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Sample records for actual clinical performance

  1. Does medical students’ clinical performance affect their actual performance during medical internship?

    PubMed Central

    Han, Eui-Ryoung; Chung, Eun-Kyung

    2016-01-01

    INTRODUCTION This study examines the relationship between the clinical performance of medical students and their performance as doctors during their internships. METHODS This retrospective study involved 63 applicants of a residency programme conducted at Chonnam National University Hospital, South Korea, in November 2012. We compared the performance of the applicants during their internship with their clinical performance during their fourth year of medical school. The performance of the applicants as interns was periodically evaluated by the faculty of each department, while their clinical performance as fourth-year medical students was assessed using the Clinical Performance Examination (CPX) and the Objective Structured Clinical Examination (OSCE). RESULTS The performance of the applicants as interns was positively correlated with their clinical performance as fourth-year medical students, as measured by the CPX and OSCE. The performance of the applicants as interns was moderately correlated with the patient-physician interaction items addressing communication and interpersonal skills in the CPX. CONCLUSION The clinical performance of medical students during their fourth year in medical school was related to their performance as medical interns. Medical students should be trained to develop good clinical skills through actual encounters with patients or simulated encounters using manikins, to enable them to become more competent doctors. PMID:26768172

  2. Does Simulator-Based Clinical Performance Correlate with Actual Hospital Behavior? The Effect of Extended Work Hours on Patient Care Provided by Medical Interns

    PubMed Central

    Gordon, James A.; Alexander, Erik K.; Lockley, Steven W.; Flynn-Evans, Erin; Venkatan, Suresh K.; Landrigan, Christopher P.; Czeisler, Charles A.

    2013-01-01

    Purpose The correlation between simulator-based medical performance and real-world behavior remains unclear. The authors conducted this study to explore whether the effects of extended work hours on clinical performance, as reported in prior hospital-based studies, could be observed in a simulator-based testing environment. Method Intern volunteers reported to the simulator laboratory in a rested state and again in a sleep-deprived state (after a traditional 24–30 hour overnight shift [n=17]). A subset also presented after a shortened overnight shift (maximum of 16 scheduled hours [n=8]). During each laboratory visit, participants managed two critically ill patients. An on-site physician scored each case, as did a blinded rater later watching videotapes of the performances (score=1 [worst] to 8 [best]; average of both cases = session score). Results Among all participants, the average simulator session score was 6.0 (95% CI: 5.6–6.4) in the rested state, and declined to 5.0 (95% CI: 4.6–5.4) after the traditional overnight shift (P<0.001). Among those who completed the shortened overnight shift, the average post-shift simulator session score was 5.8 (95% CI: 5.0–6.6) compared to 4.3 [95%CI: 3.8–4.9]) after a traditional extended shift (P<0.001). Conclusions In a clinical simulation test, medical interns performed significantly better after working a shortened overnight shift compared to a traditional extended shift. These findings are consistent with real-time hospital studies using the same shift schedule. Such an independent correlation not only confirms the detrimental impact of extended work hours on medical performance, but also supports the validity of simulation as a clinical performance assessment tool. PMID:20881679

  3. MODIS Solar Diffuser: Modelled and Actual Performance

    NASA Technical Reports Server (NTRS)

    Waluschka, Eugene; Xiong, Xiao-Xiong; Esposito, Joe; Wang, Xin-Dong; Krebs, Carolyn (Technical Monitor)

    2001-01-01

    The Moderate Resolution Imaging Spectroradiometer (MODIS) instrument's solar diffuser is used in its radiometric calibration for the reflective solar bands (VIS, NTR, and SWIR) ranging from 0.41 to 2.1 micron. The sun illuminates the solar diffuser either directly or through a attenuation screen. The attenuation screen consists of a regular array of pin holes. The attenuated illumination pattern on the solar diffuser is not uniform, but consists of a multitude of pin-hole images of the sun. This non-uniform illumination produces small, but noticeable radiometric effects. A description of the computer model used to simulate the effects of the attenuation screen is given and the predictions of the model are compared with actual, on-orbit, calibration measurements.

  4. Clinical learning environments (actual and expected): perceptions of Iran University of Medical Sciences nursing students

    PubMed Central

    Bigdeli, Shoaleh; Pakpour, Vahid; Aalaa, Maryam; Shekarabi, Robabeh; Sanjari, Mahnaz; Haghani, Hamid; Mehrdad, Neda

    2015-01-01

    Background: Educational clinical environment has an important role in nursing students' learning. Any difference between actual and expected clinical environment will decrease nursing students’ interest in clinical environments and has a negative correlation with their clinical performance. Methods: This descriptive cross-sectional study is an attempt to compare nursing students' perception of the actual and expected status of clinical environments in medical-surgical wards. Participants of the study were 127 bachelor nursing students of Iran University of Medical Sciences in the internship period. Data gathering instruments were a demographic questionnaire (including sex, age, and grade point average), and the Clinical Learning Environment Inventory (CLEI) originally developed by Professor Chan (2001), in which its modified Farsi version (Actual and Preferred forms) consisting 42 items, 6 scales and 7 items per scale was used. Descriptive and inferential statistics (t-test, paired t-test, ANOVA) were used for data analysis through SPSS version 16. Results: The results indicated that there were significant differences between the preferred and actual form in all six scales. In other word, comparing with the actual form, the mean scores of all items in the preferred form were higher. The maximum mean difference was in innovation and the highest mean difference was in involvement scale. Conclusion: It is concluded that nursing students do not have a positive perception of their actual clinical teaching environment and this perception is significantly different from their perception of their expected environment. PMID:26034726

  5. Comparisons of pilot performance in simulated and actual flight.

    PubMed

    Billings, C E; Gerke, R J; Wick, R L

    1975-03-01

    Five highly experienced professional pilots performed instrument landing system approaches under simulated instrument flight conditions in a Cessna 172 airplane and in a Link-Singer GAT-1 simulator while under the influence of orally administered secobarbital (0, 100, and 200 mg). Tracking performance in two axes and airspeed control were evaluated continuously during each approach. The data from the airplane and simulator were compared. Error and RMS variability were about half as large in the simulator as in the airplane. The observed data were more strongly associated with the drug level in the simulator than in the airplane. Further, the drug-related effects were more consistent in the simulator. Improvement in performance suggestive of learning effects were seen in the simulator, but not in actual flight. It is concluded that the GAT-1 simulator is a useful and sensitive device for studies of the effects of mild stress on pilot performance, but extrapolation of simulator data to the flight environment must be approached with considerable caution.

  6. Photovoltaic performance models: an evaluation with actual field data

    NASA Astrophysics Data System (ADS)

    TamizhMani, Govindasamy; Ishioye, John-Paul; Voropayev, Arseniy; Kang, Yi

    2008-08-01

    Prediction of energy production is crucial to the design and installation of the building integrated photovoltaic systems. This prediction should be attainable based on the commonly available parameters such as system size, orientation and tilt angle. Several commercially available as well as free downloadable software tools exist to predict energy production. Six software models have been evaluated in this study and they are: PV Watts, PVsyst, MAUI, Clean Power Estimator, Solar Advisor Model (SAM) and RETScreen. This evaluation has been done by comparing the monthly, seasonaly and annually predicted data with the actual, field data obtained over a year period on a large number of residential PV systems ranging between 2 and 3 kWdc. All the systems are located in Arizona, within the Phoenix metropolitan area which lies at latitude 33° North, and longitude 112 West, and are all connected to the electrical grid.

  7. [Method for direct generation data for formatted case report forms based on requirement for data authenticity in actual clinical conditions].

    PubMed

    Shao, Ming-Yi; Liu, Bao-Yan; He, Li-Yun; Zhang, Run-Shun

    2013-04-01

    Data authenticity is the basic requirement of clinical studies. In actual clinical conditions how to establish formatted case report forms (CRF) in line with the requirement for data authenticity is the key to ensure clinical data quality. On the basis of the characteristics of clinical data in actual clinical conditions, we determined elements for establishing formatted case report forms by comparing differences in data characteristics of CRFs in traditional clinical studies and in actual clinical conditions, and then generated formatted case report forms in line with the requirement for data authenticity in actual clinical conditions. The data of formatted CRFs generated in this study could not only meet the requirement for data authenticity of clinical studies in actual clinical conditions, but also comply with data management practices for clinical studies, thus it is deemed as a progress in technical methods.

  8. Cognition and the Placebo Effect – Dissociating Subjective Perception and Actual Performance

    PubMed Central

    Schwarz, Katharina A.; Büchel, Christian

    2015-01-01

    The influence of positive or negative expectations on clinical outcomes such as pain relief or motor performance in patients and healthy participants has been extensively investigated for years. Such research promises potential benefit for patient treatment by deliberately using expectations as means to stimulate endogenous regulation processes. Especially regarding recent interest and controversies revolving around cognitive enhancement, the question remains whether mere expectancies might also yield enhancing or impairing effects in the cognitive domain, i.e., can we improve or impair cognitive performance simply by creating a strong expectancy in participants about their performance? Moreover, previous literature suggests that especially subjective perception is highly susceptible to expectancy effects, whereas objective measures can be affected in certain domains, but not in others. Does such a dissociation of objective measures and subjective perception also apply to cognitive placebo and nocebo effects? In this study, we sought to investigate whether placebo and nocebo effects can be evoked in cognitive tasks, and whether these effects influence objective and subjective measures alike. To this end, we instructed participants about alleged effects of different tone frequencies (high, intermediate, low) on brain activity and cognitive functions. We paired each tone with specific success rates in a Flanker task paradigm as a preliminary conditioning procedure, adapted from research on placebo hypoalgesia. In a subsequent test phase, we measured reaction times and success rates in different expectancy conditions (placebo, nocebo, and control) and then asked participants how the different tone frequencies affected their performance. Interestingly, we found no effects of expectation on objective measures, but a strong effect on subjective perception, i.e., although actual performance was not affected by expectancy, participants strongly believed that the placebo

  9. Functional equivalence for response programming of actually performing versus imagining movements.

    PubMed

    Ito, M

    1999-06-01

    The present study was conducted to test the hypothesis that response programming occurs when movements are only imagined. 12 subjects were required to react and produce the sequence of same or different force by squeezing a handle as quickly and accurately as possible after the two reaction signals which were separated by the interstimulus interval of 1 sec. The reaction time to initiate the second response was examined when the first response is covertly performed, but the second response is actually performed. The reaction times to initiate the second responses were significantly shorter for imagining and actually performing different movements or the control condition. There was no significant difference in reaction time between the conditions with the same movements. These findings were interpreted as evidence for functional equivalence for response programming of actually performing versus imagining movements. PMID:10407903

  10. First-Grade Retention: Effects on Children's Actual and Perceived Performance throughout Elementary Education

    ERIC Educational Resources Information Center

    Goos, Mieke; Van Damme, Jan; Onghena, Patrick; Petry, Katja

    2011-01-01

    This study investigates the effects of repeating first grade on children's further academic growth, by tracking the actual performance and the teacher-rated performance of a cohort of Flemish first-graders until the end of elementary school. Two research questions are raised: (1) How do first-grade repeaters, at the cost of one extra year of…

  11. Consistency across repeated eyewitness interviews: contrasting police detectives' beliefs with actual eyewitness performance.

    PubMed

    Krix, Alana C; Sauerland, Melanie; Lorei, Clemens; Rispens, Imke

    2015-01-01

    In the legal system, inconsistencies in eyewitness accounts are often used to discredit witnesses' credibility. This is at odds with research findings showing that witnesses frequently report reminiscent details (details previously unrecalled) at an accuracy rate that is nearly as high as for consistently recalled information. The present study sought to put the validity of beliefs about recall consistency to a test by directly comparing them with actual memory performance in two recall attempts. All participants watched a film of a staged theft. Subsequently, the memory group (N = 84) provided one statement immediately after the film (either with the Self-Administered Interview or free recall) and one after a one-week delay. The estimation group (N = 81) consisting of experienced police detectives estimated the recall performance of the memory group. The results showed that actual recall performance was consistently underestimated. Also, a sharp decline of memory performance between recall attempts was assumed by the estimation group whereas actual accuracy remained stable. While reminiscent details were almost as accurate as consistent details, they were estimated to be much less accurate than consistent information and as inaccurate as direct contradictions. The police detectives expressed a great concern that reminiscence was the result of suggestive external influences. In conclusion, it seems that experienced police detectives hold many implicit beliefs about recall consistency that do not correspond with actual recall performance. Recommendations for police trainings are provided. These aim at fostering a differentiated view on eyewitness performance and the inclusion of more comprehensive classes on human memory structure.

  12. Optimal maintenance and consolidation therapy for multiple myeloma in actual clinical practice

    PubMed Central

    Lee, Ho Sup; Min, Chang-Ki

    2016-01-01

    Multiple myeloma is an incurable malignant plasma cell-originating cancer. Although its treatment outcomes have improved with the use of glucocorticoids, alkylating drugs, and novel agents, including proteasome inhibitors (bortezomib and carfilzomib) and immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), relapse remains a serious problem. Strategies to improve outcomes following autologous stem cell transplantation and frontline treatments in non-transplant patients include consolidation to intensify therapy and improve the depth of response and maintenance therapy to achieve long-term disease control. Many clinical trials have reported increased progression-free and overall survival rates after consolidation and maintenance therapy. The role of consolidation/maintenance therapy has been assessed in patients eligible and ineligible for transplantation and is a valuable option in clinical trial settings. However, the decision to use consolidation and/or maintenance therapy needs to be guided by the individual patient situation in actual clinical practice. This review analyzes the currently available evidence from several reported clinical trials to determine the optimal consolidation and maintenance therapy in clinical practice. PMID:27604793

  13. Optimal maintenance and consolidation therapy for multiple myeloma in actual clinical practice.

    PubMed

    Lee, Ho Sup; Min, Chang-Ki

    2016-09-01

    Multiple myeloma is an incurable malignant plasma cell-originating cancer. Although its treatment outcomes have improved with the use of glucocorticoids, alkylating drugs, and novel agents, including proteasome inhibitors (bortezomib and carfilzomib) and immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), relapse remains a serious problem. Strategies to improve outcomes following autologous stem cell transplantation and frontline treatments in non-transplant patients include consolidation to intensify therapy and improve the depth of response and maintenance therapy to achieve long-term disease control. Many clinical trials have reported increased progression-free and overall survival rates after consolidation and maintenance therapy. The role of consolidation/maintenance therapy has been assessed in patients eligible and ineligible for transplantation and is a valuable option in clinical trial settings. However, the decision to use consolidation and/or maintenance therapy needs to be guided by the individual patient situation in actual clinical practice. This review analyzes the currently available evidence from several reported clinical trials to determine the optimal consolidation and maintenance therapy in clinical practice. PMID:27604793

  14. Optimal maintenance and consolidation therapy for multiple myeloma in actual clinical practice.

    PubMed

    Lee, Ho Sup; Min, Chang-Ki

    2016-09-01

    Multiple myeloma is an incurable malignant plasma cell-originating cancer. Although its treatment outcomes have improved with the use of glucocorticoids, alkylating drugs, and novel agents, including proteasome inhibitors (bortezomib and carfilzomib) and immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), relapse remains a serious problem. Strategies to improve outcomes following autologous stem cell transplantation and frontline treatments in non-transplant patients include consolidation to intensify therapy and improve the depth of response and maintenance therapy to achieve long-term disease control. Many clinical trials have reported increased progression-free and overall survival rates after consolidation and maintenance therapy. The role of consolidation/maintenance therapy has been assessed in patients eligible and ineligible for transplantation and is a valuable option in clinical trial settings. However, the decision to use consolidation and/or maintenance therapy needs to be guided by the individual patient situation in actual clinical practice. This review analyzes the currently available evidence from several reported clinical trials to determine the optimal consolidation and maintenance therapy in clinical practice.

  15. Consistency across Repeated Eyewitness Interviews: Contrasting Police Detectives’ Beliefs with Actual Eyewitness Performance

    PubMed Central

    Krix, Alana C.; Sauerland, Melanie; Lorei, Clemens; Rispens, Imke

    2015-01-01

    In the legal system, inconsistencies in eyewitness accounts are often used to discredit witnesses’ credibility. This is at odds with research findings showing that witnesses frequently report reminiscent details (details previously unrecalled) at an accuracy rate that is nearly as high as for consistently recalled information. The present study sought to put the validity of beliefs about recall consistency to a test by directly comparing them with actual memory performance in two recall attempts. All participants watched a film of a staged theft. Subsequently, the memory group (N = 84) provided one statement immediately after the film (either with the Self-Administered Interview or free recall) and one after a one-week delay. The estimation group (N = 81) consisting of experienced police detectives estimated the recall performance of the memory group. The results showed that actual recall performance was consistently underestimated. Also, a sharp decline of memory performance between recall attempts was assumed by the estimation group whereas actual accuracy remained stable. While reminiscent details were almost as accurate as consistent details, they were estimated to be much less accurate than consistent information and as inaccurate as direct contradictions. The police detectives expressed a great concern that reminiscence was the result of suggestive external influences. In conclusion, it seems that experienced police detectives hold many implicit beliefs about recall consistency that do not correspond with actual recall performance. Recommendations for police trainings are provided. These aim at fostering a differentiated view on eyewitness performance and the inclusion of more comprehensive classes on human memory structure. PMID:25695428

  16. Evaluating Student Clinical Performance.

    ERIC Educational Resources Information Center

    Foster, Danny T.

    When the University of Iowa's athletic training education department developed evaluation criteria and methods to be used with students, attention was paid to validity, consistency, observation, and behaviors. The observations of student behaviors reflect three types of learning outcomes important to clinical education: cognitive, psychomotor, and…

  17. Working memory and acquisition of implicit knowledge by imagery training, without actual task performance.

    PubMed

    Helene, A F; Xavier, G F

    2006-04-28

    This study investigated acquisition of a mirror-reading skill via imagery training, without the actual performance of a mirror-reading task. In experiment I, healthy volunteers simulated writing on an imaginary, transparent screen placed at eye level, which could be read by an experimenter facing the subject. Performance of this irrelevant motor task required the subject to imagine the letters inverted, as if seen in a mirror from their own point of view (imagery training). A second group performed the same imagery training interspersed with a complex, secondary spelling and counting task. A third, control, group simply wrote the words as they would normally appear from their own point of view. After training with 300 words, all subjects were tested in a mirror-reading task using 60 non-words, constructed according to acceptable letter combinations of the Portuguese language. Compared with control subjects, those exposed to imagery training, including those who switched between imagery and the complex task, exhibited shorter reading times in the mirror-reading task. Experiment II employed a 2 x 3 design, including two training conditions (imagery and actual mirror-reading) and three competing task conditions (a spelling and counting switching task, a visual working memory concurrent task, and no concurrent task). Training sessions were interspersed with mirror-reading testing sessions for non-words, allowing evaluation of the mirror-reading acquisition process during training. The subjects exposed to imagery training acquired the mirror-reading skill as quickly as those exposed to the actual mirror-reading task. Further, performance of concurrent tasks together with actual mirror-reading training severely disrupted mirror-reading skill acquisition; this interference effect was not seen in subjects exposed to imagery training and performance of the switching and the concurrent tasks. These results unequivocally show that acquisition of implicit skills by top

  18. Investigating the discrepancy between the predicted and actual energy performance of buildings

    NASA Astrophysics Data System (ADS)

    Demanuele, Christine

    The threat of climate change has increased the demand for energy efficiency in buildings, with various stakeholders requesting more accurate predictions of energy consumption, and energy consultants coming under increased pressure to guarantee the energy performance of buildings. This study aims to investigate the factors causing the discrepancy which currently exists between the predicted and actual energy performance of buildings, which will lead to a deeper understanding of this discrepancy and, ultimately, more accurate energy predictions. As part of this study, a non-domestic building in London was modelled and monitored, so as to identify the main contributors to the discrepancy between the predicted and actual energy consumption. In addition, sensitivity analysis was carried out on a number of input variables to establish the set of influential parameters, and to determine whether using such techniques would successfully predict the range in which building energy consumption is likely to fall. The results show that the uncertainty calculated from differential sensitivity analysis encompasses the actual energy performance of the building. The most variable and influential parameters are those which are controlled by occupants, therefore it is paramount that management and occupants are well-informed about the building operation for energy targets to be achieved. Although the sensitivity analysis methods employed are impractical for commercial use, it is possible to develop simpler methods, encompassing all stages of building design and operation, which would decrease the discrepancy between the actual and predicted energy performance of buildings. Such techniques would be invaluable to energy consultants, for whom the cost resting on uncertainties in predictions is substantial due to more demanding clients and fines liable to be paid if energy predictions go wrong. A better understanding of the discrepancy, together with more accurate predictions, would

  19. Study on Actual Performance and Exhaust Heat of Air-conditioner Concerning Heat Island Problem

    NASA Astrophysics Data System (ADS)

    Shinomiya, Naruaki; Nishimura, Nobuya; Iyota, Hiroyuki; Kurata, Satoru

    A novel simple measuring method of actual performance of room air-conditioners by neural net work analysis (NNW) has been developed. The actual performance for a long term which is difficult to be measured by air enthalpy method is able to be measured easily by this method. In other words, actual performance of room air-conditioners can be measured by the proposed NNW method without measurement of air flow at indoor unit and outdoor unit which changes due to clogging of heat exchanger by dust. In order to gather data for training and testing the proposed NNW method, the room air-conditioner for experiment was set up. Inputs to NNW are outdoor temperature, indoor temperature, indoor wet-bulb temperature, inlet temperature of evaporator, outlet temperature of evaporator, condensation temperature and power consumption. The output from NNW is COP. The COP by NNW method has mean errors under 2.8% in quasi-steady operation condition and has mean errors under 4.6% in unsteady operation condition, compared to the COP of air enthalpy method. Results show that the COP of air conditioners can be measured easily for a long term using NNW within a high degree of accuracy.

  20. An insight into actual energy use and its drivers in high-performance buildings

    DOE PAGES

    Li, Cheng; Hong, Tianzhen; Yan, Da

    2014-07-12

    Using portfolio analysis and individual detailed case studies, we studied the energy performance and drivers of energy use in 51 high-performance office buildings in the U.S., Europe, China, and other parts of Asia. Portfolio analyses revealed that actual site energy use intensity (EUI) of the study buildings varied by a factor of as much as 11, indicating significant variation in real energy use in HPBs worldwide. Nearly half of the buildings did not meet the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) Standard 90.1-2004 energy target, raising questions about whether a building’s certification as high performing accuratelymore » indicates that a building is energy efficient and suggesting that improvement in the design and operation of HPBs is needed to realize their energy-saving potential. We studied the influence of climate, building size, and building technologies on building energy performance and found that although all are important, none are decisive factors in building energy use. EUIs were widely scattered in all climate zones. There was a trend toward low energy use in small buildings, but the correlation was not absolute; some small HPBs exhibited high energy use, and some large HPBs exhibited low energy use. We were unable to identify a set of efficient technologies that correlated directly to low EUIs. In two case studies, we investigated the influence of occupant behavior as well as operation and maintenance on energy performance and found that both play significant roles in realizing energy savings. We conclude that no single factor determines the actual energy performance of HPBs, and adding multiple efficient technologies does not necessarily improve building energy performance; therefore, an integrated design approach that takes account of climate, technology, occupant behavior, and operations and maintenance practices should be implemented to maximize energy savings in HPBs. As a result, these

  1. An insight into actual energy use and its drivers in high-performance buildings

    SciTech Connect

    Li, Cheng; Hong, Tianzhen; Yan, Da

    2014-07-12

    Using portfolio analysis and individual detailed case studies, we studied the energy performance and drivers of energy use in 51 high-performance office buildings in the U.S., Europe, China, and other parts of Asia. Portfolio analyses revealed that actual site energy use intensity (EUI) of the study buildings varied by a factor of as much as 11, indicating significant variation in real energy use in HPBs worldwide. Nearly half of the buildings did not meet the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) Standard 90.1-2004 energy target, raising questions about whether a building’s certification as high performing accurately indicates that a building is energy efficient and suggesting that improvement in the design and operation of HPBs is needed to realize their energy-saving potential. We studied the influence of climate, building size, and building technologies on building energy performance and found that although all are important, none are decisive factors in building energy use. EUIs were widely scattered in all climate zones. There was a trend toward low energy use in small buildings, but the correlation was not absolute; some small HPBs exhibited high energy use, and some large HPBs exhibited low energy use. We were unable to identify a set of efficient technologies that correlated directly to low EUIs. In two case studies, we investigated the influence of occupant behavior as well as operation and maintenance on energy performance and found that both play significant roles in realizing energy savings. We conclude that no single factor determines the actual energy performance of HPBs, and adding multiple efficient technologies does not necessarily improve building energy performance; therefore, an integrated design approach that takes account of climate, technology, occupant behavior, and operations and maintenance practices should be implemented to maximize energy savings in HPBs. As a result, these findings are

  2. Virologic response and haematologic toxicity of boceprevir- and telaprevir-containing regimens in actual clinical settings

    PubMed Central

    Butt, A. A.; Yan, P.; Shaikh, O. S.; Freiberg, M. S.; Re, V. Lo; Justice, A. C.; Sherman, K. E.

    2016-01-01

    SUMMARY Effectiveness, safety and tolerability of boceprevir (BOC) and telaprevir (TPV) in actual clinical settings remain unknown. We determined rates of sustained virologic response (SVR) and haematologic adverse effects among persons treated with BOC- or TPV-containing regimens, compared with pegylated interferon/ribavirin (PEG/RBV). Using an established cohort of hepatitis C virus (HCV)-infected persons, Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), we identified those treated with a BOC- or TPV-containing regimen and HCV genotype 1-infected controls treated with PEG/RBV. We excluded those with HIV co-infection and missing HCV RNA values to determine SVR. Primary endpoints were SVR (undetectable HCV RNA ≥12 weeks after treatment completion) and haematologic toxicity (grade 3/4 anaemia, neutropenia and thrombocytopenia). We evaluated 2288 persons on BOC-, 409 on TPV-containing regimen and 6308 on PEG/RBV. Among these groups, respectively, 31%, 43% and 9% were treatment-experienced; 17%, 37% and 14% had baseline cirrhosis; 63%, 54% and 48% were genotype 1a. SVR rates among noncirrhotics were as follows: treatment naïve: 65% (BOC), 67% (TPV) and 31% (PEG/RBV); treatment experienced: 57% (BOC), 54% (TPV) and 13% (PEG/RBV); (P-value not significant for BOC vs TPV; P < 0.0001 for BOC or TPV vs PEG/RBV). Haematologic toxicities among BOC-, TPV- and PEG/RBV-treated groups were as follows: grade 3/4 anaemia 7%, 11% and 3%; grade 4 thrombocytopenia 2.2%, 5.4% and 1.7%; grade 4 neutropenia 8.2%, 5.6% and 3.4%. SVR rates are higher and closer to those reported in pivotal clinical trials among BOC- and TPV-treated persons compared with PEG/RBV-treated persons. Haematologic adverse events are frequent, but severe toxicity is uncommon. PMID:25524834

  3. PERFORMANCE TESTING OF THE NEXT-GENERATION CSSX SOLVENT WITH ACTUAL SRS TANK WASTE

    SciTech Connect

    Pierce, R.; Peters, T.; Crowder, M.; Fink, S.

    2011-11-01

    Efforts are underway to qualify the Next-Generation Solvent for the Caustic Side Solvent Extraction (CSSX) process. Researchers at multiple national laboratories have been involved in this effort. As part of the effort to qualify the solvent extraction system at the Savannah River Site (SRS), SRNL performed a number of tests at various scales. First, SRNL completed a series of batch equilibrium, or Extraction-Scrub-Strip (ESS), tests. These tests used {approx}30 mL of Next-Generation Solvent and either actual SRS tank waste, or waste simulant solutions. The results from these cesium mass transfer tests were used to predict solvent behavior under a number of conditions. At a larger scale, SRNL assembled 12 stages of 2-cm (diameter) centrifugal contactors. This rack of contactors is structurally similar to one tested in 2001 during the demonstration of the baseline CSSX process. Assembly and mechanical testing found no issues. SRNL performed a nonradiological test using 35 L of cesium-spiked caustic waste simulant and 39 L of actual tank waste. Test results are discussed; particularly those related to the effectiveness of extraction.

  4. Time interval moderates the relationship between psyching-up and actual sprint performance.

    PubMed

    Hammoudi-Nassib, Sarra; Chtara, Moktar; Nassib, Sabri; Briki, Walid; Hammoudi-Riahi, Sabra; Tod, David; Chamari, Karim

    2014-11-01

    This study attempted to test whether the strongest effect of psyching-up (PU) strategy on actual sprint performance can be observed when the strategy is used immediately (or almost) before performance compared with when there is a delay between PU and performance. To do so, 16 male sprinters (age, 20.6 ± 1.3 years; body mass, 77.5 ± 7.1 kg; height, 180.8 ± 5.6 cm) were enrolled in a counterbalanced experimental design in which participants were randomly assigned to 10 sessions (2 [Experimental Condition: imagery vs. distraction] × 5 [Time Intervals: no interval, 1 minute, 2 minutes, 3 minutes, and 5 minutes]). Before performing the experimental tasks, participants rated: (a) the Hooper index, (b) their degree of self-confidence, and (c) after the completion of the experimental test; they rated their perceived effort. Findings showed that the imagery significantly improved sprint performance. Specifically, the imagery enhanced performance on the phase of acceleration (0-10 m) and on the overall sprint (0-30 m) when used immediately before performance and at 1- and 2-minute intervals but not for 3- and 5-minute intervals. These findings support the hypothesis that the potential effect of the PU strategy on performance vanishes over time. The pre-experimental task Hooper and self-efficacy indexes did not change across the 10 experimental sessions, reinforcing the view that the observed performance changes were directly caused by the experimental manipulation and not through any altered status of the athletes (self-efficacy, fatigue/recovery, and stress). The potential mechanisms underlying such a process and practical applications are discussed.

  5. Actual versus design performance of solar systems in the National Solar Data Network

    NASA Astrophysics Data System (ADS)

    Logee, T. L.; Kendall, P. W.

    1984-09-01

    Field measured performance were compared to the designer predicted performance. The field measured data were collected by the National Solar Data Network (NSDN) over a period of 6 years. Data from 25 solar systems were selected from a data pool of some 170 solar systems. Several concerns arose which can be partially allayed by study of the NSDN data. These are: what types of failures occurred and why; how good was the design versus actual performance; why was predicted performance not achieved in the field; and which components should be integrated with a system type for good performance. The measured results were also compared to f-chart 5.1 results. This comparison is a type of normalization in that all systems are modeled with the same process. An added benefit of this normalization is a further validation of the f-Chart model on a fairly large scale. The systems are modeled using equipment design parameters, measured loads, and f-Chart weather data from nearby cities.

  6. Optimization of CCGT power plant and performance analysis using MATLAB/Simulink with actual operational data.

    PubMed

    Hasan, Naimul; Rai, Jitendra Nath; Arora, Bharat Bhushan

    2014-01-01

    In the Modern scenario, the naturally available resources for power generation are being depleted at an alarming rate; firstly due to wastage of power at consumer end, secondly due to inefficiency of various power system components. A Combined Cycle Gas Turbine (CCGT) integrates two cycles- Brayton cycle (Gas Turbine) and Rankine cycle (Steam Turbine) with the objective of increasing overall plant efficiency. This is accomplished by utilising the exhaust of Gas Turbine through a waste-heat recovery boiler to run a Steam Turbine. The efficiency of a gas turbine which ranges from 28% to 33% can hence be raised to about 60% by recovering some of the low grade thermal energy from the exhaust gas for steam turbine process. This paper is a study for the modelling of CCGT and comparing it with actual operational data. The performance model for CCGT plant was developed in MATLAB/Simulink. PMID:24936394

  7. Optimization of CCGT power plant and performance analysis using MATLAB/Simulink with actual operational data.

    PubMed

    Hasan, Naimul; Rai, Jitendra Nath; Arora, Bharat Bhushan

    2014-01-01

    In the Modern scenario, the naturally available resources for power generation are being depleted at an alarming rate; firstly due to wastage of power at consumer end, secondly due to inefficiency of various power system components. A Combined Cycle Gas Turbine (CCGT) integrates two cycles- Brayton cycle (Gas Turbine) and Rankine cycle (Steam Turbine) with the objective of increasing overall plant efficiency. This is accomplished by utilising the exhaust of Gas Turbine through a waste-heat recovery boiler to run a Steam Turbine. The efficiency of a gas turbine which ranges from 28% to 33% can hence be raised to about 60% by recovering some of the low grade thermal energy from the exhaust gas for steam turbine process. This paper is a study for the modelling of CCGT and comparing it with actual operational data. The performance model for CCGT plant was developed in MATLAB/Simulink.

  8. Prediction of student clinical performance.

    PubMed

    Hobfoll, S E; Benor, D E

    1981-07-01

    The predictive validity of 'traditional' tools utilized in the selection of medical students was evaluated in a 'non-traditional' selection paradigm, where a wide range of previous-academic ability was represented. The validity of the use of pre-academic grades and examination scores in the prediction of success in clinical performance was examined in a medical school which de-emphasizes these indicators and emphasizes personal characteristics assessed via interview ratings in student selection. Grades and examination scores were found to have no relation to clinical ratings which have an added interpersonal and community emphasis during the fourth-sixth years of medical school. A positive trend was found for interview ratings with clinical performance, but the skewed nature of interview scores was seen as limiting investigation of this variable. The meaning of these results vis-à-vis the continued use of academic and examination related selection criteria was discussed. PMID:7253988

  9. Changes In Actual And Perceived Physical Abilities In Clinically Obese Children: A 9-Month Multi-Component Intervention Study

    PubMed Central

    Morano, Milena; Colella, Dario; Rutigliano, Irene; Fiore, Pietro; Pettoello-Mantovani, Massimo; Campanozzi, Angelo

    2012-01-01

    Objectives (1) To examine relationships among changes in physical activity, physical fitness and some psychosocial determinants of activity behavior in a clinical sample of obese children involved in a multi-component program; (2) to investigate the causal relationship over time between physical activity and one of its strongest correlates (i.e. perceived physical ability). Methods Self-reported physical activity and health-related fitness tests were administered before and after a 9-month intervention in 24 boys and 20 girls aged 8 to 11 years. Individuals’ perceptions of strength, speed and agility were assessed using the Perceived Physical Ability Scale, while body image was measured using Collins’ Child Figure Drawings. Results Findings showed that body mass index, physical activity, performances on throwing and weight-bearing tasks, perceived physical ability and body image significantly improved after treatment among obese children. Gender differences were found in the correlational analyses, showing a link between actual and perceived physical abilities in boys, but not in girls. For the specific measurement interval of this study, perception of physical ability was an antecedent and not a potential consequence of physical activity. Conclusions Results indicate that a multi-component activity program not based merely on a dose-effect approach enhances adherence of the participants and has the potential to increase the lifelong exercise skills of obese children. Rather than focusing entirely on diet and weight loss, findings support the inclusion of interventions directed toward improving perceived physical ability that is predictive of subsequent physical activity. PMID:23239985

  10. Would Socrates Have Actually Used the "Socratic Method" for Clinical Teaching?

    PubMed

    Stoddard, Hugh A; O'Dell, David V

    2016-09-01

    Medical students and residents are familiar with clinical teaching methods in which a faculty member poses a series of questions to them. This technique is often called the "Socratic method," but it is frequently perceived by learners as an attempt to demean them, a practice that is colloquially known as "pimping." The distinction between Socratic teaching and pimping lies in the perception of "psychological safety." Psychological safety allows learners to answer questions or ask for help without threats to their dignity or worthiness. In a psychologically safe clinical teaching context, learners recognize that questions posed by attending physicians probe their current understanding and guide them to expand their knowledge. In pimping, questions are posed to embarrass the learner and to reinforce the teacher's position of power over them. Absent a threat of disparagement or condemnation, learners are able to focus on building schema for knowledge, skills, and attitudes, rather than worrying about shielding their self-worth. This article presents the proper Socratic method, as intended by Socrates, and contrasts it with pimping. This perspective defines psychological safety as the pivotal factor distinguishing Socratic teaching from pimping, and establishes the foundation for empirical studies of these common practices in medical education.

  11. Evaluating the caregiver's intervention in the elder's task performance: capacity versus actual behavior.

    PubMed

    Fulmer, T; Gurland, B

    1997-09-01

    As an elder's functional impairment increases, so in general does the tendency for the caregiver to intervene in the elder's daily activities and initiatives. To a certain extent, such intervention is necessary to compensate for the elder's loss of independent ability, and without such intervention, adverse outcomes for the elder are a possibility. The need for some intervention is usually clear-cut for advanced dementia, given its associated severe disability and handicap, but less clear in elders who are just beginning to show signs of cognitive decline. This study used the paradigm of medication management to look at whether the discrepancy between capacity for self-medication administration and actual self-administration behavior as demonstrated by the Medication Management Test (MMT) is greater for elders with poorer cognitive functioning. A sample of 51 cognitively impaired elders and 74 cognitively normal elders was used to look at the relationship between predicted capacity and actual self-administration of medication, stratifying by level of cognitive status. The highly significant concordance between the MMT score and caregivers' report of medication administration supports the expectation that capacity is influenced by cognitive status. In those discordant cases, further information is needed to interpret help in medication administration as excessive or insufficient intervention. PMID:9309470

  12. Frontoparietal cortex and cerebellum contribution to the update of actual and mental motor performance during the day.

    PubMed

    Bonzano, Laura; Roccatagliata, Luca; Ruggeri, Piero; Papaxanthis, Charalambos; Bove, Marco

    2016-01-01

    Actual and imagined movement speed increases from early morning until mid-afternoon. Here, we investigated the neural correlates of these daily changes. Fifteen subjects performed actual and imagined right finger opposition movement sequences at 8 am and 2 pm. Both actual and imagined movements were significantly faster at 2 pm than 8 am. In the morning, actual movements significantly activated the left primary somatosensory and motor areas, and bilaterally the cerebellum; in the afternoon activations were similar but reduced. Contrast analysis revealed greater activity in the cerebellum, the left primary sensorimotor cortex and parietal lobe in the morning than in the afternoon. Imagined movements in the morning significantly activated the parietal association cortices bilaterally, the left supplementary and premotor areas, and the right orbitofrontal cortex and cerebellum. In the afternoon, the frontal lobe was significantly activated with the right cerebellum. Contrast analysis revealed increased activity in the left parietal lobe in the morning than in the afternoon. For both tasks, speed in the morning was significantly related to the BOLD signal in the brain areas resulted more active. These findings suggest that motor performance is continuously updated on a daily basis with a predominant role of the frontoparietal cortex and cerebellum. PMID:27444783

  13. Frontoparietal cortex and cerebellum contribution to the update of actual and mental motor performance during the day

    PubMed Central

    Bonzano, Laura; Roccatagliata, Luca; Ruggeri, Piero; Papaxanthis, Charalambos; Bove, Marco

    2016-01-01

    Actual and imagined movement speed increases from early morning until mid-afternoon. Here, we investigated the neural correlates of these daily changes. Fifteen subjects performed actual and imagined right finger opposition movement sequences at 8 am and 2 pm. Both actual and imagined movements were significantly faster at 2 pm than 8 am. In the morning, actual movements significantly activated the left primary somatosensory and motor areas, and bilaterally the cerebellum; in the afternoon activations were similar but reduced. Contrast analysis revealed greater activity in the cerebellum, the left primary sensorimotor cortex and parietal lobe in the morning than in the afternoon. Imagined movements in the morning significantly activated the parietal association cortices bilaterally, the left supplementary and premotor areas, and the right orbitofrontal cortex and cerebellum. In the afternoon, the frontal lobe was significantly activated with the right cerebellum. Contrast analysis revealed increased activity in the left parietal lobe in the morning than in the afternoon. For both tasks, speed in the morning was significantly related to the BOLD signal in the brain areas resulted more active. These findings suggest that motor performance is continuously updated on a daily basis with a predominant role of the frontoparietal cortex and cerebellum. PMID:27444783

  14. How accurately can students estimate their performance on an exam and how does this relate to their actual performance on the exam?

    NASA Astrophysics Data System (ADS)

    Rebello, N. Sanjay

    2012-02-01

    Research has shown students' beliefs regarding their own abilities in math and science can influence their performance in these disciplines. I investigated the relationship between students' estimated performance and actual performance on five exams in a second semester calculus-based physics class. Students in a second-semester calculus-based physics class were given about 72 hours after the completion of each of five exams, to estimate their individual and class mean score on each exam. Students were given extra credit worth 1% of the exam points for estimating their score correct within 2% of the actual score and another 1% extra credit for estimating the class mean score within 2% of the correct value. I compared students' individual and mean score estimations with the actual scores to investigate the relationship between estimation accuracies and exam performance of the students as well as trends over the semester.

  15. Clinical examples of 3D dose distribution reconstruction, based on the actual MLC leaves movement, for dynamic treatment techniques

    PubMed Central

    Osewski, Wojciech; Dolla, Łukasz; Radwan, Michał; Szlag, Marta; Rutkowski, Roman; Smolińska, Barbara; Ślosarek, Krzysztof

    2014-01-01

    Aim To present practical examples of our new algorithm for reconstruction of 3D dose distribution, based on the actual MLC leaf movement. Background DynaLog and RTplan files were used by DDcon software to prepare a new RTplan file for dose distribution reconstruction. Materials and methods Four different clinically relevant scenarios were used to assess the feasibility of the proposed new approach: (1) Reconstruction of whole treatment sessions for prostate cancer; (2) Reconstruction of IMRT verification treatment plan; (3) Dose reconstruction in breast cancer; (4) Reconstruction of interrupted arc and complementary plan for an interrupted VMAT treatment session of prostate cancer. The applied reconstruction method was validated by comparing reconstructed and measured fluence maps. For all statistical analysis, the U Mann–Whitney test was used. Results In the first two and the fourth cases, there were no statistically significant differences between the planned and reconstructed dose distribution (p = 0.910, p = 0.975, p = 0.893, respectively). In the third case the differences were statistically significant (p = 0.015). Treatment plan had to be reconstructed. Conclusion Developed dose distribution reconstruction algorithm presents a very useful QA tool. It provides means for 3D dose distribution verification in patient volume and allows to evaluate the influence of actual MLC leaf motion on the dose distribution. PMID:25337416

  16. Does verbal encouragement actually improve performance in the 6-minute walk test?

    PubMed

    Marinho, Patrícia E M; Raposo, Maria Cristina; Dean, Elizabeth; Guerra, Ricardo O; de Andrade, Arméle Dornelas

    2014-11-01

    The purpose of this study was to evaluate the performance in the 6-minute walk test (6 MWT) of elderly patients with chronic obstructive pulmonary disease (COPD) by comparing to a group of healthy elderly patients, performed with and without verbal encouragement. This cross-sectional study compared 40 patients with COPD (forced expiratory volume in the first second (FEV1%) = 53.7 ± 23.8%; forced vital capacity (FVC%) = 65.5 ± 20.8%; and the FEV1/FVC ratio = 55.4 ± 12.4) and 40 healthy elderly patients (control). The 6 MWT's were performed with and without verbal encouragement according to the American Thoracic Society (ATS), monitoring the distance walked (6 MWD), the duration of walking (TW) and the perceived effort index (PEI) through the Borg scale between the groups. No differences were observed in patients with COPD when the tests were performed with and without verbal encouragement for the 6 MWD, TW and PEI, the same occurring in the control group for the 6 MWD, TW and PEI, respectively. The use of verbal encouragement was not sufficient to promote improvement in the performance of the 6 MWT (6 MWD, TW and PEI) of patients with COPD and healthy elderly patients.

  17. Predicted versus Actual Performance in Undergraduate Organic Chemistry and Implications for Student Advising

    ERIC Educational Resources Information Center

    Pursell, David P.

    2007-01-01

    Performance as measured by grades in the first and second semesters of organic chemistry was predicted using pre-college measures (SAT scores, high school rank, validation exams) and college measures (general chemistry GPA, overall college GPA prior to beginning organic chemistry, first-semester organic chemistry GPA). Data indicate that overall…

  18. Can medical students accurately predict their learning? A study comparing perceived and actual performance in neuroanatomy.

    PubMed

    Hall, Samuel R; Stephens, Jonny R; Seaby, Eleanor G; Andrade, Matheus Gesteira; Lowry, Andrew F; Parton, Will J C; Smith, Claire F; Border, Scott

    2016-10-01

    It is important that clinicians are able to adequately assess their level of knowledge and competence in order to be safe practitioners of medicine. The medical literature contains numerous examples of poor self-assessment accuracy amongst medical students over a range of subjects however this ability in neuroanatomy has yet to be observed. Second year medical students attending neuroanatomy revision sessions at the University of Southampton and the competitors of the National Undergraduate Neuroanatomy Competition were asked to rate their level of knowledge in neuroanatomy. The responses from the former group were compared to performance on a ten item multiple choice question examination and the latter group were compared to their performance within the competition. In both cohorts, self-assessments of perceived level of knowledge correlated weakly to their performance in their respective objective knowledge assessments (r = 0.30 and r = 0.44). Within the NUNC, this correlation improved when students were instead asked to rate their performance on a specific examination within the competition (spotter, rS = 0.68; MCQ, rS = 0.58). Despite its inherent difficulty, medical student self-assessment accuracy in neuroanatomy is comparable to other subjects within the medical curriculum. Anat Sci Educ 9: 488-495. © 2016 American Association of Anatomists.

  19. Evidence supporting primary prevention of cardiovascular diseases with statins: Gaps between updated clinical results and actual practice.

    PubMed

    Bruckert, Eric; Ferrières, Jean

    2014-03-01

    The use of pharmacological lipid-lowering intervention in individuals with hypercholesterolaemia and known cardiovascular disease or diabetes/chronic kidney disease is well established. Current European Society of Cardiology guidelines recommend immediate initiation of drugs in adjunct to lifestyle intervention in these patients at high or very high cardiovascular risk. In these clinical settings, statins are generally chosen as the first-choice drug intervention, in consideration of the robust evidence showing a reduction in all-cause mortality and major adverse cardiac events (MACE). In contrast, primary prevention with statins, even in the subset of patients at high-risk of cardiovascular events, is not well implemented. This might be related to a lack of public awareness regarding the actual risk associated with prolonged exposure to high concentrations of low-density lipoprotein cholesterol (LDL-C) and uncertainties in the clinical evidence coming from the earliest trials in this patient subset. However, recent observational studies suggest that lowering LDL-C earlier in life and for a longer duration can substantially decrease the burden of cardiovascular disease and mortality. Moreover, results from recent well-conducted large meta-analyses of randomized clinical trials showed that primary prevention with statins reduced all-cause mortality by 14% and MACE by > 20% - findings similar to those observed for the use of statins in secondary prevention. Recently published American Heart Association/American College of Cardiology guidelines on the treatment of blood cholesterol emphasize that primary prevention using high-dose statins in individuals with LDL-C ≥ 190 mg/dL induces a benefit in atherosclerotic cardiovascular risk reduction that clearly exceeds the potential for adverse effects. We aim in this review to discuss the new data that advocate the use of statins in primary prevention earlier and more frequently, putting the efficacy evidence into

  20. Propensity-matched analysis of the gap between capacity and actual performance of dressing in patients with stroke.

    PubMed

    Fujita, Takaaki; Sato, Atsushi; Yamamoto, Yuichi; Otsuki, Koji; Iokawa, Kazuaki; Sone, Toshimasa; Midorikawa, Manabu; Tsuchiya, Kenji; Bumsuk, Lee; Tozato, Fusae

    2016-06-01

    [Purpose] Dressing is an activity of daily living for which stroke patients often show discrepancies between capacity and actual performance. The aim of this study was to elucidate the physical function and unilateral spatial neglect in stroke patients that reduce their level of actual performance despite having the capacity for dressing independently. [Subjects and Methods] This retrospective study included 60 first-time stroke patients judged by occupational therapists as able to dress independently. The patients were divided into two groups according to their FIM(®) instrument scores for dressing the upper and lower body: an independent group with both scores ≥6 and an assistance group with one or both scores ≤5. After adjusting for confounding factors through propensity score matching, the groups were compared by using Stroke Impairment Assessment Set items, the Simple Test for Evaluating Hand Function of both upper limbs, and the Berg balance scale. [Results] The assistance group had a significantly lower score for the Berg balance scale than the independent dressing group (31.0 ± 12.3 vs. 47.8 ± 7.4). [Conclusion] The results of the present study suggested that the balance function has an effect on the discrepancy between dressing capacity and performance.

  1. Propensity-matched analysis of the gap between capacity and actual performance of dressing in patients with stroke.

    PubMed

    Fujita, Takaaki; Sato, Atsushi; Yamamoto, Yuichi; Otsuki, Koji; Iokawa, Kazuaki; Sone, Toshimasa; Midorikawa, Manabu; Tsuchiya, Kenji; Bumsuk, Lee; Tozato, Fusae

    2016-06-01

    [Purpose] Dressing is an activity of daily living for which stroke patients often show discrepancies between capacity and actual performance. The aim of this study was to elucidate the physical function and unilateral spatial neglect in stroke patients that reduce their level of actual performance despite having the capacity for dressing independently. [Subjects and Methods] This retrospective study included 60 first-time stroke patients judged by occupational therapists as able to dress independently. The patients were divided into two groups according to their FIM(®) instrument scores for dressing the upper and lower body: an independent group with both scores ≥6 and an assistance group with one or both scores ≤5. After adjusting for confounding factors through propensity score matching, the groups were compared by using Stroke Impairment Assessment Set items, the Simple Test for Evaluating Hand Function of both upper limbs, and the Berg balance scale. [Results] The assistance group had a significantly lower score for the Berg balance scale than the independent dressing group (31.0 ± 12.3 vs. 47.8 ± 7.4). [Conclusion] The results of the present study suggested that the balance function has an effect on the discrepancy between dressing capacity and performance. PMID:27390439

  2. Actual versus predicted performance of an active solar heating system - A comparison using FCHART 4.0

    NASA Astrophysics Data System (ADS)

    Wetzel, P. E.

    1981-11-01

    The performance of an active solar heating system added to a house in Denver, CO was compared with predictions made by the FCHART 4.0 computer program. The house featured 43.23 sq m of collectors with an ethylene-glycol/water heat transfer fluid, and a 3.23 cu m storage tank. The house hot water was preheated in the storage tank, and home space heat was furnished whenever the storage water was above 32 C. Actual meteorological and heating demand data were used for the comparison, rather than long-term averages. Although monthly predictions by the FCHART program were found to diverge from measured data, the annual demand and supply predictions provided a good fit, i.e. within 9%, and were within 1% of the measured solar energy contributed to storage.

  3. Method for evaluating performance of clinical pharmacists.

    PubMed

    Schumock, G T; Leister, K A; Edwards, D; Wareham, P S; Burkhart, V D

    1990-01-01

    A performance-evaluation process that satisfies Joint Commission on Accreditation of Healthcare Organizations criteria and state policies is described. A three-part, criteria-based, weighted performance-evaluation tool specific for clinical pharmacists was designed for use in two institutions affiliated with the University of Washington. The three parts are self-appraisal and goal setting, peer evaluation, and supervisory evaluation. Objective criteria within each section were weighted to reflect the relative importance of that characteristic to the job that the clinical pharmacist performs. The performance score for each criterion is multiplied by the weighted value to produce an outcome score. The peer evaluation and self-appraisal/goal-setting parts of the evaluation are completed before the formal performance-evaluation interview. The supervisory evaluation is completed during the interview. For this evaluation, supervisors use both the standard university employee performance evaluation form and a set of specific criteria applicable to the clinical pharmacists in these institutions. The first performance evaluations done under this new system were conducted in May 1989. Pharmacists believed that the new system was more objective and allowed more interchange between the manager and the pharmacist. The peer-evaluation part of the system was seen as extremely constructive. This three-part, criteria-based system for evaluation of the job performance of clinical pharmacists could easily be adopted by other pharmacy departments.

  4. Is Talk ‘Cheap’? An Initial Investigation of the Equivalence of Alcohol Purchase Task Performance for Hypothetical and Actual Rewards

    PubMed Central

    Amlung, Michael; Acker, John; Stojek, Monika; Murphy, James G.; MacKillop, James

    2011-01-01

    Background Behavioral economic alcohol purchase tasks (APTs) are self-report measures of alcohol demand that assess estimated consumption at escalating levels of price. However, the relationship between estimated performance for hypothetical outcomes and choices for actual outcomes has not been determined. The present study examined both the correspondence between choices for hypothetical and actual outcomes, and the correspondence between estimated alcohol consumption and actual drinking behavior. A collateral goal of the study was to examine the effects of alcohol cues on APT performance. Methods Forty one heavy-drinking adults (56% male) participated in a human laboratory protocol comprising APTs for hypothetical and actual alcohol and money, an alcohol cue reactivity paradigm, an alcohol self-administration period, and a recovery period. Results Pearson correlations revealed very high correspondence between APT performance for hypothetical and actual alcohol (ps < .001). Estimated consumption on the APT was similarly strongly associated with actual consumption during the self-administration period (r = .87, p <.001). Exposure to alcohol cues significantly increased subjective craving and arousal, and had a trend-level effect on intensity of demand, in spite of notable ceiling effects. Associations among motivational indices were highly variable, suggesting multidimensionality. Conclusions These results suggest there may be close correspondence both between value preferences for hypothetical alcohol and actual alcohol, and between estimated consumption and actual consumption. Methodological considerations and priorities for future studies are discussed. PMID:22017303

  5. Copy number variants in a sample of patients with psychotic disorders: is standard screening relevant for actual clinical practice?

    PubMed Central

    Van de Kerkhof, Noortje WA; Feenstra, Ilse; van der Heijden, Frank MMA; de Leeuw, Nicole; Pfundt, Rolph; Stöber, Gerald; Egger, Jos IM; Verhoeven, Willem MA

    2012-01-01

    With the introduction of new genetic techniques such as genome-wide array comparative genomic hybridization, studies on the putative genetic etiology of schizophrenia have focused on the detection of copy number variants (CNVs), ie, microdeletions and/or microduplications, that are estimated to be present in up to 3% of patients with schizophrenia. In this study, out of a sample of 100 patients with psychotic disorders, 80 were investigated by array for the presence of CNVs. The assessment of the severity of psychiatric symptoms was performed using standardized instruments and ICD-10 was applied for diagnostic classification. In three patients, a submicroscopic CNV was demonstrated, one with a loss in 1q21.1 and two with a gain in 1p13.3 and 7q11.2, respectively. The association between these or other CNVs and schizophrenia or schizophrenia-like psychoses and their clinical implications still remain equivocal. While the CNV affected genes may enhance the vulnerability for psychiatric disorders via effects on neuronal architecture, these insights have not resulted in major changes in clinical practice as yet. Therefore, genome-wide array analysis should presently be restricted to those patients in whom psychotic symptoms are paired with other signs, particularly dysmorphisms and intellectual impairment. PMID:22848183

  6. Performance changes and relationship between vertical jump measures and actual sprint performance in elite sprinters with visual impairment throughout a Parapan American games training season

    PubMed Central

    Loturco, Irineu; Winckler, Ciro; Kobal, Ronaldo; Cal Abad, Cesar C.; Kitamura, Katia; Veríssimo, Amaury W.; Pereira, Lucas A.; Nakamura, Fábio Y.

    2015-01-01

    The aims of this study were to estimate the magnitude of variability and progression in actual competitive and field vertical jump test performances in elite Paralympic sprinters with visual impairment in the year leading up to the 2015 Parapan American Games, and to investigate the relationships between loaded and unloaded vertical jumping test results and actual competitive sprinting performance. Fifteen Brazilian Paralympic sprinters with visual impairment attended seven official competitions (four national, two international and the Parapan American Games 2015) between April 2014 and August 2015, in the 100- and 200-m dash. In addition, they were tested in five different periods using loaded (mean propulsive power [MPP] in jump squat [JS] exercise) and unloaded (squat jump [SJ] height) vertical jumps within the 3 weeks immediately prior to the main competitions. The smallest important effect on performances was calculated as half of the within-athlete race-to-race (or test-to-test) variability and a multiple regression analysis was performed to predict the 100- and 200-m dash performances using the vertical jump test results. Competitive performance was enhanced during the Parapan American Games in comparison to the previous competition averages, overcoming the smallest worthwhile enhancement in both the 100- (0.9%) and 200-m dash (1.43%). In addition, The SJ and JS explained 66% of the performance variance in the competitive results. This study showed that vertical jump tests, in loaded and unloaded conditions, could be good predictors of the athletes' sprinting performance, and that during the Parapan American Games the Brazilian team reached its peak competitive performance. PMID:26594181

  7. What predicts performance during clinical psychology training?

    PubMed Central

    Scior, Katrina; Bradley, Caroline E; Potts, Henry W W; Woolf, Katherine; de C Williams, Amanda C

    2014-01-01

    Objectives While the question of who is likely to be selected for clinical psychology training has been studied, evidence on performance during training is scant. This study explored data from seven consecutive intakes of the UK's largest clinical psychology training course, aiming to identify what factors predict better or poorer outcomes. Design Longitudinal cross-sectional study using prospective and retrospective data. Method Characteristics at application were analysed in relation to a range of in-course assessments for 274 trainee clinical psychologists who had completed or were in the final stage of their training. Results Trainees were diverse in age, pre-training experience, and academic performance at A-level (advanced level certificate required for university admission), but not in gender or ethnicity. Failure rates across the three performance domains (academic, clinical, research) were very low, suggesting that selection was successful in screening out less suitable candidates. Key predictors of good performance on the course were better A-levels and better degree class. Non-white students performed less well on two outcomes. Type and extent of pre-training clinical experience on outcomes had varied effects on outcome. Research supervisor ratings emerged as global indicators and predicted nearly all outcomes, but may have been biased as they were retrospective. Referee ratings predicted only one of the seven outcomes examined, and interview ratings predicted none of the outcomes. Conclusions Predicting who will do well or poorly in clinical psychology training is complex. Interview and referee ratings may well be successful in screening out unsuitable candidates, but appear to be a poor guide to performance on the course. Practitioner points While referee and selection interview ratings did not predict performance during training, they may be useful in screening out unsuitable candidates at the application stage High school final academic performance

  8. [Organization, administration, and performance of clinical studies].

    PubMed

    Bachner, Mark; Steininger, Tanja; Gneist, Margit

    2008-01-01

    This contribution deals with all important organizational and administrative aspects of clinical studies in German speaking countries. All trials are to be executed in accordance with the Good Clinical Practice (GCP) Guidelines. GCP applies to the process of designing, conducting, recording, and reporting of clinical studies. Compliance with GCP facilitates the mutual acceptance of resulting clinical data by the respective regulatory authorities worldwide. Before initiating a clinical study the investigator has to obtain written and dated approval from the responsible ethics committee, the competent authorities, and the hospital administration. The investigator's study file contains all essential study documents. One of the most important tasks of an investigator is to properly inform the prospective subjects and to obtain their informed consent. All relevant treatment-related information has to be recorded in the patient files. These source data are transferred to case report forms. During monitoring visits, audits, and inspections, source data verification will be performed routinely. Any adverse events (AEs) must be documented according to the CTCAE, the Common Terminology Criteria for Adverse Events. All serious adverse events (SAEs) have to be reported to the sponsor immediately. At the end of the study a termination visit is performed, and all authorities are officially informed about the termination of the trial.

  9. Combining a clinical ladder and performance appraisal system as a reward strategy: the EXCEL clinical ladder program.

    PubMed

    Moe, J K; Lonowski, L R; Yancer, D A

    1994-09-01

    In response to the dramatic changes occurring in health care today and a desire to reward professional nurses for clinical behaviors that would be valued in the future, Bergan Mercy Medical Center (BMMC) has developed an innovative clinical ladder/performance appraisal system. The BMMC EXCEL Clinical Ladder program, which is based on the developmental model of Patricia Benner, is a competency-based system that uniquely combines a clinical ladder and performance appraisal system. The program is clinically focused and contains optional components in which registered nurses (RNs) can receive additional credit for participation in professional growth and leadership activities. Nurses document examples of their practice through nursing narratives that describe actual clinical situations. The development and implementation processes, challenges encountered, and recommendations for alternative approaches to the implementation of such a unique system are discussed.

  10. [Performing madness: the clinic as stage].

    PubMed

    Herrn, Rainer; Friedland, Alexander

    2014-12-01

    In the second half of the nine- teenth century, clinical demonstrations became the dominant teaching method in psychiatry, playing a key role in medical-professional disputes, as well. This paper traces this widely used though historiographically neglected practice of knowledge implementation and mediation, as demonstrated in the psychiatric clinic of the Berlin Charité (Psychiatrische und Nervenklinik der Berliner Charité) from 1881 to 1927. Documentation of this practice, found within individual medical records, forms the basis of this research. The concept of 'theatricality' assists in uncovering the dramatic quality of the clinical demonstration: Psychiatric knowledge was not simply disseminated through such a practice; rather, such knowledge was first performatively created through the very logic of its presentation of exemplary patient histories, as well as through the examination and diagnostic positioning of its patients. The 'success' of such presentations depended on many variables, related to staff, time, place, and other situational factors. These include the presence of appropriate lecture halls, the availability and calculated selection of patients, and the employment of specific performative techniques by doctors for the sake of producing desired results. As one effect, clinical demonstrations also encouraged patients to both learn and rehearse behavior considered relevant to the particular diagnosis that was to be demonstrated. PMID:25671967

  11. Performance Assessment of Counseling Skills Based on Specific Theories: Acquisition, Retention and Transfer to Actual Counseling Sessions

    ERIC Educational Resources Information Center

    Schaefle, Scott; Smaby, Marlowe H.; Packman, Jill; Maddux, Cleborne D.

    2007-01-01

    The purposes of the present study were to determine if (a) students trained to demonstrate specific skills learn these skills and transfer them to actual counseling sessions; (b) mastery of counseling skills differs by students' adherence to one of four general counseling theories; (c) mastery of counseling skills is related to counseling goal…

  12. Direct and Indirect Effects of Completion versus Accuracy Contingencies on Practice-Exam and Actual-Exam Performance

    ERIC Educational Resources Information Center

    Oliver, Renee; Williams, Robert L.

    2005-01-01

    Students in four sections of an undergraduate educational course (two large and two small sections) took out-of-class practice exams prior to actual exams for each of five course units. Each course unit consisted of five class sessions focusing on a specific developmental theme. Some sections received practice-exam credit based on the number of…

  13. Impact of potential and (scintillometer-based) actual evapotranspiration estimates on the performance of a lumped rainfall-runoff model

    NASA Astrophysics Data System (ADS)

    Samain, B.; Pauwels, V. R. N.

    2013-11-01

    Evapotranspiration (ET) plays a key role in hydrological impact studies and operational flood forecasting models as ET represents a loss of water from a catchment. Although ET is a major component of the catchment water balance, the evapotranspiration input for rainfall-runoff models is often simplified in contrast to the detailed estimates of catchment averaged precipitation. In this study, an existing conceptual rainfall-runoff model calibrated for and operational in the Bellebeek catchment in Belgium firstly has been validated and its sensitivity to different available potential ET input has been studied. It has been shown that when applying a calibrated rainfall-runoff model, the model input should be consistent with the input used for the calibration process, not only on the volume of ET, but also on the seasonal pattern. Secondly, estimates of the actual evapotranspiration based on measurements of a large aperture scintillometer (LAS) have been used as model forcing in the rainfall-runoff model. From this analysis, it has been shown that the actual evapotranspiration is a crucial factor in simulating the catchment water balance and the resulting stream flow. Regarding the actual evapotranspiration estimates from the LAS, it has been concluded that they can be considered realistic in summer months. In the months where stable conditions prevail (autumn, winter and (early) spring), an underestimation of the actual evapotranspiration is made, which has an important impact on the catchment's water balance.

  14. How do clinicians actually use the Diagnostic and Statistical Manual of Mental Disorders in clinical practice and why we need to know more.

    PubMed

    First, Michael B; Bhat, Venkat; Adler, David; Dixon, Lisa; Goldman, Beth; Koh, Steve; Levine, Bruce; Oslin, David; Siris, Sam

    2014-12-01

    The clinical use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is explicitly stated as a goal for both the DSM Fourth Edition and DSM Fifth Edition (DSM-5) revisions. Many uses assume a relatively faithful application of the DSM diagnostic definitions. However, studies demonstrate significant discrepancies between clinical psychiatric diagnoses with those made using structured interviews suggesting that clinicians do not systematically apply the diagnostic criteria. The limited information regarding how clinicians actually use the DSM raises important questions: a) How can the clinical use be improved without first having a baseline assessment? b) How can potentially significant shifts in practice patterns based on wording changes be assessed without knowing the extent to which the criteria are used as written? Given the American Psychiatric Association's plans for interim revisions to the DSM-5, the value of a detailed exploration of its actual use in clinical practice remains a significant ongoing concern and deserves further study including a number of survey and in vivo studies.

  15. Biodegradation of polyacrylamide by anaerobic digestion under mesophilic condition and its performance in actual dewatered sludge system.

    PubMed

    Dai, Xiaohu; Luo, Fan; Yi, Jing; He, Qunbiao; Dong, Bin

    2014-02-01

    Polyacrylamide (PAM) used in sludge dewatering widely exists in high-solid anaerobic digestion. Degradation of polyacrylamide accompanied with accumulation of its toxic monomer is important to disposition of biogas residues. The potential of anaerobic digestion activity in microbial utilization of PAM was investigated in this study. The results indicated that the utilization rate of PAM (as nitrogen source) was influenced by accumulation of ammonia, while cumulative removal of amide group was accorded with zeroth order reaction in actual dewatered system. The adjoining amide group can combined into ether group after biodegradation. PAM can be broken down in different position of its carbon chain backbone. In actual sludge system, the hydrolytic PAM was liable to combined tyrosine-rich protein to form colloid complex, and then consumed as carbon source to form monomer when easily degradable organics were exhausted. The accumulation of acrylamide was leveled off ultimately, accompanied with the yield of methane.

  16. Implications of Self-Deception for Self-Reported Intrinsic and Extrinsic Motivational Dispositions and Actual Learning Performance: A Higher Order Structural Model

    ERIC Educational Resources Information Center

    Hirschfeld, Robert R.; Thomas, Christopher H.; McNatt, D. Brian

    2008-01-01

    The authors explored implications of individuals' self-deception (a trait) for their self-reported intrinsic and extrinsic motivational dispositions and their actual learning performance. In doing so, a higher order structural model was developed and tested in which intrinsic and extrinsic motivational dispositions were underlying factors that…

  17. Differences Between Actual Motor Ability and Physical Self-Concept (Perceived Motor Performance/Body Image) of Fifth-Grade Boys.

    ERIC Educational Resources Information Center

    Boling, Robert; Kirk, Pamela

    Differences between high and low perceived physical self-concept and actual motor performance of 120 fifth grade boys were investigated. Self-concept was measured by the Physical Self-Concept Scale. Motor proficiency was measured by a four-item advanced agility/coordination test battery: hand-eye coordination; foot-eye coordination; whole body…

  18. The Role of Teacher and Family Opinions in Identifying Gifted Kindergarten Children and the Consistence of These Views with Children's Actual Performance

    ERIC Educational Resources Information Center

    Daglioglu, H. Elif; Suveren, Senem

    2013-01-01

    This study was conducted in order to identify gifted children attending kindergartens of elementary schools, determine how successful families and teachers were in selecting these children, and see how consistent their opinions were with children's actual performance. Participants were children attending kindergartens of elementary schools,…

  19. Mothers' and Teachers' Estimations of First Graders' Literacy Level and Their Relation to the Children's Actual Performance in Different SES Groups

    ERIC Educational Resources Information Center

    Korat, Ofra

    2011-01-01

    The relationship between mothers' and teachers' estimations of 60 children's literacy level and their actual performance were investigated in two different socio-economic status (SES) groups: low (LSES) and high (HSES). The children's reading (fluency, accuracy and comprehension) and spelling levels were measured. The mothers evaluated their own…

  20. Design and Convergence Performance Analysis of Aspherical Acoustic Lens Applied to Ambient Noise Imaging in Actual Ocean Experiment

    NASA Astrophysics Data System (ADS)

    Mori, Kazuyoshi; Ogasawara, Hanako; Nakamura, Toshiaki; Tsuchiya, Takenobu; Endoh, Nobuyuki

    2011-07-01

    In this study, an aspherical lens with the aperture diameter of 1.0 m was designed for utilization in an actual ocean experiment of ambient noise imaging (ANI). It was expected that this ANI system would realize directional resolution, which is a beam width of 1° at the center frequency of 120 kHz. We analyzed the sound pressure distribution focused by the designed lens using the 3D finite difference time domain method. The frequency dependence of a -3 dB area was then compared between 120 kHz and the higher or lower frequency. The analysis results suggested that the designed lens has fine directional resolution over the center frequency of 120 kHz. We had measured the directivity of the designed lens in an actual ocean experiment in Uchiura Bay in November of 2010. It was verified that the ANI system with this lens realizes a beam width of 1° at 120 kHz.

