Measurement of consumer preference for treatments used to induce labour: a willingness-to-pay approach.

PubMed

Taylor, Susan J.; Armour, Carol L.

2000-09-01

AIM: The purpose of the study was to assess the acceptability to consumers of two methods of induction of labour using a willingness-to-pay (WTP) approach. The methods compared were amniotomy plus oxytocin and prostaglandin E2 vaginal gel, followed by oxytocin if necessary. METHODS: A description of each method was presented, in questionnaire format, to pregnant women attending a public hospital ante-natal clinic. Women were asked to choose one of the two treatments, then give a valuation in dollar terms for both their preferred treatment and the alternative. RESULTS: It was found that 73.7% of patients preferred gel. The mean maximum WTP for amniotomy plus oxytocin was Aus$133 while that for gel was Aus$178 (P=0.0001). Those who chose amniotomy plus oxytocin were WTP 90% more for their preferred treatment compared with the alternative (Aus$180 vs. Aus$95). Similarly, those who preferred gel were WTP 90% more for their preferred treatment compared with the alternative (Aus$222 vs. Aus$119). CONCLUSION: Consumers were able to assess drug information provided on the two therapies, make an informed choice and to value that choice. Information obtained in this way, combined with information on costs, could be used in policy decision-making.

Measurement of consumer preference for treatments used to induce labour: a willingness‐to‐pay approach

PubMed Central

Taylor, Susan J.; Armour, Carol L.

2001-01-01

Aim The purpose of the study was to assess the acceptability to consumers of two methods of induction of labour using a willingness‐to‐pay (WTP) approach. The methods compared were amniotomy plus oxytocin and prostaglandin E2 vaginal gel, followed by oxytocin if necessary. Methods A description of each method was presented, in questionnaire format, to pregnant women attending a public hospital ante‐natal clinic. Women were asked to choose one of the two treatments, then give a valuation in dollar terms for both their preferred treatment and the alternative. Results It was found that 73.7% of patients preferred gel. The mean maximum WTP for amniotomy plus oxytocin was Aus$133 while that for gel was Aus$178 (P=0.0001). Those who chose amniotomy plus oxytocin were WTP 90% more for their preferred treatment compared with the alternative (Aus$180 vs. Aus$95). Similarly, those who preferred gel were WTP 90% more for their preferred treatment compared with the alternative (Aus$222 vs. Aus$119). Conclusion Consumers were able to assess drug information provided on the two therapies, make an informed choice and to value that choice. Information obtained in this way, combined with information on costs, could be used in policy decision‐making. PMID:11281930

Alternative methods for the control of postharvest citrus diseases.

PubMed

Talibi, I; Boubaker, H; Boudyach, E H; Ait Ben Aoumar, A

2014-07-01

The postharvest diseases of citrus fruit cause considerable losses during storage and transportation. These diseases are managed principally by the application of synthetic fungicides. However, the increasing concern for health hazards and environmental pollution due to chemical use has required the development of alternative strategies for the control of postharvest citrus diseases. Management of postharvest diseases using microbial antagonists, natural plant-derived products and Generally Recognized As Safe compounds has been demonstrated to be most suitable to replace the synthetic fungicides, which are either being banned or recommended for limited use. However, application of these alternatives by themselves may not always provide a commercially acceptable level of control of postharvest citrus diseases comparable to that obtained with synthetic fungicides. To provide more effective disease control, a multifaceted approach based on the combination of different postharvest treatments has been adopted. Actually, despite the distinctive features of these alternative methods, several reasons hinder the commercial use of such treatments. Consequently, research should emphasize the development of appropriate tools to effectively implement these alternative methods to commercial citrus production. © 2014 The Society for Applied Microbiology.

Synthetic sea water - An improved stress corrosion test medium for aluminum alloys

NASA Technical Reports Server (NTRS)

Humphries, T. S.; Nelson, E. E.

1973-01-01

A major problem in evaluating the stress corrosion cracking resistance of aluminum alloys by alternate immersion in 3.5 percent salt (NaCl) water is excessive pitting corrosion. Several methods were examined to eliminate this problem and to find an improved accelerated test medium. These included the addition of chromate inhibitors, surface treatment of specimens, and immersion in synthetic sea water. The results indicate that alternate immersion in synthetic sea water is a very promising stress corrosion test medium. Neither chromate inhibitors nor surface treatment (anodize and alodine) of the aluminum specimens improved the performance of alternate immersion in 3.5 percent salt water sufficiently to be classified as an effective stress corrosion test method.

The reasons for using and not using alternative medicine in Khorramabad women, west of Iran.

PubMed

Mahmoudi, Ghaffar Ali; Almasi, Vahid; Lorzadeh, Nahid; Khansari, Azadeh

2015-06-01

To evaluate reasons for using and not using alternative medicines. The cross-sectional study was conducted in 2009 on women over 18 years of age in Khorramabad, Iran. The subjects were selected by using cluster and simple random sampling method. The data were recorded in a questionnaire that involved questions about the subjects' age, marital status, their opinions on their general health, and advantages and disadvantages of conventional and alternative medicine. Of the 1600 women initially selected, 1551(97%) represented the final sample. The mean age of the participants was 35.04±10.71 years. Overall, 435(28%) spoke of disadvantages of alternative medicine; 277(18%) about the advantages of alternative medicine; 523(34%) about the advantages of conventional treatments; and 316(20%) about the disadvantages of conventional treatments. The most prevalent reason for not using the conventional treatments was the cost factor in 159(50.3%). Trust in physicians 328(62.7%) and distrust in alternative medicine therapists 317(73%) were the most prevalent reasons for using conventional treatments and not using alternative medicine. Similar studies should be done on the reasons for using and not using each medication of alternative medicines separately.

Rosacea Patient Perspectives on Homeopathic and Over-the-counter Therapies

PubMed Central

Lan, Lucy; Kuo, Sandy; Huang, Karen E.; Taylor, Sarah L.; Feldman, Steven R.

2015-01-01

Background: Rosacea patients commonly employ nonprescription therapies. The authors’ aim was to understand rosacea patients’ perceptions of over-the-counter products, complementary and alternative medicine, and homeopathic therapies. Method: A public, online discussion forum comprising 3,350 members and 27,051 posts provided a source of 346 posts on patient perceptions on alternative rosacea treatments. Results: Three major themes of nonprescription treatment were identified—motivation for use, patient-provider discussions, and experience with these treatments. Perceived medication failure, barriers to treatment, and distrust of physicians drive patients to seek nonprescription therapies. Still, patients prefer to consult a physician on incorporating nonprescription therapies into treatment. Complementary and alternative medicine natural products (19.4% of posts), complementary and alternative medicine practices (16.5%), and homeopathic medicine (3.8%) were commonly discussed. Conclusion: Physicians have an opportunity to be a trusted source of information on the strengths and weaknesses of skin care products and other complementary treatments for rosacea. PMID:26557217

Factors related to complementary/alternative medicine use among cancer patients in central Anatolia.

PubMed

Er, Ozlem; Mistik, Selcuk; Ozkan, Metin; Ozturk, Ahmet; Altinbas, Mustafa

2008-01-01

We aimed to evaluate the prevalence of and factors related to the use of complementary/alternative medicine among cancer patients undergoing or following conventional treatment at the Erciyes University Oncology Hospital in Central Anatolia. Face-to-face interview and a questionnaire were carried out with cancer patients attending the outpatient clinic of Medical Oncology. Questionnaire items included patients' demographic data, treatment, use of complementary/alternative medicine and possible related factors. Multivariate analysis was performed to compare the factors related to use of complementary/alternative medicine. A total of 268 consecutive cancer patients were enrolled in the study. Overall, 43% of the patients were using or had used complementary/alternative medicine. Totally, 90% of the patients using complementary/alternative medicine utilized herbs, and most of the herbs used were stinging nettle. Nearly half of the patients using complementary/alternative medicine (46.1%) were aiming to fight the disease. Among users, nearly half of them regarded the method used as effective and 54 (50.5%) suggested the use of complementary/alternative medicine to other patients. Only 23.1% of the patients discussed the use of complementary/alternative medicine with their physician. In logistic regression analysis, younger age, higher educational status, advanced stage of the disease, longer duration of the disease and current treatment status were significantly associated with the use of complementary/alternative medicine. In our regression model, the predictivity rate of these variables was 72.2% for use of complementary/alternative medicine according to the backward Wald test. Use of complementary/alternative medicine among cancer patients in our center is modestly high, and the most common method is herbal therapy. Communication between the patient and the physician should be improved on this subject.

Wastewater Treatment and Reuse Treatment Technology Evaluation and Development

EPA Science Inventory

This project will assess the effectiveness of a Biomass Concentrator Reactor (BCR) to remove endocrine disrupting chemicals (EDCs) from wastewater. This technology could provide an alternative to traditional wastewater treatment methods.

Complementary and alternative medicine usage and its determinant factors among Iranian infertile couples.

PubMed

Dehghan, Mahlagha; Mokhtarabadi, Sima; Heidari, Fatemeh Ghaedi

2018-04-04

Background The aim of this study was to determine the status of utilizing some complementary and alternative medicine techniques in infertile couples. Methods This was a cross-sectional study conducted on 250 infertile couples referred to a hospital in Kerman using convenience sampling. A researcher-made questionnaire was used to study the prevalence and user satisfaction of complementary and alternative medicines. Results Results indicated that 49.6% of the infertile couples used at least one of the complementary and alternative medicines during the past year. Most individuals used spiritual techniques (71.8% used praying and 70.2% used Nazr) and medicinal plants (54.8%). Safety is the most important factor affecting the satisfaction of infertile couples with complementary treatments (couples think that such treatments are safe (54.8%)). Discussion Concerning high prevalence of complementary and alternative treatments in infertile couples, incorporating such treatments into the healthcare education and promoting the awareness of infertile individuals seem crucial.

Evaluating transportation systems management & operations (TSM&O) benefits to alternative intersection treatments.

DOT National Transportation Integrated Search

2015-12-01

This research provides a comprehensive review and assessment of current alternative intersection methods : which successfully eliminate the left-turn phase. With increasing traffic and limited resources, the Florida : Department of Transportati...

Integration of alternative feedstreams for biomass treatment and utilization

DOEpatents

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

2011-03-22

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

Mental disorders frequency alternative and complementary medicine usage among patients with hypertension and type 2 diabetes mellitus.

PubMed

Keskin, Ahmet; BIlge, Ugur

2014-01-01

Diabetes mellitus (DM) and hypertension (HT) are chronic disorders with which mental disorders may coexist and for which patients may resort to alternative medicine use. Alternative and complementary medicine is a treatment option that patients tend to use. This study is to determine the prevalence of mental disorders among patients diagnosed with DM and HT and their use of alternative medicine methods. Materials and Methods The study was conducted in a primary care setting. The data were collected from the Family Health Center No. 4 at Ηankaya, Ankara, Turkey. It involved patients aged between 18 and 65, who were on follow-up treatment for DM and HT. Patients accepted to participate in the study were administered the sociodemographic data form, the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire and the alternative medicine inquiry form. One hundred and sixteen patients with HT and 119 patients with DM (type 2) were recruited for the study. In this study, 47.4% of HT patients and 53.8% of the DM patients were diagnosed with a PRIME-MD. The most commonly encountered disorder was mood disorders, in 37.1% of the HT patients and 45.4% of the DM patients. In this study, four HT patients (0.3%) and no DM patients stated that they resorted to complimentary medicine, which can use be used alongside conventional medical treatment and may help to feel better and cope better with any chronic condition. All four HT patients were using multivitamin combinations to support the treatment. As the alternative medicine usage was described as treatment used instead of conventional medical treatment we did not find any patient using alternative medicine. Mental disorders may coexist with HT and DM. Some of the HT and DM patients suffering from a mental disorder seek psychiatric support, while others do not. We believe that it is important to examine patients for mental disorders, while being followed-up for a chronic disease.

Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis.

PubMed

Cooperberg, Matthew R; Ramakrishna, Naren R; Duff, Steven B; Hughes, Kathleen E; Sadownik, Sara; Smith, Joseph A; Tewari, Ashutosh K

2013-03-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Multiple treatment alternatives exist for localised prostate cancer, with few high-quality studies directly comparing their comparative effectiveness and costs. The present study is the most comprehensive cost-effectiveness analysis to date for localised prostate cancer, conducted with a lifetime horizon and accounting for survival, health-related quality-of-life, and cost impact of secondary treatments and other downstream events, as well as primary treatment choices. The analysis found minor differences, generally slightly favouring surgical methods, in quality-adjusted life years across treatment options. However, radiation therapy (RT) was consistently more expensive than surgery, and some alternatives, e.g. intensity-modulated RT for low-risk disease, were dominated - that is, both more expensive and less effective than competing alternatives. To characterise the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (RT: dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy, or combination), using a comprehensive, lifetime decision analytical model. A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes after primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. In each Markov cycle, patients could have remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the USA payer perspective, with incorporation of patient costs in a sensitivity analysis. Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6-10.5 for intermediate-risk patients and 7.8-9.3 for high-risk patients. There were no statistically significant differences among surgical methods, which tended to be more effective than RT methods, with the exception of combined external beam + brachytherapy for high-risk disease. RT methods were consistently more expensive than surgical methods; costs ranged from $19 901 (robot-assisted prostatectomy for low-risk disease) to $50 276 (combined RT for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions about strategies to improve efficiency of treatment selection for localised prostate cancer. © 2012 BJU International.

Deep Brain Stimulation as a Treatment for Refractory Epilepsy: Review of the Current State-of-the-Art.

PubMed

Ganguli, Malika P; Upton, Adrian R M; Kamath, Markad V

2017-01-01

Epilepsy affects ∼ 1% of the global population, and 33% of patients are nonresponsive to medication and must seek alternative treatment options. Alternative options such as surgery and ablation exist but are not appropriate treatment plans for some patients. Neurostimulation methods such as vagal nerve stimulation, responsive neural stimulation, and deep brain stimulation (DBS) are viable alternatives for medically refractory patients. DBS stimulation has been used in the treatment of Parkinson's disease, dystonia, and pain management. For the treatment of epilepsy, DBS has been found to be an effective treatment plan, with promising results of reduced seizure frequency and intensity. In this review, we discuss DBS surgery and equipment, mechanisms of DBS for epilepsy, and efficacy, technological specifications, and suggestions for future research. We also review a historical summary of experiments involving DBS for epilepsy. Our literature review suggests that further studies are warranted for medically refractory epilepsy using DBS.

DISINFECTION BY-PRODUCTS IN DRINKING WATER TREATMENT SYSTEMS

EPA Science Inventory

Due to concerns over trihalomethanes (THMs) and other halogenated by-products that can be formed during chlorination of drinking water, alternative disinfectants are being explored. Several drinking water treatment plants in the United States have altered their treatment methods...

Evaluation of Alternative Euthanasia Methods of Neonatal Chickens

PubMed Central

Gurung, Shailesh; White, Dima; Archer, Gregory; Zhao, Dan; Farnell, Yuhua; Byrd, J. Allen; Peebles, E. David

2018-01-01

Simple Summary Male layer chicks do not have economic value and are humanely killed after hatching. The layer industry is seeking alternative methods to humanely kill recently hatched male chicks. This study evaluated the use of gases or negative air pressure as a means of humane and viable alternatives to maceration. The treatments included carbon dioxide, nitrogen, reduced air pressure, and a negative control. The study showed that chicks exposed to treatments, gases or negative air pressure, did not differ significantly in terms of the physiological stress response. The use of carbon dioxide resulted in a faster onset of unconsciousness and ultimately death as compared to nitrogen or negative air pressure treatments. Abstract Hatched male layer chicks are currently euthanized by maceration in the United States. Public concerns on the use of maceration have led to the search for alternative methods. We hypothesized that gas inhalation and low atmospheric pressure stunning (LAPS) are viable and humane alternatives to instantaneous mechanical destruction. The objective of this study was to evaluate the physiological and behavioral responses of recently hatched male layer chicks when subjected to carbon dioxide, nitrogen inhalation, or LAPS. The study consisted of seven treatments: breathing air (NEG), 25% carbon dioxide (CO2), 50% CO2, 75% CO2, 90% CO2, 100% nitrogen (N2), or LAPS. Ten day-of-hatch, male layer chicks were randomly assigned to each treatment, and each treatment was replicated on ten different days. A custom-made vacuum system was used to reduce air pressure inside the chamber from 100.12 kPa to 15.3 kPa for the LAPS treatment. Serum corticosterone and serotonin levels were measured using commercially available competitive enzyme linked immunosorbent assay (ELISA). Latencies to loss of posture and motionlessness were determined from video recordings. The 25% and 50% CO2 treatments were discontinued after the first replication, as the majority of the chicks recovered. The chicks in the negative (NEG) group had significantly higher levels of corticosterone than the other four euthanasia treatments. On the other hand, the serotonin levels of chicks in the NEG group was significantly lower when compared to the other four euthanasia treatments. The latencies to loss of posture and motionlessness of chicks exposed to 75% and 90% CO2 were significantly shorter than those in the LAPS and N2 inhalation treatments. These data suggest that the stress responses of chicks to the CO2, N2, and LAPS treatments do not differ among each other. However, the CO2 inhalation method was faster in inducing loss of posture and motionlessness in chicks than the LAPS and N2 inhalation treatments. PMID:29522442

Systematic Desensitization as a Method of Teaching a General Anxiety-Reducing Skill

ERIC Educational Resources Information Center

Zemore, Robert

1975-01-01

College students were treated with either a standard or modified version of systematic desensitization. Relative to a no-treatment control group, both treatment methods produced significant reductions in both the treated and untreated fears. The implications these findings have for two alternative conceptions of systematic desensitization are…

Beliefs and perceptions of women with newly diagnosed breast cancer who refused conventional treatment in favor of alternative therapies.

PubMed

Citrin, Dennis L; Bloom, Diane L; Grutsch, James F; Mortensen, Sara J; Lis, Christopher G

2012-01-01

Although breast cancer is a highly treatable disease, some women reject conventional treatment opting for unproven "alternative therapy" that may contribute to poor health outcomes. This study sought to understand why some women make this decision and to identify messages that might lead to greater acceptance of evidence-based treatment. This study explored treatment decision making through in-depth interviews with 60 breast cancer patients identified by their treating oncologists. Thirty refused some or all conventional treatment, opting for alternative therapies, whereas 30 accepted both conventional and alternative treatments. All completed the Beck Anxiety Inventory and the Rotter Locus of Control scale. Negative first experiences with "uncaring, insensitive, and unnecessarily harsh" oncologists, fear of side effects, and belief in the efficacy of alternative therapies were key factors in the decision to reject potentially life-prolonging conventional therapy. Refusers differed from controls in their perceptions of the value of conventional treatment, believing that chemotherapy and radiotherapy were riskier (p < .0073) and less beneficial (p < .0001) than did controls. Controls perceived alternative medicine alone as riskier than did refusers because its value for treating cancer is unproven (p < .0001). Refusers believed they could heal themselves naturally from cancer with simple holistic methods like raw fruits, vegetables, and supplements. According to interviewees, a compassionate approach to cancer care plus physicians who acknowledge their fears, communicate hope, educate them about their options, and allow them time to come to terms with their diagnosis before starting treatment might have led them to better treatment choices.

Greenhouse gas emissions from alternative water supply processes in southern California, USA

NASA Astrophysics Data System (ADS)

Schneider, A.; Townsend-Small, A.

2012-12-01

Burgeoning population centers and declining hydrological resources have encouraged the development of alternative water treatment systems, including desalination and wastewater recycling. These processes currently provide potable water for millions of people and assist in satisfying agricultural and landscaping irrigation demands. There are a variety of alternative water production methods in place, and while they help to reduce the demands placed on aquifers, during their operation they are also significant sources of greenhouse gases. The environmental advantages of these alternative water production methods need to be carefully weighed against their energy footprints and greenhouse gas emissions profiles. This study measured the greenhouse gas emissions of a wastewater treatment and recycling facility in Orange County, California to get a more complete picture of the carbon footprint of the plant. We measured atmospheric emissions of CO2, CH4, and N2O throughout the water recycling process and at various times of the day and week. This allowed us to assemble a thorough, cross-sectional profile of greenhouse gas emissions from the facility. We then compared the measured emissions of the treatment plant to the modeled emissions of desalination plants in order to assess the relative carbon footprints of the two water production methods. Other water supply alternatives, including regional water importation, were also included in the comparison in order to provide a more complete understanding of the potential greenhouse gas emissions. Finally, we assessed the significance of wastewater treatment as an urban greenhouse gas source when compared to other known emissions in the region. This research offers a valuable tool for sustainable urban and regional development by providing planners with a quantified comparison of the carbon footprints of several water production options.

[Methods of traditional chinese medicine in the treatment of patients with interstitial cystitis/bladder pain syndrome].

PubMed

Ignashov, A Yu; Deng, B; Kuzmin, I V; Slesarevskaya, M N

2018-03-01

In recent years, there has been an increasing interest in alternative (complementary) treatments of interstitial cystitis/bladder pain syndrome (IC/BPS). This is due both to the high incidence of IC/BPS and to a lack of effectiveness of conventional treatments. One of the directions of alternative therapies is a traditional Chinese medicine using a special diet, various animal and plant-derived medicines, breathing exercises and acupuncture. This review analyzes the accumulated experience in using traditional Chinese medicine in the treatment of patients with IC/BPS. The presented data indicate that these methods appear to be promising, since they are effective in a significant number of patients, lead to an improvement in their quality of life, are non-invasive and well tolerated. However, due to the lack of clinical studies, the efficacy of this treatment modalities needs to be confirmed.

Assessment of health-care waste disposal methods using a VIKOR-based fuzzy multi-criteria decision making method.

PubMed

Liu, Hu-Chen; Wu, Jing; Li, Ping

2013-12-01

Nowadays selection of the appropriate treatment method in health-care waste (HCW) management has become a challenge task for the municipal authorities especially in developing countries. Assessment of HCW disposal alternatives can be regarded as a complicated multi-criteria decision making (MCDM) problem which requires consideration of multiple alternative solutions and conflicting tangible and intangible criteria. The objective of this paper is to present a new MCDM technique based on fuzzy set theory and VIKOR method for evaluating HCW disposal methods. Linguistic variables are used by decision makers to assess the ratings and weights for the established criteria. The ordered weighted averaging (OWA) operator is utilized to aggregate individual opinions of decision makers into a group assessment. The computational procedure of the proposed framework is illustrated through a case study in Shanghai, one of the largest cities of China. The HCW treatment alternatives considered in this study include "incineration", "steam sterilization", "microwave" and "landfill". The results obtained using the proposed approach are analyzed in a comparative way. Copyright © 2013. Published by Elsevier Ltd.

Antitumor effects of electrochemical treatment

PubMed Central

González, Maraelys Morales; Zamora, Lisset Ortíz; Cabrales, Luis Enrique Bergues; Sierra González, Gustavo Victoriano; de Oliveira, Luciana Oliveira; Zanella, Rodrigo; Buzaid, Antonio Carlos; Parise, Orlando; Brito, Luciana Macedo; Teixeira, Cesar Augusto Antunes; Gomes, Marina das Neves; Moreno, Gleyce; Feo da Veiga, Venicio; Telló, Marcos; Holandino, Carla

2013-01-01

Electrochemical treatment is an alternative modality for tumor treatment based on the application of a low intensity direct electric current to the tumor tissue through two or more platinum electrodes placed within the tumor zone or in the surrounding areas. This treatment is noted for its great effectiveness, minimal invasiveness and local effect. Several studies have been conducted worldwide to evaluate the antitumoral effect of this therapy. In all these studies a variety of biochemical and physiological responses of tumors to the applied treatment have been obtained. By this reason, researchers have suggested various mechanisms to explain how direct electric current destroys tumor cells. Although, it is generally accepted this treatment induces electrolysis, electroosmosis and electroporation in tumoral tissues. However, action mechanism of this alternative modality on the tumor tissue is not well understood. Although the principle of Electrochemical treatment is simple, a standardized method is not yet available. The mechanism by which Electrochemical treatment affects tumor growth and survival may represent more complex process. The present work analyzes the latest and most important research done on the electrochemical treatment of tumors. We conclude with our point of view about the destruction mechanism features of this alternative therapy. Also, we suggest some mechanisms and strategies from the thermodynamic point of view for this therapy. In the area of Electrochemical treatment of cancer this tool has been exploited very little and much work remains to be done. Electrochemical treatment constitutes a good therapeutic option for patients that have failed the conventional oncology methods. PMID:23592904

CAPSULE REPORT: AQUEOUS MERCURY TREATMENT

EPA Science Inventory

This report describes established technologies and identifies evolving methods for treating aqueous mercury. The information provided encompasses full-, pilot- and bench-scale treatment results as presented in the technical literature. The report describes alternative technologi...

[Alternative treatment methods in ENT].

PubMed

Friese, K H

1997-08-01

In this review, the most important complementary und alternative therapies are discussed, focusing particularly on their use in otorhinolaryngology. These therapies include balneology, Kneipp therapy, microbiological therapy, fasting, excretion therapy, different oxygen therapies, hydro-colon therapy, urine therapy, own-blood therapy, Bach therapy, orthomolecular therapy, order therapy, environmental medicine, phytotherapy, homeopathy, complex homeopathy, anthroposophy, neural therapy, electroaccupuncture according to Voll and similar therapies, nasal reflex therapy, reflex-zone massage, manual therapy, massage, lymph drainage, aroma therapy, thermotherapy, bioresonance, kinesiology, hopi candles, and dietetics. Some of these methods and regimens can be recommended, but others should be rejected. In universities, these methods are only represented to a minor extend, but are more accepted by otorhinolaryngologists in practice. This paper provides a guide to which alternative therapies are sensible and possible in otorhinolaryngology. The aim is to stimulate interest in these methods. It is necessary to discuss these alternative methods reasonably and credibly with patients.

Magnetotherapy in the treatment of viral conjunctivitis and keratitis.

PubMed

Pasek, Jarosław; Pasek, Tomasz; Herba, Ewa; Misiak, Anna; Sieroń-Stołtny, Karolina; Sieroń, Aleksander

2008-01-01

Ocular infections are one of the most frequent causes of ailments among the patients coming to ophthalmologic offices. This article presents one of the physical medicine's methods--magnetotherapy--which uses the alternating low frequency magnetic fields in the therapy of viral conjunctivitis and keratitis in a 49-year-old female patient. Basing on the obtained results it was stated that this method broadens the treatment possibilities becoming a precious supplement and support treatment method in ophthalmology.

Chapter 29: Unproved and controversial methods and theories in allergy-immunology.

PubMed

Shah, Rachna; Greenberger, Paul A

2012-01-01

Unproved methods and controversial theories in the diagnosis and management of allergy-immunology are those that lack scientific credibility. Some definitions are provided for perspective because in chronic medical conditions, frequently, nonscientifically based treatments are developed that can have a very positive psychological effect on the patients in the absence of objective physical benefit. Standard practice can be described as "the methods of diagnosis and treatment used by reputable physicians in a particular subspecialty or primary care practice" with the understanding that diagnosis and treatment options are consistent with established mechanisms of conditions or diseases.(3) Conventional medicine (Western or allopathic medicine) is that which is practiced by the majority of MDs, DOs, psychologists, RNs, and physical therapists. Complementary medicine uses the practice of conventional medicine with complementary and alternative medicine such as using acupuncture for pain relief in addition to opioids. Alternative medicine implies use of complementary and alternative practices in place of conventional medicine. Unproved and controversial methods and theories do not have supporting data, validation, and sufficient scientific scrutiny, and they should not be used in the practice of allergy-immunology. Some examples of unproven theories about allergic immunologic conditions include allergic toxemia, idiopathic environmental intolerance, association with childhood vaccinations, and adrenal fatigue. Unconventional (unproved) diagnostic methods for allergic-immunologic conditions include cytotoxic tests, provocation-neutralization, electrodermal diagnosis, applied kinesiology assessments, and serum IgG or IgG(4) testing. Unproven treatments and intervention methods for allergic-immunologic conditions include acupuncture, homeopathy ("likes cure likes"), halotherapy, and autologous urine injections.

[Congenital ChagaśDisease: epidemiology, laboratorial diagnosis, prognosis and treatment].

PubMed

Reiche, E M; Inouye, M M; Bonametti, A M; Jankevicius, J V

1996-01-01

The authors review studies about epidemiology, clinical aspects and methods used in laboratorial diagnosis of congenital Chagas'disease, emphasizing the limitations in their specificity and sensibility, and suggest alternative methods to improve the accuracy and the quality of the laboratorial diagnosis of congenital Chagaśdisease, essential to an efficient treatment.

Quint: An R package for the identification of subgroups of clients who differ in which treatment alternative is best for them.

PubMed

Dusseldorp, Elise; Doove, Lisa; Mechelen, Iven van

2016-06-01

In the analysis of randomized controlled trials (RCTs), treatment effect heterogeneity often occurs, implying differences across (subgroups of) clients in treatment efficacy. This phenomenon is typically referred to as treatment-subgroup interactions. The identification of subgroups of clients, defined in terms of pretreatment characteristics that are involved in a treatment-subgroup interaction, is a methodologically challenging task, especially when many characteristics are available that may interact with treatment and when no comprehensive a priori hypotheses on relevant subgroups are available. A special type of treatment-subgroup interaction occurs if the ranking of treatment alternatives in terms of efficacy differs across subgroups of clients (e.g., for one subgroup treatment A is better than B and for another subgroup treatment B is better than A). These are called qualitative treatment-subgroup interactions and are most important for optimal treatment assignment. The method QUINT (Qualitative INteraction Trees) was recently proposed to induce subgroups involved in such interactions from RCT data. The result of an analysis with QUINT is a binary tree from which treatment assignment criteria can be derived. The implementation of this method, the R package quint, is the topic of this paper. The analysis process is described step-by-step using data from the Breast Cancer Recovery Project, showing the reader all functions included in the package. The output is explained and given a substantive interpretation. Furthermore, an overview is given of the tuning parameters involved in the analysis, along with possible motivational concerns associated with choice alternatives that are available to the user.

MEMBRANES FOR DRINKING WATER TREATMENT

EPA Science Inventory

Various treatment technologies have proven effective in controlling halogenated disinfection by-products such as precursor removal and the use of alternative disinfectants. One of the most promising methods for halogenated by-product control includes removal of precursors before ...

Attitudes toward Hepatitis B Virus among Vietnamese, Chinese and Korean Americans in the Houston Area, Texas

PubMed Central

Hwang, Jessica P.; Roundtree, Aimee K.; Suarez-Almazor, Maria E.

2017-01-01

Objectives We explored attitudes about prevention, screening and treatment of hepatitis B virus (HBV) infection in Chinese, Korean and Vietnamese communities. Methods We use qualitative methods in 12 focus groups (n=113) of adults who self-reported their ethnicity to be Chinese, Korean, or Vietnamese. We use grounded theory (i.e., consensus-building between co-coders about recurring, emerging themes) for analysis. Results Diet, nutrition, fatigue and stress were misidentified as HBV causes. Improving hygiene, diet, exercise, and holistic methods were misidentified as viable HBV prevention methods. Common screening problems included not affording test and not understanding test results. Participants shared reasons for using complementary and alternative medicine—when Western medicine fails or becomes unaffordable. Participants sought information from medical providers and fellow community members, but also from the internet. Conclusions Many of the attitudes and opinions that emerged may deter participation in HBV screening, prevention and treatment, insofar as community members may factor them into healthcare decision-making, choose alternative but ineffective methods of prevention and treatment, and undervalue the benefits of screening. More patient education in both traditional and new media is necessary for clarifying transmission, screening and treatment misunderstandings. PMID:22302653

Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials.

PubMed

Bernardi, Mauro; Caraceni, Paolo; Navickis, Roberta J; Wilkes, Mahlon M

2012-04-01

Albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin, such as artificial colloids and vasoconstrictors, have been widely investigated. The aim of this meta-analysis was to determine whether morbidity and mortality differ between patients receiving albumin versus alternative treatments. The meta-analysis included randomized trials evaluating albumin infusion in patients with tense ascites. Primary endpoints were postparacentesis circulatory dysfunction, hyponatremia, and mortality. Eligible trials were sought by multiple methods, including computer searches of bibliographic and abstract databases and the Cochrane Library. Results were quantitatively combined under a fixed-effects model. Seventeen trials with 1,225 total patients were included. There was no evidence of heterogeneity or publication bias. Compared with alternative treatments, albumin reduced the incidence of postparacentesis circulatory dysfunction (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.27-0.55). Significant reductions in that complication by albumin were also shown in subgroup analyses versus each of the other volume expanders tested (e.g., dextran, gelatin, hydroxyethyl starch, and hypertonic saline). The occurrence of hyponatremia was also decreased by albumin, compared with alternative treatments (OR, 0.58; 95% CI, 0.39-0.87). In addition, mortality was lower in patients receiving albumin than alternative treatments (OR, 0.64; 95% CI, 0.41-0.98). This meta-analysis provides evidence that albumin reduces morbidity and mortality among patients with tense ascites undergoing large-volume paracentesis, as compared with alternative treatments investigated thus far. Copyright © 2011 American Association for the Study of Liver Diseases.

OCCURRENCE OF IODINATED DBPS

EPA Science Inventory

Several drinking water treatment plants in the United States have altered their treatment methods and adopted alternative disinfectants in order to comply with a U.S. Environmental Protection Agency (EPA) regulation that limits the level of trihalomethanes (THMs) in drinking wate...

METHODS FOR PEROXIDES

EPA Science Inventory

The application of ozone as an alternative disinfectant for drinking water treatment has received increased attention in recent years. Ozone offers advantages for water treatment such as removal of taste and odor compounds, some dissolved inorganics and even color, which makes i...

A 20 Year Review of Punishment and Alternative Methods to Treat Problem Behaviors in Developmentally Delayed Persons.

ERIC Educational Resources Information Center

Matson, Johnny L.; Taras, Marie E.

1989-01-01

Studies assessing treatments for severe behavior problems of developmentally delayed persons were reviewed. Procedures used in the 382 studies, published from 1967-1987, were analyzed in terms of problem behaviors, side effects, and treatment methods. Also examined were number of studies reported yearly, maintenance and generalization of effects,…

Fullerenols as a new therapeutic approach in nanomedicine.

PubMed

Grebowski, Jacek; Kazmierska, Paulina; Krokosz, Anita

2013-01-01

Recently, much attention has been paid to the bioactive properties of water-soluble fullerene derivatives: fullerenols, with emphasis on their pro- and antioxidative properties. Due to their hydrophilic properties and the ability to scavenge free radicals, fullerenols may, in the future, provide a serious alternative to the currently used pharmacological methods in chemotherapy, treatment of neurodegenerative diseases, and radiobiology. Some of the most widely used drugs in chemotherapy are anthracycline antibiotics. Anthracycline therapy, in spite of its effective antitumor activity, induces systemic oxidative stress, which interferes with the effectiveness of the treatment and results in serious side effects. Fullerenols may counteract the harmful effects of anthracyclines by scavenging free radicals and thereby improve the effects of chemotherapy. Additionally, due to the hollow spherical shape, fullerenols may be used as drug carriers. Moreover, because of the existence of the currently ineffective ways for neurodegenerative diseases treatment, alternative compounds, which could prevent the negative effects of oxidative stress in the brain, are still sought. In the search of alternative methods of treatment and diagnosis, today's science is increasingly reaching for tools in the field of nanomedicine, for example, fullerenes and their water-soluble derivatives, which is addressed in the present paper.

Cell-delivered magnetic nanoparticles caused hyperthermia-mediated increased survival in a murine pancreatic cancer model.

PubMed

Basel, Matthew T; Balivada, Sivasai; Wang, Hongwang; Shrestha, Tej B; Seo, Gwi Moon; Pyle, Marla; Abayaweera, Gayani; Dani, Raj; Koper, Olga B; Tamura, Masaaki; Chikan, Viktor; Bossmann, Stefan H; Troyer, Deryl L

2012-01-01

Using magnetic nanoparticles to absorb alternating magnetic field energy as a method of generating localized hyperthermia has been shown to be a potential cancer treatment. This report demonstrates a system that uses tumor homing cells to actively carry iron/iron oxide nanoparticles into tumor tissue for alternating magnetic field treatment. Paramagnetic iron/ iron oxide nanoparticles were synthesized and loaded into RAW264.7 cells (mouse monocyte/ macrophage-like cells), which have been shown to be tumor homing cells. A murine model of disseminated peritoneal pancreatic cancer was then generated by intraperitoneal injection of Pan02 cells. After tumor development, monocyte/macrophage-like cells loaded with iron/ iron oxide nanoparticles were injected intraperitoneally and allowed to migrate into the tumor. Three days after injection, mice were exposed to an alternating magnetic field for 20 minutes to cause the cell-delivered nanoparticles to generate heat. This treatment regimen was repeated three times. A survival study demonstrated that this system can significantly increase survival in a murine pancreatic cancer model, with an average post-tumor insertion life expectancy increase of 31%. This system has the potential to become a useful method for specifically and actively delivering nanoparticles for local hyperthermia treatment of cancer.

Fullerenols as a New Therapeutic Approach in Nanomedicine

PubMed Central

2013-01-01

Recently, much attention has been paid to the bioactive properties of water-soluble fullerene derivatives: fullerenols, with emphasis on their pro- and antioxidative properties. Due to their hydrophilic properties and the ability to scavenge free radicals, fullerenols may, in the future, provide a serious alternative to the currently used pharmacological methods in chemotherapy, treatment of neurodegenerative diseases, and radiobiology. Some of the most widely used drugs in chemotherapy are anthracycline antibiotics. Anthracycline therapy, in spite of its effective antitumor activity, induces systemic oxidative stress, which interferes with the effectiveness of the treatment and results in serious side effects. Fullerenols may counteract the harmful effects of anthracyclines by scavenging free radicals and thereby improve the effects of chemotherapy. Additionally, due to the hollow spherical shape, fullerenols may be used as drug carriers. Moreover, because of the existence of the currently ineffective ways for neurodegenerative diseases treatment, alternative compounds, which could prevent the negative effects of oxidative stress in the brain, are still sought. In the search of alternative methods of treatment and diagnosis, today's science is increasingly reaching for tools in the field of nanomedicine, for example, fullerenes and their water-soluble derivatives, which is addressed in the present paper. PMID:24222914

Pericardium-6 Acupressure for the Prevention of Postoperative Nausea and Vomiting

DTIC Science & Technology

1999-10-01

designed not only to inform anesthesia providers on the use of an alternative treatment method but also to aid in patient care and safety during...14 x Current Pharmacological Treatment for PONV............................................. 16 Proposed Mechanisms of Action...of Acupressure .......................................... 20 Acupressure for Treatment of PONV

Case Study Using Ultrasound to Treat /[turned r]/

ERIC Educational Resources Information Center

Modha, Geetanjalee; Bernhardt, B. May; Church, Robyn; Bacsfalvi, Penelope

2008-01-01

Background: Ultrasound has shown promise as visual feedback in remediation of /[turned r]/.Aims: To compare treatment for [turned r] with and without ultrasound.Methods & Procedures: A Canadian English-speaking adolescent participated in a case study with a no treatment baseline, alternating treatment blocks with and without ultrasound and a…

Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF®.

PubMed

Herráez, Óscar; Asencio-Egea, María Ángeles; Huertas-Vaquero, María; Carranza-González, Rafael; Castellanos-Monedero, Jesús; Franco-Huerta, María; Barberá-Farré, José Ramón; Tenías-Burillo, José María

To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Developing Alternative Methods/Techniques for Plant Establishment Under Reduced Irrigation

DOT National Transportation Integrated Search

2009-06-10

The purpose of the study was to evaluate soil treatments for their effect on establishment of wild-land : shrubs without supplemental irrigation. The treatments that significantly improved growth over irrigation : alone at a central California fill s...

Alternative materials for the modification and stabilization of unstable subgrade soils

DOT National Transportation Integrated Search

1997-05-01

This study examines two lime by-products and two fly ashes for treatment of unstable (CBR<6) subgrade soils. The treatment methods include both modification and stabilization. Modification is temporily enhancing subgrade stability to improve construc...

CHARACTERIZING TOXICOLOGICALLY IMPORTANT DRINKING WATER DISINFECTION BY-PRODUCTS

EPA Science Inventory

Due to concerns over trihalomethanes (THMs) and other halogenated by-products that can be formed during chlorination of drinking water, alternative disinfectants are being explored. Several drinking water treatment plants in the United States have altered their treatment methods...

Computed tomography scan in supine and prone positions: an alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment.

PubMed

Cortés-González, Jeff R; Ortiz-Lara, Gerardo E; Salinas, Matías; Hernández-Galván, Fernando; Gómez-Guerra, Lauro S

2013-04-01

To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.

[Atherectomy for peripheral arterial disease].

PubMed

Londero, Louise Skovgaard; Høgh, Annette Langager; Lindholt, Jes Sanddal

2015-04-13

Symptomatic peripheral arterial disease is managed according to national and international guidelines and the number of vascular reconstructions performed each year has increased over the past decade mainly due to an increasing frequency of endovascular procedures. Atherectomy as an alternative to the established treatment of symptomatic peripheral arterial disease has recently been analysed in a Cochrane review. In Denmark, atherectomy is not performed and so far the evidence is poor as the method is not an alternative to the established treatment in this country.

Attitudes toward hepatitis B virus among Vietnamese, Chinese and Korean Americans in the Houston area, Texas.

PubMed

Hwang, Jessica P; Roundtree, Aimee K; Suarez-Almazor, Maria E

2012-10-01

We explored attitudes about prevention, screening and treatment of hepatitis B virus (HBV) infection in Chinese, Korean and Vietnamese communities. We use qualitative methods in 12 focus groups (n = 113) of adults who self-reported their ethnicity to be Chinese, Korean, or Vietnamese. We use grounded theory (i.e., consensus-building between co-coders about recurring, emerging themes) for analysis. Diet, nutrition, fatigue and stress were misidentified as HBV causes. Improving hygiene, diet, exercise, and holistic methods were misidentified as viable HBV prevention methods. Common screening problems included not affording test and not understanding test results. Participants shared reasons for using complementary and alternative medicine--when Western medicine fails or becomes unaffordable. Participants sought information from medical providers and fellow community members, but also from the internet. Many of the attitudes and opinions that emerged may deter participation in HBV screening, prevention and treatment, insofar as community members may factor them into healthcare decision-making, choose alternative but ineffective methods of prevention and treatment, and undervalue the benefits of screening. More patient education in both traditional and new media is necessary for clarifying transmission, screening and treatment misunderstandings.

Mixed strategy to allocate resources with air pollution treatment in China: based on the analytic network process and large-group decision-making method.

PubMed

Chen, Xi; Zhao, Liu; Özdemir, Mujgan Sagir; Liang, Haiming

2018-04-05

The resource allocation of air pollution treatment in China is a complex problem, since many alternatives are available and many criteria influence mutually. A number of stakeholders participate in this issue holding different opinions because of the benefits they value. So a method is needed, based on the analytic network process (ANP) and large-group decision-making (LGDM), to rank the alternatives considering interdependent criteria and stakeholders' opinions. In this method, the criteria related to air pollution treatment are examined by experts. Then, the network structure of the problem is constructed based on the relationships between the criteria. Further, every participant in each group provide comparison matrices by judging the importance between criteria according to dominance, regarding a certain criteria (or goal), and the geometric average comparison matrix of each group is obtained. The decision weight of each group is derived by combining the subjective weight and the objective weight, in which the subjective weight is provided by organizers, while the objective weight is determined by considering the consensus levels of groups. The final comparison matrices are obtained by the geometric average of comparison matrices and the decision weights. Next, the resource allocation is made according to the priorities of the alternatives using the super decision software. Finally, an example is given to illustrate the use of the proposed method.

The efficacy of subsurface flow reed bed treatment in the removal of Campylobacter spp., faecal coliforms and Escherichia coli from poultry litter.

PubMed

Duggan, J; Bates, M P; Phillips, C A

2001-06-01

The use of poultry waste as a fertiliser on arable land is an accepted method of waste treatment. However, run-off from such practices may result in contamination of the watercourse by human pathogens. In this study the effectiveness of using constructed wetlands as an alternative treatment for poultry manure waste was evaluated. Enumeration of Campylobacter spp., Escherichia coli, total coliforms and total aerobes were carried out on influent and effluent samples from reed beds loaded with poultry waste. For both sequential loading and continuous loading there was a statistically significant mean log reduction of 3.56 and 4.25 for E. coli, 3.2 and 3.88 for coliforms, 3.85 and 4.2 for total aerobic counts and 3.13 and 2.96 for Campylobacter spp., respectively. This method, which has been previously recognised as cost-effective and environmentally acceptable, provides an efficient method for reducing numbers of these bacteria in poultry waste and therefore an effective alternative treatment for such waste or waters containing run off from land previously spread with poultry manure.

The role of information search in seeking alternative treatment for back pain: a qualitative analysis

PubMed Central

2014-01-01

Background Health consumers have moved away from a reliance on medical practitioner advice to more independent decision processes and so their information search processes have subsequently widened. This study examined how persons with back pain searched for alternative treatment types and service providers. That is, what information do they seek and how; what sources do they use and why; and by what means do they search for it? Methods 12 persons with back pain were interviewed. The method used was convergent interviewing. This involved a series of semi-structured questions to obtain open-ended answers. The interviewer analysed the responses and refined the questions after each interview, to converge on the dominant factors influencing decisions about treatment patterns. Results Persons with back pain mainly search their memories and use word of mouth (their doctor and friends) for information about potential treatments and service providers. Their search is generally limited due to personal, provider-related and information-supply reasons. However, they did want in-depth information about the alternative treatments and providers in an attempt to establish apriori their efficacy in treating their specific back problems. They searched different sources depending on the type of information they required. Conclusions The findings differ from previous studies about the types of information health consumers require when searching for information about alternative or mainstream healthcare services. The results have identified for the first time that limited information availability was only one of three categories of reasons identified about why persons with back pain do not search for more information particularly from external non-personal sources. PMID:24725300

Effects of Alternate Test Formats in Online Courses

ERIC Educational Resources Information Center

Francis, Alan

2010-01-01

The purpose of this study was to compare differences in methods of testing for two undergraduate online courses to determine the effect of alternate test formats in relation to participant grades. Specific purposes of this study were to determine whether a difference existed in student test scores between the control and treatment groups and…

Evaluation of healthcare waste treatment/disposal alternatives by using multi-criteria decision-making techniques.

PubMed

Özkan, Aysun

2013-02-01

Healthcare waste should be managed carefully because of infected, pathological, etc. content especially in developing countries. Applied management systems must be the most appropriate solution from a technical, environmental, economic and social point of view. The main objective of this study was to analyse the current status of healthcare waste management in Turkey, and to investigate the most appropriate treatment/disposal option by using different decision-making techniques. For this purpose, five different healthcare waste treatment/disposal alternatives including incineration, microwaving, on-site sterilization, off-site sterilization and landfill were evaluated according to two multi-criteria decision-making techniques: analytic network process (ANP) and ELECTRE. In this context, benefits, costs and risks for the alternatives were taken into consideration. Furthermore, the prioritization and ranking of the alternatives were determined and compared for both methods. According to the comparisons, the off-site sterilization technique was found to be the most appropriate solution in both cases.

Radiofrequency ablation for oral and maxillofacial pathologies: A description of the technique

NASA Astrophysics Data System (ADS)

Tandon, Rahul; Stevens, Timothy W.; Herford, Alan S.

2014-03-01

Introduction: Radiofrequency ablation (RFA) refers to a high-frequency current that heats and coagulates tissue. In the standard RFA setup, three components are used: a generator, an active electrode, and a dispersive electrode. RFA has garnered support in many of the surgical fields as an alternative to traditional procedures used in tumor removal. Other methods can prove to be more invasive and disfiguring to the patient, in addition to the unwarranted side effects; however, RFA provides a more localized treatment, resulting in decreased co-morbidity to the patient. Currently, its use in the field of oral and maxillofacial surgery is limited, as its technology has not reached our field. By describing its limited use to the optics community, we hope to expand its uses and provide patients with one more alternative treatment option. Methods and Uses: We will describe the use of RFA on three types of pathology: lymphangioma, rhabdomyoscarcoma, oral squamous cell carcinoma, and neoplastic osseous metastasis. The majority of treatments geared towards these pathologies involve surgical resection, followed by reconstruction. However, damage to vital structures coupled with esthetic disfigurement makes RFA a more valuable alternative. In many of the cases, the tumors were successfully removed without recurrence. Conclusion: While the use of RFA has been scarce in our field, we believe that with more exposure it can gain momentum as an alternative to current treatment options. However, there are improvements that we feel can be made, helping to maximize its effectiveness.

Medical expulsive treatment in pediatric urolithiasis.

PubMed

Atan, Ali; Balcı, Melih

2015-03-01

The frequency of stone disease in childhood ranges between 0.1-5 percent. Stone disease occurs as a result of enviromental, metabolic, anatomical, infectious and nutritional factors. Percutaneous nephrolitotomy, uretherorenoscopy, laparoscopic surgery, open surgery and extracorporeal shock wave lithothripsy are treatment alternatives for stone disease during childhood. However, these methods are not completely innocent. Some complications may occur after these procedures. These procedures are generally not cost- effective. Even invasive procedures have high success rates, so medical expulsive treatment modalities have become an alternative for a group of patients. Nonsteroidal anti- inflammatory drugs, antimuscarinic drugs, phospodiesterase type 5 inhibitors, steroids, calcium channel blockers and alpha blockers are treatment alterneatives used for this modality in the literature. The drug is chosen according to the location, size, and composition of the stone, recent technology, cost, surgeon's experience and surgeon's and the parents' preferences. In this review article the following topics will be discussed such as "Why medical expulsive treatment is needed during childhood? Which drug should be chosen for which stone type? How long should a treatment of urolithiasis last?

Surgical Management of Supratentorial Intracerebral Hemorrhages: Endoscopic Versus Open Surgery.

PubMed

Eroglu, Umit; Kahilogullari, Gokmen; Dogan, Ihsan; Yakar, Fatih; Al-Beyati, Eyyub S M; Ozgural, Onur; Cohen-Gadol, Aaron A; Ugur, Hasan Caglar

2018-06-01

Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment. We compared intracerebral hematoma drainage in 2 groups of 17 patients each, treated with minimally invasive endoscopic method versus craniotomy. All the patients were treated for supratentorial spontaneous hemorrhage between December 2013 and February 2017 at the Neurosurgery Clinic of Ankara University Faculty of Medicine. We retrospectively evaluated 34 patients surgically treated between December 2013 and February 2017. All patients underwent surgery within the first 24 hours. Patients in the early surgery group had better surgical outcomes. In the neuroendoscopic group, Glasgow Coma Scale increased from 6 to 11 at 1 week postoperatively compared with 5 to 9 in the craniotomy group. Minimally invasive endoscopic hematoma evacuation may be a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas. Copyright © 2018 Elsevier Inc. All rights reserved.

Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs.

PubMed

Glassman, Paul; Caputo, Anthony; Dougherty, Nancy; Lyons, Ray; Messieha, Zakaria; Miller, Christine; Peltier, Bruce; Romer, Maureen

2009-01-01

Many people with special needs (PSN) have difficulty having good oral health or accessing oral health services because of a disability or medical condition. The number of people with these conditions living in community settings and needing oral health services is increasing dramatically due to advances in medical care, deinstitutionalization, and changing societal values. Many of these individuals require additional supports beyond local anesthesia in order to receive dental treatment services. The purpose of this consensus statement is to focus on the decision-making process for choosing a method of treatment or a combination of methods for facilitating dental treatment for these individuals. These guidelines are intended to assist oral health professionals and other interested parties in planning and carrying out oral health treatment for PSN. Considerations for planning treatment and considerations for each of several alternative modalities are listed. Also discussed are considerations for the use of combinations of modalities and considerations for the repeated or frequent use of these modalities. Finally, the need to advocate for adequate education and reimbursement for the full range of support alternatives is addressed. The Special Care Dentistry Association (SCDA) is dedicated to improving oral health and well being of PSN. The SCDA hopes that these guidelines can help oral health professionals and other interested individuals and groups to work together to ensure that PSN can achieve a "lifetime of oral health."

Cell-delivered magnetic nanoparticles caused hyperthermia-mediated increased survival in a murine pancreatic cancer model

PubMed Central

Basel, Matthew T; Balivada, Sivasai; Wang, Hongwang; Shrestha, Tej B; Seo, Gwi Moon; Pyle, Marla; Abayaweera, Gayani; Dani, Raj; Koper, Olga B; Tamura, Masaaki; Chikan, Viktor; Bossmann, Stefan H; Troyer, Deryl L

2012-01-01

Using magnetic nanoparticles to absorb alternating magnetic field energy as a method of generating localized hyperthermia has been shown to be a potential cancer treatment. This report demonstrates a system that uses tumor homing cells to actively carry iron/iron oxide nanoparticles into tumor tissue for alternating magnetic field treatment. Paramagnetic iron/ iron oxide nanoparticles were synthesized and loaded into RAW264.7 cells (mouse monocyte/ macrophage-like cells), which have been shown to be tumor homing cells. A murine model of disseminated peritoneal pancreatic cancer was then generated by intraperitoneal injection of Pan02 cells. After tumor development, monocyte/macrophage-like cells loaded with iron/ iron oxide nanoparticles were injected intraperitoneally and allowed to migrate into the tumor. Three days after injection, mice were exposed to an alternating magnetic field for 20 minutes to cause the cell-delivered nanoparticles to generate heat. This treatment regimen was repeated three times. A survival study demonstrated that this system can significantly increase survival in a murine pancreatic cancer model, with an average post-tumor insertion life expectancy increase of 31%. This system has the potential to become a useful method for specifically and actively delivering nanoparticles for local hyperthermia treatment of cancer. PMID:22287840

Treatment of Chemical Equilibrium without Using Thermodynamics or Statistical Mechanics.

ERIC Educational Resources Information Center

Nelson, P. G.

1986-01-01

Discusses the conventional approaches to teaching about chemical equilibrium in advanced physical chemistry courses. Presents an alternative approach to the treatment of this concept by using Boltzmann's distribution law. Lists five advantages to using this method as compared with the other approaches. (TW)

Alternative silvicultural practices in Appalachian forest ecosystems: implications for species diversity, ecosystem resilience, and commercial timber production

Treesearch

Thomas R. Fox; Carola A. Haas; David W. Smith; David L. Loftis; Shepard M. Zedaker; Robert H. Jones; A.L. Hammett

2007-01-01

Increasing demands for timber and non-timber forest products often conflict with demands to maintain biodiversity and ecosystem processes. To examine tradeoffs between these goals, we implemented six alternative management systems using a stand-level, replicated experiment. The treatments included four silvicultural regeneration methods designed to sustain timber...

Hyperbaric oxygen therapy with topical negative pressure: an alternative treatment for the refractory sternal wound infection.

PubMed

Sun, I-Feng; Lee, Su-Shin; Chiu, Chaw-Chi; Lin, Sin-Daw; Lai, Chung-Sheng

2008-01-01

Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the cause of postoperative morbidity and mortality. We present a case of deep sternal wound infection after sternotomy. The patient received three treatments of surgical debridement, irrigation, topical negative pressure (TNP) dressing, and hyperbaric oxygen (HBO) therapy. Forty-five HBO therapy sessions were administered. After nine weeks, the sternal wound was healed and completely epithelialized. This conservative therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.

A Multimodal Communication Program for Aphasia during Inpatient Rehabilitation: A Case Study

PubMed Central

Wallace, Sarah E.; Purdy, Mary; Skidmore, Elizabeth

2014-01-01

BACKGROUND Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. OBJECTIVE The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. METHODS Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. RESULTS Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. CONCLUSIONS Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting. PMID:25227547

Harvested rainwater quality before and after treatment in six full-scale residential systems

EPA Science Inventory

Rainwater harvesting (RWH) is an alternative method of providing water for indoor domestic use, but the water quality after treatment and distribution at individual residences is not well documented. In this study, water quality parameters were measured at the cistern and indoor ...

Comparison of Elastography, Serum Marker Scores, and Histology for the Assessment of Liver Fibrosis in Hepatitis B Virus (HBV)-Infected Patients in Burkina Faso

PubMed Central

Bonnard, Philippe; Sombié, Roger; Lescure, Francois-Xavier; Bougouma, Alain; Guiard-Schmid, Jean Baptiste; Poynard, Thierry; Calès, Paul; Housset, Chantal; Callard, Patrice; Pendeven, Catherine Le; Drabo, Joseph; Carrat, Fabrice; Pialoux, Gilles

2010-01-01

Liver fibrosis (LF) must be assessed before talking treatment decisions in hepatitis B. In Burkina Faso, liver biopsy (LB) remains the “gold standard” method for this purpose. Access to treatment might be simpler if reliable alternative techniques for LF evaluation were available. The hepatitis B virus (HBV)-infected patients who underwent LB was invited to have liver stiffness measurement (Fibroscan) and serum marker assays. Fifty-nine patients were enrolled. The performance of each technique for distinguishing F0F1 from F2F3F4 was compared. The area under receiver operating characteristic (AUROC) curves was 0.61, 0.71, 0.79, 0.82, and 0.87 for the aspartate transaminase to platelet ratio index (APRI), Fib-4, Fibrotest, Fibrometre, and Fibroscan. Elastometric thresholds were identified for significant fibrosis and cirrhosis. Combined use of Fibroscan and a serum marker could avoid 80% of biopsies. This study shows that the results of alternative methods concord with those of histology in HBV-infected patients in Burkina Faso. These alternative techniques could help physicians to identify patients requiring treatment. PMID:20207872

Integrative medicine in allergy and immunology.

PubMed

Chang, Christopher; Gershwin, M Eric

2013-06-01

Integrative medicine is a relatively new discipline which attempts to combine allopathic medicine with alternative or complementary medicine, to reap the benefits of both forms of medicine in optimizing the care of patients. Integrative medicine concentrates on treating the patient as a whole, both in body and mind. While the scientific method and "evidence-based" clinical research drives the management and treatment of diseases in conventional Western medicine, alternative or complementary medicine is based on unproven yet potentially beneficial techniques that have been developed throughout history, dating back to the ancient cultures in the Middle East, Africa, and China. In spite of the lack of evidence of most alternative medicine techniques, these methodologies have been practiced for centuries with great acceptance in many countries. It is in the Western world, where "modern" medicine is dictated by the scientific method, that the most controversy in the use of these alternative modes of therapy exists. Since the science behind alternative medicine is incomplete or non-existent, it is difficult for those trained in Western medicine to accept or adopt this approach. But perhaps it is the failure of Western medicine to adequately guarantee our well being and good health that have led to the ongoing debate between the medical profession and the general public as to the benefits of these alternative treatments. In one sense, integrative medicine may be a futile attempt to coin a new term in the hope of legitimizing alternative medicine. On the other hand, there is a wealth of historical experience in the use of the techniques. Studies to evaluate the scientific basis behind ancient medical techniques are ongoing, and it is to be expected that the results will neither be uniformly positive nor negative. Of particular interest is the effect of traditional medicine, herbal formulations, and manipulative techniques on the immune system, and its application in the treatment of autoimmune and allergic diseases. Studies are being designed or conducted to investigate immune effects of herbal formulations or their components. Herbal plants or medicines may lead to skewing of the Th1/Th2 balance in either direction, thus may offer potential application in the treatment of allergic or autoimmune diseases.

