Evaluation on the cost-effective threshold of osteoporosis treatment on elderly women in China using discrete event simulation model.

PubMed

Ni, W; Jiang, Y

2017-02-01

This study used a simulation model to determine the cost-effective threshold of fracture risk to treat osteoporosis among elderly Chinese women. Osteoporosis treatment is cost-effective among average-risk women who are at least 75 years old and above-average-risk women who are younger than 75 years old. Aging of the Chinese population is imposing increasing economic burden of osteoporosis. This study evaluated the cost-effectiveness of osteoporosis treatment among the senior Chinese women population. A discrete event simulation model using age-specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture; costs (2015 US dollars); and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingness to pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute 10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. In baseline analysis, simulated ICERs were higher than the WTP threshold among Chinese women younger than 75, but much lower than the WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher WTP threshold or a lower annual treatment cost. A 30 % increase in WTP or a 30 % reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85. The current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs.

Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis

PubMed Central

de Souza, Ana Célia Caetano; Borges, José Wicto Pereira; Moreira, Thereza Maria Magalhães

2016-01-01

ABSTRACT OBJECTIVE To verify the effects of antihypertensive treatment (pharmacological and non-pharmacological) on the health-related quality of life of individuals with hypertension. METHODS We conducted a systematic review with meta-analysis using the following databases: IBECS, LILACS, SciELO, Medline, Cochrane, Science Direct, Scopus and the Brazilian Capes Theses and Dissertations Database. The statistical analysis was performed using Review Manager, version 5.2. The average difference was used for the summarization of meta-analytic effect by the fixed-effect model. Twenty studies were included. RESULTS The summarization of the effect showed an average increase of 2.45 points (95%CI 1.02–3.87; p < 0.0008) in the quality of life of individuals adhering to non-pharmacological treatment for arterial hypertension. Adherence to pharmacological treatment indicated an average increase of 9.24 points (95%CI 8.16–10.33; p < 0.00001) in the quality of life of individuals with arterial hypertension. CONCLUSIONS Non-pharmacological treatment improves the overall quality of life and physical domain of people with arterial hypertension. Adherence to pharmacological treatment has a positive impact on the mental and physical domains of patients, as it did on the overall quality of life score. PMID:28099657

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.

Effect of average flow and capacity utilization on effluent water quality from US municipal wastewater treatment facilities.

PubMed

Weirich, Scott R; Silverstein, Joann; Rajagopalan, Balaji

2011-08-01

There is increasing interest in decentralization of wastewater collection and treatment systems. However, there have been no systematic studies of the performance of small treatment facilities compared with larger plants. A statistical analysis of 4 years of discharge monthly report (DMR) data from 210 operating wastewater treatment facilities was conducted to determine the effect of average flow rate and capacity utilization on effluent biochemical oxygen demand (BOD), total suspended solids (TSS), ammonia, and fecal coliforms relative to permitted values. Relationships were quantified using generalized linear models (GLMs). Small facilities (40 m³/d) had violation rates greater than 10 times that of the largest facilities (400,000 m³/d) for BOD, TSS, and ammonia. For facilities with average flows less than 40,000 m³/d, increasing capacity utilization was correlated with increased effluent levels of BOD and TSS. Larger facilities tended to operate at flows closer to their design capacity while maintaining treatment suggesting greater efficiency. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Treatment Effect of Grade Repetitions

ERIC Educational Resources Information Center

Mahjoub, Mohamed-Badrane

2017-01-01

This paper estimates the treatment effect of grade repetitions in French junior high schools, using a value-added test score as outcome and quarter of birth as instrument. With linear two-stage least squares, local average treatment effect is estimated at around 1.6 times the standard deviation of the achievement gain. With non-linear…

Empirical likelihood inference in randomized clinical trials.

PubMed

Zhang, Biao

2017-01-01

In individually randomized controlled trials, in addition to the primary outcome, information is often available on a number of covariates prior to randomization. This information is frequently utilized to undertake adjustment for baseline characteristics in order to increase precision of the estimation of average treatment effects; such adjustment is usually performed via covariate adjustment in outcome regression models. Although the use of covariate adjustment is widely seen as desirable for making treatment effect estimates more precise and the corresponding hypothesis tests more powerful, there are considerable concerns that objective inference in randomized clinical trials can potentially be compromised. In this paper, we study an empirical likelihood approach to covariate adjustment and propose two unbiased estimating functions that automatically decouple evaluation of average treatment effects from regression modeling of covariate-outcome relationships. The resulting empirical likelihood estimator of the average treatment effect is as efficient as the existing efficient adjusted estimators 1 when separate treatment-specific working regression models are correctly specified, yet are at least as efficient as the existing efficient adjusted estimators 1 for any given treatment-specific working regression models whether or not they coincide with the true treatment-specific covariate-outcome relationships. We present a simulation study to compare the finite sample performance of various methods along with some results on analysis of a data set from an HIV clinical trial. The simulation results indicate that the proposed empirical likelihood approach is more efficient and powerful than its competitors when the working covariate-outcome relationships by treatment status are misspecified.

Improving Learning in Primary Schools of Developing Countries: A Meta-Analysis of Randomized Experiments

ERIC Educational Resources Information Center

McEwan, Patrick J.

2015-01-01

I gathered 77 randomized experiments (with 111 treatment arms) that evaluated the effects of school-based interventions on learning in developing-country primary schools. On average, monetary grants and deworming treatments had mean effect sizes that were close to zero and not statistically significant. Nutritional treatments, treatments that…

The effectiveness of sexual offender treatment for juveniles as measured by recidivism: a meta-analysis.

PubMed

Reitzel, Lorraine R; Carbonell, Joyce L

2006-10-01

Published and unpublished data from nine studies on juvenile sexual offender treatment effectiveness were summarized by meta-analysis (N=2986, 2604 known male). Recidivism rates for sexual, non-sexual violent, non-sexual non-violent crimes, and unspecified non-sexual were as follows: 12.53%, 24.73%, 28.51%, and 20.40%, respectively, based on an average 59-month follow-up period. Four included studies contained a control group (n=2288) and five studies included a comparison treatment group (n=698). An average weighted effect size of 0.43 (CI=0.33-0.55) was obtained, indicating a statistically significant effect of treatment on sexual recidivism. However, individual study characteristics (e.g., handling of dropouts and non-equivalent follow-up periods between treatment groups) suggest that results should be interpreted with caution. A comparison of odds ratios by quality of study design indicated that higher quality designs yielded better effect sizes, though the difference between groups was not significant.

Estimation and Identification of the Complier Average Causal Effect Parameter in Education RCTs

ERIC Educational Resources Information Center

Schochet, Peter Z.; Chiang, Hanley S.

2011-01-01

In randomized control trials (RCTs) in the education field, the complier average causal effect (CACE) parameter is often of policy interest, because it pertains to intervention effects for students who receive a meaningful dose of treatment services. This article uses a causal inference and instrumental variables framework to examine the…

Identifying the Average Causal Mediation Effects with Multiple Mediators in the Presence of Treatment Non-Compliance

ERIC Educational Resources Information Center

Park, Soojin

2015-01-01

Identifying the causal mechanisms is becoming more essential in social and medical sciences. In the presence of treatment non-compliance, the Intent-To-Treated effect (hereafter, ITT effect) is identified as long as the treatment is randomized (Angrist et al., 1996). However, the mediated portion of effect is not identified without additional…

Iatrogenic radiation exposure to patients with early onset spine and chest wall deformities.

PubMed

Khorsand, Derek; Song, Kit M; Swanson, Jonathan; Alessio, Adam; Redding, Gregory; Waldhausen, John

2013-08-01

Retrospective cohort series. Characterize average iatrogenic radiation dose to a cohort of children with thoracic insufficiency syndrome (TIS) during assessment and treatment at a single center with vertically expandable prosthetic titanium rib. Children with TIS undergo extensive evaluations to characterize their deformity. No standardized radiographical evaluation exists, but all reports use extensive imaging. The source and level of radiation these patients receive is not currently known. We evaluated a retrospective consecutive cohort of 62 children who had surgical treatment of TIS at our center from 2001-2011. Typical care included obtaining serial radiographs, spine and chest computed tomographic (CT) scans, ventilation/perfusion scans, and magnetic resonance images. Epochs of treatment were divided into time of initial evaluation to the end of initial vertically expandable prosthetic titanium rib implantation with each subsequent epoch delineated by the next surgical intervention. The effective dose for each examination was estimated within millisieverts (mSv). Plain radiographs were calculated from references. Effective dose was directly estimated for CT scans since 2007 and an average of effective dose from 2007-2011 was used for scans before 2007. Effective dose from fluoroscopy was directly estimated. All doses were reported in mSv. A cohort of 62 children had a total of 447 procedures. There were a total of 290 CT scans, 4293 radiographs, 147 magnetic resonance images, and 134 ventilation/perfusion scans. The average accumulated effective dose was 59.6 mSv for children who had completed all treatment, 13.0 mSv up to initial surgery, and 3.2 mSv for each subsequent epoch of treatment. CT scans accounted for 74% of total radiation dose. Children managed for TIS using a consistent protocol received iatrogenic radiation doses that were on average 4 times the estimated average US background radiation exposure of 3 mSv/yr. CT scans comprised 74% of the total dose. 3.

Reconsidering Findings of "No Effects" in Randomized Control Trials: Modeling Differences in Treatment Impacts

ERIC Educational Resources Information Center

Chaney, Bradford

2016-01-01

The primary technique that many researchers use to analyze data from randomized control trials (RCTs)--detecting the average treatment effect (ATE)--imposes assumptions upon the data that often are not correct. Both theory and past research suggest that treatments may have significant impacts on subgroups even when showing no overall effect.…

Emissions of ammonia, carbon dioxide, and hydrogen sulfide from swine wastewater during and after acidification treatment: effect of pH, mixing and aeration.

PubMed

Dai, X R; Blanes-Vidal, V

2013-01-30

This study aimed at evaluating the effect of swine slurry acidification and acidification-aeration treatments on ammonia (NH(3)), carbon dioxide (CO(2)) and hydrogen sulfide (H(2)S) emissions during slurry treatment and subsequent undisturbed storage. The study was conducted in an experimental setup consisting of nine dynamic flux chambers. Three pH levels (pH = 6.0, pH = 5.8 and pH = 5.5), combined with short-term aeration and venting (with an inert gas) treatments were studied. Acidification reduced average NH(3) emissions from swine slurry stored after acidification treatment compared to emissions during storage of non-acidified slurry. The reduction were 50%, 62% and 77% when pH was reduce to 6.0, 5.8 and 5.5, respectively. However, it had no significant effect on average CO(2) and H(2)S emissions during storage of slurry after acidification. Aeration of the slurry for 30 min had no effect on average NH(3), CO(2) and H(2)S emissions both during the process and from stored slurry after venting treatments. During aeration treatment, the NH(3), CO(2) and H(2)S release pattern observed was related to the liquid turbulence caused by the gas bubbles rather than to biological oxidation processes in this study. Copyright © 2012 Elsevier Ltd. All rights reserved.

Percutaneous needle fasciotomy for recurrent Dupuytren disease.

PubMed

van Rijssen, Annet L; Werker, Paul M N

2012-09-01

Increasing options to treat Dupuytren disease include percutaneous needle fasciotomy (PNF), a minimally invasive technique that has proven to be effective for the treatment of primary disease. However, its effect on recurrent disease is not clear. We studied 30 patients with recurrent Dupuytren disease in 40 fingers, with a mean follow-up of 4.4 years. Primary outcome measures were total passive extension deficit reduction and interval to a second recurrence, defined as an increase of more than 30° compared with the result at the end of the previous treatment. We noted complications. Total passive extension reduction was 76%. Percutaneous needle fasciotomy was especially effective for the metacarpophalangeal joint, with an average reduction of 93%, whereas the average reduction in the proximal interphalangeal joint was 57%. A total of 50% of patients did not develop a secondary recurrence during follow-up. The other 50% did, and we treated recurrence within an average of 1.4 years after PNF. By means of PNF, we postponed tertiary treatment an average of 2.9 years starting from the initial treatment for Dupuytren disease. We successfully treated all secondary recurrences by limited fasciectomy, according to patients' wishes. We noted no major adverse effects. Percutaneous needle fasciotomy can be applied effectively for recurrent disease; 50% of patients remain free of recurrence for a mean of 4.4 years. If a secondary recurrence occurs, it does so relatively early after treatment. Patients must therefore be willing to accept this uncertainty in the context of the advantages of PNF, such as fast recovery, low complication rate, and minimal invasiveness. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Meta-Analysis of Rare Binary Adverse Event Data

PubMed Central

Bhaumik, Dulal K.; Amatya, Anup; Normand, Sharon-Lise; Greenhouse, Joel; Kaizar, Eloise; Neelon, Brian; Gibbons, Robert D.

2013-01-01

We examine the use of fixed-effects and random-effects moment-based meta-analytic methods for analysis of binary adverse event data. Special attention is paid to the case of rare adverse events which are commonly encountered in routine practice. We study estimation of model parameters and between-study heterogeneity. In addition, we examine traditional approaches to hypothesis testing of the average treatment effect and detection of the heterogeneity of treatment effect across studies. We derive three new methods, simple (unweighted) average treatment effect estimator, a new heterogeneity estimator, and a parametric bootstrapping test for heterogeneity. We then study the statistical properties of both the traditional and new methods via simulation. We find that in general, moment-based estimators of combined treatment effects and heterogeneity are biased and the degree of bias is proportional to the rarity of the event under study. The new methods eliminate much, but not all of this bias. The various estimators and hypothesis testing methods are then compared and contrasted using an example dataset on treatment of stable coronary artery disease. PMID:23734068

Evaluating clinical trial design: systematic review of randomized vehicle-controlled trials for determining efficacy of benzoyl peroxide topical therapy for acne.

PubMed

Lamel, Sonia A; Sivamani, Raja K; Rahvar, Maral; Maibach, Howard I

2015-11-01

Determined efficacies of benzoyl peroxide may be affected by study design, implementation, and vehicle effects. We sought to elucidate areas that may allow improvement in determining accurate treatment efficacies by determining rates of active treatment and vehicle responders in randomized controlled trials assessing the efficacy of topical benzoyl peroxide to treat acne. We conducted a systematic review of randomized vehicle-controlled trials evaluating the efficacy of topical benzoyl peroxide for the treatment of acne. We compared response rates of vehicle treatment arms versus those in benzoyl peroxide arms. Twelve trials met inclusion criteria with 2818 patients receiving benzoyl peroxide monotherapy treatment and 2004 receiving vehicle treatment. The average percent reduction in total number of acne lesions was 44.3 (SD = 9.2) and 27.8 (SD = 21.0) for the active and vehicle treatment groups, respectively. The average reduction in non-inflammatory lesions was 41.5 % (SD = 9.4) in the active treatment group and 27.0 % (SD = 20.9) in the vehicle group. The average percent decrease in inflammatory lesions was 52.1 (SD = 10.4) in the benzoyl peroxide group and 34.7 (SD = 22.7) in the vehicle group. The average percentage of participants achieving success per designated study outcomes was 28.6 (SD = 17.3) and 15.2 (SD = 9.5) in the active treatment and vehicle groups, respectively. Patient responses in randomized controlled trials evaluating topical acne therapies may be affected by clinical trial design, implementation, the biologic effects of vehicles, and natural disease progression. "No treatment" groups may facilitate determination of accurate treatment efficacies.

An economic evaluation of the healthcare cost of tinnitus management in the UK.

PubMed

Stockdale, David; McFerran, Don; Brazier, Peter; Pritchard, Clive; Kay, Tony; Dowrick, Christopher; Hoare, Derek J

2017-08-22

There is no standard treatment pathway for tinnitus patients in the UK. Possible therapies include education and reassurance, cognitive behavioural therapies, modified tinnitus retraining therapy (education and sound enrichment), or amplification of external sound using hearing aids. However, the effectiveness of most therapies is somewhat controversial. As health services come under economic pressure to deploy resources more effectively there is an increasing need to demonstrate the value of tinnitus therapies, and how value may be continuously enhanced. The objective of this project was to map out existing clinical practice, estimate the NHS costs associated with the management approaches used, and obtain initial indicative estimates of cost-effectiveness. Current treatment pathways, costs and health outcomes were determined from the tinnitus literature, national statistics, a patient survey, and expert opinion. These were used to create an Excel-based economic model of therapy options for tinnitus patients. The probabilities associated with the likelihood of an individual patient receiving a particular combination of therapies was used to calculate the average cost of treatment per patient, average health outcome per patient measured in QALYs gained, and cost-effectiveness, measured by the average cost per QALY gained. The average cost of tinnitus treatment per patient per year is GB£717, equating to an NHS healthcare bill of GB£750 million per year. Across all pathways, tinnitus therapy costs £10,600 per QALY gained. Results were relatively insensitive to restrictions on access to cognitive behaviour therapy, and a subsequent reliance on other therapies. NHS provisions for tinnitus are cost-effective against the National Institute for Health and Care Excellence cost-effective threshold. Most interventions help, but education alone offers very small QALY gains. The most cost-effective therapies in the model were delivered within audiology.

Cost-effectiveness analysis of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis.

PubMed

Cardona-Arias, Jaiberth Antonio; López-Carvajal, Liliana; Tamayo Plata, Mery Patricia; Vélez, Iván Darío

2017-05-01

The treatment of cutaneous leishmaniasis is toxic, has contraindications, and a high cost. The objective of this study was to estimate the cost-effectiveness of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis. Effectiveness was the proportion of healing and safety with the adverse effects; these parameters were estimated from a controlled clinical trial and a meta-analysis. A standard costing was conducted. Average and incremental cost-effectiveness ratios were estimated. The uncertainty regarding effectiveness, safety, and costs was determined through sensitivity analyses. The total costs were $66,807 with Glucantime and $14,079 with thermotherapy. The therapeutic effectiveness rates were 64.2% for thermotherapy and 85.1% for Glucantime. The average cost-effectiveness ratios ranged between $721 and $1275 for Glucantime and between $187 and $390 for thermotherapy. Based on the meta-analysis, thermotherapy may be a dominant strategy. The excellent cost-effectiveness ratio of thermotherapy shows the relevance of its inclusion in guidelines for the treatment. © 2017 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, 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.

The Influence of Direct Instruction on Student Self-appraisals: A Hierarchical Analysis of Treatment and Aptitude-Treatment Interaction Effects.

ERIC Educational Resources Information Center

Corno, Lyn; And Others

1981-01-01

Treatment and aptitude-treatment interaction (ATI) effects were assessed on grade 3 student self-appraisal data relating to self-esteem, attitude, anxiety, and locus of control. In particular, parent instruction in learning skills resulted in significantly higher average scores on student self-esteem and attitude and lower scores on anxiety.…

Outcomes from switching from rotigotine patch to alternate therapies in Parkinson's disease.

PubMed

Chitnis, Shilpa; Jaffery, Manall; Dewey, Richard B

2012-01-01

When rotigotine patch was withdrawn from the US market, we prospectively gathered data on efficacy, side effects, and daytime sedation on patients while taking rotigotine and following the switch to alternate therapies. Patients rated the efficacy of rotigotine on a scale of 0-5 (ineffective to extremely effective) and completed the Epworth Sleepiness Scale. At a follow-up visit a mean of 3 months later, patients rated their change in efficacy and side effects on a scale of -3 to +3 (much worse to much better) and again completed the Epworth Sleepiness Scale. Thirty-three patients were switched to a single alternate treatment. On rotigotine, the average efficacy score was 3.5, and after switching, the average change in efficacy was -0.67 (worsening). Average change scores for efficacy and adverse effects were 0.25 and 0.38 for levodopa, -0.88 and -0.25 for ropinirole IR, -1.2 and -0.83 for ropinirole XL, -0.80 and 1.0 for pramipexole, and -1.0 and 0.50 for rasagiline, respectively. Average change in Epworth score on each alternate agent was -3.9, -2.3, 1.3, 3.0, and 1. Rotigotine was an effective treatment with all groups deteriorating after switch except for the levodopa group. Fifty-eight percent of patients preferred rotigotine versus 36% preferring the alternate treatment.

Retrospective analysis of antibiotic treatments against piscirickettsiosis in farmed Atlantic salmon Salmo salar in Chile.

PubMed

Price, Derek; Stryhn, Henrik; Sánchez, Javier; Ibarra, Rolando; Tello, Alfredo; St-Hilaire, Sophie

2016-03-30

Piscirickettsiosis is the most prevalent salt-water infectious disease in farmed salmonids in Chile. Antimicrobials are used to treat this disease; however, there is growing concern about the poor response to therapeutants on some fish farms. The objective of this study was to assess whether factors such as type of antibiotic used, average fish weight, temperature at the beginning of the treatment, and mortality at the time of treatment administration affect the probability of treatment failure against piscirickettsiosis. Pen-level treatment and production information for the first treatment event from 2014 pens on 118 farms was used in a logistic mixed model to assess treatment failure. We defined a failed treatment as when the average mortality 3 wk after the treatment was above 0.1%. Farm and company were included in the model as random effects. We found that the antibiotic product, mortality level before the treatment, and fish weight at the start of the treatment all had a significant effect on treatment outcome. Our results suggest that antibiotic treatment success is higher if the treatment is administered when mortality associated with piscirickettsiosis is relatively low. We discuss the effect of weight on treatment success and its potential relationships with husbandry practices and drug pharmacokinetics.

Assessing the clinical effectiveness of an algorithmic approach for mucosal lichen planus (MLP): A retrospective review.

PubMed

Ashack, Kurt A; Haley, Laura L; Luther, Chelsea A; Riemer, Christie A; Ashack, Richard J

2016-06-01

Mucosal lichen planus (MLP) is a therapeutic challenge in need of a new treatment approach because of its debilitating effect on patient's quality of life. We sought to evaluate a standardized treatment plan for patients with MLP. A second objective was to describe the effect of mycophenolate mofetil in this patient population. The study retrospectively analyzed 53 patients with MLP treated using a standardized algorithm. The number of MLP lesions, disease activity, and pain at the last visit were compared with baseline scores determined at the initial visit. Results were analyzed using the paired samples t test and confirmed with the Wilcoxon matched pairs signed rank test. The average number of lesions was reduced from 3.77 to 1.67 (P < .001). The average disease activity was reduced from 2.73 to 0.90 (P < .001). Average pain reported decreased from 2.03 to 1.03 (P < .001). This study was a retrospective analysis of a small patient population. There was no universal symptom severity scale used at the time of treatment for some patients. The standardized treatment plan reduced symptoms for patients with MLP. Mycophenolate mofetil appears to be a reasonable treatment option for these patients. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Applying Propensity Score Methods in Medical Research: Pitfalls and Prospects

PubMed Central

Luo, Zhehui; Gardiner, Joseph C.; Bradley, Cathy J.

2012-01-01

The authors review experimental and nonexperimental causal inference methods, focusing on assumptions for the validity of instrumental variables and propensity score (PS) methods. They provide guidance in four areas for the analysis and reporting of PS methods in medical research and selectively evaluate mainstream medical journal articles from 2000 to 2005 in the four areas, namely, examination of balance, overlapping support description, use of estimated PS for evaluation of treatment effect, and sensitivity analyses. In spite of the many pitfalls, when appropriately evaluated and applied, PS methods can be powerful tools in assessing average treatment effects in observational studies. Appropriate PS applications can create experimental conditions using observational data when randomized controlled trials are not feasible and, thus, lead researchers to an efficient estimator of the average treatment effect. PMID:20442340

Is LLLT effective in the management of TMJ pain?

NASA Astrophysics Data System (ADS)

Pinheiro, Antonio L. B.; Manzi, Cecilia T.; Rolim, Aluizio B.; Vieira, Alessandro L. B.

1999-05-01

This paper reports the result of the use of LLLT on the treatment of TMJ pain and present LLLT as an effective method of treating such problem. One hundred and eighty one female and 23 male patients aged between 7 and 81 years old (average 36.9 years old) suffering TMJ pain were treated with 632.8, 670, and 830nm diodes lasers at the Laser Center of the UFPE. The treatment consisted of a series of 12 applications twice a week. Patients were treated with an average dose of 3 J/cm2. One hundred forty one out of 204 patients were asymptomatic at the end of the treatment, 37 improved considerably and 26 were symptomatic. These result show although LLLT does not cure TMJ disorders it is effective in reducing TMJ pain.

The effect of sulphadoxine/pyrimethamine on gametocytes in falciparum malaria.

PubMed

Ittiravivongs, A; Vasuvat, C; Kongrod, S

1984-09-01

A study of the effect of sulphadoxine/pyrimethamine (Fansidar) on P. falciparum's gametocytes in peripheral blood was carried out in Western Thailand. One group of 77 patients with asexual form P. falciparum sensitive to Fansidar were followed weekly to detect the appearance and the duration of gametocytes in peripheral blood after Fansidar treatment on the basis of thick blood film examination. Another group of 14 patients with sexual form P. falciparum was not given any antimalarial treatment and also followed up weekly. No significant difference of average duration of detectable gametocytes was observed between the groups. The average number of days that gametocytes appeared after asexual form in patients receiving treatment was the same as in the untreated group. It is unlikely that Fansidar has the stimulating effect on gametocytogenesis as previously reported.

Stochastic modelling to assess economic effects of treatment of chronic subclinical mastitis caused by Streptococcus uberis.

PubMed

Steeneveld, Wilma; Swinkels, Jantijn; Hogeveen, Henk

2007-11-01

Chronic subclinical mastitis is usually not treated during the lactation. However, some veterinarians regard treatment of some types of subclinical mastitis to be effective. The goal of this research was to develop a stochastic Monte Carlo simulation model to support decisions around treatment of chronic subclinical mastitis caused by Streptococcus uberis. Factors in the model included the probability of cure after treatment, probability of the cow becoming clinically diseased, transmission of infection to other cows, and physiological effects of the infection. Using basic input parameters for Dutch circumstances, the average economic costs per cow of an untreated chronic subclinical mastitis case caused by Str. uberis in a single quarter from day of diagnosis onwards was euro109. With treatment, the average costs were higher (euro120). Thus, for the average cow, treatment was not efficient economically. However, the risk of high costs was much higher when cows with chronic subclinical mastitis were not treated. A sensitivity analysis showed that profitability of treatment of chronic subclinical Str. uberis mastitis depended on farm-specific factors (such as economic value of discarded milk) and cow-specific factors (such as day of diagnosis, duration of infection, amount of transmission to other cows and cure rate). Therefore, herd level protocols are not sufficient and decision support should be cow specific. Given the importance of cow-specific factors, information from the current model could be applied to automatic decision support systems.

Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of re-incarceration.

PubMed

Larney, Sarah; Toson, Barbara; Burns, Lucy; Dolan, Kate

2012-02-01

People who use heroin are frequently incarcerated multiple times. Reducing re-incarceration of this group is important for reducing both health risks associated with incarceration and the costs of correctional administration. Opioid substitution treatment (OST) in prisons may help to reduce re-incarceration, but research findings on this topic have been mixed. In this study, we examined the effect of OST in prison and after release on re-incarceration. Longitudinal cohort study. SETTING, PARTICIPANTS AND MEASUREMENTS: Data on OST and incarceration were linked for a cohort of 375 male heroin users recruited originally in prisons in New South Wales, Australia. Data were linked for the period 1 June 1997-31 December 2006. Re-incarceration was examined using recurrent-event survival analysis models. Model 1 examined the effect of OST status at release from prison (i.e. in treatment versus out of treatment on the day of release) on re-incarceration. Model 2 considered the effect of remaining in OST after release on risk of re-incarceration. Ninety per cent of participants were re-incarcerated following their first observed release. Pre-incarceration cocaine use was associated with a 13% increase in the average risk of re-incarceration. There was no significant association between simply being in OST at the time of release and risk of re-incarceration; however, in the model taking into account post-release retention in treatment, the average risk of re-incarceration was reduced by 20% while participants were in treatment. In New South Wales, Australia, opioid substitution treatment after release from prison has reduced the average risk of re-incarceration by one-fifth. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Contingent Vouchers and Motivational Interviewing for Cigarette Smokers in Residential Substance Abuse Treatment

PubMed Central

Rohsenow, Damaris J.; Tidey, Jennifer W.; Martin, Rosemarie A.; Colby, Suzanne M.; Sirota, Alan D.; Swift, Robert M.; Monti, Peter M.

2015-01-01

Residential drug treatment provides an opportunity to intervene with smokers substance use disorders (SUD). A randomized controlled clinical trial compared: (1) Contingent Vouchers (CV) for smoking abstinence to Noncontingent Vouchers (NCV), crossed with (2) Motivational Interviewing (MI) or Brief Advice (BA), for 184 smokers in SUD treatment. During the voucher period, 36% of carbon monoxide readings indicated smoking abstinence for those receiving CV versus 13% with NCV (p < .001). Post-treatment point-prevalence abstinence rates were low (3–4% at each follow up), with more abstinence when CV was combined with MI (6.6% on average) than with BA (0% on average). No differential effects on drug use or motivation to quit smoking occurred. Thus, CV had limited effects on long-term smoking abstinence in this population but effects were improved when CV was combined with MI. More effective methods are needed to increase motivation to quit smoking and quit rates in this high-risk population. PMID:25805668

A Systematic Review of the Effectiveness of Psychological Treatments for IBS in Gastroenterology Settings: Promising but in Need of Further Study.

PubMed

Thakur, Elyse R; Shapiro, Jordan; Chan, Johanna; Lumley, Mark A; Cully, Jeffrey A; Bradford, Andrea; El-Serag, Hashem B

2018-05-10

Psychological treatments are efficacious for irritable bowel syndrome (IBS) in clinical trials; however, their effectiveness when conducted in gastroenterology practice settings is unclear. To perform a systematic review of the types and effects of psychological treatments for IBS conducted in gastroenterology clinics. We searched PubMed, EMBASE, and Cochrane central register. Studies conducted in gastroenterology clinic settings with IBS patients who were clinically referred from gastroenterology were included. We identified 3078 citations, of which only eight studies were eligible. Seven studies compared psychological treatments (average n = 25.7; range 12-43) to controls (average n = 25.4 patients; range 12-47), whereas one study compared two active "bonafide" interventions. Psychological treatments varied (cognitive-behavioral therapy, guided affective imagery, mindfulness, hypnosis, biofeedback, emotional awareness training). However, across approaches, short-term benefits were seen. IBS symptoms improved significantly among patients in cognitive and behavioral therapies, mindfulness-based stress reduction, guided affective imagery, and emotional awareness training compared with controls; there was a similar trend for gut-directed hypnotherapy. Similarly, IBS symptoms improved in a study of two active biofeedback and hypnosis treatments. Evidence for the effectiveness of psychological treatment in gastroenterology practice is promising but limited. Study designs that involve a blending of efficacy and effectiveness components are needed.

Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports.

PubMed

Brown, Amy C; Hairfield, Michelle; Richards, Douglas G; McMillin, David L; Mein, Eric A; Nelson, Carl D

2004-09-01

This research evaluated five case studies of patients with psoriasis following a dietary regimen. There is no cure for psoriasis and the multiple treatments currently available only attempt to reduce the severity of symptoms. Treatments range from topical applications, systemic therapies, and phototherapy; while some are effective, many are associated with significant adverse effects. There is a need for effective, affordable therapies with fewer side effects that address the causes of the disorder. Evaluation consisted of a study group of five patients diagnosed with chronic plaque psoriasis (two men and three women, average age 52 years; range 40-68 years) attending a 10-day, live-in program during which a physician assessed psoriasis symptoms and bowel permeability. Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark water were consumed daily. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period when measured by the Psoriasis Area and Severity Index (PASI) (average pre- and post-test scores were 18.2 and 8.7, respectively), the Psoriasis Severity Scale (PSS) (average pre- and post-test scores were 14.6 and 5.4, respectively), and the lactulose/mannitol test of intestinal permeability (average pre- and post-test scores were 0.066 to 0.026, respectively). These results suggest a dietary regimen based on Edgar Cayce's readings may be an effective medical nutrition therapy for the complementary treatment of psoriasis; however, further research is warranted to confirm these results.

LASER RESENSITIZATION OF MEDICALLY UNRESPONSIVE NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Efficacy and Implications.

PubMed

Luttrull, Jeffrey K; Chang, David B; Margolis, Benjamin W L; Dorin, Giorgio; Luttrull, David K

2015-06-01

Drug tolerance is the most common cause of treatment failure in neovascular age-related macular degeneration. "Low-intensity/high-density" subthreshold diode micropulse laser (SDM) has been reported effective for a number of retinal disorders without adverse effects. It has been proposed that SDM normalizes retinal pigment epithelial function. On this basis, it has been postulated that SDM treatment might restore responsiveness to anti-vascular endothelial growth factor drugs in drug-tolerant eyes. Subthreshold diode micropulse laser treatment was performed in consecutive eyes unresponsive to all anti-vascular endothelial growth factor drugs, including at least three consecutive ineffective aflibercept injections. Monthly aflibercept was resumed 1 month after SDM treatment. Thirteen eyes of 12 patients, aged 73 to 97 years (average, 84 years), receiving 16 to 67 (average, 34) anti-vascular endothelial growth factor injections before SDM treatment were included and followed for 3 months to 7 months (average, 5 months) after SDM treatment. After SDM treatment and resumption of aflibercept, 92% (12 of 13) of eyes improved, with complete resolution of macular exudation in 69% (9 of 13). Visual acuity remained unchanged. Central and maximum macular thicknesses significantly improved. Subthreshold diode micropulse laser treatment restored drug response in drug-tolerant eyes with neovascular age-related macular degeneration. Based on these findings, a theory of SDM action is proposed, suggesting a wider role for SDM as retinal reparative/protective therapy.

Under What Assumptions Do Site-by-Treatment Instruments Identify Average Causal Effects?

ERIC Educational Resources Information Center

Reardon, Sean F.; Raudenbush, Stephen W.

2011-01-01

The purpose of this paper is to clarify the assumptions that must be met if this--multiple site, multiple mediator--strategy, hereafter referred to as "MSMM," is to identify the average causal effects (ATE) in the populations of interest. The authors' investigation of the assumptions of the multiple-mediator, multiple-site IV model demonstrates…

Latent class instrumental variables: A clinical and biostatistical perspective

PubMed Central

Baker, Stuart G.; Kramer, Barnett S.; Lindeman, Karen S.

2015-01-01

In some two-arm randomized trials, some participants receive the treatment assigned to the other arm as a result of technical problems, refusal of a treatment invitation, or a choice of treatment in an encouragement design. In some before-and-after studies, the availability of a new treatment changes from one time period to this next. Under assumptions that are often reasonable, the latent class instrumental variable (IV) method estimates the effect of treatment received in the aforementioned scenarios involving all-or-none compliance and all-or-none availability. Key aspects are four initial latent classes (sometimes called principal strata) based on treatment received if in each randomization group or time period, the exclusion restriction assumption (in which randomization group or time period is an instrumental variable), the monotonicity assumption (which drops an implausible latent class from the analysis), and the estimated effect of receiving treatment in one latent class (sometimes called efficacy, the local average treatment effect, or the complier average causal effect). Since its independent formulations in the biostatistics and econometrics literatures, the latent class IV method (which has no well-established name) has gained increasing popularity. We review the latent class IV method from a clinical and biostatistical perspective, focusing on underlying assumptions, methodological extensions, and applications in our fields of obstetrics and cancer research. PMID:26239275

Endoscopic treatment of prepatellar bursitis.

PubMed

Huang, Yu-Chih; Yeh, Wen-Lin

2011-03-01

Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21-55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory.

Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial

PubMed Central

Smith, Ellen M. Lavoie; Pang, Herbert; Cirrincione, Constance; Fleishman, Stewart; Paskett, Electra D.; Ahles, Tim; Bressler, Linda R.; Fadul, Camilo E.; Knox, Chetaye; Le-Lindqwister, Nguyet; Gilman, Paul B.; Shapiro, Charles L.

2013-01-01

Context There are no known effective treatments for painful chemotherapy-induced peripheral neuropathy (CIPN). Objective The primary objective was to determine the effect of duloxetine 60 mg daily on CIPN “average” pain severity Design Randomized, double-blind, placebo-controlled crossover Setting Eight National Cancer Institute (NCI)-funded cooperative research networks recruited patients from community and academic settings between April 2008 and March 2011. Study follow-up was completed July 2012. Patients 231 patients ≥ 25 years of age were randomized (stratified by chemotherapy drug and CIPN comorbid risk) to receive either duloxetine followed by placebo or placebo followed by duloxetine. Eligible patients reported ≥ Grade 1 sensory CIPN per the NCI Common Toxicity Criteria for Adverse Events and ≥ 4/10 average CIPN-related pain following paclitaxel or oxaliplatin treatment. 81% completed the initial treatment period. Intervention The initial treatment consisted of duloxetine/placebo 30mg/one capsule daily for the first week, then 60mg/two capsules for four additional weeks Outcome Measure The primary hypothesis was that duloxetine would be more effective than placebo in decreasing CIPN pain. Pain severity was assessed using the Brief Pain Inventory-Short Form “average pain” item [0 (no pain) – 10 (as bad as can imagine)]. Results Individuals receiving duloxetine as initial treatment (weeks 1–5) reported a larger mean decrease in average pain (1.06; 95% CI: 0.72, 1.40) compared to placebo-treated patients (0.34; 95% CI: 0.01, 0.66) (p = 0.003) (effect size = 0.513). The observed mean difference in the average pain score between the duloxetine and placebo groups was 0.73 (95% CI: 0.26, 1.20). 59% of duloxetine-treated patients compared to 38% of placebo-treated patients reported decreased pain of any amount. Conclusions Among patients with painful CIPN, the use of duloxetine compared with placebo for 5 weeks resulted in a greater reduction in pain. PMID:23549581

[Cappuccino coffee treatment of xerostomia in patients taking tricyclic antidepressants: preliminary report].

PubMed

Chodorowski, Zygmunt

2002-01-01

10 patients underwent a trial treatment with Cappuccino coffee. All of them (8 university lecturers and 2 clerks) aged from 60 to 69 (average 63) years old, used tricyclic antidepressant because of insomnia as a monosymptomatic type of depression or insomnia as a dominant symptom in the course of depression. One, evening dose of doxepine was from 150 to 250 (average 225) mg, causing xerostomia next day usually between 9-15 o'clock. The five-minute--chewing of 15.0 g of Cappuccino coffee increased the amount of saliva, decreased xerostomia and improved the ability of speech. Beneficial effect of coffee lasted from 0.5 to 4 (average about 2) hours. To the best of our knowledge there are no publications dealing with the positive effect of coffee in xerostomia.

Cost-effectiveness of lung volume reduction coil treatment in patients with severe emphysema: results from the 2-year follow-up crossover REVOLENS study (REVOLENS-2 study).

PubMed

Bulsei, Julie; Leroy, Sylvie; Perotin, Jeanne-Marie; Mal, Hervé; Marquette, Charles-Hugo; Dutau, Hervé; Bourdin, Arnaud; Vergnon, Jean-Michel; Pison, Christophe; Kessler, Romain; Jounieaux, Vincent; Salaün, Mathieu; Marceau, Armelle; Dukic, Sylvain; Barbe, Coralie; Bonnaire, Margaux; Deslee, Gaëtan; Durand-Zaleski, Isabelle

2018-05-09

The REVOLENS study compared lung volume reduction coil treatment to usual care in patients with severe emphysema at 1 year, resulting in improved quality-adjusted life-year (QALY) and higher costs. Durability of the coil treatment benefit and its cost-effectiveness at 2 years are now assessed. After one year, the REVOLENS trial's usual care group patients received coil treatment (second-line coil treatment group). Costs and QALYs were assessed in both arms at 2 years and an incremental cost-effectiveness ratio in cost per QALY gained was calculated. The uncertainty of the results was estimated by probabilistic bootstrapping. The average cost of coil treatment in both groups was estimated at €24,356. The average total cost at 2 years was €9655 higher in the first-line coil treatment group (p = 0.07) and the difference in QALY between the two groups was 0.127 (p = 0.12) in favor of first-line coil treatment group. The 2-year incremental cost-effectiveness ratio (ICER) was €75,978 / QALY. The scatter plot of the probabilistic bootstrapping had 92% of the replications in the top right-hand quadrant. First-line coil treatment was more expensive but also more effective than second-line coil treatment at 2 years, with a 2-year ICER of €75,978 / QALY. ClinicalTrials.gov Identifier NCT01822795 .

ESTIMATING PERSON-CENTERED TREATMENT (PeT) EFFECTS USING INSTRUMENTAL VARIABLES: AN APPLICATION TO EVALUATING PROSTATE CANCER TREATMENTS

PubMed Central

BASU, ANIRBAN

2014-01-01

SUMMARY This paper builds on the methods of local instrumental variables developed by Heckman and Vytlacil (1999, 2001, 2005) to estimate person-centered treatment (PeT) effects that are conditioned on the person’s observed characteristics and averaged over the potential conditional distribution of unobserved characteristics that lead them to their observed treatment choices. PeT effects are more individualized than conditional treatment effects from a randomized setting with the same observed characteristics. PeT effects can be easily aggregated to construct any of the mean treatment effect parameters and, more importantly, are well suited to comprehend individual-level treatment effect heterogeneity. The paper presents the theory behind PeT effects, and applies it to study the variation in individual-level comparative effects of prostate cancer treatments on overall survival and costs. PMID:25620844

A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial.

PubMed

Fairhall, Nicola; Sherrington, Catherine; Cameron, Ian D; Kurrle, Susan E; Lord, Stephen R; Lockwood, Keri; Herbert, Robert D

2017-01-01

What is the effect of a multifactorial intervention on frailty and mobility in frail older people who comply with their allocated treatment? Secondary analysis of a randomised, controlled trial to derive an estimate of complier average causal effect (CACE) of treatment. A total of 241 frail community-dwelling people aged ≥ 70 years. Intervention participants received a 12-month multidisciplinary intervention targeting frailty, with home exercise as an important component. Control participants received usual care. Primary outcomes were frailty, assessed using the Cardiovascular Health Study criteria (range 0 to 5 criteria), and mobility measured using the 12-point Short Physical Performance Battery. Outcomes were assessed 12 months after randomisation. The treating physiotherapist evaluated the amount of treatment received on a 5-point scale. 216 participants (90%) completed the study. The median amount of treatment received was 25 to 50% (range 0 to 100). The CACE (ie, the effect of treatment in participants compliant with allocation) was to reduce frailty by 1.0 frailty criterion (95% CI 0.4 to 1.5) and increase mobility by 3.2 points (95% CI 1.8 to 4.6) at 12 months. The mean CACE was substantially larger than the intention-to-treat effect, which was to reduce frailty by 0.4 frailty criteria (95% CI 0.1 to 0.7) and increase mobility by 1.4 points (95% CI 0.8 to 2.1) at 12 months. Overall, compliance was low in this group of frail people. The effect of the treatment on participants who comply with allocated treatment was substantially greater than the effect of allocation on all trial participants. Australian and New Zealand Trial Registry ANZCTRN12608000250336. [Fairhall N, Sherrington C, Cameron ID, Kurrle SE, Lord SR, Lockwood K, Herbert RD (2016) A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial.Journal of Physiotherapy63: 40-44]. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Height Response to Harvesting Intensity and Site Preparation in Four Young Loblolly Pine Plantations

Treesearch

Thomas J. Dean; Ray A. Newbold

2002-01-01

A study was conducted to analyze the general effects of harvesting intensity and postharvest treatments on the average, three-year height of loblolly pine (Pinus taeda L.). This was accomplished by analyzing treatment effects across four study sites by treating the locations as random effects in the statistical model. Whole-tree harvesting using...

Is Scientifically Based Reading Instruction Effective for Students with Below-Average IQs?

ERIC Educational Resources Information Center

Allor, Jill H.; Mathes, Patricia G.; Roberts, J. Kyle; Cheatham, Jennifer P.; Al Otaiba, Stephanie

2014-01-01

This longitudinal randomized-control trial investigated the effectiveness of scientifically based reading instruction for students with IQs ranging from 40 to 80, including students with intellectual disability (ID). Students were randomly assigned into treatment (n = 76) and contrast (n = 65) groups. Students in the treatment group received…

The Short-Term Effect of Integrated Complementary and Alternative Medicine Treatment in Inpatients Diagnosed with Lumbar Intervertebral Disc Herniation: A Prospective Observational Study.

PubMed

Shin, Joon-Shik; Lee, Jinho; Kim, Me-Riong; Jung, Jaehoon; Shin, Byung-Cheul; Lee, Myeong Soo; Ha, In-Hyuk

2016-07-01

This study aimed to investigate the short-term effect of hospital-based intensive nonsurgical treatment in lumbar intervertebral disc herniation (IDH) inpatients admitted to an integrated hospital that offers both complementary and alternative medicine (CAM) and conventional medicine treatment. A prospective observational study. A private Korean medicine hospital inpatient setting in Korea. A total of 524 inpatients diagnosed with lumbar IDH admitted from June 1, 2012, to May 31, 2013. The participants received treatment according to a CAM treatment protocol (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation) and conventional medicine treatment as needed. Numeric rating scale (NRS) of low back pain (LBP) and leg pain, Oswestry Disability Index (ODI), and patient global impression of change. The study also assessed whether improvement was obtained over minimal clinically important difference (MCID) in LBP or leg pain. The average hospital stay was 24.4 ± 13.2 days. The majority of patients received CAM treatment and a few selected conventional medicine, such as pain killers (22.7%; 4.2 ± 3.0 administrations) or nerve blocks (14.1%; 1.4 ± 0.7 sessions). At discharge, the average reduction in NRS was 3.18 ± 2.29 (95% confidence interval [CI], 2.99-3.38) for LBP and 2.61 ± 2.60 (95% CI, 2.38-2.83) for leg pain the average reduction in ODI was 19.45 ± 19.53 (95% CI, 17.77-21.12). Two-hundred and seventy patients (51.5%) showed improvement over MCID in both NRS and ODI, 150 (28.6%) in either NRS or ODI, and 104 (19.8%) in neither. Integrated CAM treatment during hospitalization was effective for patients with lumbar IDH who had severe LBP and disability. However, these results must be investigated further to assess whether the effects surpass those seen with placebo and are cost-effective.

Effect of treatment temperature on the microstructure of asphalt binders: insights on the development of dispersed domains.

PubMed

Menapace, I; Masad, E; Bhasin, A

2016-04-01

This paper offers important insights on the development of the microstructure in asphalt binders as a function of the treatment temperature. Different treatment temperatures are useful to understand how dispersed domains form when different driving energies for the mobility of molecular species are provided. Small and flat dispersed domains, with average diameter between 0.02 and 0.70 μm, were detected on the surface of two binders at room temperature, and these domains were observed to grow with an increase in treatment temperature (up to over 2 μm). Bee-like structures started to appear after treatment at or above 100°C. Moreover, the effect of the binder thickness on its microstructure at room temperature and at higher treatment temperatures was investigated and is discussed in this paper. At room temperature, the average size of the dispersed domains increased as the binder thickness decreased. A hypothesis that conciliates current theories on the origin and development of dispersed domains is proposed. Small dispersed domains (average diameter around 0.02 μm) are present in the bulk of the binder, whereas larger domains and bee-like structures develop on the surface, following heat treatment or mechanical disturbance that reduces the film thickness. Molecular mobility and association are the key factors in the development of binder microstructure. © 2015 The Authors Journal of Microscopy © 2015 Royal Microscopical Society.

Long-term psychological effects in children treated for intracranial tumors

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

Jannoun, L.; Bloom, H.J.

1990-04-01

The results are reported of the psychological assessment of 62 children who presented with primary intracranial tumors and who received radiotherapy at the Royal Marsden Hospital between 1963 and 1973. Evaluations were carried out 3-20 years after treatment. All patients were free from progressive tumor at testing. The average IQ of the total series was within the normal range (Full-Scale IQ 92) but 23% of the patients were functioning at an educationally subnormal level of intelligence (IQ less than 80). Sex, tumor type, tumor location and the radiotherapy volume and site of maximum dose were not found to have amore » significant effect on intellectual outcome. A significant correlation was found between intelligence and age at the time of treatment. Children who received treatment under the age of 5 years were more adversely affected (average IQ 72) than those who were aged 6-10 (average IQ 93) and those aged 11-15 years (average IQ 107). The incidence of neurological abnormalities and physical disability was significantly greater among patients with supratentorial tumors (72% of cases), compared with patients with infratentorial lesions (44% of cases). The results were discussed in terms of the management of young patients with intracranial tumors.« less

Effectiveness duckweed (Lemna minor) as an alternative native chicken feed native chicken (Gallus domesticus)

NASA Astrophysics Data System (ADS)

Putra, A.; Ritonga, M. Z.

2018-02-01

This study aimed to know the effectiveness duckweed as feed as native chicken (Gallus domesticus) on growth period (weight gain, feed intake and feed conversion). This research was conducted in Desa Telaga Jernih Kabupaten Langkat. The study was conducted in February 2017 until May 2017. This study use completely randomized design (CRD) with 4 treatments and 5 Replication, where each treatment consisting of 5 Native chickens unsexing. The treatment was used P0 = control (feed manufacturing), P1 = ration conventional with 10% duckweed, P2 = ration conventional with 20% duckweed, P3 = ration conventional with 30% duckweed. The parameters observed were weight gain, feed consumption and feed conversion. The results showed not significantly effect in body weight gain, feed consumption and feed conversion. Where the average of best weight gain on treatment P0 (control), P2 (20% duckweed), P3 (30% duckweed) and P1 (10% duckweed), average of best feed consumption in P0 (control), P2 (20% duckweed ) Of P1 (10% duckweed) and P3 (30% duckweed), P1 (10% duckweed) and P3 (30% duckweed), average of best feed conversion rate in P0 (control), P2 (20% duckweed) P1 (10% duckweed) and P3 (30% duckweed).

Using Propensity Score Matching Methods to Improve Generalization from Randomized Experiments

ERIC Educational Resources Information Center

Tipton, Elizabeth

2011-01-01

The main result of an experiment is typically an estimate of the average treatment effect (ATE) and its standard error. In most experiments, the number of covariates that may be moderators is large. One way this issue is typically skirted is by interpreting the ATE as the average effect for "some" population. Cornfield and Tukey (1956)…

[Surgical treatment of inferior pole comminuted fractures of patella with new type tension band].

PubMed

Sun, B; Zhang, Z S; Zhou, F; Tian, Y; Ji, H Q; Guo, Y; Lv, Y; Yang, Z W

2015-04-18

To study the effectiveness of inferior pole fracture of patella treating by the new tension band. From Dec. 2011 to Dec. 2013, 21 patients with inferior pole fracture of patella were treated with the new tension band which consisted of cannulated screw, titanium cable and shims. There were 21 patients[10 males, 11 females, the average age was 54 years(21 to 79)],of whom,all were "fell on knees". The average operation time was 89 min (57-197 min),the follow-up visits were done from 7-31 months (average 18 months), the bone healing time was from 8-12 weeks (average 10.5 weeks). The post operation assessment was done by Bostman score, from 20-30 (average 27),10 excellent,and 11 good. No complication occurred. The new tension band is the effective treatment for inferior pole fracture of patella. The internal fixation is reliable, it is simple to operate, and patients can take exercises as early as possible. Therefore, the new tension band has a better clinical value.

Anomia treatment platform as behavioral engine for use in research on physiological adjuvants to neurorehabilitation.

PubMed

Kendall, Diane; Raymer, Anastasia; Rose, Miranda; Gilbert, JoEllen; Gonzalez Rothi, Leslie J

2014-01-01

The purpose of this study was to create a "behavioral treatment engine" for future use in research on physiological adjuvants in aphasia rehabilitation. We chose the behavioral target anomia, which is a feature displayed by many persons who have aphasia. Further, we wished to saturate the treatment approach with many strategies and cues that have been empirically reported to have a positive influence on aphasia outcome, with the goal being to optimize the potential for positive response in most participants. A single-subject multiple baseline design with replication across eight participants was employed. Four men and four women, with an average age of 62 yr and an average of 63.13 mo poststroke onset, served as participants. Word-retrieval treatment was administered 3 d/wk, 1 h/d for a total of 20 treatment hours (6-7 wk). Positive acquisition effects were evident in all eight participants (d effect size [ES] = 5.40). Treatment effects were maintained 3 mo after treatment termination for five participants (d ES = 2.94). Within and across semantic category, generalization was minimal (d ES = 0.43 within and 1.09 across). This study demonstrates that this behavioral treatment engine provides a solid platform on which to base future studies whereby various treatment conditions are manipulated and pharmacologic support is added.

Effects of leader topping and branch pruning on efficiency of Douglas-fir cone harvesting with a tree shaker.

Treesearch

D.L. Copes

1985-01-01

In 1983, a study was conducted to evaluate the effects of leader topping and branch pruning on the efficiency to tree shaking to remove Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) cones. Removal efficiency for three topping and pruning treatments averaged 69 percent, whereas for the uncut control treatment it was 62 percent. The treatment...

The effective forces transmitted by high-speed, low-amplitude thoracic manipulation.

PubMed

Herzog, W; Kats, M; Symons, B

2001-10-01

Twenty asymptomatic volunteers each received three spinal manipulative treatments to the thoracic spine. The treatments consisted of a straight posterior-to-anterior high-speed, low-amplitude thrust to the transverse process of T3-T10 using a reinforced hypothenar contact. All treatments were given by a full-time practicing clinician with 3 years of experience. The primary objective of this study was to quantify local measures of loading applied by the clinician on the volunteers during spinal manipulative treatments and to compare these local measures of loading with previously described global measures. The sparse information on the mechanics of spinal manipulative treatments deals exclusively with global force or pressure measurements. On the basis of these global data, incorrect conclusions may be drawn about the beneficial effects of spinal manipulative therapy, the loading of internal structures, and the risks associated with these treatments. Twenty asymptomatic subjects each received three posterior-to-anterior, high-speed, low-amplitude spinal manipulative treatments to the transverse process of the thoracic spine. Total force, local force, contact area, peak pressure, and average pressure at the contact interface between clinician and subject were measured continuously by use of a thin, flexible pressure pad. Local and global measures of loading were compared and analyzed by use of nonparametric statistics (alpha = 0.01). The average peak total force was 238.2 N. The average peak local force over a target area of 25 mm2 was 5 N, indicating that global measures of loading vastly overestimate the local effective forces at the target site. The peak pressure point moved, on average, 9.8 mm during the course of the manipulation. To the authors' best knowledge, this is the first study to quantify local, effective measures of loading and compare them with the global measures typically used. The conclusions are limited because the study used a single clinician. The effective loading of specific target sites is much smaller than the global measures might suggest. This result occurs because as the forces during spinal manipulative treatment increase, so does the contact area; therefore, much of the total treatment force is taken up by non-target-specific tissues. Because of the vast discrepancy between the global and local measures of loading, it is suggested that risk-benefit assessments of high-speed, low-amplitude spinal manipulative treatments should be made, including local measures of loading. Finally, because theoretical approaches and the inverse dynamics approach can provide only global measures of loading, the results of such studies should be interpreted with caution.

High-intensity focused ultrasound treatment of placenta accreta after vaginal delivery: a preliminary study.

PubMed

Bai, Y; Luo, X; Li, Q; Yin, N; Fu, X; Zhang, H; Qi, H

2016-04-01

To evaluate the safety and efficiency of high-intensity focused ultrasound (HIFU) in the treatment of placenta accreta after vaginal delivery. Enrolled into this study between September 2011 and September 2013 were 12 patients who had been diagnosed with placenta accreta following vaginal delivery and who had stable vital signs. All patients were treated using an ultrasound-guided HIFU treatment system. As indication of the effectiveness of the treatment we considered decreased vascular index on color Doppler imaging, decrease in size of residual placenta compared with pretreatment size on assessment by three-dimensional ultrasound with Virtual Organ Computer-aided Analysis, reduced signal intensity and degree of enhancement on magnetic resonance imaging and avoidance of hysterectomy following treatment. To assess the safety of HIFU treatment, we recorded side effects, hemorrhage, infection, sex steroid levels, return of menses and subsequent pregnancy. Patients were followed up in this preliminary study until December 2013. The 12 patients receiving HIFU treatment had an average postpartum hospital stay of 6.8 days and an average period of residual placental involution of 36.9 days. HIFU treatment did not apparently increase the risk of infection or hemorrhage and no patient required hysterectomy. In all patients menstruation recommenced after an average of 80.2 days, and sex steroid levels during the middle luteal phase of the second menstrual cycle were normal. Two patients became pregnant again during the follow-up period. This preliminary study suggests that ultrasound-guided HIFU is a safe and effective non-invasive method to treat placenta accreta patients after vaginal delivery who have stable vital signs and desire to preserve fertility. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Choosing Models for Health Care Cost Analyses: Issues of Nonlinearity and Endogeneity

PubMed Central

Garrido, Melissa M; Deb, Partha; Burgess, James F; Penrod, Joan D

2012-01-01

Objective To compare methods of analyzing endogenous treatment effect models for nonlinear outcomes and illustrate the impact of model specification on estimates of treatment effects such as health care costs. Data Sources Secondary data on cost and utilization for inpatients hospitalized in five Veterans Affairs acute care facilities in 2005–2006. Study Design We compare results from analyses with full information maximum simulated likelihood (FIMSL); control function (CF) approaches employing different types and functional forms for the residuals, including the special case of two-stage residual inclusion; and two-stage least squares (2SLS). As an example, we examine the effect of an inpatient palliative care (PC) consultation on direct costs of care per day. Data Collection/Extraction Methods We analyzed data for 3,389 inpatients with one or more life-limiting diseases. Principal Findings The distribution of average treatment effects on the treated and local average treatment effects of a PC consultation depended on model specification. CF and FIMSL estimates were more similar to each other than to 2SLS estimates. CF estimates were sensitive to choice and functional form of residual. Conclusions When modeling cost or other nonlinear data with endogeneity, one should be aware of the impact of model specification and treatment effect choice on results. PMID:22524165

Effect of bevacizumab on radiation necrosis of the brain

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

Gonzalez, Javier; Kumar, Ashok J.; Conrad, Charles A.

Purpose: Because blocking vascular endothelial growth factor (VEGF) from reaching leaky capillaries is a logical strategy for the treatment of radiation necrosis, we reasoned that bevacizumab might be an effective treatment of radiation necrosis. Patients and Methods: Fifteen patients with malignant brain tumors were treated with bevacizumab or bevacizumab combination for their tumor on either a 5 mg/kg/2-week or 7.5 mg/kg/3-week schedule. Radiation necrosis was diagnosed in 8 of these patients on the basis of magnetic resonance imaging (MRI) and biopsy. MRI studies were obtained before treatment and at 6-week to 8-week intervals. Results: Of the 8 patients with radiationmore » necrosis, posttreatment MRI performed an average of 8.1 weeks after the start of bevacizumab therapy showed a reduction in all 8 patients in both the MRI fluid-attenuated inversion-recovery (FLAIR) abnormalities and T1-weighted post-Gd-contrast abnormalities. The average area change in the T1-weighted post-Gd-contrast abnormalities was 48% ({+-}22 SD), and the average change in the FLAIR images was 60% ({+-}18 SD). The average reduction in daily dexamethasone requirements was 8.6 mg ({+-}3.6). Conclusion: Bevacizumab, alone and in combination with other agents, can reduce radiation necrosis by decreasing capillary leakage and the associated brain edema. Our findings will need to be confirmed in a randomized trial to determine the optimal duration of treatment.« less

Non-ablative scar revision using a long pulsed frequency doubled Nd:YAG laser.

PubMed

Cassuto, Daniel; Emanuelli, Guglielmo

2003-12-01

Unsightly scars often are the only reminder of a previous surgical or traumatic wound. Surgical or ablative scar revision is sought by patients, sometimes unnecessarily. When the aesthetic drawback is mainly a result of hypervascularity or hyperpigmentation, these problems can be specifically targeted with a wavelength that is well absorbed by the two above mentioned chromophores. Some degree of epidermal tightening can also be achieved, which is sometimes useful in slightly atrophic scars. The average improvement after 2-3 sessions was 81% (75%-100%) clearance, as judged by an independent observer who reviewed pre- and post-treatment photographs. No undesired effects were reported. All our patients were satisfied and required no further treatment. Selective photothermolysis by means of a long pulsed frequency doubled Nd:YAG laser (DioLite 532, IRIDEX Corporation, Mountain View, CA, USA) was used to eliminate the unsightly vascular and pigmented components of 23 mature scars (scars older than 2 years) in 22 consecutive patients. Energy densities of 17-22 j/cm2 were used with a 500 micron spot, or 65-90 j/cm2 with a 200 micron spot. overall scar clearance averaged 81% after 2.4 treatments. Facial scars showed the best clearance averaging 94% after 2 treatments. Inframammary scars were the most difficult to clear averaging 46%. Postoperative undesired effects were immediate erythema and swelling that subsided within 2-10 hours and microcrusting on 19/22 (88%) patients that resolved within one week. No other temporary or permanent undesired effects such as purpura, hypo- or hyperpigmentation were noticed, even in patients with darker skin types.

Effects of particle size and hydro-thermal treatment of feed on performance and stomach health in fattening pigs.

PubMed

Liermann, Wendy; Berk, Andreas; Böschen, Verena; Dänicke, Sven

2015-01-01

Effects of grinding and hydro-thermal treatment of feed on growth performance, slaughter traits, nutrient digestibility, stomach content and stomach health were examined by using 96 crossbred fattening pigs. Pigs were fed a grain-soybean meal-based diet processed by various technical treatments. Feeding groups differed in particle size after grinding (finely vs. coarsely ground feed) and hydro-thermal treatment (without hydro-thermal treatment, pelleting, expanding, expanding and pelleting). Fine grinding and hydro-thermal treatment showed significant improvements on the digestibility of crude nutrients and content of metabolisable energy. Hydro-thermal treatment influenced average daily gain (ADG) and average daily feed intake (DFI) significantly. Finely ground pelleted feed without expanding enhanced performances by increasing ADG and decreasing feed-to-gain ratio (FGR) of fattening pigs. Coarsely ground feed without hydro-thermal treatment resulted in the highest ADG and DFI, however also in the highest FGR. Expanded feed decreased DFI and ADG. Slaughter traits were not affected by treatments. Coarsely ground feed without hydro-thermal treatment had protective effects on the health of gastric pars nonglandularis, however, pelleting increased gastric lesions. Hydro-thermal treatment, especially expanding, resulted in clumping of stomach content which possibly induced satiety by slower ingesta passage rate and thus decreased feed intake. Pigs fed pelleted feed showed less pronounced development of clumps in stomach content compared with expanded feed.

Latent class instrumental variables: a clinical and biostatistical perspective.

PubMed

Baker, Stuart G; Kramer, Barnett S; Lindeman, Karen S

2016-01-15

In some two-arm randomized trials, some participants receive the treatment assigned to the other arm as a result of technical problems, refusal of a treatment invitation, or a choice of treatment in an encouragement design. In some before-and-after studies, the availability of a new treatment changes from one time period to this next. Under assumptions that are often reasonable, the latent class instrumental variable (IV) method estimates the effect of treatment received in the aforementioned scenarios involving all-or-none compliance and all-or-none availability. Key aspects are four initial latent classes (sometimes called principal strata) based on treatment received if in each randomization group or time period, the exclusion restriction assumption (in which randomization group or time period is an instrumental variable), the monotonicity assumption (which drops an implausible latent class from the analysis), and the estimated effect of receiving treatment in one latent class (sometimes called efficacy, the local average treatment effect, or the complier average causal effect). Since its independent formulations in the biostatistics and econometrics literatures, the latent class IV method (which has no well-established name) has gained increasing popularity. We review the latent class IV method from a clinical and biostatistical perspective, focusing on underlying assumptions, methodological extensions, and applications in our fields of obstetrics and cancer research. Copyright © 2015 John Wiley & Sons, Ltd.

[Treatment of Alcohol Withdrawal Syndrome with Oxazepam or Clomethiazole - A Naturalistic Observational Study].

PubMed

Verthein, Uwe; Kuhn, Silke; Gabriel, Katrin; Mautsch, Ulrich; Reimer, Jens; Behrendt, Klaus

2018-03-01

Whilst internationally benzodiazepines are first choice for treatment of alcohol withdrawal syndrome, Germany has a long tradition with clomethiazole. This study explores effectiveness of clomethiazole versus oxazepam in the treatment of alcohol withdrawal syndrome within an observational, stratified, non-inferiority study in routine care. Main outcome criterion was severity of the alcohol withdrawal syndrome (Alcohol Withdrawal Syndrome [AWS]) Scale in the first five days. Additionally, the association between the detoxification protocol (five vs. ten days) and AWS-Score was examined. 453 patients (74.2 % male, average age 47.1 years [± 9.2]) took part; 249 received oxazepam (55.0 %) and 204 clomethiazole (45.0 %). The average duration of inpatient treatment was 14.0 days (± 6.3) in both groups. The average AWS-score was lower in the oxazepam group compared to the clomethiazole group (50.0 [± 26.5] vs. 56.2 [± 31.5]; p < .05; effect size d = - .25). Patients with a shorter detoxification protocol had a lower AWS sum score compared to patients with a longer protocol (p < .001; d = - .46). In treatment of alcohol withdrawal syndrome in routine care oxazepam yields at least comparable results to clomethiazole. © Georg Thieme Verlag KG Stuttgart · New York.

Carbamylated monomeric allergoids as a therapeutic option for sublingual immunotherapy of dust mite- and grass pollen-induced allergic rhinoconjunctivitis: a systematic review of published trials with a meta-analysis of treatment using Lais® tablets.

PubMed

Mösges, R; Ritter, B; Kayoko, G; Allekotte, S

2010-10-01

Lais® allergoid tablets contain allergens that are modified by carbamylation. Due to their modified chemical structure, they are suitable for sublingual immunotherapy (SLIT) (13, 16, 17, 24). Based on their small molecule size of 12 to 40 kDa, they can be easily absorbed via the oral mucosa (1). In this review, we studied the efficacy of SLIT with carbamylated monomeric allergoid tablets in the treatment of grass pollen- and dust mite-induced allergic rhinoconjunctivitis on the basis of symptom and medication score improvements. Following a selective internet and databank search, six trials-some placebo-controlled-regarding the treatment of grass pollen- (n = 266) and dust mite-induced (n = 241) allergic rhinoconjunctivitis were used to draw conclusions regarding the clinical efficacy of allergoid tablets. The primary endpoints in these trials were decreases in the need for allergy medications and/or reductions in the occurrence of rhinoconjunctivitis symptoms. Data was recorded from patient diaries regarding their symptoms and medications used and conclusions were then drawn about the effectiveness and tolerabieity of Lais® tablets. The average improvement in symptom score in three trials of grass pollen allergy treatment was 34% in comparison to the placebo group. The treatment of dust mite-induced rhinoconjunctivitis produced an average symptom score improvement of 22% compared to the placebo or control groups. The intake of symptomatic rescue medication during allergoid tablet therapy declined. Treatment of grass pollen allergies and dust mite-induced rhinoconjunctivitis showed an average medication score improvement of 49% and 24%, respectively. Few side effects were documented in the trials and predominantly local effects were observed. Severe systemic side effects did not occur. On the basis of the trial results summarized in this review, we suggest that SLIT using Lais® sublingual tablets is an effective and well-tolerated form of treatment.

Clinic research on the treatment for humeral shaft fracture with minimal invasive plate osteosynthesis: a retrospective study of 128 cases.

PubMed

Chen, H; Hu, X; Yang, G; Xiang, M

2017-04-01

Minimal invasive plate osteosynthesis (MIPO) is one of the most important techniques in the treatment for humeral shaft fractures. This study was performed to evaluate the efficacy of MIPO technique for the treatment for humeral shaft fractures. We retrospectively evaluated 128 cases with humeral shaft fractures that were treated with MIPO technique from March 2005 to August 2008. All the patients were followed up by routine radiological imaging and clinical examinations. Constant-Murley score and HSS elbow joint score were used to evaluate the treatment outcome. The average duration of the surgery was 60 min (range 40-95 min) without blood transfusion. All fractures healed without infection. All cases recovered carrying angle except four cases with 10°-15° cubitus varus. After the average follow-up of 23 (13-38) months, satisfactory function was achieved according to Constant-Murley score and HSS elbow joint score. Constant-Murley score was 80 on average (range 68-91). According to HSS elbow joint score, there were 123 cases of excellent clinical outcome and five cases of effective outcome. It seems to be a safe and effective method for managing humeral shaft fractures with MIPO technique.

[Comparison of the effectiveness and cost of treatment with humid environment as compared to traditional cure. Clinical trial on primary care patients with venous leg ulcers and pressure ulcers].

PubMed

Capillas Pérez, R; Cabré Aguilar, V; Gil Colomé, A M; Gaitano García, A; Torra i Bou, J E

2000-01-01

The discovery of moist environment dressings as alternatives to the traditional treatments based on exposing wounds to air, opened new expectations for the care and treatment of chronic wounds. Over the years, these expectations have led to the availability of new moist environment dressings which have made it possible to improve the care provided to patients suffering this kind of wounds, as well as providing important reasons to weigh in terms of cost-benefit-effectiveness at the time of selecting which type of treatment should be employed. The lack of comparative analysis among traditional treatments and moist environment treatments for chronic wounds among patients receiving primary health care led the authors to perform an analysis comparing these aforementioned options of treatment on patients suffering venous leg ulcers or pressure ulcers. The authors designed a Randomized Clinical Trial involving patients receiving ambulatory care in order to compare the effectiveness and cost-benefit of traditional versus moist environment dressing during the treatment of patients suffering stage II or III pressure ulcers or venous leg ulcers. In this trial, variables related to effectiveness of both treatments, as well as their costs were analyzed. 70 wounds were included in this Randomized Clinical Trial, 41 were venous leg ulcers of which 21 received a moist environment treatment while 20 received traditional cure, the other 29 wounds were pressure ulcers of which 15 received moist environment dressings treatment and 14 received traditional dressings. No statistically significant differences were found among the defining variables for these lesions in either group under treatment. In the venous leg ulcer study group, the authors conclusions were an average of 18.13 days, 16.33 treatment sessions and a cost of 10,616 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 18.22 days, 4.54 treatment sessions and a cost of 2409 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. In the pressure ulcers study group, the authors conclusions were an average of 12.18 days, 12.1 treatment sessions and a cost of 15,490 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 7.12 days, 1.86 treatment sessions and a cost of 2610 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. The results of this randomized clinical trial demosntrated that the moist environment treatment group was more effective and had a better cost-benefit ratio than the traditional treatment group in the treatment of pressure ulcers and venous leg ulcers on patients cared for by nursing personnel in primary health care centers all of which agrees with publications consulted by authors.

Effect of Amblyopia Treatment on Macular Thickness in Eyes With Myopic Anisometropic Amblyopia.

PubMed

Pang, Yi; Frantz, Kelly A; Block, Sandra; Goodfellow, Geoffrey W; Allison, Christine

2015-04-01

To determine whether abnormal macular thickness in myopic anisometropic amblyopia differed after amblyopia treatment. Furthermore, to investigate whether effect of treatment on macular thickness was associated with subject age or improvement in stereoacuity. Seventeen children (mean age: 9.0 [±3.0] years, ranging from 5.7-13.9 years) with myopic anisometropic amblyopia (visual acuity [VA] in amblyopic eyes: 20/80-20/400) were recruited and treated with 16-week refractive correction, followed by an additional 16-week refractive correction and patching. Macular thickness, best-corrected VA, and stereoacuity were measured both before and after amblyopia treatment. Factorial repeated-measures analysis of variance was performed to determine whether macular thickness in amblyopic eyes changed after amblyopia treatment. Mean baseline VA in the amblyopic eye was 1.0 ± 0.3 logMAR and improved to 0.7 ± 0.3 after amblyopia treatment (P < 0.0001). The interaction between eye and amblyopia treatment was statistically significant for average foveal thickness (P = 0.040). There was no treatment effect on fellow eyes (P = 0.245); however, the average foveal thickness in the amblyopic eye was significantly reduced after amblyopia treatment (P = 0.049). No statistically significant interactions were found for the other macular thickness parameters (P > 0.05). Abnormal central macula associated with myopic anisometropic amblyopia tended to be thinner following amblyopia treatment with no significant changes in peripheral macular thickness.

SU-F-T-121: Abdominal Compression Effectively Reduces the Interplay Effect and Enables Pencil Beam Scanning Proton Therapy of Liver Tumors

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

Souris, K; University of Pennsylvania, Philadelphia, PA; Glick, A

Purpose: To study if abdominal compression can reduce breathing motion and mitigate interplay effect in pencil beam scanning proton therapy (PBSPT) treatment of liver tumors in order to better spare healthy liver volumes compared with photon therapy. Methods: Ten patients, six having large tumors initially treated with IMRT and four having small tumors treated with SBRT, were replanned for PBSPT. ITV and beam-specific PTVs based on 4D-CT were used to ensure target coverage in PBSPT. The use of an abdominal compression belt and volumetric repainting was investigated to mitigate the interplay effect between breathing motion and PBSPT dynamic delivery. Anmore » in-house Matlab script has been developed to simulate this interplay effect. The dose is computed on each phase individually by sorting all spots according to their simulated delivery timing. The final dose distribution is then obtained by accumulating all dose maps to a reference phase. Results: For equivalent target coverage PBSPT reduced average healthy liver dose by 9.5% of the prescription dose compared with IMRT/SBRT. Abdominal compression of 113.2±42.2 mmHg was effective for all 10 patients and reduced average motion by 2.25 mm. As a result, the average ITV volume decreased from 128.2% to 123.1% of CTV volume. Similarly, the average beam-specific PTV volume decreased from 193.2% to 183.3%. For 8 of the 10 patients, the average motion was reduced below 5 mm, and up to 3 repainting were sufficient to mitigate interplay. For the other two patients with larger residual motion, 4–5 repainting were needed. Conclusion: We recommend evaluation of the 4DCT motion histogram following simulation and the interplay effect following treatment planning in order to personalize the use of compression and volumetric repainting for each patient. Abdominal compression enables safe and more effective PBS treatment of liver tumors by reduction of motion and interplay effect. Kevin Souris is supported by IBA and Televie Grant from F.R.S.-FNRS. Liyong Lin is partially supported by Varian.« less

A long-term copper exposure in a freshwater ecosystem using lotic mesocosms: Invertebrate community responses

USGS Publications Warehouse

Joachim, Sandrine; Roussel, Hélène; Bonzom, Jean-Marc; Thybaud, Eric; Mebane, Christopher A.; Brink, Paul Van den; Gauthier, Laury

2017-01-01

A lotic mesocosm study was carried out in 20-m-long channels, under continuous, environmentally realistic concentrations of copper (Cu) in low, medium, and high exposures (nominally 0, 5, 25, and 75 μg L−1; average effective concentrations <0.5, 4, 20, and 57 μg L−1 respectively) for 18 mo. Total abundance, taxa richness, and community structure of zooplankton, macroinvertebrates, and emerging insects were severely affected at Cu treatment levels of 25 and 75 μg L−1. Some taxa were sensitive to Cu, including gastropods such as Lymnaea spp. and Physasp., crustaceans such as Chydorus sphaericus, Gammarus pulex, and Asellus aquaticus, rotifers such as Mytilina sp. and Trichocerca sp., leeches such as Erpobdella sp., and the emergence of dipteran insects such as Chironomini. Other taxa appeared to be tolerant or favored by indirect effects, as in Chironimidae larvae, the emergence of Orthocladiinae, and the zooplankter Vorticella sp., which increased in the 25 and 75 μg L−1 treatments. After approximately 8 mo of Cu exposure, the macroinvertebrate community in the high treatment was decimated to the point that few organisms could be detected, with moderate effects in the medium treatment, and very slight effects in the low-Cu treatment. Subsequently, most taxa in the high-Cu exposure began a gradual and partial recovery. By the end of the study at 18 mo, macroinvertebrate taxa richness was similar to control richness, although overall abundances remained lower than controls. After 18 mo of copper exposure, a no-observed-effect concentration at the community level for consumers was set at 5 μg L−1 (4 μg L−1 as average effective concentration), and a lowest-observed-effect concentration at 25 μg L−1(20 μg L−1 as average effective concentration). 

Effect of complementation of cattle cooling systems with feedline soakers on lactating dairy cows in a desert environment.

PubMed

Ortiz, X A; Smith, J F; Bradford, B J; Harner, J P; Oddy, A

2011-02-01

Two experiments were conducted on a commercial dairy farm in eastern Saudi Arabia to investigate the effects of Korral Kool (KK; Korral Kool Inc., Mesa, AZ) cattle cooling systems complemented with feedline soakers on core body temperature (CBT) of dairy cows. In both experiments, cows had access to KK 24h/d. In the first experiment, 7 primiparous and 6 multiparous lactating Holstein dairy cows were assigned to 1 of 2 pens, which were assigned randomly to treatment sequence over 4 d in a switchback design. Soakers were on (ON24) or off (OFF24) for 24h/d. For the second experiment, 20 multiparous lactating Holstein cows were assigned randomly to 1 of 2 pens, which were assigned randomly to treatment sequence in a switchback design. This experiment lasted 4 d and feedline soakers alternately remained off or were on (ON12) for 12h/d. In experiment 1, average ambient temperature was 30 ± 0.9°C and average relative humidity was 44 ± 14% (mean ± SD). Feedline soakers complementing KK systems for 24 h/d decreased the mean CBT of lactating dairy cows compared with KK systems alone (38.80 vs. 38.98 ± 0.061°C, respectively). A significant treatment by time interaction was found. The greatest treatment effects occurred at 2100 h; treatment means at this time were 39.26 and 38.85 ± 0.085°C for OFF24 and ON24 treatments, respectively. In experiment 2, average ambient temperature was 35 ± 1.5°C and average relative humidity was 33 ± 16%. Feedline soakers running for 12 h/d significantly decreased the mean 24-h CBT from 39.16 to 38.99 ± 0.084°C. Treatment by time interaction was also significant; the greatest treatment effects occurred at 1500 h, when ON12 reduced CBT from 39.38 to 38.81 ± 0.088°C. These results demonstrate that complementing the KK system with feedline soakers decreased the CBT of dairy cows housed in desert environments. However, the combined systems were not sufficient to lower CBT to normal temperatures in this extreme environment. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Virtual Reality Hypnosis In The Treatment Of Chronic Neuropathic Pain: A Case Report

PubMed Central

Oneal, Brent J.; Patterson, David R.; Soltani, Maryam; Teeley, Aubriana; Jensen, Mark P.

2009-01-01

This case report evaluates virtual reality hypnosis (VRH) in treating chronic neuropathic pain in a patient with a 5-year history of failed treatments. The patient participated in a 6-month trial of VRH, and her pain ratings of intensity and unpleasantness dropped on average 36% and 33%, respectively, over the course of 33 sessions. In addition, she reported both no pain and a reduction of pain for an average of 3.86 and 12.21 hours, respectively, after treatment sessions throughout the course of the VRH treatment. These reductions and the duration of treatment effects following VRH treatment were superior to those following a trial of standard hypnosis (non-VR) treatment. However, the pain reductions with VRH did not persist over long periods of time. The findings support the potential of VRH treatment for helping individuals with refractory chronic pain conditions. PMID:18726807

A financial analysis of maxillomandibular fixation versus rigid internal fixation for treatment of mandibular fractures.

PubMed

Schmidt, B L; Kearns, G; Gordon, N; Kaban, L B

2000-11-01

The aim of this study was to compare the cost-effectiveness of mandibular fracture treatment by closed reduction with maxillomandibular fixation (CRF) with open reduction and rigid internal fixation (ORIF). This was a retrospective study of 85 patients admitted to the Oral and Maxillofacial Surgery Service at San Francisco General Hospital and treated for mandibular fractures from January 1 to December 31, 1993. The patients were divided into 2 groups: 1) those treated with CRF and 2) those treated with ORIF. The outcome variables were length of hospital stay, duration of anesthesia, and time in operating room. The charge for primary fracture treatment included the fees for the operation and hospitalization without any complications. Within the group of 85 patients treated for mandibular fractures in 1993, 10 patients treated with CRF and 10 patients treated with ORIF were randomly selected, and hospital billing statements were used to estimate the average charge of primary treatment. The average charge to manage a major postoperative infection also was estimated based on the billing statements of 10 randomly selected patients treated in 1992 (5 treated with CRF, 5 with ORIF) who required hospital admission for the management of a complication. The average total charge was computed by using the average charge for primary treatment plus the incidence of postoperative infection multiplied by the average charge for management of that complication. Eighty-five patients were included in the study. The average charge for primary treatment was $10,100 for the CRF group and $28,362 for the ORIF group. The average charge for the inpatient management of a major postoperative infection was $26,671 for the CRF group and $39,213 for the ORIF group. The average total charge for management of a mandible fracture with CRF was $10,927; the total charge for the ORIF group was $34,636. The results of this retrospective study suggest that the use of CRF in the management of mandibular fractures at our institution provides considerable savings over treatment by using ORIF. The use of ORIF should be reserved for patients and fracture types with specific indications.

Variance estimation when using inverse probability of treatment weighting (IPTW) with survival analysis.

PubMed

Austin, Peter C

2016-12-30

Propensity score methods are used to reduce the effects of observed confounding when using observational data to estimate the effects of treatments or exposures. A popular method of using the propensity score is inverse probability of treatment weighting (IPTW). When using this method, a weight is calculated for each subject that is equal to the inverse of the probability of receiving the treatment that was actually received. These weights are then incorporated into the analyses to minimize the effects of observed confounding. Previous research has found that these methods result in unbiased estimation when estimating the effect of treatment on survival outcomes. However, conventional methods of variance estimation were shown to result in biased estimates of standard error. In this study, we conducted an extensive set of Monte Carlo simulations to examine different methods of variance estimation when using a weighted Cox proportional hazards model to estimate the effect of treatment. We considered three variance estimation methods: (i) a naïve model-based variance estimator; (ii) a robust sandwich-type variance estimator; and (iii) a bootstrap variance estimator. We considered estimation of both the average treatment effect and the average treatment effect in the treated. We found that the use of a bootstrap estimator resulted in approximately correct estimates of standard errors and confidence intervals with the correct coverage rates. The other estimators resulted in biased estimates of standard errors and confidence intervals with incorrect coverage rates. Our simulations were informed by a case study examining the effect of statin prescribing on mortality. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

Estimating Causal Effects of Education Interventions Using a Two-Rating Regression Discontinuity Design: Lessons from a Simulation Study

ERIC Educational Resources Information Center

Porter, Kristin E.; Reardon, Sean F.; Unlu, Fatih; Bloom, Howard S.; Robinson-Cimpian, Joseph P.

2014-01-01

A valuable extension of the single-rating regression discontinuity design (RDD) is a multiple-rating RDD (MRRDD). To date, four main methods have been used to estimate average treatment effects at the multiple treatment frontiers of an MRRDD: the "surface" method, the "frontier" method, the "binding-score" method, and…

Effectiveness of a psychosocial weight management program for individuals with schizophrenia.

PubMed

Niv, Noosha; Cohen, Amy N; Hamilton, Alison; Reist, Christopher; Young, Alexander S

2014-07-01

The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and Body Mass Index (BMI) were assessed at baseline, 1 year later, and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds, and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed.

Implementation and Effectiveness of a Psychosocial Weight Management Program for Individuals with Schizophrenia

PubMed Central

Niv, Noosha; Cohen, Amy N.; Hamilton, Alison; Reist, Christopher; Young, Alexander S.

