for imaging's effectiveness in determining treatment response among metastatic breast cancer patients is limited. More rigorous research is needed to address imaging's value in this patient population.

  9. The Acceptability of Treatments for Depression to a Community Sample of Adolescent Girls

    ERIC Educational Resources Information Center

    Caporino, Nicole E.; Karver, Marc S.

    2012-01-01

    An efficacious treatment is diminished in value if consumers do not seek it out and adhere to it, making treatment acceptability an important predictor of the effectiveness of treatment. This study examined the acceptability of treatments for depression to 67 female high school students. All participants read a vignette describing a depressed…

  10. Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities.

    PubMed

    McClure, Erin A; Acquavita, Shauna P; Dunn, Kelly E; Stoller, Kenneth B; Stitzer, Maxine L

    2014-02-01

    The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) versus non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics.

  11. Tumor treating fields: a novel treatment modality and its use in brain tumors

    PubMed Central

    Pacheco, Patricia

    2016-01-01

    Tumor treating fields (TTFields) are low-intensity electric fields alternating at an intermediate frequency (200kHz), which have been demonstrated to block cell division and interfere with organelle assembly. This novel treatment modality has shown promise in a variety of tumor types. It has been evaluated in randomized phase 3 trials in glioblastoma (GBM) and demonstrated to prolong progression-free survival (PFS) and overall survival (OS) when administered together with standard maintenance temozolomide (TMZ) chemotherapy in patients with newly diagnosed GBM. TTFields are continuously delivered by 4 transducer arrays consisting each of 9 insulated electrodes that are placed on the patient’s shaved scalp and connected to a portable device. Here we summarize the preclinical data and mechanism of action, the available clinical data, and further outlook of this treatment modality in brain tumors and other cancer indications. PMID:27664860

  12. A bibliographical survey of bruxism with special emphasis on non-traditional treatment modalities.

    PubMed

    Nissani, M

    2001-06-01

    After proposing a common-sense definition of bruxism, this partial review distills its various symptoms and consequences from the literature. That literature suggests that the splint-the most popular treatment modality-falls short in some respects. The research literature is even less sanguine about the efficacy of such other traditional therapies as sound alarms and stress reduction. Given the limited success of traditional approaches, and given, moreover, the high incidence of bruxism and its harmful consequences, clinicians may occasionally be interested in experimenting with non-intrusive, safe, less widely known, treatment modalities. To meet this need, this review-unlike all other reviews of the subject-focuses on such comparatively unpopular or recent approaches.

  13. Solid tumor models for the assessment of different treatment modalities. XXII. The alternate utilization of radiotherapy and chemotherapy

    SciTech Connect

    Looney, W.B.; Hopkins, H.A.; Carter, W.H. Jr.

    1984-08-01

    Major increases in the time between administration of two modalities, radiation and cyclophosphamide (CP), from 1 to 7 days and in the overall time of delivery of 3 courses of combined therapy from 24 to 35 days were carried out in rats with hepatoma 3924A without major loss of therapeutic effectiveness. Cure rates of 50% or greater could be maintained even though treatment was given over much longer time periods. The radiation was given as hyperfractionated, split-course schedules which were devised by increasing the number of 250 rad fractions over a 2-day period. Increasing the total radiation dose from 6000 to 7500 rad in the series given CP 1 day after each of three courses of radiation results in an increase in total tumor cure rates from 50% to 60%. The tumor cure rate in the series given CP 7 days after radiation increased from 10% to 70% when the total radiation dose was increased from 6000 to 7500 rad. Increasing the total radiation dose from 6000 to 7500 rad increased the magnitude of the acute skin reaction as well as the duration of recovery. However, the skin reactions for both the 6000 and 7500 rad were acceptable. Host toxicity and normal tissue reaction were within acceptable limits for both modalities. The results of these studies, therefore, indicate that excessive toxicity, one of the major deterrents to the effective combined utilization of these two primary means of cancer management, may be avoided by temporal separation of delivery while maintaining tumor cure rates of 50% or greater.

  14. Acceptability of alternative treatments for school refusal: evaluations by students, caregivers, and professionals.

    PubMed

    Gullone, E; King, N J

    1991-11-01

    School refusal is a debilitating condition that may be treated in various ways. This study examined the acceptability and perceived effectiveness of alternative treatments for school refusal. A total of 376 people comprising students, parents, and professionals, were required to evaluate several treatment options in relation to a vignette. Despite its potential aversiveness, behavioural management was the most acceptable treatment approach followed, in order, by home tuition with psychotherapy, hospitalisation, and medication. A strong positive relationship was found between acceptability and perceived effectiveness.

  15. Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol

    ERIC Educational Resources Information Center

    Eifert, Georg H.; Forsyth, John P.; Arch, Joanna; Espejo, Emmanuel; Keller, Melody; Langer, David

    2009-01-01

    Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to…

  16. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome.

    PubMed

    Kaya, Erkan; Zinnuroglu, Murat; Tugcu, Ilknur

    2011-02-01

    The purpose of this study was to determine and compare the efficacy of kinesio tape and physical therapy modalities in patients with shoulder impingement syndrome. Patients (n = 55) were treated with kinesio tape (n = 30) three times by intervals of 3 days or a daily program of local modalities (n = 25) for 2 weeks. Response to treatment was evaluated with the Disability of Arm, Shoulder, and Hand scale. Patients were questioned for the night pain, daily pain, and pain with motion. Outcome measures except for the Disability of Arm, Shoulder, and Hand scale were assessed at baseline, first, and second weeks of the treatment. Disability of Arm, Shoulder, and Hand scale was evaluated only before and after the treatment. Disability of Arm, Shoulder, and Hand scale and visual analog scale scores decreased significantly in both treatment groups as compared with the baseline levels. The rest, night, and movement median pain scores of the kinesio taping (20, 40, and 50, respectively) group were statistically significantly lower (p values were 0.001, 0.01, and 0.001, respectively) at the first week examination as compared with the physical therapy group (50, 70, and 70, respectively). However, there was no significant difference in the same parameters between two groups at the second week (0.109, 0.07, and 0.218 for rest, night, and movement median pain scores, respectively). Disability of Arm, Shoulder, and Hand scale scores of the kinesio taping group were significantly lower at the second week as compared with the physical therapy group. No side effects were observed. Kinesio tape has been found to be more effective than the local modalities at the first week and was similarly effective at the second week of the treatment. Kinesio taping may be an alternative treatment option in the treatment of shoulder impingement syndrome especially when an immediate effect is needed.

  17. Light and laser treatment modalities for disseminated superficial actinic porokeratosis: a systematic review.

    PubMed

    Aird, Gregory A; Sitenga, Jenna L; Nguyen, Austin Huy; Vaudreuil, Adam; Huerter, Christopher J

    2017-02-27

    Treatment of disseminated superficial actinic porokeratosis (DSAP) is poorly standardized. The present review seeks to comprehensively discuss the potential for laser and light modalities in the treatment of DSAP. A systematic review of light and laser treatment modalities was conducted to include 26 cases of patients with DSAP. Systematic review resulted in 14 articles to be included. Photodynamic therapy (PDT) overall was the least successful treatment modality, with clinical improvement seen in a minority of patients (MAL-PDT: N = 9 patients, 33.3% showed improvement; ALA-PDT: N = 3 patients, 0% improvement; hypericin-PDT: N = 2 patients, 0% improvement) after numerous post-procedural side effects of hyperpigmentation, inflammation, erythema, and discomfort. Overall, in the available reports, PDT demonstrates poor outcomes with greater incidence of side effects. The response rates of DSAP lesions treated with lasers were as follows: (Q-switched ruby lasers: N = 2, 100%; CO2 laser: N = 1, 100%; PDT and CO2 combination therapy: N = 2, 0-50%; erbium and neodymium YAG lasers: N = 2, 100%; fractional 1927-nm thulium fiber lasers: N = 2, 100%; Grenz rays: N = 1, 100%; and fractional photothermolysis: N = 2, 100%). The side effects of laser therapy were minimal and included mild erythema, slight hyperpigmentation, and moderate edema. Laser therapy is a promising treatment option for DSAP with an excellent side effect profile. However, higher power studies are required to determine optimal guidelines for laser treatment of DSAP.

  18. Solitary Plasmacytoma of the Cecum and the Ascending Colon: Surgical Resection as a Treatment Modality

    PubMed Central

    Dalgic, Tahsin; Bostanci, Erdal Birol; Cakir, Tebessum; Ozer, Ilter; Ulas, Murat; Aydog, Gulden; Akoglu, Musa

    2015-01-01

    Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases. PMID:25954564

  19. Nonoperative therapies for combined modality treatment of hepatocellular cancer: expert consensus statement.

    PubMed

    Schwarz, Roderich E; Abou-Alfa, Ghassan K; Geschwind, Jeffrey F; Krishnan, Sunil; Salem, Riad; Venook, Alan P

    2010-06-01

    Although surgical resection and liver transplantation are the only treatment modalities that enable prolonged survival in patients with hepatocellular carcinoma (HCC), the majority of HCC patients presents with advanced disease and do not undergo resective or ablative therapy. Transarterial chemoembolization (TACE) is indicated in intermediate/advanced stage unresectable HCC even in the setting of portal vein involvement (excluding main portal vein). Sorafenib has been shown to improve survival of patients with advanced HCC in two controlled randomized trials. Yttrium 90 is a safe microembolization treatment that can be used as an alternative to TACE in patients with advanced liver only disease or in case of portal vein thrombosis. External beam radiation can be helpful to provide local control in selected unresectable HCC. These different treatment modalities may be combined in the treatment strategy of HCC and also used as a bridge to resection or liver transplantation. Patients should undergo formal multidisciplinary evaluation prior to initiating any such treatment in order to individualize the best available options.

  20. Therapeutic outcomes of mandibular advancement devices as an initial treatment modality for obstructive sleep apnea

    PubMed Central

    Park, Pona; Jeon, Hyoung Won; Han, Doo Hee; Won, Tae-Bin; Kim, Dong-Young; Rhee, Chae-Seo; Kim, Hyun Jik

    2016-01-01

    Abstract Although continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA), there is a need for alternative treatment options, such as sleep surgeries and mandibular advancement devices (MADs), to overcome the limitations of CPAP. This study aimed to analyze the therapeutic outcomes of OSA subjects who were treated with a MAD, and to estimate the clinical impact of MAD as a first-line treatment for OSA. Forty-seven patients diagnosed with OSA received an adjustable MAD as an initial treatment. Drug-induced sleep endoscopic findings and sleep parameters (both pre-MAD and post-MAD treatment), such as apnea index, oxygen saturation, and degree of daytime sleepiness, were assessed retrospectively. The MAD treatment resulted in a significant reduction in apnea–hypopnea index, and also a significant elevation in lowest oxygen saturation. Satisfactory results of MAD treatment as a first treatment modality were observed in 27 patients, and a successful outcome was reached in approximately 72% of patients. The OSA patients who had lower body mass index and upper airway narrowing at the level of palate and tongue base showed relatively higher rates of a satisfactory outcome even in cases of moderate or severe OSA. These results suggest that the use of a MAD may be an alternative treatment option in OSA patients with retropalatal and retroglossal area narrowing regardless of disease severity. Additionally, MADs can be recommended as an initial treatment modality, and the effectiveness of MADs in achieving success may not be inferior to CPAP. PMID:27861349

  1. Acceptability of Treatment for a Student Sleeping in the College Classroom

    ERIC Educational Resources Information Center

    Carter, Stacy L.; Punyanunt-Carter, Narissra Maria

    2006-01-01

    This study focused on various treatments for addressing the classroom misbehavior of sleeping during class. The findings revealed that students found some methods of addressing this problem behavior by the instructor more acceptable than other methods of treating the behavior. College students rated the most acceptable instructor treatment for…

  2. Efficacy of ozone and other treatment modalities for retained placenta in dairy cows.

    PubMed

    Zobel, R; Tkalčić, S

    2013-02-01

    Retained placenta is a worldwide recognized clinical condition in puerperal cows, which can significantly affect their health and fertility. Available treatment modalities are often of questionable efficacy or associated with time constraints, practicality or monetary considerations for their wide application in a routine dairy practice. The objective of this study was to compare and assess the efficacy of different treatment options, including a novel ozone treatment, for the retained placenta. Two hundred cows diagnosed with retained placenta were divided into five treatment groups, each receiving a different treatment option. Group A (n = 40) was given a combination treatment of intrauterine ozone and parenteral cephalexin; group B (n = 40) was given intrauterine ozone; group C (n = 40) was given a combination of parenteral cephalexin and intrauterine antibiotic tablets; group D (n = 40) was given only parenteral cephalexin and group E (n = 40) was given parenteral prostaglandins in 11-day intervals. The control group (group Z, n = 200) included cows that gave birth without assistance and were not diagnosed with a retained placenta. The ozone treatment (groups A and B) was found to be the most effective modality resulting in the shortest period of days open, the smallest number of artificial inseminations until pregnancy, the smallest number of animals diagnosed with fever within 10 days post-calving, the highest percentage of animals pregnant within 200 days after calving and the smallest number of animals culled because of infertility, when compared to the other treatment groups. The intrauterine ozone flush therefore has a potential as an efficacious and cost-effective treatment option for retained placenta, with an overall positive effect on puerperal health and fertility in cows.

  3. Non-pharmacological treatment options for refractory epilepsy: an overview of human treatment modalities and their potential utility in dogs.

    PubMed

    Martlé, Valentine; Van Ham, Luc; Raedt, Robrecht; Vonck, Kristl; Boon, Paul; Bhatti, Sofie

    2014-03-01

    Refractory epilepsy is a common disorder both in humans and dogs and treatment protocols are difficult to optimise. In humans, different non-pharmacological treatment modalities currently available include surgery, the ketogenic diet and neurostimulation. Surgery leads to freedom from seizures in 50-75% of patients, but requires strict patient selection. The ketogenic diet is indicated in severe childhood epilepsies, but efficacy is limited and long-term compliance can be problematic. In the past decade, various types of neurostimulation have emerged as promising treatment modalities for humans with refractory epilepsy. Currently, none of these treatment options are used in routine daily clinical practice to treat dogs with the condition. Since many dogs with poorly controlled seizures do not survive, the search for alternative treatment options for canine refractory epilepsy should be prioritised. This review provides an overview of non-pharmacological treatment options for human refractory epilepsy. The current knowledge and limitations of these treatments in canine refractory epilepsy is also discussed.

  4. Clinical characteristics and comparative study of different modalities of treatment of pseudocyst pinna.

    PubMed

    Patigaroo, Suhail Amin; Mehfooz, Nazia; Patigaroo, Fozia Amin; Kirmani, Masood H; Waheed, Arafat; Bhat, Shakura

    2012-07-01

    The aims of the article were to study the clinical characteristic of patients with pseudocysts and to compare different common modalities of treatment and introduce the concept of observation in pseudocyst management. Twenty-eight patients were diagnosed with pseudocyst of the auricle between June 2009 and June 2011 in a medical college hospital. The patients were divided into four groups each of seven patients on the basis of primary treatment offered. Four primary treatments offered were simple aspiration, aspiration with intralesional steroid, incision and drainage with removal of anterior cartilage leaflet with buttoning, and lastly, simple observation and reassurance. All 28 patients were male with involvement of right side more than left and no one had bilateral involvement. Adults in the age group of 30-40 were commonly affected. Most of the patients had history of significant trauma by security forces. Most common site of involvement was scaphoid and triangular fossa. The best form of treatment with minimum recurrence was incision and drainage with removal of anterior cartilage leaflet with buttoning. Simple observation as a treatment option was found to be as good as intralesional steroids. Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. It is a rare condition and is hardly encountered in routine ENT practice. Bilateral diseases are uncommon. Most common site of occurrence is triangular and scaphoid fossa. Many modalities of treatment have been recommended in literature with varied recurrence and failure rates. The best treatment is surgical deroofing followed by buttoning with minimum recurrences. An option of simple observation for 2-3 months should be discussed with each patient and was found to be as good as intralesional steroids.

  5. Development of Advanced Multi-Modality Radiation Treatment Planning Software for Neutron Radiotherapy and Beyond

    SciTech Connect

    Nigg, D; Wessol, D; Wemple, C; Harkin, G; Hartmann-Siantar, C

    2002-08-20

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. As a logical next step in the development of modern radiotherapy planning tools to support the most advanced research, INEEL and Lawrence Livermore National Laboratory (LLNL), the developers of the PEREGRTNE computational engine for radiotherapy treatment planning applications, have recently launched a new project to collaborate in the development of a ''next-generation'' multi-modality treatment planning software system that will be useful for all modern forms of radiotherapy.

  6. Reduction of diabetic foot ulcer healing times through use of advanced treatment modalities.

    PubMed

    Mulder, Gerit; Tenenhaus, Mayer; D'Souza, Gehaan F

    2014-12-01

    Diabetic wounds are a major health care problem associated with delayed healing and high amputation rates. This review systematically evaluated newer wound care therapies for the treatment of diabetic wounds. More recent means of approaching diabetic foot ulcers include various dressings, off-loading shoes, and bioengineered skin constructs and growth factors. Electrical stimulation, phototherapy, electromagnetic fields, and shockwave therapy have been further proposed as potential treatments. A brief overview of these treatments is presented using peer-reviewed evidenced-based literature. A review of the literature demonstrated that treatment of diabetic wounds has focused on either prevention of the wounds in the form of off-loading shoes or adequate protective dressings or on direct treatment of wounds with bioengineered skin constructs, growth factors, or medical devices that accelerate wound healing. The authors' conclusion, following extensive literature review, is that although excellent national and international guidelines exist regarding suggested approaches to the treatment of the diabetic foot ulcer, there is no definitive or universal consensus on the choice of specific treatment modalities. The importance of optimizing comorbidities and the disease state, hemodynamics, local and peripheral skin and wound care, and metabolic challenges while reducing biological and bacterial burden and minimizing trauma remain the primary approach, followed by choice of the most appropriate treatment material or product.

  7. Radiotherapy as an effective treatment modality for follicular lymphoma: a single institution experience

    PubMed Central

    Choi, Seo Hee; Cho, Jaeho; Kim, Jin Seok; Cheong, June-Won

    2015-01-01

    Purpose Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma that is highly sensitive to radiotherapy (RT). However, the effectiveness of RT has not been well established. We reviewed our experiences to assess the role of RT for FL and analyze treatment results. Materials and Methods Retrospective analysis was done on 29 patients who received first RT between January 2003 and August 2013. Of 23 early stage (stage I, II) patients, 16 received RT alone, four received chemotherapy followed by RT, two received RT postoperatively, and one received salvage RT for relapse after resection. Six advanced-stage (stage III, IV) patients received RT after chemotherapy: two received consolidation RT, three received salvage RT for residual lesions, and one received RT for progressive sites. Median RT dose was 30.6 Gy (range, 21.6 to 48.6 Gy). Median follow-up duration was 62 months (range, 6 to 141 months). Results All patients showed complete response in the radiation field. Eight outfield relapses were reported. Seven patients received salvage treatment (three chemotherapy, four RT). Four patients showed excellent responses, especially to RT. Estimated 5-year and 10-year relapse-free survivals were 72% and 60%. In the RT-alone group, 5-year relapse-free survival was 74.5%. All advanced-stage patients were disease-free with 100% 5-year overall survival. Disease-specific death was noted in only one patient; four others died of other unrelated causes. No significant toxicity was reported. Conclusion RT resulted in excellent treatment outcomes for all FL stages when used as a primary treatment modality for early stage or salvage-treatment modality for advanced-stage disease. PMID:26756031

  8. Mortality assessment of patients with hepatocellular carcinoma according to underlying disease and treatment modalities

    PubMed Central

    Golabi, Pegah; Fazel, Sofie; Otgonsuren, Munkhzul; Sayiner, Mehmet; Locklear, Cameron T.; Younossi, Zobair M.

    2017-01-01

    Abstract Hepatocellular carcinoma (HCC) is among the most common types of cancer. Liver transplantation (LT) and surgical resection (SR) are primary surgical treatment options for HCC. The aim of the study was to assess mortality within 2 years postdiagnosis among patients with HCC according to their treatment modalities. We examined data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database between 2001 and 2009. SEER registries collect demographics, cancer stage and historical types, and treatments. Medicare claims include diagnoses, procedures, and survival status for each beneficiary. Patients with HCC were identified using the International Classification of Disease Oncology, Third Edition Site code C22.0 and Histology Code 8170-8175. Treatment modalities were LT, SR, or nonsurgical treatment. Total of 11,187 cases was included (age at diagnosis: 72 years, 69% male, 67% White). HCC patients who underwent LT were younger (61 vs 71 years), sicker (presence of decompensated cirrhosis: 80% vs 23%), and less likely to die within 2 years (29% vs 44%, all P < 0.01), compared to SR patients. In multivariate analysis, older age (HR: 1.01 [95% CI = 1.01–1.01]), stage of HCC other than local (HR: 1.81[95%CI = 1.70–1.91]), and being treated with SR (HR: 1.95 [95%CI = 1.55–2.46]) were independent predictors of mortality within 2 years. Furthermore, the presence of decompensated cirrhosis (HR: 1.84 [95%CI = 1.73–1.96]) and alcoholic liver disease (HR: 1.19[95%CI = 1.11–1.28]) increased within 2 years mortality. Mortality within 2 years postdiagnosis of HCC was significantly higher in patients treated with SR than LT. PMID:28248853

  9. Does the Use of Telemental Health Alter the Treatment Experience? Inmates' Perceptions of Telemental Health versus Face-to-Face Treatment Modalities

    ERIC Educational Resources Information Center

    Morgan, Robert D.; Patrick, Amber R.; Magaletta, Philip R.

    2008-01-01

    In corrections, where staffing limitations tax an overburdened mental health system, telemental health is an increasingly common mode of mental health service delivery. Although telemental health presents an efficient treatment modality for a spectrum of mental health services, it is imperative to study how this modality influences key elements of…

  10. Effects of Professional Group Membership, Intervention Type, and Diagnostic Label on Treatment Acceptability.

    ERIC Educational Resources Information Center

    Fairbanks, Larry D.; Stinnett, Terry A.

    1997-01-01

    Investigates professionals' ratings of treatment acceptability for two interventions. Teachers, school psychologists, and school social workers (N=97) viewed a vignette of a student exhibiting disruptive behavior and then rated the intervention's acceptability. Results show that professional group membership produced a significant interaction…

  11. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... inadequate intake or abnormal output, a physician determines that the inmate's life or health will be.... Staff shall document their treatment efforts in the medical record of the inmate. (c) When,...

  12. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... inadequate intake or abnormal output, a physician determines that the inmate's life or health will be.... Staff shall document their treatment efforts in the medical record of the inmate. (c) When,...

  13. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... inadequate intake or abnormal output, a physician determines that the inmate's life or health will be.... Staff shall document their treatment efforts in the medical record of the inmate. (c) When,...

  14. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... inadequate intake or abnormal output, a physician determines that the inmate's life or health will be.... Staff shall document their treatment efforts in the medical record of the inmate. (c) When,...

  15. 28 CFR 549.65 - Refusal to accept treatment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... inadequate intake or abnormal output, a physician determines that the inmate's life or health will be.... Staff shall document their treatment efforts in the medical record of the inmate. (c) When,...

  16. Comparison of Local Recurrence Rate of Three Treatment Modalities for Kimura Disease.

    PubMed

    Ye, Peng; Wei, Tai; Yu, Guang-Yan; Wu, Li-Ling; Peng, Xin

    2016-01-01

    Eosinophilic hyperplastic lymphogranuloma, also known as Kimura disease, is a benign and chronic inflammatory condition, predominantly involving the head and neck region. Surgical excision, radiotherapy (RA), surgical resection combined with low-dose postoperative radiotherapy and oral corticosteroids are 4 treatment modalities reported to control this disease effectively. Local recurrence, however, is common and the optimum treatment for Kimura disease is controversial. Thus, the present meta-analysis was performed to identify the treatment modality associated with the lowest local recurrence. Electronic databases (Cochrane Library, Wiley Online Library, PubMed, Chinese National Knowledge Infrastructure, and Wanfang Data) were searched. Data were also obtained from other sources such as related references and communication with the relevant authors. Two reviewers screened the literature according to preselected criteria. All studies involving different treatments for Kimura disease were collected. After data extraction and research quality assessment, the meta-analysis of 22 studies involving 570 patients was conducted using STATA 12.1 software. Meta-analysis revealed that administration of RA or surgical excision alone were inferior in controlling local recurrence compared with surgical resection combined with postoperative RA (risk ratio (RR) = 2.72; 95% confidence interval (CI), 1.47-5.04 and RR = 4.72; 95% CI, 2.53-8.82). Surgical excision alone did not show significant advantage in controlling local recurrence compared with RA alone (RR = 2.13; 95% CI, 0.88-5.17). Surgical resection combined with postoperative RA is superior to either surgery or RA alone in treating Kimura disease. More large scale prospective randomized controlled trials, however, should be conducted to assess the long-term effects and safety issues.

  17. High energy devices versus low energy devices in orthopedics treatment modalities

    NASA Astrophysics Data System (ADS)

    Schultheiss, Reiner

    2003-10-01

    The orthopedic consensus group defined in 1997 the 42 most likely relevant parameters of orthopedic shock wave devices. The idea of this approach was to correlate the different clinical outcomes with the physical properties of the different devices with respect to their acoustical waves. Several changes in the hypothesis of the dose effect relationship have been noticed since the first orthopedic treatments. The relation started with the maximum pressure p+, followed by the total energy, the energy density; and finally the single treatment approach using high, and then the multiple treatment method using low energy. Motivated by the reimbursement situation in Germany some manufacturers began to redefine high and low energy devices independent of the treatment modality. The OssaTron as a high energy, single treatment electro hydraulic device gained FDA approval as the first orthopedic ESWT device for plantar fasciitis and, more recently, for lateral epicondylitis. Two low energy devices have now also gained FDA approval based upon a single treatment. Comparing the acoustic data, differences between the OssaTron and the other devices are obvious and will be elaborated upon. Cluster analysis of the outcomes and the acoustical data are presented and new concepts will be suggested.

  18. An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa.

    PubMed

    Timko, C Alix; Zucker, Nancy L; Herbert, James D; Rodriguez, Daniel; Merwin, Rhonda M

    2015-06-01

    Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12-18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed.

  19. Comparing different treatment modalities for partial nephrectomies without ischemic period: laser, Hydro-Jet and RF

    NASA Astrophysics Data System (ADS)

    de Boorder, Tjeerd; Boeken Kruger, Arto; Klaessens, John; Grimbergen, Matthijs; Verdaasdonk, Rudolf

    2008-02-01

    The treatment of partial nefrectomies is usually performed under a warm ischemic period. Recently, various treatment modalities have become available to perform a partial nefrectomy without clamping off the blood circulation. We have studied three devices in laboratory setting, investigating the thermal and high speed imaging techniques in tissue models and consequently, applying the instruments in the clinic during open procedures especially looking at efficacy and blood loss. The continuous wave 2.0 micron laser of 70 W (Revolix, LISA laser) is used as a fiber delivered knife cutting through circulated tissue with controlled hemostasis for vessels up to 3 mm diameter. The 2 μm wavelength effectively vaporizes tissue water and coagulates the smaller vessels. The Hydro-Jet (ERBE, Germany) uses high pressure (20-80 bar) to ejects a water jet of 40 um diameter at high velocity (10-30 m/s). The parenchyma is resected while vessels are preserved. Consequently, the exposed vessels can be coagulated in a controlled way with minimal blood loss. The water jet showed to induce cavitation bubbles that resect the soft tissue from the matrix leaving the elastic microvessels intact. Various systems are based on bipolar RF technology. We are using the Habib device (Rita 1500X RF generator) to create a coagulation zone around the tumor. Subsequently, the tumor can be resected along the coagulation zone with minimal bleeding. The treatment modalities investigated, have their own advantages and, stand-alone or in combination, can facilitate laparoscopic partial nephrectomies without an ischemic period.

  20. Dielectric studies on struvite urinary crystals, a gateway to the new treatment modality for urolithiasis

    NASA Astrophysics Data System (ADS)

    Rajan, Reshma; Raj, N. Arunai Nambi; Madeswaran, S.; Babu, D. Rajan

    2015-09-01

    Struvite or magnesium ammonium phosphate hexahydrate (MAPH) are biological crystals, found in the kidney, which are formed due to the infection caused by urea splitting bacteria in the urinary tract. The struvite crystals observe different morphologies and were developed using single diffusion gel growth technique. The crystalline nature and its composition were studied from different characterization techniques like X-ray Diffraction (XRD) and FTIR. The dielectric behavior of the developed crystal was studied by varying temperature and at different frequencies. The parameters like dielectric constant, dielectric loss, ac conductivity, ac resistivity, impedance and admittance of the struvite crystals were calculated. The studies proved that the dielectric loss or dissipation heat is high in lower frequencies at normal body temperature, which develops a plasma state in the stones and in turn leads to the disintegration of urinary stones. The dielectric nature of the stones leads to the dielectric therapy, which will be a gateway for future treatment modality for urolithiasis.

  1. Dielectric studies on struvite urinary crystals, a gateway to the new treatment modality for urolithiasis.

    PubMed

    Rajan, Reshma; Raj, N Arunai Nambi; Madeswaran, S; Babu, D Rajan

    2015-09-05

    Struvite or magnesium ammonium phosphate hexahydrate (MAPH) are biological crystals, found in the kidney, which are formed due to the infection caused by urea splitting bacteria in the urinary tract. The struvite crystals observe different morphologies and were developed using single diffusion gel growth technique. The crystalline nature and its composition were studied from different characterization techniques like X-ray Diffraction (XRD) and FTIR. The dielectric behavior of the developed crystal was studied by varying temperature and at different frequencies. The parameters like dielectric constant, dielectric loss, ac conductivity, ac resistivity, impedance and admittance of the struvite crystals were calculated. The studies proved that the dielectric loss or dissipation heat is high in lower frequencies at normal body temperature, which develops a plasma state in the stones and in turn leads to the disintegration of urinary stones. The dielectric nature of the stones leads to the dielectric therapy, which will be a gateway for future treatment modality for urolithiasis.

  2. Giant juvenile fibroadenoma: a case and review of novel modalities in treatment.

    PubMed

    Sosin, Michael; Feldman, Elizabeth

    2012-01-01

    A giant juvenile fibroadenoma is defined as a fibroadenoma greater than 5 centimeters in size occurring in the pediatric population. It frequently affects adolescents. Rapid growth of the mass may result in breast asymmetry and deformity. Varying techniques in surgical extirpation have been described in order to optimize aesthetics and minimize distortion. The advent of new methods to remove benign breast disease is in its infancy stages. Many practitioners are unaware of the novel options that are emerging in the treatment of fibroadenoma. We describe an excision of a 12 centimeter giant juvenile fibroadenoma and adjacent juvenile fibroadenoma using a strategically atypical incision that resulted in excellent cosmesis and contour of the breast without subsequent reconstruction. Multiple modalities of removing a fibroadenoma are described with a review of the associated risks, benefits, and long term implications as well as a discussion on the indication for reconstructive surgery in patients with giant juvenile fibroadenoma.

  3. Cold atmospheric plasma, a novel promising anti-cancer treatment modality.

    PubMed

    Yan, Dayun; Sherman, Jonathan H; Keidar, Michael

    2016-11-11

    Over the past decade, cold atmospheric plasma (CAP), a near room temperature ionized gas has shown its promising application in cancer therapy. Two CAP devices, namely dielectric barrier discharge and plasma jet, show significantly anti-cancer capacity over dozens of cancer cell lines in vitro and several subcutaneous xenograft tumors in vivo. In contrast to conventional anti-cancer approaches and drugs, CAP is a selective anti-cancer treatment modality. Thus far establishing the chemical and molecular mechanism of the anti-cancer capacity of CAP is far from complete. In this review, we provide a comprehensive introduction of the basics of CAP, state of the art research in this field, the primary challenges, and future directions to cancer biologists.

  4. Current adjuvant treatment modalities for gastric cancer: From history to the future.

    PubMed

    Kilic, Leyla; Ordu, Cetin; Yildiz, Ibrahim; Sen, Fatma; Keskin, Serkan; Ciftci, Rumeysa; Pilanci, Kezban Nur

    2016-05-15

    The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials. However, the benefits were evident for only certain patients, which were not very homogeneous regarding the type of surgery, chemotherapy regimens, and stage of disease. Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate. Regardless of the extent of surgery, multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement. Moreover, in the era of individualized treatment for most of the other cancer types, identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation. The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients.

  5. Photodynamic Therapy – A Non-invasive Treatment Modality for Precancerous Lesions

    PubMed Central

    Maloth, Kotya Naik; Velpula, Nagalaxmi; Kodangal, Srikanth; Sangmesh, Mithare; Vellamchetla, Kiran; Ugrappa, Sridevi; Meka, Nagajyothi

    2016-01-01

    Introduction: Oral premalignant lesions are conditions having high potential tendency for transformation into malignancy. The use of a conservative and effective treatment modality is one of the best strategies for cancer prevention. Photodynamic therapy (PDT) is a non-invasive method for topical and selective treatment of oral precancerous lesions. The present study was taken up to determine the efficacy of PDT in oral precancerous lesions. Methods: The study consisted 13 patients with 24 oral leukoplakia (OL) lesions and 8 with 20 oral lichen planus (OLP) lesions, divided into control and study groups. These lesions were affecting various intraoral sites, the buccal mucosa being the most common site followed by tongue and gingiva. The treatment regimen of PDT included 98% 5–aminolevulinic acid (5-ALA) which is topical applied and irradiated with light emitting diode (LED) of 420 nm wavelengths at several sessions. Results: In OL 16.6% of cases showed complete response, 66.6% partial response and 16.6% no response of the lesions to the treatment. In OLP 80% and 20% of the lesions showed partial and no response respectively. The differences with control groups for OL + OLP were found to be significant (P < 0.001). Conclusion: Based on the results of the present study, we can conclude that PDT appears to be a feasible alternative to conventional therapy for oral premalignant lesions. PMID:27330695

  6. Current adjuvant treatment modalities for gastric cancer: From history to the future

    PubMed Central

    Kilic, Leyla; Ordu, Cetin; Yildiz, Ibrahim; Sen, Fatma; Keskin, Serkan; Ciftci, Rumeysa; Pilanci, Kezban Nur

    2016-01-01

    The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials. However, the benefits were evident for only certain patients, which were not very homogeneous regarding the type of surgery, chemotherapy regimens, and stage of disease. Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate. Regardless of the extent of surgery, multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement. Moreover, in the era of individualized treatment for most of the other cancer types, identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation. The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients. PMID:27190583

  7. Conservative treatment modalities and outcomes for osteoarthritis: the concomitant pyramid of treatment.

    PubMed

    Langworthy, Michael J; Saad, Amira; Langworthy, Nadia M

    2010-06-01

    This article reviews current treatment algorithms for the conservative treatment of hip and knee osteoarthritis. The available treatment options for osteoarthritis (physical therapy, medical therapeutics, steroid injections, nutraceuticals, hyaluronic acid injections, acupuncture, pulsed electrical stimulation, and topical ointments) are compared to determine efficacy in the treatment of pain and return of function in the osteoarthritic joint. A literature review was conducted to determine combinations of appropriate concomitant therapy. Based on the available literature, we conclude that an early transition to multimodal and concomitant therapy is the most efficacious approach to decrease pain and improve joint function in the osteoarthritic hip and knee.

  8. Quality of Life in 807 Patients with Vestibular Schwannoma: Comparing Treatment Modalities.

    PubMed

    Soulier, Géke; van Leeuwen, Bibian M; Putter, Hein; Jansen, Jeroen C; Malessy, Martijn J A; van Benthem, Peter Paul G; van der Mey, Andel G L; Stiggelbout, Anne M

    2017-03-01

    Objective In vestibular schwannoma treatment, the choice among treatment modalities is controversial. The first aim of this study was to examine the quality of life of patients with vestibular schwannoma having undergone observation, radiation therapy, or microsurgical resection. The second aim was to examine the relationship between perceived symptoms and quality of life. Last, the association between quality of life and time since treatment was studied. Study Design Cross-sectional study. Setting Tertiary referral center. Subjects and Methods A total of 1208 patients treated for sporadic vestibular schwannoma between 2004 and 2014 were mailed the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire and additional questions on symptoms associated with vestibular schwannoma. Total and domain scores were calculated and compared among treatment groups. Propensity scores were used, and results were stratified according to tumor size to control for potential confounders. Correlations were calculated to examine the relationship between self-reported symptoms and quality of life, as well as between quality of life and time since treatment. Results Patients with small tumors (≤10 mm) under observation showed a higher PANQOL score when compared with the radiation therapy and microsurgical resection groups. A strong negative correlation was found between self-reported symptoms and quality of life, with balance problems and vertigo having the largest impact. No correlation was found between PANQOL score and time since treatment. Conclusion This study suggests that patients with small vestibular schwannomas experience better quality of life when managed with observation than do patients who have undergone active treatment.

  9. A multi-modal treatment approach for the shoulder: A 4 patient case series

    PubMed Central

    Pribicevic, Mario; Pollard, Henry

    2005-01-01

    Background This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach. Clinical Features Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage), 7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS), range of motion (goniometer) and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities. Conclusion This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome. PMID:16168053

  10. Combined modality treatment for stage I-II non-Hodgkin's lymphomas: CVP versus BACOP chemotherapy

    SciTech Connect

    Bajetta, E.; Valagussa, P.; Bonadonna, G.; Lattuada, A.; Buzzoni, R.; Rilke, F.; Banfi, A.

    1988-07-01

    This paper reports the 5-year results of a prospective randomized study beginning in 1976 on 177 evaluable patients with pathologic Stage I-IE and II-IIE non-Hodgkin's lymphomas with diffuse histology according to the Rappaport classification. Treatment consisted of either CVP or BACOP chemotherapy (3 cycles) followed by regional radiotherapy (40 to 50 Gy) and further cycles of either combination. In both arms, complete remission at the end of combined treatment was high (CVP 93%, BACOP 98%) regardless of age, stage or bulky disease. At 5 years, the comparative freedom from first progression was 62% for CVP vs 78% for BACOP (p = 0.02), respectively. Clinically relevant differences favoring BACOP chemotherapy were essentially documented in patients with large cell lymphomas (International Working Formulation), those with Stage II having more than three involved anatomical sites, bulky disease and age over 60 years. Recurrence within radiation fields was documented in only 5% of complete responders. Combined treatment was, in general, well tolerated particularly when BACOP was used. In only 2 patients given CVP post radiation cutaneous fibrosis was documented. Second solid tumors were detected in 4 patients. One patient started on CVP died because of brain stem necrosis after 45 Gy. We conclude that in Stage I-II patients with nodal and extranodal diffuse non-Hodgkin's lymphomas, particularly large cell lymphomas, combined modality approach with primary Adriamycin and bleomycin containing regimen, such as BACOP, followed by adjuvant radiotherapy offers high chances of cure with minimal toxicity.

  11. Development of a multi-modal Monte-Carlo radiation treatment planning system combined with PHITS

    NASA Astrophysics Data System (ADS)

    Kumada, Hiroaki; Nakamura, Takemi; Komeda, Masao; Matsumura, Akira

    2009-07-01

    A new multi-modal Monte-Carlo radiation treatment planning system is under development at Japan Atomic Energy Agency. This system (developing code: JCDS-FX) builds on fundamental technologies of JCDS. JCDS was developed by JAEA to perform treatment planning of boron neutron capture therapy (BNCT) which is being conducted at JRR-4 in JAEA. JCDS has many advantages based on practical accomplishments for actual clinical trials of BNCT at JRR-4, the advantages have been taken over to JCDS-FX. One of the features of JCDS-FX is that PHITS has been applied to particle transport calculation. PHITS is a multipurpose particle Monte-Carlo transport code, thus application of PHITS enables to evaluate doses for not only BNCT but also several radiotherapies like proton therapy. To verify calculation accuracy of JCDS-FX with PHITS for BNCT, treatment planning of an actual BNCT conducted at JRR-4 was performed retrospectively. The verification results demonstrated the new system was applicable to BNCT clinical trials in practical use. In framework of R&D for laser-driven proton therapy, we begin study for application of JCDS-FX combined with PHITS to proton therapy in addition to BNCT. Several features and performances of the new multimodal Monte-Carlo radiotherapy planning system are presented.

  12. [Dacarbazine, a chemotherapeutic against metastatic melanoma and a reference drug for new treatment modalities].

    PubMed

    Koprowska, Kamila; Czyż, Małgorzata

    2011-11-23

    Melanoma is a tumour derived from melanocytes, cells of neuroectodermal origin. Melanoma treatment represents a challenge to oncologists due to its aggressive course and early and multiple metastases. Surgical excision of lesions is a highly effective intervention, but only in early stages. In contrast, median survival of patients with metastatic melanoma is still below one year. In 2011 the FDA and EMA have approved new drugs, ipilimumab and vemurafenib, that might be a major breakthrough in treating patients with advanced melanoma. However, time is needed to conclude whether they replace dacarbazine, a drug used for over 30 years in the therapy of metastatic melanoma, even if the response rate was only 10-15%. The mechanism of dacarbazine action is not clear but it is probably based on methylation of purine bases in DNA. The low therapeutic efficacy of dacarbazine might be the consequence of rapid removal of DNA lesions by repair systems. A high melanoma chemoresistance is also driven by the extent and nature of alterations in signal transductions in tumour cells. None of the previously conducted trials proved superiority of any treatment modality over monotherapy with dacarbazine. Higher response rates did not correlate with survival benefit, and more intense adverse effects were frequently observed. There are some expectations for targeted therapy and immunotherapy, which have already demonstrated some efficacy in clinical studies. This review aims at providing the current knowledge on dacarbazine and its analogue, temozolomide, including the latest results of clinical studies combining these drugs with other treatment protocols.

  13. Development of a multi-modal Monte-Carlo radiation treatment planning system combined with PHITS

    SciTech Connect

    Kumada, Hiroaki; Nakamura, Takemi; Komeda, Masao; Matsumura, Akira

    2009-07-25

    A new multi-modal Monte-Carlo radiation treatment planning system is under development at Japan Atomic Energy Agency. This system (developing code: JCDS-FX) builds on fundamental technologies of JCDS. JCDS was developed by JAEA to perform treatment planning of boron neutron capture therapy (BNCT) which is being conducted at JRR-4 in JAEA. JCDS has many advantages based on practical accomplishments for actual clinical trials of BNCT at JRR-4, the advantages have been taken over to JCDS-FX. One of the features of JCDS-FX is that PHITS has been applied to particle transport calculation. PHITS is a multipurpose particle Monte-Carlo transport code, thus application of PHITS enables to evaluate doses for not only BNCT but also several radiotherapies like proton therapy. To verify calculation accuracy of JCDS-FX with PHITS for BNCT, treatment planning of an actual BNCT conducted at JRR-4 was performed retrospectively. The verification results demonstrated the new system was applicable to BNCT clinical trials in practical use. In framework of R and D for laser-driven proton therapy, we begin study for application of JCDS-FX combined with PHITS to proton therapy in addition to BNCT. Several features and performances of the new multimodal Monte-Carlo radiotherapy planning system are presented.

  14. Acceptable Care? Illness Constructions, Healthworlds, and Accessible Chronic Treatment in South Africa

    PubMed Central

    Harris, Bronwyn; Eyles, John; Moshabela, Mosa

    2015-01-01

    Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas—conversely—these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating “disease” to responding to “illness” by acknowledging and incorporating patients’ healthworlds in patient–provider interactions. PMID:25829509

  15. Acceptance and Commitment Therapy Modules: Differential Impact on Treatment Processes and Outcomes

    PubMed Central

    Villatte, Jennifer L.; Vilardaga, Roger; Villatte, Matthieu; Plumb Vilardaga, Jennifer C.; Atkins, David C.; Hayes, Steven C.

    2015-01-01

    A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau- U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults. PMID:26716932

  16. Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes.

    PubMed

    Villatte, Jennifer L; Vilardaga, Roger; Villatte, Matthieu; Plumb Vilardaga, Jennifer C; Atkins, David C; Hayes, Steven C

    2016-02-01

    A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau-U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults.

  17. Evidence of invasive and noninvasive treatment modalities for hypertrophic scars: A systematic review.

    PubMed

    Kafka, Mona; Collins, Vanessa; Kamolz, Lars-Peter; Rappl, Thomas; Branski, Ludwik K; Wurzer, Paul

    2017-01-01

    Currently, there are various therapeutic approaches to reduce hypertrophic scarring; however, there is no standard evidence-based treatment protocol. Hence, a systematic review was performed to obtain a summary of the latest clinical trials to evaluate evidence for the treatment of hypertrophic scars. The review protocol was registered and approved by PROSPERO (CRD42015027040). PubMed and Web of Science were searched using predefined MeSH-Terms to identify studies published within the last 10 years regarding treatment for hypertrophic scars. Exclusion criteria included a level of evidence (LoE) lower than I, nonhuman in vivo studies, in vitro studies, studies on keloids, literature reviews, and non-English articles. The literature search identified 1,029 unique articles, whereas 6 articles were prospective, randomized, blinded, controlled clinical trials with a LoE I, and were thus included in the systematic analysis. Three clinical trials evaluated silicone products and pressure garments, and the other three studies investigated the efficacy of intralesional injections of triamcinolone (TAC), 5-Fluorouracil (5-FU) combined with TAC as well as the additional irradiation with a 585 nm pulsed-dye laser (PDL). Intralesional injections revealed significant improvements of the scar quality in terms of height, thickness, erythema, and pigmentation. Pressure garments showed favorable results but there was no evidence that silicone products were able to improve the scar quality. The systematic review demonstrated that there are just a few clinical trials with a LoE of I. Consequently, evidence is still lacking especially for noninvasive treatment regimens for hypertrophic scars. Intralesional injections of 5-FU mixed with a low dose of TAC can be seen as most appropriate treatment modality. Prospective clinical trials to determine the efficiency of silicone products are warranted.

  18. Technological Advances in the Treatment of Cancer: Combining Modalities to Optimize Outcomes.

    PubMed

    Wong, Eric T; Toms, Steven A; Ahluwalia, Manmeet S

    2015-11-01

    The anticancer treatment modality tumor treating fields (TTFields; Optune, Novocure) use the lower frequency range of the electromagnetic spectrum to destroy tumor cells during mitosis. This treatment has been evaluated in several trials of patients with glioblastoma. In these patients, TTFields are delivered through 4 transducer arrays applied to the scalp. In a phase 3 clinical trial of patients with recurrent glioblastoma, TTFields were as effective as chemotherapy, and were associated with fewer and milder systemic toxicities. Data from a phase 3 trial in newly diagnosed glioblastoma suggested that the addition of TTFields to postoperative radiation therapy and chemotherapy represents an important advance in the management of newly diagnosed glioblastoma. Ongoing clinical trials are investigating the efficacy and safety of TTFields in other tumor types, including pancreatic cancer, mesothelioma, ovarian cancer, and non–small cell lung cancer. Other recent advances in the management of cancer have been seen with immunomodulatory therapy, including immune checkpoint inhibitors. Further study will be necessary to evaluate whether TTFields will enhance or impair other established and newly emerging therapies.

  19. Medical management of failed back surgery syndrome in Europe: evaluation modalities and treatment proposals.

    PubMed

    Durand, G; Girodon, J; Debiais, F

    2015-03-01

    Failed back surgery syndrome (FBSS) is defined as persistent pain more than 3 months after any form of spinal surgery. Due to its multifactorial origin, FBSS is often difficult to treat. In this context of failed back surgery, a very thorough assessment must be conducted concerning the site and characteristics of the pain (nociceptive or neuropathic), its mode of onset (presence or absence of pain-free intervals), and its impact on the patient's work and social life. Physical examination must exclude a non-spinal cause for the pain. MRI is the imaging modality of choice in this disease, but is often difficult to interpret, as MR signals are modified for 6 months after the operation. Scar tissue, which can be distinguished from recurrent disc hernia by its gadolinium enhancement, is present even in asymptomatic patients. After having eliminated infection and sacroiliac or posterior facet joint disease, the main aetiologies investigated are foraminal stenosis, degenerative disc disease, recurrent disc hernia, and non-union of spinal fusion; sometimes patients only experience persistent neuropathic pain. The treatment of failed back surgery syndrome with a predominant neuropathic component is based on the use of analgesics, especially antiepileptics, antidepressants or transcutaneous electrical stimulation. Epidural spinal infiltration should be considered as second-line treatment in view of the risk of serious neurological complications. Management must be based on a global, multidisciplinary approach with identification of any cognitive or behavioural disorders in combination with an appropriate functional rehabilitation programme.

  20. Non-injecting routes of administration among entrants to three treatment modalities for heroin dependence.

    PubMed

    Darke, Shane; Hetherington, Kate; Ross, Joanne; Lynskey, Michael; Teesson, Maree

    2004-06-01

    A sample of 535 entrants to opioid dependence treatments across three treatment modalities were administered a structured interview to ascertain the prevalence of non-injecting heroin use. Ten per cent of participants had used heroin primarily by smoking/inhaling in the month preceding interview, and 9% had used heroin and other drugs exclusively by non-injecting routes. Non-injectors were younger (25.3 vs. 29.5 years), had higher levels of education (10.6 vs. 10.0 years), were more likely to be employed (33 vs. 18%) and had lower levels of recent crime (31 vs. 56%). They also had shorter heroin using careers (5.1 vs. 9.9 years), fewer symptoms of dependence (5.1 vs. 5.6), had been enrolled in fewer previous treatment episodes (3.3 vs. 11.5) and had less extensive lifetime (8.0 vs. 9.1 drug classes) and recent (3.6 vs. 4.9) polydrug use. Non-injectors were substantially less likely to report lifetime (13% vs. 58%) or recent (2% vs. 29%) heroin overdoses. There were no differences between the general physical and psychological health of the two groups. While non-injectors had a lower level of post-traumatic stress disorder (29% vs. 34%), there were no differences in levels of major depression, attempted suicide, antisocial personality disorder, or borderline personality disorder. A substantial minority of Australian treatment entrants are now using heroin exclusively by non-injecting routes. While this group is younger, and has substantially reduced risk of overdose and blood borne virus transmission, the physical and psychological health of non-injectors mirrors that of injectors.

  1. Effect of Treatment Modality on Long-Term Outcomes in Attention-Deficit/Hyperactivity Disorder: A Systematic Review

    PubMed Central

    Arnold, L. Eugene; Hodgkins, Paul; Caci, Hervé; Kahle, Jennifer; Young, Susan

    2015-01-01

    Background Evaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood. Methods A systematic search of 12 literature databases using Cochrane’s guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment. Results The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%–75%) or treatment duration (62%–72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length. Conclusions While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age

  2. Insomnia treatment acceptability and preferences of male Iraq and Afghanistan combat veterans and their healthcare providers.

    PubMed

    Epstein, Dana R; Babcock-Parziale, Judith L; Haynes, Patricia L; Herb, Christine A

    2012-01-01

    Sleep difficulty is a prevalent problem among returning Veterans. Although there is strong evidence for the efficacy and durability of cognitive-behavioral treatment for insomnia (CBT-I) in the general population, the interventions require motivation, attention, and adherence from patients to achieve successful outcomes. Given the unique characteristics of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who have experienced blast-related injuries and other trauma, CBT-I for these patients may require modification, including alternative delivery methods, to ensure effective implementation and positive outcomes. We interviewed 18 OIF/OEF Veterans who screened positive for mild traumatic brain injury and 19 healthcare providers to determine the acceptability of insomnia treatments and preferences for the interventions and treatment delivery. Veterans and providers had distinct preferences for insomnia treatment and its delivery. The treatments the Veterans found most acceptable were also the ones they preferred: relaxation treatment and pharmacotherapy. The providers identified relaxation therapy as the most acceptable treatment. Veterans preferred the individual treatment format as well as electronic methods of treatment delivery. Despite some differences between patients and providers, a compromise through modification of empirically supported behavioral treatments is feasible, and implications for preference-based insomnia intervention development and testing are discussed.

  3. Treatment Needs of Driving While Intoxicated Offenders: The Need for a Multi-modal Approach to Treatment

    PubMed Central

    Mullen, Jillian; Ryan, Stacy R.; Mathias, Charles W.; Dougherty, Donald M.

    2015-01-01

    Objective This study aimed to characterize and compare the treatment needs of adults with driving while intoxicated (DWI) offenses recruited from a correctional residential treatment facility and the community to provide recommendations for treatment development. Method A total of 119 adults (59 Residential, 60 Community) with at least one DWI offense were administered clinical diagnostic interviews to assess substance use disorders and completed a battery of questionnaires assessing demographic characteristics, legal history, psychiatric diagnoses, medical diagnoses, and health care utilization. Results Almost all (96.6%) DWI offenders met clinical diagnostic criteria for an alcohol use disorder, approximately half of the sample also met diagnostic criteria for co-morbid substance use disorders and a substantial proportion also reported psychiatric and medical co-morbidities. However, a high percentage were not receiving treatment for these issues, most likely as a result of having limited access to care as the majority of participants had no current health insurance (64.45%) or primary care physician (74.0%). The residential sample had more extensive criminal histories compared to the community sample but was generally representative of the community in terms of their clinical characteristics. For instance, the groups did not differ in rates of substance use, psychiatric and medical health diagnoses or in the treatment of such issues, with the exception of alcohol abuse treatment. Conclusions DWI offenders represent a clinical population with high levels of complex and competing treatment needs which are not currently being met. Our findings demonstrate the need for standardized screening of DWI offenders and call for the development of a multi-modal treatment approach in efforts to reduce recidivism. PMID:25664371

  4. Experiential Education, Outdoor Adventure As a Modality in Residential Treatment. A Survey of Programs, Principles, Research and Practice.

    ERIC Educational Resources Information Center

    Duindam, Ton

    Orthopedagogisch Centrum (OC) Michiel is a multifunctional regional institution in the Netherlands that serves troubled families and youth at risk. Outdoor programs are used as a treatment modality for adolescents with behavior disorders, drug addictions, or criminal records. Outward Bound was the first experiential outdoor program in the…

  5. Acceptance and Commitment Therapy for a Heterogeneous Group of Treatment-Resistant Clients: A Treatment Development Study

    ERIC Educational Resources Information Center

    Clarke, Sue; Kingston, Jessica; Wilson, Kelly G.; Bolderston, Helen; Remington, Bob

    2012-01-01

    Acceptance and commitment therapy (ACT) has been shown to have broad applicability to different diagnostic groups, and there are theoretical reasons to consider its use with clients with chronic mental health problems. We report an innovative treatment development evaluation of ACT for a heterogeneous group of "treatment-resistant clients" (N =…

  6. Five-Year Survival Among Stage IIIA Lung Cancer Patients Receiving Two Different Treatment Modalities.

    PubMed

    Bilfinger, Thomas; Keresztes, Roger; Albano, Denise; Nemesure, Barbara

    2016-07-21

    BACKGROUND Five-year survival rates among stage IIIA lung cancer patients range between 2% and 15%, and there is currently no consensus regarding optimal treatment approaches for these patients. The current investigation evaluated survival outcomes among stage IIIA lung cancer patients receiving 2 different treatment modalities, neoadjuvant chemotherapy followed by resection versus chemoradiation alone. MATERIAL AND METHODS This retrospective study is based on 127 patients attending the Lung Cancer Evaluation Center at Stony Brook Cancer Center between 2002 and 2014. Patients were treated either with neoadjuvant chemotherapy followed by resection or a regimen of chemoradiation alone. Kaplan-Meier curves were used to compare survival outcomes between groups and Cox proportional hazard models were used to evaluate treatment effects on survival, while adjusting for possible confounders. RESULTS Approximately one-fourth (n=33) of patients received neoadjuvant chemotherapy followed by surgery, whereas 94 patients received definitive chemoradiation. Patients in the surgical group were found to be significantly younger than those receiving chemoradiation alone (60.1 vs. 67.9 years, respectively; p=0.001). Five-year survival among patients receiving preoperative chemotherapy followed by resection was significantly higher than that among patients receiving chemoradiation alone (63% vs. 19%, respectively; p<0.001), whereas the hazard ratio (HR) was 3-4 times greater in the latter group (HR=3.77, 95% confidence interval=1.87, 7.61). CONCLUSIONS Findings from this study indicate that preoperative chemotherapy followed by resection can improve survival outcomes for stage IIIA lung cancer patients compared with chemoradiation alone. The results reflect a select surgical group of patients; thus, the data highlight the need to develop new therapies that may result in more patients being viable surgical candidates.

  7. A novel thermal treatment modality for controlling breast tumor growth and progression.

    PubMed

    Xie, Yifan; Liu, Ping; Xu, Lisa X

    2012-01-01

    The new concept of keeping primary tumor under control in situ to suppress distant foci sheds light on the novel treatment of metastatic tumor. Hyperthermia is considered as one of the means for controlling tumor growth. In this study, a novel thermal modality was built to introduce hyperthermia effect on tumor to suppress its growth and progression using 4T1 murine mammary carcinoma, a common animal model of metastatic breast cancer. A mildly raised temperature (i.e.39°C) was imposed on the skin surface of the implanted tumor using a thermal heating pad. Periodic heating (12 hours per day) was carried out for 3 days, 7 days, 14 days, and 21 days, respectively. The tumor growth rate was found significantly decreased in comparison to the control without hyperthermia. Biological evidences associated with tumor angiogenesis and metastasis were examined using histological analyses. Accordingly, the effect of mild hyperthermia on immune cell infiltration into tumors was also investigated. It was demonstrated that a delayed tumor growth and malignancy progression was achieved by mediating tumor cell apoptosis, vascular injury, degrading metastasis potential and as well as inhibiting the immunosuppressive cell myeloid derived suppressor cells (MDSCs) recruitment. Further mechanistic studies will be performed to explore the quantitative relationship between tumor progression and thermal dose in the near future.

  8. The Heart of Change: Acceptance and Intimacy Mediate Treatment Response in a Brief Couples Intervention

    PubMed Central

    Hawrilenko, Matt; Gray, Tatiana D.; Cordova, James V.

    2015-01-01

    This study examined mediators of a brief couples intervention. Intimate safety, acceptance, and activation were examined in two roles: their contribution to marital satisfaction gains in the first two weeks after treatment (contemporaneous effects), and how early changes in the mediators influenced longer-term changes in marital satisfaction over two years of follow-up (lagged effects). Married couples (N = 215) were randomized to intervention or wait-list control and followed for two years. Latent change score models were used to examine contemporaneous and time-lagged mediation. A booster intervention in the second year was used for a replication study. Changes in intimate safety and acceptance were uniquely associated with contemporaneous treatment effects on relationship satisfaction in year one, but only acceptance was uniquely associated with contemporaneous effects in year two. With respect to lagged effects, early changes in acceptance partially mediated later changes in marital satisfaction in year one, whereas the same effect for intimate safety was marginally significant. These lagged paths were moderate in size and indirect effects were small. No lagged effects were significant in year two. Changes in activation were not significant as either a contemporaneous or lagged predictor of changes in relationship satisfaction. This study found moderate support for acceptance and more limited support for intimate safety as mediators of short and long-term treatment response, suggesting that these processes play an important role in sustaining marital health. PMID:26524618

  9. Impact of Treatment Modalities on Survival of Patients With Locoregional Esophageal Squamous-Cell Carcinoma in Taiwan.