  1. How accurately does the VIVO Harvester reflect actual Clinical and Translational Sciences Award–affiliated faculty member publications?*

    PubMed Central

    Eldredge, Jonathan D.; Kroth, Philip J.; Murray-Krezan, Cristina; Hantak, Chad M.; Weagel, Edward F.; Hannigan, Gale G.

    2015-01-01

    Objective: The research tested the accuracy of the VIVO Harvester software in identifying publications authored by faculty members affiliated with a National Institutes of Health Clinical and Translational Sciences Award (CTSA) site. Methods: Health sciences librarians created “gold standard” lists of references for the years 2001 to 2011 from PubMed for twenty-five randomly selected investigators from one CTSA site. These gold standard lists were compared to the same twenty-five investigators' reference lists produced by VIVO Harvester. The authors subjected the discrepancies between the lists to sensitivity and specificity analyses. Results: The VIVO Harvester correctly identified only about 65% of the total eligible PubMed references for the years 2001–2011 for the CTSA-affiliated investigators. The identified references produced by VIVO Harvester were precise yet incomplete. The sensitivity rate was 0.65, and the specificity rate was 1.00. Conclusion: While the references produced by VIVO Harvester could be confirmed in PubMed, the VIVO Harvester retrieved only two-thirds of the required references from PubMed. National Institutes of Health CTSA sites will need to supplement VIVO Harvester–produced references with the expert searching skills of health sciences librarians. Implications: Health sciences librarians with searching skills need to alert their CTSA sites about these deficiencies and offer their skills to advance their sites' missions. PMID:25552940

  2. Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke

    PubMed Central

    Lin, Cheryl B; Cox, Margueritte; Olson, DaiWai M; Britz, Gavin W; Constable, Mark; Fonarow, Gregg C; Schwamm, Lee; Peterson, Eric D; Shah, Bimal R

    2015-01-01

    Background Timely thrombolytic therapy can improve stroke outcomes. Nevertheless, the ability of US hospitals to meet guidelines for intravenous tissue plasminogen activator (tPA) remains suboptimal. What is unclear is whether hospitals accurately perceive their rate of tPA “door-to-needle” (DTN) time within 60 minutes and how DTN rates compare across different hospitals. Methods and Results DTN performance was defined by the percentage of treated patients who received tPA within 60 minutes of arrival. Telephone surveys were obtained from staff at 141 Get With The Guidelines hospitals, representing top, middle, and lowDTN performance. Less than one-third (29.1%) of staff accurately identified their DTN performance. Among middle- and low-performing hospitals (n=92), 56 sites (60.9%) overestimated their performance; 42% of middle performers and 85% of low performers overestimated their performance. Sites that overestimated tended to have lower annual volumes of tPA administration (median 8.4 patients [25th to 75th percentile 5.9 to 11.8] versus 10.2 patients [25th to 75th percentile 8.2 to 17.3], P=0.047), smaller percentages of eligible patients receiving tPA (84.7% versus 89.8%, P=0.008), and smaller percentages of DTN ≤60 minutes among treated patients (10.6% versus 16.6%, P=0.002). Conclusions Hospitals often overestimate their ability to deliver timely tPA to treated patients. Our findings indicate the need to routinely provide comparative provider performance rates as a key step to improving the quality of acute stroke care. PMID:26201547

  3. Is less really more: Does a prefrontal efficiency genotype actually confer better performance when working memory becomes difficult?

    PubMed

    Ihne, Jessica L; Gallagher, Natalie M; Sullivan, Marie; Callicott, Joseph H; Green, Adam E

    2016-01-01

    Perhaps the most widely studied effect to emerge from the combination of neuroimaging and human genetics is the association of the COMT-Val(108/158)Met polymorphism with prefrontal activity during working memory. COMT-Val is a putative risk factor in schizophrenia, which is characterized by disordered prefrontal function. Work in healthy populations has sought to characterize mechanisms by which the valine (Val) allele may lead to disadvantaged prefrontal cognition. Lower activity in methionine (Met) carriers has been interpreted as advantageous neural efficiency. Notably, however, studies reporting COMT effects on neural efficiency have generally not reported working memory performance effects. Those studies have employed relatively low/easy working memory loads. Higher loads are known to elicit individual differences in working memory performance that are not visible at lower loads. If COMT-Met confers greater neural efficiency when working memory is easy, a reasonable prediction is that Met carriers will be better able to cope with increasing demand for neural resources when working memory becomes difficult. To our knowledge, this prediction has thus far gone untested. Here, we tested performance on three working memory tasks. Performance on each task was measured at multiple levels of load/difficulty, including loads more demanding than those used in prior studies. We found no genotype-by-load interactions or main effects of COMT genotype on accuracy or reaction time. Indeed, even testing for performance differences at each load of each task failed to find a single significant effect of COMT genotype. Thus, even if COMT genotype has the effects on prefrontal efficiency that prior work has suggested, such effects may not directly impact high-load working memory ability. The present findings accord with previous evidence that behavioral effects of COMT are small or nonexistent and, more broadly, with a growing consensus that substantial effects on phenotype will

  4. The development of a test system for investigating the performances of personal aerosol samplers under actual workplace conditions.

    PubMed

    Botham, R A; Hughson, G W; Vincent, J H; Mark, D

    1991-10-01

    The performances of new "total" aerosol samplers for use in workplaces are required to match the inhalability criteria as contained in the latest recommendations of the International Standards Organization (ISO) and the American Conference of Governmental Industrial Hygienists (ACGIH). In the past, practical evaluations have been carried out under idealized conditions in wind tunnels, and there is now the need to extend these to more realistic workplace conditions. This paper describes a new test system that was designed and built for this purpose. It consisted of a life-size mannequin mounted on a trolley so that it can be taken to and wheeled around in workplaces. The mannequin itself incorporated a robotic arm so that, under joystick control, it can be made to simulate a range of worker movements, orientations, and attitudes. An electronically controlled, compact breathing machine provided a range of typical breathing parameters for the mannequin. The pump also provided air movement for a number of personal samplers that were mounted on the torso of the mannequin and tested in that position. Sampler performance should be assessed by comparing directly the aerosol collected by the sampler with that inhaled by the mannequin (and collected on filters inside the head).

  5. Examining the Relationship between Clinical Decision Support and Performance Measurement

    PubMed Central

    Haggstrom, David A.; Saleem, Jason J.; Militello, Laura G.; Arbuckle, Nicole; Flanagan, Mindy; Doebbeling, Bradley N.

    2009-01-01

    In concept and practice, clinical decision support (CDS) and performance measurement represent distinct approaches to organizational change, yet these two organizational processes are interrelated. We set out to better understand how the relationship between the two is perceived, as well as how they jointly influence clinical practice. To understand the use of CDS at benchmark institutions, we conducted semistructured interviews with key managers, information technology personnel, and clinical leaders during a qualitative field study. Improved performance was frequently cited as a rationale for the use of clinical reminders. Pay-for-performance efforts also appeared to provide motivation for the use of clinical reminders. Shared performance measures were associated with shared clinical reminders. The close link between clinical reminders and performance measurement causes these tools to have many of the same implementation challenges. PMID:20351854

  6. Clinical Performance Characteristics of the Adiana® System for Permanent Contraception: The First Year of Commercial Use

    PubMed Central

    Herbst, Seth J; Evantash, Edward G

    2010-01-01

    In 2009, the Adiana® System for Permanent Contraception was approved by the US Food and Drug Administration and became the second device on the market for hysteroscopic sterilization. This article outlines the basics of the Adiana procedure as it relates to the initial 12-month clinical experience following commercial launch. Safety, efficacy, and practical applications are explored to provide a better understanding of product performance characteristics in the first year of actual clinical use. PMID:21364847

  7. Predictors of Successful Clinical Performance in Associate Degree Nursing Students.

    PubMed

    Rice, Eileen

    2015-01-01

    The purpose of this study was to explore self-efficacy and emotional intelligence (EI) as predictors for successful clinical performance in nursing students. Students (n = 56) from 5 associate degree in nursing (ADN) schools in 2 Northeastern states participated in the study. Findings demonstrated significant relationships among EI, self-efficacy, and student-rated clinical competence. The findings from this study support the importance of fostering clinical self-efficacy and building EI abilities in ADN students. PMID:25628244

  8. Relationship between clinical fieldwork educator performance and health professional students' perceptions of their practice education learning environments.

    PubMed

    Brown, Ted; Williams, Brett; Lynch, Marty

    2013-12-01

    The Dundee Ready Education Environment Measure, Clinical Teaching Effectiveness Instrument, and Clinical Learning Environment Inventory were completed by 548 undergraduate students (54.5% response rate) enrolled in eight health professional bachelor degree courses. Regression analysis was used to investigate the significant predictors of the Clinical Teaching Effectiveness Instrument with the Dundee Ready Education Environment Measure and Clinical Learning Environment Inventory subscales as independent variables. The results indicated that the Dundee Ready Education Environment Measure and Clinical Learning Environment Inventory Actual version subscale scores explained 44% of the total variance in the Clinical Teaching Effectiveness Instrument score. The Dundee Ready Education Environment Measure subscale Academic Self-Perception explained 1.1% of the variance in the Clinical Teaching Effectiveness Instrument score. The Clinical Learning Environment Inventory Actual subscales accounted for the following variance percentages in the Clinical Teaching Effectiveness Instrument score: personalization, 1.1%; satisfaction, 1.7%; task orientation, 5.1%; and innovation, 6.2%. Aspects of the clinical learning environment appear to be predictive of the effectiveness of the clinical teaching that students experience. Fieldwork educator performance might be a significant contributing factor toward student skill development and practitioner success.

  9. Clinical performance and skill retention after simulation-based education for nephrology fellows.

    PubMed

    Ahya, Shubhada N; Barsuk, Jeffrey H; Cohen, Elaine R; Tuazon, Jennifer; McGaghie, William C; Wayne, Diane B

    2012-07-01

    We previously demonstrated that simulation-based education (SBE) improved temporary hemodialysis catheter (THDC) insertion skills by nephrology fellows. SBE, featuring deliberate practice and rigorous achievement standards, was a powerful method to enhance THDC insertion skills in nephrology fellows. However, experts have called for further research to evaluate skill transfer from the simulated environment to actual clinical care and skill retention. This is a prospective observational cohort study of THDC insertion skills. Twelve nephrology fellows from three academic centers in Chicago were evaluated using a skills checklist from July 2008 to June 2009. Simulator-trained fellows were tested after the SBE intervention and expected to meet or exceed a minimum passing score (MPS) set by an expert panel. To assess transfer of skill to clinical care, three simulator-trained fellows were assessed at 6 months on actual patient THDC insertions using the checklist. To assess retention of skill, 11 of 12 simulator-trained fellows were reassessed at 1 year using the checklist and central venous catheter simulator. Outcomes were determined by THDC insertion skill performance. Simulator-trained fellows scored similarly during 6-month THDC insertions on actual patients and immediate posttest (M = 86.2%, SD = 22.3% vs. M = 93.5%, SD = 5.3%, p = 0.32). However, 1 year after SBE, simulated THDC insertion scores were significantly lower than at immediate posttest (M = 73.4%, SD = 22.2% vs. M = 93.5%, SD = 5.3%, p = 0.01). Our results show that nephrology fellows who completed SBE displayed high levels of performance during THDC insertions on actual patients 6 months later. At 1 year, there was statistically significant skills decay. We recommend booster training at 6 months.

  10. The role of visual perception measures used in sports vision programmes in predicting actual game performance in Division I collegiate hockey players.

    PubMed

    Poltavski, Dmitri; Biberdorf, David

    2015-01-01

    Abstract In the growing field of sports vision little is still known about unique attributes of visual processing in ice hockey and what role visual processing plays in the overall athlete's performance. In the present study we evaluated whether visual, perceptual and cognitive/motor variables collected using the Nike SPARQ Sensory Training Station have significant relevance to the real game statistics of 38 Division I collegiate male and female hockey players. The results demonstrated that 69% of variance in the goals made by forwards in 2011-2013 could be predicted by their faster reaction time to a visual stimulus, better visual memory, better visual discrimination and a faster ability to shift focus between near and far objects. Approximately 33% of variance in game points was significantly related to better discrimination among competing visual stimuli. In addition, reaction time to a visual stimulus as well as stereoptic quickness significantly accounted for 24% of variance in the mean duration of the player's penalty time. This is one of the first studies to show that some of the visual skills that state-of-the-art generalised sports vision programmes are purported to target may indeed be important for hockey players' actual performance on the ice. PMID:25142869

  11. The role of visual perception measures used in sports vision programmes in predicting actual game performance in Division I collegiate hockey players.

    PubMed

    Poltavski, Dmitri; Biberdorf, David

    2015-01-01

    Abstract In the growing field of sports vision little is still known about unique attributes of visual processing in ice hockey and what role visual processing plays in the overall athlete's performance. In the present study we evaluated whether visual, perceptual and cognitive/motor variables collected using the Nike SPARQ Sensory Training Station have significant relevance to the real game statistics of 38 Division I collegiate male and female hockey players. The results demonstrated that 69% of variance in the goals made by forwards in 2011-2013 could be predicted by their faster reaction time to a visual stimulus, better visual memory, better visual discrimination and a faster ability to shift focus between near and far objects. Approximately 33% of variance in game points was significantly related to better discrimination among competing visual stimuli. In addition, reaction time to a visual stimulus as well as stereoptic quickness significantly accounted for 24% of variance in the mean duration of the player's penalty time. This is one of the first studies to show that some of the visual skills that state-of-the-art generalised sports vision programmes are purported to target may indeed be important for hockey players' actual performance on the ice.

  12. Perceived factors of family planning clinic performance and service quality.

    PubMed

    Roberto, E L

    1993-01-01

    As part of a larger operations research project, this 1990 study analyzed the performance of the Philippine Department of Health's (DOH) family planning (FP) clinics. Specific study objectives were 1) to measure acceptor targets, servicing capacity utilization, outreach, and costs; 2) to determine what providers believed affected performance; 3) to record which quality indicator providers use; and 4) to determine the perceptions of acceptors about clinic personnel, the clinic as a FP outlet, FP service processing, and FP service quality. Data were gathered from clinic records and from sample surveys in 25 clinics in four specified locations. Eight clients were sampled from each of the 100 clinics. It was found that clinic staff accepted low attainment of FP acceptor targets and that clinic capacity utilization levels were at 25% of capacity. Providers were unaware of the number of potential FP acceptors in their areas and had no information about the costs of running their clinics. The FP clinic managers identified 34 major determinants of clinic performance, but more than half reported that they had very little control over these determinants. The providers described quality service from the point of view of the acceptors and described the quality of a clinic in terms of the minimal physical characteristics required. The acceptor survey revealed that acceptor satisfaction depends upon 1) clinic accessibility and lay-out, 2) intensive personal contact, and 3) clinic infrastructure. The study uncovered a need for the DOH to institute management training programs for clinic managers and to provide managers with the resources and personnel to shift priorities in favor of FP coverage and prevalence. Managers, who are resource allocators, must also receive information about the costs of FP services in their clinics. In addition, the DOH's determination that its FP program would be facility- rather than community-based should be modified to incorporate community outreach

  13. An evaluation of the clinical performance of newly qualified nurses: a competency based assessment.

    PubMed

    O'Connor, S E; Pearce, J; Smith, R L; Voegeli, D; Walton, P

    2001-10-01

    The clinical performance of newly qualified staff nurses, or their 'fitness for purpose' has become a central professional and corporate issue and highlighted as a central causes for the reforms recommended by the Peach report (Peach 1999). However the ability to gauge the performance of newly qualified nurses remains a largely subjective exercise relying upon anecdotal evidence or general statements of newly qualified nurses' feelings of inadequacy on qualification. This article seeks to address this issue by reporting the findings of project that sought to compare the expectations of senior nurses regarding the level of competence of newly qualified nurses with that of the actual level of competency as assessed by the preceptors after 8 weeks in post. Using a specifically designed instrument to assess clinical competency a comparison has been made between 139 senior nurses' expectations of the competency of newly qualified nurses and the actual competence as assessed by preceptors of 36 newly qualified nurses after 8 weeks in post. The findings indicate that the senior nurses have clear subjective expectations of the competence level of newly qualified nurses. However these expectations are consistently lower than the actual level of competency demonstrated by the newly qualified nurses as assessed by their preceptors. This research demonstrates that through the use of a validated tool newly qualified nurses consistently perform at a higher level of competency than that expected by senior nurses. The ability to estimate competency levels by objective means should be developed. Further research is needed involving a larger sample of Trusts and Schools of Nursing to replicate the results of this study and to compare methods of the assessment of performance in terms of competency in practice on qualification. It is through developments based upon research such as this that a systematic evaluation of the contribution of Schools of Nursing to the competence of newly

  14. Workplace Correlates and Scholarly Performance of Clinical Pharmacy Faculty.

    ERIC Educational Resources Information Center

    Jungnickel, Paul W.; Creswell, John W.

    1994-01-01

    This study sought to develop a correlate model of 3-year scholarly performance of 296 clinical pharmacy faculty. Participants were surveyed concerning refereed research, grants/books research, and nonresearch scholarship. Eight correlates, including two related to the departmental workplace, emerged as significant factors in scholarly performance.…

  15. Controlling Rater Stringency Error in Clinical Performance Rating: Further Validation of a Performance Rating Theory.

    ERIC Educational Resources Information Center

    Cason, Gerald J.; And Others

    Prior research in a single clinical training setting has shown Cason and Cason's (1981) simplified model of their performance rating theory can improve rating reliability and validity through statistical control of rater stringency error. Here, the model was applied to clinical performance ratings of 14 cohorts (about 250 students and 200 raters)…

  16. Spiral microstrip hyperthermia applicators: technical design and clinical performance.

    PubMed

    Samulski, T V; Fessenden, P; Lee, E R; Kapp, D S; Tanabe, E; McEuen, A

    1990-01-01

    Spiral microstrip microwave (MW) antennas have been developed and adapted for use as clinical hyperthermia applicators. The design has been configured in a variety of forms including single fixed antenna applicators, multi-element arrays, and mechanically scanned single or paired antennas. The latter three configurations have been used to allow an expansion of the effective heating area. Specific absorption rate (SAR) distributions measured in phantom have been used to estimate the depth and volume of effective heating. The estimates are made using the bioheat equation assuming uniformly perfused tissue. In excess of 500 treatments of patients with advanced or recurrent localized superficial tumors have been performed using this applicator technology. Data from clinical treatments have been analyzed to quantify the heating performance and verify the suitability of these applicators for clinical use. Good microwave coupling efficiency together with the compact applicator size have proved to be valuable clinical assets.

  17. Spiral microstrip hyperthermia applicators: technical design and clinical performance.

    PubMed

    Samulski, T V; Fessenden, P; Lee, E R; Kapp, D S; Tanabe, E; McEuen, A

    1990-01-01

    Spiral microstrip microwave (MW) antennas have been developed and adapted for use as clinical hyperthermia applicators. The design has been configured in a variety of forms including single fixed antenna applicators, multi-element arrays, and mechanically scanned single or paired antennas. The latter three configurations have been used to allow an expansion of the effective heating area. Specific absorption rate (SAR) distributions measured in phantom have been used to estimate the depth and volume of effective heating. The estimates are made using the bioheat equation assuming uniformly perfused tissue. In excess of 500 treatments of patients with advanced or recurrent localized superficial tumors have been performed using this applicator technology. Data from clinical treatments have been analyzed to quantify the heating performance and verify the suitability of these applicators for clinical use. Good microwave coupling efficiency together with the compact applicator size have proved to be valuable clinical assets. PMID:2298626

  18. 'I've used the word cancer but it's actually good news': discursive performativity of cancer and the identity of urological cancer services.

    PubMed

    Kazimierczak, Karolina Agata; Skea, Zoe

    2015-03-01

    Drawing on the ethnographic study of urological cancer services, this article explores how a set of particular discourses embedded in the everyday clinical work in a large teaching hospital in the UK helps materialise particular configurations of cancer and related professional identities. Emerging on the intersection of specific socio-material arrangements (cancer survival rates, treatment regimens, cancer staging classifications, metaphors, clinical specialities) and operating across a number of differential relations (curable/incurable, treatable/untreatable, aggressive/nonaggressive), these configurations help constitute the categories of 'good' and 'bad' cancers as separate and contrasting entities. These categories help materialise particular distributions of power and are thus implicated in the making of specific claims about the identity of urological cancer services as unique and privileged. Exploring these issues in view of feminist and material-semiotic approaches to studying science, technology and medicine, this article seeks to move away from the understanding of cancer discourses as primarily linguistic performances, proposing to see them instead as arrangements of practices and relations simultaneously material and semiotic through which particular categories, entities and phenomena acquire their determinate nature. In doing so, it seeks to contribute to sociology's broader concern with discursive performativity of cancer. PMID:25847531

  19. 'I've used the word cancer but it's actually good news': discursive performativity of cancer and the identity of urological cancer services.

    PubMed

    Kazimierczak, Karolina Agata; Skea, Zoe

    2015-03-01

    Drawing on the ethnographic study of urological cancer services, this article explores how a set of particular discourses embedded in the everyday clinical work in a large teaching hospital in the UK helps materialise particular configurations of cancer and related professional identities. Emerging on the intersection of specific socio-material arrangements (cancer survival rates, treatment regimens, cancer staging classifications, metaphors, clinical specialities) and operating across a number of differential relations (curable/incurable, treatable/untreatable, aggressive/nonaggressive), these configurations help constitute the categories of 'good' and 'bad' cancers as separate and contrasting entities. These categories help materialise particular distributions of power and are thus implicated in the making of specific claims about the identity of urological cancer services as unique and privileged. Exploring these issues in view of feminist and material-semiotic approaches to studying science, technology and medicine, this article seeks to move away from the understanding of cancer discourses as primarily linguistic performances, proposing to see them instead as arrangements of practices and relations simultaneously material and semiotic through which particular categories, entities and phenomena acquire their determinate nature. In doing so, it seeks to contribute to sociology's broader concern with discursive performativity of cancer.

  20. Work Satisfaction and Performance of Physicians in Pediatric Outpatient Clinics

    PubMed Central

    Nathanson, Constance A.; Becker, Marshall H.

    1973-01-01

    The sources and consequences of variations in work satisfaction are investigated in a study of approximately 100 physicians in six pediatric outpatient clinics, half of them associated with teaching hospitals and half with community hospitals. Measures of work satisfaction, role conflict, and performance are related to physicians' perceived internal and external reward values, controlling for clinic attributes and physicians' background characteristics, and differences between the two clinic types are documented. Implications of the study results for potential conflict between outpatient care and academic aims in teaching hospitals are discussed and avenues of possible further research are suggested. PMID:4705214

  1. Clinical performance of three anterior restorative materials over 10 years.

    PubMed

    Jokstad, A; Mjör, I A; Nilner, K; Kaping, S

    1994-02-01

    The long-term performance of two chemically activated composite resins was compared to that of one silicate cement. Bulk and cavosurface marginal discoloration was evaluated with both an indirect photographic method and the direct US Public Health Service evaluation system. The results confirmed that composite resins had superior performance but higher secondary caries incidence than did silicate cements. The macrofilled composite resins showed better clinical performance than the microfilled restorations, as well as similar incidences of bulk and marginal discoloration. The agreement between the scores obtained with the direct evaluation criteria and those resulting from the indirect evaluation method was relatively poor. The indirect scores were usually the same or poorer than the direct clinical scores. The results indicated that the clinical evaluation may be the least sensitive of the two methods. The discrepancy in the scorings may, on the other hand, signify that the indirect photographic method records reflectance spectra that are not normally obtained in vivo.

  2. The effect of communicating the genetic risk of cardiometabolic disorders on motivation and actual engagement in preventative lifestyle modification and clinical outcome: a systematic review and meta-analysis of randomised controlled trials.

    PubMed

    Li, Sherly X; Ye, Zheng; Whelan, Kevin; Truby, Helen

    2016-09-01

    Genetic risk prediction of chronic conditions including obesity, diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest. We aimed to understand whether the latter is indeed true by conducting a systematic review and meta-analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification. We included all randomised controlled trials (RCT) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease, without restrictions on age, duration of intervention or language. We conducted random-effects meta-analyses for perceived motivation for behaviour change and clinical changes (weight loss) and a narrative analysis for other outcomes. Within the thirteen studies reviewed, five were vignette studies (hypothetical RCT) and seven were clinical RCT. There was no consistent effect of genetic risk on actual motivation for weight loss, perceived motivation for dietary change (control v. genetic risk group standardised mean difference (smd) -0·15; 95 % CI -1·03, 0·73, P=0·74) or actual change in dietary behaviour. Similar results were observed for actual weight loss (control v. high genetic risk SMD 0·29 kg; 95 % CI -0·74, 1·31, P=0·58). This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults. Of thirteen studies, eight were at high or unclear risk of bias. Additional larger-scale, high-quality clinical RCT are warranted. PMID:27405704

  3. The effect of communicating the genetic risk of cardiometabolic disorders on motivation and actual engagement in preventative lifestyle modification and clinical outcome: a systematic review and meta-analysis of randomised controlled trials.

    PubMed

    Li, Sherly X; Ye, Zheng; Whelan, Kevin; Truby, Helen

    2016-09-01

    Genetic risk prediction of chronic conditions including obesity, diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest. We aimed to understand whether the latter is indeed true by conducting a systematic review and meta-analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification. We included all randomised controlled trials (RCT) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease, without restrictions on age, duration of intervention or language. We conducted random-effects meta-analyses for perceived motivation for behaviour change and clinical changes (weight loss) and a narrative analysis for other outcomes. Within the thirteen studies reviewed, five were vignette studies (hypothetical RCT) and seven were clinical RCT. There was no consistent effect of genetic risk on actual motivation for weight loss, perceived motivation for dietary change (control v. genetic risk group standardised mean difference (smd) -0·15; 95 % CI -1·03, 0·73, P=0·74) or actual change in dietary behaviour. Similar results were observed for actual weight loss (control v. high genetic risk SMD 0·29 kg; 95 % CI -0·74, 1·31, P=0·58). This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults. Of thirteen studies, eight were at high or unclear risk of bias. Additional larger-scale, high-quality clinical RCT are warranted.

  4. Environmental performance of an integrated fixed-film activated sludge (IFAS) reactor treating actual municipal wastewater during start-up phase.

    PubMed

    Singh, Nitin Kumar; Kazmi, Absar Ahmad; Starkl, Markus

    2015-01-01

    The present study summarizes the start-up performance and lessons learned during the start-up and optimization of a pilot-scale plant employing integrated fixed film activated sludge (IFAS) process treating actual municipal wastewater. A comprehensive start-up was tailored and implemented to cater for all the challenges and problems associated with start-up. After attaining desired suspended biomass (2,000-3,000 mg/L) and sludge age (∼7 days), the average biological oxygen demand (BOD) and chemical oxygen demand (COD) removals were observed as 77.3 and 70.9%, respectively, at optimized conditions, i.e. hydraulic retention time (HRT), 6.9 h; return sludge rate, 160%. The influent concentrations of COD, BOD, total suspended solids, NH3-N, total nitrogen and total phosphorus were found to be in the range of 157-476 mg/L, 115-283 mg/L, 152-428 mg/L, 23.2-49.3 mg/L, 30.1-52 mg/L and 3.6-7.8 mg/L, respectively, and the minimum effluent concentrations were achieved as ∼49 mg/L, 23 mg/L, 35 mg/L, 2.2 mg/L, 3.4 mg/L and 2.8 mg/L, respectively, at optimum state. The present system was found effective in the removal of pathogenic bacteria (Escherichia coli, 79%; Salmonella spp., 97.5%; Shigella spp., 92.9%) as well as coliforms (total coliforms, 97.65%; faecal coliforms, 80.35%) without any disinfection unit. Moreover it was observed that the time required for the stabilization of the plant was approximately 3 weeks if other parameters (sludge age, HRT and dissolved oxygen) are set to optimized values. PMID:26540547

  5. Clinical Vignettes Improve Performance in Anatomy Practical Assessment

    ERIC Educational Resources Information Center

    Ikah, December S. K.; Finn, Gabrielle M.; Swamy, Meenakshi; White, Pamela M.; McLachlan, John C.

    2015-01-01

    Although medical curricula now adopt an integrated teaching approach, this is not adequately reflected in assessment of anatomy knowledge and skills. In this study, we aimed to explore the impact of the addition of clinical vignette to item stems on students' performance in anatomy practical examinations. In this study, 129 undergraduate medical…

  6. Analysis of factors that predict clinical performance in medical school.

    PubMed

    White, Casey B; Dey, Eric L; Fantone, Joseph C

    2009-10-01

    Academic achievement indices including GPAs and MCAT scores are used to predict the spectrum of medical student academic performance types. However, use of these measures ignores two changes influencing medical school admissions: student diversity and affirmative action, and an increased focus on communication skills. To determine if GPA and MCAT predict performance in medical school consistently across students, and whether either predicts clinical performance in clerkships. A path model was developed to examine relationships among indices of medical student performance during the first three years of medical school for five cohorts of medical students. A structural equation approach was used to calculate the coefficients hypothesized in the model for majority and minority students. Significant differences between majority and minority students were observed. MCAT scores, for example, did not predict performance of minority students in the first year of medical school but did predict performance of majority students. This information may be of use to medical school admissions and resident selection committees. PMID:18030590

  7. Clinical simulation training improves the clinical performance of Chinese medical students

    PubMed Central

    Zhang, Ming-ya; Cheng, Xin; Xu, An-ding; Luo, Liang-ping; Yang, Xuesong

    2015-01-01

    Background Modern medical education promotes medical students’ clinical operating capacity rather than the mastery of theoretical knowledge. To accomplish this objective, clinical skill training using various simulations was introduced into medical education to cultivate creativity and develop the practical ability of students. However, quantitative analysis of the efficiency of clinical skill training with simulations is lacking. Methods In the present study, we compared the mean scores of medical students (Jinan University) who graduated in 2013 and 2014 on 16 stations between traditional training (control) and simulative training groups. In addition, in a clinical skill competition, the objective structured clinical examination (OSCE) scores of participating medical students trained using traditional and simulative training were compared. The data were statistically analyzed and qualitatively described. Results The results revealed that simulative training could significantly enhance the graduate score of medical students compared with the control. The OSCE scores of participating medical students in the clinical skill competition, trained using simulations, were dramatically higher than those of students trained through traditional methods, and we also observed that the OSCE marks were significantly increased for the same participant after simulative training for the clinical skill competition. Conclusions Taken together, these data indicate that clinical skill training with a variety of simulations could substantially promote the clinical performance of medical students and optimize the resources used for medical education, although a precise analysis of each specialization is needed in the future. PMID:26478142

  8. Clinical laboratory as an economic model for business performance analysis

    PubMed Central

    Buljanović, Vikica; Patajac, Hrvoje; Petrovečki, Mladen

    2011-01-01

    Aim To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths. Methods Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory. Results Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465. Conclusion The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by

  9. Improvements in and actual performance of the Plant Experiment Unit onboard Kibo, the Japanese experiment module on the international space station

    NASA Astrophysics Data System (ADS)

    Yano, Sachiko; Kasahara, Haruo; Masuda, Daisuke; Tanigaki, Fumiaki; Shimazu, Toru; Suzuki, Hiromi; Karahara, Ichirou; Soga, Kouichi; Hoson, Takayuki; Tayama, Ichiro; Tsuchiya, Yoshikazu; Kamisaka, Seiichiro

    2013-03-01

    In 2004, Japan Aerospace Exploration Agency developed the engineered model of the Plant Experiment Unit and the Cell Biology Experiment Facility. The Plant Experiment Unit was designed to be installed in the Cell Biology Experiment Facility and to support the seed-to-seed life cycle experiment of Arabidopsis plants in space in the project named Space Seed. Ground-based experiments to test the Plant Experiment Unit showed that the unit needed further improvement of a system to control the water content of a seedbed using an infrared moisture analyzer and that it was difficult to keep the relative humidity inside the Plant Experiment Unit between 70 and 80% because the Cell Biology Experiment Facility had neither a ventilation system nor a dehumidifying system. Therefore, excess moisture inside the Cell Biology Experiment Facility was removed with desiccant bags containing calcium chloride. Eight flight models of the Plant Experiment Unit in which dry Arabidopsis seeds were fixed to the seedbed with gum arabic were launched to the International Space Station in the space shuttle STS-128 (17A) on August 28, 2009. Plant Experiment Unit were installed in the Cell Biology Experiment Facility with desiccant boxes, and then the Space Seed experiment was started in the Japanese Experiment Module, named Kibo, which was part of the International Space Station, on September 10, 2009 by watering the seedbed and terminated 2 months later on November 11, 2009. On April 19, 2010, the Arabidopsis plants harvested in Kibo were retrieved and brought back to Earth by the space shuttle mission STS-131 (19A). The present paper describes the Space Seed experiment with particular reference to the development of the Plant Experiment Unit and its actual performance in Kibo onboard the International Space Station. Downlinked images from Kibo showed that the seeds had started germinating 3 days after the initial watering. The plants continued growing, producing rosette leaves, inflorescence

  10. Clinical Performance of a New Biomimetic Double Network Material

    PubMed Central

    Dirxen, Christine; Blunck, Uwe; Preissner, Saskia

    2013-01-01

    Background: The development of ceramics during the last years was overwhelming. However, the focus was laid on the hardness and the strength of the restorative materials, resulting in high antagonistic tooth wear. This is critical for patients with bruxism. Objectives: The purpose of this study was to evaluate the clinical performance of the new double hybrid material for non-invasive treatment approaches. Material and Methods: The new approach of the material tested, was to modify ceramics to create a biomimetic material that has similar physical properties like dentin and enamel and is still as strong as conventional ceramics. Results: The produced crowns had a thickness ranging from 0.5 to 1.5 mm. To evaluate the clinical performance and durability of the crowns, the patient was examined half a year later. The crowns were still intact and soft tissues appeared healthy and this was achieved without any loss of tooth structure. Conclusions: The material can be milled to thin layers, but is still strong enough to prevent cracks which are stopped by the interpenetrating polymer within the network. Depending on the clinical situation, minimally- up to non-invasive restorations can be milled. Clinical Relevance: Dentistry aims in preservation of tooth structure. Patients suffering from loss of tooth structure (dental erosion, Amelogenesis imperfecta) or even young patients could benefit from minimally-invasive crowns. Due to a Vickers hardness between dentin and enamel, antagonistic tooth wear is very low. This might be interesting for treating patients with bruxism. PMID:24167534

  11. Performance evaluation and clinical applications of 3D plenoptic cameras

    NASA Astrophysics Data System (ADS)

    Decker, Ryan; Shademan, Azad; Opfermann, Justin; Leonard, Simon; Kim, Peter C. W.; Krieger, Axel

    2015-06-01

    The observation and 3D quantification of arbitrary scenes using optical imaging systems is challenging, but increasingly necessary in many fields. This paper provides a technical basis for the application of plenoptic cameras in medical and medical robotics applications, and rigorously evaluates camera integration and performance in the clinical setting. It discusses plenoptic camera calibration and setup, assesses plenoptic imaging in a clinically relevant context, and in the context of other quantitative imaging technologies. We report the methods used for camera calibration, precision and accuracy results in an ideal and simulated surgical setting. Afterwards, we report performance during a surgical task. Test results showed the average precision of the plenoptic camera to be 0.90mm, increasing to 1.37mm for tissue across the calibrated FOV. The ideal accuracy was 1.14mm. The camera showed submillimeter error during a simulated surgical task.

  12. Form and Actuality

    NASA Astrophysics Data System (ADS)

    Bitbol, Michel

    A basic choice underlies physics. It consists of banishing actual situations from theoretical descriptions, in order to reach a universal formal construct. Actualities are then thought of as mere local appearances of a transcendent reality supposedly described by the formal construct. Despite its impressive success, this method has left major loopholes in the foundations of science. In this paper, I document two of these loopholes. One is the problem of time asymmetry in statistical thermodynamics, and the other is the measurement problem of quantum mechanics. Then, adopting a broader philosophical standpoint, I try to turn the whole picture upside down. Here, full priority is given to actuality (construed as a mode of the immanent reality self-reflectively being itself) over formal constructs. The characteristic aporias of this variety of "Copernican revolution" are discussed.

  13. Elevated serum CA 19-9 level associated with a splenic cyst: which is the actual clinical management? Review of the literature.

    PubMed

    Bresadola, Vittorio; Pravisani, Riccardo; Terrosu, Giovanni; Risaliti, Andrea

    2015-01-01

    Splenic cysts are relatively rare entities. The differential diagnosis for these lesions includes parasite infections, results of previous trauma or infarction, congenital forms, primitive splenic neoplasm or cystic metastasis. They can be either symptomatic, causing mainly abdominal pain, or asymptomatic, thus being diagnosed as in incidental finding during radiological examination for other clinical reasons: among these a raised serum level of CA 19-9 can be a case. It has been demonstrated that epidermoid and mesothelial congenital cyst can be associated with a pathological level of this tumor marker which is usually correlated to biliopancreatic and colonic carcinomas. The aim of the present study is to present the case of an asymptomatic epidermoid splenic cyst associated with a continuous increase of CA 19-9 and to describe the applied clinical workup and surgical management by laparoscopic total splenectomy. Moreover, to analyze the demographics, clinical and pathological features of these infrequent lesions and to confront our therapeutic management with that of the other reported cases, we conducted a systematic review of the literature.

  14. Development of the Canadian Physiotherapy Assessment of Clinical Performance: A New Tool to Assess Physiotherapy Students' Performance in Clinical Education

    PubMed Central

    Brooks, Dina; Norman, Kathleen E.; Herold, Jodi; Beaton, Dorcas E.

    2015-01-01

    ABSTRACT Purpose: To develop the first draft of a Canadian tool to assess physiotherapy (PT) students' performance in clinical education (CE). Phase 1: to gain consensus on the items within the new tool, the number and placement of the comment boxes, and the rating scale; Phase 2: to explore the face and content validity of the draft tool. Methods: Phase 1 used the Delphi method; Phase 2 used cognitive interviewing methods with recent graduates and clinical instructors (CIs) and detailed interviews with clinical education and measurement experts. Results: Consensus was reached on the first draft of the new tool by round 3 of the Delphi process, which was completed by 21 participants. Interviews were completed with 13 CIs, 6 recent graduates, and 7 experts. Recent graduates and CIs were able to interpret the tool accurately, felt they could apply it to a recent CE experience, and provided suggestions to improve the draft. Experts provided salient advice. Conclusions: The first draft of a new tool to assess PT students in CE, the Canadian Physiotherapy Assessment of Clinical Performance (ACP), was developed and will undergo further development and testing, including national consultation with stakeholders. Data from Phase 2 will contribute to developing an online education module for CIs and students. PMID:26839459

  15. An integrated evaluation for the performance of clinical engineering department.

    PubMed

    Yousry, Ahmed M; Ouda, Bassem K; Eldeib, Ayman M

    2014-01-01

    Performance benchmarking have become a very important component in all successful organizations nowadays that must be used by Clinical Engineering Department (CED) in hospitals. Many researchers identified essential mainstream performance indicators needed to improve the CED's performance. These studies revealed mainstream performance indicators that use the database of a CED to evaluate its performance. In this work, we believe that those indicators are insufficient for hospitals. Additional important indicators should be included to improve the evaluation accuracy. Therefore, we added new indicators: technical/maintenance indicators, economic indicators, intrinsic criticality indicators, basic hospital indicators, equipment acquisition, and safety indicators. Data is collected from 10 hospitals that cover different types of healthcare organizations. We developed a software tool that analyses collected data to provide a score for each CED under evaluation. Our results indicate that there is an average gap of 67% between the CEDs' performance and the ideal target. The reasons for the noncompliance are discussed in order to improve performance of CEDs under evaluation.

  16. Clinical performance feedback and quality improvement opportunities for perioperative physicians.

    PubMed

    Kaye, Alan David; Okanlawon, Olutoyin J; Urman, Richard D

    2014-01-01

    Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care. PMID:24833948

  17. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    PubMed Central

    Kaye, Alan David; Okanlawon, Olutoyin J; Urman, Richard D

    2014-01-01

    Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The “buy-in” includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care. PMID:24833948

  18. Assessment of ambulatory blood pressure recorders: accuracy and clinical performance.

    PubMed

    White, W B

    1991-06-01

    There are now more than ten different manufacturers of non-invasive, portable blood pressure monitors in North America, Europe, and Japan. These ambulatory blood pressure recorders measure blood pressure by either auscultatory or oscillometric methodology. Technologic advances in the recorders have resulted in reduction in monitor size, reduction in or absence of motor noise during cuff inflation, ability to program the recorder without an external computer system, and enhanced precision. Recently, there has been concern that more structured validation protocols have not been implemented prior to the widespread marking of ambulatory blood pressure recorders. There is a need for proper assessment of recorders prior to use in clinical research or practice. Data on several existing recorders suggest that while most are reasonably accurate during resting measurements, many lose this accuracy during motion, and clinical performance may vary among the monitors. Validation studies of ambulatory recorders should include comparison with mercury column and intra-arterial determinations, resting and motion measurements, and assessment of clinical performance in hypertensive patients. PMID:1893652

  19. Performance evaluation of 24 ion exchange materials for removing cesium and strontium from actual and simulated N-Reactor storage basin water

    SciTech Connect

    Brown, G.N.; Carson, K.J.; DesChane, J.R.; Elovich, R.J.

    1997-09-01

    This report describes the evaluation of 24 organic and inorganic ion exchange materials for removing cesium and strontium from actual and simulated waters from the 100 Area 105 N-Reactor fuel storage basin. The data described in this report can be applied for developing and evaluating ion exchange pre-treatment process flowsheets. Cesium and strontium batch distribution ratios (K{sub d}`s), decontamination factors (DF), and material loadings (mmol g{sup -1}) are compared as a function of ion exchange material and initial cesium concentration. The actual and simulated N-Basin waters contain relatively low levels of aluminum, barium, calcium, potassium, and magnesium (ranging from 8.33E-04 to 6.40E-05 M), with slightly higher levels of boron (6.63E-03 M) and sodium (1.62E-03 M). The {sup 137}Cs level is 1.74E-06 Ci L-{sup 1} which corresponds to approximately 4.87E-10 M Cs. The initial Na/Cs ratio was 3.33E+06. The concentration of total strontium is 4.45E-06 M, while the {sup 90}Sr radioactive component was measured to be 6.13E-06 Ci L{sup -1}. Simulant tests were conducted by contacting 0.067 g or each ion exchange material with approximately 100 mL of either the actual or simulated N-Basin water. The simulants contained variable initial cesium concentrations ranging from 1.00E-04 to 2.57E- 10 M Cs while all other components were held constant. For all materials, the average cesium K{sub d} was independent of cesium concentration below approximately 1.0E-06 M. Above this level, the average cesium K{sub d} values decreased significantly. Cesium K{sub d} values exceeding 1.0E+07 mL g{sup -1} were measured in the simulated N-Basin water. However, when measured in the actual N-Basin water the values were several orders of magnitude lower, with a maximum of 1.24E+05 mL g{sup -1} observed.

  20. [Gluten--mechanisms of intolerance, symptoms and treatment possibilities of IgE-related allergy for gluten in the light of actual clinical and immunological studies].

    PubMed

    Obtułowicz, Krystyna; Waga, Jacek; Dyga, Wojciech

    2015-01-01

    Gluten is the product of a chemical bond of wheat prolamin proteins (glia- dins and glutenins) in an aqueous me- dium. IgE mediated gluten allergy can be induced either by gluten as an in- gredient in foods or wheat prolamines present in the air. The aim of the study was clinical analysis of 13 patients, who demonstrated elevated levels of gluten specific IgE and identification of the most allergenic protein fractions from several samples of wheat using serum of examined subjects. Clinical analysis showed the occupational allergy to gluten in the form of rhinitis, asthma and airborne dermatistis in 9 subjects, whose symptoms disappeared during isolation from occupational exposure despite the use of a normal diet. In case of 4 patients with severe forms of chronic urticaria and atopic dermatitis, who are also allergic to grass pollen at the same time, the introduction of a gluten-free diet resulted in improvement of health conditions. The study of wheat protein fractions revealed a significant polymorphism dependent on the wheat sample. In the protein fractions, low and high molecular glutenin fractions, and alpha, beta, gamma, and omega-gliadins were separated. It has been shown that the strongest immunogenic effect causes omega-5 gliadin fraction. The removal of this fraction resulted in reduction of skin reactivity evaluated by skin prick test in the studied patients.

  1. Early performance in a humanistic medicine course as a predictor of dental students' later clinical performance.

    PubMed

    Nelson, Linda Pollak; Maramaldi, Peter; Kinnunen, Taru H; Kalenderian, Elsbeth

    2013-08-01

    The purpose of this study was to test the hypothesis that dental students' early ability to demonstrate a humanistic approach with patients is associated with later clinical performance. A first-year humanistic medicine course, Patient Doctor I (PDI), at Harvard School of Dental Medicine combines training in conducting the medical interview with human values, placing a high value on strengthening relationships with patients and emphasizing empowerment, respect, and strong communication skills. Retrospective data were collected in the following domains: PDI course evaluations, admissions information, National Board Dental Examination Parts I and II scores, and Promotions Committee and faculty evaluation scores for hand skills and humanistic and interactive patient-student skills. Planned linear contrasts comparisons were performed for each clinical outcome variable. Tests to support the a priori hypothesis of linear relationships between PDI evaluation ratings and clinical performance, defined as hand skills and humanistic and interactive patient-student skills scores, were significant, both at p=0.03. This study demonstrated the feasibility of measuring dental students' humanistic qualities during the first year. Humanistic qualities (PDI performance) during the first year were found to be associated with clinical performance in the third year of dental school.

  2. Assessing clinical reasoning abilities of medical students using clinical performance examination

    PubMed Central

    Im, Sunju; Kim, Do-Kyong; Kong, Hyun-Hee; Roh, Hye-Rin; Oh, Young-Rim; Seo, Ji-Hyun

    2016-01-01

    Purpose: The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX) for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students. Methods: Third-year medical school students (n=313) in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP) note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey. Results: The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students’ performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5%) identified essential problem early and only 58 (18.5%) performed systematic history taking and physical examination. One hundred seventy-three of them (55.3%) communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes. Conclusion: To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping. PMID:26838567

  3. AQP4 autoantibody assay performance in clinical laboratory service

    PubMed Central

    Fryer, J.P.; Lennon, V.A.; Pittock, S.J.; Jenkins, S.M.; Fallier-Becker, P.; Clardy, S.L.; Horta, E.; Jedynak, E.A.; Lucchinetti, C.F.; Shuster, E.A.; Weinshenker, B.G.; Wingerchuk, D.M.

    2014-01-01

    Objective: To compare performance of contemporary aquaporin-4–immunoglobulin (Ig) G assays in clinical service. Methods: Sera from neurologic patients (4 groups) and controls were tested initially by service ELISA (recombinant human aquaporin-4, M1 isoform) and then by cell-based fluorescence assays: fixed (CBA, M1-aquaporin-4, observer-scored) and live (fluorescence-activated cell sorting [FACS], M1 and M23 aquaporin-4 isoforms). Group 1: all Mayo Clinic patients tested from January to May 2012; group 2: consecutive aquaporin-4-IgG–positive patients from September 2011 (Mayo and non-Mayo); group 3: suspected ELISA false-negatives from 2011 to 2013 (physician-reported, high likelihood of neuromyelitis optica spectrum disorders [NMOSDs] clinically); group 4: suspected ELISA false-positives (physician-reported, not NMOSD clinically). Results: Group 1 (n = 388): M1-FACS assay performed optimally (areas under the curves: M1 = 0.64; M23 = 0.57 [p = 0.02]). Group 2 (n = 30): NMOSD clinical diagnosis was confirmed by: M23-FACS, 24; M1-FACS, 23; M1-CBA, 20; and M1-ELISA, 18. Six results were suspected false-positive: M23-FACS, 2; M1-ELISA, 2; and M23-FACS, M1-FACS, and M1-CBA, 2. Group 3 (n = 31, suspected M1-ELISA false-negatives): results were positive for 5 sera: M1-FACS, 5; M23-FACS, 3; and M1-CBA, 2. Group 4 (n = 41, suspected M1-ELISA false-positives): all negative except 1 (positive only by M1-CBA). M1/M23-cotransfected cells expressing smaller membrane arrays of aquaporin-4 yielded fewer false- positive FACS results than M23-transfected cells. Conclusion: Aquaporin-4-transfected CBAs, particularly M1-FACS, perform optimally in aiding NMOSD serologic diagnosis. High-order arrays of M23-aquaporin-4 may yield false-positive results by binding IgG nonspecifically. PMID:25340055

  4. Clinical translation of a high performance neural prosthesis

    PubMed Central

    Gilja, Vikash; Pandarinath, Chethan; Blabe, Christine H.; Nuyujukian, Paul; Simeral, John D.; Sarma, Anish A.; Sorice, Brittany L.; Perge, János A.; Jarosiewicz, Beata; Hochberg, Leigh R.; Shenoy, Krishna V.; Henderson, Jaimie M.

    2016-01-01

    Neural prostheses have the potential to improve the quality of life of individuals with paralysis by directly mapping neural activity to limb and computer control signals. We translated a neural prosthetic system previously developed in animal model studies for use by two individuals with amyotrophic lateral sclerosis (ALS) implanted with intracortical microelectrode arrays. Measured more than a year post-implantation, the demonstrated neural cursor control has the highest published performance achieved by a person to date, more than double that of previous pilot clinical trial participants. PMID:26413781

  5. Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study

    PubMed Central

    2014-01-01

    with physiologic stress, and heart rate elevation alone correlates poorly with both perceived stress and performance. Non-technical performance in the simulation setting may be more closely tied to one’s level of clinical experience than to perceived or actual stress. PMID:25064689

  6. Pay-for-performance in a community substance abuse clinic

    PubMed Central

    Vandrey, Ryan; Stitzer, Maxine L.; Acquavita, Shauna P.; Quinn-Stabile, Patricia

    2011-01-01

    Pay-for-performance (P4P) strategies improve employee productivity and morale in business settings and are increasingly being implemented in medical care settings. This study investigated whether P4P could improve treatment utilization and retention at a community drug treatment clinic. Counselors had the opportunity to earn cash bonuses based on therapy attendance rates of individual clients as well as the quarterly retention rates of their caseload. Using a pre-post study design, average therapy sessions attended during the first month of treatment increased from 4.6 sessions prior to the intervention to 5.5 sessions per client during the intervention. The 90-day client retention rate increased from 40% to 53%. Additional analyses suggest that the improvement in 90-day retention was mediated by the increase in attendance during the first month of treatment. This project demonstrates that implementing a P4P incentive program in community drug abuse treatment clinics is feasible and effective at improving utilization and retention. PMID:21489739

  7. Pay-for-performance in a community substance abuse clinic.

    PubMed

    Vandrey, Ryan; Stitzer, Maxine L; Acquavita, Shauna P; Quinn-Stabile, Patricia

    2011-09-01

    Pay-for-performance (P4P) strategies improve employee productivity and morale in business settings and are increasingly being implemented in medical care settings. This study investigated whether P4P could improve treatment utilization and retention at a community drug treatment clinic. Counselors had the opportunity to earn cash bonuses based on therapy attendance rates of individual clients and on the quarterly retention rates of their caseload. Using a pre-post study design, average therapy sessions attended during the first month of treatment increased from 4.6 sessions prior to the intervention to 5.5 sessions per client during the intervention. The 90-day client retention rate increased from 40% to 53%. Additional analyses suggest that the improvement in the 90-day retention was mediated by the increase in attendance during the first month of treatment. This project demonstrates that implementing a P4P incentive program in community drug abuse treatment clinics is feasible and effective at improving utilization and retention. PMID:21489739

  8. T-wave alternans: clinical performance, limitations and analysis methodologies.

    PubMed

    Garcia, Euler V; Pastore, Carlos Alberto; Samesima, Nelson; Pereira Filho, Horácio G

    2011-03-01

    Accurate recognition of individuals at higher immediate risk of sudden cardiac death (SCD) is still an open question. The fortuitous nature of acute cardiovascular events just does not seem to fit the well-known model of ventricular tachycardia/fibrillation induction in a static arrhythmogenic substrate by a synchronous trigger. On the mechanism of SCD, a dynamical electrical instability would better explain the rarity of the simultaneous association of a correct trigger and an appropriate cardiac substrate. Several studies have been conducted trying to measure this cardiac electrical instability (or any valid surrogate) in an ECG beat stream. Among the current possible candidates we can number QT prolongation, QT dispersion, late potentials, T-wave alternans (TWA), and heart rate turbulence. This article reviews the particular role of TWA in the current cardiac risk stratification scenario. TWA findings are still heterogeneous, ranging from very good to nearly null prognostic performance depending on the clinical population observed and clinical protocol in use. To fill the current gaps in the TWA base of knowledge, practitioners, and researchers should better explore the technical features of the several technologies available for TWA evaluation and pay greater attention to the fact that TWA values are responsive to several factors other than medications. Information about the cellular and subcellular mechanisms of TWA is outside the scope of this article, but the reader is referred to some of the good papers available on this topic whenever this extra information could help the understanding of the concepts and facts covered herein. PMID:21359487

  9. The impact of selected contextual factors on experts' clinical reasoning performance (does context impact clinical reasoning performance in experts?).

    PubMed

    Durning, Steven J; Artino, Anthony R; Boulet, John R; Dorrance, Kevin; van der Vleuten, Cees; Schuwirth, Lambert

    2012-03-01

    Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive load theories (CLT). Using these theories, we explored the influence of selected contextual factors on clinical reasoning performance in internal medicine experts. We constructed and validated a series of videotapes portraying different chief complaints for three common diagnoses seen in internal medicine. Using the situated cognition framework, we modified selected contextual factors--patient, encounter, and/or physician--in each videotape. Following each videotape, participants completed a post-encounter form (PEF) and a think-aloud protocol. A survey estimating recent exposure from their practice to the correct videotape diagnoses was also completed. The time given to complete the PEF was randomly varied with each videotape. Qualitative utterances from the think-aloud procedure were converted to numeric measures of cognitive load. Survey and cognitive load measures were correlated with PEF performance. Pearson correlations were used to assess relations between the independent variables (cognitive load, survey of experience, contextual factors modified) and PEF performance. To further explore context specificity, analysis of covariance (ANCOVA) was used to assess differences in PEF scores, by diagnosis, after controlling for time. Low correlations between PEF sections, both across diagnoses and within each diagnosis, were observed (r values ranged from -.63 to .60). Limiting the time to complete the PEF impacted PEF performance (r = .2 to .4). Context specificity was further substantiated by demonstrating significant differences on most PEF section scores with a diagnosis (ANCOVA). Cognitive load measures were negatively correlated with PEF scores. The presence of

  10. The impact of selected contextual factors on experts' clinical reasoning performance (does context impact clinical reasoning performance in experts?).

    PubMed

    Durning, Steven J; Artino, Anthony R; Boulet, John R; Dorrance, Kevin; van der Vleuten, Cees; Schuwirth, Lambert

    2012-03-01

    Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive load theories (CLT). Using these theories, we explored the influence of selected contextual factors on clinical reasoning performance in internal medicine experts. We constructed and validated a series of videotapes portraying different chief complaints for three common diagnoses seen in internal medicine. Using the situated cognition framework, we modified selected contextual factors--patient, encounter, and/or physician--in each videotape. Following each videotape, participants completed a post-encounter form (PEF) and a think-aloud protocol. A survey estimating recent exposure from their practice to the correct videotape diagnoses was also completed. The time given to complete the PEF was randomly varied with each videotape. Qualitative utterances from the think-aloud procedure were converted to numeric measures of cognitive load. Survey and cognitive load measures were correlated with PEF performance. Pearson correlations were used to assess relations between the independent variables (cognitive load, survey of experience, contextual factors modified) and PEF performance. To further explore context specificity, analysis of covariance (ANCOVA) was used to assess differences in PEF scores, by diagnosis, after controlling for time. Low correlations between PEF sections, both across diagnoses and within each diagnosis, were observed (r values ranged from -.63 to .60). Limiting the time to complete the PEF impacted PEF performance (r = .2 to .4). Context specificity was further substantiated by demonstrating significant differences on most PEF section scores with a diagnosis (ANCOVA). Cognitive load measures were negatively correlated with PEF scores. The presence of

  11. Exploring the Effects of Multimedia Learning on Pre-Service Teachers' Perceived and Actual Learning Performance: The Use of Embedded Summarized Texts in Educational Media

    ERIC Educational Resources Information Center

    Wu, Leon Yufeng; Yamanaka, Akio

    2013-01-01

    In light of the increased usage of instructional media for teaching and learning, the design of these media as aids to convey the content for learning can be crucial for effective learning outcomes. In this vein, the literature has given attention to how concurrent on-screen text can be designed using these media to enhance learning performance.…

  12. Performance-optimized clinical IMRT planning on modern CPUs

    NASA Astrophysics Data System (ADS)

    Ziegenhein, Peter; Kamerling, Cornelis Ph; Bangert, Mark; Kunkel, Julian; Oelfke, Uwe

    2013-06-01

    Intensity modulated treatment plan optimization is a computationally expensive task. The feasibility of advanced applications in intensity modulated radiation therapy as every day treatment planning, frequent re-planning for adaptive radiation therapy and large-scale planning research severely depends on the runtime of the plan optimization implementation. Modern computational systems are built as parallel architectures to yield high performance. The use of GPUs, as one class of parallel systems, has become very popular in the field of medical physics. In contrast we utilize the multi-core central processing unit (CPU), which is the heart of every modern computer and does not have to be purchased additionally. In this work we present an ultra-fast, high precision implementation of the inverse plan optimization problem using a quasi-Newton method on pre-calculated dose influence data sets. We redefined the classical optimization algorithm to achieve a minimal runtime and high scalability on CPUs. Using the proposed methods in this work, a total plan optimization process can be carried out in only a few seconds on a low-cost CPU-based desktop computer at clinical resolution and quality. We have shown that our implementation uses the CPU hardware resources efficiently with runtimes comparable to GPU implementations, at lower costs.

  13. Physician judgment in clinical settings: methodological influences and cognitive performance.

    PubMed

    Dawson, N V

    1993-07-01

    Understanding the quality of physicians' intuitive judgments is essential in determining the appropriate use of their judgments in medical decision-making (vis-a-vis analytical or actuarial approaches). As part of this process, the quality of physicians' predictions must be assessed because prediction is fundamental to common clinical tasks: determining diagnosis, prognosis, and therapy; establishing monitoring intervals; performing screening and preventive maneuvers. Critical evaluation of predictive capabilities requires an assessment of the components of the prediction process: the data available for prediction, the method used for prediction, and the accuracy of prediction. Although variation in and uncertainty about the underlying data elements are often acknowledged as a source of inaccurate predictions, prediction also can be confounded by both methodological and cognitive limitations. During the past two decades, numerous factors have been recognized that may bias test characteristics (sensitivity and specificity). These same factors may also produce bias in intuitive judgments. The use of cognitive processes to simplify judgment tasks (e.g., the availability and representativeness heuristics) and the presence of certain biases in the judgment process (e.g., ego, regret) may present obstacles to accurate estimation of probabilities by physicians. Limitations on the intuitive use of information (cognitive biases) have been demonstrated in both medical and nonmedical decision-making settings. Recent studies have led to a deepening understanding of the advantages and disadvantages of intuitive and analytical approaches to decision making. Here, many aspects of the basis for this understanding are reviewed.

  14. Analytical performance specifications: relating laboratory performance to quality required for intended clinical use.

    PubMed

    Dalenberg, Daniel A; Schryver, Patricia G; Klee, George G

    2013-03-01

    This article proposes analytic performance goals for five quality indicators: precision, trueness, linearity, detection limits, and consistency across instruments and time. We defined our goals using methods linked to clinical practice data. Goals for desirable precision and trueness are based on biological variation. Linearity goals are related to total error recommendations. Detection limit goals are derived from 0.1 percentile of patient values. Goals for consistency are derived from the variability of distributions of patient test values. Data were collected and evaluated for each of these quality indicators for 46 chemistry tests measured on the Roche cobas 8000 analyzer.

  15. Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network

    PubMed Central

    Gilbert, Gregg H; Riley, Joseph L; Eleazer, Paul D; Benjamin, Paul L; Funkhouser, Ellen

    2015-01-01

    Objectives Use of a rubber dam during root canal treatment is considered the standard of care because it enhances patient safety and optimises the odds of successful treatment. Nonetheless, not all dentists use a rubber dam, creating disconnect between presumed standard of care and what is actually done in clinical practice. Little is known about dentists’ attitudes towards use of the rubber dam in their practices. The objectives were to: (1) quantify these attitudes and (2) test the hypothesis that specific attitudes are significantly associated with rubber dam use. Setting National Dental Practice-Based Research Network (NationalDentalPBRN.org). Participants 1490 network dentists. Outcome measures Dentists completed a questionnaire about their attitudes towards rubber dam use during root canal treatment. Three attitude scales comprised 33 items that used a 5-point ordinal scale to measure beliefs about effectiveness, inconvenience, ease of placement, comparison to other isolation techniques and patient factors. Factor analysis, cluster analysis and multivariable logistic regression analysed the relationship between attitudes and rubber dam use. Results All items had responses at each point on the 5-point scale, with an overall pattern of substantial variation across dentists. Five attitudinal factors (rubber dam effectiveness; inconvenient/time-consuming; ease of placement; effectiveness compared to Isolite; patient factors) and 4 clusters of practitioners were identified. Each factor and cluster was independently and strongly associated with rubber dam use. Conclusions General dentists have substantial variation in attitudes about rubber dam use. Beliefs that rubber dam use is not effective, inconvenient, time-consuming, not easy to place or affected by patient factors, were independently and significantly associated with lower rubber dam use. These attitudes explain why there is substantial discordance between presumed standard of care and actual practice

  16. Change in Action: Using Positive Deviance to Improve Student Clinical Performance

    ERIC Educational Resources Information Center

    Zaidi, Zareen; Jaffery, Tara; Shahid, Afshan; Moin, Shaheen; Gilani, Ahsen; Burdick, William

    2012-01-01

    At our medical college many students have lower ratings in their clinical performance once they start their clinical years (third year). This is contrary to their results in other written exams. Some students demonstrate better clinical performance. We used the six-step Positive Deviance (PD) Conceptual Framework to identify and disseminate the…

  17. Narrative descriptions should replace grades and numerical ratings for clinical performance in medical education in the United States

    PubMed Central

    Hanson, Janice L.; Rosenberg, Adam A.; Lane, J. Lindsey

    2013-01-01

    Background: In medical education, evaluation of clinical performance is based almost universally on rating scales for defined aspects of performance and scores on examinations and checklists. Unfortunately, scores and grades do not capture progress and competence among learners in the complex tasks and roles required to practice medicine. While the literature suggests serious problems with the validity and reliability of ratings of clinical performance based on numerical scores, the critical issue is not that judgments about what is observed vary from rater to rater but that these judgments are lost when translated into numbers on a scale. As the Next Accreditation System of the Accreditation Council on Graduate Medical Education (ACGME) takes effect, medical educators have an opportunity to create new processes of evaluation to document and facilitate progress of medical learners in the required areas of competence. Proposal and initial experience: Narrative descriptions of learner performance in the clinical environment, gathered using a framework for observation that builds a shared understanding of competence among the faculty, promise to provide meaningful qualitative data closely linked to the work of physicians. With descriptions grouped in categories and matched to milestones, core faculty can place each learner along the milestones' continua of progress. This provides the foundation for meaningful feedback to facilitate the progress of each learner as well as documentation of progress toward competence. Implications: This narrative evaluation system addresses educational needs as well as the goals of the Next Accreditation System for explicitly documented progress. Educators at other levels of education and in other professions experience similar needs for authentic assessment and, with meaningful frameworks that describe roles and tasks, may also find useful a system built on descriptions of learner performance in actual work settings. Conclusions: We

  18. 42 CFR 493.1453 - Condition: Laboratories performing high complexity testing; clinical consultant.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Condition: Laboratories performing high complexity testing; clinical consultant. The laboratory must have a... testing; clinical consultant. 493.1453 Section 493.1453 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION...

  19. Symposium on research advances in clinical PET. Final performance report

    SciTech Connect

    J. Michael McGehee

    1992-01-01

    The Institute for Clinical PET and the U.S. Department of Energy (DOE) co-sponsored a symposium entitled 'Research in PET: International and Institutional Perspectives' that highlighted the activities of many leading investigators in the U.S. and throughout the world. Research programs at the DOE were discussed as were potential directions of PET research. International as well as institutional perspectives on PET research were presented. This symposium was successful in reaching those interested in research advances of clinical PET.

  20. Influence of clinical mastitis during early lactation on reproductive performance of Jersey cows.

    PubMed

    Barker, A R; Schrick, F N; Lewis, M J; Dowlen, H H; Oliver, S P

    1998-05-01

    The purpose of this study was to determine the influence of clinical mastitis on reproductive performance of high producing Jersey cows. Cows (n = 102) with clinical mastitis during the first 150 d of lactation were evaluated. Groups were balanced according to lactation number and days of lactation and sub-divided as follows: group 1, clinical mastitis before first artificial insemination (AI) (n = 48); group 2, clinical mastitis between first AI and pregnancy (n = 14); group 3, clinical mastitis after confirmed pregnancy (n = 40); and group 4, control cows (n = 103) with no clinical mastitis. No differences in reproductive performance were detected because of milk production or mastitis caused by Gram-positive or Gram-negative pathogens. The number of days to first AI was significantly greater for cows with clinical mastitis before first AI (93.6 d) than for all other groups (71.0 d). Artificial inseminations per conception were significantly greater for cows with clinical mastitis after first AI (2.9) than for cows with clinical mastitis before first AI (1.6), cows with no clinical mastitis, or cows with clinical mastitis after confirmed pregnancy (1.7). The number of days to conception for cows with clinical mastitis after first AI (136.6 d) was significantly greater than that for control cows and that for cows that developed clinical mastitis after confirmed pregnancy (92.1 d). Clinical mastitis during early lactation markedly influenced reproductive performance of Jersey cows.

  1. Interim Outcomes Assessment of the Comprehensive Clinical Performance Grid for Student Evaluation.

    ERIC Educational Resources Information Center

    Tolls, Dorothy Bazzinotti; Carlson, Nancy; Wilson, Roger; Richman, Jack

    2001-01-01

    Assessed the viability of the Comprehensive Clinical Performance Grid for Student Evaluation, introduced at The New England College of Optometry in 1996 in clinical student assessment. Analyzed faculty and student feedback and consistency with previous evaluations, between evaluators, and between clinical sites and tracts. Found satisfaction with…

  2. Performance-based staff development. A baseline for clinical competence.

    PubMed

    Snyder-Halpern, R; Buczkowski, E

    1990-01-01

    Changes in health-care financing, complex technological advancements, and an expanding nursing knowledge base have made it increasingly difficult for health care educators to assess and enhance the development of professional nurses. Using a set of objective evaluation methods and tools, educators assessed the competency of novice and experienced staff. This information identified learning and practice needs that formed the bases for individualized orientation and clinical educational programs.

  3. Nurse practitioner education: enhancing performance through the use of the Objective Structured Clinical Assessment.

    PubMed

    Bramble, K

    1994-02-01

    An Objective Structured Clinical Assessment (OSCA) was implemented in a graduate nurse practitioner (NP) program to determine the effect that participation in this type of clinical simulation would have on the cognitive and clinical competency of students. Based on the analysis of data, participation in the OSCA simulations did not lead to significantly better cognitive or clinical performance. Support for the OSCA was shown, however, by NP students when subjectively evaluating their experiences. All students agreed or strongly agreed that OSCA participation was a valuable learning experience and that the feedback provided was beneficial to their clinical and cognitive performance.