2013-01-01

The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and BMI were assessed at baseline, 1 year later and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed. PMID:22430566

Patterns of Symptomatic Recovery in Psychotherapy.

ERIC Educational Resources Information Center

Kopta, Stephen Mark; And Others

1994-01-01

Used psychotherapy dosage model in which effect was probability of recovery to compare treatment response rates for psychological symptoms. Administered symptom checklists to 854 psychotherapy outpatients at intake and during treatment. Chronic distress symptoms demonstrated fastest average response rate, whereas characterological symptoms…

A Two Group-Two Treatment Research Design.

ERIC Educational Resources Information Center

Maxey, James H.

A two group-two treatment research design is presented; it allows for the assessment of the individual and the combined effects of the two treatments. Advantages include: (1) Initial evaluation represents an estimate of the stabilities of the measurements; and (2) Observation 4 compared with the average of Observation 1 and Observation 2 tests the…

Response of white-footed mice (Peromyscus leucopus) to fire and fire surrogate fuel reduction treatments in a southern Appalachian hardwood forest

USGS Publications Warehouse

Greenberg, C.H.; Otis, D.L.; Waldrop, T.A.

2006-01-01

An experiment conducted as part of the multidisciplinary National Fire and Fire Surrogate Study was designed to determine effects of three fuel reduction techniques on small mammals and habitat structure in the southern Appalachian mountains. Four experimental units, each >14-ha were contained within each of three replicate blocks at the Green River Game Land, Polk County, NC. Treatments were (1) prescribed burning (B); (2) mechanical felling of shrubs and small trees (M); (3) mechanical felling + burning (MB); (4) controls (C). Mechanical understory felling treatments were conducted in winter 2001-2002, and prescribed burning was conducted in March 2003. After treatment, there were fewer live trees, more snags, and greater canopy openness in MB than in other treatments. Leaf litter depth was reduced by burning in both B and MB treatments, and tall shrub cover was reduced in all fuel reduction treatments compared to C. Coarse woody debris pieces and percent cover were similar among treatments and controls. We captured 990 individuals of eight rodent species a total of 2823 times. Because white-footed mice composed >79% of all captures, we focused on this species. Populations in experimental units increased 228% on average between 2001 and 2002, but there was no evidence of an effect of the mechanical treatment. From 2002 to 2003, all units again showed an average increase in relative population size, but increases were greater in MB than in the other treatments. Age structure and male to female ratio were not affected by the fuel reduction treatment. Average adult body weight declined from 2001 to 2002, but less so in M than in units that remained C in both years. The proportion of mice captured near coarse woody debris was similar to the proportion captured in open areas for all treatments, indicating that white-footed mice did not use coarse woody debris preferentially or change their use patterns in response to fuel reduction treatments. Land managers should understand possible effects of different fuel reduction treatments on white-footed mouse populations, as they are an important component of the fauna and food chain of deciduous southern Appalachian forests.

Physical therapy treatments for low back pain in children and adolescents: a meta-analysis

PubMed Central

2013-01-01

Background Low back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents. Methods Studies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments). Results Eight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant. Conclusions Of all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP. PMID:23374375

Physical therapy treatments for low back pain in children and adolescents: a meta-analysis.

PubMed

Calvo-Muñoz, Inmaculada; Gómez-Conesa, Antonia; Sánchez-Meca, Julio

2013-02-02

Low back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents. Studies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments). Eight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant. Of all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP.

[Laser thermokeratoplasty in the treatment of hyperopia in children].

PubMed

Kulikova, I L; Pashtaev, N P; Suslikov, S V

2006-01-01

The effectiveness, safety, and stability of multimodality treatment for hyperopia, hyperopic and mixed astigmatism complicated by amblyopia and anisometropia were studied in 117 patients (117 eyes) aged 9 to 16 years, by using the new laser units "Lik-100" and "Glasser" at 1.54 microm. The patients were divided into 3 groups: 1) 43 patients (43 eyes) with hyperopia, spheric anisometropia and amblyopia; 2) 38 patients (38 eyes) with hyperopia, simple and complicated hyperopic astigmatism, astigmatic anisometropia, and amblyopia; 3) 36 patients (36 eyes) with hyperopia, simple and complicated hyperopic astigmatism, mixed anisometropia, and amblyopia. All the groups underwent multimodality treatment involving laser thermokeratoplasty and drug therapy for amblyopia. In children and adolescents, the refraction effect was 2.99 and 3.61 (mean 3.37 +/- 0.60) diopters, respectively. Astigmatism diminished by 2.01 diopters (63%) in children and by 2.62 diopters (79%) in adolescents (mean 2/35 diopters). The predictability of a refraction effect in the range of +/- 0.5 diopters averaged 77% in all the groups. Anisometropia diminished by an average of 2.88 +/- 0.8 diopters, which was 85% of the baseline data (the upper range of residual refraction was not more than 1.5 diopters. In all the groups, uncorrectable visual acuity increased by an average of 0.36 diopters (0.43 and 0.4 diopters in children and adolescents, respectively); correctable visual acuity increased by an average of 0.22 diopters (0.36 and 0.31 diopters in children and adolescents, respectively). Loss of correctable visual acuity lines did not greater than 2.7% (5 eyes). That of endothelial cells was not more than 6-8%. The angle of squint strabismus could be decreased or corrected in 79% after treatment. Binocular vision restored in 57%.

[Intra-detrusor injection of botulinumtoxin in patients with refractory overactive bladder].

PubMed

Krhut, J; Kopecký, J

2007-12-01

Symptoms of overactive bladder affect the quality of patients' life significantly. There is a standard treatment consisting in application of anticholinergics or possibly other conservative methods. This treatment fails at a certain part of patients however. While radical surgical therapy used to be offered to such patients in the past, the botulinumtoxin injection is available at present. The aim of the paper is to assess the efficacy and safety of this treatment method in own set of female patients with refractory overractive bladder. The set totals of 16 female patients with refractory overactive bladder. The average age in the set is 52.7 (38-69) years. Patients were treated by the application of botulinumtoxin in the period 6/2004-12/2006; the follow-up is 21.6 (6-36) months. In all cases the Dysport preparation in the dose 1000 UI was used for application. Botulinumtoxin has been applied during a short endoscopic procedure using a flexible needle into 40 points in the detrusor. Subjective satisfaction, data from voiding diaries, urodynamic parameters and the duration of effect persistence were evaluated. Subjective satisfaction with the treatment result was reached in 13 (81.3%) patients. In 12 (75.0%) patients the full continence was obtained. Average urinary bladder evacuation frequency decreased from 15.8/24 h to 5.5/24 h after the treatment, the number of urgency episodes decreased from 7.7/24 h to 0.8/24 h while average evacuated volume increased from 107.9 to 329.0 ml. The maximum cystometric capacity increased from 151.9 ml to 311.2 ml while maximum detrusor pressure decreased from 31.0 to 143 cm H2O at urodynamic assesment. The changes in all monitored parameters were statistically significant. The effect duration was 10.3 (6-13) months. No side effects of the application were registered during the treatment. The application of botulinumtoxin into detrusor is an effective and safe treatment method for refractory overactive bladder. Final standardization of the treatment by botulinumtoxin additional studies focused especially to the research of the relation among the dose, solution and clinical effect are necessary.

Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series.

PubMed

Dillon, John P; Freedman, Ilan; Tan, James S M; Mitchell, David; English, Shaun

2012-07-01

Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery. We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36 years (23-68 years). The average hospital stay was 6 days (4-9 days). No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18 days (7-22 days). We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement.

Talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for treatment of equinus deformity in adults.

PubMed

Gursu, Sarper; Bahar, Hakan; Camurcu, Yalkin; Yildirim, Timur; Buyuk, Fettah; Ozcan, Cagri; Sahin, Vedat

2015-01-01

Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults. Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months). Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02). The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone. Level IV, case series. © The Author(s) 2014.

Single-stage CO2 laser assisted uvuloplasty for treatment of snoring and mild obstructive sleep apnoea.

PubMed

Herford, A S; Finn, R

2000-08-01

The purpose of this study was to describe a single-stage laser assisted uvuloplasty (uvulectomy) and to determine its effectiveness in treatment of snoring and mild obstructive sleep apnoea (OSA). All patients treated with laser assisted uvuloplasty in a 49-month period for snoring and/or mild OSA were studied. Frequency of snoring before and after surgery, loudness of snoring and postoperative discomfort were investigated. Patients were asked to evaluate change in daytime energy, sleep habits, missed days of work and also overall satisfaction following laser assisted uvuloplasty. Thirty patients underwent a single-stage laser assisted uvuloplasty. A preoperative diagnosis of OSA was established in 19 patients, the remaining 11 patients were treated for snoring. There were no complications and only one patient required an additional stage. A questionnaire was completed by 18 patients (10 patients diagnosed with sleep apnoea, and eight patients with snoring only). Preoperatively the frequency of snoring averaged 9.3 cm on a visual analogue scale. Postoperatively there were 12 patients with either none or very minimal snoring and six patients who had an average score of 3.2. Loudness of snoring also decreased from an average of 5.4 to 2.5 cm. Postoperative discomfort averaged 1.1 cm. Improvement in sleep was noted by 16 patients and improved daytime energy was noted by 17 patients. Eleven patients reported that they missed at least one day of work postoperatively with an average of 3 days missed. Patient satisfaction was reported by 17 patients with only one stating that he was unsatisfied with the procedure. Laser-assisted uvuloplasty (uvulectomy) is an effective surgical procedure for treatment of snoring and some types of OSA. A single-stage procedure appears to be effective and may further decrease the morbidity associated with this disease.

Cryoablation for the treatment of occipital neuralgia.

PubMed

Kim, Chong H; Hu, Wayne; Gao, Jeff; Dragan, Kristin; Whealton, Thomas; Julian, Christina

2015-01-01

Treatment of occipital neuralgia (ON) can be complex, though many treatment options exist. Cryoablation (CA) is an interventional modality that has been used successfully in chronic neuropathic conditions and is one such option. To study and evaluate the efficacy and safety of cryoablation for treatment of ON. Retrospective evaluation. Academic university-based pain management center. All patients received local anesthetic injections for ON. Patients with greater than or equal to 50% relief and less than 2 week duration of relief were treated with CA. Thirty-eight patients with an average age of 49.6 years were included. Of the 38 patients, 20 were treated for unilateral greater ON, 10 for unilateral greater and lesser ON, and 8 for bilateral greater ON. There were 10 men and 28 women, with an average age of 45.2 years and 51.1 years, respectively. The average relief for all local anesthetic injections was 71.2%, 58.3% for patients who reported 50 - 74% relief (Group 1) and 82.75% for patients who reported greater than 75% relief (Group 2). The average improvement of pain relief with CA was 57.9% with an average duration of 6.1 months overall. Group 1 reported an average of 45.2% relief for an average of 4.1 months with CA. In comparison, Group 2 reported an average of 70.5% relief for 8.1 months. The percentage of relief (P = 0.007) and duration of relief (P = 0.0006) was significantly improved in those reporting at least 75% relief of pain with local anesthetic injections (Group 2 vs Group 1). Though no significance in improvement from CA was found in men, significance was seen in women with at least 75% benefit with local anesthetic injections in terms of duration (P = 0.03) and percentage (P = 0.001) of pain relief with CA. The average pain score prior to CA was 8 (0 - 10 visual analog scale, VAS), this improved to 4.2, improvement of 3.8 following CA at 6 months (P = 0.03). Of the 38 patients, 3 (7.8%) adverse effects were seen. Two patients reported post procedure neuritis and one was monitored for procedure-related hematoma. Study limitations include the retrospective nature of the study. Additionally, only the percentage of relief, pain score, and duration of relief were collected. CA is safe, and should be considered in patients with ON. Cryoablation, cryoanalgesia, occipital neuralgia, treatment, adverse effects.

Effect of mannitol on cerebrovascular pressure reactivity in patients with intracranial hypertension.

PubMed

Tang, Sung-Chun; Lin, Ru-Jen; Shieh, Jiann-Shing; Wu, An-Yeu; Lai, Dar-Ming; Huang, Sheng-Jean; Jeng, Jiann-Shing

2015-09-01

Mannitol is commonly used in patients with increased intracranial pressure (ICP), but its effect on cerebrovascular pressure reactivity (CVPR) is uncertain. We analyzed the changes of pressure reactivity index (PRx) during the course of mannitol treatment. Twenty-one patients who received mannitol treatment for increased ICP were recruited prospectively. Continuous waveforms of arterial blood pressure (ABP) and ICP were collected simultaneously for 60 minutes (10 minutes at baseline and 50 minutes since mannitol administration) during 37 events of mannitol treatment. The correlation coefficients between the mean ABP and ICP were averaged every 10 minutes and labeled as the PRx. The linear correlation of six time points of PRx in each event was calculated to represent the trend of CVPR changes. The negative slope of correlation was defined as improvement in CVPR under mannitol treatment and vice versa. At baseline, the average of ICP was 26.0 ± 9.1 mmHg and the values of PRx were significantly correlated with ICP (p = 0.0044, r = 0.46). After mannitol administration, the average of ICP decreased significantly to 21.2 ± 11.1 mmHg (p = 0.036), and CVPR improved in 59.4 % of all events. Further analysis showed that low baseline cerebral perfusion pressure was the only hemodynamic parameter significant association with the improvement of CVPR after mannitol treatment (p = 0.039). Despite lowering ICP, mannitol may have diverse effects on CVPR in patients with intracranial hypertension. Our study suggests that mannitol infusion may have a beneficial effect on CVPR, particularly in those with a low cerebral perfusion pressure at baseline. Copyright © 2013. Published by Elsevier B.V.

Efficacy of memory rehabilitation therapy: a meta-analysis of TBI and stroke cognitive rehabilitation literature.

PubMed

Elliott, Madison; Parente, Frederick

2014-01-01

To examine the efficacy of cognitive rehabilitation strategies specifically designed to improve memory after traumatic brain injury (TBI) and stroke vs. memory improvement with the passage of time. A meta-analysis was performed on 26 studies of memory retraining and recovery that were published between the years of 1985 and 2013. Effect sizes (ESs) from each study were calculated and converted to Pearson's r and then analysed to assess the overall effect size and the relationship among the ESs, patient demographics and treatment interventions. RESULTS indicated a significant average ES (r = 0.51) in the treatment intervention conditions, as well as a significant average ES (r = 0.31) in the control conditions, in which participants did not receive any treatment. The largest ESs occurred in studies of stroke patients and studies concerning working memory rehabilitation. RESULTS showed that memory rehabilitation was an effective therapeutic intervention, especially for stroke patients and for working memory as a treatment domain. However, the results also indicated that significant memory improvement occurred spontaneously over time.

Surgical Treatment of Moderate Hallux Valgus: A Comparison of Distal Chevron Metatarsal Osteotomy With and Without Lateral Soft-Tissue Release.

PubMed

Grle, Maki; Vrgoc, Goran; Bohacek, Ivan; Hohnjec, Vladimir; Martinac, Marko; Brkic, Iva; Stefan, Lovro; Jotanovic, Zdravko

2017-12-01

The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has a beneficial or detrimental effect on the outcome of distal Chevron first metatarsal osteotomy (DCMO) in the treatment of moderate hallux valgus (HV). We compared the effect of different surgical treatments in 2 groups of patients: group I (23 patients, 25 feet, average age of 55 [from 43 to 77] years) was subjected to DCMO only, whereas group II (18 patients, 23 feet, average age of 59 [from 52 to 70] years]) was subjected to DCMO with LSTR. The American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scale survey was conducted postoperatively, followed by the brief survey on postoperative patient satisfaction. The patient follow-up period was from 18 to 24 months after surgical treatment, on average. After surgical intervention, both groups of patients presented with an improved HV angle, but there was no significant difference between the groups. However, group II showed significant improvements in medial sesamoid bone position and patient satisfaction scores as compared with group I. Our midterm follow-up of surgical treatments for moderate HV deformity suggests that both procedures provide good postoperative results. However, according to our results, DCMO with LSTR provides better results than procedures without LSTR. Therapeutic, Level III: Retrospective comparative study.

Efficacy of pulsed radiofrequency medial branch treatment in low back pain patients.

PubMed

Kim, Do Hyoung; Han, Seong Rok; Choi, Chan Young; Sohn, Moon Jun; Lee, Chae Heuck

2016-04-27

It was thought that the efficacy of pulsed radiofrequency (PRF) treatment of the medial branch in patients with lower back pain was not as long lasting as that of continuous radiofrequency (CRF) thermo-coagulation techniques. The goal of this study was to determine the efficacy and the long-term effects of PRF treatment of the medial branch in selected low back pain patients. We retrospectively reviewed and analyzed patients with lower back pain who underwent PRF treatment on the medial branch at our institute. Pain relief was evaluated by visual analog scale (VAS) score at pretreatment, 2 weeks, 6 months, 1 year and 2 years post-treatment. Oswestry disability index (ODI) score was evaluated pretreatment and at 2 years post-treatment. We also recorded the satisfaction period after PRF treatment. Twenty-three patients were available for the 2-year follow-up analysis. None of the patients had any side effects or procedure-related complications during the follow up period. The average VAS score declined from 7.1 ± 2.4 pre-treatment to 2.9 ± 2.1 2 weeks post-treatment, 2.6 ± 1.8 at 6 months, 2.8 ± 2.1 at 1 year and 3.0 ± 2.5 at 2 years. The average ODI score decreased from 33.6 ± 13.6 pre-treatment to 15.3 ± 5.7 at 2 years post-treatment. Mean satisfaction period after PRF treatment was 16.6 ± 9.43 months. PRF treatment on the medial branch is an effective and safe treatment option for patients with lower back pain.

The use of Collagenase Clostridium Histolyticum in the management of Dupuytren's contracture-outcomes of a pilot study in a District General Hospital setting.

PubMed

Murphy, Lynn E; Murphy, Karen M; Kilpatrick, Shauneen M; Thompson, Neville W

2017-05-01

Collagenase Clostridium Histolyticum (CCH) is a recognised treatment option for adult patients presenting with Dupuytren's contracture (DC). Twenty male patients with established DC were treated using CCH. The average metacarpophalangeal (MCP) joint and proximal interphalangeal joint (PIP) contractures pre-treatment were 52 0 (range, 0 - 75 0 ) and 35 0 (range, 0 - 84 0 ) respectively. The average DASH score pre-treatment was 24.2 points (range, 0 - 68.2 points). Patients were reviewed at lmonth, 3months and at an average of 23 months (17 to 27 months). MCP joint contractures significantly improved compared to pre-treatment and the improvement was maintained at latest follow up. PIP joint contractures did significantly improve but to a lesser degree and there was no significant improvement compared to pre-treatment beyond 3months. A trend for MCP and PIP joint contracture recurrence was observed at latest follow up but did not reach statistical significance. DASH scores significantly improved from pre-treatment and the improvement was maintained at latest follow up. At 3months, the average patient satisfaction score was 9.5 (range, 6 - 10), which decreased to 8.6 (range, 6 - 10) at latest follow up. We estimated a potential cost saving of approximately £70,000 by treating 20 patients using CCH compared to inpatient operative fasciectomy. CCH is a useful option in the management of DC in appropriately selected patients. Cost-effectiveness in the treatment of DC should be carefully considered.

Estimating Causal Effects of Education Interventions Using a Two-Rating Regression Discontinuity Design: Lessons from a Simulation Study and an Application

ERIC Educational Resources Information Center

Porter, Kristin E.; Reardon, Sean F.; Unlu, Fatih; Bloom, Howard S.; Cimpian, Joseph R.

2017-01-01

A valuable extension of the single-rating regression discontinuity design (RDD) is a multiple-rating RDD (MRRDD). To date, four main methods have been used to estimate average treatment effects at the multiple treatment frontiers of an MRRDD: the "surface" method, the "frontier" method, the "binding-score" method, and…

How Much Do the Effects of Education and Training Programs Vary across Sites? Evidence from Past Multisite Randomized Trials

ERIC Educational Resources Information Center

Weiss, Michael J.; Bloom, Howard S.; Verbitsky-Savitz, Natalya; Gupta, Himani; Vigil, Alma E.; Cullinan, Daniel N.

2017-01-01

Multisite trials, in which individuals are randomly assigned to alternative treatment arms within sites, offer an excellent opportunity to estimate the cross-site average effect of treatment assignment (intent to treat or ITT) "and" the amount by which this impact varies across sites. Although both of these statistics are substantively…

Effectiveness of cognitive behavioral therapy on health-related quality of life: An evaluation of therapies provided by trainee therapists.

PubMed

Henriksson, Sophie; Anclair, Malin; Hiltunen, Arto J

2016-06-01

The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health-related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Results of Ponseti Brasil Program: Multicentric Study in 1621 Feet: Preliminary Results.

PubMed

Nogueira, Monica P; Queiroz, Ana C D B F; Melanda, Alessandro G; Tedesco, Ana P; Brandão, Antonio L G; Beling, Claudio; Violante, Francisco H; Brandão, Gilberto F; Ferreira, Laura F A; Brambila, Leandro S; Leite, Leopoldina M; Zabeu, Jose L; Kim, Jung H; Fernandes, Kalyana E; Arima, Marcia A S; Aguilar, Maria D P Q; Farias Filho, Orlando C D; Oliveira Filho, Oscar B D A; Pinho, Solange D S; Moulin, Paulo; Volpi, Reinaldo; Fox, Mark; Greenwald, Miles F; Lyle, Brandon; Morcuende, Jose A

The Ponseti method has been shown to be the most effective treatment for congenital clubfoot. The current challenge is to establish sustainable national clubfoot treatment programs that utilize the Ponseti method and integrate it within a nation's governmental health system. The Brazilian Ponseti Program (Programa Ponseti Brasil) has increased awareness of the utility of the Ponseti method and has trained >500 Brazilian orthopaedic surgeons in it. A group of 18 of those surgeons had been able to reproduce the Ponseti clubfoot treatment, and compiled their initial results through structured spreadsheet. The study compiled 1040 patients for a total of 1621 feet. The average follow-up time was 2.3 years with an average correction time of approximately 3 months. Patients required an average of 6.40 casts to achieve correction. This study demonstrates that good initial correction rates are reproducible after training; from 1040 patients only 1.4% required a posteromedial release. Level IV.

Value-based medicine, comparative effectiveness, and cost-effectiveness analysis of topical cyclosporine for the treatment of dry eye syndrome.

PubMed

Brown, Melissa M; Brown, Gary C; Brown, Heidi C; Peet, Jonathan; Roth, Zachary

2009-02-01

To assess the comparative effectiveness and cost-effectiveness (cost-utility) of a 0.05% emulsion of topical cyclosporine (Restasis; Allergan Inc, Irvine, California) for the treatment of moderate to severe dry eye syndrome that is unresponsive to conventional therapy. Data from 2 multicenter, randomized, clinical trials and Food and Drug Administration files for topical cyclosporine, 0.05%, emulsion were used in Center for Value-Based Medicine analyses. Analyses included value-based medicine as a comparative effectiveness analysis and average cost-utility analysis using societal and third-party insurer cost perspectives. Outcome measures of comparative effectiveness were quality-adjusted life-year (QALY) gain and percentage of improvement in quality of life, and for cost-effectiveness were cost-utility ratio (CUR) using dollars per QALY. Topical cyclosporine, 0.05%, confers a value gain (comparative effectiveness) of 0.0319 QALY per year compared with topical lubricant therapy, a 4.3% improvement in quality of life for the average patient with moderate to severe dry eye syndrome that is unresponsive to conventional lubricant therapy. The societal perspective incremental CUR for cyclosporine over vehicle therapy is $34,953 per QALY and the societal perspective average CUR is $11,199 per QALY. The third-party-insurer incremental CUR is $37,179 per QALY, while the third-party-insurer perspective average CUR is $34,343 per QALY. Topical cyclosporine emulsion, 0.05%, confers considerable patient value and is a cost-effective therapy for moderate to severe dry eye syndrome that is unresponsive to conventional therapy.

Use of yeast (Pichia kudriavzevii) as a novel feed additive to ameliorate the effects of aflatoxin B1 on broiler chicken performance.

PubMed

Magnoli, A P; Rodriguez, M C; González Pereyra, M L; Poloni, V L; Peralta, M F; Nilson, A J; Miazzo, R D; Bagnis, G; Chiacchiera, S M; Cavaglieri, L R

2017-11-01

The aim of this study was to evaluate the efficacy of autochthonous Pichia kudriavzevii as a novel bioadsorbent for aflatoxin B 1 (AFB 1 ). The selection of this yeast was based on the AFB 1 adsorption capacity previously demonstrated in vitro (Magnoli et al. 2016). One-day-old Cobb broilers (n = 160) were randomly assigned to four dietary treatments (T1: basal diet (B); T2: B + 0.1% yeast; T3: B + AFB 1 , 100 μg/kg; T4: B + 0.1% yeast + AFB 1 , 100 μg/kg). Performance parameters (average daily weight gain body, average daily consumption, feed conversion ratio, carcass weight, and dead weight), biochemical parameters (albumin, globulin, and albumin/globulin), liver pathological changes, and AFB 1 residual levels in the liver and excreta were evaluated. Significant differences (P < 0.05) in performance parameters were observed among treatments and controls: T3 group showed the lowest average daily body weight gain value while in T4 group, the value of this parameter increased significantly (P < 0.05). T3 and T4 groups showed the lowest and highest values for average daily feed consumption, respectively. The feed conversion ratio (FC) showed no significant differences among treatments. T3 group showed the lowest dead weight and carcass weight compared with T1 group. The biochemical parameters showed no significant differences among treatments. T3 group showed macroscopic and microscopic liver changes compared to the control. Aflatoxin B 1 levels (μg/g) were detected in broiler livers and showed significant differences among treatments (P < 0.05). In conclusion, native P. kudriavzevii incorporation (0.1%) in broiler diets containing AFB 1 was shown to be effective in ameliorating the adverse effects of AFB 1 on production.

A four-session acceptance and commitment therapy based intervention for depressive symptoms delivered by masters degree level psychology students: a preliminary study.

PubMed

Kohtala, Aino; Lappalainen, Raimo; Savonen, Laura; Timo, Elina; Tolvanen, Asko

2015-05-01

Depressive symptoms are one of the main reasons for seeking psychological help. Shorter interventions using briefly trained therapists could offer a solution to the ever-rising need for early and easily applicable psychological treatments. The current study examines the effectiveness of a four-session Acceptance and Commitment Therapy (ACT) based treatment for self-reported depressive symptoms administered by Masters level psychology students. This paper reports the effectiveness of a brief intervention compared to a waiting list control (WLC) group. Participants were randomized into two groups: ACT (n = 28) and waiting list (n = 29). Long-term effects were examined using a 6-month follow-up. The treatment group's level of depressive symptoms (Beck Depression Inventory) decreased by an average of 47%, compared to an average decrease of 4% in the WLC group. Changes in psychological well-being in the ACT group were better throughout, and treatment outcomes were maintained after 6 months. The posttreatment "between-group" and follow-up "with-in group" effect sizes (Cohen's d) were large to medium for depressive symptoms and psychological flexibility. The results support the brief ACT-based intervention for sub-clinical depressive symptoms when treatment was conducted by briefly trained psychology students. It also contributes to the growing body of evidence on brief ACT-based treatments and inexperienced therapists.

[Effects of acupuncture on circadian rhythm of blood pressure in patients with essential hypertension].

PubMed

Lei, Yun; Jin, Jiu; Ban, Haipeng; Du, Yuzheng

2017-11-12

To observe the effects of acupuncture combined with medication on circadian rhythm of blood pressure in patients with essential hypertension. Sixty-four patients of essential hypertension were randomly divided into an observation group and a control group, 32 cases in each group. All the patients maintained original treatment (taking antihypertensive medication); the patients in the observation group were treated with acupuncture method of " Huoxue Sanfeng , Shugan Jianpi ", once a day, five times per week, for totally 6 weeks (30 times). The circadian rhythm of blood pressure and related dynamic parameters were observed before and after treatment in the two groups. (1) The differences of daytime average systolic blood pressure (dASBP), daytime average diastolic blood pressure (dADBP), nighttime average systolic blood pressure (nASBP) and circadian rhythm of systolic blood pressure before and after treatment were significant in the observation group (all P <0.05); the differences of circadian rhythm of blood pressure and related dynamic parameters before and after treatment were insignificant in the control group (all P >0.05). The nASBP and circadian rhythm of systolic blood pressure in the observation group were significantly different from those in the control group (all P <0.05). (2) After the treatment, the spoon-shaped rate of circadian rhythm of blood pressure in the observation group was higher than that in the control group ( P <0.05). The acupuncture combined with medication could effectively improve the circadian rhythm of blood pressure and related dynamic parameters in patients with essential hypertension.

SU-E-T-558: Assessing the Effect of Inter-Fractional Motion in Esophageal Sparing Plans.

PubMed

Williamson, R; Bluett, J; Niedzielski, J; Liao, Z; Gomez, D; Court, L

2012-06-01

To compare esophageal dose distributions in esophageal sparing IMRT plans with predicted dose distributions which include the effect of inter-fraction motion. Seven lung cancer patients were used, each with a standard and an esophageal sparing plan (74Gy, 2Gy fractions). The average max dose to esophagus was 8351cGy and 7758cGy for the standard and sparing plans, respectively. The average length of esophagus for which the total circumference was treated above 60Gy (LETT60) was 9.4cm in the standard plans and 5.8cm in the sparing plans. In order to simulate inter-fractional motion, a three-dimensional rigid shift was applied to the calculated dose field. A simulated course of treatment consisted of a single systematic shift applied throughout the treatment as well a random shift for each of the 37 fractions. Both systematic and random shifts were generated from Gaussian distributions of 3mm and 5mm standard deviation. Each treatment course was simulated 1000 times to obtain an expected distribution of the delivered dose. Simulated treatment dose received by the esophagus was less than dose seen in the treatment plan. The average reduction in maximum esophageal dose for the standard plans was 234cGy and 386cGY for the 3mm and 5mm Gaussian distributions, respectively. The average reduction in LETT60 was 0.6cm and 1.7cm, for the 3mm and 5mm distributions respectively. For the esophageal sparing plans, the average reduction in maximum esophageal dose was 94cGy and 202cGy for 3mm and 5mm Gaussian distributions, respectively. The average change in LETT60 for the esophageal sparing plans was smaller, at 0.1cm (increase) and 0.6cm (reduction), for the 3mm and 5mm distributions, respectively. Interfraction motion consistently reduced the maximum doses to the esophagus for both standard and esophageal sparing plans. © 2012 American Association of Physicists in Medicine.

Combined use of monopolar radiofrequency and transdermal drug delivery in the treatment of melasma.

PubMed

Cameli, Norma; Abril, Elva; Mariano, Maria; Berardesca, Enzo

2014-07-01

Melasma is a common acquired pigmentary disorder that has a considerable psychological impact on the patient. The recurrent and refractory nature of this condition makes it difficult for treatment. We aim to evaluate the efficacy and safety of a combined system that simultaneously uses monopolar radiofrequency (RF) and transdermal drug delivery of phytocomplex containing 1% kojic acid in the treatment of melasma. Fifty patients affected by melasma underwent 6 sessions of treatment at 1-week intervals. The outcome was evaluated before treatment (T0) and 1 month (T1) and 6 months (T2) after treatment using the Melasma Area and Severity Index score, a Mexameter, and Visioface devices for digital and ultraviolet computerized image analysis of skin color. The image analysis showed that hyperpigmentation was significantly reduced at T1 and T2 compared with baseline. Melasma Area and Severity Index score, the average melanin score, and the average erythema values showed a significant reduction. No side effects were observed or reported. This study describes the first report of improvement in melasma through the combined use of monopolar RF with transdermal delivery of depigmenting agents. This could be a safe, tolerable, and effective alternative tool for the treatment of melasma.

Globally efficient non-parametric inference of average treatment effects by empirical balancing calibration weighting

PubMed Central

Chan, Kwun Chuen Gary; Yam, Sheung Chi Phillip; Zhang, Zheng

2015-01-01

Summary The estimation of average treatment effects based on observational data is extremely important in practice and has been studied by generations of statisticians under different frameworks. Existing globally efficient estimators require non-parametric estimation of a propensity score function, an outcome regression function or both, but their performance can be poor in practical sample sizes. Without explicitly estimating either functions, we consider a wide class calibration weights constructed to attain an exact three-way balance of the moments of observed covariates among the treated, the control, and the combined group. The wide class includes exponential tilting, empirical likelihood and generalized regression as important special cases, and extends survey calibration estimators to different statistical problems and with important distinctions. Global semiparametric efficiency for the estimation of average treatment effects is established for this general class of calibration estimators. The results show that efficiency can be achieved by solely balancing the covariate distributions without resorting to direct estimation of propensity score or outcome regression function. We also propose a consistent estimator for the efficient asymptotic variance, which does not involve additional functional estimation of either the propensity score or the outcome regression functions. The proposed variance estimator outperforms existing estimators that require a direct approximation of the efficient influence function. PMID:27346982

Globally efficient non-parametric inference of average treatment effects by empirical balancing calibration weighting.

PubMed

Chan, Kwun Chuen Gary; Yam, Sheung Chi Phillip; Zhang, Zheng

2016-06-01

The estimation of average treatment effects based on observational data is extremely important in practice and has been studied by generations of statisticians under different frameworks. Existing globally efficient estimators require non-parametric estimation of a propensity score function, an outcome regression function or both, but their performance can be poor in practical sample sizes. Without explicitly estimating either functions, we consider a wide class calibration weights constructed to attain an exact three-way balance of the moments of observed covariates among the treated, the control, and the combined group. The wide class includes exponential tilting, empirical likelihood and generalized regression as important special cases, and extends survey calibration estimators to different statistical problems and with important distinctions. Global semiparametric efficiency for the estimation of average treatment effects is established for this general class of calibration estimators. The results show that efficiency can be achieved by solely balancing the covariate distributions without resorting to direct estimation of propensity score or outcome regression function. We also propose a consistent estimator for the efficient asymptotic variance, which does not involve additional functional estimation of either the propensity score or the outcome regression functions. The proposed variance estimator outperforms existing estimators that require a direct approximation of the efficient influence function.

The effect of telehealth systems and satisfaction with health expenditure among patients with metabolic syndrome.

PubMed

Uei, Shu-Lin; Tsai, Chung-Hung; Kuo, Yu-Ming

2016-04-29

Telehealth cost analysis has become a crucial issue for governments in recent years. In this study, we examined cases of metabolic syndrome in Hualien County, Taiwan. This research adopted the framework proposed by Marchand to establish a study process. In addition, descriptive statistics, a t test, analysis of variance, and regression analysis were employed to analyze 100 questionnaires. The results of the t$ test revealed significant differences in medical health expenditure, number of clinical visits for medical treatment, average amount of time spent commuting to clinics, amount of time spent undergoing medical treatment, and average number of people accompanying patients to medical care facilities or assisting with other tasks in the past one month, indicating that offering telehealth care services can reduce health expenditure. The statistical analysis results revealed that customer satisfaction has a positive effect on reducing health expenditure. Therefore, this study proves that telehealth care systems can effectively reduce health expenditure and directly improve customer satisfaction with medical treatment.

[Case-control study on measurement of coracoclavicular and acromioclavicular ligament injuries during internal fixation operation for the treatment of fresh acromioclavicular joint dislocation of Tossy type III].

PubMed

Guan, Ting-Jin; Sun, Peng; Zheng, Liang-Guo; Qi, Xiang-Yang

2014-01-01

To study measurement methods of acromioclavicular and coracoclavicular ligament injuries,its therapeutic effects and complications during internal fixation operation for the treatment of fresh acromioclavicular joint dislocations of Tossy type III. From July 2003 to May 2012,127 patients with acromioclavicular joint dislocations of Tossy type III were treated with wire fixation from coracoid process to clavicle or hook-plate fixation. The patients were divided into group A (63 cases) and group B (64 cases) according to whether acromioclavicular ligament and coracoclavicular ligament were repaired or not. In group A (ligaments repaired), there were 39 males and 24 females with an average age of (33.25 +/- 8.46) years old (ranged from 17 to 59 years). And in group B (no ligaments repaired), there were 41 males and 23 females with an average age of (34.10 +/- 7.19) years (ranged from 19 to 57 years). The operation times, intraoperative blood loss, postoperative infections, internal fixation failure, recurrence and other complications, together with therapeutic effects were compared between two groups. The outcome was analyzed according to Karlsson standard. In group A, 54 patients got an excellent result and 9 good according to Karlsson standard;the average operative time was (55.90 +/- 26.56) min; the average intraoperative bleeding amount was (99.80 +/- 50.30) ml; 1 patient had wire broken without re-dislocation at 16 weeks after operation, 3 patients got wound fat liquefaction and recovered after treatment, 1 patient had pain after shoulder joint motion and pain disappeared after implants were taken out. In group B, 52 patients got an excellent result and 12 good according to Karlsson standard; the average operative time was (49.50 +/- 23.14) min; the average intraoperative bleeding amount was (87.30 +/- 46.41) ml; 2 patients got wound fat liquefaction, and 2 patients had pain after shoulder joint motion. All the patients were followed up, and the duration ranged from 9 to 16 months. All internal steel-wire or hook plate were taken out during 4 to 9 months without acromioclavicular joint re dislocation. There were no significant difference in the average operative time, the average intraoperative blood less, complication recurrence rates of fixation failure, wound fat liquefaction, postoperative infection, acromioclavicular joint re-dislocation, and therapeutic effects between two groups. Both wire and clavicular hook plate fixation, performed for fresh acromioclavicular joint dislocation with Tossy type III, are simple, effective, less invasive method with less blood loss. In addition, the treatment without ligaments repaired could not increase incidence of complications.

Picosecond laser with specialized optic for facial rejuvenation using a compressed treatment interval.

PubMed

Khetarpal, Shilpi; Desai, Shraddha; Kruter, Laura; Prather, Heidi; Petrell, Kathleen; Depina, Joahinha; Arndt, Kenneth; Dover, Jeffrey S

2016-10-01

Studies using a 755 nm picosecond laser with a focus lens array have been reported to be effective for facial wrinkles and pigmentation. This study reports the safety and efficacy using a shorter interval of 2-3 weeks between treatments. Nineteen female subjects and one male subject, primarily Fitzpatrick skin types II and III (one skin type I), who had mild to moderate wrinkles and sun-induced pigmentation were enrolled and treated using the 755 nm PicoSure Laser with focus lens array. The skin was cleansed then wiped with an alcohol wipe prior to treatment. Lidocaine 30% ointment and/or forced air cooling could be used to increase subject comfort. Adjacent pulses, with minimal overlap (10% or less), were delivered to the full face. Subjects received four treatments, performed at 2-3-week intervals. The laser energy used was 0.71 J/cm 2 . The physician administered 3-7 passes with an average total of 6,253 pulses per treatment. Follow-up visits occurred at 1 and 3 months post-last treatment at which the physician scored satisfaction and improvement and subjects scored satisfaction and likelihood to recommend to others. The most common side effects were mild swelling, pain, redness, and crusting, most of which subsided within hours of the treatment, with the latest resolving within 48 hours. This is similar to a previous reported study (Weiss et al. ASLMS 2015) where treatments were performed every 6 weeks with side effects resolving within 24 hours. At the 1 and 3 month follow-up visits, 94% (n = 19) and 93% (n = 15) of subjects scored themselves as satisfied or extremely satisfied with their overall results and 81% and 93% were likely to recommend the treatment based on global assessment, respectively. The treating physician was satisfied with 93% of subject's overall results. Three blinded evaluators were able to correctly identify the baseline from post-treatment photographs in 77% of the subjects at the 1 month follow-up and 69% of the subjects at the 3 month follow-up, on average. The average treatment pain score was 4.2 on a 1-10 scale. A compressed treatment interval expedites results without increasing side effects and resulted in a high physician and subject satisfaction rate. Lasers Surg. Med. 48:723-726, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Effectiveness of a stress management pilot program aimed at reducing the incidence of sports injuries in young football (soccer) players.

PubMed

Olmedilla-Zafra, Aurelio; Rubio, Victor J; Ortega, Enrique; García-Mas, Alexandre

2017-03-01

Several attempts to reduce the incidence of sport injuries using psychosocial interventions produced fruitful, although inconclusive results. This paper presents the effectiveness and implementation issues of a pilot 3-month stress-management and muscle relaxation program aimed at reducing sport injury incidence. Pre-post treatment-non treatment group comparison. The program was administered by a trained psychologist on a once-a-week, 1-h session basis. Seventy-four male soccer players from four National Youth league teams voluntarily participated. Teams were randomly assigned to either treatment/non-treatment group. Injury protocol, Self-monitoring cards, Athletes' satisfaction and commitment survey, Coaches' interview. Group main effect and Time-Group interaction effect were both statistically significant, F(1,60) = 8.30, p = 0.005, η 2 p  = 0.121, with the average number of injuries larger in the post-treatment phase of non-treatment group (p = 0.005, η 2 p  = 0.077). There was a significant decrease in the average number of injuries for the intervention group before and after implementing the program (p < 0.001, η 2 p  = 0.309). A controlled implementation of a psychosocial program was effective in reducing youth soccer sport injuries, with a high level of satisfaction and commitment from the athletes, as well as high acceptance from the coaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

A new modeling and inference approach for the Systolic Blood Pressure Intervention Trial outcomes.

PubMed

Yang, Song; Ambrosius, Walter T; Fine, Lawrence J; Bress, Adam P; Cushman, William C; Raj, Dominic S; Rehman, Shakaib; Tamariz, Leonardo

2018-06-01

Background/aims In clinical trials with time-to-event outcomes, usually the significance tests and confidence intervals are based on a proportional hazards model. Thus, the temporal pattern of the treatment effect is not directly considered. This could be problematic if the proportional hazards assumption is violated, as such violation could impact both interim and final estimates of the treatment effect. Methods We describe the application of inference procedures developed recently in the literature for time-to-event outcomes when the treatment effect may or may not be time-dependent. The inference procedures are based on a new model which contains the proportional hazards model as a sub-model. The temporal pattern of the treatment effect can then be expressed and displayed. The average hazard ratio is used as the summary measure of the treatment effect. The test of the null hypothesis uses adaptive weights that often lead to improvement in power over the log-rank test. Results Without needing to assume proportional hazards, the new approach yields results consistent with previously published findings in the Systolic Blood Pressure Intervention Trial. It provides a visual display of the time course of the treatment effect. At four of the five scheduled interim looks, the new approach yields smaller p values than the log-rank test. The average hazard ratio and its confidence interval indicates a treatment effect nearly a year earlier than a restricted mean survival time-based approach. Conclusion When the hazards are proportional between the comparison groups, the new methods yield results very close to the traditional approaches. When the proportional hazards assumption is violated, the new methods continue to be applicable and can potentially be more sensitive to departure from the null hypothesis.

Development of an economic model to assess the cost-effectiveness of hawthorn extract as an adjunct treatment for heart failure in Australia

PubMed Central

Ford, Emily; Adams, Jon; Graves, Nicholas

2012-01-01

Objective An economic model was developed to evaluate the cost-effectiveness of hawthorn extract as an adjunctive treatment for heart failure in Australia. Methods A Markov model of chronic heart failure was developed to compare the costs and outcomes of standard treatment and standard treatment with hawthorn extract. Health states were defined by the New York Heart Association (NYHA) classification system and death. For any given cycle, patients could remain in the same NYHA class, experience an improvement or deterioration in NYHA class, be hospitalised or die. Model inputs were derived from the published medical literature, and the output was quality-adjusted life years (QALYs). Probabilistic sensitivity analysis was conducted. The expected value of perfect information (EVPI) and the expected value of partial perfect information (EVPPI) were conducted to establish the value of further research and the ideal target for such research. Results Hawthorn extract increased costs by $1866.78 and resulted in a gain of 0.02 QALYs. The incremental cost-effectiveness ratio was $85 160.33 per QALY. The cost-effectiveness acceptability curve indicated that at a threshold of $40 000 the new treatment had a 0.29 probability of being cost-effective. The average incremental net monetary benefit (NMB) was −$1791.64, the average NMB for the standard treatment was $92 067.49, and for hawthorn extract $90 275.84. Additional research is potentially cost-effective if research is not proposed to cost more than $325 million. Utilities form the most important target parameter group for further research. Conclusions Hawthorn extract is not currently considered to be cost-effective in as an adjunctive treatment for heart failure in Australia. Further research in the area of utilities is warranted. PMID:22942231

Development of an economic model to assess the cost-effectiveness of hawthorn extract as an adjunct treatment for heart failure in Australia.

PubMed

Ford, Emily; Adams, Jon; Graves, Nicholas

2012-01-01

An economic model was developed to evaluate the cost-effectiveness of hawthorn extract as an adjunctive treatment for heart failure in Australia. A Markov model of chronic heart failure was developed to compare the costs and outcomes of standard treatment and standard treatment with hawthorn extract. Health states were defined by the New York Heart Association (NYHA) classification system and death. For any given cycle, patients could remain in the same NYHA class, experience an improvement or deterioration in NYHA class, be hospitalised or die. Model inputs were derived from the published medical literature, and the output was quality-adjusted life years (QALYs). Probabilistic sensitivity analysis was conducted. The expected value of perfect information (EVPI) and the expected value of partial perfect information (EVPPI) were conducted to establish the value of further research and the ideal target for such research. Hawthorn extract increased costs by $1866.78 and resulted in a gain of 0.02 QALYs. The incremental cost-effectiveness ratio was $85 160.33 per QALY. The cost-effectiveness acceptability curve indicated that at a threshold of $40 000 the new treatment had a 0.29 probability of being cost-effective. The average incremental net monetary benefit (NMB) was -$1791.64, the average NMB for the standard treatment was $92 067.49, and for hawthorn extract $90 275.84. Additional research is potentially cost-effective if research is not proposed to cost more than $325 million. Utilities form the most important target parameter group for further research. Hawthorn extract is not currently considered to be cost-effective in as an adjunctive treatment for heart failure in Australia. Further research in the area of utilities is warranted.

Randomized trial of betahistine mesilate tablets as augmentation for oxcarbazepine and carbamazepine in treating vestibular paroxysmia.

PubMed

Xue, Hui; Xiang, Wenping; Yu, Yichuan; Liu, Guorong; Chong, Yi; Zhou, Jiying

2018-01-01

Vestibular paroxysmia (VP) is a rare episodic peripheral vestibular disorder. This study was conducted to compare the efficacy and acceptability of carbamazepine (CBZ) plus betahistine mesilate tablets (BMT) (CBZ+BMT) and oxcarbazepine (OXC) plus BMT (OXC+BMT) in treating VP, and investigated whether the synergistic effect could be increased along with the increased dose of BMT. VP patients were recruited and randomly assigned to receive CBZ+BMT or OXC+BMT. The doses of CBZ and OXC were set to 200 and 300 mg/time, twice daily, respectively. The doses of BMT were set to 12 and 18 mg/time, twice daily. Half of the patients in each group received BMT 12 mg/time and the other half received BMT 18 mg/time. The treatment was continued for 12 weeks. The vertigo frequency, vertigo score, vertigo duration, response rate, and drug-related side effects were analyzed. In total, 92 patients in the CBZ+BMT group and 93 patients in the OXC+BMT group completed this trial. After 12 weeks of treatment, the two groups had similar average vertigo frequency, average vertigo score, average vertigo duration, and response rate. But the incidence of side effects was significantly higher in the CBZ+BMT group than in the OXC+BMT group ( p =0.04). Subgroup analysis found that patients receiving BMT (18 mg) had greater reductions in average vertigo frequency, average vertigo duration, and average vertigo score, and higher response rates than patients receiving BMT (12 mg). These results demonstrated that OXC+BMT may be suitable as an alternative method in VP patients with CBZ hypersensitivity, and the synergistic effect could be increased along with the increased dose of BMT.

The effects of raking on sugar pine mortality following prescribed fire in Sequoia and Kings Canyon National Parks, California, USA

USGS Publications Warehouse

Nesmith, Jonathan C. B.; O'Hara, Kevin L.; van Mantgem, Phillip J.; de Valpine, Perry

2010-01-01

Prescribed fire is an important tool for fuel reduction, the control of competing vegetation, and forest restoration. The accumulated fuels associated with historical fire exclusion can cause undesirably high tree mortality rates following prescribed fires and wildfires. This is especially true for sugar pine (Pinus lambertiana Douglas), which is already negatively affected by the introduced pathogen white pine blister rust (Cronartium ribicola J.C. Fisch. ex Rabenh). We tested the efficacy of raking away fuels around the base of sugar pine to reduce mortality following prescribed fire in Sequoia and Kings Canyon national parks, California, USA. This study was conducted in three prescribed fires and included 457 trees, half of which had the fuels around their bases raked away to mineral soil to 0.5 m away from the stem. Fire effects were assessed and tree mortality was recorded for three years after prescribed fires. Overall, raking had no detectable effect on mortality: raked trees averaged 30% mortality compared to 36% for unraked trees. There was a significant effect, however, between the interaction of raking and average pre-treatment forest floor fuel depth: the predicted probability of survival of a 50 cm dbh tree was 0.94 vs. 0.96 when average pre-treatment fuel depth was 0 cm for a raked and unraked tree, respectively. When average pre-treatment forest floor fuel depth was 30 cm, the predicted probability of survival for a raked 50 cm dbh tree was 0.60 compared to only 0.07 for an unraked tree. Raking did not affect mortality when fire intensity, measured as percent crown volume scorched, was very low (0% scorch) or very high (>80% scorch), but the raking treatment significantly increased the proportion of trees that survived by 9.6% for trees that burned under moderate fire intensity (1% to 80% scorch). Raking significantly reduced the likelihood of bole charring and bark beetle activity three years post fire. Fuel depth and anticipated fire intensity need to be accounted for to maximize the effectiveness of the treatments. Raking is an important management option to reduce tree mortality from prescribed fire, but is most effective under specific fuel and burning conditions.

In vitro study of the effects of ultrasound-mediated glycerol on optical attenuation of human normal and cancerous esophageal tissues with optical coherence tomography

NASA Astrophysics Data System (ADS)

Zhang, Y. Q.; Wei, H. J.; Yang, H. Q.; Guo, Z. Y.; Xie, S. S.; Gu, H. M.; Guo, X.; Zhu, Z. G.

2013-06-01

Previous studies from our group have demonstrated that glucose solution can induce optical clearing enhancement of esophageal tissues with optical coherence tomography (OCT). The aims of this study were to evaluate the optical clearing effects of ultrasound-mediated optical clearing agents (OCAs) and to find more effective methods to distinguish human normal esophageal tissues (NE) and cancerous esophageal tissues (CE). Here we used the OCT technique to investigate the optical attenuation of NE and CE in vitro after treatment with 30% glycerol alone and glycerol combined with ultrasound, respectively. Experimental results showed that the averaged attenuation coefficient of CE was significantly larger than that of NE. The maximal decreases of averaged attenuation coefficients of NE and CE were approximately 48.7% and 36.2% after treatment with 30% glycerol alone, and they were significantly lower than those treated with 30% glycerol and ultrasound (57.5% in NE and 44.8% in CE). Moreover, after treatment with 30% glycerol alone, the averaged attenuation coefficients of NE and CE reached their minima in about 80 min and 65 min, respectively. The times were much shorter in NE and CE after treatment with glycerol with ultrasound, being about 62 min and 50 min, respectively. The results suggest that there is a significant difference in the optical properties of NE and CE, and that OCT with an ultrasound-OCAs combination has the ability to distinguish CE from NE.

Stroke thrombolysis: save a minute, save a day.

PubMed

Meretoja, Atte; Keshtkaran, Mahsa; Saver, Jeffrey L; Tatlisumak, Turgut; Parsons, Mark W; Kaste, Markku; Davis, Stephen M; Donnan, Geoffrey A; Churilov, Leonid

2014-04-01

Stroke thrombolysis is highly time-critical, but data on long-term effects of small reductions in treatment delays have not been available. Our objective was to quantify patient lifetime benefits gained from faster treatment. Observational prospective data of consecutive stroke patients treated with intravenous thrombolysis in Australian and Finnish centers (1998-2011; n=2258) provided distributions of age, sex, stroke severity, onset-to-treatment times, and 3-month modified Rankin Scale in daily clinical practice. Treatment effects derived from a pooled analysis of thrombolysis trials were used to model the shift in 3-month modified Rankin Scale distributions with reducing treatment delays, from which we derived the expected lifetime and level of long-term disability with faster treatment. Each minute of onset-to-treatment time saved granted on average 1.8 days of extra healthy life (95% prediction interval, 0.9-2.7). Benefit was observed in all groups: each minute provided 0.6 day in old severe (age, 80 years; National Institutes of Health Stroke Scale [NIHSS] score, 20) patients, 0.9 day in old mild (age, 80 years; NIHSS score, 4) patients, 2.7 days in young mild (age, 50 years; NIHSS score, 4) patients, and 3.5 days in young severe (age, 50 years; NIHSS score, 20) patients. Women gained slightly more than men over their longer lifetimes. In the whole cohort, each 15 minute decrease in treatment delay provided an average equivalent of 1 month of additional disability-free life. Realistically achievable small reductions in stroke thrombolysis delays would result in significant and robust average health benefits over patients' lifetimes. The awareness of concrete importance of speed could promote practice change.

Comparison of treatment effect sizes from pivotal and postapproval trials of novel therapeutics approved by the FDA based on surrogate markers of disease: a meta-epidemiological study.

PubMed

Wallach, Joshua D; Ciani, Oriana; Pease, Alison M; Gonsalves, Gregg S; Krumholz, Harlan M; Taylor, Rod S; Ross, Joseph S

2018-03-21

The U.S. Food and Drug Administration (FDA) often approves new drugs based on trials that use surrogate markers for endpoints, which involve certain trade-offs and may risk making erroneous inferences about the medical product's actual clinical effect. This study aims to compare the treatment effects among pivotal trials supporting FDA approval of novel therapeutics based on surrogate markers of disease with those observed among postapproval trials for the same indication. We searched Drugs@FDA and PubMed to identify published randomized superiority design pivotal trials for all novel drugs initially approved by the FDA between 2005 and 2012 based on surrogate markers as primary endpoints and published postapproval trials using the same surrogate markers or patient-relevant outcomes as endpoints. Summary ratio of odds ratios (RORs) and difference between standardized mean differences (dSMDs) were used to quantify the average difference in treatment effects between pivotal and matched postapproval trials. Between 2005 and 2012, the FDA approved 88 novel drugs for 90 indications based on one or multiple pivotal trials using surrogate markers of disease. Of these, 27 novel drugs for 27 indications were approved based on pivotal trials using surrogate markers as primary endpoints that could be matched to at least one postapproval trial, for a total of 43 matches. For nine (75.0%) of the 12 matches using the same non-continuous surrogate markers as trial endpoints, pivotal trials had larger treatment effects than postapproval trials. On average, treatment effects were 50% higher (more beneficial) in the pivotal than the postapproval trials (ROR 1.5; 95% confidence interval CI 1.01-2.23). For 17 (54.8%) of the 31 matches using the same continuous surrogate markers as trial endpoints, pivotal trials had larger treatment effects than the postapproval trials. On average, there was no difference in treatment effects between pivotal and postapproval trials (dSMDs 0.01; 95% CI -0.15-0.16). Many postapproval drug trials are not directly comparable to previously published pivotal trials, particularly with respect to endpoint selection. Although treatment effects from pivotal trials supporting FDA approval of novel therapeutics based on non-continuous surrogate markers of disease are often larger than those observed among postapproval trials using surrogate markers as trial endpoints, there is no evidence of difference between pivotal and postapproval trials using continuous surrogate markers.

Unexpected Decrease in Milk Production after Fenbendazole Treatment of Dairy Cows during Early Grazing Season

PubMed Central

Ravinet, Nadine; Chartier, Christophe; Bareille, Nathalie; Lehebel, Anne; Ponnau, Adeline; Brisseau, Nadine; Chauvin, Alain

2016-01-01

Gastrointestinal nematodes (GIN) infection can impair milk production (MP) in dairy cows. To investigate whether MP would be optimized by spring targeted-selective anthelmintic treatment in grazing cows, we assessed (1) the effect on MP of an anthelmintic treatment applied 1.5 to 2 months after turn-out, and (2) herd and individual indicators associated with the post-treatment MP response. A randomized controlled clinical trial was conducted in 13 dairy farms (578 cows) in western France in spring 2012. In each herd, lactating cows of the treatment group received fenbendazole orally, control cows remained untreated. Daily cow MP was recorded from 2 weeks before until 15 weeks after treatment. Individual serum pepsinogen and anti-Ostertagia antibody levels (expressed as ODR), faecal egg count and bulk tank milk (BTM) Ostertagia ODR were measured at treatment time. Anthelmintic treatment applied during the previous housing period was recorded for each cow. In each herd, information regarding heifers’ grazing and anthelmintic treatment history was collected to assess the Time of Effective Contact (TEC, in months) with GIN infective larvae before the first calving. The effect of treatment on weekly MP averages and its relationships with herd and individual indicators were studied using linear mixed models with two nested random effects (cow within herd). Unexpectedly, spring treatment had a significant detrimental effect on MP (-0.92 kg/cow/day on average). This negative MP response was particularly marked in high producing cows, in cows not treated during the previous housing period or with high pepsinogen levels, and in cows from herds with a high TEC or a high BTM ODR. This post-treatment decrease in MP may be associated with immuno-inflammatory mechanisms. Until further studies can assess whether this unexpected result can be generalized, non-persistent treatment of immunized adult dairy cows against GIN should not be recommended in early grazing season. PMID:26808824

Unexpected Decrease in Milk Production after Fenbendazole Treatment of Dairy Cows during Early Grazing Season.

PubMed

Ravinet, Nadine; Chartier, Christophe; Bareille, Nathalie; Lehebel, Anne; Ponnau, Adeline; Brisseau, Nadine; Chauvin, Alain

2016-01-01

Gastrointestinal nematodes (GIN) infection can impair milk production (MP) in dairy cows. To investigate whether MP would be optimized by spring targeted-selective anthelmintic treatment in grazing cows, we assessed (1) the effect on MP of an anthelmintic treatment applied 1.5 to 2 months after turn-out, and (2) herd and individual indicators associated with the post-treatment MP response. A randomized controlled clinical trial was conducted in 13 dairy farms (578 cows) in western France in spring 2012. In each herd, lactating cows of the treatment group received fenbendazole orally, control cows remained untreated. Daily cow MP was recorded from 2 weeks before until 15 weeks after treatment. Individual serum pepsinogen and anti-Ostertagia antibody levels (expressed as ODR), faecal egg count and bulk tank milk (BTM) Ostertagia ODR were measured at treatment time. Anthelmintic treatment applied during the previous housing period was recorded for each cow. In each herd, information regarding heifers' grazing and anthelmintic treatment history was collected to assess the Time of Effective Contact (TEC, in months) with GIN infective larvae before the first calving. The effect of treatment on weekly MP averages and its relationships with herd and individual indicators were studied using linear mixed models with two nested random effects (cow within herd). Unexpectedly, spring treatment had a significant detrimental effect on MP (-0.92 kg/cow/day on average). This negative MP response was particularly marked in high producing cows, in cows not treated during the previous housing period or with high pepsinogen levels, and in cows from herds with a high TEC or a high BTM ODR. This post-treatment decrease in MP may be associated with immuno-inflammatory mechanisms. Until further studies can assess whether this unexpected result can be generalized, non-persistent treatment of immunized adult dairy cows against GIN should not be recommended in early grazing season.

[The use of mood stabilizers in preventive treatment of patients with schizoaffective disorders].

PubMed

Chritinin, D F; Sumarokova, M A

2014-01-01

To study an effect of combination therapy consisting of mood stabilizers on the quality of remission in patients with schizoaffective disorders. Authors examined 56 outpatients with ICD-10 diagnosis of schizoaffective disorder (F25). Patients in remission received anti-relapse therapy with antipsychotics and were not treated with mood stabilizers for at least two years, and then they received a combined anti-relapse therapy, including both antipsychotics and mood stabilizers. The combined use of pharmacotherapy creates a better remission. No statistically significant differences in the effect of different groups of mood stabilizers on the average duration of remission are identified. The inclusion of mood stabilizers in the scheme of preventive treatment has no effect on the average duration of subsequent hospitalization. Mood stabilizers are effective in the prevention of suicidal behavior in patients with schizoaffective disorder, they reduce the risk of disability in patients with schizoaffective disorder and increase compliance.

Experimental Research and Mathematical Modeling of Parameters Effecting on Cutting Force and SurfaceRoughness in CNC Turning Process

NASA Astrophysics Data System (ADS)

Zeqiri, F.; Alkan, M.; Kaya, B.; Toros, S.

2018-01-01

In this paper, the effects of cutting parameters on cutting forces and surface roughness based on Taguchi experimental design method are determined. Taguchi L9 orthogonal array is used to investigate the effects of machining parameters. Optimal cutting conditions are determined using the signal/noise (S/N) ratio which is calculated by average surface roughness and cutting force. Using results of analysis, effects of parameters on both average surface roughness and cutting forces are calculated on Minitab 17 using ANOVA method. The material that was investigated is Inconel 625 steel for two cases with heat treatment and without heat treatment. The predicted and calculated values with measurement are very close to each other. Confirmation test of results showed that the Taguchi method was very successful in the optimization of machining parameters for maximum surface roughness and cutting forces in the CNC turning process.

Influence of Meniett® treatment on hearing.

PubMed

Barbara, Maurizio; Lazzarino, Antonio Ivan; Biagini, Michela; Costa, Michele; Monini, Simonetta

2010-11-01

Meniett® treatment was not shown to avoid deterioration of hearing threshold in patients with Meniere's disease (MD), even when achieving a fairly good therapeutic outcome on vertigo control. To describe the effect of Meniett® treatment on hearing threshold in patients with MD. From a cohort of 55 patients with diagnosis of definitive MD, who underwent Meniett® treatment over the last decade, 27 were selected for the present study as having at least 2 years from the end of treatment. They all received the treatment for 1 month and underwent hearing evaluation as pure tone average (PTA) from 500 to 4000 Hertz at the time of diagnosis, immediately before the treatment, immediately after the treatment, and at the end of the follow-up. Vertigo control was assessed by applying the 1995 AAO-HNS criteria as well as by administration of the Dizziness Handicap Inventory (DHI) questionnaire. Statistical analysis was carried out using paired t test, Wilcoxon signed-rank tests, and multiple linear regressions. PTA values increased on average by 7.1 dB (95% CI = 2.7-11.5; p = 0.003) during the time period from the beginning of the treatment to the end of the follow-up. Q scores decreased on average by 20.6 (95% CI = 8.8-32.4; p < 0.001) during the pre- and post-Meniett® time-span. These two outcomes appeared not to influence each other.

Comparison of drinking water treatment process streams for optimal bacteriological water quality.

PubMed

Ho, Lionel; Braun, Kalan; Fabris, Rolando; Hoefel, Daniel; Morran, Jim; Monis, Paul; Drikas, Mary

2012-08-01

Four pilot-scale treatment process streams (Stream 1 - Conventional treatment (coagulation/flocculation/dual media filtration); Stream 2 - Magnetic ion exchange (MIEX)/Conventional treatment; Stream 3 - MIEX/Conventional treatment/granular activated carbon (GAC) filtration; Stream 4 - Microfiltration/nanofiltration) were commissioned to compare their effectiveness in producing high quality potable water prior to disinfection. Despite receiving highly variable source water quality throughout the investigation, each stream consistently reduced colour and turbidity to below Australian Drinking Water Guideline levels, with the exception of Stream 1 which was difficult to manage due to the reactive nature of coagulation control. Of particular interest was the bacteriological quality of the treated waters where flow cytometry was shown to be the superior monitoring tool in comparison to the traditional heterotrophic plate count method. Based on removal of total and active bacteria, the treatment process streams were ranked in the order: Stream 4 (average log removal of 2.7) > Stream 2 (average log removal of 2.3) > Stream 3 (average log removal of 1.5) > Stream 1 (average log removal of 1.0). The lower removals in Stream 3 were attributed to bacteria detaching from the GAC filter. Bacterial community analysis revealed that the treatments affected the bacteria present, with the communities in streams incorporating conventional treatment clustering with each other, while the community composition of Stream 4 was very different to those of Streams 1, 2 and 3. MIEX treatment was shown to enhance removal of bacteria due to more efficient flocculation which was validated through the novel application of the photometric dispersion analyser. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effects of Extended Camera Baseline and Image Magnification on Target Detection Time and Target Recognition with a Stereoscopic TV System.

DTIC Science & Technology

1986-02-01

rates. Target detection times were calculated by averaging response times for all trials within a treatment condition, excluding trials in which...responses in a treatment condition by the total number of valid trials within that condition. Each of these dependent measures was subjected to its own...or 1905 mm). Comparisons among the various treatment means for this effect revealed 13 4~ ~ q-. ~ ~ .-..... 2.309 A EXPERIMENT ONE. 2.29- 0 0 z 2.19

Two-Year and Lifetime Cost-Effectiveness of Intensity Modulated Radiation Therapy Versus 3-Dimensional Conformal Radiation Therapy for Head-and-Neck Cancer

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

Kohler, Racquel E.; Sheets, Nathan C.; Wheeler, Stephanie B.

2013-11-15

Purpose: To assess the cost-effectiveness of intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3D-CRT) in the treatment of head-and neck-cancer (HNC). Methods and Materials: We used a Markov model to simulate radiation therapy-induced xerostomia and dysphagia in a hypothetical cohort of 65-year-old HNC patients. Model input parameters were derived from PARSPORT (CRUK/03/005) patient-level trial data and quality-of-life and Medicare cost data from published literature. We calculated average incremental cost-effectiveness ratios (ICERs) from the US health care perspective as cost per quality-adjusted life-year (QALY) gained and compared our ICERs with current cost-effectiveness standards whereby treatment comparators less thanmore » $50,000 per QALY gained are considered cost-effective. Results: In the first 2 years after initial treatment, IMRT is not cost-effective compared with 3D-CRT, given an average ICER of $101,100 per QALY gained. However, over 15 years (remaining lifetime on the basis of average life expectancy of a 65-year-old), IMRT is more cost-effective at $34,523 per QALY gained. Conclusion: Although HNC patients receiving IMRT will likely experience reduced xerostomia and dysphagia symptoms, the small quality-of-life benefit associated with IMRT is not cost-effective in the short term but may be cost-effective over a patient's lifetime, assuming benefits persist over time and patients are healthy and likely to live for a sustained period. Additional data quantifying the long-term benefits of IMRT, however, are needed.« less

Long-term infusions of ghrelin and obestatin in early lactation dairy cows.

PubMed

Roche, J R; Sheahan, A J; Chagas, L M; Blache, D; Berry, D P; Kay, J K

2008-12-01

Ghrelin is an endogenous ligand of the growth hormone secretagogue receptor and a potential orexigenic agent in monogastrics and ruminants. Obestatin has been reported to have the opposite (anorexigenic) effect. Fifty one multiparous cows were randomly allocated to 1 of 3 groups (n = 17): a control group and 2 groups with cows continuously infused with 0.74 mumol/d of ghrelin (GHR group) or obestatin (OBE group) subcutaneously. Infusions began 21 d in milk, and treatments continued for 8 wk. Generalized linear models were used to determine the treatment effect on average daily and cumulative milk production and composition, and plasma ghrelin, growth hormone, insulin-like growth factor (IGF)-1, leptin, nonesterified fatty acids, and glucose. Mixed models, with cow included as a repeated effect, were used to determine if treatment effects differed by week postcalving for milk production, body weight, and body condition score (BCS; scale 1 to 10). Parity, breed, week of the year at calving, treatment, week postcalving, and the 2 wk preexperimental average of each measure (covariate) were included as fixed effects. Treatment did not affect dry matter intake. Cows infused with GHR lost more BCS (-0.71 units) over the 8-wk study period than the control (-0.23 BCS units) cows, and on average were thinner than cows in either of the other 2 treatments (0.2 BCS units). Consistent with the extra BCS loss in GHR cows, plasma IGF-1, glucose, and leptin concentrations were reduced and plasma nonesterified fatty acid concentrations were greater in GHR cows. Despite a numerical tendency for GHR cows to produce more milk (1,779 kg) than control (1,681 kg) or OBE (1,714 kg) cows during the 8-wk period, milk production differences were not statistically different. However, the timing of the numerical separation of the lactation curves coincided with the significant changes in BCS, IGF-1, and leptin. Results indicate a positive effect of ghrelin infusion on lipolysis. Further research is required to determine if the numerical increase in milk production, which coincides with the increased negative energy balance, is real.

Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review.

PubMed

Mouhayar, Youssef; Yin, Ophelia; Mumford, Sunni L; Segars, James H

2017-06-01

The cost of fertility treatment is expensive and interventions that reduce cost can lead to greater efficiency and fewer embryos transferred. Endometrial polyps contribute to infertility and are frequently removed prior to infertility treatment. It is unclear whether polypectomy reduces fertility treatment cost and if so, the magnitude of cost reduction afforded by the procedure. The aim of this study was to determine whether performing office or operative hysteroscopic polypectomy prior to infertility treatment would be cost-effective. PubMed, Embase, and Cochrane libraries were used to identify publications reporting pregnancy rates after hysteroscopic polypectomy. Studies were required to have a polypectomy treatment group and control group of patients with polyps that were not resected. The charges of infertility treatments and polypectomy were obtained through infertility organizations and a private healthcare cost reporting website. These charges were applied to a decision tree model over the range of pregnancy rates observed in the representative studies to calculate an average cost per clinical or ongoing pregnancy. A sensitivity analysis was conducted to assess cost savings of polypectomy over a range of pregnancy rates and polypectomy costs. Pre-treatment office or operative hysteroscopic polypectomy ultimately saved €6658 ($7480) and €728 ($818), respectively, of the average cost per clinical pregnancy in women treated with four cycles of intrauterine insemination. Polypectomy prior to intrauterine insemination was cost-effective for clinical pregnancy rates greater than 30.2% for office polypectomy and 52.6% for operative polypectomy and for polypectomy price <€4414 ($4959). Office polypectomy or operative polypectomy saved €15,854 ($17,813) and €6644 ($7465), respectively, from the average cost per ongoing pregnancy for in vitro fertilization/intracytoplasmic sperm injection treated women and was cost-effective for ongoing pregnancy rates greater than 26.4% (office polypectomy) and 31.7% (operative polypectomy) and polypectomy price <€6376 ($7164). These findings suggested that office or operative hysteroscopic polypectomy was cost-effective when performed prior to both intrauterine insemination and in vitro fertilization over a range of plausible pregnancy rates and procedural costs. Copyright © 2017 Elsevier B.V. All rights reserved.

On Estimation of the Survivor Average Causal Effect in Observational Studies when Important Confounders are Missing Due to Death

PubMed Central

Egleston, Brian L.; Scharfstein, Daniel O.; MacKenzie, Ellen

2008-01-01

We focus on estimation of the causal effect of treatment on the functional status of individuals at a fixed point in time t* after they have experienced a catastrophic event, from observational data with the following features: (1) treatment is imposed shortly after the event and is non-randomized, (2) individuals who survive to t* are scheduled to be interviewed, (3) there is interview non-response, (4) individuals who die prior to t* are missing information on pre-event confounders, (5) medical records are abstracted on all individuals to obtain information on post-event, pre-treatment confounding factors. To address the issue of survivor bias, we seek to estimate the survivor average causal effect (SACE), the effect of treatment on functional status among the cohort of individuals who would survive to t* regardless of whether or not assigned to treatment. To estimate this effect from observational data, we need to impose untestable assumptions, which depend on the collection of all confounding factors. Since pre-event information is missing on those who die prior to t*, it is unlikely that these data are missing at random (MAR). We introduce a sensitivity analysis methodology to evaluate the robustness of SACE inferences to deviations from the MAR assumption. We apply our methodology to the evaluation of the effect of trauma center care on vitality outcomes using data from the National Study on Costs and Outcomes of Trauma Care. PMID:18759833

Empirically supported treatments for panic disorder with agoraphobia in a Spanish psychology clinic.

PubMed

Ballesteros, Francisco; Labrador, Francisco J

2014-10-27

The aim of this work is to study the sociodemographic and clinical characteristics of patients diagnosed with Panic Disorder with Agoraphobia (PD/Ag), as well as the characteristics of the treatment and its results and cost in a University Psychology Clinic. Fifty patients demanded psychological assistance for PD/Ag; 80% were women, with an average age of 29.22 years (SD = 9.03). Mean number of evaluation sessions was 3.26 (SD = 1.03), and of treatment sessions, 13.39 (SD = 9.237). Of the patients, 83.33% were discharged (that is, questionnaire scores were below the cut-off point indicated by the authors, and no PD/Ag was observed at readministration of the semistructured interview), 5.5% refused treatment, and 11% were dropouts. The average number of treatment sessions of patients who achieved therapeutic success was 15.13 (SD = 8.98). Effect sizes (d) greater than 1 were obtained in all the scales. Changes in all scales were significant (p < .05). The estimated cost of treatment for patients who achieved therapeutic success was 945.12€. The treatment results are at least similar to those of studies of efficacy and effectiveness for PD/Ag. The utility of generalizing treatments developed in research settings to a welfare clinic is discussed.

A Complier Average Causal Effect Analysis of the Stimulant Reduction Intervention using Dosed Exercise Study.

PubMed

Carmody, Thomas; Greer, Tracy L; Walker, Robrina; Rethorst, Chad D; Trivedi, Madhukar H

2018-06-01

Exercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causal effects (CACE) analysis was conducted to determine the potential effectiveness of adequately dosed exercise. The STimulant use Reduction Intervention using Dosed Exercise study was a randomized controlled trial comparing a 12 kcal/kg/week (KKW) exercise dose versus a health education control conducted at nine residential substance use treatment settings across the U.S. that are affiliated with the National Drug Abuse Treatment Clinical Trials Network. Participants were sedentary but medically approved for exercise, used stimulants within 30 days prior to study entry, and received a DSM-IV stimulant abuse or dependence diagnosis within the past year. A CACE analysis adjusted to include only participants with a minimum threshold of adherence (at least 8.3 KKW) and using a negative-binomial hurdle model focused on 218 participants who were 36.2% female, mean age 39.4 years ( SD =11.1), and averaged 13.0 ( SD =9.2) stimulant use days in the 30 days before residential treatment. The outcome was days of stimulant use as assessed by the self-reported TimeLine Follow Back and urine drug screen results. The CACE-adjusted analysis found a significantly lower probability of relapse to stimulant use in the exercise group versus the health education group (41.0% vs. 55.7%, p <.01) and significantly lower days of stimulant use among those who relapsed (5.0 days vs. 9.9 days, p <.01). The CACE adjustment revealed significant, positive effects for exercise. Further research is warranted to develop strategies for exercise adherence that can ensure achievement of an exercise dose sufficient to produce a significant treatment effect.

SU-E-T-622: Planning Technique for Passively-Scattered Involved-Node Proton Therapy of Mediastinal Lymphoma with Consideration of Cardiac Motion

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

Flampouri, S; Li, Z; Hoppe, B

2015-06-15

Purpose: To develop a treatment planning method for passively-scattered involved-node proton therapy of mediastinal lymphoma robust to breathing and cardiac motions. Methods: Beam-specific planning treatment volumes (bsPTV) are calculated for each proton field to incorporate pertinent uncertainties. Geometric margins are added laterally to each beam while margins for range uncertainty due to setup errors, breathing, and calibration curve uncertainties are added along each beam. The calculation of breathing motion and deformation effects on proton range includes all 4DCT phases. The anisotropic water equivalent margins are translated to distances on average 4DCT. Treatment plans are designed so each beam adequately coversmore » the corresponding bsPTV. For targets close to the heart, cardiac motion effects on dosemaps are estimated by using a library of anonymous ECG-gated cardiac CTs (cCT). The cCT, originally contrast-enhanced, are partially overridden to allow meaningful proton dose calculations. Targets similar to the treatment targets are drawn on one or more cCT sets matching the anatomy of the patient. Plans based on the average cCT are calculated on individual phases, then deformed to the average and accumulated. When clinically significant dose discrepancies occur between planned and accumulated doses, the patient plan is modified to reduce the cardiac motion effects. Results: We found that bsPTVs as planning targets create dose distributions similar to the conventional proton planning distributions, while they are a valuable tool for visualization of the uncertainties. For large targets with variability in motion and depth, integral dose was reduced because of the anisotropic margins. In most cases, heart motion has a clinically insignificant effect on target coverage. Conclusion: A treatment planning method was developed and used for proton therapy of mediastinal lymphoma. The technique incorporates bsPTVs compensating for all common sources of uncertainties and estimation of the effects of cardiac motion not commonly performed.« less

Herbicide Tests For Kudzu Eradication

Treesearch

James H. Miller; Ronald E. True

1986-01-01

Kudzu control treatments using 15 herbicides at 1 and 2 rates were tested at six locations in Georgia and Alabama. Treatments and retreatments occurred over a 2-year period. Tordon® 101 Mixture at 2 gal/acre was the most cost-effective treatment, averaging about $77 per acre for herbicide costs. Tordon® 10K Pellets (presently not being manufactured) gave slightly...

The effectiveness of crude papain enzyme supplement for tilapia’s (Oreochromis niloticus) growth at the floating nets of Cirata Reservoir

NASA Astrophysics Data System (ADS)

Rostika, R.; Sunarto; Sugiyanto, H. N.; Dewanti, L. P.

2018-03-01

Papain is an enzyme capable of hydrolyzing protease into a more simple elements i.e. the peptide to amino acids. The enzyme in the feed can increase the absorption of protein and digestion rate in the digestive tract of fish. This research examined the effective level of enzyme papain to increase the Feed Utilization Efficiency (FUE), Protein Efficiency Ratio (PER) and Average Daily Gain (ADG). This research used Completely Randomized Design (CRD) with five treatments i.e. treatment A (control), treatment B (1.5 %), treatment C (2.25 %), treatment D (3 %) and treatment E (3.75 %) in triplicate. Tilapia (Oreochromis niloticus) with the average initial weight of 17 g, and initial total lenght of 8–10 cm was fed three times daily at feeding rate of 5 % of the total body weight. The results showed that supplementation of papain in the feed significantly increased the activity of protease, FUE, PER and ADG. The optimal dose of the enzyme papain at 3.75 % was able to increase 48.31 % of FUE, 2.13 % of PER and 2.07 % of ADG.

The Implications of "Contamination" for Experimental Design in Education

ERIC Educational Resources Information Center

Rhoads, Christopher H.

2011-01-01

Experimental designs that randomly assign entire clusters of individuals (e.g., schools and classrooms) to treatments are frequently advocated as a way of guarding against contamination of the estimated average causal effect of treatment. However, in the absence of contamination, experimental designs that randomly assign intact clusters to…

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

An objective Bayesian analysis of a crossover design via model selection and model averaging.

PubMed

Li, Dandan; Sivaganesan, Siva

2016-11-10

Inference about the treatment effect in a crossover design has received much attention over time owing to the uncertainty in the existence of the carryover effect and its impact on the estimation of the treatment effect. Adding to this uncertainty is that the existence of the carryover effect and its size may depend on the presence of the treatment effect and its size. We consider estimation and testing hypothesis about the treatment effect in a two-period crossover design, assuming normally distributed response variable, and use an objective Bayesian approach to test the hypothesis about the treatment effect and to estimate its size when it exists while accounting for the uncertainty about the presence of the carryover effect as well as the treatment and period effects. We evaluate and compare the performance of the proposed approach with a standard frequentist approach using simulated data, and real data. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

PubMed

Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

2016-05-01

This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Hay fever & homeopathy: a case series evaluation.

PubMed

Pandey, Vinita

2016-05-01

Seasonal allergic rhinitis (hay fever) is common and can considerably reduce the quality of life of sufferers. Despite the wide everyday application and promising results with homeopathy, scientific evidence of its effectiveness for most ailments is scarce. The assessment of the clinical effectiveness of homeopathic remedies in the alleviation of hay fever symptoms in a typical clinical setting. We performed a clinical observational study of eight patients in the treatment of hay fever symptoms over a two-year period (2012 and 2013) using Measure Yourself Medical Outcome Profile (MYMOP) self-evaluation questionnaires at baseline and again after two weeks and four weeks of homeopathic treatment. The individualized prescription - either a single remedy or multiple remedies - was based on the totality of each patient's symptoms. The average MYMOP scores for the eyes, nose, activity and wellbeing had improved significantly after two and four weeks of homeopathic treatment. The overall average MYMOP profile score at baseline was 3.83 (standard deviation, SD, 0.78). After 14 and 28 days of treatment the average score had fallen to 1.14 (SD, 0.36; P<0.001) and 1.06 (SD, 0.25; P<0.001) respectively. Individualized homeopathic treatment was associated with significant alleviation of hay fever symptoms, enabling the reduction in use of conventional treatment. The results presented in this study can be considered as a step towards a pilot pragmatic study that would use more robust outcome measures and include a larger number of patients prescribed a single or a multiple homeopathic prescription on an individualized basis. Copyright © 2016 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Average effect estimates remain similar as evidence evolves from single trials to high-quality bodies of evidence: a meta-epidemiologic study.

PubMed

Gartlehner, Gerald; Dobrescu, Andreea; Evans, Tammeka Swinson; Thaler, Kylie; Nussbaumer, Barbara; Sommer, Isolde; Lohr, Kathleen N

2016-01-01

The objective of our study was to use a diverse sample of medical interventions to assess empirically whether first trials rendered substantially different treatment effect estimates than reliable, high-quality bodies of evidence. We used a meta-epidemiologic study design using 100 randomly selected bodies of evidence from Cochrane reports that had been graded as high quality of evidence. To determine the concordance of effect estimates between first and subsequent trials, we applied both quantitative and qualitative approaches. For quantitative assessment, we used Lin's concordance correlation and calculated z-scores; to determine the magnitude of differences of treatment effects, we calculated standardized mean differences (SMDs) and ratios of relative risks. We determined qualitative concordance based on a two-tiered approach incorporating changes in statistical significance and magnitude of effect. First trials both overestimated and underestimated the true treatment effects in no discernible pattern. Nevertheless, depending on the definition of concordance, effect estimates of first trials were concordant with pooled subsequent studies in at least 33% but up to 50% of comparisons. The pooled magnitude of change as bodies of evidence advanced from single trials to high-quality bodies of evidence was 0.16 SMD [95% confidence interval (CI): 0.12, 0.21]. In 80% of comparisons, the difference in effect estimates was smaller than 0.5 SMDs. In first trials with large treatment effects (>0.5 SMD), however, estimates of effect substantially changed as new evidence accrued (mean change 0.68 SMD; 95% CI: 0.50, 0.86). Results of first trials often change, but the magnitude of change, on average, is small. Exceptions are first trials that present large treatment effects, which often dissipate as new evidence accrues. Copyright © 2016 Elsevier Inc. All rights reserved.

Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups

PubMed Central

Lancee, Jaap; Beun, Robbert Jan; Neerincx, Mark A; Brinkman, Willem-Paul

2015-01-01

Background Several technologies have been proposed to support the reduction of insomnia complaints. A user-centered assessment of these technologies could provide insight into underlying factors related to treatment adherence. Objective Gaining insight into adherence to technology-mediated insomnia treatment as a solid base for improving those adherence rates by applying adherence-enhancing strategies. Methods Adherence to technology-mediated sleep products was studied in three ways. First, a meta-analysis was performed to investigate adherence rates in technology-mediated insomnia therapy. Several databases were queried for technology-mediated insomnia treatments. After inclusion and exclusion steps, data from 18 studies were retrieved and aggregated to find an average adherence rate. Next, 15 semistructured interviews about sleep-support technologies were conducted to investigate perceived adherence. Lastly, several scenarios were written about the usage of a virtual sleep coach that could support adherence rates. The scenarios were discussed in six different focus groups consisting of potential users (n=15), sleep experts (n=7), and coaches (n=9). Results From the meta-analysis, average treatment adherence appeared to be approximately 52% (95% CI 43%-61%) for technology-mediated insomnia treatments. This means that, on average, half of the treatment exercises were not executed, suggesting there is a substantial need for adherence and room for improvement in this area. However, the users in the interviews believed they adhered quite well to their sleep products. Users mentioned relying on personal commitment (ie, willpower) for therapy adherence. Participants of the focus groups reconfirmed their belief in the effectiveness of personal commitment, which they regarded as more effective than adherence-enhancing strategies. Conclusions Although adherence rates for insomnia interventions indicate extensive room for improvement, users might not consider adherence to be a problem; they believe willpower to be an effective adherence strategy. A virtual coach should be able to cope with this “adherence bias” and persuade users to accept adherence-enhancing strategies, such as reminders, compliments, and community building. PMID:26341671

Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups.

PubMed

Horsch, Corine; Lancee, Jaap; Beun, Robbert Jan; Neerincx, Mark A; Brinkman, Willem-Paul

2015-09-04

Several technologies have been proposed to support the reduction of insomnia complaints. A user-centered assessment of these technologies could provide insight into underlying factors related to treatment adherence. Gaining insight into adherence to technology-mediated insomnia treatment as a solid base for improving those adherence rates by applying adherence-enhancing strategies. Adherence to technology-mediated sleep products was studied in three ways. First, a meta-analysis was performed to investigate adherence rates in technology-mediated insomnia therapy. Several databases were queried for technology-mediated insomnia treatments. After inclusion and exclusion steps, data from 18 studies were retrieved and aggregated to find an average adherence rate. Next, 15 semistructured interviews about sleep-support technologies were conducted to investigate perceived adherence. Lastly, several scenarios were written about the usage of a virtual sleep coach that could support adherence rates. The scenarios were discussed in six different focus groups consisting of potential users (n=15), sleep experts (n=7), and coaches (n=9). From the meta-analysis, average treatment adherence appeared to be approximately 52% (95% CI 43%-61%) for technology-mediated insomnia treatments. This means that, on average, half of the treatment exercises were not executed, suggesting there is a substantial need for adherence and room for improvement in this area. However, the users in the interviews believed they adhered quite well to their sleep products. Users mentioned relying on personal commitment (ie, willpower) for therapy adherence. Participants of the focus groups reconfirmed their belief in the effectiveness of personal commitment, which they regarded as more effective than adherence-enhancing strategies. Although adherence rates for insomnia interventions indicate extensive room for improvement, users might not consider adherence to be a problem; they believe willpower to be an effective adherence strategy. A virtual coach should be able to cope with this "adherence bias" and persuade users to accept adherence-enhancing strategies, such as reminders, compliments, and community building.

Effects of Saccharomyces cerevisiae Supplementation and Anhydrous Ammonia Treatment of Wheat Straw on In-situ Degradability and, Rumen Fermentation and Growth Performance of Yearling Lambs

PubMed Central

Cömert, Muazzez; Şayan, Yılmaz; Özelçam, Hülya; Baykal, Gülşah Yeğenoğlu

2015-01-01

The effects of Saccharomyces cerevisiae supplementation (6.6×108 cfu) and anhydrous ammonia treatment (3%) of wheat straw (WS) were investigated on in-situ dry matter (DM) degradability, and on rumen fermentation and growth performance of lambs. Rumen-fistulated Menemen sheep fed a diet with and without live yeast were used to assess the DM degradability characteristics of WS and ammonia-treated wheat straw (WSNH3). Twenty-six yearling Menemen male lambs were fed in four groups. Lambs of control group (WS) received untreated WS without supplemental yeast, whereas other three groups were fed WS treated with anhydrous ammonia (WSNH3 group), untreated WS and yeast (WS+YEAST group) or WS treated with anhydrous ammonia and yeast (WSNH3+YEAST group). Supplemented live yeast (4 g/d) was added in the diet. Lambs were offered untreated or ammonia treated WS ad-libitum and concentrate was fed at 1% of live body weight. The degradability of the water-insoluble (fraction B) was significantly increased by all of the treatment groups. Potential degradability (A+B), effective DM degradability’s (pe2, pe5, and pe8) and average daily weight gain increased only in WSNH3+YEAST group (p<0.05). Voluntary DM intake was not increased by the treatments (p>0.05), but voluntary metabolizable energy and crude protein intake were increased by WSNH3 and by WSNH3+YEAST (p<0.05). Average daily rumen pH was not affected by any of the treatments, but average daily NH3-N was significantly higher in the WSNH3 and WSNH3+YEAST groups, and total volatile fatty acids were significantly higher in the WS+YEAST and WSNH3+YEAST groups. In conclusion, the improvement of feed value of WS was better by the combination of ammonia-treatment and yeast supplementation compared to either treatment alone. PMID:25656177

HETEROGENEITY IN TREATMENT EFFECT AND COMPARATIVE EFFECTIVENESS RESEARCH.

PubMed

Luo, Zhehui

2011-10-01

The ultimate goal of comparative effectiveness research (CER) is to develop and disseminate evidence-based information about which interventions are most effective for which patients under what circumstances. To achieve this goal it is crucial that researchers in methodology development find appropriate methods for detecting the presence and sources of heterogeneity in treatment effect (HTE). Comparing with the typically reported average treatment effect (ATE) in randomized controlled trials and non-experimental (i.e., observational) studies, identifying and reporting HTE better reflect the nature and purposes of CER. Methodologies of CER include meta-analysis, systematic review, design of experiments that encompasses HTE, and statistical correction of various types of estimation bias, which is the focus of this review.

Childhood obesity: the epidemic of the third millenium.

PubMed

Archenti, Anna; Pasqualinotto, Lucia

2008-08-01

Italy is the European country with the most obese and overweight children and teenagers. Most of them have a family history of obesity and this condition may increase the risk of many diseases. This study involved 52 patients (32 females and 20 males) between 6 and 17 years of age with an average BMI of31.5. The patients underwent a three-month treatment which included an overview of individual caloric intake and creation of a suitable diet, an exercise program and counselling sessions with a psychologist in order to support the patients and families. Anthropometric changes were evaluated at the end of the three months and during follow-up to assess the effectiveness of the treatment. Before starting the treatment the average weight of the patients was 81.8 kg, after the treatment it decreased to 79.4 kg. Likewise, the average BMI of the patients was 31.3 before the treatment and 30.4 after the treatment. Both of these results are statistically significant. This study confirms the importance of teamwork in the treatment of childhood obesity and the importance of approaching the problem with the entire family. A real problem exists for patients who are strongly dependent on the habits, determination and flexibility of their family. In conclusion, the success of this treatment is strongly related to the psychological attitude of the family.

[Local effects of transdermal treatment with rotigotine].

PubMed

Bermejo, Pedro Emilio; Zea, María Ascensión; Alba-Alcántara, Lucía; Ruiz-Huete, Cristina

2013-04-01

Rotigotine is the first transdermal non-ergolinic dopaminergic agonist used in the treatment of Parkinson's disease. It has several important advantages such as once-daily administration, absence of interactions with food, steady levels in plasma and continuous dopaminergic stimulation. Although its systemic side effects are similar to those seen in other dopaminergic agonists, rotigotine also has local side effects derived from the site of application. The aim of this paper is to review those local problems. A retrospective analysis was carried out in order to identify the first 165 patients treated with rotigotine. Patients with intracranial lesions, psychiatric pathology or dementia were excluded. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. In all, 94 males and 71 females were identified, with an average age of 65.2 and an average rotigotine daily dose of 11.3 mg. Local side effects were present in 21 patients and they were usually mild. Two patients abandoned the treatment because of these local adverse events, presenting erythema and prurigo. Thirty patients complained about lack of adherence of the patch, specially when it was hot, and 36 about the formation of wrinkles in the patch. None of these problems was associated to motor fluctuations or other complications. Local complications of transdermal rotigotine are mild but frequent. We consider it is necessarily to take them into account to get a better treatment of patients suffering from Parkinson's disease.

Analysis of alcohol-based hand sanitizer delivery systems: efficacy of foam, gel, and wipes against influenza A (H1N1) virus on hands.

PubMed

Larson, Elaine L; Cohen, Bevin; Baxter, Kathleen A

2012-11-01

Minimal research has been published evaluating the effectiveness of hand hygiene delivery systems (ie, rubs, foams, or wipes) at removing viruses from hands. The purposes of this study were to determine the effect of several alcohol-based hand sanitizers in removing influenza A (H1N1) virus, and to compare the effectiveness of foam, gel, and hand wipe products. Hands of 30 volunteers were inoculated with H1N1 and randomized to treatment with foam, gel, or hand wipe applied to half of each volunteer's finger pads. The log(10) count of each subject's treated and untreated finger pads were averaged. Log(10) reductions were calculated from these differences and averaged within treatment group. Between-treatment analysis compared changes from the untreated finger pads using analysis of covariance with treatment as a factor and the average log(10) untreated finger pads as the covariate. Log(10) counts on control finger pads were 2.7-5.3 log(10) of the 50% infectious dose for tissue culture (TCID(50)/0.1 mL) (mean, 3.8 ± 0.5 log(10) TCID(50)/0.1 mL), and treated finger pad counts for all test products were 0.5-1.9 log(10) TCID(50)/0.1 mL (mean, 0.53 ± 0.17 log(10) TCID(50)/0.1 mL). Treatments with all products resulted in a significant reduction in viral titers (>3 logs) at their respective exposure times that were statistically comparable. All 3 delivery systems (foam, gel, and wipe) produced significantly reduced viral counts on hands. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

A pharmacokinetic/viral kinetic model to evaluate the treatment effectiveness of danoprevir against chronic HCV

PubMed Central

Canini, Laetitia; Chatterjee, Anushree; Guedj, Jeremie; Lemenuel-Diot, Annabelle; Brennan, Barbara; Smith, Patrick F; Perelson, Alan S

2014-01-01

Background Viral kinetic models have proven useful to characterize treatment effectiveness during HCV therapy with interferon (IFN) or with direct acting antivirals (DAAs). Methods We use a pharmacokinetic/viral kinetic (PK/VK) model to describe HCV RNA kinetics during treatment with danoprevir, a protease inhibitor. In a phase 1 study, danoprevir monotherapy was administered for 14 days in ascending doses ranging from 200 to 600 mg per day to 40 patients of whom 32 were treatment-naïve and 8 were non-responders to prior PEG-IFN-α/ribavirin treatment. Results In most patients, a biphasic decline of HCV RNA during therapy was observed. A two-compartment PK model and a VK model that considered treatment effectiveness to vary with the predicted danoprevir concentration inside the second compartment provided a good fit to the viral load data. A time-varying effectiveness model was also used to fit the viral load data. The antiviral effectiveness increased in a dose-dependent manner, with a 14-day time-averaged effectiveness of 0.95 at the lowest dose (100 mg bid) and 0.99 at the highest dose (200 mg tid). Prior IFN non-responders exhibited a 14-day time-averaged effectiveness of 0.98 (300 mg bid). The second phase decline showed two different behaviors, with 30% of patients exhibiting a rapid decline of HCV RNA, comparable to that seen with other protease inhibitors (>0.3 d−1), whereas the viral decline was slower in the other patients. Conclusions Our results are consistent with the modest SVR rates from the INFORM-SVR study where patients were treated with a combination of mericitabine and ritonavir-boosted danoprevir. PMID:25321394

A pharmacokinetic/viral kinetic model to evaluate the treatment effectiveness of danoprevir against chronic HCV

DOE PAGES

Canini, Laetitia; Chatterjee, Anushree; Guedj, Jeremie; ...

2014-10-16

Background—Viral kinetic models have proven useful to characterize treatment effectiveness during HCV therapy with interferon (IFN) or with direct acting antivirals (DAAs). Methods—We use a pharmacokinetic/viral kinetic (PK/VK) model to describe HCV RNA kinetics during treatment with danoprevir, a protease inhibitor. In a phase 1 study, danoprevir monotherapy was administered for 14 days in ascending doses ranging from 200 to 600 mg per day to 40 patients of whom 32 were treatment-naïve and 8 were non-responders to prior PEG-IFN-α/ribavirin treatment. Results—In most patients, a biphasic decline of HCV RNA during therapy was observed. A two-compartment PK model and a VKmore » model that considered treatment effectiveness to vary with the predicted danoprevir concentration inside the second compartment provided a good fit to the viral load data. A time-varying effectiveness model was also used to fit the viral load data. We found the antiviral effectiveness increased in a dose-dependent manner, with a 14-day time-averaged effectiveness of 0.95 at the lowest dose (100 mg bid) and 0.99 at the highest dose (200 mg tid). Prior IFN non-responders exhibited a 14-day time-averaged effectiveness of 0.98 (300 mg bid). Finally, the second phase decline showed two different behaviors, with 30% of patients exhibiting a rapid decline of HCV RNA, comparable to that seen with other protease inhibitors (>0.3 d-1), whereas the viral decline was slower in the other patients. Conclusions—Our results are consistent with the modest SVR rates from the INFORM-SVR study where patients were treated with a combination of mericitabine and ritonavir-boosted danoprevir.« less

Cost-effectiveness of stereotactic radiosurgery with and without whole-brain radiotherapy for the treatment of newly diagnosed brain metastases.

PubMed

Hall, Matthew D; McGee, James L; McGee, Mackenzie C; Hall, Kevin A; Neils, David M; Klopfenstein, Jeffrey D; Elwood, Patrick W

2014-12-01

Stereotactic radiosurgery (SRS) alone is increasingly used in patients with newly diagnosed brain metastases. Stereotactic radiosurgery used together with whole-brain radiotherapy (WBRT) reduces intracranial failure rates, but this combination also causes greater neurocognitive toxicity and does not improve survival. Critics of SRS alone contend that deferring WBRT results in an increased need for salvage therapy and in higher costs. The authors compared the cost-effectiveness of treatment with SRS alone, SRS and WBRT (SRS+WBRT), and surgery followed by SRS (S+SRS) at the authors' institution. The authors retrospectively reviewed the medical records of 289 patients in whom brain metastases were newly diagnosed and who were treated between May 2001 and December 2007. Overall survival curves were plotted using the Kaplan-Meier method. Multivariate proportional hazards analysis (MVA) was used to identify factors associated with overall survival. Survival data were complete for 96.2% of patients, and comprehensive data on the resource use for imaging, hospitalizations, and salvage therapies were available from the medical records. Treatment costs included the cost of initial and all salvage therapies for brain metastases, hospitalizations, management of complications, and imaging. They were computed on the basis of the 2007 Medicare fee schedule from a payer perspective. Average treatment cost and average cost per month of median survival were compared. Sensitivity analysis was performed to examine the impact of variations in key cost variables. No significant differences in overall survival were observed among patients treated with SRS alone, SRS+WBRT, or S+SRS with respective median survival of 9.8, 7.4, and 10.6 months. The MVA detected a significant association of overall survival with female sex, Karnofsky Performance Scale (KPS) score, primary tumor control, absence of extracranial metastases, and number of brain metastases. Salvage therapy was required in 43% of SRS-alone and 26% of SRS+WBRT patients (p < 0.009). Despite an increased need for salvage therapy, the average cost per month of median survival was $2412 per month for SRS alone, $3220 per month for SRS+WBRT, and $4360 per month for S+SRS (p < 0.03). Compared with SRS+WBRT, SRS alone had an average incremental cost savings of $110 per patient. Sensitivity analysis confirmed that the average treatment cost of SRS alone remained less than or was comparable to SRS+WBRT over a wide range of costs and treatment efficacies. Despite an increased need for salvage therapy, patients with newly diagnosed brain metastases treated with SRS alone have similar overall survival and receive more cost-effective care than those treated with SRS+WBRT. Compared with SRS+WBRT, initial management with SRS alone does not result in a higher average cost.

Effects of self-hypnosis training and cognitive restructuring on daily pain intensity and catastrophizing in individuals with multiple sclerosis and chronic pain.

PubMed

Jensen, Mark P; Ehde, Dawn M; Gertz, Kevin J; Stoelb, Brenda L; Dillworth, Tiara M; Hirsh, Adam T; Molton, Ivan R; Kraft, George H

2011-01-01

Fifteen adults with multiple sclerosis were given 16 sessions of treatment for chronic pain that included 4 sessions each of 4 different treatment modules: (a) an education control intervention; (b) self-hypnosis training (HYP); (c) cognitive restructuring (CR); and (d) a combined hypnosis-cognitive restructuring intervention (CR-HYP). The findings supported the greater beneficial effects of HYP, relative to CR, on average pain intensity. The CR-HYP treatment appeared to have beneficial effects greater than the effects of CR and HYP alone. Future research examining the efficacy of an intervention that combines CR and HYP is warranted.

Understanding the impact of career academy attendance: an application of the principal stratification framework for causal effects accounting for partial compliance.

PubMed

Page, Lindsay C

2012-04-01

Results from MDRC's longitudinal, random-assignment evaluation of career-academy high schools reveal that several years after high-school completion, those randomized to receive the academy opportunity realized a $175 (11%) increase in monthly earnings, on average. In this paper, I investigate the impact of duration of actual academy enrollment, as nearly half of treatment group students either never enrolled or participated for only a portion of high school. I capitalize on data from this experimental evaluation and utilize a principal stratification framework and Bayesian inference to investigate the causal impact of academy participation. This analysis focuses on a sample of 1,306 students across seven sites in the MDRC evaluation. Participation is measured by number of years of academy enrollment, and the outcome of interest is average monthly earnings in the period of four to eight years after high school graduation. I estimate an average causal effect of treatment assignment on subsequent monthly earnings of approximately $588 among males who remained enrolled in an academy throughout high school and more modest impacts among those who participated only partially. Different from an instrumental variables approach to treatment non-compliance, which allows for the estimation of linear returns to treatment take-up, the more general framework of principal stratification allows for the consideration of non-linear returns, although at the expense of additional model-based assumptions.

Covariate selection with group lasso and doubly robust estimation of causal effects

PubMed Central

Koch, Brandon; Vock, David M.; Wolfson, Julian

2017-01-01

Summary The efficiency of doubly robust estimators of the average causal effect (ACE) of a treatment can be improved by including in the treatment and outcome models only those covariates which are related to both treatment and outcome (i.e., confounders) or related only to the outcome. However, it is often challenging to identify such covariates among the large number that may be measured in a given study. In this paper, we propose GLiDeR (Group Lasso and Doubly Robust Estimation), a novel variable selection technique for identifying confounders and predictors of outcome using an adaptive group lasso approach that simultaneously performs coefficient selection, regularization, and estimation across the treatment and outcome models. The selected variables and corresponding coefficient estimates are used in a standard doubly robust ACE estimator. We provide asymptotic results showing that, for a broad class of data generating mechanisms, GLiDeR yields a consistent estimator of the ACE when either the outcome or treatment model is correctly specified. A comprehensive simulation study shows that GLiDeR is more efficient than doubly robust methods using standard variable selection techniques and has substantial computational advantages over a recently proposed doubly robust Bayesian model averaging method. We illustrate our method by estimating the causal treatment effect of bilateral versus single-lung transplant on forced expiratory volume in one year after transplant using an observational registry. PMID:28636276

Covariate selection with group lasso and doubly robust estimation of causal effects.

PubMed

Koch, Brandon; Vock, David M; Wolfson, Julian

2018-03-01

The efficiency of doubly robust estimators of the average causal effect (ACE) of a treatment can be improved by including in the treatment and outcome models only those covariates which are related to both treatment and outcome (i.e., confounders) or related only to the outcome. However, it is often challenging to identify such covariates among the large number that may be measured in a given study. In this article, we propose GLiDeR (Group Lasso and Doubly Robust Estimation), a novel variable selection technique for identifying confounders and predictors of outcome using an adaptive group lasso approach that simultaneously performs coefficient selection, regularization, and estimation across the treatment and outcome models. The selected variables and corresponding coefficient estimates are used in a standard doubly robust ACE estimator. We provide asymptotic results showing that, for a broad class of data generating mechanisms, GLiDeR yields a consistent estimator of the ACE when either the outcome or treatment model is correctly specified. A comprehensive simulation study shows that GLiDeR is more efficient than doubly robust methods using standard variable selection techniques and has substantial computational advantages over a recently proposed doubly robust Bayesian model averaging method. We illustrate our method by estimating the causal treatment effect of bilateral versus single-lung transplant on forced expiratory volume in one year after transplant using an observational registry. © 2017, The International Biometric Society.

Delayed treatment of decompression sickness with short, no-air-break tables: review of 140 cases.

PubMed

Cianci, Paul; Slade, John B

2006-10-01

Most cases of decompression sickness (DCS) in the U.S. are treated with hyperbaric oxygen using U.S. Navy Treatment Tables 5 and 6, although detailed analysis shows that those tables were based on limited data. We reviewed the development of these protocols and offer an alternative treatment table more suitable for monoplace chambers that has proven effective in the treatment of DCS in patients presenting to our facility. We reviewed the outcomes for 140 cases of DCS in civilian divers treated with the shorter tables at our facility from January 1983 through December 2002. Onset of symptoms averaged 9.3 h after surfacing. At presentation, 44% of the patients demonstrated mental aberration. The average delay from onset of symptoms to treatment was 93.5 h; median delay was 48 h. Complete recovery in the total group of 140 patients was 87%. When 30 patients with low probability of DCS were excluded, the recovery rate was 98%. All patients with cerebral symptoms recovered. Patients with the highest severity scores showed a high rate of complete recovery (97.5%). Short oxygen treatment tables as originally described by Hart are effective in the treatment of DCS, even with long delays to definitive recompression that often occur among civilian divers presenting to a major Divers Alert Network referral center.

Investigation of continuous effect modifiers in a meta-analysis on higher versus lower PEEP in patients requiring mechanical ventilation--protocol of the ICEM study.

PubMed

Kasenda, Benjamin; Sauerbrei, Willi; Royston, Patrick; Briel, Matthias

2014-05-20

Categorizing an inherently continuous predictor in prognostic analyses raises several critical methodological issues: dependence of the statistical significance on the number and position of the chosen cut-point(s), loss of statistical power, and faulty interpretation of the results if a non-linear association is incorrectly assumed to be linear. This also applies to a therapeutic context where investigators of randomized clinical trials (RCTs) are interested in interactions between treatment assignment and one or more continuous predictors. Our goal is to apply the multivariable fractional polynomial interaction (MFPI) approach to investigate interactions between continuous patient baseline variables and the allocated treatment in an individual patient data meta-analysis of three RCTs (N = 2,299) from the intensive care field. For each study, MFPI will provide a continuous treatment effect function. Functions from each of the three studies will be averaged by a novel meta-analysis approach for functions. We will plot treatment effect functions separately for each study and also the averaged function. The averaged function with a related confidence interval will provide a suitable basis to assess whether a continuous patient characteristic modifies the treatment comparison and may be relevant for clinical decision-making. The compared interventions will be a higher or lower positive end-expiratory pressure (PEEP) ventilation strategy in patients requiring mechanical ventilation. The continuous baseline variables body mass index, PaO2/FiO2, respiratory compliance, and oxygenation index will be the investigated potential effect modifiers. Clinical outcomes for this analysis will be in-hospital mortality, time to death, time to unassisted breathing, and pneumothorax. This project will be the first meta-analysis to combine continuous treatment effect functions derived by the MFPI procedure separately in each of several RCTs. Such an approach requires individual patient data (IPD). They are available from an earlier IPD meta-analysis using different methods for analysis. This new analysis strategy allows assessing whether treatment effects interact with continuous baseline patient characteristics and avoids categorization-based subgroup analyses. These interaction analyses of the present study will be exploratory in nature. However, they may help to foster future research using the MFPI approach to improve interaction analyses of continuous predictors in RCTs and IPD meta-analyses. This study is registered in PROSPERO (CRD42012003129).

Growth performance, hematology, and meat quality characteristics of Mutton Merino lambs fed canola-based diets.

PubMed

Sekali, M; Marume, U; Mlambo, V; Strydom, P E

2016-08-01

A 56-day feeding trial was carried out to evaluate the effect of feeding canola meal (CM) on growth performance, hematology, and meat quality parameters of lambs. Twenty lambs with an average body weight of 23 ± 2.64 kg were randomly assigned to five dietary treatments and fed in individual cages for 56 days. The soya bean meal (SBM) in the control ration was replaced with canola meal at 0 (CM0), 25 (CM25), 50 (CM50), 75 (CM75), and 100 % (CM100) inclusion levels. Average daily weight gain (ADWG) and average daily feed intake (ADFI) were significantly higher in the CM25 and CM50, respectively. Feed conversion ratio (FCR) (3.09-3.41) and slaughter weight (SLW) (33.2-34.7 kg) were, however, similar among the treatment groups. Diet had no effect on carcass length (78.7-83.7 cm) and ultimate meat pH (pHu) (5.70-5.81). Nevertheless, hot carcass weight (HCW) (16.5-18.7 kg) and cold carcass weight (CCW) (16.2-18.2 kg) were higher (P < 0.05) in the CM0 and CM50 treatment groups. The shear force measurements (1.67-2.17 kg) differed (P < 0.05) across treatments. There was no dietary effect on the lightness (L*) (33.5-35.8), redness (a*) (11.35-12.7), and yellowness (b*) (13.4-14.8) of meat. In conclusion, CM can completely replace SBM in lamb diets without any negative effects on growth performance, general health, and meat quality of Mutton Merino lambs.

Microwave influence on the isolated heart function. 2: Combined effect of radiation and some drugs

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

Pakhomov, A.G.; Dubovick, B.V.; Degtyariov, I.G.

1995-09-01

The combined effects of microwave radiation and some drugs were studied in an isolated frog auricle preparation. The experiments established that exposure to pulse-modulated 915 Mhz microwaves for up to 40 min had no effect on either the rate or the amplitude of spontaneous auricle twitches, unless the average absorbed power was high enough to produce preparation heating. Treatment of the preparation with saline containing (0.6--3.0) 10{sup {minus}5} M of propranolol or (0.5--1.5) 10{sup {minus}7} M of atropine altered neither its pacemaker nor its contractile functions; these drugs also had no effect when they were combined with nonthermal microwave irradiation.more » Caffeine (1 mM) strongly increased the average heart power, which was calculated as the product of twitch rate ad amplitude. The caffeine effect appeared to be significantly augmented (by about 15%, P<0.02) under exposure to burst-type pulsed microwaves (pulse width, 1.5 msec; pause, 2.5 msec; 8 pulses/burst, 16 bursts/s; average SAR, 8--10 W/kg). By itself, this modulation was not effective; the heating of the preparation and saline during exposure was approximately 0.1 C, which could not account for the detected changes. The experimental results demonstrate that caffeine treatment increases the microwave sensitivity of the frog auricle preparation and reveals primarily subthreshold, nonthermal microwave effect.« less

Low Intensity Behavioral Treatment Supplementing Preschool Services for Young Children with Autism Spectrum Disorders and Severe to Mild Intellectual disability

ERIC Educational Resources Information Center

Peters-Scheffer, Nienke; Didden, Robert; Mulders, Monique; Korzilius, Hubert

2010-01-01

This study evaluated the effectiveness of low intensity behavioral treatment (on average 6.5h per week) supplementing preschool services in 3-6-year-old children with autism spectrum disorder and severe to mild intellectual disability. Treatment was implemented in preschools (i.e., daycare centers) and a discrete trial teaching approach was used.…

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

Protective effects of green tea on olanzapine-induced-metabolic syndrome in rats.

PubMed

Razavi, Bibi Marjan; Lookian, Fariba; Hosseinzadeh, Hossein

2017-08-01

Atypical antipsychotics particularly olanzapine are associated with obesity and serious metabolic disturbances. As green tea (Camellia sinensis) is generally associated with beneficial effects on obesity and other metabolic disturbances, this study was undertaken to evaluate the effect of green tea aqueous extract (GTAE) on olanzapine induced weight gain and metabolic abnormalities in rats. Male Wistar rats were divided into eight groups: control, olanzapine (5mg/kg/day, IP.), GTAE (25, 50 and 100mg/kg/day, IP.) plus olanzapine and GTAE (25, 50 and 100mg/kg/day, IP.). Treatments were continued for 11 days. Body weight gain, average food and water intake were measured during the experiment. Plasma lipid, glucose and leptin levels, mean systolic blood pressure and total locomotion were evaluated at the end of experiment. Olanzapine induced significant weight gain at the end of treatment (10.38% of body weight) when compared to control (3.13% of body weight) in male Wistar rats. Average food and water intake were increased by olanzapine treatment. 11days olanzapine administration led to hyperleptinemia, hyperglycemia and dyslipidemia. Olanzapine also increased mean systolic blood pressure and decreased total locomotion. GTAE decreased significantly body weight gain and average food and water intake, improved the changes in lipid profile as well as fasting blood glucose, and finally decreased hyperleptinemia and hypertension induced by olanzapine. Results of this study demonstrated that GTAE could exert protective effects against olanzapine induced obesity partially due to its lowering effect on leptin. GTAE improved other metabolic abnormalities including dyslipidemia, hyperglycemia and hypertension induced by olanzapine in rats. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Women with breast cancer report substantially more disease- and treatment-related side or late effects than registered by clinical oncologists: a cross-sectional study of a standard follow-up program in an oncological department.

PubMed

Ellegaard, Mai-Britt Bjørklund; Grau, Cai; Zachariae, Robert; Jensen, Anders Bonde

2017-08-01

Follow-up after breast cancer treatment is standard due to the risk of development of new primary cancers and recurrent disease. The aim of the present study was to evaluate a standard follow-up program in an oncological department by assessing: (1) Symptoms or signs of new primary cancer or recurrent disease, (2) Disease- and treatment-related physical and psychosocial side or late effects, and (3) relevant actions by oncology staff. In a cross-sectional study, 194 women who came for follow-up visit after treatment for primary surgery were included. The clinical oncologists registered symptoms and signs of recurrent disease or new primary cancer. Side or late effects were both assessed by patient and the clinical oncologists. Loco-regional or distant signs of recurrent disease were suspected in eight (5%) patients. Further examinations revealed no disease recurrence. Most patients (93%) reported some degree of side or late effects. Statistically significant more side or late effects were reported by the women (average: 6.9) than registered by the clinical oncologists (average: 2.4), p < 0.001. The three most often patient-reported side or late effects were hot flushes (35%), fatigue (32%), and sleep disturbance (31%). None of the scheduled or additional visits resulted in detection of recurrent disease. Furthermore, the majority of patients reported side or late effects. Statistically significant more women reported side or late effects than registered by the clinical oncologists. This suggests the need for rethinking of the follow-up programs with more emphasis upon side or late effects of the treatment.

Music therapy for people with schizophrenia and schizophrenia-like disorders.

PubMed

Mössler, Karin; Chen, Xijing; Heldal, Tor Olav; Gold, Christian

2011-12-07

Music therapy is a therapeutic method that uses musical interaction as a means of communication and expression. The aim of the therapy is to help people with serious mental disorders to develop relationships and to address issues they may not be able to using words alone. To review the effects of music therapy, or music therapy added to standard care, compared with 'placebo' therapy, standard care or no treatment for people with serious mental disorders such as schizophrenia. We searched the Cochrane Schizophrenia Group Trials Register (December 2010) and supplemented this by contacting relevant study authors, handsearching of music therapy journals and manual searches of reference lists. All randomised controlled trials (RCTs) that compared music therapy with standard care, placebo therapy, or no treatment. Studies were reliably selected, quality assessed and data extracted. We excluded data where more than 30% of participants in any group were lost to follow-up. We synthesised non-skewed continuous endpoint data from valid scales using a standardised mean difference (SMD). If statistical heterogeneity was found, we examined treatment 'dosage' and treatment approach as possible sources of heterogeneity. We included eight studies (total 483 participants). These examined effects of music therapy over the short- to medium-term (one to four months), with treatment 'dosage' varying from seven to 78 sessions. Music therapy added to standard care was superior to standard care for global state (medium-term, 1 RCT, n = 72, RR 0.10 95% CI 0.03 to 0.31, NNT 2 95% CI 1.2 to 2.2). Continuous data identified good effects on negative symptoms (4 RCTs, n = 240, SMD average endpoint Scale for the Assessment of Negative Symptoms (SANS) -0.74 95% CI -1.00 to -0.47); general mental state (1 RCT, n = 69, SMD average endpoint Positive and Negative Symptoms Scale (PANSS) -0.36 95% CI -0.85 to 0.12; 2 RCTs, n=100, SMD average endpoint Brief Psychiatric Rating Scale (BPRS) -0.73 95% CI -1.16 to -0.31); depression (2 RCTs, n = 90, SMD average endpoint Self-Rating Depression Scale (SDS) -0.63 95% CI -1.06 to -0.21; 1 RCT, n = 30, SMD average endpoint Hamilton Depression Scale (Ham-D) -0.52 95% CI -1.25 to -0.21 ); and anxiety (1 RCT, n = 60, SMD average endpoint SAS -0.61 95% CI -1.13 to -0.09). Positive effects were also found for social functioning (1 RCT, n = 70, SMD average endpoint Social Disability Schedule for Inpatients (SDSI) score -0.78 95% CI -1.27 to -0.28). Furthermore, some aspects of cognitive functioning and behaviour seem to develop positively through music therapy. Effects, however, were inconsistent across studies and depended on the number of music therapy sessions as well as the quality of the music therapy provided. Music therapy as an addition to standard care helps people with schizophrenia to improve their global state, mental state (including negative symptoms) and social functioning if a sufficient number of music therapy sessions are provided by qualified music therapists. Further research should especially address the long-term effects of music therapy, dose-response relationships, as well as the relevance of outcomes measures in relation to music therapy.

The balanced survivor average causal effect.

PubMed

Greene, Tom; Joffe, Marshall; Hu, Bo; Li, Liang; Boucher, Ken

2013-05-07

Statistical analysis of longitudinal outcomes is often complicated by the absence of observable values in patients who die prior to their scheduled measurement. In such cases, the longitudinal data are said to be "truncated by death" to emphasize that the longitudinal measurements are not simply missing, but are undefined after death. Recently, the truncation by death problem has been investigated using the framework of principal stratification to define the target estimand as the survivor average causal effect (SACE), which in the context of a two-group randomized clinical trial is the mean difference in the longitudinal outcome between the treatment and control groups for the principal stratum of always-survivors. The SACE is not identified without untestable assumptions. These assumptions have often been formulated in terms of a monotonicity constraint requiring that the treatment does not reduce survival in any patient, in conjunction with assumed values for mean differences in the longitudinal outcome between certain principal strata. In this paper, we introduce an alternative estimand, the balanced-SACE, which is defined as the average causal effect on the longitudinal outcome in a particular subset of the always-survivors that is balanced with respect to the potential survival times under the treatment and control. We propose a simple estimator of the balanced-SACE that compares the longitudinal outcomes between equivalent fractions of the longest surviving patients between the treatment and control groups and does not require a monotonicity assumption. We provide expressions for the large sample bias of the estimator, along with sensitivity analyses and strategies to minimize this bias. We consider statistical inference under a bootstrap resampling procedure.

Technical Note: Treatment of Sacroiliac Joint Pain with Peripheral Nerve Stimulation.

PubMed

Guentchev, Marin; Preuss, Christian; Rink, Rainer; Peter, Levente; Wocker, Ernst-Ludwig; Tuettenberg, Jochen

2015-07-01

Sacroiliac joint (SIJ) pain affects older adults with a prevalence of up to 20% among patients with chronic low back pain. While pain medication, joint blocks and denervation procedures achieve pain relief in most patients, some cases fail to improve. Our goal was to determine the effectiveness of SIJ peripheral nerve stimulation in patients with severe conservative therapy-refractory SIJ pain. Here we present 12 patients with severe conservative therapy-refractory pain receiving an SIJ peripheral nerve stimulation. Patient satisfaction, pain, and quality of life were evaluated by means of the International Patient Satisfaction Index (IPSI), visual analog scale (VAS), and Oswestry Disability Index 2.0 (ODI) using standard questionnaires. For stimulation we placed an eight-pole peripheral nerve electrode parallel to the SIJ. Two weeks postoperatively, our patients reported an average ODI reduction from 57% to 32% and VAS from 9 to 2.1. IPSI was 1.1. After six months, the therapy was rated as effective in seven out of eight patients reporting at that period. The average ODI was low at 34% (p = 0.0006), while the VAS index rose to 3.8 (p < 0.0001) and IPSI to 1.9. Twelve months after stimulation, six out of seven patients considered their treatment a success with an average ODI of 21% (p < 0.0005), VAS 1.7 (p < 0.0001), and IPSI 1.3. We conclude that SIJ stimulation is a promising therapeutic strategy in the treatment of intractable SIJ pain. Further studies are required to determine the precise target group and long-term effect of this novel treatment method. © 2014 International Neuromodulation Society.

Administration of an Herbal Complex, Jakyak-Gamcho-Tang (JGT), for Plantar Fasciitis in Military Medical Service: A Case Report.

PubMed

Kwon, Seungwon; Jung, Woo-Sang; Moon, Sang-Kwan; Cho, Ki-Ho; Shin, Kyoung-Ho

Plantar fasciitis is a common disease affecting the heel and plantar side of the foot. This condition can be improved within 6 months with conservative treatments such as stretching, nonsteroidal anti-inflammatory drugs (NSAIDs), extracorporeal shockwave therapy, and corticosteroid injection. However, soldiers need a faster and safer therapy for symptomatic relief to meet the requirements of their occupation. In this report, we reveal that Jakyak-Gamcho-Tang (JGT), an herbal complex, had a positive effect in a case series of 10 military patients with plantar fasciitis. We treated 10 patients with chronic and acute plantar fasciitis with the JGT herbal complex for 21.00 ± 5.72 days. During JGT administration, the patients continued to perform calf-strengthening exercises. After JGT administration, the average foot function index (FFI) score was reduced from 41.11 ± 7.86 to 1.65 ± 3.60 and the average facial rating scale (FRS) was reduced from 5.65 ± 0.88 to 0.40 ± 0.70. A statistically significant difference was observed between the average FFI and FRS measured before and after treatment (paired t test, P < .001). At the conclusion of JGT treatment, all 10 patients (100%) had reduced symptoms of plantar fasciitis. In 7 out of the 10 patients (70%), no pain was experienced after the treatment. In this case series, we show the clinical effects of JGT on pain control in patients with plantar fasciitis. Further clinical studies investigating the effects of JGT are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Retrospective review of efficacy of radiofrequency ablation for treatment of colorectal cancer liver metastases from a Canadian perspective.

PubMed

Kwan, Benjamin Y M; Kielar, Ania Z; El-Maraghi, Robert H; Garcia, Lourdes M

2014-02-01

A retrospective single-center review of ultrasound-guided radiofrequency ablation (RFA) treatment of colorectal cancer liver metastases was performed. This study reviews the primary and secondary technical effectiveness, overall survival of patients, recurrence-free survival, tumour-free survival, rates of local recurrence, and postprocedural RFA complications. Technical effectiveness and rates of complication with respect to tumour location and size were evaluated. Our results were compared with similar studies from Europe and North America. A total of 63 patients (109 tumours) treated with RFA between February 2004 and December 2009 were reviewed. Average and median follow-up time was 19.4 and 16.5 months, respectively (range, 1-54 months). Data from patient charts, pathology, and Picture Archiving and Communication System was integrated into an Excel database. Statistical Analysis Software was used for statistical analysis. Primary and secondary technical effectiveness of percutaneous and intraoperative RFA were 90.8% and 92.7%, respectively. Average (SE) tumour-free survival was 14.4 ± 1.4 months (range, 1-43 months), and average (SE) recurrence-free survival was 33.5 ± 2.3 months (range, 2-50 months). Local recurrence was seen in 31.2% of treated tumours (range, 2-50 months) (34/109). Overall survival was 89.4% at 1 year, 70.0% at 2 years, and 38.1% at 3 years, with an average (SE) overall survival of 37.0 ± 2.8 months. There were 14 postprocedural complications. There was no statistically significant difference in technical effectiveness for small tumours (1-2 cm) vs intermediate ones (3-5 cm). There was no difference in technical effectiveness for peripheral vs parenchymal tumours. This study demonstrated good-quality outcomes for RFA treatment of colorectal cancer liver metastases from a Canadian perspective and compared favorably with published studies. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Profiles of Juvenile Male Incest Perpetrators: Preliminary Treatment Implications.

ERIC Educational Resources Information Center

Nanjundappa, G.; And Others

1987-01-01

Evaluated the effects on participants' self-image of sexual offenses they had committed. Subjects (N=6) were male adolescents convicted of child molestation in a residential treatment and care facility. Results suggested subjects (who were themselves victims of family violence) perceived an above average self-image and handled their problems by…

78 FR 11858 - Applications for New Awards; Arts in Education Model Development and Dissemination Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-20

... the treatment for project participants and, where feasible, for a comparison group of non... in the project (control group). The effect of the project is the average difference in outcomes between the treatment and control groups. Integrating means (i) encouraging the use of high-quality arts...

A tale of two pectins: Diverse fine structures can result from identical processive PME treatments on similar high DM subtrates

USDA-ARS?s Scientific Manuscript database

The effects of a processive pectin-methylesterase treatment on two different pectins, both possessing a high degree of methylesterification, were investigated. While the starting samples were purportedly very similar in fine structure, and even though the sample-averaged degree of methylesterificati...

LONG-RANGE RESULTS OF THE RADIOACTIVE PHOSPHORUS THERAPY OF POLYCYTHEMIA VERA

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

Fazekas, S.; Nagy, G.; Petranyi, G.

1963-02-01

The results of P/sup 32/ treatment of 22 patients with polycythemia vera are presented. Some patients received a single dose of P/sup 32/, others repeated doses. In general the therapeutic effect was satisfactory. The average length of remission after the first treatment was 10.8 months. (P.C.H.)

Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

PubMed

Swift, Joshua K; Greenberg, Roger P; Tompkins, Kelley A; Parkin, Susannah R

2017-03-01

The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow.

PubMed

Rougraff, Bruce T; Kling, Thomas J

2002-06-01

The treatment of unicameral bone cysts varies from open bone-grafting procedures to percutaneous injection of corticosteroids or bone marrow. The purpose of this study was to evaluate the feasibility and effectiveness of percutaneous injection of a mixture of demineralized bone matrix and autogenous bone marrow for the treatment of simple bone cysts. Twenty-three patients with an active unicameral bone cyst were treated with trephination and injection of allogeneic demineralized bone matrix and autogenous bone marrow. The patients were followed for an average of fifty months (range, thirty to eighty-one months), at which time pain, function, and radiographic signs of resolution of the cyst were assessed. The average time until the patients had pain relief was five weeks, and the average time until the patients returned to full, unrestricted activities was six weeks. Bone-healing at the site of the injection was first seen radiographically at three to six months. No patient had a pathologic fracture during this early bone-healing stage. Cortical remodeling was seen radiographically by six to nine months, and after one year the response was usually complete, changing very little from then on. Five patients required a second injection because of recurrence of the cyst, and all five had a clinically and radiographically quiescent cyst after an average of thirty-six additional months of follow-up. Seven of the twenty-three patients had incomplete healing manifested by small, persistent radiolucent areas within the original cyst. None of these cysts increased in size or resulted in pain or fracture. Percutaneous injection of allogeneic demineralized bone matrix and autogenous bone marrow is an effective treatment for unicameral bone cysts.

SU-E-T-318: The Effect of Patient Positioning Errors On Target Coverage and Cochlear Dose in Stereotactic Radiosurgery Treatment of Acoustic Neuromas

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

Dellamonica, D.; Luo, G.; Ding, G.

Purpose: Setup errors on the order of millimeters may cause under-dosing of targets and significant changes in dose to critical structures especially when planning with tight margins in stereotactic radiosurgery. This study evaluates the effects of these types of patient positioning uncertainties on planning target volume (PTV) coverage and cochlear dose for stereotactic treatments of acoustic neuromas. Methods: Twelve acoustic neuroma patient treatment plans were retrospectively evaluated in Brainlab iPlan RT Dose 4.1.3. All treatment beams were shaped by HDMLC from a Varian TX machine. Seven patients had planning margins of 2mm, five had 1–1.5mm. Six treatment plans were createdmore » for each patient simulating a 1mm setup error in six possible directions: anterior-posterior, lateral, and superiorinferior. The arcs and HDMLC shapes were kept the same for each plan. Change in PTV coverage and mean dose to the cochlea was evaluated for each plan. Results: The average change in PTV coverage for the 72 simulated plans was −1.7% (range: −5 to +1.1%). The largest average change in coverage was observed for shifts in the patient's superior direction (−2.9%). The change in mean cochlear dose was highly dependent upon the direction of the shift. Shifts in the anterior and superior direction resulted in an average increase in dose of 13.5 and 3.8%, respectively, while shifts in the posterior and inferior direction resulted in an average decrease in dose of 17.9 and 10.2%. The average change in dose to the cochlea was 13.9% (range: 1.4 to 48.6%). No difference was observed based on the size of the planning margin. Conclusion: This study indicates that if the positioning uncertainty is kept within 1mm the setup errors may not result in significant under-dosing of the acoustic neuroma target volumes. However, the change in mean cochlear dose is highly dependent upon the direction of the shift.« less

Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter.

PubMed

Kimura, Utako; Takeuchi, Kaori; Kinoshita, Ayako; Takamori, Kenji; Hiruma, Masataro; Suga, Yasushi

2012-04-01

Onychomycosis is a relatively common fungal infection. Current treatments have limited applicability and low cure rates. Recently introduced laser therapy has shown to be a safe and effective treatment for onychomycosis. In this study, we evaluate a submillisecond Nd:YAG 1,064 nm laser for treating onychomycoses of the tonail. Thirteen subjects (9 female, 4 male) with 37 affected toenails received 1 to 3 treatments 4 and/or 8 weeks apart with a sub-millisecond 1,064 nm Nd:YAG laser. Diagnosis of onychomycosis was confirmed with microscopy. Average follow-up time was 16 weeks post-final treatment. Photos were taken and degree of turbidity was determined using a turbidity scale (ranging from "0 = clear nail" to "10 = completely turbid nail") at each visit. Improvement in turbidity was determined by comparison of turbidity scores at baseline and 16-week follow-up on average. Efficacy was assessed by an overall improvement scale (0 to 4), which combined improvement in turbidity scores and microscopic examination. Overall improvement was classified as "4 = complete clearance" if the turbidity score indicated "0 = clear nail" accompanied by a negative microscopic result. No microscopic examination was performed unless the turbidity score showed "0 = clear nail." Treatments were well tolerated by all subjects and there were no adverse events. Of the 37 toenails treated, 30 (81%) had "moderate" to "complete" clearance average of 16 weeks post-final treatment. Nineteen toenails (51%) were completely clear and all tested negative for fungal infection on direct microscopic analysis. Seven (19%) toenails had significant clearance and four (11%) had moderate clearance. The preliminary results of this study show this treatment modality is safe and effective for the treatment of onychomycosis in the short term. Additional studies are needed to more fully assess the clinical and mycological benefits as well as optimize the treatment protocol and parameters.

Effects of duckweed (Spriodela polyrrhiza) remediation on the composition of dissolved organic matter in effluent of scale pig farms.

PubMed

Li, Lei; Liu, Ming; Wu, Meng; Jiang, Chunyu; Chen, Xiaofen; Ma, Xiaoyan; Liu, Jia; Li, Weitao; Tang, Xiaoxue; Li, Zhongpei

2017-05-01

The swine effluent studied was collected from scale pig farms, located in Yujiang County of Jiangxi Province, China, and duckweed (Spriodela polyrrhiza) was selected to dispose the effluent. The purpose of this study was to elucidate the effects of duckweed growth on the dissolved organic matter composition in swine effluent. Throughout the experiment period, the concentrations of organic matter were determined regularly, and the excitation-emission matrix (3DEEM) spectroscopy was used to characterize the fluorescence component. Compared with no-duckweed treatments (controls), the specific ultra-violet absorbance at 254nm (SUVA 254 ) was increased by a final average of 34.4% as the phytoremediation using duckweed, and the removal rate of DOC was increased by a final average of 28.0%. In swine effluent, four fluorescence components were identified, including two protein-like (tryptophan, tyrosine) and two humic-like (fulvic acids, humic acids) components. For all treatments, the concentrations of protein-like components decreased by a final average of 69.0%. As the growth of duckweed, the concentrations of humic-like components were increased by a final average of 123.5% than controls. Significant and positive correlations were observed between SUVA 254 and humic-like components. Compared with the controls, the humification index (HIX) increased by a final average of 9.0% for duckweed treatments. Meanwhile, the duckweed growth leaded to a lower biological index (BIX) and a higher proportion of microbial-derived fulvic acids than controls. In conclusion, the duckweed remediation not only enhanced the removal rate of organic matter in swine effluent, but also increased the percent of humic substances. Copyright © 2016. Published by Elsevier B.V.

[Responses of soil microbial carbon metabolism to the leaf litter composition in Liaohe River Nature Reserve of northern Hebei Province, China].

PubMed

Li, Tian-yu; Kang, Feng-feng; Han, Hai-rong; Gao, Jing; Song, Xiao-shuai; Yu, Shu; Zhao, Jin-long; Yu, Xiao-wen

2015-03-01

Using litter bag method, we studied the effects of single and mixed litters from Betula platyphlla, Populus davidiana and Quercus mongolica on soil microbial biomass carbon (MBC), microbial respiration (MR) and microbial metabolic quotient (qCO2) in 0-5, 5-10 and 10-20 cm soil layers. The results showed that the average contents of MBC in 0-20 cm soil layer were 124.84, 325.29, 349.79 and 319.02 mg . kg-1 in the leaf litter removal treatment, Betula platyphlla treatment, Populus davidiana treatment and Quercus mongolica treatment, and the corresponding average rates of MR were 0.66, 1.12, 1.16 and 1.10 µg . g-1 . h-1, respectively. Meanwhile, in 0-20 cm soil layer, the average contents of MBC in the treatments with single leaf litter, mixed litter of two plant species and mixed litter of three plant species were 331. 37, 418. 52 and 529. 34 mg . kg-1, and the corresponding average rates of MR were 1.13, 1.30 and 1.46 µg . g-1 . h-1, respectively. In contrast to the MBC and MR, qCO2 in soil showed a reverse pattern. Our study suggested that characteristics of microbial carbolic metabolism were influenced by litter quality. Namely, the treatment with high litter quality had higher MBC, MR and utilization efficiency of soil carbon, compared with the treatment with low litter quality. Moreover, mixture of different species of leaf litter improved soil microbial activities, increased utilization efficiency on soil carbon and promoted diversity of microbial metabolic pathways, which could then contribute to maintaining and enhancing soil quality of forestland.

A Comparison of Inpatient Cost Per Day in General Surgery Patients with Type 2 Diabetes Treated with Basal-Bolus versus Sliding Scale Insulin Regimens.

PubMed

Phillips, Victoria L; Byrd, Anwar L; Adeel, Saira; Peng, Limin; Smiley, Dawn D; Umpierrez, Guillermo E

2017-01-01

The identification of cost-effective glycaemic management strategies is critical to hospitals. Treatment with a basal-bolus insulin (BBI) regimen has been shown to result in better glycaemic control and fewer complications than sliding scale regular insulin (SSI) in general surgery patients with type 2 diabetes mellitus (T2DM), but the effect on costs is unknown. We conducted a post hoc analysis of the RABBIT Surgery trial to examine whether total inpatient costs per day for general surgery patients with T2DM treated with BBI ( n  = 103) differed from those for patients with T2DM treated with SSI ( n  = 99) regimens. Data were collected from patient clinical and hospital billing records. Charges were adjusted to reflect hospital costs. General linearized models were used to estimate the risk-adjusted effects of BBI versus SSI treatment on average total inpatient costs per day. Risk-adjusted average total inpatient costs per day were $US5404. Treatment with BBI compared with SSI reduced average total inpatient costs per day by $US751 (14%; 95% confidence interval [CI] 20-4). Being treated in a university medical centre, being African American or having a bowel procedure or higher-volume pharmacy use significantly reduced costs per day. In general surgery patients with T2DM, a BBI regimen significantly reduced average total hospital costs per day compared with an SSI regimen. BBI has been shown to improve outcomes in a randomized controlled trial. Those results, combined with our findings regarding savings, suggest that hospitals should consider adopting BBI regimens in patients with T2DM undergoing surgery.

The Effect of Allopurinol on Renal Function.

PubMed

Krishnamurthy, Aneesa; Lazaro, Deana; Stefanov, Dimitre G; Blumenthal, David; Gerber, Donald; Patel, Sheetal

2017-01-01

Hyperuricemia is associated with development of gout, hypertension, and renal disease. The impact of allopurinol, a urate-lowering therapy, on renal function is unclear, especially in patients with chronic kidney disease who are at higher risk of hypersensitivity reaction. The aim of this study was to determine the effect of allopurinol on kidney function in hyperuricemic male veterans. This is a retrospective cohort study using pharmacy, medical, and laboratory records of veterans enrolled at the Veterans Administration New York Harbor Healthcare System, Brooklyn campus. Fifty patients with hyperuricemia defined as a serum uric acid greater than 7 mg/dL (average of ~9 mg/dL), newly started on allopurinol for any reason, with evidence of treatment compliance, were matched by age, race, sex, and estimated glomerular filtration rate (EGFR) to 50 hyperuricemic control subjects. The retrospective cases were observed from October 2000 until November 2006, at which time there was a change in the laboratory analyzer, making further comparisons inappropriate. On average, patients treated with a mean 221 (SD, 96) mg/d dose of allopurinol achieved 11.9 mL/min higher GFR (95% confidence interval, 4.8-11.9 mg/d dose; P = 0.01) than did the control group. Treatment effect was found to depend on the initial EGFR, as indicated by the significant treatment by initial EGFR interaction (P = 0.004) and increased with a higher initial EGFR. The allopurinol-treated group had a 0.10 mg/dL lower final creatinine level (95% confidence interval, 0.003-0.20 mg/dL; P = 0.04) than did the control subjects, adjusted for initial creatinine and age. The average length of follow-up was 3.4 years. There were 5 mild adverse events in the treated cases. Treatment of hyperuricemic patients with allopurinol over an average of 3.4 years resulted in a significant improvement of kidney function in this male cohort from the Veterans Administration Healthcare System. Clinicians should consider this potential benefit of allopurinol in the treatment of patients with hyperuricemia, those with overall maintained renal function.

Effectiveness of Acupressure Treatment for Pain Management and Fatigue Relief in Gulf War Veterans

DTIC Science & Technology

2017-12-01

AWARD NUMBER: W81XWH-12-1-0567 TITLE: Effectiveness of Acupressure Treatment for Pain Management and Fatigue Relief in Gulf War Veterans...Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time...of information . Send comments regarding this burden estimate or any other aspect of this collection of information , including suggestions for

Literature-Related Discovery: Potential Treatments and Preventives for SARS

DTIC Science & Technology

2010-01-01

evaluated the immunomodulatory effects of probiotic Bacillus cereus var. toyoi on the systemic immunity of piglets……Blood samples of probiotic ...and IFN-gamma production of polyclonally stimulated PBMCs was on average higher in the probiotic group. Specific proliferative responses of PBMCs...average higher in the probiotic group. In conclusion, B. cereus var. toyoi therefore alters the immune status of piglets as indicated by changes in

Effects of brush management on the hydrologic budget and water quality in and adjacent to Honey Creek State Natural Area, Comal County, Texas, 2001-10

USGS Publications Warehouse

Banta, J. Ryan; Slattery, Richard N.

2011-01-01

The U.S. Geological Survey, in cooperation with the U.S. Department of Agriculture Natural Resources Conservation Service, the Edwards Region Grazing Lands Conservation Initiative, the Texas State Soil and Water Conservation Board, the San Antonio River Authority, the Edwards Aquifer Authority, Texas Parks and Wildlife, the Guadalupe Blanco River Authority, and the San Antonio Water System, evaluated the hydrologic effects of ashe juniper (Juniperus ashei) removal as a brush management conservation practice in and adjacent to the Honey Creek State Natural Area in Comal County, Tex. By removing the ashe juniper and allowing native grasses to reestablish in the area as a brush management conservation practice, the hydrology in the watershed might change. Using a simplified mass balance approach of the hydrologic cycle, the incoming rainfall was distributed to surface water runoff, evapotranspiration, or groundwater recharge. After hydrologic data were collected in adjacent watersheds for 3 years, brush management occurred on the treatment watershed while the reference watershed was left in its original condition. Hydrologic data were collected for another 6 years. Hydrologic data include rainfall, streamflow, evapotranspiration, and water quality. Groundwater recharge was not directly measured but potential groundwater recharge was calculated using a simplified mass balance approach. The resulting hydrologic datasets were examined for differences between the watersheds and between pre- and post-treatment periods to assess the effects of brush management. The streamflow to rainfall relation (expressed as event unit runoff to event rainfall relation) did not change between the watersheds during pre- and post-treatment periods. The daily evapotranspiration rates at the reference watershed and treatment watershed sites exhibited a seasonal cycle during the pre- and post-treatment periods, with intra- and interannual variability. Statistical analyses indicate the mean difference in daily evapotranspiration rates between the two watershed sites is greater during the post-treatment than the pre-treatment period. Average annual rainfall, streamflow, evapotranspiration, and potential groundwater-recharge conditions were incorporated into a single hydrologic budget (expressed as a percentage of the average annual rainfall) applied to each watershed before and after treatment to evaluate the effects of brush management. During the post-treatment period, the percent average annual unit runoff in the reference watershed was similar to that in the treatment watershed, however, the difference in percentages of average annual evapotranspiration and potential groundwater recharge were more appreciable between the reference and treatment watersheds than during the pre-treatment period. Using graphical comparisons, no notable differences in major ion or nutrient concentrations were found between samples collected at the reference watershed (site 1C) and treatment watershed (site 2C) during pre- and post-treatment periods. Suspended-sediment loads were calculated from samples collected at sites 1C and 2T. The relation between suspended-sediment loads and streamflow calculated from samples collected from sites 1C and 2T did not exhibit a statistically significant difference during the pre-treatment period, whereas during the post-treatment period, relation between suspended-sediment loads and streamflow did exhibit a statistically significant difference. The suspended-sediment load to streamflow relations indicate that for the same streamflow, the suspended-sediment loads calculated from site 2T were generally less than suspended-sediment loads calculated from site 1C during the post-treatment period.

Microbiological indicators of water quality in the Xochimilco canals, Mexico City.

PubMed

Juárez-Figueroa, Luis Alfredo; Silva-Sánchez, Jesús; Uribe-Salas, Felipe Javier; Cifuentes-García, Enrique

2003-01-01

To quantify microbiology indicators of fecal contamination in the effluents of two waste water treatment plants and in samples collected in several canals in Xochimilco. A cross sectional study was performed. Ten sites, 5 from plant effluents and 5 from canals, were selected for sampling during November and December 2001. Fecal coliforms and enterococci were quantified by membrane filtration, male specific (F+) and somatic coliphages by double agar layer technique, and Cryptosporidium oocysts and Giardia cysts by concentration with Envirocheck filter followed by immunofluorescence microscopy quantification. The average of organisms counts from effluents and canal water were compared with t Student test. Treated water discharge in canals showed a low count of Fecal Coliforms (average 40.4/100 ml), enterococci (average 58.8/100 ml) and Cryptosporidium oocysts (average 13.2/100 l), while coliphages and Giardia cyst rendered higher counts (average 1467.5/100 ml and 1199.8/100 l, respectively) suggesting the water treatment methods could fail to remove these agents. A significant lower count of Giardia cysts (average 45/100 l) and no Cryptosporidium oocysts were found in irrigation canals, which suggests a natural clearance of these pathogens. Strains of Escherichia coli isolated in one of the canals contaminated with sewage had antimicrobial multi-resistance that was transferred by conjugation suggesting that resistance is encoded in a plasmid potentially transferable to other pathogenic bacteria. Cost effective and culturally acceptable waste treatment methods will require careful planning and consultation if they are to be adopted and mantained by local populations.

Effects of sawdust bedding dry matter on lying behavior of dairy cows: a dose-dependent response.

PubMed

Reich, L J; Weary, D M; Veira, D M; von Keyserlingk, M A G

2010-04-01

The objective was to determine the effect of sawdust bedding dry matter on the lying behavior of Holstein cows. Dry matter (DM) was varied systematically over 5 treatment levels to test how cows respond to damp bedding. This experiment was repeated during summer and winter to test if the effects of damp bedding varied with season. The 5 bedding treatments averaged (+/-SD) 89.8+/-3.7, 74.2+/-6.4, 62.2+/-6.3, 43.9+/-4.0, and 34.7+/-3.8% DM. Over the course of the trial, minimum and maximum temperatures in the barn were 2.6+/-2.0 and 6.8+/-2.2 degrees C in the winter and 13.3+/-2.5 and 22.6+/-4.1 degrees C in the summer. In both seasons, 5 groups of 3 nonlactating cows were housed in free stalls bedded with sawdust. Following a 5-d acclimation period on dry bedding, groups were exposed to the 5 bedding treatments in a 5 x 5 Latin square. Each treatment lasted 4 d, followed by 1 d when the cows were provided with dry bedding. Stall usage was assessed by 24-h video scanned at 5-min intervals. Responses were analyzed within group (n=5) as the observational unit. Bedding DM affected lying time, averaging 10.4+/-0.4 h/d on the wettest treatment and increasing to 11.5+/-0.4 h/d on the driest bedding. Lying time varied with season, averaging 12.1+/-0.4 h/d across treatments during the winter and 9.9+/-0.6 h/d during the summer, but season and bedding DM did not interact. These results indicate that access to dry bedding is important for dairy cows. Copyright (c) 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effects of Different Ratios of Sewage Sludge and Cattle Manure on Growth and Propagation of Eisenia Fetida

PubMed Central

Liu, Fei; Zhu, Pengfei; Zhang, Lichao; Zhou, Xiujie; Sun, Chongyu; Cheng, Yunhuan

2016-01-01

Domestic sewage sludge and cattle manure are rich in nutrition elements, but without proper disposal, are harmful to the environment. Here with an indoor culture method, we used Eisenia fetida to dispose different ratios of sewage sludge and cattle manure, and thereby investigated the effects and acting rules of these sludge-manure mixtures on the growth and reproduction of E. fetida. We find these mixtures are food sources for E. fetida, and their physiochemical properties are significantly changed after disposal by earthworms. Paired samples t-test shows the average change after different treatments is -20.37% for total organic carbon, 85.71% for total Kjeldahl N, -6.67% for total P, 8.33% for pH, -24.78% for EC (ms·cm-1), and -57.10% for C/N ratio. The average growth rate after treatment CD-70 is 9.20 mg·worm-1·day-1; the average growth rates of E. fetida on day 0–28, day 29–56, and day 57–91 are 9.33, 11.90 and 6.95 mg·worm-1·day-1, respectively, indicating a trend of "rapid—rapidest—slow" growth. Other treatments all show this trend. Though all earthworms developed reproductive rings during the test periods, the appearing time and the cocoon production time both differed among these treatments. The cocoon production amount is maximized to 233 after treatment CD-70. The cocoon production rates are significantly different among these treatments, and the maximum and mean are 0.32 and 0.17–0.32, cocoons·worm-1· day-1, respectively. E. fetida can modestly enrich Cd, but is not very effective over Sb or other heavy metals. E. fetida can remove a part of heavy metals from sewage sludge and cattle manure. Generally, the mixtures of sewage sludge and cattle manure can largely affect the growth and propagation of E. fetida in a ratio-dependent way. PMID:27257977

Effects of Different Ratios of Sewage Sludge and Cattle Manure on Growth and Propagation of Eisenia Fetida.

PubMed

Li, Yukui; Liu, Qingchuan; Liu, Fei; Zhu, Pengfei; Zhang, Lichao; Zhou, Xiujie; Sun, Chongyu; Cheng, Yunhuan

2016-01-01

Domestic sewage sludge and cattle manure are rich in nutrition elements, but without proper disposal, are harmful to the environment. Here with an indoor culture method, we used Eisenia fetida to dispose different ratios of sewage sludge and cattle manure, and thereby investigated the effects and acting rules of these sludge-manure mixtures on the growth and reproduction of E. fetida. We find these mixtures are food sources for E. fetida, and their physiochemical properties are significantly changed after disposal by earthworms. Paired samples t-test shows the average change after different treatments is -20.37% for total organic carbon, 85.71% for total Kjeldahl N, -6.67% for total P, 8.33% for pH, -24.78% for EC (ms·cm-1), and -57.10% for C/N ratio. The average growth rate after treatment CD-70 is 9.20 mg·worm-1·day-1; the average growth rates of E. fetida on day 0-28, day 29-56, and day 57-91 are 9.33, 11.90 and 6.95 mg·worm-1·day-1, respectively, indicating a trend of "rapid-rapidest-slow" growth. Other treatments all show this trend. Though all earthworms developed reproductive rings during the test periods, the appearing time and the cocoon production time both differed among these treatments. The cocoon production amount is maximized to 233 after treatment CD-70. The cocoon production rates are significantly different among these treatments, and the maximum and mean are 0.32 and 0.17-0.32, cocoons·worm-1· day-1, respectively. E. fetida can modestly enrich Cd, but is not very effective over Sb or other heavy metals. E. fetida can remove a part of heavy metals from sewage sludge and cattle manure. Generally, the mixtures of sewage sludge and cattle manure can largely affect the growth and propagation of E. fetida in a ratio-dependent way.

Do nurse-led skill training interventions affect informal caregivers' out-of-pocket expenditures?

PubMed

Van Houtven, Courtney Harold; Thorpe, Joshua M; Chestnutt, Deborah; Molloy, Margory; Boling, John C; Davis, Linda Lindsey

2013-02-01

This paper is a report of a study of the Assistance, Support, and Self-health Initiated through Skill Training (ASSIST) randomized control trial. The aim of this paper is to understand whether participating in ASSIST significantly changed the out-of-pocket (OOP) costs for family caregivers of Alzheimer's disease (AD) or Parkinson's disease (PD) patients. Secondary analysis of randomized control trial data, calculating average treatment effects of the intervention on OOP costs. Enrollment in the ASSIST trial occurred between 2002 and 2007 at 2 sites: Durham, North Carolina, and Birmingham, Alabama. We profile OOP costs for caregivers who participated in the ASSIST study and use 2-part expenditure models to examine the average treatment effect of the intervention on caregiver OOP expenditures. ASSIST-trained AD and PD caregivers reported monthly OOP expenditures that averaged $500-$600. The intervention increased the likelihood of caregivers spending any money OOP by 26 percentage points over usual care, but the intervention did not significantly increase overall OOP costs. The ASSIST intervention was effective and inexpensive to the caregiver in direct monetary outlays; thus, there are minimal unintended consequences of the trial on caregiver financial well-being.

Treatment Effect in Earlier Trials of Patients With Chronic Medical Conditions: A Meta-Epidemiologic Study.

PubMed

Alahdab, Fares; Farah, Wigdan; Almasri, Jehad; Barrionuevo, Patricia; Zaiem, Feras; Benkhadra, Raed; Asi, Noor; Alsawas, Mouaz; Pang, Yifan; Ahmed, Ahmed T; Rajjo, Tamim; Kanwar, Amrit; Benkhadra, Khalid; Razouki, Zayd; Murad, M Hassan; Wang, Zhen

2018-03-01

To determine whether the early trials in chronic medical conditions demonstrate an effect size that is larger than that in subsequent trials. We identified randomized controlled trials (RCTs) evaluating a drug or device in patients with chronic medical conditions through meta-analyses (MAs) published between January 1, 2007, and June 23, 2015, in the 10 general medical journals with highest impact factor. We estimated the prevalence of having the largest effect size or heterogeneity in the first 2 published trials. We evaluated the association of the exaggerated early effect with several a priori hypothesized explanatory variables. We included 70 MAs that had included a total of 930 trials (average of 13 [range, 5-48] RCTs per MA) with average follow-up of 24 (range, 1-168) months. The prevalence of the exaggerated early effect (ie, proportion of MAs with largest effect or heterogeneity in the first 2 trials) was 37%. These early trials had an effect size that was on average 2.67 times larger than the overall pooled effect size (ratio of relative effects, 2.67; 95% CI, 2.12-3.37). The presence of exaggerated effect was not significantly associated with trial size; number of events; length of follow-up; intervention duration; number of study sites; inpatient versus outpatient setting; funding source; stopping a trial early; adequacy of random sequence generation, allocation concealment, or blinding; loss to follow-up or the test for publication bias. Trials evaluating treatments of chronic medical conditions published early in the chain of evidence commonly demonstrate an exaggerated treatment effect compared with subsequent trials. At the present time, this phenomenon remains unpredictable. Considering the increasing morbidity and mortality of chronic medical conditions, decision makers should act on early evidence with caution. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

[Stiletto needle and needle-knife for influence of gravity index in treating knee osteoarthritis].

PubMed

Gu, Li-Jun; Zhang, Bin; Li, Wen-Hua; Tang, Yan; Dong, Fu-Hui

2017-12-25

To explore stiletto needle and needle-knife for influence of double sufficient weight in treating knee osteoarthritis patients. One hundred and thirteen early and medium term knee osteoarthritis patients were randomly divided into three groups, including stiletto needle group(38 cases), needle-knife group (38 cases) and voltaren group (37 cases). In stiletto needle group, there were 13 males and 25 females with an average of(55.87±7.72) years old, treated by stiletto needle once a week, and 2 weeks were a course; there were 11 males and 27 females in needle-knife group with an average of(57.11±7.07) years old, treated by acupotome once a week, and 2 weeks were a course; there were 12 males and 25 females in voltaren group with an average age of(57.62±8.08) years old, treated by votalin emulsion smearing 3 to 5 cm on painful area of knee joint, three times a day for 2 weeks; 36 patients in normal group, including 11 males and 25 females with a mean age of (55.28±7.55) years old, treated with nothing. Gravitational four lattice used to measure bipedal back and forth load before and after treatment in further observe weight-bearing situation among three groups, d value, which was the distance from center of gravity to original point, was measured as a obvervational index, JOA score was used to evaluate clinical effect. Five patients were fall out, including 2 patients in stiletto needle group, 2 patients in needle-knife group and 1 patient in voltaren group. Other 108 patients were followed-up from 28 to 35 d with an average of 30 d, and without untoward effect. There was significant difference in d value between treatment group and control group at 1 month after treatment( P <0.05); there was significant difference in d value among treatment group at 1 month after treatment( P >0.05), and d value was decreased before treatment than that of after treatment. There was no significant difference in JOA score among treatment group after treatment at 1 month( P <0.05); while had significant difference between groups( P >0.05) after treatment at 1 month. Stiletto needle, needle-knife and voltaren for the treatment of knee osteoarthritis at early and middle stage, center of gravity is closer to original point, and weight-bearing is improved. It is a easy method of four lattice to measure change of weight-bearing in KOA patients after treatment.

A clinical study on the usefulness of autologous plasma filler in the treatment of nasolabial fold wrinkles.

PubMed

Choi, Young-Jun; Kim, Han-Saem; Min, Joon Hong; Nam, Jae-Hui; Lee, Ga-Young; Kim, Won-Serk

2017-06-01

Recently, the efficacy of autologous plasma filler for the reduction of facial wrinkles has been demonstrated. The aim of our study is to validate the efficacy and safety of autologous plasma filler in treating nasolabial fold wrinkles. Twenty Korean patients with moderate-to-severe nasolabial fold wrinkles were enrolled. The patients were treated with one session of autologous plasma filler. The wrinkle improvement effects were evaluated at 1-week, 4-week, 8-week, and 12-week after the treatment. Three assessment methods were applied. First, two independent dermatologists assessed cosmetic results using a 5-point wrinkle assessment scale. Second, global aesthetic improvement score was used for assessment of the final cosmetic results. Third, patient satisfaction was surveyed. Also, the adverse effects associated to treatment were observed. Mean age of the patients was 44.5 years. The average 5-point wrinkle assessment scale score was significantly improved at 1, 4, 8, and 12 weeks after treatment, comparing to before treatment (p < 0.01). The patients' average global aesthetic improvement score also indicated better cosmetic outcomes. The clinical improvement with sufficient patients' satisfaction and no significant adverse events demonstrated that novel autologous plasma filler could be considered as efficient and safety treatment option for nasolabial fold wrinkles.

Test of Fruit Extract Pare (Momordica charantia L.) to Quality of Ejaculated Spermatozoa Mice (Mus musculus L.)

NASA Astrophysics Data System (ADS)

Fifendy, M.; Indriati, G.

2018-04-01

Pare (Momordica charantia L.) can be used in the treatment of various diseases, such as influenza, cancer, anti-inflammatory, anti-HIV, antimitotic and antifertilitas. This study aimed to determine the effect of the herbal bitter (Momordica charantia L.) to ejaculated sperm quality mice (Mus musculus L.). This research was conducted using Completely Randomized Design (CRD) with 4 treatments and 6 replications, water and fed adlibitum. First treatment is given solvent extract. Second treatments extract were given 0.2 gram, third treatment were given 0.4 gram of extracts and fourth treatment were treated exstrac 0.6 gram were orally for 30 days. After the mice decapitated, dissected and take sperm from vas deferens. Then, the sperm preparation determined using the improved Neubauer. Data were analyzed by ANOVA (Analysis of Varians). The results shoured at doses of 0,2 gram, the average sperm count was 19.89. decrease significant when compared with the control in which the average number of sperm 29.13. So with this research the effective doses to decrease sperm count and can be used as a contraception medication dosage was 0,2 gram. It can be conclude that the extract of bitter (Momordica charantia L.) can decrease the quality of the ejaculated sperm of mice (Mus musculus L.)

Histopathological assessment of cadmium effect on testicles and kidney of Oreochromis niloticus in different salinity

NASA Astrophysics Data System (ADS)

Hayati, Alfiah; Pratiwi, Hanna; Khoiriyah, Inayatul; Winarni, Dwi; Sugiharto

2017-06-01

This study was aimed to determine the effect of cadmium on testicles and kidney structure of Oreochromis niloticus in different salinity. Twenty-seven Oreochromis niloticus at age of 5±0.5 months with average size 11±1 cm and average weight 250±50 g were used and divided into nine treatment groups with variations in salinity (0, 5 and 10 ‰) and cadmium levels (0, 2.5, and 5 ppm). After two weeks of treatment periods, testicles and kidney was collected and then processed into histological slide. Result showed that cadmium and salinity variations caused change in diameter of seminiferous tubules in the testicles. Kidney structure also showing various damage such as necrosis and inflammation from groups treated with various concentration of salinity and cadmium. Smallest diameter of seminiferous tubules of the testicles and the highest percentage necrosis and inflammation of kidney was found from salinity:cadmium = 0‰ : 5 ppm treatment.

[Low-dose omega-3 fatty acids as lipid lowering agents in the practice. A field study of ambulatory patients in general practice].

PubMed

Zakaria, B; Bertsch, S

1992-04-10

BASICS: Clinical trials have shown that omega-3 fatty acids are also effective at smaller doses than those so far recommended for lowering lipid concentrations. Testing this finding in a large number of unselected outpatients. Open multicentric trial involving 197 patients with dyslipoproteinemia. Treatment comprised omega-3 fatty acids, 1.1 to 1.4 g per day administered for a period of 12 weeks. After 12 weeks of treatment, serum triglycerides decreased on average by about 23%, total cholesterol by about 10%, and LDL cholesterol by about 5%. HDL cholesterol rose by an average of 16%. The fish oil preparation (Eicosapen, Nycomed, Munich) was well tolerated; a fishy taste and mild gastrointestinal complaints led to discontinuation of treatment in only four cases. It was also found that the effect of omega-3 fatty acids was appreciably greater in hypertensives than in patients with normal blood pressure--not only on systolic and diastolic blood pressure, but also on serum triglycerides and HDL.

High dose urokinase for restoration of patency of occluded permanent central venous catheters in hemodialysis patients.

PubMed

Shavit, L; Lifschitz, M; Plaksin, J; Grenader, T; Slotki, I

2010-10-01

Catheter thrombosis is common and results in inadequate dialysis treatment and, frequently, in catheter loss. Since dialysis treatment runs on a strict schedule, occluded catheters need to be restored in a timely and cost effective manner. We present a new shortened protocol of urokinase infusion that allows hemodialysis to be performed within 90 minutes. To chronic hemodialysis patients, who developed complete catheter occlusion, urokinase was infused simultaneously through both lumens of the catheter (125,000 units to each lumen) over 90 minutes. Technical success was defined as restoring blood pump speed to at least 250 ml/min. We determined the average time from catheter placement to first clot event (primary patency PP), recurrent clot event after urokinase treatment (secondary patency SP), catheter salvage rate and cause for removal. 37 catheters developed total thrombosis and urokinase was used to restore patency one or more times (total 47 treatments). Catheter salvage rate was 97 %. The average time of PP was 152 ± 56 days (7 - 784 days). Nine patients (30%) developed recurrent occlusion and the average time of SP was 64 ± 34 days (2 - 364 days). One catheter was removed because of dysfunction due to thrombosis. Other catheters were removed due to infection, fistula maturation or fell out spontaneously. Hemodialysis was performed immediately after treatment with blood speed of 250 ml/min in all patients. Our protocol is highly effective, short, and allows to restore patency of totally occluded central venous catheters with minimal disruption of the dialysis session.

Ambient air pollution, lung function, and airway responsiveness in asthmatic children.

PubMed

Ierodiakonou, Despo; Zanobetti, Antonella; Coull, Brent A; Melly, Steve; Postma, Dirkje S; Boezen, H Marike; Vonk, Judith M; Williams, Paul V; Shapiro, Gail G; McKone, Edward F; Hallstrand, Teal S; Koenig, Jane Q; Schildcrout, Jonathan S; Lumley, Thomas; Fuhlbrigge, Anne N; Koutrakis, Petros; Schwartz, Joel; Weiss, Scott T; Gold, Diane R

2016-02-01

Although ambient air pollution has been linked to reduced lung function in healthy children, longitudinal analyses of pollution effects in asthmatic patients are lacking. We sought to investigate pollution effects in a longitudinal asthma study and effect modification by controller medications. We examined associations of lung function and methacholine responsiveness (PC20) with ozone, carbon monoxide (CO), nitrogen dioxide, and sulfur dioxide concentrations in 1003 asthmatic children participating in a 4-year clinical trial. We further investigated whether budesonide and nedocromil modified pollution effects. Daily pollutant concentrations were linked to ZIP/postal code of residence. Linear mixed models tested associations of within-subject pollutant concentrations with FEV1 and forced vital capacity (FVC) percent predicted, FEV1/FVC ratio, and PC20, adjusting for seasonality and confounders. Same-day and 1-week average CO concentrations were negatively associated with postbronchodilator percent predicted FEV1 (change per interquartile range, -0.33 [95% CI, -0.49 to -0.16] and -0.41 [95% CI, -0.62 to -0.21], respectively) and FVC (-0.19 [95% CI, -0.25 to -0.07] and -0.25 [95% CI, -0.43 to -0.07], respectively). Longer-term 4-month CO averages were negatively associated with prebronchodilator percent predicted FEV1 and FVC (-0.36 [95% CI, -0.62 to -0.10] and -0.21 [95% CI, -0.42 to -0.01], respectively). Four-month averaged CO and ozone concentrations were negatively associated with FEV1/FVC ratio (P < .05). Increased 4-month average nitrogen dioxide concentrations were associated with reduced postbronchodilator FEV1 and FVC percent predicted. Long-term exposures to sulfur dioxide were associated with reduced PC20 (percent change per interquartile range, -6% [95% CI, -11% to -1.5%]). Treatment augmented the negative short-term CO effect on PC20. Air pollution adversely influences lung function and PC20 in asthmatic children. Treatment with controller medications might not protect but rather worsens the effects of CO on PC20. This clinical trial design evaluates modification of pollution effects by treatment without confounding by indication. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Ambient air pollution, lung function and airway responsiveness in children with asthma

PubMed Central

Ierodiakonou, Despo; Zanobetti, Antonella; Coull, Brent A.; Melly, Steve; Postma, Dirkje S.; Boezen, H. Marike; Vonk, Judith M.; Williams, Paul V.; Shapiro, Gail G.; McKone, Edward F.; Hallstrand, Teal S.; Koenig, Jane Q.; Schildcrout, Jonathan S.; Lumley, Thomas; Fuhlbrigge, Anne N.; Koutrakis, Petros; Schwartz, Joel; Weiss, Scott T.; Gold, Diane R

2016-01-01

Background Although ambient air pollution has been linked to reduced lung function in healthy children, longitudinal analyses of pollution effects in asthma are lacking. Objective To investigate pollution effects in a longitudinal asthma study and effect modification by controller medications. Methods We examined associations of lung function and methacholine responsiveness (PC20) with ozone, carbon monoxide (CO), nitrogen dioxide (NO2) and sulfur dioxide (SO2) levels in 1,003 asthmatic children participating in a 4-year clinical trial. We further investigated whether budesonide and nedocromil modified pollution effects. Daily pollutant concentrations were linked to zip/postal code of residence. Linear mixed models tested associations of within-subject pollutant concentrations with FEV1 and FVC %predicted, FEV1/FVC and PC20, adjusting for seasonality and confounders. Results Same-day and 1-week average CO levels were negatively associated with post-bronchodilator %predicted FEV1 (change(95%CI) per IQR: −0.33(−0.49, −0.16), −0.41(−0.62, −0.21), respectively) and FVC (−0.19(−0.25, −0.07), −0.25(−0.43, −0.07)). Longer-term four-month averages of CO were negatively associated with prebronchodilator %predicted FEV1 and FVC (−0.36(−0.62, −0.10), −0.21(−0.42, −0.01)). Four-month averaged CO and ozone levels were negatively associated with FEV1/FVC (p<0.05). Increased four-month average NO2 levels were associated with reduced post-bronchodilator FEV1 and FVC %predicted. Long-term exposures to SO2 were associated with reduced PC20 (%change(95%CI) per IQR:-6(-11,-1.5)). Treatment augmented the negative short-term CO effect on PC20. Conclusions Air pollution adversely influences lung function and PC20 in asthmatic children. Treatment with controller medications may not protect but worsens the CO effects on PC20. This clinical trial design evaluates modification of pollution effects by treatment without confounding by indication. PMID:26187234

Treatment of Crohn's disease with cannabis: an observational study.

PubMed

Naftali, Timna; Lev, Lihi Bar; Yablecovitch, Doron; Yablekovitz, Doron; Half, Elisabeth; Konikoff, Fred M

2011-08-01

The marijuana plant cannabis is known to have therapeutic effects, including improvement of inflammatory processes. However, no report of patients using cannabis for Crohn's disease (CD) was ever published. To describe the effects of cannabis use in patients suffering from CD. In this retrospective observational study we examined disease activity, use of medication, need for surgery, and hospitalization before and after cannabis use in 30 patients (26 males) with CD. Disease activity was assessed by the Harvey Bradshaw index for Crohn's disease. Of the 30 patients 21 improved significantly after treatment with cannabis. The average Harvey Bradshaw index improved from 14 +/- 6.7 to 7 +/- 4.7 (P < 0.001). The need for other medication was significantly reduced. Fifteen of the patients had 19 surgeries during an average period of 9 years before cannabis use, but only 2 required surgery during an average period of 3 years of cannabis use. This is the first report of cannabis use in Crohn's disease in humans. The results indicate that cannabis may have a positive effect on disease activity, as reflected by reduction in disease activity index and in the need for other drugs and surgery. Prospective placebo-controlled studies are warranted to fully evaluate the efficacy and side effects of cannabis in CD.