    PubMed

    Chen, Hui-Shan; Hung, Wei-Heng; Ko, Jiunn-Liang; Hsu, Po-Kuei; Liu, Chia-Chuan; Wu, Shiao-Chi; Lin, Ching-Hsiung; Wang, Bing-Yen

    2016-03-01

    The optimal treatment modality for locoregional esophageal squamous-cell carcinoma (ESCC) is still undetermined. This study investigated the treatment modalities affecting survival of patients with ESCC in Taiwan.Data on 6202 patients who underwent treatment for locoregional esophageal squamous-cell carcinoma during 2008 to 2012 in Taiwan were collected from the Taiwan Cancer Registry. Patients were stratified by clinical stage. The major treatment approaches included definitive chemoradiotherapy, preoperative chemoradiation followed by esophagectomy, esophagectomy followed by adjuvant therapy, and esophagectomy alone. The impact of different treatment modalities on overall survival was analyzed.The majority of patients had stage III disease (n = 4091; 65.96%), followed by stage II (n = 1582, 25.51%) and stage I cancer (n = 529, 8.53%). The 3-year overall survival rates were 60.65% for patients with stage I disease, 36.21% for those with stage II cancer, and 21.39% for patients with stage III carcinoma. Surgery alone was associated with significantly better overall survival than the other treatment modalities for patients with stage I disease (P = 0.029) and was associated with significantly worse overall survival for patients with stage III cancer (P < 0.001). There was no survival risk difference among the different treatment methods for patients with clinical stage II disease.Multimodality treatment is recommended for patients with stage II-III esophageal squamous-cell carcinoma. Patients with clinical stage I disease can be treated with esophagectomy without preoperative therapy.

  10. Acupuncture: a potential modality for the treatment of auricular pruritus in Ramsay Hunt Syndrome with multiple cranial nerve lesions.

    PubMed

    Liu, Lan Ying; Wang, He Sheng; Sun, Jian Hua

    2015-03-01

    Auricular pruritus coexisted with multiple cranial nerve lesions in Ramsay Hunt syndrome has been rarely reported in the literature especially its treatment. However, auricular pruritus cannot be better improved along with the improvement of multiple cranial nerve lesions. We tried to solve the problem with acupuncture and got experience from it. The following 2 cases of Ramsay Hunt syndrome show a potential modality for the treatment of auricular pruritus with acupuncture.

  11. Comparison of Sexual Function and Hormonal Parameters Between Mood Stabilizer Treatment Modalities in Bipolar Disorder

    PubMed Central

    KESEBİR, Sermin; TOPRAK, Burak; BAYKARAN, Burak; HARİRİ, Aytül; BİLİCİ, Mustafa

    2014-01-01

    Introduction The aim of this study was to determine the differences between lithium and atypical antipsychotics (quetiapine and olanzapine) with regard to their effects on sexual functions and hormonal variables and to assess the findings in term of gender differences, in patients with bipolar disorder. Method 28 female and 29 male patients diagnosed as having bipolar disorder type I according to the DSM-IV, using lithium or quetiapine and quetiapine+lithium or olanzapine and olanzapine+lithium were evaluated consecutively. Being in remission period and given informed consent were set as inclusion criteria in these cases. Interviews with the patients were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and SKIP-TURK. Sexual functions and satisfaction were evaluated with the Arizona Sexual Experiences Scale (ASEX) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Blood samples of the patients were taken in order to determine prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and free testosterone (T) levels. Results GRISS scores in male patients were higher than in female patients (p=.001). The number of manic, depressive and total episodes, and functionality levels were similar between the treatment groups, both in female and male patients. No differences were found between treatment modalities in terms of hormone levels both in female and male patients. Among females, ASEX scores of the patients treated with lithium monotherapy were less than the ones treated with quetiapine and olanzapine. Among patients with quetiapine monotherapy, GRISS scores in male patients were higher than in female patients. Conclusion There are some evidences showing gender-based differences in the side effects of atypical antipsychotic drugs. Future studies with a specific focus on this topic are needed in order to have a better understanding of the basic mechanisms of gender differences.

  12. Delayed split whole abdominal irradiation in the combined modality treatment of ovarian cancer

    SciTech Connect

    Calkins, A.R.; Rosenshein, N.B.; Fox, M.G.; Order, S.E. )

    1991-04-01

    Fifty-eight patients with ovarian malignancies have been treated using a delayed split whole abdominal irradiation technique (DSA) allowing the entire tumor volume to be irradiated with tumoricidal fractional doses without undue toxicity. The lower hemiabdomen was irradiated with 2 Gy per fraction to a total dose of 40 Gy. A 2-6 hour delay was used between the irradiation of each half of the abdomen to avoid excessive acute gastrointestinal toxicity. The upper hemiabdomen was irradiated with 1.5 Gy per fraction to a total dose of 30 Gy. The acute toxicity was acceptable, with 53 of 58 patients able to complete the prescribed course of treatment. Three patients (5%) experienced grade 3 or greater acute gastrointestinal toxicity. Fourteen of 60 patients (24%) required treatment breaks because of thrombocytopenia. Nadir platelet counts were lower in patients who had received previous chemotherapy than in previously untreated patients (80,000 vs 118,000; p = .02). However, only 4 out of 60 patients were unable to complete DSA because of prolonged thrombocytopenia. In addition to DSA, patients were also treated with intraperitoneal 32P (52 patients), intraperitoneal human ovarian antitumor serum (14 patients), and prior (14 patients) or subsequent (32 patients) chemotherapy. Granulocytopenia was more severe among patients who had received prior chemotherapy (mean nadir 900 vs 2200). Seven patients (11.5%) developed delayed bowel obstruction in the absence of recurrence. There was one death caused by hepatitis, presumably related to colloidal 32P and DSA. Twenty-five percent of Stage III optimally cytoreduced patients were disease-free at 5 years; these patients had a median survival of 45 months. DSA irradiation is an acceptable technique for delivering a high fractional dose of radiation to the entire peritoneal cavity.

  13. Yoga as the "next wave" of therapeutic modalities for treatment of insomnia.

    PubMed

    Kennedy, Sarah L

    2014-01-01

    Insomnia rates continue to rise, especially among specific populations. Current nonpharmacological treatments rely primarily upon cognitive behavioral therapy for insomnia (CBT-I), which was introduced in the 1970s. Newer treatments have incorporated CBT "third wave" techniques, including mindfulness and acceptance techniques. Yoga practice is well suited to complement existing therapies and to address sleep problems in a more holistic way. Current theoretical and empirical approaches to treating insomnia are discussed, with an emphasis on the role of yoga in addressing precipitating and perpetuating factors in insomnia that have previously been largely overlooked.An estimated one-third of U.S. adults suffer from insomnia (Chen, Gelaye, & Williams, 2013; Mellinger, Balter, & Uhlenhuth, 1985; Ohayon, 2002), and the problem appears to be growing. While treatment for insomnia has helped to alleviate the problem for some (Irwin, Cole, & Nicassio, 2006; Morin et al., 2009), prevalence of insomnia is on the rise, especially among certain groups, including elderly and military populations (Morin, 2009; Mysliwiec et al., 2013). Rising rates of insomnia have been attributed to changes in lifestyle and environmental factors, including increased reliance on technology and decreased synchrony with natural wake-sleep rhythms (Brahinsky, 2013; Wallace-Guy et al., 2002; Yun, Bazar, Gerber, Lee, & Daniel, 2005).

  14. 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…

  15. Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder

    ERIC Educational Resources Information Center

    Orsillo, Susan M.; Batten, Sonja V.

    2005-01-01

    The current article describes the application of a behavioral psychotherapy, acceptance and commitment therapy (ACT), to the treatment of post-traumatic stress disorder (PTSD). It is argued that PTSD can be conceptualized as a disorder that is developed and maintained in traumatized individuals as a result of excessive, ineffective attempts to…

  16. Personal Paradigm Shifts among ABA and PBS Experts: Comparisons in Treatment Acceptability

    ERIC Educational Resources Information Center

    Brown, Fredda; Michaels, Craig A.; Oliva, Christopher M.; Woolf, Sara B.

    2008-01-01

    Applied behavior analysis (ABA) experts were surveyed to examine their perceptions of treatment acceptability of commonly used decelerative consequence-based behavioral procedures and the factors that have influenced shifts in these perceptions over time. These results were then compared with the perceptions of positive behavior supports (PBS)…

  17. Children with Developmental Disabilities and Sleep Problems: Parental Beliefs and Treatment Acceptability

    ERIC Educational Resources Information Center

    Keenan, Ruth A.; Wild, Matt R.; McArthur, Irene; Espie, Colin A.

    2007-01-01

    Background: This exploratory study investigated the relationships between illness beliefs and treatment acceptability among parents of children with a developmental disability living at home who had sleep onset or maintenance problems. Materials and Methods: A within-subject correlational design was employed. The parents of 58 children each…

  18. A Preliminary Investigation of Acceptance and Commitment Therapy as a Treatment for Marijuana Dependence in Adults

    ERIC Educational Resources Information Center

    Twohig, Michael P.; Shoenberger, Deacon; Hayes, Steven C.

    2007-01-01

    In this investigation, 3 adults who met criteria for marijuana dependence were treated using an abbreviated version of acceptance and commitment therapy (ACT). The treatment was delivered in eight weekly 90-min individual sessions. The effects of the intervention were assessed using a nonconcurrent multiple baseline across participants design.…

  19. Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process

    ERIC Educational Resources Information Center

    Vowles, Kevin E.; McCracken, Lance M.

    2008-01-01

    Developing approaches within cognitive behavioral therapy are increasingly process-oriented and based on a functional and contextual framework that differs from the focus of earlier work. The present study investigated the effectiveness of acceptance and commitment therapy (S. C. Hayes, K. Strosahl, & K. G. Wilson, 1999) in the treatment of…

  20. Using Acceptance and Commitment Therapy during Methadone Dose Reduction: Rationale, Treatment Description, and a Case Report

    ERIC Educational Resources Information Center

    Stotts, Angela L.; Masuda, Akihiko; Wilson, Kelly

    2009-01-01

    Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from an MM client who voluntarily participated in an Acceptance and…

  1. Early Intervention and Treatment Acceptability: Multiple Perspectives for Improving Service Delivery in Home Settings.

    ERIC Educational Resources Information Center

    Paget, Kathleen D.

    1991-01-01

    This article examines issues related to treatment acceptability in early intervention programs, by applying concepts pertaining to collaboration, cultural difference, compliance and freedom of choice, family life cycles, and systems theory. A paradigm for designing home-based intervention plans with families of preschoolers with behavior disorders…

  2. Experiential acceptance, motivation for recovery, and treatment outcome in eating disorders

    PubMed Central

    Espel, Hallie M.; Goldstein, Stephanie P.; Manasse, Stephanie M.; Juarascio, Adrienne S.

    2016-01-01

    Purpose This study sought to test whether the relationship between experiential acceptance (EA) and treatment outcome among eating disorder (ED) patients was mediated by motivation. Methods Upon admission to a residential ED treatment facility, female patients completed measures of EA, motivation, and baseline ED symptom severity (covariate); symptom severity was reassessed at discharge. Results Higher levels of baseline EA predicted significantly greater symptom reduction during treatment. Moreover, results from bootstrapped mediation analyses indicated that the relationship between EA and treatment outcome was partially mediated by motivation: increased EA was associated with greater motivation to give up ED behaviors at the beginning of treatment, and this led to greater symptom reduction from admission to discharge. Conclusions Motivation appears to be one mechanism by which EA facilitates improved treatment outcomes in EDs. Further development of interventions that promote EA as a means for improving motivation and subsequent ED treatment response may be warranted. PMID:26511501

  3. Imaging Modalities for Assessment of Treatment Response to Nonsurgical Hepatocellular Carcinoma Therapy: Contrast-Enhanced US, CT, and MRI.

    PubMed

    Minami, Yasunori; Kudo, Masatoshi

    2015-03-01

    Tumor response and time to progression have been considered pivotal for surrogate assessment of treatment efficacy for patients with hepatocellular carcinoma (HCC). Recent advancements in imaging modalities such as contrast-enhanced ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are playing an important role in assessing the therapeutic effects of HCC treatments. According to some HCC clinical guidelines, post-therapeutic evaluation of HCC patients is based exclusively on contrast-enhanced dynamic imaging criteria. The recommended techniques are contrast-enhanced CT or contrast-enhanced MRI. Contrast-enhanced US is employed more in the positive diagnosis of HCC than in post-therapeutic monitoring. Although contrast enhancement is an important finding on imaging, enhancement does not necessarily depict the same phenomenon across modalities. We need to become well acquainted with the characteristics of each modality, including not only contrast-enhanced CT and MRI but also contrast-enhanced US. Many nonsurgical treatment options are now available for unresectable HCC, and accurate assessment of tumor response is essential to achieve favorable outcomes. For the assessment of successful radiofrequency ablation (RFA), the achievement of a sufficient ablation margin as well the absence of tumor vascular enhancement is essential. To evaluate the response to transcatheter arterial chemoembolization (TACE), enhanced tumor shrinkage is relied on as a measure of antitumor activity. Here, we give an overview of the current status of imaging assessment of HCC response to nonsurgical treatments including RFA and TACE.

  4. Treatment Outcomes of Locally Advanced Oropharyngeal Cancer: A Comparison Between Combined Modality Radio-Chemotherapy and Two Variants of Single Modality Altered Fractionation Radiotherapy

    SciTech Connect

    Kader, Hosam A.; Mydin, Aminudin R.; Wilson, Matthew; Alexander, Cheryl; Shahi, Jeevin; Pathak, Irvin; Wu, Jonn S.; Truong, Pauline T.

    2011-07-15

    Purpose: To compare outcomes in patients with locally advanced oropharyngeal cancer treated with radio-chemotherapy (RT-CT), accelerated fractionation radiotherapy (AccRT), or hypofractionated radiotherapy (HypoRT). Methods and Materials: Subjects were 321 consecutive patients with newly diagnosed oropharyngeal cancer, Stage III or IVA/B, treated between January 2001 and December 2005 at the BC Cancer Agency with RT-CT (n = 157), AccRT (n = 57), or HypoRT (n = 107). Outcomes examined were disease-specific survival (DSS), locoregional control (LRC), overall survival (OS), rate of G-tube use, and rate of hospitalization for acute complications. Results: Median follow-up was 3.4 years. Three-year Kaplan-Meier DSS with RT-CT, AccRT, and HypoRT were 80%, 81%, and 74%, respectively (p = 0.219). Cox regression analysis identified treatment modality as a significant factor affecting DSS (p = 0.038). Compared with RT-CT, the hazard ratio (HR) for DSS was 1.0 with AccRT and 2.0 with HypoRT (p = 0.021). Kaplan-Meier pairwise comparisons found no significant difference in LRC and OS between RT-CT and AccRT. HypoRT was associated with significantly lower LRC (p = 0.005) and OS (p = 0.008) compared with RT-CT. There were significant differences in the rates of G-tube use (p < 0.001) and of hospitalization (p = 0.036) among the three treatment groups, with the most frequent rates observed in the RT-CT group. Conclusions: In patients with locally advanced oropharyngeal cancer, AccRT conferred DSS, LRC, and OS comparable to that of RT-CT. Patients treated with RT-CT experienced higher rates of treatment-related acute toxicities. HypoRT was associated with the least favorable outcomes.

  5. Different modalities for treatment of recurrent aphthous stomatitis. A Randomized clinical trial

    PubMed Central

    Nasry, Sherine A.; El Shenawy, Hanaa M.; Mostafa, Dina; Ammar, Nagwa M.

    2016-01-01

    Background The underlying etiology of recurrent aphthous stomatitis (RAS) is unclear and treatment aims to provide symptomatic and faster relief. This study compared the efficacy of diode laser, a herbal combination of Acacia nilotica and Licorice (A and L) and Amlexanox in the management of RAS. Material and Methods Sixty patients with minor aphthae were selected and randomly divided into four groups of 15 each. Group I and II received adhesive preparations of a herbal mixture of A and L and a 2 mg Amlexanox paste respectively, group III received diode laser and the fourth group (control) used a placebo. Ulcer size, pain score were recorded on days 1, 2 and 5. Results Laser group showed the statistically highest mean percentage (%) of reduction in pain scores and ulcer size than the other groups. The mean % of reduction in pain scores was 43.3+20.0 at day 2 and 67.8+21.5 % at day 5 in the laser group while Amlexanox group demonstrated a 29.8 +11.3 and 61.9+24.5 mean % of reduction in pain scores at day 2 and 5 respectively. A and L group showed a lower mean % of reduction in pain scores than laser and Amlexanox groups with a 22.2+10.5 and 43.4+15.8 mean % reduction in pain scores at day 2 and day 5 respectively. Similarly the highest mean % of reduction in ulcer size was seen in the laser group being 52.7+19.8 at day 2 and 85.1+22.0 at day 5, while it was 48.1+16.5 at day 2 and 77.8+28.7 at day 5 in the Amlexanox group and 42.0+11.5 at day 2 and 63.0+20.5 at day 5 in the A and L group. Conclusions All treatment modalities reduced pain and ulcer size than placebo group. Laser therapy demonstrated the highest percentage of reduction of pain score and ulcer size. Key words:Aphthous stomatitis, laser, herbal plants, Acacia nilotica, Licorice. PMID:27957263

  6. Equivalence in Dose Fall-Off for Isocentric and Nonisocentric Intracranial Treatment Modalities and Its Impact on Dose Fractionation Schemes

    SciTech Connect

    Ma Lijun; Sahgal, Arjun; Descovich, Martina; Cho, Y.-B.; Chuang, Cynthia; Huang, Kim; Laperriere, Normand J.; Shrieve, Dennis C.; Larson, David A.

    2010-03-01

    Purpose: To investigate whether dose fall-off characteristics would be significantly different among intracranial radiosurgery modalities and the influence of these characteristics on fractionation schemes in terms of normal tissue sparing. Methods and Materials: An analytic model was developed to measure dose fall-off characteristics near the target independent of treatment modalities. Variations in the peripheral dose fall-off characteristics were then examined and compared for intracranial tumors treated with Gamma Knife, Cyberknife, or Novalis LINAC-based system. Equivalent uniform biologic effective dose (EUBED) for the normal brain tissue was calculated. Functional dependence of the normal brain EUBED on varying numbers of fractions (1 to 30) was studied for the three modalities. Results: The derived model fitted remarkably well for all the cases (R{sup 2} > 0.99). No statistically significant differences in the dose fall-off relationships were found between the three modalities. Based on the extent of variations in the dose fall-off curves, normal brain EUBED was found to decrease with increasing number of fractions for the targets, with alpha/beta ranging from 10 to 20. This decrease was most pronounced for hypofractionated treatments with fewer than 10 fractions. Additionally, EUBED was found to increase slightly with increasing number of fractions for targets with alpha/beta ranging from 2 to 5. Conclusion: Nearly identical dose fall-off characteristics were found for the Gamma Knife, Cyberknife, and Novalis systems. Based on EUBED calculations, normal brain sparing was found to favor hypofractionated treatments for fast-growing tumors with alpha/beta ranging from 10 to 20 and single fraction treatment for abnormal tissues with low alpha/beta values such as alpha/beta = 2.

  7. Relationship status acceptance, alcohol use, and the perpetration of verbal aggression among males mandated to treatment for intimate partner violence.

    PubMed

    Crane, Cory A; Hawes, Samuel W; Oberleitner, Lindsay M S; Mandel, Dolores; Easton, Caroline J

    2013-09-01

    Forty substance using, male offenders of intimate partner violence completed measures of alcohol use and relationship status acceptance during a pretreatment screening session. They also completed a measure of verbal aggression after each month of a 12-week intervention program. Treatment length, heavy episodic drinking, and relationship status acceptance were used to assess the frequency of verbal aggression at each of the four assessment periods in a repeated measures ANCOVA. Main effects were detected for both alcohol and acceptance variables such that greater verbal aggression was observed among participants with a recent history of heavy episodic drinking and failure to accept the status of the relationship with their female victim. The interaction between time in treatment and relationship status acceptance was significant and showed that participants who accepted their relationship status reported low verbal aggression across measurement occasions while those who did not accept their relationship status reported high initial verbal aggression that decreased over treatment.

  8. Team acceptance of specific recommendations for the treatment of VPI as provided by speech pathologists.

    PubMed

    Dixon-Wood, V L; Williams, W N; Seagle, M B

    1991-07-01

    This retrospective study describes the frequency of one team's acceptance of speech pathologists' recommendations for specific secondary treatment procedures for the correction of VPI for 100 consecutive patients. In addition, assessment was made of the level of success in eliminating VPI relative to treatments utilized that were recommended by speech pathologists versus level of success when treatment other than that recommended by speech pathologists were used. For the 78 patients who received the treatment procedure recommended by speech pathologists, only 10 percent continued to demonstrate any clinically significant residual speech problem associated with VPI. However, for the 22 patients who received treatment other than that which had been recommended, 32 percent continued to demonstrate clinically significant speech problems associated with VPI. Data is presented on the success rate for correcting VPI relative to specific treatment recommendations including pharyngeal flap, palatal pushback, pharyngeal wall implant, tonsillectomy, prosthetic palatal lifts, and speech therapy.

  9. Efficacy, acceptability and cost effectiveness of four therapeutic agents for treatment of scabies.

    PubMed

    Abdel-Raheem, Talal A; Méabed, Eman M H; Nasef, Ghada A; Abdel Wahed, Wafaa Y; Rohaim, Rania M A

    2016-10-01

    The aim of this study is to evaluate four drug regimens for treatment of scabies as regard their efficacy, acceptability and cost effectiveness. Two hundred cases with ordinary scabies were randomized into four groups. First group received ivermectin 200 μg/kg body weight single oral dose, repeated after one week. The second received benzyl benzoate 20% cream. The third received permethrin 2.5%-5% lotion, whereas the fourth group received 5-10% sulfur ointment. Topical treatments were applied for five consecutive nights. Patients were followed up for two weeks for cure rate and adverse effects. At the end of the study, permethrin provided a significant efficacy of 88% and acceptability in 100% of cases, but had higher cost to treat one case (20.25 LE). Ivermectin provided efficacy and acceptability rates of 84% and 96%, respectively, and had a cheaper cost (9.5 LE). Benzyl benzoate provided 80% for both rates and was the cheapest drug. Sulfur ointment provided the least rates, and it was the most expensive. Treatment choice will depend on the age, the general condition of cases, patient compliance to topical treatment and his ability to stick to its roles, and the economic condition of the patient.

  10. SU-E-T-410: Evaluation of Treatment Modalities for Stereotactic Lung Radiation Therapy: A Phantom Study

    SciTech Connect

    Mohatt, D; Malhotra, H

    2015-06-15

    Purpose: To evaluate and verify the accuracy of alternative treatment modalities for stereotactic lung therapy with end-to-end testing. We compared three dimensional conformal therapy (3DCRT), dynamic conformal arc therapy (DCAT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) treatment using 6 MV, 6 MV flattening filter free (FFF) and 10 MV FFF photons. Methods: A QUASAR respiratory motion phantom was utilized with custom ion chamber and gafchromatic EBT2 film inserts. The phantom contained a low density lung medium with a cylindrical polystyrene tumor (35 cc). Pseudo representative structures for various organs at risk (OAR) were created. All treatment plans were created using Eclipse ver. 11 using the same image and structure sets, and delivered via Varian TrueBeam STx linear accelerator equipped with high definition MLC. Evaluation of plan quality followed ROTG 0813 criterion for conformity index (CI100%), high dose spillage, D2cm, and R50%. Results: All treatment plans met the OAR dose constraints per protocol and could be delivered without any beam hold offs or other interlocks and hence were deemed clinically safe. For equivalent beam energies, target conformity was improved for all modalities when switching to FFF mode. Treatment efficiency increased for VMAT FFF by a factor of 3–4 over IMRT, and up to factor of 7 when compared to 3DCRT. Pass rates were > 97% for all treatment using gamma criteria of 3%, 3mm. Absolute dose at iso-center was verified with ion chamber, and found to be within 2% of the treatment planning system. Conclusion: The higher dose rate associated with FFF not only reduces delivery times, but in most cases enhances plan quality. The one modality with succeeding best results for all RTOG criterions was VMAT 6 MV FFF. This end-to-end testing provides necessary confidence in the entire dose delivery chain for lung SBRT patients.

  11. Memory Characteristics and Modality in Multimedia Learning: An Aptitude-Treatment-Interaction Study

    ERIC Educational Resources Information Center

    Seufert, Tina; Schutze, Maren; Brunken, Roland

    2009-01-01

    According to the modality effect in multimedia, a text accompanying a picture should be auditorily presented instead of visually in order to avoid split of attention. In two experimental studies (34 and 78 participants, respectively), the impact and possible compensatory effects of two aptitude variables, that is, memory strategy skills and…

  12. Treatment Acceptability of Behavioral Interventions for Children: An Assessment by Mothers of Children with Disruptive Behavior Disorders.

    ERIC Educational Resources Information Center

    Jones, Melanie L.; Eyberg, Sheila M.; Adams, Christina D.; Boggs, Stephen R.

    1998-01-01

    Study assesses the acceptability of six child-management interventions as rated by mothers (N=20) of children referred for treatment for a disruptive-behavior disorder. Positive reinforcement was rated as a more acceptable treatment than response time, time-out, differential attention, overcorrection, and spanking. Results validate findings of…

  13. The feasibility and acceptability of virtual environments in the treatment of childhood social anxiety disorder

    PubMed Central

    Wong, Nina; Beidel, Deborah C.; Spitalnick, Josh

    2013-01-01

    Objective Two significant challenges for the dissemination of social skills training programs are the need to assure generalizability and provide sufficient practice opportunities. In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This study evaluated the utility of an interactive virtual school environment for the treatment of social anxiety disorder in preadolescent children. Method Eleven children with a primary diagnosis of social anxiety disorder between 8 to 12 years old participated in this initial feasibility trial. All children were treated with Social Effectiveness Therapy for Children, an empirically supported treatment for children with social anxiety disorder. However, the in vivo peer generalization sessions and standard parent-assisted homework assignments were substituted by practice in a virtual environment. Results Overall, the virtual environment programs were acceptable, feasible, and credible treatment components. Both children and clinicians were satisfied with using the virtual environment technology, and children believed it was a high quality program overall. Additionally, parents were satisfied with the virtual environment augmented treatment and indicated that they would recommend the program to family and friends. Conclusion Virtual environments are viewed as acceptable and credible by potential recipients. Furthermore, they are easy to implement by even novice users and appear to be useful adjunctive elements for the treatment of childhood social anxiety disorder. PMID:24144182

  14. The feasibility and acceptability of virtual environments in the treatment of childhood social anxiety disorder.

    PubMed

    Sarver, Nina Wong; Beidel, Deborah C; Spitalnick, Josh S

    2014-01-01

    Two significant challenges for the dissemination of social skills training programs are the need to assure generalizability and provide sufficient practice opportunities. In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This study evaluated the utility of an interactive virtual school environment for the treatment of social anxiety disorder in preadolescent children. Eleven children with a primary diagnosis of social anxiety disorder between 8 to 12 years old participated in this initial feasibility trial. All children were treated with Social Effectiveness Therapy for Children, an empirically supported treatment for children with social anxiety disorder. However, the in vivo peer generalization sessions and standard parent-assisted homework assignments were substituted by practice in a virtual environment. Overall, the virtual environment programs were acceptable, feasible, and credible treatment components. Both children and clinicians were satisfied with using the virtual environment technology, and children believed it was a high-quality program overall. In addition, parents were satisfied with the virtual environment augmented treatment and indicated that they would recommend the program to family and friends. Findings indicate that the virtual environments are viewed as acceptable and credible by potential recipients. Furthermore, they are easy to implement by even novice users and appear to be useful adjunctive elements for the treatment of childhood social anxiety disorder.

  15. Generation of Composite Dose and Biological Effective Dose (BED) Over Multiple Treatment Modalities and Multistage Planning Using Deformable Image Registration

    SciTech Connect

    Zhang, Geoffrey Huang, T-C; Feygelman, Vladimir; Stevens, Craig; Forster, Kenneth

    2010-07-01

    Currently there are no commercially available tools to generate composite plans across different treatment modalities and/or different planning image sets. Without a composite plan, it may be difficult to perform a meaningful dosimetric evaluation of the overall treatment course. In this paper, we introduce a method to generate composite biological effective dose (BED) plans over multiple radiotherapy treatment modalities and/or multistage plans, using deformable image registration. Two cases were used to demonstrate the method. Case I was prostate cancer treated with intensity-modulated radiation therapy (IMRT) and a permanent seed implant. Case II involved lung cancer treated with two treatment plans generated on two separate computed tomography image sets. Thin-plate spline or optical flow methods were used as appropriate to generate deformation matrices. The deformation matrices were then applied to the dose matrices and the resulting physical doses were converted to BED and added to yield the composite plan. Cell proliferation and sublethal repair were considered in the BED calculations. The difference in BED between normal tissues and tumor volumes was accounted for by using different BED models, {alpha}/{beta} values, and cell potential doubling times. The method to generate composite BED plans presented in this paper provides information not available with the traditional simple dose summation or physical dose summation. With the understanding of limitations and uncertainties of the algorithms involved, it may be valuable for the overall treatment plan evaluation.

  16. Acceptance and Commitment Therapy and Behavioral Activation for the Treatment of Depression: Description and Comparison

    PubMed Central

    Kanter, Jonathan W; Baruch, David E; Gaynor, Scott T

    2006-01-01

    The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the “common cold” of outpatient populations. Two treatments for depression have emerged: acceptance and commitment therapy (ACT) and behavioral activation (BA). At times ACT and BA may suggest largely redundant intervention strategies. However, at other times the two treatments differ dramatically and may present opposing conceptualizations. This paper will compare and contrast these two important treatment approaches. Then, the relevant data will be presented and discussed. We will end with some thoughts on how and when ACT or BA should be employed clinically in the treatment of depression. PMID:22478462

  17. Post-traumatic stress disorder: cognitive hypnotherapy, mindfulness, and acceptance-based treatment approaches.

    PubMed

    Lynn, Steven Jay; Malakataris, Anne; Condon, Liam; Maxwell, Reed; Cleere, Colleen

    2012-04-01

    In this article, we describe how cognitive hypnotherapy can be used in conjunction with evidence-based practices for the treatment of post-traumatic stress disorder (PTSD). We review cognitive-behavioral interventions for PTSD, including mindfulness and acceptance-based approaches, and contend that (a) empirical support for the use of hypnosis in treating a variety of conditions is considerable; (b) hypnosis is fundamentally a cognitive-behavioral intervention; (c) psychological interventions with a firm footing in cognitive-behavioral therapy (CBT) are well-suited to treat the symptoms of PTSD; and (d) hypnosis can be a useful adjunct to evidence-based cognitive-behavioral approaches, including mindfulness and acceptance-based interventions, for treating PTSD.

  18. Does the use of telemental health alter the treatment experience? Inmates' perceptions of telemental health versus face-to-face treatment modalities.

    PubMed

    Morgan, Robert D; Patrick, Amber R; Magaletta, Philip R

    2008-02-01

    In corrections, where staffing limitations tax an overburdened mental health system, telemental health is an increasingly common mode of mental health service delivery. Although telemental health presents an efficient treatment modality for a spectrum of mental health services, it is imperative to study how this modality influences key elements of the treatment experience. In this study, the authors compared inmates' perceptions of the working alliance, postsession mood, and satisfaction with psychiatric and psychological mental health services delivered through 2 different modalities: telemental health and face-to-face. Participants consisted of 186 inmates who received mental health services (36 via telepsychology, 50 via face-to-face psychology, 50 via telepsychiatry, and 50 via face-to-face psychiatry). Results indicate no significant differences in inmates' perceptions of the work alliance with the mental health professional, postsession mood, or overall satisfaction with services when telemental health and face-to-face modalities were compared within each type of mental health service. Implications of these findings are presented.

  19. Concurrent Treatment for Adolescent and Parent Depressed Mood and Suicidality: Feasibility, Acceptability, and Preliminary Findings

    PubMed Central

    Wolff, Jennifer C.; Seaboyer, Lourah M.; Hunt, Jeffrey; Esposito-Smythers, Christianne; Nugent, Nicole; Zlotnick, Caron; Miller, Ivan

    2015-01-01

    Abstract Objective: The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]). Methods: A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSM-IV criteria for current or past MDE. Results: The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent–adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups. Conclusions: The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a

  20. Removal kinetics of antibodies against glutamic acid decarboxylase by various plasmapheresis modalities in the treatment of neurological disorders.

    PubMed

    Ohkubo, Atsushi; Okado, Tomokazu; Kurashima, Naoki; Maeda, Takuma; Miyamoto, Satoko; Nakamura, Ayako; Seshima, Hiroshi; Iimori, Soichiro; Sohara, Eisei; Uchida, Shinichi; Rai, Tatemitsu

    2014-06-01

    Plasmapheresis is one of the acute treatment modalities for neurological disorders associated with antibodies against glutamic acid decarboxylase (anti-GAD). However, there is little information about the removal kinetics of anti-GAD by various plasmapheresis modalities. Here, we investigated the removal rate of anti-GAD and fibrinogen (Fib) by immunoadsorption (IA), plasma exchange using a conventional plasma separator (OP-PE), and plasma exchange using a high cut-off selective membrane plasma separator (EC-PE) in two cases of anti-GAD-associated neurological diseases. In case 1, IA and OP-PE were used, and the percent reductions were as follows: anti-GAD: 38.2% and 69.1% and Fib: 67.7% and 68.2%, respectively. In case 2, OP-PE and EC-PE were used, and the percent reductions were as follows: anti-GAD: 65.8% and 48.5% and Fib: 68.5% and 19.8%, respectively. OP-PE could remove anti-GAD more efficiently than IA. Further, EC-PE could maintain coagulation factors such as Fib better than IA and OP-PE. It is important to select the appropriate plasmapheresis modality on the basis of the removal kinetics.

  1. Comparative assessment of different treatment modalities in miners with vibration- and noise-induced disease

    SciTech Connect

    Velskaya, M.L.; Nekhorosheva, M.A.; Konovalova, S.I.; Kukhtina, G.V.; Gonchar, I.G.; Terentyeva, D.P.; Grishchenko, L.A.; Soboleva, N.P.; Kharitonov, S.A.; Priklonskiy, I.V.

    1985-02-01

    A group of 71 miners with vibration sickness and noise-induced pathology were managed either by standard methods, or in combination with acupuncture and/or hyperbaric oxygenation for a comparative assessment of the effectiveness of the different therapeutic approaches. Analysis of subjective factors as well as standard physiological parameters (EKG, rheoencephalography, peripheral rheography, EEG, neuropsychological tests) demonstrate that both acupuncture and hyperbaric oxygenation are effective modalities in the majority of the subjects. Nevertheless, the lack of improvement in certain criteria, or even what could be regarded as adverse sequelae, suggest that the use of hyperbaric oxygenation in the management of such disorders be approached with considerable care.

  2. Safety, Efficacy, and Patient Acceptability of Everolimus in the Treatment of Breast Cancer

    PubMed Central

    Lousberg, Laurence; Jerusalem, Guy

    2016-01-01

    Everolimus combined with exemestane is an important treatment option for patients suffering from estrogen receptor-positive, human epidermal growth factor receptor 2-negative, advanced breast cancer (ABC) who have been previously treated with a nonsteroidal aromatase inhibitor (NSAI). After presentation of phase III registration trial BOLERO-2, several phase IIIb trials have been started to evaluate this regimen in a more real-world setting. Here, we review the efficacy and safety data published or presented at selected international meetings. These studies confirmed the outcome observed in the BOLERO-2 trial. Patient acceptance rate is also discussed by focusing on the permanent everolimus discontinuation rate in these trials. Factors influencing the safety profile are also reported, including the impact of age. The optimal sequence of combined therapy approaches associating targeted and endocrine therapy (ET) has yet to be determined as new treatment options such as cyclin-dependent kinase inhibitors become available. However, everolimus–exemestane remains an important treatment option with a major impact on progression-free survival (PFS) and an acceptable safety profile. PMID:28096680

  3. Safety, Efficacy, and Patient Acceptability of Everolimus in the Treatment of Breast Cancer.

    PubMed

    Lousberg, Laurence; Jerusalem, Guy

    2016-01-01

    Everolimus combined with exemestane is an important treatment option for patients suffering from estrogen receptor-positive, human epidermal growth factor receptor 2-negative, advanced breast cancer (ABC) who have been previously treated with a nonsteroidal aromatase inhibitor (NSAI). After presentation of phase III registration trial BOLERO-2, several phase IIIb trials have been started to evaluate this regimen in a more real-world setting. Here, we review the efficacy and safety data published or presented at selected international meetings. These studies confirmed the outcome observed in the BOLERO-2 trial. Patient acceptance rate is also discussed by focusing on the permanent everolimus discontinuation rate in these trials. Factors influencing the safety profile are also reported, including the impact of age. The optimal sequence of combined therapy approaches associating targeted and endocrine therapy (ET) has yet to be determined as new treatment options such as cyclin-dependent kinase inhibitors become available. However, everolimus-exemestane remains an important treatment option with a major impact on progression-free survival (PFS) and an acceptable safety profile.

  4. LANL Waste acceptance criteria, Chapter 3, radioactive liquid waste treatment facility

    SciTech Connect

    McClenahan, Robert L.

    2006-08-01

    The Radioactive Liquid Waste Treatment Facility (RLWTF) receives and treats aqueous radioactive wastewater generated at Los Alamos National Laboratory (LANL) to meet he discharge criteria specified in a National Pollution Discharge Elimination System (NPDES) permit. The majority of this wastewater is received at the RLWTF through a network of buried pipelines, known as the Radioactive Liquid Waste Collection System (RLWCS). Other wastewater is transported to the RLWTF by truck. The Waste Acceptance Criteria (WAC) outlined in this Chapter are applicable to all radioactive wastewaters which are conveyed to the Technical Area 50(T A-50), RL WTF by the RLWCS or by truck.

  5. Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970–2009

    PubMed Central

    2013-01-01

    Background The optimal treatment of complex, displaced proximal humeral fractures is controversial. A systematic literature review of the time period from 1970 to 2009 was conducted. The purpose was to evaluate the clinical success and complications of the available treatment modalities to determine specific treatment recommendations for the different fracture patterns. Methods The databases (PubMed/EMBASE) were searched for the time period (01/1970–09/2009). Study quality, treatment modalities, classification, outcome scores and complications of 200 publications including 9377 patients were analyzed. Interventions were compared by analysis of variance with subsequent Tukey’s-test. Complication rates among methods were compared by using Pearson’s-chi-square-test and pairwise comparisons using Fisher’s-two-tailed-exact-test. Results Hemiarthroplasty, angle-stable plate and non-operative treatment were used for 63% of the follow-up-patients. For 3- and 4-part fractures, patients with hemiarthroplasty [3-Part: 56.4 (lower/upper 95% confidence interval (CI): 43.3-68.7); 4-Part: 49.4 (CI: 42.2-56.7)] received a lower score than different surgical head-preserving methods such as ORIF [3-Part: 82.4 (CI: 76.6-86.9); 4-Part: 83.0 (CI:78.7-86.6)], intramedullary nailing [3-Part: 79.1 (CI:74.0-83.4)] or angle-stable plates [4-Part: 66.4 (CI: 59.7-72.4)]. The overall complication rate was 56%. The most common complications were fracture-displacement, malunion, humeral head necrosis and malreduction. The highest complication rates were documented for conventional plate and hemiarthroplasty and for AO-C, AO-A, for 3- and 4-part fractures. Only 25% of the data were reported with detailed classification results and the corresponding outcome scores. Discussion Despite the large amount of patients included, it is difficult to determine adequate recommendations for the treatment of proximal humeral fractures because a relevant lack of follow-up data impaired subsequent

  6. Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda

    PubMed Central

    Mayanja, Yunia; Mukose, Aggrey David; Nakubulwa, Susan; Omosa-Manyonyi, Gloria

    2016-01-01

    Background The prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance. Methods We enrolled 241 FSWs in a cross sectional study; they were aged ≥ 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. Mantel-Haenszel tests for interaction were performed. Results Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning ≤ $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education. Conclusion Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment. PMID:27171270

  7. College Students' Perceptions of Treatment Acceptability of How College Professors Deal with Disruptive Talking in the Classroom

    ERIC Educational Resources Information Center

    Carter, Stacy L.; Punyanunt-Carter, Narissra Maria

    2009-01-01

    This study focused on various treatments for addressing the classroom misbehavior of disruptive talking during class lecture. The findings revealed that students found some methods of addressing this problem behavior by the instructor more acceptable than other methods of treating the behavior. College students rated the most acceptable instructor…

  8. Understanding the tissue interaction of new treatment modalities in laparoscopic surgery in view of safe and effective application (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Grimbergen, Matthijs C. M.; Klaessens, John H.; van der Veen, Albert J.; Verdaasdonk, Rudolf M.

    2016-03-01

    During laparoscopic surgery, devices are require to either cut, ablate or coagulate tissue and veins with high precision and controlled lateral damage preferably in an one-for-all modality. The tissue interactions of 3 new treatment modalities were studied using special imaging techniques to obtain a better understanding the working mechanism in view of effective and safe application. The Plasmajet produces a high temperature ionized gas 'flame' directed to the tissue surface at the tip of a 4 mm diameter rigid hand piece. The Lumenis DUO CO2 laser enables endoscopic laser energy delivery through a 1 mm outer diameter flexible hollow waveguide. The 2 µm 'Thulium' laser is delivered by (standard) 400 µm diameter optical fiber. Thermal imaging and Schlieren techniques were used to assess the superficial ablative and coagulation effects these surgical instruments scanning at preset velocities and distances from the surface of biological tissues and phantoms . The CO2 was very effective in tissue ablation even at a distance up to 10 mm due to a very small diverging beam from the hollow waveguide. In contrast, the Thulium laser showed less ablation and increasing coagulation at larger distance to the tissue. The gas 'flame' of the Plasmajet spread the thermal energy over the surface for effective superficial ablation and coagulation. However, the pressure of the gas flow is substantial on the tissue surface creating turbulence and even indirect cooling. The specific ablation and coagulation effects of the three treatment modalities have to be appreciate and the effective and safe application will depend on the preference and skills of the surgeon

  9. SU-E-T-178: Experimental Study of Acceptable Movement Conditions for SBRT Lung Treatments

    SciTech Connect

    Carrasco de Fez, P; Ruiz-Martinez, A; Jornet, N; Eudaldo, T; Latorre-Musoll, A; Ribas, Morales M

    2014-06-01

    Purpose: To experimentally study the acceptable movement conditions for SBRT lung treatments we quantified with film dosimetry the change in dose distributions due to periodic movements of 5 different amplitudes and 4 respiratory gating duty cycles on a SBRT treatment plan. Methods: We planned a SBRT treatment plan for the QUASAR™ (Modus Medical) phantom equipped with the respiratory motion device. We placed a 3 mm water-equivalent sphere simulating a tumour inside the lung-equivalent insert. This sphere is divided in two hemispheres that allow placing films in between. We used radiochromic EBT2™ (Ashland) films. We oriented the lung insert in such a way that sagittal dose distributions could be measured. We applied a sinusoidal movement with 3 s period for 5 different amplitudes of 0(static), 5, 7, 10, 15 and 20 mm without gating. For the 20 mm amplitude we studied the gating technique with 4 duty cycles of 20, 40, 60 and 80% of the respiratory cycle. Each situation was irradiated in a Clinac 2100 linac (Varian) equipped with the RPM™ system. FilmQA Pro™ (Ashland) software together with an Expression 10000XL scanner (EPSON) were used to analyze and compare the measured dose distributions with those planned by the Eclipse™ TPS v. 8.9 (Varian) by means of gamma analysis with 6 criteria: 5%/3mm, 5%/2mm, 5%/1mm, 3%/3mm, 3%/2mm and 2%/2mm (threshold of 10%). Results: Movements with amplitude of less than 7mm do not significantly modified the dosimetry. Gating duty cycles of less than 40% yielded also acceptable results for a 2 cm amplitude movement. Conclusion: To safely perform daily accurate SBRT treatments, movements have to be restricted to 7 mm amplitude (±3.5 mm). Otherwise, a gating strategy should be considered.

  10. Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities

    PubMed Central

    Jerjes, Waseem; Upile, Tahwinder; Abbas, Syedda; Kafas, Panagiotis; Vourvachis, Michael; Rob, Jubli; Mc Carthy, Eileen; Angouridakis, Nikolaos; Hopper, Colin

    2008-01-01

    This review explores the aetiology of temporomandibular disorders and discusses the controversies in variable treatment modalities. Pathologies of the temporomandibular joint (TMJ) and its' associated muscles of mastication are jointly termed temporomandibular disorders (TMDs). TMDs present with a variety of symptoms which include pain in the joint and its surrounding area, jaw clicking, limited jaw opening and headaches. It is mainly reported by middle aged females who tend to recognize the symptoms more readily than males and therefore more commonly seek professional help. Several aetiological factors have been acknowledged including local trauma, bruxism, malocclusion, stress and psychiatric illnesses. The Research Diagnostic Criteria of the Temporomandibular Disorders (RDC/TMD) is advanced to other criteria as it takes into consideration the socio-psychological status of the patient. Several treatment modalities have been recommended including homecare practices, splint therapy, occlusal adjustment, analgesics and the use of psychotropic medication; as well as surgery, supplementary therapy and cognitive behavioural therapy. Although splint therapy and occlusal adjustment have been extensively used, there is no evidence to suggest that they can be curative; a number of evidence-based trials have concluded that these appliances should not be suggested as part of the routine care. Surgery, except in very rare cases, is discouraged since it is the most invasive alternative; recent studies have shown healthier outcome with cognitive behavioural therapy. PMID:18973654

  11. Acceptance and commitment therapy as a treatment for problematic internet pornography viewing.

    PubMed

    Twohig, Michael P; Crosby, Jesse M

    2010-09-01

    Despite the prevalence of problematic Internet pornography viewing and the breadth of intervention approaches to potentially address it, no studies to address this problem have been reported to date. An emerging treatment approach, Acceptance and Commitment Therapy (ACT), holds promise as a treatment for Internet pornography viewing because of its focus on processes hypothesized to underlie this maladaptive behavior. In the first experiment on the treatment of problematic Internet pornography viewing, 6 adult males who reported that their Internet pornography viewing was affecting their quality of life were treated in eight 1.5-hour sessions of ACT for problematic pornography viewing. The effects of the intervention were assessed in a multiple-baseline-across-participants design with time viewing pornography as the dependent variable. Treatment resulted in an 85% reduction in viewing at posttreatment with results being maintained at 3-month follow-up (83% reduction). Increases were seen on measures of quality of life, and reductions were seen on measures of OCD and scrupulosity. Weekly measures of ACT-consistent processes showed reductions that corresponded with reductions in viewing. Large reductions were seen on a measure of psychological flexibility, and minor reductions were seen on measures of thought-action fusion and thought control. Overall, results suggest the promise of ACT as a treatment for problematic Internet pornography viewing and the value of future randomized trials of this approach.

  12. Reluctance to Accept Alcohol Treatment by Alcoholic Liver Disease Transplant Patients: A Qualitative Study

    PubMed Central

    Heyes, Cathy M.; Schofield, Toni; Gribble, Robert; Day, Carolyn A.; Haber, Paul S.

    2016-01-01

    Background Liver transplantation (LT) is the optimum treatment for patients with end-stage alcoholic liver disease (ALD). However, despite a recognized risk of relapse to harmful drinking, ALD transplant patients are reluctant to use speciality alcohol treatment to support their abstinence, even when offered within the LT context. This study aimed to understand and identify factors contributing to alcohol treatment reluctance by ALD patients undergoing transplantation. Methods We conducted an in-depth qualitative study of ALD transplant patients. Minimally structured face-to-face interviews explored participants' alcohol-related experiences and their reasons for not using alcohol treatment during the course of their transplantation. Thematic analysis was used to analyze and interpret interview data to understand treatment reluctance based on participants' experiences. Results Five major themes were identified among 3 subgroups of patients (pretransplant and posttransplant abstainers and posttransplant relapsers): (i) the “contract” of mandatory abstinence, (ii) the “gap in the program” involving the lack of candour between patient and staff about alcohol-related matters and the lack of addiction services, (iii) a preference by participants to self-manage their alcohol use disorder, (iv) social support as a facilitator of abstinence and the risk of relapse when social support is diminished, and (v) the fear of stigmatization. Each of these factors were dynamically interrelated and differed slightly for each subgroup. Conclusions The LT services may benefit from the inclusion of integrated specialist addiction services in their model of care. Such an approach may enhance the acceptability of alcohol treatment and reduce the risk of relapse among ALD transplant participants, especially for those whose social supports have diminished. PMID:27795986

  13. Theoretical and numerical treatment of modal instability in high-power core and cladding-pumped Raman fiber amplifiers.

    PubMed

    Naderi, Shadi; Dajani, Iyad; Grosek, Jacob; Madden, Timothy

    2016-07-25

    Raman fiber lasers have been proposed as potential candidates for scaling beyond the power limitations imposed on near diffraction-limited rare-earth doped fiber lasers. One limitation is the modal instability (MI) and we explore the physics of this phenomenon in Raman fiber amplifiers (RFAs). By utilizing the conservation of number of photons and conservation of energy in the absence of loss, the 3 × 3 governing system of nonlinear equations describing the pump and the signal modal content are decoupled and solved analytically for cladding-pumped RFAs. By comparing the extracted signal at MI threshold for the same step index-fiber, it is found that the MI threshold is independent of the length of the amplifier or whether the amplifier is co-pumped or counter-pumped; dictated by the integrated heat load along the length of fiber. We extend our treatment to gain-tailored RFAs and show that this approach is of limited utility in suppressing MI. Finally, we formulate the physics of MI in core-pumped RFAs where both pump and signal interferences participate in writing the time-dependent index of refraction grating.

  14. Gain-switched 311-nm Ti:Sapphire laser might be a potential treatment modality for atopic dermatitis.

    PubMed

    Choi, Sun Young; Oh, Chang Taek; Kwon, Tae-Rin; Kwon, Hyun Jung; Choi, Eun Ja; Jang, Yu-Jin; Kim, Hye Sung; Chu, Hong; Mun, Seog Kyun; Kim, Myeung Nam; Kim, Beom Joon

    2016-09-01

    Phototherapy with 311-nm narrowband-UVB (NBUVB) is an effective adjuvant treatment modality for atopic dermatitis (AD). In this study, we evaluated the therapeutic effect of the newly developed gain-switched 311-nm Ti:Sapphire laser device using a NC/Nga mouse AD model. A total number of 50 mice were used in this study. Atopic dermatitis (AD) was induced in mice by exposure to Dermatophagoides farina. These, NC/Nga mice were then treated with conventional 311-nm NBUVB or the newly developed gain-switched 311-nm Ti:Sapphire laser. The clinical features, dermatitis severity scores, and scratching behavior were assessed. In addition, serologic analyses including inflammatory cytokines and histological analyses were performed. Gain-switched 311-nm Ti:Sapphire laser improved the AD-like skin lesions, severity, and symptoms of AD in the NC/Nga mouse model. This new laser also modulated the immune response found in the AD model, including hyper-IgE, upregulated Th2 cytokines, and the Th2-mediated allergic inflammatory reaction. Gain-switched 311-nm Ti:Sapphire laser shows therapeutic promise via an immune-modulation mechanism in an AD mouse model. These data suggest that gain-switched 311-nm Ti:Sapphire laser may be useful as a targeted phototherapy modality for AD.

  15. Risk of hospitalization for hypoglycemia among older Korean people with diabetes mellitus: Interactions between treatment modalities and comorbidities.

    PubMed

    Kim, Hyun Min; Seong, Jong-Mi; Kim, Jaetaek

    2016-10-01

    The objective of this study was to carry out a large population-based study to understand the factors associated with hypoglycemia-related hospitalizations among older Korean adults with diabetes mellitus.This study analyzed data from a subset of the 2013 Health Insurance and Review and Assessment service-Adult Patient Sample. A total of 307,170 subjects, comprising 41.7% men and 58.3% women, had diabetes mellitus. Hypertension (80.8%) was the most common comorbidity, and dyslipidemia (59.0%) and ischemic heart disease (21.3%) were also prevalent. Approximately half of the patients with diabetes had >2 comorbidities, and two-thirds of the patients had >3 comorbidities. The proportion of patients taking insulin or sulfonylureas was 54.9%, and 23.2% of the patients were taking other medications. About 21.9% of the patients were treated nonpharmacologically. A total of 2867 hypoglycemia-related admission occurred, the incident rate was 9.33 per 1000 person. The risk was higher among female patients and older patients with several comorbidities, including cardiovascular disease, cerebrovascular disease, chronic liver disease, chronic kidney disease, dementia, and malignancies. Treatment modalities, including insulin and sulfonylureas, were associated with a high risk of hypoglycemia. After adjustments for age, sex, the different comorbidities, and the treatment modalities, we determined that chronic kidney disease and dementia were associated with a high risk of hypoglycemia-related hospitalization (odds ratio [OR] = 2.52 and OR = 1.93, respectively). Furthermore, patients with chronic kidney disease or dementia who were treated with sulfonylureas and insulin had very high risks of hypoglycemia, and the incident rate was 66.6 and 63.75 per 1000 person, respectively.In conclusion, the presence of comorbidities, especially chronic kidney disease and dementia, increased the risk of hypoglycemia-associated hospitalization within this population of older patients

  16. Acceptance and commitment therapy in the treatment of anxiety: a systematic review.

    PubMed

    Swain, Jessica; Hancock, Karen; Hainsworth, Cassandra; Bowman, Jenny

    2013-12-01

    With a lifetime prevalence of approximately 17% among community-dwelling adults, anxiety disorders are among the most pervasive of contemporary psychiatric afflictions. Traditional Cognitive Behaviour Therapy (CBT) is currently the first line evidence-based psychosocial intervention for the treatment of anxiety. Previous research, however, has found that a significant proportion of patients do not respond to traditional CBT or exhibit residual symptomatology at treatment cessation. Additionally, there is a paucity of evidence among child populations and for the comparative effectiveness of alternative interventions. Acceptance and Commitment Therapy (ACT) has a growing empirical base demonstrating its efficacy for an array of problems. A systematic review was conducted to examine the evidence for ACT in the treatment of anxiety. PsycInfo, PsycArticles, PsycExtra, Medline and Proquest databases were searched, reference lists examined and citation searches conducted. Two independent reviewers analysed results, determined study eligibility and assessed methodological quality. Thirty-eight studies met inclusion criteria (total n=323). The spectrum of DSM-IV anxiety disorders as well as test and public speaking anxiety were examined. Studies were predominantly between-group design and case studies, with few employing control comparisons. Several methodological issues limit conclusions; however results provide preliminary support for ACT. Larger scale, methodologically rigorous trials are needed to consolidate these findings.

  17. USING HERBAL TEA IN THE TREATMENT MODALITY: SPECIAL REFERENCE TO SLIRNTEA IN OVERWEIGHT INDIVIDUALS

    PubMed Central

    Vidya, T.J.; Kulkarni, Kala Suhas

    2002-01-01

    Herbal tea blends were famed since ancient times for their medicinal value. There are many weight management methods available including certain drugs, which are however associated with side effects. Herb teas are an easy, safe and effective method for weight control. SlimTea is an herbal tea prepared by the Himalaya Drug company that offers an easy method of weight management in overweight individuals. A study with a group of 35 volunteers between 30-40 years of age and about 4-6 kgs overweight were treated with 2 cups of SlimTea daily, for a period of two months. Initial weight of each individual was compared with the weight at the end of the study. Results indicated a reduction in body weight by 2 kgs, along with decreased edema and a feeling of heaviness of the body. The herbal tea was accepted comfortably without side effects. Hence, SlimTea can be consumed for weight management. PMID:22557055

  18. Suction Evacuation with Methotrexate as a Successful Treatment Modality for Caesarean Scar Pregnancies

    PubMed Central

    Datta, Sumita; Jha, Chitra

    2015-01-01

    Pregnancy resulting from the implantation of an embryo within a scar of a previous Caesarean section is extremely rare. The diagnosis and treatment of Caesarean scar pregnancies (CSPs) are challenging and the optimal course of treatment is still to be determined. We report a case series of six patients with CSPs who presented to the Royal Hospital in Muscat, Oman, between October 2012 and April 2014. All of the patients were successfully treated with systemic methotrexate and five patients underwent suction evacuation either before or after the methotrexate administration. The patients were followed up for a period of 6–9 weeks after treatment and recovered completely without any significant complications. Suction evacuation with methotrexate can therefore be considered an effective treatment option with good maternal outcomes. PMID:26629384

  19. Deacetylase inhibitors as a novel modality in the treatment of multiple myeloma.

    PubMed

    Richardson, Paul G; Moreau, Philippe; Laubach, Jacob P; Maglio, Michelle E; Lonial, Sagar; San-Miguel, Jesus

    2017-03-01

    Deacetylase enzymes remove acetyl groups from histone and nonhistone proteins. Dysregulation of deacetylase activity is a hallmark of malignancy, including multiple myeloma (MM). Deacetylase inhibitors (DACi) cause epigenetic modification and inhibition of the aggresome pathway, resulting in death of MM cells. Panobinostat, a pan-DACi, has shown significant clinical benefit and is the first DACi approved for the treatment of MM. It is approved for use in combination with bortezomib and dexamethasone for the treatment of patients with relapsed or relapsed and refractory MM who have received ≥2 prior regimens including bortezomib and an immunomodulatory drug. Ricolinostat and ACY-241, which selectively inhibit HDAC6 and the aggresome pathway, are currently being studied in combination with dexamethasone and bortezomib or an immunomodulatory drug for the treatment of relapsed and refractory MM. In this review, we discuss the data from key clinical trials investigating deacetylase inhibitors as novel treatment options for MM.