  4. Balancing act. Using the clinic scorecard to improve practice performance.

    PubMed

    Scanlan, Art

    2007-02-01

    The balanced scorecard is a strategic management system that impels managers to focus on the performance metrics that drive success. It measures the business process and links a management method for process improvement to strategic goals. A medical practice can use a balanced scorecard to improve operational performance and quality or service, which generates higher levels of patient satisfaction and better financial management. PMID:17345944

  5. Electroencephalogram associations to cognitive performance in clinically active nurses.

    PubMed

    Lees, Ty; Khushaba, Rami; Lal, Sara

    2016-07-01

    Cognitive impairment is traditionally identified via cognitive screening tools that have limited ability in detecting early or transitional stages of impairment. The dynamic nature of physiological variables such as the electroencephalogram (EEG) may provide alternate means for detecting these transitions. However, previous research examining EEG and cognitive performance is largely confined to samples with diagnosed cognitive impairments, and research examining non-impaired, and occupation specific samples, is limited. The present study aimed to investigate the associations between frontal pole and central EEG and cognitive performance in a sample of male and female nurses, and to determine the significance of these associations. Fifty seven nurses participated in the study, in which two lead bipolar EEG was recorded at positions Fp1 (frontal polar), Fp2, C3 (central) and C4 during a baseline and an active phase involving the common neuropsychological Stroop test. Participants' cognitive performance was assessed using the mini-mental state exam (MMSE) and Cognistat screening tools. Significant correlations between EEG beta activity and the outcome of MMSE and Cognistat were revealed, where an increased beta activity was associated to an increased global cognitive performance. Additionally, domain specific cognitive performance was also significantly associated to various EEG variables. The study identified potential EEG biomarkers for global and domain specific cognitive performance, and provides initial groundwork for the development of future EEG based biomarkers for detection of cognitive pathologies. PMID:27244262

  6. The Use of Paired Comparisons for Developing Criteria for the Observation of Student Clinical Performance.

    ERIC Educational Resources Information Center

    Rippey, Robert M.; Krutchkoff, David J.

    1984-01-01

    The method of paired comparisons was used to rank 42 dental students on their performance in emergency and screening clinic rotations. Results suggest this methodology may provide more internally consistent student assessments on more subtle aspects of clinical performance than those assessed by multiple-choice tests or written performance…

  7. Modified distal shoe appliance--fabrication and clinical performance.

    PubMed

    Gujjar, Kumar Raghav; Indushekar, K R; Amith, H V; Sharma, Shefali Li

    2012-01-01

    When the primary second molar is prematurely lost, mesial movement and migration of the permanent first molar often occurs. This is one of the most difficult problems of the developing dentition confronted by pediatric dentists. Use of a space maintainer that will guide the permanent first molar into its normal position is indicated. In cases with bilateral premature loss of primary molars, the conventional design of distal shoe poses a variety of problems and, therefore, necessitates a customized design for the eruption guidance of permanent first molars. The purpose of this case report is to discuss an innovative design of a distal shoe appliance, which was used with good clinical results.

  8. Clinical performance evaluation of the prototype digital breast tomosynthesis system

    NASA Astrophysics Data System (ADS)

    Kim, Y.; Kim, H.; Park, H.; Choi, J.; Choi, Y.

    2012-03-01

    The rapid development and clinical use of digital mammography in the past decade has made possible the development of digital breast tomosynthesis (DBT), which can overcome the limitation of conventional mammography and improve the specificity of mammography with improved marginal visibility of lesion and early breast cancer detection, especially for women with dense breast. The purpose of this study is to characterize the physical properties of DBT system and to optimize the exposure condition using effective modulation transfer function (eMTF), effective noise power spectrum (eNPS), and effective detective quantum efficiency (eDQE). The first generation KERI prototype digital tomosyntesis system for breast imaging using CMOS flat panel detector was used in this study. It was found that the spatial frequency dependent metrics depend on both the inherent properties of the detector and imaging geometry including breast thickness. For thicker breast, eDQE decreases as scatter fraction increases at fixed tube voltage. Moreover, eMTF shows no significant difference as changing tube voltage while eDQE at 27 kVp is relatively degraded. Consequently, the quantitative evaluation of the DBT system with different exposure condition and breast thickness should be fully considered before building the system and application in clinical hospital.

  9. Analysis of Factors that Predict Clinical Performance in Medical School

    ERIC Educational Resources Information Center

    White, Casey B.; Dey, Eric L.; Fantone, Joseph C.

    2009-01-01

    Academic achievement indices including GPAs and MCAT scores are used to predict the spectrum of medical student academic performance types. However, use of these measures ignores two changes influencing medical school admissions: student diversity and affirmative action, and an increased focus on communication skills. To determine if GPA and MCAT…

  10. Seeking value in Medicare: performance measurement for clinical professionals.

    PubMed

    Sprague, Lisa

    2013-10-30

    The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to encourage the adoption of technology to support quality improvement. Participation in all is voluntary. However, a decision not to participate increasingly carries a financial penalty, as Congress (and, by extension, the U.S. Department of Health and Human Services, or HHS) tries to encourage behavior it cannot force.

  11. Seeking value in Medicare: performance measurement for clinical professionals.

    PubMed

    Sprague, Lisa

    2013-10-30

    The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to encourage the adoption of technology to support quality improvement. Participation in all is voluntary. However, a decision not to participate increasingly carries a financial penalty, as Congress (and, by extension, the U.S. Department of Health and Human Services, or HHS) tries to encourage behavior it cannot force. PMID:24312987

  12. Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA

    PubMed Central

    2012-01-01

    Background Hospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways. Method Given this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed. Results A typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation. Conclusions ICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of

  13. Realizing actual feedback control of complex network

    NASA Astrophysics Data System (ADS)

    Tu, Chengyi; Cheng, Yuhua

    2014-06-01

    In this paper, we present the concept of feedbackability and how to identify the Minimum Feedbackability Set of an arbitrary complex directed network. Furthermore, we design an estimator and a feedback controller accessing one MFS to realize actual feedback control, i.e. control the system to our desired state according to the estimated system internal state from the output of estimator. Last but not least, we perform numerical simulations of a small linear time-invariant dynamics network and a real simple food network to verify the theoretical results. The framework presented here could make an arbitrary complex directed network realize actual feedback control and deepen our understanding of complex systems.

  14. Optical ensemble analysis of intraocular lens performance through a simulated clinical trial with ZEMAX.

    PubMed

    Zhao, Huawei

    2009-01-01

    A ZEMAX model was constructed to simulate a clinical trial of intraocular lenses (IOLs) based on a clinically oriented Monte Carlo ensemble analysis using postoperative ocular parameters. The purpose of this model is to test the feasibility of streamlining and optimizing both the design process and the clinical testing of IOLs. This optical ensemble analysis (OEA) is also validated. Simulated pseudophakic eyes were generated by using the tolerancing and programming features of ZEMAX optical design software. OEA methodology was verified by demonstrating that the results of clinical performance simulations were consistent with previously published clinical performance data using the same types of IOLs. From these results we conclude that the OEA method can objectively simulate the potential clinical trial performance of IOLs.

  15. The Clinical Outcomes Assessment Toolkit: A Framework to Support Automated Clinical Records–based Outcomes Assessment and Performance Measurement Research

    PubMed Central

    D'Avolio, Leonard W.; Bui, Alex A.T.

    2008-01-01

    The Clinical Outcomes Assessment Toolkit (COAT) was created through a collaboration between the University of California, Los Angeles and Brigham and Women's Hospital to address the challenge of gathering, formatting, and abstracting data for clinical outcomes and performance measurement research. COAT provides a framework for the development of information pipelines to transform clinical data from its original structured, semi-structured, and unstructured forms to a standardized format amenable to statistical analysis. This system includes a collection of clinical data structures, reusable utilities for information analysis and transformation, and a graphical user interface through which pipelines can be controlled and their results audited by nontechnical users. The COAT architecture is presented, as well as two case studies of current implementations in the domain of prostate cancer outcomes assessment. PMID:18308990

  16. Emotional intelligence and clinical interview performance of dental students.

    PubMed

    Hannah, Annette; Lim, Bee T; Ayers, Kathryn M S

    2009-09-01

    One hundred and sixteen third-year dental students participating in a consultation skills course in Dunedin, New Zealand, completed a standardized psychometric Social Skills Inventory (SSI) and were assessed by tutors, simulated patients, and themselves. Students with higher social skills abilities obtained higher performance scores and demonstrated better interview structure. Patients reported being more likely to return to students for a dental consultation following the second interview, and students' consultation skills were rated (by tutors, patients, and students) higher at the end of the course than the beginning. Female students had higher global social skills abilities and were more emotionally expressive and sensitive than male students, while the latter had better emotional control. Female students performed better in the first interview than male students, but there was no significant gender difference in the second interview. Tutor and simulated patient ratings suggested that a consultation skills course can increase the ability of students in general, and English as a second language students in particular, to relate to their patients, manage anxiety, identify ethical issues, and recognize significant psychosocial issues that lead to more accurate diagnosis and treatment processes, ensuring the effective delivery of patient-centered dental education.

  17. The Impact of Selected Contextual Factors on Experts' Clinical Reasoning Performance (Does Context Impact Clinical Reasoning Performance in Experts?)

    ERIC Educational Resources Information Center

    Durning, Steven J.; Artino, Anthony R.; Boulet, John R.; Dorrance, Kevin; van der Vleuten, Cees; Schuwirth, Lambert

    2012-01-01

    Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive load theories (CLT). Using these theories, we…

  18. The measurement of performance in a physical therapy clinical program. A ROI approach.

    PubMed

    Harp, Scott S

    2004-01-01

    This research presents the development and implementation of a measurement model that yields the return on investment (ROI) in a physical therapy clinical program. A performance measurement model was constructed, which determined the ROI of a clinical program in physical therapy using revenue, patient outcomes, staff productivity, costs, and patient satisfaction. Implementation used archival data for 2 groups of patients in a back and neck rehabilitation program. An expert panel was formed to review the model. Based on the results, ROI provided a more comprehensive tool to measure performance than traditional evaluation measures. ROI appears beneficial, making it a useful tool for health care professionals to measure the performance of PT clinical programs.

  19. Effects of continuing professional development on clinical performance

    PubMed Central

    Goulet, François; Hudon, Eveline; Gagnon, Robert; Gauvin, Eliane; Lemire, Francine; Arsenault, Isabelle

    2013-01-01

    Abstract Objective To evaluate the link between the quantity and quality of continuing professional development (CPD) activities completed by family physicians in Quebec and the quality of their practice. Design Retrospective analysis of data collected during professional inspection visits (PIVs). Setting Quebec. Participants Three groups were created from among Quebec family physicians who had been subject to PIVs (peer evaluation) by the Collège des médecins du Québec between 1998 and 2005. Group 1 was composed of physicians who were members of the College of Family Physicians of Canada, which requires participation in 250 hours of CPD in every 5-year cycle. Group 2 was composed of family physicians who were not members of the College of Family Physicians of Canada but who had declared at least 50 hours a year of CPD on their Collège des médecins du Québec annual notice of assessment for the same period. Group 3 was composed of family physicians who had declared fewer than 10 hours of CPD a year. Main outcome measures During the PIV, the following characteristics were examined: record keeping, quality and number of hours of CPD activities, and quality of professional practice based on 3 components— clinical investigation, accuracy of diagnosis, and appropriateness of treatment plan and follow-up. Results The factors associated with a high quality of practice were privileges in a hospital or local community health centre (institution) and a substantial number of accredited CPD hours (Mainpro-M1, Credit I, or Mainpro-C). The factors associated with a poor quality of practice were advanced age of the physician, absence of privileges in an institution (hospital or local community health centre), and participation in CPD activities that were more informal, such as reading and non-accredited activities (Mainpro-M2). Conclusion This study supports earlier research showing that CPD activities of sufficient quality and quantity are correlated with a high quality

  20. Development of the Computerized Model of Performance-Based Measurement System to Measure Nurses' Clinical Competence.

    PubMed

    Liou, Shwu-Ru; Liu, Hsiu-Chen; Tsai, Shu-Ling; Cheng, Ching-Yu; Yu, Wei-Chieh; Chu, Tsui-Ping

    2016-04-01

    Critical thinking skills and clinical competence are for providing quality patient care. The purpose of this study is to develop the Computerized Model of Performance-Based Measurement system based on the Clinical Reasoning Model. The system can evaluate and identify learning needs for clinical competency and be used as a learning tool to increase clinical competency by using computers. The system includes 10 high-risk, high-volume clinical case scenarios coupled with questions testing clinical reasoning, interpersonal, and technical skills. Questions were sequenced to reflect patients' changing condition and arranged by following the process of collecting and managing information, diagnosing and differentiating urgency of problems, and solving problems. The content validity and known-groups validity was established. The Kuder-Richardson Formula 20 was 0.90 and test-retest reliability was supported (r = 0.78). Nursing educators can use the system to understand students' needs for achieving clinical competence, and therefore, educational plans can be made to better prepare students and facilitate their smooth transition to a future clinical environment. Clinical nurses can use the system to evaluate their performance-based abilities and weakness in clinical reasoning. Appropriate training programs can be designed and implemented to practically promote nurses' clinical competence and quality of patient care. PMID:26829522

  1. The Preschool Repetition Test: An Evaluation of Performance in Typically Developing and Clinically Referred Children

    ERIC Educational Resources Information Center

    Chiat, Shula; Roy, Penny

    2007-01-01

    Purpose: To determine the psychometric properties of the Preschool Repetition (PSRep) Test (Roy & Chiat, 2004), to establish the range of performance in typically developing children and variables affecting this performance, and to compare the performance of clinically referred children. Method: The PSRep Test comprises 18 words and 18…

  2. Poorly Performing Physicians: Does the Script Concordance Test Detect Bad Clinical Reasoning?

    ERIC Educational Resources Information Center

    Goulet, Francois; Jacques, Andre; Gagnon, Robert; Charlin, Bernard; Shabah, Abdo

    2010-01-01

    Introduction: Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The College des Medecins du Quebec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer…

  3. Video Analysis of Athletic Training Student Performance: Changing Educational Competency into Clinical Proficiency

    ERIC Educational Resources Information Center

    Kawaguchi, Jeffrey K.

    2009-01-01

    Context: Assessing clinical proficiency and documenting learning over time is quite challenging. Educators must look for unique ways to effectively examine students' performance and archive evidence of their academic progress. Objective: To discuss the use of video analysis to bridge the gap from educational competency to clinical proficiency, and…

  4. Clinical Observed Performance Evaluation: A Prospective Study in Final Year Students of Surgery

    ERIC Educational Resources Information Center

    Markey, G. C.; Browne, K.; Hunter, K.; Hill, A. D.

    2011-01-01

    We report a prospective study of clinical observed performance evaluation (COPE) for 197 medical students in the pre-qualification year of clinical education. Psychometric quality was the main endpoint. Students were assessed in groups of 5 in 40-min patient encounters, with each student the focus of evaluation for 8 min. Each student had a series…

  5. 42 CFR 493.1415 - Condition: Laboratories performing moderate complexity testing; clinical consultant.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... laboratory must have a clinical consultant who meets the qualification requirements of § 493.1417 of this... complexity testing; clinical consultant. 493.1415 Section 493.1415 Public Health CENTERS FOR MEDICARE... LABORATORY REQUIREMENTS Personnel for Nonwaived Testing Laboratories Performing Moderate Complexity...

  6. Disclosure of investigators' recruitment performance in multicenter clinical trials: a further step for research transparency.

    PubMed

    Dal-Ré, Rafael; Moher, David; Gluud, Christian; Treweek, Shaun; Demotes-Mainard, Jacques; Carné, Xavier

    2011-12-01

    Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends.

  7. Linguistic Theory and Actual Language.

    ERIC Educational Resources Information Center

    Segerdahl, Par

    1995-01-01

    Examines Noam Chomsky's (1957) discussion of "grammaticalness" and the role of linguistics in the "correct" way of speaking and writing. It is argued that the concern of linguistics with the tools of grammar has resulted in confusion, with the tools becoming mixed up with the actual language, thereby becoming the central element in a metaphysical…

  8. El Observatorio Gemini - Status actual

    NASA Astrophysics Data System (ADS)

    Levato, H.

    Se hace una breve descripción de la situación actual del Observatorio Gemini y de las últimas decisiones del Board para incrementar la eficiencia operativa. Se hace también una breve referencia al uso argentino del observatorio.

  9. Grading the performance of clinical skills: lessons to be learned from the performing arts.

    PubMed

    Roberts, Deborah

    2011-08-01

    The drift towards competency based nurse interventions has seen a growth in concern regarding the most appropriate methods of assessment of such competencies. Nurse educators and practitioners alike are struggling with the concept of measuring the performance of nursing skills; due to an uneasy relationship between competence, capability, intuition and expertise. Different currencies of value may be ascribed to the assessment of nursing practice, resulting in the use of subjective judgements together with the development of assessment criteria which have different weightings, depending on the values of the assessor. Within the performing arts, students' practice performance is also assessed, with seemingly many similarities between applying value to performance in dance or theatre and nursing. Within performing arts assessment a balancing act is also being played out between academic education and professional training (where complex performances are notoriously hard to evaluate). This paper explores the nature of assessment within the performing arts and makes suggestions regarding their application within the context of nurse education. If nursing is indeed a blend of art and science, then it seems sensible to look to the performing arts to see if lessons could be learned.

  10. 77 FR 30016 - Clinical Study Design and Performance of Hospital Glucose Sensors

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-21

    ... HUMAN SERVICES Food and Drug Administration Clinical Study Design and Performance of Hospital Glucose... Study Design and Performance of Hospital Glucose Sensors.'' The purpose of this public meeting is to... intended to be used in hospital point of care settings. DATES: Date and Time: The public meeting will...

  11. The Relationship between Emotional Intelligence, Self-Efficacy, and Clinical Performance in Associate Degree Nursing Students

    ERIC Educational Resources Information Center

    Rice, Eileen W.

    2013-01-01

    The purpose of this study was to explore self-efficacy, an individual's beliefs about his or her ability to perform a series of tasks, and emotional intelligence, an individual's ability to perceive, use, understand, and manage emotions, as predictors for successful clinical performance in nursing students. The participants were 49 female and 7…

  12. Videotape Reliability: A Method of Evaluation of a Clinical Performance Examination.

    ERIC Educational Resources Information Center

    And Others; Liu, Philip

    1980-01-01

    A method of statistically analyzing clinical performance examinations for reliability and the application of this method in determining the reliability of two examinations of skill in administering anesthesia are described. Videotaped performances for the Spinal Anesthesia Skill Examination and the Anesthesia Setup and Machine Checkout Examination…

  13. Measuring physicians' performance in clinical practice: reliability, classification accuracy, and validity.

    PubMed

    Weifeng Weng; Hess, Brian J; Lynn, Lorna A; Holmboe, Eric S; Lipner, Rebecca S

    2010-09-01

    Much research has been devoted to addressing challenges in achieving reliable assessments of physicians' clinical performance but less work has focused on whether valid and accurate classification decisions are feasible. This study used 957 physicians certified in internal medicine (IM) or a subspecialty, who completed the American Board of Internal Medicine (ABIM) Diabetes Practice Improvement Module (PIM). Ten clinical and two patient-experience measures were aggregated into a composite measure. The composite measure score was highly reliable (r = .91) and classification accuracy was high across the entire score scale (>0.90), which indicated that it is possible to differentiate high-performing and low-performing physicians. Physicians certified in endocrinology and those who scored higher on their IM certification examination had higher composite scores, providing some validity evidence. In summary, it is feasible to create a psychometrically robust composite measure of physicians' clinical performance, specifically for the quality of care they provide to patients with diabetes.

  14. Clinical performance of a light-cured denture base material compared to polymethylmethacrylate--a randomized clinical study.

    PubMed

    Gohlke-Wehrße, Hanna-Lena; Giese-Kraft, Katja; Wöstmann, Bernd

    2012-06-01

    The aim of this study was to evaluate the clinical long-term performance of a visible light-cured resin (VLCR) denture base material and to compare it to a well-established polymethylmethacrylate (PMMA)-based denture acrylic in a randomized split-mouth clinical long-term study. One hundred removable partial dentures in 90 patients, with at least two saddles each, were investigated. One saddle was made of VLCR, while the other was made of PMMA at random. Plaque adhesion, tissue reaction, and technical parameters of the dentures were assessed 6, 12, and 18 months after treatment. Statistical analysis was performed using the Wilcoxon rank-sum test. Though VLCR showed higher plaque adhesion than PMMA after 6, 12, and 18 months (p < 0.001), there were no important differences with regard to tissue reaction. Concerning plaque adhesion, surface quality with regard to the lower side, interfaces between denture acrylic and metal and the boundary between denture acrylic and denture tooth PMMA was rated higher than VLCR. The surface quality of the upper side of the denture saddles showed no significant differences (p > 0.05). Neither VLCR nor PMMA showed discoloration at any point in time (p > 0.05). It can be concluded that VLCR is a viable alternative for the production of removable dentures. Especially in patients with hypersensitivities to PMMA, VLCR is particularly suitable for clinical use.

  15. The influence of training on the rating of physical therapist student performance in the clinical setting.

    PubMed

    Vendrely, Ann; Carter, Russell

    2004-01-01

    Physical therapist education consists of two distinct elements: the didactic preparation and the clinical education experiences. Clinical instructors at affiliated clinics supervise physical therapist students during clinical education. A clinical instructor can receive additional training through two commonly offered programs: Clinical Performance Instrument (CPI) training, which involves 1 hour of instruction, and Clinical Instructor Education and Credentialing Program (CIECP), which includes 15 contact hours of instruction and assessment. The purpose of this study was to determine if completion of either or both of these training programs affected the rating of the CPI by a clinical instructor. Thirty-four licensed physical therapists participated in the study. They were current clinical instructors or physical therapists who were interested in becoming clinical instructors. The subjects were shown a videotape of a simulated student interacting with a simulated client. The subjects were asked to rate the student's performance using the first five criteria of the CPI. The first five criteria were selected for the study because of their designation as determinants for a successful clinical education experience. Background and demographic data were gathered in addition to the CPI ratings. Four groups of clinical instructors were determined from their previous training, then differences in CPI ratings were analyzed. The groups were CIECP and CPI training, CIECP training only, CPI training only, and no training. A multivariate analysis of variance showed statistical significance between training groups but no statistical significance based on previous use of the CPI. Post hoc tests identified the differences as occurring between the group with CIECP and CPI training compared with the groups with only CPI training or no training when rating the first criterion for safety. Rating the second criterion of responsible behavior was different between the CIECP-only group

  16. Rodents as pre-clinical models for predicting vaccine performance in humans.

    PubMed

    Riese, Peggy; Trittel, Stephanie; Schulze, Kai; Guzmán, Carlos A

    2015-01-01

    Vaccines represent a key building block for establishing a successful and sustainable control strategy against infectious diseases. Vaccine development often depends on the availability of correlates for protection and reliable animal models for the screening, selection and prioritization of potential vaccine candidates. This is performed according to their immunogenicity, efficacy and safety profiles in pre-clinical studies, which are also critical for identification of candidate antigens, selection of an optimal delivery system and design of appropriate vaccine formulations. Thus, pre-clinical studies in animal models are a prerequisite for addressing crucial issues and generating a solid pre-clinical package for the approval of clinical trials. This review addresses the strengths, limitations and perspectives of rodents as a vaccine development and pre-clinical validation tool. PMID:26268433

  17. Using business intelligence to improve performance.

    PubMed

    Wadsworth, Tom; Graves, Brian; Glass, Steve; Harrison, A Marc; Donovan, Chris; Proctor, Andrew

    2009-10-01

    Cleveland Clinic's enterprise performance management program offers proof that comparisons of actual performance against strategic objectives can enable healthcare organization to achieve rapid organizational change. Here are four lessons Cleveland Clinic learned from this initiative: Align performance metrics with strategic initiatives. Structure dashboards for the CEO. Link performance to annual reviews. Customize dashboard views to the specific user.

  18. What is the relationship between emotional intelligence and dental student clinical performance?

    PubMed

    Victoroff, Kristin Zakariasen; Boyatzis, Richard E

    2013-04-01

    Emotional intelligence has emerged as a key factor in differentiating average from outstanding performers in managerial and leadership positions across multiple business settings, but relatively few studies have examined the role of emotional intelligence in the health care professions. The purpose of this study was to examine the relationship between emotional intelligence (EI) and dental student clinical performance. All third- and fourth-year students at a single U.S. dental school were invited to participate. Participation rate was 74 percent (100/136). Dental students' EI was assessed using the Emotional Competence Inventory-University version (ECI-U), a seventy-two-item, 360-degree questionnaire completed by both self and other raters. The ECI-U measured twenty-two EI competencies grouped into four clusters (Self-Awareness, Self-Management, Social Awareness, and Relationship Management). Clinical performance was assessed using the mean grade assigned by clinical preceptors. This grade represents an overall assessment of a student's clinical performance including diagnostic and treatment planning skills, time utilization, preparation and organization, fundamental knowledge, technical skills, self-evaluation, professionalism, and patient management. Additional variables were didactic grade point average (GPA) in Years 1 and 2, preclinical GPA in Years 1 and 2, Dental Admission Test academic average and Perceptual Ability Test scores, year of study, age, and gender. Multiple linear regression analyses were conducted. The Self-Management cluster of competencies (b=0.448, p<0.05) and preclinical GPA (b=0.317, p<0.01) were significantly correlated with mean clinical grade. The Self-Management competencies were emotional self-control, achievement orientation, initiative, trustworthiness, conscientiousness, adaptability, and optimism. In this sample, dental students' EI competencies related to Self-Management were significant predictors of mean clinical grade

  19. What is the relationship between emotional intelligence and dental student clinical performance?

    PubMed

    Victoroff, Kristin Zakariasen; Boyatzis, Richard E

    2013-04-01

    Emotional intelligence has emerged as a key factor in differentiating average from outstanding performers in managerial and leadership positions across multiple business settings, but relatively few studies have examined the role of emotional intelligence in the health care professions. The purpose of this study was to examine the relationship between emotional intelligence (EI) and dental student clinical performance. All third- and fourth-year students at a single U.S. dental school were invited to participate. Participation rate was 74 percent (100/136). Dental students' EI was assessed using the Emotional Competence Inventory-University version (ECI-U), a seventy-two-item, 360-degree questionnaire completed by both self and other raters. The ECI-U measured twenty-two EI competencies grouped into four clusters (Self-Awareness, Self-Management, Social Awareness, and Relationship Management). Clinical performance was assessed using the mean grade assigned by clinical preceptors. This grade represents an overall assessment of a student's clinical performance including diagnostic and treatment planning skills, time utilization, preparation and organization, fundamental knowledge, technical skills, self-evaluation, professionalism, and patient management. Additional variables were didactic grade point average (GPA) in Years 1 and 2, preclinical GPA in Years 1 and 2, Dental Admission Test academic average and Perceptual Ability Test scores, year of study, age, and gender. Multiple linear regression analyses were conducted. The Self-Management cluster of competencies (b=0.448, p<0.05) and preclinical GPA (b=0.317, p<0.01) were significantly correlated with mean clinical grade. The Self-Management competencies were emotional self-control, achievement orientation, initiative, trustworthiness, conscientiousness, adaptability, and optimism. In this sample, dental students' EI competencies related to Self-Management were significant predictors of mean clinical grade

  20. Relationship between perceived and actual motor competence among college students.

    PubMed

    Wang, Jianyu; Liu, Wenhao; Bian, Wei

    2013-02-01

    The relationship between perceived and actual motor competence was examined among college students. Participants were 114 college students (55 men, 59 women; M age = 22.3 yr., SD = 3.9). All participants completed a short survey on perception of motor competence in basketball and took a Control Basketball Dribble Test to assess their actual motor skill. Perceived motor competence in basketball was significantly related to basketball dribbling performance. Given the positive relationship between actual motor competence and perceived competence, enhancing an individual's actual motor competence may contribute to their perceived competence, which may improve an individual's physical activity participation.

  1. A fax-back oxygenator-perfusionist clinical performance data collection and statistical analysis method.

    PubMed

    Riley, J B; Berryessa, R G; Justison, G A; Nolan, K M; Hoerr, H R

    1998-09-01

    A method to collect clinical oxygenator performance data daily is described. At the end of a bypass procedure, the perfusionist fills in a fax-back form designed to automatically input patient-oxygenator performance data into a computer spreadsheet. Multiple blood gases, FiO2, gas and blood flow data, venous oxygenator blood inlet conditions (hemoglobin, O2 saturation, hematocrit and temperature), time on bypass and device manufacturer information are collected at the end of each cardiopulmonary bypass procedure at multiple institutions. A large sample database is created that allows multi-parametric analyses in regard to clinical practice, device performance, manufacturing consistency and patient requirements. The database and analyses facilitate institutional, manufacturer, and clinician benchmarking. Monthly reports to the clinicians give valuable feedback to improve oxygenator use and patient blood gas control. Reports to the device manufacturer provide information used to evaluate the clinical consequences of small changes in the manufacturing process.

  2. A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

    PubMed

    McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

    2015-06-01

    Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes. PMID:26056200

  3. A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

    PubMed

    McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

    2015-06-01

    Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes.

  4. Emotional Intelligence in Internal Medicine Residents: Educational Implications for Clinical Performance and Burnout.

    PubMed

    Satterfield, Jason; Swenson, Sara; Rabow, Michael

    2009-01-01

    We measured emotional intelligence (EQ; the ability to perceive, understand, and manage emotions in the self and others) in a sample of 28 internal medicine residents at the beginning and end of an academic year. EQ scores increased significantly over the course of the year. Higher EQ scores at the end of the year were significantly related to higher ratings for overall clinical performance and medical interviewing. Higher EQ scores also correlated with lower levels of burnout. Results suggest that clinically significant changes in EQ can occur over the course of medical training. Further study should determine if and how educational interventions can affect EQ, EQ-related performance, and burnout.

  5. Design Characteristics Influence Performance of Clinical Prediction Rules in Validation: A Meta-Epidemiological Study

    PubMed Central

    Ban, Jong-Wook; Emparanza, José Ignacio; Urreta, Iratxe; Burls, Amanda

    2016-01-01

    Background Many new clinical prediction rules are derived and validated. But the design and reporting quality of clinical prediction research has been less than optimal. We aimed to assess whether design characteristics of validation studies were associated with the overestimation of clinical prediction rules’ performance. We also aimed to evaluate whether validation studies clearly reported important methodological characteristics. Methods Electronic databases were searched for systematic reviews of clinical prediction rule studies published between 2006 and 2010. Data were extracted from the eligible validation studies included in the systematic reviews. A meta-analytic meta-epidemiological approach was used to assess the influence of design characteristics on predictive performance. From each validation study, it was assessed whether 7 design and 7 reporting characteristics were properly described. Results A total of 287 validation studies of clinical prediction rule were collected from 15 systematic reviews (31 meta-analyses). Validation studies using case-control design produced a summary diagnostic odds ratio (DOR) 2.2 times (95% CI: 1.2–4.3) larger than validation studies using cohort design and unclear design. When differential verification was used, the summary DOR was overestimated by twofold (95% CI: 1.2 -3.1) compared to complete, partial and unclear verification. The summary RDOR of validation studies with inadequate sample size was 1.9 (95% CI: 1.2 -3.1) compared to studies with adequate sample size. Study site, reliability, and clinical prediction rule was adequately described in 10.1%, 9.4%, and 7.0% of validation studies respectively. Conclusion Validation studies with design shortcomings may overestimate the performance of clinical prediction rules. The quality of reporting among studies validating clinical prediction rules needs to be improved. PMID:26730980

  6. How People Actually Use Thermostats

    SciTech Connect

    Meier, Alan; Aragon, Cecilia; Hurwitz, Becky; Mujumdar, Dhawal; Peffer, Therese; Perry, Daniel; Pritoni, Marco

    2010-08-15

    Residential thermostats have been a key element in controlling heating and cooling systems for over sixty years. However, today's modern programmable thermostats (PTs) are complicated and difficult for users to understand, leading to errors in operation and wasted energy. Four separate tests of usability were conducted in preparation for a larger study. These tests included personal interviews, an on-line survey, photographing actual thermostat settings, and measurements of ability to accomplish four tasks related to effective use of a PT. The interviews revealed that many occupants used the PT as an on-off switch and most demonstrated little knowledge of how to operate it. The on-line survey found that 89% of the respondents rarely or never used the PT to set a weekday or weekend program. The photographic survey (in low income homes) found that only 30% of the PTs were actually programmed. In the usability test, we found that we could quantify the difference in usability of two PTs as measured in time to accomplish tasks. Users accomplished the tasks in consistently shorter times with the touchscreen unit than with buttons. None of these studies are representative of the entire population of users but, together, they illustrate the importance of improving user interfaces in PTs.

  7. Performance of Clinical Nurse Educators in Teaching Pharmacology and Medication Management: Nursing Students’ Perceptions

    PubMed Central

    Ghamari Zare, Zohre; Adib-Hajbaghery, Mohsen

    2016-01-01

    Background Pharmacological knowledge and medication management skills of student nurses greatly depend on the clinical nurse educators’ performance in this critical issue. However, the Iranian nurse educators’ performance in teaching pharmacology and medication management are not adequately studied. Objectives The current study aimed to investigate the nursing students’ perceptions on the status of clinical pharmaceutical and medication management education. Materials and Methods A cross-sectional study was conducted on all 152 nursing students registered in the seventh and eighth semesters at the Qom and Naragh branches of Islamic Azad University, and Kashan University of Medical Sciences in 2013 - 2014 academic year. The students’ perceptions on the performance of clinical nurse educators in teaching pharmacology and medication management were assessed using a researcher made questionnaire. The questionnaire consisted of 31 items regarding clinical educators’ performance in teaching pharmacology and medication management and two questions about students’ satisfaction with their level of knowledge and skills in pharmacology and medication management. Descriptive statistics was employed and analysis of variance was performed to compare the mean of scores of teaching pharmacology and medication management in the three universities. Results Among a total of 152 subjects, 82.9% were female and their mean age was 22.57 ± 1.55 years. According to the students, instructors had the weakest performance in the three items of teaching pharmacology and medication management based on the students’ learning needs, teaching medication management through a patient-centered method and teaching pharmacology and medication management based on the course plan. The students’ satisfaction regarding their own knowledge and skill of pharmacology and medication management was at medium level. Conclusions Nursing students gave a relatively low score in several aspects of

  8. Clinically Normal Stereopsis Does Not Ensure a Performance Benefit from Stereoscopic 3D Depth Cues

    NASA Astrophysics Data System (ADS)

    McIntire, John P.; Havig, Paul R.; Harrington, Lawrence K.; Wright, Steve T.; Watamaniuk, Scott N. J.; Heft, Eric L.

    2014-09-01

    To investigate the effect of manipulating disparity on task performance and viewing comfort, twelve participants were tested on a virtual object precision placement task while viewing a stereoscopic 3D (S3D) display. All participants had normal or corrected-to-normal visual acuity, passed the Titmus stereovision clinical test, and demonstrated normal binocular function, including phorias and binocular fusion ranges. Each participant completed six experimental sessions with different maximum binocular disparity limits. The results for ten of the twelve participants were generally as expected, demonstrating a large performance advantage when S3D cues were provided. The sessions with the larger disparity limits typically resulted in the best performance, and the sessions with no S3D cues the poorest performance. However, one participant demonstrated poorer performance in sessions with smaller disparity limits but improved performance in sessions with the larger disparity limits. Another participant's performance declined whenever any S3D cues were provided. Follow-up testing suggested that the phenomenon of pseudo-stereoanomaly may account for one viewer's atypical performance, while the phenomenon of stereoanomaly might account for the other. Overall, the results demonstrate that a subset of viewers with clinically normal binocular and stereoscopic vision may have difficulty performing depth-related tasks on S3D displays. The possibility of the vergence-accommodation conflict contributing to individual performance differences is also discussed.

  9. Effective Clinical Supervision in Substance Use Disorder Treatment Programs and Counselor Job Performance

    PubMed Central

    2013-01-01

    When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors’ careers, providing challenging assignments, role modeling, accepting/confirming counselors’ competence, overall supervisor task proficiency). Clinical supervisors rated counselors’ job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors’ task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training. PMID:25061265

  10. Safety of patients--actual problem of modern medicine (review).

    PubMed

    Tsintsadze, Neriman; Samnidze, L; Beridze, T; Tsintsadze, M; Tsintsadze, Nino

    2011-09-01

    Safety of patients is actual problem of up-to-date medicine. The current successful treatment of various sicknesses is achieved by implementation in clinical practice such medical preparations (medications), which are characterized with the high therapeutic activity, low toxicity and prolonged effects. In spite of evidence of the pharmacotherapeutical advances, the frequency of complications after medication has grown - that is why the safety of patients is the acute actual problem of medicine and ecological state of human population today. PMID:22156680

  11. Clinical hypnosis with a Little League baseball population: performance enhancement and resolving traumatic experiences.

    PubMed

    Iglesias, Alex; Iglesias, Adam

    2011-01-01

    A model for the use of clinical hypnosis with a Little League population was proposed and outlined with dual emphasis: performance enhancement and resolving traumatic experiences. The Performance Enhancement Training Model was developed to enhance performance with this non-patient population. It employed clinical hypnosis to bring to fruition recommendations made by coaches to enhance players' batting proficiency. The second emphasis of the proposed model focused on the resolution of involuntary maladaptive habits secondary to a traumatic experience that impede or compromise optimum performance. Included in this category were detrimental defensive habits "at the plate" after a beaming by a pitch and detrimental defensive habits "on the field" after being hit by a batted ball.

  12. Perceived job importance and job performance satisfaction of selected clinical nutrition management responsibilities.

    PubMed

    Pratt, Peggy E; Kwon, Junehee; Rew, Martha L

    2005-07-01

    A nationwide survey of clinical nutrition managers was conducted to assess perceived importance of selected job responsibilities and perceived performance satisfaction of those job responsibilities. A questionnaire was developed to achieve the study objectives, validated by an expert panel, and pilot-tested prior to data collection. All members of the American Dietetic Association's Clinical Nutrition Management dietetic practice group (N=1,668) were asked to rate the importance of selected job responsibilities and their satisfaction with those responsibilities using Likert-type scales with descriptions. Results revealed that clinical nutrition managers perceived all job responsibilities listed in the questionnaire to be important (ie, the mean score of each responsibility was >3.0 of a 4.0 scale). Respondents rated regulatory-related job responsibilities as most important and were most satisfied with their performance of these responsibilities. Following regulatory-related responsibilities, clinical nutrition managers perceived patient satisfaction and staff retention to be more important than other responsibilities. In general, clinical nutrition managers were more satisfied with their job performance for job responsibilities that they ranked as more important.

  13. Correlation between clinical performance and degree of conversion of resin cements: a literature review

    PubMed Central

    DE SOUZA, Grace; BRAGA, Roberto Ruggiero; CESAR, Paulo Francisco; LOPES, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used. PMID:26398507

  14. Correlation between clinical performance and degree of conversion of resin cements: a literature review.

    PubMed

    De Souza, Grace; Braga, Roberto Ruggiero; Cesar, Paulo Francisco; Lopes, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used.

  15. Correlation between clinical performance and degree of conversion of resin cements: a literature review.

    PubMed

    De Souza, Grace; Braga, Roberto Ruggiero; Cesar, Paulo Francisco; Lopes, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used. PMID:26398507

  16. Organizational Characteristics of High- and Low-Performing Anticoagulation Clinics in the Veterans Health Administration

    PubMed Central

    Rose, Adam J; Petrakis, Beth Ann; Callahan, Patricia; Mambourg, Scott; Patel, Dimple; Hylek, Elaine M; Bokhour, Barbara G

    2012-01-01

    Objective Anticoagulation clinics (ACCs) can improve anticoagulation control and prevent adverse events. However, ACCs vary widely in their performance on anticoagulation control. Our objective was to compare the organization and management of top-performing with that of bottom-performing ACCs. Data Sources/Study Setting Three high outlier and three low outlier ACCs in the Veterans Health Administration (VA). Study Design Site visits with qualitative data collection and analysis. Data Collection/Extraction Methods We conducted semi-structured interviews with ACC staff regarding work flow, staffing, organization, and quality assurance efforts. We also observed ACC operations and collected documents, such as the clinic protocol. We used grounded thematic analysis to examine site-level factors associated with high and low outlier status. Principal Findings High outlier sites were characterized by (1) adequate (pharmacist) staffing and effective use of (nonpharmacist) support personnel; (2) innovation to standardize clinical practice around evidence-based guidelines; (3) the presence of a quality champion for the ACC; (4) higher staff qualifications; (5) a climate of ongoing group learning; and (6) internal efforts to measure performance. Although high outliers had all of these features, no low outlier had more than two of them. Conclusions The top-performing ACCs in the VA system shared six relatively recognizable characteristics. Efforts to improve performance should focus on these domains. PMID:22299722

  17. Does sensitivity measured from screening test-sets predict clinical performance?

    NASA Astrophysics Data System (ADS)

    Soh, BaoLin P.; Lee, Warwick B.; Mello-Thoms, Claudia R.; Tapia, Kriscia A.; Ryan, John; Hung, Wai Tak; Thompson, Graham J.; Heard, Rob; Brennan, Patrick C.

    2014-03-01

    Aim: To examine the relationship between sensitivity measured from the BREAST test-set and clinical performance. Background: Although the UK and Australia national breast screening programs have regarded PERFORMS and BREAST test-set strategies as possible methods of estimating readers' clinical efficacy, the relationship between test-set and real life performance results has never been satisfactorily understood. Methods: Forty-one radiologists from BreastScreen New South Wales participated in this study. Each reader interpreted a BREAST test-set which comprised sixty de-identified mammographic examinations sourced from the BreastScreen Digital Imaging Library. Spearman's rank correlation coefficient was used to compare the sensitivity measured from the BREAST test-set with screen readers' clinical audit data. Results: Results shown statistically significant positive moderate correlations between test-set sensitivity and each of the following metrics: rate of invasive cancer per 10 000 reads (r=0.495; p < 0.01); rate of small invasive cancer per 10 000 reads (r=0.546; p < 0.001); detection rate of all invasive cancers and DCIS per 10 000 reads (r=0.444; p < 0.01). Conclusion: Comparison between sensitivity measured from the BREAST test-set and real life detection rate demonstrated statistically significant positive moderate correlations which validated that such test-set strategies can reflect readers' clinical performance and be used as a quality assurance tool. The strength of correlation demonstrated in this study was higher than previously found by others.

  18. Should Athletic Training Educators Utilize Grades When Evaluating Student Clinical Performance?

    ERIC Educational Resources Information Center

    Scriber, Kent; Gray, Courtney; Millspaugh, Rose

    2010-01-01

    Objective: To explore and address some of the challenges for assessing, interpreting, and grading athletic training students' clinical performance and to suggest athletic training educators consider using a more universal assessment method for professional consistency. Background: In years past students learned from teachers or mentors on an…

  19. Using Performance Assessments to Determine Competence in Clinical Athletic Training Education: How Valid Are Our Assessments?

    ERIC Educational Resources Information Center

    Thompson, Gayle A.; Moss, Robert; Applegate, Brooks

    2014-01-01

    Context: Validity arguments can be used to provide evidence that instructors are drawing accurate conclusions from the results of students' clinical performance assessments (PAs). Little research has been conducted in athletic training education to determine if the evidence supports the use of current PAs. Measurement theories designed to…

  20. The Relationship between Self-Efficacy and Student Physician Assistant Clinical Performance.

    ERIC Educational Resources Information Center

    Opacic, Deborah A.

    2003-01-01

    Multivariate analysis of data from measures of self-efficacy, values, outcomes expectation, health care experience, and grade point average for 300 physician assistant students revealed that self-efficacy is a significant predictor of clinical performance. The importance of considering noncognitive variables in addition to academic ones was…

  1. Age-Related Decline and Diagnostic Performance of More and Less Prevalent Clinical Cases

    ERIC Educational Resources Information Center

    St-Onge, Christina; Landry, Marjolaine; Xhignesse, Marianne; Voyer, Gilles; Tremblay-Lavoie, Stéphanie; Mamede, Sílvia; Schmidt, Henk; Rikers, Remy

    2016-01-01

    Since cognitive abilities have been shown to decrease with age, it is expected that older physicians would not perform as well as their younger counterparts on clinical cases unless their expertise can counteract the cognitive effects of aging. However, studies on the topic have shown contradictory results. This study aimed to further investigate…

  2. The Correlation of Learning Styles with Student Performance In Academic and Clinical Course Work.

    ERIC Educational Resources Information Center

    Cunningham, M. Jo; Trickey, Becki A.

    1983-01-01

    The purpose of this study was to determine any correlation between learning styles and performance in the academic and clinical course work of occupational therapy students at the Medical University of South Carolina. (Availability: RAM Associates LTD., P.O. Box N, Laurel, MD 20707) (SSH)

  3. Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

    PubMed Central

    Carr, Brendan M.; Romeiser, Jamie; Ruan, Joyce; Gupta, Sandeep; Seifert, Frank C.; Zhu, Wei

    2015-01-01

    Abstract Background/aim Clinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed. Methods Long‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed. Results Mortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences. Conclusions Long‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30) PMID:26543019

  4. Further insight into the incremental value of new markers: the interpretation of performance measures and the importance of clinical context.

    PubMed

    Kerr, Kathleen F; Bansal, Aasthaa; Pepe, Margaret S

    2012-09-15

    In this issue of the Journal, Pencina and et al. (Am J Epidemiol. 2012;176(6):492-494) examine the operating characteristics of measures of incremental value. Their goal is to provide benchmarks for the measures that can help identify the most promising markers among multiple candidates. They consider a setting in which new predictors are conditionally independent of established predictors. In the present article, the authors consider more general settings. Their results indicate that some of the conclusions made by Pencina et al. are limited to the specific scenarios the authors considered. For example, Pencina et al. observed that continuous net reclassification improvement was invariant to the strength of the baseline model, but the authors of the present study show this invariance does not hold generally. Further, they disagree with the suggestion that such invariance would be desirable for a measure of incremental value. They also do not see evidence to support the claim that the measures provide complementary information. In addition, they show that correlation with baseline predictors can lead to much bigger gains in performance than the conditional independence scenario studied by Pencina et al. Finally, the authors note that the motivation of providing benchmarks actually reinforces previous observations that the problem with these measures is they do not have useful clinical interpretations. If they did, researchers could use the measures directly and benchmarks would not be needed.

  5. Molecular conformations, interactions, and properties associated with drug efficiency and clinical performance among VEGFR TK inhibitors

    SciTech Connect

    McTigue, Michele; Murray, Brion William; Chen, Jeffrey H.; Deng, Ya-Li; Solowiej, James; Kania, Robert S.

    2012-09-17

    We performed analyses of compounds in clinical development which have shown that ligand efficient-molecules with privileged physical properties and low dose are less likely to fail in the various stages of clinical testing, have fewer postapproval withdrawals, and are less likely to receive black box safety warnings. However, detailed side-by-side examination of molecular interactions and properties within single drug classes are lacking. As a class, VEGF receptor tyrosine kinase inhibitors (VEGFR TKIs) have changed the landscape of how cancer is treated, particularly in clear cell renal cell carcinoma, which is molecularly linked to the VEGF signaling axis. Despite the clear role of the molecular target, member molecules of this validated drug class exhibit distinct clinical efficacy and safety profiles in comparable renal cell carcinoma clinical studies. The first head-to-head randomized phase III comparative study between active VEGFR TKIs has confirmed significant differences in clinical performance [Rini BI, et al. (2011) Lancet 378:193–1939]. To elucidate how fundamental drug potency–efficiency is achieved and impacts differentiation within the VEGFR TKI class, we determined potencies, time dependence, selectivities, and X-ray structures of the drug–kinase complexes using a VEGFR2 TK construct inclusive of the important juxtamembrane domain. Collectively, the studies elucidate unique drug–kinase interactions that are dependent on distinct juxtamembrane domain conformations, resulting in significant potency and ligand efficiency differences. Finally, the identified structural trends are consistent with in vitro measurements, which translate well to clinical performance, underscoring a principle that may be broadly applicable to prospective drug design for optimal in vivo performance.

  6. Performance of speech-language pathology students in problem-based learning tutorials and in clinical practice.

    PubMed

    Ho, Diana W L; Whitehill, Tara L; Ciocca, Valter

    2014-01-01

    The purpose of the study was to identify if performance of speech-language pathology students in problem-based learning (PBL) tutorials could predict subsequent clinical performance evaluated through (a) a non-standardized, custom clinical evaluation form (HKU form) and (b) a standardized competency assessment for speech pathology developed in Australia (COMPASS®). Students' scores from PBL tutorial performance were correlated with scores in clinical placement on both the HKU form and the COMPASS. Significant correlations were found between students' PBL tutorial performance (reflective journals and participation in the tutorial process) and their clinical performance (treatment and interpersonal skills) on the HKU clinical evaluation form. Significant correlations were also found between (a) PBL tutorial performance (participation in the tutorial process) and their clinical performance (all generic and occupational competencies, and the overall score) on the COMPASS, (b) PBL tutorial performance (reading forms) and two occupational competencies on the COMPASS, (c) PBL tutorial performance (reflective journals) and four occupational competencies and the overall score on the COMPASS. The results highlighted the need for validating the assessment for the learning process in PBL tutorials with empirical evidence and the advantage of assessing clinical performance through COMPASS in Hong Kong. Tutors, clinical supervisors and students should be given clear behavioral descriptors for expected performance in PBL tutorials and clinical practice at different year levels.

  7. The correlation of student performance in preclinical and clinical prosthodontic assessments.

    PubMed

    Curtis, Donald A; Lind, Samuel L; Brear, Sheila; Finzen, Frederick C

    2007-03-01

    Tracking student performance in preclinical and clinical courses can be helpful in developing and refining a curriculum. Our objective was to correlate student performance on three fixed prosthodontic examinations taken by eighty junior dental students. Examinations included a knowledge-based objective structured clinical examination (OSCE), a manual skills exercise completed on a typodont (Typodont), and a competency casting exam (Casting CE) on a patient. Multiple regression analysis indicated that the OSCE and Typodont exam scores, as independent variables, were not statistically significant predictors (P=0.07; P=0.87, respectively) of Casting CE exam performance, which was the dependent variable. Correlations were weak for the OSCE (r=0.21) and nearly nonexistent for the Typodont exam(r=0.03) when compared to the Casting CE. Our results indicate a weak correlation between an OSCE-based knowledge exam measuring students' knowledge of critical errors in preparations and castings and a competency exam involving the preparation of a full veneer crown. Results also indicate virtually no correlation between a typodont preparation examination designed to provide a measure of students' clinical skill and a clinical competency exam involving the preparation of a full crown. PMID:17389571

  8. Influence of Anesthesiology Residents' Noncognitive Skills on the Occurrence of Critical Incidents and the Residents' Overall Clinical Performances.

    ERIC Educational Resources Information Center

    Rhoton, M. Frances; And Others

    1991-01-01

    Analysis of medical residents' clinical performances in five teaching hospital anesthesiology departments revealed that noncognitive performance in some areas was a powerful predictor of overall clinical performance and was related to the occurrence of critical incidents. Noncognitive predictors included conscientiousness, management, confidence,…

  9. Performance-based quality specifications: the relationship between process critical control parameters, critical quality attributes, and clinical performance.

    PubMed

    Short, Steven M; Cogdill, Robert P; Drennen, James K; Anderson, Carl A

    2011-04-01

    The quality of pharmaceutical products is currently evaluated through a series of tests that do not explicitly communicate the clinical consequences of product variability. A previously published risk simulation platform was used to generate quantitative estimates of inefficacy and toxicity for 288 uniform lots of extended-release theophylline tablets displaying various levels of content uniformity and dissolution variability. These data were used to evaluate the univariate specifications utilized in the United States Pharmacopeia (USP) <711> and <905>. Simulation revealed that the specifications are too lenient for content uniformity, both in terms of inefficacy and toxicity, whereas the criteria for dissolution testing are too strict for inefficacy and inaccurate for toxicity. The USP tests also failed to pinpoint the clinical interaction between content uniformity and dissolution variability. Additionally, the simulation platform was used to define the underlying relationship between product quality attributes and clinical performance. Here, content uniformity and Weibull dissolution time constants were used as inputs to the design spaces, which were conditioned on quantitative estimates of inefficacy and toxicity. This methodology enhances the information content of the design space by omitting quality surrogates (e.g., dissolution, moisture content) that are utilized in current design space practices.

  10. Hospital board and management practices are strongly related to hospital performance on clinical quality metrics.

    PubMed

    Tsai, Thomas C; Jha, Ashish K; Gawande, Atul A; Huckman, Robert S; Bloom, Nicholas; Sadun, Raffaella

    2015-08-01

    National policies to improve health care quality have largely focused on clinical provider outcomes and, more recently, payment reform. Yet the association between hospital leadership and quality, although crucial to driving quality improvement, has not been explored in depth. We collected data from surveys of nationally representative groups of hospitals in the United States and England to examine the relationships among hospital boards, management practices of front-line managers, and the quality of care delivered. First, we found that hospitals with more effective management practices provided higher-quality care. Second, higher-rated hospital boards had superior performance by hospital management staff. Finally, we identified two signatures of high-performing hospital boards and management practice. Hospitals with boards that paid greater attention to clinical quality had management that better monitored quality performance. Similarly, we found that hospitals with boards that used clinical quality metrics more effectively had higher performance by hospital management staff on target setting and operations. These findings help increase understanding of the dynamics among boards, front-line management, and quality of care and could provide new targets for improving care delivery.

  11. Hospital board and management practices are strongly related to hospital performance on clinical quality metrics.

    PubMed

    Tsai, Thomas C; Jha, Ashish K; Gawande, Atul A; Huckman, Robert S; Bloom, Nicholas; Sadun, Raffaella

    2015-08-01

    National policies to improve health care quality have largely focused on clinical provider outcomes and, more recently, payment reform. Yet the association between hospital leadership and quality, although crucial to driving quality improvement, has not been explored in depth. We collected data from surveys of nationally representative groups of hospitals in the United States and England to examine the relationships among hospital boards, management practices of front-line managers, and the quality of care delivered. First, we found that hospitals with more effective management practices provided higher-quality care. Second, higher-rated hospital boards had superior performance by hospital management staff. Finally, we identified two signatures of high-performing hospital boards and management practice. Hospitals with boards that paid greater attention to clinical quality had management that better monitored quality performance. Similarly, we found that hospitals with boards that used clinical quality metrics more effectively had higher performance by hospital management staff on target setting and operations. These findings help increase understanding of the dynamics among boards, front-line management, and quality of care and could provide new targets for improving care delivery. PMID:26240243

  12. C-SPECT - a Clinical Cardiac SPECT/Tct Platform: Design Concepts and Performance Potential

    PubMed Central

    Chang, Wei; Ordonez, Caesar E.; Liang, Haoning; Li, Yusheng; Liu, Jingai

    2013-01-01

    Because of scarcity of photons emitted from the heart, clinical cardiac SPECT imaging is mainly limited by photon statistics. The sub-optimal detection efficiency of current SPECT systems not only limits the quality of clinical cardiac SPECT imaging but also makes more advanced potential applications difficult to be realized. We propose a high-performance system platform - C-SPECT, which has its sampling geometry optimized for detection of emitted photons in quality and quantity. The C-SPECT has a stationary C-shaped gantry that surrounds the left-front side of a patient’s thorax. The stationary C-shaped collimator and detector systems in the gantry provide effective and efficient detection and sampling of photon emission. For cardiac imaging, the C-SPECT platform could achieve 2 to 4 times the system geometric efficiency of conventional SPECT systems at the same sampling resolution. This platform also includes an integrated transmission CT for attenuation correction. The ability of C-SPECT systems to perform sequential high-quality emission and transmission imaging could bring cost-effective high-performance to clinical imaging. In addition, a C-SPECT system could provide high detection efficiency to accommodate fast acquisition rate for gated and dynamic cardiac imaging. This paper describes the design concepts and performance potential of C-SPECT, and illustrates how these concepts can be implemented in a basic system. PMID:23885129

  13. Blood pressure control in treated hypertensive patients: clinical performance of general practitioners.

    PubMed Central

    Frijling, B D; Spies, T H; Lobo, C M; Hulscher, M E; van Drenth, B B; Braspenning, J C; Prins, A; van der Wouden, J C; Grol, R P

    2001-01-01

    BACKGROUND: The blood pressure of many treated hypertensive patients remains above recommended target levels. This discrepancy may be related to general practitioners' (GPs') actions. AIM: To assess clinical performance of GPs in blood pressure control in treated hypertensive patients and to explore the influence of patient and GP characteristics on clinical performance. DESIGN OF STUDY: Cross-sectional study conducted on 195 GPs with invitations to participate made via bulletins and by letter. SETTING: One hundred and thirty-two practices in the southern half of The Netherlands from November 1996 to April 1997. METHOD: Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediately after follow-up visits of hypertensive patients treated with antihypertensive medication. RESULTS: The GPs recorded 3526 follow-up visits. In 63% of these consultations the diastolic blood pressure (DBP) was 90 mmHg or above. The median performance rates of the GPs were less than 51% for most of the recommended actions, even at a DBP of > or = 100 mmHg. Performance of non-pharmacological actions increased gradually with increasing DBP; prescribing an increase in antihypertensive medication and making a follow-up appointment scheduled within six weeks rose steeply at a DBP of > or = 100 mmHg. Patient and GP characteristics contributed little to clinical performance. Action performance rates varied considerably between GPs. CONCLUSION: GPs seem to target their actions at a DBP of below 100 mmHg, whereas guidelines recommend targeting at a DBP of below 90 mmHg. PMID:11271892

  14. The actual goals of geoethics

    NASA Astrophysics Data System (ADS)

    Nemec, Vaclav

    2014-05-01

    The most actual goals of geoethics have been formulated as results of the International Conference on Geoethics (October 2013) held at the geoethics birth-place Pribram (Czech Republic): In the sphere of education and public enlightenment an appropriate needed minimum know how of Earth sciences should be intensively promoted together with cultivating ethical way of thinking and acting for the sustainable well-being of the society. The actual activities of the Intergovernmental Panel of Climate Changes are not sustainable with the existing knowledge of the Earth sciences (as presented in the results of the 33rd and 34th International Geological Congresses). This knowledge should be incorporated into any further work of the IPCC. In the sphere of legislation in a large international co-operation following steps are needed: - to re-formulate the term of a "false alarm" and its legal consequences, - to demand very consequently the needed evaluation of existing risks, - to solve problems of rights of individuals and minorities in cases of the optimum use of mineral resources and of the optimum protection of the local population against emergency dangers and disasters; common good (well-being) must be considered as the priority when solving ethical dilemmas. The precaution principle should be applied in any decision making process. Earth scientists presenting their expert opinions are not exempted from civil, administrative or even criminal liabilities. Details must be established by national law and jurisprudence. The well known case of the L'Aquila earthquake (2009) should serve as a serious warning because of the proven misuse of geoethics for protecting top Italian seismologists responsible and sentenced for their inadequate superficial behaviour causing lot of human victims. Another recent scandal with the Himalayan fossil fraud will be also documented. A support is needed for any effort to analyze and to disclose the problems of the deformation of the contemporary

  15. Is medical perspective on clinical governance practices associated with clinical units’ performance and mortality? A cross-sectional study through a record-linkage procedure

    PubMed Central

    Sarchielli, Guido; De Plato, Giovanni; Cavalli, Mario; Albertini, Stefano; Nonni, Ilaria; Bencivenni, Lucia; Montali, Arianna; Ventura, Antonio; Montali, Francesca

    2016-01-01

    Objective: Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units’ performance measured through mortality rates and efficiency indicators. Methods: This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors’ knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units’ performance indicators which include patients’ mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. Results: The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units’ efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units’ mortality rates (odds ratio, −8.677; 95% confidence interval, −16.654, −0.700). Conclusion: The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical

  16. Association of community-based dental education components with fourth-year dental students' clinical performance.

    PubMed

    Major, Nicole; McQuistan, Michelle R; Qian, Fang

    2014-08-01

    The purpose of this study was to assess which components of a community-based dental education (CBDE) program at The University of Iowa College of Dentistry & Dental Clinics were associated with overall student performance. This retrospective study analyzed data for 444 fourth-year students who graduated in 2006 through 2011. Information pertaining to students' CBDE rotations and their final grades from the comprehensive clinic (in two areas: Production and Competence) were used for statistical analysis. Bivariate analyses indicated that students who completed CBDE in the fall were more likely to receive an A or B in Production compared to students who completed CBDE in the spring. However, students who completed CBDE in the beginning or end of the academic year were more likely to receive an A or B in Competence compared to those who completed CBDE in the middle of the year. Students who treated a variety of patient types during CBDE experiences (comprehensive and emergency care vs. mainly comprehensive care) were more likely to receive better grades in Production, while CBDE clinic type was not associated with grades. Dental schools should consider how CBDE may impact students' performance in their institutional clinics when developing and evaluating CBDE programs.

  17. Magnetic bead-based nucleic acid purification kit: Clinical application and performance evaluation in stool specimens.

    PubMed

    Yoon, Jihoon G; Kang, Jin Seok; Hwang, Seung Yong; Song, Jaewoo; Jeong, Seok Hoon

    2016-05-01

    Two different methods - the semi-automated magnetic bead-based kit (SK, Stool DNA/RNA Purification kit®) and the manual membrane column-based kit (QS, QIAamp® DNA Stool Mini kit) - for purifying nucleic acids from clinical stool samples were compared and evaluated. The SK kit was more user-friendly than QS due to the reduced manual processing, partial automation, and short turnaround time with half cost. Furthermore, SK produced high yields in both DNA and RNA extractions but poor purity in RNA extraction. In the assessment of rotavirus and Clostridium difficile infection, both kits had equivalent or more sensitive performance compared with the standard method. Although SK showed some interference and inhibition in nucleic acid extraction, the performance, including the repeatability, linearity, analytical sensitivity, and matrix effect, was sufficient for routine clinical use. PMID:27030641

  18. Clinical effects of iridectomy performed by laser YAG Nd+3 Q switch

    NASA Astrophysics Data System (ADS)

    Kecik, Tadeusz; Zydecki, Miroslaw

    1995-03-01

    Clinical effects of iridectomy performed by the use of laser Yag Nd+3-Q-switch on 38 patients treated for intra-ocular pressure increase were analyzed. In 32 cases primary glaucoma was diagnosed. In 11 cases secondary glaucoma was caused by pupil blocking. Pressure normalization was obtained in 27 cases (71%). In the remaining 11 patients pressure decreasing was acquired but at the same time administration of antiglaucoma medicines was indispensable. Time of observation took from 4 weeks to 3 years.

  19. Improving performance in golf: current research and implications from a clinical perspective

    PubMed Central

    Evans, Kerrie; Tuttle, Neil

    2015-01-01

    Golf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed. However, while it is generally accepted that an exercise program can improve a golfer's physical measurements and some golf performance variables, translating the findings from research into clinical practice to optimise an individual golfer's performance remains challenging. This paper discusses how biomechanical and motor control research has informed current practice and discusses how emerging sophisticated tools and research designs may better assist golfers improve their performance. PMID:26537808

  20. Improving performance in golf: current research and implications from a clinical perspective.

    PubMed

    Evans, Kerrie; Tuttle, Neil

    2015-01-01

    Golf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed. However, while it is generally accepted that an exercise program can improve a golfer's physical measurements and some golf performance variables, translating the findings from research into clinical practice to optimise an individual golfer's performance remains challenging. This paper discusses how biomechanical and motor control research has informed current practice and discusses how emerging sophisticated tools and research designs may better assist golfers improve their performance. PMID:26537808

  1. Can anterior cruciate ligament reconstruction be performed routinely in day clinic?

    PubMed

    De Beule, J; Vandenneucker, H; Claes, S; Bellemans, J

    2014-09-01

    Anterior cruciate ligament reconstruction is performed as an outpatient procedure in selected cases. Whether it can be safely performed on a routine basis in day clinic remains unclear. Our hypothesis was that routinely performing outpatient anterior cruciate ligament reconstruction would be equally safe as compared to inpatient procedures. A cohort of 355 patients who underwent outpatient primary reconstruction was analysed at an average follow-up of 3.8 years. Four patients (1.1%) could not be discharged or were readmitted within 24 hours. The 1-month readmission rate was 1.4%. The overall complication rate was 12.1% (43 cases) of which 4.2% (15 patients) occurred within the first 30 days. Performing anterior cruciate ligament reconstructions routinely in day clinic is associated with almost negligible readmission rates and has similar complication rates as for standard in-hospital anterior cruciate ligament reconstructions. Outpatient anterior cruciate ligament reconstructions can therefore be safely performed without specific preoperative patient selection protocols.

  2. Odor naming and interpretation performance in 881 schizophrenia subjects: association with clinical parameters

    PubMed Central

    2013-01-01

    Background Olfactory function tests are sensitive tools for assessing sensory-cognitive processing in schizophrenia. However, associations of central olfactory measures with clinical outcome parameters have not been simultaneously studied in large samples of schizophrenia patients. Methods In the framework of the comprehensive phenotyping of the GRAS (Göttingen Research Association for Schizophrenia) cohort, we modified and extended existing odor naming (active memory retrieval) and interpretation (attribute assignment) tasks to evaluate them in 881 schizophrenia patients and 102 healthy controls matched for age, gender and smoking behavior. Associations with emotional processing, neuropsychological test performance and disease outcome were studied. Results Schizophrenia patients underperformed controls in both olfactory tasks. Odor naming deficits were primarily associated with compromised cognition, interpretation deficits with positive symptom severity and general alertness. Contrasting schizophrenia extreme performers of odor interpretation (best versus worst percentile; N=88 each) and healthy individuals (N=102) underscores the obvious relationship between impaired odor interpretation and psychopathology, cognitive dysfunctioning, and emotional processing (all p<0.004). Conclusions The strong association of performance in higher olfactory measures, odor naming and interpretation, with lead symptoms of schizophrenia and determinants of disease severity highlights their clinical and scientific significance. Based on the results obtained here in an exploratory fashion in a large patient sample, the development of an easy-to-use clinical test with improved psychometric properties may be encouraged. PMID:24229413

  3. Prevalence of outsourcing and perception of clinical nutrition managers on performance of health care dietetics services.

    PubMed

    Kwon, Junehee; Yoon, Barbara J H

    2003-08-01

    A nationwide survey of clinical dietitians and clinical nutrition managers was conducted to assess the prevalence of outsourcing in health care dietetics services and to evaluate perceived performance of dietetics services. A questionnaire was developed, validated by an expert panel, and pilot tested prior to data collection. Members of the Clinical Nutrition Management Dietetic Practice Group (N=1,668) were selected as the study sample. Of 431 respondents, 152 (35.3%) indicated that management of both patient and cafeteria foodservices was outsourced. When mean scores of perceived performance ratings were compared using t test, respondents from self-operated facilities rated several items related to patient and cafeteria food quality and material and human resource utilization higher than respondents at contract-managed facilities. No significant differences were found in performance related to decision-making process, buying power, or training programs. Results suggest that careful weighing of advantages and disadvantages of outsourcing is needed before making decisions regarding outsourcing dietetics services.

  4. Student Exposure to Actual Patients in the Classroom.

    ERIC Educational Resources Information Center

    Chisholm, Marie A.; McCall, Charles Y.; Francisco, George E., Jr.; Poirier, Sylvie

    1997-01-01

    Two clinical courses for first-year dental students were designed to develop students' interaction skills through actual patient case presentations and discussions and an interdisciplinary teaching approach. Results indicate students preferred the case presentations, with or without lecture, to the lecture-only approach and felt they learned more…

  5. Modeling relationships between traditional preadmission measures and clinical skills performance on a medical licensure examination.

    PubMed

    Roberts, William L; Pugliano, Gina; Langenau, Erik; Boulet, John R

    2012-08-01

    Medical schools employ a variety of preadmission measures to select students most likely to succeed in the program. The Medical College Admission Test (MCAT) and the undergraduate college grade point average (uGPA) are two academic measures typically used to select students in medical school. The assumption that presently used preadmission measures can predict clinical skill performance on a medical licensure examination was evaluated within a validity argument framework (Kane 1992). A hierarchical generalized linear model tested relationships between the log-odds of failing a high-stakes medical licensure performance examination and matriculant academic and non-academic preadmission measures, controlling for student-and school-variables. Data includes 3,189 matriculants from 22 osteopathic medical schools tested in 2009-2010. Unconditional unit-specific model expected average log-odds of failing the examination across medical schools is -3.05 (se = 0.11) or 5%. Student-level estimated coefficients for MCAT Verbal Reasoning scores (0.03), Physical Sciences scores (0.05), Biological Sciences scores (0.04), uGPA(science) (0.07), and uGPA(non-science) (0.26) lacked association with the log-odds of failing the COMLEX-USA Level 2-PE, controlling for all other predictors in the model. Evidence from this study shows that present preadmission measures of academic ability are not related to later clinical skill performance. Given that clinical skill performance is an important part of medical practice, selection measures should be developed to identify students who will be successful in communication and be able to demonstrate the ability to systematically collect a medical history, perform a physical examination, and synthesize this information to diagnose and manage patient conditions.