Rate and predictors of negative effects of psychotherapy in psychiatric and psychosomatic inpatients.

PubMed

Rheker, Julia; Beisel, Sylvia; Kräling, Svenja; Rief, Winfried

2017-08-01

Studies examining the rates of negative effects of psychotherapy are rare and the reported rates differ widely. To be able to calculate adequate benefit-cost ratios in conjunction with different samples and settings, we need a deeper understanding of these effects. We therefore investigated whether different treatment settings would reveal varying rates and kinds of negative effects by recruiting patients from a psychiatric (n=93) and a psychosomatic rehabilitation (n=63) hospital. Negative effects of psychotherapy were assessed with the Inventory for the Assessment of Negative Effects of Psychotherapy post-treatment. To investigate whether patients' pre-treatment expectations have an influence on reported negative effects, patients filled in the Patient Questionnaire on Therapy Expectation and Evaluation prior to treatment begin. Patients from the psychiatric hospital reported an average 1.41 negative effects, with 58.7% reporting at least one negative effect. Those from the psychosomatic hospital reported 0.76 negative effects on average, with 45.2% of patients reporting at least one negative effect. The differences between these samples are significant. The two samples' top three reported types of negative effects are that patients had experienced more downs during or just before the end of the therapy, that patients had difficulty making important decisions without the therapist, and that patients were concerned that colleagues or friends might find out about the therapy. A regression analysis revealed that the clinical setting (psychosomatic rehabilitation hospital vs. psychiatric hospital) and expectations in the form of hope of improvement were significant predictors for negative effects of psychotherapy. Our study highlights the need to examine the negative effects of psychotherapy in different settings and samples to better evaluate the benefit-cost ratios of treatments for different patient groups. It also shows that we need guidelines for assessing and reporting negative effects. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Effects of internal electrode cooling on irreversible electroporation using a perfused organ model.

PubMed

O'Brien, Timothy J; Bonakdar, Mohammad; Bhonsle, Suyashree; Neal, Robert E; Aardema, Charles H; Robertson, John L; Goldberg, S Nahum; Davalos, Rafael V

2018-05-28

This study evaluates the effects of active electrode cooling, via internal fluid circulation, on the irreversible electroporation (IRE) lesion, deployed electric current and temperature changes using a perfused porcine liver model. A bipolar electrode delivered IRE electric pulses with or without activation of internal cooling to nine porcine mechanically perfused livers. Pulse schemes included a constant voltage, and a preconditioned delivery combined with an arc-mitigation algorithm. After treatment, organs were dissected, and treatment zones were stained using triphenyl-tetrazolium chloride (TTC) to demonstrate viability. Thirty-nine treatments were performed with an internally cooled applicator and 21 with a non-cooled applicator. For the constant voltage scenario, the average final electrical current measured was 26.37 and 29.20 A for the cooled and uncooled electrodes respectively ([Formula: see text]). The average final temperature measured was 33.01 and 42.43 °C for the cooled and uncooled electrodes respectively ([Formula: see text]). The average measured ablations (fixed lesion) were 3.88-by-2.08 cm and 3.86-by-2.12 cm for the cooled and uncooled electrode respectively ([Formula: see text], [Formula: see text]). Similarly, the preconditioned/arc-mitigation scenario yielded an average final electrical current measurement of a 41.07 and 47.20 A for the cooled and uncooled electrodes respectively ([Formula: see text]). The average final temperature measured was 34.93 and 44.90 °C for the cooled and uncooled electrodes respectively ([Formula: see text]). The average measured ablations (fixed lesion) were 3.67-by-2.27 cm and 3.58-by-2.09 cm for the cooled and uncooled applicators ([Formula: see text]). The internally-cooled bipolar applicator offers advantages that could improve clinical outcomes. Thermally mitigating internal perfusion technology reduced tissue temperatures and electric current while maintaining similar lesion sizes.

Hair removal for Fitzpatrick skin types V and VI using light and heat energy technology.

PubMed

Sadick, Neil S; Krespi, Yoseph

2006-09-01

To determine the safety and efficacy of a light and heat energy (LHE)-based system (SkinStaion system; Radiancy Inc, Orangeburg, NY, USA) for hair removal in subjects with skin types V and VI. Thirty-one subjects with Fitzpatrick skin types V and VI were consented for treatment with the system. Twenty-six subjects completed the 12-week follow-up. Safety was evaluated at each visit and efficacy was evaluated at both follow-up visits. An average hair clearance of 41.7% from 57 treatment sites was reported at the 6-week follow-up visit and a 35.5% average hair clearance was reported at the 12-week follow-up. Edema was only reported in 2 cases (7.7%) of the study population. Eleven cases of erythema were reported following treatment. Treatment with the modified LHE system was safe and effective for hair removal in patients with skin types V and VI.

Sexual Assault Education Programs: A Meta-Analytic Examination of Their Effectiveness

ERIC Educational Resources Information Center

Anderson, Linda A.; Whiston, Susan C.

2005-01-01

Meta-analyses of the effectiveness of college sexual assault education programs on seven outcome measure categories were conducted using 69 studies that involved 102 treatment interventions and 18,172 participants. Five of the outcome categories had significant average effect sizes (i.e., rape attitudes, rape-related attitudes, rape knowledge,…

The Efficacy and Safety of On-demand Tramadol and Paroxetine Use in Treatment of Life Long Premature Ejaculation: A Randomized Double-blind Placebo-controlled Clinical Trial

PubMed Central

Hamidi-Madani, Ali; Motiee, Reza; Mokhtari, Gholamreza; Nasseh, Hamidreza; Esmaeili, Samaneh; Kazemnezhad, Ehsan

2018-01-01

Background: Several medical therapies have been proposed for the treatment of premature ejaculation (PE). Paroxetine and tramadol were both reported to be effective in treatment of PE. In this study, the therapeutic effects of tramadol, paroxetine and placebo were compared in treatment of primary PE. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 150 patients were divided into 3 groups. One group was treated with tramadol 50 mg ondemand, the other group took paroxetine 20 mg on-demand and the third group was treated with placebo. Before starting treatment and after 12 weeks, patients were asked to measure their average intravaginal ejaculation latency time (IELT) and fill the PEP (Premature Ejaculation Profile) questionnaire. Results: At the end of the 12th week, the mean IELT and average of PEP scores improved in all 3 groups. The increase in tramadol group was significantly higher than the paroxetine and placebo groups (p<0.0001). There were no significant differences in terms of side effects between the 3 groups. Conclusion: The results showed that despite an increase in mean IELT and PEP scores in all 3 groups, the rate of improvement in tramadol group was significantly more than the others. Thus, tramadol may be considered as an appropriate alternative therapeutic option for lifelong PE. PMID:29850442

The Efficacy and Safety of On-demand Tramadol and Paroxetine Use in Treatment of Life Long Premature Ejaculation: A Randomized Double-blind Placebo-controlled Clinical Trial.

PubMed

Hamidi-Madani, Ali; Motiee, Reza; Mokhtari, Gholamreza; Nasseh, Hamidreza; Esmaeili, Samaneh; Kazemnezhad, Ehsan

2018-01-01

Several medical therapies have been proposed for the treatment of premature ejaculation (PE). Paroxetine and tramadol were both reported to be effective in treatment of PE. In this study, the therapeutic effects of tramadol, paroxetine and placebo were compared in treatment of primary PE. In this randomized, double-blind, placebo-controlled clinical trial, 150 patients were divided into 3 groups. One group was treated with tramadol 50 mg ondemand, the other group took paroxetine 20 mg on-demand and the third group was treated with placebo. Before starting treatment and after 12 weeks, patients were asked to measure their average intravaginal ejaculation latency time (IELT) and fill the PEP (Premature Ejaculation Profile) questionnaire. At the end of the 12th week, the mean IELT and average of PEP scores improved in all 3 groups. The increase in tramadol group was significantly higher than the paroxetine and placebo groups (p<0.0001). There were no significant differences in terms of side effects between the 3 groups. The results showed that despite an increase in mean IELT and PEP scores in all 3 groups, the rate of improvement in tramadol group was significantly more than the others. Thus, tramadol may be considered as an appropriate alternative therapeutic option for lifelong PE.

[Is therapy with local infiltrations feasible in primary care consultations?].

PubMed

Magaña Loarte, J E; Pérez Franco, J; Sánchez Sánchez, G

1999-01-01

To study the feasibility of local infiltration in primary care consultations. Before-and-after intervention study. Two clinics at an urban health centre. Patients diagnosed with pathology of tender areas and treated with corticosteroid infiltration between May 1997 and May 1998. Corticoid infiltration plus local anaesthetic. Weekly check-up. Analysis of the variables: sex, age, diagnosis, time elapsed between indication and start of treatment, subjective assessment of pain before and after treatment (VRS scale), number of infiltrations per patient, side-effects. Evaluation of overall and individual effectiveness. 41 patients were infiltrated. Average age was 58. Most common pathologies were: rotary joint tendinitis (48.7%), anserine bursitis (24.4%), plantar fasciitis (7.3%). Average number of infiltrations per pathology: 1.3. Mean waiting time: 3.5 days. Comparison of pain by means of VRS (range 0-5) before and after treatment used the Wilcoxon test, with a statistically significant difference and p < 0.001 (z = -5.5109). For 35 patients (85.4%), pain was solved very well (values 0 and 1 on the VRS). For 3 patients (7.3%), improvement was moderate; and for 3 (7.3%) there was no improvement. 1. Treatment with local infiltration of corticosteroids is effective in dealing with pain, and is an alternative to treatment with NSAIDs. 2. It is feasible in primary care, and there are many advantages if the general practitioner employs this therapeutic technique.

Magnitude of efficacy measurements in grass allergy immunotherapy trials is highly dependent on pollen exposure.

PubMed

Durham, S R; Nelson, H S; Nolte, H; Bernstein, D I; Creticos, P S; Li, Z; Andersen, J S

2014-05-01

The objective was to evaluate the association between grass pollen exposure, allergy symptoms and impact on measured treatment effect after grass sublingual immunotherapy (SLIT)-tablet treatment. The association between grass pollen counts and total combined rhinoconjunctivitis symptom and medication score (TCS) was based on a post hoc analysis of data collected over six trials and seven grass pollen seasons across North America and Europe, including 2363 subjects treated with grass SLIT-tablet or placebo. Daily pollen counts were obtained from centralized pollen databases. The effect of treatment on the relationship between the TCS and pollen counts was investigated, and the relative difference between grass SLIT-tablet and placebo as a function of average grass pollen counts was modelled by linear regression. The magnitude of treatment effect based on TCS was greater with higher pollen exposure (P < 0.001). The relative treatment effect in terms of TCS for each trial was correlated with the average grass pollen exposure during the first period of the season, with predicted reduction in TCS = 12% + 0.35% × pollen count (slope significantly different from 0, P = 0.003; R(2)  = 0.66). Corresponding correlations to the entire grass pollen season and to the peak season were equally good, whereas there was a poor correlation between difference in measured efficacy and pollen exposure during the last part of the season. In seasonal allergy trials with grass SLIT-tablet, the observed treatment effect is highly dependent on pollen exposure with the magnitude being greater with higher pollen exposure. This is an important relationship to consider when interpreting individual clinical trial results. © 2014 The Authors. Allergy Published by John Wiley & Sons Ltd.

Magnitude of efficacy measurements in grass allergy immunotherapy trials is highly dependent on pollen exposure

PubMed Central

Durham, S R; Nelson, H S; Nolte, H; Bernstein, D I; Creticos, P S; Li, Z; Andersen, J S

2014-01-01

Background The objective was to evaluate the association between grass pollen exposure, allergy symptoms and impact on measured treatment effect after grass sublingual immunotherapy (SLIT)-tablet treatment. Methods The association between grass pollen counts and total combined rhinoconjunctivitis symptom and medication score (TCS) was based on a post hoc analysis of data collected over six trials and seven grass pollen seasons across North America and Europe, including 2363 subjects treated with grass SLIT-tablet or placebo. Daily pollen counts were obtained from centralized pollen databases. The effect of treatment on the relationship between the TCS and pollen counts was investigated, and the relative difference between grass SLIT-tablet and placebo as a function of average grass pollen counts was modelled by linear regression. Results The magnitude of treatment effect based on TCS was greater with higher pollen exposure (P < 0.001). The relative treatment effect in terms of TCS for each trial was correlated with the average grass pollen exposure during the first period of the season, with predicted reduction in TCS = 12% + 0.35% × pollen count (slope significantly different from 0, P = 0.003; R2 = 0.66). Corresponding correlations to the entire grass pollen season and to the peak season were equally good, whereas there was a poor correlation between difference in measured efficacy and pollen exposure during the last part of the season. Conclusions In seasonal allergy trials with grass SLIT-tablet, the observed treatment effect is highly dependent on pollen exposure with the magnitude being greater with higher pollen exposure. This is an important relationship to consider when interpreting individual clinical trial results. PMID:24605984

Short-Term Effects of Pulsed Radiofrequency on Chronic Refractory Cervical Radicular Pain

PubMed Central

Choi, Gyu-Sik; Cho, Yun-Woo; Lee, Dong-Kyu

2011-01-01

Objective To evaluate the short-term effectiveness of pulsed radiofrequency on the dorsal root ganglion (DRG) in patients with chronic refractory cervical radicular pain. Method Fifteen patients (13 males, 2 females; mean age, 55.9 years) with chronic radicular pain due to cervical disc herniation or foraminal stenosis refractory to active rehabilitative management, including transforaminal cervical epidural steroid injection and exercise, were selected. All patients received pulsed radiofrequency on the symptomatic cervical dorsal root ganglion and were carefully evaluated for neurologic deficits and side effects. The clinical outcomes were measured using a visual analogue scale (VAS) and a neck disability index (NDI) before treatment, one and three months after treatment. Successful pain relief was defined as a 50% or greater reduction in the VAS score as compared with the pre-treatment score. After three months, we categorized the patients' satisfaction. Results The average VAS for radicular pain was reduced significantly from 5.3 at pretreatment to 2.5 at 3 months post-treatment (p<0.05). Eleven of 15 patients (77.3%) after cervical pulsed RF stimulation reported pain relief of 50% or more at the 3 month follow-up. The average NDI was significantly reduced from 44.0% at pretreatment to 35.8% 3 months post-treatment (p<0.05). At 3 months post-treatment, eleven of fifteen patients (73.3%) were satisfied with their status. No adverse effects were observed. Conclusion The results demonstrate that the application of pulsed radiofrequency on DRG might be an effective short-term intervention for chronic refractory cervical radicular pain. Further studies, including a randomized controlled trial with long-term follow-up, are now needed. PMID:22506211

Cost-effectiveness of oral alitretinoin in patients with severe chronic hand eczema - a long-term analysis from a Swiss perspective

PubMed Central

2010-01-01

Background The impact on patients suffering from chronic hand eczema (CHE) is enormous, as no licensed systemic treatment option with proven efficacy for CHE is available. Alitretinoin is a novel agent which showed high clinical efficacy in patients with severe, refractory CHE. We assessed the cost-effectiveness of alitretinoin for CHE patient treatment from a Swiss third party payer perspective. A further objective of this study was to determine the burden of disease in Switzerland. Methods A long-term Markov cohort simulation model was used to estimate direct medical costs (€) and clinical effectiveness (quality adjusted life years, QALYs) of treating severe CHE patients with alitretinoin. Comparison was against the standard treatment of supportive care (optimised emollient therapy). Information on response rates were derived from a randomized controlled clinical trial. Costs were considered from the perspective of the Swiss health system. Swiss epidemiological data was derived from official Swiss Statistic institutions. Results Annual costs of alitretinoin treatment accounted for €2'212. After a time horizon of 22.4 years, average remaining long-term costs accounted for €42'208 or €38'795 in the alitretinoin and the standard treatment arm, respectively. Compared with the standard therapy, the addition of alitretinoin yielded an average gain of 0.230 QALYs at the end of the simulation. Accordingly, the incremental cost-effectiveness ratio resulted in €14'816/QALY gained. These results were robust to changes in key model assumptions. Conclusion The therapy for CHE patients is currently insufficient. In our long-term model we identified the treatment with alitretinoin as a cost-effective alternative for the therapy of CHE patients in Switzerland. PMID:20579358

Effectiveness of different rescanning techniques for scanned proton radiotherapy in lung cancer patients

NASA Astrophysics Data System (ADS)

Engwall, E.; Glimelius, L.; Hynning, E.

2018-05-01

Non-small cell lung cancer (NSCLC) is a tumour type thought to be well-suited for proton radiotherapy. However, the lung region poses many problems related to organ motion and can for actively scanned beams induce severe interplay effects. In this study we investigate four mitigating rescanning techniques: (1) volumetric rescanning, (2) layered rescanning, (3) breath-sampled (BS) layered rescanning, and (4) continuous breath-sampled (CBS) layered rescanning. The breath-sampled methods will spread the layer rescans over a full breathing cycle, resulting in an improved averaging effect at the expense of longer treatment times. In CBS, we aim at further improving the averaging by delivering as many rescans as possible within one breathing cycle. The interplay effect was evaluated for 4D robustly optimized treatment plans (with and without rescanning) for seven NSCLC patients in the treatment planning system RayStation. The optimization and final dose calculation used a Monte Carlo dose engine to account for the density heterogeneities in the lung region. A realistic treatment delivery time structure given from the IBA ScanAlgo simulation tool served as basis for the interplay evaluation. Both slow (2.0 s) and fast (0.1 s) energy switching times were simulated. For all seven studied patients, rescanning improves the dose conformity to the target. The general trend is that the breath-sampled techniques are superior to layered and volumetric rescanning with respect to both target coverage and variability in dose to OARs. The spacing between rescans in our breath-sampled techniques is set at planning, based on the average breathing cycle length obtained in conjunction with CT acquisition. For moderately varied breathing cycle lengths between planning and delivery (up to 15%), the breath-sampled techniques still mitigate the interplay effect well. This shows the potential for smooth implementation at the clinic without additional motion monitoring equipment.

Detecting Responses of Loblolly Pine Stand Development to Site-Preparation Intensity: A Modeling Approach

Treesearch

Mingguang Xu; Timothy B. Harrington; M. Boyd Edwards

1997-01-01

Data from an existing site preparation experiment in the Georgia Piedmont were subjected to a modeling approach to analyze effects of site preparation intensity on stand development of loblolly pine (Pinus taeda L.) 5 to 12 years since treatment. An average stand height model that incorporated indicator variables for treatment provided an accurate...

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

Schooneveldt, G.; Kok, H.P.; Bakker, A.

Purpose: Hyperthermia combined with Mitomycin C is used for the treatment of non-muscle invasive bladder cancer (NMIBC), using a phased array system of microwave antennas for bladder heating. Often some air is present in the bladder, which effectively blocks the microwave radiation, potentially preventing proper treatment of that part of the bladder. Air can be a relevant fraction of the bladder content and large air pockets are expected to have a noticeable influence on achieved temperatures. Methods: We analysed 14 NMIBC patients treated at our institute with our AMC-4 hyperthermia device with four 70MHz antennas around the pelvis. A CTmore » scan was made after treatment and a physician delineated the bladder on the CT scan. On the same scan, the amount of air present in the bladder was delineated. Using our in-house developed hyperthermia treatment planning system, we simulated the treatment using the clinically applied device settings. We did this once with the air pocket delineated on the CT scan, and once with the same volume filled with bladder tissue. Results: The patients had on average 4.2ml (range 0.8–10.1ml) air in the bladder. The bladder volume was delineated by the physician, that is including air pocket and bladder wall, was on average 253ml (range 93–452ml). The average volume in which changes exceeded 0.25°C was 22ml (range 0–108 ml), with the bladder being up to 2°C cooler when an air pocket was present. Except for extreme cases, there was no evident relation between the quantity of air and the difference in temperature. Conclusion: The effect of an air pocket in the bladder during bladder hyperthermia treatment varies strongly between patients. Generally, this leads to lower temperatures in the bladder, potentially affecting treatment quality, and suggesting that care need be taken to minimise the size of air pockets during hyperthermia treatments. The KWF Dutch Cancer Society financially supported this work, grant UVA 2012-5539.« less

[Efficacy of E-max porcelain laminate veneer on esthetic restoration for anterior teeth over 2 years].

PubMed

Zhang, Ning; Tao, Lin-shuai; Zhang, Xiao-dong

2013-12-01

To evaluate the clinical effect of E-max porcelain laminate veneer on esthetic restoration for anterior teeth over 2 years. E-max porcelain laminate veneer was used in 45 patients with 120 defective anterior teeth. Improved Ryge veneer reexamination standards including the integrity of ceramic veneer, marginal adaptation, gingival health and color match were adopted to evaluate the of clinical effect during 2 years of follow-up. The average satisfaction rate instantly after treatment, 1 year after treatment and 2 years after treatment was 93%, 95% and 94%, respectively. E-max porcelain laminate veneer has fewer side effects, better aesthetics and biological characteristics. The treatment is cost-efficient, safe and long-lasting.

[Treatment of complex tibial plateau fractures with bilateral locking plate and bone graft].

PubMed

Yan, Ying-Jie; Cheng, Zhan-Wei; Feng, Kai; Yan, Shao-Hua

2012-07-01

To explore the effective methods for the treatment of complex tibial plateau fractures. From May 2008 to April 2011, 28 patients with complex tibial plateau fractures were treated indirect reduction techniques, bilateral locking plate fixation combined with autologous bone grafts. There were 21 males and 7 females, with an average age of 43 years ranging from 21 to 65. There were 11 cases in Schatzker type V, 17 in VI. The effect was evaluated by Rasmussen standard on clinical and radiological. All patients were followed-up for 7 to 36 months (averaged of 21.5 months). Healing time of fracture was from 3 to 8 months (averaged 5.5 months). The results of Rasmussen scores in clinical was 4.50 +/- 1.32 in pain, 4.32 +/- 1.63 in walking ability, 4.07 +/- 1.34 in knee activity, 4.78 +/- 1.27 in stability of the knee, 4.85 +/- 1.12 in stretch knee; the results in radiation was 5.07 +/- 0.92 in articular surface collapse, 5.00 +/- 0.98 in platform widened, 5.14 +/- 0.85 in knee external varus. The effect result was excellent in 8 cases, good in 15, fair in 3 and poor in 2. The key for the treatment of complex tibial plateau fractures was to fully assess the damage as much as possible to protect the soft tissue, select the appropriate timing of surgery and surgical incision, application of indirect reduction techniques, limited incision and effective internal fixation to restore joint surface smooth and good limb alignment, early exercise, in order to achieve maximum recovery of joint function.

Efficacy of the Q-switched Neodymium: Yttrium Aluminum Garnet Laser in the Treatment of Blue-black Amateur and Professional Tattoos.

PubMed

Lakshmi, Chembolli; Krishnaswamy, Gayathri

2015-01-01

Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same. The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions. This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4-6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm(2). The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs. After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos. Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals.

The effects of a flexible visual acuity-driven ranibizumab treatment regimen in age-related macular degeneration: outcomes of a drug and disease model.

PubMed

Holz, Frank G; Korobelnik, Jean-François; Lanzetta, Paolo; Mitchell, Paul; Schmidt-Erfurth, Ursula; Wolf, Sebastian; Markabi, Sabri; Schmidli, Heinz; Weichselberger, Andreas

2010-01-01

Differences in treatment responses to ranibizumab injections observed within trials involving monthly (MARINA and ANCHOR studies) and quarterly (PIER study) treatment suggest that an individualized treatment regimen may be effective in neovascular age-related macular degeneration. In the present study, a drug and disease model was used to evaluate the impact of an individualized, flexible treatment regimen on disease progression. For visual acuity (VA), a model was developed on the 12-month data from ANCHOR, MARINA, and PIER. Data from untreated patients were used to model patient-specific disease progression in terms of VA loss. Data from treated patients from the period after the three initial injections were used to model the effect of predicted ranibizumab vitreous concentration on VA loss. The model was checked by comparing simulations of VA outcomes after monthly and quarterly injections during this period with trial data. A flexible VA-guided regimen (after the three initial injections) in which treatment is initiated by loss of >5 letters from best previously observed VA scores was simulated. Simulated monthly and quarterly VA-guided regimens showed good agreement with trial data. Simulation of VA-driven individualized treatment suggests that this regimen, on average, sustains the initial gains in VA seen in clinical trials at month 3. The model predicted that, on average, to maintain initial VA gains, an estimated 5.1 ranibizumab injections are needed during the 9 months after the three initial monthly injections, which amounts to a total of 8.1 injections during the first year. A flexible, individualized VA-guided regimen after the three initial injections may sustain vision improvement with ranibizumab and could improve cost-effectiveness and convenience and reduce drug administration-associated risks.

Serotoninergic manipulation, meal-induced satiety and eating pattern: effect of fluoxetine in obese female subjects.

PubMed

Lawton, C L; Wales, J K; Hill, A J; Blundell, J E

1995-07-01

Twelve nondepressed healthy female obese subjects (BMI > 30 kg/m2) took part in a study which conformed to a double-blind randomized crossover design. Each subject acted as her own control across 2 weeks of treatment with either 60 mg of the 5-HT reuptake inhibitor fluoxetine or matching placebo. On days 7 and 14 of both treatment phases subjects were provided with fixed energy lunch meals high in either CHO or fat. The effect of these meals on satiety during the fluoxetine and placebo phases was assessed by a battery of procedures. Subjects felt less hungry after consuming the high CHO meal than after consuming the high-fat meal. They also felt less hungry when taking fluoxetine than when taking the placebo. Analysis of energy intake from the test meal revealed a main effect of prior lunch meal type (high CHO or high fat) and a main effect of drug treatment. Subjects consumed an average of 574 kcal following the high CHO meal compared to 689 kcal following the high-fat meal. Subjects also consumed an average of 532 kcal when taking fluoxetine compared to 730 kcal when taking the placebo. Fluoxetine did not exert any significant effects on macronutrient selection. Mean daily energy intake, calculated from food diary records, was 1881 kcal when subjects were taking the placebo compared to 1460 kcal when taking fluoxetine (a reduction of 22.4%). Fluoxetine treatment produced a significant weight loss of 1.97 kg over the two weeks of treatment compared to a weight loss of only 0.04 kg on placebo.

Podcast effectiveness as scaffolding support for students enrolled in first-semester general chemistry laboratories

NASA Astrophysics Data System (ADS)

Powell, Mary Cynthia Barton

Podcasts covering essential first-semester general chemistry laboratory techniques and central concepts that aid in experimental design or data processing were prepared and made available for students to access on an as-needed basis on iPhones→ or iPod touches→. Research focused in three areas: the extent of podcast usage, the numbers and types of interactions between instructors and research teams, and student performance on graded assignments. Data analysis indicates that the podcast treatment research teams accessed a podcast 2.86 times on average during each week that podcasts were available. Comparison of interaction data for the lecture treatment research teams and podcast treatment research teams reveals that interactions with instructors were statistically significantly fewer for teams that had podcast access rather than a pre-laboratory lecture. The implication of the results is that student research teams were able to gather laboratory information more effectively when it was presented in an on-demand podcast format. Finally, statistical analysis of data on student performance on graded assignments indicates no significant differences between outcome measures for the treatment groups when compared as cohorts. The only statistically significant difference is between students judged to be highly motivated; for this sub-group the students in the podcast treatment group earned a course average that was statistically significantly higher than those in the lecture treatment group. This research study provides some of the first data collected on the effectiveness of podcasts delivered as needed in a first-semester general chemistry laboratory setting.

[Evaluation on effect of treatment and assistance to advanced schistosomiasis patients in Hunan Province from 2004 to 2013].

PubMed

Li, Sheng-ming; Zhao, Zheng-yuan; Peng, Zai-zhi; Wang, Zhang-hua; Li, Yuan; Guo, Feng-ying; Ren, Guang-hui

2014-08-01

To comprehensively evaluate the effect of the program of treatment and assistance to advanced schistosomiasis patients in Hunan Province from 2004 to 2013. The fund investment of the program, the profits of hospitals and the improvement of the patients' health were investigated by data collection and questionnaire survey. The evaluation index system of treatment and assistance to advanced schistosomiasis in Hunan Province was constructed by the Delphi method and analytic hierarchy process, and the program was assessed comprehensively. The evaluation index system including 6 primary indices and 33 secondary indices was established. Among all the primary indices, the score of the treatment and assistance (22.25) was the highest, and that of the satisfaction assessment (8.15) was the lowest, and the score of the comprehensive assessment was 87.06. The average cure rate of the patients was 13.08% from 2004 to 2013. More than 60% of the patients' disease condition got better, and nearly 70% of the patients' psychological condition improved, and more than 70% of patients' self-help ability and social contact improved, as well as family happiness increased. In addition, the annual average cost for caretakers decreased by 2000 Yuan, and the profits of all the fixed-point hospitals for treatment and assistance increased. The effectiveness and efficiency of the treatment and assistance to advanced schistosomiasis patients in Hunan Province is obvious, and the government should continuously invest in the program.

[Case control study on clinical effects of sacrococcygeal manipulation in the treatment of coccyx pain].

PubMed

Wang, Di; Luo, Jie; Li, Jia-Dong; Pei, Ming-Ming; Zhang, Wei

2016-09-25

To study the clinical efficacy of sacral manual therapy in the treatment of coccygodynia. From November 2013 to July 2015, 184 patients with sacrococcygeal pain were divided into treatment group and control group. There were 26 males and 65 females in the treatment group, with an average age of (39.63±11.62) years old. In the control group, there were 31 males and 62 females, with an average age of (41.47±11.56) years old. The patients in the treatment group were treated with sacrococcygeal massage therapy, 3 times a week for 2 weeks. The patients in the control group were treated with Diclofenac Diethylamine Emulgel, 2 times a day for 2 weeks. The VAS pain score, score in rating scale of sacrococcygeal pain and degree of tenderness were obtained on the first day of treatment, 2, 7, 14 days and 3 months after treatment to evaluate clinical results. When comparing the VAS pain score of sacrococcygeal pain within the two groups, the differences began to reach statistical significance on the second day( P <0.001). The chagne of VAS pain scores, the change of scores in rating scale of sacrococcygeal pain and the degree of tenderness in the treatment group were all significontly larger that those in the contral group from the second day. The curative effect of sacral manipulation group is better than that of Diclofenac Diethylamine Emulgel group in the treatment of sacrococcygeal pain.

Clinical comparison of potassium-titanyl-phosphate (KTP) versus neodymium:YAG (Nd:YAG) laser treatment for lower extremity telangiectases.

PubMed

Ozden, Müge Güler; Bahçivan, Muzaffer; Aydin, Fatma; Şentürk, Nilgün; Bek, Yüksel; Cantürk, Tayyar; Turanli, Ahmet Yaşar

2011-06-01

The Nd:YAG laser has been considered the gold standard of treatment for leg veins, but pain and side effects have fueled physicians to use treatment alternatives. To compare the clinical efficacy of the long-pulsed 1064-nm Nd:YAG laser with KTP laser irradiation in the treatment of leg telangiectasia. A series of 16 patients with size-matched superficial telangiectases of the lower extremities were randomly assigned to receive three consecutive monthly treatments with the long-pulsed 1064-nm Nd:YAG on one leg and 532-nm KTP laser irradiation on the other. For the 16 patients who completed the study, 64 leg vein sites were treated. Average clinical improvement scores were 1.94 and 1.25 for the KTP laser-treated leg and 3.38 and 3.50 for the Nd:YAG laser-treated leg with thin (≤ 1 mm) and large (1-3 mm) vessels, respectively. After the third treatment session, average improvement scores of 2.44, 1.31 and 3.75, 3.23 were given for the KTP and Nd:YAG laser-treated sides, respectively. Both the 1064-nm Nd:YAG and KTP lasers are effective in the treatment of lower extremity telangiectases. However, the KTP laser has very low efficacy with vessels larger than 1 mm and should not be elected when treating such vessels.

The effectiveness of empirical anti-parasitic treatment in returning travellers with persistent abdominal symptoms.

PubMed

Nissan, Batel; Lachish, Tamar; Schwartz, Eli

2018-01-01

Persistent abdominal symptoms (PAS) are common among returning-travellers. In the absence of sensitive tests to identify intestinal parasites, gastrointestinal (GI) symptoms often remain a diagnostic challenge. In this study we examined the effectiveness of empirical anti-parasitic treatment in returning-travellers with PAS despite no positive stool-test. A retrospective study among returning travellers who approached the clinic between the years 2014 and 2016 with GI complaints without a positive stool-test. The empirical treatment included broad-spectrum anti-parasitic agents-oral Tinidazole and Albendazole. A follow-up questionnaire was performed at least 6 months post-treatment. A total of 102 patients responded the questionnaire-50% women; average age 31.14 (±12.20) years. The average duration of complaints before treatment was 16.52 (±30.06) months. Common GI symptoms included abdominal pain (83.3%) and diarrhoea (78.4%); 67.6% of the patients complained of extreme fatigue. Overall, 69% of the patients reported an improvement in GI symptoms, 37% of them reported full recovery within a few weeks post-treatment. Furthermore, there was an improvement in the energy level and general well-being in 68% and 70% of the patients, respectively. Only 33% of the patients reported minor side effects related to the treatment. The improvement in GI symptoms, energy level and general well-being shortly after anti-parasitic treatment justifies this empirical approach in returning-travellers with PAS despite negative stool-tests. The association between fatigue and PAS post-travel and the improvement in both as a response to treatment defines fatigue as part of a new syndrome-'Post-travel fatigue and abdominal symptoms'. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

SFG analysis of the molecular structures at the surfaces and buried interfaces of PECVD ultralow-dielectric constant pSiCOH

NASA Astrophysics Data System (ADS)

Zhang, Xiaoxian; Myers, John N.; Huang, Huai; Shobha, Hosadurga; Chen, Zhan; Grill, Alfred

2016-02-01

PECVD deposited porous SiCOH with ultralow dielectric constant has been successfully integrated as the insulator in advanced interconnects to decrease the RC delay. The effects of NH3 plasma treatment and the effectiveness of the dielectric repair on molecular structures at the surface and buried interface of a pSiCOH film deposited on top of a SiCNH film on a Si wafer were fully characterized using sum frequency generation vibrational spectroscopy (SFG), supplemented by X-ray photoelectron spectroscopy. After exposure to NH3 plasma for 18 s, about 40% of the methyl groups were removed from the pSiCOH surface, and the average orientation of surface methyl groups tilted more towards the surface. The repair method used here effectively repaired the molecular structures at the pSiCOH surface but did not totally recover the entire plasma-damaged layer. Additionally, simulated SFG spectra with various average orientations of methyl groups at the SiCNH/pSiCOH buried interface were compared with the experimental SFG spectra collected using three different laser input angles to determine the molecular structural information at the SiCNH/pSiCOH buried interface after NH3 plasma treatment and repair. The molecular structures including the coverage and the average orientation of methyl groups at the buried interface were found to be unchanged by NH3 plasma treatment and repair.

The effects of pay-for-performance on tuberculosis treatment in Taiwan.

PubMed

Li, Ya-Hsin; Tsai, Wen-Chen; Khan, Mahmud; Yang, Wen-Ta; Lee, Tsuey-Fong; Wu, Yi-Chun; Kung, Pei-Tseng

2010-07-01

In order to make tuberculosis (TB) treatment more effective and to lower the transmission rate of the disease, the Bureau of National Health Insurance (BNHI) in Taiwan implemented the 'Pay-for-Performance on Tuberculosis' programme (P4P on TB) in 2004. This study investigates the effectiveness of the P4P system in terms of cure rate and length of treatment. This retrospective study obtained information on all TB cases in the national data sets of Taiwan for the years 2002 to 2005. The number of cases in pre-P4P years (2002 and 2003) was 25 754, compared with 33 536 in the post-P4P implementation years (2004 and 2005). The effectiveness of the programme was evaluated by comparing the TB cure rate and length of treatment before and after the implementation of the P4P programme, and between participating and non-participating hospitals. Logistic regression analysis was conducted to explore the factors affecting TB patients' cure rate within a 12-month treatment period. The cure rate and the average length of treatment before the implementation of P4P were 46.9% and 256.24 days, respectively, compared with 63.0% and 249.74 days after implementation of P4P. The cure rate and length of treatment in P4P hospitals were 68.1% and 249.13 days, respectively, compared with 42.4% and 53.71 days in non-P4P hospitals. This study found that both the cure rate and average length of treatment for cured cases improved significantly after the implementation of the P4P on TB programme in Taiwan. Compared with non-P4P hospitals, P4P hospitals had significantly better treatment outcomes. Patients' age, income level, the physician density of a patient's place of residence, and whether the hospital has joined the P4P on TB programme are factors affecting the treatment outcomes of TB patients in Taiwan.

Effect of dissolved oxygen on nitrate removal using polycaprolactone as an organic carbon source and biofilm carrier in fixed-film denitrifying reactors.

PubMed

Luo, Guozhi; Xu, Guimei; Gao, Jinfang; Tan, Hongxin

2016-05-01

Nitrate-nitrogen (NO3(-)-N) always accumulates in commercial recirculating aquaculture systems (RASs) with aerobic nitrification units. The ability to reduce NO3(-)-N consistently and confidently could help RASs to become more sustainable. The rich dissolved oxygen (DO) content and sensitive organisms stocked in RASs increase the difficulty of denitrifying technology. A denitrifying process using biologically degradable polymers as an organic carbon source and biofilm carrier was proposed because of its space-efficient nature and strong ability to remove NO3(-)-N from RASs. The effect of dissolved oxygen (DO) levels on heterotrophic denitrification in fixed-film reactors filled with polycaprolactone (PCL) was explored in the current experiment. DO conditions in the influent of the denitrifying reactors were set up as follows: the anoxic treatment group (Group A, average DO concentration of 0.28±0.05mg/L), the low-oxygen treatment DO group (Group B, average DO concentration of 2.50±0.24mg/L) and the aerated treatment group (Group C, average DO concentration of 5.63±0.57mg/L). Feeding with 200mg/L of NO3(-)-N, the NO3(-)-N removal rates were 1.53, 1.60 and 1.42kg/m(3) PCL/day in Groups A, B and C, respectively. No significant difference in NO3(-)-N removal rates was observed among the three treatments. It was concluded that the inhibitory effects of DO concentrations lower than 6mg/L on heterotrophic denitrification in the fixed-film reactors filled with PCL can be mitigated. Copyright © 2015. Published by Elsevier B.V.

Effects of whole body cryotherapy and cold water immersion on knee skin temperature.

PubMed

Costello, J T; Donnelly, A E; Karki, A; Selfe, J

2014-01-01

This study sought to (a) compare and contrast the effect of 2 commonly used cryotherapy treatments, 4 min of -110 °C whole body cryotherapy and 8 °C cold water immersion, on knee skin temperature and (b) establish whether either protocol was capable of achieving a skin temperature (<13 °C) believed to be required for analgesic purposes. After ethics committee approval and written informed consent was obtained, 10 healthy males (26.5±4.9 yr, 183.5±6.0 cm, 90.7±19.9 kg, 26.8±5.0 kg/m2, 23.0±9.3% body fat; mean±SD) participated in this randomised controlled crossover study. Skin temperature around the patellar region was assessed in both knees via non-contact, infrared thermal imaging and recorded pre-, immediately post-treatment and every 10 min thereafter for 60 min. Compared to baseline, average, minimum and maximum skin temperatures were significantly reduced (p<0.001) immediately post-treatment and at 10, 20, 30, 40, 50 and 60 min after both cooling modalities. Average and minimum skin temperatures were lower (p<0.05) immediately after whole body cryotherapy (19.0±0.9 °C) compared to cold water immersion (20.5±0.6 °C). However, from 10 to 60 min post, the average, minimum and maximum skin temperatures were lower (p<0.05) following the cold water treatment. Finally, neither protocol achieved a skin temperature believed to be required to elicit an analgesic effect. © Georg Thieme Verlag KG Stuttgart · New York.

Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy.

PubMed

Wu, Cheng; Hua, Li-Xin; Zhang, Jian-Zhong; Zhou, Xun-Rong; Zhong, Wei; Ni, Hao-Dong

2017-01-01

This study was proposed to compare the clinical effectiveness of mini-tract percutaneous nephrolithotomy (MPCNL) with standard-tract percutaneous nephrolithotomy (SPCNL) and verify whether MPCNL is associated with both higher renal pelvic pressure (RPP) and incidence of postoperative fever. A total of 228 patients with kidney stone were randomly allocated to the MPCNL group (n=114) and SPCNL group (n=114). Both intraoperative and postoperative indexes along with the incidence of complications were compared between the two treatment groups. RPP was measured using a baroreceptor which was connected to an open-ended ureteric catheter during the operation of percutaneous nephrolithotomy. The MPCNL group exhibited significantly longer average operation time, more average amount of flush water, and lesser average amount of bleeding during the operation than the SPCNL group (p<0.05). Moreover, significantly lesser average amount of postoperative serum creatinine, shorter average hospital stay, and more average amount of postoperative hemoglobin were observed in the MPCNL group than in the SPCNL group (p<0.05). MPCNL were more applicable to clear caliceal stones (p<0.05), whereas SPCNL were more effective for the removal of simple pelvic stones. The difference in the incidence of postoperative fever between the two treatment groups also appeared to be significant (p<0.05). Logistic regression provided solid evidence that both RPP and its accumulation time at which RPP≥30 mmHg significantly affected the incidence of postoperative fever. MPCNL was correlated with both higher RPP and increased likelihood of postoperative fever compared with SPCNL. Copyright © 2016 The Authors. Published by Elsevier Taiwan.. All rights reserved.

Effects of chito-oligosaccharide supplementation on performance, nutrient digestibility, and serum composition in broiler chickens.

PubMed

Li, X J; Piao, X S; Kim, S W; Liu, P; Wang, L; Shen, Y B; Jung, S C; Lee, H S

2007-06-01

A total of 196 day-old male broiler chicks were randomly allocated to 1 of 4 treatments in a study conducted to determine the effects of dietary supplementation of chito-oligosaccharide (COS) on growth, nutrient digestibility, and serum composition. The experimental diets consisted of an unsupplemented control diet based on corn, soybean meal, and fish meal or similar diets supplemented with either chlortetracycline, 50 mg/kg of COS, or 100 mg/kg of COS. Each treatment was fed to 7 replicate pens of birds, with 7 birds per pen. Broiler performance, nutrient digestibility, cecal microbial concentrations, and serum indices were measured at the end of the starter (d 21) and grower phases (d 42). During the starter period and overall, broilers fed 50 or 100 mg/kg of COS had better (P<0.05) average daily gain, average daily feed intake, and feed conversion than the control birds. The performance of birds fed chlortetracycline was generally intermediate between that of the control and the 2 COS treatments. Compared with the birds in the control or chlortetracycline treatments, the birds receiving 100 mg/kg of COS had better nutrient digestibility of DM, energy, calcium, and phosphorus; higher (P<0.05) concentrations of cecal Lactobacillus; and lower (P<0.05) serum triglyceride and total cholesterol during the starter phase. During the grower phase, the birds fed 100 mg/kg of COS had higher (P<0.05) calcium digestibility and CP retention than those fed the chlortetracycline treatment, and lower concentrations of cecal Escherichia coli than birds in the control treatment. The serum growth hormone level in birds fed 50 mg/kg of COS was higher (P<0.05) than in the other treatments. The birds fed 100 mg/kg of COS had lower (P<0.05) serum triglyceride, higher (P<0.05) serum high-density lipoprotein cholesterol, and higher serum total protein content than birds in the other treatments. In conclusion, dietary supplementation with COS appeared to improve the average daily gain of broilers by increasing the average daily feed intake and nutrient digestibility and modulating the concentrations of cecal microbial flora. Additionally, COS increased serum protein and high-density lipoprotein cholesterol and decreased serum triglyceride.

Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/segmental nerve for lumbar radicular pain.

PubMed

Nagda, Jyotsna V; Davis, Craig W; Bajwa, Zahid H; Simopoulos, Thomas T

2011-01-01

Chronic lumbosacral radicular pain is a common source of radiating leg pain seen in pain management patients. These patients are frequently managed conservatively with multiple modalities including medications, physical therapy, and epidural steroid injections. Radiofrequency has been used to treat chronic radicular pain for over 30 years; however, there is a paucity of literature about the safety and efficacy of repeat radiofrequency lesioning. To determine the safety, success rate, and duration of pain relief of repeat pulsed radiofrequency (PRF) and continuous radiofrequency (CRF) lesioning of the dorsal root ganglion (DRG)/ sacral segmental nerves (SN) in patients with chronic lumbosacral radicular pain. Retrospective chart review Outpatient multidisciplinary pain center Medical record review of patients who were treated with pulsed and continuous radiofrequency lesioning of the lumbar dorsal root ganglia and segmental nerves and who reported initial success were evaluated for recurrence of pain and repeat radiofrequency treatment. Responses to subsequent treatments were compared to initial treatments for success rates, average duration of relief, and adverse neurologic side-effects. Retrospective chart review without a control group. Twenty-six women and 24 men were identified who received 50% pain relief or better after PRF and CRF of the lumbar DRG/ sacral SN for lumbosacral radicular pain. The mean age was 62 years (range, 25-86). The mean duration of relief for the 40 patients who had 2 treatments was 4.7 months (range 0-24; Se [standard error] 0.74). Twenty-eight patients had 3 treatments with an average duration of relief of 4.5 months (range 0-19 months; Se 0.74). Twenty patients had 4 treatments with a mean duration of relief of 4.4 months (range 0.5-18; Se 0.95) and 18 patients who had 5 or more treatments received an average duration of relief of 4.3 months (range 0.5-18; Se 1.03). The average duration of relief and success frequency remained constant after each subsequent radiofrequency treatment. Of the 50 total patients, there was only 1 reported complication, specifically, transient thigh numbness which resolved after one week. Repeated pulsed and continuous radiofrequency ablation of the lumbar dorsal root ganglion/segmental nerve shows promise to be a safe and effective long-term palliative management for lumbosacral radicular pain in some patients.

Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers.

PubMed

Fields, Dail; Pruett, Jana; Roman, Paul M

2015-01-01

The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA.

Measuring treatment costs of typical waste electrical and electronic equipment: A pre-research for Chinese policy making.

PubMed

Li, Jinhui; Dong, Qingyin; Liu, Lili; Song, Qingbin

2016-11-01

Waste Electrical and Electronic Equipment (WEEE) volume is increasing, worldwide. In 2011, the Chinese government issued new regulations on WEEE recycling and disposal, establishing a WEEE treatment subsidy funded by a levy on producers of electrical and electronic equipment. In order to evaluate WEEE recycling treatment costs and revenue possibilities under the new regulations, and to propose suggestions for cost-effective WEEE management, a comprehensive revenue-expenditure model (REM), were established for this study, including 7 types of costs, 4 types of fees, and one type of revenue. Since TV sets dominated the volume of WEEE treated from 2013 to 2014, with a contribution rate of 87.3%, TV sets were taken as a representative case. Results showed that the treatment cost varied from 46.4RMB/unit to 82.5RMB/unit, with a treatment quantity of 130,000 units to 1,200,000 units per year in China. Collection cost accounted for the largest portion (about 70.0%), while taxes and fees (about 11.0 %) and labor cost (about 7.0 %) contributed less. The average costs for disposal, sales, and taxes had no influence on treatment quantity (TQ). TQ might have an adverse effect on average labor and management costs; while average collection and purchase fees, and financing costs, would vary with purchase price, and the average sales fees and taxes would vary with the sales of dismantled materials and other recycled products. Recycling enterprises could reduce their costs by setting up online and offline collection platforms, cooperating with individual collectors, creating door-to-door collection channels, improving production efficiency and reducing administrative expenditures. The government could provide economic incentives-such as subsidies, low-cost loans, tax cuts and credits-and could also raise public awareness of waste management and environmental protection, in order to capture some of the WEEE currently discarded into the general waste stream. Foreign companies with advanced WEEE utilization technology could invest or participate in this area, producing profits for themselves while helping to develop and implement environmentally friendly and energy-saving technologies applicable to the Chinese market. Copyright © 2016 Elsevier Ltd. All rights reserved.

Treatment of concentrated industrial wastewaters originating from oil shale and the like by electrolysis polyurethane foam interaction

DOEpatents

Tiernan, Joan E.

1990-01-01

Highly concentrated and toxic petroleum-based and synthetic fuels wastewaters such as oil shale retort water are treated in a unit treatment process by electrolysis in a reactor containing oleophilic, ionized, open-celled polyurethane foams and subjected to mixing and laminar flow conditions at an average detention time of six hours. Both the polyurethane foams and the foam regenerate solution are re-used. The treatment is a cost-effective process for waste-waters which are not treatable, or are not cost-effectively treatable, by conventional process series.

IS INCREASED HCV CASE-FINDING COMBINED WITH CURRENT OR 8–12 WEEK DAA THERAPY COST-EFFECTIVE IN UK PRISONS? A PREVENTION BENEFIT ANALYSIS

PubMed Central

Martin, Natasha K; Vickerman, Peter; Brew, Iain F; Williamson, Joan; Miners, Alec; Irving, William L; Saksena, Sushma; Hutchinson, Sharon J; Mandal, Sema; O’Moore, Eamonn; Hickman, Matthew

2016-01-01

Background Prisoners have a high prevalence of Hepatitis C virus (HCV), but case-finding may not have been cost-effective because treatment often exceeded average prison stay combined with a lack of continuity-of-care. We assess the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. Methods A dynamic HCV transmission model assesses the cost-effectiveness of doubling HCV case-finding (achieved through introducing opt-out HCV testing in UK pilot prisons) and increasing treatment in UK prisons, compared to status-quo voluntary risk-based testing (6% prison entrants/year), using currently recommended therapies (8–24 weeks) or IFN-free DAAs (8–12 weeks, 95% SVR, £3300/wk). Costs (GBP£) and health utilities (quality-adjusted life-years, QALYs) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assume 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/exPWID treated within 2 months of diagnosis in prison. PWID and ex/nonPWID are in prison an average 4/8 months, respectively. Results Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/QALY gained compared to current testing/treatment, and is 45% likely to be cost-effective under a £20,000 willingness-to-pay (WTP) threshold. Switching to 8–12 week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/QALY gained). Excluding prevention benefit decreases cost-effectiveness. If >10% referred PWID are treated in prison (2.5% base-case), either treatment could be highly cost-effective (ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or 8 weeks duration. Conclusions Increased HCV testing in UK prisons (such as through opt-out testing) is borderline cost-effective compared to status-quo voluntary risk-based testing under a £20,000 WTP with current treatments, but likely to be cost-effective if short-course IFN-free DAAs are used, and could be highly cost-effective if PWID treatment rates were increased. PMID:26864802

Incremental cost-utility of sevelamer relative to calcium carbonate for treatment of hyperphosphatemia among pre-dialysis chronic kidney disease patients.

PubMed

Nguyen, Hai V; Bose, Saideep; Finkelstein, Eric

2016-04-28

Sevelamer is an alternative to calcium carbonate for the treatment of hyperphosphatemia among non-dialysis dependent patients with chronic kidney disease (CKD). Although some studies show that it may reduce mortality and delay the onset of dialysis when compared to calcium carbonate, it is also significantly more expensive. Prior studies looking at the incremental cost-effectiveness of sevelamer versus calcium carbonate in pre-dialysis patients are based on data from a single clinical trial. The goal of our study is to use a wider range of clinical data to achieve a more contemporary and robust cost-effectiveness analysis. We used a Markov model to estimate the lifetime costs and quality-adjusted life years (QALYs) gained for treatment with sevelamer versus calcium carbonate. The model simulated transitions among three health states (CKD not requiring dialysis, end-stage renal disease, and death). Data on transition probabilities and utilities were obtained from the published literature. Costs were calculated from a third party payer perspective and included medication, hospitalization, and dialysis. Sensitivity analyses were also run to encompass a wide range of assumptions about the dose, costs, and effectiveness of sevelamer. Over a lifetime, the average cost per patient treated with sevelamer is S$180,724. The estimated cost for patients treated with calcium carbonate is S$152,988. A patient treated with sevelamer gains, on average, 6.34 QALYs relative to no treatment, whereas a patient taking calcium carbonate gains 5.81 QALYs. Therefore, sevelamer produces an incremental cost-effectiveness ratio (ICER) of S$51,756 per QALY gained relative to calcium carbonate. Based on established benchmarks for cost-effectiveness, sevelamer is cost effective relative to calcium carbonate for the treatment of hyperphosphatemia among patients with chronic kidney disease initially not on dialysis.

Evaluation of the clastogenicity and anticlastogenicity of vitamin B6 in human lymphocyte cultures.

PubMed

Takeuchi, Paula Lumy; Antunes, Lusânia Maria Greggi; Takahashi, Catarina Satie

2007-06-01

Insufficient intakes of many micronutrients found in fruits and vegetables, such as folic acid, vitamins C and B6 may lead to DNA damage, cancer, and degenerative disease. The investigation of dietary antioxidants is a field of great interest for elucidating mechanisms of mutagenesis/carcinogenesis. The present study was undertaken to investigate the effects of vitamin B6 on the induction of chromosomal aberrations in cultured human lymphocytes and to examine the possible anticlastogenic effect of this vitamin on chromosomal damage induced by the antitumor drug doxorubicin. The results showed that when the cultures treated with vitamin B6 were compared with the untreated control in terms of total chromosomal damage and abnormal metaphases, pre- and simultaneous treatment with this vitamin showed no significant differences. In the post-treatment, average and above average concentrations of vitamin B6 alone showed a clastogenic effect. In the simultaneous protocol, this vitamin (15, 90 and 120 microg/mL) was effective in inhibiting chromosomal aberrations induced by doxorubicin (p<0.05), with a reduction of 33.1% with the highest concentration tested. However, in the post-treatment, the associations of vitamin B6 and doxorubicin exerted a more evident clastogenic effect than that observed in the cultures exposed only to the antitumor drug. In the present investigation, the inability of vitamin B6 to decrease chromosomal damage induced by doxorubicin in the pre- and post-treatments could be justified by the instability of this vitamin as a free radical scavenger. In conclusion, the results from this study confirmed that vitamin B6 is protective against chromosomal damage induced by doxorubicin in cultured human lymphocytes, but that the effects depend on concentration and form of treatment.

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

Canini, Laetitia; Chatterjee, Anushree; Guedj, Jeremie

Background—Viral kinetic models have proven useful to characterize treatment effectiveness during HCV therapy with interferon (IFN) or with direct acting antivirals (DAAs). Methods—We use a pharmacokinetic/viral kinetic (PK/VK) model to describe HCV RNA kinetics during treatment with danoprevir, a protease inhibitor. In a phase 1 study, danoprevir monotherapy was administered for 14 days in ascending doses ranging from 200 to 600 mg per day to 40 patients of whom 32 were treatment-naïve and 8 were non-responders to prior PEG-IFN-α/ribavirin treatment. Results—In most patients, a biphasic decline of HCV RNA during therapy was observed. A two-compartment PK model and a VKmore » model that considered treatment effectiveness to vary with the predicted danoprevir concentration inside the second compartment provided a good fit to the viral load data. A time-varying effectiveness model was also used to fit the viral load data. We found the antiviral effectiveness increased in a dose-dependent manner, with a 14-day time-averaged effectiveness of 0.95 at the lowest dose (100 mg bid) and 0.99 at the highest dose (200 mg tid). Prior IFN non-responders exhibited a 14-day time-averaged effectiveness of 0.98 (300 mg bid). Finally, the second phase decline showed two different behaviors, with 30% of patients exhibiting a rapid decline of HCV RNA, comparable to that seen with other protease inhibitors (>0.3 d-1), whereas the viral decline was slower in the other patients. Conclusions—Our results are consistent with the modest SVR rates from the INFORM-SVR study where patients were treated with a combination of mericitabine and ritonavir-boosted danoprevir.« less

Antibiotics for asymptomatic bacteriuria in pregnancy.

PubMed

Smaill, Fiona M; Vazquez, Juan C

2015-08-07

Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 March 2015) and reference lists of retrieved studies. Randomized trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Fourteen studies, involving almost 2000 women, were included. Antibiotic treatment compared with placebo or no treatment reduced the incidence of pyelonephritis (average risk ratio (RR) 0.23, 95% confidence interval (CI) 0.13 to 0.41; 11 studies, 1932 women; very low quality evidence). Antibiotic treatment was also associated with a reduction in the incidence of low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; six studies, 1437 babies; low quality evidence) and preterm birth (RR 0.27, 95% CI 0.11 to 0.62; two studies, 242 women; low quality evidence). A reduction in persistent bacteriuria at the time of delivery was seen (average RR 0.30, 95% CI 0.18 to 0.53; four studies; 596 women). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes and maternal adverse effects were rarely described.Overall, all 14 studies were assessed as being at high or unclear risk of bias. While many studies lacked an adequate description of methods and the risk of bias could only be assessed as unclear, in almost all studies there was at least one domain where the risk of bias was judged as high. The three primary outcomes were assessed with GRADE software and given a quality rating. Evidence for pyelonephritis, preterm birth and birthweight less than 2500 g was assessed as of low or very low quality. While antibiotic treatment is effective in reducing the risk of pyelonephritis in pregnancy, the estimate of the effect is very uncertain because of the very low quality of the evidence. The reduction in low birthweight and preterm birth with antibiotic treatment is consistent with theories about the role of infection in adverse pregnancy outcomes, but this association should be interpreted with caution given the very poor quality of the included studies.

Quasi-analytical treatment of spatially averaged radiation transfer in complex terrain

NASA Astrophysics Data System (ADS)

Löwe, H.; Helbig, N.

2012-04-01

We provide a new quasi-analytical method to compute the topographic influence on the effective albedo of complex topography as required for meteorological, land-surface or climate models. We investigate radiative transfer in complex terrain via the radiosity equation on isotropic Gaussian random fields. Under controlled approximations we derive expressions for domain averages of direct, diffuse and terrain radiation and the sky view factor. Domain averaged quantities are related to a type of level-crossing probability of the random field which is approximated by longstanding results developed for acoustic scattering at ocean boundaries. This allows us to express all non-local horizon effects in terms of a local terrain parameter, namely the mean squared slope. Emerging integrals are computed numerically and fit formulas are given for practical purposes. As an implication of our approach we provide an expression for the effective albedo of complex terrain in terms of the sun elevation angle, mean squared slope, the area averaged surface albedo, and the direct-to-diffuse ratio of solar radiation. As an application, we compute the effective albedo for the Swiss Alps and discuss possible generalizations of the method.

A study of respiration-correlated cone-beam CT scans to correct target positioning errors in radiotherapy of thoracic cancer

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

Santoro, J. P.; McNamara, J.; Yorke, E.

2012-10-15

Purpose: There is increasingly widespread usage of cone-beam CT (CBCT) for guiding radiation treatment in advanced-stage lung tumors, but difficulties associated with daily CBCT in conventionally fractionated treatments include imaging dose to the patient, increased workload and longer treatment times. Respiration-correlated cone-beam CT (RC-CBCT) can improve localization accuracy in mobile lung tumors, but further increases the time and workload for conventionally fractionated treatments. This study investigates whether RC-CBCT-guided correction of systematic tumor deviations in standard fractionated lung tumor radiation treatments is more effective than 2D image-based correction of skeletal deviations alone. A second study goal compares respiration-correlated vs respiration-averaged imagesmore » for determining tumor deviations. Methods: Eleven stage II-IV nonsmall cell lung cancer patients are enrolled in an IRB-approved prospective off-line protocol using RC-CBCT guidance to correct for systematic errors in GTV position. Patients receive a respiration-correlated planning CT (RCCT) at simulation, daily kilovoltage RC-CBCT scans during the first week of treatment and weekly scans thereafter. Four types of correction methods are compared: (1) systematic error in gross tumor volume (GTV) position, (2) systematic error in skeletal anatomy, (3) daily skeletal corrections, and (4) weekly skeletal corrections. The comparison is in terms of weighted average of the residual GTV deviations measured from the RC-CBCT scans and representing the estimated residual deviation over the treatment course. In the second study goal, GTV deviations computed from matching RCCT and RC-CBCT are compared to deviations computed from matching respiration-averaged images consisting of a CBCT reconstructed using all projections and an average-intensity-projection CT computed from the RCCT. Results: Of the eleven patients in the GTV-based systematic correction protocol, two required no correction, seven required a single correction, one required two corrections, and one required three corrections. Mean residual GTV deviation (3D distance) following GTV-based systematic correction (mean {+-} 1 standard deviation 4.8 {+-} 1.5 mm) is significantly lower than for systematic skeletal-based (6.5 {+-} 2.9 mm, p= 0.015), and weekly skeletal-based correction (7.2 {+-} 3.0 mm, p= 0.001), but is not significantly lower than daily skeletal-based correction (5.4 {+-} 2.6 mm, p= 0.34). In two cases, first-day CBCT images reveal tumor changes-one showing tumor growth, the other showing large tumor displacement-that are not readily observed in radiographs. Differences in computed GTV deviations between respiration-correlated and respiration-averaged images are 0.2 {+-} 1.8 mm in the superior-inferior direction and are of similar magnitude in the other directions. Conclusions: An off-line protocol to correct GTV-based systematic error in locally advanced lung tumor cases can be effective at reducing tumor deviations, although the findings need confirmation with larger patient statistics. In some cases, a single cone-beam CT can be useful for assessing tumor changes early in treatment, if more than a few days elapse between simulation and the start of treatment. Tumor deviations measured with respiration-averaged CT and CBCT images are consistent with those measured with respiration-correlated images; the respiration-averaged method is more easily implemented in the clinic.« less

Comparison of clinical effectiveness of laser acupuncture and amitriptyline in diabetic peripheral neuropathy (DPN): a sham controlled randomized clinical trial

NASA Astrophysics Data System (ADS)

Hassan Khan, Imran; Anwar, Shahzad; Hanif, Asif; Ayub, Muhammad; Jamil Raja, Arsalan

2014-02-01

Background: Painful neuropathy is a very common complication in diabetic patients. Various treatment strategies like manual therapies, conservative management, drug therapy and exercise have been opted for this problem. Studies have shown clinical effectiveness of laser acupuncture as well. On the other hand, Amitryptaline is also a commonly used treatment for this disease. We aim to compare the efficacy of both treatments. Objective: To assess the effect of laser acupuncture in patients suffering from painful diabetic neuropathy and its comparison with standard of care. Patients and Method: This study was conducted in Diabetic and Endocrine Management Center (DEMC) Lahore General Hospital, Lahore, Pakistan. A randomized control trial (RCT) was opted and a total of 164 patients were chosen using Non-probability purposive sampling technique. Pain was graded by using a patient friendly Visual Analogue Score (VAS), scoring from 0 to 10. Treatment was done involving organized fortnightly follow ups. Data of all patients was recorded on Performa and was entered and analyzed for descriptive statistics in PASW 18 (IBM®. SPSS). Results: A total of 164 subjects were included in the study who were subdivided into three groups labeled as A, B and C for laser therapy treatment, amitryptaline treatment and controls respectively. The mean age of subjects was 51.54+/-10.46 in Group A, 49.38+/-10.56 in Group B and 51.70+/-11.43 in Group C. The difference of mean ages in all study groups was statistically insignificant (p-value= 0.469). The average pain score in patients who received laser therapy was 5.95+/-0.91 before treatment, whereas after treatment it was 4.31+/-0.98. The mean pain score in subjects having Amitryptaline before starting the treatment was 6.87+/-0.71 and after treatment, it was 6.23+/-0.98. The mean score for daily life activities in subjects who received laser therapy was 9.562.37 before treatment, while after treatment it was 7.56+/-1.54. The average score for daily life activities in patients having Amitryptaline before starting the treatment was 9.05+/-1.93 and after treatment, it was 8.11+/-1.71. Average depression and anxiety score in patients receiving laser therapy was 9.29+/-2.28 before treatment, whereas after treatment it was found to be 7.42+/-1.91. Similarly, the mean depression and anxiety score in patients of Amitryptaline group before starting the treatment was 9.38+/-2.21 and after treatment, it was 8.38+/-2.14. Conclusion: The mean score in our study reveals that laser therapy shows better outcomes in improvement of pain relief, depression, anxiety and daily life activities compared to amitryptaline in patients of diabetic neuropathy.

76 FR 55658 - Applications for New Awards; Supporting Effective Educator Development Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

... defined in this notice), or other strategies. Definitions: Carefully matched comparison group design means... in the project (control group). The effect of the project is the average difference in outcomes between the treatment and control groups. High-need students means students at risk of educational failure...

School Counseling Outcome: A Meta-Analytic Examination of Interventions

ERIC Educational Resources Information Center

Whiston, Susan C.; Tai, Wendi Lee; Rahardja, Daryn; Eder, Kelly

2011-01-01

The effectiveness of school counseling interventions is important in this era of evidence-based practices. In this study, Meta-Analysis 1 involved treatment-control comparisons and Meta-Analysis 2 involved pretest-posttest differences. The overall average weighted effect size for school counseling interventions was 0.30. The study examined whether…

What Is the Minimum Information Needed to Estimate Average Treatment Effects in Education RCTs?

ERIC Educational Resources Information Center

Schochet, Peter Z.

2014-01-01

Randomized controlled trials (RCTs) are considered the "gold standard" for evaluating an intervention's effectiveness. Recently, the federal government has placed increased emphasis on the use of opportunistic experiments. A key criterion for conducting opportunistic experiments, however, is that there is relatively easy access to data…

The experimental evidence for weight-loss treatment of essential hypertension: a critical review.

PubMed Central

Hovell, M F

1982-01-01

The empirical evidence concerning the therapeutic effects of weight loss for hypertension treatment was reviewed. Interventions were critically reviewed for strength of measures and experimental design. Six of 21 intervention studies proved to be methodologically strong. However, only one study was considered a randomized clinical trial, testing the combined effects of weight reduction and pharmacological treatment of hypertension. Average blood pressure decrease obtained from the methodologically strongest studies was -21 mmHg and -13 mmHg, for systolic and diastolic measures, respectively. This magnitude change suggests that weight loss may be a clinically and statistically significant treatment. Confounding and bias variables, such as adherence to diet, medication, salt consumption, etc., were discussed and future areas of research were outlined. It was concluded that weight loss appears to be an effective and safe treatment of hypertension. PMID:7039371

[Influence of the effect of general anaesthesia and restraint during dental treatment on dental anxiety and behavior in children].

PubMed

Zhang, Hong-mei; Xia, Bin; Wang, Jian-hong; Chen, Xiao-xian; Ge, Li-hong

2015-02-18

To compare the level of dental anxiety and dental behavior between dental fear children with dental treatment under general anaesthesia (GA) and those under restraint. The GA group included 31 dental fear children aged 4-6-year-old who received dental treatment under the GA. The restraint group included 31 dental fear children aged 4-6-year-old who received dental treatment under the restraint. Age, gender, parent's education level, decayed-missing-filled-tooth (dmft) and face version of the Modified Child Dental Anxiety Scale (MCDASf) score before treatment were matched between the two groups. The Chinese version of MCDASf was used to evaluate the level of dental anxiety in each child before treatment, right after treatment and before examination at recall visit 2-3 weeks after treatment. And the Chinese version of Venham Clinical Anxiety and Cooperative Behavior Scale was used to evaluate children's dental behavior in each child before treatment and before examination at recall visit 2-3 weeks after treatment. The average scores of MCDASf in GA group right after treatment and before recall were lower than that before treatment. The difference was statistically significant (P<0.05). Furthermore, the average score of MCDASf before recall was lower than those after treatment, and the difference was statistically significant (P<0.05). The average scores of MCDASf in restraint group right after treatment and 2-3 weeks after treatment were higher than those before treatment, but the difference was not statistically significant (P>0.05). Children's dental behavior was significantly improved at recall visit in both groups (P<0.01). Dental fear could be reduced by treatment under GA. The children's dental behavior was improved after GA. Restraint did not result in the significant elevation of dental anxiety level, but dental behavior was improved after restraint during the short-term recall.

A novel anoxic-aerobic biofilter process using new composite packing material for the treatment of rural domestic wastewater.

PubMed

Pan, L T; Han, Y

2016-01-01

A pilot scale experiment was conducted to evaluate the characteristics of contaminants removal in a continuously two-stage biological process composed of an anoxic biofilter (AF) and an biological aerated filter (BAF). This novel process was developed by introducing new composite packing material (MZF) into bioreactors to treat rural domestic wastewater. A comparative study conducted by the same process with ceramsite as packing material under the same conditions showed that a MZF system with a Fe proportion in the packing material performed better in chemical oxygen demand (COD) removal (average 91.5%), ammonia (NH4(+)-N) removal (average 98.3%), total nitrogen (TN) removal (average 64.8%) and total phosphorus (TP) removal (average 90%). After treatment of the MZF system, the concentrations of COD, NH4(+)-N, TN and TP in effluent were 20.3 mg/L, 0.5 mg/L, 11.5 mg/L and 0.3 mg/L, respectively. The simultaneously high efficiencies of nitrification, denitrification and phosphorus removal were achieved by the coupling effects of biological and chemical processes in the MZF system. The results of this study showed that the application of MZF might be a favorable choice as packing material in biofilters for treatment of rural domestic wastewater.

[Manipulative reduction and small splint fixation combined with micromovement exercise for treatment of humeral shaft fractures].

PubMed

Tang, Hao-chen; Xiang, Ming; Chen, Hang; Hu, Xiao-chuan; Yang, Guo-yong

2016-01-01

To investigate the therapeutic efficacy of bone-setting manipulative reduction and small splint fixation combined with micro-movement theory exercise for treatment of humeral shaft fractures. From March 2011 to February 2014, 64 cases of humeral shaft fractures were treated by bone-setting manipulative reduction and small splint fixation including 28 males and 36 females with an average age of 38.1 years old ranging from 22 to 67 years old. According to the classification of AO/OTA, there were 10 cases of type A1, 12 cases of type A2,11 cases of type A3,10 cases of type B1,12 cases of type B2, 7 cases of type B3, 2 cases of type C1, 1 case of type C2, 1 case of type C3. After close reduction early functional exercise performed according to micro-movement theory. All patients had no other parts of the fractures, neurovascular injury, and serious medical problems. Patients were followed up for fracture healing, shoulder and elbow joint function recovery, and curative effect. All patients were followed up from 10 to 12 months with an average of 10.3 months. Of them, 2 cases had a small amount of callus growth at 3 months after close reduction, so instead of operation; 2 cases appeared radial nerve symptoms after close reduction ,so instead of operation. Other patients were osseous healing, the time was 8 to 12 weeks with an average of 10.2 weeks. After osseous healing, according to Constant-Murley score system ,the average score was (93.5 ± 3.2) points, the result was excellent in 29 cases, good in 29 cases, fair in 6 cases, excellent and good rate was 90.3%; according to the Mayo score system, the average score was (93.7 ± 4.2) points, the result was excellent in 35 cases, good in 23 cases, fair in 6 cases, excellent and good rate was 91.9%. Bone-setting manipulative reduction and small splint fixation combined with micromovement theory exercise for treatment of humeral shaft fractures has advantage of positive effect, easy and inexpensive method, the treatment has relevant scientific basis and practical value, it can effectively reduce complications, promote patients early recovery.

Pharmacoeconomic analysis of recombinant factor VIIa versus APCC in the treatment of minor-to-moderate bleeds in hemophilia patients with inhibitors.

PubMed

Joshi, Ashish V; Stephens, Jennifer M; Munro, Vicki; Mathew, Prasad; Botteman, Marc F

2006-01-01

To compare the cost-effectiveness of three treatment regimens using recombinant activated Factor VII (rFVIIa), NovoSeven, and activated prothrombin-complex concentrate (APCC), FEIBA VH, for home treatment of minor-to-moderate bleeds in hemophilia patients with inhibitors. A literature-based, decision-analytic model was developed to compare three treatment regimens. The regimens consisting of first-, second-, and third-line treatments were: rFVIIa-rFVIIa-rFVIIa; APCC-rFVIIa-rFVIIa; and APCC-APCC-rFVIIa. Patients not responding to first-line treatment were administered second-line treatment, and those failing second-line received third-line treatment. Using literature and expert opinion, the model structure and base-case inputs were adapted to the US from a previously published analysis. The percentage of evaluable bleeds controlled with rFVIIa and APCC were obtained from published literature. Drug costs (2005 US$) based on average wholesale price were included in the base-case model. Univariate and probabilistic sensitivity analyses (second-order Monte Carlo simulation) were conducted by varying the efficacy, re-bleeding rates, patient weight, and dosing to ascertain robustness of the model. In the base-case analysis, the average cost per resolved bleed using rFVIIa as first-, second-, and third-line treatment was $28 076. Using APCC as first-line and rFVIIa as second- and third-line treatment resulted in an average cost per resolved bleed of $30 883, whereas the regimen using APCC as first- and second-line, and rFVIIa as third-line treatment was the most expensive, with an average cost per resolved bleed of $32 150. Cost offsets occurred for the rFVIIa-only regimen through avoidance of second and third lines of treatment. In probabilistic sensitivity analyses, the rFVIIa-only strategy was the least expensive strategy more than 68% of the time. The management of minor-to-moderate bleeds extends beyond the initial line of treatment, and should include the economic impact of re-bleeding and failures over multiple lines of treatment. In the majority of cases, the rFVIIa-only regimen appears to be a less expensive treatment option in inhibitor patients with minor-to-moderate bleeds over three lines of treatment.

[Cost effectiveness in treatment of acute myeloid leukemia].

PubMed

Nordmann, P; Schaffner, A; Dazzi, H

2000-12-23

Although the rise in health costs is a widely debated issue, in Switzerland it was until recently taken for granted that patients are given the best available treatment regardless of cost. An example of a disease requiring costly treatment is acute myelogenous leukaemia (AML). To relate cost to benefit we calculated expenditure per life years gained. To assess costs we determined the real cost of treatment up to total remission, followed by consolidation or withdrawal of treatment or death. For survival time exceeding the 2-year observation period we used data from recent literature. The average cost of treatment ranges up to 107,592 Swiss francs (CHF). In 1997 we treated 23 leukaemia patients at Zurich University Hospital and gained a total of 210 life years. This represents an average cost of CHF 11,741 per life year gained. Chief cost items were therapy and personnel costs for nursing staff, followed by hotel business and personnel costs for doctors and diagnosis. Our results for AML treatment are far removed from the $61,500 ranging up to $166,000 discussed in the literature as the "critical" QALY (quality adjusted life years) value. This is the first time the actual costs of AML therapy have been shown for a Swiss cohort. Despite high initial treatment costs and success only in a limited number of patients, the expenditure per QALY is surprisingly low and shows clearly the effectiveness of apparently costly acute medicine.

Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm.

PubMed

Wang, Wendy T J; Olson, Sharon L; Campbell, Anne H; Hanten, William P; Gleeson, Peggy B

2003-03-01

The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention. One treatment group of 30 patients with neck pain completed physical therapy treatment. The control group of convenience was formed by a cohort group of 27 subjects who also had neck pain but did not receive treatment for various reasons. There were no significant differences between groups in demographic data and the initial test scores of the outcome measures. A quasi-experimental, nonequivalent, pretest-posttest control group design was used. A physical therapist rendered an eclectic intervention to the treatment group based on a clinical decision-making algorithm. Treatment outcome measures included the following five dependent variables: cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion endurance test, and the Patient Specific Functional Scale. Both the treatment and control groups completed the initial and follow-up examinations, with an average duration of 4 wk between tests. Five mixed analyses of variance with follow-up tests showed a significant difference for all outcome measures in the treatment group compared with the control group. After an average 4 wk of physical therapy intervention, patients in the treatment group demonstrated statistically significant increases of cervical range of motion, decrease of pain, increases of physical performance measures, and decreases in the level of disability. The control group showed no differences in all five outcome variables between the initial and follow-up test scores. This study delineated algorithm-based clinical reasoning strategies for evaluating and treating patients with cervical pain. The algorithm can help clinicians classify patients with cervical pain into clinical patterns and provides pattern-specific guidelines for physical therapy interventions. An organized and specific physical therapy program was effective in improving the status of patients with neck pain.

Effects of Alcohol on the Pharmacokinetics of Blonanserin and N-Deethylated Blonanserin in Healthy Chinese Subjects.

PubMed

Deng, Shuhua; Ni, Xiaojia; Shang, Dewei; Wang, Zhanzhang; Zhang, Ming; Hu, Jinqing; Zhu, Xiuqing; Lu, Haoyang; Chen, Yuqing; Zhang, Yuefeng; Peng, Huan; Wen, Yuguan

2018-04-01

Blonanserin is a novel antipsychotic drug approved for the treatment of schizophrenia in East Asia. The main objective of the present study was to investigate the effect of alcohol on the pharmacokinetic properties of blonanserin and its metabolite N-deethyl blonanserin in healthy Chinese male subjects under fasting conditions. The study was designed as a randomized, open-label, crossover clinical investigation in 10 male volunteers, each of whom received 2 treatments under fasted conditions: treatment A, blonanserin (8 mg) with water, and treatment B, blonanserin (8 mg) with alcohol (1 mL/kg). The average values of areas under the curve (AUCs) and mean peak plasma concentrations (Cmax) were noticeably increased by alcohol consumption. In treatment A, average values of AUC0-24h, AUC0-∞, and Cmax were 3178 ng/h/L, 3879 ng/h/L, and 492 ng/L for blonanserin, and 1932 ng/h/L, 4208 ng/h/L, and 137 ng/L for N-deethylated blonanserin, respectively. In treatment B, AUC0-∞ and Cmax were both increased 2.4-fold for blonanserin and 1.4-fold and 1.7-fold, respectively, for N-deethylated blonanserin (P < 0.05). Compared with treatment A, clearance (Clz/F) of blonanserin and N-deethylated blonanserin decreased significantly (2.4-fold and 1.7-fold, respectively) in treatment B (P < 0.05). Alcohol delayed the absorption and reduced the clearance of blonanserin, leading to a 1.8-fold increase in the time to reach Cmax (Tmax) and half life time (t1/2) (P < 0.05). Alcohol increased the bioavailability of blonanserin and N-deethyl blonanserin in healthy subjects and the marked effect of alcohol on blonanserin bioavailability should be taken into consideration in deciding dosing schedules in clinical therapy.

[The costs of new drugs compared to current standard treatment].

PubMed

Ujeyl, Mariam; Schlegel, Claudia; Gundert-Remy, Ursula

2013-01-01

Until AMNOG came into effect Germany had free pricing of new drugs. Our exemplary work investigates the costs of new drugs that were licensed in the two years prior to AMNOG, and compares them to the costs of standard treatment that has been used in pivotal trials. Also, the important components of pharmaceutical prices will be illustrated. We retrospectively analysed the European Public Assessment Reports of proprietary medicinal products that the European Medicinal Agency initially approved in 2009 and 2010 and that were tested against an active control in at least one pivotal trial. If the standard treatment was a generic, the average pharmacy retail price of new drugs was 7.4 times (median 7.1) higher than that of standard treatment. If the standard treatment was an originator drug the average price was 1.4 times (median 1.2) higher than that of the new drug. There was no clear correlation of an increase in costs for new drugs and their "grade of innovation" as rated according to the criteria of Fricke. Our study shows that prices of new drugs must be linked to the evidence of comparative benefit; since German drug pricing is complex, cost saving effects obtained thereby will depend on a range of other rules and decisions. Copyright © 2013. Published by Elsevier GmbH.

[Application of surface electromyography in the treatment of adolescent idiopathic scoliosis with traditional spinal balanced therapy].

PubMed

Du, Hong-Gen; Ye, Shu-Liang; Xu, Jin-Yuan; Jiang, Zhong; Song, Hong-Quan; Yu, Ji-Wei

2013-11-01

To evaluate the values of surface electromyography (sEMG) in the treatment of adolescent idiophathic scoliosis (AIS) with non-surgical therapy. From October 2011 to May 2012, the data of 33 patients with AIS underwent traditional spinal balanced therapy were analyzed. There were 14 males and 19 females with an average age of (15.40 +/- 3.01) years,ranging in Cobb angle from 13 degrees to 40 degrees, course of disease more than 3 months. X-rays showed 21 cases were type C and 9 cases were type S. Preoperative and postoperative 6 months, Cobb angle, the ratio of averaged electromyography paramete (AEMG), security of treatment were observed. Thirty cases (90.9%) accomplished the treatment and detection. No harmful effects to vital sign was found and no fracture, dislocation, apopsychia, infection of pin hole was found. There was positive correlation between the ratio of AEMG and Cobb angle (P = 0.003). The ratio of AEMG decreased after treatment,and indicated the improvement of myosthenic otherness. sEMG can be used as a objective examination in evaluating difference of muscle electricity activity on both concaved and convex sides for patients of AIS, so it is a qualified objective examination for effectiveness evaluation and assessment aggravation risk, and has great value in clinic.

Growth performance of indigenous sheep fed Sporobolus virginicus grass hay grown in saline desert lands and irrigated with high salt content ground water.

PubMed

Alhadrami, G A; Al-Shorepy, S A; Yousef, A M

2010-12-01

Twenty-eight indigenous ewe lambs (6 months of age and 14.4 kg body weight (BW)) were used to evaluate the effect of feeding Sporobolus grass hay (SGH) as the only source of forage on growth, and feed and water intakes. The ewe lambs were randomly and equally allocated to two treatment groups (14 lambs/group). The ewe lambs in group 1 (treatment 1) received SGH, while lambs in group 2 (treatment 2) received Rhodes grass hay (RGH) as the only source of forage. Water was available at all times for both treatment groups. Sporobolus grass was irrigated with brackish water of high salt content (20,000 ppm) and grown in saline desert lands (sabkha) in the United Arab Emirates. The average daily dry matter intake was significantly (P < .05) higher for the animals fed SGH than those fed RGH at all stages. Both water intakes per unit body gain and water intake per unit feed intake were significant (P < .05) between the two treatments group at all stages. Average daily gain did not differ significantly (P > .05) between the two groups at all stages. From these data, we conclude that SGH can replace Rhodes hay in sheep diet without significant effect on sheep performance.