  20. Educating Social Workers about the Use of Chemotherapy and Other Treatment Modalities.

    ERIC Educational Resources Information Center

    Friedman-Cohen, Nancy; Kenward, Kevin

    1981-01-01

    Literature relating to standardization of chemotherapy in treating severely mentally ill adolescents is reviewed. The extent of and reliance on chemotherapy for effective and prompt treatment and rehabilitation are questioned and further comparative research is suggested. (MSE)

  1. A Novel Therapeutic Modality for Advanced-Stage Prostate Cancer Treatment

    DTIC Science & Technology

    2015-10-01

    There is an urgent need to develop effective therapies for the treatment of advanced stage prostate cancer (PrCa) due to their limited or no response to...metastatic PrCa. Our results illustrated that ORM treatment effectively inhibited invasion and motility of PrCa cells. Further, we observed that ORM... effectively inhibits metastasis associated protein 1 (MTA1) in PrCa cells. MTA1 has been reported to be very tightly associated with cancer metastasis in

  2. Cancer rates, medical comorbidities, and treatment modalities in the oldest patients.

    PubMed

    Zeber, John E; Copeland, Laurel A; Hosek, Brandon J; Karnad, Anand B; Lawrence, Valerie A; Sanchez-Reilly, Sandra E

    2008-09-01

    Cancer disproportionately afflicts older patients, with 56% of incident diagnoses and 71% of deaths occurring in this population. Yet little is known about the "oldest of the old", oncology patients underrepresented in clinical trials. We examined elderly veterans diagnosed with lung, colorectal, prostate or head-neck cancer in 2005 (n=194,797), analyses comparing treatment receipt by age group, 70-84 versus 85-115. Treatment was more common among younger elders, including surgery (1.3% versus 0.6%), chemotherapy (2.1% versus 0.8%) and radiation (1.7% versus 0.7%). Differences were sharper for certain cancers, e.g., chemotherapy for lung (9.0% versus 2.9%), or colorectal surgery (5.8% versus 3.4%). Cancer prevalence is high among elders yet treatment rates appear extremely low, despite evidence of well-tolerated treatment. Toxicity concerns and comorbidities may inhibit pursuit of definitive treatment. As we reconcile definitions of 'elderly' with appropriate treatment options, compassionate care requires identifying geriatric oncology guidelines that improve survival and quality of life.

  3. Combined Modality Treatment for PET-Positive Non-Hodgkin Lymphoma: Favorable Outcomes of Combined Modality Treatment for Patients With Non-Hodgkin Lymphoma and Positive Interim or Postchemotherapy FDG-PET

    SciTech Connect

    Halasz, Lia M.; Jacene, Heather A.; Catalano, Paul J.; Van den Abbeele, Annick D.; LaCasce, Ann; Mauch, Peter M.; Ng, Andrea K.

    2012-08-01

    Purpose: To evaluate outcomes of patients treated for aggressive non-Hodgkin lymphoma (NHL) with combined modality therapy based on [{sup 18}F]fluoro-2-deoxy-2-D-glucose positron emission tomography (FDG-PET) response. Methods and Materials: We studied 59 patients with aggressive NHL, who received chemotherapy and radiation therapy (RT) from 2001 to 2008. Among them, 83% of patients had stage I/II disease. Patients with B-cell lymphoma received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)-based chemotherapy, and 1 patient with anaplastic lymphoma kinase-negative anaplastic T-cell lymphoma received CHOP therapy. Interim and postchemotherapy FDG-PET or FDG-PET/computed tomography (CT) scans were performed for restaging. All patients received consolidated involved-field RT. Median RT dose was 36 Gy (range, 28.8-50 Gy). Progression-free survival (PFS) and local control (LC) rates were calculated with and without a negative interim or postchemotherapy FDG-PET scan. Results: Median follow-up was 46.5 months. Thirty-nine patients had negative FDG-PET results by the end of chemotherapy, including 12 patients who had a negative interim FDG-PET scan and no postchemotherapy PET. Twenty patients were FDG-PET-positive, including 7 patients with positive interim FDG-PET and no postchemotherapy FDG-PET scans. The 3-year actuarial PFS rates for patients with negative versus positive FDG-PET scans were 97% and 90%, respectively. The 3-year actuarial LC rates for patients with negative versus positive FDG-PET scans were 100% and 90%, respectively. Conclusions: Patients who had a positive interim or postchemotherapy FDG-PET had a PFS rate of 90% at 3 years after combined modality treatment, suggesting that a large proportion of these patients can be cured with consolidated RT.

  4. Treatment Outcome of Combined Modalities for Buccal Cancers: Unilateral or Bilateral Neck Radiation?

    SciTech Connect

    Lin, C.-Y.; Lee, L.-Y.; Huang, S.-F.; Kang, C.-J.; Fan, K.-H.; Wang, H.-M.; Chen, I.-H.; Liao, C.-T.

    2008-04-01

    Purpose: To evaluate the outcome of treatment for buccal cancers and assess the impact of unilateral vs. bilateral adjuvant neck radiation. Methods and Materials: We retrospectively reviewed the course of 145 patients newly diagnosed with buccal squamous cell carcinoma without distant metastases who completed definitive treatment between January 1994 and December 2000. Of 145 patients, 112 (77%) had Stage III or IV disease. All underwent radical surgery with postoperative radiotherapy (median dose, 64 Gy), including unilateral neck treatment in most (n = 120, 82.8%). After 1997, cisplatin-based concomitant chemoradiotherapy was given for high-risk patients with more than two involved lymph nodes, extracapsular spread, and/or positive margins. Results: The 5-year disease-specific survival rate for Stages I-IV was 87%, 83%, 61%, and 60%, respectively (p = 0.01). The most significant prognostic factor was N stage, with the 5-year disease-specific survival rate for N0, N1, and N2 being 79%, 65%, and 54%, respectively (p 0.001). For patients with more than two lymph nodes or positive extracapsular spread, cisplatin-based concomitant chemoradiotherapy improved locoregional control (p = 0.02). Locoregional control did not differ between patients undergoing unilateral or bilateral neck treatments (p = 0.95). Contralateral neck failure occurred in only 2.1%. Conclusions: In patients with buccal carcinoma after radical resection, ipsilateral neck radiation is adequate. Bilateral prophylactic neck treatment does not confer an added benefit.

  5. Development of a short form of the Treatment Evaluation Inventory for acceptability of psychological interventions.

    PubMed

    Newton, J T; Sturmey, P

    2004-04-01

    The Treatment Evaluation Inventory of Kazdin, French, and Sherick is a 19-item measure of the perceived acceptability of behavioural treatments. Development of two brief forms was based on data from two sources. For Study 1, data from 218 completed questionnaires were used to develop internally consistent brief scales. In Study 2 internal consistency and the validity of the brief forms were estimated for a set of 131 questionnaires. Item reduction was achieved by analysis of item-total minus item correlations. Brief forms with 3, 6, 9, and 12 items were proposed. Their internal consistency (Cronbach alpha) and construct validity were based on correlations of scores on each short form with the full scale scores and on comparing means of different forms. Discriminant validity was based on the difference between two groups (estimated effect size 0.7). Scores for all forms showed high internal consistency and correlated highly with total scale scores. Only the 12-item brief scale yielded mean scores similar to the full scale. The 3-item form could be used as a quick screen, and the 12-item form for more intensive purposes as it is most similar to the full-scale.

  6. Acceptance and Commitment Therapy for the Treatment of Posttraumatic Stress Among Adolescents.

    PubMed

    Woidneck, Michelle R; Morrison, Kate L; Twohig, Michael P

    2014-07-01

    The number of individuals who meet diagnostic criteria for posttraumatic stress disorder (PTSD) is a small percentage of those exposed to trauma; many youth who do not meet criteria for PTSD continue to experience problematic posttraumatic stress (PTS) symptomology. Acceptance and commitment therapy (ACT) has shown preliminary effectiveness in the treatment of adult PTSD, but its effectiveness in treating PTS in youth is unknown. Using a multiple-baseline design, this study investigated the effectiveness of 10 weeks of ACT to treat PTS in youth. Four adolescents from a community sample and three adolescents from a residential sample participated. The Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA), Child PTSD Symptom Scale (CPSS), and Comprehensive Quality of Life Scale were completed at pretreatment, posttreatment, and 3-month follow-up. Individuals reported baseline data for 7 to 66 days. Symptom and process measures were completed at each session. Results revealed a decrease in PTS symptomology across both samples with mean reductions in self-reported PTS symptomology at posttreatment of 69% and 81% for the community and residential samples, respectively, and an overall 68% and 84% respective reduction at follow-up. Reductions in clinician rated measures of PTSD were observed for all participants with mean reductions of 57% and 61% in the community and residential samples at posttreatment, and 71% and 60% at follow-up, respectively. Results provide preliminary support for ACT as a treatment for adolescent PTS. Empirical and clinical implications as well as limitations and future directions are discussed.

  7. [Dual antiplatelet therapy for treatment and secondary prevention of coronary artery disease: indications, modalities and duration].

    PubMed

    Degrauwe, Sophie; Iglesias, Juan F

    2016-05-25

    The choice and optimal duration of dualantiplatelet therapy (DAPT) for the treatment of coronary artery disease (CAD) represent a challenging clinical dilemma. Antiplatelet treatment strategies are determined by the clinical setting, patient comorbidities and management strategy. While aspirin remains the cornerstone for secondary prevention of CAD, DAPT significantly reduces recurrent ischemic adverse events at the expense of an increased risk of major bleeding complications. A tailored approach based on individual ischemic and hemorrhagic risk assessment is currently recommended. This review aims to provide a contemporary overview on the current body of evidence concerning DAPT for treatment and secondary prevention of CAD with practical emphasis on current indications, choice, combination and optimal duration of antiplatelet therapy.

  8. Anticancer treatment and fertility: Effect of therapeutic modalities on reproductive system and functions.

    PubMed

    Vassilakopoulou, Maria; Boostandoost, Erfaneh; Papaxoinis, George; de La Motte Rouge, Thibault; Khayat, David; Psyrri, Amanda

    2016-01-01

    The significant improvement of cancer treatments entailed a longer life in cancer survivors and raised expectations for higher quality of life with minimized long-term toxicity. Infertility and gonadal dysfunction are adverse effects of anticancer therapy or may be related to specific tumors. In female cancer survivors, premature ovarian failure is common after antineoplastic treatments resulting in infertility and other morbidities related to oestrogen deficiency such as osteoporosis. In male cancer survivors, infertility and persistent a zoospermia is a more common long-term adverse effect than hypogonadism because germ cells are more sensitive to chemotherapy and radiotherapy than leydig cells. Gonadal toxicity and compromise of reproductive functions will be more efficiently prevented and treated if addressed before treatment initiation. This review focuses on these issues in young cancer survivors of childbearing age, where methods of protecting or restoring endocrine function and fertility need to be considered.

  9. Short-Term Outcomes of Acute Low-Tone Sensorineural Hearing Loss According to Treatment Modality

    PubMed Central

    Chang, Jinkyung; Yum, Gunhwee; Im, Ha-Young; Jung, Jong Yoon; Rah, Yoon Chan

    2016-01-01

    Background and Objectives We compared improvements in hearing thresholds in acute low-tone sensorineural hearing loss (ALHL) patients after two different treatments: steroid alone and steroid and diuretic combined. We analyzed how the duration between the onset of symptoms and the initiation of treatment affected hearing loss improvement and investigated the relation between presence of vertigo in ALHL patients and ALHL progression to Ménière's disease (MD). Subjects and Methods We retrospectively analyzed the medical records of 47 ALHL patients aged 21 to 76 years. Patients received either orally administered steroid alone (n=12) or steroid and diuretic combined (n=35). We compared improvements in the two groups' hearing thresholds at three lower frequencies (125, 250, and 500 Hz) after participants had received one month of each respective treatment. Results Our two treatments did not show any statistical difference in hearing loss improvement after one month. Forty percent of ALHL patients with vertigo developed MD, which was a significantly higher rate than the 12.5% of ALHL patients without vertigo who developed MD. The shorter duration between the onset of symptoms and the initiation of treatment significantly increased improvement in the sum of lower frequency hearing threshold after one month. Conclusions The current study suggests that steroid and diuretic administered together and steroid alone similarly improve the hearing threshold in ALHL patients after one month. We concluded that patients should initiate ALHL treatment as soon as they experience symptoms. ALHL patients should also be notified of their higher risk of developing MD. PMID:27144234

  10. Integrating Spiritual and Western Treatment Modalities in a Native American Substance User Center: Provider Perspectives

    PubMed Central

    Moghaddam, Jacquelene F.; Momper, Sandra L.

    2014-01-01

    Few studies examine how traditional Native American and Western healing practices are being integrated in Native American substance user treatment centers. Data are presented from a 2008 study of providers of integrated substance user treatment for Native Americans at an urban Western US center. Nineteen semi-structured interviews were conducted to examine 10 providers’ views of the integration of traditional and Western healing and the impact on recovery for clients. We used a grounded theory approach to data analysis with manual and NVivo codes and themes developed. Limitations and implications for practice are discussed. PMID:21810077

  11. [From intellectual disability to new treatment modalities of fragile X syndrome].

    PubMed

    Jønch, Aia Elise; Timshel, Susanne; Carlsen Lunding, Jytte Merete; Grønskov, Karen; Brøndum-Nielsen, Karen

    2014-02-24

    In 1943 a large family with X-linked mental retardation was described by Martin & Bell. This family had what we know today as fragile X syndrome, the most common inherited form of intellectual disability. Current knowledge about the specific gene, the encoded protein and the pathophysiological mechanisms involved has made it possible to develop pharmacological treatment trials. Fragile X syndrome therefore is on its way as model disorder for targeted treatments in genetic medicine, and this article reviews clinical and therapeutic aspects of the syndrome.

  12. Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes.

    PubMed

    Kavoussi, Nicholas; Canvasser, Noah; Caddedu, Jeffrey

    2016-08-01

    The widespread utilization of abdominal imaging has led to an increase in incidentally detected small renal masses. Although partial nephrectomy is still considered the gold standard treatment for these masses, there are risks associated with surgical excision, potentially limiting treatment for older patients with multiple comorbidities. A variety of ablative techniques have developed over the past several decades, altering the management of small renal masses. It is likely that improvements in technology will only broaden the applications of ablative therapy. This article provides an update on the various ablative techniques and outcomes.

  13. Physical modalities for treating acne and rosacea.

    PubMed

    Jalian, H Ray; Levin, Yakir; Wanner, Molly

    2016-06-01

    Physical modalities provide an important adjunct to medical treatment of acne and rosacea. In patients who cannot tolerate or fail medical treatments, physical modalities offer an alternative approach. For cases of acne scarring, phymatous changes of rosacea, and rosacea-associated telangiectasia, physical modalities such as laser and light treatments represent the treatment of choice. We will review the use of laser and light treatments, photodynamic therapy, and other physical modalities such as targeted therapies for the treatment of acne and rosacea.

  14. Using Mindfulness in the Treatment of Adolescent Sexual Abusers: Contributing Common Factor or a Primary Modality?

    ERIC Educational Resources Information Center

    Jennings, Jerry L.; Apsche, Jack A.; Blossom, Paige; Bayles, Corliss

    2013-01-01

    Although mindfulness has become a mainstream methodology in mental health treatment, it is a relatively new approach with adolescents, and perhaps especially youth with sexual behavior problems. Nevertheless, clinical experience and several empirical studies are available to show the effectiveness of a systematic mindfulness- based methodology for…

  15. A Case of Symptomatic Tracheal Diverticulum and Surgical Resection as a Treatment Modality

    PubMed Central

    Lee, Shin-Young; Joo, Seok; Lee, Geun Dong; Ham, Seok Jin; Park, Chul Hwan; Lee, Sungsoo

    2016-01-01

    Tracheal diverticulum is often diagnosed incidentally and, due to its rarity, there is no standard treatment. It is a benign entity, but has the potential to cause specific symptoms, such as chronic upper respiratory infection and chronic cough. Symptomatic tracheal diverticulum can be medically treated, but likelihood of recurrence is high. We report a case of surgical resection of symptomatic tracheal diverticulum to prevent recurrence. PMID:27734005

  16. Renal function related to different treatment modalities for malignant germ cell tumours.

    PubMed Central

    Aass, N.; Fosså, S. D.; Aas, M.; Lindegaard, M. W.

    1990-01-01

    The renal function was evaluated with 131I-Hippuran clearance in 171 patients with malignant germ cell tumours. Assessments were performed before treatment and at three fixed times afterwards within 5 years. The patients were treated with surgery only (20 patients), infra-diaphragmatic radiotherapy only (median midplane dose 36 Gy) (48 patients), cisplatin-based chemotherapy (total cisplatin dose 500-850 mg) plus surgery (64 patients), cisplatin-based chemotherapy (total cisplatin dose greater than 850 mg) with or without surgery (23 patients) or cisplatin-based chemotherapy (total cisplatin dose 500-850 mg) plus infra-diaphragmatic radiotherapy (16 patients). No renal impairment was observed for patients treated with surgery only. In patients who received radiotherapy no change of the renal function occurred during the first year post-treatment. Three to five years after treatment discontinuation a statistically significant reduction within the normal range was observed in patients who were greater than 40 years at the time of irradiation. Cisplatin-based chemotherapy led to a statistically significant irreversible renal impairment for all the three groups. The greatest reduction was seen in patients who received the highest total cisplatin dose or who were treated with irradiation in addition to chemotherapy. The clinical significance of the observed nephrotoxicity is still unknown. PMID:2173944

  17. WSTO9 (TOOKAD) mediated photodynamic therapy as an alternative modality in the treatment of prostate cancer

    NASA Astrophysics Data System (ADS)

    Chen, Qun; Huang, Zheng; Luck, David L.; Beckers, Jill; Brun, Pierre-Herve; Wilson, Brian C.; Scherz, Avigdor; Salomon, Yoram; Hetzel, Fred W.

    2002-06-01

    Photodynamic therapy (PDT) utilizes optical energy to activate a pre-administered photosensitizer drug to achieve a localized tumor control. In the presented study, PDT mediated with a second-generation photosensitizer, WST09 (TOOKAD, Steba Biotech, The Netherlands), is investigated as an alternative therapy in the treatment of prostate cancer. In vivo canine prostate is used as the animal model. PDT was performed by irradiating the surgically exposed prostates both superficially and interstitially with a diode laser (763 nm) to activate the intra-operatively i.v. infused photosensitizer. During light irradiation, tissue optical properties, and temperature were monitored. During the one-week to 3-month period post PDT treatment, the dogs recovered well with little or no complications. The prostates were harvested and subjected to histopathological evaluations. Maximum lesion size of over 3 cm in dimension could be achieved with a single treatment, suggesting the therapy is extremely effective in destroying prostatic tissue. Although we found there was loss of epithelial lining in prostatic urethra, there was no evidence it had caused urinary tract side effects as reported in those studies utilizing transurethral irradiation. In conclusion, we found second generation photosensitizer WST09 mediated PDT may provide an excellent alternative to treat prostate cancer.

  18. The ox-foot-model for investigating endoluminal thermal treatment modalities of varicosis vein diseases.

    PubMed

    Sroka, Ronald; Weick, Kathrin; Steckmaier, Stefanie; Steckmaier, Bernd; Blagova, Radka; Sroka, Ina; Sadeghi-Azandaryani, Mojtaba; Maier, Johann; Schmedt, Claus-Georg

    2012-01-01

    The introduction of technical surgical innovations in clinical medicine is preceded by preclinical evaluation of prototypes. Surgical aspects such as energy dependent tissue response and tissue sealing to reduce bleeding are usually investigated in animal experiments. Extra-corporal organ models can provide the required experimental information without harming animals and thus reduce or even replace in vivo experiments. Here we describe the ex vivo ox-foot-model, which can be used for surgical investigations and for training purposes. In the ox-foot-model the vein remains in its anatomical bed under reproducible experimental conditions, i.e., blood perfusion, blood pressure, and temperature. Innovative endoluminal surgical procedures using laser light and radio frequency for varicosis treatment were tested. Treatment parameters were investigated systematically in a large number of samples. A standardized preclinical testing procedure could be established and optimized on the basis of acute macroscopic and histological findings. Further, optical coherence tomography could be evaluated as a time-saving diagnostic tool. The ox-foot-model is suitable for training surgical techniques relevant for the treatment of varicosis veins. It is a cost-effective alternative to conventional in vivo experiments, providing standardized experimental conditions and reproducible experimental results while respecting the Principles of Humane Experimental Techniques: Reduction, Refinement, and Replacement of animal experiments.

  19. A novel treatment modality for myofascial pain syndrome: hyperbaric oxygen therapy.

    PubMed

    Kiralp, Mehmet Zeki; Uzun, Günalp; Dinçer, Omit; Sen, Ahmet; Yildiz, Senol; Tekin, Levent; Dursun, Hasan

    2009-01-01

    The aim of the present study was to evaluate the effects of hyperbaric oxygen (HBO) therapy on myofascial pain syndrome (MPS). Thirty patients with the diagnosis of MPS were divided into HBO (n=20) and control groups (n=10). Patients in the HBO group received a total of 10 HBO treatments in 2 weeks. Patients in the control group received placebo treatment in a hyperbaric chamber. Pain threshold and visual analogue scale (VAS) measurements were performed immediately before and after HBO therapy and 3 months thereafter. Additionally, Pain Disability Index (PDI) and Short Form 12 Health Survey (SF-12) evaluations were done before HBO and after 3 months. HBO therapy was well tolerated with no complications. In the HBO group, pain threshold significantly increased and VAS scores significantly decreased immediately after and 3 months after HBO therapy. PDI, Mental and Physical Health SF-12 scores improved significantly with HBO therapy after 3 months compared with pretreatment values. In the control group, pain thresholds, VAS score, and Mental Health SF-12 scores did not change with placebo treatment; however, significant improvement was observed in the Physical Health SF-12 test. We concluded that HBO therapy may be a valuable alternative to other methods in the management of MPS. Our results warrant further randomized, double-blinded and placebo-controlled studies to evaluate the possible role of HBO in the management of MPS.

  20. A Case Report of Catatonia and Neuroleptic Malignant Syndrome With Multiple Treatment Modalities

    PubMed Central

    Chiou, Yu-Jie; Lee, Yu; Lin, Chin-Chuen; Huang, Tiao-Lai

    2015-01-01

    Abstract We describe a case with complicated clinical presentations who was difficult to treat. We described the possible etiologies and differential diagnosis of neuroleptic malignant syndrome (NMS), catatonia, and infection, in details. This patient was also referred to neuro-intensive care unit for extensive workup and treatments by neurologist guidelines. In addition, we also used lorazepam–diazepam protocol and antipsychotics, but both failed to completely relieve her symptoms. She eventually responded to electroconvulsive therapy (ECT). A 60-year-old female patient with schizophrenia was diagnosed to suspected pneumonia, urinary tract infection, and retarded catatonia at first. The brain computed tomography revealed no significant finding. She developed NMS caused by the administration of low-dose quetiapine (200 mg) after carbamazepine was discontinued. The Francis–Yacoub NMS rating scale (F-Y scale) total score was 90. We utilized lorazepam–diazepam protocol and prescribed bromocriptine and amantadine, but NMS was not improved. Meanwhile, we arranged the brain magnetic resonance imaging to survey the physical problem, which revealed agenesis of septum pellucidum and dilated lateral ventricles. She was then transferred to the neuro-intensive care unit on the 15th hospital day for complete study. The results of cerebrospinal fluid study and electroencephalography were unremarkable. She was transferred back to psychiatric ward on the 21st hospital day with residual catatonic and parkinsonian symptoms of NMS, and the F-Y scale total score was 63. Finally, her residual catatonic condition that followed NMS got improved after 11 sessions of ECT. On the 47th hospital day, the F-Y scale total score was 9. This report underscores that the ECT is an effective treatment for a patient of NMS when other treatments have failed. PMID:26512569

  1. Treatment modalities for surgical management of anterior palatal fistula: Comparison of various techniques, their outcomes, and the factors governing treatment plan: A retrospective study

    PubMed Central

    Bonanthaya, Krishnamurthy; Shetty, Pritham; Sharma, Abhimanyu; Ahlawat, Jyoti; Passi, Deepak; Singh, Mahinder

    2016-01-01

    Aim: Aim of this retrospective study was to access the various surgical treatment options available for repair of Anterior palatal fistula depending upon their size and presenting age, and also to anticipate the treatment outcome. Materials and Methods: The series include study report of forty patients with secondary anterior palatal fistula post cleft palate repair, reported in a single unit during a duration of 3 years. All the cases were managed surgically under general anesthesia. The patients were classified depending upon the location of anterior palatal fistula (APF), the quality of tissue and age of patients to chalk out a justified treatment option outlay. Results: Forty cases were split for surgical correction into various options depending on their size, site, and quality of the tissue. Most of the cases were operated with a Bardach's Redo for fistula closure (n = 16) (40%) and crevicular flap technique (n = 13) (32.5%). Our overall success (satisfactory results) was 77.5% as observed in 31 out of 40 cases with individual success rates for Bardach's and crevicular being 75% and 77%, respectively. There was reduction in size of fistula in three cases (7.5%) and a remnant pinpoint hole in four cases (10%) among all the operated cases. Conclusion: Management of post palatoplasty fistulas of the hard palate presents a challenging situation for a clinician following the surgical correction of cleft palate. Current paper describes the diagnosis and clinical management of forty cases reporting with unilateral APF following cleft palate surgery, over 3 years. Authors have attempted to propose different treatment modalities for surgical management of unilateral APF. It was concluded in the primary review that the size of fistula was irrelevant in determining the clinical outcome. Instead, the quality and condition of the adjacent tissue appear to be the major governing factors for selecting treatment modality as well as the surgical consequences. PMID:28356685

  2. Clinical outcomes of antimicrobial lock solutions used in a treatment modality: a retrospective case series analysis

    PubMed Central

    Bookstaver, P Brandon; Gerrald, Katherine R; Moran, Robert R

    2010-01-01

    Background Antimicrobial lock therapy (ALT) may be considered as adjunctive therapy in the treatment of catheter-related bloodstream infections (CRBSI) when catheter removal is not a favorable option. Objective To evaluate the outcomes associated with ALT as adjunctive treatment of CRBSI. Methods This was a 24-month retrospective case series analysis evaluating patients treated for more than 24 hours with ALT. The primary outcome was blood culture sterilization for 30 days posttherapy. The impact of ALT duration and time to initiation on central venous catheter (CVC) salvage were evaluated. Logistic regression modeled the association between ALT and sterilization rates, with a prespecified level of significance (α) of 0.1. Results Twenty-six cases were included in data analysis. Patients included ranged from 5 months to 82 years of age; 77% of patients were receiving total parenteral nutrition or chemotherapy. The majority of patients received vancomycin, daptomycin, or gentamicin combined with heparin in a lock solution. Blood culture sterilization was achieved in 69.2% of cases, and sterilization plus CVC retention was achieved in 11 cases (42.3%). Longer durations of ALT (≥9 days) were significantly correlated with blood culture sterilization (odds ratio = 1.367, P = 0.077). Conclusion ALT used as an adjunct to systemic therapy for adequate duration in CRBSI can achieve CVC sterilization and retainment without subsequent infectious complications. PMID:22291495

  3. Multi-modality imaging to assess metabolic response to dichloroacetate treatment in tumor models

    PubMed Central

    Neveu, Marie-Aline; Preter, Géraldine De; Joudiou, Nicolas; Bol, Anne; Brender, Jeffery R.; Saito, Keita; Kishimoto, Shun; Grégoire, Vincent; Jordan, Bénédicte F.; Krishna, Murali C.; Feron, Olivier; Gallez, Bernard

    2016-01-01

    Reverting glycolytic metabolism is an attractive strategy for cancer therapy as upregulated glycolysis is a hallmark in various cancers. Dichloroacetate (DCA), long used to treat lactic acidosis in various pathologies, has emerged as a promising anti-cancer drug. By inhibiting the pyruvate dehydrogenase kinase, DCA reactivates the mitochondrial function and decreases the glycolytic flux in tumor cells resulting in cell cycle arrest and apoptosis. We recently documented that DCA was able to induce a metabolic switch preferentially in glycolytic cancer cells, leading to a more oxidative phenotype and decreasing proliferation, while oxidative cells remained less sensitive to DCA treatment. To evaluate the relevance of this observation in vivo, the aim of the present study was to characterize the effect of DCA in glycolytic MDA-MB-231 tumors and in oxidative SiHa tumors using advanced pharmacodynamic metabolic biomarkers. Oxygen consumption, studied by 17O magnetic resonance spectroscopy, glucose uptake, evaluated by 18F-FDG PET and pyruvate transformation into lactate, measured using hyperpolarized 13C-magnetic resonance spectroscopy, were monitored before and 24 hours after DCA treatment in tumor bearing mice. In both tumor models, no clear metabolic shift was observed. Surprisingly, all these imaging parameters concur to the conclusion that both glycolytic tumors and oxidative tumors presented a similar response to DCA. These results highlight a major discordance in metabolic cancer cell bioenergetics between in vitro and in vivo setups, indicating critical role of the local microenvironment in tumor metabolic behaviors. PMID:28082726

  4. Stem cell therapy: A novel & futuristic treatment modality for disaster injuries

    PubMed Central

    Gurudutta, G.U.; Satija, Neeraj Kumar; Singh, Vimal Kishor; Verma, Yogesh Kumar; Gupta, Pallavi; Tripathi, R.P.

    2012-01-01

    Stem cell therapy hold the potential to meet the demand for transplant cells/tissues needed for treating damages resulting from both natural and man-made disasters. Pluripotency makes embryonic stem cells and induced pluripotent stem cells ideal for use, but their teratogenic character is a major hindrance. Therapeutic benefits of bone marrow transplantation are well known but characterizing the potentialities of haematopoietic and mesenchymal cells is essential. Haematopoietic stem cells (HSCs) have been used for treating both haematopoietic and non-haematopoietic disorders. Ease of isolation, in vitro expansion, and hypoimmunogenecity have brought mesenchymal stem cells (MSCs) into limelight. Though differentiation of MSCs into tissue-specific cells has been reported, differentiation-independent mechanisms seem to play a more significant role in tissue repair which need to be addressed further. The safety and feasibility of MSCs have been demonstrated in clinical trials, and their use in combination with HSC for radiation injury treatment seems to have extended benefit. Therefore, using stem cells for treatment of disaster injuries along with the conventional medical practice would likely accelerate the repair process and improve the quality of life of the victim. PMID:22382178

  5. Clinical outcomes associated with evolving treatment modalities and radiation techniques for base-of-tongue carcinoma: thirty years of institutional experience.

    PubMed

    Chen, Leechuan Andy; Anker, Christopher J; Hunt, Jason P; Buchmann, Luke O; Grossmann, Kenneth F; Boucher, Kenneth; Fang, Li-Ming Christine; Shrieve, Dennis C; Hitchcock, Ying J

    2015-05-01

    Curative treatment for base-of-tongue squamous cell carcinoma (BOT SCC) has evolved over time; however, comparative outcomes analysis for various treatment strategies is lacking. The authors reviewed the evolution of treatment modality and radiotherapy (RT) technique for 231 consecutive BOT SCC patients at our institution between 1981 and 2011. Treatment modalities included definitive chemoradiotherapy (chemoRT) (42%), definitive RT (33%), surgery followed by RT (20%), and surgery alone (5%). RT techniques included external beam plus interstitial brachytherapy (EBRT + IB) (37%), conventional EBRT (29%), intensity-modulated radiation therapy ± simultaneous integrated boost (IMRT ± SIB) (34%). Clinical characteristics and outcomes were stratified by modality or RT technique. Treatment modality evolved from definitive RT (1980s-1990s) to definitive chemoRT (1990s-2000s). RT technique evolved from EBRT + IB (1980s-1990s) to conventional EBRT (1990s-2000s) to IMRT + SIB (2000s). With median alive follow-up of 6 years (0.3-28 years), the 5-year LC, LRC, and OS rates were 80%, 73%, and 51%. There was no difference in distribution of gender, age, stage among treatment modalities. Definitive chemoRT had improved LRC (HR 1.6) and OS (HR 1.7) compared to definitive RT. IMRT + SIB had improved LRC (HR 3.2), DFS (HR 3.4), and OS (HR 3.0) compared to conventional EBRT. Over the past 30 years, BOT SCC treatment has undergone major paradigm shifts that incorporate nonsurgical functional preservation, concurrent chemotherapy, and advanced RT techniques. Excellent locoregional control and survival outcomes are associated with accelerated IMRT with chemotherapy.

  6. Diabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities.

    PubMed

    Amin, Noha; Doupis, John

    2016-04-10

    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.

  7. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

    PubMed Central

    Amin, Noha; Doupis, John

    2016-01-01

    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities. PMID:27076876

  8. Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review

    PubMed Central

    McAlinden, C

    2014-01-01

    Purpose Systemic review to compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect. Methods Searches of the following databases were performed: PubMed, Cochrane Central Register of Controlled Trials, Ovid, EMBASE, metaRegister of Controlled Trials, and ClinicalTrials.gov. Only randomised controlled trials (RCTs) published in peer-reviewed journals comparing SLT to other glaucoma treatment options were considered. The main outcome measure was the change in IOP from baseline. Results An initial search of PubMed identified 23 RCTs with 17 meeting the inclusion criteria. Nine RCTs compared 180° SLT to 180° argon laser trabeculoplasty (ALT) and one trial compared 360° SLT to 360° ALT, all reporting no difference in terms of IOP reduction from baseline. One RCT reported better outcomes with SLT at 1 year but this effect regressed at 2 years. Three trials compared 360° SLT to medical therapy and found no difference between the two treatment options. One trial found greater IOP reduction with latanoprost vs 90° and 180° SLT, and greater IOP reduction with 180° and 360° SLT versus 90° SLT, however no differences were found between 360° SLT versus latanoprost or 360° vs 180° SLT. Two trials compared 180° SLT to 360° SLT finding no difference in IOP reduction. Two trials compared 180° SLT to 90° SLT, one finding no significant difference and one finding greater IOP reduction with 180° SLT over 90° SLT. One trial compared excimer laser trabeculotomy (ELT) to 180° SLT, finding no differences in IOP reduction up to 3 months follow-up but greater IOP reduction with ELT at time intervals between 9 and 24 months. There were no RCTs identified that compared SLT to surgery. Conclusion In terms of the IOP lowering effect, there is no difference between SLT and ALT. Three trials indicate no difference between 360° SLT and medical therapy, with one of the trials indicating greater

  9. Breast Cancer: Conventional Diagnosis and Treatment Modalities and Recent Patents and Technologies

    PubMed Central

    Nounou, Mohamed I.; ElAmrawy, Fatema; Ahmed, Nada; Abdelraouf, Kamilia; Goda, Satyanarayana; Syed-Sha-Qhattal, Hussaini

    2015-01-01

    Breast cancer is the most prevalent cancer among women worldwide. However, increased survival is due to the dramatic advances in the screening methods, early diagnosis, and breakthroughs in treatments. Over the course of the last decade, many acquisitions have taken place in this critical field of research in the pharmaceutical industry. Advances in molecular biology and pharmacology aided in better understanding of breast cancer, enabling the design of smarter therapeutics able to target cancer and respond to its microenvironment efficiently. Patents and research papers investigating diagnosis and treatment strategies for breast cancer using novel technologies have been surveyed for the past 15 years. Various nanocarriers have been introduced to improve the therapeutic efficacy of anticancer drugs, including liposomes, polymeric micelles, quantum dots, nanoparticles, and dendrimers. This review provides an overview of breast cancer, conventional therapy, novel technologies in the management of breast cancer, and rational approaches for targeting breast cancer. HIGHLIGHTS Breast cancer is the most common cancer in women worldwide. However, survival rates vary widely, optimistically heading toward a positive trend. Increased survival is due to the drastic shift in the screening methods, early diagnosis, and breakthroughs in treatments. Different strategies of breast cancer classification and staging have evolved over the years. Intrinsic (molecular) subtyping is essential in clinical trials and well understanding of the disease. Many novel technologies are being developed to detect distant metastases and recurrent disease as well as to assess response to breast cancer management. Intensive research efforts are actively ongoing to take novel breast cancer therapeutics to potential clinical application. Most of the recent research papers and patents discuss one of the following strategies: the development of new drug entities that specifically target the breast tumor

  10. Treatment modalities for advanced ALK-rearranged non-small-cell lung cancer.

    PubMed

    Sullivan, Ivana; Planchard, David

    2016-04-01

    The ALK gene plays a key role in the pathogenesis of non-small-cell lung cancer (NSCLC). Patients with NSCLC harboring an ALK-rearrangement represent the second oncogene addiction to be identified in this disease. Crizotinib was the first ALK inhibitor showing pronounced clinical activity, and is now a reference treatment for ALK-positive NSCLC disease. However, despite initial impressive responses to crizotinib, acquired resistance almost invariably develops within 12 months. The pressing need for effective second-line agents has prompted the rapid development of next-generation ALK inhibitors. These agents, notably ceritinib and alectinib as the most developed, have a higher potency against ALK than crizotinib, along with activity against tumors harboring crizotinib-resistant mutations and potentially improved CNS penetration.

  11. Antibiotics resistance of Helicobacter pylori and treatment modalities in children with H. pylori infection.

    PubMed

    Seo, Ji-Hyun; Woo, Hyang-Ok; Youn, Hee-Shang; Rhee, Kwang-Ho

    2014-02-01

    Pediatric infection with Helicobacter pylori may occur early in childhood and persist lifelong. Global pediatric clinical studies have reported a decreasing tendency in the overall rate of H. pylori eradication. In pediatric patients with H. pylori infection, pediatric patients with peptic ulcer, and the first-degree relatives of patients with a history of gastric cancer, it is commonly recommended that H. pylori strains be eradicated. Antibiotic drug resistance to H. pylori, which has been reported to vary widely between geographic regions, is mainly associated with treatment failure in these patients. It is therefore imperative that the antibiotic resistance rates of H. pylori in children and adolescents be meticulously monitored across countries and throughout geographic regions. This paper particularly focuses on the antibiotic drug resistance of H. pylori and the thearpy of pediatric H. pylori infection cases.

  12. Differences in the availability of diagnostics and treatment modalities for chronic hepatitis B across Europe.

    PubMed

    Ozaras, R; Corti, G; Ruta, S; Lacombe, K; Mondelli, M U; Irwing, W L; Puoti, M; Khalighi, A; Santos, M L; Harxhi, A; Lazarevic, I; Soriano, V; Gervain, J; Leblebicioglu, H; Salmon, D; Arends, J E

    2015-11-01

    The prevalence and management of chronic hepatitis B virus (HBV) infection differ among European countries. The availability and reimbursement of diagnostics and drugs may also vary, determining distinct treatment outcomes. Herein, we analyse differences in medical facilities for the care of patients with chronic HBV infection across Europe. A survey was sent to the members of the ESCMID Study Group for Viral Hepatitis, all of whom are experts in chronic HBV infection management. The comprehensive survey asked questions regarding hepatitis B surface antigen (HBsAg) prevalence, the availability of diagnostics and drugs marketed, and distinct clinical practice behaviours in the management of chronic HBV infection. World Bank data were used to assess the economic status of the countries. With 16 expert physicians responding (69%), the HBsAg prevalence rates were <1% in France, Hungary, Italy, The Netherlands, Portugal, Spain, and the UK, intermediate (1-5%) in Turkey, Romania, and Serbia, and high (>5%) in Albania and Iran. Regarding the availability and reimbursement of HBV diagnostics (HBV DNA and liver stiffness measurement), HBV drugs (interferon, lamivudine, tenofovir, and entecavir), HBV prophylaxis, and duration of HBeAg-positive and HBeAg-negative HBV infection, the majority of high-income and middle-income countries had no restrictions; Albania, Iran and Serbia had several restrictions in diagnostics and HBV drugs. The countries in the high-income group were also the ones with no restrictions in medical facilities, whereas the upper-middle-income countries had some restrictions. The prevalence of chronic HBV infection is much higher in southern and eastern than in western European countries. Despite the availability of European guidelines, policies for diagnostics and treatment vary significantly across European countries.

  13. A prototype worldwide survey of diagnostic and treatment modalities for stroke.

    PubMed

    Aiyagari, Venkatesh; Pandey, Dilip K; Testai, Fernando D; Grysiewicz, Rebbeca A; Tsiskaridze, Alexander; Sacks, Claudio; Ogun, Yomi; Ogunrin, Olubunmi A; Uthman, Basim M; Lindsay, Patrice; Gorelick, Philip B

    2015-02-01

    Stroke is a global health problem. However, very little is known about stroke care in low- to middle-income countries. Obtaining country-specific information could enable us to develop targeted programs to improve stroke care. We surveyed neurologists from 12 countries (Chile, Georgia, Nigeria, Qatar, India, Lithuania, Kazakhstan, Indonesia, Denmark, Brazil, Belgium, and Bangladesh) using a web-based survey tool. Data were analyzed both for individual countries and by income classification (low income, lower middle income, upper middle income, and high income). Six percent (n = 200) of 3123 targeted physicians completed the survey. There was a significant correlation between income classification and access and affordability of head computed tomography scan (ρ = .215, P = .002), transthoracic echocardiogram (ρ = .181, P = .012), extracranial carotid Doppler ultrasound (ρ = .312, P ≤ .000), cardiac telemetry (ρ = .353, P ≤ .000), and stroke treatments such as intravenous thrombolysis (ρ = .276, P ≤ .001), and carotid endarterectomy (ρ = .214, P ≤ .004); stroke quality measures such as venous thromboembolism prophylaxis during hospital stay (ρ = .163, P ≤ .022), discharge from hospital on antithrombotic therapy (ρ = .266, P ≤ .000), consideration for acute thrombolytic therapy (ρ = .358, P ≤ .000), and antithrombotic therapy prescribed by end of hospital day 2 (ρ = .334, P ≤ .000). However, there was no significant correlation between income classification and the access and affordability of antiplatelet agents, vitamin K antagonists and statins, anticoagulation for atrial fibrillation/flutter, statin medication, stroke education, and assessment for rehabilitation. Our study shows that it is possible to get an overview of stroke treatment measures in different countries by conducting an internet-based survey. The generalizability of the findings may be limited by the low survey response rate.

  14. Treatment of Pediatric Obsessive Compulsive Disorder Utilizing Parent-Facilitated Acceptance and Commitment Therapy

    ERIC Educational Resources Information Center

    Barney, Jennifer Y.; Field, Clint E.; Morrison, Kate L.; Twohig, Michael P.

    2017-01-01

    Acceptance and commitment therapy (ACT) is a modern form of cognitive behavior therapy that uses acceptance and mindfulness-based procedures to address clinical issues. A brief protocol of ACT was used with 3 children ages 10 and 11 years who were diagnosed with obsessive compulsive disorder (OCD). Results showed notable and clinically significant…

  15. Role of emerging neuroimaging modalities in patients with cognitive impairment: a review from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012

    PubMed Central

    2013-01-01

    The Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) was held 3 to 4 May 2012 in Montreal, Quebec, Canada. A group of neuroimaging experts were assigned the task of reviewing and summarizing the literature on clinical and research applications of different neuroimaging modalities in cognitive disorders. This paper summarizes the literature and recommendations made to the conference regarding the role of several emerging neuroimaging modalities in cognitive disorders. Functional magnetic resonance imaging (MRI), magnetic resonance spectroscopy, and diffusion tensor imaging are discussed in detail within this paper. Other emergent neuroimaging modalities such as positron emission tomography with novel ligands, high-field MRI, arterial spin labeling MRI and noncerebral blood flow single-photon emission computerized tomography are only discussed briefly. Neuroimaging modalities that were recommended at the CCCDTD4 for both clinical and research applications such as amyloid and flurodeoxyglucose positron emission tomography, computerized tomography and structural MRI are discussed in a separate paper by the same authors. A literature search was conducted using the PubMed database including articles in English that involved human subjects and covered the period from the last CCCDTD publication (CCCDTD3; January 2006) until April 2012. Search terms included the name of the specific modality, dementia, Alzheimer's disease, and mild cognitive impairment. A separate search used the same parameters but was restricted to review articles to identify recent evidence-based reviews. Case studies and small case series were not included. Papers representing current evidence were selected, reviewed, and summarized, and the results were presented at the CCCDTD4 meeting with recommendations regarding the utility of various neuroimaging modalities in cognitive disorders. The evidence was graded according to the Oxford Centre for Evidence Based

  16. Role of emerging neuroimaging modalities in patients with cognitive impairment: a review from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012.

    PubMed

    Burhan, Amer M; Bartha, Robert; Bocti, Christian; Borrie, Michael; Laforce, Robert; Rosa-Neto, Pedro; Soucy, Jean-Paul

    2013-07-08

    The Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) was held 3 to 4 May 2012 in Montreal, Quebec, Canada. A group of neuroimaging experts were assigned the task of reviewing and summarizing the literature on clinical and research applications of different neuroimaging modalities in cognitive disorders. This paper summarizes the literature and recommendations made to the conference regarding the role of several emerging neuroimaging modalities in cognitive disorders. Functional magnetic resonance imaging (MRI), magnetic resonance spectroscopy, and diffusion tensor imaging are discussed in detail within this paper. Other emergent neuroimaging modalities such as positron emission tomography with novel ligands, high-field MRI, arterial spin labeling MRI and noncerebral blood flow single-photon emission computerized tomography are only discussed briefly. Neuroimaging modalities that were recommended at the CCCDTD4 for both clinical and research applications such as amyloid and flurodeoxyglucose positron emission tomography, computerized tomography and structural MRI are discussed in a separate paper by the same authors. A literature search was conducted using the PubMed database including articles in English that involved human subjects and covered the period from the last CCCDTD publication (CCCDTD3; January 2006) until April 2012. Search terms included the name of the specific modality, dementia, Alzheimer's disease, and mild cognitive impairment. A separate search used the same parameters but was restricted to review articles to identify recent evidence-based reviews. Case studies and small case series were not included. Papers representing current evidence were selected, reviewed, and summarized, and the results were presented at the CCCDTD4 meeting with recommendations regarding the utility of various neuroimaging modalities in cognitive disorders. The evidence was graded according to the Oxford Centre for Evidence Based

  17. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment.

    PubMed

    Mathieu, Daniel; Marroni, Alessandro; Kot, Jacek

    2017-03-01

    The tenth European Consensus Conference on Hyperbaric Medicine took place in April 2016, attended by a large delegation of experts from Europe and elsewhere. The focus of the meeting was the revision of the European Committee on Hyperbaric Medicine (ECHM) list of accepted indications for hyperbaric oxygen treatment (HBOT), based on a thorough review of the best available research and evidence-based medicine (EBM). For this scope, the modified GRADE system for evidence analysis, together with the DELPHI system for consensus evaluation, were adopted. The indications for HBOT, including those promulgated by the ECHM previously, were analysed by selected experts, based on an extensive review of the literature and of the available EBM studies. The indications were divided as follows: Type 1, where HBOT is strongly indicated as a primary treatment method, as it is supported by sufficiently strong evidence; Type 2, where HBOT is suggested as it is supported by acceptable levels of evidence; Type 3, where HBOT can be considered as a possible/optional measure, but it is not yet supported by sufficiently strong evidence. For each type, three levels of evidence were considered: A, when the number of randomised controlled trials (RCTs) is considered sufficient; B, when there are some RCTs in favour of the indication and there is ample expert consensus; C, when the conditions do not allow for proper RCTs but there is ample and international expert consensus. For the first time, the conference also issued 'negative' recommendations for those conditions where there is Type 1 evidence that HBOT is not indicated. The conference also gave consensus-agreed recommendations for the standard of practice of HBOT.

  18. Treatment modalities for caries management, including a new resin infiltration system.

    PubMed

    Kugel, Gerard; Arsenault, Peter; Papas, Athena

    2009-10-01

    Seemingly against all odds, dental caries still affects most people in the US. While fluoridated products, school-based screening and cleaning programs, better patient education, and professional and chemotherapeutic interventions have all impacted certain populations, caries is still the most prevalent chronic childhood disease and continues to affect a high percentage of adolescents, young and middle-aged adults, and seniors. Much research has proven that dental caries is not just an occasional cycle of cavitation but a complex and infectious disease process. Historically, addressing the caries challenge has relied on prevention and restoration, with no intermediary means to stop lesion progression. Recently, a technique called caries infiltration was introduced that fills the noncavitated pores of an incipient lesion with a low-viscosity resin by capillary action, creating a barrier that blocks further bacterial diffusion and lesion development. This microinvasive method for stabilizing early lesions requires no drilling or anesthesia and does not alter the tooth's anatomic shape. In cases of white spot lesions in the esthetic zone, it also eliminates opaqueness and blends with surrounding natural teeth. This article presents an overview of caries prevention initiatives and a case demonstrating the new caries infiltration technique. Combined with shifting the focus to caries risk assessment, this promising technology may prove to be a significant addition to the profession's caries treatment armamentarium.

  19. New modalities in the treatment of exocrine pancreatic insufficiency in cystic fibrosis.

    PubMed

    Heijerman, H G

    1992-10-01

    Pancreatic insufficiency is the second most important pathophysiological expression of cystic fibrosis (CF) and occurs in the majority of patients. It leads to fat malabsorption and high energy losses in the stools and is one of the major causes of malnutrition often seen in CF. Although the development of enteric-coated enzyme preparations offers a dramatic improvement in therapy, it is still difficult to achieve complete correction of fat malabsorption. The cause for this treatment failure is the relative acidic environment in the duodenum induced by a decreased pancreatic bicarbonate output. To improve the efficacy of enteric-coated preparations the dissolution of these preparations in the duodenum must be optimised in order to achieve a high intraduodenal enzyme concentration. With the aim to increase intraduodenal pH, additional therapy with H2-antagonists and oral prostaglandins has been tested without unequivocal success. Omeprazole, a gastric acid inhibitor with more potency and duration of action compared to H2-antagonists, improves the efficacy of enteric-coated capsules of pancreatin dramatically. With a daily dose of 20 mg in addition to Pancrease (3 x 4 capsules) near normalization of faecal fat excretion will be reached in most CF patients with persistent steatorrhoea.

  20. Monocytic delivery of therapeutic oxygen bubbles for dual-modality treatment of tumor hypoxia.

    PubMed

    Huang, Wen-Chia; Shen, Ming-Yin; Chen, Hsin-Hung; Lin, Sung-Chyr; Chiang, Wen-Hsuan; Wu, Pei-Hsuan; Chang, Chien-Wen; Chiang, Chi-Shiun; Chiu, Hsin-Cheng

    2015-12-28

    Photodynamic therapy (PDT) is a powerful technique photochemically tailored for activating apoptosis of malignant cells. Although PDT has shown promise in several clinical applications, malignant cells in hypoxic regions are often resistant to PDT due to the transport limitation of therapeutics and the oxygen-dependent nature of PDT. Herein, we present an innovative strategy for overcoming the limits of PDT in tumor hypoxia using bone marrow-derived monocytes as cellular vehicles for co-transport of oxygen and red light activatable photosensitizer, chlorin e6 (Ce6). Superparamagnetic iron oxide nanoparticle/Ce6/oxygen-loaded polymer bubbles were prepared and internalized into tumortropic monocytes. These functional bubbles were found harmless to cellular hosts without external triggers. Nevertheless, the therapeutic monocytes exhibited a superior performance in inhibiting tumor growth on Tramp-C1 tumor-bearing mice (C57BL/6J) upon the treatments of tumors with high frequency magnetic field and red light laser (660 nm). Histological examinations of the tumor sections confirmed the successful cellular transport of therapeutic payloads to tumor hypoxia and the pronounced antitumor effect elicited by combined hyperthermia/photodynamic therapy along with the additional oxygen supply. This work demonstrates that this oxygen/therapeutic co-delivery via tumortropic monocytes toward tumor hypoxia is promising for improving PDT efficacy.

  1. Impact of infertility characteristics and treatment modalities on singleton pregnancies after assisted reproduction.

    PubMed

    Poikkeus, P; Unkila-Kallio, L; Vilska, S; Repokari, L; Punamäki, R-L; Aitokallio-Tallberg, A; Sinkkonen, J; Almqvist, F; Tulppala, M; Tiitinen, A

    2006-07-01

    Obstetric and neonatal outcomes of assisted reproduction and control singletons were evaluated after taking into account treatment characteristics and infertility background. The elective single embryo transfer (eSET) group (n = 45) was compared with the compulsory single embryo transfer (cSET; n = 52), double embryo transfer (DET; n = 227) and control (n = 304) groups. Infertility-related prognostic factors for neonatal outcomes were also analysed. Data were collected with structured questionnaires at gestational week 20 and 8 weeks after delivery. Spontaneous onset of delivery was more typical of the eSET group than of cSET and DET groups (68.9 versus 52.0%, P = 0.02). Mean (+/-SD) gestation at birth (39.3 +/- 1.6 weeks) and mean birth weight (3,470 +/- 505 g) of eSET singletons were comparable with other assisted reproduction groups, but gestational duration was lower than in the eSET group than in the control group (39.9 +/- 1.4; P < 0.05). However, numbers of preterm births and low birth weight infants were similar between groups. History of induced abortion increased risk of preterm birth (OR 4.5 and 95% CI 1.2-17.1) in assisted reproduction singletons. A small though clinically unimportant difference in gestational age at birth and birth weight between assisted reproduction and control singletons was found regardless of the number of embryos transferred.

  2. Combined-modality treatment for advanced oral tongue squamous cell carcinoma

    SciTech Connect

    Fan, K.-H.; Lin, C.-Y. |; Kang, C.-J.; Huang, S.-F.; Chen, I.-H.; Liao, C.-T. |; Wang, H.-M. |; Cheng, A.-J. |; Chang, J.T.-C. ||. E-mail: jtchang@adm.cgmh.org.tw

    2007-02-01

    Purpose: The aim of this study was to investigate prognostic factors in advanced-stage oral tongue cancer treated with postoperative adjuvant therapy and to identify indications for adjuvant concomitant chemoradiotherapy (CCRT). Methods and Materials: We retrospectively reviewed the records of 201 patients with advanced squamous cell carcinoma of the oral tongue managed between January 1995 and November 2002. All had undergone wide excision and neck dissection plus adjuvant radiotherapy or CCRT. Based on postoperative staging, 123 (61.2%) patients had Stage IV and 78 (38.8%) had Stage III disease. All patients were followed for at least 18 months after completion of radiotherapy or until death. The median follow-up was 40.4 months for surviving patients. The median dose of radiotherapy was 64.8 Gy (range, 58.8-72.8 Gy). Cisplatin-based regimens were used for chemotherapy. Results: The 3-year overall survival (OS) and recurrence-free survival (RFS) rates were 48% and 50.8%, respectively. Stage, multiple nodal metastases, differentiation, and extracapsular spread (ECS) significantly affected disease-specific survival on univariate analysis. On multivariate analysis, multiple nodal metastases, differentiation, ECS, and CCRT were independent prognostic factors. If ECS was present, only CCRT significantly improved survival (3-year RFS with ECS and with CCRT = 48.2% vs. without CCRT = 15%, p = 0.038). In the presence of other poor prognostic factors, results of the two treatment strategies did not significantly differ. Conclusions: Based on this study, ECS appears to be an absolute indication for adjuvant CCRT. CCRT can not be shown to be statistically better than radiotherapy alone in this retrospective series when ECS is not present.

  3. Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization.

    PubMed

    Crockett, S D; Sperry, S L W; Miller, C Brock; Shaheen, N J; Dellon, E S

    2013-01-01

    Esophageal foreign body impaction (EFBI) often requires urgent evaluation and treatment, but characteristics of emergency department (ED) care such as timing of presentation and therapeutic procedures and costs of care are unknown. We aimed to study health-care utilization for patients with EFBI presenting to the ED. Cases of EFBI from 2002 to 2009 were identified by querying three different databases from the University of North Carolina Hospitals for all records with ICD-9 CM code 935.1: 'foreign body in the esophagus.' Charts were reviewed to confirm EFBI and extract pertinent data related to the ED visit, including time of presentation, length of ED stay, medications administered, type of procedure performed, characteristics of procedures, and time to therapeutic procedure. Hospital charges for EFBI encounters and consult fees were determined from the Physicians' Fee Reference 2010, and were compiled to estimate costs. Of the 548 cases of EFBI identified, 351 subjects (64%) presented to the ED. A total of 118 (34%) patients received a medication to treat EFBI, which was only effective in 8% of those patients. Two hundred ninety (83%) subjects underwent a procedure including esophagogastroduodenoscopy (EGD) (n=206) or ear, nose, and throat surgery (ENT)-performed laryngoscopy/esophagoscopy (n=138). Admission to the hospital occurred in 162 (46%) of cases. There was no relationship between ED arrival time and time-to-procedure or total time in ED. There was also no significant relationship between delivery of ED medications and likelihood of undergoing a procedure, or between ED arrival time and delivery of medications. The charges associated with a typical EFBI episode ranged from $2284-$6218. In conclusion, the majority of patients with EFBI at our institution presented to the ED. Medical management was largely ineffective. A therapeutic procedure was required to clear the EFBI in most patients. Time of ED arrival made no difference in time

  4. Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities.

    PubMed

    Busoni, M; Deganello, A; Gallo, O

    2015-12-01

    The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared with a control group of 86 patients without fistula, randomly selected from a pool of 352 total laryngectomies, performed between January 1999 to October 2014. The overall incidence of PCF in the series was 24.4%; we recorded rates of 19.0%, 28.6% and 30.3% following primary total laryngectomy (PTL), salvage laryngectomy post-radiotherapy (RT-STL) and salvage laryngectomy postchemoradiotherapy (CRT-STL), respectively. Multivariate analysis revealed that the relative risk of fistula was respectively 2.47, 3.09 and 7.69 for hypoalbuminaemia ≤3.5 g/dL, RT-STL and CRT-STL. An early onset of PCF within 10 postoperative days was recorded in case of salvage total laryngectomy. The management of PCF significantly differed between PTL, RT-STL and CTRT-STL, with exclusive conservative treatment for PTL (93.55%), while in the CRT-STL group surgical closure with regional flaps (58.82%) prevailed. Conservative management, adjuvant hyperbaric oxygen therapy and surgical closure were equally distributed in the RT-STL group. Thorough knowledge of patient-related risk factors and its prognostic value, allows the surgeon to better evaluate preventive strategies with the aim of minimising fistula formation, hospitalisation times and related costs.