Cost of non-persistence with oral bisphosphonates in post-menopausal osteoporosis treatment in France

PubMed Central

2011-01-01

Background During the last decade, oral bisphosphonates (BP) became the most widely prescribed pharmacologic class for post-menopausal osteoporosis. However, many surveys revealed the important issue of poor persistence with those drugs resulting in a failure of treatment to reduce fracture risk sufficiently. Using a published Markov model, this study analyses the economic impact of non-persistence with bisphosphonates in the context of the introduction of generics in France. Methods Direct costs of vertebral, hip and wrist fracture were assessed and included in an existing 10-year Markov model developed to analyse consequences of non-persistence. Three alternatives of comparison were set: no treatment, real-world persistence, and ideal persistence. Simulated patients' characteristics matched those from a French observational study and the real-world adherence alternative employed persistence data from published database analysis. The risk of fracture of menopausal women and the risk reduction associated with the drugs were based on results reported in clinical trials. Incremental cost-effectiveness ratios (ICERs) were calculated first between real-world adherence and no treatment alternatives, and second between ideal and real-world persistence alternatives. The cost of non-persistence was defined as the difference between total cost of ideal and real-world persistence alternatives. Results Within fractured women population, mean costs of 10-year management of fracture were significantly different between the three alternatives with €7,239 (± €4,783), €6,711 (± €4,410) and €6,134 (± €3,945) in the no-treatment, the real-world and ideal persistence alternatives, respectively (p < 0.0001). Cost-effectiveness ratio for real-world treatment persistence compared with no-treatment alternative was found dominant and as well, alternative of ideal persistence dominated the former. Each ten percentage point of persistence gain amounted to €58 per patient, and extrapolation resulted in a global annual cost of non-persistence of over €30 million to the French health care system, with a substantial transfer from hospital to pharmacy budgets. Conclusion Within term, improving persistence with oral bisphosphonates should be economically dominant on levels currently known in real-world. Given this potential savings, ambitious adherence-enhancing interventions should be considered in osteoporotic patients. PMID:21702989

Site disturbances associated with alternative prescriptions in an upland hardwood forest of northern Alabama

Treesearch

Emily Carter; Robert B. Rummer; Bryce Stokes

1997-01-01

A study was installed in an upland hardwood forest to evaluate the site impacts associated with three alternative prescriptions --- clearcut, deferment cut, and strip cut. Two methods of site impact assessment were employed: 1) assignment of disturbance classes to selected points within each treatment area; and 2) measurement of soil bulk density, gravimetric water...

Profitable capitation requires accurate costing.

PubMed

West, D A; Hicks, L L; Balas, E A; West, T D

1996-01-01

In the name of costing accuracy, nurses are asked to track inventory use on per treatment basis when more significant costs, such as general overhead and nursing salaries, are usually allocated to patients or treatments on an average cost basis. Accurate treatment costing and financial viability require analysis of all resources actually consumed in treatment delivery, including nursing services and inventory. More precise costing information enables more profitable decisions as is demonstrated by comparing the ratio-of-cost-to-treatment method (aggregate costing) with alternative activity-based costing methods (ABC). Nurses must participate in this costing process to assure that capitation bids are based upon accurate costs rather than simple averages.

A Novel Method of Localization for Moving Objects with an Alternating Magnetic Field

PubMed Central

Gao, Xiang; Yan, Shenggang; Li, Bin

2017-01-01

Magnetic detection technology has wide applications in the fields of geological exploration, biomedical treatment, wreck removal and localization of unexploded ordinance. A large number of methods have been developed to locate targets with static magnetic fields, however, the relation between the problem of localization of moving objectives with alternating magnetic fields and the localization with a static magnetic field is rarely studied. A novel method of target localization based on coherent demodulation was proposed in this paper. The problem of localization of moving objects with an alternating magnetic field was transformed into the localization with a static magnetic field. The Levenberg-Marquardt (L-M) algorithm was applied to calculate the position of the target with magnetic field data measured by a single three-component magnetic sensor. Theoretical simulation and experimental results demonstrate the effectiveness of the proposed method. PMID:28430153

[Systematic Review of the Application of Complementary and Alternative Medicine and their Potential Therapeutic Benefits in the Treatment of Ophthalmology Patients].

PubMed

Welte, A K; Hahn, U; Büssing, A; Krummenauer, F

2017-05-01

Purpose A systematic review was carried out of the reported therapeutic effects of complementary and alternative medicine methods as supplementary or primary treatments for patients suffering from glaucoma, cataract or age-related macular degeneration (AMD). Material and Methods For the years 1990 to 2013, the following databases were screened for reports of the application of complementary and alternative treatments: PubMed, Cochrane Library, EMBASE, CAMbase and AMED. Both randomised and prospective non-randomised patient trials were included in the review; results were evaluated in the following classes: "phytotherapy", "acupuncture/acupressure", "biofeedback" and "other alternative treatments". The studies were evaluated by measures of clinical effect, statistical significance (p value and/or confidence interval) and the underlying trial design. Results 30 clinical trials were included, including 13 on glaucoma, 5 on cataract and 12 on AMD patients. These trials were based on patient numbers of 6 - 332, 27 - 157 and 6 - 328 patients, respectively. Phytotherapy was applied in 14 trials, including 6 on glaucoma patients (all 6 with a controlled design, and 3 of which reporting statistically significant results); 5 trials were on cataract patients (3 with a controlled design and 2 with a significant result) and 3 on AMD patients (only 1 with a controlled design, with a significant result). Acupuncture/acupressure was investigated in 9 trials, 5 on glaucoma patients (3 with a controlled design, 1 with a significant result); no acupuncture/acupressure trial was found in cataract patients, but 4 trials in AMD patients (none with a controlled design). Biofeedback was studied in 4 trials, all on AMD patients (only one with a controlled design, without statistically significant findings). Conclusion Despite its rigorous inclusion criteria, this review identified several clinical trials on complementary and alternative medicine in ophthalmological patients. Phytotherapeutic methods gave significant results in half of the reported controlled trials, whereas there were few significant benefits with acupuncture or acupressure. Georg Thieme Verlag KG Stuttgart · New York.

Advances in digital technology and orthodontics: a reference to the Invisalign method.

PubMed

Melkos, Aristides B

2005-05-01

Increased aesthetic demands during orthodontic treatment resulted in several treatment alternatives. However, the need to avoid conventional fixed orthodontic appliances led, with the use of computer-aided scanning, imaging, and manufacturing technology, to the development of new therapy concepts such as Invisalign. The Invisalign orthodontic technique involves a series of clear removable appliances and has been applied to correct a variety of malocclusions. The Invisalign method is an aesthetic orthodontic option for many patients, but it is suited mainly to adults or adolescents who have a fully erupted dentition and it has its indications and limitations. It handles simple to moderate non-extraction alignments better than mild to moderate extraction cases. The aligners are clear and therefore aesthetically ideal for the patient; they are comfortable to wear and, as they are removable, they provide simplicity of care and better oral hygiene. They also allow the evaluation of treatment options in detail before beginning treatment by using a virtual treatment model. It is also important to point out that this method has some disadvantages, which are associated with patient compliance, limited control over specific tooth movements, and additional documentation time. The Invisalign concept is an aesthetic alternative in orthodontic treatment, with advantages and disadvantages. It can be utilized to treat simple to moderate alignment cases, especially in adults, and serves as an additional part of the armamentarium of the orthodontist.

Application of the BRAFO tiered approach for benefit-risk assessment to case studies on heat processing contaminants.

PubMed

Schütte, Katrin; Boeing, Heiner; Hart, Andy; Heeschen, Walther; Reimerdes, Ernst H; Santare, Dace; Skog, Kerstin; Chiodini, Alessandro

2012-11-01

The aim of the European Funded Project BRAFO (benefit-risk analysis of foods) project was to develop a framework that allows quantitative comparison of human health risks and benefits of foods based on a common scale of measurement. This publication describes the application of the BRAFO methodology to three different case studies: the formation of acrylamide in potato and cereal based products, the formation of benzo(a)pyrene through smoking and grilling of meat and fish and the heat-treatment of milk. Reference, alternative scenario and target population represented the basic structure to test the tiers of the framework. Various intervention methods intended to reduce acrylamide in potato and cereal products were evaluated against the historical production methods. In conclusion the benefits of the acrylamide-reducing measures were considered prevailing. For benzo(a)pyrene, three illustrated alternative scenarios were evaluated against the most common smoking practice. The alternative scenarios were assessed as delivering benefits, introducing only minimal potential risks. Similar considerations were made for heat treatment of milk where the comparison of the microbiological effects of heat treatment, physico-chemical changes of milk constituents with positive and negative health effects was assessed. In general, based on data available, benefits of the heat treatment were outweighing any risks. Copyright © 2012 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.

ESTIMATING TREATMENT EFFECTS ON HEALTHCARE COSTS UNDER EXOGENEITY: IS THERE A ‘MAGIC BULLET’?

PubMed Central

Polsky, Daniel; Manning, Willard G.

2011-01-01

Methods for estimating average treatment effects, under the assumption of no unmeasured confounders, include regression models; propensity score adjustments using stratification, weighting, or matching; and doubly robust estimators (a combination of both). Researchers continue to debate about the best estimator for outcomes such as health care cost data, as they are usually characterized by an asymmetric distribution and heterogeneous treatment effects,. Challenges in finding the right specifications for regression models are well documented in the literature. Propensity score estimators are proposed as alternatives to overcoming these challenges. Using simulations, we find that in moderate size samples (n= 5000), balancing on propensity scores that are estimated from saturated specifications can balance the covariate means across treatment arms but fails to balance higher-order moments and covariances amongst covariates. Therefore, unlike regression model, even if a formal model for outcomes is not required, propensity score estimators can be inefficient at best and biased at worst for health care cost data. Our simulation study, designed to take a ‘proof by contradiction’ approach, proves that no one estimator can be considered the best under all data generating processes for outcomes such as costs. The inverse-propensity weighted estimator is most likely to be unbiased under alternate data generating processes but is prone to bias under misspecification of the propensity score model and is inefficient compared to an unbiased regression estimator. Our results show that there are no ‘magic bullets’ when it comes to estimating treatment effects in health care costs. Care should be taken before naively applying any one estimator to estimate average treatment effects in these data. We illustrate the performance of alternative methods in a cost dataset on breast cancer treatment. PMID:22199462

Randomized Clinical Trial: The Use of SpeechEasy® in Stuttering Treatment

ERIC Educational Resources Information Center

Ritto, Ana Paula; Juste, Fabiola Staróbole; Stuart, Andrew; Kalinowski, Joseph; de Andrade, Claudia Regina Furquim

2016-01-01

Background: Numerous studies have demonstrated the benefit of devices delivering altered auditory feedback (AAF) as a therapeutic alternative for those who stutter. Aims: The effectiveness of a device delivering AAF (SpeechEasy®) was compared with behavioural techniques in the treatment of stuttering in a randomized clinical trial. Methods &…

Automatic identification of comparative effectiveness research from Medline citations to support clinicians’ treatment information needs

PubMed Central

Zhang, Mingyuan; Fiol, Guilherme Del; Grout, Randall W.; Jonnalagadda, Siddhartha; Medlin, Richard; Mishra, Rashmi; Weir, Charlene; Liu, Hongfang; Mostafa, Javed; Fiszman, Marcelo

2014-01-01

Online knowledge resources such as Medline can address most clinicians’ patient care information needs. Yet, significant barriers, notably lack of time, limit the use of these sources at the point of care. The most common information needs raised by clinicians are treatment-related. Comparative effectiveness studies allow clinicians to consider multiple treatment alternatives for a particular problem. Still, solutions are needed to enable efficient and effective consumption of comparative effectiveness research at the point of care. Objective Design and assess an algorithm for automatically identifying comparative effectiveness studies and extracting the interventions investigated in these studies. Methods The algorithm combines semantic natural language processing, Medline citation metadata, and machine learning techniques. We assessed the algorithm in a case study of treatment alternatives for depression. Results Both precision and recall for identifying comparative studies was 0.83. A total of 86% of the interventions extracted perfectly or partially matched the gold standard. Conclusion Overall, the algorithm achieved reasonable performance. The method provides building blocks for the automatic summarization of comparative effectiveness research to inform point of care decision-making. PMID:23920677

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

PubMed

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

2017-01-01

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

Awareness and practice of patient's rights law in Lithuania

PubMed Central

Ducinskiene, Danute; Vladickiene, Jurgita; Kalediene, Ramune; Haapala, Irja

2006-01-01

Background Patient's rights law is intended to secure good medical practice, but it can also serve to improve understanding between patients and medical staff if both were aware of their rights. Methods Awareness and practice of the new patient's rights law in Lithuanian health care institutions was explored through a survey of 255 medical staff and 451 patients in the four Kaunas city medical units in 2002. Participation rates were 74% and 66%, respectively. Results Majority of the medical staff (85%) and little over one half of the patients (56%) had heard or read about the Law on Patient's Rights (p < 0.001). Only 50% of professionals compared to 69% of patients thought information for patients about diagnosis, treatment results and alternative treatments is necessary (p < 0.001). A clear discrepancy was indicated between physicians informing the patients (80% – 98% of physicians) and patients actually knowing (37% – 54%) their treatment prognosis, disease complications or possible alternative treatment methods. Conclusion These results suggest a need for awareness-raising among patients to improve the practical implementation of the Patient's Rights Law in Lithuania. PMID:16948855

Unorthodox Alternative Therapies Marketed to Treat Lyme Disease

PubMed Central

Lantos, Paul M.; Shapiro, Eugene D.; Auwaerter, Paul G.; Baker, Phillip J.; Halperin, John J.; McSweegan, Edward; Wormser, Gary P.

2015-01-01

Background. Some patients with medically unexplained symptoms or alternative medical diagnoses suspect that they chronically suffer from the tick-borne infection Lyme disease. These patients are commonly targeted by providers of alternative therapies. This study was designed to identify and characterize the range of unorthodox alternative therapies advertised to patients with a diagnosis of Lyme disease. Methods. Internet searches using the Google search engine were performed to identify the websites of clinics and services that marketed nonantimicrobial therapies for Lyme disease. We subsequently used the PubMed search engine to identify any scientific studies evaluating such treatments for Lyme disease. Websites were included in our review so long as they advertised a commercial, nonantimicrobial product or service that specifically mentioned utility for Lyme disease. Websites with patient testimonials (such as discussion groups) were excluded unless the testimonial appeared as marketing on a commercial site. Results. More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments. Conclusions. Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful. PMID:25852124

Complementary and alternative medicine: attitudes, knowledge and use among surgeons and anaesthesiologists in Hungary.

PubMed

Soós, Sándor Árpád; Jeszenői, Norbert; Darvas, Katalin; Harsányi, László

2016-11-08

Despite their worldwide popularity the question of using non-conventional treatments is a source of controversy among medical professionals. Although these methods may have potential benefits it presents a problem when patients use non-conventional treatments in the perioperative period without informing their attending physician about it and this may cause adverse events and complications. To prevent this, physicians need to have a profound knowledge about non-conventional treatments. An anonymous questionnaire was distributed among surgeons and anaesthesiologists working in Hungarian university clinics and in selected city or county hospitals. Questionnaires were distributed by post, online or in person. Altogether 258 questionnaires were received from 22 clinical and hospital departments. Anaesthesiologists and surgeons use reflexology, Traditional Chinese Medicine, herbal medicine and manual therapy most frequently in their clinical practice. Traditional Chinese Medicine was considered to be the most scientifically sound method, while homeopathy was perceived as the least well-grounded method. Neural therapy was the least well-known method among our subjects. Among the subjects of our survey only 3.1 % of perioperative care physicians had some qualifications in non-conventional medicine, 12.4 % considered themselves to be well-informed in this topic and 48.4 % would like to study some complementary method. Women were significantly more interested in alternative treatments than men, p = 0.001427; OR: 2.2765. Anaesthesiologists would be significantly more willing to learn non-conventional methods than surgeons. 86.4 % of the participants thought that non-conventional treatments should be evaluated from the point of view of evidence. Both surgeons and anaesthesiologists accept the application of integrative medicine and they also approve of the idea of teaching these methods at universities. According to perioperative care physicians, non-conventional methods should be evaluated based on evidence. They also expressed a willingness to learn about those treatments that meet the criteria of evidence and apply these in their clinical practice.

[Performance comparison of material tests for cadmium and lead in food contact plastics].

PubMed

Mutsuga, Motoh; Abe, Tomoyuki; Abe, Yutaka; Ishii, Rie; Itoh, Yuko; Ohno, Hiroyuki; Ohno, Yuichiro; Ozaki, Asako; Kakihara, Yoshiteru; Kaneko, Reiko; Kawamura, Yoko; Shibata, Hiroshi; Sekido, Haruko; Sonobe, Hironori; Takasaka, Noriko; Tajima, Yoshiyasu; Tanaka, Aoi; Nomura, Chie; Hikida, Akinori; Matsuyama, Sigetomo; Murakami, Ryo; Yamaguchi, Miku; Wada, Takenari; Watanabe, Kazunari; Akiyama, Hiroshi

2014-01-01

Based on the Japanese Food Sanitation Law, the performances of official and alternative material test methods for cadmium (Cd) and lead (Pb) in food contact plastics were compared. Nineteen laboratories participated to an interlaboratory study, and quantified Cd and Pb in three PVC pellets. in the official method, a sample is digested with H2SO4, taken up in HCl, and evaporated to dryness on a water bath, then measured by atomic absorption spectrometry (AAS) or inductively coupled plasma-optical emission spectrometry (ICP-OES). Statistical treatment revealed that the trueness, repeatability (RSDr) and reproducibility (RSDr) were 86-95%, 3.1-9.4% and 8.6-22.1%, respectively. The values of the performance parameters fulfilled the requirements , and the performances met the test specifications. The combination of evaporation to dryness on a hot plate and measurement by AAS or ICP-OES is applicable as an alternative method. However, the trueness and RSDr were inferior to those of the official method. The performance parameters obtained by using the microwave digestion method (MW method) to prepare test solution were better than those of the official method. Thus, the MW method is available as an alternative method. Induced coupled plasma-mass spectrometry (ICP-MS) is also available as an alternative method. However, it is necessary to ensure complete digestion of the sample.

Assessment of health-care waste disposal methods using a VIKOR-based fuzzy multi-criteria decision making method

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

Liu, Hu-Chen; Department of Industrial Engineering and Management, Tokyo Institute of Technology, Tokyo 152-8552; Wu, Jing

Highlights: • Propose a VIKOR-based fuzzy MCDM technique for evaluating HCW disposal methods. • Linguistic variables are used to assess the ratings and weights for the criteria. • The OWA operator is utilized to aggregate individual opinions of decision makers. • A case study is given to illustrate the procedure of the proposed framework. - Abstract: Nowadays selection of the appropriate treatment method in health-care waste (HCW) management has become a challenge task for the municipal authorities especially in developing countries. Assessment of HCW disposal alternatives can be regarded as a complicated multi-criteria decision making (MCDM) problem which requires considerationmore » of multiple alternative solutions and conflicting tangible and intangible criteria. The objective of this paper is to present a new MCDM technique based on fuzzy set theory and VIKOR method for evaluating HCW disposal methods. Linguistic variables are used by decision makers to assess the ratings and weights for the established criteria. The ordered weighted averaging (OWA) operator is utilized to aggregate individual opinions of decision makers into a group assessment. The computational procedure of the proposed framework is illustrated through a case study in Shanghai, one of the largest cities of China. The HCW treatment alternatives considered in this study include “incineration”, “steam sterilization”, “microwave” and “landfill”. The results obtained using the proposed approach are analyzed in a comparative way.« less

Head and Neck Cancers

MedlinePlus

... plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home. Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients ...

An Artificial Intelligence Tutor: A Supplementary Tool for Teaching and Practicing Braille

ERIC Educational Resources Information Center

McCarthy, Tessa; Rosenblum, L. Penny; Johnson, Benny G.; Dittel, Jeffrey; Kearns, Devin M.

2016-01-01

Introduction: This study evaluated the usability and effectiveness of an artificial intelligence Braille Tutor designed to supplement the instruction of students with visual impairments as they learned to write braille contractions. Methods: A mixed-methods design was used, which incorporated a single-subject, adapted alternating treatments design…

Alternative products to treat allergic rhinitis and alternative routes for allergy immunotherapy.

PubMed

Ipci, Kagan; Oktemer, Tugba; Muluk, Nuray Bayar; Şahin, Ethem; Altıntoprak, Niyazi; Bafaqeeh, Sameer Ali; Kurt, Yasemin; Mladina, Ranko; Šubarić, Marin; Cingi, Cemal

2016-09-01

Some alternative products instead of immunotherapy are used in patients with allergic rhinitis (AR). In this paper, alternative products to treat allergic rhinitis and alternative routes for allergy immunotherapy are reviewed. Alternative products and methods used instead of immunotherapy are tea therapy, acupuncture, Nigella sativa, cinnamon bark, Spanish needle, acerola, capsaicin (Capsicum annum), allergen-absorbing ointment, and cellulose powder. N. sativa has been used in AR treatment due to its anti-inflammatory effects. N. sativa oil also inhibits the cyclooxygenase and 5-lipoxygenase pathways of arachidonic acid metabolism. The beneficial effects of N. sativa seed supplementation on the symptoms of AR may be due to its antihistaminic properties. To improve the efficacy of immunotherapy, some measures are taken regarding known immunotherapy applications and alternative routes of intralymphatic immunotherapy and epicutaneous immunotherapy are used. There are alternative routes and products to improve the efficacy of immunotherapy.

Acupuncture (PDQ)

MedlinePlus

... patients who were waiting to receive treatment later. Observational studies have also reported both real acupuncture and ... NCCIH) are sponsoring a number of clinical trials (research studies) at ... and alternative methods. Few CAM therapies have been tested using demanding ...

Contingency Space Analysis: An Alternative Method for Identifying Contingent Relations from Observational Data

PubMed Central

Martens, Brian K; DiGennaro, Florence D; Reed, Derek D; Szczech, Frances M; Rosenthal, Blair D

2008-01-01

Descriptive assessment methods have been used in applied settings to identify consequences for problem behavior, thereby aiding in the design of effective treatment programs. Consensus has not been reached, however, regarding the types of data or analytic strategies that are most useful for describing behavior–consequence relations. One promising approach involves the analysis of conditional probabilities from sequential recordings of behavior and events that follow its occurrence. In this paper we review several strategies for identifying contingent relations from conditional probabilities, and propose an alternative strategy known as a contingency space analysis (CSA). Step-by-step procedures for conducting and interpreting a CSA using sample data are presented, followed by discussion of the potential use of a CSA for conducting descriptive assessments, informing intervention design, and evaluating changes in reinforcement contingencies following treatment. PMID:18468280

Treatment of migraine and tension-type headache in Croatia.

PubMed

Vuković, Vlasta; Plavec, Davor; Lovrencić Huzjan, Arijana; Budisić, Mislav; Demarin, Vida

2010-06-01

The aim of this study was to assess the treatment patterns of migraine and tension-type headache in the Croatian population. Analysis included the proportion of patients who were taking specific antimigraine therapy and the number of tablets per attack per month, the proportion of patients who were taking prophylactic therapy or using alternative treatment methods and their satisfaction with the treatment. The design of the study was a cross-sectional survey. Self-completed questionnaires were randomly distributed to adults >18 years of age in the Croatian population. A total of 616 questionnaires were analyzed: 115 patients with migraine (M), 327 patients with tension-type headache (TTH), and 174 patients with probable migraine (PM) and TTH. Specific antimigraine therapy was taken by half of patients with migraine: 35.7% of patients used triptans and 21.7% ergotamines. Prophylactic treatment had been used by 13.9% of M, 1.2% of TTH, and 6.9% of PM patients. Alternative methods of treatment were tried by 27% of M and TTH patients. Only 16.8% of patients with M pay regular visits to physicians, while 36.3% never visited a physician. More than half of TTH patients have never visited a physician. The majority of patients are only partially satisfied with their current treatment, and almost one-third are not satisfied. Results of this study indicate that the treatment of primary headaches in Croatia should be improved.

[Head and neck paragangliomas: An interdisciplinary challenge].

PubMed

Künzel, J; Bahr, K; Hainz, M; Rossmann, H; Matthias, C

2015-12-01

Current treatment strategies for head and neck paragangliomas are moving away from radical resection and toward surgical tumor reduction, in order to preserve function and reduce morbidity. Radiotherapy modalities are alternative primary treatment options. A PubMed search of the relevant literature on genetics and treatment of head and neck paragangliomas was conducted. The rapid progress made in genetic research was mainly triggered by two factors: firstly, the establishment of central registries for paraganglioma patients and secondly, the availability of next-generation sequencing methods. Exome sequencing and a gene-panel sequencing approach have already been successfully applied to paraganglioma syndromes. The latter method in particular is rapid and cost-effective, and may soon replace complex genotyping algorithms. The literature provides good evidence that diversified modern treatment options are available to realize individual treatment concepts for almost all paraganglioma manifestations. Generally, small and symptomatic tumors should be completely resected, particularly in younger patients. Considering the patient's age, symptoms, morbidity risk, and comorbidities, larger tumors should be surgically treated in a function-preserving manner. In these cases, primary radiotherapy is an equivalent alternative option. A "wait and scan" strategy is possible in selected cases. The potential morbidity of surgical treatment must be weighed against the expectable quality of life. Comprehensive consultation with the patient about possible treatment modalities is mandatory. Treatment decision making should involve a multidisciplinary team of experts.

Assessment of the efficiency and economic viability of various methods of treatment of sanitary landfill leachate.

PubMed

Gupta, S K; Singh, Gurdeep

2007-12-01

This study assesses the efficiency of various physico-chemical, biological and other tertiary methods for treating leachate. An evaluation study on the treatability of the leachate from methane phase bed (MPB) reactor indicated that at an optimum hydraulic retention time of 6 days, the efficiency of the reactor in terms of biological oxygen demand (BOD) and chemical oxygen demand (COD) removal was 91.29 and 82.69%, respectively. Recycling of the treated leachate through the municipal solid waste layers in the leachate recycling unit (LRU) resulted in a significant increase in the biodegradation of organics present in the leachate. Optimum BOD and COD removal efficiencies were achieved at the third recycle; additional recycling of the leachate did not produce any significant improvement. Physico-chemical treatment of the leachate demonstrated that alum and lime (Option 2) were more economical than coagulants lime and MgCO(3). A cost analysis of the economics of the various treatments revealed that the alternative treatment consisting of a MPB bed followed by a LRU and aerated lagoon is the most cost-effective treatment. However, the alternative consisting of a MPB followed by the LRU and a soil column, which is slightly more costly, would be the most appropriate treatment when adequate land is readily available.

Fuzzy decision-making framework for treatment selection based on the combined QUALIFLEX-TODIM method

NASA Astrophysics Data System (ADS)

Ji, Pu; Zhang, Hong-yu; Wang, Jian-qiang

2017-10-01

Treatment selection is a multi-criteria decision-making problem of significant concern in the medical field. In this study, a fuzzy decision-making framework is established for treatment selection. The framework mitigates information loss by introducing single-valued trapezoidal neutrosophic numbers to denote evaluation information. Treatment selection has multiple criteria that remarkably exceed the alternatives. In consideration of this characteristic, the framework utilises the idea of the qualitative flexible multiple criteria method. Furthermore, it considers the risk-averse behaviour of a decision maker by employing a concordance index based on TODIM (an acronym in Portuguese of interactive and multi-criteria decision-making) method. A sensitivity analysis is performed to illustrate the robustness of the framework. Finally, a comparative analysis is conducted to compare the framework with several extant methods. Results indicate the advantages of the framework and its better performance compared with the extant methods.

A novel method to accelerate orthodontic tooth movement

PubMed Central

Buyuk, S. Kutalmış; Yavuz, Mustafa C.; Genc, Esra; Sunar, Oguzhan

2018-01-01

This clinical case report presents fixed orthodontic treatment of a patient with moderately crowded teeth. It was performed with a new technique called ‘discision’. Discision method that was described for the first time by the present authors yielded predictable outcomes, and orthodontic treatment was completed in a short period of time. The total duration of orthodontic treatment was 4 months. Class I molar and canine relationships were established at the end of the treatment. Moreover, crowding in the mandible and maxilla was corrected, and optimal overjet and overbite were established. No scar tissue was observed in any gingival region on which discision was performed. The discision technique was developed as a minimally invasive alternative method to piezocision technique, and the authors suggest that this new method yields good outcomes in achieving rapid tooth movement. PMID:29436571

Microbial survey of a full-scale, biologically active filter for treatment of drinking water.

PubMed

White, Colin P; Debry, Ronald W; Lytle, Darren A

2012-09-01

The microbial community of a full-scale, biologically active drinking water filter was surveyed using molecular techniques. Nitrosomonas, Nitrospira, Sphingomonadales, and Rhizobiales dominated the clone libraries. The results elucidate the microbial ecology of biological filters and demonstrate that biological treatment of drinking water should be considered a viable alternative to physicochemical methods.

The Evaluation and Treatment of Aggression Maintained by Attention and Automatic Reinforcement.

ERIC Educational Resources Information Center

Thompson, Rachel H.; Fisher, Wayne W.; Piazza, Cathleen C.; Kuhn, David E.

1998-01-01

A study used direct and indirect methods to assess and treat several topographies of the aggression of a 7-year-old boy with severe mental retardation and pervasive personality disorder. Functional communication training with extinction reduced all forms of aggression except chin grinding, which was reduced by an alternative treatment. (Author/CR)

Complementary and Alternative Medicine for Treatment of Food Allergy.

PubMed

Li, Xiu-Min

2018-02-01

The prevalence of food allergy is increasing. Food allergy can be life threatening and there is no approved treatment available. Allergen avoidance and rescue medication remain the sole management tools. Complementary and alternative medicine (CAM) use is common in the United States. However, research into safety and efficacy for food allergy is limited. Continued scientific research into food allergy herbal formula 2 (FAHF-2), refined methods of formulation, purified compounds, and other modalities are needed. Traditional Chinese medicine is the main component of CAM in the United States. Conventional doctors, CAM practitioners, and patients' families must collaborate to comanage these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Pentadiagonal alternating-direction-implicit finite-difference time-domain method for two-dimensional Schrödinger equation

NASA Astrophysics Data System (ADS)

Tay, Wei Choon; Tan, Eng Leong

2014-07-01

In this paper, we have proposed a pentadiagonal alternating-direction-implicit (Penta-ADI) finite-difference time-domain (FDTD) method for the two-dimensional Schrödinger equation. Through the separation of complex wave function into real and imaginary parts, a pentadiagonal system of equations for the ADI method is obtained, which results in our Penta-ADI method. The Penta-ADI method is further simplified into pentadiagonal fundamental ADI (Penta-FADI) method, which has matrix-operator-free right-hand-sides (RHS), leading to the simplest and most concise update equations. As the Penta-FADI method involves five stencils in the left-hand-sides (LHS) of the pentadiagonal update equations, special treatments that are required for the implementation of the Dirichlet's boundary conditions will be discussed. Using the Penta-FADI method, a significantly higher efficiency gain can be achieved over the conventional Tri-ADI method, which involves a tridiagonal system of equations.

Evaluation of alternatives to cautery disbudding of dairy goat kids using physiological measures of immediate and longer-term pain.

PubMed

Hempstead, Melissa N; Waas, Joseph R; Stewart, Mairi; Cave, Vanessa M; Sutherland, Mhairi A

2018-06-01

We evaluated alternatives to cautery disbudding of goat kids using physiological measures of immediate and longer-term pain. Fifty Saanen doe kids were randomly assigned to 1 of 5 treatments (n = 10/treatment): (1) cautery disbudding (CAUT), (2) caustic paste disbudding (CASP), (3) liquid nitrogen disbudding (CRYO), (4) clove oil injected into the horn bud (CLOV), or (5) sham disbudding (SHAM). Serum cortisol and haptoglobin concentrations were measured from blood samples collected immediately before treatment (baseline) and at 15, 30, 60, and 120 min and then again at 6 and 24 h post-treatment. An infrared thermography camera was used to take images of the horn buds 24 h pre- and 24, 48, and 72 h post-treatment to measure skin temperature. Body weight was measured daily for 1 wk to assess weight change post-treatment. Images of the horn buds were taken at d 1, 2, and 7 and at 6 wk post-treatment to assess tissue damage and wound healing. Mean cortisol concentrations were elevated in CASP kids 1 h post-treatment relative to CAUT kids. Cortisol concentrations of CRYO kids were higher than those of CAUT kids 30 min post-treatment; concentrations for CLOV kids were similar to CAUT kids post-treatment. Mean haptoglobin concentrations were similar across treatments over time; however, CLOV kids had higher concentrations at 24 h post-treatment than all other treatments. Skin temperatures of CASP and CLOV kids were elevated relative to CAUT kids at all time points post-treatment, and all disbudded kids had skin temperatures above those of SHAM kids at 72 h post-treatment. Treatment did not influence weight gain. The CAUT kids had large, open wounds exposing bone; small scabs were still evident 6 wk post-treatment. The CASP kids had red and open, raw wounds that generated large eschars, apparent for up to 6 wk. The CRYO kids had closed, dry wounds initially, but over time lesions appeared that caused open wounds; small scabs were present 6 wk post-treatment. The CLOV kids had closed, dry wounds with blackened skin; healed skin and minimal scabs were present 6 wk post-treatment. Caustic paste and cryosurgical disbudding appeared to cause more pain compared with cautery disbudding; thus, these methods may not provide good alternatives to cautery disbudding. Clove oil appeared to cause a similar pain response as cautery disbudding and smaller wounds with earlier tissue repair; this method shows promise as an alternative to cautery disbudding. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Detention basin alternative outlet design study.

DOT National Transportation Integrated Search

2016-10-01

This study examines the outlets structures CDOT has historically employed to drain water quality treatment detention basins and flood control basins, presents two new methods of metering the water quality capture volume (WQCV), namely 1) the Elliptic...

Noninvasive treatment alternative for intractable startle epilepsy

PubMed Central

Klinkenberg, Sylvia; Ubbink, Sander; Vles, Johannes; de Louw, Anton; van Hall, Mariette Debeij; Scheijen, Dyon; Brokx, Jan

2014-01-01

We describe a treatment alternative for intractable, startle-provoked, epileptic seizures in four children aged between 8 and 14. Three of the four children had symptomatic localization-related epilepsy. They all suffered from intractable epilepsy precipitated by sudden sounds. The fact that seizures tended to occur with high frequency – more than one seizure a day – had a clear impact on daily life. Clinical seizure pattern demonstrated asymmetric tonic posturing in all four children. Three children experienced several seizure types including focal seizure onset. All children had focal neurological signs or learning disabilities or a combination of both. Our noninvasive treatment method using psychoeducational counseling and sound generators was applied in four children, resulting in a seizure frequency reduction of ≥ 50% in two of them. PMID:25667869

Advanced analysis technique for the evaluation of linear alternators and linear motors

NASA Technical Reports Server (NTRS)

Holliday, Jeffrey C.

1995-01-01

A method for the mathematical analysis of linear alternator and linear motor devices and designs is described, and an example of its use is included. The technique seeks to surpass other methods of analysis by including more rigorous treatment of phenomena normally omitted or coarsely approximated such as eddy braking, non-linear material properties, and power losses generated within structures surrounding the device. The technique is broadly applicable to linear alternators and linear motors involving iron yoke structures and moving permanent magnets. The technique involves the application of Amperian current equivalents to the modeling of the moving permanent magnet components within a finite element formulation. The resulting steady state and transient mode field solutions can simultaneously account for the moving and static field sources within and around the device.

Estimation of dynamic treatment strategies for maintenance therapy of children with acute lymphoblastic leukaemia: an application of history-adjusted marginal structural models.

PubMed

Rosthøj, S; Keiding, N; Schmiegelow, K

2012-02-28

Childhood acute lymphoblastic leukaemia is treated with long-term intensive chemotherapy. During the latter part of the treatment, the maintenance therapy, the patients receive oral doses of two cytostatics. The doses are tailored to blood counts measured on a weekly basis, and the treatment is therefore highly dynamic. In 1992-1996, the Nordic Society of Paediatric Haematology and Oncology (NOPHO) conducted a randomised study (NOPHO-ALL-92) to investigate the effect of a new and more sophisticated dynamic treatment strategy. Unexpectedly, the new strategy worsened the outcome for the girls, whereas there were no treatment differences for the boys. There are as yet no general guidelines for optimising the treatment. On basis of the data from this study, our goal is to formulate an alternative dosing strategy. We use recently developed methods proposed by van der Laan et al. to obtain statistical models that may be used in the guidance of how the physicians should assign the doses to the patients to obtain the target of the treatment. We present a possible strategy and discuss the reliability of this strategy. The implementation is complicated, and we touch upon the limitations of the methods in relation to the formulation of alternative dosing strategies for the maintenance therapy. Copyright © 2011 John Wiley & Sons, Ltd.

40 CFR 142.46 - Alternative treatment techniques.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Alternative treatment techniques. 142... Administrator Under Section 1415(a) of the Act § 142.46 Alternative treatment techniques. The Administrator may... that an alternative treatment technique not included in such requirement is at least as efficient in...

Successful use of Gamma Knife surgery in a distal lenticulostriate artery aneurysm intervention.

PubMed

Lan, ZhiGang; Li, Jin; You, Chao; Chen, Jing

2012-02-01

We report a case of a 21-year-old woman who underwent radiosurgical treatment of a distal lenticulostriate artery (LSA) aneurysm. Twenty-two months after treatment, repeat angiography demonstrated patency of the parent vessel and complete obliteration of the aneurysm. Our case implies that Gamma Knife surgery (GKS) might serve as an alternative microinvasive technique in the treatment of LSA aneurysms, making this procedure a potential addition to present methods.

A decision support tool for selecting the optimal sewage sludge treatment.

PubMed

Turunen, Ville; Sorvari, Jaana; Mikola, Anna

2018-02-01

Sewage sludge contains significant amounts of resources, such as nutrients and organic matter. At the same time, the organic contaminants (OC) found in sewage sludge are of growing concern. Consequently, in many European countries incineration is currently favored over recycling in agriculture. This study presents a Multi-Attribute Value Theory (MAVT)-based decision support tool (DST) for facilitating sludge treatment decisions. Essential decision criteria were recognized and prioritized, i.e., weighted, by experts from water utilities. Since the fate of organic contaminants was in focus, a simple scoring method was developed to take into account their environmental risks. The final DST assigns each sludge treatment method a preference score expressing its superiority compared to alternative methods. The DST was validated by testing it with data from two Finnish municipal wastewater treatment plants (WWTP). The validation results of the first case study preferred sludge pyrolysis (preference score: 0.629) to other alternatives: composting and incineration (score 0.580, and 0.484 respectively). The preference scores were influenced by WWTP dependent factors, i.e., the operating environment and the weighting of the criteria. A lack of data emerged as the main practical limitation. Therefore, not all of the relevant criteria could be included in the value tree. More data are needed on the effects of treatment methods on the availability of nutrients, the quality of organic matter and sludge-borne OCs. Despite these shortcomings, the DST proved useful and adaptable in decision-making. It can also help achieve a more transparent, understandable and comprehensive decision-making process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Alternate energy sources for catheter ablation.

PubMed

Wang, P J; Homoud, M K; Link, M S; Estes III, N A

1999-07-01

Because of the limitations of conventional radiofrequency ablation in creating large or linear lesions, alternative energy sources have been used as possible methods of catheter ablation. Modified radiofrequency energy, cryoablation, and microwave, laser, and ultrasound technologies may be able to create longer, deeper, and more controlled lesions and may be particularly suited for the treatment of ventricular tachycardias and for linear atrial ablation. Future studies will establish the efficacy of these new and promising technologies.

The use of alternative therapies in the Saskatchewan stroke rehabilitation population

PubMed Central

Blackmer, Jeff; Jefromova, Ludmilla

2002-01-01

Background Many patients use alternative therapies. The purpose of this study was to determine the percentage of stroke rehabilitation patients in Saskatchewan using alternative therapies, whether patients found these therapies effective in alleviating stroke-related symptoms, how often those patients who used alternative therapies discuss this fact with their primary care doctor and the main reason why patients might not do so. Methods Telephone questionnaire surveys were conducted with 117 patients who had suffered a stroke and undergone inpatient or outpatient rehabilitation at Saskatoon City Hospital. Results The study revealed that 26.5% of 117 stroke rehabilitation patients visited alternative practitioners at least once or used some form of unconventional therapy. Only 16.1% of patients found that alternative therapy made them feel much better. Of those who used alternative therapy, 61.3% did not discuss this fact with their primary physician. Many of the respondents (47.3%) who did not inform their physician stated that they did not see the necessity of talking about these treatments and 21.1% did not discuss the issue with their physician because they felt that he or she might disapprove of alternative therapies. Conclusion A relatively small percentage of stroke patients found alternative therapies beneficial. Doctors should be aware that a significant number of patients will try alternative treatment without discussion with their primary care physician or specialist. The current study suggests that after completing routine questioning, doctors should also ask their patients about their use of alternative therapies and, when appropriate, review issues of safety and efficacy. PMID:12095423

Do labeled versus unlabeled treatments of alternatives' names influence stated choice outputs? Results from a mode choice study.

PubMed

Jin, Wen; Jiang, Hai; Liu, Yimin; Klampfl, Erica

2017-01-01

Discrete choice experiments have been widely applied to elicit behavioral preferences in the literature. In many of these experiments, the alternatives are named alternatives, meaning that they are naturally associated with specific names. For example, in a mode choice study, the alternatives can be associated with names such as car, taxi, bus, and subway. A fundamental issue that arises in stated choice experiments is whether to treat the alternatives' names as labels (that is, labeled treatment), or as attributes (that is, unlabeled treatment) in the design as well as the presentation phases of the choice sets. In this research, we investigate the impact of labeled versus unlabeled treatments of alternatives' names on the outcome of stated choice experiments, a question that has not been thoroughly investigated in the literature. Using results from a mode choice study, we find that the labeled or the unlabeled treatment of alternatives' names in either the design or the presentation phase of the choice experiment does not statistically affect the estimates of the coefficient parameters. We then proceed to measure the influence toward the willingness-to-pay (WTP) estimates. By using a random-effects model to relate the conditional WTP estimates to the socioeconomic characteristics of the individuals and the labeled versus unlabeled treatments of alternatives' names, we find that: a) Given the treatment of alternatives' names in the presentation phase, the treatment of alternatives' names in the design phase does not statistically affect the estimates of the WTP measures; and b) Given the treatment of alternatives' names in the design phase, the labeled treatment of alternatives' names in the presentation phase causes the corresponding WTP estimates to be slightly higher.

Evaluating forest product potential as part of planning ecological restoration treatments on forested landscapes

Treesearch

R. James Barbour; Ryan Singleton; Douglas A. Maguire

2007-01-01

As landscape-scale assessments and modeling become a more common method for evaluating alternatives in integrated resource management, new techniques are needed to display and evaluate outcomes for large numbers of stands over long periods. In this proof of concept, we evaluate the potential to provide financial support for silvicultural treatments by selling timber...

Microbial Survey of a Full-Scale, Biologically Active Filter for Treatment of Drinking Water

PubMed Central

DeBry, Ronald W.; Lytle, Darren A.

2012-01-01

The microbial community of a full-scale, biologically active drinking water filter was surveyed using molecular techniques. Nitrosomonas, Nitrospira, Sphingomonadales, and Rhizobiales dominated the clone libraries. The results elucidate the microbial ecology of biological filters and demonstrate that biological treatment of drinking water should be considered a viable alternative to physicochemical methods. PMID:22752177

TREATMENT SWITCHING: STATISTICAL AND DECISION-MAKING CHALLENGES AND APPROACHES.

PubMed

Latimer, Nicholas R; Henshall, Chris; Siebert, Uwe; Bell, Helen

2016-01-01

Treatment switching refers to the situation in a randomized controlled trial where patients switch from their randomly assigned treatment onto an alternative. Often, switching is from the control group onto the experimental treatment. In this instance, a standard intention-to-treat analysis does not identify the true comparative effectiveness of the treatments under investigation. We aim to describe statistical methods for adjusting for treatment switching in a comprehensible way for nonstatisticians, and to summarize views on these methods expressed by stakeholders at the 2014 Adelaide International Workshop on Treatment Switching in Clinical Trials. We describe three statistical methods used to adjust for treatment switching: marginal structural models, two-stage adjustment, and rank preserving structural failure time models. We draw upon discussion heard at the Adelaide International Workshop to explore the views of stakeholders on the acceptability of these methods. Stakeholders noted that adjustment methods are based on assumptions, the validity of which may often be questionable. There was disagreement on the acceptability of adjustment methods, but consensus that when these are used, they should be justified rigorously. The utility of adjustment methods depends upon the decision being made and the processes used by the decision-maker. Treatment switching makes estimating the true comparative effect of a new treatment challenging. However, many decision-makers have reservations with adjustment methods. These, and how they affect the utility of adjustment methods, require further exploration. Further technical work is required to develop adjustment methods to meet real world needs, to enhance their acceptability to decision-makers.

Could conscious sedation with midazolam for dental procedures be an alternative to general anesthesia?

PubMed

Silay, E; Candirli, C; Taskesen, F; Coskuner, I; Ceyhanli, K T; Yildiz, H

2013-01-01

The aim of our study was to evaluate the likelihood that conscious sedation (CS) with intravenous midazolam could become an alternative modality to general anesthesia (GA) for dental procedures. In our study, 58 and 47 American Society of Anesthesiologists (ASA)-1 pediatric patients, aged 2-12 (mean 6) years, underwent dental procedures and minor oral surgical procedures under GA and CS with intravenous midazolam, respectively. The two groups were evaluated in terms of vital signs, duration of the treatment procedure, patient behavior, and the treatment comfort experienced by the physicians. The oxygen saturation level was significantly lower (GA: 99.0 ± 0.30, CS: 98.4 ± 1.02; P < 0.001) and the duration of the treatment procedure was significantly shorter (P < 0.001) in the sedation group compared with the GA group. The physicians encountered various difficulties during implementation of the treatment strategy in cases where they used CS. Minor oral surgical procedures and tooth extraction processes requiring no saline irrigation, however, could be performed successfully under CS. In cases requiring multiple dental management issues, the sedation method was not found to be a useful alternative to GA.

What Is Heartburn Worth?

PubMed Central

Heudebert, Gustavo R; Centor, Robert M; Klapow, Joshua C; Marks, Robert; Johnson, Lawrence; Wilcox, C Mel

2000-01-01

OBJECTIVE T o determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. METHODS We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. MAIN RESULTS Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. CONCLUSIONS Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life. PMID:10718898

Time-lapse analysis of potential cellular responsiveness to Johrei, a Japanese healing technique

PubMed Central

Taft, Ryan; Moore, Dan; Yount, Garret

2005-01-01

Background Johrei is an alternative healing practice which involves the channeling of a purported universal healing energy to influence the health of another person. Despite little evidence to support the efficacy of such practices the use of such treatments is on the rise. Methods We assessed cultured human cancer cells for potential responsiveness to Johrei treatment from a short distance. Johrei treatment was delivered by practitioners who participated in teams of two, alternating every half hour for a total of four hours of treatment. The practitioners followed a defined set of mental procedures to minimize variability in mental states between experiments. An environmental chamber maintained optimal growth conditions for cells throughout the experiments. Computerized time-lapse microscopy allowed documentation of cancer cell proliferation and cell death before, during and after Johrei treatments. Results Comparing eight control experiments with eight Johrei intervention experiments, we found no evidence of a reproducible cellular response to Johrei treatment. Conclusion Cell death and proliferation rates of cultured human cancer cells do not appear responsive to Johrei treatment from a short distance. PMID:15667653

Propensity-score matching in economic analyses: comparison with regression models, instrumental variables, residual inclusion, differences-in-differences, and decomposition methods.

PubMed

Crown, William H

2014-02-01

This paper examines the use of propensity score matching in economic analyses of observational data. Several excellent papers have previously reviewed practical aspects of propensity score estimation and other aspects of the propensity score literature. The purpose of this paper is to compare the conceptual foundation of propensity score models with alternative estimators of treatment effects. References are provided to empirical comparisons among methods that have appeared in the literature. These comparisons are available for a subset of the methods considered in this paper. However, in some cases, no pairwise comparisons of particular methods are yet available, and there are no examples of comparisons across all of the methods surveyed here. Irrespective of the availability of empirical comparisons, the goal of this paper is to provide some intuition about the relative merits of alternative estimators in health economic evaluations where nonlinearity, sample size, availability of pre/post data, heterogeneity, and missing variables can have important implications for choice of methodology. Also considered is the potential combination of propensity score matching with alternative methods such as differences-in-differences and decomposition methods that have not yet appeared in the empirical literature.

Evaluation of sites for the location of WEEE recycling plants in Spain.

PubMed

Queiruga, Dolores; Walther, Grit; González-Benito, Javier; Spengler, Thomas

2008-01-01

As a consequence of new European legal regulations for treatment of waste electrical and electronic equipment (WEEE), recycling plants have to be installed in Spain. In this context, this contribution describes a method for ranking of Spanish municipalities according to their appropriateness for the installation of these plants. In order to rank the alternatives, the discrete multi-criteria decision method PROMETHEE (Preference Ranking Organisation METHod for Enrichment Evaluations), combined with a surveys of experts, is applied. As existing plants are located in North and East Spain, a significant concentration of top ranking municipalities can be observed in South and Central Spain. The method does not present an optimal structure of the future recycling system, but provides a selection of good alternatives for potential locations of recycling plants.

Hepatotoxic microcystin removal using pumice embedded monolithic composite cryogel as an alternative water treatment method.

PubMed

Gurbuz, Fatma; Ceylan, Şeyda; Odabaşı, Mehmet; Codd, Geoffrey A

2016-03-01

Microcystins are the most commonly encountered water-borne cyanotoxins which present short- and long-term risks to human health. Guidelines at international and national level, and legislation in some countries, have been introduced for the effective health risk management of these potent hepatotoxic, tumour-promoters. The stable cyclic structure of microcystins and their common production by cyanobacteria in waterbodies at times of high total dissolved organic carbon content presents challenges to drinking water treatment facilities, with conventional, advanced and novel strategies under evaluation. Here, we have studied the removal of microcystins using three different forms of pumice particles (PPs), which are embedded into macroporous cryogel columns. Macroporous composite cryogel columns (MCCs) are a new generation of separation media designed to face this challenging task. Three different MCCs were prepared by adding plain PPs, Cu(2+)-attached PPs and Fe(3+)-attached PPs to reaction media before the cryogelation step. Column studies showed that MCCs could be successfully used as an alternative water treatment method for successful microcystin removal. Copyright © 2016 Elsevier Ltd. All rights reserved.

Functional Analyses and Treatment of Precursor Behavior

PubMed Central

Najdowski, Adel C; Wallace, Michele D; Ellsworth, Carrie L; MacAleese, Alicia N; Cleveland, Jackie M

2008-01-01

Functional analysis has been demonstrated to be an effective method to identify environmental variables that maintain problem behavior. However, there are cases when conducting functional analyses of severe problem behavior may be contraindicated. The current study applied functional analysis procedures to a class of behavior that preceded severe problem behavior (precursor behavior) and evaluated treatments based on the outcomes of the functional analyses of precursor behavior. Responding for all participants was differentiated during the functional analyses, and individualized treatments eliminated precursor behavior. These results suggest that functional analysis of precursor behavior may offer an alternative, indirect method to assess the operant function of severe problem behavior. PMID:18468282

Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids-An Up-to-Date Review.

PubMed

Ciebiera, Michał; Łukaszuk, Krzysztof; Męczekalski, Błażej; Ciebiera, Magdalena; Wojtyła, Cezary; Słabuszewska-Jóźwiak, Aneta; Jakiel, Grzegorz

2017-12-01

Uterine fibroids (UFs) are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs). Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of) surgery or selective progesterone receptor modulators (SPRMs). Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG), elagolix, aromatase inhibitors (AIs), and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs), carried out by successive phases.

Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids—An Up-to-Date Review

PubMed Central

Łukaszuk, Krzysztof; Męczekalski, Błażej; Ciebiera, Magdalena; Wojtyła, Cezary; Słabuszewska-Jóźwiak, Aneta; Jakiel, Grzegorz

2017-01-01

Uterine fibroids (UFs) are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs). Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of) surgery or selective progesterone receptor modulators (SPRMs). Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG), elagolix, aromatase inhibitors (AIs), and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs), carried out by successive phases. PMID:29194370

Effect of Cyclic Precalcification of Nanotubular TiO2 Layer on the Bioactivity of Titanium Implant

PubMed Central

Park, Il Song; Yang, Eun Jin; Bae, Tae Sung

2013-01-01

The objective of this study is to investigate the effect of cyclic precalcification treatment to impart bioactive properties for titanium implants. Before precalcification, the titanium implants were subjected to blasting using hydroxyapatite (HAp), a resorbable blasting medium (RBM treated), and anodized using an electrolyte containing glycerol, H2O, and NH4F. Precalcification treatment was performed by two different methods, namely, continuous immersion treatment (CIT) and alternate immersion treatment (AIT). In CIT, the RBM treated and anodized titanium implants were immersed in 0.05 M NaH2PO4 solution at 80°C and saturated Ca(OH)2 solution at 100°C for 20 min, whereas during AIT, they were immersed alternatively in both solutions for 1 min for 20 cycles. Anodizing of the titanium implants enables the formation of self-organized TiO2 nanotubes. Cyclic precalcification treatment imparts a better bioactive property and enables an increase in activation level of the titanium implants. The removal torque values of the RBM treated, CIT treated, and AIT treated titanium implants are 10.8 ± 3.7 Ncm, 17.5 ± 3.5 Ncm, and 28.1 ± 2.4 Ncm, respectively. The findings of the study indicate the cyclic precalcification in an effective surface treatment method that would help accelerate osseointegration and impart bioactive property of titanium implants. PMID:24069596

Proteogenomic analysis reveals alternative splicing and translation as part of the abscisic acid response in Arabidopsis seedlings.

PubMed

Zhu, Fu-Yuan; Chen, Mo-Xian; Ye, Neng-Hui; Shi, Lu; Ma, Kai-Long; Yang, Jing-Fang; Cao, Yun-Ying; Zhang, Youjun; Yoshida, Takuya; Fernie, Alisdair R; Fan, Guang-Yi; Wen, Bo; Zhou, Ruo; Liu, Tie-Yuan; Fan, Tao; Gao, Bei; Zhang, Di; Hao, Ge-Fei; Xiao, Shi; Liu, Ying-Gao; Zhang, Jianhua

2017-08-01

In eukaryotes, mechanisms such as alternative splicing (AS) and alternative translation initiation (ATI) contribute to organismal protein diversity. Specifically, splicing factors play crucial roles in responses to environment and development cues; however, the underlying mechanisms are not well investigated in plants. Here, we report the parallel employment of short-read RNA sequencing, single molecule long-read sequencing and proteomic identification to unravel AS isoforms and previously unannotated proteins in response to abscisic acid (ABA) treatment. Combining the data from the two sequencing methods, approximately 83.4% of intron-containing genes were alternatively spliced. Two AS types, which are referred to as alternative first exon (AFE) and alternative last exon (ALE), were more abundant than intron retention (IR); however, by contrast to AS events detected under normal conditions, differentially expressed AS isoforms were more likely to be translated. ABA extensively affects the AS pattern, indicated by the increasing number of non-conventional splicing sites. This work also identified thousands of unannotated peptides and proteins by ATI based on mass spectrometry and a virtual peptide library deduced from both strands of coding regions within the Arabidopsis genome. The results enhance our understanding of AS and alternative translation mechanisms under normal conditions, and in response to ABA treatment. © 2017 The Authors The Plant Journal © 2017 John Wiley & Sons Ltd.

Experiential sampling in the study of multiple personality disorder.

PubMed

Loewenstein, R J; Hamilton, J; Alagna, S; Reid, N; deVries, M

1987-01-01

The authors describe the application of experiential sampling, a new time-sampling method, to the assessment of rapid state changes in a woman with multiple personality disorder. She was signaled at random intervals during study periods and asked to provide information on alternate personality switches, amnesia, and mood state. The alternates displayed some characteristics that were as different as those occurring between separate individuals studied previously with this method. There were notable discrepancies between the self-report study data and information reported during therapy hours. The authors conclude that the phenomenology of multiple personality disorder is frequently more complex than is suspected early in the course of treatment.

Simultaneous quantitative analysis of olmesartan, amlodipine and hydrochlorothiazide in their combined dosage form utilizing classical and alternating least squares based chemometric methods.

PubMed

Darwish, Hany W; Bakheit, Ahmed H; Abdelhameed, Ali S

2016-03-01

Simultaneous spectrophotometric analysis of a multi-component dosage form of olmesartan, amlodipine and hydrochlorothiazide used for the treatment of hypertension has been carried out using various chemometric methods. Multivariate calibration methods include classical least squares (CLS) executed by net analyte processing (NAP-CLS), orthogonal signal correction (OSC-CLS) and direct orthogonal signal correction (DOSC-CLS) in addition to multivariate curve resolution-alternating least squares (MCR-ALS). Results demonstrated the efficiency of the proposed methods as quantitative tools of analysis as well as their qualitative capability. The three analytes were determined precisely using the aforementioned methods in an external data set and in a dosage form after optimization of experimental conditions. Finally, the efficiency of the models was validated via comparison with the partial least squares (PLS) method in terms of accuracy and precision.

An Alternative Method of Intermaxillary Fixation for Simple Pediatric Mandible Fractures.

PubMed

Farber, Scott J; Nguyen, Dennis C; Harvey, Alan A; Patel, Kamlesh B

2016-03-01

Mandibular fractures represent a substantial portion of facial fractures in the pediatric population. Pediatric mandibles differ from their adult counterparts in the presence of mixed dentition. Avoidance of injury to developing tooth follicles is critical. Simple mandibular fractures can be treated with intermaxillary fixation (IMF) using arch bars or bone screws. This report describes an alternative to these methods using silk sutures and an algorithm to assist in treating simple mandibular fractures in the pediatric population. A retrospective chart review was performed and the records of 1 surgeon were examined. Pediatric patients who underwent treatment for a mandibular fracture in the operating room from 2011 to 2015 were identified using Common Procedural Terminology codes. Data collected included age, gender, type of fracture, type of treatment used, duration of fixation, and presence of complications. Five patients with a mean age of 6.8 years at presentation were identified. Fracture types were unilateral fractures of the condylar neck (n = 3), bilateral fractures of the condylar head (n = 1), and a unilateral fracture of the condylar head with an associated parasymphyseal fracture (n = 1). IMF was performed in 4 patients using silk sutures, and bone screw fixation was performed in the other patient. No post-treatment complications or malocclusion were reported. Average duration of IMF was 18.5 days. An algorithm is presented to assist in the treatment of pediatric mandibular fractures. Silk suture fixation is a viable and safe alternative to arch bars or bone screws for routine mandibular fractures. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Statistical primer: propensity score matching and its alternatives.