Polarized Line Formation in Arbitrary Strength Magnetic Fields Angle-averaged and Angle-dependent Partial Frequency Redistribution

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

Sampoorna, M.; Nagendra, K. N.; Stenflo, J. O., E-mail: sampoorna@iiap.res.in, E-mail: knn@iiap.res.in, E-mail: stenflo@astro.phys.ethz.ch

Magnetic fields in the solar atmosphere leave their fingerprints in the polarized spectrum of the Sun via the Hanle and Zeeman effects. While the Hanle and Zeeman effects dominate, respectively, in the weak and strong field regimes, both these effects jointly operate in the intermediate field strength regime. Therefore, it is necessary to solve the polarized line transfer equation, including the combined influence of Hanle and Zeeman effects. Furthermore, it is required to take into account the effects of partial frequency redistribution (PRD) in scattering when dealing with strong chromospheric lines with broad damping wings. In this paper, we presentmore » a numerical method to solve the problem of polarized PRD line formation in magnetic fields of arbitrary strength and orientation. This numerical method is based on the concept of operator perturbation. For our studies, we consider a two-level atom model without hyperfine structure and lower-level polarization. We compare the PRD idealization of angle-averaged Hanle–Zeeman redistribution matrices with the full treatment of angle-dependent PRD, to indicate when the idealized treatment is inadequate and what kind of polarization effects are specific to angle-dependent PRD. Because the angle-dependent treatment is presently computationally prohibitive when applied to realistic model atmospheres, we present the computed emergent Stokes profiles for a range of magnetic fields, with the assumption of an isothermal one-dimensional medium.« less

Using Goal Setting, Task Clarification, and Feedback to Increase the Use of the Hands-Free Technique by Hospital Operating Room Staff

ERIC Educational Resources Information Center

Cunningham, Thomas R.; Austin, John

2007-01-01

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from…

Simulated Long-term Effects of the MOFEP Cutting Treatments

Treesearch

David R. Larsen

1997-01-01

Changes in average basal area and volume per acre were simulated for a 35-year pertod using the treatments designated for sites 4, 5, and 6 of the Missouri Ozark Forest Ecosystem Project. A traditional growth and yield model (Central States TWIGS variant of the Forest Vegetation Simulator) was used with Landscape Management System Software to simulate and display...

Biophysical Approach to Mechanisms of Cancer Prevention and Treatment with Green Tea Catechins.

PubMed

Suganuma, Masami; Takahashi, Atsushi; Watanabe, Tatsuro; Iida, Keisuke; Matsuzaki, Takahisa; Yoshikawa, Hiroshi Y; Fujiki, Hirota

2016-11-18

Green tea catechin and green tea extract are now recognized as non-toxic cancer preventives for humans. We first review our brief historical development of green tea cancer prevention. Based on exciting evidence that green tea catechin, (-)-epigallocatechin gallate (EGCG) in drinking water inhibited lung metastasis of B16 melanoma cells, we and other researchers have studied the inhibitory mechanisms of metastasis with green tea catechins using biomechanical tools, atomic force microscopy (AFM) and microfluidic optical stretcher. Specifically, determination of biophysical properties of cancer cells, low cell stiffness, and high deformability in relation to migration, along with biophysical effects, were studied by treatment with green tea catechins. The study with AFM revealed that low average values of Young's moduli, indicating low cell stiffness, are closely associated with strong potential of cell migration and metastasis for various cancer cells. It is important to note that treatments with EGCG and green tea extract elevated the average values of Young's moduli resulting in increased stiffness (large elasticity) of melanomas and various cancer cells. We discuss here the biophysical basis of multifunctions of green tea catechins and green tea extract leading to beneficial effects for cancer prevention and treatment.

Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Osteoid Osteoma: A Case Series Report.

PubMed

Rovella, Marcello S; Martins, Guilherme L P; Cavalcanti, Conrado F A; Bor-Seng-Shu, Edson; Camargo, Olavo P; Cerri, Giovanni G; Menezes, Marcos R

2016-04-01

Osteoid osteoma is painful benign tumor. The aim of this study was to report our initial experience using magnetic resonance-guided focused ultrasound to treat osteoid osteomas. This retrospective single-center study included four patients treated with magnetic resonance-guided focused ultrasound. They presented with severe pain with reduced quality of life and a poor response to clinical treatment. The pre- and post-treatment evaluation comprised computed tomography and magnetic resonance imaging and focused on quality of life and the impact of pain on daily activities. After treatment, three patients had complete pain resolution with no recurrence. One patient had a recurrence of symptoms after 2 wk and underwent a new successful treatment with increased energy levels. On average, 13 sonications were administered (8-18 sonications/treatment) with an average energy of 2,003 J (range: 1,063-3,522 J). Magnetic resonance-guided focused ultrasound appears to be a feasible, tolerable and effective treatment in selected patients with osteoid osteomas. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Monitoring propranolol treatment in periocular infantile haemangioma.

PubMed

Burne, R; Taylor, R

2014-11-01

To develop a tool for assessing amblyopic risk and monitoring the treatment effect of propranolol in periocular haemangioma management. We present a study of nine children with periocular haemangioma who underwent propranolol treatment at York Hospital between 2009 and 2013.A proposed measure of amblyogenic risk based on the induced anisometropia resulting from a periocular haemangioma was calculated in the form of a single quantitative value, measured in dioptres. This calculation used published work and developed it to produce a new function, termed the delta defocus equivalent (DFE-∂).Refraction measurements were retrospectively collected from patients' notes in order to measure the trend of DFE-∂ over the treatment period with propranolol. The average DFE-∂ at commencement of propranolol was 1.54 (±0.62) D. The average at the end of treatment was 0.39 (±0.38) D. This work presents a possible tool for assessing amblyopic risk in cases of periocular infantile haemangioma. The DFE-∂ gives a measure in dioptres, which may represent the true amblyopic risk, and so be useful in supporting treatment decisions in paediatric ophthalmology.

Exploring psychological mechanisms of clinical response to an internet-delivered psychological pain management program.

PubMed

Gandy, M; Karin, E; Jones, M P; McDonald, S; Sharpe, L; Titov, N; Dear, B F

2018-05-13

The evidence for Internet-delivered pain management programs for chronic pain is growing, but there is little empirical understanding of how they effect change. Understanding mechanisms of clinical response to these programs could inform their effective development and delivery. A large sample (n = 396) from a previous randomized controlled trial of a validated internet-delivered psychological pain management program, the Pain Course, was used to examine the influence of three potential psychological mechanisms (pain acceptance, pain self-efficacy, fear of movement/re-injury) on treatment-related change in disability, depression, anxiety and average pain. Analyses involved generalized estimating equation models for clinical outcomes that adjusted for co-occurring change in psychological variables. This was paired with cross-lagged analysis to assess for evidence of causality. Analyses involved two time points, pre-treatment and post-treatment. Changes in pain-acceptance were strongly associated with changes in three (depression, anxiety and average pain) of the four clinical outcomes. Changes in self-efficacy were also strongly associated with two (anxiety and average pain) clinical outcomes. These findings suggest that participants were unlikely to improve in these clinical outcomes without also experiencing increases in their pain self-efficacy and pain acceptance. However, there was no clear evidence from cross-lagged analyses to currently support these psychological variables as direct mechanisms of clinical improvements. There was only statistical evidence to suggest higher levels of self-efficacy moderated improvements in depression. The findings suggest that, while clinical improvements are closely associated with improvements in pain acceptance and self-efficacy, these psychological variables may not drive the treatment effects observed. This study employed robust statistical techniques to assess the psychological mechanisms of an established internet-delivered pain management program. While clinical improvements (e.g. depression, anxiety, pain) were closely associated with improvements in psychological variables (e.g. pain self-efficacy and pain acceptance), these variables do not appear to be treatment mechanisms. © 2018 European Pain Federation - EFIC®.

He-Ne laser treatment on menorrhagia

NASA Astrophysics Data System (ADS)

Ding, Ai-Hua

1993-03-01

By using He-Ne laser treatment, 84.7 - 91.1% of patients with menorrhagia, a common symptom of multiple gynecological diseases, are treated effectively. After laser irradiation, the amount of vaginal bleeding was reduced 47.1% on average. It has been proven that low-energy laser is an effective non-traumatic, painless, and easily acceptable new physical method in patients with menorrhagia. To study the mechanisms of efficiency, the quantitative determination of PGE2, PGF2(alpha ), 6-Keto-PGF1(alpha ), TXB2 in endometrium and blood flow before and after treatment were carried out. The results suggest that the effectiveness may be due to the recovery regulation of local uterine PGS level.

MOSFET detectors in quality assurance of tomotherapy treatments.

PubMed

Cherpak, Amanda; Studinski, Ryan C N; Cygler, Joanna E

2008-02-01

The purpose of this work was to characterize metal oxide semiconductor field-effect transistors (MOSFETs) in a 6 MV conventional linac and investigate their use for quality assurance of radiotherapy treatments with a tomotherapy Hi-Art unit. High sensitivity and standard sensitivity MOSFETs were first calibrated and then tested for reproducibility, field size dependence, and accuracy of measuring surface dose in a 6 MV beam as well as in a tomotherapy Hi-Art unit. In vivo measurements were performed on both a RANDO phantom and several head and neck cancer patients treated with tomotherapy and compared to TLD measurements and treatment plan doses to evaluate the performance of MOSFETs in a high gradient radiation field. The average calibration factor found was 0.345+/-2.5%cGy/mV for the high sensitivity MOSFETs tested and 0.901+/-2.4%cGy/mV for the standard sensitivity MOSFETs. MOSFET measured surface doses had an average agreement with ion chamber measurements of 1.55% for the high sensitivity MOSFET and 5.23% for the standard sensitivity MOSFET when averaged over all trials and field sizes tested. No significant dependence on field size was found for the standard sensitivity MOSFETs, however a maximum difference of 5.34% was found for the high sensitivity MOSFET calibration factors in the field sizes tested. Measurements made with MOSFETS on head and neck patients treated on a tomotherapy Hi-Art unit had an average agreement of (3.26+/-0.03)% with TLD measurements, however the average of the absolute difference between the MOSFET measurements and the treatment plan skin doses was (12.2+/-7.5)%. The MOSFET measured patient skin doses also had good reproducibility, with inter-fraction deviations ranging from 1.4% to 6.6%. Similar results were found from trials using a RANDO phantom. The MOSFETs performed well when used in the tomotherapy Hi-Art unit and did not increase the overall treatment set-up time when used for patient measurements. It was found that MOSFETs are suitable detectors for surface dose measurements in both conventional beam and tomotherapy treatments and they can provide valuable skin dose information in areas where the treatment planning system may not be accurate.

Productivity and growth performance of edamame (Glycin Max L Merril) due to the addition of sitokinin

NASA Astrophysics Data System (ADS)

Rohmawati, Irma; Ulfah, Maria

2018-05-01

Global market demand towards edamame is quite high, but production of edamame is still very low. Edamame have to increased its production. Many researchers stated that sitokinin effect on the activities of enzymes in metabolic processes of plants. This research aims to analyze response of plant physiological Edamame applied with hormones sitokinin especially in aspects of growth and productivity. The research was carried out in March-May 2017. This study used a Randomized Complete Design method with three treatment factors that is A (unannounced sitokinin hormone), B (hormone siokinin 0.5 mL) C (hormone sitokinin 1 mL) with 5 repetitions. The parameters observed were higher plants, number of leaves, and the weight of the fruit. Research shows that treatment with hormone sitokinin effect on the growth and the production of edamame. The addition of the sitokinin hormones can increase the growth of leaves, stems, and fruit productivity. Results of the study showed treatment C (sitokinin 1 mL) gives signifcant effect. At the age of 48 HST by administering hormones 1 mL, has an average height of 28.8 cm, average number of leaves 15, and heavy weight fruit 17.43 grams.

Inpatient and Day Hospital Treatment of Patients with Depression and Job-related Burnout.

PubMed

Meyer, Lisa Kristin; Lange, Sabine; Behringer, Johanna; Söllner, Wolfgang

Burnout is a process of physical and emotional exhaustion that often results in clinical depression. Detailed descriptions and evaluations of specialized psychosomatic treatment are rare. This pilot study investigates the feasibility of inpatient and day hospital treatment of patients with burnout syndrome. Additionally, we present results of an initial, noncontrolled, pre-post-evaluation of changes in symptoms and individual work-related risk factors for burnout. Sixty-four consecutive patients with burnout syndrome were assessed before and after specialized multimodal treatment using a clinical symptom checklist (ICD-10 Symptom Rating) and burnout-specific instruments (Maslach Burnout Inventory, Occupational Stress & Coping Inventory). Patients' average age was 45 (range 23 to 61), 70% were currently employed, 24% in managerial positions or self-employed, and 89% diagnosed with an affective disorder. The average length of time off work due to illness in the past year was 13 weeks. Treatment lasted five weeks on average. After treatment, depression (p < 0.001; effect size d = 0.79), emotional exhaustion (p = 0.001; d = 0.41), and the subjective significance of work (p = 0.001; d = 0.36) decreased, while emotional distancing (p < 0.001; d = 0.56), balance and mental stability (p < 0.001; d = 0.38) and life satisfaction (p < 0.001; d = 0.37) increased. Clinical significance was determined using the Reliable Change Index. The treatment program described here is well accepted by patients with severe burnout. It contributes to positive changes in symptoms and work-related risk factors. Controlled studies are necessary to establish treatment efficacy.

[Short-term clinical effects of Achillon in repair of acute Achilles tendon rupture].

PubMed

Diao, Zhen-Bin; Chu, Hai-Kun; Li, Na; Sha, Xian-Hui; Chang, Shu-Song

2012-11-01

To study the clinical effects of Achillon for the treatment of acute Achilles tendon rupture (AATR). From April 2009 to April 2010, 19 patients with AATR who were treated with Achillon were retrospectively analyzed. There were 17 males and 2 females, with an average age of 40.2 years (30 to 58 years). There were 9 cases of sports injury, and 2 case of fall injury. The time from injury to surgery ranged from 0 to 8 days (2.2 days on average). The results of Thompson test and single heel rise test were positive in 19 cases. Clinical data were assessed with the patient satisfaction and the AOFAS hindfoot score during follow-up. All the patients were followed up, and the duration ranged from 12 to 28 months (19.9 months on average). The average operation time was 41 minutes. There were no wound infections, recurrent rupture, or sural nerve complications. At the latest follow-up, 18 patients were totally satisfied with the surgical result, 1 patient feel generally due to mild pain when running. None of the patients were dissatisfied with the final results the latest follow-up. At the latest follow-up, the AOFAS score was 98.42 +/- 3.29 (89 to 100). All the patients regained normal range of motion and were able to resume their previous activities at six months after operation, with a high rate of satisfaction. Average decreased of mid-calf circumference was (0.82 +/- 0.85) cm (ranged from 0 to 3 cm). Treatment with Achillon is safe, effective for AATR with low incidence of complications and early active rehabilitation can be carried out. It is a good method to treat AATR.

Effects of long term feeding of Quillaja saponins on sex ratio, muscle and serum cholesterol and LH levels in Nile tilapia (Oreochromis niloticus (L)).

PubMed

Francis, George; Levavi-Sivan, Berta; Avitan, Ayelet; Becker, Klaus

2002-12-01

Seventeen-day-old Nile tilapia fry were fed a standard diet (C) or diets containing 50-700 mg kg(-1) Quillaja saponin (QS) extract (groups S50, S150, S300, S500 and S700). After the first 8 weeks, 30 randomly selected tilapia from each of the treatments were placed in separate aquaria and fed the standard diet without saponins from then on (these were designated S50/C, S150/C, S300/C, S500/C and S700/C). The fish grew from an initial average weight of approximately 30 mg to a final average weight of 79 g during the 6-month feeding period. The difference between the average weight of C-fed tilapia and the treatment with the highest average weight after 6 months was 53.5%. The sex ratio of tilapia in the saponin-fed groups deviated from the normal 50:50 male:female ratio, with the S700 group showing a significantly higher number of males. Quillaja saponin stimulated LH release from dispersed tilapia pituitary cells in vitro. This effect was abolished in the presence of dilute calf serum. Serum LH values did not show any diet-dependent trend in either male or female tilapia in vivo. In both continuously saponin-fed and only-initially saponin-fed groups, the average serum (but not muscle) cholesterol levels in males showed an increasing trend (R(2) values of 0.62 and 0.69) with increasing dietary saponin level. It was concluded that dietary QS has the potential to change the sex-ratio in favour of males. More investigations are required to determine the mechanism of action and the optimum dietary level of QS for maximum effects.

Results of a bone splint technique for the treatment of lower limb deformities in children with type I osteogenesis imperfecta

PubMed Central

Lin, Dasheng; Zhai, Wenliang; Lian, Kejian; Ding, Zhenqi

2013-01-01

Background: Children with osteogenesis imperfecta (OI) can suffer from frequent fractures and limb deformities, resulting in impaired ambulation. Osteopenia and thin cortices complicate orthopedic treatment in this group. This study evaluates the clinical results of a bone splint technique for the treatment of lower limb deformities in children with type I OI. The technique consists of internal plating combined with cortical strut allograft fixation. Materials and Methods: We prospectively followed nine children (five boys, four girls) with lower limb deformities due to type I OI, who had been treated with the bone splint technique (11 femurs, four tibias) between 2003 and 2006. The fracture healing time, deformity improvement, ambulation ability and complications were recorded to evaluate treatment effects. Results: At the time of surgery the average age in our study was 7.7 years (range 5-12 years). The average length of followup was 69 months (range 60-84 months). All patients had good fracture healing with an average healing time of 14 weeks (range 12-16 weeks) and none experienced further fractures, deformity, or nonunion. The fixation remained stable throughout the procedure in all cases, with no evidence of loosening or breakage of screws and the deformity and mobility significantly improved after surgery. Of the two children confined to bed before surgery, one was able to walk on crutches and the other needed a wheelchair. The other seven patients could walk without walking aids or support like crutches. Conclusions: These findings suggest that the bone splint technique provides good mechanical support and increases the bone mass. It is an effective treatment for children with OI and lower limb deformities. PMID:23960282

The effects of iron treatment on viscosity in children with cyanotic congenital heart disease.

PubMed

Terlemez, Semiha; Tunaoğlu, Fatma Sedef; Göktaş, Tayfun; Çelik, Bülent; Erbaş, Deniz; Koçak, Ülker; Kula, Serdar; Oğuz, Ayşe Deniz

2017-01-01

This study was planned to determine the effects of iron treatment in children with cyanotic congenital heart disease. A total of 39 patients with cyanotic congenital heart disease including 20 (51%) females, 19 (49%) males and whose mean age was 9.9 ± 6.2 years, average weight was 33 ± 18.4 kg were evaluated. Patients were categorized into two groups as having iron deficiency and no iron deficiency with respect to their ferritin levels. 4 mg/kg/day iron treatment with two valences was applied to the groups with iron deficiency for 3 months. Clinical and laboratory findings of both groups were assessed at the outset and 3 months later and viscosity measurements were carried out. Iron deficiency was identified in 21 (53.8%) out of 39 patients. Average Hb and Hct values following 3-month iron treatment increased from 14.8 ± 2.4 g/dl to 16.0 ± 2.0 (P = 0.003) and from %45.8 ± 7.5 to %47.6 ± 7.2 (P = 0.052), respectively. Average viscosity value, however, was 5.6 ± 1.0 cP, it reduced to 5.5 ± 1.0 cP value by demonstrating very little reduction (P = 0.741). Nevertheless, O 2 sat value increased from 71.7 to 75% and complaints such as headache, visual blurriness, having frequent sinusitis decreased. It was observed that iron treatment increased Hb and Hct levels in patients with cyanotic congenital heart disease without raising viscosity and it ensured improvement in clinical symptoms.

A facility-wide approach to recreation programming for adults who are severely and profoundly retarded.

PubMed

Burch, M R; Reiss, M; Bailey, J S

1985-01-01

A facility-wide recreation program was designed and implemented in order to increase staff and client participation in daily leisure activities at an intermediate care facility for severely and profoundly mentally retarded adults. The baseline phase of the study consisted of having recreational materials available during scheduled recreation periods. The treatment was a package program consisting of (1) providing the staff with preplanned materials and activities, (2) assigning staff to specific roles, and (3) monitoring staff and providing feedback by supervisors. The treatment was implemented on the two living units of the Liberty Intermediate Care Facility. Treatment effects were similar on both units. Client participation increased from a baseline average of less than 10% to nearly 50% and staff participation increased from less than 10% to an average of 60% during program implementation.

Effects of the lercanidipine-enalapril combination vs. the corresponding monotherapies on home blood pressure in hypertension: evidence from a large database.

PubMed

Mancia, Giuseppe; Omboni, Stefano; Chazova, Irina; Coca, Antonio; Girerd, Xavier; Haller, Hermann; Parati, Gianfranco; Pauletto, Paolo; Pupek-Musialik, Danuta; Svyshchenko, Yevgeniya

2016-01-01

To compare a combination of a dihydropyridine calcium-channel blocker with an angiotensin converting enzyme inhibitor vs. monotherapy with one or the other drug and placebo for their effects on home blood pressure (HBP). After a 2-week placebo wash-out, patients with an elevated office blood pressure (BP) (diastolic 100-109 and systolic <180 mmHg) and HBP (diastolic ≥85 mmHg) were randomized double-blind to a 10-week treatment with placebo, lercanidipine, 10 or 20 mg daily, enalapril, 10 or 20 mg daily, or the four possible combinations. In addition to office BP, HBP was self-measured via a validated semiautomatic device twice in the morning and twice in the evening during the 7 days before randomization and at the end of treatment. Baseline and treatment HBP values were separately averaged for each day, morning, evening or the whole monitoring period, excluding the first day. Day-by-day HBP variability was defined as the SD or the variation coefficient of the daily BP averages. Eight hundred and fifty-four patients with valid HBP recordings at baseline and at the end of treatment were analyzed (intention-to-treat population). From the baseline value (147.0±11.6 mmHg) systolic/diastolic HBP showed a small reduction (average baseline-adjusted change: -1.8/-1.6 mmHg) with placebo, a more marked significant fall with monotherapies (-8.8/-5.9 mmHg, P < 0.001/<0.001 vs. placebo) and even more with combination treatment (11.6/-7.6 mmHg, P < 0.001/ < 0.001 vs. placebo and P < 0.01/ < 0.05 vs. monotherapy). A similar pattern was observed for each of the days of the BP self-monitoring period as well as for either morning or evening values, although the difference between mono and combination treatment appeared to be consistently significant for the morning values only. Day-by-day systolic BP-SD was unaffected by placebo and slightly reduced by drug treatments, with no, however, significant changes in SBP-variation coefficient. Baseline and end of treatment HBP values showed a limited correlation with office BP values, this being particularly the case for treatment-induced changes (correlation coefficients: 0.37 for systolic and 0.45 for diastolic BP). This large HBP database shows that the lercanidipine-enalapril combination lowers HBP more effectively than the corresponding monotherapies and placebo, and that this greater effect is consistent between days. ClinicalTrials.gov identifier: NCT01093807.

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.

Botulinum toxin injections for the treatment of hemifacial spasm over 16 years.

PubMed

Sorgun, Mine Hayriye; Yilmaz, Rezzak; Akin, Yusuf Alper; Mercan, Fatma Nazli; Akbostanci, Muhittin Cenk

2015-08-01

The aim of this study was to investigate the efficacy and side effects of botulinum toxin (BTX) in the treatment of hemifacial spasm (HFS). We also focused on the divergence between different injection techniques and commercial forms. We retrospectively evaluated 470 sessions of BTX injections administered to 68 patients with HFS. The initial time of improvement, duration and degree of improvement, and frequency and duration of adverse effects were analysed. Pretarsal and preseptal injections and Botox (Allergan, Irvine, CA, USA) and Dysport (Ipsen Biopharmaceuticals, Paris, France) brands were compared in terms of efficacy and side effects, accompanied by a review of papers which reported BTX treatment of HFS. An average of 34.5 units was used per patient. The first improvement was felt after 8 days and lasted for 14.8 weeks. Patients experienced a 73.7% improvement. In 79.7% of injections, no adverse effect was reported, in 4.9% erythema, ecchymosis, and swelling in the injection area, in 3.6% facial asymmetry, in 3.4% ptosis, in 3.2% diplopia, and in 2.3% difficulty of eye closure was detected. Patients reported 75% improvement on average after 314 sessions of pretarsal injections and 72.7% improvement after 156 sessions of preseptal injections (p=0.001). The efficacy and side effects of Botox and Dysport were similar. BTX is an effective and safe treatment option for HFS. No difference was determined between Botox and Dysport, and pretarsal injection is better than preseptal injection regarding the reported degree of improvement. Copyright © 2015 Elsevier Ltd. All rights reserved.

Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population.

PubMed

Fader, Ryan R; Mitchell, Justin J; Traub, Shaun; Nichols, Roger; Roper, Michelle; Mei Dan, Omer; McCarty, Eric C

2014-01-01

chronic proximal hamstring tendinopathies is a disabling activity related condition. Currently, there is no well-accepted or extensively documented non-operative treatment option that provides consistently successful results. to evaluate the efficacy of ultrasound guided platelet-rich plasma injections in treating chronic proximal hamstring tendinopathies. a total of 18 consecutive patients were retrospectively analyzed. All patients received a single injection of platelet rich plasma via ultra-sound guidance by a single radiologist. Outcome measures included a questionnaire evaluating previous treatments, visual analog scale (VAS) for pain, subjective improvement, history of injury, and return to activity. the patient population included 12 females and 6 males. The average age at the time of the injection was 42.6 years (19-60). Provocative activities included running, biking, swimming. The average body mass index of patients was 22.9 (17.2-30.2). The average time of chronic pain prior to receiving the first injection was 32.6 months (6-120). All patients had attempted other forms of non-surgical treatment prior to entering the study. The average VAS pre-injection was 4.6 (0-8). Six months after the injection, 10/18 patients had 80% or greater improvement in their VAS. Overall, the average improvement was 63% (5-100). The only documented side effect was post-injection discomfort that resolved within seventy-two hours. chronic hamstring tendinopathy is a debilitating condition secondary to the pain, which limits an athlete's ability to perform. For refractory cases of chronic insertional proximal hamstring injuries, platelet-rich plasma injections are safe and show benefit in the majority of patients in our study, allowing return to pre-injury activities. Case series; Level of evidence, 4.

Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population

PubMed Central

Fader, Ryan R.; Mitchell, Justin J.; Traub, Shaun; Nichols, Roger; Roper, Michelle; Mei Dan, Omer; McCarty, Eric C.

2014-01-01

Summary Background: chronic proximal hamstring tendinopathies is a disabling activity related condition. Currently, there is no well-accepted or extensively documented non-operative treatment option that provides consistently successful results. Purpose: to evaluate the efficacy of ultrasound guided platelet-rich plasma injections in treating chronic proximal hamstring tendinopathies. Methods: a total of 18 consecutive patients were retrospectively analyzed. All patients received a single injection of platelet rich plasma via ultra-sound guidance by a single radiologist. Outcome measures included a questionnaire evaluating previous treatments, visual analog scale (VAS) for pain, subjective improvement, history of injury, and return to activity. Results: the patient population included 12 females and 6 males. The average age at the time of the injection was 42.6 years (19–60). Provocative activities included running, biking, swimming. The average body mass index of patients was 22.9 (17.2–30.2). The average time of chronic pain prior to receiving the first injection was 32.6 months (6–120). All patients had attempted other forms of non-surgical treatment prior to entering the study. The average VAS pre-injection was 4.6 (0–8). Six months after the injection, 10/18 patients had 80% or greater improvement in their VAS. Overall, the average improvement was 63% (5–100). The only documented side effect was post-injection discomfort that resolved within seventy-two hours. Conclusion: chronic hamstring tendinopathy is a debilitating condition secondary to the pain, which limits an athlete’s ability to perform. For refractory cases of chronic insertional proximal hamstring injuries, platelet-rich plasma injections are safe and show benefit in the majority of patients in our study, allowing return to pre-injury activities. Study Design: Case series; Level of evidence, 4. PMID:25767784

Selective Window Application of Gentamicin+ Dexamethasone in Meniere's Disease.

PubMed

Ardıç, Fazıl Necdet; Tümkaya, Funda; Aykal, Kamil; Çabuk, Burçin

2017-08-01

The purpose of the study is to prevent hearing loss when using intratympanic (IT) gentamicin for intractable Meniere's disease. It is a retrospective case review study. Twenty five patients who had definite Meniere's disease and had either selective window application or weekly IT gentamicin were included into the study. First group (selective) had dexamethasone on the round window and gentamicin on oval window during exploratory tympanotomy procedure. The second group had IT gentamicin at weekly intervals. The degree of caloric weakness (CW), average hearing level in low pitch (HLP) (250, 500, 1000, 2000 Hz) and high pitch (HHP) (4000, 6000, 8000 Hz) were compared before and after treatment. The need for further treatment was noted. In the first group, the average HLP was increased from 51.6±7dB to 52.2±5.6 dB. The average HHP was increased 41.96±20.2 dB to 47.2±18.3 dB after treatment. The CW changed from 37.6±23.9 % to 54.6±30.6 %. In the second group, the average HLP was increased from 56.3±10.5 dB to 61.65±18.3 dB. The average HHP was increased 59.05±17.4 dB to 69.4±21.98 dB after treatment. The CW changed from 45.8±22.3% to 71.53±29.63 %. Both methods had statisticaly significant increase in caloric weakness. But only IT gentamicin led a significant hearing loss in HHP. The use of dexamethasone and gentamycin via different windows in the middle ear is safe and effective method for Meniere's disease in the short term. Application of dexamethasone protects not only the hearing cells but vestibular cells also.

Effect of Epley's maneuver on the quality of life of paroxismal positional benign vertigo patients.

PubMed

Pereira, Alcione Botelho; Santos, Juliana Nunes; Volpe, Fernando Madalena

2010-01-01

Quality of life (QoL) is significantly impaired by vertigo. The effect of specific treatments on QoL deserves investigation. To assess the effect of repositioning maneuvers on the QoL of benign paroxysmal positioning vertigo (BPPV) patients. A retrospective study design consiting of reviews of charts of BPPV patients in a vestibular rehabilitation unit at a teaching institution in Belo Horizonte, MG, Brazil, from 2007 to 2008. Pre- and post-therapy (Epley's repositioning maneuver) scores on the physical, functional and emotional dimensions of the Dizziness Handicap Inventory (DHI) were analyzed. Twenty-one patients were included, eighteen (86%) were females; the average age was 53.2 years. Ten patients presented bilateral BPPV; in eleven it was unilateral. The mean interval between assessments (pre- and post-treatment) was 21 days. The average number of required maneuvers was 2.3 (±1.1). Pre-treatment DHI results showed a significant impact of BPPV on quality of life. Initial scores for physical (17.5), functional (17.3), emotional (13.2) dimensions decreased with therapy: respectively 3.7, 3.9, and 3.2 (p<0.001). In the present sample, Epley's maneuver had a positive and significant effect on emotional, physical and functional dimensions of quality of life, as measured by the DHI scores before and after therapy.

Positive health-care effects of an alcohol ignition interlock programme among driving while impaired (DWI) offenders.

PubMed

Bjerre, Bo; Kostela, Johan; Selén, Jan

2007-11-01

To compare the costs of hospital care and sick leave/disability pensions between two groups of driving while impaired (DWI) offenders: participants in an alcohol ignition interlock programme (AIIP) and controls with revoked licences, but with no comparable opportunity to participate in an AIIP. As an alternative to licence revocation DWI offenders can participate in a voluntary 2-year AIIP permitting the offender to drive under strict regulations entailing regular medical check-ups. The participants are forced to alter their alcohol habits and those who cannot demonstrate sobriety are dismissed from the programme. Participants are liable for all costs themselves. Quasi-experimental, with a non-equivalent control group used for comparison; intent-to-treat design. Based on the number of occasions/days in hospital and on sick leave/disability pension, the health-care costs for public insurance have been calculated. Average total health-care costs were 25% lower among AIIP participants (1156 individuals) than among controls (815 individuals) during the 2-year treatment period. This corresponds to over 1000 euros (SEK9610) less annual costs per average participant. For those who complete the 2-year programme the cost reduction was more pronounced; 37% during the treatment and 20% during the post-treatment period. The positive health-care effects were due apparently to reduced alcohol consumption. The social benefit of being allowed to drive while in the AIIP may also have contributed. The reduction in health-care costs was significant only during the 2-year treatment period, but among those who completed the entire AIIP sustained effects were also observed in the post-treatment period. The effects were comparable to those of regular alcoholism treatment programmes.

The cost-effectiveness of IVF in the UK: a comparison of three gonadotrophin treatments.

PubMed

Sykes, D; Out, H J; Palmer, S J; van Loon, J

2001-12-01

The objective of this study was to evaluate the cost-effectiveness of women undergoing IVF treatment with recombinant FSH (rFSH) in comparison with highly purified urinary FSH (uFSH-HP) and human menopausal gonadotrophins (HMG). A decision-analytic model was used to estimate cost-effectiveness ratios for 'the average cost per ongoing pregnancy' and 'incremental cost per additional pregnancy' for women entering into IVF treatment for a maximum of three cycles. The model was constructed based on a previously published large prospective randomized clinical trial comparing rFSH and uFSH-HP. Where necessary, these data were augmented with a combination of expert opinion, evidence from the literature and observational data relating to the management and cost of IVF treatment in the UK. The cost of rFSH, uFSH-HP and HMG were obtained from National Health Service list prices in the UK. The model predicted a cumulative pregnancy rate after three cycles of 57.1% for rFSH and 44.4% for both uFSH-HP and HMG. The cost of IVF treatment was 5135 pounds sterling for rFSH, 4806 pounds sterling for uFSH-HP and 4202 pounds sterling for HMG. When assessed in association with outcomes, the average cost per ongoing pregnancy was more favourable with rFSH (8992 pounds sterling) than with either uFSH-HP (10 834 pounds sterling) or HMG (9472 pounds sterling). The incremental cost per additional pregnancy was 2583 pounds sterling using rFSH instead of uFSH-HP and 7321 pounds sterling using rFSH instead of HMG. These results were robust to changes in the baseline assumptions of the model. rFSH is a cost-effective treatment strategy in ovulation induction prior to IVF.

Evaluating Heterogeneous Conservation Effects of Forest Protection in Indonesia

PubMed Central

Shah, Payal; Baylis, Kathy

2015-01-01

Establishing legal protection for forest areas is the most common policy used to limit forest loss. This article evaluates the effectiveness of seven Indonesian forest protected areas introduced between 1999 and 2012. Specifically, we explore how the effectiveness of these parks varies over space. Protected areas have mixed success in preserving forest, and it is important for conservationists to understand where they work and where they do not. Observed differences in the estimated treatment effect of protection may be driven by several factors. Indonesia is particularly diverse, with the landscape, forest and forest threats varying greatly from region to region, and this diversity may drive differences in the effectiveness of protected areas in conserving forest. However, the observed variation may also be spurious and arise from differing degrees of bias in the estimated treatment effect over space. In this paper, we use a difference-in-differences approach comparing treated observations and matched controls to estimate the effect of each protected area. We then distinguish the true variation in protected area effectiveness from spurious variation driven by several sources of estimation bias. Based on our most flexible method that allows the data generating process to vary across space, we find that the national average effect of protection preserves an additional 1.1% of forest cover; however the effect of individual parks range from a decrease of 3.4% to an increase of 5.3% and the effect of most parks differ from the national average. Potential biases may affect estimates in two parks, but results consistently show Sebangau National Park is more effective while two parks are substantially less able to protect forest cover than the national average. PMID:26039754

Evaluating heterogeneous conservation effects of forest protection in Indonesia.

PubMed

Shah, Payal; Baylis, Kathy

2015-01-01

Establishing legal protection for forest areas is the most common policy used to limit forest loss. This article evaluates the effectiveness of seven Indonesian forest protected areas introduced between 1999 and 2012. Specifically, we explore how the effectiveness of these parks varies over space. Protected areas have mixed success in preserving forest, and it is important for conservationists to understand where they work and where they do not. Observed differences in the estimated treatment effect of protection may be driven by several factors. Indonesia is particularly diverse, with the landscape, forest and forest threats varying greatly from region to region, and this diversity may drive differences in the effectiveness of protected areas in conserving forest. However, the observed variation may also be spurious and arise from differing degrees of bias in the estimated treatment effect over space. In this paper, we use a difference-in-differences approach comparing treated observations and matched controls to estimate the effect of each protected area. We then distinguish the true variation in protected area effectiveness from spurious variation driven by several sources of estimation bias. Based on our most flexible method that allows the data generating process to vary across space, we find that the national average effect of protection preserves an additional 1.1% of forest cover; however the effect of individual parks range from a decrease of 3.4% to an increase of 5.3% and the effect of most parks differ from the national average. Potential biases may affect estimates in two parks, but results consistently show Sebangau National Park is more effective while two parks are substantially less able to protect forest cover than the national average.

Do Nurse-Led Skill Training Interventions Affect Informal Caregivers’ Out-of-Pocket Expenditures?

PubMed Central

Van Houtven, Courtney Harold; Thorpe, Joshua M.; Chestnutt, Deborah; Molloy, Margory; Boling, John C.; Davis, Linda Lindsey

2013-01-01

Purpose of the Study: This paper is a report of a study of the Assistance, Support, and Self-health Initiated through Skill Training (ASSIST) randomized control trial. The aim of this paper is to understand whether participating in ASSIST significantly changed the out-of-pocket (OOP) costs for family caregivers of Alzheimer’s disease (AD) or Parkinson's disease (PD) patients. Design and Methods: Secondary analysis of randomized control trial data, calculating average treatment effects of the intervention on OOP costs. Enrollment in the ASSIST trial occurred between 2002 and 2007 at 2 sites: Durham, North Carolina, and Birmingham, Alabama. We profile OOP costs for caregivers who participated in the ASSIST study and use 2-part expenditure models to examine the average treatment effect of the intervention on caregiver OOP expenditures. Results: ASSIST-trained AD and PD caregivers reported monthly OOP expenditures that averaged $500–$600. The intervention increased the likelihood of caregivers spending any money OOP by 26 percentage points over usual care, but the intervention did not significantly increase overall OOP costs. Implications: The ASSIST intervention was effective and inexpensive to the caregiver in direct monetary outlays; thus, there are minimal unintended consequences of the trial on caregiver financial well-being. PMID:22459694

Granisetron transdermal system improves refractory nausea and vomiting in gastroparesis.

PubMed

Simmons, Kellie; Parkman, Henry P

2014-06-01

Symptoms of gastroparesis include nausea and vomiting, which can markedly diminish quality of life. Nausea and vomiting can also make treatment with oral antiemetics problematic. Our aim was to determine whether treatment-resistant nausea and vomiting in patients with gastroparesis improve after granisetron transdermal patch (GTP) therapy. In an open-label pilot study, patients with gastroparesis and symptoms of nausea and vomiting refractory to conventional treatment were treated with GTP. After 2 weeks, patients were asked to assess their therapeutic response using the Clinical Patient Grading Assessment Scale (CPGAS; +7 = completely better; 0 = no change; -7 = very considerably worse). Responders were defined as CPGAS score >0, non-responders as ≤0. Patients (n = 36) were treated with GTP. Of these 36 patients, one patient discontinued treatment due to the GTP not adhering to the skin. Of the remaining 35 patients, 18 improved, 15 remained the same, and two worsened. The average CPGAS score was +1.8 ± 0.4 (SEM) (P < 0.05 vs 0). Of the 18 patients with improvement, the average CPGAS score was +3.7 ± 0.3 (SEM), corresponding to "somewhat" to "moderately better" improvement in nausea/vomiting. Side effects occurred in nine patients: four developed constipation, three patients had skin rash, and two reported headaches. GTP was moderately effective in reducing refractory symptoms of nausea and/or vomiting from gastroparesis in 50% of patients. Mild side effects were reported by 25% of patients. GTP may be an effective treatment for nausea and vomiting in gastroparesis, and further study is warranted.

Evaluation of the Effect of Low Dietary Fermentable Carbohydrate Content on Growth Performance, Nutrient Digestibility, Blood Characteristics, and Meat Quality in Finishing Pigs

PubMed Central

Hong, S. M.; Hwang, J. H.; Kim, I. H.

2012-01-01

A total of 96 pigs (49.23±3.20 kg) were used in an 11 wk growth trial to evaluate the effect of fermentable carbohydrate (FC) content on growth performance, apparent total tract digestibility (ATTD) of nutrient, blood profile, and meat quality. The dietary treatments were: i) negative control (NC), basal diet, ii) positive control (PC), NC+antibiotics (positive control diet with 5 ppm flavomycin), iii) PCL, PC-13% lower FC, and iv) NCL, NC-13% lower FC. The growth performance (average daily gain, average daily feed intake, and gain/feed) didn’t differ among treatments through the whole experiment. These pigs fed the PCL diet had the greater (p<0.05) apparent total tract digestibility (ATTD) of dry matter than those from PC and NC treatment at the end of the experiment. No differences were observed in white blood cell (WBC), red blood cell (RBC), and lymphocyte concentration among different treatments. After the feeding period, meat samples were collected from the pigs at slaughter. The pigs in NCL and PCL treatments had greater (p<0.05) backfat thickness and lower lean percentage. The color value of loin was higher (p<0.05) in NCL treatment compared to PCL treatment. Also, the NCL treatment had higher (p<0.05) marbling value than PC treatment. The drip loss was depressed by PCL and NCL treatment comapared to NC treatments. The water holding capacity (WHC) was higher (p<0.05) in NC and PCL treatment. In conclusion, the low FC can improve digestibility and meat quality of finishing pigs. PMID:25049693

Interventions for Posttraumatic Stress With Children Exposed to Violence: Factors Associated With Treatment Success.

PubMed

Miller-Graff, Laura E; Campion, Karen

2016-03-01

In the past 15 years, there have been a substantial number of rigorous studies examining the effectiveness of various treatments for child trauma and posttraumatic stress disorder (PTSD). Although a number of review articles exist, many have focused on randomized controlled trials or specific treatment methodologies, both of which limit the ability to draw conclusions across studies and the statistical power to test the effect of particular treatment characteristics on treatment outcomes. The current study is a review and meta-analysis of 74 studies examining treatments for children exposed to violence. After reviewing the literature, we examined the relationship of a variety of treatment characteristics (e.g., group or individual treatments) and sample characteristics (e.g., average age) on treatment effect sizes. Results indicated that individual therapies and those with exposure paradigms within a cognitive-behavioral therapy or skills-building framework show the most promise, but treatment is somewhat less effective for those with more severe symptomology and for younger children. Future treatments should consider the developmental and social contexts that may impede treatment progress for young children and consider how best to develop the effectiveness of group interventions that can be readily delivered in settings of mass trauma. © 2015 Wiley Periodicals, Inc.

Synoviorthesis with 32P-colloidal chromic phosphate in rheumatoid arthritis--clinical, histopathologic and arthrographic changes.

PubMed

Onetti, C M; Gutiérrez, E; Hliba, E; Aguirre, C R

1982-01-01

Synoviorthesis was performed in 217 joints from 111 patients suffering from different stages of rheumatoid arthritis (RA). 32P-colloidal chromic phosphate was employed, with an average dose from 6 mCi for large joints (knees) to 0.3 mCi for small peripheral joints such as average dose from 6 mCi for large joints (knees) to 0.3 mCi for small peripheral joints such as the MCP or PIP joints. Satisfactory clinical results were observed in 84% of the cases and no significant side effects resulted after a follow-up period from 1 to 10 years. Striking effects after treatment were observed through histopathological studies (light and electron microscopy) and the use of contrast arthrography. We concluded that radioactive synovectomy with 32P-chromate is a very useful method for the local treatment of RA.

Effect of Temperature on Feeding Period of Larval Blacklegged Ticks (Acari: Ixodidae) on Eastern Fence Lizards.

PubMed

Rulison, Eric L; Lebrun, Roger A; Ginsberg, Howard S

2014-11-01

Ambient temperature can influence tick development time, and can potentially affect tick interactions with pathogens and with vertebrate hosts. We studied the effect of ambient temperature on duration of attachment of larval blacklegged ticks, Ixodes scapularis Say, to eastern fence lizards, Sceloporus undulatus (Bosc & Daudin). Feeding periods of larvae that attached to lizards under preferred temperature conditions for the lizards (WARM treatment: temperatures averaged 36.6°C at the top of the cage and 25.8°C at the bottom, allowing behavioral thermoregulation) were shorter than for larvae on lizards held under cool conditions (COOL treatment temperatures averaged 28.4°C at top of cage and 24.9°C at the bottom). The lizards were infested with larvae four times at roughly monthly intervals. Larval numbers successfully engorging and dropping declined and feeding period was longer after the first infestation. © 2014 Entomological Society of America.

Effect of temperature on feeding period of larval blacklegged ticks (Acari: Ixodidae) on eastern fence lizards

USGS Publications Warehouse

Rulison, Eric L.; LeBrun, Roger A.; Ginsberg, Howard S.

2014-01-01

Ambient temperature can influence tick development time, and can potentially affect tick interactions with pathogens and with vertebrate hosts. We studied the effect of ambient temperature on duration of attachment of larval blacklegged ticks, Ixodes scapularis Say, to eastern fence lizards, Sceloporus undulatus (Bose & Daudin). Feeding periods of larvae that attached to lizards under preferred temperature conditions for the lizards (WARM treatment: temperatures averaged 36.6°C at the top of the cage and 25.8°C at the bottom, allowing behavioral thermoregulation) were shorter than for larvae on lizards held under cool conditions (COOL treatment temperatures averaged 28.4°C at top of cage and 24.9°C at the bottom). The lizards were infested with larvae four times at roughly monthly intervals. Larval numbers successfully engorging and dropping declined and feeding period was longer after the first infestation.

The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. The AGIS Investigators.

PubMed

2000-12-01

To investigate the effect of cataract on visual function and the role of cataract in explaining a race-treatment interaction in outcomes of glaucoma surgery. The Advanced Glaucoma Intervention Study (AGIS) enrolled 332 black patients (451 eyes) and 249 white patients (325 eyes) with advanced glaucoma. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy sequence or a trabeculectomy-ALT-trabeculectomy sequence. From the AGIS experience with cataract surgery during follow-up, we estimated the expected change in visual function scores from before cataract surgery to after cataract surgery. Then, for eyes with cataract not removed, we used these estimates of expected change to adjust visual function scores for the presumed effects of cataract. In turn, we used the adjusted scores to obtain cataract-adjusted main outcome measures. Average percent of eyes with decrease of visual field (APDVF) and average percent of eyes with decrease of visual acuity (APDVA). Within the 2 months before cataract surgery, visual acuity was better in eyes of white patients than of black patients by an average of approximately 2 lines on the visual acuity test chart. Cataract surgery improved visual acuity and visual field defect scores, with the amounts of improvement greater when preoperative visual acuity was lower. Adjustments for cataract brought about the following relative reductions: for APDVF, a relative reduction of 5% to 11% in black patients and 9% to 11% in white patients; for APDVA, a relative reduction of 45% to 49% in black patients and 31% to 38% in white patients; and for the APDVF and APDVA race-treatment interactions, relative reductions of 25% and 45%, respectively. On average, visual function scores improved after cataract surgery. The findings of reduced race-treatment interactions after adjustment for cataract do not alter our earlier conclusion that the AGIS 7-year results support use of the ALT-trabeculectomy-trabeculectomy sequence for black patients and of the trabeculectomy-ALT-trabeculectomy sequence for white patients without life-threatening health problems. The choice of treatment should take into account individual patient characteristics and needs.

Association between costs and quality of acute myocardial infarction care hospitals under the Korea National Health Insurance program.

PubMed

Kang, Hee-Chung; Hong, Jae-Seok

2017-08-01

If cost reductions produce a cost-quality trade-off, healthcare policy makers need to be more circumspect about the use of cost-effective initiatives. Additional empirical evidence about the relationship between cost and quality is needed to design a value-based payment system. We examined the association between cost and quality performances for acute myocardial infarction (AMI) care at the hospital level.In 2008, this cross-sectional study examined 69 hospitals with 6599 patients hospitalized under the Korea National Health Insurance (KNHI) program. We separately estimated hospital-specific effects on cost and quality using the fixed effect models adjusting for average patient risk. The analysis examined the association between the estimated hospital effects against the treatment cost and quality. All hospitals were distributed over the 4 cost × quality quadrants rather than concentrated in only the trade-off quadrants (i.e., above-average cost and above-average quality, below-average cost and below-average quality). We found no significant trade-off between cost and quality among hospitals providing AMI care in Korea.Our results further contribute to formulating a rationale for value-based hospital-level incentive programs by supporting the necessity of different approaches depending on the quality location of a hospital in these 4 quadrants.

Survival and metamorphosis of low-density populations of larval sea lampreys (Petromyzon marinus) in streams following lampricide treatment

USGS Publications Warehouse

Johnson, Nicholas S.; Swink, William D.; Brenden, Travis O.; Slade, Jeffrey W.; Steeves, Todd B.; Fodale, Michael F.; Jones, Michael L.

2014-01-01

Sea lamprey Petromyzon marinus control in the Great Lakes primarily involves application of lampricides to streams where larval production occurs to kill larvae prior to their metamorphosing and entering the lakes as parasites (juveniles). Because lampricides are not 100% effective, larvae that survive treatment maymetamorphose before streams are again treated. Larvae that survive treatment have not beenwidely studied, so their dynamics are notwell understood.Wetagged and released larvae in six Great Lake tributaries following lampricide treatment and estimated vital demographic rates using multistate tag-recovery models. Model-averaged larval survivals ranged from 56.8 to 57.6%. Model-averaged adult recovery rates, which were the product of juvenile survivals and adult capture probabilities, ranged from 6.8 to 9.3%. Using stochastic simulations, we estimated production of juvenile sea lampreys from a hypothetical population of treatment survivors under different growth conditions based on parameter estimates from this research. For fast-growing populations, juvenile production peaked 2 years after treatment. For slow-growing populations, juvenile production was approximately one-third that of fast-growing populations,with production not peaking until 4 years after treatment. Our results suggest that dynamics (i.e., survival, metamorphosis) of residual larval populations are very similar to those of untreated larval populations. Consequently, residual populations do not necessarily warrant special consideration for the purpose of sea lamprey control and can be ranked for treatment along with other populations. Consecutive lampricide treatments, which are under evaluation by the sea lamprey control program, would bemost effective for reducing juvenile production in large, fast-growing populations.

Effect of Different Fertilizer Application on the Soil Fertility of Paddy Soils in Red Soil Region of Southern China

PubMed Central

Dong, Wenyi; Zhang, Xinyu; Wang, Huimin; Dai, Xiaoqin; Sun, Xiaomin; Qiu, Weiwen; Yang, Fengting

2012-01-01

Appropriate fertilizer application is an important management practice to improve soil fertility and quality in the red soil regions of China. In the present study, we examined the effects of five fertilization treatments [these were: no fertilizer (CK), rice straw return (SR), chemical fertilizer (NPK), organic manure (OM) and green manure (GM)] on soil pH, soil organic carbon (SOC), total nitrogen (TN), C/N ratio and available nutrients (AN, AP and AK) contents in the plowed layer (0–20 cm) of paddy soil from 1998 to 2009 in Jiangxi Province, southern China. Results showed that the soil pH was the lowest with an average of 5.33 units in CK and was significantly higher in NPK (5.89 units) and OM (5.63 units) treatments (P<0.05). The application of fertilizers have remarkably improved SOC and TN values compared with the CK, Specifically, the OM treatment resulted in the highest SOC and TN concentrations (72.5% and 51.2% higher than CK) and NPK treatment increased the SOC and TN contents by 22.0% and 17.8% compared with CK. The average amounts of C/N ratio ranged from 9.66 to 10.98 in different treatments, and reached the highest in OM treatment (P<0.05). During the experimental period, the average AN and AP contents were highest in OM treatment (about 1.6 and 29.6 times of that in the CK, respectively) and second highest in NPK treatment (about 1.2 and 20.3 times of that in the CK). Unlike AN and AP, the highest value of AK content was observed in NPK treatments with 38.10 mg·kg−1. Thus, these indicated that organic manure should be recommended to improve soil fertility in this region and K fertilizer should be simultaneously applied considering the soil K contents. Considering the long-term fertilizer efficiency, our results also suggest that annual straw returning application could improve soil fertility in this trial region. PMID:23028550

SU-E-T-478: Sliding Window Multi-Criteria IMRT Optimization

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

Craft, D; Papp, D; Unkelbach, J

2014-06-01

Purpose: To demonstrate a method for what-you-see-is-what-you-get multi-criteria Pareto surface navigation for step and shoot IMRT treatment planning. Methods: We show mathematically how multiple sliding window treatment plans can be averaged to yield a single plan whose dose distribution is the dosimetric average of the averaged plans. This is incorporated into the Pareto surface navigation based approach to treatment planning in such a way that as the user navigates the surface, the plans he/she is viewing are ready to be delivered (i.e. there is no extra ‘segment the plans’ step that often leads to unacceptable plan degradation in step andmore » shoot Pareto surface navigation). We also describe how the technique can be applied to VMAT. Briefly, sliding window VMAT plans are created such that MLC leaves paint out fluence maps every 15 degrees or so. These fluence map leaf trajectories are averaged in the same way the static beam IMRT ones are. Results: We show mathematically that fluence maps are exactly averaged using our leaf sweep averaging algorithm. Leaf transmission and output factor corrections effects, which are ignored in this work, can lead to small errors in terms of the dose distributions not being exactly averaged even though the fluence maps are. However, our demonstrations show that the dose distributions are almost exactly averaged as well. We demonstrate the technique both for IMRT and VMAT. Conclusions: By turning to sliding window delivery, we show that the problem of losing plan fidelity during the conversion of an idealized fluence map plan into a deliverable plan is remedied. This will allow for multicriteria optimization that avoids the pitfall that the planning has to be redone after the conversion into MLC segments due to plan quality decline. David Craft partially funded by RaySearch Laboratories.« less

[Treatment of Pilon fractures complicated with fractures of fibula with titanic elastic nailing].

PubMed

Liu, Yi-jun; Lin, Fu-qing; Guo, Yu-xiang

2010-02-01

To explore the effect of titanic elastic nailing (TEN) fixing for Pilon fractures complicated with fractures of fibula. From March 2007 to March 2009, 20 patients with Pilon fractures complicated with fractures of fibula were surgically treated with TEN. There were 14 males and 7 females with an average age of 42.6 years ranging from 35 to 70 years. Among them, 12 cases were on the left, 8 cases were on the right. All patients were followed-up for from 6 to 23 months (averaged 11.6 months). The symptoms of all patients had primarily relieved and the patients coulde ambulate at 2 to 3 months after treatment. According to Johner-Wruhs critera, the therapeutic results were excellent in 10 cases, good in 8 cases, fair in 2 cases. No case had skin infection and skin necrosis. Treatment of Pilon fractures complicated with fractures of fibula with TEN has the advantages such as less invasion, high rate of bone union and less soft tissue complication, it is a safe and effective procedure.

Residues of azoxystrobin, fenhexamid and pyrimethanil in strawberry following field treatments and the effect of domestic washing.

PubMed

Angioni, A; Schirra, M; Garau, V L; Melis, M; Tuberoso, C I G; Cabras, P

2004-11-01

Residues of the pesticides azoxystrobin, fenhexamid and pyrimethanil were determined in strawberry after field treatment. The effect of 'home' washing with tap water and a commercially available vegetable detergent on residue levels was also studied. After treatment, azoxystrobin and pyrimethanil residues on strawberry were on average 0.55 and 2.98 mg kg(-1), respectively, values below the maximum residue level (MRL) fixed by the European Union (2.0 and 5 mg kg(-1), respectively), while fenhexamid residues were on average 2.99 mg kg(-1), which is very close to the MRL of 3.0 mg kg(-1), but some samples were over the MRL. Thereafter, all residues declined, with a half-life of about 8 days (azoxystrobin and fenhexamid) and 4.8 days (pyrimethanil). Washing the fruit with tap water reduced the residues of azoxystrobin and fenhexamid but did not affect pyrimethanil residues. Finally, when fruits were washed with a commercial detergent, greater amounts were removed (about 45% of azoxystrobin and pyrimethanil and 60% of fenhexamid).

Effect of timing of count events on estimates of sea lice abundance and interpretation of effectiveness following bath treatments.

PubMed

Gautam, R; Vanderstichel, R; Boerlage, A S; Revie, C W; Hammell, K L

2017-03-01

Effectiveness of sea lice bath treatment is often assessed by comparing pre- and post-treatment counts. However, in practice, the post-treatment counting window varies from the day of treatment to several days after treatment. In this study, we assess the effect of post-treatment lag time on sea lice abundance estimates after chemical bath treatment using data from the sea lice data management program (Fish-iTrends) between 2010 and 2014. Data on two life stages, (i) adult female (AF) and (ii) pre-adult and adult male (PAAM), were aggregated at the cage level and log-transformed. Average sea lice counts by post-treatment lag time were computed for AF and PAAM and compared relative to treatment day, using linear mixed models. There were 720 observations (treatment events) that uniquely matched pre- and post-treatment counts from 53 farms. Lag time had a significant effect on the estimated sea lice abundance, which was influenced by season and pre-treatment sea lice levels. During summer, sea lice were at a minimum when counted 1 day post-treatment irrespective of pre-treatment sea lice levels, whereas in the spring and autumn, low levels were observed for PAAM over a longer interval of time, provided the pre-treatment sea lice levels were >5-10. © 2016 John Wiley & Sons Ltd.

Modification of immune responses and digestive system microbiota of lactating dairy cows by feeding Bovamine(R)

USDA-ARS?s Scientific Manuscript database

We evaluated the immune modulatory effects as well as effects on productivity of Bovamine® (Lactobacillus acidophilus strain NP51 and Probionibacterium freudenreichii) fed to Holstein and Jersey dairy cows during late lactation (average DIM = 202.44 days on wk-0). Cows were randomized to treatment g...

Music therapy for schizophrenia or schizophrenia-like illnesses.

PubMed

Gold, C; Heldal, T O; Dahle, T; Wigram, T

2005-04-18

Music therapy is a psychotherapeutic method that uses musical interaction as a means of communication and expression. The aim of the therapy is to help people with serious mental illness to develop relationships and to address issues they may not be able to using words alone. To review the effects of music therapy, or music therapy added to standard care, compared to placebo, standard care or no treatment for people with serious mental illnesses such as schizophrenia. The Cochrane Schizophrenia Group's Register (July 2002) was searched. This was supplemented by hand searching of music therapy journals, manual searches of reference lists, and contacting relevant authors. All randomised controlled trials that compared music therapy with standard care or other psychosocial interventions for schizophrenia. Studies were reliably selected, quality assessed and data extracted. Data were excluded where more than 30% of participants in any group were lost to follow up. Non-skewed continuous endpoint data from valid scales were synthesised using a standardised mean difference (SMD). If statistical heterogeneity was found, treatment 'dosage' and treatment approach were examined as possible sources of heterogeneity. Four studies were included. These examined the effects of music therapy over the short to medium term (1 to 3 months), with treatment 'dosage' varying from 7 to 78 sessions. Music therapy added to standard care was superior to standard care alone for global state (medium term, 1 RCT, n = 72, RR 0.10 CI 0.03 to 0.31, NNT 2 CI 1.2 to 2.2). Continuous data suggested some positive effects on general mental state (1 RCT, n=69, SMD average endpoint PANSS -0.36 CI -0.85 to 0.12; 1 RCT, n=70, SMD average endpoint BPRS -1.25 CI -1.77 to -0.73),on negative symptoms (3 RCTs, n=180, SMD average endpoint SANS -0.86 CI -1.17 to -0.55) and social functioning (1 RCT, n=70, SMD average endpoint SDSI score -0.78 CI -1.27 to -0.28). However these latter effects were inconsistent across studies and depended on the number of music therapy sessions. All results were for the 1-3 month follow up. Music therapy as an addition to standard care helps people with schizophrenia to improve their global state and may also improve mental state and functioning if a sufficient number of music therapy sessions are provided. Further research should address the dose-effect relationship and the long-term effects of music therapy.

Accounting for dropout in xenografted tumour efficacy studies: integrated endpoint analysis, reduced bias and better use of animals.

PubMed

Martin, Emma C; Aarons, Leon; Yates, James W T

2016-07-01

Xenograft studies are commonly used to assess the efficacy of new compounds and characterise their dose-response relationship. Analysis often involves comparing the final tumour sizes across dose groups. This can cause bias, as often in xenograft studies a tumour burden limit (TBL) is imposed for ethical reasons, leading to the animals with the largest tumours being excluded from the final analysis. This means the average tumour size, particularly in the control group, is underestimated, leading to an underestimate of the treatment effect. Four methods to account for dropout due to the TBL are proposed, which use all the available data instead of only final observations: modelling, pattern mixture models, treating dropouts as censored using the M3 method and joint modelling of tumour growth and dropout. The methods were applied to both a simulated data set and a real example. All four proposed methods led to an improvement in the estimate of treatment effect in the simulated data. The joint modelling method performed most strongly, with the censoring method also providing a good estimate of the treatment effect, but with higher uncertainty. In the real data example, the dose-response estimated using the censoring and joint modelling methods was higher than the very flat curve estimated from average final measurements. Accounting for dropout using the proposed censoring or joint modelling methods allows the treatment effect to be recovered in studies where it may have been obscured due to dropout caused by the TBL.

The economic burden of pneumonia and meningitis among children less than five years old in Hanoi, Vietnam.

PubMed

Le, Phuc; Griffiths, Ulla K; Anh, Dang D; Franzini, Luisa; Chan, Wenyaw; Pham, Ha; Swint, John M

2014-11-01

To estimate the average treatment costs of pneumonia and meningitis among children under five years of age in a tertiary hospital in Hanoi, Vietnam from societal, health sector and household perspectives. We used a cost-of-illness approach to identify cost categories to be included for different perspectives. A prospective survey was conducted among eligible patients to get detailed personal costing items. From the perspective of the health sector, the mean costs for treating a case of pneumonia and meningitis were USD 180 and USD 300, respectively. From the household's perspective, the average treatment costs were USD 272 for pneumonia and USD 534 for meningitis. When also including indirect costs, the average total treatment costs from the societal perspective were USD 318 for pneumonia and USD 727 for meningitis. The study contributed to limited evidence on the high treatment costs of pneumonia and meningitis to the Vietnamese society, which is useful for a cost-effectiveness analysis of Haemophilus influenzae type b vaccine or other relevant disease preventions. It also indicated a need to re-evaluate the health insurance policy for children under 6 years old, so that the unnecessarily high out-of-pocket costs of these diseases are reduced. © 2014 John Wiley & Sons Ltd.

Treatment of Clavicular Nonunions with Shape Memory Ni-Ti Alloy Swan-Like Bone Connector

NASA Astrophysics Data System (ADS)

Liu, Xin-Wei; Xu, Shuo-Gui; Wang, Pan-Feng; Zhang, Chun-Cai

2011-07-01

Disability caused by nonunited fracture of the clavicle is a rare condition that is expressed by local pain. This condition is usually treated by reduction of the fracture and stable fixation with augmentation by autogenous bone graft. This is a retrospective study to assess outcome of the treatment of clavicular nonunion with a novel shape memory Ni-Ti alloy swan-like bone connector (SMC). August, 2003 to December, 2006, 5 consecutive patients with clavicular nonunion were treated using SMC in our hospital. The SMC device was cooled with ice before implantation and then warmed to 40-50 °C after implantation, to produce balanced axial and compression forces that would stabilize the fracture. We have used cancellous bone grafting in all our cases to obtain solid healing. Average follow-up was 37 months (range 25-58). In all patients, satisfactory osseous union was achieved. There was no complication from the hardware. The average Constant score which is for evaluating function of injured shoulder after operation was 86 points (average Constant score for the unaffected shoulder was 95). All patients were very satisfied with the treatment and outcome. The SMC provides a new effective method for fracture fixation and treatment of bone nonunion for clavicle.

[Therapeutic observation of subcutaneous pedicle screw-rod system with modified placement for Tile B pelvic fractures].

PubMed

Wu, Xiao-Tian; Chen, Nong; Pan, Fu-Gen; Liu, Zuo-Qing; He, Xiao-Jian

2017-03-25

To investigate the feasibility and therapeutic effect of subcutaneous pedicle screw-rod system with modified placement in treatment of Tile B pelvic fractures. From June 2014 to August 2015, 14 patients with Tile B pelvic fractures were treated by subcutaneous pedicle screw-rod system with modified placement in the anterior inferior iliac spine and pubic tubercle. There were 8 males and 6 females, aged from 23 to 65 years with an average of 42 years. Operative time, intraoperative blood loss, fracture healing and postoperative complication were observed and clinical effects were evaluated by Matta reduction standard and Majeed score. All patients were followed up from 8 to 15 months with an average of 10.5 months. Operative time was 25 to 45 min with an average of 32 min;intraoperative blood loss was 10 to 35 ml with an average of 18 ml. All fractures got primary healing and healed time was 9 to 14 weeks with an average of 12.5 weeks. No postoperative incision infection, internal fixation failure and ectopic ossification were found, 4 cases occurred unilateral lateral femoral cutaneous nerve injury and 1 case occurred unilateral femoral nerve paralysis, but all restored finally. According to Matta criteria, reduction was excellent in 7 cases, good in 5 cases, fair in 2 case. According to Majeed score system, the functional evaluation at last follow-up was excellent in 5 cases, good in 7 cases, fair in 2 cases with the average score of 81.50±8.05. Subcutaneous pedicle screw-rod system with modified placement in the anterior inferior iliac spine and pubic tubercle have advantages of strong reduction, less trauma and complications, and is a promising surgical method in the treatment of Tile B pelvic fractures.

Cost-effectiveness of detecting and treating diabetic retinopathy.

PubMed

Javitt, J C; Aiello, L P

1996-01-01

To determine, from the health insurer's perspective, the cost of preventing vision loss in patients with diabetes mellitus through ophthalmologic screening and treatment and to calculate the cost-effectiveness of these interventions as compared with that of other medical interventions. Computer modeling, incorporating data from population-based epidemiologic studies and multicenter clinical trials. Monte Carlo simulation was used, combined with sensitivity analysis and present value analysis of cost savings. Screening and treatment of eye disease in patients with diabetes mellitus costs $3190 per quality-adjusted life-year (QALY) saved. This average cost is a weighted average (based on prevalence disease) of the cost-effectiveness of detecting and treating diabetic eye disease in those with insulin-dependent diabetes mellitus ($1996 per QALY), those with non-insulin-dependent diabetes mellitus (NIDDM) who use insulin for glycemic control ($2933 per QALY), and those with NIDDM who do not use insulin for glycemic control ($3530 per QALY). Our analysis indicates that prevention programs aimed at improving eye care for diabetic persons not only result in substantial federal budgetary savings but are highly cost-effective health investments for society. Ophthalmologic screening for diabetic persons is more cost-effective than many routinely provided health interventions. Because diabetic eye disease is the leading cause of new cases of blindness among working-age Americans, these results support the widespread use of screening and treatment for diabetic eye disease.

Examining the Effect of Automatic Promotion on Students' Learning Achievements in Uganda's Primary Education

ERIC Educational Resources Information Center

Okurut, Jeje Moses

2015-01-01

This study employed a difference-in-differences analysis technique to estimate the average treatment effect of automatic promotion on students' cognitive learning outcomes in Uganda's primary education. Regression results indicate a positive policy effect on learning achievements in literacy and numeracy at primary three (P3) and primary six (P6).…

The cost-utility of photodynamic therapy in eyes with neovascular macular degeneration--a value-based reappraisal with 5-year data.

PubMed

Brown, Gary C; Brown, Melissa M; Campanella, Joseph; Beauchamp, George R

2005-10-01

To assess the value conferred by photodynamic therapy (PDT) and the cost-utility of PDT for the treatment of classic, subfoveal choroidal neovascularization associated with age-related macular degeneration (ARMD). Average cost-utility analysis utilizing clinical trial data, patient-based time tradeoff utility preferences, and a third party insurer cost perspective. Five-year visual acuity data from the TAP (Treatment of Age-related Macular Degeneration With Photodynamic Therapy) Investigation were modeled into a 12-year, value-based, reference case, cost-utility model utilizing year 2004 Medicare costs and an outcome of dollar/QALY (dollars/quality-adjusted life-year). Discounting of outcomes and costs using net present value analysis with a 3% annual rate was performed as recommended by the Panel for Cost-Effectiveness in Health and Medicine. PDT with verteporfin (Visudyne) dye for classic subfoveal choroidal neovascularization confers an 8.1% quality of life (value) improvement over the 12-year life expectancy of the reference case, while during the last 8 years the value improvement is 9.5%. The average cost-utility of the intervention is dollar 31,103/QALY (quality-adjusted life-year). Extensive one-way sensitivity analysis values range from dollar 20,736/QALY if treatment efficacy is increased by 50% to dollar 62,207 if treatment efficacy is decreased by 50%, indicating robustness of the model. PDT using verteporfin dye to treat classic subfoveal choroidal neovascularization is a very cost-effective treatment by conventional standards. The marked improvement in cost-effectiveness compared with a previous report results from the facts that the treatment benefit increasingly accrues during 5 years of follow-up while the number of yearly treatments diminishes markedly during that time.

ADHD symptoms impact smoking outcomes and withdrawal in response to Varenicline treatment for smoking cessation.

PubMed

Bidwell, L Cinnamon; Karoly, Hollis C; Hutchison, Kent E; Bryan, Angela D

2017-10-01

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with nicotine dependence and difficulty quitting smoking. Few cessation trials specifically consider the impact of ADHD on treatment outcomes, including those testing established pharmacological therapies, such as varenicline. The current study focused on the impact of pretreatment ADHD inattention (IN) and hyperactivity-impulsivity (HI) symptoms on treatment outcome in a randomized controlled trial of varenicline [N=205, average age=34.13(10.07), average baseline cigarettes per day=14.71(7.06)]. Given that varenicline's putative therapeutic mechanism is attenuation of withdrawal severity during abstinence, we also tested changes in withdrawal as a mediator of treatment effects in high and low ADHD groups. ADHD symptom severity in this sample was in the subclinical range. Cessation was associated with HI, but not IN, such that high HI individuals on varenicline reported the lowest smoking levels at the end of treatment across all groups (3.06cig/day for high HI vs 4.02cig/day for low HI). Individuals with high HI who received placebo had the highest smoking at the end of treatment (7.69cigs/day for high HI vs 5.56cig/day for low HI). Patterns continued at follow-up. Varenicline significantly reduced withdrawal for those with high HI, but not low HI. However, path models did not support an indirect effect of medication on reducing smoking via withdrawal in either group, suggesting that unmeasured variables are involved in varenicline's effect on reducing smoking. These data add to a gap in the smoking cessation literature regarding the impact of ADHD symptoms on the efficacy and mechanisms of frontline pharmacological treatments. Copyright © 2017 Elsevier B.V. All rights reserved.

Alzheimer’s Prevention Initiative: A Plan to Accelerate the Evaluation of Presymptomatic Treatments

PubMed Central

Reiman, Eric M.; Langbaum, Jessica B.S.; Fleisher, Adam S.; Caselli, Richard J.; Chen, Kewei; Ayutyanont, Napatkamon; Quiroz, Yakeel T.; Kosik, Kenneth S.; Lopera, Francisco; Tariot, Pierre N.

2012-01-01

There is an urgent need to find effective presymptomatic Alzheimer’s disease (AD) treatments that reduce the risk of AD symptoms or prevent them completely. It currently takes too many healthy people, too much money and too many years to evaluate the range of promising presymptomatic treatments using clinical endpoints. We have used brain imaging and other measurements to track some of the earliest changes associated with the predisposition to AD. We have proposed the Alzheimer’s Prevention Initiative (API) to evaluate investigational amyloid-modifying treatments in healthy people who, based on their age and genetic background, are at the highest imminent risk of developing symptomatic AD using brain imaging, cerebrospinal fluid (CSF), and cognitive endpoints. In one trial, we propose to study AD-causing presenilin 1 [PS1] mutation carriers from the world’s largest early-onset AD kindred in Antioquia, Colombia, close to their estimated average age at clinical onset. In another trial, we propose to study apolipoprotein E (APOE)ε4 homozygotes (and possibly heterozygotes) close to their estimated average age at clinical onset. The API has several goals: 1) to evaluate investigational AD-modifying treatments sooner than otherwise possible; 2) to determine the extent to which the treatment’s brain imaging and other biomarker effects predict a clinical benefit—information needed to help qualify biomarker endpoints for use in pivotal prevention trials; 3) to provide a better test of the amyloid hypothesis than clinical trials in symptomatic patients, when these treatments may be too little too late to exert their most profound effect; 4) to establish AD prevention registries needed to support these and other presymptomatic AD trials; and 5) to give those individuals at highest imminent risk of AD symptoms access to the most promising investigational treatments in clinical trials. PMID:21971471

Botulinum toxin treatment of hemifacial spasm.

PubMed Central

Elston, J S

1986-01-01

Six patients with hemifacial spasm were treated with injections of botulinum toxin A into the orbicularis oculi; the abnormal movements around the eye were relieved for an average of 15 weeks. There were no systemic or significant local side effects, and in view of the risks involved in neurosurgical treatment, a trial of botulinum toxin injections is recommended in the first instance in this condition. PMID:3746313

Introduction of black walnut and northern red oak seedlings in an upland hardwood forest in southeastern Ohio

Treesearch

Donald E. Hilt

1977-01-01

Black walnut and northern red oak seedlings were planted on a clearcut area in 1964. Three cultural treatments were applied to seedlings to control competing trees. Average height and survival were analyzed 13 growing seasons after planting. Results indicated that black walnut seedlings can be effectively established on good sites if cultural treatments are applied....

[Attention therapy for children - long-term affects of the ATTENTIONER].

PubMed

Jacobs, Claus; Petermann, Franz

2008-11-01

A high percentage of children are affected by attention deficit disorders. For a large proportion the cardinal symptom is inattention; in particular, deficits in selective attention prevail. The ATTENTIONER offers an effective training method for the treatment of selective attention deficit. In 2007, long-term effects of therapy were already reported by Jacobs and Petermann, who examined children ten weeks after therapy on average. In the current study three measurements were conducted: pre-intervention, post-intervention, and at follow-up ten to 76 months after post-intervention. Significant long-term effects on measures of selective attention were observed. At follow-up the majority of patients achieved average results which were not clinically relevant. For most children stable therapy effects can be achieved with the ATTENTIONER.

Efficacy and Safety of a Fixed Combination of Tramadol and Paracetamol (Acetaminophen) as Pain Therapy Within Palliative Medicine

PubMed Central

Husic, Samir; Izic, Senad; Matic, Srecko; Sukalo, Aziz

2015-01-01

Goal: The goal of the research was to determine the efficacy of a fixed combination of tramadol and paracetamol (acetaminophen) in the treatment of pain of patients with the advanced stage of cancer. Material and methods: A prospective study was conducted at the Center for Palliative Care, University Clinical Center Tuzla, Bosnia and Herzegovina, from January 1st to December 31st 2013. A total of 353 patients who were treated with a fixed combination of tramadol and acetaminophen (37.5 mg and 325 mg) at the initial dosage 3x1 tablet (112.5 mg tramadol and 975 mg acetaminophen) for pain intensity 4, up to 4x2 tablets (300 mg of tramadol and 2600 mg paracetamol) for pain intensity 7 and 8. If the patient during previous day has two or more pain episodes that required a “rescue dose” of tramadol, increased was the dose of fixed combination tramadol and acetaminophen to a maximum of 8 tablets daily (300 mg of tramadol and 2600 mg paracetamol). Statistical analysis was performed by biomedical software MedCalc for Windows version 9.4.2.0. The difference was considered significant for P<0.05. Results: The average duration of treatment with a fixed combination tramadol and acetaminophen was 57 days (13-330 days). Already after 24 hours of treatment the average pain score was significantly lower (p<0.0001) compared to the admission day [5.00 (4:00 to 8:00) during the first days versus 2.00 (1:00 to 7:00) during the second day of treatment]. The average dose of the fixed combination tramadol and acetaminophen tablets was 4.8 ± 1.8 (180 mg of tramadol and 1560 mg paracetamol). Side effects, in the treatment of pain with a fixed combination tramadol and acetaminophen, were found in 29.18% of patients, with a predominance of nausea and vomiting. Conclusion: Fixed combination of tramadol and acetaminophen can be used as an effective combination in the treatment of chronic cancer pain, with frequent dose evaluation and mild side effects. PMID:25870531

Efficacy and safety of a fixed combination of tramadol and paracetamol (acetaminophen) as pain therapy within palliative medicine.

PubMed

Husic, Samir; Izic, Senad; Matic, Srecko; Sukalo, Aziz

2015-02-01

The goal of the research was to determine the efficacy of a fixed combination of tramadol and paracetamol (acetaminophen) in the treatment of pain of patients with the advanced stage of cancer. A prospective study was conducted at the Center for Palliative Care, University Clinical Center Tuzla, Bosnia and Herzegovina, from January 1(st) to December 31(st) 2013. A total of 353 patients who were treated with a fixed combination of tramadol and acetaminophen (37.5 mg and 325 mg) at the initial dosage 3x1 tablet (112.5 mg tramadol and 975 mg acetaminophen) for pain intensity 4, up to 4x2 tablets (300 mg of tramadol and 2600 mg paracetamol) for pain intensity 7 and 8. If the patient during previous day has two or more pain episodes that required a "rescue dose" of tramadol, increased was the dose of fixed combination tramadol and acetaminophen to a maximum of 8 tablets daily (300 mg of tramadol and 2600 mg paracetamol). Statistical analysis was performed by biomedical software MedCalc for Windows version 9.4.2.0. The difference was considered significant for P<0.05. The average duration of treatment with a fixed combination tramadol and acetaminophen was 57 days (13-330 days). Already after 24 hours of treatment the average pain score was significantly lower (p<0.0001) compared to the admission day [5.00 (4:00 to 8:00) during the first days versus 2.00 (1:00 to 7:00) during the second day of treatment]. The average dose of the fixed combination tramadol and acetaminophen tablets was 4.8 ± 1.8 (180 mg of tramadol and 1560 mg paracetamol). Side effects, in the treatment of pain with a fixed combination tramadol and acetaminophen, were found in 29.18% of patients, with a predominance of nausea and vomiting. Fixed combination of tramadol and acetaminophen can be used as an effective combination in the treatment of chronic cancer pain, with frequent dose evaluation and mild side effects.

The Effect of Buzz Group Technique and Clustering Technique in Teaching Writing at the First Class of SMA HKBP I Tarutung

ERIC Educational Resources Information Center

Pangaribuan, Tagor; Manik, Sondang

2018-01-01

This research held at SMA HKBP 1 Tarutung North Sumatra on the research result of test XI[superscript 2] and XI[superscript 2] students, after they got treatment in teaching writing in recount text by using buzz group and clustering technique. The average score (X) was 67.7 and the total score buzz group the average score (X) was 77.2 and in…

“Threshold‐crossing”: A Useful Way to Establish the Counterfactual in Clinical Trials?

PubMed Central

Eichler, H‐G; Bloechl‐Daum, B; Bauer, P; Bretz, F; Brown, J; Hampson, LV; Honig, P; Krams, M; Leufkens, H; Lim, R; Lumpkin, MM; Murphy, MJ; Pignatti, F; Posch, M; Schneeweiss, S; Trusheim, M

2016-01-01

A central question in the assessment of benefit/harm of new treatments is: how does the average outcome on the new treatment (the factual) compare to the average outcome had patients received no treatment or a different treatment known to be effective (the counterfactual)? Randomized controlled trials (RCTs) are the standard for comparing the factual with the counterfactual. Recent developments necessitate and enable a new way of determining the counterfactual for some new medicines. For select situations, we propose a new framework for evidence generation, which we call “threshold‐crossing.” This framework leverages the wealth of information that is becoming available from completed RCTs and from real world data sources. Relying on formalized procedures, information gleaned from these data is used to estimate the counterfactual, enabling efficacy assessment of new drugs. We propose future (research) activities to enable “threshold‐crossing” for carefully selected products and indications in which RCTs are not feasible. PMID:27650716

The early results of excimer laser photorefractive keratectomy for compound myopic astigmatism.

PubMed

Horgan, S E; Pearson, R V

1996-01-01

An excimer laser (VISX Twenty/Twenty Excimer Refractive System) was used to treat 51 eyes for myopia and astigmatism. Uncorrected pretreatment visual acuity was between 6/18 and 6/60 (log unit +0.45 to +1.0) in 59% and worse than 6/60 in 29%. The mean pretreatment spherical refractive error was -4.05 dioptre (range 1.25 to 13.25), and the mean pretreatment cylindrical error was -0.97 dioptre (range 0.25 to 4.00). Uncorrected visual acuity measured 6/6 or better (log unit 0.0 or less) in 80% at three months, and averaged 6/6 for all eyes at six months post-treatment, with 75% eyes obtaining 6/6 or better. The mean post-treatment spherical error decayed according to pre-treatment values, with a mean sphere of -0.20 dioptre for eyes initially less than -2.00 dioptre, -0.40 dioptre (for those between -2.25 and -3.00), -0.71 dioptre (for those between -4.25 and -5.00), and -1.15 dioptre for eyes initially above -6.25 dioptre. Vectored cylindrical correction exhibited response proportional to initial refraction, with a mean post-treatment cylinder of -1.83 dioptre for eyes formerly averaging -3.08 dioptre, -0.55 dioptre (eyes initially averaging -1.63 dioptre), and -0.51 dioptre (eyes initially averaging -0.67 dioptre). Vector analysis of post-treatment astigmatism showed 58% eyes exhibiting 51 or more degrees of axis shift, although 34% eyes remained within 20 degrees of their pretreatment axis. An effective reduction in spherocylindrical error was achieved with all eyes, although axis misalignment was a common event.

Detecting treatment-subgroup interactions in clustered data with generalized linear mixed-effects model trees.

PubMed

Fokkema, M; Smits, N; Zeileis, A; Hothorn, T; Kelderman, H

2017-10-25

Identification of subgroups of patients for whom treatment A is more effective than treatment B, and vice versa, is of key importance to the development of personalized medicine. Tree-based algorithms are helpful tools for the detection of such interactions, but none of the available algorithms allow for taking into account clustered or nested dataset structures, which are particularly common in psychological research. Therefore, we propose the generalized linear mixed-effects model tree (GLMM tree) algorithm, which allows for the detection of treatment-subgroup interactions, while accounting for the clustered structure of a dataset. The algorithm uses model-based recursive partitioning to detect treatment-subgroup interactions, and a GLMM to estimate the random-effects parameters. In a simulation study, GLMM trees show higher accuracy in recovering treatment-subgroup interactions, higher predictive accuracy, and lower type II error rates than linear-model-based recursive partitioning and mixed-effects regression trees. Also, GLMM trees show somewhat higher predictive accuracy than linear mixed-effects models with pre-specified interaction effects, on average. We illustrate the application of GLMM trees on an individual patient-level data meta-analysis on treatments for depression. We conclude that GLMM trees are a promising exploratory tool for the detection of treatment-subgroup interactions in clustered datasets.