  5. Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy as Treatments for Academic Procrastination: A Randomized Controlled Group Session

    ERIC Educational Resources Information Center

    Wang, Shuo; Zhou, Ya; Yu, Shi; Ran, Li-Wen; Liu, Xiang-Ping; Chen, Yu-Fei

    2017-01-01

    Objective: This study tested the efficacy of Acceptance and Commitment Therapy (ACT), compared with Cognitive-Behavioral Therapy (CBT), in alleviating academic procrastination. Method: A total of 60 (53.3% male) undergraduates suffering from academic procrastination were randomly assigned to two treatment groups (ACT and CBT) and a control group.…

  6. Local Massage with Topical Analgesic, a Novel Treatment Modality for Temporomandibular Muscular Pain, a Case Study Report of 5 Consecutive Cases

    PubMed Central

    Wong, R.W.K; Rabie, A.B.M

    2008-01-01

    Introduction: Temporomandibular disorders (TMDs) represent a group of painful conditions involving the muscles of mastication and the temporomandibular joint. Ping On Ointment has been used in the Chinese Orthopedics as a soothing massage balm for muscular aches, strain and sprain. If topical application of the ointment can be effective for the treatment of TMD muscular pain, it may be the long-sought-after method for safe, simple, cheap, non-invasive, and effective treatment modality of TMD muscular pain. Purpose: This report documented a case study of the first five consecutive cases using this treatment modality. Results: All cases resulted in complete remission of pain within one month of topical massage. Conclusion: This treatment method has high potential to benefit a significant number of people and randomized control trials should be performed. PMID:19506702

  7. Assessment of normal tissue complications following prostate cancer irradiation: Comparison of radiation treatment modalities using NTCP models

    SciTech Connect

    Takam, Rungdham; Bezak, Eva; Yeoh, Eric E.; Marcu, Loredana

    2010-09-15

    Purpose: Normal tissue complication probability (NTCP) of the rectum, bladder, urethra, and femoral heads following several techniques for radiation treatment of prostate cancer were evaluated applying the relative seriality and Lyman models. Methods: Model parameters from literature were used in this evaluation. The treatment techniques included external (standard fractionated, hypofractionated, and dose-escalated) three-dimensional conformal radiotherapy (3D-CRT), low-dose-rate (LDR) brachytherapy (I-125 seeds), and high-dose-rate (HDR) brachytherapy (Ir-192 source). Dose-volume histograms (DVHs) of the rectum, bladder, and urethra retrieved from corresponding treatment planning systems were converted to biological effective dose-based and equivalent dose-based DVHs, respectively, in order to account for differences in radiation treatment modality and fractionation schedule. Results: Results indicated that with hypofractionated 3D-CRT (20 fractions of 2.75 Gy/fraction delivered five times/week to total dose of 55 Gy), NTCP of the rectum, bladder, and urethra were less than those for standard fractionated 3D-CRT using a four-field technique (32 fractions of 2 Gy/fraction delivered five times/week to total dose of 64 Gy) and dose-escalated 3D-CRT. Rectal and bladder NTCPs (5.2% and 6.6%, respectively) following the dose-escalated four-field 3D-CRT (2 Gy/fraction to total dose of 74 Gy) were the highest among analyzed treatment techniques. The average NTCP for the rectum and urethra were 0.6% and 24.7% for LDR-BT and 0.5% and 11.2% for HDR-BT. Conclusions: Although brachytherapy techniques resulted in delivering larger equivalent doses to normal tissues, the corresponding NTCPs were lower than those of external beam techniques other than the urethra because of much smaller volumes irradiated to higher doses. Among analyzed normal tissues, the femoral heads were found to have the lowest probability of complications as most of their volume was irradiated to lower

  8. Effectiveness and Patient Acceptability of Stellate Ganglion Block (SGB) for Treatment of Posttraumatic Stress Disorder (PTSD) Symptoms Among Active Duty Military Members

    DTIC Science & Technology

    2016-03-01

    Page 1 of 63 AWARD NUMBER: W81XWH-15-2-0015 TITLE: Effectiveness and Patient Acceptability of Stellate Ganglion Block (SGB) for Treatment of...SUBTITLE 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-15-2-0015 Effectiveness and Patient Acceptability of Stellate Ganglion Block (SGB) for Treatment...study seeks to evaluate the effectiveness and acceptability of stellate ganglion block (SGB) for treatment of Posttraumatic Stress Disorder (PTSD

  9. Feasibility and acceptability of CD-ROM-based cognitive-behavioural treatment for binge-eating disorder.

    PubMed

    Shapiro, Jennifer R; Reba-Harrelson, Lauren; Dymek-Valentine, Maureen; Woolson, Sandra L; Hamer, Robert M; Bulik, Cynthia M

    2007-05-01

    We compared preliminary feasibility and acceptability of CD-ROM-delivered CBT for overweight individuals with binge-eating disorder (BED) to 10 weekly group CBT sessions (Group) and to a waiting list control (WL). Attrition was numerically greater in the Group than the CD-ROM condition; although only Group differed significantly from WL in dropout rates. Those in the CD-ROM condition reported continued use of their CD-ROM after treatment. Also, the majority of WL participants elected to receive CD-ROM over Group treatment at the end of the waiting period. Preliminarily, no significant differences emerged across the active treatment groups on most outcome measures. However, there was a significantly greater decline in binge days in the two active groups relative to WL. CD-ROM appears to be an acceptable and at least initially preferred method of CBT delivery for overweight individuals with BED.

  10. SU-E-T-01: (In)dependence of Plan Quality On Treatment Modalities and Target-To-Critical Structure Geometry for Brain Tumor

    SciTech Connect

    Ruan, D; Shao, W; Low, D; Kupelian, P; Qi, S X

    2015-06-15

    Purpose: To evaluate and test the hypothesis that plan quality may be systematically affected by treatment delivery techniques and target-tocritical structure geometric relationship in radiotherapy for brain tumor. Methods: Thirty-four consecutive brain tumor patients treated between 2011–2014 were analyzed. Among this cohort, 10 were planned with 3DCRT, 11 with RadipArc, and 13 with helical IMRT on TomoTherapy. The selected dosimetric endpoints (i.e., PTV V100, maximum brainstem/chiasm/ optic nerve doses) were considered as a vector in a highdimensional space. A Pareto analysis was performed to identify the subset of Pareto-efficient plans.The geometric relationships, specifically the overlapping volume and centroid-of-mass distance between each critical structure to the PTV were extracted as potential geometric features. The classification-tree analyses were repeated using these geometric features with and without the treatment modality as an additional categorical predictor. In both scenarios, the dominant features to prognosticate the Pareto membership were identified and the tree structures to provide optimal inference were recorded. The classification performance was further analyzed to determine the role of treatment modality in affecting plan quality. Results: Seven Pareto-efficient plans were identified based on dosimetric endpoints (3 from 3DCRT, 3 from RapicArc, 1 from Tomo), which implies that the evaluated treatment modality may have a minor influence on plan quality. Classification trees with/without the treatment modality as a predictor both achieved accuracy of 88.2%: with 100% sensitivity and 87.1% specificity for the former, and 66.7% sensitivity and 96.0% specificity for the latter. The coincidence of accuracy from both analyses further indicates no-to-weak dependence of plan quality on treatment modality. Both analyses have identified the brainstem to PTV distance as the primary predictive feature for Pareto-efficiency. Conclusion: Pareto

  11. Lifestyle interventions for cardiovascular disease risk reduction: a systematic review of the effects of diet composition, food provision, and treatment modality on weight loss.

    PubMed

    Dutton, Gareth R; Laitner, Melissa H; Perri, Michael G

    2014-10-01

    The purpose of this systematic review was to evaluate, synthesize, and interpret findings from recent randomized controlled trials (RCTs) of dietary and lifestyle weight loss interventions examining the effects of (1) diet composition, (2) use of food provision, and (3) modality of treatment delivery on weight loss. Trials comparing different dietary approaches indicated that reducing carbohydrate intake promoted greater initial weight loss than other approaches but did not appear to significantly improve long-term outcomes. Food provision appears to enhance adherence to reduction in energy intake and produce greater initial weight losses. The long-term benefits of food provision are less clear. Trials comparing alternative treatment modalities suggest that phone-based treatment produce short- and long-term weight reductions equivalent to face-to-face interventions. The use of Internet and mobile technologies are associated with smaller reductions in body weight than face-to-face interventions. Based on this review, clinical implications and future research directions are provided.

  12. Feasibility, Acceptability, and Impact of a Web-based Gratitude Exercise among Individuals in Outpatient Treatment for Alcohol Use Disorder

    PubMed Central

    Krentzman, Amy R.; Mannella, Kristin A.; Hassett, Afton L.; Barnett, Nancy P.; Cranford, James A.; Brower, Kirk J.; Higgins, Margaret M.; Meyer, Piper S.

    2015-01-01

    This mixed-methods pilot study examined the feasibility, acceptability, and impact of a web-based gratitude exercise (the ‘Three Good Things’ exercise (TGT)) among 23 adults in outpatient treatment for alcohol use disorder (AUD). Participants were randomized to TGT or a placebo condition. The intervention was feasible with high rates of completion. Participants found TGT acceptable and welcomed the structure of daily emails; however, they found it difficult at times and discontinued TGT when the study ended. Participants associated TGT with gratitude, although there were no observed changes in grateful disposition over time. TGT had a significant effect on decreasing negative affect and increasing unactivated (e.g., feeling calm, at ease) positive affect, although there were no differences between groups at the 8 week follow up. Qualitative results converged on quantitative findings that TGT was convenient, feasible, and acceptable, and additionally suggested that TGT was beneficial for engendering positive cognitions and reinforcing recovery. PMID:27076837

  13. Long-term quality of life after intensified multi-modality treatment of oral cancer including intra-arterial induction chemotherapy and adjuvant chemoradiation

    PubMed Central

    Kovács, Adorján F.; Stefenelli, Ulrich; Thorn, Gerrit

    2015-01-01

    Background: Quality of life (QoL) studies are well established when accompanying trials in head and neck cancer, but studies on long-term survivors are rare. Aims: The aim was to evaluate long-term follow-up patients treated with an intensified multi-modality therapy. Setting and Design: Cross-sectional study, tertiary care center. Patients and Methods: A total of 135 oral/oropharyngeal cancer survivors having been treated with an effective four modality treatment (intra-arterial induction chemotherapy, radical surgery, adjuvant radiation, concurrent systemic chemotherapy) filled European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and HN35 questionnaires. Mean distance to treatment was 6.1 (1.3–16.6) years. Results were compared with a reference patient population (EORTC reference manual). In-study group comparison was also carried out. Statistical Analysis: One-sample t-test, Mann–Whitney-test, Kruskal–Wallis analysis. Results: QoL scores of both populations were well comparable. Global health status, cognitive and social functioning, fatigue, social eating, status of teeth, mouth opening and dryness, and sticky saliva were significantly worse in the study population; pain and need for pain killers, cough, need for nutritional support, problems with weight loss and gain were judged to be significantly less. Patients 1-year posttreatment had generally worse scores as compared to patients with two or more years distance to treatment. Complex reconstructive measures and adjuvant (chemo) radiation were main reasons for significant impairment of QoL. Conclusion Subjective disease status of patients following a maximized multi-modality treatment showed an expectable high degree of limitations, but was generally comparable to a reference group treated less intensively, suggesting that the administration of an intensified multi-modality treatment is feasible in terms of QoL/effectivity ratio. PMID:26389030

  14. Retrospective comparison of the effectiveness of various treatment modalities of extragastric MALT lymphoma: a single-center analysis.

    PubMed

    Wöhrer, Stefan; Kiesewetter, Barbara; Fischbach, Julia; Müllauer, Leonhard; Troch, Marlene; Lukas, Julius; Mayerhoefer, Marius E; Raderer, Markus

    2014-08-01

    We have performed a retrospective analysis of all patients with extragastric mucosa-associated lymphoid tissue (MALT) lymphoma treated at our institution to compare the efficacy of first-line therapeutic modalities including surgery, radiation, systemic therapy, and antibiotics. One hundred eighty-five patients with extragastric MALT lymphoma with a median age of 63 (interquartile range (IQR) 50-74) years and a median follow-up time of 49 (IQR 18-103) months were retrospectively analyzed. Time to progression and time to next therapy were used as surrogate endpoints for efficacy. Patients having either surgery (100 %), chemo/immunotherapy (85.5 %), or radiation (80 %) had significantly (p = 0.01) higher response rates than patients treated with antibiotics (33.3 %). Patients who were irradiated had significantly more progressive disease, but also the longest follow-up time. Stage, elevated LDH, anemia, elevated beta-2 microglobulin, plasmacytic differentiation, monoclonal gammopathy, or autoimmune disease did not influence the rate of disease progression nor did complete remission or partial remission from initial therapy influence time to and rate of progression. There was no significant difference in the median time to progression (p = 0.141), but the estimated time to progression (p = 0.023) as well as the estimated time to next therapy (p = 0.021) was significantly different among the various cohorts favoring surgery, chemo/immunotherapy, and radiation. Our results suggest extragastric MALT lymphoma as a potential systemic disease irrespective of initial stage. Radiation, surgery, and chemo/immunotherapy seem to be equally effective in achieving remissions and prolonged progression free survivals, but a curative potential is questionable. Localized MALT lymphomas affecting the thyroid gland or the lungs have excellent long-term progression-free survivals with surgical treatment only.

  15. Feasibility and Acceptability of the PROMIS Measures in Children and Adolescents in Active Cancer Treatment and Survivorship

    PubMed Central

    Menard, Johanna C.; Hinds, Pamela S.; Jacobs, Shana S.; Cranston, Katie; Wang, Jichuan; DeWalt, Darren A.; Gross, Heather E.

    2013-01-01

    Background Patient-reported outcomes (PROs) related to symptoms, function, and quality of life during and following cancer treatment can guide care for pediatric cancer patients. To advance the science of PROs, the National Institutes of Health funded the Patient Reported Outcomes Measurement Information System (PROMIS). Objective To assess feasibility and acceptability of the PROMIS pediatric measures, as defined by enrollment and attrition rates as well as missingness by measure, item, participant, and assessment time point. Methods 8-to-18 year olds participated in two studies: PROMIS I, a cross-sectional study of children in active cancer treatment or survivorship, and PROMIS II, a longitudinal study with 3 assessment time points for children receiving curative treatment. Results PROMIS I (n=200) and PROMIS II (n=94) had enrollment rates of 92.5% and 89.7%, respectively. For PROMIS I, measure missingness was acceptable (8% missed any measures) and was not related to other study variables. For PROMIS II, measure missingness was minimal (0.8%), and item-level missingness was relatively low. In general, items that were skipped asked about experiences that participants had not encountered in the past 7 days. Conclusions In both studies, the PROMIS instruments demonstrated good feasibility and acceptability among pediatric cancer patients. Overall, we had high enrollment, low attrition, and acceptable rates of measure and item missingness. Implications for Practice Our results demonstrate that PROMIS measures are acceptable to 8-to-18 year-olds in different points of cancer care and feasible for use in pediatric cancer inpatient and outpatient settings. PMID:24036439

  16. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review.

    PubMed

    Veehof, M M; Trompetter, H R; Bohlmeijer, E T; Schreurs, K M G

    2016-01-01

    The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies' quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.

  17. Diagnostic modalities.

    PubMed

    Elstob, Alison; Gonsalves, Michael; Patel, Uday

    2016-12-01

    The incidental detection of small renal masses on imaging undertaken to evaluate unrelated symptoms or conditions is an increasingly common occurrence. Accurate imaging characterisation is fundamental to determining optimum patient management. The goals of imaging small renal masses include determining whether a lesion is solid or cystic, if there are signs of biological aggressiveness and whether the lesion is likely benign or malignant. The current imaging practices and the evidence supporting the use of different imaging modalities for the characterisation of small renal masses are discussed. CT remains the primary imaging modality and is able to classify most masses into surgical or non-surgical lesions. MRI and contrast enhanced ultrasound are most often employed to problem solve in lesions deemed indeterminate on contrast enhanced CT or for patients in which CECT is contraindicated. Percutaneous biopsy should be considered in lesions that remain indeterminate after initial imaging investigations. Given the central role of imaging in the management of small renal masses, all multidisciplinary team members involved in renal cancer care should have an understanding of the performance of the different imaging modalities.

  18. Acceptance and Commitment Therapy for Treatment-Resistant Posttraumatic Stress Disorder: A Case Study

    ERIC Educational Resources Information Center

    Twohig, Michael P.

    2009-01-01

    An adult woman with chronic posttraumatic stress disorder (PTSD) and major depressive disorder who was nonresponsive to 20 sessions of cognitive behavior therapy (CBT) is presented in this case study. Two months after her CBT trial, she was treated with 21 sessions of Acceptance and Commitment Therapy (ACT) for PTSD. Measurements of PTSD severity,…

  19. Supervising Trainees in Acceptance and Commitment Therapy for Treatment of Posttraumatic Stress Disorder

    ERIC Educational Resources Information Center

    Walser, Robyn D.; Westrup, Darrah

    2006-01-01

    Acceptance and Commitment Therapy (ACT, Hayes, Strosahl, & Wilson, 1999) is a behaviorally based intervention designed to target and reduce experiential avoidance and cognitive fusion (holding the thoughts in one's mind to be literally true) while at the same time helping clients to make powerful life enhancing behavioral changes that are in line…

  20. Effect of salt treatments on survival and consumer acceptance of freshwater prawn, Macrobrachium rosenbergii

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Post harvest acclimation of live freshwater prawns to a mixture of water and marine salt increases the consumer acceptability of the finished product. However, the high cost of marine salts prohibits their use in commercial practice. Therefore, the identification of successful, cost effective salt a...

  1. Using Descriptive Assessment in the Treatment of Bite Acceptance and Food Refusal

    ERIC Educational Resources Information Center

    Casey, Sean D.; Perrin, Christopher J.; Lesser, Aaron D.; Perrin, Stefanie H.; Casey, Cheryl L.; Reed, Gregory K.

    2009-01-01

    The feeding behaviors of two children who maintained failure to thrive diagnoses and displayed food refusal are assessed in their homes. Descriptive assessments are used to identify schedules of consequence provided by each child's care providers for bite acceptance and food refusal behaviors. Assessments reveal rich schedules of praise and access…

  2. Acceptance and Commitment Therapy as a Treatment for Scrupulosity in Obsessive Compulsive Disorder

    ERIC Educational Resources Information Center

    Dehlin, John P.; Morrison, Kate L.; Twohig, Michael P.

    2013-01-01

    This study evaluated acceptance and commitment therapy (ACT) for scrupulosity-based obsessive compulsive disorder (OCD). Five adults were treated with eight sessions of ACT, without in-session exposure, in a multiple baseline across participants design. Daily monitoring of compulsions and avoided valued activities were tracked throughout the…

  3. A Clinical Study of Melasma and a Comparison of the Therapeutic Effect of Certain Currently Available Topical Modalities for its Treatment

    PubMed Central

    Sardesai, Vidyadhar R; Kolte, Jennifer N; Srinivas, Babu N

    2013-01-01

    Background: Melasma is a common acquired facial hypermelanosis. Conventional treatment of melasma includes a sunscreen and hypopigmenting agents. The treatment of this recalcitrant disorder is often difficult and unsatisfactory. Aims: The objective is to carry out a detailed clinical study of melasma and to assess the therapeutic effect and side effects of certain currently available topical modalities for the treatment of melasma. Materials and Methods: 160 patients of all age groups and both sexes were treated sequentially with five different combination regimes for 3 months. Assessment of the response was done subjectively as well as by melasma area and severity index (MASI). Results: Out of the five modalities studied, the modified Kligman's formula was the most effective. However, it had comparatively higher incidence of side effects. Conclusions: Among the currently available topical modalities for the treatment of melasma, the most effective combination is the modified Kligman's formula. However, in view of the side effects it causes, it must be used with caution and proper counseling. PMID:23723484

  4. Safety, efficacy, actions, and patient acceptability of drospirenone/ethinyl estradiol contraceptive pills in the treatment of premenstrual dysphoric disorder

    PubMed Central

    Breech, Lesley L; Braverman, Paula K

    2010-01-01

    Premenstrual dysphoric disorder (PMDD) is estimated to affect 3%–8% of reproductive age women. Multiple therapeutic modalities have been evaluated with varying efficacy for the associated somatic and mood symptoms. The majority of older studies had shown that oral contraceptive pills (OCs) were most effective for the physical symptoms. However, newer OCs containing a novel progestin, drospirenone, have shown promise in alleviating both the somatic and affective/behavioral symptoms. This progestin, which is a derivative of spironolactone, has both antimineralocorticoid and antiandrogenic activity. A 24/4 formulation containing 20 μg of ethinyl estradiol has been found effective in randomized double-blind placebo-controlled trials utilizing established scales documenting symptoms associated with PMDD. Multiple studies have shown that drospirenone-containing OCs are safe without evidence of clinically adverse effects on carbohydrate metabolism, lipids, blood pressure, weight, serum potassium or increased thrombotic events compared to other low dose OCs. In addition, significant improvements have been demonstrated in acne, hirsutism, and fluid retention symptoms. Several open label studies demonstrated good patient compliance and reported satisfaction with the method. Because of the significant placebo effect demonstrated in the blinded placebo-controlled trials, additional large randomized placebo-controlled trials are needed to confirm the efficacy of the drospirenone OCs in the treatment of PMDD. However, this OC formulation appears to be a promising therapeutic modality. PMID:21072278

  5. Integrating screening, brief intervention and referral to treatment (SBIRT) into an abortion clinic: an exploratory study of acceptability.

    PubMed

    Appel, Lindsay; Ramanadhan, Shaalini; Hladky, Katherine; Welsh, Chris; Terplan, Mishka

    2015-04-01

    Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective means of identifying problematic substance use. We evaluated the acceptability of SBIRT in an abortion clinic via an anonymous survey of 100 participants. Clients were comfortable being asked about their substance use, receiving counseling, and treatment referral (mean Likert 1.1, 1.5, and 1.6, respectively) and were only minimally embarrassed when asked about substance use (mean Likert 3.6). These findings suggest that integrating SBIRT into an abortion clinic may be feasible. However, future studies are needed to assess the efficacy of abortion clinic SBIRT in reducing risky substance use.

  6. A comparison of treatment modalities for nasal extranodal natural killer/T-cell lymphoma in early stages: The efficacy of CHOP regimen based concurrent chemoradiotherapy.

    PubMed

    Cao, Jianzhong; Lan, Shengmin; Shen, Liuhai; Si, Hongwei; Zhang, Ning; Li, Hongwei; Guo, Ruyuan

    2016-11-25

    This study was designed to evaluate the efficacy of several treatment modalities, including CHOP based concurrent chemoradiotherapy (CCRT), for the patients with stage IE or IIE nasal extranodal NK/T-cell lymphoma (nasal ENKL). The cases were retrieved between 2000 and 2010 (n=94), and were followed to the end of February 2016. The patients were grouped into A (chemotherapy alone; CT alone), B (sequential treatment) and C (CCRT). For those with efficacy evaluation for overall treatment (n=90), CR was attained in 60.0% (18/30), 69.8% (30/43) and 76.5% (13/17) patients in the group A, B and C, respectively. The 5-year OS rate was 35.2%, 41.9% and 70.6% in the group A, B and C, respectively. For patients with early stage diseases (IE and IIE), the ECOG performance status and the Ann Arbor stage were significant prognostic factors for both OS and PFS. Among the stage IE patients, besides the ECOG performance status, three prognostic factors which related to treatments (treatment modalities, efficacy of initial and overall treatment) were significant against OS or PFS. In conclusion, compared to chemotherapy alone and sequential treatment, nasal ENKL patients in early stages, especially stage IE, benefit the most from CHOP based concurrent chemoradiotherapy.

  7. Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation.

    PubMed

    Juarascio, Adrienne; Shaw, Jena; Forman, Evan; Timko, C Alix; Herbert, James; Butryn, Meghan; Bunnell, Douglas; Matteucci, Alyssa; Lowe, Michael

    2013-07-01

    Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

  8. Counselor Attitudes Toward Contingency Management for Substance Use Disorder: Effectiveness, Acceptability, and Endorsement of Incentives for Treatment Attendance and Abstinence.

    PubMed

    Aletraris, Lydia; Shelton, Jeff S; Roman, Paul M

    2015-10-01

    Despite research demonstrating its effectiveness, use of contingency management (CM) in substance use disorder treatment has been limited. Given the vital role that counselors play as arbiters in the use of therapies, examination of their attitudes can provide insight into how further use of CM might be effectively promoted. In this paper, we examine 731 counselors' attitudes toward the effectiveness and acceptability of CM in treatment, as well as their specific attitudes toward both unspecified and tangible incentives for treatment attendance and abstinence. Compared to cognitive behavioral therapy, motivational interviewing, and community reinforcement approach, counselors rated CM as the least effective and least acceptable psychosocial intervention. Exposure through the use of CM in a counselor's employing organization was positively associated with perceptions of acceptability, agreement that incentives have a positive effect on the client-counselor relationship, and endorsement of tangible incentives for abstinence. Endorsement of tangible incentives for treatment attendance was significantly greater among counselors with more years in the treatment field, and counselors who held at least a master's degree. Counselors' adaptability or openness to innovations was also positively associated with attitudes toward CM. Further, female counselors and counselors with a greater 12-step philosophy were less likely to endorse the use of incentives. A highlight of our study is that it offers the first specific assessment of the impact of "Promoting Awareness of Motivational Incentives" (PAMI), a Web-based tool based on findings of CM protocols tested within the Clinical Trials Network (CTN), on counselors employed outside the CTN. We found that 10% of counselors had accessed PAMI, and those who had accessed PAMI were more likely to report a higher degree of perceived effectiveness of CM than those who had not. This study lays the groundwork for vital research on the

  9. Acceptability of solar disinfection of drinking water treatment in Kathmandu Valley, Nepal.

    PubMed

    Rainey, Rochelle C; Harding, Anna K

    2005-10-01

    This research examines the acceptability of solar disinfection of drinking water (SODIS) in a village in Kathmandu Valley, Nepal, using constructs from the Health Belief Model as a framework to identify local understandings of water, sanitation and health issues. There has been no published research on the acceptability of SODIS in household testing in Nepal. Understanding the context of water and water purity in Nepalese villages is essential to identify culturally appropriate interventions to improve the quality of drinking water and health. Forty households from the village census list were randomly selected and the senior woman in each household was asked to participate. Baseline data on water sources and behaviors were collected in March 2002, followed by training in SODIS. Follow-up data were collected in June and July 2002. Only 9% of households routinely adopted SODIS. Participants mentioned the benefit of treating water to reduce stomach ailments, but this did not outweigh the perceived barriers of heavy domestic and agricultural workloads, other cultural barriers, uncertainty about the necessity of treating the water, and lack of knowledge that untreated drinking water causes diarrhea. Strategies for developing safe water systems must include public health education about waterborne diseases, source water protection, and a motivational component to achieve implementation and sustained use. In addition, other options for disinfecting water should be provided, given the women's work constraints and low level of formal education.

  10. Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial.

    PubMed

    Westin, Vendela Zetterqvist; Schulin, Mikael; Hesser, Hugo; Karlsson, Marianne; Noe, Reza Zare; Olofsson, Ulrike; Stalby, Magnus; Wisung, Gisela; Andersson, Gerhard

    2011-11-01

    The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen's d=1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen's d=0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.

  11. Primary Care Patients with Depression Are Less Accepting of Treatment Than Those Seen by Mental Health Specialists

    PubMed Central

    Van Voorhees, Benjamin W; Cooper, Lisa A; Rost, Kathryn M; Nutting, Paul; Rubenstein, Lisa V; Meredith, Lisa; Wang, Nae-Yuh; Ford, Daniel E

    2003-01-01

    OBJECTIVE This study examined whether depressed patients treated exclusively in primary care report less need for care and less acceptability of treatment options than those depressed patients treated in the specialty mental health setting after up to 6 months of treatment. DESIGN Cross-sectional study. SETTING Forty-five community primary care practices. PARTICIPANTS A total of 881 persons with major depression who had received mental health services in the previous 6 months and who enrolled in 3 of the 4 Quality Improvement for Depression Collaboration Studies. MEASUREMENTS AND RESULTS Patients were categorized into 1 of 2 groups: 1) having received mental health services exclusively from a primary care provider (45%), or 2) having received any services from a mental health specialist (55%) in the previous 6 months. Compared with patients who received care from mental health specialists, patients who received mental health services exclusively from primary care providers had 2.7-fold the odds (95% confidence interval [CI], 1.6 to 4.4) of reporting that no treatment was definitely acceptable and had 2.4-fold the odds (95% CI, 1.5 to 3.9) of reporting that evidence-based treatment options (antidepressant medication) were definitely not acceptable. These results were adjusted for demographic, social/behavioral, depression severity, and economic factors using multiple logistic regression analysis. CONCLUSIONS Patients with depression treated exclusively by primary care providers have attitudes and beliefs more averse to care than those seen by mental health specialists. These differences in attitudes and beliefs may contribute to lower quality depression care observed in comparisons of primary care and specialty mental health providers. PMID:14687257

  12. Treatment Effectiveness, Stimulus Generalization, and Acceptability to Parents of Functional Communication Training

    ERIC Educational Resources Information Center

    Wacker, David P.; Berg, Wendy K.; Harding, Jay W.; Barretto, Anjali; Rankin, Barbara; Ganzer, Jed

    2005-01-01

    We trained parents to conduct functional analyses (n = 25) and functional communication training (n = 23) in home settings over a four-year period with 25 young children who had developmental and behavioural disorders. For 12 of the children, pre-treatment (baseline) probes and post-treatment stimulus condition probes were conducted to assess…

  13. The Acceptability of an Internet-Based Self-Help Treatment for Fear of Public Speaking

    ERIC Educational Resources Information Center

    Botella, C.; Gallego, M. J.; Garcia-Palacios, A.; Banos, R. M.; Quero, S.; Alcaniz, M.

    2009-01-01

    Several randomised controlled studies have shown the efficacy of Internet-based self-help treatments. These studies have centred their attention on axis I (efficacy) of the Guidelines for Empirically Validated Treatments, although there are a few studies that also take into account axis II (effectiveness). The aim of the present work was to test…

  14. Clinical holistic medicine: holistic sexology and treatment of vulvodynia through existential therapy and acceptance through touch.

    PubMed

    Ventegodt, Søren; Morad, Mohammed; Hyam, Eytan; Merrick, Joav

    2004-08-04

    Sexual problems are found in four major forms: lack of libido, lack of arousal and potency, pain and discomfort during intercourse, and lack of orgasm. It is possible to work with a holistic approach to sexology in the clinic in order to find and repair the negative beliefs, repressions of love, and lack of purpose of life, which are the core to problems like arousal, potency, and pain with repression of gender and sexuality. It is important not to focus only on the gender and genitals in understanding the patient"s sexual problems. It is of equal importance not to neglect the body, its parts, and the feelings and emotions connected to them. Shame, guilt, helplessness, fear, disgust, anger, hatred, and other strong feelings are almost always an important part of a sexual problem and these feelings are often "held" by the tissue of the pelvis and sexual organs. The patient with sexual problems can be helped both by healing existence in general and by discharging old painful emotions from the tissues. The later process of local healing is often facilitated by a simple technique: accepting contact via touch. This is a very simple technique, where the self-acceptance of the patient is to be promoted, for example, asking the female patient to put her hand on her stomach (uterus) or vulva, after which the holistic physician puts his hand supportively around hers. When done with care and after obtaining the necessary trust of the patient, this aspect of holding often releases the old negative emotions of shame bound to the touched areas. Afterwards, the emotional problems become a subject for conversational therapy and further holistic processing. Primary vulvodynia seems to be one of the diseases that can be cured after only a few successful sessions of working with acceptance through touch. The technique can be used as an isolated procedure or as a part of a pelvic examination. When touching the genitals with the intention of sexual healing, a written therapeutic

  15. Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment.

    PubMed

    Rollins, Angela L; Kukla, Marina; Salyers, Michelle P; McGrew, John H; Flanagan, Mindy E; Leslie, Doug L; Hunt, Marcia G; McGuire, Alan B

    2017-01-04

    Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.

  16. Feasibility and Acceptability of a Mobile Intervention to Improve Treatment Adherence in Bipolar Disorder: A Pilot Study

    PubMed Central

    Wenze, Susan J.; Armey, Michael F.; Miller, Ivan W.

    2014-01-01

    We evaluated the feasibility and acceptability of a two week-long ecological momentary intervention (EMI), delivered via personal digital assistants (PDAs), to improve treatment adherence in bipolar disorder. EMIs use mobile technology to deliver treatment as clients engage in their typical daily routines, in their usual settings. Overall, participants (N = 14) stated that EMI sessions were helpful, user-friendly, and engaging, and reported satisfaction with the timing and burden of sessions, as well as the method of delivery. All participants completed the study and all PDAs were returned undamaged. On average, participants completed 92% of EMI sessions. Although this study was not designed to assess efficacy, depression scores decreased significantly over the study period and data suggest relatively high rates of treatment adherence; missed medication was reported 3% of the time and 3 participants reported missing a total of 6 mental health appointments. Negative feedback largely involved technical and logistical issues, many of which are easily addressable. These preliminary findings add to the growing body of literature indicating that mobile technology-assisted interventions are feasible to implement and acceptable to patients with serious mental illnesses. PMID:24402464

  17. Feasibility and Acceptability of a Mobile Intervention to Improve Treatment Adherence in Bipolar Disorder: A Pilot Study.

    PubMed

    Wenze, Susan J; Armey, Michael F; Miller, Ivan W

    2014-07-01

    We evaluated the feasibility and acceptability of a 2-week-long ecological momentary intervention (EMI), delivered via personal digital assistants (PDAs), to improve treatment adherence in bipolar disorder. EMIs use mobile technology to deliver treatment as clients engage in their typical daily routines, in their usual settings. Overall, participants (N = 14) stated that EMI sessions were helpful, user-friendly, and engaging, and reported satisfaction with the timing and burden of sessions, as well as the method of delivery. All participants completed the study, and all PDAs were returned undamaged. On average, participants completed 92% of EMI sessions. Although this study was not designed to assess efficacy, depression scores decreased significantly over the study period and data suggest relatively high rates of treatment adherence; missed medication was reported 3% of the time and three participants reported missing a total of six mental health appointments. Negative feedback largely involved technical and logistical issues, many of which are easily addressable. These preliminary findings add to the growing body of literature indicating that mobile-technology-assisted interventions are feasible to implement and acceptable to patients with serious mental illnesses.

  18. Combined modality therapy for esophageal cancer.

    PubMed

    Minsky, Bruce D

    2003-08-01

    Treatment approaches for esophageal cancer include primary treatment (surgical or nonsurgical) or adjuvant treatment (preoperative or postoperative). Primary treatments include surgery alone, radiation therapy alone, and radiation therapy plus chemotherapy (combined modality therapy). Adjuvant therapies include preoperative or postoperative radiation therapy, preoperative chemotherapy, and preoperative combined modality therapy. There is considerable controversy as to the ideal therapeutic approach. This review will examine the results of these approaches as well as combined modality therapy using novel regimens.

  19. Why we should not routinely apply irreversible electroporation as an alternative curative treatment modality for localized prostate cancer at this stage.

    PubMed

    Wendler, J J; Ganzer, R; Hadaschik, B; Blana, A; Henkel, T; Köhrmann, K U; Machtens, S; Roosen, A; Salomon, G; Sentker, L; Witzsch, U; Schlemmer, H P; Baumunk, D; Köllermann, J; Schostak, M; Liehr, U B

    2017-01-01

    Irreversible electroporation (IRE), a new tissue ablation procedure available since 2007, could meet the requirements for ideal focal therapy of prostate cancer with its postulated features, especially the absence of a thermal ablation effect. Thus far, there is not enough evidence of its effectiveness or adverse effects to justify its use as a definitive treatment option for localized prostate cancer. Moreover, neither optimal nor individual treatment parameters nor uniform endpoints have been defined thus far. No advantages over established treatment procedures have as yet been demonstrated. Nevertheless, IRE is now being increasingly applied for primary prostate cancer therapy outside clinical trials, not least through active advertising in the lay press. This review reflects the previous relevant literature on IRE of the prostate or prostate cancer and shows why we should not adopt IRE as a routine treatment modality at this stage.

  20. The Epidemiology of Psychiatric Disorders among Repeat DUI Offenders Accepting a Treatment-Sentencing Option

    ERIC Educational Resources Information Center

    Shaffer, Howard J.; Nelson, Sarah E.; LaPlante, Debi A.; LaBrie, Richard A.; Albanese, Mark; Caro, Gabriel

    2007-01-01

    Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N = 729) to a 2-week…

  1. The epidemiology of psychiatric disorders among repeat DUI offenders accepting a treatment-sentencing option.

    PubMed

    Shaffer, Howard J; Nelson, Sarah E; LaPlante, Debi A; LaBrie, Richard A; Albanese, Mark; Caro, Gabriel

    2007-10-01

    Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N = 729) to a 2-week inpatient treatment facility for court-sentenced repeat DUI offenders (i.e., offenders electing treatment in place of prison time) from April 17, 2005, to April 23, 2006. Participants completed the Composite International Diagnostic Interview, which assessed the following disorders using criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994): alcohol use and drug use, bipolar, generalized anxiety, posttraumatic stress, intermittent explosive, conduct, attention deficit, nicotine dependence, pathological gambling, and major depressive. Repeat DUI offenders evidenced higher lifetime and 12-month prevalence of alcohol use and drug use disorders, conduct disorder, posttraumatic stress disorder, generalized anxiety disorder, and bipolar disorder compared with the general population. Almost half qualified for lifetime diagnoses of both addiction (i.e., alcohol, drug, nicotine, and/or gambling) and a psychiatric disorder. Lifetime and past-year comorbidity rates were higher among participants than in the general population. These results suggest that clinicians should consider multimorbidity within DUI treatment protocols.

  2. The Acceptability of Therapist-Assisted, Internet-Delivered Treatment for College Students

    ERIC Educational Resources Information Center

    Travers, M. Fallon; Benton, S. A.

    2014-01-01

    University and college counseling centers struggle with rising service demands without a corresponding increase in resources. Consequently, counseling centers must seek creative ways to not only maintain the status quo, but expand capacity while preserving effectiveness. In other countries, therapist-assisted, Internet-delivered treatment has been…

  3. Acceptance and Commitment Therapy versus Cognitive Therapy for the Treatment of Comorbid Eating Pathology

    ERIC Educational Resources Information Center

    Juarascio, Adrienne S.; Forman, Evan M.; Herbert, James D.

    2010-01-01

    Previous research has indicated that although eating pathology is prevalent in college populations, both CBT and non-CBT-based therapies achieve only limited effectiveness. The current study examined several questions related to the treatment of eating pathology within the context of a larger randomized controlled trial that compared standard CBT…

  4. Acceptance and Commitment Therapy and Habit Reversal Training for the Treatment of Trichotillomania

    ERIC Educational Resources Information Center

    Crosby, Jesse M.; Dehlin, John P.; Mitchell, P. R.; Twohig, Michael P.

    2012-01-01

    Trichotillomania is a behavioral problem, and is often referred to as a habit disorder, but it is important to consider the cognitive and emotional components of the behavior. Current treatment recommendations include a traditional behavioral approach (Habit Reversal Training; HRT) combined with an approach that addresses the cognitive and…

  5. Assessing Treatment Acceptability with Consumers of Outpatient Child Behavior Management Services.

    ERIC Educational Resources Information Center

    Miltenberger, Raymond G.; And Others

    1989-01-01

    Parents' and grandparents' ratings of alternative treatments for children with behavior disorders were assessed. Differential reinforcement of other behavior (DRO), time-out, response cost, spanking, and medication were applied to noncompliance, aggression, tantrums, and hyperactivity. DRO, response cost, and time-out were found significantly more…

  6. Acceptance and Commitment Therapy and Behavioral Activation for the Treatment of Depression: Description and Comparison

    ERIC Educational Resources Information Center

    Kanter, Jonathan W.; Baruch, David E.; Gaynor, Scott T.

    2006-01-01

    The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the "common cold" of outpatient populations. Two treatments for depression have emerged:…

  7. The Epidemiology of Psychiatric Disorders among Repeat DUI Offenders Accepting a Treatment-Sentencing Option

    ERIC Educational Resources Information Center

    Shaffer, Howard J.; Nelson, Sarah E.; LaPlante, Debi A.; LaBrie, Richard A.; Albanese, Mark; Caro, Gabriel

    2007-01-01

    Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N=729) to a 2-week…

  8. Risk of major depression in patients with chronic renal failure on different treatment modalities: A matched-cohort and population-based study in Taiwan.

    PubMed

    Chen, Shih-Feng; Wang, I-Jen; Lang, Hui-Chu

    2016-01-01

    The influence of different treatment modalities on the risk of developing major depression in patients with chronic renal failure (CRF) is not well understood. We aimed to explore the incidence of major depression among patients with CRF who were on different dialysis modalities, who had received renal transplantation (RT), and those who had not yet received any of the aforementioned renal replacement therapies. We conducted a population-based retrospective cohort study using a national health insurance research database. This study investigated 89,336 study controls, 17,889 patients with chronic kidney disease on conservative treatment, 3823 patients on hemodialysis (HD), 351 patients on peritoneal dialysis (PD), and 322 patients who had RT. We followed all individuals until the occurrence of major depression or the date of loss to follow-up. The PD group had the highest risk (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.26-4.69), whereas the RT group had the lowest risk (HR 0.18; 95% CI 0.03-1.29) of developing major depression compared with the control group. Patients initiated on PD had a higher risk of developing major depression than patients initiated on HD (pairwise comparison: HR 2.20; 95% CI 1.09-4.46). Different treatment modalities are associated with different risks of developing major depression in patients with CRF. Among renal replacement therapies, patients who have had RT have the lowest risk of developing major depression. Patients who initiate renal therapy on PD may have a higher risk of major depression compared with patients who initiate renal therapy on HD.

  9. Lifestyle Interventions for Cardiovascular Disease Risk Reduction: A Systematic Review of the Effects of Diet Composition, Food Provision, and Treatment Modality on Weight Loss

    PubMed Central

    Laitner, Melissa H.; Perri, Michael G.

    2014-01-01

    The purpose of this systematic review was to evaluate, synthesize, and interpret findings from recent randomized controlled trials (RCTs) of dietary and lifestyle weight loss interventions examining the effects of 1) diet composition, 2) use of food provision, and 3) modality of treatment delivery on weight loss. Trials comparing different dietary approaches indicated that reducing carbohydrate intake promoted greater initial weight loss than other approaches but did not appear to significantly improve long-term outcomes. Food provision appears to enhance adherence to reduction in energy intake and produce greater initial weight losses. The long-term benefits of food provision are less clear. Trials comparing alternative treatment modalities suggest that phone-based treatment produce short- and long-term weight reductions equivalent to face-to-face interventions. The use of Internet and mobile technologies are associated with smaller reductions in body weight than face-to-face interventions. Based on this review, clinical implications and future research directions are provided. PMID:25092578

  10. Orally disintegrating vardenafil tablets for the treatment of erectile dysfunction: efficacy, safety, and patient acceptability

    PubMed Central

    Green, Roger; Hicks, Rodney W

    2011-01-01

    Background: Erectile dysfunction (ED) is a well-documented medical condition that is expected to increase significantly over the next several decades, especially as men live longer and the prevalence of diabetes and cardiovascular diseases increase. Pharmacology agents are often the first line treatment approach. Newer solid dosage forms, known as orally disintegrating tablets (ODT), are now available as one treatment option. Objectives: To review the drug delivery mechanisms of ODTs in general and to review safety and efficacy of vardenafil ODT (a PDE-5 inhibitor) as a treatment option for management of ED. Method: Literature reviews were performed of pharmaceutical dosage forms and the POTENT I (n = 358 subjects) and POTENT II (n = 337 subjects) studies that investigated vardenafil ODT. Results: Vardenafil ODT has been successfully used in multiple age groups and in multiple settings with men from various ethnic backgrounds. Efficacy of vardenafil ODT, as measured using the International Index of Erectile Function (IIEF-EF) and from the Sexual Encounter Profile (SEP) was significantly greater than placebo (P < 0.0001) at 12 weeks. Safety profiles were similar to film-coated dosage forms with no patient deaths reported. Conclusion: Vardenafil ODT offers a convenient, ready-to-use approach for combating ED. Safety concerns are similar to other PDE-5 inhibitors and practitioners should counsel patients accordingly. PMID:21573049

  11. Clinical-pathological features and treatment modalities associated with recurrence in DCIS and micro-invasive carcinoma: Who to treat more and who to treat less.

    PubMed

    Toss, Angela; Palazzo, Juan; Berger, Adam; Guiles, Frances; Sendecki, Jocelyn Andrel; Simone, Nicole; Anne, Rani; Avery, Tiffany; Jaslow, Rebecca; Lazar, Melissa; Tsangaris, Theodore; Cristofanilli, Massimo

    2016-10-01

    The primary aim in the management of DCIS is the prevention of recurrence and contralateral tumor. Risk factors for DCIS recurrence and appropriate treatments are still widely debated. Adjuvant therapies after surgical resection reduce recurrences and contralateral disease, but these treatments have significant financial costs, side effects and there is a group of low-risk patients who would not gain additional benefit. The aim of our analysis was to identify clinical-pathological features and treatment modalities associated with recurrence in DCIS and microinvasive carcinoma. In the Thomas Jefferson University Cancer Registry of Philadelphia, we identified 865 patients with DCIS or micro-invasive carcinoma treated between 2003 and 2013. Associations between recurrence and demographic factors (age at diagnosis, ethnicity), biological features (ER, PR and HER2) and treatment modalities (surgery, radiotherapy and endocrine treatment) were assessed. Our single institution register-based study showed that distribution of age at diagnosis and biological features did not significantly differ among ethnic groups. Younger women and micro-invasive carcinoma patients were more likely to undergo mastectomy, while African Americans were more likely to take endocrine therapy and undergo radiotherapy. In our sample only ER/PR negative DCIS were associated with significantly higher recurrence rate. Moreover, we reported a high rate of HER2 positive recurrences, suggesting that expression of this oncogene may represent a potential biomarker for DCIS at high risk of recurrence. To better define the molecular profile of the subgroup at worse prognosis might help to identify biomarkers predictive of recurrence or second tumors, identifying patients candidates for more appropriate treatments.

  12. Impact of Dialectical Behavior Therapy versus Community Treatment by Experts on Emotional Experience, Expression, and Acceptance in Borderline Personality Disorder

    PubMed Central

    Neacsiu, Andrada D.; Lungu, Anita; Harned, Melanie S.; Rizvi, Shireen L.; Linehan, Marsha M.

    2014-01-01

    Evidence suggests that heightened negative affectivity is a prominent feature of Borderline Personality Disorder (BPD) that often leads to maladaptive behaviors. Nevertheless, there is little research examining treatment effects on the experience and expression of specific negative emotions. Dialectical Behavior Therapy (DBT) is an effective treatment for BPD, hypothesized to reduce negative affectivity (Linehan, 1993a). The present study analyzes secondary data from a randomized controlled trial with the aim to assess the unique effectiveness of DBT when compared to Community Treatment by Experts (CTBE) in changing the experience, expression, and acceptance of negative emotions. Suicidal and/or self-injuring women with BPD (n = 101) were randomly assigned to DBT or CTBE for one year of treatment and one year of follow-up. Several indices of emotional experience and expression were assessed. Results indicate that DBT decreased experiential avoidance and expressed anger significantly more than CTBE. No differences between DBT and CTBE were found in improving guilt, shame, anxiety, or anger suppression, trait, and control. These results suggest that DBT has unique effects on improving the expression of anger and experiential avoidance, whereas changes in the experience of specific negative emotions may be accounted for by general factors associated with expert therapy. Implications of the findings are discussed. PMID:24418652

  13. Efficacy, quality of life, and acceptability outcomes of atypical antipsychotic augmentation treatment for treatment-resistant depression: protocol for a systematic review and network meta-analysis

    PubMed Central

    2014-01-01

    Background Major depressive disorder (MDD) is a debilitating and costly mental disorder. Although commercially available antidepressants have proliferated over the last 20 years, a substantial number of patients either do not respond adequately to these drugs or are unable to tolerate their adverse effects. One common approach has been to augment conventional antidepressants with an adjunctive agent, but the optimal selection of atypical antipsychotic agents for adjunctive treatment of treatment-resistant depression (TRD) remains controversial. Methods/Design An electronic literature search of PubMed, the Cochrane Library, Embase, Web of Science, LiLACS, CINAHL, and PsycINFO for studies will be conducted with no restrictions on language, publication year, or publication type. Several clinical trial registry agencies, pharmaceutical company websites, and FDA reports will also be reviewed. Randomized clinical trials (RCTs) with atypical antipsychotic augmentation treatment for treatment-resistant depression will be considered. Data will be independently extracted by two reviewers. Traditional pairwise meta-analyses will be performed for RCTs that directly compare different treatment arms. Then, Bayesian network meta-analyses will be performed to compare the relative efficacy and acceptability of different atypical antipsychotic agents (and doses). A sensitivity analysis will be performed by excluding studies classified as a small sample size, having a high placebo effect. Discussion This systematic review and network meta-analysis will comparatively analyze the efficacy, quality of life, and acceptability profiles of atypical antipsychotic medications used for the adjunctive treatment of TRD. The findings should provide clinically relevant implications for comprehensively understanding the risk–benefit profiles of these adjunctive treatments. Systematic review registration PROSPERO CRD 42014009666. PMID:25373601

  14. Trends in task shifting in HIV treatment in Africa: Effectiveness, challenges and acceptability to the health professions

    PubMed Central

    Mayers, Pat

    2015-01-01

    Background Task shifting has been suggested to meet the demand for initiating and managing more patients on antiretroviral therapy. Although the idea of task shifting is not new, it acquires new relevance in the context of current healthcare delivery. Aim To appraise current trends in task shifting related to HIV treatment programmes in order to evaluate evidence related to the effectiveness of this strategy in addressing human resource constraints and improving patient outcomes, challenges identified in practice and the acceptability of this strategy to the health professions. Method Electronic databases were searched for studies published in English between January 2009 and December 2014. Keywords such as ‘task shifting’, ‘HIV treatment’, ‘human resources’ and ‘health professions’ were used. Results Evidence suggests that task shifting is an effective strategy for addressing human resource constraints in healthcare systems in many countries and provides a cost-effective approach without compromising patient outcomes. Challenges include inadequate supervision support and mentoring, absent regulatory frameworks, a lack of general health system strengthening and the need for monitoring and evaluation. The strategy generally seems to be accepted by the health professions although several arguments against task shifting as a long-term approach have been raised. Conclusion Task shifting occurs in many settings other than HIV treatment programmes and is viewed as a key strategy for governing human resources for healthcare. It may be an opportune time to review current task shifting recommendations to include a wider range of programmes and incorporate initiatives to address current challenges. PMID:26245622

  15. Is treatment in a day hospital step-down program superior to outpatient individual psychotherapy for patients with personality disorders? 36 months follow-up of a randomized clinical trial comparing different treatment modalities.

    PubMed

    Gullestad, Frida Slagstad; Wilberg, Theresa; Klungsøyr, Ole; Johansen, Merete Selsbakk; Urnes, Oyvind; Karterud, Sigmund

    2012-01-01

    Despite increasing interest in the development of effective treatments for patients with PDs, there is still no consensus about the optimal treatment setting for this group of patients. This study reports the 36 months follow-up of the Ullevål Personality Project (UPP) (n=113), a randomized clinical trial comparing two treatment modalities for patients with PDs: an intensive long-term step-down treatment program, consisting of short-term day hospital treatment followed by combined group and individual psychotherapy organized in a hospital setting, with "ordinary" outpatient individual psychotherapy in private practice for patients with moderate to severe PDs. Patients in both treatment groups showed improvements in several clinical measures after 36 months. However, contrary to our expectations, patients in the outpatient treatment setting improved significantly more. Possible explanations for this surprising finding are discussed. The study cannot exclude the possibility that treatment aspects other than differences in modalities could explain some of the differential effectiveness (e.g. differences between therapists).

  16. Acceptance and Commitment Therapy in the Treatment of Alcohol Use Disorder and Comorbid Affective Disorder: A Pilot Matched Control Trial.

    PubMed

    Thekiso, Thekiso B; Murphy, Philip; Milnes, Jennie; Lambe, Kathryn; Curtin, Aisling; Farren, Conor K

    2015-11-01

    This study examined whether acceptance and commitment therapy (ACT) enhances treatment as usual (TAU) in improving treatment outcomes in patients with alcohol use disorder (AUD) and comorbid affective disorder. Fifty-two participants were included in the study, of whom 26 were patients with AUD and either depression or bipolar disorder treated with ACT group therapy in parallel with TAU (inpatient integrated treatment) and 26 were matched controls who had received TAU alone. Drinking and craving outcomes were total alcohol abstinence, cumulative abstinence duration (CAD) and Obsessive Compulsive Drinking Scale (OCDS) scores at 3 and 6 months postintervention. Affective and anxiety outcomes were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Young Mania Rating Scale (YMRS) scores at these follow-ups. Baseline demographic and clinical characteristics were similar in both groups. Retention rates were high: 100% of the ACT group were followed up at 3 and 6 months; 92.3% and 84.6% of the TAU alone group were followed up at 3 and 6 months, respectively. Patients in the ACT group reported significantly higher CAD at 3 and 6 months, significantly lower BDI and BAI scores at 3 and 6 months, and significantly lower OCDS scores at 3 months, than those who received only TAU. No other significant differences in treatment outcomes were found between the groups. ACT provides added benefit to TAU in improving drinking, craving, depression and anxiety outcomes in patients with AUD and comorbid affective disorder. Most treatment improvements were sustained over a 6-month follow-up period.

  17. Hair biology and its comprehensive sequence in female pattern baldness: diagnosis and treatment modalities--Part I.

    PubMed

    Sehgal, Virendra N; Srivastava, Govind; Aggarwal, Ashok K; Midha, Rashmi

    2013-01-01

    Hair may be a source of concern for patients when there is a change in its texture, amount, or thickness. It can present in women as androgenic alopecia also called female pattern baldness, and in men as adrogenic alopecia, also called male pattern baldness. Thinning/rarefaction affecting the vertex is a progressive condition, and hair loss in women has been interpreted and classified differently from that in men. The Ludwig classification for women's hair loss seems to be the most accepted assessment, which will be outlined in this review, along with the hair growth cycle that encompasses anagen, catagen, telogen, exogen, and kenogen.

  18. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities

    PubMed Central

    Qiu, Wen-Jun; Li, Yi-Fan; Ji, Yun-Han; Xu, Wei; Zhu, Xiao-Dong; Tang, Xian-Zhong; Zhao, Huan-Li; Wang, Gui-Bin; Jia, Yue-Qing; Zhu, Shi-Cai; Zhang, Feng-Fang; Liu, Hong-Mei

    2015-01-01

    In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined. PMID:26549312

  19. An Investigation of Feasibility and Safety of Bi‐Modal Stimulation for the Treatment of Tinnitus: An Open‐Label Pilot Study

    PubMed Central

    D'Arcy, Shona; Pearlmutter, Barak A.; Crispino, Gloria; Lalor, Edmund C.; Conlon, Brendan J.

    2016-01-01

    Objectives Tinnitus is the perception of sound in the absence of an external auditory stimulus. It is widely believed that tinnitus, in patients with associated hearing loss, is a neurological phenomenon primarily affecting the central auditory structures. However, there is growing evidence for the involvement of the somatosensory system in this form of tinnitus. For this reason it has been suggested that the condition may be amenable to bi‐modal stimulation of the auditory and somatosensory systems. We conducted a pilot study to investigate the feasibility and safety of a device that delivers simultaneous auditory and somatosensory stimulation to treat the symptoms of chronic tinnitus. Methods A cohort of 54 patients used the stimulation device for 10 weeks. Auditory stimulation was delivered via headphones and somatosensory stimulation was delivered via electrical stimulation of the tongue. Patient usage, logged by the device, was used to classify patients as compliant or noncompliant. Safety was assessed by reported adverse events and changes in tinnitus outcome measures. Response to treatment was assessed using tinnitus outcome measures: Minimum Masking Level (MML), Tinnitus Loudness Matching (TLM), and Tinnitus Handicap Inventory (THI). Results The device was well tolerated by patients and no adverse events or serious difficulties using the device were reported. Overall, 68% of patients met the defined compliance threshold. Compliant patients (N = 30) demonstrated statistically significant improvements in mean outcome measures after 10 weeks of treatment: THI (−11.7 pts, p < 0.001), TLM (−7.5dB, p < 0.001), and MML (−9.7dB, p < 0.001). The noncompliant group (N = 14) demonstrated no statistical improvements. Conclusion This study demonstrates the feasibility and safety of a new bi‐modal stimulation device and supports the potential efficacy of this new treatment for tinnitus. PMID:27310062

  20. The local treatment modalities in FIGO stage I-II small-cell carcinoma of the cervix are determined by disease stage and lymph node status.

    PubMed

    Zhou, Juan; Yang, Hong-Yi; Wu, San-Gang; He, Zhen-Yu; Lin, Huan-Xin; Sun, Jia-Yuan; Li, Qun; Guo, Zhan-Wen

    2016-06-01

    The purpose of this study was to identify the optimal local treatment modalities for International Federation of Gynecology and Obstetrics (FIGO) stage I-II small-cell carcinoma of the cervix (SCCC), including cancer-directed surgery (CDS) and/or radiotherapy (RT). The Surveillance Epidemiology and End Results (SEER) database was used to identify SCCC patients from 1988 to 2012, and analyzed using Kaplan-Meier survival and Cox regression proportional hazard methods to determine factors significant for cause-specific survival (CSS) and overall (OS). A total of 208 patients of SCCC were enrolled. The median follow-up time was 31 months. Fifty-eight (27.9%) patients were treated with primary CDS, 88 (42.3%) patients underwent CDS combined with RT, and 62 (29.8%) patients were treated with primary RT. Univariate and multivariate analyses showed that local treatment modalities were independent prognostic factors for CSS and OS. Patients who had undergone CDS had better CSS and OS, compared with patients who had been treated with combined CDS and RT or RT alone. The 5-year CSS and OS of entire group was 49.8% and 46.4%, respectively. The 5-year CSS in the groups of patients receiving CDS, CDS combined with RT, and RT alone were 67.9%, 49.7%, and 32.6%, respectively (P < 0.001). The 5-year OS in patients treated with CDS, CDS combined with RT, and RT alone were 64.9%, 46.2%, and 28.8% (P < 0.001). Primary surgery was associated with improved CSS and OS for FIGO stage I and lymph node negative disease. Primary surgery is the most effective local treatment for FIGO stage I-II SCCC, as adjuvant RT or radical RT does not improve survival compared to radical surgery, especially in patients with FIGO stage I and lymph node negative disease.

  1. Effects of medical and mental status on treatment modalities in patients treated under general anaesthesia at the KTU Faculty of Dentistry in Trabzon, Turkey: A comparative retrospective study.

    PubMed

    Baygin, Ozgul; Tuzuner, Tamer; Kusgoz, Adem; Yahyaoglu, Gorkem; Yilmaz, Nagehan; Aksoy, Simge

    2017-02-01

    This study evaluated the differences in dental conditions and treatment modalities between disabled and non-cooperative healthy children under general anaesthesia. The data were collected from paediatric patients between 3 and 15 years of age who received dental treatment under general anaesthesia. Patients with at least one mental/physical disturbance (group 1) and other healthy non-cooperative patients (group 2) were compared with regard to gender, age, weight, and treatment time-type. The statistical analyses were performed using Fisher's exact and Mann-Whitney U tests. No significant differences were observed between the groups with regard to gender, weight and treatment-time (p>0.05). The numbers of treated teeth (p<0.01) and extractions (p<0.001) were higher in group 1 than in group 2, whereas the frequency of advanced restorative procedures for group 1 was lower than that for group 2, including preventive-resin-restoration (p<0.001), glass-ionomer-cement (p<0.05), root-canal (p<0.001) and stainless-steel-crowns (p<0.001). This study supports the hypothesis that the general condition of the patients may alter the type of treatment provided and confirms the necessity of performing preventive procedures.