PubMed

Benedetto, Umberto; Head, Stuart J; Angelini, Gianni D; Blackstone, Eugene H

2018-06-01

Propensity score (PS) methods offer certain advantages over more traditional regression methods to control for confounding by indication in observational studies. Although multivariable regression models adjust for confounders by modelling the relationship between covariates and outcome, the PS methods estimate the treatment effect by modelling the relationship between confounders and treatment assignment. Therefore, methods based on the PS are not limited by the number of events, and their use may be warranted when the number of confounders is large, or the number of outcomes is small. The PS is the probability for a subject to receive a treatment conditional on a set of baseline characteristics (confounders). The PS is commonly estimated using logistic regression, and it is used to match patients with similar distribution of confounders so that difference in outcomes gives unbiased estimate of treatment effect. This review summarizes basic concepts of the PS matching and provides guidance in implementing matching and other methods based on the PS, such as stratification, weighting and covariate adjustment.

The influence of alternative plant propagation and stand establishment techniques on survival and growth of eastern cottonwood (Populus deltoids Bartr.) clones

Treesearch

Donald J. Kaczmarek; Randall Rousseau; Jeff A. Wright; Brian Wachelka

2014-01-01

Four eastern cottonwood clones, including standard operational clone ST66 and three advanced clonal selections were produced and included in a test utilizing five different plant propagation methods. Despite relatively large first-year growth differences among clones, all clones demonstrated similar responses to the treatments and clone × cutting treatment interactions...

Basic Mechanisms Underlying Postchemotherapy Cognitive Impairment

DTIC Science & Technology

2010-04-01

Anagnostaras et al., 2001; Gerlai, 2001; Maren, 2008). None of the drug treatments affected either context- or cue-specific fear conditioning (data not shown...The grant proposal focused on using spontaneous alternation and fear conditioning as the two methods to assess the effects of drug treatment on...treat other conditions . Thus, the pathway to begin to use these drugs to treat post-chemotherapy cognitive impairment might be short

Labelling out: the personal account of an ex-alcoholic lesbian feminist.

PubMed

Staddon, Patsy

2005-01-01

In this paper, I look at my past alcohol dependency from a political as well as personal perspective. I consider the problems caused in my life and that of other lesbians by alcohol abuse, outdated treatment methods and self-help organizations such as AA, which misrepresent social factors leading to alcohol abuse. I focus on a series of themes: the personal and political; lesbian bar styles; alternative realities; lesbian problem drinking; problems facing lesbians in treatment and engaging with Alcoholics Anonymous; treatment as it often is and treatment as it should be.

Carbide and carbonitride surface treatment method for refractory metals

DOEpatents

Meyer, G.A.; Schildbach, M.A.

1996-12-03

A carbide and carbonitride surface treatment method for refractory metals is provided, in steps including, heating a part formed of boron, chromium, hafnium, molybdenum, niobium, tantalum, titanium, tungsten or zirconium, or alloys thereof, in an evacuated chamber and then introducing reaction gases including nitrogen and hydrogen, either in elemental or water vapor form, which react with a source of elemental carbon to form carbon-containing gaseous reactants which then react with the metal part to form the desired surface layer. Apparatus for practicing the method is also provided, in the form of a carbide and carbonitride surface treatment system including a reaction chamber, a source of elemental carbon, a heating subassembly and a source of reaction gases. Alternative methods of providing the elemental carbon and the reaction gases are provided, as well as methods of supporting the metal part, evacuating the chamber with a vacuum subassembly and heating all of the components to the desired temperature. 5 figs.

Treatment and disposal alternatives for health-care waste in developing countries--a case study in Istanbul, Turkey.

PubMed

Alagöz, B Aylin Zeren; Kocasoy, Günay

2007-02-01

Efficient health-care waste management is crucial for the prevention of the exposure of health-care workers, patients, and the community to infections, toxic wastes and injuries as well as the protection of the environment (Safe Management of Wastes from Health-care Activities. World Health Organization, Geneva). The amount of health-care waste produced in the Istanbul Metropolitan City in Turkey is 30 ton day(-1) in total. The method used for the final disposal of most of the health-care waste of Istanbul is incineration. However, a great portion of the infectious waste is disposed of with the domestic waste into the sanitary landfill because of improper segregation practices applied in the health-care institutions. Therefore the alternatives for the treatment and disposal of health-care waste were evaluated. The technical information related to the available treatment technologies including incineration, microwave irradiation, mobile or stationary sterilization, etc. were also investigated. The capital investment cost, transportation/operational costs for each alternative method and the different locations for installation were compared. When the data collected were evaluated, it was found that separate handling and disposal of health-care waste generated on the European and the Asian sides of the city was the most economic and practicable solution. As a result, it was concluded that the capacity of the Kemerburgaz-Odayeri incineration plant is enough to incinerate the health-care waste generated on the European side of Istanbul, the construction of a new incineration plant or a stationary sterilization unit for the disposal of health-care waste generated on the Asian side was the most effective alternative.

Interactive videodisc instruction is an alternative method for learning and performing a critical nursing skill.

PubMed

DeAmicis, P A

1997-01-01

A study was conducted to compare the effectiveness of interactive videodisc instruction (IVDI) with the traditional lecture/demonstration as an alternative method for learning and performing a critical nursing skill. Students were assigned randomly to a treatment group that worked in small groups to complete the IVDI on intravenous therapy skills and a control group receiving the same content in a classroom lecture/demonstration format. After the instruction, each subject performed a re-demonstration of the learned skills using specific guidelines. Results revealed that although the IVDI group scored higher on the overall re-demonstration, there was no significant difference in the ability of the two groups to effectively perform this critical nursing skill. These findings support the use of IVDI as an alternative self-paced, independent study method for learning psychomotor skills and are consistent with previous studies, which indicate that working in small groups on the computer has a positive effect on self-efficacy and achievement.

Development of an evidence-based decision pathway for vestibular schwannoma treatment options.

PubMed

Linkov, Faina; Valappil, Benita; McAfee, Jacob; Goughnour, Sharon L; Hildrew, Douglas M; McCall, Andrew A; Linkov, Igor; Hirsch, Barry; Snyderman, Carl

To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways. Copyright © 2016 Elsevier Inc. All rights reserved.

Alzheimer's Disease Facts and Figures

MedlinePlus Videos and Cool Tools

... After Diagnosis Treatments Medications for Memory Treatments for Behavior Treatments for Sleep Changes Alternative Treatments Questions for ... Dental Care Treatments Medications for Memory Treatments for Behavior Treatments for Sleep Changes Alternative Treatments Questions for ...

Measuring the individual benefit of a medical or behavioral treatment using generalized linear mixed-effects models.

PubMed

Diaz, Francisco J

2016-10-15

We propose statistical definitions of the individual benefit of a medical or behavioral treatment and of the severity of a chronic illness. These definitions are used to develop a graphical method that can be used by statisticians and clinicians in the data analysis of clinical trials from the perspective of personalized medicine. The method focuses on assessing and comparing individual effects of treatments rather than average effects and can be used with continuous and discrete responses, including dichotomous and count responses. The method is based on new developments in generalized linear mixed-effects models, which are introduced in this article. To illustrate, analyses of data from the Sequenced Treatment Alternatives to Relieve Depression clinical trial of sequences of treatments for depression and data from a clinical trial of respiratory treatments are presented. The estimation of individual benefits is also explained. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Multicenter, randomized, open-label Phase II study comparing S-1 alternate-day oral therapy with the standard daily regimen as a first-line treatment in patients with unresectable advanced pancreatic cancer.

PubMed

Yamaue, Hiroki; Shimizu, Atsushi; Hagiwara, Yasuhiro; Sho, Masayuki; Yanagimoto, Hiroaki; Nakamori, Shoji; Ueno, Hideki; Ishii, Hiroshi; Kitano, Masayuki; Sugimori, Kazuya; Maguchi, Hiroyuki; Ohkawa, Shinichi; Imaoka, Hiroshi; Hashimoto, Daisuke; Ueda, Kazuki; Nebiki, Hiroko; Nagakawa, Tatsuya; Isayama, Hiroyuki; Yokota, Isao; Ohashi, Yasuo; Shirasaka, Tetsuhiko

2017-04-01

Non-inferiority for overall survival (OS) following alternate-day treatment with the oral anticancer drug S-1 compared with standard daily treatment was assessed in Japanese patients with unresectable advanced pancreatic cancer in a multicenter, randomized, phase II study. This trial was registered at the UMIN Clinical Trials Registry (no. 000008604). Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned 2:1 to treatment with alternate-day (twice daily on alternate days from days 1 through 42 of a 42-day cycle) or daily (twice daily on days 1 through 28 of a 42-day cycle) treatment with S-1. The primary endpoint was OS. Secondary endpoints were progression-free survival (PFS), time to treatment failure, response rate, quality of life assessments, and safety. A total of 190 patients were enrolled, of which 185 were included in the final analysis (alternate-day: 121; daily: 64). Median OS was 9.4 for the alternate-day group and 10.4 months for the daily group [hazard ratio (HR), 1.19; 95% credible interval, 0.86 to 1.64], indicating that non-inferiority of alternate-day treatment to daily treatment was not demonstrated. Median PFS was 3.0 for the alternate-day group and 4.2 months for the daily group (HR, 1.65; 95% credible interval, 1.20-2.29). The incidence of anorexia, fatigue, neutrophils, pigmentation, and pneumonitis was lower in alternate-day treatment compared with daily treatment. S-1 for advanced pancreatic cancer should be taken daily as recommended, based on the decreased OS and PFS and marginal improvement in safety observed in the alternate-day group.

Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies.

PubMed

Ablin, Jacob; Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia; Häuser, Winfried

2013-01-01

Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques).

A survey on psychiatric patients' use of non-medical alternative practitioners: incidence, methods, estimation, and satisfaction.

PubMed

Demling, J H; Neubauer, S; Luderer, H-J; Wörthmüller, M

2002-12-01

We investigated to what extent psychiatric inpatients consult Heilpraktiker, i.e. non-academically trained providers of complementary and alternative medicine (CAM), which diagnostic and therapeutic methods Heilpraktiker employ, how patients assess Heilpraictikers' professional competence, CAM in general and issues of satisfaction for those who have had experience with Heilpraktiker. Four hundred and seventy three patients admitted to a psychiatric university department during a 9-month period filled out a questionnaire developed for this investigation. About one third of the patients had consulted a Heilpraktiker, a quarter of these for their current psychiatric illness. Women were in the majority. Patients with the highest secondary school education consulted Heilpraktiker less often. There was considerable 'customer loyalty' towards Heilpraktiker. Largely the same diagnostic and treatment methods were employed for mental illness as for somatic complaints. Except for iridology, exotic or dangerous methods played a secondary role. Patients generally revealed a very positive attitude toward Heilpraktiker and CAM, although methods were rated differently. CAM enjoyed greater appreciation among women and patients who had consulted Heilpraktiker. Patients with personal experience were, on the whole, very satisfied with the professional competence, with the atmosphere in the practice and staff concern for the patient's well-being. Degree of satisfaction correlated closely with frequency of consultation. More patients with neurotic disorders considered the cost unreasonable than others, despite comparatively frequent visits. Psychiatric patients seek out Heilpraktiker to a considerable degree. Especially those who have relevant experience rank Heilpraktiker highly, in particular due to their 'psychotherapeutic' attitude, but professional competence is also valued. Methods of CAM received mixed reviews from patients but are generally seen in a positive light. It is recommended that doctors collecting case history data on their patients also ask about experience with alternative practitioners and treatments.

40 CFR 268.46 - Alternative treatment standards based on HTMR.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Alternative treatment standards based on HTMR. 268.46 Section 268.46 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) LAND DISPOSAL RESTRICTIONS Treatment Standards § 268.46 Alternative treatment...

Exploring methods for prevention of oxidative stain in soft maple

Treesearch

Michael C. Wiemann; Richard D. Bergman; Mark Knaebe; Scott A. Bowe

2009-01-01

Interior gray enzymatic oxidative stain for white woods such as maple has plagued the wood industry for many years because methods that have been found to reduce stain are hard to scale up to industrial levels. We examined possible alternative treatments to eliminate stain in soft maple (Acer rubrum L.), and found that exposure to sulfur dioxide gas eliminates interior...

Ozone Gas as a Benign Sterilization Treatment for PLGA Nanofiber Scaffolds

PubMed Central

de Jesus Andreoli Pinto, Terezinha; Bou-Chacra, Nadia Araci; Galante, Raquel; de Araújo, Gabriel Lima Barros; do Nascimento Pedrosa, Tatiana; Maria-Engler, Silvya Stuchi

2016-01-01

The use of electrospun nanofibers for tissue engineering and regenerative medicine applications is a growing trend as they provide improved support for cell proliferation and survival due, in part, to their morphology mimicking that of the extracellular matrix. Sterilization is a critical step in the fabrication process of implantable biomaterial scaffolds for clinical use, but many of the existing methods used to date can negatively affect scaffold properties and performance. Poly(lactic-co-glycolic acid) (PLGA) has been widely used as a biodegradable polymer for 3D scaffolds and can be significantly affected by current sterilization techniques. The aim of this study was to investigate pulsed ozone gas as an alternative method for sterilizing PLGA nanofibers. The morphology, mechanical properties, physicochemical properties, and response of cells to PLGA nanofiber scaffolds were assessed following different degrees of ozone gas sterilization. This treatment killed Geobacillus stearothermophilus spores, the most common biological indicator used for validation of sterilization processes. In addition, the method preserved all of the characteristics of nonsterilized PLGA nanofibers at all degrees of sterilization tested. These findings suggest that ozone gas can be applied as an alternative method for sterilizing electrospun PLGA nanofiber scaffolds without detrimental effects. PMID:26757850

Ozone Gas as a Benign Sterilization Treatment for PLGA Nanofiber Scaffolds.

PubMed

Rediguieri, Carolina Fracalossi; Pinto, Terezinha de Jesus Andreoli; Bou-Chacra, Nadia Araci; Galante, Raquel; de Araújo, Gabriel Lima Barros; Pedrosa, Tatiana do Nascimento; Maria-Engler, Silvya Stuchi; De Bank, Paul A

2016-04-01

The use of electrospun nanofibers for tissue engineering and regenerative medicine applications is a growing trend as they provide improved support for cell proliferation and survival due, in part, to their morphology mimicking that of the extracellular matrix. Sterilization is a critical step in the fabrication process of implantable biomaterial scaffolds for clinical use, but many of the existing methods used to date can negatively affect scaffold properties and performance. Poly(lactic-co-glycolic acid) (PLGA) has been widely used as a biodegradable polymer for 3D scaffolds and can be significantly affected by current sterilization techniques. The aim of this study was to investigate pulsed ozone gas as an alternative method for sterilizing PLGA nanofibers. The morphology, mechanical properties, physicochemical properties, and response of cells to PLGA nanofiber scaffolds were assessed following different degrees of ozone gas sterilization. This treatment killed Geobacillus stearothermophilus spores, the most common biological indicator used for validation of sterilization processes. In addition, the method preserved all of the characteristics of nonsterilized PLGA nanofibers at all degrees of sterilization tested. These findings suggest that ozone gas can be applied as an alternative method for sterilizing electrospun PLGA nanofiber scaffolds without detrimental effects.

Successful ongoing pregnancies after vitrification of oocytes.

PubMed

Lucena, Elkin; Bernal, Diana Patricia; Lucena, Carolina; Rojas, Alejandro; Moran, Abby; Lucena, Andrés

2006-01-01

To demonstrate the efficiency of vitrifying mature human oocytes for different clinical indications. Descriptive case series. Cryobiology laboratory, Centro Colombiano de Fertilidad y Esterilidad-CECOLFES LTDA. (Bogotá, Colombia). Oocyte vitrification was offered as an alternative management for patients undergoing infertility treatment because of ovarian hyperstimulation syndrome, premature ovarian failure, natural ovarian failure, male factor, poor response, or oocyte donation. Mature oocytes were obtained from 33 donor women and 40 patients undergoing infertility treatment. Oocytes were retrieved by ultrasound-guided transvaginal aspiration and vitrified with the Cryotops method, with 30% ethylene glycol, 30% dimethyl sulfoxide, and 0.5 mol/L sucrose. Viability was assessed 3 hours after thawing. The surviving oocytes were inseminated by intracytoplasmic sperm injection. Fertilization was evaluated after 24 hours. The zygotes were further cultured in vitro for up to 72 hours until time of embryo transfer. Recovery, viability, fertilization, and pregnancy rates. Oocyte vitrification with the Cryotop method resulted in high rates of recovery, viability, fertilization, cleavage, and ongoing pregnancy. Vitrification with the Cryotop method is an efficient, fast, and economical method for oocyte cryopreservation that offers high rates of survival, fertilization, embryo development, and ongoing normal pregnancies, providing a new alternative for the management of female infertility.

Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K.

PubMed

Hand, Darren; Averley, Paul; Lyne, John; Girdler, Nick

2011-01-01

Child dental anxiety is widespread, and it is not always possible to treat children using traditional methods such as behavioural management, local anaesthesia and even relative analgesia. In such cases a dental general anaesthetic (DGA) is the only option available to facilitate dental treatment in anxious children. This study describes an advanced conscious sedation protocol which allows invasive treatment to be carried out in anxious children. It incorporates the use of titrated intravenous midazolam and fentanyl and inhalation agents, sevoflurane and nitrous oxide/oxygen, which is administered by a Consultant Anaesthetist. The aim is to produce an evidence- based study which can offer a sedation technique as a safe and effective alternative to a DGA. Retrospective audit. 267 clinical records were audited retrospectively from a specialist sedation-based clinic, for children aged 5-15 years old. The subjects all underwent invasive dental procedures with this technique between August and November 2008 as an alternative to a DGA. 262/267 (98%) of the subjects were treated safely and successfully and without the loss of verbal communication using this technique. This included many treatments requiring four quadrant dentistry, with both restorations and extractions as necessary being carried out in one visit. 5 subjects (2%) did not tolerate treatment and had to be referred for a DGA. No medical emergencies occurred. Based on the evidence for this group of patients, this advanced conscious sedation technique, offers a safe and effective alternative to DGA. This technique must be carried out in an appropriate environment by an appropriately trained and experienced team who are able to comply with the recommendations for "alternative" sedation techniques.

Random forests of interaction trees for estimating individualized treatment effects in randomized trials.

PubMed

Su, Xiaogang; Peña, Annette T; Liu, Lei; Levine, Richard A

2018-04-29

Assessing heterogeneous treatment effects is a growing interest in advancing precision medicine. Individualized treatment effects (ITEs) play a critical role in such an endeavor. Concerning experimental data collected from randomized trials, we put forward a method, termed random forests of interaction trees (RFIT), for estimating ITE on the basis of interaction trees. To this end, we propose a smooth sigmoid surrogate method, as an alternative to greedy search, to speed up tree construction. The RFIT outperforms the "separate regression" approach in estimating ITE. Furthermore, standard errors for the estimated ITE via RFIT are obtained with the infinitesimal jackknife method. We assess and illustrate the use of RFIT via both simulation and the analysis of data from an acupuncture headache trial. Copyright © 2018 John Wiley & Sons, Ltd.

Correction of gene expression data: Performance-dependency on inter-replicate and inter-treatment biases.

PubMed

Darbani, Behrooz; Stewart, C Neal; Noeparvar, Shahin; Borg, Søren

2014-10-20

This report investigates for the first time the potential inter-treatment bias source of cell number for gene expression studies. Cell-number bias can affect gene expression analysis when comparing samples with unequal total cellular RNA content or with different RNA extraction efficiencies. For maximal reliability of analysis, therefore, comparisons should be performed at the cellular level. This could be accomplished using an appropriate correction method that can detect and remove the inter-treatment bias for cell-number. Based on inter-treatment variations of reference genes, we introduce an analytical approach to examine the suitability of correction methods by considering the inter-treatment bias as well as the inter-replicate variance, which allows use of the best correction method with minimum residual bias. Analyses of RNA sequencing and microarray data showed that the efficiencies of correction methods are influenced by the inter-treatment bias as well as the inter-replicate variance. Therefore, we recommend inspecting both of the bias sources in order to apply the most efficient correction method. As an alternative correction strategy, sequential application of different correction approaches is also advised. Copyright © 2014 Elsevier B.V. All rights reserved.

Noninvasive thermal ablation of hepatocellular carcinoma by using magnetic resonance imaging-guided focused ultrasound.

PubMed

Jolesz, Ferenc A; Hynynen, Kullervo; McDannold, Nathan; Freundlich, David; Kopelman, Doron

2004-11-01

A number of minimally invasive methods have been tested for the thermal ablation of liver tumors as an alternative to surgical resection. The use of focused ultrasound transducers to ablate deep tumors offers the first completely noninvasive alternative to these techniques. By increasing the flexibility of this technology with modern phased-array transducer design and by combining it with magnetic resonance imaging for targeting and online guidance, a powerful tool results with the potential to offer treatment to a larger population of patients, to reduce trauma to the patient, and to reduce the cost of treatment. In this article, we review previous work with focused ultrasound in the liver and recent experimental results with magnetic resonance imaging guidance.

Use of complementary and alternative medicine in children with cancer: effect on survival.

PubMed

Karalı, Yasin; Demirkaya, Metin; Sevinir, Betül

2012-05-01

The objective of the present study was to determine the type, frequency, the reason why complementary and alternative medicine (CAM) treatments are used, the factors related with their use, and the effects of CAM usage on long-term survival. Families of a total of 120 children with cancer between 0-18 years of age, including 50 (41.7%) girls and 70 (58.3%) boys, participated in our study. The authors found that 88 patients (73.3%) used at least one CAM method, the most common (95.5%) of which was biologically based therapies. Most frequently used biologically based therapies were dietary supplements and herbal products. The most commonly used dietary supplement or herbal product was honey (43.2%) or stinging nettle (43.2%), respectively. We found that patients used such CAM methods as complementary to, but not instead of, conventional therapy. Sixty-nine out of 88 patient families (78.4%) shared the CAM method they used with their physicians. No statistically significant relation was found between socioeconomic, sociodemographic, or other factors or items and CAM use. The mean follow-up period of the CAM users and nonusers groups was 79.4 ± 36.7 (21.3-217.9) and 90.9 ± 50.3 (27.4-193.7) months, respectively. Five-year survival rates for CAM users and nonusers were found as 81.5% and 86.5%, respectively (P > .05). In conclusion, families of children with cancer use complementary and alternative treatment frequently. They do not attempt to replace conventional treatment with CAM. Higher rates of CAM use was found in families with higher educational level. CAM usage did not affect the long-term survival.

[Complementary medicine--Jewish medical ethics].

PubMed

Katz, Yisrae; Schiff, Elad

2011-08-01

In Israel, as in the Western world, the use of different methods of complementary and alternative medicine ICAM) is spreading. CAM raises ethical questions of concern to healthcare providers and to the public: Can physicians recommend a treatment that has no scientific evidence? Should the government include such therapies in the health budget? Can complementary therapists receive protection against lawsuits if their treatment is recognized? The purpose of this article is to present a Jewish perspective on these issues. The fundamental sources that deal with the subject are based on the approach of rabbinic authorities toward unproven medicine, as expressed in the "Mishnah" and "Talmud" (200-500 C.E). The great Jewish scholar who discusses the subject in detail is Maimonides (1135-1204), who defines what "medicine" is and claims that medicine has to rely on reason or experience. Contemporary Jewish commentators present their position based on the interpretation of Maimonides' texts. In this article we claim that treatments can be divided into four groups, each group having a different halachic status: (1) Treatment that might be dangerous--should not be used. (2) Treatment that is safe--can be used, but has no other special status. (3) Treatment recognized by alternative therapists--has consequences for the observant Jew, such as laws of Kashrut and Shabbat. (4) Treatment that was tested and proven using modern medical methods has public significance--the therapist is entitled to legal defense if he made a reasonable mistake; the government can consider funding such treatment using public money. This article presents the Jewish halachic sources upon which we propose an ethical-practical approach to CAM.

Kinesiotaping as an alternative treatment method for carpal tunnel syndrome.

PubMed

Geler Külcü, Duygu; Bursali, Canan; Aktaş, İlknur; Bozkurt Alp, Selin; Ünlü Özkan, Feyza; Akpinar, Pınar

2016-06-23

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Conservative treatment choices are not always satisfactory. The aim of this study was to investigate the effect of kinesiotaping (KT) on pain level, grip strength, and functional status compared with that of placebo KT and orthotic device (OD) in patients with CTS. In this randomized, placebo-controlled study, participants were allocated into one of three groups: an experimental KT group (Group 1), a placebo KT group (Group 2), and an OD group (Group 3). Visual analogue scale (VAS) and Douleur Neuropathique 4 (DN4) scores, dynamometric grip strength measures, and the Boston CTS questionnaire (BQ) were the outcome measures. All groups significantly improved in terms of VAS scores (P < 0.05), DN4 scores (P < 0.05), and BQ scores (P < 0.05). Grip strength improved in Group 3 (P = 0.001). There was a significant difference among the groups with respect to BQ scores (P < 0.05). KT application for the treatment of CTS should be an alternative treatment choice.

Method of treating intermetallic alloy hydrogenation/oxidation catalysts for improved impurity poisoning resistance, regeneration and increased activity

DOEpatents

Wright, Randy B.

1992-01-01

Alternate, successive high temperature oxidation and reduction treatments, in either order, of intermetallic alloy hydrogenation and intermetallic alloy oxidation catalysts unexpectedly improves the impurity poisoning resistance, regeneration capacity and/or activity of the catalysts. The particular alloy, and the final high temperature treatment given alloy (oxidation or reduction) will be chosen to correspond to the function of the catalyst (oxidation or hydrogenation).

Comparison of shape memory polymer foam versus bare metal coil treatments in an in vivo porcine sidewall aneurysm model.

PubMed

Horn, John; Hwang, Wonjun; Jessen, Staci L; Keller, Brandis K; Miller, Matthew W; Tuzun, Egemen; Hartman, Jonathan; Clubb, Fred J; Maitland, Duncan J

2017-10-01

The endovascular delivery of platinum alloy bare metal coils has been widely adapted to treat intracranial aneurysms. Despite the widespread clinical use of this technique, numerous suboptimal outcomes are possible. These may include chronic inflammation, low volume filling, coil compaction, and recanalization, all of which can lead to aneurysm recurrence, need for retreatment, and/or potential rupture. This study evaluates a treatment alternative in which polyurethane shape memory polymer (SMP) foam is used as an embolic aneurysm filler. The performance of this treatment method was compared to that of bare metal coils in a head-to-head in vivo study utilizing a porcine vein pouch aneurysm model. After 90 and 180 days post-treatment, gross and histological observations were used to assess aneurysm healing. At 90 days, the foam-treated aneurysms were at an advanced stage of healing compared to the coil-treated aneurysms and showed no signs of chronic inflammation. At 180 days, the foam-treated aneurysms exhibited an 89-93% reduction in cross-sectional area; whereas coiled aneurysms displayed an 18-34% area reduction. The superior healing in the foam-treated aneurysms at earlier stages suggests that SMP foam may be a viable alternative to current treatment methods. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1892-1905, 2017. © 2016 Wiley Periodicals, Inc.

Application of botulinum toxin to treat sialorrhea in amyotrophic lateral sclerosis patients: a literature review

PubMed Central

de Oliveira, Ademar Francisco; Silva, Gêssyca Adryene de Menezes; Almeida, Débora Milenna Xavier

2016-01-01

ABSTRACT Amyotrophic lateral sclerosis is a progressive and fatal neurodegenerative disease characterized by the degeneration of motor neurons, which are the central nervous system cells that control voluntary muscle movements. The excessive salivation (sialorrhea) is present in approximately 50% of amyotrophic lateral sclerosis cases. Thus, some alternative therapeutic methods are sought, such as anticholinergic drugs and surgery. Recently the use of botulinum toxin applied at a midpoint of the salivary glands, often guided by ultrasound, have demonstrated positive results. The objective was to review the literature to demonstrate an alternative method to treatments of sialorrhea in patients with amyotrophic lateral sclerosis. In recent studies, the efficacy of botulinum toxin is confirmed, although new applications are required. Since the side effects are negligible, this is an alternative to treat amyotrophic lateral sclerosis, and other patients with diseases that present sialorrhea. PMID:27759834

[Biotechnological therapies for the treatment of back pain: alternatives to corticosteroids].

PubMed

Moser, C; Thiel, H-J; Grönemeyer, D

2013-12-01

In recent years, it is increasingly clear that back pain is not only caused by biomechanical problems. Currently, biologically-based local therapy concepts for the treatment of affected spinal regions as an alternative to the standard treatment with steroids are in development or in early stages of clinical application. The common features of these new therapies are to intervene in the regulation of homeostasis at various key points at the affected region and specifically to suppress or block catabolic influences as well as to provide with anti-inflammatory substances and growth factors. These include on one hand the genetically produced Biologicals such as TNF-α inhibitors and cytokine antagonists and on the other hand therapies with autologous blood preparations (Autologous Conditioned Serum [ACS], and Platelet Rich Plasma formulations [PRP]). This article presents the individual methods, gives an overview of developments and results of various studies and discusses current recommendations.

[Alternative medicine, beliefs, and management of people with HIV in Gabon].

PubMed

Yaba, W; Chippaux, J P; Obiang-Ndong, G P; Msellati, P

2013-01-01

According to WHO, 80% of the population in Africa has used alternative medicine for primary health care at least once. Gabon continues to have a high prevalence of HIV, estimated in 2011 at 5.2%. Overall, 22 253 PLWHA (people living with HIV/AIDS) - adults and children - are being treated, including 9976 on ARVs (antiretroviral drugs). The procedures for ARV initiation are very long, ARVs are frequently out of stock, and treatment in care centers for PLWHA is stigmatized: all these factors favor the development of alternative medicine for HIV care in Gabon. To analyze the impact of alternative medicine in the treatment of PLWHA in Gabon. This cross-sectional survey was conducted during a total of four months between May 2009 and September 2010 among PLWHA older than 18 years who had been receiving ARVs for at least 6 months and consented to participate (7 centers) and among physicians and other caregivers of these centers (8 centers). We used a simple random sample method. Epidata software was used for data collection, and the analyses were performed with SAS™ software. Of the 5752 patients on ARVs followed at the 7 study sites, 422 PLWHA were interviewed (58.3% of them women): 284 (67.29%) in Libreville and 138 (38.7) in the provinces. Christians accounted for 90.5% (including 21.5% from Protestant evangelical churches), and Muslins for 5.68%, while 4% stated that they had no religion. 12.5% of doctors referred their patients to religious or spiritual groups. Our study showed that half of PLWHA did not know the procedures for access to ARV treatment and that beliefs about HIV/AIDS differed strongly according to place of residence. Finally, the cultural context related to alternative medicine is very present in the PLWHA treatment settings in Gabon. Although PLWHAs have easy access to ARVs, their association with organized and controlled alternative medicine can be beneficial.

Review of Recent Methodological Developments in Group-Randomized Trials: Part 2-Analysis.

PubMed

Turner, Elizabeth L; Prague, Melanie; Gallis, John A; Li, Fan; Murray, David M

2017-07-01

In 2004, Murray et al. reviewed methodological developments in the design and analysis of group-randomized trials (GRTs). We have updated that review with developments in analysis of the past 13 years, with a companion article to focus on developments in design. We discuss developments in the topics of the earlier review (e.g., methods for parallel-arm GRTs, individually randomized group-treatment trials, and missing data) and in new topics, including methods to account for multiple-level clustering and alternative estimation methods (e.g., augmented generalized estimating equations, targeted maximum likelihood, and quadratic inference functions). In addition, we describe developments in analysis of alternative group designs (including stepped-wedge GRTs, network-randomized trials, and pseudocluster randomized trials), which require clustering to be accounted for in their design and analysis.

Evaluation of alternative environmentally friendly matrix solid phase dispersion solid supports for the simultaneous extraction of 15 pesticides of different chemical classes from drinking water treatment sludge.

PubMed

Soares, Karina Lotz; Cerqueira, Maristela Barnes Rodrigues; Caldas, Sergiane Souza; Primel, Ednei Gilberto

2017-09-01

This study describes the development, optimization and validation of a method for the extraction of 15 pesticides of different chemical classes in drinking water treatment sludge (DWTS) by vortex-assisted Matrix Solid Phase Dispersion (MSPD) with determination by gas chromatography coupled to mass spectrometry. It focused on the application of alternative and different solid supports to the extraction step of the MSPD. The main parameters that influenced the extraction were studied in order to obtain better recovery responses. Recoveries ranged from 70 to 120% with RSD below 20% for all analytes. Limits of quantification (LOQ) of the method ranged from 5 to 500 μg kg -1 whereas the analytical curves showed correlation coefficients above 0.997. The method under investigation used low volume of solvent (5 mL), low sample mass (1.5 g) and low mass of chitin (0.5 g), an environmentally friendly support. It has advantages, such as speed, simplicity and low cost material, over other methods. When the method was applied, 4 out of 15 pesticides were detected in the DWTS samples in concentrations below the LOQ. Copyright © 2017 Elsevier Ltd. All rights reserved.

Utilizing fungus myceliated grain for molt induction and performance in commercial laying hens.

PubMed

Willis, W L; Isikhuemhen, O S; Allen, J W; Byers, A; King, K; Thomas, C

2009-10-01

Molting in poultry is used to rejuvenate hens for a second or third laying cycle. Feed withdrawal was once the most effective method used for molt induction; however, it has being phased out due to food safety and animal welfare concerns. This study evaluated the utilization of fungus myceliated grain as a safe and effective alternative for inducing molt, enhancing immunity, reducing Salmonella growth, and returning to egg production. Laying hens were subjected to 1 of 5 treatments: 1) nonfed (NF), 2) full-fed (FF), 3) fungus myceliated meal (FM), 4) 90% fungus myceliated meal+10% standard layer ration (FM-90), and 5) 90% alfalfa meal+10% fungus myceliated meal (AF-90). Each treatment condition was replicated 9 times during a 9-d molt period. The results revealed that egg production for treatments 1 and 3 ceased completely by d 5, whereas hens in treatments 4 and 5 ceased egg production by d 6. The percentage of BW loss decreased significantly (P<0.05) in treatments 1 (57%), 2 (8%), 3 (35%), 4 (37%), and 5 (44%). Ovary weights of hens fed all molting diets decreased significantly from the full-fed control but did not differ significantly (P<0.05) from each other. Salmonella population in the crop, ovary, and ceca from hens differed significantly (P<0.05) among treatments. Return to egg production differed between treatments with higher production beginning in treatment 3 and ending in treatment 5. Antibody titers did differ (P<0.05) among treatments. From these results, fungus myceliated meal appears to be a viable alternative to conventional feed withdrawal and other methods for the successful induction of molt and retention of postmolt performance.

Behaviors of providers of traditional korean medicine therapy and complementary and alternative medicine therapy for the treatment of cancer patients.

PubMed

Yu, Jun-Sang; Kim, Chun-Bae; Kim, Ki-Kyong; Lee, Ji-Eun; Kim, Min-Young

2015-03-01

In Korea, cancer is one of the most important causes of death. Cancer patients have sought alternative methods, like complementary and alternative medicine (CAM) together with Western medicine, to treat cancer. Also, there are many kinds of providers of CAM therapy, including providers of Korean oriental medicine therapy. The purpose of this study is to identify the behaviors of Korean oriental medicine therapy and CAM therapy providers who treat cancer patients and to provide background knowledge for establishing a new policy with the management and quality control of CAM. Structured and well organized questionnaires were made, and 350 persons were surveyed concerning the providers of CAM or Korean oriental medicine. The questionnaires were collected and analyzed. The questionnaires (182) were collected. The questionnaires identified a total of 73 known providers, such as medicinal professionals or other providers of CAM suppliers, 35.6% of whom had had experience with treating cancer patients (52.6% vs. 29.6%). The treatment methods were a little different: alternative therapy and nutritional therapy being preferred by medicinal professionals and mind body modulation therapy and alternative therapy being preferred by other CAM providers. Four patients (7.4%) experienced side effects, and 6 patients (12.5%) experienced legal problems. As the method for managing the therapy, CAM providers, medicinal professionals, and other CAM providers had different viewpoints. For example, some CAM providers stated that both legislation and an official education on CAM or a national examination were needed as a first step to establish the provider's qualifications and that as a second step, a license test was needed for quality control. To the contrary, medicinal professionals stated that a license test was needed before legislation. Adequate management and quality control of CAM providers is thought to involve both education and legislation.

Reproduction control in cats: new developments in non-surgical methods.

PubMed

Goericke-Pesch, Sandra

2010-07-01

Reproduction control is an area of feline medicine that is assuming increasing importance in companion animal practice. Signs of oestrus such as increased vocalisation, rolling on the ground and a very short interoestrous interval may negatively influence the relationship between cat and owner, and prompt the owner to seek a method of reproduction control. In breeding catteries, control of reproduction may be needed as part of a planned breeding programme. Surgical contraception is not always the owner's wish - especially when a cat may be intended for future breeding. Besides, ethical principles and animal welfare legislation in an increasing number of countries are imposing restrictions on this 'classical approach' to reproduction control. Progestins are routinely used as non-surgical alternatives in cases where fertility is to be preserved, but the associated risks of uterine disease, mammary tumours, fibroadenomatosis or diabetes mellitus have to be taken into account - especially in predisposed animals. Modern, effective pharmacological alternatives are available for managing oestrous suppression and unwanted pregnancy. Detailed knowledge of the physiology of the oestrous cycle in the cat is necessary to ensure that the appropriate treatment is chosen for the individual animal and its owner. This article presents an update for small animal practitioners on these alternative methods; specifically, the use of slow-release GnRH agonists or melatonin implants for hormonal contraception, and the antiprogestin aglepristone for pregnancy termination. Several studies have documented the mode of action and risk of side effects of the traditional alternative to surgical castration - treatment with progestins. Evidence underpinning the safety and efficacy of GnRH agonists and melatonin implants for suppression of fertility in queens and toms is reviewed. Copyright 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

[Metabolic surgery in treatment of diabetes mellitus of type II].

PubMed

Sedov, V M; Fishman, M B

2013-01-01

Nowadays, according to data of WHO, the diabetes mellitus was diagnosed in more than 280 million people. The diabetes mellitus type II had 90% patients. The applied methods of conservative therapy seldom lead to euglycemia condition of patients. Last years the treatment of diabetes mellitus was carried out by the method of different bariatic interventions. Good results was obtained, they should be analyzed and investigate. The results of treatment of 142 patients from 628 patients (with type II) were estimated. The patients were undergone by different bariatic interventions. Modern laparoscopic operations were performed on all the patients. Controlled bandage of stomach had 81 of patients. Gastric resection was performed in 28. Gastric bypass surgery was carried out in 22 of patients and biliopancreatic diversion - in 11. The improvement of control of leukemia level was obtained. Diabetes type II could be treated by surgical methods. The best results were obtained after combined operations, which potentially could present an alternative method of treatment of type II diabetes.

Gestalt Approaches to Conjoint Therapy

ERIC Educational Resources Information Center

Kelly, Brian J.; Gill, John D.

1978-01-01

An alternative to individual counseling is marriage and family counseling. It is the preferred mode of treatment for all but the social isolate. The specific methods by which persons avoid healthy contacts are discussed, as are counseling methodologies which are based on Gestalt and family systems theory. (Author)

Preservation Using Pesticides: Some Words of Caution.

ERIC Educational Resources Information Center

Davis, Mary

1985-01-01

Addresses problem of insects and other pests in library facility and material maintenance. Highlights include dangers of chemical pesticides; alternative methods for treatment of book infestations (light and temperature regulation, freezing, establishment of low oxygen atmosphere, microwaves and radiation, boric acid); and state and federal laws…

[Role of percutaneous vertebroplasty and kyphoplasty in the treatment of oncology disorders of the spine].

PubMed

Ryska, P; Rehák, S; Odráka, K; Maisnar, V; Raupach, J; Málek, V; Renc, O; Kaltofen, K

2006-01-01

The aim of the study is to present results of a prospective uncontrolled clinical study. Percutaneous vertebroplasty or kyphoplasty are minimally invasive methods based on polymethylmethacrylate (PMMA) bone cement application into the damaged vertebra. This leads to decrease of the pain and vertebral body stabilisation. Oncology disorders of the spine are relatively common, having a wide alternative of various methods of treatment. Patients, according to their findings and indication criteria, are treated surgically or conservatively, oncological treatment is usually based on radiotherapy. Authors discuss the role of these invasive procedures in the treating algorithm of patients with spinal metasthases and multiple myeloma. From September 2003 to December 2005, 21 percutaneous vertebroplasties in 14 patients, mean age 68.7 (47-80) year, were performed in our department. During one treatment session 1-2 vertebrae (total of 21 vertebrae) in level Th9 - L5 were treated. Vertebroplasties and kyphoplasty were performed under fluoroscopy guidance. Transpedicular acces was used. Totally, 3 asymptomatic complications were proved. As first, a bone cement leaked paravertebrally during L5 body treatment, as second, a bone cement leaked into paravertebral veins, and as third, a bone cement leaked into the intervertebral space. Visual analog scale (VAS) was 8.9 points before procedure, 1.9 point 3 months after procedure and 2.6 points 6 months after procedure. We did not prove a symptomatic or total complication. According to our experience, percutaneous vertebroplasty is an effective alternative treatment of painful oncologic spine disease.

Adjusting for treatment switching in randomised controlled trials - A simulation study and a simplified two-stage method.

PubMed

Latimer, Nicholas R; Abrams, K R; Lambert, P C; Crowther, M J; Wailoo, A J; Morden, J P; Akehurst, R L; Campbell, M J

2017-04-01

Estimates of the overall survival benefit of new cancer treatments are often confounded by treatment switching in randomised controlled trials (RCTs) - whereby patients randomised to the control group are permitted to switch onto the experimental treatment upon disease progression. In health technology assessment, estimates of the unconfounded overall survival benefit associated with the new treatment are needed. Several switching adjustment methods have been advocated in the literature, some of which have been used in health technology assessment. However, it is unclear which methods are likely to produce least bias in realistic RCT-based scenarios. We simulated RCTs in which switching, associated with patient prognosis, was permitted. Treatment effect size and time dependency, switching proportions and disease severity were varied across scenarios. We assessed the performance of alternative adjustment methods based upon bias, coverage and mean squared error, related to the estimation of true restricted mean survival in the absence of switching in the control group. We found that when the treatment effect was not time-dependent, rank preserving structural failure time models (RPSFTM) and iterative parameter estimation methods produced low levels of bias. However, in the presence of a time-dependent treatment effect, these methods produced higher levels of bias, similar to those produced by an inverse probability of censoring weights method. The inverse probability of censoring weights and structural nested models produced high levels of bias when switching proportions exceeded 85%. A simplified two-stage Weibull method produced low bias across all scenarios and provided the treatment switching mechanism is suitable, represents an appropriate adjustment method.

The cost of refusing treatment and equality of outcome.

PubMed Central

Savulescu, J

1998-01-01

Patients have a right to refuse medical treatment. But what should happen after a patient has refused recommended treatment? In many cases, patients receive alternative forms of treatment. These forms of care may be less cost-effective. Does respect for autonomy extend to providing these alternatives? How for does justice constrain autonomy? I begin by providing three arguments that such alternatives should not be offered to those who refuse treatment. I argue that the best argument which refusers can appeal to is based on the egalitarian principle of equality of outcome. However, this principle does not ultimately support a right to less cost-effective alternatives. I focus on Jehovah's Witnesses refusing blood and requesting alternative treatments. However, the point applies to many patients who refuse cost-effective medical care. PMID:9752624

Complementary and alternative medicine for pain management in U.S.- and foreign-born Chinese women with breast cancer.

PubMed

Wong-Kim, Evaon; Merighi, Joseph R

2007-11-01

This study explores beliefs about complementary and alternative medicine (CAM) use for pain management among 15 U.S.-born and 15 foreign-born Chinese women with breast cancer. For this investigation, trilingual interviewers conducted individual, face-to-face, qualitative interviews in Cantonese, Mandarin, or English. All study participants lived in San Francisco, and the foreign-born women had resided in the U.S. for 15 years or fewer. Findings indicate that many participants consider CAM a viable method of pain management. However, concerns about affordability and quality of treatment prevent some women from using CAM on a regular basis. Many participants indicated that Western health care providers are poorly equipped to provide CAM to manage the pain resulting from breast cancer treatment. Future research should explore how access to CAM can be improved for poor and uninsured patients with cancer and how alternative approaches to pain management can be integrated more broadly in the U.S. health care system.

Complementary and alternative treatment in functional dyspepsia

PubMed Central

Chiarioni, Giuseppe; Pesce, Marcella; Fantin, Alberto; Sarnelli, Giovanni

2017-01-01

Introduction and aim The popularity of complementary and alternative medicine (CAM) in treating functional gastrointestinal disorders (FGIDs) has steadily increased in Western countries. We aimed at analyzing available data on CAM effectiveness in functional dyspepsia (FD) patients. Methods A bibliographical search was performed in PubMed using the following keywords: “complementary/alternative medicine,” “hypnosis,” “acupuncture” and/or “functional dyspepsia.” Results In community settings, almost 50% of patients with FGIDs used CAM therapies. Herbal remedies consist of multi-component preparations, whose mechanisms of action have not been systematically clarified. Few studies analyzed the effectiveness of acupuncture in Western countries, yielding conflicting results and possibly reflecting a population bias of this treatment. Hypnosis has been extensively used in irritable bowel syndrome, but few data support its role in treating FD. Conclusions Although some supporting well-designed studies have been recently performed, additional randomized, controlled trials are needed before stating any recommendation on CAM effectiveness in treating FD. PMID:29435308

Implementation of the 3Rs (refinement, reduction, and replacement): validation and regulatory acceptance considerations for alternative toxicological test methods.

PubMed

Schechtman, Leonard M

2002-01-01

Toxicological testing in the current regulatory environment is steeped in a history of using animals to answer questions about the safety of products to which humans are exposed. That history forms the basis for the testing strategies that have evolved to satisfy the needs of the regulatory bodies that render decisions that affect, for the most part, virtually all phases of premarket product development and evaluation and, to a lesser extent, postmarketing surveillance. Only relatively recently have the levels of awareness of, and responsiveness to, animal welfare issues reached current proportions. That paradigm shift, although sluggish, has nevertheless been progressive. New and alternative toxicological methods for hazard evaluation and risk assessment have now been adopted and are being viewed as a means to address those issues in a manner that considers humane treatment of animals yet maintains scientific credibility and preserves the goal of ensuring human safety. To facilitate this transition, regulatory agencies and regulated industry must work together toward improved approaches. They will need assurance that the methods will be reliable and the results comparable with, or better than, those derived from the current classical methods. That confidence will be a function of the scientific validation and resultant acceptance of any given method. In the United States, to fulfill this need, the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) and its operational center, the National Toxicology Program Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM), have been constituted as prescribed in federal law. Under this mandate, ICCVAM has developed a process and established criteria for the scientific validation and regulatory acceptance of new and alternative methods. The role of ICCVAM in the validation and acceptance process and the criteria instituted toward that end are described. Also discussed are the participation of the US Food and Drug Administration (FDA) in the ICCVAM process and that agency's approach to the application and implementation of ICCVAM-recommended methods.

Direct evaluation of radiobiological parameters from clinical data in the case of ion beam therapy: an alternative approach to the relative biological effectiveness.

PubMed

Cometto, A; Russo, G; Bourhaleb, F; Milian, F M; Giordanengo, S; Marchetto, F; Cirio, R; Attili, A

2014-12-07

The relative biological effectiveness (RBE) concept is commonly used in treatment planning for ion beam therapy. Whether models based on in vitro/in vivo RBE data can be used to predict human response to treatments is an open issue. In this work an alternative method, based on an effective radiobiological parameterization directly derived from clinical data, is presented. The method has been applied to the analysis of prostate cancer trials with protons and carbon ions.Prostate cancer trials with proton and carbon ion beams reporting 5 year-local control (LC5) and grade 2 (G2) or higher genitourinary toxicity rates (TOX) were selected from literature to test the method. Treatment simulations were performed on a representative subset of patients to produce dose and linear energy transfer distribution, which were used as explicative physical variables for the radiobiological modelling. Two models were taken into consideration: the microdosimetric kinetic model (MKM) and a linear model (LM). The radiobiological parameters of the LM and MKM were obtained by coupling them with the tumor control probability and normal tissue complication probability models to fit the LC5 and TOX data through likelihood maximization. The model ranking was based on the Akaike information criterion.Results showed large confidence intervals due to the limited variety of available treatment schedules. RBE values, such as RBE = 1.1 for protons in the treated volume, were derived as a by-product of the method, showing a consistency with current approaches. Carbon ion RBE values were also derived, showing lower values than those assumed for the original treatment planning in the target region, whereas higher values were found in the bladder. Most importantly, this work shows the possibility to infer the radiobiological parametrization for proton and carbon ion treatment directly from clinical data.

The effects of Cosmos caudatus (ulam raja) on dynamic and cellular bone histomorphometry in ovariectomized rats

PubMed Central

2013-01-01

Background Cosmos caudatus is a local plant which has antioxidant properties and contains high calcium. It is also reported to be able to strengthen the bone. This report is an extension to previously published article in Evidence Based Complementary and Alternative Medicine (doi:10.1155/2012/817814). In this study, we determined the effectiveness of C. caudatus as an alternative treatment for osteoporosis due to post-menopause by looking at the dynamic and cellular paramaters of bone histomorphometry. Methods Forty female Wistar rats were divided into four groups i.e. sham operated, ovariectomized, ovariectomized treated with calcium 1% ad libitum and ovariectomized force-fed with 500 mg/kg C. caudatus extract. Treatment was given six days a week for eight weeks. Results Dynamic and cellular histomorphometry parameters were measured. C. caudatus increased double-labeled surface (dLS/BS), mineral appositional rate (MAR), osteoid volume (OV/BV) and osteoblast surface (Ob.S/BS). C. caudatus also gave better results compared to calcium 1% in the osteoid volume (OV/BV) parameter. Conclusions C. caudatus at the 500 mg/kg dose may be an alternative treatment in restoring bone damage that may occur in post-menopausal women. PMID:23800238

Dementia: treating patients and caregivers with complementary and alternative medicine--results of a clinical expert conference using the World Café method.

PubMed

Teut, Michael; Bloedt, Susanne; Baur, Roland; Betsch, Frederik; Elies, Michael; Fruehwald, Maria; Fuesgen, Ingo; Kerckhoff, Annette; Krüger, Eckard; Schimpf, Dorothee; Schnabel, Katharina; Walach, Harald; Warme, Britta; Warning, Albercht; Wilkens, Johannes; Witt, Claudia M

2013-01-01

In Germany the number of inhabitants with dementia is expected to increase from 1.2 million at present to 2.3 million in 2050. Our aim was to investigate which treatments complementary and alternative medicine (CAM) experts consider to be of therapeutic use in developing treatment strategies and hypotheses for further clinical studies. In a participatory group workshop the 'World Café' method was used. As questions we asked: 1) 'Based on your clinical experience, which CAM therapies are effective in the treatment of patients with dementia? 2) Based on your clinical experience, which CAM therapies are effective in the treatment of lay and professional caregivers of patients with dementia?, and 3) How should a CAM treatment program look like?' Further Delphi rounds were used to reach consensus and summarize the results. The 2-day workshop took place in January 2012 in Berlin. A total of 17 experts participated. The most important subject in the treatment was the need to understand patients' biographies in order to individualize the therapy. Therapy itself consists of the therapeutic relationship, nonmedical therapies such as sports, massage, music and arts therapy as well as medical treatment such as herbal or homeopathic medicines. With regard to caregivers the most important aim is to prevent or reduce psychological distress, e.g., by mind-body programs. Instead of single treatments, more general elements such as understanding the patients' biographies, therapeutic relationships, individualizing, networking, and self-care emerged as main results. An integrative treatment program should connect outpatient and inpatient care as well as all experts. CAM training courses should be offered to doctors, nurses, and caregivers. Future clinical studies should focus on complex intervention programs integrating these key elements. © 2013 S. Karger GmbH, Freiburg.

Characterization of non-typable strains of Staphylococcus aureus from cases of hospital infection.

PubMed Central

Vindel, A.; Martín-Bourgon, C.; Saez-Nieto, J. A.

1987-01-01

A high percentage of non-typable (NT) Staphylococcus aureus strains was isolated in Spanish hospitals during 1984 and 1985. Several alternative methods of typing were employed to study these isolates. These were: phage-typing at 1000 X RTD, phage-typing after heat-treatment (48 degrees C), thermal shock (56 degrees C), reverse-typing and induction of additional phages. Using these methods the number of NT isolates was reduced by 60%. Best results were obtained with heat-treatment. Additional phages and reverse-typing were also useful. A scheme for the study of outbreaks and sporadic cases caused by NT strains is proposed using the methods described. PMID:3609172

High density Polyethylene plastic waste treatment with microwave heating pyrolysis method using coconut-shell activated carbon to produce alternative fuels

NASA Astrophysics Data System (ADS)

Juliastuti, S. R.; Hisbullah, M. I.; Abdillah, M.

2018-03-01

Pyrolysis is a technology that could crack polimer such as plastic waste into alternative fuels. This research uses microwave heating methode, which more efficient than conventional heating methode. The plastic waste used is 200 grams of HDPE, with feed to catalyst weight ratio are 1:1, 0.6:1, 0.4:1. Pyrolysis was run at temperatures of 250, 300, 350, & 400 °C for 15, 30 and 45 min. From the experimental result, the best variable of pyrolysis process with microwave method is at 45 minutes, at 400°C, and 1:1 feed to catalyst weight ratio. Result shows that yield of liquid and gas product is 99.22%; yield of residue is 0.78%; value of liquid product’s composition (cycloparaffin and n-paraffin) is 54.09% and concentration of methane gas is 10.2%.

Live feed enrichment with probiotics: current methods and future perspectives on increasing finfish larviculture success

USDA-ARS?s Scientific Manuscript database

Probiotics - active or inactive microorganisms incorporated to animal feeds - are considered a potential alternative to other treatments intended to enhance immune response, growth, or feed efficiency in animal rearing systems. While probiotics are extensively used in livestock practices, their use ...

Labeled ALPHA4BETA2 ligands and methods therefor

DOEpatents

Mukherjee, Jogeshwar; Pichika, Ramaiah; Potkin, Steven; Leslie, Frances; Chattopadhyay, Sankha

2013-02-19

Contemplated compositions and methods are employed to bind in vitro and in vivo to an .alpha.4.beta.2 nicotinic acetylcholine receptor in a highly selective manner. Where such compounds are labeled, compositions and methods employing such compounds can be used for PET and SPECT analysis. Alternatively, and/or additionally contemplated compounds can be used as antagonists, partial agonists or agonists in the treatment of diseases or conditions associated with .alpha.4.beta..beta.2 dysfunction.

Median nitrate concentrations in groundwater in the New Jersey Highlands Region estimated using regression models and land-surface characteristics

USGS Publications Warehouse

Baker, Ronald J.; Chepiga, Mary M.; Cauller, Stephen J.

2015-01-01

The Kaplan-Meier method of estimating summary statistics from left-censored data was applied in order to include nondetects (left-censored data) in median nitrate-concentration calculations. Median concentrations also were determined using three alternative methods of handling nondetects. Treatment of the 23 percent of samples that were nondetects had little effect on estimated median nitrate concentrations because method detection limits were mostly less than median values.

Allergy. Conventional and alternative concepts. A report of the Royal College of Physicians Committee on Clinical Immunology and Allergy.

PubMed

Kay, A B; Lessof, M H

1992-10-01

Allergy is an exaggerated response of the immune system to external substances. It plays a role in a wide range of diseases. In some, such as summer hayfever, the symptoms are due entirely to allergy. In other conditions, particularly asthma, eczema and urticaria, allergy plays a part in some patients but not all. In these situations, allergy may have either a major role or provide just one of many triggers. In an individual patient's illness, the importance of allergy may change with time. The most common allergens (substances causing allergy) are grass and tree pollens, the house dust mite, products from pets and other animals, agents encountered in industry, wasp and bee venom, drugs, and certain foods. Food allergy presents a particularly difficult problem. Some individuals who react to food suffer from food allergy in its strict sense but in others there is no evidence of an alteration in the immune system. Here the term 'food intolerance' is preferable. Conventional doctors treat allergy by allergen avoidance--where this is possible--and drugs that relieve symptoms. In a few selected cases, in which other methods have failed, immunotherapy (desensitisation or hyposensitisation) is recommended. Although patients who consult practitioners of alternative allergy may do so by preference, it is often also because they are dissatisfied with the conventional approach to diagnosis and treatment, or because they have conditions which conventional doctors do not accept as having an allergic basis. There is a very wide range of alternative approaches to allergy, including the methods used by clinical ecologists and other treatments such as acupuncture and homoeopathy. Hypnosis may have a small role to play in helping the asthmatic and similar effects have been suggested for acupuncture. Furthermore, it is likely that there are still many active ingredients in medicinal plants used by herbalists but these need to be clearly identified and purified before their usefulness can be evaluated properly. Apart from these situations, we have yet to be convinced by substantial evidence that any of the other alternative methods of diagnosing or treating allergic disease are of proven value. There have, however, been many false and misleading claims and serious harm may be caused by misdiagnosis or delays in appropriate treatment. The public should be warned against costly methods of diagnosis and treatment which have not been validated.(ABSTRACT TRUNCATED AT 400 WORDS)

Evaluation of Treatment Technologies for Wastewater from Insensitive Munitions Production. Phase 1: Technology Down-Selection

DTIC Science & Technology

2013-11-01

the AOP reactor according to the target process formulation. Gases were vented to a GAC vessel. ERDC/EL TR-13-20 94 10.2.2 Results and Discussion...destructive and filtration methods such as biological treatment (destructive), chemical reduction (destructive), reverse osmosis (RO)/nano- filtration ... filtration ), and advanced oxidation processes (destructive). A comprehensive evaluation of alternatives relies on a detailed list of criteria, allowing for

Method of treating intermetallic alloy hydrogenation/oxidation catalysts for improved impurity poisoning resistance, regeneration and increased activity

DOEpatents

Wright, R.B.

1992-01-14

Alternate, successive high temperature oxidation and reduction treatments, in either order, of intermetallic alloy hydrogenation and intermetallic alloy oxidation catalysts unexpectedly improves the impurity poisoning resistance, regeneration capacity and/or activity of the catalysts. The particular alloy, and the final high temperature treatment given alloy (oxidation or reduction) will be chosen to correspond to the function of the catalyst (oxidation or hydrogenation). 23 figs.

Progress in Controlling Breast Cancer. Hearing before the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Eighth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC.

This report contains testimony on the subject of breast cancer. Under consideration was a proposed bill that will assure women that physicians and surgeons inform breast cancer patients of alternative, effective, methods of treatment and will ensure that the woman will have to give her informed consent before any treatment is initiated. Also…

Perspectives on Home-based Healthcare as an Alternative to Hospital Admission After Emergency Treatment

PubMed Central

Stuck, Amy; Crowley, Christopher; Martinez, Tracy; Wittgrove, Alan; Brennan, Jesse J.; Chan, Theodore C.; Castillo, Edward M.