Hypouricemic and arthritis relapse-reducing effects of compound tufuling oral-liquid in intercritical and chronic gout

PubMed Central

Xie, Zhijun; Wu, Huaxiang; Jing, Xiaoqing; Li, Xiuyang; Li, Yasong; Han, Yongmei; Gao, Xiangfu; Tang, Xiaopo; Sun, Jing; Fan, Yongshen; Wen, Chengping

2017-01-01

Abstract Trial Design: In the double-blind, randomized, controlled trial, we aimed to evaluate the effects of compound tufuling oral liquid (CoTOL) on serum uric acid (sUA) levels and recurrence of acute gouty arthritis in intercritical and chronic gout treatment. Methods: A total of 210 patients with gout were screened from 8 hospitals to observe the sUA and acute gouty arthritis recurrence rate-reducing effects of CoTOL in intercritical and chronic gout during a 12-week treatment. We treated 139 and 71 patients with CoTOL and the placebo, respectively, and evaluated their sUA levels, acute gouty arthritis recurrence rate, and adverse events at week 0, 6, and 12. Results: Twenty-five and 12 patients in the treatment and control groups, respectively, had interrupted treatments, whereas 114 and 59 cases, respectively, completed their treatments. At the end of the 12-week treatment, the average decrease in sUA was 74.26 (95% confidence interval [CI]: 56.74–91.77 μmol/L) and 28.81 μmol/L (95% CI: 4.91–52.71 μmol/L) in the treatment and control groups, respectively (P = 0.004). The average decrease rate of sUA was 12.76% (95% CI: 9.82%–15.70%) and 4.57% (95% CI: 0.42%–8.71%) in the treatment and control groups, respectively (P = 0.004), and the gouty arthritis recurrence rate of the treatment group was lower than that of the control group (from week 6 to 12, 21.93% and 50.88% in the treatment and control group, respectively, P < 0.001; from baseline to week 12, 38.5% and 63.16%, respectively, P = 0.003). Severe adverse events were not observed in either groups, and fewer leucopenia incidences were observed in the treatment group than those in the control group (3/139 vs. 7/71, respectively, P = 0.033). Conclusion: CoTOL reduced sUA levels and effectively prevented acute arthritis recurrence in intercritical and chronic gout without serious adverse events. PMID:28296744

Midline Dose Verification with Diode In Vivo Dosimetry for External Photon Therapy of Head and Neck and Pelvis Cancers During Initial Large-Field Treatments

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

Tung, Chuan-Jong; Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan; Yu, Pei-Chieh

2010-01-01

During radiotherapy treatments, quality assurance/control is essential, particularly dose delivery to patients. This study was designed to verify midline doses with diode in vivo dosimetry. Dosimetry was studied for 6-MV bilateral fields in head and neck cancer treatments and 10-MV bilateral and anteroposterior/posteroanterior (AP/PA) fields in pelvic cancer treatments. Calibrations with corrections of diodes were performed using plastic water phantoms; 190 and 100 portals were studied for head and neck and pelvis treatments, respectively. Calculations of midline doses were made using the midline transmission, arithmetic mean, and geometric mean algorithms. These midline doses were compared with the treatment planning systemmore » target doses for lateral or AP (PA) portals and paired opposed portals. For head and neck treatments, all 3 algorithms were satisfactory, although the geometric mean algorithm was less accurate and more uncertain. For pelvis treatments, the arithmetic mean algorithm seemed unacceptable, whereas the other algorithms were satisfactory. The random error was reduced by using averaged midline doses of paired opposed portals because the asymmetric effect was averaged out. Considering the simplicity of in vivo dosimetry, the arithmetic mean and geometric mean algorithm should be adopted for head/neck and pelvis treatments, respectively.« less

A novel convolution-based approach to address ionization chamber volume averaging effect in model-based treatment planning systems

NASA Astrophysics Data System (ADS)

Barraclough, Brendan; Li, Jonathan G.; Lebron, Sharon; Fan, Qiyong; Liu, Chihray; Yan, Guanghua

2015-08-01

The ionization chamber volume averaging effect is a well-known issue without an elegant solution. The purpose of this study is to propose a novel convolution-based approach to address the volume averaging effect in model-based treatment planning systems (TPSs). Ionization chamber-measured beam profiles can be regarded as the convolution between the detector response function and the implicit real profiles. Existing approaches address the issue by trying to remove the volume averaging effect from the measurement. In contrast, our proposed method imports the measured profiles directly into the TPS and addresses the problem by reoptimizing pertinent parameters of the TPS beam model. In the iterative beam modeling process, the TPS-calculated beam profiles are convolved with the same detector response function. Beam model parameters responsible for the penumbra are optimized to drive the convolved profiles to match the measured profiles. Since the convolved and the measured profiles are subject to identical volume averaging effect, the calculated profiles match the real profiles when the optimization converges. The method was applied to reoptimize a CC13 beam model commissioned with profiles measured with a standard ionization chamber (Scanditronix Wellhofer, Bartlett, TN). The reoptimized beam model was validated by comparing the TPS-calculated profiles with diode-measured profiles. Its performance in intensity-modulated radiation therapy (IMRT) quality assurance (QA) for ten head-and-neck patients was compared with the CC13 beam model and a clinical beam model (manually optimized, clinically proven) using standard Gamma comparisons. The beam profiles calculated with the reoptimized beam model showed excellent agreement with diode measurement at all measured geometries. Performance of the reoptimized beam model was comparable with that of the clinical beam model in IMRT QA. The average passing rates using the reoptimized beam model increased substantially from 92.1% to 99.3% with 3%/3 mm and from 79.2% to 95.2% with 2%/2 mm when compared with the CC13 beam model. These results show the effectiveness of the proposed method. Less inter-user variability can be expected of the final beam model. It is also found that the method can be easily integrated into model-based TPS.

Design of the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study (NC ProCESS).

PubMed

Chen, Ronald C; Carpenter, William R; Kim, Mimi; Hendrix, Laura H; Agans, Robert P; Meyer, Anne-Marie; Hoffmeyer, Anna; Reeve, Bryce B; Nielsen, Matthew E; Usinger, Deborah S; Strigo, Tara S; Jackman, Anne M; Anderson, Mary; Godley, Paul A

2015-01-01

The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) was designed in collaboration with stakeholders to compare the effectiveness of different treatment options for localized prostate cancer. Using the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry, 1,419 patients (57% of eligible) with newly-diagnosed localized prostate cancer were enrolled from January 2011 to June 2013, on average 5 weeks after diagnosis. All participants were enrolled prior to treatment and this population-based cohort is sociodemographically diverse. Prospective follow-up continues to collect data on treatments received, disease control, survival and patient-reported outcomes. This study highlights several important considerations regarding stakeholder involvement, study design and generalizability regarding comparative effectiveness research in prostate cancer.

Effect of rising chemotherapy costs on the cost savings of colorectal cancer screening.

PubMed

Lansdorp-Vogelaar, Iris; van Ballegooijen, Marjolein; Zauber, Ann G; Habbema, J Dik F; Kuipers, Ernst J

2009-10-21

Although colorectal cancer screening is cost-effective, it requires a considerable net investment by governments or insurance companies. If screening was cost saving, governments and insurance companies might be more inclined to invest in colorectal cancer screening programs. We examined whether colorectal cancer screening would become cost saving with the widespread use of the newer, more expensive chemotherapies. We used the MISCAN-Colon microsimulation model to assess whether widespread use of new chemotherapies would affect the treatment savings of colorectal cancer screening in the general population. We considered three scenarios for chemotherapy use: the past, the present, and the near future. We assumed that survival improved and treatment costs for patients diagnosed with advanced stages of colorectal cancer increased over the scenarios. Screening strategies considered were annual guaiac fecal occult blood testing (FOBT), annual immunochemical FOBT, sigmoidoscopy every 5 years, colonoscopy every 10 years, and the combination of sigmoidoscopy every 5 years and annual guaiac FOBT. Analyses were conducted from the perspective of the health-care system for a cohort of 50-year-old individuals who were at average risk of colorectal cancer and were screened with 100% adherence from age 50 years to age 80 years and followed up until death. Compared with no screening, the treatment savings from preventing advanced colorectal cancer and colorectal cancer deaths by screening more than doubled with the widespread use of new chemotherapies. The lifetime average treatment savings were larger than the lifetime average screening costs for screening with Hemoccult II, immunochemical FOBT, sigmoidoscopy, and the combination of sigmoidoscopy and Hemoccult II (average savings vs costs per individual in the population: Hemoccult II, $1398 vs $859; immunochemical FOBT, $1756 vs $1565; sigmoidoscopy, $1706 vs $1575; sigmoidoscopy and Hemoccult II $1931 vs $1878). Colonoscopy did not become cost saving, but the total net costs of this strategy decreased from $1317 to $296 per individual in the population. With the increase in chemotherapy costs for advanced colorectal cancer, most colorectal cancer screening strategies have become cost saving. As a consequence, screening is a desirable approach not only to reduce colorectal cancer incidence and mortality but also to control the costs of colorectal cancer treatment.

[The clinical features and surgical treatment strategies of cervical kyphosis].

PubMed

Fang, Jia-hu; Jia, Lian-shun; Zhou, Xu-hui; Song, Li-jun; Cai, Wei-hua; Li, Xiang

2010-10-15

To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis. From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group, including 4 male and 5 female patients, aged from 17 to 72 years (average age of 35 years). Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group, including 11 male and 11 female patients, aged from 14 to 40 years (average age of 29 years), who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association (AISA). During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the operations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed. In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was -1.29 ° (preoperative 54.24 °). In conservative group, the average Cobb angle was -5.41 ° (before treatment 11.20 °) 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms. In the early period of cervical kyphosis, adopt postural therapy, plaster braces to correct an imbalance in cervical spine biomechanics can prevent deformity development. According to patients' clinical characteristics, choosing individual treatment programs can correct the severe cervical kyphosis and achieve good outcome.

Effects of breast and colorectal cancer on labour market outcomes-average effects and educational gradients.

PubMed

Heinesen, Eskil; Kolodziejczyk, Christophe

2013-12-01

We estimate causal effects of breast and colorectal cancer on labour market outcomes 1-3 years after the diagnosis. Based on Danish administrative data we estimate average treatment effects on the treated by propensity score weighting methods using persons with no cancer diagnosis as control group. We conduct robustness checks using matching, difference-in-differences methods and an alternative control group of later cancer patients. The different methods give approximately the same results. Cancer increases the risks of leaving the labour force and receiving disability pension, and the effects are larger for the less educated. Effects on income are small and mostly insignificant. We investigate some of the mechanisms which may be important in explaining the educational gradient in effects of cancer on labour market attachment. Copyright © 2013 Elsevier B.V. All rights reserved.

[Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

PubMed

Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

2018-05-25

To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has advantages of small trauma, fixed fixation, quick recovery, early postoperative functional exercise. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

[Role of the L-arginine-NO system in the prevention and treatment of cardiovascular diseases in pregnant women].

PubMed

Vladymyrov, O A; Tofan, N I

2003-01-01

Investigations on using of index possibilities of L-arginin/NO system in evaluation of sanatorium-resort treatment effectiveness of pregnant with cardiovascular disorders were conducted. It was analyzed the dynamics of twenty four hour cycle rhythm of L-arginin and total nitrites and nitrates constance in saliva of 58 pregnant, 20 of which were suffering from metabolic cardiomyopathy, 23-from neurocirculatory dystonia and 15 were healthy pregnant. As the result of examination there were found out considerable changes of parameter values of biological rhythms: duration of rhythm, average twenty four hour cycle range of activity, amount of difference between max index per twenty hour cycle and average index per twenty hour cycle, period of max and min activity. Analysis of tendencies of twenty four hour cycles rhythms concerning dynamics of sanatorium-resort treatment will give possibility to define characteristic features of recovering values of this parameter.

The endoscopic stapler diverticulotomy for Zenker's diverticulum.

PubMed

Manni, Johannes J; Kremer, Bernd; Rinkel, Rico N P M

2004-02-01

This paper describes the surgical procedure of the endoscopic stapler treatment of Zenker's diverticulum and analyzes the results of 24 consecutive operated patients. In three patients the endoscopic exposure of the diverticulum was not possible. Twenty-one patients underwent endoscopic stapler treatment without any peri- or postoperative complications. The follow-up period was 4 to 29 months (average 18 months). The average total time for surgery was 25 min. Postoperatively, a nasogastric feeding tube was not necessary: all patients resumed oral intake 12 h after surgery. Discharge from the hospital followed the 2nd postoperative day. All patients had complete or nearly complete resolution of symptoms at the 4-month follow-up. Recurrent complaints were an indication for repeat of the contrast barium esophagram. Two patients revealed a residual diverticulum 7 and 11 months after treatment. In comparison with results and complication rates in the literature of the external, transcutaneous techniques and endoscopic diverticulotomy procedures, the endoscopic stapler treatment of Zenker's diverticulum is a safe, (cost-)effective and minimally invasive method and to be considered as the initial treatment of choice.

Predicting therapy success for treatment as usual and blended treatment in the domain of depression.

PubMed

van Breda, Ward; Bremer, Vincent; Becker, Dennis; Hoogendoorn, Mark; Funk, Burkhardt; Ruwaard, Jeroen; Riper, Heleen

2018-06-01

In this paper, we explore the potential of predicting therapy success for patients in mental health care. Such predictions can eventually improve the process of matching effective therapy types to individuals. In the EU project E-COMPARED, a variety of information is gathered about patients suffering from depression. We use this data, where 276 patients received treatment as usual and 227 received blended treatment, to investigate to what extent we are able to predict therapy success. We utilize different encoding strategies for preprocessing, varying feature selection techniques, and different statistical procedures for this purpose. Significant predictive power is found with average AUC values up to 0.7628 for treatment as usual and 0.7765 for blended treatment. Adding daily assessment data for blended treatment does currently not add predictive accuracy. Cost effectiveness analysis is needed to determine the added potential for real-world applications.

Primary SWL Is an Efficient and Cost-Effective Treatment for Lower Pole Renal Stones Between 10 and 20 mm in Size: A Large Single Center Study.

PubMed

Chan, Luke H; Good, Daniel W; Laing, Karina; Phipps, Simon; Thomas, Ben G; Keanie, Julian Y; Tolley, David A; Cutress, Mark L

2017-05-01

To assess the clinical features, outcomes, complications, and cost-effectiveness of shockwave lithotripsy (SWL), flexible ureterorenoscopy (FURS), and percutaneous nephrolithotomy (PCNL) in the treatment of lower pole (LP) stones (10-20 mm) in a large tertiary referral center. Consecutive patients treated for solitary LP stones (10-20 mm) between 2008 and 2013 were identified from a prospective database. SWL was used as primary treatment in all cases (following a stone multidisciplinary team assessment), with FURS and PCNL reserved for SWL contraindications, failure, or patient choice. "Success" was defined as stone free and/or clinically insignificant stone fragments (≤3 mm) at 1 and 3 months follow-up. Effect of anatomy on SWL success was determined from using CT images and regression analysis. Average cost per treatment modality (including additional second-line treatments) was calculated for each group using the National Health Service England 2014/15 National Tariff Healthcare Resource Group codes. Two hundred twenty-five patients were included (mean age 54.9; median stone size 12 mm). One hundred ninety-eight (88%), 21 (9.3%), and 6 (2.7%) patients underwent SWL, FURS, and PCNL as primary treatments, respectively, for median stone sizes of 12, 12, and 20 mm. Overall success rates were 82.8%, 76.1%, and 66.7%, respectively (p < 0.05). Sixty-three percent of patients undergoing primary SWL were effectively treated after one session. Anatomical analysis determined infundibulopelvic angle and infundibular length to be significantly different in patients effectively treated with SWL (p = 0.04). The average cost per treatment modality was also significantly lower for SWL (£750) than for FURS (£1261) or PCNL (£2658) (p < 0.01). SWL is both an efficacious and cost-effective primary treatment for patients with solitary LP stones (10-20 mm). The majority of patients can be effectively treated with primary SWL in a dedicated stone center, with the benefits of a short length of stay, low complication, and auxiliary treatment rates. The referral of such patients to high-volume lithotripsy centers with demonstrable outcomes should be given due consideration.

Parkinson's disease management strategies.

PubMed

Rajput, Alex; Rajput, Ali H

2006-01-01

Parkinson's disease (PD) treatment strategies should consider each patient individually. Drug therapy is the mainstay of treatment. An average 62-year-old male first diagnosed with PD will likely live for 20 years and treatment should be geared for long-term control of symptoms and quality of life. Of the currently available drugs, none are neurotoxic to the human substantia nigra and none are neuroprotective. As PD is a progressive disorder, all drugs have adverse effects and reduced efficacy with time. PD patients need regular follow-ups to make necessary medication adjustments. There is no perfect treatment. The authors have discussed their treatment methods and the reasoning behind it. Depending on the patient's age, the predominant symptoms and quality of life, treatment is individualized. In an average patient the least potent drugs, such as anticholinergics or amantadine, are administered first adding a dopamine agonist later on. Levodopa (LD) remains the most useful drug for PD and is reserved for later stages of disease. The objective is to keep the patient at Hoehn and Yahr Stage 2.0 or lower level of disability (bilateral findings with preserved postural reflexes) during off-stage and to avoid adverse effects. There is no long-term difference between standard preparations and control release formulations of LD/carbidopa or LD/benserazide. In older subjects, the first choice is LD. In patients who cannot be managed medically, surgical treatment is an option in selected patients (nondemented, <70 years old, previous good LD response). The surgical treatment of choice is currently subthalamic nucleus deep-brain stimulation. Physiotherapy, occupational therapy and speech therapy are valuable in advanced PD cases.

Cost of improving Access to Psychological Therapies (IAPT) programme: an analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region.

PubMed

Radhakrishnan, Muralikrishnan; Hammond, Geoffrey; Jones, Peter B; Watson, Alison; McMillan-Shields, Fiona; Lafortune, Louise

2013-01-01

Recent literature on Improving Access to Psychological Therapies (IAPT) has reported on improvements in clinical outcomes, changes in employment status and the concept of recovery attributable to IAPT treatment, but not on the costs of the programme. This article reports the costs associated with a single session, completed course of treatment and recovery for four treatment courses (i.e., remaining in low or high intensity treatment, stepping up or down) in IAPT services in 5 East of England region Primary Care Trusts. Costs were estimated using treatment activity data and gross financial information, along with assumptions about how these financial data could be broken down. The estimated average cost of a high intensity session was £177 and the average cost for a low intensity session was £99. The average cost of treatment was £493 (low intensity), £1416 (high intensity), £699 (stepped down), £1514 (stepped up) and £877 (All). The cost per recovered patient was £1043 (low intensity), £2895 (high intensity), £1653 (stepped down), £2914 (stepped up) and £1766 (All). Sensitivity analysis revealed that the costs are sensitive to cost ratio assumptions, indicating that inaccurate ratios are likely to influence overall estimates. Results indicate the cost per session exceeds previously reported estimates, but cost of treatment is only marginally higher. The current cost estimates are supportive of the originally proposed IAPT model on cost-benefit grounds. The study also provides a framework to estimate costs using financial data, especially when programmes have block contract arrangements. Replication and additional analyses along with evidence-based discussion regarding alternative, cost-effective methods of intervention is recommended. Copyright © 2012 Elsevier Ltd. All rights reserved.

Treatment of chronic neurogenic cough with in-office superior laryngeal nerve block.

PubMed

Simpson, C Blake; Tibbetts, Kathleen M; Loochtan, Michael J; Dominguez, Laura M

2018-04-18

Neurogenic cough is believed to result from a sensory neuropathy involving the internal branch of the superior laryngeal nerve (SLN). We present our outcomes for the treatment of neurogenic cough with localized blockade of the internal branch of the SLN. A retrospective chart review of patients who underwent in-office percutaneous SLN block for treatment of neurogenic cough between 2015 and 2017 was conducted. Patient demographics, indications for injection, and response to treatment were recorded and analyzed. Cough severity index (CSI) scores before and after treatment were compared. Twenty-three patients underwent percutaneous blockade of the internal branch of the SLN in the clinic setting, and five patients were excluded for incomplete records. The indication was neurogenic cough as a diagnosis of exclusion. The injectable substance used was a 1:1 mixture of a long-acting particulate corticosteroid and a local anesthetic. Unilateral injections were performed in 13 patients, and five patients underwent bilateral injections. Of the unilateral injections, 10 were left-sided. Patients underwent an average of 2.4 SLN block procedures (range 1-7). Mean follow-up time postinjection was 85.4 days (7-450 days). Cough severity index scores decreased significantly from an average of 26.8 pretreatment to 14.6 posttreatment (P < 0.0001). The SLN block is an effective treatment for neurogenic cough, with average CSI scores significantly improved following injection. Further study is necessary to determine the characteristics of patients' responses to treatment, long-term outcomes, and efficacy of the procedure when compared to placebo and other accepted treatments for neurogenic cough. 4. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

A novel PSB-EDI system for high ammonia wastewater treatment, biomass production and nitrogen resource recovery: PSB system.

PubMed

Wang, Hangyao; Zhou, Qin; Zhang, Guangming; Yan, Guokai; Lu, Haifeng; Sun, Liyan

A novel process coupling photosynthetic bacteria (PSB) with electrodeionization (EDI) treatment was proposed to treat high ammonia wastewater and recover bio-resources and nitrogen. The first stage (PSB treatment) was used to degrade organic pollutants and accumulate biomass, while the second stage (EDI) was for nitrogen removal and recovery. The first stage was the focus in this study. The results showed that using PSB to transform organic pollutants in wastewater into biomass was practical. PSB could acclimatize to wastewater with a chemical oxygen demand (COD) of 2,300 mg/L and an ammonia nitrogen (NH4(+)-N) concentration of 288-4,600 mg/L. The suitable pH was 6.0-9.0, the average COD removal reached 80%, and the biomass increased by an average of 9.16 times. The wastewater COD removal was independent of the NH4(+)-N concentration. Moreover, the PSB functioned effectively when the inoculum size was only 10 mg/L. The PSB-treated wastewater was then further handled in an EDI system. More than 90% of the NH4(+)-N was removed from the wastewater and condensed in the concentrate, which could be used to produce nitrogen fertilizer. In the whole system, the average NH4(+)-N removal was 94%, and the average NH4(+)-N condensing ratio was 10.0.

Cost per care of the first year of direct antiviral agents in the Liguria Region: a multicenter analysis

PubMed Central

Cenderello, Giovanni; Fanizza, Caterina; Marenco, Simona; Nicolini, Laura Ambra; Artioli, Stefania; Baldissarro, Isabella; Dentone, Chiara; De Leo, Pasqualina; Di Biagio, Antonio

2017-01-01

Aims Despite the remarkable efficacy shown in clinical practice, concerns have been raised about the costs associated with direct antiviral agent (DAA) therapy. This article presents the real-life costs for DAA treatment sustained by the Italian National Health Service in the Liguria Region (Northern Italy). Methods A retrospective analysis of the cost per care sustained for DAA treatment, relating to the period from January 1 to December 31, 2015 in five centers in Liguria was performed. All patients undergoing DAA-based treatments for hepatitis C virus (HCV) infection were enrolled. On-treatment costs included: HCV treatment, laboratory test, outpatient services, attended visits, drugs used for the management of adverse events (erythropoietin, albumin or red blood cell packs) and inpatient service admissions. Results In total, 327 patients were enrolled. No difference in terms of sustained virologic response (SVR) rate among different treatments was reported. The majority (85.0%) of patients did not report any side effects and only 15 (4.6%) required hospital admission. Forty-two patients (12.8%) required high-cost drugs for the management of adverse events. The overall cost sustained was €14,744,433. DAA±ribavirin (RBV) accounted for the wide majority of this cost (98.9%; €14,585,123). Genotype (GT) 1, the most commonly treated GT, was associated with an average cost of €43,445 per patient. Detailed analysis of the costs for GT 1 showed the treatment based on ritonavir boosted paritaprevir/ombitasvir + dasabuvir±RBV with an average cost of €24,978 (RBV+) and €25,448 (RBV−) per patient was the most cost-effective. The average cost per SVR was €48,184. Once again, the ritonavir boosted paritaprevir/ombitasvir + dasabuvir regimen was associated with the lowest cost/SVR (€25,448/SVR [GT 1b] and similar results for other GTs). Conclusion Antiviral regimen is the major contributor to costs in the treatment of HCV infection. Appropriate regimen selection could result in a major cost saving, which can be reinvested to allow more patients to be treated. PMID:28579812

A cost and clinical effectiveness analysis among moist wound healing dressings versus traditional methods in home care patients with pressure ulcers.

PubMed

Souliotis, Kyriakos; Kalemikerakis, Ioannis; Saridi, Maria; Papageorgiou, Manto; Kalokerinou, Athena

2016-05-01

The aim of the study was a cost and clinical effectiveness analysis between moist wound healing dressings and gauze in a homecare set up for the treatment of stage III and IV pressure ulcers up to complete healing. In addition, we assessed the overall economic burden on the Healthcare System. Treatment method for each patient was chosen randomly by using sealed opaque envelopes. The authors monitored the healing progress and recorded treatment costs without interfering with the treatment process. The healing progress was estimated by using surface measurement transparent films. To estimate treatment costs, the authors took into account labor costs, cost of dressings, as well the cost of other materials such as cleansing gauzes, normal saline, syringes, examination gloves, antiseptics and adhesive tape. The patient group under treatment with moist wound healing dressings consisted of 27 men and 20 women aged 75.1 ± 8,6 and had an average ulcer surface of 43.5 ± 30.70 cm(2) ; the patient group under treatment with gauze comprised 25 men and 23 women aged 77.02 ± 8.02 and had an average ulcer surface 41.52 ± 29.41 cm(2) (p = 0.25, 95% CI, Student's t test). The average healing time for the moist wound healing dressings group' was 85.56 ± 52.09 days, while 121.4 ± 52.21 days for the "gauze group" (p = 0.0001, 95% CI, Student's t test). The dressing change frequency per patient was reduced in the "moist wound healing dressings group," 49.5 ± 29.61, compared with a dressing change frequency per patient of 222.6 ± 101.86 for the "gauze group" (p = 0.0001, 95% CI, Student's t test). The use of moist wound healing dressings had a lower total treatment cost of 1,351 € per patient compared with, the use of gauzes (3,888 €). © 2016 by the Wound Healing Society.

What is the effect of area size when using local area practice style as an instrument?

PubMed

Brooks, John M; Tang, Yuexin; Chapman, Cole G; Cook, Elizabeth A; Chrischilles, Elizabeth A

2013-08-01

Discuss the tradeoffs inherent in choosing a local area size when using a measure of local area practice style as an instrument in instrumental variable estimation when assessing treatment effectiveness. Assess the effectiveness of angiotensin converting-enzyme inhibitors and angiotensin receptor blockers on survival after acute myocardial infarction for Medicare beneficiaries using practice style instruments based on different-sized local areas around patients. We contrasted treatment effect estimates using different local area sizes in terms of the strength of the relationship between local area practice styles and individual patient treatment choices; and indirect assessments of the assumption violations. Using smaller local areas to measure practice styles exploits more treatment variation and results in smaller standard errors. However, if treatment effects are heterogeneous, the use of smaller local areas may increase the risk that local practice style measures are dominated by differences in average treatment effectiveness across areas and bias results toward greater effectiveness. Local area practice style measures can be useful instruments in instrumental variable analysis, but the use of smaller local area sizes to generate greater treatment variation may result in treatment effect estimates that are biased toward higher effectiveness. Assessment of whether ecological bias can be mitigated by changing local area size requires the use of outside data sources. Copyright © 2013 Elsevier Inc. All rights reserved.

Establishment of a rice-duck integrated farming system and its effects on soil fertility and rice disease control

NASA Astrophysics Data System (ADS)

Teng, Qing; Hu, Xue-Feng; Cheng, Chang; Luo, Zhi-Qing; Luo, Fan

2015-04-01

Rice-duck integrated farming is an ecological farming system newly established in some areas of southern China . It was reported that the ducks walking around the paddy fields is beneficial to control weed hazards and reduce rice pests and diseases. To study and evaluate the effects of the rice-duck integrated farming on soil fertility and rice disease control, a field experiment of rice cultivation was carried out in the suburb of Shanghai in 2014. It includes a treatment of raising ducks in the fields and a control without ducks. The treatment was implemented by building a duck coop nearby the experimental fields and driving 15 ducks into a plot at daytime since the early stage of rice growth. Each plot is 667 m2 in area. The treatment and control were replicated for three times. No any herbicides, pesticides, fungicides and chemical fertilizers were applied during the experiment to prevent any disturbance to duck growing and rice weed hazards and disease incidences from agrochemicals. The results are as follows: (1) The incidences of rice leaf rollers (Cnaphalocrocis medinalis) and stem borers treated with ducks, 0.45%and 1.18% on average, respectively, are lower than those of the control, 0.74% and 1.44% on average, respectively. At the late stage of rice growth, the incidence of rice sheath blight treated with ducks, 13.15% on average, is significantly lower than that of the control, 16.9% on average; and the incidence of rice planthoppers treated with ducks, 11.3 per hill on average, is also significantly lower than that of the control, 47.4 per hill on average. (2) The number of weeds in the plots treated with ducks, 8.3 per m2 on average, is significantly lower than that of the control, 87.5 m2 on average. (3) Raising ducks in the fields could also enhance soil enzyme activity and nutrient status. At the late stage of rice growth, the activities of urease, phosphatase, sucrase and catalase in the soils treated with ducks are 1.39 times, 1.40 times, 1.29 times and 1.13 times those of the control, respectively; and the content of available P and alkali-hydrolyzable N in the soils treated with ducks, 23.35 mg kg-1 and 107.33 mg kg-1, on average, respectively, are significantly higher than those of the control, 15.70 mg kg-1 and 84.00 mg kg-1 on average, respectively. (4) The grain yield of the plots treated with ducks, 6456.25 kg hm-2 on average, is significantly higher than that of the control, 3403.81 kg hm-2. In short, raising ducks in the paddy fields not only shows a potential of controlling weed hazards and reducing rice pests and diseases, but also effectively improves soil fertility and rice grain yield. Such rice-duck integrated farming will highly contribute to establishing an organic or low-input farming system in southern China in the future.

Identification and estimation of survivor average causal effects.

PubMed

Tchetgen Tchetgen, Eric J

2014-09-20

In longitudinal studies, outcomes ascertained at follow-up are typically undefined for individuals who die prior to the follow-up visit. In such settings, outcomes are said to be truncated by death and inference about the effects of a point treatment or exposure, restricted to individuals alive at the follow-up visit, could be biased even if as in experimental studies, treatment assignment were randomized. To account for truncation by death, the survivor average causal effect (SACE) defines the effect of treatment on the outcome for the subset of individuals who would have survived regardless of exposure status. In this paper, the author nonparametrically identifies SACE by leveraging post-exposure longitudinal correlates of survival and outcome that may also mediate the exposure effects on survival and outcome. Nonparametric identification is achieved by supposing that the longitudinal data arise from a certain nonparametric structural equations model and by making the monotonicity assumption that the effect of exposure on survival agrees in its direction across individuals. A novel weighted analysis involving a consistent estimate of the survival process is shown to produce consistent estimates of SACE. A data illustration is given, and the methods are extended to the context of time-varying exposures. We discuss a sensitivity analysis framework that relaxes assumptions about independent errors in the nonparametric structural equations model and may be used to assess the extent to which inference may be altered by a violation of key identifying assumptions. © 2014 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd.

Identification and estimation of survivor average causal effects

PubMed Central

Tchetgen, Eric J Tchetgen

2014-01-01

In longitudinal studies, outcomes ascertained at follow-up are typically undefined for individuals who die prior to the follow-up visit. In such settings, outcomes are said to be truncated by death and inference about the effects of a point treatment or exposure, restricted to individuals alive at the follow-up visit, could be biased even if as in experimental studies, treatment assignment were randomized. To account for truncation by death, the survivor average causal effect (SACE) defines the effect of treatment on the outcome for the subset of individuals who would have survived regardless of exposure status. In this paper, the author nonparametrically identifies SACE by leveraging post-exposure longitudinal correlates of survival and outcome that may also mediate the exposure effects on survival and outcome. Nonparametric identification is achieved by supposing that the longitudinal data arise from a certain nonparametric structural equations model and by making the monotonicity assumption that the effect of exposure on survival agrees in its direction across individuals. A novel weighted analysis involving a consistent estimate of the survival process is shown to produce consistent estimates of SACE. A data illustration is given, and the methods are extended to the context of time-varying exposures. We discuss a sensitivity analysis framework that relaxes assumptions about independent errors in the nonparametric structural equations model and may be used to assess the extent to which inference may be altered by a violation of key identifying assumptions. © 2014 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd. PMID:24889022

Generalizability of findings from randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network.

PubMed

Susukida, Ryoko; Crum, Rosa M; Ebnesajjad, Cyrus; Stuart, Elizabeth A; Mojtabai, Ramin

2017-07-01

To compare randomized controlled trial (RCT) sample treatment effects with the population effects of substance use disorder (SUD) treatment. Statistical weighting was used to re-compute the effects from 10 RCTs such that the participants in the trials had characteristics that resembled those of patients in the target populations. Multi-site RCTs and usual SUD treatment settings in the United States. A total of 3592 patients in 10 RCTs and 1 602 226 patients from usual SUD treatment settings between 2001 and 2009. Three outcomes of SUD treatment were examined: retention, urine toxicology and abstinence. We weighted the RCT sample treatment effects using propensity scores representing the conditional probability of participating in RCTs. Weighting the samples changed the significance of estimated sample treatment effects. Most commonly, positive effects of trials became statistically non-significant after weighting (three trials for retention and urine toxicology and one trial for abstinence); also, non-significant effects became significantly positive (one trial for abstinence) and significantly negative effects became non-significant (two trials for abstinence). There was suggestive evidence of treatment effect heterogeneity in subgroups that are under- or over-represented in the trials, some of which were consistent with the differences in average treatment effects between weighted and unweighted results. The findings of randomized controlled trials (RCTs) for substance use disorder treatment do not appear to be directly generalizable to target populations when the RCT samples do not reflect adequately the target populations and there is treatment effect heterogeneity across patient subgroups. © 2017 Society for the Study of Addiction.

Bedtime administration of cilnidipine controls morning hypertension.

PubMed

Ashizawa, Naoto; Seto, Shinji; Shibata, Yoshisada; Yano, Katsusuke

2007-09-01

Morning blood pressure (BP) level plays an important role in the incidence of cardiovascular disease. Recently, Kario, et al proposed the usefulness of ME difference (morning minus evening systolic BP) and ME average (average of morning and evening systolic BP) for the evaluation of antihypertensive treatment. Cilnidipine is a novel calcium channel blocker (CCB) that exerts inhibitory actions not only on L-type but also on N-type calcium channels. We investigated the effect of bedtime administration of cilnidipine (10 mg) in addition to the antihypertensive treatment for uncontrolled morning hypertension. Twenty-three hypertensive outpatients (13 males and 10 females; mean age, 66.9 years) with stable antihypertensive medication and uncontrolled morning BP were studied using self-measured BP monitoring in the morning and evening. Morning SBP (P < 0.001) and DBP (P < 0.001) decreased significantly from 150.2 +/- 8.7 and 87.8 +/- 9.3 to 132.7 +/- 7.4 and 77.5 +/- 8.5 mmHg, respectively, after the addition of cilnidipine. Morning heart rate did not change (63.3 +/- 7.0 to 64.1 +/- 9.4). The evening SBP, but not DBP, decreased significantly after treatment. Both the ME average (P < 0.001) and ME difference (P < 0.01) significantly decreased from 143.0 +/- 9.2 and 14.3 +/- 12.4 to 131.3 +/- 7.2 and 2.8 +/- 9.2 mmHg after treatment, respectively. The microalbuminuria decreased from 39.6 +/- 13.2 to 27.3 +/- 8.4 mg/g Cr. In conclusion, L-/N-type CCB cilnidipine may be useful for patients with uncontrollable morning hypertension by reducing both ME average and ME difference.

Quasi-analytical treatment of spatially averaged radiation transfer in complex terrain

NASA Astrophysics Data System (ADS)

LöWe, H.; Helbig, N.

2012-10-01

We provide a new quasi-analytical method to compute the subgrid topographic influences on the shortwave radiation fluxes and the effective albedo in complex terrain as required for large-scale meteorological, land surface, or climate models. We investigate radiative transfer in complex terrain via the radiosity equation on isotropic Gaussian random fields. Under controlled approximations we derive expressions for domain-averaged fluxes of direct, diffuse, and terrain radiation and the sky view factor. Domain-averaged quantities can be related to a type of level-crossing probability of the random field, which is approximated by long-standing results developed for acoustic scattering at ocean boundaries. This allows us to express all nonlocal horizon effects in terms of a local terrain parameter, namely, the mean-square slope. Emerging integrals are computed numerically, and fit formulas are given for practical purposes. As an implication of our approach, we provide an expression for the effective albedo of complex terrain in terms of the Sun elevation angle, mean-square slope, the area-averaged surface albedo, and the ratio of atmospheric direct beam to diffuse radiation. For demonstration we compute the decrease of the effective albedo relative to the area-averaged albedo in Switzerland for idealized snow-covered and clear-sky conditions at noon in winter. We find an average decrease of 5.8% and spatial patterns which originate from characteristics of the underlying relief. Limitations and possible generalizations of the method are discussed.

Effectiveness of Educational Technology in Promoting Quality of Life and Treatment Adherence in Hypertensive People

PubMed Central

de Souza, Ana Célia Caetano; Moreira, Thereza Maria Magalhaes; de Oliveira, Edmar Souza; de Menezes, Anaíze Viana Bezerra; Loureiro, Aline Maria Oliveira; Silva, Camila Brasileiro de Araújo; Linard, Jair Gomes; de Almeida, Italo Lennon Sales; Mattos, Samuel Miranda; Borges, José Wicto Pereira

2016-01-01

The objective of this study was to test the effectiveness of an educational intervention with use of educational technology (flipchart) to promote quality of life (QOL) and treatment adherence in people with hypertension. It was an intervention study of before-and-after type conducted with 116 hypertensive people registered in Primary Health Care Units. The educational interventions were conducted using the flipchart educational technology. Quality of life was assessed through the MINICHAL (lowest score = better QOL) and the QATSH (higher score = better adherence) was used to assess the adherence to hypertension treatment. Both were measured before and after applying the intervention. In the analysis, we used the Student’s t-test for paired data. The average baseline quality of life was 11.66 ± 7.55, and 7.71 ± 5.72 two months after the intervention, showing a statistically significant reduction (p <0.001) and mean of differences of 3.95. The average baseline adherence to treatment was 98.03 ± 7.08 and 100.71 ± 6.88 two months after the intervention, which is statistically significant (p < 0.001), and mean of differences of 2.68. The conclusion was that the educational intervention using the flipchart improved the total score of quality of life in the scores of physical and mental domains, and increased adherence to hypertension treatment in people with the disease. PMID:27851752

Effectiveness of Educational Technology in Promoting Quality of Life and Treatment Adherence in Hypertensive People.

PubMed

de Souza, Ana Célia Caetano; Moreira, Thereza Maria Magalhaes; Oliveira, Edmar Souza de; Menezes, Anaíze Viana Bezerra de; Loureiro, Aline Maria Oliveira; Silva, Camila Brasileiro de Araújo; Linard, Jair Gomes; Almeida, Italo Lennon Sales de; Mattos, Samuel Miranda; Borges, José Wicto Pereira

2016-01-01

The objective of this study was to test the effectiveness of an educational intervention with use of educational technology (flipchart) to promote quality of life (QOL) and treatment adherence in people with hypertension. It was an intervention study of before-and-after type conducted with 116 hypertensive people registered in Primary Health Care Units. The educational interventions were conducted using the flipchart educational technology. Quality of life was assessed through the MINICHAL (lowest score = better QOL) and the QATSH (higher score = better adherence) was used to assess the adherence to hypertension treatment. Both were measured before and after applying the intervention. In the analysis, we used the Student's t-test for paired data. The average baseline quality of life was 11.66 ± 7.55, and 7.71 ± 5.72 two months after the intervention, showing a statistically significant reduction (p <0.001) and mean of differences of 3.95. The average baseline adherence to treatment was 98.03 ± 7.08 and 100.71 ± 6.88 two months after the intervention, which is statistically significant (p < 0.001), and mean of differences of 2.68. The conclusion was that the educational intervention using the flipchart improved the total score of quality of life in the scores of physical and mental domains, and increased adherence to hypertension treatment in people with the disease.

Cost-effectiveness model for hepatitis C screening and treatment: Implications for Egypt and other countries with high prevalence

PubMed Central

Kim, David D.; Hutton, David W.; Raouf, Ahmed A.; Salama, Mohsen; Hablas, Ahmed; Seifeldin, Ibrahim A.; Soliman, Amr S.

2014-01-01

Hepatitis C Virus (HCV) infection is a major cause of cirrhosis and liver cancer, and many developing countries report intermediate-to-high prevalence. However, the economic impact of screening and treatment for HCV in high prevalence countries has not been well studied. Thus, we examined the cost-effectiveness of screening and treatment for HCV infection for asymptomatic, average-risk adults using a Markov decision analytic model. In our model, we collected age-specific prevalence, disease progression rates for Egyptians, and local cost estimates in Egypt, which has the highest prevalence of HCV infection (~15%) in the world. We estimated the incremental cost-effectiveness ratio (ICER) and conducted sensitivity analyses to determine how cost-effective HCV screening and treatment might be in other developing countries with high and intermediate prevalence. In Egypt, implementing a screening program using triple-therapy treatment (sofosbuvir with pegylated interferon and ribavirin) was dominant compared to no screening because it would have lower total costs and improve health outcomes. HCV screening and treatment would also be cost-effective in global settings with intermediate costs of drug treatment (~$8,000) and a higher sustained viral response rate (70–80%). PMID:25469976

Efficacy of the Q-switched Neodymium: Yttrium Aluminum Garnet Laser in the Treatment of Blue-black Amateur and Professional Tattoos

PubMed Central

Lakshmi, Chembolli; Krishnaswamy, Gayathri

2015-01-01

Background: Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same. Aim: The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions. Materials and Methods: This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4–6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm2. The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs. Results: After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos. Conclusion: Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals. PMID:26677271

Treatment of odontogenic infections: An analysis of two antibiotic regimens.

PubMed

Bhagania, Manish; Youseff, Wael; Mehra, Pushkar; Figueroa, Ruben

2018-01-01

Retrospective analysis of the efficacy for two commonly used antibiotic regimens in the management of severe odontogenic infections. Evaluation of records of patients admitted to the Oral and Maxillofacial Surgery service at Boston University Medical Center from 2009 to 2014 with severe infections of odontogenic origin (SOI). Patients were divided into two groups based on the administered intravenous antibiotic: 1) Group I: Clindamycin only and 2) Group II: Penicillin and Metronidazole. Variables evaluated included demographic characteristics, ASA status, and anatomic site of infection risk, length of hospital stay, antibiotic failure, and pharmaceutical treatment cost. 78 patients (46 males and 32 females) were included in the study. There were 57 patients in group I (average age 32.6 years) and 21 in Group II (average age 32.8 years). The average white cell count at time of admission count was higher in Group I (19.3) versus Group II (17.4). Antibiotic failure rate was 3.5% in Group I and 4.7% for group 2 patients. Clindamycin alone and combination of Penicillin with Metronidazole are both effective pharmaceutical regimens for SOI. Clindamycin therapy resulted in shorter hospital stay and lower net treatment costs with a slightly higher success rate.

A comparison of speech outcomes using radical intravelar veloplasty or furlow palatoplasty for the treatment of velopharyngeal insufficiency associated with occult submucous cleft palate.

PubMed

Afrooz, Paul Nader; MacIsaac, Zoe; Rottgers, Stephen Alex; Ford, Matthew; Grunwaldt, Lorelei J; Kumar, Anand R

2015-02-01

The safety, efficacy, and direct comparison of various surgical treatments for velopharyngeal insufficiency (VPI) associated with occult submucous cleft palate (OSMCP) are poorly characterized. The aim of this study was to report and analyze the safety and efficacy of Furlow palatoplasty (FP) versus radical intravelar veloplasty (IVV) for treatment of VPI associated with OSMCP. A retrospective review of one institution's experience treating VPI associated with OSMCP using IVV (group 1) or FP (group 2) during 24 months was performed. Statistical significance was determined by Wilcoxon matched-pair, Independent-Samples Mann-Whitney U, and analysis of variance (SPSS 20.0.0). In group 1 (IVV), 18 patients were identified from August 2010 to 2011 (12 male and 6 female patients; average age, 5.39 years). Seven patients were syndromic and 11 were nonsyndromic. In group 2 (FP), 17 patients were identified from August 2009 to 2011 (8 male and 9 female patients; average age, 8.37 years). Three patients were syndromic and 14 patients were nonsyndromic. There was statistical significance between the average pretreatment Pittsburgh Weighted Speech Score (PWSS) of the 2 groups (group 1 and 2 averages 19.06 and 11.05, respectively, P=0.002), but there was no statistical significance postoperatively (group 1 and 2 averages 4.50 and 4.69, respectively, P=0.405). One patient from each group required secondary speech surgery. Average operative time was greater for FP (140 minutes; range, 93-177 minutes) compared to IVV (95 minutes; range, 58-135 minutes), P<0.001. Average hospital stay was 3.9 days for IVV (range, 2-9 days) and 3.2 days for FP (range, 2-6 days), with no significant difference (P=0.116). There were no postsurgical wound infections, oral-nasal fistulas, postoperative bleeding complications, or mortalities. Nonsyndromic patients with hypernasal speech are treated effectively and safely with either IVV or FP. Intravelar veloplasty trended toward lower speech scores than FP (76% IVV, 58% FP PWSS absolute reduction). Syndromic patients with OSMCP may be more effectively treated with FP (72% IVV vs 79% FP PWSS absolute reduction). Intravelar veloplasty is associated with shorter operative times. Both techniques are associated with low morbidity, improved speech scores, and low reoperative rates.

A Meta-Analysis of Morphological Interventions: Effects on Literacy Achievement of Children with Literacy Difficulties

ERIC Educational Resources Information Center

Goodwin, Amanda P.; Ahn, Soyeon

2010-01-01

This study synthesizes 79 standardized mean-change differences between control and treatment groups from 17 independent studies, investigating the effect of morphological interventions on literacy outcomes for students with literacy difficulties. Average total sample size ranged from 15 to 261 from a wide range of grade levels. Overall,…

Average Treatment Effect of School-Wide Positive Behavioral Interventions and Supports on School-Level Academic Achievement in Florida

ERIC Educational Resources Information Center

Gage, Nicholas A.; Leite, Walter; Childs, Karen; Kincaid, Don

2017-01-01

The relationship between school-wide positive behavioral interventions and supports (SWPBIS) and school-level academic achievement has not been established. Most experimental research has found little to no evidence that SWPBIS has a distal effect on school-level achievement. Yet, an underlying assumption of SWPBIS is that improving social…

An Empirical Comparison of Randomized Control Trials and Regression Discontinuity Estimations

ERIC Educational Resources Information Center

Barrera-Osorio, Felipe; Filmer, Deon; McIntyre, Joe

2014-01-01

Randomized controlled trials (RCTs) and regression discontinuity (RD) studies both provide estimates of causal effects. A major difference between the two is that RD only estimates local average treatment effects (LATE) near the cutoff point of the forcing variable. This has been cited as a drawback to RD designs (Cook & Wong, 2008).…

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh.

PubMed

Puett, Chloe; Sadler, Kate; Alderman, Harold; Coates, Jennifer; Fiedler, John L; Myatt, Mark

2013-07-01

This study assessed the cost-effectiveness of adding the community-based management of severe acute malnutrition (CMAM) to a community-based health and nutrition programme delivered by community health workers (CHWs) in southern Bangladesh. The cost-effectiveness of this model of treatment for severe acute malnutrition (SAM) was compared with the cost-effectiveness of the 'standard of care' for SAM (i.e. inpatient treatment), augmented with community surveillance by CHWs to detect cases, in a neighbouring area. An activity-based cost model was used, and a societal perspective taken, to include all costs incurred in the programme by providers and participants for the management of SAM in both areas. Cost data were coupled with programme effectiveness data. The community-based strategy cost US$26 per disability-adjusted life year (DALY) averted, compared with US$1344 per DALY averted for inpatient treatment. The average cost to participant households for their child to recover from SAM in community treatment was one-sixth that of inpatient treatment. These results suggest that this model of treatment for SAM is highly cost-effective and that CHWs, given adequate supervision and training, can be employed effectively to expand access to treatment for SAM in Bangladesh.

Initial results from a field experiment to support the assessment of fuel treatment effectiveness in reducing wildfire intensity and spread rate

Treesearch

Eric Mueller; Nicholas Skowronski; Kenneth Clark; Robert Kremens; Michael Gallagher; Jan Thomas; Mohamad El Houssami; Alexander Filkod; Bret Butler; John Hom; William Mell; Albert Simeoni

2015-01-01

Hazardous fuel reduction treatments conducted both through prescribed fire and mechanical means are a critical part of the mitigation of wildland fire risk in the United States. The US Federal Government has spent an average of $500t million each year on fuel reduction, from 2002-2012 (Gorte 2011). At present, however, rigorous experimental measurement of the...

Progressive Muscle Relaxation and Pain Perception in Abdominal Surgery Patients

DTIC Science & Technology

1989-05-01

Twenty-one females were randomly assigned to one of three treatment groups: dental splint and physiotherapy , a relaxation program, or a minimal...overall treatment effect was average weekly frequency of pain (F = 5.25, p < .05). The relaxation and dental physiotherapy groups reported lower pain...significantly less pain intensity than the control group (TENS), while the dental/ physiotherapy group reported significantly less frequency of pain than

Effects of organic fertilizers on soil physicochemistry and on the yield and botanical composition of forage over 3 years.

PubMed

Matos-Moreira, Mariana; López-Mosquera, M Elvira; Cunha, Mario; Sáinz Osés, María Jesús; Rodríguez, Teresa; Carral, Emilio V

2011-07-01

Organic wastes have been reported to reduce saturation of the exchange complex by Al in Al-rich acid soils. For 3 years, the main soil fertility properties were studied in plots sown with mixed pasture species. These plots were fertilized with cattle slurry, dairy sludge (DS), or granulated broiler litter (BL) in comparison with mineral fertilizer. Al saturation levels were low after the initial inorganic liming treatment (19.00-33.71%) but tended to rise under all treatments (21.09-61.37%) except BL (8.45-30.98%), which was also associated with the highest average soil pH and the highest average levels of exchangeable Ca2+, Mg2+, and K+. Treatment DS performed similarly to mineral fertilizer in most respects, but it led to greater available P levels. Under the dry conditions of the second and third years of the study, BL and DS treatments were associated with significantly greater forage yields than the other treatments. Under DS treatment, available P levels were too low to allow the maintenance of mixed pasture, clover being eliminated by the less P-dependent species.

Effects of Organic Fertilizers on Soil Physicochemistry and on the Yield and Botanical Composition of Forage over 3 Years.

PubMed

Matos-Moreira, Mariana; Elvira López-Mosquera, M; Cunha, Mario; Jesús Sáinz Osés, María; Rodríguez, Teresa; Carral, Emilio V

2011-07-01

Organic wastes have been reported to reduce saturation of the exchange complex by Al in Al-rich acid soils. For 3 years, the main soil fertility properties were studied in plots sown with mixed pasture species. These plots were fertilized with cattle slurry, dairy sludge (DS), or granulated broiler litter (BL) in comparison with mineral fertilizer. Al saturation levels were low after the initial inorganic liming treatment (19.00-33.71%) but tended to rise under all treatments (21.09-61.37%) except BL (8.45-30.98%), which was also associated with the highest average soil pH and the highest average levels of exchangeable Ca 2+ , Mg 2+ , and K + . Treatment DS performed similarly to mineral fertilizer in most respects, but it led to greater available P levels. Under the dry conditions of the second and third years of the study, BL and DS treatments were associated with significantly greater forage yields than the other treatments. Under DS treatment, available P levels were too low to allow the maintenance of mixed pasture, clover being eliminated by the less P-dependent species. [Box: see text].

Physiological responses of Kobresia pygmaea to warming in Qinghai-Tibetan Plateau permafrost region

NASA Astrophysics Data System (ADS)

Yang, Y.; Wang, G. X.; Yang, L. D.; Guo, J. Y.; Li, N.

2012-02-01

Kobresia pygmaea (C. B. Clarke) C. B. Clarke is one dominant herbaceous species in the alpine meadows of the Qinghai-Tibetan Plateau. From 2006 to 2009, a warming experiment was conducted in this permafrost region. Two 2-year warming treatments with an annual average warming of 2.1 °C and 4.4 °C, and one 4-year warming treatment with an annual average warming of 2.3 °C were established to examine physiological responses of K. pygmaea to warming. Our results indicated that 2-years of warming increased malondialdehyde and non-structural carbohydrates in the plants. There was no effect of 2-year warming on electrolyte leakage and free proline content. In the 2-year warming treatment, superoxide dismutase activity and peroxidase activity increased, ascorbate peroxidase activity and ascorbic acid only increased in 2-year high warming treatment, whereas in the 4-year warming treatment, active oxygen species, electrolyte leakage, UV-absorbing compounds and anthocyanins decreased. The 4-year warming treatment also significantly increased non-structural carbonhydrate and free proline accumulation for osmotic adjustment. The results of this study suggest that K. pygmaea could adapt to a warmer environment in the future.

Safety, Tolerability, and Antihypertensive Effect of SER100, an Opiate Receptor-Like 1 (ORL-1) Partial Agonist, in Patients With Isolated Systolic Hypertension.

PubMed

Kantola, Ilkka; Scheinin, Mika; Gulbrandsen, Trygve; Meland, Nils; Smerud, Knut T

2017-11-01

The purpose of the present trial was to evaluate safety, tolerability, and effect on systolic blood pressure (SBP) of SER100 in a small group of patients with isolated systolic hypertension (ISH) in treatment with at least 1 antihypertensive drug. Eligible patients were randomized to either SER100 (10 mg) or placebo in a crossover design, and 2 doses were given subcutaneously (SC), 8 hours apart, on 2 consecutive days. On all treatment days patients were monitored with an ambulatory blood pressure measurement device for 12 daytime hours. Seventeen patients completed treatment. There were no serious or severe adverse events. Relative to placebo SER100 induced an average reduction of SBP during the 2 treatment days of 7.0 mm Hg (P = 0.0032), whereas the average reduction of diastolic blood pressure (DBP) over the same period was 3.8 mm Hg (P = 0.0011). For patients with ISH, this short-term cross-over study of SC SER100 demonstrated an acceptable safety profile and consistent, significant lowering of SBP and DBP. As initial clinical proof of concept for a new class of drugs, a nociceptin agonist peptide, the results were encouraging and warrant further research. © 2016, The American College of Clinical Pharmacology.

The impact of hospital mergers on treatment intensity and health outcomes.

PubMed

Hayford, Tamara B

2012-06-01

To analyze the impact of hospital mergers on treatment intensity and health outcomes. Hospital inpatient data from California for 1990 through 2006, encompassing 40 mergers. I used a geographic-based IV approach to determine the effect of a zip code's exposure to a merger. The merged facility's market share represents exposure, instrumented with combined premerge shares. Additional specifications include Herfindahl Index (HHI), instrumented with predicted change in HHI. The primary specification results indicate that merger completion is associated with a 3.7 percent increase in the utilization of bypass surgery and angioplasty and a 1.7 percent increase in inpatient mortality above averages in 2000 for the average zip code. Isolating the competition mechanism mutes the treatment intensity result slightly, but it more than doubles the merger exposure effect on inpatient mortality to a 3.9 percent increase. The competition mechanism is associated with a sizeable increase in number of procedures. Unlike previous studies, this analysis finds that hospital mergers are associated with increased treatment intensity and higher inpatient mortality rates among heart disease patients. Access to additional outcome measures such as 30-day mortality and readmission rates might shed additional light on whether the relationship between these outcomes is causal. © Health Research and Educational Trust.

[Surgical treatment strategy of the floating shoulder injury].

PubMed

Song, Zhe; Xue, Han-Zhong; Li, Zhong; Zhuang, Yan; Wang, Qian; Ma, Teng; Zhang, Kun

2013-10-18

To discuss the clinical characteristics and the surgical treatment strategy of the floating shoulder injury. 26 cases with the floating shoulder injury between January 2006 and January 2012 were retrospectively evaluated. There were 15 males and 11 females with an average age of 35.2 (22-60) years. According to Wong's classification of floating shoulder injury: type IA, 3 cases; type IB, 9 cases; type II, 4 cases; type IIIA, 6 cases; type IIIB, 4 cases. All the 26 cases had accepted the surgical treatment. We observed the postoperative fracture reduction, damage repair, fracture healing and internal fixation through the X-ray films. We also evaluated the shoulder function regularly according to the Constant scores and Herscovici evaluation criteria. The 26 cases were followed up for an average of 16.8 (12-24) months.All the fractures healed for a mean time of 2.4 months, the mean Constant score was 89.4 (60-100). The effect of Herscovici evaluation criteria: excellent, 15 cases; good, 8 cases;fair, 3 cases;the excellent rate 88.5%. Open reduction and internal fixation is an effective method for the treatment of floating shoulder injury, but we should select the reset sequence and fixation methods according to the type of fracture and degree of displacement.

LOW-LEVEL LASER THERAPY AFTER CARPAL TUNNEL RELEASE

PubMed Central

Alves, Marcelo de Pinho Teixeira; de Araújo, Gabriel Costa Serrão

2015-01-01

Objective: Evaluate the post-operative treatment of CTS, using the LLLT. Method: We prospectively evaluated 58 patients with CTS, randomly divided into two groups: treatment with LLLT (Group 1) and placebo (Group 2). A 830 nm gallium-aluminum-arsenic laser was used, with a power of 30 mW. Results: There was female predominance in both groups. The mean age of the patients in Group 1 was 44.3 years and in Group 2, 51.9 years. The average duration of disease progression was around two years in both groups. The average time elapsed since discharge from treatment was 3.6 months in both groups, and fewer patients had postoperative complaints in Group 1 than in Group 2. At the end of the treatment, in Group 1, 29.41% of the patients presented electromyographic abnormalities, while in Group 2, 63.64% of the patients had abnormalities, after six months. Conclusion: This was an initial study on adjuvant therapy using postoperative LLLT on CTS. The method presented was sufficient for postoperative evaluation of the patients in this study. Patients undergoing LLLT after surgery for CTS were benefited and had better functional outcomes than shown by the control group. The technique was effective and did not have any adverse effects on the patients studied. PMID:27027075

The Impact of Hospital Mergers on Treatment Intensity and Health Outcomes

PubMed Central

Hayford, Tamara B

2012-01-01

Objective To analyze the impact of hospital mergers on treatment intensity and health outcomes. Data Hospital inpatient data from California for 1990 through 2006, encompassing 40 mergers. Study Design I used a geographic-based IV approach to determine the effect of a zip code's exposure to a merger. The merged facility's market share represents exposure, instrumented with combined premerge shares. Additional specifications include Herfindahl Index (HHI), instrumented with predicted change in HHI. Results The primary specification results indicate that merger completion is associated with a 3.7 percent increase in the utilization of bypass surgery and angioplasty and a 1.7 percent increase in inpatient mortality above averages in 2000 for the average zip code. Isolating the competition mechanism mutes the treatment intensity result slightly, but it more than doubles the merger exposure effect on inpatient mortality to a 3.9 percent increase. The competition mechanism is associated with a sizeable increase in number of procedures. Conclusions Unlike previous studies, this analysis finds that hospital mergers are associated with increased treatment intensity and higher inpatient mortality rates among heart disease patients. Access to additional outcome measures such as 30-day mortality and readmission rates might shed additional light on whether the relationship between these outcomes is causal. PMID:22098308

[Effects of the first premolar extraction on the third molar angulation].

PubMed

He, Yu-hong; Duan, Yin-zhong; Pan, Ji-jun; Xi, Lan-lan

2008-08-01

To analyze the effects about inclinations of the second and the third molars in patients treated with or without premolar extractions. Fifty-six adolescents were chosen and divided into the first premolar extraction and non-extraction groups, 30 and 26 patients respectively. The pre-treatment and post-treatment panoramic radiographs were made. Angles between long axis of the third molar and the occlusal plane (the second molar alike), and long axis of the second and the third molar were measured and evaluated. The maxillary and mandibular third molar angulations were all improved after treatment in two groups. Compared with non-extraction group, the average changes of angle between long axis of the third molar and the occlusal plane increased significantly in maxilla and mandible (P < 0.05). Average changes of angles between long axis of the second and the third molar decreased and had statistically significant difference (P < 0.05). The change of angle between long axis of mandibular second molar and the occlusal plane had statistically significant difference (P < 0.05), but there was no statistically significant difference in maxillary second molar (P > 0.05). The first premolar extraction in orthodontic treatment could improve the third molar angulations and it would promote the eruption of the third molar.

How do Hospitals Respond to Price Changes? Evidence from Norway.

PubMed

Januleviciute, Jurgita; Askildsen, Jan Erik; Kaarboe, Oddvar; Siciliani, Luigi; Sutton, Matt

2016-05-01

Many publicly funded health systems use activity-based financing to increase hospital production and efficiency. The aim of this study is to investigate whether price changes for different treatments affect the number of patients treated and the mix of activity provided by hospitals. We exploit the variations in prices created by the changes in the national average treatment cost per diagnosis-related group (DRG) offered to Norwegian hospitals over a period of 5 years (2003-2007). We use the data from Norwegian Patient Register, containing individual-level information on age, gender, type of treatment, diagnosis, number of co-morbidities and the national average treatment costs per DRG. We employ fixed-effect models to examine the changes in the number of patients treated within the DRGs over time. The results suggest that a 10% increase in price leads to about 0.8-1.3% increase in the number of patients treated for DRGs, which are medical (for both emergency and elective patients). In contrast, we find no price effect for DRGs that are surgical (for both emergency and elective patients). Moreover, we find evidence of upcoding. A 10% increase in the ratio of prices between patients with and without complications increases the proportion of patients coded with complications by 0.3-0.4 percentage points. Copyright © 2015 John Wiley & Sons, Ltd.

Study of Convective Flow Effects in Endwall Casing Treatments in Transonic Compressor Rotors

NASA Technical Reports Server (NTRS)

Hah, Chunill; Mueller, Martin W.; Schiffer, Heinz-Peter

2012-01-01

The unsteady convective flow effects in a transonic compressor rotor with a circumferential-groove casing treatment are investigated in this paper. Experimental results show that the circumferential-groove casing treatment increases the compressor stall margin by almost 50% for the current transonic compressor rotor. Steady flow simulation of the current casing treatment, however, yields only a 15% gain in stall margin. The flow field at near-stall operation is highly unsteady due to several self-induced flow phenomena. These include shock oscillation, vortex shedding at the trailing edge, and interaction between the passage shock and the tip clearance vortex. The primary focus of the current investigation is to assess the effects of flow unsteadiness and unsteady flow convection on the circumferential-groove casing treatment. Unsteady Reynolds-averaged Navier-Stokes (URANS) and Large Eddy Simulation (LES) techniques were applied in addition to steady Reynolds-averaged Navier-Stokes (RANS) to simulate the flow field at near-stall operation and to determine changes in stall margin. The current investigation reveals that unsteady flow effects are as important as steady flow effects on the performance of the circumferential grooves casing treatment in extending the stall margin of the current transonic compressor rotor. The primary unsteady flow mechanism is unsteady flow injection from the grooves into the main flow near the casing. Flows moving into and out of the grooves are caused due to local pressure difference near the grooves. As the pressure field becomes transient due to self-induced flow oscillation, flow injection from the grooves also becomes unsteady. The unsteady flow simulation shows that this unsteady flow injection from the grooves is substantial and contributes significantly to extending the compressor stall margin. Unsteady flows into and out of the grooves have as large a role as steady flows in the circumferential grooves. While the circumferential-groove casing treatment seems to be a steady flow device, unsteady flow effects should be included to accurately assess its performance as the flow is transient at near-stall operation.

A pilot treatment study for mild traumatic brain injury: Neuroimaging changes detected by MEG after low-intensity pulse-based transcranial electrical stimulation.

PubMed

Huang, Ming-Xiong; Swan, Ashley Robb; Quinto, Annemarie Angeles; Matthews, Scott; Harrington, Deborah L; Nichols, Sharon; Bruder, Barry J; Snook, Corey C; Huang, Charles W; Baker, Dewleen G; Lee, Roland R

2017-01-01

Mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members, Veterans, and civilians. However, few treatments are available for mTBI, partially because the mechanism of persistent mTBI deficits is not fully understood. We used magnetoencephalography (MEG) to investigate neuronal changes in individuals with mTBI following a passive neurofeedback-based treatment programme called IASIS. This programme involved applying low-intensity pulses using transcranial electrical stimulation (LIP-tES) with electroencephalography monitoring. Study participants included six individuals with mTBI and persistent post-concussive symptoms (PCS). MEG exams were performed at baseline and follow-up to evaluate the effect of IASIS on brain functioning. At the baseline MEG exam, all participants had abnormal slow-waves. In the follow-up MEG exam, the participants showed significantly reduced abnormal slow-waves with an average reduction of 53.6 ± 24.6% in slow-wave total score. The participants also showed significant reduction of PCS scores after IASIS treatment, with an average reduction of 52.76 ± 26.4% in PCS total score. The present study demonstrates, for the first time, the neuroimaging-based documentation of the effect of LIP-tES treatment on brain functioning in mTBI. The mechanisms of LIP-tES treatment are discussed, with an emphasis on LIP-tES's potentiation of the mTBI healing process.

[Effect of NaOH-treatment on advanced anaerobic biogasification of Spartina alterniflora].

PubMed

Chen, Guang-Yin; Zheng, Zheng; Chang, Zhi-Zhou; Ye, Xiao-Mei

2011-08-01

In order to improve the biotransformation rate of Sparnina alterniflora, effect of NaOH-treatment on anaerobic dry-mesophilic digestion of Spartina alterniflora and feasibility of NaOH-treatment as a pretreatment of biogas residues of Spartina alterniflora for advanced anaerobic biogasification were conducted under lab-scale conditions. The results indicated that there was less improvement to biogas yield with NaOH-treatment and the cumulative biogas yield of Spartina alterniflora was 358.94 mL/g TS which was 92.42% to that of control (CK). However, the average methane content was improved slightly with 1.84% improvement. After solid-state pretreatment with 5% NaOH solution for 48 h, the biogas residue of Spartina alterniflora was used for advanced biogasification. This experiment was conducted under 35 degrees C +/- 1 degrees C with initial total solid loading of 8%. The cumulative biogas yield was 209.73 mL/g TS with 70.78% of average methane content, but the biotransformation rate was only 23.29% which was much lower than that of Spartina alterniflora. The fermentation type was propionic acid type fermentation. After two-phase fermentation treatment, cellulose content was decreased significantly while lignin and hemicellulose content were increased. The crystalinity of cellulose of biogas residue decreased after two-phase anaerobic fermentation which was consistent to result of FTIR. The comprehensive analysis of experiment indicated that biogas residue of Spartina alterniflora was still a good material for biogas production and NaOH-treatment was a good pretreatment for biogas production.

Effect of vegetation type on treatment performance and bioelectric production of constructed wetland modules combined with microbial fuel cell (CW-MFC) treating synthetic wastewater.

PubMed

Saz, Çağdaş; Türe, Cengiz; Türker, Onur Can; Yakar, Anıl

2018-03-01

An operation of microcosm-constructed wetland modules combined with microbial fuel cell device (CW-MFC) was assessed for wastewater treatment and bioelectric generation. One of the crucial aims of the present experiment is also to determine effect of vegetation on wastewater treatment process and bioelectric production in wetland matrix with microbial fuel cell. Accordingly, CW-MFC modules with vegetation had higher treatment efficiency compared to unplanted wetland module, and average COD, NH 4 + , and TP removal efficiency in vegetated wetland modules were ranged from 85 to 88%, 95 to 97%, and 95 to 97%, respectively. However, the highest NO 3 - removal (63%) was achieved by unplanted control module during the experiment period. The maximum average output voltage, power density, and Coulombic efficiency were obtained in wetland module vegetated with Typha angustifolia for 1.01 ± 0.14 V, 7.47 ± 13.7 mWatt/m 2 , and 8.28 ± 10.4%, respectively. The results suggest that the presence of Typha angustifolia vegetation in the CW-MFC matrix provides the benefits for treatment efficiency and bioelectric production; thus, it increases microbial activities which are responsible for biodegradation of organic compounds and catalyzed to electron flow from anode to cathode. Consequently, we suggest that engineers can use vegetated wetland matrix with Typha angustifolia in CW-MFC module in order to maximize treatment efficiency and bioelectric production.

Experimentally studied dynamic dose interplay does not meaningfully affect target dose in VMAT SBRT lung treatments.

PubMed

Stambaugh, Cassandra; Nelms, Benjamin E; Dilling, Thomas; Stevens, Craig; Latifi, Kujtim; Zhang, Geoffrey; Moros, Eduardo; Feygelman, Vladimir

2013-09-01

The effects of respiratory motion on the tumor dose can be divided into the gradient and interplay effects. While the interplay effect is likely to average out over a large number of fractions, it may play a role in hypofractionated [stereotactic body radiation therapy (SBRT)] treatments. This subject has been extensively studied for intensity modulated radiation therapy but less so for volumetric modulated arc therapy (VMAT), particularly in application to hypofractionated regimens. Also, no experimental study has provided full four-dimensional (4D) dose reconstruction in this scenario. The authors demonstrate how a recently described motion perturbation method, with full 4D dose reconstruction, is applied to describe the gradient and interplay effects during VMAT lung SBRT treatments. VMAT dose delivered to a moving target in a patient can be reconstructed by applying perturbations to the treatment planning system-calculated static 3D dose. Ten SBRT patients treated with 6 MV VMAT beams in five fractions were selected. The target motion (motion kernel) was approximated by 3D rigid body translation, with the tumor centroids defined on the ten phases of the 4DCT. The motion was assumed to be periodic, with the period T being an average from the empirical 4DCT respiratory trace. The real observed tumor motion (total displacement ≤ 8 mm) was evaluated first. Then, the motion range was artificially increased to 2 or 3 cm. Finally, T was increased to 60 s. While not realistic, making T comparable to the delivery time elucidates if the interplay effect can be observed. For a single fraction, the authors quantified the interplay effect as the maximum difference in the target dosimetric indices, most importantly the near-minimum dose (D99%), between all possible starting phases. For the three- and five-fractions, statistical simulations were performed when substantial interplay was found. For the motion amplitudes and periods obtained from the 4DCT, the interplay effect is negligible (<0.2%). It is also small (0.9% average, 2.2% maximum) when the target excursion increased to 2-3 cm. Only with large motion and increased period (60 s) was a significant interplay effect observed, with D99% ranging from 16% low to 17% high. The interplay effect was statistically significantly lower for the three- and five-fraction statistical simulations. Overall, the gradient effect dominates the clinical situation. A novel method was used to reconstruct the volumetric dose to a moving tumor during lung SBRT VMAT deliveries. With the studied planning and treatment technique for realistic motion periods, regardless of the amplitude, the interplay has nearly no impact on the near-minimum dose. The interplay effect was observed, for study purposes only, with the period comparable to the VMAT delivery time.

Effects of chronic methamphetamine on psychomotor and cognitive functions and dopamine signaling in the brain.

PubMed

Thanos, Panayotis K; Kim, Ronald; Delis, Foteini; Rocco, Mark J; Cho, Jacob; Volkow, Nora D

2017-03-01

Methamphetamine (MA) studies in animals usually involve acute, binge, or short-term exposure to the drug. However, addicts take substantial amounts of MA for extended periods of time. Here we wished to study the effects of MA exposure on brain and behavior, using an animal model analogous to this pattern of MA intake. MA doses, 4 and 8mg/kg/day, were based on previously reported average daily freely available MA self-administration levels. We examined the effects of 16 week MA treatment on psychomotor and cognitive function in the rat using open field and novel object recognition tests and we studied the adaptations of the dopaminergic system, using in vitro and in vivo receptor imaging. We show that chronic MA treatment, at doses that correspond to the average daily freely available self-administration levels in the rat, disorganizes open field activity, impairs alert exploratory behavior and anxiety-like state, and downregulates dopamine transporter in the striatum. Under these treatment conditions, dopamine terminal functional integrity in the nucleus accumbens is also affected. In addition, lower dopamine D1 receptor binding density, and, to a smaller degree, lower dopamine D2 receptor binding density were observed. Potential mechanisms related to these alterations are discussed. Copyright © 2016. Published by Elsevier B.V.

Non-invasive indicators associated with the milk yield response after anthelmintic treatment at calving in dairy cows.

PubMed

Verschave, Sien H; Vercruysse, Jozef; Forbes, Andrew; Opsomer, Geert; Hostens, Miel; Duchateau, Luc; Charlier, Johannes

2014-11-14

Gastrointestinal nematodes are an important cause of reduced performance in cattle. Previous studies in Europe showed that after anthelmintic treatment an average gain in milk production of around 1 kg per day/cow can be expected. However, (1) these studies have mainly evaluated group-based anthelmintic treatments during the grazing season or at housing and (2) little is known about parameters affecting variations in the treatment response amongst cows. A better knowledge of such parameters could help to select animals that benefit most from treatment and thus lead to a more rational use of anthelmintics. Therefore, a randomized, non-blinded, controlled clinical trial was performed on 11 commercial dairy farms (477 animals) in Belgium, aiming (1) to study the effect of eprinomectin treatment at calving on milk production and (2) to investigate whether the milk yield response was related to non-invasive animal parameters such that these could be used to inform targeted selective treatment decisions. Analyses show that eprinomectin treatment around calving resulted in an average (± standard error) increase of 0.97 (±0.41) kg in daily milk yield that was followed up over 274 days on average. Milk yield responses were higher in multiparous compared to primiparous cows and in cows with a high (4(th) quartile) anti-O. ostertagi antibody level in a milk sample from the previous lactation. Nonetheless, high responses were also seen in animals with a low (1(st) quartile) anti-O. ostertagi antibody level. In addition, positive treatment responses were associated with higher faecal egg counts and a moderate body condition score at calving (2(nd) quartile). In conclusion, this study provides novel insights into the production response after anthelmintic treatment at calving and factors which influence this. The data could be used to support the development of evidence-based targeted selective anthelmintic treatment strategies in dairy cattle.

Experimental treatment of a refinery waste air stream, for BTEX removal, by water scrubbing and biotrickling on a bed of Mitilus edulis shells.

PubMed

Torretta, Vincenzo; Collivignarelli, Maria Cristina; Raboni, Massimo; Viotti, Paolo

2015-01-01

The paper presents the results of a two-stage pilot plant for the removal of benzene, toluene, ethylbenzene and xylene (BTEX) from a waste air stream of a refinery wastewater treatment plant (WWTP). The pilot plant consisted of a water scrubber followed by a biotrickling filter (BTF). The exhausted air was drawn from the main works of the WWTP in order to prevent the free migration to the atmosphere of these volatile hazardous contaminants. Concentrations were detected at average values of 12.4 mg Nm(-3) for benzene, 11.1 mg Nm(-3) for toluene, 2.7 mg Nm(-3) for ethylbenzene and 9.5 mg Nm(-3) for xylene, with considerable fluctuation mainly for benzene and toluene (peak concentrations of 56.8 and 55.0 mg Nm(-3), respectively). The two treatment stages proved to play an effective complementary task: the water scrubber demonstrated the ability to remove the concentration peaks, whereas the BTF was effective as a polishing stage. The overall average removal efficiency achieved was 94.8% while the scrubber and BTF elimination capacity were 37.8 and 15.6 g BTEX d(-1) m(-3), respectively. This result has led to outlet average concentrations of 1.02, 0.25, 0.32 and 0.26 mg Nm(-3) for benzene, toluene, ethylbenzene and xylene, respectively. The paper also compares these final concentrations with toxic and odour threshold concentrations.

Competition in the Dutch hospital sector: an analysis of health care volume and cost.

PubMed

Krabbe-Alkemade, Y J F M; Groot, T L C M; Lindeboom, M

2017-03-01

This paper evaluates the impact of market competition on health care volume and cost. At the start of 2005, the financing system of Dutch hospitals started to be gradually changed from a closed-end budgeting system to a non-regulated price competitive prospective reimbursement system. The gradual implementation of price competition is a 'natural experiment' that provides a unique opportunity to analyze the effects of market competition on hospital behavior. We have access to a unique database, which contains hospital discharge data of diagnosis treatment combinations (DBCs) of individual patients, including detailed care activities. Difference-in-difference estimates show that the implementation of market-based competition leads to relatively lower total costs, production volume and number of activities overall. Difference-in-difference estimates on treatment level show that the average costs for outpatient DBCs decreased due to a decrease in the number of activities per DBC. The introduction of market competition led to an increase of average costs of inpatient DBCs. Since both volume and number of activities have not changed significantly, we conclude that the cost increase is likely the result of more expensive activities. A possible explanation for our finding is that hospitals look for possible efficiency improvements in predominantly outpatient care products that are relatively straightforward, using easily analyzable technologies. The effects of competition on average cost and the relative shares of inpatient and outpatient treatments on specialty level are significant but contrary for cardiology and orthopedics, suggesting that specialties react differently to competitive incentives.

Comparison effect of azithromycin gel 2% with clindamycin gel 1% in patients with acne.

PubMed

Mokhtari, Fatemeh; Faghihi, Gita; Basiri, Akram; Farhadi, Sadaf; Nilforoushzadeh, Mohammadali; Behfar, Shadi

2016-01-01

Acne vulgaris is the most common skin disease. Local and systemic antimicrobial drugs are used for its treatment. But increasing resistance of Propionibacterium acnes to antibiotics has been reported. In a double-blind clinical trial, 40 patients with mild to moderate acne vulgaris were recruited. one side of the face was treated with Clindamycin Gel 1% and the other side with Azithromycin Topical Gel 2% BID for 8 weeks and then they were assessed. Average age was 21. 8 ± 7 years. 82.5% of them were female. Average number of papules, pustules and comedones was similarly reduced in both groups and, no significant difference was observed between the two groups (P > 0.05, repeated measurs ANOVA). The mean indexes of ASI and TLC also significantly decreased during treatment in both groups, no significant difference was observed between the two groups. (P > 0.05, repeated measurs ANOVA). Also, impact of both drugs on papules and pustules was 2-3 times greater than the effect on comedones. Average satisfaction score was not significant between the two groups (P = 0.6, repeated measurs ANOVA). finally, frequency distribution of complications was not significant between the two groups (P > 0.05, Fisher Exact test). Azithromycin gel has medical impact at least similar to Clindamycin Gel in treatment of mild to moderate acne vulgaris, and it may be consider as suitable drug for resistant acne to conventional topical therapy.

Antibiotics for treating bacterial vaginosis in pregnancy.

PubMed

Brocklehurst, Peter; Gordon, Adrienne; Heatley, Emer; Milan, Stephen J

2013-01-31

Bacterial vaginosis is an imbalance of the normal vaginal flora with an overgrowth of anaerobic bacteria and a lack of the normal lactobacillary flora. Women may have symptoms of a characteristic vaginal discharge but are often asymptomatic. Bacterial vaginosis during pregnancy has been associated with poor perinatal outcomes and, in particular, preterm birth (PTB). Identification and treatment may reduce the risk of PTB and its consequences. To assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2012), searched cited references from retrieved articles and reviewed abstracts, letters to the editor and editorials. Randomised trials comparing antibiotic treatment with placebo or no treatment, or comparing two or more antibiotic regimens in pregnant women with bacterial vaginosis or intermediate vaginal flora whether symptomatic or asymptomatic and detected through screening. Two review authors independently assessed trials for inclusion, trial quality and extracted data. We contacted study authors for additional information. We included 21 trials of good quality, involving 7847 women diagnosed with bacterial vaginosis or intermediate vaginal flora.Antibiotic therapy was shown to be effective at eradicating bacterial vaginosis during pregnancy (average risk ratio (RR) 0.42; 95% confidence interval (CI) 0.31 to 0.56; 10 trials, 4403 women; random-effects, T² = 0.19, I² = 91%). Antibiotic treatment also reduced the risk of late miscarriage (RR 0.20; 95% CI 0.05 to 0.76; two trials, 1270 women, fixed-effect, I² = 0%).Treatment did not reduce the risk of PTB before 37 weeks (average RR 0.88; 95% CI 0.71 to 1.09; 13 trials, 6491 women; random-effects, T² = 0.06, I² = 48%), or the risk of preterm prelabour rupture of membranes (RR 0.74; 95% CI 0.30 to 1.84; two trials, 493 women). It did increase the risk of side-effects sufficient to stop or change treatment (RR 1.66; 95% CI 1.02 to 2.68; four trials, 2323 women, fixed-effect, I² = 0%).In this updated review, treatment before 20 weeks' gestation did not reduce the risk of PTB less than 37 weeks (average RR 0.85; 95% CI 0.62 to 1.17; five trials, 4088 women; random-effects, T² = 0.06, I² = 49%).In women with a previous PTB, treatment did not affect the risk of subsequent PTB (average RR 0.78; 95% CI 0.42 to 1.48; three trials, 421 women; random-effects, T² = 0.19, I² = 72%).In women with abnormal vaginal flora (intermediate flora or bacterial vaginosis), treatment may reduce the risk of PTB before 37 weeks (RR 0.53; 95% CI 0.34 to 0.84; two trials, 894 women).One small trial of 156 women compared metronidazole and clindamycin, both oral and vaginal, with no significant differences seen for any of the pre-specified primary outcomes. Statistically significant differences were seen for the outcomes of prolongation of gestational age (days) (mean difference (MD) 1.00; 95% CI 0.26 to 1.74) and birthweight (grams) (MD 75.18; 95% CI 25.37 to 124.99) however these represent relatively small differences in the clinical setting.Oral antibiotics versus vaginal antibiotics did not reduce the risk of PTB (RR 1.09; 95% CI 0.78 to 1.52; two trials, 264 women). Oral antibiotics had some advantage over vaginal antibiotics (whether metronidazole or clindamycin) with respect to admission to neonatal unit (RR 0.63; 95% CI 0.42 to 0.92, one trial, 156 women), prolongation of gestational age (days) (MD 9.00; 95% CI 8.20 to 9.80; one trial, 156 women) and birthweight (grams) (MD 342.13; 95% CI 293.04 to 391.22; one trial, 156 women).Different frequency of dosing of antibiotics was assessed in one small trial and showed no significant difference for any outcome assessed. Antibiotic treatment can eradicate bacterial vaginosis in pregnancy. The overall risk of PTB was not significantly reduced. This review provides little evidence that screening and treating all pregnant women with bacterial vaginosis will prevent PTB and its consequences. When screening criteria were broadened to include women with abnormal flora there was a 47% reduction in preterm birth, however this is limited to two included studies.

Effect of dietary calcium and phosphorus levels on the total tract digestibility of innate and supplemental organic and inorganic microminerals in a corn-soybean meal based diet of grower pigs.

PubMed

Jolliff, J S; Mahan, D C

2013-06-01

The effects of Ca and P (CaP) levels and micromineral sources on mineral digestibility were evaluated in growing pigs. Treatments consisted of 2 levels of CaP and 3 trace mineral (TM) treatments arranged as a 2 × 3 factorial in a randomized complete block design with 8 replicates. The CaP levels evaluated were: 1) 0.65% Ca and 0.55% P [standard CaP (Std CaP)], and 2) 1.00% Ca and 0.85% P (High CaP). The TM treatments were: 1) Basal, without supplemental TM, 2) Basal supplemented with organic TM, and 3) Basal supplemented with inorganic TM. Both organic and inorganic TM premixes added 15 mg Cu, 150 mg Fe, 10 mg Mn, 0.3 mg Se, and 140 mg Zn/kg diet. Diets were formulated using corn soybean meal with a Ca to P ratio of 1.18 in both CaP treatments. Barrows with an initial BW of 45 kg were acclimated to stainless steel metabolism crates where diets were fed for 14 d before a 10-d collection period. Pigs within replicates were fed equivalent amounts of feed at 0800 and 1600 h each day with water provided free choice. Total feces, urine, and feed orts were collected daily. Essential macro- and microminerals were analyzed by inductively coupled plasma analysis. Increasing dietary CaP decreased the digestibility of Ca and Zn. Phosphorus digestibility did not change when the P inclusion level increased from 0.55 to 0.85% Ptotal. The High CaP level resulted in a lower urinary excretion of most minerals, particularly Cu (P < 0.05) and Mn (P < 0.05), as dietary CaP level increased but the others were not statistically significant. A summary of the ATTD for each of the experimental variables was statistically analyzed and averaged for the experiment. Although there were few statistical differences with individual minerals, they generally demonstrated a decline in digestibility when the High CaP was fed, averaging a 3% lower digestibility consistently than when the Std CaP level was fed. Organic TM averaged an approximately 5% greater digestibility than the average inorganic microminerals with the difference between minerals within each source relatively consistent. These results indicate that CaP level had the greatest effect on mineral digestibility, organic microminerals had a greater digestibility than inorganic minerals, and the innate microminerals had an average apparent digestibility of 45%.