  2. Do counselor techniques predict quitting during smoking cessation treatment? A component analysis of telephone-delivered Acceptance and Commitment Therapy.

    PubMed

    Vilardaga, Roger; Heffner, Jaimee L; Mercer, Laina D; Bricker, Jonathan B

    2014-10-01

    No studies to date have examined the effect of counselor techniques on smoking cessation over the course of treatment. To address this gap, we examined the degree to which the use of specific Acceptance and Commitment Therapy (ACT) counseling techniques in a given session predicted smoking cessation reported at the next session. The data came from the ACT arm of a randomized controlled trial of a telephone-delivered smoking cessation intervention. Trained raters coded 139 counseling sessions across 44 participants. The openness, awareness and activation components of the ACT model were rated for each telephone counseling session. Multilevel logistic regression models were used to estimate the predictive relationship between each component during any given telephone session and smoking cessation at the following telephone session. For every 1-unit increase in counselors' use of openness and awareness techniques there were 42% and 52% decreases in the odds of smoking at the next counseling session, respectively. However, there was no significant predictive relationship between counselors' use of activation techniques and smoking cessation. Overall, results highlight the theoretical and clinical value of examining therapists' techniques as predictors of outcome during the course of treatment.

  3. Repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training is a safe and effective modality for the treatment of Alzheimer's disease: clinical experience.

    PubMed

    Rabey, Jose Martin; Dobronevsky, Evgenia

    2016-12-01

    Alzheimer's disease (AD) is the most common type of dementia among the elderly. Common treatments available and non-pharmacological interventions have their limitations, and new therapeutic approaches are critically needed. Transcranial magnetic stimulation (TMS) is a non-invasive technique that generates an electric current-inducing modulation in cortical excitability. The previous clinical trials showed that combinations of rTMS and cognitive training (rTMS-COG), as provided by the NeuroAD medical device system, offer a novel, safe, and effective method improving mild-to-moderate AD patients. In this article, we present our experience with rTMS-COG treatment, in clinical settings, of 30 mild-to-moderate AD patients that received rTMS-COG commercial treatments in two clinics for 1-h daily sessions, 5 days per week, for 6 weeks (30 sessions). Five patients returned for a second treatment. ADAS-Cog and MMSE scores were measured pre- and post-treatments. The main analyses were conducted on patients who received 1 treatment (n = 30). Data received from the five returning patients were analyzed separately. The effect of rTMS-COG treatment was statistically significant regarding both ADAS-Cog (-2.4 point improvement, PV <0.001) and MMSE (+1.7 points improvement, PV <0.001) scores. About 80 % of patients gained some cognitive improvement following NeuroAD treatment, with more than 60 % improving by more than two points, for a minimum of 9 months. The Neuronix NeuroAD System was shown to be a safe and effective non-invasive modality for cognitive improvement of Alzheimer patients, with measurable outcomes lasting, in some of them, for up to 1 year, following completion of the 6-week daily intervention course (a carryover effect).

  4. Blood glutamate grabbing does not reduce the hematoma in an intracerebral hemorrhage model but it is a safe excitotoxic treatment modality

    PubMed Central

    Silva-Candal, Andrés da; Vieites-Prado, Alba; Gutiérrez-Fernández, María; Rey, Ramón I; Argibay, Bárbara; Mirelman, David; Sobrino, Tomás; Rodríguez-Frutos, Berta; Castillo, José; Campos, Francisco

    2015-01-01

    Recent studies have shown that blood glutamate grabbing is an effective strategy to reduce the excitotoxic effect of extracellular glutamate released during ischemic brain injury. The purpose of the study was to investigate the effect of two of the most efficient blood glutamate grabbers (oxaloacetate and recombinant glutamate oxaloacetate transaminase 1: rGOT1) in a rat model of intracerebral hemorrhage (ICH). Intracerebral hemorrhage was produced by injecting collagenase into the basal ganglia. Three treatment groups were developed: a control group treated with saline, a group treated with oxaloacetate, and a final group treated with human rGOT1. Treatments were given 1 hour after hemorrhage. Hematoma volume (analyzed by magnetic resonance imaging (MRI)), neurologic deficit, and blood glutamate and GOT levels were quantified over a period of 14 days after surgery. The results observed showed that the treatments used induced a significant reduction of blood glutamate levels; however, they did not reduce the hematoma, nor did they improve the neurologic deficit. In the present experimental study, we have shown that this novel therapeutic strategy is not effective in case of ICH pathology. More importantly, these findings suggest that blood glutamate grabbers are a safe treatment modality that can be given in cases of suspected ischemic stroke without previous neuroimaging. PMID:25735920

  5. A Comparative Study of Two Modalities, 4% Hydroquinone Versus 30% Salicylic Acid in Periorbital Hyperpigmentation and Assessment of Quality of Life Before and After Treatment

    PubMed Central

    Ranjan, Rashmi; Sarkar, Rashmi; Garg, Vijay Kumar; Gupta, Tanvi

    2016-01-01

    Background: Periorbital hyperpigmentation (POH) is a common hyperpigmentary problem of the face, which can be psychologically distressing and it can influence an individual's quality of life. However, this condition has received less attention in literature. Aims and Objectives: To study the clinico-etiological features and the effect of two therapeutic modalities on the quality of life in patients of POH before and after treatment. Materials and Methods: Fifty patients attending the outpatient clinic of Dermatology Department, with clinically evident POH were included. All patients were divided randomly into two groups of 25 each and one group was treated with 4% hydroquinone and another group with 30% salicylic acid for 12 weeks. Assessment with visual analog scale (VAS) was done at 4, 6, and 12 weeks, and outcome of the patients was analyzed statistically. Results: Majority of the cases, i.e. 26 (52%) were in the age group of 20–30 years. Females comprised 74% of the study population. On VAS, most of the patients showed mild improvement (10–30%) at 12 weeks of treatment in both the groups. Separately, both the treatments significantly improved the dermatological life quality index of the patients although there was no significant difference found between the two groups. Conclusion: POH is less responsive to standard treatments due to its multifactorial etiology and deposition of melanin in both dermis and epidermis. However, even the mild to moderate improvement in appearance can cause an improvement in the quality of life of the patients. PMID:27512187

  6. The Relationship of Symptoms of Anxiety and Depression with Disease Severity and Treatment Modality in Myasthenia Gravis: A Cross-sectional Study

    PubMed Central

    AYSAL, Fikret; KARAMUSTAFALIOĞLU, Oğuz; ÖZÇELİK, Başak; YILMAZ, Meltem; KARAMUSTAFALIOĞLU, Nesrin; YUMRUKÇAL, Hüseyin; TANKAYA, Onur

    2013-01-01

    Introduction Findings about the relationship between psychopathology and severity of myasthenia gravis (MG) seem scarce and conflicting. The aim of this study was to investigate the relationship of depressive and anxiety symptoms with disease severity and treatment modalities among a cohort of patients with MG. Methods Sixty-seven patients, who presented to the neuromuscular outpatient clinic, at a neuropsychiatry hospital in Istanbul, Turkey in a two-month period, were recruited consecutively. A total of 42 patients with MG were invited to participate in the study. None of the patients refused to participate. Severity of MG was assessed according to the Osserman and Genkins classification. The participants were evaluated by a sociodemographic form, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Hamilton Depression Rating Scale 17-item version (HAM-D), and the Hamilton Anxiety Rating Scale (HAM-A). Results The patients with stage IIB MG had significantly higher scores on the BAI, HAM-D, HAM-A total and somatic anxiety than those with stage I and IIA MG (p<0.05). Likewise, the patients taking a combination of prednisolone+pyridostigmine/azathioprine had significantly higher scores on the BAI, HAM-D, HAM-A total and somatic anxiety than those taking only prednisolone (p<0.05). Linear regression analysis revealed that disease severity and stressful life events were the factors associated with the HAM-D scores. Disease severity, treatment modalities, and gender were the factors associated with the HAM-A scores. Conclusion The results of the present study may suggest that patients with relatively more severe MG or those taking a combination of immunosupressive and anticholinesterase medications need psychiatric/psychological evaluation. PMID:28360560

  7. Long-Term Survival of Dental Implants Placed in the Grafted Maxillary Sinus: Systematic Review and Meta-Analysis of Treatment Modalities

    PubMed Central

    Duttenhoefer, Fabian; Souren, Cyriel; Menne, Dieter; Emmerich, Dominik; Schön, Ralf; Sauerbier, Sebastian

    2013-01-01

    Background A prevalent modality to increase the amount of available bone prior to implantation is grafting of the maxillary sinus. Multiple factors such as the surgical technique, moment of implant placement as well as grafting materials and membranes are known to affect implant survival. However, the role of different factor combinations and associated reciprocal effects remain unclear. Conventional statistical methods do not consider inconsistency of study designs and do not take covariables into account. Hence, a systematic research and meta-analysis was conducted to investigate the influence of various treatment modalities on implant survival in the grafted maxillary sinus. Materials and Methods A meta-analysis was conducted according to the PRISMA guidelines. Articles published from 1980 through January 2013 were electronically and manually searched in MEDLINE (Ovid), the Cochrane Register of Controlled Trials, the Database of Abstracts of Effects, and the Cochrane Database of Systematic Reviews. Clinical reports on single intervention sinus augmentation with root-form implants, a minimum of 10 patients and 6 months of loading were eligible for inclusion if implant survival was stated or calculable. Results were calculated by non-parametric univariate Kaplan-Meier analysis and Bayesian multivariate interval-censored Cox regression. Results A total of 122 publications on 16268 endosseous implants placed in grafted maxillary sinus were included. The treatment parameters surgical approach, grafting material and implant type showed no selective preference. However, application of membranes showed a significantly reduced hazard-ratio, independent of other co-factors. Conclusions The use of membranes is the most significant factor to achieve long-term implant survival in sinus augmentation procedures. More data exceeding 3 years follow-up are needed to address prospective confounding and improve clinical evidence. PMID:24058679

  8. Effect of Treatment Modality on the Hypothalamic–Pituitary Function of Patients Treated with Radiation Therapy for Pituitary Adenomas: Hypothalamic Dose and Endocrine Outcomes

    PubMed Central

    Elson, Andrew; Bovi, Joseph; Kaur, Kawaljeet; Maas, Diana; Sinson, Grant; Schultz, Chris

    2014-01-01

    Background: Both fractionated external beam radiotherapy and single fraction radiosurgery for pituitary adenomas are associated with the risk of hypothalamic–pituitary (HP) axis dysfunction. Objective: To analyze the effect of treatment modality (Linac, TomoTherapy, or gamma knife) on hypothalamic dose and correlate these with HP-axis deficits after radiotherapy. Methods: Radiation plans of patients treated post-operatively for pituitary adenomas using Linac-based 3D-conformal radiotherapy (CRT) (n = 11), TomoTherapy-based intensity modulated radiation therapy (IMRT) (n = 10), or gamma knife stereotactic radiosurgery (n = 12) were retrospectively reviewed. Dose to the hypothalamus was analyzed and post-radiotherapy hormone function including growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, prolactin, and gonadotropins (follicle stimulating hormone/luteinizing hormone) were assessed. Results: Post-radiation, 13 of 27 (48%) patients eligible for analysis developed at least one new hormone deficit, of which 8 of 11 (72%) occurred in the Linac group, 4 of 8 (50%) occurred in the TomoTherapy group, and 1 of 8 (12.5%) occurred in the gamma knife group. Compared with fractionated techniques, gamma knife showed improved hypothalamic sparing for DMax Hypo and V12Gy. For fractionated modalities, TomoTherapy showed improved dosimetric characteristics over Linac-based treatment with hypothalamic DMean (44.8 vs. 26.8 Gy p = 0.02), DMax (49.8 vs. 39.1 Gy p = 0.04), and V12Gy (100 vs. 76% p = 0.004). Conclusion: Maximal dosimetric avoidance of the hypothalamus was achieved using gamma knife-based radiosurgery followed by TomoTherapy-based IMRT, and Linac-based 3D conformal radiation therapy, respectively. PMID:24782984

  9. Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases.

    PubMed

    Yang, Jun; Ma, Lin; Wang, Xiao-Shen; Xu, Wei Xu; Cong, Xiao-Hu; Xu, Shou-Ping; Ju, Zhong-Jian; Du, Lei; Cai, Bo-Ning; Yang, Jack

    2016-01-01

    To investigate the dosimetric characteristics of 4 SBRT-capable dose delivery systems, CyberKnife (CK), Helical TomoTherapy (HT), Volumetric Modulated Arc Therapy (VMAT) by Varian RapidArc (RA), and segmental step-and-shoot intensity-modulated radiation therapy (IMRT) by Elekta, on isolated thoracic spinal lesions. CK, HT, RA, and IMRT planning were performed simultaneously for 10 randomly selected patients with 6 body types and 6 body + pedicle types with isolated thoracic lesions. The prescription was set with curative intent and dose of either 33Gy in 3 fractions (3F) or 40Gy in 5F to cover at least 90% of the planning target volume (PTV), correspondingly. Different dosimetric indices, beam-on time, and monitor units (MUs) were evaluated to compare the advantages/disadvantages of each delivery modality. In ensuring the dose-volume constraints for cord and esophagus of the premise, CK, HT, and RA all achieved a sharp conformity index (CI) and a small penumbra volume compared to IMRT. RA achieved a CI comparable to those from CK, HT, and IMRT. CK had a heterogeneous dose distribution in the target as its radiosurgical nature with less dose uniformity inside the target. CK had the longest beam-on time and the largest MUs, followed by HT and RA. IMRT presented the shortest beam-on time and the least MUs delivery. For the body-type lesions, CK, HT, and RA satisfied the target coverage criterion in 6 cases, but the criterion was satisfied in only 3 (50%) cases with the IMRT technique. For the body + pedicle-type lesions, HT satisfied the criterion of the target coverage of ≥90% in 4 of the 6 cases, and reached a target coverage of 89.0% in another case. However, the criterion of the target coverage of ≥90% was reached in 2 cases by CK and RA, and only in 1 case by IMRT. For curative-intent SBRT of isolated thoracic spinal lesions, RA is the first choice for the body-type lesions owing to its delivery efficiency (time); the second choice is CK or HT; HT is the

  10. Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases

    SciTech Connect

    Yang, Jun; Ma, Lin; Wang, Xiao-Shen; Xu, Wei Xu; Cong, Xiao-Hu; Xu, Shou-Ping; Ju, Zhong-Jian; Du, Lei; Cai, Bo-Ning; Yang, Jack

    2016-07-01

    To investigate the dosimetric characteristics of 4 SBRT-capable dose delivery systems, CyberKnife (CK), Helical TomoTherapy (HT), Volumetric Modulated Arc Therapy (VMAT) by Varian RapidArc (RA), and segmental step-and-shoot intensity-modulated radiation therapy (IMRT) by Elekta, on isolated thoracic spinal lesions. CK, HT, RA, and IMRT planning were performed simultaneously for 10 randomly selected patients with 6 body types and 6 body + pedicle types with isolated thoracic lesions. The prescription was set with curative intent and dose of either 33 Gy in 3 fractions (3F) or 40 Gy in 5F to cover at least 90% of the planning target volume (PTV), correspondingly. Different dosimetric indices, beam-on time, and monitor units (MUs) were evaluated to compare the advantages/disadvantages of each delivery modality. In ensuring the dose-volume constraints for cord and esophagus of the premise, CK, HT, and RA all achieved a sharp conformity index (CI) and a small penumbra volume compared to IMRT. RA achieved a CI comparable to those from CK, HT, and IMRT. CK had a heterogeneous dose distribution in the target as its radiosurgical nature with less dose uniformity inside the target. CK had the longest beam-on time and the largest MUs, followed by HT and RA. IMRT presented the shortest beam-on time and the least MUs delivery. For the body-type lesions, CK, HT, and RA satisfied the target coverage criterion in 6 cases, but the criterion was satisfied in only 3 (50%) cases with the IMRT technique. For the body + pedicle-type lesions, HT satisfied the criterion of the target coverage of ≥90% in 4 of the 6 cases, and reached a target coverage of 89.0% in another case. However, the criterion of the target coverage of ≥90% was reached in 2 cases by CK and RA, and only in 1 case by IMRT. For curative-intent SBRT of isolated thoracic spinal lesions, RA is the first choice for the body-type lesions owing to its delivery efficiency (time); the second choice is CK or HT; HT is the

  11. Acceptability of a web-based community reinforcement approach for substance use disorders with treatment-seeking American Indians/Alaska Natives.

    PubMed

    Campbell, Aimee N C; Turrigiano, Eva; Moore, Michelle; Miele, Gloria M; Rieckmann, Traci; Hu, Mei-Chen; Kropp, Frankie; Ringor-Carty, Roz; Nunes, Edward V

    2015-05-01

    Longstanding disparities in substance use disorders and treatment access exist among American Indians/Alaska Natives (AI/AN). Computerized, web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes. Prior research supports the efficacy of a web-based version [therapeutic education system (TES)] of the community reinforcement approach to improve outcomes among outpatients in substance abuse treatment; however, TES has not been tested among AI/AN. The results from this mixed method acceptability study among a diverse sample of urban AI/AN (N = 40) show that TES was acceptable across seven indices (range 7.8-9.4 on 0-10 scales with 10 indicating highest acceptability). Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted.

  12. Acceptability of a Web-based Community Reinforcement Approach for Substance Use Disorders with Treatment-seeking American Indians/Alaska Natives

    PubMed Central

    Campbell, Aimee N. C.; Turrigiano, Eva; Moore, Michelle; Miele, Gloria M.; Rieckmann, Traci; Hu, Mei-Chen; Kropp, Frankie; Ringor-Carty, Roz; Nunes, Edward V.

    2014-01-01

    Longstanding disparities in substance use disorders and treatment access exist among American Indian/Alaska Natives (AI/AN). Computerized, web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes. Prior research supports the efficacy of a web-based version (Therapeutic Education System [TES]) of the Community Reinforcement Approach to improve outcomes among outpatients in substance abuse treatment; however, TES has not been tested among AI/AN. The results from this mixed method acceptability study among a diverse sample of urban AI/AN (N=40) show that TES was acceptable across seven indices (range=7.8 to 9.4 on 0 to 10 scales with 10 indicating highest acceptability). Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted. PMID:25022913

  13. A Biofilm Pocket Model to Evaluate Different Non-Surgical Periodontal Treatment Modalities in Terms of Biofilm Removal and Reformation, Surface Alterations and Attachment of Periodontal Ligament Fibroblasts

    PubMed Central

    Hägi, Tobias T.; Klemensberger, Sabrina; Bereiter, Riccarda; Nietzsche, Sandor; Cosgarea, Raluca; Flury, Simon; Lussi, Adrian; Sculean, Anton; Eick, Sigrun

    2015-01-01

    Background and Aim There is a lack of suitable in vitro models to evaluate various treatment modalities intending to remove subgingival bacterial biofilm. Consequently, the aims of this in vitro-study were: a) to establish a pocket model enabling mechanical removal of biofilm and b) to evaluate repeated non-surgical periodontal treatment with respect to biofilm removal and reformation, surface alterations, tooth hard-substance-loss, and attachment of periodontal ligament (PDL) fibroblasts. Material and Methods Standardized human dentin specimens were colonized by multi-species biofilms for 3.5 days and subsequently placed into artificially created pockets. Non-surgical periodontal treatment was performed as follows: a) hand-instrumentation with curettes (CUR), b) ultrasonication (US), c) subgingival air-polishing using erythritol (EAP) and d) subgingival air-polishing using erythritol combined with chlorhexidine digluconate (EAP-CHX). The reduction and recolonization of bacterial counts, surface roughness (Ra and Rz), the caused tooth substance-loss (thickness) as well as the attachment of PDL fibroblasts were evaluated and statistically analyzed by means of ANOVA with Post-Hoc LSD. Results After 5 treatments, bacterial reduction in biofilms was highest when applying EAP-CHX (4 log10). The lowest reduction was found after CUR (2 log10). Additionally, substance-loss was the highest when using CUR (128±40 µm) in comparison with US (14±12 µm), EAP (6±7 µm) and EAP-CHX (11±10) µm). Surface was roughened when using CUR and US. Surfaces exposed to US and to EAP attracted the highest numbers of PDL fibroblasts. Conclusion The established biofilm model simulating a periodontal pocket combined with interchangeable placements of test specimens with multi-species biofilms enables the evaluation of different non-surgical treatment modalities on biofilm removal and surface alterations. Compared to hand instrumentation the application of ultrasonication and of air

  14. Changes in orthodontic treatment modalities in the past 20 years: exploring the link between technology and scientific evidence.

    PubMed

    Bradley, T Gerard

    2013-01-01

    STATEMENT OF THE ISSUE: Is there a link between the many perceived advances in orthodontic techniques/therapy and science in the past 20 years? The purpose of this paper is to take five topics and match the perceptions with the scientific evidence. The variety of appliances and the swings in treatment philosophy have been dramatic, including the swing from extraction to non-extraction therapy, the introduction of space-age wires, appliances that grow mandibles, the introduction and extraordinary growth of Invisalign, and reduced friction brackets to reduce treatment time, all with claims by manufacturers of better results than ever before. The focus is on faster treatment, reduced visits/appointments and superior results. Most of these 'advancements' represent what has been the 'juggernaut of technology'. Five questions are posed, and an evidence-based approach is used to critically examine the literature in these selected topics.

  15. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study.

    PubMed

    Cuesta-Barriuso, R; Gómez-Conesa, A; López-Pina, J-A

    2014-01-01

    Although different techniques of physiotherapy have been described for the treatment of haemophilic arthropathy (HA) of ankle, hardly any studies have been applied manual therapy or educational physiotherapy and home exercises. The aim of this study was to assess the effectiveness of manual therapy and educational physiotherapy in the treatment of HA of the ankle. Thirty-one patients with HA of the ankle with a mean age of 35.29 (SD: 12.877) years randomized to manual therapy group (n = 11), educational group (n = 10) and a control group (n = 10). The two physiotherapy programmes were one with manual therapy articular traction, passive stretching of the gastrocnemius muscles, and exercises for muscle strength and proprioception (MT group) and the other with educational sessions and home exercises (E group). The study lasted for 12 weeks. The treatment with manual therapy improved the gastrocnemius muscle circumference, and the pain of ankle (P < 0.05). Six months later, MT group still enjoyed improvement. In the educational group there were improvements, but not significant, in the measured variables. No patient had ankle haemarthrosis during the study. The treatment with manual therapy improved the circumference of gastrocnemius and lessened pain in the patients with haemophilic arthropathy of the ankle.

  16. Treatment Modalities and Outcomes in Patients with Advanced Invasive Thymoma or Thymic Carcinoma: A Retrospective Multicenter Study

    PubMed Central

    Modh, Ankit; Rimner, Andreas; Allen, Pamela K.; Greenfield, Brad; Marom, Edith M.; Rice, David; Huang, James; Rosenzweig, Kenneth E.; Komaki, Ritsuko; Gomez, Daniel R.

    2016-01-01

    Introduction We investigated relationships between treatment characteristics and long-term outcomes in patients with locally advanced thymoma or thymic carcinoma. Methods We retrospectively reviewed 146 patients treated in 1980–2011 at two tertiary cancer care centers, 110 with Masaoka-Koga stage III–IVa invasive thymoma and 36 with stage I–IVa thymic carcinoma. Survival probabilities were estimated with the Kaplan-Meier method. Risk factors related to survival were identified by univariate and multivariate competing risk analysis, with overall survival (OS) as the competing risk. Cox regression analysis was used to identify risk factors for OS. Results Median follow-up time for all patients was 64 months. At 5/10 years, rates of OS and freedom from recurrence (FFR) were 81/58% and 81/65%, respectively. Of patients who underwent surgery, trimodality treatment produced better survival compared to less aggressive treatment among patients with stage III disease (p=0.03). Among patients who underwent trimodality treatment, patients with stage III disease had better OS (p=0.03) and FFR (p<0.001) than those with stage IVA disease. On Cox regression analysis, decreased OS was associated with thymic carcinoma (hazard ratio [HR]=7.36, 95% CI=2.38–22.77, p=0.001), R2/unresectable disease (HR=8.45, 95% CI=1.44–49.42, p=0.02) and an Eastern Cooperative Oncology Group performance score of 1 (HR=8.14, 95% CI=1.55–42.75, p=0.01) or 2–3 (HR=29.60, 95% CI=4.0–218.98, p=0.001) versus 0. Conclusion Aggressive treatment with chemotherapy, surgical resection, and postoperative radiation therapy can produce long-term survival for patients with invasive thymic malignanices. PMID:24390276

  17. Multi-modal assessment of long-term erythropoietin treatment after neonatal hypoxic-ischemic injury in rat brain.

    PubMed

    van de Looij, Yohan; Chatagner, Alexandra; Quairiaux, Charles; Gruetter, Rolf; Hüppi, Petra S; Sizonenko, Stéphane V

    2014-01-01

    Erythropoietin (EPO) has been recognized as a neuroprotective agent. In animal models of neonatal brain injury, exogenous EPO has been shown to reduce lesion size, improve structure and function. Experimental studies have focused on short course treatment after injury. Timing, dose and length of treatment in preterm brain damage remain to be defined. We have evaluated the effects of high dose and long-term EPO treatment in hypoxic-ischemic (HI) injury in 3 days old (P3) rat pups using histopathology, magnetic resonance imaging (MRI) and spectroscopy (MRS) as well as functional assessment with somatosensory-evoked potentials (SEP). After HI, rat pups were assessed by MRI for initial damage and were randomized to receive EPO or vehicle. At the end of treatment period (P25) the size of resulting cortical damage and white matter (WM) microstructure integrity were assessed by MRI and cortical metabolism by MRS. Whisker elicited SEP were recorded to evaluate somatosensory function. Brains were collected for neuropathological assessment. The EPO treated animals did not show significant decrease of the HI induced cortical loss at P25. WM microstructure measured by diffusion tensor imaging was improved and SEP response in the injured cortex was recovered in the EPO treated animals compared to vehicle treated animals. In addition, the metabolic profile was less altered in the EPO group. Long-term treatment with high dose EPO after HI injury in the very immature rat brain induced recovery of WM microstructure and connectivity as well as somatosensory cortical function despite no effects on volume of cortical damage. This indicates that long-term high-dose EPO induces recovery of structural and functional connectivity despite persisting gross anatomical cortical alteration resulting from HI.

  18. Adoption of Transoral Robotic Surgery Compared With Other Surgical Modalities for Treatment of Oropharyngeal Squamous Cell Carcinoma

    PubMed Central

    Cracchiolo, Jennifer R.; Roman, Benjamin R.; Kutler, David I.; Kuhel, William I.; Cohen, Marc A.

    2016-01-01

    Background and Objectives Transoral robotic surgery (TORS) has increased for treatment of oropharyngeal squamous cell carcinoma (OPSCC). To define the adoption of TORS, we analyzed patterns of surgical treatment for OPSCC in the US. Methods Cases of T1–T3 OPSCC treated with surgery between 2010 and 2013 from the National Cancer Database were queried. Results Of 3,071 patients who underwent primary surgical management for T1–T3 OPSCC, 846 (28%) underwent TORS. On multivariable analysis, low tumor stage (T2 vs T1: OR 0.75, CI 0.37–0.51, p<0.0001; T3 vs T1: O.R. 0.33, CI 0.28–0.38, p<0.0001), treatment at an academic cancer center (O.R. 2.23, C.I. 1.29–3.88, p=0.004) and treatment at a high volume hospital (34–155 cases vs 1–4 cases: O.R. 9.07, C.I. 3.19–25.79, p<0.0001) were associated with increased TORS approach. Significant geographic variation was observed, with high adoption in the Middle Atlantic. Positive margin rates were lower when TORS was performed at a high volume vs. low volume hospital (8.2% vs 16.7% respectively, p=0.001). Conclusions Tumor and non-tumor factors are associated with TORS adoption. This analysis suggests uneven diffusion of this technology in the treatment of OPSCC. PMID:27392812

  19. Fractional CO2 laser as an effective modality in treatment of striae alba in skin types III and IV

    PubMed Central

    Naein, Farahnaz Fatemi; Soghrati, Mehrnaz

    2012-01-01

    Context: Rapid stretching of the skin over the weak connective tissue leads to development of striae distensae. Recently, researchers have shown special interest towards use of fractional photothermolysis in treatment of striae and several studies have shown its usefulness. Our aim was to assess the efficacy of Fractional CO2 laser in treatment of striae alba. Materials and Methods: A randomized clinical trial was carried out in female patients with striae alba. Ninety two striae were randomly selected and divided into two groups. Five sessions of laser resurfacing, were performed in Group 1, every 2–4 weeks. Group 2 was treated with 10% glycolic acid+0.05% tretinoin cream nightly during the study. Photographs were taken from the striae before and two weeks after the end of treatment. Mean surface area of striae compared between two groups. Patients’ views regarding the degree of improvement were assessed via visual analogue scale (VAS). Results: Forty six striae in Group 1 underwent laser resurfacing and 46 matched striae in Group 2, were treated with topical cream. Mean difference of striae surface area, was significantly decreased after treatment in Group 1 (-37.1±15.6 cm2) in comparison with Group 2(-7.9±9 cm2) (P value >0.001). Mean VAS was significantly higher in Group 1 (3.05±0.74) compared to Group 2 (0.63±0.66) (P value >0.001). Conclusions: Fractional photothermolysis via Fractional CO2 laser seems to be an effective method for treatment of striae alba. PMID:23825991

  20. Multi-Modal Assessment of Long-Term Erythropoietin Treatment after Neonatal Hypoxic-Ischemic Injury in Rat Brain

    PubMed Central

    Quairiaux, Charles; Gruetter, Rolf; Hüppi, Petra S.; Sizonenko, Stéphane V.

    2014-01-01

    Erythropoietin (EPO) has been recognized as a neuroprotective agent. In animal models of neonatal brain injury, exogenous EPO has been shown to reduce lesion size, improve structure and function. Experimental studies have focused on short course treatment after injury. Timing, dose and length of treatment in preterm brain damage remain to be defined. We have evaluated the effects of high dose and long-term EPO treatment in hypoxic-ischemic (HI) injury in 3 days old (P3) rat pups using histopathology, magnetic resonance imaging (MRI) and spectroscopy (MRS) as well as functional assessment with somatosensory-evoked potentials (SEP). After HI, rat pups were assessed by MRI for initial damage and were randomized to receive EPO or vehicle. At the end of treatment period (P25) the size of resulting cortical damage and white matter (WM) microstructure integrity were assessed by MRI and cortical metabolism by MRS. Whisker elicited SEP were recorded to evaluate somatosensory function. Brains were collected for neuropathological assessment. The EPO treated animals did not show significant decrease of the HI induced cortical loss at P25. WM microstructure measured by diffusion tensor imaging was improved and SEP response in the injured cortex was recovered in the EPO treated animals compared to vehicle treated animals. In addition, the metabolic profile was less altered in the EPO group. Long-term treatment with high dose EPO after HI injury in the very immature rat brain induced recovery of WM microstructure and connectivity as well as somatosensory cortical function despite no effects on volume of cortical damage. This indicates that long-term high-dose EPO induces recovery of structural and functional connectivity despite persisting gross anatomical cortical alteration resulting from HI. PMID:24755676

  1. The effect of child characteristics on teachers' acceptability of classroom-based behavioral strategies and psychostimulant medication for the treatment of ADHD.

    PubMed

    Pisecco, S; Huzinec, C; Curtis, D

    2001-09-01

    Studied the effect of student characteristics on teachers' ratings of treatment acceptability for attention deficit hyperactivity disorder (ADHD). Participants (N = 159) included experienced elementary school teachers who read 1 of 6 vignettes describing a child with symptoms representative of ADHD. Vignettes varied by sex and symptom-subtype classification. However, the number and specific type of symptoms described in the vignettes were consistent across all conditions. Next, teachers read a description of a daily report card (DRC), response cost technique, classroom lottery, and medication and rated their levels of agreement to the items of the Behavioral Intervention Rating Scale (BIRS). Teachers preferred the DRC to all other forms of treatment. However, there was a significant interaction between the type of treatment and sex of the student on the 3 factors (Treatment Acceptability, Treatment Effectiveness, and Timeliness) of the BIRS.

  2. Emerging concepts in the treatment of myofascial pain: a review of medications, modalities, and needle-based interventions.

    PubMed

    Annaswamy, Thiru Mandyam; De Luigi, Arthur J; O'Neill, Bryan J; Keole, Nandita; Berbrayer, David

    2011-10-01

    Significant developments and changes in the use of interventions and treatments for the management of myofascial pain syndrome have occurred in the past 10 years. These emerging concepts have changed the approach for clinicians who manage these pain disorders. However, wide variations in practice patterns prevail, and no clear consensus exists regarding when and how to use these interventions; in addition, awareness of the evidence basis behind their use is limited. This review examines the most recent advances in the treatment of myofascial pain syndromes. Specifically, the evidence basis of various emerging interventions is reviewed and recommendations for routine clinical practice and their rationale are provided. The purpose of this review is to provide the clinician with a better understanding of emerging concepts in the interventions used for myofascial pain syndromes.

  3. Assessing Acceptability of a Diagnostic and Malaria Treatment Package Delivered by Community Health Workers in Malaria-Endemic Settings of Burkina Faso, Nigeria, and Uganda

    PubMed Central

    Jegede, Ayodele S.; Oshiname, Frederick O.; Sanou, Armande K.; Nsungwa-Sabiiti, Jesca; Ajayi, IkeOluwapo O.; Siribié, Mohamadou; Afonne, Chinenye; Sermé, Luc; Falade, Catherine O.

    2016-01-01

    Background. The efficacy of artemisinin-based combination therapy (ACT) and rectal artesunate for severe malaria in children is proven. However, acceptability of a package of interventions that included use of malaria rapid diagnostic tests (RDTs), ACTs, and rectal artesunate when provided by community health workers (CHWs) is uncertain. This study assessed acceptability of use of CHWs for case management of malaria using RDTs, ACTs, and rectal artesunate. Methods. The study was carried out in Burkina Faso, Nigeria, and Uganda in 2015 toward the end of an intervention using CHWs to provide diagnosis and treatment. Focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with parents of sick children, community leaders, and health workers to understand whether they accepted the package for case management of malaria using CHWs. Transcripts from FGDs and KII recordings were analyzed using content analysis. The findings were described, interpreted, and reported in the form of narratives. Results. Treatment of malaria using the CHWs was acceptable to caregivers and communities. The CHWs were perceived to be accessible, diligent, and effective. There were no physical, social, or cultural barriers to accessing the CHWs’ services. Respondents were extremely positive about the intervention and were concerned that CHWs had limited financial and nonfinancial incentives that would reduce their motivation and willingness to continue. Conclusions. Treatment of malaria using CHWs was fully accepted. CHWs should be compensated, trained, and well supervised. Clinical Trials Registration. ISRCTN13858170. PMID:27941109

  4. User and Provider Acceptability of Intermittent Screening and Treatment and Intermittent Preventive Treatment with Dihydroartemisinin-Piperaquine to Prevent Malaria in Pregnancy in Western Kenya

    PubMed Central

    Hill, Jenny; Hoyt, Jenna; Achieng, Florence; Ouma, Peter; L’lanziva, Anne; Kariuki, Simon; Desai, Meghna; Webster, Jayne

    2016-01-01

    Background The World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) alongside long-lasting insecticide-treated nets (LLIN) and case management for reducing the risks associated with malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. Due to increasing Plasmodium falciparum resistance to SP, the search for alternative drugs or strategies to control malaria in pregnancy is a priority. We assessed the acceptability among pregnant women and health providers of intermittent screening and treatment (ISTp) and IPTp with dihydroartemisinin-piperaquine (DP) as alternative strategies in the context of an un-blinded clinical trial. Methods Qualitative data were collected through ten focus group discussions with women participating in a randomized controlled trial to evaluate ISTp or IPTp with DP (multi-day regimen) versus IPTp with SP (single dose) in western Kenya. Individual in-depth interviews were conducted with 26 health providers working in the trial facilities and trial staff. Results Women appreciated the advantages of being tested with a rapid diagnostic test (RDT) at every ANC visit (although a few women disliked finger pricks) and accepted that they would not receive any antimalarial when tested RDT-negative. There were differences in women’s experiences of the efficacy of antimalarials between the trial arms, with more women in the IPTp-SP arm reporting they had experienced malaria episodes. Side effects were experienced among women taking DP and SP. Although women and trial staff reported adherence to the full DP regimen within the trial, health providers were not confident that women would adhere to multi-day regimens in non-trial settings. Health providers recognized the advantages of ISTp in reducing unnecessary exposure to drugs, but lacked confidence in the reliability of RDTs compared to microscopy. Conclusions Our findings indicate that, within a

  5. Frame modal analysis

    NASA Technical Reports Server (NTRS)

    Guyan, R. J.; Heckenlaible, R. N.

    1971-01-01

    Computer model calculates natural frequencies and modal displacements of three-dimensional frame structures, and generates stiffness and mass matrices. Structures may be divided into several substructures prior to calculation of modal characteristics.

  6. Hypofractionated Intensity Modulated Radiation Therapy in Combined Modality Treatment for Bladder Preservation in Elderly Patients With Invasive Bladder Cancer

    SciTech Connect

    Turgeon, Guy-Anne; Souhami, Luis; Cury, Fabio L.; Faria, Sergio L.; Duclos, Marie; Sturgeon, Jeremy; Kassouf, Wassim

    2014-02-01

    Purpose/Objective(s): To review our experience with bladder-preserving trimodality treatment (TMT) using hypofractionated intensity modulated radiation therapy (IMRT) for the treatment of elderly patients with muscle-invasive bladder cancer. Methods and Materials: Retrospective study of elderly patients treated with TMT using hypofractionated IMRT (50 Gy in 20 fractions) with concomitant weekly radiosensitizing chemotherapy. Eligibility criteria were as follows: age ≥70 years, a proven diagnosis of muscle-invasive transitional cell bladder carcinoma, stage T2-T3N0M0 disease, and receipt of TMT with curative intent. Response rate was assessed by cystoscopic evaluation and bladder biopsy. Results: 24 patients with a median age of 79 years were eligible. A complete response was confirmed in 83% of the patients. Of the remaining patients, 1 of them underwent salvage cystectomy, and no disease was found in the bladder on histopathologic assessment. After a median follow-up time of 28 months, of the patients with a complete response, 2 patients had muscle-invasive recurrence, 1 experienced locoregional failure, and 3 experienced distant metastasis. The overall and cancer-specific survival rates at 3 years were 61% and 71%, respectively. Of the surviving patients, 75% have a disease-free and functioning bladder. All patients completed hypofractionated IMRT, and 19 patients tolerated all 4 cycles of chemotherapy. Acute grade 3 gastrointestinal or genitourinary toxicities occurred in only 4% of the patients, and acute grade 3 or 4 hematologic toxicities, liver toxicities, or both were experienced by 17% of the cohort. No patient experienced grade 4 gastrointestinal or genitourinary toxicity. Conclusions: Hypofractionated IMRT with concurrent radiosensitizing chemotherapy appears to be an effective and well-tolerated curative treatment strategy in the elderly population and should be considered for patients who are not candidates for cystectomy or who wish to avoid

  7. A Case Report of Catatonia and Neuroleptic Malignant Syndrome With Multiple Treatment Modalities: Short Communication and Literature Review.

    PubMed

    Chiou, Yu-Jie; Lee, Yu; Lin, Chin-Chuen; Huang, Tiao-Lai

    2015-10-01

    We describe a case with complicated clinical presentations who was difficult to treat. We described the possible etiologies and differential diagnosis of neuroleptic malignant syndrome (NMS), catatonia, and infection, in details. This patient was also referred to neuro-intensive care unit for extensive workup and treatments by neurologist guidelines. In addition, we also used lorazepam-diazepam protocol and antipsychotics, but both failed to completely relieve her symptoms. She eventually responded to electroconvulsive therapy (ECT).A 60-year-old female patient with schizophrenia was diagnosed to suspected pneumonia, urinary tract infection, and retarded catatonia at first. The brain computed tomography revealed no significant finding. She developed NMS caused by the administration of low-dose quetiapine (200 mg) after carbamazepine was discontinued. The Francis-Yacoub NMS rating scale (F-Y scale) total score was 90. We utilized lorazepam-diazepam protocol and prescribed bromocriptine and amantadine, but NMS was not improved. Meanwhile, we arranged the brain magnetic resonance imaging to survey the physical problem, which revealed agenesis of septum pellucidum and dilated lateral ventricles. She was then transferred to the neuro-intensive care unit on the 15th hospital day for complete study. The results of cerebrospinal fluid study and electroencephalography were unremarkable. She was transferred back to psychiatric ward on the 21st hospital day with residual catatonic and parkinsonian symptoms of NMS, and the F-Y scale total score was 63. Finally, her residual catatonic condition that followed NMS got improved after 11 sessions of ECT. On the 47th hospital day, the F-Y scale total score was 9.This report underscores that the ECT is an effective treatment for a patient of NMS when other treatments have failed.

  8. SU-F-BRA-02: Electromagnetic Tracking in Brachytherapy as An Advanced Modality for Treatment Quality Assurance

    SciTech Connect

    Kellermeier, M; Herbolzheimer, J; Kreppner, S; Lotter, M; Strnad, V; Bert, C

    2015-06-15

    Purpose: To present the use of Electromagnetic Tracking (EMT) for quality assurance in brachytherapy by means of phantom studies and to assess the clinical applicability of EMT during HDR breast brachytherapy. Methods: An EMT system was investigated to examine its suitability for clinical applications in brachytherapy. A field generator served as electromagnetic field emitter. Sensors (magnetic sensitive only), connected to a control unit, were used and their respective position and orientation inside a pre-defined measurement volume (500 mm cube length) determined. Up to three 6DoF sensors were placed on the phantom’s surface to obtain additional reference coordinates used to derive relative measured positions of a smaller 5DoF sensor inserted in the 6F catheters of the implant. The catheters were successively measured by manual displacement of the sensor at ∼40 mm/s. The measured catheter tracks, acquired multiple times at various locations (CT and treatment room), were smoothed, divided into intervals (2.5 mm dwell step size), registered (rigid Iterative Closest Point transformation) and compared against the known phantom geometry. Results: The reference coordinates were used to exclude the influence of external (e.g., respiratory-induced) motion. Precision tests in a clinical setting showed variances below 1 mm (translational) and 1° (rotational), respectively. Our method for catheter reconstruction preserved the length of the tracked catheter (within 1 mm). The measured tracking accuracy was 1±0.3 mm (maximum: 2 mm). The results are less accurate in environments potentially interfering with the magnetic field, e.g., in the vicinity of ferromagnetic table components. Conclusion: Our EMT system is able to perform reproducible and accurate catheter tracking and reconstruction. Currently, measurements of the implant geometry in HDR breast treatments are initiated. Online implant monitoring by means of EM tracking may be a first step towards advanced

  9. Dentofacial development in long-term survivors of acute lymphoblastic leukemia. A comparison of three treatment modalities

    SciTech Connect

    Sonis, A.L.; Tarbell, N.; Valachovic, R.W.; Gelber, R.; Schwenn, M.; Sallan, S. )

    1990-12-15

    Ninety-seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone, chemotherapy plus 1800-cGy cranial irradiation (RT), or chemotherapy plus 2400-cGy RT were evaluated for effects of therapy on dentofacial development. All patients were seen at least 5 years postdiagnosis. Dental abnormalities were determined from panoramic radiographs, and craniofacial evaluations were made from lateral cephalometric radiographs. Ninety-one (94%) of all patients and 41 (100%) of patients younger than 5 years of age at diagnosis had abnormal dental development. The severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received RT. Observed dental abnormalities included tooth agenesis, arrested root development, microdontia, and enamel dysplasias. Craniofacial abnormalities occurred in 18 of 20 (90%) of those patients who received chemotherapy plus 2400-cGy RT before 5 years of age. Mean cephalometric values of this group showed significant deficient mandibular development. The results of this study suggest that the severity of dentofacial-developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial RT.

  10. A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus

    ERIC Educational Resources Information Center

    Hesser, Hugo; Gustafsson, Tore; Lunden, Charlotte; Henrikson, Oskar; Fattahi, Kidjan; Johnsson, Erik; Westin, Vendela Zetterqvist; Carlbring, Per; Maki-Torkko, Elina; Kaldo, Viktor; Andersson, Gerhard

    2012-01-01

    Objective: Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format. Method: Ninety-nine participants (mean age = 48.5 years; 43% female) who were…

  11. A Community-based Survey of the Awareness and Acceptability of Oral Rehydration Therapy (ORT) as a Treatment for Acute Diarrhoea in Children.

    ERIC Educational Resources Information Center

    Ekanem, E. E.; Benebo, N. S.

    1988-01-01

    A total of 267 Nigerian mothers with children under the age of five years were investigated regarding the degree of their awareness and acceptance of oral rehydration therapy in the treatment of childhood diarrhea. Results indicate that only 39 percent of the mothers had heard of ORT in treating diarrhea. (RJC)

  12. Implant treatment planning considerations.

    PubMed

    Kao, Richard T

    2008-04-01

    As dental implants become a more accepted treatment modality, there is a need for all parties involved with implant dentistry to be familiar with various treatment planning issues. Though the success can be highly rewarding, failure to forecast treatment planning issues can result in an increase of surgical needs, surgical cost, and even case failure. In this issue, the focus is on implant treatment planning considerations.

  13. MO-DE-210-03: Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities

    SciTech Connect

    Ding, K.

    2015-06-15

    Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities. It is inexpensive, portable and provides good soft tissue contrast. For challenging soft tissue targets such as pancreatic cancer, ultrasound imaging can be used in combination with pre-treatment MRI and/or CT to transfer important anatomical features for target localization at time of treatment. The non-invasive and non-ionizing nature of ultrasound imaging is particularly powerful for intra-fraction localization and monitoring. Recognizing these advantages, efforts are being made to incorporate novel robotic approaches to position and manipulate the ultrasound probe during irradiation. These recent enabling developments hold potential to bring ultrasound imaging to a new level of IGRT applications. However, many challenges, not limited to image registration, robotic deployment, probe interference and image acquisition rate, need to be addressed to realize the full potential of IGRT with ultrasound imaging. Learning Objectives: Understand the benefits and limitations in using ultrasound to augment MRI and/or CT for motion monitoring during radiation therapy delivery. Understanding passive and active robotic approaches to implement ultrasound imaging for intra-fraction monitoring. Understand issues of probe interference with radiotherapy treatment. Understand the critical clinical workflow for effective and reproducible IGRT using ultrasound guidance. The work of X.L. is supported in part by Elekta; J.W. and K.D. is supported in part by a NIH grant R01 CA161613 and by Elekta; D.H. is support in part by a NIH grant R41 CA174089.

  14. Newer Imaging Modalities to Assist With Target Localization in the Radiation Treatment of Prostate Cancer and Possible Lymph Node Metastases

    SciTech Connect

    John, Subhash S. Zietman, Anthony L.; Shipley, William U.; Harisinghani, Mukesh G.

    2008-05-01

    Precise localization of prostate cancer and the drainage lymph nodes is mandatory to define an accurate clinical target volume for conformal radiotherapy. Better target definition and delineation on a daily basis is surely important in quality assurance for fractionated radiation therapy. This article reviews the evidence for major emerging techniques that show promise in better identifying the clinical target volume. Partial prostate boost by brachytherapy, intensity-modulated radiation therapy, or protons has become possible not only with standard imaging techniques but also with the availability of metabolic images obtained by magnetic resonance spectroscopy. Even though fluorine-18 fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography has not been found to be useful, novel radiolabeled tracers may eventually prove of value in the diagnosis and treatment planning of prostate cancer. For the metastatic lymph nodes, lymphotropic nanoparticle-enhanced magnetic resonance imaging using ultra-small superparamagnetic iron oxide particles has greater accuracy as compared with conventional techniques and has been instrumental in delineating the lymphatic drainage of the prostate gland. These novel investigational techniques could further help in optimizing conformal radiotherapy for patients with prostate cancer. The concepts of biologic target volume, real target volume, and multidimensional conformal radiotherapy are being explored.

  15. Newer imaging modalities to assist with target localization in the radiation treatment of prostate cancer and possible lymph node metastases.

    PubMed

    John, Subhash S; Zietman, Anthony L; Shipley, William U; Harisinghani, Mukesh G

    2008-01-01

    Precise localization of prostate cancer and the drainage lymph nodes is mandatory to define an accurate clinical target volume for conformal radiotherapy. Better target definition and delineation on a daily basis is surely important in quality assurance for fractionated radiation therapy. This article reviews the evidence for major emerging techniques that show promise in better identifying the clinical target volume. Partial prostate boost by brachytherapy, intensity-modulated radiation therapy, or protons has become possible not only with standard imaging techniques but also with the availability of metabolic images obtained by magnetic resonance spectroscopy. Even though fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography has not been found to be useful, novel radiolabeled tracers may eventually prove of value in the diagnosis and treatment planning of prostate cancer. For the metastatic lymph nodes, lymphotropic nanoparticle-enhanced magnetic resonance imaging using ultra-small superparamagnetic iron oxide particles has greater accuracy as compared with conventional techniques and has been instrumental in delineating the lymphatic drainage of the prostate gland. These novel investigational techniques could further help in optimizing conformal radiotherapy for patients with prostate cancer. The concepts of biologic target volume, real target volume, and multidimensional conformal radiotherapy are being explored.

  16. Laser- and electrosurgery as a treatment modality of BPH: urodynamic evaluation of seven different techniques in 280 patients

    NASA Astrophysics Data System (ADS)

    van Swol, Christiaan F. P.; van Venrooij, Ger E. P. M.; Eckhardt, Mardy D.; Grimbergen, Matthijs C. M.; Verdaasdonck, Rudolf M.; Boon, Tom A.

    1999-06-01

    Laser treatment of the prostate as an alternative for transurethral resection of the prostate (TURP) has evolved from a complicated troublesome procedure to a single office procedure. In this study, we compared the efficacy of different electrosurgical and laser techniques. The data of seven prospective studies in 280 patients were evaluated. The patients were treated for bladder outlet obstruction due to benign prostatic hyperplasia during the period from 1992 until 1998. Five procedures were offered using Nd:YAG laser light, including ultrasound-guided free beam, a free beam technique applying either a predetermined energy dose or a visually-guided energy does, contact laser prostatectomy and a hybrid method where free beam coagulation was followed by contact laser. Two procedures were offered using electrosurgery comprising transurethral resection and transurethral electrovaporization. The clinical outcome was assessed pre-operatively and 6 months post-operatively by free flowmetry, post-void residual, and Shaeffer obstruction grade. Results after 6 months are shown in the table below.

  17. Vicarious trauma and first responders: a case study utilizing eye movement desensitization and reprocessing (EMDR) as the primary treatment modality.

    PubMed

    Keenan, Paul; Royle, Liz

    2007-01-01

    Traumatic events can occur and adversely affect people during their lifetime. Natural disasters such as the earthquake in Pakistan in 2005 or the Tsunami in Asia in 2004, terrorist atrocities around the world, or personal events such as physical or sexual assault, can result in psychological difficulties for those people directly affected by these events. The diagnostic term Posttraumatic Stress Disorder (PTSD; Diagnostic and Statistical Manual of Mental Disorders, 4th edition, DSM IV 1994) is generally used to explain the often-severe psychological sequalae (van der Kolk, 1996; Servan-Schreiber 2004; Shapiro, 1995) that people may exhibit when directly affected by trauma. However, what of those people not directly involved in the trauma, but those who have borne witness to it, either by listening to the stories of survivors, or in the case of the helping professionals (such as police officers, nurses, doctors, psychotherapists, fire-fighters), actively working with survivors in psychological distress? This paper examines the potential psychological consequences for those in helping professions who are working with traumatized clients. This paper then focuses on a specific treatment intervention, EMDR, utilizing a case study by way of explanation.

  18. Pediatric Cranio-spinal Axis Irradiation: Comparison of Radiation-induced Secondary Malignancy Estimations Based on Three Methods of Analysis for Three Different Treatment Modalities.

    PubMed

    Myers, P A; Mavroidis, P; Komisopoulos, G; Papanikolaou, N; Stathakis, S

    2015-04-01

    Pediatric cranio-spinal axis irradiation (CSI) is a valuable treatment for many central nervous system (CNS) diseases, but due to the life expectancies and quality of life expectations for children, the minimization of the risk for radiation-induced secondary malignancies must be a high priority. This study compared the estimated CSI-induced secondary malignancy risks of three radiation therapy modalities using three different models. Twenty-four (n = 24) pediatric patients previously treated with CSI for tumors of the CNS were planned using three different treatment modalities: three-dimensional conformal radiation therapy (3D-CRT), volume modulated arc therapy (VMAT), and Tomotherapy. Each plan was designed to deliver 23.4 Gy (1.8 Gy/fraction) to the target which was defined as the entire brain and spinal column with a 0.7 cm expansion. The mean doses as well as the dose volume histograms (DVH) of specific organs were analyzed for secondary malignancy risk according to three different methods: the effective dose equivalent (EDE), the excess relative risk (ERR), and the linear quadratic (LQ) models. Using the EDE model, the average secondary risk was highest for the 3D-CRT plans (37.60%), compared to VMAT (28.05%) and Tomotherapy (27.90%). The ERR model showed similarly that the 3D-CRT plans had considerably higher risk (10.84%) than VMAT and Tomotherapy, which showed almost equal risks (7.05 and 7.07%, respectively). The LQ model requires organ-specific cell survival parameters, which for the lungs, heart, and breast relevant values were found and applied. The lung risk for secondary malignancy was found to be 1.00, 1.96, and 2.07% for 3D-CRT, VMAT, and Tomotherapy, respectively. The secondary cancer risk for breast was estimated to be 0.09, 0.21, and 0.27% and for heart it was 9.75, 6.02 and 6.29% for 3D-CRT, VMAT, and Tomotherapy, respectively. Based on three methods of secondary malignancy estimation, the 3D-CRT plans produced highest radiation

  19. Multi-Modality Phantom Development

    SciTech Connect

    Huber, Jennifer S.; Peng, Qiyu; Moses, William W.

    2009-03-20

    Multi-modality imaging has an increasing role in the diagnosis and treatment of a large number of diseases, particularly if both functional and anatomical information are acquired and accurately co-registered. Hence, there is a resulting need for multi modality phantoms in order to validate image co-registration and calibrate the imaging systems. We present our PET-ultrasound phantom development, including PET and ultrasound images of a simple prostate phantom. We use agar and gelatin mixed with a radioactive solution. We also present our development of custom multi-modality phantoms that are compatible with PET, transrectal ultrasound (TRUS), MRI and CT imaging. We describe both our selection of tissue mimicking materials and phantom construction procedures. These custom PET-TRUS-CT-MRI prostate phantoms use agargelatin radioactive mixtures with additional contrast agents and preservatives. We show multi-modality images of these custom prostate phantoms, as well as discuss phantom construction alternatives. Although we are currently focused on prostate imaging, this phantom development is applicable to many multi-modality imaging applications.

  20. Comparison of survival in patients with non-oat cell carcinoma of lung using various types of treatment modalities

    SciTech Connect

    Akbiyik, N.; Garvey, J.; Kalra, J.; Alexander, L.

    1982-09-01

    From 1967-1977, 560 patients with carcinoma of the lung were seen. Of these, 73 patients underwent lobectomy/pneumonectomy with/without postoperative radiation; 27 are alive today (Group A). Two hundred and seventy patients had distant metastasis when first seen, or it developed during treatment and so they were excluded from the study (Group B). One hundred ninety-seven patients were inoperable or unresectable intrathoraic unilateral (Group C) and treated with one of the following regimens: (1) High dose split course radiotherapy (RT) 3000 rad in 2 weeks followed by 2 weeks rest, then 3000 rad in 2 weeks (2150 ret). (2) Radiotherapy as in regimen1 followed by combination chemotherapy. (3) Continuous RT 6000 rad in 6 weeks. (4) Radiotherapy as in regimen3 followed by combination chemotherapy. (5) Combination chemotherapy alone. RT was administered by /sup 60/Cobalt unit. The survival percentages are discussed later. Chemotherapeutic agents consisted of 2 different drug regimens: vincristine + cyclophosphamide + adriamycin or cyclophosphamide + methotrexate + vincristine CCNU. The 5 month to 5 year survivals in Group C patients treated with two forms of RT techniques were comparable with RT + chemotherapy. Patients receiving chemotherapy alone had a shorter survival rate than those treated with RT alone. In July 1976 a new protocol was started for Stage II squamous cell carcinoma of the lung in which 22 patients received 5000 rad in 5 weeks and were randomized for immunotherapy to receive (a) Methanol Extract Residue (MER) every 4 weeks. (b) VAC (Vincristine) 1.4mg/m/sup 2/IV + adriamycin 50 mg/m/sup 2/IV + cyclophosphamide 500 mg/m/sup 2/IV every 4 weeks or (c) MER + VAC every 4 months. Median survivals for the different regimens were not statistically significant.