2017-01-01

Introduction The study objective was to explore emergency physicians’ (EP) awareness, willingness, and prior experience regarding transitioning patients to home-based healthcare following emergency department (ED) evaluation and treatment; and to explore patient selection criteria, processes, and services that would facilitate use of home-based healthcare as an alternative to hospitalization. Methods We provided a five-question survey to 52 EPs, gauging previous experience referring patients to home-based healthcare, patient selection, and motivators and challenges when considering home-based options as an alternative to admission. In addition, we conducted three focus groups and four interviews. Results Of participating EPs, 92% completed the survey, 38% reported ordering home-based healthcare from the ED as an alternative to admission, 90% ranked cellulitis among the top three medical conditions for home-based healthcare, 90% ranked “reduce unnecessary hospitalizations and observation stays” among their top three perceived motivators for using home-based care, and 77% ranked “no existing process in place to refer to home-based care” among their top three perceived barriers. Focus group and interview themes included the need for alternatives to admission; the longer-term benefits of home-based healthcare; the need for streamlined transition processes; and the need for highly qualified home-care staff capable of responding the same day or within 24 hours. Conclusion The study found that EPs are receptive to referring patients for home-based healthcare following ED treatment and believe people with certain diagnoses are likely to benefit, with the dominant barrier being the absence of an efficient referral process. PMID:28611899

Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013)

PubMed Central

Brahim, Lucia Regina; Valete-Rosalino, Cláudia Maria; Antônio, Liliane de Fátima; Pimentel, Maria Inês Fernandes; Lyra, Marcelo Rosandiski; Paes, Luiz Eduardo de Carvalho; da Costa, Ananda Dutra; Vieira, Iracema Forni; Dias, Cristina Maria Giordano; Duque, Maria Cristina de Oliveira; Marzochi, Mauro Celio de Almeida; Schubach, Armando de Oliveira

2017-01-01

BACKGROUND American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil. OBJECTIVES To evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013. METHODS Data were recovered from records of all ATL patients diagnosed during that period. FINDINGS Out of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up. MAIN CONCLUSIONS Alternative MA schedules resulted in low lethality without increase of relapse or late ML incidence. PMID:29211245

A closer look: Alternative pain management practices by heart failure patients with chronic pain.

PubMed

McDonald, Deborah Dillon; Soutar, Christina; Chan, Maria Agudelo; Afriyie, Angela

2015-01-01

To describe alternative non-pharmaceutical non-nutraceutical pain self-management strategies used by people with heart failure (HF) in order to reduce chronic non-cardiac pain. Little is known about alternative pain self-treatments used by HF patients with chronic pain. A cross-sectional descriptive design was used with 25 hospitalized HF patients who had chronic pain and used at least one alternative pain treatment. Pain intensity, pain interference with function, and current pain treatments were measured with the Brief Pain Inventory. Alternative treatments included walking, stretching, use of heat and cold. Five patients used evidence-based pain treatments for their chronic pain conditions. Patients reported moderate pain intensity and pain interference with activity. Patients with HF and chronic pain use few alternative pain treatments. Screening for chronic pain and referral to Integrative Medicine and/or Palliative care for a pain management consult might reduce the added burden of pain in people with HF. Copyright © 2015 Elsevier Inc. All rights reserved.

ENGINEERING STUDY FOR THE 200 AREA EFFLUENT TREATMENT FACILITY (ETF) SECONDARY WASTE TREATMENT OF PROJECTED FUTURE WASTE FEEDS

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

LUECK, K.J.

2004-10-18

This report documents an engineering study conducted to evaluate alternatives for treating secondary waste in the secondary treatment train (STT) of the Hanford Site 200 Area Effluent Treatment Facility (ETF). The study evaluates ETF STT treatment alternatives and recommends preferred alternatives for meeting the projected future missions of the ETF. The preferred alternative(s) will process projected future ETF influents to produce a solid waste acceptable for final disposal on the Hanford Site. The main text of this report summarizes the ETF past and projected operations, lists the assumptions about projected operations that provide the basis for the engineering evaluation, andmore » summarizes the evaluation process. The evaluation process includes identification of available modifications to the current ETF process, screens those modifications for technical viability, evaluates the technically viable alternatives, and provides conclusions and recommendations based on that evaluation.« less

Functional Medicine Approach to Traumatic Brain Injury.

PubMed

Richer, Alice C

2017-08-01

Background: The U.S. military has seen dramatic increases in traumatic brain injuries (TBIs) among military personnel due to the nature of modern-day conflicts. Conventional TBI treatment for secondary brain injuries has suboptimal success rates, and patients, families, and healthcare professionals are increasingly turning to alternative medicine treatments. Objective: Effective treatments for the secondary injury cascades that occur after an initial brain trauma are unclear at this time. The goal of successful treatment options for secondary TBI injuries is to reduce oxidative stress, excitotoxicity, and inflammation while supporting mitochondrial functions and repair of membranes, synapses, and axons. Intervention: A new paradigm of medical care, known as functional medicine, is increasing in popularity and acceptance. Functional medicine combines conventional treatment methods with complementary, genetic, holistic, and nutritional therapies. The approach is to assess the patient as a whole person, taking into account the interconnectedness of the body and its unique reaction to disease, injury, and illness while working to restore balance and optimal health. Functional medicine treatment recommendations often include the use of acupuncture, Ayurveda, chiropractic manipulation, detoxification programs, herbal and homeopathic supplements, specialized diets, massage, meditation and mindfulness practices, neurobiofeedback, nutritional supplements, t'ai chi , and yoga. At present, some of these alternative treatments appear to be beneficial, but more research is needed to validate reported outcomes. Conclusions: Few clinical studies validate the effectiveness of alternative therapies for TBIs. However, further clinical trials and empirical studies warrant further investigation based on some reported positive results from research studies, case histories, anecdotal evidence, and widespread popularity of some approaches. To date, only nutritional therapies and hyperbaric oxygen therapy have shown the most promise and potential for improved outcomes for the treatment of secondary TBI injuries.

Functional Medicine Approach to Traumatic Brain Injury

PubMed Central

2017-01-01

Abstract Background: The U.S. military has seen dramatic increases in traumatic brain injuries (TBIs) among military personnel due to the nature of modern-day conflicts. Conventional TBI treatment for secondary brain injuries has suboptimal success rates, and patients, families, and healthcare professionals are increasingly turning to alternative medicine treatments. Objective: Effective treatments for the secondary injury cascades that occur after an initial brain trauma are unclear at this time. The goal of successful treatment options for secondary TBI injuries is to reduce oxidative stress, excitotoxicity, and inflammation while supporting mitochondrial functions and repair of membranes, synapses, and axons. Intervention: A new paradigm of medical care, known as functional medicine, is increasing in popularity and acceptance. Functional medicine combines conventional treatment methods with complementary, genetic, holistic, and nutritional therapies. The approach is to assess the patient as a whole person, taking into account the interconnectedness of the body and its unique reaction to disease, injury, and illness while working to restore balance and optimal health. Functional medicine treatment recommendations often include the use of acupuncture, Ayurveda, chiropractic manipulation, detoxification programs, herbal and homeopathic supplements, specialized diets, massage, meditation and mindfulness practices, neurobiofeedback, nutritional supplements, t'ai chi, and yoga. At present, some of these alternative treatments appear to be beneficial, but more research is needed to validate reported outcomes. Conclusions: Few clinical studies validate the effectiveness of alternative therapies for TBIs. However, further clinical trials and empirical studies warrant further investigation based on some reported positive results from research studies, case histories, anecdotal evidence, and widespread popularity of some approaches. To date, only nutritional therapies and hyperbaric oxygen therapy have shown the most promise and potential for improved outcomes for the treatment of secondary TBI injuries. PMID:28874921

Alternative treatment technology information center computer database system

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

Sullivan, D.

1995-10-01

The Alternative Treatment Technology Information Center (ATTIC) computer database system was developed pursuant to the 1986 Superfund law amendments. It provides up-to-date information on innovative treatment technologies to clean up hazardous waste sites. ATTIC v2.0 provides access to several independent databases as well as a mechanism for retrieving full-text documents of key literature. It can be accessed with a personal computer and modem 24 hours a day, and there are no user fees. ATTIC provides {open_quotes}one-stop shopping{close_quotes} for information on alternative treatment options by accessing several databases: (1) treatment technology database; this contains abstracts from the literature on all typesmore » of treatment technologies, including biological, chemical, physical, and thermal methods. The best literature as viewed by experts is highlighted. (2) treatability study database; this provides performance information on technologies to remove contaminants from wastewaters and soils. It is derived from treatability studies. This database is available through ATTIC or separately as a disk that can be mailed to you. (3) underground storage tank database; this presents information on underground storage tank corrective actions, surface spills, emergency response, and remedial actions. (4) oil/chemical spill database; this provides abstracts on treatment and disposal of spilled oil and chemicals. In addition to these separate databases, ATTIC allows immediate access to other disk-based systems such as the Vendor Information System for Innovative Treatment Technologies (VISITT) and the Bioremediation in the Field Search System (BFSS). The user may download these programs to their own PC via a high-speed modem. Also via modem, users are able to download entire documents through the ATTIC system. Currently, about fifty publications are available, including Superfund Innovative Technology Evaluation (SITE) program documents.« less

Disinfection of sewage wastewater and sludge by electron treatment

NASA Astrophysics Data System (ADS)

Trump, J. G.; Merrill, E. W.; Wright, K. A.

The use of machine-accelerated electrons to disinfect sewage waterwaste and sludge is discussed. The method is shown to be practical and energy-efficient for the broad spectrum disinfection of pathogenic organisms in municipal wastewaters and sludge removed from them. Studies of biological, chemical and physical effects are reported. Electron treatment is suggested as an alternative to chlorination of municipal liquid wastes after electron treatment to provide disinfection. Disposal of sewage sludge is recommended as an agricultural resource by subsurface land injection, or as a nutrient for fish populations by widespread ocean dispersal.

Implementation Science for closing the treatment gap for mental disorders by translating evidence base into practice: experiences from the PRIME project.

PubMed

Shidhaye, Rahul

2015-12-01

This paper utilizes the experience of PRIME (Programme for Improving Mental health care) to exemplify how implementation science provides key insights and approaches to closing the treatment gap for mental disorders. The real-world application of strategies described in the implementation science literature, accompanied by use of alternative, rigorous evaluation methods to assess their impact on patient outcomes, can help in closing the mental health treatment gap in disadvantaged populations. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Use of miniplates as a method for orthodontic anchorage: a case report.

PubMed

Peres, Fernando Gianzanti; Padovan, Luis Eduardo Marques; Kluppel, Leandro Eduardo; Albuquerque, Gustavo Calvalcanti; Souza, Paulo Cesar Ulson de; Claudino, Marcela

2016-01-01

Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction. This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study. The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars.

Development of nanomaterial-enabled advanced oxidation techniques for treatment of organic micropollutants

NASA Astrophysics Data System (ADS)

Oulton, Rebekah Lynn

Increasing demand for limited fresh water resources necessitates that alternative water sources be developed. Nonpotable reuse of treated wastewater represents one such alternative. However, the ubiquitous presence of organic micropollutants such as pharmaceuticals and personal care products (PPCPs) in wastewater effluents limits use of this resource. Numerous investigations have examined PPCP fate during wastewater treatment, focusing on their removal during conventional and advanced treatment processes. Analysis of influent and effluent data from published studies reveals that at best 1-log10 concentration unit of PPCP removal can generally be achieved with conventional treatment. In contrast, plants employing advanced treatment methods, particularly ozonation and/or membranes, remove most PPCPs often to levels below analytical detection limits. However, membrane treatment is cost prohibitive for many facilities, and ozone treatment can be very selective. Ozone-recalcitrant compounds require the use of Advanced Oxidation Processes (AOPs), which utilize highly reactive hydroxyl radicals (*OH) to target resistant pollutants. Due to cost and energy use concerns associated with current AOPs, alternatives such as catalytic ozonation are under investigation. Catalytic ozonation uses substrates such as activated carbon to promote *OH formation during ozonation. Here, we show that multi-walled carbon nanotubes (MWCNTs) represent another viable substrate, promoting *OH formation during ozonation to levels exceeding activated carbon and equivalent to conventional ozone-based AOPs. Via a series of batch reactions, we observ a strong correlation between *OH formation and MWCNT surface oxygen concentrations. Results suggest that deprotonated carboxyl groups on the CNT surface are integral to their reactivity toward ozone and corresponding *OH formation. From a practical standpoint, we show that industrial grade MWCNTs exhibit similar *OH production as their research-grade counterparts. Accelerated aging studies indicate that MWCNTs maintain surface reactivity for an extended period during ozonation treatment. Further, *OH generation is essentially unaffected in complex water matrices containing known radical scavengers, and is effective for degradation of the ozone-recalcitrant herbicide atrazine. A proof-of-concept study verified that results from batch systems can be replicated in a flow-through reactor utilizing MWCNTs immobilized on a ceramic membrane support. Collective, results suggest that CNT-enhanced ozonation may provide a viable treatment alternative for emerging organic micropollutants.

Assessment of the Evolution of Cancer Treatment Therapies

PubMed Central

Arruebo, Manuel; Vilaboa, Nuria; Sáez-Gutierrez, Berta; Lambea, Julio; Tres, Alejandro; Valladares, Mónica; González-Fernández, África

2011-01-01

Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first choice in many cases. Nanotechnology has recently arrived on the scene, offering nanostructures as new therapeutic alternatives for controlled drug delivery, for combining imaging and treatment, applying hyperthermia, and providing directed target therapy, among others. These therapies can be applied either alone or in combination with other components (antibodies, peptides, folic acid, etc.). In addition, gene therapy is also offering promising new methods for treatment. Here, we present a review of the evolution of cancer treatments, starting with chemotherapy, surgery, radiation and immunotherapy, and moving on to the most promising cutting-edge therapies (gene therapy and nanomedicine). We offer an historical point of view that covers the arrival of these therapies to clinical practice and the market, and the promises and challenges they present. PMID:24212956

Negotiating complementary and alternative medicine use in primary care visits with older patients

PubMed Central

Koenig, Christopher J.; Ho, Evelyn Y.; Yadegar, Vivien; Tarn, Derjung M.

2013-01-01

Objective To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. Methods Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. Results Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician–patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. Conclusion Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. Practice implications Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use. PMID:22483672

Pollution Impact and Alternative Treatment for Produced Water

NASA Astrophysics Data System (ADS)

Hedar, Yusran; Budiyono

2018-02-01

Oil and gas exploration and production are two of the activities that potentially cause pollution and environmental damage. The largest waste generated from this activity is produced water. Produced water contains hazardous pollutants of both organic and inorganic materials, so that the produced water of oil and gas production cannot be discharged directly to the environment. Uncontrolled discharge can lead to the environmental damage, killing the life of water and plants. The produced water needs to be handled and fulfill the quality standards before being discharged to the environment. Several studies to reduce the contaminants in the produced water were conducted by researchers. Among them were gravity based separation - flotation, separation technique based on filtration, and biological process treatment. Therefore, some of these methods can be used as an alternative waste handling of produced water.

Renewal, Resurgence, and Alternative Reinforcement Context

PubMed Central

Sweeney, Mary M.; Shahan, Timothy A.

2015-01-01

Resurgence, relapse induced by the removal of alternative reinforcement, and renewal, relapse induced by a change in contextual stimuli, are typically studied separately in operant conditioning paradigms. In analogous treatments of operant problem behavior, aspects of both relapse phenomena can operate simultaneously. Therefore, the purpose of this study was to examine a novel method for studying resurgence and renewal in the same experimental preparation. An alternative source of reinforcement was available during extinction for one group of rats (a typical resurgence preparation). Another group experienced an operant renewal preparation in which the extinction context was distinguished via olfactory and visual stimuli. A third group experienced alternative reinforcement delivery in the new context, a novel combination of typical resurgence and renewal preparations. Removal of alternative reinforcement and/or a change in context induced relapse, relative to an extinction-only control group. When alternative reinforcement was delivered in a novel context, the alternative response was less persistent relative to when extinction of the alternative response took place in the context in which it was trained. This methodology might be used to illustrate shared (or distinct) mechanisms of resurgence and renewal, and to determine how delivering alternative reinforcement in another context may affect persistence and relapse. PMID:25936876

[Prolonged blockade of nervus ischiadicus in a system of complex treatment of patients, suffering complicated diabetic foot syndrome].

PubMed

Shapoval, S D; Savon, I L; Sofilkanych, M M

2015-03-01

General principles of treatment in patients, suffering diabetic foot syndrome, are adduced. There was proved, that reconvalescence of the patients depends not only on quality of complex treatment, but from optimal choice of anesthesia method, its impact on postoperative period course. Application of prolonged blockade of n. ischiadicus gives possibility to perform operative intervention on the lower extremity in full volume, guarantees sufficient motor and sensory block, permits patients to reject from application of narcotic analgetics, to reduce the dose of strong nonnarcotic analgetics, the terms of transition of the wound process phase I into phase II, promotes early activization of patients postoperatively, constitutes alternative for other methods of anesthesiological support.

Carbide and carbonitride surface treatment method for refractory metals

DOEpatents

Meyer, Glenn A.; Schildbach, Marcus A.

1996-01-01

A carbide and carbonitride surface treatment method for refractory metals is provided, in steps including, heating a part formed of boron, chromium, hafnium, molybdenum, niobium, tantalum, titanium, tungsten or zirconium, or alloys thereof, in an evacuated chamber and then introducing reaction gases including nitrogen and hydrogen, either in elemental or water vapor form, which react with a source of elemental carbon to form carbon-containing gaseous reactants which then react with the metal part to form the desired surface layer. Apparatus for practicing the method is also provided, in the form of a carbide and carbonitride surface treatment system (10) including a reaction chamber (14), a source of elemental carbon (17), a heating subassembly (20) and a source of reaction gases (23). Alternative methods of providing the elemental carbon (17) and the reaction gases (23) are provided, as well as methods of supporting the metal part (12), evacuating the chamber (14) with a vacuum subassembly (18) and heating all of the components to the desired temperature.

Toward Enhancing Treatment for Pregnant Smokers: Laying the Groundwork for the Use of Complementary and Alternative Medicine Approaches.

PubMed

Loree, Amy M; Ondersma, Steven J; Grekin, Emily R

2017-05-01

Although effective treatments exist, most women who smoke during pregnancy neither seek nor receive treatment. Complementary and alternative medicine (CAM) treatments (eg, mindfulness, yoga, and acupuncture) may be attractive, low-cost options that can be used to assist a large proportion of pregnant women with smoking cessation. This study examined participant characteristics and treatment utilization among pregnant smokers in the National Survey on Drug Use and Health (NSDUH) and the National Health Interview Survey (NHIS) in order to explore the prevalence and predictors of CAM use for any purpose within this population. Results indicated that a considerable proportion (6.9%-29.1%) of pregnant smokers are already accessing CAM, particularly Whites and those of greater socioeconomic status. Use of yoga, meditation, and massage increased across study waves. NSDUH participants were most likely to report seeking chiropractic or massage therapy; NHIS participants most frequently reported use of herbs/supplements, deep breathing, and meditation. Up to roughly a quarter of women endorsed traditional/conventional and CAM treatment use, suggesting that some pregnant smokers are open to trying a variety of approaches to promote health. Further research is needed to validate CAM treatments for smoking cessation and to guide safety and treatment recommendations during pregnancy. CAM treatments may be an attractive treatment alternative for pregnant smokers. However, no previous investigations have examined whether pregnant smokers seek out these treatments. Using nationally representative survey data, the present study aimed to explore whether pregnant smokers use CAM treatments. We found that approximately 7%-29% of pregnant smokers reported using a variety of CAM methods, suggesting the need for further investigation into the efficacy and dissemination of CAM for smoking in pregnancy. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

[Alternative medicine: faith or science?].

PubMed

Pletscher, A

1990-04-21

For the success of both alternative and scientific (conventional) medicine, factors such as the psychological influence of the doctor, loving care, human affection, the patient's belief in the treatment, the suggestive power of attractive (even unproven) theories, dogmas and chance events (e.g. spontaneous remissions) etc. play a major role. Some practices of alternative medicine have a particularly strong appeal to the non-rational side of the human being. Conventional medicine includes a component which is based on scientific and statistical methods. The possibility that in alternative medicine principles and effects exist which are not (yet) known to scientific medicine, but which match up to scientific criteria, cannot be excluded. However, up to now this has not been convincingly proven. The difficulties which arise in the elucidation of this problem are discussed in the light of examples from the literature and some experiments of our own.

Evaluating the storage environment in hypobaric chambers used for disinfesting fresh fruits

USDA-ARS?s Scientific Manuscript database

Low pressure (LP) treatment has potential as an alternative non-chemical postharvest disinfestation method for fresh fruits. A validated computer simulation model was used to determine the thickness of insulation foam needed to cover the hypobaric chamber walls in order to stabilize the air temperat...

Live feed enrichment with probiotics: current methods and future perspectives on increasing finfish larviculture success

USDA-ARS?s Scientific Manuscript database

Probiotics are considered an alternative to other treatments enhancing immune response, growth, or feed efficiency in animal rearing systems. While probiotics are extensively used in livestock practices, their use in aquaculture has not been as prevalent due to many factors, including a knowledge ga...

Private vs. Public Care for Juvenile Offenders: A Qualitative Examination.

ERIC Educational Resources Information Center

Kronick, Robert F.

1993-01-01

Examined effectiveness of methods used by public and private institutions' handling of incarcerated delinquents. Concluded that organizational culture is key concept in delivery of services to incarcerated children and youth; that private sector provides alternative to public in delivery of services; that alcohol and drug treatment programs are…

A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation.

PubMed

Safain, Mina; Roguski, Marie; Antoniou, Alexander; Schirmer, Clemens M; Schirmer, Clemens S; Malek, Adel M; Riesenburger, Ron

2013-03-01

Object The traditional methods for managing symptomatic chronic subdural hematoma (SDH) include evacuation via a bur hole or craniotomy, both with or without drain placement. Because chronic SDH frequently occurs in elderly patients with multiple comorbidities, the bedside approach afforded by the subdural evacuating port system (SEPS) is an attractive alternative method that is performed under local anesthesia and conscious sedation. The goal of this study was to evaluate the radiographic and clinical outcomes of SEPS as compared with traditional methods. Methods A prospectively maintained database of 23 chronic SDHs treated by bur hole or craniotomy and of 23 chronic SDHs treated by SEPS drainage at Tufts Medical Center was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcome was collected. The volume of SDH before and after treatment was semiautomatically measured using imaging software. Results There was no significant difference in initial SDH volume (94.5 cm(3) vs 112.6 cm(3), respectively; p = 0.25) or final SDH volume (31.9 cm(3) vs 28.2 cm(3), respectively; p = 0.65) between SEPS drainage and traditional methods. In addition, there was no difference in mortality (4.3% vs 9.1%, respectively; p = 0.61), length of stay (11 days vs 9.1 days, respectively; p = 0.48), or stability of subdural evacuation (94.1% vs 83.3%, respectively; p = 0.60) for the SEPS and traditional groups at an average follow-up of 12 and 15 weeks, respectively. Only 2 of 23 SDHs treated by SEPS required further treatment by bur hole or craniotomy due to inadequate evacuation of subdural blood. Conclusions The SEPS is a safe and effective alternative to traditional methods of evacuation of chronic SDHs and should be considered in patients presenting with a symptomatic chronic SDH.

Complementary medicine for alcohol dependence in Italian services: a mail questionnaire.

PubMed

Bardazzi, Gabriele; Merluzzi, Jo-Anne; Voller, Fabio; Fontana, Aldo; Abenavoli, Ludovico; Leggio, Lorenzo; Addolorato, Giovanni

2006-08-01

It is well known that Complementary Medicine (CM) is extensively used in western countries for the treatment of many afflictions. CM has been recently promoted in addiction treatment. To evaluate CM use in alcohol dependence we planned a mail questionnaire for Italian alcohol services. We sent out 612 questionnaires. Health services that were unable to respond to the questionnaire within a 20-day limit period were contacted by phone and if we obtained agreement to participate in the study the questionnaire was sent by fax. We obtained 312 (51.82%) completed questionnaires. Only 16.50% of Italian services use CM for alcohol dependence treatment and acupuncture is utilized more frequently than other methods (phytotherapy, homeopathy, etc.). In Italian alcohol services CM is identified as an instrument incorporated into traditional alcohol treatments (self-help groups, drug treatment, etc.) and not an alternative method. In fact, health services that use it as a principal method of treatment were a rare event in our study (1%). CM plays an integrated role with traditional forms of alcohol treatment in Italian alcohol services and this utilization could be useful to reduce drop-outs and improve alcohol treatment compliance.

Bovine mastitis: An appraisal of its alternative herbal cure.

PubMed

Mushtaq, Saleem; Shah, Aabid Manzoor; Shah, Aiyatullah; Lone, Sajad Ahmad; Hussain, Aehtesham; Hassan, Qazi Parvaiz; Ali, Md Niamat

2018-01-01

Bovine mastitis is globally recognized as the most common and costly disease affecting dairy herds. The disease causes huge financial losses to dairy industries by reduced yield and milk quality, deaths and culling of affected cows and also by associated treatment costs. The disease occurs due to invasion of the mammary glands by pathogenic bacteria followed by their multiplication in the milk producing tissues. The most common treatment method available against bovine mastitis is the intra-mammary infusion of antibiotics. However, their use is associated with the problem of antimicrobial resistance. This scenario has made search for alternative treatment approaches necessary. Medicinal plants with their well-established history are an excellent natural product resource used as an alternative therapy. Antibacterial agents from plants can act as important sources of novel antibiotics, efflux pump inhibitors, compounds that target bacterial virulence or can be used in combination with existing drugs. The plants form an essential component of ethno-veterinary medicine used in the treatment of different diseases like bovine mastitis. This review article attempts to provide an overview of the different medicinal plants used in the treatment of bovine mastitis. Antimicrobial studies of these plant species and some of their isolated constituents have been reviewed in detail. It highlights the logic and precedence behind mining this important natural product resource. Our own research findings in this direction and future scope of research are also discussed briefly. Copyright © 2017 Elsevier Ltd. All rights reserved.

Alternative synthesis of 3-acetyl, 3-epoxy, and 3-formyl chlorins from a 3-vinyl chlorin, methyl pyropheophorbide-a, via iodination.

PubMed

Oba, Toru; Masuya, Takuto; Yasuda, Satoru; Ito, Satoshi

2015-08-01

We developed novel methods to convert the C3-vinyl group of a chlorophyll derivative, methyl pyropheophorbide-a, into an acetyl group, an epoxy group, and a formyl group via iodination with I2 and phenyliodine(III) bis(trifluoroacetate). Reaction of the iodinated intermediate with ethylene glycol and subsequent treatment with base led to formation of the C3-acetyl chlorin. Reaction of the iodinated intermediate with ethylenediamine afforded the C3-oxiranyl chlorin. The C3-formyl chlorin was readily derived from the epoxide without hazardous reagents such as OsO4. These reactions were facile and useful alternatives to the previous methods. Copyright © 2015 Elsevier Ltd. All rights reserved.

Leprosy-associated Chronic Wound Management Using Biomaterials

PubMed Central

Sivasubramanian, Srinivasan; Mohana, Sambasivam; Maheswari, Paulraj; Victoria, Victor; Thangam, Ramar; Mahalingam, Jayashri; Chandrasekar-Janebjer, Gayathri; Savariar, Vincent; Madhan, Balaraman; Gunasekaran, Palani; Kitambi, Satish S

2018-01-01

Background: Deformities and neuropathic chronic ulcers are the common features associated with leprosy-cured individuals that impact their quality of life and impair rehabilitation efforts. The challenging aspects for treatment of chronic wounds are the factors that inhibit healing. We reasoned that limited success of various therapeutic interventions could be due to the fact that leprosy-cured individual's physiology gets acclimatized to having a chronic wound that any therapeutic intervention is counterbalanced to maintain status quo at the wound site. Therefore, an alternative strategy would be to use biomaterials that gradually alter the wound site allowing the individual's physiology to participate in the healing process. Aims: Developing the human amnion (Amn)-derived biomaterial scaffolds and evaluating its use to heal chronic wounds in leprosy-cured but deformed persons (LCDPs). Materials and Methods: Using an enzymatic protocol, we have developed a rapid method to generate biomaterial scaffolds from discarded human Amn. A clinical trial on 26 LCDPs was performed with the biomaterial, and its wound-healing potential was then compared with LCDPs undergoing standard treatment procedure. Results: Biomaterial-based treatment of chronic wounds on LCDP displayed a higher efficiency in healing when compared to standard treatment. Conclusions: This study exemplifies that biomaterial-based treatment of leprosy-wounds offers an excellent affordable alternative for wound management. This study underlines the importance of involving both local wound environment and systemic effects for healing. In addition, we highlight wound healing as a necessity for successful rehabilitation and reintegration of leprosy-cured person into the society. PMID:29910571

Inactivation of Geobacillus stearothermophilus spores by alkaline hydrolysis applied to medical waste treatment.

PubMed

Pinho, Sílvia C; Nunes, Olga C; Lobo-da-Cunha, Alexandre; Almeida, Manuel F

2015-09-15

Although alkaline hydrolysis treatment emerges as an alternative disinfection/sterilization method for medical waste, information on its effects on the inactivation of biological indicators is scarce. The effects of alkaline treatment on the resistance of Geobacillus stearothermophilus spores were investigated and the influence of temperature (80 °C, 100 °C and 110 °C) and NaOH concentration was evaluated. In addition, spore inactivation in the presence of animal tissues and discarded medical components, used as surrogate of medical waste, was also assessed. The effectiveness of the alkaline treatment was carried out by determination of survival curves and D-values. No significant differences were seen in D-values obtained at 80 °C and 100 °C for NaOH concentrations of 0.5 M and 0.75 M. The D-values obtained at 110 °C (2.3-0.5 min) were approximately 3 times lower than those at 100 °C (8.8-1.6 min). Independent of the presence of animal tissues and discarded medical components, 6 log10 reduction times varied between 66 and 5 min at 100 °C-0.1 M NaOH and 110 °C-1 M NaOH, respectively. The alkaline treatment may be used in future as a disinfection or sterilization alternative method for contaminated waste. Copyright © 2015 Elsevier Ltd. All rights reserved.

The improvement of autism spectrum disorders on children communication ability with PECS method Multimedia Augmented Reality-Based

NASA Astrophysics Data System (ADS)

Taryadi; Kurniawan, I.

2018-01-01

This research was done to examine the usage of PECS method (Picture Exchange Communication System) multimedia augmented reality based as a learning alternative in training the communication of autism childen. The aim of this research were developing an approach to improve the communication ability before and after an intervension with PECS multimedia augmented reality method. The subject of this research were 12 autism children in Inclusion school in Pekalongan region. The experiment method was used with the single subject research approach. The research resulted that the average ability level in communication before and after the treatment has shown 47% while during the treatment the average level is 65%. Whereas there is an improvement after intervension stage with the average of 76%..

A simple, fast, and inexpensive CTAB-PVP-silica based method for genomic DNA isolation from single, small insect larvae and pupae.

PubMed

Huanca-Mamani, W; Rivera-Cabello, D; Maita-Maita, J

2015-07-17

In this study, we report a modified CTAB-PVP method combined with silicon dioxide (silica) treatment for the extraction of high quality genomic DNA from a single larva or pupa. This method efficiently obtains DNA from small specimens, which is difficult and challenging because of the small amount of starting tissue. Maceration with liquid nitrogen, phenol treatment, and the ethanol precipitation step are eliminated using this methodology. The A260/A280 absorbance ratios of the isolated DNA were approximately 1.8, suggesting that the DNA is pure and can be used for further molecular analysis. The quality of the isolated DNA permits molecular applications and represents a fast, cheap, and effective alternative method for laboratories with low budgets.

Brain Biology Machine Initiative: Developing Innovative Novel Methods to Improve Neuro-Rehabilitation for Amputees and Treatment for Patients at Remote Sites with Acute Brain Injury

DTIC Science & Technology

2010-10-01

bode well for the future. The paper we submitted to the Journal of Neuroscience detailing the TVAG rabies tracer system was accepted with revisions...of brain electrical activity. Stas Kounitsky successfully completed the port of the new vector-additive implicit (VAI) method for the anisotropic ...Alternating Difference 14 Implicit (ADI) for isotropic head models, and the Vector Additive Implicit (VAI) for anisotropic head models. The ADI method

Traditional, complementary, and alternative medicine approaches to mental health care and psychological wellbeing in India and China.

PubMed

Thirthalli, Jagadisha; Zhou, Liang; Kumar, Kishore; Gao, Jie; Vaid, Henna; Liu, Huiming; Hankey, Alex; Wang, Guojun; Gangadhar, Bangalore N; Nie, Jing-Bao; Nichter, Mark

2016-07-01

India and China face the same challenge of having too few trained psychiatric personnel to manage effectively the substantial burden of mental illness within their population. At the same time, both countries have many practitioners of traditional, complementary, and alternative medicine who are a potential resource for delivery of mental health care. In our paper, part of The Lancet and Lancet Psychiatry's Series about the China-India Mental Health Alliance, we describe and compare types of traditional, complementary, and alternative medicine in India and China. Further, we provide a systematic overview of evidence assessing the effectiveness of these alternative approaches for mental illness and discuss challenges in research. We suggest how practitioners of traditional, complementary, and alternative medicine and mental health professionals might forge collaborative relationships to provide more accessible, affordable, and acceptable mental health care in India and China. A substantial proportion of individuals with mental illness use traditional, complementary, and alternative medicine, either exclusively or with biomedicine, for reasons ranging from faith and cultural congruence to accessibility, cost, and belief that these approaches are safe. Systematic reviews of the effectiveness of traditional, complementary, and alternative medicine find several approaches to be promising for treatment of mental illness, but most clinical trials included in these systematic reviews have methodological limitations. Contemporary methods to establish efficacy and safety-typically through randomised controlled trials-need to be complemented by other means. The community of practice built on collaborative relationships between practitioners of traditional, complementary, and alternative medicine and providers of mental health care holds promise in bridging the treatment gap in mental health care in India and China. Copyright © 2016 Elsevier Ltd. All rights reserved.

Destructive treatment of waste gas by catalytic afterburning and adsorption

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

Eppel, S.A.; Kochetkova, R.P.; Kolisnyk, G.P.

1983-07-01

Because of the considerable energy costs involved in the use of catalytic afterburning to clean up waste gases, an alternative method is suggested: adsorption with the use of low-cost adsorbents that are regenerated by destruction of the substances that has been taken up. Activated semicoke (ASK) is proposed as an adsorbent and tested. On the basis of the results, ASK is recommended for the treatment of waste gases to remove oxygen-containing, sulfurcontaining, and tarry compounds.

Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts. An economic decision model.

PubMed

Thomas, K S; Keogh-Brown, M R; Chalmers, J R; Fordham, R J; Holland, R C; Armstrong, S J; Bachmann, M O; Howe, A H; Rodgers, S; Avery, A J; Harvey, I; Williams, H C

2006-08-01

To estimate the costs of commonly used treatments for cutaneous warts, as well as their health benefits and risk. To create an economic decision model to evaluate the cost-effectiveness of these treatments, and, as a result, assess whether a randomised controlled trial (RCT) would be feasible and cost-effective. Focus groups, structured interviews and observation of practice. Postal survey sent to 723 patients. A recently updated Cochrane systematic review and published cost and prescribing data. Primary and secondary data collection methods were used to inform the development of an economic decision model. Data from the postal survey provided estimates of the effectiveness of wart treatments in a primary care setting. These estimates were compared with outcomes reported in the Cochrane review of wart treatment, which were largely obtained from RCTs conducted in secondary care. A decision model was developed including a variety of over-the-counter (OTC) and GP-prescribed treatments. The model simulated 10,000 patients and adopted a societal perspective. OTC treatments were used by a substantial number of patients (57%) before attending the GP surgery. By far the most commonly used OTC preparation was salicylic acid (SA). The results of the economic model suggested that of the treatments prescribed by a GP, the most cost-effective treatment was SA, with an incremental cost-effectiveness ratio (ICER) of 2.20 pound/% cured. The ICERs for cryotherapy varied widely (from 1.95 to 7.06 pound/% cured) depending on the frequency of applications and the mode of delivery. The most cost-effective mode of delivery was through nurse-led cryotherapy clinics (ICER = 1.95 pound/% cured) and this could be a cost-effective alternative to GP-prescribed SA. Overall, the OTC therapies were the most cost-effective treatment options. ICERs ranged from 0.22 pound/% cured for OTC duct tape and 0.76 pound/% cured for OTC cryotherapy to 1.12 pound/% cured for OTC SA. However, evidence in support of OTC duct tape and OTC cryotherapy is very limited. Side-effects were commonly reported for both SA and cryotherapy, particularly a burning sensation, pain and blistering. Cryotherapy delivered by a doctor is an expensive option for the treatment of warts in primary care. Alternative options such as GP-prescribed SA and nurse-led cryotherapy clinics provide more cost-effective alternatives, but are still expensive compared with self-treatment. Given the minor nature of most cutaneous warts, coupled with the fact that the majority spontaneously resolve in time, it may be concluded that a shift towards self-treatment is warranted. Although both duct tape and OTC cryotherapy appear promising new self-treatment options from both a cost and an effectiveness perspective, more research is required to confirm the efficacy of these two methods of wart treatment. If these treatments are shown to be as cost-effective as or more cost-effective than conventional treatments, then a shift in service delivery away from primary care towards more OTC treatment is likely. A public awareness campaign would be useful to educate patients about the self-limiting nature of warts and the possible alternative OTC treatment options available. Two future RCTs are recommended for consideration: a trial of SA compared with nurse-led cryotherapy in primary care, and a trial of home treatments. Greater understanding of the efficacy of these home treatments will give doctors a wider choice of treatment options, and may help to reduce the overall demand for cryotherapy in primary care.

Alternative Menopause Treatments

MedlinePlus

... symptoms—non-estrogen prescription drugs, and complementary and alternative medicine (CAM). What is CAM? CAM refers to practices ... my menopause symptoms without medicine? Are there any alternative medicine treatments you would recommend I try for relief ...

Use of Ozone to Treat Ileostomy Dermatitis in an Experimental Rat Model

PubMed Central

Biçer, Şenol; Sayar, İlyas; Gürsul, Cebrail; Işık, Arda; Aydın, Merve; Peker, Kemal; Demiryilmaz, İsmail

2016-01-01

Background Dermatitis associated with ileostomy is an important problem that affects many people, especially children. The aim of this study was to investigate the therapeutic effects of ozone on dermatitis due to ileostomy, and to develop an alternative treatment option. Material/Methods A total of 28 rats were divided into 4 groups: control, ileostomy, ozone, and zinc oxide. Ileostomy was performed in all rats except the control group. After a 1-week waiting time, the ozone group was administered ozone therapy and the zinc oxide group was administered zinc oxide cream locally once a day for a total of 7 days. All rats were sacrificed at the end of this period. The efficacy of treatment was examined by biochemical, histopathological, and immunohistochemical parameters. The levels of malondialdehyde (MDA), total glutathione (tGSH), total antioxidant capacity (TAC), and total oxidant status (TOS) were measured from tissue. Vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) were examined immunohistochemically. Results Dermatitis occurred pathologically in all rats that underwent ileostomy surgery. The lowest dermatitis score was in the ozone treatment group (p<0.05). Ileostomy dermatitis caused increased levels of MDA and TOS. Ozone treatment resulted in reduced MDA and TOS levels, while the levels of tGSH and TAC were increased (p<0.05). Both VEGF and PCNA immunostaining were augmented in the ozone treatment group (p<0.05). Conclusions Local ozone application may be a good alternative compared to the conventional treatment methods for the prevention of skin lesions that develop after ileostomy. PMID:26947591

Factors associated to adherence to different treatment schemes with meglumine antimoniate in a clinical trial for cutaneous leishmaniasis.

PubMed

Ribeiro, Madelon Novato; Pimentel, Maria Inês Fernandes; Schubach, Armando de Oliveira; Oliveira, Raquel de Vasconcellos Carvalhães de; Teixeira, José Liporage; Leite, Madson Pedro da Silva; Fonseca, Monique; Santos, Ginelza Peres Lima dos; Salgueiro, Mariza Matos; Ferreira e Vasconcellos, Erica de Camargo; Lyra, Marcelo Rosandiski; Saheki, Mauricio Naoto; Valete-Rosalino, Claudia Maria

2014-01-01

The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL), in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule); we observed 82.1% (vial return), 86.0% (monitoring card), 66.7% (Morisky test) and 86.0% (modified Morisky test) adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods.

Decision-making process of patients with gynecological cancer regarding their cancer treatment choices using the analytic hierarchy process.

PubMed

Kitamura, Yuko

2010-12-01

In order to support patients' decision-making regarding cancer treatments, it is important to clarify which criteria that cancer patients use to set priorities in their treatment choices. Using the analytic hierarchy process (AHP), a mathematical decision-making method, this article investigates the criteria and the priorities of patients with gynecological cancer. In the AHP, multiple and hierarchical criteria in the decision-making process were organized by a repeated pairwise judgment of the participants so as to serialize the alternatives along with the rational order of the priorities. For the alternatives "to receive treatment" and "to not receive treatment," the following five criteria were set: "anxiety about relapse and metastasis", "distress about side-effects", "advice of family", "advice of medical staff", and "economic burden". The participants determined a pairwise priority scale, as well as a priority scale between the alternatives for every criterion. The logical consistency of their answers was checked by a consistency index (CI). The participants were 31 patients with ovarian or endometrial cancer who were being followed up after undergoing surgery and adjuvant chemotherapy. Of the participants who answered the questionnaire, 17 satisfied the logical consistency. Of the five criteria for the treatment choices, "anxiety about relapse and metastasis" and "advice of medical staff" were found to be the important factors for treatment choice; however, the weight attached to the priority criteria differed much among the patients. The AHP made it possible to support patients' decision-making in order to clarify their priority criteria and to quantitatively present their decision-making process. © 2010 The Author. Journal compilation © 2010 Japan Academy of Nursing Science.

Mandibular Advancement Splint as Short-Term Alternative Treatment in Patients with Obstructive Sleep Apnea Already Effectively Treated with Continuous Positive Airway Pressure

PubMed Central

Almeida, Fernanda R.; Mulgrew, Alan; Ayas, Najib; Tsuda, Hiroko; Lowe, Alan A.; Fox, Nurit; Harrison, Sandra; Fleetham, John A.

2013-01-01

Study Objectives: CPAP is used as the first-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP. Methods: Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months. Results: Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m2 completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased significantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no significant differences in SAQLI between MAS and CPAP treatment, while ESS decreased significantly on MAS. MAS self-reported usage was correlated with treatment efficacy (r = 0.52; p < 0.05). Seventy-five percent of the patients reported being sufficiently satisfied with MAS to continue to use it as an alternative short-term therapy. Conclusions: MAS partially or completely reduced sleep disordered breathing in the majority of selected, successfully CPAP-treated severe OSA patients. Many patients can probably effectively use MAS as a short-term treatment alternative to CPAP. Clinical Trial Registration: ClinicalTrials.gov registration number NCT00358605. Commentary: A commentary on this article appears in this issue on page 325. Citation: Almeida FR; Mulgrew A; Ayas N; Tsuda H; Lowe AA; Fox N; Harrison S; Fleetham JA. Mandibular advancement splint as short-term alternative treatment in patients with obstructive sleep apnea already effectively treated with continuous positive airway pressure. J Clin Sleep Med 2013;9(4):319-324. PMID:23585745

Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques.

PubMed

Costrini, A

1990-02-01

This manuscript compares the whole body cooling techniques in the emergency treatment of heatstroke. Historically, the use of cold water immersion with skin massage has been quite successful in rapidly lowering body temperature and in avoiding severe complications or death. Recent studies have suggested alternative therapies, including the use of a warm air spray, the use of helicopter downdraft, and pharmacological agents. While evidence exists to support these methods, they have not been shown to reduce fatalities as effectively as ice water immersion. Although several cooling methods may have clinical use, all techniques rely on the prompt recognition of symptoms and immediate action in the field.

The challenge to unify treatment of high-temperature fatigue - A partisan proposal based on strainrange partitioning

NASA Technical Reports Server (NTRS)

Manson, S. S.

1972-01-01

The strainrange partitioning concept divides the imposed strain into four basic ranges involving time-dependent and time-independent components. It is shown that some of the results presented at the symposium can be better correlated on the basis of this concept than by alternative methods. It is also suggested that methods of data generation and analysis can be helpfully guided by this approach. Potential applicability of the concept to the treatment of frequency and hold-time effects, environmental influence, crack initiation and growth, thermal fatigue, and code specifications are briefly considered. A required experimental program is outlined.

A 20 year review of punishment and alternative methods to treat problem behaviors in developmentally delayed persons.

PubMed

Matson, J L; Taras, M E

1989-01-01

Relevant journals were reviewed (n = 23) for a 20 year period (1967 to 1987) to assess the status of treatments for severe behavior problems of developmentally delayed persons. A hand search of journals was made; 382 studies were identified. Procedures were analyzed by problem behaviors treated, side effects reported, whether the procedure involved painful stimuli, nonpainful stimuli, food satiation, positive procedures, extinction or combinations of methods. The number of studies reported yearly was also plotted. The implication of these data for federal and state policy makers and for treatment programs dealing with difficult to treat clients is discussed.

Complementary and Alternative Medicine for Patients

MedlinePlus

... Ask about Your Treatment Research Complementary and Alternative Medicine for Patients Complementary and alternative medicine (CAM) is ... based on scientific evidence from research studies. Complementary medicine refers to treatments that are used with standard ...

A Movable Combined Water Treatment Facility for Rainwater Harvesting

NASA Astrophysics Data System (ADS)

Zhang, L.; Liao, L.

2003-12-01

Alarming water shortage and increased water scarcity world wide has led to increased interests in alternative water sources. Rainwater harvesting is one of them which is getting more and more attention. There is a huge potential for generalization and extension of rainwater harvesting system as an alternative water supply. This is especially important for arid and semi-arid regions where the water shortage blocks further social, economical development. Earlier laboratory experiments and field study showed that harvested rainwater requires treatments of different degrees in order to meet the WHO drinking water standards. The main focus of this study is to ascertain the quality of stored rainwater for drinking purposes with emphasis on water disinfection and pollutants removal. A movable, low-cost, fully functional small scale treatment facility is proposed and tested under simulated field condition. A number of actual and potential hazardous pollutants were identified in the collected water samples together with laboratory test. The corresponding water purification procedure and fresh-keeping methods are discussed. The final proposal of this movable facility needs to be further examined to achieve optimal combined treatment efficiency.

Inactivation of Cytomegalovirus in Breast Milk Using Ultraviolet-C Irradiation: Opportunities for a New Treatment Option in Breast Milk Banking

PubMed Central

Hod, Nurul; Jayaraman, Jothsna; Marchant, Elizabeth A.; Christen, Lukas; Chiang, Peter; Hartmann, Peter; Simmer, Karen

2016-01-01

Pasteurized donor human milk is provided by milk banks to very preterm babies where their maternal supply is insufficient or unavailable. Donor milk is currently processed by Holder pasteurization, producing a microbiologically safe product but significantly reducing immunoprotective components. Ultraviolet-C (UV-C) irradiation at 254 nm is being investigated as an alternative treatment method and has been shown to preserve components such as lactoferrin, lysozyme and secretory IgA considerably better than Holder pasteurization. We describe the inactivation of cytomegalovirus, a virus commonly excreted into breast milk, using UV-C irradiation. Full replication was ablated by various treatment doses. However, evidence of viral immediate early proteins within the cells was never completely eliminated indicating that some viral gene transcription was still occurring. In conclusion, UV-C may be a safe alternative to pasteurisation for the treatment of human donor milk that preserves the bioactivity. However, our data suggests that CMV inactivation will have to be carefully evaluated for each device designed to treat breast milk using UV-C irradiation. PMID:27537346

Inactivation of Cytomegalovirus in Breast Milk Using Ultraviolet-C Irradiation: Opportunities for a New Treatment Option in Breast Milk Banking.

PubMed

Lloyd, Megan L; Hod, Nurul; Jayaraman, Jothsna; Marchant, Elizabeth A; Christen, Lukas; Chiang, Peter; Hartmann, Peter; Shellam, Geoffrey R; Simmer, Karen

2016-01-01

Pasteurized donor human milk is provided by milk banks to very preterm babies where their maternal supply is insufficient or unavailable. Donor milk is currently processed by Holder pasteurization, producing a microbiologically safe product but significantly reducing immunoprotective components. Ultraviolet-C (UV-C) irradiation at 254 nm is being investigated as an alternative treatment method and has been shown to preserve components such as lactoferrin, lysozyme and secretory IgA considerably better than Holder pasteurization. We describe the inactivation of cytomegalovirus, a virus commonly excreted into breast milk, using UV-C irradiation. Full replication was ablated by various treatment doses. However, evidence of viral immediate early proteins within the cells was never completely eliminated indicating that some viral gene transcription was still occurring. In conclusion, UV-C may be a safe alternative to pasteurisation for the treatment of human donor milk that preserves the bioactivity. However, our data suggests that CMV inactivation will have to be carefully evaluated for each device designed to treat breast milk using UV-C irradiation.

Laparoscopic surgical treatment of umbilical hernia and small eventrations with prosthetic mesh using omentum overlay.

PubMed

Bratu, D; Sabău, A; Dumitra, A; Sabău, D; Miheţiu, A; Beli, L; Hulpuş, R

2014-01-01

Umbilical hernias and abdominal incisional hernias represent current pathologies which require numerous surgical alternative ways of treatment in prosthetic or non prosthetic,open or minimally invasive surgery. The method proposed by us is a less expensive option with no additional risks compared to other similar procedures as surgical technique. We conducted a retrospective study between 01.01.2008 - 01.06.2013 in which we considered a number of 23 patients with umbilical hernia and eventration, patients who received laparoscopic intraperitoneal polyester mesh covered with omentum, procedure applied at the IInd Surgery Clinic, Clinical County Emergency Hospital Sibiu. Out of 23 patients with postoperative umbilical hernia and eventration cases in which we used this surgical technique,16 were umbilical hernias and 7 post incisional hernias. The average time of surgery was 1 hour and 40 minutes, recording 4 postoperative complications remitted under conservative treatment, with a mean hospitalization of 4.1 days. Proepiploic laparoscopic treatment using omentum is a reliable alternative to a more expensive and difficult procedure involving Dual Mesh. Celsius.

Examining treatment adherence among parents of children with autism spectrum disorder.

PubMed

Hock, Robert; Kinsman, Anne; Ortaglia, Andrew

2015-07-01

Children with Autism Spectrum Disorder (ASD) participate in a variety of treatments, including medication, behavioral, alternative and developmental treatments. Parent adherence to these treatments is crucial for positive child outcomes. The current study: 1) Explored patterns of parent adherence across the full range of treatments that are prescribed to children with ASD and, 2) Examined whether parent demographics, parent treatment attitudes, and child ASD severity contribute to parents' adherence across ASD treatments. Questionnaires were distributed to parents of children with ASD in a southeastern state. Parents (N = 274) were included if they were parenting a child with ASD who was receiving treatment for ASD symptoms. Paired t-tests and multiple linear regression were used to assess the study aims. Adherence to medication treatment was significantly greater than adherence to behavioral, developmental, or alternative treatments (adjusted p-values 0.0006, 0.0030, 0.0006 respectively). Perceived family burden of a treatment was associated with lower adherence to medication, developmental, and alternative treatments. Finally, greater ASD severity was associated with lower adherence to alternative treatments. Overall, the independent variables accounted for more variance in adherence to medication and alternative treatments than in behavioral and developmental treatments. Parents' adherence to ASD treatment differs significantly by treatment type and is influenced by parental perceptions of the burden of treatment on the family. These findings highlight the importance of understanding and addressing the impact of ASD treatment regimens on family life. Copyright © 2015 Elsevier Inc. All rights reserved.

Knowledge, Attitude and Practice of General Practitioners toward Complementary and Alternative Medicine: a Cross-Sectional Study.

PubMed

Barikani, Ameneh; Beheshti, Akram; Javadi, Maryam; Yasi, Marzieh

2015-08-01

Orientation of public and physicians to the complementary and alternative medicine (CAM) is one of the most prominent symbols of structural changes in the health service system. The aim of his study was a determination of knowledge, attitude, and practice of general practitioners in complementary and alternative medicine. This cross- sectional study was conducted in Qazvin, Iran in 2013. A self-administered questionnaire was used for collecting data including four information parts: population information, physicians' attitude and knowledge, methods of getting information and their function. A total of 228 physicians in Qazvin comprised the population of study according to the deputy of treatment's report of Qazvin University of Medical Sciences. A total of 150 physicians were selected randomly, and SPSS Statistical program was used to enter questionnaires' data. Results were analyzed as descriptive statistics and statistical analysis. Sixty percent of all responders were male. About sixty (59.4) percent of participating practitioners had worked less than 10 years.96.4 percent had a positive attitude towards complementary and alternative medicine. Knowledge of practitioners about traditional medicine in 11 percent was good, 36.3% and 52.7% had average and little information, respectively. 17.9% of practitioners offered their patients complementary and alternative medicine for treatment. Although there was little knowledge among practitioners about traditional medicine and complementary approaches, a significant percentage of them had attitude higher than the lower limit.

Is Exercise a Viable Treatment for Depression?

PubMed Central

Blumenthal, James A.; Smith, Patrick J.; Hoffman, Benson M.

2013-01-01

Depression is a common disorder that is associated with compromised quality of life, increased health care costs, and greater risk for a variety of medical conditions, particularly coronary heart disease. This review examines methods for assessing depression and discusses current treatment approaches. Traditional treatments include psychotherapy and antidepressant medications, but such treatments are not effective for all patients and alternative approaches have recently received increased attention, especially the use of aerobic exercise. This review examines evidence that exercise is effective in improving depressive symptoms among patients with major depression and offers practical suggestions for helping patients initiate and maintain exercise in their daily lives. PMID:23750100

Determination of VA health care costs.

PubMed

Barnett, Paul G

2003-09-01

In the absence of billing data, alternative methods are used to estimate the cost of hospital stays, outpatient visits, and treatment innovations in the U.S. Department of Veterans Affairs (VA). The choice of method represents a trade-off between accuracy and research cost. The direct measurement method gathers information on staff activities, supplies, equipment, space, and workload. Since it is expensive, direct measurement should be reserved for finding short-run costs, evaluating provider efficiency, or determining the cost of treatments that are innovative or unique to VA. The pseudo-bill method combines utilization data with a non-VA reimbursement schedule. The cost regression method estimates the cost of VA hospital stays by applying the relationship between cost and characteristics of non-VA hospitalizations. The Health Economics Resource Center uses pseudo-bill and cost regression methods to create an encounter-level database of VA costs. Researchers are also beginning to use the VA activity-based cost allocation system.

Water treatment: Chitosan associated with electrochemical methods

NASA Astrophysics Data System (ADS)

Tamiasso-Martinhon, Priscila; Marques Teixeira de Souza, João; Cruzeiro da Silva, Silvia Maria; Pellegrini Pessoa, Fernando Luiz; Sousa, Célia

2017-04-01

Pollution of water bodies due to the presence of toxic metals and organic compounds, bring out a series of environmental problems of public, government and social character. In addition, water pollution, has become the target and source of concern in many industrial sectors. Therefore, it is essential to develop technologies for treatment and purification of water. Chitosan is a natural product derived from chitin, extracted mainly from the shells of crustaceans. It is a low cost, renewable and biodegradable biopolymer of great socioeconomic and environmental importance. The classic treatment of wastewater containing metals involves physical chemistry processes of precipitation, ion exchange and electrochemistry. Electrochemical technology has been presented as the most promising methods for treating wastewater polluted with metals, colloids, dyes or oil in water emulsions; besides being used in removing organic compounds. Alternative methods like adsorption with biosorbents have been investigated. The great advantage of this latter over other techniques is the low generation of residues, easy recovery of metals and the possibility of reuse of the adsorbent. This article aimed to carry out an exploratory study, of bibliographical nature, on the use of chitosan in electrochemical methods for water treatment.

Alternative practices of achieving anaesthesia for dental procedures: a review.

PubMed

Angelo, Zavattini; Polyvios, Charalambous

2018-04-01

Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations.

Alternative practices of achieving anaesthesia for dental procedures: a review

PubMed Central

2018-01-01

Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations. PMID:29744382

The Effect of Complementary and Alternative Medicine on Subfertile Women with In Vitro Fertilization

PubMed Central

Zhang, Yuehui; Fu, Yiman; Han, Fengjuan; Kuang, Hongying; Hu, Min; Wu, Xiaoke

2014-01-01

About 10–15% of couples have difficulty conceiving at some point in their reproductive lives and thus have to seek specialist fertility care. One of the most commonly used treatment options is in vitro fertilization (IVF) and its related expansions. Despite many recent technological advances, the average IVF live birth rate per single initiated cycle is still only 30%. Consequently, there is a need to find new therapies to promote the efficiency of the procedure. Many patients have turned to complementary and alternative medical (CAM) treatments as an adjuvant therapy to improve their chances of success when they undergo IVF treatment. At present, several CAM methods have been used in infertile couples with IVF, which has achieved obvious effects. However, biologically plausible mechanisms of the action of CAM for IVF have not been systematically reviewed. This review briefly summarizes the current progress of the impact of CAM on the outcomes of IVF and introduces the mechanisms. PMID:24527047

CFIRP: What we learned in the first ten years

USGS Publications Warehouse

Chambers, C.L.; McComb, W.C.; Tappeiner, J. C.; Kellogg, L.D.; Johnson, R.L.; Spycher, G.

1999-01-01

In response to public dissatisfaction with forest management methods, we initiated the College of Forestry Integrated Research Project (CFIRP) to test alternative silvicultural systems in Douglas-fir (Pseudotsuga menziesii stands in western Oregon. We compared costs and biological and human responses among a control and three replicated silvicultural alternatives to clearcutting that retained structural features found in old Douglas-fir forests. Treatments were applied within 8- to 15-ha stands and attempted to mimic crown fires (modified clearcut), windthrow (green tree retention), and small-scale impacts such as root rot diseases (small patch group selection). We also compared costs in three unreplicated treatments (large patch group selection, wedge cut, and strip cut). Each treatment included differences in the pattern of retained dead trees (snags), as either scattered individuals or as clumps. Good communication among researchers and managers, a long-term commitment to the project, and careful documentation of research sites and data are important to the success of long-term silvicultural research projects. To date, over 30 publications have resulted from the project.

The effectiveness and safety of Iranian herbal medicines for treatment of premenstrual syndrome: A systematic review

PubMed Central

Maleki-Saghooni, Nahid; Karimi, Fatemeh Zahra; Behboodi Moghadam, Zahra; Mirzaii Najmabadi, Khadigeh

2018-01-01

Objective: Premenstrual syndrome (PMS) is one of the most common problems among women of reproductive age. The popularity of complementary/alternative therapies has grown in recent years, and these treatments have been more commonly used by women (48.9%) than men (37.8%). The aim of this systematic review was to assess effectiveness and safety of Iranian herbal medicines for treatment of premenstrual syndrome. Methods: PubMed, Scopus, Cochrane, and Google Scholar were searched along with SID, Magiran and Irandoc up to Dec 2017. Inclusion criteria consist of Iranian, published, randomized controlled trials (RCTs) using Iranian herbal medicine for treatment of reproductive age women with PMS. Eventually Eighteen RCTs met the inclusion criteria. Results: Overall, studies have shown that Vitex agnuscastus, Hypericum perforatum, Matricaria chamomilla, saffron, Curcumin, Melissa officinalis, Zataria multiflora, Wheat Germ Extract, Echinophora platyloba, Foeniculum vulgare, Valerian root extract, Citrus sinensis, Zingiber officinale and Flax seed might alleviate symptoms of PMS. Conclusion: This research demonstrated efficacy and safety of Iranian herbal medicines in alleviating PMS. Therefore, herbal medicine can be regarded as an alternative treatment for women suffering from PMS. PMID:29632841

Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective.