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

Tan, Yi, E-mail: tanyi@dlut.edu.cn; You, Xiaogang; You, Qifan

Electron beam smelting (EBS) has been used to fabricate the Inconel 740 superalloy. Microstructures, hardness, and deformation characteristics of the alloy are studied. It is observed that carbides and fine secondary phase nuclei are distributed in the hot worked EBS 740 superalloy. The Ostwald ripening occurs during solution treatment and leads to aggregation of the γ′ precipitates, the size of γ′ precipitates varies from several nanometers to more than one hundred nanometers as a result. The average size of the secondary phase is < 30 nm after aging treatment and the average Vickers hardness is measured to be about 370.more » The critical shear stress is calculated to be 0.627 GPa with governing mechanism of shearing, causing a stronger strengthening effect than the traditionally prepared Inconel 740 superalloy. The compression behavior indicates that the EBS 740 superalloy shows higher flow stress than 740H at low Zener-Hollomon parameter, which may arise from the undissolved γ′ precipitates and higher activation energy Q. The tensile results show that the fracture surface exhibits a ductile fracture pattern, in contrast to no obvious plastic deformation on the macroscopic fracture. Crack propagation proceeds in a transgranular fracture mode with facets and voids presented on the fracture surface. - Graphical abstract: Electron beam smelting (EBS) has been used to fabricate the Inconel 740 superalloy. Microstructures, hardness, and deformation characteristics of the alloy are studied. The average size of the secondary phase is < 30 nm after aging treatment and the average Vickers hardness is measured to be about 370. The critical shear stress is calculated to be 0.627 GPa with governing mechanism of shearing, causing a stronger strengthening effect than the traditionally prepared Inconel 740 superalloy. The EBS 740 superalloy shows higher flow stress than 740H at low Zener-Hollomon parameter, which may arise from the undissolved γ′ precipitates and higher activation energy Q. The EBS technology shows encouraging potential in preparation of nickel-based superalloys. Morphologies of γ′ precipitates and Vickers hardness as well as hot compression curves for electron beam smelting 740 superalloy. - Highlights: • Electron beam smelting, a novel method, was used to prepare the Inconel 740 superalloy. • The average size of the γ′ precipitates after aging treatment is < 30 nm. • The shearing mode generates a stronger strengthening effect than the traditional 740. • At low Zener-Hollomon parameter, the EBS 740 shows higher flow stress than 740H.« less

Loxoprofen sodium treatment for elderly men with refractory nocturia: effect on night-time urine production.

PubMed

Okada, Shinsuke; Watanabe, Hideki; Kojima, Yoshiyuki; Yanai, Yoshimasa; Sasaki, Shoichi; Kohri, Kenjiro

2008-05-01

We evaluated the efficacy of loxoprofen sodium for refractory nocturia. Twelve men (mean age, 75.1 +/- 5.7) with nocturia were enrolled in this study. All patients received 60 mg loxoprofen sodium prior to sleeping at night for 14 days. Nine of 12 patients (75%) felt more satisfaction than previous treatments. Patients were grouped into a loxoprofen sodium-effective (n = 7) and ineffective groups (n = 5) based on the results of the frequency-volume chart. In the effective group, interestingly, night-time urine volume showed significant reduction (P < 0.05). On the other hand, the average single voided volume at night and 24-h urine volume showed no significant change. There was a statistically significant difference in the night-time urine volume after treatment between groups (P < 0.01). Loxoprofen sodium is an effective treatment for some patients with refractory nocturia. The main effect mechanism of loxoprofen sodium may involve the reduction of night-time urine production.

A Comparative Study of Liquid Nitrogen Cryotherapy as Monotherapy versus in Combination with Podophyllin in the Treatment of Condyloma Acuminata.

PubMed

Sharma, Nidhi; Sharma, Sanjeev; Singhal, Chetna

2017-03-01

Condyloma Acuminata (CA) is a common viral sexually transmitted disease. Although various treatment modalities are available for treating CA, but none of them can achieve 100% response rate. In a search for better response rate and less recurrence rate, the combination of cytotoxic agent Podophyllin with ablative liquid nitrogen cryotherapy was evaluated over cryotherapy alone. To evaluate the synergistic effect of Podophyllin as a chemotherapeutic adjunct to an ablative therapy of liquid nitrogen cryotherapy versus liquid nitrogen cryotherapy alone in the treatment of CA. Sixty patients with multiple CA were randomly assigned to two groups in the study. Thirty patients in group A received double freeze thaw cycle of 25 seconds of liquid nitrogen cryotherapy. Thirty patients in Group B were subjected to liquid nitrogen cryotherapy in a similar manner followed by application of not more than 0.5 ml of 25% Podophyllin solution. All patients were followed up at 1, 4, 8, 12 and 24 weeks after the treatment to monitor the response to therapy and evaluation for any recurrence. When the number of unresponsive lesions were more than 30% of original lesions at 4 weeks follow-up, then the whole procedure was repeated again. The complete response rate and the recurrence rate in the Group B in our study were comparable to Group A as the difference was statistically insignificant. But the differentiating point was that the similar results were obtained in Group B with an average1.2 sessions per patient in comparison to an average of 1.67 sessions per patient in Group A. Cryotherapy represents a simple, safe and effective regimen for the treatment of multiple CA which in combination with Podophyllin is even more effective as a single session procedure; thereby shortening the treatment regimen.

Morinda citrifolia L. leaf extract as antibacterial Salmonella typhimurium to increase productivity of quail (Coturnix coturnix japonica).

PubMed

Retnani, Y; Dan, T M Wardiny; Taryati

2014-04-01

The objective of this study was to apply effect of Morinda citrifolia L. citrifolia L. leaf extract as antibacterial of Salmonella typhimurium on mortality of Day Old Quail (DOQ), egg production and Hen day, hatchability of layer quail. This research was conducted at Laboratory of microbiology and laboratory of poultry nutrition, faculty of animal science, bogor agricultural university and slamet quail farms cilangkap, sukabumi, west java, Indonesia on March-July 2012. Two hundred and forty heads of quail were randomly assigned to four dietary treatments (sixty heads of quail/treatment). Experimental design used was Completely Randomized Design (CRD). The treatments consist of level of biscuit Morinda citrifolia L. Citrifolia L. leaf extract i.e R1 = 0%, R2 = 5%, R3 = 10%, R4 = 15%. The results indicated the treatments had significant effect (p < 0.05) on mortality of Day Old Quail (DOQ). The average mortality of Day Old Quail (DOQ) was given extract Morinda citrifolia L. leaf were R1 (4.00%), R2 (1.00%), R3 (1.33%), R4 (0.67%). The average mortality of Day Old Quail (DOQ) was given 15% extract Morinda citrifolia L. leaf (R4) was lowest than control treatment (R1). The results of the analysis indicated that Morinda citrifolia L. leaf of quail drink had not significant effect (p > 0.05) on egg production, hen day and hatchability. It was concluded that the Morinda citrifolia L. leaf extract 15% can reduce mortality of Day Old Quail (DOQ) and can increase its egg production, hen day and hatchability.

Acute electroconvulsive therapy followed by maintenance electroconvulsive therapy decreases hospital re-admission rates of older patients with severe mental illness.

PubMed

Shelef, Assaf; Mazeh, Doron; Berger, Uri; Baruch, Yehuda; Barak, Yoram

2015-06-01

Electroconvulsive therapy (ECT) is a highly effective treatment for patients with severe mental illness (SMI). Maintenance ECT (M-ECT) is required for many elderly patients experiencing severe recurrent forms of mood disorders, whereas M-ECT for schizophrenia patients is a poorly studied treatment. We report on the outcomes in aged patients with SMI: schizophrenia and severe affective disorders treated by M-ECT of varying duration to prevent relapse after a successful course of acute ECT. The study measured the effectiveness of M-ECT in preventing hospital readmissions and reducing admission days. A retrospective chart review of 42 consecutive patients comparing the number and length of psychiatric admissions before and after the start of M-ECT was used. We analyzed diagnoses, previous ECT treatments, number of ECT treatments, and number and length of psychiatric admissions before and after M-ECT. Mean age in our sample was 71.5 (6.9) years. Twenty-two (52%) patients experienced severe affective disorders and 20 (48%) experienced schizophrenia. Patients were administered 92.8 (85.9) M-ECT treatments. Average duration of the M-ECT course was 34 (29.8) months. There were on average 1.88 admissions before M-ECT and only 0.38 admissions in the M-ECT period (P < 0.001). Duration of mean hospitalization stay decreased from 215.9 to 12.4 days during the M-ECT (P < 0.01). Our findings suggest that acute ECT followed by M-ECT is highly effective in selected elderly patients with SMIs.

Benzodiazepines for delirium.

PubMed

Lonergan, Edmund; Luxenberg, Jay; Areosa Sastre, Almudena

2009-10-07

Delirium occurs in 30% of hospitalised patients and is associated with prolonged hospital stay and increased morbidity and mortality. The results of uncontrolled studies have been unclear, with some suggesting that benzodiazepines may be useful in controlling non-alcohol related delirium. To determine the effectiveness and incidence of adverse effects of benzodiazapines in the treatment of non-alcohol withdrawal related delirium. The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 26 February 2008 using the search terms: (deliri* or confusion) and (benzo* or lorazepam," or "alprazolam" or "ativan" or diazepam or valium or chlordiazepam).The CDCIG Specialized Register contains records from major health databases (including MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, LILACS) as well as many ongoing trial databases and grey literature sources. Trials had to be unconfounded, randomized and with concealed allocation of subjects. Additionally, selected trials had to have assessed patients pre- and post-treatment. Where crossover design was present, only data from the first part of the trial were to be examined. Two reviewers extracted data from included trials. Data were pooled where possible, and were to be analysed using appropriate statistical methods. Odd ratios or average differences were to be calculated. Only "intention to treat" data were to be included. Only one trial satisfying the selection criteria could be identified. In this trial, comparing the effect of the benzodiazepine, lorazepam, with dexmedetomidine, a selective alpha-2-adrenergic receptor agonist, on delirium among mechanically ventilated intensive care unit patients, dexmedetomidine treatment was associated with an increased number of delirium- and coma-free days compared with lorazepam treated patients (dexmedetomidine patients, average seven days; lorazepam patients, average three days; P = 0.01). One partially controlled study showed no advantage of a benzodiazepine (alprazolam) compared with neuroleptics in treating agitation associated with delirium, and another partially controlled study showed decreased effectiveness of a benzodiazepine (lorazepam), and increased adverse effects, compared with neuroleptics (haloperidol, chlorpromazine) for the treatment of acute confusion. No adequately controlled trials could be found to support the use of benzodiazepines in the treatment of non-alcohol withdrawal related delirium among hospitalised patients, and at this time benzodiazepines cannot be recommended for the control of this condition. Because of the scarcity of trials with randomization of patients, placebo control, and adequate concealment of allocation of subjects, it is clear that further research is required to determine the role of benzodiazepines in the treatment of non-alcohol withdrawal related delirium.

Benzodiazepines for delirium.

PubMed

Lonergan, Edmund; Luxenberg, Jay; Areosa Sastre, Almudena; Wyller, Torgeir Bruun

2009-01-21

Delirium occurs in 30% of hospitalised patients and is associated with prolonged hospital stay and increased morbidity and mortality. The results of uncontrolled studies have been unclear, with some suggesting that benzodiazepines may be useful in controlling non-alcohol related delirium. To determine the effectiveness and incidence of adverse effects of benzodiazapines in the treatment of non-alcohol withdrawal related delirium. The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 26 February 2008 using the search terms: (deliri* or confusion) and (benzo* or lorazepam," or "alprazolam" or "ativan" or diazepam or valium or chlordiazepam).The CDCIG Specialized Register contains records from major health databases (including MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, LILACS) as well as many ongoing trial databases and grey literature sources. Trials had to be unconfounded, randomized and with concealed allocation of subjects. Additionally, selected trials had to have assessed patients pre- and post-treatment. Where crossover design was present, only data from the first part of the trial were to be examined. Two reviewers extracted data from included trials. Data were pooled where possible, and were to be analysed using appropriate statistical methods. Odd ratios or average differences were to be calculated. Only "intention to treat" data were to be included. Only one trial satisfying the selection criteria could be identified. In this trial, comparing the effect of the benzodiazepine, lorazepam, with dexmedetomidine, a selective alpha-2-adrenergic receptor agonist, on delirium among mechanically ventilated intensive care unit patients, dexmedetomidine treatment was associated with an increased number of delirium- and coma-free days compared with lorazepam treated patients (dexmedetomidine patients, average seven days; lorazepam patients, average three days; P = 0.01). One partially controlled study showed no advantage of a benzodiazepine (alprazolam) compared with neuroleptics in treating agitation associated with delirium, and another partially controlled study showed decreased effectiveness of a benzodiazepine (lorazepam), and increased adverse effects, compared with neuroleptics (haloperidol, chlorpromazine) for the treatment of acute confusion. No adequately controlled trials could be found to support the use of benzodiazepines in the treatment of non-alcohol withdrawal related delirium among hospitalised patients, and at this time benzodiazepines cannot be recommended for the control of this condition. Because of the scarcity of trials with randomization of patients, placebo control, and adequate concealment of allocation of subjects, it is clear that further research is required to determine the role of benzodiazepines in the treatment of non-alcohol withdrawal related delirium.

Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience

PubMed Central

Eze, Kenneth C.; Irekpita, E.; Salami, T. A.

2016-01-01

Background: The first extracorporeal shock wave lithotripsy (ESWL) used in Nigeria was at Igbinedion Hospital and Medical Research Centre (IHMRC), Okada in 1992 and it functioned for 6 consecutive years. The objectives of this study were to analyze the cost-effectiveness of the procedure and highlight the associated factors that led to its failure. Methods: A retrospective study of medical records and publications associated with the use of ESWL at IHMRC, Okada, for the period of 1992 to 1998. The study was conducted between January 2003 and November 2008. Unclassified authentic information relating to the use of ESWL and treatment of upper urinary tract stones was obtained from the IHMRC Okada and some government hospitals on hospital bills. Relevant documents in public domains related to the national and international wages and emoluments of medical workers and socioeconomic development of Nigeria within the time the ESWL functioned were studied. Result: A total of 32 patients were treated with 51 treatment sessions which is an average of nine patients per year and an average of two treatment sessions per patient were involved. The reasons for the low patronage were the extremely low stone formation rate of Nigerians, poverty, and out-of-pocket payment system. In addition, each treatment session of ESWL at Okada cost an average of $681.8 compared to $227.3 for open nephrolithotomy in a nearby high profile teaching hospital. The IHMRC, Okada, paid an average annual salary of ₦180,000 ($8,181.8) for each medical consultant compared to ₦120,000 ($5,454.5) paid by federal teaching hospitals in Nigeria within the period. Expatriate consultant doctors from Europe and USA who initially manned the lithotriptor at IHMRC, Okada, were paid much higher salaries. Average annual income of $5,909 for each of the 6 years amounting to a total of $34,771.7 for the six years was realized which could not maintain staff salaries in the hospital leading to staff emigration, decline of the hospital services, and eventual closure of the ESWL procedure center in the hospital in 1998. Conclusion: ESWL at Okada was not cost-effective both to patients and the hospital management. Despite these, ESWL is desirable in poor-resource countries because of its noninvasiveness, low morbidity, and usability in patients who are unfit for open surgery. Purchasing high technological medical equipment as commodities by sub-Saharan Africans without considering the prevalence of diseases they are meant to cater for, their maintenance for steady function during useful lifespan, their cost-effectiveness and how to recoup the money spent on investments depletes the scarce foreign exchange reserve of the home countries and is eventually counterproductive as exemplified by this case. PMID:27185978

Medically supervised water-only fasting in the treatment of borderline hypertension.

PubMed

Goldhamer, Alan C; Lisle, Douglas J; Sultana, Peter; Anderson, Scott V; Parpia, Banoo; Hughes, Barry; Campbell, T Colin

2002-10-01

Hypertension-related diseases are the leading causes of morbidity and mortality in industrially developed societies. Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg. Dietary and lifestyle modifications are effective in the treatment of borderline hypertension. One such lifestyle intervention is the use of medically supervised water-only fasting as a safe and effective means of normalizing BP and initiating health-promoting behavioral changes. Sixty-eight (68) consecutive patients with borderline hypertension with systolic BP in excess of 119 mm Hg and diastolic BP less than 91 mm Hg were treated in an inpatient setting under medical supervision. The treatment program consisted of a short prefasting period (approximately 1-2 days on average) during which food consumption was limited to fruits and vegetables followed by medically supervised water-only fasting (approximately 13.6 days on average). Fasting was followed by a refeeding period (approximately 6.0 days on average). The refeeding program consisted of a low-fat, low-sodium, plant-based, vegan diet. Approximately 82% of the subjects achieved BP at or below 120/80 mm Hg by the end of the treatment program. The mean BP reduction was 20/7 mm Hg, with the greatest decrease being observed for subjects with the highest baseline BP. A linear regression of BP decrease against baseline BP showed that the estimated BP below which no further decrease would be expected was 96.0/67.0 mm Hg at the end of the fast and 99.2/67.3 mm Hg at the end of refeeding. These levels are in agreement with other estimates of the BP below which stroke events are eliminated, thus suggesting that these levels could be regarded as the "ideal" BP values. Medically supervised water-only fasting appears to be a safe and effective means of normalizing BP and may assist in motivating health-promoting diet and lifestyle changes.

Multi-arm group sequential designs with a simultaneous stopping rule.

PubMed

Urach, S; Posch, M

2016-12-30

Multi-arm group sequential clinical trials are efficient designs to compare multiple treatments to a control. They allow one to test for treatment effects already in interim analyses and can have a lower average sample number than fixed sample designs. Their operating characteristics depend on the stopping rule: We consider simultaneous stopping, where the whole trial is stopped as soon as for any of the arms the null hypothesis of no treatment effect can be rejected, and separate stopping, where only recruitment to arms for which a significant treatment effect could be demonstrated is stopped, but the other arms are continued. For both stopping rules, the family-wise error rate can be controlled by the closed testing procedure applied to group sequential tests of intersection and elementary hypotheses. The group sequential boundaries for the separate stopping rule also control the family-wise error rate if the simultaneous stopping rule is applied. However, we show that for the simultaneous stopping rule, one can apply improved, less conservative stopping boundaries for local tests of elementary hypotheses. We derive corresponding improved Pocock and O'Brien type boundaries as well as optimized boundaries to maximize the power or average sample number and investigate the operating characteristics and small sample properties of the resulting designs. To control the power to reject at least one null hypothesis, the simultaneous stopping rule requires a lower average sample number than the separate stopping rule. This comes at the cost of a lower power to reject all null hypotheses. Some of this loss in power can be regained by applying the improved stopping boundaries for the simultaneous stopping rule. The procedures are illustrated with clinical trials in systemic sclerosis and narcolepsy. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

Effect of biotin supplementation on claw horn growth in young, clinically healthy cattle

PubMed Central

da Silva, Luiz Antônio Franco; Franco, Leandro Guimarães; Atayde, Ingrid Bueno; da Cunha, Paulo Henrique Jorge; de Moura, Maria Ivete; Goulart, Daniel Silva

2010-01-01

The effects of orally administered biotin supplementation on the growth of claw horn in young, clinically healthy cattle were analyzed. Twelve, 1-year-old Girolando cattle were randomly assigned to receive either 12.5 mg of diluted powdered biotin (GI) or a control treatment (GII) for 40 consecutive days. Cattle in the GI group showed an average hoof growth of 11.3 ± 0.72 mm, while those in GII had an average hoof growth of 7.2 ± 0.78 mm. The results confirmed the positive effect of biotin supplementation on the growth of angle and length of the dorsal hoof wall, hoof sole length, and on resistance to wearing, in young cattle extensively managed. PMID:20808571

Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis.

PubMed

Kirsch, I; Montgomery, G; Sapirstein, G

1995-04-01

A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.

Effects of Fatty Acid and Geraniol Repellent-Oil Mixtures Applied to Cattle on Blood Feeding and Reproductive Parameters in Field Populations of Haematobia irritans (Diptera: Muscidae).

PubMed

Mullens, Bradley A; Soto, Diane; Gerry, Alec C; Fowler, Fallon E; Diniz, Alesha N

2018-02-28

California pastured cattle were treated with 250 ml of a 15% mixture of fatty acids (C8-C9-C10) or 125 ml of 2% geraniol in a mineral oil carrier to assess impacts on horn flies, Haematobia irritans (L.) (Diptera: Muscidae) over two summers. Horn flies were netted from cattle every 3-4 d for 2 wk before treatment, 2 wk during treatment (four treatments, with flies collected before each treatment), and 2 wk after treatments ceased. Blood meal weights were estimated by hemoglobin assay of excised abdomens. Other females were dissected to determine the number of active ovarioles and the stage of primary follicle development. Depending on year and herd, pretreatment males contained an average of 0.6-1.0 mg of blood, while females contained 1.7-2.7 mg. Pretreatment egg development (least developed oocytes were stage 1 and fully developed eggs were stage 5) averaged 3.7-4.3, and number of active ovarioles averaged 18.1 to 19.6/female. During treatment periods, significant reductions in blood weight were noted for females, but usually not for males, and females also often exhibited reduced mean oocyte stage and number of active ovarioles. Peaks in proportions of young nulliparous females (oocyte stages 1 or 2) were seen during some repellent application periods. This suggested older females had been killed or driven off from the local population by the treatments, and flies on cattle included more young flies that likely were recent arrivals. The repellent-oil mixture thus impacted blood feeding, reproductive fitness, and probably age structure in the field.

Low degree of satisfactory individual pain relief in post-operative pain trials.

PubMed

Geisler, A; Dahl, J B; Karlsen, A P H; Persson, E; Mathiesen, O

2017-01-01

The majority of clinical trials regarding post-operative pain treatment focuses on the average analgesic efficacy, rather than on efficacy in individual patients. It has been argued, that in acute pain trials, the underlying distributions are often skewed, which makes the average unfit as the only way to measure efficacy. Consequently, dichotomised, individual responder analyses using a predefined 'favourable' response, e.g. Visual Analogue Scale (VAS) pain scores ≤ 30, have recently been suggested as a more clinical relevant outcome. We re-analysed data from 16 randomised controlled trials of post-operative pain treatment and from meta-analyses of a systematic review regarding hip arthroplasty. The predefined success criterion was that at least 80% of patients in active treatment groups should obtain VAS < 30 at 6 and 24 h post-operatively. In the analysis of data from the randomised controlled trials, we found that at 6 h post-operatively, 50% (95% CI: 31-69) of patients allocated to active treatment reached the success criterion for pain at rest and 14% (95% CI: 5-34) for pain during mobilisation. At 24 h post-operatively, 60% (95% CI: 38-78) of patients allocated to active treatment reached the success criterion for pain at rest, and 15% (95% CI: 5-36) for pain during mobilisation. Similar results were found for trials from the meta-analyses. Our results indicate that for conventional, explanatory trials of post-operative pain, individual patient's achievement of a favourable response to analgesic treatment is rather low. Future pragmatic clinical trials should focus on both average pain levels and individual responder analyses in order to promote effective pain treatment at the individually patient level. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Ranibizumab treatment in age-related macular degeneration: a meta-analysis of one-year results.

PubMed

Gerding, H

2014-04-01

Although ranibizumab is widely used in age-related macular degeneration there is no systematic data available on the relation between treatment frequency and functional efficacy within the first 12 months of follow-up. A meta-analysis was performed on available MEDLINE literature. 47 relevant clinical studies (54 case series) could be identified covering 11706 treated eyes. Non-linear and linear regressions were calculated for the relation between treatment frequency and functional outcome (average gain in visual acuity, % of eyes losing less than 15 letters of visual acuity, % of eyes gaining ≥ 15 letters) within the first year of care. Mean improvement of average visual gain was +4.9 ± 3.6 (mean ± 1 standard deviation) letters (case-weighted: 3.3 letters). The average number of ranibizumab injections until month 12 was 6.3 ± 2.0 (case-weighted: 5.9). 92.4 ± 3.9% of eyes (case-weighted: 91.9%) lost less than three lines of visual acuity and 24.5 ± 8.2% (case-weighted: 23.3) gained more than 3 lines within the first year. Analysis of the relation between the number of injections and functional improvement indicated best fit for non-linear equations. A nearly stepwise improvement of functional gain occurred between 6.8 and 7.2 injections/year. A saturation effect of treatment occurred at higher injection frequency. The results of this meta-analysis clearly indicate a non-linear relation between the number of injections and functional gain of ranibizumab within the first 12 months of treatment. Treatment saturation seems to occur at a treatment frequency >7.2 injections within the first 12 months. Georg Thieme Verlag KG Stuttgart · New York.

Mesoscale simulations of shock compaction of a granular ceramic: effects of mesostructure and mixed-cell strength treatment

NASA Astrophysics Data System (ADS)

Derrick, J. G.; LaJeunesse, J. W.; Davison, T. M.; Borg, J. P.; Collins, G. S.

2018-04-01

The shock response of granular materials is important in a variety of contexts but the precise dynamics of grains during compaction is poorly understood. Here we use 2D mesoscale numerical simulations of the shock compaction of granular tungsten carbide to investigate the effect of internal structure within the particle bed and ‘stiction’ between grains on the shock response. An increase in the average number of contacts with other particles, per particle, tends to shift the Hugoniot to higher shock velocities, lower particle velocities and lower densities. This shift is sensitive to inter-particle shear resistance. Eulerian shock physics codes approximate friction between, and interlocking of, grains with their treatment of mixed cell strength (stiction) and here we show that this has a significant effect on the shock response. When studying the compaction of particle beds it is not common to quantify the pre-compaction internal structure, yet our results suggest that such differences should be taken into account, either by using identical beds or by averaging results over multiple experiments.

A novel dual‐wavelength, Nd:YAG, picosecond‐domain laser safely and effectively removes multicolor tattoos

PubMed Central

Schomacker, Kevin T.; Basilavecchio, Lisa D.; Plugis, Jessica M.; Bhawalkar, Jayant D.

2015-01-01

Background and Objectives Although nanosecond‐domain lasers have been the mainstay of laser tattoo removal for decades, recent disruptive innovations in laser design have introduced a new class of commercial Q‐switched lasers that generate picosecond‐domain pulses. Study A picosecond‐domain, Nd:YAG laser with a KTP frequency‐doubling crystal was used to treat 31 decorative tattoos in 21 subjects. Safety and effectiveness were determined by blinded evaluation of digital images in this prospective clinical study. Results The average clearance overall as evaluated by blinded observers evaluating randomized digital photographs was 79 ± 0.9% (mean ± sem) after an average of 6.5 treatments. Of the 31 tattoos completing treatment, 6 had evidence of mild hyper‐ or hypo‐pigmentation by evaluation of photographs. Conclusion The 350 picosecond, 532 nm, and 450 picosecond 1,064 nm Nd:YAG laser is safe and effective for removing decorative tattoos. Lasers Surg. Med. 47:542–548, 2015. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc. PMID:26175187

Scented guide ropes as a method to enhance brown treesnake (Boiga irregularis) trap capture success on Guam

USGS Publications Warehouse

Mason, L.C.; Savidge, J.A.; Rodda, G.H.; Yackel Adams, A.A.

2011-01-01

Current methods for controlling the invasive Brown Treesnake (Boiga irregularis) on Guam include a modified minnow trap with a live mouse lure. We investigated the effects on capture success of augmenting these traps with scented guide ropes leading to trap entrances. Initial screening of scent preferences was based on time spent in scented and unscented arms of a Y-maze. Preferences of large and small snakes were scored for six different prey scents (live and carrion gecko, skink, and mouse). Large snakes spent more time in the maze arm scented with live gecko and carrion gecko, whereas small snakes spent more time in the arm scented with carrion mouse and carrion gecko. After the laboratory study, a pilot trapping session was conducted in the field using three treatments (live mouse-scented ropes, carrion gecko-scented ropes, and carrion mouse-scented ropes) and two controls (traps with unscented guide ropes and those with no ropes attached). Contrary to laboratory results, live mouse-scented ropes were most effective. We conducted a second trapping session using live mouse-scented ropes as well as the two controls used in the pilot study. For snakes of below-average to average condition, the number of captures for traps with live mouse-scented ropes was higher than for traps with no ropes. However, for snakes of above-average condition, there were no differences in capture rates between trap treatments. Overall, treatment effects were weaker than latent individual heterogeneity and the influence of snake body size, with large snakes trapped more readily. ?? 2011 Society for the Study of Amphibians and Reptiles.

Emergency coronary artery bypass grafting using minimized versus standard extracorporeal circulation – a propensity score analysis

PubMed Central

2013-01-01

Background The impact of minimized extracorporeal circulation (MECC) for emergency revascularization remains controversial. Methods A total of 348 patients underwent emergency CABG with MECC (n=146) or conventional extracorporeal circulation (CECC; n=175) between January 2005 and December 2010. Using propensity score matching after binary logistic regression, 100 patients, who underwent CABG with MECC could be matched with 100 patients, who underwent CABG with CECC. Primary outcome was 30-day mortality. Results Unadjusted 30-day mortality was 14.8% in patients with CECC and 6.9% in those with MECC (mean difference −7.9%; p=0.03). The adjusted mean difference (average treatment effect of the treated, ATT) after matching was −1.0% (95% CI −8.6 to 7.6; p=1.0). Intensive care unit stay (adjusted mean difference 1.0; 95% CI −0.2 to 3.2; p=0.70) and hospital stay (adjusted mean difference 1.0; 95% CI −2.0 to 3.6; p=0.40) did not show significant differences between both groups. The adjusted mean difference for postoperative low cardiac output syndrome was −1.1% (95% CI −7.3 to 7.1; p=0.83) without significant differences between CECC and MECC. Postoperative mechanical ventilation time, drain loss, postoperative rethoracotomy, postoperative neurological events, new onset renal replacement therapy and respiratory failure also had insignificant average treatment effects of the treated. In addition, all average treatment effects (ATEs) did not significantly differ between both groups. Conclusion Using propensity score estimation and matching, we did not observe significant differences in terms of survival and further outcomes in patients who undergo emergency CABG with CECC or MECC, but our results call for further analysis. PMID:23547910

Comparison of the effectiveness of compression stockings and layer compression systems in venous ulceration treatment

PubMed Central

Jawień, Arkadiusz; Cierzniakowska, Katarzyna; Cwajda-Białasik, Justyna; Mościcka, Paulina

2010-01-01

Introduction The aim of the research was to compare the dynamics of venous ulcer healing when treated with the use of compression stockings as well as original two- and four-layer bandage systems. Material and methods A group of 46 patients suffering from venous ulcers was studied. This group consisted of 36 (78.3%) women and 10 (21.70%) men aged between 41 and 88 years (the average age was 66.6 years and the median was 67). Patients were randomized into three groups, for treatment with the ProGuide two-layer system, Profore four-layer compression, and with the use of compression stockings class II. In the case of multi-layer compression, compression ensuring 40 mmHg blood pressure at ankle level was used. Results In all patients, independently of the type of compression therapy, a few significant statistical changes of ulceration area in time were observed (Student’s t test for matched pairs, p < 0.05). The largest loss of ulceration area in each of the successive measurements was observed in patients treated with the four-layer system – on average 0.63 cm2/per week. The smallest loss of ulceration area was observed in patients using compression stockings – on average 0.44 cm2/per week. However, the observed differences were not statistically significant (Kruskal-Wallis test H = 4.45, p > 0.05). Conclusions A systematic compression therapy, applied with preliminary blood pressure of 40 mmHg, is an effective method of conservative treatment of venous ulcers. Compression stockings and prepared systems of multi-layer compression were characterized by similar clinical effectiveness. PMID:22419941

Therapist empathy, homework compliance, and outcome in cognitive behavioral therapy for generalized anxiety disorder: partitioning within- and between-therapist effects.

PubMed

Hara, Kimberley M; Aviram, Adi; Constantino, Michael J; Westra, Henny A; Antony, Martin M

2017-09-01

Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients' subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist-client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients' ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist's caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.

Treatment of port-wine stains with a noncoherent pulsed light source: a retrospective study.

PubMed

Raulin, C; Schroeter, C A; Weiss, R A; Keiner, M; Werner, S

1999-06-01

We investigated whether a noncoherent intense pulsed light source (IPLS) would be effective in therapy of port-wine stains (PWSs). To evaluate the efficacy in treatment of PWSs with IPLS, a retrospective study was initiated. The data were collected by physicians working in private practices and departments of university hospitals and medical centers, respectively. A total of 37 randomly selected patients with a total of 40 PWSs were included in the study. Clinical PWS characteristics recorded were color and location of the PWS. All patients were treated with IPLS. Data collected included treatment parameter (filters, pulse duration, fluence, and pulse sequencing), percentage of clearance, and side effects (purpura, blisters, crusting, altered pigmentation, and scarring). Good and complete (70%-100%) clearance was achieved in 28 of 40 PWSs treated with IPLS. The average number of treatment sessions in PWSs reaching 100% clearance included 4.0 for pink PWSs and 1.5 for red PWSs. The average number of sessions for purple PWSs reaching good clearance (70%-99%) was 4.2 sessions. Parameters used most frequently were 515- and 550-nm cut-off filters, pulse duration of 2.5 to 5.0 milliseconds, and fluences of 24 to 60 J/cm2. Side effects included purpura in 133 (76%), superficial blisters in 14 (8%), and crusting in 35 (20%). Transient pigmentation changes were seen in 10.8% of patients (hypopigmentation in 3 [8.1%], hyperpigmentation in 1 [2.7%]). No scarring was observed. Intense pulsed light source presents an effective and safe method for treating PWSs, especially purple PWSs.

Clinical analysis of thoracoscopic surgery combined with intraoperative autologous blood transfusion in the treatment of traumatic hemothorax.

PubMed

Ma, Hu-Sai; Ma, Ju-Hua; Xue, Feng-Lai; Fu, Xiang-Ning; Zhang, Ni

2016-12-01

From January 2013 to January 2015, 19 patients of traumatic hemothorax with hemorrhagic shock were treated in our department by thoracoscopic surgery combined with autologous blood transfusion. This study retrospectively analyzed the therapeutic effect and shared our experience. The average amount of blood transfused back was 662.41 ml ± 269.15 ml. None of the patients developed transfusion reaction and were all discharged uneventfully. Thoracoscopic surgery combined with autologous blood trans- fusion is effective in the rescue of patients with progressive hemothorax and hemorrhagic shock. When corresponding indications are well managed, treatment for these patients is quicker, safer, and more effective.

Root-knot nematode management in double-cropped plasticulture vegetables.

PubMed

Desaeger, J A; Csinos, A S

2006-03-01

Combination treatments of chisel-injected fumigants (methyl bromide, 1,3-D, metam sodium, and chloropicrin) on a first crop, followed by drip-applied fumigants (metam sodium and 1,3-D +/- chloropicrin) on a second crop, with and without oxamyl drip applications were evaluated for control of Meloidogyne incognita in three different tests (2002 to 2004) in Tifton, GA. First crops were eggplant or tomato, and second crops were cantaloupe, squash, or jalapeno pepper. Double-cropped vegetables suffered much greater root-knot nematode (RKN) pressure than first crops, and almost-total yield loss occurred when second crops received no nematicide treatment. On a first crop of eggplant, all fumigants provided good nematode control and average yield increases of 10% to 15 %. On second crops, higher application rates and fumigant combinations (metam sodium and 1,3-D +/- chloropicrin) improved RKN control and increased yields on average by 20% to 35 % compared to the nonfumigated control. Oxamyl increased yields of the first crop in 2003 on average by 10% to 15% but had no effect in 2004 when RKN failed to establish itself. On double-cropped squash in 2003, oxamyl following fumigation provided significant additional reduction in nematode infection and increased squash yields on average by 30% to 75%.

Comparative Effect of Dietary Soybean Oil, Fish Oil, and Coconut Oil on Performance, Egg Quality and Some Blood Parameters in Laying Hens.

PubMed

Dong, X F; Liu, S; Tong, J M

2018-04-14

Two hundred and sixteen 28-wk-old Hy-line laying hens were randomly distributed to three dietary treatments and fed 1of 3 diets containing 8% soybean oil, fish oil, or coconut oil from 28 to 47 wk of age to investigate comparative effect of dietary soybean oil, fish oil, and coconut oil on the performance, egg quality and blood malondialdehyde (MDA), aspartate transaminase (AST) and uric acid (UA). Hens fed fish oil showed poor performance compared with soybean oil or coconut oil, and especially egg weight throughout the trial was significantly and consistently decreased (P < 0.05) due to dietary fish oil. Unexpectedly, shell reflectivity throughout the majority of the trial was consistently and significantly higher (P < 0.05) when hens fed fish oil than that when fed soybean oil or coconut oil. Dietary treatments affected (P < 0.05) shell shape at 4 of 8 time points tested. Average shell shape in fish oil treatment was higher (P < 0.05) than that of coconut oil group. Albumen height, Haugh unit and yolk color were influenced by dietary treatments only at 1 or 2 time points. However, average albumen height and Haugh unit in fish oil treatment were higher (P < 0.05) than that of soybean oil or coconut oil treatments and average yolk color in coconut oil treatment was higher (P < 0.05) than that of soybean oil group. Serum MDA, AST and UA concentrations were increased (P < 0.05) by fish oil during the majority of the first 2 mo of the trial. These data suggested that the inclusion of fish oil into feed may reduce the performance of laying hens, especially the egg weight, decrease the intensity of egg brown color and increase blood MDA, AST and UA levels compared with soybean oil or coconut oil. As a result, hens fed fish oil may lay smaller, longer and lighter-brown eggs whereas those fed coconut oil produce blunter and darker-brown eggs relative to soybean oil.

High intensity focused ultrasound (HIFU) treatment of BPH: results of a multi-center phase III study

NASA Astrophysics Data System (ADS)

Sanghvi, N.; Gardner, T.; Koch, M.; Bihrle, R.; Foster, R.; Resnick, M.; Seftel, A.; Grunberger, I.; Stiedle, C.; Corchan, J.

2003-04-01

The five centers phase III trial was to show that HIFU can treat prostate tissue thermally for symptomatic relief of BPH and improve flow rates. At five sites, 68 BPH patients were treated with the Sonablate device (Focus Surgery, Inc. Indianapolis, IN). A urethral Foley catheter was inserted into the urethra to aid in positioning and was kept in-situ during the treatment. A cooling device was used to cool the rectal wall. The patients returned home within a few hours after the procedure. The Foley catheter was kept electively to avoid any incidence of acute urinary retention following the therapy. The catheter was removed after 4-5 days. The average treatment time was 38 minutes. The patients were treated without pain, blood loss or complications. At 90 days post treatment, average Qmax and AUA Symptom Scores improved from 8.7 ml/s to 12.66 ml/s (48%) and 23.06 to 11.62 (52%), respectively. Significant prostate tissue changes took place before and after the treatment. 80% of the patients had cavity formation at the site of treatment at the bladder neck and prostate. Nonsurgical HIFU therapy is safe and effective for providing symptomatic relief of BPH symptoms and the treatment can be performed as an outpatient procedure.

In vivo and in vitro analysis of low level light therapy: a useful therapeutic approach for sensitive skin.

PubMed

Choi, M; Kim, J E; Cho, K H; Lee, J H

2013-11-01

Sensitive skin is a relatively common dermatologic condition and no optimal treatments have been established so far. Low-level laser/light therapy (LLLT) has been used for its biostimulative effect in various clinical settings. The purpose of this study was to investigate whether low-level laser/light therapy can improve sensitive skin clinically and to evaluate the effects of LLLT on skin in vitro. Twenty-eight patients complaining of sensitive skin were treated with low-level polarized light, and clinical results were evaluated using subjective and objective method. To investigate possible working mechanism of LLLT on skin, cultured human keratinocytes pretreated with nontoxic concentration of sodium lauryl sulfate (SLS) were used. Cytokines released from irritated keratinocytes after LLLT were analyzed. All patients showed subjective and objective improvement after treatment. No adverse effects were reported. The average number of LLLT sessions required to achieve clinical improvement was 9.9, and cumulative dose of LLLT was 71.3 J/cm(2) on the average. Erythema index decreased significantly after LLLT treatment (p = 0.017). In vitro assay showed that LLLT significantly reduced the release of VEGF from SLS-pretreated keratinocytes (p = 0.021). Our results suggest that LLLT could be a useful and safe treatment modality for sensitive skin, and modification of inflammatory cytokines released from irritated keratinocytes may be considered as one of plausible mechanisms in sensitive skin treated with LLLT.

Comparative effectiveness of propranolol and botulinum for the treatment of essential voice tremor.

PubMed

Justicz, Natalie; Hapner, Edie R; Josephs, Joshua S; Boone, Benjamin C; Jinnah, Hyder A; Johns, Michael M

2016-01-01

To assess the comparative effectiveness of botulinum toxin and propranolol in patients with essential vocal tremor (EVT). Individual prospective cohort study. Study patients were recruited at the Emory Voice Center from patients seeking treatment for EVT. Exclusion criteria included current β-blocker treatment, spasmodic dysphonia, or other disease that prevented the use of propranolol therapy. A 10-week washout period from prior botulinum toxin treatment occurred before enrollment. Patients were assessed via the Voice-Related Quality-Of-Life (VRQOL) questionnaire, Quality of life in Essential Tremor questionnaire, and blinded perceptual voice assessment. These assessments were made at baseline voice 2 weeks after propranolol therapy and 4 weeks after botulinum toxin injection. Eighteen patients were enrolled. After 2 to 4 weeks of propranolol therapy (with a maximum dosage of 60 mg to 90 mg per day), patients report an average ΔVRQOL of 9.31. Six patients report significant VRQOL improvement >10, with the rest reporting changes between -7.5 and 7.5. Fifteen patients were followed for at least 4 weeks after botulinum toxin injection, reporting an average improvement in scaled VRQOL of 22.00. Blinded perceptual voice assessment demonstrates an improvement in overall severity of tremor with botulinum toxin. In some patients with EVT, propranolol led to significant vocal improvement with no major side effects. Although botulinum toxin remains the gold-standard therapy for patients with EVT, propranolol represents a possible alternative or adjuvant therapy for certain patients. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Comparative Effectiveness of Propranolol and Botulinum for the Treatment of Essential Voice Tremor

PubMed Central

Justicz, Natalie; Hapner, Edie R.; Josephs, Joshua S.; Boone, Benjamin C.; Jinnah, Hyder A.; Johns, Michael M.

2016-01-01

Objectives/Hypothesis To assess the comparative effectiveness of botulinum toxin and propranolol in patients with essential vocal tremor (EVT). Study Design Individual prospective cohort study. Methods Study patients were recruited at the Emory Voice Center from patients seeking treatment for EVT. Exclusion criteria included current β-blocker treatment, spasmodic dysphonia, or other disease that prevented the use of propranolol therapy. A 10-week washout period from prior botulinum toxin treatment occurred before enrollment. Patients were assessed via the Voice-Related Quality-Of-Life (VRQOL) questionnaire, Quality of life in Essential Tremor questionnaire, and blinded perceptual voice assessment. These assessments were made at baseline voice 2 weeks after propranolol therapy and 4 weeks after botulinum toxin injection. Results Eighteen patients were enrolled. After 2 to 4 weeks of propranolol therapy (with a maximum dosage of 60 mg to 90 mg per day), patients report an average ΔVRQOL of 9.31. Six patients report significant VRQOL improvement >10, with the rest reporting changes between −7.5 and 7.5. Fifteen patients were followed for at least 4 weeks after botulinum toxin injection, reporting an average improvement in scaled VRQOL of 22.00. Blinded perceptual voice assessment demonstrates an improvement in overall severity of tremor with botulinum toxin. Conclusions In some patients with EVT, propranolol led to significant vocal improvement with no major side effects. Although botulinum toxin remains the gold-standard therapy for patients with EVT, propranolol represents a possible alternative or adjuvant therapy for certain patients. PMID:26198384

Lactation performance of Holstein cows treated with 2 formulations of recombinant bovine somatotropin in a large commercial dairy herd in Brazil.

PubMed

de Morais, J P G; da S Cruz, A P; Minami, N S; Veronese, L P; Del Valle, T A; Aramini, J

2017-07-01

The objectives of this controlled study were to compare the effects of 2 different formulations of recombinant bovine somatotropin (rbST) on milk yield, milk composition (fat and protein), milk somatic cell count, and body condition score (BCS) among dairy cattle in a large commercial herd. Regulatory approved 500-mg zinc sesame oil base rbST (ZSO-rbST; Elanco Animal Health, Greenfield, IN) and vitamin E lecithin base rbST (VEL-rbST; LG Life Sciences, Seoul, South Korea) formulations were administered per the manufacturers' recommendations every 14 d over 17 injection cycles starting at 57 to 70 d of lactation (90 cows per rbST group). Control cows (n = 60) received no rbST. Somatotropin-treated animals (VEL-rbST and ZSO-rbST combined) had increased average milk yield and protein percentage and lower average BCS compared with control cows. For primiparous cows, average milk yield was 37.75 kg/d with the ZSO-rbST treatment and 35.72 kg/d with the VEL-rbST treatment. For multiparous cows, average milk yield was 40.13 kg/d with the ZSO-rbST treatment and 38.81 kg/d with the VEL-rbST treatment. There were no differences in milk fat percentage between VEL-rbST and ZSO-rbST treatments, but milk protein content was greater with VEL-rbST treatment than with ZSO-rbST treatment. Nonetheless, cows treated with ZSO-rbST yielded more kilograms of fat and protein per day than cows treated with VEL-rbST. No significant differences in BCS were found between both rbST treatment groups. The differential increase in milk yield between cows treated with ZSO-rbST and VEL-rbST was driven by rbST response differences both within the 14-d cycle and throughout the 17 injection cycles. The cows treated with VEL-rbST demonstrated a more variable 14-d milk yield response curve, with more pronounced valleys between injections compared with the ZSO-rbST formulation. In addition, only the ZSO-rbST treatment was effective in modifying the lactation persistency compared with control cows. Compared with the VEL-rbST formulation, the ZSO-rbST formulation yielded more kilograms of milk, fat, and protein with less milk variation throughout the seventeen 14-d lactation cycles for both primiparous and multiparous cows. The Authors. Published by the Federation of Animal Science Societies and Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Treatment of fibroadenomatosis in 14 cats with aglepristone - changes in blood parameters and follow-up.

PubMed

Jurka, P; Max, A

2009-11-28

Fourteen female cats with fibroadenomatosis were treated with aglepristone, and the effectiveness of the treatment and its effect on selected haematological and blood chemistry parameters were studied. The cats were monitored for 12 months after the end of the treatment. Complete remission of the clinical signs was achieved on average 3.9 weeks after the treatment began; the success of the treatment confirmed the clinical diagnosis of fibroadenomatosis. During the course of the treatment the cats' haematological parameters returned to normal. In cats that had previously been treated with long-acting medroxyprogesterone acetate, treatment with aglepristone for five weeks was recommended. Cases of fibroadenomatosis reappearing after a few months should be regarded as new disease rather than a relapse. Six cats were subsequently mated and four gave birth to one or more litters; all the pregnancies proceeded normally with no clinically evident fibroadenomatosis. The other eight cats underwent ovariohysterectomy soon after the aglepristone treatment was completed.

Cost-effective solutions for sewage treatment in developing countries--the case of Brazil.

PubMed

Jordão, E P; Volschan, I

2004-01-01

Cost-effective solutions are a must in developing countries, not only regarding investment costs, but also in respect to technology and operating practices. With these two goals in mind, in Brazil a particular effort has been directed for the development and application of the Chemical Enhanced Primary Treatment (CEPT) process and of the Upflow Anaerobic Sludge Blanket (UASB) process, both followed by complementary secondary treatment. Both technologies are under current expansion in Brazil. Large CEPT plants have been designed and built, up to 3.7 m3/s average design flow, as well as large UASB reactors, up to 3.0 m3/s average design flow. The applied technologies are cost-effective: they present low investment and efficiencies of BOD removal of up to 50% to 70%. They allow the plant construction in steps, an initial phase with efficiency over the usual primary treatment, and in order to achieve best effluent quality and meet legal water quality standards, a logic upgrade post-treatment can later on be implemented. The higher initial reduction of BOD and TSS also permits savings in construction and operational costs of secondary treatment, due to lower organic load and lower energy consumption. Sludge represents a particular point of attention: in the cases when the CEPT was used, Chemical Stabilisation of the Sludge (CSS) has also been practiced, eliminating the high construction costs of the digesters, all the plant staying chemically operated. In the cases when the UASB is used preceding secondary treatment, sludge can easily return to the anaerobic vessel, the costly sludge digestion unit being avoided. UASB reactors have practically no equipment in the anaerobic vessel, no energy consumption, low sludge production, and when applied in hot climates as in Brazil, heating devices are not required. The Brazilian experience, some particular cases, special comments on design and different secondary treatment processes are presented in this paper, as a contribution to the discussion of cost and benefits, a prime point to be considered.

The effectiveness of glucose, sucrose, and fructose in treating hypoglycemia in children with type 1 diabetes.

PubMed

Husband, Allison C; Crawford, Susan; McCoy, Lesley A; Pacaud, Danièle

2010-05-01

There is a lack of evidence regarding the most effective treatment option for managing naturally occurring hypoglycemia in children with type 1 diabetes. The objectives of this study were (i) to determine if sucrose and fructose are equally effective as glucose in the treatment of spontaneous hypoglycemia in children with type 1 diabetes; and (ii) to determine prestudy and poststudy hypoglycemia treatment preferences. Thirty-three subjects [aged 5.4-15.5 yr and average duration of type 1 diabetes of 3.1 yr (SD = 2.3)] participated in a randomized, crossover design. The main outcome was the effectiveness of treatment as defined by a blood glucose meter reading that was > or = 4.0 mmol/L 15 min after treatment. Each subject treated five hypoglycemic events with each treatment type: glucose (BD Glucose Tablets), sucrose (Skittles), and fructose (Fruit to Go). There was a significant difference between the effectiveness of the three treatments [Wilk's Lambda F(2,28) = 8.64, p = 0.001]. No significant difference between treatment with glucose and treatment with sucrose was noted, but the treatment effectiveness for fructose was significantly lower than sucrose [F (1,29) = 16.09, p < 0.001] and glucose [F (1,29) = 15.64, p < 0.001]. The preferred treatment choices before the study were as follows: 36% glucose, 18% sucrose, and 33% fructose sources. Poststudy, 52% of children preferred the same treatment, which was effective (glucose or sucrose), followed by 35% who changed their preference to an effective treatment. Skittles are as effective in treating hypoglycemia as more expensive BD Glucose Tablets in children with type 1 diabetes.

Effects of parental number and duration of the breeding period on the effective population size and genetic diversity of a captive population of the endangered Tokyo bitterling Tanakia tanago (Teleostei: Cyprinidae).

PubMed

Kubota, Hitoshi; Watanabe, Katsutoshi

2012-01-01

The maintenance of genetic diversity is one of the chief concerns in the captive breeding of endangered species. Using microsatellite and mtDNA markers, we examined the effects of two key variables (parental number and duration of breeding period) on effective population size (N(e) ) and genetic diversity of offspring in an experimental breeding program for the endangered Tokyo bitterling, Tanakia tanago. Average heterozygosity and number of alleles of offspring estimated from microsatellite data increased with parental number in a breeding aquarium, and exhibited higher values for a long breeding period treatment (9 weeks) compared with a short breeding period (3 weeks). Haplotype diversity in mtDNA of offspring decreased with the reduction in parental number, and this tendency was greater for the short breeding period treatment. Genetic estimates of N(e) obtained with two single-sample estimation methods were consistently higher for the long breeding period treatment with the same number of parental fish. Average N(e) /N ratios were ranged from 0.5 to 1.4, and were high especially in the long breeding period with small and medium parental number treatments. Our results suggest that the spawning intervals of females and alternative mating behaviors of males influence the effective size and genetic diversity of offspring in bitterling. To maintain the genetic diversity of captive T. tanago, we recommend that captive breeding programs should be conducted for a sufficiently long period with an optimal level of parental density, as well as using an adequate number of parents. © 2011 Wiley Periodicals, Inc.

The Effect of Herbaceous Legume of Feed in In-Vitro Digestibility

NASA Astrophysics Data System (ADS)

Ratnawaty, S.; Hartutik; Chuzaemi, S.

2018-02-01

This study was carried out to evaluate in-vitro digestibility of herbal legumesin feed. The materials used in this study were three types of herbal legumes namely Clitoria ternatea Q5455 (CT Q5455), Clitoria ternatea cv. Milgarra (CT cv Milgarra) and Stylosanthes seabrana (S. seabrana), The treatments were P0 = 100% Grass; P1 = 50% Grass+ 50% CT Q5455, P2 = 50% Grass + 50% CT cv. Milgarra, P3 = 50% Grass + 50% S. seabrana. The result showed that the treatments had a significant effect (P <0.05). The highest dry matter (DM) digestibilitywas in P1 (60.35%) and P3 (60.22%). The DM digestibility of the highest raw materials was in CT cv. Milgarra (73.49%) and the lowest one was in S. seabrana (63.90%). The treatments had a very significant effect (P <0.01) on the organic matter (OM) Digestibility. The highest OM digestibility wasin P1 (63.04%) and P3 (61.89%). The highest value of OM digestibility of raw materials was in CT cv. Milgarra (73.90%) and the lowest one was in S. seabrana (63.85%). The treatmentshad a significant effect (P <0.05) on the crude protein (CP) digestibility. The average CP digestibility of feed was at the same value in all treatments but in CT Q5455 (67.25%). The treatmentshad a significant effect (P <0.05) on the total digestible nutrients (TDN). The highest TDN was in P1 (66.19%) and the lowest one was in P0 (51.38%). Average TDN of the highest raw material was in CT cv. Milgarra (77.59%) and the lowest was in S. seabrana (67.04%).

Effects of Anti-diarrhoeal Herbs on Growth Performance, Nutrient Digestibility, and Meat Quality in Pigs

PubMed Central

Cho, J. H.; Zhang, S.; Kim, I. H.

2012-01-01

Two studies were conducted to investigate the effects of anti-diarrhoeal herbs on growth performance, nutrient digestibility, and meat quality in pigs. In Exp 1, 150 weanling-growing piglets (average BW = 7.5±0.24 kg, average age = 27±1 d) were allotted into one of the five dietary treatments, including: i) CON, basal diet, ii) DP, basal diet+1 g/kg date pits, iii) JH, basal diet+0.5 g/kg Japanese-honeysuckle, iv) HCT, basal diet+1 g/kg houttuynia cordata thunb, and v) LE, basal diet+1 g/kg laquer tree extract. From wk 0 to 5, the JH, HCT and LE groups presented higher (p<0.05) ADFI, ADG and gain/feed ratio (G/F) than CON and DP groups. During wk 5 to 10, Pigs fed JH, HCT and LE diets indicated higher (p<0.05) ADG and ADFI than the pigs fed CON and DP diets. During the entire experimental period, a significant increase of ADG appeared in JH, HCT and LE (p<0.05). Pigs fed JH, HCT and LE diets got a higher (p<0.05) ADFI than the pigs fed CON and DP diets. Pigs fed diets with supplementations of herb additives revealled lower (p<0.05) score of diarrhea pigs during d 2 to d 6 compared with pigs fed CON diet. In Exp 2, 60 growing-finishing barrows and gilts (average BW = 54.10±1.20 kg, average age = 54±3 d) were allotted to three treatments: i) CON, basal diet; ii) YG, basal diet+1 g/kg yellow ginger and iii) HR, basal dietary+1 g/kg hoantchy root, respectively. From wk 0 to 5, Dietary supplementation of YG and HR enhanced (p<0.05) ADG. No difference was found between YG and HR treatments. During, wk 5 to 10, ADG also was observed higher in YG and HR treatments than CON group (p<0.05). Additional, YG had the highest ADG (p<0.05) among treatments. There was always an increase of ADG in YG and HR (p<0.05) through all periods. HR treatment showed a lower (p<0.05) score of diarrhoeal pigs on d 1and d 2 compared with CON treatment. Pigs fed YG and HR diets had a higher (p<0.05) longissimus muscle area (LMA) than pigs fed CON diet. In conclusion, anti-diarrhoeal herbs can improve growth performance, and prevent diarrhea incidence in pigs, it can also increase LMA in finishing pigs. PMID:25049522

Causal inference with measurement error in outcomes: Bias analysis and estimation methods.

PubMed

Shu, Di; Yi, Grace Y

2017-01-01

Inverse probability weighting estimation has been popularly used to consistently estimate the average treatment effect. Its validity, however, is challenged by the presence of error-prone variables. In this paper, we explore the inverse probability weighting estimation with mismeasured outcome variables. We study the impact of measurement error for both continuous and discrete outcome variables and reveal interesting consequences of the naive analysis which ignores measurement error. When a continuous outcome variable is mismeasured under an additive measurement error model, the naive analysis may still yield a consistent estimator; when the outcome is binary, we derive the asymptotic bias in a closed-form. Furthermore, we develop consistent estimation procedures for practical scenarios where either validation data or replicates are available. With validation data, we propose an efficient method for estimation of average treatment effect; the efficiency gain is substantial relative to usual methods of using validation data. To provide protection against model misspecification, we further propose a doubly robust estimator which is consistent even when either the treatment model or the outcome model is misspecified. Simulation studies are reported to assess the performance of the proposed methods. An application to a smoking cessation dataset is presented.

Picosecond 532-nm neodymium-doped yttrium aluminum garnet laser-a promising modality for the management of verrucous epidermal nevi.

PubMed

Levi, Assi; Amitai, Dan Ben; Mimouni, Daniel; Leshem, Yael A; Arzi, Ofir; Lapidoth, Moshe

2018-04-01

The verrucous epidermal nevus (VEN) is the most common type of epidermal nevi. As lesions can be disfiguring, treatment is often sought. Many therapeutic approaches have been reported, with variable efficacy and safety. Picosecond (PS) lasers are novel laser devices designated to target small chromophores. A side effect of these lasers is blistering due to epidermal-dermal separation. We aimed to harness this side effect of the PS lasers to treat patients with VEN. The purpose of this study was to report our experience treating VEN using a PS 532-nm laser. We present a retrospective case series of six patients with large VEN who were treated using a PS 532-nm laser (2-6 treatments, 8-10 weeks apart). Response in clinical photographs was assessed by two independent dermatologists and graded on a scale of 0 (exacerbation) to 4 (76-100% improvement). Patient satisfaction was recorded on a scale of 1-5. All patients demonstrated significant improvement. Average improvement was 3.7 on the quartile scale of improvement. Patient satisfaction rate averaged 4.7. The PS 532-nm laser is a promising novel modality for the treatment of large VEN.

A clinical trial to evaluate the effects of flumethrin or ivermectin treatment on hemoparasites, gastrointestinal parasites, conception and daily weight gain in a dairy farm in Japan.

PubMed

Yamane, I; Arai, S; Nakamura, Y; Hisashi, M; Fukazawa, Y; Onuki, T

2000-02-01

A clinical trial was performed to compare the effects of flumethrin and ivermectin treatments of grazing heifers at one farm in central Japan. 64 heifers were randomly allocated into two groups. Flumethrin (1 mg/kg pour on) was applied approximately once every 3 weeks to heifers in one group and heifers in the second group were injected approximately once every month with ivermectin (200 microg/kg; id). Between groups, no significant differences were detected in the proportions of animals that showed parasitemia of Theileria sergenti and conception risks. Significantly lower average log-transformed nematode-egg counts and higher average daily weight gain were observed in the ivermectin-treated group. Animals with higher body weight at the start of grazing and lower log-transformed total nematode-egg and coccidia-oocyst counts had higher odds of conceiving. Animals with ivermectin treatment, lower body weight at the start of grazing and lower log-transformed coccidia-oocyst count had higher daily weight gain. Ivermectin may be more useful in this farm because of the higher productivity for cattle and lower cost for its usage.

Health care costs attributable to the treatment of rheumatoid arthritis.

PubMed

Sørensen, J

2004-01-01

A 'programme budget' for the resources used in the treatment and care of patients with rheumatoid arthritis (RA) was developed with a view of helping decision-makers assess the appropriateness of the current use of resources and to discuss future resource allocation. The programme budget was developed using data from several national administrative registers. Patients with RA were identified by hospital diagnostic codes. The incremental cost of treating RA was defined as the difference in resource use for patients with and without RA. Incremental mortality due to RA was defined in similar way. Cost data were estimated for 5-year age groups. Patients with RA used on average 3.2 times as many health care resources as people without RA. The average 1997 incremental costs of primary and hospital care were EUR 253 and EUR 2.660 per patient respectively, corresponding to a national incremental cost of EUR 30 million (2000 price level). RA resulted in an annual loss of 1,549 life years. The programme budget approach is a useful tool in resource allocation decision-making, but discussions of alternative resource allocations must be based on robust studies of effectiveness and cost-effectiveness in the treatment of patients with RA.

Leachate treatment system using constructed wetlands, Town of Fenton sanitary landfill, Broome County, New York. Final report

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

Not Available

1993-11-01

Municipal sanitary landfills generate leachate that New York State regulations require to be collected and treated to avoid contaminating surface water and groundwater. One option for treating leachate is to haul it to municipal wastewater treatment facility. This option may be expensive, may require excessive energy for transportation, and may require pretreatment to protect the receiving facility`s processes. An alternative is on-site treatment and discharge. Personnel from the Town of Fenton, New York; Hawk Engineering, P.C.; Cornell University; and Ithaca College designed, built, and operated a pilot constructed wetland for treating leachate at the Town of Fenton`s municipal landfill. Themore » system, consisting of two overland flow beds and two subsurface flow beds has been effective for 18 months in reducing levels of ammonia (averaging 85% removal by volatilization and denitrification) and total iron (averaging 95% removal by precipitation and sedimentation), two key constituents of the Fenton landfill`s leachate. The system effects these reductions with zero chemical and energy inputs and minimal maintenance. A third key constituent of the leachate, manganese, apparently passes through the beds with minimal removal. Details and wetland considerations are described.« less

A problem unstuck? Evaluating the effectiveness of sticker prompts for encouraging household food waste recycling behaviour.

PubMed

Shearer, Linzi; Gatersleben, Birgitta; Morse, Stephen; Smyth, Matthew; Hunt, Sally

2017-02-01

This Randomised Control Trial (RCT) investigated the effectiveness of using stickers as a visual prompt to encourage the separate collection of household food waste for recycling in two local authorities in South East England. During a baseline period of up to 15weeks, separately collected food waste was weighed (in tonnes) and averaged across households in both treatment (N=33,716 households within 29 defined areas) and control groups (N=30,568 households within 26 areas). A sticker prompt was then affixed to the lids of refuse bins in the treatment group area only. Weights for both groups were subsequently measured across a 16-week experimental period. Results showed that, in the control group, there was no change in the average weight of food waste captured for recycling between the baseline and experimental period. However, there was a significant increase (20.74%) in the treatment group, and this change in behaviour persisted in the longer term. Sticker prompts therefore appear to have a significant and sustained impact on food waste recycling rates, while being simple, practically feasible and inexpensive (£0.35 per household) for local authorities to implement at scale. Copyright © 2016 Elsevier Ltd. All rights reserved.

Results of a large-scale randomized behavior change intervention on road safety in Kenya.

PubMed

Habyarimana, James; Jack, William

2015-08-25

Road accidents kill 1.3 million people each year, most in the developing world. We test the efficacy of evocative messages, delivered on stickers placed inside Kenyan matatus, or minibuses, in reducing road accidents. We randomize the intervention, which nudges passengers to complain to their drivers directly, across 12,000 vehicles and find that on average it reduces insurance claims rates of matatus by between one-quarter and one-third and is associated with 140 fewer road accidents per year than predicted. Messages promoting collective action are especially effective, and evocative images are an important motivator. Average maximum speeds and average moving speeds are 1-2 km/h lower in vehicles assigned to treatment. We cannot reject the null hypothesis of no placebo effect. We were unable to discern any impact of a complementary radio campaign on insurance claims. Finally, the sticker intervention is inexpensive: we estimate the cost-effectiveness of the most impactful stickers to be between $10 and $45 per disability-adjusted life-year saved.

Encounter Preparedness, Satisfaction, and Performance Effects of Influence in Assertive Community Treatment (ACT) Teams.

PubMed

Pisansky, Andrew J; Wholey, Douglas R; Cain, Cindy; Zhu, Xi

2017-07-01

Assertive community treatment (ACT) teams are linked to high quality outcomes for individuals with severe mental illness. This paper tests arguments that influence shared between team members is associated with better encounter preparedness, higher work satisfaction, and improved performance in ACT teams. Influence is conceptualized in three ways: the average level according to team members, the team's evaluation of the dispersion of team member influence, and as the person-organization fit of individual perception of empowerment. The study design is a retrospective observational design using survey data from a longitudinal study of 26 ACT teams (approximately 275 team members total) over 18 months. This study finds that average team influence and person-organization fit are positively correlated with encounter preparedness and satisfaction. Dispersion of influence was not significantly correlated with study outcomes. Influence in ACT teams has multiple dimensions, each with differential effects on team outcomes. These findings provide guidance as to how one might encourage equal and substantive contribution from ACT team members.

Do Preschool Special Education Services Make a Difference in Kindergarten Reading and Mathematics Skills?: A Propensity Score Weighting Analysis

ERIC Educational Resources Information Center

Sullivan, Amanda L.; Field, Samuel

2013-01-01

The purpose of this study was to examine the average treatment effect of preschool special education services on children's kindergarten academic skills. Using data from a nationally representative sample of United States children who participated in the Early Childhood Longitudinal Study--Birth Cohort, we examined the effectiveness of preschool…

Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: efficacy and treatment cost.

PubMed

Taylor, Frederick; Levine, Laurence

2010-01-01

The efficacy of oral clomiphene citrate (CC) in the treatment of male hypogonadism and male infertility (MI) with low serum testosterone and normal gonadotropin levels has been reported. The aim of this article is to evaluate CC and testosterone gel replacement therapy (TGRT) with regard to biochemical and clinical efficacy and cost. The main outcome measures were change in serum testosterone with CC and TGRT therapy, and change in the androgen deficiency in aging male (ADAM) questionnaire scores with CC therapy. Men receiving CC or TGRT with either Androgel 1% or Testim 1% for hypogonadism (defined as testosterone < 300 ng/mL) or MI were included. Serum values were collected 1-2 months after treatment initiation and semi-annually thereafter. Retrospective data collection was performed via chart review. Subjective follow up of patients receiving CC was performed via telephone interview using the ADAM questionnaire. A hundred and four men (65 CC and 39 TGRT) were identified who began CC (50 mg every other day) or TGRT (5 g). Average age (years) was 42(CC) vs. 57 (TGRT). Average follow up was 23 months (CC, range 8-40 months) vs. 46 months (TGRT, range 6-149 months). Average posttreatment testosterone was 573 ng/dL in the CC group and 553 ng/dL in the TGRT group (P value < 0.001). The monthly cost of Testim 1% (5 gm daily) is $270, Androgel 1% (5 gm daily) is $265, and CC (50 mg every other day) is $83. Among CC patients, the average pretreatment ADAM score was 4.9 vs. 2.1 at follow up (P < 0.05). Average pretreatment ADAM sexual function domain score was 0.76 vs. 0.23 at follow up (P < 0.05). There were no adverse events reported. CC represents a treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and lower cost as compared with TGRT.

Blocking carbohydrate absorption and weight loss: a clinical trial using Phase 2 brand proprietary fractionated white bean extract.

PubMed

Udani, Jay; Hardy, Mary; Madsen, Damian C

2004-03-01

Phase 2' starch neutralizer brand bean extract product ("Phase 2") is a water-extract of a common white bean (Phaseolus vulgaris) that has been shown in vitro to inhibit the digestive enzyme alpha-amylase. Inhibiting this enzyme may prevent the digestion of complex carbohydrates, thus decreasing the number of carbohydrate calories absorbed and potentially promoting weight loss. Fifty obese adults were screened to participate in a randomized, double-blind, placebo-controlled study evaluating the effects of treatment with Phase 2 versus placebo on weight loss. Participants were randomized to receive either 1500 mg Phase 2 or an identical placebo twice daily with meals. The active study period was eight weeks. Thirty-nine subjects completed the initial screening process and 27 subjects completed the study. The results after eight weeks demonstrated the Phase 2 group lost an average of 3.79 lbs (average of 0.47 lb per week) compared with the placebo group, which lost an average of 1.65 lbs (average of 0.21 lb per week), representing a difference of 129 percent (p=0.35). Triglyceride levels in the Phase 2 group were reduced an average of 26.3 mg/dL, more than three times greater a reduction than observed in the placebo group (8.2 mg/dL) (p=0.07). No adverse events during the study were attributed to the study medication. Clinical trends were identified for weight loss and a decrease in triglycerides, although statistical significance was not reached. Phase 2 shows potential promise as an adjunct therapy in the treatment of obesity and hypertriglyceridemia and further studies with larger numbers of subjects are warranted to conclusively demonstrate effectiveness.

Simulation of the effects of seasonally varying pumping on intraborehole flow and the vulnerability of public-supply wells to contamination

USGS Publications Warehouse

Yager, Richard M.; Heywood, Charles E.

2014-01-01

Public-supply wells with long screens in alluvial aquifers can produce waters of differing quality from different depths. Seasonal changes in quality are linked to seasonal changes in pumping rates that influence the distribution of flow into the well screens under pumping conditions and the magnitude and direction of intraborehole flow within the wells under ambient conditions. Groundwater flow and transport simulations with MODFLOW and MT3DMS were developed to quantify the effects of changes in average seasonal pumping rates on intraborehole flow and water quality at two long-screened, public-supply wells, in Albuquerque, New Mexico and Modesto, California, where widespread pumping has altered groundwater flow patterns. Simulation results indicate that both wells produce water requiring additional treatment to maintain potable quality in winter when groundwater withdrawals are reduced because less water is derived from parts of the aquifer that contain water requiring less treatment. Simulation results indicate that the water quality at both wells could be improved by increasing average winter-pumping rates to induce more lateral flow from parts of the aquifer that contain better quality water. Arsenic-bearing water produced by the Albuquerque well could be reduced from 55% to 45% by doubling average winter-pumping rate, while nitrate- and uranium-bearing water produced by the Modesto well could be reduced from 95% to 65% by nearly tripling the average winter-pumping rate. Higher average winter-pumping rates would also reduce the volume of intraborehole flow within both wells and prevent the exchange of poor quality water between shallow and deep parts of both aquifers.

[Efficacy evaluation of epsiprantel (Cestex) against Echinococcus mutilocularis in dogs and cats].

PubMed

Eckert, J; Thompson, R C; Bucklar, H; Bilger, B; Deplazes, P

2001-01-01

Helminth-free dogs and cats were experimentally infected with protoscoleces of Echinococcus multilocularis and used in controlled trials for efficacy evaluation of the cestodicide epsiprantel. In two separate trials each 4 dogs were treated at day 20 post infection (p.i.) with average oral dosages of 5.1 (4.9-5.3) and 5.4 (5.2-5.8) mg/kg body weight (b.w.) epsiprantel, respectively, and necropsied at day 24 p.i. Among each 4 dogs of the two untreated control groups all animals were infected and had high intestinal worm burdens with averages of 33.575 and 100.725 E. multilocularis specimens per animal (individual worm burdens in group Ib 59,500-149,800, group IIb 20,500-43,200); in the two groups of treated dogs the average worm burdens were reduced by 99.6 and 99.9%. Among 8 treated dogs 4 were helminth-free, the other 4 had residual worm burdens (10-70 in 3 dogs, 1480 in 1 dog). In each 5 cats single oral treatments with average doses of 2.7 (2.7-2.8) and 5.5 (5.5-5.5) mg/kg b.w. epsiprantel were 100% effective against E. multilocularis 20 days p.i. and eliminated the worm burdens from all 10 animals. In the untreated group of 5 cats the average worm burden was 2864 per animal (individual worm burdens 20-6830). Side effects of the drug treatment were not observed. The results of the study show that in single therapeutic dosages recommended by the producer (dogs 5.5 mg, cats 2.75 mg/kg b.w.) epsiprantel eliminates E. multilocularis to over 99% or completely, but residual worm burdens may persist in some animals.

Parental satisfaction, efficacy, and adverse events in 54 patients treated with cantharidin for molluscum contagiosum infection.

PubMed

Cathcart, Shelley; Coloe, Jacqueline; Morrell, Dean S

2009-03-01

To study the efficacy, tolerability, and parental satisfaction of cantharidin in a patient population at a pediatric dermatology referral center. Chart review was completed for 110 patients who presented with molluscum infection and were treated with cantharidin. A total of 54 were available for follow-up by telephone interview regarding adverse effects, parental satisfaction, and overall clearance of the infection. Of those who were reachable, 96% improved after treatment with cantharidin. Parental satisfaction was 78%. Patients received an average of 2.2 treatments irrespective of outcome. Overall, 46% of patients experienced adverse events, including pain, pruritus, secondary infection, brisk immune response, and temporary hypopigmentation and 9% experienced an adverse event that they classified as severe. The results contribute to the data supporting cantharidin as a safe and effective treatment of molluscum contagiosum. Compared with other treatments, it appears to be equally effective and well-tolerated and should be considered a potential front-line treatment.

Short- and Long-Term Outcomes of Deep Brain Stimulation in Patients 70 Years and Older with Parkinson Disease.

PubMed

Mathkour, Mansour; Garces, Juanita; Scullen, Tyler; Hanna, Joshua; Valle-Giler, Edison; Kahn, Lora; Arrington, Teresa; Houghton, David; Lea, Georgia; Biro, Erin; Bui, Cuong J; Sulaiman, Olawale A R; Smith, Roger D

2017-01-01

Parkinson disease (PD) is a common neurodegenerative disease in elderly patients that may be treated with deep brain stimulation (DBS). DBS is an accepted surgical treatment in PD patients <70 years that demonstrates marked improvement in disease symptomology. Patients ≥70 years historically have been excluded from DBS therapy. Our objective is to evaluate the short- and long-term outcomes in patients with PD ≥70 years who underwent DBS at our center. In our single-center study, we retrospectively assessed a prospective registry of patients with PD treated with DBS who were ≥70 years old at the time of their procedure. Univariate analyses and 1-sample paired t test were used to evaluate data. Motor scores were evaluated with the Unified Parkinson's Disease Rating Scale III, and the effects on medication requirements were evaluated with levodopa equivalence daily doses (LEDD). Thirty-seven patients were followed for an average of 42.2 months post-DBS. The average ages at diagnosis and at the time of DBS surgery were 63.05 years and 72.45 years, respectively. Significant reductions in the average Unified Parkinson's Disease Rating Scale III score were observed (preoperative 31.8; postoperative 15.6; P < 0.0001). Significant reductions in the average LEDD (preoperative 891.94 mg; postoperative 559.6 mg; P = 0.0008) and medication doses per day (preoperative 11.54; postoperative 7.97; P = 0.0112) also were present. DBS is effective in treating elderly patients with PD. Patients experienced improvement in motor function, LEDD, and medication doses per day after DBS. Our results suggest that DBS is an effective treatment modality in elderly patients with PD. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of sodium naphthenate and air-ionization corona discharge as surface treatments for the ethylene-tetrafluoroethylene polymer (ETFE) to improve adhesion between ETFE and acrylonitrile-butadiene-styrene polymer (ABS) in the presence of a cyanoacrylate adhesive (CAA)

NASA Astrophysics Data System (ADS)

Lucía Johanning-Solís, Ana; Stradi-Granados, Benito A.

2014-09-01

This study compares two ethylene-tetrafluoroethylene (ETFE) surface activation treatments, namely chemical attack with a solution of sodium naphthenate and plasma erosion via air-ionization corona discharge in order to improve the adhesive properties of the ETFE. An experimental design was prepared for both treatments in order to assess the effect of the treatment characteristics on the tensile load needed to break the bond between the ETFE and the acrylonitrile-butadiene-styrene polymer (ABS) formed with a cyanoacrylate adhesive (CAA) applied between them. The reason for the selection of this problem is that both polymers are frequently used in the biomedical industry for their properties, and they need to be joined firmly in biomedical devices, and the cyanoacrylate adhesive is the adhesive traditionally used for fluoropolymers, in this case the ETFE, and the same CAA has also shown good adhesion with ABS. However, the strength of the bond for the triplet ETFE-CAA-ABS has not been reported and the improvement of the strength of the bond with surface treatments is not found in scholarly journals for modern medical devices such as stents and snares. Both treatments were compared based on the aforementioned design of experiments. The case where ETFE receives no surface treatment serves as the reference. The results indicated that the three factors evaluated (initial drying of the material, temperature of the chemical bath, and immersion time), and their interactions have no significant effect over the tensile load at failure (tensile strength) of the adhesive bond being evaluated. For the air-ionization corona discharge treatment, two factors were evaluated: discharge exposition time and air pressure. The results obtained from this experimental design indicate that there is no significant difference between the levels of the factors evaluated. These results were unexpected as the ranges used were representative of the maximum ranges permissible in manufacturing operations. As for the comparison of the treatments, it was determined that the treatments have statistically significant differences. It was also determined that there is a significant statistical difference between the processes where a surface treatment is performed and the process where no surface treatment is applied to the ETFE. The chemical treatment results in a higher tensile load at failure (tensile strength) of 276.6 N on average, the air ionization treatment has an average of 248.4 N, and the process with no treatment has the lower ultimate tensile strength average of 53 N. This comparison has demonstrated that the best treatment is the chemical treatment with sodium naphthenate under the conditions tested.

Nightguard vital bleaching: side effects and patient satisfaction 10 to 17 years post-treatment.

PubMed

Boushell, Lee W; Ritter, André V; Garland, Glenn E; Tiwana, Karen K; Smith, Lynn R; Broome, Angela; Leonard, Ralph H

2012-06-01

  The long-term patient satisfaction and safety of nightguard vital bleaching (NGVB) requires further evaluation.   The purpose of this study was to evaluate patients' satisfaction and identify side effects of NGVB up to 17 years post-treatment.   Thirty-one participants who had completed previous NGVB studies using 10% carbamide peroxide were contacted at least 10 years post-treatment (range 10-17 years, average 12.3 years). Participants reported shade satisfaction (very satisfied [VS], partially satisfied [PS], or not satisfied [NS]) as well as potential complications. Participants had teeth # 6 to 11 examined for tooth vitality, gingival inflammation (Löe's Gingival Index [GI]), and radiographically for external cervical resorption (ECR).   All of the participants had successful lightening of their teeth. Sixty-one percent (19) had not retreated their teeth. Of those who had not retreated their teeth and who responded to the question of whitening satisfaction, 31% (4/13) were VS, 54% (7/13) were PS, and 15% (2/13) were NS with their current shade. Of those who had retreated their teeth, all were VS or PS. Ninety-one percent of the examined teeth had GI = 0 (normal), 7% had GI = 1 (mild inflammation), and 2% had GI = 2 (moderate inflammation). Sixty-nine percent of teeth tested responded to a cold stimulus. Radiographs did not detect ECR or apical lesions. No participant reported having a gingival biopsy post-treatment, and 87% would whiten again.   Patient satisfaction with NGVB may last as long as 12.3 years in average (range 10-17 years) post-treatment. GI and ECR findings were considered within the normal expectations for the sample studied, suggesting minimal clinical post-NGVB side effects up to 17 years. Nightguard vital bleaching provides patient satisfaction with minimal side effects up to 17 years post-treatment. © 2011 Wiley Periodicals, Inc.

Analytical Computation of Effective Grid Parameters for the Finite-Difference Seismic Waveform Modeling With the PREM, IASP91, SP6, and AK135

NASA Astrophysics Data System (ADS)

Toyokuni, G.; Takenaka, H.

2007-12-01

We propose a method to obtain effective grid parameters for the finite-difference (FD) method with standard Earth models using analytical ways. In spite of the broad use of the heterogeneous FD formulation for seismic waveform modeling, accurate treatment of material discontinuities inside the grid cells has been a serious problem for many years. One possible way to solve this problem is to introduce effective grid elastic moduli and densities (effective parameters) calculated by the volume harmonic averaging of elastic moduli and volume arithmetic averaging of density in grid cells. This scheme enables us to put a material discontinuity into an arbitrary position in the spatial grids. Most of the methods used for synthetic seismogram calculation today receives the blessing of the standard Earth models, such as the PREM, IASP91, SP6, and AK135, represented as functions of normalized radius. For the FD computation of seismic waveform with such models, we first need accurate treatment of material discontinuities in radius. This study provides a numerical scheme for analytical calculations of the effective parameters for an arbitrary spatial grids in radial direction as to these major four standard Earth models making the best use of their functional features. This scheme can analytically obtain the integral volume averages through partial fraction decompositions (PFDs) and integral formulae. We have developed a FORTRAN subroutine to perform the computations, which is opened to utilization in a large variety of FD schemes ranging from 1-D to 3-D, with conventional- and staggered-grids. In the presentation, we show some numerical examples displaying the accuracy of the FD synthetics simulated with the analytical effective parameters.

40 CFR 63.7943 - How do I determine the average VOHAP concentration of my remediation material?

Code of Federal Regulations, 2012 CFR

2012-07-01

... knowledge as specified in paragraph (c) of this section. These methods may be used to determine the average... within, a remediation material management unit or treatment process; or (3) Remediation material that is... management unit or treatment process. (b) Direct measurement. To determine the average total VOHAP...

40 CFR 63.7943 - How do I determine the average VOHAP concentration of my remediation material?

Code of Federal Regulations, 2013 CFR

2013-07-01

... knowledge as specified in paragraph (c) of this section. These methods may be used to determine the average... within, a remediation material management unit or treatment process; or (3) Remediation material that is... management unit or treatment process. (b) Direct measurement. To determine the average total VOHAP...

"Threshold-crossing": A Useful Way to Establish the Counterfactual in Clinical Trials?