  1. Recombinant interferon alpha 2b for ocular surface squamous neoplasia: An efficient and cost-effective treatment modality in Asian Indian patients

    PubMed Central

    Kaliki, Swathi; Singh, Swati; Iram, Sadiya; Tripuraneni, Dharani

    2016-01-01

    Purpose: The purpose was to study the efficacy of interferon alpha 2b (INF α2b) in the treatment of ocular surface squamous neoplasia (OSSN) and analyze its cost-effectiveness in India. Study Design: This was a retrospective study of thirty patients with OSSN treated with topical INF α2b (1 MIU/cc) ± perilesional INF α2b (5 MIU/cc). Results: The tumor involved cornea (n = 9, 30%), conjunctivo-limbal-corneal surface (n = 19, 63%), or bulbar conjunctiva (n = 2, 7%). The mean basal dimension of the tumor was 16 mm. The tumors belonged to Tis (n = 6, 20%) or T3 (n = 24, 80%) based on the American Joint Committee Classification, 7th edition. In the six patients with Tis, three cycles of topical INF α2b were used for immunoprevention. In the remaining 24 patients, INF α2b was advised for immunoreduction, but served as immunotherapy with 100% tumor regression in 22 (92%) cases, and resulted in 95% immunoreduction in 2 (6%) cases. Complete tumor regression by immunotherapy (n = 22) was achieved with a mean number of three topical INF α2b cycles and two perilesional injections. All these 22 patients received three additional topical INF α2b cycles after complete tumor regression. For immunoreduction (n = 2), both patients received six cycles of topical INF α2b which was three perilesional INF α2b injections. The mean total treatment cost per patient with INF α2b was INR 9164 ($US 137). Based on maximum basal diameter of tumor at presentation, the mean total treatment cost per patient with INF α2b was INR 4866 ($US 73) for eyes with microscopic evidence of tumor residue (n = 6), INR 9607 ($US 143) for tumors ≤10 mm (n = 13), and INR 10,985 ($US 164) for tumors >10 mm (n = 11), with two patients needing additional surgical excision for complete tumor control. Conclusion: INF α2b can be used for immunoreduction, immunotherapy, or immunoprevention of OSSN. INF α2b is a cost-effective treatment modality for OSSN at an average total treatment cost of INR 9164 ($US

  2. Improved Survival in Patients With Stage III-IV Head and Neck Cancer Treated With Radiotherapy as Primary Local Treatment Modality

    SciTech Connect

    Rusthoven, Kyle E.; Raben, David; Chen Changhu

    2008-10-01

    Purpose: To evaluate the overall and cause-specific survival in patients with Stage III-IVb head and neck squamous cell carcinoma treated with radiotherapy (RT) as the primary local treatment modality. Methods and Materials: The survival of patients with American Joint Committee on Cancer Stage III-IVb head and neck squamous cell carcinoma treated with primary RT was queried using the Surveillance, Epidemiology and End Results database. The effect of the year of treatment on overall and cause-specific survival was analyzed as a categorical and continuous variable. The patterns of care for these patients were also evaluated. Results: Between 1988 and 2004, 6,759 patients were identified. Survival was significantly improved in patients treated more recently. When analyzed as a continuous variable, each year was associated with a 3% and 4.1% reduction in the relative risk of overall and cause-specific mortality, respectively (p < 0.0001). Patients treated after 1998 had a 7.6% and 6.1% absolute improvement in overall and cause-specific survival, respectively, compared with patients treated before 1998 (overall survival, hazard ratio, 0.81; cause-specific survival, hazard ratio, 0.77; p < 0.0001). This benefit in survival was limited to tumors of the oral cavity, oropharynx, and hypopharynx. The use of RT increased among patients treated more recently. This shift in patterns of care was most pronounced for tumors of the larynx and hypopharynx. Conclusions: The overall and cause-specific survival of patients with Stage III-IVb head and neck squamous cell carcinoma treated with primary RT has improved with time. The improvement is consistent with that observed in a large meta-analysis of randomized patients treated with concurrent chemoradiotherapy.

  3. Reducing the probability of radiation-induced hepatic toxicity by changing the treatment modality from helical tomotherapy to fixed-beam intensity-modulated radiotherapy

    PubMed Central

    Song, Jin Ho; Son, Seok Hyun; Kay, Chul Seung; Jang, Hong Seok

    2015-01-01

    Purpose To estimate and compare the risk of radiation-induced hepatic toxicity (RIHT) in helical tomotherapy and fixed-beam intensity-modulated radiotherapy (IMRT) for the treatment of hepatocellular carcinoma (HCC). Materials and Methods Twenty patients with unresectable HCC treated with tomotherapy were selected. We performed tomotherapy re-planning to reduce the non-target normal liver volume receiving a dose of more than 15 Gy (NTNL-V15Gy), and we created a fixed-beam IMRT plan (FB-P). We compared the dosimetric results as well as the estimated probability of RIHT among the tomotherapy initial plan (T-IP), the tomotherapy re-plan (T-RP), and the FB-P. Results Comparing the T-RP and FB-P, the homogeneity index was 0.11 better with the T-RP. However, the mean NTNL-V15Gy was 6.3% lower with the FB-P. These differences result in a decline in the probability of RIHT from 0.216 in the T-RP to 0.115 in the FB-P. In patients whose NTNL-V15Gy was higher than 43.2% with the T-RP, the probability of RIHT markedly reduced from 0.533 to 0.274. Conclusions By changing the treatment modality from tomotherapy to fixed-beam IMRT, we could reduce the liver dose and the probability of RIHT without scarifying the target coverage, especially in patients whose liver dose is high. PMID:26376679

  4. Disease control and treatment modalities have impact on quality of life in acromegaly evaluated by Acromegaly Quality of Life (AcroQoL) Questionnaire.

    PubMed

    Vandeva, Silvia; Yaneva, Maria; Natchev, Emil; Elenkova, Atanaska; Kalinov, Krasimir; Zacharieva, Sabina

    2015-08-01

    Various factors influence quality of life (QoL) in acromegaly. Whether disease control and treatment approach are related to QoL is still a matter of debate. The aim of the present study was to evaluate QoL in patients with acromegaly using the disease-specific Acromegaly Quality of Life Questionnaire in respect to disease activity, treatment modalities, and other factors. We studied 212 patients with acromegaly in a cross-sectional manner over a 6-year period in a single tertiary center. As a second step, seventy of the patients who were with active disease at baseline were followed up prospectively and 45 of them were in remission at re-evaluation. In regard to the cross-sectional group, active acromegaly independently predicted worse appearance scores. Prior radiotherapy and older age were independent negative predictors of all scales. Female gender negatively predicted all scales except the appearance domain. Longer duration of remission predicted worse personal relations scores in biochemically controlled patients. The use of somatostatin analog (SSA) was associated with worse personal relations scores, while higher IGF-1 index predicted worse appearance scores in patients with active acromegaly. In the prospective group, achievement of remission independently predicted improvement of the total scale. Lower corresponding baseline scores predicted improvement of the total, physical, and appearance scales, while the absence of hypopituitarism independently predicted improvement of the appearance scale. The use of SSA was associated with improvement of the total and appearance scores. In conclusion, QoL is a multifactorial issue that needs an individualized approach for detection and management.

  5. Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability

    PubMed Central

    Botella, Cristina; Serrano, Berenice; Baños, Rosa M; Garcia-Palacios, Azucena

    2015-01-01

    Introduction The essential feature of post-traumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. According to evidence-based intervention guidelines and empirical evidence, one of the most extensively researched and validated treatments for PTSD is prolonged exposure to traumatic events; however, exposure therapy can present some limitations. Virtual reality (VR) can help to improve prolonged exposure because it creates fictitious, safe, and controllable situations that can enhance emotional engagement and acceptance. Objective In addition to carrying out a review to evaluate the efficacy of VR exposure-based therapy (VR-EBT) for the treatment of PTSD, the aim of this study was to contribute to analyzing the use of VR-EBT by: first, evaluating the adequacy of psychological treatment protocols that use VR-EBT to treat PTSD; and second, analyzing the acceptability of VR-EBT. Method We performed a replica search with descriptors and databases used in two previous reviews and updated to April 2015. Next, we carried out an evaluation of the efficacy, adequacy, and acceptability of VR-EBT protocols. Results Results showed that VR-EBT was effective in the treatment of PTSD. The findings related to adequacy showed that not all studies using VR-EBT reported having followed the clinical guidelines for evidence-based interventions in the treatment of PTSD. Regarding acceptability, few studies evaluated this subject. However, the findings are very promising, and patients reported high acceptability and satisfaction with the inclusion of VR in the treatment of PTSD. Conclusion The main weaknesses identified in this review focus on the need for more controlled studies, the need to standardize treatment protocols using VR-EBT, and the need to include assessments of acceptability and related variables. Finally, this paper highlights some directions and future perspectives for using VR-EBT in PTSD

  6. Use of thermo-coagulation as an alternative treatment modality in a 'screen-and-treat' programme of cervical screening in rural Malawi.

    PubMed

    Campbell, Christine; Kafwafwa, Savel; Brown, Hilary; Walker, Graeme; Madetsa, Belito; Deeny, Miriam; Kabota, Beatrice; Morton, David; Ter Haar, Reynier; Grant, Liz; Cubie, Heather A

    2016-08-15

    The incidence of cervical cancer in Malawi is the highest in the world and projected to increase in the absence of interventions. Although government policy supports screening using visual inspection with acetic acid (VIA), screening provision is limited due to lack of infrastructure, trained personnel, and the cost and availability of gas for cryotherapy. Recently, thermo-coagulation has been acknowledged as a safe and acceptable procedure suitable for low-resource settings. We introduced thermo-coagulation for treatment of VIA-positive lesions as an alternative to cryotherapy within a cervical screening service based on VIA, coupled with appropriate, sustainable pathways of care for women with high-grade lesions and cancers. Detailed planning was undertaken for VIA clinics, and approvals were obtained from the Ministry of Health, Regional and Village Chiefs. Educational resources were developed. Thermo-coagulators were introduced into hospital and health centre settings, with theoretical and practical training in safe use and maintenance of equipment. A total of 7,088 previously unscreened women attended VIA clinics between October 2013 and March 2015. Screening clinics were held daily in the hospital and weekly in the health centres. Overall, VIA positivity was 6.1%. Almost 90% received same day treatment in the hospital setting, and 3- to 6-month cure rates of more than 90% are observed. Thermo-coagulation proved feasible and acceptable in this setting. Effective implementation requires comprehensive training and provider support, ongoing competency assessment, quality assurance and improvement audit. Thermo-coagulation offers an effective alternative to cryotherapy and encouraged VIA screening of many more women.

  7. Evaluating transdiagnostic treatment for distress and impairment in veterans: a multi-site randomized controlled trial of Acceptance and Commitment Therapy.

    PubMed

    Lang, Ariel J; Schnurr, Paula P; Jain, Sonia; Raman, Rema; Walser, Robyn; Bolton, Elisa; Chabot, Aimee; Benedek, David

    2012-01-01

    Military personnel who engaged in the conflicts in Afghanistan and Iraq frequently present for mental health care because of the stresses of service and readjustment. Although excellent treatments are available to treat the typical presenting problems, there is a need for additional empirically supported treatment approaches for this population. Because these veterans have high levels of comorbidity, transdiagnostic treatment - treatment that applies to more than one diagnosis - may be an efficient approach for this group. Acceptance and Commitment Therapy (ACT) is one such approach that is well-known and has high face validity for veterans, but it has not been rigorously evaluated as a treatment for trauma-related mental health problems. Described herein is an ongoing multi-site randomized clinical trial of ACT as compared to a psychotherapy control. Challenges in designing an RCT to evaluate transdiagnostic treatment and in executing a multi-site psychotherapy trial are discussed.

  8. Understanding the acceptability and adherence to paediatric antiretroviral treatment in the new formulation of pellets (LPV/r): the protocol of a realist evaluation

    PubMed Central

    Nöstlinger, Christiana; Lee, Janice; Salami, Olawale; Lallemant, Marc; Ouma, Onyango; Nyamongo, Isaac; Marchal, Bruno

    2017-01-01

    Background Improving access to paediatric HIV treatment requires both large-scale treatment programmes and medication that is adapted to infants and children's needs. The WHO recommends lopinavir/ritonavir as first-line antiretroviral therapy for all HIV-infected children younger than 3 years. There is currently little evidence on the acceptability of, and adherence to, a formulation of this combination treatment if given in the form of pellets. This protocol presents how we will carry a realist evaluation to assess the factors that contribute to the acceptability and adherence to the new pellets formulation in 3 hospitals in Kenya. Methods We structured the protocol along the realist evaluation cycle following 4 steps: (1) the initial programme theory, (2) the study design, (3) the data collection methods and (4) the data analysis plan. Theories of behavioural sciences were reviewed for frames that could provide insights into how using such new formulations may contribute to better acceptability and adherence. Ethics and dissemination This study was approved by the Institutional Review Board of the Institute of Tropical Medicine, the Ethical Committee of the University Hospital Antwerp and the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee. We aim to disseminate the findings through international conferences and peer-reviewed journals and to share them with Drugs for Neglected Diseases initiative's (DNDi) programme managers and with the Kenyan healthcare providers. Discussion In developing this study, we encountered some challenges. First, methods to measure the acceptability of any formulation and adherence to it are not standardised. The second challenge is common in realist evaluation and relates to how to choose from different potentially interesting theoretical frameworks. We identified relevant and empirically tested theories from behavioural science that may be helpful in our study. We will test them in 3 settings by

  9. TextTB: A Mixed Method Pilot Study Evaluating Acceptance, Feasibility, and Exploring Initial Efficacy of a Text Messaging Intervention to Support TB Treatment Adherence.

    PubMed

    Iribarren, Sarah; Beck, Susan; Pearce, Patricia F; Chirico, Cristina; Etchevarria, Mirta; Cardinale, Daniel; Rubinstein, Fernando

    2013-01-01

    Objective. To assess a text messaging intervention to promote tuberculosis (TB) treatment adherence. Methods. A mixed-methods pilot study was conducted within a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were 18 or older, and had mobile phone access were recruited and randomized to usual care plus either medication calendar (n = 19) or text messaging intervention (n = 18) for the first two months of treatment. Primary outcomes were feasibility and acceptability; secondary outcomes explored initial efficacy. Results. Feasibility was evidenced by high access to mobile phones, familiarity with texting, most phones limited to basic features, a low rate of participant refusal, and many describing suboptimal TB understanding. Acceptability was evidenced by participants indicating feeling cared for, supported, responsible for their treatment, and many self-reporting adherence without a reminder. Participants in the texting group self-reported adherence on average 77% of the days whereas only 53% in calendar group returned diaries. Exploring initial efficacy, microscopy testing was low and treatment outcomes were similar in both groups. Conclusion. The texting intervention was well accepted and feasible with greater reporting of adherence using text messaging than the diary. Further evaluation of the texting intervention is warranted.

  10. TextTB: A Mixed Method Pilot Study Evaluating Acceptance, Feasibility, and Exploring Initial Efficacy of a Text Messaging Intervention to Support TB Treatment Adherence

    PubMed Central

    Pearce, Patricia F.; Chirico, Cristina; Etchevarria, Mirta; Cardinale, Daniel; Rubinstein, Fernando

    2013-01-01

    Objective. To assess a text messaging intervention to promote tuberculosis (TB) treatment adherence. Methods. A mixed-methods pilot study was conducted within a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were 18 or older, and had mobile phone access were recruited and randomized to usual care plus either medication calendar (n = 19) or text messaging intervention (n = 18) for the first two months of treatment. Primary outcomes were feasibility and acceptability; secondary outcomes explored initial efficacy. Results. Feasibility was evidenced by high access to mobile phones, familiarity with texting, most phones limited to basic features, a low rate of participant refusal, and many describing suboptimal TB understanding. Acceptability was evidenced by participants indicating feeling cared for, supported, responsible for their treatment, and many self-reporting adherence without a reminder. Participants in the texting group self-reported adherence on average 77% of the days whereas only 53% in calendar group returned diaries. Exploring initial efficacy, microscopy testing was low and treatment outcomes were similar in both groups. Conclusion. The texting intervention was well accepted and feasible with greater reporting of adherence using text messaging than the diary. Further evaluation of the texting intervention is warranted. PMID:24455238

  11. Improving Health Worker Adherence to Malaria Treatment Guidelines in Papua New Guinea: Feasibility and Acceptability of a Text Message Reminder Service

    PubMed Central

    Kurumop, Serah F.; Bullen, Chris; Whittaker, Robyn; Betuela, Inoni; Hetzel, Manuel W.; Pulford, Justin

    2013-01-01

    The aim of this study is to assess whether a text message reminder service designed to support health worker adherence to a revised malaria treatment protocol is feasible and acceptable in Papua New Guinea (PNG). The study took place in six purposively selected health facilities located in the Eastern Highlands Province (EHP) of PNG. Ten text messages designed to remind participants of key elements of the new NMTP were transmitted to 42 health workers twice over a two week period (two text messages per day, Monday to Friday) via the country’s largest mobile network provider. The feasibility and acceptability of the text message reminder service was assessed by transmission reports, participant diaries and group discussions. Findings indicate that the vast majority of text messages were successfully transmitted, participants’ had regular mobile phone access and that most text messages were read most of the time and were considered both acceptable and clinically useful. Nevertheless, the study found that PNG health workers may tire of the service if the same messages are repeated too many times and that health workers may be reluctant to utilize more comprehensive, yet complementary, resources. In conclusion, a text message reminder service to support health worker adherence to the new malaria treatment protocol is feasible and acceptable in PNG. A rigorous pragmatic, effectiveness trial would be justified on the basis of these findings. PMID:24116122

  12. Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

    ERIC Educational Resources Information Center

    Morton, Jane; Snowdon, Sharon; Gopold, Michelle; Guymer, Elise

    2012-01-01

    A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current…

  13. Comparison of Younger and Older Adults' Acceptability of Treatment for Generalized Anxiety Disorder Co-Occurring with Parkinson's Disease

    ERIC Educational Resources Information Center

    Lundervold, Duane A.; Ament, Patrick A.; Holt, Peter S.; Hunt, Lauren S.

    2013-01-01

    Acceptability ratings of medication or Behavioral Relaxation Training (BRT), for general anxiety disorder (GAD) co-occurring with Parkinson's Disease (PD) were obtained from younger ("n" = 79) and older ("n" = 54) adults. Participants read a case description of an older adult with PD and comorbid GAD followed by a description…

  14. Effect of organic acid treatments on microbial safety and overall acceptability of fresh-cut melon cubes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is much interest in developing effective minimal processing methodologies for fruits and vegetables that would enhance the microbial safety and not change overall acceptability. In this study, several organic acids (EDTA, nisin, sorbic acid and sodium lactate) generally regarded as safe (GRAS)...

  15. Modal testing the EOLE

    SciTech Connect

    Carne, T.G.; Lauffer, J.P.; Gomez, A.J.; Benjannet, H.

    1988-04-01

    This report presents the results of the modal test of the 110-m-tall EOLE wind turbine. Modal testing an immense and flexible wind turbine poses a number of problems. It requires innovative excitation techniques since the modal frequencies of this type of structure are quite low /emdash/ some below 1.0 Hz. Also, substantial energy must be input to the structure to obtain reasonable levels of response. Step-relaxation and wind were used to excite the structure.

  16. Multishaker modal testing

    NASA Technical Reports Server (NTRS)

    Craig, R. R., Jr.

    1983-01-01

    Procedures for improving the modal modeling of structures using test data and to determine appropriate analytical models based on substructure experimental data were explored. Two related research topics were considered in modal modeling: using several independently acquired columns of frequency response data, and modal modeling using simultaneous multi-point excitation. In component mode synthesis modeling, the emphasis is on determining the best way to employ complex modes and residuals.

  17. Perceptions and Acceptability of Short Message Services Technology to Improve Treatment Adherence amongst Tuberculosis Patients in Peru: A Focus Group Study

    PubMed Central

    Albino, Sandra; Tabb, Karen M.; Requena, David; Egoavil, Miguel; Pineros-Leano, Maria F.; Zunt, Joseph R.; García, Patricia J.

    2014-01-01

    Background Tuberculosis (TB) is global health concern and a leading infectious cause of mortality. Reversing TB incidence and disease-related mortality is a major global health priority. Infectious disease mortality is directly linked to failure to adhere to treatments. Using technology to send reminders by short message services have been shown to improve treatment adherence. However, few studies have examined tuberculosis patient perceptions and attitudes towards using SMS technology to increase treatment adherence. In this study, we sought to investigate perceptions related to feasibility and acceptability of using text messaging to improve treatment adherence among adults who were receiving treatment for TB in Callao, Peru. Methods We conducted focus group qualitative interviews with current TB positive and non-contagious participants to understand the attitudes, perceptions, and feasibility of using short message service (SMS) reminders to improve TB treatment adherence. Subjects receiving care through the National TB Program were recruited through public health centers in Ventanilla, Callao, Peru. In four focus groups, we interviewed 16 patients. All interviews were recorded and transcribed verbatim. Thematic network analysis and codebook techniques were used to analyze data. Results Three major themes emerged from the data: limits on health literacy and information posed challenges to successful TB treatment adherence, treatment motivation at times facilitated adherence to TB treatment, and acceptability of SMS including positive perceptions of SMS to improve TB treatment adherence. The majority of patients shared considerations about how to effectively and confidentially administer an SMS intervention with TB positive participants. Conclusion The overall perceptions of the use of SMS were positive and indicated that SMS technology may be an efficient way to transmit motivational texts on treatment, health education information, and simple reminders to

  18. Modal testing the EOLE

    SciTech Connect

    Carne, T.G.; Lauffer, J.P.; Gomez, A.J.

    1987-01-01

    Modal testing an immense and flexible wind turbine poses a number of problems. It requires innovative excitation techniques since the modal frequencies of this type of structure are quite low. Also, substantial energy must be input to the structure to obtain reasonable levels of response. In this paper, the results of the modal test of the 110 m tall EOLE wind turbine are presented which had a number of modal frequencies below 1.0 Hz. Step-relaxation and wind were used to excite the structure. 5 refs., 14 figs., 2 tabs.

  19. Acceptance and Commitment Therapy and nicotine patch for smokers with bipolar disorder: preliminary evaluation of in-person and telephone-delivered treatment

    PubMed Central

    Heffner, Jaimee L; McClure, Jennifer B; Mull, Kristin E; Anthenelli, Robert M; Bricker, Jonathan B

    2015-01-01

    Objectives People with bipolar disorder are two to three times more likely to smoke and 50% less likely to quit than the general population. New treatments are needed to improve smoking cessation outcomes in this group. The study aim was to develop and pilot test a novel cessation intervention for smokers with bipolar disorder using Acceptance and Commitment Therapy (ACT) combined with nicotine patch. Methods The 10-session ACT intervention was initially evaluated as in-person, individual counseling (n = 10), then as telephone-delivered counseling (n = 6). Participants were adult smokers with no more than mild current symptoms of bipolar disorder. Results For the in-person protocol, end-of-treatment outcomes were: 80% retention, 40% of participants with carbon monoxide (CO)-verified seven-day point prevalence abstinence (PPA), 90% satisfied with treatment, 8.3 of 10 sessions attended, and 54% increase in acceptance of cravings to smoke (i.e., ACT’s theory-based change process) from baseline. The seven-day PPA at one-month follow-up was 30%. For the telephone protocol, end-of-treatment outcomes were: 67% retention, 33% reporting seven-day PPA, 100% satisfied with treatment, 6.7 of 10 treatment calls completed, and 55% increase in acceptance from baseline. At one-month follow up, seven-day PPA was 17%. The proportion of treatment completers who used at least 80% of the nicotine patches was 62.5% for the in-person protocol and 0% for the telephone protocol. Conclusions Both in-person and telephone-delivered ACT were feasible. Despite low adherence to nicotine patch, the intervention showed preliminary evidence of facilitating quitting and impacting ACT’s change mechanism. A randomized, controlled trial of this targeted ACT intervention is now needed. PMID:25912192

  20. The Efficacy of Three Modalities of Internet-Based Psychotherapy for Non–Treatment-Seeking Online Problem Gamblers: A Randomized Controlled Trial

    PubMed Central

    Tanguy, Marie-Laure; Lagadec, Marthylle; Benyamina, Amine; Aubin, Henri-Jean; Reynaud, Michel

    2016-01-01

    Background Internet-based interventions targeted at the most at-risk gamblers could reduce the treatment gap for addictive disorders. Currently, no clinical trial has included non–treatment-seeking patients who have been recruited directly in their gambling environment. This study was the first exclusively Internet-based randomized controlled trial among non–help-seeking problem gamblers with naturalistic recruitment in their gambling environment. Objective The aim of this study was to assess the efficacy of three modalities of Internet-based psychotherapies with or without guidance, compared to a control condition, among problem gamblers who play online poker. Methods All active poker gamblers on the Winamax website were systematically offered screening. All problem poker gamblers identified with a Problem Gambling Severity Index (PGSI) score of ≥5 were eligible to be included in the trial. Problem gamblers were randomized into four groups: (1) waiting list (control group), (2) personalized normalized feedback on their gambling status by email, (3) an email containing a self-help book to be downloaded with a Cognitive Behavioral Therapy (CBT) program without guidance, and (4) the same CBT program emailed weekly by a trained psychologist with personalized guidance. Efficacy was assessed based on the change in PGSI between baseline and 6 weeks (end of treatment) or 12 weeks (maintenance) and supported by player account-based gambling data automatically collected at the three time points. Results All groups met high attrition rates (83%), but the group with guidance had a significantly higher dropout rate than the other three groups, including the control group. Although all groups showed some improvement, with a mean decrease of 1.35 on the PGSI, no significant difference in efficacy between the groups was observed. One-third of the problem gamblers fell below the problem gambling threshold at 6 weeks. Conclusions Guidance could have aversively affected

  1. Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea.

    PubMed

    Chung, Su Jin; Park, Min Jung; Kang, Seung Joo; Kang, Hae Yeon; Chung, Goh Eun; Kim, Sang Gyun; Jung, Hyun Chae

    2012-11-15

    We investigated risk factors for gastric cancer (GC) and effect of annual endoscopic screening on detection and treatment modality of GC. Asymptomatic adults who underwent upper endoscopy during health checkups at Seoul National University Hospital Healthcare System Gangnam Center were enrolled. We compared clinicopathologic characteristics of GC according to screening interval (repeated vs. infrequent, annual vs. biennial). After age- and sex-matching, relative risk was computed by hazard ratio (HR) using Cox proportional regression with multivariate adjustment. Of the 58,849 subjects who received screening endoscopy, 277 (0.47%) were found to have GC. Intestinal type comprised 55.4% (102/184) followed by diffuse type (n = 65, 35.3%). Age ≥ 50 years, family history and smoking independently increased the risk of GC for both types, whereas male gender [HR = 4.81, 95% confidence interval (CI): 2.72-8.03] and intestinal metaplasia (IM) (HR = 10.87, 95% CI: 3.36-22.30) were significant predictors for intestinal type only. Proportion of early gastric cancer (EGC) was 98.6% (71/72) in annual screening group and 80.7% (46/57) in biennial screening group (p < 0.01). In the former, tumor size was smaller (1.7 ± 1.3 vs. 2.3 ± 1.8 cm; p < 0.01] and proportion of intramucosal cancer was larger (75.0 vs. 56.1%; p = 0.04). Endoscopic resection was performed more frequently in annual screening group (56.9 vs. 33.3%; p = 0.02). IM along with male gender and older age was a strong risk factor for intestinal type GC. Annual screening group improved detection of early-stage and endoscopically treatable GC suggesting that intensive screening and surveillance may be useful for high-risk subpopulations with epidemiologic risk factors or premalignant lesions such as IM.

  2. Video: Modalities and Methodologies

    ERIC Educational Resources Information Center

    Hadfield, Mark; Haw, Kaye

    2012-01-01

    In this article, we set out to explore what we describe as the use of video in various modalities. For us, modality is a synthesizing construct that draws together and differentiates between the notion of "video" both as a method and as a methodology. It encompasses the use of the term video as both product and process, and as a data…

  3. Cost effectiveness of endometrial ablation with the NovaSure® system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives

    PubMed Central

    Miller, Jeffrey D; Lenhart, Gregory M; Bonafede, Machaon M; Basinski, Cindy M; Lukes, Andrea S; Troeger, Kathleen A

    2015-01-01

    Objectives Abnormal uterine bleeding (AUB) interferes with physical, emotional, and social well-being, impacting the quality of life of more than 10 million women in the USA. Hysterectomy, the most common surgical treatment of AUB, has significant morbidity, low mortality, long recovery, and high associated health care costs. Global endometrial ablation (GEA) provides a surgical alternative with reduced morbidity, cost, and recovery time. The NovaSure® system utilizes unique radiofrequency impedance-based GEA technology. This study evaluated cost effectiveness of AUB treatment with NovaSure ablation versus other GEA modalities and versus hysterectomy from the US commercial and Medicaid payer perspectives. Methods A health state transition (semi-Markov) model was developed using epidemiologic, clinical, and economic data from commercial and Medicaid claims database analyses, supplemented by published literature. Three hypothetical cohorts of women receiving AUB interventions were simulated over 1-, 3-, and 5-year horizons to evaluate clinical and economic outcomes for NovaSure, other GEA modalities, and hysterectomy. Results Model analyses show lower costs for NovaSure-treated patients than for those treated with other GEA modalities or hysterectomy over all time frames under commercial payer and Medicaid perspectives. By Year 3, cost savings versus other GEA were $930 (commercial) and $3,000 (Medicaid); cost savings versus hysterectomy were $6,500 (commercial) and $8,900 (Medicaid). Coinciding with a 43%–71% reduction in need for re-ablation, there were 69%–88% fewer intervention/reintervention complications for NovaSure-treated patients versus other GEA modalities, and 82%–91% fewer versus hysterectomy. Furthermore, NovaSure-treated patients had fewer days of work absence and short-term disability. Cost-effectiveness metrics showed NovaSure treatment as economically dominant over other GEA modalities in all circumstances. With few exceptions, similar

  4. Acceptance and Commitment Therapy as a Novel Treatment for Eating Disorders: An Initial Test of Efficacy and Mediation

    ERIC Educational Resources Information Center

    Juarascio, Adrienne; Shaw, Jena; Forman, Evan; Timko, C. Alix; Herbert, James; Butryn, Meghan; Bunnell, Douglas; Matteucci, Alyssa; Lowe, Michael

    2013-01-01

    Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high…

  5. Integrating mindfulness meditation with cognitive and behavioural therapies: the challenge of combining acceptance- and change-based strategies.

    PubMed

    Lau, Mark A; McMain, Shelley F

    2005-11-01

    Recent innovations in psychological treatments have integrated mindfulness meditation techniques with traditional cognitive and behavioural therapies, challenging traditional cognitive and behavioural therapists to integrate acceptance- and change-based strategies. This article details how 2 treatments, mindfulness-based cognitive therapy and dialectical behaviour therapy, have met this challenge. We review the integration rationale underlying the 2 treatments, how the treatments combine strategies from each modality to accomplish treatment goals, implications for therapist training, and treatment effectiveness. In addition, we discuss the challenges of assessing the benefits of incorporating acceptance-based strategies. Both therapies have integrated acceptance-based mindfulness approaches with change-based cognitive and behavioural therapies to create efficacious treatments.

  6. Modality, probability, and mental models.

    PubMed

    Hinterecker, Thomas; Knauff, Markus; Johnson-Laird, P N

    2016-10-01

    We report 3 experiments investigating novel sorts of inference, such as: A or B or both. Therefore, possibly (A and B). Where the contents were sensible assertions, for example, Space tourism will achieve widespread popularity in the next 50 years or advances in material science will lead to the development of antigravity materials in the next 50 years, or both. Most participants accepted the inferences as valid, though they are invalid in modal logic and in probabilistic logic too. But, the theory of mental models predicts that individuals should accept them. In contrast, inferences of this sort—A or B but not both. Therefore, A or B or both—are both logically valid and probabilistically valid. Yet, as the model theory also predicts, most reasoners rejected them. The participants’ estimates of probabilities showed that their inferences tended not to be based on probabilistic validity, but that they did rate acceptable conclusions as more probable than unacceptable conclusions. We discuss the implications of the results for current theories of reasoning.

  7. Feasibility and Acceptability of Bibliotherapy and Telephone Sessions for the Treatment of Late-life Anxiety Disorders.

    PubMed

    Brenes, Gretchen A; McCall, W Vaughn; Williamson, Jeff D; Stanley, Melinda A

    2010-01-01

    This article describes the development of Biblio and Telephone Therapy or BTT, a cognitive-behavioral treatment program for late-life anxiety disorders. Although studies have examined bibliotherapy for the treatment of late-life depression, none have studied it as a format for treating late-life anxiety. The application of this treatment to 4 older adults with Generalized Anxiety Disorder (GAD) and/or Panic Disorder (PD) is described and benefits, advantages and limitations are discussed.

  8. Feasibility and Acceptability of Bibliotherapy and Telephone Sessions for the Treatment of Late-life Anxiety Disorders

    PubMed Central

    Brenes, Gretchen A.; McCall, W. Vaughn; Williamson, Jeff D.; Stanley, Melinda A.

    2010-01-01

    This article describes the development of Biblio and Telephone Therapy or BTT, a cognitive-behavioral treatment program for late-life anxiety disorders. Although studies have examined bibliotherapy for the treatment of late-life depression, none have studied it as a format for treating late-life anxiety. The application of this treatment to 4 older adults with Generalized Anxiety Disorder (GAD) and/or Panic Disorder (PD) is described and benefits, advantages and limitations are discussed. PMID:20661315

  9. Conceptual Structure within and between Modalities.

    PubMed

    Dilkina, Katia; Lambon Ralph, Matthew A

    2012-01-01

    Current views of semantic memory share the assumption that conceptual representations are based on multimodal experience, which activates distinct modality-specific brain regions. This proposition is widely accepted, yet little is known about how each modality contributes to conceptual knowledge and how the structure of this contribution varies across these multiple information sources. We used verbal feature lists, features from drawings, and verbal co-occurrence statistics from latent semantic analysis to examine the informational structure in four domains of knowledge: perceptual, functional, encyclopedic, and verbal. The goals of the analysis were three-fold: (1) to assess the structure within individual modalities; (2) to compare structures between modalities; and (3) to assess the degree to which concepts organize categorically or randomly. Our results indicated significant and unique structure in all four modalities: perceptually, concepts organize based on prominent features such as shape, size, color, and parts; functionally, they group based on use and interaction; encyclopedically, they arrange based on commonality in location or behavior; and verbally, they group associatively or relationally. Visual/perceptual knowledge gives rise to the strongest hierarchical organization and is closest to classic taxonomic structure. Information is organized somewhat similarly in the perceptual and encyclopedic domains, which differs significantly from the structure in the functional and verbal domains. Notably, the verbal modality has the most unique organization, which is not at all categorical but also not random. The idiosyncrasy and complexity of conceptual structure across modalities raise the question of how all of these modality-specific experiences are fused together into coherent, multifaceted yet unified concepts. Accordingly, both methodological and theoretical implications of the present findings are discussed.

  10. Treatment of Infantile Hemangioma in Regional Hospitals With eHealth Support: Evaluation of Feasibility and Acceptance by Parents and Doctors

    PubMed Central

    van Os-Medendorp, Harmieke; van Renselaar, Wilco; Breugem, Corstiaan C; Pasmans, Suzanne GMA

    2014-01-01

    Background Since beta blockers became the preferred treatment for infantile hemangiomas (IH), the number of patients eligible for treatment is increasing. Currently treatment of IH with beta blockers is mainly reserved for expert centers, where wait times are lengthening. This demonstrated the need for development of a more efficient and accessible way of providing care for children needing treatment for IH. An eHealth intervention, Hemangioma Treatment Plan (HTP), was developed to treat IH in regional hospitals with online support from an academic doctor. Objective Our goal was to evaluate the feasibility of the eHealth intervention by determining its use, acceptance, and usability. By evaluating the feasibility, usage can be predicted and points for improvement can be defined, thereby facilitating implementation of the intervention. Methods Parents of children with an IH, presenting between October 2012 and November 2013 at the tertiary expert Center for Congenital Vascular Anomalies Utrecht, requiring treatment with a beta blocker, were asked to participate in the digital HTP. Both parents and regional doctors were sent a study questionnaire. Acceptance and usability of the HTP were evaluated by using the modified Technology Acceptance Model. Results A total of 31 parents and 22 regional doctors participated in the eHealth intervention and received the questionnaire, and 25 parents and 15 doctors responded (response rates respectively 81% and 68%). A majority of the parents (96%, 24/25) and the regional doctors (87%, 13/15) considered the eHealth intervention useful in the care for IH. Most parents (76%, 19/25) and over half of the regional doctors (53%, 8/15) found the HTP easy to use. Technical problems using the HTP were reported by 28% (7/25) of the parents and 73% (11/15) of the doctors. The majority of parents (92%, 23/25) felt positive about usage of the HTP during treatment of their child. All regional doctors (100%, 15/15) felt positive about transition

  11. Comparison of Different Treatment Modalities for Type 1 Diabetes, Including Sensor-Augmented Insulin Regimens, in 52 Weeks of Follow-Up: A COMISAIR Study

    PubMed Central

    Petruželková, Lenka; Flekač, Milan; Pelcl, Tomáš; Matoulek, Martin; Daňková, Martina; Škrha, Jan; Svačina, Štěpán; Prázný, Martin

    2016-01-01

    Abstract Objective: To compare different treatment modalities for patients with type 1 diabetes (T1D) based on real-time continuous glucose monitoring (RT-CGM) or self-monitoring of blood glucose (SMBG) combined with multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII). Research Design and Methods: Sixty-five T1D patients were followed up for a year. Of these, 27 started RT-CGM as part of a sensor-augmented insulin regimen (SAIR); within this SAIR group, 15 subjects started sensor-augmented pump (SAP) therapy and the remaining 12 continued with MDIs (MDIs + RT-CGM). A second group of 20 patients initiated CSII without RT-CGM, while a third group of 18 subjects continued on MDIs and SMBG. The main endpoints were reduction of HbA1c, glycemic variability (GV), and incidence of hypoglycemia. Results: After a year, the baseline mean HbA1c in the SAIR group (8.3%) decreased to 7.1% (P < 0.0001); both SAIR subgroups, SAP and MDIs + RT-CGM, showed comparable improvement. The CSII group also had reduced HbA1c (8.4% ± 0.9% vs. 7.9% ± 0.7%; P < 0.05). Both SAIRs were superior to MDIs (P = 0.002) and CSII (P = 0.0032). GV was also lowered, both in the SAIR (P < 0.0001) and CSII (P < 0.05) groups. Reduced incidence of hypoglycemia was observed only with SAIR (8% ± 4% vs. 6% ± 3%; P < 0.01). Conclusion: Both SAIRs, SAP and MDIs + RT-CGM, provided significant and comparable decrease of HbA1c with concurrent reduction of hypoglycemia. This improvement was greater than that seen with CSII. The combination of RT-CGM and MDIs can be a suitable alternative to SAP for some patients. PMID:27482825

  12. Communication Technology Use and mHealth Acceptance among HIV-infected Men who have Sex with Men in Peru: Implications for HIV Prevention and Treatment

    PubMed Central

    Krishnan, Archana; Ferro, Enrico G.; Weikum, Damian; Vagenas, Panagiotis; Lama, Javier R.; Sanchez, Jorge; Altice, Frederick L.

    2014-01-01

    The HIV epidemic in Peru is concentrated among men who have sex with men (MSM). Given that MSM have been documented as early adopters of emerging technology, we examined communication technology access and utilization, and mobile health (mHealth) acceptance among Peruvian MSM and transgender women (TGW) in order to gauge opportunities for mHealth-enabled HIV interventions. A convenience sample of 359 HIV-infected MSM and TGW recruited from three sites in Lima, Peru completed standardized assessments of alcohol use disorders (AUDs), risky sexual behavior, and antiretroviral therapy (ART) adherence along with self-constructed measures of communication technology access and utilization, and mHealth acceptance. Most (86%) participants had daily access to any cell phone, including smartphones (30%). The most frequent communication activities were receiving and making calls, and receiving and sending text messages using cell phones. On a 5-point Likert scale, participants expressed interest in using mHealth for medication reminders (M=3.21, SD=1.32) and engaging in anonymous online interactions with health professionals to discuss HIV-related issues (M=3.56, SD=1.33). Importantly, no significant differences were found in communication technology use and mHealth acceptance among participants with AUDs, depression and suboptimal ART adherence, all of which are associated with poor HIV treatment outcomes. Findings show support for implementing mHealth-based intervention strategies using cell phones to assess and reduce HIV-risk behaviors among HIV-infected MSM and TGW. PMID:25285464

  13. Communication technology use and mHealth acceptance among HIV-infected men who have sex with men in Peru: implications for HIV prevention and treatment.

    PubMed

    Krishnan, Archana; Ferro, Enrico G; Weikum, Damian; Vagenas, Panagiotis; Lama, Javier R; Sanchez, Jorge; Altice, Frederick L

    2015-01-01

    The HIV epidemic in Peru is concentrated among men who have sex with men (MSM). Given that MSM have been documented as early adopters of emerging technology, we examined communication technology access and utilization, and mobile health (mHealth) acceptance among Peruvian MSM and transgender women (TGW) in order to gauge opportunities for mHealth-enabled HIV interventions. A convenience sample of 359 HIV-infected MSM and TGW recruited from three sites in Lima, Peru completed standardized assessments of alcohol use disorders (AUDs), risky sexual behavior, and antiretroviral therapy (ART) adherence along with self-constructed measures of communication technology access and utilization, and mHealth acceptance. Most participants (86%) had daily access to any cell phone, including smartphones (30%). The most frequent communication activities were receiving and making calls, and receiving and sending text messages using cell phones. On a 5-point Likert scale, participants expressed interest in using mHealth for medication reminders (M = 3.21, SD = 1.32) and engaging in anonymous online interactions with health professionals to discuss HIV-related issues (M = 3.56, SD = 1.33). Importantly, no significant differences were found in communication technology use and mHealth acceptance among participants with AUDs, depression, and suboptimal ART adherence, all of which are associated with poor HIV treatment outcomes. Findings show support for implementing mHealth-based intervention strategies using cell phones to assess and reduce HIV-risk behaviors among HIV-infected MSM and TGW.

  14. Activation instead of blocking mesolimbic dopaminergic reward circuitry is a preferred modality in the long term treatment of reward deficiency syndrome (RDS): a commentary

    PubMed Central

    Blum, Kenneth; Chen, Amanda Lih Chuan; Chen, Thomas JH; Braverman, Eric R; Reinking, Jeffrey; Blum, Seth H; Cassel, Kimberly; Downs, Bernard W; Waite, Roger L; Williams, Lonna; Prihoda, Thomas J; Kerner, Mallory M; Palomo, Tomas; Comings, David E; Tung, Howard; Rhoades, Patrick; Oscar-Berman, Marlene

    2008-01-01

    Background and hypothesis Based on neurochemical and genetic evidence, we suggest that both prevention and treatment of multiple addictions, such as dependence to alcohol, nicotine and glucose, should involve a biphasic approach. Thus, acute treatment should consist of preferential blocking of postsynaptic Nucleus Accumbens (NAc) dopamine receptors (D1-D5), whereas long term activation of the mesolimbic dopaminergic system should involve activation and/or release of Dopamine (DA) at the NAc site. Failure to do so will result in abnormal mood, behavior and potential suicide ideation. Individuals possessing a paucity of serotonergic and/or dopaminergic receptors, and an increased rate of synaptic DA catabolism due to high catabolic genotype of the COMT gene, are predisposed to self-medicating any substance or behavior that will activate DA release, including alcohol, opiates, psychostimulants, nicotine, gambling, sex, and even excessive internet gaming. Acute utilization of these substances and/or stimulatory behaviors induces a feeling of well being. Unfortunately, sustained and prolonged abuse leads to a toxic" pseudo feeling" of well being resulting in tolerance and disease or discomfort. Thus, a reduced number of DA receptors, due to carrying the DRD2 A1 allelic genotype, results in excessive craving behavior; whereas a normal or sufficient amount of DA receptors results in low craving behavior. In terms of preventing substance abuse, one goal would be to induce a proliferation of DA D2 receptors in genetically prone individuals. While in vivo experiments using a typical D2 receptor agonist induce down regulation, experiments in vitro have shown that constant stimulation of the DA receptor system via a known D2 agonist results in significant proliferation of D2 receptors in spite of genetic antecedents. In essence, D2 receptor stimulation signals negative feedback mechanisms in the mesolimbic system to induce mRNA expression causing proliferation of D2 receptors

  15. Evaluation of aromatic pathway induction for creosote contaminated soils in slurried soil media designed to achieve environmentally acceptable treatment endpoints

    SciTech Connect

    Glaser, J.; McCauley, P.; Potter, C.; Herrmann, R.; Dosani, M.

    1995-12-31

    Polyaromatic hydrocarbon contaminants (PAHs) are commonly associated with the use of creosote for wood preservation and the process residues left by municipal gas production. The biological treatment of this set of organic compounds has been found to be difficult since they have low water solubility and reactivity in soil systems. Liquid culture studies have shown that inducer chemicals may assist the biotreatment of PAH contaminated soils. A set of designed experimental treatments were conducted to evaluate the incorporation of potential inducer compounds. The inducers chosen for evaluation were 2-hydroxybenzoic acid and phthalic acid with treatment controls of 3-hydroxybenzoic acid and terephthalic acid at three concentrations in slurried creosote-contaminated soil. An abiotic treatment control of formaldehyde was used for contrast. The designed treatment evaluation used 250mL Erlenmeyer flask slurry reaction vessels. The flask study used an orbital shaker to maintain slurry suspension. At selected time points throughout the study individual flask reactors were sacrificed and the contents were analyzed for PAH concentration, nutrients, and biomass (FAME Analysis). Depletion of individual PAHs, total PAHs, 2 and 3-ring, and 4 and 6-ring PAHs was correlation with the biomass. The effect of selected surfactant addition was also evaluated. Rates of PAH depletion and applications to larger scale investigations will be discussed.

  16. Response modalities and time-sharing performance

    NASA Technical Reports Server (NTRS)

    Vidulich, Michael A.

    1986-01-01

    An experiment performed to investigate the role of resource competition and asymmetric transfer in dual-task performance is described. It is shown that there is an advantage to mixed manual/speech response modality configurations that cannot be accounted for by asymmetric transfer. The present results support the multiple resources approach to the application of speech technology. Once speech recognition achieves an acceptable level of operational reliability, speech controls can be used to reduce resource competition and improve performance in multitask environments.

  17. Brief treatment with a highly selective immunoproteasome inhibitor promotes long-term cardiac allograft acceptance in mice

    PubMed Central

    Sula Karreci, Esilida; Fan, Hao; Uehara, Mayuko; Mihali, Albana B.; Singh, Pradeep K.; Kurdi, Ahmed T.; Solhjou, Zhabiz; Riella, Leonardo V.; Ghobrial, Irene; Laragione, Teresina; Routray, Sujit; Assaker, Jean Pierre; Wang, Rong; Sukenick, George; Shi, Lei; Barrat, Franck J.; Nathan, Carl F.; Lin, Gang; Azzi, Jamil

    2016-01-01

    Constitutive proteasomes (c-20S) are ubiquitously expressed cellular proteases that degrade polyubiquitinated proteins and regulate cell functions. An isoform of proteasome, the immunoproteasome (i-20S), is highly expressed in human T cells, dendritic cells (DCs), and B cells, suggesting that it could be a potential target for inflammatory diseases, including those involving autoimmunity and alloimmunity. Here, we describe DPLG3, a rationally designed, noncovalent inhibitor of the immunoproteasome chymotryptic subunit β5i that has thousands-fold selectivity over constitutive β5c. DPLG3 suppressed cytokine release from blood mononuclear cells and the activation of DCs and T cells, diminished accumulation of effector T cells, promoted expression of exhaustion and coinhibitory markers on T cells, and synergized with CTLA4-Ig to promote long-term acceptance of cardiac allografts across a major histocompatibility barrier. These findings demonstrate the potential value of using brief posttransplant immunoproteasome inhibition to entrain a long-term response favorable to allograft survival as part of an immunomodulatory regimen that is neither broadly immunosuppressive nor toxic. PMID:27956634

  18. Therapeutic strategies for combined-modality therapy of locally advanced non-small-cell lung cancer: rationale for consolidation docetaxel therapy.

    PubMed

    Gandara, David R; Vallières, Eric; Gaspar, Laurie E; Kelly, Karen; Albain, Kathy S; Herbst, Roy S; Lara, Primo N; Mack, Philip; Gumerlock, Paul H; Crowley, John J

    2005-12-01

    Currently, there is no accepted standard of care for locally advanced and surgically unresectable non-small-cell lung cancer. Typically, treatment for patients with good performance status consists of a combination of chemotherapy and thoracic radiation therapy (RT), but the integration of these modalities and the respective dose schedules vary considerably. Herein, we review the rationale for a treatment paradigm employing consolidation docetaxel therapy after concurrent chemotherapy/RT and the results of recent clinical trials using this approach.

  19. Efficacy of modified antimicrobial treatments on microbial safety and overall acceptability of fresh-cut cantaloupe melons

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cantaloupe melon has been associated with outbreaks of foodborne illness linked with consumption of fresh-cut cantaloupes contaminated with Salmonella and E. coli 0157:H7 including the most recent outbreak of listeriosis suggesting the need to develop an effective antimicrobial wash treatment for th...

  20. An Open Trial of a New Acceptance-Based Behavioral Treatment for Major Depression with Psychotic Features

    ERIC Educational Resources Information Center

    Gaudiano, Brandon A.; Nowlan, Kathryn; Brown, Lily A.; Epstein-Lubow, Gary; Miller, Ivan W.

    2013-01-01

    Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In…

  1. The metaphysics of quantum mechanics: Modal interpretations

    NASA Astrophysics Data System (ADS)

    Gluck, Stuart Murray

    2004-11-01

    This dissertation begins with the argument that a preferred way of doing metaphysics is through philosophy of physics. An understanding of quantum physics is vital to answering questions such as: What counts as an individual object in physical ontology? Is the universe fundamentally indeterministic? Are indiscernibles identical? This study explores how the various modal interpretations of quantum mechanics answer these sorts of questions; modal accounts are one of the two classes of interpretations along with so-called collapse accounts. This study suggests a new alternative within the class of modal views that yields a more plausible ontology, one in which the Principle of the Identity of Indisceribles is necessarily true. Next, it shows that modal interpretations can consistently deny that the universe must be fundamentally indeterministic so long as they accept certain other metaphysical commitments: either a perfect initial distribution of states in the universe or some form of primitive dispositional properties. Finally, the study sketches out a future research project for modal interpretations based on developing quantified quantum logic.

  2. Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review.

    PubMed

    Whiting, Diane L; Deane, Frank P; Simpson, Grahame K; McLeod, Hamish J; Ciarrochi, Joseph

    2017-03-01

    This paper provides a selective review of cognitive and psychological flexibility in the context of treatment for psychological distress after traumatic brain injury, with a focus on acceptance-based therapies. Cognitive flexibility is a component of executive function that is referred to mostly in the context of neuropsychological research and practice. Psychological flexibility, from a clinical psychology perspective, is linked to health and well-being and is an identified treatment outcome for therapies such as acceptance and commitment therapy (ACT). There are a number of overlaps between the constructs. They both manifest in the ability to change behaviour (either a thought or an action) in response to environmental change, with similarities in neural substrate and mental processes. Impairments in both show a strong association with psychopathology. People with a traumatic brain injury (TBI) often suffer impairments in their cognitive flexibility as a result of damage to areas controlling executive processes but have a positive response to therapies that promote psychological flexibility. Overall, psychological flexibility appears a more overarching construct and cognitive flexibility may be a subcomponent of it but not necessarily a pre-requisite. Further research into therapies which claim to improve psychological flexibility, such as ACT, needs to be undertaken in TBI populations in order to clarify its utility in this group.

  3. Acceptance speech.

    PubMed

    Yusuf, C K

    1994-01-01

    I am proud and honored to accept this award on behalf of the Government of Bangladesh, and the millions of Bangladeshi children saved by oral rehydration solution. The Government of Bangladesh is grateful for this recognition of its commitment to international health and population research and cost-effective health care for all. The Government of Bangladesh has already made remarkable strides forward in the health and population sector, and this was recognized in UNICEF's 1993 "State of the World's Children". The national contraceptive prevalence rate, at 40%, is higher than that of many developed countries. It is appropriate that Bangladesh, where ORS was discovered, has the largest ORS production capacity in the world. It was remarkable that after the devastating cyclone in 1991, the country was able to produce enough ORS to meet the needs and remain self-sufficient. Similarly, Bangladesh has one of the most effective, flexible and efficient control of diarrheal disease and epidemic response program in the world. Through the country, doctors have been trained in diarrheal disease management, and stores of ORS are maintained ready for any outbreak. Despite grim predictions after the 1991 cyclone and the 1993 floods, relatively few people died from diarrheal disease. This is indicative of the strength of the national program. I want to take this opportunity to acknowledge the contribution of ICDDR, B and the important role it plays in supporting the Government's efforts in the health and population sector. The partnership between the Government of Bangladesh and ICDDR, B has already borne great fruit, and I hope and believe that it will continue to do so for many years in the future. Thank you.

  4. Outpatient treatment of low-risk venous thromboembolism with monotherapy oral anticoagulation: patient quality of life outcomes and clinician acceptance

    PubMed Central

    Kline, Jeffrey A; Kahler, Zachary P; Beam, Daren M

    2016-01-01

    Background Oral monotherapy anticoagulation has facilitated home treatment of venous thromboembolism (VTE) in outpatients. Objectives The aim of this study was to measure efficacy, safety, as well as patient and physician perceptions produced by a protocol that selected VTE patients as low-risk patients by the Hestia criteria, and initiated home anticoagulation with an oral factor Xa antagonist. Methods Patients were administered the Venous Insufficiency Epidemiological and Economic Study Quality of life/Symptoms questionnaire [VEINEs QoL/Sym] and the physical component summary [PCS] from the Rand 36-Item Short Form Health Survey [SF36]). The primary outcomes were VTE recurrence and hemorrhage at 30 days. Secondary outcomes compared psychometric test scores between patients with deep vein thrombosis (DVT) to those with pulmonary embolism (PE). Patient perceptions were abstracted from written comments and physician perceptions specific to PE outpatient treatment obtained from structured survey. Results From April 2013 to September 2015, 253 patients were treated, including 67 with PE. Within 30 days, 2/253 patients had recurrent DVT and 2/253 had major hemorrhage; all four had DVT at enrollment. The initial PCS scores did not differ between DVT and PE patients (37.2±13.9 and 38.0±12.1, respectively) and both DVT and PE patients had similar improvement over the treatment period (42.2±12.9 and 43.4±12.7, respectively), consistent with prior literature. The most common adverse event was menorrhagia, present in 15% of women. Themes from patient-written responses reflected satisfaction with increased autonomy. Physicians’ (N=116) before-to-after protocol comfort level with home treatment of PE increased 48% on visual analog scale. Conclusion Hestia-negative VTE patients treated with oral monotherapy at home had low rates of VTE recurrence and bleeding, as well as quality of life measurements similar to prior reports. PMID:27143861

  5. Use of Respiratory-Correlated Four-Dimensional Computed Tomography to Determine Acceptable Treatment Margins for Locally Advanced Pancreatic Adenocarcinoma

    SciTech Connect

    Goldstein, Seth D.; Ford, Eric C.; Duhon, Mario; McNutt, Todd; Wong, John; Herman, Joseph M.

    2010-02-01

    Purpose: Respiratory-induced excursions of locally advanced pancreatic adenocarcinoma could affect dose delivery. This study quantified tumor motion and evaluated standard treatment margins. Methods and Materials: Respiratory-correlated four-dimensional computed tomography images were obtained on 30 patients with locally advanced pancreatic adenocarcinoma; 15 of whom underwent repeat scanning before cone-down treatment. Treatment planning software was used to contour the gross tumor volume (GTV), bilateral kidneys, and biliary stent. Excursions were calculated according to the centroid of the contoured volumes. Results: The mean +- standard deviation GTV excursion in the superoinferior (SI) direction was 0.55 +- 0.23 cm; an expansion of 1.0 cm adequately accounted for the GTV motion in 97% of locally advanced pancreatic adenocarcinoma patients. Motion GTVs were generated and resulted in a 25% average volume increase compared with the static GTV. Of the 30 patients, 17 had biliary stents. The mean SI stent excursion was 0.84 +- 0.32 cm, significantly greater than the GTV motion. The xiphoid process moved an average of 0.35 +- 0.12 cm, significantly less than the GTV. The mean SI motion of the left and right kidneys was 0.65 +- 0.27 cm and 0.77 +- 0.30 cm, respectively. At repeat scanning, no significant changes were seen in the mean GTV size (p = .8) or excursion (p = .3). Conclusion: These data suggest that an asymmetric expansion of 1.0, 0.7, and 0.6 cm along the respective SI, anteroposterior, and medial-lateral directions is recommended if a respiratory-correlated four-dimensional computed tomography scan is not available to evaluate the tumor motion during treatment planning. Surrogates of tumor motion, such as biliary stents or external markers, should be used with caution.

  6. A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning

    PubMed Central

    Kanstrup, Marie; Wicksell, Rikard K.; Kemani, Mike; Wiwe Lipsker, Camilla; Lekander, Mats; Holmström, Linda

    2016-01-01

    Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%–63% of the adolescents across the different outcome measures and in 54%–76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions. PMID:27854323

  7. A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning.

    PubMed

    Kanstrup, Marie; Wicksell, Rikard K; Kemani, Mike; Wiwe Lipsker, Camilla; Lekander, Mats; Holmström, Linda

    2016-11-16

    Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%-63% of the adolescents across the different outcome measures and in 54%-76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.

  8. Dominant modal decomposition method

    NASA Astrophysics Data System (ADS)

    Dombovari, Zoltan

    2017-03-01

    The paper deals with the automatic decomposition of experimental frequency response functions (FRF's) of mechanical structures. The decomposition of FRF's is based on the Green function representation of free vibratory systems. After the determination of the impulse dynamic subspace, the system matrix is formulated and the poles are calculated directly. By means of the corresponding eigenvectors, the contribution of each element of the impulse dynamic subspace is determined and the sufficient decomposition of the corresponding FRF is carried out. With the presented dominant modal decomposition (DMD) method, the mode shapes, the modal participation vectors and the modal scaling factors are identified using the decomposed FRF's. Analytical example is presented along with experimental case studies taken from machine tool industry.

  9. Perceptions of the feasibility and acceptability of a smartphone application for the treatment of binge eating disorders: Qualitative feedback from a user population and clinicians

    PubMed Central

    Goldstein, Stephanie P.; Manasse, Stephanie M.; Forman, Evan M.; Butryn, Meghan L.

    2016-01-01

    Background Binge eating, a major public health problem, is characterized by recurrent episodes of out-of-control eating in which an individual consumes an unusually large amount of food in a discrete time period. Limitations of existing treatments for binge eating (both in-person psychotherapy and guided self-help) indicate that smartphone applications (apps) may be an ideal alternative or enhancement. An app for binge eating could aid treatment dissemination, engagement, and/or compliance. However, no research to date has examined user perceptions of a therapeutic app for binge eating, which is critical for development. Objectives The purposes of the current study were to conceptualize a potential app for binge eating and obtain feedback regarding feasibility and acceptability from target users (i.e., individuals with binge eating) and clinicians specializing in the treatment of binge eating. Methods Our team conceptualized a smartphone app that contained self-help material, functions to monitor behavior, and provisions of in-the-moment interventions. We presented this app (e.g., feature explanations, mock screen shots) through phone interviews with clinicians who specialize in the treatment of binge eating (n=10), and focus groups with individuals experiencing binge eating (n=11). Participants were asked to discuss customization, user burden, terminology, attrition, data visualization, comprehensiveness, reminders, feasibility, acceptability, and perceived effectiveness of the proposed app. Thematic analyses were conducted from qualitative data (e.g., audio recordings and interview notes) obtained via the focus groups and interviews. Results Results indicated that our proposed app would be highly feasible and acceptable to users and clinicians, though concerns about the degree of personalization and customizability were noted. Conclusions The current study details highly specific feedback and ideas regarding essential app features from target users and clinicians

  10. Perceived urgency mapping across modalities within a driving context.

    PubMed

    Baldwin, Carryl L; Lewis, Bridget A

    2014-09-01

    Hazard mapping is essential to effective driver-vehicle interface (DVI) design. Determining which modality to use for situations of different criticality requires an understanding of the relative impact of signal parameters within each modality on perceptions of urgency and annoyance. Towards this goal we obtained psychometric functions for visual, auditory and tactile interpulse interval (IPI), visual color, signal word, and auditory fundamental frequency on perceptions of urgency, annoyance, and acceptability. Results indicate that manipulation of IPI in the tactile modality, relative to visual and auditory, has greater utility (greater impact on urgency than annoyance). Manipulations of color were generally rated as less annoying and more acceptable than auditory and tactile stimuli; but they were also rated as lower in urgency relative to other modality manipulations. Manipulation of auditory fundamental frequency resulted in high ratings of both urgency and annoyance. Results of the current investigation can be used to guide DVI design and evaluation.