PubMed

Gomez-de-León, Andrés; Gómez-Almaguer, David; Ruiz-Delgado, Guillermo J; Ruiz-Arguelles, Guillermo J

2017-09-01

The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.

An Assessment of Propensity Score Matching as a Nonexperimental Impact Estimator: Evidence from Mexico's PROGRESA Program

ERIC Educational Resources Information Center

Diaz, Juan Jose; Handa, Sudhanshu

2006-01-01

Not all policy questions can be addressed by social experiments. Nonexperimental evaluation methods provide an alternative to experimental designs but their results depend on untestable assumptions. This paper presents evidence on the reliability of propensity score matching (PSM), which estimates treatment effects under the assumption of…

Twin Studies and Their Implications for Molecular Genetic Studies: Endophenotypes Integrate Quantitative and Molecular Genetics in ADHD Research

ERIC Educational Resources Information Center

Wood, Alexis C.; Neale, Michael C.

2010-01-01

Objective: To describe the utility of twin studies for attention-deficit/hyperactivity disorder (ADHD) research and demonstrate their potential for the identification of alternative phenotypes suitable for genomewide association, developmental risk assessment, treatment response, and intervention targets. Method: Brief descriptions of the classic…

Initial small mammal responses to alternative pine regeneration methods in Arkansas and Oklahoma: preliminary findings

Treesearch

Ronald E. Thill; Roger W. Perry; Nancy E. Koerth; Philip A. Tappe; David G. Peitz

2004-01-01

Abstract - We studied winter small mammal communities in the Ouachita Mountains of west-central Arkansas and eastern Oklahoma using Sherman live traps in four replications of four regeneration treatments (clearcut/plant, shelterwood, single-tree selection, and group selection), plus four mature, untreated "controls." Data on relative small...

Read-Aloud Accommodations, Expository Text, and Adolescents with Learning Disabilities

ERIC Educational Resources Information Center

Meyer, Nancy K.; Bouck, Emily C.

2017-01-01

Adolescents with learning disabilities in reading have difficulties with reading and understanding difficult gradelevel curricular material. One frequently used method of support is using read-aloud accommodations, which can be live read-alouds or text-to-speech (TTS) read-alouds. A single case alternating treatment design was used to examine the…

Development and evaluation of the photoload sampling technique

Treesearch

Robert E. Keane; Laura J. Dickinson

2007-01-01

Wildland fire managers need better estimates of fuel loading so they can accurately predict potential fire behavior and effects of alternative fuel and ecosystem restoration treatments. This report presents the development and evaluation of a new fuel sampling method, called the photoload sampling technique, to quickly and accurately estimate loadings for six common...

Influence of Colour on Acquisition and Generalisation of Graphic Symbols

ERIC Educational Resources Information Center

Hetzroni, O. E.; Ne'eman, A.

2013-01-01

Background: Children with autism may benefit from using graphic symbols for their communication, language and literacy development. The purpose of this study was to investigate the influence of colour versus grey-scale displays on the identification of graphic symbols using a computer-based intervention. Method: An alternating treatment design was…

Investigating public perceptions and knowledge translation priorities to improve water safety for residents with private water supplies: a cross-sectional study in Newfoundland and Labrador

PubMed Central

2013-01-01

Background The first objective of this study was to investigate the public perceptions of private water and alternative sources with respect to safety, quality, testing and treatment in Newfoundland and Labrador (NL), Canada. The second objective was to provide public health practitioners with recommendations for improving knowledge translation (KT) efforts in NL, based on assessments of respondents’ perceived information needs and preferred KT methods. Methods A cross-sectional telephone survey of 618 households with private water supplies was conducted in March-April, 2007. Questions pertained to respondents’ perceptions of their tap water, water concerns, alternative water use, well characteristics, and water testing behaviours. Results Approximately 94% of households were supplied by private wells (50% drilled and 50% dug wells), while 6% obtained water from roadside ponds, rivers or springs (RPRS). While 85% rated their water quality highly, 55% nevertheless had concerns about its overall safety. Approximately 11% of respondents never tested their water, and of the 89% that had, 80% tested at frequencies below provincial recommendations for bacterial testing. More than one-third of respondents reported treating their water in the home, and 78% employed active carbon filtration methods. Respondents wanted more information on testing options and advice on effective treatment methods. Targeted advertising through television, flyers/brochures and/or radio is recommended as a first step to increase awareness. More active KT methods involving key stakeholders may be most effective in improving testing and treatment behaviour. Conclusions The results presented here can assist public health practitioners in tailoring current KT initiatives to influence well owner stewardship behaviour. PMID:24365203

Headspace solid-phase microextraction (HS-SPME) and liquid-liquid extraction (LLE): comparison of the performance in classification of ecstasy tablets. Part 2.

PubMed

Bonadio, Federica; Margot, Pierre; Delémont, Olivier; Esseiva, Pierre

2008-11-20

Headspace solid-phase microextraction (HS-SPME) is assessed as an alternative to liquid-liquid extraction (LLE) currently used for 3,4-methylenedioxymethampethamine (MDMA) profiling. Both methods were compared evaluating their performance in discriminating and classifying samples. For this purpose 62 different seizures were analysed using both extraction techniques followed by gas chromatography-mass spectroscopy (GC-MS). A previously validated method provided data for HS-SPME, whereas LLE data were collected applying a harmonized methodology developed and used in the European project CHAMP. After suitable pre-treatment, similarities between sample pairs were studied using the Pearson correlation. Both methods enable to distinguish between samples coming from the same pre-tabletting batches and samples coming from different pre-tabletting batches. This finding emphasizes the use of HS-SPME as an effective alternative to LLE, with additional advantages such as sample preparation and a solvent-free process.

Effectiveness of an Alternative Dental Workforce Model on the Oral Health of Low-Income Children in a School-Based Setting

PubMed Central

Walker, Mary; Gadbury-Amyot, Cynthia; Liu, Ying; Kelly, Patricia; Branson, Bonnie

2015-01-01

Objectives. We evaluated the effect of an alternative dental workforce program—Kansas’s Extended Care Permit (ECP) program—as a function of changes in oral health. Methods. We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal–Wallis test, and Pearson correlations. Results. The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P = .014), restorations (P = .002), and treatment urgency (P = .038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (–0.12), increase in restorations (0.21), and decrease in treatment urgency (–0.15). Conclusions. Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services. PMID:26180957

Evaluation of spray application methods for navel orangeworm control in almonds.

PubMed

Markle, James C; Niederholzer, Franz Ja; Zalom, Frank G

2016-12-01

Gear Up/Throttle Down (GUTD) and Inward Only strategies represent potential alternatives to conventional airblast applications to reduce spray drift. This study evaluates Inward Only and a modified version of GUTD in almonds, the largest US tree crop, at the recommended hull split treatment timing for control of navel orangeworm (NOW), the key almond insect pest. Conventional treatment produced the most drift (15.6% of total bifenthrin load), while the GUTD and Inward Only treatments produced only 7.6 and 9.7% respectively. For all methods, 92-94% of the drift was found in the first 15.2 m downwind of the orchard. NOW control was lower for the Inward Only treatment compared with the GUTD and conventional treatments. NOW control was consistently lower at 4.88 m height relative to 2.44 m in all treatments, reflecting the reduced deposition higher in the tree canopy recorded in deposition samples. While Inward Only treatments reduced spray drift relative to the conventional application method, poorer control of NOW, the key insect pest of almonds, in the Inward Only treatment would likely limit its voluntary use by growers. However, GUTD holds promise for use at the hull split treatment timing to address spray drift. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Controlling grape must fermentation in early winemaking phases: the role of electrochemical treatment.

PubMed

Lustrato, G; Alfano, G; Belli, C; Grazia, L; Iorizzo, M; Maiuro, L; Massarella, F; Zanardini, E; Ranalli, G

2003-01-01

To contribute to an understanding of the phenomena related to the effect of low electric current (LEC) in grape must fermentation during laboratory and pilot plant scale winemaking, with selected co-culture yeasts (Saccharomyces cerevisiae strain 404 and Hanseniaspora guilliermodii strain 465). LEC (10, 30, 50 and 100 mA) was applied to fresh grape must as an alternative method to the usual addition of SO2. Parameters such as polarity, treatment duration (24-96 h) and type of inoculum yeast were varied one at a time. LEC decreased the survival time and increased the death rate of H. guilliermondii strain 465 in co-cultures, whereas it did not affect the growth and survival of S. cerevisiae strain 40. A final comparison was made of the main physico-chemical parameters on wine obtained after the different tests. The results have demonstrated that the low voltage treatment using a pair of graphite electrodes had a positive effect on grape juice fermentation (yeast microflora) during the early stages of winemaking, even with the potential of being an alternative method to the usual addition of SO2. These results could be of significant importance in developing new winemaking technologies for an innovative yeast fermentation control process for 'biological wine'.

Narcotic antagonists. Treatment tool for addiction.

PubMed

Valentine, N M; Meyer, R E

1976-09-01

Narcotic antagonists have recently gained attention through research aimed at evaluating both biochemical effects and treatment potential for opiate addiction. Narcotic antagonists are a classification of drugs which block the euphoric (and all other) effects of opiates. Naltrexone is the most promising narcotic antagonist based on ability to produce blockade, length of duration, and relative absence of side effects. The narcotic antagonists offer an adjunctive or alternative method of treatment for opiate addicts based on Wikler's biobehavioral theory of conditioned abstinence. Narcotic antagonists are presently being investigated at seven research centers throughout the United States and may be available for clinical use in the future.

Use of miniplates as a method for orthodontic anchorage: a case report

PubMed Central

Peres, Fernando Gianzanti; Padovan, Luis Eduardo Marques; Kluppel, Leandro Eduardo; Albuquerque, Gustavo Calvalcanti; de Souza, Paulo Cesar Ulson; Claudino, Marcela

2016-01-01

ABSTRACT Introduction: Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction. Objectives: This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study. Conclusions: The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars. PMID:27901235

What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology.

PubMed

Nanavati, Sujal M

2014-12-01

Since the 1960s, interventional radiology has played a role in the management of gastrointestinal bleeding. What began primarily as a diagnostic modality has evolved into much more of a therapeutic tool. And although the frequency of gastrointestinal bleeding has diminished thanks to management by pharmacologic and endoscopic methods, the need for additional invasive interventions still exists. Transcatheter angiography and intervention is a fundamental step in the algorithm for the treatment of gastrointestinal bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

A comparison of analytic hierarchy process and conjoint analysis methods in assessing treatment alternatives for stroke rehabilitation.

PubMed

Ijzerman, Maarten J; van Til, Janine A; Bridges, John F P

2012-01-01

With growing emphasis on patient involvement in health technology assessment, there is a need for scientific methods that formally elicit patient preferences. Analytic hierarchy process (AHP) and conjoint analysis (CA) are two established scientific methods - albeit with very different objectives. The objective of this study was to compare the performance of AHP and CA in eliciting patient preferences for treatment alternatives for stroke rehabilitation. Five competing treatments for drop-foot impairment in stroke were identified. One survey, including the AHP and CA questions, was sent to 142 patients, resulting in 89 patients for final analysis (response rate 63%). Standard software was used to calculate attribute weights from both AHP and CA. Performance weights for the treatments were obtained from an expert panel using AHP. Subsequently, the mean predicted preference for each of the five treatments was calculated using the AHP and CA weights. Differences were tested using non-parametric tests. Furthermore, all treatments were rank ordered for each individual patient, using the AHP and CA weights. Important attributes in both AHP and CA were the clinical outcome (0.3 in AHP and 0.33 in CA) and risk of complications (about 0.2 in both AHP and CA). Main differences between the methods were found for the attributes 'impact of treatment' (0.06 for AHP and 0.28 for two combined attributes in CA) and 'cosmetics and comfort' (0.28 for two combined attributes in AHP and 0.05 for CA). On a group level, the most preferred treatments were soft tissue surgery (STS) and orthopedic shoes (OS). However, STS was most preferred using AHP weights versus OS using CA weights (p < 0.001). This difference was even more obvious when interpreting the individual treatment ranks. Nearly all patients preferred STS according to the AHP predictions, while >50% of the patients chose OS instead of STS, as most preferred treatment using CA weights. While we found differences between AHP and CA, these differences were most likely caused by the labeling of the attributes and the elicitation of performance judgments. CA scenarios are built using the level descriptions, and hence provide realistic treatment scenarios. In AHP, patients only compared less concrete attributes such as 'impact of treatment.' This led to less realistic choices, and thus overestimation of the preference for the surgical scenarios. Several recommendations are given on how to use AHP and CA in assessing patient preferences.

Fibre Optic Sensors for Selected Wastewater Characteristics

PubMed Central

Chong, Su Sin; Abdul Aziz, A. R.; Harun, Sulaiman W.

2013-01-01

Demand for online and real-time measurements techniques to meet environmental regulation and treatment compliance are increasing. However the conventional techniques, which involve scheduled sampling and chemical analysis can be expensive and time consuming. Therefore cheaper and faster alternatives to monitor wastewater characteristics are required as alternatives to conventional methods. This paper reviews existing conventional techniques and optical and fibre optic sensors to determine selected wastewater characteristics which are colour, Chemical Oxygen Demand (COD) and Biological Oxygen Demand (BOD). The review confirms that with appropriate configuration, calibration and fibre features the parameters can be determined with accuracy comparable to conventional method. With more research in this area, the potential for using FOS for online and real-time measurement of more wastewater parameters for various types of industrial effluent are promising. PMID:23881131

Survey of German non-medical practitioners regarding complementary and alternative medicine in oncology.

PubMed

Koehl, Benjamin; Muenstedt, Karsten; Micke, Oliver; Muecke, Ralph; Buentzel, Jens; Stoll, Christoph; Prott, Franz Josef; Dennert, Gabriele; Senf, Bianca; Huebner, Jutta

2014-01-01

In total, 40-70% of cancer patients use complementary or alternative medicine (CAM). Many of them ask for advice from non-medical practitioners (NMPs). Our aim was to investigate the attitude of NMPs regarding their treatments for cancer patients. A survey was performed on members of NMP associations, using an online questionnaire on diagnosis and treatment, goals for using CAM, communication with the oncologist, and sources of information. Of the 1,500 members of the NMP associations, 299 took part. The treatments were found to be heterogeneous. Homeopathy is used by 45% of the NMPs; 10% believe it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets are used by more than 10% of the NMPs. None of the treatments is discussed with the respective physician on a regular basis. Many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies. © 2014 S. Karger GmbH, Freiburg.

Understanding Treatment Effect Estimates When Treatment Effects Are Heterogeneous for More Than One Outcome.

PubMed

Brooks, John M; Chapman, Cole G; Schroeder, Mary C

2018-06-01

Patient-centred care requires evidence of treatment effects across many outcomes. Outcomes can be beneficial (e.g. increased survival or cure rates) or detrimental (e.g. adverse events, pain associated with treatment, treatment costs, time required for treatment). Treatment effects may also be heterogeneous across outcomes and across patients. Randomized controlled trials are usually insufficient to supply evidence across outcomes. Observational data analysis is an alternative, with the caveat that the treatments observed are choices. Real-world treatment choice often involves complex assessment of expected effects across the array of outcomes. Failure to account for this complexity when interpreting treatment effect estimates could lead to clinical and policy mistakes. Our objective was to assess the properties of treatment effect estimates based on choice when treatments have heterogeneous effects on both beneficial and detrimental outcomes across patients. Simulation methods were used to highlight the sensitivity of treatment effect estimates to the distributions of treatment effects across patients across outcomes. Scenarios with alternative correlations between benefit and detriment treatment effects across patients were used. Regression and instrumental variable estimators were applied to the simulated data for both outcomes. True treatment effect parameters are sensitive to the relationships of treatment effectiveness across outcomes in each study population. In each simulation scenario, treatment effect estimate interpretations for each outcome are aligned with results shown previously in single outcome models, but these estimates vary across simulated populations with the correlations of treatment effects across patients across outcomes. If estimator assumptions are valid, estimates across outcomes can be used to assess the optimality of treatment rates in a study population. However, because true treatment effect parameters are sensitive to correlations of treatment effects across outcomes, decision makers should be cautious about generalizing estimates to other populations.

An Evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: A Sequenced Treatment Alternatives to Relieve Depression Trial Report

PubMed Central

Rush, A. John; Bernstein, Ira H.; Trivedi, Madhukar H.; Carmody, Thomas J.; Wisniewski, Stephen; Mundt, James C.; Shores-Wilson, Kathy; Biggs, Melanie M.; Woo, Ada; Nierenberg, Andrew A.; Fava, Maurizio

2010-01-01

Background Nine DSM-IV-TR criterion symptom domains are evaluated to diagnose major depressive disorder (MDD). The Quick Inventory of Depressive Symptomatology (QIDS) provides an efficient assessment of these domains and is available as a clinician rating (QIDS-C16), a self-report (QIDS-SR16), and in an automated, interactive voice response (IVR) (QIDS-IVR16) telephone system. This report compares the performance of these three versions of the QIDS and the 17-item Hamilton Rating Scale for Depression (HRSD17). Methods Data were acquired at baseline and exit from the first treatment step (citalopram) in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Outpatients with nonpsychotic MDD who completed all four ratings within ±2 days were identified from the first 1500 STAR*D subjects. Both item response theory and classical test theory analyses were conducted. Results The three methods for obtaining QIDS data produced consistent findings regarding relationships between the nine symptom domains and overall depression, demonstrating interchangeability among the three methods. The HRSD17, while generally satisfactory, rarely utilized the full range of item scores, and evidence suggested multidimensional measurement properties. Conclusions In nonpsychotic MDD outpatients without overt cognitive impairment, clinician assessment of depression severity using either the QIDS-C16 or HRSD17 may be successfully replaced by either the self-report or IVR version of the QIDS. PMID:16199008

The Cost-Effectiveness of Three Screening Alternatives for People with Diabetes with No or Early Diabetic Retinopathy

PubMed Central

Rein, David B; Wittenborn, John S; Zhang, Xinzhi; Allaire, Benjamin A; Song, Michael S; Klein, Ronald; Saaddine, Jinan B

2011-01-01

Objective To determine whether biennial eye evaluation or telemedicine screening are cost-effective alternatives to current recommendations for the estimated 10 million people aged 30–84 with diabetes but no or minimal diabetic retinopathy. Data Sources United Kingdom Prospective Diabetes Study, National Health and Nutrition Examination Survey, American Academy of Ophthalmology Preferred Practice Patterns, Medicare Payment Schedule. Study Design Cost-effectiveness Monte Carlo simulation. Data Collection/Extraction Methods Literature review, analysis of existing surveys. Principal Findings Biennial eye evaluation was the most cost-effective treatment option when the ability to detect other eye conditions was included in the model. Telemedicine was most cost-effective when other eye conditions were not considered or when telemedicine was assumed to detect refractive error. The current annual eye evaluation recommendation was costly compared with either treatment alternative. Self-referral was most cost-effective up to a willingness to pay (WTP) of U.S.$37,600, with either biennial or annual evaluation most cost-effective at higher WTP levels. Conclusions Annual eye evaluations are costly and add little benefit compared with either plausible alternative. More research on the ability of telemedicine to detect other eye conditions is needed to determine whether it is more cost-effective than biennial eye evaluation. PMID:21492158

Analysis of alternative splicing events for cancer diagnosis using a multiplexing nanophotonic biosensor

PubMed Central

Huertas, César S.; Domínguez-Zotes, Santos; Lechuga, Laura M.

2017-01-01

Personalized medicine is a promising tool not only for prevention, screening and development of more efficient treatment strategies, but also for diminishing the side effects caused by current therapies. Deciphering gene regulation pathways provides a reliable prognostic analysis to elucidate the origin of grave diseases and facilitate the selection of the most adequate treatment for each individual. Alternative splicing of mRNA precursors is one of these gene regulation pathways and enables cells to generate different protein outputs from the same gene depending on their developmental or homeostatic status. Its deregulation is strongly linked to disease onset and progression constituting a relevant and innovative class of biomarker. Herein we report a highly selective and sensitive nanophotonic biosensor based on the direct monitoring of the aberrant alternative splicing of Fas gene. Unlike conventional methods, the nanobiosensor performs a real-time detection of the specific isoforms in the fM-pM range without any cDNA synthesis or PCR amplification requirements. The nanobiosensor has been proven isoform-specific with no crosshybridization, greatly minimizing detection biases. The demonstrated high sensitivity and specificity make our nanobiosensor ideal for examining significant tumor-associated expression shifts of alternatively spliced isoforms for the early and accurate theranostics of cancer. PMID:28120920

Analysis of alternative splicing events for cancer diagnosis using a multiplexing nanophotonic biosensor.

PubMed

Huertas, César S; Domínguez-Zotes, Santos; Lechuga, Laura M

2017-01-25

Personalized medicine is a promising tool not only for prevention, screening and development of more efficient treatment strategies, but also for diminishing the side effects caused by current therapies. Deciphering gene regulation pathways provides a reliable prognostic analysis to elucidate the origin of grave diseases and facilitate the selection of the most adequate treatment for each individual. Alternative splicing of mRNA precursors is one of these gene regulation pathways and enables cells to generate different protein outputs from the same gene depending on their developmental or homeostatic status. Its deregulation is strongly linked to disease onset and progression constituting a relevant and innovative class of biomarker. Herein we report a highly selective and sensitive nanophotonic biosensor based on the direct monitoring of the aberrant alternative splicing of Fas gene. Unlike conventional methods, the nanobiosensor performs a real-time detection of the specific isoforms in the fM-pM range without any cDNA synthesis or PCR amplification requirements. The nanobiosensor has been proven isoform-specific with no crosshybridization, greatly minimizing detection biases. The demonstrated high sensitivity and specificity make our nanobiosensor ideal for examining significant tumor-associated expression shifts of alternatively spliced isoforms for the early and accurate theranostics of cancer.

Brief Report: Alternative Approaches to the Development of Effective Treatments for Autism.

ERIC Educational Resources Information Center

Rimland, Bernard; Baker, Sidney M.

1996-01-01

The most widely used "alternative" biomedical treatments for autism are reviewed, including: nutritional supplements, especially megadose vitamin B6 and magnesium; treatment of food allergies and intolerances; treatment of microbial infections; and treatment of immune system dysfunction. The Defeat Autism Now! project is briefly…

Treatment of head lice with dimeticone 4% lotion: comparison of two formulations in a randomised controlled trial in rural Turkey

PubMed Central

2009-01-01

Background Dimeticone 4% lotion was shown to be an effective treatment for head louse infestation in two randomised controlled trials in England. It is not affected by insecticide resistance but efficacy obtained (70-75%) was lower than expected. This study was designed to evaluate efficacy of dimeticone 4% lotion in a geographically, socially, and culturally different setting, in rural Turkey and, in order to achieve blinding, it was compared with a potential alternative formulation. Methods Children from two village schools were screened for head lice by detection combing. All infested students and family members could participate, giving access to treatment for the whole community. Two investigator applied treatments were given 7 days apart. Outcome was assessed by detection combing three times between treatments and twice the week following second treatment. Results In the intention to treat group 35/36 treated using dimeticone 4% had no lice after the second treatment but there were two protocol violators giving 91.7% treatment success. The alternative product gave 30/36 (83.3%) treatment success, a difference of 8.4% (95% CI -9.8% to 26.2%). The cure rates per-protocol were 33/34 (97.1%) and 30/35 (85.7%) respectively. We were unable to find any newly emerged louse nymphs on 77.8% of dimeticone 4% treated participants or on 66.7% of those treated with the alternative formulation. No adverse events were identified. Conclusion Our results confirm the efficacy of dimeticone 4% lotion against lice and eggs and we found no detectable difference between this product and dimeticone 4% lotion with nerolidol 2% added. We believe that the high cure rate was related to the lower intensity of infestation in Turkey, together with the level of community engagement, compared with previous studies in the UK. Trial Registration Current Controlled Trials ISRCTN10431107 PMID:19951427

Alternative approaches to conventional treatment of acute uncomplicated urinary tract infection in women.

PubMed

Foxman, Betsy; Buxton, Miatta

2013-04-01

The increasing resistance of uropathogens to antibiotics and recognition of the generally self-limiting nature of uncomplicated urinary tract infection (UTI) suggest that it is time to reconsider empirical treatment of UTI using antibiotics. Identifying new and effective strategies to prevent recurrences and alternative treatment strategies are a high priority. We review the recent literature regarding the effects of functional food products, probiotics, vaccines, and alternative treatments on treating and preventing UTI.

Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

PubMed Central

Lake, James; Turner, Mason Spain

2017-01-01

Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

Dechlorination by ultraviolet radiation: a suitable alternative to activated carbon in dialysis water systems?

PubMed

James, Ray

2009-12-01

Chlorine-based products are widely used in the water supply industry, and the potential for adverse effects in the haemodialysis setting is well documented. To date, the most commonly used method of chlorine removal has been granular activated carbon filters. An increasingly popular method of dechlorination is the use of high intensity, broad-spectrum UV systems to reduce both free chlorine and combined chlorine compounds (chloramines) into easily removed by-products. UV radiation has been successfully used in the pharmaceutical and food industries to destroy free chlorine and/or chloramines present in water, and kill all known spoilage microorganisms including bacteria, viruses, yeasts and moulds (and their spores). This nonchemical method can offer significant advantages and benefits compared to conventional dechlorination technologies currently employed in dialysis water systems. Whilst UV treatment at 254 nm wavelength has been routinely used for disinfection purposes in dialysis water systems, this paper considers whether UV radiation can be used as an alternative to more traditional methods of chlorine removal.

Nonpharmacological treatment of epilepsy

PubMed Central

Saxena, V. S.; Nadkarni, V. V.

2011-01-01

Nonpharmacological treatment of epilepsy includes surgery, vagal nerve stimulation, ketogenic diet, and other alternative/complementary therapies, e.g., yoga, Ayurveda, electroencephalography (EEG) biofeedback technique, aerobic exercise, music therapy, transcranial magnetic stimulation, acupuncture, and herbal remedies (traditional Chinese medicine). Alternative therapies, despite the term, should not be considered as an alternative to antiepileptic medication; they complement accepted drug treatment. Alternative therapies like yoga, through techniques that relax the body and mind, reduce stress, improve seizure control, and also improve quality of life. Ketogenic diet is a safe and effective treatment for intractable epilepsies; it has been recommended since 1921. The diet induces ketosis, which may control seizures. The most successful treatment of epilepsy is with modern antiepileptic drugs, which can achieve control of seizures in 70–80% cases. Patients opt for alternative therapies because they may be dissatisfied with antiepileptic drugs due to their unpleasant side effects, the long duration of treatment, failure to achieve control of seizures, cultural beliefs and, in the case of women, because they wish to get pregnant Surgical treatment may lead to physical and psychological sequelae and is an option only for a minority of patients. This article presents supportive evidence from randomized controlled trials done to assess the benefit of non-pharmacological treatment. PMID:22028523

“Living proof” and the pseudo-science of alternative cancer treatments

PubMed Central

Vickers, Andrew J.; Cassileth, Barrie R.

2008-01-01

Michael Gearin-Tosh was an English Professor at Oxford University who was diagnosed with multiple myeloma in 1994. He rejected conventional chemotherapeutic approaches and turned to a variety of alternative cancer treatments, particularly those involving nutritional supplements and dietary change. In 2002, Dr Gearin-Tosh published a book, “Living Proof”, recounting his experiences. The book gained significant public and media attention. One chapter was written by Carmen Wheatley, an advocate of alternative cancer treatments. In distinction to Dr Gearin-Tosh’s personal story, Dr Wheatley makes general claims about cancer treatment that are supposedly based on the research literature. This appears to provide scientific validation for a highly unconventional program of cancer care. However, the scientific case made for alternative cancer treatments in “Living Proof” does not bear serious examination. There are numerous inaccuracies, omissions and misrepresentations. Many important claims are either entirely unsubstantiated or not supported by the literature cited. In conclusion, a highly publicized book gives the impression that alternative cancer treatments are supported by scientific research. It also suggests that little progress has been made in the conventional treatment of myeloma. This is highly misleading and may lead to cancer patients rejecting effective treatments. PMID:18302909

Living proof and the pseudoscience of alternative cancer treatments.

PubMed

Vickers, Andrew J; Cassileth, Barrie R

2008-01-01

Michael Gearin-Tosh was an English professor at Oxford University who was diagnosed with multiple myeloma in 1994. He rejected conventional chemotherapeutic approaches and turned to a variety of alternative cancer treatments, particularly those involving nutritional supplements and dietary change. In 2002, Dr. Gearin-Tosh published a book, Living Proof: A Medical Mutiny, recounting his experiences. The book gained significant public and media attention. One chapter was written by Carmen Wheatley, an advocate of alternative cancer treatments. In distinction to Dr. Gearin-Tosh's personal story, Dr. Wheatley makes general claims about cancer treatment that are supposedly based on the research literature. This appears to provide scientific validation for a highly unconventional program of cancer care. However, the scientific case made for alternative cancer treatments in Living Proof does not bear serious examination. There are numerous inaccuracies, omissions, and misrepresentations. Many important claims are either entirely unsubstantiated or not supported by the literature cited. In conclusion, a highly publicized book gives the impression that alternative cancer treatments are supported by scientific research. It also suggests that little progress has been made in the conventional treatment of myeloma. This is highly misleading and may lead to cancer patients rejecting effective treatments.

Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco

PubMed Central

Alonso, Sergi; Tachfouti, Nabil; Najdi, Adil; Sicuri, Elisa; Picado, Albert

2017-01-01

Introduction Visceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco. Methods A decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices. Results Implementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial). Conclusions The results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries. PMID:29018581

Complementary and alternative medicine use in children with thalassaemia.

PubMed

Efe, Emine; Işler, Ayşegül; Sarvan, Süreyya; Başer, Hayriye; Yeşilipek, Akif

2013-03-01

The aims of this study were to: (1) determine the types of complementary and alternative medicine use among children with thalassaemia as reported by parents and (2) describe sociodemographic and medical factors associated with the use of such treatments in families residing in southern Turkey. Thalassaemia is one of the most common human genetic diseases. Despite the therapeutic efforts, patients will encounter a variety of physical and psychological problems. Therefore, the use of complementary and alternative medicines among children thalassaemia is becoming increasingly popular. This is a descriptive study of complementary and alternative medicine. This study was conducted in the Hematology Outpatient Clinic at Akdeniz University Hospital and in the Thalassemia Centre at Ministry of Health Antalya Education and Research Hospital, Antalya, Turkey, between January 2010-December 2010. Parents of 97 paediatric patients, among 125 parents who applied to the haematology outpatient clinic and thalassaemia centre between these dates, agreed to take part in the study with whom contact could be made were included. Data were collected by using a questionnaire. The proportion of parents who reported using one or more of the complementary and alternative medicine methods was 82·5%. Of these parents, 61·8% were using prayer/spiritual practice, 47·4% were using nutritional supplements and 35·1% were using animal materials. It was determined that a significant portion of the parents using complementary and alternative medicine use it to treat their children's health problems, they were informed about complementary and alternative medicine by their paediatricians and family elders, and they have discussed the use of complementary and alternative medicine with healthcare professionals. To sustain medical treatment and prognosis of thalassaemia, it is important for nurses to consult with their patients and parents regarding the use and potential risks of some complementary and alternative medicine. © 2012 Blackwell Publishing Ltd.

Optimization of radiotherapy. Some notes on the principles and practice of optimization in cancer treatment and implications for clinical research.

PubMed

Andrews, J R

1981-01-01

Two methods dominate cancer treatment--one, the traditional best practice, individualized treatment method and two, the a priori determined decision method of the interinstitutional, cooperative, clinical trial. In the first, choices are infinite and can be made at the time of treatment; in the second, choices are finite and are made in advance of treatment on a random basis. Neither method systematically selects, identifies, or formalizes the optimum level of effect in the treatment chosen. Of the two, it can be argued that the first, other things being equal, is more likely to select the optimum treatment. The determination of level of effect for the optimization of cancer treatment requires the generation of dose-response relationships for both benefit and risk and the introduction of benefit and risk considerations and judgements. The clinical trial, as presently constituted, doses not yield this kind of information, it being, generally, of the binary yes or no, better or worse type. The best practice, individualized treatment method can yield, when adequately documented, both a range of dose-response relationships and a variety of benefit and risk considerations. The presentation will be limited to a consideration of a single modality of cancer treatment, radiation therapy, but an analogy with other modalities of cancer treatment will be inferred. Criteria for optimization will be developed and graphic means for its identification and formalization will be demonstrated with examples taken from the radiotherapy literature. The general problem of optimization theory and practice will be discussed; the necessity for its exploration in relation to the increasing complexity of cancer treatment will be developed; and recommendations for clinical research will be made including a proposal for the support of clinics as an alternative to the support of programs.

Vaginal Candidiasis Infection Treated Using Apple Cider Vinegar: A Case Report.

PubMed

Ozen, Betul; Baser, Muruvvet

2017-11-07

A 32-y-old married woman was admitted with intense vaginal discharge with foul odor, itching, groin pain, and infertility for the past 5 y. Candida albicans was isolated from the culture of vaginal swab. The patient was diagnosed with chronic vaginal candida infection. She failed to respond to integrative medicine methods prescribed. Recovery was achieved with the application of apple cider vinegar. Alternative treatment methods can be employed in patients unresponsive to medical therapies. As being one of these methods, application of apple cider vinegar can cure vaginal candida infection.

Laser radiation in tennis elbow treatment: a new minimally invasive alternative

NASA Astrophysics Data System (ADS)

Paganini, Stefan; Thal, Dietmar R.; Werkmann, Klaus

1998-01-01

The epicondylitis humeri radialis (EHR) (tennis elbow), is a common disease in elbow joint pain syndromes. We treated patients with chronic pain for at least one year and no improvement with conservative or operative therapies with a new minimal invasive method, the EHR-Laser radiation (EHR- LR). With this method periepicondylar coagulations were applied to the trigger points of the patients. For this the previously established technique of facet joint coagulation with the Nd:Yag-laser was modified. In a follow-up study of between 6 weeks and 2 years all patients reported either a significant pain reduction or were symptom free. EHR-LR is a new method situated between conservative and surgical treatments for minimal invasive therapy of EHR. Several therapeutic rationales were discussed for the resulting pain reduction.

Simplified Method for Groundwater Treatment Using Dilution and Ceramic Filter

NASA Astrophysics Data System (ADS)

Musa, S.; Ariff, N. A.; Kadir, M. N. Abdul; Denan, F.

2016-07-01

Groundwater is one of the natural resources that is not susceptible to pollutants. However, increasing activities of municipal, industrial, agricultural or extreme land use activities have resulted in groundwater contamination as occured at the Research Centre for Soft Soil Malaysia (RECESS), Universiti Tun Hussein Onn Malaysia (UTHM). Thus, aims of this study is to treat groundwater by using rainwater and simple ceramic filter as a treatment agent. The treatment uses rain water dilution, ceramic filters and combined method of dilute and filtering as an alternate treatment which are simple and more practical compared to modern or chemical methods. The water went through dilution treatment processes able to get rid of 57% reduction compared to initial condition. Meanwhile, the water that passes through the filtering process successfully get rid of as much as 86% groundwater parameters where only chloride does not pass the standard. Favorable results for the combination methods of dilution and filtration methods that can succesfully eliminate 100% parameters that donot pass the standards of the Ministry of Health and the Interim National Drinking Water Quality Standard such as those found in groundwater in RECESS, UTHM especially sulfate and chloride. As a result, it allows the raw water that will use clean drinking water and safe. It also proves that the method used in this study is very effective in improving the quality of groundwater.

Is alternate rapid maxillary expansion and constriction an effective protocol in the treatment of Class III malocclusion? A systematic review

PubMed Central

Pithon, Matheus Melo; Santos, Nathalia de Lima; dos Santos, Camila Rangel Barreto; Baião, Felipe Carvalho Souza; Pinheiro, Murilo Costa Rangel; Matos, Manoel; Souza, Ianderlei Andrade; de Paula, Rafael Pereira

2016-01-01

ABSTRACT Introduction: the treatment of Class III malocclusion in early age is one of the greatest challenges for orthodontists, and the establishment of more effective treatment method is a constant concern for these professionals. Thus, the objective of this systematic review is to verify the effectiveness of the therapy protocol for alternate rapid maxillary expansion and constriction (Alt-RAMEC) in the early treatment of Class III malocclusion. Methods: searches were performed in the following electronic databases: Cochrane Library, Medline (EBSCO and PubMed), SciELO, LILACS and Scopus. The following inclusion criteria were used: in vivo studies conducted with early intervention (patient in craniofacial development phase) with the use of the Alt-RAMEC protocol. Reviews, case reports, editorials, and studies with syndromic patients or under use of systemic drug were excluded. Duplicates were also excluded. The studies were assessed for methodological quality using the Cochrane tool for assessment of risk of bias, and classified as high or low risk of bias. Results: 53 articles were found. Duplicates exclusion was thus performed and 35 articles remained. After inclusion analysis, only 5 matched the criteria. Two articles were classified as low risk of bias and three as high risk of bias. It was observed that the Alt-RAMEC enable protraction in less time and with better results, promoting greater effectiveness in the protraction treatment of Class III malocclusion. Conclusions: Although there is positive evidence of the effectiveness of early treatment with the Alt-RAMEC protocol in patients with Class III malocclusion, further studies are needed to confirm its effectiveness using long-term methodology. PMID:28125138

Treatment, promotion, commotion: Antibiotic alternatives in food-producing animals

USDA-ARS?s Scientific Manuscript database

Alternatives to antibiotics in animal agriculture are urgently needed but present a complex problem because of their various uses: disease treatment, disease prevention, and feed efficiency improvement. Numerous antibiotic alternatives, such as feed amended with pre- and probiotics, have been propos...

Complementary and Alternative Medicine Treatments for Generalized Anxiety Disorder: Systematic Review and Meta-analysis of Randomized Controlled Trials.

PubMed

Barić, Hrvoje; Đorđević, Veljko; Cerovečki, Ivan; Trkulja, Vladimir

2018-03-01

The objective was to evaluate efficacy/safety of complementary and alternative medicine (CAM) methods for generalized anxiety disorder (GAD) based on randomized controlled trials in adults. Data sources. Six electronic databases ("generalized anxiety (disorder)" and "randomized trial") and reference lists of identified publications were searched to March 2017. Eligibility: full-text publications (English, German language); CAM versus conventional treatment, placebo/sham or no treatment; GAD diagnosed according to standard criteria; and a validated scale for disease severity. Of the 6693 screened records, 32 were included (18 on biologically-based therapies, exclusively herbal preparations; eight on manipulative and body-based therapies; and three on alternative medical systems and three on mind-body therapies). Cochrane Collaboration methodology was used for quality assessment and data extraction. Direct comparisons of Kava Kava (Piper methysticum) extracts to placebo (4 quality trials, n = 233) were highly heterogeneous. Network meta-regression reduced heterogeneity and suggested a modest Kava effect [end-of-treatment Hamilton Anxiety scale score difference adjusted for baseline scores and trial duration: - 3.24 (95% CI - 6.65, 0.17; P = 0.059), Kava Kava 4 arms, n = 139; placebo 5 arms, n = 359]. Lavender (Lavandula angustifolia) extract (1 quality trial, 10 weeks, n = 523) and a combination of extracts of C. oxycantha, E. californica and magnesium (1 quality trial, 12 weeks, n = 264) were superior to placebo and balneotherapy was superior to paroxetine (1 quality trial, 8 weeks, n = 237) indicating efficacy. All other trials were small and/or of modest/low quality and/or lacked assay sensitivity. Safety reporting was poor. Evidence about efficacy/safety of most CAM methods in GAD is limited. Apparent efficacy of certain herbal preparations and body-based therapies requires further confirmation.

Sprinkle Treatment experimental project construction and first-year evaluation.

DOT National Transportation Integrated Search

1986-07-01

The Department's Research Section recognized the need for alternatives to the friction course materials. One such alternative which appeared promising was Sprinkle Treatment. Sprinkle Treatment, initiated in 1977 by the Federal Highway Administration...

[Treatment of the infected wound with exposed silver-ring vascular graft and delayed Thiersch method of skin transplant covering ].

PubMed

Nenezić, Dragoslav; Pandaitan, Simon; Ilijevski, Nenad; Matić, Predrag; Gajin, Predag; Radak, Dorde

2005-01-01

Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft.

[Cognitive therapy has been shown to be effective in panic disorder].

PubMed

d'Elia, G; Holsten, F

1998-10-28

Cognitive therapists suggest panic disorder to result from 'catastrophic' misinterpretation of bodily sensations. The patient suffering from panic disorder consistently misinterprets normal anxiety responses, such as racing heart, breathlessness or dizziness, as indicating impending disaster. Cognitive therapists, who challenge the traditional view of anxiety as 'free-floating' and irrational, argue that the patient's anxiety is an understandable response to their misinterpretations, and advocate a treatment method based on the patient's specific cognitive make-up and on the principle of collaborative empiricism. The patient is gently guided to identify and challenge idiosyncratic cognitions, and to consider alternative interpretations of danger signs. The article provides an outline of the treatment method and its empirical support.

Unconventional Pretreatment of Lignocellulose with Low-Temperature Plasma.

PubMed

Vanneste, Jens; Ennaert, Thijs; Vanhulsel, Annick; Sels, Bert

2017-01-10

Lignocellulose represents a potential supply of sustainable feedstock for the production of biofuels and chemicals. There is, however, an important cost and efficiency challenge associated with the conversion of such lignocellulosics. Because its structure is complex and not prone to undergo chemical reactions very easily, chemical and mechanical pretreatments are usually necessary to be able to refine them into the compositional building blocks (carbohydrates and lignin) from which value-added platform molecules, such as glucose, ethylene glycol, 5-hydroxymethylfurfural, and levulinic acid, and biofuels, such as bioderived naphtha, kerosene, and diesel fractions, will be produced. Conventional (wet) methods are usually polluting, aggressive, and highly energy consuming, so any alternative activation procedure of the lignocellulose is highly recommended and anticipated in recent and future biomass research. Lignocellulosic plasma activation has emerged as an interesting (dry) treatment technique. In the long run, in particular, in times of fairly accessible renewable electricity, plasma may be considered as an alternative to conventional pretreatment methods, but current knowledge is too little and examples too few to guarantee that statement. This review therefore highlights recent knowledge, advancements, and shortcomings in the field of plasma treatment of cellulose and lignocellulose with regard to the (structural and chemical) effects and impact on the future of pretreatment methods. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Remediation alternatives for low-level herbicide contaminated groundwater

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

Conger, R.M.

In early 1995, an evaluation of alternatives for remediation of a shallow groundwater plume containing low-levels of an organic herbicide was conducted at BASF Corporation, a petrochemical facility located in Ascension Parish, Louisiana. The contaminated site is located on an undeveloped portion of property within 1/4 mile of the east bank of the Mississippi River near the community of Geismar. Environmental assessment data indicated that about two acres of the thirty acre site had been contaminated from past waste management practices with the herbicide bentazon. Shallow soils and groundwater between 5 to 15 feet in depth were affected. Maximum concentrationsmore » of bentazon in groundwater were less than seven parts per million. To identify potentially feasible remediation alternatives, the environmental assessment data, available research, and cost effectiveness were reviewed. After consideration of a preliminary list of alternatives, only two potentially feasible alternatives could be identified. Groundwater pumping, the most commonly used remediation alternative, followed by carbon adsorption treatment was identified as was a new innovative alternative known as vegetative transpiration. This alternative relies on the natural transpiration processes of vegetation to bioremediate organic contaminants. Advantages identified during screening suggest that the transpiration method could be the best remediation alternative to address both economic and environmental factors. An experiment to test critical factors of the vegetatived transpiration alternative with bentazon was recommended before a final decision on feasibility can be made.« less

A Pocock Approach to Sequential Meta-Analysis of Clinical Trials

ERIC Educational Resources Information Center

Shuster, Jonathan J.; Neu, Josef

2013-01-01

Three recent papers have provided sequential methods for meta-analysis of two-treatment randomized clinical trials. This paper provides an alternate approach that has three desirable features. First, when carried out prospectively (i.e., we only have the results up to the time of our current analysis), we do not require knowledge of the…

Comparative Effectiveness of Two Sight-Word Reading Interventions for a Student with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Mulé, Christina M.; Volpe, Robert J.; Fefer, Sarah; Leslie, Laurel K.; Luiselli, Jim

2015-01-01

Traditional drill and practice (TDP) and incremental rehearsal (IR) are flashcard drill techniques for teaching sight words to students. Although both have extensive research support, no study to date has compared these methods with children who have autism spectrum disorder (ASD). Utilizing an adaptive alternating treatments design, the present…

Tree thinning treatments alter soil properties, arbuscular mycorrhizal fungi and understory plant communities

Treesearch

Suzanne M. Neal

2007-01-01

Forest management practices designed to reduce fire risk, particularly thinning followed by burning slash piles, can cause below ground disturbance that creates favorable conditions for exotic plant species. Newer fuel-reduction methods, such as mechanical mastication are being examined as potential alternatives to the burning of slash piles. We compared soil...

Endovascular Stent Graft Placement in the Treatment of Ruptured Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta: Case Report and Review of the Literature

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

Dogan, Sozen, E-mail: sozendogan@hotmail.com; Memis, Ahmet, E-mail: ahmemis@yahoo.co; Kale, Arzum, E-mail: arzumkale@kenthospital.com

We report a successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement. This procedure is starting to be accepted as an alternative method to surgery, and we review similar cases in the literature.

Effects of Wait Time When Communicating with Children Who Have Sensory and Additional Disabilities

ERIC Educational Resources Information Center

Johnson, Nicole; Parker, Amy T.

2013-01-01

Introduction: This study utilized wait-time procedures to determine if they are effective in helping children with deafblindness or multiple disabilities that include a visual impairment communicate in their home. Methods: A single subject with an alternating treatment design was used for the study. Zero- to one-second wait time was utilized…

A review of double-diffusion wood preservation suitable for Alaska.

Treesearch

K. Josephine Pavia

2006-01-01

Currently, all treated lumber used in Alaska is imported from the 48 contiguous states and Canada because there are no wood-treating facilities in Alaska. This report explores conventional and alternative wood-treating methods and reviews previous studies and laboratory tests on treated wood. In investigating wood treatment as a possible processing option for Alaska...

Identification of Average Treatment Effects in Social Experiments under Alternative Forms of Attrition

ERIC Educational Resources Information Center

Huber, Martin

2012-01-01

As any empirical method used for causal analysis, social experiments are prone to attrition which may flaw the validity of the results. This article considers the problem of partially missing outcomes in experiments. First, it systematically reveals under which forms of attrition--in terms of its relation to observable and/or unobservable…

26 CFR 1.665(f)-1A - Undistributed capital gain.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TAX (CONTINUED) INCOME TAXES Treatment of Excess Distributions of Trusts Applicable to Taxable Years.... (ii) The amount of taxes imposed on the trust for such year attributable to such gains, as defined in § 1.665(d)-1A, and (iii) In the case of a trust that does not use the alternative method for computing...

Sensitivity of Equated Aggregate Scores to the Treatment of Misbehaving Common Items

ERIC Educational Resources Information Center

Michaelides, Michalis P.

2010-01-01

The delta-plot method (Angoff, 1972) is a graphical technique used in the context of test equating for identifying common items with aberrant changes in their item difficulties across administrations or alternate forms. This brief research report explores the effects on equated aggregate scores when delta-plot outliers are either retained in or…

Alternative right ventricular pacing sites.

PubMed

Łuciuk, Dariusz; Łuciuk, Marek; Gajek, Jacek

2015-01-01

The main adverse effect of chronic stimulation is stimulation-induced heart failure in case of ventricular contraction dyssynchrony. Because of this fact, new techniques of stimulation should be considered to optimize electrotherapy. One of these methods is pacing from alternative right ventricular sites. The purpose of this article is to review currently accumulated data about alternative sites of cardiac pacing. Medline and PubMed bases were used to search English and Polish reports published recently. Recent studies report a deleterious effect of long term apical pacing. It is suggested that permanent apical stimulation, by omitting physiological conduction pattern with His-Purkinie network, may lead to electrical and mechanical dyssynchrony of heart muscle contraction. In the long term this pathological situation can lead to severe heart failure and death. Because of this, scientists began to search for some alternative sites of cardiac pacing to reduce the deleterious effect of stimulation. Based on current accumulated data, it is suggested that the right ventricular outflow tract, right ventricular septum, direct His-bundle or biventricular pacing are better alternatives due to more physiological electrical impulse propagation within the heart and the reduction of the dyssynchrony effect. These methods should preserve a better left ventricular function and prevent the development of heart failure in permanent paced patients. As there is still not enough, long-term, randomized, prospective, cross-over and multicenter studies, further research is required to validate the benefits of using this kind of therapy. The article should pay attention to new sites of cardiac stimulation as a better and safer method of treatment.

Treatment hurts: Lay theories of graded exposure in the treatment of four anxiety disorders

PubMed Central

Furnham, Adrian; Wilson, Emma; Chapman, Amy; Persuad, Raj

2013-01-01

Objective This paper concerned the perceived suffering/side effects caused by various well-known treatments for personal problems. It looked at whether people understood whether potentially painful treatments that confront negative aversive affect were effective or not. Method In total, 106 participants completed a long questionnaire assessing the ‘psychological pain’ ratings of 30 psychotherapy treatments, varying in fear exposure, for four relatively common anxiety disorders: social phobia, agoraphobia, post-traumatic stress disorder, and obsessive compulsive disorder. Results Factor analytic results revealed four clear factors underlying lay efficacy beliefs of psychotherapy interventions, varying in fear exposure: talking therapies, fear confrontation, fear avoidance, and alternative therapies. Talking therapies were rated the most effective across all disorders, but also the most painful. Fear avoidance therapies were rated the least effective and, along with alternative medicine, the least painful. Treatments involving fear exposure were rated the most painful. Regression analysis revealed talking therapies to be rated more efficacious by younger subjects than older subjects. Conclusion Most people seem able to differentiate between the efficacies of interventions for different anxiety disorders and hold consensually held optimistic conceptions about the usefulness of psychotherapy treatments and counseling that involve fear exposure, despite knowledge of the psychophysical side effects that these therapies often entail. They favored talking cures over others, but that may have been due to misleading items in the questionnaire. PMID:26405431

A new conservative-dynamic treatment for the acute ruptured Achilles tendon.

PubMed

Neumayer, Felix; Mouhsine, Elyazid; Arlettaz, Yvan; Gremion, Gérald; Wettstein, Michael; Crevoisier, Xavier

2010-03-01

There is a trend towards surgical treatment of acute ruptured Achilles tendon. While classical open surgical procedures have been shown to restore good functional capacity, they are potentially associated with significant complications like wound infection and paresthesia. Modern mini-invasive surgical techniques significantly reduce these complications and are also associated with good functional results so that they can be considered as the surgical treatment of choice. Nevertheless, there is still a need for conservative alternative and recent studies report good results with conservative treatment in rigid casts or braces. We report the use of a dynamic ankle brace in the conservative treatment of Achilles tendon rupture in a prospective non-randomised study of 57 consecutive patients. Patients were evaluated at an average follow-up time of 5 years using the modified Leppilahti Ankle Score, and the first 30 patients additionally underwent a clinical examination and muscular testing with a Cybex isokinetic dynamometer at 6 and 12 months. We found good and excellent results in most cases. We observed five complete re-ruptures, almost exclusively in case of poor patient's compliance, two partial re-ruptures and one deep venous thrombosis complicated by pulmonary embolism. Although prospective comparison with other modern treatment options is still required, the functional outcome after early ankle mobilisation in a dynamic cast is good enough to ethically propose this method as an alternative to surgical treatment.

A New Green Method for the Quantitative Analysis of Enrofloxacin by Fourier-Transform Infrared Spectroscopy.

PubMed

Rebouças, Camila Tavares; Kogawa, Ana Carolina; Salgado, Hérida Regina Nunes

2018-05-18

Background: A green analytical chemistry method was developed for quantification of enrofloxacin in tablets. The drug, a second-generation fluoroquinolone, was first introduced in veterinary medicine for the treatment of various bacterial species. Objective: This study proposed to develop, validate, and apply a reliable, low-cost, fast, and simple IR spectroscopy method for quantitative routine determination of enrofloxacin in tablets. Methods: The method was completely validated according to the International Conference on Harmonisation guidelines, showing accuracy, precision, selectivity, robustness, and linearity. Results: It was linear over the concentration range of 1.0-3.0 mg with correlation coefficients >0.9999 and LOD and LOQ of 0.12 and 0.36 mg, respectively. Conclusions: Now that this IR method has met performance qualifications, it can be adopted and applied for the analysis of enrofloxacin tablets for production process control. The validated method can also be utilized to quantify enrofloxacin in tablets and thus is an environmentally friendly alternative for the routine analysis of enrofloxacin in quality control. Highlights: A new green method for the quantitative analysis of enrofloxacin by Fourier-Transform Infrared spectroscopy was validated. It is a fast, clean and low-cost alternative for the evaluation of enrofloxacin tablets.

Depopulation of Caged Layer Hens with a Compressed Air Foam System

PubMed Central

Gurung, Shailesh; Hoffman, John; Stringfellow, Kendre; Abi-Ghanem, Daad; Zhao, Dan; Caldwell, David; Lee, Jason; Styles, Darrel; Berghman, Luc; Byrd, James; Farnell, Yuhua; Archer, Gregory

2018-01-01

Simple Summary Reportable diseases, such as avian influenza, spread rapidly among poultry, resulting in the death of a large number of birds. Once such a disease has been diagnosed at a farm, infected and susceptible birds are rapidly killed to prevent the spread of the disease. The methods to eliminate infected caged laying hens are limited. An experiment was conducted to study the effectiveness of foam made from compressed air, water, and soap to kill laying hens in cages. The study found that stress levels of the hens killed using compressed air foam in cages to be similar to the hens killed by carbon dioxide or the negative control. Hens exposed to carbon dioxide died earlier as compared to the foam methods. The authors conclude that application of compressed air foam in cages is an alternative to methods such as gas inhalation and ventilation shutdown to rapidly and humanely kill laying hens during epidemics. Abstract During the 2014–2015 US highly pathogenic avian influenza (HPAI) outbreak, 50.4 million commercial layers and turkeys were affected, resulting in economic losses of $3.3 billion. Rapid depopulation of infected poultry is vital to contain and eradicate reportable diseases like HPAI. The hypothesis of the experiment was that a compressed air foam (CAF) system may be used as an alternative to carbon dioxide (CO2) inhalation for depopulating caged layer hens. The objective of this study was to evaluate corticosterone (CORT) and time to cessation of movement (COM) of hens subjected to CAF, CO2 inhalation, and negative control (NEG) treatments. In Experiment 1, two independent trials were conducted using young and spent hens. Experiment 1 consisted of five treatments: NEG, CO2 added to a chamber, a CO2 pre-charged chamber, CAF in cages, and CAF in a chamber. In Experiment 2, only spent hens were randomly assigned to three treatments: CAF in cages, CO2 added to a chamber, and aspirated foam. Serum CORT levels of young hens were not significantly different among the CAF in cages, CAF in a chamber, NEG control, and CO2 inhalation treatments. However, spent hens subjected to the CAF in a chamber had significantly higher CORT levels than birds in the rest of the treatments. Times to COM of spent hens subjected to CAF in cages and aspirated foam were significantly greater than of birds exposed to the CO2 in a chamber treatment. These data suggest that applying CAF in cages is a viable alternative for layer hen depopulation during a reportable disease outbreak. PMID:29324639

[Perioperative use of medical hypnosis. Therapy options for anaesthetists and surgeons].

PubMed

Hermes, D; Trübger, D; Hakim, S G; Sieg, P

2004-04-01

Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis. Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable. Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.

Evaluation of magnetic resonance signal modification induced by hyaluronic acid therapy in chondromalacia patellae: a preliminary study.

PubMed

Magarelli, N; Palmieri, D; Ottaviano, L; Savastano, M; Barbato, M; Leone, A; Maggialetti, A; Ciampa, F P; Bonomo, L

2008-01-01

Hyaluronic Acid (HA) is an alternative method for the treatment of osteoarthritis (OA), which acts on pain through a double action: anti-inflammatory and synovial fluid (SF) visco-supplementation. Magnetic Resonance Imaging (MRI), utilizing specific sequences, is a valid method for studying the initial phase of chondral damage. The analysis of the data, obtained through the intensity of values taken by positioning Region of Interest (ROIs) within the lesion, determining the differences before and after treatment with HA injected into the knee. The results obtained after six months and one year from the injection were statistically different in respect to those taken before, immediately and after three months of treatment. MRI represents a valid tool to evaluate the grade of chondromalacia patellae and also to follow the cartilage modification induced by HA therapy.

It’s a Matter of Trust: Older African Americans Speak About Their Health Care Encounters

PubMed Central

Hansen, Bryan R.; Hodgson, Nancy A.; Gitlin, Laura N.

2015-01-01

Purpose To examine perceptions of older African Americans’ encounters with health care providers and ways to enhance trust. Method Transcribed semi-structured interviews with African American senior center members were analyzed, using Pattern Coding method. Results Four themes emerged: “Added Insult of Ageism,” “Alternative Remedies,” “Good Providers in a ‘Broken’ System,” and “The Foundation of Trust Is Person Recognition.” Provider behaviors leading to mistrust included erroneously assuming stereotypical preferences and competence, spending inadequate time listening to patients, disregarding patient preferences, and insufficiently explaining treatments. Discussion Of importance to improving trust among older African American patients is valuing individual histories and preferences by reallocating scarce time to person-centered listening, individualizing treatments, more completely explaining interventions, and assuring that patients understand and agree with treatment plans. PMID:25669876

Force Eruption of Mandibular Second Incisor in an 11- Year Old Boy: A Technical Report

PubMed Central

Sobhnamayan, F; Moazami, F; Hamedi, S; Meshki, R

2013-01-01

There is a great challenge in the treatment of deeply fractured and un-restorable teeth among dentists. Orthodontic force eruption is a method of treatment for these teeth to preserve natural root system and periodontal structures. This technical report is a new modification of this procedure presented in an 11- year old boy with deeply fractured left second mandibular incisor. The fractured teeth were treated with root canal therapy and a file #80 was modified to become a hook cemented into the fractured tooth. Anterior teeth were splinted and used as anchorage to help the root extrusion. 1-year follow up of the tooth showed the convenience of the treatment. This simple and low-cost method can be an acceptable alternative to the current high cost techniques, achieving the same results. PMID:24724126

An alternative empirical likelihood method in missing response problems and causal inference.