  6. Tests for bactericidal effects of antimicrobial agents: technical performance and clinical relevance.

    PubMed Central

    Peterson, L R; Shanholtzer, C J

    1992-01-01

    Bactericidal testing has been used for several decades as a guide for antimicrobial therapy of serious infections. Such testing is most frequently performed when bactericidal antimicrobial agent therapy is considered necessary (such as when treating infectious endocarditis or infection in an immunocompromised host). It has also been used to ensure that the infecting organism is killed by (not tolerant to) usually bactericidal compounds. However, few data are available to support the role of such tests in direct patient care. Several important variables affect the reproducibility of the test results; however, proposed reference methods are now available for performing the MBC test. With minor modifications, these can provide a standardized approach for laboratories that need to perform them. Currently, little evidence is available to support the routine use of such testing for the care of individual patients. However, testing of new (investigational) antimicrobial agents can be beneficial in determining their potential to provide bactericidal antimicrobial activity during clinical use. New methods to assess bactericidal activity are being developed, but as yet none have been rigorously tested in patient care settings; further, for most of these methods, little information is available as to which technical parameters affect their results. In clinical laboratories, all bactericidal tests must be performed with rigorously standardized techniques and adequate controls, bearing in mind the limitations of the currently available test procedures. PMID:1423219

  7. Effects of structured written feedback by cards on medical students’ performance at Mini Clinical Evaluation Exercise (Mini-CEX) in an outpatient clinic

    PubMed Central

    HAGHANI, FARIBA; HATEF KHORAMI, MOHAMMAD; FAKHARI, MOHAMMAD

    2016-01-01

    Introduction Feedback cards are recommended as a feasible tool for structured written feedback delivery in clinical education while effectiveness of this tool on the medical students’ performance is still questionable.  The purpose of this study was to compare the effects of structured written feedback by cards as well as verbal feedback versus verbal feedback alone on the clinical performance of medical students at the Mini Clinical Evaluation Exercise (Mini-CEX) test in an outpatient clinic. Methods This is a quasi-experimental study with pre- and post-test comprising four groups in two terms of medical students’ externship. The students’ performance was assessed through the Mini-Clinical Evaluation Exercise (Mini-CEX) as a clinical performance evaluation tool. Structured written feedbacks were given to two experimental groups by designed feedback cards as well as verbal feedback, while in the two control groups feedback was delivered verbally as a routine approach in clinical education. Results By consecutive sampling method, 62 externship students were enrolled in this study and seven students were excluded from the final analysis due to their absence for three days. According to the ANOVA analysis and Post Hoc Tukey test,  no statistically significant difference was observed among the four groups at the pre-test, whereas a statistically significant difference was observed between the experimental and control groups at the post-test  (F = 4.023, p =0.012). The effect size of the structured written feedbacks on clinical performance was 0.19. Conclusion Structured written feedback by cards could improve the performance of medical students in a statistical sense. Further studies must be conducted in other clinical courses with longer durations. PMID:27382581

  8. [Performance evaluation of VITEK 2 system in meropenem susceptibility testing of clinical Pseudomonas aeruginosa isolates].

    PubMed

    Acuner, Ibrahim Cağatay; Bayramoğlu, Gülçin; Birinci, Asuman; Cekiç Cihan, Ciğdem; Bek, Yüksel; Durupınar, Belma

    2011-07-01

    Pseudomonas aeruginosa is an important opportunistic pathogen associated with various community-acquired or nosocomial infections. Multi-drug resistant P.aeruginosa strains increasingly cause epidemics and spread in various hospital wards and geographic regions. Carbapenems are among the most effective antimicrobials in the treatment of multi-drug resistant P.aeruginosa infections, and meropenem is the most successful among alternatives in initial therapy. Particularly in severe infections, inappropriate or inadequate initial antimicrobial therapy is independently associated with adverse clinical and economic outcomes. Availability of accurate and rapid susceptibility testing is a priority. Most of the automated microbiology systems can provide rapid results within 8 to 12 hours. In comparison to standard methods, problems in the antimicrobial susceptibility testing of particular microorganisms and antimicrobial agents have been reported for automated microbiology systems. Failures have been reported previously especially in the susceptibility testing of P.aeruginosa versus carbapenem. Most of these studies are designed according to the Food and Drug Administration (FDA, USA) performance analysis scheme (Class II Special Controls Guidance Document: Antimicrobial Susceptibility Test Systems) in a simplified form. However, there are many lacking issues in the design of most of these studies. Among these, insufficient sample size, use of inappropriate reference method, lack of reproducibility testing, and inadequate distribution of study isolates in interpretative categories are of notice. There are only few studies in the literature that evaluate the performance of automated systems in antimicrobial susceptibility testing of carbapenems in clinical P.aeruginosa isolates with a sufficient sample size (n ? 100). However, most of these studies still have one or more major deficiencies in the study design. Furthermore, none of these studies evaluate the performance of

  9. Effects of repetitive transcranial magnetic stimulation on clinical, social, and cognitive performance in postpartum depression

    PubMed Central

    Myczkowski, Martin Luiz; Dias, Álvaro Machado; Luvisotto, Tatiana; Arnaut, Debora; Bellini, Bianca Boura; Mansur, Carlos Gustavo; Rennó, Joel; Tortella, Gabriel; Ribeiro, Philip Leite; Marcolin, Marco Antônio

    2012-01-01

    Background: This randomized, placebo-controlled, double-blind pilot study evaluated the impact of repetitive transcranial magnetic stimulation (rTMS) on clinical, cognitive, and social performance in women suffering with postpartum depression. Methods: Fourteen patients were randomized to receive 20 sessions of sham rTMS or active 5 Hz rTMS over the left dorsolateral prefrontal cortex. Psychiatric clinical scales and a neuropsychological battery were applied at baseline (pretreatment), week 4 (end of treatment), and week 6 (follow-up, posttreatment week 2). Results: The active rTMS group showed significant improvement 2 weeks after the end of rTMS treatment (week 6) in Hamilton Depression Rating Scale (P = 0.020), Global Assessment Scale (P = 0.037), Clinical Global Impression (P = 0.047), and Social Adjustment Scale-Self Report-Work at Home (P = 0.020). Conclusion: This study suggests that rTMS has the potential to improve the clinical condition in postpartum depression, while producing marginal gains in social and cognitive function. PMID:23118543

  10. Three-year clinical performance of two indirect composite inlays compared to direct composite restorations

    PubMed Central

    Ozakar-Ilda, Nurcan; Zorba, Yahya O.; Yildiz, Mehmet; Erdem, Vildan; Seven, Nilgun

    2013-01-01

    Objective: Despite the incremental build-up of resin composite restorations, their polymerization shrinkage during curing presents a serious problem. Indirect composite resin systems represent an alternative in overcoming some of the deficiencies of direct composite restorations. The hypothesis of the present study states that the clinical performance of restorations may be affected by different generation and application techniques. Study Design: Sixty restorations (20 DI system (Coltène/Whaledent AG, Altstätten, Switzerland) composite inlays, 20 Tescera ATL system (BISCO Inc. Schaumburg, Illinois, USA) composite inlays, and 20 direct composites) were applied to premolar teeth in 49 patients. Restorations were clinically evaluated by two examiners. Data were analyzed using the Kruskal-Wallis, Mann-Whitney U, Wilcoxon Signed Ranks, and X2 tests. Results: The Tescera ATL system performed significantly better than both direct composite restorations (p<0.001) and DI system (p<0.05). Conclusion: Within the limitations of this 3-year clinical study, indirect resin restorations showed better scores than direct restorations. In addition, the Tescera ATL system was found to be more successful than the DI system and direct composite restorations. Key words:Composite, inlay, direct composite restorations, indirect composite restorations. PMID:23524423

  11. The impact of companion diagnostic device measurement performance on clinical validation of personalized medicine.

    PubMed

    Li, Meijuan; Yu, Tinghui; Hu, Yun-Fu

    2015-06-30

    A key component of personalized medicine is companion diagnostics that measure biomarkers, for example, protein expression, gene amplification or specific mutations. Most of the recent attention concerning molecular cancer diagnostics has been focused on the biomarkers of response to therapy, such as V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations in metastatic colorectal cancer, epidermal growth factor receptor mutations in metastatic malignant melanoma. The presence or absence of these markers is directly linked to the response rates of particular targeted therapies with small-molecule kinase inhibitors or antibodies. Therefore, testing for these markers has become a critical step in the target therapy of the aforementioned tumors. The core capability of personalized medicine is the companion diagnostic devices' (CDx) ability to accurately and precisely stratify patients by their likelihood of benefit (or harm) from a particular therapy. There is no reference in the literature discussing the impact of device's measurement performance, for example, analytical accuracy and precision on treatment effects, variances, and sample sizes of clinical trial for the personalized medicine. In this paper, using both analytical and estimation method, we assessed the impact of CDx measurement performance as a function of positive and negative predictive values and imprecision (standard deviation) on treatment effects, variances of clinical outcome, and sample sizes for the clinical trials. PMID:25779099

  12. Hand function and performance of daily activities in systemic lupus erythematosus: a clinical study.

    PubMed

    Malcus Johnsson, P; Sandqvist, G; Nilsson, J-Å; Bengtsson, A A; Sturfelt, G; Nived, O

    2015-07-01

    This clinical study was performed to investigate hand problems in individuals with systemic lupus erythematosus (SLE) in comparison with healthy controls, and to explore problems in the performance of daily activities related to these hand problems, in order to objectify findings from a previous mail survey. We also investigated whether a simple hand test could detect hand problems in SLE. All individuals, 71 with SLE and 71 healthy controls, were examined for manifestations in body structures and body functions of the hands with a study-specific protocol. The simple hand test was performed by all the individuals and the arthritis impact measurement scale (AIMS 2) questionnaire was completed by the SLE individuals. In the SLE group, 58% had some kind of difficulty in the simple hand test, compared with 8% in the control group. Fifty percent of the SLE individuals experienced problems in performing daily activities due to hand deficits. Pain in the hands, reduced strength and dexterity, Raynaud's phenomenon and trigger finger were the most prominent body functions affecting the performance of daily activities. Deficits in hand function are common in SLE and affect the performance of daily activities. The simple hand test may be a useful tool in detecting hand problems.

  13. The American Society for Clinical Pathology resident in-service examination: does resident performance provide insight into the effectiveness of clinical pathology education?

    PubMed

    McKenna, Barbara J

    2007-06-01

    The resident in-service examination in pathology is an in-training exercise that is taken by virtually all pathology residents in the United States as well as by some participants in Canada, Ireland, and Lebanon. Although all of the anatomic pathology topics in the examination, with only one exception-forensic pathology, show significant improvement in scores over the 4 years of residency training, three areas of clinical pathology training (laboratory administration, clinical chemistry, and microbiology) show significantly lower improvement in performance over the years of residency training. By contrast, transfusion medicine, hematopathology and the special topics section of the examination all demonstrate improved performance by residents over time. While the reason behind these differences must remain speculative at this time, these findings suggest that measures to improve effectiveness in clinical pathology training might be suggested by examining the differences between residency training practices between higher and lower performing areas of clinical pathology. PMID:17556086

  14. The American Society for Clinical Pathology resident in-service examination: does resident performance provide insight into the effectiveness of clinical pathology education?

    PubMed

    McKenna, Barbara J

    2007-06-01

    The resident in-service examination in pathology is an in-training exercise that is taken by virtually all pathology residents in the United States as well as by some participants in Canada, Ireland, and Lebanon. Although all of the anatomic pathology topics in the examination, with only one exception-forensic pathology, show significant improvement in scores over the 4 years of residency training, three areas of clinical pathology training (laboratory administration, clinical chemistry, and microbiology) show significantly lower improvement in performance over the years of residency training. By contrast, transfusion medicine, hematopathology and the special topics section of the examination all demonstrate improved performance by residents over time. While the reason behind these differences must remain speculative at this time, these findings suggest that measures to improve effectiveness in clinical pathology training might be suggested by examining the differences between residency training practices between higher and lower performing areas of clinical pathology.

  15. Perceived accessibility versus actual physical accessibility of healthcare facilities.

    PubMed

    Sanchez, J; Byfield, G; Brown, T T; LaFavor, K; Murphy, D; Laud, P

    2000-01-01

    This study addressed how healthcare clinics perceive themselves in regard to accessibility for persons with spinal cord injuries (SCI). All 40 of the clinics surveyed reported that they were wheelchair accessible; however, there was significant variability in the number of sites that actually met the guidelines of the Americans with Disability Act. In general, a person using a wheelchair could enter the building, the examination room, and the bathroom. The majority of sites did not have an examination table that could be lowered to wheelchair level. Most reported limited experience in working with persons with (SCI), yet they claimed to be able to assist with difficult transfers. Only one site knew about autonomic dysreflexia. Problems of accessibility appeared to be seriously compounded by the clinics' perception of how they met physical accessibility guidelines without consideration of the actual needs of persons with SCI. This study addressed the perception of accessibility as reported by clinic managers versus actual accessibility in healthcare clinics in a Midwestern metropolitan area for persons using wheelchairs. PMID:10754921

  16. Performance of rural health clinics: an examination of efficiency and Medicare beneficiary outcomes

    PubMed Central

    Ortiz, J; Wan, TH

    2012-01-01

    Introduction In 2011, some 3800 Rural Health Clinics (RHCs) delivered primary care in underserved rural areas throughout the USA. To date, little research has been conducted to identify the variability in RHC performance. In an effort to address the knowledge gaps, a national, longitudinal study was conducted of a panel of 3565 RHCs. The goals of the study were to determine: (1) the relationship between two aspects of performance: efficiency and effectiveness; and (2) the factors that influence variation in RHC performance. Methods A non-experimental study of RHC performance was conducted using 2 years of secondary data from multiple sources. A study panel of RHCs was formed. This panel was composed of all RHCs continuously in operation during the period 2006–2007. The study panel was divided into two subsets - one for the provider-based clinics; another for the independent clinics. The individual RHC was the unit of analysis throughout the study. Descriptive statistics were calculated for each subset. Bivariate analyses was conducted of the relationships between the clinic characteristics and the performance outcome measures, as well as the interrelationships between various clinic characteristics using χ2, t-tests, Cramer's V, Pearson correlation, and Spearman correlation statistics. Next, using covariance structure analysis, the interrelationships were examined among the context (community or demographic factors), design (organizational structure and other mediating factors), and performance (efficiency and effectiveness) of RHCs. Three hypotheses were tested: (1) the effectiveness of RHCs is positively influenced by efficiency; (2) there is a reciprocal relationship between RHC efficiency and effectiveness; and (3) large RHCs are more efficient than small RHCs. Results To test the hypotheses that effectiveness of RHCs is positively influenced by efficiency and that there is a reciprocal relationship between efficiency and effectiveness, two covariance

  17. Clinical performance of porcelain laminate veneers: outcomes of the aesthetic pre-evaluative temporary (APT) technique.

    PubMed

    Gurel, Galip; Morimoto, Susana; Calamita, Marcelo A; Coachman, Christian; Sesma, Newton

    2012-12-01

    This article evaluates the long-term clinical performance of porcelain laminate veneers bonded to teeth prepared with the use of an additive mock-up and aesthetic pre-evaluative temporary (APT) technique over a 12-year period. Sixty-six patients were restored with 580 porcelain laminate veneers. The technique, used for diagnosis, esthetic design, tooth preparation, and provisional restoration fabrication, was based on the APT protocol. The influence of several factors on the durability of veneers was analyzed according to pre- and postoperative parameters. With utilization of the APT restoration, over 80% of tooth preparations were confined to the dental enamel. Over 12 years, 42 laminate veneers failed, but when the preparations were limited to the enamel, the failure rate resulting from debonding and microleakage decreased to 0%. Porcelain laminate veneers presented a successful clinical performance in terms of marginal adaptation, discoloration, gingival recession, secondary caries, postoperative sensitivity, and satisfaction with restoration shade at the end of 12 years. The APT technique facilitated diagnosis, communication, and preparation, providing predictability for the restorative treatment. Limiting the preparation depth to the enamel surface significantly increases the performance of porcelain laminate veneers.

  18. 56-month clinical performance of Class I and II resin composite restorations

    PubMed Central

    PAZINATTO, Flavia Bittencourt; GIONORDOLI NETO, Ranulfo; WANG, Linda; MONDELLI, José; MONDELLI, Rafael Francisco Lia; NAVARRO, Maria Fidela de Lima

    2012-01-01

    Objective This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth. Material and Methods Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (a=0.05). Results After 56 months, 25 patients (31 Class I and 36 Class II) were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations. Conclusions Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment. PMID:22858698

  19. The “Laboratory” Effect: Comparing Radiologists' Performance and Variability during Prospective Clinical and Laboratory Mammography Interpretations1

    PubMed Central

    Gur, David; Bandos, Andriy I.; Cohen, Cathy S.; Hakim, Christiane M.; Hardesty, Lara A.; Ganott, Marie A.; Perrin, Ronald L.; Poller, William R.; Shah, Ratan; Sumkin, Jules H.; Wallace, Luisa P.; Rockette, Howard E.

    2008-01-01

    Purpose: To compare radiologists' performance during interpretation of screening mammograms in the clinic with their performance when reading the same mammograms in a retrospective laboratory study. Materials and Methods: This study was conducted under an institutional review board–approved, HIPAA-compliant protocol; the need for informed consent was waived. Nine experienced radiologists rated an enriched set of mammograms that they had personally read in the clinic (the “reader-specific” set) mixed with an enriched “common” set of mammograms that none of the participants had previously read in the clinic by using a screening Breast Imaging Reporting and Data System (BI-RADS) rating scale. The original clinical recommendations to recall the women for a diagnostic work-up, for both reader-specific and common sets, were compared with their recommendations during the retrospective experiment. The results are presented in terms of reader-specific and group-averaged sensitivity and specificity levels and the dispersion (spread) of reader-specific performance estimates. Results: On average, the radiologists' performance was significantly better in the clinic than in the laboratory (P = .035). Interreader dispersion of the computed performance levels was significantly lower during the clinical interpretations (P < .01). Conclusion: Retrospective laboratory experiments may not represent either expected performance levels or interreader variability during clinical interpretations of the same set of mammograms in the clinical environment well. © RSNA, 2008 PMID:18682584

  20. Budget goal commitment, clinical managers' use of budget information and performance.

    PubMed

    Macinati, Manuela S; Rizzo, Marco G

    2014-08-01

    Despite the importance placed on accounting as a means to influence performance in public healthcare, there is still a lot to be learned about the role of management accounting in clinical managers' work behavior and their link with organizational performance. The article aims at analyzing the motivational role of budgetary participation and the intervening role of individuals' mental states and behaviors in influencing the relationship between budgetary participation and performance. According to the goal-setting theory, SEM technique was used to test the relationships among variables. The data were collected by a survey conducted in an Italian hospital. The results show that: (i) budgetary participation does not directly influence the use of budget information, but the latter is encouraged by the level of budget goal commitment which, as a result, is influenced by the positive motivational consequences of participative budgeting; (ii) budget goal commitment does not directly influence performance, but the relationship is mediated by the use of budget information. This study contributes to health policy and management accounting literature and has significant policy implications. Mainly, the findings prove that the introduction of business-like techniques in the healthcare sector can improve performance if attitudinal and behavioral variables are adequately stimulated.

  1. Budget goal commitment, clinical managers' use of budget information and performance.

    PubMed

    Macinati, Manuela S; Rizzo, Marco G

    2014-08-01

    Despite the importance placed on accounting as a means to influence performance in public healthcare, there is still a lot to be learned about the role of management accounting in clinical managers' work behavior and their link with organizational performance. The article aims at analyzing the motivational role of budgetary participation and the intervening role of individuals' mental states and behaviors in influencing the relationship between budgetary participation and performance. According to the goal-setting theory, SEM technique was used to test the relationships among variables. The data were collected by a survey conducted in an Italian hospital. The results show that: (i) budgetary participation does not directly influence the use of budget information, but the latter is encouraged by the level of budget goal commitment which, as a result, is influenced by the positive motivational consequences of participative budgeting; (ii) budget goal commitment does not directly influence performance, but the relationship is mediated by the use of budget information. This study contributes to health policy and management accounting literature and has significant policy implications. Mainly, the findings prove that the introduction of business-like techniques in the healthcare sector can improve performance if attitudinal and behavioral variables are adequately stimulated. PMID:24929475

  2. Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

    PubMed Central

    Udani, Ankeet D.; Macario, Alex; Tanaka, Maria A.; Tanaka, Pedro P.

    2014-01-01

    Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear. PMID:25157263

  3. Getting better, but not well: A 1.5 year follow-up of cognitive performance and cortisol levels in clinical and non-Clinical burnout.

    PubMed

    Oosterholt, Bart G; Maes, Joseph H R; Van der Linden, Dimitri; Verbraak, Marc J P M; Kompier, Michiel A J

    2016-05-01

    The purpose was to reexamine cognitive performance and cortisol levels of initial clinical burnout patients, non-clinical burnout individuals, and healthy controls. After 1.5-years of the initial measurement, clinical burnout patients showed a reduction of burnout symptoms and general physical and psychological complaints, but these were still elevated compared with controls. Nonetheless, they continued to report cognitive problems and still showed a minor impaired cognitive test performance. However, they no longer reported larger subjective costs associated with cognitive test performance and their cortisol awakening response (CAR) returned to a normal level. Compared with controls, non-clinical burnout individuals still reported the same, elevated, level of burnout symptoms, general physical and psychological complaints, and cognitive problems. Their cognitive test performance and associated subjective costs remained normal. However, they seemed to continue to display a lowered CAR. To conclude, after 1.5-years, clinical burnout patients got better, but not 'well', and non-clinical burnout individuals remained not 'well'.

  4. Importance/performance analysis: a tool for service quality control by clinical laboratories.

    PubMed

    Scammon, D L; Weiss, R

    1991-01-01

    A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

  5. A review and clinical summary of vitamin D in regard to bone health and athletic performance.

    PubMed

    Neal, Sara; Sykes, Jeannie; Rigby, Michael; Hess, Bryan

    2015-05-01

    The large amount of scientific literature regarding vitamin D can be overwhelming and confusing. Some organizations have made specific guidelines and recommendations regarding optimal blood levels of vitamin D. In the sports medicine literature, new information about the effects of vitamin D on performance and bone health abound. Most of these articles seem to raise more questions than they answer. Are athletes at increased risk of vitamin D deficiency? Does vitamin D deficiency affect athletic performance? Should athletes be tested for deficiency? What is the optimal goal for vitamin D levels in athletes and is this different from the general population? The goal of this article is to provide clinical insight and clarity, both for those practicing in the primary care setting as well as for those taking care of athletes.

  6. Confidence level in performing clinical procedures among medical officers in nonspecialist government hospitals in Penang, Malaysia.

    PubMed

    Othman, Mohamad Sabri; Merican, Hassan; Lee, Yew Fong; Ch'ng, Kean Siang; Thurairatnam, Dharminy

    2015-03-01

    A prospective cross-sectional study was conducted at 3 government hospitals over 6 months to evaluate the confidence level of medical officers (MOs) to perform clinical procedure in nonspecialist government hospitals in Penang. An anonymous self-administered questionnaire in English was designed based on the elective and emergency procedures stated in the houseman training logbook. The questionnaire was distributed to the MOs from Penang State Health Department through the respective hospital directors and returned to Penang State Health Department on completion. The results showed that there was statistically significant difference between those who had undergone 12 months and 24 months as houseman in performing both elective and emergency procedures. MOs who had spent 24 months as housemen expressed higher confidence level than those who had only 12 months of experience. We also found that the confidence level was statistically and significantly influenced by visiting specialist and working together with cooperative experienced paramedics.

  7. The relationship between medical students’ epistemological beliefs and achievement on a clinical performance examination

    PubMed Central

    Oh, Sun-A; Chung, Eun-Kyung; Han, Eui-Ryoung; Woo, Young-Jong; Kevin, Deiter

    2016-01-01

    Purpose: This study was to explore the relationship between clinical performance examination (CPX) achievement and epistemological beliefs to investigate the potentials of epistemological beliefs in ill-structured medical problem solving tasks. Methods: We administered the epistemological beliefs questionnaire (EBQ) to fourth-year medical students and correlated the results with their CPX scores. The EBQ comprised 61 items reflecting five belief systems: certainty of knowledge, source of knowledge, rigidity of learning, ability to learn, and speed of knowledge acquisition. The CPX included scores for history taking, physical examination, and patient-physician interaction. Results: The higher epistemological beliefs group obtained significantly higher scores on the CPX with regard to history taking and patient-physician interaction. The epistemological beliefs scores on certainty of knowledge and source of knowledge were significantly positively correlated with patient-physician interaction. The epistemological beliefs scores for ability to learn were significantly positively correlated with those for history taking, physical examination, and patient-physician interaction. Conclusion: Students with more sophisticated and advanced epistemological beliefs stances used more comprehensive and varied approaches in the patient-physician interaction. Therefore, educational efforts that encourage discussions pertaining to epistemological views should be considered to improve clinical reasoning and problem-solving competence in the clinic setting. PMID:26838566

  8. Comparison of simulated and actual wind shear radar data products

    NASA Technical Reports Server (NTRS)

    Britt, Charles L.; Crittenden, Lucille H.

    1992-01-01

    Prior to the development of the NASA experimental wind shear radar system, extensive computer simulations were conducted to determine the performance of the radar in combined weather and ground clutter environments. The simulation of the radar used analytical microburst models to determine weather returns and synthetic aperture radar (SAR) maps to determine ground clutter returns. These simulations were used to guide the development of hazard detection algorithms and to predict their performance. The structure of the radar simulation is reviewed. Actual flight data results from the Orlando and Denver tests are compared with simulated results. Areas of agreement and disagreement of actual and simulated results are shown.

  9. How painful are shockwave lithotripsy and endoscopic procedures performed at outpatient urology clinics?

    PubMed

    Jeong, Byong Chang; Park, Hyoung Keun; Kwak, Cheol; Oh, Seong-June; Kim, Hyeon Hoe

    2005-08-01

    Our aim was to investigate the subjective pain felt by patients during shockwave lithotripsy (SWL) and endoscopic procedures such as cystoscopy, retrograde ureteral stenting, retrograde pyelography (RGP), and ureteroscopic lithotripsy performed in an outpatient clinic, and to identify how severe pain during such procedures is. We estimated subjective pain in 984 patients after SWL (186), cystoscopy (489), retrograde ureteral stenting (127), RGP (97), and ureteroscopic lithotripsy (85) performed by a single expert in an outpatient clinic using a prospective questionnaire with a ten point visual analog scale between January 2001 and December 2003. There was no premedication in any procedure except ureteroscopic lithotripsy for which an intramuscular injection of analgesics (pethidine HCl 50 mg) was used. The pain scale score in SWL was 6.62+/-2.27, the highest among the procedures (P<0.05). Pain scores for endoscopies were 4.48+/-2.07 in retrograde ureteral stenting, 3.81+/-2.06 in ureteroscopic lithotripsy, 3.72+/-1.75 in RGP, and 3.08+/-1.95 in cystoscopy. In this study, we observed that patients feel most pain in SWL without anesthesia, and that pain during ureteroscopic lithotripsy under local anesthesia is not high, compared with other endoscopic procedures.

  10. Episiotomy and its relationship to various clinical variables that influence its performance

    PubMed Central

    Ballesteros-Meseguer, Carmen; Carrillo-García, César; Meseguer-de-Pedro, Mariano; Canteras-Jordana, Manuel; Martínez-Roche, Mª Emilia

    2016-01-01

    Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure. PMID:27224064

  11. The biopharmaceutics risk assessment roadmap for optimizing clinical drug product performance.

    PubMed

    Selen, Arzu; Dickinson, Paul A; Müllertz, Anette; Crison, John R; Mistry, Hitesh B; Cruañes, Maria T; Martinez, Marilyn N; Lennernäs, Hans; Wigal, Tim L; Swinney, David C; Polli, James E; Serajuddin, Abu T M; Cook, Jack A; Dressman, Jennifer B

    2014-11-01

    The biopharmaceutics risk assessment roadmap (BioRAM) optimizes drug product development and performance by using therapy-driven target drug delivery profiles as a framework to achieve the desired therapeutic outcome. Hence, clinical relevance is directly built into early formulation development. Biopharmaceutics tools are used to identify and address potential challenges to optimize the drug product for patient benefit. For illustration, BioRAM is applied to four relatively common therapy-driven drug delivery scenarios: rapid therapeutic onset, multiphasic delivery, delayed therapeutic onset, and maintenance of target exposure. BioRAM considers the therapeutic target with the drug substance characteristics and enables collection of critical knowledge for development of a dosage form that can perform consistently for meeting the patient's needs. Accordingly, the key factors are identified and in vitro, in vivo, and in silico modeling and simulation techniques are used to elucidate the optimal drug delivery rate and pattern. BioRAM enables (1) feasibility assessment for the dosage form, (2) development and conduct of appropriate "learning and confirming" studies, (3) transparency in decision-making, (4) assurance of drug product quality during lifecycle management, and (5) development of robust linkages between the desired clinical outcome and the necessary product quality attributes for inclusion in the quality target product profile.

  12. Diagnostic tests for influenza and other respiratory viruses: determining performance specifications based on clinical setting.

    PubMed

    Takahashi, Hiroshi; Otsuka, Yoshihito; Patterson, Bruce K

    2010-06-01

    The lack of sensitivity of rapid immunoassays in detecting the novel 2009 H1N1 influenza virus infection has led to recommendations on influenza diagnostic testing for clinicians treating patients as well as advising clinicians on testing decisions. Studies have also shown that rapid immunoassays for seasonal influenza virus show considerable variability in performance characteristics, based on age of patient, prevalence of disease, course of infection, and the quality of the kit used. While public health authorities are currently focused on influenza virus diagnostics, a lack of sensitivity of rapid immunoassays for other viral respiratory pathogens has been widely reported, such as the very limited value of rapid immunoassays for the detection of respiratory syncytial virus in adults. In light of the lack of sensitivity of diagnostic tests for suspected 2009 H1N1 influenza virus infection, as well as their variable performance characteristics for seasonal influenza virus, a number of recommendations have been made by public health authorities advising clinicians on the need for clinical judgment as an important part of testing and treatment decisions as well as reliance on local epidemiologic and surveillance data. With the availability of new molecular methodologies that are user-friendly and allow the front-line physician as well as hospital infection control programs to significantly improve respiratory viral diagnostics, there is a need to carefully determine the most optimal diagnostic testing methodology based on the clinical setting. This review will describe the historical, current, and changing dynamics of respiratory virus infection diagnostics.

  13. Pemetrexed clinical studies in performance status 2 patients with non-small cell lung cancer (Review).

    PubMed

    Zinner, Ralph; Visseren-Grul, Carla; Spigel, David R; Obasaju, Coleman

    2016-01-01

    Because poor performance status (PS) is an independent prognostic factor in non-small cell lung cancer (NSCLC), PS scores are widely used by oncologists to make treatment decisions. Advanced NSCLC patients with an Eastern Cooperative Oncology Group PS of 2 have poor prognoses and are frequently excluded from clinical trials. This article reviews the efficacy and safety of pemetrexed in this patient group. We identified English-language literature (through March 2015) involving completed and ongoing studies through searches of PubMed, meeting abstracts, ClinicalTrials.gov and the European Clinical Trials Register; search terms included 'pemetrexed,' 'NSCLC' and 'PS2'. Only studies reporting ≥1 subset analysis of PS2 patients receiving pemetrexed were chosen. Our search identified a total of ten pemetrexed studies in PS2 patients. Eight studies included only chemonaive patients, one study included both chemonaive patients and patients with one prior chemotherapy regimen and one study included only patients with one prior regimen. In subset analyses in these studies, PS2 patients had worse outcomes than PS0-1 patients regardless of treatment. In a phase 3 study, chemonaive advanced NSCLC patients with PS2 receiving pemetrexed‑carboplatin versus pemetrexed experienced improved overall survival [hazard ratio (HR)=0.62; P=0.001], progression-free survival (HR=0.46; P<0.001) and response (P=0.032). This review confirms the poorer outcomes in PS2 vs. PS0-1 patients. Although it is not an approved combination therapy, in clinical studies, PS2 patients treated with pemetrexed plus carboplatin as first-line therapy had improved response rates and survival. Additional research on PS2 patients is needed.

  14. Development of a new contact lens multipurpose solution: Comparative analysis of microbiological, biological and clinical performance

    PubMed Central

    Kilvington, Simon; Huang, Ling; Kao, Eugenia; Powell, Charles H.

    2010-01-01

    Purpose Antimicrobial, cytotoxicity and clinical performance of a new soft contact lens multi-purpose solution (COMPLETE® RevitaLens) based on polyquaternium-1 and alexidine dihydrochloride (NuMPS) was evaluated. Methods Antimicrobial efficacy was assessed according to ISO 14729 for both biocidal and regimen performance against bacteria and fungi. Acanthamoeba efficacy was tested along with ability to retain antimicrobial activity on partial evaporation. In vitro cytotoxicity of NuMPS and OPTI-FREE® RepleniSH® MPS (MPS-3) was assessed based on ISO 10993-5 and United States Pharmacopeia (USP) methods. In addition, a 3 month, double-masked, parallel group clinical trial comparing safety and acceptability with respect to MPS-3 was conducted with 4 silicone hydrogel (SiHy) and FDA Group IV lens types. Results NuMPS showed broad antimicrobial efficacy, including Acanthamoeba, giving a 3–4 log10 reduction in viability after 6 hours contact time. NuMPS also passed ISO 14729 regimens with SiHy and etafilcon lenses for bacteria, fungi and also Acanthamoeba. The cytotoxicity of NuMPS was equivalent or better compared to MPS-3. In the clinical trial, there was no statistically significant between-group difference in corneal staining (p > 0.05). Patients using MPS-3 had more adverse events than patients using NuMPS: 11.8 % (11/93) versus 2.8 % (5/177), respectively, (p < 0.05). There were no differences noted in cleanliness or wearing comfort (p > 0.05). Conclusion Taken together, the results of these studies indicate that the NuMPS is a novel and effective soft contact lens care solution.

  15. Human reliability assessment in surgery--a new approach for improving surgical performance and clinical outcome.

    PubMed Central

    Cuschieri, A.

    2000-01-01

    Surgical operative performance is currently assessed by audit of morbidity, mortality and, especially in patients with cancer, in terms of long-term outcome. Its chief merit is the identification of problems and sub-optimal results by individual surgeons/centres. There is one aspect of audit that constitutes its intrinsic weakness, the verdict on performance it gives is always retrospective--the problem is identified because of the bad results thrown up by analysis of the data. As a result, there is a distinct possibility that surgeons might exclude patients with potentially curative conditions because of increased operative risk due to co-morbid disease from major surgery because of a fear, conscious or otherwise, of comparative under-performance. There is a methodology in established use by industry that is both prospective and prescriptive in ensuring optimal performance--human reliability assessment (HRA), which can be translated into clinical practice. This paper explains the nature of HRA and reports on its initial use in surgery. PMID:10743422

  16. Examining communication and team performance during clinical handover in a complex environment: the private sector post-anaesthetic care unit.

    PubMed

    Botti, Mari; Bucknall, Tracey; Cameron, Peter; Johnstone, Megan-Jane; Redley, Bernice; Evans, Sue; Jeffcott, Shelly

    2009-06-01

    Threats to patient safety during clinical handover have been identified as an ongoing problem in health care delivery. In complex handover situations, organisational, cultural, behavioural and environmental factors associated with team performance can affect patient safety by undermining the stability of team functioning and the effectiveness of interprofessional communication. We present a practical framework for promoting systematic, comprehensive measurement of the factors involved in clinical handover. The framework can be used to develop viable solutions to the problems of clinical handover. The framework was devised and used in a recent project examining interprofessional communication and team performance during clinical handover in post-anaesthetic care units. The framework combines five key concepts: clinical governance, clinician engagement, ecological validity, safety culture and team climate, and sustainability. We believe that use of this framework will help overcome the limitations of previous research that has not taken into account the complex and multifaceted influences on clinical handover and interprofessional communication.

  17. A pixellated γ-camera based on CdTe detectors clinical interests and performances

    NASA Astrophysics Data System (ADS)

    Chambron, J.; Arntz, Y.; Eclancher, B.; Scheiber, Ch; Siffert, P.; Hage Hali, M.; Regal, R.; Kazandjian, A.; Prat, V.; Thomas, S.; Warren, S.; Matz, R.; Jahnke, A.; Karman, M.; Pszota, A.; Nemeth, L.

    2000-07-01

    A mobile gamma camera dedicated to nuclear cardiology, based on a 15 cm×15 cm detection matrix of 2304 CdTe detector elements, 2.83 mm×2.83 mm×2 mm, has been developed with a European Community support to academic and industrial research centres. The intrinsic properties of the semiconductor crystals - low-ionisation energy, high-energy resolution, high attenuation coefficient - are potentially attractive to improve the γ-camera performances. But their use as γ detectors for medical imaging at high resolution requires production of high-grade materials and large quantities of sophisticated read-out electronics. The decision was taken to use CdTe rather than CdZnTe, because the manufacturer (Eurorad, France) has a large experience for producing high-grade materials, with a good homogeneity and stability and whose transport properties, characterised by the mobility-lifetime product, are at least 5 times greater than that of CdZnTe. The detector matrix is divided in 9 square units, each unit is composed of 256 detectors shared in 16 modules. Each module consists in a thin ceramic plate holding a line of 16 detectors, in four groups of four for an easy replacement, and holding a special 16 channels integrated circuit designed by CLRC (UK). A detection and acquisition logic based on a DSP card and a PC has been programmed by Eurorad for spectral and counting acquisition modes. Collimators LEAP and LEHR from commercial design, mobile gantry and clinical software were provided by Siemens (Germany). The γ-camera head housing, its general mounting and the electric connections were performed by Phase Laboratory (CNRS, France). The compactness of the γ-camera head, thin detectors matrix, electronic readout and collimator, facilitates the detection of close γ sources with the advantage of a high spatial resolution. Such an equipment is intended to bedside explorations. There is a growing clinical requirement in nuclear cardiology to early assess the extent of an

  18. Performance Evaluation of an Automated ELISA System for Alzheimer's Disease Detection in Clinical Routine.

    PubMed

    Chiasserini, Davide; Biscetti, Leonardo; Farotti, Lucia; Eusebi, Paolo; Salvadori, Nicola; Lisetti, Viviana; Baschieri, Francesca; Chipi, Elena; Frattini, Giulia; Stoops, Erik; Vanderstichele, Hugo; Calabresi, Paolo; Parnetti, Lucilla

    2016-07-22

    The variability of Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers undermines their full-fledged introduction into routine diagnostics and clinical trials. Automation may help to increase precision and decrease operator errors, eventually improving the diagnostic performance. Here we evaluated three new CSF immunoassays, EUROIMMUNtrademark amyloid-β 1-40 (Aβ1-40), amyloid-β 1-42 (Aβ1-42), and total tau (t-tau), in combination with automated analysis of the samples. The CSF biomarkers were measured in a cohort consisting of AD patients (n = 28), mild cognitive impairment (MCI, n = 77), and neurological controls (OND, n = 35). MCI patients were evaluated yearly and cognitive functions were assessed by Mini-Mental State Examination. The patients clinically diagnosed with AD and MCI were classified according to the CSF biomarkers profile following NIA-AA criteria and the Erlangen score. Technical evaluation of the immunoassays was performed together with the calculation of their diagnostic performance. Furthermore, the results for EUROIMMUN Aβ1-42 and t-tau were compared to standard immunoassay methods (INNOTESTtrademark). EUROIMMUN assays for Aβ1-42 and t-tau correlated with INNOTEST (r = 0.83, p < 0.001 for both) and allowed a similar interpretation of the CSF profiles. The Aβ1-42/Aβ1-40 ratio measured with EUROIMMUN was the best parameter for AD detection and improved the diagnostic accuracy of Aβ1-42 (area under the curve = 0.93). In MCI patients, the Aβ1-42/Aβ1-40 ratio was associated with cognitive decline and clinical progression to AD.The diagnostic performance of the EUROIMMUN assays with automation is comparable to other currently used methods. The variability of the method and the value of the Aβ1-42/Aβ1-40 ratio in AD diagnosis need to be validated in large multi-center studies. PMID:27447425

  19. The effect of student self-video of performance on clinical skill competency: a randomised controlled trial.

    PubMed

    Maloney, Stephen; Storr, Michael; Morgan, Prue; Ilic, Dragan

    2013-03-01

    Emerging technologies and student information technology literacy are enabling new methods of teaching and learning for clinical skill performance. Facilitating experiential practice and reflection on performance through student self-video, and exposure to peer benchmarks, may promote greater levels of skill competency. This study examines the impact of student self-video on the attainment of clinical skills. A total of 60 Physiotherapy students (100%) consented to participate in the randomised controlled trial. One group (50%) was taught a complex clinical skill with regular practical tutoring, whilst the other group (50%) supplemented the tutoring with a self-video task aimed at promoting reflection on performance. Student skill performance was measured in an objective structured clinical examination (OSCE). Students also completed an anonymous questionnaire, which explored their perception of their learning experiences. Students received significantly higher scores in the OSCE when the examined clinical skill had been supplemented with a self-video of performance task (P = 0.048). Descriptive analysis of the questionnaires relating to student perceptions on the teaching methods identified that the self-video of performance task utilised contributed to improvement in their clinical performance and their confidence for future clinical practice. Students identified a number of aspects of the submission process that contributed to this perception of educational value. The novel results of this study demonstrate that greater clinical skill competency is achieved when traditional tutoring methods are supplemented with student self-video of performance tasks. Additional benefits included the ability of staff and students to monitor longitudinal performance, and an increase in feedback opportunities.

  20. Clinical Trial Performance of Community-vs University-Based Practices in the Submacular Surgery Trials (SST)

    PubMed Central

    2005-01-01

    Objective: To compare the performance of community- vs university-based clinical centers in 3 multicenter randomized clinical trials of intraocular surgery. Methods: Each Submacular Surgery Trials clinical center was classified as a university-based center, if the contract to perform as a center was signed by a university official, or as a community-based center. The 2 groups of centers were compared on performance, assessed cumulatively by the Submacular Surgery Trials Quality Assurance and Monitoring Subcommittee. Outcome Measures: Patient accrual, completion of scheduled examinations, completion of masked vision examinations 2 years after enrollment (the designated primary study end point evaluation time), timeliness of submission of retinal photographs required by protocol to the Photograph Reading Center, completion of health- and vision-related quality-of-life interviews, and timeliness of submission of the primary outcome data to the Coordinating Center after completion of the examination. Results: Almost all centers performed at a very high (good) level, although there was a trend for some community-based centers to be at the lower end of most distributions. Conclusions: Most community- and university-based centers performed well in these multicenter clinical trials. Monitoring performance and periodically providing feedback to clinical center investigators may encourage excellent performance in areas critical to the success of clinical trials, regardless of whether the center is community or university based. PMID:15197061

  1. Performance comparison of multi-label learning algorithms on clinical data for chronic diseases.

    PubMed

    Zufferey, Damien; Hofer, Thomas; Hennebert, Jean; Schumacher, Michael; Ingold, Rolf; Bromuri, Stefano

    2015-10-01

    We are motivated by the issue of classifying diseases of chronically ill patients to assist physicians in their everyday work. Our goal is to provide a performance comparison of state-of-the-art multi-label learning algorithms for the analysis of multivariate sequential clinical data from medical records of patients affected by chronic diseases. As a matter of fact, the multi-label learning approach appears to be a good candidate for modeling overlapped medical conditions, specific to chronically ill patients. With the availability of such comparison study, the evaluation of new algorithms should be enhanced. According to the method, we choose a summary statistics approach for the processing of the sequential clinical data, so that the extracted features maintain an interpretable link to their corresponding medical records. The publicly available MIMIC-II dataset, which contains more than 19,000 patients with chronic diseases, is used in this study. For the comparison we selected the following multi-label algorithms: ML-kNN, AdaBoostMH, binary relevance, classifier chains, HOMER and RAkEL. Regarding the results, binary relevance approaches, despite their elementary design and their independence assumption concerning the chronic illnesses, perform optimally in most scenarios, in particular for the detection of relevant diseases. In addition, binary relevance approaches scale up to large dataset and are easy to learn. However, the RAkEL algorithm, despite its scalability problems when it is confronted to large dataset, performs well in the scenario which consists of the ranking of the labels according to the dominant disease of the patient.

  2. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

    PubMed

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-03-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

  3. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial

    PubMed Central

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-01-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists. PMID:27134355

  4. Formative Assessment of Procedural Skills: Students' Responses to the Objective Structured Clinical Examination and the Integrated Performance Procedural Instrument

    ERIC Educational Resources Information Center

    Nestel, Debra; Kneebone, Roger; Nolan, Carmel; Akhtar, Kash; Darzi, Ara

    2011-01-01

    Assessment of clinical skills is a critical element of undergraduate medical education. We compare a traditional approach to procedural skills assessment--the Objective Structured Clinical Examination (OSCE) with the Integrated Performance Procedural Instrument (IPPI). In both approaches, students work through "stations" or "scenarios" undertaking…

  5. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

    PubMed

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-03-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists. PMID:27134355

  6. Performance of Clinical Signs in the Diagnosis of Dehydration in Children with Acute Gastroenteritis

    PubMed Central

    Hoxha, Teuta; Xhelili, Luan; Azemi, Mehmedali; Avdiu, Muharrem; Ismaili-Jaha, Vlora; Efendija-Beqa, Urata; Grajcevci-Uka, Violeta

    2015-01-01

    Background: Acute evaluation and treatment of children presenting with dehydration represent one of the most common situation in the pediatric emergency department. To identify dehydration in infants and children before treatment, a number of symptoms and clinical signs have been evaluated. The aim of the study was to describe the performance of clinical signs in detecting dehydration in children. Methods: Two hundred children aged 1 month to 5 year were involved in our prospective study. The clinical assessment consisted of the ten clinical signs of dehydration, including those recommended by WHO (World Health Organization), heart rate, and capillary refill time. Results: Two hundred patients with diarrhea were enrolled in the study. The mean age was 15.62±9.03 months and 57.5% were male. Of these 121 had a fluid deficit of < 5%, 68 had a deficit of 5 to 9% and 11(5.5%) had a deficit of 10% or more. Patients classified as having no or mild, moderate, and severe dehydration were found to have the following respective gains in percent weight at the end of illness: 2.44±0.3, 6.05± 1.01 and, 10.66± 0.28, respectively. All clinical signs were found more frequently with increasing amounts of dehydration(p<0.001, One–way ANOVA). The median number of findings among subjects with no or mild dehydration (deficit <5%) was 3; among those with moderate dehydration (deficit 5% to 9%) was 6.5 and among those with severe dehydration (deficit >10%) the median was 9 (p<0.0001, Kruskal-Wallis test). Using stepwise linear regression and a p value of <0.05 for entry into the model, a four-variable model including sunken eyes, skin elasticity, week radial pulse, and general appearance was derived. Conclusion: None of the 10 findings studied, is sufficiently accurate to be used in isolation. When considered together, sunken eyes, decreased skin turgor, weak pulse and general appearance provide the best explanatory power of the physical signs considered. PMID:25870468

  7. Using performance indicators to monitor attendance at the Broken Hill blood lead screening clinic.

    PubMed

    Boreland, Frances; Lyle, David

    2009-04-01

    Although the average blood lead level of 1-4-year-old children in Broken Hill has halved since 1991, about 1 in 5 still have blood lead levels higher than the national target (<10 microg/dL). The estimated proportion of children attending the Lead Clinic has declined, to approximately 42% in 2006, raising concern that some children with elevated blood lead levels may not be presenting, thus missing out on appropriate treatment and advice. The aim of this study was to describe patterns of attendance at the clinic as a first step to understanding what factors contribute to clinic attendance and non-attendance. Routinely collected data from the Lead Clinic database were used to describe the impact of factors such as child age, the lead-risk area in which they live, seasonal influences and specific promotional activities on clinic attendance rates from 1999 to June 2007. Estimates of the number of children living in each of the five lead-risk areas were derived from 2001 and 2006 census data and estimates of the number of children born to mothers resident in Broken Hill were derived from the Midwives Data Collection. Attendance rates declined by approximately one-third during the study period. Younger children, and those living closer to the central mining area, were more likely to attend for blood lead screening. Cohort analysis indicated cumulative attendance has declined, with children born in 2005 having a cumulative incidence at 18 months of age 5-10% lower than that for previous birth cohorts. The majority (54%) of children who developed a notifiable blood lead level (15 microg/dL) were first detected at 2 years of age or older, a number of whom (40%) had no recorded tests before the age of 2 years. The analysis has demonstrated the benefits of using an expanded set of performance indicators to monitor the blood lead screening programme. It provides valuable additional information about the reach of the programme. Next steps include seeking additional feedback

  8. Towards building high performance medical image management system for clinical trials

    NASA Astrophysics Data System (ADS)

    Wang, Fusheng; Lee, Rubao; Zhang, Xiaodong; Saltz, Joel

    2011-03-01

    Medical image based biomarkers are being established for therapeutic cancer clinical trials, where image assessment is among the essential tasks. Large scale image assessment is often performed by a large group of experts by retrieving images from a centralized image repository to workstations to markup and annotate images. In such environment, it is critical to provide a high performance image management system that supports efficient concurrent image retrievals in a distributed environment. There are several major challenges: high throughput of large scale image data over the Internet from the server for multiple concurrent client users, efficient communication protocols for transporting data, and effective management of versioning of data for audit trails. We study the major bottlenecks for such a system, propose and evaluate a solution by using a hybrid image storage with solid state drives and hard disk drives, RESTfulWeb Services based protocols for exchanging image data, and a database based versioning scheme for efficient archive of image revision history. Our experiments show promising results of our methods, and our work provides a guideline for building enterprise level high performance medical image management systems.

  9. A Comparison of Neuropsychological Performance Between US and Russia: Preparing for a Global Clinical Trial

    PubMed Central

    Hayden, Kathleen M.; Makeeva, Oksana A.; Newby, L. Kristin; Plassman, Brenda L.; Markova, Valentina V.; Dunham, Ashley; Romero, Heather R.; Melikyan, Zarui A.; Germain, Cassandra M.; Welsh-Bohmer, Kathleen A.; Roses, Allen D.

    2014-01-01

    Background Understanding regional differences in cognitive performance is important for interpretation of data from large multinational clinical trials. Methods Data from Durham and Cabarrus Counties in North Carolina, U.S. and Tomsk, Russia (n=2,972) were evaluated. The Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (Trails B), CERAD Word List Memory Test delayed recall (WLM), and self-report ADCS Mail-In Cognitive Function Screening Instrument (MCFSI) were administered at each site. Multilevel modeling measured the variance explained by site and predictors of cognitive performance. Results Site differences accounted for 11% of the variation on the MoCA; 1.6% on Trails B; 1.7% on WLM; and 0.8% in MCFSI scores. Prior memory testing was significantly associated with WLM. Diabetes and stroke were significantly associated with Trails B and MCFSI. Conclusions Sources of variation include cultural differences, health conditions, and exposure to test stimuli. Findings highlight the importance of local norms to interpret test performance. PMID:25066497

  10. Towards Building High Performance Medical Image Management System for Clinical Trials

    PubMed Central

    Wang, Fusheng; Lee, Rubao; Zhang, Xiaodong; Saltz, Joel

    2011-01-01

    Medical image based biomarkers are being established for therapeutic cancer clinical trials, where image assessment is among the essential tasks. Large scale image assessment is often performed by a large group of experts by retrieving images from a centralized image repository to workstations to markup and annotate images. In such environment, it is critical to provide a high performance image management system that supports efficient concurrent image retrievals in a distributed environment. There are several major challenges: high throughput of large scale image data over the Internet from the server for multiple concurrent client users, efficient communication protocols for transporting data, and effective management of versioning of data for audit trails. We study the major bottlenecks for such a system, propose and evaluate a solution by using a hybrid image storage with solid state drives and hard disk drives, RESTful Web Services based protocols for exchanging image data, and a database based versioning scheme for efficient archive of image revision history. Our experiments show promising results of our methods, and our work provides a guideline for building enterprise level high performance medical image management systems. PMID:21603096

  11. Massage and mobilization of the feet and ankles in elderly adults: effect on clinical balance performance.

    PubMed

    Vaillant, Jacques; Rouland, Audrey; Martigné, Pascale; Braujou, Renaud; Nissen, Michael J; Caillat-Miousse, Jean-Louis; Vuillerme, Nicolas; Nougier, Vincent; Juvin, Robert

    2009-12-01

    The aim of this study was to evaluate the effects of a session of plantar massage and joint mobilization of the feet and ankles on clinical balance performance in elderly people. A randomized, placebo-controlled, cross-over trial was used to examine the immediate effects of manual massage and mobilization of the feet and ankles. Twenty-eight subjects, aged from 65 to 95 years (78.8+/-8.5 years - mean+/-SD) were recruited from community nursing homes. Main outcome measures were the performances in three tests: One Leg Balance (OLB) test, Timed Up and Go (TUG) test and Lateral Reach (LR) test. Results demonstrated a significant improvement after massage and mobilization compared with placebo for the OLB test (1.1+/-1.7s versus 0.4+/-1.2s, p<0.01) and the TUG test (0.9+/-2.6s versus 0.2+/-1.2s, p<0.05). Conversely, performances in the LR test did not improve significantly. These results emphasise the positive impact of a single session of manual therapy applied to the feet and ankles on balance in elderly subjects.

  12. Improving performance of natural language processing part-of-speech tagging on clinical narratives through domain adaptation

    PubMed Central

    Ferraro, Jeffrey P; Daumé, Hal; DuVall, Scott L; Chapman, Wendy W; Harkema, Henk; Haug, Peter J

    2013-01-01

    Objective Natural language processing (NLP) tasks are commonly decomposed into subtasks, chained together to form processing pipelines. The residual error produced in these subtasks propagates, adversely affecting the end objectives. Limited availability of annotated clinical data remains a barrier to reaching state-of-the-art operating characteristics using statistically based NLP tools in the clinical domain. Here we explore the unique linguistic constructions of clinical texts and demonstrate the loss in operating characteristics when out-of-the-box part-of-speech (POS) tagging tools are applied to the clinical domain. We test a domain adaptation approach integrating a novel lexical-generation probability rule used in a transformation-based learner to boost POS performance on clinical narratives. Methods Two target corpora from independent healthcare institutions were constructed from high frequency clinical narratives. Four leading POS taggers with their out-of-the-box models trained from general English and biomedical abstracts were evaluated against these clinical corpora. A high performing domain adaptation method, Easy Adapt, was compared to our newly proposed method ClinAdapt. Results The evaluated POS taggers drop in accuracy by 8.5–15% when tested on clinical narratives. The highest performing tagger reports an accuracy of 88.6%. Domain adaptation with Easy Adapt reports accuracies of 88.3–91.0% on clinical texts. ClinAdapt reports 93.2–93.9%. Conclusions ClinAdapt successfully boosts POS tagging performance through domain adaptation requiring a modest amount of annotated clinical data. Improving the performance of critical NLP subtasks is expected to reduce pipeline error propagation leading to better overall results on complex processing tasks. PMID:23486109

  13. What clinical activities do advanced-practice registered dietitian nutritionists perform? Results of a Delphi study.

    PubMed

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; Rothpletz Puglia, Pamela; O'Sullivan Maillet, Julie

    2014-05-01

    Activities performed by advanced-practice registered dietitian nutritionists (RDNs) have yet to be clearly elucidated. The study aimed to gain consensus on the practice activities of advanced-practice RDNs who provide direct clinical nutrition care. A three-round Delphi study was conducted. Purposive sampling identified 117 RDN experts working as clinicians and/or managers in direct care settings that met inclusion criteria for advanced-level practice. In Round 1, 85 experts provided open-ended advanced-level practice activities linked to the Nutrition Care Process sections. Using content analysis, the responses were coded into activity statements. In Round 2, experts rated the essentiality of these activities. In Round 3, experts re-rated statements not reaching consensus while viewing their previous rating, the group median, and comments. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 were neither essential nor nonessential, and 5.0 to 7.0 were nonessential. Consensus was reached when the interquartile range of responses to each question was <2.0. Seventy-six (89.4%) experts completed all rounds. From 770 comments, 129 activity statements were generated. All statements reached consensus: 97.7% as essential; 0.8% as nonessential; and 1.5% as neither. Of essential activities, 67.5% were highly essential with limited variability (median=1.0; interquartile range≤2.0). Advanced-practice RDNs' tasks are patient-centered and reflect complex care; involve a comprehensive and discriminating approach; are grounded in advanced knowledge and expertise in clinical nutrition; include use of advanced interviewing, education, and counseling strategies; and require communication with patient, families, and the health care team. The high-level of consensus from experts suggest advanced-level clinical nutrition practice exists and can be defined.

  14. Pharmacists' Perceptions of the Barriers and Facilitators to the Implementation of Clinical Pharmacy Key Performance Indicators

    PubMed Central

    Minard, Laura V; Deal, Heidi; Harrison, Megan E; Toombs, Kent; Neville, Heather; Meade, Andrea

    2016-01-01

    Background In hospitals around the world, there has been no consensus regarding which clinical activities a pharmacist should focus on until recently. In 2011, a Canadian clinical pharmacy key performance indicator (cpKPI) collaborative was formed. The goal of the collaborative was to advance pharmacy practice in order to improve patient outcomes and enhance the quality of care provided to patients by hospital pharmacists. Following a literature review, which indicated that pharmacists can improve patient outcomes by carrying out specific activities, and an evidence-informed consensus process, a final set of eight cpKPIs were established. Canadian hospitals leading the cpKPI initiative are currently in the early stages of implementing these indicators. Objective To explore pharmacists' perceptions of the barriers and facilitators to the implementation of cpKPIs. Methods Clinical pharmacists employed by the Nova Scotia Health Authority were invited to participate in focus groups. Focus group discussions were audio-recorded and transcribed, and data was analyzed using thematic analysis. Findings Three focus groups, including 26 pharmacists, were conducted in February 2015. Three major themes were identified. Resisting the change was comprised of documentation challenges, increased workload, practice environment constraints, and competing priorities. Embracing cpKPIs was composed of seeing the benefit, demonstrating value, and existing supports. Navigating the unknown was made up of quality versus quantity battle, and insights into the future. Conclusions Although pharmacists were challenged by documentation and other changes associated with the implementation of cpKPIs, they demonstrated significant support for cpKPIs and were able to see benefits of the implementation. Pharmacists came up with suggestions for overcoming resistance associated with the implementation of cpKPIs and provided insights into the future of pharmacy practice. The identification of barriers

  15. Vestibular Performance During High-Acceleration Stimuli Correlates with Clinical Decline in SCA6.

    PubMed

    Huh, Young Eun; Kim, Ji-Soo; Kim, Hyo-Jung; Park, Seong-Ho; Jeon, Beom Seok; Kim, Jong-Min; Cho, Jin Whan; Zee, David S

    2015-06-01

    In spinocerebellar ataxia type 6 (SCA6), the vestibular dysfunction and its correlation with other clinical parameters require further exploration. We determined vestibular responses over a broad range of stimulus acceleration in 11 patients with SCA6 (six men, age range=33-72 years, mean age±SD=59±12 years) using bithermal caloric irrigations, rotary chair, and head impulse tests. Correlations were also pursued among disability scores, as measured using the International Cooperative Ataxia Rating Scale, disease duration, age at onset, cytosine-adenine-guanine (CAG) repeat length, and the gain of the vestibulo-ocular reflex (VOR). In response to relatively low-acceleration, low-frequency rotational and bithermal caloric stimuli, the VOR gains were normal or increased regardless of the severity of disease. On the other hand, with relatively high-acceleration, high-frequency head impulses, there was a relative increase in gain in the mildly affected patients and a decrease in gain in the more severely affected patients and gains were negatively correlated with the severity of disease (Spearman correlation, R=-0.927, p<0.001). Selective decrease of the vestibular responses during high-acceleration, high-frequency stimuli may be ascribed to degeneration of either the flocculus or vestibular nuclei. The performance of the VOR during high-acceleration, high-frequency head impulses may be a quantitative indicator of clinical decline in SCA6.

  16. Placebo mechanisms across different conditions: from the clinical setting to physical performance

    PubMed Central

    Pollo, Antonella; Carlino, Elisa; Benedetti, Fabrizio

    2011-01-01

    Although the great increase in interest in the placebo phenomenon was spurred by the clinical implications of its use, the progressive elucidation of the neurobiological and pharmacological mechanisms underlying the placebo effect also helps cast new light on the relationship between mind (and brain) and body, a topic of foremost philosophical importance but also a major medical issue in light of the complex interactions between the brain on the one hand and body functions on the other. While the concept of placebo can be a general one, with a broad definition generally applicable to many different contexts, the description of the cerebral processes called into action in specific situations can vary widely. In this paper, examples will be given where physiological or pathological conditions are altered following the administration of an inert substance or verbal instructions tailored to induce expectation of a change, and explanations will be offered with details on neurotransmitter changes and neural pathways activated. As an instance of how placebo effects can extend beyond the clinical setting, data in the physical performance domain and implications for sport competitions will also be presented and discussed. PMID:21576136

  17. A review of the clinical performance of the Aptima HPV assay.

    PubMed

    Haedicke, Juliane; Iftner, Thomas

    2016-03-01

    This comprehensive review compiles published data from 62 original articles comparing different HPV tests and one meta-analysis on the clinical performance of the Aptima HR HPV (AHPV) assay in either screening or referral populations as well as for the purpose of test of cure. A number of publications with technical issues were also considered. Besides a brief introduction in the development of E6/E7 mRNA testing, the review summarizes data on analytical sensitivies and specificities, as well as on clinical sensitivity, specificity, NPV and PPV with histological endpoints CIN2+ and CIN3+, where available. Although most studies were of cross-sectional design, five studies with a longitudinal prospective design or component were identified. In addition to the study design, sample size, age and CIN2/3+ prevalence of the respective cohort are listed. This allows direct comparison of the published data in the respective groups. One major outcome of this review is the remarkably stable similar sensitivities of AHPV and HC2 independent from study design for detection of CIN2/3+ combined with a higher specificity of the AHPV. The second outcome was the longitudinal predictive value derived from registry linkage and other prospective studies that would support the applicability of the AHPV test in primary screening with at least a three year screening interval. PMID:26614686

  18. Commitment to Change Statements Can Predict Actual Change in Practice

    ERIC Educational Resources Information Center

    Wakefield, Jacqueline; Herbert, Carol P.; Maclure, Malcolm; Dormuth, Colin; Wright, James M.; Legare, Jeanne; Brett-MacLean, Pamela; Premi, John

    2003-01-01

    Introduction: Statements of commitment to change are advocated both to promote and to assess continuing education interventions. However, most studies of commitment to change have used self-reported outcomes, and self-reports may significantly overestimate actual performance. As part of an educational randomized controlled trial, this study…

  19. The evaluation of myomectomies performed during cesarean section in our clinic

    PubMed Central

    Celal, Kadı; Hülya, Çıçek

    2011-01-01

    Background: We evaluated the data of patients who had applied myomectomy during cesarean section operation in our clinic between April, 2008 and December, 2010. Objective: I0 n this period, 3689 cesarean sections were done in our clinic, we analyzed their data retrospectively and determined 27 myomectomy cases during cesarean section operation. The age of the patients, the numbers of pregnancy, parities, the rates of abortus, indications of cesarean, pregnancy weeks, residential areas of myoms detected during the cesarean and their size, were recorded. Furthermore, pre-operative and post-operative hemoglobin (Hb) values, differences between hemoglobin values, whether there was bleeding or not, the need of blood transfusion if it occurred, the duration of operation and hospitaization and the pathological diagnoses of myomectomy materials, were examined. Materials and Methods: Retrospective study of myomectomies. Results: The mean age of patients was 29.6±5.9 (19-42) and mean gestational age was 39.2±1.0(37-42) weeks. The mean size of the fibroids was 5.94±6.29 cm3 (0.96-26.50 cm3). Subserous myoms were the most frequently seen ones (24 of 27 patients=89%) with fundal, corporal localizations in most of the instances. T0 he pre-operative and post-operative values of Hb were 11.8±1.52 (8.6-10.5) and 10.3±2.6 (6.9-13.3) g/dl respectively and the difference was statistically significant (P<0.001). Blood transfusion was not necessary in any patient. The mean duration of the operation was found to be 40.7±13.9 (13-60) minutes. Conclusion: Myomectomies can be performed safely during cesarean section by experienced obstetricians and gynecologists, and myomectomy performed for fibroids in appropriate localizations does not increase post-operative bleeding or maternal morbidity or mortality. PMID:22083246

  20. Associations between CMS's Clinical Performance Measures project benchmarks, profit structure, and mortality in dialysis units.

    PubMed

    Szczech, L A; Klassen, P S; Chua, B; Hedayati, S S; Flanigan, M; McClellan, W M; Reddan, D N; Rettig, R A; Frankenfield, D L; Owen, W F

    2006-06-01

    Prior studies observing greater mortality in for-profit dialysis units have not captured information about benchmarks of care. This study was undertaken to examine the association between profit status and mortality while achieving benchmarks. Utilizing data from the US Renal Data System and the Centers for Medicare & Medicaid Services' end-stage renal disease (ESRD) Clinical Performance Measures project, hemodialysis units were categorized as for-profit or not-for-profit. Associations with mortality at 1 year were estimated using Cox regression. Two thousand six hundred and eighty-five dialysis units (31,515 patients) were designated as for-profit and 1018 (15,085 patients) as not-for-profit. Patients in for-profit facilities were more likely to be older, black, female, diabetic, and have higher urea reduction ratio (URR), hematocrit, serum albumin, and transferrin saturation. Patients (19.4 and 18.6%) in for-profit and not-for-profit units died, respectively. In unadjusted analyses, profit status was not associated with mortality (hazard ratio (HR)=1.04, P=0.09). When added to models with profit status, the following resulted in a significant association between profit status (for-profit vs not-for-profit) and increasing mortality risk: URR, hematocrit, albumin, and ESRD Network. In adjusted models, patients in for-profit facilities had a greater death risk (HR 1.09, P=0.004). More patients in for-profit units met clinical benchmarks. Survival among patients in for-profit units was similar to not-for-profit units. This suggests that in the contemporary era, interventions in for-profit dialysis units have not impaired their ability to deliver performance benchmarks and do not affect survival. PMID:16732194

  1. Performance of SaSelect, a Chromogenic Medium for Detection of Staphylococci in Clinical Specimens

    PubMed Central

    Kerttula, Anne-Marie; Kaukoranta, Suvi-Sirkku

    2014-01-01

    In a preliminary study, known staphylococcus (n = 86) and other microbial (n = 12) isolates were plated on three chromogenic media, SaSelect (Bio-Rad, Hercules, CA, USA), CHROMagar Staph. aureus (CHROMagar Microbiology, Paris, France), and S. aureus ID (bioMérieux, Marcy l'Etoile, France). The sensitivities of all the media to detect Staphylococcus aureus after 24 h of incubation were high (100.0%). However, their specificities varied at 93.3% (95% confidence interval [CI], 86.0% to 100.0%) (CHROMagar Staph. aureus), 97.8% (95% CI, 93.5% to 100.0%) (S. aureus ID), and 100.0% (SaSelect). SaSelect also showed the highest sensitivity for recovery and differentiation of other staphylococci. As the best performing chromogenic medium, SaSelect was then prospectively compared to conventional culture and identification tests for the detection of staphylococci from 2,780 clinical specimens. A total of 1,589 staphylococcal isolates were recovered. Of these, 912 were S. aureus and 677 were other staphylococci. The sensitivity and specificity of SaSelect to detect S. aureus in clinical specimens after 24 h of incubation were 99.6% and 99.9% (95% CI, 99.2% to 100.0% and 99.8% to 100.0%), respectively, whereas the sensitivity and specificity using conventional plates combined with laboratory identification methods were 96.8% and 99.5% (95% CI, 95.7 to 97.9% and 99.2% to 99.8%). For the recovery and preliminary identification of other staphylococci, the sensitivity and specificity of SaSelect were 94.4% and 99.9%. SaSelect is a well-performing chromogenic medium that significantly improved the detection of staphylococci, especially S. aureus, compared to conventional culture (P < 0.0001). PMID:24430448

  2. Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards

    PubMed Central

    2011-01-01

    Background Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician-certified verbal autopsy (PCVA) using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 VAs. The study was also designed to analyze issues related to PCVA, such as the impact of a second physician reader on the cause of death assigned, the variation in performance with and without household recall of health care experience (HCE), and the importance of local information for physicians reading VAs. Methods The certification was performed by 24 physicians. The assignment of VA was random and blinded. Each VA was certified by one physician. Half of the VAs were reviewed by a different physician with household recall of health care experience included. The completed death certificate was processed for automated ICD-10 coding of the underlying cause of death. PCVA was compared to gold standard cause of death assignment based on strictly defined clinical diagnostic criteria that are part of the Population Health Metrics Research Consortium (PHMRC) gold standard verbal autopsy study. Results For individual cause assignment, the overall chance-corrected concordance for PCVA against the gold standard cause of death is less than 50%, with substantial variability by cause and physician. Physicians assign the correct cause around 30% of the time without HCE, and addition of HCE improves performance in adults to 45% and slightly higher in children to 48%. Physicians estimate cause-specific mortality fractions (CSMFs) with considerable error for adults, children, and neonates. Only for neonates for a cause list of six causes with HCE is accuracy above 0.7. In all three age groups, CSMF accuracy improves when household recall of health care experience is available. Conclusions Results show that physician coding for cause of death

  3. An immersive “simulation week” enhances clinical performance of incoming surgical interns improved performance persists at 6 months follow-up

    PubMed Central

    Singh, Pritam; Aggarwal, Rajesh; Pucher, Philip H.; Hashimoto, Daniel A.; Beyer-Berjot, Laura; Bharathan, Rasiah; Middleton, Katherine E.; Jones, Joanne; Darzi, Ara

    2015-01-01

    Background The transition from student to intern can be challenging. The “August” or “July effect” describes increased errors and reduced patient safety during this transition. The study objectives were to develop, pilot, and evaluate clinical performance after an immersive simulation course for incoming interns. Methods Graduating students were recruited for a 1-week immersive simulation course. Controls received no simulation training. Primary outcome (at baseline, and 1 and 6 months) was clinical performance on Objective Structured Clinical Examinations (OSCE) of clinical procedures and surgical technical skills. Secondary outcomes were self-reported confidence and clinical procedure logbook data. Results Nineteen students were recruited. Sixteen completed the 6-month follow-up, 10 in the intervention group and 6 in the control group. No differences were demonstrated between interventions and controls at baseline (OSCE [median, 66 vs 78; P = .181], technical skills [48 vs 52.5; P = .381], and confidence [101 vs 96; P = .368]). Interventions outperformed controls at 1 month (OSCE [111 vs 82; P = .001], technical skills [78.5 vs 63; P = .030], and confidence [142 vs 119; P < .001]), and 6 months (OSCE [107 vs 93; P = .007], technical skills [92.5 vs 69; P = .044], and confidence [148 vs 129; P = .022]). No differences were observed in numbers of clinical procedures performed at 1 (P = .958), 4 (P = .093), or 6 months (P = .713). Conclusion The immersive simulation course objectively improved subjects’ clinical skills, technical skills, and confidence. Despite similar clinical experience as controls, the intervention group’s improved performance persisted at 6 months follow-up. This feasible and effective intervention to ease transition from student to intern could reduce errors and enhance patient safety. PMID:25633735

  4. Technology transfer from biomedical research to clinical practice: measuring innovation performance.

    PubMed

    Balas, E Andrew; Elkin, Peter L

    2013-12-01

    Studies documented 17 years of transfer time from clinical trials to practice of care. Launched in 2002, the National Institutes of Health (NIH) translational research initiative needs to develop metrics for impact assessment. A recent White House report highlighted that research and development productivity is declining as a result of increased research spending while the new drugs output is flat. The goal of this study was to develop an expanded model of research-based innovation and performance thresholds of transfer from research to practice. Models for transfer of research to practice have been collected and reviewed. Subsequently, innovation pathways have been specified based on common characteristics. An integrated, intellectual property transfer model is described. The central but often disregarded role of research innovation disclosure is highlighted. Measures of research transfer and milestones of progress have been identified based on the Association of University Technology Managers 2012 performance reports. Numeric milestones of technology transfer are recommended at threshold (top 50%), target (top 25%), and stretch goal (top 10%) performance levels. Transfer measures and corresponding target levels include research spending to disclosure (<$1.88 million), disclosure to patents (>0.81), patents to start-up (>0.1), patents to licenses (>2.25), and average per license income (>$48,000). Several limitations of measurement are described. Academic institutions should take strategic steps to bring innovation to the center of scholarly discussions. Research on research, particularly on pathways to disclosures, is needed to improve R&D productivity. Researchers should be informed about the technology transfer performance of their institution and regulations should better support innovators.