  11. Recreating an esthetically and functionally acceptable dentition: a multidisciplinary approach.

    PubMed

    Goyal, Mukesh Kumar; Goyal, Shelly; Hegde, Veena; Balkrishana, Dhanasekar; Narayana, Aparna I

    2013-01-01

    Patients today demand a youthful, attractive smile with comfortable functional acceptance. The complete oral rehabilitation of patients with a functionally compromised dentition frequently involves a multidisciplinary approach and presents a considerable clinical challenge. To a great extent, proper patient selection and careful interdisciplinary treatment planning, including acknowledgment of the patient's perceived needs, reasons for seeking services, financial ability, and socioeconomic profile, can govern the predictability of successful restorations. This clinical report describes a successful interdisciplinary approach for the management of a severely worn dentition with reduced vertical dimension of occlusion. Treatment modalities included periodontal crown lengthening procedures, endodontic treatment followed by post and core restorations, and prosthetic rehabilitation for severe tooth surface loss and reduced vertical dimension of occlusion comprising metal-ceramic restorations in esthetic zones and full-metal restorations in posterior regions.

  12. Key factors in the acceptability of treatment as prevention (TasP) in Scotland: a qualitative study with communities affected by HIV

    PubMed Central

    Young, I; Flowers, P; McDaid, L M

    2015-01-01

    Objectives There is a clear need to understand the factors that might prevent and/or facilitate the effective use of HIV treatment as prevention (TasP) at an individual level. This paper reports on findings from the first qualitative study in the UK exploring the acceptability of TasP among gay, bisexual and/or men who have sex with men (MSM) and migrant African communities in Scotland. Methods We conducted seven exploratory focus group discussions (FGDs) with convenience samples of MSM (five FGDs, n=22) and mixed-gender African (two FGDs, n=11) participants. Of these, three FGDs were conducted with HIV-positive MSM (n=14) and one FGD with HIV-positive Africans (n=8). We then conducted 34 in-depth interviews (IDIs) with a purposive sample of MSM (n=20) and Africans (n=14, women=10). Half were HIV-positive (MSM, n=10; African, n=7). FGD and IDI data were analysed thematically drawing on predetermined and emergent themes. Results We found that inequalities in HIV literacy could be a barrier to TasP, as could social constraints, such as criminalisation of transmission, increased risk of sexually transmitted infection and increased burden of treatment. We also identified psychological barriers such as perceptions of risk. However, relationships and shared decision making were identified as potential facilitators for TasP. Conclusions Our results suggest that potential use and management of TasP may not be straightforward. It could be contingent on reducing inequalities in HIV literacy, minimising the perceived burden of treatment and other potential risks, and addressing the dynamics of existing and socially acceptable risk management strategies, especially in relation to long-term serodiscordant relationships. PMID:25482649

  13. Public acceptability of the use of gamma rays from spent nuclear fuel as a hazardous waste treatment process

    SciTech Connect

    Mincher, B.J.; Wells, R.P.; Reilly, H.J.

    1992-01-01

    Three methods were used to estimate public reaction to the use of gamma irradiation of hazardous wastes as a hazardous waste treatment process. The gamma source of interest is spent nuclear fuel. The first method is Benefit-Risk Decision Making, where the benefits of the proposed technology are compared to its risks. The second analysis compares the proposed technology to the other, currently used nuclear technologies and estimates public reaction based on that comparison. The third analysis is called Analysis of Public Consent, and is based on the professional methods of the Institute for Participatory Management and Planning. The conclusion of all three methods is that the proposed technology should not result in negative public reaction sufficient to prevent implementation.

  14. The Effects of a Brief Acceptance-Based Behavioral Treatment Versus Traditional Cognitive-Behavioral Treatment for Public Speaking Anxiety: An Exploratory Trial Examining Differential Effects on Performance and Neurophysiology.

    PubMed

    Glassman, Lisa H; Forman, Evan M; Herbert, James D; Bradley, Lauren E; Foster, Elizabeth E; Izzetoglu, Meltem; Ruocco, Anthony C

    2016-09-01

    Individuals with public speaking anxiety (PSA) experience fear and avoidance that can cause extreme distress, impaired speaking performance, and associated problems in psychosocial functioning. Most extant interventions for PSA emphasize anxiety reduction rather than enhancing behavioral performance. We compared the efficacy of two brief cognitive-behavioral interventions, a traditional cognitive-behavior treatment (tCBT) and an acceptance-based behavior treatment (ABBT), on public speaking performance and anxiety in a clinical sample of persons with PSA. The effects of treatment on prefrontal brain activation were also examined. Participants (n = 21) were randomized to 90 min of an ABBT or a tCBT intervention. Assessments took place at pre- and post-treatment and included self-rated anxiety and observer-rated performance measures, a behavioral assessment, and prefrontal cortical activity measurements using functional near-infrared spectroscopy (fNIRS). Exploratory results indicated that participants in the ABBT condition experienced greater improvements in observer-rated performance relative to those in the tCBT condition, while those in the tCBT condition experienced greater reductions in subjective anxiety levels. Individuals in the ABBT condition also exhibited a trend toward greater treatment-related reductions in blood volume in the left dorsolateral prefrontal cortex relative to those who received tCBT. Overall, these findings preliminarily suggest that acceptance-based treatments may free more cognitive resources in comparison with tCBT, possibly resulting in greater improvements in objectively rated behavioral performances for ABBT interventions.

  15. Teaching German Modal Particles.

    ERIC Educational Resources Information Center

    Rosler, Dietmar

    1982-01-01

    Believes modern linguistics has done little to explore German modal particles because by focusing on sentences as the basic category for linguistic thinking these words did not seem to matter. Describes model which gives students experience with these particles in meaningful communication. (Author/BK)

  16. Efficacy and Acceptability of Different Auxiliary Drugs in Pediatric Sevoflurane Anesthesia: A Network Meta-analysis of Mixed Treatment Comparisons

    PubMed Central

    Wang, Wuchao; Huang, Panchuan; Gao, Weiwei; Cao, Fangli; Yi, Mingling; Chen, Liyong; Guo, Xiaoli

    2016-01-01

    Emergence agitation preventive medicine should be combined with pediatric anesthesia because of the high frequency of emergence agitation. However, it is challenging to determine the most appropriate medication that can be introduced into pediatric anesthesia for the sake of emergence agitation prevention. We reviewed and retrieved the data from PubMed and Embase. Various medications were assessed based on several endpoints including Emergence agitation outcomes (EA), postoperative nausea and vomiting (PONV), the number of patients who required analgesic (RA), pediatric anesthesia emergence delirium (PAED), the extubation time, the emergency time and the duration of post-anesthesia care unit (PACU) stay. Both traditional and network meta-analysis were carried in this study. A total of 45 articles were complied with the selection criteria and the corresponding articles were reviewed. Fentanyl demonstrated the highest cumulative ranking probability which was followed by those of ketamine and dexmedetomidine with respect to EA and PAED. When PONV and RA were concerned together, clonidine exhibited the highest cumulative ranking probability compared to other medications. Our study suggested that dexmedetomidine perhaps is the most appropriate prophylactic treatment which can be introduced into anesthesia for preventing emergence agitation. PMID:27830713

  17. Treatment of Irradiated Graphite to meet Acceptance Criteria for Waste Disposal: A New IAEA Collaborative Research Program - 12443

    SciTech Connect

    Wickham, A.J.; Drace, Z.

    2012-07-01

    World-wide, more than 250,000 tonnes of irradiated graphite have arisen through commercial nuclear-power operations and from military production reactors. Whilst most nations responsible for the generation of this material have in mind repository disposal alongside other radwaste, the lack of progress in this regard has led in some cases to difficulties where, for example, the site of an existing graphite-moderated reactor is required for re-utilisation. In any case, graphite as a radwaste stream has unique chemical and physical properties which may lend itself to more radical and innovative treatment and disposal options, including the recovery of useful isotopes and also recycling within the nuclear industry. Such aspects are important in making the case for future graphite-moderated reactor options (for example, High-Temperature Reactors planned for simultaneous power production and high-grade heat sources for such applications as hydrogen production for road fuel). A number of initiatives have taken place since the mid 1990s aimed at exploring such alternative strategies and, more recently, improving technology offers new options at all stages of the dismantling and disposal process. A new IAEA Collaborative Research Program aims to build upon the work already done and the knowledge achieved, in order to identify the risks and uncertainties associated with alternative options for graphite disposal, along with cost comparisons, thus enabling individual Member States to have the best-available information at their disposal to configure their own programs. (authors)

  18. Comparative efficacy and acceptability of first-generation and second-generation antidepressants in the acute treatment of major depression: protocol for a network meta-analysis

    PubMed Central

    Salanti, Georgia; Atkinson, Lauren Z; Leucht, Stefan; Ruhe, Henricus G; Turner, Erick H; Chaimani, Anna; Ogawa, Yusuke; Takeshima, Nozomi; Hayasaka, Yu; Imai, Hissei; Shinohara, Kiyomi; Suganuma, Aya; Watanabe, Norio; Stockton, Sarah; Geddes, John R

    2016-01-01

    Introduction Many antidepressants are indicated for the treatment of major depression. Two network meta-analyses have provided the most comprehensive assessments to date, accounting for both direct and indirect comparisons; however, these reported conflicting interpretation of results. Here, we present a protocol for a systematic review and network meta-analysis aimed at updating the evidence base and comparing all second-generation as well as selected first-generation antidepressants in terms of efficacy and acceptability in the acute treatment of major depression. Methods and analysis We will include all randomised controlled trials reported as double-blind and comparing one active drug with another or with placebo in the acute phase treatment of major depression in adults. We are interested in comparing the following active agents: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. The main outcomes will be the proportion of patients who responded to or dropped out of the allocated treatment. Published and unpublished studies will be sought through relevant database searches, trial registries and websites; all reference selection and data extraction will be conducted by at least two independent reviewers. We will conduct a random effects network meta-analysis to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. To rank the various treatments for each outcome, we will use the surface under the cumulative ranking curve and the mean ranks. We will employ local as well as global methods to evaluate consistency. We will fit our model in a Bayesian framework using OpenBUGS, and produce results and various checks in Stata and R. We will also assess the quality of evidence contributing to network

  19. Virtual reality for the induction of positive emotions in the treatment of fibromyalgia: a pilot study over acceptability, satisfaction, and the effect of virtual reality on mood.

    PubMed

    Herrero, Rocio; García-Palacios, Azucena; Castilla, Diana; Molinari, Guadalupe; Botella, Cristina

    2014-06-01

    One of the most important aspects of fibromyalgia syndrome (FMS) is its impact on quality of life, increasing negative emotions and dysfunctional coping strategies. One of these strategies is to avoid activities, especially meaningful activities, which reduces positive reinforcement. Commencing significant daily activities could enable chronic patients to experience a more fulfilling life. However, the main difficulty found in FMS patients is their willingness to start those activities. Promoting positive emotions could enhance activity management. The aim of this paper is to present a description of a system along with data regarding the acceptability, satisfaction, and preliminary efficacy of a virtual reality (VR) environment for the promotion of positive emotions. The VR environment was especially designed for chronic pain patients. Results showed significant increases in general mood state, positive emotions, motivation, and self-efficacy. These preliminary findings show the potential of VR as an adjunct to the psychological treatment of such an important health problem as chronic pain.

  20. A qualitative study of patients' knowledge and views of about oral health and acceptability of related intervention in an Australian inpatient alcohol and drug treatment facility.

    PubMed

    Cheah, Alison Li Sun; Pandey, Ram; Daglish, Mark; Ford, Pauline J; Patterson, Sue

    2017-01-20

    Social factors, health behaviours and the direct effects of substances contribute to the poor oral health and restricted access to dental services experienced by people who are dependent on drugs and/or alcohol. Admission for inpatient withdrawal management provides an opportunity for intervention to promote oral health but to be effective it must be acceptable to patients. To support intervention design, we examined patients' views about oral health, practices and treatment access, and appropriateness of health-promoting intervention in this context. Given paucity of knowledge in the area we employed a qualitative approach, data were collected in semi-structured interviews with inpatients of a public specialist alcohol and drug unit in Australia in September 2014. Analysis employed the framework approach. All 14 participants wanted 'good teeth' but few diligently attended to oral healthcare; most sought assistance only in emergencies. Participants' knowledge of services was limited and practical and affective barriers hindered access. With none recalling attention to oral health during admission, support was strong for incorporation of oral health in inpatient assessments. Participants wanted information about the impact of substances on oral health and oral hygiene practices provided in various formats, and facilitated referral to non-judgemental, affordable treatment. Patients regarded promotion of oral health in the inpatient context as important, relevant and acceptable. Support should respect the different knowledge, practices and motivations for oral health and recovery, of patients. Addressing practical and affective barriers to dental services will require collaboration between drug and alcohol and dental services, and this should be the focus of further research.

  1. The acceptability of intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in southern Tanzania

    PubMed Central

    Pool, Robert; Mushi, Adiel; Schellenberg, Joanna Armstrong; Mrisho, Mwifadhi; Alonso, Pedro; Montgomery, Catherine; Tanner, Marcel; Mshinda, Hassan; Schellenberg, David

    2008-01-01

    Background Intermittent preventive treatment of malaria in infants (IPTi) reduces the incidence of clinical malaria. However, before making decisions about implementation, it is essential to ensure that IPTi is acceptable, that it does not adversely affect attitudes to immunization or existing health seeking behaviour. This paper reports on the reception of IPTi during the first implementation study of IPTi in southern Tanzania. Methods Data were collected through in-depth interviews, focus group discussions and participant observation carried out by a central team of social scientists and a network of key informants/interviewers who resided permanently in the study sites. Results IPTi was generally acceptable. This was related to routinization of immunization and resonance with traditional practices. Promoting "health" was considered more important than preventing specific diseases. Many women thought that immunization was obligatory and that health staff might be unwilling to assist in the future if they were non-adherent. Weighing and socialising were important reasons for clinic attendance. Non-adherence was due largely to practical, social and structural factors, many of which could be overcome. Reasons for non-adherence were sometimes interlinked. Health staff and "road to child health" cards were the main source of information on the intervention, rather than the specially designed posters. Women did not generally discuss child health matters outside the clinic, and information about the intervention percolated slowly through the community. Although there were some rumours about sulphadoxine pyrimethamine (SP), it was generally acceptable as a drug for IPTi, although mothers did not like the way tablets were administered. There is no evidence that IPTi had a negative effect on attitudes or adherence to the expanded programme on immunisation (EPI) or treatment seeking or existing malaria prevention. Conclusion In order to improve adherence to both EPI and

  2. PET in oncology: will it replace the other modalities?

    PubMed

    Hoh, C K; Schiepers, C; Seltzer, M A; Gambhir, S S; Silverman, D H; Czernin, J; Maddahi, J; Phelps, M E

    1997-04-01

    Medical imaging technology is rapidly expanding and the role of each modality is being redefined constantly. PET has been around since the early sixties and gained clinical acceptance in oncology only after an extreme number of scientific publications. Although PET has the unique ability to image biochemical processes in vivo, this ability is not fully used as a clinical imaging tool. In this overview, the role of PET in relation to other tumor imaging modalities will be discussed and the reported results in the literature will be reviewed. In predicting the future of PET, technical improvements of other imaging modalities need to be dealt with. The fundamental physical principles for image formation with computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), photon-emission tomography (PET), and single photon emission CT (SPECT) will not change. The potential variety of radiopharmaceuticals which may be developed is unlimited, however, and this provides nuclear imaging techniques with a significant advantage and adaptive features for future biologic imaging. The current applications of PET in oncology have been in characterizing tumor lesions, differentiating recurrent disease from treatment effects, staging tumors, evaluating the extent of disease, and monitoring therapy. The future developments in medicine may use the unique capabilities of PET not only in diagnostic imaging but also in molecular medicine and genetics. The articles discussed in this review were selected from a literature search covering the last 3 years, and in which comparisons of PET with conventional imaging were addressed specifically. PET studies with the glucose analogue fluorine-18-labeled deoxyglucose (FDG) have shown the ability of detecting tumor foci in a variety of histological neoplasms such as thyroid cancer, breast cancer, lymphoma, lung cancer, head and neck carcinoma, colorectal cancer, ovarian carcinoma, and musculoskeletal tumors. Also, the contribution

  3. Acceptance of tinnitus: validation of the tinnitus acceptance questionnaire.

    PubMed

    Weise, Cornelia; Kleinstäuber, Maria; Hesser, Hugo; Westin, Vendela Zetterqvist; Andersson, Gerhard

    2013-01-01

    The concept of acceptance has recently received growing attention within tinnitus research due to the fact that tinnitus acceptance is one of the major targets of psychotherapeutic treatments. Accordingly, acceptance-based treatments will most likely be increasingly offered to tinnitus patients and assessments of acceptance-related behaviours will thus be needed. The current study investigated the factorial structure of the Tinnitus Acceptance Questionnaire (TAQ) and the role of tinnitus acceptance as mediating link between sound perception (i.e. subjective loudness of tinnitus) and tinnitus distress. In total, 424 patients with chronic tinnitus completed the TAQ and validated measures of tinnitus distress, anxiety, and depression online. Confirmatory factor analysis provided support to a good fit of the data to the hypothesised bifactor model (root-mean-square-error of approximation = .065; Comparative Fit Index = .974; Tucker-Lewis Index = .958; standardised root mean square residual = .032). In addition, mediation analysis, using a non-parametric joint coefficient approach, revealed that tinnitus-specific acceptance partially mediated the relation between subjective tinnitus loudness and tinnitus distress (path ab = 5.96; 95% CI: 4.49, 7.69). In a multiple mediator model, tinnitus acceptance had a significantly stronger indirect effect than anxiety. The results confirm the factorial structure of the TAQ and suggest the importance of a general acceptance factor that contributes important unique variance beyond that of the first-order factors activity engagement and tinnitus suppression. Tinnitus acceptance as measured with the TAQ is proposed to be a key construct in tinnitus research and should be further implemented into treatment concepts to reduce tinnitus distress.

  4. Digital multishaker modal testing

    NASA Technical Reports Server (NTRS)

    Blair, M.; Craig, R. R., Jr.

    1983-01-01

    A review of several modal testing techniques is made, along with brief discussions of their advantages and limitations. A new technique is presented which overcomes many of the previous limitations. Several simulated experiments are included to verify the validity and accuracy of the new method. Conclusions are drawn from the simulation studies and recommendations for further work are presented. The complete computer code configured for the simulation study is presented.

  5. Multishaker modal testing

    NASA Technical Reports Server (NTRS)

    Craig, Roy R., Jr.

    1987-01-01

    The major accomplishments of this research are: (1) the refinement and documentation of a multi-input, multi-output modal parameter estimation algorithm which is applicable to general linear, time-invariant dynamic systems; (2) the development and testing of an unsymmetric block-Lanzcos algorithm for reduced-order modeling of linear systems with arbitrary damping; and (3) the development of a control-structure-interaction (CSI) test facility.

  6. Use, perceptions, and acceptability of a ready-to-use supplementary food among adult HIV patients initiating antiretroviral treatment: a qualitative study in Ethiopia

    PubMed Central

    Olsen, Mette Frahm; Tesfaye, Markos; Kaestel, Pernille; Friis, Henrik; Holm, Lotte

    2013-01-01

    Objectives Ready-to-use supplementary foods (RUSF) are used increasingly in human immunodeficiency virus (HIV) programs, but little is known about how it is used and viewed by patients. We used qualitative methods to explore the use, perceptions, and acceptability of RUSF among adult HIV patients in Jimma, Ethiopia. Methods The study obtained data from direct observations and 24 in-depth interviews with HIV patients receiving RUSF. Results Participants were generally very motivated to take RUSF and viewed it as beneficial. RUSF was described as a means to fill a nutritional gap, to “rebuild the body,” and protect it from harmful effects of antiretroviral treatment (ART). Many experienced nausea and vomiting when starting the supplement. This caused some to stop supplementation, but the majority adapted to RUSF. The supplement was eaten separately from meal situations and only had a little influence on household food practices. RUSF was described as food with “medicinal qualities,” which meant that many social and religious conventions related to food did not apply to it. The main concerns about RUSF related to the risk of HIV disclosure and its social consequences. Conclusion HIV patients view RUSF in a context of competing livelihood needs. RUSF intake was motivated by a strong wish to get well, while the risk of HIV disclosure caused concerns. Despite the motivation for improving health, the preservation of social networks was prioritized, and nondisclosure was often a necessary strategy. Food sharing and religious fasting practices were not barriers to the acceptability of RUSF. This study highlights the importance of ensuring that supplementation strategies, like other HIV services, are compatible with the sociocultural context of patients. PMID:23766634

  7. On the Translation of Modality in an MT-System.

    ERIC Educational Resources Information Center

    Svendsen, Uffe Sonne

    The use of a model for treatment of English modals in a machine translation system being developed in Europe is discussed. The Eurotra system, sponsored by the Commission of the European Communities, is designed to translate into the nine official languages of the European Economic Community. The report first examines modality, the different ways…

  8. Olfactory neuroblastoma (esthesioneuroblastoma): towards minimally invasive surgery and multi-modality treatment strategies - an updated critical review of the current literature.

    PubMed

    Papacharalampous, G X; Vlastarakos, P V; Chrysovergis, A; Saravakos, P K; Kotsis, G P; Davilis, D I

    2013-01-01

    Olfactory neuroblastoma (esthesioneuroblastoma) was first described by Berger and Luc in 1924. It is considered to be an uncommon malignancy of the nasal cavity. The tumor arises from the specialized sensory epithelial olfactory cells, normally situated at the upper part of the nasal cavity, including the superior nasal concha, the roof of the nose and the cribriform plate. The imaging modalities of choice are computed tomography (CT) and magnetic resonance imaging (MRI). Combination of surgery and radiotherapy (either conventional radiotherapy or stereotactic radiosurgery), with or without chemotherapy is considered to be the standard of care for primary site disease by the majority of researchers. Combined transfacial and neurosurgical conventional approaches are also adopted in many reported cases, mainly due to the endocranial extension and the close anatomic relationship of esthesioneuroblastomas with the ethmoid roof and cribriform plate. Recent literature supports that endoscopic resection correlates with similar oncologic control rates compared with conventional open surgery, provided that basic oncologic surgical principles with clearance of margins and intradural dissection (when required) are completely maintained.

  9. Modal Interfaces in Hawaii

    NASA Technical Reports Server (NTRS)

    Wright, E. Alvey

    1974-01-01

    Hawaii, an archipelago where transportation distances are short but the interfaces are many, seeks elimination of modal changes by totally-submerged hydrofoil craft operating at the water surface directly between tourist resort destinations, by dual mode rapid transit vehicles operating directly between the deplaning bridges at Honolulu International Airport and hotel porte-cochere at Waikiki, by demand responsive vehicles for collection and distribution operating on fixed guideways for line haul, and by roll-on/roll-off inter-island ferries for all models of manually operated ground vehicles. The paper also describes facilitation of unavoidable interfaces by innovative sub-systems.

  10. RF Modal Quantity Gaging

    NASA Technical Reports Server (NTRS)

    Vanleuven, K.

    1989-01-01

    The primary objective is to provide a concept of a radio frequency (RF) modal resonance technique which is being investigated as a method for gaging the quantities of subcritical cryogenic propellants in metallic tanks. Of special interest are the potential applications of the technique to microgravity propellant gaging situations. The results of concept testing using cryogenic oxygen, hydrogen, and nitrogen, as well as paraffin simulations of microgravity fluid orientations, are reported. These test results were positive and showed that the gaging concept was viable.

  11. Multishaker modal testing

    NASA Technical Reports Server (NTRS)

    Craig, R. R., Jr.

    1985-01-01

    A component mode synthesis method for damped structures was developed and modal test methods were explored which could be employed to determine the relevant parameters required by the component mode synthesis method. Research was conducted on the following topics: (1) Development of a generalized time-domain component mode synthesis technique for damped systems; (2) Development of a frequency-domain component mode synthesis method for damped systems; and (3) Development of a system identification algorithm applicable to general damped systems. Abstracts are presented of the major publications which have been previously issued on these topics.

  12. Modal identification experiment

    NASA Technical Reports Server (NTRS)

    Kvaternik, Raymond G.

    1992-01-01

    The Modal Identification Experiment (MIE) is a proposed on-orbit experiment being developed by NASA's Office of Aeronautics and Space Technology wherein a series of vibration measurements would be made on various configurations of Space Station Freedom (SSF) during its on-orbit assembly phase. The experiment is to be conducted in conjunction with station reboost operations and consists of measuring the dynamic responses of the spacecraft produced by station-based attitude control system and reboost thrusters, recording and transmitting the data, and processing the data on the ground to identify the natural frequencies, damping factors, and shapes of significant vibratory modes. The experiment would likely be a part of the Space Station on-orbit verification. Basic research objectives of MIE are to evaluate and improve methods for analytically modeling large space structures, to develop techniques for performing in-space modal testing, and to validate candidate techniques for in-space modal identification. From an engineering point of view, MIE will provide the first opportunity to obtain vibration data for the fully-assembled structure because SSF is too large and too flexible to be tested as a single unit on the ground. Such full-system data is essential for validating the analytical model of SSF which would be used in any engineering efforts associated with structural or control system changes that might be made to the station as missions evolve over time. Extensive analytical simulations of on-orbit tests, as well exploratory laboratory simulations using small-scale models, have been conducted in-house and under contract to develop a measurement plan and evaluate its potential performance. In particular, performance trade and parametric studies conducted as part of these simulations were used to resolve issues related to the number and location of the measurements, the type of excitation, data acquisition and data processing, effects of noise and nonlinearities

  13. Physical therapy modalities in management of fibromyalgia.

    PubMed

    Gur, Ali

    2006-01-01

    The etiology of fibromyalgia syndrome (FM) is uncertain and the prognosis for symptomatic recovery is generally poor. A wide variety of interventions are used in the management of FM. There is, however, no clear consensus on the treatment of choice and FM remains relatively refractory to treatment. Therefore, prevention, causal therapy and rehabilitation are not possible. FM patients frequently use alternative therapies, indicating dissatisfaction or ineffectiveness of traditional medical therapy. Alternative therapies are generally perceived to be more "natural" and as a result, to have fewer adverse effects. Despite the positive results found, the number of publications related to the application of physical therapy modalities such as acupuncture, transcutaneous electrical stimulation, laser, biofeedback, electrotherapy and magnetic field is still scant, especially concerning FM treatment. The demonstration of a long-term effective intervention for managing the symptoms associated with FM is needed. Multidisciplinary approaches to management include physical and medical therapeutic strategies. Treatment modalities should be individualised for patients based on target symptoms and impairment in functioning. Patience and positive attitude on part of the physician and active involvement of patients and their families in treatment are likely to enhance improvement. It can be concluded that there is a need for larger, more systematic and methodologically sound randomised controlled clinical trials to evaluate the effectiveness of physical therapy modalities of managing FM. We will review some of the existing studies of physical therapy relevant in the treatment of FM and give some practical advice for their use.

  14. Dosimetric comparison of three different treatment modalities for total scalp irradiation: the conventional lateral photon-electron technique, helical tomotherapy, and volumetric-modulated arc therapy.

    PubMed

    Song, Jin Ho; Jung, Ji-Young; Park, Hyung-Wook; Lee, Gi Woong; Chae, Soo-Min; Kay, Chul Seung; Son, Seok Hyun

    2015-07-01

    The aim of this study was to compare lateral photon-electron (LPE), helical tomotherapy (HT), and volumetric-modulated arc therapy (VMAT) plans for total scalp irradiation. We selected a single adult model case and compared the dosimetric results for the three plans. All plans mainly used 6-MV photon beams, and the prescription dose was 60 Gy in 30 fractions. First, we compared the LPE, HT and VMAT plans, with all plans including a 1-cm bolus. We also compared HT plans with and without the bolus. The conformity indices for LPE, HT and VMAT were 1.73, 1.35 and 1.49, respectively. The HT plan showed the best conformity and the LPE plan showed the worst. However, the plans had similar homogeneity indexes. The dose to the hippocampus was the highest in the VMAT plan, with a mean of 6.7 Gy, compared with 3.5 Gy in the LPE plan and 4.8 Gy in the HT plan. The doses to the optical structures were all within the clinically acceptable range. The beam-on time and monitor units were highest in the HT plan. The HT plans with and without a bolus showed similar target coverage and organ-at-risk (OAR) sparing. The HT plan showed the best target coverage and conformity, with low doses to the brain and hippocampus. This plan also had the advantage of not necessarily requiring a bolus. Although the VMAT plan showed better conformity than the LPE plan and acceptable OAR sparing, the dose to the hippocampus should be considered when high doses are prescribed.

  15. Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India.

    PubMed

    Chatterjee, Sudipto; Chowdhary, Neerja; Pednekar, Sulochana; Cohen, Alex; Andrew, Gracy; Andrew, Gracy; Araya, Ricardo; Simon, Gregory; King, Michael; Telles, Shirley; Verdeli, Helena; Clougherty, Kathleen; Kirkwood, Betty; Patel, Vikram

    2008-02-01

    Common mental disorders, such as depression and anxiety, pose a major public health burden in developing countries. Although these disorders are thought to be best managed in primary care settings, there is a dearth of evidence about how this can be achieved in low resource settings. The MANAS project is an attempt to integrate an evidence based package of treatments into routine public and private primary care settings in Goa, India. Before initiating the trial, we carried out extensive preparatory work, over a period of 15 months, to examine the feasibility and acceptability of the planned intervention. This paper describes the systematic development and evaluation of the intervention through this preparatory phase. The preparatory stage, which was implemented in three phases, utilized quantitative and qualitative methods to inform our understanding of the potential problems and possible solutions in implementing the trial and led to critical modifications of the original intervention plan. Investing in systematic formative work prior to conducting expensive trials of the effectiveness of complex interventions is a useful exercise which potentially improves the likelihood of a positive result of such trials.

  16. Changes in Cognitive-Behavioral Constructs Across Treatment Modalities for Seasonal Affective Disorder: Cognitive-Behavioral Therapy, Light Therapy, and their Combination"

    DTIC Science & Technology

    2003-01-01

    significant response rate of only 43% in those experiencing moderate to severe SAD symptoms ( Terman et al., 1989). In addition, residual...Seasonal Affective Disorder Version (SIGH-SAD; Williams, Link, Rosenthal, Amira, & Terman , 1992) and the Beck Depression Inventory – Second Edition...compared at post- treatment based on pre-determined criteria established in previous SAD research ( Terman et al.1989). Post-treatment remission rates

  17. SU-F-BRD-08: A Novel Technique to Derive a Clinically-Acceptable Beam Model for Proton Pencil-Beam Scanning in a Commercial Treatment Planning System

    SciTech Connect

    Scholey, J. E.; Lin, L.; Ainsley, C. G.

    2015-06-15

    Purpose: To evaluate the accuracy and limitations of a commercially-available treatment planning system’s (TPS’s) dose calculation algorithm for proton pencil-beam scanning (PBS) and present a novel technique to efficiently derive a clinically-acceptable beam model. Methods: In-air fluence profiles of PBS spots were modeled in the TPS alternately as single-(SG) and double-Gaussian (DG) functions, based on fits to commissioning data. Uniform-fluence, single-energy-layer square fields of various sizes and energies were calculated with both beam models and delivered to water. Dose was measured at several depths. Motivated by observed discrepancies in measured-versus-calculated dose comparisons, a third model was constructed based on double-Gaussian parameters contrived through a novel technique developed to minimize these differences (DGC). Eleven cuboid-dose-distribution-shaped fields with varying range/modulation and field size were subsequently generated in the TPS, using each of the three beam models described, and delivered to water. Dose was measured at the middle of each spread-out Bragg peak. Results: For energies <160 MeV, the DG model fit square-field measurements to <2% at all depths, while the SG model could disagree by >6%. For energies >160 MeV, both SG and DG models fit square-field measurements to <1% at <4 cm depth, but could exceed 6% deeper. By comparison, disagreement with the DGC model was always <3%. For the cuboid plans, calculation-versus-measured percent dose differences exceeded 7% for the SG model, being larger for smaller fields. The DG model showed <3% disagreement for all field sizes in shorter-range beams, although >5% differences for smaller fields persisted in longer-range beams. In contrast, the DGC model predicted measurements to <2% for all beams. Conclusion: Neither the TPS’s SG nor DG models, employed as intended, are ideally suited for routine clinical use. However, via a novel technique to be presented, its DG model can be

  18. Acceptability and efficacy of interactive short message service intervention in improving HIV medication adherence in Chinese antiretroviral treatment-naïve individuals

    PubMed Central

    Ruan, Ye; Xiao, Xueling; Chen, Jia; Li, Xianhong; Williams, Ann Bartley; Wang, Honghong

    2017-01-01

    Aim The aim of this study was to examine the acceptability and efficacy of interactive short message service (SMS) in improving medication adherence in antiretroviral treatment (ART)-naïve individuals living with HIV/AIDS in Hengyang, Hunan, China. Background SMS via mobile phone has emerged as a potential tool for improving ART adherence. However, most studies used SMS only as a medication reminder, with few studies exploring the effect of comprehensive, interactive SMS. Patients and methods In a randomized controlled trial, 100 HIV-positive patients on ART for <3 months were randomized into control or intervention arm. Participants in the control group received routine standard instruction for ART medication in the HIV clinics, while the intervention group received 6 months of an SMS intervention in addition to the standard care. A total of 124 text messages within 6 modules were edited, preinstalled, and sent to participants according to personalized schedules. Knowledge (of HIV and HIV medications), self-reported antiretroviral adherence (Visual Analog Scale [VAS] and Community Programs for Clinical Research on AIDS [CPCRA] Antiretroviral Medication Self-Report), and CD4 count were assessed at baseline and immediate post-intervention. Intervention participants were interviewed after completion of the study about their satisfaction with and acceptability of the SMS intervention. Results Baseline assessments were comparable between arms. Repeated-measures analysis showed that both HIV-related and ART medication knowledge of the intervention group showed better improvement over time than those of the control group after the intervention (P<0.0001). For the adherence measures, compared with the control group, participants in the intervention group had significantly higher VAS mean score (Z=2.735, P=0.006) and lower suboptimal adherence rate (Z=2.208, P=0.027) at the end of the study. The intervention had no effect on CD4 cell count. Almost all (96%) intervention

  19. Active Authentication Linguistic Modalities

    DTIC Science & Technology

    2013-12-01

    sensor (legitimate/illegitimate user) are fed into a Decision Fusion Center ( DFC ) which applies the Chair-Varshney fusion algorithm to generate a...global decision. The DFC minimizes the probability of error using the local-sensor False Rejection Rates (FAR) and False Acceptance Rates (FRR) as well... DFC ) which applies the Chair-Varshney fusion algorithm to generate a global decision. The DFC minimizes the probability of error using the local

  20. Hahn Sequence Space of Modals

    PubMed Central

    Balasubramanian, T.; Zion Chella Ruth, S.

    2014-01-01

    The history of modal intervals goes back to the very first publications on the topic of interval calculus. The modal interval analysis is used in Computer graphics and Computer Aided Design (CAD), namely, the computation of narrow bounds on Bezier and B-Spline curves. Since modal intervals are used in many fields, we introduce a new sequence space h(gI) called the Hahn sequence space of modal intervals. We have given some new definitions and theorems. Some inclusion relation and some topological properties of this space are investigated. Also dual spaces of this space are computed. PMID:27382628

  1. Experiential Education, Outdoor Adventure As a Modality in Youth Care and Residential Treatment. A Survey of Programs, Principles, Research and Practice on the European Continent, Especially the Netherlands.

    ERIC Educational Resources Information Center

    Duindam, Ton

    Orthopedagogisch Centrum Michiel is a multifunctional institution in the eastern Netherlands for youth with emotional problems. The staff of the institution's residential treatment center has gradually become involved with outdoor experiential education through training programs, conferences, special projects, and supervised programs. Activities…

  2. IMPACT: Imaging and Molecular Markers for Patients with Lung Cancer: Approaches with Molecular Targets, Complementary/Innovative Treatments, and Therapeutic Modalities

    DTIC Science & Technology

    2016-04-01

    results showed disappointing response rates and survival benefit of epidermal growth factor receptor (EGFR) inhibitor gefitinib (Iressa™) for non...February 2015 – 14 February 2016 Project 1: Targeting epidermal growth factor receptor signaling to enhance response of lung cancer to...the last injection of erlotinib. Tumor growth delay was assessed following treatment. Tumors were measured every other day in two orthogonal

  3. Dialysis modality selection: physician guided or patient led?*

    PubMed Central

    Winterbottom, Anna; Bekker, Hilary

    2016-01-01

    The process of choosing dialysis modality for patients is complex and requires input from the expert renal team. Although it is commonplace for nephrologists to recommend dialysis modalities to patients, this might not always lead to the patient receiving treatment which they regard as most suitable. Nephrologists should consider whether it is appropriate for pre-dialysis education to be directive, or whether the choice between treatment options should be led by the patient. PMID:27994862

  4. Efficacy, safety, acceptability and affordability of cryotherapy: a review of current literature.

    PubMed

    McClung, E C; Blumenthal, P D

    2012-04-01

    As a result of widespread screening and treatment programs, the incidence of cervical cancer has decreased by as much as 75% in the developed world. Commonly used treatment modalities for precancerous lesions include cone biopsy, the Loop Electrosurgical Excision Procedure (LEEP), laser ablation and cryotherapy. In recent years LEEP has replaced cryotherapy as a commonly provided outpatient procedure in many places; however increased awareness of the burden of cervical cancer in the developing world and increased awareness of long term consequences of LEEP ‑ such as cervical insufficiency ‑ have renewed interest in cryotherapy. We reviewed current literature addressing the technique, efficacy, safety and acceptability of cryotherapy, as well as special topics such as cost effectiveness, HIV, and low resource settings. Among studies we reviewed, cure rates ranged from 56.8-96.6% among prospective controlled trials and from 70-95.5% among observational studies. Cryotherapy has very low complication rates and serious complications requiring medical intervention or affecting future reproductive outcomes are extremely rare. Side effects including vaginal discharge and cramping are temporary, generally self-limited, and well tolerated after anticipatory patient counseling. When surveyed, women find cryotherapy highly acceptable. Compared to other treatment modalities, cryotherapy is very affordable and feasible to integrate into cervical cancer screening and treatment programs.

  5. Clinical characteristics and selection of treatment modality for patients with vitreomacular traction: real-world implementation of NICE guidance (TA297)

    PubMed Central

    Pritchard, Edward William James; Ilyas, Shams-Ulislam; Amar, Soha Khaled; Yang, Yit Chuin; Narendran, Nirodhini

    2016-01-01

    Aim To investigate the qualitative aspects in patient selection and the quantitative impact of disease burden in real world treatment of vitreomacular traction (VMT) and implementation of the National Institute for Health and Care Excellence (NICE) guidance (TA297). Methods A monocentric, retrospective review of consecutive patients undergoing optical coherence tomography (OCT) imaging over a 3 month period. Patients with VMT in at least one eye were identified for further data collection on laterality, visual acuity, symptoms, presence of epiretinal membrane, macular hole and treatment selection. Results A total of 3472 patients underwent OCT imaging with a total of 6878 eyes scanned. Out of 87 patients, 74 patients had unilateral VMT (38 right, 36 left) and 13 patients had bilateral VMT. Eighteen patients with unilateral VMT satisfied NICE criteria of severe sight problems in the affected eye. Eight were managed for a coexisting pathology, one refused treatment, one patient did not attend, two closed spontaneously, and one received ocriplasmin prior to the study start date. Only two patients with unilateral VMT received ocriplasmin and three underwent vitrectomy. Those failing to meet NICE criteria for unilateral VMT were predominantly asymptomatic (n=49) or had coexisting ERM (n=5) or both (n=2). Conclusion Ocriplasmin provides an alternative treatment for patients with symptomatic VMT. Our data shows that the majority of patients with VMT do not meet NICE TA297 primarily due to lack of symptoms. Those meeting NICE criteria, but not treated, tended to have coexisting macular pathology. Variation in patient selection due to subjective factors not outlined in NICE guidance suggests that real world outcomes of ocriplasmin therapy should be interpreted with caution. PMID:26834452

  6. IMPACT: Imaging and Molecular Markers for Patients with Lung Cancer: Approaches with Molecular Targets, Complementary/Innovative Treatments, and Therapeutic Modalities

    DTIC Science & Technology

    2013-02-01

    Treatment was tolerated well with mostly grade 1/2 toxicities (hyperglycemia, hypertriglyceridemia, anemia and fatigue) and 31 of 32 patients proceeded...adults are direct results of smoking. In children and young adults, tobacco use remains a major public health problem in spite of the recent declines...in smoking prevalence among children and adolescents. Over the past 2-3 decades, numerous factors of smoking initiation among adolescents have been

  7. Multi-modality treatment of primary nonresectable intrahepatic cholangiocarcinoma with /sup 131/I anti-CEA--a Radiation Therapy Oncology Group Study

    SciTech Connect

    Stillwagon, G.B.; Order, S.E.; Klein, J.L.; Leichner, P.K.; Leibel, S.A.; Siegelman, S.S.; Fishman, E.K.; Ettinger, D.S.; Haulk, T.; Kopher, K.

    1987-05-01

    Thirty-seven patients with primary nonresectable intrahepatic cholangiocarcinoma (57% with prior treatment and/or metastasis) were prospectively treated with external radiation, chemotherapy, and /sup 131/I labelled anti-CEA. Therapy began in all trials with whole liver irradiation (21.0 Gy, 3.0 Gy/Fx, 4 days/week, 10 MV photons) with alternate treatment day chemotherapy (Adriamycin, 15 mg + 5-FU, 500 mg). One month after external beam therapy, chemotherapy was given (Adriamycin, 15 mg + 5-FU, 500 mg) followed the next day by the first administration of /sup 131/I anti-CEA. The treatment schedule used was 20 mCi day 0; 10 mCi day 5 as an outpatient. This schedule was derived from tumor dose estimates which indicated that 20 mCi (8-10 mCi/mg IgG) was sufficient to achieve tumor saturation with a tumor effective half-life of 3 to 5 days, depending upon the species of animal from which the antibody was obtained. The median tumor dose for the 20 mCi + 10 mCi regimen was 6.2 Gy. Antibody therapy was delivered in 2-month cycles using antibody generated in different species of animals; rabbit, pig, monkey, and bovine. Toxicity was limited to hematologic toxicity and was manifested as thrombocytopenia and leukocytopenia (3.2% Grade IV for each according to RTOG toxicity criteria). Tumor remission evaluated by CT scan digitized tumor volume analysis indicated a 26.6% partial response (PR). Tumor remission by physical examination indicated a 33.3% remission rate (25.9% PR and 7.4% complete remission (CR). The median survival for patients who responded was 15.2 months. The actuarial median survival for the entire group of patients (metastases and previous treatment) was 6.5 months. The longest partial remission is presently more than 4 years.

  8. Biomarkers of Treatment Toxicity in Combined-Modality Cancer Therapies with Radiation and Systemic Drugs: Study Design, Multiplex Methods, Molecular Networks

    PubMed Central

    Ree, Anne Hansen; Meltzer, Sebastian; Flatmark, Kjersti; Dueland, Svein; Kalanxhi, Erta

    2014-01-01

    Organ toxicity in cancer therapy is likely caused by an underlying disposition for given pathophysiological mechanisms in the individual patient. Mechanistic data on treatment toxicity at the patient level are scarce; hence, probabilistic and translational linkages among different layers of data information, all the way from cellular targets of the therapeutic exposure to tissues and ultimately the patient’s organ systems, are required. Throughout all of these layers, untoward treatment effects may be viewed as perturbations that propagate within a hierarchically structured network from one functional level to the next, at each level causing disturbances that reach a critical threshold, which ultimately are manifested as clinical adverse reactions. Advances in bioinformatics permit compilation of information across the various levels of data organization, presumably enabling integrated systems biology-based prediction of treatment safety. In view of the complexity of biological responses to cancer therapy, this communication reports on a “top-down” strategy, starting with the systematic assessment of adverse effects within a defined therapeutic context and proceeding to transcriptomic and proteomic analysis of relevant patient tissue samples and computational exploration of the resulting data, with the ultimate aim of utilizing information from functional connectivity networks in evaluation of patient safety in multimodal cancer therapy. PMID:25501337

  9. MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage.

    PubMed

    Jayaraman, R C; Reid, R W; Foley, J M; Prior, B M; Dudley, G A; Weingand, K W; Meyer, R A

    2004-10-01

    The aim of this study was to monitor the effects of topical heat and/or static stretch treatments on the recovery of muscle damage by eccentric exercise. For this purpose, 32 untrained male subjects performed intense eccentric knee extension exercise, followed by 2 weeks of treatment (heat, stretch, heat plus stretch) or no treatment (control, n=8/group). Isometric strength testing, pain ratings, and multi-echo magnetic resonance imaging of the thigh were performed before and at 2, 3, 4, 8, and 15 days following the exercise. Increased T2 relaxation time, muscle swelling, pain ratings, and strength loss confirmed significant muscle damage during the post-exercise period. Pain ratings and muscle volume recovered to baseline by 15 days, although muscle strength remained lower [77 (4) vs. 95 (3) kg pre-exercise, mean (SE)] and T2 values higher [32.2 (0.8) vs. 28.6 (0.2) ms pre-exercise]. Our results indicate that heat and/or static stretching does not consistently reduce soreness, swelling or muscle damage. The practical implication of our findings is that clinicians should be aware that prescribing heat and/or static stretching following intense eccentric or unaccustomed exercise will not enhance the recovery of damaged muscles.

  10. Integrative medicine as adjunct therapy in the treatment of atopic dermatitis--the role of traditional Chinese medicine, dietary supplements, and other modalities.

    PubMed

    DiNicola, C; Kekevian, A; Chang, C

    2013-06-01

    Atopic dermatitis (AD) is becoming increasingly prevalent in the pediatric population, with rates reportedly as high as 18-25 %. Westernized medicine has traditionally used a combination of emollients, antihistamines, corticosteroids, and immunomodulating agents to combat this often frustrating disease. Of late, integrative medicine has become the subject of more research as concerns grow regarding prolonged use of corticosteroids and their side effects in pediatric patients. Probiotics have been extensively studied to define their role in the treatment and prevention of AD in children. Unfortunately, results are varying showing significant improvement in some patients but not all. With regard to prevention, studies show that the use of probiotics during pregnancy does decrease the incidence of AD in children. Prebiotics and synbiotics are also a conceivable option for prevention of AD. A number of studies on Chinese herbal medicine have been performed, with a collective result of symptom improvement and decreased levels of inflammatory cytokines. However, there were reports of asymptomatic transaminitis in a few patients that warrant further testing. While the herbs tested in more recent randomized clinical trials were free from corticosteroids, a previous study showed high levels of dexamethasone in unlabeled herbal eczema creams. Vitamins and minerals have also been suggested as an alternative treatment of AD. Studies however have not yet demonstrated improvement of AD with vitamin or mineral supplementation. Topical vitamin B(12) is the exception to this; however, no topical vitamin B(12) preparation is available for use. Finally, relaxation techniques are also being investigated as adjunctive methods of treatment, but well-designed scientific studies are lacking.

  11. Activation of endogenous p53 by combined p19Arf gene transfer and nutlin-3 drug treatment modalities in the murine cell lines B16 and C6

    PubMed Central

    2010-01-01

    Background Reactivation of p53 by either gene transfer or pharmacologic approaches may compensate for loss of p19Arf or excess mdm2 expression, common events in melanoma and glioma. In our previous work, we constructed the pCLPG retroviral vector where transgene expression is controlled by p53 through a p53-responsive promoter. The use of this vector to introduce p19Arf into tumor cells that harbor p53wt should yield viral expression of p19Arf which, in turn, would activate the endogenous p53 and result in enhanced vector expression and tumor suppression. Since nutlin-3 can activate p53 by blocking its interaction with mdm2, we explored the possibility that the combination of p19Arf gene transfer and nutlin-3 drug treatment may provide an additive benefit in stimulating p53 function. Methods B16 (mouse melanoma) and C6 (rat glioma) cell lines, which harbor p53wt, were transduced with pCLPGp19 and these were additionally treated with nutlin-3 or the DNA damaging agent, doxorubicin. Viral expression was confirmed by Western, Northern and immunofluorescence assays. p53 function was assessed by reporter gene activity provided by a p53-responsive construct. Alterations in proliferation and viability were measured by colony formation, growth curve, cell cycle and MTT assays. In an animal model, B16 cells were treated with the pCLPGp19 virus and/or drugs before subcutaneous injection in C57BL/6 mice, observation of tumor progression and histopathologic analyses. Results Here we show that the functional activation of endogenous p53wt in B16 was particularly challenging, but accomplished when combined gene transfer and drug treatments were applied, resulting in increased transactivation by p53, marked cell cycle alteration and reduced viability in culture. In an animal model, B16 cells treated with both p19Arf and nutlin-3 yielded increased necrosis and decreased BrdU marking. In comparison, C6 cells were quite susceptible to either treatment, yet p53 was further activated

  12. Mimicry for all modalities.

    PubMed

    Dalziell, Anastasia H; Welbergen, Justin A

    2016-06-01

    Mimicry is a canonical example of adaptive signal design. In principle, what constitutes mimicry is independent of the taxonomic identity of the mimic, the ecological context in which it operates, and the sensory modality through which it is expressed. However, in practice the study of mimicry is inconsistent across research fields, with theoretical and empirical advances often failing to cross taxonomic and sensory divides. We propose a novel conceptual framework whereby mimicry evolves if a receiver perceives the similarity between a mimic and a model and as a result confers a selective benefit onto the mimic. Here, misidentification and/or deception are no longer formal requirements, and mimicry can evolve irrespective of the underlying proximate mechanisms. The centrality of receiver perception in this framework enables us to formally distinguish mimicry from perceptual exploitation and integrate mimicry and multicomponent signalling theory for the first time. In addition, it resolves inconsistencies in our understanding of the role of learning in mimicry evolution, and shows that imperfect mimicry is expected to be the norm. Mimicry remains a key model for understanding signal evolution and cognition, and we recommend the adoption of a unified approach to stimulate future interdisciplinary developments in this fascinating area of research.

  13. In Vitro-Activity of Er:YAG Laser in Comparison with other Treatment Modalities on Biofilm Ablation from Implant and Tooth Surfaces

    PubMed Central

    Meier, Ivan; Spoerlé, Florian; Bender, Philip; Aoki, Akira; Izumi, Yuichi; Salvi, Giovanni E.; Sculean, Anton

    2017-01-01

    Background and Aim Bacterial biofilms play a major role in the etiology of periodontal and peri-implant diseases. The aim of the study was to evaluate the removal of bacterial biofilms and attachment of epithelial cells (EC), gingival fibroblasts (GF) and osteoblast-like cells (OC) to dentin and titanium surfaces after Er:YAG laser (Er:YAG) in comparison with other treatment methods. Material and Methods Multi-species bacterial biofilms were grown on standardized dentin and titanium specimens with a sand-blasted and acid etched (SLA) surface for 3.5 d. Thereafter, the specimens were placed into artificially-created pockets. The following methods for biofilm removal were used: 1) Gracey (dentin) or titanium curettes (CUR), 2) Er:YAG, 3) photodynamic therapy (PDT) and 4) CUR with adjunctive PDT (CUR/PDT). Colony forming units (CFUs) of the remaining biofilms and attachment of EC, GF and OC were determined. Statistical analysis was performed by means of ANOVA with post-hoc LSD. Results All treatment methods decreased statistically significantly (p<0.001) total CFUs in biofilms compared with untreated dentin and titanium surfaces respectively. On dentin, Er:YAG was equally efficient as CUR and PDT but inferior to CUR/PDT (p = 0.005). On titanium, surfaces, the use of Er:YAG resulted in statistically significantly superior biofilm removal compared to the 3 other treatments (each p<0.001). Counts of attached EC, GF and OC were the lowest on untreated contaminated dentin and titanium surfaces each. After CUR/PDT higher EC counts were found on dentin (p = 0.006). On titanium, all decontamination methods statistically significantly increased (p<0.001) the counts of attached EC without differences between groups. Statistically significantly higher counts of GF (p = 0.024) and OC (p<0.001) were observed after Er:YAG decontamination compared with untreated surfaces. Conclusion Ablation of subgingival biofilms and in particular decontamination of titanium implant surfaces with

  14. Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review.

    PubMed

    Macey, Matthew Ryan; Raynor, Mathew C

    2016-09-01

    Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL.

  15. Fractional 532-nm Q-switched Nd:YAG laser: One of the safest novel treatment modality to treat café-au-lait macules.

    PubMed

    Won, Kwang Hee; Lee, Ye Jin; Rhee, Do Young; Chang, Sung Eun

    2016-10-01

    Café-au-lait macules (CALMs) are benign epidermal basilar hyperpigmentations that can be found in an isolated form or in association with neurocutaneous syndromes. Frequency-doubled Q-switched neodymium-doped yttrium aluminum garnet laser (532-nm QSNYL) does not penetrate deeply into the skin and is therefore suitable for epidermal pigmented lesion. Fractional photothermolysis (FP) targets only very small areas of the skin, without injuring adjacent areas of healthy, normal skin. Herein, we report a case of CALMs successfully treated with fractional 532-nm QSNYL. By applying FP to 532-nm QSNYL, we could treat CALMs safely with less downtime as compared to conventional laser treatments and expect more energy delivery for each microscopic hole, thereby allowing higher response rate.

  16. Role of carboplatin in multi-modality treatment of canine tonsillar squamous cell carcinoma--a case series of five dogs.

    PubMed

    Murphy, S; Hayes, A; Adams, V; Maglennon, G; Neath, P; Ladlow, J; Brearley, M J

    2006-04-01

    Canine tonsillar squamous cell carcinoma is an aggressive disease with a poor prognosis. A retrospective study was undertaken of all dogs that were presented between January 1999 and January 2004 to the Animal Health Trust for the treatment of tonsillar squamous cell carcinoma. Five cases were identified, and their median survival time was 211 days (95 per cent confidence interval 80 to 352) with two of the five dogs remaining alive at the end of the study, 826 and 1628 days from diagnosis with no clinical signs of disease. The protocol was well tolerated with only one of the five dogs showing toxicity associated with carboplatin and all dogs that started radiotherapy completing it. Compared with results of previous studies, these cases suggest that surgical cytoreduction followed by coarse fractionated radiotherapy together with carboplatin may be a useful way to treat this tumour. Carboplatin alone caused partial remission in the two cases where it was used as neo-adjunctive therapy.

  17. Interpreting Metaphor of Modality in Advertising English

    ERIC Educational Resources Information Center

    Xu, Jian

    2009-01-01

    Based on a review of the historical and current studies on modality, this paper aims at interpreting metaphor of modality and its functions in advertising English according to theories of modality system and metaphor of modality in systemic-functional linguistics with a corpus we have collected. It is pointed out that metaphor of modality, a usual…

  18. Extracorporeal Shock Wave Stimulation as Alternative Treatment Modality for Wrist and Fingers Spasticity in Poststroke Patients: A Prospective, Open-Label, Preliminary Clinical Trial

    PubMed Central

    2016-01-01

    Objective. To evaluate the effectiveness of radial shock waves (rESW) for wrist and fingers flexors spasticity in stroke patients. Methods. Twenty patients with upper limb muscle spasticity were enrolled in the study and treated with a single session of rESW. The spasticity level of the radio carpal (RC) and finger (FF) joints was assessed using Modified Ashworth Scale (MAS). The resting bioelectrical activity of the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) was examined using surface electromyography (sEMG). Trophic conditions were measured using infrared thermal (IRT) imaging. All measurements were conducted at baseline (t0), immediately after rESW (t1), and 1 (t2) and 24 (t3) hours following rESW. Results. Significant reduction in MAS was observed for the RC joint in t1, as well as for the FF joints in t1, t2, and t3. A significant decrease in sEMG was shown for the FCR muscle in t1 and t2, as well as for the FCU muscle in t1 and t3. Also, a significant increase in IRT value was observed in t3 only. Conclusions. A single session of rESW could be an effective alternative treatment for reduction of limb spasticity and could lead to improvement of trophic conditions of the spastic muscles. PMID:27504139

  19. Offer/Acceptance Ratio.

    ERIC Educational Resources Information Center

    Collins, Mimi

    1997-01-01

    Explores how human resource professionals, with above average offer/acceptance ratios, streamline their recruitment efforts. Profiles company strategies with internships, internal promotion, cooperative education programs, and how to get candidates to accept offers. Also discusses how to use the offer/acceptance ratio as a measure of program…

  20. SU-F-BRD-05: Dosimetric Comparison of Protocol-Based SBRT Lung Treatment Modalities: Statistically Significant VMAT Advantages Over Fixed- Beam IMRT

    SciTech Connect

    Best, R; Harrell, A; Geesey, C; Libby, B; Wijesooriya, K

    2014-06-15

    Purpose: The purpose of this study is to inter-compare and find statistically significant differences between flattened field fixed-beam (FB) IMRT with flattening-filter free (FFF) volumetric modulated arc therapy (VMAT) for stereotactic body radiation therapy SBRT. Methods: SBRT plans using FB IMRT and FFF VMAT were generated for fifteen SBRT lung patients using 6 MV beams. For each patient, both IMRT and VMAT plans were created for comparison. Plans were generated utilizing RTOG 0915 (peripheral, 10 patients) and RTOG 0813 (medial, 5 patients) lung protocols. Target dose, critical structure dose, and treatment time were compared and tested for statistical significance. Parameters of interest included prescription isodose surface coverage, target dose heterogeneity, high dose spillage (location and volume), low dose spillage (location and volume), lung dose spillage, and critical structure maximum- and volumetric-dose limits. Results: For all criteria, we found equivalent or higher conformality with VMAT plans as well as reduced critical structure doses. Several differences passed a Student's t-test of significance: VMAT reduced the high dose spillage, evaluated with conformality index (CI), by an average of 9.4%±15.1% (p=0.030) compared to IMRT. VMAT plans reduced the lung volume receiving 20 Gy by 16.2%±15.0% (p=0.016) compared with IMRT. For the RTOG 0915 peripheral lesions, the volumes of lung receiving 12.4 Gy and 11.6 Gy were reduced by 27.0%±13.8% and 27.5%±12.6% (for both, p<0.001) in VMAT plans. Of the 26 protocol pass/fail criteria, VMAT plans were able to achieve an average of 0.2±0.7 (p=0.026) more constraints than the IMRT plans. Conclusions: FFF VMAT has dosimetric advantages over fixed beam IMRT for lung SBRT. Significant advantages included increased dose conformity, and reduced organs-at-risk doses. The overall improvements in terms of protocol pass/fail criteria were more modest and will require more patient data to establish difference

  1. The street children of Manila are affected by early-in-life periodontal infection: description of a treatment modality: sea salt.