PubMed

Ren, Kaili; Drummond, Christopher A; Brewster, Pamela S; Haller, Steven T; Tian, Jiang; Cooper, Christopher J; Zhang, Biao

2016-11-30

Missing responses are common problems in medical, social, and economic studies. When responses are missing at random, a complete case data analysis may result in biases. A popular debias method is inverse probability weighting proposed by Horvitz and Thompson. To improve efficiency, Robins et al. proposed an augmented inverse probability weighting method. The augmented inverse probability weighting estimator has a double-robustness property and achieves the semiparametric efficiency lower bound when the regression model and propensity score model are both correctly specified. In this paper, we introduce an empirical likelihood-based estimator as an alternative to Qin and Zhang (2007). Our proposed estimator is also doubly robust and locally efficient. Simulation results show that the proposed estimator has better performance when the propensity score is correctly modeled. Moreover, the proposed method can be applied in the estimation of average treatment effect in observational causal inferences. Finally, we apply our method to an observational study of smoking, using data from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions clinical trial. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Imaging Tumor Response and Tumoral Heterogeneity in Non-Small Cell Lung Cancer Treated With Antiangiogenic Therapy: Comparison of the Prognostic Ability of RECIST 1.1, an Alternate Method (Crabb), and Image Heterogeneity Analysis.

PubMed

Yip, Connie; Tacelli, Nunzia; Remy-Jardin, Martine; Scherpereel, Arnaud; Cortot, Alexis; Lafitte, Jean-Jacques; Wallyn, Frederic; Remy, Jacques; Bassett, Paul; Siddique, Musib; Cook, Gary J R; Landau, David B; Goh, Vicky

2015-09-01

We aimed to assess computed tomography (CT) intratumoral heterogeneity changes, and compared the prognostic ability of the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, an alternate response method (Crabb), and CT heterogeneity in non-small cell lung cancer treated with chemotherapy with and without bevacizumab. Forty patients treated with chemotherapy (group C) or chemotherapy and bevacizumab (group BC) underwent contrast-enhanced CT at baseline and after 1, 3, and 6 cycles of chemotherapy. Radiologic response was assessed using RECIST 1.1 and an alternate method. CT heterogeneity analysis generating global and locoregional parameters depicting tumor image spatial intensity characteristics was performed. Heterogeneity parameters between the 2 groups were compared using the Mann-Whitney U test. Associations between heterogeneity parameters and radiologic response with overall survival were assessed using Cox regression. Global and locoregional heterogeneity parameters changed with treatment, with increased tumor heterogeneity in group BC. Entropy [group C: median -0.2% (interquartile range -2.2, 1.7) vs. group BC: 0.7% (-0.7, 3.5), P=0.10] and busyness [-27.7% (-62.2, -5.0) vs. -11.5% (-29.1, 92.4), P=0.10] showed a greater reduction in group C, whereas uniformity [1.9% (-8.0, 9.8) vs. -5.0% (-13.9, 5.6), P=0.10] showed a relative increase after 1 cycle but did not reach statistical significance. Two (9%) and 1 (6%) additional responders were identified using the alternate method compared with RECIST in group C and group BC, respectively. Heterogeneity parameters were not significant prognostic factors. The alternate response method described by Crabb identified more responders compared with RECIST. However, both criteria and baseline imaging heterogeneity parameters were not prognostic of survival.

Treatment Effect Estimation Using Nonlinear Two-Stage Instrumental Variable Estimators: Another Cautionary Note.

PubMed

Chapman, Cole G; Brooks, John M

2016-12-01

To examine the settings of simulation evidence supporting use of nonlinear two-stage residual inclusion (2SRI) instrumental variable (IV) methods for estimating average treatment effects (ATE) using observational data and investigate potential bias of 2SRI across alternative scenarios of essential heterogeneity and uniqueness of marginal patients. Potential bias of linear and nonlinear IV methods for ATE and local average treatment effects (LATE) is assessed using simulation models with a binary outcome and binary endogenous treatment across settings varying by the relationship between treatment effectiveness and treatment choice. Results show that nonlinear 2SRI models produce estimates of ATE and LATE that are substantially biased when the relationships between treatment and outcome for marginal patients are unique from relationships for the full population. Bias of linear IV estimates for LATE was low across all scenarios. Researchers are increasingly opting for nonlinear 2SRI to estimate treatment effects in models with binary and otherwise inherently nonlinear dependent variables, believing that it produces generally unbiased and consistent estimates. This research shows that positive properties of nonlinear 2SRI rely on assumptions about the relationships between treatment effect heterogeneity and choice. © Health Research and Educational Trust.

Microbiological Safety of Animal Wastes Processed by Physical Heat Treatment: An Alternative To Eliminate Human Pathogens in Biological Soil Amendments as Recommended by the Food Safety Modernization Act.

PubMed

Chen, Zhao; Jiang, Xiuping

2017-03-01

Animal wastes have high nutritional value as biological soil amendments of animal origin for plant cultivation in sustainable agriculture; however, they can be sources of some human pathogens. Although composting is an effective way to reduce pathogen levels in animal wastes, pathogens may still survive under certain conditions and persist in the composted products, which potentially could lead to fresh produce contamination. According to the U.S. Food and Drug Administration Food Safety Modernization Act, alternative treatments are recommended for reducing or eliminating human pathogens in raw animal manure. Physical heat treatments can be considered an effective method to inactivate pathogens in animal wastes. However, microbial inactivation in animal wastes can be affected by many factors, such as composition of animal wastes, type and physiological stage of the tested microorganism, and heat source. Following some current processing guidelines for physical heat treatments may not be adequate for completely eliminating pathogens from animal wastes. Therefore, this article primarily reviews the microbiological safety and economic value of physically heat-treated animal wastes as biological soil amendments.

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

PubMed

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

2010-01-01

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

Development of phantom and methodology for 3D and 4D dose intercomparisons for advanced lung radiotherapy

NASA Astrophysics Data System (ADS)

Caloz, Misael; Kafrouni, Marilyne; Leturgie, Quentin; Corde, Stéphanie; Downes, Simon; Lehmann, Joerg; Thwaites, David

2015-01-01

There are few reported intercomparisons or audits of combinations of advanced radiotherapy methods, particularly for 4D treatments. As part of an evaluation of the implementation of advanced radiotherapy technology, a phantom and associated methods, initially developed for in-house commissioning and QA of 4D lung treatments, has been developed further with the aim of using it for end-to-end dose intercomparison of 4D treatment planning and delivery. The respiratory thorax phantom can house moving inserts with variable speed (breathing rate) and motion amplitude. In one set-up mode it contains a small ion chamber for point dose measurements, or alternatively it can hold strips of radiochromic film to measure dose distributions. Initial pilot and feasibility measurements have been carried out in one hospital to thoroughly test the methods and procedures before using it more widely across a range of hospitals and treatment systems. Overall, the results show good agreement between measured and calculated doses and distributions, supporting the use of the phantom and methodology for multi-centre intercomparisons. However, before wider use, refinements of the method and analysis are currently underway particularly for the film measurements.

Management of a new isolated metastasis during sunitinib treatment in renal cell carcinoma patients: a lesson from two cases.

PubMed

Shablak, Alaaeldin; O'Dwyer, Jackie; Hawkins, Robert; Board, Ruth

2011-01-01

Metastatic renal cell carcinoma (mRCC) is a difficult to treat malignancy and currently Sunitinib is a standard of care first-line therapy. A new metastasis during the treatment is considered a sign of drug failure and alternative therapeutic methods should be tried. Here, we report 2 cases of newly diagnosed isolated metastasis during Sunitinib treatment of mRCC patients. Our management plan included local palliative therapy to the lesion followed by recommencing of Sunitinib. This resulted in a good symptomatic relief locally as well as good overall control of the disease. Copyright © 2010 S. Karger AG, Basel.

Assessment of NASA Dual Microstructure Heat Treatment Method for Multiple Forging Batch Heat Treatment

NASA Technical Reports Server (NTRS)

Gayda, John (Technical Monitor); Lemsky, Joe

2004-01-01

NASA dual microstructure heat treatment technology previously demonstrated on single forging heat treat batches of a generic disk shape was successfully demonstrated on a multiple disk batch of a production shape component. A group of four Rolls-Royce Corporation 3rd Stage AE2100 forgings produced from alloy ME209 were successfully dual microstructure heat treated as a single heat treat batch. The forgings responded uniformly as evidenced by part-to-part consistent thermocouple recordings and resultant macrostructures, and from ultrasonic examination. Multiple disk DMHT processing offers a low cost alternative to other published dual microstructure processing techniques.

Endodontic therapy of a mandibular third molar with 5 canals: a case report.

PubMed

Silberman, Adrian; Heilborn, Carlos; Cohenca, Nestor

2009-06-01

Endodontic treatment of third molars often becomes part of comprehensive treatment plans, as it represents a more conservative and less invasive approach than its therapeutic alternatives. The frequency of anatomic variations in mandibular molars, particularly root canal configuration, requires 2 periapical radiographs from different angles. Upon reading and interpretation of the radiographs, the clinician should consider the anatomy and level of difficulty of the endodontic procedure and refer the patient to an endodontist, if deemed necessary. The present article discusses the successful treatment and preservation of a mandibular third molar with 5 root canals, as well as methods for its clinical management.

[Surgical treatment of varicose vein using the tumescent technique of local anesthesia].

PubMed

Bjelanović, Zoran; Leković, Ivan; Drasković, Miroljub; Misović, Sidor; Veljović, Milić

2011-02-01

Tumescent local anesthesia (TLA) is a technique for local and regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large amounts of a diluted solution of local anesthetic. This technique is applied in plastic surgery, liposuction as well as in dermatology for the entire series of dermatocosmetic procedures. The purpose of this study was to determine efficiency of surgical treatment of varicose vein using TLA as an alternative method to a conventional treatment for varicose vein. Seventy-two patients with varicose vein were enrolled in the study. All of them were operated on applying TLA, from April 2008 to November 2009. TLA solution consisted of local anesthetics was used. TLA solutions used were: 1% prilocaine-chloride with adrenaline supplement, and 2% lidocaine-chloride and adrenaline in concentration of 0.1%-0.4%. Out of 72 patients, we stripped great saphenous vein from 60 patient and did varicectomy as well as ligation of insufficiently perforating veins. In 12 patients we did partial varicectomy and ligation of perforating veins. There were not any patients with the need for continued surgery, as well as bringing patient to the general anesthesia due to pain during the surgery. One patient came for postoperative opening wound in the groin, one for infection of the wound and one for the formation of seroma in the groin. There were not any allergic reactions or systemic complications in the operations as well as postoperative period. Postoperatively, all the patients were treated with compressive elastic bandage during the period of 6 weeks as well as anticoagulation prophylaxis in the duration of 5 days. Surgery of varicose veins with implementation of TLA is easy and safe method with very low percentage of complications and unwanted effects. It is a good alternative method to classic surgery of varicose veins. The economic aspect is a very important component because the cost of this method is significantly lower than that of a classical surgical treatment of varicose veins.

Single-Tooth Osteotomy Combined Wide Linear Corticotomy Under Local Anesthesia for Correcting Anterior Protrusion With Ectopically Erupted Canine.

PubMed

Iskenderoglu, Nur Serife; Choi, Byung-Joon; Seo, Kyung Won; Lee, Yeon-Ji; Lee, Baek-Soo; Kim, Seong-Hun

2017-01-01

This article presents the alternative surgical treatments of both anterior protrusion by carrying out retraction on mandibular anterior fragment, meanwhile applying retraction force on maxilla anterior teeth and ectopically erupted canine with using platelet-rich fibrin (PRF). Anterior segmental osteotomy was combined with linear corticotomy under local anesthesia. The correction of right ectopic canine was achieved through 2 stages. First, dento-osseous osteotomy on palatal side was performed. Then second osteotomy with immediate manual repositioning of the canine with concomitant first premolar extraction was enhanced with PRF, which was prepared by centrifuging patient's blood, applied into buccal side of high canine during osteotomy. Mandibular retraction was accomplished by anterior segmental osteotomy. Single-tooth osteotomy is a more effective surgical method for ankylosed or ectopically erupted tooth in orthodontic treatment. It can reduce the total orthodontic treatment time and root resorption, 1 common complication. Significant improved bone formation was seen with the addition of PRF on noncritical size defects in the animal model. It is reasonable to think that PRF can promote bone regeneration. So early bone formation also can reduce the complication such as postoperative infection. As an alternative to anterior protrusion and ectopically erupted canine treatment, segmental osteotomy and corticotomy combined platelet-rich plasma can enhance orthodontic treatment outcome.

Behavioral Economic Predictors of Overweight Children’s Weight Loss

PubMed Central

Best, John R.; Theim, Kelly R.; Gredysa, Dana M.; Stein, Richard I.; Welch, R. Robinson; Saelens, Brian E.; Perri, Michael G.; Schechtman, Kenneth B.; Epstein, Leonard H.; Wilfley, Denise E.

2012-01-01

Objective Our goal was to determine whether behavioral economic constructs—including impulsivity (i.e., steep discounting of delayed food and monetary rewards), the relative reinforcing value of food (RRVfood), and environmental enrichment (i.e., the presence of alternatives to unhealthy foods in the home and neighborhood environments)—are significant pretreatment predictors of overweight children’s weight loss within family-based treatment. Method Overweight children (N = 241; ages 7–12 years; 63% female; 65% non-Hispanic White) enrolled in a 16-week family-based obesity treatment with at least one parent. At baseline, children completed a task to assess RRVfood and delay discounting measures of snack foods and money to assess impulsivity. Parents completed questionnaires to assess environmental enrichment. Results Children who found food highly reinforcing and steeply discounted future food rewards at baseline showed a blunted response to treatment compared with children without this combination of risk factors. High environmental enrichment was associated with treatment success only among children who did not find food highly reinforcing. Monetary discounting rate predicted weight loss, regardless of children’s level of RRVfood. Conclusions Investigation is warranted into novel approaches to obesity treatment that target underlying impulsivity and RRVfood. Enriching the environment with alternatives to unhealthy eating may facilitate weight loss, especially for children with low RRVfood. PMID:22924332

Mind-body practices: an alternative, drug-free treatment for smoking cessation? A systematic review of the literature

PubMed Central

Carim-Todd, Laura; Mitchell, Suzanne H.; Oken, Barry S.

2013-01-01

Objective The limited success of current smoking cessation therapies encourages research into new treatment strategies. Mind-body practices such as yoga and meditation have the potential to aid smoking cessation and become an alternative drug-free treatment option. The aim of this article is to assess the efficacy of yoga and other meditation-based interventions for smoking cessation, to identify the challenges of clinical trials applying mind-body treatments, and to outline directions for future research on these types of mind-body therapies to assist in smoking cessation. Method A systematic review of the scientific literature. Results Fourteen clinical trials met the inclusion criteria defined for this review. Each article was reviewed thoroughly, and evaluated for quality, design, and methodology. Although primary outcomes differed between studies, the fourteen articles, most with some limitations, reported promising effects supporting further investigation of the use of these practices to improve smoking cessation. Conclusions The literature supports yoga and meditation-based therapies as candidates to assist smoking cessation. However, the small number of studies available and associated methodological problems require more clinical trials with larger sample sizes and carefully monitored interventions to determine rigorously if yoga and meditation are effective treatments. PMID:23664122

Generalization of the disruptive effects of alternative stimuli when combined with target stimuli in extinction.

PubMed

Podlesnik, Christopher A; Miranda-Dukoski, Ludmila; Jonas Chan, C K; Bland, Vikki J; Bai, John Y H

2017-09-01

Differential-reinforcement treatments reduce target problem behavior in the short term but at the expense of making it more persistent long term. Basic and translational research based on behavioral momentum theory suggests that combining features of stimuli governing an alternative response with the stimuli governing target responding could make target responding less persistent. However, changes to the alternative stimulus context when combining alternative and target stimuli could diminish the effectiveness of the alternative stimulus in reducing target responding. In an animal model with pigeons, the present study reinforced responding in the presence of target and alternative stimuli. When combining the alternative and target stimuli during extinction, we altered the alternative stimulus through changes in line orientation. We found that (1) combining alternative and target stimuli in extinction more effectively decreased target responding than presenting the target stimulus on its own; (2) combining these stimuli was more effective in decreasing target responding trained with lower reinforcement rates; and (3) changing the alternative stimulus reduced its effectiveness when it was combined with the target stimulus. Therefore, changing alternative stimuli (e.g., therapist, clinical setting) during behavioral treatments that combine alternative and target stimuli could reduce the effectiveness of those treatments in disrupting problem behavior. © 2017 Society for the Experimental Analysis of Behavior.

A multidisciplinary approach to scars: a narrative review

PubMed Central

Zanier, Emiliano; Bordoni, Bruno

2015-01-01

The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm – both manual and psychophysical relaxing techniques – and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines. PMID:26316774

Econometric analysis to evaluate the effect of community-based health insurance on reducing informal self-care in Burkina Faso

PubMed Central

Robyn, Paul Jacob; Hill, Allan; Liu, Yuanli; Souares, Aurélia; Savadogo, Germain; Sié, Ali; Sauerborn, Rainer

2012-01-01

Objective This study examines the role of community-based health insurance (CBHI) in influencing health-seeking behaviour in Burkina Faso, West Africa. Community-based health insurance was introduced in Nouna district, Burkina Faso, in 2004 with the goal to improve access to contracted providers based at primary- and secondary-level facilities. The paper specifically examines the effect of CBHI enrolment on reducing the prevalence of seeking modern and traditional methods of self-treatment as the first choice in care among the insured population. Methods Three stages of analysis were adopted to measure this effect. First, propensity score matching was used to minimize the observed baseline differences between the insured and uninsured populations. Second, through matching the average treatment effect on the treated, the effect of insurance enrolment on health-seeking behaviour was estimated. Finally, multinomial logistic regression was applied to model demand for available health care options, including no treatment, traditional self-treatment, modern self-treatment, traditional healers and facility-based care. Results For the first choice in care sought, there was no significant difference in the prevalence of self-treatment among the insured and uninsured populations, reaching over 55% for each group. When comparing the alternative option of no treatment, CBHI played no significant role in reducing the demand for self-care (either traditional or modern) or utilization of traditional healers, while it did significantly increase consumption of facility-based care. The average treatment effect on the treated was insignificant for traditional self-care, modern self-care and traditional healer, but was significant with a positive effect for use of facility care. Discussion While CBHI does have a positive impact on facility care utilization, its effect on reducing the prevalence of self-care is limited. The policy recommendations for improving the CBHI scheme’s responsiveness to population health care demand should incorporate community-based initiatives that offer attractive and appropriate alternatives to self-care. PMID:21414993

Safety evaluation of right turns followed by U-turns as an alternative to direct left turns : conflict analysis, Vol. 2

DOT National Transportation Integrated Search

2001-10-01

This project evaluated the safety and operational impacts of two alternative left-turn treatments from driveways/side streets. The two treatments were (1) direct left turns and (2) right turns followed by U-turns. Safety analyses of the alternatives ...

76 FR 21673 - Alternative Efficiency Determination Methods and Alternate Rating Methods

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-18

... EERE-2011-BP-TP-00024] RIN 1904-AC46 Alternative Efficiency Determination Methods and Alternate Rating Methods AGENCY: Office of Energy Efficiency and Renewable Energy, Department of Energy. ACTION: Notice of... and data related to the use of computer simulations, mathematical methods, and other alternative...

27 CFR 19.26 - Alternate methods or procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Alternate methods or... Provisions Alternate Methods Or Procedures and Experimental Operations § 19.26 Alternate methods or procedures. (a) General. The appropriate TTB officer may approve the use of an alternate method or procedure...

48 CFR 32.503-9 - Liquidation rates-alternate method.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-alternate method. 32.503-9 Section 32.503-9 Federal Acquisition Regulations System FEDERAL ACQUISITION... Liquidation rates—alternate method. (a) The liquidation rate determined under 32.503-8 shall apply throughout... the alternate method in this 32.503-9. The objective of the alternate liquidation rate method is to...

48 CFR 32.503-9 - Liquidation rates-alternate method.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-alternate method. 32.503-9 Section 32.503-9 Federal Acquisition Regulations System FEDERAL ACQUISITION... Liquidation rates—alternate method. (a) The liquidation rate determined under 32.503-8 shall apply throughout... the alternate method in this 32.503-9. The objective of the alternate liquidation rate method is to...

Musical training as an alternative and effective method for neuro-education and neuro-rehabilitation

PubMed Central

François, Clément; Grau-Sánchez, Jennifer; Duarte, Esther; Rodriguez-Fornells, Antoni

2015-01-01

In the last decade, important advances in the field of cognitive science, psychology, and neuroscience have largely contributed to improve our knowledge on brain functioning. More recently, a line of research has been developed that aims at using musical training and practice as alternative tools for boosting specific perceptual, motor, cognitive, and emotional skills both in healthy population and in neurologic patients. These findings are of great hope for a better treatment of language-based learning disorders or motor impairment in chronic non-communicative diseases. In the first part of this review, we highlight several studies showing that learning to play a musical instrument can induce substantial neuroplastic changes in cortical and subcortical regions of motor, auditory and speech processing networks in healthy population. In a second part, we provide an overview of the evidence showing that musical training can be an alternative, low-cost and effective method for the treatment of language-based learning impaired populations. We then report results of the few studies showing that training with musical instruments can have positive effects on motor, emotional, and cognitive deficits observed in patients with non-communicable diseases such as stroke or Parkinson Disease. Despite inherent differences between musical training in educational and rehabilitation contexts, these results favor the idea that the structural, multimodal, and emotional properties of musical training can play an important role in developing new, creative and cost-effective intervention programs for education and rehabilitation in the next future. PMID:25972820

Musical training as an alternative and effective method for neuro-education and neuro-rehabilitation.

PubMed

François, Clément; Grau-Sánchez, Jennifer; Duarte, Esther; Rodriguez-Fornells, Antoni

2015-01-01

In the last decade, important advances in the field of cognitive science, psychology, and neuroscience have largely contributed to improve our knowledge on brain functioning. More recently, a line of research has been developed that aims at using musical training and practice as alternative tools for boosting specific perceptual, motor, cognitive, and emotional skills both in healthy population and in neurologic patients. These findings are of great hope for a better treatment of language-based learning disorders or motor impairment in chronic non-communicative diseases. In the first part of this review, we highlight several studies showing that learning to play a musical instrument can induce substantial neuroplastic changes in cortical and subcortical regions of motor, auditory and speech processing networks in healthy population. In a second part, we provide an overview of the evidence showing that musical training can be an alternative, low-cost and effective method for the treatment of language-based learning impaired populations. We then report results of the few studies showing that training with musical instruments can have positive effects on motor, emotional, and cognitive deficits observed in patients with non-communicable diseases such as stroke or Parkinson Disease. Despite inherent differences between musical training in educational and rehabilitation contexts, these results favor the idea that the structural, multimodal, and emotional properties of musical training can play an important role in developing new, creative and cost-effective intervention programs for education and rehabilitation in the next future.

Complementary and Alternative Medicine (CAM) Treatments and Pediatric Psychopharmacology

ERIC Educational Resources Information Center

Rey, Joseph M.; Walter, Garry; Soh, Nerissa

2008-01-01

Children and adolescents often use complementary and alternative medicine (CAM) treatments outside their indications, particularly to lose weight. Some of the herbal remedies and dietary supplements that may of relevance for psychopharmacological practice are discussed with respect to CAM treatments.

Laryngeal debridement: an alternative treatment for a laryngopyocele presenting with severe airway obstruction.

PubMed

Fraser, L; Pittore, B; Frampton, S; Brennan, P; Puxeddu, R

2011-04-01

The laryngocele is an abnormal saccular dilatation of the ventricle of Morgagni, which maintains its communication with the laryngeal vestibule. Three types of laryngoceles have been described: internal, external, and combined or mixed in relation to the position of the sac with respect to the thyrohyoid membrane. If the laryngocele becomes obstructed and infected it leads to the so-called laryngopyocele which, although a rare disease (8% of laryngoceles), can become an emergency causing severe airway obstruction needing urgent management, even tracheostomy. An alternative method is presented of emergency management of an internal laryngopyocele causing severe airway obstruction using a laryngeal microdebrider and avoiding tracheostomy.

Evolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.

PubMed

Carpenter, Christopher R; Platts-Mills, Timothy F

2013-02-01

Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care. Copyright © 2013 Elsevier Inc. All rights reserved.

Development and evaluation of N-naphthyl-N,O-succinyl chitosan micelles containing clotrimazole for oral candidiasis treatment.

PubMed

Tonglairoum, Prasopchai; Woraphatphadung, Thisirak; Ngawhirunpat, Tanasait; Rojanarata, Theerasak; Akkaramongkolporn, Prasert; Sajomsang, Warayuth; Opanasopit, Praneet

2017-03-01

Clotrimazole (CZ)-loaded N-naphthyl-N,O-succinyl chitosan (NSCS) micelles have been developed as an alternative for oral candidiasis treatment. NSCS was synthesized by reductive N-amination and N,O-succinylation. CZ was incorporated into the micelles using various methods, including the dropping method, the dialysis method, and the O/W emulsion method. The size and morphology of the CZ-loaded micelles were characterized using dynamic light scattering measurements (DLS) and a transmission electron microscope (TEM), respectively. The drug entrapment efficiency, loading capacity, release characteristics, and antifungal activity against Candida albicans were also evaluated. The CZ-loaded micelles prepared using different methods differed in the size of micelles. The micelles ranged in size from 120 nm to 173 nm. The micelles prepared via the O/W emulsion method offered the highest percentage entrapment efficiency and loading capacity. The CZ released from the CZ-loaded micelles at much faster rate compared to CZ powder. The CZ-loaded NSCS micelles can significantly hinder the growth of Candida cells after contact. These CZ-loaded NSCS micelles offer great antifungal activity and might be further developed to be a promising candidate for oral candidiasis treatment.

Complementary therapy.

PubMed

1998-01-01

In developing countries with little access to antiviral therapy, there is evidence that counseling and adopting a health lifestyle may delay the progression of AIDS. In India, some doctors have reported that of 460 persons counseled on lifestyle, 85 percent had CD4 counts over 500. The lifestyle changes included maintaining a positive attitude, yoga, adhering to a balanced vegetarian diet with vitamin supplementation, minimum medication use, and not using tobacco. It is noted that these "treatment" methods are not considered alternative medicine, since they are the main source of treatment in some developing countries.

Effect of high pressure treatment on the characteristics of a model emulsion

NASA Astrophysics Data System (ADS)

Denavaut, Maxence; Verret, Catherine; El Moueffak, Abdelhamid; Largeteau, Alain; Quéveau, Delphine; de Lamballerie, Marie

2014-10-01

The aim of this study was to investigate the use of HP (high pressure) technology as a possible alternative method for decontamination of non-food medium. HP (500 MPa) did not modify significantly the physicochemical characteristics of a model non-food emulsion. A 10 min HP treatment inactivated totally Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Aspergillus niger and Candida albicans even if all the five microorganisms were inoculated together, regardless of the initial load. No recovery was observed until six months of storage at 25°C.

Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report.

PubMed

Mohd Rizal, M Y; Kosai, N R; Sutton, P A; Rozman, Z; Razman, J; Harunarashid, H; Das, S

2013-01-01

Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.

Ballast Water Treatment, U.S. Great Lakes Bulk Carrier Engineering and Cost Study. Volume 2: Analysis of On-Board Treatment Methods, Alternative Ballast Water Management Practices, and Implementation Costs

DTIC Science & Technology

2013-11-01

flushing filter, disinfection with injected chlorine dioxide (chlorine dioxide is generated onboard from two component chemicals, sulfuric acid...Management System 400 80 250-8000 (10000) Sulfuric Acid and Purate for ClO2 generation Yes 0.005-0.028 8-18 Decreased sediment, potential corrosion...feed chemicals, Purate and sulfuric acid. 5. Operational and Maintenance Cost: Estimated operating and maintenance cost is $80/1000 m3 of ballast

Towards better environmental performance of wastewater sludge treatment using endpoint approach in LCA methodology.

PubMed

Alyaseri, Isam; Zhou, Jianpeng

2017-03-01

The aim of this study is to use the life cycle assessment method to measure the environmental performance of the sludge incineration process in a wastewater treatment plant and to propose an alternative that can reduce the environmental impact. To show the damages caused by the treatment processes, the study aimed to use an endpoint approach in evaluating impacts on human health, ecosystem quality, and resources due to the processes. A case study was taken at Bissell Point Wastewater Treatment Plant in Saint Louis, Missouri, U.S. The plant-specific data along with literature data from technical publications were used to build an inventory, and then analyzed the environmental burdens from sludge handling unit in the year 2011. The impact assessment method chosen was ReCipe 2008. The existing scenario (dewatering-multiple hearth incineration-ash to landfill) was evaluated and three alternative scenarios (fluid bed incineration and anaerobic digestion with and without land application) with energy recovery from heat or biogas were proposed and analyzed to find the one with the least environmental impact. The existing scenario shows that the most significant impacts are related to depletion in resources and damage to human health. These impacts mainly came from the operation phase (electricity and fuel consumption and emissions related to combustion). Alternatives showed better performance than the existing scenario. Using ReCipe endpoint methodology, and among the three alternatives tested, the anaerobic digestion had the best overall environmental performance. It is recommended to convert to fluid bed incineration if the concerns were more about human health or to anaerobic digestion if the concerns were more about depletion in resources. The endpoint approach may simplify the outcomes of this study as follows: if the plant is converted to fluid bed incineration, it could prevent an average of 43.2 DALYs in human life, save 0.059 species in the area from extinction, and make a 62% reduction in the plant's current expenses needed by future generations to extract resources per year. At the same time it may prevent 36.1 DALYs in humans, save 0.157 species, and make a 101% reduction in current expenses on resources per year, if converting to anaerobic digestion.

Various Strategies for Pain-Free Root Canal Treatment

PubMed Central

Parirokh, Masoud; V. Abbott, Paul

2014-01-01

Introduction: Achieving successful anesthesia and performing pain-free root canal treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose. The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases. Materials and Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion. Results: Numerous studies investigated to pain management during root canal treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region. Conclusion: According to most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia. PMID:24396370

An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: a sequenced treatment alternatives to relieve depression trial report.

PubMed

Rush, A John; Bernstein, Ira H; Trivedi, Madhukar H; Carmody, Thomas J; Wisniewski, Stephen; Mundt, James C; Shores-Wilson, Kathy; Biggs, Melanie M; Woo, Ada; Nierenberg, Andrew A; Fava, Maurizio

2006-03-15

Nine DSM-IV-TR criterion symptom domains are evaluated to diagnose major depressive disorder (MDD). The Quick Inventory of Depressive Symptomatology (QIDS) provides an efficient assessment of these domains and is available as a clinician rating (QIDS-C16), a self-report (QIDS-SR16), and in an automated, interactive voice response (IVR) (QIDS-IVR16) telephone system. This report compares the performance of these three versions of the QIDS and the 17-item Hamilton Rating Scale for Depression (HRSD17). Data were acquired at baseline and exit from the first treatment step (citalopram) in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Outpatients with nonpsychotic MDD who completed all four ratings within +/-2 days were identified from the first 1500 STAR*D subjects. Both item response theory and classical test theory analyses were conducted. The three methods for obtaining QIDS data produced consistent findings regarding relationships between the nine symptom domains and overall depression, demonstrating interchangeability among the three methods. The HRSD17, while generally satisfactory, rarely utilized the full range of item scores, and evidence suggested multidimensional measurement properties. In nonpsychotic MDD outpatients without overt cognitive impairment, clinician assessment of depression severity using either the QIDS-C16 or HRSD17 may be successfully replaced by either the self-report or IVR version of the QIDS.

Selecting forest residue treatment alternatives using goal programming.

Treesearch

Bruce B. Bare; Brian F. Anholt

1976-01-01

The use of goal programing for selecting forest residue treatment alternatives within a multiple goal framework is described. The basic features of goal programing are reviewed and illustrated with a hypothetical problem involving the selection of residue treatments for 10 cutting units. Twelve residue-regeneration treatment combinations are evaluated by using physical...

Alternative prosthodontic-based treatment of a patient with hypocalcified type Amelogenesis Imperfecta.

PubMed

Jivanescu, Anca; Miglionico, Antonio; Barua, Souman; Hategan, Simona Ioana

2017-07-01

The Amelogenesis Imperfecta is associated with malocclusion and usually requires an interdisciplinary treatment. Due to the patient's refusal of orthodontic treatment, prosthodontics-based treatments alternative was considered and planned. The patient was treated with zirconia-based fixed partial dentures, which resulted in improved occlusion, better oral health, and improved esthetic appearance.

Alternative and Integrative Medicine

MedlinePlus

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

Comparison of alternative flue gas dry treatment technologies in waste-to-energy processes.

PubMed

Dal Pozzo, Alessandro; Antonioni, Giacomo; Guglielmi, Daniele; Stramigioli, Carlo; Cozzani, Valerio

2016-05-01

Acid gases such as HCl and SO2 are harmful both for human health and ecosystem integrity, hence their removal is a key step of the flue gas treatment of Waste-to-Energy (WtE) plants. Methods based on the injection of dry sorbents are among the Best Available Techniques for acid gas removal. In particular, systems based on double reaction and filtration stages represent nowadays an effective technology for emission control. The aim of the present study is the simulation of a reference two-stage (2S) dry treatment system performance and its comparison to three benchmarking alternatives based on single stage sodium bicarbonate injection. A modelling procedure was applied in order to identify the optimal operating configuration of the 2S system for different reference waste compositions, and to determine the total annual cost of operation. Taking into account both operating and capital costs, the 2S system appears the most cost-effective solution for medium to high chlorine content wastes. A Monte Carlo sensitivity analysis was carried out to assess the robustness of the results. Copyright © 2016. Published by Elsevier Ltd.

Doubly robust nonparametric inference on the average treatment effect.

PubMed

Benkeser, D; Carone, M; Laan, M J Van Der; Gilbert, P B

2017-12-01

Doubly robust estimators are widely used to draw inference about the average effect of a treatment. Such estimators are consistent for the effect of interest if either one of two nuisance parameters is consistently estimated. However, if flexible, data-adaptive estimators of these nuisance parameters are used, double robustness does not readily extend to inference. We present a general theoretical study of the behaviour of doubly robust estimators of an average treatment effect when one of the nuisance parameters is inconsistently estimated. We contrast different methods for constructing such estimators and investigate the extent to which they may be modified to also allow doubly robust inference. We find that while targeted minimum loss-based estimation can be used to solve this problem very naturally, common alternative frameworks appear to be inappropriate for this purpose. We provide a theoretical study and a numerical evaluation of the alternatives considered. Our simulations highlight the need for and usefulness of these approaches in practice, while our theoretical developments have broad implications for the construction of estimators that permit doubly robust inference in other problems.

Consistently estimating absolute risk difference when translating evidence to jurisdictions of interest.

PubMed

Eckermann, Simon; Coory, Michael; Willan, Andrew R

2011-02-01

Economic analysis and assessment of net clinical benefit often requires estimation of absolute risk difference (ARD) for binary outcomes (e.g. survival, response, disease progression) given baseline epidemiological risk in a jurisdiction of interest and trial evidence of treatment effects. Typically, the assumption is made that relative treatment effects are constant across baseline risk, in which case relative risk (RR) or odds ratios (OR) could be applied to estimate ARD. The objective of this article is to establish whether such use of RR or OR allows consistent estimates of ARD. ARD is calculated from alternative framing of effects (e.g. mortality vs survival) applying standard methods for translating evidence with RR and OR. For RR, the RR is applied to baseline risk in the jurisdiction to estimate treatment risk; for OR, the baseline risk is converted to odds, the OR applied and the resulting treatment odds converted back to risk. ARD is shown to be consistently estimated with OR but changes with framing of effects using RR wherever there is a treatment effect and epidemiological risk differs from trial risk. Additionally, in indirect comparisons, ARD is shown to be consistently estimated with OR, while calculation with RR allows inconsistency, with alternative framing of effects in the direction, let alone the extent, of ARD. OR ensures consistent calculation of ARD in translating evidence from trial settings and across trials in direct and indirect comparisons, avoiding inconsistencies from RR with alternative outcome framing and associated biases. These findings are critical for consistently translating evidence to inform economic analysis and assessment of net clinical benefit, as translation of evidence is proposed precisely where the advantages of OR over RR arise.

[A systematic review of the effectiveness of alternative weight-loss products' ingredients].

PubMed

de Lira-García, Cynthia; Souto-Gallardo, María; Bacardí-Gascón, Monserrat; Jiménez-Cruz, Arturo

2008-01-01

The high demand for obesity treatment and conventional therapies' lack of effectiveness increases the use of alternative products. This study was aimed at assessing evidence from randomised clinical trials regarding the effectiveness of alternative weight-loss products' ingredients. A survey was conducted in Ensenada, Baja California, to assess the frequency of consuming alternative products used for weight reduction. The ingredients in the products most in demand were included in this review. The Pubmed database was searched for all randomised clinical trial papers including these ingredients and assessing weight loss. Thirty-six percent of the subjects questioned had used alternative methods for weight-loss, 83% of them being women. The most frequently used products were shakes, tea, pills and flaxseed/linseed. Sixteen randomised clinical trials using four ingredients were used: Garcinia cambogia, green tea, L-carnitina and flaxseed. Only two studies (green tea and Garcinia cambogia) showed significant weight-loss (25%) amongst control and experimental groups. There was no significant difference between the groups in the studies regarding L-carnitina and flaxseed. There is a lack of evidence regarding quality studies justifying the use of alternative products for weight loss.

Non-Pharmacological Treatments for ADHD in Youth

PubMed Central

Sharma, Anup; Gerbarg, Patricia L.; Brown, Richard P.

2016-01-01

Background Complementary and alternative medicine (CAM) in psychiatry or integrative psychiatry covers a wide range of biological, psychological and mind-body treatments that enhance standard medical practices and patient outcomes. While CAM approaches are popular amongst patients in their practice as well as in self-report because of their ease of use, health professionals have received limited education in these interventions and often are unaware of their patients’ use of CAM treatments. Method This overview highlights evidence-based CAM treatments for attention deficit hyperactivity disorder (ADHD) including dietary interventions, phytomedicines, mind-body practices and neurofeedback. Results While conventional treatments are the mainstays for ADHD, there are a large number of available treatments that can be used to enhance treatment response. Conclusion With improved education and further scientific and clinical research, validated integrative treatments will provide more effective, lower risk and lower cost care for patients with ADHD. PMID:27489754

Alternatives to Drug Treatment for Hyperactivity.

ERIC Educational Resources Information Center

Den Houtter, Kathryn

1980-01-01

Results from recent studies on the effectiveness of Ritalin for "hyperactivity" show that this treatment is dubious at best. This article presents an alternative treatment approach, placing emphasis on devising an appropriate learning situation that meets the needs of the so-called hyperactive child. (Author)

Alternative Treatment Technologies – Working With the Pathogen Equivalency Committee

EPA Science Inventory

Under current Federal regulations (40 CFR 503), municipal sludge must be treated prior to land application. The regulations identify two classes of treatment with respect to pathogen reduction: Class B (three alternatives) which provides a minimum acceptable level of treatment;...

Alternative/Complementary Approaches to Treatment of Children with Autism Spectrum Disorders.

ERIC Educational Resources Information Center

Levy, Susan E.; Hyman, Susan L.

2002-01-01

This article reviews common complementary or alternative medicine (CAM) treatments used to address symptoms of autistic spectrum disorders, including vitamin supplements, medications, antibiotics, antifungals, diet strategies, chelation/mercury detoxification, and nonbiologic treatments. Strategies that professionals may use in assessing the…

Treatment of Escape-Maintained Challenging Behavior Using Chained Schedules: An Evaluation of the Effects of Thinning Positive plus Negative Reinforcement During Functional Communication Training

PubMed Central

Zangrillo, Amanda N.; Fisher, Wayne W.; Greer, Brian D.; Owen, Todd M.; DeSouza, Andresa A.

2016-01-01

Objective Previous research has supported functional communication training (FCT) as an effective intervention for reducing challenging behavior. Clinicians often program schedule-thinning procedures to increase the portability of the treatment (i.e., reinforcement is provided less frequently). For individuals with escape-maintained problem behavior, chained schedules have proven effective in increasing task completion and supplemental procedures may ameliorate reemergence of challenging behavior as access to reinforcement is decreased. The present study compared the use of a chained schedule-thinning procedure with and without alternative reinforcement (e.g., toys and activities) embedded in an intervention in which escape from the task is provided contingent on a request for a break. Method Two individuals with escape-maintained challenging behavior participated. We compared two treatment conditions, escape-only and escape-to-tangibles, using a single-subject, alternating treatments design with each treatment implemented in a distinct academic context. Results With the escape-to-tangibles treatment, we reached the final schedule in both contexts with both participants (4 successes out of 4 applications). We did not reach the final schedule with either participant with the escape-only intervention (0 successes out of 2 applications). Conclusion The current results provided preliminary confirmation that providing positive plus negative reinforcement would decrease destructive behavior, increase compliance, and facilitate reinforcer-schedule thinning. PMID:28626579

Estimating volumes and costs of forest biomass in western Montana using forest inventory and geospatial data

Treesearch

Dan Loeffler; David E. Calkin; Robin P. Silverstein

2006-01-01

Utilizing timber harvest residues (biomass) for renewable energy production provides an alternative disposal method to onsite burning that may improve the economic viability of hazardous fuels treatments. Due to the relatively low value of biomass, accurate estimates of biomass volumes and costs of collection and delivery are essential if investment in renewable energy...

Methotrexate for rheumatoid arthritis patients who are on hemodialysis.

PubMed

Al-Hasani, Hasanein; Roussou, Euthalia

2011-12-01

Methotrexate (MTX) can be toxic to patients suffering from end stage renal disease (ESRD) on hemodialysis even at low doses. This increase in toxicity is more notable in terms of bone marrow suppression in the form of pancytopenia. Many methods of elimination including dialysis itself have been proven ineffective, and alternate treatments with anti-TNF alpha blockers can be considered.

Experimental treatment of neoplasic diseases and tumors with iono magnetic therapy

NASA Astrophysics Data System (ADS)

Rizsanyi, Elek Karsay; Quiróz, David Lavan; Huamaccto, Carlos Levano; Marroquín, Erwin Guerra

2001-10-01

The Iono Magnetic Therapy is a alternative control method for cell growth population in pancreas and cerebral cancer. The magnetic field applied to cells with cancer decrease the growth of this cells or their multiplication. We observed a potential difference opposite to cell potential and propose that the ionic interchange is very slow tampering with cell growth in cancer.

Initial Wildlife Habitat Responses to Alternative Forest Regeneration Methods in the Ouachita Mountains

Treesearch

Ronald E. Thill; Roger W. Perry; Nancy E. Koerth; Philip A. Tappe; David G. Peitz

2004-01-01

In conjunction with phase II bird and small mammal studies, we measured an array of habitat features in 20 stands representing 4 replications of 4 pine regeneration treatments (clearcut/plant, pine-hardwood shelterwood, pine-hardwood single-tree selection, and pine-hardwood group selection) plus 4 untreated controls. At study initiation, all stands were > 60 years...

Spelling Practice Intervention: A Comparison of Tablet PC and Picture Cards as Spelling Practice Methods for Students with Developmental Disabilities

ERIC Educational Resources Information Center

Seok, Soonhwa; DaCosta, Boaventura; Yu, Byeong Min

2015-01-01

The present study compared a spelling practice intervention using a tablet personal computer (PC) and picture cards with three students diagnosed with developmental disabilities. An alternating-treatments design with a non-concurrent multiple-baseline across participants was used. The aims of the present study were: (a) to determine if…

The photoload sampling technique: estimating surface fuel loadings from downward-looking photographs of synthetic fuelbeds

Treesearch

Robert E. Keane; Laura J. Dickinson

2007-01-01

Fire managers need better estimates of fuel loading so they can more accurately predict the potential fire behavior and effects of alternative fuel and ecosystem restoration treatments. This report presents a new fuel sampling method, called the photoload sampling technique, to quickly and accurately estimate loadings for six common surface fuel components (1 hr, 10 hr...

Complementary or Alternative Medicine as Possible Determinant of Decreased Persistence to Aromatase Inhibitor Therapy among Older Women with Non-Metastatic Breast Cancer

PubMed Central

Huiart, Laetitia; Bouhnik, Anne-Deborah; Rey, Dominique; Rousseau, Frédérique; Retornaz, Frédérique; Meresse, Mégane; Bendiane, Marc Karim; Viens, Patrice; Giorgi, Roch

2013-01-01

Purpose Aromatase inhibitor therapy (AI) significantly improves survival in breast cancer patients. Little is known about adherence and persistence to aromatase inhibitors and about the causes of treatment discontinuation among older women. Methods We constituted a cohort of women over 65 receiving a first AI therapy for breast cancer between 2006 and 2008, and followed them until June 2011. Women were selected in the population-based French National Health Insurance databases, and data was collected on the basis of pharmacy refills, medical records and face-to-face interviews. Non-persistence to treatment was defined as the first treatment discontinuation lasting more than 3 consecutive months. Time to treatment discontinuation was studied using survival analysis techniques. Results Overall among the 382 selected women, non-persistence to treatment went from 8.7% (95%CI: 6.2–12.1) at 1 year, to 15.6% (95%CI: 12.2–19.8) at 2 years, 20.8% (95%CI: 16.7–25.6) at 3 years, and 24.7% (95%CI: 19.5–31.0) at 4 years. In the multivariate analysis on a sub-sample of 233 women with available data, women using complementary or alternative medicine (CAM) (HR = 3.2; 95%CI: 1.5–6.9) or suffering from comorbidities (HR = 2.2; 95%CI: 1.0–4.8) were more likely to discontinue their treatment, whereas women with polypharmacy (HR = 0.4; 95%CI: 0.2–0.91) were less likely to discontinue. In addition, 13% of the women with positive hormonal receptor status did not fill any prescription for anti-hormonal therapy. Conclusion AI therapy is discontinued prematurely in a substantial portion of older patients. Some patients may use CAM not as a complementary treatment, but as an alternative to conventional medicine. Improving patient-physician communication on the use of CAM may improve hormonal therapy adherence. PMID:24367488

Homeopathy in the Age of Antimicrobial Resistance: Is It a Viable Treatment for Upper Respiratory Tract Infections?

PubMed

Fixsen, Alison

2018-05-01

 Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multi-resistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place.  Critical review of post 1994 clinical studies featuring homeopathic treatment of acute URTIs and their complications. Study design, treatment intervention, cohort group, measurement and outcome were considered. Discussion focused on the extent to which homeopathy is used to treat URTIs, rate of improvement and tolerability of the treatment, complications of URTIs, prophylactic and long-term effects, and the use of combination versus single homeopathic remedies.  Multiple peer-reviewed studies were found in which homeopathy had been used to treat URTIs and associated symptoms (cough, pharyngitis, tonsillitis, otitis media, acute sinusitis, etc.). Nine randomised controlled trials (RCTs) and 8 observational/cohort studies were analysed, 7 of which were paediatric studies. Seven RCTs used combination remedies with multiple constituents. Results for homeopathy treatment were positive overall, with faster resolution, reduced use of antibiotics and possible prophylactic and longer-term benefits.  Variations in size, location, cohort and outcome measures make comparisons and generalisations concerning homeopathic clinical trials for URTIs problematic. Nevertheless, study findings suggest at least equivalence between homeopathy and conventional treatment for uncomplicated URTI cases, with fewer adverse events and potentially broader therapeutic outcomes. The use of non-individualised homeopathic compounds tailored for the paediatric population merits further investigation, including through cohort studies. In the light of antimicrobial resistance, homeopathy offers alternative strategies for minor infections and possible prevention of recurring URTIs. The Faculty of Homeopathy.

Effects of health insurance on non-working married women’s medical care use and bed days at home

PubMed Central

2013-01-01

Background This study examines whether bed days are alternative methods to medical care use for treating a particular illness. If bed days at home are considered as an alternative to medical treatment, then medical care use and bed days at home should be influenced by an individual’s health insurance status. Method This study uses data from the 2003 Medical Expenditure Panel Survey (MEPS) on medical care use and bed days at home for each contracted illness of non-working married women. Results The results suggest that the health insurance status of non-working married women has considerable influence on their choice between medical care use and bed days at home. In addition, those with health insurance are more likely to use medical care and less likely to use bed days at home, but they tend to avoid the simultaneous use of medical care and bed days at home. Conclusions In contrast to previous studies’ findings indicating that absences from work and medical care use among working males may be complements, this study’s results for non-working married women without health insurance suggest that they use rest and medical treatment as substitutes, not complements. PMID:23816313

Properties of fired clay brick incorporating with sewage sludge waste

NASA Astrophysics Data System (ADS)

Kadir, Aeslina Abdul; Salim, Nurul Salhana Abdul; Sarani, Noor Amira; Rahmat, Nur Aqma Izurin; Abdullah, Mohd Mustafa Al Bakri

2017-09-01

The production of sludge in wastewater treatment plant is about to increase every year and most of the sludge was directly disposed to landfill. In addition, the constraint to treat sludge is very high in cost and time- consuming could be disadvantages to the responsible parties. Therefore, this research was conducted to utilize sludge produced from the wastewater treatment plant into fired clay brick as one of the alternatives of disposal method. In this study, the research attempt to incorporate sewage sludge waste (SSW) into fired clay brick. The sewage sludge brick (SSB) mixtures were incorporated with 0%, 1%, 5%, 10%, and 20% of SSW. The manufactured bricks were fired at 1050°C with heating rate of 1°C/min. Physical and mechanical properties test were conducted such as shrinkage, density, water absorption and compressive strength. As the conclusion, brick with utilization 5% of SSW is acceptable to produce good quality of brick. This study shows by using SSW in fired clay brick could be an alternative method to dispose of the SSW and also could act as a replacement material for brick manufacturing with appropriate mix and design.

Risk-based cost-benefit analysis for evaluating microbial risk mitigation in a drinking water system.

PubMed

Bergion, Viktor; Lindhe, Andreas; Sokolova, Ekaterina; Rosén, Lars

2018-04-01

Waterborne outbreaks of gastrointestinal diseases can cause large costs to society. Risk management needs to be holistic and transparent in order to reduce these risks in an effective manner. Microbial risk mitigation measures in a drinking water system were investigated using a novel approach combining probabilistic risk assessment and cost-benefit analysis. Lake Vomb in Sweden was used to exemplify and illustrate the risk-based decision model. Four mitigation alternatives were compared, where the first three alternatives, A1-A3, represented connecting 25, 50 and 75%, respectively, of on-site wastewater treatment systems in the catchment to the municipal wastewater treatment plant. The fourth alternative, A4, represented installing a UV-disinfection unit in the drinking water treatment plant. Quantitative microbial risk assessment was used to estimate the positive health effects in terms of quality adjusted life years (QALYs), resulting from the four mitigation alternatives. The health benefits were monetised using a unit cost per QALY. For each mitigation alternative, the net present value of health and environmental benefits and investment, maintenance and running costs was calculated. The results showed that only A4 can reduce the risk (probability of infection) below the World Health Organization guidelines of 10 -4 infections per person per year (looking at the 95th percentile). Furthermore, all alternatives resulted in a negative net present value. However, the net present value would be positive (looking at the 50 th percentile using a 1% discount rate) if non-monetised benefits (e.g. increased property value divided evenly over the studied time horizon and reduced microbial risks posed to animals), estimated at 800-1200 SEK (€100-150) per connected on-site wastewater treatment system per year, were included. This risk-based decision model creates a robust and transparent decision support tool. It is flexible enough to be tailored and applied to local settings of drinking water systems. The model provides a clear and holistic structure for decisions related to microbial risk mitigation. To improve the decision model, we suggest to further develop the valuation and monetisation of health effects and to refine the propagation of uncertainties and variabilities between the included methods. Copyright © 2018 Elsevier Ltd. All rights reserved.

77 FR 31756 - Energy Conservation Program: Alternative Efficiency Determination Methods and Alternative Rating...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

...-AC46 Energy Conservation Program: Alternative Efficiency Determination Methods and Alternative Rating Methods: Public Meeting AGENCY: Office of Energy Efficiency and Renewable Energy, Department of Energy... regulations authorizing the use of alternative methods of determining energy efficiency or energy consumption...

Effects of alternate drip irrigation and superabsorbent polymers on growth and water use of young coffee tree.

PubMed

Liu, Xiaogang; Li, Fusheng; Yang, Qiliang; Wang, Xinle

2016-07-01

To obtain optimal irrigation management for young coffee tree, the effects of alternate drip irrigation (ADI) and superabsorbent polymers on physiology, growth, dry mass accumulation and water use on one-year old Coffea arabica L. tree were investigated. This experiment had three drip irrigation methods, i.e., conventional drip irrigation (CDI), alternate drip irrigation (ADI) and fixed drip irrigation (FDI), and two levels of superabsorbent polymers, i.e., no superabsorbent polymers (NSAP) and added superabsorbent polymers (SAP). Compared to CDI, ADI saved irrigation water by 32.1% and increased water use efficiency (WUE) by 29.9%. SAP increased root-shoot ratio, total dry mass and WUE by 20.3, 24.9 and 33.0%, respectively, when compared to NSAP. Compared to CDI with NSAP treatment, ADI with SAP treatment increased total dry mass by 13.8% and saved irrigation water by 34.4%, thus increased WUE by 73.4%, and it increased root activity, the contents of chlorophyll and soluble sugar in leaves by 162.4, 38.0 and 8.5%, but reduced the contents of proline and malondialdehyde in leaves by 7.2 and 9.7%, respectively. Thus, alternate drip irrigation with superabsorbent polymers increased the growth and WUE of young Coffea arabica L. tree and was optimal irrigation management for young coffee tree.

Effects of expiring reimbursability of pentaerythrityl tetranitrate (PETN, pentalong®) on anti-anginal therapy: an observational study.

PubMed

Grimmsmann, Thomas; Chenot, Jean-François; Angelow, Aniela

2015-08-01

Pentaerythrityl tetranitrate (PETN) was the most commonly prescribed long-acting nitrate in Germany. We aimed to assess whether the discontinuation of PETN reimbursability in 2011 resulted in alternative prescriptions of anti-anginal medications or in a discontinuation of anti-anginal therapy. This is an observational study using health claims data from one German federal state analysing all patients discontinuing a PETN treatment. Patients starting a new alternative anti-anginal treatment (long-acting nitrates, molsidome, ivabradine and ranolazine) were compared with patients without a new anti-anginal treatment with respect to use of short-acting nitrates, beta blockers (BBs) and calcium channel blockers (CCBs). Out of 12,909 patients, 12,763 (99%) discontinued PETN until 12/2012. Of these, 52% started an alternative anti-anginal treatment, 43% did not receive any alternative treatment and 5% were excluded from analysis. Before termination of PETN reimbursability, 65% of patients received BBs, 29% CCBs and 10% short-acting nitrates. In patients started on alternative anti-anginal treatment, prescription rates for short-acting nitrates, BBs and CCBs remained constant after discontinuing PETN. In patients without any alternative anti-anginal treatment, prescription rates for BBs and CCBs did not change meaningfully (<3%), and prescription rates for short-acting nitrates decreased from 9% to 6%. Half of the patients discontinued PETN without alternative. This did not lead to increased prescription rates of standard IHD medications or total medication number indicating that there might still be a high percentage of ischaemic heart disease patients treated unnecessarily with long-acting nitrates. The undertreatment with prognostically relevant first-line medications indicates a need for better guideline implementation activities. Copyright © 2015 John Wiley & Sons, Ltd.

Cost-Effectiveness of Nitrogen Mitigation by Alternative ...

EPA Pesticide Factsheets

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. We seek to address two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes, and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets and neighborhood-scale blackwater digesters are also attractive options in some cases, particularly best-case nitrogen mitigation; innovative/advanced septic system

Role of Alternative Therapies for Chronic Pain Syndromes.

PubMed

Thomas, Donna-Ann; Maslin, Benjamin; Legler, Aron; Springer, Erin; Asgerally, Abbas; Vadivelu, Nalini

2016-05-01

There is increasing interest in the use of complimentary and alternative medicine (CAM) for the treatment of chronic pain. This review examines alternative and complimentary therapies, which can be incorporated as part of a biopsychosocial approach in the treatment of chronic pain syndromes. In the present investigation, literature from articles indexed on PubMed was evaluated including topics of alternative therapies, complimentary therapies, pain psychology, biofeedback therapy, physical exercise therapies, acupuncture, natural and herbal supplements, whole-body cryotherapy, and smartphone technologies in the treatment of chronic pain syndromes. This review highlights the key role of psychology in the treatment of chronic pain. Cognitive behavior therapy appears to be the most impactful while biofeedback therapy has also been shown to be effective for chronic pain. Exercise therapy has been shown to be effective in short-, intermediate-, and long-term pain states. When compared to that in sham controls, acupuncture has shown some benefit for neck pain immediately after the procedure and in the short term and improvement has also been demonstrated in the treatment of headaches. The role of smartphones and whole-body cryotherapy are new modalities and further studies are needed. Recent literature suggests that several alternate therapies could play a role in the treatment of chronic pain, supporting the biopsychosocial model in the treatment of pain states.

Safety evaluation of right turns followed by U-turns as an alternative to direct left turns : crash data analysis, Vol. 1

DOT National Transportation Integrated Search

2001-10-01

This project evaluated the safety and operational impacts of two alternative left-turn treatments from driveway/side streets. The two treatments were: (1) direct left turns and, (2) right turns followed by U-turns. Safety analyses of the alternatives...

Costs and Effectiveness of Treatment Alternatives for Proximal Caries Lesions

PubMed Central

Schwendicke, Falk; Meyer-Lueckel, Hendrik; Stolpe, Michael; Dörfer, Christof Edmund; Paris, Sebastian

2014-01-01

Objectives Invasive therapy of proximal caries lesions initiates a cascade of re-treatment cycles with increasing loss of dental hard tissue. Non- and micro-invasive treatment aim at delaying this cascade and may thus reduce both the health and economic burden of such lesions. This study compared the costs and effectiveness of alternative treatments of proximal caries lesions. Methods A Markov-process model was used to simulate the events following the treatment of a proximal posterior lesion (E2/D1) in a 20-year-old patient in Germany. We compared three interventions (non-invasive; micro-invasive using resin infiltration; invasive using composite restoration). We calculated the risk of complications of initial and possible follow-up treatments and modelled time-dependent non-linear transition probabilities. Costs were calculated based on item-fee catalogues in Germany. Monte-Carlo-microsimulations were performed to compare cost-effectiveness of non- versus micro-invasive treatment and to analyse lifetime costs of all three treatments. Results Micro-invasive treatment was both more costly and more effective than non-invasive therapy, with ceiling-value-thresholds for willingness-to-pay between 16.73 € for E2 and 1.57 € for D1 lesions. Invasive treatment was the most costly strategy. Calculated costs and effectiveness were sensitive to lesion stage, patient’s age, discounting rate and assumed initial treatment costs. Conclusions Non- and micro-invasive treatments have lower long-term costs than invasive therapy of proximal lesions. Micro-invasive therapy had the highest cost-effectiveness for treating D1 lesions in young patients. Decision makers with a willingness-to-pay over 16.73 € and 1.57 € for E2 and D1 lesions, respectively, will find micro-invasive treatment more cost-effective than non-invasive therapy. PMID:24475208

Efficacy of alternate day versus daily dosing of rosuvastatin

PubMed Central

Dulay, Daisy; LaHaye, Stephen A; Lahey, Karen A; Day, Andrew G

2009-01-01

BACKGROUND: Compared with other statins, rosuvastatin has a relatively long half-life, which may allow for the administration of this medication on an alternate day basis. OBJECTIVE: To compare the efficacy of administering rosuvastatin on a daily basis versus on an alternate day basis for the treatment of dyslipidemia. METHODS: In the present crossover study, 45 patients with documented hypercholesterolemia requiring pharmacotherapy were administered either 20 mg of rosuvastatin on alternate days or 10 mg of rosuvastatin daily for six weeks. After a four-week washout period, patients were then switched to the other regimen for another six weeks. The primary end point was the percentage reduction of low-density lipoprotein cholesterol (LDL-C). RESULTS: LDL-C decreased by 48.5% versus 40.9% with daily and alternate day dosing, respectively. This represented an additional absolute reduction of LDL-C of 7.6% (95% CI 1.8% to 13.4%, P=0.012) with the daily dosing regimen. Both dosing regimens provided similar improvements in high-density lipoprotein cholesterol and triglycerides. CONCLUSIONS: Compared with alternate day dosing, daily dosing of rosuvastatin provides a statistically significant advantage in LDL-C reduction. However, the alternate day regimen may be a viable option for those patients in whom cost is a limitation to compliance. PMID:19214297

[Are there alternative therapeutical options other than CPAP in the treatment of the obstructive sleep apnea syndrome].