  5. Self-Actualization, Liberalism, and Humanistic Education.

    ERIC Educational Resources Information Center

    Porter, Charles Mack

    1979-01-01

    The relationship between personality factors and political orientation has long been of interest to psychologists. This study tests the hypothesis that there is no significant relationship between self-actualization and liberalism-conservatism. The hypothesis is supported. (Author)

  6. A review of performance of near-infrared fluorescence imaging devices used in clinical studies

    PubMed Central

    Zhu, B

    2015-01-01

    Near-infrared fluorescence (NIRF) molecular imaging holds great promise as a new “point-of-care” medical imaging modality that can potentially provide the sensitivity of nuclear medicine techniques, but without the radioactivity that can otherwise place limitations of usage. Recently, NIRF imaging devices of a variety of designs have emerged in the market and in investigational clinical studies using indocyanine green (ICG) as a non-targeting NIRF contrast agent to demark the blood and lymphatic vasculatures both non-invasively and intraoperatively. Approved in the USA since 1956 for intravenous administration, ICG has been more recently used off label in intradermal or subcutaneous administrations for fluorescence imaging of the lymphatic vasculature and lymph nodes. Herein, we summarize the devices of a variety of designs, summarize their performance in lymphatic imaging in a tabular format and comment on necessary efforts to develop standards for device performance to compare and use these emerging devices in future, NIRF molecular imaging studies. PMID:25410320

  7. Initial Clinical Experience Performing Patient Treatment Verification With an Electronic Portal Imaging Device Transit Dosimeter

    SciTech Connect

    Berry, Sean L.; Polvorosa, Cynthia; Cheng, Simon; Deutsch, Israel; Chao, K. S. Clifford; Wuu, Cheng-Shie

    2014-01-01

    Purpose: To prospectively evaluate a 2-dimensional transit dosimetry algorithm's performance on a patient population and to analyze the issues that would arise in a widespread clinical adoption of transit electronic portal imaging device (EPID) dosimetry. Methods and Materials: Eleven patients were enrolled on the protocol; 9 completed and were analyzed. Pretreatment intensity modulated radiation therapy (IMRT) patient-specific quality assurance was performed using a stringent local 3%, 3-mm γ criterion to verify that the planned fluence had been appropriately transferred to and delivered by the linear accelerator. Transit dosimetric EPID images were then acquired during treatment and compared offline with predicted transit images using a global 5%, 3-mm γ criterion. Results: There were 288 transit images analyzed. The overall γ pass rate was 89.1% ± 9.8% (average ± 1 SD). For the subset of images for which the linear accelerator couch did not interfere with the measurement, the γ pass rate was 95.7% ± 2.4%. A case study is presented in which the transit dosimetry algorithm was able to identify that a lung patient's bilateral pleural effusion had resolved in the time between the planning CT scan and the treatment. Conclusions: The EPID transit dosimetry algorithm under consideration, previously described and verified in a phantom study, is feasible for use in treatment delivery verification for real patients. Two-dimensional EPID transit dosimetry can play an important role in indicating when a treatment delivery is inconsistent with the original plan.

  8. Performance of four carbon dioxide absorbents in experimental and clinical settings.

    PubMed

    Yamakage, M; Takahashi, K; Takahashi, M; Satoh, J-I; Namiki, A

    2009-03-01

    To evaluate the performance of four kinds of carbon dioxide (CO(2)) absorbents (Medisorb GE Healthcare, Amsorb Plus Armstrong Medical, YabashiLime Yabashi Industries, and Sodasorb LF Grace Performance Chemicals), we measured their dust production, acceptability of colour indicator, and CO(2) absorption capacity in in vitro experimental settings and the concentration of compound A in an inspired anaesthetic circuit during in vivo clinical practice. In vitro, the order of the dust amount was Sodasorb LF > Medisorb > Amsorb Plus = YabashiLime both before and after shaking. The order of the color acceptability was similar: Sodasorb LF > Amsorb Plus = Medisorb > YabashiLime both initially and 16 h after CO(2) exhaustion. During exposure to 200 ml.min(-1) CO(2) in vitro, the period until 1 kg of fresh soda lime allowed inspired CO(2) to increase to 0.7 kPa (as a mark of utilisation of the absorbent) was longer with Medisorb (1978 min) than with the other absorbents (1270-1375 min). In vivo, compound A (1.0% inspired sevoflurane) was detected only when using Medisorb. While Medisorb has the best ability to absorb CO(2), it alone produces compound A.

  9. Performance and specificity rates in the Test of Memory Malingering: an investigation into pediatric clinical populations.

    PubMed

    Loughan, Ashlee R; Perna, Robert

    2014-01-01

    Symptom validity tests are becoming standard as an effort measure during pediatric neuropsychological assessment. An important component of symptom validity test use is understanding limitations of these measures and how select clinical groups may have difficulty with them. Research has begun to clarify the limits of the Test of Memory Malingering (TOMM) with diverse childhood diagnoses. This study compared TOMM scores of children (N = 86) classified with common childhood disorders. Findings suggest that a substantial proportion of children performed below the recommended cutoff score of 45 on Trial 2 and attained varied specificity rates. This included children with conduct disorders (85%), affective disorders (92%), traumatic brain injury (83%), attention-deficit hyperactivity disorder (93%), learning disabilities (100%), and pervasive developmental disorder (88%). The group with the most children scoring below the cutoff was children with intellectual disabilities (76%). This finding is consistent with some of the adult research suggesting that very limited cognitive ability may compromise TOMM performance. Caution may be necessary when drawing conclusions about test-taking effort based on the recommended TOMM cutoff scores when evaluating children with disabilities. PMID:24236938

  10. The Effect of Student Self-Video of Performance on Clinical Skill Competency: A Randomised Controlled Trial

    ERIC Educational Resources Information Center

    Maloney, Stephen; Storr, Michael; Morgan, Prue; Ilic, Dragan

    2013-01-01

    Emerging technologies and student information technology literacy are enabling new methods of teaching and learning for clinical skill performance. Facilitating experiential practice and reflection on performance through student self-video, and exposure to peer benchmarks, may promote greater levels of skill competency. This study examines the…

  11. Investigation of the clinical performance of a novel solid-state diagnostic dosimeter.

    PubMed

    Tse, Jason; McLean, Donald

    2015-01-01

    This study investigated the clinical performance of a novel solid-state diagnostic dosimeter, the RaySafe Xi transparent detector, by comparing its performance to a reference-class ionization chamber. Firstly a comparison of dosimeter response "free-in-air" with standard beam qualities was made, followed by an investigation into its relative transparency in an X-ray field and angular sensitivity dependence. The second part of the study looked at the overall performance of the transparent detector under scatter conditions with a number of beam qualities, including standard beam and those hardened by copper (Cu) filtration of thickness up to 0.9 mm, as would be encountered in the equipment testing of fluoroscopy systems. Overall, the transparent detector has demonstrated equivalent measurement properties to the ionization chamber under standard conditions and provided similar X-ray attenuation as reflected by the nearly identical radiographic parameters selected for both dosimeters by the automatic dose rate control (ADRC) system. Yet, it also possessed an asymmetric angular response which respectively under- and overestimated the dose contribution from the rear and lateral directions by the same amount of 50%. The transparent detector provided comparable dose reading of ± 3% to the ionization chamber with standard beam qualities and backscatter radiation present. These results were in good agreement with those of free-in-air measurement, indicating that the angular under- and overresponse might potentially compensate one another for accurate measurement. However, for identical Cu filtered beam qualities and setups, the transparent detector on average overresponded by 5.4% across the useful tube voltage range. In conclusion, the transparent detector, with its novel design, is essentially equivalent, within a 5% tolerance, to an ionization chamber, except in situations where beams hardened with Cu filtration are used with backscatter radiation present requiring

  12. Building a medical multimedia database system to integrate clinical information: an application of high-performance computing and communications technology.

    PubMed

    Lowe, H J; Buchanan, B G; Cooper, G F; Vries, J K

    1995-01-01

    The rapid growth of diagnostic-imaging technologies over the past two decades has dramatically increased the amount of nontextual data generated in clinical medicine. The architecture of traditional, text-oriented, clinical information systems has made the integration of digitized clinical images with the patient record problematic. Systems for the classification, retrieval, and integration of clinical images are in their infancy. Recent advances in high-performance computing, imaging, and networking technology now make it technologically and economically feasible to develop an integrated, multimedia, electronic patient record. As part of The National Library of Medicine's Biomedical Applications of High-Performance Computing and Communications program, we plan to develop Image Engine, a prototype microcomputer-based system for the storage, retrieval, integration, and sharing of a wide range of clinically important digital images. Images stored in the Image Engine database will be indexed and organized using the Unified Medical Language System Metathesaurus and will be dynamically linked to data in a text-based, clinical information system. We will evaluate Image Engine by initially implementing it in three clinical domains (oncology, gastroenterology, and clinical pathology) at the University of Pittsburgh Medical Center. PMID:7703940

  13. Building a medical multimedia database system to integrate clinical information: an application of high-performance computing and communications technology.

    PubMed

    Lowe, H J; Buchanan, B G; Cooper, G F; Vries, J K

    1995-01-01

    The rapid growth of diagnostic-imaging technologies over the past two decades has dramatically increased the amount of nontextual data generated in clinical medicine. The architecture of traditional, text-oriented, clinical information systems has made the integration of digitized clinical images with the patient record problematic. Systems for the classification, retrieval, and integration of clinical images are in their infancy. Recent advances in high-performance computing, imaging, and networking technology now make it technologically and economically feasible to develop an integrated, multimedia, electronic patient record. As part of The National Library of Medicine's Biomedical Applications of High-Performance Computing and Communications program, we plan to develop Image Engine, a prototype microcomputer-based system for the storage, retrieval, integration, and sharing of a wide range of clinically important digital images. Images stored in the Image Engine database will be indexed and organized using the Unified Medical Language System Metathesaurus and will be dynamically linked to data in a text-based, clinical information system. We will evaluate Image Engine by initially implementing it in three clinical domains (oncology, gastroenterology, and clinical pathology) at the University of Pittsburgh Medical Center.

  14. Clinical performance of KeraSoft® IC in irregular corneas

    PubMed Central

    Su, Stephanie; Johns, Lynette; Rah, Marjorie J; Ryan, Robert; Barr, Joseph

    2015-01-01

    Purpose This study evaluated the clinical performance of KeraSoft® IC (KIC) soft contact lenses in subjects with irregular corneas. Patients and methods This was a 12-month, prospective, open-label, observational study, which enrolled 43 subjects who were 18 years of age or older with irregular corneas. Subjects were fit according to the KIC Fitting Manual (kerasoftic.com). After achieving best fit according to the fitting manual, lenses were assessed for comfort, vision, centration, rotation, and movement. Subjects were instructed to wear their lenses between 8 and 16 hours each day. Assessments at the exit visit included logMAR visual acuity with high and low contrast, spherocylindrical overrefraction, slit-lamp findings, adverse events, and subjective outcomes. Results The average base curve was 8.17±0.32 mm (n=70 eyes), and the average diameter dispensed was 14.53±0.12 mm (n=70 eyes). From the baseline to 12 months, there was statistically significant improvement in logMAR visual acuity with high contrast (P=0.038), but no significant difference in low-contrast visual acuity was observed (P>0.05). Slit-lamp findings were ≤ grade 1 for the majority of subjects (89%). Two nonserious adverse events were reported for two of the 84 enrolled eyes (two subjects). At 12 months, subjects reported improvements from habitual baseline for comfort and vision, both upon insertion and just before removal of lenses. Conclusion Clinical outcomes at 12 months showed good visual, safety, and subjective outcomes for subjects with corneal irregularities who wore KeraSoft® IC soft contact lenses. PMID:26543347

  15. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance.

    PubMed

    Ohte, Nobuyuki; Narita, Hitomi; Sugawara, Motoaki; Niki, Kiyomi; Okada, Takashi; Harada, Akimitsu; Hayano, Junichiro; Kimura, Genjiro

    2003-07-01

    Wave intensity (WI) is a novel hemodynamic index, which is defined as (d P/d t) x (d U/d t) at any site of the circulation, where d P/d t and d U/d t are the derivatives of blood pressure and velocity with respect to time, respectively. However, the pathophysiological meanings of this index have not been fully elucidated in the clinical setting. Accordingly, we investigated this issue in 64 patients who underwent invasive evaluation of left ventricular (LV) function. WI was obtained at the right carotid artery using a color Doppler system for blood velocity measurement combined with an echo-tracking method for detecting vessel diameter changes. The vessel diameter changes were automatically converted to pressure waveforms by calibrating its peak and minimum values by systolic and diastolic brachial blood pressures. The WI of the patients showed two sharp positive peaks. The first peak was found at the very early phase of LV ejection, while the second peak was observed near end-ejection. The magnitude of the first peak of WI significantly correlated with the maximum rate of LV pressure rise (LV max. d P/d t) (r = 0.74, P < 0.001). The amplitude of the second peak of WI significantly correlated with the time constant of LV relaxation (r = -0.77, P < 0.001). The amplitude of the second peak was significantly greater in patients with the inertia force of late systolic aortic flow than in those without the inertia force (3,080 +/- 1,741 vs 1,890 +/- 1,291 mmHg m s(-3), P < 0.01). These findings demonstrate that the magnitude of the first peak of WI reflects LV contractile performance, and the amplitude of the second peak of WI is determined by LV behavior during the period from late systole to isovolumic relaxation. WI is a noninvasively obtained, clinically useful parameter for the evaluation of LV systolic and early diastolic performance at the same time.

  16. SU-E-J-35: Clinical Performance Evaluation of a Phase II Proton CT Scanner

    SciTech Connect

    Mandapaka, A; Ghebremedhin, A; Farley, D; Giacometti, V; Vence, N; Bashkirov, V; Patyal, B; Schulte, R; Plautz, T; Zatserklyaniy, A; Johnson, R; Sadrozinski, H

    2014-06-01

    Purpose: To develop the methodology to evaluate the clinical performance of a Phase II Proton CT scanner Methods: Range errors on the order of 3%-5% constitute a major uncertainty in current charged particle treatment planning based on Hounsfield Unit (HU)-relative stopping power (RSP) calibration curves. Within our proton CT collaboration, we previously developed and built a Phase I proton CT scanner that provided a sensitive area of 9 cm (axial) × 18 cm (in-plane). This scanner served to get initial experience with this new treatment planning tool and to incorporate lessons learned into the next generation design. A Phase II scanner was recently completed and is now undergoing initial performance testing. It will increase the proton acquisition rate and provide a larger detection area of 9 cm x 36 cm. We are now designing a comprehensive evaluation program to test the image quality, imaging dose, and range uncertainty associated with this scanner. The testing will be performed along the lines of AAPM TG 66. Results: In our discussion of the evaluation protocol we identified the following priorities. The image quality of proton CT images, in particular spatial resolution and low-density contrast discrimination, will be evaluated with the Catphan600 phantom. Initial testing showed that the Catphan uniformity phantom did not provide sufficient uniformity; it was thus replaced by a cylindrical water phantom. The imaging dose will be tested with a Catphan dose module, and compared to a typical cone beam CT dose for comparable image quality. Lastly, we developed a dedicated dosimetry range phantom based on the CIRS pediatric head phantom HN715. Conclusion: A formal evaluation of proton CT as a new tool for proton treatment planning is an important task. The availability of the new Phase II proton CT scanner will allow us to perform this task. This research is supported by the National Institute of Biomedical Imaging and Bioengineering of the NIH under award number R01

  17. Clinical Neuropathology practice news 1-2014: pyrosequencing meets clinical and analytical performance criteria for routine testing of MGMT promoter methylation status in glioblastoma.

    PubMed

    Preusser, Matthias; Berghoff, Anna S; Manzl, Claudia; Filipits, Martin; Weinhäusel, Andreas; Pulverer, Walter; Dieckmann, Karin; Widhalm, Georg; Wöhrer, Adelheid; Knosp, Engelbert; Marosi, Christine; Hainfellner, Johannes A

    2014-01-01

    Testing of the MGMT promoter methylation status in glioblastoma is relevant for clinical decision making and research applications. Two recent and independent phase III therapy trials confirmed a prognostic and predictive value of the MGMT promoter methylation status in elderly glioblastoma patients. Several methods for MGMT promoter methylation testing have been proposed, but seem to be of limited test reliability. Therefore, and also due to feasibility reasons, translation of MGMT methylation testing into routine use has been protracted so far. Pyrosequencing after prior DNA bisulfite modification has emerged as a reliable, accurate, fast and easy-to-use method for MGMT promoter methylation testing in tumor tissues (including formalin fixed and paraffin-embedded samples). We performed an intra- and inter-laboratory ring trial which demonstrates a high analytical performance of this technique. Thus, pyrosequencing- based assessment of MGMT promoter methylation status in glioblastoma meets the criteria of high analytical test performance and can be recommended for clinical application, provided that strict quality control is performed. Our article summarizes clinical indications, practical instructions and open issues for MGMT promoter methylation testing in glioblastoma using pyrosequencing. PMID:24359605

  18. Clinical Neuropathology practice news 1-2014: Pyrosequencing meets clinical and analytical performance criteria for routine testing of MGMT promoter methylation status in glioblastoma

    PubMed Central

    Preusser, Matthias; Berghoff, Anna S.; Manzl, Claudia; Filipits, Martin; Weinhäusel, Andreas; Pulverer, Walter; Dieckmann, Karin; Widhalm, Georg; Wöhrer, Adelheid; Knosp, Engelbert; Marosi, Christine; Hainfellner, Johannes A.

    2014-01-01

    Testing of the MGMT promoter methylation status in glioblastoma is relevant for clinical decision making and research applications. Two recent and independent phase III therapy trials confirmed a prognostic and predictive value of the MGMT promoter methylation status in elderly glioblastoma patients. Several methods for MGMT promoter methylation testing have been proposed, but seem to be of limited test reliability. Therefore, and also due to feasibility reasons, translation of MGMT methylation testing into routine use has been protracted so far. Pyrosequencing after prior DNA bisulfite modification has emerged as a reliable, accurate, fast and easy-to-use method for MGMT promoter methylation testing in tumor tissues (including formalin-fixed and paraffin-embedded samples). We performed an intra- and inter-laboratory ring trial which demonstrates a high analytical performance of this technique. Thus, pyrosequencing-based assessment of MGMT promoter methylation status in glioblastoma meets the criteria of high analytical test performance and can be recommended for clinical application, provided that strict quality control is performed. Our article summarizes clinical indications, practical instructions and open issues for MGMT promoter methylation testing in glioblastoma using pyrosequencing. PMID:24359605

  19. Clinical Implications of Referral Bias in the Diagnostic Performance of Exercise Testing for Coronary Artery Disease

    PubMed Central

    Ladapo, Joseph A.; Blecker, Saul; Elashoff, Michael R.; Federspiel, Jerome J.; Vieira, Dorice L.; Sharma, Gaurav; Monane, Mark; Rosenberg, Steven; Phelps, Charles E.; Douglas, Pamela S.

    2013-01-01

    Background Exercise testing with echocardiography or myocardial perfusion imaging is widely used to risk‐stratify patients with suspected coronary artery disease. However, reports of diagnostic performance rarely adjust for referral bias, and this practice may adversely influence patient care. Therefore, we evaluated the potential impact of referral bias on diagnostic effectiveness and clinical decision‐making. Methods and Results Searching PubMed and EMBASE (1990–2012), 2 investigators independently evaluated eligibility and abstracted data on study characteristics and referral patterns. Diagnostic performance reported in 4 previously published meta‐analyses of exercise echocardiography and myocardial perfusion imaging was adjusted using pooled referral rates and Bayesian methods. Twenty‐one studies reported referral patterns in 49 006 patients (mean age 60.7 years, 39.6% women, and 0.8% prior history of myocardial infarction). Catheterization referral rates after normal and abnormal exercise tests were 4.0% (95% CI, 2.9% to 5.0%) and 42.5% (36.2% to 48.9%), respectively, with odds ratio for referral after an abnormal test of 14.6 (10.7 to 19.9). After adjustment for referral, exercise echocardiography sensitivity fell from 84% (80% to 89%) to 34% (27% to 41%), and specificity rose from 77% (69% to 86%) to 99% (99% to 100%). Similarly, exercise myocardial perfusion imaging sensitivity fell from 85% (81% to 88%) to 38% (31% to 44%), and specificity rose from 69% (61% to 78%) to 99% (99% to 100%). Summary receiver operating curve analysis demonstrated only modest changes in overall discriminatory power but adjusting for referral increased positive‐predictive value and reduced negative‐predictive value. Conclusions Exercise echocardiography and myocardial perfusion imaging are considerably less sensitive and more specific for coronary artery disease after adjustment for referral. Given these findings, future work should assess the comparative ability of

  20. Identification of performance indicators across a network of clinical cancer programs

    PubMed Central

    Khare, S.R.; Batist, G.; Bartlett, G.

    2016-01-01

    Background Cancer quality indicators have previously been described for a single tumour site or a single treatment modality, or according to distinct data sources. Our objective was to identify cancer quality indicators across all treatment modalities specific to breast, prostate, colorectal, and lung cancer. Methods Candidate indicators for each tumour site were extracted from the relevant literature and rated in a modified Delphi approach by multidisciplinary groups of expert clinicians from 3 clinical cancer programs. All rating rounds were conducted by e-mail, except for one that was conducted as a face-to-face expert panel meeting, thus modifying the original Delphi technique. Four high-level indicators were chosen for immediate data collection. A list of confounding variables was also constructed in a separate literature review. Results A total of 156 candidate indicators were identified for breast cancer, 68 for colorectal cancer, 40 for lung cancer, and 43 for prostate cancer. Iterative rounds of ratings led to a final list of 20 evidence- and consensus-based indicators each for colorectal and lung cancer, and 19 each for breast and prostate cancer. Approximately 30 clinicians participated in the selection of the breast, lung, and prostate indicators; approximately 50 clinicians participated in the selection of the colorectal indicators. Conclusions The modified Delphi approach that incorporates an in-person meeting of expert clinicians is an effective and efficient method for performance indicator selection and offers the added benefit of optimal clinician engagement. The finalized indicator lists for each tumour site, together with salient confounding variables, can be directly adopted (or adapted) for deployment within a performance improvement program. PMID:27122972

  1. Statistical model based iterative reconstruction (MBIR) in clinical CT systems: Experimental assessment of noise performance

    PubMed Central

    Li, Ke; Tang, Jie; Chen, Guang-Hong

    2014-01-01

    Purpose: To reduce radiation dose in CT imaging, the statistical model based iterative reconstruction (MBIR) method has been introduced for clinical use. Based on the principle of MBIR and its nonlinear nature, the noise performance of MBIR is expected to be different from that of the well-understood filtered backprojection (FBP) reconstruction method. The purpose of this work is to experimentally assess the unique noise characteristics of MBIR using a state-of-the-art clinical CT system. Methods: Three physical phantoms, including a water cylinder and two pediatric head phantoms, were scanned in axial scanning mode using a 64-slice CT scanner (Discovery CT750 HD, GE Healthcare, Waukesha, WI) at seven different mAs levels (5, 12.5, 25, 50, 100, 200, 300). At each mAs level, each phantom was repeatedly scanned 50 times to generate an image ensemble for noise analysis. Both the FBP method with a standard kernel and the MBIR method (Veo®, GE Healthcare, Waukesha, WI) were used for CT image reconstruction. Three-dimensional (3D) noise power spectrum (NPS), two-dimensional (2D) NPS, and zero-dimensional NPS (noise variance) were assessed both globally and locally. Noise magnitude, noise spatial correlation, noise spatial uniformity and their dose dependence were examined for the two reconstruction methods. Results: (1) At each dose level and at each frequency, the magnitude of the NPS of MBIR was smaller than that of FBP. (2) While the shape of the NPS of FBP was dose-independent, the shape of the NPS of MBIR was strongly dose-dependent; lower dose lead to a “redder” NPS with a lower mean frequency value. (3) The noise standard deviation (σ) of MBIR and dose were found to be related through a power law of σ ∝ (dose)−β with the component β ≈ 0.25, which violated the classical σ ∝ (dose)−0.5 power law in FBP. (4) With MBIR, noise reduction was most prominent for thin image slices. (5) MBIR lead to better noise spatial uniformity when compared

  2. Statistical model based iterative reconstruction (MBIR) in clinical CT systems: Experimental assessment of noise performance

    SciTech Connect

    Li, Ke; Tang, Jie; Chen, Guang-Hong

    2014-04-15

    Purpose: To reduce radiation dose in CT imaging, the statistical model based iterative reconstruction (MBIR) method has been introduced for clinical use. Based on the principle of MBIR and its nonlinear nature, the noise performance of MBIR is expected to be different from that of the well-understood filtered backprojection (FBP) reconstruction method. The purpose of this work is to experimentally assess the unique noise characteristics of MBIR using a state-of-the-art clinical CT system. Methods: Three physical phantoms, including a water cylinder and two pediatric head phantoms, were scanned in axial scanning mode using a 64-slice CT scanner (Discovery CT750 HD, GE Healthcare, Waukesha, WI) at seven different mAs levels (5, 12.5, 25, 50, 100, 200, 300). At each mAs level, each phantom was repeatedly scanned 50 times to generate an image ensemble for noise analysis. Both the FBP method with a standard kernel and the MBIR method (Veo{sup ®}, GE Healthcare, Waukesha, WI) were used for CT image reconstruction. Three-dimensional (3D) noise power spectrum (NPS), two-dimensional (2D) NPS, and zero-dimensional NPS (noise variance) were assessed both globally and locally. Noise magnitude, noise spatial correlation, noise spatial uniformity and their dose dependence were examined for the two reconstruction methods. Results: (1) At each dose level and at each frequency, the magnitude of the NPS of MBIR was smaller than that of FBP. (2) While the shape of the NPS of FBP was dose-independent, the shape of the NPS of MBIR was strongly dose-dependent; lower dose lead to a “redder” NPS with a lower mean frequency value. (3) The noise standard deviation (σ) of MBIR and dose were found to be related through a power law of σ ∝ (dose){sup −β} with the component β ≈ 0.25, which violated the classical σ ∝ (dose){sup −0.5} power law in FBP. (4) With MBIR, noise reduction was most prominent for thin image slices. (5) MBIR lead to better noise spatial

  3. External quality assurance performance of clinical research laboratories in sub-saharan Africa.

    PubMed

    Amukele, Timothy K; Michael, Kurt; Hanes, Mary; Miller, Robert E; Jackson, J Brooks

    2012-11-01

    Patient Safety Monitoring in International Laboratories (JHU-SMILE) is a resource at Johns Hopkins University that supports and monitors laboratories in National Institutes of Health-funded international clinical trials. To determine the impact of the JHU-SMILE quality assurance scheme in sub-Saharan African laboratories, we reviewed 40 to 60 months of external quality assurance (EQA) results of the College of American Pathologists (CAP) in these laboratories. We reviewed the performance of 8 analytes: albumin, alanine aminotransferase, creatinine, sodium, WBC, hemoglobin, hematocrit, and the human immunodeficiency virus antibody rapid test. Over the 40- to 60-month observation period, the sub-Saharan laboratories had a 1.63% failure rate, which was 40% lower than the 2011 CAP-wide rate of 2.8%. Seventy-six percent of the observed EQA failures occurred in 4 of the 21 laboratories. These results demonstrate that a system of remote monitoring, feedback, and audits can support quality in low-resource settings, even in places without strong regulatory support for laboratory quality.

  4. A study of fixed prosthodontics performed at a university clinic 18 years after insertion.

    PubMed

    Sundh, B; Odman, P

    1997-01-01

    This study obtained information on the long-term efficiency of prosthetic rehabilitation with fixed partial dentures performed by undergraduate students. From a list of discharged patients treated from 1975 to 1976 by undergraduate students at a dental school, 101 were recalled for free clinical examinations after 6, 11, and 18 years. A total of 163 fixed partial dentures were inserted. The majority (85%) of the fixed partial dentures were acrylic resin veneer-gold restorations; 15% were metal ceramic restorations. During this study period, 14 individuals died, leaving 138 fixed partial dentures to be examined. Of these, 35 (25%) were removed after a mean of 11 years in function, which left 75% in place and functioning after 18 years. The main causes for removal included caries, periodontitis, root fracture, and endodontic complications. Fewer metal ceramic restorations than acrylic resin veneer-gold restorations were removed. The removal rate for abutments with cast posts and cores was higher than the removal rate of total abutments. There was no difference in removal frequency between fixed partial dentures with moderate cantilever extensions and those with end-supported extensions.

  5. The performance of the Health of the Nation Outcome Scales as measures of clinical severity.

    PubMed

    Müller, Mario; Vandeleur, Caroline; Weniger, Godehard; Prinz, Susanne; Vetter, Stefan; Egger, Stephan T

    2016-05-30

    The aim of this study was to examine the performance of the Health of the Nation Outcome Scales (HoNOS) against other measures of functioning and mental health in a full three-year cohort of admissions to a psychiatric hospital. A sample of N=1719 patients (35.3% females, aged 17-78 years) was assessed using observer-rated measures and self-reports of psychopathology at admission. Self-reports were available from 51.7% of the sample (34.4% females, aged 17-76 years). Functioning and psychopathology were compared across five ICD-10 diagnostic groups: substance use disorders, schizophrenia and psychotic disorders, affective disorders, anxiety/somatoform disorders and personality disorders. Associations between the measures were examined, stratifying by diagnostic subgroup. The HoNOS were strongly linked to other measures primarily in psychotic disorders (except for the behavioral subscale), while those with substance use disorders showed rather poor links. Those with anxiety/somatoform disorders showed null or only small associations. This study raises questions about the overall validity of the HoNOS. It seems to entail different levels of validity when applied to different diagnostic groups. In clinical practice the HoNOS should not be used as a stand-alone instrument to assess outcome but rather as part of a more comprehensive battery including diagnosis-specific measures. PMID:27137958

  6. Clinical performance and survival of space maintainers: evaluation over a period of 5 years.

    PubMed

    Rajab, Lamis D

    2002-01-01

    The study investigated the clinical performance of 387 space maintainers fitted in 358 patients aged from 3 to 9 years in the Department of Pediatric Dentistry at the Faculty of Dentistry-University of Jordan from 1996 to 2000. Failure occurred in 119 appliances (30.7%), of which 49.6% were due to solder breakage, 32.8% from cement loss, 11% from soft tissue lesions, 4.2% from eruption interference, and 2.5% were completely lost. By using the Kaplan-Meier method, the estimated median survival time for space maintainers was 18 months. Lingual arches had the lowest median survival time of 14 months. Bands and loops, Nance appliances, and removable partial dentures had similar probability of survival. Fixed bilateral mandibular appliances recorded lower survival time than fixed bilateral maxillary appliances. Gender, age, type of dentition, fixed vs. removable, year of placement of the appliance and number of space maintainers fitted simultaneously in the same patient had no significant effect on survival of the appliances.

  7. Performance characteristics of next-generation sequencing in clinical mutation detection of colorectal cancers.

    PubMed

    Haley, Lisa; Tseng, Li-Hui; Zheng, Gang; Dudley, Jonathan; Anderson, Derek A; Azad, Nilofer S; Gocke, Christopher D; Eshleman, James R; Lin, Ming-Tseh

    2015-10-01

    Activating mutations in downstream genes of the epidermal growth factor receptor (EGFR) pathway may cause anti-EGFR resistance in patients with colorectal cancers. We present performance characteristics of a next-generation sequencing assay designed to detect such mutations. In this retrospective quality assessment study, we analyzed mutation detected in the KRAS, NRAS, BRAF, and PIK3CA genes by a clinically validated next-generation sequencing assay in 310 colorectal cancer specimens. Tumor cellularity and mutant allele frequency were analyzed to identify tumor heterogeneity and mutant allele-specific imbalance. Next-generation sequencing showed precise measurement of mutant allele frequencies and detected 23% of mutations with 2-20% mutant allele frequencies. Of the KRAS mutations detected, 17% were outside of codons 12 and 13. Among PIK3CA mutations, 48% were outside of codons 542, 545, and 1047. The percentage of tumors with predicted resistance to anti-EGFR therapy increased from 40% when testing for only mutations in KRAS exon 2 to 47% when testing for KRAS exons 2-4, 48% when testing for KRAS and NRAS exons 2-4, 58% when including BRAF codon 600 mutations, and 59% when adding PIK3CA exon 20 mutations. Right-sided colorectal cancers carried a higher risk of predicted anti-EGFR resistance. A concomitant KRAS mutation was detected in 51% of PIK3CA, 23% of NRAS, and 33% of kinase-impaired BRAF-mutated tumors. Lower than expected mutant allele frequency indicated tumor heterogeneity, while higher than expected mutant allele frequency indicated mutant allele-specific imbalance. Two paired neuroendocrine carcinomas and adjacent adenomas showed identical KRAS mutations, but only PIK3CA mutations in neuroendocrine carcinomas. Next-generation sequencing is a robust tool for mutation detection in clinical laboratories. It demonstrates high analytic sensitivity and broad reportable range, and it provides simultaneous detection of concomitant mutations and a quantitative

  8. The impact of clinical and demographic variables on cognitive performance in methamphetamine-dependent individuals in rural South Carolina.

    PubMed

    Price, Kimber L; DeSantis, Stacia M; Simpson, Annie N; Tolliver, Bryan K; McRae-Clark, Aimee L; Saladin, Michael E; Baker, Nathaniel L; Wagner, Mark T; Brady, Kathleen T

    2011-01-01

    Inconsistencies in reports on methamphetamine (METH) associated cognitive dysfunction may be attributed, at least in part, to the diversity of study sample features (eg, clinical and demographic characteristics). The current study assessed cognitive function in a METH-dependent population from rural South Carolina, and the impact of demographic and clinical characteristics on performance. Seventy-one male (28.2%) and female (71.8%) METH-dependent subjects were administered a battery of neurocognitive tests including the Test of Memory Malingering (TOMM), Shipley Institute of Living Scale, Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Grooved Pegboard Test, California Verbal Learning Test (CVLT), and Wisconsin Card Sorting Test (WCST). Demographic and clinical characteristics (eg, gender, frequency of METH use) were examined as predictors of performance. Subjects scored significantly lower than expected on one test of attention and one of fine motor function, but performed adequately on all other tests. There were no predictors of performance on attention; however, more frequent METH use was associated with better performance for males and worse for females on fine motor skills. The METH-dependent individuals in this population exhibit very limited cognitive impairment. The marked differences in education, Intellectual Quotient (IQ), and gender in our sample when compared to the published literature may contribute to these findings. Characterization of the impact of clinical and/or demographic features on cognitive deficits could be important in guiding the development of treatment interventions.

  9. Clinical Performance of a Dermal Filler Containing Natural Glycolic Acid and a Polylactic Acid Polymer

    PubMed Central

    Macchetto, Pedro Cervantes; Durán Páramo, Rosa Margarita

    2010-01-01

    : seven in two sessions, eight in three sessions, 14 in four sessions, and one in five sessions. Each treatment session was separated by approximately 20 days as per the manufacturer's instructions. The follow-up phase consisted of four observation periods over two years from the last injection. The primary efficacy endpoint was measurement of correction of human immunodeficiency virus highly active antiretroviral therapy induced facial lipoatrophy. Using a multipoint scale of facial divergence, correction was measured as a percentage of correction (diversion correction percentage) from baseline. A secondary endpoint was safety based upon the incidence and type of adverse events experienced. All 30 patients completed the active treatment phase with 100 percent (N=30) undergoing at least two treatments at Days 1 and 20 after entry into study. Seventy-four percent (n=23) underwent a third treatment at Day 60, and 50 percent (n=15) received a fourth treatment at Day 80. A single subject received a fifth treatment at Day 100. There were no serious adverse events and no adverse events noted during the study period. Histology through skin biopsy (2mm punch) was performed on 10 subjects, and all subjects had dermal skin thickness measured with ultrasound. Histology demonstrated a foreign body reaction with multinucleated giant cells with phagocytized lactate crystals. New collagen formation was demonstrated. United States measurements of dermal skin thickness increase ranged from 0.22cm to 0.37cm. All subjects were rated for expected injection events to include erythema, edema, ecchymosis, and hematoma. This dermal collagen stimulator containing glycolic acid and polylactic acid represents a tangible alternative in therapeutic and aesthetic medicine. More than four years of clinical trials have demonstrated that this dermal collagen stimulator helps to improve the exterior quality of the skin while restoring lost facial volumes. Patient satisfaction was high due to its

  10. Developing Human Resources through Actualizing Human Potential

    ERIC Educational Resources Information Center

    Clarken, Rodney H.

    2012-01-01

    The key to human resource development is in actualizing individual and collective thinking, feeling and choosing potentials related to our minds, hearts and wills respectively. These capacities and faculties must be balanced and regulated according to the standards of truth, love and justice for individual, community and institutional development,…

  11. [Actual diet of patients with gastrointestinal diseases].

    PubMed

    Loranskaia, T I; Shakhovskaia, A K; Pavliuchkova, M S

    2000-01-01

    The study of actual nutrition of patients with erosive-ulcerative lesions in the gastroduodenal zone and of patients with operated ulcer has revealed defects in intake of essential nutrients by these patients: overeating of animal fat and refined carbohydrates, deficiency of oil, vitamins A, B2, C, D and food fibers.

  12. Humanistic Education and Self-Actualization Theory.

    ERIC Educational Resources Information Center

    Farmer, Rod

    1984-01-01

    Stresses the need for theoretical justification for the development of humanistic education programs in today's schools. Explores Abraham Maslow's hierarchy of needs and theory of self-actualization. Argues that Maslow's theory may be the best available for educators concerned with educating the whole child. (JHZ)

  13. Group Counseling for Self-Actualization.

    ERIC Educational Resources Information Center

    Streich, William H.; Keeler, Douglas J.

    Self-concept, creativity, growth orientation, an integrated value system, and receptiveness to new experiences are considered to be crucial variables to the self-actualization process. A regular, year-long group counseling program was conducted with 85 randomly selected gifted secondary students in the Farmington, Connecticut Public Schools. A…

  14. Teenagers' Perceived and Actual Probabilities of Pregnancy.

    ERIC Educational Resources Information Center

    Namerow, Pearila Brickner; And Others

    1987-01-01

    Explored adolescent females' (N=425) actual and perceived probabilities of pregnancy. Subjects estimated their likelihood of becoming pregnant the last time they had intercourse, and indicated the dates of last intercourse and last menstrual period. Found that the distributions of perceived probability of pregnancy were nearly identical for both…

  15. [The role of ethical committees in drug trials performed according to "Good Clinical Practice"].

    PubMed

    Kerpel-Fronius, S

    1991-03-31

    According to the author, the prerequisites for the more active participation of Hungary in the international clinical drug research are the introduction of GCP and the limitation of the time needed for study approval to 3-4 months. The scientific and ethical aspects of the approval should be separated at each phase of drug development for securing a rapid and clear administrative approach. The first task falls into the domain of the appropriate national agency. In Hungary it is performed by experts whose activity is coordinated by the National Institute of Pharmacy (OGYI). On the other hand, it is the primary and exclusive responsibility of the Ethical Committees to supervise the safety of the trial subjects. The sponsor has to apply for the scientific-governmental approval, while trial permission from the Ethical Committee must be requested by the investigator(s). The latter contacts should be also meticulously documented according the guidelines of GCP. It is recommended that, in line with well-established international principles, all ethical problems related to drug development should be dealt with at local, hospital-based Ethical Committees. Furthermore, the continuous medical-social supervision demanded by GCP can be realised only through the conscientious work of the local committees. Any additional "official loops" will lead only to the prolongation of the trial approval and would result in a confusing bureaucratic process blurring the responsibility of the participants. For the safe functioning of the drug approval process an auditing system based on the cooperation of the Drug Regulatory Agency and the Scientific Ethical Committee of the Ministry of Public Welfare should be put in place urgently.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. FRACTIONAL CRYSTALLIZATION FLOWSHEET TESTS WITH ACTUAL TANK WASTE

    SciTech Connect

    HERTING, D.L.

    2006-10-18

    Laboratory-scale flowsheet tests of the fractional crystallization process were conducted with actual tank waste samples in a hot cell at the 222-S Laboratory. The process is designed to separate medium-curie liquid waste into a low-curie stream for feeding to supplemental treatment and a high-curie stream for double-shell tank storage. Separations criteria (for Cs-137 sulfate, and sodium) were exceeded in all three of the flowsheet tests that were performed.

  17. FRACTIONAL CRYSTALLIZATION FLOWSHEET TESTS WITH ACTUAL TANK WASTE

    SciTech Connect

    HERTING, D.L.

    2007-04-13

    Laboratory-scale flowsheet tests of the fractional crystallization process were conducted with actual tank waste samples in a hot cell at the 2224 Laboratory. The process is designed to separate medium-curie liquid waste into a low-curie stream for feeding to supplemental treatment and a high-curie stream for double-shell tank storage. Separations criteria (for Cesium-137 sulfate and sodium) were exceeded in all three of the flowsheet tests that were performed.

  18. [Similarity of monozygotic twins regarding vocal performance and acoustic markers and possible clinical significance].

    PubMed

    Fuchs, M; Oeken, J; Hotopp, T; Täschner, R; Hentschel, B; Behrendt, W

    2000-06-01

    Auditory similarities in voices of monozygotic twins have already been described in the literature. However, is there a clinical relevance? Thus, the present study was designed to identify parameters of vocal performance and acoustic features which are significantly more similar in monozygotic twins than in non-related persons. In our hypothesis, comparable prerequisites for an increased vocal load in a profession or in an artistic education of the voice could be due to these similarities. We compared intra-pair differences with data from a control group. Moreover, we examined the correlation of intra-pair differences with the age of the monozygotic twins. A greater difference in older twin pairs than in younger pairs could show the effect of an exogene influence. In addition to the few phoniatric studies in twins in the literature, we used current methods for acoustic analysis. We examined seven parameters of vocal performance and three acoustic features in 31 monozygotic twin pairs (median age 36 years, range 18-75 years) and compared them with 30 control group pairs, which consisted of non-related persons of the same age and sex, newly combined from the group of monozygotic twins ("statistical twins"). We found significant differences in seven of ten parameters (vocal range, highest and lowest vocal fundamental frequency, fundamental speaking frequency, maximum voice intensity, number of partials, vibrato of intensity; U-test by Mann-Whitney). No correlation of the differences of the identical twins with age was found in the examined parameters. The voices of identical twins are significantly more similar than those of non-related persons regarding the above mentioned features. Thus, the suitability of the voices of monozygotic twins for professions with a high demand on voice is comparable. Results of the group comparison correlate largely with the literature. The missing correlation with age could be due to the fact that the environmental effects were not

  19. Effects of LifeSkills Training on Medical Students' Performance in Dealing with Complex Clinical Cases

    ERIC Educational Resources Information Center

    Campo, Ana E.; Williams, Virginia; Williams, Redford B.; Segundo, Marisol A.; Lydston, David; Weiss, Stephen M.'

    2008-01-01

    Objective: Sound clinical judgment is the cornerstone of medical practice and begins early during medical education. The authors consider the effect of personality characteristics (hostility, anger, cynicism) on clinical judgment and whether a brief intervention can affect this process. Methods: Two sophomore medical classes (experimental,…

  20. Guidelines for clinical engineering programs--Part I: guidelines for electrical isolation; Part II: performance evaluation of clinical engineering programs.

    PubMed

    Ridgway, M

    1980-01-01

    This series presents guidelines for: electrically isolated inputs and outputs; measuring the performance of hospital biomedical engineering programs; evaluating the risk of electric shock in hospitals; and for isolated power in anesthetizing locations. In Part I, specific recommendations are given for the use of insulated approach, battery-powered monitors in surgery, and for isolation requirements for devices connected to cardiac leads. In Part II, checklists are provided for the self-evaluation of an in-house, biomedical engineering staff. Parts III and IV, in future issues of this Journal, will include discussion of the theoretical electrical hazard potential in reference to the use of isolated power systems. The question of whether isolated power should be required in all anesthetizing locations will be discussed in Part IV.

  1. Do Expert Clinical Teachers Have a Shared Understanding of What Constitutes a Competent Reasoning Performance in Case-Based Teaching?

    ERIC Educational Resources Information Center

    Gauthier, Geneviève; Lajoie, Susanne P.

    2014-01-01

    To explore the assessment challenge related to case based learning we study how experienced clinical teachers--i.e., those who regularly teach and assess case-based learning--conceptualize the notion of competent reasoning performance for specific teaching cases. Through an in-depth qualitative case study of five expert teachers, we investigate…

  2. Reproducing Actual Morphology of Planetary Lava Flows

    NASA Astrophysics Data System (ADS)

    Miyamoto, H.; Sasaki, S.

    1996-03-01

    Assuming that lava flows behave as non-isothermal laminar Bingham fluids, we developed a numerical code of lava flows. We take the self gravity effects and cooling mechanisms into account. The calculation method is a kind of cellular automata using a reduced random space method, which can eliminate the mesh shape dependence. We can calculate large scale lava flows precisely without numerical instability and reproduce morphology of actual lava flows.

  3. The Actual Apollo 13 Prime Crew

    NASA Technical Reports Server (NTRS)

    1970-01-01

    The actual Apollo 13 lunar landing mission prime crew from left to right are: Commander, James A. Lovell Jr., Command Module pilot, John L. Swigert Jr.and Lunar Module pilot, Fred W. Haise Jr. The original Command Module pilot for this mission was Thomas 'Ken' Mattingly Jr. but due to exposure to German measles he was replaced by his backup, Command Module pilot, John L. 'Jack' Swigert Jr.

  4. Observations and Performances “with distinction” by Physical Therapy Students in Clinical Education: Analysis of Checkboxes on the Physical Therapist Clinical Performance Instrument (PT-CPI) over a 4-Year Period

    PubMed Central

    Booth, Randy

    2015-01-01

    ABSTRACT Purpose: To describe how often the 24 performance criteria of the Physical Therapist Clinical Performance Instrument (PT-CPI) were not observed and how often they were rated exceptionally well for physical therapy (PT) students in relation to clinical placement descriptors. Methods: Indicators of “not observed,” performance “with distinction,” and “significant concerns” were tabulated from 1,460 clinical placements between 2008 and 2012. The rates for these indicators were evaluated with respect to catchment area, practice setting (hospital/institutional or community-based), practice area (musculoskeletal, cardiorespiratory, neurology, paediatrics, geriatrics, or variety), and level (junior to senior). Results: Of the 24 PT-CPI criteria, 15 had observation rates >95%. Of the other nine criteria, some showed significant differences in observation rates across level, practice setting, and practice area. Ratings of “with distinction” were awarded most often for criteria related to professionalism and communication and were awarded more often in community-based settings than in hospital/institutional settings. For some criteria, “with distinction” was awarded more often in paediatrics placements than in other areas. The “significant concerns” checkboxes were rarely used. Conclusions: The overall observation rates were very similar to those reported elsewhere. The findings related to performance “with distinction” and observation rates relative to setting and practice area are new contributions to physical therapy knowledge. PMID:25931650

  5. A Clinical Assessment Tool for Advanced Theory of Mind Performance in 5 to 12 Year Olds

    ERIC Educational Resources Information Center

    O'Hare, Anne E.; Bremner, Lynne; Nash, Marysia; Happe, Francesca; Pettigrew, Luisa M.

    2009-01-01

    One hundred forty typically developing 5- to 12-year-old children were assessed with a test of advanced theory of mind employing Happe's strange stories. There was no significant difference in performance between boys and girls. The stories discriminated performance across the different ages with the lowest performance being in the younger…

  6. Cognitive performance is of clinical importance, but is unrelated to pain severity in women with chronic fatigue syndrome.

    PubMed

    Ickmans, Kelly; Meeus, Mira; Kos, Daphne; Clarys, Peter; Meersdom, Geert; Lambrecht, Luc; Pattyn, Nathalie; Nijs, Jo

    2013-10-01

    In various chronic pain populations, decreased cognitive performance is known to be related to pain severity. Yet, this relationship has not been investigated in patients with chronic fatigue syndrome (CFS). This study investigated the relationship between cognitive performance and (1) pain severity, (2) level of fatigue, and (3) self-reported symptoms and health status in women with CFS. Examining the latter relationships is important for clinical practice, since people with CFS are often suspected to exaggerate their symptoms. A sample of 29 female CFS patients and 17 healthy controls aged 18 to 45 years filled out three questionnaires (Medical Outcomes Study 36-Item Short-Form Health Survey, Checklist Individual Strength (CIS), and CFS Symptom List) and performed three performance-based cognitive tests (psychomotor vigilance task, Stroop task, and operation span task), respectively. In both groups, pain severity was not associated with cognitive performance. In CFS patients, the level of fatigue measured with the CFS Symptom List, but not with the CIS, was significantly correlated with sustained attention. Self-reported mental health was negatively correlated with all investigated cognitive domains in the CFS group. These results provide evidence for the clinical importance of objectively measured cognitive problems in female CFS patients. Furthermore, a state-like measure (CFS Symptom List) appears to be superior over a trait-like measure (CIS) in representing cognitive fatigue in people with CFS. Finally, the lack of a significant relationship between cognitive performance and self-reported pain severity suggests that pain in CFS might be unique.

  7. Predicting Performance during Clinical Years from the New Medical College Admission Test.

    ERIC Educational Resources Information Center

    Caroline, Jan D.; And Others

    1983-01-01

    The results of a predictive validity study of the new Medical College Admission Test (MCAT) using criteria from the clinical years of undergraduate medical education are discussed. The criteria included course grades and faculty ratings of clerks in internal medicine, surgery, obstetrics and gynecology, pediatrics, and psychiatry. (Author/MLW)

  8. Evidence-based practice: how to perform and use systematic reviews for clinical decision-making.

    PubMed

    Kranke, Peter

    2010-09-01

    One approach to clinical decision-making requires the integration of the best available research evidence with individual clinical expertise and patient values, and is known as evidence-based medicine (EBM). In clinical decision-making with the current best evidence, systematic reviews have an important role. This review article covers the basic principles of systematic reviews and meta-analyses, and their role in the process of evidence-based decision-making. The problems associated with traditional narrative reviews are discussed, as well as the way systematic reviews limit bias associated with the assembly, critical appraisal and synthesis of studies addressing specific clinical questions. The relevant steps in writing a systematic review from the formulation of an initial research question to sensitivity analyses in conjunction with the combined analysis of the pooled data are described. Important issues that need to be considered when appraising a systematic review or meta-analysis are outlined. Some of the terms that are used in the reporting of systematic reviews and meta-analyses, such as relative risk, confidence interval, Forest plot or L'Abbé plot, will be introduced and explained. PMID:20523217

  9. The Performance of Standardized Patients in Portraying Clinical Scenarios in Speech-Language Therapy

    ERIC Educational Resources Information Center

    Hill, Anne E.; Davidson, Bronwyn J.; Theodoros, Deborah G.

    2013-01-01

    Background: Standardized patients (SPs) are frequently included in the clinical preparation of students in the health sciences. An acknowledged benefit of using SPs is the opportunity to provide a standardized method by which students can demonstrate and develop their competency. Relatively little is known, however, about the capacity of SPs to…

  10. Human Patient Simulations: Evaluation of Self-Efficacy and Anxiety in Clinical Skills Performance

    ERIC Educational Resources Information Center

    Onovo, Grace N.

    2013-01-01

    The relationship between self-efficacy (self-confidence) and anxiety levels, and the use of Human Patient Simulations (HPS) as a teaching-learning strategy, has not been sufficiently studied in the area of clinical nursing education. Despite the evidence in the literature indicating that HPS increases self-efficacy/self-confidence and decreases…

  11. Air resistance measurements on actual airplane parts

    NASA Technical Reports Server (NTRS)

    Weiselsberger, C

    1923-01-01

    For the calculation of the parasite resistance of an airplane, a knowledge of the resistance of the individual structural and accessory parts is necessary. The most reliable basis for this is given by tests with actual airplane parts at airspeeds which occur in practice. The data given here relate to the landing gear of a Siemanms-Schuckert DI airplane; the landing gear of a 'Luftfahrzeug-Gesellschaft' airplane (type Roland Dlla); landing gear of a 'Flugzeugbau Friedrichshafen' G airplane; a machine gun, and the exhaust manifold of a 269 HP engine.

  12. Explosive Percolation Transition is Actually Continuous

    NASA Astrophysics Data System (ADS)

    da Costa, R. A.; Dorogovtsev, S. N.; Goltsev, A. V.; Mendes, J. F. F.

    2010-12-01

    Recently a discontinuous percolation transition was reported in a new “explosive percolation” problem for irreversible systems [D. Achlioptas, R. M. D’Souza, and J. Spencer, Science 323, 1453 (2009)SCIEAS0036-807510.1126/science.1167782] in striking contrast to ordinary percolation. We consider a representative model which shows that the explosive percolation transition is actually a continuous, second order phase transition though with a uniquely small critical exponent of the percolation cluster size. We describe the unusual scaling properties of this transition and find its critical exponents and dimensions.

  13. Impaired Physical Performance and Clinical Responses after a Recreational Bodybuilder's Self-Administration of Steroids: A Case Report.

    PubMed

    Veras, Katherine; Silva-Junior, Fernando Lopes; Lima-Silva, Adriano Eduardo; De-Oliveira, Fernando Roberto; Pires, Flávio Oliveira

    2015-12-01

    We reported clinical and physical responses to 7 weeks of anabolic-androgenic steroid (AAS) self-administration in a male recreational bodybuilder. He was self-administrating a total of 3,250 mg of testosterone when his previous and current clinical and physical trials records were revisited. Body shape, performance, and biochemistry results were clustered into three phases labeled PRE (before the self-use), POST I (immediately at the cessation of the 7-week administration), and POST II (12 weeks after the cessation). Elevated testosterone and estradiol levels were observed in the POST I phase, while hepatic and renal functions remained altered in the POST II phase. Body mass and body fat percentages increased throughout the three phases. When adjusted according to body mass, drops in aerobic and anaerobic power and capacity (2.1% to 12.9%) were observed across the phases. This case report shows that overall performance decreased when a bodybuilding practitioner self-administered AAS.

  14. The actual citation impact of European oncological research.

    PubMed

    López-Illescas, Carmen; de Moya-Anegón, Félix; Moed, Henk F

    2008-01-01

    This study provides an overview of the research performance of major European countries in the field Oncology, the most important journals in which they published their research articles, and the most important academic institutions publishing them. The analysis was based on Thomson Scientific's Web of Science (WoS) and calculated bibliometric indicators of publication activity and actual citation impact. Studying the time period 2000-2006, it gives an update of earlier studies, but at the same time it expands their methodologies, using a broader definition of the field, calculating indicators of actual citation impact, and analysing new and policy relevant aspects. Findings suggest that the emergence of Asian countries in the field Oncology has displaced European articles more strongly than articles from the USA; that oncologists who have published their articles in important, more general journals or in journals covering other specialties, rather than in their own specialist journals, have generated a relatively high actual citation impact; and that universities from Germany, and--to a lesser extent--those from Italy, the Netherlands, UK, and Sweden, dominate a ranking of European universities based on number of articles in oncology. The outcomes illustrate that different bibliometric methodologies may lead to different outcomes, and that outcomes should be interpreted with care.

  15. Predicting academic performance and clinical competency for international dental students: seeking the most efficient and effective measures.

    PubMed

    Stacey, D Graham; Whittaker, John M

    2005-02-01

    Measures used in the selection of international dental students to a U.S. D.D.S. program were examined to identify the grouping that most effectively and efficiently predicted academic performance and clinical competency. Archival records from the International Dental Program (IDP) at Loma Linda University provided data on 171 students who had trained in countries outside the United States. The students sought admission to the D.D.S. degree program, successful completion of which qualified them to sit for U.S. licensure. As with most dental schools, competition is high for admission to the D.D.S. program. The study's goal was to identify what measures contributed to a fair and accurate selection process for dental school applicants from other nations. Multiple regression analyses identified National Board Part II and dexterity measures as significant predictors of academic performance and clinical competency. National Board Part I, TOEFL, and faculty interviews added no significant additional help in predicting eventual academic performance and clinical competency.

  16. The Effects of Sex Steroids on Spatial Performance: A Review and an Experimental Clinical Investigation.

    ERIC Educational Resources Information Center

    Liben, Lynn S.; Susman, Elizabeth J.; Finkelstein, Jordan W.; Chinchilli, Vernon M.; Kunselman, Susan; Schwab, Jacqueline; Dubas, Judith Semon; Demers, Laurence M.; Lookingbill, Georgia; D'Arcangelo, M. Rose; Krogh, Holleen R.; Kulin, Howard E.

    2002-01-01

    Investigated the relationship between sex hormones and spatial performance among adolescents treated with sex steroids for delayed puberty. Found that spatial performance varied according to gender but did not vary with levels of actively circulating sex steroids. Reviewed physiological mechanisms, developmental periods, and past empirical work…

  17. Hospital-level correlation between clinical and service quality performance for heart failure treatment.

    PubMed

    Gesell, Sabina B; Clark, Paul Alexander; Mylod, Deirdre E; Wolosin, Robert J; Drain, Maxwell; Lanser, Peter; Hall, Melvin F

    2005-01-01

    A national cross-sectional study correlates the satisfaction ratings of heart failure patients (diagnosis related group 127) and the Centers for Medicare & Medicaid Services' process-based quality measures for heart failure treatment for 32 hospitals during the first and second quarters of 2004. Two of the four measures of clinical quality showed statistically significant, moderately strong, positive correlations with a global measure of satisfaction and with, respectively, 5 and 7 subscales of the 10 subscales of satisfaction under examination (Pearson's r ranged between .40 and .67, 2-tailed; p < .05). Findings demonstrate that quality need not be a zero-sum issue, with clinical quality and service quality competing for resources and attention.

  18. The Pitfalls of Collegial Coaching: An Analysis of Collegial Coaching in Medical Education and Its Influence on Stimulating Reflection and Performance of Novice Clinical Teachers

    ERIC Educational Resources Information Center

    Truijen, Karin J. P.; van Woerkom, Marianne

    2008-01-01

    Purpose: Competent clinical teachers are essential for clinical teaching. According to the literature, coaching can contribute to improved levels of reflection and better performance of clinical teachers. By engaging in a dialogue about coachee's teaching behaviour, coaches can stimulate reflection of novice teachers. This study aims to gain…

  19. ASFNR recommendations for clinical performance of MR dynamic susceptibility contrast perfusion imaging of the brain.

    PubMed

    Welker, K; Boxerman, J; Kalnin, A; Kaufmann, T; Shiroishi, M; Wintermark, M

    2015-06-01

    MR perfusion imaging is becoming an increasingly common means of evaluating a variety of cerebral pathologies, including tumors and ischemia. In particular, there has been great interest in the use of MR perfusion imaging for both assessing brain tumor grade and for monitoring for tumor recurrence in previously treated patients. Of the various techniques devised for evaluating cerebral perfusion imaging, the dynamic susceptibility contrast method has been employed most widely among clinical MR imaging practitioners. However, when implementing DSC MR perfusion imaging in a contemporary radiology practice, a neuroradiologist is confronted with a large number of decisions. These include choices surrounding appropriate patient selection, scan-acquisition parameters, data-postprocessing methods, image interpretation, and reporting. Throughout the imaging literature, there is conflicting advice on these issues. In an effort to provide guidance to neuroradiologists struggling to implement DSC perfusion imaging in their MR imaging practice, the Clinical Practice Committee of the American Society of Functional Neuroradiology has provided the following recommendations. This guidance is based on review of the literature coupled with the practice experience of the authors. While the ASFNR acknowledges that alternate means of carrying out DSC perfusion imaging may yield clinically acceptable results, the following recommendations should provide a framework for achieving routine success in this complicated-but-rewarding aspect of neuroradiology MR imaging practice.

  20. Evaluation of Effective Factors on the Clinical Performance of General Surgeons in Tehran University of Medical Science, 2015

    PubMed Central

    Farzianpour, Fereshteh; Mohamadi, Efat; najafpour, Zhila; Yousefinezhadi, Taraneh; Forootan, Sara; Foroushani, Abbas Rahimi

    2016-01-01

    Background and Objective: Existence of doctors with high performance is one of the necessary conditions to provide high quality services. There are different motivations, which could affect their performance. Recognizing Factors which effect the performance of doctors as an effective force in health care centers is necessary. The aim of this article was evaluate the effective factors which influence on clinical performance of general surgery of Tehran University of Medical Sciences in 2015. Methods: This is a cross-sectional qualitative-quantitative study. This research conducted in 3 phases-phases I: (use of library studies and databases to collect data), phase II: localization of detected factors in first phase by using the Delphi technique and phase III: prioritizing the affecting factors on performance of doctors by using qualitative interviews. Results: 12 articles were analyzed from 300 abstracts during the evaluation process. The output of assessment identified 23 factors was sent to surgeons and their assistants for obtaining their opinions. Quantitative analysis of the findings showed that “work qualification” (86.1%) and “managers and supervisors style” (50%) have respectively the most and the least impact on the performance of doctors. Finally 18 effective factors were identified and prioritized in the performance of general surgeons. Conclusion: The results showed that motivation and performance is not a single operating parameter and it depends on several factors according to cultural background. Therefore it is necessary to design, implementation and monitoring based on key determinants of effective interventions due to cultural background. PMID:27157161

  1. The actual status of Astronomy in Moldova

    NASA Astrophysics Data System (ADS)

    Gaina, A.

    The astronomical research in the Republic of Moldova after Nicolae Donitch (Donici)(1874-1956(?)) were renewed in 1957, when a satellites observations station was open in Chisinau. Fotometric observations and rotations of first Soviet artificial satellites were investigated under a program SPIN put in action by the Academy of Sciences of former Socialist Countries. The works were conducted by Assoc. prof. Dr. V. Grigorevskij, which conducted also research in variable stars. Later, at the beginning of 60-th, an astronomical Observatory at the Chisinau State University named after Lenin (actually: the State University of Moldova), placed in Lozovo-Ciuciuleni villages was open, which were coordinated by Odessa State University (Prof. V.P. Tsesevich) and the Astrosovet of the USSR. Two main groups worked in this area: first conducted by V. Grigorevskij (till 1971) and second conducted by L.I. Shakun (till 1988), both graduated from Odessa State University. Besides this research areas another astronomical observations were made: Comets observations, astroclimate and atmospheric optics in collaboration with the Institute of the Atmospheric optics of the Siberian branch of the USSR (V. Chernobai, I. Nacu, C. Usov and A.F. Poiata). Comets observations were also made since 1988 by D. I. Gorodetskij which came to Chisinau from Alma-Ata and collaborated with Ukrainean astronomers conducted by K.I. Churyumov. Another part of space research was made at the State University of Tiraspol since the beggining of 70-th by a group of teaching staff of the Tiraspol State Pedagogical University: M.D. Polanuer, V.S. Sholokhov. No a collaboration between Moldovan astronomers and Transdniestrian ones actually exist due to War in Transdniestria in 1992. An important area of research concerned the Radiophysics of the Ionosphere, which was conducted in Beltsy at the Beltsy State Pedagogical Institute by a group of teaching staff of the University since the beginning of 70-th: N. D. Filip, E

  2. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  3. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  4. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  5. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  6. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  7. Clinical Studies of Real-Time Monitoring of Lithotripter Performance Using Passive Acoustic Sensors

    NASA Astrophysics Data System (ADS)

    Leighton, T. G.; Fedele, F.; Coleman, A. J.; McCarthy, C.; Ryves, S.; Hurrell, A. M.; De Stefano, A.; White, P. R.

    2008-09-01

    This paper describes the development and clinical testing of a passive device which monitors the passive acoustic emissions generated within the patient's body during Extracorporeal Shock Wave Lithotripsy (ESWL). Designed and clinically tested so that it can be operated by a nurse, the device analyses the echoes generated in the body in response to each ESWL shock, and so gives real time shock-by-shock feedback on whether the stone was at the focus of the lithotripter, and if so whether the previous shock contributed to stone fragmentation when that shock reached the focus. A shock is defined as being `effective' if these two conditions are satisfied. Not only can the device provide real-time feedback to the operator, but the trends in shock `effectiveness' can inform treatment. In particular, at any time during the treatment (once a statistically significant number of shocks have been delivered), the percentage of shocks which were `effective' provides a treatment score TS(t) which reflects the effectiveness of the treatment up to that point. The TS(t) figure is automatically delivered by the device without user intervention. Two clinical studies of the device were conducted, the ethics guidelines permitting only use of the value of TS(t) obtained at the end of treatment (this value is termed the treatment score TS0). The acoustically-derived treatment score was compared with the treatment score CTS2 given by the consultant urologist at the three-week patient's follow-up appointment. In the first clinical study (phase 1), records could be compared for 30 out of the 118 patients originally recruited, and the results of phase 1 were used to refine the parameter values (the `rules') with which the acoustic device provides its treatment score. These rules were tested in phase 2, for which records were compared for 49 of the 85 patients recruited. Considering just the phase 2 results (since the phase 1 data were used to draw up the `rules' under which phase 2 operated

  8. Performance of online drug information databases as clinical decision support tools in infectious disease medication management.