    PubMed

    Michel, J F; Michel, M G; Nadan, J; Nowzari, H

    2013-01-01

    Thousands of street children of Manila are affected by early-in-life oral infection. The aim of the present investigation was to evaluate the effectiveness of a sea-salt mouthrinse solution in street children of Manila affected by mild to severe forms of periodontal disease. These children were all in need of special protection: abandoned, abused, exploited, neglected, orphaned, poor. During 3 oral-health missions in 2003, 2004 and 2005, 617 abandoned children (5 to 13 year-old), received oral examination at a non-sectarian child-caring institution in Metro Manila (Virlanie Foundation) by calibrated examiners. A treatment based on what could be done was proposed: 1. Teaching of a precise tooth brushing technique with sea-salt, controlled and reinforced every two days for one week by calibrated health educators, 2. The application of sea-salt water mouthrinse (2.5 gram in 20 ml). Periodontal measurements were repeated at the end of each mission. All children returned to child-caring institution for the followup examinations. In 2003, 10 male and 11 female (n=21) were diagnosed with aggressive periodontitis. In 2009 and 2010, none was affected by aggressive periodontitis. For all patients, the gingival index decreased from 1.08 at the first mission to 1.04 at the end of the second mission and 0.98 at the end of the third mission. The periodontal index decreased from 1.33 at the first mission to 0.98 at the second mission and 0.92 at the last mission. The present investigation confirms that prevention and early diagnosis can result in success with minimum cost. The provided oral health program empowered street children in the most desperate circumstances to be educated and become self-reliant, independent, and responsible. We propose here an antimicrobial approach which has a high degree of efficacy and tolerability, and can be implemented in virtually all parts of the world using low-cost resources.

  2. Oxaliplatin-based combined-modality therapy for rectal cancer.

    PubMed

    Minsky, Bruce D

    2003-08-01

    There are two conventional treatments for clinically resectable rectal cancer. The first is surgery, and, if the tumor is T3 and/or N1-2, this is followed by postoperative combined-modality therapy. The second, for patients with ultrasound T3 or clinical T4 disease, is preoperative combined-modality therapy followed by surgery and postoperative chemotherapy. In this review, the results of these approaches as well as novel combined-modality approaches using oxaliplatin-based regimens will be presented.

  3. Gender-based Outcomes and Acceptability of a Computer-assisted Psychosocial Intervention for Substance Use Disorders

    PubMed Central

    Campbell, Aimee N. C.; Nunes, Edward V.; Pavlicova, Martina; Hatch-Maillette, Mary; Hu, Mei-Chen; Bailey, Genie L.; Sugarman, Dawn E.; Miele, Gloria M.; Rieckmann, Traci; Shores-Wilson, Kathy; Turrigiano, Eva; Greenfield, Shelly F.

    2015-01-01

    Background Digital technologies show promise for increasing treatment accessibility and improving quality of care, but little is known about gender differences. This secondary analysis uses data from a multi-site effectiveness trial of a computer-assisted behavioral intervention, conducted within NIDA's National Drug Abuse Clinical Trials Network, to explore gender differences in intervention acceptability and treatment outcomes. Methods Men (n=314) and women (n=192) were randomly assigned to 12-weeks of treatment-as-usual (TAU) or modified TAU + Therapeutic Education System (TES), whereby TES substituted for 2 hours of TAU per week. TES is comprised of 62 web-delivered, multimedia modules, covering skills for achieving and maintaining abstinence plus prize-based incentives contingent on abstinence and treatment adherence. Outcomes were: (1) abstinence from drugs and heavy drinking in the last 4 weeks of treatment, (2) retention, (3) social functioning, and (4) drug and alcohol craving. Acceptability was the mean score across five indicators (i.e., interesting, useful, novel, easy to understand, and satisfaction). Results Gender did not moderate the effect of treatment on any outcome. Women reported higher acceptability scores at week 4 (p=.02), but no gender differences were detected at weeks 8 or 12. Acceptability was positively associated with abstinence, but only among women (p=.01). Conclusions Findings suggest that men and women derive similar benefits from participating in a computer-assisted intervention, a promising outcome as technology-based treatments expand. Acceptability was associated with abstinence outcomes among women. Future research should explore characteristics of women who report less satisfaction with this modality of treatment and ways to improve overall acceptability. PMID:25613105

  4. Asymptotic modal analysis and statistical energy analysis

    NASA Technical Reports Server (NTRS)

    Dowell, Earl H.

    1988-01-01

    Statistical Energy Analysis (SEA) is defined by considering the asymptotic limit of Classical Modal Analysis, an approach called Asymptotic Modal Analysis (AMA). The general approach is described for both structural and acoustical systems. The theoretical foundation is presented for structural systems, and experimental verification is presented for a structural plate responding to a random force. Work accomplished subsequent to the grant initiation focusses on the acoustic response of an interior cavity (i.e., an aircraft or spacecraft fuselage) with a portion of the wall vibrating in a large number of structural modes. First results were presented at the ASME Winter Annual Meeting in December, 1987, and accepted for publication in the Journal of Vibration, Acoustics, Stress and Reliability in Design. It is shown that asymptotically as the number of acoustic modes excited becomes large, the pressure level in the cavity becomes uniform except at the cavity boundaries. However, the mean square pressure at the cavity corner, edge and wall is, respectively, 8, 4, and 2 times the value in the cavity interior. Also it is shown that when the portion of the wall which is vibrating is near a cavity corner or edge, the response is significantly higher.

  5. LIMS user acceptance testing.

    PubMed

    Klein, Corbett S

    2003-01-01

    Laboratory Information Management Systems (LIMS) play a key role in the pharmaceutical industry. Thorough and accurate validation of such systems is critical and is a regulatory requirement. LIMS user acceptance testing is one aspect of this testing and enables the user to make a decision to accept or reject implementation of the system. This paper discusses key elements in facilitating the development and execution of a LIMS User Acceptance Test Plan (UATP).

  6. On Maximum FODO Acceptance

    SciTech Connect

    Batygin, Yuri Konstantinovich

    2014-12-24

    This note illustrates maximum acceptance of FODO quadrupole focusing channel. Acceptance is the largest Floquet ellipse of a matched beam: A = $\\frac{a^2}{β}$$_{max}$ where a is the aperture of the channel and βmax is the largest value of beta-function in the channel. If aperture of the channel is restricted by a circle of radius a, the s-s acceptance is available for particles oscillating at median plane, y=0. Particles outside median plane will occupy smaller phase space area. In x-y plane, cross section of the accepted beam has a shape of ellipse with truncated boundaries.

  7. Modal Substructuring of Geometrically Nonlinear Finite-Element Models

    SciTech Connect

    Kuether, Robert J.; Allen, Matthew S.; Hollkamp, Joseph J.

    2015-12-21

    The efficiency of a modal substructuring method depends on the component modes used to reduce each subcomponent model. Methods such as Craig–Bampton have been used extensively to reduce linear finite-element models with thousands or even millions of degrees of freedom down orders of magnitude while maintaining acceptable accuracy. A novel reduction method is proposed here for geometrically nonlinear finite-element models using the fixed-interface and constraint modes of the linearized system to reduce each subcomponent model. The geometric nonlinearity requires an additional cubic and quadratic polynomial function in the modal equations, and the nonlinear stiffness coefficients are determined by applying a series of static loads and using the finite-element code to compute the response. The geometrically nonlinear, reduced modal equations for each subcomponent are then coupled by satisfying compatibility and force equilibrium. This modal substructuring approach is an extension of the Craig–Bampton method and is readily applied to geometrically nonlinear models built directly within commercial finite-element packages. The efficiency of this new approach is demonstrated on two example problems: one that couples two geometrically nonlinear beams at a shared rotational degree of freedom, and another that couples an axial spring element to the axial degree of freedom of a geometrically nonlinear beam. The nonlinear normal modes of the assembled models are compared with those of a truth model to assess the accuracy of the novel modal substructuring approach.

  8. Modal Substructuring of Geometrically Nonlinear Finite-Element Models

    DOE PAGES

    Kuether, Robert J.; Allen, Matthew S.; Hollkamp, Joseph J.

    2015-12-21

    The efficiency of a modal substructuring method depends on the component modes used to reduce each subcomponent model. Methods such as Craig–Bampton have been used extensively to reduce linear finite-element models with thousands or even millions of degrees of freedom down orders of magnitude while maintaining acceptable accuracy. A novel reduction method is proposed here for geometrically nonlinear finite-element models using the fixed-interface and constraint modes of the linearized system to reduce each subcomponent model. The geometric nonlinearity requires an additional cubic and quadratic polynomial function in the modal equations, and the nonlinear stiffness coefficients are determined by applying amore » series of static loads and using the finite-element code to compute the response. The geometrically nonlinear, reduced modal equations for each subcomponent are then coupled by satisfying compatibility and force equilibrium. This modal substructuring approach is an extension of the Craig–Bampton method and is readily applied to geometrically nonlinear models built directly within commercial finite-element packages. The efficiency of this new approach is demonstrated on two example problems: one that couples two geometrically nonlinear beams at a shared rotational degree of freedom, and another that couples an axial spring element to the axial degree of freedom of a geometrically nonlinear beam. The nonlinear normal modes of the assembled models are compared with those of a truth model to assess the accuracy of the novel modal substructuring approach.« less

  9. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options

    PubMed Central

    2013-01-01

    Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical treatment modalities that are under active investigation. PMID:24053624

  10. A study to evaluate the acceptability, feasibility and impact of packaged interventions (“Diarrhea Pack”) for prevention and treatment of childhood diarrhea in rural Pakistan

    PubMed Central

    2013-01-01

    Background Diarrhea remains one of the leading public health issues in developing countries and is a major contributor in morbidity and mortality in children under five years of age. Interventions such as ORS, Zinc, water purification and improved hygiene and sanitation can significantly reduce the diarrhea burden but their coverage remains low and has not been tested as packaged intervention before. This study attempts to evaluate the package of evidence based interventions in a “Diarrhea Pack” through first level health care providers at domiciliary level in community based settings. This study sought to evaluate the acceptability, feasibility and impact of diarrhea Pack on diarrhea burden. Methods A cluster randomized design was used to evaluate the objectives of the project a union council was considered as a cluster for analysis, a total of eight clusters, four in intervention and four in control were included in the study. We conducted a baseline survey in all clusters followed by the delivery of diarrhea Pack in intervention clusters through community health workers at domiciliary level and through sales promoters to health care providers and pharmacies. Four quarterly surveillance rounds were conducted to evaluate the impact of diarrhea pack in all clusters by an independent team of Field workers. Results Both the intervention and control clusters were similar at the baseline but as the study progress we found a significant increase in uptake of ORS and Zinc along with the reduction in antibiotic use, diarrhea burden and hospitalization in intervention clusters when compared with the control clusters. We found that the Diarrhea Pack was well accepted with all of its components in the community. Conclusion The intervention was well accepted and had a productive impact on the uptake of ORS and zinc and reduction in the use of antibiotics. It is feasible to deliver interventions such as diarrhea pack through community health workers in community settings

  11. Effect of Therapeutic Modalities on Patients With Patellofemoral Pain Syndrome

    PubMed Central

    Lake, David A.; Wofford, Nancy H.

    2011-01-01

    Context: Patellofemoral pain syndrome (PFPS) is a common orthopaedic condition for which operative and nonoperative treatments have been used. Therapeutic modalities have been recommended for the treatment of patients with PFPS—including cold, ultrasound, phonophoresis, iontophoresis, neuromuscular electrical stimulation, electrical stimulation for pain control, electromyographic biofeedback, and laser. Objective: To determine the effectiveness of therapeutic modalities for the treatment of patients with PFPS. Data Sources: In May and August 2010, Medline was searched using the following databases: PubMed, CINAHL, Web of Science Citation Index, Science Direct, ProQuest Nursing & Allied Health, and Your Journals@OVID. Study Selection: Selected studies were randomized controlled trials that used a therapeutic modality to treat patients with PFPS. The review included articles with all outcome measures relevant for the PFPS patient: knee extension and flexion strength (isokinetic and isometric), patellofemoral pain assessment during activities of daily life, functional tests (eg, squats), Kujala patellofemoral score, and electromyographic recording from knee flexors and extensors and quadriceps femoris cross-sectional areas. Data Extraction: Authors conducted independent quality appraisals of studies using the PEDro Scale and a system designed for analysis of studies on interventions for patellofemoral pain. Results: Twelve studies met criteria: 1 on the effects of cold and ultrasound together, ice alone, iontophoresis, and phonophoresis; 3, neuromuscular electrical stimulation; 4, electromyographic biofeedback; 3, electrical stimulation for control of pain; and 1, laser. Discussion: Most studies were of low to moderate quality. Some reported that therapeutic modalities, when combined with other treatments, may be of some benefit for pain management or other symptoms. There was no consistent evidence of any beneficial effect when a therapeutic modality was used alone

  12. Moderators and Non-Specific Predictors of Treatment Outcome for Anxiety Disorders : A Comparison of Cognitive Behavioral Therapy to Acceptance and Commitment Therapy

    ERIC Educational Resources Information Center

    Wolitzky-Taylor, Kate B.; Arch, Joanna J.; Rosenfield, David; Craske, Michelle G.

    2012-01-01

    Objective: Understanding for whom, and under what conditions, treatments exert their greatest effects is essential for developing personalized medicine. Research investigating moderators of outcome among evidence-based treatments for anxiety disorders is lacking. The current study examined several theory-driven and atheoretical putative moderators…

  13. Therapeutic efficacy, secondary effects, and patient acceptability of 10% sulfur in either pork fat or cold cream for the treatment of scabies.

    PubMed

    Avila-Romay, A; Alvarez-Franco, M; Ruiz-Maldonado, R

    1991-03-01

    Twenty-six children with scabies and 32 contacts were treated with 10% sulfur in cold cream. A 100% clinical cure rate was observed, although 56.8% of patients experienced some kind of mild, transient cutaneous reaction. An additional 25 children with scabies and 28 contacts were treated with 10% sulfur and 1% salicylic acid in pork fat. Of these, 88% were clinically cured and 73.5% had some cutaneous adverse effects. In both groups, most adverse effects were related to skin dryness or postscabetic reaction. The cold cream base was more acceptable to patients than the pork fat base. However, the pork fat base was significantly cheaper and easier to obtain than the cold cream base, and 238 times less expensive than the cheapest commercial scabicidal medication available in the United States.

  14. Manual for Modal Profile Analysis.

    ERIC Educational Resources Information Center

    Skinner, Harvey A.; Lei, Hau

    Modal Profile Analysis (MPA) is a Fortran IV program for the identification and cross validation of relatively homogenous subgroups within a dimensional or ordination space. This classification approach is designed for use with several samples in a multiple replication design. The program consists of three stages: (1) identification of preliminary…

  15. Modal Filters for Infrared Interferometry

    NASA Technical Reports Server (NTRS)

    Ksendzov, Alexander; MacDonald, Daniel R.; Soibel, Alexander

    2009-01-01

    Modal filters in the approximately equal to 10-micrometer spectral range have been implemented as planar dielectric waveguides in infrared interferometric applications such as searching for Earth-like planets. When looking for a small, dim object ("Earth") in close proximity to a large, bright object ("Sun"), the interferometric technique uses beams from two telescopes combined with a 180 phase shift in order to cancel the light from a brighter object. The interferometer baseline can be adjusted so that, at the same time, the light from the dimmer object arrives at the combiner in phase. This light can be detected and its infrared (IR) optical spectra can be studied. The cancellation of light from the "Sun" to approximately equal to 10(exp 6) is required; this is not possible without special devices-modal filters- that equalize the wavefronts arriving from the two telescopes. Currently, modal filters in the approximately equal to 10-micrometer spectral range are implemented as single- mode fibers. Using semiconductor technology, single-mode waveguides for use as modal filters were fabricated. Two designs were implemented: one using an InGaAs waveguide layer matched to an InP substrate, and one using InAlAs matched to an InP substrate. Photon Design software was used to design the waveguides, with the main feature all designs being single-mode operation in the 10.5- to 17-micrometer spectral range. Preliminary results show that the filter's rejection ratio is 26 dB.

  16. Study modality and false recall.

    PubMed

    Smith, Rebekah E; Engle, Randall W

    2011-01-01

    False memories occur when individuals mistakenly report an event as having taken place when that event did not in fact occur. The DRM (Deese, 1959; Roediger & McDermott, 1995) paradigm provides an effective technique for creating and investigating false memories. In this paradigm participants study a list of words (e.g., SOUR, CANDY,…) that are highly associated to a non-presented critical item (e.g., SWEET). The study phase is followed by a test of memory for the study list words. Researchers typically find very high levels of false recall of the critical non-presented item. However, the likelihood of falsely remembering the non-presented critical items can be reduced by presenting studied associates visually rather than auditorally (e.g., Smith & Hunt, 1998). This is referred to as the modality effect in false memory. The current study investigated the role of resource availability in the expression of this modality effect in false recall. In Experiment 1 false recall was reduced in the visual study presentation condition relative to the auditory condition for participants with higher working memory capacity, but not for participants with lower working memory capacity. In Experiment 2 the effect of study modality on false recall was eliminated by the addition of a divided attention task at encoding. Both studies support the proposal that resource availability plays a role in the expression of the modality effect in the DRM paradigm (Smith, Lozito, & Bayen, 2005).

  17. Imaging modalities in spinal disorders

    SciTech Connect

    Kricun, M.E.

    1986-01-01

    This book provides an approach to the various imaging modalities used to view the spine. It discusses the indications, limitations and practical use of each in the diagnosis, work-up and staging of various spinal disorders, and compares each of them in various clinical settings. Topics covered include low back pain syndrome, disk disease, spinal cord lesions, congenital abnormalities, and trauma.

  18. Arithmetic Memory Is Modality Specific

    PubMed Central

    Myers, Timothy; Szücs, Dénes

    2015-01-01

    In regards to numerical cognition and working memory, it is an open question as to whether numbers are stored into and retrieved from a central abstract representation or from separate notation-specific representations. This study seeks to help answer this by utilizing the numeral modality effect (NME) in three experiments to explore how numbers are processed by the human brain. The participants were presented with numbers (1–9) as either Arabic digits or written number words (Arabic digits and dot matrices in Experiment 2) at the first (S1) and second (S2) stimuli. The participant’s task was to add the first two stimuli together and verify whether the answer (S3), presented simultaneously with S2, was correct. We hypothesized that if reaction time (RT) at S2/S3 depends on the modality of S1 then numbers are retrieved from modality specific memory stores. Indeed, RT depended on the modality of S1 whenever S2 was an Arabic digit which argues against the concept of numbers being stored and retrieved from a central, abstract representation. PMID:26716692

  19. A General Framework for Modal Deduction

    NASA Technical Reports Server (NTRS)

    Frisch, Alan M.; Scherl, Richard B.

    1991-01-01

    A general method of automated modal logic theorem proving is discussed and illustrated. This method is based on the substitutional framework for the development of systems for hybrid reasoning. Sentences in modal logic are translated into a constraint logic in which the constraints represent the connections between worlds in the possible world semantics for modal logic. Deduction in the constraint logic is performed by a non-modal deductive system which has been systematically enhanced with special-purpose constraint processing mechanisms. The result is a modal logic theorem prover, whose soundness and completeness is an immediate consequence of the correctness of the non-modal deductive system and some general results on constraint deduction. The framework achieves significant generality in that it provides for the extension of a wide range of non-modal systems to corresponding modal systems and that can be done for a wide range of modal logics.

  20. Newbery Medal Acceptance.

    ERIC Educational Resources Information Center

    Freedman, Russell

    1988-01-01

    Presents the Newbery Medal acceptance speech of Russell Freedman, writer of children's nonfiction. Discusses the place of nonfiction in the world of children's literature, the evolution of children's biographies, and the author's work on "Lincoln." (ARH)

  1. Diagnosing cardiac disease during pregnancy: imaging modalities.

    PubMed

    Ntusi, Ntobeko A; Samuels, Petronella; Moosa, Sulaiman; Mocumbi, Ana O

    2016-01-01

    Pregnant women with known or suspected cardiovascular disease (CVD) often require cardiovascular imaging during pregnancy. The accepted maximum limit of ionising radiation exposure to the foetus during pregnancy is a cumulative dose of 5 rad. Concerns related to imaging modalities that involve ionising radiation include teratogenesis, mutagenesis and childhood malignancy. Importantly, no single imaging study approaches this cautionary dose of 5 rad (50 mSv or 50 mGy). Diagnostic imaging procedures that may be used in pregnancy include chest radiography, fluoroscopy, echocardiography, invasive angiography, cardiovascular computed tomography, computed tomographic pulmonary angiography, cardiovascular magnetic resonance (CMR) and nuclear techniques. Echocardiography and CMR appear to be completely safe in pregnancy and are not associated with any adverse foetal effects, provided there are no general contra-indications to MR imaging. Concerns related to safety of imaging tests must be balanced against the importance of accurate diagnosis and thorough assessment of the pathological condition. Decisions about imaging in pregnancy are premised on understanding the physiology of pregnancy, understanding basic concepts of ionising radiation, the clinical manifestations of existent CVD in pregnancy and features of new CVD. The cardiologist/physician must understand the indications for and limitations of, and the potential harmful effects of each test during pregnancy. Current evidence suggests that a single cardiovascular radiological study during pregnancy is safe and should be undertaken at all times when clinically justified. In this article, the different imaging modalities are reviewed in terms of how they work, how safe they are and what their clinical utility in pregnancy is. Furthermore, the safety of contrast agents in pregnancy is also reviewed.

  2. Primary combined-modality therapy for esophageal cancer.

    PubMed

    Minsky, Bruce D

    2006-04-01

    Based on positive results from the Radiation Therapy Oncology Group (RTOG) 85-01 trial, the conventional nonsurgical treatment of esophageal carcinoma is combined-modality therapy. Dose intensification of the RTOG 85-01 regimen, examined in the Intergroup (INT)-0123/RTOG 94-05 trial, did not improve local control or survival. Areas of clinical investigation include the development of combined-modality therapy regimens with newer systemic agents, the use of 18F-fluorodeoxyglucose positron-emission tomography to assist in the development of innovative radiation treatment planning techniques, and the identification of prognostic molecular markers. The addition of surgery following primary combined-modality therapy apparently does not improve survival, but this finding is controversial.

  3. Emollient efficacy and acceptability in the treatment of eczematous dry skin: A double-blind, randomised comparison of two UK-marketed products

    PubMed Central

    Djokic-Gallagher, Jasmina; Rosher, Philip; Walker, Jennine; Sykes, Krystyna; Hart, Valerie

    2016-01-01

    Abstract Objective: The aim of this study was to compare the moisturising efficacy and acceptability of physical characteristics of two commonly prescribed emollients licenced in the UK, Doublebase Dayleve gel (DELP) and Diprobase cream (DIPC). Methods: The study was a double-blind, concurrent bi-lateral comparison in female eczema subjects with dry skin. Results: In Part 1, comparing the area under the curve (AUC) change from baseline corneometer readings over 24 h following single applications of the emollients to the volar forearms of 34 subjects, the AUC for DELP was more than three times that seen for DIPC (p < 0.0001). In Part 2, comparing the same outcome measured over 5 days of twice daily applications to the lower legs in 36 subjects, the AUC for DELP was approximately five times that for DIPC (p < 0.0001). 69% of subjects “Like Slightly” or “Like Strongly” DELP compared to 33% for DIPC (p = 0.025). 72% indicated they would use DELP again compared to 33% for DIPC (p = 0.033). 75% of subjects preferred DELP, 17% preferred DIPC and 8% expressed no preference (p = 0.0004). PMID:26864095

  4. Vocabulary acquisition in aphasia: Modality can matter.

    PubMed

    Tuomiranta, Leena; Grönroos, Ann-Mari; Martin, Nadine; Laine, Matti

    2014-11-01

    The present case study investigated modality-specific aspects of novel word acquisition in aphasia. It was prompted by recent aphasia case studies indicating great interindividual variability in the ability to learn and maintain novel words in aphasia. Moreover, two previous case studies revealed a striking effect of input modality by showing effective word learning and re-learning via visual input only (Kohen, Sola, Tuomiranta, Laine, & Martin, 2012; Tuomiranta et al., 2014). The present participant TS with chronic nonfluent aphasia and post-semantic anomia was administered novel word-referent learning tasks. In the first experiment, the learning phase included simultaneous phonological and orthographic input, while the follow-up was probed separately for spoken and written responses. In the second experiment, we studied the effect of four different input and output modality combinations on her ability to learn to name the novel items. In the first experiment, TS's spoken naming performance during the learning phase was just within the range of healthy controls. Maintenance declined and remained outside that range during the whole 6-month follow-up. However, TS maintained the learned words better in written than in spoken naming throughout the follow-up, and in written naming, her maintenance stayed within the control's range up to 8 weeks post-training. The second experiment indicated that the best learning outcome was achieved with orthographic input. Orthographic input combined with orthographic output resulted in fast and accurate learning of the novel words. Interestingly, TS's test profile was opposite to her learning profile, as she repeated better than she read aloud in the linguistic background assessment. The results from the present case highlight the importance of multiple learning channels for word acquisition in individuals with aphasia. Probing the functionality of different input and output channels for learning may also prove valuable in tailoring

  5. a Logic-Algebraic Framework for Contextuality and Modality in Quantum Systems

    NASA Astrophysics Data System (ADS)

    Freytes, Hector

    2014-03-01

    In this work we develop a modal structure for the simultaneous treatment of actual and possible properties of quantum systems. A logical system based on orthomodular lattices enriched with a modal operator is given, obtaining algebraic completeness and completeness with respect to a Kripke-style semantic. We show that, in spite of the fact that, the language is enriched with the addition of a modal operator, contextuality remains a central feature of quantum systems.

  6. The acceptability and feasibility of the Positive Reinforcement Opportunity Project, a community-based contingency management methamphetamine treatment program for gay and bisexual men in San Francisco.

    PubMed

    Strona, Frank V; McCright, Jacque; Hjord, Hanna; Ahrens, Katherine; Tierney, Steven; Shoptaw, Steven; Klausner, Jeffrey D

    2006-11-01

    The Positive Reinforcement Opportunity Project (PROP) was a pilot program developed to build on the efficacy of contingency management (CM) using positive reinforcement to address the treatment needs of gay and bisexual men currently using crystal methamphetamines (meth). It was hypothesized that a version of CM could be implemented in San Francisco that was less costly than traditional treatment methods and reached gay and other MSM using meth who also engaged in high-risk sexual activity. Of the 178 men who participated in PROPfrom December 2003 to December 2005, many self-reported behaviors for acquiring and spreading sexually transmitted diseases including HIV infection. During the initial intake, 73% reported high-risk sexual behavior in the prior three months, with 60% reporting anal receptive and/or insertive sex without condoms. This report describes the implementation of PROP and suggest both its limitations and potential strengths. Initial findings suggest that PROP was a useful and low cost substance use treatment option that resulted in a 35% 90-day completion rate, which is similar to graduation rates from traditional, more costly treatment options. Further evaluation of the limited data from three- and six-month follow-up of those who completed PROP is currently ongoing.

  7. Modal Analysis for Grid Operation

    SciTech Connect

    2011-03-03

    MANGO software is to provide a solution for improving small signal stability of power systems through adjusting operator-controllable variables using PMU measurement. System oscillation problems are one of the major threats to the grid stability and reliability in California and the Western Interconnection. These problems result in power fluctuations, lower grid operation efficiency, and may even lead to large-scale grid breakup and outages. This MANGO software aims to solve this problem by automatically generating recommended operation procedures termed Modal Analysis for Grid Operation (MANGO) to improve damping of inter-area oscillation modes. The MANGO procedure includes three steps: recognizing small signal stability problems, implementing operating point adjustment using modal sensitivity, and evaluating the effectiveness of the adjustment. The MANGO software package is designed to help implement the MANGO procedure.

  8. Review of Smartphone Applications for the Treatment of Eating Disorders

    PubMed Central

    Juarascio, Adrienne S.; Manasse, Stephanie M.; Goldstein, Stephanie P.; Forman, Evan M.; Butryn, Meghan L.

    2016-01-01

    mHealth tools may be a feasible modality for delivering evidence-based treatments and principles (EBPs), and may enhance treatment for eating disorders (EDs). However, research on the efficacy of mHealth tools for EDs and the extent to which they include EBPs is lacking. The current study sought to (i) review existing apps for EDs, (ii) determine the extent to which available treatment apps utilize EBPs, and (iii) assess the degree to which existing smartphone apps utilize recent advances in smartphone technology. Overall, existing ED intervention apps contained minimal EBPs and failed to incorporate smartphone capabilities. For smartphone apps to be a feasible and effective ED treatment modality, it may be useful for creators to begin taking utilizing the abilities that set smartphones apart from in-person treatment while incorporating EBPs. Before mHealth tools are incorporated into treatments for EDs, it is necessary that the feasibility, acceptability, and efficacy be evaluated. PMID:25303148

  9. Green-Kubo Modal Analysis

    NASA Astrophysics Data System (ADS)

    Henry, Asegun

    A new method for direct calculation of the modal contributions to thermal conductivity, which is termed Green-Kubo modal analysis (GKMA) will be presented. The GKMA method combines the lattice dynamics formalism with the Green-Kubo formula for thermal conductivity, such that the thermal conductivity becomes a direct summation of modal contributions, where one need not define the phonon velocity. As a result, the GKMA method can be applied to any material/group of atoms, where the atoms vibrate around stable equilibrium positions, which includes crystalline line compounds, non-stoichiometric compounds, random alloys, amorphous materials and even rigid molecules. By using molecular dynamics simulations to obtain the time history of each mode's contribution to the heat current, one naturally includes anharmonicity to full order and can obtain insight into the interactions between different modes through the cross-correlations. Several example materials will be discussed and the specific attention will be devoted to new fundamental questions that arise from the changes in mode character that occur in disordered systems. The GKMA method provides new insight into the nature of phonon transport, as it casts the problem in terms of mode-mode correlation instead of scattering, and provides a general unified formalism that can be used to understand phonon-phonon interactions in essentially any class of materials or structures where the atoms vibrate around stable equilibrium sites.

  10. Accepting space radiation risks.

    PubMed

    Schimmerling, Walter

    2010-08-01

    The human exploration of space inevitably involves exposure to radiation. Associated with this exposure are multiple risks, i.e., probabilities that certain aspects of an astronaut's health or performance will be degraded. The management of these risks requires that such probabilities be accurately predicted, that the actual exposures be verified, and that comprehensive records be maintained. Implicit in these actions is the fact that, at some point, a decision has been made to accept a certain level of risk. This paper examines ethical and practical considerations involved in arriving at a determination that risks are acceptable, roles that the parties involved may play, and obligations arising out of reliance on the informed consent paradigm seen as the basis for ethical radiation risk acceptance in space.

  11. Antitumor effects of electrochemical treatment

    PubMed Central

    González, Maraelys Morales; Zamora, Lisset Ortíz; Cabrales, Luis Enrique Bergues; Sierra González, Gustavo Victoriano; de Oliveira, Luciana Oliveira; Zanella, Rodrigo; Buzaid, Antonio Carlos; Parise, Orlando; Brito, Luciana Macedo; Teixeira, Cesar Augusto Antunes; Gomes, Marina das Neves; Moreno, Gleyce; Feo da Veiga, Venicio; Telló, Marcos; Holandino, Carla

    2013-01-01

    Electrochemical treatment is an alternative modality for tumor treatment based on the application of a low intensity direct electric current to the tumor tissue through two or more platinum electrodes placed within the tumor zone or in the surrounding areas. This treatment is noted for its great effectiveness, minimal invasiveness and local effect. Several studies have been conducted worldwide to evaluate the antitumoral effect of this therapy. In all these studies a variety of biochemical and physiological responses of tumors to the applied treatment have been obtained. By this reason, researchers have suggested various mechanisms to explain how direct electric current destroys tumor cells. Although, it is generally accepted this treatment induces electrolysis, electroosmosis and electroporation in tumoral tissues. However, action mechanism of this alternative modality on the tumor tissue is not well understood. Although the principle of Electrochemical treatment is simple, a standardized method is not yet available. The mechanism by which Electrochemical treatment affects tumor growth and survival may represent more complex process. The present work analyzes the latest and most important research done on the electrochemical treatment of tumors. We conclude with our point of view about the destruction mechanism features of this alternative therapy. Also, we suggest some mechanisms and strategies from the thermodynamic point of view for this therapy. In the area of Electrochemical treatment of cancer this tool has been exploited very little and much work remains to be done. Electrochemical treatment constitutes a good therapeutic option for patients that have failed the conventional oncology methods. PMID:23592904

  12. Why was Relativity Accepted?

    NASA Astrophysics Data System (ADS)

    Brush, S. G.

    Historians of science have published many studies of the reception of Einstein's special and general theories of relativity. Based on a review of these studies, and my own research on the role of the light-bending prediction in the reception of general relativity, I discuss the role of three kinds of reasons for accepting relativity (1) empirical predictions and explanations; (2) social-psychological factors; and (3) aesthetic-mathematical factors. According to the historical studies, acceptance was a three-stage process. First, a few leading scientists adopted the special theory for aesthetic-mathematical reasons. In the second stage, their enthusiastic advocacy persuaded other scientists to work on the theory and apply it to problems currently of interest in atomic physics. The special theory was accepted by many German physicists by 1910 and had begun to attract some interest in other countries. In the third stage, the confirmation of Einstein's light-bending prediction attracted much public attention and forced all physicists to take the general theory of relativity seriously. In addition to light-bending, the explanation of the advance of Mercury's perihelion was considered strong evidence by theoretical physicists. The American astronomers who conducted successful tests of general relativity became defenders of the theory. There is little evidence that relativity was `socially constructed' but its initial acceptance was facilitated by the prestige and resources of its advocates.

  13. UGV acceptance testing

    NASA Astrophysics Data System (ADS)

    Kramer, Jeffrey A.; Murphy, Robin R.

    2006-05-01

    With over 100 models of unmanned vehicles now available for military and civilian safety, security or rescue applications, it is important to for agencies to establish acceptance testing. However, there appears to be no general guidelines for what constitutes a reasonable acceptance test. This paper describes i) a preliminary method for acceptance testing by a customer of the mechanical and electrical components of an unmanned ground vehicle system, ii) how it has been applied to a man-packable micro-robot, and iii) discusses the value of testing both to ensure that the customer has a workable system and to improve design. The test method automated the operation of the robot to repeatedly exercise all aspects and combinations of components on the robot for 6 hours. The acceptance testing process uncovered many failures consistent with those shown to occur in the field, showing that testing by the user does predict failures. The process also demonstrated that the testing by the manufacturer can provide important design data that can be used to identify, diagnose, and prevent long-term problems. Also, the structured testing environment showed that sensor systems can be used to predict errors and changes in performance, as well as uncovering unmodeled behavior in subsystems.

  14. Approaches to acceptable risk

    SciTech Connect

    Whipple, C.

    1997-04-30

    Several alternative approaches to address the question {open_quotes}How safe is safe enough?{close_quotes} are reviewed and an attempt is made to apply the reasoning behind these approaches to the issue of acceptability of radiation exposures received in space. The approaches to the issue of the acceptability of technological risk described here are primarily analytical, and are drawn from examples in the management of environmental health risks. These include risk-based approaches, in which specific quantitative risk targets determine the acceptability of an activity, and cost-benefit and decision analysis, which generally focus on the estimation and evaluation of risks, benefits and costs, in a framework that balances these factors against each other. These analytical methods tend by their quantitative nature to emphasize the magnitude of risks, costs and alternatives, and to downplay other factors, especially those that are not easily expressed in quantitative terms, that affect acceptance or rejection of risk. Such other factors include the issues of risk perceptions and how and by whom risk decisions are made.

  15. Causality and cross-modal integration.

    PubMed

    Schutz, Michael; Kubovy, Michael

    2009-12-01

    Schutz and Lipscomb (2007) reported an audiovisual illusion in which the length of the gesture used to produce a sound altered the perception of that sound's duration. This contradicts the widely accepted claim that the auditory system generally dominates temporal tasks because of its superior temporal acuity. Here, in the first of 4 experiments, we show that impact gestures influence duration ratings of percussive but not sustained sounds. In the 2nd, we show that the illusion is present even if the percussive sound occurs up to 700 ms after the visible impact, but disappears if the percussive sound precedes the visible impact. In the 3rd experiment, we show that only the motion after the visible impact influences perceived tone duration. The 4th experiment (replacing the impact gestures with the written text long and short) suggests that the phenomenon is not due to response bias. Given that visual influence in this paradigm is dependent on the presence of an ecologically plausible audiovisual relationship, we conclude that cross-modal causality plays a key role in governing the integration of sensory information.

  16. Modality and Task Switching Interactions using Bi-Modal and Bivalent Stimuli

    ERIC Educational Resources Information Center

    Sandhu, Rajwant; Dyson, Benjamin J.

    2013-01-01

    Investigations of concurrent task and modality switching effects have to date been studied under conditions of uni-modal stimulus presentation. As such, it is difficult to directly compare resultant task and modality switching effects, as the stimuli afford both tasks on each trial, but only one modality. The current study investigated task and…

  17. Noise elimination algorithm for modal analysis

    SciTech Connect

    Bao, X. X.; Li, C. L.; Xiong, C. B.

    2015-07-27

    Modal analysis is an ongoing interdisciplinary physical issue. Modal parameters estimation is applied to determine the dynamic characteristics of structures under vibration excitation. Modal analysis is more challenging for the measured vibration response signals are contaminated with noise. This study develops a mathematical algorithm of structured low rank approximation combined with the complex exponential method to estimate the modal parameters. Physical experiments using a steel cantilever beam with ten accelerometers mounted, excited by an impulse load, demonstrate that this method can significantly eliminate noise from measured signals and accurately identify the modal frequencies and damping ratios. This study provides a fundamental mechanism of noise elimination using structured low rank approximation in physical fields.

  18. Modal Mineralogy of Lunar Soils

    NASA Astrophysics Data System (ADS)

    Taylor, J.; Martel, L.; Lucey, P. G.; Crites, S. T.; Blake, D. F.

    2012-12-01

    Modal mineralogy of the lunar regolith is fundamentally important. It varies with the composition of underlying bedrock, extent of addition of materials excavated by impact both local and distant, and small-scale reworking by micrometeorite bombardment, so it contains information about local geological history. Determining modal mineralogy of soils provides vital ground truth to remote sensing studies. Mineralogy can be determined by a variety of techniques that provide complementary information: X-Ray Diffraction (XRD), optical point counting, element mapping by scanning electron microscopy (SEM) or electron microprobe (EMP), and normative calculation from a bulk chemical analysis. SEM and EMP element mapping can be converted into mineral modal abundances in a variety of ways, including defining compositional windows for specific minerals and using image processing techniques. XRD provides direct determination of the phases present, but gives little information about the chemical composition of those phases. We have launched a project to determine the modal mineralogy of over 100 lunar soils from all Apollo sites. The goal is to use this quantitative mineralogy and laboratory and remote reflectance spectra of the same soils to improve our ability to extract quantitative mineralogy from remote sensing data. Samples (< 1mm bulk soils) were dry-sieved and the <150 micron fractions analyzed in a Terra XRD instrument (InXitu, Inc.) using sample sizes of ~35 mg. We reduced the data using Reitveld refinement as implemented by the Jade program (Materials Data, Inc.). Glass abundances were determined by choosing a linear background and fitting a broad Gaussian to the scattering hump above background. Quantitative XRD is well established, but usually requires some calibration, in spite of the sophisticated Reitveld refinement and whole-pattern fitting. We calibrated the instrument by using mixtures of terrestrial minerals and results from the Lunar Sample Characterization

  19. Monte Carlo simulations of medical imaging modalities

    SciTech Connect

    Estes, G.P.

    1998-09-01

    Because continuous-energy Monte Carlo radiation transport calculations can be nearly exact simulations of physical reality (within data limitations, geometric approximations, transport algorithms, etc.), it follows that one should be able to closely approximate the results of many experiments from first-principles computations. This line of reasoning has led to various MCNP studies that involve simulations of medical imaging modalities and other visualization methods such as radiography, Anger camera, computerized tomography (CT) scans, and SABRINA particle track visualization. It is the intent of this paper to summarize some of these imaging simulations in the hope of stimulating further work, especially as computer power increases. Improved interpretation and prediction of medical images should ultimately lead to enhanced medical treatments. It is also reasonable to assume that such computations could be used to design new or more effective imaging instruments.

  20. Acceptance and Mindfulness in Behavior Therapy: A Comparison of Dialectical Behavior Therapy and Acceptance and Commitment Therapy

    ERIC Educational Resources Information Center

    Chapman, Alexander L.

    2006-01-01

    Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) are both innovative behavioral treatments that incorporate mindfulness practices and acceptance-based interventions into their treatment packages. Although there are many similarities between these treatments, including the fact that they are part of a newer "wave" in…

  1. Modal Identification Experiment accommodations review

    NASA Technical Reports Server (NTRS)

    Klich, Phillip J.; Stillwagen, Frederic H.; Mutton, Philip

    1994-01-01

    The Modal Identification Experiment (MIE) will monitor the structure of the Space Station Freedom (SSF), and measure its response to a sequence of induced disturbances. The MIE will determine the frequency, damping, and shape of the important modes during the SSF assembly sequence including the Permanently Manned Configuration. This paper describes the accommodations for the proposed instrumentation, the data processing hardware, and the communications data rates. An overview of the MIE operational modes for measuring SSF acceleration forces with accelerometers is presented. The SSF instrumentation channel allocations and the Data Management System (DMS) services required for MIE are also discussed.

  2. Performance acceptance test of a portable instrument to detect uranium in water at the DOE Advanced Waste Water Treatment Plant, Fernald, Ohio

    SciTech Connect

    Anderson, M.S.; Weeks, S.J.

    1997-03-28

    The Eppendorf-Biotronik Model IC 2001-2, a portable field ruggedized ion chromatography instrument, was rigorously tested at the DOE Advanced Waste Water Treatment Plant, Fernald, Ohio. This instrument rapidly detected the uranium concentration in water, and has a detection limit in the low ppb range without using the sample concentrating feature. The test set of samples analyzed included: ``Real World`` water samples from the AWWT containing uranium concentrations in the 9--110 ppb range, a sample blank, and a performance evaluation sample. The AWWT samples contained sets of both raw water and acid-preserved water samples. Selected samples were analyzed in quadruplicate to asses the instrument`s precision, and these results were compared with the results from an off-site confirmatory laboratory to assess the instrument`s accuracy. Additional comparisons with on-site laboratory instruments, Chemcheck KPA-11 and Scintrex UA-3 are reported. Overall, the Eppendorf-Biotronik IC 2001-2 performed exceptionally well providing a detection limit in the low ppb region (< 10 ppb) and giving rapid (< 5 minutes) accurate and reproducible analytical results for the AWWT, ``real world``, water samples with uranium concentrations in the region of interest (10--40 ppb). The per sample operating cost for this instrument is equivalent to the per sample cost for the currently used KPA. The time required to analyze a sample and provide a result is approximately the same for the CI 2001-2, KPA, and Scintrex instruments.

  3. Acceptability of human risk.

    PubMed

    Kasperson, R E

    1983-10-01

    This paper has three objectives: to explore the nature of the problem implicit in the term "risk acceptability," to examine the possible contributions of scientific information to risk standard-setting, and to argue that societal response is best guided by considerations of process rather than formal methods of analysis. Most technological risks are not accepted but are imposed. There is also little reason to expect consensus among individuals on their tolerance of risk. Moreover, debates about risk levels are often at base debates over the adequacy of the institutions which manage the risks. Scientific information can contribute three broad types of analyses to risk-setting deliberations: contextual analysis, equity assessment, and public preference analysis. More effective risk-setting decisions will involve attention to the process used, particularly in regard to the requirements of procedural justice and democratic responsibility.

  4. Acceptability of human risk.

    PubMed Central

    Kasperson, R E

    1983-01-01

    This paper has three objectives: to explore the nature of the problem implicit in the term "risk acceptability," to examine the possible contributions of scientific information to risk standard-setting, and to argue that societal response is best guided by considerations of process rather than formal methods of analysis. Most technological risks are not accepted but are imposed. There is also little reason to expect consensus among individuals on their tolerance of risk. Moreover, debates about risk levels are often at base debates over the adequacy of the institutions which manage the risks. Scientific information can contribute three broad types of analyses to risk-setting deliberations: contextual analysis, equity assessment, and public preference analysis. More effective risk-setting decisions will involve attention to the process used, particularly in regard to the requirements of procedural justice and democratic responsibility. PMID:6418541

  5. Acceptance Test Plan.

    DTIC Science & Technology

    2014-09-26

    7 RD-Ai507 154 CCEPTANCE TEST PLN(U) WESTINGHOUSE DEFENSE ND i/i ELECTRO ICS CENTER BALTIMORE MD DEVELOPMENT AND OPERATIONS DIY D C KRRiJS 28 JUN...Ln ACCEPTANCE TEST PLAN FOR SPECIAL RELIABILITY TESTS FOR BROADBAND MICROWAVE AMPLIFIER PANEL David C. Kraus, Reliability Engineer WESTINGHOUSE ...ORGANIZATION b. OFFICE SYMBOL 7g& NAME OF MONITORING ORGANIZATION tIf appdeg ble) WESTINGHOUSE ELECTRIC CORP. - NAVAL RESEARCH LABORATORY e. AOORES$ (Ci7t

  6. Motivating Low Socioeconomic Status Smokers to Accept Evidence-Based Smoking Cessation Treatment: A Brief Intervention for the Community Agency Setting

    PubMed Central

    Reeder, Kevin M.; TerBeek, Erin G.; Fiore, Michael C.; Baker, Timothy B.

    2015-01-01

    Introduction: Individuals of low socioeconomic status (SES), smoke at very high rates but make fewer and less successful quit attempts than do other smokers. Low-SES smokers have specific beliefs about smoking and quitting that may serve as barriers to making quit attempts. The purpose of this study was to test the impact of a brief intervention addressing these beliefs on making calls to a telephone quit line. Methods: Of 522 smokers entering the study at 5 Wisconsin Salvation Army (SA) sites, 102 expressed motivation to quit and served as a comparison group. The remaining 420 smokers were not motivated to quit and were randomly assigned to 1 of 3 conditions: an intervention group who received brief counseling focused on cessation goals and beliefs, an attention-control group, and a low contact control group. The primary outcome was the rate at which smokers made a call to the Wisconsin tobacco quit line (WTQL) during their SA visit. Secondary outcome measures included motivational variables, stage of change, changes in beliefs about smoking and quitting, and self-reported abstinence. Results: Unmotivated participants in the intervention condition called the WTQL at a significantly higher rate (12.2%) than did those in the 2 control conditions (2.2% and 1.4%) (p < .01) and approached the rate of calling by participants who were initially motivated to quit (15.7%). Intervention condition participants also showed improved motivation to quit and stage of change. Conclusions: A brief, targeted motivational intervention focusing on cessation goals and beliefs increased the initiation of an evidence-based tobacco cessation treatment by low-SES smokers. PMID:26180226

  7. Age and Acceptance of Euthanasia.

    ERIC Educational Resources Information Center

    Ward, Russell A.

    1980-01-01

    Study explores relationship between age (and sex and race) and acceptance of euthanasia. Women and non-Whites were less accepting because of religiosity. Among older people less acceptance was attributable to their lesser education and greater religiosity. Results suggest that quality of life in old age affects acceptability of euthanasia. (Author)

  8. Graduate Student Perceptions of Multi-Modal Tablet Use in Academic Environments

    ERIC Educational Resources Information Center

    Bryant, Ezzard C., Jr.

    2016-01-01

    The purpose of this study was to explore graduate student perceptions of use and the ease of use of multi-modal tablets to access electronic course materials, and the perceived differences based on students' gender, age, college of enrollment, and previous experience. This study used the Unified Theory of Acceptance and Use of Technology to…

  9. The PACT study protocol: a time series study investigating the impact, acceptability and cost of an integrated model for psychosocial screening, care and treatment of patients with urological and head and neck cancers

    PubMed Central

    Girgis, Afaf; Kelly, Brian; Boyes, Allison; Haas, Marion; Viney, Rosalie; Descallar, Joseph; Candler, Hayley; Bellamy, Douglas; Proietto, Anthony

    2014-01-01

    Introduction While there is good evidence of the effectiveness of a variety of interventions and services to prevent and/or relieve distress experienced by people affected by cancer, much of this psychosocial morbidity is undetected and untreated, with consequent exacerbated suffering, decreased satisfaction with care, impaired adherence to treatment regimens and poorer morbidity and mortality outcomes. The objective of this study is to develop, implement and assess the impact, acceptability and cost of an integrated, patient-centred Psychosocial Assessment, Care and Treatment (PACT) model of care for patients with urological and head and neck cancers. Methods and analysis A time series research design will be used to test the PACT model of care, newly introduced in an Australian tertiary hospital. The primary outcome is system-level impact, assessed through audit of patients’ medical records and Medicare claims for follow-up care. The secondary outcomes are impact of the model on patients' experience and healthcare professionals’ (HCPs) knowledge and confidence, assessed via patient and HCP surveys at baseline and at follow-up. Acceptability of the intervention will be assessed through HCP interviews at follow-up, and cost will be assessed from Medicare and Pharmaceutical Benefits Scheme claims information and information logged pertaining to intervention activities (eg, time spent by the newly appointed psycho-oncology staff in direct patient contact, providing training sessions, engaging in case review) and their associated costs (eg, salaries, training materials and videoconferencing). Ethics and dissemination Ethics approval was obtained from the Human Research Ethics Committees of Hunter New England Local Health District and the University of NSW. Results The results will be widely disseminated to the funding body and through peer-reviewed publications, HCP and consumer publications, oncology conferences and meetings. Trial registration The study is

  10. Protocol for a multicentre study to assess feasibility, acceptability, effectiveness and direct costs of TRIumPH (Treatment and Recovery In PsycHosis): integrated care pathway for psychosis

    PubMed Central

    Rathod, Shanaya; Garner, Christie; Griffiths, Alison; Dimitrov, Borislav D; Newman-Taylor, Katherine; Woodfine, Chris; Hansen, Lars; Tabraham, Paul; Ward, Karen; Asher, Carolyn; Phiri, Peter; Naeem, Farooq; North, Pippa; Munshi, Tariq; Kingdon, David

    2016-01-01

    Introduction Duration of untreated psychosis (time between the onset of symptoms and start of treatment) is considered the strongest predictor of symptom severity and outcome. Integrated care pathways that prescribe timeframes around access and interventions can potentially improve quality of care. Methods and analysis A multicentre mixed methods study to assess feasibility, acceptability, effectiveness and analysis of direct costs of an integrated care pathway for psychosis. A pragmatic, non-randomised, controlled trial design is used to compare the impact of Treatment and Recovery In PsycHosis (TRIumPH; Intervention) by comparison between NHS organisations that adopt TRIumPH and those that continue with care as usual (Control). Quantitative and qualitative methods will be used. We will use routinely collected quantitative data and study-specific questionnaires and focus groups to compare service user outcomes, satisfaction and adherence to intervention between sites that adopt TRIumPH versus sites that continue with usual care pathways. Setting 4 UK Mental health organisations. Two will implement TRIumPH whereas two will continue care as usual. Participants Staff, carers, individuals accepted to early intervention in psychosis teams in participating organisations for the study period. Intervention TRIumPH—Integrated Care Pathway for psychosis that has a holistic approach and prescribes time frames against interventions; developed using intelligence from data; co-produced with patients, carers, clinicians and other stakeholders. Outcomes Feasibility will be assessed through adherence to the process measures. Satisfaction and acceptability will be assessed using questionnaires and focus groups. Effectiveness will be assessed through data collection and evaluation of patient outcomes, including clinical, functional and recovery outcomes, physical health, acute care use. Outcome measures will be assessed at baseline, 12 and 24 months to measure whether there is

  11. How to Meet the Neighbors: Modality Effects on Phonological Generalization

    PubMed Central

    Gierut, Judith A.; Morrisette, Michele L.

    2015-01-01

    Long-term auditory priming of words from dense neighborhoods has been posited as a learning mechanism that affects change in the phonological structure of children’s lexical representations. An apparent confound associated with the modality of priming responsible for structural change has been introduced in the literature, which challenges this proposal. Thus, our purpose was to evaluate prime modality in treatment of children with phonological delay. Nine children were assigned to auditory-visual, auditory or visual priming of words from dense neighborhoods prior to treatment of production as the independent variable. The dependent variable was phonological generalization. Results showed that auditory priming (with or without visual input) promoted greater generalization on an order of magnitude of 3:1. Findings support the theoretical significance of auditory priming for phonological learning and demonstrate the applied utility of priming in clinical treatment. PMID:25000373

  12. Task-specific transfer of perceptual learning across sensory modalities.

    PubMed

    McGovern, David P; Astle, Andrew T; Clavin, Sarah L; Newell, Fiona N

    2016-01-11

    It is now widely accepted that primary cortical areas of the brain that were once thought to be sensory-specific undergo significant functional reorganisation following sensory deprivation. For instance, loss of vision or audition leads to the brain areas normally associated with these senses being recruited by the remaining sensory modalities [1]. Despite this, little is known about the rules governing crossmodal plasticity in people who experience typical sensory development, or the potential behavioural consequences. Here, we used a novel perceptual learning paradigm to assess whether the benefits associated with training on a task in one sense transfer to another sense. Participants were randomly assigned to a spatial or temporal task that could be performed visually or aurally, which they practiced for five days; before and after training, we measured discrimination thresholds on all four conditions and calculated the extent of transfer between them. Our results show a clear transfer of learning between sensory modalities; however, generalisation was limited to particular conditions. Specifically, learned improvements on the spatial task transferred from the visual domain to the auditory domain, but not vice versa. Conversely, benefits derived from training on the temporal task transferred from the auditory domain to visual domain, but not vice versa. These results suggest a unidirectional transfer of perceptual learning from dominant to non-dominant sensory modalities and place important constraints on models of multisensory processing and plasticity.

  13. High acceptance recoil polarimeter

    SciTech Connect

    The HARP Collaboration

    1992-12-05

    In order to detect neutrons and protons in the 50 to 600 MeV energy range and measure their polarization, an efficient, low-noise, self-calibrating device is being designed. This detector, known as the High Acceptance Recoil Polarimeter (HARP), is based on the recoil principle of proton detection from np[r arrow]n[prime]p[prime] or pp[r arrow]p[prime]p[prime] scattering (detected particles are underlined) which intrinsically yields polarization information on the incoming particle. HARP will be commissioned to carry out experiments in 1994.

  14. Baby-Crying Acceptance

    NASA Astrophysics Data System (ADS)

    Martins, Tiago; de Magalhães, Sérgio Tenreiro

    The baby's crying is his most important mean of communication. The crying monitoring performed by devices that have been developed doesn't ensure the complete safety of the child. It is necessary to join, to these technological resources, means of communicating the results to the responsible, which would involve the digital processing of information available from crying. The survey carried out, enabled to understand the level of adoption, in the continental territory of Portugal, of a technology that will be able to do such a digital processing. It was used the TAM as the theoretical referential. The statistical analysis showed that there is a good probability of acceptance of such a system.

  15. New Ultrasound Modalities in Rheumatology.

    PubMed

    Gutierrez, Marwin; Okano, Tadashi; Reginato, Anthony M; Cazenave, Tomas; Ventura-Rios, Lucio; Bertolazzi, Chiara; Pineda, Carlos

    2015-12-01

    Over the years, ultrasound (US) has accumulated important evidence supporting its relevant role for the assessment of inflammatory processes of different rheumatologic diseases, as well as in the follow-up in assessing the response to different therapeutic approaches. This has been possible because of the increase in training, competency, and knowledge, as well as the rapid progress in the US technologies.Currently, some US machines can be equipped by sophisticated software modalities (i.e., 3-dimensional US, elastosonography, automated cardiovascular software, and fusion imaging) that can augment US traditional role as a safe, fast, and easy-to-perform modality and giving it new life and increased relevance in rheumatology. In this article, we evaluated the US developments, from conventional B-mode to more sophisticated technologies, and their potential clinical impact in the field of rheumatology.Three-dimensional US can improve the accuracy of the assessment of bone erosions and the quantification of power Doppler because of its multiplanar view including coronal, axial and sagital view. Elastosonography is still looking for its role in rheumatology. Preliminary works induce us to consider it as a promise tool for the assessment of tendon pathology and skin of patients with connective tissue disorders. The automated method for the measurement of carotid intima-media thickness permits a rapid and accurate assessment. The preliminary published data showed that it is reliable, and valid compared to the traditional method; they also support the future of rheumatologists as the direct operators in evaluating the cardiovascular risk in daily practice. Fusion imaging increases the diagnostic power of US, displaying simultaneously in the monitor, the US image, and the corresponding computed tomography/magnetic resonance imaging image. However, there are no sufficient data supporting its application in daily rheumatologic practice.

  16. The Brustkrebs-Studien.de website for breast cancer patients: User acceptance of a German internet portal offering information on the disease and treatment options, and a clinical trials matching service

    PubMed Central

    2010-01-01

    Background The internet portal http://www.brustkrebs-studien.de (BKS) was launched in 2000 by the German Society of Senology (DGS) and the Baden-Württemberg Institute for Women's Health (IFG) to provide expert-written information on breast cancer online and to encourage and facilitate the participation of breast cancer patients in clinical trials. We describe the development of BKS and its applications, and report on website statistics and user acceptance. Methods Existing registries, including ClinicalTrials.gov, were analysed before we designed BKS, which combines a trial registry, a knowledge portal, and an online second opinion service. An advisory board guided the process. Log files and patient enquiries for trial participation and second opinions were analysed. A two-week user satisfaction survey was conducted online. Results During 10/2005-06/2010, the portal attracted 702,655 visitors, generating 15,507,454 page views. By 06/2010, the website's active scientific community consisted of 189 investigators and physicians, and the registry covered 163 clinical trial protocols. In 2009, 143 patients requested trial enrolment and 119 sought second opinions or individual treatment advice from the expert panel. During the two-week survey in 2008, 5,702 BKS visitors submitted 507 evaluable questionnaires. Portal acceptance was high. Respondents trusted information correctness (80%), welcomed self-matching to clinical trials (79%) and planned to use the portal in the future (76%)