PubMed

Randerath, W; Bauer, M; Blau, A; Fietze, I; Galetke, W; Hein, H; Maurer, J T; Orth, M; Rasche, K; Rühle, K-H; Sanner, B; Stuck, B A; Verse, T

2007-07-01

Many patients with the obstructive sleep apnea syndrome (OSAS) look for alternative conservative or surgical therapies to avoid to be treated with continuous positive airway pressure. In view of the high prevalence and the relevant impairment of the patients lots of methods are offered which promise definitive cure or relevant improvement of OSAS. The working group "Apnea" in the German Society of Sleep Medicine and Research established a task force to evaluate the scientific literature on non-CPAP therapies in the treatment of OSAS according to the standards of evidence-based medicine. This paper summarizes the results of the task force. The data were unsatisfactorily for most of the methods. Sufficient data were available for intraoral appliances (IOA) and the maxillomandibular osteotomy (MMO). IOA's can reduce mild to moderate respiratory disturbances, MMO are efficient in the short and long term but are performed only in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment of OSAS. Most surgical procedures still lack sufficient data according to the criteria of evidence based medicine. Resections of muscular tissue within the soft palate have to be strictly avoided. But even success following gentle soft palate procedures is difficult to predict and often decreases after years. Results in other anatomical regions seem to be more stable over time. Today combined surgeries in the sense of multi-level surgery concepts are of increasing interest in the secondary treatment after failure of nasal ventilation therapy although more data from prospective controlled studies are needed. There is no evidence for any other treatment options.

A cost-minimization analysis of an RCT of three retention methods.

PubMed

Tynelius, Gudrun Edman; Lilja-Karlander, Eva; Petrén, Sofia

2014-08-01

There are few cost evaluation studies of orthodontic retention treatment. The aim of this study was to compare the costs in a randomized controlled trial of three retention methods during 2 years of retention treatment. To determine which alternative has the lower cost, a cost-minimization analysis (CMA) was undertaken, based on that the outcome of the treatment alternatives was equivalent. The study comprised 75 patients in 3 groups consisting of 25 each. The first group had a vacuum-formed retainer (VFR) in the maxilla and a cuspid retainer in the mandible (group V-CTC), the second group had a VFR in the maxilla combined with stripping of the incisors and cuspids in the mandible (group V-S), and the third group had a prefabricated positioner (group P). Direct cost (premises, staff salaries, material and laboratory costs) and indirect costs (loss of time at school) were calculated. Societal costs were defined as the sum of direct and indirect costs. The societal costs/patient for scheduled appointments for 2 years of retention treatment in group V-CTC were €497, group V-S €451 and group P €420. Societal costs for unscheduled appointments in group V-CTC were €807 and in group V-S €303. In group P, there were no unscheduled appointments. After 2 years of retention in compliant patients, the cuspid retainer was the least cost-effective retention appliance. The CMA showed that for a clinically similar result, there were differences in societal costs, but treatment decisions should always be performed on an individual basis. © The Author 2013. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Sludge utilisation in agriculture: possibilities and prospects in Greece.

PubMed

Andreadakis, A D; Mamals, D; Gavalaki, E; Kampylafka, S

2002-01-01

The paper presents the prospects for agricultural utilisation of the sludge produced from wastewater treatment plants in Greece and more specifically focuses on a critical review of the legislatory framework, determination of the quantitative and qualitative characteristics of the produced sludges, examination of possible sludge treatment methods and evaluation of the possibilities and prospects of sludge utilisation on the basis of the above considerations. Landfilling is practically the only route to sludge disposal in Greece. However, in view of the anticipated future restrictions for landfilling within the European Union, this method is clearly a short-term solution and alternative options, including agricultural reuse, must be implemented. The results of a recent survey are presented and discussed in relation to this need.

Neurofeedback Treatment and Posttraumatic Stress Disorder: Effectiveness of Neurofeedback on Posttraumatic Stress Disorder and the Optimal Choice of Protocol.

PubMed

Reiter, Karen; Andersen, Søren Bo; Carlsson, Jessica

2016-02-01

Neurofeedback is an alternative, noninvasive approach used in the treatment of a wide range of neuropsychiatric disorders, including posttraumatic stress disorder (PTSD). Many different neurofeedback protocols and methods exist. Likewise, PTSD is a heterogeneous disorder. To review the evidence on effectiveness and preferred protocol when using neurofeedback treatment on PTSD, a systematic search of PubMed, PsychInfo, Embase, and Cochrane databases was undertaken. Five studies were included in this review. Neurofeedback had a statistically significant effect in three studies. Neurobiological changes were reported in three studies. Interpretation of results is, however, limited by differences between the studies and several issues regarding design. The optimistic results presented here qualify neurofeedback as probably efficacious for PTSD treatment.

Microbial Biofilms and Chronic Wounds

PubMed Central

Omar, Amin; Wright, J. Barry; Schultz, Gregory; Burrell, Robert; Nadworny, Patricia

2017-01-01

Background is provided on biofilms, including their formation, tolerance mechanisms, structure, and morphology within the context of chronic wounds. The features of biofilms in chronic wounds are discussed in detail, as is the impact of biofilm on wound chronicity. Difficulties associated with the use of standard susceptibility tests (minimum inhibitory concentrations or MICs) to determine appropriate treatment regimens for, or develop new treatments for use in, chronic wounds are discussed, with alternate test methods specific to biofilms being recommended. Animal models appropriate for evaluating biofilm treatments are also described. Current and potential future therapies for treatment of biofilm-containing chronic wounds, including probiotic therapy, virulence attenuation, biofilm phenotype expression attenuation, immune response suppression, and aggressive debridement combined with antimicrobial dressings, are described. PMID:28272369

The genetics of addiction—a translational perspective

PubMed Central

Agrawal, A; Verweij, K J H; Gillespie, N A; Heath, A C; Lessov-Schlaggar, C N; Martin, N G; Nelson, E C; Slutske, W S; Whitfield, J B; Lynskey, M T

2012-01-01

Addictions are serious and common psychiatric disorders, and are among the leading contributors to preventable death. This selective review outlines and highlights the need for a multi-method translational approach to genetic studies of these important conditions, including both licit (alcohol, nicotine) and illicit (cannabis, cocaine, opiates) drug addictions and the behavioral addiction of disordered gambling. First, we review existing knowledge from twin studies that indicates both the substantial heritability of substance-specific addictions and the genetic overlap across addiction to different substances. Next, we discuss the limited number of candidate genes which have shown consistent replication, and the implications of emerging genomewide association findings for the genetic architecture of addictions. Finally, we review the utility of extensions to existing methods such as novel phenotyping, including the use of endophenotypes, biomarkers and neuroimaging outcomes; emerging methods for identifying alternative sources of genetic variation and accompanying statistical methodologies to interpret them; the role of gene–environment interplay; and importantly, the potential role of genetic variation in suggesting new alternatives for treatment of addictions. PMID:22806211

Bayesian propensity scores for high-dimensional causal inference: A comparison of drug-eluting to bare-metal coronary stents.

PubMed

Spertus, Jacob V; Normand, Sharon-Lise T

2018-04-23

High-dimensional data provide many potential confounders that may bolster the plausibility of the ignorability assumption in causal inference problems. Propensity score methods are powerful causal inference tools, which are popular in health care research and are particularly useful for high-dimensional data. Recent interest has surrounded a Bayesian treatment of propensity scores in order to flexibly model the treatment assignment mechanism and summarize posterior quantities while incorporating variance from the treatment model. We discuss methods for Bayesian propensity score analysis of binary treatments, focusing on modern methods for high-dimensional Bayesian regression and the propagation of uncertainty. We introduce a novel and simple estimator for the average treatment effect that capitalizes on conjugacy of the beta and binomial distributions. Through simulations, we show the utility of horseshoe priors and Bayesian additive regression trees paired with our new estimator, while demonstrating the importance of including variance from the treatment regression model. An application to cardiac stent data with almost 500 confounders and 9000 patients illustrates approaches and facilitates comparison with existing alternatives. As measured by a falsifiability endpoint, we improved confounder adjustment compared with past observational research of the same problem. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Cat dissection and human cadaver prosection versus sculpting human structures from clay: A comparison of alternate approaches to human anatomy laboratory education

NASA Astrophysics Data System (ADS)

Waters, John R.

Dissection and vivisection are traditional approaches to biology laboratory education. In the case of human anatomy teaching laboratories, there is a long tradition of using human and animal cadaver specimens in the classroom. In a review of the literature comparing traditional dissection and vivisection lessons to alternative lessons designed to reduce the time spent dissecting or the numbers of animals used, we conclude that it is difficult to come to any conclusion regarding the efficacy of different approaches. An analysis of the literature is confounded because many studies have very low statistical power or other methodological weaknesses, and investigators rely on a wide variety of testing instruments to measure an equally varied number of course objectives. Additional well designed studies are necessary before educators can reach any informed conclusions about the efficacy of traditional versus alternative approaches to laboratory education. In our experiments, we compared a traditional cat dissection based undergraduate human anatomy lesson to an alternative where students sculpted human muscles onto plastic human skeletons. Students in the alternative treatment performed significantly better than their peers in the traditional treatment when answering both lower and higher order human anatomy questions. In a subsequent experiment with a similar design, we concluded that the superior performance of the students in the alternative treatment on anatomy exams was likely due to the similarity between the human anatomy representation studied in lab, and the human anatomy questions asked on the exams. When the anatomy questions were presented in the context of a cat specimen, students in the traditional cat dissection treatment outperformed their peers in the alternative treatment. In a final experiment where student performance on a human anatomy exam was compared between a traditional prosected human cadaver treatment and the alternative clay sculpting treatment, no significant difference were detected, suggesting that the complexity or simplicity of the anatomy representation is less important than the similarity between the learning experience and the testing experience.

A Review of Indigo Naturalis as an Alternative Treatment for Nail Psoriasis.

PubMed

McDermott, Laura; Madan, Raman; Rupani, Reena; Siegel, Daniel

2016-03-01

Nail psoriasis is challenging to treat. The few currently available therapies are limited in efficacy, and often produce unfavorable side effects. A plant extract widely used in Traditional Chinese Medicine, indigo naturalis (Qing Dai), is presented in this review as an alternative topical treatment for skin and nail psoriasis. The purpose of this article is to present information on a viable alternative treatment with a favorable side effect profile for a difficult disease to treat. A PubMed search for the term "indigo naturalis" was performed, and literature from 2006 to the present relevant to indigo naturalis and treatment of psoriasis and nail psoriasis was reviewed. Indigo naturalis shares several therapeutic mechanisms with current psoriasis treatments, such as regulation of keratinocyte proliferation and differentiation, restoration of epidermal barrier function, and reduction of inflammatory processes. Clinically, it is well tolerated. Recent research of indigo naturalis suggests that it is a safe, inexpensive, and effective alternative topical treatment for skin and nail psoriasis.

The perspective of celiac disease patients on emerging treatment options and non-celiac gluten sensitivity.

PubMed

Greuter, Thomas; Schmidlin, Sandra; Lattmann, Jaqueline; Stotz, Matthias; Lehmann, Romina; Zeitz, Jonas; Scharl, Michael; Misselwitz, Benjamin; Pohl, Daniel; Fried, Michael; Tutuian, Radu; Fasano, Alessio; Schoepfer, Alain M; Rogler, Gerhard; Biedermann, Luc; Vavricka, Stephan R

2017-03-01

Non-celiac gluten sensitivity (NCGS) and emerging treatment options are hot topics in the celiac disease (CeD) scientific literature. However, very little is known about the perspective on these issues of CeD patients. We performed a large patient survey among unselected CeD patients in Switzerland. A total of 1689 patients were analyzed. 57.5% have previously heard of NCGS. 64.5% believe in the existence of this entity. Regarding a potential influence of NCGS on CeD awareness, 31.7% show a positive and 27.5% a negative perception. Patients with prior use of alternative medicine and women more often have heard of and believe in the existence of NCGS vs. those never having used alternative methods and men, respectively (66.9 vs. 56.9%, p=0.001 and 78.5 vs. 69.0%, p=0.001; 60.7 vs. 44.2%, p<0.001 and 71.0 vs. 60.8%, p=0.002). Women and patients ≥30 years more often show a negative attitude towards NCGS (32.2% vs. 24.8%, p=0.024 and 32.2% vs. 24.2%, p=0.018). With regard to emerging treatment options for CeD, 43.3% have previously heard of novel agents, more women than men (46.0 vs. 38.0%, p=0.019). Perception of and attitude towards NCGS differ depending on sex, age and prior use of alternative medicine. Knowledge of the progress towards emerging treatment options is currently limited. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Assessing treatment effects in older breast cancer patients: systematic review of observational research methods.

PubMed

de Glas, N A; Kiderlen, M; de Craen, A J M; Hamaker, M E; Portielje, J E A; van de Velde, C J H; Liefers, G J; Bastiaannet, E

2015-03-01

Solid evidence of treatment effects in older women with breast cancer is lacking, as they are generally underrepresented in randomized clinical trials on which guideline recommendations are based. An alternative way to study treatment effects in older patients could be to use data from observational studies. However, using appropriate methods in analyzing observational data is a key condition in order to draw valid conclusions, as directly comparing treatments generally results in biased estimates due to confounding by indication. The aim of this systematic review was to investigate the methods that have been used in observational studies that assessed the effects of breast cancer treatment on survival, breast cancer survival and recurrence in older patients (aged 65 years and older). Studies were identified through systematic review of the literature published between January 1st 2009 and December 13th 2013 in the PubMed database and EMBASe. Finally, 31 studies fulfilled the inclusion criteria. Of these, 22 studies directly compared two treatments. Fifteen out of these 22 studies addressed the problem of confounding by indication, while seven studies did not. Nine studies used some form of instrumental variable analysis. In conclusion, the vast majority of observational studies that investigate treatment effects in older breast cancer patients compared treatments directly. These studies are therefore likely to be biased. Observational research will be essential to improve treatment and outcome of older breast cancer patients, but the use of accurate methods is essential to draw valid conclusions from this type of data. Copyright © 2015 Elsevier Ltd. All rights reserved.

Alternate energy source usage methods for in situ heat treatment processes

DOEpatents

Stone, Jr., Francis Marion; Goodwin, Charles R; Richard, Jr., James E

2014-10-14

Systems, methods, and heaters for treating a subsurface formation are described herein. At least one method for providing power to one or more subsurface heaters is described herein. The method may include monitoring one or more operating parameters of the heaters, the intermittent power source, and a transformer coupled to the intermittent power source that transforms power from the intermittent power source to power with appropriate operating parameters for the heaters; and controlling the power output of the transformer so that a constant voltage is provided to the heaters regardless of the load of the heaters and the power output provided by the intermittent power source.

Parents' Views and Experiences about Complementary and Alternative Medicine Treatments for Their Children with Autistic Spectrum Disorder

ERIC Educational Resources Information Center

Senel, Hatice Gunayer

2010-01-01

Use of complementary and alternative medicine (CAM) treatments have been increasing for children with autistic spectrum disorder (ASD). In this study, 38 Turkish parents of children with ASD were surveyed related with their use of CAM treatments, experiences, and views for each treatment. They mentioned "Vitamins and minerals",…

An Alternating Treatment Comparison of Minimal and Maximal Opposition Sound Selection in Turkish Phonological Disorders

ERIC Educational Resources Information Center

Topbas, Seyhun; Unal, Ozlem

2010-01-01

A single-subject alternating treatment design in combination with a staggered multiple baseline model across subjects was implemented with two 6:0 year-old girls, monozygotic twins, who were referred to a university clinic for evaluation and treatment. The treatment programme was structured according to variants of "minimal pair contrast…

Use of Complementary and Alternative Medicine (CAM) Treatments by Parents of Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Christon, Lillian M.; Mackintosh, Virginia H.; Myers, Barbara J.

2010-01-01

Parents of children with autism spectrum disorders (ASDs) may elect to use complementary and alternative medicine (CAM) treatments with their children in place of, or in addition to, conventional treatments. CAM treatments are controversial and understudied and, for most, the efficacy has not been established. The current study (n = 248) examined…

[Use of alternative medicine in the treatment of allergic diseases].

PubMed

Félix Berumen, José Alfredo; González Díaz, Sandra Nora; Canseco González, Carlos; Arias Cruz, Alfredo

2004-01-01

The alternative medicine and the complementary medicine are forms of treatment very spread and frequently demanded by patients with allergic diseases. According to recent studies, homeopathy, acupuncture and herbal medicine are the most commonly used types of alternative medicine. To know the frequency in the use of different types of alternative medicine for the treatment of allergic diseases in patients attended at the Centro Regional de Alergia e Immunologia Clínica of the Hospital Universitario de Monterrey, Nuevo León. A transversal, descriptive and observational study was done by the use of questionnaires applied to patients and/or patients' relatives attended in this Center. This survey included questions to focus the investigation in the use of a Iternative medicine for the treatment of any allergic disease. The data analysis was done by descriptive statistics. Four hundred one questionnaires were applied. The average age of the patients was of 14 years (range from 1 to 73 years). Fourty-seven percent (189 patients) were female and 58.2% (212 patients) were male. The diagnoses included: allergic rhinitis in 215 patients (53.6), asthma in 97 (24.2%), rhinitis and asthma in 73 (18.2) and atopic dermatitis in 16 (4%). Out of the patients 34.4% (138) had used at least one type of alternative medicine for the treatment of their allergic disease. Homeopathy was the most commonly used type of alternative medicine (78.2%), followed by the natural medicine (31.5%). Alternative medicine for the treatment of allergic diseases is frequent in patients who attend to this center. Homeopathy and the natural medicine are the most used.

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

Sun, Li-Min, E-mail: limin.sun@yahoo.com; Huang, Chih-Jen; Faculty of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan

Acute skin reaction during adjuvant radiotherapy for breast cancer is an inevitable process, and its severity is related to the skin dose. A high–skin dose area can be speculated based on the isodose distribution shown on a treatment planning. To determine whether treatment planning can reflect high–skin dose location, 80 patients were collected and their skin doses in different areas were measured using a thermoluminescent dosimeter to locate the highest–skin dose area in each patient. We determined whether the skin dose is consistent with the highest-dose area estimated by the treatment planning of the same patient. The χ{sup 2} andmore » Fisher exact tests revealed that these 2 methods yielded more consistent results when the highest-dose spots were located in the axillary and breast areas but not in the inframammary area. We suggest that skin doses shown on the treatment planning might be a reliable and simple alternative method for estimating the highest skin doses in some areas.« less

Faecal microbiota transplant - prospects and safety.

PubMed

Bartnicka, Anna; Szachta, Patrycja; Gałecka, Mirosława

2015-01-01

The intestinal microbiota, either directly or indirectly, plays an important role in maintaining the homeostasis of the body. The intestine microorganisms are significant due to the role they play in stimulating the development of the immune system, protecting against pathogens, and also managing metabolic and nutrient processing. The effectiveness of probiotics and prebiotics in various gastrointestinal diseases has been repeatedly confirmed. However, increasing interest in faecal transplantation has also been observed. Its efficacy in the treatment of pseudomembranous colitis has been repeatedly demonstrated. More often this method is discussed regarding the possibility of using it in other diseases linked with dysbiosis. Faecal microbiota transplantation, because of its rapid efficacy, minimal risk and adverse effects, relatively low cost, and the ability to re-establish the correct intestinal microbiota profile, could be an alternative treatment method in several other diseases. This paper will introduce the latest therapeutic aspects of microbiota transplantation, including its implications in the treatment of gastrointestinal diseases.

Production of cellulose II from native cellulose by near- and supercritical water solubilization.

PubMed

Sasaki, Mitsuru; Adschiri, Tadafumi; Arai, Kunio

2003-08-27

We explored conditions for dissolving microcrystalline cellulose in high-temperature and high-pressure water without catalyst and in order to produce cellulose II in a rapid and selective manner. For understanding reactions of microcrystalline cellulose in subcritical and supercritical water, its solubilization treatment was conducted using a continuous-flow-type microreactor. It was found that cellulose could dissolve in near- and supercritical water at short treatment times of 0.02-0.4 s, resulting in the formation of cellulose II in relatively high yield after the treatment. Next, characteristics of the cellulose II obtained were investigated. As a result, it was confirmed that the relative crystallinity index and the degree of polymerization of the cellulose II were high values ranging from 80 to 60% and from 50 to 30%, respectively. From these findings, it was suggested that this method had high potential as an alternative technique for the conventional cellulose II production method.

Complementary and alternative medicine for allergic rhinitis.

PubMed

Man, Li-Xing

2009-06-01

Otolaryngologists and other physicians who diagnose and treat allergic rhinitis encounter patients who use complementary medicine and alternative remedies. This article reviews the recent literature regarding complementary and alternative therapies for the treatment of allergic rhinitis. There are a myriad of modalities for treating allergic rhinitis. Few are studied with rigorous randomized, double-blind, placebo-controlled trials for clinical efficacy. Often, the biological mechanisms and adverse effects are even less well understood. A few therapies, including spirulina, butterbur, and phototherapy hold some promise. Thus far, complementary and alternative therapies have not been integrated into the general treatment armamentarium of allergic rhinitis. Several studies report beneficial effects of certain alternative treatments for allergic rhinitis. Additional insight into the mechanisms of action, short-term and long-term effects, and adverse events is needed.

Unproven (questionable) cancer therapies.

PubMed Central

Brigden, M L

1995-01-01

More than half of all cancer patients use some form of alternative treatment during the course of their illness. Alternative therapies are often started early in patients' illness, and their use is frequently not acknowledged to health care professionals. Some alternative therapies are harmful, and their promoters may be fraudulent. Persons who try alternative cancer therapies may not be poorly educated but may ultimately abandon conventional treatment. Recent attention has focused on aspects of questionable therapies that make these treatments attractive to patients and that may be perceived as being deficient in the practice of conventional health care professionals. Physicians with patients with cancer should always make sure that unproven therapies are discussed early in the therapeutic relationship. They should also attempt to be aware of alternative therapies that are in vogue in their particular geographic area. PMID:8533410

Bone Graft Alternatives

MedlinePlus

... Spine Treatment Spondylolisthesis BLOG FIND A SPECIALIST Treatments Bone Graft Alternatives Patient Education Committee Patient Education Committee ... procedure such as spinal fusion. What Types of Bone Grafts are There? Bone grafts that are transplanted ...

Why does choice enhance treatment effectiveness? Using placebo treatments to demonstrate the role of personal control.

PubMed

Geers, Andrew L; Rose, Jason P; Fowler, Stephanie L; Rasinski, Heather M; Brown, Jill A; Helfer, Suzanne G

2013-10-01

In modern health care, individuals frequently exercise choice over health treatment alternatives. A growing body of research suggests that when individuals choose between treatment options, treatment effectiveness can increase, although little experimental evidence exists clarifying this effect. Four studies were conducted to test the hypothesis that exercising choice over treatment alternatives enhances outcomes by providing greater personal control. Consistent with this possibility, in Study 1 individuals who chronically desired control reported less pain from a laboratory pain task when they were able to select between placebo analgesic treatments. Study 2 replicated this finding with an auditory discomfort paradigm. In Study 3, the desire for control was experimentally induced, and participants with high desire for control benefited more from a placebo treatment when they were able to choose their treatment. Study 4 revealed that the benefit of choice on treatment efficacy was partially mediated by thoughts of personal control. This research suggests that when individuals desire control, choice over treatment alternatives improves treatment effectiveness by enhancing personal control.

Multi-Laboratory Study of Five Methods for the Determination of Brevetoxins in Shellfish Tissue Extracts.

PubMed

Dickey, Robert W; Plakas, Steven M; Jester, Edward L E; El Said, Kathleen R; Johannessen, Jan N; Flewelling, Leanne J; Scott, Paula; Hammond, Dan G; Van Dolah, Frances M; Leighfield, Tod A; Bottein Dachraoui, Marie-Yasmine; Ramsdell, John S; Pierce, Richard H; Henry, Mike S; Poli, Mark A; Walker, Calvin; Kurtz, Jan; Naar, Jerome; Baden, Daniel G; Musser, Steve M; White, Kevin D; Truman, Penelope; Miller, Aaron; Hawryluk, Timothy P; Wekell, Marleen M; Stirling, David; Quilliam, Michael A; Lee, Jung K

A thirteen-laboratory comparative study tested the performance of four methods as alternatives to mouse bioassay for the determination of brevetoxins in shellfish. The methods were N2a neuroblastoma cell assay, two variations of the sodium channel receptor binding assay, competitive ELISA, and LC/MS. Three to five laboratories independently performed each method using centrally prepared spiked and naturally incurred test samples. Competitive ELISA and receptor binding (96-well format) compared most favorably with mouse bioassay. Between-laboratory relative standard deviations (RSDR) ranged from 10 to 20% for ELISA and 14 to 31% for receptor binding. Within-laboratory (RSDr) ranged from 6 to 15% for ELISA, and 5 to 31% for receptor binding. Cell assay was extremely sensitive but data variation rendered it unsuitable for statistical treatment. LC/MS performed as well as ELISA on spiked test samples but was inordinately affected by lack of toxin-metabolite standards, uniform instrumental parameters, or both, on incurred test samples. The ELISA and receptor binding assay are good alternatives to mouse bioassay for the determination of brevetoxins in shellfish.

Economic Evaluation of Complementary and Alternative Medicine in Oncology: Is There a Difference Compared to Conventional Medicine?

PubMed

Huebner, Jutta; Prott, Franz J; Muecke, Ralph; Stoll, Christoph; Buentzel, Jens; Muenstedt, Karsten; Micke, Oliver

2017-01-01

To analyze the financial burden of complementary and alternative medicine (CAM) in cancer treatment. Based on a systematic search of the literature (Medline and the Cochrane Library, combining the MeSH terms 'complementary therapies', 'neoplasms', 'costs', 'cost analysis', and 'cost-benefit analysis'), an expert panel discussed different types of analyses and their significance for CAM in oncology. Of 755 publications, 43 met our criteria. The types of economic analyses and their parameters discussed for CAM in oncology were cost, cost-benefit, cost-effectiveness, and cost-utility analyses. Only a few articles included arguments in favor of or against these different methods, and only a few arguments were specific for CAM because most CAM methods address a broad range of treatment aim parameters to assess effectiveness and are hard to define. Additionally, the choice of comparative treatments is difficult. To evaluate utility, healthy subjects may not be adequate as patients with a life-threatening disease and may be judged differently, especially with respect to a holistic treatment approach. We did not find any arguments in the literature that were directed at the economic analysis of CAM in oncology. Therefore, a comprehensive approach assessment based on criteria from evidence-based medicine evaluating direct and indirect costs is recommended. The usual approaches to conventional medicine to assess costs, benefits, and effectiveness seem adequate in the field of CAM in oncology. Additionally, a thorough deliberation on the comparator, endpoints, and instruments is mandatory for designing studies. © 2016 S. Karger AG, Basel.

Coping behavior in multiple sclerosis-complementary and alternative medicine: A cross-sectional study.

PubMed

Rommer, Paulus S; König, Nicolaus; Sühnel, Annett; Zettl, Uwe K

2018-04-10

Treatment options for multiple sclerosis (MS) have enlarged tremendously over the last years. Nonetheless, lots of patients look for alternative treatment options. The use of complementary and alternative medicine (CAM) is widespread in MS, however, its scientific investigation is limited so far. The aim of the study is to analyse clinical and demographical differences of MS patients in dependency of their CAM utilization as coping strategy. A total of 254 patients with a clinically definite MS were examined in a semistructured interview. Additional standardized questionnaires were used to measure different aspects of coping with illness. All patients underwent neurological examination. About 206 of all enrolled patients are CAM users (81.1%). They have a longer disease duration (8.3 years vs 7.3 years, P = 0.028) and show higher disability (median EDSS 4.0 vs 2.0, P < 0.001) than nonusers. CAM users differed significantly from nonusers in their coping behavior (P = 0.035). Users are brooding more heavily over the disease, looking for more information about MS, and are looking for a sense of their disease in religion more often than nonusers. CAM users are at a higher risk of depression. Almost two-thirds of CAM users (57.6%) reported positive effects on the well-being of their state of health. Coping behavior differs significantly between CAM users and nonusers. CAM utilization is associated with higher disability and depression. More than 80% of our cohort has used alternative or complementary methods. CAM utilization may mirror unmet needs in the treatment of MS. © 2018 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

Listening Clearly: Alternative Treatments for Adolescent Depression

ERIC Educational Resources Information Center

McGlasson, Terry D.

2012-01-01

For many years now, Cognitive Behavioral Therapy and anti-depressant medications have been the primary treatments for adolescent depression. However, there are many youth today with mild to moderate depressive symptoms for whom these treatments are not necessary. This article briefly summarizes several alternative therapeutic approaches for…

Impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: a systematic review protocol.

PubMed

Matsunaka, Eriko; Ueki, Shingo; Makimoto, Kiyoko

2015-10-01

The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants. Immediately after cleft lip repair in infants, breastfeeding and bottle-feeding are generally restricted. Alternative feeding methods such as spoon-feeding are recommended to avoid placing tension on the surgical wound. However, some studies have reported that alternative feeding methods are a source of stress to the infant and cause them to cry incessantly, resulting in postoperative weight loss. This suggests that these alternative feeding methods may have an unfavorable impact on surgical wound healing. However, a consensus on this topic has not been reached. The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants.Cleft lip and/or palate is a craniofacial anomaly and one of the most common birth defects. The incidence of cleft lip and/or palate differs among races, ethnic groups and geographical areas. The prevalence of cleft lip and/or palate is highest in South American countries (Bolivia: 22.94 per 10,000 live births; Paraguay: 14.90 per 10,000 live births), followed by Asian countries (China: 13.60 per 10,000 live births; Japan: 16.04 per 10,000 live births). The prevalence is lowest in African countries (3.54 per 10,000 live births). The overall worldwide prevalence is 7.9 per 10,000 births.A cleft lip and/or a cleft palate can occur separately, although they are more likely to occur together early in pregnancy. These anomalies can be surgically repaired. Without proper treatment, patients have aesthetic and functional problems, such as feeding disorders, otitis media and speech difficulties.Patients with cleft lip and/or palate usually undergo a combination of surgical procedures, speech therapy and orthodontic treatment from infancy to young adulthood. Comprehensive treatment is provided with thoughtful consideration of the balance between intervention and growth. Cleft lip repair is carried out first in comprehensive treatment regimens. The aim of cleft lip repair is to create contrast between the lip and external nose and provide good muscular continuity across the cleft without any scarring. It is usually performed from three to six months of age. Surgery is delayed until this age to allow for growth of the lip structure and assessment of the patient for the presence of comorbidities. The ability of newborn patients with cleft lip and/or palate to drink milk is important for proper growth and development.For cleft lip and/or palate patients in the newborn developmental stage, feeding can be an area of great concern and anxiety for their parents. One study found that 32% of newborn patients with cleft lip and/or palate had poor feeding skills. Feeding difficulties lead to poor growth and development in early infancy and increase the burden of care. Therefore, it is important for new parents to learn appropriate feeding techniques. Infants with cleft lip can generally drink milk from the breast through various ways of feeding. In contrast, infants with both cleft lip and palate have difficulty sucking the nipple because of weak intraoral negative pressure, and specially designed nipples are generally used. Although such infants suckle with weakened pressure, these nipples enable them to drink milk by lightly pushing them through their lip. However, after cleft lip repair, infants with cleft lip and/or palate are forced to change their feeding methods (even infants who have managed to drink milk before the repair).Breastfeeding and bottle-feeding are generally restricted immediately after cleft lip repair. Alternative feeding methods such as the use of a spoon, cup or syringe are recommended to avoid placing tension on the surgical incision. The use of a very soft nipple of sufficient size is recommended to provide a dripping milk flow, thus avoiding tension on the operative site. Some authors have recommended that patients with cleft lip and/or palate be spoon-fed for a certain period of time after cleft lip repair to avoid tension on the surgical site. However, management of the surgical site after surgical repair of cleft lip and/or palate varies among countries and healthcare centers. Little evidence-based research is available to guide healthcare staff members through the many treatment protocols for cleft lip and/or palate. No consensus about feeding methods after cleft lip repair has been reached.The above mentioned alternative feeding methods might influence the process of surgical wound healing. Minimizing crying has been considered to be the most important factor in avoiding tension on the surgical wound. In one study, however, 21.7% of infants who were given milk by a spoon on the first day after cleft lip repair resisted feeding by crying and/or moving the head laterally, while all infants fed by the nipple that had been used preoperatively accepted feeding without a major observable response. In another study, infants who were breastfed or bottle-fed after the repair were reportedly more relaxed than spoon-fed or syringe-fed infants. Changes in feeding methods seem to stress the infants and cause them to cry, which places tension on the wound.These alternative feeding methods may also have other impacts on surgical wound healing. One study reported that infants took longer to drink milk using alternative feeding methods than when using traditional feeding methods after the surgery. A systematic review suggested that alternative feeding methods were associated with less postoperative weight gain in patients than traditional feeding methods. Postoperative nutritional intake also influences wound healing. A long duration of feeding milk coupled with weight loss after the surgery suggests unnecessary energy consumption associated with the alternative feeding methods. Wound healing may consequently be inhibited or delayed.Wound healing complications after surgery include wound infection, dehiscence and proliferative scarring. Surgical wound dehiscence has been regarded as a typical complication after cleft lip and/or palate repair, followed by pyrexia. In one case series, post-surgical complications were found in 11 of 2100 infants who underwent surgical cleft lip and/or palate repair during a seven-year period. Wound dehiscence results from tissue failure rather than improper suturing technique. Therefore, alternative feeding methods are recommended to avoid placing tension on the surgical wound. However, no strong evidence has been presented to show that breastfeeding or bottle-feeding after cleft lip repair may cause surgical wound dehiscence among infants with cleft lip.Our initial search failed to find any systematic review examining the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair using the Cochrane Library, the JBI Database of Systematic Reviews and Implementation Reports, and other bibliographic databases, including MEDLINE and CINAHL. The proposed systematic review will contribute to the understanding of this topic and identify areas for further research. If breastfeeding or bottle-feeding is recommended immediately after cleft lip repair, the patients will experience less stress and crying, placing less tension on the wound than with alternative feeding methods. Breastfeeding or bottle-feeding will result in more weight gain, facilitating wound healing.

Cost-effectiveness analysis of mammography and clinical breast examination strategies

PubMed Central

Ahern, Charlotte Hsieh; Shen, Yu

2009-01-01

Purpose Breast cancer screening by mammography and clinical breast exam are commonly used for early tumor detection. Previous cost-effectiveness studies considered mammography alone or did not account for all relevant costs. In this study, we assessed the cost-effectiveness of screening schedules recommended by three major cancer organizations and compared them with alternative strategies. We considered costs of screening examinations, subsequent work-up, biopsy, and treatment interventions after diagnosis. Methods We used a microsimulation model to generate women’s life histories, and assessed screening and treatment impacts on survival. Using statistical models, we accounted for age-specific incidence, preclinical disease duration, and age-specific sensitivity and specificity for each screening modality. The outcomes of interest were quality-adjusted life years (QALYs) saved and total costs with a 3% annual discount rate. Incremental cost-effectiveness ratios were used to compare strategies. Sensitivity analyses were performed by varying some of the assumptions. Results Compared to guidelines from the National Cancer Institute and the U.S. Preventive Services Task Force, alternative strategies were more efficient. Mammography and clinical breast exam in alternating years from ages 40 to 79 was a cost-effective alternative compared to the guidelines, costing $35,500 per QALY saved compared with no screening. The American Cancer Society guideline was the most effective and the most expensive, costing over $680,000 for an added QALY compared to the above alternative. Conclusion Screening strategies with lower costs and benefits comparable to those currently recommended should be considered for implementation in practice and for future guidelines. PMID:19258473

Pattern of informed consent acquisition in patients undergoing emergent endovascular treatment for acute ischemic stroke

PubMed Central

Qureshi, Adnan I; Gilani, Sarwat; Adil, Malik M; Majidi, Shahram; Hassan, Ameer E; Miley, Jefferson T; Rodriguez, Gustavo J

2014-01-01

Background Telephone consent and two physician consents based on medical necessity are alternate strategies for time sensitive medical decisions but are not uniformly accepted for clinical practice or recruitment into clinical trials. We determined the rate of and associated outcomes with alternate consenting strategies in consecutive acute ischemic stroke patients receiving emergent endovascular treatment. Methods We divided patients into those treated based on in-person consent and those based on alternate strategies. We identified clinical and procedural differences and differences in hospital outcomes: symptomatic ICH and favorable outcome (defined by modified Rankin Scale of 0–2 at discharge) based on consenting methodology. Results Of a total of 159 patients treated, 119 were treated based on in-person consent (by the patient in 27 and legally authorized representative in 92 procedures). Another 40 patients were treated using alternate strategies (20 telephone consents and 20 two physician consents based on medical necessity). There was no difference in the mean ages and proportion of men among the two groups based on consenting methodology. There was a significantly greater time interval incurred between CT scan and initiation of endovascular procedure in those in whom in-person consent was obtained (117 ± 65 min versus 101 ± 45 min, p = 0.01). There was no significant difference in rates of ICH (9% versus 8%, p = 0.9), or favorable outcome at discharge (28% versus 30%, p = 0.8). Conclusions Consent through alternate strategies does not adversely affect procedural characteristics or outcome of patients and may be more time efficient than in-person consenting process. PMID:25132906

Treatment of Outliers via Interpolation Method with Neural Network Forecast Performances

NASA Astrophysics Data System (ADS)

Wahir, N. A.; Nor, M. E.; Rusiman, M. S.; Gopal, K.

2018-04-01

Outliers often lurk in many datasets, especially in real data. Such anomalous data can negatively affect statistical analyses, primarily normality, variance, and estimation aspects. Hence, handling the occurrences of outliers require special attention. Therefore, it is important to determine the suitable ways in treating outliers so as to ensure that the quality of the analyzed data is indeed high. As such, this paper discusses an alternative method to treat outliers via linear interpolation method. In fact, assuming outlier as a missing value in the dataset allows the application of the interpolation method to interpolate the outliers thus, enabling the comparison of data series using forecast accuracy before and after outlier treatment. With that, the monthly time series of Malaysian tourist arrivals from January 1998 until December 2015 had been used to interpolate the new series. The results indicated that the linear interpolation method, which was comprised of improved time series data, displayed better results, when compared to the original time series data in forecasting from both Box-Jenkins and neural network approaches.

A practical method for extending the biuret assay to protein determination of corn-based products.

PubMed

Liu, Zelong; Pan, Junhui

2017-06-01

A modified biuret method suitable for protein determination of corn-based products was developed by introducing a combination of an alkaline reagent with sodium dodecyl sulfate (reagent A) and heat treatments. The method was tested on seven corn-based samples. The results showed mostly good agreement (P>0.05) as compared to the Kjeldahl values. The proposed method was found to enhance the accuracy of prediction on zein content using bovine serum albumin as standard. Reagent A and sample treatment were proved to effectively improve protein solubilization for the thermally-dried corn-based products, e.g. corn gluten meal. The absorbance was stable for at least 1-h. Moreover, the whole measurement of protein content only needs 15-20min more than the traditional biuret assay, and can be performed in batches. The findings suggest that the proposed method could be a timesaving alternative for routine protein analyses in corn processing factories. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Conservative treatment of idiopathic scoliosis with physical therapy and orthoses].

PubMed

Weiss, H-R

2003-02-01

Opinions differ in the international literature about the efficacy of conservative approaches to scoliosis treatment. Because this divergence of opinion corresponds to a great discrepancy in the standards applied to conservative treatment methods, it is not astonishing that the results of conservative treatment as described in the literature also differ. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated.Moreover, it is clear from the published literature that it is the functional and physiological impairments of scoliosis patients--including pain, torso deformity, psychological disturbance, and pulmonary dysfunction--which require therapeutic intervention. In Germany the triad of outpatient physiotherapy, intensive inpatient rehabilitation, and bracing has proven effective in conservative scoliosis treatment.Indication, content, and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative scoliosis treatment as an alternative to patients, including those for whom surgery is indicated.

[Occlusion treatment for amblyopia. Age dependence and dose-response relationship].

PubMed

Fronius, M

2016-04-01

Based on clinical experience and studies on animal models the age of 6-7 years was regarded as the limit for treatment of amblyopia, although functional improvement was also occasionally reported in older patients. New technical developments as well as insights from clinical studies and the neurosciences have attracted considerable attention to this topic. Various aspects of the age dependence of amblyopia treatment are discussed in this article, e. g. prescription, electronic monitoring of occlusion dosage, calculation of indicators for age-dependent plasticity of the visual system, and novel, alternative treatment approaches. Besides a discussion of the recent literature, results of studies by our "Child Vision Research Unit" in Frankfurt are presented: results of a questionnaire about prescription habits concerning age limits of patching, electronic recording of occlusion in patients beyond the conventional treatment age, calculation of dose-response function and efficiency of patching and their age dependence. The results of the questionnaire illustrate the uncertainty about age limits of prescription with significant deviations from the guideline of the German Ophthalmological Society (DOG). Electronic recording of occlusion allowed the quantification of declining dose-response function and treatment efficiency between 5 and 16 years of age. Reports about successful treatment with conventional and novel methods in adults are at variance with the notion of a rigid adult visual system lacking plasticity. Electronic recording of patching allowed new insights into the age-dependent susceptibility of the visual system and contributes to a more evidence-based treatment of amblyopia. Alternative approaches for adults challenge established notions about age limits of amblyopia therapy. Further studies comparing different treatment options are urgently needed.

Bridging the gap in complementary and alternative medicine research: manualization as a means of promoting standardization and flexibility of treatment in clinical trials of acupuncture.

PubMed

Schnyer, Rosa N; Allen, John J B

2002-10-01

An important methodological challenge encountered in acupuncture clinical research involves the design of treatment protocols that help ensure standardization and replicability while allowing for the necessary flexibility to tailor treatments to each individual. Manualization of protocols used in clinical trials of acupuncture and other traditionally-based complementary and alternative medicine (CAM) systems facilitates the systematic delivery of replicable and standardized, yet individually-tailored treatments. To facilitate high-quality CAM acupuncture research by outlining a method for the systematic design and implementation of protocols used in CAM clinical trials based on the concept of treatment manualization. A series of treatment manuals was developed to systematically articulate the Chinese medical theoretical and clinical framework for a given Western-defined illness, to increase the quality and consistency of treatment, and to standardize the technical aspects of the protocol. In all, three manuals were developed for National Institutes of Health (NIH)-funded clinical trials of acupuncture for depression, spasticity in cerebral palsy, and repetitive stress injury. In Part I, the rationale underlying these manuals and the challenges encountered in creating them are discussed, and qualitative assessments of their utility are provided. In Part II, a methodology to develop treatment manuals for use in clinical trials is detailed, and examples are given. A treatment manual provides a precise way to train and supervise practitioners, enable evaluation of conformity and competence, facilitate the training process, and increase the ability to identify the active therapeutic ingredients in clinical trials of acupuncture.

Complementary and alternative medicine for multiple sclerosis.

PubMed

Schwarz, S; Knorr, C; Geiger, H; Flachenecker, P

2008-09-01

We analyzed characteristics, motivation, and effectiveness of complementary and alternative medicine in a large sample of people with multiple sclerosis. A 53-item survey was mailed to the members of the German Multiple Sclerosis Society, chapter of Baden-Wuerttemberg. Surveys of 1573 patients (48.5 +/- 11.7 years, 74% women, duration of illness 18.1 +/- 10.5 years) were analyzed. In comparison with conventional medicine, more patients displayed a positive attitude toward complementary and alternative medicine (44% vs 38%, P < 0.05), with 70% reporting lifetime use of at least one method. Among a wide variety of complementary and alternative medicine, diet modification (41%), Omega-3 fatty acids (37%), removal of amalgam fillings (28%), vitamins E (28%), B (36%), and C (28%), homeopathy (26%), and selenium (24%) were cited most frequently. Most respondents (69%) were satisfied with the effects of complementary and alternative medicine. Use of complementary and alternative medicine was associated with religiosity, functional independence, female sex, white-collar job, and higher education (P < 0.05). Compared with conventional therapies, complementary and alternative medicine rarely showed unwanted side effects (9% vs 59%, P < 0.00001). A total of 52% stated that the initial consultation with their physician lasted less than 15 min. To conclude, main reasons for the use of complementary and alternative medicine include the high rate of side effects and low levels of satisfaction with conventional treatments and brief patients/physicians contacts.

Valuing Treatments for Parkinson Disease Incorporating Process Utility: Performance of Best-Worst Scaling, Time Trade-Off, and Visual Analogue Scales.

PubMed

Weernink, Marieke G M; Groothuis-Oudshoorn, Catharina G M; IJzerman, Maarten J; van Til, Janine A

2016-01-01

The objective of this study was to compare treatment profiles including both health outcomes and process characteristics in Parkinson disease using best-worst scaling (BWS), time trade-off (TTO), and visual analogue scales (VAS). From the model comprising of seven attributes with three levels, six unique profiles were selected representing process-related factors and health outcomes in Parkinson disease. A Web-based survey (N = 613) was conducted in a general population to estimate process-related utilities using profile-based BWS (case 2), multiprofile-based BWS (case 3), TTO, and VAS. The rank order of the six profiles was compared, convergent validity among methods was assessed, and individual analysis focused on the differentiation between pairs of profiles with methods used. The aggregated health-state utilities for the six treatment profiles were highly comparable for all methods and no rank reversals were identified. On the individual level, the convergent validity between all methods was strong; however, respondents differentiated less in the utility of closely related treatment profiles with a VAS or TTO than with BWS. For TTO and VAS, this resulted in nonsignificant differences in mean utilities for closely related treatment profiles. This study suggests that all methods are equally able to measure process-related utility when the aim is to estimate the overall value of treatments. On an individual level, such as in shared decision making, BWS allows for better prioritization of treatment alternatives, especially if they are closely related. The decision-making problem and the need for explicit trade-off between attributes should determine the choice for a method. Copyright © 2016. Published by Elsevier Inc.

Considerations for using data envelopment analysis for the assessment of radiotherapy treatment plan quality.

PubMed

Simpson, John; Raith, Andrea; Rouse, Paul; Ehrgott, Matthias

2017-10-09

Purpose The operations research method of data envelopment analysis (DEA) shows promise for assessing radiotherapy treatment plan quality. The purpose of this paper is to consider the technical requirements for using DEA for plan assessment. Design/methodology/approach In total, 41 prostate treatment plans were retrospectively analysed using the DEA method. The authors investigate the impact of DEA weight restrictions with reference to the ability to differentiate plan performance at a level of clinical significance. Patient geometry influences plan quality and the authors compare differing approaches for managing patient geometry within the DEA method. Findings The input-oriented DEA method is the method of choice when performing plan analysis using the key undesirable plan metrics as the DEA inputs. When considering multiple inputs, it is necessary to constrain the DEA input weights in order to identify potential plan improvements at a level of clinical significance. All tested approaches for the consideration of patient geometry yielded consistent results. Research limitations/implications This work is based on prostate plans and individual recommendations would therefore need to be validated for other treatment sites. Notwithstanding, the method that requires both optimised DEA weights according to clinical significance and appropriate accounting for patient geometric factors is universally applicable. Practical implications DEA can potentially be used during treatment plan development to guide the planning process or alternatively used retrospectively for treatment plan quality audit. Social implications DEA is independent of the planning system platform and therefore has the potential to be used for multi-institutional quality audit. Originality/value To the authors' knowledge, this is the first published examination of the optimal approach in the use of DEA for radiotherapy treatment plan assessment.

STDs and Pregnancy

MedlinePlus

... Status of EPT Legal/Policy Toolkit Gemifloxacin Procaine Penicillin G Shortage Additional Resources Archive Drug Notices Azithromycin ... Pyloric Stenosis Cefixime Spectinomycin – Alternative Treatments Alternatives to Penicillin G Updating the STD Treatment Guidelines 2010 Guidelines ...

STDs and Infertility

MedlinePlus

... Status of EPT Legal/Policy Toolkit Gemifloxacin Procaine Penicillin G Shortage Additional Resources Archive Drug Notices Azithromycin ... Pyloric Stenosis Cefixime Spectinomycin – Alternative Treatments Alternatives to Penicillin G Updating the STD Treatment Guidelines 2010 Guidelines ...

Comparison of atmospheric microplasma and plasma jet irradiation for increasing of skin permeability

NASA Astrophysics Data System (ADS)

Shimizu, K.; Tran, N. A.; Hayashida, K.; Blajan, M.

2016-08-01

Atmospheric plasma is attracting interest for medical applications such as sterilization, treatment of cancer cells and blood coagulation. Application of atmospheric plasma in dermatology has potential as a novel tool for wound healing, skin rejuvenation and treatment of wrinkles. In this study, we investigated the enhancement of percutaneous absorption of dye as alternative agents of transdermal drugs. Hypodermic needles are often the only way to deliver large-molecule drugs into the dermis, although a safe transdermal drug delivery method that does not require needles would be desirable. We therefore explored the feasibility of using atmospheric microplasma irradiation to enhance percutaneous absorption of drugs, as an alternative delivery method to conventional hypodermic needles. Pig skin was used as a biological sample, exposed to atmospheric microplasma, and analyzed by attenuated total reflection-Fourier transform infrared spectroscopy. A tape stripping test, a representative method for evaluating skin barrier performance, was also conducted for comparison. Transepidermal water loss (TEWL) was measured and compared with and without atmospheric microplasma irradiation, to quantify water evaporation from the inner body through the skin barrier. The results show that the stratum corneum, the outermost skin layer, could be chemically and physically modified by atmospheric microplasma irradiation. Physical damage to the skin by microplasma irradiation and an atmospheric plasma jet was also assessed by observing the skin surface. The results suggest that atmospheric microplasma has the potential to enhance percutaneous absorption.

Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review.

PubMed

Prins, Fieke M; Kerkmeijer, Linda G W; Pronk, Anne A; Vonken, Evert-Jan P A; Meijer, Richard P; Bex, Axel; Barendrecht, Maurits M

2017-10-01

The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments. Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy. The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4. Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.

$L^1$ penalization of volumetric dose objectives in optimal control of PDEs

DOE PAGES

Barnard, Richard C.; Clason, Christian

2017-02-11

This work is concerned with a class of PDE-constrained optimization problems that are motivated by an application in radiotherapy treatment planning. Here the primary design objective is to minimize the volume where a functional of the state violates a prescribed level, but prescribing these levels in the form of pointwise state constraints leads to infeasible problems. We therefore propose an alternative approach based on L 1 penalization of the violation that is also applicable when state constraints are infeasible. We establish well-posedness of the corresponding optimal control problem, derive first-order optimality conditions, discuss convergence of minimizers as the penalty parametermore » tends to infinity, and present a semismooth Newton method for their efficient numerical solution. Finally, the performance of this method for a model problem is illustrated and contrasted with an alternative approach based on (regularized) state constraints.« less

Fragment-based drug discovery as alternative strategy to the drug development for neglected diseases.

PubMed

Mello, Juliana da Fonseca Rezende E; Gomes, Renan Augusto; Vital-Fujii, Drielli Gomes; Ferreira, Glaucio Monteiro; Trossini, Gustavo Henrique Goulart

2017-12-01

Neglected diseases (NDs) affect large populations and almost whole continents, representing 12% of the global health burden. In contrast, the treatment available today is limited and sometimes ineffective. Under this scenery, the Fragment-Based Drug Discovery emerged as one of the most promising alternatives to the traditional methods of drug development. This method allows achieving new lead compounds with smaller size of fragment libraries. Even with the wide Fragment-Based Drug Discovery success resulting in new effective therapeutic agents against different diseases, until this moment few studies have been applied this approach for NDs area. In this article, we discuss the basic Fragment-Based Drug Discovery process, brief successful ideas of general applications and show a landscape of its use in NDs, encouraging the implementation of this strategy as an interesting way to optimize the development of new drugs to NDs. © 2017 John Wiley & Sons A/S.

[Regional electro-hyperthermia--technical principles, clinical results and health insurance aspects].

PubMed

Heyll, Uwe

2012-06-01

The method of electro-hyperthermia is based on the production of alternating currents from capacitive coupled electrodes. Because of the associated heating of body tissues, the electro-hyperthermia is promoted as an alternative to the more sophisticated methods of scientific hyperthermia, which find use in oncologic diseases. The analysis of technical data, however, reveals that the electro-hyperthermia is not qualified for a focused, effective and therapeutically useful heating of circumscribed target areas. Data from clinical studies demonstrating efficacy for defined indications are not available. The application of electro-hyperthermia is excluded form the German system of public health insurance. As proof of medical necessity cannot be provided, there is also no claim for reimbursement from private health insurance. According to legal regulations in Germany, an invoice as hyperthermia treatment is usually not possible. Rather, an item from the electrotherapy section of the official provision of medical fees (GOA) has to be chosen.

Photonic devices on planar and curved substrates and methods for fabrication thereof

DOEpatents

Bartl, Michael H.; Barhoum, Moussa; Riassetto, David

2016-08-02

A versatile and rapid sol-gel technique for the fabrication of high quality one-dimensional photonic bandgap materials. For example, silica/titania multi-layer materials may be fabricated by a sol-gel chemistry route combined with dip-coating onto planar or curved substrate. A shock-cooling step immediately following the thin film heat-treatment process is introduced. This step was found important in the prevention of film crack formation--especially in silica/titania alternating stack materials with a high number of layers. The versatility of this sol-gel method is demonstrated by the fabrication of various Bragg stack-type materials with fine-tuned optical properties by tailoring the number and sequence of alternating layers, the film thickness and the effective refractive index of the deposited thin films. Measured optical properties show good agreement with theoretical simulations confirming the high quality of these sol-gel fabricated optical materials.

An Efficient, Noniterative Method of Identifying the Cost-Effectiveness Frontier.

PubMed

Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D

2016-01-01

Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we also provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem. © The Author(s) 2015.

An Efficient, Non-iterative Method of Identifying the Cost-Effectiveness Frontier

PubMed Central

Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D.

2015-01-01

Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we additionally provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem. PMID:25926282

Proven Alternatives for Aboveground Treatment of Arsenic in Groundwater

EPA Pesticide Factsheets

This issue paper, developed for EPA's Engineering Forum, identifies and summarizes experiences with proven aboveground treatment alternatives for arsenic in groundwater, and provides information on their relative effectiveness and cost.

Dietary Fat Quantity and Type Induce Transcriptome-Wide Effects on Alternative Splicing of Pre-mRNA in Rat Skeletal Muscle.

PubMed

Black, Adam J; Ravi, Suhana; Jefferson, Leonard S; Kimball, Scot R; Schilder, Rudolf J

2017-09-01

Background: Fat-enriched diets produce metabolic changes in skeletal muscle, which in turn can mediate changes in gene regulation. Objective: We examined the high-fat-diet-induced changes in skeletal muscle gene expression by characterizing variations in pre-mRNA alternative splicing. Methods: Affymetrix Exon Array analysis was performed on the transcriptome of the gastrocnemius/plantaris complex of male obesity-prone Sprague-Dawley rats fed a 10% or 60% fat (lard) diet for 2 or 8 wk. The validation of exon array results was focused on troponin T ( Tnnt3 ). Tnnt3 splice form analyses were extended in studies of rats fed 10% or 30% fat diets across 1- to 8-wk treatment periods and rats fed 10% or 45% fat diets with fat sources from lard or mono- or polyunsaturated fats for 2 wk. Nuclear magnetic resonance (NMR) was used to measure body composition. Results: Consumption of a 60% fat diet for 2 or 8 wk resulted in alternative splicing of 668 and 726 pre-mRNAs, respectively, compared with rats fed a 10% fat diet. Tnnt3 transcripts were alternatively spliced in rats fed a 60% fat diet for either 2 or 8 wk. The high-fat-diet-induced changes in Tnnt3 alternative splicing were observed in rats fed a 30% fat diet across 1- to 8-wk treatment periods. Moreover, this effect depended on fat type, because Tnnt3 alternative splicing occurred in response to 45% fat diets enriched with lard but not in response to diets enriched with mono- or polyunsaturated fatty acids. Fat mass (a proxy for obesity as measured by NMR) did not differ between groups in any study. Conclusions: Rat skeletal muscle responds to overconsumption of dietary fat by modifying gene expression through pre-mRNA alternative splicing. Variations in Tnnt3 alternative splicing occur independently of obesity and are dependent on dietary fat quantity and suggest a role for saturated fatty acids in the high-fat-diet-induced modifications in Tnnt3 alternative splicing. © 2017 American Society for Nutrition.

Spontaneous regression of tumour and the role of microbial infection – possibilities for cancer treatment

PubMed Central

Cervinkova, Monika

2016-01-01

This review deals with the role of microorganisms in spontaneous regression of a tumour. Spontaneous cancer regression is a phenomenon that has been described for many centuries. One of the most well known methods of inducing spontaneous regression of cancer is the application of Coley’s toxin (heat-killed Streptococcus pyogenes and Serratia marcescens), which has been used for the successful treatment of sarcomas, carcinomas, lymphomas, myelomas and melanomas. In clinical practice, the use of Bacillus Calmette-Guérin vaccine for the treatment of superficial urinary bladder cancer is the most common instance of the application of microorganisms for the treatment of cancer. This review provides further information on other tested bacteria – Clostridium spp., Bifidobacterium spp., Lactobacillus spp. and Salmonella spp. – in this field of study. Among new age methods, bactofection, alternative gene therapy, combination bacteriolytic therapy and bacteria-directed enzyme prodrug therapy are some of the potential cancer treatment modalities that use microorganisms. We have also provided information about the interconnection among microorganisms, immune system response, and the possible mechanisms involved in the spontaneous regression of tumours. PMID:26813865

Spontaneous regression of tumour and the role of microbial infection--possibilities for cancer treatment.