    PubMed

    Polen, Hyla H; Zapantis, Antonia; Clauson, Kevin A; Clauson, Kevin Alan; Jebrock, Jennifer; Paris, Mark

    2008-01-01

    Infectious disease (ID) medication management is complex and clinical decision support tools (CDSTs) can provide valuable assistance. This study evaluated scope and completeness of ID drug information found in online databases by evaluating their ability to answer 147 question/answer pairs. Scope scores produced highest rankings (%) for: Micromedex (82.3), Lexi-Comp/American Hospital Formulary Service (81.0), and Medscape Drug Reference (81.0); lowest includes: Epocrates Online Premium (47.0), Johns Hopkins ABX Guide (45.6), and PEPID PDC (40.8). PMID:18999059

  9. Long-Term Clinical Performance of Aesthetic Restorations in Primary Molars: A Case Report

    PubMed Central

    Pomarico, Luciana; Neves, Beatriz Gonçalves; Maia, Lucianne Cople; Primo, Laura Guimarães

    2011-01-01

    There is a great diversity of restorative materials and techniques for deciduous molars with significant coronal destruction, including resin composite restorations and biologic restorations (portions of natural teeth). By using 4 evaluation methods, this study aimed at longitudinally evaluating the effectiveness of restorations in the deciduous molars of a patient having high caries activity, using adhesive techniques. The evaluation methods consisted of the fibre-optic transillumination method, clinical evaluation based on the United States Public Health Service criteria, radiographs, and an indirect method, scanning electron microscopy. Despite the patient's poor biofilm control, the restorative techniques were shown to be efficacious, particularly the biologic restorative technique. PMID:22567439

  10. Performance of the DTL electrode compared to the jet contact lens electrode in clinical testing.

    PubMed

    Yin, Hang; Pardue, Machelle T

    2004-01-01

    To compare the recording characteristics of the DTL fiber and Jet contact lens electrodes, ERG responses were recorded from 20 normal subjects using the ISCEV standard clinical protocol. In each subject, the DTL electrode was placed in the right eye and the Jet contact lens in the left eye after 30 min of dark-adaptation. After presenting standard dark- and light-adapted stimuli, each response was analyzed for a- and b-wave amplitude and implicit time. Each subject was then asked to rate the comfort of each electrode. Responses recorded with the DTL are larger and faster for the dark-adapted dim white and red flashes. In contrast, the Jet electrode records larger responses for the dark-adapted standard flash and light-adapted flashes. Of these differences, only the standard flash is statistically significant. However, overall the DTL electrode has greater variability than the Jet electrode across all recordings. The DTL and Jet electrodes cannot be used interchangeably as demonstrated by a Bland and Altman analysis of agreement. Thus, separate normative values need to be collected for each type of electrode to accurately assess retinal function. Based on the comfort assessment of the two electrodes, the subjects preferred the DTL electrode over the Jet electrode. Due to the superior comfort level of the DTL and its similarities to the Jet contact lens electrode in ERG recordings, the DTL electrode appears to be a good alternative to the Jet electrode in routine clinical testing when used with the appropriate normative values.

  11. Clinical performance of a nanofilled resin composite with and without an intermediary layer of flowable composite: a 2-year evaluation.

    PubMed

    Stefanski, Sebastian; van Dijken, Jan W V

    2012-02-01

    The objective of this prospective clinical follow-up was to evaluate the 2-year clinical performance of a nanofilled resin composite in class II restorations. The restorations were made with and without intermediary layer of a nanofilled flowable resin composite studied in an intraindividual comparison. Each participant received at least two, as similar as possible, class II restorations of the nanofilled resin composite. One restoration of each pair (54) was chosen at random to be restored with an intermediary layer with flowable nanofilled resin composite. The other was restored without. The restorations were evaluated with slightly modified US Public Health Services criteria at baseline, 1, and 2 years. Ninety-two restorations, 46 pairs, were evaluated at 2 years. A prediction of the caries risk showed that 22 of the evaluated 48 patients were considered as high-risk patients. Two failures were observed, one in each group, resulting in a 2.2% failure rate. No statistical difference was seen between the restorations restored with and without layer of flowable resin composite. The nanofilled resin composite showed very good surface characteristics and color match, which did not change significantly during the follow-up period. The nanofilled resin composite showed a good clinical performance with a 2.2% failure rate after 2 years. No differences were observed between the restorations with and without the nanofilled flowable resin intermediary layer.

  12. Correlation of Clinical Neuromusculoskeletal and Central Somatosensory Performance: Variability in Controls and Patients With Severe and Mild Focal Hand Dystonia

    PubMed Central

    Byl, Nancy N.; Nagarajan, Srikantan S.; Merzenich, Michael M.; Roberts, Tim; McKenzie, Alison

    2002-01-01

    Focal hand dystonia (FHd) is a recalcitrant, disabling movement disorder, characterized by involuntary co-contractions of agonists and antagonists, that can develop in patients who overuse or misuse their hands. The aim of this study was to document clinical neuromusculoskeletal performance and somatosensory responses (magnetoencephalography) in healthy controls and in FHd subjects with mild versus severe hand dystonia. The performance of healthy subjects (n = 17) was significantly better than that of FHd subjects (n = 17) on all clinical parameters. Those with mild dystonia (n = 10) demonstrated better musculoskeletal skills, task-specific motor performance, and sensory discrimination, but the performance of sensory and fine motor tasks was slower than that of patients with severe dystonia. In terms of somatosensory evoked field responses (SEFs), FHd subjects demonstrated a significant difference in the location of the hand representation on the x and y axes, lower amplitude of SEFs integrated across latency, and a higher ratio of mean SEF amplitude to latency than the controls. Bilaterally,. those with FHd (mild and severe) lacked progressive sequencing of the digits from inferior to superior. On the affected digits, subjects with severe dystonia had a significantly higher ratio of SEF amplitude to latency and a significantly smaller mean volume of the cortical hand representation than those with mild dystonia. Severity of dystonia positively correlated with the ratio of SEF mean amplitude to latency (0.9029 affected, 0.8477 unaffected; p<0.01). The results of the present study strengthen the evidence that patients with FHd demonstrate signs of somatosensory degradation of the hand that correlates with clinical sensorimotor dysfunction, with characteristics of the dedifferentiation varying by the severity of hand dystonia. If these findings represent aberrant learning, then effective rehabilitation must incorporate the principles of neuroplasticity. Training must

  13. Effects of system tuning and RAM disk on the performance of a clinical laboratory information system.

    PubMed

    Eggert, A A; Emmerich, K A; Blankenheim, T J; Smulka, G J

    1989-01-01

    Improvements in the performance of a laboratory computer system do not necessarily require the replacement of major portions of the system and may not require the acquisition of any hardware at all. Major bottlenecks may exist in the ways that the operating system manages its resources and the algorithm used for timesharing decisions. Moreover, significant throughput improvements may be attainable by switching to a faster storage device if substantial disk activity is performed. In this study the fractions of time used for each of the types of tasks a laboratory computer system performs (e.g. applications programs, disk transfer, queue cycler) are defined and measured. Methods for reducing the time fractions of the various types of overhead are evaluated by doing before and after studies. The combined results of the three studies indicated that a 50% improvement could be gained through system tuning and faster storage without replacement of the computer itself.

  14. Using a service oriented architecture approach to clinical decision support: performance results from two CDS Consortium demonstrations.

    PubMed

    Paterno, Marilyn D; Goldberg, Howard S; Simonaitis, Linas; Dixon, Brian E; Wright, Adam; Rocha, Beatriz H; Ramelson, Harley Z; Middleton, Blackford

    2012-01-01

    The Clinical Decision Support Consortium has completed two demonstration trials involving a web service for the execution of clinical decision support (CDS) rules in one or more electronic health record (EHR) systems. The initial trial ran in a local EHR at Partners HealthCare. A second EHR site, associated with Wishard Memorial Hospital, Indianapolis, IN, was added in the second trial. Data were gathered during each 6 month period and analyzed to assess performance, reliability, and response time in the form of means and standard deviations for all technical components of the service, including assembling and preparation of input data. The mean service call time for each period was just over 2 seconds. In this paper we report on the findings and analysis to date while describing the areas for further analysis and optimization as we continue to expand our use of a Services Oriented Architecture approach for CDS across multiple institutions.

  15. Credibility of neuropsychological performances of Persian Gulf War veterans and military control subjects participating in clinical epidemiological research.

    PubMed

    Barrash, Joseph; Denburg, Natalie L; Moser, David J; Woolson, Robert F; Schumacher, Amy J; Doebbeling, Bradley N

    2007-07-01

    We investigated whether Persian Gulf War veterans (GWVs) were more likely than Persian Gulf War-era veterans deployed elsewhere (GEVs) to have noncredible neuropsychological examinations. A total of 301 GWVs and 99 GEVs underwent neuropsychological testing. The credibility of 173 examinations showing impairment was evaluated based on test performances, clinical background, psychometric measures, and other self-report data. All 11 examinations judged less than fully credible by one neuropsychologist, plus 19 examinations judged impaired but credible, were then evaluated independently by two more neuropsychologists. Noncredibility was judged with excellent reliability (93% agreement). Seven examinations were judged noncredible. Rates of noncredibility did not differ between GWVs (1%) and GEVs (4%). The pattern of associations of noncredible examinations with cognitive, psychological, and clinical variables generally indicated defective neuropsychological scores, with no coherent pattern, and personality disorder. Findings supported the validity of noncredibility judgments and suggested that noncredible examinations are not a significant problem in neuropsychological investigations of GWVs.

  16. Protocol for exercise hemodynamic assessment: performing an invasive cardiopulmonary exercise test in clinical practice

    PubMed Central

    Berry, Natalia C.; Manyoo, Agarwal; Oldham, William M.; Stephens, Thomas E.; Goldstein, Ronald H.; Waxman, Aaron B.; Tracy, Julie A.; Leary, Peter J.; Leopold, Jane A.; Kinlay, Scott; Opotowsky, Alexander R.; Systrom, David M.

    2015-01-01

    Abstract Invasive cardiopulmonary exercise testing (iCPET) combines full central hemodynamic assessment with continuous measurements of pulmonary gas exchange and ventilation to help in understanding the pathophysiology underpinning unexplained exertional intolerance. There is increasing evidence to support the use of iCPET as a key methodology for diagnosing heart failure with preserved ejection fraction and exercise-induced pulmonary hypertension as occult causes of exercise limitation, but there is little information available outlining the methodology to use this diagnostic test in clinical practice. To bridge this knowledge gap, the operational protocol for iCPET at our institution is discussed in detail. In turn, a standardized iCPET protocol may provide a common framework to describe the evolving understanding of mechanism(s) that limit exercise capacity and to facilitate research efforts to define novel treatments in these patients. PMID:26697168

  17. On shrinkage and model extrapolation in the evaluation of clinical center performance

    PubMed Central

    Varewyck, Machteld; Goetghebeur, Els; Eriksson, Marie; Vansteelandt, Stijn

    2014-01-01

    We consider statistical methods for benchmarking clinical centers based on a dichotomous outcome indicator. Borrowing ideas from the causal inference literature, we aim to reveal how the entire study population would have fared under the current care level of each center. To this end, we evaluate direct standardization based on fixed versus random center effects outcome models that incorporate patient-specific baseline covariates to adjust for differential case-mix. We explore fixed effects (FE) regression with Firth correction and normal mixed effects (ME) regression to maintain convergence in the presence of very small centers. Moreover, we study doubly robust FE regression to avoid outcome model extrapolation. Simulation studies show that shrinkage following standard ME modeling can result in substantial power loss relative to the considered alternatives, especially for small centers. Results are consistent with findings in the analysis of 30-day mortality risk following acute stroke across 90 centers in the Swedish Stroke Register. PMID:24812420

  18. Immunoassays for quantifying choriogonadotropin compared for assay performance and clinical application.

    PubMed

    Witherspoon, L R; Shuler, S E; Joseph, G F; Baird, E F; Neely, H R; Sonnemaker, R E

    1992-06-01

    We examined calibration and accuracy, precision, sensitivity, specificity, and "hook" effects for recently revised automated choriogonadotropin (hCG) immunoassay systems (Baxter-Dade Stratus II, Abbott IMx intact hCG and total beta hCG) and compared them with a widely used immunoradiometric assay (Hybritech). We estimated hCG in pregnant women, women with trophoblastic disease, nonpregnant young and menopausal women, normal men, and men with testicular tumors. We found clinically unimportant differences in calibration (all calibrated to the 3rd International Standard). Detection of hCG by all four assays was limited by their responses in serum from nonpregnant women and men. Precision within-run was best for the automated instruments, but all four assays had similar between-run precision. The Hybritech, Stratus, and IMx intact assays are specific for intact hCG. The IMx total beta assay quantifies both free beta subunit and beta subunit present in intact hCG. There is a clinically important hook effect in the Hybritech assay but not the Stratus or IMx assays (to 1.2 x 10(6) int. units/L). Results for pregnant women were similar by all four assays. We measured "hCG" to 8 int. units/L in menopausal women, which weakly correlated with concentrations of lutropin and follitropin and was, in part, explained by crossreactivity. There was no sample-probe carryover in either instrument. We found the IMx diluting module as well as results at the extremes of the IMx calibration curves (less than 10, 800-1200 int. units/L) unreliable but encountered no such problems with the Stratus system. Both automated systems involve batch analyzers with limited throughput but provide hCG concentration estimates much more quickly than the Hybritech assay can.

  19. Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

    PubMed Central

    Langenau, Erik E.; Zhang, Xiuyuan; Roberts, William L.; DeChamplain, Andre F.; Boulet, John R.

    2012-01-01

    Background High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Results Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Discussion Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first

  20. Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing.

    PubMed

    Plößl, Sebastian; Herzog, Beatrice; Glien, Alexander; Plontke, Stefan; Herzog, Michael

    2016-04-01

    There is currently no standardized ear, nose, and throat (ENT) clinical examination for patients with sleep-disordered breathing (SDB). As a result, there are large inter-individual differences in the examinations due to an inadequate estimation of the relevance of certain anatomic sites. We aimed to identify which examinations/dynamic tests are considered most relevant by German ENT physicians. A questionnaire was designed, evaluating 23 anatomic sites/dynamic tests of the upper aero-digestive tract. The questionnaire was sent to all German ENT departments (n = 153), including universities and other tertiary or secondary referral centers, by postal mail. In addition, almost all private ENT specialists registered with the German professional association (n = 2496) were contacted via e-mail. Participants assessed how often they examined the sites/dynamic tests, subjective importance, and the impact on the therapeutic procedure. A mean score of relevance (mSOR) was generated (minimum score 1; maximum score 75) from these three items. The response rate for hospitals was 58.8 %; while, it was 4.1 % for ENT specialists in private practice. Therefore, the total response rate was 7.3 %. Of the 23 assessed items, some showed a high overall relevance, such as the tonsils (mSOR 64.75), webbing (mSOR 58.14), uvula (mSOR 55.12), or tongue base (mSOR 53.99). Other examinations, such as simulated snoring (mSOR 19.34) or the Mueller maneuver (mSOR 18.98), were estimated as less relevant. Our data reflect the assessment of German otorhinolaryngologists on the clinical examination of SDB patients. The results should be considered as a basis for compiling a standardized procedure.

  1. Clinical Performance of Viscous Glass Ionomer Cement in Posterior Cavities over Two Years

    PubMed Central

    Frankenberger, Roland; Garcia-Godoy, Franklin; Krämer, Norbert

    2009-01-01

    In this controlled prospective clinical study the highly viscous glass ionomer cement Ketac Molar was clinically assessed in Class I and Class II cavities. Forty-nine subjects (mean age 32.3 years) received 108 restorations placed by six operators in conventional Black I and II type cavities with undercuts after excavating primary lesions or after removing insufficient restorations. At baseline, and after 6, 12, and 24 months, restorations were assessed by two independent investigators according to modified USPHS codes and criteria. Impressions of the restorations were taken and epoxy replicas were made. Between the baseline and the 24-month recall, 51 representative samples were analyzed at 130 × magnification by use of a stereo light microscope (SLM). Recall rates were 83% after 6 months, 50% after 12 months, and 24% after 24 months. Failure rates after 24 months were 8% for Class I and 40% for Class II fillings, mainly due to bulk fracture at occlusally loaded areas (Kaplan Meier survival analysis). Significant changes over time were found for the criteria “surface roughness”, “marginal integrity”, “restoration integrity”, and “overall judgement” (P < .05; Friedman test). SLM analysis revealed statistically significant differences for the following criteria over time (baseline/6 months/12 months (in % of entire evaluable margin length); P < .05; Friedman 2-way ANOVA): perfect margin 37/19/11, negative step formation 26/49/57, gap formation 2/7/9, and overhang 24/11/8. Replicas exhibited mainly negative step formation as main finding due to apparently inferior wear resistance (P < .05). Gap formations were more frequently observed in Class II restorations than in Class I (12% versus 3% after 12 months; P < .05, Mann-Whitney-U test). The evaluated margin lengths were not statistically different (P > .05, Friedman 2-way ANOVA). PMID:20339470

  2. Evaluation of a BED-SIDE platelet function assay: performance and clinical utility.

    PubMed

    Lau, Wei C; Walker, C Ty; Obilby, David; Wash, Mark M; Carville, David G M; Guyer, Kirk E; Bates, Eric R

    2002-01-01

    Platelets have a pivotal role in the initial defense against insult to the vasculature and are also recognized of critical importance in the acute care settings of percutaneous coronary intervention and cardiopulmonary bypass. In these environments both platelet count and function may be markedly compromised. Unfortunately, current assays to evaluate the parameters of platelet count and function are of limited utility for bed-side testing. Moreover, it is suggested that there may be significant inter patient variation in response to antiplatelet therapy that may be exacerbated by other agents (e.g. heparin) that are routinely administered during cardiac intervention. Here we describe a practical, rapid and user-friendly whole blood platelet function assay that has been developed for use in bed-side settings. Platelet agonists were formulated with an anticoagulant and lyophilized in blood collection tubes standardised to receive a l mL fresh whole blood sample. In the presence of an agonist, platelets are activated and interact (aggregate). Using traditional cell counting principles, non-aggregated platelets are counted whereas aggregated platelets are not. The percentage (%) of functional platelets in reference to a baseline tube may then be determined. Results are available within four minutes. Platelet aggregation in whole blood demonstrated good correlation with turbidometric aggregometry for both ADP (r=0.91) and collagen (r=0.88). Moreover, in clinical settings where antiplatelet agents were administered, this rapid, bed-side, platelet function assay demonstrated utility in monitoring patient response to these therapies. This novel bed-side assay of platelet function is extremely suitable for the clinical environment with a rapid turn-around time. In addition, it provides a full haematology profile, including platelet count, and should permit enhancement of transfusion and interventional decisions. PMID:17890800

  3. Clinically-relevant reperfusion in acute ischemic stroke MTT performs better than Tmax and TTP

    PubMed Central

    Kong, Linglong; Zhu, Hongtu; Vo, Katie D.; Powers, William J.; Lin, Weili; Lee, Jin-Moo

    2014-01-01

    Background While several MRI parameters are used to assess tissue perfusion during hyperacute stroke, it is unclear which is optimal for measuring clinically-relevant reperfusion. We directly compared MTT prolongation (MTTp), TTP, and time-to-maximum (Tmax) to determine which best predicted neurological improvement and tissue salvage following early reperfusion. Methods Acute ischemic stroke patients underwent three MRI's: <4.5hr (tp1), at 6hr (tp2), and at 1 month after onset. Perfusion deficits at tp1 and tp2 were defined by MTTp, TTP, or Tmax beyond four commonly-used thresholds. Percent reperfusion (%Reperf) was calculated for each parameter and threshold. Regression analysis was used to fit %Reperf for each parameter and threshold as a predictor of neurological improvement [defined as admission National Institutes of Health Stroke Scale (NIHSS) – 1 month NIHSS (ΔNIHSS)] after adjusting for baseline clinical variables. Volume of reperfusion, for each parameter and threshold, was correlated with tissue salvage, defined as tp1 perfusion deficit volume – final infarct volume. Results 50 patients were scanned at 2.7 hours and 6.2 hours after stroke onset. %Reperf predicted ΔNIHSS for all MTTp thresholds, for Tmax > 6s and > 8s, but for no TTP thresholds. Tissue salvage significantly correlated with reperfusion for all MTTp thresholds and with Tmax > 6s, while there was no correlation with any TTP threshold. Among all parameters, reperfusion defined by MTTp was most strongly associated with ΔNIHSS (MTTp>3s, p=0.0002) and tissue salvage (MTTp> 3s and 4s, P<0.0001). Conclusion MTT-defined reperfusion was the best predictor of neurological improvement and tissue salvage in hyperacute ischemic stroke. PMID:24500786

  4. Clinical Performance of Viscous Glass Ionomer Cement in Posterior Cavities over Two Years.

    PubMed

    Frankenberger, Roland; Garcia-Godoy, Franklin; Krämer, Norbert

    2009-01-01

    In this controlled prospective clinical study the highly viscous glass ionomer cement Ketac Molar was clinically assessed in Class I and Class II cavities. Forty-nine subjects (mean age 32.3 years) received 108 restorations placed by six operators in conventional Black I and II type cavities with undercuts after excavating primary lesions or after removing insufficient restorations. At baseline, and after 6, 12, and 24 months, restorations were assessed by two independent investigators according to modified USPHS codes and criteria. Impressions of the restorations were taken and epoxy replicas were made. Between the baseline and the 24-month recall, 51 representative samples were analyzed at 130 x magnification by use of a stereo light microscope (SLM). Recall rates were 83% after 6 months, 50% after 12 months, and 24% after 24 months. Failure rates after 24 months were 8% for Class I and 40% for Class II fillings, mainly due to bulk fracture at occlusally loaded areas (Kaplan Meier survival analysis). Significant changes over time were found for the criteria "surface roughness", "marginal integrity", "restoration integrity", and "overall judgement" (P < .05; Friedman test). SLM analysis revealed statistically significant differences for the following criteria over time (baseline/6 months/12 months (in % of entire evaluable margin length); P < .05; Friedman 2-way ANOVA): perfect margin 37/19/11, negative step formation 26/49/57, gap formation 2/7/9, and overhang 24/11/8. Replicas exhibited mainly negative step formation as main finding due to apparently inferior wear resistance (P < .05). Gap formations were more frequently observed in Class II restorations than in Class I (12% versus 3% after 12 months; P < .05, Mann-Whitney-U test). The evaluated margin lengths were not statistically different (P > .05, Friedman 2-way ANOVA).

  5. Classifying Schizophrenia Using Multimodal Multivariate Pattern Recognition Analysis: Evaluating the Impact of Individual Clinical Profiles on the Neurodiagnostic Performance.

    PubMed

    Cabral, Carlos; Kambeitz-Ilankovic, Lana; Kambeitz, Joseph; Calhoun, Vince D; Dwyer, Dominic B; von Saldern, Sebastian; Urquijo, Maria F; Falkai, Peter; Koutsouleris, Nikolaos

    2016-07-01

    Previous studies have shown that structural brain changes are among the best-studied candidate markers for schizophrenia (SZ) along with functional connectivity (FC) alterations of resting-state (RS) patterns. This study aimed to investigate effects of clinical and sociodemographic variables on the classification by applying multivariate pattern analysis (MVPA) to both gray matter (GM) volume and FC measures in patients with SZ and healthy controls (HC). RS and structural magnetic resonance imaging data (sMRI) from 74 HC and 71 SZ patients were obtained from a Mind Research Network COBRE dataset available via COINS (http://coins.mrn.org/dx). We used a MVPA framework using support-vector machines embedded in a repeated, nested cross-validation to generate a multi-modal diagnostic system and evaluate its generalizability. The dependence of neurodiagnostic performance on clinical and sociodemographic variables was evaluated. The RS classifier showed a slightly higher accuracy (70.5%) compared to the structural classifier (69.7%). The combination of sMRI and RS outperformed single MRI modalities classification by reaching 75% accuracy. The RS based moderator analysis revealed that the neurodiagnostic performance was driven by older SZ patients with an earlier illness onset and more pronounced negative symptoms. In contrast, there was no linear relationship between the clinical variables and neuroanatomically derived group membership measures. This study achieved higher accuracy distinguishing HC from SZ patients by fusing 2 imaging modalities. In addition the results of RS based moderator analysis showed that age of patients, as well as their age at the illness onset were the most important clinical features. PMID:27460614

  6. Formative evaluation of a telemedicine model for delivering clinical neurophysiology services part I: Utility, technical performance and service provider perspective

    PubMed Central

    2010-01-01

    Background Formative evaluation is conducted in the early stages of system implementation to assess how it works in practice and to identify opportunities for improving technical and process performance. A formative evaluation of a teleneurophysiology service was conducted to examine its technical and sociological dimensions. Methods A teleneurophysiology service providing routine EEG investigation was established. Service use, technical performance and satisfaction of clinical neurophysiology personnel were assessed qualitatively and quantitatively. These were contrasted with a previously reported analysis of the need for teleneurophysiology, and examination of expectation and satisfaction with clinical neurophysiology services in Ireland. A preliminary cost-benefit analysis was also conducted. Results Over the course of 40 clinical sessions during 20 weeks, 142 EEG investigations were recorded and stored on a file server at a satellite centre which was 130 miles away from the host clinical neurophysiology department. Using a virtual private network, the EEGs were accessed by a consultant neurophysiologist at the host centre for interpretation. The model resulted in a 5-fold increase in access to EEG services as well as reducing average waiting times for investigation by a half. Technically the model worked well, although a temporary loss of virtual private network connectivity highlighted the need for clarity in terms of responsibility for troubleshooting and repair of equipment problems. Referral quality, communication between host and satellite centres, quality of EEG recordings, and ease of EEG review and reporting indicated that appropriate organisational processes were adopted by the service. Compared to traditional CN service delivery, the teleneurophysiology model resulted in a comparable unit cost per EEG. Conclusion Observations suggest that when traditional organisational boundaries are crossed challenges associated with the social dimension of service

  7. Classifying Schizophrenia Using Multimodal Multivariate Pattern Recognition Analysis: Evaluating the Impact of Individual Clinical Profiles on the Neurodiagnostic Performance.

    PubMed

    Cabral, Carlos; Kambeitz-Ilankovic, Lana; Kambeitz, Joseph; Calhoun, Vince D; Dwyer, Dominic B; von Saldern, Sebastian; Urquijo, Maria F; Falkai, Peter; Koutsouleris, Nikolaos

    2016-07-01

    Previous studies have shown that structural brain changes are among the best-studied candidate markers for schizophrenia (SZ) along with functional connectivity (FC) alterations of resting-state (RS) patterns. This study aimed to investigate effects of clinical and sociodemographic variables on the classification by applying multivariate pattern analysis (MVPA) to both gray matter (GM) volume and FC measures in patients with SZ and healthy controls (HC). RS and structural magnetic resonance imaging data (sMRI) from 74 HC and 71 SZ patients were obtained from a Mind Research Network COBRE dataset available via COINS (http://coins.mrn.org/dx). We used a MVPA framework using support-vector machines embedded in a repeated, nested cross-validation to generate a multi-modal diagnostic system and evaluate its generalizability. The dependence of neurodiagnostic performance on clinical and sociodemographic variables was evaluated. The RS classifier showed a slightly higher accuracy (70.5%) compared to the structural classifier (69.7%). The combination of sMRI and RS outperformed single MRI modalities classification by reaching 75% accuracy. The RS based moderator analysis revealed that the neurodiagnostic performance was driven by older SZ patients with an earlier illness onset and more pronounced negative symptoms. In contrast, there was no linear relationship between the clinical variables and neuroanatomically derived group membership measures. This study achieved higher accuracy distinguishing HC from SZ patients by fusing 2 imaging modalities. In addition the results of RS based moderator analysis showed that age of patients, as well as their age at the illness onset were the most important clinical features.

  8. Caustic-Side Solvent Extraction: Prediction of Cesium Extraction for Actual Wastes and Actual Waste Simulants

    SciTech Connect

    Delmau, L.H.; Haverlock, T.J.; Sloop, F.V., Jr.; Moyer, B.A.

    2003-02-01

    This report presents the work that followed the CSSX model development completed in FY2002. The developed cesium and potassium extraction model was based on extraction data obtained from simple aqueous media. It was tested to ensure the validity of the prediction for the cesium extraction from actual waste. Compositions of the actual tank waste were obtained from the Savannah River Site personnel and were used to prepare defined simulants and to predict cesium distribution ratios using the model. It was therefore possible to compare the cesium distribution ratios obtained from the actual waste, the simulant, and the predicted values. It was determined that the predicted values agree with the measured values for the simulants. Predicted values also agreed, with three exceptions, with measured values for the tank wastes. Discrepancies were attributed in part to the uncertainty in the cation/anion balance in the actual waste composition, but likely more so to the uncertainty in the potassium concentration in the waste, given the demonstrated large competing effect of this metal on cesium extraction. It was demonstrated that the upper limit for the potassium concentration in the feed ought to not exceed 0.05 M in order to maintain suitable cesium distribution ratios.

  9. Methylphenidate improves reading performance in children with attention deficit hyperactivity disorder and comorbid dyslexia: an unblinded clinical trial.

    PubMed

    Keulers, Esther H H; Hendriksen, Jos G M; Feron, Frans J M; Wassenberg, Renske; Wuisman-Frerker, Mea G F; Jolles, Jelle; Vles, Johan S H

    2007-01-01

    Attention Deficit Hyperactivity Disorder (ADHD) and dyslexia are frequently co-occurring disorders. Although methylphenidate (MPH) is the primary treatment for ADHD, the effect on reading in children with these comorbid problems is not yet known. This study was an unblinded clinical trial to evaluate the reading performance before and after treatment with MPH. Reading performance was compared with General Linear Model repeated measures between three groups: (1) an experimental group of children with both ADHD and dyslexia (N = 24), (2) a control group of children with ADHD (N = 9) and (3) a control group of children with dyslexia (N = 10). MPH improved reading performance significantly stronger in the experimental group than in the control groups; the number of correctly read words increased to a larger extent. In conclusion, MPH proved to be an aid in the reading process of children with ADHD and comorbid dyslexia by improving the learning conditions, but MPH cannot cure the reading disorder. Future research should study the effect of MPH on reading in a double-blind clinical trial. PMID:17169593

  10. Patient punctuality and clinic performance: observations from an academic-based private practice pain centre: a prospective quality improvement study

    PubMed Central

    Williams, Kayode A; Chambers, Chester G; Dada, Maqbool; McLeod, Julia C; Ulatowski, John A

    2014-01-01

    Objectives The aim of this study was to examine the effects of an intervention to alter patient unpunctuality. The major hypothesis was that the intervention will change the distribution of patient unpunctuality by decreasing patient tardiness and increasing patient earliness. Design Prospective Quality Improvement. Setting Specialty Pain Clinic in suburban Baltimore, Maryland, USA. Participants The patient population ranged in age from 18 to 93 years. All patients presenting to the clinic during the study period were included in the study. The average monthly volume was 86.2 (SD=13) patients. A total of 1500 patient visits were included in this study. Interventions We tracked appointment times and patient arrival times at an ambulatory pain clinic. An intervention was made in which patients were informed that tardy patients would not be seen and would be rescheduled. This policy was enforced over a 12-month period. Primary and secondary outcome measures The distribution of patient unpunctuality was developed preintervention and at 12 months after implementation. Distribution parameters were used as inputs to a discrete event simulation to determine effects of the change in patient unpunctuality on clinic delay. Results Data regarding patient unpunctuality were gathered by direct observation before and after implementation of the intervention. The mean unpunctuality changed from −20.5 min (110 observations, SD=1.7) preintervention to −23.2 (169, 1.2) at 1 month after the intervention, −23.8 min (69, 1.8) at 6 months and −25.0 min (71, 1.2) after 1 year. The unpunctuality 12 months after initiation of the intervention was significantly different from that prior to the intervention (p<0.05). Conclusions Physicians and staff are able to alter patient arrival patterns to reduce patient unpunctuality. Reducing tardiness improves some measures of clinic performance, but may not always improve waiting times. Accommodating early arriving patients

  11. Clinical Performance of Aspergillus PCR for Testing Serum and Plasma: a Study by the European Aspergillus PCR Initiative.

    PubMed

    White, P Lewis; Barnes, Rosemary A; Springer, Jan; Klingspor, Lena; Cuenca-Estrella, Manuel; Morton, C Oliver; Lagrou, Katrien; Bretagne, Stéphane; Melchers, Willem J G; Mengoli, Carlo; Donnelly, J Peter; Heinz, Werner J; Loeffler, Juergen

    2015-09-01

    Aspergillus PCR testing of serum provides technical simplicity but with potentially reduced sensitivity compared to whole-blood testing. With diseases for which screening to exclude disease represents an optimal strategy, sensitivity is paramount. The associated analytical study confirmed that DNA concentrations were greater in plasma than those in serum. The aim of the current investigation was to confirm analytical findings by comparing the performance of Aspergillus PCR testing of plasma and serum in the clinical setting. Standardized Aspergillus PCR was performed on plasma and serum samples concurrently obtained from hematology patients in a multicenter retrospective anonymous case-control study, with cases diagnosed according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) consensus definitions (19 proven/probable cases and 42 controls). Clinical performance and clinical utility (time to positivity) were calculated for both kinds of samples. The sensitivity and specificity for Aspergillus PCR when testing serum were 68.4% and 76.2%, respectively, and for plasma, they were 94.7% and 83.3%, respectively. Eighty-five percent of serum and plasma PCR results were concordant. On average, plasma PCR was positive 16.8 days before diagnosis and was the earliest indicator of infection in 13 cases, combined with other biomarkers in five cases. On average, serum PCR was positive 10.8 days before diagnosis and was the earliest indicator of infection in six cases, combined with other biomarkers in three cases. These results confirm the analytical finding that the sensitivity of Aspergillus PCR using plasma is superior to that using serum. PCR positivity occurs earlier when testing plasma and provides sufficient sensitivity for the screening of invasive aspergillosis while maintaining methodological simplicity.

  12. Addition of meloxicam to the treatment of clinical mastitis improves subsequent reproductive performance.

    PubMed

    McDougall, S; Abbeloos, E; Piepers, S; Rao, A S; Astiz, S; van Werven, T; Statham, J; Pérez-Villalobos, N

    2016-03-01

    A blinded, negative controlled, randomized intervention study was undertaken to test the hypothesis that addition of meloxicam, a nonsteroidal anti-inflammatory drug, to antimicrobial treatment of mild to moderate clinical mastitis would improve fertility and reduce the risk of removal from the herd. Cows (n=509) from 61 herds in 8 regions (sites) in 6 European countries were enrolled. Following herd-owner diagnosis of mild to moderate clinical mastitis within the first 120 d of lactation in a single gland, the rectal temperature, milk appearance, and California Mastitis Test score were assessed. Cows were randomly assigned within each site to be treated either with meloxicam or a placebo (control). All cows were additionally treated with 1 to 4 intramammary infusions of cephalexin and kanamycin at 24-h intervals. Prior to treatment and at 14 and 21 d posttreatment, milk samples were collected for bacteriology and somatic cell count. Cows were bred by artificial insemination and pregnancy status was subsequently defined. General estimating equations were used to determine the effect of treatment (meloxicam versus control) on bacteriological cure, somatic cell count, the probability of being inseminated by 21 d after the voluntary waiting period, the probability of conception to first artificial insemination, the number of artificial insemination/conception, the probability of pregnancy by 120 or 200 d postcalving, and the risk of removal by 300 d after treatment. Cox's proportional hazards models were used to test the effect of treatment on the calving to first insemination and calving to conception intervals. Groups did not differ in terms of age, clot score, California Mastitis Test score, rectal temperature, number of antimicrobial treatments given or bacteria present at the time of enrollment, but cows treated with meloxicam had greater days in milk at enrollment. Cows treated with meloxicam had a higher bacteriological cure proportion than those treated with

  13. Addition of meloxicam to the treatment of clinical mastitis improves subsequent reproductive performance.

    PubMed

    McDougall, S; Abbeloos, E; Piepers, S; Rao, A S; Astiz, S; van Werven, T; Statham, J; Pérez-Villalobos, N

    2016-03-01

    A blinded, negative controlled, randomized intervention study was undertaken to test the hypothesis that addition of meloxicam, a nonsteroidal anti-inflammatory drug, to antimicrobial treatment of mild to moderate clinical mastitis would improve fertility and reduce the risk of removal from the herd. Cows (n=509) from 61 herds in 8 regions (sites) in 6 European countries were enrolled. Following herd-owner diagnosis of mild to moderate clinical mastitis within the first 120 d of lactation in a single gland, the rectal temperature, milk appearance, and California Mastitis Test score were assessed. Cows were randomly assigned within each site to be treated either with meloxicam or a placebo (control). All cows were additionally treated with 1 to 4 intramammary infusions of cephalexin and kanamycin at 24-h intervals. Prior to treatment and at 14 and 21 d posttreatment, milk samples were collected for bacteriology and somatic cell count. Cows were bred by artificial insemination and pregnancy status was subsequently defined. General estimating equations were used to determine the effect of treatment (meloxicam versus control) on bacteriological cure, somatic cell count, the probability of being inseminated by 21 d after the voluntary waiting period, the probability of conception to first artificial insemination, the number of artificial insemination/conception, the probability of pregnancy by 120 or 200 d postcalving, and the risk of removal by 300 d after treatment. Cox's proportional hazards models were used to test the effect of treatment on the calving to first insemination and calving to conception intervals. Groups did not differ in terms of age, clot score, California Mastitis Test score, rectal temperature, number of antimicrobial treatments given or bacteria present at the time of enrollment, but cows treated with meloxicam had greater days in milk at enrollment. Cows treated with meloxicam had a higher bacteriological cure proportion than those treated with

  14. Assessing Scientific Practices Using Machine-Learning Methods: How Closely Do They Match Clinical Interview Performance?

    NASA Astrophysics Data System (ADS)

    Beggrow, Elizabeth P.; Ha, Minsu; Nehm, Ross H.; Pearl, Dennis; Boone, William J.

    2013-07-01

    The landscape of science education is being transformed by the new Framework for Science Education (National Research Council, A framework for K-12 science education: practices, crosscutting concepts, and core ideas. The National Academies Press, Washington, DC, 2012), which emphasizes the centrality of scientific practices—such as explanation, argumentation, and communication—in science teaching, learning, and assessment. A major challenge facing the field of science education is developing assessment tools that are capable of validly and efficiently evaluating these practices. Our study examined the efficacy of a free, open-source machine-learning tool for evaluating the quality of students' written explanations of the causes of evolutionary change relative to three other approaches: (1) human-scored written explanations, (2) a multiple-choice test, and (3) clinical oral interviews. A large sample of undergraduates (n = 104) exposed to varying amounts of evolution content completed all three assessments: a clinical oral interview, a written open-response assessment, and a multiple-choice test. Rasch analysis was used to compute linear person measures and linear item measures on a single logit scale. We found that the multiple-choice test displayed poor person and item fit (mean square outfit >1.3), while both oral interview measures and computer-generated written response measures exhibited acceptable fit (average mean square outfit for interview: person 0.97, item 0.97; computer: person 1.03, item 1.06). Multiple-choice test measures were more weakly associated with interview measures (r = 0.35) than the computer-scored explanation measures (r = 0.63). Overall, Rasch analysis indicated that computer-scored written explanation measures (1) have the strongest correspondence to oral interview measures; (2) are capable of capturing students' normative scientific and naive ideas as accurately as human-scored explanations, and (3) more validly detect understanding

  15. Food-borne botulism: still actual topic.

    PubMed

    Brola, Waldemar; Fudala, Malgorzata; Gacek, Szymon; Gruenpeter, Pawel

    2013-02-06

    Even though since the mid-1990s the number of food-borne botulism cases has systematically decreased and it now occurs in Poland relatively rarely, it is still a real epidemiological problem. There are about 30 cases of botulism in Poland a year, which ranks Poland the first among the European Union. In most cases the symptomatology of botulism is typical, however it does not always fully coincide with the one described in medical manuals which emphasise the dramatic clinical course of botulism with its frequent fatal consequences. Diagnosis of botulism may be difficult because of its rare prevalence and a variable clinical course, especially in old patients. Authors of this paper describe two cases of botulism and diagnostic problems associated with it.

  16. Performance of chromogenic media for Candida in rapid presumptive identification of Candida species from clinical materials

    PubMed Central

    Pravin Charles, M. V.; Kali, Arunava; Joseph, Noyal Mariya

    2015-01-01

    Background: In perspective of the worldwide increase in a number of immunocompromised patients, the need for identification of Candida species has become a major concern. The development of chromogenic differential media, introduced recently, facilitate rapid speciation. However, it can be employed for routine mycology workup only after an exhaustive evaluation of its benefit and cost effectiveness. This study was undertaken to evaluate the benefit and cost effectiveness of chromogenic media for speciation of Candida clinical isolates. Materials and Methods: Sputum samples of 382 patients were screened for the presence of Candida spp. by Gram stain and culture on sabouraud dextrose agar. Candida species were identified using Gram stain morphology, germ tube formation, cornmeal agar with Tween-80, sugar fermentation tests and morphology on HiCrome Candida differential agar. All the Candida isolates were inoculated on HiCrome Candida agar (HiMedia, Mumbai, India). Results: The sensitivity and specificity of HiCrome agar for identification of Candida albicans were 90% and 96.42%, respectively whereas sensitivity and specificity of carbohydrate fermentation test were 86.67% and 74.07%, respectively. Sensitivity and specificity values of HiCrome agar for detection of C. albicans, Candida parapsilosis and Candida glabrata were above 90%. Conclusions: We found HiCrome agar has high sensitivity and specificity comparable to that of the conventional method. In addition, use of this differential media could significantly cut down the turnaround time as well as cost of sample processing. PMID:26109791

  17. Clinical Dementia Rating Performed Several Years prior to Death Predicts Regional Alzheimer’s Neuropathology

    PubMed Central

    Beeri, Michal Schnaider; Silverman, Jeremy M.; Schmeidler, James; Wysocki, Michael; Grossman, Hillel Z.; Purohit, Dushyant P.; Perl, Daniel P.; Haroutunian, Vahram

    2011-01-01

    Aims To assess the relationships between early and late antemortem measures of dementia severity and Alzheimer disease (AD) neuropathology severity. Methods 40 residents of a nursing home, average age at death 82.0, participated in this longitudinal cohort study with postmortem assessment. Severity of dementia was measured by Clinical Dementia Rating (CDR) at two time points, averaging 4.5 and 1.0 years before death. Densities of postmortem neuritic plaques (NPs) and neurofibrillary tangles (NFTs) were measured in the cerebral cortex, hippocampus, and entorhinal cortex. Results For most brain areas, both early and late CDRs were significantly associated with NPs and NFTs. CDRs assessed proximal to death predicted NFTs beyond the contribution of early CDRs. NPs were predicted by both early and late CDRs. NPs were predictive of both early and late CDRs after controlling for NFTs. NFTs were only associated significantly with late CDR in the cerebral cortex after controlling for NPs. Conclusions Even if assessed several years before death, dementia severity is associated with AD neuropathology. NPs are more strongly associated with dementia severity than NFTs. NFTs consistently associate better with late than early CDR, suggesting that these neuropathological changes may occur relatively later in the course of the disease. PMID:18367838

  18. Resident dashboards: helping your clinical competency committee visualize trainees’ key performance indicators

    PubMed Central

    Friedman, Karen A.; Raimo, John; Spielmann, Kelly; Chaudhry, Saima

    2016-01-01

    Introduction Under the Next Accreditation System, programs need to find ways to collect and assess meaningful reportable information on its residents to assist the program director regarding resident milestone progression. This paper discusses the process that one large Internal Medicine Residency Program used to provide both quantitative and qualitative data to its clinical competency committee (CCC) through the creation of a resident dashboard. Methods Program leadership at a large university-based program developed four new end of rotation evaluations based on the American Board of Internal Medicine (ABIM) and Accreditation Council of Graduated Medical Education's (ACGME) 22 reportable milestones. A resident dashboard was then created to pull together both milestone- and non-milestone-based quantitative data and qualitative data compiled from faculty, nurses, peers, staff, and patients. Results Dashboards were distributed to the members of the CCC in preparation for the semiannual CCC meeting. CCC members adjudicated quantitative and qualitative data to present their cohort of residents at the CCC meeting. Based on the committee's response, evaluation scores remained the same or were adjusted. Final milestone scores were then entered into the accreditation data system (ADS) on the ACGME website. Conclusions The process of resident assessment is complex and should comprise both quantitative and qualitative data. The dashboard is a valuable tool for program leadership to use both when evaluating house staff on a semiannual basis at the CCC and to the resident in person. PMID:27037226

  19. The effect of surface tension reduction on the clinical performance of sodium hypochlorite in endodontics.

    PubMed

    Rossi-Fedele, G; Prichard, J W; Steier, L; de Figueiredo, J A P

    2013-06-01

    Sodium hypochlorite (NaOCl) is recommended as an endodontic irrigant in view of its broad antimicrobial and tissue dissolution capacities. To enhance its penetration into inaccessible areas of root canals and to improve its overall effect, the addition of surface-active agents has been suggested. The aim of this investigation was to review the effect of the reduction of the surface tension on the performance of NaOCl in endodontics. A search was performed in the Medline electronic database (articles published up to 28 July 2012, in English) with the search terms and combinations as follows: 'sodium hypochlorite AND surface tension or interfacial force or interfacial tension or surface-active agent or amphiphilic agent or surface active agent or surfactant or tenside or detergent'. The purpose of this search was to identify publications that compared NaOCl alone and NaOCl modified with the addition of a surface-active agent in endodontics. A hand search of articles published online ('in-press' and 'early view'), and appearing in the reference list of the articles included, was further performed, using the same search criteria as the electronic search. The search identified 302 publications, of which 11 fulfilled the inclusion/exclusion criteria of the review. The evidence available suggests that surface-active agents improve the penetration of NaOCl in the main canal and have no effect on its pulp tissue dissolution ability. There are, however, insufficient data to enable a sound conclusion to be drawn regarding the effect of modifying NaOCl's surface tension on lubrication, antimicrobial and smear layer or debris removal abilities.

  20. Total lumbar disc replacement in athletes: clinical results, return to sport and athletic performance

    PubMed Central

    Wiechert, Karsten; Khattab, Mohamed F.; Korge, Andreas; Mayer, H. Michael

    2007-01-01

    Despite the increasing popularity of total lumbar disc replacement (TDR) in predominantly young and active patients, no previous study has addressed possibilities, limitations and potential risks regarding athletic performance following TDR. Mechanical concerns remain and the implant’s resilience as regards its load-bearing capacity during sporting activities is unknown. Thirty-nine athletic patients fulfilled the inclusion criteria for this study. These patients participated in a large variety of different types of sport. Significant and lasting pain-relief was attained following TDR with a mean follow-up of 26.3 months (range 9–50.7 months; FU rate 97.4%). Sporting activity was resumed within the first 3 months (38.5%) to 6 months (30.7%) with peak performance being reached after 5.2 months. Thirty-seven patients (94.9%) achieved resumption of sporting activity. Athletic performance improved significantly in 33 patients (84.6%). Minor subsidence was observed in 13 patients (30%) within the first 3 months with no further implant migration thereafter in 12 patients. Participation in all types of sport recorded in this study was accessible for a high rate of patients up to the level of professional athletes as well as those participating in extreme sports. Preoperative participation in sport proved to be a strong positive predictor for highly satisfactory postoperative outcome following TDR. In a selected group of patients, however, preoperative inability to participate in sporting activities did not impair postoperative physical activity. Due to the young age of the patients and significant load increase exerted during athletic activities, persisting concerns regarding the future behaviour of the implant remain and will require longer follow-up, modified investigation techniques and larger patient cohorts. PMID:17205239

  1. Do we have to perform a renal biopsy? Clinical dilemmas in a case with nephrotic syndrome.

    PubMed

    Akimoto, Tetsu; Otani, Naoko; Takeshima, Eri; Saito, Osamu; Kusano, Eiji; Nagata, Daisuke

    2014-01-01

    Renal biopsy is one of the pivotal diagnostic tools used in the field of nephrology. A morphological analysis of the kidney may also be of value for the overall management of patients with diabetic nephropathy. However, the indications for renal biopsy differ considerably among nephrologists, and no global consensus regarding performing this procedure among diabetic patients with various renal manifestations has yet been achieved. In this report, we would like to describe our serendipitous experience with a male type 2 diabetic patient presenting with nephrotic syndrome complicated by concurrent gastric carcinoma. We also discuss several conundrums that arose in the current case, which had an impact on our diagnostic and therapeutic decisions.

  2. Poor symptom and performance validity in regularly referred Hospital outpatients: Link with standard clinical measures, and role of incentives.

    PubMed

    Dandachi-FitzGerald, Brechje; van Twillert, Björn; van de Sande, Peter; van Os, Yindee; Ponds, Rudolf W H M

    2016-05-30

    We investigated the frequency of symptom validity test (SVT) failure and its clinical correlates in a large, heterogeneous sample of hospital outpatients referred for psychological assessment for clinical purposes. We studied patients (N=469), who were regularly referred for assessment to the psychology departments of five hospitals. Background characteristics, including information about incentives, were obtained with a checklist completed by the clinician. As a measure of over-reporting, the Structured Inventory of Malingered Symptomatology (SIMS) was administered to all patients. The Amsterdam Short-Term Memory test (ASTM), a cognitive underperformance measure, was only administered to patients who were referred for a neuropsychological assessment. Symptom over-reporting occurred in a minority of patients, ranging from 12% to 19% in the main diagnostic patient groups. Patients with morbid obesity had a low rate of over-reporting (1%). The SIMS was positively associated with levels of self-reported psychological symptoms. Cognitive underperformance occurred in 29.3% of the neuropsychological assessments. The ASTM was negatively associated with memory test performance. We found no association between SVT failure and financial incentives. Our results support the recommendation to routinely evaluate symptom validity in clinical assessments of hospital patients. The dynamics behind invalid symptom reporting need to be further elucidated. PMID:27137961

  3. Old wine in new bottles: validating the clinical utility of SPECT in predicting cognitive performance in mild traumatic brain injury.

    PubMed

    Romero, Kristoffer; Lobaugh, Nancy J; Black, Sandra E; Ehrlich, Lisa; Feinstein, Anthony

    2015-01-30

    The neural underpinnings of cognitive dysfunction in mild traumatic brain injury (TBI) are not fully understood. Consequently, patient prognosis using existing clinical imaging is somewhat imprecise. Single photon emission computed tomography (SPECT) is a frequently employed investigation in this population, notwithstanding uncertainty over the clinical utility of the data obtained. In this study, subjects with mild TBI underwent (99m)Tc-ECD SPECT scanning, and were administered a brief battery of cognitive tests and self-report symptom scales of concussion and emotional distress. Testing took place 2 weeks (n=84) and 1 year (n=49) post-injury. Multivariate analysis (i.e., partial least squares analysis) revealed that frontal perfusion in right superior frontal and middle frontal gyri predicted poorer performance on the Stroop test, an index of executive function, both at initial and follow-up testing. Conversely, SPECT scans categorized as normal or abnormal by radiologists did not differentiate cognitively impaired from intact subjects. These results demonstrate the clinical utility of SPECT in mild TBI, but only when data are subjected to blood flow quantification analysis.

  4. Clinical performance of indirect composite resin inlays/onlays in a dental school: observations up to 34 months.

    PubMed

    Leirskar, J; Henaug, T; Thoresen, N R; Nordbø, H; von der Fehr, F R

    1999-08-01

    The aim of this retrospective clinical study was to evaluate the clinical performance of indirect composite resin inlays and onlays. Patients among the dental school clientele in need of posterior approximal filings and preferring esthetic restorations were included. Clinical teachers or trained students under supervision carried out the preparations, made impressions and prepared stone casts. Inlays made from either Tetric, Z100 or Maxxim were light-cured and placed in a light oven for secondary curing, before being luted with a dual cure cement. At recall, the inlays were evaluated using slightly modified US Public Health Service (USPHS) criteria. Twenty-two patients with 50 fillings presented for the assessment. The right censored observation periods ranged from 12 to 34 months, with a mean of 20. With the only exception of an early fracture of one onlay, all restorations were classified as successful. This was based on 15 "A" (optimal) and 34 "B" (acceptable) ratings, each of which representing the lowest rating for the individual restoration. The major reason for the "B" ratings was imperfect gingival marginal adaptation due to a small surplus of bonding material and/or luting cement.

  5. Safety evaluation of daidzein in laying hens: part I. Effects on laying performance, clinical blood parameters, and organs development.

    PubMed

    Shi, S R; Gu, H; Chang, L L; Wang, Z Y; Tong, H B; Zou, J M

    2013-05-01

    Daidzein, an estrogen-like product, becomes increasingly popular as a dietary supplement, particularly for postpeak-estrus animals seeking a safe natural alternative to play a role of estrogen. However, there is little available safety data of it for raisers and consumers. A subchronic laying hen safety study was conducted to examine if the high-dose daidzein could affect the safety of hens selves, including laying performance, clinical blood parameters and organs development. Seven hundred and sixty-eight 56-week-old Hyline Brown were randomly assigned to 4 groups with 8 replicates of 24 birds each and 3weeks later fed diets supplemented with 0, 10, 50 and 100mg of daidzein/kg for 12weeks. The mortality was significantly decreased (P<0.05). No treatment related adverse clinical signs were observed. Mean egg production, egg mass and feed conversion of whole experiment period was significantly influenced by dietary daidzein supplement (P<0.05), showing significant quadratic response to increasing dietary daidzein supplement (P=0.029, P=0.003 and P=0.019, respectively). There was no statistically significant changes in haematology (P>0.05). In clinical chemistry parameters, total protein, total cholesterol, calcium and phosphorus were significantly affected by dietary daidzein supplement (P<0.05). The no observed adverse effect level (NOAEL) is considered to be 50mg/kg. PMID:23391597

  6. The effect of tilmicosin administered to ewes prior to lambing on incidence of clinical mastitis and subsequent lamb performance.

    PubMed

    Croft, A; Duffield, T; Menzies, P; Leslie, K; Bagg, R; Dick, P

    2000-04-01

    The effect of tilmicosin on the incidence of clinical mastitis and subsequent lamb performance was studied in 9 sheep flocks in Ontario. Ewes were treated randomly with either tilmicosin or placebo approximately one month prior to lambing. Outcome was assessed by comparing rates of clinical mastitis, palpable udder abnormalities, and preweaning (50-day) lamb weights between the 2 treatment groups, while controlling for other important variables. Lambs raised by multiparous ewes treated with tilmicosin were significantly heavier than lambs from placebo-treated multiparous ewes at 50 days. Lambs from tilmicosin-treated ewes were on average 0.52 kg heavier than lambs in the placebo group. There was no difference between treatment groups in the weight of lambs from first parity ewes. Tilmicosin treatment resulted in a 43% decrease in palpable udder abnormalities. Incidence of clinical mastitis did not differ between experimental groups. The administration of tilmicosin prelambing, at the time of routine clostridial disease vaccination, may be a beneficial and convenient way to reduce mastitis infection and improve the preweaning gain of lambs.

  7. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance

    PubMed Central

    2016-01-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus. PMID:27478327

  8. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

    PubMed

    Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

    2016-08-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus. PMID:27478327

  9. Consequences of Predicted or Actual Asteroid Impacts

    NASA Astrophysics Data System (ADS)

    Chapman, C. R.

    2003-12-01

    Earth impact by an asteroid could have enormous physical and environmental consequences. Impactors larger than 2 km diameter could be so destructive as to threaten civilization. Since such events greatly exceed any other natural or man-made catastrophe, much extrapolation is necessary just to understand environmental implications (e.g. sudden global cooling, tsunami magnitude, toxic effects). Responses of vital elements of the ecosystem (e.g. agriculture) and of human society to such an impact are conjectural. For instance, response to the Blackout of 2003 was restrained, but response to 9/11 terrorism was arguably exaggerated and dysfunctional; would society be fragile or robust in the face of global catastrophe? Even small impacts, or predictions of impacts (accurate or faulty), could generate disproportionate responses, especially if news media reports are hyped or inaccurate or if responsible entities (e.g. military organizations in regions of conflict) are inadequately aware of the phenomenology of small impacts. Asteroid impact is the one geophysical hazard of high potential consequence with which we, fortunately, have essentially no historical experience. It is thus important that decision makers familiarize themselves with the hazard and that society (perhaps using a formal procedure, like a National Academy of Sciences study) evaluate the priority of addressing the hazard by (a) further telescopic searches for dangerous but still-undiscovered asteroids and (b) development of mitigation strategies (including deflection of an oncoming asteroid and on- Earth civil defense). I exemplify these issues by discussing several representative cases that span the range of parameters. Many of the specific physical consequences of impact involve effects like those of other geophysical disasters (flood, fire, earthquake, etc.), but the psychological and sociological aspects of predicted and actual impacts are distinctive. Standard economic cost/benefit analyses may not

  10. Performance variations among clinically available deformable image registration tools in adaptive radiotherapy - how should we evaluate and interpret the result?

    PubMed

    Nie, Ke; Pouliot, Jean; Smith, Eric; Chuang, Cynthia

    2016-01-01

    The purpose of this study is to evaluate the performance variations in commercial deformable image registration (DIR) tools for adaptive radiation therapy and further to interpret the differences using clinically available terms. Three clinical examples (prostate, head and neck (HN), and cranial spinal irradiation (CSI) with L-spine boost) were evaluated in this study. Firstly, computerized deformed CT images were generated using simulation QA software with virtual deformations of bladder filling (prostate), neck flexion/bite-block repositioning/tumor shrinkage (HN), and vertebral body rotation (CSI). The corresponding transformation matrices served as a "reference" for the following comparisons. Three commercialized DIR algorithms: the free-form deformation from MIMVista 5.5 and the RegRefine from MIMMaestro 6.0, the multipass B-spline from VelocityAI v3.0.1, and the adap-tive demons from OnQ rts 2.1.15, were applied between the initial images and the deformed CT sets. The generated adaptive contours and dose distributions were compared with the "reference" and among each other. The performance in transfer-ring contours was comparable among all three tools with an average Dice similarity coefficient of 0.81 for all the organs. However, the dose warping accuracy appeared to rely on the evaluation end points and methodologies. Point-dose differences could show a difference of up to 23.3 Gy inside the PTVs and to overestimate up to 13.2 Gy for OARs, which was substantial for a 72 Gy prescription dose. Dose-volume histogram-based evaluation might not be sensitive enough to illustrate all the detailed variations, while isodose assessment on a slice-by-slice basis could be tedious. We further explored the possibility of using 3D gamma index analysis for warping dose variation assessment, and observed differences in dose warping using different DIR tools. Overall, our results demonstrated that evaluation based only on the performance of contour transformation could not

  11. Clinical Implication of Performance Status in Patients with Hepatocellular Carcinoma Complicating with Cirrhosis

    PubMed Central

    Nishikawa, Hiroki; Kita, Ryuichi; Kimura, Toru; Ohara, Yoshiaki; Sakamoto, Azusa; Saito, Sumio; Nishijima, Norihiro; Nasu, Akihiro; Komekado, Hideyuki; Osaki, Yukio

    2015-01-01

    Background and aims: The aims of our study were to elucidate the relationship between baseline characteristics of hepatocellular carcinoma (HCC) patients complicating with liver cirrhosis (LC) and performance status (PS) and to investigate the impact of PS on survival in patients with HCC complicating with LC. Methods: In a total of 1003 patients diagnosed with HCC complicating with LC, we divided into two groups of PS ≥1 (n=251) and PS 0 (n=752) as evaluated by using the Eastern Cooperative Oncology Group criteria at the time of HCC diagnosis. Baseline characteristics between these two groups were compared. We also performed univariate and multivariate analyses of factors contributing to overall survival (OS). Results: The median follow-up period was 1.6 years in the PS ≥1 group and 3.1 years in the PS 0 group. The 1-, 3- and 5-year OS rates after each initial therapy for HCC were 90.3%, 67.4% and 49.8%, respectively, in the PS 0 group and 73.4%, 42.0% and 17.7%, respectively, in the PS ≥1 group (P<0.001). A worse PS was significantly associated with age, gender, Child-Pugh classification, HCC stage, Japan Integrated Staging score, initial treatment option for HCC, maximum tumor size, alanine aminotransferase value, hypoalbuminemia, hyperbilirubinemia, renal insufficiency, hyponatremia, prothrombin time prolongation, platelet count and tumor marker level. In multivariate analyses, poorer PS was an independent predictor linked to OS with a hazard ratio of 1.773 (P<0.001). Conclusions: PS was closely associated with status of HCC patients with LC and could be an important predictor for these populations. PMID:25767611

  12. Noninferiority and Equivalence Evaluation of Clinical Performance among Computed Radiography, Film, and Digitized Film for Telemammography Services

    PubMed Central

    Romero, Javier A.; Bernal, Oscar A.; Moreno, Angela P.; Velasco, Sofía C.

    2016-01-01

    Objective. The aim of this study was to evaluate and compare the clinical performance of different alternatives to implement low-cost screening telemammography. We compared computed radiography, film printed images, and digitized films produced with a specialized film digitizer and a digital camera. Material and Methods. The ethics committee of our institution approved this study. We assessed the equivalence of the clinical performance of observers for cancer detection. The factorial design included 70 screening patients, four technological alternatives, and cases interpreted by seven radiologists, for a total of 1,960 observations. The variables evaluated were the positive predictive value (PPV), accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curves (AUC). Result. The mean values for the observed variables were as follows: accuracy ranged from 0.77 to 0.82, the PPV ranged from 0.67 to 0.68, sensitivity ranged from 0.64 to 0.74, specificity ranged from 0.87 to 0.90, and the AUC ranged from 0.87 to 0.90. At a difference of 0.1 to claim equivalence, all alternatives were equivalent for all variables. Conclusion. Our findings suggest that telemammography screening programs may be provided to underserved populations at a low cost, using a film digitizer or a digital camera. PMID:27777584

  13. Performance of research ethics committees in Spain. A prospective study of 100 applications for clinical trial protocols on medicines.

    PubMed Central

    Dal-Ré, R; Espada, J; Ortega, R

    1999-01-01

    OBJECTIVES: To review the characteristics and performance of research ethics committees in Spain in the evaluation of multicentre clinical trial drug protocols. DESIGN: A prospective study of 100 applications. SETTING: Forty-one committees reviewing clinical trial protocols, involving 50 hospitals in 25 cities. MAIN MEASURES: Protocol-related features, characteristics of research ethics committees and evaluation dynamics. RESULTS: The 100 applications involved 15 protocols (of which 12 were multinational) with 12 drugs. Committees met monthly (except one). They had a mean number of 12 members, requested a mean of six complete dossiers and nine additional copies of the protocol with a mean deadline of 14 days before the meeting. All applications were approved except three (two of the three were open-label long-term safety trials rejected by the same committee), which were approved by the other committees involved. The mean time from submission to approval was 64 days. The mean time from submission to arrival of the approval document at our offices was 85 days. Twenty-five committees raised queries for 38 of the 97 finally approved applications. Impact of evaluation fee, number of members, queries raised and experience of committees on timings were not statistically significant. CONCLUSION: Obtaining ethical approval is time-consuming. There is much diversity in the research ethics committees' performance. A remarkable delay (> 20 days) exists between the decision and the arrival of the written approval, suggesting administrative or organisational problems. PMID:10390685

  14. Evaluation of the Clinical Impact of ISO 4049 in Comparison with Miniflexural Test on Mechanical Performances of Resin Based Composite

    PubMed Central

    Calabrese, Luigi; Fabiano, Francesca; Bonaccorsi, Lucio Maria; Fabiano, Valerio; Borsellino, Chiara

    2015-01-01

    The aim of this study was to evaluate the effect of different specimens dimensions on the mechanical properties of a commercial microfilled resin composite by using a modified ISO 4049 standard protocol, that generally provides specimen dimensions of 25 mm length × 2 mm width × 2 mm height; these standard dimensions are not clinically realistic considering the teeth diameter and length average. Furthermore, the overlapping irradiations required lead to specimens that are not homogeneous with the presence of some flaws due to packaging steps. For this reason, a miniflexural test was employed in this work both to simulate clinically realistic dimensions and to concentrate fewer defects. The flexural tests were performed at varying span length, in the range between 18.5 mm as stated by the ISO 4049 flexural test (IFT) and 10.5 mm according to the miniflexural test (MFT), at the increasing of layers with a 1 mm buildup multilayering technique. The results evidenced the impact of specimen dimensions on mechanical performances and consequently stability of resin-based composite with the formation of an asymmetrical structure which possesses higher stiffness and strength at increasing layering steps. PMID:25815011

  15. Impaired Physical Performance and Clinical Responses after a Recreational Bodybuilder's Self-Administration of Steroids: A Case Report

    PubMed Central

    Veras, Katherine; Silva-Junior, Fernando Lopes; Lima-Silva, Adriano Eduardo; De-Oliveira, Fernando Roberto

    2015-01-01

    We reported clinical and physical responses to 7 weeks of anabolic-androgenic steroid (AAS) self-administration in a male recreational bodybuilder. He was self-administrating a total of 3,250 mg of testosterone when his previous and current clinical and physical trials records were revisited. Body shape, performance, and biochemistry results were clustered into three phases labeled PRE (before the self-use), POST I (immediately at the cessation of the 7-week administration), and POST II (12 weeks after the cessation). Elevated testosterone and estradiol levels were observed in the POST I phase, while hepatic and renal functions remained altered in the POST II phase. Body mass and body fat percentages increased throughout the three phases. When adjusted according to body mass, drops in aerobic and anaerobic power and capacity (2.1% to 12.9%) were observed across the phases. This case report shows that overall performance decreased when a bodybuilding practitioner self-administered AAS. PMID:26770942

  16. Impaired Physical Performance and Clinical Responses after a Recreational Bodybuilder's Self-Administration of Steroids: A Case Report.

    PubMed

    Veras, Katherine; Silva-Junior, Fernando Lopes; Lima-Silva, Adriano Eduardo; De-Oliveira, Fernando Roberto; Pires, Flávio Oliveira

    2015-12-01

    We reported clinical and physical responses to 7 weeks of anabolic-androgenic steroid (AAS) self-administration in a male recreational bodybuilder. He was self-administrating a total of 3,250 mg of testosterone when his previous and current clinical and physical trials records were revisited. Body shape, performance, and biochemistry results were clustered into three phases labeled PRE (before the self-use), POST I (immediately at the cessation of the 7-week administration), and POST II (12 weeks after the cessation). Elevated testosterone and estradiol levels were observed in the POST I phase, while hepatic and renal functions remained altered in the POST II phase. Body mass and body fat percentages increased throughout the three phases. When adjusted according to body mass, drops in aerobic and anaerobic power and capacity (2.1% to 12.9%) were observed across the phases. This case report shows that overall performance decreased when a bodybuilding practitioner self-administered AAS. PMID:26770942

  17. Pilonidal Sinus Operations Performed Under Local Anesthesia versus the General Anesthesia: Clinical Trial Study

    PubMed Central

    Rahmani, Nasrin; Baradari, Afshin Gholipour; Heydari Yazdi, Seyed Mohammad-Javad; Firouzian, Abolfazl; Hashemi, Seyyed Abbas; Fazli, Mehran; Sadeghian, Iman

    2016-01-01

    Backgrounds: Various methods were defined to prepare patients for the pilonidal sinus surgery including local, spinal, and general anesthesia. But there is no powerful evidence to differ these procedures. Therefore, in the current study, we compared local and general anesthesia in the pilonidal sinus surgery. Methods and Material: In this clinical trial (IRCT201312031786N5) study 60 patients with the pilonidal sinus disease divided to two groups of local anesthesia versus general anesthesia. For local anesthesia we used 6ml of 2% lidocaine with an epinephrine (1:200,000), 6 ml of 0.5% bupivacaine, 1ml fentanyl (50 μg/ml), 1ml clonidine (75 μg/ml) and for general anesthesia fentanyl 1.5 μg.kg-1, thiopental 3-5 mg.kg-1, followed by the trachea intubation facilitated by atracurim 0.5 mg.kg-1 with maintenance of isoflurane 1-3% in nitrous oxygen 70% and oxygen 30%. The student t-test and Chi-square test were applied to evaluate the differences. Results: There were 30 patients with the mean age of 27.43±8.42 years in local anesthesia group and 30 cases with the mean age of 27.5±8.44 years underwent general anesthesia. The recovery time was significantly lower in the local anesthesia group (P=0.000). The oxygen saturation of the general anesthesia group was significantly higher at 1 and 20 minutes after the operation. The average of pain score was significantly higher in general anesthesia group at 3h and 6h after surgery (P<0.001). There were no significant differences in post-operative complications and hospital length of stay. Conclusion: This investigation revealed that local anesthesia has decreased pain during 48 hours after the surgery, shorter recovery time, and the less consumption of painkillers. So, we concluded that we can consider local anesthesia as a good alternative for the general anesthesia in the pilonidal sinus surgery. PMID:27157165

  18. Clinical Performance and Biocompatibility of Novel Hyaluronan-Based Heparin-Bonded Extracorporeal Circuits

    PubMed Central

    Gunaydin, Serdar; Mccusker, Kevin; Vijay, Venkataramana

    2005-01-01

    Abstract: We tested documented in vitro and ex vivo advantages of novel hyaluronan based heparin bonded extracorporeal circuits in a prospective randomized study. During the period from June until September 2005, 40 patients undergoing reoperation for coronary artery bypass grafting were allocated into two equal groups (n = 20): Group 1 was treated with hyaluronan-based heparin-bonded circuits and group 2 was treated with uncoated control circuits. Complete blood count, fibrinogen, albumin, C3a, interleukin-2 levels, and thromboelastographic data were documented after induction of anesthesia (T1) and heparin administration before cardiopulmonary bypass (CPB) (T2), 15 minutes after initiation of CPB (T3), before cessation of CPB (T4), 15 minutes after reversal with protamine (T5), and the first postoperative day at 8:00 a.m. (T6). Hollow fibers were collected for consecutive biomaterial analysis by optical and scanning electron microscopy (SEM). Desorbed protein deposition on fibers was compared by spectrophotometry. Leukocyte counts were lower in T4-T6 in group 1 (p < .05). Platelet counts demonstrated significant differences at T4 and T5 in coated group (p < .05). Albumin and fibrinogen levels were better preserved in Group 1 at T4, T5 and T4, T6, consecutively (p < .05). C3a and IL-2 levels were lower at T3-T5 and T4-T5 in intervention group (p < .05). Postoperative hemorrhage was 412 ± 50 mL in group 1 and 684 ± 50 ml in group 2 (p < .05). Respiratory support time was shorter in group 1 versus control (p < .05). Platelet adhesion was significantly lower in intervention group. Amount of desorbed protein was 1.44 ± 0.01 mg/dL in group 1 and 1.94 ± 0.01 mg/dL in control (p < .05). SEM and spectrophotometry demonstrated better surface preservation in the hyaluronan coated group. Novel hyaluronan-based heparin-bonded circuits reduce platelet adhesion-aggregation and protein adsorption and provide better perioperative clinical parameters through platelet, albumin

  19. Test performance and classification statistics for the Rey Auditory Verbal Learning Test in selected clinical samples.