PubMed

Eichler, H-G; Bloechl-Daum, B; Bauer, P; Bretz, F; Brown, J; Hampson, L V; Honig, P; Krams, M; Leufkens, H; Lim, R; Lumpkin, M M; Murphy, M J; Pignatti, F; Posch, M; Schneeweiss, S; Trusheim, M; Koenig, F

2016-12-01

A central question in the assessment of benefit/harm of new treatments is: how does the average outcome on the new treatment (the factual) compare to the average outcome had patients received no treatment or a different treatment known to be effective (the counterfactual)? Randomized controlled trials (RCTs) are the standard for comparing the factual with the counterfactual. Recent developments necessitate and enable a new way of determining the counterfactual for some new medicines. For select situations, we propose a new framework for evidence generation, which we call "threshold-crossing." This framework leverages the wealth of information that is becoming available from completed RCTs and from real world data sources. Relying on formalized procedures, information gleaned from these data is used to estimate the counterfactual, enabling efficacy assessment of new drugs. We propose future (research) activities to enable "threshold-crossing" for carefully selected products and indications in which RCTs are not feasible. © 2016 The Authors Clinical Pharmacology & Therapeutics published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

The thermal fatigue resistance of H-13 Die Steel for aluminum die casting dies

NASA Technical Reports Server (NTRS)

1982-01-01

The effects of welding, five selected surface coatings, and stress relieving on the thermal fatigue resistance of H-13 Die Steel for aluminum die casting dies were studied using eleven thermal fatigue specimens. Stress relieving was conducted after each 5,000 cycle interval at 1050 F for three hours. Four thermal fatigue specimens were welded with H-13 or maraging steel welding rods at ambient and elevated temperatures and subsequently, subjected to different post-weld heat treatments. Crack patterns were examined at 5,000, 10,000, and 15,000 cycles. The thermal fatigue resistance is expressed by two crack parameters which are the average maximum crack and the average cracked area. The results indicate that a significant improvement in thermal fatigue resistance over the control was obtained from the stress-relieving treatment. Small improvements were obtained from the H-13 welded specimens and from a salt bath nitrogen and carbon-surface treatment. The other surface treatments and welded specimens either did not affect or had a detrimental influence on the thermal fatigue properties of the H-13 die steel.

The impact of system level factors on treatment timeliness: utilizing the Toyota Production System to implement direct intake scheduling in a semi-rural community mental health clinic.

PubMed

Weaver, Addie; Greeno, Catherine G; Goughler, Donald H; Yarzebinski, Kathleen; Zimmerman, Tina; Anderson, Carol

2013-07-01

This study examined the effect of using the Toyota Production System (TPS) to change intake procedures on treatment timeliness within a semi-rural community mental health clinic. One hundred randomly selected cases opened the year before the change and 100 randomly selected cases opened the year after the change were reviewed. An analysis of covariance demonstrated that changing intake procedures significantly decreased the number of days consumers waited for appointments (F(1,160) = 4.9; p = .03) from an average of 11 to 8 days. The pattern of difference on treatment timeliness was significantly different between adult and child programs (F(1,160) = 4.2; p = .04), with children waiting an average of 4 days longer than adults for appointments. Findings suggest that small system level changes may elicit important changes and that TPS offers a valuable model to improve processes within community mental health settings. Results also indicate that different factors drive adult and children's treatment timeliness.

[Treatment of acromion base fractures with double plates internal fixation].

PubMed

Lü, Guo-Qiang; Zhu, Jun-Kun; Lan, Shu-Hua; Wu, Quan-Zhou; Zheng, Rong-Zong; Zheng, Chong-Wu

2013-09-01

To study clinical effects of double plates fixation for the treatment of acromion base fracutres. From January 2010 to May 2012, 7 patients with acromion base fractures were treated with double plates ORIF surgical treatment. There were 5 males and 2 females, with an average age of 36.3 years old (ranged, 24 to 62 years old). All fractures were acuted and closed injuries. The duration from injury to surgery was 4.6 days (ranged, 2 to 10 days). Hardegger functional criterion, Visual Analogue Scale (VAS) and complications of the patients were documented analysis. All the patients were followed up,and the duration ranged from 4 to 13 months (averaged 8.9 months). The healing duration of fractures ranged from 8 to 14 weeks without any infection, shoulder instability, subacromial impingement syndrome, nonunion and failure of internal fixation. At the latest follow-up, the VAS ranged from 0 to 5. According to Hardegger criterion, 2 patients got an excellent result, 4 good and 1 poor. Double plates ORIF plays a positive role in the treatment of acromion base fractures, which reduces complications and maximally restore the function of shoulder.

The Impact of System Level Factors on Treatment Timeliness: Utilizing the Toyota Production System to Implement Direct Intake Scheduling in a Semi-Rural Community Mental Health Clinic

PubMed Central

Weaver, A.; Greeno, C.G.; Goughler, D.H.; Yarzebinski, K.; Zimmerman, T.; Anderson, C.

2013-01-01

This study examined the effect of using the Toyota Production System (TPS) to change intake procedures on treatment timeliness within a semi-rural community mental health clinic. One hundred randomly selected cases opened the year before the change and one hundred randomly selected cases opened the year after the change were reviewed. An analysis of covariance (ANCOVA) demonstrated that changing intake procedures significantly decreased the number of days consumers waited for appointments (F(1,160)=4.9; p=.03) from an average of 11 days to 8 days. The pattern of difference on treatment timeliness was significantly different between adult and child programs (F(1,160)=4.2; p=.04), with children waiting an average of 4 days longer than adults for appointments. Findings suggest that small system level changes may elicit important changes and that TPS offers a valuable model to improve processes within community mental health settings. Results also indicate that different factors drive adult and children’s treatment timeliness. PMID:23576137

[Case-control study on local injection of autoallergic platelet rich plasma or whole blood for the treatment of tennis elbow].

PubMed

Zhao, Li-Lai; Tong, Pei-Jian; Xiao, Lu-Wei; Zhu, Qiu-Liang; Xu, Bin; Yan, Mao-Hua

2014-11-01

To compare therapeutic effects of local injection with autoallergic platelet rich plasma (PRP) or autoallergic whole blood (AWB) for the treatment of chronic tennis elbow. From January 2011 to January 2014, 40 patients with chronic tennis elbow were divided into 2 groups, 20 cases in each group: PRP group and AWB group. There were 20 patients in PRP group treated with local injection of autoallergic platelet rich plasma, including 5 males and 15 females, with an average age of (47.50 ± 9.86) years old; and the average course of disease was (4.67 ± 3.27) months. Among the 20 patients in AWB group treated with local injection of autoallergic whole blood, 3 patients were male and 17 patients were female, with an average age of (46.50 ± 9.96) years old;and the average course of disease was (4.53 ± 2.27) months. The elbow joint was fixed with elastic stockings after injection. All the patients were guided to do strengthening and extension exercises during the follow-up period. Visual analog scale (VAS), Mayo scores for elbow and pressure pain threshold (PPT) were used to evaluate clinical effects after injection immediately and 4,8 weeks after treatment. Results:All the patients were followed up,there were no infections and swelling occurred. The VAS, Mayo and PPT scores of patients in PRP group were improved from pre-therapy 7.22 ± 1.32, 56.71 ± 10.90 and 17.47 ± 4.62 to 2.73 ± 1.00, 91.59 ± 6.95 and 21.35 ± 4.80 respectively 8 weeks after treatment. The VAS, Mayo and PPT scores of patients in AWB group were improved from pre-therapy 7.16 ±1.27, 54.72 ± 8.36 and 17.06 ± 4.83 to 3.81 ± 1.36, 82.06 ± 7.89 and 20.12 ± 4.97 respectively 8 weeks after treatment. All the pain and functional variables including VAS, PPT, and Mayo scores were improved significantly in both groups 4 weeks after injection. On the 4th week after injection, there was no statistically significant difference in PPT between two groups; while the VAS and Mayo score of AWB group were lower than those of PRP group. On the 8th week after injection, the VAS of AWB group was higher than that of PRP group; but the Mayo and PPT scores of AWB group were lower than those of PRP group. PRP and AWB injections are both effective to treat chronic lateral epicondylitis. Compared with AWB injection, PRP injection may be more effective in releasing pain and improving function for a longer time.

Conservative Treatment of Distal Radius Fractures: A Prospective Descriptive Study.

PubMed

Aparicio, Pilar; Izquierdo, Óscar; Castellanos, Juan

2017-06-01

Disability of the upper limb is one of the consequences of distal radius fracture (DRF). The outcome of DRF treatment is based on objective clinical variables, as strength or range of movement (ROM); sometimes these variables do not correlate with the functional level of the patient. The principal objective of our study was to assess the repercussion of conservative treatment of DRF on upper limb disability. This is a retrospective review of prospectively collected data. We collected data of 61 nonconsecutive DRFs treated conservatively from July 2007 to August 2008. Average Disabilities of the Arm, Shoulder and Hand (DASH) score before fracture was 20.8 points; average DASH score after the fracture was 42.6. There was a significant increase in the upper limb disability after 1 year of follow-up in the patients treated conservatively ( P < .001; size effect, 1.06). Average radial inclination, radial tilt, and radial length were 18.18°, 3.35°, and 5.76 mm, respectively. Average ROM for flexion-extension was 100.6° and for pronation-supination 144.0°. ROM for flexion-extension of the unaffected wrist was 128.2° and for pronation-supination 172.4°. We did not find any significant statistical correlation between the increase in disability and the decrease in the ROM ( P > .05). We did not find any significant statistical correlation between the increase in the disability and the worsening in the radiological parameters ( P > .05). Our results confirm the hypothesis that the conservative treatment of DRF produced an increase in the upper limb disability after 1 year of follow-up. Our study does not show a correlation between the increase in upper limb disability and the decrease in wrist ROM. Our study did not find a correlation between radiological measures and DASH scores.

Greater occipital nerve excision for occipital neuralgia refractory to nerve decompression.

PubMed

Ducic, Ivica; Felder, John M; Khan, Neelam; Youn, Sojin

2014-02-01

Patients who undergo occipital nerve decompression for treatment of migraine headaches due to occipital neuralgia have already exhausted medical options for treatment. When surgical decompression fails, it is unknown how best to help these patients. We examine our experience performing greater occipital nerve (GON) excision for pain relief in this select, refractory group of patients. A retrospective chart review supplemented by a follow-up survey was performed on all patients under the care of the senior author who had undergone GON excision after failing occipital nerve decompression. Headache severity was measured by the migraine headache index (MHI) and disability by the migraine disability assessment. Success rate was considered the percentage of patients who experienced a 50% or greater reduction in MHI at final follow-up. Seventy-one of 108 patients responded to the follow-up survey and were included in the study. Average follow-up was 33 months. The success rate of surgery was 70.4%; 41% of patients showed a 90% or greater decrease in MHI. The MHI changed, on average, from 146 to 49, for an average reduction of 63% (P < 0.001). Migraine disability assessment scores decreased by an average of 49% (P < 0.001). Multivariate analysis revealed that a diagnosis of cervicogenic headache was associated with failure of surgery. The most common adverse effect was bothersome numbness or hypersensitivity in the denervated area, occurring in up to 31% of patients. Excision of the GON is a valid option for pain relief in patients with occipital headaches refractory to both medical treatment and surgical decompression. Potential risks include failure in patients with cervicogenic headache and hypersensitivity of the denervated area. To provide the best outcome to these patients who have failed all previous medical and surgical treatments, a multidisciplinary team approach remains critical.

Class III correction using an inter-arch spring-loaded module

PubMed Central

2014-01-01

Background A retrospective study was conducted to determine the cephalometric changes in a group of Class III patients treated with the inter-arch spring-loaded module (CS2000®, Dynaflex, St. Ann, MO, USA). Methods Thirty Caucasian patients (15 males, 15 females) with an average pre-treatment age of 9.6 years were treated consecutively with this appliance and compared with a control group of subjects from the Bolton-Brush Study who were matched in age, gender, and craniofacial morphology to the treatment group. Lateral cephalograms were taken before treatment and after removal of the CS2000® appliance. The treatment effects of the CS2000® appliance were calculated by subtracting the changes due to growth (control group) from the treatment changes. Results All patients were improved to a Class I dental arch relationship with a positive overjet. Significant sagittal, vertical, and angular changes were found between the pre- and post-treatment radiographs. With an average treatment time of 1.3 years, the maxillary base moved forward by 0.8 mm, while the mandibular base moved backward by 2.8 mm together with improvements in the ANB and Wits measurements. The maxillary incisor moved forward by 1.3 mm and the mandibular incisor moved forward by 1.0 mm. The maxillary molar moved forward by 1.0 mm while the mandibular molar moved backward by 0.6 mm. The average overjet correction was 3.9 mm and 92% of the correction was due to skeletal contribution and 8% was due to dental contribution. The average molar correction was 5.2 mm and 69% of the correction was due to skeletal contribution and 31% was due to dental contribution. Conclusions Mild to moderate Class III malocclusion can be corrected using the inter-arch spring-loaded appliance with minimal patient compliance. The overjet correction was contributed by forward movement of the maxilla, backward and downward movement of the mandible, and proclination of the maxillary incisors. The molar relationship was corrected by mesialization of the maxillary molars, distalization of the mandibular molars together with a rotation of the occlusal plane. PMID:24934153

The upward spiral of drug costs: a time series analysis of drugs used in the treatment of hemophilia.

PubMed

Rogoff, Edward G; Guirguis, Hany S; Lipton, Richard A; Seremetis, Stephanie V; DiMichele, Donna M; Agnew, George M; Karpatkin, Margaret; Barish, Robert J; Jones, Robert L; Bianco, Celso; Knothe, Barbara D; Lee, Myung-Soo

2002-10-01

Hemophilia is an expensive disease because its treatment is heavily dependent on costly clotting factor drugs. Over the last nine years,a consortium of three Comprehensive Hemophilia Treatment Centers and other hospitals, which purchased clotting factors for their patients, has seen treatment costs escalate on average 17% annually. Currently, new, even more expensive drugs are entering the market. This study analyzes 3,244 purchases that were made over a nine-year period totaling nearly 500 million units of clotting factor, representing every product on the market. Purchases were made both apart from and under the Federal Public Health Service (PHS)discount pricing rules. The main cause of the increases was the move to newer, more expensive products. The average price of existing products increased less than 2%per year, but new products were priced, on average, 47% higher than existing products. Overall consumption increased by an average of 5% per year, likely reflecting prophylactic treatment modalities that require greater amounts of clotting factor. Government pricing programs, such as the PHS program, were ineffective or counterproductive at reducing costs. There is a notable absence of competition in this market, with a few dominant companies having a functional monopoly in the largest segments of the market. Prices of older products are not lowered, even when new products are brought to market. A few products that serve small patient groups have had their prices increased substantially. This escalation is likely to continue as new, more expensive clotting factor drugs are developed. Since these new products are not proven to be any safer or more effective than the current products, this situation creates a risk of intervention by government and insurers to address both treatment costs and exhaustion of patients' insurance caps. Drug companies are not serving the patients by pricing new, but often very similar, products so aggressively. The trends seen in this patient group will likely be seen in other patient groups in the future. Ultimately, doctors and patients will lose treatment options and health care availability unless collaborative strategies are developed to reduce costs.

Single-treatment porcine zona pellucida immunocontraception associated with reduction of a population of white-tailed deer (Odocoileus virginianus).

PubMed

Rutberg, Allen T; Naugle, Ricky E; Verret, Frank

2013-12-01

Previous reports have demonstrated gradual reductions of white-tailed deer (Odocoileus virginianus) populations through immunocontraception, with stabilization occurring after 2-4 yr of treatment, and subsequent reductions of 6-10% annually. These studies employed porcine zona pellucida (PZP) vaccines that required two initial treatments and annual retreatments. From 2005 to 2010, 258 adult and yearling female deer on Fripp Island, South Carolina, were treated with one of several PZP preparations designed to produce 2+ yr of effective contraception with a single treatment. These included several preparations of SpayVac and of native PZP-adjuvant emulsion plus PZP and QA-21 in timed-release pellets. Deer were chemically immobilized, ear-tagged, and administered initial treatments by hand in February-March. Some treated deer were boosted remotely with PZP-adjuvant emulsion 1.5 - 4.5 yr after initial treatments. Ground-based distance sampling was used to estimate deer population density at Fripp Island, a resort community, and at a relatively undeveloped neighboring control site, Hunting Island. Most vaccine preparations tested reduced fawning rates by 75% to 95% for at least 1 yr. From 2005 to 2011, deer density on Fripp Island declined by 50%, from 72 deer/km(2) to 36 deer/km(2), an average annual reduction of 11%. In contrast, population density on the Hunting Island control site fluctuated between 2005 and 2011, averaging 23 deer/km(2) (range, 19-28 deer/km(2)). Population declines on Fripp Island were associated with an increase in the proportion of treated females and with a progressive decrease in winter fawn:doe ratios, from 1.21 fawns/doe in 2005 to 0.19 fawns/doe in 2010. Winter fawn:doe ratios averaged 1.36 fawns/doe (range, 0.84 - 1.62 fawns/doe) at the Hunting Island control site. Annual survivorship averaged approximately 79% among ear-tagged females. The rate at which deer populations diminished in association with PZP treatments on Fripp Island was higher than that seen at other study sites, although the reasons for the more rapid decline on Fripp Island are not well understood.

Effects of citrus pulp, fish by-product and Bacillus subtilis fermentation biomass on growth performance, nutrient digestibility, and fecal microflora of weanling pigs.

PubMed

Noh, Hyun Suk; Ingale, Santosh Laxman; Lee, Su Hyup; Kim, Kwang Hyun; Kwon, Ill Kyong; Kim, Young Hwa; Chae, Byung Jo

2014-01-01

An experiment was conducted to investigate the effects of dietary supplementation with citrus pulp, fish by-product, and Bacillus subtilis fermentation biomass on the growth performance, apparent total tract digestibility (ATTD) of nutrients, and fecal microflora of weanling pigs. A total of 180 weaned piglets (Landrace × Yorkshire × Duroc) were randomly allotted to three treatments on the basis of body weight (BW). There were six replicate pens in each treatment with 10 piglets per pen. Dietary treatments were corn-soybean meal-based basal diet supplemented with 0 (control), 2.5, and 5.0% citrus pulp, fish by-product, and B. subtilis fermentation biomass. The isocaloric and isoproteineous experimental diets were fed in mash form in two phases (d 0 ~ 14, phase I and d 15 ~ 28, phase II). Dietary treatments had significant linear effects on gain to feed ratio (G:F) in all periods, whereas significant linear effects on ATTD of dry matter (DM), gross energy (GE), and ash were only observed in phase I. Piglets fed diet supplemented with 5.0% citrus pulp, fish by-product, and B. subtilis fermentation biomass showed greater (p < 0.05) G:F (phase I, phase II, and overall) as well as ATTD of DM, GE, and ash (phase I) than pigs fed control diet. Dietary treatments also had significant linear effects on total anaerobic bacteria populations by d 14 and 28. In addition, piglets fed diet supplemented with 5.0% citrus pulp, fish by-product and B. subtilis fermentation biomass showed greater (p < 0.05) fecal total anaerobic bacteria populations (d 14 and 28) than pigs fed control diet. Dietary treatments had no significant effects (linear or quadratic) on average daily gain (ADG), average dial feed intake (ADFI; phase I, phase II, and overall), or fecal populations of Bifidobacterium spp., Clostridium spp., and coliforms (d 14 and 28). These results indicate that dietary supplementation with 5.0% citrus pulp, fish by-product, and B. subtilis fermentation biomass has the potential to improve the feed efficiency, nutrient digestibility, and fecal microflora of weanling pigs.

Treatment of cervical spine fractures with halo vest method in children and young people.

PubMed

Tomaszewski, Ryszard; Pyzińska, Marta

2014-01-01

The Halo Vest method is a non-invasive treatment of cervical spine fractures. It is successfully applied in adults, which is supported by numerous studies, but has rarely been used among children and young people. There is little published research in this field. The aim of the paper is to present the effectiveness of Halo Vest external fixation in children and to evaluate the complication rate of this method. A retrospective study of 6 patients with cervical spine fractures with an average age of 13.3 years (range: 10 to 17 years) treated with Halo Vest external fixation between 2004 and 2013. The type and cause of fracture, treatment outcome and complications were evaluated. The average duration of follow-up was 55 months. In 5 cases, the treatment result was satisfactory. In one case, there were complications in the form of an external infection around the cranial pins. 1. The Halo Vest system can be applied as a non-operative method of treating cervical spine fractures in children and young people. 2. The criteria of eligibility for specific types of cervical spine fracture treatment in children and young people require further investigation, especially with regard to eliminating complications.

Feasibility of on-line temperature-based hyperthermia treatment planning to improve tumour temperatures during locoregional hyperthermia.

PubMed

Kok, H P; Korshuize-van Straten, L; Bakker, A; de Kroon-Oldenhof, R; Westerveld, G H; Versteijne, E; Stalpers, L J A; Crezee, J

2017-11-16

The effectiveness of hyperthermia is strongly dependent on the achieved tumour temperatures. Phased-array systems allow flexible power steering to realise good tumour heating while avoiding excessive heating in normal tissue, but the limited quantitative accuracy of pre-treatment planning complicates realising optimal tumour heating. On-line hyperthermia treatment planning could help to improve the heating quality. This paper demonstrates the feasibility of using on-line temperature-based treatment planning to improve the heating quality during hyperthermia in three patients. Hyperthermia treatment planning was performed using the Plan2Heat software package combined with a dedicated graphical user interface for on-line application. Electric fields were pre-calculated to allow instant update and visualisation of the predicted temperature distribution for user-selected phase-amplitude settings during treatment. On-line treatment planning using manual variation of system settings for the AMC-8 hyperthermia system was applied in one patient with a deep-seated pelvic melanoma metastasis and two cervical cancer patients. For a clinically relevant improvement the increase in average target temperature should be at least 0.2 °C. With the assistance of on-line treatment planning a substantial improvement in tumour temperatures was realised for all three patients. In the melanoma patient, the average measured target temperature increased from 38.30 °C to 39.15 °C (i.e. +0.85 °C). In the cervical cancer patients, the average measured target temperature increased from 41.30 °C to 42.05 °C (i.e. +0.75 °C) and from 41.70 °C to 42.80 °C (i.e. +1.1 °C), respectively. On-line temperature-based treatment planning is clinically feasible to improve tumour temperatures. A next, worthwhile step is automatic optimisation for a larger number of patients.

Combined modality treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer.

PubMed

Kohara, Hiroyuki; Miyauchi, Takako; Suehiro, Yoko; Ueoka, Hiroshi; Takeyama, Hiroyasu; Morita, Tatsuya

2004-12-01

Fatigue is one of the most distressful symptoms experienced by patients with advanced cancer. Aromatherapy, footsoak, and reflexology are popular health care modality treatments in Japan, however, the effectiveness of each treatment for cancer-related fatigue has not been fully established. To investigate the effectiveness of combined modality treatment consisting of aromatherapy, footsoak, and reflexology against fatigue, an open study was performed in 20 terminally ill patients with cancer. After a patch test was performed, patients received aromatherapy that was accompanied with footsoak in warm water containing lavender essential oil for 3 minutes, followed by reflexology treatment with jojoba oil containing lavender for 10 min. Fatigue was evaluated using the Cancer Fatigue Scale (CFS) before, 1 hour after, and 4 hours after treatment. Total CFS scores improved significantly after this treatment (from 25.6 +/- 11.0 to 18.1 +/- 10.0, p < 0.001). Among three CFS subscales, physical and cognitive subscale scores were reduced significantly (11.3 +/- 6.1 to 6.7 +/- 6.1, p < 0.001; 4.5 +/- 3.2 to 2.4 +/- 2.4, p < 0.001). No adverse effects were experienced. Because all patients desired to continue this treatment, they received treatment eight times on average. Combined modality treatment consisting of aromatherapy, footsoak, and reflexology appears to be effective for alleviating fatigue in terminally ill cancer patients. To confirm safety and effectiveness of this combined modality treatment, further investigation including randomized treatment assignment is warranted.

Effects of antenna placement and antibiotic treatment on loss of simulated transmitters and mortality in hybrid striped bass

USGS Publications Warehouse

Isely, J.J.; Young, S.P.; Jones, T.A.; Schaffler, James J.

2002-01-01

We compared the effects of two antenna placements (trailing and nontrailing) and antibiotic treatments (treated and nontreated) on mortality and transmitter loss in hybrid striped bass Morone saxatilis ?? M. chrysops (364 ?? 28 mm total length, 645 ?? 129 g [mean ?? SD]) implanted with simulated transmitters and held in the laboratory for 90 d. Although antibiotic treatment significantly increased the time to first mortality in fish surgically implanted with simulated transmitters (by an average of 14 d), we did not detect an effect on cumulative mortality. We also did not detect an effect of antenna type on the time to first mortality, but cumulative mortality was higher in the trailing antenna groups (50%) than in the nontrailing antenna groups (12%). Three transmitters were expelled during the study, all from trailing-antenna treatment groups, indicating a significant effect of antenna placement on the level of transmitter expulsion. Antibiotic treatment appears to be effective in preventing initial postsurgical infection; however, the antenna may serve as a continuous source of irritation and route of infection into the body cavity. The potential for infection and mortality in experimental animals must be weighed against the improved performance of transmitters with trailing antennas.

Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects.

PubMed

Oosterveld, Fredrikus G J; Rasker, Johannes J; Floors, Mark; Landkroon, Robert; van Rennes, Bob; Zwijnenberg, Jan; van de Laar, Mart A F J; Koel, Gerard J

2009-01-01

To study the effects of infrared (IR) Sauna, a form of total-body hyperthermia in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients were treated for a 4-week period with a series of eight IR treatments. Seventeen RA patients and 17 AS patients were studied. IR was well tolerated, and no adverse effects were reported, no exacerbation of disease. Pain and stiffness decreased clinically, and improvements were statistically significant (p < 0.05 and p < 0.001 in RA and AS patients, respectively) during an IR session. Fatigue also decreased. Both RA and AS patients felt comfortable on average during and especially after treatment. In the RA and AS patients, pain, stiffness, and fatigue also showed clinical improvements during the 4-week treatment period, but these did not reach statistical significance. No relevant changes in disease activity scores were found, indicating no exacerbation of disease activity. In conclusion, infrared treatment has statistically significant short-term beneficial effects and clinically relevant period effects during treatment in RA and AS patients without enhancing disease activity. IR has good tolerability and no adverse effects.

One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children.

PubMed

Hu, Xiongke; Zhang, Hongqi; Yin, Xinhua; Chen, Yong; Yu, Honggui; Zhou, Zhenhai

2016-03-01

The purpose of this study is to investigate the clinical efficacy and feasibility of one-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children. From December 2007 to May 2012, 13 patients (six males and seven females) suffering from lumbar spinal tuberculosis with kyphosis were admitted. All patients were treated with one-stage posterior focus debridement, fusion, and instrumentation. Then, the clinical efficacy was estimated by statistical analysis based on the data about Frankel grade, the Cobb angle of kyphosis, and erythrocyte sedimentation rate (ESR), which were collected at certain time. The age of all patients ranged from 5 to 13 years (average, 8.8 years). Operation time ranged from 120 to 190 min (average, 165 min). Intraoperative blood loss ranged from 200 to 800 ml (average, 460 ml). All patients were followed up for 24 to 57 months postoperatively (average, 33.5 months). The Cobb angle was changed significantly between preoperation and postoperation (P < 0.05), and there was no significant loss at the last follow-up. The preoperation ESR (62.5 ± 15.7) returned to normal (16.6 ± 8.1) within 3 months postoperatively in all patients (P < 0.05). Bone fusion was achieved within 3-5 months (average, 3.5 months). In the 13 cases, no postoperative severe complications occurred and neurologic function improved in various degrees. The outcomes of follow-up showed that one-stage posterior focus debridement, fusion, and instrumentation can be an effective treatment method for the lumbar spinal tuberculosis with kyphosis in children.

Electron momentum densities in disordered muffin-tin alloys

NASA Astrophysics Data System (ADS)

Bansil, A.; Rao, R. S.; Mijnarends, P. E.; Schwartz, L.

1981-04-01

The application of average t-matrix (ATA) and coherent potential (CPA) approximations to the calculation of average electron momentum density ρ(p-->) in random muffin-tin alloys AxB1-x is considered. The necessary equations for the general matrix elements of the operators describing scattering by the CPA atom and also by an A or B atom embedded in the effective medium are derived. Various versions of the ATA for ρ(p-->) are discussed. Several ρ(p-->) curves calculated on the basis of the CPA and ATA in CuxNi1-x are presented. These results are used to delineate the effects on ρ(p-->) of self-consistency in the treatment of disorder.

Field trial on the control effect of fipronil bait against German cockroaches

PubMed Central

Ree, Han-Il; Lee, In-Yong; Jeon, Soung-Hoo

2006-01-01

A field trial on the control effect of fipronil poison bait against German cockroaches (Blatella germanica) was carried out at different restaurant types in Sinchon, Seoul, Republic of Korea. Monitoring was performed applying food baited traps for 2 days per week. Reduction rates of German cockroaches by applying fipronil baits were 90.9% at Korean restaurants, 96.4% at Chinese restaurants, and 89.4% in beer hall kitchens after 4 weeks of the treatment. Overall average of the reduction rate was 93.9%. As the natural reduction rate at untreated restaurants was 11.5% after 4 weeks, a correction of the average reduction rate by applying the Abbot formula was 93.1%. PMID:16969066

Survey Results of Pain Treatments in Adults with Cerebral Palsy

PubMed Central

Hirsh, Adam T.; Kratz, Anna L.; Engel, Joyce M.; Jensen, Mark P.

2011-01-01

Objectives To identify the types and frequencies of pain treatments used by individuals with cerebral palsy (CP); examine the perceived effectiveness of these treatments; and identify the types of healthcare providers that were accessed for pain-related services. Design A cross-sectional survey design was employed. 83 adults (mean age=40.3 years, SD=13.6) with CP indicated their pain location and intensity during the past 3 months. Next, they indicated their use of 24 different pain treatments and the effectiveness of each. Finally, participants indicated the frequency of pain-related healthcare visits to specific providers over the past 6 months. Results 63% of participants reported experiencing chronic pain and rated their pain intensity over the past week as 5.1/10, on average. The most common pain locations were the lower back, hips, and legs. Physical interventions (e.g., physical therapy, strengthening) were the most common pain treatments reportedly used, and were rated as moderately effective. Many other treatments were also used, and participants sought pain-related care from a variety of providers. Conclusions Although participants reportedly accessed pain care from a variety of providers, and perceived that several types of treatments were effective, many of the treatments rated as effective were rarely used or provided. Future research using clinical trial methods would further elucidate the specific pain treatments that are most beneficial for adults with CP. PMID:21273894

Survey results of pain treatments in adults with cerebral palsy.

PubMed

Hirsh, Adam T; Kratz, Anna L; Engel, Joyce M; Jensen, Mark P

2011-03-01

The aims of this study were to identify the types and frequencies of pain treatments used by individuals with cerebral palsy, examine the perceived effectiveness of these treatments, and identify the types of healthcare providers that were accessed for pain-related services. A cross-sectional survey design was used. A total of 83 adults (mean [SD] age, 40.3 [13.6] yrs) with cerebral palsy indicated their pain location and intensity during the past 3 mos. Next, they indicated their use of 24 different pain treatments and the effectiveness of each. Finally, participants indicated the frequency of pain-related healthcare visits to specific providers over the past 6 mos. Of the participants, 63% reported experiencing chronic pain and rated their pain intensity over the past week as 5.1 of 10, on average. The most common pain locations were the lower back, hips, and legs. Physical interventions (e.g., physical therapy, strengthening) were the most common pain treatments reportedly used and were rated as moderately effective. Many other treatments were also used, and participants sought pain-related care from a variety of providers. Although participants reportedly accessed pain care from a variety of providers and perceived that several types of treatments were effective, many of the treatments rated as effective were rarely used or provided. Future research using clinical trial methods would further elucidate the specific pain treatments that are most beneficial for adults with cerebral palsy.

The effect of simultaneous negative and positive defocus on eye growth and development of refractive state in marmosets.

PubMed

Benavente-Perez, Alexandra; Nour, Ann; Troilo, David

2012-09-21

We evaluated the effect of imposing negative and positive defocus simultaneously on the eye growth and refractive state of the common marmoset, a New World primate that compensates for either negative and positive defocus when they are imposed individually. Ten marmosets were reared with multizone contact lenses of alternating powers (-5 diopters [D]/+5 D), 50:50 ratio for average pupil of 2.80 mm over the right eye (experimental) and plano over the fellow eye (control) from 10 to 12 weeks. The effects on refraction (mean spherical equivalent [MSE]) and vitreous chamber depth (VC) were measured and compared to untreated, and -5 D and +5 D single vision contact lens-reared marmosets. Over the course of the treatment, pupil diameters ranged from 2.26 to 2.76 mm, leading to 1.5 times greater exposure to negative than positive power zones. Despite this, at different intervals during treatment, treated eyes were on average relatively more hyperopic and smaller than controls (experimental-control [exp-con] mean MSE ± SE +1.44 ± 0.45 D, mean VC ± SE -0.05 ± 0.02 mm) and the effects were similar to those in marmosets raised on +5 D single vision contact lenses (exp-con mean MSE ± SE +1.62 ± 0.44 D. mean VC ± SE -0.06 ± 0.03 mm). Six weeks into treatment, the interocular growth rates in multizone animals were already lower than in -5 D-treated animals (multizone -1.0 ± 0.1 μm/day, -5 D +2.1 ± 0.9 μm/day) and did not change significantly throughout treatment. Imposing hyperopic and myopic defocus simultaneously using concentric contact lenses resulted in relatively smaller and less myopic eyes, despite treated eyes being exposed to a greater percentage of negative defocus. Exposing the retina to combined dioptric powers with multifocal lenses that include positive defocus might be an effective treatment to control myopia development or progression.

Cumulative receipt of an anti-poverty tax credit for families did not impact tobacco smoking among parents.

PubMed

Pega, Frank; Gilsanz, Paola; Kawachi, Ichiro; Wilson, Nick; Blakely, Tony

2017-04-01

The effect of anti-poverty tax credit interventions on tobacco consumption is unclear. Previous studies have estimated short-term effects, did not isolate the effects of cumulative dose of tax credits, produced conflicting results, and used methods with limited control for some time-varying confounders (e.g., those affected by prior treatment) and treatment regimen (i.e., study participants' tax credit receipt pattern over time). We estimated the longer-term, cumulative effect of New Zealand's Family Tax Credit (FTC) on tobacco consumption, using a natural experiment (administrative errors leading to exogenous variation in FTC receipt) and methods specifically for controlling confounding, reverse causation, and treatment regimen. We extracted seven waves (2002-2009) of the nationally representative Survey of Family, Income and Employment including 4404 working-age (18-65 years) parents in families. The exposure was the total numbers of years of receiving FTC. The outcomes were regular smoking and the average daily number of cigarettes usually smoked at wave 7. We estimated average treatment effects using inverse probability of treatment weighting and marginal structural modelling. Each additional year of receiving FTC affected neither the odds of regular tobacco smoking among all parents (odds ratio 1.02, 95% confidence interval 0.94-1.11), nor the number of cigarettes smoked among parents who smoked regularly (rate ratio 1.01, 95% confidence interval 0.99-1.03). We found no evidence for an association between the cumulative number of years of receiving an anti-poverty tax credit and tobacco smoking or consumption among parents. The assumptions of marginal structural modelling are quite demanding, and we therefore cannot rule out residual confounding. Nonetheless, our results suggest that tax credit programme participation will not increase tobacco consumption among poor parents, at least in this high-income country. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Primacy of Cognition in Schizophrenia

ERIC Educational Resources Information Center

Heinrichs, R. Walter

2005-01-01

Cognitive tasks and concepts are used increasingly in schizophrenia science and treatment. Recent meta-analyses show that across a spectrum of research domains only cognitive measures distinguish a majority of schizophrenia patients from healthy people. Average effect sizes derived from common clinical tests of attention, memory, language, and…

The impact of prison-based treatment on sex offender recidivism: evidence from Minnesota.

PubMed

Duwe, Grant; Goldman, Robin A

2009-09-01

Using a retrospective quasi-experimental design, this study evaluates the effectiveness of prison-based treatment by examining recidivism outcomes among 2,040 sex offenders released from Minnesota prisons between 1990 and 2003 (average follow-up period of 9.3 years). To reduce observed selection bias, the authors used propensity score matching to create a comparison group of 1,020 untreated sex offenders who were not significantly different from the 1,020 treated offenders. In addition, intent-to-treat analyses and the Rosenbaum bounds method were used to test the sensitivity of the findings to treatment refuser and unobserved selection bias. Results from the Cox regression analyses revealed that participating in treatment significantly reduced the hazard ratio for rearrest by 27% for sexual recidivism, 18% for violent recidivism, and 12% for general recidivism. These findings are consistent with the growing body of research supporting the effectiveness of cognitive-behavioral treatment for sex offenders.

HiFiVS Modeling of Flow Diverter Deployment Enables Hemodynamic Characterization of Complex Intracranial Aneurysm Cases

PubMed Central

Xiang, Jianping; Damiano, Robert J.; Lin, Ning; Snyder, Kenneth V.; Siddiqui, Adnan H.; Levy, Elad I.; Meng, Hui

2016-01-01

Object Flow diversion via Pipeline Embolization Device (PED) represents the most recent advancement in endovascular therapy of intracranial aneurysms. This exploratory study aims at a proof of concept for an advanced device-modeling tool in conjunction with computational fluid dynamics (CFD) to evaluate flow modification effects by PED in real treatment cases. Methods We performed computational modeling of three PED-treated complex aneurysm cases. Case I had a fusiform vertebral aneurysm treated with a single PED. Case II had a giant internal carotid artery (ICA) aneurysm treated with 2 PEDs. Case III consisted of two tandem ICA aneurysms (a and b) treated by a single PED. Our recently developed high fidelity virtual stenting (HiFiVS) technique was used to recapitulate the clinical deployment process of PEDs in silico for these three cases. Pre- and post-treatment aneurysmal hemodynamics using CFD simulation was analyzed. Changes in aneurysmal flow velocity, inflow rate, and wall shear stress (WSS) (quantifying flow reduction) and turnover time (quantifying stasis) were calculated and compared with clinical outcome. Results In Case I (occluded within the first 3 months), the aneurysm experienced the most drastic aneurysmal flow reduction after PED placement, where the aneurysmal average velocity, inflow rate and average WSS was decreased by 76.3%, 82.5% and 74.0%, respectively, while the turnover time was increased to 572.1% of its pre-treatment value. In Case II (occluded at 6 months), aneurysmal average velocity, inflow rate and average WSS were decreased by 39.4%, 38.6%, and 59.1%, respectively, and turnover time increased to 163.0%. In Case III, Aneurysm III-a (occluded at 6 months) experienced decrease by 38.0%, 28.4%, and 50.9% in aneurysmal average velocity, inflow rate and average WSS, respectively and increase to 139.6% in turnover time, which was quite similar to Aneurysm II. Surprisingly, the adjacent Aneurysm III-b experienced more substantial flow reduction (decrease by 77.7%, 53.0%, and 84.4% in average velocity, inflow rate and average WSS, respectively, and increase to 213.0% in turnover time) than Aneurysm III-a, which qualitatively agreed with angiographic observation at 3-month follow-up. However, Aneurysm III-b remained patent at both 6 months and 9 months. A closer examination of the vascular anatomy of Case III revealed blood draining to the ophthalmic artery off Aneurysm III-b, which may have prevented its complete thrombosis. Conclusion This proof-of-concept study demonstrates that HiFiVE modeling of flow diverter deployment enables detailed characterization of hemodynamic alteration by PED placement. Post-treatment aneurysmal flow reduction may be correlated with aneurysm occlusion outcome. However, predicting aneurysm treatment outcome by flow diverters also requires consideration of other factors including vascular anatomy. PMID:26090829

Meta-Analyses of Seven of NIDA’s Principles of Drug Addiction Treatment

PubMed Central

Pearson, Frank S.; Prendergast, Michael L.; Podus, Deborah; Vazan, Peter; Greenwell, Lisa; Hamilton, Zachary

2011-01-01

Seven of the 13 Principles of Drug Addiction Treatment disseminated by the National Institute on Drug Abuse (NIDA) were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in EPT, we found that five of the NIDA principles examined are supported: matching treatment to the client’s needs; attending to the multiple needs of clients; behavioral counseling interventions; treatment plan reassessment; and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period of time and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or of unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders. PMID:22119178

Meta-analyses of seven of the National Institute on Drug Abuse's principles of drug addiction treatment.

PubMed

Pearson, Frank S; Prendergast, Michael L; Podus, Deborah; Vazan, Peter; Greenwell, Lisa; Hamilton, Zachary

2012-07-01

Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the client's needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders. Copyright © 2012 Elsevier Inc. All rights reserved.

The effect of stimulant and sedative use on treatment outcome of patients admitted to methadone maintenance treatment.

PubMed

DeMaria, P A; Sterling, R; Weinstein, S P

2000-01-01

While methadone maintenance treatment (MMT) has been demonstrated to be an effective treatment for opiate dependence, its impact on the treatment outcome of other illicit drug abuse is not as clear. Using the initial urine drug screen (UDS) and follow-up UDS at 1, 6, 12, and 24 months, 167 patients consecutively admitted to MMT were evaluated for opiate, sedative (predominantly benzodiazepine), and stimulant (predominantly cocaine) use. Retention for the opiate only group was 97.32 days longer on average than for patients using opiates along with stimulants, sedatives, or both stimulants and sedatives. Patients abusing opiates only had the greatest decrease in drug use; however, MMT was also associated with decreases in cocaine and sedative use over the 24 month follow-up period. There was no evidence that patients "switched" their drugs of abuse with time in treatment. The negative impact of non-opiate drug use on outcome in MMT and its implications for treatment planning are discussed.

Technique optimization of orbital atherectomy in calcified peripheral lesions of the lower extremities: the CONFIRM series, a prospective multicenter registry.

PubMed

Das, Tony; Mustapha, Jihad; Indes, Jeffrey; Vorhies, Robert; Beasley, Robert; Doshi, Nilesh; Adams, George L

2014-01-01

The purpose of CONFIRM registry series was to evaluate the use of orbital atherectomy (OA) in peripheral lesions of the lower extremities, as well as optimize the technique of OA. Methods of treating calcified arteries (historically a strong predictor of treatment failure) have improved significantly over the past decade and now include minimally invasive endovascular treatments, such as OA with unique versatility in modifying calcific lesions above and below-the-knee. Patients (3135) undergoing OA by more than 350 physicians at over 200 US institutions were enrolled on an "all-comers" basis, resulting in registries that provided site-reported patient demographics, ABI, Rutherford classification, co-morbidities, lesion characteristics, plaque morphology, device usage parameters, and procedural outcomes. Treatment with OA reduced pre-procedural stenosis from an average of 88-35%. Final residual stenosis after adjunctive treatments, typically low-pressure percutaneous transluminal angioplasty (PTA), averaged 10%. Plaque removal was most effective for severely calcified lesions and least effective for soft plaque. Shorter spin times and smaller crown sizes significantly lowered procedural complications which included slow flow (4.4%), embolism (2.2%), and spasm (6.3%), emphasizing the importance of treatment regimens that focus on plaque modification over maximizing luminal gain. The OA technique optimization, which resulted in a change of device usage across the CONFIRM registry series, corresponded to a lower incidence of adverse events irrespective of calcium burden or co-morbidities. Copyright © 2013 The Authors. Wiley Periodicals, Inc.

Oral Hypertonic Saline Is Effective in Reversing Acute Mild-to-Moderate Symptomatic Exercise -Associated Hyponatremia.

PubMed

Bridges, Eileen; Altherwi, Tawfeeq; Correa, José A; Hew-Butler, Tamara

2018-01-23

To determine whether oral administration of 3% hypertonic saline (HTS) is as efficacious as intravenous (IV) 3% saline in reversing symptoms of mild-to-moderate symptomatic exercise-associated hyponatremia (EAH) in athletes during and after a long-distance triathlon. Noninferiority, open-label, parallel-group, randomized control trial to IV or oral HTS. We used permuted block randomization with sealed envelopes, containing the word either "oral" or "IV." Annual long-distance triathlon (3.8-km swim, 180-km bike, and 42-km run) at Mont-Tremblant, Quebec, Canada. Twenty race finishers with mild to moderately symptomatic EAH. Age, sex, race finish time, and 9 clinical symptoms. Time from treatment to discharge. We successfully randomized 20 participants to receive either an oral (n = 11) or IV (n = 9) bolus of HTS. We performed venipuncture to measure serum sodium (Na) at presentation to the medical clinic and at time of symptom resolution after the intervention. The average time from treatment to discharge was 75.8 minutes (SD 29.7) for the IV treatment group and 50.3 minutes (SD 26.8) for the oral treatment group (t test, P = 0.02). Serum Na before and after treatment was not significantly different in both groups. There was no difference on presentation between groups in age, sex, or race finish time, both groups presented with an average of 6 symptoms. Oral HTS is effective in reversing symptoms of mild-to-moderate hyponatremia in EAH.

Effectiveness of bridge V.A.C. dressings in the treatment of diabetic foot ulcers

PubMed Central

Nather, Aziz; Hong, Ng Yau; Lin, Wong Keng; Sakharam, Joshi Abhijit

2011-01-01

Objectives This is a prospective study of the clinical efficacy of the V.A.C. Granufoam Bridge Dressing for the treatment of diabetic foot ulcers. Materials and methods Five consecutive patients with diabetic foot ulcers were treated with V.A.C. Granufoam Bridge Dressings and studied over a period of 22–48 days. The indications for treatment included diabetic patients with open ray amputation wounds and wounds post-drainage for abscess with exposed deep structures. Clinical outcome was measured in terms of reduction in wound dimensions, presence of wound granulation, microbial clearance, and development of wound complications. Results Our results showed that with V.A.C. therapy, wound healing occurred in all patients. The number of dressings required ranged from 8 to 10. The baseline average wound size was 23.1 cm2. Wound areas shrunk by 18.4–41.7%. All subjects achieved 100% wound bed granulation with an average length of treatment of 33 days. Microbial clearance was achieved in all cases. All wounds healed by secondary intention in one case and four cases required split-thickness skin grafting. Conclusion The V.A.C. Granufoam Bridge Dressing is effective in the treatment of diabetic foot ulcers. It promotes reduction of wound area, wound bed granulation, and microbial clearance. By allowing placement of the suction pad outside the foot, it allowed patients to wear protective shoes and to walk non-weight bearing with crutches during V.A.C. therapy. PMID:22396825

Cost effectiveness of tibial nonunion treatment: A comparison between rhBMP-7 and autologous bone graft in two Italian centres.

PubMed

Giorgio Calori, Maria; Capanna, Rodolfo; Colombo, Massimiliano; De Biase, Pietro; O'Sullivan, Carol; Cartareggia, Valentina; Conti, Costanza

2013-12-01

Current evidences show that recombinant human bone morphogenetic protein 7 (rhBMP-7, eptotermin alfa) can be considered an effective alternative to autologous bone graft (ABG) in the treatment of tibial nonunions. Few studies, so far, have analysed the costs of treating tibial nonunions with either rhBMP-7 or ABG and none of them has specifically considered the Italian situation. The aim of the present study was to capture, through observational retrospective methods, the direct medical costs associated with the treatment of tibial nonunions with rhBMP-7 or ABG in Italy and to compare the cost effectiveness of the two interventions. The secondary objective was to perform a cost-reimbursement analysis for hospitalisations associated with the two treatments. Data of 54 patients with indication for tibial nonunion were collected from existing data sources. Of these patients, 26 were treated with ABG and 28 with rhBMP-7. The study captured the direct medical costs for treating each tibial nonunion, considering both inpatient and outpatient care. The hospital reimbursement was calculated from discharge registries, based on diagnosis-related group (DRG) values. A subgroup of patients (n=30) was also interviewed to capture perceived health during the follow-up, and the quality-adjusted life years (QALYs) were subsequently computed. The two groups were similar for what concerns baseline characteristics. While the medical costs incurred during the hospitalisation associated with treatment were on average €3091.21 higher (P<0.001) in patients treated with rhBMP-7 (reflecting the product procurement costs), the costs incurred during the follow-up were on average €2344.45 higher (P=0.02) in patients treated with ABG. Considering all costs incurred from the treatment, there was a borderline statistical evidence (P=0.04) for a mean increase of €795.42, in the rhBMP-7 group. Furthermore, the study demonstrated that, without appropriate reimbursement, the hospital undergoes significant losses (P=0.003) when using rhBMP-7 instead of ABG. In contrast to these losses, in Italy, the average cost to achieve a successful outcome was €488.96 lower in patients treated with rhBMP-7 and, additionally, the cost per QALY gained was below the cost-utility threshold of $50,000. Copyright © 2013 Elsevier Ltd. All rights reserved.

Prevalence of Adverse Effects Post-Brachytherapy on Women with Uterine Cervix Cancer in Durango, Mexico

NASA Astrophysics Data System (ADS)

Herrera, Higmar; Yañez, Elvia; Deras, Diana C.; Reyes, Francianella

2010-12-01

This work aimed at determining the local prevalence of adverse effects on women with CaCu that recieved LDR brachytherapy treatment at CECAN. The data was extracted from the patient's and medical physics' departement records. Non Gaussian statistics was used due to dose distribution characteristics. A total of 103 patients were studied with average age of 55±13 years and Ia-IV FIGO clinical clasification. The observed prevalence is higher than that reported by other studies. It was observed that patients with proctitis were prescribed a slightly higher dose than those without adverse effects (90% confidence). Patients with proctitis also presented higher age (95% confidence) when compared with the mean of the studied population. The inverse applies to the group with other adverse effects, its average age is lower than the mean (90% confidence).

Dietary counselling and nutritional support in oropharyngeal cancer patients treated with radiotherapy: persistent weight loss during 1-year follow-ups.

PubMed

Vlooswijk, C P; van Rooij, P H E; Kruize, J C; Schuring, H A; Al-Mamgani, A; de Roos, N M

2016-01-01

The need for dietary counselling and nutritional support in oropharyngeal cancer patients is generally accepted. However, evidence for the effectiveness is sparse. The aim of this study was to describe dietary counselling, nutritional support, body weight and toxicity during and after treatment, and investigate the effect of pre-treatment body mass index (BMI) on survival in oropharyngeal cancer patients. A retrospective chart review was made in 276 oropharyngeal cancer patients treated with radiotherapy (RT). End points were dietary consultations, weight loss, toxicity, overall survival and disease-free survival. Almost all oropharyngeal cancer patients received dietary counselling (94%) and nutritional support (99%). Dietary counselling decreased sharply shortly after treatment to 38% at 1 year after treatment. Overall weight loss increased during the first year of follow-up and ranged from 3% at start of RT, until 11% at 1 year after RT. Overall survival was significantly longer for patients with a BMI above average (P=0.01). Acute dysphagia (P=0.001), mucositis (P=0.000) and toxicity grade 3 (P=0.002) were significantly more prevalent in patients who had lost 10% or more of their body weight. This study showed that patients continue to lose body weight during and until 1 year after treatment, despite nutrition support and frequent dietetic consultation. A BMI above average appears to increase survival time. Future studies, preferably randomized trials, are needed to compare standard dietary counselling with more intensive dietary counselling that consists of earlier and/or prolonged treatment.

Laser therapy and sclerotherapy in the treatment of oral and maxillofacial hemangioma and vascular malformations

NASA Astrophysics Data System (ADS)

Crişan, Bogdan; BǎciuÅ£, Mihaela; BǎciuÅ£, Grigore; Crişan, Liana; Bran, Simion; Rotar, Horatiu; Moldovan, Iuliu; Vǎcǎraş, Sergiu; Mitre, Ileana; Barbur, Ioan; Magdaş, Andreea; Dinu, Cristian

2016-03-01

Hemangioma and vascular malformations in the field of oral and maxillofacial surgery is a pathology more often found in recent years in patients. The aim of this study was to evaluate the efficacy of the laser photocoagulation performed with a diode laser (Ga-Al-As) 980 nm wavelength in the treatment of vascular lesions which are located on the oral and maxillofacial areas, using color Doppler ultrasonography for evaluation of the results. We also made a comparison between laser therapy and sclerotherapy in order to establish treatment protocols and recommendations associated with this pathology. We conducted a controlled study on a group of 92 patients (38 male and 54 female patients, with an average age of 36 years) having low flow hemangioma and vascular malformations. Patients in this trial received one of the methods of treatment for vascular lesions such as hemangioma and vascular malformations: laser therapy or sclerotherapy. After laser therapy we have achieved a reduction in size of hemangioma and vascular malformations treated with such a procedure, and the aesthetic results were favorable. No reperfusion or recanalization of laser treated vascular lesions was observed after an average follow-up of 6 to 12 months. In case of sclerotherapy a reduction in the size of vascular lesions was also obtained. The 980 nm diode laser has been proved to be an effective tool in the treatment of hemangioma and vascular malformations in oral and maxillofacial area. Laser therapy in the treatment of vascular lesions was more effective than the sclerotherapy procedure.

Novel Multivalent Wound-Healing Ointment Provides Bioburden Control and Moisture Management: A Retrospective Registry Data Analysis.

PubMed

Serena, Thomas; Connell, Heather; McConnell, Sharon; Patel, Keyur; Doner, Bryan; Sabo, Matthew; Miller, Michael; Serena, Laura; Le, Lam T; Goldsmith, David; Chung, Jane

2016-10-01

The purpose of this retrospective registry data analysis was to explore the effectiveness of a novel multivalent topical ointment (Terrasil Infection Control Wound Care Ointment; Aspiera Medical, Woonsocket, Rhode Island), containing a patented mineral complex and 0.2% benzethonium chloride in the treatment of nonhealing acute and chronic wounds. Aspiera Medical designed a registry to capture physician experiences and treatment results with Terrasil Infection Control Wound Care Ointment. Physicians were asked to enter deidentified patient data into an online registry. Wound clinics in the United States were asked to participate in the registry. Physicians at 4 wound clinics treated 30 patients (26 of whom completed the treatment) with various chronic wounds that had persisted for an average of 6 months and entered treatment data into the registry. Patients applied the ointment according to physician orders. Concurrent treatments used by patients included offloading, compression wraps, and dressings, such as collagen and calcium alginate. Patients were treated until complete wound closure or lost to follow-up. Physicians calculated each patient's percentage wound reduction at each visit. Thirty patients were entered into the registry. Pretreatment and posttreatment measurements were available for 26 of them. Patients achieved an average surface area reduction of 84% in a mean of 23 days' treatment. The antimicrobial and moisturizing ointment studied appears to be effective in promoting wound closure in a variety of acute and chronic wounds. Wounds studied included diabetic foot ulcers, venous leg ulcers, venous stasis ulcers, surgical infections, burns, and insect bites. The results of this registry data analysis will be used to inform planned clinical trials.

Long-term contraception in a small implant: A review of Suprelorin (deslorelin) studies in cats.

PubMed

Fontaine, Christelle

2015-09-01

Deslorelin (Suprelorin®; Virbac) is a gonadotropin-releasing hormone (GnRH) agonist licensed in select countries for the long-term suppression of fertility in adult male dogs and male ferrets. This article summarizes studies investigating the use of deslorelin implants for the long-term suppression of fertility in male and female domestic cats. Slow-release deslorelin implants have been shown to generate effective, safe and reversible long-term contraception in male and female cats. In pubertal cats, a 4.7 mg deslorelin implant suppressed steroid sex hormones for an average of approximately 20 months (range 15-25 months) in males and an average of approximately 24 months (range 16-37 months) in females. Reversibility has been demonstrated by fertile matings approximately 2 years post-treatment in both male and female adult cats. In prepubertal female cats of approximately 4 months of age, puberty was postponed to an average of approximately 10 months of age (range 6-15 months) by a 4.7 mg deslorelin implant. The large variability in the duration of suppression of gonadal activity makes the definition of the optimal time for reimplantation quite challenging. In addition, the temporary stimulation phase occurring in the weeks following deslorelin implantation can induce in adult female cats a fertile estrus that needs to be managed to avoid unwanted pregnancy. Longer duration and larger scale controlled field studies implementing blinding, a negative control group and a carefully controlled randomization to each group are needed. Furthermore, the effects of repeated treatment need to be investigated. Finally, the effect of treatment on growth and bone quality of prepubertal cats needs to be assessed. However, the ease of use, long-lasting effects and reversibility of deslorelin implants are strong positive points supporting their use for controlling feline reproduction. © The Author(s) 2015.

Bioactive treatment promotes osteoblast differentiation on titanium materials fabricated by selective laser melting technology.

PubMed

Tsukanaka, Masako; Fujibayashi, Shunsuke; Takemoto, Mitsuru; Matsushita, Tomiharu; Kokubo, Tadashi; Nakamura, Takashi; Sasaki, Kiyoyuki; Matsuda, Shuichi

2016-01-01

Selective laser melting (SLM) technology is useful for the fabrication of porous titanium implants with complex shapes and structures. The materials fabricated by SLM characteristically have a very rough surface (average surface roughness, Ra=24.58 µm). In this study, we evaluated morphologically and biochemically the specific effects of this very rough surface and the additional effects of a bioactive treatment on osteoblast proliferation and differentiation. Flat-rolled titanium materials (Ra=1.02 µm) were used as the controls. On the treated materials fabricated by SLM, we observed enhanced osteoblast differentiation compared with the flat-rolled materials and the untreated materials fabricated by SLM. No significant differences were observed between the flat-rolled materials and the untreated materials fabricated by SLM in their effects on osteoblast differentiation. We concluded that the very rough surface fabricated by SLM had to undergo a bioactive treatment to obtain a positive effect on osteoblast differentiation.

Meta-analysis of the influence of Saccharomyces cerevisiae supplementation on ruminal parameters and milk production of ruminants.

PubMed

Desnoyers, M; Giger-Reverdin, S; Bertin, G; Duvaux-Ponter, C; Sauvant, D

2009-04-01

The effects of yeast supplementation on intake, production, and rumen fermentation characteristics have been widely studied, but results are inconsistent between different studies. A quantitative meta-analysis was applied to 110 papers, 157 experiments, and 376 treatments dealing with yeast supplementation in ruminants. The objective was first to highlight the major quantitative effects of live yeast supplementation on intake, rumen fermentation, and milk production, and second, to identify major differences in experimental conditions between studies that can affect the response to treatment. Some of these experimental conditions are referred to as interfering factors. Yeast supplementation increased rumen pH (+0.03 on average) and rumen volatile fatty acid concentration (+2.17 mM on average), tended to decrease rumen lactic acid concentration (-0.9 mM on average), and had no influence on acetate-to-propionate ratio. Total-tract organic matter digestibility was also increased by yeast supplementation (+0.8% on average). Yeast supplementation increased dry matter intake (DMI; +0.44 g/kg of body weight; BW), milk yield (+1.2 g/kg of BW), and tended to increase milk fat content (+0.05%), but had no influence on milk protein content. Dose effects of yeast supplementation, expressed as log(10) [1+(cfu per 100 kg of BW)], globally confirmed the qualitative effects observed in the first analysis. The positive effect of yeast supplementation on rumen pH increased with the percentage of concentrate in the diet and with the DMI level. It was negatively correlated with the level of dietary neutral detergent fiber (NDF). The positive effect of yeast supplementation on rumen volatile fatty acid concentration increased with DMI and crude protein levels. The positive effect of yeast supplementation on organic matter digestibility increased with the percentage of concentrate and NDF in the diet. The negative effect of yeast supplementation on lactic acid concentration tended to decrease when the DMI level and the percentage of concentrate in the diet increased. The effects of interfering factors were globally similar when either dose effect or qualitative effect of yeast was taken into account. Although rumen fermentation efficiency per se was not measured, these results suggest an improvement in rumen fermentation by yeast supplementation. This effect could, however, be modulated by several different factors such as DMI, percentage of concentrate or NDF in the diet, or species.

Effect of lung and target density on small-field dose coverage and PTV definition

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

Higgins, Patrick D., E-mail: higgi010@umn.edu; Ehler, Eric D.; Cho, Lawrence C.

We have studied the effect of target and lung density on block margin for small stereotactic body radiotherapy (SBRT) targets. A phantom (50 × 50 × 50 cm{sup 3}) was created in the Pinnacle (V9.2) planning system with a 23-cm diameter lung region of interest insert. Diameter targets of 1.6, 2.0, 3.0, and 4.0 cm were placed in the lung region of interest and centered at a physical depth of 15 cm. Target densities evaluated were 0.1 to 1.0 g/cm{sup 3}, whereas the surrounding lung density was varied between 0.05 and 0.6 g/cm{sup 3}. A dose of 100 cGy wasmore » delivered to the isocenter via a single 6-MV field, and the ratio of the average dose to points defining the lateral edges of the target to the isocenter dose was recorded for each combination. Field margins were varied from none to 1.5 cm in 0.25-cm steps. Data obtained in the phantom study were used to predict planning treatment volume (PTV) margins that would match the clinical PTV and isodose prescription for a clinical set of 39 SBRT cases. The average internal target volume (ITV) density was 0.73 ± 0.17, average local lung density was 0.33 ± 0.16, and average ITV diameter was 2.16 ± 0.8 cm. The phantom results initially underpredicted PTV margins by 0.35 cm. With this offset included in the model, the ratio of predicted-to-clinical PTVs was 1.05 ± 0.32. For a given target and lung density, it was found that treatment margin was insensitive to target diameter, except for the smallest (1.6-cm diameter) target, for which the treatment margin was more sensitive to density changes than the larger targets. We have developed a graphical relationship for block margin as a function of target and lung density, which should save time in the planning phase by shortening the design of PTV margins that can satisfy Radiation Therapy Oncology Group mandated treatment volume ratios.« less

Treatment of corns by injectable silicone.

PubMed

Balkin, S W

1975-09-01

Corns and calluses are the most frequently encountered foot complaints. The choices of care range from self trimming and application of over-the-counter remedies to professional treatment, which may include tendon, skin, and bone surgery. A technique using fluid silicone injected subdermally to cushion corns is described. Twenty-nine patients with 71 digital pressure keratoses were injected between 1965 and 1970. Results of treatment of 77% of the corns were rated good to excellent after an average follow-up period of six years, and no serious reactions have been observed. The procedure offers an effective, nondisabling method of treatment, as opposed to lifelong palliation or surgical intervention.

Trabeculotomy combined with phacoemulsification and implantation of an intraocular lens for the treatment of primary open-angle glaucoma and coexisting cataract.

PubMed

Tanihara, H; Honjo, M; Inatani, M; Honda, Y; Ogino, N; Ueno, S; Negi, A; Ichioka, H; Mizoguchi, T; Matsumura, M; Nagata, M

1997-10-01

The authors previously reported the usefulness of trabeculotomy ab externo for the treatment of primary open-angle glaucoma in adult patients. In an attempt to elucidate the long-term risk-to-benefit ratio of this surgical modality in combination with cataract surgery, the authors conducted a retrospective study of the surgical effects and complications of a triple procedure: phacoemulsification, implantation (of an intraocular lens), and trabeculotomy (PIT). The authors conducted a retrospective study of patients treated with PIT at multiple hospitals. Intraocular pressure (IOP) and visual function data were obtained from patients after PIT as an initial surgical treatment in cases where antiglaucoma medications failed to resolve uncontrolled IOP (higher than 21 mm Hg). Included in this study were 96 eyes of 64 patients with primary open-angle glaucoma and coexisting cataract. The mean follow-up period was 22.6 +/- 14.7 months (range 3-56 months). In 94 (98%) of the 96 eyes, the IOP was well controlled, having achieved a level of 21 mm Hg or lower at the final examinations. The mean preoperative IOP of the 33 eyes that underwent the triple procedure using a single flap method (PIT-I) was 24.3 +/- 3.9 mm Hg, with an average of 2.1 +/- 1.1 medications. At the final examinations, the mean IOP had dropped to 16.0 +/- 1.2 mm Hg, with an average of 1.2 +/- 1.2 medications. The mean preoperative IOP of the 63 eyes that underwent the triple procedure using a double flap method (PIT-II) was 26.2 +/- 6.2 mm Hg, with an average of 1.9 +/- 1.2 medications. At the final examination, the mean IOP for this group was 15.6 +/- 2.9 mm Hg, with an average of 1.0 +/- 0.9 medications. The long-term results from this multicenter study showed that the triple procedure, PIT, can be useful and effective as an initial surgical treatment for open-angle glaucoma in glaucoma patients with coexisting cataract.

[Physiotherapy in Women with Overactive Bladder].

PubMed

Henscher, U; Tholen, R; Kirschner-Hermanns, R

2016-08-01

As regards treatment for overactive bladder, physiotherapeutic interventions can be seen as an alternative to drug treatment. Targeted pelvic floor and bladder training is used to decrease the number of voids and the incontinence episodes or to increase the average voided volume in women with overactive bladder (3 systematic reviews with evidence level 1/1a).An additional option to treat women with overactive bladder is to use functional electrical stimulation and magnetic stimulation.2 systematic reviews 1 2 and 2 RCTs 3 4 reveal a low level of evidence (2 studies with level 2/2b) for the use of electrical stimulation (transcutaneous, vaginal or transanal) to reduce incontinence episodes and the number of voids and to increase the average voided volume. The trial from Yamanishi et al. (2014) shows that magnetic stimulation has a positive effect 5. Further studies are needed to evaluate the benefit of conservative treatment procedures for overactive bladder. © Georg Thieme Verlag KG Stuttgart · New York.

Using an experimental manipulation to determine the effectiveness of a stock enhancement program

USGS Publications Warehouse

Stewart, David R.; Long, James M.

2015-01-01

We used an experimental manipulation to determine the impact of stocking 178 mm channel catfish Ictalurus punctatus in six impoundments. The study design consisted of equal numbers (two) of control, ceased-stock, and stocked treatments that were sampled one year before and two years after stocking. Relative abundance, growth, size structure, and average weight significantly changed over time based on samples collected with hoop nets. Catch rates decreased at both ceased-stock lakes and increased for one stocked lake, while growth rates changed for at least one ceased-stock and stocked lake. The average weight of channel catfish in the ceased-stock treatment increased by 6% and 25%, whereas weight decreased by 28% and 78% in both stocked lakes. The variability in observed responses between lakes in both ceased-stock and stocked treatments indicates that a one-size-fits-all stocking agenda is impractical, suggesting lake specific and density-dependent mechanisms affect channel catfish population dynamics.

Influence of Pulse Electrodeposition and Heat Treatment on Microstructure, Tribological, and Corrosion Behavior of Nano-Grain Size Co-W Coatings

NASA Astrophysics Data System (ADS)

Abazari, Somayeh; Rastegari, Saeed; Kheirandish, Shahram

2017-07-01

In the present study, Co-W nano-structured alloy coatings are produced on low-carbon steel substrate by means of pulse electrodeposition from a citrate-based bath under different average current densities and duty cycles. The results indicate that the coating deposited under 60% of duty cycle and 1 A/dm2 of average current density exhibit optimum pulse plating conditions with 44.38 wt.% W, 37 nm grain size, and 758 HV microhardness. The effect of heat treatment temperature on microstructure, composition, corrosion behavior, and morphology of amorphous deposited Co-W alloy with 44 wt.% W was investigated. The microhardness of the coating increased to 1052 HV after heat treatment at 600 °C, which is due to the formation of Co3W and CoWO4 phases in the deposit. Furthermore, the coatings heat-treated at 600 °C had lower friction coefficients and better wear resistance under various loads than before heating.

The effect of dietary betaine in Eimeria acervulina-infected chicks.

PubMed

Matthews, J O; Southern, L L

2000-01-01

Two experiments were conducted to evaluate the effect of dietary betaine in broiler chicks with either chronic (CHR; 2.5 x 10(5) sporulated oocysts on Day 1, 4, 7, and 10) or acute (ACT; 1.0 x 10(6) sporulated oocysts on Day 1) Eimeria acervulina infections. Three hundred (Experiment 1) or 600 (Experiment 2), 4-d-old male chicks were used in the 14-d experiments. In both experiments, a 2 x 3 factorial arrangement of treatments was used: two levels of betaine (0 or 0.075%) and three levels of coccidiosis infection (uninfected, CHR, or ACT). Each treatment was replicated five (Experiment 1) or 10 (Experiment 2) times with 10 chicks per replicate. In Experiment 1, the ACT infection decreased (P < 0.01) average daily gain and gain:feed, and the CHR infection decreased (P < 0.02) average daily gain. The ACT and CHR infections decreased (P < 0.06) Day 7 plasma carotenoids and Day 14 plasma total protein, and the ACT infection also decreased (P < 0.06) Day 7 plasma total protein. Average daily gain and Day 7 plasma total protein were increased in CHR chicks fed betaine but were decreased in uninfected chicks fed betaine (CHR x betaine; P < 0.09). Chicks fed betaine had decreased (P < 0.06) Day 7 plasma carotenoids. In Experiment 2 the CHR and ACT infections decreased (P < 0.01) average daily gain, average daily feed intake, grain:feed ratio, Days 7 and 14 plasma carotenoids, and Day 7 plasma total protein. Chicks fed betaine had increased (P < 0.07) average daily gains, gain:feed ratios, and lesion scores. Day 14 plasma carotenoids and plasma total protein were decreased in uninfected chicks fed betaine but were increased in CHR chicks fed betaine (CHR x betaine; P < 0.04); plasma carotenoids also were increased in ACT chicks fed betaine (ACT x betaine; P < 0.05). Betaine did not consistently affect growth performance, plasma constituents, or lesion score in CHR or ACT coccidiosis-infected chicks.

Managing tile drainage, subirrigation, and nitrogen fertilization to enhance crop yields and reduce nitrate loss.

PubMed

Drury, C F; Tan, C S; Reynolds, W D; Welacky, T W; Oloya, T O; Gaynor, J D

2009-01-01

Improving field-crop use of fertilizer nitrogen is essential for protecting water quality and increasing crop yields. The objective of this study was to determine the effectiveness of controlled tile drainage (CD) and controlled tile drainage with subsurface irrigation (CDS) for mitigating off-field nitrate losses and enhancing crop yields. The CD and CDS systems were compared on a clay loam soil to traditional unrestricted tile drainage (UTD) under a corn (Zea Mays L.)-soybean (Glycine Max. (L.) Merr.) rotation at two nitrogen (N) fertilization rates (N1: 150 kg N ha(-1) applied to corn, no N applied to soybean; N2: 200 kg N ha(-1) applied to corn, 50 kg N ha(-1) applied to soybean). The N concentrations in tile flow events with the UTD treatment exceeded the provisional long-term aquatic life limit (LT-ALL) for freshwater (4.7 mg N L(-1)) 72% of the time at the N1 rate and 78% at the N2 rate, whereas only 24% of tile flow events at N1 and 40% at N2 exceeded the LT-ALL for the CDS treatment. Exceedances in N concentration for surface runoff and tile drainage were greater during the growing season than the non-growing season. At the N1 rate, CD and CDS reduced average annual N losses via tile drainage by 44 and 66%, respectively, relative to UTD. At the N2 rate, the average annual decreases in N loss were 31 and 68%, respectively. Crop yields from CDS were increased by an average of 2.8% relative to UTD at the N2 rate but were reduced by an average of 6.5% at the N1 rate. Hence, CD and CDS were effective for reducing average nitrate losses in tile drainage, but CDS increased average crop yields only when additional N fertilizer was applied.

Classification of Newborn Ear Malformations and their Treatment with the EarWell Infant Ear Correction System.

PubMed

Daniali, Lily N; Rezzadeh, Kameron; Shell, Cheryl; Trovato, Matthew; Ha, Richard; Byrd, H Steve

2017-03-01

A single practice's treatment protocol and outcomes following molding therapy on newborn ear deformations and malformations with the EarWell Infant Ear Correction System were reviewed. A classification system for grading the severity of constricted ear malformations was created on the basis of anatomical findings. A retrospective chart/photograph review of a consecutive series of infants treated with the EarWell System from 2011 to 2014 was undertaken. The infants were placed in either deformation or malformation groups. Three classes of malformation were identified. Data regarding treatment induction, duration of treatment, and quality of outcome were collected for all study patients. One hundred seventy-five infant ear malformations and 303 infant ear deformities were treated with the EarWell System. The average age at initiation of treatment was 12 days; the mean duration of treatment was 37 days. An average of six office visits was required. Treated malformations included constricted ears [172 ears (98 percent)] and cryptotia [three ears (2 percent)]. Cup ear (34 ears) was considered a constricted malformation, in contrast to the prominent ear deformity. Constricted ears were assigned to one of three classes, with each subsequent class indicating increasing severity: class I, 77 ears (45 percent); class II, 81 ears (47 percent); and class III, 14 ears (8 percent). Molding therapy with the EarWell System reduced the severity by an average of 1.2 points (p < 0.01). Complications included minor superficial excoriations and abrasions. The EarWell System was shown to be effective in eliminating or reducing the need for surgery in all but the most severe malformations. Therapeutic, IV.

Acute Diarrhoea in Children: Determination of Duration Using a Combined Bismuth Hydroxide Gel and Oral Rehydration Solution Therapy vs. Oral Rehydration Solution

PubMed Central

Oviedo, Adriana; Díaz, Mirna; Valenzuela, María Laura; Vidal, Victoria; Racca, Liliana; Bottai, Hebe; Priore, Graciela; Peluffo, Graciela; Di Bartolomeo, Susana; Cabral, Graciela; Toca, María del Carmen

2016-01-01

Oral rehydration salt (ORS) treatment in young children with acute diarrhoea (AD) has contributed to decrease mortality associated with dehydration although effective strategies to reduce morbidity associated with this disease are required. The aim of this study was to evaluate the diarrhoea duration when using combined colloidal bismuth hydroxide gel (CBHG) and oral rehydration salt treatment compared with ORS therapy in children with AD. We designed a double-blind, randomised prospective study with treatment and control groups. Patients aged one to 12 years, with no prior pathology and with AD of less than 48 h were included. The Chi-squared and Mann-Whitney tests were used, as well as the Cox proportional hazards model and the Kaplan-Meier estimator. Patients were randomised into an ORS and CBHG treatment group and a control group for ORS plus placebo. (Average age: 3.2 years). The result of the post-treatment evaluation with respect to the average duration of AD was 25.5 h for the treated group vs. 41.5 h for the control group (p = 0.015). The average number of stools was 4.8 in the treated group and 8.2 in the control group (p = 0.032). We conclude that the use of CBHG plus ORS significantly reduced the duration of AD, the number of stools and the percentage of children with persistent AD after 24 h of treatment compared to the control group. AD remitted almost twice as fast in patients treated with CBHG and ORS compared to those who received ORS plus placebo. PMID:28009823

[Follow-up study of quality of life and treatment of eating disorder: dynamics of the depressive and anxiety symptoms].

PubMed

Banaś, Anna; Januszkiewicz-Grabias, Aloiza; Radziwiłłowicz, Piotr; Smoczyński, Stefan

2002-01-01

A group of 56 female patients with eating disorders (36 anorexic and 20 bulimic) aged 16-48 (average 23.9) was studied. According to DSM-IV and ICD-10 among anorectic 8 (14.3%) represented restricting type and 28 (50%)-bulimic type, among bulimic-12 (21.4%)-purging type and 8 (14.3%)-nonpurging type. They were treated average 21.5 months in the I Department of Psychiatry Medical University of Gdansk (some of them were outpatients) between 1995-2000. Duration of disorders was 4 months-10 years (X +/- SD33.8 +/- 28.6 months). Follow-up period lasted from 4 months to 2 years. All patients were examined twice time (before and after treatment) with the following methods: Structured Questionnaire, Hospital Depression and Anxiety Scale Beck Depression Inventory (BDI), PIL by Crumbaugh and Maholick, Spielberger Self-Evaluation Questionnaire. The aim of our examination was to define changes in the state of patients after complex treatment (pharmacotherapy and psychotherapy) and important parameters of quality of life in our groups. After complex treatment (pharmacotherapy, individual and group psychotherapy) which lasted average 21.5 months we observed significant improvement of depressive and anxiety symptoms. Pharmacotherapy included tricyclic antidepressants (55.4%), tetracyclic antidepressants (10.7%), SSRI (44.6%), neuroleptics (10.7%), carbamazepine (32.1%). Some patients were treated more than one medicine. We received high correlation between ideal weight and weight after treatment. Therefore we supposed that our complex therapy was effective and improved approval of self-image and weight. Significance of life after treatment depended on intensity of depression in BDI and intensity of anxiety as state. The long lasting complex therapy significantly lowered depressive and anxiety symptoms (in subjective and objective aspects) in our group of patients with eating disorders.

Dielectrophoresis enhances the whitening effect of carbamide peroxide on enamel.

PubMed

Ivanoff, Chris S; Hottel, Timothy L; Garcia-Godoy, Franklin; Riga, Alan T

2011-10-01

To compare the enamel whitening effect of a 20-minute dielectrophoresis enhanced electrochemical delivery to a 20-minute diffusion treatment. Forty freshly extracted human teeth without detectable caries or restoration were stored in distilled water at 4 degrees C and used within 1 month of extraction. Two different bleaching gels (Plus White 5 Minute Speed Whitening Gel and 35% Opalescence PF gel) were tested. The study had two parts: Part 1--Quantitative comparison of hydrogen peroxide (H2O2, HP) absorption--following application of an over-the-counter 35% HP whitening gel (Plus White 5 Minute Speed Whitening Gel) to 30 (n = 30) extracted human teeth by conventional diffusion or dielectrophoresis. The amount of H2O2 that diffused from the dentin was measured by a colorimetric oxidation-reduction reaction kit. HP concentration was measured by UV-Vis spectroscopy at 550 nm. Part 2--HP diffusion in stained teeth--35% carbamide peroxide whitening gel (35% Opalescence PF gel) was applied to 10 extracted human teeth (n = 10) stained by immersion in a black tea solution for 48 hours. The teeth were randomly assigned to the 20-minute dielectrophoresis or diffusion treatment group; whitening was evaluated by a dental spectrophotometer and macro-photography. Part 1: The analysis found significant differences between both groups with relative percent errors of 3% or less (a single outlier had an RPE of 12%). The average absorbance for the dielectrophoresis group in round 1 was 79% greater than the diffusion group. The average absorbance for the dielectrophoresis group in round 2 was 130% greater than the diffusion group. A single-factor ANOVA found a statistically significant difference between the diffusion and dielectrophoresis groups (P = 0.01). Part 2--The average change in Shade Guide Units (SGU) was 0.6 for the diffusion group, well under the error of measurement of 0.82 SGU. The average change in SGU for the dielectrophoresis group was 9, significantly above the error of measurement and 14 times or 1,400% greater than the diffusion group average. A single-factor ANOVA found a statistically significant difference between the diffusion and dielectrophoresis treatment groups (P < 0.001).

Fully endoscopic resection of juvenile nasopharyngeal angiofibroma - own experience and clinical outcomes.

PubMed

Kopeć, Tomasz; Borucki, Łukasz; Szyfter, Witold

2014-07-01

The treatment of choice in juvenile nasopharyngeal angiofibroma (JNA) is surgery - nowadays endoscopic techniques. The aim of the study was to present the results of endoscopic treatment in patients diagnosed with juvenile angiofibroma. In this retrospective case series, 10 patients with a diagnosis of JNA treated at the Department of Otolaryngology of the Medical University in Poznań from 2006 to June 2013 were included. The age of patients were between 11 and 19 years old (14.6 on average). In 9 out of 10 patients the treatment was preceded by embolization. The surgery used the endoscopic approach through one nostril and the four-handed technique. Total resection was possible in all cases. Blood loss ranged from 100 to 250 ml. Post-operative hospitalization lasted from 3 to 5 days (3.3 days on average). Recurrence was reported in one patient. The observation lasted from six months to seven years (3.55 on average). Endoscopic resection of juvenile angiofibroma is safe for the patient. Moreover, if the evaluation of the tumour size and staging is correct, the ability of total removal of the tumour is very high. It is also connected with small blood loss, short hospital stay and good cosmetic effects. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Clinical evaluation of preadjusted appliance based on Chinese normal occlusion].

PubMed

Chen, Lin; Gao, Xue-Mei; Zeng, Xiang-Long

2008-02-01

To evaluate the effect of the preadjusted appliance (Z1 appliance) based on Chinese normal occlusion. Thirty non-extraction patients were treated with Z1 appliance. No wire bending was made during treatment. The results of these 30 cases had been evaluated by five senior orthodontists. Models were analysed quantitatively to testify and evaluate the efficiency of the appliance. The average score for post-treatment models was 91.2 (total score was 100). The model measurements indicated that average projective distance on occlusal plane between proximal contact points of adjacent teeth was less than 0.3 mm, which demonstrated good alignment. The prominence of crowns was almost coincident with the data of Chinese normal occlusion. For the average tip of most teeth, there was no statistical difference between the study group and the normal control group. The crown torque variation tendency from anterior to posterior was similar to that in the subjects with normal occlusion. However, the cases treated with Z1 appliance achieved more negative torque in the lower posterior segment. The result of the non-extraction patients treated with Z1 appliance was quite satisfied. Wire bending could be reduced during treatment. It was necessary to adjust the crown torque values for lower posterior teeth.

Liquid Nitrogen Cryotherapy for Conjunctival Lymphangiectasia: A Case Series

PubMed Central

Fraunfelder, Frederick W.

2009-01-01

Purpose: To report a case series of conjunctival lymphangiectasia treated with liquid nitrogen cryotherapy. Methods: A 1.5-mm Brymill cryoprobe was applied in a double freeze-thaw method after an incisional biopsy of a portion of the conjunctiva in patients with conjunctival lymphangiectasia. Freeze times were 1 to 2 seconds with thawing of 5 to 10 seconds between treatments. Patients were reexamined at 1 day, 2 weeks, 3 months, 6 months, and yearly following cryotherapy. Results: Five eyes of 4 patients (3 male and 1 female) with biopsy-proven conjunctival lymphangiectasia underwent liquid nitrogen cryotherapy. The average patient age was 53 years. Ocular examination revealed large lymphatic vessels that were translucent and without conjunctival injection. Subjective symptoms included epiphora, ocular irritation, eye redness, and occasional blurred vision. After treatment with liquid nitrogen cryotherapy, the patients’ symptoms and signs resolved within 2 weeks. Lymphangiectasia recurred twice in one patient, at 1 and 3 years postoperatively. In another patient, lymphangiectasia recurred at 6 months. The average time to recurrence in these 3 eyes was 18 months. Average length of follow-up was 24.5 months for all subjects. Conclusion: Liquid nitrogen cryotherapy may be an effective surgical alternative in the treatment of conjunctival lymphangiectasia. Cryotherapy may need to be repeated in some instances. PMID:20126499

Liquid nitrogen cryotherapy for conjunctival lymphangiectasia: a case series.

PubMed

Fraunfelder, Frederick W

2009-12-01

To report a case series of conjunctival lymphangiectasia treated with liquid nitrogen cryotherapy. A 1.5-mm Brymill cryoprobe was applied in a double freeze-thaw method after an incisional biopsy of a portion of the conjunctiva in patients with conjunctival lymphangiectasia. Freeze times were 1 to 2 seconds with thawing of 5 to 10 seconds between treatments. Patients were reexamined at 1 day, 2 weeks, 3 months, 6 months, and yearly following cryotherapy. Five eyes of 4 patients (3 male and 1 female) with biopsy-proven conjunctival lymphangiectasia underwent liquid nitrogen cryotherapy. The average patient age was 53 years. Ocular examination revealed large lymphatic vessels that were translucent and without conjunctival injection. Subjective symptoms included epiphora, ocular irritation, eye redness, and occasional blurred vision. After treatment with liquid nitrogen cryotherapy, the patients' symptoms and signs resolved within 2 weeks. Lymphangiectasia recurred twice in one patient, at 1 and 3 years postoperatively. In another patient, lymphangiectasia recurred at 6 months. The average time to recurrence in these 3 eyes was 18 months. Average length of follow-up was 24.5 months for all subjects. Liquid nitrogen cryotherapy may be an effective surgical alternative in the treatment of conjunctival lymphangiectasia. Cryotherapy may need to be repeated in some instances.