PubMed

Kucerova, Petra; Cervinkova, Monika

2016-04-01

This review deals with the role of microorganisms in spontaneous regression of a tumour. Spontaneous cancer regression is a phenomenon that has been described for many centuries. One of the most well known methods of inducing spontaneous regression of cancer is the application of Coley's toxin (heat-killed Streptococcus pyogenes and Serratia marcescens), which has been used for the successful treatment of sarcomas, carcinomas, lymphomas, myelomas and melanomas. In clinical practice, the use of Bacillus Calmette-Guérin vaccine for the treatment of superficial urinary bladder cancer is the most common instance of the application of microorganisms for the treatment of cancer. This review provides further information on other tested bacteria--Clostridium spp., Bifidobacterium spp., Lactobacillus spp. and Salmonella spp.--in this field of study. Among new age methods, bactofection, alternative gene therapy, combination bacteriolytic therapy and bacteria-directed enzyme prodrug therapy are some of the potential cancer treatment modalities that use microorganisms. We have also provided information about the interconnection among microorganisms, immune system response, and the possible mechanisms involved in the spontaneous regression of tumours.

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients.

PubMed

Mostofi, Keyvan; Marnet, Dominique

2011-01-01

Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature. We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection. Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.

Recycling microcavity optical biosensors.

PubMed

Hunt, Heather K; Armani, Andrea M

2011-04-01

Optical biosensors have tremendous potential for commercial applications in medical diagnostics, environmental monitoring, and food safety evaluation. In these applications, sensor reuse is desirable to reduce costs. To achieve this, harsh, wet chemistry treatments are required to remove surface chemistry from the sensor, typically resulting in reduced sensor performance and increased noise due to recognition moiety and optical transducer degradation. In the present work, we suggest an alternative, dry-chemistry method, based on O₂ plasma treatment. This approach is compatible with typical fabrication of substrate-based optical transducers. This treatment completely removes the recognition moiety, allowing the transducer surface to be refreshed with new recognition elements and thus enabling the sensor to be recycled.

Recent advances in AIDS-related cryptococcal meningitis treatment with an emphasis on resource limited settings

PubMed Central

Lofgren, Sarah M; Abassi, Mahsa; Rhein, Joshua; Boulware, David R

2017-01-01

Introduction Recent advances in the treatment and prevention of cryptococcal meningitis have the potential to decrease AIDS-related deaths. Areas covered Targeted screening for asymptomatic cryptococcal antigenemia in persons with AIDS is a cost effective method for reducing early mortality in patients on antiretroviral therapy. For persons with symptomatic cryptococcal meningitis, optimal initial management with amphotericin and flucytosine improves survival compared to alternative therapies; however, amphotericin is difficult to administer and flucytosine has not been available in middle or low income countries, where cryptococcal meningitis is most prevalent. Expert Commentary Improved care for cryptococcal meningitis patients in resource-limited settings is possible, and new treatment possibilities are emerging. PMID:28111998

Treatment of Insomnia, Insomnia Symptoms, and Obstructive Sleep Apnea During and After Menopause: Therapeutic Approaches

PubMed Central

Tal, Joshua Z.; Suh, Sooyeon A.; Dowdle, Claire L.; Nowakowski, Sara

2015-01-01

Understanding sleep complaints among menopausal women is an emerging area of clinical and research interest. Several recent reviews have focused on mechanisms of menopausal insomnia and symptoms. In this review, we present a discussion on the most relevant and recent publications on the treatment of sleep disorders for menopausal women, with a focus on menopause-related insomnia, insomnia symptoms, and obstructive sleep apnea. We discuss both nonpharmacological and pharmacological treatments, including cognitive-behavioral therapy for insomnia (CBT-I), complementary and alternative medicine, hormone replacement therapy, sedative hypnotics, antidepressants, and continuous positive airway pressure. In addition, we briefly discuss methods and considerations of assessment of sleep disorders in menopausal women. PMID:26478725

Central composite design parameterization of microalgae/cyanobacteria co-culture pretreatment for enhanced lipid extraction using an external clamp-on ultrasonic transducer.

PubMed

Ellison, Candice R; Overa, Sean; Boldor, Dorin

2018-05-19

Lipids extracted from algal biomass could provide an abundant, rapidly growing, high yield feedstock for bio-diesel and other green fuels to supplement current fossil-based sources. Ultrasound pretreatment is a mechanical cell disruption method that has been shown to enhance lipid recovery from algae due to cavitation effects that disrupt algae cell walls. In this study, a locally grown mixture of Chlorella vulgaris/Cyanobacteria leptolyngbya was sonicated in an ultrasonic reactor with a clamp-on transducer prior to solvent lipid extraction. This configuration allows for a non-contact delivery method of ultrasonic energy with improved operational advantages (no fouling of transducer, continuous operation, and fully scalable design). A central composite design (CCD) was implemented to statistically analyze and evaluate the effect of ultrasonic power (350-750 W) and treatment time (5-30 min) on lipid yield. Lipid recovery was found to increase with both ultrasonic power and treatment time. Total lipid yields (on dry biomass basis) extracted via the Bligh and Dyer method from Chlorella vulgaris/cyanobacteria co-culture ranged from 8.3% for untreated algae to 16.9% for algae sonicated with 750 W power for 30 min, which corresponds to more than a doubling of lipid recovery due to ultrasound pretreatment. Increased power and treatment times were found to increase the degree of cell disruption as observed in the SEM and TEM images after ultrasonic pretreatment. Additionally, hexane (1:1 v/v) was evaluated as an alternative to the standard Bligh & Dyer (2:2:1.8 v/v/v chloroform/methanol/cell suspension) lipid extraction solvent system. On average, the Bligh and Dyer method extracted on average over twice the amount of lipids compared to hexane extraction. The lipid profile of the algae extracts indicates high concentrations of lauric acid (12:0), palmitic acid (16:0), stearic acid (18:0), oleic acid (18:1), and linoleic acid (18:2). This particular configuration of an ultrasonic system proved to be a viable method for the pretreatment of algae for enhanced lipid yields. Future research should focus on identifying alternative extraction solvents and expanding the range of treatment conditions to optimize the ultrasonic power and treatment times for maximum lipid recovery. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of hardwood retention, season of year, and landform on the perceived scenic beauty of forest plots in the Ouachita Mountains

Treesearch

James H. Gramann; Victor A. Rudis

1994-01-01

Results from a study of the within-stand visual effects of alternative reproduction cutting methods on 20 experimental plots in the Ouachita National Forest are presented. Treatments varied in their level of hardwood retention from complete suppression of hardwoods to retention of 30 ft2/acre of basal area. Using color transparency film, plots...

Antifungal activity of extracts from Piper aduncum leaves prepared by different solvents and extraction techniques against dermatophytes Trichophyton rubrum and Trichophyton interdigitale.

PubMed

Santos, Maximillan Leite; Magalhães, Chaiana Froés; da Rosa, Marcelo Barcellos; de Assis Santos, Daniel; Brasileiro, Beatriz Gonçalves; de Carvalho, Leandro Machado; da Silva, Marcelo Barreto; Zani, Carlos Leomar; de Siqueira, Ezequias Pessoa; Peres, Rodrigo Loreto; Andrade, Anderson Assunção

2013-12-01

The effects of different solvents and extraction techniques upon the phytochemical profile and anti-Trichophyton activity of extracts from Piper aduncum leaves were evaluated. Extract done by maceration method with ethanol has higher content of sesquiterpenes and antifungal activity. This extract may be useful as an alternative treatment for dermatophytosis.

Antifungal activity of extracts from Piper aduncum leaves prepared by different solvents and extraction techniques against dermatophytes Trichophyton rubrum and Trichophyton interdigitale

PubMed Central

Santos, Maximillan Leite; Magalhães, Chaiana Froés; da Rosa, Marcelo Barcellos; de Assis Santos, Daniel; Brasileiro, Beatriz Gonçalves; de Carvalho, Leandro Machado; da Silva, Marcelo Barreto; Zani, Carlos Leomar; de Siqueira, Ezequias Pessoa; Peres, Rodrigo Loreto; Andrade, Anderson Assunção

2013-01-01

The effects of different solvents and extraction techniques upon the phytochemical profile and anti-Trichophyton activity of extracts from Piper aduncum leaves were evaluated. Extract done by maceration method with ethanol has higher content of sesquiterpenes and antifungal activity. This extract may be useful as an alternative treatment for dermatophytosis. PMID:24688522

Long-term impacts of even-aged timber management on abundance and body condition of terrestrial amphibians in Northwestern California

Treesearch

N.E. Karraker; H.H. Welsh Jr

2006-01-01

Conservation needs for amphibians in managed timberlands may differ based upon the species present and the timber harvesting methods employed. Clearcuts have been documented to be detrimental to amphibians but the impacts of associated silvicultural edges and alternative harvesting treatments are not well understood. The primary objective of this study was to determine...

Alternative pavement designs : Randolph park and ride.

DOT National Transportation Integrated Search

2013-05-01

Previous research on alternative pavement type bidding has proven that various treatments : are unique in terms of constructability, material characteristics, and associated performance. : While some treatments may have higher initial costs, it is im...

27 CFR 27.221 - Alternate methods or procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Alternate methods or... Miscellaneous Provisions § 27.221 Alternate methods or procedures. (a) Application. An importer who desires to use an alternate method or procedure in lieu of a method or procedure prescribed by this part must...

27 CFR 17.3 - Alternate methods or procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Alternate methods or... PRODUCTS General Provisions § 17.3 Alternate methods or procedures. (a) General. The appropriate TTB officer may approve the use of an alternate method or procedure in lieu of a method or procedure...

76 FR 9777 - Recent Postings of Broadly Applicable Alternative Test Methods

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... Applicable Alternative Test Methods AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of availability. SUMMARY: This notice announces the broadly applicable alternative test method approval decisions... technical questions about individual alternative test method decisions, refer to the contact person...

A dosimetric analysis of intensity-modulated radiation therapy (IMRT) as an alternative to adjuvant high-dose-rate (HDR) brachytherapy in early endometrial cancer patients

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

Aydogan, Bulent; Mundt, Arno J.; Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL

2006-05-01

Purpose: To evaluate the role of intensity-modulated radiation treatment (IMRT) as an alternative to high-dose-rate (HDR) brachytherapy in the treatment of the vagina in postoperative early endometrial cancer patients after surgery. Methods and Materials: Planning computed tomography (CT) scans of 10 patients previously treated with HDR were used in this study. In all cases, a dose of 700 cGy/fraction was prescribed at a distance of 0.5 cm from the cylinder surface. The same CT scans were then used in IMRT planning. In this paradigm, the vaginal cylinder represents a component of a hypothetical immobilization system that would be indexed tomore » the linac treatment table. Results: Our study showed that IMRT provided relatively lower rectal doses than HDR when treatment was prescribed at a distance of 0.5 cm away from the cylinder surface. Maximum rectal doses were lower with IMRT compared with HDR (average: 89.0% vs. 142.6%, respectively, p < 0.05). Moreover, the mean rectal dose was lower in IMRT plans compared with HDR plans with treatment prescribed either to the surface (average: 14.8% vs. 21.4%, respectively, p < 0.05) or to 0.5 cm (average: 19.6% vs. 33.5%, respectively, p < 0.05). IMRT plans had planning target volume (PTV) coverage comparable with HDR (average PTV minimum for treatment prescribed to 0.5 cm: 93.9% vs. 92.1%, p = 0.71, respectively) with less inhomogeneity (average PTV maximum: 110.8% vs. 381.6%, p < 0.05). Conclusion: Our dosimetric analysis suggests that when used in conjunction with a suitable immobilization system, IMRT may provide an alternative to HDR brachytherapy in women with early endometrial cancer after hysterectomy. However, more studies are needed to evaluate the clinical merit of the IMRT in these patients.« less

Removing environmental organic pollutants with bioremediation and phytoremediation.

PubMed

Kang, Jun Won

2014-06-01

Hazardous organic pollutants represent a threat to human, animal, and environmental health. If left unmanaged, these pollutants could cause concern. Many researchers have stepped up efforts to find more sustainable and cost-effective alternatives to using hazardous chemicals and treatments to remove existing harmful pollutants. Environmental biotechnology, such as bioremediation and phytoremediation, is a promising field that utilizes natural resources including microbes and plants to eliminate toxic organic contaminants. This technology offers an attractive alternative to other conventional remediation processes because of its relatively low cost and environmentally-friendly method. This review discusses current biological technologies for the removal of organic contaminants, including chlorinated hydrocarbons, focusing on their limitation and recent efforts to correct the drawbacks.

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

ERIC Educational Resources Information Center

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

2014-01-01

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

Review of literature on the finite-element solution of the equations of two-dimensional surface-water flow in the horizontal plane

USGS Publications Warehouse

Lee, Jonathan K.; Froehlich, David C.

1987-01-01

Published literature on the application of the finite-element method to solving the equations of two-dimensional surface-water flow in the horizontal plane is reviewed in this report. The finite-element method is ideally suited to modeling two-dimensional flow over complex topography with spatially variable resistance. A two-dimensional finite-element surface-water flow model with depth and vertically averaged velocity components as dependent variables allows the user great flexibility in defining geometric features such as the boundaries of a water body, channels, islands, dikes, and embankments. The following topics are reviewed in this report: alternative formulations of the equations of two-dimensional surface-water flow in the horizontal plane; basic concepts of the finite-element method; discretization of the flow domain and representation of the dependent flow variables; treatment of boundary conditions; discretization of the time domain; methods for modeling bottom, surface, and lateral stresses; approaches to solving systems of nonlinear equations; techniques for solving systems of linear equations; finite-element alternatives to Galerkin's method of weighted residuals; techniques of model validation; and preparation of model input data. References are listed in the final chapter.

Probabilistic drug connectivity mapping

PubMed Central

2014-01-01

Background The aim of connectivity mapping is to match drugs using drug-treatment gene expression profiles from multiple cell lines. This can be viewed as an information retrieval task, with the goal of finding the most relevant profiles for a given query drug. We infer the relevance for retrieval by data-driven probabilistic modeling of the drug responses, resulting in probabilistic connectivity mapping, and further consider the available cell lines as different data sources. We use a special type of probabilistic model to separate what is shared and specific between the sources, in contrast to earlier connectivity mapping methods that have intentionally aggregated all available data, neglecting information about the differences between the cell lines. Results We show that the probabilistic multi-source connectivity mapping method is superior to alternatives in finding functionally and chemically similar drugs from the Connectivity Map data set. We also demonstrate that an extension of the method is capable of retrieving combinations of drugs that match different relevant parts of the query drug response profile. Conclusions The probabilistic modeling-based connectivity mapping method provides a promising alternative to earlier methods. Principled integration of data from different cell lines helps to identify relevant responses for specific drug repositioning applications. PMID:24742351

A Simple Method for Principal Strata Effects When the Outcome Has Been Truncated Due to Death

PubMed Central

Chiba, Yasutaka; VanderWeele, Tyler J.

2011-01-01

In randomized trials with follow-up, outcomes such as quality of life may be undefined for individuals who die before the follow-up is complete. In such settings, restricting analysis to those who survive can give rise to biased outcome comparisons. An alternative approach is to consider the “principal strata effect” or “survivor average causal effect” (SACE), defined as the effect of treatment on the outcome among the subpopulation that would have survived under either treatment arm. The authors describe a very simple technique that can be used to assess the SACE. They give both a sensitivity analysis technique and conditions under which a crude comparison provides a conservative estimate of the SACE. The method is illustrated using data from the ARDSnet (Acute Respiratory Distress Syndrome Network) clinical trial comparing low-volume ventilation and traditional ventilation methods for individuals with acute respiratory distress syndrome. PMID:21354986

A simple method for principal strata effects when the outcome has been truncated due to death.

PubMed

Chiba, Yasutaka; VanderWeele, Tyler J

2011-04-01

In randomized trials with follow-up, outcomes such as quality of life may be undefined for individuals who die before the follow-up is complete. In such settings, restricting analysis to those who survive can give rise to biased outcome comparisons. An alternative approach is to consider the "principal strata effect" or "survivor average causal effect" (SACE), defined as the effect of treatment on the outcome among the subpopulation that would have survived under either treatment arm. The authors describe a very simple technique that can be used to assess the SACE. They give both a sensitivity analysis technique and conditions under which a crude comparison provides a conservative estimate of the SACE. The method is illustrated using data from the ARDSnet (Acute Respiratory Distress Syndrome Network) clinical trial comparing low-volume ventilation and traditional ventilation methods for individuals with acute respiratory distress syndrome.

Noninvasive ocular drug delivery: potential transcorneal and other alternative delivery routes for therapeutic molecules in glaucoma.

PubMed

Foldvari, Marianna

2014-01-01

Drug delivery to the eye is made difficult by multiple barriers (such as the tear film, cornea, and vitreous) between the surface of the eye and the treatment site. These barriers are difficult to surmount for the purposes of drug delivery without causing toxicity. Using nanotechnology tools to control, manipulate, and study delivery systems, new approaches to delivering drugs, genes, and antigens that are effective and safe can be developed. Topical administration to the ocular surface would be the safest method for delivery, as it is noninvasive and painless compared with other delivery methods. However, there is only limited success using topical delivery methods, especially for gene therapy. Current thinking on treatments of the future enabled by nanodelivery systems and the identification of target specificity parameters that require deeper understanding to develop successful topical delivery systems for glaucoma is highlighted.

A Reconstruction Method for the Estimation of Temperatures of Multiple Sources Applied for Nanoparticle-Mediated Hyperthermia.

PubMed

Steinberg, Idan; Tamir, Gil; Gannot, Israel

2018-03-16

Solid malignant tumors are one of the leading causes of death worldwide. Many times complete removal is not possible and alternative methods such as focused hyperthermia are used. Precise control of the hyperthermia process is imperative for the successful application of such treatment. To that end, this research presents a fast method that enables the estimation of deep tissue heat distribution by capturing and processing the transient temperature at the boundary based on a bio-heat transfer model. The theoretical model is rigorously developed and thoroughly validated by a series of experiments. A 10-fold improvement is demonstrated in resolution and visibility on tissue mimicking phantoms. The inverse problem is demonstrated as well with a successful application of the model for imaging deep-tissue embedded heat sources. Thereby, allowing the physician then ability to dynamically evaluate the hyperthermia treatment efficiency in real time.

Microwave Heating as an Alternative Quarantine Method for Disinfestation of Stored Food Grains

PubMed Central

Kumar, Girish; Shah, Narendra G.

2013-01-01

Insects and pests constitute a major threat to food supplies all over the world. Some estimates put the loss of food grains because of infestation to about 40% of the world production. Contemporary disinfestation methods are chemical fumigation, ionizing radiation, controlled atmosphere, conventional hot air treatment, and dielectric heating, that is, radio frequency and microwave energy, and so forth. Though chemical fumigation is being used extensively in stored food grains, regulatory issues, insect resistance, and environmental concerns demand technically effective and environmentally sound quarantine methods. Recent studies have indicated that microwave treatment is a potential means of replacing other techniques because of selective heating, pollution free environment, equivalent or better quality retention, energy minimization, and so forth. The current paper reviews the recent advances in Microwave (MW) disinfestation of stored food products and its principle and experimental results from previous studies in order to establish the usefulness of this technology. PMID:26904615

77 FR 43827 - International Workshop on Alternative Methods for Leptospira

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES International Workshop on Alternative Methods for... NTP Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM) announces an ``International Workshop on Alternative Methods for Leptospira Vaccine Potency Testing: State of the Science and...

Commencement Bay Nearshore/Tideflats Superfund Site, Tacoma, Washington Remedial Investigations. Evaluation of Alternative Dredging Methods and Equipment, Disposal Methods and Sites, and Site Control and Treatment Practices for Contaminated Sediments.

DTIC Science & Technology

1985-06-01

material may have on ground water and drain- age systems and the possible burial of hazardous materials already existing on the site. The Port of Tacoma is...good resistance to inorganic chemicals; high gas permeability Asphalt- Core layer Of blown asphalt M Flexible enough to conform to Ages rapidly in hot...Tendst to harden on aging ; low polyethylene reacting polyethylene with acids, and alkalis tensile strength; tenoericy to chlorine and sulfur dioxide

Complementary Health Approaches Used in the Intensive Care Unit.

PubMed

Erdoğan, Zeynep; Atik, Derya

Intensive care units are care centers where, in order to provide the maximum benefit to individuals whose life is in danger, many lifesaving technological tools and devices are present, and morbidity and mortality rates are high. In the intensive care unit, when classic treatments fail or become unbearable because of side effects, complementary methods have been suggested to be the best alternative. Complementary health approaches are methods that are used both for the continuation and the improvement of the well-being of an individual and as additions to medical treatments that are based on a holistic approach. These applications are especially helpful in the treatment of the stresses, anxieties, and other symptoms of unstable patients in the intensive care unit who do not tolerate traditional treatment methods well, increasing their psychological and physiological well-being, helping them sleep and rest. In intensive care patients, in order to decrease the incidence of postoperative atrial fibrillation, antiemetic and medicine needs, mechanical ventilation duration, and the intensity of the disease as well as to cope with symptoms such as pain, anxiety, physiological parameters, dyspnea, and sleep problems, body-mind interventions such as massage, reflexology, acupressure, aromatherapy, music therapy, energy therapies (healing touch, therapeutic touch, the Yakson method), and prayer are used as complementary health approaches.

Shining a light in the black box of orphan drug pricing

PubMed Central

2014-01-01

Background The pricing mechanism of orphan drugs appears arbitrary and has been referred to as a “black box”. Therefore, the aim of this study is to investigate how drug- and disease-specific variables relate to orphan drug prices. Additionally, we aim to explore if certain country-specific pricing and reimbursement policies affect the price level of orphan drugs. Methods Annual treatment costs per indication per patient were calculated for 59 orphan drugs with a publicly available price in Belgium, the Netherlands, Czech Republic, France, Italy and the United Kingdom. A multiple linear regression model was built with 14 drug- and disease-specific variables. A Mann-Whitney U test was used to explore whether there is a correlation between annual treatment costs of orphan drugs across countries with different pricing and reimbursement policies. Results Repurposed orphan drugs, orally administered orphan drugs or orphan drugs for which an alternative treatment is available are associated with lower annual treatment costs. Orphan drugs with multiple orphan indications, for chronic treatments or for which an improvement in overall survival or quality-of-life has been demonstrated, are associated with higher annual treatment costs. No association was found between annual treatments cost of orphan drugs across countries and the different pricing and reimbursement systems. Conclusions This study has shown that prices of orphan drugs are influenced by factors such as the availability of an alternative drug treatment, repurposing, etc. Current debate about the affordability of orphan drugs highlights the need for more transparency in orphan drug price setting. PMID:24767472

Rare Copy Number Variation in Treatment-Resistant Major Depressive Disorder

PubMed Central

O’Dushlaine, Colm; Ripke, Stephan; Ruderfer, Douglas M.; Hamilton, Steven P.; Fava, Maurizio; Iosifescu, Dan V.; Kohane, Isaac S.; Churchill, Susanne E.; Castro, Victor M.; Clements, Caitlin C.; Blumenthal, Sarah R.; Murphy, Shawn N.; Smoller, Jordan W.; Perlis, Roy H.

2014-01-01

Background While antidepressant treatment response appears to be partially heritable, no consistent genetic associations have been identified. Large, rare copy number variants (CNVs) play a role in other neuropsychiatric diseases, so we assessed their association with treatment-resistant depression (TRD). Methods We analyzed data from two genome-wide association studies comprising 1263 Caucasian patients with major depressive disorder. One was drawn from a large health system by applying natural language processing to electronic health records (i2b2 cohort). The second consisted of a multicenter study of sequential antidepressant treatments, Sequenced Treatment Alternatives to Relieve Depression. The Birdsuite package was used to identify rare deletions and duplications. Individuals without symptomatic remission, despite two antidepressant treatment trials, were contrasted with those who remitted with a first treatment trial. Results CNV data were derived for 778 subjects in the i2b2 cohort, including 300 subjects (37%) with TRD, and 485 subjects in Sequenced Treatment Alternatives to Relieve Depression cohort, including 152 (31%) with TRD. CNV burden analyses identified modest enrichment of duplications in cases (empirical p = .04 for duplications of 100–200 kilobase) and a particular deletion region spanning gene PABPC4L (empirical p = .02, 6 cases: 0 controls). Pathway analysis suggested enrichment of CNVs intersecting genes regulating actin cytoskeleton. However, none of these associations survived genome-wide correction. Conclusions Contribution of rare CNVs to TRD appears to be modest, individually or in aggregate. The electronic health record-based methodology demonstrated here should facilitate collection of larger TRD cohorts necessary to further characterize these effects. PMID:24529801

Treatment of oral squamous cell carcinoma using anti-HER2 immunonanoshells

PubMed Central

Fekrazad, Reza; Hakimiha, Neda; Farokhi, Enice; Rasaee, Mohammad Javad; Ardestani, Mehdi Shafiee; Kalhori, Katayoun AM; Sheikholeslami, Farzaneh

2011-01-01

Background Worldwide, oral squamous cell carcinoma (potentially mediated by HER2) is recognized as the most commonly occurring malignant neoplasm of the oral cavity. Anti-HER2 nanobodies conjugated to gold-silica nanoshells and used as photothermal treatment for oral squamous cell carcinoma may provide a novel therapeutic alternative to current treatment for this disease. Methods KB epithelial or HeLaS3 cell cultures (controls) were exposed to these immunonanoshells, and plasmon resonance electron initiation specific to gold was employed to burn the tumor cells. Results Following this treatment, significant cell death occurred in the KB tumor cell cultures while there was no evidence of cellular damage or death in the HeLaS3 cell cultures. Conclusion These findings suggest that photothermal treatment of oral squamous cell carcinoma has considerable advantages. PMID:22131825

Pharmacokinetic interactions of herbal medicines for the treatment of chronic hepatitis.

PubMed

Hsueh, Tun-Pin; Lin, Wan-Ling; Tsai, Tung-Hu

2017-04-01

Chronic liver disease is a serious global health problem, and an increasing number of patients are seeking alternative medicines or complementary treatment. Herbal medicines account for 16.8% of patients with chronic liver disease who use complementary and alternative therapies. A survey of the National Health Insurance Research Database in Taiwan reported that Long-Dan-Xie-Gan-Tang, Jia-Wei-Xia-Yao-San, and Xiao-Chai-Hu-Tang (Sho-saiko-to) were the most frequent formula prescriptions for chronic hepatitis used by traditional Chinese medicine physicians. Bioanalytical methods of herbal medicines for the treatment of chronic hepatitis were developed to investigate pharmacokinetics properties, but multicomponent herbal formulas have been seldom discussed. The pharmacokinetics of herbal formulas is closely related to efficacy, efficiency, and patient safety of traditional herbal medicines. Potential herbal formula-drug interactions are another essential issue during herbal formula administration in chronic hepatitis patients. In a survey with the PubMed database, this review article evaluates the existing evidence-based data associated with the documented pharmacokinetics profiles and potential herbal-drug interactions of herbal formulas for the treatment of chronic hepatitis. In addition, the existing pharmacokinetic profiles were further linked with clinical practice to provide insight for the safety and specific use of traditional herbal medicines. Copyright © 2016. Published by Elsevier B.V.

Efficacy of octenidine dihydrochloride and 2-phenoxyethanol in the topical treatment of inflammatory acne.

PubMed

Mayr-Kanhäuser, Sigrid; Kränke, Birger; Aberer, Werner

2008-09-01

With the increase in antibiotic-resistant strains of microorganisms in acne lesions, the search for alternative treatment methods has become important. We studied the efficacy of a combination of the antiseptic substances octenidine dihydrochloride and 2-phenoxyethanol (O/P) in mild to moderate inflammatory acne vulgaris. Thirty patients were instructed to apply O/P once or twice daily for a 6-week treatment period. Determination of efficacy included the numerical documentation of inflammatory and non-inflammatory lesions within defined regions of the face by the investigator, and photodocumentation of the clinical picture as well as the fluorescence pattern under Wood's light. Twenty-four patients completed the study. The number of papules and pustules decreased more than 50% in seventeen and nineteen patients, respectively. Acne lesions worsened in only one patient. Mild adverse reactions (erythema, burning, and scaling) were seen in two patients. Therefore, O/P was highly effective in treating inflammatory lesions of facial acne, but there was no essential efficacy in the non-inflammatory primary acne lesions. Topical O/P is a good and cost-effective alternative in the treatment of mild to moderate inflammatory acne lesions and may allow reduced application of anti-acne antibiotics to prevent development of resistance.

The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment.

PubMed

Morzaria, S; Damrose, E J

2011-07-01

Botulinum toxin injection under electromyographic guidance is the 'gold standard' for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction. To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients. Stanford University Voice and Swallowing Center. Prospective case series (evidence level four). Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose-response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively. Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total). The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.

Rapid detox: understanding new treatment approaches for the addicted patient.

PubMed

McCabe, S

2000-01-01

Despite substantive advances in understanding of genetic and biochemical basis of substance abuse and addiction in the last decade, little information has been translated into alternative treatment models for the addicted patient. Rapid detox, an alternative form of detox treatment, is gaining in both acceptance and popularity. To increase readers' understanding of the neurobiology of addiction and the mode of action of new detox approaches for patients addicted to opiate drugs. A review of the current literature pertaining to rapid detox. Rapid detox is a viable alternative for selected patients attempting to detox from opiate agents of abuse. Increasing knowledge of new treatment approaches allows nurses working to assist addicted patients in planning and receiving treatment based on new awareness of the neurobiology of addiction.

Prevention of thromboembolic events in patients with atrial fibrillation - new anticoagulants.

PubMed

Campos, Alexandre Holthausen; Cirenza, Cláudio

2011-09-01

The authors present alternatives for the treatment of cardiac arrhythmias. Its detection is based on the use of different methods that record the cardiac electrical activity. The treatment involves intervening in the underlying disorder, antiarrhythmic drugs, stimulation and cardiac defibrillation devices, and, less often, surgery. The technological advances in the last two decades have provided greater efficiency in diagnoses and therapy. Atrial fibrilation patients will benefit from a new set of anticoagulant drugs tested in the past three years. The potential advantages include greater safety and efficacy, as well as convenience for not requiring frequent laboratory controls.

[Advances in the research of effects of music therapy on pain and anxiety in burn patients].

PubMed

Jinyi, Li; Yungui, Wang

2015-06-01

Pain and anxiety engender major psychic problems during all phases of treatment for burn patients. Analgesic alone does not allay these problems satisfactorily in these patients. Music therapy, as an important complementary and alternative therapy, has been widely used in multiple medical fields. However, its positive effect on alleviation of pain and anxiety in burn patients is undefined. The objective of this review is to summarize the feasibility, application fields, methods, and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment.

Synthesis of wood treatment alternatives for timber railroad structures.

DOT National Transportation Integrated Search

2011-12-01

A wealth of information exists on various wood preservatives, treatment techniques, curing practices, and other engineered : controls, along with alternative materials for replacement. This study was initiated to review and synthesize available : inf...

Addressing holistic healthcare needs of oncology patients: Implementation and evaluation of a complementary and alternative medicine (CAM) course within an elective module designed for healthcare professionals.

PubMed

Klafke, Nadja; Homberg, Angelika; Glassen, Katharina; Mahler, Cornelia

2016-12-01

Patients, and especially oncology patients, increasingly demand information and application of complementary therapies to supplement their conventional medical treatment and follow-up care. Due to the widespread interest in holistic treatment opportunities in oncology populations, healthcare professionals need to be prepared in differentiating evidence-based methods of the complementary and alternative medicine (CAM) spectrum and how to consult with patients about it. This paper reports on the implementation and evaluation of a newly designed module "Complementary and Alternative Medicine in oncological healthcare" in the bachelor degree program Interprofessional Health Care (B.Sc.). The study applied a developed evaluation questionnaire to capture students' perspectives on the CAM contents. This assessment instrument was administered pre and post the CAM teaching unit. Interprofessional medical education, University Hospital Heidelberg, Germany. The integration of the CAM elective module was possible and was met by positive response. Students' interest was reflected in an increase of their self-reported knowledge gain and positive CAM attitude. Comparison of pre and post evaluation data demonstrate that, particularly, students' expectations on developing their own opinion about CAM, and getting an overview of the evidence-base of different CAM methods have been met. Evaluation results indicate that the module content was in line with the students' expectations and may have positively impacted on their general CAM attitude. The results support us in continuing to offer this CAM course within the elective module to prepare today's healthcare professionals for patient-oriented healthcare delivery. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Importance of Considering Differences in Study Design in Network Meta-analysis: An Application Using Anti-Tumor Necrosis Factor Drugs for Ulcerative Colitis.

PubMed

Cameron, Chris; Ewara, Emmanuel; Wilson, Florence R; Varu, Abhishek; Dyrda, Peter; Hutton, Brian; Ingham, Michael

2017-11-01

Adaptive trial designs present a methodological challenge when performing network meta-analysis (NMA), as data from such adaptive trial designs differ from conventional parallel design randomized controlled trials (RCTs). We aim to illustrate the importance of considering study design when conducting an NMA. Three NMAs comparing anti-tumor necrosis factor drugs for ulcerative colitis were compared and the analyses replicated using Bayesian NMA. The NMA comprised 3 RCTs comparing 4 treatments (adalimumab 40 mg, golimumab 50 mg, golimumab 100 mg, infliximab 5 mg/kg) and placebo. We investigated the impact of incorporating differences in the study design among the 3 RCTs and presented 3 alternative methods on how to convert outcome data derived from one form of adaptive design to more conventional parallel RCTs. Combining RCT results without considering variations in study design resulted in effect estimates that were biased against golimumab. In contrast, using the 3 alternative methods to convert outcome data from one form of adaptive design to a format more consistent with conventional parallel RCTs facilitated more transparent consideration of differences in study design. This approach is more likely to yield appropriate estimates of comparative efficacy when conducting an NMA, which includes treatments that use an alternative study design. RCTs based on adaptive study designs should not be combined with traditional parallel RCT designs in NMA. We have presented potential approaches to convert data from one form of adaptive design to more conventional parallel RCTs to facilitate transparent and less-biased comparisons.

Complementary and alternative medicine treatments for low back pain.

PubMed

Marlowe, Dan

2012-09-01

Complementary and alternative medicine, often referred to as integrated medicine, is often used for the treatment of low back pain. This article presents 6 therapies (ie, behavioral treatment, acupuncture, manipulation, prolotherapy, neuroreflexotherapy, and herbal treatments), which are discussed in terms of the specifics of the modality, as well as the empirical evidence related to their effectiveness. Copyright © 2012 Elsevier Inc. All rights reserved.

29 CFR 4211.23 - Approval of alternative method.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Approval of alternative method. 4211.23 Section 4211.23... Subject to PBGC Approval § 4211.23 Approval of alternative method. (a) General. The PBGC shall approve an alternative allocation method or modification to an allocation method if the PBGC determines that adoption of...

Use of the Analytic Hierarchy Process for Medication Decision-Making in Type 2 Diabetes

PubMed Central

Maruthur, Nisa M.; Joy, Susan M.; Dolan, James G.; Shihab, Hasan M.; Singh, Sonal

2015-01-01

Aim To investigate the feasibility and utility of the Analytic Hierarchy Process (AHP) for medication decision-making in type 2 diabetes. Methods We conducted an AHP with nine diabetes experts using structured interviews to rank add-on therapies (to metformin) for type 2 diabetes. During the AHP, participants compared treatment alternatives relative to eight outcomes (hemoglobin A1c-lowering and seven potential harms) and the relative importance of the different outcomes. The AHP model and instrument were pre-tested and pilot-tested prior to use. Results were discussed and an evaluation of the AHP was conducted during a group session. We conducted the quantitative analysis using Expert Choice software with the ideal mode to determine the priority of treatment alternatives. Results Participants judged exenatide to be the best add-on therapy followed by sitagliptin, sulfonylureas, and then pioglitazone. Maximizing benefit was judged 21% more important than minimizing harm. Minimizing severe hypoglycemia was judged to be the most important harm to avoid. Exenatide was the best overall alternative if the importance of minimizing harms was prioritized completely over maximizing benefits. Participants reported that the AHP improved transparency, consistency, and an understanding of others’ perspectives and agreed that the results reflected the views of the group. Conclusions The AHP is feasible and useful to make decisions about diabetes medications. Future studies which incorporate stakeholder preferences should evaluate other decision contexts, objectives, and treatments. PMID:26000636

A complex systems science perspective for whole systems of complementary and alternative medicine research.

PubMed

Koithan, Mary; Bell, Iris R; Niemeyer, Kathryn; Pincus, David

2012-01-01

Whole systems complementary and alternative medicine (WS-CAM) approaches share a basic worldview that embraces interconnectedness; emergent, non-linear outcomes to treatment that include both local and global changes in the human condition; a contextual view of human beings that are inseparable from and responsive to their environments; and interventions that are complex, synergistic, and interdependent. These fundamental beliefs and principles run counter to the assumptions of reductionism and conventional biomedical research methods that presuppose unidimensional simple causes and thus dismantle and individually test various interventions that comprise only single aspects of the WSCAM system. This paper will demonstrate the superior fit and practical advantages of using complex adaptive systems (CAS) and related modeling approaches to develop the scientific basis for WS-CAM. Furthermore, the details of these CAS models will be used to provide working hypotheses to explain clinical phenomena such as (a) persistence of changes for weeks to months between treatments and/or after cessation of treatment, (b) nonlocal and whole systems changes resulting from therapy, (c) Hering's law, and (d) healing crises. Finally, complex systems science will be used to offer an alternative perspective on cause, beyond the simple reductionism of mainstream mechanistic ontology and more parsimonious than the historical vitalism of WS-CAM. Rather, complex systems science provides a scientifically rigorous, yet essentially holistic ontological perspective with which to conceptualize and empirically explore the development of disease and illness experiences, as well as experiences of healing and wellness. Copyright © 2012 S. Karger AG, Basel.

Oncologists' and naturopaths' nutrition beliefs and practices.

PubMed

Novak, K L; Chapman, G E

2001-01-01

Despite the widespread use of complementary and alternative therapies by persons with cancer, little is known about how the understandings of complementary and alternative practitioners of these therapies compare with those of conventional physicians. The broad purpose of this research was, thus, to explore the beliefs of physicians and complementary and alternative health practitioners, their use of scientific and other types of evidence, and their counseling practices. The specific issue addressed was the beliefs and practices of oncologists and naturopaths regarding the role of diet in breast cancer prevention and treatment. A qualitative research design was used, involving in-depth semistructured interviews with 10 oncologists and 11 naturopaths. Interviews were tape-recorded, transcribed verbatim, and analyzed using qualitative methods. The oncologists believed that there is little evidence of a role for diet in breast cancer prevention and treatment, citing the lack of evidence from randomized controlled trials. They reported that they provide only general advice on healthy eating to patients. The naturopaths believed that diet is strongly implicated in breast cancer development, prevention, and treatment. They justified this belief by using scientific evidence from a variety of types of studies, logic or common sense, and their clinical experiences. Naturopaths reported that they provide patients with specific suggestions for foods to avoid or to emphasize in diets. The differences in the advice provided by oncologists and naturopaths are associated with different decision-making or knowledge construction systems. Educating patients about these differences will help patients to make more informed healthcare choices.

A regulator's view of comparative effectiveness research.

PubMed

Temple, Robert

2012-02-01

'Comparative effectiveness' is the current enthusiasm, and for good reason. After knowing a treatment works, the most critical question is how it compares with alternatives. Comparative studies are not commonly conducted by drug companies and they represent a significant methodological challenge. Comparative data could include evidence of overall superiority to an alternative or advantages in identifiable subsets, for example, people who do not respond to or tolerate alternatives, or members of a genetic subset and could also include convincing evidence that there is little difference between two treatments. To describe regulations, guidance, and Food and Drug Administration experience related to studies of comparative effectiveness, including approaches to showing superiority and problems encountered in showing similarity. Review of Food and Drug Administration regulations and guidance and experience with showing superiority and similarity, particularly related to randomized trials and epidemiologic studies. Methods exist, and they have been successful for showing overall superiority of one drug over another, advantages in specific population subsets. Efforts to show true equivalence face problems of definition and very large sample sizes needed to rule out small differences. There is need for further discussion of what is meant by similarity or equivalence of two treatments. Comparative studies are challenging because differences between effective therapies are likely to be small and can be detected reliably only in randomized trials, often large ones. Despite the difficulties, comparative trials have been successful and we clearly would like to see more of them.

Attitudes toward buprenorphine and methadone among opioid-dependent individuals

PubMed Central

Schwartz, Robert P.; Kelly, Sharon M.; O'Grady, Kevin E.; Mitchell, Shannon Gwin; Peterson, James A.; Reisinger, Heather Schacht; Agar, Michael H.; Brown, Barry S.

2009-01-01

Attitudes and beliefs about drug abuse treatment have long been known to shape response to that treatment. Two major pharmacological alternatives are available for opioid dependence: methadone, which has been available for the past 40 years, and buprenorphine, a recently-introduced medication. This mixed methods study examined the attitudes of opioid-dependent individuals toward methadone and buprenorphine. A total of 195 participants (n = 140 who were enrolling in one of 6 Baltimore area methadone programs and n = 55 who were out-of-treatment) were administered the Attitudes toward Methadone and toward Buprenorphine Scales and a subset (n = 46) received an ethnographic interview. In-treatment group had significantly more positive attitudes toward methadone than did the out-of-treatment group (p < .001), while they did not differ in their attitudes toward buprenorphine. Both groups had significantly more positive attitudes toward buprenorphine than methadone. Addressing these attitudes may increase treatment entry and retention. PMID:18770082

Comparison of Self-Prompting of Cooking Skills via Picture-Based Cookbooks and Video Recipes

ERIC Educational Resources Information Center

Mechling, Linda C.; Stephens, Erin

2009-01-01

This investigation compared the use of static picture prompting, in a cookbook format, and video prompting to self-prompt four students with moderate intellectual disabilities to independently complete multi-step cooking tasks. An adapted alternating treatments design (AATD) with baseline, alternating treatments, and final treatment condition, was…

Effects of ecological restoration alternative treatments on nonnative plant species establishment (P-53)

Treesearch

Michael T. Stoddard; Christopher M. McGlone; Peter Z. Fule

2008-01-01

Disturbances generated by forest restoration treatments have the potential for enhancing the establishment of nonnative species thereby impeding long-term native plant recovery. In a ponderosa pine forest next to the Fort Valley Experimental Forest, Arizona, we examined the establishment of nonnative species after three alternative treatments with different intensities...

Effects of ecological restoration alternative treatments on nonnative plant species establishment

Treesearch

Michael T. Stoddard; Christopher M. McGlone; Peter Z. Fule

2008-01-01

Disturbances generated by forest restoration treatments have the potential for enhancing the establishment of nonnative species thereby impeding long-term native plant recovery. In a ponderosa pine forest next to the Fort Valley Experimental Forest, Arizona, we examined the establishment of nonnative species after three alternative treatments with different intensities...

Linear combinations come alive in crossover designs.

PubMed

Shuster, Jonathan J

2017-10-30

Before learning anything about statistical inference in beginning service courses in biostatistics, students learn how to calculate the mean and variance of linear combinations of random variables. Practical precalculus examples of the importance of these exercises can be helpful for instructors, the target audience of this paper. We shall present applications to the "1-sample" and "2-sample" methods for randomized short-term 2-treatment crossover studies, where patients experience both treatments in random order with a "washout" between the active treatment periods. First, we show that the 2-sample method is preferred as it eliminates "conditional bias" when sample sizes by order differ and produces a smaller variance. We also demonstrate that it is usually advisable to use the differences in posttests (ignoring baseline and post washout values) rather than the differences between the changes in treatment from the start of the period to the end of the period ("delta of delta"). Although the intent is not to provide a definitive discussion of crossover designs, we provide a section and references to excellent alternative methods, where instructors can provide motivation to students to explore the topic in greater detail in future readings or courses. Copyright © 2017 John Wiley & Sons, Ltd.

Apparatus and method for treating a cathode material provided on a thin-film substrate

DOEpatents

Hanson, Eric J.; Kooyer, Richard L.

2001-01-01

An apparatus and method for treating a cathode material provided on a surface of a continuous thin-film substrate and a treated thin-film cathode having increased smoothness are disclosed. A web of untreated cathode material is moved between a feed mechanism and a take-up mechanism, and passed through a treatment station. The web of cathode material typically includes areas having surface defects, such as prominences extending from the surface of the cathode material. The surface of the cathode material is treated with an abrasive material to reduce the height of the prominences so as to increase an 85 degree gloss value of the cathode material surface by at least approximately 10. The web of cathode material may be subjected to a subsequent abrasive treatment at the same or other treatment station. Burnishing or lapping film is employed at a treatment station to process the cathode material. An abrasive roller may alternatively be used to process the web of cathode material. The apparatus and method of the present invention may also be employed to treat the surface of a lithium anode foil so as to cleanse and reduce the roughness of the anode foil surface.

Apparatus and method for treating a cathode material provided on a thin-film substrate

DOEpatents

Hanson, Eric J.; Kooyer, Richard L.

2003-01-01

An apparatus and method for treating a cathode material provided on a surface of a continuous thin-film substrate and a treated thin-film cathode having increased smoothness are disclosed. A web of untreated cathode material is moved between a feed mechanism and a take-up mechanism, and passed through a treatment station. The web of cathode material typically includes areas having surface defects, such as prominences extending from the surface of the cathode material. The surface of the cathode material is treated with an abrasive material to reduce the height of the prominences so as to increase an 85 degree gloss value of the cathode material surface by at least approximately 10. The web of cathode material may be subjected to a subsequent abrasive treatment at the same or other treatment station. Burnishing or lapping film is employed at a treatment station to process the cathode material. An abrasive roller may alternatively be used to process the web of cathode material. The apparatus and method of the present invention may also be employed to treat the surface of a lithium anode foil so as to cleanse and reduce the roughness of the anode foil surface.

Rehabilitation of a periodontal patient with rapidly progressing marginal alveolar bone loss: 1-year follow-up.

PubMed

Sewón, L A; Ampula, L; Vallittu, P K

2000-08-01

The present case report describes a 1-year follow-up of functional rehabilitation of a young periodontal patient with severely advanced, rapidly progressing marginal bone loss treated by using a new splinting material, i.e., glass fiber-reinforced composite (FRC). Apart from one single tooth, the young man had retained all his natural teeth. Periodontal treatment was based on cleaning and root planing enabled by partial-thickness-flap operations. This method was selected to avoid further damage to the remaining alveolar bone. After healing for 6 months, a cavity retained internal FRC splint was constructed and 1 missing lower molar was replaced by an inlay-retained FRC resin-bonded fixed partial denture (FPD). A 12 months follow-up period revealed a healthy periodontium and good functional and esthetic results. The new material allows the use of periodontal treatment methods instead of prosthetic alternatives, which until now have been a more generally used approach in the treatment of severely advanced periodontal cases. Internal fiber-reinforced composite splinting being affordable for the patient, easy for the clinician to construct and giving good esthetic and functional results, suggests that the method may be a valuable aid in periodontal treatment.

High-intensity focused ultrasound treatment for intra-abdominal desmoid tumors: a report of four cases.

PubMed

Shi, Yulan; Huang, Yanqin; Zhou, Meiqi; Ying, Xiao; Hu, Xiaoye

2016-04-01

Desmoid tumors are rare clonal fibroblastic proliferations that can arise at abdominal or extra-abdominal sites. Complete surgical resection is the primary treatment for resectable desmoid tumors, but a high rate of local recurrence has been reported even after complete resection. For patients with a recurrent tumor, the goals of treatment are to control the recurrence, maintain quality of life, and prolong survival. Radiofrequency ablation, radiotherapy, chemotherapy, and other medical therapies can be used as alternative methods, but there are considerable controversies over the roles of these methods in the management of desmoid tumors. High-intensity focused ultrasound (HIFU) is a minimally invasive and effective method for treatment of solid tumors. We used HIFU to treat four patients with intra-abdominal desmoid tumors from June 2011 to September 2013. Post-procedural pain was seen in all patients. One patient had an intra-abdominal abscess and another suffered a slight injury to the femoral nerve. The patients were followed up for 19-46 months (mean 34 months) until April 2015. The tumor in one patient disappeared, and no tumor progression was observed in the other patients.

Interventional MSK procedures: the hip.

PubMed

Dodré, Emilie; Lefebvre, Guillaume; Cockenpot, Eric; Chastanet, Patrick; Cotten, Anne

2016-01-01

Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intra-articular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease, thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumour destruction based on temperature, such as radiofrequency ablation (RFA) and cryotherapy, are performed for the management of musculoskeletal metastases. MR-guided focused ultrasound surgery provides a non-invasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumours, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat non-displaced or minimally displaced acetabular roof fractures.

Use of Arginine Hydrochloride in the Treatment of Metabolic Alkalosis or Hypochloremia in Pediatric Patients

PubMed Central

Hernandez, Elvin A.; Parbuoni, Kristine A.

2018-01-01

OBJECTIVES Dosing of arginine for treatment of hypochloremia or metabolic alkalosis is laborious and has inherent variability in dose selection. The primary objective of this study was to determine the efficacy of arginine in the treatment of metabolic alkalosis and hypochloremia. Secondary objectives were to determine an optimal dose, route, and frequency for arginine administration in the treatment of these conditions. METHODS This single center, retrospective, descriptive study was conducted in children who received arginine for treatment of hypochloremia or metabolic alkalosis. Treatment success was assessed by measuring serum chloride and bicarbonate concentrations after arginine administration. RESULTS Of the 464 orders analyzed, 177 met inclusion criteria in 82 unique patients. Fifty percent (n = 81) of arginine administrations used to manage hypochloremia saw normalization of abnormal chloride levels, and 83% (n = 62) of arginine administrations used to treat metabolic alkalosis saw normalization of abnormal bicarbonate levels. Patients who received arginine to resolve hypochloremia were statistically significantly more likely to have their hypochloremia resolve if they used alternative dosing methods compared to established dosing methods (76 vs. 5, p = 0.001). However, this relationship was not seen for patients with metabolic alkalosis (11 vs. 51, p = 1.000). The median percentage of calculated daily dose of arginine needed for resolution of hypochloremia was 59% and was 35% for metabolic alkalosis. CONCLUSIONS Arginine is effective to improve metabolic alkalosis and hypochloremia. Established dosing methods are not more effective than other methods in resolving metabolic alkalosis or hypochloremia. Further prospective studies are warranted to validate these results. PMID:29720912

77 FR 8865 - Recent Postings of Broadly Applicable Alternative Test Methods

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-15

... Applicable Alternative Test Methods AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of availability. SUMMARY: This notice announces the broadly applicable alternative test method approval decisions... INFORMATION CONTACT: An electronic copy of each alternative test method approval document is available on the...

75 FR 7593 - Recent Postings of Broadly Applicable Alternative Test Methods

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

... Applicable Alternative Test Methods AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of availability. SUMMARY: This notice announces the broadly applicable alternative test method approval decisions... electronic copy of each alternative test method approval document is available on EPA's Web site at http...

77 FR 40358 - Meeting of the Scientific Advisory Committee on Alternative Toxicological Methods (SACATM)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-09

... Alternative Toxicological Methods (SACATM) AGENCY: Division of the National Toxicology Program (DNTP.../live ). SACATM advises the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM), the NTP Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM...

78 FR 11174 - Recent Postings of Broadly Applicable Alternative Test Methods

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-15

... Applicable Alternative Test Methods AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of availability. SUMMARY: This notice announces the broadly applicable alternative test method approval decisions... INFORMATION CONTACT: An electronic copy of each alternative test method approval document is available on the...

Alternate hot and cold application in the management of heel pain: A pilot study.

PubMed

Arankalle, Dhananjay; Wardle, Jon; Nair, Pradeep M K

2016-12-01

Despite a long-standing tradition of naturopathic physical therapy and hydrotherapy use in the treatment of musculoskeletal conditions, neither naturopathy, nor specific aspects of hydrotherapy have been tested for efficacy in the treatment of heel pain. Patients (n=20) were assigned to standard naturopathic physiotherapy care (NPC) with two adjuvant therapy groups: a control group (therapeutic ultrasound, n=10), or alternating compresses (n=10). Pain scores were measured before and after treatment using Visual Analog Scale (VAS) and foot functionality was measured using the Foot Function Index (FFI). FFI reduced from 46.97 to 31.98 (p=0.005) among normal protocol patients and from 49.72 to 21.35 (p=<0.001) among patients receiving the alternating compress protocol. Average VAS pain intensity in the seven days of treatment decreased from 3.53 to 2.53cm (p=<0.001) among patients receiving NPC and from 4.09 to 2.61cm (p=<0.001) amongst those receiving NPC plus alternating compresses. There was no significant difference in pain score reduction between the two groups (p=0.206), but patients with alternating compresses as part of their treatment had significant improvements in foot functionality (p=0.007). Naturopathic physical therapy significantly improves foot functionality and pain scores in heel pain. Additionally, alternating compresses improve foot functionality scores. Copyright © 2016 Elsevier Ltd. All rights reserved.

Allergic contact dermatitis from ophthalmic products: can pre-treatment with sodium lauryl sulfate increase patch test sensitivity?

PubMed

Corazza, Monica; Virgili, Annarosa

2005-05-01

In patients suspected of allergic contact dermatitis because of topical ophthalmic medicaments, patch tests performed with patients' own products are often negative. The irritant anionic surfactant sodium lauryl sulfate (SLS) may alter the stratum corneum and increase antigen penetration. Pre-treatment of the skin with SLS 0.5% for 24 h was performed in the sites of patch tests with patients' own products in 15 selected patients. In patients previously negative to their own products tested with conventional patch tests, SLS pre-treatment showed 6 new relevant positive reactions and induced a stronger positive reaction in 1 patient. SLS pre-treatment could be proposed as an alternative promising method, which may increase sensitivity of patch tests with patients' own products.

Interplay between pro-inflammatory cytokines and growth factors in depressive illnesses

PubMed Central

Audet, Marie-Claude; Anisman, Hymie

2013-01-01

The development of depressive disorders had long been attributed to monoamine variations, and pharmacological treatment strategies likewise focused on methods of altering monoamine availability. However, the limited success achieved by treatments that altered these processes spurred the search for alternative mechanisms and treatments. Here we provide a brief overview concerning a possible role for pro-inflammatory cytokines and growth factors in major depression, as well as the possibility of targeting these factors in treating this disorder. The data suggest that focusing on one or another cytokine or growth factor might be counterproductive, especially as these factors may act sequentially or in parallel in affecting depressive disorders. It is also suggested that cytokines and growth factors might be useful biomarkers for individualized treatments of depressive illnesses. PMID:23675319

The Combination of Laser Therapy and Metal Nanoparticles in Cancer Treatment Originated From Epithelial Tissues: A Literature Review

PubMed Central

Fekrazad, Reza; Naghdi, Nafiseh; Nokhbatolfoghahaei, Hanieh; Bagheri, Hossein

2016-01-01

Several methods have been employed for cancer treatment including surgery, chemotherapy and radiation therapy. Today, recent advances in medical science and development of new technologies, have led to the introduction of new methods such as hormone therapy, Photodynamic therapy (PDT), treatments using nanoparticles and eventually combinations of lasers and nanoparticles. The unique features of LASERs such as photo-thermal properties and the particular characteristics of nanoparticles, given their extremely small size, may provide an interesting combined therapeutic effect. The purpose of this study was to review the simultaneous application of lasers and metal nanoparticles for the treatment of cancers with epithelial origin. A comprehensive search in electronic sources including PubMed, Google Scholar and Science Direct was carried out between 2000 and 2013. Among the initial 400 articles, 250 articles applied nanoparticles and lasers in combination, in which more than 50 articles covered the treatment of cancer with epithelial origin. In the future, the combination of laser and nanoparticles may be used as a new or an alternative method for cancer therapy or diagnosis. Obviously, to exclude the effect of laser’s wavelength and nanoparticle’s properties more animal studies and clinical trials are required as a lack of perfect studies PMID:27330701

Chemically controlled closed-loop insulin delivery.

PubMed

Ravaine, Valérie; Ancla, Christophe; Catargi, Bogdan

2008-11-24

Alternative treatments for diabetes are currently being investigated to improve both patient comfort and avoid complications due to hyperglycaemia episodes. In the absence of a cure like pancreas or beta-islets transplants, the ideal method would be an artificial "closed-loop" system able to mimic pancreas activity. This would operate continuously and automatically, causing appropriate response to losses and gains in glucose levels. Chemically controlled closed-loop insulin delivery has been explored by two main strategies. The first one consists in delivering insulin with a glucose-responsive matrix. Polymeric hydrogels that swell or shrink according to the glucose concentration allow delivering insulin doses adapted to the glucose concentration. The second strategy consists in modifying insulin itself with glucose-sensitive functional groups that trigger its activity. Recent developments made in these areas represent significant progress in terms of biocompatibility, selectivity, pharmacokinetics, and easiness of administration, as required for in vivo applications. Although some issues still have to be overcome, this field of research is promising as a possible alternative to other approaches for diabetes treatment.

Complementary and alternative treatment of musculoskeletal pain.

PubMed

Grazio, Simeon; Balen, Diana

2011-12-01

The use of complementary and alternative medicine (CAM) is high and increasing worldwide. Patients usually use CAM in addition to conventional medicine, mainly to treat pain. In a large number of cases, people use CAM for chronic musculoskeletal pain as in osteoarthritis, back pain, neck pain, or fibromyalgia. Herewith, a review is presented of CAM efficacy in treating musculoskeletal pain for which, however, no scientific research has so far provided evidence solid enough. In some rare cases where adequate pain control cannot be achieved, CAM might be considered in rational and individual approach based on the first general rule in medicine "not to harm" and on the utility theory of each intervention, i.e. according to the presumed mechanism of painful stimulus and with close monitoring of the patient's response. Further high quality studies are warranted to elucidate the efficacy and side effects of CAM methods. Therefore, conventional medicine remains the main mode of treatment for patients with musculoskeletal painful conditions.

Chiropractic intervention in the treatment of postmenopausal climacteric symptoms and insomnia: A review.

PubMed

Goto, Viviane; Frange, Cristina; Andersen, Monica L; Júnior, José M S; Tufik, Sergio; Hachul, Helena

2014-05-01

Insomnia is a frequent postmenopausal symptom and may be due to hormonal changes, depressive states related to this period of life, hot flashes or nocturia. Chiropractic care has been demonstrated to be effective in the treatment of these symptoms. The aim of this study was to review chiropractic interventions in postmenopausal women as a possible management approach to menopausal symptoms and insomnia. A PubMed search was conducted by cross-referencing the key words insomnia, sleep, and menopause with chiropractic. The search used an end date of January 2014 and retrieved 17 articles. Three articles were eligible for the study. All epidemiological data from large surveys demonstrated a lack of evidence for chiropractic intervention as a complementary and alternative therapeutic method in the management of menopausal symptoms and insomnia. There is no evidence for the effectiveness of chiropractic intervention as a complementary and alternative therapy for menopausal symptoms and insomnia. Further studies with proper methodological designs are warranted. Copyright © 2014. Published by Elsevier Ireland Ltd.