    PubMed

    Schoenberg, Mike R; Dawson, Kyra A; Duff, Kevin; Patton, Doyle; Scott, James G; Adams, Russell L

    2006-10-01

    The Rey Auditory Verbal Learning Test [RAVLT; Rey, A. (1941). L'examen psychologique dans les cas d'encéphalopathie traumatique. Archives de Psychologie, 28, 21] is a commonly used neuropsychological measure that assesses verbal learning and memory. Normative data have been compiled [Schmidt, M. (1996). Rey Auditory and Verbal Learning Test: A handbook. Los Angeles, CA: Western Psychological Services]. When assessing an individual suspected of neurological dysfunction, useful comparisons include the extent that the patient deviates from healthy peers and also how closely the subject's performance matches those with known brain injury. This study provides the means and S.D.'s of 392 individuals with documented neurological dysfunction [closed head TBI (n=68), neoplasms (n=57), stroke (n=47), Dementia of the Alzheimer's type (n=158), and presurgical epilepsy left seizure focus (n=28), presurgical epilepsy right seizure focus (n=34)] and 122 patients with no known neurological dysfunction and psychiatric complaints. Patients were stratified into three age groups, 16-35, 36-59, and 60-88. Data were provided for trials I-V, List B, immediate recall, 30-min delayed recall, and recognition. Classification characteristics of the RAVLT using [Schmidt, M. (1996). Rey Auditory and Verbal Learning Test: A handbook. Los Angeles, CA: Western Psychological Services] meta-norms found the RAVLT to best distinguish patients suspected of Alzheimer's disease from the psychiatric comparison group. PMID:16987634

  20. Prospective Clinical Study of 551 Cases of Liposuction and Abdominoplasty Performed Individually and in Combination

    PubMed Central

    2013-01-01

    Background: Despite the popularity of these procedures, there are limited published prospective studies evaluating liposuction and abdominoplasty. Lipoabdominoplasty is a subject of recent attention. Several investigators have recommended alternative techniques that preserve the Scarpa fascia in an effort to reduce complications, particularly the risk of seromas. Methods: Over a 5-year period, 551 consecutive patients were treated with ultrasonic liposuction alone (n = 384), liposuction/abdominoplasty (n = 150), or abdominoplasty alone (n = 17). In lipoabdominoplasties, the abdomen and flanks were first treated with liposuction. A traditional flap dissection was used for all abdominoplasties. Scalpel dissection was used rather than electrodissection. A supine “jackknife” position was used in surgery to provide maximum hip flexion, allowing a secure deep fascial repair. Results: The complication rate after liposuction was 4.2% vs 50% for patients treated with an abdominoplasty. Approximately half of the abdominoplasty complications were minor scar deformities, including widened umbilical scars (17.3%) that were revised. The seroma rate after abdominoplasties was 5.4%; there were no seromas after liposuction alone. Conclusions: Lipoabdominoplasty may be performed safely, so that patients may benefit from both modalities. The seroma rate is reduced by avoiding electrodissection, making Scarpa fascia preservation a moot point. A deep fascial repair keeps the abdominoplasty scar within the bikini line. Deep venous thrombosis and other complications may be minimized with precautions that do not include anticoagulation. PMID:25289226

  1. Performance of Al2O3:C optically stimulated luminescence dosimeters for clinical radiation therapy applications.

    PubMed

    Hu, B; Wang, Y; Zealey, W

    2009-12-01

    A commercial Optical Stimulated Luminescence (OSL) dosimetry system developed by Landauer was tested to analyse the possibility of using OSL dosimetry for external beam radiotherapy planning checks. Experiments were performed to determine signal sensitivity, dose response range, beam type/energy dependency, reproducibility and linearity. Optical annealing processes to test OSL material reusability were also studied. In each case the measurements were converted into absorbed dose. The experimental results show that OSL dosimetry provides a wide dose response range, good linearity and reproducibility for the doses up to 800cGy. The OSL output is linear with dose up to 600cGy range showing a maximum deviation from linearity of 2.0% for the doses above 600cGy. The standard deviation in response of 20 dosimeters was 3.0%. After optical annealing using incandescent light, the readout intensity decreased by approximately 98% in the first 30 minutes. The readout intensity, I, decreased after repeated optical annealing as a power law, given by I infinity t (-1.3). This study concludes that OSL dosimetry can provide an alternative dosimetry technique for use in in-vivo dosimetry if rigorous measurement protocols are established. PMID:20169842

  2. 40 CFR 74.22 - Actual SO2 emissions rate.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Actual SO2 emissions rate. 74.22... (CONTINUED) SULFUR DIOXIDE OPT-INS Allowance Calculations for Combustion Sources § 74.22 Actual SO2 emissions... actual SO2 emissions rate shall be 1985. (2) For combustion sources that commenced operation...

  3. Actualization and the Fear of Death: Retesting an Existential Hypothesis.

    ERIC Educational Resources Information Center

    Wood, Keith; Robinson, Paul J.

    1982-01-01

    Demonstrates that within a group of highly actualized individuals, the degree to which "own death" is integrated into constructs of self is a far more powerful predictor of fear of death than actualization. Findings suggest that actualization and integration are independent in their overall effect on fear of death. (Author)

  4. Clinical relevance of optimizing vitamin D status in soldiers to enhance physical and cognitive performance.

    PubMed

    Wentz, Laurel M; Eldred, Jerad D; Henry, Michael D; Berry-Cabán, Cristóbal S

    2014-01-01

    Vitamin D deficiency initiates a loss of combat effectiveness by impairing physical and cognitive functioning of combat Operators. Synthesized in response to sunlight and consumed in the diet, vitamin D functions as a hormone and regulates gene expression for nearly 300 genes throughout the human body. These target genes are involved processes essential to combat operations, such as immune function, response to stress, inflammation, and regulation of calcium movement. Since widespread vitamin D deficiency is observed across the U.S. population, poor vitamin D status is expected in Servicemembers. Physical conditions linked to vitamin D deficiency include increased risk for muscle or bone injury, muscle weakness, and reduced neuromuscular function. Hormonally, vitamin D levels have been positively correlated with testosterone levels. Vitamin D deficiency is also associated with cognitive decline, depression, and may prolong recovery following mild traumatic brain injury (mTBI). Since vitamin D deficiency elevates systemic inflammation, poor vitamin D status at the time of brain injury may prolong the inflammatory response and exacerbate postconcussive symptoms. Furthermore, veterans with mTBI experience chronic endocrine dysfunction. While vitamin D status has not been assessed post-mTBI, it is plausible that vitamin D levels are altered along with testosterone and growth hormone, raising the question of whether vitamin D deficiency results from trauma-related hormonal abnormalities or whether vitamin D deficiency increases the risk for endocrine dysfunction. Through its association with testosterone production, vitamin D deficiency may increase the risk for posttraumatic stress disorder (PTSD) since testosterone levels are altered in veterans with PTSD. Therefore, vitamin D status has a significant impact on Operator health and performance. Supplementing vita-min D to deficient Operators provides a noninvasive and low-cost intervention to maintain combat force

  5. Determining performance characteristics of an NGS-based HLA typing method for clinical applications.

    PubMed

    Duke, J L; Lind, C; Mackiewicz, K; Ferriola, D; Papazoglou, A; Gasiewski, A; Heron, S; Huynh, A; McLaughlin, L; Rogers, M; Slavich, L; Walker, R; Monos, D S

    2016-03-01

    This study presents performance specifications of an in-house developed human leukocyte antigen (HLA) typing assay using next-generation sequencing (NGS) on the Illumina MiSeq platform. A total of 253 samples, previously characterized for HLA-A, -B, -C, -DRB1 and -DQB1 were included in this study, which were typed at high-resolution using a combination of Sanger sequencing, sequence-specific primer (SSP) and sequence-specific oligonucleotide probe (SSOP) technologies and recorded at the two-field level. Samples were selected with alleles that cover a high percentage of HLA specificities in each of five different race/ethnic groups: European, African-American, Asian Pacific Islander, Hispanic and Native American. Sequencing data were analyzed by two software programs, Omixon's target and GenDx's NGSengine. A number of metrics including allele balance, sensitivity, specificity, precision, accuracy and remaining ambiguity were assessed. Data analyzed by the two software systems are shown independently. The majority of alleles were identical in the exonic sequences (third field) with both programs for HLA-A, -B, -C and -DQB1 in 97.7% of allele determinations. Among the remaining discrepant genotype calls at least one of the analysis programs agreed with the reference typing. Upon additional manual analysis 100% of the 2530 alleles were concordant with the reference HLA genotypes; the remaining ambiguities did not exceed 0.8%. The results demonstrate the feasibility and significant benefit of HLA typing by NGS as this technology is highly accurate, eliminates virtually all ambiguities, provides complete sequencing information for the length of the HLA gene and forms the basis for utilizing a single methodology for HLA typing in the immunogenetics labs.

  6. The evaluation of direct composite restorations for the worn mandibular anterior dentition - clinical performance and patient satisfaction.

    PubMed

    Poyser, N J; Briggs, P F A; Chana, H S; Kelleher, M G D; Porter, R W J; Patel, M M

    2007-05-01

    This prospective split-mouth clinical trial evaluated the performance and patient satisfaction of 168 Herculite XRV direct composite restorations bonded to the worn anterior dentition of 18 patients with localized anterior tooth surface loss. One hundred and six of these restorations were placed on the mandibular anterior teeth. The restorations increased the anterior occlusal vertical dimension between 0.5 and 5 mm and the posterior occlusal contacts were restored after a mean duration of 6.2 months (range: 3-13 months) in 14 out of the 15 'Dahl' sub-group patients. The restorations were evaluated after 2.5 years of service by five examiners. Four patients and 23 mandibular restorations were lost to follow-up. Multiple clinical and restorative variables were assessed to determine their influence on restoration performance. Complete failure occurred in 6% of the restorations. Circumferential preparation and height of the restorative addition did not influence the performance of the restorations. A Visual Analogue Scale (VAS) was used to assess the patient's opinion regarding sensitivity, aesthetics, longevity and function of the worn mandibular anterior teeth. A statistically significant difference (95% CI) was found between the pre-operative and 1-month review VAS responses for aesthetics and longevity and this was maintained at the 2.5-year review. Direct composite restorations placed at an increased occlusal vertical dimension are a simple and time-efficient method of managing the worn mandibular anterior dentition. Patient's acceptance and adaptation to the technique is good and the results are accompanied with a high level of patient satisfaction that is maintained for the medium-term.

  7. A comparative study based on image quality and clinical task performance for CT reconstruction algorithms in radiotherapy.

    PubMed

    Li, Hua; Dolly, Steven; Chen, Hsin-Chen; Anastasio, Mark A; Low, Daniel A; Li, Harold H; Michalski, Jeff M; Thorstad, Wade L; Gay, Hiram; Mutic, Sasa

    2016-07-08

    CT image reconstruction is typically evaluated based on the ability to reduce the radiation dose to as-low-as-reasonably-achievable (ALARA) while maintaining acceptable image quality. However, the determination of common image quality metrics, such as noise, contrast, and contrast-to-noise ratio, is often insufficient for describing clinical radiotherapy task performance. In this study we designed and implemented a new comparative analysis method associating image quality, radiation dose, and patient size with radiotherapy task performance, with the purpose of guiding the clinical radiotherapy usage of CT reconstruction algorithms. The iDose4 iterative reconstruction algorithm was selected as the target for comparison, wherein filtered back-projection (FBP) reconstruction was regarded as the baseline. Both phantom and patient images were analyzed. A layer-adjustable anthropomorphic pelvis phantom capable of mimicking 38-58 cm lateral diameter-sized patients was imaged and reconstructed by the FBP and iDose4 algorithms with varying noise-reduction-levels, respectively. The resulting image sets were quantitatively assessed by two image quality indices, noise and contrast-to-noise ratio, and two clinical task-based indices, target CT Hounsfield number (for electron density determination) and structure contouring accuracy (for dose-volume calculations). Additionally, CT images of 34 patients reconstructed with iDose4 with six noise reduction levels were qualitatively evaluated by two radiation oncologists using a five-point scoring mechanism. For the phantom experiments, iDose4 achieved noise reduction up to 66.1% and CNR improvement up to 53.2%, compared to FBP without considering the changes of spatial resolution among images and the clinical acceptance of reconstructed images. Such improvements consistently appeared across different iDose4 noise reduction levels, exhibiting limited interlevel noise (< 5 HU) and target CT number variations (< 1 HU). The radiation

  8. Performance Scores in General Practice: A Comparison between the Clinical versus Medication-Based Approach to Identify Target Populations

    PubMed Central

    Saint-Lary, Olivier; Boisnault, Philippe; Naiditch, Michel; Szidon, Philippe; Duhot, Didier; Bourgueil, Yann; Pelletier-Fleury, Nathalie

    2012-01-01

    Context From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators. Methods A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007. Two indicators regarding the prescription for statins and aspirin in these populations were calculated. Results We analyzed data from 21.690 patients collected by 61 GPs via electronic medical files. Following the clinical-based approach, 2.278 patients were diabetic, 8,271 had hypertension and 1.539 had both against respectively 1.730, 8.511 and 1.304 following the medication-based approach (% agreement = 96%, kappa = 0.69). The main reasons for these differences were: forgetting to code the morbidities in the clinical approach, not taking into account the population of patients who were given life style and diet rules only or taking into account patients for whom morbidities other than hypertension could justify the use of antihypertensive drugs in the medication-based approach. The mean (confidence interval) per doctor was 33.7% (31.5–35.9) for statin indicator and 38.4% (35.4–41.4) for aspirin indicator when the target populations were identified on the basis of clinical criteria whereas they were 37.9% (36.3–39.4) and 43.8% (41.4–46.3) on the basis of treatment criteria. Conclusion The two approaches yield very “similar” scores but these scores cover different realities and offer food for thought on the possible usage of these indicators in the

  9. Throwing patterns used by collegiate baseball players in actual games.

    PubMed

    Barrett, David D; Burton, Allen W

    2002-03-01

    The form of 3,684 throws made by 100 players in 7 collegiate baseball games was examined in relation to position, distance, and active and inactive situations. All throws made from the first pitch to the last out for 94 half innings were videotaped from the stands. The results showed that the interrater reliability of task, environment, and performance measures were all acceptable to excellent (percentage of agreement was at least 80%), indicating that qualitative aspects of throwing can be reliably measured in an actual sport context. Alternatives to the most advanced pattern were observed at least half the time for catchers and infielders at most distances in both active and inactive situations andfor pitchers and outfielders only in inactive situations.

  10. Investigation of multichannel phased array performance for fetal MR imaging on 1.5T clinical MR system

    PubMed Central

    Li, Ye; Pang, Yong; Vigneron, Daniel; Glenn, Orit; Xu, Duan; Zhang, Xiaoliang

    2011-01-01

    Fetal MRI on 1.5T clinical scanner has been increasingly becoming a powerful imaging tool for studying fetal brain abnormalities in vivo. Due to limited availability of dedicated fetal phased arrays, commercial torso or cardiac phased arrays are routinely used for fetal scans, which are unable to provide optimized SNR and parallel imaging performance with a small number coil elements, and insufficient coverage and filling factor. This poses a demand for the investigation and development of dedicated and efficient radiofrequency (RF) hardware to improve fetal imaging. In this work, an investigational approach to simulate the performance of multichannel flexible phased arrays is proposed to find a better solution to fetal MR imaging. A 32 channel fetal array is presented to increase coil sensitivity, coverage and parallel imaging performance. The electromagnetic field distribution of each element of the fetal array is numerically simulated by using finite-difference time-domain (FDTD) method. The array performance, including B1 coverage, parallel reconstructed images and artifact power, is then theoretically calculated and compared with the torso array. Study results show that the proposed array is capable of increasing B1 field strength as well as sensitivity homogeneity in the entire area of uterus. This would ensure high quality imaging regardless of the location of the fetus in the uterus. In addition, the paralleling imaging performance of the proposed fetal array is validated by using artifact power comparison with torso array. These results demonstrate the feasibility of the 32 channel flexible array for fetal MR imaging at 1.5T. PMID:22408747

  11. Does Self-Efficacy Affect Cognitive Performance in Persons with Clinically Isolated Syndrome and Early Relapsing Remitting Multiple Sclerosis?

    PubMed Central

    Jongen, Peter Joseph; Wesnes, Keith; van Geel, Björn; Pop, Paul; Schrijver, Hans; Visser, Leo H.; Gilhuis, H. Jacobus; Sinnige, Ludovicus G.; Brands, Augustina M.

    2015-01-01

    In persons with multiple sclerosis (MS) a lowered self-efficacy negatively affects physical activities. Against this background we studied the relationship between self-efficacy and cognitive performance in the early stages of MS. Thirty-three patients with Clinically Isolated Syndrome (CIS) and early Relapsing Remitting MS (eRRMS) were assessed for self-efficacy (MSSES-18), cognition (CDR System), fatigue (MFIS-5), depressive symptoms (BDI), disease impact (MSIS-29), and disability (EDSS). Correlative analyses were performed between self-efficacy and cognitive scores, and stepwise regression analyses identified predictors of cognition and self-efficacy. Good correlations existed between total self-efficacy and Power of Attention (r= 0.65; P< 0.001), Reaction Time Variability (r= 0.57; P< 0.001), and Speed of Memory (r= 0.53; P< 0.01), and between control self-efficacy and Reaction Time Variability (r= 0.55; P< 0.01). Total self-efficacy predicted 40% of Power of Attention, 34% of Reaction Time Variability, and 40% of Speed of Memory variabilities. Disease impact predicted 65% of total self-efficacy and 58% of control self-efficacy variabilities. The findings may suggest that in persons with CIS and eRRMS self-efficacy may positively affect cognitive performance and that prevention of disease activity may preserve self-efficacy. PMID:26064686

  12. A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success

    PubMed Central

    Wright, Adam; Ash, Joan S; Erickson, Jessica L; Wasserman, Joe; Bunce, Arwen; Stanescu, Ana; St Hilaire, Daniel; Panzenhagen, Morgan; Gebhardt, Eric; McMullen, Carmit; Middleton, Blackford; Sittig, Dean F

    2014-01-01

    Objective To describe the activities performed by people involved in clinical decision support (CDS) at leading sites. Materials and methods We conducted ethnographic observations at seven diverse sites with a history of excellence in CDS using the Rapid Assessment Process and analyzed the data using a series of card sorts, informed by Linstone's Multiple Perspectives Model. Results We identified 18 activities and grouped them into four areas. Area 1: Fostering relationships across the organization, with activities (a) training and support, (b) visibility/presence on the floor, (c) liaising between people, (d) administration and leadership, (e) project management, (f) cheerleading/buy-in/sponsorship, (g) preparing for CDS implementation. Area 2: Assembling the system with activities (a) providing technical support, (b) CDS content development, (c) purchasing products from vendors (d) knowledge management, (e) system integration. Area 3: Using CDS to achieve the organization's goals with activities (a) reporting, (b) requirements-gathering/specifications, (c) monitoring CDS, (d) linking CDS to goals, (e) managing data. Area 4: Participation in external policy and standards activities (this area consists of only a single activity). We also identified a set of recommendations associated with these 18 activities. Discussion All 18 activities we identified were performed at all sites, although the way they were organized into roles differed substantially. We consider these activities critical to the success of a CDS program. Conclusions A series of activities are performed by sites strong in CDS, and sites adopting CDS should ensure they incorporate these activities into their efforts. PMID:23999670

  13. Comparing new BSN RN self skills assessment to actual skills demonstration.

    PubMed

    Adair, Jean; Hughes, Lin; Davis, Sue; Wolcott-Breci, Mary

    2014-01-01

    The purpose of the study was to compare the self-skills assessment with the skill competence during an actual skills demonstration of newly hired bachelor of science in nursing (BSN) registered nurse graduates. This retrospective study included 32 randomly selected BSN registered nurse graduates from January 2010 to December 31, 2010. The participants were already hired into a midwest health system. Because this was a retrospective study, no demographic data were collected, and no consent from participants was needed. This study included a clinical skills check list where the participants rated themselves on specific skills utilizing a Likert scale ranging from 1 (no knowledge) to 4 (able to perform independently). The same clinical check list was utilized by an expert registered nurse when the skill was demonstrated. This study compared the difference between the subject's self-rating of skills and the clinical demonstration of the skills. We used t tests in the analysis to demonstrate the differences between the participant's self-rating of skills and the expert evaluation of the clinical demonstration of the skills. The data were inserted into the Statistical Package for the Social Sciences 19 software program to assist in the analysis process. The study demonstrated 17 significant differences in the skills ratings between the participant and competency demonstration of new BSN graduates. These significant results (2 tailed) ranged from .000 to .048.The 17 out of 46 specific skills where differences were noted included the following: staple removal, nasal pharyngeal suctioning, urinary catheter specimen collection, site care dressing change, urinary catheter irrigation, Juzo application and measurement, 5-lead telemetry, oral airway insertion, hemovac/Jackson Pratt, oral pharyngeal suctioning, urinary catheter insertion, dry suction chest drainage, bed to cart/slider board, urinary catheter removal, antiembolism stockings, measurement and application, removal of

  14. Clinical performance of a dermal filler containing natural glycolic Acid and a polylactic Acid polymer: results of a clinical trial in human immunodeficiency virus subjects with facial lipoatrophy.

    PubMed

    Tagle, Jorge M; Macchetto, Pedro Cervantes; Durán Páramo, Rosa Margarita

    2010-02-01

    : seven in two sessions, eight in three sessions, 14 in four sessions, and one in five sessions. Each treatment session was separated by approximately 20 days as per the manufacturer's instructions. The follow-up phase consisted of four observation periods over two years from the last injection. The primary efficacy endpoint was measurement of correction of human immunodeficiency virus highly active antiretroviral therapy induced facial lipoatrophy. Using a multipoint scale of facial divergence, correction was measured as a percentage of correction (diversion correction percentage) from baseline. A secondary endpoint was safety based upon the incidence and type of adverse events experienced. All 30 patients completed the active treatment phase with 100 percent (N=30) undergoing at least two treatments at Days 1 and 20 after entry into study. Seventy-four percent (n=23) underwent a third treatment at Day 60, and 50 percent (n=15) received a fourth treatment at Day 80. A single subject received a fifth treatment at Day 100. There were no serious adverse events and no adverse events noted during the study period. Histology through skin biopsy (2mm punch) was performed on 10 subjects, and all subjects had dermal skin thickness measured with ultrasound. Histology demonstrated a foreign body reaction with multinucleated giant cells with phagocytized lactate crystals. New collagen formation was demonstrated. United States measurements of dermal skin thickness increase ranged from 0.22cm to 0.37cm. All subjects were rated for expected injection events to include erythema, edema, ecchymosis, and hematoma. This dermal collagen stimulator containing glycolic acid and polylactic acid represents a tangible alternative in therapeutic and aesthetic medicine. More than four years of clinical trials have demonstrated that this dermal collagen stimulator helps to improve the exterior quality of the skin while restoring lost facial volumes. Patient satisfaction was high due to its

  15. [Dogs babesiosis--still actually problem].

    PubMed

    Adaszek, Łukasz; Winiarczyk, Stanisław

    2008-01-01

    Babesiosis (piroplasmosis) is a tick-borne disease with a symptoms of hemolytic anemia. For the first time babesiosis was described in dogs in United States in 1934. The etiological factor of this disease in Poland is protozoa Babesia canis, and its vector--Dermacentor-tick. The most common symptoms of babesiosis are: icterus, hemoglobinuria, occasionally vomits and diarrhea. The biochemical examination of blood serum from sick animals can reveal the increase of activity of AST, ALT, the increase of total bilirubine, urea and creatynine concentrations. The results of hematological examinations can show anemia, leucopenia and thrombocytopenia. The diagnosis of babesiosis bases on anamnesis, clinical examinations of dogs, microscopical examinations of blood smears from sick animals; IF-assay and PCR can also be helpful for the diagnosis of babesiosis. Till now does not exist the effective immunoprophylaxis against this disease. Babesiosis is well-known disease, however there are still problems with therapy of infected animals. Most effective drug in therapy of dog piroplasmosis is imidocarb, but sometimes can be observed side effects after it application. It is possible that the genetically differences which are detected in subspecies may have an influence on the severity of disease and the effectiveness of therapy.

  16. Strontium and Actinides Removal from Savannah River Site Actual Waste Samples by Freshly Precipitated Manganese Oxide

    SciTech Connect

    Barnes, M.J.

    2003-10-30

    The authors investigated the performance of freshly precipitated manganese oxide and monosodium titanate (MST) for the removal of strontium (Sr) and actinides from actual high-level waste. Manganese oxide precipitation occurs upon addition of a reductant such as formate (HCO2-) or peroxide (H2O2) to a waste solution containing permanganate (MnO4-). Tests described in this document address the capability of manganese oxide treatment to remove Rs, Pu, and Np from actual high-level waste containing elevated concentrations of Pu. Additionally, tests investigate MST (using two unique batches) performance with the same waste for direct comparison to the manganese oxide performance.

  17. Performance of 3 real-time PCR assays for direct detection of Staphylococcus aureus and MRSA from clinical samples.

    PubMed

    Mehta, Maitry S; McClure, J T; Mangold, Kathy; Peterson, Lance R

    2015-11-01

    We compared 3 real-time PCR assays: off-label use of 2 commercial assays (BD-GeneOhm™ MRSA assay for methicillin-resistant Staphylococcus aureus [MRSA] detection and BD-GeneOhm StaphSR™ for MRSA and methicillin-susceptible S. aureus detection) and an in-house real-time PCR assay for detection of total S. aureus from clinical specimens. Testing was performed on 200 distinct specimens. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using culture as the gold standard. The prevalence of S. aureus in the samples was 44.5%, and MRSA was 20%. For total S. aureus, the StaphSR-PCR and the in-house PCR assays had a sensitivity and specificity of 94.4% and 96.4% and 93.3% and 99.1%, respectively. For MRSA detection, the StaphSR and the BD GeneOhm assay had a sensitivity and specificity of 92.5% and 98.8% and 92.5% and 96.3%, respectively. This study demonstrates the potential use of tests like the StaphSR-PCR assay for rapid detection of S. aureus and MRSA directly from clinical specimens; however, culture follow-up would be needed to identify other potential pathogens in the specimen.

  18. Clinical performance of a new levonorgestrel-releasing intrauterine device. A randomized comparison with a nova-T-copper device.

    PubMed

    Nilsson, C G; Luukkainen, T; Diaz, J; Allonen, H

    1982-04-01

    The clinical performance of two levonorgestrel-releasing intrauterine devices (IUDs) with different release rates was studied and compared with a copper-releasing Nova-T device in a randomized partly double-blind multiclinical trial. Special attention was given to patterns of bleeding, hormonal side-effects, blood pressure and body weight. The clinical acceptability of the levonorgestrel IUDs was as good as that of the copper-releasing IUD. A highly significant decrease in the amount of menstrual blood loss was seen with the levonorgestrel-IUDs, the users of which experienced fewer days of bleeding than prior to insertion. Patients suffering from dysmenorrhea experienced relief from this symptom after insertion of a levonorgestrel-IUD. Some side-effects, usually referred to as hormonal, increased during the levonorgestrel-IUD use, but did not result in higher termination rates than with the Nova-T device. No changes in body weight were recorded for the levonorgestrel-IUDs and a slight decrease in both systolic and diastolic blood pressure was found after one year of use. No infections were recorded.

  19. Identifying Engineering, Clinical and Patient's Metrics for Evaluating and Quantifying Performance of Brain-Machine Interface (BMI) Systems

    PubMed Central

    Contreras-Vidal, Jose L.

    2015-01-01

    Brain-machine interface (BMI) devices have unparalleled potential to restore functional movement capabilities to stroke, paralyzed and amputee patients. Although BMI systems have achieved success in a handful of investigative studies, translation of closed-loop neuroprosthetic devices from the laboratory to the market is challenged by gaps in the scientific data regarding long-term device reliability and safety, uncertainty in the regulatory, market and reimbursement pathways, lack of metrics for evaluating and quantifying performance in BMI systems, as well as patient-acceptance challenges that impede their fast and effective translation to the end user. This review focuses on the identification of engineering, clinical and user's BMI metrics for new and existing BMI applications. PMID:26330746

  20. Gauging triple stores with actual biological data

    PubMed Central

    2012-01-01

    Background Semantic Web technologies have been developed to overcome the limitations of the current Web and conventional data integration solutions. The Semantic Web is expected to link all the data present on the Internet instead of linking just documents. One of the foundations of the Semantic Web technologies is the knowledge representation language Resource Description Framework (RDF). Knowledge expressed in RDF is typically stored in so-called triple stores (also known as RDF stores), from which it can be retrieved with SPARQL, a language designed for querying RDF-based models. The Semantic Web technologies should allow federated queries over multiple triple stores. In this paper we compare the efficiency of a set of biologically relevant queries as applied to a number of different triple store implementations. Results Previously we developed a library of queries to guide the use of our knowledge base Cell Cycle Ontology implemented as a triple store. We have now compared the performance of these queries on five non-commercial triple stores: OpenLink Virtuoso (Open-Source Edition), Jena SDB, Jena TDB, SwiftOWLIM and 4Store. We examined three performance aspects: the data uploading time, the query execution time and the scalability. The queries we had chosen addressed diverse ontological or biological questions, and we found that individual store performance was quite query-specific. We identified three groups of queries displaying similar behaviour across the different stores: 1) relatively short response time queries, 2) moderate response time queries and 3) relatively long response time queries. SwiftOWLIM proved to be a winner in the first group, 4Store in the second one and Virtuoso in the third one. Conclusions Our analysis showed that some queries behaved idiosyncratically, in a triple store specific manner, mainly with SwiftOWLIM and 4Store. Virtuoso, as expected, displayed a very balanced performance - its load time and its response time for all the

  1. Use of Self-Organizing Maps for Balanced Scorecard analysis to monitor the performance of dialysis clinic chains.

    PubMed

    Cattinelli, Isabella; Bolzoni, Elena; Barbieri, Carlo; Mari, Flavio; Martin-Guerrero, José David; Soria-Olivas, Emilio; Martinez-Martinez, José Maria; Gomez-Sanchis, Juan; Amato, Claudia; Stopper, Andrea; Gatti, Emanuele

    2012-03-01

    The Balanced Scorecard (BSC) is a validated tool to monitor enterprise performances against specific objectives. Through the choice and the evaluation of strategic Key Performance Indicators (KPIs), it provides a measure of the past company's outcome and allows planning future managerial strategies. The Fresenius Medical Care (FME) BSC makes use of 30 KPIs for a continuous quality improvement strategy within its dialysis clinics. Each KPI is monthly associated to a score that summarizes the clinic efficiency for that month. Standard statistical methods are currently used to analyze the BSC data and to give a comprehensive view of the corporate improvements to the top management. We herein propose the Self-Organizing Maps (SOMs) as an innovative approach to extrapolate information from the FME BSC data and to present it in an easy-readable informative form. A SOM is a computational technique that allows projecting high-dimensional datasets to a two-dimensional space (map), thus providing a compressed representation. The SOM unsupervised (self-organizing) training procedure results in a map that preserves similarity relations existing in the original dataset; in this way, the information contained in the high-dimensional space can be more easily visualized and understood. The present work demonstrates the effectiveness of the SOM approach in extracting useful information from the 30-dimensional BSC dataset: indeed, SOMs enabled both to highlight expected relationships between the KPIs and to uncover results not predictable with traditional analyses. Hence we suggest SOMs as a reliable complementary approach to the standard methods for BSC interpretation.

  2. Computer-aided detection in full-field digital mammography in a clinical population: performance of radiologist and technologists.

    PubMed

    van den Biggelaar, Frank J H M; Kessels, Alphons G H; van Engelshoven, Jos M A; Boetes, Carla; Flobbe, Karin

    2010-04-01

    The purpose of the study was to evaluate the impact of a computer-aided detection (CAD) system on the performance of mammogram readers in interpreting digital mammograms in a clinical population. Furthermore, the ability of a CAD system to detect breast cancer in digital mammography was studied in comparison to the performance of radiologists and technologists as mammogram readers. Digital mammograms of 1,048 consecutive patients were evaluated by a radiologist and three technologists. Abnormalities were recorded and an imaging conclusion was given as a BI-RADS score before and after CAD analysis. Pathology results during 12 months follow up were used as a reference standard for breast cancer. Fifty-one malignancies were found in 50 patients. Sensitivity and specificity were computed before and after CAD analysis and provided with 95% CIs. In order to assess the detection rate of malignancies by CAD and the observers, the pathological locations of these 51 breast cancers were matched with the locations of the CAD marks and the mammographic locations that were considered to be suspicious by the observers. For all observers, the sensitivity rates did not change after application of CAD. A mean sensitivity of 92% was found for all technologists and 84% for the radiologist. For two technologists, the specificity decreased (from 84 to 83% and from 77 to 75%). For the radiologist and one technologist, the application of CAD did not have any impact on the specificity rates (95 and 83%, respectively). CAD detected 78% of all malignancies. Five malignancies were indicated by CAD without being noticed as suspicious by the observers. In conclusion, the results show that systematic application of CAD in a clinical patient population failed to improve the overall sensitivity of mammogram interpretation by the readers and was associated with an increase in false-positive results. However, CAD marked five malignancies that were missed by the different readers. PMID:19418215

  3. Use of Self-Organizing Maps for Balanced Scorecard analysis to monitor the performance of dialysis clinic chains.

    PubMed

    Cattinelli, Isabella; Bolzoni, Elena; Barbieri, Carlo; Mari, Flavio; Martin-Guerrero, José David; Soria-Olivas, Emilio; Martinez-Martinez, José Maria; Gomez-Sanchis, Juan; Amato, Claudia; Stopper, Andrea; Gatti, Emanuele

    2012-03-01

    The Balanced Scorecard (BSC) is a validated tool to monitor enterprise performances against specific objectives. Through the choice and the evaluation of strategic Key Performance Indicators (KPIs), it provides a measure of the past company's outcome and allows planning future managerial strategies. The Fresenius Medical Care (FME) BSC makes use of 30 KPIs for a continuous quality improvement strategy within its dialysis clinics. Each KPI is monthly associated to a score that summarizes the clinic efficiency for that month. Standard statistical methods are currently used to analyze the BSC data and to give a comprehensive view of the corporate improvements to the top management. We herein propose the Self-Organizing Maps (SOMs) as an innovative approach to extrapolate information from the FME BSC data and to present it in an easy-readable informative form. A SOM is a computational technique that allows projecting high-dimensional datasets to a two-dimensional space (map), thus providing a compressed representation. The SOM unsupervised (self-organizing) training procedure results in a map that preserves similarity relations existing in the original dataset; in this way, the information contained in the high-dimensional space can be more easily visualized and understood. The present work demonstrates the effectiveness of the SOM approach in extracting useful information from the 30-dimensional BSC dataset: indeed, SOMs enabled both to highlight expected relationships between the KPIs and to uncover results not predictable with traditional analyses. Hence we suggest SOMs as a reliable complementary approach to the standard methods for BSC interpretation. PMID:22083440

  4. The Effect of Nursing Faculty Presence on Students' Level of Anxiety, Self-Confidence, and Clinical Performance during a Clinical Simulation Experience

    ERIC Educational Resources Information Center

    Horsley, Trisha Leann

    2012-01-01

    Nursing schools design their clinical simulation labs based upon faculty's perception of the optimal environment to meet the students' learning needs, other programs' success with integrating high-tech clinical simulation, and the funds available. No research has been conducted on nursing faculty presence during a summative…

  5. The effect of intrauterine infusion of dextrose on clinical endometritis cure rate and reproductive performance of dairy cows.

    PubMed

    Machado, V S; Oikonomou, G; Ganda, E K; Stephens, L; Milhomem, M; Freitas, G L; Zinicola, M; Pearson, J; Wieland, M; Guard, C; Gilbert, R O; Bicalho, R C

    2015-06-01

    The main objective of this study was to evaluate the intrauterine administration use of 200 mL of 50% dextrose solution as a treatment against clinical endometritis (CE); CE cure rate and reproductive performance were evaluated. Additionally, the association of several relevant risk factors, such as retained placenta (RP), metritis, CE, anovulation, hyperketonemia, and body condition score with reproductive performance, early embryonic mortality, and CE were evaluated. A total of 1,313 Holstein cows housed on 4 commercial dairy farms were enrolled in the study. At 7±3 DIM cows were examined for metritis and had blood collected to determine serum β-hydroxybutyrate concentration. To determine if cows had ovulated at least once before 44±3 DIM, the presence of a corpus luteum was evaluated by ovarian ultrasonography at 30±3 DIM and at 44±3 DIM. At 30±3 DIM, CE was diagnosed using the Metricheck device (SimcroTech, Hamilton, New Zealand); cows with purulent or mucopurulent vaginal discharge were diagnosed as having CE. Cows diagnosed with CE (n=175) were randomly allocated into 2 treatment groups: treatment (intrauterine infusion of 200 mL of 50% dextrose) or control (no infusion). Clinical endometritis cows were re-evaluated as described above at 44±3 DIM, and cows that were free of purulent or mucopurulent vaginal discharge were considered cured. Intrauterine infusion of dextrose tended to have a detrimental effect on CE cure rate, and treatment did not have an effect on first-service conception rate and early embryonic mortality. A multivariable Cox's proportional hazard model was performed to evaluate the effect of several variables on reproductive performance; the variables RP, CE, parity, anovulation, and the interaction term between parity and anovulation were associated with hazard of pregnancy. Cows that did not have RP or CE were more likely to conceive than cows that were diagnosed with RP or CE. Cows that had RP were at 3.36 times higher odds of

  6. Discomfort Glare: What Do We Actually Know?

    SciTech Connect

    Clear, Robert D.

    2012-04-19

    We reviewed glare models with an eye for missing conditions or inconsistencies. We found ambiguities as to when to use small source versus large source models, and as to what constitutes a glare source in a complex scene. We also found surprisingly little information validating the assumed independence of the factors driving glare. A barrier to progress in glare research is the lack of a standardized dependent measure of glare. We inverted the glare models to predict luminance, and compared model predictions against the 1949 Luckiesh and Guth data that form the basis of many of them. The models perform surprisingly poorly, particularly with regards to the luminance-size relationship and additivity. Evaluating glare in complex scenes may require fundamental changes to form of the glare models.

  7. [Analytical performances of the i-STAT portable clinical analyzer for the measurement of PO2 and PCO2].

    PubMed

    Sachs, C; Finetti, P; Rabouine, P; Abdoulaye, F

    2002-01-01

    Aware of some limitations on blood gas results, we performed an extensive evaluation before introducing i-STATs in our hospitals. Three i-STATs were tested in parallel with an ABL-520, on three types of cartridges (EG7, EG6 and EG3), using tonometered whole blood (9 gas levels, n = 720) and aqueous QC solutions (3 levels, n = 600). Reference systems were the theoretical calculated values from gas composition used for tonometry and results given by the ABL-520, respectively. On aqueous controls dispersion intervals reached 10-20 mmHg for both analytes for inter-lot as well as intra-lot data. PO2 values on blood showed marked dispersion: 5 mmHg (CV = 2 to 7%) at clinically critical levels. PCO2 showed several (10%) major outliers: mV recording of the PCO2 electrode allowed to incriminate a pre-humidification problem (due to incorrect shipping conditions). Once outliers have been discarted, there still was a 5 mmHg non negligible residual dispersion (CV = 3 to 5%). i-STAT analytical performances for blood gases which are the analytes whose determination at the bed-side is potentially the most useful, do not match capabilities of classical laboratory instruments. Thus even though the i-STAT approach represents a seducive solution for the STAT problem, for the moment, it's use cannot be recommended in a hospital environment where classical instruments can be made available.

  8. Standardization in Clinical Enzymology – Results of a Survey Performed in 2008 in Big Hospital Laboratories in Poland

    PubMed Central

    Pollak, Joanna

    2009-01-01

    The survey was performed in December 2008 in 21 big hospital laboratories in Poland. The purpose of this survey was to estimate how the IFCC standardization in clinical enzymology is recognized and followed in medical laboratories. Each participant received a short questionnaire in an electronic version consisting of 5 questions dealing with the main features for the Reference Procedures for measurement of catalytic activity concentrations of CK, LDH, GGTP, AST and ALT. Measurement temperature for all enzyme assays in question was 37°C and wavelenght was 340 nm for LDH, ALT, AST and CK in all but one lab. Most of laboratories (80%) performed GGTP assay according to the reference procedure. Surprisingly, the methods used for the LDH measurement were discordant with the IFCC reference procedure in respect to reaction principle in 50% of laboratories. On the other hand, methods for measurements of catalytic activity concentration of ALT and AST were incompatible with the IFCC reference procedures in respect to reaction mixture composition in 55% of laboratories.

  9. Indicated and actual mass inventory measurements for an inverted U-tube steam generator

    SciTech Connect

    Loomis, G.G.; Plessinger, M.P.; Boucher, T.J.

    1986-01-01

    Results from an experimental investigation of actual versus indicated secondary liquid level in a steam generator at steaming conditions are presented. The experimental investigation was performed in two different small scale U-tube-in-shell steam generators at typical pressurized water reactor operating conditions (5-7 MPa; saturated) in the Semiscale facility. During steaming conditions, the indicated secondary liquid level was found to vary considerably from the actual ''bottled-up'' liquid level. These difference between indicated and actual liquid level are related to the frictional pressure drop associated with the two-phase steaming condition in the riser. Data from a series of bottle-up experiments (Simultaneously, the primary heat source and secondary feed and steam are terminated) are tabulated and the actual liquid level is correlated to the indicated liquid level.

  10. Neuromuscular adaptation to actual and simulated weightlessness

    NASA Technical Reports Server (NTRS)

    Edgerton, V. R.; Roy, R. R.

    1994-01-01

    The chronic "unloading" of the neuromuscular system during spaceflight has detrimental functional and morphological effects. Changes in the metabolic and mechanical properties of the musculature can be attributed largely to the loss of muscle protein and the alteration in the relative proportion of the proteins in skeletal muscle, particularly in the muscles that have an antigravity function under normal loading conditions. These adaptations could result in decrements in the performance of routine or specialized motor tasks, both of which may be critical for survival in an altered gravitational field, i.e., during spaceflight and during return to 1 G. For example, the loss in extensor muscle mass requires a higher percentage of recruitment of the motor pools for any specific motor task. Thus, a faster rate of fatigue will occur in the activated muscles. These consequences emphasize the importance of developing techniques for minimizing muscle loss during spaceflight, at least in preparation for the return to 1 G after spaceflight. New insights into the complexity and the interactive elements that contribute to the neuromuscular adaptations to space have been gained from studies of the role of exercise and/or growth factors as countermeasures of atrophy. The present chapter illustrates the inevitable interactive effects of neural and muscular systems in adapting to space. It also describes the considerable progress that has been made toward the goal of minimizing the functional impact of the stimuli that induce the neuromuscular adaptations to space.

  11. [Tuberculosis: actual problems with diagnosis and treatment].

    PubMed

    Korzeniewska-Koseła, Maria

    2016-01-01

    Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex. It remains health problem also in developed countries. Most common form of tuberculosis is pulmonary disease but other sites of the body can be affected (extrapulmonary TB). As TB incidence falls, the probability of developing active diseases in people infected with M. tuberculosis is higher among imunocompromised people and in people from risk groups. People who present with unexplained cough lasting two or more weeks or with findings suggestive of tuberculosis on chest radiographs should be evaluated for tuberculosis. For patients suspected of having pulmonary or extrapulmonary tuberculosis specimens from the sites of involvement should be obtained for microbiological tests. Bronchoscopy and BAL should be performed in patients that do not produce sputum and with negative sputum smears. Ct scan may also play an important role in the evaluation of patients suspected of having TB but with negative sputum smears. The standard therapy for TB should consist of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol in the initial phase and of isoniazid and rifampicin given for 4 months (the continuation phase). PMID:27421129

  12. Dynamical stability in the acquisition and performance of rhythmic ball manipulation: theoretical insights with a clinical slant.

    PubMed

    Sternad, Dagmar; Dijkstra, Tjeerd M H

    2004-01-01

    Three experiments illustrate how a task-based approach and dynamical modeling of a perceptual-motor task can provide a useful framework for understanding functional and dysfunctional behavior. In the chosen task, subjects held a racket and bounced a ball rhythmically in the air with invariant ball amplitude. As such, the task could be cast into a mechanical model that encompassed the movements of the actor (racket) and the manipulandum (ball). In this form, the movement task is a dynamical system that displays dynamical stability, i.e., performance where perturbations die out by themselves. The hypothesis is that skilled actors seek to perform with this "passive" stability as it alleviates the control demands because perturbations do not require explicit corrections. In the experimental data, this strategy could be characterized by a single parameter, the acceleration of the racket at impact, which provided quantitative predictions. Experiment 1 established that subjects with normal sensorimotor functions indeed performed with racket acceleration values that were predicted to provide passive stability. Experiment 2 showed that subjects improved their skill over a course of 40 practice trials, as evidenced in decreased variability and accompanied by a change in racket acceleration toward values that provided optimal stability. In experiment 3, perturbations were applied and the subjects' adaptability was tested. When perturbations were large enough, subjects altered their racket timing to resume contact that provided stability. The results are discussed with their relevance to clinical contexts: How can such a task-based approach provide insights into the control of functional and dysfunctional movements? Can such behavioral results serve as a diagnostic tool? How can this approach to sensorimotor behavior stimulate physicians and therapists to progress therapeutic measures?

  13. Developing search strategies for clinical practice guidelines in SUMSearch and Google Scholar and assessing their retrieval performance

    PubMed Central

    Haase, Andrea; Follmann, Markus; Skipka, Guido; Kirchner, Hanna

    2007-01-01

    Background Information overload, increasing time constraints, and inappropriate search strategies complicate the detection of clinical practice guidelines (CPGs). The aim of this study was to provide clinicians with recommendations for search strategies to efficiently identify relevant CPGs in SUMSearch and Google Scholar. Methods We compared the retrieval efficiency (retrieval performance) of search strategies to identify CPGs in SUMSearch and Google Scholar. For this purpose, a two-term GLAD (GuideLine And Disease) strategy was developed, combining a defined CPG term with a specific disease term (MeSH term). We used three different CPG terms and nine MeSH terms for nine selected diseases to identify the most efficient GLAD strategy for each search engine. The retrievals for the nine diseases were pooled. To compare GLAD strategies, we used a manual review of all retrievals as a reference standard. The CPGs detected had to fulfil predefined criteria, e.g., the inclusion of therapeutic recommendations. Retrieval performance was evaluated by calculating so-called diagnostic parameters (sensitivity, specificity, and "Number Needed to Read" [NNR]) for search strategies. Results The search yielded a total of 2830 retrievals; 987 (34.9%) in Google Scholar and 1843 (65.1%) in SUMSearch. Altogether, we found 119 unique and relevant guidelines for nine diseases (reference standard). Overall, the GLAD strategies showed a better retrieval performance in SUMSearch than in Google Scholar. The performance pattern between search engines was similar: search strategies including the term "guideline" yielded the highest sensitivity (SUMSearch: 81.5%; Google Scholar: 31.9%), and search strategies including the term "practice guideline" yielded the highest specificity (SUMSearch: 89.5%; Google Scholar: 95.7%), and the lowest NNR (SUMSearch: 7.0; Google Scholar: 9.3). Conclusion SUMSearch is a useful tool to swiftly gain an overview of available CPGs. Its retrieval performance is

  14. Isolating the actual signal of paleointensity?

    NASA Astrophysics Data System (ADS)

    Valet, J. M.; Moreno, E.; Bassinot, F.; Herrero-Bervera, E.

    2011-12-01

    Signals of relative and absolute paleointensity suffer inaccuracies and contaminations that must be considered to improve our knowledge of the field variations. Climatically related changes in rock magnetic parameters are frequently suspected of influencing the signal of relative paleointensity extrated from marine sediments. High resolution measurements of climatic and magnetic parameters have been performed on two cores from the eastern China Sea and the western Caroline Basin. On both cores, magnetic parameters show a strong imprint of climatic changes but the absence of relationship between the inclination and the bulk density indicates that the directional changes do not depend on lithology. All normalization parameters yielded similar estimates of relative paleointensity (RPI), but we have noticed the persistence of climatic components in the signal. Principal Component Analysis (PCA) applied to different parameters related to climate, lithology and paleointensity has allowed to extract a "clean" magnetic signal that we refer as "principal component of paleointensity (PCP)" which is in better agreement with the Sint-2000 composite curve and provides a reliable record of relative paleointensity. The presence of climatic frequencies in RPIs most likely reflects the influence of lithology on the response of magnetization to field intensity. We suggest that PCA analysis can be very useful to approach these problems. Not only can the calculation separate overlapping climatic and magnetic signals, but it indicates what confidence should be given to the data. Incidentally, the present results emphasize the importance of carrying out detailed paleoclimatic analyses along with paleointensity studies. Many approaches have been proposed during the past 20 years for experiments of absolute paleointensity in order to reduce the duration of the experiments and increase the number of field determinations. However, this is frequently obtained to the detriment of the accuracy

  15. Dual-energy X-ray performs as well as clinical computed tomography for the measurement of visceral fat.

    PubMed

    Micklesfield, Lisa K; Goedecke, Julia H; Punyanitya, Mark; Wilson, Kevin E; Kelly, Thomas L

    2012-05-01

    Visceral adipose tissue (VAT) is associated with adverse health effects including cardiovascular disease and type 2 diabetes. We developed a dual-energy X-ray absorptiometry (DXA) measurement of visceral adipose tissue (DXA-VAT) as a low cost and low radiation alternative to computed tomography (CT). DXA-VAT was compared to VAT assessed using CT by an expert reader (E-VAT). In addition, the same CT slice was also read by a clinical radiographer (C-VAT) and a best-fit anthropomorphic and demographic VAT model (A-VAT) was developed. Whole body DXA, CT at L4-L5, and anthropometry were measured on 272 black and white South African women (age 29 ± 8 years, BMI 28 ± 7 kg/m(2), waist circumference (WC) 89 ± 16 cm). Approximately one-half of the dataset (n = 141) was randomly selected and used as a training set for the development of DXA-VAT and A-VAT, which were then used to estimate VAT on the remaining 131 women in a blinded fashion. DXA-VAT (r = 0.93, standard error of the estimate (SEE) = 16 cm(2)) and C-VAT (r = 0.93, SEE = 16 cm(2)) were strongly correlated to E-VAT. These correlations with E-VAT were significantly stronger (P < 0.001) than the correlations of individual anthropometry measurements and the A-VAT model (WC + age, r = 0.79, SEE = 27 cm(2)). The inclusion of anthropometric and demographic measurements did not substantially improve the correlation between DXA-VAT and E-VAT. DXA-VAT performed as well as a clinical read of VAT from a CT scan and better than anthropomorphic and demographic models. PMID:22240726

  16. Preclinical and Clinical Performance of the Efoora Test, a Rapid Test for Detection of Human Immunodeficiency Virus-Specific Antibodies

    PubMed Central

    Arens, Max Q.; Mundy, Linda M.; Amsterdam, Daniel; Barrett, J. Tom; Bigg, Dan; Bruckner, David; Hanna, Bruce; Prince, Harry; Purington, Timothy; Hanna, Todd; Hewitt, Ross; Kalinka, Carolyn; Koppes, Thomas; Maxwell, Sarz; Moe, Ardis; Doymaz, Mehmet; Poulter, Melinda; Saber-Tehrani, Maryam; Simard, Lorenzo; Wilkins-Carmody, Donna; Vidaver, John; Berger, Cheryl; Davis, Alan H.; Alzona, Mortimer T.

    2005-01-01

    Barriers to effective diagnostic testing for human immunodeficiency virus type 1 (HIV-1) infection can be reduced with simple, reliable, and rapid detection methods. Our objective was to determine the accuracy, sensitivity, and specificity of a new rapid, lateral-flow immunochromatographic HIV-1 antibody detection device. Preclinical studies were performed using seroconversion, cross-reaction, and interference panels, archived clinical specimens, and fresh whole blood. In a multicenter, prospective clinical trial, a four-sample matrix of capillary (fingerstick) whole-blood specimens and venous whole blood, plasma, and serum was tested for HIV-1 antibodies with the Efoora HIV rapid test (Efoora Inc., Buffalo Grove, IL) and compared with an enzyme immunoassay (EIA) (Abbott Laboratories) licensed by the Food and Drug Administration. Western blot and nucleic acid test supplemental assays were employed to adjudicate discordant samples. Preclinical testing of seroconversion panels showed that antibodies were often detected earlier by the rapid test than by a reference EIA. No significant interference or cross-reactions were observed. Testing of 4,984 archived specimens yielded a sensitivity of 99.2% and a specificity of 99.7%. A prospective multicenter clinical study with 2,954 adult volunteers demonstrated sensitivity and specificity for the Efoora HIV rapid test of 99.8% (95% confidence interval [CI], 99.3 and 99.98%) and 99.0% (95% CI, 98.5 and 99.4%), respectively. Reactive rapid HIV-1 antibody detection was confirmed in 99.6% of those with a known HIV infection (n = 939), 5.2% of those in the high-risk group (n = 1,003), and 0.1% of those in the low-risk group (n = 1,012). For 21 (0.71%) patients, there was discordance between the results of the rapid test and the confirmatory EIA/Western blot tests. We conclude that the Efoora HIV rapid test is a simple, rapid assay for detection of HIV-1 antibodies, with high sensitivity and specificity compared to a standardized

  17. Thermal Protection System Cavity Heating for Simplified and Actual Geometries Using Computational Fluid Dynamics Simulations with Unstructured Grids

    NASA Technical Reports Server (NTRS)

    McCloud, Peter L.

    2010-01-01

    Thermal Protection System (TPS) Cavity Heating is predicted using Computational Fluid Dynamics (CFD) on unstructured grids for both simplified cavities and actual cavity geometries. Validation was performed using comparisons to wind tunnel experimental results and CFD predictions using structured grids. Full-scale predictions were made for simplified and actual geometry configurations on the Space Shuttle Orbiter in a mission support timeframe.

  18. An Analysis of the Actual Processes of Physicists' Research and the Implications for Teaching Scientific Inquiry in School

    ERIC Educational Resources Information Center

    Park, Jongwon; Jang, Kyoung-Ae; Kim, Ikgyun

    2009-01-01

    Investigation of scientists' actual processes of conducting research can provide us with more realistic aspects of scientific inquiry. This study was performed to identify three aspects of scientists' actual research: their motivations for scientific inquiry, the scientific inquiry skills they used, and the main types of results obtained from…

  19. Automated versus Manual Sample Inoculations in Routine Clinical Microbiology: a Performance Evaluation of the Fully Automated InoqulA Instrument

    PubMed Central

    Froment, P.; Marchandin, H.; Vande Perre, P.

    2014-01-01

    The process of plate streaking has been automated to improve the culture readings, isolation quality, and workflow of microbiology laboratories. However, instruments have not been well evaluated under routine conditions. We aimed to evaluate the performance of the fully automated InoqulA instrument (BD Kiestra B.V., The Netherlands) in the automated seeding of liquid specimens and samples collected using swabs with transport medium. We compared manual and automated methods according to the (i) within-run reproducibility using Escherichia coli-calibrated suspensions, (ii) intersample contamination using a series of alternating sterile broths and broths with >105 CFU/ml of either E. coli or Proteus mirabilis, (iii) isolation quality with standardized mixed bacterial suspensions of diverse complexity and a 4-category standardized scale (very poor, poor, fair to good, or excellent), and (iv) agreement of the results obtained from 244 clinical specimens. By involving 15 technicians in the latter part of the comparative study, we estimated the variability in the culture quality at the level of the laboratory team. The instrument produced satisfactory reproducibility with no sample cross-contamination, and it performed better than the manual method, with more colony types recovered and isolated (up to 11% and 17%, respectively). Finally, we showed that the instrument did not shorten the seeding time over short periods of work compared to that for the manual method. Altogether, the instrument improved the quality and standardization of the isolation, thereby contributing to a better overall workflow, shortened the time to results, and provided more accurate results for polymicrobial specimens. PMID:24353001

  20. Performance evaluation of Puritan® universal transport system (UniTranz-RT™) for preservation and transport of clinical viruses.

    PubMed

    Brasel, Trevor; Madhusudhan, Kunapuli T; Agans, Krystle; Dearen, Karen; Jones, Sara L; Sherwood, Robert L

    2015-10-01

    The ability of a non-propagating microbial transport medium to maintain the viability of clinically relevant viruses was compared to a similar commercial medium to establish performance equivalence. Two dilutions of stock of test viruses, namely adenovirus (AdV), cytomegalovirus (CMV), echovirus Type 30 (EV), herpes simplex virus (HSV) types 1 and 2, influenza A, parainfluenza 3 (PIV), respiratory syncytial virus (RSV), and varicella zoster virus (VZV), were spiked into Puritan® Medical Products Company Universal Transport System (UniTranz-RT™) and BD(TM) Universal Viral Transport System (UVT) and incubated at 4 °C and room temperature (RT) for up to 72 hr. Post incubation assessment of recovery of AdV, EV, HSV-2, PIV, and VZV from UniTranz-RT™ and UVT using shell vial assays followed by immunofluorescence staining demonstrated statistically significant differences between both transport media. In general, significantly higher recoveries of AdV, EV, and VZV were found from UniTranz-RT™ than UVT whereas HSV-2 and PIV were recovered better from UVT than UniTranz-RT™, under specific test conditions. The recovery of HSV-1, influenza A, PIV, and RSV showed no significant differences between transport media. Sulforhodamine B-based assay analysis of UniTranz-RT™ lots prior to and at expiration exhibited no cytotoxicity. The overall results of the study validate the full performance of UniTranz-RT™ as a viral transport medium and establish its effectiveness on par with the UVT.

  1. Application of the Sherlock Mycobacteria Identification System using high-performance liquid chromatography in a clinical laboratory.

    PubMed

    Kellogg, J A; Bankert, D A; Withers, G S; Sweimler, W; Kiehn, T E; Pfyffer, G E

    2001-03-01

    There is a growing need for a more accurate, rapid, and cost-effective alternative to conventional tests for identification of clinical isolates of Mycobacterium species. Therefore, the ability of the Sherlock Mycobacteria Identification System (SMIS; MIDI, Inc.) using computerized software and a Hewlett-Packard series 1100 high-performance liquid chromatograph to identify mycobacteria was compared to identification using phenotypic characteristics, biochemical tests, probes (Gen-Probe, Inc.), gas-liquid chromatography, and, when necessary, PCR-restriction enzyme analysis of the 65-kDa heat shock protein gene and 16S rRNA gene sequencing. Culture, harvesting, saponification, extraction, derivatization, and chromatography were performed following MIDI's instructions. Of 370 isolates and stock cultures tested, 327 (88%) were given species names by the SMIS. SMIS software correctly identified 279 of the isolates (75% of the total number of isolates and 85% of the named isolates). The overall predictive value of accuracy (correct calls divided by total calls of a species) for SMIS species identification was 85%, ranging from only 27% (3 of 11) for M. asiaticum to 100% for species or groups including M. malmoense (8 of 8), M. nonchromogenicum (11 of 11), and the M. chelonae-abscessus complex (21 of 21). By determining relative peak height ratios (RPHRs) and relative retention times (RRTs) of selected mycolic acid peaks, as well as phenotypic properties, all 48 SMIS-misidentified isolates and 39 (91%) of the 43 unidentified isolates could be correctly identified. Material and labor costs per isolate were $10.94 for SMIS, $26.58 for probes, and $42.31 for biochemical identification. The SMIS, combined with knowledge of RPHRs, RRTs, and phenotypic characteristics, offers a rapid, reasonably accurate, cost-effective alternative to more traditional methods of mycobacterial species identification.

  2. The relation between actual exposure to political violence and preparatory intervention for exposure to media coverage of terrorism.

    PubMed

    Slone, Michelle; Shoshani, Anat; Baumgarten-Katz, Inbar

    2008-07-01

    This laboratory study examined differential effects of television broadcasts of terrorism on viewers' anxiety according to their actual exposure history, and differential efficacy of a preparatory intervention in moderating elevated anxiety for high or low actual exposure. Participants were 80 young Israeli adults, randomly allocated to a terrorism or non-terrorism media broadcast, and for each type of exposure, to a preparatory or control intervention. Actual political violence and terrorism exposure history was assessed, and anxiety measured explicitly and indirectly prior and subsequent to the intervention and media exposure manipulation. Results showed that in the terrorism media exposure, participants with high more than low actual political life events (PLE) exposure showed higher post-test levels of indirectly measured anxiety. Clinical intervention before the terrorism media exposure moderated indirectly measured anxiety among participants with high PLE exposure, but increased anxiety for low PLE. Findings outline preparatory measures that could maximize coping for the high PLE actual exposure at-risk sector.

  3. Comparison of I-gel with Classic Laryngeal Mask Airway Regarding the Ease of Use and Clinical Performance

    PubMed Central

    Arı, Dilek Erdoğan; Ar, Arzu Yıldırım; Karip, Ceren Şanlı; Siyahkoç, İncifer; Arslan, Ahmet Hakan; Akgün, Fatma Nur

    2015-01-01

    Objective I-gel is a new supraglottic airway device without an inflatable cuff. We aimed to compare I-gel and the classic laryngeal mask airway (LMA) regarding the ease of use and clinical performance in Turkish population. Methods Fifty American Society of Anesthesiologists (ASA) I–II patients were randomly allocated into two groups: Group I-gel and Group LMA. Insertion time and success in first attempt were recorded. Peak, plato and mean airway pressures, EtCO2, airway compliance and leak volume were periodically recorded during the operation. The presence of blood on device removal and postoperative sore throat were also assessed. Results The device insertion time in Group I-gel was shorter than that in Group LMA (21.00±4.15 vs. 30.40±12.17 s, p=0.001). The success rate in first attempt, peak, plato and mean airway pressures, EtCO2 and airway compliance did not differ between the groups. The leak volume was lower in Group I-gel 5 and 45 min after insertion (p=0.041 and p=0.027). The presence of blood on device removal and postoperative sore throat were similar in both groups. Conclusion I-gel may be a more advantageous supraglottic airway device compared with LMA. PMID:27366518

  4. Self-Actualization Effects Of A Marathon Growth Group

    ERIC Educational Resources Information Center

    Jones, Dorothy S.; Medvene, Arnold M.

    1975-01-01

    This study examined the effects of a marathon group experience on university student's level of self-actualization two days and six weeks after the experience. Gains in self-actualization as a result of marathon group participation depended upon an individual's level of ego strength upon entering the group. (Author)

  5. The Self-Actualization of Polk Community College Students.

    ERIC Educational Resources Information Center

    Pearsall, Howard E.; Thompson, Paul V., Jr.

    This article investigates the concept of self-actualization introduced by Abraham Maslow (1954). A summary of Maslow's Needs Hierarchy, along with a description of the characteristics of the self-actualized person, is presented. An analysis of humanistic education reveals it has much to offer as a means of promoting the principles of…

  6. Depression and Self-Actualization in Gifted Adolescents.

    ERIC Educational Resources Information Center

    Berndt, David J.; And Others

    1982-01-01

    Investigated the relationship between depressive affect and self-actualization in gifted adolescents (N=248). Found that gifted students who were not self-actualizing types were more depressed; and guilt, low self-esteem, learned helplessness, and cognitive difficulty were important symptoms. Gifted adolescents tended to be more socially…

  7. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Certificates of actual cost....

  8. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Certificates of actual cost....

  9. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Certificates of actual cost....

  10. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Certificates of actual cost....

  11. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Certificates of actual cost....

  12. SELF-ACTUALIZATION AND THE UTILIZATION OF TALENT.

    ERIC Educational Resources Information Center

    FRENCH, JOHN R.P.; MILLER, DANIEL R.

    THIS STUDY ATTEMPTED (1) TO DEVELOP A THEORY OF THE CAUSES AND CONSEQUENCES OF SELF-ACTUALIZATION AS RELATED TO THE UTILIZATION OF TALENT, (2) TO FIT THE THEORY TO EXISTING DATA, AND (3) TO PLAN ONE OR MORE RESEARCH PROJECTS TO TEST THE THEORY. TWO ARTICLES ON IDENTITY AND MOTIVATION AND SELF-ACTUALIZATION AND SELF-IDENTITY THEORY REPORTED THE…

  13. Facebook as a Library Tool: Perceived vs. Actual Use

    ERIC Educational Resources Information Center

    Jacobson, Terra B.

    2011-01-01

    As Facebook has come to dominate the social networking site arena, more libraries have created their own library pages on Facebook to create library awareness and to function as a marketing tool. This paper examines reported versus actual use of Facebook in libraries to identify discrepancies between intended goals and actual use. The results of a…

  14. A Study of Self-Actualization and Facilitative Communication.

    ERIC Educational Resources Information Center

    Omizo, Michael M.

    1981-01-01

    Examined the relationship between self-actualization measures and ability in facilitative communication of trainees from counseling, social work, and psychology programs to determine if differences existed between the three groups. Self-actualization indexes were significantly correlated with ability in facilitative communication. (RC)

  15. 26 CFR 1.962-3 - Treatment of actual distributions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 10 2013-04-01 2013-04-01 false Treatment of actual distributions. 1.962-3... TAX (CONTINUED) INCOME TAXES (CONTINUED) Controlled Foreign Corporations § 1.962-3 Treatment of actual... a foreign corporation. (ii) Treatment of section 962 earnings and profits under § 1.959-3....

  16. Accuracy of one algorithm used to modify a planned DVH with data from actual dose delivery.

    PubMed

    Ma, Tianjun; Podgorsak, Matthew B; Kumaraswamy, Lalith K

    2016-01-01

    Detection and accurate quantification of treatment delivery errors is important in radiation therapy. This study aims to evaluate the accuracy of DVH based QA in quantifying delivery errors. Eighteen previously treated VMAT plans (prostate, H&N, and brain) were randomly chosen for this study. Conventional IMRT delivery QA was done with the ArcCHECK diode detector for error-free plans and plans with the following modifications: 1) induced monitor unit differences up to ± 3.0%, 2) control point deletion (3, 5, and 8 control points were deleted for each arc), and 3) gantry angle shift (2° uniform shift clockwise and counterclockwise). 2D and 3D distance-to-agreement (DTA) analyses were performed for all plans with SNC Patient software and 3DVH software, respectively. Subsequently, accuracy of the reconstructed DVH curves and DVH parameters in 3DVH software were analyzed for all selected cases using the plans in the Eclipse treatment planning system as standard. 3D DTA analysis for error-induced plans generally gave high pass rates, whereas the 2D evaluation seemed to be more sensitive to detecting delivery errors. The average differences for DVH parameters between each pair of Eclipse recalculation and 3DVH prediction were within 2% for all three types of error-induced treatment plans. This illustrates that 3DVH accurately quantifies delivery errors in terms of actual dose delivered to the patients. 2D DTA analysis should be routinely used for clinical evaluation. Any concerns or dose discrepancies should be further analyzed through DVH-based QA for clinically relevant results and confirmation of a conventional passing-rate-based QA. PMID:27685140

  17. Actual Body Weight and the Parent's Perspective of Child's Body Weight among Rural Canadian Children.

    PubMed

    Karunanayake, Chandima P; Rennie, Donna C; Hildebrand, Carole; Lawson, Joshua A; Hagel, Louise; Dosman, James A; Pahwa, Punam; The Saskatchewan Rural Health Study Team

    2016-01-01

    The prevalence of being overweight during childhood continues to increase in the USA and Canada and children living in rural areas are more at risk than their urban counterparts. The objectives of this study were to evaluate how well the parent's perception of their child's weight status correlated with objectively measured weight status among a group of rural children and to identify predictors of inaccurate parental perceptions of child's weight status. Participants were children from the Saskatchewan Rural Health Study conducted in 2010. Self-administered questionnaires were distributed through rural schools to parents of children in grades one to eight. Parents reported their child's height and weight and rated their child's weight status (underweight, just about the right weight, or overweight). Standardized body mass index (BMI) categories were calculated for clinically measured height and weight and for parental report of height and weight for 584 children. Logistic regression analysis was performed to identify predictors of misclassification of the parent's perception of child's weight status adjusting for potential confounders. Clinically measured overweight was much higher (26.5%) compared to parental perceived overweight (7.9%). The misclassification of the child's BMI was more likely to occur if the child was a boy (odds ratio (OR) = 1.58) or non-Caucasian (OR = 2.03). Overweight was high in this group of rural children and parental perception of weight status underestimated the actual weight status of overweight school-age children. Parental reporting of child weight status has implications for public health policy and prevention strategies. Future research should focus on assessing longitudinal effects of parental misperceptions of child's weight status. PMID:27527235

  18. Experimental evaluation of actual delivered dose using mega-voltage cone-beam CT and direct point dose measurement

    SciTech Connect

    Matsubara, Kana; Kohno, Ryosuke; Nishioka, Shie; Shibuya, Toshiyuki; Ariji, Takaki; Akimoto, Tetsuo; Saitoh, Hidetoshi

    2013-07-01

    Radiation therapy in patients is planned by using computed tomography (CT) images acquired before start of the treatment course. Here, tumor shrinkage or weight loss or both, which are common during the treatment course for patients with head-and-neck (H and N) cancer, causes unexpected differences from the plan, as well as dose uncertainty with the daily positional error of patients. For accurate clinical evaluation, it is essential to identify these anatomical changes and daily positional errors, as well as consequent dosimetric changes. To evaluate the actual delivered dose, the authors proposed direct dose measurement and dose calculation with mega-voltage cone-beam CT (MVCBCT). The purpose of the present study was to experimentally evaluate dose calculation by MVCBCT. Furthermore, actual delivered dose was evaluated directly with accurate phantom setup. Because MVCBCT has CT-number variation, even when the analyzed object has a uniform density, a specific and simple CT-number correction method was developed and applied for the H and N site of a RANDO phantom. Dose distributions were calculated with the corrected MVCBCT images of a cylindrical polymethyl methacrylate phantom. Treatment processes from planning to beam delivery were performed for the H and N site of the RANDO phantom. The image-guided radiation therapy procedure was utilized for the phantom setup to improve measurement reliability. The calculated dose in the RANDO phantom was compared to the measured dose obtained by metal-oxide-semiconductor field-effect transistor detectors. In the polymethyl methacrylate phantom, the calculated and measured doses agreed within about +3%. In the RANDO phantom, the dose difference was less than +5%. The calculated dose based on simulation-CT agreed with the measured dose within±3%, even in the region with a high dose gradient. The actual delivered dose was successfully determined by dose calculation with MVCBCT, and the point dose measurement with the image

  19. Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK's quality and outcomes framework

    PubMed Central

    Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim

    2013-01-01

    Objectives To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Design Retrospective longitudinal study. Setting Data for 2007–2008 to 2010–2011, extracted from the clinical computer systems of general practices in England. Participants All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Main outcome measures Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Results Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Conclusions Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system. PMID:23913774

  20. Diagnostic Performance of Ultrasonography for Detection of Abruption and Its Clinical Correlation and Maternal and Foetal Outcome

    PubMed Central

    Vaswani, Babita Prakash; Patange, R.P.; Laddad, Manisha Manish; Bhosale, Rajashree Babasaheb

    2016-01-01

    Introduction Placental abruption complicates about 1% of singleton pregnancies and is an important cause of perinatal mortality and morbidity. Though sensitivity and reliability of ultrasound are poor for detecting or excluding placental abruption, because of the advances in ultrasound resolution, imaging and interpretation, sensitivity of ultrasound is better than what was reported previously. Aim To determine the diagnostic performance of Ultrasonography (USG) for the detection of placental abruption and whether sonographic results correlate with maternal and foetal management and outcome. Materials and Methods Thirty patients with clinical diagnosis of placental abruption were studied in the Obstetrics and Gynaecology Department of Krishna Institute of Medical Sciences, over a period of 6 months. These patients underwent ultrasonography for confirmation. Obstetric and neonatal outcome and sonographic results were compared and reviewed. Sonographic sensitivity and specificity and positive and negative predictive values were calculated. Results Incidence of abruption in present study was 1.56% (28 patients out of 1786 total deliveries). Sensitivity of ultrasonography in the diagnosis of abruption was 57% (CI 37.15%-75.57%) while its specificity was 100% (CI 15.81%-100%) with a positive predictive value of 100% (CI 79.42%-100%) and a 14% (CI 1.78% - 42.83%) negative predictive value. An 87.5% of patients(14 out of 16) with a positive USG finding of abruption had Intrauterine foetal Death (IUD)/still birth while 91.6% of patients (11 out of 12) with negative USG findings of abruption gave birth to babies who required NICU admission. Conclusion Sonography is not sensitive for the detection of placental abruption but it is highly specific. Positive sonographic findings are associated with increased maternal morbidity, require more aggressive obstetric management and it is associated with worse perinatal outcome. In case of a negative USG finding, but a strong clinical

  1. Randomized Comparison of Actual and Ideal Body Weight for Size Selection of the Laryngeal Mask Airway Classic in Overweight Patients.

    PubMed

    Kim, Min-Soo; Lee, Jong Seok; Nam, Sang Beom; Kang, Hyo Jong; Kim, Ji Eun

    2015-08-01

    Size selection of the laryngeal mask airway (LMA) Classic based on actual body weight remains a common practice. However, ideal body weight might allow for a better size selection in obese patients. The purpose of our study was to compare the utility of ideal body weight and actual body weight when choosing the appropriate size of the LMA Classic by a randomized clinical trial. One hundred patients with age 20 to 70 yr, body mass index ≥25 kg/m(2), and the difference between LMA sizes based on actual weight and ideal weight were allocated to insert the LMA Classic using either actual body weight or ideal body weight in a weight-based formula for size selection. After insertion of the device, several variables including insertion parameters, sealing function, fiberoptic imaging, and complications were investigated. The insertion success rate at the first attempt was lower in the actual weight group (82%) than in the ideal weight group (96%), even it did not show significant difference. The ideal weight group had significantly shorter insertion time and easier placement. However, fiberoptic views were significantly better in the actual weight group. Intraoperative complications, sore throat in the recovery room, and dysphonia at postoperative 24 hr occurred significantly less often in the ideal weight group than in the actual weight group. It is suggested that the ideal body weight may be beneficial to the size selection of the LMA Classic in overweight patients (Clinical Trial Registry, NCT 01843270).

  2. Comparison of predicted and actual consequences of missense mutations.

    PubMed

    Miosge, Lisa A; Field, Matthew A; Sontani, Yovina; Cho, Vicky; Johnson, Simon; Palkova, Anna; Balakishnan, Bhavani; Liang, Rong; Zhang, Yafei; Lyon, Stephen; Beutler, Bruce; Whittle, Belinda; Bertram, Edward M; Enders, Anselm; Goodnow, Christopher C; Andrews, T Daniel

    2015-09-15

    Each person's genome sequence has thousands of missense variants. Practical interpretation of their functional significance must rely on computational inferences in the absence of exhaustive experimental measurements. Here we analyzed the efficacy of these inferences in 33 de novo missense mutations revealed by sequencing in first-generation progeny of N-ethyl-N-nitrosourea-treated mice, involving 23 essential immune system genes. PolyPhen2, SIFT, MutationAssessor, Panther, CADD, and Condel were used to predict each mutation's functional importance, whereas the actual effect was measured by breeding and testing homozygotes for the expected in vivo loss-of-function phenotype. Only 20% of mutations predicted to be deleterious by PolyPhen2 (and 15% by CADD) showed a discernible phenotype in individual homozygotes. Half of all possible missense mutations in the same 23 immune genes were predicted to be deleterious, and most of these appear to become subject to purifying selection because few persist between separate mouse substrains, rodents, or primates. Because defects in immune genes could be phenotypically masked in vivo by compensation and environment, we compared inferences by the same tools with the in vitro phenotype of all 2,314 possible missense variants in TP53; 42% of mutations predicted by PolyPhen2 to be deleterious (and 45% by CADD) had little measurable consequence for TP53-promoted transcription. We conclude that for de novo or low-frequency missense mutations found by genome sequencing, half those inferred as deleterious correspond to nearly neutral mutations that have little impact on the clinical phenotype of individual cases but will nevertheless become subject to purifying selection.

  3. Comparison of predicted and actual consequences of missense mutations

    PubMed Central

    Miosge, Lisa A.; Field, Matthew A.; Sontani, Yovina; Cho, Vicky; Johnson, Simon; Palkova, Anna; Balakishnan, Bhavani; Liang, Rong; Zhang, Yafei; Lyon, Stephen; Beutler, Bruce; Whittle, Belinda; Bertram, Edward M.; Enders, Anselm; Goodnow, Christopher C.; Andrews, T. Daniel

    2015-01-01

    Each person’s genome sequence has thousands of missense variants. Practical interpretation of their functional significance must rely on computational inferences in the absence of exhaustive experimental measurements. Here we analyzed the efficacy of these inferences in 33 de novo missense mutations revealed by sequencing in first-generation progeny of N-ethyl-N-nitrosourea–treated mice, involving 23 essential immune system genes. PolyPhen2, SIFT, MutationAssessor, Panther, CADD, and Condel were used to predict each mutation’s functional importance, whereas the actual effect was measured by breeding and testing homozygotes for the expected in vivo loss-of-function phenotype. Only 20% of mutations predicted to be deleterious by PolyPhen2 (and 15% by CADD) showed a discernible phenotype in individual homozygotes. Half of all possible missense mutations in the same 23 immune genes were predicted to be deleterious, and most of these appear to become subject to purifying selection because few persist between separate mouse substrains, rodents, or primates. Because defects in immune genes could be phenotypically masked in vivo by compensation and environment, we compared inferences by the same tools with the in vitro phenotype of all 2,314 possible missense variants in TP53; 42% of mutations predicted by PolyPhen2 to be deleterious (and 45% by CADD) had little measurable consequence for TP53-promoted transcription. We conclude that for de novo or low-frequency missense mutations found by genome sequencing, half those inferred as deleterious correspond to nearly neutral mutations that have little impact on the clinical phenotype of individual cases but will nevertheless become subject to purifying selection. PMID:26269570

  4. Comparison of predicted and actual consequences of missense mutations.

    PubMed

    Miosge, Lisa A; Field, Matthew A; Sontani, Yovina; Cho, Vicky; Johnson, Simon; Palkova, Anna; Balakishnan, Bhavani; Liang, Rong; Zhang, Yafei; Lyon, Stephen; Beutler, Bruce; Whittle, Belinda; Bertram, Edward M; Enders, Anselm; Goodnow, Christopher C; Andrews, T Daniel

    2015-09-15

    Each person's genome sequence has thousands of missense variants. Practical interpretation of their functional significance must rely on computational inferences in the absence of exhaustive experimental measurements. Here we analyzed the efficacy of these inferences in 33 de novo missense mutations revealed by sequencing in first-generation progeny of N-ethyl-N-nitrosourea-treated mice, involving 23 essential immune system genes. PolyPhen2, SIFT, MutationAssessor, Panther, CADD, and Condel were used to predict each mutation's functional importance, whereas the actual effect was measured by breeding and testing homozygotes for the expected in vivo loss-of-function phenotype. Only 20% of mutations predicted to be deleterious by PolyPhen2 (and 15% by CADD) showed a discernible phenotype in individual homozygotes. Half of all possible missense mutations in the same 23 immune genes were predicted to be deleterious, and most of these appear to become subject to purifying selection because few persist between separate mouse substrains, rodents, or primates. Because defects in immune genes could be phenotypically masked in vivo by compensation and environment, we compared inferences by the same tools with the in vitro phenotype of all 2,314 possible missense variants in TP53; 42% of mutations predicted by PolyPhen2 to be deleterious (and 45% by CADD) had little measurable consequence for TP53-promoted transcription. We conclude that for de novo or low-frequency missense mutations found by genome sequencing, half those inferred as deleterious correspond to nearly neutral mutations that have little impact on the clinical phenotype of individual cases but will nevertheless become subject to purifying selection. PMID:26269570

  5. An Examination of Expected versus Actual Tasks of Public School Secondary Assistant Principals throughout Indiana

    ERIC Educational Resources Information Center

    Scott, Valarie M.

    2011-01-01

    It is generally recognized that the assistant principal's position is a launching point for a career in school administration. The scarcity of research and literature pertaining to the role of the assistant principal led the researcher to compare the actual tasks being performed by public school assistant principals to their ideal job…

  6. The Challenge to Cumulative Learning: Do Introductory Courses Actually Benefit Advanced Students?

    ERIC Educational Resources Information Center

    Nathanson, Craig; Paulhus, Delroy L.; Williams, Kevin M.

    2004-01-01

    Previous research has questioned the educational value of taking introductory courses in psychology. Study 1 confirmed the usual null to negative associations between taking introductory psychology and performance in a subsequent psychology course. Study 2 showed that, after controlling for IQ, there was actually a positive association between…

  7. Evaluation of the technical performance of three different commercial digital breast tomosynthesis systems in the clinical environment.

    PubMed

    Rodríguez-Ruiz, A; Castillo, M; Garayoa, J; Chevalier, M

    2016-06-01

    The aim of this work was to research and evaluate the performance of three different digital breast tomosynthesis (DBT) systems in the clinical environment (Siemens Mammomat Inspiration, Hologic Selenia Dimensions, and Fujifilm Amulet Innovality). The characterization included the study of the detector, the automatic exposure control, and the resolution of DBT projections and reconstructed planes. The modulation transfer function (MTF) of the DBT projections was measured with a 1mm thick steel edge, showing a strong anisotropy (30-40% lower MTF0.5 frequencies in the tube travel direction). The in-plane MTF0.5, measured with a 25μm tungsten wire, ranges from 1.3 to 1.8lp/mm in the tube-travel direction and between 2.4 and 3.7lp/mm in the chest wall-nipple. In the latter direction, the MTF peak shift is more emphasized for large angular range systems (2.0 versus 1.0lp/mm). In-depth resolution of the planes, via the full width at half maximum (FWHM) from the point spread function of a 25μm tungsten wire, is not only influenced by angular range and yields 1.3-4.6mm among systems. The artifact spread function from 1mm diameter tungsten beads depends mainly on angular range, yielding two tendencies whether large (FWHM is 4.5mm) or small (FWHM is 10mm) angular range is used. DBT delivers per scan a mean glandular dose between 1.4 and 2.7mGy for a 45mm thick polymethyl methacrylate (PMMA) block. In conclusion, we have identified and analysed specific metrics that can be used for quality assurance of DBT systems.

  8. Clinical and radiographic results and wear performance in different generations of a cementless porous-coated acetabular cup

    PubMed Central

    García-Cimbrelo, E.

    2007-01-01

    We compared clinical results and wear performance in two different generations of a cementless porous-coated cup, analysing the long-term results of 83 uncemented Harris-Galante I cups (32-mm femoral head) and 93 uncemented Harris-Galante II cups (28-mm femoral head). All polyethylene liners were gamma irradiated in air. Polyethylene linear wear was estimated using a software package. The minimum follow-up was 10 years. Nine Harris-Galante I cups and two Harris-Galante II cups were revised due to aseptic loosening or polyethylene problems. The mean femoral head penetration at 6 weeks after surgery was 0.15 ± 0.05 mm for the Harris-Galante I cups and 0.12 ± 0.03 for the Harris-Galante II cups (p < 0.001);but mean wear was 0.13 ± 0.23 mm per year for the Harris-Galante I cups and 0.11 ± 0.10 for the Harris-Galante II cups (p = 0.740). Most of the metallic shells in both groups showed stable fixation. The so-called second-generation cups had lower initial polyethylene wear that resulted in less polyethylene wear at the latest the follow-up, but the overall wear rate was similar in both groups despite the different femoral head sizes and the improved locking mechanism. PMID:17265157

  9. 41 CFR 301-11.3 - Must my agency pay an allowance (either a per diem allowance or actual expense)?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... per diem allowance or actual expense)? Yes, unless: (a) You perform travel to a training event under the Government Employees Training Act (5 U.S.C. 4101-4118), and you agree not to be paid per...

  10. Implementation of quality control performance criteria and approved guidelines for upgrading of clinical chemistry laboratory procedures in Alexandria University hospitals.

    PubMed

    Rizk, Mohamed Moustafa M; el-Badawi, Nashwa A; Moez, Pacint E; Khattab, Azza A

    2009-03-01

    The aim of the present work was to assess the quality of work in Clinical Pathology Department, Alexandria Main University Hospital, Egypt; as regards the pre-analytical and analytical phases of testing; for later accreditation. This evaluation was performed using inspection sheets that were designed according to the CAP 2006 recommendations. All checklist questions that could not be answered "yes" were considered deficiencies and had to be corrected before being accredited. The questions were classified into ten groups; each group contained a number of questions concerning one of the pre-analytical and analytical assessment activities. We ranked our results into 4 categories according to the degree of fulfillment. The total number of questions that were answered "no" at the start and the end of the study accounted for 64/101 (63.4%) and 34/101 (33.7%) questions respectively. Most of the deficiencies were detected in the pre-analytical phase of the testing process; the first two checklists were used for the evaluation of this phase. At the start of the study, the degree of requirements fulfillment in checklist I and II were 0% and 21.1% respectively. By the end of the study the degree of fulfillment became, 85.7% and 63.2% respectively. Average number of sample rejection due to different causes was evaluated before and after implementing CAP recommendations; these causes include haemolysis, clotted serum, quantity not sufficient, and lost samples; the percentage of rejected samples before implementing CAP recommendations was 15.8%, 1.81%, 0.70%, and 0.51% respectively, while after implementing CAP recommendations it was 7%, 0.77%, 0.08%, and 0.05%, respectively. We concluded that the presence of standardized protocol for the pre-analytical activities had improved the quality of samples received by the lab, and we also concluded that accreditation allows laboratories to evaluate their performance, their compliance with the requirements of the accrediting association

  11. The Effects of a Combined Task Clarification, Goal Setting, Feedback, and Performance Contingent Consequence Intervention Package on Telephone Customer Service in a Medical Clinic Environment

    ERIC Educational Resources Information Center

    Slowiak, Julie M.; Madden, Gregory J.; Mathews, Ramona

    2006-01-01

    Appointment coordinators at a mid-western medical clinic were to provide exceptional telephone customer service. This included using a standard greeting, speaking in an appropriate tone of voice during the conversation, and using a standard closing to end the call. An analysis suggested performance deficiencies resulted from weak antecedents, poor…

  12. Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique

    PubMed Central

    2010-01-01

    Background Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability. Methods In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed. Results An estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times. Conclusions Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding

  13. Ultra-high performance liquid chromatography tandem mass spectrometric method for the determination of tamoxifen, N-desmethyltamoxifen, 4-hydroxytamoxifen and endoxifen in dried blood spots--development, validation and clinical application during breast cancer adjuvant therapy.

    PubMed

    Antunes, Marina Venzon; Raymundo, Suziane; de Oliveira, Vanessa; Staudt, Dilana Elisabeth; Gössling, Gustavo; Peteffi, Giovana Piva; Biazús, Jorge Villanova; Cavalheiro, José Antônio; Tre-Hardy, Marie; Capron, Arnaud; Haufroid, Vincent; Wallemacq, Pierre; Schwartsmann, Gilberto; Linden, Rafael

    2015-01-01

    A LC-MSMS method for the simultaneous determination of tamoxifen, N-desmethyltamoxifen, 4-hydroxytamoxifen and endoxifen in dried blood spots samples was developed and validated. The method employs an ultrasound-assisted liquid extraction and a reversed phase separation in an Acquity(®) C18 column (150×2.1 mm, 1.7 µm). Mobile phase was a mixture of formic acid 0.1% (v/v) pH 2.7 and acetonitrile (gradient from 60:40 to 50:50, v/v). Total analytical run time was 8 min. Precision assays showed CV % lower than 10.75% and accuracy in the range 94.5 to 110.3%. Mean analytes recoveries from DBS ranged from 40% to 92%. The method was successfully applied to 91 paired clinical DBS and plasma samples. Dried blood spots concentrations were highly correlated to plasma, with rs>0.83 (P<0.01). Median estimated plasma concentrations after hematocrit and partition factor adjustment were: TAM 123.3 ng mL(-1); NDT 267.9 ng mL(-1), EDF 10.0 ng mL(-1) and HTF 1.3 ng mL(-1,) representing in average 98 to 104% of the actually measured concentrations. The DBS method was able to identify 96% of patients with plasma EDF concentrations below the clinical threshold related to better prognosis (5.9 ng mL(-1)). The procedure has adequate analytical performance and can be an efficient tool to optimize adjuvant breast cancer treatment, especially in resource limited settings. PMID:25476377

  14. A protocol for evaluating progressive levels of simulation fidelity in the development of technical skills, integrated performance and woman centred clinical assessment skills in undergraduate midwifery students

    PubMed Central

    2013-01-01

    Background Simulation as a pedagogical approach has been used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice. However, evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity are lacking. Woman centred care is a core premise of the midwifery profession and describes the behaviours of an individual midwife who demonstrates safe and effective care of the individual woman. Woman centred care occurs when the midwife modifies the care to ensure the needs of each individual woman are respected and addressed. However, a review of the literature demonstrates an absence of a valid and reliable tool to measure the development of woman centred care behaviours. This study aims to determine which level of fidelity in simulated learning experiences provides the most effective learning outcomes in the development of woman centred clinical assessment behaviors and skills in student midwives. Methods/Design Three-arm, randomised, intervention trial. In this research we plan to: a) trial three levels of simulation fidelity - low, medium and progressive, on student midwives performing the procedure of vaginal examination; b) measure clinical assessment skills using the Global Rating Scale (GRS) and Integrated Procedural Performance Instrument (IPPI); and c) pilot the newly developed Woman Centred Care Scale (WCCS) to measure clinical behaviors related to Woman-Centredness. Discussion This project aims to enhance knowledge in relation to the appropriate levels of fidelity in simulation that yield the best educational outcomes for the development of woman centred clinical assessment in student midwives. The outcomes of this project may contribute to improved woman centred clinical assessment for student midwives, and more broadly influence decision making regarding education resource allocation for

  15. A new definition of pharmaceutical quality: assembly of a risk simulation platform to investigate the impact of manufacturing/product variability on clinical performance.

    PubMed

    Short, Steven M; Cogdill, Robert P; D'Amico, Frank; Drennen, James K; Anderson, Carl A

    2010-12-01

    The absence of a unanimous, industry-specific definition of quality is, to a certain degree, impeding the progress of ongoing efforts to "modernize" the pharmaceutical industry. This work was predicated on requests by Dr. Woodcock (FDA) to re-define pharmaceutical quality in terms of risk by linking production characteristics to clinical attributes. A risk simulation platform that integrates population statistics, drug delivery system characteristics, dosing guidelines, patient compliance estimates, production metrics, and pharmacokinetic, pharmacodynamic, and in vitro-in vivo correlation models to investigate the impact of manufacturing variability on clinical performance of a model extended-release theophylline solid oral dosage system was developed. Manufacturing was characterized by inter- and intra-batch content uniformity and dissolution variability metrics, while clinical performance was described by a probabilistic pharmacodynamic model that expressed the probability of inefficacy and toxicity as a function of plasma concentrations. Least-squares regression revealed that both patient compliance variables, percent of doses taken and dosing time variability, significantly impacted efficacy and toxicity. Additionally, intra-batch content uniformity variability elicited a significant change in risk scores for the two adverse events and, therefore, was identified as a critical quality attribute. The proposed methodology demonstrates that pharmaceutical quality can be recast to explicitly reflect clinical performance.

  16. Dense Annotation of Free-Text Critical Care Discharge Summaries from an Indian Hospital and Associated Performance of a Clinical NLP Annotator.

    PubMed

    Ramanan, S V; Radhakrishna, Kedar; Waghmare, Abijeet; Raj, Tony; Nathan, Senthil P; Sreerama, Sai Madhukar; Sampath, Sriram

    2016-08-01

    Electronic Health Record (EHR) use in India is generally poor, and structured clinical information is mostly lacking. This work is the first attempt aimed at evaluating unstructured text mining for extracting relevant clinical information from Indian clinical records. We annotated a corpus of 250 discharge summaries from an Intensive Care Unit (ICU) in India, with markups for diseases, procedures, and lab parameters, their attributes, as well as key demographic information and administrative variables such as patient outcomes. In this process, we have constructed guidelines for an annotation scheme useful to clinicians in the Indian context. We evaluated the performance of an NLP engine, Cocoa, on a cohort of these Indian clinical records. We have produced an annotated corpus of roughly 90 thousand words, which to our knowledge is the first tagged clinical corpus from India. Cocoa was evaluated on a test corpus of 50 documents. The overlap F-scores across the major categories, namely disease/symptoms, procedures, laboratory parameters and outcomes, are 0.856, 0.834, 0.961 and 0.872 respectively. These results are competitive with results from recent shared tasks based on US records. The annotated corpus and associated results from the Cocoa engine indicate that unstructured text mining is a viable method for cohort analysis in the Indian clinical context, where structured EHR records are largely absent.

  17. Dense Annotation of Free-Text Critical Care Discharge Summaries from an Indian Hospital and Associated Performance of a Clinical NLP Annotator.

    PubMed

    Ramanan, S V; Radhakrishna, Kedar; Waghmare, Abijeet; Raj, Tony; Nathan, Senthil P; Sreerama, Sai Madhukar; Sampath, Sriram

    2016-08-01

    Electronic Health Record (EHR) use in India is generally poor, and structured clinical information is mostly lacking. This work is the first attempt aimed at evaluating unstructured text mining for extracting relevant clinical information from Indian clinical records. We annotated a corpus of 250 discharge summaries from an Intensive Care Unit (ICU) in India, with markups for diseases, procedures, and lab parameters, their attributes, as well as key demographic information and administrative variables such as patient outcomes. In this process, we have constructed guidelines for an annotation scheme useful to clinicians in the Indian context. We evaluated the performance of an NLP engine, Cocoa, on a cohort of these Indian clinical records. We have produced an annotated corpus of roughly 90 thousand words, which to our knowledge is the first tagged clinical corpus from India. Cocoa was evaluated on a test corpus of 50 documents. The overlap F-scores across the major categories, namely disease/symptoms, procedures, laboratory parameters and outcomes, are 0.856, 0.834, 0.961 and 0.872 respectively. These results are competitive with results from recent shared tasks based on US records. The annotated corpus and associated results from the Cocoa engine indicate that unstructured text mining is a viable method for cohort analysis in the Indian clinical context, where structured EHR records are largely absent. PMID:27342107

  18. On the power of autobiographical memories: from threat and challenge appraisals to actual behaviour.

    PubMed

    Selimbegović, Leila; Régner, Isabelle; Huguet, Pascal; Chatard, Armand

    2016-11-01

    Autobiographical memories are a major feature of mental life in humans. However, research on the influence of autobiographical recall on actual behaviour is scarce. We predicted and found that general memories of failure and specific memories of success resulted in worse performance than general memories of success and specific memories of failure. This performance pattern was mediated by task appraisal, suggesting that autobiographical memories (of failure and success) impact performance by shaping the perception of the upcoming task. Combined with the fact that these effects occurred even when the content of autobiographical memories was unrelated to the upcoming task, the present research represents an important step forward in understanding how autobiographical recall influences actual behaviour.

  19. Relationship of perceived and actual motor competence in children.

    PubMed

    Raudsepp, Lennart; Liblik, Raino

    2002-06-01

    The purpose of this study was to examine the relationship between children's actual and perceived motor competence. 280 children between the ages of 10 and 13 years individually completed the Children's Physical Self-perception Profile which assesses perceptions of sport competence, physical conditioning, strength, body attractiveness, and general physical self-worth. The internal reliabilities (a) of the subscales ranged from .75 to .82. After completing the profile, the subject's actual motor competence was measured using tests of aerobic fitness and functional strength. Body fatness (sum of five skinfolds) was measured as an objective measure of perceived body attractiveness. Analysis of variance showed that boys and girls differed in perceived competence and actual motor competence. The boys showed higher perceived competence on four scores, but there was no sex difference in perception of body attractiveness. Correlations and regression analysis showed that actual and perceived motor competence were significantly but only moderately (r =.25-.56) correlated. In addition, items of perceived physical competence and age accounted for 17% (sit-ups) to 25% (endurance shuttle run) of the variance in actual motor competence of the children. These findings showed that 10- to 13-yr-old children can only moderately assess personal motor competence. PMID:12186225

  20. Noninvasive prenatal testing in the general obstetric population: clinical performance and counseling considerations in over 85 000 cases†

    PubMed Central

    Snyder, Holly L.; de Feo, Eileen; Kruglyak, Kristina M.; Halks‐Miller, Meredith; Curnow, Kirsten J.; Bhatt, Sucheta

    2016-01-01

    Abstract Objective The primary goal of this study was to provide clinically relevant information for appropriate patient counseling. Method Demographics and test metrics were reviewed for 86 658 clinical cases. Outcome information was requested for samples reported as aneuploidy detected or suspected for chromosomes 21, 18, or 13; voluntary outcome reporting was encouraged for all discordant outcomes. Results Of 86 658 cases, 85 298 (98.4%) met inclusion criteria for result reporting. Of the 1360 (1.6%) cancellations, only 101 (0.1%) were for technical reasons. Average time to result was 3.3 business days. Aneuploidy was detected or suspected in 2142 (2.5%) samples. For aneuploidy detected cases with known clinical outcomes, the overall positive predictive value (PPV) was 83.5% (608/728); observed PPVs for trisomies 21, 18, and 13 ranged from 50.0 to 92.8%. As individual PPVs are determined by a patient's prior risk, we developed a chart for counseling patients on positive predictive value based on maternal age. Conclusion This large‐scale report reinforces that noninvasive prenatal testing is a highly accurate screen for fetal aneuploidy in the general obstetric population. Test improvements have facilitated a reduction in failure rates, time to result, and borderline results/unclassifiable results. We have developed a positive predictive value counseling tool to ensure appropriate patient education, counseling, and clinical utilization. © 2015 Illumina. Prenatal Diagnosis published by John Wiley & Sons, Ltd. PMID:26715197

  1. Clinical Performance and Management Outcomes with the DecisionDx-UM Gene Expression Profile Test in a Prospective Multicenter Study

    PubMed Central

    Plasseraud, Kristen Meldi; Tsai, Tony; Shildkrot, Yevgeniy; Middlebrook, Brooke; Maetzold, Derek; Wilkinson, Jeff; Stone, John; Johnson, Clare; Oelschlager, Kristen; Aaberg, Thomas M.

    2016-01-01

    Uveal melanoma management is challenging due to its metastatic propensity. DecisionDx-UM is a prospectively validated molecular test that interrogates primary tumor biology to provide objective information about metastatic potential that can be used in determining appropriate patient care. To evaluate the continued clinical validity and utility of DecisionDx-UM, beginning March 2010, 70 patients were enrolled in a prospective, multicenter, IRB-approved study to document patient management differences and clinical outcomes associated with low-risk Class 1 and high-risk Class 2 results indicated by DecisionDx-UM testing. Thirty-seven patients in the prospective study were Class 1 and 33 were Class 2. Class 1 patients had 100% 3-year metastasis-free survival compared to 63% for Class 2 (log rank test p = 0.003) with 27.3 median follow-up months in this interim analysis. Class 2 patients received significantly higher-intensity monitoring and more oncology/clinical trial referrals compared to Class 1 patients (Fisher's exact test p = 2.1 × 10−13 and p = 0.04, resp.). The results of this study provide additional, prospective evidence in an independent cohort of patients that Class 1 and Class 2 patients are managed according to the differential metastatic risk indicated by DecisionDx-UM. The trial is registered with Clinical Application of DecisionDx-UM Gene Expression Assay Results (NCT02376920). PMID:27446211

  2. Neuropsychological Test Performance and the Attention Deficit Disorders: Clinical Utility of the Luria-Nebraska Neuropsychological Battery-Children's Revision.

    ERIC Educational Resources Information Center

    Schaughency, Elizabeth A.; And Others

    1989-01-01

    Administered Luria-Nebraska Neuropsychological Battery--Children's Revision (LNNB-CR) to 54 clinic-referred children aged 8-12 years. Compared children reliably diagnosed as attention deficit disorder (ADD) with hyperactivity, without hyperactivity, and control group with internalizing disorders. Findings failed to support hypothesis that ADD is…

  3. A comprehensive review of post-market clinical studies performed in adults with an Asian probiotic formulation.

    PubMed

    Tompkins, T A; Xu, X; Ahmarani, J

    2010-03-01

    Probiotics as dietary supplements have been readily accepted by Asian populations. Use of certain probiotic preparations is widespread and the number of clinical trials undertaken with such products is unparalleled in western scientific literature. One such preparation, containing a combination of Enterococcus faecium R0026 and Bacillus subtilis R0179, has 23 publications on post-market clinical studies involving over 1,800 adults. The majority of these publications are printed in Chinese and Korean journals. This review examines the clinical findings with this probiotic combination. As mono-therapy, it has been used to overcome symptoms associated with chronic diarrhoea and irritable bowel syndrome. It has been used as co-adjuvant therapy with sulfasalazine and mesalazine to improve remission times in mild to moderate Ulcerative Colitis and to improve compliance with conventional triple therapy for Helicobacter pylori eradication. While the much of the data is preliminary and the study designs require refinement, the contribution of these trials should not be ignored. The information derived in this review will provide practitioners with practical information on appropriate applications for probiotic supplements, expected outcomes, dosing regimes, safety and reported adverse events. Furthermore, identification of problems in these trials should help researchers design better clinical trials when investigating probiotic products.

  4. Performance of a Cartridge-Based Assay for Detection of Clinically Significant Human Papillomavirus (HPV) Infection: Lessons from VALGENT (Validation of HPV Genotyping Tests).

    PubMed

    Cuschieri, Kate; Geraets, Daan; Cuzick, Jack; Cadman, Louise; Moore, Catherine; Vanden Broeck, Davy; Padalko, Elisaveta; Quint, Wim; Arbyn, Marc

    2016-09-01

    The Validation of Human Papillomavirus (HPV) Genotyping Tests (VALGENT) studies offer an opportunity to clinically validate HPV assays for use in primary screening for cervical cancer and also provide a framework for the comparison of analytical and type-specific performance. Through VALGENT, we assessed the performance of the cartridge-based Xpert HPV assay (Xpert HPV), which detects 14 high-risk (HR) types and resolves HPV16 and HPV18/45. Samples from women attending the United Kingdom cervical screening program enriched with cytologically abnormal samples were collated. All had been previously tested by a clinically validated standard comparator test (SCT), the GP5+/6+ enzyme immunoassay (EIA). The clinical sensitivity and specificity of the Xpert HPV for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and CIN3+ relative to those of the SCT were assessed as were the inter- and intralaboratory reproducibilities according to international criteria for test validation. Type concordance for HPV16 and HPV18/45 between the Xpert HPV and the SCT was also analyzed. The Xpert HPV detected 94% of CIN2+ and 98% of CIN3+ lesions among all screened women and 90% of CIN2+ and 96% of CIN3+ lesions in women 30 years and older. The specificity for CIN1 or less (≤CIN1) was 83% (95% confidence interval [CI], 80 to 85%) in all women and 88% (95% CI, 86 to 91%) in women 30 years and older. Inter- and intralaboratory agreements for the Xpert HPV were 98% and 97%, respectively. The kappa agreements for HPV16 and HPV18/45 between the clinically validated reference test (GP5+/6+ LMNX) and the Xpert HPV were 0.92 and 0.91, respectively. The clinical performance and reproducibility of the Xpert HPV are comparable to those of well-established HPV assays and fulfill the criteria for use in primary cervical cancer screening.

  5. Pilot Eye Scanning under Actual Single Pilot Instrument Flight

    NASA Astrophysics Data System (ADS)

    Rinoie, Kenichi; Sunada, Yasuto

    Operations under single pilot instrument flight rules for general aviation aircraft is known to be one of the most demanding pilot tasks. Scanning numerous instruments plays a key role for perception and decision-making during flight. Flight experiments have been done by a single engine light airplane to investigate the pilot eye scanning technique for IFR flights. Comparisons between the results by an actual flight and those by a PC-based flight simulator are made. The experimental difficulties of pilot eye scanning measurements during the actual IFR flight are discussed.

  6. Meditation and college students' self-actualization and rated stress.

    PubMed

    Janowiak, J J; Hackman, R

    1994-10-01

    This paper concerns the efficacy of meditation and relaxation in promoting self-actualization and changes in self-reported stress among 62 college students. Two groups were given mantra meditation and a yogic relaxation technique referred to as Shavasana. Pre- and posttest measures were taken on the Personal Orientation Inventory and the Behavioral Relaxation Scale. Both groups showed significant increases in scores on self-actualization; however, no differences were found between groups. Meditation training was associated with larger gains in scores on measures of systematic relaxed behavior than of the relaxation training.

  7. Inclusion of Dynamic Clinical Data Improves the Predictive Performance of a 30-Day Readmission Risk Model in Kidney Transplantation

    PubMed Central

    Taber, David J; Palanisamy, Arun P; Srinivas, Titte R; Gebregziabher, Mulugeta; Odeghe, John; Chavin, Kenneth D; Egede, Leonard E; Baliga, Prabhakar K

    2015-01-01

    Background 30-day readmissions (30DRA) are a highly scrutinized measure of healthcare quality and relatively frequent among kidney transplants (KTX). Development of predictive risk models are critical to reducing 30DRA and improving outcomes. Current approaches rely on fixed variables derived from administrative data. These models may not capture clinical evolution that is critical to predicting outcomes. Methods We directed a retrospective analysis towards: 1) developing parsimonious risk models for 30DRA and 2) comparing efficiency of models based on the use of immutable versus dynamic data. Baseline and in-hospital clinical and outcomes data were collected from adult KTX recipients between 2005 – 12. Risk models were developed using backward logistic regression and compared for predictive efficacy using ROC Curves. Results Of 1,147 KTX patients, 123 had 30DRA. Risk factors for 30DRA included recipient comorbidities, transplant factors, and index hospitalization patient level clinical data. The initial fixed variable model included 9 risk factors and was modestly predictive (AUC 0.64, 95% CI 0.58–0.69). The model was parsimoniously reduced to 6 risks, which remained modestly predictive (AUC 0.63, 95% CI 0.58–0.69). The initial predictive model using 13 fixed and dynamic variables was significantly predictive (AUC 0.73, 95% CI 0.67–0.80), with parsimonious reduction to 9 variables maintaining predictive efficacy (AUC 0.73, 95% CI 0.67–0.79). The final model using dynamically evolving clinical data outperformed the model using static variables (p=0.009). Internal validation demonstrated the final model was stable with minimal bias. Conclusion We demonstrate that modeling dynamic clinical data outperformed models utilizing immutable data in predicting 30DRA. PMID:25594549

  8. Performances and Reliability of Bruker Microflex LT and VITEK MS MALDI-TOF Mass Spectrometry Systems for the Identification of Clinical Microorganisms.

    PubMed

    Bilecen, Kivanc; Yaman, Gorkem; Ciftci, Ugur; Laleli, Yahya Rauf

    2015-01-01

    In clinical microbiology laboratories, routine microbial identification is mostly performed using culture based methodologies requiring 24 to 72 hours from culturing to identification. Matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) technology has been established as a cost effective, reliable, and faster alternative identification platform. In this study, we evaluated the reliability of the two available MALDI-TOF MS systems for their routine clinical level identification accuracy and efficiency in a clinical microbiology laboratory setting. A total of 1,341 routine phenotypically identified clinical bacterial and fungal isolates were selected and simultaneously analyzed using VITEK MS (bioMérieux, France) and Microflex LT (Bruker Diagnostics, Germany) MALDI-TOF MS systems. For any isolate that could not be identified with either of the systems and for any discordant result, 16S rDNA gene or ITS1/ITS2 sequencing was used. VITEK MS and Microflex LT correctly identified 1,303 (97.17%) and 1,298 (96.79%) isolates to the species level, respectively. In 114 (8.50%) isolates initial phenotypic identification was inaccurate. Both systems showed a similar identification efficiency and workflow robustness, and they were twice as more accurate compared to routine phenotypic identification in our sample pool. MALDITOF systems with their accuracy and robustness offer a good identification platform for routine clinical microbiology laboratories.

  9. Radiology image perception and observer performance: How does expertise and clinical information alter interpretation? Stroke detection explored through eye-tracking

    NASA Astrophysics Data System (ADS)

    Cooper, Lindsey; Gale, Alastair; Darker, Iain; Toms, Andoni; Saada, Janak

    2009-02-01

    Historically, radiology research has been dominated by chest and breast screening. Few studies have examined complex interpretative tasks such as the reading of multidimensional brain CT or MRI scans. Additionally, no studies at the time of writing have explored the interpretation of stroke images; from novices through to experienced practitioners using eye movement analysis. Finally, there appears a lack of evidence on the clinical effects of radiology reports and their influence on image appraisal and clinical diagnosis. A computer-based, eye-tracking study was designed to assess diagnostic accuracy and interpretation in stroke CT and MR imagery. Eight predetermined clinical cases, five images per case, were presented to participants (novices, trainee, and radiologists; n=8). The presence or absence of abnormalities was rated on a five-point Likert scale and their locations reported. Half cases of the cases were accompanied by clinical information; half were not, to assess the impact of information on observer performance. Results highlight differences in visual search patterns amongst novice, trainee and expert observers; the most marked differences occurred between novice readers and experts. Experts spent more time in challenging areas of interest (AOI) than novices and trainee, and were more confident unless a lesion was large and obvious. The time to first AOI fixation differed by size, shape and clarity of lesion. 'Time to lesion' dropped significantly when recognition appeared to occur between slices. The influence of clinical information was minimal.

  10. Performances and Reliability of Bruker Microflex LT and VITEK MS MALDI-TOF Mass Spectrometry Systems for the Identification of Clinical Microorganisms

    PubMed Central

    Yaman, Gorkem; Ciftci, Ugur; Laleli, Yahya Rauf

    2015-01-01

    In clinical microbiology laboratories, routine microbial identification is mostly performed using culture based methodologies requiring 24 to 72 hours from culturing to identification. Matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) technology has been established as a cost effective, reliable, and faster alternative identification platform. In this study, we evaluated the reliability of the two available MALDI-TOF MS systems for their routine clinical level identification accuracy and efficiency in a clinical microbiology laboratory setting. A total of 1,341 routine phenotypically identified clinical bacterial and fungal isolates were selected and simultaneously analyzed using VITEK MS (bioMérieux, France) and Microflex LT (Bruker Diagnostics, Germany) MALDI-TOF MS systems. For any isolate that could not be identified with either of the systems and for any discordant result, 16S rDNA gene or ITS1/ITS2 sequencing was used. VITEK MS and Microflex LT correctly identified 1,303 (97.17%) and 1,298 (96.79%) isolates to the species level, respectively. In 114 (8.50%) isolates initial phenotypic identification was inaccurate. Both systems showed a similar identification efficiency and workflow robustness, and they were twice as more accurate compared to routine phenotypic identification in our sample pool. MALDITOF systems with their accuracy and robustness offer a good identification platform for routine clinical microbiology laboratories. PMID:26793718

  11. Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging.

    PubMed

    Ooi, Chin Chin; Schneider, Michal Elisabeth; Malliaras, Peter; Chadwick, Martine; Connell, David Alister

    2015-01-01

    This primary aim of this study was to evaluate the diagnostic performance of axial-strain sonoelastography (ASE), B-mode ultrasound (US) and color Doppler US in confirming clinically symptomatic Achilles tendinopathy. The secondary aim was to establish the relationship between the strain ratio during sonoelastography and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores. The VISA-A questionnaire is a validated clinical rating scale that evaluates the symptoms and dysfunction of the Achilles tendon. One hundred twenty Achilles tendons of 120 consecutively registered patients with clinical symptoms of Achilles tendinopathy and another 120 gender- and age-matched, asymptomatic Achilles tendons of 120 healthy volunteers were assessed with B-mode US, ASE and color Doppler US. Symptomatic patients had significantly higher strain ratio scores and softer Achilles tendon properties compared with controls (p < 0.001). The strain ratio was moderately correlated with VISA-A scores (r = -0.62, p < 0.001). The diagnostic accuracy of B-mode US, ASE and color Doppler US in confirming clinically symptomatic Achilles tendinopathy was 94.7%, 97.8% and 82.5% respectively. There was excellent correlation between the clinical reference standard and the grade of tendon quality on ASE (κ = 0.91, p < 0.05), compared with B-mode US (κ = 0.74, p < 0.05) and color Doppler imaging (κ = 0.49, p < 0.05). ASE is an accurate clinical tool in the evaluation of Achilles tendinopathy, with results comparable to those of B-mode US and excellent correlation with clinical findings. The strain ratio may offer promise as a supplementary tool for the objective evaluation of Achilles tendon properties.

  12. Carbon dioxide fixation by microalgae photosynthesis using actual flue gas discharged from a boiler

    SciTech Connect

    Matsumoto, Hiroyo; Shioji, Norio; Hamasaki, Akihiro

    1995-12-31

    To mitigate CO{sub 2} discharged from thermal power plants, studies on CO{sub 2} fixation by the photosynthesis of microalgae using actual exhaust gas have been carried out. The results are as follows: (1) A method is proposed for evaluating the maximum photosynthesis rate in the raceway cultivator using only the algal physical properties; (2) Outdoor cultivation tests taking actual flue gas were performed with no trouble or break throughout 1 yr using the strain collected in the test; (3) The produced microalgae is effective as solid fuel; and (4) The feasibility studies of this system were performed. The system required large land area, but the area is smaller than that required for other biomass systems, such as tree farms.

  13. Education and Decision Making at the Time of Triptan Prescribing: Patient Expectations vs Actual Practice

    PubMed Central

    Mathew, Paul G.; Pavlovic, Jelena M.; Lettich, Alyssa; Wells, Rebecca E.; Robertson, Carrie E.; Mullin, Kathleen; Charleston, Larry; Dodick, David W.; Schwedt, Todd J.

    2014-01-01

    Background Optimizing patient satisfaction with their medical care and maximizing patient adherence with treatment plans requires an understanding of patient preferences regarding education and their role in decision making when treatments are prescribed. Objective To assess the congruence between patient expectations and actual practice regarding education and decision making at the time a triptan is prescribed. Methods This multicenter cross-sectional survey was performed by headache fellow members of the American Headache Society Headache Fellows Research Consortium at their respective tertiary care headache clinics. Migraine patients who were new patients to the headache clinic and who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years) completed questionnaires that assessed the education they received and their role in decision making at the time a triptan was first prescribed as well as their desire for education and participation in decision making when a triptan is prescribed. Results Consistent with patient preference, most participants received the majority of their education about the triptan from the prescriber's office (70.2%). In descending rank order, participants most desired to be informed about how to decide if a triptan should be taken, when during the course of migraine a triptan should be taken, possible side effects, cost, and how to obtain refills. Regarding side effects, most participants preferred to receive education about the most common side effects of a triptan rather than addressing all possible side effects. Regarding triptan dosing, participants desired to be informed in descending order of importance about taking other medications with triptans, how many doses can be taken for each migraine, how many doses can be taken each week/month, what to do if the triptan does not work, and the triptan mechanism of action. The vast majority of

  14. MLCMS Actual Use, Perceived Use, and Experiences of Use

    ERIC Educational Resources Information Center

    Asiimwe, Edgar Napoleon; Grönlund, Åke

    2015-01-01

    Mobile learning involves use of mobile devices to participate in learning activities. Most e-learning activities are available to participants through learning systems such as learning content management systems (LCMS). Due to certain challenges, LCMS are not equally accessible on all mobile devices. This study investigates actual use, perceived…

  15. Actual Leisure Participation of Norwegian Adolescents with Down Syndrome

    ERIC Educational Resources Information Center

    Dolva, Anne-Stine; Kleiven, Jo; Kollstad, Marit

    2014-01-01

    This article reports the actual participation in leisure activities by a sample of Norwegian adolescents with Down syndrome aged 14. Representing a first generation to grow up in a relatively inclusive context, they live with their families, attend mainstream schools, and are part of common community life. Leisure information was obtained in…

  16. Actualizing Concepts in Home Management: Proceedings of a National Conference.

    ERIC Educational Resources Information Center

    American Home Economics Association, Washington, DC.

    The booklet prints the following papers delivered at a national conference: Actualizing Concepts in Home Management: Decision Making, Dorothy Z. Price; Innovations in Teaching: Ergonomics, Fern E. Hunt; Relevant Concepts of Home Management: Innovations in Teaching, Kay P. Edwards; Standards in a Managerial Context, Florence S. Walker; Organizing:…

  17. Reported vs. Actual Job Search by Unemployment Insurance Claimants.

    ERIC Educational Resources Information Center

    St. Louis, Robert D.; And Others

    1986-01-01

    Compares self-reported job search contacts of unemployment insurance recipients with independently verified job-search contacts. The separate equations estimated for reported and actual job contacts suggest that systematic misreporting may distort the conclusions. Some implications of the findings for reported unemployment rates also are explored.…

  18. Progressive Digressions: Home Schooling for Self-Actualization.

    ERIC Educational Resources Information Center

    Rivero, Lisa

    2002-01-01

    Maslow's (1971) theory of primary creativeness is used as the basis for a self-actualization model of education. Examples of how to use the model in creative homeschooling are provided. Key elements include digressive and immersion learning, self-directed learning, and the integration of work and play. Teaching suggestions are provided. (Contains…

  19. 40 CFR 74.22 - Actual SO2 emissions rate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ....6 for natural gas For other fuels, the combustion source must specify the SO2 emissions factor. (c... (2) For a combustion source submitting annual data: ER04AP95.005 where, “quantity of fuel consumed... (CONTINUED) SULFUR DIOXIDE OPT-INS Allowance Calculations for Combustion Sources § 74.22 Actual SO2...

  20. 40 CFR 74.22 - Actual SO2 emissions rate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ....6 for natural gas For other fuels, the combustion source must specify the SO2 emissions factor. (c... (2) For a combustion source submitting annual data: ER04AP95.005 where, “quantity of fuel consumed... (CONTINUED) SULFUR DIOXIDE OPT-INS Allowance Calculations for Combustion Sources § 74.22 Actual SO2...

  1. The Implications of Language for Facilitating Self-Actualization.

    ERIC Educational Resources Information Center

    Davis, Charleen Katharine

    The purpose of this study was to delineate the implications of language within an educational context as a means of facilitating self-actualization. Three premises identified in a priori fashion were drawn from the literature in linguistics, psychology, and general semantics, creating a three-part language continuum--acquisition, development, and…

  2. Stability Tests with Actual Savannah River Site Radioactive Waste

    SciTech Connect

    Walker, D.D.

    2002-09-09

    solutions in two laboratory experiments. The first experiment tested four waste solutions for supersaturation of aluminum by monitoring the aluminum concentration after seeding with gibbsite. The second experiment tested two waste samples for precipitation of aluminosilicates by heating the solutions to accelerate solids formation. The results of the experiments with actual waste solutions are supported in this report.

  3. What Does the Force Concept Inventory Actually Measure?

    ERIC Educational Resources Information Center

    Huffman, Douglas; Heller, Patricia

    1995-01-01

    The Force Concept Inventory (FCI) is a 29-question, multiple-choice test designed to assess students' Newtonian and non-Newtonian conceptions of force. Presents an analysis of FCI results as one way to determine what the inventory actually measures. (LZ)

  4. 24 CFR 242.42 - Certificates of actual cost.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Endorsement for Insurance § 242.42 Certificates of actual cost. (a) The... cost, such certification shall be final and incontestable except for fraud or...

  5. 24 CFR 242.42 - Certificates of actual cost.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Endorsement for Insurance § 242.42 Certificates of actual cost. (a) The... cost, such certification shall be final and incontestable except for fraud or...

  6. A Taxometric Analysis of Actual Internet Sports Gambling Behavior

    ERIC Educational Resources Information Center

    Braverman, Julia; LaBrie, Richard A.; Shaffer, Howard J.

    2011-01-01

    This article presents findings from the first taxometric study of actual gambling behavior to determine whether we can represent the characteristics of extreme gambling as qualitatively distinct (i.e., taxonic) or as a point along a dimension. We analyzed the bets made during a 24-month study period by the 4,595 most involved gamblers among a…

  7. Testing two temporal upscaling schemes for the estimation of the time variability of the actual evapotranspiration

    NASA Astrophysics Data System (ADS)

    Maltese, A.; Capodici, F.; Ciraolo, G.; La Loggia, G.

    2015-10-01

    Temporal availability of grapes actual evapotranspiration is an emerging issue since vineyards farms are more and more converted from rainfed to irrigated agricultural systems. The manuscript aims to verify the accuracy of the actual evapotranspiration retrieval coupling a single source energy balance approach and two different temporal upscaling schemes. The first scheme tests the temporal upscaling of the main input variables, namely the NDVI, albedo and LST; the second scheme tests the temporal upscaling of the energy balance output, the actual evapotranspiration. The temporal upscaling schemes were implemented on: i) airborne remote sensing data acquired monthly during a whole irrigation season over a Sicilian vineyard; ii) low resolution MODIS products released daily or weekly; iii) meteorological data acquired by standard gauge stations. Daily MODIS LST products (MOD11A1) were disaggregated using the DisTrad model, 8-days black and white sky albedo products (MCD43A) allowed modeling the total albedo, and 8-days NDVI products (MOD13Q1) were modeled using the Fisher approach. Results were validated both in time and space. The temporal validation was carried out using the actual evapotranspiration measured in situ using data collected by a flux tower through the eddy covariance technique. The spatial validation involved airborne images acquired at different times from June to September 2008. Results aim to test whether the upscaling of the energy balance input or output data performed better.

  8. Radiomic Profiling of Glioblastoma: Identifying an Imaging Predictor of Patient Survival with Improved Performance over Established Clinical and Radiologic Risk Models.

    PubMed

    Kickingereder, Philipp; Burth, Sina; Wick, Antje; Götz, Michael; Eidel, Oliver; Schlemmer, Heinz-Peter; Maier-Hein, Klaus H; Wick, Wolfgang; Bendszus, Martin; Radbruch, Alexander; Bonekamp, David

    2016-09-01

    Purpose To evaluate whether radiomic feature-based magnetic resonance (MR) imaging signatures allow prediction of survival and stratification of patients with newly diagnosed glioblastoma with improved accuracy compared with that of established clinical and radiologic risk models. Materials and Methods Retrospective evaluation of data was approved by the local ethics committee and informed consent was waived. A total of 119 patients (allocated in a 2:1 ratio to a discovery [n = 79] or validation [n = 40] set) with newly diagnosed glioblastoma were subjected to radiomic feature extraction (12 190 features extracted, including first-order, volume, shape, and texture features) from the multiparametric (contrast material-enhanced T1-weighted and fluid-attenuated inversion-recovery imaging sequences) and multiregional (contrast-enhanced and unenhanced) tumor volumes. Radiomic features of patients in the discovery set were subjected to a supervised principal component (SPC) analysis to predict progression-free survival (PFS) and overall survival (OS) and were validated in the validation set. The performance of a Cox proportional hazards model with the SPC analysis predictor was assessed with C index and integrated Brier scores (IBS, lower scores indicating higher accuracy) and compared with Cox models based on clinical (age and Karnofsky performance score) and radiologic (Gaussian normalized relative cerebral blood volume and apparent diffusion coefficient) parameters. Results SPC analysis allowed stratification based on 11 features of patients in the discovery set into a low- or high-risk group for PFS (hazard ratio [HR], 2.43; P = .002) and OS (HR, 4.33; P < .001), and the results were validated successfully in the validation set for PFS (HR, 2.28; P = .032) and OS (HR, 3.45; P = .004). The performance of the SPC analysis (OS: IBS, 0.149; C index, 0.654; PFS: IBS, 0.138; C index, 0.611) was higher compared with that of the radiologic (OS: IBS, 0.175; C index, 0

  9. Global Positioning System Derived Performance Measures Are Responsive Indicators of Physical Activity, Disease and the Success of Clinical Treatments in Domestic Dogs

    PubMed Central

    Bruno, Elizabeth A.; Guthrie, James W.; Ellwood, Stephen A.; Mellanby, Richard J.; Clements, Dylan N.

    2015-01-01

    Objective To assess the use of Global Positioning System receiver (GPS) derived performance measures for differentiating between: 1) different outdoor activities in healthy dogs; 2) healthy dogs and those with osteoarthritis; 3) osteoarthritic dogs before and after treatment with non-steroidal anti-inflammatory analgesia. Design Prospective study. Animals Ten healthy dogs and seven dogs with osteoarthritis of the elbow joint (OA dogs). Procedure Healthy dogs were walked on a standard route on-lead, off-lead and subjected to playing activity (chasing a ball) whilst wearing a GPS collar. Each dog was walked for five consecutive days. Dogs with OA were subjected to a single off-lead walk whilst wearing a GPS collar, and then administered oral Carprofen analgesia daily for two weeks. OA dogs were then subjected to the same walk, again wearing a GPS collar. Results GPS derived measures of physical performance could differentiate between on-lead activity, off-lead activity and playing activity in healthy dogs, and between healthy dogs and OA dogs. Variation in the performance measures analysed was greater between individual dogs than for individual dogs on different days. Performance measures could differentiate healthy dogs from OA dogs. OA Dogs treated with Carprofen analgesia showed improvements in their physical performance, which returned to values indistinguishable from those of healthy dogs on nearly all the measures assessed. Conclusions and Clinical Relevance GPS derived measures of physical performance in dogs are objective, easy to quantify, and can be used to gauge the effects of disease and success of clinical treatments. Specific stimuli can be used to modulate physical performance beyond the self-governed boundaries that dogs will naturally express when allowed to exercise freely without stimulation. PMID:25692761

  10. OPTICAL PRINCIPLES, BIOMECHANICS, AND INITIAL CLINICAL PERFORMANCE OF A DUAL-OPTIC ACCOMMODATING INTRAOCULAR LENS (AN AMERICAN OPHTHALMOLOGICAL SOCIETY THESIS)

    PubMed Central

    McLeod, Stephen D.

    2006-01-01

    Purpose To design and develop an accommodating intraocular lens (IOL) for endocapsular fixation with extended accommodative range that can be adapted to current standard extracapsular phacoemulsification technique. Methods Ray tracing analysis and lens design; finite element modeling of biomechanical properties; cadaver eye implantation; initial clinical evaluation. Results Ray tracing analysis indicated that a dual-optic design with a high plus-power front optic coupled to an optically compensatory minus posterior optic produced greater change in conjugation power of the eye compared to that produced by axial movement of a single-optic IOL, and that magnification effects were unlikely to account for improved near vision. Finite element modeling indicated that the two optics can be linked by spring-loaded haptics that allow anterior and posterior axial displacement of the front optic in response to changes in ciliary body tone and capsular tension. A dual-optic single-piece foldable silicone lens was constructed based on these principles. Subsequent initial clinical evaluation in 24 human eyes after phacoemulsification for cataract indicated mean 3.22 diopters of accommodation (range, 1 to 5 D) based on defocus curve measurement. Accommodative amplitude evaluation at 1- and 6-month follow-up in all eyes indicated that the accommodative range was maintained and that the lens was well tolerated. Conclusions A dual-optic design increases the accommodative effect of axial optic displacement, with minimal magnification effect. Initial clinical trials suggest that IOLs designed on this principle might provide true pseudophakic accommodation following cataract extraction and lens implantation. PMID:17471355

  11. Diagnostic Performance of a New Rapid Lateral Flow Immunoassay in Patients Suspected of Heparin-Induced Thrombocytopenia and Its Clinical Consequences.

    PubMed

    Berroëta, Clarisse; Crespin, Malvina; Bouabdallah, Kamel; Pargade, Sophie; Huchet, François-Xavier; Bourel, Patrick; Philip, Ivan; Lebuisson, Agathe

    2016-02-01

    We prospectively evaluated the diagnostic accuracy of a new rapid assay (STic Expert HIT) alone or in combination with a clinical score in 90 HIT-suspected patients. The 4Ts score was calculated, and ELISA and serotonin-release assay (SRA) were performed; the average time taken for test results were 2 and 5 days for ELISA and SRA, respectively. The STic test was performed in our laboratory as an evaluation exercise and the result was available in 1 hour, but results were not communicated to the clinicians so as to not influence management. Diagnostic performance of STic test was assessed, alone and in combination with 4Ts score. HIT was diagnosed in 19 patients. The sensitivity, specificity, and positive and negative predictive values for the STic test alone were 95%, 92%, 75%, and 98%, respectively, with an accuracy of 92%. The likelihood ratio for positive and negative results with the STic test was 11.2 and 0.06. The combination of the 4Ts score and the STic test results had a negative predictive value of 100% and a negative likelihood ratio of 0. The favorable performance of the STic test may allow for the rapid exclusion of HIT in combination with a low to intermediate pretest clinical probability. During the subsequent year, using the STic test in real time to rapidly exclude the diagnosis, we observed a 50% reduction in danaparoid administration in HIT-suspected patients. PMID:26595149

  12. 19 CFR 162.79b - Recovery of actual loss of duties, taxes and fees or actual loss of revenue.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... case in which a monetary penalty is not assessed or a written notification of claim of monetary penalty is not issued, the port director will issue a written notice to the person of the liability for the... actual loss of revenue. Whether or not a monetary penalty is assessed under this subpart, the...

  13. Hypothetical ratings of coronary angiography appropriateness: are they associated with actual angiographic findings, mortality, and revascularisation rate? The ACRE study

    PubMed Central

    Hemingway, H; Crook, A; Banerjee, S; Dawson, J; Feder, G; Magee, P; Wood, A; Philpott, S; Timmis, A

    2001-01-01

    OBJECTIVE—To determine whether ratings of coronary angiography appropriateness derived by an expert panel on hypothetical patients are associated with actual angiographic findings, mortality, and subsequent revascularisation in the ACRE (appropriateness of coronary revascularisation) study.
DESIGN—Population based, prospective study. The ACRE expert panel rated hypothetical clinical indications as inappropriate, uncertain, or appropriate before recruitment of a cohort of real patients.
SETTING—Royal Hospitals Trust, London, UK.
PARTICIPANTS—3631 consecutive patients undergoing coronary angiography (no exclusion criteria).
MAIN OUTCOME MEASURES—Angiographic findings, mortality (n = 226 deaths), and revascularisation (n = 1556 procedures) over 2.5 years of follow up.
RESULTS—The indications for coronary angiography were rated appropriate in 2253 (62%) patients. 166 (5%) coronary angiograms were performed for indications rated inappropriate, largely for asymptomatic or atypical chest pain presentations. The remaining 1212 (33%) angiograms were rated uncertain, of which 47% were in patients with mild angina and no exercise ECG or in patients with unstable angina controlled by inpatient management. Three vessel disease was more likely among appropriate cases and normal coronaries were more likely among inappropriate cases (p < 0.001). Mortality and revascularisation rates were highest among patients with an appropriate indication, intermediate in those with an uncertain indication, and lowest in the inappropriate group (log rank p = 0.018 and p < 0.0001, respectively).
CONCLUSION—The ACRE ratings of appropriateness for angiography predicted angiographic findings, mortality, and revascularisation rates. These findings support the clinical usefulness of expert panel methods in defining criteria for performing coronary angiography.


Keywords: coronary artery disease; coronary angiography; coronary artery bypass graft

  14. Integration of imaging into clinical practice to assess the delivery and performance of macromolecular and nanotechnology-based oncology therapies.

    PubMed

    Spence, Tara; De Souza, Raquel; Dou, Yannan; Stapleton, Shawn; Reilly, Raymond M; Allen, Christine

    2015-12-10

    Functional and molecular imaging has become increasingly used to evaluate interpatient and intrapatient tumor heterogeneity. Imaging allows for assessment of microenvironment parameters including tumor hypoxia, perfusion and proliferation, as well as tumor metabolism and the intratumoral distribution of specific molecular markers. Imaging information may be used to stratify patients for targeted therapies, and to define patient populations that may benefit from alternative therapeutic approaches. It also provides a method for non-invasive monitoring of treatment response at earlier time-points than traditional cues, such as tumor shrinkage. Further, companion diagnostic imaging techniques are becoming progressively more important for development and clinical implementation of targeted therapies. Imaging-based companion diagnostics are likely to be essential for the validation and FDA approval of targeted nanotherapies and macromolecular medicines. This review describes recent clinical advances in the use of functional and molecular imaging to evaluate the tumor microenvironment. Additionally, this article focuses on image-based assessment of distribution and anti-tumor effect of nano- and macromolecular systems.

  15. SU-E-J-102: Performance Variations Among Clinically Available Deformable Image Registration Tools in Adaptive Radiotherapy: How Should We Evaluate and Interpret the Result?

    SciTech Connect

    Nie, K; Pouliot, J; Smith, E; Chuang, C

    2015-06-15

    Purpose: To evaluate the performance variations in commercial deformable image registration (DIR) tools for adaptive radiation therapy. Methods: Representative plans from three different anatomical sites, prostate, head-and-neck (HN) and cranial spinal irradiation (CSI) with L-spine boost, were included. Computerized deformed CT images were first generated using virtual DIR QA software (ImSimQA) for each case. The corresponding transformations served as the “reference”. Three commercial software packages MIMVista v5.5 and MIMMaestro v6.0, VelocityAI v2.6.2, and OnQ rts v2.1.15 were tested. The warped contours and doses were compared with the “reference” and among each other. Results: The performance in transferring contours was comparable among all three tools with an average DICE coefficient of 0.81 for all the organs. However, the performance of dose warping accuracy appeared to rely on the evaluation end points. Volume based DVH comparisons were not sensitive enough to illustrate all the detailed variations while isodose assessment on a slice-by-slice basis could be tedious. Point-based evaluation was over-sensitive by having up to 30% hot/cold-spot differences. If adapting the 3mm/3% gamma analysis into the evaluation of dose warping, all three algorithms presented a reasonable level of equivalency. One algorithm had over 10% of the voxels not meeting this criterion for the HN case while another showed disagreement for the CSI case. Conclusion: Overall, our results demonstrated that evaluation based only on the performance of contour transformation could not guarantee the accuracy in dose warping. However, the performance of dose warping accuracy relied on the evaluation methodologies. Nevertheless, as more DIR tools are available for clinical use, the performance could vary at certain degrees. A standard quality assurance criterion with clinical meaning should be established for DIR QA, similar to the gamma index concept, in the near future.

  16. Actual curriculum development practices instrument: Testing for factorial validity

    NASA Astrophysics Data System (ADS)

    Foi, Liew Yon; Bakar, Kamariah Abu; Hamzah, Mohd Sahandri Gani; Alwi, Nor Hayati

    2014-09-01

    The Actual Curriculum Development Practices Instrument (ACDP-I) was developed and the factorial validity of the ACDP-I was tested (n = 107) using exploratory factor analysis procedures in the earlier work of [1]. Despite the ACDP-I appears to be content and construct valid instrument with very high internal reliability qualities for using in Malaysia, the accumulated evidences are still needed to provide a sound scientific basis for the proposed score interpretations. Therefore, the present study addresses this concern by utilising the confirmatory factor analysis to further confirm the theoretical structure of the variable Actual Curriculum Development Practices (ACDP) and enrich the psychometrical properties of ACDP-I. Results of this study have practical implication to both researchers and educators whose concerns focus on teachers' classroom practices and the instrument development and validation process.

  17. 63. VIEW OF AUTOTRANSFERS. THE ACTUAL AUTOTRANSFERS ARE ENCLOSED IN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic La